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Step 1 (Steffanie) > Pharm > Flashcards

Pharm Flashcards

1
Q

Characteristics of drugs eliminated by the liver

A

High lipophilicity and a high volume of distribution

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2
Q

How are highly lipophilic anesthetic drugs distributed in the body?

A

Rapidly distributed to organs with high blood flow (brain, liver, kidneys, lungs) then rapidly redistributed to tissues with relatively lower blood flow (skeletal muscle, fat, bone)

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3
Q

What is the formula for half life?

A

T1/2 = (0.7 x Vd) / CL

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4
Q

Which antihistamines should be avoided in elderly patients?

A

Avoid 1st generation antihistamines - hydroxyzine, promethazine, chlorpheniramine, diphenhydramine

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5
Q

Which antihistamines can be given to elderly patients?

A

Newer generation antihistamines - loratadine, cetirizine

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6
Q

Mechanism of action of Rifampin

A

Inhibition of bacterial DNA-dependent RNA polymerase

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7
Q

Side effects of Rifampin

A

Red-orange body fluids

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8
Q

What is the mechanism of action of Digoxin?

A

Positive inotropic agent.
Directly inhibits the Na-K-ATPase pump in myocardial cells, leading to decreased sodium efflux and increase in intracellular sodium. This reduces the forward activity of the sodium-calcium exchanger, causing increased intracellular calcium and improved myocyte contractility.

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9
Q

How is tissue necrosis prevented with NE extravasation?

A

Local injection of alpha 1 blocking drug, such as phentolamine

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10
Q

Which drug can cause a disulfiram-like reaction when combined with alcohol?

A

Metronidazole

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11
Q

How do ACE inhibitors effect GFR?

A

Promote efferent arteriolar dilation, causing GFR reduction

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12
Q

Drug used to treat neuroleptic malignant syndrome

A

Dantrolene, a direct acting skeletal muscle relaxant

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13
Q

Phenylephrine

A

Selective alpha-1 adrenergic receptor agonist that increases peripheral vascular resistance and systolic BP and decreases pulse pressure and HR

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14
Q

Timolol

A

Nonselective beta blocker. Diminishes the secretion of aqueous humor by the ciliary epithelium for treatment of open-angle glaucoma

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15
Q

Acetazolamide treatment of open angle glaucoma

A

Carbonic anhydrase inhibitor. Decreases aqueous humor secretion by the ciliary epithelium

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16
Q

Which drugs work to treat open angle glaucoma by increasing the outflow of aqueous humor?

A

Prostaglandin F2alpha (latanoprost, travoprost) and cholinomimetics (pilocarpine, carbachol)

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17
Q

Atenolol

A

Selective beta-1 adrenergic antagonist. B1 adrenergic receptors are found in cardiac tissue and renal juxtaglomerular cells, but not in vascular smooth muscle.

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18
Q

Fidaxomicin

A

Macrocyclic antibiotic that inhibits the sigma subunit of RNA polymerase, leading to protein synthesis impairment and cell death. Administered orally. Used to treat C. diff

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19
Q

Bosentan

A

Endothelin-receptor antagonist that block effects of endothelin. Used for treatment of idiopathic pulmonary arterial hypertension

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20
Q

Drugs associated with drug-induced lupus erythematosus (DILE)

A

Hydralazine, Procainamide, Isoniazid, Minocycline, Quinidine

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21
Q

The 3 current Alzheimer’s Disease specific therapies

A

Cholinesterase Inhibitor (Donepezil), antioxidants (Vit E), and NMDA receptor antagonists (Memantine)

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22
Q

How does aspirin toxicity present?

A

Fever, tinnitus, tachypnea. Initially develop a primary respiratory alkalosis followed by a mixed respiratory anion gap metabolic acidosis

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23
Q

Rare complication of metformin therapy

A

Lactic acidosis. Risk increased in pts with underlying renal insufficiency

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24
Q

Use caution when prescribing fibrates to?

A

Patients with underlying gallbladder disease - can promote gallstone formation

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25
Q

Initial empiric treatment of coagulase-negative staphylococcal infection?

A

Vancomycin

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26
Q

Phenoxybenzamine

A

Irreversible alpha 1 and alpha 2 adrenergic antagonist. Primarily used to treat pheochromocytoma

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27
Q

Calcium channel blockers that primarily affect peripheral arteries and cause vasodilation

A

Dihydropyridines (nifedipine, amlodipine)

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28
Q

Calcium channel blockers that affect the myocardium and can cause bradycardia and slowed atrioventricular conduction

A

Nondihydropyridines (verapamil, diltiazem)

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29
Q

Dobutamine mechanism

A

Beta-adrenergic agonist with predominant activity on B1 receptors and weak activity on B2 and A1 receptors. Stimulation of B1 receptros leads to increased production of cAMP and increased cytosolic Ca concentration. Results in increased myocardial contractility

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30
Q

What occurs when nitrates and phosphodiesterase inhibitors are used together?

A

Profound systemic hypotension because they both increase intracellular cGMP which causes vascular smooth muscle relaxation

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31
Q

Hypoglycemic but only symptoms are sweating and hunger. Which medication is causing this?

A

Non-selective beta-blockers (propanolol, timolol, nadolol) exacerbate hypoglycemia and mask its adrenergic symptoms mediated by norepinephrine and epinephrine

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32
Q

Which medications have negative chronotropic effects?

A

beta-adrenergic blockers (eg, metoprolol, atenolol), non-dihydropyridine calcium channel blockers (eg, verapamil, diltiazem), cardiac glycosides (eg, digoxin), amiodarone and sotalol, cholinergic agonists (eg, pilocarpine, rivastigmine)

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33
Q

What substance accumulates in embryonic tissues as a result of methotrexate used to treat ectopic pregnancy?

A

Dihydrofolate. Methotrexate completely inhibits dihydrofolate reductase, which catalyzes synthesis of tetrahydrofolate

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34
Q

Niacin uses

A

Hyperlipidemia - effective in raising HDL cholesterol and lowering triglycerides and LDL levels

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35
Q

Niacin side effects

A

Flushing, warmth, itching; primarily mediated by the release of prostaglandins

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36
Q

Reduce the rate of spontaneous depolarization in cardiac pacemaker cells by prolonging phase 4

A

Acetylcholine and adenosine

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37
Q

Binding strength in subclasses of class I antiarrhythmics

A

IC (Flecainide, propafenone) > IA (Quinidine, procainamide, disopyramide) > IB (Lidocaine, mexiletine)

weaker binding = faster dissociation

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38
Q

Mechanism of beta-adrenergic agonists

A

Stimulate the beta-2 adrenergic receptor, a Gs protein-coupled receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations

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39
Q

Cromolyn sodium mechanism

A

Inhibits mast cell degranulation and release of histamine and leukotrienes

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40
Q

Class III antiarrhythmics

A

Amiodarone, sotalol, dofetilide. Predominantly block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential, thereby prolonging repolarization and total action potential duration

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41
Q

Neprilysin inhibition

A

A metalloprotease that cleaves endogenous peptides. Inhibition of Neprilysin leads to increased levels of endogenous natriuretic peptides, which improves outcomes in patients with chronic systolic HF

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42
Q

Most common adverse effect of thrombolysis

A

hemorrhage

43
Q

Where do potassium sparing diuretics act?

A

On the late distal tubule and cortical collecting duct to antagonize the effects of aldosterone

44
Q

Fenoldopam

A

Short acting, selective, peripheral dopamine-1 receptor agonist. Activates adenylyl cyclase and raises intracellular cAMP, resulting in vasodilation of most arterial beds with corresponding decrease in systemic BP. Renal vasodilation is prominent and leads to increased renal perfusion, diuresis, and natriuresis. Used in HTN emergency in patients with acute kidney injury

45
Q

Isoproteranol

A

Nonselective beta-adrenergic agonist. Increases cardiac contractility by acting on myocardial B1 adrenergic receptors. Also binds B2 receptors and causes vasodilation by relaxation of vascular smooth muscle, leading to decreased vascular resistance and mean arterial BP

46
Q

Cilostazol

A

Reduces platelet activation by inhibiting platelet phosphodiesterase, the enzyme responsible for breakdown of cAMP. It is also a direct vasodilator. Net effect is decrease in claudication symptoms and increase in pain free walking distances in patients with peripheral arterial disease

47
Q

Fibrates

A

Fenofibrate, gemfibrozil. Activate PPAR-alpha, which increases the synthesis of lipoprotein lipase. Most effective agents for the treatment of hypertriglyceridemia

48
Q

What medication improves Graves ophthalmopathy?

A

Glucocorticoids

49
Q

Best basal long-acting insulins

A

Glargine and detemir insulin

50
Q

Best short acting insulins

A

Lispro, aspart, glulisine. Very rapid onset of action with peak effects coinciding with peak postprandial hyperglycemia

51
Q

What medication can reduce the risk of gynecomastia?

A

Tamoxifen, a selective estrogen receptor modulator that acts as an estrogen antagonist

52
Q

Which medications cause medication induced body fat redistribution (lipoatrophy/lipodystrophy)

A

Common adverse effect of highly-active antiretroviral therapy (HAART)

53
Q

Beta blockers affect on renin release

A

Inhibit release of renin from renal juxtaglomerular cells through antagonism of beta-1 receptors on these cells. Prevents activation of the renin-angiotensin-aldosterone pathway

54
Q

What is required for patients taking a long acting nitrate?

A

A nitrate free interval to prevent development of tolerance

55
Q

Abciximab

A

GP IIb/IIIa receptor antagonist. Inhibits binding of the receptor to fibrinogen. Used to treat unstable angina and acute coronary syndrome

56
Q

What are the most effective lipid lowering drugs for primary and secondary prevention of cardiovascular events?

A

HMG-CoA reductase inhibitors (statins)

57
Q

How is post thyroidectomy hypocalcemia treated?

A

Supplementation with oral calcium and vitamin D

58
Q

Finasteride

A

5-alpha reductase inhibitor that suppresses peripheral conversion of testosterone to DHT. Used to treat BPH and androgenetic alopecia

59
Q

How does mycobacteria become resistant to INH?

A

Non-expression of the catalase-peroxidase enzyme or through genetic modification of the INH binding site on the mycolic acid synthesis enzyme

60
Q

Thiazide diuretics and calcium

A

Increase calcium absorption in the distal convoluted tubules. Recommended for treating HTN in pts at risk for osteoporosis

61
Q

Amlodipine

A

Dihydropyridine calcium channel blocker used to treat HTN. Side effects - headache, flushing, dizziness, peripheral edema

62
Q

Physostigmine

A

Cholinesterase inhibitor. Can reverse anticholinergic toxicity

63
Q

Sildenafil

A

Phosphodiesterase inhibitor. Decreased the degradation of cGMP. Elevated intracellular cGMP levels lead to relaxation of vascular smooth muscle and vasodilation

64
Q

Where is Digoxin cleared?

A

Cleared by the kidneys. Elderly patients may require dose reduction due to age related renal insufficiency

65
Q

Dobutamine

A

Beta adrenergic agonist with predominant activity on beta-1 receptors. Causes an increased in HR and cardiac contractility, leading to an increase in myocardial oxygen consumption

66
Q

Lidocaine

A

Class IB antiarrhythmic. Tends to bind to inactivated sodium channels and rapidly dissociates. Effective in suppressing ventricular tachyarrthymias induced by rapidly depolarizing and ischemix myocardium

67
Q

Oseltamivir

A

Neuraminidase inhibitor used in the treatment and prevention of influenza A and B. Impairs release of newly formed virions from infected host cells and impairs viral penetration of mucous secretions that overlie the respiratory epithelium

68
Q

Mealtime insulin analogs

A

Lispro, Aspart, Glulisine

69
Q

Class IV antiarrhythmics

A

Verapamil, Diltiazem. Calcium channel blockers in slow-response cardiac tissues, slowing phase 4 and phase 0

70
Q

Canagliflozin

A

Sodium-glucose cotransporter 2 (SGLT2) inhibitors. Decrease proximal tubular reabsoprtion of glucose, thereby promoting urinary glucose loss. Monitor serum creatinine

71
Q

Doxazosin

A

Alpha-1 blocker. Useful for treatment of BPH and HTN

72
Q

Disapyramide

A

Class IA antiarrhythmic. Sodium channel-blocking agent that depresses phase 0 depolarization. Also prolong repolarization due to moderate potassium channel blocking activity

73
Q

Terbinafine

A

Used for treatment of dermatophytosis. Inhibits synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase

74
Q

Chlorthalidone

A

Thiazide diuretic. Raises serum calcium, uric acid, glucose, cholesterol, and triglyceride levels. Lower serum sodium, potassium, and magnesium levels

75
Q

Drugs that inhibit dihydrofolate reductase

A

Trimethoprim, methotrexate, and pyrimethamine

76
Q

Medications associated with an increased risk of osteoporosis

A

Proton pump inhibitors, glucocorticoids, aromatase inhibitors, and anticonvulsants that induce cytochrome P450

77
Q

Mechanism of colchicine

A

Inhibits polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis and emigration to sites inflamed by tissue deposition of monosodium urate crystals

78
Q

Valproate

A

Broad-spectrum antiepileptic that is effective for absence and tonic clonic seizures

79
Q

What drugs are used for hypertensive emergency?

A

Nitroprusside and Fenoldopam

80
Q

HMG-CoA reductase inhibitors

A

Statins. Hepatotoxicity, myopathy

81
Q

Bile acid resins

A

Cholestyramine, colestipol, colesevelam. Prevent intestinal reabsorption of bile acids.

82
Q

Ezetimibe

A

Prevents cholesterol absorption at small intestine brush border

83
Q

Fibrates

A

Large decrease in TGs. Upregulate LPL leading to increased TG clearance. Myopathy, cholesterol gallstones due in inhibition of 7-alpha hydroxylase

84
Q

Niacin

A

Inhibits lipolysis in adipose tissue. Red flushed face, hyperglycemia, hyperuricemia

85
Q

PCSK9 Inhibitors

A

Inactivation of LDL receptor degradation. Neurocognitive effects

86
Q

Which classes of antiarrhytmics can cause torsades?

A

Class 1A, Class III

87
Q

Treatment for urgency incontinence

A

Antimuscarinics (oxybutynin)

88
Q

Osmotic diuretic. Increases tubular fluid osmolarity and increases urine flow. Clinical use in drug overdose and elevated ICP

A

Mannitol

89
Q

Acetazolamide

A

Carbonic anhydrase inhibitor. Used for glaucoma, metabolic alkalosis, altitude sickness, pseudotumor cerebri

90
Q

Loop diuretics

A

Furosemide, bumetanide, torsemide. Inhibit Na/K/2Cl system of thick ascending limb. Stimulate PGE release. Increase calcium excretion. Clinical use = edematous states, HTN, hypercalcemia

91
Q

Adverse effects of loop diuretics

A

Ototoxicity, hypokalemia, hypomagnesemia, dehydration, sulfa allergy, metabolic alkalosis, interstitial nephritis, gout

92
Q

Thiaze diuretics

A

Inhibit NaCl reabsorption in early DCT. Decreased calcium excretion. Clinical use = HTN, HF, idiopathic hypercalciuria, nephrogenic DI, osteoporosis.

93
Q

Potassium sparing diuretics

A

Spironolactone, Epleronone, Amiloride, Triameterene. Act on cortical collecting tubule.

94
Q

ACE Inhibitors

A

End in -pril. Can cause cough and angioedema due to increased bradykinin

95
Q

ARBs

A

End in -sartan.

96
Q

Aliskiren

A

Direct renin inhibitor. Used for HTN. Contraindicated in pts already taking ACE inhibitor or ARB and in pregnancy.

97
Q

Amlodipine

A

Dihydropyridine calcium channel blocker commonly used for HTN.

98
Q

Side effects of Amlodipine

A

Headache, flushing, dizziness, peripheral edema

99
Q

Fibrates mechanism

A

Lower triglyceride levels by activating PPAR-alpha, which leads to decreased hepatic VLDL prod and increased LPL activity

100
Q

Extended-spectrum beta-lactamase producing E. coli

A

Genes encoding these enzymes are often on plasmids

101
Q

Adverse side effects of Ethambutol

A

Optic neuropathy that results in color blindness, central scotoma, and decreased visual acuity

102
Q

How does Desmopressin work to treat hemophilia A?

A

By increasing the circulating level of factor VIII

103
Q

Varenicline

A

Partial agonist of nicotinic acetylcholine receptors

104
Q

What drug binds to the immunophilin FK-506 binding protein, forming a complex that binds and inhibits mTOR? This blocks IL-2 signal transduction and prevents cell cycle progression and lymphocyte proliferation

A

Sirolimus

Step 1 (Steffanie) (21 decks)

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