QB - PHARM Flashcards
1
Q
Pentamidine (3)
A
Pneumocystis jiroveci pneumonia (HIV)
Leishmaniasis
African Sleeping sickness
2
Q
Nifurtimox
A
Chagas’ disease (Trypanosoma cruzi)
3
Q
Mebendazole
A
Ascariasis
Trichuriasis
Hookworm
Pinworm
4
Q
Ivermectin
A
Onchocerciasis (river blindness)
5
Q
Metronidazole
A
Giardia lamblia
Entamoeba histolytica
Trichomonas vaginalis
C. difficile pseudomembranous colitis
6
Q
Giardia lamblia
A
Metronidazole
7
Q
Entamoeba histolytica
A
Metronidazole
8
Q
Trichomonas vaginalis
A
Metronidazole
9
Q
C. difficile pseudomembranous colitis
A
Metronidazole
10
Q
Cloroquine, Mefloquine
A
Plasmodium (malaria)
11
Q
Primaquine
A
P. vivax
P. ovale
12
Q
Methotrexate
A
Antifolate (cancer therapy)
13
Q
Trimethoprim
A
Antifolate (inhibits DHF to THF)
Treats UTI & ear infections
14
Q
UTI & ear infections
A
Trimethoprim
15
Q
Imatinib
A
CML (bcr-abl tyrosine kinase inhibitor)
16
Q
Enoxaparin
A
Low-molecular weight heparin (better bioavailability, longer half-life)
17
Q
Lepirudin, Bivalirudin
A
derivatives of Hirudin - INHIBITS thrombin (alternative for heparin)
18
Q
Clopidogrel, Ticlopidine
A
Blocks ADP receptors - prevent binding of gpIIb/IIIa to fibrinogen (NO PLATELET aggregation)
For coronary stenting/acute coronary syndrome
19
Q
Abciximab
A
Bind DIRECTLY to gpIIb/IIIa on activated platelets - NO PLATELET aggregation
Fibrinogen serves as linker molecule btwn gpIIb/IIIa receptors on two different platelets
20
Q
Dactinomycin
Doxorubicin
Bleomycin
A
Intercalates DNA - Antitumor antibiotics
21
Q
Dactinomycin
A
Intercalates DNA - antitumor antibiotics
22
Q
Doxorubicin
A
Intercalates DNA - Antitumor antibiotics
23
Q
Bleomycin
A
Intercalates DNA - Antitumor antibiotics
24
Q
Cyclophosphamide
Nitrosureas
A
Alkylating agents - crosslinks DNA
Cyclophosphamide - solid tumors, leukemia, lymphomas
Nitrosureas - brain tumors
25
Vincristine, Vinblastine
| Paclitaxel
Microtubule inhibitors
Vincristine, Vinblastine - block mitotic spindle formation
Paclitaxel - mitotic spindle cannot dissolve (stuck in hyperstabilization) - breast/ovarian cancers
26
Cisplatin
Crosslinks DNA
Testicular, ovary, bladder cancer; lung carcinomas
Nephrotoxic, acoustic nerve damage
27
Etoposide
Inhibit topoisomerase II
28
Hydroxyurea
Inhibit ribonucleotide reductase --> decrease DNA synthesis (S phase)
Rx for CML, sickle cell disease
29
Prednisone
CLL, non-Hodgkin's lymphoma
30
Tamoxifen
SERM - selective estrogen receptor antagonist in breast, agonist in bone
Raloxifene - no increased risk of endometrial cancer (like Tamoxifen)
31
Trastuzumab (Herceptin)
Breast cancer - cardiotoxic
32
Rituximab
antibody against CD20
Non-hodgkin's lymphoma, rheumatoid arthritis
33
Bevacizumab
Solid tumors
monoclonal antibody against VEGF
Inhibits angiogenesis
34
Dabigatran, Argatroban
Direct thrombin inhibitors
Prolongs TT (without affecting PT or PTT)
35
Heparin
Increases antithrombin binding/neutralization of thrombin & factor Xa (prevents clots)
SHORT term management of DVT (deep vein thrombosis)/peri-operative non ambulatory patients
36
Warfarin
Inhibits Vitamin K dependent clotting factors (II, VII, IX, X)
Inhibits carboxylation of GLUTAMIC ACID residues
Monitor PT/INR
LONG TERM prevention of recurrent venous thrombosis
37
Lepirudin, Argatroban
Direct thrombin inhibitors
Use for Heparin-induced thrombocytopenia
38
Ticlopidine, Clopidogrel
Inhibit ADP mediated platelet aggregation
Unstable angina
39
Rofecoxib
Selective COX2 inhibitor - provides ANTI-INFLAMMATION but does not interfere w/ COX1 (on platelets and in GI tract)
Selective COX2 side effect: increased GI bleeding
Aspirin = irreversible inhibitor of COX1&2
40
Dapsone, Nitrites effect on blood
Methemoglobinemia (Fe2+ oxidized to Fe3+)
41
Vincristine
Inhibits microtubule formation (M phase)
| Neurotoxic --> peripheral neuropathies
42
Topoisomerase I and II inhibitors
Hydroxyurea
Inhibits synthesis pathway
43
Ganciclovir
CMV - MOST COMMON use for HIV patients
Retinitis, esophagitis, pneumonia
polyneuropathy, transverse myelitis, encephalitis
44
Mechanism of Ganciclovir & adverse rxns
Interferes w/ human host cell DNA synthesis (greater effect than acyclovir)
Adverse rxns:
Neutropenia
Anemia
Thrombocytopenia
45
What drug used in conjuction w/ Ganciclovir will exacerbate its side effects?
Zidovudine (AZT)
AZT used for HIV patients
Inhibit some mammalian cellular and mitochondrial DNA polymerases --> bone marrow suppression --> anemia, granulocytopenia
AZT + Ganciclovir in HIV patients --> neutropenia & anemia
46
Ampicillin
Listeria monocytogenes
| Meningitis in immunosuppressed
47
Amphotericin
Cryptococcus neoformans
| Meningitis in AIDS patients
48
Risperidone
Schizophrenia
Side effect: hyperprolactinemia --> amenorrhea
49
Colchicine
Inhibits tubulin polymerization into microtubules -- impairs neutrophil mitosis --> decrease neutrophil motility
Disrupts membrane-dependent functions (chemotaxis and phagocytosis)
Treats GOUTY arthritis
Side effect = abdominal pain, nausea, diarrhea
50
Avoid using colchicine in what kind of patients?
Elderly w/ renal dysfunction
51
Terbinafine
Inhibits squalene epoxidase --> NO ergosterol SYNTHESIS
Rx for dermatophytosis
52
Amphotericin B
| Nystatin
BINDS to ergosterol - makes holes in CELL MEMBRANE
53
Caspofungin
```
Echinocandin class (INHIBITS CELL WALL synthesis)
Blocks synthesis of B(1,3)-D-glucan
```
54
Rx for Candida & Aspergillus
Caspofungin
55
Flucytosine
Antimetabolite
5-FU in fungal cell - inhibits protein synthesis via RNA miscoding
Cryptococcal infections (given w/ amphotericin B)
Fungal infections
56
Rx of Endometriosis
Leuprolide
| Danazol
57
Metyrapone
Inhibits production of cortisol
| See ACTH surge then product buildup of 11-deoxycortisol (17-OH corticosteroids in urine)
58
Rx for gouty arthritis
1. Indomethacin (NSAID)
2. Colchicine (acute relief - inhibits neutrophil migration into inflamed areas)
3. Allopurinol (prevention of gout - lowers serum uric acid)
59
Indomethacin; mechanism? Uses?
Close patent ductus arteriosus (lowers prostaglandins)
COX1 & COX2 inhibitor -- suppresses prostaglandin synthesis --> anti-inflammatory agent & pain reliever
60
Rx for septic arthritis
Ceftriaxone - gonococcus infection
61
Somatosatin analogs
Octreotide
| Lanreotide
62
Acarbose; what enzyme is inhibited?
Inhibits a-glucosidase
Impairs hydrolysis of sugars (limits postprandial absorption of sugars)
63
Metformin
Increase sensitivity of target tissue to insulin
64
Rosiglitazone (a thiazolidinedione)
Similar to metformin (biguanide)
65
Enalapril
ACE inhibitor - decreases diabetic proteinuria
66
Glyburide
Sulfonylurea that increases rate of insulin secretion (can see C peptide levels increase as insulin secretion increases)
67
Colchicine
Acute management of GOUT
Interfere w/ adhesion molecules & microtubule formation responsible for neutrophil chemotaxis and phagocytosis --> reduce inflammation!
Side effect: diarrhea, nausea/vomiting (hence only use colchicine when patients have contraindication to NSAIDs -- peptic ulcer/renal failure patients)
68
Glucocorticosteroids (for gout)
Acute gout - inhibits Phospholipase A2 activity --> less inflammation
69
What two drugs are contraindicated in acute gouty attacks?
Probenecid
Allopurinol
May exacerbate symptoms
70
Probenecid
Probenecid - Decrease proximal tubular uric acid reabsorption (decrease uric acid levels)
Rx for gout
71
Allopurinol
Allopurinol - Inhibition of xanthine oxidase
Rx for gout
72
Pioglitazone
A type of thiazolidnediones (TZDs)
Binds peroxisome proliferator activated receptor (PPAR-gamma) --> increase ADIPONECTIN synthesis (low levels of adiponectin seen in type II diabetes)
Adiponectin decreases insulin resistance
Side effects: fluid retention, weight gain, precipitation of congestive heart failure
73
Action of adiponectin
Decreases insulin resistance
Rx for diabetics
74
Exenatide
Glucagon like polypeptide (GLP-1)
Decrease additional release of glucagon
Increase insulin release
Induce satiety
Decrease gastric emptying (slow rate of sugar absorbed from foods to enter into blood circulation)
DECREASE blood glucose
75
Major side effects of following drugs:
1. Etanercept
2. Methotrexate or Leflunomide
3. Amiodarone
4. Hydroxychloroquine
5. NSAIDs
1. Etanercept: TNF-a inhibitor to treat RA/psoriasis/psoriatic arthritis -- need PPD skin test (more susceptible to infectious agents)
2. Methotrexate or Leflunomide -- Hepatotoxic
3. Amiodarone - Pulmonary fibrosis
4. Hydroxychloroquine - Ophthalmologic
5. NSAIDs - GI blood loss
76
TNF-alpha inhibitors for RA treatment
Infliximab
Etanercept
Adalimumab
77
Infliximab
TNF-alpha inhibitors -- RA treatment
78
Etanercept
TNF-alpha inhibitors -- RA treatment
79
Adalimunab
TNF-alpha inhibitors -- RA treatment
80
Inhibitors of purine/pyrimidine synthesis for RA treatment
Methotrexate
Leflunomide
Azathioprine
81
Methotrexate
Inhibitors of purine/pyrimidine synthesis -- RA treatment
82
Leflunomide
Inhibitors of purine/pyrimidine synthesis -- RA treatment
83
Azathioprine
Inhibitors of purine/pyrimidine synthesis -- RA treatment
84
Chlorthalidone
Thiazide diurectic
Increase Ca2+ resorption in early distal collecting tubule of nephron
85
Clomiphene
Selective estrogen receptor modulator
PREVENTS negative feedback inhibition on hypothalamus --> increased FSH and LH release (infertility treatment for women who want to ovulate and get pregnant)
86
Mitotane
Adrenocorticolytic drug -- for adrenocortical carcinoma
87
Spironolactone
Androgen receptor antagonist - inhibits testosterone synthesis
Treats acne & hirsutism
Gynecomastia & testicular atrophy in men
Also a K+ sparing diuretic
88
Other drugs (other than spironolactone) to treat hirsutism
Flutamide (testosterone receptor antagonist)
Finasteride (5-alpha-reductase inhibitor)
89
Haloperidol, Fluphenazine
blocks D2 receptors (dopamine) --> strong cholinergic influence (M1 receptor mediated)
EXTRAPYRAMIDAL effects:
acute dystonic reactions (muscle spasms, tongue protrusions/twisting, eyes deviated upwards)
akathisia (inner restlessness, can't sit still)
parkinsonism
90
Diphenhydramine, Benztropine
M1 receptor antagonist
re-establish dopaminergic-cholinergic balance
used to treat extrapyramidal effects
91
Flumazenil
GABA antagonist - counter acute overdoses of Benzodiazepine
92
Chlorpromazine, Clozapine
H1-histamine receptor
| Sedation
93
Chlorpromazine, Thioridazine
Low potency antipsychotics
Anticholinergic side effects = confusion, dry mouth, urinary retention
Blocks central and peripheral muscarinic cholinergic receptors
94
Flutamide
Competes w/ testosterone and DHT for receptors on prostate tumors
(prevents androgen-receptor binding on tumors --> tumors shrink in size)
Need to be administered w/ GnRH agonist
Side effect (androgen depletion): hot flashes, gynecomastia, impotence
95
GnRH agonists
Leuprolide, goserelin, nafarelin, histrelin
binds GnRH receptors in anterior pituitary -- inhibit LH and FSH
decreased LH --> decreased Leydig cell stimulation --> diminished testosterone
96
Ketoconazole
Decrease synthesis of steroid hormones in gonads/adrenals
97
Anastrozole
Decreased peripheral androgen aromatization - blocks estrogen production selectively
Treatment of postmenopausal women w/ breast cancer (their greatest source of estrogen is conversion of androstenedione in the adrenal glands to estrone in liver, muscle, fat VIA aromatization
98
Finasteride
Inhibits 5-a-reductase
Decrease conversion of testosterone to DHEA (dihydrotestosterone) - also abbreviated DHT
discordant decrease in DHT
99
Alpha-glucosidase inhibitors
Acarbose and Miglitol
Decrease disaccharidase activity at intestinal brush border --> less carbohydrate absorption
Side effect: flatulence, bloating, abdominal pain, rash
100
Sulfonylurea (mechanism)
Membrane ion channels
101
Insulin (mechanism)
Surface TYROSINE KINASE-coupled receptors
102
Glucagon-like polypeptide (GLP-1)
Secreted by intestinal L cells (response to food intake)
Induces satiety, decrease gastric emptying, increase insulin release
GLP-1 acts through cell surface receptors coupled to G protein-adenyl cyclase system
E.g. Exenatide (long acting GLP-1) for DIABETES type II
103
Bisphosphonates
Osteoporosis, Paget's disease of bone, malignancy-induced hypercalcemia
Structural analogs of pyrophosphate - compoent of hydroxyapatite
"-DRONATE" endings
Alendronate, Risedronate, Ibandronate
Bisphosphonates make hydroxyapatite more INSOLUBLE - also decrease bone resorption by interfering w/ osteoclasts
Patients need to stay upright for at least 30 mins. to prevent reflux; given in fasting state w/ plenty of water
Be mindful of use in RENAL failure patients
104
OA
Morning stiffness for <30mins (shorter than RA patients)
Bony swelling of DIP and PIP
Use-dependent joint pain in weight bearing joints (alleviated w/ rest)
105
Tamoxifen
| Raloxifene
SERMs: have different effect on estrogen levels in different tissues
Breast - antiestrogenic effect
Bone - partial estrogen agonist (minimizes bone resorption effect - treats osteoporosis in post menopausal women)
**Endometrium - estrogen agonist (increase incidence of endometrial cancers)
Serum: normalizes LDL (somewhat improves lipid profile)
Other concerns: Thromboembolic disease
106
Amiodarone
Class III anti-arrhythmic
Side effects:
a) Prolong QT interval (K+ mediated repolarization)
b) THYROID dysfunction -- induces HYPOthyroidism (treat w/ LEVOTHYROXINE)
c) blue-gray skin discoloration
d) corneal micro-deposits
e) drug-related hepatitis
107
Long term treatment for gouty arthritis (tophaceous gout)
Uricosuric drugs (avoid in renal failure pts):
Probenecid
Sulfinpyrazone
Xanthine oxidase inhibitors:
Allopurinol** (best)
108
Zileuton
Lipoxygenase inhibitor
Allergic rhinitis & bronchial asthma
109
Treatment for Gonorrhea vs. Chlamydia
```
Gonorrhea = Ceftriaxone
Chlamydia = Azithromycin or Doxycycline
```
110
Thiazolidinediones (TZDs)
Decrease insulin resistance by acting on PPAR-gamma --> increase adiponectin levels in type II diabetes
PPAR-gamma activation --> increase fat mass secondary to increased differentiation of preadipocytes into mature adipocytes (adiponectin is cytokine secreted by adipocytes)
Side effect: fluid retention, weight gain, CHF due to fluid retention
111
Rituximab
CD20+ non-Hodgkin's lymphoma - B cells
112
Infliximab
binds TNF-alpha (involved in inflammatory response)
TNF is intercellular signaling protein
RA, Crohn's disease
113
Certolizumab
TNF-alpha
| also for autoimmune diseases
114
Imatinib
Philadelphia chromosome positive chronic myelogenous leukemia
kit-positive GIST (gastrointestinal stromal tumors)
115
Vancomycin resistance
D-Ala-D-Ala to D-Ala-D-Lac
116
Valproate risk
Neural tube defects (inhibit intestinal folic acid absorption)
117
Dantrolene
Malignant hyperthermia
118
Breast cancer
Doxorubicin (cardiotoxic)
119
Acetazolamide
Carbonic anhydrase inhibitor - PROXIMAL TUBULE --> block reabsorption of HCO3- --> increased urinary pH --> metabolic acidosis (since there's no bicarb around to buffer)
BAD for kid with diabetes who is admited in acidosis state
120
Indications for Acetazolamide
Diuretic (proximal tubule)
Open-angle and close-angle glaucoma (decrease HCO3- and aqueous humor formation) --> relieve pressure
121
Side effects of Acetazolamide
Somnolence
Paresthesias
Urine alkalinization*
122
Macrolides
Cholestatic hepatitis
123
Quinolones
Tendon rupture
124
Tetracyclines in kids
Staining of teeth
125
Benzodiazepines
Short: 24hrs
TRIAZOLAM - short acting (avoid daytime sleepiness) - treats anxiety/insomnia/acute seziures/alcohol withdrawal
LORAZEPAM - intermediate
DIAZEPAM, FLURAZEPAM - long acting (excessive daytime fatigue, impaired judgement)
126
Phencyclidine (PCP)
NMDAR inhibition
(NMDA is receptor for excitatory neurotransmitter glutamate)
Moderate use - feelings of detachment + distance
Paranoia, hallucinations
Very hostile and aggressive
127
Heroin
Opiate
| Euphoria, constricted pupils, lethargy, clammy skin, nausea
128
Amphetamine
NE effects
Used for ADHD
Rapid heart rate, high BP, anxiousness, sweating, tremors, dry mouth, hallucinations
129
Coacine
Inhibits reuptake of dopamine, NE, serotonin
Blurry vision, tremors, twitching, chest pain, irritability, hallucinations/delusions, high BP+HR
130
Diazepam
CNS depressant
Confusion, mild amnesia, sedation, slurred speech, low BP and HR
131
Lysergic acid diethylamide (LSD)
Serotonin receptor agonist
Hallucinations --> delusions --> severe paranoia
132
Marijuana
Contains tetrahydrocannabinol (THC)
Euphoria, short term memory loss, perception distortion
Silliness, red eyes, slowed reflexes, dizziness, impaired coordination
133
Beta blockers
Used for relieving tachycardia + chest pain in atherosclerotic coronary artery disease patients
(reduce BP and cardiac work, HR)
Noncardioselect agents precipitate asthma symptoms = bad!
B1 - SLOWS heart rate
B2 - bronchoconstriction + wheezing
134
Reserpine
Inhibits dopamine entry into presynaptic vesicles = chemical sympathectomy
135
Guanethidine
Inhibit NE release --> LOWER BP and HR
136
Tricyclic antidepressants
| Cocaine
Inhibit NE reuptake --> INCREASE NE concentration at presynaptic neurons --> constant stimulation
Sympathomimetic: Precipitate ANGINA (coronary artery vasoconstriction) + MI
Cocaine causes INCREASED BP, chest pain, agitation, mydriasis, DRAMATIC symmetric pupillary dilation that remains responsive to light, tachycardia
Nasal mucosal atrophy, partial septum destruction = patient uses cocaine
137
Phenelzine
MAO inhibitor (decreases rate of inactivation of neurotransmitters by monoamine oxidase --> INCREASE concentration of serotonin, NE, dopamine)
dietary restriction: cheese, wine
138
Sertaline
SSRI (selective serotonine reuptake inhibitor)
Co-administration w/ MAO inhibitor could result in SEROTONIN SYNDROME: restlessness, hyperreflexia, diaphoresis, tremors (excessive serotonin)
Need to wait 2 weeks after MAO inhibitor discontinuation before beginning SSRI - gives body chance to replenish monoamine oxidase stores (monoamine oxidase responsible for breaking down monoamine neurotransmitters)
139
Desmopressin uses
Vasopressin (ADH) - used for diabetes insipidus
High dose:
increases factor VIII activity in hemophilia A
treats vWF disease
140
Leuprolide
analog of GnRH
continuous administration - suppresses LH and FSH
initial transient phase of increase in both testosterone & DHT --> stable decrease in testosterone & DHT
prostatic cancer, precocious puberty, endometriosis
141
Finasteride
Antiandrogen
| BPH via inhibition of a-reductase
142
Ondansetron
Antiemetic
| blocks 5-HT3 seroton receptors
143
Flutamide
Prostate cancer
| androgen inhibitor
144
Octreotide
Somatostatin analog
| Controls symptoms of carcinoid syndrome (flushing, wheezing, diarrhea, syncope)
145
Sodium valproate
Absence & tonic-clonic seizures
Ethosuximide also good for absence seizures (does NOT treat tonic-clonic)
146
Carbamazepine
Blocks Na channels (less propagation of action potential)
Complex partial seizures
Generalized tonic-clonic seizures
Trigeminal neuralgia
BIPOLAR
side effect:
- AGRANULOCYTOSIS or aplastic anemia (bone marrow suppression)
- Hepatotoxic
- SIADH
147
Phenytoin
Blocks Na+ channels prolonging rate of recovery (increase refractory period -- blocks further action potentials from firing)
Tonic-clonic seizures
STATUS EPILEPTICUS
Side effects: lymphadenopathy, hirsutism, coarsening of facial features, acne, gingival hypertrophy
148
Lithium toxicity
Nephrogenic diabetes insipidus
Monitor TSH and BUN
149
Foscarnet
Treats CMV in HIV patients
(Can also use ganciclovir, cidofovir)
Ganciclovir first line treatment for CMV RETINITIS (but side effect = neutropenia) so shouldn't give to HIV pt. in bone marrow suppression state already (due to Zidovudine)
Side effect:
HYPOcalcemia, HYPOphosphatemia, HYPOmagnesium
Foscarnet wastes Mg2+ --> DECREASE PTH release --> decrease calcium
LOW Ca2+ and Mg2+ --> seizures*
150
Acyclovir
Treatment for HSV-2
Nucleoside analog - incorporates into viral DNA chain --> terminates DNA synthesis
Nephro + Neurotoxic
Delirium/tremor
151
Lamivudine toxicity
Nucleoside reverse transcriptase inhibitor (NRTI) for HIV
peripheral neuropathy
lactic acidosis
152
Indinavir usage & toxicity
Protease inhibitor (HIV)
fat redistribution
hyperglycemia (insulin resistance)
hypertriglyceridemia
153
Furosemide, Torsemide, Bumetanide
```
Loop diuretics (ascending loop of Henle)
Na-K-2Cl symporter blocked
```
Otoxicity
154
HCTZ, chlorthalidone
```
Thiazide diuretic (blocks Na-Cl in DCT)
for edema secondary to HF, renal disease, liver disease
```
Hyperuricemia
Hypercalcemia*
155
Triamterene, Spironolactone, Amiloride
K+ sparing diuretic (collecting tubule)
Hyperkalemia
156
Acetazolamide
Carbonic anhydrase inhibitor (PCT)
Metabolic acidosis (blocks reabsorption of NaHCO3)
157
Mannitol
Osmotic diuretic - descending limb of Henle's loop & proximal tubule
Hypernatremia
Pulmonary edema
158
ACE inhibitors
decreases efferent arteriole of kidneys from constriction
decreases GFR
used for HTN, HF, renal failure patients
159
Atorvastatin
HMG-CoA reductase inhibitor
muscle toxicity
hepatic dysfunction
160
Metformin (acid-base effect)
Lactic acidosis
161
Prazosin
selective alpha-1 adrenergic antagonist
Uses:
HTN
Urinary retention (due to BPH)
side effect: HYPOtension (postural hypotension)
162
Rituximab
anti-CD20
B-cell lymphomas
rheumatoid arthritis
163
Infliximab
IgG antibody to TNF-alpha
Rheumatoid arthritis
Ankylosing spondylitis
Crohn's disease
164
IL-2
Renal cell carcinoma
| Melanoma
165
Imatinib
CML
Philadelphia chromosome
BCR/ABL protein tyrosine kinase
166
Omalizumab
anti-IgE
| asthma
167
Abciximab
gp IIb/IIIa receptor antagonist
blocks final step of platelet aggregation
administered during angioplasty in patients w/ acute coronary syndrome
168
Cetuximab
```
anti-EGFR
non-small cell lung cancer
CRC
pancreatic cancer
squamous cell carcinoma (head and neck)
```
169
Bevacizumab
anti-VEGF
metastatic colon/renal carcinoma
non-small cell lung cancer
recurrent glioblastoma multiforme
170
Muromonab-CD3 (OKT3)
anti-CD3 antibodies
treatment of acute rejection in patients w/ kidney, heart, liver transplants
anti-CD3 antibodies bind to and inhibit T lymphocytes
171
Amifostine
free radical scavenger
decrease nephrotoxicity when using Cisplatin (platinum containing chemo drug that crosslinks DNA causing acute renal tubular injury)
decrease nephrotoxicity w/ alkylating chemo agents
172
Leucovorin
Folinic acid
methotrexate (MTX) overdose
173
Filgrastim
G-CSF analog
stimulate proliferation and differentiation of granulocytes; used to minimize granulocytopenia after myelosuppressive chemo
174
Dexrazoxane
Iron chelator
prevent anthracycline-induced (doxorubicin) cardiotoxicity (CHF)
175
Fomepizole
ANTIDOTE for ethanol (rubbing alcohol) or ethylene glycol (antifreeze) poisoning
176
Raltegravir
HIV integrase inhibitor (HIV can't integrate into host genome and use host machinery to make more viral mRNA)
177
Maraviroc
CCR5/CXCR4 antagonist
178
Ritonavir, Saquinavir
Protease inhibitor (HIV)
179
Enfuvirtide
Fusion inhibitor (HIV)
prevents viral attachment to cells
180
Lamivudine, Tenofovir, Efavirenz
RT inhibitor (HIV)
181
Desmopressin
Release of factor VIII and vWF from endothelial cells
Treats Hemophilia A (bleeding into joints - hemarthrosis)
also ADH analog - treats diabetes insipidus (increase reabsorption of H20 in collecting tubules)
182
Metoclopramide
Dopamine antagonist (D1 receptor causes vasodilation/relaxation of smooth muscles/vessels)
Gastro-prokinetic (increase gastric emptying in patients w/ gastroparesis)
Treats nausea and vomiting
Migraine headache
183
NNRTI
Nevirapine, Efavirenz, Delavirdine
NNRTI:
inhibits RT of HIV - prevent incorporation of DNA copy of viral genome into host DNA
184
Ropinirole
Non-ergoline dopamine agonist
Restless legs syndrome
D2, D3, D4 dopamine agonist w/ highest affinity for D3
metabolized by P450 CYP1A2
185
Alprazolam
Short acting BENZO
Moderate to severe anxiety and panic attacks
Anxiety associated w/ depression
186
Zolpidem
Short acting BENZO
| For insomnia, sleeping on overseas plane trip
187
Hemicholinium
Inhibits uptake of choline - prevents formation of Ach
188
Vesamicol
Inhibits packaging of Ach into transport vesicles
189
Botulinum toxin
Blocks release of Ach (flaccid paralysis)
190
Metyrosine
Blocks conversion of tyrosine to DOPA
191
Reserpine
Blocks packaging of Dopamine/NE into vesicles
192
Guanethidine, Bretylium
Blocks release of NE
193
Cocaine
TCAs
Amphetamine
Blocks reuptake of NE
194
Amphetamine
Stimulates NE release
| Blocks reuptake of NE
195
H1 blockers (1st generation)
Diphenhydramine
Chlorpheniramine
Dimenhydrinate
Allergy
Motion sickness
Sleep aid
Sedation, antimuscarinic, anti-alpha-adrenergic
196
H1 blockers (2nd generation)
Loratadine
Fexofenadine
Allergy
Decrease CNS entry (less sedative effect)
197
Albuterol
Relaxes bronchial smooth muscle (B2)
198
Salmeterol, Formoterol
Long acting B2 agonist (prophylaxis)
Tremor, arrhythmia (side effects)
Be careful using w/ heart disease patients that may be on B-blocker
199
Theophylline
Inhibits phosphodiesterase -- decrease cAMP hydrolysis -- bronchodilation
NARROW TI = cardiotoxic & neurotoxic
Metabolized by P450
Blocks adenosine
200
Beclomethasone
| Fluticasone
Corticosteroids - Inhibit synthesis of cytokines
Inactivate NF-kB (TNF-a not made, no other inflammatory agents)
1st line therapy for chronic asthma
201
Montelukast
| Zafirlukast
block leukotriene D4 receptors
for chronic asthma prophylaxis
202
Zileuton
5-lipoxygenase pathway inhibitor
block conversion of arachidonic aicd to leukotrienes
203
Omalizumab
monoclonal anti-IgE antibody - inhibits IgE binding to mast cells
used in allergic asthma
204
Guaifenesin
Thins respiratory secretions (does not suppress reflex)
205
N-acetylcysteine
mucolytic - can loosen mucus plugs in CF patients
antidote for acetaminophen toxicity
prevents radiocontrast-induced nephropathy in patients w/ renal insufficiency
206
Bosentan
Treats pulmonary arterial HTN
antagonize endothelin-1 receptors --> decrease pulmonary vascular resistance
207
Dextromethorphan
Antitussive (antagonize NMDA glutamate receptors)
Codeine analog
Naloxone given for overdose
208
Pseudoephedrine
| Phenylephrine
Sympthomimemtic alpha-agonistic nasal decongestant
Pseudoephedrine also as a stimulant
Open obstructed eustachian tubes
Toxicity - HTN, CNS stimulation/anxiety
209
Methacholine
Muscarinic receptor agonist
| Asthma challenge testing
210
Amphotericin B
| Nystatin
polyene antifungal
| BINDS ergosterol --> pore formation and cell lysis
211
Terbinafine
inhibits squalene-2,3-epoxidase (ultimately decrease ergosterol synthesis)
accumulates in skin & nails
treats dermatophytoses
212
Griseofulvin
enters fungal cells
| binds microtubules --> inhibits microtubules
213
Caspofungin
| Micafungin
block 1,3-beta-D-glucan synthesis (polysaccharide component of fungal CELL WALL)
214
Flucytosine
inhibits DNA replication and RNA (protein synthesis) in fungal cells
synergistic w/ amphotericin B
** cryptococcal meningitis
215
Ketoconazole, Fluconazole
INHIBIT SYNTHESIS of ergosterol
```
P450 inhibitor (increase conc of other drugs in system)
Increase toxicity:
warfarin
cyclosporine
tacrolimus
phenytoin
isoniazid
rifampin
oral hypoglycemics
```
216
Cyclosporine
Decrease IL-2 synthesis --> inhibit T cell proliferation
| immunosuppressant (transplant pts)
217
Chloramphenicol
Inhibits bacterial peptidyltransferase (cant transfer aa from A to P site - can't form peptide bonds)
218
Streptomycin
Inhibit INITIATION complex formation
| Binds and distorts prokaryotic 30S ribosomal subunit
219
Clindamycin
| Erythromycin
Inhibit TRANSLOCATION
220
Tetracycline
Inhibit aminoacyl-tRNA binding in A site
221
Isoniazid
+ rifampin
+streptomycin, ethambutol, and/or pyrazinamide
M. tuberculosis treatment
222
Cromolyn
| Nedocromil
Inhibit mast cell DEGRANULATION
prevention/prophylactic treatment
aspirin hypersensitivity/exercise-induced asthma, seasonal allergies
223
Glucocorticoids (asthma)
Inhibit phospholipase A2 --> inhibit formation of arachidonic acid --> NO prostaglandins (from COX) & leukotrienes (from lipoxygenase)
224
Isoproterenol
B1 and B2 adrenergic agonist
Increase HR, CO
Decrease peripheral arterial resistance
Bronchodilation in asthmatics
Indicated in asthma, COPD (but not in pt. with MI)
225
Selective B-blocker (A-M) vs Non-selective B-blocker (N-Z)
Selective (A-M) B-blockers don't have pulmonary effects: better for pts. with pre-existing PULMONARY issues
Non-selective: B2 blocker causes BRONCHOCONSTRICTION, peripheral VASOSPASM, predispose diabetics to HYPOglycemia
226
TB treatment
Rifampin (inhibits bacterial DNA-dependent RNA polymerase) - inhibits transcription
+ isoniazid + pyrazinamide + ethambutol
and/or streptomycin
227
Lithium toxicity
Hypothyroidism - measure TSH levels regularly
Nephrogenic diabetes insipidus
Teratogenic (Ebstein's anomaly)
228
Valproic acid toxicity
Hepatitis
| Teratogenicity
229
Fluphenazine
Extrapyramidal symptoms (tardive dyskinesia later on)
230
Clozapine
Treats delusions/hallucinations
Atypical antipsychotic: acts on D4 receptors (instead of D2 recepors) -- not likely to cause dopaminergic side effects (pseudoparkinsonism, tardive dyskinesia, hyperprolactinemia)
Side effects:
Agranulocytosis
Seizures
231
Risperidone
Atypical antipsychotic
Side effect: Hyperprolactinemia
232
Carbamazepine: side effect
Agranulocytosis
233
Which antipsychotic causes prolonged QT?
Ziprasidone
234
Treatment for absence seizures
Ethosuximide
| Sodium valproate
235
Anticonvulsant therapy
Diazepam, Lorazepam, Midazolam
236
Treatment for gneralized tonic-clonic seizures
Phenobarbital
237
Treatment for complex partial seizures or generalized tonic-clonic seizures
Carbamazepine
238
Methylphenidate
Indirect-acting sympathomimetic
ADHD disorder
Narcolepsy
239
Rapid acting insulins
Lispro
Aspart
Glulisine
Action starts in 15 minutes
Peaks at 45-75 minutes
240
Regular (short) acting insulins
Action starts in 30 mins
Peaks at 2-4 hours
Lasts 5-8 hours
Given SQ
Used to treat DKA (hypotension, tachycardia in young patient w/ diabetes type I)
241
Intermediate acting insulin
NPH
Starts working in 2 hours
Peaks 4-12 hours
Lasts 18 hours
242
Long acting insulin
Detemir
Contains fatty acid side chain that binds to albumin = prolonged action
Works within 2 hrs
Peaks 3-9 hrs
Lasts up to 24 hrs
243
Slow release insulin
```
Glargine
insulin analog (long duration of action)
```
Lasts 24hrs
244
Allopurinol
| Rasburicase
Reduce uric acid levels during tumor lysis syndrome
Prevent acute renal failure in pts. undergoing chemo for high grade lymphomas/leukemias
245
Denosumab
prevents osteoclast activation (prevents bone loss)
| prevents RANKL and RANK interaction
246
Folinic acid (Leucovorin)
Reverse toxicities of MTX (methotrexate) on GI and bone marrow
247
Amitriptyline
TCA
block muscarinic receptors receptors (anti-cholinergic)
overdose mimics ATROPINE toxicity
248
Adverse effect of nonselective B-adrenergic blockers
Masked symptoms of hypoglycemia
Bradyarrhythmias
Worsening of Raynaud phenomenon
CNS depression
249
Treatment to prevent recurrence of HSV-2
Oral daily valacyclovir, acyclovir, famciclovir after incidence
250
Ethosuximide
Blocks T-type Ca2+ channels in thalamic neurons --> hyperpolarization
Absence seizures
251
Drug that mimics atropine toxicity
Amitriptyline (+ other TCAs)
Antimuscarinic
fever, cutaenous flushing, dry oral mucosa, dilated poorly reactive pupils, confusion
252
Prazosin toxicity
a1-adrenergic blocker
treats HTN and urinary retention (due to BPH)
side effect: postural hypotension
253
Side effect of nonselective B-adrenergic blockers
masked symptoms of hypoglycemia in diabetics
worsening of Raynaud phenomenon
254
selective alpha-1 blockers (preference for using these)
no alpha2 blockage (alpha-2 suppresses sympathetics)
selective alpha1 blockage causes less tachycardia
255
Lamivudine
NRTI
Treatment of HIV-1 and HIV-2
256
Valacyclovir
Acyclovir
Famciclovir
HSV-2
positive Tzanck smear
genital vesicular rash
257
MTX and 5-FU both inhibit thymidylate formation; what drug can be used to overcome MTX
Leucovorin (N5-formyl-THF) bypasses DHF reductase -- overcome MTX
Leucovorin potentiates 5-FU by strengthening thymidylate synthase
MTX: inhibits DHF reductase
5-FU: stabilizes THF & thymidylate syntheatse --> less thymidylate synthetase available for thymidine synthesis
258
Drug-induced Parkinsonism can be side effect of antipsychotics; treatment of drug induced Parkinsonism?
Anticholinergics (benztropine and trihexylphenidyl) for patients w/ drug-induced Parkinsonism
Levodopa contraindicated - precipitate psychosis
Dopamine agonists (bromocriptine) - used in idiopathic Parkinsonism BUT NOT in drug-induced Parkinsonism (can exacerbate underlying psychosis)
259
Mechanism of -statin drugs
| e.g. Atorvastatin
Statins inhibit HMG CoA reductase --> DECREASE cholesterol synthesis by liver
Body responds by increasin gLDL receptors on hepatocytes to increase LDL uptake from circulation (therefore decreasing LDL circulating in blood)
260
Side effects of Haloperidol; why can't you give it to patients w/ drug-induced Parkinsonism?
Haloperidol = first gen. antipsychotic = dopamine-receptor blocker (causes Parkinsonian symptoms)
Extrapyramidal side effects
261
What drug is used to noramlize prolactin levels and prevent amenorrhea-galactorrhea?
Dopamine agonists (Bromocriptine)
262
Drugs that decrease VLDV
Fibrates and nicotinic acid therapy
Decrease hepatic production of VLDL --> treatment for primary hypertriglyceridemia (increased VLDL)
263
Ezetimibe
Decrease intestinal absorption of dietary cholesterol
264
Biliary excretion of cholesterol increase or decrease in patients on statins?
Biliary excretion of cholesterol DECREASES in pts. on statins due to decreased synthesis of cholesterol in liver
265
Treatment for generalized anxiety disorder; why does this drug have low abuse potential?
Buspirone - selective agonist of 5HT(1A) receptor
Dependence does not occur
Reduced potential for abused compared to Benzodiazepines
266
Amphotericin B
Systemic candidiasis
267
Nystatin
Oral candidiasis
"swish and swallow"
binds to ergosterol in fungal cell membrane --> formation of pores and leakage of ungal cell contents
268
Griseofulvin
inhibits fungal cell mitosis @ metaphase
| indicated for treatment of dermatophytoses
269
Penicillins
B lactam antibiotics
| Inhibit peptidoglycan cross-links in bacterial cell wall
270
Terbinafine
```
Accumulates in skin, nails, adipose tissue
treat dermatophytosis (onychomycoses)
```
271
Nicotinic acid (Niacin) use; side effects?
Niacin (vitamin B3) treatment of dyslipidemia
- Decrease synthesis of VLDL and hepatic triglycerides
- Decrease conversion of VLDL to LDL
- Increase HDL
Cutaneous symptoms -- flushing, warmth, itching
mediated by prostaglandins (pre-treatment w/ ASA helps symptoms)
272
Skin side effect of Vancomycin
Red man syndrome - histamine release
273
Serotonin precursor
Tryptophan
274
Serotonin importance in neuro drugs
Serotonin = mood regulation
Selective serotonin reuptake inhibitors --> increase serotonin levels --> people happier (antidepressant medication)
275
Statins: MOA
inhibiting enzyme HMG-CoA reductase
| upregulation of hepatocyte LDL receptors --> increased uptake of LDL cholesterol from circulation
276
Bile acid-binding resins mechanism
Cholestyramine
Colestipol
binds bile acid -- intereferes w/ hepatic recycling/reabsorption of bile acids
hepatic cholesterol used in order to re-synthesis more bile acids (since there's no bile acids around) -- increased uptake of LDL from circulation to make bile acids
277
Bile acid-binding resins (side effects)
Constipating & bloating
Malabsorption of vitamin K
Hypertriglyceridemia -- do not use w/ patients that already have hypertrigylceridemia!!
Exacerbate diverticulosis (due to constipating side effect)
Gallbladder stones
278
Niacin (vitamin B3) - relation to GI
Inhibit hepatic VLDL production
| Used to increase HDL levels
279
Drug of choice for alcohol withdrawal
Long-acting benzodiazepines (chlordiazepoxide, diazepam)
Short-acting benzodiazepines (lorazepam, oxazepam) preferrer for advanced liver dysfunction
280
Mechanism by which drugs given in alcohol withdrawl works?
Give GABA agonists such as barbituates or benzodiazepines (similar effect as alcohol)
alcohol withdrawl symptoms:
patient who has been in hospital and hasn't had access to alcohol --> CNS excitation (since there's no alcohol to stimulate GABA receptors) --> tremulousness, insomnia, anxiety, headache, autonomic hyperactivity (variable BP, diaphoresis, tachycardia)
281
Baclofen
GABA agonist -- spastic conditions
282
Haloperidol (toxicity)
lowers serizure threshold
283
Phenobarbital
barbituate anticonvulsant - enhances GABA activity
284
Treatment for active tuberculosis
```
Rifampin
Ethambutol
Isoniazid
Pyrazinamide
and/or Streptomycin
```
285
Rx for atypical mycobacterial infections (e.g. Mycobacterium avium complex)
Macrolide + Rifampin + Ethambutol
286
Rx for Staph endocarditis
IV nafcillin + aminoglycoside (gentamicin)
287
Bacterial resistance to rifampin -- mechanism?
genetic mutation of bacterial DNA-dependent RNA polymerase
Rifampin needs to be administered as part of multi-drug regimen
P450 inducer (other drugs will be metabolized more rapidly w/ co-administration with rifampin)
288
Mycobacterial resistance to isoniazid?
Catalase-peroxidase
or
Genetic modification of isoniazid binding site on mycolic acid synthesis enzyme
289
Resistance to ethambutol
Inhibit synthesis of mycobacterial cell wall via increase production of arabinosyl transferase
290
Resistance to Pyrazinamide
Lowers the environmental pH to kill M. tuberculosis
| Drug has to be converted to active form via pyrazinamidase (bacterial mutate this enzyme)
291
Mechanism of digoxin on AV conduction
Decrease AV nodal conduction via increased paraympathetic tone (vagus nerve --> decrease rate of AV conduction --> ventricles contract at more normal rate --> adequate fiastolic filling time --> normal cardiac output)
*prevents rapid ventricular response (usually accompanying a. fib) -- which leads to poor CO and backup of blood in lungs (heart failure)
292
Digoxin effect on ventricular contractility
blockade of NA-K-ATPase on cardiac myocytes --> increased itracellular Ca2+ levels in sarcoplasmic reticulum --> maximal crosslinking of actin and myosin --> increased ventricular contractility
293
Isoniazid can lead to deficiency of which enzyme?
Vitamin B6 (pyridoxine)
Isoniazid chemically similar to B6:
competes w/ B6 to make GABA --> defective product
Peripheral neuropathy
Drug also increases excretion of B6
Need to give supplemental B6 with Isoniazid
294
Chronic treatment to prevent bronchial asthma
Fluticasone (inhaled glucocorticoid)
Cortiscosteroids = strongest effect on inflammatory compoenent of astham
(steroids usually end in "-sone")
295
Action of glucocorticoids on lungs
Not for treat of acute episodes of asthma
inhibit formation of cytokines responsible for asthma
apoptosis of inflammatory cells (macrophages, lymphocytes, eosinophils)
decrease amount of mucus produced by goblet cells
reduce airway hyperresponsiveness by decreasing inflammation
296
Nifedipine
DHP Ca2+ channel blocker
Treats HTN
Blocks Ca2+ influx into bronchial smooth muscle cells --> bronchodilation
297
Acyclovir use
Herpes simplex infections
298
Clarithromycin + other antibiotics
Mycobacterium avium complex
299
Leukocyte interferon-a
hepatitis B and C
hairy cell leukemia
condyloma acuminatum (HPV)
Kaposi's sarcoma
300
Pentamidine
Pneumocystis pneumonia
301
Sulfonylurea or meglitnide abuse - action on blood sugar
Increase insulin, c-peptide, pro-insulin levels
bind to ATP-dependent K+ channels on pancreatic beta cells --> inhibit hyperpolarizing potassium current --> depolarization --> Ca2+ channels opening --> exocytosis of secretory granules filled w/ mature insulin & c-peptide
302
Main site of action of nitroglycerin
Venodilator --> large veins
Treats angina by venodilating --> blood collects in venous system --> decrease preload --> decrease ventricular wall stress --> decrease cardiac O2 demand
303
Vessels in which nifedipine and prazosin works
Nifedipine (Ca2+ channel blocker)
Prazosin (alpha1-adrenergic blocker)
Small arteries and arterioles -- primary site of hormonal regulation of systemic blood pressure and primary vascular site of action of vasoactive antihypertensive drugs
304
Absence of lamellar bodies of type II pneumocytes
Patchy alveolar atelectasis (collapse)
| Neonatal respiratory distress syndrome
305
Methotrexate (MTX) - mechanism & additional drugs given in conjunction w/
Inhibits DHF reductase --> block folinic acid synthesis
Can be given w/ Leflunomide & TNF-a inhibitors for rheumatoid arthritis
306
Side effects of MTX
Stomatitis (painful mouth ulcers) - supplement w/ folic acid
Hepatotoxicity
Myelosuppression (increased risk for opportunistic infections)
B cell lymphomas
Pulmonary fibrosis
contraindicated in pregnancy
307
Side effects of Naproxen
GI bleeding
fluid retention
worsening HTN
308
Minocycline
Treats early mild rheumatoid arthritis
photosensitivity (mild side effect)
309
Hydroxychloroquine
main use - SLE
can be used for early mild seronegative rheumatoid arthritis
permanent retinal damage (serious adverse)
310
Corticosteroid chronic use - side effects?
weight gain
hyperglycemia
bone density, skin striae, proximal muscle weakness
used w/ NSAIDs -- potentiate risk for GI bleeding
311
Valproic acid
blocks NMDA receptors - affects K+ current
can also affect Na+ channels and GABA receptors
312
Similar mechanism of:
Phenytoin
Carbamazepine
Valproic acid
reducing Na+ channels' abiltiy to recover from inactivation
313
Phenoxybenzamine (indication); also effect on insulin
long acting alpha-blocker used for pheochromocytoma
blockage of alpha-receptors --> unopposed beta effects --> increase beta2-adrenergic stimulation = increase insulin release
314
Diphenhydramine
Antihistamine (blocks H1 histamine receptor)
| Anticholinergic activity
315
Propranolol
Non-cardioselective beta blocker
inhibits insulin secretion -- increase risk of diabetes mellitus for patients on long term beta blocker use
316
Drug used to decrease severity of inflammation and decrease extraocular volume in Grave's opthalmopathy
Prednisone (high dose glucocorticoid)
317
Rx that inhibits thyroid peroxidase; how?
Methimazole
Propylthiouracil
Responsible for oxidation (organification) of iodide to iodine at apical-colloid interface
Iodine + tyrosine (on thyroglobulin) --> T1, T2, T3 thyroxin
318
TCA overdose - cause of death?
TCAs inhibit reuptake of NE and serotonin
Inhibit fast Na+ channels --> arrhythmias (phase 0 prolonged, prolonged WRS complex) --> negative inotropy --> decrease contractility, refractory hypotension, peripheral vasodilation --> v. fib
319
Rx that causes serotonin syndrome; symptoms?
MAO inhibitor + SSRI (or large doses of SSRI)
hyperthermia, autonomic instability, muscle rigidity, myoclonus, diaphoresis
320
Examples of TCAs
Imipramine
Amitryptyline
Clomipramine
321
Treatment for TCA overdose
Normal saline
| Hypertonic sodium bicarbonate
322
Mechanism of Warfarin
inhibits vitamin K dependent g-carboxylation of glutamic acid residues of clotting factors II, VII, IX, X
323
Reversal of warfarin-induced anticoagulation
```
Fresh frozen plasma (rapid reversal)
vitamin K (re-synthesis of clotting factors)
```
324
Reversal of heparin
Protamine (binds to heparin and inactivates it)
325
Aminocaproic acid
Antifibrinolytic - inhibits fibrinolysis (inhibits plasminogen)
326
Acylclovir mechanism of action
Guanosine analog
Needs to be activated by viral thymidine kinase (TK)
acyclovir monophosphate --> phosphorylated to active form --> impairs viral DNA polymerase-mediated replication of virus
Rx for HSV-1&HSV2
Related drugs: Famciclovir
Valaciclovir
EBV and CMV do not have same thymidine kinase as HSV - so drug is not as effective
327
Medroxyprogesterone (Depo Provera)
Progesterone-only contraceptive via IM injection once every 12 weeks
328
Medroxyprogesterone acetate
Decreases endometrial hyperplasia (decrease risk of endometrial carcinoma)
Good for postmenopausal women on estrogen replacement
Long-acting contraceptive
Side effect: decreased bone mineral density
329
Raloxifene
Estrogen agonist: bone, cardiovascular, blood lipoproteins
Estrogen antagonist: breast, uterus
330
Alendronate
Synthetic bisphosphonate (analog of pyrophosphate)
bone resorption inhibitor
331
Leuprolide
GnRH analog
agonist - pulsatile administration
antagonist - continuous administration
agonist - estrogen levels increase (protect against osteoporosis)
antagonist - estrogen levels decrease (protect against breast cancer in post-menopausal women)
332
Cholestyramine
Colestipol
Colesevelam
Bile acid-binding resins - binds bile acid in GI tract - interferes w/ enterohepatic circulation
LDL reduced (hepatic cholesterol used up to make new bile acids) --> increased uptake of LDL from circulation (lowering LDL from blood)
side effect: hypertriglyceridemia, VLDL increase
usually given w/ a statin (but at least 4 hrs apart so that bile-acid resin doesn't interfere w/ absorption of statin)
333
Gemfibrozil
| Fenofibrate
decrease serum triglycerides by reducing hepatic triglyceride production
Fibrates activate PPAR-alpha --> PPAR-alpha activates lipoprotein lipase
decreased VLDL cholesterol (decreases LDL)
decreased TRIGLYCERIDES
increase HDL
334
Halothane
| Sevoflurane
Have bronchodilation properties -- preferred in patients w/ asthma (since inhalation anesthetics tend to cause postoperative atelectasis via suppression of muciliary clearance)
335
Fluorinated anesthetics - effect on cerebral blood flow
Increase cerebral blood flow (via decreased vascular resistance) --> increased intracranial pressure -- bad!
336
Side effects of inhlation anesthetics
Increased cerebral blood flow --> increased ICP
myocardial depression, hypotension
respiratory depression
decreased renal function
337
Symptoms of opioid withdrawal in an infant born to mom who abuses opioids
Pupillary dilatation
Rhinorrhea, sneezing, nasal stuffiness
Diarrhea
Chills, tremors, jittery movements
338
Treatment of choice for acute opioid withdrawal in neonate
Tincture of opium or paregoric
339
Naloxone
Opioid receptor antagonist
Rx for acute opioid intoxication or overdose
DO NOT give to patients w/ opioid withdrawal -- can cause seizures
340
Folic acid (folate)
RBC production
Lowers homocysteine levels
Prevents neural tube defects
341
Sodium bicarbonate
IV - treatment for acidosis and hyperkalemia
| Oral - alkalinizing agent/antacid
342
Treatment regimen for M. tuberculosis
Isoniazid - mycolic acid synthesis - disturbs cell wall - disturbs ability of mycobacteria to have acid fast reaction on stain
Ethambutol - inhibit mycobacterial cell wall synthesis (no effect on creation of mycolic acid)
Rifampin - halts protein synthesis via inhibition of bacterial DNA dependent RNA polymerase -- prevents transcription of DNA into mRNA
343
Where does acetazolamide work?
Proximal convulated tubule
| Carbonic anhydrase inhibitor
344
Site of action of loop diuretics; what are they?
Thick ascending limb of loop of Henle
Furosemide
Bumetanide
Torsemide
Ethacrynic acid
345
Site of action of thiazide diuretics; side effect?
Distal convoluted tubule
Exacerbates hypokalemia
346
What renal drugs has potential to cause hypokalemia?
Loop diuretics (except K+ sparing ones)
347
What type of neuro/psych drug causes diabetes insipidus?
Lithium -- treats bipolar disease
Lithium inhibits action of vasopression (ADH) --> polyuria & polydipsia
348
Vancomycin resistance: D-ala-D-ala substitution for mutated sequence; what is the sequence?
D-ala-D-lactate
349
What renal drug should be given to patient w/ HTN and CHF who also has osteoporosis?
Hydrochlorothiazide -- increases absorption of Ca2+ (distal convoluted tubule)
Reabsorption also prevents painful renal stones (from hypercalciuria)
350
Where does Ca2+ reabsorption take place in renal tubules? What drug causes this?
Distal convoluted tubule -- Hydrochlorothiazide
351
Site of action between osmotic diuretics & loop diuretics?
Osmotic diuretic - descending limb of loop of Henle & proximal tubule (mannitol)
Loop diuretic - thick ascending limb of loop of Henle (furosemide)
352
Furosemide
Loop diuretic -- treats HTN and CHF
Increases urinary Ca2+ LOSS --> worsens osteoporosis in post-menopausal women
353
Spironolactone
Inhibits testosterone (and other steroid hormones)
Used for antiandrogenic action --> treats hirsutism & androgen-dependent malignancies
354
Acarbose
Oral hypoglycemic agents
Rx for type 2 diabetes mellitus
355
Substance in sunscreen to block UVB light
Para-aminobenzoic acid (PABA) esters
| Protects against UVB (290-320nm wavelength)
356
What drug is used to diagnose asthma in pt. who presents w/ asthma symptoms but has normal spirometry values?
Methacholine challenge
Methacholine = muscarinic cholinergic agonist --> bronchoconstriction + increased airway secretions
Administration of Methacholine --> decrease FEV1 by more than 20% indicates bronchial asthama
357
Varenicline
Partial agonist at nicotinic acetylcholine receptors; only releases limited downstream - LESS stimulation of reward pathways (than nicotine)
Helps patients w/ cessation of tobacco (reduces withdrawal cravings; attenuating rewarding effects of nicotine)
358
Antidepressant that does NOT cause sexual dysfunction; what are side effects?
Bupropion - does not have sexual dysfunction side effect
has stimulatory effect --> treatment for depression w/ associated psychomotor retardation/hypersomnia
treats nicotine dependence
side effect: agitation, insomnia, seizures
359
Trazodone
highly sedating anti-depressant (helpful for pts. w/ insomnia)
causes priapism
360
Antimetabolite = folate antagonist
Methotrexate
361
Antimetbolite - purine analogs
6-MP
Fludarabine (for CLL)
Cladribine (for hairy cell leukemia)
362
Cladribine
for Hairy Cell Leukemia
| Resistant to adenosine deaminase (adenosine functions in purine disposal pathway)
363
Antimetabolite - pyrimidine analogs
5-FU
Capecitabine
Cytarabine
Gemcitabine
364
Lomustine
Nitrosurea
DNA alkylation & cross-bridge formation
Requires non-enzymatic hydroxylation
Penetrates CNS
365
Dacarbazine
Cell-cycle nonspecific methylating agent
366
Cisplatin
Pt-containing chemotherapeutic agent -- forms cytotoxic metabolite in environments w/ low chloride concentration
367
Mercaptopurine
Converted to active metabolite by HGPRT
Inactivated by xanthine oxidase
368
What is administered before bronchoscopy to decrease respiratory mucous secretions & promote bronchodilation?
Atropine
369
Mechanism of atropine
Anti-muscarinic (anti-parasympathetics)
```
symptoms of toxicity:
flushed skin, hyperthermia (atropine fever)
mydriasis & cycloplegia
bronchodilation
tachycardia
constipation, urinary retention
```
370
Mechanism of physostigmine
Anti-acetylcholinesterase --> increases Ach concentrations
Tertiary amine - capable of crossing blood-brain barrier
(contrast w/ neostigmine & edrophonium -- quaternary ammonium structure LIMITS CNS penetration)
Used to reverse atropine toxicity
371
Significance of HMG-CoA reductase; what drugs target this enzyme?
Statins -- inhibit HMG-CoA reductase -- reduce LDL cholesterol
HMG-CoA reductase converts HMG-CoA to cholesterol
372
What drugs taken w/ a statin will increase susceptibility to myopathy (muscle pain + increased serum creatine kinase)?
Statins + fibrates (gemfibrozil or fenofibrate)
Statins alone increase risk of myopathy & hepatitis
Simvastatin - highest associated risk of myopathy
Gemfibrozil - increase concentration of statins
Fenofibrate - causes myopathy by itself
373
Cholestyramine + statin use common; why must they be dosed at least 4hrs apart?
Cholestyramine (bile acid sequestrant) reduces GI absorption of statins
374
Combination of fibric acid derivatives + bile acid-binding resins increases risk for?
Cholesterol gallstones (increased cholesterol concentration in bile)
375
First line treatment for hypertriglyceridemia
Fibrates
376
Mechanism of niacin
Improves hyperlipidemia by decreasing synthesis of hepatic triglycerides & VLDL
Used in conjunction w/ fibrates to lower TGs
377
First line treatment for hypercholesterolemia
Statins - inhibits HMG-CoA reductase
Use Ezetimibe to inhibit absorption of cholesterol (if pts. need additional help lowering cholesterol)
378
Why is ACE-I or ARB preferred for diabetics?
Slow progression of diabetic nephropathy (decrease progression to ESRD)
Antihypertensive effect
379
Doxazosin
Prazosin
Terazosin
alpha-1 blocker
treats HTN and BPH
380
Pt. w/ pre-existing coronary arter disease + CHF + HTN; what type of cardioselective beta blockers is needed?
Metoprolol
| Atenolol
381
Hydrochlorothiazide (HCTZ) indications
1st line med for essential HTN
pts. w/ osteoporosis (increases Ca2+)
Isolated systolic HTN
382
What drug combinations can increase likelihood of gallstone formation?
Gemfibrozil & cholestyramine
Cholestyramine: binds bile acid --> dumps it into bile (increases cholesterol content of bile --> gallstone formation); the good thing about binding bile acids is that liver has to use up LDL to make new bile acids, thus LOWERING LDL in circulation (at the expense of increase risk of gallstone formation)
Gemfibrozil - increase cholesterol content of bile (decrease liver synthesis of TGs)
383
MOA for Ondansetron, Granisetron, Dolasetron
Blocks vagus-mediated naseau/vomiting (vagal terminals w/ 5-HT3 receptors initiate vagus n. activity in medulla oblongata's "vomit center")
Blocks serotonin in chemoreceptor trigger zone
Good for preventing chemo-induced vomiting
384
Mifepristone (RU-486)
Anti-progestin
Anti-glucocorticoid
Used as abortifacient
385
Danazol
synthetic androgen
treats endometriosis
treats hereditary angioedema
```
side effects:
hirsutism
masculinization
fluid retention
weight gain
```
386
Drug mechanism of statins vs. bile acid-binding resins
Statins: inhibit HMG CoA reductase --> no cholesterol synthesis --> liver increases LDL receptors on surface to uptake LDL (cholesterol source) from circulation --> this lowers cholesterol in blood
Bile acid-binding resins: Inhibits reabsorption of bile acids --> liver has to make new bile acids by consuming liver cholesterol; also takes up LDL from circulation as cholesterol source to make more bile; statins taken together w/ bile acid-binding resins to avoid this effect
387
Why is it good to give patient that w/ severe pain and severe hematuria Celecoxib?
Celecoxib is an NSAID and selective COX-2 inhibitor
Does NOT have side effects of bleeding & GI ulceration (platelets only express COX-1)
388
Both traditional NSAIDs as well as selective COX-2 inhibitors can exacerbate what condition?
Fluid retention --> HTN
389
Where is COX-2 expressed (other than platelets)?
Vascular endothelial cells & vascular smooth muscle cells --> vascular DILATATION
390
What protacyclin is increased by COX-2?
PGI2 --> anticoagulation and vascular dilatation
391
Mechanism of ASA
Irreversibly inhibiting platelet aggregation via ACETYLATION of serine residues of platelet COX enzymes
392
What Rx (mucarinic Ach antagonists) is used to treat obstructive diseases such as asthma and COPD?
Tiotropium
Ipratorpium
Drugs decrease mucus secretion, decrease bronchoconstriction by inhibit muscarinic Ach receptors (parasympathetics)
393
Serious side effects of statins?
Myopathy (increase serum CK --> muscle pain = rhabdomyolysis)
Hepatitis
394
Metabolism of statins through what system?
With exception of PRAVASTATIN, all statin drugs metabolized by P-450 system
395
Nausea, vomiting associated w/ levodopa use; mechanism? How do you avoid these symptoms?
Peripheral conversion of levodopa --> DOPAMINE
Take Carbidopa (dopa-decarboxylase inhibitor) to limit peripheral conversion of levodopa --> decrease nausea and vomiting
396
Rx for plasmodium species
Chloroquine = Plasmodium in bloodstream
Primaquine = latent P. vivax and P. ovale in liver
397
Dietary restrictions & drug-drug interactions of monoamine oxidase inhibitors (MAOIs); examples of MAOIs?
Restrictions = cheese, wine
Drug-drug interactions w/ SSRI
Phenelzine
Tranylcypromine
398
Indication of Phenelzine
Atypical depression/resistant depression
Mood reactivity
Leaden fatigues (arms and legs feel heavy)
Increased sleep and appetite
399
Rx for auditory hallucinations
Schizoprenia
Rx: Haloperidol, Chlorpromazine
400
Bimodal distribution in drug metabolism of Isoniazid; why?
Isoinazid metabolized by ACETYLATION
See bimodal distribution (2 peaks) of drug metabolism: correlates w/ SLOW and FAST acetylators; slow acetylators at higher risk of adverse reactions
401
What drug used for inflammatory disorders of bowel and skin is metabolized via METHYLATION?
6-mercaptopurine
402
Common Rx used for invasive MRSA infections?
Vancomycin
Daptomycin
Linezolid
403
Vancomycin: MOA and adverse effects?
Blocks glycopeptide polymerization via binding to D-ala-D-ala
Adverse:
Red man syndrome
Nephrotoxicity
404
Daptomycin: MOA and adverse effects?
Depolarization of cellular membrane
Adverse:
Myopathy --> CPK elevation
Inactivated by pulmonary surfactant
405
Linezolid: MOA and adverse effects?
Inhibits bacterial protein synthesis by binding 50S subunit
Adverse:
Thrombocytopenia
Optic neuritis
High risk for serotonin syndrome
406
What is the effect on K+ levels in blood when patient is using drugs that decrease aldosterone secretion (e.g. ACE inhibitors)?
Less aldosterone secretion --> less Na+ retention
Na+ and K+ always go in opposite ways
Less Na+ retention --> more K+ retention --> hyperkalemia
ACE inhibitors (eg. Lisinopril) decrease amount of aldosterone secreted -- predispose to HYPERKALEMIA;
more intense hyperkalemia when ACE inhibitor used w/ K+ sparing diuretics (amiloride, triamterene, spironolactone)
Pts. with renal insufficiency (more hyperkalemia) or pts. taking K+ supplements
407
Specific beta-1 blockers
| A-M -- "olol"
Decrease contractility & HR
| Inhibit renin release --> antihypertension
408
Indapamide
Thiazide diuretic
| Blocks Na+-Cl symporters in distal tubules
409
Amlodipine: MOA
DHP Ca2+ channel blocker
Blocks vascular smooth muscle --> peripheral vasodilation, improved coronary blood flow
DHP causes SIGNIFICANT vasodilatoin --> REFLEX TACHYCARDIA; can also cause peripheral edema
410
Morphine: effect on blood vessels
Vasodilator
Increases venous capacitance
Decrease systemic vascular resistance
CNS sympatholytic
Can treat ischemic chest pain; esp. during acute MI
411
Medications that can cause HYPERKALEMIA
Non-selective B-blockers (N-Z olol) - inhibits beta-2 mediated intracellular K+ uptake
ACE inhibitors
ARBs
K+ sparing diuretics - block epithelial Na+ channel (ENaC) or aldosterone receptor
Cardiac glycosides (digoxin) - inhibits Na+/K+ ATPase pump
NSAIDs - impaired local prostaglandin synthesis --> reduced renin & aldosterone secretion
412
Didanosine; use & adverse rxn?
HIV RT inhibitor
Adverse rxn: pancreatitis
413
Injection of a substance causes blanching of vein, induration & pallor of tissues surrounding IV site -- what is occuring? What substance is injected? How can this be prevented?
NE infusion --> NE extravasation --> a1 receptor mediated vasoconstriction --> local tissue necrosis
Tissue necrosis can be prevented by local injection of alpha-1 blocking drug (e.g. phentolamine)
414
Enalapril
ACE inhibitor
CHF
HTN
Diabetic nephropathy
415
Isoniazid side effects
Hepatocyte damage
Peripheral neuropathy (need to simultaneously administer pyridoxine)
416
Indication & major toxicity: Statins
High LDL
toxicity:
hepatitis, myopathy
417
Indication & major toxicity: Niacin
Low HDL
```
toxicity:
cutaneous vasodilation
HYPERglycemia (acanthosis nigricans)
HYPERuricemia/gout
hepatitis
```
418
Indication & major toxicity: Fibric acid derivatives
| Gemfibrozil & fenofibrate
High TG
toxicity:
gallstones
myopathy (worse when combined w/ statins)
419
Indication & major toxicity: Bile acid-binding resins (Ezetimibe)
High LDL
toxicity:
GI upset
Hypertriglyceridemia
Malabsorption
420
Rx for benign prostatic hyperplasia and HTN
alpha-1 blockers
| Doxazosin, Prazosin, Terazosin
421
Common side effect of K+ sparing diuretics
Gynecomastia (more common w/ spironolactone use than eplerenone)
422
DHP vs. non-DHP Ca2+ channel blocker
DHP Ca2+ channel blocker: selective for vascular smooth muscle -- vessels! (eg. Amlodipine)
Non-DHP Ca2+ channel blocker: selective for heart (Verapamil)
423
Indications for ribavirin
Nucleoside analog - inhibits guanine nucleotides
RSV or Hep C
424
Oseltamivir
sialic acid analogue inhibitor
influenza A & B neuraminidases
425
Amantadine
Impairs UNCOATING of influenza A virion after it is endocytosed by host cell
426
What drug may precipitate opioid withdrawal when used w/ morphine?
Pentazocine (weak opiod narcotic - produces analgesic effects w/ little abuse potential)
Partial agonist activity and weak antagonist activity at mu receptors; when used w/ other selective mu receptor agonists (eg morphine) --> pentazocine can compete w/ other mu AGONISTS and produce ANTAGONISTIC effect
--
Opioid narcotics = selective mu receptor AGONISTS
427
Rx for sickle cell anemia; mechanism of drug?
Hydroxyurea increases HbF synthesis
Gardos (Ca2+ dependent) K+ channel blockers inhibit efflux of K+ and H2O from cell --> prevents dehydration of RBCs & reduce polymerization of HbS
428
Disulfiram
Used for recovering alcoholics
Causes acetaldehyde accumulation --> bad side effects everytime someone consumes alcohol
429
Metronidazole
Trichomonas vaginitis & bacterial vaginosis
Metronidazole + alcohol = acetaldehyde accumulation (bad side effects) b/c metronidazole inhibits alcohol oxidizing enzymes
430
What drug can cause atrialization of right ventricle?
Lithium --> Ebstein's anomaly in infants in utero
Apical displacement of tricuspid valve leaflets --> decrease volume of RV (atrialization of RV)
Lithium used to treat bipolar disease
431
Infant born w/ irritability, diarrhea, vomiting; could be due to withdrawal symptoms of what?
Narcotic use
432
Side effect of direct vasodilators? What are some examples of direct vasodilators? What drugs are given in combination to decrease side effects?
Hydralazine
Minoxidil
Used for HTN
Significant arterial vasodilation can cause REFLEX sympathetic activation (sodium and fluid retention to bring BP up) --> tachycardia and edema
Give sympatholytics & diuretics to help w/ side effects
433
Persistent cough & angioedema - side effect of what Rx?
ACE inhibitor
434
Failure of alveolar air to equilibrate w/ venous blood gases; possible cause?
Poor perfusion -- no exchange btwn alveoli & vessels (normal equilibration is pO2 ~100mmHg and pCO2 ~40mmHg)
435
Significant side effects of antihyperlipidemic medications
Statins - hepatoxicity, muscle toxicity
Fibrates - muscle (esp combined w/ statins); gallstones
Bile acid sequestrants - DECREASE absorption of digoxin, warfarin, fat-soluble vitamins; nausea, bloating, cramping
Niacin - hepatotoxicity; flushing, warmth, pruritus
Ezetimibe - hepatotoxicity (esp. with statins)
436
Blood supply of spleen
Splenic artery from celiac trunk (foregut) BUT spleen is MESODERM-derived
foregut: esophagus --> 2nd part of duodenum, liver, gallbladder, and small portion of pancreas
437
Nesiritide
BNP (brain natriuretic peptide)
dilates arteriole & veins - promotes diuresis
usually released in pts. w/ systolic dysfunction in CHF (increased heart volume in heart that can't pump out a lot of blood --> increased stretching triggers ANP from atria or BNP from brain to be released to decrease volume)
438
Bradykinin relationship to adrenergic and renin-AT-aldosterone system
Bradykinin produced by kidneys when adrenergics and renin-AT-aldosterone system activated
Constricts veins, dilates arterioles --> increase renal perfusion
ANGIOEDEMA
439
Ranitidine
Proton pump inhibitor
Ranitidine superior to H2 blockers for treatment of peptic ulcer disease
440
Misoprostol
PGE1 analog
Prevents NSAID-induced ulcer disease
441
Liver function tests should be monitored for what drugs?
Carbamazepine
Isoniazid (can cause full-blown hepatitis)
442
What drugs affect TSH and T3/T4 levels (levels should be monitored?)
Lithium - hypothyroidism
Amiodarone - hypothyroidism
443
Entacapone
COMT inhibitor - increase levodopa bioavailability by inhibiting peripheral methylation (so levodopa can't be degraded peripherally --> more levodopa in brain); Entacapone HAS to be used in combination w/ levodopa; Entacapone by itself has no effects
Tolcapone - COMT inhibitor that inhibits both peripheral and central methylation -- NOT used as often because of hepatotoxicity
444
COMT inhibitor: what does it stand for?
Catechol-O-methyltransferase inhibitor
No peripheral methylation
445
What does Carbidopa do when used in conjunction w/ levodopa?
Carbidopa is a peripheral dopa decarboxylase inhibitor
446
How is selegiline different from levodopa?
Selegiline is a MAO-B inhibitor --> decrease central dopamine degradation
Levodopa + carbidopa --> dopamine precursor
Entacapone is a COMT inhibitor --> increase bioavailability of levodopa in brain (HAS TO BE USED in combination w/ levodopa)
447
Amantadine: indications
Anti-influenza antiviral
ALSO used to enhance effects of endogenous dopamine (increase synthesis, release, re-uptake of dopamine)
448
Dopamine agonists (4)
Bromocriptine
Pergolide
Pramipexole
Ropinerole
stimulate dopamine receptors (D2 receptors)
449
What drugs are used to treat drug-induced Parkinson's disease? What is the MOA of these drugs?
Trihexyphenidyl
Benztropine
Inhibit central muscarinic receptors
Pts. w/ tremor as predominant symptom respond best
450
Ergonovine: MOA
Ergonovine = ergot alkaloid --> constrict smooth muscle via alpha-adrenergic and serotonergic receptors
451
Ergonovine test - what disease does it diagnose?
Prinzmetal's angina
Coronary vasospasm --> transient transmural ischemia --> ST segment elevation (& chest pain due to ischemia)
452
Cancer drug toxicities:
1. Vincristine
2. Bleomycin
3. Doxorubicin
4. Cyclophosphamide
5. Mercaptopurine
6. Methotrexate
1. Vincristine - inhibit microtubule polymerization (M phase) -- NEUROTOXIC (finger numbness/tingling)
2. Bleomycin - PULMONARY FIBROSIS (dry cough + exertional dyspnea); flagellate skin discoloration
3. Doxorubicin - CHF
4. Cyclophosphamide - hemorrhagic cystitis
5. Mercaptopurine (S-phase): abdominal pain/jaundice/cholestasis
6. Methotrexate (for rheumatoid arthritis): cirrhosis
453
Difference btwn actions of SMX and Trimethoprim/Pyrimethamine
SMX: inhibits dihydropteroate synthase -- inhibits DHF acid synthesis
TMP/Pyrimethamine: inhibits DHF reductase -- inhibits THF acid synthesis
454
Bacitracin: MOA
Inhibit mucopeptide transfer into growing cell wall --> inhibit cell wall synthesis
455
What drugs inhibit HDF reductase?
TMP
Methotrexate
Pyrimethamine
Inhibit DHF reductase --> inhibit THF acid formation
456
What part of cell cycle does Methotrexate inhibit?
S phase (can't synthesize purine and thymidylic acid)
457
Pyrimethamine: indications
Antimalarial
Toxoplasmosis
Inhibits DHF acid reductase
458
Drugs that cause sulfa allergies (7)
```
Celecoxib
Furosemide
Thiazide
TMP-SMX
Sulfasalazine
Sulfonylureas
Acetazolamide
```
459
Potassium citrate is prescribed as prophylaxis to what?
Calcium stones in urine
Citrate binds free Ca2+
460
Calcium oxalate crystal vs. Calcium phosphate (struvite) crystals
Calcium oxalate - requires acidic pH
Calcium phosphate (struvite) - requires alkaline pH
461
AZT (Zidovudine): MOA
NRTI (nucleoside reverse transcriptase inhibitor)
competes w/ RT --> incorporated into viral genome as THYMIDINE analog
has azido group in place of -OH group normally found at 3' end of thymidine
LACK of free 3' -OH prevents new nucleotides from being added in replicating DNA --> PREVENTS DNA CHAIN ELONGATION
