Pharm 2 - Kaplan

Question 1

Statins…side effects

Answer 1

Myalgias
Rhabdomyolysis (if increased [ ] or w/ Gemfibrozil)

Question 2

Bile acid sequestrants…drugs?

Bad things?

When NOT to use?

Answer 2

Cholestipol, Cholestiramine

Increased VLDL and TGs
Malabsorption of lipid-soluble vitamins
Hyperglycemia

Hypertriglyceridemia

Question 3

Niacin - MoA

Side effect? How to treat?

Answer 3

Inhibits VLDL synthesis

Flushing (aspirin)

Question 4

Fibrates - MoA

Use?

Answer 4

Increase PPAR-alpha –> increased lipoprotein lipases

Hypertriglyceridemia

Question 5

Ezetimibe - MoA

Answer 5

Prevents cholesterol absorption, decreasing LDL

Question 6

Orlistat - MoA

Use?

Answer 6

Inhibits pancreatic lipase –> decreased TG breakdown

Weight loss

Question 7

Only drugs besides Benzos that can be inhibited by Flumazenil

Why?

Answer 7

Zolpidem, Zaleplon

Also block the BZ1 receptor on the GABA-A receptor

Question 8

Buspirone - MoA

Importance?

Problem?

Answer 8

Serotonin-1A receptor partial agonist

NO SEDATION (not GABA)

Slow onset (few weeks)

Question 9

2 pathways to treating anxiety (w/ difference)

Answer 9

GABA agonists - FAST

Serotonin agonists - SLOW

Question 10

2 pathways to treating sleep disorders

Answer 10

Melatonin agonists (Ramelteon)
GABA agonists (Zolpidem, Zaleplon, BZs)

Question 11

Ethylene glycol – metabolic byproducts

Damage?

Answer 11

Glycoaldehyde –> glycolic acid –> oxalic acid

Nephrotoxicity

Question 12

Methanol – metabolic byproducts

Damage?

Answer 12

Formaldehyde –> formic acid

Ocular damage

Question 13

Commonality between ethanol, methanol, and ethylene glycol

Cheap treatment for the later 2? Why?

Answer 13

All use alcohol dehydrogenase

Ethanol = greatest affinity for the enzyme

Question 14

Fomepizole - MoA

Advantage?

What else might be needed?

Answer 14

Long-acting inhibitor of alcohol dehydrogenase

No formation of acetaldehyde –> no hangover S/S

Dialysis to get rid of the substance floating around

Question 15

Disulfiram - MoA

Answer 15

Inhibitor of acetaldehyde dehydrogenase –> accumulation of acetaldehyde –> hangover symptoms

Question 16

Drug that causes disulfiram effect

Answer 16

**Metronidazole (Chlorpropamide) (Griseofulvin)

Question 17

Treatments for UTIs

Answer 17

Amoxicillin
Cephalosporins
Nitrofurantoin
TMP-SMX

Question 18

Sirolimus…MoA

How does it differ from tacrolimus and cyclosporin?

Side effects?

Answer 18

Inhibits T-cells by binding mTOR (serine-threonine kinase)

Limited neuro and nephrotoxicity

Hypertriglyceridemia, hypercholesterolemia

Question 19

Empiric treatment protocols for community acquired strep pneumonia (3)

Answer 19

If healthy – macrolide or doxycycline
If comorbidity – macrolide, PLUS fluoroquinolone or beta-lactam
If CURB-65 – fluoroquinolone, or beta-lactam + macrolide

Question 20

Serotonin receptor…

• 1A partial agonist
• 1B/1D agonist
• 2 antagonist
• 3 antagonist

Answer 20

Buspirone (depression)

-triptans (migraine abortion)

Atypical antipsychotics, Cyproheptadine

-setrons (emesis)

Question 21

Treatment of acute cholelithiasis (w/ MoA)

Answer 21

Ursodiol (ursodeoxycholic acid) – concentrates in bile, decreases bile cholesterol, hepatic cholesterol production, and cholesterol absorption

Question 22

Famotidine - MoA

Answer 22

H2 antagonist –> decreased gastric acid secretion

Question 23

Alosetron - MoA and Use

Adverse effect?

Answer 23

5-HT3 antagonist – diarrhea-predominant IBS

Ischemic colitis

Question 24

Sulfasalazine - explain

Answer 24

Split by colon bacteria into 5-ASA and sulfapyridine

• 5-ASA = ulcerative colitis
• SP = rheumatoid arthritis

Question 25

Mesalamine - MoA

Answer 25

5-ASA for Crohn's Disease

Question 26

MoA and Use for... - Alprostadil - Misoprostol - Dinoprostone - Epoprostenol - Latanoprost - Carboprost

Answer 26

``` A = PGE1 - vasodilation for ED M = PGE1 - cervical ripening and induction D = PGE2 - cervical ripening and induction E = PGI2 - vasodilation for pulmonary hypertension L = PGF2a - glaucoma C = PGF2a - uterine SM contraction for abortion and hemorrhage ```

Question 27

Nitroprusside - side effects

Answer 27

Hypotension Cyanide poisoning Methemoglobin

Question 28

ALS... - Drugs for spasticity treatment? - Drug for life prolongation?

Answer 28

Spasticity = Baclofen (GABA-B agonist), alpha-2 agonists Life = Riluzole (glutamate and Na+ antagonist --> decreased excitatory toxicity)

Question 29

Recently started a new drug... - Fever - Impaired autonomic stability - Muscle rigidity and breakdown - Myoglobinuria - Altered mental status Treatment?

Answer 29

Neuroleptic malignant syndrome (typical antipsychotics) Dantrolene, Amantadine, or Bromocriptine

Question 30

Treatment for hepatic encephalopathy

Answer 30

Lactulose -- converted to lactic acid, causing acidotic colon and excretion of NH3 as NH4+ Rifamixin or Neomycin -- destroy colonic urease-producing bacteria

Question 31

Effects of glucocorticoids on calcium and bone

Answer 31

- Increase osteoclasts (bone breakdown) - Decrease Ca++ channels in intestine - Oppose Vitamin D - Decrease reabsorption in kidney

Question 32

Drug for inhibition of RSV

Answer 32

Palivizumab (anti-RSV fusion protein antibody)

Question 33

Jarisch-Herxheimer reaction...treatment? Explain

Answer 33

Anti-TNF drug (Infliximab) Endotoxin --> direct macrophage activation --> IL-1, IL-6 (pyrogens), and TNF-alpha

Question 34

2 functions of metoclopramide (w/ mechanisms)

Answer 34

- Anti-emetic (D2 antagonist in area postrema) | - Pro-motility (enhances response to acetylcholine in intestines)

Question 35

How exactly do furosemide and digoxin interact?

Answer 35

Digoxin binds to the K+ binding place on the Na/K ATPase, thus as serum K+ decreases from furosemide, digoxin binds more easily

Question 36

Acyclovir...MoA Requires what?

Answer 36

Inhibits viral DNA polymerase Phosphorylation by viral thymidine kinase (Herpes Helps) or by the host thymidine kinase (all other target viruses)

Question 37

Drugs that can lead to hypertensive emergencies

Answer 37

Cocaine, Amphetamines, PCP, MAOIs, Triptans

Question 38

Psychiatric Hepatic Neurologic Ring around iris Treatment?

Answer 38

Wilson's disease (Copper accumulation) Penicillamine, trientine (chelation)

Question 39

Drugs that can cause disulfiram-like reaction

Answer 39

Metronidazole Some cephalosporins Griseofulvin 1st gen sulfonylureas