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Flashcards in 3/15 pharm Deck (111)
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1
Q
Clearance can be impaired w/defects in which systems?
A
cardiac, renal, hepatic.
2
Q
Clearance
-equation:
A
Cl = (rate of elim of drug)/(plasma drug conc.)
Cl = (Vd)*(Ke)
Cl = (Q)*(Er)

Q = flow to that organ (ie. liver)
Er = extraction ratio
3
Q
Loading dose
-equation
A
Loading dose = (Cp)(Vd) / (F)

Cp = target plasma concentration at steady state
F = bioavailability
4
Q
Maintenance dose (MD)
-equation
A
MD = (Cp)(Cl)(t) / F

t = dosage interval (time between doses), if not administered continuously.
*If continuous, leave t out. You will also know its IV so F = 1. B/c only IV is continuous.
5
Q
In liver or renal disease, does maintenance dose inc. or dec.?
A
Dec.
-less being cleared, so less dose needed.
6
Q
Which drugs follow zero-order elimination?
-mnemonic?
A
-Phenytoin, Ethanol, and Aspirin (at high or toxic concentrations).

-PEA. (A pea is round, shaped like the “0” in
“zero-order.”)
7
Q
Capacity-limited elimination
-0 or 1st order?
A
0 order elim.
8
Q
Flow-dependent elimination
-0 or 1st order?
A
1st order elim.
9
Q
Phase I drug metabolism
A
P450 system
-Reduction, oxidation, hydrolysis.
10
Q
Phase II drug metabolism
A
Conjugation (Glucuronidation, Acetylation, Sulfation)
11
Q
Which is most common P450 enzyme?
A
CYP3A4 = most common
12
Q
Name 3 drugs that might cause trouble in a slow acetylator.
-which would also have a bimodal pop. distribution.
A
-hydralazine, isoniazid, procainamade

*HIP: its not hip to be a slow acetylator.
13
Q
What kind of antagonist is ketamine?
A
-ketamine (noncompetitive antagonist) on NMDA receptors.
14
Q
Therapeutic index:
-equation:
A
TI = Toxic dose/Effective dose
*high therapeutic index is good b/c that means theres a big difference btwn toxic and effective doses.
15
Q
Whats good, a high or low therapeutic index?
A
High.
-Safer drugs have higher TI values.
16
Q
Is the therapeutic index the same as therapeutic window?
A
No, b/c the therapeutic window would never extend all the way until the toxic dose.
17
Q
Some receptors that respond to autonomic neurotrasmitters/drugs receive NO nerve innervation (must get ligand through blood).
-can you name these uninnervated autonomic receptors?
A
-muscarinic receptors on endothelium of blood vessels
-adrenoreceptors on apocrine sweat glands
-alpha-2 and beta adrenoreceptors in blood vessels.
18
Q
para/pre, sym/pre: all release what?
A
ACh
19
Q
All ganglia have what type of receptor?
A
Nicotinic: ligand-gated ion channels.
20
Q
Do all sym/post release NE?
A
NO
-adrenal medulla releases NE and epi.
-sym/post release ACh that innervate sweat glands & piloerector muscles. These = sympathetic cholinergic.
21
Q
sympathetic cholinergic
A
sym/post that releases ACh
-innervate sweat glands & piloerector muscles.
22
Q
All glands have what receptors on them?
A
muscarinic
-even sweat glands that have sym/post innervation: these sym/posts dump ACh, not NE (sympathetic cholinergic).
23
Q
adrenal medulla & sweat glands = part of sym nervous system but are innervated by _______ fibers.
A
cholinergic
24
Q
Nicotinic ACh receptors
-what type of receptor is it?
A
-ligand-gated Na/K channels.
25
Q
which receptors are more sensitive to activation, alpha or beta?
A
beta
26
Q
Epi: acting more on alpha1 or beta2?
-low dose =
-high dose =
A
-low dose - acts more on beta-2
-high dose - acts more on alpha-1

*remember, beta-receptors are more sensitive.
27
Q
Ciliary muscle innervation:
A
-muscarinic
-its NOT dual innervated.

*if there is an effect on accomodation, its a muscarinic (agonist or antagonist) drug
28
Q
Cycloplega = what is it, what can cause it?
A
paralysis of ciliary muscles = M-antagonist
29
Q
Gs => inc. cAMP => PKA => phosphorylates MLC kinase.
-whats the result?
A
smooth muscle relaxation
-hence beta-2 (Gs) causing smooth muscle relaxation in lungs.
30
Q
Hemicholinium
-mech:
-use:
A
-Prevents reuptake of choline so you have less in nerve terminal so you make less ACh and release less ACh.
*NO CLINICAL USE.
31
Q
NMJ
-what kind of receptor?
A
nicotinic, ACh.
32
Q
Reserpine
A
-inhibit vesicular monoamine transporter (VMAT); limit dopamine vesicle packaging and release.

*used in huntingtons.
33
Q
guanethidine
A
-like botulinum but for NE.
*not clinically used
34
Q
Where do you find AChE?
A
-AChE is only found in the synpatic cleft.
-Not everywhere you find a M or N receptor.

*that means AChE inhibitor can not vasodilate b/c endothelial cell M3 receptors are not innervated = no synaptic cleft.
35
Q
Can AChE inhibitors vasodilate?
A
-AChE is only found in the synpatic cleft.
-Not everywhere you find a M or N receptor.

*that means AChE inhibitor can not vasodilate b/c endothelial cell M3 receptors are not innervated = no synaptic cleft.
36
Q
M agonists
-give pattern of what type of lung disease?
A
-obstructive, like COPD.
37
Q
What an effect you can see via cholinomimetic drugs that you dont see w/parasym. nerve stimulation?
A
sweating
-b/c sweat glands have sym innervation but release ACh at the sweat glands M3 receptor.
38
Q
Is bethanechol resistant or sensitive to AChE?
A
-resistant to AChE.
-not the same exact structure as ACh so its not broken down by AChE!
39
Q
Someone at movie and gets intense pain in their eyes.
A
-They're in a dark room, their pupils dilate, the angle gets smaller, and this precipitates their glaucoma
40
Q
Administer _______ to Cystic Fibrosis pt to get sweat so you can do sweat test
A
pilocarpine
41
Q
Pilocarpine is resistant or sensitive to AChE?
A
resistant, just like bethanechol.
-not exactly the same structure as ACh so AChE doesn't break it down.
42
Q
myasthenic crisis
A
not enough ACh
43
Q
cholinergic crisis
A
too much ACh
-can resemble myasthenic crisis
44
Q
Which receptors do AChE inhibitors act at?
A
muscarinic & nicotinic
45
Q
atropine OD
-which AChE inhibtor can you give?
A
-physostigmine bc atropine gets into CNS and so does physostigmine.
*physostigmine = a tertiary amine = not charged, lipid soluble.
46
Q
Myasthenia Gravis
-how was it historically Dx?
-how is it Dx now?
A
-historically: edrophonium.
-Myasthenia now diagnosed by anti-AChR Ab (anti-
acetylcholine receptor antibody) test.
47
Q
What to watch out for before giving cholinomimetic?
A
COPD, asthma, peptic ulcers.
48
Q
parathion
A
organophosphate
-irreversible AChE inhibtor.
49
Q
sarin
A
organophosphate
-irreversible AChE inhibtor.

*nerve gas
50
Q
organophosphate poisoning
-Tx:
A
-atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early).
51
Q
why isn't atropine enough for organophosphate poisoning tx?
A
Atropine is a muscarinic antagonist.
-it is NOT a nicotinic antagonist!
-Nicotinic toxicity is treated by regenerating active cholinesterase w/pralidoxime.
52
Q
Which one gets desensitized, muscarinic or nicotinic?
A
nicotinic
-muscarinic does NOT get desensitized.
*succinylcholine acts on nicotinic.
53
Q
Glycopyrrolate
-mech:
-use:
A
muscarinic antagonist
-Parenteral: preoperative use to reduce airway secretions.
-Oral: drooling, peptic ulcer.
54
Q
Atropine
-uses:
A
Used to treat bradycardia & for ophthalmic applications.
55
Q
ACh
-its excitation of skeletal muscle & CNS mediated via which receptor?
A
nicotinic
56
Q
Jimson weed
-what effects?
A
-atropine poisoning if you consume Jimson weed.
-aka Belladonna alkaloids.
57
Q
hexamethonium, mecamylamine
-what are they?
-use?
A
-nicotinic (ganglion) blockers
-They will be used in problems b/c they block baroreflex changes in heart rate.
-If you use these you WIPE OUT the ANS, b/c all ganglia use Nn receptors.
*just remember what the predominant tone on the system is at rest, and cancel out that tone.
58
Q
What resting tone does our heart have?
A
PARA
59
Q
Epi
-low dose effects:
A
-B/c beta receptors are more sensitive, you will get primarily a beta response with a low dose of epi.
-THIS IS KEY. At low dose acts like isoproterinol (nonselective beta agonist).
60
Q
Epi
-medium dose
A
-alpha-1 gets involved.
*alpha-1 and beta-2 antagonize each other.
-so at medium dose epi looks like a beta-1 agonist. (like DOPUTAMINE, a selective beta-1 agonist)
61
Q
Epi
-high dose
A
-alpha-1 will PREDOMINATE.
-You will vasoconstrict and get inc. BP.
-You will get tachy OR reflex brady. This looks just like NE.

*you can not distinguish NE and high dose EPI in cardiac parameters.
62
Q
NE vs high dose epi.
-differences:
A
-If it bronchodilates, inc. lipolysis, inc. glycogenolysis, or inc. gluconeogenesis; then it MUST be EPI,
-beta-2 does these things and NE does NOT act on beta-2.
63
Q
How do you unmask beta-2 action of epi?
A
-give an alpha-1 blocker.
-alpha 1 is opposing beta-2.
64
Q
Can NE, under any circumstances, reduce BP?
A
NO
65
Q
Can epi, under any circumstances, reduce BP?
A
Yes, but only at low dose where beta-2 is activated but alpha-1 is not.
66
Q
Isoproterenol
-what does it do to pulse pressure?
A
nonselective beta-agonist.
-inc inotropy = inc systolic.
-inc vasodilation = dec diastolic
*inc. pulse pressure.
67
Q
cardiac stress testing
-which drug is used?
A
dobutamine
68
Q
terbutaline
-mech:
-use:
A
-beta-2 agonist
-reduce premature uterine contractions
69
Q
beta agonist
-can they cause hypo or hyperkalemia?
A
hypokalemia
-inc activity of Na/K pump which brings K into cells.
70
Q
name some mobile pool releasers
A
tyramine, amphetamine, ephedrine.
71
Q
Ephedrine
-mech:
-use:
A
-releases stored catecholamines.
-Nasal decongestion, urinary incontinence, hypotension.
72
Q
Cocaine intox
-should you give beta-blockers?
A
-No.
-you never want to risk having unopposed alpha-1 action by blocking beta-2.
-can get hypertensive crisis.
73
Q
amphetamine & cocaine
-predominantly the inc. in which chemical leads to addiction?
A
dopamine
74
Q
Clonidine
-uses
A
-ADHD, severe pain, and a variety of off-label indications (e.g., ethanol and opioid withdrawal).
75
Q
Whats the only anti-HTN drug w/approved analgesic use?
A
clonidine
76
Q
phentolamine vs phenoxybenzamine
-which one is irreversible?
A
phenoxybenzamine = irreversible
-both =nonselective alpha blockers
77
Q
Give ________ to patients on MAO inhibitors who eat
tyramine-containing foods
A
phentolamine
78
Q
Can tamulosin also be used for HTN like other alpha-1 blockers?
A
-No, tamulosin more specific for smooth muscle in urinary tract.
79
Q
Mirtazapine
-mech:
-use:
-s/e:
A
-alpha-2 blocker
-depression
-inc appetite, inc serum cholesterol, sedation.
80
Q
Beta-blocker OD
-tx:
A
glucagon
-beta-1 & beta-2 both = Gs, they inc. cAMP.
-glucagon also = Gs, so it inc. cAMP as well.
81
Q
beta-blockers
-can you use in a diabetic?
A
-Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks; not contraindicated
82
Q
beat-blocker
-s/e:
A
-Impotence
-CV adverse effects
-CNS adverse effects (seizures, sedation, sleep alterations)
-dyslipidemia (metoprolol)
-asthmatics/COPDers (may cause exacerbation)
83
Q
beta-1 selective blockers
-mnemonic?
A
A to M
84
Q
non-selective beta-blockers
-mnemonic?
A
N to Z
85
Q
pindolol
-why is it better to use in asthmatics?
A
-partial non-selective agonist.
-it will also have some sympathetic effects, like slightly bronchodilating for instance.
86
Q
beta-blockers
-which ones are non-selective ALPHA & beta blockers?
A
-carvedilol, labetalol

*dont end w/"olol".
87
Q
Nebivolol
-what is unique about it?
A
Nebivolol combines cardiac-selective β1-adrenergic blockade with stimulation of β3-receptors, which activate nitric oxide synthase in the vasculature.
88
Q
Which drugs can cause cutaneous flushing?
-mnemonic?
A
VANC
-Vancomycin, Adenosine, Niacin, Ca2+ channel
blockers.
89
Q
Which drugs can cause Hyperglycemia?
-mnemonic?
A
Taking Pills Necessitates Having Blood Checked
-Tacrolimus
-Protease inhibitors
-Niacin
-HCTZ
-β-blockers
-Corticosteroids
90
Q
Which drugs can cause hypothyroidism?
A
Lithium, amiodarone, sulfonamides
91
Q
Which drugs can cause diarrhea?
-mnemonic?
A
Might Excite Colon On Accident
-Metformin
-Erythromycin
-Colchicine
-Orlistat
-Acarbose
92
Q
Lanugo
-what is it?
-what disease is it seen in?
A
Fine body hair
-anorexia nervosa
93
Q
Parotitis
-bulimia or anorexia?
A
Both
-there is binge/purge type of anorexia.
94
Q
Does calcium bind troponin or tropomyosin?
A
-troponin C
95
Q
Prominent U wave
-hypo or hyperkalemia?
A
hypokalemia
96
Q
what happens to haptoglobin-Hb complex?
A
its hepatically cleared
97
Q
Winged scapula
-common causes?
A
-mastectomy surgery & accidentally nick the long thoracic nerve.
-stab wounds.
98
Q
clavicular fx
-where in clavicle?
A
middle 1/3
99
Q
ACL & PCL
-connect which two bones?
A
tibia & femur
100
Q
ACL & PCL
-which one more commonly injured?
A
ACL
101
Q
ACL or PCL
-which one attaches to medial condyle of femur?
A
PCL
*anterior lateral surface of medial epicondyle of femur.
102
Q
ACL or PCL
-which one attaches to the lateral condyle of femur?
A
ACL
*post. medial lateral femoral condyle.
103
Q
Where on femur does PCL attach?
A
medial condyle of femur.
104
Q
Where on femur does ACL attach?
A
lateral condyle of femur.
105
Q
Septic arthritis
-usually due to what?
-how do u treat it?
A
gonococcus
-ceftriaxone
106
Q
How does colchicine reduce acute inflammation of gouty arthritis?
A
inhibits neutrophil migration into inflamed areas.
107
Q
Which vitamin D is created upon exposure to sun?
A
D3 = cholecalciferol
108
Q
Major cause of morbidity in sarcoidodis?
A
pulm. fibrosis.
109
Q
medial or lateral cruciate ligament attached to its corresponding meniscus?
A
MCL.
110
Q
Ligation of sup. thyroid art:
-which nerve at risk?
A
-external branch of superior laryngeal n.
111
Q
Ligation of inf. thyroid art:
-which nerve at risk?
A
-recurrent laryngeal n.