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Step One Pharmacology > Will's pharm > Flashcards

Will's pharm Flashcards

1
Q

Nifedipine

A

dihydropyridine
L-type CCB
vasodilator

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2
Q

Verapamil

A

non-dihydropyridine
L-type CCB
anti-arrythmic
little vasodilation

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3
Q

Diltiazem

A

non-dihydropyridine
L-type CCB
anti-arrythmic
mild vasodilateion

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4
Q

Amlodipine

A

dihydropyridine
L-type CCB
vasodilator

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5
Q

Milrinone

A

Phosphodiesterase-3 inhibitor

inotropic

Rx; Acute HF where other tx failed, chronic use is associated with INCREASED mortality

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6
Q

Vasopressin (desmopressin)

A

Gq/s

vasoconstriction (esp. high levels)
inserts aquaporins

Rx; cardiac arrest, vwb disease, poor adh release, hemophilia A (not B)…bc it realeases factor 8from endoth cells

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7
Q

Hydralazine

A

increase cGMP vasodilate arteries > veins; afterload reduction

Co administer with B-blocker to prevent reflex tachycardia. B blocker is considered safe in pregnancy

Rx; HTN in pregnancy, used with methyldopa and BB
Alternate is CCB

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8
Q

methyldopa

A

CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)

Used in HTN during pregnancy 1st line with hydralazine
Alternate is CCB

SE: decreased libido

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9
Q

HTN drugs to avoid in pregnancy

A

ACE-inhibitor, ARB’s, nitroprusside

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10
Q

Nitroprusside

A

Short acting, increase cGMP through NO release. may cause cyanide toxicity. Onset within 30seconds

Mixed
arterioles > venules (even though “nitro”)

Rx; malignant HTN
SE: Cyanide poisoning

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11
Q

Fenoldopam

A

D1 agonist -> vasodilation of coronary, peripheral, renal, splanchnic.

->decrease BP increase natriuresis

Rx; malignant HTN

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12
Q

Nitroglycerine

A

NO release, increase cGMP

venodilator&raquo_space; arteriolar

Rx; Angina, pulmonary edema

SE: hypotension, flushing, headache, reflex tach,

  • *MONDAY DISEASE.
  • -Anti anginal’s need period of drug free to prevent resistance
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13
Q

Isosorbide dinitrate

A

NO release, increase cGMP

venodilator&raquo_space; arteriolar

Rx; Angina, pulmonary edema, fairly long acting

SE: hypotension, flushing, headache, reflex tach, MONDAY DISEASE.
–Anti anginal’s need period of drug free to prevent resistance

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14
Q

Rifampin

A

RNA Polymerase OF PROKARYOTES

Rx;

  • Tb
  • Monotherapy prophylaxis neisseria meningitites and H.Flu
  • Induce P450 in liver
  • *Makes body fluid yellow/orange
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15
Q

Denosumab

A

RANKL monoclonal antibody on osteoblasts.
RANK receptor is on osteoclasts
RANKL induces osteoclast growth/maturation

Rx; osteoporosis, tumors of bone

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16
Q

Alendronate

A

Bisphosphonate
binds calcium and taken up into osteoclast… inhibits them

Rx; osteoporosis (T score <-2.5)

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17
Q

Osteopenia T score

A

T score -1 -> -2.5

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18
Q

Actinomycin D

A

Inhibits RNA polymerase II

Used in

  • Choriocarcinoma
  • rhabdomyosarcoma
  • wilms tumor
  • ewing sarcoma
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19
Q

Pioglitazone

-glitazones

A

Binds/activates PPAR-gamma transcription factor
-> regulates fatty acid storage and glucose metabolism. Increases insulin sensitivity and lvl of adiponectin

Rx; DMII

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20
Q

Fibrates

A

Believed to Bind/activates PPAR-gamma transcription factor
-> regulates fatty acid storage –> increased LPL

Most powerful Triglyceride lowering agent

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21
Q

Chloroquine

A

BLOCKS Plasmodium HEME polymerase

Acute Tx for malaria (vivax, ovale, malariae)

Falciparium is resistant everywhere except north of panama canal

** Always combine with a second drug if treating falciparum (like mefloquine)

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22
Q

Mefloquine

A

Works against M. Falciparum resistant to Chloroquine.

**Always combine two drugs to tx falciparum

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23
Q

Quinidine/Quinine

A

Used for severe malarial infections IV

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24
Q

Mebendazole

A

Rx; Intestinal Nematodes

“Round worms are BENDY”

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25
Q

Praziquantel

A

Rx; Cestodes (tapeworms) and Trematodes (flukes)

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26
Q

Toxoplasma gondii Tx in general and when prophylaxis in AIDS

A

Sulfadiazine + pyrimethamine

Prophylaxis if CD4 < 100

**CMV more likely below 100 as well

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27
Q

PCP/ Pneumocystis jirovecii pneumonia Tx in general and when prophylaxis in AIDS

A

TMP-SMX

AIDS Proph CD4 < 200

**It’s a yeast but with cholesterol cell membrane instead of ergosterol

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28
Q

Mycobacterium Avium Tx in general and when prophylaxis in AIDS

A

MACROLIDE: azithromycin or clarithromycin

AIDS Proph CD4 < 50

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29
Q

MOA Streptomycin

A

(An aminoglycoside) Inhibit initiation complex binding at Prokaryotic 30S subunit (P site)

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30
Q

MOA Tetracycline

A

inhibits tRNA binding at Prokaryotic 30s subunit (A site)

*doxycycline, minocycline are tetracyclines

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31
Q

Chloramphenicol
MOA
USE
SE

A

inhibits peptidyl transferase at prokaryotic 50S subunit
USE:

SE: dose dependent (reversible) anemia, thrombocytopenia, and/or leukopenia. OR DOSE INDEPENDENT irreversible aplastic anemia -> death/disability without tx (bone marrow transplant)

Grey baby syndrome (poor glucuronidation -> excretion)

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32
Q

MOA Macrolide

A

Inhibits translocation at 50S Prok. Subunit

clarithromycin, azithromycin, erythromycin

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33
Q

MOA Shiga, EHEC, or ricin toxin

A

Inhibit tRNA binding Eukaryotic 60S subunit by removing ONE single adenine residue

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34
Q

MOA Diptheria

A

Inhibit translocation binding at EF-2 eukaryotes, by adp ribosylation

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35
Q

MOA pseudomonas

A

Inhibit translocation binding at EF-2 eukaryotes by adp ribosylation

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36
Q

Linezolid

A

Inhibit initiation complex binding at Prokaryotic 50S subunit (P site), for Vanco resistant staph/enterococci

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37
Q

Clindamycin
MOA
USE

A

Inhibits transpeptidation = translocation at 50S Prok. Subunit
USE: Anaerobic above diaphragm, aerobic gram positive
SE: Pseudomembranous colitis (C diff overgrowth with cytotoxin B actin cytoskeleton destruction)

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38
Q

Perchlorate

A

Blocks Sodium-Iodide cotransporter in Hyperthyroidism

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39
Q

Pertechnetate

A

Blocks Sodium-Iodide cotransporter in Hyperthyroidism

**99mmTc-pertechnetate used to dx ectopic gastric mucosa (in meckels diverticulum)

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40
Q

Propylthiouracil

A

Blocks Conversion of Iodide to Iodine (via thyroid peroxidase) in apical colloid in hyperthyroidism

AND

Blocks 5’-deiodinase conversion of T4->T3 in peripheral tissues

**T3 being the more active form

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41
Q

Methimazole

A

Blocks conversion of iodide to iodine (thyroid peroxidase) in apical colloid during hyperthyroidism

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42
Q

Lithium
Tx
SE’s

also, why does it work in brain if it’s Li+?

A

Tx; Bipolar disorder (manic episode +maintenance) augments antidepressives

SE: Diabetes insipidus (goes through Na channel to block aquaporin), hypothyroid, sometimes hyperthyroid… watch renal function, thyroid lvls, lithium lvls, arrhythmia’s, ebstein’s anomaly, TREMOR

Li+ is the smallest drug we have -> can penetrate BBB even though it’s charged. (EtOH is similar)

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43
Q

Lamotrigine
Tx
SE

A

MOA: blocks Na channels
tx; seizures and bipolar disorder (depressive symptoms)

SE Rash, Steven-johnson syndrome

SJS milder form of Toxic epidermal necrolysis. Epidermis separates from dermis. Immune complex deposition disorder.

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44
Q

Medications that cause seizures

A

buproprion (antidepressant), clozapine (anti-psychotic), isoniazid, cipro, imipenem

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45
Q

Potassium citrate use

A

Used to prevent calcium stones. The citrate binds calcium and lets you pee it out

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46
Q

Treatment for Alzheimers Dz

A

1) cholinesterase inhibitors (Donepezil = Aricept)
- only one to cross BBB besides physostigmine
2) Anti-oxidants (Vitamin E)
3) NMDA receptor antagonists (memantine)

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47
Q

Traztuzimab

A

“Herceptin”

Tx for erb2 positive breast cancer, it is a monoclonal antibody

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48
Q

Tamoxifen

Tx and SE

A

ER antagonist in breast tissue, agonist in endometrium

Tx for ER positive breast cancer

SE: proestrogenic in endometrium -> endometrial polyp and endometrial carcinoma
**associated with increased density bone (agonist on bone)

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49
Q

Diazoxide

A

Potassium channel opener. Causes hyperpolarization -> smooth muscle relaxation/ vasodilation.

Diazoxide is Drug of choice in INSULINOMA’s

SE: Hyperglycemia bc opens ATP-potassium channel in pancreatic beta cells

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50
Q

WHy don’t we use thiazides in diabetics?

A

Because they open K channels on pancreatic B cells -> hyperglycemia

thiazides: hyper GLUC
hyperglycemia, lipidemia, uremia, calcemia
+ hyponatremia, hypokalemia, metabolic alkalosis

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51
Q

minoxidil

A

Potassium channel opener. Causes hyperpolarization -> smooth muscle relaxation/ vasodilation.

-used 2nd line for refractory HTN bc reflex tachy and glycemic effects

SE: Hyperglycemia bc opens ATP-potassium channel in pancreatic beta cells

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52
Q

Fomepizole

A

Used to tx methanol/ethylene glycol toxicity

Mech: Inhibits alcohol dehydrogenase, which converts methanol to formaldehyde.

**Also need to dialize patients to get rid of methanol

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53
Q

-Azoles as related to alcohol

A

All -azoles inhibit alcohol metabolism (think fluconazole and fomepizole)

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54
Q

Disulfiram

A

Inhibits acetaldehyde dehydrogenase -> build up of acetaldehyde which is quite toxic.

acetaldehyde -> acetic acid(acetate)

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55
Q

JAK-STAT pathway

-what promotes it?

A

GH, EPO, cytokines

–> dimerize an intracellular tyrosine kinase

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56
Q

Methylene Blue

A

Reduces Iron from Ferric -> Ferrous (2+ state)

As in nitrite poisoning

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57
Q

Deferoxamine

A

Used in acute/chronic iron overload, especially when phlebotomy is contraindicated. Chelates Iron

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58
Q

Statin, why rhabdomyolysis/muscle aches?

A

Statin interferes with cholesterol synthesis, in this instance Farnesyl isn’t made, which is needed for Coenzyme Q of electron transport. If CoQ not around, cannot do ETC very well in aerobic tissues where statins distributed to.

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59
Q

In ETC, match drugs with complex inhib

Barbituates
Doxorubicin
Rotenone
Antimycin A
Daunorubicin
Oligomycin
Cyanide
CO
Nitroprusside
A

IN ORDER
Complex I: Barbituates, Rotenone (insecticide), MPP from meperidine

(Complex II), only in FADH2 electron transport

CoQ: Doxo/Daunorubicin (Anti cancer, cause dilated cardiomyopathy, don’t penetrate CNS

Complex III: Antimycin A (produced by streptomyces bacteria)

cytC (apoptosis)

Complex IV: Cyanide (nitroprusside) , CO

Complex V: Oligomycin (from streptomyces) inhibits Fo of ATP synthase

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60
Q

Two uncouplers of ETC?

A

High does Aspirin

2,4-DNP: Dinitrophenol => used to lose weight

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61
Q

Mipomersen
USE
MOA

A

Used ONLY for homozygous type II dyslipidemia (Familial hypercholesterolemia)

MOA: It is anti-sense mRNA for B100, will bind B100 mRNA in liver, prevent translation, and prevent it from releasing VLDL

WOW

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62
Q

In cancer, what do alkylating agents do?

A

Cross link DNA

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63
Q

Hydroxyurea
MOA
USE

A

Inhibits ribonucleotide reductase (which removes an OH from ribose - > Deoxyribose) such that DNA cannot be formed

USE Polycythemia Vera
-Sickle cell (increases fetal hgb)

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64
Q

6-mercaptopurine (6-MP) MOA

A

Blocks de novo purine synthesis (along line of PRPP -> IMP)

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65
Q

5-Flourouracil (5-FU)

A

Inhibits thymidylate synthase (can’t make dTMP from dUMP bc flourine group on 5’ position)

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66
Q

Methotrexate (MTX)

A

Inhibits dihydrofolate reductase (DHF->THF) –> leads to decreased de novo synthesis of dTMP, AMP, GMP

USE: RA, malignancy, vasculitis

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67
Q

Trimethoprim (TMP)

A

Inhibits BACTERIAL dihydrofolate reductase (DHF->THF) –> decreased de novo synthesisdTMP, AMP, GMP

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68
Q

etoposide MOA/use

A

anti-cancer, blocks topoisomerase

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69
Q

Bleomycin MOA/use

A

THE ONLY G2 phase specific anticancer;
MOA: complexes iron, forming ROS -> DNA strand breakage

***cause interstitial fibrosis

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70
Q

Vincristine
MOA
USE

A

MOA: Prevents microtubule formation (arrests M phase as a mitotic spindle toxin)

USE: Hodgkin’s lymphoma, wilms tumor, and others

SE: paresthesia’s, loss of DTR (particularly ankle)

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71
Q

Doxorubicin
MOA
USE
Special SE

A

An anthracycline
MOA: Inserts btw DNA bases-> Strand breakage
USE: Breast, bladder, ovarian cancer, leukemia
SE: Inhibits CoQ formation (not in CNS) –> dilated cardiomyopathy by disruption ETC

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72
Q

cana(gliflozin)
dapa(gliflozin)

MOA
USe

A

Inhibit SGLT-2 (so it’s in the kidney’s) theraby increasing glucose excretion

USE: DMII

    • Assess renal function prior to administration
  • ** “Glucose-is-a-flozin through the urine”
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73
Q

Bromocriptine

A 
D2 agonist (need to add info)
USE: prolactinoma, Parkinsons
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74
Q

Octreotide

MOA
USES

A

Somatostatin analogue with higher activity

Rx;

  • acromegally (Inhibits GH release)
  • carcinoid tumor ( symptomatic relief: many carcinoids have somatostatin receptors, activation of which decreases it’s activity)
  • Esophageal varices rupture (somehow decreases portal vein pressure)
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75
Q

Cyclosporine
MOA
USE

A

Calcineurin inhibitor: Calcineurin is a calcium dependent serine-threonine phosphatase, activates specific transcription factor (NFATc) -> induces expression of IL-2 ->activation of CTL, helper T cells, reg. t cells.

USE:
-Transplant rejection
-RA
-Psoriasis
-Eye drops: keratoconjunctivitis sicca (Sjogren’s syndrome)
keratitis being involvement of cornea, conjunctiva the protection over sclera

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76
Q

Tacrolimus/tacralimus
MOA
USE

A

Calcineurin inhibitor: Calcineurin is a calcium dependent serine-threonine phosphatase, activates (by dephosphorylating) specific transcription factor (NFATc) -> induces expression of IL-2 ->activation of CTL, helper T cells, reg. t cells.

USE: Transplant rejection and…

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77
Q

ergonavine
MOA
USE

A

An ergot alkaloid that stimulates alpha adrenergic and seratonergic vascular smooth muscle receptors -> vasoconstriction

USE: Used at low doses to diagnose prinzmetal’s angina

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78
Q

Amiloride

A 
Blocks ENaC (epithelial sodium channel) 
Used as K sparing diuretic
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79
Q

Triamterene

A 
BLocks ENaC (epithelial sodium channel)
Used as K sparing diuretic
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80
Q

cabergoline
MOA
USE

A

D2 agonist

USE: Prolactinoma, Parkinsons

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81
Q

Anaerobe rule
Above diaphragm
Below Diaphragm

A

Above: Clindamycin
Below: Metronidazole

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82
Q

Paclitaxel
MOA
USE

A

Binds B-tubulin, enhances Microtubule polymerization leading to disarray and death in metaphase

USE: Anti-cancer

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83
Q

Clopidogrel

A

MOA: Irreversible ADP receptor blocker, prevents platelet aggregation

USE: Alterntive or synergestic with aspirin as anti-platelet

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84
Q

Ticlopidine

A

MOA: As above

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85
Q

Terbutaline

A

MOA: B2 agonist
USE: asthma
offlabel- tocolytic (uterine relaxation)

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86
Q

Phenoxybenzamine
MOA
USE

A

Irreversible nonselective alpha antagonist

USE: Give prior to B blockers and Surgery for pheochromocytoma to prevent massive vasoconstriction/htn crisis

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87
Q

Trazodone
MOA
USE
SE

A

MOA: inhibit serotonin reuptake

Serotonin antagonist and reuptake inhibitor

USE: Highly sedating anti-depressant often used as adjunct therapy with SSRI’s

SE: Priaprism

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88
Q

Phenelzine
MOA
USE
SE

A

Monoamine oxidase inhibitor: (MAO-I ) A mitochondrial enzyme that deaminates neurotransmitters (seratonin, melatonin, NE, Epi, Dopamine)

USE: Antidepressent, especially ATYPICAL DEPRESSION combined with SSRI’s
SE: Tyramines( cheese, red wine, beer, fish) –> HTN crisis somehow, having to do with tyramine not broken down by MAO

HTN crisis = malignant htn, blurred vision, neurologic signs

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89
Q

Monoamine oxidase

What is it?

A

Enzyme that deaminates monoamines. Monoamines being carbon structures with ONE amine group attached to an aromatic ring by a two carbon chain. Monoamines are derived from aromatic rings (ie tryptophan, tyrosine, phenylalanine)

ie: think serotonin, melatonin, Dopamine, NE, Epi

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90
Q

Ivermectin
MOA
USE

A

Somehow increases inhibitory neurotransmission in worms -> paralysis

USE: Strongyloides Stercorais

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91
Q

Mebendazole
MOA
USE

A

MOA: inhibits microtubules -»> eventually leads to immobilization -> excretion of that shit

USE: Nematodes (roundworms)

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92
Q

Praziquantel

USE

A

MOA: unknown

USE: Cestodes (tapeworms) and trematodes (flukes)

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93
Q

Ethosuximide
MOA
USe

A

MOA: block T-type calcium channels (3hz)
USE: Absence seizures
**if fails -> valproic acid

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94
Q

Barbituates

A

MOA: prolong Cl- channel opening. AND can open ion channel alone (dose dependent)

USE:

OVERDOSE Tx; supportive and diurese with alkaline urine
+complex I inhibition -> low ATP

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95
Q

Valproic Acid

A

BLocks NA channels (prevent depolarization and increase refractory period

USE: Generalized seizures, 2nd for absence seizure, mania

SE: hepatotoxic, spina bifida

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96
Q

Phenytoin (Dilantin)
USE
unique SE

A

Na channel blocker, for seizures

unique SE: gingival hyperplasia, hirsutism, teratogen, megaloplastic anemia, drug induced lupus, SJS, aplastic anemia, fetal hydantoin syndrome

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97
Q

Carbamazepine

A

NA channel blocker
USE: generalized seizures, trigeminal neuralgia (works 80% of time), mania (mood stabilizer)

SE: Aplastic anemia, p450 inducer, hepatotoxic, fetal hydantoin syndrome

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98
Q

Volume of distribution

low, medium, high Vd

A

Vd= amount of drug in body/plasma concentration

  • Large charged molecules or protein bound have low Vd
  • small hydrophillic molecules => ECF => medium Vd
  • small lipophillic; high

Total body water = 42L
Extracellular= 14L (1/3)
Intracellular= 28L (2/3)

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99
Q

Half Life

A

A first order elimination property

t1/2= (0.7xVd)/CL

**The higher the Vd, the longer the half life (bc drug must get back into plasma to be cleared)

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100
Q

How long does it take for a drug infused at constant rate to reach steady state?

A

4-5 half lives

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101
Q

Therapeutic Index

equation/meaning of high/low

A

“TILE”

TI= Lethal dose(50)/Effective Dose(50)
or
TI= Toxic dose(50)/Effective Dose(50)

**These are using Medians
High TI means safer than low TI

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102
Q

4 Drugs with low therapeutic index

A
  • Digoxin
  • Lithium
  • Theophylline (phosphodiesterase inhib used in COPD/asthma)
  • Warfarin

“The Drugs With Low therapeutic index”

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103
Q

5 drugs that are noncompetitive antagonists (a relatively rare occurrence in pharm)

A 
Phenoxybenzamine (for alpha 1&2 receptors)
ASA
Digoxin
Allopurinol (xanthine oxidase inhib)
PPI's
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104
Q

Allopurinol
MOA
USE

A

MOA: Xanthine oxidase inhibitor
USE: To treat conditions of hyperuricemia
-Chronic Gout (useless or bad for acute gout)
-Tumor lysis syndrome
-Lesch-Nyhan

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105
Q

Potentiation is also rare

what’s an example?

A

Potentiation = less drug/molecule -> higher response

Benzo’s, which increase frequency of Cl channel opening in presence of GABA

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106
Q

Benzodiazapines

A

MOA: Benzo’s, which bind gamma site and increase frequency of Cl channel opening in presence of GABA(a)
BZ1-sedation
BZ2-cognitive
Anterograde amnesia

Reverse: flumazenil
rarely coma/death without more stimuli bc we rely on the natural gaba to stimulate

**they are metabolized from active -> still active form in liver
Diazepam is super long acting, it’s P450 metabolites have t1/2 60 hrs, use for anxiety

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107
Q

Zero order drugs (3)

A

PEA

Phenytoin
Ethanol
ASA

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108
Q

weak acids (6)

A

R-COOH R-OO’ + H

ASA, cephalosporins, PCN, loop, thiazide, barbituate

**trap in basic env: bicarbonate, (historically acetazolamide)

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109
Q

weak bases (4)

A

R-NH3 R-NH2

morphine, local anesthetics, amphetamines (NMDA antagonist with dissociative properties), PCP

**trap in acidic env: ammonium chloride (NH4-Cl), vitamin C, cranberry juice

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110
Q

Acetamenophen overdose and antidote

A

Overdose = 250mg/kg
N-Acetylcysteine (NAC) reduces hepatic damage. Has a thiol (sulfer group) that it can donate for normal sulfation, or it can act as a direct binder of the toxic metabolite of tylenol NAPQI.

  • acetamenophen overdose saturates glucuronidation and sulfation, and exhausts glutathione stores (so you have to use phase 1 metabolism).
  • -> Without glutathione to bind the toxic metabolite –> fucked

***N-Acetylcysteine is also used for renal protection during iodine contrast radiographic studies

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111
Q 
Warfarin 
MOA
USE
Reversal
distribution
A

MOA: Inhibit VKORc = Inhibit vit K epoxide reductase which is necessary to recycle vit k to be used with vit k dependent gamma carboxylation of glutamic acid residues of 279 10 C S

USE: Afib, recurrent dvts, ect.

Reversal: acute: fresh frozen plasma
-longer, use vit K

Distribution: 98% bound to proteins, so giving a drug that displaces it (like sulfonamide for infection) will increase active coumadin in the blood

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112
Q

1)Are sulfonamides highly protein bound in blood?
2)Effect on coumadin/
bilirubin (in neonate esp)

3) Serious hematologic SE?

A

Sulfonamides will displace coumadin from protein bound in blood in elderly -> bleeding

Also, displace bilirubin -> kernicterus

SE: may cause aplastic anemia

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113
Q

levodopa/carbidopa
MOA
USE

A

Levodopa MOA: Replaces some dopamine in CNS to counteract loss of dopaminergic neurons in substantia nigra pars compacta.

** Note that levodopa (L-Dopa) is more liphophillic than dopamine so it crosses BBB. Also, carbidopa inhibits peripheral degradation of levodopa.

USE: Parkinson’s

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114
Q

Theophylline

aminophylline

A

methylxanthine= phosphodiesterase inhibitor,

Tx; asthma, COPD

-Antidote: Beta blocker
Low TI, P450 substrate as well

SE: blocks adenosine -> arrhythmias

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115
Q

ASA
MOA
USE
SE

A

weak acid
Irreversible acetylator of COX1 (low lvl) and COX1/2 (higher lvl)

Prevents platelet production of Thromboxane A2 which has the effects of promoting platelet aggregation, vasoconstriction, and PROLIFERATION of vascular smooth muscle cells

USED: Analgesic, antipyretic, antiplatelet, kawasaki, prevention colorectal cancer

SE:

  • resp alkalosis, metabolic acidosis (ETC uncoupler)
  • GI bleeding
  • low dose risk of gout (increase uric acid), but not at high dose

**FOR overdose: alkalize urine (bicarb), correct electrolyte imbalances, gastric vacuum

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116
Q

Digoxin

A

Inhibit Na/K ATPase by binding K+ site, some cholinergic/vagal action

  • > inotropic (increased Ca intracellular)
  • > use in atrial fib bc depresses AV and SA node

SE: visual changes, GI upset

  • potassium chl (to treat hypokelemia)… but can have hyperkalemia which is poor prognostic indicator
  • There are anti-dig antibody Fab fragments
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117
Q

Flumazenil

A

Antidote for Benzodiazepine overdose Bz1/2

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118
Q

TCA overdose
S/S?
Treatment?

A

MOA&S/S: Blocks Na fast channels in heart -> QRS/QT prolongation and arrythmias.
-Hypotension, confusion, hallucination, flushed face, dry mouth

Tx; with Bicarbonate

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119
Q

Organophsphate/cholinesterase inhibitor poisoining
S/S
Tx;

A

SS: DUMBBELSS
diarrhea, urination, miosis, bronchoconstriction, bradycardia, excitation of skeletal muscle, lacrimation, sweating, salivation

Tx; Atropine + pralidoxime(2-PAM)

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120
Q

Atropine/anticholinergic toxicity

A 
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat (mydriasis)
Mad as a hatter
  • *Jimson weed is a rare cause from the plant alkaloid
  • **Can cause acute andle-closure glaucoma in elderly
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121
Q

Infliximab

A

Monoclonal antibody to TNF-alpha used in autoimmune diseases like

  • psoriasis
  • RA
  • ankylosing spondylitis
  • UC
  • crohns
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122
Q

benztropine

A

Anti-muscarinic
Tx; treat drug induced parkinsonism in psychotics
-also can be used for Regular parkinsons

SE: dry as a bone, mad as a hatter, blind as a bat, red as a beet, full as a flask, hot as a hare

**retro-orbital pain from glaucoma induced by anti-muscarinic action

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123
Q

Haldol
MOA
USE
SE

A

MOA: Potent D2 blocker as a reverse agonist (produces the opposite effect on a receptor than a normal agonist would) => a (-) efficacy

USE: 1st gen antipsychotic
Schizo
hyperactive delirium
hyperactive aggression
2nd line huntington's

SE:
extra-pyramidal symptoms: tarditive dyskinesia(irregular jerky movements) , drug induced-parkinsonism (rigidity/bradykinesia(decreased body movement)/tremor), akathisia (inner restlessness/desire to move)

124
Q

Leuprolide
MOA
USE

A

MOA: Altered for longer t1/2, GnRH analogue used to suppress LH/FSH

USE: Androgen dependent cancers cancers (like prostate)

  • infertility (pulsatile)
  • fibroids (continuous)
  • precocious puberty (continuous)
125
Q

Finasteride
MOA
USE

A

MOA: 5alpha-reductase inhibitor (cannot testosterone -> DHT)

USE: BPH, male pattern baldness, male->female transexual

126
Q

Hemicholinium

MOA

A

MOA: Block reuptake of choline from (Acetate+choline= Acetylcholine) on neurons

USE: NO CLINICAL USE

127
Q

Lispro action

A

Rapid action (peaks within an hour)

“lisp bro”

128
Q

Aspart action

A

Rapid action (peaks within an hour)

“Aspartially Glutinous need to use quick acting insulin”

129
Q

Glulisine action

A

Rapid action (peaks within an hour)

“Aspartially Glutinous need to use quick acting insulin”

130
Q

Glargine action

A

Long acting 24hr

“Gargle with glargine so it’s a long time till you go to the Detemir Dentist”

131
Q

Detemir action

A

Long acting 24 hr
“Detemir Dentist”
Gargle with glargine so it’s a long time till you go to the Detemir Dentist

132
Q

3 molecules that act through activating NUCLEAR receptors vs cytoplasmic (most steroids you think of are cytoplasmic)

A

Retinoids (vit A), PPAR, T3/T4

133
Q

Phentolamine
MOA
USE

A

Reversible nonselective alpha antagonist (as apposed to the irreversible phenoxybenzamine)

USE: Pheochromocytoma surgery(better to use phenoxy). Epinephrine necrosis of digits. Give to PPL who are on MAO inhibitors who eat tyramine-containing foods.

134
Q

Clonidine

A

CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)

USE: HTN(rare), ADHD

135
Q

-Zosins

Prazosin
Tarazosin
Doxazosin

A

Peripheral Alpha 1 selective antagonists = vasodilation
Less reflex tachycardia than nonselective alpha antagonists bc preserved alpha 2 feedback (physiologic inhibition of NE release)

USE: Rarely used for HTN Tarazosin/doxazosin used for BPH because they relax the prostatic smooth muscle

136
Q

Tamsulosin
MOA
USE

A

Peripheral Alpha 1 selective antagonist but especially for A,D receptors on prostate vs 1B on vasculatire

USE: for BPH because it relaxes the prostatic smooth muscle

137
Q

Atenolol

A

Beta1 selective Beta blocker
USE: HTN

**doesn’t cause vasoconstriction from blocking B2 activity. Doesn’t cause bronchoconstriction by the same mechanism

138
Q

Metoprolol

A

Beta1 selective Beta blocker
-HTN, stable-acute MI, HF

**doesn’t cause vasoconstriction from blocking B2 activity. Doesn’t cause bronchoconstriction by the same mechanism

139
Q

Pindolol

A

Nonselective Beta blocker with Beta agonist activity.
USE: HTN

** never use pindolol, acebutolol, or any other B blocker with B agonist activity in angina, CHF, or prinzmetal (angina)

140
Q

B-blockers for heart failure

A

Metoprolol ( Beta 1)
Carvedilol, (nonselective Beta BUT also blocks alpha 1)

  • ***NEVER USE
    propranolol: bc it reduces cardiac output (b1) AND increases peripheral resistance (B2 blockade). often used in Essential tremor

Pindolol : intrinsic sympathomimetic activity should be avoided

141
Q

labetolol

A

nonselective Beta BUT also blocks alpha 1

USE: HTN

142
Q

Carvedilol

A

nonselective Beta BUT also blocks alpha 1

USE: HTN, HF, Left ventricular dysfunction post MI

143
Q

Isoproterenol

MOA

A

MOA: B1,B2 agonist, causes OVERALL decrease in MAP bc of B2 agonist, but increase in HR from B1 and reflex tachy

Can create same effect with Epi and phentolamine/phenoxybenzamine

This is in contrast to Giving NE (a>b): alpha 1 asoconstriction -> reflex bradycardia that is not overcome by B1 activity

Epi by itself increases HR and MAP

144
Q

Mirtazapine

A

CNS alpha-2 antagonist centrally -> increase release of NE and serotonin NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)

USE: Depression…

SE weight gain

145
Q

Phenylephrine

A

Pure alpha-1/2 agonist

USED: hypotension, ocular procedures (mydriatic), rhinitis (decongestant)

146
Q

bethanechol
MOA
USE

A

Muscarinic agonist

USE: Postoperative ileus, neurogenic ileus, urinary retention

147
Q

edrophonium

A 
Cholinesterase inhibitor (short acting)
USE: used to diagnose myasthenia gravis
148
Q

Open angle glaucoma tx

A

Timolol: B blocker(nonselective), actually decreases aqueous humor production

M3 agonist (pilocarpine)- opens angle by causing miosis/stretching of tissue

Latanoprost: Prostaglandin F analogue Increases outflow (canal of schlemm)

149
Q

Contraindicated drugs in glaucoma

A 
alpha 1 agonists (closes angle)
Beta agonists (increases aqueous production)
Muscarinic antagonists (closes angle)
150
Q

Acute angle closure glaucoma

A

carbonic anhydrase inhibitors (acetazolamide) : decreases aquous humor production

pilocarpine (M3 agonist)

Timolol (nonselective B antagonist)

151
Q

ecothiophate

A

IRREVERSIBLE AChE-inhibitor

152
Q

Risperidone

A

atypical antipsychotic
USE: schizo, bipolar, OCD, mania, depression, tourrette

SE: fewer extrapyramidal and antichoinergic SE, Weight Gain

153
Q

Amantadine

A

MOA is strange: blocks NMDA and MAO

Tx; parkinsons

154
Q

Colchicine
MOA
USe

A

MOA: Blocks Tubulin polymerization leading to impaired leukocyte migration/phagocytosis -> decreased inflammation

USE: acute gouty arthritis, prophylaxis of gout

155
Q 
Vancomycin 
MOA
USE
SE
Resistance profiles
A

MOA: Inhibit
USE:
SE: Histamine release with rapid administration (red man syndrome)

Resistance profiles:

156
Q 
Metronidazole
MOA
USE
SE
Resistance profiles
A

sdfsf

157
Q

What class of antibiotics is Gentamicin?

A

Aminoglycoside

158
Q

Cholestyramine
MOA
USE
SE

A

MOA: Bile acid resin: binds and prevents reabsorption of bile acids, liver must make more cholesterol
USE: Hypercholesterolemia

SE: Pateints hate the taste and GI discomfort, decreased absorption of fat soluble vitamins, Cholesterol gallstones

159
Q

Niacin (B3)
MOA
USE
SE

A

MOA: Inhibits HSL which leads to less TG’s broken down in fat. Liver holds onto VLDL–> lowers LDL, TG, and increases HDL

USE: Hypertriglyceride, hypercholesterolemia

SE: Red, flushed face (tx with asa)

  • Hyperuricemia
  • Hyperglycemia (insulin resistance)
  • *has vasodilatory effects -> may need to decrease vasodilation
160
Q

Ezetimibe

MOA

A

BLocks cholesterol absorption at small intestine brush border

161
Q

Dantrolene
MOA
USE

A

Binds and prevents ryanodine receptor in SR/ER, as such prevents skeletal muscle excitation contraction coupling

USE: malignant hyperthermia with some inhaled anesthetics (halothane, and others) + succinylcholine

**malignant hyperthermia susceptibility is autosomal dominant, usually a defect in RYR

162
Q

Serotonin syndrome (overdose SSRI)

S/s
hyperthermia, hyperreflexia, myoclonas, diarrhea, flushing, autonomic instability (tachycardia)

A

1) Benzos + supportive care

2) Cyproheptadine (serotonin antagonist), not used that much

163
Q

Rituximab

A

Monoclonal antibody against CD20

Tx; B cell lymphoma’s

164
Q

odynophagia vs dysphagia

A

dysphagia: difficulty swallowing
odonynophagia: pain on swallowing

165
Q

muromonab-CD3

A

Antibody
targets CD3, blocks T cell interaction with MHCI/II on presenting cells

prevents acute transplant rejection, especially KIDNEY

166
Q

rapamycin
MOA
USE

A

Inhibits mTOR. This inhibits T-cell proliferation in response to IL2

USED: kidney transplant
– In combination with cyclosporine and corticosteroids. **Also used with drug-eluting stents

167
Q

3 drugs used in kidney transplant

A

cyclosporin (calcineurin inhibitor: block Ca dependent inducement of IL-2 production and it’s receptor)

rapamycin (mTOR inhibitor: block response to IL2)

Corticosteroids

168
Q

Azathioprine
MOA
USE

A

MOA: antimetabolic precursor to 6-mercaptopurine; interferes with nucleic acid synthesis. Toxic to proliferating t cells

USE: organ transplant, autoimmune disorders

169
Q

Abciximab
MOA
USE

A

MOA: Ab against gpIIb/IIIa
USE: antiplatelet

170
Q

Eculizumab
MOA
USE

A

MOA: Ab against C5 convertase (which does C5->C5a&C5b)
USE: PNH

**C5 convertase is a conglomeration of complement factors C4b2a3b

171
Q

Palivizumab

A

MOA: blocks fusion protein on RSV paramyxovirdae
USE: Prevent pneumonia in premature infants

172
Q

phencyclidine
MOA
USE
SE

A

PCP (street drug)
MOA: NMDA receptor antagonist -> release of excitatory neurotransmitters

USE: hallucinogen
SE: violent behavior, dissociation, amnesia, NYSTAGMUS (horizontal and vertical), ataxia

**dissociation = drastic changes in memory, personality, motor activity; associated with multiple personality disorder. mental processes that split from one another. behaviors of attatchement and Withdrawal

173
Q

Lysergic Acid Diethylamide
USE
SE

A

LSD (street drug)
USE: hallucinogen
SE: VISUAL HALLUCINATIONS, euphoria, dysphoric/panic, tachycardia, HTN, FLASHBACKS

**Dysphoria = profound sense of unease or dissatisfaction

174
Q

Cocaine
MOA
USE
SE

A

MOA: Inhibits reuptake of CNS neurotransmitters (via NET) (Dopamine, NE, Seratonin)

USE: Stimulant, euphoria
SE: Agitation, CHEST PAIN, SEIZURES, tachycardia, HTN, mydriasis

*** Acute intoxication lasts less than an hour
Withdrawal: psychomotor retardation (crash)

175
Q

Methamphetamine
MOA
USE
SE

A

MOA: Causes neurotransmitter release AND blocks reuptake of CNS neurotransmitters
USE: Stimulant
SE: psychosis, diaphoresis, tachycardia, HTN, choreiform movements, tooth decay

**Acute intocivation lasts for up to 20hrs

176
Q

Heroin

A

Opioid, euphoria
SE: Depressed mental status, Miosis, Respiratory depression, constipation

withdrawal: dilated pupils, yawning, lacrimation, abdominal cramping

177
Q

cromolyn sodium

USE

A

2nd line after steroids: Prevents mast cell degranulation independent of stimuli present (prophylaxis for asthma)

**nedocromil is another of the same class

178
Q

Demeclocycline

A

Shit antibiotic that causes nephrogenic DI, can use for SIADH

179
Q

ambrisenton

bosentin

A

MOA: endothelin receptor blocker

Tx; pulmonary HTN

180
Q

Scopolamine
MOA
USE

A

Selective Muscarinic antagonist

USED: tx symptoms (diarrhea, sweating, cramping) in MG without affecting nicotinic receptors

181
Q

-nib suffix

like imatinib

A

kinase inhibitor

182
Q

-cept suffix

A

receptor molecule

183
Q

Etanercept
MOA
USE

A

MOA: TNF-alpha receptor linked to Fc for removal by body macrophages

Tx for RA as adjunct to methotrexate

184
Q

certolizumab

A

Ab against TNF-alpha, pegylated and without the Fc portion

185
Q

Isotretinoin

A

Vitamin A derivative used in acne, promotes cell differentiation

SE: birth defects

186
Q

Benzoyl peroxide

A

Antibiotic used against acne

187
Q

Tx for psoriasis

A

PUVA
Psoralen(improves UVA absorption) + UVA light to dmg and decrease production of keratinocytes

  • corticosteroids
  • immune modulating therapy
  • Topical vitamin D: inhibits keratinocyte proliferation and promotes differentiation. (calcipotriene, calcitriol, tacalcitol)
188
Q

Dexrazoxane

A

MOA: iron chelating agent that prevents formation of oxygen free radicals as caused by…

USE coadministration with
Doxo/dauno- rubicin (and other anthracyclines)

189
Q

Vemurafenib

A

inhibitor of BRAF for BRAF + melanoma

190
Q

enoxaparin

A

lmwh, binds and activates ATIII

191
Q

fondaparinox

A

INDIRECT: factor 10a inhibitor

binds to ATII since it is indirect

192
Q

Cyanide poisoning antidote

A

Nitrite to cause met-hgb and bing up CN -> thiosulfate which donates sulfer to rhodanase in liver -> convert cyanide to thiocyanate

193
Q

Heparin antidote

A

Protamine sulfate

194
Q

tPA, streptokinase(nonfibrin specific), urokinase(prostate remember?) overdose antidote

reteplase, tenecteplase… as well

A

Aminocaproic acid (analogue of lysine), inhibits conversion of plasminogen -> plasmin

195
Q

lead poisoning antidote

A

dimercaprol, succimer, CaNaEDTA (drug of choice), penicillamine

196
Q

Mercury, arsenic, gold poisoning

A

Dimercaprol, succimer

CaNaEDTA (drug of choice for mercury)

197
Q

Copper poisoning

A

penicillamine

198
Q

cyanide conversion by liver

A

rhodanase converts cyanide to thiocyanate, which though still toxic, can be excreted by kidneys

199
Q

lepiruden

A

Direct thrombin inhibitor, doesn’t require antithrombin III, used in heparin induced thrombocytopenia

200
Q

Argatroban

A

Direct thrombin inhibitor, doesn’t require AT-III, used in heparin induced thrombocytopenia

201
Q

what antibiotic increases risk of tendon rupture

A

floroquinolones, esp. the achilles tendon

202
Q

What’s a predisposing factor for poorly/agenic development of lumbar/sacral spine with flaccid paralysis in a fetus?

A

Relatively rare, DM is a risk factor for this

203
Q

Signs of neonatal hypothyroidism

A 
5 P's
Pot belly
Pale
Puffy face
protruding umbilicus
protuberant tongue

**mild jaundice, floppy baby, myxedema of skin

204
Q

Sign of vitamin A toxicity from fetal exposure in a neonate

A 
Digeorge like S/S
craniofacial abnormalities
great vessel abn
auditory defects
posterior fossa defects
205
Q

what is osteocalcin?

A

A marker of bone formation (secreted with osteoid)

206
Q

medication given to decrease ICP in short term

A

Mannitol

MOA: osmotically draws fluid into vasculature (also diureses patient)

SE: can cause a fairly acute PULMONARY EDEMA by increaseing pressure within the vasculature by fluid overload. originally will cause hyponatremia -> hypernatremia as kidneys pull sodium back in/become fluid depleted.

**Contraindicated in anuria and CHF

207
Q

what is paradoxical disinhibition?

A

It is the disinhibition caused by GABA agonists like alcohol and benzos, and barbituates at low doses.

208
Q

where is the natural subunit receptor for GABA cells?

A

the alpha subunit, bc there is alpha, beta, gamma, and other sites

209
Q

which site does barbituate bind?

A

GABA(a) Beta site (allosteric binding) with

210
Q

which site does benzo bind?

A

GABA(a) gamma site (allosteric binding)

211
Q

GABA(a) vs GABA(b)

A

GABA(a) does Cl- influx, GABA(b) does K efflux through a G protein

212
Q

Why is Baclofen special?

A

the only GABA(b) drug

rx; spasticity

213
Q

Name the 3 non benzo drugs used for sleep

A

zolpidem (ambien), zaleplon, eszoplicone
BZ1 agonists (sedation)
vs NOT BZ2(cognition

Flumazenil can reverse

214
Q

barbituate suffix

A
  • barbital

- pental

215
Q

buspirone
MOA
USE

A

MOA:
5-Ht partial agonist, has a ceiling effect (no sedative effect but will also not induce anxiety and overactivity)

USE: used for general anxiety ONLY
1-2 weeks for effect

216
Q

Maintenance dose

A

(Desired plasma concentration x clearance) /bioavailability

**make sure to adjust for time

217
Q

Loading dose

A

(Desired plasma concentration x Vd)/ bioavailability

Vd= dose in body/concentration in plasma

218
Q

drug used fof vasospasm prevention after subarachnoid hemorrhage

A

nimodipine
CCB

spasm usually occurs 2-4 days after bleed

219
Q

treat status epilpticus

A

Tx; with benzo

1) lorazepam(ativan)
2) diazepam (valium, long half life)

220
Q

treat eclampsia

A

1) IV magnesium sulfate

2) benzo

221
Q

anti epileptic teratogens

A

phenytoin
valproic acid (folate inhibition of absorption)
carbamazapine

PVC

also these are what you use for generalized tonic clonic seizures

222
Q

SJS drugs

A

seizure drugs: lamotrigene, carbamazepine, phenytoin, phneobarb

allopurinol
PCN
Sulfonamides

223
Q

agranulocytosis

A

carbamazapine (antiseizure
clozapine (antipsychotic)
colchicine
PTU and methimazole

224
Q

Dabigatran

A

Direct (oral) thrombin inhibitor

others: argabotran, bivalirudin

225
Q

Rivaroxaban

A

Direct 10a inhibitor (oral)

226
Q

tetrodotoxine

A

from puffer fish

binds Na channel and prevents action potential

227
Q

action of opioids

A

on mu receptor increases K efflux through G protein signalling -> hyperpolarization

228
Q

Parkinson’s tx

A

BALSA

#bromocriptine, 
#amantadine
#levodopa/cabidopa
#selegiline, rasagiline (inhibit MAO-b breakdown of dopamine), helpful in MPTP exposure
        #entacapone/tolcapone (COMT inhibitor which breaks down dopamine as well)

Anticholinergic (benztropine)

Can lesion/overstimulate subthalamic nucleus with deep brain stimulation dbs

229
Q

tetrabenazine/reserpine
MOA
USE

A

blocks dopamine release through vesicular monoamine transporter (VMAT) inhibition. LESS dopamine vessicle packaging

USE: huntingtons chorea

230
Q

ergots in general

A

vasoconstrict

231
Q

multiple sclerosis tx

A

B-IFN (actually not common now)
steroid immunosuppression
natalizumab (also used for crohns), block integrins
rituximab
others
+
symptomatic (muscarinic antagonist oxybutinin)

232
Q

natalizumab

A

humanized monoclonal antibody against integrins, used in MS and crohns disease

233
Q

oxybutinin

A 
muscarinic antagonist used for genitourinary; 
#urgency and bladder spasms (as might occur in UMN lesion or MS)
234
Q

Riluzole

A

Tx ALS, decreases presynaptic glutamate release

ri(LOU)zole for LOU Gehrig disease

235
Q

methylphenidate

A

MOA: DNRI; Stimulant, dopamine, norepi reuptake inhibitor

USE: ADHD (most common)

*others include dexmethylphenidate, dextroamphetamine

236
Q

acamprosate

A

moa unknown, affects flutamate receptors

USE: prevent alcohol relapse

237
Q

suboxone

A

buprenorphone (partial agonist mu receptors) with naloxone (antagonist )

USE: opioid addiction tx

238
Q

is opioid withdrawal lethal? what do you treat it with?

A

opioid withdrawal is NOT lethal
tx; methadone (relieve symptoms)
+suboxone (naloxone + buprenorphone)

239
Q

chlorpromazine

thioridazine

A 
-zine = traditional neuroleptics
low potency antipsychotics (neuroleptics)
-high anticholinergic SE
-antidopaminergic in mesolimbic area
-antiadrenergic

USE: Schizo

**every other neuroleptic is high potency with fewer anticholinergic SE, but extrapyramidal effects/tardive dyskinesia

“Cheating Thieves are LOW”

240
Q

clozapine

A

-pine = atypical antipsychotic
MOA: complicated; anti dop, antiadren, antiserotonin
USE: schizo(helps + and - symptoms), bipolar, ocd,

SE: agranulocytosis (weekly WBC monitoring), seizures; less EPS and antichoinergic than traditional

olanzapine is another atypical, as is risperidone

**Clozapine is the gold standard for TREATMENT RESISTANT schizophrenia, must fail 2 antipsychotics prior to use

241
Q

Extrapyramidal side effects of neuroleptics

A

hrs: acute dystonia (muscle spasm, stiffness, oculogyric crisis(upward deviation of eyes)
days: akathisia (restless)
wks: bradykinesia (parkinsonism)
months: tardive dyskinesia )smack lips, stereotyped facial movements

242
Q

High potency neuroleptics (3)

A

“Try Fly High”
trifluoperazine
fluphenazine
haldol

antipsychotics, mostly of positive symptom control

SE: Extrapyramidal rxn

243
Q

neuroleptic malignant syndrome

A

from typical antipsychotics; rigidity, myoglobinuria, autonomic instability(tachycardia), hyperpyrexia, rhabdomyolisis

tx; dantrolene or d2 agonist

244
Q

leukovorin

A

used as a folate supplement with methotrexate

245
Q

tricyclic antidepressant
MOA
USE
SE

A

MOA: block NE/serotinin

USE: major depression, bedwetting, ocd, fibromyalgia

3C's
cardiotoxicity (tachy, hypotension
cns (obtundended, coma, seizure)
antiCholinergic (mydriasis, pyrexia, anhidrosis)
-hyperpyrexia
-respiratory depression

tx overdose with benzo and bicarb

*imipramine and others…

246
Q

Bupropion

A

MOA: NDRI (norepi dopamine reuptake inhibitor)
USE: antidepressant, smoking cessation

SE: seizures (NO SEXUAL Dysfunction), stimulant

247
Q

Clonidine

A

CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)

Used in HTN

SE: decreased libido

248
Q

triazolam

A

SHORT acting benzo 24hrs

249
Q

Use for IFN-alpha, IFN B, IFN gamma

A

IFN alpha= Chronic Hep B,C and kaposi’s sarcoma

IFN B = MS

IFN gamma = NADPH oxidase deficiency

250
Q

ATRA

A

All trans retinoic acid

tc of PML to mature the myeloblasts

251
Q

cladribine (2-cda)

A

adenosine deaminase inhibitor used in hairy cell leukemia

252
Q

cerebrform nuclei

A

leukemic spread of mycosis fungoides into blood. called sezary cells

253
Q

pautrier microabscesses

A

cd4 aggregates in epidermis from mycosis fungoides neoplasm

254
Q

Class I, II, III, IV antiarrythmics

A

Anesthetics, Block, Knife, Cuts

I: sodium channel blockers -> slow/block conduction, decrease slope phase 0 (increase QRS duration)
- variable potassium block

II: Beta Blockers: decrease cAMP -> lower Ca currents (increase PR) interval, lower phase 4 slope (decrease If)

III: K channel blockers: increase effective refractory period (increased QT)

IV: Calcium channel blockers: increase ERP, decrease conduction velocity SA/AV, increase PR

255
Q

amiodarone

A 
antiarrhythmic (class III)
Class I, II, III, IV effects because it alters lipid membrane of cell

Major therapeutic effect: prolong action potential and refractoriness. + everything =

=> decrease SA firing, suppress automaticity, interrupt reentrant circuits, prolong PR, QRS, QT
+ vasodilation (alpha and CCB effects) and negative inotrope (B-block and CCB). usually without CO decrease bc vasodilate > inotrope

SE: PULMONARY FIBROSIS, HEPATOTOXICITY, HYPERTHYROIDISM (it’s 40% iodine by weight), corneal deposits, skin deposits (blue/grey) -> phorodermatitis, contipation, neurologic probs, bradycardia, heart block, CHF.

256
Q

leucovorin

A

Folate supplement used for “rescue” during tx with methotrexate to supply some folate

can also help the cancer cells, but cancer is often necrotic with poor vascularization and can sometimes not take up as much as normal cells….

257
Q

Sulfonamides

A

MOA: BLock dihydropderoate synthase which converts PABA + pteridine -> dihydropderoic acid -> DHF

dihydropderoate only in bacteria

258
Q

iloprost

epoprostenol

A

tx of pulm htn to vasodilate

also use sildanefil, boesenan/ambrisentan/nifedipine

259
Q

dapsone

A

antibiotic for acne

260
Q

benzoate
MOA
USe

A

MOA: binds amino acids for secretion in urine
USE: hyperammonemia and its intoxication

261
Q

phenylbutyrate
MOA
USE

A

MOA: binds amino acids for secretion in urine
USE: hyperammonemia

262
Q

lactulose
MOA
USE

A

MOA: insoluble (diarrhea), or bacterial fermentation -> acidifiy intestinal contents

USE: Constipation

hyperammonemia (traps NH4+ in acidified intestines)

263
Q

tuberculosis treatment

A

Treat with RIPE before they RIP

rifampin (RNA polymerase the pooper)

isoniazid (block mycolic acid synth ) bacterial catalase peroxidase (KatG) converts INH to active metabolite. resistance if decrease production of KatG

pyrazinamide (uncertain mechanism of inhibiting cell wall synthesis), works in macrophage phagolysosomes with low pH

ethambutol (block arabinosyltransferase carbohydrate polymerization of cell wall)

or replace P or E with flouroquinolone or streptomycin

264
Q

Ustekinumab

A

USE: psoriasis (and other prob)

inhibits IL12, IL23 and inhibits differentiation into Th1 and Th17 cells

265
Q

sotalol, ibutilide, dofetilide, amiodarone

A 
class III antiarrhythmic K channel blockers
potassium
266
Q

omalizumab
MOA
USE

A

Anti-IgE antibody. binds mostly unbound serum IgE

USE: allergic asthma refractory to steroids and B2agonists

267
Q

guafenesin

USE

A

expectorant: thins respiratory secretions, doesn’t suppress cough reflex

268
Q

N-acetylcysteine

A
  • loosens mucous plugs in CF patients by cleaving disulfide bonds.
  • also used as antidote for acetamenophen overdose
  • renal protective with iodine contrast studies
269
Q

dextromethorphan
MOA
USE

A

MOA: NMDA antagonist. synthetic codeine analog with mild opioid effects

USE: antitussive
Naloxone used for overdose

270
Q

loperamide (and diphenoxylate)

A

opioid agonists that work on myenteric plexus to decrease GI motility.

271
Q

echinocandins (caspofungin/ micafungin)

A

inhibit B1,3D-glucan synthesis, a component of fungal cell wall

USE: candida and aspergillus

272
Q

topiramate

A

anticonvulsant also used for migraine prophylaxis

273
Q

buprenorphone

A

partial mu opioid agonist

USE: opioid addiction

274
Q

Varenicline

A

partial nicotinic agonist used to give some pleasure, decrease withdrawal, and decrease reward from smoking.

works within nervous system at alpha4beta2-nicotinic receptor…whatever

275
Q

Tx for hyperK

A

calcium gluconate (cardioprotective/prevents depolarization from hyperkalemia)

bicarb/beta agonist
Insulin
Glucose
Kayexalate (potassium binder)

276
Q

amphotericin B
MOA
USE
SE

A

MOA: binds and makes holes in ergosterol membranes
USE: for invasive fungal infections

SE: many; especially renal -> vasoconstriction decreases GFR + RTN from direct toxicity
-> hypokalemia and hypomagnesemia

277
Q

acyclovir

A

MOA: phosphorylated by thymidine kinase from virus (guanosine analogue). Chain termination of DNA polymerase

USE: HSV 1,2 and VZV
SE: crystalization in kidneys if high concentration -> renal tubular damage. Prevent with adequate saline infusion.

278
Q

bumetanide

A

loop diuretic

OH DANG

  • ototoxicity
  • hypokalemia, hypocalcemia,
  • dehydration
  • sulfa Allergy (except ethacrynic acid)
  • nephritis (interstitial)
  • Gout

+hypocalcemia

**also torsemide, bumetinide, furosemide

279
Q

ethacrynic acid

A

NON SULFA loop diuretic

280
Q

tolvaptan

A

competitive V2 antagonist

USE: hyponatremia to block insertion of aquaporins

281
Q

Beta 1 on kidneys

A

agonist increases renin release

282
Q

cyclophosphamide

A

MOA: cross links DNA at guanine-7 residues
USE: cancer and autoimmune diseases

SE: hemorrhagic cystitis, prevent with mesna (2mercaptoethansulfonate)

283
Q

are thiazides or loops more likely to give you hyponatremia?

A

thiazides, they retain the corticomedullary gradient so when vasopressin increases they can have massive free water reabsorption

because loops abolish the corticomedullary gradient water is absorbed in proximal tubule and collecting ducts isotonically and with less free water

284
Q

alemtuzumab

A

antibody against CD52tx; CLL

directly cytotoxic/induces complement killing

285
Q

enfuvirtide

A

binds gp41 and prevents HIV fusion

286
Q

clomiphene

A

USED in PCOS patients that want to get pregnant

estrogen receptor modulator that works in hypothalamus to prevent negative feedback of estrogen -> promote GnRH cycles/FSH&LH production/ovulation

287
Q

Plan B action

A

Large dose of progesterone

  • feedback inhibits LH -> inhibits ovulation
  • inhibits luteal stage
288
Q

Mifepristone
use
MOA

A

abortion pill
partial agonist but essentially anti-progesterone -> blocks corpus luteum progesterone from maintaining placenta

*coadministered with misoprostol which encourages contractions/effacement of cervix

289
Q

anastrazole

A

aromatase inhibitor

used in ER positive cancers

290
Q

flutamide

A

competitive inhibitor of androgens at testosterone receptor

used in prostate cancer

291
Q

raloxifene

A

SERM
USE: agonist on bone to reduce resorption of bone (osteoporosis)

  • *antiestrogen breast and endometrium
  • **increases blood lipoproteins
292
Q

terbinafine

A

oral antifungal (squalene epoxidase inhibitor)

bocks squalene -> lanosterol

(azoles block lanosterol -> ergosterol)

293
Q

HIV protease inhibitor SE

A

-navir tease a protease inhibitor

fat redistribution (they’re not really sure of MOA)

294
Q

mercury or lead poisoning DRUG of choice

A

CaNaEDTA: though dimercaprol can also be used

295
Q

syrup of ipecac

A

emetic used to throw up poisons

296
Q

foscarnet
MOA
USE

A

MOA: viral DNA polymerase inhibitor binds to pyrophosphate-binding site

USE: CMV retinitis when ganciclovir fails, acyclovir resistant HSV

SE: nephrotoxicity: hypocalcemia, hypomagnesemia => may promote seizures

  • *Think of HIV <50CD4 count treated for eye problems
  • *cidofovir is similar, no pyrophospate binding site.
297
Q

Ribavirin
MOA
USE
SE

A

MOA: inhibits IMP dehydrogenase
USE: RSV, chronic hep C
SE: hemolytic anemia. TERATOGEN

298
Q 
NRTI SE's
general
and
Tenofovir
zdv (zidovudine)
A

bone marrow suppression: reverse with G-CSF and EPO

nucleosides -> lactic acidosis

tenofovir -> rash

ZDV-> megaloblastic anemia. ZDV is used as prophylaxis and during pregnancy to reduce transmission

**assoc with mitochondrial toxicity

299
Q

mesna

(2-mercaptoethansulfate

A

used to inactivate chemo products in the urine

300
Q

filgrastim

A

G-CSF

used to differentiate granulocytes in conditions like death from chemo or zidovudine

301
Q

bipolar mood stabilizer

A

Lithium (manic and depressive)

Valproic acid (hepatotoxicity, neural tube defects) depressives/s

carbamazepine (agranulocytosis) depressive s/s
Lamotrigine (SJS): used for depressive s/s

302
Q

glyburide

A

MOA: sulfonylurea, blocks K channels -> depolerize and release insulin
+
mild diuresis

USE: DMII
SE: hypoglycemia, heartburn

303
Q

Fluconazole

A

MOA: inhibit fungal p450, prevents ergosterol synthesis -> prevents cell membrane synthesis

USE: mycotics

304
Q

Felodipine

A

MOA: dihydropyridine Ca channel blocker, higher selectivity for vascular channels than cardiac. weakly diuretic

USE: HTN

305
Q

trihexyphenidyl

A

MOA: antispasmotic; relaxes smooth muscle directly and also indirectly inhibits parasympathetic nervous system. Anticholinergic type effects

USE: parkinsonism
SE: see benztropine

Step One Pharmacology (6 decks)

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