MOA

Question 1

Mechanism of Action

Answer 1

Drug Name

Question 2

inhibits Na+/K+-ATPase via binding to K+-binding site → ↑[Na+]int leading to ↑[Ca2+]int → ↑Force of cardiac Contractility → ↑SV & ↑CO

↑CO → ↓Compensatory sympathetic activity & ↑Vagal activity (↓HR; direct SA and AV node depression)

Answer 2

Digoxin

Question 3

Positive ionotropic actions via inhibition of PDE3, enzyme that inactivates cAMP in cells ↑cAMP in heart → ↑PKA activity & ↑Ca2+ influx → Positive ionotropic action

Answer 3

Milrinone

Question 4

β1-adrenergic agonist with weak β2 and α1 selective activities

Cardiogenic shock (β1 inotropic effect → ↑Heart contractility and cardiac output

Answer 4

Dobutamine

Question 5

↓Afterload via dilation of arterioles

Answer 5

Hydralazine

Question 6

↓Ang. II → ↓Preload and ↓Afterload via ↓Salt & water retention

↓ANG II generation → ↓After-load via ↓ANG II-mediated vasoconstriction induced by ↑sympathetic outflow and ↓Preload via ↓Aldosterone synthesis & secretion

Answer 6

ACE Inhibitors:

Captopril, Enalapril, Lisinopril

Question 7

↓Preload and ↓Afterload via ↓Salt & water retention

Answer 7

ARBs:

Valsartan

Question 8

↓Preload via aldosterone receptor antagonism

↓Distal tubular /Collecting duct Na+-K+ exchange → ↓Preload

Answer 8

Spironolactone

Question 9

↓Renin → ↓Preload via ↓AT-Aldosterone activities; ↓Afterload via ↓AT-vasoconstrictive activities

β1-Blockade → ↓Renin release by the renal JG cells → ↓Preload via ↓Ang. II/ Aldosterone formation, thus, ↓H2O/salt retention

Answer 9

Metoprolol

Question 10

↓Renin → ↓Preload via ↓AT-Aldosterone activities; ↓Afterload via ↓AT-vasoconstrictive activities

β1-/β2-receptor block → Slow cardiac rhythm & ↓Force of cardiac contraction → ↓Cardiac output & ↓Preload

β1-Blockade → ↓Renin release by the renal JG cells → ↓Preload via ↓Ang. II/ Aldosterone formation, thus, ↓H2O/salt retention

Vascular α1-receptor block → ↓After-load (i.e., ↓BP and ↓Heart failure)

Answer 10

Carvedilol

Question 11

A first-generation antihistamine with unclear MOA

Answer 11

Diphenhydramine

Question 12

Act as vasoconstrictors in the nasal mucosa and stimulate α1-adrenergic receptors on venous sinusoids

Answer 12

Phenylephrine (intranasal)

Pseudoephedrine (oral)

Question 13

Activation of β1, α1, and α2 receptors, leading to α1-vasoconstriction in cardiovascular system leading to increase in BP, and decreased HR, some increase in CO

Answer 13

Norepinephrine

Question 14

anion‐exchange resins bind negatively
charged bile acids & bile salts in the small
intestine → Insoluble Resin‐bile acid/salt complex excreted in feces

– ↓[Bile acid] → ↑Cholesterol to bile acids
conversion in hepatocytes
– ↓[Cholesterol]intracellular → ↑Hepatic uptake of LDL leading to ↓Plasma LDL
– ↑Hepatic uptake is due to upregulation of cell surface LDL receptors

Answer 14

Bile acid sequestrants (resins)

Cholestyramine, Colestipol, and Colesevelam

Question 15

Annexins are synthesized; annexins inhibit PLA2 thus inhibiting the breakdown of phospholipids to arachidonic acid: this inhibits the synthesis of prostaglandins and leukotrienes

Reduce the number of eosinophils, basophils, and mast cells in the nasal mucosa and epithelium

Inhibit directly the release of mediators from mast cells and basophils

Answer 15

Fluticasone (intranasal)

Prednisone (oral)

Question 16

bind to antithrombin and accelerate the rate at which it inhibits various coagulation
proteases

IXa, Xa, XIIa, and thrombin are inhibited

Answer 16

Heparin

Question 17

bind to antithrombin and accelerate the rate at which it inhibits various coagulation
proteases

IXa, Xa, XIIa, and thrombin are inhibited

shorter chain length which limits their activity against thrombin

Answer 17

low-molecular-weight heparin

[enoxaparin]

Question 18

bind to the 30S ribosome blocking binding of

aminoacyl-tRNA to the A site

Answer 18

Tetracyclines - Doxycycline

Question 19

bind to the 30S ribosome inhibiting protein

synthesis by interfering with the initiation complex

Answer 19

Aminoglycosides - Gentamicin

Question 20

binds tightly to short peptides that contain

D-alanyl-D-alanine at the free carboxyl end; prevents elongation of the linear peptidoglycan polymer

Answer 20

Vancomycin

Question 21

Binds to 50S subunit of ribosomes and inhibits translocation

Answer 21

Azithromycin, clarithromycin and erythromycin (Macrolides)

Question 22

binds to ergosterol in fungal cell membranes forming pores resulting in increase permeability of the cell membrane and loss of cell constituents.

Answer 22

Amphotericin B

Question 23

Block arteriolar (minimal effects on heart) L type Ca2+ channels

Inhibit Ca2+ influx → Muscle relaxation.

Answer 23

Dihydropyridines: Amlodipine, Nifedipine

Question 24

block beta-1 adrenoceptors

Decreases myocardial oxygen demand: leads to decrease in contractility, HR and CO

Answer 24

Metoprolol, atenolol (cardio-selective)

Propranolol

Question 25

Block release of inflammatory | mediators from mast cells

Answer 25

Cromolyn

Question 26

block the enzyme lanosterol 14-α-demethylase inhibiting | the conversion of lanosterol to ergosterol

Answer 26

Fluconazole & Itraconazole (triazoles)

Question 27

block the enzyme lanosterol 14-α-demethylase inhibiting | the conversion of lanosterol to ergosterol

Answer 27

Ketoconazole (imidazole)

Question 28

Blocks pathologic prolongation of late inward Na+ current in cardiac cells thereby decreasing sodium and calcium buildup Decreases myocardial oxygen demand Decreases diastolic wall tension Increased diastolic sub-endocardial perfusion Increases vasodilation

Answer 28

Ranolazine

Question 29

Blocks release of inflammatory mediators from mast cells and basophils leading to decrease in numbers of infiltrating inflammatory cells and decrease bronchial hyperresponsiveness

Answer 29

Cromolyn (Inhaled)

Question 30

Blocks the enzyme 5-lipoxygenase leading to decrease in leukotriene synthesis Blocks infiltration of inflammatory cells & prevents bronchoconstriction

Answer 30

Zileuton

Question 31

Competitive antagonist at the cysLT1 blocking the effects of LTC4, LTD4, and LTE4

Answer 31

Montelukast

Question 32

competitive antagonist of ACh for muscarinic receptors

Answer 32

Ipratropium | Tiotropium

Question 33

competitive inhibitor of dihydrofolate reductase structural analog of para-aminobenzoic acid (PABA) which can inhibit incorporation of PABA into dihydropteroic acid interfering with folate metabolism

Answer 33

Trimethoprim-sulfamethoxazole

Question 34

Competitively antagonize the actions of histamine ONLY at H1 receptors ``` Cardiovascular i. Partially inhibit vasodilation caused by histamine; incomplete since H2 receptors also are involved ii. Block capillary permeability iii. Flare and itch inhibited ``` Airway Antagonize histamine-induced bronchoconstriction in asthmatics Neural tissue—inhibit pruritus

Answer 34

Cetirizine; Chlorpheniramine; Diphenhydramine; Fexofenadine; Loratadine

Question 35

contain large oncotically active molecules that are derived from natural products which expand the intravascular space with little loss into the interstitium Intravenous administration increases preload which increases stroke volume and cardiac output

Answer 35

Colloidal solutions

Question 36

counteracts intravascular volume expansion via ↑venous capacitance → ↓Preload Releases nitric oxide → ↑cGMP via activation of soluble guanylate cyclase to relax blood vessels, veins in particular → ↓Preload

Answer 36

Isosorbide dinitrate

Question 37

Decrease the sensitivity of cough center to incoming stimuli

Answer 37

Codeine

Question 38

Direct Factor Xa inhibitor not requiring antithrombin

Answer 38

Rivaroxaban

Question 39

Direct thrombin inhibitor Able to inhibit circulating and clot-bound thrombin Contains the sequence Phe-Pro-Arg-Pro; thrombin slowly cleaves the Arg-Pro peptide bond and thus regains activity

Answer 39

Bivalirudin

Question 40

Direct thrombin inhibitor; Able to inhibit circulating and clot-bound thrombin Directly interacts with the thrombin molecule; binds to the active site

Answer 40

Dabigatran

Question 41

equi‐active on heart & blood vessel L type Ca++ channels slows AV conduction directly, ↓HR, contractility, BP & ↓O2 demand Inhibit Ca2+ influx → Muscle relaxation.

Answer 41

Non-DHP: Diltiazem, Verapamil

Question 42

Fab fragment of a humanized monoclonal antibody directed against the αIIbβ3 (glycoprotein Iib/IIIa) receptor Prevents binding of fibrinogen and platelet aggregation

Answer 42

Abciximab

Question 43

facilitates increased chloride transport by potentiating the channel-open probability (or gating) of the CFTR protein

Answer 43

Ivacaftor

Question 44

Fibrinolytic drugs t-PA binds to fibrin and activates bound plasminogen; plasmin degrades fibrin and dissolves the clot

Answer 44

tPA; alteplase

Question 45

i. Competitive antagonists at the cysLT1 | ii. Block the effects of LTC4, LTD4, and LTE4

Answer 45

Montelukast

Question 46

improves the processing of the mutant CFTR

Answer 46

Lumacaftor

Question 47

Increases HDL (by decreasing HDL hepatic uptake), decreases LDL (by reducing triglyceride synthesis), decreases VLDL synthesis Also has anti-inflammatory effects on vasculature and inhibitory effects on thrombosis

Answer 47

Niacin (Vit B3)

Question 48

Inhibit of (HMG‐CoA) reductase ``` ↓Hepatic cholesterol synthesis → ↓Hepatocyte [Cholesterol] → ↑Hepatic expression of LDL receptors (a primary mechanism for LDL internalization & degradation) ```

Answer 48

Statins

Question 49

inhibition of transpeptidase, a PBP, causes rapid cell lysis by autolysins

Answer 49

``` Ceftriaxone Amoxicillin + clavulanate Penicillin G and V Piperacillin + tazobactam Ampicillin Nafcillin ```

Question 50

inhibits arabinosyl transferases, enzymes involved mycobacterial cell wall synthesis bacteriostatic

Answer 50

Ethambutol

Question 51

Inhibits DNA gyrase (gram-negative organisms; responsible for formation of negative DNA supercoils) Inhibits topoisomerase IV (gram-positive organisms; separates interlinked daughter DNA molecules that are a product of DNA replication

Answer 51

Fluoroquinolone- Levofloxacin

Question 52

Inhibits neuraminidase thus inhibiting release of the virus so that it cannot spread to other cells

Answer 52

Oseltamivir (oral) | Zanamivir (inhalation)

Question 53

inhibits one or more enzymes needed for the synthesis of mycolic acids (specific constituents of mycobacterial cell wall) drug is bacteriostatic for resting mycobacteria but bactericidal for rapidly dividing mycobacteria

Answer 53

Isoniazid

Question 54

Inhibits RNA synthesis by binding to the DNA-dependent RNA polymerase bactericidal

Answer 54

Rifampin

Question 55

inhibits synthesis of mycolic acid bactericidal

Answer 55

Pyrazinamide

Question 56

Inhibits uncoating: blocks proton channel inhibiting viral uncoating which requires acidic environment (influenza A virus contains a membrane protein M2 which forms a proton channel)

Answer 56

Amantadine

Question 57

inhibits vitamin K epoxide reductase which is the enzyme that regenerates reduced vitamin K; action in the liver

Answer 57

Warfain

Question 58

Irreversible inhibition of COX-1 which inhibits synthesis of TXA2 in platelets

Answer 58

Acetylsalicylic acid (aspirin)

Question 59

isotonic solutions that contain either saline or a saline equivalent which freely distribute within the extracellular fluid compartment Intravenous administration increases preload which increases stroke volume and cardiac output

Answer 59

Crystalloids

Question 60

Low doses: activation of D1-receptors leading to vasodilation Intermediate doses: also activation of β1 receptors and release of norepinephrine from nerve terminals leading to increased SV and HR High doses: also activation of α1 receptors leading to increased SVR

Answer 60

Dopamine

Question 61

Low doses: activation of β1-adrenergic receptors leading to increases in HR and contractility Increasing doses: More α1-receptor stimulation occurs, resulting in vasoconstriction and corresponding increased SVR

Answer 61

Epinephrine

Question 62

Muscarinic receptor antagonist

Answer 62

Ipratropium (intranasal)

Question 63

Na+ excretion & ↓Preload Inhibits Na+-K+-2Cl- symporter in TALH → ↑NaCl in tubular lumen & ↑Tubular urine →↓Blood volume & ↓Preload

Answer 63

Furosemide

Question 64

Peroxisome proliferator-activated receptor (PPAR)-α agonist ↓Fasting & postprandial Triglycerides via ↓VLDL, VLDL remnants & IDL – ↑Vascular expression of lipoprotein lipase – ↓Triglyceride synthesis

Answer 64

Fibrates

Question 65

Prodrug converted to an unknown active metabolite Active metabolite irreversibly blocks the P12Y12 component of ADP receptors on platelets, which in turn inhibits the binding of fibrinogen to glycoprotein IIb/IIIa on platelet surface

Answer 65

Clopidogrel

Question 66

recombinant human deoxyribonuclease depolymerizes the DNA from degenerating leukocytes (which cause purulent airway secretions), thereby decreasing viscosity of sputum

Answer 66

Dornase α

Question 67

``` Recombinant humanized (chimeric) monoclonal IgG antibody directed against circulating IgE blocking binding of IgE to mast cells and basophils ```

Answer 67

Omalizumab (Intravenous or subcutaneous)

Question 68

release of intra‐molecular nitric oxide (NO) leads to increased cGMP and vasodilation Decreases myocardial oxygen demand: - dilate large veins (capicitance vessels), thereby decreasing preload, which decreases myocardial oxygen demand, and cardiac work - decrease afterload Increases myocardial oxygen supply: Relaxation of large coronary epicardial arteries

Answer 68

Nitroglycerin | Isosorbide dinitrate; Isosorbide mononitrate

Question 69

reversible inhibitor of the P12Y12 component of ADP receptors on platelets

Answer 69

Ticagrelor

Question 70

selective inhibition of PDE4 leading to | increased intracellular levels of cAMP and a reduction in inflammation

Answer 70

Roflumilast

Question 71

Selectively inhibits intestinal absorption of dietary and biliary cholesterol in the small intestine Blocks sterol transporter NPC1L1 in brush border

Answer 71

Cholesterol absorption inhibitors Ezetimibe

Question 72

Smooth muscle - relaxation; important in bronchi Phosphodiesterase inhibition leading to increased cAMP Adenosine receptor blockade

Answer 72

Theophylline | Aminophylline

Question 73

Stimulates β1-receptors leading to an increase in the contractility of cardiac myocytes β2-vasodilatory > α1-vasoconstrictive actions leading to decreased SVR

Answer 73

Dobutamine

Question 74

Structurally related to codeine

Answer 74

Dextromethorphan

Question 75

Suppress inflammation | Decrease bronchial hyperresponsiveness

Answer 75

Beclomethasone; budesonide, flunisolide, | fluticasone (Inhaled)

Question 76

synthetic purine nucleoside analog; drug inhibits replication of RNA and DNA viruses

Answer 76

Ribavirin

Question 77

vascular V1-receptors coupled to phospholipase C activation leads to calcium release from sarcoplasmic reticulum in smooth muscle cells leading to vasoconstriction and increased SVR

Answer 77

Vasopressin

Question 78

Xa inhibitor causes a permanent conformational change in antithrombin

Answer 78

Fondaparinux

Question 79

α1-adrenergic agonist Increases systolic, diastolic, and mean arterial pressures through vasoconstriction

Answer 79

Phenylephrine

Question 80

α1-adrenergic receptor activation causes vasoconstriction increasing systemic vascular resistance and blood pressure β-adrenergic receptor activation causes bronchodilation and increases cardiac rate and contractility Inhibits release of mediators from mast cells and basophils

Answer 80

Epinephrine

Question 81

β2 adrenergic receptor agonists Activation of β2 receptors leading to increased adenyly cyclase activity leading to increased intracellular cAMP levels and bronchodilation

Answer 81

Albuterol (Inhaled & oral)

Question 82

β2 adrenergic receptor agonists Activation of β2 receptors leading to increased adenyly cyclase activity leading to increased intracellular cAMP levels and bronchodilation

Answer 82

Salmeterol (Inhaled)