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PHARM > Weeks 1-6 > Flashcards

Weeks 1-6 Flashcards

1
Q

known side-effect of acetylsalicylic acid in susceptible individuals is

A

potential to thin stomach lining

& cause ulcers, bleeding risk

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2
Q

Aspirin works as an anticoagulant by inhibiting formation of this molecule:

A

Thromboxane A2

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3
Q

Atenolol is an example of a(n)

A

Beta1-blocker

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4
Q

Which of the following is an effective treatment for CHF (congestive heart failure), but has a particularly low therapeutic index, and substantial adverse effects?

A

Digoxin (digitalis)

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5
Q

Digoxin treats angina primarily by

A

not used for angina?

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6
Q

Which of the following is an effective treatment for CHF (congestive heart failure), but has a particularly low therapeutic index, and substantial adverse effects?

A

Digoxin (digitalis)

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7
Q

Which of the following is NOT an effective treatment for CHF (congestive heart failure)?

A

Anticoagulants

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8
Q

A known side-effect of Celebrex is

A

Increased risk of MI

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9
Q

Simvastatin

A

Lowers blood cholesterol by inhibiting synthesis of cholesterol in the liver

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10
Q

Myopathy is sometimes a side-effect of:

A

Pravastatin

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11
Q

Ezetimibe (Zetia)

A

Lowers blood cholesterol by inhibiting dietary absorption of cholesterol

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12
Q

Acetaminophen is

A

An OTC drug that does not affect blood clotting or stomach ulceration

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13
Q

Acetylsalicylic acid is

A

An OTC drug that is often prescribed at low doses to reduce risk of MI

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14
Q

Verapamil (Calan) is an example of a(n)

A

Ca-channel blocker

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15
Q

Verapamil (Calan) is an example of a(n)

A

Ca-channel blocker

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16
Q

Promethazine (Phenergan) is an

A

Anti-emetic drug, NOT used with cancer chemotherapy

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17
Q

Ondansetron (Zofran)is an

A

Anti-emetic drug, used with cancer chemotherapy

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18
Q

Risperidone is an

A

Antipsychotic drug used with schizophrenia

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19
Q

Positive symptoms of schizophrenia include

A

Auditory hallucinations

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20
Q

Extrapyramidal symptoms

A

Can result from treatment with haloperidol

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21
Q

Anti-emetic drugs act on the CTZ (chemical trigger zone) which is found in

A

the medulla oblongata, outside the blood-brain barrier

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22
Q

Trazodone (Desyrel)is an example of a(n

A

SARI antidepressant

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23
Q

SSRI’s are sometimes prescribed together with amitriptyline to treat this side-effect of SSRI’s

A

Insomnia

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24
Q

Biochemically, depression seems to result from

A

Deficiencies of serotonin, dopamine and norepinephrine

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25
Q

Which of the following drug classes is also commonly used in treatment of bipolar disorder?

A

Anti-seizure medications

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26
Q

Barbiturate drugs are

A

Seldom used due to their risk of respiratory depression

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27
Q

Which of the following is NOT a side-effect of benzodiazepine drugs:

A

Respiratory depression

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28
Q

Midazolam (Versed) is a benzodiazepine that is

A

given IV before surgery (or colonoscopy etc) to produce sedation and amnesia.

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29
Q

Diazepam (Valium) is a benzodiazepine that is

A

sometimes used IV for status epilepticus.

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30
Q

Buspirone (Buspar) is a non-benzodiazepine drug that is

A

effective against anxiety and is not sleep-inducing

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31
Q

Complex seizures are characterized by

A

Confusion or loss of consciousness

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32
Q

Valproic acid (along with several other anti-seizure medications) is characterized by

A

Low therapeutic index

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33
Q

Phenytoin (along with several other anti-seizure medications) is characterized by:

A

High potential for teratogenicity

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34
Q

In addition to treating seizures, gabapentin is FDA-approved for

A

Treating shingles pain

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35
Q

A drug that is sometimes used IV to stop status epilepticus, but is not generally effective to prevent future seizures is

A

diazepam

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36
Q

Phenobarbital is a drug that is

A

Used occasionally for treatment of seizures

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37
Q

Lorazepam (Ativan) is a benzodiazepine that is:

A

used to treat a wide variety of conditions, including anxiety, alcoholism withdrawal, and chemotherapy-related nausea

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38
Q

Zolpidem (Ambien) is a non-benzodiazepine drug that is

A

widely prescribed, now available as a generic, and seems to have fewer withdrawal symptoms than benzodiazepines. treats insomnia.

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39
Q

Petit mal seizures are uniquely characterized by:

A

Absence of movement

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40
Q

Gabapentin (along with several other anti-seizure medications) is characterized by:

A

High frequency of off-label prescriptions

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41
Q

Valproic acid (along with several other anti-seizure medications) is characterized by:

A

High potential for teratogenicity

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42
Q

In addition to treating seizures, topiramate is FDA-approved for

A

Migraine prevention

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43
Q

Albuterol works by

A

acting as an agonist of B2 adrenergic receptors

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44
Q

Mometasone / Nasonex works as

A

an anti-inflammatory steroid

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45
Q

montelukast / Singulair works by

A

inhibiting release of inflammatory leukotrienes

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46
Q

Salmeterol asthma prescriptions have come into question because:

A

a recent study shows it relieves symptoms but may increase risk of asthma-related death

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47
Q

Which of the following drugs is a β

blocker that is less specific and no longer widely used?

A

propranolol

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48
Q

Which of the following drugs is a β

blocker that is now widely used to lower blood pressure?

A

metoprolol

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49
Q

Succinylcholine is used as a(n)

A

neuromuscular junction blocker in surgery

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50
Q

Chantix (varenicline) is used as a(n)

A

aid to smoking cessation

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51
Q

Side effects of excess dopamine in peripheral circulation include

A

High blood pressure and tachycardia

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52
Q

Ropinirole (Requip)is:

A

a PD drug that works as a dopamine agonist by imitating the action of dopamine.

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53
Q

Which of the following drugs is a β

blocker that is used opthalmologically to treat glaucoma?

A

timolol

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54
Q

Salmeterol / Serevent works by

A

acting as an agonist of B2 adrenergic receptors

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55
Q

Cromolyn sodium works by

A

stabilizing the membrane of mast cells to prevent histamine release

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56
Q

Side effects of excess dopamine in peripheral circulation include

A

High blood pressure and tachycardia

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57
Q

Selegiline is:

A

a PD drug that works by inhibiting dopamine inactivation in the brain.

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58
Q

Chantix (varenicline) is used as a(n)

A

aid to smoking cessation

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59
Q

Succinylcholine is used as a(n)

A

neuromuscular junction blocker in surgery

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60
Q

Sevoflurane is used

A

as an inhalation anesthetic

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61
Q

Stanozolol is an anabolic steroid that works by binding to a receptor protein inside cells, increasing mRNA & protein synthesis in the same way that testosterone does.
Accordingly, that receptor protein works as a(n)

A

Nuclear receptor

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62
Q

Stanozolol is an anabolic steroid that works by binding to a receptor protein inside cells, increasing mRNA & protein synthesis in the same way that testosterone does.
Accordingly, stanozolol works as a(n)

A

Agonist

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63
Q

Digoxin binds to the sodium-potassium pump of cardiac myocytes, inhibiting ion flow. Accordingly, digoxin works as a(n)

A

Antagonist

64
Q

Albuterol binds to a receptor in the autonomic nervous system, causing that receptor to be activated, expanding the airway. Accordingly, albuterol works as a(n)

A

Agonist

65
Q

Chronic users of heroin find that it takes more and more drug over time to achieve the same high. Research shows these users have fewer receptors on their neurons than nonusers.
This best illustrates

A

Pharmacodynamic tolerance

66
Q

A patient, concerned about his blood pressure, started taking 3x the prescribed dose of his metoprolol, a β-blocker. He was disappointed to find that his blood pressure remained about the same as with the regular dose. This best illustrates

A

Saturation

67
Q

After taking one acetaminophen pill, a patient’s headache is lessened. After taking two pills the headache is gone. This best illustrates

A

Dose response

68
Q

Ipratropium bromide (Atrovent) is used

A

to treat COPD

69
Q

Nicotinic acetylcholine receptors are found at

A

Pre-ganglionic synapses of the sympathetic and parasympathetic systems

70
Q

Adrenergic receptors are found at

A

Post-ganglionic synapses of the sympathetic system

71
Q

Buspirone binds to a type of serotonin receptor in the CNS, causing that receptor to release a signal, leading to neuron firing. Accordingly, buspirone works as a(n)

A

Agonist

72
Q

Selegiline binds to an isoform of monoamine oxidase (MAO), preventing MAO from breaking down dopamine. Accordingly, MAO works as a(n)

A

Enzyme

73
Q

Selegiline binds to an isoform of monoamine oxidase (MAO), preventing MAO from breaking down dopamine. Accordingly, selegiline works as a(n)

A

Antagonist

74
Q

Albuterol binds to a receptor in the autonomic nervous system, causing that receptor to be activated, expanding the airway. Accordingly, albuterol works as a(n)

A

Agonist

75
Q

Adrenergic agonists such as methamphetamine can induce xerostomia, aka

A

dry mouth

76
Q

Select the drug currently used as an inhalation anesthetic in the U.S.

A

desflurane

77
Q

Patients taking AZT and saquinavir (both anti-HIV drugs) together have much better outcomes than taking either drug individually. This best illustrates

A

Additive or synergistic effects

78
Q

Patients taking Coumadin (a blood thinner that is quite non-polar/lipophilic) may need to reduce its dosage if they begin taking Dilantin (an anti-seizure drug, also lipophilic). This best illustrates

A

Competition for serum albumin

79
Q

Patients who stop taking atenolol (a β-blocker) often experience rebound hypertension.
This best illustrates

A

Physical dependence

80
Q

phase II trials test for

A

effective treatment of a disease in a few individuals, before it has been approved by the FDA

81
Q

phase I trials test for:

A

lack of toxicity in a small number of healthy human subjects

82
Q

A sustained release drug is

A

Often encapsulated in tiny spheres

83
Q

An enteric coated pill is specially treated to

A

Avoid irritating the stomach lining

84
Q

Category A/B/C etc

refers to

A

Level of risk for birth defects

85
Q

A drug with a short half-life

A

May be quickly broken down by cytochrome P450 enzymes

86
Q

Variations in drug metabolism may occur due to:

A

Genetics
Kidney disease
Hepatitis or liver cirrhosis
Age (newborns & geriatrics)

87
Q

When naming a drug, the generic name is:

A

Not capitalized

88
Q

A hydroxyl (-OH) group should be categorized as

A

Polar

89
Q

Adding acid to an amine-containing drug makes it

A

An ionic form

90
Q

Category A drugs are ones that:

A

Have been convincingly demonstrated not to cause birth defects in humans

91
Q

ACE inhibitors and Valium (diazepam) are drugs that are classed

A

Category D

92
Q

A drug with a high therapeutic index

A

Has a wide range between when its beneficial effects and its toxic effects occur

93
Q

Illegal drugs with no accepted use in the U.S. are classified as:

A

Schedule I

94
Q

A transdermal patch is most suitable for a drug that is/has

A

Lipophilic

95
Q

A drug with a high therapeutic index

A

Has a wide range between when its beneficial effects and its toxic effects occur

96
Q

Adding acid to an amine-containing drug makes it

A

More water-soluble

97
Q

Phase I/II/III etc

refers to

A

Stage of clinical development and FDA approval

98
Q

The Ames test looks for:

A

carcinogenicity using bacterial growth plates

99
Q

Category D drugs are ones that:

A

Have clinical data showing some risk of birth defects in humans, but may sometimes be prescribed anyway.

100
Q

Synthroid (synthetic thyroid hormone) is an example of a drug that is classed

A

Category A

101
Q

Tolterodine or oxybutynin are used primarily to treat

A

Incontinence

102
Q

Mometasone is used primarily to treat

A

Asthma

103
Q

Atenolol is used primarily to treat

A

Hypertension

104
Q

Phenytoin is used primarily to treat

A

Seizures

105
Q

Levodopa and carbidopa are used primarily to treat

A

Parkinson’s disease

106
Q

Aprazolam is used primarily to treat

A

Anxiety

107
Q

Clonidine is used primarily to treat

A

Hypertension

108
Q

Zolpidem is used primarily to treat

A

Insomnia

109
Q

Tolterodine and oxybutynin are classed as

A

muscarinic antagonists

110
Q

Serevent is classed as a(n)

A

beta2 agonist

111
Q

Bethanecol is classed as a(n)

A

muscarinic agonist

112
Q

Timolol is classed as a(n)

A

non-specific beta blocker

113
Q

Doxazosin and tamsulosin are classed as

A

alpha blockers

114
Q

Atropine is used to treat

A

Organophosphate poisoning

115
Q

Bethanecol is used to treat

A

postsurgical difficulty with urination

116
Q

Tiotropium bromide and ipratropium bromide are used primarily to treat

A

COPD

117
Q

Methylphenidate is used to treat

A

ADHD

118
Q

Amphetamine is used to treat

A

ADHD

119
Q

Blood pressure

A

cardiac output x systemic vascular
resistance
b.p. = CO x SVR

120
Q

Ways to reduce blood pressure

pharmacological

A 
reduce blood volume
– diuretics
vasodilation – either arteries, veins or both
– Ca channel blockers,
– ACE inhibitors, alpha1 antagonists
– other vasodilators
decrease pumping rate or strength
– beta blockers
121
Q

Ways to reduce blood pressure

NON-pharmacological!

A

• weight reduction
– 60% hypertensive patients are overweight
• DASH (Diet Approach to Stop Hypertension)
– diet low in saturated fats, high in fruits and vegetables
(April 1997 NEJM)
• cessation of smoking – nicotine causes vasoconstriction
• reducing caffeine – caffeine is a vasoconstrictor
• reducing alcohol
• aerobic exercise
• Na restriction

122
Q

Diuretics

A 
-Inhibit Na+ reabsorption: 
– Less Na+ reabsorbed causes less water reabsorption
– Net effect lowers blood volume
– Loss of K+ can be a problem
-Also to reduce edema in CHF
123
Q

Primary diuretics

A

-furosemide (Lasix)
-hydrochlorothiazide (HCTZ)
Both cause loss of K+
(hypokalemia) in distal tubule
– Heart arrhythmia, muscle cramps & weakness

124
Q

potassium-sparing diuretics

A 
Inhibit Na+
/K+ exchange pump
– in late distal convoluted tubule
– Leaves Na+ in urine, K+ in blood
-Amiloride, triamterene
-Spironolactone
125
Q

b1-blockers

A

Inhibit b1-adrenergic receptors of sympathetic NS
– Decrease heart rate, contractility and cardiac output
Fatigue, dizziness, bradycardia, depression
-Metoprolol
-atenolol

126
Q

ACE inhibitors

A

Angiotensin converting enzyme
– Part of the renin-angiotensin-aldosterone system
• Hypertension as a complication of diabetes, renal disease
– angiotensin II causes vasoconstriction
• Also increases perfusion pressure in glomeruli
-lisinopril: Net vasodilation, decreased blood pressure

127
Q

Angiotensin II receptor antagonists

A

Similar principle to ACE inhibitors, but block
the receptor instead of blocking production
-losartan, valsartan, other “-sartan” drugs
-category D

128
Q

Calcium channel blockers

A

• Calcium channels open & allow Ca2+ into cytoplasm
causing vasoconstriction
• contraction of vascular smooth muscle
– Also increase contraction of heart muscle
• raises pacemaker activity in SA node, raises conduction through AV node
Ca channel blockers work better for African Americans
than ACE inhibitors, b-blockers
• Ca channel blockers lower blood pressure, but their
reduction of cardiovascular mortality may be limited
• Also used for angina, atrial fibrillation

129
Q

Ca channel blocker drugs

A

nifedipine (Procardia), amlodipine (Norvasc)
– Block VSM contraction, but not heart muscle
• Others: verapamil (Calan), diltiazem (Cardizem)
– block Ca channels in both VSM and heart
– risk of AV heart block in predisposed patients

130
Q

clonidine (Catapres)

A

• inhibits the sympathetic system via CNS
– decreases heart rate, causes vasodilation
• 40% of patients experience drowsiness,
sedation
• Available in a transdermal patch

131
Q

Angina

A

• Sudden pain beneath sternum
– often radiating to left shoulder and arm
• Occurs when arteries cannot provide enough
oxygen to the heart

132
Q

Classic angina

A

– due to partially occluded coronary arteries
– Triggered by physical exertion (or emotional
excitement)

133
Q

Nitroglycerin

A

Vasodilator, mainly in veins, some in arteries
– Converted to nitric oxide (NO)
– Decreases venous return & strain on heart
• Sublingual pill
– Fast-acting (~1 min) & short acting: t½ 5-7 min
– Avoids liver first pass effect
– [Variant angina: relaxes vasospasm too]
• Extended-release patch: Nitro-dur
– 12h on, 12h off

134
Q

Other angina drugs

A

Ca channel blockers
– relax vascular smooth muscle, increase oxygen
supply to heart
– Long-acting forms, mostly used prophylactically
• Eg. nifedipine
• b-blockers
– Lower heart rate (and contractility), reducing
oxygen demand of the heart
– Related: b-blockers reduce risk of a 2nd MI

135
Q

Congestive Heart Failure

A

Ineffective pumping due to lower contractility,
lowers arterial blood pressure causing:
– Reflex tachycardia due to b1 stimulation
– Less filtering by kidneys,
• less urine, more blood volume
– Arterial vasoconstriction due to renin release
• Venous backup of blood, high venous pressure
– Peripheral & pulmonary edema
– Heart enlargement

136
Q

CHF drugs

A

Diuretics!
– Reduce edema, blood volume, venous pressure
– furosemide (Lasix) most commonly used
digoxin (digitalis)
– From foxglove flowers
– Increases heart contractility
– Low TI, heart dysrhythmias, AV heart block, v-fib
• More likely with hypokalemia
– May not increase life expectancy, but may improve
heart performance

137
Q

Other CHF drugs

A

• ACE inhibitors (-pril)
– Cause arteriovasodilation.
– Lessen after-load on heart
• Beta blockers
– Lowering heart rate & contractility seems contradictory
– Lowering heart rate can increase ejection fraction
– Also affect renin-angiotensin system

138
Q

Blood clotting

A

-Too high clotting tendency can trigger MI, ischemic
stroke, DVT, pulmonary embolism
-Clot formation begins with platelet plug aggregation
– Next: fibrinogen converted to fibrin to form a thrombus
– Arterial: due to a rough surface that attracts platelets
– Venous: due to blood stagnation
• Clotting is restrained by antithrombin III, heparin
• Clots are broken down by activating plasmin

139
Q

Anticoagulants

A
  • Heparin
  • enoxaparin (Lovenox)
  • warfarin (Coumadin)
  • ASA (Aspirin)
  • thromboxane A2
  • clopidrogrel (Plavix)
  • tPA (Alteplase)
140
Q

Heparin

A 
Sugar polymer, found naturally in blood
• Binds antithrombin III and activates it 1000x
– Blocks blood-clotting cascade
• Prevents thrombin from converting
fibrinogen into insoluble fibrin
• IV administration
– Inactivated by HCl in the stomach
141
Q

enoxaparin (Lovenox)

A

– Low-MW heparin, more reproducible effect, longer t½
– Home SC injections possible bid
• Often used with open-heart surgery, hip/knee replacements

142
Q

warfarin (Coumadin)

A 
Antagonist of vitamin
K, which is needed
for synthesis of
several clotting
factors
– Factors VII, IX, X and
prothrombin
– Inhibits further
synthesis, not existing
factors
• Takes 2-5 days to
reach max effect
143
Q

Coumadin and diet

A

Vitamin K is found in many foods, especially
green leafy vegetables
– Day-to-day variations in diet affect coagulation
• Delayed effect
– Risk of either clotting or hemorrhaging
• Low TI, need for ongoing monitoring of PTT
– prothrombin time for clotting
– want INR (international normalized ratio) of 2.0-3.5
– Anticoagulation clinics are a major healthcare business

144
Q

Pentoxifylline

Trental

A 
• Reduces blood viscosity
– Unknown mechanism
• Treats intermittent claudication
– Muscle pain (ache or cramp, often calf muscle)
from exercise
– Generally due to atherosclerosis
145
Q

Acetylsalicylic acid

ASA, Aspirin

A

• Aspirin inhibits formation
of thromboxane A2
– via COX1 (cyclooxygenase)
enzyme
• Thromboxane triggers
platelet activation &
aggregation, the 1st step in blood clotting
– Thromboxane is similar to prostaglandins
• Both can be related to inflammation
• Low dose (80mg daily) “baby aspirin”
• Aspirin is not literally a “blood thinner”

146
Q

clopidogrel (Plavix)

A

Extensively used with arterial stents, to
prevent MI, stroke, angina
• Also inhibits platelet activation/aggregation
– Different mechanism than aspirin
– does not have the potential to thin stomach lining
& cause ulcers that aspirin does
• More expensive than aspirin
– Patent expired 2012
• Bleeding is a risk with aspirin or Plavix, but
much less so than with Coumadin

147
Q

tPA (Alteplase)

A 
Tissue plasminogen activator
– Causes breakdown of clots
– Used for treatment of MIs, ischemic strokes
• treatment must occur within a few hours of the event
– Hemorrhage is a possible side effect
• Human enzyme (protein)
– produced via genetic engineering
• ~$4000 per treatment
148
Q

cholesterol

A

Synthesized by liver and absorbed in diet
• Some cholesterol is needed in cell membranes
– Some also needed for bile salts, steroid hormones
• Excess cholesterol accumulates via LDL in artery walls
– LDL >135 mg/dl (or total chol > 200) is a cause for concern
– LDL levels are affected by diet, genetics
• HDL is used by circulating macrophages to
scavenge/recycle cholesterol
– More HDL is better, lower ratio (<5) of LDL/HDL is better
– Aerobic exercise & moderate alcohol consumption both increase HDL levels

149
Q

Statin drugs

A

Lower LDL by blocking synthesis of cholesterol by
the liver
– Does not affect dietary absorption of cholesterol
– Controversy over whether statins for older patients is
worthwhile (benefit of lower chol declines with age)
• Adverse effects:
– Myopathy, liver abnormalities
– GI disturbances, teratogenic (X)
• Generic names all end in “-statin”!
– lovastatin (Mevacor), pravastatin (Pravachol),
simvastatin (Zocor), atorvastatin (Lipitor)

150
Q

Ezetimibe (Zetia)

A

Inhibits intestinal absorption of cholesterol
from diet
• Can be combined with statin drugs
– Vytorin is ezetimibe + simvastatin

151
Q

EPO (erythropoietin)

A 
Natural human protein that
stimulates production of red
blood cells
– Produced by genetic engineering
• Treatment of chronic anemia
– Also cancer patients with
anemia
• Abused by endurance athletes,
especially professional cyclists
152
Q

Cholesterol-lowering drugs

A 
statin drugs
– lovastatin, pravastatin,
atorvastatin
• Ezetemibe (Zetia)
• erythropoietin (EPO, Procrit)
153
Q

CHF

A

-diuretics
• digoxin (digitalis)
• ACE inhibitors
• beta blockers

154
Q

Angina

A

nitroglycerin
– Nitro-dur
• beta blockers
• Ca channel blockers

155
Q

“-xaban” drugs

A

-apixaban (Eliquis), rivaroxaban (Xarelto)
-Specific, competitive inhibitors of factor Xa, Oral bioavailability
Antidote: andexanet alfa: Engineered protein based on factor Xa,
binds more tightly to drug than factor Xa does

156
Q

Pradaxa (dabigatran)

a specific thrombin inhibitor

A

Safer than coumadin?
– No particular dietary restrictions
• Frequent INR monitoring not needed
– Higher incidence of GI bleeds
– Similar heart attack risk
Uses: prevent heart attack, stroke, DVT, PE
– With atrial fibrillation, after joint replacement
Antidote: Praxbind (idarucizumab)
– Monoclonal antibody that binds/removes drug,
effective within minutes, approved 2015

PHARM (6 decks)

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