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Anatomy Step1 Buzzwords > sketchy pharm > Flashcards

sketchy pharm Flashcards

1
Q

What type of receptor is the one for the adrenal medulla?

A

NICOTINIC acetylcholine (for producing Epi/Norepi and shit)

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2
Q

M1

A

CNS, Enteric (GI) nervous system—Gq (IP3/DAG)

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3
Q

M2

A

Heart—namely decreasing (Atria, SA, AV)—it is Gi after all

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4
Q

M3

A

Glands, bladder, smooth muscles, smooth muscle of eye

Also VESSELS—-causes release of Nitric oxide from endothelial cells and you get more cGMP and muscarinic effects. So you vasodilate

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5
Q

Nicotinic vs Muscarinic receptors

A

Nicotinic: Ion channels
M1: Gq (IP3/DAG)
M2: Gi (lowering cAMP)
M3: Gq (IP3/DAG)

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6
Q

What happens to M3 in atherosclerosis

A

the vascular epithelial damage from atherosclerosis stimualtes muscarinic receptors and you get VASOCONSTRICTION (instead of dilation)

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7
Q

Bethanechol

A

Cholemimetic. Mostly used for secretion and motor activation of gut
(eg neurogenic ileus, post op ileus–NONobstructive GI)

Or to increase urinary secretion (again NONobstructive)

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8
Q

Pilocarpine

A

Increases salivation
Treat glaucoma (reduce IOP by contracting ciliary body—relaxing it and accomodating lens—so muscle basedi t sounds like)
also causes miosis (activating sphincter pupil muscle in acute angle closure glaucoma)

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9
Q

Carbachol

A

both muscarinic and nicotinic

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10
Q

Methacholine

A

muscarinic stimulant; contracts bronchial smooth muscle tree-> exacerbate COPD and asthma

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11
Q

Vareniciline

A

partial nicotinic agonist used for smoking cessation (provides some degree of stimulation to get rid of craving Im guessing)

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12
Q

Tertiary vs Quatenary Acetylcholine esterase inhibitors and significance

A

Quatenary can’t cross the BBB (pyrido,neo,edrophonium)

Tertiary can (Physostigmine)

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13
Q

Long term management of MG

A

Pyridostigmine
Neostigmine less used
Edrophonium for the challenge aka tensilon test

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14
Q

Nondepolarizing neuromuscular blocking agents

A

curare compounds
tubocurarine, pancuronium, cistracurium
Reverse effects with acetylcholinesterase inhibitors afterwards.

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15
Q

Depolarizing NM block agent

A

Succinylcholine (doesn’t get metabolized, aggressively binds)—PHASE S1 block of depolarizing blockade. IRREVERSIBLE (cholinesterase inhibitors wont do shit)
phase 2 it will

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16
Q

Neostigmine post surgery

A

Neostigmine for post op bladder and urinary retention

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17
Q

Physosigmine use

A

used for atropine overdose (Jimson weed, or belladonna flower)—competitive block so can be overcome

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18
Q

Type of paralysis in acetylcholine esterase inhibitor overdose

A

flaccid paralysis (BB SLUDGE guy, could be frmo organophosphates for example)

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19
Q

Use of pralidoxime & atropine

A

regeneration of choline esterase; affects NICOTINIC components, CANT CROSS BBB
Atropine: CAN cross BBB, but can’t affect nicotinic receptors (so can’t affect paralysis)

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20
Q

Why do you need to traet organopsophate-choliensterase complex fast?

A

“Aging” effect where the bond becomes irreversible

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21
Q

Galnatime, Rivasgmine, Donepezil

A

all acetylcholinesterase inhibitors that can treat Alzheimers

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22
Q

Antimuscarinic blockers

A 
Atropine
Ipratropium
Tiotropium
Oxybutynin
Tolterodine
Scoloplamine
Benzotropine
Trihexylphenidyl
obviously side effects for shit like TCAs too
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23
Q

Major side effects of TMP-SMX (or at least unique)

A

Pancytopenia, megaloblastic anemia, teratagogenic (neural tube defects), interstital nephritis, Renal tubular acidosis (type IV), CYP450 inhibitor, photosensitivity, kernicterus, SJS, hemolytic anemia g6pd

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24
Q

major side effect Ethambutol

A

optic neuritis (red green colorblindness)

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25
Q

major sideeffect pyrazinamide

A

tb drug, hyperuricemia

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26
Q

major side effect dapsone

A

leprosy drug; agranulocytosis, also hemolytic anemia with g6pd

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27
Q

mycobacter avium tx

A

macrolide and ethambutol

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28
Q

rifampin big side effects

A

CYP450 inducer, orange red body fluid

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29
Q

isonazide big side effects

A

b6 deficiency (so give pyrixodine, this is what give hte peripheral neuropathy), worse side effects in slow acetylators, anion gap metabolic acidosis, drug induced lupus, CYP450 inhibitor

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30
Q

rifampin prophylaxis uses

A

n meningi, h influ

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31
Q

drugs for myco leprae

A

dapsone, rifampin, maybe add clofazamine if its the major leprosy

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32
Q

major side effects aminoglycoside and major resistance

A

ototoxicity, nephrotoxicity, ATN, neuromusc blockade (avoid in mg), teratogen (ototoxicity)
resistance is acetylation enzyme

of note it is the only ribosome guy that is bacteriocidal, IV

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33
Q

Linezolid major side effects

A

neutropenia, serotonin syndrome (minor MAOi effect), optic neuropathy, peripheral neuropathy

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34
Q

major Chloramphenicol side effects

A

gray baby syndrome, aplastic anemia, regular anemia

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35
Q

marcolide big side effects

A

cyp450 inhibitor, prolong qt, hepatitis and jaundice

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36
Q

tetracycline big side effects and resistance

A

resistance: efflux pumps and altering the ribosome

adverse rxn is teeth skin discoloration (binding to calcium, tertaogenic)
fanconi syndrome (esp expired tetracyclines; type II renal tubular acidosis)
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37
Q

daptomycin use and major side effects, moa

A

can use for VRE. Can’t use for pneumonia (surfactant destroys it)

moa is inserting its tail into bacterial cell wall/membrane?

major side effects: myopathy, rhabdomyolysis (monitor CK)

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38
Q

major side effects panems

A

skin rash, GI, reduce seizure threshold (esp imipeneum with renal failure). good drugs for penicilin allergies

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39
Q

Vancomycin major side effects

A

red man syndrome (histamine mediated)
can increase risk of ototoxicity with aminoglycosides
thrombophelitis

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40
Q

major side effects griseofulvin, moa

A

grnaulocytopenia, CYP450 inducer—bind microtubule and halt mitosis.

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41
Q

major side effects Echniocandins (what are these), moa

A

these are the fungins that alter B2 glucan. ONLY CELL WALL GUYS. adverse rxn is histamine release in IV

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42
Q

teribafine moa, adverse rxn

A

inhibit fungal sequeale epoxidase, get squalene accumulation (is toxic)
hepatotoxicity

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43
Q

moa major side effects of azoles, what one can you use for PCOS/Cushing/hirsutism shit

A

inhibit ergesterol synthesis
adverse rxn is CYP450 inhibitor (esp voriconazole, this guy also causes blurry flashes of light and color blindness)
fluconazole is your crypt meningitis guy
voriconazole is your invasive aspergillis and candida esophagitis guy
itraconazole is more systemic dimorphics and tinea
Ketoconazole: Hirsutism guy. inhibits 1720 desmolase (anti androgen effect, 1st step in steroid syn)

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44
Q

major side effects of flouroquinolones, name a use or two

A

complicated pseudomonas; osteomyeloitis sickle cell, pyelonephritis, anthrax

can fuck up absorption with antacids

adverse: long qt, tendon rupture (kids, elderly, steroids, pregnancy)

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45
Q

major side effect amphotericin

A 
infusion related headache, hypotension, fever, chills, thrombophelitis
cns admin (intrathecal): fever, seizure, neuro damage
Renal damage (prerenal azotemia, hypokalemic type 1 tubualr injury, can manage with magnesium I think also do volume expansion with saline before admin). anemia from epo issues
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46
Q

Nystatin moa

A

same as amphotericin; binds to ergesterol and forms pores to induce electrolyte leakage

47
Q

metronidazole main sx, moa

A

forms free radicals-> damgae bact dna

disulfram rxn

48
Q

interferon beta use

A

relapsing remiting ms

49
Q

interferon gamma usage

A

treats CGD, or diseases with deficiecny in it

50
Q

interferon alpha usage, adverse rxn

A

hep B and C, hairy cell leuekmia, malig melanoma, Kaposis sarcoma, Condyloma accumuinatica, RENAL CELL CARCINOMA (also in general pegylated version lasts longer)
adverse: myelosuppression, flu symp, tinnitus, mood disorders, drug induced lupus

51
Q

entry and fusion inhibitors for HIV, names, moa, adverse rxn

A

maraviroc (block CCR5): so gotta genotype. (gp120)
enfurvitide; binds gp41 (fusion)
Can fuck both thse up with an env mutation (processed in host ER normally)
integrase inhibitors (pol gene)—eg is raltegravir. adverse rxn of rhabdomyolysis. Pol mutation fucks these up (as well as NRTIs, NNRTIs)

52
Q

Ribavirin moa, adverse rxn

A

Guanosine nucleoside naalog; needs to be phosphorylated 3 times (inhibits rna activity)
used in HCV with interferon alpha
adverse rxn are dose dependent hmeolytic anemia, tertaogen (must be on contraceptive)

53
Q

Sineprevir moa, use

A

NS3,4 protease inhibitors
can be used in HCV
adverse rxn are photosensitivity and cyp450inhibitor

54
Q

sofosbuvir moa, adverse rnx

A

direct poylmerase inhibitor; stop NS5B RNA production (I think this is for HCV as well), fatigue, nausea

55
Q

NRTIs unique side effects, qualities

A

tenofovir: nucleotide, does not need phosphorylation
stauvidine, lamivudine, zidouvine: lipodystrophy
lamivudine, stavudine, didenosine: periph neuropathy
didenosine: pancreatitis
Abacavir: HLAB57 allele issues (type IV hypersensitivity)
emtricabine: hyperpigmenting palms and soles
Zimivudine is your pregnancy guy, but it also can cause myelosuppression (in addition to lipodystrophy….periph neuropathy

in general names is “-dine”

56
Q

NNRTIs names and uses, adverse rxn

A

Efavirenz, Nevirapine, Delavirdine (watch the dine on the last one, I guess it sounds elvish), doesnt need phosphorylation, doesnt incoporate into DNA strand

adverse rxn: liver fialure (often fast within 6 weeks), CNS side effects (weird ones like nightmares and insomnia), tertaogenic
Nevirapine is a CYP450 inducer
Efa nad dela induce and inhibit cyp450
also SJS TEN

57
Q

Protease inhibitor name, adverse rxn

A

-navir
adverse rxn: hyperglycemia (insulin resistance), hyperlipiedemia, lipodystrophy, nephrolithiasis (esp indinavir, make sure htey have adequate hydration)
CYP450 inhibition (esp ritonavir, can be used theopetically)

58
Q

HSV, VZV tx

A

acyclovir/clovir guys in general.
Cidofuvir does not need phosphorylation
Foscarnet does not need any activaiton (inhibits viral DNA polymerase at pyrophosphate site)
Acyclovir is your only IV guy (so good for encephalitis and neonates)

Adverse rxn acyclovir: interstital nephritis/nephrolithiasis, be sure to hydrate
foscartnet has those hypo

59
Q

acyclovir adverse rxn (maybe other clovir too)

A

interstital nephritis/nephrolithiasis, be sure to hydrate, all drugs have CNS side effects

60
Q

CMV tx

A

oral vanciclovir/ganciclovir to prevent reactivation in HIV/transplant 9also CMV retinitis concern)
UL97 mutation, use foscarnet (this does first step of phosphorylation normally), cidofovir can be alright too

61
Q

adverse rxn ganciclovir and valciclovir

A

myelosuppression

62
Q

adverse rxn for fascarnet

A

hypocalcemia, hypomansium, renal toxiciity->hypokalemia, seizures

63
Q

What do you need to pair cidofovir with

A

probenicid; block its nephrotoxici effects (blocking the renal secrvetion)

64
Q

how could you be resistant to foscarnet or cidofovoir

A

dna polymerase mutation

65
Q

benzotropine

A

centrally acting M1 antagonist

66
Q

scolpamine

A

m1 antagonist crossing BBB for motion sicknes

67
Q

antimuscarnic heart effects

A

block parasymp effects of M2 on SA and AV nodes (increase HR and AV nodal conduction)—so can be useful in heart block (eg atropine)

68
Q

ipratroprium and tiotropium

A

M3 antagonists useful in COPD (bronchodilate, decrease secretions). tiotropium is longer lasting, dissociates more slowly

69
Q

oxybuytin, tolterodine

A

m3 antagonists use to treat incontinence (specifically urge incontinence htat occurs at night caused by detrusor overstimulation). relaxes smooth muscle in ureter and bladder wall.

70
Q

trihexyphenidryl, benzotropine

A

both m1 antagonists; can be used in parkinsons; (excess m1 linked to cog wheel rigidity, again this disease is increased Ach decreased dopamine). can also be used to tx extrapyramidal side effects from antipsychs

71
Q

antimuscarinic side effects

A

dry eyes and mouth
inhibit m3 sweat glands-> hyperthermia
blurred vision
acute angle closure glaucoma (due to mydriasis- dilation)
sedation, confusion,agitation, hallucination (m1, esp elderly)

72
Q

alpha 1 effects

A

Gq-> so increase IP3 and DAG (more Ca2+)
increase periph art tone (vasoconstrict), also venoconstrict, increase MAP
activate pupillary dilator muscle (pup dilation aka mydriasis)
urethral sphincter, prostatic muscle contraction (urinary retention)

73
Q

alpha 2 effects

A

basically decrease sympathetic tone (sympatholytics)
coupled to gi, decrease camp
inhibit NT release
decrease insulin release
inhibit lipolysis and release of fatty acids
decrease aqueous humor production at ciliary body

74
Q

brimonidine

A

alpha 2 agonist for open angle glaucoma (decrease AH prod at ciliary body)

75
Q

beta 1 agonist

A

Gs->increase cAMP and intracell calcium
SA and AV node: increase cardiac contractility, HR, CO
increase renin release

76
Q

beta 2 agonists

A

gs increase camp activate pka
coronary and skeletal muscle VASODILATION, decrease SVR
bronchodilation (look for -rol suffix eg albuterol)
act at ciliary body increase ah production
stimulates lipolysis and release of free fatty acids
increase insulin release (beta 2 islet cells) (can cause hypokalemia as a result)
gluconeogenesis at liver
relax uterine smooth muscle

77
Q

phenylephrine

A

alpha 1 agonist
treat nasal congestion (due to vasoconstriction)
increase MAP and systolic pressure (vasoconstrict) and diastolic (venoconstrict)
causes mydriasis
REFLEX BRADYCARDIA

78
Q

Norepinephrine

A

alpha agonist and beta 1 (more alpha)
increase map, systolic and diastolic
reflex bradycardia
increase cardiac contractility (beta 1 mediated)
widens pulse pressure (systolic and diastolic increase, but beta 1 makes more systolic)

79
Q

use for agonists in septic shock

A

phenylephrine, norepinephrine increase SVR and venosu return

80
Q

dobutamine

A

B1>b2
increase HR, cardiac contractility, CO—USE IN CARDIOGENIC SHOCK
moderate vasodilation (beta 2, decrease SVR)
increase systolic pressure (beta1)
decrease diastolic pressure (alpha 2 arterial dilation)
increase in pulse pressure (due to b1 effects)

81
Q

terbutaline, ritodrine

A

beta 2 agonist used to relax uterus and prevent premature labor

82
Q

Epinephrine

A 
beta, alpha activity
LOW doses (beta>alpha): bronchodilate (b2), decrease diastolic pressure (b2), increase HR (b1)
HIGH doses (alpha>beta):
increase MAP (alpha1)
increase systolic pressuer (alpha1), increase pulse pressure (alpha 1 but beta 1 contractility increase)
decrease diastolic (beta2)

Great in anaphylactic shock (bronchodilate, increase SVR)

83
Q

metyrosine

A

prevent conversion of tyrosine to L-DOPA

84
Q

cocaine

A

inhibit NET DAT
agitatino, dilation ,tachycardia, hypertension, mucosal atrophy, myocardial ischemia, coronary vasospasm (and thus angina)

85
Q

what to avoid in cocaine tx

A

dont give them a beta blocker (unopposed alpha action), severe hypertension

86
Q

atomoxetine

A

ADHD tx (serratra)

87
Q

reserpine

A

block VMAT, deplete NT Stores

88
Q

VMAT

A

vesicular monoamine transporter; moves catecholamines into presynaptic vesicle

89
Q

amphetamine

A

displace catecholamines into synapse
ADHD tx
appetite suppression

90
Q

modafinil

A

narcolepsy tx

91
Q

Dopamine

A 
D1 (Gs), D2 (Gi)
low dose
D1 increase renal blood flow
medium dose: acts on beta 1 to affect cardiac receptors (has those effects of increase contractility, HR, CO)
D2 is your cns guy
92
Q

clonidine

A

alpha 2 agonist
inhibits symp tone, reduc bp
treats hypertension, hypertensive urgency, can be used for ADHD

93
Q

alpha methyldopa

A

a2 agonist

htn tx, ESP GESTATIONAL HTN

94
Q

tizanidine

A

a2 agonist

muscle relaxant

95
Q

phentolamine

A

reversible alpha 1 and alpha 2 antagonist
vasodilates
cocaine tox, preop pheo
can cause reflex tachy

96
Q

phenoxybenzamine

A

IRREVERSIBLE alpha 1 and alpha 2 antaognist
tx for cocaine toxicity (phentolamine probs works too), preop pheo
can cause reflex tachy

97
Q

-osin suffix

A

alpha 1 antagonists (prazosin, doxazosin, tamulosin, terazosin)
treat BPH (relax smooth muscle prostate and urethra)
vasodilation
prazosin has unique use in PTSD

98
Q

mirtazapine

A

alpha 2 antagonist, atypical antidepression

enhances serotonin release

99
Q

why beta blockers relieve angina

A

decrease myocardial oxygen demand (decrease contractility and HR)

100
Q

beta blockers A-M

A

more beta1>beta 2, mostly cardioselective

101
Q

beta blockers and mortality rate

A

decrease it; dont forget they modify cardiac remodeling effects

102
Q

carvedilol

A

beta block and alpha 1 block, also mortality reducing for heart stuff

103
Q

timolol

A

beta block for glaucoma; (antagonize beta 2, reduce AH production at ciliary epithelium)

104
Q

beta block adverse effects

A

worsen asthma, COPD (esp nonselective N-Z, antagonize bronchodilate)
impotence
heart block

105
Q

acebutolol, pindolol

A

a beta 1 antagonist with some agonist activity—avoid in HF patients or MI patients

106
Q

Hypertensive emergency

A

labetalol or esmolol

107
Q

Labetalol

A

other beta block and alpha 1 block
use to treat HTN in pregnany
good for hypertensive emergency
good for htn in general

108
Q

unique beta block uses

A

thyroid storm
migrane prophylaxis
essential tremor
aortic disseciton (including labetolol)

109
Q

tx beta blocker toxicity

A

glucagon

110
Q

fenolodopam

A

d1 agonist for hypertension

111
Q

isoproternolol

A

b1 and b2 agonist for heart block

112
Q

advantage clonidine and methyldopa for htn

A

dont reduce kidney blood flow

113
Q

midodrine

A

selective alpha 1 guy; good for orthostatic HTN

114
Q

ephendrine

A

like amphetamines; release stored catecholamines

nasal decongest, urinary retention, hypotension

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