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MNI Drugs > MNI DRUGS > Flashcards

MNI DRUGS Flashcards

1
Q

Isocarboxazid

A

MAO inhibitor

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2
Q

Phenelzine

A

MAO inhibitor

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3
Q

Tranylcypromine

A

MAO inhibitor

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4
Q

Selegiline

A

MAO inhibitor

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5
Q

Amitryptaline

A

TCA

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6
Q

Clomipramine

A

TCA

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7
Q

Desipramine

A

TCA

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8
Q

Imipramine

A

TCA

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9
Q

Nortriptyline

A

TCA

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10
Q

Citalopram

A

SSRI

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11
Q

Escitalopram

A

SSRI

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12
Q

Fluoxetine

A

SSRI

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13
Q

Fluvoxamine

A

SSRI

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14
Q

Paroxetine

A

SSRI

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15
Q

Sertraline

A

SSRI

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16
Q

Venlafaxine

A

SNRI

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17
Q

Duloxetine

A

SNRI

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18
Q

Bupropion

A

NDRI

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19
Q

Nefazodone

A

SARI

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20
Q

Trazodone

A

SARI

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21
Q

Mirtazapine

A

NASSA

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22
Q

Drug for bipolar disorder

A

Lithium

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23
Q

Alternative drug to Lithium antiepileptics

A

valproate and carbamazepine

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24
Q

Drug used for hypertension thought to increase depression. Depletes serotonin, norepinephrine and dopamine in rat brains

A

reserpine

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25
Q

Drug used for TB that is found to lift depression in chronically ill patients

A

Iproniazid and isoniazid

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26
Q

Signs of serotonin syndrome

A

hyperthermia, muscle rigidity, myoclonus

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27
Q

Treatment for serotonin syndrome

A

serotonin antagonist called cyproheptadine

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28
Q

Of the MAO inhibitors which does not react with foods?

A

Selegiline

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29
Q

What kinds of drugs are involved with depletion of tyramine break down in cheese products?

A

MAO inhibitors

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30
Q

Over the counter meds for cold contraindicated with MAOI if they contain

A

pseudoephedrine and phenylpropanolamine

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31
Q

Tricyclic antidepressant more selective for SERT

A

clomipramine

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32
Q

Tricyclic antidepressant more selective for NET

A

Desipramine and nortriptyline

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33
Q

Conduction block due to Tricyclic antidepressant can be treated with what?

A

Due to NA channel blockage, Arrhythmias due to this can be treated with sodium bicarbonate. which are the most common cause of death with these drugs

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34
Q

What is the drug of choice in treating depression?

A

SSRI

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35
Q

AE of SSRI

A

Excess serotonin causes GI upset, sexual dys, nausea,vomiting, serotonin syndrome when combined with MAOI

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36
Q

What drug is very dangerous to combine with MAOI

A

SSRI

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37
Q

What can an overdose of SSRI cause?

A

seizure

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38
Q

AE of Nefazodone

A

hepatotoxicity

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39
Q

AE of Trazadone

A

blocks alpha1 and H1 receptors/ very sedating, it is a hypnotic and can cause priapism.

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40
Q

What drugs are effected in treating depression where SSRI dont work?

A

SNRI- venlafaxine and duloxetine

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41
Q

What kinds of drug for depression inhibits norepinephrine and dopamine uptake?

A

bupoprion/ NDRI

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42
Q

What is the only drug not associated with sexual dysfunction

A

NDRI, bupoprion

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43
Q

AE of Bupoprion when overdosed?

A

seizures

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44
Q

What kind of drug is useful in a depressed patient with insomnia and agitation?

A

NASSA/ mirtazapine

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45
Q

What are the AE of mirtazapine

A

weight gain and sedation

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46
Q

antidepressant discontinuation syndrome can occur in drugs with short half lives what are these?

A

paroxitine (SSRI)

Venlafaxine (SNRI)

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47
Q

Antidepressant discontinuation syndrome is less likely in drugs with long half life such as…

A

fluoxetine (SSRI)

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48
Q

what enzyme does lithium inhibit?

A

inositol polyphosphatase and monophosphatase, blocks PIP2

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49
Q

AE of lithium

A

hypothyroidism, weight gain, nephrogenic diabetes insipidus, edema, dermatitis, alopecia, leukocytosis, can increase congenital anomalies in new borns,

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50
Q

What treats nephrogenic diabetes insipidus in patients on lithium?

A

amiloride, thiazides and NSAIDS

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51
Q

What is the DOC for Generalized anxiety?

A

antidepressants SSRI if not then SNRI ( venlafaxine is next), and TCA ( if didnt respond to other two)

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52
Q

What anxiety disorder can Benzos not be used alone for?

A

PTSD or OCD

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53
Q

How long does it take for antidepressants to work for GAD?

A

4-6 weeks, as a result you can give benzodiazepine in unison tapered.

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54
Q

What drug is used for acute management of GAD?

A

Benzodiazepines

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55
Q

Drug that acts as a second line for GAD does not cause dependacy/ withdrawal no alcohol potentiation or sedative hypnotic effects/ no psychomotor impairment, no dependency
Only used as anxiolytic

A

Buspirone

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56
Q

What are the DOC for panic disorders?

A

SSRI> TCA>MAOI

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57
Q

What is used to reduce an acute panic attack?

A

either Benzodiazepine alone or +SSRI

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58
Q

If patient has cormorbid depression plus panic disorder what is the rule?

A

only give an SSRI

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59
Q

In a patient with panic disorder what drug can cause rebound anxiety between doses and can cause withdrawal including seizures?

A

Alprazolam

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60
Q

what is the DOC for social anxiety?

A

SSRI

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61
Q

How long do SSRIs take to work in patients with social anxiety?

A

8-12 weeks

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62
Q

What are the DOC for OCD?

A

clomipramine, fluoxetine, fluoxamine, paroxetine, sertraline

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63
Q

If a patient with OCD has increased anxiousness what do you give plus their normal med?

A

benzodiazepine

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64
Q

DOC for PTSD?

A

SSRI ( sertraline)…. venlafaxine, MAOI and TCA work but bad effects.

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65
Q

What drugs do you give for acute treatment of PTSD?

A

sertraline and paroxitine

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66
Q

what treats performance anxiety?

A

propranolol/naldolol AE-hypotension

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67
Q

Overactivity of the mesolimbic pathway can cause

A

positive symptoms (midbrain to limbic system)

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68
Q

What decreases positive symptoms?

A

blockade of D2 in mesolimbic pathway.

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69
Q

Underactivity of the mesocortical pathway can cause

A

negative symptoms/ and cognitive symptoms ( blockade of D2 causes this).

projects from midbrain to prefrontal cortex

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70
Q

What pathway is associated with prolactin secretion?

A

Tuberoinfundibular:

projects from hypothalamus to anterior pituitary

dopamine released here inhibits prolactin

blocked dopamine ( increases prolactin)= galactorrhea

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71
Q

Blockade of D2 in the nigrostriatal pathway leads to

A

movement disorders/ extrapyramidal rxns

this is from substantial nigra to basal ganglia.

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72
Q

GABA’s primary directive is to fine tune

A

movement

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73
Q

5HT2 receptor stimulation causes

A

hallucinations

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74
Q

LSD and Mescaline are

A

5HT2 agonists that cause hallucinations

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75
Q

What are the classical antipsychotic drugs

A

Chlorpromazine, fluphenazine, haloperidol, thioridazine

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76
Q

What is the only classical antipsychotic drug that does not have “ zine”

A

haloperidol

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77
Q

What are the atypical antipsychotic drugs?

A

clozapine, respiradone, olanzapine, quetiapine, aripiprazole

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78
Q

what is the only drug of the atypical antipsychotics that doesn’t end in done or pine?

A

aripiprazole

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79
Q

What are the high potency antipsychotic drugs?

A

fluphenazine, haloperidol

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80
Q

What are the low potency antipsychotic drugs?

A

chlorpromazine and thioridazine

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81
Q

What is the job of classical antipsychotics?

A

they block the mesolimbic pathway ( block D2 receptors) to lessen + symptoms

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82
Q

What class of drugs treats negative psychotic symptoms ?

A

atypical antipsychotics

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83
Q

What is the job of atypical antipsychotics?

A

block multiple receptors and relieve of negative symptoms via the mesocortical pathway.

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84
Q

What are the receptors that clozapine has a high affinity for?

A

D1,D4, 5Ht2, muscarinic and alpha adrenergic receptors, also a D2 blocker

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85
Q

What atypical antipsychotic is more like to have EPR?

A

respiradone

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86
Q

What atypical antipsychotic is considered a partial agonist at D2 and 5HT1A receptor , but antagonist at 5HT2A?

A

Aripiprazole

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87
Q

The onset of an antipsychotic is how long? aka how long does it take to work?

A

less than 24 hours

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88
Q

Most antipsychotics are antiemetic except

A

aripiprazole and thioridazine

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89
Q

What antipsychotics experience the most extrapyramidal reactions?

A

the high D2 potency ones like Fluphenazine and Haloperidol (FHP).

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90
Q

What drugs are less likely to cause EPRs?

A

drugs with high anticholinergic activity like chlorpromazine and thioridazine and the atypicals

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91
Q

What are the EPRS?

A

Parkinsonism, dystonia, akathisia, tardive dyskynesia

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92
Q

What can treat Parkinsonism?

A

antimuscarinics such as benztropine and trihexyphenidyl, with diphenhydramine or amantadine NO LEVODOPA

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93
Q

what can treat dystonia ( involuntary muscle contractions)?

A

Treated with benztropine, trihexyphenidyl, diphenhydramine

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94
Q

What can treat Akathisia ( need to be in constant motion?

A

first change dosage of antipsychotic or the actual drug, clonazepam or propranolol

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95
Q

What can treat Tardive Diskynesia ? ( facial tics, late occurring choreoatheroid movements)

A

first change dosage of antipsychotic or the actual drug, tetrabenazine or valbenazine they inhibit VMAT
can also use Benzos…

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96
Q

For patiesnt who require antipsychotics and have tardive diskynesia what do you give ?

A

clozapine

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97
Q

Sedation is an AE of what kind of antipsychotic?

A

low potency classical or atypical drug

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98
Q

What clinically characterizes Neuroleptic Malignant Syndrome an AE of antipsychotics ?

A

Rare, life threatening rigidity, tremor, hyperthermia, altered mental status, autonomic instability, increased WBC, increased CK and myoglobinemia with potential nephrotoxicity. myoglobinemia is usually what kills people

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99
Q

What treats Neuroleptic malignant syndrome?

A

Dantrolene and bromocriptine

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100
Q

What is the AE of clozapine?

A

causes agranulocytosis

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101
Q

what drug causes a high incidence of QTc and T wave changes and rarely produce ventricular arrhythmias and sudden death?

A

thioridazine

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102
Q

Patient is female and has amenorrhea, galactorrhea syndrome and infertility what kind of antipsychotic drug is this patient most likely taking?

A

classical antipsychotic

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103
Q

Male has loss of libido, fertility and potency what antipsychotic drug is he likely taking?

A

a classical antipsychotic

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104
Q

What antipsychotic drug causes deposits in cornea and lens?

A

chlorpromazine

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105
Q

what antipsychotic drug causes retinal deposits?

A

thioridazine

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106
Q

What kind of antipsychotic drugs have the most metabolic effects such as type 2 diabetes, weight gain, hypertension, hyperlipidemia?

A

atypical agents… on chart aripiprazole had this the least

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107
Q

what are non-psychiatric reasons to take an antipsychotic?

A

nausea and vomiting, combined with fentanyl in neuroleptic anesthesia

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108
Q

Which involves more CNS effects? hypnosis or sedation?

A

hypnosis

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109
Q

Gaba is a ______ neurotransmitter of the CNS?

A

inhibitory

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110
Q

Where does GABA bind to on the Gaba receptor?

A

between alpha and beta subunits

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111
Q

Where do Benzodiazepines bind on the Gaba receptor?

A

between alpha and gamma subunits (BZ1 and BZ2)

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112
Q

What forms of anxiolytic drugs are positive allosteric modulators of GABA A receptors?

A

They increase GABA and increase CL

Benzodiazepines, Barbiturates, and Non-Benzodiazepine benzodiazepine receptor agonists= Z drugs

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113
Q

What are the functions of benzodiazepines ?

A

they reduce anxiety, sedative and hypnotic, anticonvulsant, and muscle relaxant

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114
Q

What is the onset for benzodiazepines?

A

30 min to an hour, because they are lipophillic and completely absorbed

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115
Q

Cl channels open more FREQUENTLY IN what allosteric modulator of Gaba A receptors?

A

Benzodiazepines

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116
Q

Cl channels open for more DURATION in what allosteric modulator of Gaba A receptors?

A

Barbiturates

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117
Q

What are the Long acting benzodiazepines?

A

FCD ALOT MT

FCD: Flurazepam, Clonazepam, Diazepam,

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118
Q

What are the intermediate acting Benzodiazepines?

A

ALOT: Alprazolam, Lorazepam, Oxazepam, Temazepam

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119
Q

What are the short acting Benzodiazepines?

A

MT: Midazolam, Triazolam

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120
Q

Benzodiazepines and Barbiturates are ________ dependent

A

dose

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121
Q

Most Benzos undergo phase I reactions by

A

CYP3A4 they are later conjugated into glucoronides and urinated.

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122
Q

_______is an active metabolite of clinical Benzos and is metabolized to oxazepam

A

Desmethyldiazepam

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123
Q

What benzodiazepine drugs are conjugated directly and not metabolized by P450 system?

A

Lorazepam, Oxazepam, Temazepam (LOT)

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124
Q

What benzodiazepine has a half life of 30-100 hours ?

A

Flurazepam ( long acting) and is metabolize by the liver.

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125
Q

What Benzodiazepine/ anxiolytic drug can treat skeletal muscle spasms, spacity from degenerative disorders like MS and cerebral palsy?

A

diazepam

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126
Q

What anxiolytic drug/ Benzodiazepine can treat most seizures?

A

clonazepam

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127
Q

what anxiolytic drug/ Benzodiazepine can treat status epilipticus ?

A

Midazolam, lorazepam, diazepam

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128
Q

What is the DOC for alcohol withdrawal?

A

Benzodiazepines

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129
Q

What anxiolytic drug/ Benzodiazepine can treat sleep disorders?

A

Temazepam- intermediate acting

triazolam- short acting

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130
Q

What are the adverse effects of Benzodiazepines?

A

Drowsiness and confusion, ataxia, cognitive impairment, psych effects: ( paradoxical/anxiety), irritability, hostility, rage, paranoia, depression, suicidal ideation, dependence ( no coma or death)

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131
Q

what is withdrawal like after benzodiazepines?

A

confusion, anxiety, agitation, restlessness, insomnia, tension

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132
Q

Name a Benzodiazepine antagonist

A

Flumazenil

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133
Q

Flumazenil can block the effects of what drugs?

A

benzodiazepines and Z drugs: reverses the CNS depressant effects of Benzo overdose also for recovery of benzodiazepines as an anesthetic. This drug can precipitate withdrawals and cause seizures

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134
Q

If flumazenil is not working on Benzo overdose patient, what do you do?

A

apply more drug because it has a short half life

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135
Q

What is the MOA of barbiturates?

A

activates CL independent of GABA, they block glutamate receptors and inhibit voltage gated sodium and calcium channels. this is the reason for their general anesthetic and CNS depression effects…

1- sedation/hypnosis 2- anesthesia 3- depress respirations and suppress hypoxic chemoreceptor response to CO2= death

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136
Q

what are the AE of Barbiturates?

A

Drowsiness, impaired concentration, paradoxical excitement, hypersensitivity, hang over, pulmonary depression, worsened pain perception, dependence withdrawal and poisoning to CV and resp

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137
Q

What drugs are the Non-Benzodiazepine Benzodiazepine receptor agonists?

A

Z drugs: zolpidem, Zaleplon, Eszoplicon

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138
Q

What drug is only approved as a hypnotic and only acts on BZ1 receptor subtype, no muscle relaxing, or anticonvulsant effects… ?

A

Z drugs

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139
Q

what Z drug is used for short term treatment of insomnia characterized by issues of sleep onset?

A

Zolpidem ( short acting)

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140
Q

Which is an ultrashort acting Z drug?

A

zaleplon

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141
Q

which z drug as the shortest half life?

A

zaleplon ( 20 min) others are 30 min

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142
Q

What drug is a 5HT1A partial agonist?

A

buspirone

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143
Q

What drug has no hypnotic, anticonvulsant or muscle relaxant properties, it is ONLY an ANXIOLYTIC?

A

Buspirone

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144
Q

What is the onset time for buspirone?

A

2-3 weeks

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145
Q

What drug is a melatonin agonist (MT1 and MT2)?

A

Ramelteon

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146
Q

what does Ramelteon treat?

A

insomnia with difficulties at sleep onset. can be given long term.

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147
Q

What are the AE of Ramelteon?

A

dizziness, somnolence, fatigue, endocrine changes, decrease in testosterone, increase in prolactin

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148
Q

What drugs are Orexin receptor antagonist?

A

Suvorexant, and Lemborexant

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149
Q

What do Orexin A and B do?

A

promote wakefulness by activating the OX1 and OX2 receptors.

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150
Q

What is the function of Suvorexant/ Lemborexant ( Orexin Receptor antagonists)?

A

treat insomnia, promote sleepiness in onset or maintenance

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151
Q

Adverse effects of Orexin receptor antagonist ?

A

daytime somnolence and worsening of depression, suicidal ideation.. contraindicated in narcolepsy

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152
Q

A TCA used to treat insomnia characterized by sleep maintenance. The antagonist of the H1 receptor is responsible for the sedation.

A

Doxepin

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153
Q

Antihistamine with antiemetic activity approved for symptomatic relief of anxiety

A

hydroxazine

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154
Q

Nonprescription antihistamine with sedating properties used to treat mild types of insomnia

A

diphenhydramine and doxylamine

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155
Q

What treats tyramine induced hypertension ?

A

phentolamine and prazosin

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156
Q

What is the clinical presentation for the Cheese Reaction?

A

tachycardia, seizures, stroke, arrhythmias and hypertension

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157
Q

What are the main clinical effects of Parkinson’s ?

A

Resting Tremor, Muscular Rigidity, Bradykinesia, Gait imparment

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158
Q

what amino acid does Dopamine comes from_______

A

tyrosine

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159
Q

In Parkinson there is a loss of neurons in ______ pathway

A

the dopaminergic nigrostriatal pathway

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160
Q

D1 receptors ________ adenylyl cyclase

A

increases

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161
Q

D2 receptors ______ adenylyl cyclase, ____ K conductance, ______ Ca conductance

A

decrease, increase, decrease

most anti-parkinson drugs work at the D2 receptors

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162
Q

This drug for Parkinsons restores dopamine levels in the extrapyramidal centers. It uses residual dopaminergic neurons during early disease from substantia nigra….

A

Levodopa

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163
Q

Levodopa crosses the BBB what enzyme turns it into dopamine there?

A

Dopa decarboxylase

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164
Q

______ delays appearance of levodopa in plasma

A

food

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165
Q

When Levodopa is converted by dopa decarboxylase at the periphery, what are the AE?

A

nausea, vomiting, cardiac arrythmias hypotension

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166
Q

What Parkinson’s drug is a Dopa decarboxylase inhibitor?

A

Carbidopa

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167
Q

What is the function of carbidopa?

A

given simultaneously to levodopa, increases availability of levodopa to CNS by decreasing metabolism of it in GI tract and peripheral tissues.

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168
Q

Sinemet

A

Levodopa plus carbidopa

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169
Q

When does the Sinemet ( levodopa+ carbidopa) combo decline in response?

A

during 3rd to 5th year of therapy. this concoction does not stop the progression of PD

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170
Q

What are the contraindications of Levodopa?

A

Vit B6 ( cofactor for dopa decarboxylase which will increase peripheral metabolism), nonspecific MAOI can present hypertensive crisis, psychotic patients, people with angle closure glaucoma, cardiac patients at risk of arrythmias, Avoid taking antipsychotics, admin with hypertensive will increase risk of orthostatic hypotension, active peptic ulcer due to risk of GI bleeding on levodopa

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171
Q

What is the ergot dopamine agonist for Parkinson’s?

A

Bromocriptine, a D2 agonist that is barely used

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172
Q

_________ drugs do not depend on nigrostriatal neurons, and dont need enzymatic conversion for activity

A

dopamine receptor agonists

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173
Q

What are the non-Ergot dopamine agonists for PD?

A

pramipexole, Ropinirole, Rotigotine

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174
Q

What drugs are commonly used for initial treatment of younger patients with PD?

A

Non-ergot dopamine agonist, pramipexole, and ropinirole

These are less effective in treating motor symptoms of PD, they are less likely to cause motor fluctuations or dyskinesia

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175
Q

What Parkinson drug is transdermal once daily use?

A

Rotigotine

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176
Q

What is a common side of effect of Dopamine receptor antagonist?

A

compulsive behaviors (ICD)

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177
Q

What Parkinson drugs will cause nasal congestion, headache, increased arousal, pulmonary infiltrations, pleural and retroperitoneal fibrosis and erythromelalgia?

A

Bromocriptine/ ergot dopamine agonist

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178
Q

what are the AE of the non-ergot dopamine agonists?

A

uncontrollable somnolence.

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179
Q

What are the contraindications of dopamine receptor agonists?

A

antipsychotics, CNS depressants ( increase risk of somnolence and confusion), psychotic illness, recent MI, active peptic ulcer.

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180
Q

What drug is used as rescue therapy and is a non-ergot dopamine agonist? what drug must be used together with it and why?

A

apomorphine is an emetogenic, and you need an anti- emetic together with it like trimethobenzamide

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181
Q

Drug used for rescue therapy treatment of off episodes of akinesia on patients on dopaminergic therapy

A

apomorphine

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182
Q

What are the AE of apomorphine

A

Qt prolongation, dyskinesia, drowsiness, sweating, hypotension

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183
Q

What are the inhibitors of dopamine metabolism?

A

MAO I and COMT I

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184
Q

what are the two MAO I used in the treatment of PD?

A

selegiline and rasagiline

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185
Q

this drug selectively and irreversible inhibits MAOB ( which metabolizes dopamine) it slows breakdown of dopamine in the brain and can get you to lower the levodopa dose, it enhances the effects of levodopa, used as an adjunct to levodopa

A

Selegiline

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186
Q

what PD drug is metabolized to methamphetamine and Beta amphetamine?

A

selegiline

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187
Q

If you take selegiline for PD and you tae it too late in the day what may happen?

A

insomnia

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188
Q

What MAOB inhibitor is approved for PD besides selegiline?

A

rasagiline

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189
Q

MAO-B inhibitor drug plus serotonergic drug can cause what?

A

serotonin syndrome and hypertensive crisis if taken within 14 days together

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190
Q

Concomitant use of MAO B and sympathomimetic can cause…?

A

severe hypertension

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191
Q

When dopa decarboxylase is inhibited what is increased ?

A

3-0-methyldopa which competes with levodopa for a carrier that transports across intestinal mucosa and BBB

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192
Q

Tolcapone and entacapone are _________

A

COMT inhibitors

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193
Q

What is the action of COMT inhibitors?

A

inhibit comt, allow for decreased metabolism of levodopa and decreased of 3-o methyldopa, increases uptake of levodopa, and increases dopamine levels in the Brain

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194
Q

What is the AE Tolcapone?

A

Fulminating hepatic necrosis

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195
Q

Does tolcapone or entacapone cross BBB?

A

Tolcapone does, for this reason entacapone is preferred drug because it is only at the periphery. this drug is concocted with levodopa and carbidopa and sold as fixed dose.

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196
Q

An antiviral drug used for PD that may increase dopamine release and inhibit dopamine reuptake

A

amantadine

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197
Q

What Parkinson Drug is a NDMA antagonist?

A

Amantadine

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198
Q

what are the AE if amantadine?

A

restlessness, confusion agitation, hallucination, ACUTE TOXIC PSYCHOSIS, peripheral edema, orthostatic hypotension, HF

Use with caution with patient with hx of seizure and HF.

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199
Q

What drug has a risk of Livedo reticularis?

A

Amantadine

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200
Q

What antimuscarinc drugs can be used in PD to treat tremor and rigidity?

A

Benztropine and trihexyphenidyl.
- also work for drooling
these drugs have sympathetic AE.

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201
Q

Who is contraindicated with antimuscarinic drugs like benztropine and trihexyphenidl for PD?

A

glaucoma pts, prostatic hypertrophy, pyloric stenosis.

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202
Q

The excessive self administration of any substance for nonmedical purposes

A

abuse , hallucinogens are drugs of abuse that do not lead to addiction

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203
Q

impaired control over drug use, compulsive use, continued use despite harm

A

addiction

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204
Q

What can cause drug withdrawal?

A

Abrupt cessation, rapid dose reduction, admin of antagonist

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205
Q

What is the prime target of addictive drugs?

A

mesolimbic dopamine system

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206
Q

Drugs that inhibit Gaba and as a result increase dopamine are

A

Opioids, Cannabinoids, benzodiazepines, ethanol

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207
Q

Drugs that directly stimulate dopaminergic neurons

A

nicotine and ethanol

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208
Q

Drugs that block or reverse DAT

A

cocaine, amphetamines, MDMA

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209
Q

What are the CNS depressants?

A

ethanol, benzodiazepines, barbiturates

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210
Q

Whaty does ethanol cause that makes it a depressant?

A

it produces sedation and sleep

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211
Q

Channels influenced by alcohol

A

Gabaa receptor, Kir3/ GIRK channels, Adenosine reuptake, Glycine receptors, NMDA receptors, 5HT3 receptors

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212
Q

Withdrawal associated with tremor, nausea, vomiting, sweating agitation and anxiety followed by hallucinations and seizures 24-48 hours later and then DELIRIUM TREMENS 48-72 hours later. Characterizes withdrawal from what substance?

A

ethanol

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213
Q

How many hours till delirium tremens kicks in in an alcoholic?

A

48-72 hours

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214
Q

What are the agents used to treat alcohol WITHDRAWAL?

A

long acting benzo, Diazepam and chlordiazepoxide

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215
Q

If you have an elderly patient undergoing withdrawal from alcohol or someone with liver failure what would you prescribe?

A

intermediate acting benzo lorazepam and oxazepam

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216
Q

What drugs are used to treat alcohol addiction?

A

Disulfram, naltrexone, acamprostate

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217
Q

What drug is an inhibitor of aldehyde dehydrogenase?

A

disulfiram. It creates an aversion to drinking.

doesnt allow for conversion of atetalaldehyde to acetate

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218
Q

PT takes a tablet that gives them an aversion to alcohol because they experience nausea, headache, flushing, and hypotension as a result of it. what drug is it?

A

disulfiram

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219
Q

What drug that is a treatment of alcohol addiction is considered an opioid antagonist?

A

naltrexone

it antagonizes the release of U receptor from the endogenous opioids set out by alcohol that releases dopamine

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220
Q

what drug reduces cravings for alcohol and decreases relapse to heavy drinking?

A

naltrexone

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221
Q

What alcohol treatment drug works by blocking a hyperglutamatergic state in the alcoholic brain?

A

acamprostate

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222
Q

what drug of alcohol treatment of addiction is an NMDA receptor antagonist?

A

acamprostate, it prevents relapse of drinking

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223
Q

what treatment of alcohol addiction prevents relapse drinking?

A

acamprostate

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224
Q

What drug facilitates Gaba function in alcohol addiction, antagonizes glutamate and may reduce cravings but is not approved by the FDA?

A

Topiramate

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225
Q

Withdrawal of what drug causes tremors, anxiety, perceptual disturbances, dysphoria, psychosis, and seizures? can be life threatening

A

Benzodiazepines

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226
Q

How do you manage withdrawal of benzodiazepine?

A

if the pt is on a short acting drug, you give them a long acting drug. Diazepam is the most used, then the dose is gradually reduced

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227
Q

What are the psychostimulants?

A

methylxanthines, cocaine, ampthetamines

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228
Q

Methylxanthines include:

A

Caffeine, theophylline, and theobromine

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229
Q

What is the mechanism of Methylxanthines (ex caffeine) ?

A

Block presynaptic adenosine receptors

activation of adenosine receptors inhibits norepinephrine release, blocking them increases norepinephrine

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230
Q

100-200 mg of coffee/ 1-2 cups per day

A

decrease in fatigue and increased mental alertness

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231
Q

1.5g 12-15 cups of coffee

A

anxiety and tremors

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232
Q

2-5g of caffeine

A

spinal cord stimulated

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233
Q

What is the withdrawal effect of methylxanthines?

A

fatigue and sedation.

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234
Q

Cocaine and amphetamines are considered schedule ______ drugs by DEA

A

II

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235
Q

_______ inhibits dopamine, norepinephrine and serotonin reuptake

A

cocaine

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236
Q

what causes the euphoria of cocaine

A

prolongation of dopaminergic effects in the brains limbic system

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237
Q

This drug acts by stimulating the cortex and brainstorm. It increases mental awareness and produces a feeling of well being and euphoria. Paranoia occurs after repeated doses.
At high doses: tremors, convulsions, followed by respiratory and vasomotor depression

A

Cocaine

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238
Q

What drug potentiates adrenergic stimulation peripherally ?

A

Cocaine

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239
Q

Patient undergoes withdrawal from a drug and has the following symptoms: dysphoria, depression, sleepiness, fatigue, craving the drug, bradycardia,

A

Cocaine

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240
Q

What drugs have been tested as treatment for cocaine abuse ?

A

Antidepressants and dopamine agonists: none have demonstrated clear efficacy

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241
Q

This drug increases release of catecholamines, are weak inhibitors of MAO, and are direct catechilaminergic agonists in the brain

A

Amphetamines

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242
Q

Amphetamines are taken up into neurons by _______. Once in the neuron, amphetamines interfere with _____ depleting synaptic vesicles

A

amine transporters.

VMAT

Levels of dopamine in the cytoplasm increase and are released into the synapse by reversal of the DAT.

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243
Q

What are the uses of amphetamine?

A

attention deficit syndrome ( amphetamine and methylphenidate), narcolepsy ( amphetamine and methylphenidate)

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244
Q

What drug experiences these withdrawal signs? increased appetite, sleepiness, exhaustion, and mental depression

A

Amphetamines and antidepressants are given

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245
Q

Amphetamine normally causes

A

increased alertness, decreased fatigue, depressed appetite and insomnia

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246
Q

The rewarding effects of nicotine requires involvement of the ____________ area where nicotinic receptors are expressed on dopamine neurons

A

ventral tegmental area

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247
Q

what drug is a full agonist of the nicotine receptor?

A

nicotine

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248
Q

IN low doses what does nicotine cause?

A

ganglionic stimulation by depolarization- causes euphoria and relaxation, improves attention learning, problem solving and reaction time

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249
Q

in high doses what does nicotine cause?

A

ganglionic blockade- central respiratory paralysis and severe hypotension caused by medullary paralysis
nicotine is an appetite suppressant

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250
Q

What does nicotine withdrawal consist of?

A

irritability and sleepiness

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251
Q

what drug is a partial agonist at nicotinic receptors in the CNS and reduces the reward of smoking?

A

Varenicline and buproprion

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252
Q

what are the opioid drugs?

A

heroin, morphine, codeine, oxycodone

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253
Q

Patient is withdrawing like this: dysphoria, lacrimation, rhinorrhea, and yawning. What drug was it?

A

opioid… the withdrawal is actually not life threatening

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254
Q

How do you treat opioid withdrawal with the use of an opioid agonist? what drugs are used?

A

you give an opioid agonist and slowly reduce it.

Methadone and buprenorphine

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255
Q

What drug is useful for detoxification and maintenance of the chronic relapsing heroin addict?

A

methadone

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256
Q

How do you treat opioid withdrawal with the use of an opioid antagonist? what drugs are used?

A

Naltrexone…. high affinity for u opioid receptor. this drug will not satisfy a craving or relieve the withdrawal symptoms. Naltrexone can be used after detox for patient with high motivation to remain opioid free

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257
Q

Marijuana has two receptor subtypes CB1 and CB2. both are G protein linked receptors and couple to Gi. where are each found?

A

CB1- in the brain and mediate psychological effects of THC ( receptor at Gabaergic neurons in the ventral tegmental area)
CB2- present mainly on immune cells

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258
Q

Binding of THC to CB1 receptors ______ gaba release

A

decreases…. this decrease of Gaba release disinhibits dopaminergic neurons resulting in increased dopamine release

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259
Q

What drug can produce euphoria, followed by drowsiness and relaxation. affects the short term memory and mental activity. causes impairment of highly skilled motor activity.

other: appetite stimulation, xerostomia, visual hallucinations, delusions, enhancement of sensory activity. At high doses- toxic psychosis

A

marijuana

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260
Q

what occurs at high doses of marijuana?

A

toxic psychosis

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261
Q

what are the 3 cannabinoids approved by the FDA for medical use?

A

nabilone, dronabinol, Cannabidiol (CBD)

Dronabinol is the synthetic form of THC.
Nabilone is a synthetic derivative of THC.

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262
Q

What form of marijuana is approved for nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond to conventional antiemetic treatments ?

A

Dronabinol and nabilone

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263
Q

What Marijuana based drug is approved for anorexia associated with weight loss in patients with AIDS?

A

Dronabinol

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264
Q

What marijuana based product is approved for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex

A

CBD

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265
Q

What are the psychedelic agents?

A

LSD, Mescaline, Psilocybin, Phenciclidine, MDMA

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266
Q

What drugs affect thought, perception and mood and do not cause marked psychomotor stimulation or depression?

A

psychedelic agents

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267
Q

what is the mechanism of LSD?

A

agonist at 5HT2 receptors in CNS

268
Q

patients on _____ experience somatic + psychomimmetic effects such as

Somatic: mydriasis, hypertension, tachycardia, increased body temperature, flushing, sweating, tremors, and piloerection

A

LSD

269
Q

______ does not cause addiction or withdrawal

A

LSD

270
Q

Severe agitation due to LSD can be treated with

A

diazepam

271
Q

What drug is a dissociative anesthetic?

A

PCP: phencyclidine, blocks reuptake of norepinephrine and dopamine it causes both cholinergic and anticholinergic effects.

272
Q

What drug has actions at nicotinic receptors and opioid receptors?

A

PCP phencyclidine

273
Q

The dissociative properties of PCP are thought to come from __________

A

non-competitive antagonism at NMDA receptors

274
Q

Patient presents with violent, bizarre behavior, psychosis, NYSTAGMUS, tachycardia, hypertension, diaphoresis, mitosis, anesthesia, and analgesia

A

PCP use… nystagmus and both adrenergic and muscarinic symptoms

275
Q

There is no antidote for PCP but how do we treat violent psychotic behavior and seizures?

A

with benzodiazepine

276
Q

what drug fosters empathy and intimacy without impairing intellectual capacities?

A

MDMA ecstasy

277
Q

What drug causes withdrawal that can cause depression for several weeks and why?

A

MDMA ecstasy. because initially it increases the concentration of serotonin in the synaptic cleft. it degenerates the neurons long term

278
Q

What are the inhalants?

A

nitrous oxide, volatile organic solvents, and organic nitrites

279
Q

What drug produces euphoria, analgesia and then loss of consciousness?

A

nitrous oxide

280
Q

100% N2O can cause__________

A

asphyxia and death

281
Q

What drug produces a sense of exhilaration and light headednesss?

A

volatile organic solvents: gasoline, paint thinner, lighter fluid, glue and degreaser

282
Q

What kinds of drugs are implicated in cancer, cardiotoxicity, neuropathy, and hepatotoxicity?

A

volatile organic solvents

283
Q

______ and ________ are organic nitrites used to enhance erection

A

amyl nitrite and butyl nitrite

284
Q

What are the entry and fusion inhibitors of the antiretrovirals?

A

Maraviroc and enfuvirtide

285
Q

This oral antiretroviral binds to CCR5 which is the core receptor necessary to enter CD4 T cells by HIV/ CCR5 antagonist

A

Maraviroc

286
Q

Hepatotoxicity is an AE of what antiretroviral drug?

A

Maraviroc

287
Q

What antiretroviral is structurally similar to gp41, an HIV protein that mediates membrane fusion.

A

enfuvirtide

288
Q

What HIV antiretroviral drug is a fusion inhibitor?

A

enfuvirtide ( given parentally)

289
Q

What drug is used for treatment experience adults with evidence of HIV replication?

A

Enfuvirtide ( structurally similar to gp41)

290
Q

What HIV is enfuvirtide not active against?

A

HIV-2

291
Q

What antiretroviral drug has AE of injection related hypersensitivity and eosinophilia?

A

Enfuvirtide

292
Q

What kind of drug is Stavudine, zidovudine, emtrictabine, lamivudine, didanosine, abacavir and tenofovir?

A

Nucleoside/nucleotide reverse transcriptase inhibitors

293
Q

the Nucleoside/nucleotide reverse transcriptase inhibitors are ______ inhibitors of reverse transcriptase

A

competitive

294
Q

What is the mechanism of Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)?

A

drug is phosphorylated by enzymes and incorporated into viral DNA by reverse transcriptase. They lack 3’OH so terminate DNA elongation.

295
Q

What DNA process do Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) inhibit?

A

terminate DNA elongation

296
Q

What are the Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) used for?

A

HIVI and HIV2

297
Q

what drugs cause AE of peripheral neurophathy, myopathy, lipoatrophy, INHIBITS MITOCHONDRIAL DNA polymerase,
pancreatitis, myelosuppression, and cardiomyopathy

A

NRTI
nucleoside/ nucleotide Reverse transcriptase inhibitors.

Stavudine, zidovudine, emtrictabine, lamivudine, didanosine, abacavir and tenofovir

298
Q

What are the specific AE of stavudine and zidovudine?

A

dyslipidemia and insulin resistance

299
Q

Stavudine is an ______ and an _____ analog

A

NRTI and a thymidine analog

300
Q

_______ is an NRTI that is a strong inhibitor of Beta and Gamma DNA polymerase..

A

Stavudine …

has a high affinity to mitochondrial DNA polymerase- can cause toxicity

301
Q

Cant mix stavudine ( NRTI) with what drug?

A

didanosine

302
Q

______ is an NRTI that is a adenosine analog and the only one that is a nucleotide

A

Tenofovir

303
Q

What NRTI has the AE of GI upset likely in lactose intolerant patients

A

Tenofovir

304
Q

what are the drug interactions of tenofovir?

A

increases didanosine concentration so need to reduce the dosage of it
decreases Atazanavit concentration so need to boost with Ritonavir

305
Q

what is the other use of tenofovir besides HIV I and HIV II?

A

hep B

306
Q

what is the drug that can be used as antiretroviral for pregnancy, labor, post party, and post exposure prophylaxis for infants of HIV, also reduces vertical transmission….

A

Zidovudine ( thymidine analog)

307
Q

What are the AE of Zidovudine?

A

Neutropenia, macrocytic anemia, lipoatrophy

308
Q

what drug cannot be given with zidovudine?

A

stavudine

309
Q

what NRTI is a cytosine analog and does not affect mitochondrial DNA synthesis or bone marrow percursors?

A

Lamivudine

310
Q

NRTI with AE of dry mouth and headache?

A

lamivudine ( no lame)

311
Q

what other thing can Lamivudine be used for besides HIV?

A

Hep B

312
Q

what NRTI drugs can be used against HEP B?

A

lamivudine or tenofovir

313
Q

What NRTI causes hyperpigmentation of palms and soles?

A

Emtricitabine ( cytosine analog) a preferred drug

314
Q

What antiretroviral drug is not recommended due to toxic dosing?

A

didanosine

pancreatitis, peripheral neuropathy

315
Q

what NRTI is a guanosine analog?

A

abacavir

316
Q

What NRTI is contraindicated if patient has HLAB5701 mutation?

A

Abacavir

317
Q

Rilpivirine, Efavirinz, nevirapine are examples of what kinds of antivirals? (VIR)

A

Non-nucleotide Reverse transcriptase inhibitors (

318
Q

AE of abacavir?

A

hypersensitivity

319
Q

What drugs are considered NONCOMPETITIVE inhibitors of reverse transcriptase?

A

non-nucleotide reverse transcriptase inhibitors (NNRTI)
rilpivirine, Efavirinz, nevirapine
They dont require phosphorylation by cellular enzymes like NRTI do

320
Q

What antiviral medication does CHAIN TERMINATION by binding to distinct site away from the active site?

A

NNRTIs (non-nucleotide reverse transcriptase inhibitors)
They inhibit DNA and RNA polymerase
rilpivirine, Efavirinz, nevirapine

321
Q

NNRTIs are used for _______ only

A

HIV I ( lacks in vitro activity for HIV-2)

322
Q

What is the AE for NNRTI?

A

skin rash ( Steven Johnson syndrome, toxic epidermal necrolysis)

323
Q

what is the advantage/disadvantage of NNRTI over NRTI?

A

Good: lack of effect on host’s blood… lack of cross resistance with NRTI as binding sites are different

Bad: cross-resistance with NNRTI
drug interaction
high chance of hypersensitivity

324
Q

what is an NNRTI recommended for pregnancy?

A

Rilpivirine

325
Q

What is a special AE besides rash that Rilpivirine has?

A

QT prolongation

326
Q

What are AE of efavirenz?

A 
CNS toxicity ( dizziness, drowsy, insomnia, nightmares, vivid dreams, headaches)
psychiatric ( depression, mania, psychosis)

Increased triglycerides, HDL total cholesterol

also TERATOGENIC

327
Q

What NNRTI causes severe hepatotoxicity? what are the rules?

A

Nevirapine
dont use in women with CD4 of > 250 and in males >400

14 day titration period at 1/2 dose to reduce serious epidermal rxn

328
Q

what NNRTI is ONLY used for post-exposure prophylaxis of high-risk infants born to HIV infected mothers?

A

Nevirapine

329
Q

Bictegravir, Raltegravir, elvitegravir, Dolutegravir are what kinds of drugs? mechanism?

A

integrase inhibitors

bind to intergrade which Is necessary for integration of viral DNA into host DNA. so they stop the final step of integration.

330
Q

What integrate inhibitor is taken with food?

A

elvitegravir

331
Q

All the integrate inhibitors cause GI upset and rash but two cause elevated CPK and rhabdomyolysis what are they?

A

raltegravir and dolutegravir

332
Q

Which integrate inhibitor requires PK enhancer?

A

elvitegravir

333
Q

used to be thought to give Neural tube defects, now shows it doesn’t what integrate inhibitor is it?

A

dolutegravir

334
Q

What are the antiviral protease inhibitors?

A

Lopinavir, indinavir, nelfinavir, darunavir, atazanavir “navir”

335
Q

What kinds of drugs inhibit HIV aspartyl protease reversibly?

A

protease inhibitors: Lopinavir, indinavir, nelfinavir, darunavir, atazanavir “navir”
- require PK enhancers and have a high potential for drug interactions
“ that was the enzyme responsible for cleavage of viral poly proteins into RT, protease, and integrase

336
Q

do protease inhibitors require phosphorylation?

A

no

337
Q

Protease inhibitors are active against

A

HIV-1 and HIV-2

338
Q

What drugs inhibit maturation and virion release?

A

protease inhibitors

339
Q

High fat meals cause what reaction to Nelfinavir or Indinavir?

A

Nelfinavir is increased in bioavailability

and Indinavir is decreased in bioavailability.

340
Q

Pt has signs of buffalo hump, facial and peripheral wasting, central obesity, breast enlargement…. what occurred and what drug is this an AE for?

A

Cushing syndrome brought upon by protease inhibitors. ( navirs).

341
Q

What are the AE in Indinavir?

A

unconjugated hyperbillirubinemia, and nephrolithiasis

342
Q

what are the AE for Darunavir?

A

sulfa alergy

343
Q

What are the AE for atazanavir?

A

not associated with dyslipidemia and hyperglycemia…..

PR prolongation. ( ataque)

344
Q

what protease inhibitor is recommended for pregnancy?

A

atazanavir

345
Q

what are the antiviral pharmokinetic enhancers?

A

Cobicistat and ritonavir

346
Q

Cobicistat and ritonavir inhibit CYP_____ to increase ______/

A

CYP3A4, antiretroviral in plasma

347
Q

what drug is used in combination with protease inhibitors but not nelfinazir?

A

ritonavir

348
Q

______ is used in combo with elvitegravir, darunavir, atazanavir

A

Cobicistat

349
Q

PreP ( pre-exposure prophylaxis) is a combination of what two drugs?

A

Emtricitabine and tenofovir

350
Q

Post exposure prophylaxis contains what drugs?

A

Emtricitabine, tenofovir, INSTI or PI
- Dolutegravir + tenofovir + emtricitabine
- Raltegravir + tenofovir + emtricitabine
28 day regimen til pt is negative

351
Q

for treatment naive pts what are the preferred regmines

A 
bictegravir+ tenofovir+ emtricitabine
Dolutegravir++
Raltegravir ++ 
dolutegravir + abacavir + lamivudine
INSTI+ 2 NTRIs
352
Q

for treatment naive pts with HLAB5701 negative patients what drug cocktail is given?

A

dolutegravir, abacavir, lamivudine

353
Q

Rules for Zidovudine admin of pregnant mothers

A

HIV RNA> 1000 copies/mL near the time of delivery
unknown HIV rna
non-adherent HAART regimen
positive expidited HIV results during labor

354
Q

newborn prophylaxis of HIV infected mothers:

mothers on HAART, <50 copies/mL viral load at time of delivery

A

low risk: zidovudine for 4-6 weeks

355
Q

newborn prophylaxis HIV. Mother not on HAART. > 50 viral load by time of delivery

A

High risk: nevirapine + zidovudine

356
Q

What are the General anesthetics that are inhaled?

A

Gases such as N2O

volatile halogenated hydrocarbons- isoflurane, desflurane, Sevoflurane, halothane, enflurane, methoxyflurane.

357
Q

Propofol, ketamine, etomidate, and barbiturates are all examples of _______ anesthetics administered _______.

A

general anesthetics administered IV…

to sedate an ICU pt that needs to be mechanically ventilated for long periods.

358
Q

what kind of anesthetic is used for maintenance of anesthesia after IV?

A

inhaled anesthetics
such as Gases such as N2O
volatile halogenated hydrocarbons- isoflurane, desflurane, Sevoflurane, halothane, enflurane, methoxyflurane.

359
Q

Infants have high alveolar ventilation and lower residual capacity thus can be induced with

A

inhaled anesthetics: Sevoflurane

360
Q

The more liposoluble an inhaled anesthetic is the _____ potent

A

more

361
Q

Onset is ______ correlated to blood solubility in in inhaled anesthetic

A

inversely

ex high onset, low blood solubility.

362
Q

Recovery of an inhaled anesthetic depends on what?

A

Redistribution in brain

363
Q

What is the MOA of an inhaled anesthetic ?

A

+ modulation of Gaba and glycine receptors and inhibition of nicotinic

364
Q

The higher the MAC the _________ the potency

A

lower
MAC= Minimum alveolar concentration

MAC of N2O is 104% and methoxyflurane is 0.15

365
Q

______________ is the result in immobility in 50% of pts when exposed to noxious stimulus like incision

A

MAC= Minimum alveolar concentration

366
Q

The oil gas partition coefficient determines the ____________ of a drug

A

potency

Oil:gas high, potency is high

367
Q

______________ is the rate at which a given concentration of drug reaches the brain

A

anesthetic induction- it depends on the solubility of the anesthetic, pulmonary ventilation rate. pulmonary blood flow. arteriovenous concentration

368
Q

If you have an anesthetic with low solubility in blood= arterial tension rises quickly and you have a _______ onset

A

Fast

369
Q

low blood:gas partition means __________ onset

A

faster

370
Q

a high ventilation rate= ______ rate of induction

A

high

371
Q

_______ is the difference in solubility between arterial and venous blood. it reflects the solubility of the anesthetic in the tissues.

A

Arteriovenous concentration gradient

uptake by tissue slows onset and recovery

372
Q

Less solubility in blood and tissue= _______ elimination

A

more ( mirrors induction) and viceversa

373
Q

_________ and _________ are inhaled anesthetics that reduce MAP ( reduce CO) by myocardial depression with little effect on PVR.

A

halothane and enflurane

Thanos will depress your heart

374
Q

These inhaled anesthetics cause vasodilation and have minimal effects on CO

A

isoflurane, desflurane and sevoflurane (SID)

Bette choice for pts with impaired Myocardial fxn

375
Q

________ lowers BP less than other inhaled anesthetics.

A

N2O

376
Q

this inhaled anesthetic can lead to ventricular arrhythmias by sensitizing myocardium to circulating catecholamines

A

halothane

DIS won’t have have a problem

377
Q

inhaled anesthetics cause increased intracranial pressure, which causes the least?

A

N20

378
Q

which inhaled anesthetic causes tonic clonic movement?

A

enflurane

379
Q

which inhaled anesthetic can cause expansion of preexisting volvulus or pneumothorax?

A

N20
avoid in pts with pneumothorax, obstructed middle eat, air embolus, obstructed loop of bowel, intraocular air bubble, and pulmonary bulla

380
Q

what inhaled anesthetic can cause severe hepatoxicity?

A

halothane

H=H

381
Q

what inhaled anesthetic can cause nephrotoxicity?

A

methoxyflurane- due to flouride release during metabolism

382
Q

Pt had recent anesthesia is experiencing tachycardia, hypertension, severe muscle rigidity, hyperthermia, acidosis what drugs can trigger this?

A

halothane and succinylcholine

Ryanodine receptor defect= increased Ca release more contractions more heat more CO2 low O2, lactose/ acidosis, dead muscle fibers= myoglobinuria and hyperkalemia

383
Q

What is the treatment for malignant hyperthermia caused potentially by halothane or succinylcholine?

A

dantrolene

384
Q

halothane and succynylcholine cannot be given to pts with _________.

A

muscular dystrophy

385
Q

what occurs if you give someone with muscular dystrophy

halothane or succynylcholine?

A

hyperkalemia and rhabdomyalisis. = unregulated extra junctional Ach depolarizing the cell

386
Q

_________ tests for susceptibility of malignancy hyperthermia

A

caffeine- halothane test

387
Q

which inhaled anesthetic causes megaloblastic anemia by reducing methionine synthase?

A

N20 causes hematotoxicity

this is a hazard for dental clinics

388
Q

What are the ultra short acting barbiturates?

A

thiopental and methohexital

389
Q

What anesthetic is used for induction of anesthesia and short surgical procedures?

A

methohexital and thiopental ( ultra short acting barbiturates)

Their anesthetic effects are eliminated by redistribution from the brain to other tissues and then they’re metabolized by the liver

390
Q

short acting barbiturates ______ ICP

but can be of concern for______

A

decrease..

asthmatics

391
Q

______ is an antiemetic used to induce and maintain anesthesia. No analgesia, metabolized in liver… it is a respiratory depressant and causes hypotension

A

Propofol

392
Q

Used for anesthetic induction of pt @ risk for hypotension. causes little CV and respiratory distress… reduce ICP
GOOD FOR HEART ISSUE pts

A

etomidate

393
Q

what general IV anesthetic causes nausea, vomiting and inhibits 11 beta hydroxylase thus causing adrenal suppression?

A

etomidate

394
Q

Which general IV anesthetic causes dissociative anesthesia, catatonia, amnesia/analgesia, w/o loss of consciousness?

A

ketamine

395
Q

which is the only general IV anesthetic that increases ICP?

A

ketamine

396
Q

Which general IV anesthetic blocks NMDA receptors?

A

ketamine

397
Q

what general IV anesthetic causes sensory and perceptual illusions and vivid dreams called “emergence phenomenon”?

A

ketamine

398
Q

what drug reduces emergence phenomenon?

A

diazepam, midazolam, propofol

399
Q

Why would you add a Benzo to a general anesthetic?

A

for anxiolytics or anterograde amnesia

-scopolamine is also an amnesiac-

400
Q

why would you add an opioid o a general anesthetic?

A

analgesia

401
Q

why a neuromuscular blocker to a general anesthetic?

A

muscle relaxation

402
Q

what antiemetic would you add to general anesthetic to treat post op nausea/vomiting?

A

ondansetron

403
Q

what antimuscarinic would you add to a generally anesthetized pt to prevent salivation and bronchiole secretion?

A

glycopyrolate

404
Q

what drug would you use to protect the heart from bradycardia caused by inhalation agents or neuromuscular blockers during anesthesia?

A

atropine (maybe glycopyrlate)

405
Q

What are the organic components of a local anesthetic?

A

a lipophilic group ( aromatic chain), intermediate chain ester or amide, ionizable group like a tertiary amine

406
Q

What are the ester local anesthetics?

A

all have 1

cocaine, benzocaine, tetracaine

407
Q

what are the amide local anesthetics?

A

all have 2 is

lidocaine, bupivacaine, prilocaine

408
Q

______ local anesthetics are more prone to hydrolysis and have shorter duration of action

A

esters “ 1 i”

cocaine, benzocaine, tetracaine

409
Q

Local anesthetics are weak bases. (PK-8-9). the larger fraction in body fluids will be ______ and it is the MOST ACTIVE FORM @ receptor.

________ crosses the biological membrane

A

cationic (+)

uncharged

410
Q

What is the MOA of local anesthetics?

A

they block voltage gated Na channels @ intracellular end and abolish the action potential leading to no depolarization.

411
Q

In local anesthetics liposolubility correlates with

A

duration of action, potency and toxicity

412
Q

When PKA in local anesthetic is close to body PH the onset is __________.

A

Faster

413
Q

what is the purpose of epinephrine admin with a local anesthetic?

A

prolongs action of the local anesthetic via vasoconstriction. it reduces the systemic absorption of it by decreasing blood flow. the result is high neuronal uptake and low systemic toxic effects.

414
Q

epinephrine is a alpha 2 receptor agonist so it inhibits _________ and _______ analgesia.

A

substance P and reduces.

415
Q

AE of epinephrine

A

delayed wound healing, tissue edema, necrosis

416
Q

what is the mechanism of cocaine?

A

causes vasoconstriction by potentiating norepinephrine, reducing its own absorption

417
Q

Esters are metabolized by

A

plasma and tissue esterase’s (pseudocholinesterase)

418
Q

amide are metabolized by

A

liver CYP450

419
Q

what are the short acting local anesthetics?

A

the “pros”

procaine chlorprocaine

420
Q

what are the intermediate acting local anesthetics?

A

Lidocaine, Mepivicaine, Prilocaine (LMP)

421
Q

What are the long acting local anesthetics?

A

BERT

bupivacaine, etidocaine, ropivacaine, tetracaine

422
Q

Toxicity due to a local anesthetic leads to ________

A

CNS stimulation that leads to CNS depression.
stimulation- restlessness and tremor that leads to clonic convulsions.
depression- respiratory failure-death

if excessive amount- peripheral death to nerve tissue

423
Q

If you have to give a large dose of a local anesthetic what do you use as prophylaxis and why?

A

Benzodiazepine for prophylaxis against seizure

424
Q

What are the CV effects of local anesthetic? also state vs cocaine effect

A

due to Na blockage- depressed cardiac pacemaker, depressed cardiac conduction, arteriolar dilation= hypotension

cocaine- opposite effect causes arrhythmias, vasoconstriction and HYPERTENSION

425
Q

What is the most cardiotoxic local anesthetic?

A

bupivicaine. <b></b>

426
Q

which local anesthetic leads to accumulation of o-toluidine which oxidizes hemoglobin to methemoglobin?

A

large doses of prilocaine

427
Q

Which local anesthetics causes allergies? what the mechanism that causes this?

A

esters. (1i), metabolized to P-aminobenzoic acid

428
Q

What local anesthetic is hydrolyzed to PABA (paraaminobenzoic acid) and inhibits action of sulfonamides?

A

procaine

- sulfonamides work to inhibit tetrahydrofolate synthesis.

429
Q

what are neuromuscular blockers used for during surgery?

A

to cause paralysis

430
Q

what are the two categories of nondepolarizing blockers (competitive antagonists)??

A

Benzylisoquinolones and ammonio steroids

431
Q

Tubocurarine, atracurium, cisatracurium, mivacurium are examples of what kind of drugs?

A

nondepolarizing blockers (antagonists):
Benzylisoquinolones
“curium”

432
Q

Pancuronium, Rocuronium, and vecuronium are examples of what kind of drug?

A

nondepolarizing blockers (antagonists): ammonio steroids

“curonium”

433
Q

What can overcome the nondepolarizing blockers (competitive antagonists)?

A

increased Ach in synapse such as with edrophonium and neostigmine… given after surgery to reverse competitive blockade

434
Q

With nondepolarizing blockers (competitive antagonists) skeletal muscle becomes ________

A

flaccid and inexcusable to stimulation, motor weakness

435
Q

Mivacurium is ________ acting

A

short, eliminated by plasma pseudocholinesterase

436
Q

atracurium, cisatracurium, rocuronium, and vecuronium are all ______ acting

A

intermediate

437
Q

tubercurarine and pancuronium are ______ acting

A

long

438
Q

______ is eliminated by the kidney which means it is a nondepolarizing blocker with a long-half life

A

pancuronium

439
Q

Atracurium had a metabolite called Didanosine and this caused what AE?

A

hypotension and seizure

440
Q

Mivacurium is hydrolyzed by _______________

A

butyrlcholinesterase ,eliminated by plasma pseudocholinesterase… not kidney or liver

441
Q

Which nondepolarizing blocker has the most rapid onset for rapid intubation and as alternative to succinylcholine?

A

rocuronium

” ready to roc”

442
Q

Succinylcholine is a _________ blocker

A

depolarizing ( agonist)

443
Q

what is the MOA of succinylcholine?

onset and duration?

A

activates nicotinic receptor and depolarizes the junction. onset <1 min… duration of block is 5-10 min
acetylcholinesterase cant metabolize it well

444
Q

Someone’s polymorphism of butyrlcholinesterase can be triggered by what drugs?
how is it treated?

A

succinylcholine and mivacurium

  • this is prolonged neuromuscular blockade

mechanical ventilation til muscle function is normal

445
Q

depolarizing blockers are administered via ______

A

IV or IM, inactive if by mouth.

they dont enter cells or cross the BBB, very polar drugs

446
Q

what are the AE of benzoquinolones? what is administered before as a result?

A

hypotension due to histamine release and GANGLIONIC blockade

antihistamines

447
Q

what are the AE of ammonio steroids?

A

produce tachycardia due to MUSCARINIC blockade- arrhythmias

448
Q

Tubocurarine blocks the _________ receptors of the autonomic ganglia and adrenal medulla causing hypotension and tachycardia

A

nicotinic receptors

449
Q

Which nondepolarizing blocker causes blockade of M2 receptor of heart?

A

pancoronium causes tachycardia.

450
Q

Which anesthetic causes activation of both nicotinic receptors of sympathetic and parasympathetics? causing bradycardia, histamine release, muscle pain hyperkalemia, increased IOP, malignant hyperthermia…

A

succinylcholine activates autonomic cholinoreceptors

451
Q

Any CNS involvement with depolarizing blockers?

A

no cannot cross BBB

452
Q

What are drugs that can enhance neuromuscular blockade?

A

tetracyclines, inhaled anesthetics, aminoglycosides

453
Q

pts with myasthenia graves ______ neuromuscular blockade when using a non-depolarizing muscle relaxant

A

increase/ they are sensitive to the blockade

454
Q

why would advanced age prolong neuromuscular blockade by a non-depolarizing muscle relaxant ?

A

decreased clearance with age

455
Q

what pts are resistant to nondepolarizing muscle relaxants?

A

burn victims, upper motor neuron problems

456
Q

malignant hyperthermia, skeletal muscle myopathy, major burns, and UMN injury are contraindications for

A

depolarizing blockers ( succinylcholine)

457
Q

__________ facilitates endotracheal entubation

A

succinylcholine

458
Q

What is a spasmolytic that is a GABAb agonist?

A

baclofen

459
Q

Spasmolytic that is an agonist at alpha2 adrenoreceptors in CNS

A

tizanadine

460
Q

_____________ interferes with Ca release by binding to RYRr in Sarcoplasmic Reticulum of skeletal muscle and is used for malignant hyperthermia

A

dantrolene

461
Q

____________ treats spasms due to cerebral palsy

A

botulamin toxin

462
Q

drug for an acute spasm

A

cyclobenzaprine- AE is antimuscarinic

463
Q

a seizure with no loss of consciousness, abnormal activity of single limb/muscle group

A

simple partial seizure

464
Q

a seizure with loss of consciousness and motor dysfunction with chewing movements diarrhea and urination

A

complex partial seizure

465
Q

seizure with loss of consciousness, be be convulsive or non-convulsive

A

general seizure

466
Q

seizure where pt stares/ rapid eye blinking…. 3 Hz spike and wave pattern

A

absence seizure

467
Q

What is the trigger for seizure?

A

increase in excitatory activity such as glutamate increase or decrease in inhibitory activity like low gaba

468
Q

what is the mechanism of anti seizure meds?

A

block voltage gated ion channels, modulation of synaptic transmission

469
Q

what are the drugs that block voltage gated Na channels as anti-seizure meds

A

phenytoin, oxcarbazepine, carbazepine, lamotrigine, zonisamide,…may effect phenobarbital, valproate, topiramate

470
Q

Drugs that block T-type calcium channels as seizure med

A

ethosuximab and valproate

471
Q

____________ drugs are effective against absence seizures

A

ethosuximab and valproate… t type calcium channel blockers

472
Q

Drugs for seizures that enhance GABAergic ( act on Gabaa) neurotransmission post-synaptically

A

benzodiazepines, barbiturates, and topiramate ( allow influx of Cl)

473
Q

Drugs for seizures that enhance Gaba neurotransmission (presynaptically)

A

tiagabin and vigabatrin

they inhibit gaba reuptake/ degredation

474
Q

which drug for seizures inhibits gaba aminotransferase?

A

vigabatrin

475
Q

which drugs for seizures reduce glutamatergic neurotransmission? (post synaptically)

A

phenobarbital and topiramate

476
Q

which drugs for seizures reduce glutamatergic neurotransmission? ( pre synaptically)

A

gabapentin and pregabalin and levetiracetam

477
Q

these drugs decrease glutamate release for treatment of seizures by blocking to pre-synaptic voltage gated Ca channels

A

gabapentin and pregabalin

478
Q

This drug binds to synaptic vesicle glycoprotein 2A (SV2A), and affects release of glutamate and GABA

A

levetiracetam

479
Q

DOC for partial or secondary tonic clonic seizure

A

these are all Na channel blockers- carbamazepine, oxcarbemazepine, levetracetam, zonisamide, phenytoin, valproate, lamotrigine, topiramate, phenobarbital

480
Q

DOC for tonic clonic + absence

A

valproate

481
Q

DOC for atypical absence seizure

A

valproate

482
Q

DOC for myoclonic seizures

A

valproate, can use topiramate as well and levetiracetam as adjunct

483
Q

DOC for atonic seizures

A

valproate, iamotrigine

484
Q

For a febrile convulsion that lasts <15 min what do you do?

A

support/ no med

485
Q

For febrile convulsions that lasts >15 min what do you do?

A

give diazepam IV or rectal

486
Q

What is it called when a patient has a single seizure lasting >5 min or 2 seizures with no recovery of consciousness in between.. can be convulsive or non convulsive?

A

status epilepticus

487
Q

What is administered in a 5-20 min seizure

A

IM midazolam, IV diazepam or lorazepam

488
Q

what is administered in a 20-40 min seizure

A

IV fosphenytoin, IV valproic acid, levetiracetam and 2n d line phenobarbital IV.

489
Q

what is administered for a 40+ min seizure

A

repeat (20-40 min) or IV thiopental, midazolam, phenobarbital,or propofol.

490
Q

What is administered for non-epileptic drug induced seizure?

A

diazepam, lorazepam, phenobarbital

491
Q

what is the AE of carbamazepine, phenobarbital and phenytoin?

A

CYP450 inducer

492
Q

what is the AE of valproate?

A

hepatotoxicity, and CYP 450 inhibitor ( inhibits metabolism of drugs)

493
Q

what is the AE of phenytoin?

A

gingival hyperplasia, coarsening of facial features in children, Hirsutism, rash, Steven Johnson syndrome, zero order kinetics elimination diplopia and ataxia

494
Q

What is the AE of carbamazepine?

A

aplastic anemia, agranulocytosis, rash, Steven Johnson

495
Q

Which anti-epileptic drugs have a black box warning about Steven Johnson and toxic epidermal necrolysis?

A

carbemazepine, phenytoin and lamotrigine

496
Q

AE of vigabatrin

A

visual field loss

497
Q

If you go ______ years discontinue seizure meds

A

3-5 years

498
Q

__________ is a teratogenic anti-epileptic drug that increases rate of fetal malformation/ neural tube defect. need to take folate with it

A

valproate

499
Q

Anti-epileptics degrade ________ in infants

A

vitamin K… take Vit K supplements last month of pregnancy

500
Q

This drug can be used for neuropathic pain and bipolar disorder

A

carbemazepine

501
Q

this drug is anti epileptic and can be used for migraines

A

topiramate

502
Q

This drug is 1st line in treating essential tremor

A

primidone and propanolol.

503
Q

child comes in with Otitis media or sinusitis… meaning the kid has strep pneumonia/ H influezae that is b lactamase negative what do you prescribe?

A

amoxicillin

also treats UTI if pregnant

504
Q

A _____ such as azithromycin is safe to give to penicillin allergic pts and pregnant pts

A

macrolide

505
Q

Vancomycin is administered ______

A

IV, and is for serious gram + infection with multidrug resistance, can be given to those allergic to penicillin

506
Q

Aminoglycosides are only used for gram ______ bacteria

A

negative, aerobic

507
Q

AE for fluroquinolone

A

CT problems such as tendon rupture

508
Q

Male with Penile discharge and unprotected sex has gram - diplococci. what is the likely diagnosis? what is DOC?

A

Gonorrhea

IM ceftriaxone and and oral azithromycin

509
Q

Pt has chancre or cutaneous or mucocutanous tissue what is the diagnosis?

A

primary syphillis

510
Q

what is Chlamydia ( which can be seen in pt with gonorrhea too) treated with?

A

azithromycin or doxycycline

511
Q

Beta lactamase producing staph is treated with what?

A

nafcillin ( dicloxacillin, oxacillin)

512
Q

Pt has intraabdominal abscess what do you treat it with?

A

Imipenem it is broad spectrum and fights aerobic and anaerobics… good for serious polymicrobial infections

513
Q

Imipenem is always given in combination with what drug and why?

A

cilastatin because it inhibits renal dehydropeptidase I

514
Q

what is the bacteria in bacterial prostitis?

A

Ecoli

515
Q

what are the first line treatment in treating ecoli?

A

the fluroquinolones like levofloxacin and ciprofloxacin

516
Q

Pt has torsade de pointes, has ecoli infection.. cannot be given fluoroquinolone, what do we give instead?

A

co-trimoxazole

517
Q

Uncomplicated UTI can be treated with

A

Nitrofurantoin or co-trimaxole

518
Q

Empiric treatment of bacterial meningitis

A

ceftriaxone and vancomycin

519
Q

H. influenza caused bacterial meningitis what drug

A

ceftriaxone alone

520
Q

Prophylaxis for family of patient suffering from bacterial meningitis can be

A

ceftriaxone, rifampin, or ciproflaxin

521
Q

Listerial meningitis is treated with

A

ampicillin and gentamicin

522
Q

Pt has endocarditis/ enterococcal endocarditis what is the empiric treatment?
Pt is allergic to vancomycin what do you give instead?

A

gentamicin and vancomycin

daptomycin

523
Q

Gentamicin is an aminoglycoside ( like amikacin, tobramycin, streptomycin, neomycin) what are the AE ?

A

nephrotoxicity and ototoxicity

524
Q

Pt has traveler’s diarrhea what microbe are they likely to have?

A

ecoli infection

525
Q

PT has traveler’s diarrhea what do you prescribe them?

if pt is pregnant what is the other choice?

A

fluoroquinolone such as ciprofloxacin (DOC) fights gram -

amoxicillin and clavulanic acid

526
Q

What antibiotic drug causes pseudomembranous colitis

what drug treats it?

A

clindamycin causes C dificilie infection often…

also typically prescribed after tooth extraction

vancomycin and metronidazole treats pseudomembranous colitis

527
Q

what is recommended for the empiric treatment of pneumonia?

A

to treat strep pneumonia a macrolide like azithromycin/ tetracycline like doxycycline

528
Q

what are the DOC for legionella pneumonia?

A

macrolide or fluoroquinolone (flox)

529
Q

What is the drug of choice for sinusitis if amoxicillin doesn’t work?

A

ceftriaxone

530
Q

how do you treat sepsis from an untreated UTI that wasn’t treatable with co-trimoxole

A

A fluroquinolone ( Flox) + gentamicin

531
Q

IF MRSA is present what do you prescribe?

A

Vancomycin

532
Q

Pt has MRSA, is resistant to vancomycin, what other drug can you give?

A

linezolid because it is recommended for Vancomycin resistant MRSA

533
Q

If patient has MRSA, serotonin syndrome and hypertension. what drug did they take?

A

linezolid

534
Q

GI procedures, C section, vaginal hysterectomy, and joint replacement require what? and what drug is it?

what is a good alternative if allergic?

A

surgical prophylactic antibiotics

1st generation cephalosporin CEFAZOLIN

clindamycin

535
Q

The main pathogen infecting someone after a dog or cat bite is what? what is the DOC

if there is an abscess present what would be the drug of choice?

A

Pasteurella
oral antibiotic amoxicillin and clavulanic acid

IV ampicillin and sulbactam

536
Q

Pt has penicillin allergy has strep throat

A

without the allergy you give pen V

but since theres an allergy you give 1st gen cephalosporin such as “ cefa” cephalexin

537
Q

you have a patient with strep throat, the pt was resistant to 1st line Pen V… why was the bacteria resistant?

A

beta lactamases destroyed the antibiotic…
- enzymatic destruction.
needed was a beta lactamase inhibitor such as clavulanic acid, sulbactam, tazobactam, avibactam

538
Q

Pregnant woman has UTI and allergy to amoxicillin. what do you give instead?

A

Nitrofurantoin. NOT Co-trimoxazole

539
Q

Pregnant woman has UTI and takes co-trimoxazole. what can her baby have?

A

Neural tube defects

540
Q

What drug inhibits translocation?

A

erythromycin

541
Q

What antibiotics target DNA gyrase?

A

fluoroquinolones (flox)

542
Q

Cefamandole, cefoperazone and cefotetan cannot be mixed with_______

A

alcohol due to a disulfiram-like reaction

543
Q

Pt has hepatic encephalopathy, doctor adds him on treatment that traps NH4 in colon promoting excretion what is the drug

A

lactulose

  • neomycin can also treat this but not that mechanism
544
Q

Pt has MRSA and has muscle pain as AE what drug is it?

A

daptomycin

545
Q

azithromycin can cause this AE

A

prolonged Qt interval

546
Q

Pt has otitis media and amoxicillin failed… then amoxicillin with cluvanic acid failed, cephalosporins work though. what was the resistance?

A

PBP proteins were modified

547
Q

What is the MOA of nitrofurantoin, a drug that treats noncomplicated UTI?

A

produces reactive intermediates that damage DNA

548
Q

Pt has urea breath rest positive, pain of stomach improves after eating…. what drug?

A

pt has pylori. give clarithromycin, amoxicillin and PPI

549
Q

Pt with high neutropenia is treated with what antibiotic?

A

piperacillin and tazobactam

550
Q

pt has trichomonas vaginalis “ strawberry cervix” greenish hue to discharge. what is the appropriate therapy if allergic to penicillin?

A

metronidazole

551
Q

what drug for aspiration pneumonia?

A

clindamycin

552
Q

If an organism changes D-Ala to Dlac what antibiotic cant be used?

A

Vancomycin.

MRSA becomes vancomycin resistant because it changes D-Ala D-ALa to D-Lac

553
Q

_______ bind reversibly to the 30s subunit

________ bind covalently to the 30s subunit

A

Tetracyclines bind reversibly- “cyclines”
Aminoglycosides are covalent
- Gentamicin is an aminoglycoside ( like amikacin, tobramycin, streptomycin, neomycin)

554
Q

what are the neuraminidase inhibitors what is the moa?

what do they treat/prevent?

A

inhibitor of siliac acid substrate for neuraminidase/ stop virion release/ decrease release of viral progeny
drugs are Peramivir, oseltamivir, zanamivir. (mivir drugs)

Influenza A and B

555
Q

neuraminidase inhibitors are used against influenza A and B (vir)… how long after infection symptoms will shorten illness duration?

A

24-48 hours

556
Q

peramivir is neuraminidase inhibitor used to treat influenza A and B what is the aministration?

A

parenteral

557
Q

oseltamivir is neuraminidase inhibitor used to treat influenza A and B what is the aministration?

A

oral

558
Q

zanamivir is neuraminidase inhibitor used to treat influenza A and B what is the aministration?

A

inhaled/intranasal

559
Q

what is the AE of permavir?

A

parenteral admin so pruritus, peeling of skin, muscle pain

560
Q

what is the AE for oseltamivir?

A

oral so GI upset

561
Q

what is the AE for zanamivir?

A

nasal so airway irritation

562
Q

zanamivir is given for influenza A and B what condition should be avoided?

A

asthma and copd

563
Q

What is the moa of endonuclease inhibitors ? what are the drugs? used for?

A

inhibits endonuclease activity of selective polymorphic acidic protein (PA) required for viral gene transcription./ stop genome replication

Baloxivir and marboxil (ox)

influenza A and B

564
Q

symptomatic pts with influenza that are over 12 years old and infected less than 48 hours ago can take…?

A

endonuclease inhibitors such as baloxivir and marboxil

565
Q

what are the AE of the endonuclease inhibitors baloxivir and marboxil?

A

bronchitis and diarrrhea

566
Q

Synthetic guanosine analogs: MOA?

what are the drugs?

A

inhibits RNA dependent RNA polymerase, inhibits viral protein synthesis
( converted to ribaviran- triphosphate which inhibits GTP formation and prevents viral mana capping)

Ribavirin

567
Q

what respiratory infection does ribavirin ( guanosine analog) treat?

A

rna and dna viruses RSV, HCV (hep C), influenza A and B, lassa fever

568
Q

AE of ribavirin?

A

hemolytic anemia and pregnancy cat X

569
Q

_________ doesn’t target viral gene products

A

interferon. (IM,IV,SC, intralesional)

instead inhibits RNA and DNA synthesis by inducing protein expression that inhibit viral infection

570
Q

What antiviral Is used for chronic HBV HCV in combination with ribavirin ?

A

IFN alpha

also treats: condyloma acuminata, hairy cell leukemia, Kaposi Sarcoma, renal cell carcinoma, malignant melanoma

571
Q

What antiviral Is used for MS?

A

IFN-beta

572
Q

what antiviral is used for chronic granulomatous disease?

A

IFN-gamma

573
Q

AE for interferons?

A

flu like symptoms and neutropenia, zidovudine may potentiate, can cause toxic accumulation of theophylline, needs to be pegylated to improve PK

574
Q

What antiviral analog inhibits HBV and HIV reverse transcriptase when phosphorylated?

A

Nucleotide/nucleoside analog

575
Q

What antiviral drug prevents vertical transmission of HEP B if given last 4 weeks of gestation?

A

lamivudine

576
Q

_______ is given for lamivudine resistant strains of HEPB and HIV? is a once daily dose drug/taken w/o food

A

entecavir

577
Q

For acute HEP B what is Recommended? what is contraindicated?

A

entecavir

pegylated IFN

578
Q

For chronic HEP B what is recommended ?

A

entecavir and pegylated IFN alpha

579
Q

What are the N3/4 A inhibitors used against previously untreated or failed to treat w interferon and ribavirin Hepatitis C virus (HCV)?

A

simeprevir, telaprevir (previr)

580
Q

AE of simeprevir, telaprevir (previr)

A

severe itching, rash, photosensitivity Steven johnson

581
Q

_________ is a NS5A inhibitor

A

ledipasvir ( also used for HCV)

582
Q

AE of ledipasvir

A

headache diarrhea

583
Q

_______ is a NS5B inhibitor

A

sofosbovir ( also used for HCV)

584
Q

AE sobosfovir

A

headache fatigue

585
Q

Acyclovir, valacyclovir, ganciclovir, valganciclovir, cidofovir, penciclovir, trifluridine are _____________ analogs. They treat ______

A

purine and pyramidine
Herpes (HSV)
ciclo in name= phosphorylated by host and viral kinase

cidofovir and trifluridine- only phosphorylated by host kinase

586
Q

what is the DOC of HSV encephalitis?

A

acyclovir

587
Q

What can acyclovir be used for?

A

HSV1, HSV2, VSV, epstein barr (HSV4), HSV encephalitis

valacyclovir as well increased bioavailabiltiy with less frequent dosing

588
Q

what is resistant to acyclovir?

A

CMV

589
Q

Topical oral and IV AE of acyclovir?

A

topical- local irritation
oral- headache, diarrhea, nausea, vomiting
IV- acute renal failure

590
Q

antiviral that works against CMV/ CMV retinitis/esophagits/colitis

A

ganciclovir ( dna poly inhibitor/ phosphorylated)

591
Q

AE of ganciclovir

A

myelosuppresion, severe-dose dependence, neutropenia

592
Q

This drug is used for CMV in HIV and AIDS patients and ganciclovir resistant HSV and is coadministred with probenecid to block renal tubular secretion.

A

cidofovir ( requires phosphorylation of host kinase not viral kinase)

593
Q

AE of cidofovir?

A

nephrotoxicity reason for coadministration with probenecid to block renal tubular secretion.

594
Q

what does topical treatment of HSV? AE?

A

cold sores= penciclovir, mild erythema

595
Q

what is the DOC for keratoconjunctivitis and recurrent epithelial keratitis?

A

trifluridine…. ( incorporates into viral DNA causing fragmentation)

596
Q

AE of trifluridine

A

transient eye irritation and palpebral edema… remember it treats keratoconjunctivitis

597
Q

IV drug for CMV retinitis in immunocompromised and acyclovir resistant HSV,VZV, ganciclovir resistant CMV and VCV

A

foscarnet

598
Q

what antiviral drug has this as AE? electrolyte disturbance (ca, mg, K), nephrotoxicity, anemia, genital ulceration men, hallucination seizure, headache

A

foscarnet

599
Q

if patient has VCV and altered thymidine kinase what drug is administered?

A

foscarnet

600
Q

anti fungal drugs polyenes, azoles and allylamines alter _______

A

cell membrane permeability

601
Q

anti fungal drugs that block nucleic acid synthesis..______

A

flucytosine

602
Q

anti fungal drug that blocks microtubule fxn _______

A

griseofulvin

603
Q

anti fungal drug that disrupts fungal cell wall _________

A

echinocandins

604
Q

Amphothericin B is a polyene antibiotic/antifungal with MOA __________

A

binds to ergosterol cell wall and forms pores in the cell membrane. the pore allows leakage of intracellular ions and macromolecules leading to cell death.

605
Q

what antifungal is administered intrathecal for meningeal disease?

A

amphothericin B

AE can be seizures/neuro probs

606
Q

What anti fungal is a fungicidal?

A

amphothericin B

607
Q

what anti fungal is used as initial induction regimen to rapidly reduce fungal burden/ for life threatening fungal infection…. to then continue therapy with azole.

A

amphothericin B ( given slow IV)

608
Q

what is the preferred treatment of deep fungal infection during pregnancy?

A

amphothericin B

609
Q

What should be measured after stating on amphothericin B

A

K and Mg due to risk of renal impairment/ azothemia/renal tubular acidosis/ binds to cholesterol in mammals and forms pores in cell membrane= renal toxicity

610
Q

what blood disorder can come from amphothericin B?

A

normocytic normochromic anemia

611
Q

treatment of amphotericin renal damage

A

sodium loading/ saline infusion with amphothericin

612
Q

what reduces nephrotoxicity risk with amphothericin?

A

lipid formulations

613
Q

treatment of mucormycosis?

A

posaconazole/ amphothericin?

614
Q

anti fungal flucytosine MOA:

A

synthetic pyridine antimetabolite taken by fungal cells via cytosine permease= 5-flurouracil= 5Fdump= inhibits thymidilate synthase blocking DTMP
5FUTP= inhibits protein synthesis

615
Q

what antifuntgal is a fungistatic?

A

flucytosine, means narrow spectrum, not used as single agent used with amphotericin B

616
Q

Treatment of cryptococcal meningitis?

A

its a fungus, flucytosine + amphotericin B

617
Q

what antifungal is used against cryptococcus and candida?

A

flucytosine +amphothericin B

618
Q

AE of flucytosine?

A

bone marrow toxicity due to 5 fluorouracil

619
Q

these antifungals ketoconazole, miconazole, clotrimazole are _______

A

imidazoles

620
Q

these antifungals itraconazole, fluconazole, variconazole, posaconazole are _________

A

triazoles

621
Q

ketoconzaole, fluconazole and itraconazole are for oral treatment of

A

dermatophytoses

622
Q

azoles inhibit ________ which is supposed to convert ianosterol to ergosterol.

A

14-alphasterol demethylase (CYP 450)

disrupts ergosterol membrane and increases permeability

623
Q

which azole causes these AE:
inhibits CYP450 in mammals, lowers plasma testosterone and causes gynecomastia, decreased libido, low male potency, menstrual irregularities.
high levels inhibit adrenal steroid synthesis and decrease plasma cortisol. potentiates warfarin and cyclosporin toxicity, absorbed better at low PH avoid H2 blockers, antacids, proton pump inhibitors

A

ketoconazole

PPI interfere with absorption of drug

624
Q

what drug is narrow spectrum and used for superficial mycoses?

A

ketoconazole

625
Q

the only good penetration of CSF azole is…?

A

fluconazole

626
Q

what is the DOC for esophageal, oropharyngeal, vulvovaginal, and urinary candidiases
candidimea, consolidation and maintenance of cryptococcal meningitis with amphothericin B, and nonsevere form?

A

fluconazole

627
Q

fluconazole is ineffective with what fungi?

A

aspergillosis and fillamentous fungi

628
Q

AE itraconazole

A

fatal arrhythmias with cisapride and lower absorption with PPI/ H2 blocker, antacid

629
Q

what drug is used to treat mycoses due to dimorphic fungi , blastomycosis, sporothrix, histoplasma, used for dermatophytosis and onchomycosis….

A

itraconazole

630
Q

DOC for invasive asperigillosis

A

voriconazole

631
Q

AE of voriconazole

A

transient visual disturbance

632
Q

what fungus has activity against zygomycetes such as mucor?

A

posaconazole

633
Q

This drug is linked to long chain fatty acid is active against aspergillosis and candida but not cryptococcus….

A 
echinocandin= caspofungin
inhibits B(1-3) D glucan
634
Q

this drug is used against onchomycosis and topically against tinea curries and corporis

A

terbinafine ( inhibits squalene epoxidase)= toxic squalene accumulation
allylamine.oral

635
Q

a topical drug that treats candiasis cutaneous oral or vaginal

A

nystatin

636
Q

amphothericin topical for _____

A

cutanous candidiasis

637
Q

what are the topical azoles?

A

clotrimazole and miconazole

638
Q

pt has candidimea what can you give?

A

fluconazole IV or echinocandin IV

639
Q

pt has cutaneous Candidiasis

A

amphothericin B topical, topical azole (clotrimazole miconazole), topical nystatin

640
Q

fusariosis is treated with

A

amphothericin B

641
Q

onchomycoses can be treated with

A

oral terbinafine, oral itraconazole, oral fluconazole

642
Q

DOC for pneumocystis pneumonia (PCP)

A

co-trimoxazole

643
Q

PO2 less than 70 in HIV PCP give……

A

prednisone + co-trimaxozole

644
Q

pt has syphyllis and is allergic to b-lactam what do you give?

A

same as DOC Pen G but desensitized

645
Q

DOC for trichuris trichuria ( whip worm), enterobius vermacularis (pin worm), A duodenale ascaris lumbricoides

A

mebendazole

646
Q

Gaba agonist that secretes CL, is the DOC for onchocerca volvulus ( river blindess) and cutaneous larva migrans
AE?

A

ivermectin

mazotti reaction

647
Q

what immobilizes microfilariae? is the DOC for lymphatic filariasis, loiasis, and tropical eosinophilia

A

diethylcarbamazine

648
Q

DOC for schistosomiasis and T. saginata

A

Praziquantal

649
Q

DOC when pt is resistant to co-trimoxazole and has Pneumocystis Pneumonia

A

pentamidine

650
Q

PTH analog that stimulates bone formation and at high doses subperiosteal bone formation

A

teriparatide

AE= hypercalcemia

651
Q

drug that inhibits RANKL and prevents osteoclast activity/ bone resorption

A

Denosumab

652
Q

what treats secondary hyperparathyroidism?

A

calcitriol
increases blood calcium and phosphate, given to pts with chronic renal failure or liver disease or low 1alpha hydroxylase

653
Q

Topical treatment of psoriasis and synthetic derivative of vitamin D

A

calcipotriol

654
Q

this is a phosphate binder that prevent hyperphosphatemia

A

phosphate binder. Sevelamer

655
Q

1st line treatment of Paget’s one disease

A

biphosphonates or calcitonin

  • drink water and stand up right to decrease risk of erosive esophagitis
656
Q

MOA of biphosphonates

A

inhibit osteoclastic activity, “ onate” drugs by inhibiting farnesyl pyrophosphate synthesis

657
Q

activates calcium sensing cell receptors in parathyroid cells, alternative to calcitriol in secondary parathyroidism due to chronic renal failure

A

Calcium receptor agonist- cinacalcet

658
Q

Used in cancer related hypercalcemia

A

plicamycin (mithracin)

659
Q

Poisoning with acetaminophen is increase of what metabolite?

A

NAPQI

660
Q

anticholinergic antidote is

A

physostigmine

661
Q

Beta blocker antidote is

A

glucagon

662
Q

Calcium channel blocker antidote?

A

calcium IV

663
Q

TCA overdose due to cardiotoxicity

A

bicarbonate

664
Q

sulfonylurea and meglitinides toxicity

A

IV octreotide if glucose infusion not enough

665
Q

CO poisoning in closed car

A

need 100% oxygen

666
Q

Methanol which is metabolized to formic acid… what is the antidote?

A

ethanol or fomepizole

667
Q

ethylene glycol poisoning ( calcium oxalate) antidote

A

fomepizole

MNI Drugs (4 decks)

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