G and G chapter ends Flashcards
(734 cards)
1
Q
Alosetron indication other than nausea
A
IBS-D
2
Q
Zofran MOA
A
5HT-3 antagonist
3
Q
Lorcaserin MOA
A
5HT-2c agonist
4
Q
Lorcaserin indication
A
Weight loss
5
Q
Scary side effect of lorcaserin at supraclinical doses
A
Hallucinations
6
Q
Triptans MOA
A
5HT-1b and d agonist
7
Q
Triptans contraindicated in what patients?
A
Ischemic heart disease and coronary artery vasospasm
8
Q
Which Triptans have drug interactions with cyp 3a4 inhibitors?
A
Eletriptan and naratriptan
9
Q
Can MAOI’s affect Triptans?
A
Yes, avoid
10
Q
4 Most common side effects with triptans
A
Dizziness, sleepiness, neck and chest pain
11
Q
Triptans safe in pregnancy?
A
No
12
Q
Triptans safe in breastfeeding?
A
No
13
Q
Can triptans be used concomitantly with SSRI’s/SNRI’s?
A
Not recommended due to serotonin syndrome
14
Q
Methylergonovine MOA
A
Broad 5-HT action
15
Q
Methylergonovine indication
A
Prevent post-partum hemorrhage
16
Q
High dose Methylergonovine can cause what unpleasant side effect?
A
Sustained uterine contracture
17
Q
Buspar MOA
A
Partial agonist 5-HT1a and D2
18
Q
Flibanserin MOA
A
5-HT1a agonist and 5-HT2 antagonist
19
Q
Flibanserin indication
A
Hypoactive sexual desire in premenopausal women
20
Q
Cabergoline MOA and indication
A
Dopamine agonist, Parkinson’s and hyperprolactinemia
21
Q
Bromocriptine MOA and indication
A
Dopamine agonist, Parkinson’s and hyperprolactinemia
22
Q
Rotigotine moa
A
Dopamine agonist
23
Q
Main reason cabergoline and bromocriptine are avoided
A
Cardiac issues (valvulopathies)
24
Q
Side effect of dopamine agonists (mirapex, requip…) early in parkinson’s
A
Impulse control
25
What benefit from use of clozapine in terms of side effects?
Less EPS
26
Why vraylar or rexulti for schizophrenia?
Improved side effect profile
27
Can adderall be used in patients that also have bipolar?
Not likely, can worsen psychosis
28
What side effects does vilazodone lack?
Sexual and weight gain
29
Milnacipran moa
SNRI
30
Duloxetine and milnacipran contraindicated in what?
Uncontrolled narrow angle glaucoma
31
Doxepin drug class
TCA
32
Desipramine drug class
TCA
33
How long to wait after taking MAOI to take TCA?
14 days
34
Blood pressure side effect of TCA’s
Orthostatic hypotension
35
3 indications of atypical antipsychotics
Depression, schizophrenia, and bipolar
36
Isocarboxazid drug class
MAOI
37
Tranylcypromine drug class
MAOI
38
MAOI’s can cause what side effect if tyramine containing foods/drinks eaten?
Hypertensive crisis
39
Trazodone and remeron moa
5-HT2 antagonist
40
Trazodone and remeron dose for successful sleep
Low dose
41
Why avoid nefazodone?
Risk of liver failure
42
Chlorpromazine drug class
1st gen antipsychotic
43
Chlorpromazine hits what 4 receptor types? What are side effects from each receptor type?
D2, muscarinic, histamine, and A1. EPS, anticholinergic, sedation, and hypotension
44
How can chlorpromazine effect the skin?
Photosensitivity
45
Haldol has higher rates of which 3 side effects?
EPS, akathisia, and hyperprolactinemia
46
Hyperprolactinemia manifestations
Infertility, decrease BMD in women, and erectile dysfunction and gynecomastia in men
47
Haldol causes less of which 4 side effects?
Anticholinergic, sedation, weight gain, hypotension
48
2 mg Haldol is equivalent to ___ mg chlorpromazine
100
49
Thiothixene drug class
1st gen antipsychotic
50
Perphenazine drug class
1st gen antipsychotic
51
Loxapine drug class
1st gen antipsychotic
52
Which 2 1st gen antipsychotics have the least EPS and akathisia?
Perphenazine and loxapine
53
Asenapine
Saphris
54
Can saphris ODT be swallowed?
No, will be dismantled by liver
55
Saphris counseling point when administering
Avoid water for 10 minutes after taking
56
How much effect does asenapine have on weight gain?
Minimal
57
What 2 GI and oral side effects does clozapine have?
Constipation and drooling
58
Iloperidone drug class
Atypical antipsychotic
59
4 common side effects of atypical antipsychotics
Anticholinergic, sedation, weight gain, and hypotension
60
Counseling point on Latuda administration
Take with 350 cal food
61
Olanzapine has dose dependent ___ effects
Anticholinergic
62
Invega has high rates of which side effect?
Hyperprolactinemia
63
Which 3 side effects are most common with Quetiapine?
Weight gain, sedation, and hypotension
64
Which 2 atypical antipsychotics have high rates of hyperprolactinemia?
Risperidone and paliperidone
65
Ziprasidone administration counseling point
Take with 500 cal food
66
Ziprasidone has improved tolerability if you need to start at high starting dose of ___ mg per day how?
With food
67
Abilify has low risk of which 2 side effects?
Weight gain and hyperprolactinemia (actually lowers prolactin)
68
Nuplazid
Pimavanserin
69
Nuplazid moa and indication
Parkinson’s disease psychosis. 5-HT2a inverse agonist without D2 affect
70
With Cyp3a4 inhibitors, do what to Nuplazid dose?
Decrease by 50% to avoid overdose
71
Clinical effects of Nuplazid take how long to be seen?
4-6 weeks
72
Monitor what 3 labs with lithium?
TSH, lithium level, and renal function
73
Therapeutic serum level for lithium in acute mania
1-1.5 meq/ml
74
Maintenance therapeutic serum level for lithium
0.6-1 meq/ml
75
Lithium may cause what 2 physical side effects?
Tremor, hair loss
76
What 3 labs are monitored with divalproex?
Divalproex level, CBC, and liver function
77
Avoid rapid dose escalation for carbamazepine to avoid ___ and ___
Sedation and ataxia
78
Why slow dose increase for lamotrigine?
To avoid SJS
79
What to do if patient on lamotrigine and divalproex?
Reduce lamotrigine dose by 50%
80
How does phenytoin affect cyp3a4?
Induction
81
2 Common phenytoin side effects
Gingival hyperplasia and facial coarsening
82
5 common side effects of carbamazepine
Drowsiness, vertigo, ataxia, blurred vision, increased seizure frequency
83
Which anti seizure meds reduce half life of lamotrigine?
Phenytoin, carbamazepine, and phenobarbital
84
Why did they make oxcarbazepine?
Less side effects and cyp induction
85
Lacosamide moa and indication
Sodium channel modulator, epilepsy
86
Ethosuximide moa and indication
Calcium channel blocker, epilepsy
87
6 common side effects of ethosuximide
GI, sleepiness, lethargy, dizziness, headache, (rash) hypersensitivity
88
Zonisamide 4 common side effects
Sleepy, ataxia, anorexia, fatigue
89
Zonisamide moa
Calcium channel blocker
90
Abrupt withdrawal of benzos can facilitate what symptom?
Seizures
91
Infinite levels can be increased in cyp___ poor metabolizers
2c19
92
Phenobarbital 2 common side effects in children:
Irritability and hyperactivity
93
Phenobarbital 2 common side effects in elderly
Agitation and confusion
94
Primidone moa
GABA enhancer
95
Primidone is a cyp 3a4 ___
Inducer
96
Fycompa
Perampanel
97
Perampanel
Fycompa
98
Fycompa 6 common side effects
Fatal, eYesight, Confusion, Offensive, iMbalance,P, Anxiety
Anxiety, confusion, imbalance, vision problems, aggression, suicidal thoughts
99
Fycompa moa
Glutamate receptor antagonist
100
Keppra 5 common side effects
slacKness, Emotionality, Poor focus, Restful, Ataxia.
Sleepy, weakness, ataxia, dizziness, mood changes
101
3 common topiramate side effects
Sleepy, fatigue, brain fog
102
Why did they make rytary?
Mixed immediate and extended release sinemet to prevent wearing off effect
103
3 Most common side effects of dopamine agonists (requip, mirapex…)
Sleepy, impulse control disorder, psychosis
104
Apomorphine drug class and indication
Dopamine agonist, Parkinson’s rescue for off episodes
105
Apomorphine must be used concurrently with what?
Nausea meds
106
Apomorphine is contraindicated with which drug class?
Zofran (5-ht3 antagonists)
107
Neupro
Rotigotine
108
Rotigotine
Neupro
109
Why are COMT inhibitors used in Parkinson’s?
To reduce peripheral metabolism of levodopa, increasing efficacy and half life
110
Entacapone drug class
COMT inhibitor
111
Why would rasagiline or selegeline be used in Parkinson’s?
As MAOI’s, they increase dopamine levels.
112
Max efficacious dose of selegiline in Parkinson’s: ___mg
40 mg
113
Amantadine effective at treating levodopa induced:
Dyskinesias
114
Rivastigmine moa and indication
Acetylcholinesterase inhibitor, dementia (Parkinson’s and alzheimer’s)
115
What is main dose limiting side effect of aricept?
GI symptoms (NVD)
116
Exelon patches have less of what side effect?
GI (NVD)
117
Memantine moa
NMDA antagonist (reduces glutamate excitation which leads to damage)
118
Tetrabenazine moa and indication
Depletes pre-synaptic catecholamines, treats tics (Huntington’s chorea)
119
2 main side effects tetrabenazine
Hypotension and suicidal depression
120
Baclofen moa
GABA receptor agonist
121
Which 4 benzos have the indication for alcohol withdrawal?
Chlordiazepoxide, valium, Ativan, and oxazepam
122
Flumenazil indication
Benzo ovedose
123
Belsomra moa
Orexin antagonist
124
Ballpark phenobarbital half life
Long
125
Levorphanol 2 unique Side effects
Delirium and hallucinations
126
As an opioid, why is loperamide sold OTC?
Poor BBB penetration, great for diarrhea
127
Why is diphenoxylate formulated with atropine?
Atropine side effects of weakness and nausea discourage abuse of the opioid component
128
What syndrome does delsym increase risk for?
Serotonin syndrome
129
Naltrexone boxed warning:
Contraindicated in liver failure and hepatitis due to dose dependent liver injury
130
Precedex should be used only up to ___ duration sedation
24 hours
131
Dexmedetomidine moa
A2 agonist
132
How long to apply lidocaine/prilocaine for onset of action?
30 minutes
133
Do not use Emla cream where topically?
Mucous membranes and open wound
134
Acamprosate indication
Alcoholism
135
Diuretic used for altitude sickness
Acetazolamide
136
Fomepizole indication
Methanol poisoning
137
Ethacrynic acid moa
Loop diuretic
138
Risk of otoxicity highest with which loop diuretic?
ETHACRYNIC ACID
139
Metolazone drug class
Thiazide diuretic
140
Thiazide diuretics have what effect on blood sugar and LDL?
Elevate
141
amiloride drug class
Potassium sparing diuretic
142
Best diuretic in PCOS
Aldactone
143
Drug of choice for central diabetes insipidus
Desmopressin
144
Major ADR with desmopressin
Water intoxication
145
Inhibition of conversion of angiotensin 1 to 2 causes blood pressure to lower how?
Lowers arteriolar resistance
146
Ace inhibitors contraindicated in renal artery ___
Stenosis
147
How does RAAS contribute to hypertension?
Volume overload, so body releases renin, which elevates angiotensin and aldosterone, leading to arteriolar contraction and elevated blood pressure.
148
Aliskiren moa
Direct renin inhibitor
149
With nitrates, need drug free interval of how long?
8 hours
150
2 indications for calcium channel blockers
Angina and HTN
151
Which formulation of calcium channel blocker preferred for angina?
Long acting or XR
152
Odd potential nifedipine side effect
Tachycardia
153
Common gi side effect with diltiazem and verapamil:
Constipation
154
4 unique and common side effects of beta blockers
Bronchospasm, peripheral vasoconstriction, depression, and worsening psoriasis
155
Ranolazine indication
Angina
156
Ivabradine moa
Decreases heart rate by inhibiting SA node firing
157
Ivabradine 2 indications
Heart failure and angina
158
Ivabradine visual side effect
Phosphene (perception of light when none entering eye)
159
Ivabradine contraindicated with what drugs?
Diltiazem or verapamil
160
Heparin moa
Thrombin and factor Xa inhibitor
161
Thiazides lose efficacy at what eGFR? 2 Exceptions:
<40, indapamide and metolazone
162
Which 3 beta blockers indicated for heart failure?
Nebivolol, metoprolol, and bisoprolol
163
2 Beta blockers of choice in peripheral artery disease
Coreg and labetalol
164
Isosorbide dinitrate and Hydralazine combo indication
Heart failure in African americans
165
3 digoxin common side effects
Nausea, diarrhea, visual disturbances
166
When is Ivabradine used in heart failure?
Not tolerating beta blockers or HR over 75 on a beta blocker
167
Quinidine indication
Prevent AF, VT, and VF
168
3 common side effects with quinidine
Diarrhea, QT prolongation, cinchonism: (tinnitus, blurred vision, flushing, dizziness, diarrhea)
169
Useful general info about theophylline dosing
Narrow therapeutic index
170
Disopyramide common side effects
Anticholinergic
171
Lidocaine systemic CNS side effects
Seizures, tinnitus, tremor, hallucinations, drowsiness, and coma
172
Mexiletine 2 indications
Chronic VT and VF prevention
173
Systemic lidocaine indications
Acute VT and VF treatment
174
Mexiletine common 2 side effects
Tremor and nausea
175
Lidocaine and Mexiletine MOA
Sodium channel blocker, fast wear off
176
Procainamide, quinidine, and disopyramide MOA:
Sodium channel blockers, intermediate wear off
177
Flecainide and propafenone MOA:
Sodium channel blockers, slow wear off
178
Which class of antiarrhythmics 1a, 1b, or 1c is best tolerated?
1c (flecainide)
179
Flecainide and propafenone increase risk of severe arrhythmia in what patient type?
Structural heart disease.
180
Flecainide increases mortality in what patient specific heart disease status?
MI
181
2 common side effects of flecainide:
Blurry vision and can worsen heart failiure
182
Additional mechanism for propafenone:
Beta blocker
183
What are class 2 antiarrhythmics?
Beta blockers
184
Nadolol preferred for what 2 specific heart disease states?
Long QT syndrome and CPVT (catecholaminergic polymorphic ventricular tachycardia) (genetic heart defect)
185
Drug of choice for acute VT and VF and to slow ventricular rate and convert A fib.
Amiodarone
186
Why does amiodarone use require periodic lung evaluation
Pulmonary fibrosis side effect
187
5 common amiodarone side effects:
Corneal deposits, hepatotoxicity, neuropathy, photosensitivity, thyroid dysfunction
188
Multaq indication
A fib prevention
189
Why use multaq?
Less side effects
190
2 common dronedarone side effects
GI disturbances and fatal hepatotoxicity
191
Multaq increases mortality in patients with severe:
heart failure
192
Sotalol, tikosyn, amiodarone , and ibutilide MOA:
Potassium channel blocker
193
Sotalol, tikosyn, and ibutilide have high risk for what side effect?
TDP
194
MOA of class 4 antiarrhythmics
Calcium channel blockers
195
4 common side effects of verapamil and diltiazem
Constipation, bradycardia, hypotension, and gingival hyperplasia
196
NDHP calcium channel blockers contraindicated in what?
Heart failure with reduced ejection fraction
197
Treat TDP with what?
Mag sulfate
198
Digoxin MOA
Sodium-potassium ATPase inhibitor
199
Digoxin indication
Rate control in a fib
200
Digoxin 3 common side effects
GI effects, arrhythmia, and visual/cognitive dysfunction
201
Avoid what 2 drug classes with Cialis and such
Nitrates and alpha inhibitors (amlodipine and clonidine…)
202
Riociguat indication
Pulmonary arterial hypertension
203
Drug class first line for severe PAH
Prostacyclin analogs
204
Treprostinil 5 side effects
Jaw pain, hypotension, myalgia, flushing, NV
205
When is dose adjustment required for lovenox?
Crcl less than 30
206
Warfarin moa
Vitamin k antagonist
207
How to adjust warfarin in renal or hepatic impairment:
None, watch INR
208
Dabigatran
Pradaxa
209
Pradaxa dose reduction at what Crcl:
30
210
When can xarelto be given twice daily?
VTE treatment and acute coronary syndrome
211
When to get reduced dose Eliquis?
2 of these: Older than 80, weight < 60 kg, or Scr >=1.5
212
Savaysa
Edoxaban
213
Savaysa moa
Factor Xa inhibitor
214
What drug can be used to reverse eliquis and xarelto?
Andexxa (andexanet alfa)
215
Alteplase indication
Thrombolysis
216
Dipyridamole moa
Inhibits platelet aggregation and causes coronary vasodilation
217
Brillinta indication
ACS
218
Effient indication
After intervention for ACS
219
Do not use prasugrel in what age
>75
220
Reduce prasugrel dose at what weight?
<60 kg
221
Statin use in pregnancy
Contraindicated
222
Safest lipid lowering drugs
Bile acid sequestrants
223
3 Common side effects of bile acid sequestrants:
Bloating, constipation, dyspepsia
224
Contraindication to bile acid sequestrant use
Hypertriglyceridemia, these increase triglycerides
225
Why is niacin included in prenatal vitamins, but contraindicated in pregnancy?
18 mg in prenatals, but 500 mg in rx strength.
226
Niacin effect on HDL, LDL, and triglycerides
Increase, decrease, decrease
227
Rx niacin 3 common side effects
Flushing, dyspepsia, and itching
228
Niacin should not be used with what class of hyperlipidemia drugs
Statins due to myopathy
229
Niacin is contraindicated with what 2 diseases?
Hx of peptic ulcer disease, and gout
230
When to choose fibrates?
Hypertriglyceridemia
231
Can fibrates be used in pregnancy?
No
232
When can fibrates be used with statins?
They should not
233
2 Most common side effects with fibrates
GI and myopathy
234
When to use zeta and bile acid sequestrants together?
Never
235
Can PCSK-9 inhibitors and statins be used together?
Yes. Complementary mechanisms.
236
How do statins Lower LDL?
Inhibit LDL biosynthesis
237
PCSK-9 moa
Increases LDL receptors and therefore LDL cell uptake.
238
PCSK-9 2 common side effects:
Influenza symptoms and URTI’s
239
Omega-3 indication
Hypertriglyceridemia
240
3 common side effects with omega-3’s
Arthralgia, nausea, and dyspepsia
241
Xifaxan 4 common side effects
Nausea, dizziness, fatigue, and swelling
242
Xifaxan moa
Antibiotic DNA synthesis inhibitor
243
Prednisone effects on cellular immunity:
Decreases pro-inflammatory cytokines IL-1 and IL-6, decreases T cell proliferation, but increases neutrophil and monocyte function.
244
2 Less obvious cyclosporine indications:
Rheumatoid arthritis and psoriasis
245
Cyclosporine severe interactions with what drug class?
Antiarrhythmics
246
9 common side effects with cyclosporine systemic
Tremor, hallucinations, drowsiness, coma, nephrotoxicity, HTN, hirsutism, HLD, and gum hyperplasia
247
Cyclosporine and tacrolimus MOA
Calcineurin inhibitor (reduce T cell activity)
248
What lab with tacrolimus?
Blood levels to avoid tacrolimus
249
Azathioprine moa
Purine metabolism inhibitor
250
5 commons side effects with azathioprine
Bone marrow suppression, infection susceptibility, hepatotoxicity, alopecia, and gi toxicity
251
Mycophenolate moa
Purine metabolism inhibitor
252
Mycophenolate 2 common side effects
GI and hematologic.
253
Sirolimus which cyp interactions?
3A, watch interactions
254
Who not to use probiotics in?
Immunocompromised: risk of translocation and septicemia.
255
Sirolimus moa
Mtor inhibitor: inhibits cytokine mediated T cell proliferation.
256
Belatacept
Nulojix
257
Belatacept moa
T cell stimulation blocker
258
Belatacept only indication
Transplant rejection prevention
259
Belatacept dose dependent risk:
Dose dependent PML, CNS lymphoproliferative disorder, and CNS infections
260
What is ATGAM?
Antibodies against numerous T cell surface molecules.
261
ATGAM indications:
Prevention and treatment of transplant rejection and aplastic anemia
262
Alemtuzumab moa
Anti cd 52, lymphocyte depletion
263
Rituximab 2 indications:
RA and MS
264
Remicade moa
TNF inhibitor
265
Enbrel moa
TNF inhibitor
266
What 4 infusion reactions with humira, Enbrel, and remicade?
Fever, urticaria, hypotension, dyspnea
267
3 risks with TNF inhibitors
Serious infections, lymphoma, and other malignancies
268
Name a first line option for MS
Ocrelizumab
269
Tecfidera indication
MS
270
Misoprostol alternative indication
GI acid protective
271
Epoprostenol drug class and indication
Prostacyclin analogue and pulmonary arterial hypertension
272
Bimatoprost common side effect vs other “prost” eye drops
Upper respiratory tract infection 10% incidence
273
Bimatoprost 2 indications:
Eyelash darkening and growth and ocular hypertension (glaucoma prevention and treatment)
274
Aspirin prolongs bleed time for how long after a dose?
36 hours
275
Aspirin associated Reye syndrome in kids is associated with what 2 symptoms/diagnoses?
Fever and flu or varicella disease
276
Diflunisal drug class
Salicylate
277
Diflunisal 2 indications
Osteo and rheumatoid arthritis
278
Why is mesalamine only used for IBD?
Specific to lower gi tract.
279
3 risk factors that lower threshold for Tylenol toxicity
Liver impairment, more than 2 alcohol drinks per day, and malnutrition
280
What is hepatotoxic acetaminophen metabolite?
NAPQI
281
What effect does Tylenol have on platelets and inflammation?
Little effect
282
NSAID used in patent ductus arteriosus in neonates
Indomethacin
283
Indomethacin high risk in what patient population?
Over 65 years old due to high incidence of side effects
284
Why is Indomethacin not used as much as other NSAIDS?
Lots of side effects 20% discontinue
285
Ketorolac effect as anti-inflammatory:
Little effect
286
Diclofenac common, severe side effect
Liver toxicity 4%
287
Mefenamic acid drug class
NSAID
288
Mefenamic acid 2 indications
Pain and dysmenorrhea
289
Mefenamic acid used in what age group and what max duration?
Over 14 and 7 days
290
Ibuprofen effect on aspirin cardioprotection
Reduces cardioprotection by competing with aspirin for cox binding site.
291
Oxaprozin drug class
NSAIDx
292
Oxaprozin half life
41-55 hours
293
Oxaprozin not indicated for what pain?
Acute, slow onset
294
Piroxicam half life
50 hours
295
Piroxicam 2 serious side effects and how common?
Serious GI and skin reactions, 5%
296
NSAID to use to avoid gi side effects
Celecoxib cox 2 selective
297
Colchicine moa
Depolymerizes microtubules, decreasing neutrophil migration into inflamed sites.
298
Which probiotics to use in C diff?
None recommended. Conflicting evidence.
299
Allopurinol secondary indication:
Calcium oxalate stones
300
In what impairment does allopurinol dose need to be adjusted?
Renal
301
Risk of ___ attacks during early allopurinol treatment.
Gout (tissue urate mobilization)
302
How long does allopurinol take to get Uris acid levels down to normal?
1 to 3 weeks
303
Allopurinol and febuxostat moa
Xanthine oxidase inhibitors
304
What is the most effective drug class for acute migraines?
Triptans (eletriptan), not CGRP’s
305
Main contraindication for triptans
Vascular disease (stroke, Coronary artery disease, heart attack hx, peripheral artery disease, CHF, pulmonary embolism hx…)
306
2 Probenecid indications
Hyperuricemia (not acute), elevated beta lactam levels
307
Probenecid moa
Uric acid reabsorption inhibitor in kidneys
308
Doxepin moa
tricyclic antidepressant
309
Doxepin topical cream indication
Itching
310
Pyrilamine moa
Combo topical Antihistamine
311
Promethazine boxed warning
Fatal respiratory depression under 2 years old
312
Bepotastine drug class
Ocular antihistamine
313
Epinastine drug class
Ocular antihistamine
314
Albuterol 4 major side effects
Tachycardia, palpitations, muscle tremors, hypokalemia
315
Levalbuterol advantage over albuterol
None
316
How is Formoterol used in asthma?
Combo with ICS
317
Loose contraindication for patients on SAMA or LABA?
Urinary retention and glaucoma
318
ICS 2 local side effects
Hoarseness and thrush
319
Which ICS ideal in children?
Budesonide
320
Montelukast moa
Leukotriene antagonist
321
Zileuton drug class
Leukotriene antagonist
322
What elevated lab contraindicates zileuton?
ALT / AST
323
Theophylline / aminophylline 5 commons side effects
Nausea, headache, diuresis, arrhythmia, seizure
324
Roflumilast moa
PDE-4 inhibitor: inhibits WBC infiltration of lung cells to prevent remodeling and elevates cAMP in lung cells
325
Omalizumab 4 indications:
Allergic asthma, food allergy (ig-E mediated), rhinosinusitis w/polyps, chronic urticaria
326
Xolair moa
Anti- ig-E
327
Dupixent moa
IL-4 antagonist
328
Dupixent 7 indications:
Moderate to severe eosinophilia asthma or ICS dependent, asthma with mod to severe atopic dermatitis, atopic dermatitis mod-severe, refractory COPD, eosinophilia esophagitis, prurigo nodularis, and sinusitis w/polyps
329
Generic growth hormone drug name
Somatropin
330
Leydig cell function
Stimulate testosterone production in the testes
331
Octreotide moa and indication
Somatostatin analog (inhibits growth hormone secretion) and acromegaly
332
Cabergoline moa and 3 indications
D2 agonist, hyperprolactinemia, Parkinson’s, and acromegaly
333
Which thyroid hormone is active? T3 or T4?
T3
334
Getting a thyroid dose that is too high can lead to what 2 diseases?
Osteoporosis and atrial fibrillation
335
Armour thyroid composition
T3 and T4
336
Methimazole and PTU moa
Reduce thyroid hormone production by interfering with iodine incorporation into tyrosyl residues
337
Methimazole pregnancy use:
Not first trimester due to embyopathy
338
Major concern with propylthiouracil:
Liver toxicity
339
What drug can be used for hyperthyroidism in the first trimester?
PTU
340
Lugol solution indication
Reduce secretion and synthesis of thyroid hormone
341
Lugol solution dose in thyroid storm in pregnancy:
Contraindicated
342
SSKI indication
Acute thyroid secretion and synthesis inhibition
343
Tamoxifen moa and indication
SERM, breast cancer treatment
344
Raloxifene moa and 2 indications
SERM, osteoporosis treatment, breast cancer prophylaxis in high risk post-menopausal women
345
SERM 2 major side effects
Hot flashes and clots
346
Clomiphene moa
Anti estrogen
347
Exemestane moa and indication
Irreversible aromatase inhibitor, breast cancer treatment
348
Anastrozole and letrozole moa and indication
Reversible aromatase inhibitor. Breast cancer treatment.
349
Risk with long term use of aromatase inhibitors:
Osteoporosis
350
Megestrol is a derivative of what naturally occurring hormone?
Progesterone
351
What activity differentiates norethindrone from other progestins?
Androgenic activity
352
Mifepristone moa
Both progesterone receptor antagonist.
353
Leuprolide moa and 2 common indications
GnRH agonist, reducing GnRH secretion, and therefore testosterone and estrogen. Endometriosis, precocious puberty
354
Leuprolide long term use side effect
Osteoporosis
355
What options exist outside clomiphene for ovulation induction?
injectable FSH and LH
356
Bicalutamide moa and indication
Androgen receptor antagonist, add on for metastatic prostate cancer
357
Finasteride moa and indications
5 alpha reductase inhibitor, reduces production of dihydrotestosterone in prostate, shrinking the prostate. Alopecia and BPH
358
Sildenafil moa and indications
PDE-5 inhibitor(allows relaxation of cavernosal smooth muscle), ED and pulmonary arterial hypertension
359
PDE-5 inhibitor DDI contraindication
Nitrates
360
3 common side effects with PDE-5 inhibitors:
Headache, flushing, and blue-green tinted vision
361
Chronic hydrocortisone dosing tip: AM and PM doses
20 mg AM, 10 mg PM for sleep
362
Fludrocortisone dose is titrated up by what? How often dosed?
Blood pressure (upright posture tolerance) once daily due to long half life
363
Corticosteroid 3 short term side effects:
Insomnia, weight gain, emotions
364
High-dose/long term corticosteroid 6 side effects:
Psychosis, infection risk, osteoporosis, osteonecrosis, myopathy, HPA axis suppression
365
2 common side effects of steroid eye drops:
Glaucoma and cataract formation
366
Chronic inhaled steroid use in children effect on height:
Slow growth velocity, no effect on final height.
367
inhaled steroid with least side effects and why:
Ciclesonide, low oral biavailability
368
Reasons for steroid use in leukemia and lymphoma
Cytotoxic effects and relief of pain, nausea, and appetite stimulation
369
Cabergoline off label use for reduction of ACTH
Cushing disease
370
Regular insulin onset and duration
30 minutes, 4-6 hours
371
Rapid acting insulin onset and duration
10 minutes, 3-4 hours
372
NPH insulin onset and duration
1 hour, 8-12 hours
373
Long acting insulin onset and duration
1 hour, 18-42 hours (Degludec 42 hours)
374
Metformin moa
Increase glucose uptake peripherally, decrease hepatic gluconeogenesis
375
3 common ADR’s with metformin
Nausea, diarrhea, and lactic acidosis
376
Why metformin stopped on hospital admit?
Contrast dye elevated levels due to renal insult
377
Is metformin used in renal and hepatic problems?
Dose adjust for renal, not in liver problems
378
Acarbose drug class and moa
Alpha glucose dose inhibitor, reduces carb breakdown in gi tract.
379
2 common side effects with acarbose
GI flatulence and elevated LFT’s
380
Name 2 DPP4’s
Sitagliptin, saxagliptin, linagliptin, alogliptin
381
DPP4 moa
Inhibit breakdown of GLP-1, increased satiety, lower blood glucose.
382
Name the 3 sulfonylureas
Glipizide, glimepiride, glyburide
383
Sulfonylurea moa
Stimulate insulin release
384
Sulfonylurea major side effect
Hypoglycemia
385
Nateglinide and repaglinide moa
Increase insulin secretion
386
Jardiance class and moa
SGLT2 inhibitor. Decrease glucose reabsorption in kidneys.
387
Main side effect of SGLT2 inhibitors:
Increased risk of UTI
388
What serious diabetes complication can SGLT2 inhibitors mask?
DKA
389
What side effect do SGLT2 inhibitors not cause that other diabetes drugs do?
Hypoglycemia
390
Actos moa
Increase peripheral insulin sensitivity
391
5 common side effects for actos:
Edema, CHF, weight gain, fractures, macular edema
392
Actos drug class
Thiazolidinedione
393
actos absolutely contraindicated in:
CHF reduced ejection fraction
394
GLP-1 agonists 5 common side effects:
Nausea, GI, headache, fatigue, sinus infection
395
Avoid using GLP-1’s with agents that do what?
Decrease GI motility (oxybutynin…)
396
Pramlintide moa
Slows gastric emptying and decreases glucagon (like amylin naturally occurring)
397
Diazoxide moa
Inhibits insulin secretion
398
Name 3 Diazoxide common side effects
Nausea, edema, hyperuricemia, thrombocytopenia, hypertrichosis (hair growth), leukopenia
399
Diazoxide 2 indications
Hypertensive crisis, hyperinsulinemia
400
Octreotide common side effect
Gallbladder abnormality
401
Parathyroid hormone effect on calcium
Release calcium from bone into bloodstream, increase gastric calcium absorption, decrease renal excretion of calcium, stimulate osteoblasts.
402
Why would vitamin d help with hypoparathyroidism?
Low blood calcium from low absorption leads to hypoparathyroidism and osteoporosis, so vitamin d helps with calcium uptake and parathyroid hormone secretion
403
Why would vitamin d help with CKD induced hyperparathyroidism?
Parathyroid is released to increase blood levels of calcium, depleting bone stores (osteoporosis). Vitamin d increases absorption of calcium.
404
Calcitriol moa
Active form of vitamin d for CKD patients.
405
Calcitriol effect on phosphate
Elevate levels of phosphate
406
Hyperphosphatemia effects in body
Calcium deposits in heart, liver, kidneys… muscle cramps
407
Hypophosphatemia body effects
Fatigue, weakness, bone pain, seizures (acute re-feeding)
408
Phosphate actions in body:
Converting ADP to ATP, bone mineralization, glycolysis, component of cell membrane and DNA and RNA, effects oxygen-carrying capacity of hemoglobin, and acts as urinary buffer by binding to free hydrogen ions.
409
First line option for reducing dietary phosphate
Tums
410
Rx option for phosphate binding
Sevelamer carbonate
411
Bisphosphonate moa
Reduce osteoclast activity, allowing bones to stay strong
412
Counseling point on bisphosphonates:
Take on empty stomach and sit up 30 minutes after dose (esophageal ulcers).
413
2 severe issues with bisphosphonates
Osteonecrosis of the jaw and femoral fractures
414
Bisphosphonates are contraindicated with delayed ___ ___
Esophageal emptying
415
When to change dose or switch from ibandronate.
Poor kidney function (CrCl under 30)
416
Zoledronate contraindicated in what 2 things?
CrCl under 35 and hypocalcemia
417
Forteo
Teriparatide
418
Forteo use limited to less than ___
2 years
419
Forteo moa
Parathyroid hormone analog (stimulates osteoblasts, increases gastric absorption of calcium, inhibits calcium excretion via kidneys)
420
Chronic high parathyroid hormone net effect
Osteoporosis
421
Pulse dosing of parathyroid hormone net effect
Bone building
422
Hormone that works opposite of parathyroid?
Calcitonin
423
Cinacalcet moa
Calcium sensing receptor mimetic (tells sensor that calcium level too high)
424
Cinacalcet 2 indications
Hypercalcemia and secondary hyperparathyroidism of CKD.
425
Side effect of cinacalcet
Hypocalcemia
426
Cinacalcet interactions:
Cyp3a4 strong inhibitors and CYP2d6 substrates.
427
Calcitonin effect on osteoclast
Inhibitor.
428
Denosumab moa
Binds to RANKL, blocks interaction between RANKL and RANK on osteoclast surface, and prevents osteoclast formation. Builds bone mass.
429
Hydrochlorothiazide effect on calcium
Reduce calcium excretion
430
Potentially serious DDI with omeprazole
Plavix, studies show increased mortality risk, some studies did not show risk. Better to avoid.
431
4 PPI side effects:
Fracture risk, diarrhea, nephritis, b-12 deficiency (long term 3 years use)
432
Misoprostol side effect
Diarrhea
433
Sucralfate side effect
Constipation
434
Prucalopride moa
5ht-4 agonist, increase GI motility
435
Prucalopride 3 indications
GERD, gastroparesis, severe constipation
436
2 side effects and 1 risk of prucalopride
Headache and diarrhea. Serious cardiac risk
437
Mechanism of gastric movement by metoclopramide:
5HT4 agonist
438
3 side effects of metoclopramide:
hyperprolactinemia (dopamine antagonism induced), CNS depression, and EPS (tar dive dyskinesia)
439
What macrolide increases gastric motility?
Erythromycin
440
Lactulose 2 indications:
Constipation and hepatic encephalopathy
441
Linzess youngest age for use:
6 years old
442
Linzess moa
Guanylate cyclase-C agonist (draw water into bowel)
443
Lubiprostone moa
Cl channel activator (draw water into bowel)
444
2 lubiprostone side effects
Nausea and diarrhea
445
Naloxegol moa
Mu opioid receptor antagonist peripherally for constipation
446
Alosetron indication
IBS-D (women)
447
Preferred antibiotic for children with traveler’s diarrhea
Azithromycin
448
Xifaxan 2 indications
Traveler’s diarrhea and IBS-D
449
What type of diarrhea does clonidine help with?
Diabetic diarrhea
450
Lomotil and loperamide soft duration limit
10 days.
451
Dicyclomine 3 contraindications
Colitis, bowel obstruction, and GERD
452
Zofran moa
5HT3 antagonist
453
Ondansetron 4 common side effects
Headache, constipation, fatigue, malaise
454
How does prochlorperazine inhibit nausea?
Dopamine antagonism at chemoreceptor trigger zone.
455
How does scopolamine inhibit nausea?
Anti muscarinic that blocks histamine signals from inner ear to vomiting center
456
5 common side effects with scopolamine
Dizziness, constipation, drowsiness, dry mouth, blurred vision
457
Ursodiol indication
Prevention and dissolution of gall stones
458
Ursodiol 2 side effects
Nausea (GI) and headache
459
Mesalamine by mouth has less effects where in GI tract?
Ileum and large intestine
460
How does sulfasalazine reach distal regions of GI tract?
Prodrug metabolized by colonic bacteria.
461
Why balsalazide?
Reaches colon and does not contain sulfa group.
462
Big risk of IBD treatment with 6 mercaptopurine
4 fold higher risk of lymphoma
463
Big risk of treatment with azathioprine
4 fold risk of lymphoma
464
What 2 antibiotics are commonly used together in pediatric Crohn’s disease? Not effective in what?
Cipro and flagyl, Ulcerative colitis
465
Positional counseling point for doxycycline and all tetracyclines:
Do not recline for 1 hour after taking orally due to esophagitis risk.
466
Metronidazole 2 common side effects
Headache and metallic taste (dysgeusia)
467
First line in giardiasis
Metronidazole
468
What is used for resistant giardiasis?
Nitazoxanide
469
Drug of choice in trichomoniasis
Metronidazole
470
3 drug regimen for toxoplasmosis:
Pyrimethamine, sulfadiazine, and leucovorin.
471
Drug of choice for cryptosporidiosis
Nitazoxanide
472
What is albendazole used for?
Intestinal worms.
473
Sulfa antibiotics: bactericidal or static?
Static, folate synthesis inhibitor.
474
How does silver sulfadiazine work?
Prevents infection via folate synthesis inhibition
475
Bactrim has excellent efficacy against what 4 bugs?
Staph aureus, staph epi, strep pyogenes, and e. Coli
476
3 common side effects of bactrim
Rash, GI upset, and hyperkalemia
477
Quinolones: cidal or static?
Cidal
478
Quinolone moa
DNA storage damage, inhibit dna topoisomerase and gyrase
479
Do not give quinolones with:
Divalent cations
480
3 common side effects with quinolones
Neuro, tendinitis, and photosensitivity
481
Quinolones are typically avoided in what 2 patient types?
Pregnancy and children
482
Cipro has excellent coverage of what 6 bugs?
E. Coli, klebsiella, proteus, serratia, salmonella, shigella
483
Levaquin has excellent coverage of bugs of cipro and which 4 additional bugs?
Strep, H flu, legionella, and chlamydia
484
Moxifloxacin cannot be used for what infection?
UTI, no penetration
485
Methenamine moa
Forms formaldehyde in urine, chronic suppression of UTI
486
Methenamine requires ___ urine to work
Acidic
487
Nitrofurantoin moa
Causes DNA damage to bacteria.
488
3 things to watch out for with nitrofurantoin
Pulmonary toxicity, peripheral neuropathy, and turns urine brown
489
Does fosfomycin have effect in blood?
No, only urine
490
Fosfomycin moa
Inhibits cell wall synthesis
491
What drug for UTI with proteus?
Fosfomycin
492
Are penicillins cidal or static?
Cidal
493
Dicloxacillin indications
Skin and soft tissue MSSA infections
494
Amoxicillin and ampicillin have excellent coverage of what 2 bugs?
Beta hemolytic strep and E. Faecalis
495
Augmentin adds excellent coverage of what 3 bugs?
B. Frag, H flu, and proteus
496
Cefadroxil what gen cephalosporin?
1st gen
497
Cephalexin and cefadroxil cover what 2 bugs excellently?
MSSA and streptococci
498
Cefuroxime, cefaclor, and cefprozil what gen?
2nd gen
499
2nd gen cephalosporins add coverage of what bugs?
H flu, proteus, E. coli, klebsiella
500
Cefpodoxime what gen?
3rd gen
501
Cefixime what gen?
3rd gen
502
Third gen cephalosporin 5 indications:
CAP, meningitis, UTI, strep endocarditis, and gonorrhea
503
Aminoglycosides cidal or static?
Cidal
504
Aminoglycoside moa
Concentration dependent, Inhibit bacterial protein synthesis
505
Aminoglycoside oral absorption
Almost none, only used orally for bowel decontamination
506
Ear administration of aminoglycosides should be avoided in what patients?
Those with tubes in (ototoxicity)
507
Tetracycline moa
Protein synthesis inhibitor
508
Tetracyclines: cidal or static?
Static
509
Why tetracyclines avoided in pregnancy and children under 8?
Binds to developing bone and causes malformations
510
Tetracyclines time or concentration dependent?
Time
511
Macrolide moa
Inhibit bacterial protein synthesis
512
Macrolide: cidal or static? Time or concentration dependent?
Static, concentration
513
Which macrolides are major cyp inhibitors?
Erythromycin and clarithromycin
514
Claithromycin usually seen in what 2 infections?
H pylori and CAP
515
Clarithromycin side effect at high doses
Tinnitus
516
Azithromycin half life
48 hours
517
When would you see telithromycin?
Macrolide resistant strep and staph
518
Why is telithromycin not used often?
Severe Hepatotoxicity
519
Clindamycin moa
Protein synthesis inhibitor
520
Clindamycin good activity against what bug class?
Strep (pyogenes, pneumo, and viridans)
521
Linezolid moa
Static protein synthesis inhibitor
522
Linezolid DDI
SSRI, serotonin syndrome
523
Why is Linezolid not dosed once daily?
Time dependent
524
Vancomycin, cidal or static? Moa
Cidal cell wall synthesis inhibitor
525
Oral vancomycin indication:
C diff
526
Is oral vancomycin absorbed?
No
527
Daptomycin not effective for what site?
Lungs (pneumonia), inactivated by lung surfactant
528
Daptomycin moa
Cidal cell wall synthesis inhibitor
529
Metronidazole moa
Disrupt dna synthesis in anaerobes
530
Metronidazole has good coverage of what 2 species?
B frag and clostridium
531
Bacitracin and mupirocin moa
Cell wall synthesis inhibitor
532
Rifampin general ddi
Potent Cyp inducer
533
Why is rifampin a problem in alcoholics?
Hepatitis
534
Tuberculosis treatment acrostic
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
535
Dapsone topical indication
Acne
536
Dapsone moa
Folate antagonist
537
Dapsone oral 4 common indications
Leprosy, malaria in combo, pneumocystis jiroveci, toxoplasma prophylaxis
538
What test prior to using dapsone
G6PD deficiency
539
Dapsone can cause what side effect at 200+ mg per day dose?
Hemolysis
540
Azole antifungal moa
Ergosterol synthesis inhibition
541
Itraconazole potent ddi
Cyp 3A4 inhibitor
542
Fluconazole inhibits what 2 cyps?
3a4 and 2c9
543
Posaconazole administration
With food
544
What drug for mucormycosis?
Isavuconazole
545
Griseofulvin moa and 2 indications
Inhibits microtubule function, ringworm and toenail fungus
546
Griseofulvin has what effect on cyp’s?
Induction
547
Terbinafine moa and 2 indications
Inhibit fungal squalene epoxidase and reduce ergosterol synthesis. Ringworm and toenail fungus
548
Terbinafine ____ in skin, nails, and fat
Accumulates
549
Acyclovir and Val limited to use in ____ viruses
Herpes
550
Best against cytomegalovirus
Valgancyclovir
551
Trifluridine indication
Ocular herpes
552
Oseltamivir moa
Neuraminidase inhibitor, prevents release of complete virus from cell.
553
Amantadine moa as antiviral
Inhibits m2 protein function
554
Entecavir moa
Inhibits HBV reverse transcriptase
555
Entecavir counseling point administration
Empty stomach
556
Tenofovir disoproxil fumarate moa
Reverse transcriptase inhibitor
557
Tenofovir 6 common side effects:
Abd. Pain, nausea, insomnia, pruritus, dizzyness, pyrexia
558
Lamivudine 2 common side effects
ENT infections and diarrhea
559
Sofosbuvir/velpatasvir indication
Hep c treatment (all genotypes)
560
Velpatasvir administration
Acidic stomach required
561
Avoid sofosbuvir if Crcl under ___
30
562
2 common side effects of sofosbuvir/velpatasvir
Fatigue and headache
563
Sofosbuvir moa
Inhibits HCV RNA polymerase
564
Difference between NRTI and NNRTI meds
NNRTI’s are newer and do not require phosphorylation to be activated, NNRTI’s are not active against HIV-2
565
Zidovudine 3 common side effects:
Anemia, neutropenia, and myopathy
566
Lamivudine 2 indications:
HBV and HIV
567
Lamivudine clinical pearl about side effects:
Essentially non toxic
568
Abacavir side effect to watch for
Hypersensitivity syndrome: fever, abd. Pain, and rash associated with HLA B*5701, stop use: potentially fatal
569
Tenofovir 3 indications:
HIV treatment, HBV, and HIV prophylaxis
570
Tenofovir 2 unique side effects:
Nephrotoxicity (severe is rare) and bone mineral density loss with chronic use
571
Emtricitabine side effect clinical pearl
Generally non toxic
572
Difference between HIV-1 and 2:
HIV-2 is slower onset, HIV-1 is predominant in America.
573
Nevirapine drug class
NNRTI
574
Nevirapine clinical pearl
Autoinducer of metabolism
575
Nevirapine most common side effect:
Rash (resolves in time)
576
Efavirenz common side effect
CNS toxicity (resolves in time, but can be severe enough to stop drug)
577
Rilpivirine counseling point
Give with food, avoid PPI
578
Etravirine common side effect
Rash that resolves
579
Ritonavir moa
Protease inhibitor, potent CYP3A4 inhibitor (boosts concentration of other drugs)
580
Ritonavir common side effect
Nausea
581
Fosamprenavir drug class
Protease inhibitor
582
Loping if drug class
Protease inhibitor
583
Atazanavir drug class and co-administered with
Protease inhibitor, ritonavir or cobicistat
584
Darunavir drug class
Protease inhibitor
585
Darunavir co administration
Must be used with ritonavir or cobicistat
586
Best tolerated protease inhibitor in HIV
Darunavir
587
Drug class for maraviroc and enfuvirtide:
Cell entry inhibitors HIV
588
Drug class ending in “gravir”
Integrase inhibitors
589
Avoid taking integrase inhibitors with what?
Divalent cations
590
Integrase inhibitor counseling point on side effects
Well tolerated
591
3 drug classes in oncology:
Alkylating agents and platinum coordination complexes, antimetabolites, and natural products
592
Alkylating agents and platinum coordination complexes MOA:
Covalent modification of DNA (damage)
593
Alkylating agents and platinum coordination complex 5 side effect types:
Immunosuppression, dividing mucosal and hair follicle cell toxicity, delayed pulmonary fibrosis, reproductive system toxicity, leukemogenesis (leukemia causing)
594
Mechlorethamine drug class:
Alkylating agent
595
Cyclophosphamide drug class
Alkylating agent
596
Methotrexate drug class:
Antimetabolite
597
Carboplatin drug class
Platinum coordination complex
598
Pemetrexed drug class
Antimetabolite
599
5-fluorouracil drug class
Antimetabolite
600
Oxaliplatin drug class
Platinum coordination complex
601
Ifosfamide drug class
Alkylating agent
602
Melphalan drug class
Alkylating agent
603
Chlorambucil drug class
Alkylating agent
604
Capecitabine drug class
Antimetabolite
605
Cytarabine drug class
Antimetabolite
606
Bendamustine drug class
Alkylating agent
607
Busulfan drug class
Alkylating agent
608
Gemcitabine drug class
Antimetabolite
609
5-azacytidine drug class
Antimetabolite
610
Carmustine drug class
Alkylating agent
611
Streptozocin drug class
Alkylating agent
612
Procarbazine drug class
Alkylating agent
613
Dacarbazine drug class
Alkylating agent
614
Temozolomide drug class
Alkylating agent
615
Cisplatin drug class
Platinum coordinating complex
616
Mercaptopurine drug class
Antimetabolite
617
Fludarabine drug class
Antimetabolite
618
Antimetabolite moa
Inhibit DNA and RNA function and formation.
619
Vinblastine drug class
Natural products
620
Vinorelbine drug class
Natural products
621
Vincristine drug class
Natural products
622
Cladribine drug class
Antimetabolite
623
Eribulin drug class
Natural products
624
Paclitaxel drug class
Natural products
625
Docetaxel drug class
Natural products
626
Clofarabine drug class
Antimetabolites
627
Topotecan drug class
Natural products
628
Irinotecan drug class
Natural products
629
Nelarabine drug class
Antimetabolite
630
Actinomycetes drug class
Natural products
631
Daunorubicin drug class
Natural products
632
Doxorubicin drug class
Natural products
633
Pentostatin drug class
Antimetabolites
634
Mitoxantrone drug class
Natural products
635
Etoposide drug class
Natural products
636
Teniposide drug class
Natural products
637
What 2 non cancer indications does mercaptopurine have?
Crohn’s and ulcerative colitis
638
Hydroxyurea moa
Inhibits conversion of ribo to deoxyribonucleotides (inhibits DNA synthesis)
639
L-asparaginase moa
Deprives leukemia cells that lack asparagine synthase.
640
Bleomycin moa
Binds to DNA and causes damage.
641
EGFR function
Growth and differentiation of epithelial cells
642
EGFR tyrosine kinase inhibitor function
Inhibit function of EGFR
643
Monoclonal antibody targeting EGFR function
Reduce expression and function of EGFR, draw in immune cells to kill cell.
644
Sunosi moa
Dopamine and norepinephrine reuptake inhibitor. Does not cause monoamine release like adderall.
645
Drug ending in Mumab?
Humanized monoclonal antibody
646
Drug ending in Zumab?
Human protein with antigen biding region from mouse
647
Drug ending in Ximab?
Chimera of human constant and mouse variable antibody domains
648
Drug ending in Omab?
Fully mousey protein sequence
649
Drug ending in ib?
Small molecule drugs, mostly tyrosine kinase inhibitors.
650
What is HER2?
Human epidermal growth factor receptor 2, a common receptor that gets over expressed in breast cancers and can lead to more aggressive tumors.
651
Jak inhibitors moa
Reduce signaling for growth factors in hematopoeisis and immune cells
652
CDK4/6 inhibitor moa
Prevent cell progression through mitosis
653
BTK inhibitor moa
Prevents excessive B cell growth and differentiation.
654
BCR-ABL inhibitor drug name and importance
Gleevec (imatinib), prevents this BCR-ABL complex from forming and causing uncontrollable cell division.
655
ALK inhibitor moa
Prevent ALK (a protein in cell membrane) from forming oncogenic drivers
656
Inhibitor of PI3K/Akt/mTOR pathway moa
Excessive signaling through this pathway is common in many cancers, these promote cell death for out of control growth.
657
Why target VEGF in cancer?
To prevent tumor cells from hijacking blood flow and nutrients to support tumor growth.
658
Describe immune checkpoint inhibitors
Cancer cells down regulate T cells to promote their own survival, but the discovery of checkpoints that cancer cells use enabled inhibitors that allow T cells to stay active and kill cancer cells.
659
Name 3 checkpoint targets for inhibition
CTLA-4, PD-1 and PD-L1
660
Which interleukin is mimicked with drugs to fight cancer? MOA
IL-2, promotes T cell and NK cell growth, stimulates B cell proliferation and antibody production. Drives development of T regs (mediates tolerance and suppression). Limits dangerous autoimmune reactions.
661
Do cancer vaccines exist?
Technically yes, but they work for treatment, not prevention.
662
Explain moa of chimeric antigen receptor T cells: (CAR-T)
CAR-T cells have an engineered antigen receptor on the T cell surface that recognizes the specific cancer cell, then activates T cells to kill it.
663
Why target PARP1, a DNA repair enzyme?
Prevents cancer cells from repairing DNA, then they die faster than normal cells.
664
BCL2 target rationale
Family of proteins on cell membrane surface that control membrane permeability and apoptosis. BCL2 is like a dam that holds back apoptotic protein activation in cancer cells. Inhibition leads to cell death.
665
Thalidomide cancer use:
Inhibits growth and differentiation of multiple myeloma cancer cells, angiogenesis inhibitor, T cell activation.
666
Proteasome inhibitor moa in cancer
Disrupts intracellular signaling cascades and leads to apoptosis.
667
Moa of CD-20 inhibitors
All B cells express this receptor, causes death of B cells, useful in lymphomas with B cell hyper differentiation.
668
CD-52 targeting moa
CD-52 is an antigen expressed on neutrophils, and all B and T cells. This causes cancer cell death via antibody flagging mechanisms.
669
CD-33 target MOA
Expressed on many hematopoetic cancer cells, once taken into cell, potent toxin bound to drug kills cell.
670
Can Linzess caps be opened?
Yes, sprinkle on applesauce or water.
671
How is Clindamycin - benzoyl peroxide gel stored in pharmacy. At home?
Fridge, then room temp for up to 10 weeks
672
Why Briviact vs levetiracetam?
Significantly less side effects
673
Why is it a breakthrough to have colony stimulating factors available for erythrocytes, granulocytes, and macrophages in cancer?
This enables use of higher dose chemo drugs and the CSF’s help prevent febrile neutropenia and other associated immunodeficiencies.
674
Why is histone deacetylase a cancer target?
Inhibiting this family of enzymes can lead to prevention of differentiation in cancer cells (turned off at the genetic level).
675
Prednisolone max daily dose for acute disease in kids under 12:
60 mg
676
Tamoxifen moa
Selective estrogen receptor modulator, reduces estrogen levels and treats breast cancer. Both agonizes and antagonizes estrogen receptor.
677
Steady state tamoxifen levels reached how long? Why?
3-4 weeks, long half life
678
4 Possible tamoxifen major toxicities (2 agonist, 2 antagonist):
Agonist: endometrial cancer and clots.
Antagonist: vasomotor symptoms and menstrual irregularities
679
Fulvestrant moa difference from tamoxifen:
estrogen receptor downregulator, no agonist activity or side effects.
680
Anastrozole moa
Aromatase inhibitor, lowers serum estrogen
681
Letrozole moa
Aromatase inhibitor
682
Aromatase inhibitors contraindication:
Use in premenopausal women with ovarian function
683
Beyond use date for long acting inhalers? Same as expiration date?
90 days from opening seal, no.
684
Aromatase inhibitor 4 common side effects
Vasomotor (hot flashes, night sweats, palpitations), arthralgia, BMD loss (and osteoporosis and fractures), vaginal dryness (dyspareunia)
685
Megestrol moa
Progesterone receptor agonist
686
Megestrol 8 common side effects
Weight gain, nausea, vomiting, edema, breakthrough bleeding, SOB, thrombophlebitis (clot associated with vein inflammation), pulmonary embolism
687
Medroxyprogesterone cancer use:
Endometrial and breast cancers
688
4 common medroxyprogesterone side effects:
Hot flashes, weight gain, depression, amenorrhea
689
Leuprolide moa and indications
Gonadotropin releasing hormone agonist: androgen deprivation in advanced prostate cancer and breast cancer (suppress estrogen and progesterone production)
690
Bicalutamide indication and moa
Non steroidal anti androgen in castration resistant prostate cancer.
691
Bicalutamide 7 common side effects
Sexual dysfunction, gynecomastia, fatigue, diarrhea, headache, muscle pain, vasomotor.
692
Perphenazine class and moa
1st gen antipsychotic, D2 antagonist
693
Abiraterone moa and indication
Inhibit sex hormone production, treatment of advanced prostate cancer
694
Counseling point with abiraterone
Take on empty stomach, food causes increased concentrations and toxicity
695
Stimulation of what ophthalmic adrenergic receptor causes mydriasis?
alpha 1
696
Stimulation of what ophthalmic cholinergic receptor causes miosis?
M3
697
Name 1 anesthetic eye drop
Tetracaine or proparacaine
698
Durezol indication and moa
Pain and inflammation. Glucocorticoid
699
Which 2 steroid creams are considered high potency?
Clobetasol and betamethasone propionate
700
Limit topical steroids to what duration?
2-3 weeks
701
Avoid concurrent application of topical retinoids with what? And why?
DEET, due to increased DEET absorption. (Separate by 30 minutes)
702
How to start topical retinoids to avoid skin irritation
Every other night administration
703
Retinoids have decreased activity in the presence of what 2 things?
Sunlight and BPO
704
Which to retinoids do not have decreased activity if exposed to the above things?
Adapalene and tazarotene
705
Pregnancy should be avoided for how long after stopping isotretinoin?
1 month
706
Pregnancy should be avoided for how long after stopping acitretin?
3 years
707
6 non skin side effects of isotretinoin:
Conjunctivitis, myalgia, arthralgia, epistaxis, decreased night vision, and hyperlipidemia
708
Calcipotriene indication
Psoriasis
709
TNF inhibitor moa in psoriasis (3)
Reduces inflammation, decreases keratinocyte proliferation, and decreases vascular adhesion
710
Calcipotriene moa
Vitamin d analog that slows production of skin cells
711
Calcipotriene potential side effect:
Kidney stones
712
Azelaic acid 3 moa’s and 2 indications
Prevents clogged pores (comedolytic), antibiotic, anti-inflammatory for acne and rosacea
713
Why use Clindamycin with benzoyl peroxide?
Prevent resistance and better efficacy
714
Avoid what topical med with dapsone?
Benzoyl peroxide (orange-brown staining of skin/hair)
715
Why is erythromycin used with BPO?
To avoid bacterial resistance and have greater efficacy
716
Sulfur skin moa
Keratolytic
717
Sulfacetamide with BPO counseling point
Orange brown staining of clothes, not skin
718
Can neosporin be used in a surgical wound?
Not typically
719
Mupirocin used against which 2 bugs?
Staph aureus and strep pyogenes
720
Can topical ivermectin be used for scabies?
No, oral only
721
Moa for ivermectin against scabies and lice
Binds glutamate-gated chloride channels, causing hyperpolarization of nerve or muscle cells
722
Lindane indications:
Scabies and lice
723
Malathion indication and moa
Head lice, acetylcholinesterase inhibitor (causing paralysis)
724
Permethrin indicated for as young as what age?
2 months
725
3 skin indications for dapsone:
Dermatitis herpetiformis (recurrent skin rash autoimmune), leprosy, neutrophilic dermatoses
726
Podofilox indication
Genital warts
727
Imiquimod moa and 3 indications
TLR-7 activator, inducing cytokines and upregulating immune response. Genital warts. Actinic keratoses, superficial basal cell carcinoma
728
Topical urea moa
Hydration, enhancing skin peeling
729
Topical sulfur moa in hyperkeratotic disorders
Breaks down keratin by binding with cysteine and reducing to hydrogen sulfide
730
Penicillamine indication
Copper poisoning
731
9Indication for deferoxamine, deferasirox, and deferiprone
Acute and chronic iron toxicity
732
How long before surgery Should sglt-2 inhibitors be stopped?
3 days
733
734
