Pharm SEs

Question 1

Cimetidine

Answer 1

• Gynecomastia
• CYP450 inhibition
  (inc’d levels of Warfarin, Phenytoin, Propranolol, Metoprolol, Quinidine, & Theophylline)

Question 2

Metformin

Answer 2

Lactic acidosis

thus contraindicated in renal failure

Question 3

Atorvastatin

Answer 3

Hepatitis & Myositis

Question 4

Tricyclic Antidepressants

Answer 4

• Tremor, insomnia (inhibition of presynaptic NE & 5HT reuptake)
• Conduction defects, arrhythmias, hypotension (blockade of cardiac fast sodium channels)
• Hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, sinus tachycardia (antagonism of central & peripheral muscarinic ACh receptors)
• Peripheral vasodilation – orthostatic hypotension (antagonism of peripheral α-1 adrenergic receptors)
• Sedation (antagonism of H1-receptors)

Question 5

Name 4 TCA drugs

Answer 5

Imipramine, Clomipramine, Doxepin, Amitriptyline

Question 6

Vancomycin

Answer 6

• Red man syndrome

- Nephrotoxicity

Question 7

Daptomycin

Answer 7

• Myopathy & CPK elevation
• inactivated by pulmonary surfactant

(used for gram-positives, including MRSA)

Question 8

Linezolid

Answer 8

• Thrombocytopenia
• Optic neuritis
• High risk for serotonin syndrome

Question 9

Propylthiouracil (PTU)

Answer 9

• Skin rash
• Agranulocytosis
• Aplastic Anemia
• Hepatotoxicity

(thionamide drug)

Question 10

Methimazole

Answer 10

• Skin rash
• Agranulocytosis
• Aplastic Anemia
• Teratogenic

(thionamide drug)

Question 11

Sulfonylureas

Answer 11

1st generation = Disulfiram-like reaction
(Tolbutamide, Chlorpropamide)

2nd generation = Hypoglycemia
(Glyburide, Glimepiride, Glipizide)

Question 12

Glitazones / thiazolidinediones

Answer 12

• Weight gain
• Edema
• Hepatotoxicity
• Heart failure

(Pioglitazone, Rosiglitazone)

Question 13

α-glucosidase inhibitors

Answer 13

GI disturbances

Acarbose, Miglitol

Question 14

Pramlitinide

Answer 14

Hypoglycemia, Nausea, Diarrhea

Amylin analog → ↓glucagon
(T1 & T2 diabetes)

Question 15

GLP-1 analogs

Answer 15

Nausea, Vomiting, Pancreatitis

Exenatide, Liraglutide
(MOA = ↑insulin, ↓glucagon release)
(T2 diabetes)

Question 16

DPP-4 inhibitors

Answer 16

Mild urinary or respiratory infections

Linagliptin, Saxagliptin, Sitagliptin
(MOA = ↑insulin, ↓glucagon release)
(T2 diabetes)

Question 17

Demeclocycline

Answer 17

• Nephrogenic DI
• Photosensitivity
• Abnormalities of bone & teeth

Question 18

Proton-Pump Inhibitors

Answer 18

• Increased risk of C. dificile infection
• Pneumonia
• Hip fractures
• ↓serum Mg(2+) w/ long-term use

Question 19

Misoprostol

Answer 19

• Diarrhea
• Contraindicated in women of childbearing potential (abortifacient)

(MOA = PGE1-analog, ↑production & secretion of mucous barrier, ↓acid production)

Question 20

Octreotide

Answer 20

Nausea, cramps, steatorrhea

Question 21

Antacids

Answer 21

Hypokalemia (all)

Question 22

Aluminum Hydroxide

Answer 22

• Constipation
• Hypophosphatemia
• Proximal muscle weakness
• Osteodystrophy
• Seizures

(antacid, thus hypokalemia also)

Question 23

Magnesium Hydroxide

Answer 23

• Diarrhea
• Hyporeflexia
• Hypotension
• Cardiac arrest

(antacid, thus hypokalemia also)

Question 24

Calcium carbonate

Answer 24

Hypercalcemia & rebound acid ↑

Question 25

Infliximab

Answer 25

- Infection (reactivation of TB) - Fever - Hypotension

Question 26

Sulfasalazine

Answer 26

- Malaise - Nausea - Sulfonamide toxicity - Reversible oligospermia

Question 27

Ondansetron

Answer 27

Headache & Constipation

Question 28

Metoclopramide

Answer 28

↑ Parkinsonian effects

Question 29

Succinylcholine

Answer 29

- Hypercalcemia - Hyperkalemia - Malignant hyperthermia

Question 30

Dantrolene: MOA & use?

Answer 30

MOA: Prevents release of Ca(2+) from sarcoplasmic reticulum of skeletal muscle Use: 1. Malignant hyperthermia, a rare but life-threatening side effect of inhalation anesthetics (except N2O) & Succinylcholine 2. Neuroleptic malignant syndrome (toxicity of antipsychotic drugs)

Question 31

Sumatriptan: MOA & use?

Answer 31

MOAs: 5-HT(1B/1D) agonist, inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces vasoconstriction Use: Acute migraine & Cluster headaches Toxicity = Coronary vasospasm (contraindicated in Prinzmetal's angina)

Question 32

Topiramate

Answer 32

Sedation, weight loss, & kidney stones | "toe-primate" picmonic (↑GABA, blocks voltage-gated Na-channels)

Question 33

Gabapentin

Answer 33

Sedation, Ataxia

Question 34

Lamotrigine

Answer 34

Stevens-Johnson Syndrome

Question 35

Valproic Acid

Answer 35

- GI distress - Hepatotoxicity (rare but fatal; measure LFTs) - Neural tube defects in fetus (spina bifida --c/i in pregnancy) - Tremor - Weight gain ("vault pro lemon" picmonic)

Question 36

Tramadol

Answer 36

- Similar to other opioids (it is a weak opioid agonist & NE/5HT-reuptake inhibitor) - decreases seizure threshold ("trauma doll" picmonic, treats chronic pain)

Question 37

Indications for Zanamivir?

Answer 37

Influenza A & B | NA & viral release inhibitor

Question 38

Indications for Oseltamivir?

Answer 38

Influenza A & B | NA & viral release inhibitor

Question 39

Indications for Ribavirin?

Answer 39

RSV (viral bronchiolitis) & Hepatitis C | nucleoside analog -- inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase

Question 40

Indications for Interferon-α?

Answer 40

Hepatits B & C & Kaposi's Sarcoma

Question 41

Indications for Amantadine?

Answer 41

Influenza A | impairs uncoating of virion after host cell endocytosis

Question 42

Indications for Famciclovir?

Answer 42

Herpez Zoster

Question 43

Indications for Acyclovir?

Answer 43

HSV & VZV (weak activity against EBV, NO activity against CMV) (Guanosine analog, preferentially inhibits viral DNA polymerase by chain termination. Monophosphorylated by HSV/VZV thymidine kinase)

Question 44

Indications for Ganciclovir?

Answer 44

CMV, especially in immunocompromised pts - Guanosine analog - 5'-monophosphate formed by CMV viral kinase - Triphosphate formed by cellular kinases - Preferentially inhibits viral DNA polymerase

Question 45

Indications for Foscarnet?

Answer 45

- CMV retinitis in immunocompromised patients that fail Ganciclovir therapy - Acyclovir-resistant HSV (viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme. Does NOT REQUIRE activation by viral kinase) **essentially it's a "pyroFOSphate" analog

Question 46

MOA of drugs, "____navir"

Answer 46

Protease inhibitors | HIV-1 protease = pol gene "navir tease a protease"

Question 47

MOA of drugs, "____clovir"

Answer 47

Nucleosides (require both viral and host-cell kinase for activation)

Question 48

MOA of drugs, "____fovir"

Answer 48

Nucleotides (only require host-cell kinase for activation)