u pharm Flashcards
low vd
3 5 liters
medium vd
14 to 16 liters
large vd
41 liters
n-acetyl transerase drugs
hydralazine, procainimid, isoniazid, dapson
how long to reach stead state?
4 to 5 half lives
low levels of active metabolites of tamoxifen in relapsed cancer patients
cypp450 polymorphism
aziathiprine and 6 mercaptopurine polymorphism
thipurine methyltransferase
anesthetic well vascularized compartments
brain, kidney, liver, lungs, heart
annesthetic poorly vascualarize compartment
skeletal muscle, bone, fat
a child with allergic rhinitis who has flushed cheeks and dilated pupils
receiving an atntagonist of muscarnic recptors (like diphenhydramine for his allergies)
antagonism of h1 was a choice but is not the answer
said this was common side effect of anticholinergics
side effect of anticholinergic in eldery
constipation, dry mouth
special property of rectal deposits
partial first pass avoidance because goes through the middle and inferior rectal veins, avoiding th e liver
who has greatest blood flow?
the small intestine
who has greatest surface area?
the small intestine
what makes something suitable for renal excretion?
hypopihlic (low vd) -> excreted directly
indicated metabolized first in the liver often
what makes something something suitable for liver metabolism?
high liphilicity, can penetrate the liver membranes and the can be excreted in bile or urine
these compounds would have high vd and good tossue penetration (including cns)
questions showed respireidone casuing?
NMS
kid with fever and status epileptogenic
treat for status epilotogenic
receptor x is stimualted and na/ca influx and k efflux
receptor x is nicottinic
central affects of l-dope
anxiety, agitation, insomnia, confusion, delusions, hallucinations
dopa decarboxylase inhbitor will not help these
ritodrine
b2 agonist for utereus
comt inhibitors in parkinsons
currently used for wearing off phenomenon
only use with sinemet
antimuscarinic?
blocking the effects of acetycholin
durgs causing DRESS syndrome
anticonvulsants (phenytoin, carbamazine), allopurinol, sulfonomide, antibiotics (minicycline, vancomycin)
dress syndrom features
fever, generalized lymphadenopathy, facial edema, diffuse sking rash, eosionophilia, and internal organ dysfunction
sings of jimsin weed poisoning
very similar to atropin
some extra ones mentioned
bronchodilation, detrusor relaxation and sphintor contraciton, secretions decreased lacrinmation, salication, sweating
CNS: hallucinations, agitation, delirium
mu delta and kappa receptors linked to?
inhibitor g proteins which than go and close ca channels or open k channels
happens and spinal and suprnail levels
exam findings in opiod OD
decreased bowel sounds bradycardia and hypotension (histamine release)
what do you treat restless leg syndrome with?
dopamine agonist (ropinirole, pramipexole)
physical exam findings in malignant hyperthermia
question just told you fever, muscle rigidity (muscle stiffness), and cyanotic skin mottling
od of insecticides atropine given, still at risk for?
muscle paralysis
od can causes E for emesis
B for bradycardia
selegiline proceeses?
MPTP to MPP+
in comparison to benzos zopidem lacks?
anticonculsant properties, no muscle relaxing effects and not used for anethesia
sinement drug response is
unpredictable
an old man with BPH has suprapubic tenderness and decreased urine output, what drug causes it?
TCA due to urinary retention
was taking it for diabetic neuropathy or insomnia
tizanidine
alpha 2 adrenergic agonist, used for spasticity in MS
i man sitting around develops chest pain, he is treated and it shows that drugs x lowers BP and HR, but then he devlops shortness of breath
beta blocker being used in the emergent treatment of MI
a man his develops flushing, diaphoresis, nausea, with a BP of 100/70 and hr of 55. Pupils are constricted but reactive to light. was treat for?
atonic bladder
a man has a stroke (65 years old) and is prescribed benzo for muscle spasticity, what drug should he avoid?
avoid other sedating agents.
alcohol, barbituates, neuroleptics, and 1st generation antihistamines
a man has sudden SOB and chest tightness. has a history of noncomliant htn. bibasilar crackles. bp is 195/115
htn emergency
treated with nitroglycerin mechanism -> myosin dephosphorylation
a diabetic taking lisinopril has try cough
give a sartan
man gets treated for afib and devlops lightheadedness, weakness, and presyncope.
he has sinus bradycardia, qt prolongation, self resolved torsades was cause of symptoms
he was on sotalol
his afib was giving him palpitations and chest pressure, and were paroxysmal. why he started the meds.
a woman gets pneumonia and then devlops hypotension and lactic acidosis. she is treated with norepi IV and tissues around IV blanch and become cold and hard. What should you inject?
the norepinephrine has extravasated and is causing intense alpha 1 effects
block with phentolamine
nitrates and angina
coronary arterioles are already maximally dilates in general so hard to dilate more (just a tid bit)
adenosine mechanism
acts on at1 receptors -> causese K to go out, hyperpolzarized membrane stays negative longer in the sinus and av node
slow sinus rate and decreased av node conduction
a 23 yearold man comes in complaing of SOB and chest pain while running. family history of an uncle who died suddenly. he has a crescnedo decrescedno systolic murmur. how would you treat this patient.
its HCM
negative inotropes are beneficial in treating the LVOT and also his angina. so use beta blockers (meoprolol) and nondehydropirying CCB (verapamil)
AVOID
Vasodilators such as dyhydropyridien CCbs, nitroglycerine, ACE inhibitors -> decreased vascular resistance) i think nitroglycerin would also have decreased preload
Dueretics -> decreased preload
All of the above will worse the LVOT
a man has an MI its complicated with sever acute HF how to treat
dobutamine
works on b1 receptors and minimal activity on b2 and a1
positive inotrope
weakly positive chronotrope
both of these things -> increased o2 consumption, but which can worsen iscemia, but in this case benefits outweight
also causes a mild vasodilation because the b2 activity is greater than b1
the net results are a decrease in systemic vascular resistance and an increase in contractility without a change in arterial pressure
dopamine factoids
remember d1 - b1 - a1
low dose -> increased in renal blood flow and gfr
medium does -> now beta 1 leads to increase contractility and pulse pressure and systolic BP rise while diastolic stays the same.
higher doses -> co decreases due to increased TPR from a1 effects
a man has a total cholesterol of 290 and triglycerides of 675 what to treat?
treat with fibrate because of the moderately eleveated triglycerides > 50 mg/dl
PPAR-A receptor activation decreases hepativc VLDL production and increases LPL activitive
mechanism of omega 3 fatty acids
lower triglycerides by decreasing VLDL output and decreasing production of apob
43 year old woman has ocasional squeezing sensatin lasting for ten to 15 minutes. not htn but active smoke. no ischemia with exercise. an ambulatroy ecg monitor shows transient st elevation in 1 avl and v1 v4 at night.. what would provoke this symptoms?
this woman has pritzmetal angina
avoid dihydroergotamine (an ergot alkaloid i think like bromocriptine) which is used to treat migraine headaches. it is vasospastic
also avoid triptans
triggers of pritzmetal
cigs, coaine,amphetamine, dihydroergotamine/triptans.
treatment of pritzmetal
tobacco and drug cessation and vasodilators (nitrates and CCBs)
a1 blockers and -dipines work mainly?
on arterioles
drugs that prolong the qt
class 1a and 3 antiarrythymics, antibiotics (macrolides and fluroquinolones, methadone, and antipsychotics (eg haloperidol)
cortisol and epinephrine are?
cortisol shows permissiveness because of upregulation of a1.
it isnt synergistic because it has no intrinsice vasoactive properties of its own
question involving phenyleprhine infusino like in FA.
what would happen?
decreased AV node conduction velocity.
points out that the kidneys have alpha 1 and their perfusion would decrease with phenyephrine infusion, just as would the sphlanich circ would too
pheynyephrine would increased increased PCWP due to increased arteriolar and venous constriction
what to treatnonischemic cardiomyopathy HF wiht?
same as ischemic
how to fix first doese hypotension of alpha blockers?
give small doses act first
DOC for hypertension and CAD and heartfailure
B blockers
drug of choice for diabetes and hypertension
ace
1st line for esssential HTN
thiazide
CCB adverse
dizziness and lightheadedness
a third effect of beta blockers you have been wondering about
they decrease vascular resistance by decreasing RAAS and endothelin (did not explain endotheln)
do not initiate B blockers in acute heart failure
three places to avoid nitrates
HCM
person on phosdieastarse inhibitors
right ventricular infarction
nitrates can cause
lgith headedness
sildenafil acts similar too?
BNP which binds the ANP receptors that activate guanylates cyclase (same thing NO activates). this causes vasocilation
thiazides cause
hypomagnesemia
a1 antagnist does what?
blunts the usual reflex upon standing
watch your what in pharmcokinetics problems?
UNITS!!! the time was in hours and minutes
man treated with two drugs for angina and gets low bp and hr
beta blockers and CCB
a drug that inccreases TPR, increases systolic BP, decreases pulse pressure, and decreases HR. what am i?
phenylephrine
Pulse pressure decreases because of reflex decrease in stroke volume and increased afterload
a woman gets a venous thromboembolism in pregnancy, how to treat
DOC is LMWH like enoxaparin
how could you medical treat gallstones if preferred?
bile acid supplement - ursodeoycholic acid
decreases cholesterol secretion and increases total bile
anticholinergic side effects of antihistamines
blurry vision, dry mouth, urinary retetion, constipation
girl consumed two bottles of insecticide. nausea, vomiting, abdominal pain, and copious diarrhea
Arsenic poinsoning
arsenic mech
binds to sufhydrl groups on PDH inhibiting cellular respiratorin
where can arsenic exposure occur?
pesticides/insecticides, contaminated water, pressure treated wood, matellurgy, glass making.
arsenic clinical features
abdominal pain, vomiting, sever watery diarrhea, delirium, hypotension from diarrhea. qtc prolongation from dehydration -> torsades. and a garlic odor.
These where in bold: Sever watery diarrhea Hypotension Qtc prolongation garlic odor
arsenic treatment?
dimercaprol
cyanide presentation
cherry red skin, confusion, abdominal pain, vomiting
how do fibrates cause gallstones?
inhibit cholesterol 7 alpha hydroxylas and increase cholesterol solubility
two common things that precipitate hepatic encephloapthy
- gi bleed
2. heavy meal
a person has a gastrojejunumy where the duodenum is resected, what will be deficient?
iron
what to give a cystic fibrosis pt for malabsorption?
pancreatice lipase
what are the independent effects of a bile acid resin and statin on cholesterol synthesis?
bile acid increase and statin decreases
statins works by decreasing intra liver cholesterol and upreguatling LDL receptors
the bile acid resin binds to the bile and causes its excretion, this upregulates more bile to be made, this causes increased LDL receptors and overall a decrease in choelsterol in the liver -> activates cholesterol synthesis
use statin to counteract and cause SYNERGISTIC action
what not to use loperamide or diphenoxylat ein?
invasive or toxin producing bugs like shigella, salmonella, c diff
what can induce COX2
il-1 and tnf a-> causes increased expression in inflammatory cells
a 26 yearold professional athelete prevents with acne, what is going on?
he is taking methytestosterone.
hes too old to have acne
dmard of choice for rheumatoid
methotrexate
initial treatment of rheumatoid
NSAIDs for symptoms relief
Most rapid relief of RA
prednisone (nsaid wasnt a choic)
neither are demards
DMARD therapy typical takes weeks to work
DMARDS
methotrexate (first line), sulfasalazine, hydroxychloroquine, minocycline, tnf a inhibitors.
relieve pain and inflammation and also modyify disease progression but takes weeks to show effect
first line for gout long term
xanthine oxidase inhibitors
what is a contraindiaction of uricosuric agents in gout?
renal colic - kidney stones
succnycholine hyperkalemia in
burns, myopathies (stem described quadrapelegic man), crush injuries, and denervation
succinycholine heart effects
bradycardia from parasympathetic stim or tachycardia from sympathetics being stimualte
lyme disease stages
early lyme disease you get flu like symptoms and erythema migrans (treat with doxycyline)
second stage you get av block and facial palsy (treat with ceftriaxone to prevent progression)
late disease features asymetric large joint arthritis and encephalopathy
desmopressure also called?
DDAVP
desmopression uses
mild hemophilia A and type 1 von willebrand disease (increases circulating factor 8 and endothelial secretin of vmf)
central diabetes insipidus and noctunral enuresis (binds v2 receptor in kidney tubules)
abciximab mimics what disease?
glanzmann thrombocytopenia
description of HIT
sever foot pain and right toe paleness
what substance will accumulate in the cell with methotraxate therapy?
so once inside methotrexate becomes polyglutamated keeping it in the cell
it inhibits DHF reductase causing, causing DHF to accumulate which becomes polyglutamted or something like that
folic acid would also accumulate, see diagram u drew in FA
vincristine causes?
finger numbness and tingling
man develops mouth ulcer on methotrexate. what to do?
give folinic acid
imagine the curves for insulins
rapid acting, regular, nph, determir, glargine
theophyllin cane cause?
seizures and tachy arrythmia
a man treated with coticosteroid cream for eczema for a number of years might devlop?
dermal atrophy
an elevtive hernia repair and high post void residual urine?
give bethanechol
female patient has acne and wants to take isotrentinoid, what should you do?
check for b hcg
a woman is diagnosed with panic disorder and is given a drugs that works in an hour and whats the action
benzo, binds allosterically to gaba
a man develops digoxin toxicity, what age related change would cause this?
a decreae in renal clearence, even in the presence of normal creatinine
an old man develops hives after eating some strawberries, he has cognitive problems. what to do?
give laratadine and avoid first gen antihistamines
a man has psoriasis and is prescribed a medication that activates a nuclear transccription factor, what was prescribed?
calcipotriene
others could be calcitriol, tacalcitol
bnind to vit d receptor and inhibit kertitinocyte proliferation and stimulate kertinocyte differntiation
a woman has a baby with pulmonary defects and potter syndrome, what caused it?
acei
get getal anuria, oligohydroaminos, pulmonary hypolasia, limb contractures (he had a shortned limb), calvirum defects (said they were underdevloped), falte facies
why does rebound congestion occur in phenylephrine use?
th nerve respond by synthesis less norepinephrine
a 2 day old girl has persistent crying termors tachpynea sneezing and diarrhea. what to treat with?
its neonatal abstinence syndrome from with of maternal opiates
treat with methadone
can also get irritability, jittery movements, vomiting,
meds with anticholinergic properties
antihistamines TCA 1st gen low potency antipsychotic 2nd gen antipsychotic clozapine antiparkinsons drugs (benztropine and triphenxidyl) belladonna alkaloids (atropine)
a woman on paroxetine devlops serotonin syndrome because she was treated with a drug for cellulitis. what drug?
linezolid
a man has zoster and the viruses are found to lack viral phosphorylating enzymes, what drug would treat?
codfovir, out of the options it was the only one that didnt need to be phosphorylated by the virus, doscarnet wasnt an option
timolol acts where?
ciliary epithelium
what to treat wet age related macular degenraion wiht?
smoking cessation and anti vegf (ranibizumab, bevacizumab)
a beta blockers would cause what effects?
a decrease in renin, at1, at2, aldosterorone, but no change in bradykinin
a man is on a mao inhibitor, wnat to switch to ssri, what must you do?
give time for presynaptic mao to be resynthezised
what would cause arrythymia in amphoterricin b?
renal tubular ydsufxn leading to electroyte problems
a man with HTN that is treated devlops sever cramping in the lower legs, whats the problem?
he was treated with a diuretic that caused hypokalemia by decreased volume and increased RAAS which can cause hypokalemia and metabolic alkalosis
a woman on respireidone devlops ammonehra and breat tenderness
answer in explnation
if more people were treated wiht penicillin for strep thorat what would u need to decrease?
cardiac surgery
why does acei cause an increase in creatinine?
decreased renal filtration fraction
side effects of EPO therapy
htn and thromboembolic events
homrone effects of acei
increased renin, at1, decreased at2 and aldosterone, increased bradkykinin
best med for primary and 2nd preventi of cardiovascular disease?
even if the hdls are low, it is still best to use hmgcoareductase inhibitor
effects of atenolol on cardiomycote(camp) jg (camp) and vacular (camp)
decreased decreased and no effects
acei hyperkalemia most common in?
renal insufficiency and pts taking k sparing diuertics
a man has exertional chest pain and is diagnosed with angina, given aspirin for secondary CVD prevention but has shortness of breath and wheezing. what to substitue with?
clopidogrel
a man on statins devlopes muscle pain, fatigue, and dark urine, what caused it?
erythromycin (cyp inhibiton) caused statin myopathy, and he had rhabdomyolysis which caused acute renal failure
dont use milrinon pharmacology in whom?
severly hypotensive people because it also raises cAMP in arterioles causing vasofilation
effects of selevtive artiolar vasodilator? and often given with?
reflex sympathetic activation which casues tachycardia and edema (from RAAS activation).
often given with sympatholytics and diuretics
dobutamine actions
b1 receptor action and weak activity on b2 and alpha 1 recptors.
a man with an acute MI is treated with alteplase and a low dose beta blocker. also given a single dose of morphine for pain. devlops an irregular breathing pattern, asymetric pinpoint pupils, and comatose.
intracranial hemmorhage from alteplase
man has acute MI and COPD history what to treat with? as far as beta blockers go?
treat him with a selective b1
absolute CI in OCPs
- history of thromboembolic event or stroke
- history of estrogen depedent tumpr
- women over 35 who smoke heavily
- hypetriglyceridemia
- decompensated or acute liver disease (would impair steroid metabolism)
- pregnancy
why does isosorbide dinitrate have such a low bioavilabilty?
high first pass metabolism
what is the major cause of first doese hypotension in acei initioation
volume depletion due to dieruetic use or HF, so in these pts start therapy at low dose
when to use b blocker for htn
migraine, esential tremor, anginapectoris/prior mi, a fib
how do beta blockers lower bp?
they do so by decreases myocardial contractility and also decreasing RAAS (would lead to decrease resistance remember)
phosphodiestares type 3 vs type 5
i think type 3 about camp and type 5 about cgmp
a man treated for depression has low bp and pulse of 100, mouth is dry and face is flushed, had grs prolongation and ventricular beats. what to treat cardiac stuff with?
sodium bicarb because hes OD on tca
adneosine can be used in?
stress test
lidocaine vs amiodiarone is acute magement of ventricular arrythymias during MI
amirodarone has replaced
treatment of PAD?
cilostazol and should also receive aspirin or clopidogrel for 2nd prevention of coronary heart disease and stroke
when do you really want to use fenoldopam?
in HTN emergency and renal inssuficiency
promotes renal perfusion, diuresism and natriuresis
statin increases?
ldl receptor density
stroke prevention after tia?
use statin, aspirin, and bp control
prevent mortality in hf patients?
acei, b beta, sprionaconte
to prevent the aldosterone remodeling
nitroglycerin tab effects? on lvedp, peripheral venous capacitence, svr
decreased, increase, decreased (slightly)
