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COMLEX/USMLE 1 > PHARM > Flashcards

PHARM Flashcards

1
Q

MOA: Blocks Na channels, State dependent- best in rapidly firing neurons
(combined with vasoconstrictors like Epi)
ADE: Arrhythmias, Cardiotoxicity

A

Local Anesthetics (indicated for minor procedures, and epidurals) **infected tissues need higher doses

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2
Q

MOA: Local anesthetic with 1 “I” in name, blocks NA channels
ADE: prone to causing allergic rxns, arrhythmias

A

Esters “cocaine, procaine”

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3
Q

MOA: Local anesthetic with 2 “I” in name, blocks NA channels
ADE: prone to LIVER FAILURE (metabolized in liver), arrhythmias, cardiotoxicity

A

Amides “Bupivacaine, lidocaine”

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4
Q

Local anesthetic that blocks Na channels, Class 1B antiarrhythmic, and use for ventricular dyrhythmias
ADE: “tingling”, respiratory depression, fatigue/drowsy, seizures

A

Lidocaine (Amide)

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5
Q

-Unknown Mechanism, act on GABA receptors
“HEISM” -HALOTHANE, ENFLURANE, ISOFLURANE, SEVOFLURANE, METHOXYFLURANE, Nitrous Oxide
ADE: resp depression, myocardial depression, bradycardia/hypotension, hepatotoxicity, nephrotoxicity, malignant hyperthermia, expansion of trapped gas

A

Inhaled Anesthetics
-Halothane: cause hepatotoxicity
-Enflurane: cause seizures
-Methoxyflurane: cause nephrotoxicity
-Nitric oxide: cause exp of trapped gas

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6
Q

-MOA: potentates GABA-A, leads to rapid anesthesia induction

A

Propofol (IV anesthetic)

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7
Q

-NMDA receptor antagonist (Arylcyclohexylamines), PCP analogs that block effects of glutamic acid at NMDA receptors
ADE: can lead to dissociative amnesia, hallucinations

A

Ketamine (IV anesthetic)

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8
Q

-Benzo Receptor Antagonist

MOA: reverses benzos via competitive inhibit of the benzo binding site on GABA receptor

ADE: seizures, intensive monitoring is necessary

A

Flumazenil (Benzo Receptor Antag)

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9
Q

-MOA: increase GABA

ADE: HYPOtension, respiratory depress, confusion, coma, drowsiness

TX: BY FLUMAZENIL

A

Benzo’s (Midazolam) -zepam/zolam
can be IV anesthetic

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10
Q

MOA: INCREASE Chloride Channel Opening, DECREASING neuron firing

-ultra short acting, IV anesthesia induction, short surgical procedures, *DOES NOT PROVIDE ANALGESIA (just LOC)
-TX: anxiety, seizures
ADE: resp/cardio depression

A

Barbituates (Thiopental) IV anesthetic

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11
Q
  • Gq protein coupled receptor, activates phospholipase C (PIP2–> DAG and IP3)
    -DAG–> protein kinase C
    -IP3–> phosphorylation

Leads to vasoconstriction, inc BP, pupillary dilator contraction, intestine/bladder sphincter contraction, in smooth muscle, URINARY RETENTION

A

Alpha 1 Receptor ***EPI PENS

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12
Q

-Gi protein coupled receptor, inhibit CAMP from ATP
-VASOCONSTRICT
-DECREASE sympathetic outflow (NE), insulin release in pancreas, lipolysis in adipose, aqueous humor production (treats glaucoma)
-INCREASE platelet aggregation

A

Alpha 2 Receptor (Brimonidine) tx: glaucoma

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13
Q

-Gs protein coupled receptor, stimulate adenylate cyclase to activate CAMP pathway–> protein Kinase A

-INCREASE HR/CO, contractility, renin release, lipolysis

A

Beta 1 Receptor

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14
Q

-Gs protein coupled receptor, stimulate adenylate cyclase to activate CAMP pathway–> protein Kinase A

-VASOLDILATE
-INCREASE CO/contractility/HR, insulin, lipolysis, aqueous humor production in eye, uterus relaxation, RELAX ciliary muscle, bronchodilator (tx asthma)

A

Beta 2 Receptor tx: asthma/stop early labor

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15
Q

-Cytochrome p450 inhibitors

A

-Quinidine, Ciprofloxacin, Isoniazid, Grapefruit juice, erythromycin, indinavir, cimetidine, sulfonamides, ketoconazole, amiodarone, Acute alc use

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16
Q

-cytochrome p450 inducers
**be careful taking birth control, can stop ur BC from working or other medications the patient is on

A

-Griseofulvin, Phenytoin, Carbamazepine, Rifampin, Barbituates, Chronic Alc Use, St. John’s Wort

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17
Q

-Class 1 Antiarrhythmic, fast inward NA currents

ADE: cinchonism, lupus like syndrome

A

Quinidine

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18
Q

End in “Navir”

A

-HIV drugs

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19
Q

-Flouroquinolone
-USED FOR GRAM NEG RODS of Urinaty/GI tracts

MOA: interferes with TOP II

A

-Ciprofloxacin (fluoroquinolone)

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20
Q

-MOA: decreases synthesis of MYCOLIC ACIDS, key components of cell wall of Mycobacterium TB

(only mono therapy prophylaxis against TB)

A

Isoniazid

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21
Q

-USED FOR B. PERTUSSIS, LEGIONELLA, MYCOPLASMA PNEUMO

-MOA: inhibits protein synthesis by binding to 23S RNA of 50S ribosomal subunit, blocking translocation

A

Erythromycin (macrolide)

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22
Q

MOA: HIV protease inhibitor that is used as antiretroviral therapy

TX: HIV/AIDS

A

Indinavir

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23
Q

MOA: Histamine H2 recetor ANTAG

TX: heartburn, decreases stomach acid production

A

Cimetidine

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24
Q

MOA: INHIBIT fungal ergol sterol synthesis

Tx: systemic mycoses

A

Ketoconazole

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25
Q

MOA: inhibit 50S ribosomal subunit, broad spectrum

TX: BACT MENINGITIS
(S. Pneumo, H. Influenza, N. Mening) AND ROCKY MOUNT SPOT FEVER

ADE: bone marrow suppress, aplastic anemia, gray baby syndrome (dec UDP glue transfer)

A

Chloramphenicol (protein synthesis inhibit)

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26
Q

-Antiarrythmic med

A

Amiodarone

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27
Q

-Oral Antifungal Drug, skin/nails
-MOA: interferes with microtubule function and mitosis of fungus

A

-Griseofulvin (Antifungal Drug)

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28
Q

-Antiepileptic Drug
-Class 1B anti arrhythmic
MOA: suppress abnormal brain activities by BLOCKING Na channels

A

Phenytoin (Antiepileptic Drug)

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29
Q

-Anticonvulsant, mood stabilizing drug
TX: epilepsy, trigeminal neuralgia

A

Carbamazepine (Anticonvulsant, mood stabilizing drug)

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30
Q

MOA: inhibiting DNA dependent RNA polymerase

TX: mycobacterium TB

A

Rifampin

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31
Q

Competitive muscarinic ANTAG
MOA: BLOCKS ACH in Muscarinic Receptors

-REVERSES “DUMBBeLSS”
Diarrhea, urination, mitosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating

-INC HR in bradycardia/dilates pupils/cycloplegia/mydriasis, ophthalmic procedures, and TX in organophosphate poisoning

-Use in Malignant glaucoma
-CONTRAINDICATED in narrow angle glaucoma

ADE: hot as a hare, mad as a hatter, red as a beet, dry as a bone

A

Atropine (anticholinergic)
does NOT block CNS excitation (e in DUMBBeLLS) bc that is by Nicotinic receptors

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32
Q

“B. O. AT. S”- blocks Ach, muscarinic antag
-Benztropine
-Oxybutynin
-Atropine
-Scopolamine

-REVERSES “DUMBBeLSS”
Diarrhea, urination, mitosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating

A

Anticholinergics

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33
Q

“PARK my BENZ”
MOA: muscarinic antag, blocks Ach
-can be used with Levodopa therapy to TX Parkinsons to reduce imbalance

ADE: blurry vision, dry mouth, urinary retention, tachy, constipation, psychosis

A

Benztropine (anticholinergic)

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34
Q

-antispasmodic med
MOA: muscarinic antag, blocks Ach

-TX: bladder spasms, stops frequent urination or urge incontinence

A

Oxybutynin (anticholinergic)

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35
Q

“SCOPe SICKNESS”
MOA: muscarinic antag, blocks Ach

TX: motion sickness, has sedative properties

A

Scopolamine (anticholinergic)

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36
Q

MOA: muscarinic antag, blocks Ach
TX: reduces airway secretions/stomach acid (helps in peptic ulcer)

**used with Neostigmine (Nm blocker) to prevent bradycardia

A

Glycopyrrolate (anticholinergic)

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37
Q

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach

-Bethanechol
-Pilocarpine
-Methacholine
-Carbachol

A

Direct Cholinomimetics

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38
Q

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach

TX: stimulate bladder contraction/GI motility, prevent urine retention

A

Bethanechol (direct cholinomimetic)

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39
Q

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach

-Causes Bronchoconstriction, Used as a test in diagnosis of asthma

A

Methacholine (direct cholinomimetic)

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40
Q

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach
**CONTRACTS Ciliary muscle for open angle glaucoma, and Pupillary/Iris Sphincter for closed angle glaucoma

-Stimulates saliva, sweat, tears, MIOSIS
-RESISTANT to acetylcholinesterase

TX: open angle/closed angle Glaucoma/ xerostomia

ADE: detached retina, decreased visual acuity, eye irritation, RARELY: bradycardia/bronchospasms

A

Pilocarpine (direct cholinomimetic)

**CONTRAINDICATION: AVOID IN ASTHMA OR BRADYCARDIA

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41
Q

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach
**RELIEVES intraocular pressure, pupillary constriction–> open angle
-TX: open angle glaucoma

A

Carbachol (direct cholinomimetic)

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42
Q

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors)

ADE: CAUSE “DUMBBeLLS”

DOESN’T CROSS BBB:
-Edrophonium
-Pyridostigmine/Neostigmine

CROSSES BBB:
-Physostigmine
-Donepezil

A

Indirect Cholinomimetics (Acetylcholinesterase Inhibitors)

CAUSE “DUMBBeLLS” (anticholinergic reverses it- the B.O.AT.S)

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43
Q

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (REVERSIBLE Acetylcholinesterase inhibitor)

USE: to DIAGNOSE Myasthenia Gravis, “tensilon test”, patients immediately show weakness, also to reverse non depolarizing drug blockade

**DOESNT CROSS BBB

A

Edrophonium (reversible indirect cholinomimetic acetylcholinesterase inhibitor)

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44
Q

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (REVERSIBLE Acetylcholinesterase inhibitor)

TX: MYASTHENIA GRAVIS

**DOESN’T CROSS BBB

A

Pyridostigmine
Neostigmine (also used to reverse Nm blockers in anesthesia/ Post surgery ileus)

*indirect cholinomimetic acetylcholinesterase inhibitors

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45
Q

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors)

-MORE HYDROPHOBIC that others

TX: atropine/anticholinergic drug overdoses, and induces miosis to help decrease intraocular press in Glaucoma

**CROSSES BBB

A

Physostigmine (indirect cholinomimetic acetylcholinesterase inhibitor)

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46
Q

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors)

TX: ALZHEIMERS DZ (to help increase Ach)

ADE: N/V, Dizziness
**CROSSES BBB

A

Donepezil (indirect cholinomimetic-acetylcholinesterase inhibitor)

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47
Q

-CAUSES “DUMBBeLSS”
Diarrhea, urination, miosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating

TX: Atropine (cross BBB) + Pralidoxime (cant cross)

A

Acetylcholinesterase Inhibitor Poisoning

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48
Q

Include “CUR”

MOA: Reversible competitive inhibitors of Ach, leads to less receptors available for Ach to bind to

USE: muscle paralysis during mech ventilation or surgery,

-Atracurium
-Mivacurium
-Pancuronium
-Rocuronium
-Tubocurarine
-Vecuronium

A

Nondepolarizing Nm BLOCKING drugs

TX: with acetylcholinesterase inhibitors (to increase Ach again) Neostigmine, Edrophonium

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49
Q

Tx: to reverse Nondepolarizing Nm Blocking drugs (Ach competitive inhibitors) “cur”

A

Neostigmine (tx myasthenia gravis) and Edrophonium (diagnoses myasthenia gravis)

**both are acetylcholinesterase inhibitors

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50
Q

-short term paralytic used in hospital

MOA: Nm blocking drug binding to motor nicotinic receptor, Ach AGONIST
-OPENS Na Channels

**keeps the nerve stuck in depolarizing/paralysis

Phase 1: Paralysis, NON reversible
Phase 2: Paralysis, Reversible/Ach receptors are desensitized to Ach (tx with Neostigmine to help reverse and overcome desensitization)

A

Succinylcholine (Ach receptor Agonist)

**induces paralysis

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51
Q

“AD BAC has HTN”
1- ACE inhibitors, lowers Ang 2 in body, preventing EA constriction in kidney, decreasing GFR, less aldosterone secretion (-“pril”)
2-Diuretics, lower BP by reducing fluid volume (osmotic, carbonic anhydrase inhibitors, loop, thiazide, potassium sparing)
3-Beta Blockers, reduce HR/CO/renin
(-“olol”)
4-Ang 2 receptor blockers, prevents Ang 2 from binding to AT1 receptor, reducing vasoconstriction (-“sartan”)
5-Calcium Chann Blockers (dihydropyridine), decrease resistance (-“dipine”)

A

Hypertension Medications for high blood pressure

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52
Q

MOA: inhibits ACE/RAAS (-“pril”)

lowers Ang 2 in body, preventing EA constriction in kidney, decreasing GFR, less aldosterone secretion

TX: HTN, CHF, Diabetic Neuropathy

ADE: increases bradykinin (vasodilator), cough CAPTOPRIL MNEUMONIC

A

ACE inhibitors (-pril)

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53
Q

-ADE: “CAPTOPRIL MNEUMONIC”

-COUGH
-ANGIOEDEMA
-POTASSIUM INCREASE (hyperkalemia)
-TASTE CHANGES
-HYPOTENSION
-PREGNANCY PROBS (can cause stillbirth, baby kidney damage, congenital malformations)
-RASH
-INC RENIN
-LOWER ANG 2

A

ACE inhibitors (-pril) TOXICITY

**affect EFFERENT ARTERIOLE OF GLOMERULUS

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54
Q

MOA: prevents Ang 2 from binding to AT1 receptor, reducing vasoconstriction, (-“sartan”)

*DO NOT AFFECT BRADYKININ (unlike ace inhibitors)… NO cough

USE: patients who are intolerant to ACE inhibitors, HTN, CHF, diabetic neuropathy

*CONTRAINDICATION: pregnancy

A

Ang 2 receptor blockers (-“sartan”)

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55
Q

Class 4 antiarrthymic -slow AV conduction (-“dipine”)

USE: angina pectoris, arrhythmias, essental HTN

*CONTRAINDICATED IN HEART BLOCKS

ADE: bradycardia, hypotension, constipation, peripheral edema, gingival hyperplasia

A

Calcium channel Blockers Verapamil and Diltiazem (non-dihydropyridine),

(-“dipine”)

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56
Q

MOA: inhibit Na-K-2Cl symporter in the THICK ASCENDING limb of loop of henle.

-Lower BP by reducing fluid volume, increases urine production, inhibiting Na/Cl reabsorption

USE: HTN, HYPERCALCEMIA, CHF

ADE: *allergic run, increase GOUT (hyperuricemia), ototoxicity, HYPOCALCEMIA, HYPOKALEMIA, HYPOMAGNESIUM, METABOLIC ALKALOSIS

**FUROSEMIDE is a SULFA drug, CONTRAINDICATED IN PT WITH SULFA ALLERGY

A

Loop Diuretics (furosemide-sulfa drug)

Ethacrynic Acid (phenoxyacetic acid derivative) is NOT a sulfa drug, so if pt needs a loop diuretic thats allergic to sulfa, can take E. Acid (everything else is same as Furosemide

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57
Q

MOA: osmotic diuretic, decreases water and Na reabsorption in PCT, inc water/Na EXCRETION, decreasing ECF volume, INCREASES URINE FLOW

**INC PLASMA/TUB FLUID OSMOLALITY

USE: high ICP, glaucoma, oliguric renal failure, drug overdoses

ADE: dehydration

A

Mannitol (osmotic diuretic)

*CONTRAINDICATED IN CHF/ANURIC PATIENTS (if they have no production of urine to begin with)

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58
Q

**FIRST LINE TX FOR HTN
MOA: inhibit NaCl and water reabsorption form DCT by blocking Na/Cl cotransporter (water also blocked)

USE: HTN, HYPOcalcemia, HYPERnatremia, edema

ADE: HYPERglycemia, HYPERlipidemia, HYPERcalcemia, HYPERuricemia, HYPOnatremia, HYPOmagnesium, HYPOkalemia Metabolic Alkalosis, DEHYDRATED

**Hydrochlorothiazide is a SULFA drug, CONTRAINDICATED IN PT WITH SULFA ALLERGY/ DO NOT GIVE TO PT BREASTFEEDING/PREGNANT

A

Thiazide Diuretics (Hydrochlorothiazide- sulfa drug)

**“thiazides cause hyperGLUC: hyperGLYCEMIA, hyperLIPIDEMIA, hyperURICEMIA, hyperCALCEMIA”

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59
Q

-MOA: inhibits carbonic anhydrase in PCT, leads to sodium bicarb diuresis/reduced bicarb in kidneys/ body, **SULFA drug

USE: glaucoma (dec IOP/dec aqueous humor in eye), altitude sickness, pseudo tumor cerebri, CHF, metab alkalosis

ADE: hyperchloremic metab acidosis, paresthesias, TYPE 2 renal tubular acidosis,

A

Acetazolamide (Carb Anhydrase Inhibitor)

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60
Q

-Blocking Na Channels/Competitive Aldosterone receptor Antagonist in Cortical Collecting Tubule/collecting duct

USE: CHF, HTN, HYPOKALEMIA (to increase K), HYPERALDOSTERONISM, EDEMA

ADE: HYPERkalemia (muscle weakness, fatal arrhythmias), HYPOaldosterone, HYPOnatremia, Gynecomastia/ED/low libido with spironolactone/Endocrine effects

**TELL PT TO AVOID POTASSIUM SUPPLEMENTS

A

K+ sparing diuretics (Spironolactone-androgen blocker ADE)/Eplerenone (like spironolactone but no androgen ADE)

**Amiloride and Triamterene are K+ sparing diuretics that act on Epithelial Sodium Channels (ENaC)

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61
Q

MOA: block/slow fast conduction in Na channels, especially depolarized cells

-REDUCES Phase 0 Depolarization SLOPE/rate
-INCREASE ERP/QT/AP/QRS
-INCREASE threshold for firing in abnormal pacemaker cells
-STATE DEPENDENT

TX: Atrial/Ventricular Tachy, Reentranct, Ectopic SVT arrhythmias (Wolfe parkinson), local anesthetics

**CONTRAINDICATED IN HYPERKALEMIA PT (too much K)

A

Class IA Antiarrhythmics (Na channel blockers)
-Procainamide, Quinidine, Disopyramide

“Double Quarter Pounders”

ALL^ ADE: TORSADES

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62
Q

-Class 1A Antiarrhythmic (Na channel blocker)
-longest half life
-USE: Ventricular Arrhythmias

ADE: Big anticholinergic side effects, worsen heart block/severe HF, TORSADES

A

DISOPYRAMIDE

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63
Q

-Class 1A Antiarrhythmic (Na channel blocker)
-Similar to others except less GI ADE, and is safer to use intravenously

ADE: DRUG INDUCED LUPUS (anti histone antibodies), TORSADES

A

PROCAINAMIDE

**only Class 1A that has ADE with drug induced lupus

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64
Q

-Class 1A Antiarrhythmic (Na channel blocker)

USE: SVT and Ventricular Arrhythmias, also used for prevention

ADE: CINCHONISM (dizzy, ringing in ears, diarrhea), thrombocytopenia, TORSADES

A

QUINIDINE

**only Class 1A that has ADE with cinchonism and thrombocytopenia

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65
Q

-MOA: highly selective for ischemic or depolarized Purkinje/Ventricular tissue, -shorten duration of ERP
-DECREASE AP, QT
-affect ischemic tissue

USE: POST MI TX, ventricular arrhythmias, digitalis overdose, TREATS TORSADES!!! **SEIZURES

ADE: CNS depress (lidocaine), GI probs (mexiletine), Drug induced lupus/ gingival hyperplasia, teratogenic effects, hirsutism/HYPERTRICHOSIS (excessive hair growth) (ALL IN PHENYTOIN), TINGLING

A

CLASS 1B NA CHANNEL BLOCKERS

-MEXILETINE
-LIDOCAINE
-TOCAINIDE
-PHENYTOIN

“MAYO, LETTUCE, TOMATO, PICKLE”

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66
Q

CLASS 1B NA CHANNEL BLOCKER

ADE: GI probs, abd discomfort

A

MEXILITINE

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67
Q

“LAST RESORT” Na channel blocker, use dependent in AV NODE/ACCESSORY TRACTS

-INCREASE QRS
-NO EFFECT ON AP, minimal QT

TX: SEVERE V TACH

Flecainide also tx: paroxysmal AFib and Atrial flutter

ADE: CHF, bradycardia, new arrhythmias

**CONTRAINDICATED IN POST - MI, ischemic heart disease

A

CLASS 1C ANTIARRYTHMICS NA CHANNEL BLOCKER
-PROPAFENONE
-FLECAINIDE

“FRIES PLEASE”

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68
Q

-K CHANNEL BLOCKER
-used when others fail
MOA: INCREASE AP/ERP/QT, they PROLONG depolarization in AV MYOCYTES (do not slow conduction like in Class 1A)

USE: ARRYTHMIAS
VTACH: amiodarone/Sotalol
afib/flutter: ilbutilide, dofetilide

ADE: ilbutilide/sotalol can cause TORSADES

A

CLASS 3 ANTIARRHTHMICS
K CHANNEL BLOCKER

-AMIODARONE (long half life, always check function tests- causes pulmonary fibrosis, hepatotoxicity, hypo/hyper thyroid)- VTACH

-ILBUTILIDE (afib/a flutter) (ade: TORSADES)

-dofetilide (afib/a flutter)

-sotalol (non selective b blocker) ADE: dizzy, TORSADES (VTACH)

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69
Q

-decrease conduction velocity (SA/AV nodes)
-INCREASE PR/ERP

TX: SVT DUE TO AV NODAL REENTRY/HTN/angina/Raynauds (Verapamil/Diltiazem), subarachnoid hemorrhage (Nimodipine)

ADE: CHF, AV block, sinus node depression, peripheral edema, constipation/gingival hyperplasia (especially verapamil)

A

CLASS 4 ANTIARRHTHYMICS
CALC CHANNEL BLOCKERS

-VERAPAMIL
-DILTIAZEM
-NIMODIPINE

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70
Q

MOA: inhibit bacterial cell well synthesis, block transpeptidase/bind to PBP
**BACTERICIDAL: cause bacterial cell death

ADE: HS type 3 rxns, vit k deficiency, disulfiram like rx when taken with alcohol, nephrotoxicity when taken with ahminoglycosides, pseudomembranous colitis, AI hemolytic anemia

A

Cephalosporins (Beta lactams)

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71
Q

*least extensive coverage
*inhibit bacterial cell wall
*P, E, K, S,S *

USE: gram positive cocci bacterial infections (staph/strep), also as pre operative prophylaxis, also gram neg (p. mirabilis, E. coli, Klebs)

*Methicillin sens Staph Aureus (MSSA), with cephalexin

A

FIRST GEN CEPHALOSPORINS (beta lactams) (FAZ/LEX)

-Cefazolin (IV/IM)
-Cephalexin (oral) -endocarditis prophylaxis

*P, E, K, S,S *

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72
Q

*inhibit bacterial cell wall
-gram neg, gram pos cocci, anaerobes
*P, E, K, H, E, N, S”
P. MIRABILIS
E. COLI
KLEBS
H. INFLUENZ
ENTEROBACTER
N. GON
SERRATIA marcessans

CEFUROXIME: only second gen that can CROSS BBB, (active against H. influenza, N. Gonorrhea, Lyme)

A

SECOND GEN CEPH (B LACTAMS)
“FOX WEARS FUR CLOTHES”

-cefoxitin
-cefuroxime
-cefaclor- ADE: SERUM SICKNESS

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73
Q

*inhibit bacterial cell wall/block peptidoglycan synthesis
-gram neg, gram pos cocci except enterococcus that are resistant to other gens “serious gram neg”

-TX all bacterial meningitis besides listeria

THEY ALL CROSS BBB

CEFTAZIDIME: ONLY 3RD GEN that can tx pseudomonas

A

THIRD GEN CEPH (B LACTAMS)
“tax, taz, triax, at dinner”

-cefotaxime
-ceftriaxone
-cefdinir
-ceftaz **only one against pseudomonas

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74
Q

*inhibit bacterial cell wall
-cover pseudomonas/enterococcus
-mod-severe hospital acquired infections by multi resistant bacteria including resistant strep pneumonia/enterococcus

A

FOURTH GEN CEPH (B LACTAMS)
“fepi the fourth”

-cefepime

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75
Q

*inhibit bacterial cell wall
**MOST COVERAGE, BUT DO NOT HAVE COVERAGE AGAINST PSEUDOMONAS

-specifically created for resistant bacteria like meth res staph aureus (MRSA)

-BROAD spectrum gram pos/neg INCLUDING ENTEROCOCCUS FAECALIS/LISTERIA

A

FIFTH GEN CEPH (B LACTAMS)
“5 TAR TOBI”

-ceftobiprole
-ceftaroline

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76
Q

MOA: bind to 23S ribosomal RNA in the 50S subunit which catalyzes formation of peptide bond, inhibits protein synthesis by blocking translocation

bacteriostatic
**gram pos cocci, atypical pneumonia, chlamydia

ADE: can lead to QT prolong, TORSADES, diarrhea, p450 inhibit, skin rash, eosinophilia, cholestatic hepatitis

A

Macrolides “-thromycin” (erythromycin, azithromycin”

**MACRO:
-motility probs
-arrhythmias (torsades)
-cholestatic hep
-rash
-eOsinophilia

-p450 inhibit

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77
Q

MOA: inhibits TOP 2 (DNA gyrase) and 4, prevents bacteria from replicating their DNA
**bactericidal

USE: gram neg rods, pneumonia, GI infxns, UTI, genital infections

ADE: tendon rupture, cartilage damage in young pt, QT prolong/teratogen/diarrhea/headache

A

Fluoroquinolones (-floxacin)

-Levo/Cipro: have psedommonas coverage

**avoid antiacids/polyvalent cations/TERATOGEN

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78
Q

Cell Wall Inhibitors
“CC is MVP”

*they have a beta lactam ring in their molecular structure

A

-penicillins
-cephalosporins
-monobactams
-carapenems
-vancomycin

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79
Q

MOA: cell wall inhibitor
-gram neg coverage, useful for penicillin allergies

A

Aztreonam (monobactam- only important one)

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80
Q

MOA: cell wall inhib
-gram pos, gram neg, anaerobic coverage

**Cilastin is often used with this to prevent breakdown by the kidneys

A

Carbapenems (imipenem and meropenem)

*they have a beta lactam ring in their molecular structure

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81
Q

-Clavulanic acid, sulbactam, tazobactam

A

Beta-Lactamase Inhibitors

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82
Q

Penicillins that have activity against pseudomonas:

A

-Ticarcillin, piperacillin

*they have a beta lactam ring in their molecular structure

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83
Q

-resistant to penicillinase
Penicillins that have activity against S. Aureus:

A

-Oxacillin, Nafcillin

*they have a beta lactam ring in their molecular structure

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84
Q

MOA: inhibit 30s subunit of ribosome leading to cell death, inhibit formation of initiation complex, resistance by Transferase enzymes

**bactericidal activity
-against gram neg rods (including pseudomonas, enterobacter)

-RESISTANT to anaerobes bc they require O2 for uptake, acetylation, adenylation, phosphorylation

ADE: nephrotoxic (esp w cephalosporins), ototoxic (esp w loop diuretics), teratogen

A

-Aminoglycosides (-“mycin”

(gentamicin, neomycin, amikacin)

*Neomycin is popular bowel surgery prep

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85
Q

-protein synthesis inhibit
-inhibits 50S subunit/blocks translocation
*bacteriostatic
-gram pos, anaerobes, strep/MRSA, aspiration pneumo/lung abscess/STI
(LUNG INFXN ABOVE DIAPHRAGM)
-B. Fragilis/C perf

ADE: pseudomemb. colitis

A

Clindamycin

86
Q

-protein synthesis inhibitors
-inhibit 30S bacterial subunit, to prevent aminoacyl attachment

-broad spectrum, limited CNS penetration/divalent cations inhibit absorption (cant take with milk, antacids, iron)

-lyme, myco pneumo, chlamydia, rickett, H. pylori

ADE: photosensitivity, teeth discoloration in children/GI distress, pill esophagitis/ TERATOGENS/inhibit bone growth in kids

A

Tetracyclines (doxycycline, minocycline)

87
Q

-protein synthesis inhibitor
-inhibit 50S ribosomal subunit /bind 23S r RNA
-ONLY against gram pos bacteria
*bacteriostatic
(meth resist MRSA, Vano resist enterococci)

ADE: bone marrow suppress, peripheral neuropathy, SEROTONIN SYND (excess serotonin, so do not use SSRI’s/MALI’s), decreased platelets, lactic acidosis

**AVOID TYRAMINE FOODS (cheese, meat, pickle, wine)

A

Linezolid

88
Q

Protein Synthesis Inhibitors (50S)/block translocation- 23S rRNA *bacteriostatic
MCLC

A

-Macrolides
-Clindamycin
-Linezolid
-Chloramphenicol

89
Q

Protein Synthesis Inhibitors (30s), bactericidal
AT

A

-Aminoglycosides
-Tetracyclines

90
Q

MOA: inhibition of bacterial DNA replication, broad spectrum

inhibit dihydropteroate synthase and dihydrofolate reductase

USES: gram pos/neg/MRSA

A

Sulfonamides (sulfamethoxazole/Trimethoprim)

Sulf: inhibits first enzyme DHP synthase
Trim: inhibits second enzyme DHF reductase

91
Q

MOA: cell wall inhibitor, has beta lactam ring, blocks transpeptidase (PBP) cross linking of cell wall, activates auto lytic enzymes

**bactericidal/beta lactamase sensitive

USES: gram pos, spirochetes (syphilis)

ADE: HS rxns (type 1), hemolytic anemia

A

Penicillins

92
Q

MOA: binds to D ala D ala (CHANGES TO D ala D lac), Inhibiting cell wall mucopeptide (N-acetylglucosamine/N-actetylmuramic acid)

**bacteriostatic against C DIFF (given to pt ORALLY w pseudomem colitis from taking c diff), bactericidal against S. AUREUS (IV)

**ONLY FOR GRAM POS/MRSA

ADE: RED MAN syndrome (nephrology, oto, thrombophlebitis-swelling/blood clot) **nonspecific mast cell degranulation leads to histamine release, diffuse flushing of face/neck/torso, prevented with antihistamine/slow IV infusion rate

**DRESS syndrome, delayed onset (drug rxn w eosinophils and systemic symptoms) fever, face edema, organ dysfunction

A

Vancomycin

93
Q

What Tetracycline treats SIADH/hyponatremia with ADE of nephrogenic DI in people without SIADH? (ADH antagonist)

A

Demeclocycline

94
Q

What Tetracycline has the longest acting, longest half life, most lipid soluble, highest penetration in the brain with ADE large amount of CNS effects like vertigo?

A

Minocycline

95
Q

What Tetracycline is used in prophylaxis against malaria, is fecally eliminated, and CAN be used in patients with renal failure?

A

doxycycline

96
Q

MOA: INHIBIT fungal ergol sterol synthesis, damages DNA

-bactericidal, forms free radical toxic metabolites, damages DNA

USE: garnella, trich, e. histolytica,
ADE: METALLIC TASTE IN MOUTH, disulfiram rxn w alcohol , ANAEROBIC LUNG INFXNS BELOW DIAPHRAGM (clinda is above)

A

Metronidazole

97
Q

-Immunosuppressent that impedes the innate immune response via dec activation of B cells. (Neut/Eiosin are inhibit with this med)

TX: malaria, RA, SLE, porphyria cutanea tardia

ADE: cardiotoxic, retinopathy (bullseye appear of macula/corneal damage), prolong QT, hemolysis in pt with G6PD def, Gi upset

A

Hydroxychloroquine (antiparasitic, immunosuppressive drug)

**should get eye exams within one year of starting

98
Q

-oral anticoagulant/prevents thrombosis/embolism
MOA: inhibits epoxide reductase/interferes w vit k clotting factors /p450

**targets extrinsic path

-inactivates prothrombin, factors 2, 7, 9, 10, C, S

ADE: lead to excessive bleeding/hemorrhage/necrosis if taken in EXCESS, TREAT THIS WITH VIT K!!! (treats fact 2, 7, 9, 10, protein C/S and helps reverse anticoagulation of warfarin)/ or fresh frozen plasma *MUCH quicker than Vit K

A

Warfarin

TERATOGEN, MONITOR INR/PT

99
Q

treats fact 2, 7, 9, 10, protein C/S and helps reverse anticoagulation of warfarin (slow)

A

Vitamin K

100
Q

treats fact 2, 5, 7, 9, 10, 11, protein C/S and helps reverse anticoagulation of warfarin (FASTER than vit k)

A

Fresh Frozen Plasma

101
Q

What is the medication for Acetaminophen overdose?

A

N-acetylcysteine - replenishes glutathione

102
Q
  • inhibit thrombin (factor 2) to suppress clotting factors, and prevent platelet aggregation (no decrease in platelets)

*continuous IV, frequent aPTT monitoring
ADE: can cause bleeding, but not associated with causing HIT, you will add this to stop HIT

A

Dabigatron (oral) and Argatroban - both Direct thrombin inhibitors

103
Q

MOA: targets 10a and 2a (thrombin)
-cofactor of antithrombin, inactivates X/IIa/short half life (helps break clots)
-binds to inhibitor antithrombin 3, causing activation of antithrombin 3, inactivates 9, 10, thrombin

-LMWH has longer half life/bioavailability (acts more on Xa) only inactivates factor 10, so aPTT is NOT prolonged

USE: Acute coronary syndrome, a fib, embolism

ADE: bleeding, heparin induced thrombocytopenia (HIT) (5-10 days after exposure, caused by heparin platelet factor 4 antibody complex–> PLATELET RELEASE/AGGREGATION, PLATELETS FALL BY 50%, you will stop heparin, start DIT- fondaparinux/danaparoid/rivaroxaban. Can be diagnosed with serotonin release assay))

TX OTHER HEPARIN OVERDOSE WITH PROTAMINE SULFATE

A

HEPARIN

SAFE IN PREG
-MONITOR aPTT (but not if using LMWH)

104
Q

-histamine H1 receptor antagonists
-diphenhydramine (benadryl)
-Promethazine
-Phenergan
-Chlorpheniramine

USE: allergies, N/V, Motion sickness, anaphylaxis

ADE: sedation, anticholinergic effects

A

FIRST GEN ANTIHISTAMINES

105
Q

-histamine H1 receptor antagonists (faster/longer acting…liphophobic)
-azelastine + fluticasone (nasal spray)
-cetirizine
-loratadine
-fexofenadine

***FEWER CNS effects/less anticholinergic/ less sedative than first gen

A

SECOND GEN ANTIHISTAMINES

106
Q

-Inhibits ergosterol synthesis/P450
-INHIBITS 14 a DEMETHYLASE (that converts lanosterol to ergosterol)

USES: fungal/candida (pseudohyphae and budding yeast), LOCAL AND LESS SERIOUS SYSTEMIC MYCOSES EXCEPT FLUCONAZOLE

ADE: inhibits testosterone synthesis, gynecomastia/liver dysfunction, teratogen

A

-Azoles (ketoconazole)/antifungal

Itraconazole: Blastomyces, Cocci, Histoplas
-voriconazole: Invase aspergillosis
-Fluconazole: can be used for CHRONIC cryptococcus/candida in AIDS, candida

107
Q

-anytipyretic/analgesic drug
MOA: reversible inhibition of COX enzymes in CNS, direct action on hypothalamus/OCCURS PRIMARILY IN CNS

USES: fever, pain, given to children instead of aspirin (prevent Reye’s)
-lacks anti inflammatory/anti platelet efects (seen w aspirin/NSAIDS)

ADE: CENTRILOBULAR hepatic necrosis (overdose= INc NAPQI and inc reactive oxygen species)

TX OVERDOSE WITH N-ACETYLCYSTEINE (GLUTATHIONE)

A

ACETAMINOPHEN (tylenol)-

108
Q

-anti inflammatory, anti analgesic, anti pyretic

MOA: REVERS INHIB OF COX 2/1, BLOCKS PROTAGLANDIN/ THROMBOXANE SYNTHESIS

COX 2 INHIBITOR = anti inflammatory
COX 2/COX 1 INHIB COMBO= anti analg
BLOCK PGE2 (via COX inhibit)= for fever
BLOCK PGE2 (indometh)= CLOSE PDA

ADE: interstitial nephritis, gastric ulcer, renal ischemia/RASH IN CHILDREN/thrombosis/do NOT TAKE W ALC

A

NSAIDS (ibuprofen, advil, motrin, naproxen, indomethacin, keorolac, aspirin)

**AVOID W ALCOHOL

109
Q

-ani inflammatory/antipyretic/anti analgesic/ antiplatelet (INC bleeding time w/out affecting PT or PTT)

MOA: IRREVERSIBLY inhibit COX 2/1,
suppresses PROTAGLANDIN/ THROMBOXANE SYNTHESIS

USE: fever, pain, HA, CV disease (prevent MI/ischemic stroke)

ADE: REYE’S SYN= micro vesicular statuses of hepatocytes/hepatoenceph. /death , TINNITUS, PEPIC ULCER, mixed resp alkalosis/met acidosis, nephropathy / hyperthermia / hyperventilating

TX: FOR ASPIRIN TOXICITY= SODIUM BICARBONATE

A

ASPIRIN (acetylsalicylic acid)/NSAID but it is irreversible not reversible

(if overdose= sodium bicarb)

110
Q

Tetracyclines
Fluoroquinolones
Sulfamethoxazole
Thiazide diuretics/loop diuretics

ALL have a ADE of what??

A

Photosensitivity- must tell pt to wear sunscreen

111
Q

Metronidazole
Procarbazine
1st gen sulf (chlorpropamide)
3rd gen cefperazone
2nd gen cefamandole

ALL have a ADE of what??

A

Disulfiram like Rxn- must tell pt to avoid alcohol

112
Q

How do you treat torsades? (PVT)

A

Magnesium Sulfate

113
Q

How do you treat Afib/Aflutter?

A

-Adenosine
Amiodarone
-Beta Block
-Calc chan block (V/D)
-Digoxin

114
Q

How do you treat digoxin toxicity?

A

Magnesium Sulfate

115
Q

How do you treat Monomorphic Vent Tachy?

A

Amiodarone
Lidocaine

116
Q

How do you treat Paroxysmal Supraventricular Tachy?

A

Adenosine

117
Q

How do you treat Sinus Bradycardia?

A

Atropine

118
Q

How do you treat tricyclic antidepressant toxicity? (aspirin)

A

Sodium Bicarbonate

119
Q

How do you treat serotonin syndrome? (hyperreflexia, disoriented, vomit, Hypertonic Emergency/fever, tremors, agitation, rigid, flushed skin, dilated pupils) -probably mixed w depression meds/”took med for migraine” (probs sumatriptan)

A

Cyproheptadine-serotonin antag (5-HT2 Block)

120
Q

How do you treat Neuroleptic Malignant Syndrome? (taking typical antipsychotics (D2 blockade) like haloperidol and fluphenazine, causing parkinsonism, HTN, hyperthermia, normal/reduced bowels?

A

-Dantrolene (ryanodine receptor binding/inhibiting calcium release from SR), cooling, sedation

121
Q

How do you treat Strep Pneumonia (gram pos lancet shaped diplococci, MCC of bacterial meningitis)?

A

Ceftriaxone plus vancomycin (steroids before antibiotics)

122
Q

How do you treat N. Meningitis (gram neg diplococcus, common in young pt in dorm rooms/army recruits)

A

Ceftriaxone

123
Q

How do you treat Listeria Mono? (facultative anaerobic gram pos rod, older pt >50)

A

Trimeth-Sulfa or Ampicillin (if penicillin allergy)

124
Q

How do you treat HSV/HSV encephalitis? (temporal lobe necrosis, blood tinged CSF, periodic materializing epileptiform discharges on EEG)

A

Acyclovir

125
Q

Treatment of Cryptococcal Meningitis? (AIDS < 100, super high opening pressure, india ink stain quick diagnosis)

A

Amph B + Flucytosine

126
Q

Treatment of Tox. Gondii? (AIDS <100, not on prophylactic TMP-SMX, multiple ring enhancing lesions on MRI)

A

Pyrimethamine and Sulfadiazine

127
Q

-MOA: main antagonism of both postsynaptic serotonin 2A and dopamine receptors

TX: SCHIZOPHRENIA (hallucinations, hearing things, disorganized speech, delusions)

ADE: LOW NEUTROPHIL COUNT (AGRANULOCYTOSIS), weight gain, neuroleptic malignant syndrome

A

-CLOZAPINE *atypical antipsychotic

(must monitor WBC count for first 6 months of pt taking and CBC if pt has any fever or infection signs)

128
Q

MOA: monoamine oxidase inhibitor (halI), irreversibly blocking monoamine oxidase (enzyme responsible for NT degradation such as serotonin, NE, dopa)

TX: depression

-TYRAMINE CONTAINING FOOD INTERACTION!!!
ADE: SEVERE HTN/HTN CRISIS, encephalopathy, papilledema, cardiac ischemia, acute kidney failure

YOU TREAT THIS ^^^^ WITH PHENTOLAMINE (reversible nonselective alpha blocker)

A

Phenelzine (MAO-I)

129
Q

What treats Strep Pneumonia (all bacterial meningitis bacteria)?

A

third gen cephalosporins + vancomycin

130
Q

Bacterial Meningitis in children strands (pos kerning, brudzinski, etc)

A

-Strep pneumo
-H. influenza
-N. Meningitis

131
Q

MOA: block potassium channel in pancreatic B cell membrane to reduce outflow of potassium, opens calcium channel, increasing calcium, releasing insulin to manage elevated glucose levels

use: type 2 diabetic drug

ADE: elderly is at high risk of ADE, hypoglycemia, rapid HR, dizzy, sweating, increased appetite, weight gain

A

Second Generation Sulfonylureas
-glipizide
-glyburide
-glimepiride

132
Q

MOA: block potassium channel in pancreatic B cell membrane to reduce outflow of potassium, opens calcium channel, increasing calcium, releasing insulin to manage elevated glucose levels

use: type 2 diabetic drug

ADE: elderly is at high risk of ADE, hypoglycemia, rapid HR, dizzy, sweating, increased appetite, weight gain
**DISULFIRAM LIKE RXN W ALCOHOL

A

First Generation Sulfonylureas
-chlorpropamide
-tolbutamide

133
Q

MOA: decreased hepatic gluconeogenesis via inhibition of mitochondrial glycerophosphate dehydrogenase/
activates AMP kinase to allow for reduced hepatic gluconeogenesis

**inc glycolysis, insulin sens, peripheral glucose uptake

use: type 2 diabetes

ADE: lactic acidosis, dec vitamin B12 levels, GI upset

A

Metformin (biguanide class)

134
Q

Moa: peroxisome PPAR-y AGONISTS, allows for glucose uptake into fat and muscle, reduces insulin resistance/inc insulin sensitivity

ADE: fluid retention, weight gain, edema, HF, fractures, osteoporosis, monitor liver function

A

Thiazolidinediones (pioglitazone, rosiglitazone)

135
Q

MOA: competitive inhibitors of intestinal brush border ALPHA GLUCOSIDASE (delays starch digestion), DEC GLUCOSE ABSORPTION, DEC POSTPRANDIAL HYPERGLYCEMIA

use: type 2 diabetes

ADE: flatulence, GI pain, diarrhea

A

Alpha glucosidase inhibitors
-acarbose, miglitol

136
Q

MOA: suppresses glucagon release, delays gastric emptying, controls appetite

use: type 2 diabetes

ADE: pancreatitis, medullary thyroid cancer

A

GLP-1 agonists
-liraglutide, dulaglutide

137
Q

MOA: inhibit DPP4, enhances GLP-1, DEC glucagon/gastric emptying, promotes satiety.. INC GLUCOSE DEP INSULIN RELEASE

use: type 2 diabetes

ADE: URI, HA, may increase risk of cancer, RESP infixes

A

DPP4 Inhibitor
-sitagliptan, saxagliptin

138
Q

type 2 diabete drugs: “1, 2 Always Take Diabetes Meds Gamma”

A

1st gen sulfonylureas (tolbutamide/chlorpropamide)
2nd gen sulfonylureas (glip, glyb, glime)
Metformin
Thiazolidinediones (pioglitazone, rosiglitazone)
Alpha glucosidase inhibitors (acarbose, miglitol)
GLP 1 agonists (-liraglutide, dulaglutide)
DPP4 Inhibitor (sitagliptan, saxagliptin)

139
Q

MOA: alkylating agent, cross links DNA (PLATINUM CONTAINING ANTINEOPLASTIC TUMOR TX)

USE: testicular, bladder, ovary, lung carcinomas

ADE: Nephrotoxicity (administer amifostine), neurotoxic, ototoxic, SEVERE N/V, BM suppress, Renal magnesium wasting, HYPOCALCEMIA, HYPOMAGNESIUM, HYPOKALEMIA, HYPONATREMIA

(Usually requires serotonin 5HT3 antagonist (ondansetron), and Neurokinin 1 blocker (aprepitant) to prevent N/V)

A

CISPLATIN

140
Q

MOA: Binds to DNA and iron, DNA-bleomycin-iron (Fe3+) complexes cause DNA breaks (antineoplastic drug)

Use: Hodgkin lymphoma, testicular cancer

ADE: pulmonary fibrosis, hyperpigmentation, rash

A

Bleomycin

141
Q

MOA: alkylating agents at N7 of guanine *antineoplastic drug

ADE: hemorrhagic cystitis *administer mesna, BM suppression, Vessication (mechlorethamine), N/V

A

Cylophosphamide, Ifosfamide

142
Q

MOA: inhibit Top 2 of S and G2 phases (antineoplastic tumor drug), to increase DNA degradation

USE: Small cell lung cancer, testicular carcinomas, lymphoma/leukemia, Ewing sarcoma

ADE: N/V, BM suppression, hypersensitivity, HAIR LOSS (alopecia), GI irritation

A

Etoposide, Teniposide

143
Q

MOA: inhibit Top 1 of S phase (antineoplastic tumor drug), preventing DNA unwinding, replication

USE: colon cancer, ovarian cancer, small cell lung cancer

ADE: N/V, BM suppression, weakness, diarrhea

A

Topotecan, Irinotecan

144
Q

MOA: alkylating agent (antineoplastic tumor drug) and cross links strands of DNA, cell cycle nonspecific

USE: Chronic Myelogenous Leukemia, and for BM ablation before BM transplant

ADE: pulmonary fibrosis, hyperpigmentation

A

Busulfan

145
Q

MOA: intercalating agent, produces free radicals, inhibits TOP 2 of cell cycle nonspecific (antineoplastic tumor drug)

ADE: N/V, BM suppression, cardiotoxic from free radicals (administer dexrazoxane)

A

Doxorubicin

146
Q

MOA: inhibit Microtubule polymerization of M phase/ inhibit mitotic spindle formation (antineoplastic tumor drug)

ADE: peripheral neuropathy, BM Suppression

A

Vinca Alkaloids:

  1. Vincristine (peripheral neuropathy)
    USE: diffuse b cell lymphoma, ALL, lymphoma, neuroblastoma, rhabdomyosarcoma, wilms tumor
  2. Vinblastine (BM suppression)
    USE: Kaposi sarcoma, Langerhans, lymphoma, testicular cancer
147
Q

MOA: inhibit microtubule DEpolymerization at M phase / PREVENT mitotic spindle BREAKDOWN (antineoplastic tumor drug)

USE: MC for advanced ovarian carcinoma, breast cancer, non small cell lung cancer

ADE: Hypersensitivity, N/V, peripheral neuropathy , BM suppression

A

Taxane Class:

Paclitaxel, Docetaxel

148
Q

MOA: non ergot, synthetic dopamine agonists, can be administered to patients with Parkinson’s who are taking levodopa and are experiencing restless legs/on off phenomenon

**nonergot derivatives do not exacerbate vasospasm in pt with concomitant peripheral vascular disease/pulmonary/retroperitoneal fibrosis

USE: Parkinsons, restless leg

ADE: N/V, uncontrolled impulses (gambling), hallucinations, delusions, postural hypotension

A

Pramipexole (scavenge free radicals),
ropinrole (effective as mono therapy),
Rotigotine (transdermal formulation)

149
Q

MOA: ERGOT dopamine agonists, can be administered to patients with Parkinson’s who are taking levodopa and are experiencing restless legs/on off phenomenon

USE: Parkinsons, restless leg, HYPERPROLACTINEMIA/ADENOMAS

ADE: VASOSPASMS, N/V, uncontrolled impulses (gambling), hallucinations, delusions, postural hypotension

A

Bromocriptine (ergotamine)- **can also treat hyperprolactinemia and adenomas

150
Q

MOA: inhibits enzymatic action of aromatase, that normally converts androgens into estrogens in females.

USE: hormone receptor positive breast cancer

A

Anastrozole

151
Q

MOA: androgen that suppresses the mid cycle surge of FSH and LH, resulting in reduction of ovarian estrogen production

ADE: excessive hair growth!!

USE: endometriosis, fibrocystic breast cancer

A

Danazol

152
Q

MOA: competitive inhibitor of 5 alpha reductase, which normally metabolizes testosterone –> dihydrotestosterone (DHT). this blocks peripheral conversion of testosterone to DHT leading to a decrease of DHT

USE: chronic treatment of benign prostatic hyperplasia, and male pattern baldness, TERATOGEN IN PREGNANCY(STAY AWAY FROM PREG FEMALES, can cause baby boy to have feminism characteristics)

**HAS NO ROLE IN MANAGING METASTATIC PROSTATE CANCER, PSA> 5 = BPH, PSA>50= PROSTATE CANCER

A

Finasteride

153
Q

MOA: osteoclast inhibitor that can be used as adjunct therapy in the management of bony metastases from prostate cancer. (helps with pain control/prevention of fractures)
**useful for PREVENTING SKELETAL COMPLICATIONS
(PSA> 50, prostate cancer)

A

Denosumab

154
Q

MOA: block the serotonin transporter and the reuptake of serotonin from neuronal synapses***FIRST LINE THERAPY FOR DEPRESSION BUT MAY CAUSE ED IN MALE PATIENTS

USE: major depression, anxiety, bulimia, OCD, PTSD, phobias

ADE: N/V, ERECTILE DYSFUNCTION, SEROTONIN SYNDROME, insomnia, bleeding, weight gain, inhibitors of P450

Management*** for serotonin syndrome, use cyproheptadine and manage seizures with benzos. For ED: give with a PD5 inhibitor or consider changing to BUPROPION

A

SSRI’S
-Fluoxetine
-Citalopram
-Paroxetine
-Sertraline
-Escitalopram
-Fluvoxamine

***FIRST LINE THERAPY FOR DEPRESSION BUT MAY CAUSE ED IN MALE PATIENTS

155
Q

What do NSAIDS block the conversion of?
**IN AFFERENT ARTERIOLE OF GLOMERULUS

A

BLOCK arachidonic acid–> prostaglandins using COX

phospholipids –> arachidonic acid in plasma membrane by phospholipase A2, then arachidonic acid–> prostaglandins is blocked by COX (NSAIDS only have affect on COX not phospholipase A2)

156
Q

Typical Antipsychotics MOA? TREAT POS SYMPTOMS
HALEY TRIES FLUT, THOUGH CANT PLAY

high potency= ^ EPS, low sedation
Haloperidol
Trifluorperazine
Fluphenazine

low potency= ^ Sedation, low EPS
Thioridazine (causes pigment retinal deposits)
Chlorpromazine (causes cornea deposits)
Pimozide (used for tourettes)

A

Block postsynaptic D2 receptors in mesolimbic, TX: schizophrenia (antipsychotic meds)

ADE: HYPERPROLACTINEMIA.. “males have white discharge coming from breast” due to blocking dopamine receptors, Neuro Malignant Syndrome (tx with dantrolene), parkinson sxs, tardive, akathisia, etc.

157
Q

ADHD STIMULANT med for kid that “blocks reuptake of dopamine and NE in presynaptic neurons through inhibition of monoamine transporters”

A

Methylphenidate

158
Q

ADHD NON-STIMULANT med that is a “selective NE reuptake inhibitor”

A

Atomoxetine

159
Q

ADHD NON-STIMULANT meds that are a “alpha 2 agonist”

A

-Clonidine
-Guanfacine

160
Q

ADHD NON-STIMULANT/DEPRESSION med that are a “NE and dopamine reuptake inhibitor”

**CONTRAINDICATION: do NOT give to patient with bulimia/eating disorders, lowers seizure threshold

A

Bupropion (good for smokers, mostly used if pt doesn’t want to take SSRI/had problem with sexual dysfunction w/ SSRI)

161
Q

What is a muscle relaxant used for muscle spasms that is associated with Multiple Sclerosis? MOA: binds GABA B RECEPTORS and reduces release of excitatory NT (glutamate and aspartate release) by Gi mechanism

A

Baclofen (anti-spasm drug)

162
Q

Atypical Antipsychotics MOA?
TREATS NEG SYMPTOMS
“A CORQ”
Aripiprazole
Clozapine (ade- agranulocytosis/low neutrophils)
Olanzapine
Risperidone
Quetiapine

**all have ADE of weight gain, PROLONG QT

A

5HT2A BLOCKERS> D2 antagonist, have less dopamine blockade so they are preferred over typical antipsychotics

**main antagonism of both postsynaptic serotonin 2A and dopamine receptors

**GET A CBC IF FEVER PRESENT

163
Q

Tricyclic Antidepressant MOA?
Amitriptyline
Nortriptyline
Imipramine (treats bedwetting)

A

Inhibit reuptake of serotonin/NE by binding to NT transporters

**also have additional receptor blockade of Muscarinic, alpha 1, histamine receptors

164
Q

Drug for smoker/bulimia that is a partial agonist at nicotinic Ach receptors?

ADE: may cause sleep probs/decreased mood, so do not give to pt with depression (should give them bupropion if they dont have bulimia)

A

Varenicline

165
Q

What stimulant drug has ~20 hour length of time, can cause violence, diaphoresis, HTN, severe agitation, Tachycardia, psychosis, TOOTH DECAY, injection marks up and down arm

A

Methamphetamine

166
Q

What drug causes vertical/horizontal nystagmus, AMS, agitation, choreoathetosis, seizures, acute psychosis?
**decreased pain perception/SUPER HERO STRENGTH delusions

A

PCP

167
Q

What drug causes BRADYCARDIA/HYPOTENSIONS, miosis, hypothermia, hypo reflex, CNS/resp depression, dec bowel sounds, constipation?

A

Heroin (OPIODS)

168
Q

What drug causes HTN, tachy, euphoria, violence, anger, pupil dilation, weight loss, INC IN SELF CONFID?

A

Cocaine

169
Q

What drug is a precursor for dopamine, crosses the BBB, increases central dopamine levels, and is used for tx of Parkinson’s? (first line)

A

Levodopa

170
Q

What drug is a irreversible peripheral dopa decarboxylase inhibitor, reduces peripheral conversion of levodopa to dopamine, as dopamine cant cross BBB, THUS allowing INC PERIPHERAL DOPA TO CROSS BBB (Parkinson’s tx)? (first line)

A

Carbidopa

171
Q

what drugs are COMT inhibitors, decreases breakdown of levodopa to 3-O methyldopa (3-OMD), ALLOWING MORE CENTRAL LEVODOPA / INC HALF LIFE OF LEVODOPA? (not first line)

A

Tolcapone, Entacapone

172
Q

What are the RIPE meds for M. TB/HIV aids pt?

A

R-rifampin
I-isoniazid
P-pyrazinamide (CAN INC URIC ACID REABSORPTION–> INCREASE GOUT)
E-Ethambutol

173
Q

What drugs block sodium in cortical collecting tube? (potassium sparing diuretics)

A

Amilioride
Triamterene

174
Q

what drugs are competitive aldosterone receptor antagonists? (potassium sparing diuretics)

A

Spironolactone
Eplerenone

175
Q

MAO-INHIBITORS? (ade: HTN crisis after eating meal w tyramine) PRITS

A

-Phenelzine
-Rasagiline
-Tranylcypromine
-Isocarboxazid
-Selegiline

TX THIS WITH PHENTOLAMINE

176
Q

What is the MOA of SNRI?

A

inhibition of serotonin and/or NE reuptake from neuronal synapses

177
Q

What drugs are these:
-venlafaxine
-duloxetine

A

SNRI’s

178
Q

What drugs are loop diuretics? (tx: Hypercalcemia, Na/K/2Cl in TAL

ADE: hypocalc/hypomag/hypokal/ hyponat, OTOTOXIC, interstitial nephritis, gout

A

-furosemide
-bumetanide
-torsemide

NON SULFA: E. Acid (more ototoxic)

179
Q

what is the drug with MOA of inhibiting Na/K ATPase and increased vagal tone?

TX: CHF/Afib

ADE: brady, ST downslope, N/V, visual disturbances (yellow green eye tint, blurry, scotoma, halo, diplopia), gynecomastia

A

Digoxin

180
Q

What drugs are these?
-prazosin
-terazosin
-doxazosin
-tamsulosin (inc urinary stream, inhibits contraction, tx BPH)

A

Alpha 1 blocker (lead to vasodilation)

181
Q

What drug inhibits alcohol dehydrogenase and is used in tx of methanol/ethylene glycol overdose?

A

Fomepizole

182
Q

How do you treat genital herpes?

A

Acyclovir/famciclovir/valacyclovir

  • MOA: inhibit DNA polymerase, leads to DNA chain termination
183
Q

how do you treat syphilis?

A

Penicillin G

-MOA: inhibit transpeptidase

184
Q

what are the 2 drugs to treat Chlamydia? (one is for preg)

A

-Doxy (tetra- binds 30s to prevent elongation)
-Azithromycin (macro- binds 50s to stop translocation) *safer in preg

185
Q

how do you treat trichonomas/ gard intestinalis?

A

-Metronidazole

MOA: form nitrogen free radicals that damage cellular components (DNA/proteins)

186
Q

How do you treat gonorrhea? (mucoprurlent discharge)

A

-Ceftriaxone (3rd gen ceph, lipophilic)
inhibit transpeptidase

187
Q

what drug to relieve chest pain the fastest? (angina pectoris)

A

Nitroglycerin (MOA: activate myosin light chain phosphatase)

188
Q

How do you treat Lupus/SLE?

A

-Glucocorticoids

MOA: diffuse thru PM to regulate gene expression

189
Q

k opioid receptor agonist AND a u opioid receptor partial agonist used as analgesia for severe pain

A

Butorphanol

190
Q

estrogen therapy is contraindicated in patients with what

A

ER 2+ breast cancer

191
Q

what diuretic is used to treat metabolic alkalosis

A

acetazolamide (carb anhydr inhibitor)

192
Q

what inhibits COX2 only in the arachidonic acid path

A

celecoxib

193
Q

what alkylating agent can cross the BBB

A

nitrosureas

194
Q

what antineoplastic drug increases free radical formation causing DNA strand breaks

A

Bleomycin

195
Q

what is preferred drug for tx schizophrenia

A

atypical antipsychotics (5HT 2 block)

A CORQ

196
Q

use of selegiline or rasagiline may enhance the ade of what

A

L-DOPA

197
Q

opioid toxicity is tx with what

A

naloxone

198
Q

what is used for relapse prevention in opioids

A

naltrexone

199
Q

Class 4 antiarrhythmics are used clinically for

A

prevention of arrhythmias and A fib rate control

200
Q

what 2 beta2 agonists are used to relax uterus and decrease contractions in women during labor

A

Terbutaline
Ritodrine

201
Q

which local anesthetic is associated with arrhythmias

A

cocaine

202
Q

use of both pd5 inhib and nitrates can lead to what

A

life threatening hypotension

203
Q

what is a small molecule inhibitor of V600E mutated BRAF used in metastatic melanoma

A

Vemurafenib

204
Q

what is a substance P antagonist that blocks NK1 receptors in brain

A

aprepitant

205
Q

what synthetic androgen is used to treat hereditary angioedema

A

danazol

206
Q

rubonucleotide reductase inhibitor used to treat polycythemia vera and CML

A

hydroxyurea

207
Q

which anti epileptics are also used as migraine prophylaxis

A

valproic acid and topiramate

208
Q

moa of allopurinol and fevuxostate is

A

inhibition of xanthine oxidase

209
Q

which anti epileptic is associated with kidney stones

A

topiramate

210
Q

overdoses of amphetamines are treated with what

A

ammonium chloride

211
Q

what interferes with reduction-oxidation reaction w molecular oxygen

A

nifutimox

COMLEX/USMLE 1 (17 decks)

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