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USMLE Pharmacology > Sheet1 > Flashcards

Sheet1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Time it takes for amount of drug to fall to half of its value; this is a constant in first order kinetics (majority of drugs)

A

Half-life (T1/2)

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2
Q

Relates the amount of drug in the body to the plasma concentration

A

Volume of distribution (VD)

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3
Q

Plasma concentration of a drug at a given time

A

Cp

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4
Q

The ratio of the rate of elimination of a drug to its plasma concentration

A

Clearance (CL)

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5
Q

The elimination of drug that occurs before it reaches the systemic circulation

A

First pass effect

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6
Q

The fraction of administered dose of a drug that reaches systemic circulation

A

Bioavailability (F)

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7
Q

When the rate of drug input equals the rate of drug elimination

A

Steady state

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8
Q

This step of metabolism makes a drug more hydrophilic and hence augments elimination

A

Phase I

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9
Q

Different steps of Phase I

A

Oxidation, reduction, hydrolysis

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10
Q

Inducers of Cytochrome P450 (CYP450)

A

Barbiturates, phenytoin, carbamazepine, and rifampin

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11
Q

Inhibitors of CYP450

A

Cimetidine, ketoconazole, erythromycin, isoniazid and grapefruit

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12
Q

Products of Phase II conjugation

A

Glucuronate, acetic acid, and glutathione sulfate

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13
Q

Type of kinetics when a constant percentage of substrate is metabolized per unit time

A

First order kinetics

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14
Q

Drug elimination with a constant amount metabolized regardless of drug concentration

A

Zero order kinetics

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15
Q

Target plasma concentration times (volume of distribution divided by bioavailability)

A

Loading dose (Cp*(Vd/F))

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16
Q

Concentration in the plasma times (clearance divided by bioavailability)

A

Maintenance dose (Cp*(CL/F))

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17
Q

Strength of interaction between drug and its receptor

A

Affinity

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18
Q

Selectivity of a drug for its receptor

A

Specificity

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19
Q

Amount of drug necessary to elicit a biologic effect; refers to the drug’s strength

A

Potency

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20
Q

Maximum response achieveable from a drug

A

Efficacy

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21
Q

Ability of a drug to produce 100% of the maximum response regardless of the potency

A

Full agonist

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22
Q

Ability to produce less than 100% of the response

A

Partial agonist

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23
Q

Ability to bind reversibly to the same site as the drug and without activating the effector system

A

Competitive antagonist

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24
Q

Class of drugs with ability to decrease the maximal response to an agonist

A

Noncompetitive antagonist

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25
Q

A hormone whose mechanism of action (MOA) utilizes intracellular receptors

A

Thyroid and steroid hormones

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26
Q

A hormone whose MOA utilizes transmembrane receptors

A

Insulin

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27
Q

Class of drugs whose MOA utilizes ligand gated ion channels

A

Benzodiazepines and calcium channel blockers

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28
Q

Median effective dose required for an effect in 50% of the population

A

ED50

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29
Q

Median toxic dose required for a toxic effect in 50% of the population

A

TD50

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30
Q

Dose which is lethal to 50% of the population

A

LD50

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31
Q

Window between therapeutic effect and toxic effect

A

Therapeutic index

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32
Q

Term for a high margin of safety

A

High therapeutic index

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33
Q

Term for a narrow margin of safety

A

Low therapeutic index

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34
Q

Antidote used for lead poisoning

A

Dimercaprol, EDTA

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35
Q

Antidote used for cyanide poisoning

A

Nitrites

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36
Q

Antidote used for anticholinergic poisoning

A

Physostigmine

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37
Q

Antidote used for organophosphate/anticholinesterase poisoning

A

Atropine, pralidoxime (2-PAM)

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38
Q

Antidote used for iron salt toxicity

A

Deferoxamine

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39
Q

Antidote used for acetaminophen (APAP) toxicity

A

N-acetylcysteine (Mucomyst)

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40
Q

Antidote for arsenic, mercury, lead, and gold poisoning

A

Dimercaprol

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41
Q

Antidote used in poisonings: copper (Wilson’s disease), lead, mercury, and arsenic

A

Penicillamine

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42
Q

Antidote used for heparin overdose

A

Protamine

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43
Q

Antidote used for warfarin toxicity

A

Vitamin K and Fresh frozen plasma (FFP)

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44
Q

Antidote for tissue plasminogen activator (t-PA), streptokinase

A

Aminocaproic acid

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45
Q

Antidote used for methanol and ethylene glycol

A

Ethanol or fomepizole

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46
Q

Antidote used for opioid toxicity

A

Naloxone (IV), naltrexone (PO)

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47
Q

Antidote used for benzodiazepine toxicity

A

Flumazenil

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48
Q

Antidote used for tricyclic antidepressants (TCA)

A

Sodium bicarbonate

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49
Q

Antidote used for carbon monoxide poisoning

A

100% O2 and hyperbaric O2

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50
Q

Antidote used for digitalis toxicity

A

Digibind (also need to d/c digoxin, normalize K+, and lidocaine if pt. Is arrhythmic)

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51
Q

Antidote used for beta agonist toxicity (eg. Metaproterenol)

A

Esmolol

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52
Q

Antidote for methotrexate toxicity

A

Leucovorin

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53
Q

Antidote for beta-blockers and hypoglycemia

A

Glucagon

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54
Q

Antidote useful for some drug induced Torsade de pointes

A

Magnesium sulfate

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55
Q

Antidote for hyperkalemia

A

sodium polystyrene sulfonate (Kayexalate)

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56
Q

Antidote for salicylate intoxication

A

Alkalinize urine, dialysis

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57
Q

Constant proportion of cell population killed rather than a constant number

A

Log-kill hypothesis

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58
Q

Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously

A

Pulse therapy

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59
Q

Toxic effect of anticancer drug can be lessened by rescue agents

A

Rescue therapy

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60
Q

Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates

A

Allopurinol

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61
Q

Pyrimidine analog that causes “Thymine-less death” given with leucovorin rescue

A

5-flouracil (5-FU)

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62
Q

Drug used in cancer therapy causes Cushing-like symptoms

A

Prednisone

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63
Q

Side effect of Mitomycin

A

SEVERE myelosuppression

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64
Q

MOA of cisplatin

A

Alkylating agent

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65
Q

Common toxicities of cisplatin

A

Nephro and ototoxicity

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66
Q

Analog of hypoxanthine, needs HGPRTase for activation

A

6-mercaptopurine (6-MP)

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67
Q

Interaction with this drug requires dose reduction of 6-MP

A

Allopurinol

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68
Q

May protect against doxorubicin toxicity by scavenging free radicals

A

Dexrazoxane

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69
Q

Blows DNA (breaks DNA strands), limiting SE is pulmonary fibrosis

A

Bleomycin

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70
Q

Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm

A

Testicular cancer

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71
Q

ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP

A

Adriamycin (doxorubicin) +bleomycin, vinblastine +dacarbazine

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72
Q

Regimen used for non-Hodgkin’s lymphoma

A

CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus rituximab

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73
Q

Regimen used for breast cancer

A

CMF (cyclophosphamide, methotrexate, and fluorouracil) and tamoxifen if ER+

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74
Q

Alkylating agent, vesicant that causes tissue damage with extravasation

A

Mechlorethamine

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75
Q

Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis

A

Cyclophosphamide

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76
Q

Prevention of cyclophosphamide induced hemorrhagic cystitis

A

Hydration and mercaptoethanesulfonate (MESNA)

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77
Q

Microtubule inhibitor that causes peripheral neuropathy, foot drop (eg. ataxia), and “pins and needles” sensation

A

Vincristine

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78
Q

Interact with microtubules (but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and cells remain frozen in metaphase

A

Paclitaxel (taxol)

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79
Q

Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides

A

Cisplatin

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80
Q

Agent similar to cisplatin, less nephrotoxic, but greater myelosuppression

A

Carboplatin

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81
Q

Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA (asparagine)

A

L-asparaginase

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82
Q

Used for hairy cell leukemia; it stimulates NK cells

A

Interferon alpha

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83
Q

Anti-androgen used for prostate cancer

A

Flutamide (Eulexin)

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84
Q

Anti-estrogen used for estrogen receptor + breast cancer

A

Tamoxifen

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85
Q

Aromatase inhibitor used in breast cancer

A

Letrozole, anastrozole

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86
Q

Newer estrogen receptor antagonist used in advanced breast cancer

A

Toremifene (Fareston)

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87
Q

Some cell cycle specific anti-cancer drugs

A

Bleomycin, vinca alkaloids, antimetabolites (eg., 5-FU, 6-MP, methotrexate, etoposide)

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88
Q

Some cell cycle non-specific drugs

A

Alkylating agents (eg., mechlorethamine, cyclophosphamide), antibiotics (doxorubicin, daunorubicin), cisplatin, nitrosourea

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89
Q

Anti-emetics used in association with anti-cancer drugs that are 5-HT3 (serotonin receptor subtype ) antagonists

A

Odansetron, granisetron

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90
Q

Nitrosoureas with high lipophilicity, used for brain tumors

A

Carmustine (BCNU) and lomustine (CCNU)

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91
Q

Produces disulfiram-like reaction with ethanol

A

Procarbazine

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92
Q

Somatostatin (SRIF) analog used for acromegaly, carcinoid, glucagonoma and other GH producing pituitary tumors

A

Octreotide

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93
Q

Somatotropin (GH) analog used in GH deficiency (dwarfism)

A

Somatrem

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94
Q

GHRH analog used as diagnostic agent

A

Sermorelin

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95
Q

GnRH agonist used for infertility or different types of CA depending on pulsatile or steady usage respectively

A

Leuprolide

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96
Q

GnRH antagonist with more immediate effects, used for infertility

A

Ganirelix

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97
Q

Dopamine (DA) agonist (for Parkinson’s disease), used also for hyperprolactinemia

A

Bromocriptine

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98
Q

Hormone inhibiting prolactin release

A

Dopamine

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99
Q

ACTH analog used for diagnosis of patients with corticosteroid abnormality

A

Cosyntropin

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100
Q

Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis

A

Desmopressin (DDAVP)

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101
Q

SE of OCs

A

Increased thromboembolic events

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102
Q

Most widely used thyroid drugs such as Synthroid and Levoxyl contain

A

L-thyroxine (T4)

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103
Q

T3 compound less widely used

A

Cytomel

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104
Q

Anti-thyroid drugs

A

Thioamides, iodides, radioactive iodine, and ipodate

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105
Q

Thioamide agents used in hyperthyroidism

A

Methimazole and propylthiouracil (PTU)

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106
Q

Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and should be used with extreme caution in pregnancy

A

PTU

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107
Q

PTU (propylthiouracil) MOA

A

Inhibits thyroid hormone synthesis by blocking iodination of the tyrosine residues of thyroglobulin

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108
Q

Can be effective for short term therapy of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism

A

Iodide salts

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109
Q

Dose may need to be increased during pregnancy or with Ocs due to increased TBG in plasma

A

Thyroxine

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110
Q

Permanently cures thyrotoxicosis, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy

A

Radioactive iodine

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111
Q

Radio contrast media that inhibits the conversion of T4 to T3

A

Ipodate

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112
Q

Block cardiac adverse effects of thyrotoxicosis such as tachycardia, inhibits the conversion of T4 to T3

A

Beta-blockers such as propranolol

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113
Q

Vitamins containing iron should NOT be taken simultaneously with levothyroxine because

A

Iron deiodinates thyroxine

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114
Q

Thyroxine dose may need to be increased in hypothyroid patient during pregnancy because

A

Estogens increase maternal TBG

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115
Q

3 zones of adrenal cortex and their products

A

Glomerulosa (mineralocorticoids), fasciculata (glucocorticoid=GC), and reticularis (adrenal androgens)

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116
Q

Pneumonic for 3 zones of adrenal cortex

A

GFR

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117
Q

Used for Addison’s disease, Congenital Adrenal Hyperplasia (CAH), inflammation, allergies, and asthma (as a local inhalation)

A

Glucocorticoids

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118
Q

Short acting glucocorticoids

A

Cortisone and hydrocortisone (equivalent to cortisol)

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119
Q

Intermediate acting glucocorticoids

A

Prednisone, methylprednisolone, prednisolone, and triamcinolone

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120
Q

Long acting glucocorticoids

A

Betamethasone and dexamethasone

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121
Q

Mineralocorticoids

A

Fludrocortisone and deoxycorticosterone

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122
Q

Some side effects of corticosteroids

A

Osteopenia, impaired wound healing, inc. risk of infection, inc. appetite, HTN, edema, PUD, euphoria, psychosis, stria, thinning of skin

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123
Q

Period of time of therapy after which GC therapy will need to be tapered

A

5-7 days

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124
Q

Used for Cushing’s syndrome (increased corticosteroid)

A

Dexamethasone suppression test

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125
Q

Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis

A

Aminoglutethimide

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126
Q

Antifungal agent used for inhibition of all gonadal and adrenal steroids

A

Ketoconazole

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127
Q

Antiprogestin used as potent antagonist of GC receptor

A

Mifepristone

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128
Q

Diuretic used to antagonize aldosterone receptors

A

Spironolactone

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129
Q

Common SE of spironolactone

A

Gynecomastia and hyperkalemia

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130
Q

Slightly increased risk of breast cancer, endometrial cancer, heart disease (questionable), has beneficial effects on bone loss

A

Estrogen

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131
Q

Antiestrogen drugs used for fertility and breast cancer respectively

A

Clomiphene and tamoxifen

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132
Q

Common SE of tamoxifen and raloxifene

A

Hot flashes

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133
Q

Selective estrogen receptor modulator (SERM) used for prevention of osteoporosis and prophylaxis in women with risk factors for breast cancer

A

Raloxifene

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134
Q

Non-steroidal estrogen agonist causes clear cell adenocarcinoma of the vagina in daughters of women who used it during pregnancy

A

Diethylstilbestrol (DES)

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135
Q

Estrogen mostly used in oral contraceptives (OC)

A

Ethinyl estradiol and mestranol

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136
Q

Anti-progesterone used as abortifacient

A

Mifepristone (RU-486)

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137
Q

Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)

A

Combination oral contraceptives (OC)

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138
Q

Oral contraceptive available in a transdermal patch

A

Ortho-Evra

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139
Q

Converted to more active form DHT by 5 alpha-reductase

A

Testosterone

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140
Q

5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness

A

Finasteride (Proscar and Propecia respectively)

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141
Q

Anabolic steroid that has potential for abuse

A

Nandrolone, oxymetholone, and oxandrolone

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142
Q

Anti-androgen used for hirsutism in females

A

Cyproterone acetate

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143
Q

Drug is used with testosterone for male fertility

A

Leuprolide

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144
Q

What do alpha cells in the pancreas produce?

A

Glucagon

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145
Q

What do beta cells in the pancreas produce?

A

Insulin

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146
Q

Where are beta cells found in the pancreas?

A

Islets of Langerhans

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147
Q

What do delta cells in the pancreas produce?

A

Somatostatin

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148
Q

Product of proinsulin cleavage used to assess insulin abuse

A

C-peptide

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149
Q

Exogenous insulin contains

A

Little C-peptide

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150
Q

Endogenous insulin contains

A

Normal C-peptide

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151
Q

Very rapid acting insulin, having fastest onset and shortest duration of action

A

Lispro (Humalog), aspart, glulisine

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152
Q

Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia

A

Regular (Humulin R)

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153
Q

Long acting insulin

A

Ultralente (humulin U)

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154
Q

Ultra long acting insulin, has over a day duration of action

A

Glargine (Lantus), detemir

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155
Q

Major SE of insulin

A

Hypoglycemia

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156
Q

Important in synthesis of glucose to glycogen in the liver

A

GLUT 2

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157
Q

Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation

A

GLUT 4

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158
Q

Examples of alpha-glucosidase inhibitors (AGI)

A

Acarbose, miglitol

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159
Q

MOA of AGI’s

A

Act on intestine, delay digestion and absorption of glucose formed from digestion of starch and disacchrides

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160
Q

SE of AGI’s

A

Flatulence (do not use beano to tx), diarrhea, abdominal cramps

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161
Q

Alpha-glucosidase inhibitor associated with elevation of LFT’s

A

Acarbose

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162
Q

Amino acid derivative, active as an insulin secretagogue

A

Nateglinide

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163
Q

MOA of nateglinide

A

Insulin secretagogue - closes ATP-sensitive K+ channel

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164
Q

Biguanide

A

Metformin

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165
Q

Drugs available in combination with metformin

A

Glyburide, glipizide, and rosiglitazone

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166
Q

MOA of metformin

A

Decreases hepatic glucose production and intestinal glucose absorption; increase insulin sensitivity

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167
Q

Vascular effects of metformin

A

Decreased micro and macro vascular disease

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168
Q

Most important potential SE of metformin

A

Lactic acidosis

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169
Q

Incidence of hyoglycemia with metformin

A

None

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170
Q

Meglitinide class of drugs

A

Repaglinide

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171
Q

MOA of repaglinide

A

Insulin release from pancreas; faster and shorter acting than sulfonylurea

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172
Q

First generation sulfonylurea

A

Chlorpropamide, tolbutamide, tolazamide, etc.

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173
Q

Second generation sulfonylurea

A

Glyburide, glipizide, glimepiride, etc.

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174
Q

MOA of both generations

A

Insulin release from pancreas by modifying K+ channels

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175
Q

Common SE of sulfonylureas, repaglinide, and nateglinide

A

Hypoglycemia

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176
Q

Sulfonylurea NOT recommended for elderly because of very long half life

A

Chlorpropamide

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177
Q

Thiazolidinediones

A

Pioglitazone, Rosiglitazone, Troglitazone (withdrawn/d from market)

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178
Q

Reason troglitazone was withdrawn from market

A

Hepatic toxicity

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179
Q

MOA of thiazolindinediones

A

Stimulate PPAR-gamma receptor to regulate CHO and lipid metabolism

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180
Q

SE of Thiazolindinediones

A

Edema, mild anemia; interaction with drugs that undergo CytP450 3A4 metabolism

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181
Q

Hyperglycemic agent that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycemia, also used to reverse severe beta-blocker overdose and smooth muscle relaxation

A

Glucagon

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182
Q

Available bisphosphonates

A

Alendronate, etidronate, risedronate, pamidronate, tiludronate, and zoledronic acid

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183
Q

MOA of Bisphosphonates

A

Inhibits osteoclast bone resorption

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184
Q

Names of three bisphosphonates available IV

A

Pamidronate, zoledronate, ibandronate

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185
Q

Uses of bisphosphonates

A

Osteoporosis, Paget’s disease, and osteolytic bone lesions, and hypercalcemia from malignancy

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186
Q

Major SE of bisphosphonates

A

Chemical esophagitis

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187
Q

Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia

A

Etidronate

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188
Q

Used for prevention of postmenopausal osteoporosis in women

A

Estrogen (HRT-Hormone replacement therapy)

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189
Q

Increase bone density, also being tested for breast CA prophylaxis

A

Raloxifene (SERM-selective estrogen receptor modulator)

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190
Q

Used intranasally and decreases bone resorption

A

Calcitonin (salmon prep)

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191
Q

Used especially in postmenopausal women, dosage should be 1500 mg

A

Calcium

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192
Q

Vitamin given with calcium to ensure proper absorption

A

Vitamin D

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193
Q

Disease caused by excess ergot alkaloids

A

St. Anthony’s Fire

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194
Q

Endogenous substances commonly interpreted as histamine, serotonin, prostaglandins, and vasoactive peptides

A

Autocoids

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195
Q

Syndrome of hypersecretion of gastric acid and pepsin usually caused by gastrinoma; it is associated with severe peptic ulceration and diarrhea

A

Zollinger-Ellison Syndrome

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196
Q

Drug that causes contraction of the uterus

A

Oxytocin

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197
Q

Distribution of histamine receptors H1, H2, and H3

A

Smooth muscle; stomach, heart, and mast cells; nerve endings, CNS respectively

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198
Q

Prototype antagonist of H1 and H2 receptors

A

Diphenhydramine and cimetridine, respectively

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199
Q

1st generation antihistamine that is highly sedating

A

Diphendydramine

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200
Q

1st generation antihistamine that is least sedating

A

Chlorpheniramine or cyclizine

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201
Q

2nd generation antihistamines

A

Fexofenadine, loratadine, and cetirizine

202
Q

Generation of antihistamine that has the most CNS effects

A

First generation due to being more lipid-soluble

203
Q

Major indication for H1 receptor antagonist

A

Use in IgE mediated allergic reaction

204
Q

Antihistamine that can be used for anxiety and insomnia and is not addictive

A

hydroxyzine (Atarax)

205
Q

H1 antagonist used in motion sickness

A

Dimenhydrinate, meclizine, and other 1st generation

206
Q

Most common side effect of 1st generation antihistamines

A

Sedation

207
Q

Lethal arrhythmias resulting from concurrent therapy with azole fungals (metabolized by CYP 3A4) and these antihistamines which inhibit the 3A4 iso-enzyme.

A

Terfenadine and astemizole (have been removed from the market)

208
Q

H2 blocker that causes the most interactions with other drugs

A

Cimetidine

209
Q

Clinical use for H2 blockers

A

Acid reflux disease, duodenal ulcer and peptic ulcer disease

210
Q

Receptors for serotonin (5HT-1) are located

A

Mostly in the brain, and they mediate synaptic inhibition via increased K+ conductance

211
Q

5HT-1d agonist used for migraine headaches

A

Sumatriptan, naratriptan, and rizatriptan

212
Q

Triptan available in parenteral and nasal formulation

A

Sumatriptan

213
Q

H1 blocker that is also a serotonin antagonist

A

Cyproheptadine

214
Q

Agents for reduction of postpartum bleeding

A

Oxytocin, ergonovine and ergotamine

215
Q

Agents used in treatment of carcinoid tumor

A

Ketanserin cyproheptadine, and phenoxybenzamine

216
Q

5HT-3 antagonist used in chemotherapeutic induced emesis

A

Ondansetron, granisetron, dolasetron and alosetron

217
Q

5HT-3 antagonist that has been associated with QRS and QTc prolongation and should not be used in patients with heart disease

A

Dolasetron

218
Q

DOC to treat chemo-induced nausea and vomiting

A

Odansetron

219
Q

Drug used in ergot alkaloids overdose, ischemia and gangrene

A

Nitroprusside

220
Q

Reason ergot alkaloids are contraindicated in pregnancy

A

Uterine contractions

221
Q

SE of ergot alkaloids

A

Hallucinations resembling psychosis

222
Q

Ergot alkaloid used as an illicit drug

A

LSD

223
Q

Dopamine agonist used in hyperprolactinemia

A

Bromocriptine

224
Q

Peptide causing increased capillary permeability and edema

A

Bradykinin and histamine

225
Q

Mediator of tissue pain, edema, inactivated by ACE, and may be a contributing factor to the development of angioedema

A

Bradykinin

226
Q

Drug causing depletion of substance P (vasodilator)

A

Capsaicin

227
Q

Prostaglandins that cause abortions

A

Prostaglandin E1 (misoprostol) PGE2, and PGF2alpha

228
Q

Difference between COX 1 and COX 2

A

COX 1 is found throughout the body and COX 2 is only in inflammatory tissue

229
Q

Drug that selectively inhibits COX 2

A

Celecoxib and rofecoxib

230
Q

Inhibitor of lipoxygenase

A

Zileuton

231
Q

Major SE of zileuton

A

Liver toxicity

232
Q

Inhibitor of leukotrienes (LTD4) receptors and used in asthma

A

Zafirlukast and montelukast

233
Q

Used in pediatrics to maintain patency of ductus arteriosis

A

PGE1

234
Q

Approved for use in severe pulmonary HTN

A

PGI2 (epoprostenol)

235
Q

Prostaglandin used in the treatment of impotence

A

Alprostadil

236
Q

Irreversible, nonselective COX inhibitor

A

Aspirin

237
Q

Class of drugs that reversibly inhibit COX

A

NSAIDS

238
Q

Primary endogenous substrate for Nitric Oxidase Synthase

A

Arginine

239
Q

MOA and effect of nitric oxide

A

Stimulates cGMP which leads to vascular smooth muscle relaxation

240
Q

Long acting beta 2 agonist used in asthma

A

Salmeterol

241
Q

Muscarinic antagonist used in asthma

A

Ipratropium

242
Q

MOA action of cromolyn

A

Mast cell stabilizer

243
Q

Methylxanthine derivative used as a remedy for intermittent claudication

A

Pentoxifylline

244
Q

MOA of corticosteroids

A

inhibit phospholipase A2

245
Q

SE of long term (>5 days) corticosteroid therapy and remedy

A

Adrenal suppression and weaning slowly, respectively

246
Q

MOA of quinolones

A

Inhibit DNA gyrase

247
Q

MOA of penicillin

A

Block cell wall synthesis by inhibiting peptidoglycan cross-linkage

248
Q

Drug used for MRSA

A

Vancomycin

249
Q

Vancomycin MOA

A

Blocks peptidoglycan synthesis

250
Q

Type of resistance found with vancomycin

A

Point mutation

251
Q

Meningitis prophylaxis in exposed patients

A

Rifampin

252
Q

Technique used to diagnose perianal itching, and the drug used to treat it

A

Scotch tape technique and mebendazole

253
Q

Two toxicities of aminoglycosides

A

nephro and ototoxicity

254
Q

DOC for Legionnaires’ disease

A

Erythromycin

255
Q

MOA of sulfonamides

A

Inhibit dihydropteroate synthase

256
Q

Penicillins active against penicillinase secreting bacteria

A

Methicillin, nafcillin, and dicloxacillin

257
Q

Cheap wide spectrum antibiotic DOC for otitis media

A

Amoxicillin

258
Q

Class of antibiotics that have 10% cross sensitivity with penicillins

A

Cephalosporins

259
Q

PCN active against pseudomonas

A

Carbenicillin, piperacillin and ticarcillin

260
Q

Antibiotic causing red-man syndrome, and prevention

A

Vancomycin, infusion at a slow rate and antihistamines

261
Q

Drug causes teeth discoloration

A

Tetracycline

262
Q

MOA of tetracycline

A

Decreases protein synthesis by inhibiting 30S ribosome

263
Q

Drug that causes gray baby syndrome and aplastic anemia

A

Chloramphenicol

264
Q

Drug notorious for causing pseudomembranous colitis

A

Clindamycin

265
Q

DOC for tx of pseudomembranous colitis

A

Metronidazole

266
Q

Treatment of resistant pseudomembranous colitis

A

ORAL vancomycin

267
Q

Anemia caused by trimethoprim

A

Megaloblastic anemia

268
Q

Reason fluoroquinolones are contraindicated in children and pregnancy

A

Cartilage damage

269
Q

DOC for giardia, bacterial vaginosis, pseudomembranous colitis, and trichomonas

A

Metronidazole

270
Q

Treatment for TB patients (think RIPE)

A

Rifampin, Isoniazid, Pyrazinamide, and Ethambutol

271
Q

Metronidazole SE if given with alcohol

A

Disulfiram-like reaction

272
Q

Common side effect of Rifampin

A

Red urine discoloration

273
Q

MOA of nystatin

A

Bind ergosterol in fungal cell membrane

274
Q

Neurotoxicity with isoniazid (INH) prevented by

A

Administration of Vit. B6 (pyridoxine)

275
Q

Toxicity of amphotericin

A

Nephrotoxicity

276
Q

SE seen only in men with administration of ketoconazole

A

Gynecomastia

277
Q

Topical DOC in impetigo

A

Topical mupirocin (Bactroban)

278
Q

DOC for influenza A

A

Amantadine

279
Q

DOC for RSV

A

Ribavirin

280
Q

DOC for CMV retinitis

A

Ganciclovir

281
Q

SE for ganciclovir

A

Neutro, leuko and thrombocytopenia

282
Q

Anti-viral agents associated with Stephen Johnson syndrome

A

Nevirapine, amprenavir

283
Q

HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism

A

Protease inhibitors

284
Q

Antivirals that are teratogens

A

Delavirdine, efavirenz, and ribavirin

285
Q

Antivirals associated with neutropenia

A

Ganciclovir, zidovudine, saquinavir, and interferon

286
Q

HIV med used to reduce transmission during birth

A

AZT (zidovudine)

287
Q

Drug used for African sleeping sickness

A

Suramin

288
Q

Drug used in Chagas disease

A

Nifurtimox

289
Q

Cephalosporins able to cross the BBB

A

Cefuroxime (2nd) generation, Ceftazidime, Ceftriaxone

290
Q

Cephalosporins NOT able to cross the BBB

A

Cefixime (3rd) generation

291
Q

Drug used for N. gonorrhea in females

A

Ceftriaxone

292
Q

Cephalosporin causes kernicterus in neonates

A

Ceftriaxone or cefuroxime

293
Q

SE of INH

A

Peripheral neuritis and hepatitis

294
Q

Aminoglycoside that is least ototoxic

A

Streptomycin

295
Q

Drug used in exoerythrocytic cycle of malaria

A

Primaquine

296
Q

Oral antibiotic of choice for moderate inflammatory acne

A

Minocycline

297
Q

Drug of choice for leprosy

A

Dapsone, rifampin and clofazimine combination

298
Q

DOC for herpes and its MOA

A

Acyclovir; incorporated into viral DNA and chain termination

299
Q

Anti-microbials that cause hemolysis in G6PD-deficient patients

A

Sulfonamides

300
Q

MOA of erythromycin

A

Inhibition of protein synthesis at the 50s subunit of ribosome

301
Q

Anti-biotic frequently used for chronic UTI prophylaxis

A

sulfamethoxazole/ trimethoprim

302
Q

Lactam that can be used in PCN allergic patients

A

Aztreonam

303
Q

SE of imipenem

A

Seizures

304
Q

Anti-viral with a dose limiting toxicity of pancreatitis

A

Didanosine

305
Q

Common side effect of hypnotic agents

A

Sedation

306
Q

Occurs when sedative hypnotics are used chronically or at high doses

A

Tolerance

307
Q

The most common type of drug interaction of sedative hypnotics with other depressant medications

A

Additive CNS depression

308
Q

Benzodiazepines used to promote sleep

A

Temazpam, trizolam, flurazepam

309
Q

Benzodiazepine used for anxiety

A

Alprazolam

310
Q

Non-benzodiazepine used as an anxiolytic

A

Buspirone

311
Q

Non-benzodiazepine used for sleep

A

Zolpidem

312
Q

Major effect of benzodiazepines on sleep at high doses

A

REM is decreased

313
Q

Neurologic SE of benzodiazepines

A

Anterograde amnesia

314
Q

Reason benzos are used cautiously in pregnancy

A

Ability to cross the placenta

315
Q

Main route of metabolism for benzodiazepines

A

Hepatic

316
Q

Benzodiazepine that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)

A

Lorazepam, oxazepam, and temazepam

317
Q

MOA for benzodiazepines

A

increase the FREQUENCY of GABA-mediated chloride ion channel opening

318
Q

Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)

A

Flumazenil

319
Q

Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin

A

Diazepam

320
Q

Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia

A

Clonazepam

321
Q

Benzodiazepines that are the most effective in the treatment of panic disorder

A

Alprazolam and Clonazepam

322
Q

Benzodiazepine that is used for anesthesia

A

Midazolam

323
Q

DOC for status epilepticus

A

Diazepam

324
Q

Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs

A

Chlordiazepoxide and Diazepam

325
Q

Agents having active metabolites, long half lives, and a high incidence of adverse effects

A

Diazepam, Flurazepam, chlordiazepoxide, and clorazepate

326
Q

Barbiturates may precipitate this hematologic condition

A

Acute intermittent porphyria

327
Q

Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property

A

Liver enzyme INDUCTION

328
Q

Barbiturates MOA

A

Increase the DURATION of GABA-mediated chloride ion channels

329
Q

Barbiturate used for the induction of anesthesia

A

Thiopental

330
Q

Site of action for zaleplon and zolpidem

A

Benzodiazepine receptor BZ1 (although do not have a benzodiazepine ring structure)

331
Q

Good hypnotic activity with less CNS SE than most benzodiazepines

A

Zolpidem, zaleplon

332
Q

Agent that is a partial agonist for the 5-HT1A receptor

A

Buspirone

333
Q

Drug of choice for generalized anxiety disorder, NOT effective in acute anxiety

A

Buspirone

334
Q

Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)

A

Ethanol

335
Q

Agent with zero-order kinetics

A

Ethanol

336
Q

Rate limiting step of alcohol metabolism

A

Aldehyde dehydrogenase

337
Q

System that increases in activity with chronic ethanol exposure and may contribute to tolerance

A

MEOS

338
Q

Enzyme that metabolizes acetaldehyde to acetate

A

Aldehyde dehydrogenase

339
Q

Agents that inhibit acetaldehyde dehydrogenase

A

Disulfiram, metronidazole, certain sulfonylureas and cephalosporins

340
Q

Agent that inhibits alcohol dyhydrogenase and its clinical use

A

FOMEPIZOLE - used to prevent formation of toxic metabolites from methanol and ethylene glycol ingestion

341
Q

Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension

A

Disulfiram

342
Q

The most common neurologic abnormality in chronic alcoholics

A

Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)

343
Q

Agent that is teratogen and causes a fetal syndrome

A

Ethanol

344
Q

Agent that is the antidote for methanol overdose

A

Ethanol, fomepizole

345
Q

Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure

A

Fomepizole

346
Q

Most frequent route of metabolism

A

Hepatic enzymes

347
Q

Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine

A

Sodium channel blockade

348
Q

MOA for benzodiazepines and barbiturates

A

GABA-related targets

349
Q

MOA for Ethosuximide

A

Calcium channels

350
Q

MOA for Valproic acid at high doses

A

Affect calcium, potassium, and sodium channels

351
Q

Drugs of choice for generalized tonic-clonic and partial seizures

A

Valproic acid and Phenytoin

352
Q

DOC for febrile seizures

A

Phenobarbital

353
Q

Drugs of choice for absence seizures

A

Ethosuximide and valproic acid

354
Q

Drug of choice for myoclonic seizures

A

Valproic acid

355
Q

Drugs of choice for status epilepticus

A

IV diazepam for short term (acute) treatment; phenytoin for prolonged therapy

356
Q

Drugs that can be used for infantile spasms

A

Corticosteroids

357
Q

Anti-seizure drugs used also for bipolar affective disorder (BAD)

A

Valproic acid, carbamazepine, phenytoin and gabapentin

358
Q

Anti-seizure drugs used also for Trigeminal neuralgia

A

Carbamazepine

359
Q

Anti-seizure drugs used also for pain of neuropathic orgin

A

Gabapentin

360
Q

Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism

A

Phenytoin

361
Q

SE of phenytoin

A

Gingival hyperplasia, nystagmus, diplopia and ataxia

362
Q

Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida

A

Carbamazepine

363
Q

Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress

A

Valproic acid

364
Q

Laboratory value required to be monitored for patients on valproic acid

A

Serum ammonia and LFT’s

365
Q

SE for Lamotrigine

A

Stevens-Johnson syndrome

366
Q

SE for Felbamate

A

Aplastic anemia and acute hepatic failure

367
Q

Anti-seizure medication also used in the prevention of migraines

A

Valproic acid

368
Q

Carbamazepine may cause

A

Agranulocytosis

369
Q

Anti-seizure drugs used as alternative drugs for mood stabilization

A

Carbamazepine, gabapentin, lamotrigine, and valproic acid

370
Q

MOA of general anesthetics

A

Most are thought to act at GABA-A receptor - chloride channel

371
Q

Inhaled anesthetic with a low blood/gas partition coefficient

A

Nitrous oxide

372
Q

Inversely related to potency of anesthetics

A

Minimum alveolar anesthetic concentration (MAC)

373
Q

Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

A

Halothane and methoxyflurane

374
Q

Most inhaled anesthetics SE

A

Decrease arterial blood pressure

375
Q

Inhaled anesthetics are myocardial depressants

A

Enflurane and halothane

376
Q

Inhaled anesthetic causes peripheral vasodilation

A

Isoflurane

377
Q

Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis

A

Halothane

378
Q

Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration

A

Nitrous oxide

379
Q

Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

A

Methoxyflurane

380
Q

Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia

A

Nitrous oxide

381
Q

Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm

A

Desflurane

382
Q

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

A

Dantrolene

383
Q

IV barbiturate used as a pre-op anesthetic

A

Thiopental

384
Q

Benzodiazepine used adjunctively in anesthesia

A

Midazolam

385
Q

Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose

A

Flumazenil

386
Q

This produces “dissociative anesthesia”, is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery

A

Ketamine

387
Q

Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia

A

Fentanyl

388
Q

State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide

A

Neuroleptanesthesia

389
Q

Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension

A

Propofol

390
Q

MOA of local anesthetics (LA’s)

A

Block voltage-dependent sodium channels

391
Q

This may enhance activity of local anesthetics

A

Hyperkalemia

392
Q

This may antagonize activity of local anesthetics

A

Hypercalcemia

393
Q

Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity

A

Vasodilation

394
Q

Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery

A

Cocaine

395
Q

Longer acting local anesthetics which are less dependent on vasoconstrictors

A

Tetracaine and bupivacaine

396
Q

These LA’s have surface activity

A

Cocaine and benzocaine

397
Q

Most important toxic effects of most local anesthetics

A

CNS toxicity

398
Q

Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage, cardiac arrhythmias, and myocardial infarction

A

Cocaine

399
Q

LA causing methemoglobinemia

A

Prilocaine

400
Q

Structurally related to acetylcholine, used to produce muscle paralysis in order to facilitate surgery or artifical ventilation. Full doses lead to respiratory paralysis and require ventilation

A

Neuromuscular blocking drugs

401
Q

These drugs strongly potentiate and prolong effect of neuromuscular blockade (NMB)

A

Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmic

402
Q

These prevent the action of Ach at the skeletal muscle endplate to produce a “surmountable blockade,” effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)

A

Nondepolarizing type antagonists

403
Q

Agent with long duration of action and is most likely to cause histamine release

A

Tubocurarine

404
Q

Non-depolarizing skeletal muscle antagonist that has short duration

A

Mivacurium

405
Q

Skeletal muscle agent that can block muscarinic receptors

A

Pancuronium

406
Q

Skeletal muscle agent that undergoes Hofmann elimination (breaks down spontaneously)

A

Atracurium

407
Q

One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis, causes muscle pain postoperatively and myoglobinuria may occur

A

Succinylcholine

408
Q

During Phase I these agents worsen muscle paralysis by succinylcholine, but during phase II they reverse the blockade produced by succinylcholine

A

Cholinesterase inhibitors

409
Q

Agents acting in the CNS or in the skeletal muscle, used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease

A

Spasmolytic drugs

410
Q

Facilitates GABA presynaptic inhibition

A

Diazepam

411
Q

GABA agonist in the spinal cord

A

Baclofen

412
Q

Similar to clonidine and may cause hypotension

A

Tizanidine

413
Q

DOC for malignant hyperthermia by acting on the sacroplasmic reticulum or skeletal muscle

A

Dantrolene

414
Q

Agent used for acute muscle spasm

A

Cyclobenzaprine

415
Q

Irreversible condition resulting from the use of antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog)

A

Drug induced Parkinsonism

416
Q

Agent used in drug therapy of Parkinson’s instead of Dopamine which has low bioavailability and does not cross the BBB

A

L-dopa

417
Q

This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE’s (GI distress, postural hypotension, and dyskinesias)

A

Carbidopa

418
Q

Clinical response that may fluctuate in tx of Parkinson’s dx

A

On-off-phenomenon

419
Q

Anti-Parkinson’s drug which increases intraocular pressure and is contraindicated in closed angle glaucoma

A

Levodopa

420
Q

Ergot alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate levodopa, causes erythromelalgia

A

Bromocriptine

421
Q

Non ergot agents used as first-line therapy in the initial management of Parkinson’s

A

Pramipexole and ropinirole

422
Q

Enhances dopaminergic neurotransmission SE’s include CNS excitation, acute toxic psychosis and livedo reticularis

A

Amantadine

423
Q

Inhibitor of MAO type B which metabolizes dopamine, used adjunct to levodopa or as sole agent in newly diagnosed patients

A

Selegiline

424
Q

Inhibitors of catechol-O-methyltransferase (COMT), used as adjuncts in Parkinson’s dx and cause acute hepatic failure (monitor LFT’s)

A

Entacapone and Tolcapone

425
Q

Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects

A

Benztropine

426
Q

Agent effective in physiologic and essential tremor

A

Propranolol

427
Q

Agents used in Huntington’s Disease

A

Tetrabenazine (amine depleting drug), Haloperidol (antipsychotic)

428
Q

Agents used in Tourette’s dx

A

Haloperidol or pimozide

429
Q

Chelating agent used in Wilson’s disease

A

Penicillamine

430
Q

Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor

A

Older antipsychotic agents, D2 receptors

431
Q

MOA of neuroleptics

A

Dopamine blockade

432
Q

Side effects occuring in antipsychotics that block dopamine

A

Hyperprolactinemia, menorrhea, galactorrhea, confusion, mood changes, decreased sexual interest, and weight gain

433
Q

Antipsychotics that reduce positive symptoms only

A

Older antipsychotics

434
Q

Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation

A

Olanzapine, aripiprazole, and sertindole

435
Q

Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia

A

Risperidone

436
Q

Atypical antipsychotic causing high prolactin levels

A

Risperidone

437
Q

Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes

A

Olanzapine

438
Q

Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker

A

Haloperidol

439
Q

Drug used in neuroleptic malignant syndrome

A

Dantrolene

440
Q

Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)

A

Muscarinic blockers

441
Q

Antipsychotic having the strongest autonomic effects

A

Thioridazine

442
Q

Antipsychotic having the weakest autonomic effects

A

Haloperidol

443
Q

Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias

A

Thioridazine

444
Q

Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause fatal agranulocytosis

A

Clozapine

445
Q

Anti-psychotic not shown to cause tardive dyskinesia

A

Clozapine

446
Q

Anti-psychotics available in depot preparation

A

Fluphenazine and haloperidol

447
Q

Reduced seizure threshold

A

Low-potency typical antipsychotics and clozapine

448
Q

Orthostatic hypotension and QT prolongation

A

Low potency phenothiazines and ziprasidone

449
Q

Increased risk of developing cataracts

A

Quetiapine

450
Q

Major route of elimination for Lithium

A

Kidneys

451
Q

Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop

A

Lithium toxicity

452
Q

Drug increases the renal clearance hence decreases levels of lithium

A

Theophylline

453
Q

Lithium is associated with this congenital defect

A

Cardiac anomalies and is contraindicated in pregnancy or lactation

454
Q

DOC for bipolar affective disorder

A

Lithium

455
Q

Concern using lithium

A

Low therapeutic index

456
Q

SE of lithium

A

Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus

457
Q

Example of three antidepressants that are indicated for obsessive compulsive disorder

A

Clomipramine, fluoxetine and fluvoxamine

458
Q

Neurotransmitters affected by the action of antidepressants

A

Norepinephrine and serotonin

459
Q

Usual time needed for full effect of antidepressant therapy

A

2 to 3 weeks

460
Q

Population group especially sensitive to side effects of antidepressants

A

Elderly patients

461
Q

All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion

A

Side-effect profile and prior pt response

462
Q

Well-tolerated and are first-line antidepressants

A

SSRI’s, bupropion, and venlafaxine

463
Q

Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression

A

Monamine oxidase inhibitors

464
Q

Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)

A

Hypertensive crisis

465
Q

MAOI should not be administered with SSRI’s or potent TCA’s due to development of this condition

A

Serotonin syndrome

466
Q

Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly

A

Tricyclic antidepressants (TCA)

467
Q

Three C’s associated with TCA toxicity

A

Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)

468
Q

Agents having higher sedation and antimuscarinic effects than other TCA’s

A

Tertiary amines

469
Q

TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects

A

Amitriptyline

470
Q

TCA used in chronic pain, enuresis, and ADD

A

Imipramine

471
Q

TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep

A

Doxepin

472
Q

TCA used in obsessive compulsive disorder (OCD), most significant of TCA’s for risk of seizure, weight gain, and neuropsychiatric signs and symptoms

A

Clomipramine

473
Q

Secondary amines that have less sedation and more excitation effect

A

Nortriptyline, Desipramine

474
Q

Side effects seen with tricyclic antidepressants

A

Muscarinic blockade (dry mouth, constipation); weak alpha-1 block (orthostatic hypotension); weak hisamine block (sedation)

475
Q

Antidepressant associated with neuroleptic malignant syndrome

A

Amoxapine

476
Q

Antidepressant associated with seizures and cardiotoxicity

A

Maprotiline

477
Q

Antidepressant having stimulant effects similar to SSRI’s and can increase blood pressure

A

Venlafaxine

478
Q

Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake

A

Venlafaxine

479
Q

Antidepressant also used for sleep that causes priapism

A

Trazodone

480
Q

Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure

A

Nefazodone

481
Q

Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE’s include dizziness, dry mouth, aggravation of psychosis, and seizures

A

Bupropion

482
Q

Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating

A

Mirtazapine

483
Q

SE of mirtazapine

A

Liver toxicity, increased serum cholesterol

484
Q

Except for these agents all SSRI have significant inhibition of CytP450 enzymes

A

Citalopram and its metabolite escitalopram

485
Q

Side effects frequently seen with SSRIs

A

CNS stimulation; GI upset

486
Q

Antidepressants with no effect on BP, no sedation

A

SSRIs

487
Q

SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx

A

Fluoxetine

488
Q

SSRI indicated for premenstrual dysphoric disorder

A

Fluoxetine (Sarafem)

489
Q

Some of SSRIs’ therapeutic effects beside depression

A

Panic attacks, social phobias, bulimia nervosa, and PMDD (premenstrual dysphoric disorder), OCD

490
Q

SSRI less likely to cause a withdrawal syndrome

A

Fluoxetine

491
Q

Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons

A

Ascending pathways

492
Q

Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release

A

Presynaptic mu, delta, and kappa receptors

493
Q

Activation of these receptors open K+ ion channels to cause membrane hyperpolarization

A

Postsynaptic Mu receptors

494
Q

Tolerance to all effects of opioid agonists can develop except

A

Miosis and constipation

495
Q

All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction

A

Meperidine

496
Q

SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone

A

Opioid Analgesics

497
Q

Strong opioid agonists

A

Morphine, methadone, meperidine, and fentanyl

498
Q

Opioids used in anesthesia

A

Morphine and fentanyl

499
Q

Opioid used in the management of withdrawal states

A

Methadone

500
Q

Opioid available trans-dermally

A

Fentanyl

USMLE Pharmacology (2 decks)

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