Pharm TT3 > Pharm TT3 > Flashcards

Pharm TT3 Flashcards

(230 cards)

Study These Flashcards
1
Q

Bacteria with natural resistance

A

P aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Resistance mechanism for streptococcus and quinolone

A

Modification to existing target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Resistance MOA for MERSA and cloxacillin

A

Acquisition of a target bypass system

- change binding site so methicillin and cloxacillin don’t work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Resistance MOA of P aeruginosa

A

Reduce cell permeability in porin

- resistant to imipenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Resistance MOA for streptococcus tetracycline

A

Efflux pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

G+ bacteria, non-resistant that we have to know

A

MSSA
S viridans
S pneumoniae
Enterococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

G+ resistant bacteria that we have to know (2)

A

MRSA

MRSA-c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

G-, non-resistant that we have to know (3)

A

E. coli
Klebsiella
H influenze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

G- resistant that we have to know (4)

A

E. coli ESBL
Klebsella ESBL
Pseudomonas
Enterobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anaerobes bacteria we have to know, non-resistant (2)

A

Actinomycetes

Peptostreptoccus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anaerobes resistant (1)

A

Bacteriode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Atypical non-resistant

A

Pycoplasma
Chlamydia
Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Penicillin properties (MOA, target, absorption, elim, ADR)

A

Inhibit transpeptidase
Only for strep infection
Anti-staph penicillin = cloxacillin
Mod to poor absorption and liable to acid secretion; renal elim
ADR: interstitial nephritis
Not for G-
Cloxacillin is DOC for MSSA and strep aureus (PO or IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Piperacillin

A

Biggest penicillin

Beta lactamases can’t cleave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cephalosporin properties

A

Same as penicillin except with 2 R groups
Dihydrothiazine
R3 changes PK, R7 changes spectrum
ADR: IgE hypersensitivity, anaphylaxis, C diff, cross sensitivity, interstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cefazolin

A

Cephalosporin
1st gen
Treat only S aureus and streptococci
Good for MSSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ceftriaxone

A

Biggest cephalosporin
For difficult infections like pseudomonas and S pneumoniae
Does strep really well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mycoplasma pneumoniae

A

No cell well
Nothing that targets cell wall works
(Penicillin and cephalosporin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Peptostretococcus

A

Part of oropharyngeal flora and easily killed by cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to treat MRSA

A

Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Does MSSA make beta lactamases

A

Yes
15% need vancomycin
85% can tx with cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clavulanic acid plus

A

Ampicillin or ticarcillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tazobactam plus

A

Pipercillin or ceftolozane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Carbapenems (drugs

A

Imipenem, cilastatin, meropenem
Meropenem not affect by meta lactamases
Good for G-/G+/ESBL and pseudomonas and bacteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Vancomycin
Doesn’t allow for crosslink to happen DOC for MRSA, and enterococcus Resistance for VRE ADR hearing loss and nephrotoxicity and red man syndrome (histamine release)
26
Daptomycin
``` Cyclic lipopeptide Mess up K channel For MRSA and enterococcus DI: surfactant antagonize the action - not for pneumonia ADR: myopathy, creatine phosphokinase increase ```
27
Treatment for C diff
Vancomycin
28
Drugs causing C diff the most
Clindamycin | Fluoroquinolones
29
Thrush symptoms
Typically asymptomatic Burning oral sensation, change in taste, tendency to bleed Erythematous: smooth red patch on mucosal area
30
Thrush risk factor
Prolonged illness, use of Ab, use of steroid, denture, dry mouth
31
Polyene
Nastatin and amphotericin B
32
Polyene MOA
Binds to ergosterol | Makes membrane dysfunctional and electrolyte imbalance
33
Amphotericin B
Only IV, poor oral and tissue distribution ADR joint pain, chills and rigor, nephrotoxicity (most common limiting toxicity of the drug) Reversible N-tox; pre-hydrate with 500ml normal saline DI: other N-tox drugs
34
Lipid amphotericin B products
Abelcet lipid and AmBisome liposome AmBisome - less infusion related side effect and less renal toxicity but same efficacy
35
Nystatin
No systemic ADR Topical 3x-4x a day Before bed or after brushing
36
Azoles
Inhibit CYP450 enzyme lanosterol 14-a-demthylase Prevents conversion of lanosterol to ergosterol lots of DI
37
Triazole common factors
80% renal elim for fluconazole, others hepatic DI: P450 drugs ADR: liver function test oral bioavailability 60%
38
Fluconazole
Candida but not C Krusei and Aspergillosis No QT 90% absorption 11% binding Both IV and oral
39
Voriconazole
Candida and Asp Visual ADR, QT, LFT Indication: aspergillosis
40
Posaconazole
No visual ADR, only oral Candida and asp 80% binding Indication: prophy for bone marrow transplant
41
Food with triazole
Fluc unchanged Increase for posa Decrease for vori
42
Fluconazole contraID
IV | May have aspergillosis
43
Echinocadin
Caspofungin, micafungin... fungin Attacks the production of B13GS (beta 1,3, glucan synthesis) - cell lysis (disrupt cell wall integrity) Only IV Hepatic elim
44
Which of triazole not used for thrush
Voriconazole
45
RNA virus
MMR, influenza, retrovirus, hepadnavirus
46
DNA virus
Herpes, chicken pox, shingles, cold sores, poxvirus, adenovirus, papillomavirus
47
Amantadine
``` Inhibits uncoating of viral RNA Only works for influenza A Teratogenic Unchanged in urine elim 100% resistance ```
48
Rimatadine
``` Inhibits uncoating of viral RNA Only works for influenza A Teratogenic Hepatic metabolism and renal excretion 100 resistance ```
49
Neuraminidase inhibitor
Prevents release of virus after first round of replication Oseltamivir and zanamivir 0% resistance
50
Oseltamivir
Oral, 80% bioavailability Prodrug - hepatic metabolism ADR: NVD and delirium
51
Zanamivir
Oral inhalation and 4% absorbed systematically Minimal metabolism and unchanged in renal and fecal elim ADR: cough, bronchospasm
52
Acyclovir
Converted by herpes thymidine kinase and become acyclovir triphosphate - blocks DNA replication Acyclovir - poor oral absorption but good for IV (ADR: nephrotoxicity) Valacyclovir - prodrug of acyclovir for oral Fanciclovir - prodrug of pencyclovir; no CSF - converted by deacetylation and oxidation All renal elim Cross resistance occurs
53
Cytomegalovirus
DNA Reactivation of latent infection Retinitis, colitis, esophagitis, pneumonitis, encephalitis Many are transplant pt and up to 70% of general pop are exposed
54
Ganciclovir
``` Works like acyclovir UL97 is the viral protein kinase Works on HSV,VZV,CMV Ganciclovir - IV only, not PO - 50% CSF and ocular Valganciclovir - PO, prodrug; hydrolysis in liver and intestine Cross resistance with acyclovir and foscarnet ```
55
NRTI
Nucleoside/tide reverse transcriptase inhibitor Blocks the copying of HIV virus Most important of ART
56
NNRTI
Non-nucleoside reverse transcriptase inhibitor Metabolism by CYP450 (lots of DI) ADR: hypersensitivity and GI intolerance
57
Protease inhibitor
Poor bioavailability if not taken with fat High alpha-1-acid glycoprotein binding Extensive metabolism and little renal elim
58
5 MOAs of ART
``` NRTI NNRTI Entry inhibitor Protease inhibitor Integrate strand transfer inhibitor (INSTIs) Regimen: 2NRTI + one other ```
59
PEP time frame
Right after needle | Triple drug therapy for 28 days and within 3 days of exposure
60
PrEP time frame and dose
Prophy Double therapy daily Tenofovir/Emticitabine HIV testing for 3mo
61
Aminoglycosides
Reduce transmembrane potential in anaerobes Bind to 30S irreversibly (bacteriocidal) Good against G- Poor penetration to CNS, poor GI absorption, renal elim ADR: N-tox, 7% ototoxicity DI: neuromuscular blocking agents and other N-tox agents (vancomycin, amphotericin B, cyclosporine) Resistance: change in transmembrane potential or acetylating/phosphorylating Synergy w/ beta lactam for aerobic G+ and G-
62
Quinolone
Inhibition of topoisomerase re-ligation after DNA gyrase open it up Moxifloxacine (good for strep pneumoniae but no MRSA) and ciprofloxacine (covers mycoplasma and pseudomonas too) ADR: QT, glucose abnormality, photosensitive, tendinitis DI: Al, Mg, Ca decrease uptake
63
Metronidazole
Inhibit Anaerobic G+/- and Protozoa Reduce in e- transport chain and metabolite cause DNA breakage Not toxic to human Good oral absorption and metabolized by liver and inhibit EtOH dehydrogenase ADR: peripheral neuropathy DI: sweating, NV, EtOH
64
Macrolide
``` Reversible 50s -> bacteriostatic Erythromycin no good for H influenza Azithro doens’t inhibit CYP450 ADR: QT, NVD (less with azithro and clarithro) (Cholestatic hepatitis with erythro) DI: many Resistance : MefA, ermB ```
65
QTc prolongation drugs
-floxacine Terfenadine Clarithro and erythromycin (more) Doxepin
66
Clindamycin
``` Reversible 50s Good for strep,staph, G+/- anaerobes Hepatic elim! ADR: C diff Resistance: bacteriode and staph ```
67
Sulfonamide (Septra)
Folic acid synthesis inhibitor (from paraaminobenzoic acid (PABA)) Bacteriostatic alone, cidal in combo (trimethoprim and sulfamethoxazole) Good oral Renal elim ADR: crystalluria, bone marrow: thrombocytopenia, leukopenia hepatitis
68
Methotrexate
Inhibit dihydrofolate reductase Inhibit diHF to tetraHF conversation Can’t create purine and pyrimidine synthesis
69
5FU
Inhibit thymidine synthase | Can’t convert uracil monophosphate to thymidine monophosphate
70
Platinum
Cause intra-strand linkage - can’t copy DNA Nephrotoxicity reversed by amifostine
71
Bleomycin
Antibiotic and alkylating | AE pulmonary fibrosis
72
Mitosis inhibitor
``` Increase microtubule polymerization but not dismantlement Vinblastin Vincristine Paclitaxel Docetaxel ```
73
-lukast
Potent inhibitor dealing with PGP and MDR | Deal with drug resistance in tumour cells
74
Hormone involved in secondary osteoporosis
Hyper PTH, hyperthyroidism, DM
75
Differences between osteoporosis and osteomalacia
Osteomalacia has decreased mineral/matrix ratio - severe Vit D deficiency - impaired mineralization
76
Regulatory factor increasing osteoclast activity (6)
``` Glucocorticoid VitD3 PTH-related peptide IL1,5,11,16 PGE2 TNFa ```
77
PTH and thiazides action on kidney
Increase Ca resorption in distal convoluted tubules
78
Furosemide action on Ca on kidney
Decrease Ca on loop of Henle
79
Vit D physiology (5)
``` Increase blood Ca, PO4 Increase Ca/PO4 resorption from bone (increase osteoclast) Increase Ca/PO4 GI absorption Increase Ca resorption from kidney Increase PTH secretion (Sounds like bad for bone) ```
80
Tx indication for phosphorus
HyperCa
81
Tx indication for Bisphosphonate (6)
``` HyperCa Bone metastasis Osteoporosis Prevent OP induced by corticosteroid Prevent OP and fracture in postmenopausal women Piaget’s disease ```
82
Calcitonin physiology
From parafollicular cell (C cells) Decrease plasma Ca and PO4 Decrease osteoclasts by inhibition of osteoclast
83
Corticosteroid on Ca
Decrease Ca GI absorption | Increase Ca renal excretion
84
Denosumab
Against RANKL Works like OPG Suppress bone turnover and contribute to BRONJ Causes fast and fatal liver failure
85
BisP MOA
Inhibit osteoclast - Decrease bone resorption and decrease dissolution of hydroxyapatite crystal Secondary cell target - OB, bone marrow cells, tumour cells - induce tumour apoptosis and decrease tumour induced osteolysis Antiangiogenic
86
BPs in Canada
Clodronate and etidronate
87
BP AE
``` PO/IV - femoral fracture, worsen renal function, conjunctivitis IV - V fib PO - constipation, GERD, gastric ulcer ```
88
BRONJ risk factor
Anti cancer tx, DM, obesity, smoking = 2x | Alcohol, poor OH, steroid = 1x
89
PTH physiology
Increase Ca but decrease PO4 in distal convoluted tubule Increase Ca GI absorption Increase resorption of bone matrix (increase osteolysis via ODF) Increase proximal tubule D3 synthesis
90
Teriparatide
PTH Increase RANKL thru GPCR Increase bone density if given chronically (paradoxical drug) - PTH1R PTH2R is in kidney, CNS, pancreases, testis, placenta Indication: alone or co-admin with estrogen/androgen - good for unresponsive BRONJ ContraID - anything that puts Ca in blood (any ID for BP)
91
Greatest risk factor for oral cancer
Tobacco (5x) Alcohol (25%) Betel leaves/nut
92
Prognosis for oral cancer on tongue
50% after 5 years | Recent study says 70%
93
Biomarker for oral cancer - genetic - salivary
Genetic: p53, telomerase, p16 Salivary: mitochondrial DNA, p53, TSG hypermethylation, CD44, free radical, endothelin
94
Viruses that induce DM1
MMR, coxsackie
95
3 counter regulatory hormone of insulin
Epi: fat and liver Glucagon: liver Glucocorticoid: gluconeogenesis,, inhibit lipocyte uptake, increase lipolysis
96
Cortisol and DM
Can cause DM Decrease affinity of insulin receptor to insulin Sustained high sugar level can also cause insensitivity
97
Insulin and liver
Increase glucose as glycogen Inhibit catabolic event during fasting - no glycogenolysis, ketogenesis, gluconeogenesis
98
Insulin and mm
Increase glucose and AA transport Increase protein synthesis Promote glycogen synthesis
99
Insulin and fat
Promote TG storage | Inhibit lipolysis
100
Rapid acting insulin
Insulin lispro, aspart, glulisine
101
Difference between insulin glargine and insulin determir
Determir has more reproducible effect
102
Split dose
Intermediate + rapid/short
103
Multiple daily dose
Long + rapid
104
Insulin therapy complication
HypoG, insulin allergy, immune insulin resistant, lipodystrophy, propranolol masks hypoG symptoms
105
Sulfonylurea
Increase release and sensitization Reduce glucagon Tachyphylaxis and 10% need to supplement insulin IDDM can take this to improve sensitivity
106
Tolbutamide
Sulfonylurea Safest 500mg po before meal The only 1st gen without active metabolite
107
Chlorpropamide
Sulfonylurea Most potent Metabolite active
108
Tolazamide
Sulfonylurea
109
Acetohexamide
Sulfonylurea | Active metabolite
110
Glyguride
2nd gen sulfonylurea | Higher incidence of hypoG episode
111
Glipizide
2nd gen sulfonylurea | Preferred in elderly
112
Metformin
Directly affect mm to increase glucose uptake and utilization Decrease liver gluconeogenesis, GI absorption, glucagon release Req presence of insulin No hypoglycemic state GI side effect on onset but will go away
113
Thiazolidinedione (-litazone)
Increase insulin peripheral response Doens’t increase release Increase glucose uptake to mm and fat Reduce glucose output
114
Glucagon’s effect on skeletal mm
Nothing | No receptor
115
Glucagon on heart
Inotropic and chronotropic | - not thru B1 receptor
116
Glucagon clinical use
Emergency hypoG Beta-blocker overdose - increase cAMP production in cardiac mm cells - doesn’t use B1 receptor
117
Cyclosporine
Inhibit IL2 by blocking activation of T -> decrease proliferation and differentiation Binds to cyclophilin (intracellular) Inhibit calcineurin -> reduce IL2
118
Cyclosporine ADR and DI
ADR: nephrotoxicity (increased by NSAID and aminoglycoside) Liver dysfunction, HT, hyperK, hyperG Gingival hyperplasia Clearance enhance by phenobarbitals, phenytoin, rafampin Reduced by ketoconazole, grape fruit, erythromycin
119
Tacrolimus
Fungal macrolide; bind to immunophilin -> inhibit calcineurin -> decrease P -> decrease IL Bound with serum protein and concentrated in RBC For transplant, co-admin with glucocorticoid; also for dermatitis and psoriasis ADR same as cyclosporine but without hirsutism and gingival hyperplasia More potent, decrase episode of rejection than cyclosporine But more nephrotoxic and neurotoxic
120
Sirolimus
``` Fungal macrolide -> FKBP -> mTOR -> inhibit serine-threonine kinase -> DNA repair and AA translation stopped Doesn’t block IL2 Blocks T cell response to cytokines Inhibit B cell proliferation For heart allograft ```
121
Corticosteroid | prednisone, dexamethasone... etc
``` Decrease PG, IL, TNFa, IFN, IgG, NO, Hist Suppresses Th Decrease T proliferation Decrease M’s APC For solid organ allograft and autoimmune ```
122
Azathioprine
Antimetabolite Inhibit purine synthesis -> prevent expension of B and T For autoimmune and some transplant ADR: leukopenia, thrombocytopenia
123
Mycophenolate
Stops purine and B/T proliferation Only for transplant Combine with corticosteroid to replace CSA and TAC Not for pregnancy
124
Leflunomide
``` Blocks pyrimidine synthesis Only for RA Active metabolite and long duration of action ADR: renal, teratogenic Not for pregnancy ```
125
Methotrexate
``` Folic acid ANT Stops dihydrofolate reductase Interferes with T cell proliferation Only for autoimmune ADR: pulmonary fibrosis, bone marrow depression, renal and liver ```
126
Cyclophosphamide
Destroy proliferating lymphoid cell For cancer and autoimmune ADR: hemorrhagic cystitis, bone marrow, sterility, cardiac tox
127
Immunomodulator Drugs causing ulcer
Sirolimus and tacrolimus
128
Deficient RBC production
Neoplasia, myelofibrosis, aplastic anemia | Fe deficient, pernicious anemia (lack of B12), renal disease
129
Increase RBC destruction
Sickle cell, antiRBC antibody, thalassemia, G6PD def, spherocytosis
130
Tx for hemochromatosis
Deferoxamine, deferasirox
131
Ethology of B12 deficiency
``` Defective secretion of IF (autoimmune) Post-gastrectomy Ileum damage (inflammatory bowel disease) ```
132
Hypersalivation treatment
``` Glycopyrrolate Scopolamine Botox Ipratropium Propantheline ```
133
Hypersalivation drug ethology
L-DOPA
134
Xerostomia treatment
Biotene Pilocarpine Cevimeline
135
Bethanechol
ACh M3 AG | For opioid induced constipation and post-op urine retention
136
Metoclopramide
Increase 5HT4; decrease DA and NANC Crosses BBB Prevent NV Prokinetic
137
Doperidone
DA ANT Indirect Doesn’t cross BBB For chemo and post-op NV
138
Acid peptic disorder etiology
Decrease pH, decrease PG | NP, NSAID, EtOH, smoking and aging
139
Tx for GERD
Metoclopramide to increase tone of LES Antacid Increase mucosal protection Eradication of HP
140
Peptic ulcer disease treatment
NaHCO3, pepto bismol Sucralfate (Al sugar polymer) - viscous shield, stim endo PG, absorb pepsin AE: constipation DI: digoxin, phenytoin, cimetidine (Tagamet), PPI
141
Cimetidine
Antihistamine Crosses BBB AE: antiandrogenic, inhibit 3A4 (warfarin, phenytoin, propranolol, lidocaine affected); also mental confusion
142
Ranitidine (Zantac)
Antihistamine No BBB, antiandrogen, P450 inhibition AE: rebound HCl overproduction, tachyphylaxis
143
-tidine
Antihistamine
144
Esomeprazole (-prazole)
PPI; very effective Irreversibly decrease HCl production DOC for peptic ulcer and GERD AE: decrease bone mass, not to be taken with H2 ANT, increase gastric stim by enterochromaffin cells (ECF), increase carcinogen
145
Misoprostol
``` Inhibition of cAMP production to stop proton pump Decrease parietal cell HCl production Increase mucous, HCO3 production Increase blood flow and epi regen High absorption Labour induction ```
146
GERD dental tx
``` Restrict reclining dental chair to more than 45 degree Aspirin and NSAID contraindicated - use acetaminophen COX2 inhibitor if severe pain - celecoxib - meloxicam (Mobicox) ```
147
DI of GI related drug in dental management
Cimetidine -> inhibit lidocaine metabolism PPI inhibit uptake of ampicillin and ketoconazole Ca/Mg chelate tetracycline and fluoroquinolone
148
Thyroid effect on renal
Increase blood flow and GFR
149
Thyroid on growth and tissue development
Maturation of bone, teeth, epidermis, hair, nail | Increase rate of skeletal muscle contraction
150
Thyroid on CNS
Neural development, wakefulness, learning capacity, normal emotional tone, peripheral nerve reflex
151
Thyroid on heart
Increase heart rate, inotropy, stroke volume, CO
152
Colloid space for thyroid
I- oxidized to I+ Tg released into there to make T3/4 - Tg made in follicle tho - release into extracellular space by diffusion
153
Myxedma coma
Severe hypoT Weakness, hypoventilation, hypoG, hypothermia Death Tx: T3 and glucose
154
Grave’s disease
Autoimmune for hyperthyroid More common in women Tx: thioamide and iodide
155
Thioamide MOA (propylthiouracil and methimazole)
``` Inhibit thyroid peroxidase-catalyzed rxn - block oxidation of iodide to iodine - block iodine organification - block coupling of iodotyrosine in the thyroglobulin ADR: agranulocytosis, granulocytopenia ```
156
Iodide MOA
Blocks lysosome, iodide transport, thyroid hormone synthesis For hyperthyroid storm or pre-op to decrease vascularization
157
Tx for thyroid storm
Beta blocker Diltiazem (CCB) PTU Hydrocortisone
158
Dental management for hyperthyroidism
More caries More PD Faster eruption Burning mouth syndrome
159
Dental management for hypothyroidism
Big tongue, inflm tongue, altered taste Delayed eruption Delayed bone resorption Salivary gland enlargement
160
Glomerulosa, fasciculata, reticularis
Aldosterone, cortisol, androgen
161
Fludrocortisone (min and glu activity)
25:1 Not anti inflm For adrenocorticoid insufficiency
162
Cortisol effect on liver and fat
Liver: increase gluconeogenesis, AA uptake, glycogen store Fat: decrease peripheral glucose uptake Net effect: maintain adequate glucose level in blood and CNS
163
Cortisol on blood, CVS, CNS, Kidney, GI, Lung
Blood: increase RBC and platelet CVS: increase heart function CNS: increase mood but suppresses ACTH and TSH/FSH Kidney: increase water and Ca excretion GI: increase HCl, decrease Ca absorption Lung: increase surfactant synthesis in final weeks of fetal development
164
Corticosteroid receptor type 1 and type 2
Type 1: mineralocorticoid -> kidney, salivary, GI | Type 2: glucocorticoid -> binds to GRE in many tissues
165
Primary Addison’s disease etiology
Autoimmune, congenital (21-hydroxylase def), viral (tuberculosis), drug (ketoconazole, radiation) SS: pigmentation, weakness, weight loss
166
Adrenal crisis etiology
Withdrawal and acute exacerbation of chronic with sepsis and stress You will see hyperK
167
Tx of adrenal crisis
IV cortisol, glucoses, saline
168
Conn’s syndrome
Too little aldosterone Too much Na, water, too little K No edema Tx: surgical, spironolactone, amiloride, eplerenone
169
Cushing‘s syndrome and Dx test
``` Too much cortisol Fat, hypoK, moon shaped, buffalo hump Kid: stunt growth Women: amenorrhea, hirsutism Dx: 24 urinary free cortisol (UFC) ```
170
Aminoglutethimide
Inhibit side chain cleavage enzyme (stops cholesterol -> pregnenolone) Tx for Cushing
171
Ketoconazole
Inhibit 17,20 hydroxylase (high dose) | Tx for Cushing
172
Trilostane
Inhibit 3b-hydroxysteroid dehydrogenase (triple action) | Tx for Cushing’s
173
Metyrapone
Inhibit 11b hydroxylase | Tx for cushing’s
174
Congenital adrenal hyperplasia
21a-hydroxylase deficiency Nothing negatively feed back ACTH (can’t produce cortisol and too much sex hormone) Tx: ketoconazole Or give exogenous cortisol to induce negative feedback
175
Pheochromocytoma
Too much E and NE Tx: phenoxybenzamine then propranolol and Nitroprusside Then surgical
176
Class 1 and 2 intracellular receptor and examples
C1: cytoplasmic - estrogen and glucocorticoid C2: nuclear - T3/4 and V3
177
Vasopressin mechanism
Anti-diuretic AC/cAMP/Gs to increase water channel V1/3; PLC/IP3 for vasoconstriction Act on medullary collecting duct
178
Diabetes insipidus
Neurogenic: replace desmopressin Nephrogenic: missing or unresponsive receptors
179
Function of eicosanoid
Inflm, pain, fever, SMC contraction and relaxation, cytoprotective, stim and inhibition of coagulation, Na and H2O retention
180
Function of PG
VasoD, inflm, uterine contraction, pain and fever and migraine, PGE for bronchoC, PGF for BronchoD, PGE/A for increase GFR and urinary flow
181
NSAID on PG
Inhibit cox ADR - GI ulcer and bleeding, dyspepsia, renal impairment DI: diuretics, ACE inhibitor, Beta blocker, SSRI, warfarin
182
Alprostadil
PGE1 VasoD, inhibit aggregation, stim GI and uterine SMC Good for infants with congenital defects restricting pulmonary or systemic blood flow For erectile dysfunction (relax trabecular smooth muscle) ADR of PGE1: Hypotension, tachycardia, cerebral bleeding, low temp, fatigue, stiff
183
Iloprost
PGI2 | Pulmonary vasoD
184
Lubiprostone
PGE1 For irritable bowel syndrome Stim Cl channel in the luminal wall to increase intestine fluid secretion
185
Dinoprostone
PGE2 Induce labour PGE2 -> PGF2a -> sensitize myometrium to oxytocin Fetal membrane also produce PGE2
186
Misoprostol (cytotec)
PGE Inhibit gastric acid Increase gastric blood flow, mucous and bicarbonate release Induce abortion Indication: protect against NSAID, gastric ulcer pt; in combo of mifepristone = abortion; cervical ripening
187
Latanaprost
PGF2a For glucoma Increase outflow Not for asthma pt (PGF = bronchoconstrictor)
188
TXA2
Induce aggregation and vasoC Decrease platelet cAMP to increase aggregation Mobilize intraC Ca, vasoC, contraction of SMC
189
TXB2
Only VasoC
190
Leukotriene
Bad Inflm and bronchospasm LTC4 D4 -> mucous secretion LTB4 -> chemotaxis
191
TCA (-triptyline, -pramine)
Block presynaptic NA and 5HT Block postsynaptic NA, Hist, ACh ADR: dry mouth, constipation, tachycardia, hypoT, urine retention, sedation DI: epi, antifungal, antidepressant, analgesic
192
SSRI
Only inhibit 5HT reuptake ADR: dry mouth, sexual dysfunction and weight loss DI: TCA, antipsychotic, warfarin, codeine, anticoagulant
193
MAOI
For ppl who can’t take SSRI and TCA Decrease degradation of NA/A/5HT ADR: blurred vision, hypertensive crisis, insomnia, sexual dysfunction
194
SNRI
5HT and NA | For mild/mod anxiety social phobia
195
NDRI
For severe depression and smoking cessation
196
SARI
Serotonin antagonist reuptake inhibitor | For depression with significant anxiety and sleep disturbances
197
St. John’s wart
Mild depression | MOAI
198
Lithium MOA
Inhibit glycogen synthase kinase 3 and inositol triphosphate (InsP3) Well absorbed and well distributed Chill ppl down Begin with low dose and increase give anti-convulsant if Li doesn’t work
199
Things causing vasoconstriction (5)
Reactive endothelial cell Increase subendothelial matrix protein exposure (Col1, VWF) TXA2 5HT ADP Together they activate GP2b3a (fibrinogen receptor)
200
Associated with arterial thrombosis
MI, stroke, ischemia | Adherence of platelet on arterial wall
201
Associated with venous thrombosis
HF, cancer, surgery | Develop in area of stagnant blood flow (deep vein thrombosis)
202
Treatment of thrombosis
Aspirin/dipyridamole/clopidogrel/GP3b2a inhibitor Heparin, warfarin, NOAC Thrombolytic and rt-PA
203
ASA
COX inhibitor -> decrease TXA2 | Antiplatelet
204
Dipyridamole
Decrease ADP from platelet | Anti-platelet
205
Clopidogrel
Decrease ADP induced aggregation | Antiplatelet
206
GP3b2a inhibitor
Abciximab (antibody) | Tirofiban (antagonist)
207
Heparin MOA and reversal
Increase antithrombin 3, decrease thrombin 2a and Factor 9a/10a Targets intrinsic pathway Accelerates antithrombin by 1000x Binds to thrombin LMW heparin has higher bioavailability and longer half life ADR: hemorrhage and heparin-induced thrombocytopenia Reversal: protamine sulphate
208
Warfarin
``` VitK inhibitor Decrease prothrombin and factor 7/9/10 Targets common, I and E pathway Long onset Must monitor PTT and INR ```
209
T/F anything increase prothrombin will increase INR and clotting time
True
210
AE of warfarin
Hemorrhage Crosses placenta Not for pregnancy
211
Reversal of warfarin
VitK | Prothrombin complex or recombinant factor 7a (Rapid reversal)
212
Dabigatran (pradaxa)
Thrombin inhibitor NOAC Reversal by Praxbind
213
Plasmin property
Fibrinolysis | Dissolves clot
214
Antifibrinolytic
``` Tranexamic acid Anistreplase Alteplase Reteplase Streptokinase Urokinase ```
215
Aminocaproic acid Tranexamic acid MOA
Antifibrinolytic Lysine analog protease inhibitor (inhibit plasminogen and plasmin) Tx for any bleeding problems
216
Usage of tranexamic acid
10ml 4.8% rinse for 10min -> spit it out
217
Prescribe NSAID after exo?
No | Use acetaminophen instead
218
Urticaria
Same as hives
219
Stinging insect allergy consequence
CV collapse
220
Food allergy
Bronchospasm
221
Pharm agents causing anaphylaxis
Antibiotic Aspirin and NSAID IV contrast agent
222
H1 H2 H3 distribution and function
H1: SMC, endothelium, CNS - vasoD, SMC contraction (bronchoC), rhinitis, pain and itchiness, motion sickness H2: gastric parietal cell and basal cells - Gastric secretion, vasoD, inhibition of IgE dependent degranulation (negative feedback) H3: CNS and some PNS - control release of monoamine and ACh, and GABA, feedback inhibition of histamine synthesis
223
Pharm effect of histamine
CNS: stim sensory ending - pain and itching CVS: vasoD; increase heart contraction and rate SMC: bronchoC Secretory: gastric acid; some pepsin and intrinsic factor; and all exocrine gland Immune response: release more histamine
224
Triple response with histamine
Reddening (small vessel dilation) Edematous wheal Red flare around wheal
225
Benadryl MOA, Tx, ADR, DI
Displace H from H1 For rhinitis, cold, allergic dermatoses (itching w/ insect bite), and antiemetic) Antivertigo (meclizine) Antitussive (diphenhydramine) ADR: CNS depression, appetite loss, constipation, insomnia, xerostomia, crosses breast and placenta DI: (Potentiates CNS depression); EtOH, GA, opiates, barbiturates
226
2nd gen antihistamine difference from 1st gen
Don’t cause sedation and drying ContraID: pregnant, lactating, liver failure, younger than 2yo ADR: somnolence, constipating
227
H2 antagonist
To decrease HCl in stomach (any ulcer, reflux, ZE syndrome)
228
Terfenadine
H2 ANT Fatal arrhythmia if taken with (ketoconazole, erythromycin, grapefruit) Prolong QT
229
Cimetidine DI
Coffee, alcohol, warfarin, lidocaine, TCA, CCB | It reduces blood flow to liver
230
All H2 blocker except famotidine (Pepcid) increase the bioavailability of ethanol (T/F)
True
Pharm TT3
flashcards
Decks in class (1)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions