Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP1 - TLe > QB - PHARM > Flashcards

QB - PHARM Flashcards

1
Q

Pentamidine (3)

A

Pneumocystis jiroveci pneumonia (HIV)
Leishmaniasis
African Sleeping sickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Nifurtimox

A

Chagas’ disease (Trypanosoma cruzi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mebendazole

A

Ascariasis
Trichuriasis
Hookworm
Pinworm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ivermectin

A

Onchocerciasis (river blindness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Metronidazole

A

Giardia lamblia
Entamoeba histolytica
Trichomonas vaginalis
C. difficile pseudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Giardia lamblia

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Entamoeba histolytica

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Trichomonas vaginalis

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

C. difficile pseudomembranous colitis

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cloroquine, Mefloquine

A

Plasmodium (malaria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primaquine

A

P. vivax

P. ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Methotrexate

A

Antifolate (cancer therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Trimethoprim

A

Antifolate (inhibits DHF to THF)

Treats UTI & ear infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UTI & ear infections

A

Trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imatinib

A

CML (bcr-abl tyrosine kinase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enoxaparin

A

Low-molecular weight heparin (better bioavailability, longer half-life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lepirudin, Bivalirudin

A

derivatives of Hirudin - INHIBITS thrombin (alternative for heparin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clopidogrel, Ticlopidine

A

Blocks ADP receptors - prevent binding of gpIIb/IIIa to fibrinogen (NO PLATELET aggregation)

For coronary stenting/acute coronary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dactinomycin
Doxorubicin
Bleomycin

A

Intercalates DNA - Antitumor antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dactinomycin

A

Intercalates DNA - antitumor antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Doxorubicin

A

Intercalates DNA - Antitumor antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bleomycin

A

Intercalates DNA - Antitumor antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cyclophosphamide

Nitrosureas

A

Alkylating agents - crosslinks DNA

Cyclophosphamide - solid tumors, leukemia, lymphomas

Nitrosureas - brain tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Vincristine, Vinblastine

Paclitaxel

A

Microtubule inhibitors

Vincristine, Vinblastine - block mitotic spindle formation

Paclitaxel - mitotic spindle cannot dissolve (stuck in hyperstabilization) - breast/ovarian cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cisplatin

A

Crosslinks DNA

Testicular, ovary, bladder cancer; lung carcinomas

Nephrotoxic, acoustic nerve damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Etoposide

A

Inhibit topoisomerase II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Hydroxyurea

A

Inhibit ribonucleotide reductase –> decrease DNA synthesis (S phase)

Rx for CML, sickle cell disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Prednisone

A

CLL, non-Hodgkin’s lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tamoxifen

A

SERM - selective estrogen receptor antagonist in breast, agonist in bone

Raloxifene - no increased risk of endometrial cancer (like Tamoxifen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Trastuzumab (Herceptin)

A

Breast cancer - cardiotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Rituximab

A

antibody against CD20

Non-hodgkin’s lymphoma, rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Bevacizumab

A

Solid tumors

monoclonal antibody against VEGF
Inhibits angiogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Dabigatran, Argatroban

A

Direct thrombin inhibitors

Prolongs TT (without affecting PT or PTT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Heparin

A

Increases antithrombin binding/neutralization of thrombin & factor Xa (prevents clots)

SHORT term management of DVT (deep vein thrombosis)/peri-operative non ambulatory patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Warfarin

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lepirudin, Argatroban

A

Direct thrombin inhibitors

Use for Heparin-induced thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Ticlopidine, Clopidogrel

A

Inhibit ADP mediated platelet aggregation

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Rofecoxib

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Dapsone, Nitrites effect on blood

A

Methemoglobinemia (Fe2+ oxidized to Fe3+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Vincristine

A

Inhibits microtubule formation (M phase)

Neurotoxic –> peripheral neuropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Topoisomerase I and II inhibitors

Hydroxyurea

A

Inhibits synthesis pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Ganciclovir

A

CMV - MOST COMMON use for HIV patients

Retinitis, esophagitis, pneumonia
polyneuropathy, transverse myelitis, encephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Mechanism of Ganciclovir & adverse rxns

A

Interferes w/ human host cell DNA synthesis (greater effect than acyclovir)

Adverse rxns:
Neutropenia
Anemia
Thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What drug used in conjuction w/ Ganciclovir will exacerbate its side effects?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Ampicillin

A

Listeria monocytogenes

Meningitis in immunosuppressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Amphotericin

A

Cryptococcus neoformans

Meningitis in AIDS patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Risperidone

A

Schizophrenia

Side effect: hyperprolactinemia –> amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Colchicine

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Avoid using colchicine in what kind of patients?

A

Elderly w/ renal dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Terbinafine

A

Inhibits squalene epoxidase –> NO ergosterol SYNTHESIS

Rx for dermatophytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Amphotericin B

Nystatin

A

BINDS to ergosterol - makes holes in CELL MEMBRANE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Caspofungin

A 
Echinocandin class (INHIBITS CELL WALL synthesis)
Blocks synthesis of B(1,3)-D-glucan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Rx for Candida & Aspergillus

A

Caspofungin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Flucytosine

A

Antimetabolite
5-FU in fungal cell - inhibits protein synthesis via RNA miscoding

Cryptococcal infections (given w/ amphotericin B)

Fungal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Rx of Endometriosis

A

Leuprolide

Danazol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Metyrapone

A

Inhibits production of cortisol

See ACTH surge then product buildup of 11-deoxycortisol (17-OH corticosteroids in urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Rx for gouty arthritis

A
  1. Indomethacin (NSAID)
  2. Colchicine (acute relief - inhibits neutrophil migration into inflamed areas)
  3. Allopurinol (prevention of gout - lowers serum uric acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Indomethacin; mechanism? Uses?

A

Close patent ductus arteriosus (lowers prostaglandins)

COX1 & COX2 inhibitor – suppresses prostaglandin synthesis –> anti-inflammatory agent & pain reliever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Rx for septic arthritis

A

Ceftriaxone - gonococcus infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Somatosatin analogs

A

Octreotide

Lanreotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Acarbose; what enzyme is inhibited?

A

Inhibits a-glucosidase

Impairs hydrolysis of sugars (limits postprandial absorption of sugars)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Metformin

A

Increase sensitivity of target tissue to insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Rosiglitazone (a thiazolidinedione)

A

Similar to metformin (biguanide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Enalapril

A

ACE inhibitor - decreases diabetic proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Glyburide

A

Sulfonylurea that increases rate of insulin secretion (can see C peptide levels increase as insulin secretion increases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Colchicine

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Glucocorticosteroids (for gout)

A

Acute gout - inhibits Phospholipase A2 activity –> less inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What two drugs are contraindicated in acute gouty attacks?

A

Probenecid
Allopurinol

May exacerbate symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Probenecid

A

Probenecid - Decrease proximal tubular uric acid reabsorption (decrease uric acid levels)

Rx for gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Allopurinol

A

Allopurinol - Inhibition of xanthine oxidase

Rx for gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Pioglitazone

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Action of adiponectin

A

Decreases insulin resistance

Rx for diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Exenatide

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Major side effects of following drugs:

  1. Etanercept
  2. Methotrexate or Leflunomide
  3. Amiodarone
  4. Hydroxychloroquine
  5. NSAIDs
A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

TNF-alpha inhibitors for RA treatment

A

Infliximab
Etanercept
Adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Infliximab

A

TNF-alpha inhibitors – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Etanercept

A

TNF-alpha inhibitors – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Adalimunab

A

TNF-alpha inhibitors – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Inhibitors of purine/pyrimidine synthesis for RA treatment

A

Methotrexate
Leflunomide
Azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Methotrexate

A

Inhibitors of purine/pyrimidine synthesis – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Leflunomide

A

Inhibitors of purine/pyrimidine synthesis – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Azathioprine

A

Inhibitors of purine/pyrimidine synthesis – RA treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Chlorthalidone

A

Thiazide diurectic

Increase Ca2+ resorption in early distal collecting tubule of nephron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Clomiphene

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Mitotane

A

Adrenocorticolytic drug – for adrenocortical carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Spironolactone

A

Androgen receptor antagonist - inhibits testosterone synthesis

Treats acne & hirsutism
Gynecomastia & testicular atrophy in men

Also a K+ sparing diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Other drugs (other than spironolactone) to treat hirsutism

A

Flutamide (testosterone receptor antagonist)

Finasteride (5-alpha-reductase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Haloperidol, Fluphenazine

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Diphenhydramine, Benztropine

A

M1 receptor antagonist

re-establish dopaminergic-cholinergic balance
used to treat extrapyramidal effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Flumazenil

A

GABA antagonist - counter acute overdoses of Benzodiazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Chlorpromazine, Clozapine

A

H1-histamine receptor

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Chlorpromazine, Thioridazine

A

Low potency antipsychotics
Anticholinergic side effects = confusion, dry mouth, urinary retention
Blocks central and peripheral muscarinic cholinergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Flutamide

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

GnRH agonists

A

Leuprolide, goserelin, nafarelin, histrelin

binds GnRH receptors in anterior pituitary – inhibit LH and FSH
decreased LH –> decreased Leydig cell stimulation –> diminished testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Ketoconazole

A

Decrease synthesis of steroid hormones in gonads/adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Anastrozole

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Finasteride

A

Inhibits 5-a-reductase
Decrease conversion of testosterone to DHEA (dihydrotestosterone) - also abbreviated DHT

discordant decrease in DHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Alpha-glucosidase inhibitors

A

Acarbose and Miglitol
Decrease disaccharidase activity at intestinal brush border –> less carbohydrate absorption
Side effect: flatulence, bloating, abdominal pain, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Sulfonylurea (mechanism)

A

Membrane ion channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Insulin (mechanism)

A

Surface TYROSINE KINASE-coupled receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Glucagon-like polypeptide (GLP-1)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Bisphosphonates

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

OA

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Tamoxifen

Raloxifene

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Amiodarone

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Long term treatment for gouty arthritis (tophaceous gout)

A

Uricosuric drugs (avoid in renal failure pts):
Probenecid
Sulfinpyrazone

Xanthine oxidase inhibitors:
Allopurinol** (best)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Zileuton

A

Lipoxygenase inhibitor

Allergic rhinitis & bronchial asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Treatment for Gonorrhea vs. Chlamydia

A 
Gonorrhea = Ceftriaxone
Chlamydia = Azithromycin or Doxycycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Thiazolidinediones (TZDs)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Rituximab

A

CD20+ non-Hodgkin’s lymphoma - B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Infliximab

A

binds TNF-alpha (involved in inflammatory response)

TNF is intercellular signaling protein

RA, Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Certolizumab

A

TNF-alpha

also for autoimmune diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Imatinib

A

Philadelphia chromosome positive chronic myelogenous leukemia
kit-positive GIST (gastrointestinal stromal tumors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Vancomycin resistance

A

D-Ala-D-Ala to D-Ala-D-Lac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Valproate risk

A

Neural tube defects (inhibit intestinal folic acid absorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Dantrolene

A

Malignant hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Breast cancer

A

Doxorubicin (cardiotoxic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Acetazolamide

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Indications for Acetazolamide

A

Diuretic (proximal tubule)

Open-angle and close-angle glaucoma (decrease HCO3- and aqueous humor formation) –> relieve pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Side effects of Acetazolamide

A

Somnolence
Paresthesias
Urine alkalinization*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Macrolides

A

Cholestatic hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Quinolones

A

Tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Tetracyclines in kids

A

Staining of teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Benzodiazepines

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Phencyclidine (PCP)

A

NMDAR inhibition
(NMDA is receptor for excitatory neurotransmitter glutamate)

Moderate use - feelings of detachment + distance

Paranoia, hallucinations
Very hostile and aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Heroin

A

Opiate

Euphoria, constricted pupils, lethargy, clammy skin, nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Amphetamine

A

NE effects
Used for ADHD

Rapid heart rate, high BP, anxiousness, sweating, tremors, dry mouth, hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Coacine

A

Inhibits reuptake of dopamine, NE, serotonin

Blurry vision, tremors, twitching, chest pain, irritability, hallucinations/delusions, high BP+HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Diazepam

A

CNS depressant

Confusion, mild amnesia, sedation, slurred speech, low BP and HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Lysergic acid diethylamide (LSD)

A

Serotonin receptor agonist

Hallucinations –> delusions –> severe paranoia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Marijuana

A

Contains tetrahydrocannabinol (THC)

Euphoria, short term memory loss, perception distortion

Silliness, red eyes, slowed reflexes, dizziness, impaired coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Beta blockers

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Reserpine

A

Inhibits dopamine entry into presynaptic vesicles = chemical sympathectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Guanethidine

A

Inhibit NE release –> LOWER BP and HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Tricyclic antidepressants

Cocaine

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Phenelzine

A

MAO inhibitor (decreases rate of inactivation of neurotransmitters by monoamine oxidase –> INCREASE concentration of serotonin, NE, dopamine)

dietary restriction: cheese, wine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Sertaline

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Desmopressin uses

A

Vasopressin (ADH) - used for diabetes insipidus

High dose:
increases factor VIII activity in hemophilia A
treats vWF disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Leuprolide

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Finasteride

A

Antiandrogen

BPH via inhibition of a-reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Ondansetron

A

Antiemetic

blocks 5-HT3 seroton receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Flutamide

A

Prostate cancer

androgen inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Octreotide

A

Somatostatin analog

Controls symptoms of carcinoid syndrome (flushing, wheezing, diarrhea, syncope)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Sodium valproate

A

Absence & tonic-clonic seizures

Ethosuximide also good for absence seizures (does NOT treat tonic-clonic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Carbamazepine

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Phenytoin

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Lithium toxicity

A

Nephrogenic diabetes insipidus

Monitor TSH and BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Foscarnet

A

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*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Acyclovir

A

Treatment for HSV-2
Nucleoside analog - incorporates into viral DNA chain –> terminates DNA synthesis

Nephro + Neurotoxic
Delirium/tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Lamivudine toxicity

A

Nucleoside reverse transcriptase inhibitor (NRTI) for HIV

peripheral neuropathy
lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Indinavir usage & toxicity

A

Protease inhibitor (HIV)

fat redistribution
hyperglycemia (insulin resistance)
hypertriglyceridemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Furosemide, Torsemide, Bumetanide

A 
Loop diuretics (ascending loop of Henle)
Na-K-2Cl symporter blocked

Otoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

HCTZ, chlorthalidone

A 
Thiazide diuretic (blocks Na-Cl in DCT)
for edema secondary to HF, renal disease, liver disease

Hyperuricemia
Hypercalcemia*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Triamterene, Spironolactone, Amiloride

A

K+ sparing diuretic (collecting tubule)

Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Acetazolamide

A

Carbonic anhydrase inhibitor (PCT)

Metabolic acidosis (blocks reabsorption of NaHCO3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Mannitol

A

Osmotic diuretic - descending limb of Henle’s loop & proximal tubule

Hypernatremia
Pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

ACE inhibitors

A

decreases efferent arteriole of kidneys from constriction
decreases GFR
used for HTN, HF, renal failure patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Atorvastatin

A

HMG-CoA reductase inhibitor
muscle toxicity
hepatic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Metformin (acid-base effect)

A

Lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Prazosin

A

selective alpha-1 adrenergic antagonist

Uses:
HTN
Urinary retention (due to BPH)

side effect: HYPOtension (postural hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Rituximab

A

anti-CD20
B-cell lymphomas
rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Infliximab

A

IgG antibody to TNF-alpha

Rheumatoid arthritis
Ankylosing spondylitis
Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

IL-2

A

Renal cell carcinoma

Melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Imatinib

A

CML
Philadelphia chromosome
BCR/ABL protein tyrosine kinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Omalizumab

A

anti-IgE

asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Abciximab

A

gp IIb/IIIa receptor antagonist
blocks final step of platelet aggregation
administered during angioplasty in patients w/ acute coronary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Cetuximab

A 
anti-EGFR
non-small cell lung cancer
CRC
pancreatic cancer
squamous cell carcinoma (head and neck)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Bevacizumab

A

anti-VEGF
metastatic colon/renal carcinoma
non-small cell lung cancer
recurrent glioblastoma multiforme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Muromonab-CD3 (OKT3)

A

anti-CD3 antibodies
treatment of acute rejection in patients w/ kidney, heart, liver transplants

anti-CD3 antibodies bind to and inhibit T lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Amifostine

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

Leucovorin

A

Folinic acid

methotrexate (MTX) overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Filgrastim

A

G-CSF analog

stimulate proliferation and differentiation of granulocytes; used to minimize granulocytopenia after myelosuppressive chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Dexrazoxane

A

Iron chelator

prevent anthracycline-induced (doxorubicin) cardiotoxicity (CHF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Fomepizole

A

ANTIDOTE for ethanol (rubbing alcohol) or ethylene glycol (antifreeze) poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Raltegravir

A

HIV integrase inhibitor (HIV can’t integrate into host genome and use host machinery to make more viral mRNA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Maraviroc

A

CCR5/CXCR4 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Ritonavir, Saquinavir

A

Protease inhibitor (HIV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Enfuvirtide

A

Fusion inhibitor (HIV)

prevents viral attachment to cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Lamivudine, Tenofovir, Efavirenz

A

RT inhibitor (HIV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Desmopressin

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Metoclopramide

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

NNRTI

A

Nevirapine, Efavirenz, Delavirdine

NNRTI:
inhibits RT of HIV - prevent incorporation of DNA copy of viral genome into host DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Ropinirole

A

Non-ergoline dopamine agonist
Restless legs syndrome
D2, D3, D4 dopamine agonist w/ highest affinity for D3
metabolized by P450 CYP1A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Alprazolam

A

Short acting BENZO
Moderate to severe anxiety and panic attacks
Anxiety associated w/ depression

186
Q

Zolpidem

A

Short acting BENZO

For insomnia, sleeping on overseas plane trip

187
Q

Hemicholinium

A

Inhibits uptake of choline - prevents formation of Ach

188
Q

Vesamicol

A

Inhibits packaging of Ach into transport vesicles

189
Q

Botulinum toxin

A

Blocks release of Ach (flaccid paralysis)

190
Q

Metyrosine

A

Blocks conversion of tyrosine to DOPA

191
Q

Reserpine

A

Blocks packaging of Dopamine/NE into vesicles

192
Q

Guanethidine, Bretylium

A

Blocks release of NE

193
Q

Cocaine
TCAs
Amphetamine

A

Blocks reuptake of NE

194
Q

Amphetamine

A

Stimulates NE release

Blocks reuptake of NE

195
Q

H1 blockers (1st generation)

A

Diphenhydramine
Chlorpheniramine
Dimenhydrinate

Allergy
Motion sickness
Sleep aid

Sedation, antimuscarinic, anti-alpha-adrenergic

196
Q

H1 blockers (2nd generation)

A

Loratadine
Fexofenadine

Allergy

Decrease CNS entry (less sedative effect)

197
Q

Albuterol

A

Relaxes bronchial smooth muscle (B2)

198
Q

Salmeterol, Formoterol

A

Long acting B2 agonist (prophylaxis)

Tremor, arrhythmia (side effects)
Be careful using w/ heart disease patients that may be on B-blocker

199
Q

Theophylline

A

Inhibits phosphodiesterase – decrease cAMP hydrolysis – bronchodilation

NARROW TI = cardiotoxic & neurotoxic
Metabolized by P450
Blocks adenosine

200
Q

Beclomethasone

Fluticasone

A

Corticosteroids - Inhibit synthesis of cytokines

Inactivate NF-kB (TNF-a not made, no other inflammatory agents)
1st line therapy for chronic asthma

201
Q

Montelukast

Zafirlukast

A

block leukotriene D4 receptors

for chronic asthma prophylaxis

202
Q

Zileuton

A

5-lipoxygenase pathway inhibitor

block conversion of arachidonic aicd to leukotrienes

203
Q

Omalizumab

A

monoclonal anti-IgE antibody - inhibits IgE binding to mast cells

used in allergic asthma

204
Q

Guaifenesin

A

Thins respiratory secretions (does not suppress reflex)

205
Q

N-acetylcysteine

A

mucolytic - can loosen mucus plugs in CF patients

antidote for acetaminophen toxicity

prevents radiocontrast-induced nephropathy in patients w/ renal insufficiency

206
Q

Bosentan

A

Treats pulmonary arterial HTN

antagonize endothelin-1 receptors –> decrease pulmonary vascular resistance

207
Q

Dextromethorphan

A

Antitussive (antagonize NMDA glutamate receptors)
Codeine analog

Naloxone given for overdose

208
Q

Pseudoephedrine

Phenylephrine

A

Sympthomimemtic alpha-agonistic nasal decongestant
Pseudoephedrine also as a stimulant
Open obstructed eustachian tubes

Toxicity - HTN, CNS stimulation/anxiety

209
Q

Methacholine

A

Muscarinic receptor agonist

Asthma challenge testing

210
Q

Amphotericin B

Nystatin

A

polyene antifungal

BINDS ergosterol –> pore formation and cell lysis

211
Q

Terbinafine

A

inhibits squalene-2,3-epoxidase (ultimately decrease ergosterol synthesis)

accumulates in skin & nails
treats dermatophytoses

212
Q

Griseofulvin

A

enters fungal cells

binds microtubules –> inhibits microtubules

213
Q

Caspofungin

Micafungin

A

block 1,3-beta-D-glucan synthesis (polysaccharide component of fungal CELL WALL)

214
Q

Flucytosine

A

inhibits DNA replication and RNA (protein synthesis) in fungal cells

synergistic w/ amphotericin B
** cryptococcal meningitis

215
Q

Ketoconazole, Fluconazole

A

INHIBIT SYNTHESIS of ergosterol

P450 inhibitor (increase conc of other drugs in system)
Increase toxicity:
warfarin
cyclosporine
tacrolimus
phenytoin
isoniazid
rifampin
oral hypoglycemics
216
Q

Cyclosporine

A

Decrease IL-2 synthesis –> inhibit T cell proliferation

immunosuppressant (transplant pts)

217
Q

Chloramphenicol

A

Inhibits bacterial peptidyltransferase (cant transfer aa from A to P site - can’t form peptide bonds)

218
Q

Streptomycin

A

Inhibit INITIATION complex formation

Binds and distorts prokaryotic 30S ribosomal subunit

219
Q

Clindamycin

Erythromycin

A

Inhibit TRANSLOCATION

220
Q

Tetracycline

A

Inhibit aminoacyl-tRNA binding in A site

221
Q

Isoniazid
+ rifampin
+streptomycin, ethambutol, and/or pyrazinamide

A

M. tuberculosis treatment

222
Q

Cromolyn

Nedocromil

A

Inhibit mast cell DEGRANULATION

prevention/prophylactic treatment
aspirin hypersensitivity/exercise-induced asthma, seasonal allergies

223
Q

Glucocorticoids (asthma)

A

Inhibit phospholipase A2 –> inhibit formation of arachidonic acid –> NO prostaglandins (from COX) & leukotrienes (from lipoxygenase)

224
Q

Isoproterenol

A

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
Q

Selective B-blocker (A-M) vs Non-selective B-blocker (N-Z)

A

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
Q

TB treatment

A

Rifampin (inhibits bacterial DNA-dependent RNA polymerase) - inhibits transcription

+ isoniazid + pyrazinamide + ethambutol
and/or streptomycin

227
Q

Lithium toxicity

A

Hypothyroidism - measure TSH levels regularly
Nephrogenic diabetes insipidus
Teratogenic (Ebstein’s anomaly)

228
Q

Valproic acid toxicity

A

Hepatitis

Teratogenicity

229
Q

Fluphenazine

A

Extrapyramidal symptoms (tardive dyskinesia later on)

230
Q

Clozapine

A

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
Q

Risperidone

A

Atypical antipsychotic

Side effect: Hyperprolactinemia

232
Q

Carbamazepine: side effect

A

Agranulocytosis

233
Q

Which antipsychotic causes prolonged QT?

A

Ziprasidone

234
Q

Treatment for absence seizures

A

Ethosuximide

Sodium valproate

235
Q

Anticonvulsant therapy

A

Diazepam, Lorazepam, Midazolam

236
Q

Treatment for gneralized tonic-clonic seizures

A

Phenobarbital

237
Q

Treatment for complex partial seizures or generalized tonic-clonic seizures

A

Carbamazepine

238
Q

Methylphenidate

A

Indirect-acting sympathomimetic

ADHD disorder
Narcolepsy

239
Q

Rapid acting insulins

A

Lispro
Aspart
Glulisine

Action starts in 15 minutes
Peaks at 45-75 minutes

240
Q

Regular (short) acting insulins

A

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
Q

Intermediate acting insulin

A

NPH
Starts working in 2 hours
Peaks 4-12 hours
Lasts 18 hours

242
Q

Long acting insulin

A

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
Q

Slow release insulin

A 
Glargine
insulin analog (long duration of action)

Lasts 24hrs

244
Q

Allopurinol

Rasburicase

A

Reduce uric acid levels during tumor lysis syndrome

Prevent acute renal failure in pts. undergoing chemo for high grade lymphomas/leukemias

245
Q

Denosumab

A

prevents osteoclast activation (prevents bone loss)

prevents RANKL and RANK interaction

246
Q

Folinic acid (Leucovorin)

A

Reverse toxicities of MTX (methotrexate) on GI and bone marrow

247
Q

Amitriptyline

A

TCA

block muscarinic receptors receptors (anti-cholinergic)

overdose mimics ATROPINE toxicity

248
Q

Adverse effect of nonselective B-adrenergic blockers

A

Masked symptoms of hypoglycemia
Bradyarrhythmias
Worsening of Raynaud phenomenon
CNS depression

249
Q

Treatment to prevent recurrence of HSV-2

A

Oral daily valacyclovir, acyclovir, famciclovir after incidence

250
Q

Ethosuximide

A

Blocks T-type Ca2+ channels in thalamic neurons –> hyperpolarization

Absence seizures

251
Q

Drug that mimics atropine toxicity

A

Amitriptyline (+ other TCAs)

Antimuscarinic
fever, cutaenous flushing, dry oral mucosa, dilated poorly reactive pupils, confusion

252
Q

Prazosin toxicity

A

a1-adrenergic blocker
treats HTN and urinary retention (due to BPH)

side effect: postural hypotension

253
Q

Side effect of nonselective B-adrenergic blockers

A

masked symptoms of hypoglycemia in diabetics

worsening of Raynaud phenomenon

254
Q

selective alpha-1 blockers (preference for using these)

A

no alpha2 blockage (alpha-2 suppresses sympathetics)

selective alpha1 blockage causes less tachycardia

255
Q

Lamivudine

A

NRTI

Treatment of HIV-1 and HIV-2

256
Q

Valacyclovir
Acyclovir
Famciclovir

A

HSV-2

positive Tzanck smear
genital vesicular rash

257
Q

MTX and 5-FU both inhibit thymidylate formation; what drug can be used to overcome MTX

A

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
Q

Drug-induced Parkinsonism can be side effect of antipsychotics; treatment of drug induced Parkinsonism?

A

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
Q

Mechanism of -statin drugs

e.g. Atorvastatin

A

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
Q

Side effects of Haloperidol; why can’t you give it to patients w/ drug-induced Parkinsonism?

A

Haloperidol = first gen. antipsychotic = dopamine-receptor blocker (causes Parkinsonian symptoms)

Extrapyramidal side effects

261
Q

What drug is used to noramlize prolactin levels and prevent amenorrhea-galactorrhea?

A

Dopamine agonists (Bromocriptine)

262
Q

Drugs that decrease VLDV

A

Fibrates and nicotinic acid therapy

Decrease hepatic production of VLDL –> treatment for primary hypertriglyceridemia (increased VLDL)

263
Q

Ezetimibe

A

Decrease intestinal absorption of dietary cholesterol

264
Q

Biliary excretion of cholesterol increase or decrease in patients on statins?

A

Biliary excretion of cholesterol DECREASES in pts. on statins due to decreased synthesis of cholesterol in liver

265
Q

Treatment for generalized anxiety disorder; why does this drug have low abuse potential?

A

Buspirone - selective agonist of 5HT(1A) receptor

Dependence does not occur
Reduced potential for abused compared to Benzodiazepines

266
Q

Amphotericin B

A

Systemic candidiasis

267
Q

Nystatin

A

Oral candidiasis
“swish and swallow”
binds to ergosterol in fungal cell membrane –> formation of pores and leakage of ungal cell contents

268
Q

Griseofulvin

A

inhibits fungal cell mitosis @ metaphase

indicated for treatment of dermatophytoses

269
Q

Penicillins

A

B lactam antibiotics

Inhibit peptidoglycan cross-links in bacterial cell wall

270
Q

Terbinafine

A 
Accumulates in skin, nails, adipose tissue
treat dermatophytosis (onychomycoses)
271
Q

Nicotinic acid (Niacin) use; side effects?

A

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
Q

Skin side effect of Vancomycin

A

Red man syndrome - histamine release

273
Q

Serotonin precursor

A

Tryptophan

274
Q

Serotonin importance in neuro drugs

A

Serotonin = mood regulation

Selective serotonin reuptake inhibitors –> increase serotonin levels –> people happier (antidepressant medication)

275
Q

Statins: MOA

A

inhibiting enzyme HMG-CoA reductase

upregulation of hepatocyte LDL receptors –> increased uptake of LDL cholesterol from circulation

276
Q

Bile acid-binding resins mechanism

A

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
Q

Bile acid-binding resins (side effects)

A

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
Q

Niacin (vitamin B3) - relation to GI

A

Inhibit hepatic VLDL production

Used to increase HDL levels

279
Q

Drug of choice for alcohol withdrawal

A

Long-acting benzodiazepines (chlordiazepoxide, diazepam)

Short-acting benzodiazepines (lorazepam, oxazepam) preferrer for advanced liver dysfunction

280
Q

Mechanism by which drugs given in alcohol withdrawl works?

A

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
Q

Baclofen

A

GABA agonist – spastic conditions

282
Q

Haloperidol (toxicity)

A

lowers serizure threshold

283
Q

Phenobarbital

A

barbituate anticonvulsant - enhances GABA activity

284
Q

Treatment for active tuberculosis

A 
Rifampin
Ethambutol
Isoniazid
Pyrazinamide
and/or Streptomycin
285
Q

Rx for atypical mycobacterial infections (e.g. Mycobacterium avium complex)

A

Macrolide + Rifampin + Ethambutol

286
Q

Rx for Staph endocarditis

A

IV nafcillin + aminoglycoside (gentamicin)

287
Q

Bacterial resistance to rifampin – mechanism?

A

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
Q

Mycobacterial resistance to isoniazid?

A

Catalase-peroxidase
or
Genetic modification of isoniazid binding site on mycolic acid synthesis enzyme

289
Q

Resistance to ethambutol

A

Inhibit synthesis of mycobacterial cell wall via increase production of arabinosyl transferase

290
Q

Resistance to Pyrazinamide

A

Lowers the environmental pH to kill M. tuberculosis

Drug has to be converted to active form via pyrazinamidase (bacterial mutate this enzyme)

291
Q

Mechanism of digoxin on AV conduction

A

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
Q

Digoxin effect on ventricular contractility

A

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
Q

Isoniazid can lead to deficiency of which enzyme?

A

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
Q

Chronic treatment to prevent bronchial asthma

A

Fluticasone (inhaled glucocorticoid)

Cortiscosteroids = strongest effect on inflammatory compoenent of astham

(steroids usually end in “-sone”)

295
Q

Action of glucocorticoids on lungs

A

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
Q

Nifedipine

A

DHP Ca2+ channel blocker

Treats HTN

Blocks Ca2+ influx into bronchial smooth muscle cells –> bronchodilation

297
Q

Acyclovir use

A

Herpes simplex infections

298
Q

Clarithromycin + other antibiotics

A

Mycobacterium avium complex

299
Q

Leukocyte interferon-a

A

hepatitis B and C
hairy cell leukemia
condyloma acuminatum (HPV)
Kaposi’s sarcoma

300
Q

Pentamidine

A

Pneumocystis pneumonia

301
Q

Sulfonylurea or meglitnide abuse - action on blood sugar

A

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
Q

Main site of action of nitroglycerin

A

Venodilator –> large veins
Treats angina by venodilating –> blood collects in venous system –> decrease preload –> decrease ventricular wall stress –> decrease cardiac O2 demand

303
Q

Vessels in which nifedipine and prazosin works

A

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
Q

Absence of lamellar bodies of type II pneumocytes

A

Patchy alveolar atelectasis (collapse)

Neonatal respiratory distress syndrome

305
Q

Methotrexate (MTX) - mechanism & additional drugs given in conjunction w/

A

Inhibits DHF reductase –> block folinic acid synthesis

Can be given w/ Leflunomide & TNF-a inhibitors for rheumatoid arthritis

306
Q

Side effects of MTX

A

Stomatitis (painful mouth ulcers) - supplement w/ folic acid
Hepatotoxicity
Myelosuppression (increased risk for opportunistic infections)
B cell lymphomas
Pulmonary fibrosis

contraindicated in pregnancy

307
Q

Side effects of Naproxen

A

GI bleeding
fluid retention
worsening HTN

308
Q

Minocycline

A

Treats early mild rheumatoid arthritis

photosensitivity (mild side effect)

309
Q

Hydroxychloroquine

A

main use - SLE

can be used for early mild seronegative rheumatoid arthritis

permanent retinal damage (serious adverse)

310
Q

Corticosteroid chronic use - side effects?

A

weight gain
hyperglycemia
bone density, skin striae, proximal muscle weakness

used w/ NSAIDs – potentiate risk for GI bleeding

311
Q

Valproic acid

A

blocks NMDA receptors - affects K+ current

can also affect Na+ channels and GABA receptors

312
Q

Similar mechanism of:
Phenytoin
Carbamazepine
Valproic acid

A

reducing Na+ channels’ abiltiy to recover from inactivation

313
Q

Phenoxybenzamine (indication); also effect on insulin

A

long acting alpha-blocker used for pheochromocytoma

blockage of alpha-receptors –> unopposed beta effects –> increase beta2-adrenergic stimulation = increase insulin release

314
Q

Diphenhydramine

A

Antihistamine (blocks H1 histamine receptor)

Anticholinergic activity

315
Q

Propranolol

A

Non-cardioselective beta blocker

inhibits insulin secretion – increase risk of diabetes mellitus for patients on long term beta blocker use

316
Q

Drug used to decrease severity of inflammation and decrease extraocular volume in Grave’s opthalmopathy

A

Prednisone (high dose glucocorticoid)

317
Q

Rx that inhibits thyroid peroxidase; how?

A

Methimazole
Propylthiouracil

Responsible for oxidation (organification) of iodide to iodine at apical-colloid interface

Iodine + tyrosine (on thyroglobulin) –> T1, T2, T3 thyroxin

318
Q

TCA overdose - cause of death?

A

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
Q

Rx that causes serotonin syndrome; symptoms?

A

MAO inhibitor + SSRI (or large doses of SSRI)

hyperthermia, autonomic instability, muscle rigidity, myoclonus, diaphoresis

320
Q

Examples of TCAs

A

Imipramine
Amitryptyline
Clomipramine

321
Q

Treatment for TCA overdose

A

Normal saline

Hypertonic sodium bicarbonate

322
Q

Mechanism of Warfarin

A

inhibits vitamin K dependent g-carboxylation of glutamic acid residues of clotting factors II, VII, IX, X

323
Q

Reversal of warfarin-induced anticoagulation

A 
Fresh frozen plasma (rapid reversal)
vitamin K (re-synthesis of clotting factors)
324
Q

Reversal of heparin

A

Protamine (binds to heparin and inactivates it)

325
Q

Aminocaproic acid

A

Antifibrinolytic - inhibits fibrinolysis (inhibits plasminogen)

326
Q

Acylclovir mechanism of action

A

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
Q

Medroxyprogesterone (Depo Provera)

A

Progesterone-only contraceptive via IM injection once every 12 weeks

328
Q

Medroxyprogesterone acetate

A

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
Q

Raloxifene

A

Estrogen agonist: bone, cardiovascular, blood lipoproteins

Estrogen antagonist: breast, uterus

330
Q

Alendronate

A

Synthetic bisphosphonate (analog of pyrophosphate)

bone resorption inhibitor

331
Q

Leuprolide

A

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
Q

Cholestyramine
Colestipol
Colesevelam

A

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
Q

Gemfibrozil

Fenofibrate

A

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
Q

Halothane

Sevoflurane

A

Have bronchodilation properties – preferred in patients w/ asthma (since inhalation anesthetics tend to cause postoperative atelectasis via suppression of muciliary clearance)

335
Q

Fluorinated anesthetics - effect on cerebral blood flow

A

Increase cerebral blood flow (via decreased vascular resistance) –> increased intracranial pressure – bad!

336
Q

Side effects of inhlation anesthetics

A

Increased cerebral blood flow –> increased ICP
myocardial depression, hypotension
respiratory depression
decreased renal function

337
Q

Symptoms of opioid withdrawal in an infant born to mom who abuses opioids

A

Pupillary dilatation
Rhinorrhea, sneezing, nasal stuffiness
Diarrhea
Chills, tremors, jittery movements

338
Q

Treatment of choice for acute opioid withdrawal in neonate

A

Tincture of opium or paregoric

339
Q

Naloxone

A

Opioid receptor antagonist
Rx for acute opioid intoxication or overdose

DO NOT give to patients w/ opioid withdrawal – can cause seizures

340
Q

Folic acid (folate)

A

RBC production
Lowers homocysteine levels
Prevents neural tube defects

341
Q

Sodium bicarbonate

A

IV - treatment for acidosis and hyperkalemia

Oral - alkalinizing agent/antacid

342
Q

Treatment regimen for M. tuberculosis

A

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
Q

Where does acetazolamide work?

A

Proximal convulated tubule

Carbonic anhydrase inhibitor

344
Q

Site of action of loop diuretics; what are they?

A

Thick ascending limb of loop of Henle

Furosemide
Bumetanide
Torsemide
Ethacrynic acid

345
Q

Site of action of thiazide diuretics; side effect?

A

Distal convoluted tubule

Exacerbates hypokalemia

346
Q

What renal drugs has potential to cause hypokalemia?

A

Loop diuretics (except K+ sparing ones)

347
Q

What type of neuro/psych drug causes diabetes insipidus?

A

Lithium – treats bipolar disease

Lithium inhibits action of vasopression (ADH) –> polyuria & polydipsia

348
Q

Vancomycin resistance: D-ala-D-ala substitution for mutated sequence; what is the sequence?

A

D-ala-D-lactate

349
Q

What renal drug should be given to patient w/ HTN and CHF who also has osteoporosis?

A

Hydrochlorothiazide – increases absorption of Ca2+ (distal convoluted tubule)

Reabsorption also prevents painful renal stones (from hypercalciuria)

350
Q

Where does Ca2+ reabsorption take place in renal tubules? What drug causes this?

A

Distal convoluted tubule – Hydrochlorothiazide

351
Q

Site of action between osmotic diuretics & loop diuretics?

A

Osmotic diuretic - descending limb of loop of Henle & proximal tubule (mannitol)

Loop diuretic - thick ascending limb of loop of Henle (furosemide)

352
Q

Furosemide

A

Loop diuretic – treats HTN and CHF

Increases urinary Ca2+ LOSS –> worsens osteoporosis in post-menopausal women

353
Q

Spironolactone

A

Inhibits testosterone (and other steroid hormones)

Used for antiandrogenic action –> treats hirsutism & androgen-dependent malignancies

354
Q

Acarbose

A

Oral hypoglycemic agents

Rx for type 2 diabetes mellitus

355
Q

Substance in sunscreen to block UVB light

A

Para-aminobenzoic acid (PABA) esters

Protects against UVB (290-320nm wavelength)

356
Q

What drug is used to diagnose asthma in pt. who presents w/ asthma symptoms but has normal spirometry values?

A

Methacholine challenge

Methacholine = muscarinic cholinergic agonist –> bronchoconstriction + increased airway secretions

Administration of Methacholine –> decrease FEV1 by more than 20% indicates bronchial asthama

357
Q

Varenicline

A

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
Q

Antidepressant that does NOT cause sexual dysfunction; what are side effects?

A

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
Q

Trazodone

A

highly sedating anti-depressant (helpful for pts. w/ insomnia)

causes priapism

360
Q

Antimetabolite = folate antagonist

A

Methotrexate

361
Q

Antimetbolite - purine analogs

A

6-MP
Fludarabine (for CLL)
Cladribine (for hairy cell leukemia)

362
Q

Cladribine

A

for Hairy Cell Leukemia

Resistant to adenosine deaminase (adenosine functions in purine disposal pathway)

363
Q

Antimetabolite - pyrimidine analogs

A

5-FU
Capecitabine
Cytarabine
Gemcitabine

364
Q

Lomustine

A

Nitrosurea
DNA alkylation & cross-bridge formation
Requires non-enzymatic hydroxylation
Penetrates CNS

365
Q

Dacarbazine

A

Cell-cycle nonspecific methylating agent

366
Q

Cisplatin

A

Pt-containing chemotherapeutic agent – forms cytotoxic metabolite in environments w/ low chloride concentration

367
Q

Mercaptopurine

A

Converted to active metabolite by HGPRT

Inactivated by xanthine oxidase

368
Q

What is administered before bronchoscopy to decrease respiratory mucous secretions & promote bronchodilation?

A

Atropine

369
Q

Mechanism of atropine

A

Anti-muscarinic (anti-parasympathetics)

symptoms of toxicity:
flushed skin, hyperthermia (atropine fever)
mydriasis & cycloplegia
bronchodilation
tachycardia
constipation, urinary retention
370
Q

Mechanism of physostigmine

A

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
Q

Significance of HMG-CoA reductase; what drugs target this enzyme?

A

Statins – inhibit HMG-CoA reductase – reduce LDL cholesterol

HMG-CoA reductase converts HMG-CoA to cholesterol

372
Q

What drugs taken w/ a statin will increase susceptibility to myopathy (muscle pain + increased serum creatine kinase)?

A

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
Q

Cholestyramine + statin use common; why must they be dosed at least 4hrs apart?

A

Cholestyramine (bile acid sequestrant) reduces GI absorption of statins

374
Q

Combination of fibric acid derivatives + bile acid-binding resins increases risk for?

A

Cholesterol gallstones (increased cholesterol concentration in bile)

375
Q

First line treatment for hypertriglyceridemia

A

Fibrates

376
Q

Mechanism of niacin

A

Improves hyperlipidemia by decreasing synthesis of hepatic triglycerides & VLDL

Used in conjunction w/ fibrates to lower TGs

377
Q

First line treatment for hypercholesterolemia

A

Statins - inhibits HMG-CoA reductase

Use Ezetimibe to inhibit absorption of cholesterol (if pts. need additional help lowering cholesterol)

378
Q

Why is ACE-I or ARB preferred for diabetics?

A

Slow progression of diabetic nephropathy (decrease progression to ESRD)

Antihypertensive effect

379
Q

Doxazosin
Prazosin
Terazosin

A

alpha-1 blocker

treats HTN and BPH

380
Q

Pt. w/ pre-existing coronary arter disease + CHF + HTN; what type of cardioselective beta blockers is needed?

A

Metoprolol

Atenolol

381
Q

Hydrochlorothiazide (HCTZ) indications

A

1st line med for essential HTN
pts. w/ osteoporosis (increases Ca2+)
Isolated systolic HTN

382
Q

What drug combinations can increase likelihood of gallstone formation?

A

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
Q

MOA for Ondansetron, Granisetron, Dolasetron

A

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
Q

Mifepristone (RU-486)

A

Anti-progestin
Anti-glucocorticoid

Used as abortifacient

385
Q

Danazol

A

synthetic androgen

treats endometriosis
treats hereditary angioedema

side effects:
hirsutism
masculinization
fluid retention
weight gain
386
Q

Drug mechanism of statins vs. bile acid-binding resins

A

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
Q

Why is it good to give patient that w/ severe pain and severe hematuria Celecoxib?

A

Celecoxib is an NSAID and selective COX-2 inhibitor

Does NOT have side effects of bleeding & GI ulceration (platelets only express COX-1)

388
Q

Both traditional NSAIDs as well as selective COX-2 inhibitors can exacerbate what condition?

A

Fluid retention –> HTN

389
Q

Where is COX-2 expressed (other than platelets)?

A

Vascular endothelial cells & vascular smooth muscle cells –> vascular DILATATION

390
Q

What protacyclin is increased by COX-2?

A

PGI2 –> anticoagulation and vascular dilatation

391
Q

Mechanism of ASA

A

Irreversibly inhibiting platelet aggregation via ACETYLATION of serine residues of platelet COX enzymes

392
Q

What Rx (mucarinic Ach antagonists) is used to treat obstructive diseases such as asthma and COPD?

A

Tiotropium
Ipratorpium

Drugs decrease mucus secretion, decrease bronchoconstriction by inhibit muscarinic Ach receptors (parasympathetics)

393
Q

Serious side effects of statins?

A

Myopathy (increase serum CK –> muscle pain = rhabdomyolysis)

Hepatitis

394
Q

Metabolism of statins through what system?

A

With exception of PRAVASTATIN, all statin drugs metabolized by P-450 system

395
Q

Nausea, vomiting associated w/ levodopa use; mechanism? How do you avoid these symptoms?

A

Peripheral conversion of levodopa –> DOPAMINE

Take Carbidopa (dopa-decarboxylase inhibitor) to limit peripheral conversion of levodopa –> decrease nausea and vomiting

396
Q

Rx for plasmodium species

A

Chloroquine = Plasmodium in bloodstream

Primaquine = latent P. vivax and P. ovale in liver

397
Q

Dietary restrictions & drug-drug interactions of monoamine oxidase inhibitors (MAOIs); examples of MAOIs?

A

Restrictions = cheese, wine
Drug-drug interactions w/ SSRI

Phenelzine
Tranylcypromine

398
Q

Indication of Phenelzine

A

Atypical depression/resistant depression

Mood reactivity
Leaden fatigues (arms and legs feel heavy)
Increased sleep and appetite

399
Q

Rx for auditory hallucinations

A

Schizoprenia

Rx: Haloperidol, Chlorpromazine

400
Q

Bimodal distribution in drug metabolism of Isoniazid; why?

A

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
Q

What drug used for inflammatory disorders of bowel and skin is metabolized via METHYLATION?

A

6-mercaptopurine

402
Q

Common Rx used for invasive MRSA infections?

A

Vancomycin
Daptomycin
Linezolid

403
Q

Vancomycin: MOA and adverse effects?

A

Blocks glycopeptide polymerization via binding to D-ala-D-ala

Adverse:
Red man syndrome
Nephrotoxicity

404
Q

Daptomycin: MOA and adverse effects?

A

Depolarization of cellular membrane

Adverse:
Myopathy –> CPK elevation
Inactivated by pulmonary surfactant

405
Q

Linezolid: MOA and adverse effects?

A

Inhibits bacterial protein synthesis by binding 50S subunit

Adverse:
Thrombocytopenia
Optic neuritis
High risk for serotonin syndrome

406
Q

What is the effect on K+ levels in blood when patient is using drugs that decrease aldosterone secretion (e.g. ACE inhibitors)?

A

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
Q

Specific beta-1 blockers

A-M – “olol”

A

Decrease contractility & HR

Inhibit renin release –> antihypertension

408
Q

Indapamide

A

Thiazide diuretic

Blocks Na+-Cl symporters in distal tubules

409
Q

Amlodipine: MOA

A

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
Q

Morphine: effect on blood vessels

A

Vasodilator

Increases venous capacitance
Decrease systemic vascular resistance
CNS sympatholytic

Can treat ischemic chest pain; esp. during acute MI

411
Q

Medications that can cause HYPERKALEMIA

A

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
Q

Didanosine; use & adverse rxn?

A

HIV RT inhibitor

Adverse rxn: pancreatitis

413
Q

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?

A

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
Q

Enalapril

A

ACE inhibitor

CHF
HTN
Diabetic nephropathy

415
Q

Isoniazid side effects

A

Hepatocyte damage

Peripheral neuropathy (need to simultaneously administer pyridoxine)

416
Q

Indication & major toxicity: Statins

A

High LDL

toxicity:
hepatitis, myopathy

417
Q

Indication & major toxicity: Niacin

A

Low HDL

toxicity:
cutaneous vasodilation
HYPERglycemia (acanthosis nigricans) 
HYPERuricemia/gout
hepatitis
418
Q

Indication & major toxicity: Fibric acid derivatives

Gemfibrozil & fenofibrate

A

High TG

toxicity:
gallstones
myopathy (worse when combined w/ statins)

419
Q

Indication & major toxicity: Bile acid-binding resins (Ezetimibe)

A

High LDL

toxicity:
GI upset
Hypertriglyceridemia
Malabsorption

420
Q

Rx for benign prostatic hyperplasia and HTN

A

alpha-1 blockers

Doxazosin, Prazosin, Terazosin

421
Q

Common side effect of K+ sparing diuretics

A

Gynecomastia (more common w/ spironolactone use than eplerenone)

422
Q

DHP vs. non-DHP Ca2+ channel blocker

A

DHP Ca2+ channel blocker: selective for vascular smooth muscle – vessels! (eg. Amlodipine)

Non-DHP Ca2+ channel blocker: selective for heart (Verapamil)

423
Q

Indications for ribavirin

A

Nucleoside analog - inhibits guanine nucleotides

RSV or Hep C

424
Q

Oseltamivir

A

sialic acid analogue inhibitor

influenza A & B neuraminidases

425
Q

Amantadine

A

Impairs UNCOATING of influenza A virion after it is endocytosed by host cell

426
Q

What drug may precipitate opioid withdrawal when used w/ morphine?

A

Pentazocine (weak opiod narcotic - produces analgesic effects w/ little abuse potential)

Opioid narcotics = selective mu receptor AGONISTS

427
Q

Rx for sickle cell anemia; mechanism of drug?

A

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
Q

Disulfiram

A

Used for recovering alcoholics

Causes acetaldehyde accumulation –> bad side effects everytime someone consumes alcohol

429
Q

Metronidazole

A

Trichomonas vaginitis & bacterial vaginosis

Metronidazole + alcohol = acetaldehyde accumulation (bad side effects) b/c metronidazole inhibits alcohol oxidizing enzymes

430
Q

What drug can cause atrialization of right ventricle?

A

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
Q

Infant born w/ irritability, diarrhea, vomiting; could be due to withdrawal symptoms of what?

A

Narcotic use

432
Q

Side effect of direct vasodilators? What are some examples of direct vasodilators? What drugs are given in combination to decrease side effects?

A

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
Q

Persistent cough & angioedema - side effect of what Rx?

A

ACE inhibitor

434
Q

Failure of alveolar air to equilibrate w/ venous blood gases; possible cause?

A

Poor perfusion – no exchange btwn alveoli & vessels (normal equilibration is pO2 ~100mmHg and pCO2 ~40mmHg)

435
Q

Significant side effects of antihyperlipidemic medications

A

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
Q

Blood supply of spleen

A

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
Q

Nesiritide

A

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
Q

Bradykinin relationship to adrenergic and renin-AT-aldosterone system

A

Bradykinin produced by kidneys when adrenergics and renin-AT-aldosterone system activated

Constricts veins, dilates arterioles –> increase renal perfusion

ANGIOEDEMA

439
Q

Ranitidine

A

Proton pump inhibitor

Ranitidine superior to H2 blockers for treatment of peptic ulcer disease

440
Q

Misoprostol

A

PGE1 analog

Prevents NSAID-induced ulcer disease

441
Q

Liver function tests should be monitored for what drugs?

A

Carbamazepine

Isoniazid (can cause full-blown hepatitis)

442
Q

What drugs affect TSH and T3/T4 levels (levels should be monitored?)

A

Lithium - hypothyroidism

Amiodarone - hypothyroidism

443
Q

Entacapone

A

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
Q

COMT inhibitor: what does it stand for?

A

Catechol-O-methyltransferase inhibitor

No peripheral methylation

445
Q

What does Carbidopa do when used in conjunction w/ levodopa?

A

Carbidopa is a peripheral dopa decarboxylase inhibitor

446
Q

How is selegiline different from levodopa?

A

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
Q

Amantadine: indications

A

Anti-influenza antiviral

ALSO used to enhance effects of endogenous dopamine (increase synthesis, release, re-uptake of dopamine)

448
Q

Dopamine agonists (4)

A

Bromocriptine
Pergolide
Pramipexole
Ropinerole

stimulate dopamine receptors (D2 receptors)

449
Q

What drugs are used to treat drug-induced Parkinson’s disease? What is the MOA of these drugs?

A

Trihexyphenidyl
Benztropine

Inhibit central muscarinic receptors
Pts. w/ tremor as predominant symptom respond best

450
Q

Ergonovine: MOA

A

Ergonovine = ergot alkaloid –> constrict smooth muscle via alpha-adrenergic and serotonergic receptors

451
Q

Ergonovine test - what disease does it diagnose?

A

Prinzmetal’s angina

Coronary vasospasm –> transient transmural ischemia –> ST segment elevation (& chest pain due to ischemia)

452
Q

Cancer drug toxicities:

  1. Vincristine
  2. Bleomycin
  3. Doxorubicin
  4. Cyclophosphamide
  5. Mercaptopurine
  6. Methotrexate
A
  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
Q

Difference btwn actions of SMX and Trimethoprim/Pyrimethamine

A

SMX: inhibits dihydropteroate synthase – inhibits DHF acid synthesis

TMP/Pyrimethamine: inhibits DHF reductase – inhibits THF acid synthesis

454
Q

Bacitracin: MOA

A

Inhibit mucopeptide transfer into growing cell wall –> inhibit cell wall synthesis

455
Q

What drugs inhibit HDF reductase?

A

TMP
Methotrexate
Pyrimethamine

Inhibit DHF reductase –> inhibit THF acid formation

456
Q

What part of cell cycle does Methotrexate inhibit?

A

S phase (can’t synthesize purine and thymidylic acid)

457
Q

Pyrimethamine: indications

A

Antimalarial
Toxoplasmosis

Inhibits DHF acid reductase

458
Q

Drugs that cause sulfa allergies (7)

A 
Celecoxib
Furosemide
Thiazide
TMP-SMX
Sulfasalazine
Sulfonylureas
Acetazolamide
459
Q

Potassium citrate is prescribed as prophylaxis to what?

A

Calcium stones in urine

Citrate binds free Ca2+

460
Q

Calcium oxalate crystal vs. Calcium phosphate (struvite) crystals

A

Calcium oxalate - requires acidic pH

Calcium phosphate (struvite) - requires alkaline pH

461
Q

AZT (Zidovudine): MOA

A

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

STEP1 - TLe (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions