EXAM #5: REVIEW Flashcards
1
Q
List the vehicles that should be used on the scalp and hairy areas.
A
Lotion Solution Gel Aerosol Foam
2
Q
List the vehicles that should be used on interriginous areas.
A
Lotion
Solution
Cream
3
Q
List the vehicles that are good for drying.
A
Powder
Paste
Tincture
Aerosol
4
Q
What bacteria can be treated with Azelaic acid?
A
P. acnes and S. epidermidis
5
Q
Describe the MOA of Azelaic acid.
A
1) Reduces inflammation
2) Reduces keratinization
3) Keratolytic and induces desquamation
6
Q
What side effects are associated with Azeliac acid?
A
1) Lightening of the skin
2) Skin dryness
7
Q
What is the MOA of benzoyl peroxide?
A
Release ROS that are harmful to anaerobic bacterial species
8
Q
What type of bacteria is benzoyl peroxide effective against?
A
Anaerobic
9
Q
How is benzoyl peroxide commonly administered?
A
In combination with Erythromycin or Clindamycin
10
Q
List the indications for the retinoid drugs.
A
1) Acne
2) Psoriasis
3) Skin aging
4) Skin cancer
11
Q
List two side effects associated with the retinoid drugs.
A
1) TERATOGEN
2) Photosensitivity and increased risk of sunburn
12
Q
What is the MOA of Tretinoin?
A
1) Reduces cohesiveness of comodomes
2) Codomolytic
3) Reduces keratinization
13
Q
What is the MOA of Adapalene?
A
1) Reduced cellular proliferation
2) Reduced inflammation
3) Comedolysis
14
Q
What is the MOA of Isotretinoin?
A
Induces apoptosis of sebum producing cells in sebaceous glands
15
Q
What is the MOA of Tazarotene?
A
1) Decreases inflammation
2) Reduces epidermal inflammation
16
Q
What are the clinical indications for Tazarotene?
A
Acne and Psoriasis
17
Q
What is the clinical indication for Acritretin?
A
Severe, reluctant psoriasis
18
Q
What is the clinical indication for Calcipotriene?
A
Psoriasis
19
Q
What is the MOA of Calcipotriene?
A
- Binds Vitamin D receptor
- Gene transcription changes are beneficial in PSORIASIS
20
Q
List five adverse effects of topical corticosteroids.
A
1) Epidermal atrophy
2) Acne
3) Enhanced fungal infection
4) Delayed wound healing
5) Hypopigmentation
21
Q
List the Psoralen drugs. What is the MOA of these drugs?
A
Methoxsalen
Trioxsalen
Administered topically or orally; activated by light; intercalate with DNA
22
Q
List four indications for the Psoralen drugs.
A
1) Alopecia
2) Cutaneous T-cell Lymphoma
3) Eczema
4) Psoriasis
23
Q
List the long-term adverse effects of the Psoralens.
A
1) Photoaging
2) Actinic keratoses
3) Nonmelanoma skin cancer
24
Q
List the three primary locations of H2 receptors.
A
1) GI parietal cells
2) Cardiac muscle
3) CNS neurons
25
What are the three general functions of histamine in the CNS?
1) Release of pituitary hormones
2) Wakefullness
3) Appetite/Satiety
26
List five clinical indications for a first generation antihistamine.
1) Allergic rhinitis
2) Allergic conjunctivitis
3) Urticaria
4) Motion sickness
5) Anti-emetic
27
What is the MOA of the H1 antihistamines?
"INVERSE AGONIST"
28
List five major side effects of the first generation antihistamines and the receptor association with that effect.
- CNS depression (H1)
- Dry mouth and urinary retention (M -- anticholinergic)
- Increased appetite and weight gain (5-HT)
- Dizziness and postural hypotension (Alpha-1)
29
List the four H1 antihistamines with the strongest anti-emetic effects.
Diphenhydramine
Promethazine
Hydroxyzine
Meclazine
30
List the three H1 antihistamines with the strongest sedative effects.
Diphenhydramine
Promethazine
Hydroxyzine
31
What H1 antihistamines have the strongest anticholinergic effects?
Diphenhydramine
| Promethazine
32
What H1 antihistamines is the strongest alpha-1 antagonist?
Promethazine
33
List second generation antihistamines.
```
Foxofenadine
Loratadine
Desoloratadine
Citrizine
Levocitrazine
Azelastine
```
34
What are the clinical pearls the remember with Foxfenadine administration?
1) Decrease dose with renal dysfunction
| 2) Don't combine with antacids
35
What is the MOA of Cromolyn and Nedocromil?
Stabilization of mast cells to prevent degranulation
36
What are the three clinical indications for Cromolyn and Nedocromil?
1) Allergic rhinitis
2) Allergic conjunctivitis
3) Exercise induced asthma
37
List two indications for Omalizumab.
1) Chronic urticaria
| 2) Asthma
38
What is Doxepin?
TCA used to treat chronic urticaria
39
What is Ketotifen?
H1 antihistamine with additional mast cell stabilizing characteristics
*Used in an ophthalmic preparation for allergic conjunctivitis*
40
What two receptors can cortisol bind to and activate?
Mineralcorticoid
| Glucocorticoid
41
List the major adverse effects seen with elevated cortisol.
1) Salt/water retention
2) Hypokalemia
3) HTN
42
What is Primary Adrenal Insufficiency? What are the symptoms?
Autoimmune or tuberculoid destruction of the adrenal cortex leading to:
- Hypotension
- Hyponatremia
- Hypokalemia
- Hypoglycemia
43
How do you treat Primary Adrenal Insufficiency?
1) Cortisol
2) Increase Na+ intake
3) Fludrocortisone
44
Aside from iatrogenic Cushing's Disease, what are the alternate etiologies of Cushing's?
1) Pituitary tumor with increased ACTH
2) Ectopic ACTH tumor
3) Adrenal tumor
45
What are the three drug therapies for Cushing's Syndrome?
Ketoconazole
Metyrapone
Mifepristone
46
What is the MOA of Ketoconazole to treat Cushing's?
Antifungal that inhibits 17-a hydroxylase
47
What toxicity is associated with Ketoconazole?
Liver toxicity
48
What is the MOA of Metyrapone to treat Cushing's?
Inhibits 11-B hydroxylase
*Note that this is also used in the diagnosis of ACTH production*
49
What is the MOA of Mifepristone?
Glucocorticoid receptor antagonist
50
What are the specific indications for Mifepristone?
1) Inoperable ectopic ACTH production
| 2) Adrenal carcinoma
51
What is the MOA of inhaled glucocorticoids in the treatment of asthma?
- Reduced proliferation and hypertrophy of airway smooth muscle
- Prevents leakage of vascular endothelium
- Reduces adhesion of molecules to vascular epithelium
- Increased epithelial integrity
52
What is a significant adverse effect of inhaled glucocorticoids, especially in kids?
Growth retardation
53
What are the local adverse effects of inhaled glucocorticoids to treat asthma?
1) Dysphonia
2) Oropharyngeal candidiasis
3) Cough
54
List four functions of the thyroid hormones.
1) Growth
2) Development
3) Body temperature
4) Energy metabolism
55
What enzyme converts T4 into T3?
5'-deiodinase
56
What is the effect of low thyroid hormone levels on the SNS?
1) Increased Beta-adrenergic receptors
| 2) Decreased Alpha-adrenergic receptors
57
List the causes of primary hypothyroidism.
1) Congenital i.e. Cretinism
2) Autoimmune Thyroiditis
3) Iodide deficiency
4) Other i.e. surgery, radiation, and meds like Lithium
58
List the drugs used to treat hypothyroidism.
Levothyroxine (T4)
Liothyronine (T3)
Liotrix (Both)
59
List the adverse effects of thyroid replacement in children,
Restlessness
Insomnia
Accelerated bone maturation
60
List the adverse effects of thyroid replacement in adults.
```
Nervousness
Heat intolerance
Palpitations
Tachycardia
Weight loss
```
61
List the adverse effects of thyroid replacement in the elderly.
A-fib
| Osteoporosis
62
List five causes of primary hyperthyroidism.
1) Grave's Disease
2) Thyroid adenoma/ carcinoma
3) Autoimmune thyroiditis
4) Thyroid storm
5) Excess iodide
63
List the thioamides.
Methimazole
| Propylthioruacil (PTU)
64
What is the MOA of the thioamides?
Inhibition of thyroid hormone synthesis in the thyroid follicle
65
What adverse effects are associated with the thioamides
| ?
```
PTU= severe hepatitis
Methimazole= altered taste and smell
```
66
List the iodides.
Potassium iodide
| Lugol's Solution
67
What are the clinical indications for the iodides?
1) Thyroid storm
| 2) Preoperative prep for surgery
68
What adverse effect is associated with the iodides?
Cold sx.
69
List the anion inhibitors that block the NIS transporter.
Percholrate
Pertechnetate
Thiocyanate
70
What is the clinical indication for the anion inhibitors?
Iodide induced hyperthyroidism
71
List four antithyroid adjuncts.
1) Propanolol
2) Diltiazem
3) Barbiturates
4) Bile acid sequestrates
72
What is the utility of Diltiazem in the treatment of hyperthyroid?
Good alternative to propanolol in patients with asthma
73
What does FSH induce the synthesis of in the Sertoli cells?
Androgen Binding Protein
74
List the metabolic effects of the androgens.
1) Increased muscle growth
2) Liver production of serum proteins
3) Kidney synthesis of EPO
4) Bone growth and bone marrow stem cell production
75
List the three theraputic androgen preparations.
Methyltestosterone (17-alkylated)
Testosterone enanthate (ester)
Testosterone
76
List the adverse effects of androgen therapy.
1) Reduction in spermatogenesis/testis size
2) Acne
3) Polycythemia
4) Prostatic enlargement
5) Na+ and H20 retention leading to HTN
6) Increased LDL and decreased HDL leading to atherosclerosis
7) Mood swings, depression, and aggression
77
What are the indications of antiandrogen therapy in makes?
1) Percocious puberty
2) BPH
3) Prostate cancer
4) Alopecia
78
List the androgen receptor antagonists.
Flutamide
| Biclatumide
79
What adverse effects are associated with the androgen receptor antagonists?
Gynecomastia
| Mild liver toxicity
80
What is the MOA of Enzalutamide?
Androgen receptor antagonist that also:
1) Inhibits nuclear translocation of the androgen receptor
2) Blocks DNA binding
3) Blocks transcriptional coactivator recruitment
81
List the GnRH agonists.
Leuprolide
| Goserelin
82
What are the outcomes of constantly elevated GnRH as seen with the GnRH agonsits?
1) Desenzitization of GnRH receptors on pituitary
2) Decreased LH production and secretion
3) Decreased Testosterone
83
What is the hallmark GnRH antagonist?
Degarelix
84
What is MOA of Abiraterone?
Androgen synthesis inhibitor that inhibits 17-alpha hydroxylase
*Indicated for metastatic prostate cancer*
85
What are the two 5-a reductase inhibitors?
Finasteride
| Dutasteride
86
What are the clinical indications for the 5-a reductase inhibitors?
BPH
| Alopecia
87
What are the key adverse effects associated with the 5-a reductase inhibitors?
Impotence
Gynecomastia
Low PSA-->false negative
88
List the PDE-5 inhibitors.
Sidenafil
Vardenafil
Tadalafil
89
What drugs are contraindicated with PDE-5 inhibitors?
HIV protease inhibitors
| Nitrates
90
What adverse effects are associated with PDE-5 inhibitors?
1) Priapism
2) Sudden vision loss
3) Cardiac events
91
Outline the two-cell hypothesis of steroidogenesis in the ovary.
LH= increased androstenedione synthesis in Theca cells, which is converted into testosterone
FSH= Converts testosterone into estradiol in the granulosa cells
92
What effect does progesterone have on uterine contractions?
Decreased contraction
93
What is the MOA of progesterone to decrease uterine contraction?
1) Decreased prostaglandin production
| 2) Maintenance of relaxin
94
What is the primary synthetic estrogen?
Ethinyl estradiol
95
What are conjugated equine estrogens? How are these used clinically?
Natural water-soluble estrogen sulfates
- Higher dose vs. synthetics
- Used for hormone replacement therapy
96
List four indications for estrogen replacement therapy.
1) Hypogonadism
2) Hormone replacement therapy
3) Contraception
4) Acne
97
What are the three goals of estrogen used in hormone replacement therapy?
1) Maintain bone density
2) Suppress hot flashes
3) Suppress urogenital atrophy
98
What are four risks specifically associated with estrogen in hormone replacement therapy?
CAD
CVA
PE
Invasive breast cancer
99
What is the MOA of estrogen as a treatment for acne?
1) Suppression of steroidogensis
| 2) Increased SHBG to decrease free testosterone
100
What are the adverse effects of non-HRT estrogen therapy?
1) Breast tenderness
2) Endometrial hyperplasia
3) Increased blood coagulation
101
What cancer risk is increased by combined HRT?
Invasive breast cancer
102
What cancer risk is increased with estrogen monotherapy?
Endometrial
103
List the progesterones.
Medroxyprogesterone (MPA)
Norethindrone
Norgestrel
104
What are the adverse effects associated with progestins?
1) Breakthrough bleeding
2) Impaired glucose tolerance
3) Changes in lipid metabolism: increased LDL and decreased HDL
105
List the "mild" adverse effects of birth control.
1) Estrogen-mediated breakthrough bleeding
2) Nausea
3) Mastalgia
4) Edema
5) Headache
6) Withdrawal bleed failure
7) Serum protein changes
106
List the "moderate" adverse effects of birth control.
1) Progestin mediated breakthrough bleeding
2) Weight gain
3) Increased skin pigmentation
4) Acne
5) Hirsutism
6) Vaginal infection
7) Amenorrhea
107
List the "severe" adverse effects of birth control.
1) Thromboembolic disease
2) MI
3) CVA
4) GI disorders e.g cholestasis
5) Depression
6) Cancer
108
List the benefits of oral contraception, aside from contraception.
1) Reduced risk of ovarian and endometrial cancer
2) Reduction in dysmenorrhea/ endometriosis
3) Decreased incidence of ectopic pregnancy
4) Decreased benign breast disease
5) Increased Hb concentrations
6) Suppression of acne and hirsutism
109
List the contraindications to estrogen containing birth control.
1) Known or suspect breast cancer
2) Thromboembolic disorder
3) Liver disease
4) Cardiovascular disease
5) Smoker over 35 y/o
110
List three classes of drugs that will induce hormone metabolsim.
1) St. John's Wort
2) Anticonvulsants
3) HIV antiretrovirals
111
What is the clinical indication for Clomiphene?
Fertility drug
112
What is the MOA of Clomiphene?
Partial agonist that blocks negative feedback on LH and FSH
*Thus, it increases the likelihood of ovulation
113
What two adverse effects are associated with Clomiphene?
1) Hot flashes
| 2) Multiple births
114
What is the effect of SERMS on the endometrium?
Partial agonists that increase proliferation of the endometrium
115
What are the adverse effects associated with Tamoxifen?
1) Hot flashes
2) Endometrial cancer
3) Nausea and vomiting
*Note that vs. Raloxifene, which is hot flashes only*
116
What are the indications for Dananzol?
1) Fibrocystic breast disease
| 2) Endometriosis
117
What is the MOA of Dananzol?
- Decreases estrogen concentrations in blood
| - Displaces estrogen from serum proteins, which increases excretion
118
List the adverse effects assocaited with Dananzol.
1) Hot flashes
2) Weight gain
3) Oily skin
4) Acne
5) Hirsutism
119
What is the MOA of anaztrozole and letrozole?
- Aromatase inhibitors
| - Prevent the conversion of testosterone to estrogen
120
What adverse effects are associated with anaztrozole adn letrozole?
1) GI disturbances
2) Hot flashes
3) Lethargy
121
List the anti-progesterone drugs.
Mifepristone
Ulipristal
*Note that Mifepristone (progesterone antagonist) is followed by MISOPROSTOL--likely test question
122
What is the MOA of Ulipristal?
Partial progesterone agonist
123
List the factors that will increase insulin secretion.
1) Glucose
2) Amino acids
3) Incretins
4) Epinephrine/ B2 stimulation
5) Vagal stimulation
124
What is the major metabolic response to insulin (at the cellular level)?
Translocation of GLUT-4 transporters from the cytoplasmic compartment to the plasma membrane
125
List the rapid acting insulins.
Insulin lispro
Insulin aspart
Insulin glulisine
126
What is an intermediate acting insulin?
NPH
*Forms protamine insulin complexes*
127
What are the two long-acting insulins?
Glargine
| Detemir
128
What is the MOA of metformin?
1) Decreased hepatic glucose output
| 2) Increased peripheral glucose utilization
129
List the Sulfonylureas.
Glimepiride
Glipizide
Glyburide
130
List the meglitinides.
Repaglinide
| Nateglinide
131
What is the MOA of the sulfonylureas and the meglitinides?
Inhibition of the ATP-sensitive K+ channel in beta-cells
132
What adverse effects are associated with the sulfonylureas and meglitinides?
Weight gain
| Hypoglycemia
133
List the glucosidase inhibitors.
Acrabose
| Miglitol
134
List the Thiazolindinediones.
Pioglitazone
| Rosiglitazone
135
What is the MOA of the Thiazolindinediones?
Increased expression of GLUT-4
136
What is the MOA of Pramlintide?
Synthetic amylin that
- Inhibit glucagon release
- Inhibits gastric emptying
- Has an anorexic effect
137
What adverse effects are associated with Pramlintide?
1) Anorexia
2) Hypoglycemia
3) Delayed drug absorption
138
List the incretin mimics.
Exenatide
| Liraglutide
139
List the DPP inhibitors.
Sitagliptin
Saxagliptin
Linagliptin
140
List four cardiovascular changes in the elderly that can result in altered pharmacokinetics.
1) Decreased sensitivity to B-adrenergic stimulation
2) Decreased baroreceptor activity
3) Decreased CO
4) Increased TPR
141
How is hepatic metabolism altered in the elderly?
1) Decreased hepatic blood flow
| 2) Reduced activity of phase I enzymes
142
What does ALD stand for?
Average Lethal Dose
143
What is the mnemonic to remember the anticholinergic toxidrome?
- Hot as a hare: increased body temperature
- Blind as a bat: mydriasis (dilated pupils)
- Dry as a bone: dry mouth, dry eyes, decreased sweat
- Red as a beet: flushed face
- Mad as a hatter: delirium
144
What are the three C's of TCA overdose?
Convulsions
Coma
Cardiac conduction
145
What is the mnemonic to remember the aspirin OD Toxidrome?
DAFT HID
```
Deafness
Appear flushed
Fever
Tinnitus
Hyperventilation
Increased sweating
Dizziness
```
146
What is a copy number variation?
Duplication or deletion of an entire gene
147
What drugs will have altered metabolism because of CYP2D6 polymorphisms?
Tamoxifen
Codiene
Paroxetine
148
What drugs will have altered metabolism because of CYP2C19 polymorphisms?
Clopidogrel
| Omperazole
149
What is the role of CYP2C9 in Warfarin therapy?
CYP2C9 metabolizes warfarin
| - Nonfucntional enzyme= increased warfarin concentration and adverse effects
150
What is the MOA of 5-dUMP?
Inhibition of thymidylate synthetase
151
What enzyme inactivates 5-FU?
DDP
152
What gene codes for thymidylate synthetase?
TYMS
153
Do polymorphisms in TYMS result in pharmcokinetic or pharmacodynamic changes?
Pharmacodynamic
154
What inactivates 6-MP?
TPMT
155
What do ERa genes code for? What drugs will be effected by ERa polymorphisms?
Estrogen receptors
- Estrogen
- Progesterone
156
What have ERa polymorphisms been associated with in estrogen HRT?
Increased HDL
