Final review

Question 1

What the drug does to the body

Answer 1

pharmacodynamics

Question 2

What the body does to the drug

Answer 2

pharmacokinetics “ADME”

Question 3

compound that binds to the receptor and stimulates biological response

Answer 3

agonist

Question 4

block or reverse effect of agonists

Answer 4

antagonist

Question 5

opposite effect of agonist

Answer 5

inverse agonist

Question 6

maximal response a drug can produce

Answer 6

efficacy

Question 7

measure of dose required to produce a response

Answer 7

potency

Question 8

theraputic dose

Answer 8

lethal dose/effective dose
LD = kills 50%
ED = 50% respond

Question 9

Is a higher index or lower index a safer drug?

Answer 9

larger

Question 10

most common form of drug deactivation

Answer 10

active drug to inactive metabolite

Question 11

inactive drug to active metabolite

Answer 11

prodrug

Question 12

acetaminophen drug metabolism

Answer 12

active drug to toxic metabolite

Question 13

What’s St. John’s wort effect on reuptake?

Answer 13

inhibits 5-HT, NE, DA

Question 14

What are ADRs of St. John’s Wort?

Answer 14

photosensitization and mild GI effects, induces formation of CYP450 isoforms (3A4, 2C9, 1A2) and p-glycoprotein drug transporter
lowers effectiveness of birth control pills, cyclosporine, digoxin, HIV PIs, warfarin

Question 15

What can coenzyme q be used for?

Answer 15

cardiovascular CHF, HTN, statin induced myopathy, Parkinson’s

Question 16

What’s the chemistry behind coenzyme q?

Answer 16

antioxidant

Question 17

What are the ADRs of coenzyme q?

Answer 17

GI disturbances (MC), rash, thrombocytopenia, dizziness, irritability, headache
similar to vitamin K and can decrease effects of warfarin

Question 18

What’s the evidence of coq?

Answer 18

significantly lower SBP by 11 and DBP by 7, improve ejection fraction by 3.7%, supplementation ameliorated statin associated muscle symptoms

Question 19

What are first gen oral antihistmaines?

Answer 19

chlorpheniramine
diphenhydramine
doxylamine
hydroxyzine
meclizine
promethazine

Question 20

What are second gen oral antihistamines?

Answer 20

cetirizine
desloratadine
fexofenadine
loratadine
levocetirizine

Question 21

What’s the MOA of oral antihistamines?

Answer 21

block H1 receptor-mediated response to histamine, competitive binding

Question 22

What’s the difference between 1st and 2nd gen oral antihistamines?

Answer 22

1st = penetrate CNS, cause sedation, interact w/ other receptors
2nd = specific for H1

Question 23

When to consider abx for bacterial sinusitis?

Answer 23

> 10 days, facial/dental pain, fever, maxillary edema

Question 24

What to treat bacterial sinusitis with if PCN allergy?

Answer 24

clindamycin, cefdinir, doxy

Question 25

Can you put eye drops in teh ear?

Answer 25

yes

Question 26

can you put ear drops in the eye?

Answer 26

no

Question 27

pharmacodynamic DI: drug alters pharmacologic action of another drug -- can it be remediated by dosing?

Answer 27

no

Question 28

pharmacokinetic DI: drug alters concentration, ex: P-glycoprotein, anion transporting polypeptides, cytochrome P450 -- can it be remediated by dosing?

Answer 28

yes

Question 29

What are medications that cause hyperkalemia?

Answer 29

angiotensin converting enzyme inhibs (ACE) angiotensin receptor blockers (ARB) potassium-sparing diuretics (amiloride, triamterene) trimethoprim aldosterone antagonists (spironolactone, eplereonone) NSAIDS Digoxin Cyclosporine or tacrolimus

Question 30

What are signs of a sedative-hypnotic overdose?

Answer 30

slurring, drunken behavior, dilated pupils, weak/rapid pulse, clammy skin, shallow respiration, coma, death

Question 31

What are signs of a sedative-hypnotic withdrawal?

Answer 31

weight loss, paresthesias, headache

Question 32

What indicates opioid overdose?

Answer 32

euphoria -> sedation -> resp depression -> coma -> death pinpoint pupils! (exp meperidine), drowsiness/sedation, bradycardia

Question 33

What indicates opioid withdrawal?

Answer 33

lacrimation, rhinorrhea, yawning, sweating, tremor, muscle jerks

Question 34

What indicates stimulant (amphetamine) overdose?

Answer 34

agitation, restlessness, tachy, hyperthermia, hyperreflexia, seizures

Question 35

What indicates stimulant withdrawal?

Answer 35

increased appetite, sleepiness, exhaustion, mental depression

Question 36

What indicates cocaine overdose?

Answer 36

euphoria, self confidence, mental alertness

Question 37

What's the DOC for cyanide?

Answer 37

cyanokit - hydroxycobalamin (v B12) so nontoxic cyanocobalamin is formed

Question 38

What is the antidote for warfarin?

Answer 38

phytonadione (vitamin K) 5-10mg

Question 39

What are G+ pathogens?

Answer 39

staph, strep, enterococci, listeria

Question 40

What do tetracyclines have DI with?

Answer 40

polyvalent cations decreasing absorption, take 2 hrs before or after

Question 41

When are macrolides reliable?

Answer 41

H. flu (not ery) H. pylori, MAC mod=s. pneumoniae, s. pyogenes

Question 42

When are macrolides clinically utilized?

Answer 42

community acquired respiratory infections, atypical mycobacterial infections, traveler's diarrhea

Question 43

When are macrolides your DOC?

Answer 43

chlamydia, H. pylori

Question 44

What are ADRs of fluoroquinolones?

Answer 44

prolongation of QT interval, Achilles tendon rupture NO in pregnant women and children inhibits warfarin metabolism too

Question 45

What are ADRs of metronidazole?

Answer 45

metallic taste, dark urine, disulfuram-like reaction with ETOH

Question 46

How do you treat paronychia for MSSA versus MRSA?

Answer 46

cephalexin vs doxycycline

Question 47

Dental infection?

Answer 47

clindamycin

Question 48

dog bites?

Answer 48

augmentin

Question 49

UTIS?

Answer 49

cipro, macrobid, bactrim

Question 50

C diff?

Answer 50

metronidazole, vanc

Question 51

CAP outpatient?

Answer 51

doxycycline or doxy + beta-lactam or lavaquin alone

Question 52

What are the 3 opioid receptors?

Answer 52

mu delta kappa

Question 53

What opioids are metabolized to active metabolites by CYP2D6?

Answer 53

codeine, oxycodone, hydrocodone fentanyl and methadone have no active metabolites!

Question 54

How to treat pain with hepatic impairment?

Answer 54

hydrocodone, morphine, oxycodone

Question 55

How to treat pain with renal impairment?

Answer 55

fetanyl

Question 56

How to treat acute pain?

Answer 56

mild - tramadol, codeine, hydrocodone moderate - oxycodone severe - hydromorphone, meperidine, morphine, fetanyl

Question 57

How to treat chronic pain?

Answer 57

mild - tramadol norco, percocet, morphine, fetanyl