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COMLEX STEP 1 2017 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the role of raltegravir in HIV management

A

integrase inhibitor

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2
Q

Which abx can precipitate Serotonin syndrome when combined with an SSRI?

A

Linezolid

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3
Q

What is the pharm therapy for alzheimers?

A 
cholinesterase inhibitors (donepezil)
NMDA receptor antagonist (memantine)
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4
Q

What is the mechanism of action of the only drug to treat influenza?

A

Zanamivir - inhibits viral neuraminidase

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5
Q

What drug is used to treat Strep Pneumo Pneumonia

A

Penicillin-based (beta lactam)

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6
Q

What are 3 drugs that can be used for MRSA?

A

Vancomycin
Daptomycin
Linezolid

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7
Q

Which antifungal drug targets the enzyme responsible for producing a fungal wall polysaccharide

A

Echinocandins - caspofungin

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8
Q

What drug has shown to improve survival in HF patients due to LV systolic dysfunction

A

Beta blockers

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9
Q

Drug interaction between Lithium and what 3 drugs can precipitate Chronic lithium toxicity (confusion, ataxia, neuromuscular excitability)?

what is one of the most common fx of lithium toxicity?

A

ACE inhibitors
nonsteroidal inflammatory drugs
thiazide diuretics

TREMOR

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10
Q

High dose corticosteroids can cause an increase in what immune cell?

A

Neutrophil

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11
Q

What is the equation of Volume of distribution of a drug?

A

amount of drug in body/plasma drug concentration

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12
Q

What is the equation of Clearance of a drug?

A

rate of elimination of drug/plasma drug concentration

= Volume of distribution * Kc(elimination constant)

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13
Q

What is the equation for half-life of a drug?

A

t1/2 = (0.693 x Vd)/CL in first order elimination

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14
Q

what three drugs have zero order elimination?

A

(PEA)
Phenytoin
Ethanol
Aspirin

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15
Q

What can result in MAO inhibitors and ingestion of tyramine rich foods (cheese, wine)

A

Increased active presynaptic neurotransmitters, increased sympathetic stimulation = HYPERTENSIVE CRISIS

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16
Q

what class of drug is Bethanechol, Carbacol, Methacholine, and Pilocarpine? What are their uses?

A

Cholinomimetic agents - Direct agonists

Bethanechol - activates bowel, bladder (post op)
Carbachol - relieves intraocular pressure in open angle glaucoma
Methacholine - challenge test for asthma dx
Pilocarpine - open/closed angle glaucoma, xerostomia (Sjogren syndrome)

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17
Q

What is the receptor selectivity of:

  1. Norepinephrine
  2. Epinephrine
  3. Isoproterenol
A
  1. a > b = CO same, bradycardia, increased peripheral resistance
  2. a~b = increased CO, tachycardia, decreased peripheral resistance (B2>a)
  3. B > a = increased CO, decreased MAP, increased HR, increased pulse pressure
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18
Q

What is the mechanism of Clonidine, Guanfacine

A

a2-agonists - used in Hypertensive urgency, ADHD, Tourette

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19
Q

What is the preferred first-line treatment for patients with moderate-severe Rheumatoid arthritis?

What are some side fx of this drug? what is the mechanism of action?

A

Methotrexate - inhibits Dihydrofolate reductase
-inhibits growth of rapidly dividing cells:
GI ulcerations
Alopecia
Pancytopenia
Hepatotoxicity

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20
Q

What is the use of Lamotrigine

What is a serious side effect to look out for?

A

Anticonvulsant for Partial/generalized seizures

–look for skin rash: (Steven-Johnson Syndrome, Toxic epidermal necrosis)

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21
Q

What are the antipsychotics

  1. low potency (2 non-neurological)
  2. high potency (2 neurological)
A
  1. Chlorpromazine, Thioridazine

2. Haloperidol, Fluphenazine

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22
Q

What are the side fx of antipsychotics

  1. low potency (Chlorpromazine, thioridazine)
  2. high potency (haloperidol, fluphenazine)
A
  1. Sedation, Anticholinergic, Orthostatic hypotension

2. EXTRAPYRAMIDAL Sx (Acute dystonia, Akathisia, Parkinsonism)

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23
Q

What drug should be administered in the case of:
pneumonia pt administered ceftriaxone
-develops trouble breathing, abdominal cramps, lightheadedness. Hypotension, diffuse maculopapular rash

A

anaphylactic shock - give epinephrine

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24
Q

What is the mechanism of action of Nedocromil and Cromolyn?

A

Prevent Mast cell degranulation

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25
Q

What is classification and mechanism of action of Dofetilide, Amiodarone, Sotelol?

A

Class III antiarrhythmic - potassium channel blocker, acts on Phase III

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26
Q

a pt is on systemic chemotherapy and develops hemorrhagic cystitis. What is the responsible agent(s) and What could have prevented these symptoms?

A

Cyclophosphamide, Ifosfamide - cause toxic substance acrolein to be excreted in urine

-give mesna (2-mercaptoethanesulfonate)

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27
Q

Which are the cardioselective beta blockers?

A

selective for B1
“A BEAM of beta-1 blockers”

Atenolol
Betaxolol
Esmolol
Acebutolol
Metoprolol

also: bisoprolol, nebivolol

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28
Q

What is the adrenergic receptor in the eye?

A

Alpha-1

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29
Q

What is the adrenergic receptor in the uterus? what drugs are used for stimulation and what is the result?

A

Beta-2

Ritodrine, Terbutaline - uterine relaxation (TOCOLYSIS)

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30
Q

After the administration of an oral opioid, right upper quadrant pain occurs. vital signs are normal. What has happened?

A

Mu opioid analgesic - contraction of smooth muscle cells in Sphincter of Oddi = spasm

= Biliary Colic (increase common bile duct pressure)

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31
Q

What two drugs display competitive inhibition of Iodine transport into the thyroid?

A

Sodium-Iodide competitive inhibitors
Perchlorate
Pertechnetate

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32
Q

What is the mechanism of action of Ethosuximide?

A

Blocks T-type Ca2+ channels in thalamic neurons

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33
Q

What is the mechanism of action of Phenytoin, carbamazepine, and Valproic acid?

A

inhibits neuronal high-frequency firing by reducing Sodium channels ability to recover after depolarization

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34
Q

what is the mechanism and use of Mifeprostol in pregnancy?

A

Progesterone Antagonist

used in combo with misoprostol to terminate pregnancy

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35
Q

Identify the drug:
used to prolong QT interval
a/w lower incidence of torsades de pointes

A

Amiodarone

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36
Q

What is the antidote for Arsenic poisoning?

A

Dimercaprol, Succimer

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37
Q

What is the antidote for B-blocker toxicity?

A

Saline, atropine, glucagon

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38
Q

What is the antidote for copper overdose?

A

Penicillamine, trientine

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39
Q

What is the antidote for Heparin?

A

Protamine sulfate

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40
Q

What is the antidote for Warfarin?

A

Vitamin K, Fresh frozen plasma

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41
Q

What drugs are P450 inducers?

A

“Guiness, Coronas, and PBRS induce Chronic Alcoholim”

Griseofulvin
Carbamazepine
Phenytoin
Barbiturates
Rifampin
St. John's Wort
Chronic Alcoholism
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42
Q

What drugs are P450 inhibitrs

A

CRACK AMIGOS

Ciprofloxacin
Ritonavir (protease inhibitors)
Amiodarone
Cimetidine
Ketoconazole
Acute Alcohol
Macrolides (erythromycin, clarithromycin)
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides
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43
Q

What is the use and mechanism of Varenicline?

A

partial agonist of nicotinic acetylcholine receptor

-used for nicotine cravings and decreases pleasure from nicotine products (decreases dopamine release)

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44
Q

What is the mechanism and use of Theophylline?

A
  1. Blocks Adenosine receptor (causes arrhythmia)

2. competitive nonselective phosphodiesterase inhib

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45
Q

What is the antidote for atropine toxicity?

A

Physostigmine (“Fix-o-stigmine”)

46
Q

Which antihypertensive drugs taken during pregnancy can cause the POTTER sequence? What is the mechanism of Injury?

A

ACE inhibitors
Angiotensin II inhibitors (-sartan)

Those drugs prevent Angiotensin II from properly helping fetal kidney development - reduced fetal diuresis = oligohydramnios

47
Q

What is the difference between Loop Diuretics and Thiazides regarding the electrolyte abnormalities they can cause?

A

Loop Diuretics - HYPOcalcemia

Thiazides - HYPERcalcemia

48
Q

Statins cause an increase in what in hepatocytes as a response to decreased total cholesterol?

A

increased in hepatocyte LDL-receptors to increase uptake of circulating LDL

49
Q

What is the mechanism of action of cholestyramine?

A

Bile-acid binder in the gut preventing reabsorption. This causes the liver to increase cholesterol use to make more bile, decreasing free cholesterol

50
Q

What type of drug is effect in preventing chemotherapy-induced vomiting?

A

5-HT3 receptor antagonists (Ondansetron, granisetron, dolasetron)

51
Q

Why do older patients received a decreased dose of digoxin?

A

Renal excretion impairment

52
Q

What is the most dangerous adverse effect of amphotericin B? What are the symptoms?

A

Nephrotoxicity

increased membrane permeability in distal tube = Hypokalemia + Hypomagnesemia
= WEAKNESS + ARRHYTHMIAS

53
Q

Which antihistamines has less CNS fx that first generation antihistamines??

A

Loratadine

Cetirizine

54
Q

What is the mechanism of action of Heparin?

A

Lowers the activity of thrombin and factor Xa

55
Q

Which abx causes a disulfiram-like effect? (

A

Metronidazole

Cefoperazone, Cefamandole (third/second gen cephalosporins)

56
Q

What does Phase I metabolism of a drug do?

A

Addition of functional group (reduction, oxidation, hydrolysis)

to make it more water soluble so it can be excreted by the kidney

57
Q

Which antimalarial drug can cause neuropsychiatric disturbances?

A

Mefloquine

58
Q

Which topic musculoskeletal pain relief medication works by depleting neurons of substance P

A

Capsaicin

59
Q

What is the pathogen responsible for Tinea Versicolor?

What is treatment?

A

Malassezia furfur - spaghettic and meatball on KOH

Selenium sulfide

60
Q

What is a well known complication of Celecoxib (COX-2 inhibitor)?

A

Thromboses - stroke, MI

61
Q

What is an adverse effect of 5-Fluorouracil?

what drug is this often administered in conjunction with?

A

Myelosuppression

often given with leucovorin

62
Q

What primary action should be taken to prevent recurrence of gout?

A

Allopurinol - xanthine oxidase inhibitor

–decreases production of uric acid

63
Q

describe the pharmacologic phenomenon:
cortisol has NO DIRECT vasoactive properties
NE + cortisol causes increased vasoconstriction than NE alone

A

Permissiveness - one hormone allows another to exert its maximal effect

64
Q

What is the use and mechanism of Fenoldopam?

A

IV used in hypertensive emergency especially in patients with renal insufficiency

  • selective peripheral dopamine-1 receptor agonist
  • causes arteriolar dilation, increases renal perfusion, promotes diuresis and natriuresis
65
Q

Which medication class is used to treat supraventricular tachycardias such as those caused by atrial fibrillation by binding to sodium fast channels responsible for phase 0 depolarization

what circumstance does this drug have a higher effect? what happens?

A

Class 1C antiarrythmic
Flecainide
propafenone

have a increased effect at higher heart rates?
–causes a prolonged QRS as a result

66
Q

What is the Mechanism and use of Gemfibrozil, bezafibrate, fenofibrate? What are two adverse effects?

A

Upregulate LDL = increased triglyceride clearance, activates PPAR-alpha to induce HDL synthesis (decrease LDL, increase HDL, greatly decreases TG)

67
Q

What is the mechanism of Digoxin?

A

inhibits Na+/K+ ATPase = indirect inhibition of Na+/Ca2+ exchanger = increase intracellular Ca2+
=POSITIVE INOTROPY

-stimulates vagus nerve = DECREASE HR

68
Q

Which antiarrhythmics are best used Post-MI? why?

A

Class 1B antiarrythmic:
Lidocaine
Mexiletine

-preferentially affect ischemic or depolarized Purkinje and ventricular tissue

69
Q

Pregnant lady present with a DVT in her left calf. What is the best treatment?

A

Low-Molecular Weight Heparins (Enoxaparin)

70
Q

What is the pharm that causes drug induced lupus?

A

SHIPP

Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
71
Q

What needs to be monitored in patients on:

  1. Warfarin
  2. Heparin
A
  1. PT

2. PTT

72
Q

What forms are Hepatitis is there is a vaccination for ?

A

Hep A, B

73
Q

What is the use/mechanism of Metoclopramide? What is a side effect to be careful of

A

stims the intestines - diabetic and postsurgery gastroparesis, antiemetic

D2 receptor antagonist, does not influence colon transport time

-side fx: D2 antagonist so DONT USE WITH PARKINSONS

74
Q

What is the biochemical signalling involved with vagal activation of gastric parietal cells?

A

Vagal stim - ACh - binds M3 receptor

  • stims Gq subunit
  • activates PLC
  • DAG, ITP
  • increased intracellular Ca2+
75
Q

65 year old presents with two days of melanotic stools, early satiety, abdominal bloating. Endoscopy shows a tumor in his stomach. Biopsy shows multiple spindle shaped cells.
What is most likely Dx, what is the associated gene defect?

A

GIST (gastrointestinal stromal tumor)

  • -c-KIT
  • -always spindle shaped
76
Q

What gene defect is related to melanin spots on lips + buccal mucosa, colonscopy showing multiple hamartomatous polyps

A

Peutz-Jegher Syndrome

STK11 gene

77
Q

A pt with portal hypertension has esophageal varices. Which vein does the esophageal vein drain into intially? What other vein does the esophageal vein anastamose with?

A

drains into Splenic vein which drains into Superior mesenteric Vein

anastamoses with the Left gastric V

78
Q

What other autoimmune disease is associated with Celiac sprue/dz?

A

Hashimotos (autoimmune thyroiditis)

79
Q

Which two diarrheal diseases should be reported to the CDC?

A

Salmonella

Shigella

80
Q

What is the first line treatment for Parkinson’s disease? what is a side effect prevented by a conjunct pharmaceutical?

A

Levodopa-carbidopa

carbidopa - prevents peripheral conversion of levodopa to dopamine
—-prevents DIZZINESS/ORTHOSTASIS

81
Q

What is a antiarrythmic drug that increases Digoxin toxicity? what is an antiarrythmic drug that can help with digoxin toxicity?

A

quinidine - increases toxicity

lidocaine - can help dysrhythmias caused by digoxin toxicity

82
Q

what is the mechanism of action of Metronidazole?

A

Forms free radicals that damage DNA

83
Q

What is the mechanism and possible use of sirolimus?

A

binds to mTOR = inhibits T-cell proliferation in response to IL-2

used w cyclosporine and corticosteroids to suppress organ rejection

84
Q

identify dz and mechanism:
33 year old italian female presents with left eye pain and blurry vision for one week. Hx: recurrent oral and genital ulcers, the most recent resolving two weeks ago. Bilateral tender, erythematous pretibial nodules

A

Behcet syndrome - activation of complement system by circulating antibody complexes

-recurrent oral aphthous ulcers, genital ulcers, uveitis, joint arthorpathy, panniculitis (inflamation of the subq fat layers beneath skin = erythema nodosum)

85
Q

How do Aspirin and Naproxen differ?

A

both are NSAIDs

  1. Aspirin IRREVERSIBLY inhibits COX
  2. Naproxen REVERSIBLY inhibits COX
86
Q

What is the most serious side effect of a TB drug that causes red/orange urine?
what is the mechanism of action?

A

rifampin - Hepatotoxicity

–inhibits DNA-dependent RNA polymerase

87
Q

Which antihypertensive should be used in pts with CREST syndrome?

A

ACE inhibitors - inhibits vasoconstriction - preventing further vascular damage and
“scleroderma renal crisis”

88
Q

Which two abx have an adverse side effect of ototoxicity? which one causes it more often?

A

Aminoglycosides (ie Gentamicin)

Vancomycin - cause ototoxicity LESS OFTEN

89
Q

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

A

4-5 half lives

90
Q

What is the equation for Maintenance Dose, Desired Plasma Concentration, Clearance, and Bioavailability?

A

Maintenance Dose = (CP * CL)/F

Cp - desired plasma concentration
CL - clearance
F - Bioavailability

91
Q

HIV patient is put on anti-retroviral therapy. He now complains of fatigue and dyspnea, new systolic murmur heard on cardio ausc. Labs show anemia nad reticulocytopenia. what is the drug administered?

A

Zidovudine - NRTI
–causes bone marrow suppression = anemia, reticulocytopenia

(inhibits DNA synthesis in bone marrow cells)

92
Q

What are the nonselective Beta blockers? what is a contraindication?

A 
PNPT
Propanolol
Nadolol
Pindolol
Timolol

contraindicated in pts with asthma and COPD

93
Q

What are the two most common side effects of Aminoglycosides (ie gentamicin)

A

Ototoxicity

Nephrotoxicity

94
Q

10 year old pt has repeated infections (Aspergillus skin infection @ 2, Staph aureus tooth abscess @5). Nitroblue tetrazolium staining test is negative. What is the likely dx?

A

Chonic Granulomatous Disease - lack of oxygen-dependent microbial killing

95
Q

What is the use/mechanism of action of flumazenil

A

Benzodiazepine overdose antidotes

-competitive antagonish at the GABA receptor - decreases POTENCY

96
Q

Identify Abx:
Treat necrotizing fasciitis
broad spectrum active against wide range of aerobic, anaerobic gram-positive, and gram negative bacteria

A

Broad spectrum Carbapenem (Meropenem)

97
Q

Why is chlamydia trachomatis (gram negative bacterium) resistant to penicillins?

A

Cell wall lacks MURAMIC ACID

  • –most other bacteria have this
  • –beta-lactam abx need muramic acid to disrupt cell wall
98
Q

what is the mechanism of the intramuscular injection therapy for a neisseria gonorrhea infection?

what is the oral therapy

A

Intramusc - Ceftriaxone

Oral (initial management of choice) = Azithromycin - Inhibition of peptide translocation on the bacterial ribosome

99
Q

Which antifungal leads to accumulation of lanosterol in fungal cell membranes? what is a common use?

A

Fluconazole - treat cryptococcal meningitis (affects HIV, immunocompromised pts)

–inhibits conversion of lanosterol to ergosterol in fungal membranes

100
Q

What are two pharm therapies (which is preferred) for bronchoalveolavage fluid contains organisms w septate hyphae Y-shaped branching pattern using a Gomori methenamine silver stain?

A

Asperigillus fumigatus

  • -Voriconazole - Preferred
  • -Amphotericin B - renal side effects
101
Q

Pt presents w nausea, vomiting, diarrhea after being administered with high dose of Methotrexate.

what is antidote?

A

Leucovorin - folic acid analogue used to reverse methotrexate toxicity

102
Q

What is the mechanism of carbidopa?

A

Inhibits DOPA DECARBOXYLASE

=decreases plasma dopamine levels

103
Q

How does aspirin cause attacks of gout?

A

competes with uric acid for renal excretion

104
Q

Which tuberculosis drug can cause blurred vision/loss of acuity?

what is the mechanism?

A

Ethambutol - inhibits Arabinosyl transferase

-obstructs formation of cell wall = bacteriostatic

105
Q

What is the most common initial step in lyme disease therapy? what is a common side effect?

A

initial Tx = Doxycycline

—phototoxic dermatitis

106
Q

What is the drug/primary mechanism used in motion sickness? (ie child getting sick in the morning on the way to school on the school bus)

A

Scopolamine - muscarinic antagonist

107
Q

What is the initial step in management of Raynaud’s phenomenon?

A

Calcium channel blockade in smooth muscle cells

108
Q

Which antiepileptic drug is the only p450 inhibitor?

A

Valproic acid

109
Q

What is the mechanism of ketamine? side fx?

A

blocks glutamate receptors

–can cause vivid dreams and hallucinatiosn commonly post-op

110
Q

What abx should be used in a pt bitten by a stray can that is allergic to sulfa and penicillin?

A

Pasteurella multocida - gram negative rod

–use Doxyycline - alternative to penicillin and sulfa if there is an allergy

111
Q

Which sedating benzo should be used in a pt with liver cirrhosis

A

Lorazepam (NOT diazepam)

—lorazepam goes straight into phase II metabolism, diazepam needs phase I

112
Q

pt with ALL is started on Allopurinol b/c of high uric acid levels. what other medication should be adjusted?

A

6-mercaptopurine

  • –xanthine oxidase is involved in metabolism of mercaptopurines
  • -allopurinol inhibits xanthine oxidase

COMLEX STEP 1 2017 (19 decks)

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