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1
Q

Most common cause of neural tube defects?

A

Folate deficiency

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2
Q

Most common preventable cause of congenital malformations in US?

A

Fetal Alcohol Syndrome

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3
Q

“Fried egg” appearance

A

Expansive clear cytoplasm seen in

  1. Oligodendrocytes
  2. Koilocytes (HPV)
  3. Testicular tumor cell (Seminoma)
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4
Q

Anti-epileptics that cause Steven’s Johnson syndrome. + 3 more

A 
Ethosuxamide
Lamotrigene
Carbamazapine
Phenytoin
Phenobarbital

Sulfonamides
Penicillin
Allopurinol

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5
Q

Anti-epileptics that are teratogens.

A

Carbamazipine
Phenytoin
Valproic acid (spina bifida)

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6
Q

Anti-epileptics that cause hepatotoxicity.

A

Valproic acid

carbamazipine

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7
Q

Drugs that induce CYP450

A 
"Coronas, guinness, and PBRS cause chronic alcoholism"
Carbamazipine
Griseofulvin
Phenytoin
Barbituates
Rifampin
St. Johns worts
Chronic alcoholism
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8
Q

Treatment for absence seizure

A

Ethosuxamide

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9
Q

treatment for tonic clonic seizure

A

Phenytoin
carbamazipine
valproic acid

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10
Q

Vitamin A toxicity can cause what neuro pathology?

A

pseudotumor cerebri (idiopathic intracranial hypertension)

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11
Q

What medications have anti-cholinergic side effects?

A

First gen H1 blockers - diphenhydramine, doxalymine, chlorpheniramine
Neuroleptics
TCA - dry mouth
amantidine

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12
Q

CYP450 inhibitors

A

CRACK AMIGOS

Cipro
Ritonavir (protease inhibitor)
Amniodorone
Cimetidine
Ketoconazole
Acute alcohol use
Macrolides
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides
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13
Q

Gq receptors

A

C(Q)utsies HAVe 1 M&M

Gq --> phospholipase C
H1
alpha1 
V1
M1
M3
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14
Q

Gi receptors

A

MAD 2

M2
alpha 2
D2

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15
Q

Gs receptors

A

B1, B2, H2, V2, D1

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16
Q

Effects of stimulation of alpha 2 receptors.

A

Decreased SNS output (Decreased NE release)
decreased insulin release
decreased lipolysis

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17
Q

Stimulation of alpha 1 receptors

A 
vasoconstriction
Increased peripheral resistance
mydriasis
increase bladder sphincter contraction
increased gut sphincter contraction
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18
Q

Stimulation of B1 receptors

A

Increased chronotropy and inotropy
Increased renin release
Increased lipolysis

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19
Q

Stimulation of B2 receptors

A

Bronchodilation
vasodilation
Decreased uterine tone (tocolytic)

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20
Q

Cholinergic (Muscarinic) effects

A

DUMBBELSS

Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal muscles
Lacrimation
Sweating
Salivation
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21
Q

Anti-Cholinergic (Muscarinic) effects

A 
Hyperpyrexia (hot as a hare)
No salivation/lacrimation (dry as a bone)
Flushing (red as a beet)
Mydriasis (Blind as a bat)
Delirium (mad as a hatter)
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22
Q

Equation for volume of distribution (Vd)

A

Vd = amount of drug in body / amount of drug in plasma

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23
Q

Equation for clearance

A

CL = (0.693 x Vd) / half-life

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24
Q

Equation for loading dose

A

Loading dose = Steady state concentration x Vd / F

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25
Maintenance dose equation
Maint dose = Steady state concentration x CL / F
26
Does a decrease in Km mean increased or decreased potency?
Increased potency
27
Does an increase in Vmax mean increased or decreased efficacy?
Increased efficacy
28
What reactions occur in Phase I drug metabolism?
Reduction, oxidation, and hydrolysis (P450) lost first in elderly Can activate pro-drug or make something toxic
29
What reactions occur in Phase II drug metabolism?
Glucuronidation, acetylation, sulfation Some elderly can be slow acetylators produces very soluble (polar) and inactive metabolites
30
Drugs used for urge incontinence.
Oxybutynin Solifenacin Tolterodine Trospium Muscarinic antagonists
31
Neuroleptic drugs often have anticholinergic effects. What drug would you use to mitigate these?
Bethanochol (cholinergic agonist)
32
What drugs cause cutaneous flushing?
Vancomycin Adenosine Niacin Dihydropiridine CCB
33
What drugs cause coronary vasospasm?
Cocaine Amphetamines Sumatriptans Ergotamine
34
What drugs cause dilated cardiomyopathy?
Anthracyclines Doxarubicin Donarubicin
35
What drugs can cause Torsaddes de pointe?
``` Class III anti-arrhythmics --> K+ block Class Ia anti-arrhythmics Macrolides Haloperidol Chloroquine Protease inhibitors for HIV antipsychotics / TCA ``` Treat with IV Mg2+
36
What drugs causes thrombocytopenia?
Heparin | Cymetidine
37
What drugs cause agranulocytosis?
Clozapine Carbemazipine Colchicine Propylthiouracil Methimazole Dapsone
38
What drugs cause aplastic anemia?
``` Carbamazepine Methimazole NSAID Benzene Chloramphenicol Propylthiouracil ```
39
What drugs can cause grey baby syndrome?
Chloramphenicol | --> UDP glucuronyltransferase hasn't matured yet in babies
40
What causes hemolysis in G6PD deficient patients?
``` Isoniazid sulfonamides dapsone primaquine aspirin ibuprofen Nitrofurantoin (UTI drug) Fava beans Naphthalene ```
41
What drugs can cause thrombotic complications?
OCP (especially in smokers >35 y/o)
42
What drugs can cause pulmonary fibrosis?
Bleomycin Amiodarone Busulfan Methotrexate
43
What drug can cause a persistent dry cough?
ACE - I | mediated by bradykinin
44
What drugs can cause pseudomembranous colitis?
Clindamycin | Amoxicillin / ampicillin
45
What drugs can cause hepatic necrosis?
Excess halothane Excess acetominophen valproic acid amitina phyloides (mushroom toxin)
46
What drugs can cause hepatitis?
``` Rifampin isoniazid Pyrazinamide statins fibrate ```
47
What drug causes tertiary adrenal insufficiency?
Corticosteroid withdrawl
48
What drugs can cause pancreatitis?
``` Didanosine (Reverse transcriptase inhibitor) Corticosteroids Alcohol Valproic acid azothioprine Diuretics (HCTZ, furosemide) ```
49
What drugs can cause gynecomastia?
``` "Some Drugs Cause Awesome Knockers" Digoxin spironolactone estrogens cimetidine chronic alcohol use (cirrhosis) ketoconazole marijuana use ```
50
What drugs can cause hot flashes?
SERMS (tamoxifen, clomiphene)
51
What drugs can cause hypothyroidism?
amiodorone Lithium sulfonamides
52
What drugs can cause gout?
Diuretics (loop / thiazide) Niacin cyclosporine pyrazinamide
53
What drugs can cause gingival hyperplasia?
Verapamil | Phenytoin
54
What drugs can cause osteoporosis?
Corticosteroids | Heparin
55
What drugs can cause photosensitivity?
SAT for Foto sulfonamides amiodarone tetracyclines 5-FU
56
What drugs can cause Steven Johnson Syndrome?
``` "CLAPPPErS" Anti-epileptics (lamotrigene, ethosuxamide, phenytoin, phenobarbital, carbamazipine) allopurinol sulfa drugs penicillin ```
57
What drugs can cause SLE-like syndrome?
``` "SHIPP-E" Sulfonamides hydralazine isoniazid procainamide phenytoin etanercept ```
58
What drugs can cause tendonitis/cartilage damage?
Fluoroquinolones
59
What drugs can cause teeth discoloration?
tetracycline
60
What drug can cause myopathy?
``` fibrates niacin colchicine hydroxychloroquine IFN alpha penicillamine statins glucocorticoids ```
61
What drugs can cause interstitial nephritis?
NSAID furosemide antibiotics
62
What drugs can cause nephrogenic diabetes insipidus?
Lithium Demeclocycline Treat with HCTZ or Amiloride
63
What drugs can cause fanconi syndrome?
expired tetracycline heavy metal exposure wilsons disease
64
What drugs can cause hemorrhagic cystitis?
cylophosphamide isofamide Prevent by co-administering MESNA
65
What drugs can cause Parkinson like syndrome?
Metaclopramide anti-psychotics reserpine
66
What drugs can cause Cinchonism (Dizziness with headache, vision changes, and tinnitus).
Quinidine | Quinine
67
What drugs can cause seizures?
``` Buproprion imipenem/cilastin isoniazid tramadol metaclopramide Enflurane Withdrawl from alcohol or benzos ```
68
What drugs can cause Tardive dyskenesia?
Antipsychotic | metoclopramide
69
What drugs can cause a disulfram like syndrome?
``` Metronidazole Cephalosporins Procarbazine Disulfram First gen sulfonylureas ```
70
What drugs cause Nephrotoxicity / Neurotoxicity?
aminoglycosides cisplatin polymixins
71
What drugs are nephrotoxic / ototoxic?
Vanco aminoglycosides cisplatin loop diuretics
72
What drugs have anti-cholinergic side effects?
Atropine TCA H1 blockers Low potency neuroleptics
73
Antidote for amphetamine
ammonium chloride (acidifies urine) Treat symptoms with benzos, anti-psychotics, and anti-hypertensives
74
Antidote for acetominophen
N-Acetylcystine (replenishes glutathione)
75
Salicylate (Aspirin) overdose antidote
Sodium Biacarb (alkalinize urine)
76
Organophosphate poisoning antidote
Pralidoxime (regenerates AChE) | Atropine - immediate
77
Anti-muscarinic antidote
Physostigmine (anti-cholinesterase)
78
B-blocker and CCB overdose antidote.
Glucagon (increases cAMP in myocardium) Atropine!!! Calcium
79
Digitalis overdose antidote (arrhythmias)
K+ and Mg2+ optimization Anti-Dig Fab fragments Atropine (for sig bradycardia)
80
Iron poisoning antidote
Deferoxamine | Deferasirox
81
Lead poisoning antidote (developmental delay, GI symptoms)
Dimercaprol / Calcium EDTA Succimer Penicillamine (3rd line agent)
82
Mercury, arsenic, or gold poisoning antidote
Dimercaprol | succimer
83
Copper, arsenic, or gold poisoning antidote
Penicillamine
84
Carbon monoxide poisoning antidote
100% O2 | Hyperbaric oxygen
85
Methemoglobin antidote
Methylene blue --> restores iron to Fe2+ | Vitamin C
86
Cyanide poisoning antidote (inhibition of cytochrome C oxidase)
Hydroxocobalamin (Vit B12 that binds cyanide and inactivates it) Thiosulfate + Nitrites (converts Hb to Met Hb) because cyanide loves metHb
87
Methanol / ethylene glycol antidote
Fomepizole (inhibits alcohol dehydrogenase) Ethanol Dialysis
88
Opioid overdose antidote
naloxone / naltrexone
89
Benzodiazepine overdose antidote
Flumazenil | Supportive care --> too rapid can lead to seizures
90
TCA overdose antidote
Sodium bicarbonate (alkalinize the urine)
91
Heparin overdose antidote
Protamine
92
Warfarin overdose antidote
vitamin K (works very slowly) Quick action --> FFP
93
tPA, streptokinase, urokinase overdose antidote
aminocaproic acid
94
Theophylline overdose (Asthmatic patients)
B-blocker
95
What electrolyte imbalance can facilitate procainamide toxicity?
hyperkalemia
96
What is the therapy for procainamide OD?
sodium lactate
97
Which anti-arrhythmic is most effectiv in acute thyrotoxic arrhythmias?
B-blockers like esmolol
98
Which anti-arrhythmic has the longest half-life?
amiodarone
99
3 uses of N-acetylcysteine
Acetominophen toxicity Mucolytic (CF) Prevention of contrast nephropathy
100
What are two 1st generation H1 blockers?
Diphenhydramine Chlorpheniramine Side effects - anti-muscarinic (blurred vision - mydriasis) anti-alpha adrenergic (hypotension, postural dizziness) anti-serotonergic (appetite stimulation and weight gain) Crosses BBB easily causing sedating effects
101
What kind of reactions occur in phase I metabolism and what types of products are produced?
Hydroxylation, reduction, oxidation Slightly more polar/soluble products are made. Sometimes can activate an inactive pro-drug or make something toxic.
102
What kind of reactions occur in phase II metabolism and what types of products are produced?
Glucuronidation, sulfation, acetylation Very polar / soluble products that are usually inactive metabolites. Easily excreted by kidney after.
103
What are the by-products of MAO and COMT activity on dopamine, NE, and epinephrine?
``` Dopamine = Homovanillic acid NE = vanillylmandelic acid Epinephrine = metanephrine ```
104
What are some drugs that have a small therapeutic index?
warfarin lithium digoxin phenobarbital
105
Where is NE made in the brain?
Locus Ceruleus (pons) Solitary tract reticular formation
106
Where is dopamine made in the brain?
Ventral tegmentum | substantia nigra pars compacta
107
Where is 5-HT made in the brain
Raphe nuclei
108
Where is ACh made in the brain?
Basal nucleus of Meynert
109
Where is GABA made in the brain?
Nucleus accumbens
110
Which drug can be used to reverse neuromuscular blockade?
Cholinesterase inhibitors | Neostigmine --> only for non-depolarizing agents like tubocurarine or vecuronium
111
First generation H1 blockers
Diphenhydramine Dimenhydrinate Chlorpheniramine
112
Second generation H1 blockers
Fexofenadine Loratidine Desloratidine Cetirizine
113
What receptors does Albuterol / salmeterol agonize / applications
B2 > B1 Acute asthma - albuterol long term asthma control - salmeterol
114
What receptors does dobutamine agonize / application
B1 > B2 > a Heart failure (inotropy >> chronotropy)
115
What receptor does dopamine agonize / application
D1 = D2 > B > a D (low doses) B (medium doses) a (large doses) Unstable bradycardia HF Shock
116
What receptor does epinephrine agonize / application
B > a Anaphylaxis asthma open-angle glaucoma
117
What receptor does isoproterenol agonize / application
B1 = B2 E-phys evaluation of arrhythmias
118
What receptor does norepinephrine agonize / application
a1 > a2 > B1 Hypotension (decreases renal perfusion)
119
What receptor does phenylephrine agonize / application
a1 > a2 ``` Hypotension (vasoconstriction) ocular procedures (mydriatic) rhinitis (decongestant) ```

Rapid Fire Facts (13 decks)

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