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