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Flashcards in EXAM #5: REVIEW Deck (156):
1

List the vehicles that should be used on the scalp and hairy areas.

Lotion
Solution
Gel
Aerosol
Foam

2

List the vehicles that should be used on interriginous areas.

Lotion
Solution
Cream

3

List the vehicles that are good for drying.

Powder
Paste
Tincture
Aerosol

4

What bacteria can be treated with Azelaic acid?

P. acnes and S. epidermidis

5

Describe the MOA of Azelaic acid.

1) Reduces inflammation
2) Reduces keratinization
3) Keratolytic and induces desquamation

6

What side effects are associated with Azeliac acid?

1) Lightening of the skin
2) Skin dryness

7

What is the MOA of benzoyl peroxide?

Release ROS that are harmful to anaerobic bacterial species

8

What type of bacteria is benzoyl peroxide effective against?

Anaerobic

9

How is benzoyl peroxide commonly administered?

In combination with Erythromycin or Clindamycin

10

List the indications for the retinoid drugs.

1) Acne
2) Psoriasis
3) Skin aging
4) Skin cancer

11

List two side effects associated with the retinoid drugs.

1) TERATOGEN
2) Photosensitivity and increased risk of sunburn

12

What is the MOA of Tretinoin?

1) Reduces cohesiveness of comodomes
2) Codomolytic
3) Reduces keratinization

13

What is the MOA of Adapalene?

1) Reduced cellular proliferation
2) Reduced inflammation
3) Comedolysis

14

What is the MOA of Isotretinoin?

Induces apoptosis of sebum producing cells in sebaceous glands

15

What is the MOA of Tazarotene?

1) Decreases inflammation
2) Reduces epidermal inflammation

16

What are the clinical indications for Tazarotene?

Acne and Psoriasis

17

What is the clinical indication for Acritretin?

Severe, reluctant psoriasis

18

What is the clinical indication for Calcipotriene?

Psoriasis

19

What is the MOA of Calcipotriene?

- Binds Vitamin D receptor
- Gene transcription changes are beneficial in PSORIASIS

20

List five adverse effects of topical corticosteroids.

1) Epidermal atrophy
2) Acne
3) Enhanced fungal infection
4) Delayed wound healing
5) Hypopigmentation

21

List the Psoralen drugs. What is the MOA of these drugs?

Methoxsalen
Trioxsalen

Administered topically or orally; activated by light; intercalate with DNA

22

List four indications for the Psoralen drugs.

1) Alopecia
2) Cutaneous T-cell Lymphoma
3) Eczema
4) Psoriasis

23

List the long-term adverse effects of the Psoralens.

1) Photoaging
2) Actinic keratoses
3) Nonmelanoma skin cancer

24

List the three primary locations of H2 receptors.

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

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