Flashcards in Drugs/ Pharm Deck (105):
Inhibits mast cell degranulation, preventing the release of chemical mediators of asthma
For prophylaxis of asthma attacks
5- HT3 receptor (serotonin) antagonists, highly effective at preventing vomiting , especially for chemo patients
Block vagus nerve mediated nausea AND block vomit center in the CTZ of the medulla
N- acetylcysteine (NAC)
A mucolytic agent, used for acetominophen overdose
-Protect kidneys in pts with renal insufficiency who need IV contrast
- mucolytic in Flu, bronchitis, cystic fibrosis
Leucovorin (Folinic acid)
Treatment of methotrexate overdose
A G-CSF (granulocyte colony stim factor) analog used to stimulate granulocytes after myelosuppressive chemotherapy
Somatostatin analog (use for Growth Hormone adenoma) suppresses the anterior pituitary response to GHRH to stop release of GH
Dopamine agonist-- suppresses prolactin (used in pts with a prolactinoma )
Argatroban -- mechanism, use ?
direct thrombin inhibitor, used for Heparin Induced Thrombocytopenia (HIT syndrome) and other times when you need to prevent clotting
best diabetes med for a pregnant woman?
a drug to both decrease the risk of bone fracture and decrs breast cancer risk in woman
a SERM (ie: Raloxifene) --> estrogen agonist at the bone and antagonist at the breast
list the P450 inhibitors:
"Florida Grapefruits Can Inhibit Some Key Enzymes"
Fluoroquinolones (Cipro, Levaquin....)
Ketoconazole (& other -azoles)
Ethanol (alcohol abuse)
also, Macrolides, Amiodarone & Ritonavir (MAR)
binds to gp41 on the HIV cell & prevents fusion & penetration into the host cell
"you can't get "en -fu" there"
vitamin that helps Psoriasis?
vitamin D (sunlight or creams like Calcipotriene)
Abciximab mechanism , use?
monoclinal AB that targets the gpIIb/IIIa and inhibits platelet aggregation
a drug with a high MW, highly bound to plasma protein, highly charged & hydrophilic --> will it have a high or low Vd?
Low volume of distribution --> all those characteristics trap the drug in the plasma compartment
best treatment for ingestion of Rat Poison?
1st line is to give FFP, then slower acting vitamin K
rat poison is usually coumadin / warfarin & FFP contains all the clotting factors you need to immediately help the bleeding
Nitrates can cause a reflex tachycardia and hypotension with a subsequent release of catecholamines--> this adverse effect can be prevented by co-administering what type of drug?
a beta blocker --> decreases HR and also blocks the effects of the catecholamines
What are the Class 1 anti-arrhythmics?
Class 1A = "Double Quarter Pounder"
((Disopyramide, Quinidine, Procainamide))
Class 1B = "Lettuce, Tomato, Mayo"
((Lidocaine, Tocainide, Mexilitine))
Class 1C = "More Fries Please"
((Moricizine, Flecainide, Propafenone))
Why do patients taking nitrates need to have a 'nitrate free interval' every day?
To prevent tolerance
Which type of drug has been shown to be beneficial for preventing the myocardial remodeling of heart failure as well as lower BP?
What is the mechanism of Nitrates?
release NO --> increase cGMP--> vasodilates (veins >> arteries) -- cause a decrease in PRELOAD --> decrs cardiac work
Side effects of IV infused adenosine?
flushing, burning in the chest, SOB (Adenosin is the drug of choice for a supravenricular tachycardia)
Where are Beta 1 receptors found?
cardiac tissue & renal JG cells
Effects of anthracyclines (Doxo- & Daunorubicin) on the heart?
form free radicals in the myocardium and cause dilated cardiomyopathy
What is the bioavailability of a drug administered IV?
Formula for Maintenance Dose?
MD = steady state plasma concentration X Clearance / Bioavailability (1 if given IV)
Formula for half life?
Vd x 0.7 / Clearance
Formula for Loading dose?
Vd x Steady state plasma concen / (Bioavailability fraction)
Where do the K+ sparing diuretics work in the nephron?
at the Collecting duct
What are the Class 3 anti-arrhythmics?? (they block K+ efflux / block phase 3 repol , prolonging the QT interval)
"K+ IS BAD"
all put you at risk for Torsades!
Most common side effects of Verapamil?
Constipation, gingival hyperplasia, bradycardia and heart block!
What antihypertensive drugs are also protective against diabetic nephropathy?
First line for hypertension treatment in pregnant women?
Hydralazine & Methyldopa
direct vasodilator (incrs cGMP --->smooth muscle relaxation and vasodilation (esp in arterioles therby reducing AFTERLOAD)
Side effects of Hydralazine
Reflex tachycardia, Lupus like syndrome, N,V, HA...
Calcium channel blockers that are more specific for cardiac than smooth muscle
Verapamil, Diltiazem (Nifedipine is more vessel selective)
Treatments for Malignant HTN?
Best drugs for lowering LDL?
Statins (HMG-Coa reductase inhibitors)
Best drugs for increasing HDL?
Niacin (reduces VLDL secretion into blood)
Best for lowering Trigs?
Fibrates (upregulate LPL)
Adverse effect of fibrates and statins (worse when given together)
Myopathy (rhabdomyolysis, myositis...)
Lipid lowering drug with side effects of flushing, hyperglycemia, hyperuricemia (gout exacerbation)
Niacin (flushing can be decreased by taking ASA)
Patients HATE these lipid lowering drugs b/c they taste bad and cause GI upset
Bile acid resins (cholestyramine) -- they prevent the liver from reabsorbing bile acids
Drug for heart failure that inhibits the Na/K ATPase and Na/Ca exchanger, therby increasing intracellular Calcium and increasing contractility
DIGOXIN (used for CHF, also helpful for afib because it stimulates the vagus nerve)
Treatment for Torsades and dig toxicity
Class 1 antiarrhythmics block_______ channels
Sodium channels (the phase 0 inward Na+ current in the ventricles) -- also prolong phase 3 & prolog the AP (class 1A the most, 1C next and 1B the least)
Class II antiarrhythmics block_______
these are Beta blockers -- block Beta receptors and decrs cAMP, decr Ca++ in the cell, decrs the slope of phase 4 at the nodes
Which drugs can treat arrhythmia but have the side effect of masking signs of hypoglycemia?
Class 2 antiarrhythmics (B-blockers) --> treat overdose with glucagon
Class III antiarrhythmics block_______
K+ channels -- they block the K+ efflux, prolong phase 3 repol and prolong the QT interval ((*risk for Torsades))
Amiodarone adverse effects
pulmonary fibrosis, hepatotoxicity, thyroid problems ((always check LFTs, PFTs and TFTs) --also blue/gray skin discolor, constipation, bradycardia , heart block
Why would you not give an opiod analgesic for a person in pain from gallbladder problems?
b/c opiods cause contraction of the smooth muscles in the Sphincter of Oddi --> increases pressure in the bile duct & GB and can lead to biliary colic pain
*Mepiridine doesn't cause much contraction & is the one to use for GB & panc pain....
mechanism of Zidovudine (for HIV)
nucleoside RT inhibitor, comp binds to RT and is incorporated into the viral genome as a Thymidine analog
-AZT doesn't have a 3' -OH group so phosphodiester bond formation is impossible
an acute extrapyramidal symptom (like dystonia) after taking a drug for psychiatric disorder --> which receptor was most likely being antagonized by the drug?
Dopamine (D2) receptors
-EPS are a result of an imbalance btw the D2 and Muscarinic receptors in the nigrostriatal tract
-they usually balance each other out -- so block one & you get symptoms
the one type of renal stone that is radiolucent (does NOT show up on XRAY)
Uric Acid stone
what mediates the flushing side effects on Niacin?
-hence you can prevent it with Aspirin
What is the mechanism of the TB drug that can cause optic neuritis as a side effect?
Ethambutol --> inhibits carbohydrate polymerization & thus peptidoglycan synthesis
What is the mechanism of Isoniazid?
inhibits Mycolic acid synthesis
Which TB drug directly inhibits bacterial RNA synthesis and can turn your tears, sweat & other secretions red/ orange?
drug for treating HTN & BPH at the same
these drugs bind to PPAR-gamma and decrease Insulin-resistance , increase adiponectin
severe HTN causes what changes to kidney arterioles?
onion-like concentric thickening of arteriolar walls
Conditions associated w/ avascular necrosis of the femoral head
1- Sickle cell
2- Vasculitis / Lupus
3- Steroids / Alcoholism
What causes the hypercalcemia in sarcoidosis?
macrophages cause increased extrarenal formation of active Vitamin D
A pt on antithyroid meds (PTU or Methimazole) --- what complication should you look out for?
Agranulocytosis (white count < 500)
Drug to give a patient who is having trouble voiding after surgery
Bethanechol (muscarinic agonist)
these drug classes function by irreversibly binding to penicillin-binding-proteins like transpeptidases...
Penicillins & Cephalosporins
What is the 1st area of the brain damaged / most susceptible to global cerebral ischemia?
Rathke's pouch comes from what embryologic layer?
Low AFP on a triple screen of a pregnant woman might indicate....
Rank the different kinds of "bruises" from smallest to largest
petechiae ( 1cm)
prevention for MAC in an HIV + pt
side effects of Caspofungin
flushing & GI upset
mechanism of Amphotericin B & Nystatin
"tears" holes in Ergosterol membranes
What fungal pneumonia can be stained w/ mucicarmine stain?
What drug is used for asthma challenge test
Side effects of -azoles?
Inhibits hormone synthesis (androgens) , can cause gynecomastia in men, hepatotoxicity
What is the most common form of Cryptococcus neoformans infection?
What side effect do Gangcyclovir & Zidovudine have in common?
Neutropenia / bone marrow suppression
how do Beta blockers help in treatment of thyrotoxicosis?
1- reduce heart rate , anxiety
2- decrs the rate of peripheral conversion of T4 to T3
Mechanism of Trimethoprim
(same as methotrexate)
pt with recent episodes of thrombophlebitis that involve multiple sites
migratory thrombophlebitis (think CANCER)
-"Trousseau's syndrome" --> especially adenocarcinomas of the pancreas, colon, or lung
lipid lowering drug that can cause INCREASED trigs
bile acid resins
Nitroprusside is metabolized to _________ & ______ so there is potential for toxicity
Cyanide and N.O
antidote for Cyanide toxicity
Sulfur (in the form of Sodium Thiosulfate)
which ACHe inhibitor can cross the BBB
Physostigmine -- can reverse Atropine toxicity
this anatomical defect is necessary for pyelonephritis to develop
Atropine can worsen _________ and is therefore contraindicated in pt's with this eye problem
- Atropine causes Mydriasis, can worsen narrowing of anterior chamber angle
long acting alpha-blocker commonly used for Pheochromocytomas
highly sedating anti-depressant that can cause priapism
mechanism of Pioglitazone
a TZD -- binds to PPAR-gamma to modify transcription , increases Adiponectin, therby decrs insulin resistance
corticosteroids cause an increase in which type of white blood cell?
Neutrophils (a result of demargination of neutrophils that were attached to vessel walls)
-they cause a decrs in all other WBC's
1st line tx for Simple & Complex Partial seizures
Tx for Myoclonic Seizures (type of generalized seizure, arrhythmic jerking movements)
1st line tx for Generalized Tonic Clonic seizures
Phenytoin (then Carbamazepine & Valproate)
Drugs that can cause a Disulfiram like reaction
I Died when I "MET that PRO SURFer at a Certain C-store"
-Sulfonureas (1st gen)
Antipsychotic drug that you must beware of Agranulocytosis...
Clozapine (hides granulocytes in the 'closet')
you can develop tolerance to all of the effects of Opiods EXCEPT:
Constipation & Miosis
drug most associated w/ Neuroleptic malignant syndrome
Oxycodone overdose would cause your pupils to ________
constrict (it is semisynthetic Opioid)
SSRI's (like Paroxetine) can be used to treat premature ejaculation b/c _____
they cause anorgasmia as a side effect!
primarily used to treat spasticity/ UMN symptoms
Baclofen -- activates GABA at muscle spindle
carbonic anhydrase inhibitor that is used to treat glaucoma, seizures, pseudotumor cerebri, altitude sickness, cystinuria, heart failure (diuretic) ..
mechanism of Acetazolamide
block Carbonic Anhydrase at the PCT
-interferes with bicarbonate (HCO3-) reabsorption in the kidneys, thereby re-acidifying the blood (and thus alkalinizing the urine).
mechanism of the atypical antipsychotic Aripriprazole
Partial agonist at dopamine receptors