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First Aid - Pharm Flashcards

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1
Q

K_m reflects ___

A

substrate affinity for enzyme (inversely)

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2
Q

V_max is a function of ___

A

enzyme concentration

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3
Q

low ___ means high enzyme affinity

A

K_m

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4
Q

inhibitors are studied with graph of ___ vs. ___

this is aka ___ plot (2)

A

1/V
1/[S]
double reciprocal
Lineweaver-Burk

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5
Q

x intercept of double reciprocal plot is ___

A

(-)1/K_m

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6
Q

y intercept of double reciprocal plot is ___

A

1/V_max

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7
Q

K_m is the ___ at which V is ___

A

substrate concentration

V_max/2

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8
Q

competitive/noncompetitive inhibitors do not change V_max

A

competitive

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9
Q

competitive/noncompetitive inhibitors do not change K_m

A

noncompetitive

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10
Q

efficacy change means ___ of dose response curve

A

vertical shift

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11
Q

potency change means ___ of dose response curve

A

horizontal shift

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12
Q

competitive inhibitors change ___

A

potency

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13
Q

non-competitive inhibitors change ___

A

efficacy

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14
Q

V_d in terms of plasma drug concentration

A

V_d = (amount of drug in body)/(plasma concentration)

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15
Q

drugs with low V_d distribute in ___
drugs with medium V_d distribute in ___
drugs with high V_d distribute in ___

A

blood
ECF or TBW
tissues

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16
Q

low V_d means ___ L

A

4–8

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17
Q

clearance (CL) in terms of plasma drug concentration (C_p)

A

CL = (rate of drug elimination)/(C_p)

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18
Q

CL in terms of V_d

A

CL = V_d x K_e

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19
Q

t_1/2 in terms of V_d

A

t_1/2 = (0.7 x V_d)/CL

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20
Q

loading dose in terms of V_d

A

LD = (C_p x V_d)/F

where F is bioavailability

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21
Q

maintenance dose in terms of C_p

A

MD = (C_p x CL)/F

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22
Q

zero order kinetics means

A

constant elimination per unit time

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23
Q

3 drugs with zero order kinetics

A

phenytoin
ethanol
aspirin

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24
Q

first order kinetics means

A

constant fraction of drug eliminated per unit time

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25
5 weak acid drugs | treat overdose of weak acid with ___
``` phenobarbital MTX TCAs aspirin bicarbonate ```
26
weak base drug __a__ | treat overdose wtih _b__
a. amphetamine | b. ammonium chloride
27
phase I metabolism is done by ___ its products are active/inactive 3 phase I reactions:
CYP450 active reduction oxidation hydrolysis
28
phase II metabolism products are active/inactive, polar/nonpolar 3 phase II reactions
inactive very polar glucuronidation acetylation sulfation
29
geriatric patients lose phase ___ metabolism first
I
30
therapeutic index
TI = LD_50/ED_50 where LD_50 is median toxic dose, ED_50 is median effective dose
31
the first synapse in a parasympathetic pathway is ___
nicotinic
32
the second synapse in a parasympathetic pathway is ___
muscarinic
33
the first synapse in a sympathetic pathway is ___
nicotinic
34
the second synapse in most sympathetic pathways is ___ | 2 exceptions are ___
noradrenergic sweat gland renal vascular smooth muscle
35
2nd synapse in sweat gland pathway is ___
muscarinic
36
2nd synapse in renal vascular smooth muscle pathway is ___
D1 dopaminergic
37
nicotinic receptor is ___tropic | muscarinic receptor is ___tropic
iono | metabo
38
nicotinic receptor is a ___-gated ___ channel
ligand | Na+/K+
39
alpha1 major functions
inc. vascular smooth muscle contraction inc. pupillary dilator muscle contraction (mydriasis) increase intestinal and bladder sphincter muscle contraction
40
alpha_1 adrenergic receptor type
G_qPCR
41
alpha_2 major function
decrease sympathetic outflow decrease insulin release decrease lipolysis increase platelet aggregation
42
alpha_2 adrenergic receptor type
G_iPCR
43
beta 1 adrenergic major functions
increase heart rate increase contractility increase renin release increase lipolysis
44
beta_1 adrenergic receptor type
G_sPCR
45
beta_2 adrenergic major functions
``` vasodilation bronchodilation increase contractility increase HR increase insulin release increase lipolysis ciliary muscle relaxation increase aqueous humor production decrease uterine tone ```
46
beta_2 adrenergic recetor type
GsPCR
47
M1 muscarinic receptor is ___ M2 muscarinic receptor is ___ M3 muscarinic receptor is ___
G_qPCR G_iPCR G_qPCR
48
M1 major functions
CNS, ENS
49
M2 major functions
decrease HR and contractility of atria
50
M3 major functions
increase exocrine gland secretion increase gut peristalsis increase bladder contraction bronchocontriction increase pupillary sphincter muscle contraction (miosis) ciliary muscle contraction (accomodation)
51
D1Rs: receptor type and | major functions
G_sPCR | renal vascular smooth muscle relaxation
52
D2Rs: receptor type and | major functions
G_iPCR | neurotransmitter modulation
53
H1Rs: receptor type and | major functions
``` G_qPCR nasal and bronchial mucus secretion vascular permeability bronchoconstriction itching pain ```
54
H2Rs: receptor type and | major functions
G_sPCR | gastric acid secretion
55
ADH V1Rs: receptor type and major functions
G_qPCR | vasoconstriction
56
ADH V2Rs: receptor type and major functions
G_sPCR | H2O reabsorption in collecting duct
57
Y is converted to ___ by ___. | this is blocked by ___, which works as a ___
DOPA Y hydroxylase metyrosine antihypertensive
58
DOPA is converted to ___ by ___. | cofactor is ___
DA DOPA decarboxylase (AAADC) B6
59
DA is imported to vesicles by ___. | this is blocked by ___
VMAT (vesicular monoamine transporter) | reserpine
60
DA is converted to ___ by ___. | cofactor is ___
NE DBH (DA beta hydroxylase) vitamin C
61
In ___, NE is converted to ___ by ___, in the ___. | ___ is required
``` adrenal medulla E PNMT (phenylethanolamine N-methyl transferase) cytoplasm SAM ```
62
After MAO-COMT in either order, DA becomes ___
HVA (homovanillic acid)
63
After MAO-COMT in either order, E becomes ___ and NE becomes ___
both become MHPG (methoxyhydroxyphenylglycol)
64
After COMT, E becomes ___ and NE becomes ___.
metanephrine | normetanephrine
65
adrenal pheochromocytomas make more ___ than ___, but other ones do the opposite
E | NE
66
catecholamine exocytosis is potentiated by ___ (2) and inhibited by ___
amphetamine ephedrine guanethidine
67
___ (3) blocks catecholamine reuptake
cocaine amphetamine TCAs
68
2 presynaptic receptors which inhibit catecholamine release
alpha_2 | M2
69
1 presynaptic receptor which facilitates catecholamine release
AII (angiotensin)
70
rate limiting step of cholinergic neurotransmission is ___ | this is inhibited by ___
Ch uptake | hemicholinium
71
ACh is synthesized by ___ from ___ and ___
choline acetyltransferase (ChAT) choline Ac CoA
72
uptake of ACh into vesicule is inhibited by ___ | vesicular exocytosis is inhibited by ___
vesamicol | botulinum
73
direct agonists: cholinomimetics
bethanechol, carbachol, pilocarpine, methacholine
74
direct cholinomimetic for GI motility
bethanechol
75
2 indications for bethanechol
ileus (post op, neurogenic) urinary retention b/c it activates bladder and bowel
76
2 direct cholinomimetics for glaucoma
pilocarpine | carbachol
77
pilocarpine causes contraction of ___ (2) | and secretion of ___ (3)
``` pupillary sphincter ciliary body saliva sweat tears ```
78
contraction of ___ helps open angle glaucoma | contraction of ___ helps closed angle glaucoma
ciliary body | sphincter pupillae
79
direct cholinomimetic for testing asthma
methacholine
80
indirect cholinomimetics are ___s
AChEI
81
Indirect agaonists (cholinomimetics)
neostigmine, pyridostigmine, physostigmine, donepezil, rivastigmins, galantamine
82
indirect cholinomimetic for GI motility
neostigmine
83
neostigmine has high/low CNS penetration
low
84
4 neostigmine indications
ileus (post op, neurogenic) urinary retention MG post op NMJ block reversal
85
cholinomimetic for MG dx
edrophonium
86
cholinomimetic for MG tx
pyridostigmine
87
2 indirect cholinomimetics for glaucoma
echothiophate | physiostigmine
88
CNS penetrations of a. pyridostigmine b. physiostigmine c. echothiophate
a. low b. high c. low
89
what indirect agonist do you use for alzheimer's?
donepezil, rivastigmine, galantamine
90
cholinesterase inhibitor poisoning
``` DUMBBELSS: Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal and CNS Lacrimation Sweating Salivation ```
91
2 antidotes for cholinergic intoxication
atropine | pralidoxime
92
pralidoxime functions in cholinergic intoxication by ___
regenerating active ChE
93
antimuscarinic for eye
atropine homatropine tropicamide
94
atropine causes ___ (2)
mydriasis | cycloplegia
95
cycloplegia means ___
inability to accomodate
96
antimuscarinic for Parkinson's disease
benztropine
97
antimuscarinic for motion sickness
scopolamine
98
2 antimuscarinic for asthma and COPD
ipratropium | tiotropium
99
2 antimuscarinics for bladder spasticity
oxybutynin darifenacin solifenacin
100
glycopyrrolate used for ___ (3)
reduce airway secretions drooling peptic ulcers
101
atropine effects
eye: pupil dilation, cycloplegia respiratory: decreased secretions from airway stomach: decreased acid secretion gut: decreased motility bladder: decreased urgency in cystitis
102
atropine toxicity
``` hot dry red blind (cycloplegia) mad (disoriented) ``` may cause acute angle-closure glaucoma, urinary retention (in BPH men or hyperthermic infants)
103
E effects which receptor
beta > alpha (with alpha at higher doses)
104
E is indicated for ___ (4)
anaphylaxis open angle glaucoma asthma hypoTN
105
NE effects which receptor
alpha_1 > alpha_2 > beta_1
106
NE is indicated for ___
hypoTN (*decreases renal perfusion)
107
isoproterenol effects which receptor
beta_1 = beta_2
108
isoproterenol is indicated for ___
evaluation of tachyarrhythmias
109
DA effects which receptor
D1 = D2 > beta > alpha
110
DA is indicated for ___ (3)
shock heart failure unstable bradycardia
111
DA's effects on the heart
+ inotrope + chronotrope at high doses
112
dobutamine effects which receptor
beta_1 > beta_2 > alpha
113
dobutamine is indicated for ___ (3)
heart failure | cardiac stress testing
114
dobutamine's effects on the heart
inotropic > chronotropic
115
phenylephrine effects which receptor
alpha_1 > alpha_2
116
phenylephrine is indicated for ___ (3)
pupil dilation nasal decongestion hypotension
117
5 beta_2-selective agonists
``` metaproterenol albuterol salmetrol terbutaline ritodrine ```
118
2 beta_2 agonists for acute asthma
metaproterenol | albuterol
119
beta_2 agonist for chronic asthma tx
salmetrol
120
2 tocolytic beta_2 agonist
terbutaline | ritodrine
121
3 indirect sympathomimetics | of these ___ (2) are secretagogues
amphetamine ephedrine cocaine amphetamine ephedrine
122
3 amphetamine indications
narcolepsy obesity ADD
123
3 ephedrine indications
nasal decongestion urinary incontinence hypoTN
124
what drug should you avoid prescribing in patients with cocaine intoxication?
beta blockers because of the unopposed alpha 1 activation leading to extreme hypertension
125
2 alpha_2 agonists
clonidine | alpha-methyldope
126
alpha_2 agonists are indicated for ___ with ___
HTN | renal disease
127
clonidine toxicity symptoms
CNS depression, bradycardia, hypotension, respiratory depression, small pupil size
128
alpha-methyl dopa toxicity symptoms
direct coombs + hemolytic anemia, SLE-like syndrome
129
2 non-selective alpha blockers | ___ is reversible blocker
phenoxybenzamine phentolamine phentolamine
130
phenoxybenzamine use:
HTN prevention in heochromocytoma
131
phenoxybenzamine toxicity:
orthostatic hypotension, reflex tachycardia
132
phentolamine use:
MAO inhibitor patients who ate too much tyramine
133
alpha_1 selective blockers end in ___
zosin
134
alpha_1 blockers are indicated for
HTN urinary retention from BPH PTSD
135
3 alpha_1 SEs
1st dose orthostatic hypoHTN dizziness headache
136
alpha_2 selective blocker
mirtazapine
137
mirtazapine is indicated for ___
depression
138
3 mirtazapine SEs
sedation hyperlipidemia hyperphagia
139
beta blockers effects
``` decrease heart rate and contractility decrease MI mortality decrease AV conduction velocity in SVT decrease cardiac output and renin secretion decrease progression of CHF decrease aqueous humor ```
140
2 beta blockers for SVT
propranolol | esmolol
141
sexual SE of beta blocker
impotence
142
acebutolol is ___-selective beta blocker
beta_1
143
atenolol is ___-selective beta blocker
beta_1
144
betaxolol is ___-selective beta blocker
beta_1
145
esmolol is ___-selective beta blocker
beta_1
146
labetalol is ___-selective beta blocker
non
147
metoprolol is ___-selective beta blocker
beta_1
148
nadolol is ___-selective beta blocker
non
149
pindolol is ___-selective beta blocker
non
150
propranolol is ___-selective beta blocker
non
151
timolol is ___-selective beta blocker
non
152
2 non-selectve alpha + beta blockers
carvedilol | labetalol
153
2 partial beta agonists
pindolol | acebutolol
154
tx for acetaminophen poisoning
N-acetyl cysteine
155
tx for salicylate poisoning (2)
bicarbonate | dialysis
156
purpose of bicarbonate in salicylate poisoning
alkalinize urine
157
tx for amphetamine poisoning
ammonium chloride
158
purpose of ammonium chloride in amphetamine poisoning
acidify urine
159
tx for anticholinesterase poisoning (2)
atropine | pralidoxime
160
tx for antimuscarinic toxicity
physiostigmine salicylate
161
tx for beta blocker toxicity
glucagon
162
tx for digitalis toxicity (5)
``` stop digitalis normalize K+ lidocaine anti-dig Fab Mg2+ ```
163
tx for Fe toxicity
desferoxamine
164
tx for Pb toxicity (4)
CaEDTA dimercaprol succimer penicillamine
165
tx for As/Au/Pb toxicity (4)
dimercaprol succimer penicillamine CaEDTA
166
tx for Cu toxicity
penicillamine
167
tx for CN- toxicity (3)
nitrite hydroxocobalamin thiosulfate
168
tx for methemoglobinemia (2)
methylene blue | vitamin C
169
tx for CO toxicity (2)
100% O2 | hyperbaric O2
170
tx for MeOH/ethylene glycol toxicity (3)
ethanol dialysis fomepizole
171
tx for opioid toxicity
naloxone
172
tx for benzo toxicity
flumazenil
173
tx for TCA toxcity
bicarbonate
174
purpose of bicarbonate in TCA toxicity
alkalinize serum
175
tx for heparin toxicity
protamine
176
tx for warfarin toxicity (2)
vitamin K | FFP
177
tx for tPA/streptokinase toxicity
aminocaproic acid
178
tx for theophylline toxicity
beta blocker
179
Fe poisoning is particularly common with ___
kids
180
Fe is cytotoxic because of ___
membrane lipid peroxidation
181
acute Fe poisoning presents with ___
gastric bleeding
182
chronic Fe poisoning presents wtih ___ (2)
metabolic acidosis | GI obstruction 2' to scarring
183
drugs causing atropine-like SEs
TCA
184
2 drugs causing coronary vasospasm
cocaine | sumatriptan
185
4 drugs causing flushing
vancomycin adenosine niacin CCBs
186
3 drugs which cause torsades
``` class Ia antiarrhythmics class III antiarrhythmics cisapride ```
187
6 drugs which cause agranulocytosis
``` clozapine carbamazepine colchicine dapsone PTU methimazole ```
188
5 drugs which cause aplastic anemia
``` chloramphenicol benzene NSAIDs PTU methimazole ```
189
drug causing direct coombs positive hemolytic anemia
alpha methyldopa
190
drug causing gray baby syndrome
chloramphenicol
191
drugs causing hemolysis in context of G6PD deficiency
``` INH sulfonamides primaquine aspirin ibuprofen nitrofurantoin ```
192
drugs causing megaloblastic anemia
pheyntoin MTX sulfa
193
drug causing cough
ACEI
194
3 drugs causing pulmonary fibrosis
bleomycin amiodarone busulfan
195
drug causing acute cholestatic hepatitis
macrolide
196
4 drugs causing hepatic necrosis
halothane VPA acetaminophen amanita phalloides
197
drug causing hepatitis
INH
198
2 drugs causing pseudomembranous colitis
clindamycin | ampicillin
199
6 drugs causing gynecomastia
``` spironolactone digitalis cimetidine alcohol ketoconazole estrogens ```
200
2 drugs causing hot flashes
tamoxifen | clomiphene
201
2 drugs causing hypothyroidism
Li | amiodarone
202
2 drugs causing gout
furosemide | thiazides
203
3 drugs causing photosensitivity
sulfonamides amiodarone tetracycline
204
8 drugs causing Stevens-Johnson syndrome
``` carbamazepine ethosuximide lamotrigine phenobarbital phenytoin sulfa penicillin allopurinol ```
205
4 drugs causing SLE-like syndrome
hydralazine INH procainamide phenytoin
206
fluoroquinolones cause ___ (3) in kids
tendonitis tendon rupture cartilage damage
207
___ causes Fanconi's syndrome
expired tetracycline
208
Fanconi's syndrome is ___ wasting of ___ (4)
``` tubular bicarbonate AAs glucose uric acid ```
209
3 drugs causing interstitial nephritis
methicillin NSAIDs furosemide
210
2 drugs causing hemorrhagic cystitis | prevent this by giving ___
CTX ifosfamide mesna
211
2 drugs which cause cinchonism
quinidine | quinine
212
cardiovascular aspects of cinchonism
flushing | arrhythmia
213
4 neurological sx of cinchonism
tinnitus/hearing loss blurry vision somnolence confusion
214
2 cutaneous sx of cinchonism
flushing | rash
215
2 drugs causing DI
Li | demeclocycline
216
4 drugs causing PD-like syndrome
haloperidol chlorpromazine metoclopramide reserpine
217
3 drugs causing seizures
buproprion imipinem/cilastatin INH
218
drugs causing tardive dyskinesia
antipsychotics
219
4 drugs causing disulfiram-like reaction
metronidazole cephalosporins (some) procarbazine 1st generation sulfonylureas
220
disulfiram-like reaction means | mechanism is ___
feeling bad after EtOH | acetaldehyde dehydrogenase inhibition
221
drug causing nephrotoxicity + neurotoxicity
polymixins
222
4 drugs causing nephrotoxicity + ototoxicity
aminoglycosides vancomycin loop diuretics cisplatin
223
9 CYP450 inducers
``` quinidine barbiturates st. john's wort phenytoin rifampin griseofulvin carbamazepine chronic alcholism ```
224
CYP450 inhibitors
``` INH sulfonamides cimetidine erythromycin grapefruit ```
225
3 drugs metabolized by alcohol dehydrogenase
ethylene glycol MeOH EtOH
226
ethylene glycol is metabolized by alcohol dehydrogenase to ___ effects are ___ (2)
oxalic acid acidosis nephrotoxicity
227
MeOH is metabolized by alcohol dehydrogenase to ___ (2) | effects are ___ (2)
formaldehyde formic acid acidosis retinal damage
228
EtOH is metabolized by alcohol dehydrogenase to ___ | effects are ___ (3)
acetaldehyde nausea vomiting hypoTN
229
___ inhibits alcohol dehydrogenase
fomepizole
230
5 non-obvious sulfa drugs
``` celecoxib probenecid thiazides sulfonylurea sumatriptan ```
231
systemic part of sulfa allergic rxn
fever
232
cutaneous part of sulfa allergic rxn (3)
rash urticaria (hives) Stevens-Johnson
233
hematologic part of sulfa allergic rxn (3)
HA thrombocytopenia agranulocytosis

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