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treatments from questions Flashcards

1
Q

treatment of all atypical pneumonias? Moa

A

macrolides: inhibit protein synthesis by block translocation of messenger RNA (bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic.

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2
Q

treatment of Mycoplasma pneumonia

A

azithromycin (macrolide)

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3
Q

HIV antiviral that causes anemia (“labs reveal new onset anemia and reticulocytopenia”)

A

Zidovudine

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4
Q

tx for somnambulism (sleepwalking)

A

TCAs or benzodiazepines. TCA moa: reuptake inhibiton of serotonin and norepi

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5
Q

serotonin syndrome (delirium, headache, autonomic instability, hyperthermia, convulsions, and coma) What causes this?

A

Meperidine use within 14 days of .monoamine oxidase inhibitors (MAO-I) (selegiline, tranylcypromine, or phenelzine) or selective serotonin reuptake inhbitors (SSRIs) This creates an excitatory rxn (serotonin syndrome)

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6
Q

meperidine moa:

A

mu opioid receptor agonist analgesis.it efficacy as an analgesic relates to inhibition of the ascending pain pathway.

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7
Q

what are most neuronal receptors, including (dopamine receptors) targeted by haloperidol, are found on?

A

post-synaptic DENDRITES

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8
Q

antidote/tx for serotonin syndrome

A

cyproheptadine (5-HT2 recptor antagonist)

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9
Q

1st line tx for narcolepsy (sudden, brief episodes of excessive daytime sleepiness and cataplexy(loss of muscle tone w/ strong emotions)

A

Modafinil (non-amphetamine alternative that acts to stimulate wakefulness)

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10
Q

drug for treating the tics from tourettes what drugs would you use?

A

dopamine D2 receptor antagonist: haloperidol (1st gen antipsychotic) however high likelihood causing extrapydramidal SE (akathisia, parkinsonism, dystonia, tardive dyskinesia)

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11
Q

levodopa for parkinsons moa

A

replenishes the dopamine lost from degen of the substantia nigra.

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12
Q

carbidopa reduces peripheral side effects of levodopa (inhibits its conversion to dopamine by)

A

inhibiting aromatic-L- amiino-acid decarboxylase. (DOPA decarboxylase)

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13
Q

restless leg syndrome (uncontrollable urge to move legs, worse at night laying down, sensation of “pins and needles” and creep crawly. Tx?

A

dopamine agonist ropinirole

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14
Q

primary tx for urinary retention caused by anesthesia?

A

bethanechol ( muscarinic receptor agonist.

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15
Q

dantrolene and bromocriptine can be used for ?

A

(NMS) neuroleptic malignant syndrome (caused by antipsychotics) and (dantrolene) malignant hyperthermia.

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16
Q

benzodiazepine (alprazolam) overdose tx?

A

Flumazenil

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17
Q

ramelteon. (tx insomnia) MOA

A

melatonin receptor agonist, binds MT1/2 in suprachiasmatic nucleus

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18
Q

pt w/ insomnia. Would you want to use a benzo (lorazepam) or Nonbenzodiazepine hypnotics (Zolpidem) note both modulate GABA receptors

A

Nonbenzo. (3 ZZZ’s put you to sleep) Zolpidem, Zaleplon, esZopiclone. Act via + allosteric modulator of the omega 1 type GABA receptor (BZ1). Minimal daytime drowsiness and low tolerance. Compared to benzo.

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19
Q

clozapaine (TCA) major side effect

A

agranulocytosis. (low WBC)

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20
Q

IV thiopental (barbiturate) is used for induction of anethesia and has rapdi onset and short duration of action why?

A

redistribution to skeletal muscle and adipose.

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21
Q

what is the most common augmenting agent in pts with resistant depression and also can be used as maintenance therapy to prevent recurrence of depression

A

lithium.

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22
Q

drugs primarily used in edema associated with heart failure?

A

loop diuretics (flurosemide, bumetanide, torsemide, ethacrynic acid) inhibit NA-K-Cl2 transporter, in thick ascending loop of henle

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23
Q

malignant hyperthermia caused by volatile anesthetics, or succinylcholine. Whats the antidote?

A

dantrolene (muscle relaxant) blocks ryanodine receptor.

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24
Q

best tx for restless leg syndrome. MOA

A

dopamine agonist (pramipexole, ropinirole)

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25
Q

drug for heparin reversal>

A

protamine

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26
Q

what would you give for hemostasis when fribinolysis is causing bleeding>

A

aminocaproic acid. (antifibrinolytic that inhibits plasminogen activators and lesser degree antiplasmin activity).

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27
Q

whats the diff bw FFP and Cryoprecipitate?

A

FFP (contains all the coagulation factors) cryoprecipitate (only cold soluble proteins “ factor VIII, fibringon, von willbrand factor, vitronectin)

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28
Q

class III antiarrhythmic durgs (amiodarone, softalol, dofetilide) predominant block?

A

block K channels and inhibit the outward K current during phase 3 (late repolarization) –> prolongation of repolarization, action potential duration, and QT interval on ECG. Used for maintenance of sinus rhythm in pts with paroxysmal a-fib!!!

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29
Q

pt with narcolepsy and has cataplexy. Tx?

A

modafinil or amphetamines.

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30
Q

pt with GAD and is scared of dependences. What drug will help her anxiety w/ lowest risk of dependence?

A

buspirone (stimulates 5-HT1A receptors)

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31
Q

antidote for TCA overdose w/ cardiac involvement

A

Sodium Bicarbonate.

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32
Q

whats the most serious sideeffect of ethosuximide?

A

SJS (malaise and fever accompanied by a rapid onset of erythematous macules –> epidermal necrosis andd sloughing of skin)

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33
Q

SSRI causes

A

wt gain and dec libido

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34
Q

haloperidol (antipsychotics) can lead to what hormone prob

A

it’s a dopamine antagonist. Thus inc prolactin –> white milky discharge.

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35
Q

moa of mthylphenidate (first line for ADHD)

A

inhibits reuptake of dopamine and nor epi

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36
Q

whats the treatment for Extrapyramidal symptoms of antipsychotic drugs. (specifically the dystonia “torticollis”) other symptoms (akathisia, parkinsonian syndrome, and tardive dyskinesia).

A

dystonia symtpoms of torticollis or oculogyric crisis “eyes stuck upward” you would use anticholinergic agents (diphenhydramine and benztropine). For akathisia (motor restlessness w/ an urge to move): beta blcokers.

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37
Q

drugs to prevent future panic attacks not acute treatment is?

A

SSRI (paroxetine)

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38
Q

most efficacious meds for treating acutge mania?

A

olanzapine, risperiodone (2nd gen) haloperidol (first)

39
Q

the gold standard/most effective tx for nocturnal enuresis is?

A

enuresis alarm (bed wetting alarm) with a bed mat.

40
Q

(methylxanthines) theophylline intoxication (use for COPD) should be monitored for?

A

Seizures and tachyarrhythmias (seizures are the major cause of morbidity and mortality

41
Q

which anti-inflammatory does not impair platelet aggregation?

A

celecoxib (reversibly and selectively inhibits COX 2 (NOT COX1 –> impairing gastric mucosa, inhibits TXA2 production)

42
Q

to minimize day time side effects you give short or intermediate acting benzos. What are they?

A

short (triazolam, Oxazepam, Midazolam), (half life 6-24hrs) INTERMEDIATE (alprazolam, lorazepam, temazepam)

43
Q

what are the long acting benzos?

A

Diazepam, Chlordiazepoxide, Flurazepam.

44
Q

first line tx for nightmares (besides nightmares caused by PTSD)

A

benzodiazepines. (PTSD give prazosin = a1 antagonist)

45
Q

pt with huntingtons, and bad chorea. The 1st line tx for chorea is tetrabenazine. What is the second line?

A

atypical antipsychotics (olanzapine) which is a serotonin-dopamine antagonist.

46
Q

kawaski disease tx. (child before age 5)

A

IV immunoglobulin

47
Q

pt gets bit by dog –> pasteurella multocida. What drug would you use if pt has penicillin and sulfa allegy

A

tetracycline (Doxycycline)

48
Q

vancomycin is associated with what adverse effect.

A

infusion related flushing

49
Q

why should pt taking metronidazole avoid alcohol

A

disulfiram like rxn

50
Q

crproheptadine is a what type of drug and used for?

A

cyrproheptadine = serotonin antagonist. Used for carcinoid and as an antidote for serotonin syndrome

51
Q

which drug is most likely to causes drowsiness? Diphenydramine or loratadine?

A

diphenhydramine (first generationi antihistamine - can cross BBB thus can cause sedation) unlike H1 blocker loratadine that is a second gen antihistamine.

52
Q

2ndbest tx after penicillin for child 7 yo that has stept pyogenes infection with penicillin allergy? What should the pt be mointored for which side effecT?

A

macrolides, erythromycin and azithromycin monitor for prolonged QTc interval (particularly erythromycin)

53
Q

a pt with a peptic ulcer caused by H pylori is started on a trip drug therapy. He complains of a rash that becomes red and itchy when he goes in the sun. whats the cause?

A

tetracyclines

54
Q

the most common used regimens for triple therapy in H pylori are?

A

clarithryomycin based (a ppi, clarithromycin, amoxicillin or metronidzaole.) the second most common = Bismuth quadruple therapy (bismuth subsalicylate, H2 blocker “ranitidine”, metronidazole, tetracycline.)

55
Q

treatment for post-herpetic neuralgia

A

TCAs (amitriptyline) anticonvulsants (Gabapentinand pregabalin) and lidocaine patches)

56
Q

whats the major side effect of this drug that inhibits phosphodiesterase 5 that normally converts cGMP –> 5-GMP, resulting increase cGMP accumulation –> inc BF to vorps cavernosum?

A

cyanopsia or blue vision (pt complains of blue tint to their vision) drug sildenafil.

57
Q

pt with breast cancer estrogen receptor +

you give her

*Anastrozole or exemestane

moa

A

decrease androgen Aromatization

58
Q

pt with pericarditis

she takes procainamide for atrial flutter

what drug should be stopped and what should be started

A

stop procainamide because its causing SLE which lead to Pericarditis

and start ibuprofen

59
Q

pregnant women develops lepromatous leprosy

what drug should not be given to this pt

A

thalidomide

bc it can cause limb reduction

60
Q

what best characterizes Etanercept

A. cell surface receptor antibody

B. chimeric monoclonal ab

C. humanized monoclonal antibody

D. small molcule receptor inhibitor

E soluble receptor decoy protein

A

Soluble receptor decoy protein to TNF -a

A = Rituximab = chimeric monoclonal ab targets CD 20 a cell receptor found on surface of B cell

B. = infliximab= chimerc monoclonal ab, against TNF a

C. Certolizumab pegol = is a pegylated humanized monoclonal ab that targets TNF a

D. imatinib mesylate is used to treat specific cancers (CML, and KIT + gastrointestinal stromal tumors. (small molecule tyrosine kinase receptor inhibitor)

61
Q

pt with TB is treated with drug A

now isolates from the growing culture become less resistant to decoloration w/ an acid alcohol agent and stop proliferating

which TB drug is responsible

A

isonized

inhibits mycolic acid synthesis

62
Q

rifampin MOA

A

inhibition of bacterial DNA dependent RNA polymerase

side effects: gi side effects, RASH, red orange body fluids, cytopenias

63
Q

what TB drug

inhibits arabinosyl transferase

and Side effect = optic neuropathy (loss of red and green color)

A

ethambutol

64
Q

tx for essential tremor besides alcohol

A

nonselective beta blocker

propranolol

or primidone

65
Q

pt given a lipid lowering agent, now she has facial flushing and a pruritic rash of on her torsa and upper extremities.

whats the mechanism of action of the drug?

A. increasing lipoprotein lipase

B. decreasing the secretion of VLDL from hepatocytes into the circulation.

A

NIACIN: decreasing the secretion of VLDL from hepatocytes into the circulation.

it increases HDL

66
Q

tx for vWD

A

desmopressin acetate

works by raising the patient’s own plasma levels of vWF by inducing release of vWF in the Weibel-Palade bodies in the endothelial cells

67
Q

The rash appeared after a few tanning sessions. Visual inspection reveals numerous marginated, ovular macules exhibiting hypopigmentation. Which of the following is the most appropriate treatment?

A

selenium sulfide lotion

(malassezia)

68
Q

Stimulation of β-2 adrenergic receptors of the sympathetic nervous system, by epinephrine, is associated with

A. decreased uterine tone

B. increased renin release

A

decreased uterine tone

vascular and nonvascular smooth muscle relaxation

incorrect is increased renin production

There are no β-2 adrenergic receptors within the kidneys. It is the β-1 adrenergic receptors that is located in the juxtaglomerular cells of the kidney. Activation of the β-1 adrenergic receptors in these specialized cells results in increased renin release

69
Q

guy with PTSD

whats the most appropriate pharmacologic therapy

A

citalopram

(SSRI) first line

70
Q

pt with Serotonin syndrome.

treatment that should be instantly started?

A

cyproheptadine

(serotonin receptor antagonist).

71
Q

first line tx of trigeminal neuralgia

moa

A

carbamazepine

blocks na channels and inhibits action potential propagtion.

72
Q

medication that inhibits dipeptidy peptidase -4 from breaking down incretins.which will help improve the efficacy of pancreatic beta cells.

A. glipizide

B. sitagliptin

pramlinitde

A

sitagliptin.

(also linagliptin, saxagliptin)

73
Q

unresponsive 62 yo man comes in from major motor vehicle accident

his BP is 160/90

a few hours after initial tx and stabilization, he develops tachypnea and decreased oxygenation.

his chest xray shows pulomnary edema.

he dies few hours later despite aggresive tx

what drug caused this pts condition

A

mannitol

is an aggressive osmotic diuretic which causes pulmonary edema

the pt was given mannitol to protect from inc ICP

74
Q

mom gives birth to child with

hearing and visual impairment,

missing or malformed earlobes

what was mom taking during pregnancy

A

isotretinoin

for her acne

75
Q

moa of flutamide

A

*impaired androgen receptor interaction

flutamide is a nonsteriodal competitive inhibitor at androgen receptors.

used for prostate cancer.

76
Q

Cystic fibrosis

what describes the dysfunctional transmembrane protein (CFTR) causing the pts disease?

A

ATP gated

mutant CFTR channel with impaired ATP binding blokcs chlroide ions, creating sticky mucus build up.

the channel opens after binding of 2 ATP molecules allowing transport of chloride ions down the electrochemical gradient.

wrong answer: cyclic nucelotide gated (important for photoreceptor and olfactory receptor neurons). these are directly activated by cAMP.

77
Q

a man with lung neoplasm presents with

cachexia a syndrome that encompasses anorexiam malaise, anemia, wt loss and generalized wasting due to underlying systemic disease.

what is causing the patients musce wasting

A

tumor necrosis factor -a

it also causes necrosis of some tumors in vitro and proudces symptoms of cachexia.

78
Q

drug of choice first line tx

for bulimia nervosa

A

fluoxetine

(SSRI)

79
Q

pt with heroin addiction

you give methodone

what drug property allows for this drug to benefit this pt

A

long half life

with sustained effects after chronic dosing and supresses cravings and withdraw symptoms for > 24 hours

incorrect is partial agonist at mu receptor (buprenorphine)

80
Q

buspirone is used for

GAD.

it is a nonbenzodiazepine anxiolytic.

what is buspirone associated with?

A. eifficacy in panic disorder

B. muscle relaxant properities

C. slow 0nset of action

A

slow onset of action.

81
Q

penetrating peptic ulcer and bleeding

lesser curvature of the stomach (most common)

what artery?

A

left gastric Artery!!

82
Q

penetrating peptic ulcer and bleeding what artery?

posterior wal of the stomach

A

splenic artery

83
Q

penetrating peptic ulcer and bleeding what artery

first part of the duodenum

A

gastroduodenal artery

84
Q

pt has esophageal varices where is the bleeding from do to portal htn?

A

left gastric vein.

85
Q

a pt on fluorinate inhaled anesthetic (isoflurane)

you expect what to increase?

A. GFR

B. effective renal plasma flow

C. Left Vent EF

D. Hepatic BF

E cerebral BF

A

cerebral blood flow increases which can cause inc ICP

you see decrease in CO, dec in hepatic bf, dec in GFR and renal plasma flow.

86
Q

visceral nausea due to GI insults (gastroenteritis, chemo, general anesthesia) what would be the receptor you would target for tx

A

5-HT3

H1 (antihistamines), Muscarinics (anticholinergic) are recommended for vestibular nauea.

dopamine antgagonists are useful for nausea associated with migraines.

87
Q

which antifungal agents inhibit fungal colony growth by changing the composition of fungal cell membrane

and

INHIBIT liver CYP 450

thus dec metabolism of several drugs?

A

-AZOLES

inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome p 450 enxzyme that converts lanosterol –> ergosterol

88
Q

Q on boards chronic alcohol abuse

decreased libido

severe gyncomastia

testicular atrophy

widespread bruises

diagnosis

A

hepatic failure

why gyncomastia and dec libido - bc estrogen accumulates and its not metabolized by the liver anymore since the liver is failing

89
Q

37 yo female. presents to ER with pain in ankles for past two months. long story short she has RA. you give her a drug. 3 months laters she presents to ER with drooping of the face on the right side with associated weakness of the upper extremity.

these findings are most likely an adverse effect of which drug?

A. aspirin

B. Celecoxib

C. ketorolac

D. indomethacin

A

celecoxib

NSAID inhibits cox 2

well known side effect is thromboses –> stroke or MI

90
Q

on boards

pt has pseudomonas induced infection on on pt w/ contact lens

tx

A

topcial clindamycin

91
Q

U world.

major adverse effect of ganciclovir

A

(bone marrow suppresion)

(neutropenia, anemia, thrombocytopenia, leukopenia)

impaired renal function

92
Q

pt treated for TB

with RIPE and pyridozine

now pt has blurring of vision

on exam shows bilateral central scotomas.

whats responsible

A

ethambutol

93
Q
A

combank (3 decks)

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