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Pharmacology > Pharma - Evals 7 > Flashcards

Pharma - Evals 7 Flashcards

1
Q

Most NMBs cause these effect

A

CNS depression
Skeletal muscle paralysis
Analgesia

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2
Q

NMB with the ULTRASHORT duration of action (5-10mins)

A

Succinylcholine

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3
Q

NMB with the SHORT duration of action (10-20mins)

A

Mivacurium

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4
Q

NMB with the INTERMEDIATE duration of action (approx. 1hour)

A

Atracurium
Vecuronium
Rocuronium

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5
Q

NMB with the LONG duration of action (approx. 1/2-2hours)

A

D-Tubocurarine
Doxacurium
Pancuronium
Pipercuronium

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6
Q

Therapeutic selection of neuromuscular blocking drugs is based on

A

Duration of intervention

Minimize cardiovascular compromise or other AE

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7
Q

Non-depolarizing NMB eliminated via PLASMA CHOLINESTERASES

A

Mivacurium

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8
Q

Non-depolarizing NMB eliminated via BILE/HEPATIC ELIMINATION

A

Vecuronium

Rocuronium

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9
Q

Non-depolarizing NMB eliminated via RENAL EXCRETION

A

Doxacurium
Pancuronium
Tubocurarine

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10
Q

Depolarizing NMB eliminated via Hoffman elimination

A

Atracurium

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11
Q

Toxic metabolite produced by Atracurium

A

Laudanosine

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12
Q

Drugs that are non-depolarizing ISOQUINOLINES (CLUE: -curium)

A

Tubocurarine

Atracurium

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13
Q

Drugs that are non-depolarizing STEROIDAL (CLUE: -curonium)

A 
Pancuronium
Pipecuronium
Rocuronium
Rapacuronium
Vecuronium
Mivacurium
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14
Q

Non-depolarizing NMB with most rapid onset of action

A

Rocuronium

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15
Q

Most commonly used class of NMB based on duration of action

A

Intermediate-acting NMB

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16
Q

Phase 1 blockage of Succinylcholine

A

Depolarization

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17
Q

Phase 2 blockage of Succinylcholine

A

Desensitization

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18
Q

Epinephrine and Phenylephrine are vasoconstrictors that limit systemic absorption by

A

Reducing side effects
Prolong duration of action
Decrease absorption thereby increasing neuronal uptake

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19
Q

Amino-ESTER local anesthetics are hydrolyzed by

A

Butyryl or pseudocholinesterase

Plasma cholinesterase

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20
Q

Amino-AMIDE local anesthetics are metabolized by

A

CYP450

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21
Q

Amino-ESTER local anesthetics are derived from

A

Benzoic acid

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22
Q

Amino-AMIDE local anesthetics are derived from

A

Aniline

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23
Q

Local anesthetics with SHORT half-lives

A

Amino-esters

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24
Q

Local anesthetics with LONG half-lives

A

Amino-amides

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25
Q

Local anesthetics that cause allergic reactions but LEAST toxic effects

A

Amino-esters

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26
Q

Local anesthetics that cause allergic reactions but MORE toxic effects

A

Amino-amides

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27
Q

Increasing the pH of an anesthetic solution will

A

Increased speed the onset of anesthesia
Improve the quality of anesthetic blockade
Prolongs that blockage by increasing the amount of free base available

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28
Q

Factors that determine the plasma concentration of local anethetics

A 
pKa (lower pH = faster onset)
Lipid solubility (more lipid solubility = more potent)
Protein binding (more protein bound = longer duration of action)
Clearance (faster metabolism = decreased risk of toxicity)
Vasoconstrictors
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29
Q

Premonitory signs of local anesthetic toxicity

A

Circumoral numbness
Dizziness
Tongue numbness
Metallic taste

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30
Q

Most important CNS toxicity due to excessive blood levels of LA

A

Convulsions

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31
Q

Effects of LOW DOSE LA - decrease rise of action potential

A

Sedation/Sleepiness
Light-headedness
Visual and auditory disturbances

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32
Q

Effects of HIGH DOSE LA - totally prevent AP firing

A

Tonic seizure
Nystagmus
Muscle twitching

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33
Q

LA causes local vasoconstriction

A

Cocaine

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34
Q

Organ that is responsible for initial rapid uptake of the LA

A

Lungs

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35
Q

Nerve types that are generally blocked by LA first

A

C and A-delta fibers

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36
Q

LA that is also a useful anti-arrhythmic agent

A

Lidocaine

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37
Q

Type of anaesthesia technique for uncomplicated appendectomy patient

A

Subarachnoid block

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38
Q

MOA of LA

A

Act on all sensory, motor, autonomic neurons and all te neurons in CNS
Block nerve transmission by inhibiting voltage-gated sodium channel, slowing down the rate of depolarization and reducing the height and rate of the action potential

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39
Q

LA that is not recommended for epidural or peripheral nerve blockade due to slow onset and systemic toxicity

A

Bupivacaine

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40
Q

Drugs that decrease bone mass

A 
Glucocorticoids
Anticonvulsants
Aromatase inhibitors
Furosemide
Heparin
Medroxyprogesterone acetate
PPIs
SSRIs
Thiazolidenediones
Thyroid replacement therapy
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41
Q

Ideal alternative to HRT because it does not increase risk for breast cancer

A

Raloxifene

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42
Q

Major drawback of Raloxifen

A

Worsen vasomotor symptomes (hot flashes)

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43
Q

Important instructions when taking oral biphosphonates

A

Swallow the whole tablet with 6-8 ounces of water
Take at least 30 minutes before any food, drink or medication
Do not lie down at least 30 minutes after intake of the drug

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44
Q

Most important co-morbidity to consider when prescribing oral biphosphonates

A

Esophageal irritation or upper GI reactions

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45
Q

Antiresorptive drugs that causes rhinitis and nasal symptoms

A

Salmon calcitonin (intranasal forms)

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46
Q

Anti-osteoporosis agent that prevent decline of bone quality, muscular force and cognitive function

A

Androgens

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47
Q

HRT of choice for alleviating vasomotor symptoms of menopause

A

Tibolone

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48
Q

Conditions that are contraindicated in Biphosphonate

A

Severe renal failure (creatinine clearance of <30 ml/minutes)
Upper GI disease

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49
Q

Anti-resorptive agent that is most suitable for prevention of bone density loss in px with multiply myeloma and hypercalcemia

A

Pamidronate

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50
Q

Agent capable of causing severe hypocalcemia

A

Zolendronate

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51
Q

Drug that is administered subcutaneously at 60 mg doses every 6 months, resulting in 68%, 41%, and 20% reductions in vertebral, hip, and nonvertebral fractures, respectively

A

Denosumab

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52
Q

Most beneficial for reducing the incidence of vertebral compression fractures by approx. 40% in osteoporotic women

A

Calcitonin

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53
Q

Distinguishing characteristic of Nabutetone among NSAIDs

A

Only non-acid NSAID

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54
Q

Hepatotoxic metabolite produced by Acetaminophen

A

NAPQI

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55
Q

NSAID that causes salicylism

A

Aspirin

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56
Q

Possible complication of COX-2 selective NSAIDs

A

Increased incidence of cardiovascular thrombotic events

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57
Q

NSAID for post-op dental patient

A

Ibuprofen Liquid gel capsule

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58
Q

DOC for children with viral infections

A

Paracetamol

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59
Q

NSAID that may cause Reye syndrome when used in children

A

Aspirin

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60
Q

Initial NSAID of choice for symptoms of heartburn because it has no antiplatelet effect and less GI symptoms

A

COX-2 selective inhibitors

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61
Q

NSAIDs that has anti-inflammatory effects

A

COX-2 non-selective NSAIDs

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62
Q

Main intermediary inihibited by NSAIDs in the inflammatory cascade

A

Prostaglandin

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63
Q

Main intermediary inihibited by DMARDs in the inflammatory cascade

A

TNF-alpha

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64
Q

DMARD of choice for pregnant women

A

Chloroquine or Hydroxychloroquine

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65
Q

DMARD of choice for treating rheumatoid arthritis

A

Methotrexate

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66
Q

Drug whose active form inhibits inosine monophosphate dehydrogenase

A

Mycophenolate mofetil

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67
Q

Active form of Mycophenolate mofetil

A

Mycophenolic acid

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68
Q

TNF-alpha inhibitor that is a recombinant Fab Ab conjugated with polyethylene glycol

A

Certolizumab

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69
Q

NSAID that may be used in gout as a replacement for Colchicine

A

Indomethacin

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70
Q

Dose in mg for intra-aurticular glucocorticoids (injectable triamcinolone acetonide) for arthritis involving the WRIST, ANKLE and ELBOWS

A

30mg

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71
Q

Dose in mg for intra-aurticular glucocorticoids (injectable triamcinolone acetonide) for arthritis involving SMALL JOINTS

A

10mg

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72
Q

Dose in mg for intra-aurticular glucocorticoids (injectable triamcinolone acetonide) for arthritis involving the KNEE

A

40mg

73
Q

Anti-gout medication that replicates the effect of uricase/uriate oxidase enzymes absent in humans

A

Pregloticase

74
Q

Prophylactic dose of Colchicine for patients who have severe attacks of gout

A

0.6mg 2-3x/day

75
Q

Most toxic anti-gout medication

A

Colchicine (as little as 8mg in 24 hours may be fatal)

76
Q

The first proposed LA for surgical procedure

A

Cocaine, ophthalmic

77
Q

Sensory modality most readily blocked by LA

A

Pain (pain > temperature, touch, deep pressure > motor function)

78
Q

Side effects of directly injecting LA into the veins or arterioles

A

Local anesthetic systemic toxicity (CNS, CVS, Hematologic, Allergic)

79
Q

Side effects of directly injecting LA proximal to the spinal cord or major nerve trunks resulting into paresthesia

A

Direct Neurotoxicity

80
Q

LA that is hydrolyzed to PABA (folate precursor) that interferes with the antibacterial effect of sulfonamides

A

Procaine

81
Q

Ester LA

A 
Benzocaine
Chloroprocaine
Cocaine
Procaine
Tetracaine
82
Q

Amide LA

A 
Bupivacaine
Etidocaine
Levobupivacaine
Lidocaine
Mepivacaine
Prilocaine
Ropivacaine
83
Q

Duration of action of LA at the site of administration depends on

A

Rate of diffusion at the site
Rate of absorption away from the site
Addition of a vasoconstrictor
Protein binding

84
Q

Absolute contraindication of LA usage

A

Patient refusal

Allergies to LA drugs

85
Q

Relative contraindications of LA

A

Active inflammation/infection at the injection site

Neurological deficits in the area of distribution

86
Q

Most cardiotoxic amice LA

A

Bupivacaine

87
Q

MOA of estrogen

A

Inhibits bone resorption by suppressing cytokines

Prolongs osteoblast lifespan by increasing production oF TNF-beta

88
Q

Uses of Calcitonin

A

Relief of pain from neoplasic bone metastasis
Treatment of Menopause-induces osteoprosis
Reduction of markers of abnormal bone-turnover

89
Q

Use of Calcitonin in Paget’s disease

A

High skeletal remodelling

90
Q

Action of glucocorticoids in bone-mineral metabolism

A

Alter bone mineral homeostasis by antagonizing vitamin-D-stimulated intestinal calcium transport

91
Q

AE of Estrogen (HRT)

A 
Breast cancer
Ovarian caner
Venous thromboembolism
Stroke
CHD
Dementia
92
Q

AE of Alendronate (Biphosphonate)

A

Cytokine release

Gastric and esophageal irritations (Abdominal pain, diarrhea)

93
Q

AE of Teriparatide (Anabolic agents)

A 
Injection site pain
Nausea
Headache
Leg cramps
Dizziness
94
Q

Biphosphonate precautions/warning

A 
Upper GI reactions
Hypocalcemia
Severe bone, joint, muscle pain
Osteonecrosis of the jaw
Atypical femur fracture
95
Q

Drug that inhibit cholesterol biosynthetic pathway important for osteoclast function

A

Zolendronate

96
Q

MOA of Denosumab

A

Monoclonal Ab approved for the treatment of post-menopausal osteoporosis that specifically targets RANKL and inhibits osteoclast formation and function

97
Q

Drugs for osteoporosis will best benefit a patient with hypoparathyroidism;
Only agent that increases bone formation and not anti-resorptive

A

Teriparatide

98
Q

MOA of Alendronate

A

Inhibit bone resorption by osteoclast apoptosis

99
Q

Metabolite of Azathioprine

A

6-thioguanine

100
Q

Metabolite of Cyclophosphamide

A

Phosphoramide mustard

101
Q

Metabolite of Leflunomide

A

A77-1726

102
Q

Metabolite of Sulfasalazine

A

Sulfapyridine

103
Q

MOA of Methotrexate in auto-immune diseases

A

Inhibits AICAR which inhibit AMP deaminase that converts AMP to adenosine, a potent anti-inflammatory (inhibiting the inhibitor)

104
Q

MOA of Cyclosporine

A

Inhibit IL-1 and IL-2 receptor production

105
Q

Drug that increases the BA of Cyclosporine

A

Grapefruit

106
Q

Indications of using Cyclosporine

A

RA, SLE, Juvenile chronic arthritis

107
Q

Biologic DMARDs (A.I.R.E.)

A

Adalimumab
Etanercept
Infliximab
Retuximab

108
Q

Non-biologic DMARDs

A 
Methotrexate
Chloroquine and hydrochloroquine
Azathioprine
Cycliphosphamide
Cyclosporine
Leflunomide
Sulfasalazine
109
Q

Types of Biologics

A

Adalimumab - Human IgG1 anti-TNF monoclonal Ab
Etanercept - Recombinant fusion protein (nonmonoclonal Ab)
Infliximab - chimeric IgG1 monoclonal Ab
Rituximab - chimeric monoclonal Ab

110
Q

DMARD of choice for px with RA, JCA and IBD

A

Sulfasalazine

111
Q

Indications of Azathioprine

A

Kidney transplant rejection
RA
SLE

112
Q

Indications of Cyclophosphamide

A

RA
SLE
Vasculitis

113
Q

Indications of Methotrexate

A 
RA
Juveile chronic arthritis
Psoriasis
Polymyositis
SLE
Vasculitis
114
Q

MOA of Leflunomide

A

Inhibit dihydroorotate dehydrogenase
Inhibits T-cell proliferation
Reduces Ab production

115
Q

Biologics administered SUBCUTANEOUSLY

A

Adalimumab and Etanercept

116
Q

Biologics administered INTRAVENOUSLY

A

Infliximab and Retuximab

117
Q

MOA of Sulfasalazine

A

Inhibits release of IL-1, 6, 12 and TNF-alpha

118
Q

Sulfonamide COX-2 inhibitor

A

Celecoxib

119
Q

NSAID associated with development of severe cutaneous reactions and cardiovascular complications

A

Valdecoxib

120
Q

NSAID ideal for asmatics

A

Non-acetylated salicylates

121
Q

Non-selective NSAID that has more selectivity for COX-2

A

Etodolac

122
Q

Propionic acid derivative NSAIDs

A 
Fenoprofen
Ketoprofen
Oxaprozin
Ibuprofen
Flubiprofen
Naproxen
123
Q

NSAID that inhibits both COX and lipooxygenase

A

Ketoprofen

124
Q

NSAID with significantly higher free fraction in women

A

Naproxen

125
Q

NSAID that does not undergo enterohepatic circulation

A

Oxaprozin

126
Q

NSAID beneficial in the suppression of intestinal polyposis and may prevent certain cancers

A

Sulindac

127
Q

NSAIDs that has prolong half-life when administered with Probenecid

A

Indomethacin

Ketoprofen

128
Q

Steroid NMB metabolite that is as 40-80% as potent as the parent drug

A

3-hydroxy metabolites

129
Q

NMB that undergoes spontaneous breakdown known as Hofmann Elimination

A

Atracurium

130
Q

Measure of the ability of the patient to metabolize succinylcholine and can be used to identify at-risk patients

A

Dibucaine number

131
Q

Drugs that prevent the bradycardic effect of succinylcholine

A

Thiopental
Atropine
Ganglionic blocking drugs

132
Q

Non-depolarizing muscle relaxants that cause hypotension as a result of systemic histamine release

A

Tubocurarine, Mivacurium and Atracurium

133
Q

Non-depolarizing muscle relaxant that causes tachycardia and smaller increase in cardiac output

A

Pancuronium

134
Q

General anesthetics that augments the effects of muscle relaxants

A

MOST&raquo_space; LEAST

Isoflurane > Sevoflurane > Desflurane > Enflurane > Halothane > Nitrous Oxide

135
Q

Antidote for steroidal NMB drug toxicity

A

Sugammadex

136
Q

Treatment for malignant hyperthermia

A

Dantrolene

137
Q

MOA of Dantrolene

A

Interferes with the release of activator calcium channel by binding to the ryanodine receptor-1 (RYR-1)

138
Q

MOA of Baclofen

A

GABA analog that selectively activates GABA-B receptrs in CNS, thereby inhibiting transmission of both monosynaptic and polysynaptic reflexes at the spinal cord level causing decreased tonic neural stimulation to muscles

139
Q

Centrally-acting spasmolytic

A 
Diazepam
Chlorzoxazone
Tizanide
Baclofen
Gabapentin
Pregabalin
Progabide
Glycine
Idrocilamide
Riluzole
140
Q

Directly-acting spasmolytic

A

Dantrolene

141
Q

NSAID for visceral pain

A

Mefenamic acid

142
Q

NSAID used for various types of arthritis such as osteoarthritis, rheumatoid arthritis, gout, and ankylosing spondylitis

A

Piroxicam

143
Q

Non-acetylated salicylates

A

Magnesium choline salicylate
Sodium salicylate
Salicysalicylate

144
Q

NSAID for the treatment of osteoporosis and RA

A

Celecoxib

145
Q

Antidote for Aspirin overdose

A

Activated charcoal

146
Q

Acetic acid derivative

A

Ketorlac
Etodolac
Indomethacin
Tolmethin

147
Q

Class of Celecoxib

A

Aryl heterocyclics

148
Q

NSAID when co-administered with ASA may decrease anti-inflammatory effect and diminish cardioprotective effect of ASA

A

Ibuprofen

149
Q

NSAID that can have a synergistic effect with morphine

A

Ketorolac

150
Q

NSAID that should be avoided in patients with history of asthma

A

Aspirin

151
Q

First line of treatment for acute gout

A

NSAIDs

152
Q

Treatment used for severe symptomatic gout

A

Glucocorticoids

153
Q

Replacement drug for Colchicine

A

Indomethacin

154
Q

NSAID that causes renal uric acid retention

A

Aspirin

155
Q

Contraindication of Aspirin

A

Precipitation of gout in acute attacks

156
Q

Newer drugs that reduce RA inflammation in a more targeted way. Biologics are made through biotechnology and target very specific proteins in cells involved in inflammation

A

Biologic DMARDs

157
Q

MOA of Azathioprine

A

Suppresses T and B cell function, Ig production and IL-2 secretion

158
Q

A potent and selective non-purine xanthine oxidase inhibitor, thereby reducing the formation of xanthine and uric acid without affecting other enzymes in the purine or pyrimidine metabolic pathway

A

Febuxostat

159
Q

Most common AE of Etanercept

A

Injection of site reactions

160
Q

Class on antibiotics that enhance the effect of aminoglycosides

A

Amikacin

161
Q

A cholinesterase inhibitor which antagonize nondepolarizing blockade by increasing the availability of acetylcholine at the motor end plate mainly by the inhibition of acetylcholinesterase

A

Edrophonium

162
Q

A neuromuscular drug that is degraded non-enzymatically by adduction of the amino acid cysteine and ester bond hydrolysis

A

Gantacurium

163
Q

Notable side effect of Baclofen

A

Drowsiness

164
Q

This light chain, a zinc-dependent protease, prevents the release of Ach by interfering the vesicle fusion through cleaving SNAP-25 for

A

BoNT-A & E

165
Q

This light chain, a zinc-dependent protease, prevents the release of Ach by interfering the vesicle fusion through cleaving SYNAPTOBREVIN-2 for

A

BoNT-B, D and F

166
Q

Give the receptor upon which these spasmolytic drugs act on

Tizanidine
Progabide
Diazepam
Baclofen

A

Tizanidine: alpha-2 adrenoreceptor agonist
Progabide: GABA-A and B
Diazepam: GABA-A
Baclofen: GABA-B

167
Q

Nerve fibers responsible majorly for the sensations of pain, temperature and touch

A

A-delta fibers

168
Q

Nerve fibers for motor functions and some sensations

A

A-beta fibers

169
Q

Nerve fibers that are more of vasomotor, pilomotor, visceromotor and some pain

A

C-fibers

170
Q

Nerve fibers that are almost same as C fibers but no pain

A

B fibers

171
Q

Nerve fiber type blocked by LA conducts fastest

A

Type A

172
Q

Part of the chemical structure determines the pharmacological property of LA

A

Intermediate link

173
Q

Metabolite of Prilocaine that converts hemoglobin to methemoglobin

A

o-toluidine

174
Q

Ester local anesthetic causes methemoglobinemia

A

Benzocaine

175
Q

Hormone Replacement Therapy Indications

A 
1. Replacement therapy for estrogen deficient postmenopausal
women
2. Increase bone idensity
3. prevent osteoporosis
4. <60 years old menopausal women
5. Reduce risk of colorectal cancer
176
Q

An anabolic agent indicated for glucocorticoid-induced osteoporosis

A

Teriparatide

177
Q

Recommendations for routine osteoporosis screening (DXA scan)

A

Women ≥ 65, men ≥ 70, and middle-aged adults
at increased clinical risk for osteoporosis:
○ Prior fracture as an adult
○ Family history of osteoporosis
○ Chronic tobacco and/or corticosteroid use
○ Low body weight
○ Early menopause

178
Q

Route of administration for HRT

A
  1. Oral
  2. Intrauterine
  3. Transdermal
  4. Vaginal
  5. Subcutaneous
179
Q

Calcitonin secretion is stimulated by

A

Gastrin
Cholecystokinin
Catecholamines

Pharmacology (2 decks)

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