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Pharma Flashcards

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1
Q

Short acting Frenzodiazepams TOM

A

Triazolam Oxazepam Midazolam

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2
Q

1st line for Pseudomonas

A

antipseudomonal PCN + amnoglycoside. Pip Tazo plus Genta. PP Pseudomonas is Pip Tazo.

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3
Q

Antibiotic requiring oxygen for uptake into host cell therefore not effective against anaerobes

A

aminoglycoside

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4
Q

synergistic antibiotics

A

Beta lactam plus aminoglycoside

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5
Q

Drugs that cause coronary vasospasm

A

Cocaine Sumatriptan Ergot alkaloid

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6
Q

Drugs that cause cutaneous flushing VANC

A

Vancomycin Adenosine Niacin Ca channel blocker

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7
Q

Drugs that cause dilated cardiomyopathy

A

Doxorubicin (adriamycin) Daunorubicin

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8
Q

Cause torsade de pointes

A

Class III (sotalol) and class Ia (quinidine) antiarrhythmics

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9
Q

Cause agranulocytosis

A

Clozapine Carbamazepine Colchicine Propylthiouracil Methimazole Dapsone

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10
Q

Cause aplastic anemia

A

Chloramphenicol Benzene NSAIDs PTU Methimazole

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11
Q

Direct Coombs test positive

A

Methodopa Penicillin

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12
Q

SE

Gray baby syndrome

A

Chloramphenicol

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13
Q

SE

Hemolysis in G6PD. IS PAIN

A

Isoniazid Sulfonamide Primaquine ASA Ibuprofen

Nitrofurantoin

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14
Q

SE

MegaloBLASTic anemia

A

Phenytoin Methotrexate Sulfa drugs

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15
Q

SE thrombotic complications

A

OCP

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16
Q

SE pulmonary fibrosis

A

Bleomycin Amiodarone Busulfan

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17
Q

SE

Acute cholestatic hepatitis , jaundice

A

Erythromycin

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18
Q

SE

Focal to massive hepatic necrosis

A

Halothane Amanita phylloides Valproic acid Acetaminophen

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19
Q

Hepatitis

A

Isoniazid

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20
Q

Pseudomembranous colitis cause

A

Ampicillin clindamycin

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21
Q

SE

Adrenocortical suppression

A

Withdrawal of steroids

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22
Q

SE
Gynecomastia
Some Drugs Create Awkward Knockers

A

Spirinolactone digitalis cimetidine alcohol ketoconazole

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23
Q

SE

Hot flashes

A

Tamoxifen clomiphene

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24
Q

SE

Hyperglycemia

A

Niacin , tacrolimus ,protease inhibitors, hctz, steroids

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25
SE | Hypothyroidism
Lithium Amiodarone sulfonamide
26
Most vestibulotoxic aminoglycoside
Gentamicin.
27
SE | Aminoglycosides
Nephrotoxicity and ototoxicity.
28
Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?
4 hours Acute dystonia - involuntary spasm of facial muscles only 4 days Akinesia - Parkinson like 4 weeks Akathisia - feeling of restlessness 4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities
29
Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease
Athetosis
30
Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca
Tamoxifen
31
Monoclonal antibody against human epidermal growth factor receptor 2
Transtuzumab or herceptin used in breast ca with HER2 over expression
32
Therapeutic antibody against CD 20 of B cell NHL
Rituximab
33
Therapeutic antibody against TNF alpha used in crohn's ds, rheumatoid arthritis, psoriatic arthritis
Infliximab, adalimumab
34
Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol
Ipratropium anti muscarinic. Competitively bucks muscarinic r Salmetrol long acting beta 2 agonist works up to 12 hours Albuterol short acting beta 2 agonist 3 to 6 hours
35
Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.
Bevacizumab or Ranibizumab
36
What is ABVD used for Hodgkin's lymphoma ?
A adriamycin (doxorubicin). intercalates DNA B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks V vinblastine - inhibit micro tubule assembly (Metaphase) D dacarbizine - alkylation agent
37
Blocks t type calcium channels used in absence with SE of SJS
Ethosuximide
38
MOA Valproic acid
Inc GABA in brain, inc na channel inactivation
39
Anti epileptic drugs that Increase Na channel inactivation
Phenytoin, carbamazepine
40
First line generalized tonic clonic seizure
Phenytoin, carbamazepine
41
First line partial simple or complex seizure
Carbamazepine
42
Status epileptics meds
Benzodiazepams (diazepam or lorazepam) and phenytoin
43
Moa phenobarbital
Inc GABA action
44
Irreversibly inhibits GABA
Vigabatrin
45
MOA Gabapentin
Inhibit Calcium channels
46
Topiramate MOA
Blocks Na channels and Inc GABA action
47
Chemo drugs acting on S phase
Antimetabolites: 5FU, methotrexate, mercaptopurine | Etoposide
48
Chemo drugs acting on G2 phase
Synthesis of components needed for mitosis Etoposide Bleomycin
49
Inhibit formation of pyrimidines
5FU, methotrexate
50
Inhibit formation of purines
Mercaptopurine
51
SE neural tube defect vs fetal hydantoin syndrome
neural tube defect : Valproic acid | fetal hydantoin syndrome: Phenytoin
52
Inhibits thymidylate synthase vs dihydrofolate reductase
thymidylate synthase inhibitor: 5FU | dihydrofolate reductase: methotrexate
53
Inhibits bacterial transpeptidase
Penicillin drug class
54
Most vestibulotoxic aminoglycoside
Gentamicin.
55
SE | Aminoglycosides
Nephrotoxicity and ototoxicity.
56
Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?
4 hours Acute dystonia - involuntary spasm of facial muscles only 4 days Akinesia - Parkinson like 4 weeks Akathisia - feeling of restlessness 4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities
57
Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease
Athetosis
58
Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca
Tamoxifen
59
Monoclonal antibody against human epidermal growth factor receptor 2
Transtuzumab or herceptin used in breast ca with HER2 over expression
60
Therapeutic antibody against CD 20 of B cell NHL
Rituximab
61
Therapeutic antibody against TNF alpha used in crohn's ds, rheumatoid arthritis, psoriatic arthritis
Infliximab, adalimumab
62
Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol
Ipratropium anti muscarinic. Competitively bucks muscarinic r Salmetrol long acting beta 2 agonist works up to 12 hours Albuterol short acting beta 2 agonist 3 to 6 hours
63
Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.
Bevacizumab or Ranibizumab
64
What is ABVD used for Hodgkin's lymphoma ?
A adriamycin (doxorubicin). intercalates DNA B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks V vinblastine - inhibit micro tubule assembly D dacarbizine - alkylation agent
65
Blocks t type calcium channels used in absence with SE of SJS
Ethosuximide
66
MOA Valproic acid
Inc GABA in brain, inc na channel inactivation
67
Anti epileptic drugs that Increase Na channel inactivation
Phenytoin, carbamazepine
68
First line generalized tonic clonic seizure
Phenytoin, carbamazepine
69
First line partial simple or complex seizure
Carbamazepine
70
Status epileptics meds
Benzodiazepams (diazepam or lorazepam) and phenytoin
71
Moa phenobarbital
Inc GABA action
72
Irreversibly inhibits GABA
Vigabatrin
73
MOA Gabapentin
Inhibit Calcium channels
74
Topiramate MOA
Blocks Na channels and Inc GABA action
75
Chemo drugs acting on S phase
Antimetabolites: 5FU, methotrexate, mercaptopurine | Etoposide
76
Chemo drugs acting on G2 phase
Synthesis of components needed for mitosis Etoposide Bleomycin
77
Inhibit formation of pyrimidines
5FU, methotrexate
78
Inhibit formation of purines
Mercaptopurine
79
SE neural tube defect vs fetal hydantoin syndrome
neural tube defect : Valproic acid | fetal hydantoin syndrome: Phenytoin
80
Inhibits thymidylate synthase vs dihydrofolate reductase
thymidylate synthase inhibitor: 5FU | dihydrofolate reductase: methotrexate
81
Inhibits bacterial transpeptidase
Penicillin drug class
82
Most vestibulotoxic aminoglycoside
Gentamicin.
83
SE | Aminoglycosides
Nephrotoxicity and ototoxicity.
84
Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?
4 hours Acute dystonia - involuntary spasm of facial muscles only 4 days Akinesia - Parkinson like 4 weeks Akathisia - feeling of restlessness 4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities
85
Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease
Athetosis
86
Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca
Tamoxifen
87
Monoclonal antibody against human epidermal growth factor receptor 2
Transtuzumab or herceptin used in breast ca with HER2 over expression
88
Therapeutic antibody against CD 20 of B cell NHL
Rituximab
89
Therapeutic antibody against TNF alpha used in crohn's ds, rheumatoid arthritis, psoriatic arthritis
Infliximab, adalimumab
90
Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol
Ipratropium anti muscarinic. Competitively bucks muscarinic r Salmetrol long acting beta 2 agonist works up to 12 hours Albuterol short acting beta 2 agonist 3 to 6 hours
91
Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.
Bevacizumab or Ranibizumab
92
What is ABVD used for Hodgkin's lymphoma ?
A adriamycin (doxorubicin). intercalates DNA B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks V vinblastine - inhibit micro tubule assembly D dacarbizine - alkylation agent
93
Blocks t type calcium channels used in absence with SE of SJS
Ethosuximide
94
MOA Valproic acid
Inc GABA in brain, inc na channel inactivation
95
Anti epileptic drugs that Increase Na channel inactivation
Phenytoin, carbamazepine
96
First line generalized tonic clonic seizure
Phenytoin, carbamazepine
97
First line partial simple or complex seizure
Carbamazepine
98
Status epileptics meds
Benzodiazepams (diazepam or lorazepam) and phenytoin
99
Moa phenobarbital
Inc GABA action
100
Irreversibly inhibits GABA
Vigabatrin
101
MOA Gabapentin
Inhibit Calcium channels
102
Topiramate MOA
Blocks Na channels and Inc GABA action
103
Chemo drugs acting on S phase
Antimetabolites: 5FU, methotrexate, mercaptopurine | Etoposide
104
Chemo drugs acting on G2 phase
Synthesis of components needed for mitosis Etoposide Bleomycin
105
Inhibit formation of pyrimidines
5FU, methotrexate
106
Inhibit formation of purines
Mercaptopurine
107
SE neural tube defect vs fetal hydantoin syndrome
neural tube defect : Valproic acid | fetal hydantoin syndrome: Phenytoin
108
Inhibits thymidylate synthase vs dihydrofolate reductase
thymidylate synthase inhibitor: 5FU | dihydrofolate reductase: methotrexate
109
Inhibits bacterial transpeptidase
Penicillin drug class
110
Medication for Alzheimer's that inhibits cholinesterase ie indirect cholinomimetic.
Donepezil Not a cure, slows down disease but does not alter course.
111
Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG. Enveloped ds DNA virus.
HSV Tzank smear
112
CYP 450 Inhibitors Quin V inhibited was SICK with RAGE
``` Quinidine V inhibited was Sulfonamides Isoniazid Cimetidine Ketoconazole Riot avid Amniodarone Grapefruit Erythromycin ```
113
CYP 450 Inducers Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp
``` Modafinil Ethanol Barbidurates Phenytoin aka phenobarbiedoll Rifampicin Smoking or St. John's wort Griseofulvin Carbamazepine ```
114
Bactericidal antibiotics Very Finely Proficient At Murder
``` Vancomycin - binds D ala D ala Fluroquinolone - inhibits DNA gyrase PCN - bind transpeptidase Aminoglycoside - inhibits initiation complex , 30s Metronidazole - ```
115
Bacteriostatic antibiotics BacteriostaTTECCS
``` Trimethoprim Tetracycline Erythromycin Clindamycin Chloramphenicol Sulfamethoxazole ```
116
Antifungal: disrupts membrane function
Amphotheracin B | Nystatin
117
Antifungal: disrupts cell wall synthesis
Caspofungin | Anidulfungin
118
Antifungal: disrupts ergosterol synthesis
Fluconazole Itraconazole Voriconazole
119
Antifungal: disrupts lanosterol synthesis
Terbinafine | Naftifine
120
SE of protease inhibitors "navir"s used in HIV tx
Lipodystrophy - fat redistribution Hyperglycemia GI intolerance, Nephropathy, Hematuria (indinavir) Lopinavir, Atazanavir, Ritonavir, Indinavir, etc
121
Nucleoside reverse transcriptase inhibitors NRTI side effect.
Bone marrow suppression Peripheral neuropathy Anemia - zidovudine Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,
122
Effect of drug on body
PharmacoDynamics
123
Effect of body on the drug
Pharmacokinetics
124
of hours max for pralidoxime to work
6 to 8 hrs Used like atropine for organophosphate poisoning
125
Used to alkalinize or acidify urine
alkalinize urine - make it Basic with Bicarbonate acidify urine - make it Acidic with Ammonium chloride
126
Sublingual hypertensive meds pathway
Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA
127
Rectal route of meds partial first pass because
Superior rectal vain -> IMV -> portal system FIRST PASS Middle rectal vein -> IIV -> IVC Inferior rectal vein -> IPV -> IIV -> IVC
128
Best topical preparation
Ointment > foam > cream Slowest drug route
129
Routes of administration Significant first pass effect ? Partially bypasses first pass effect ? Completely bypasses first pass effect ?
Significant first pass effect ? Oral Partially bypasses first pass effect ? Rectal Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)
130
Soluble drugs are _____ & ________
Non ionized and non polar aka lipid soluble
131
Drugs that have zero order kinetics ie constant elimination rate over time / Linear WHAT PET
``` Warfarin Heparin Aspirin Tolbutamide Phenytoin Ethanol Theophylline ``` Note. NO Half life in zero order!!!
132
Dosage required to have 50% efficacy aka amount needed to produce a given effect.
Potency Efficacy is the height of the curve, potency is concentration in x axis
133
Concentration required to bind 50% of receptors
Kd High Kd, low affinity etc
134
Measures of potency
ED50 median effective TD50 median toxic LD50 median lethal
135
Agonist + competitive antagonist
Dec potency but same efficacy. Lower Kmax, same Vmax Shift to the right. You need more to obtain same effect in presence of competitive antagonist.
136
Agonist plus concompetitive antagonist
DECrease efficacy, with same potency. Lower Vmax, same Kd
137
Idiosyncratic effect of allopurinol
Cataract
138
First order kinetics. Drugs metabolized 1, 2, 3 half life
1st half life 50% 2nd half life 75 % 3rd half life 87.5% It takes 4 to 5 half lives to reach 100 %
139
Area under the plasma concentration curve AUC Aka the amount of drug that reached systemic circulation
Bioavailability
140
Phase 1 reactions To make drug more polar / water soluble for excretion as urine HOaRD water
``` Hydrolysis Oxidation a Reduction Deamination ``` Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation
141
Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.
Foscarnet
142
Inhibition of neuraminidase which is necessary to release virions. Works against influenza A and B
Zanamivir | Oseltmivir
143
Nucleoside analogue that inhibits the synthesis of Guanine nucleotides. Used in RSV and Hep C (+ interferon alpha)
Ribavirin
144
Regimen for HIV
2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor NRTI: zidovudine, didanosine, lamivudine, abacavir, stavudine, emricitabine, tenofovir - no activation reqd Protease inhibitors: "-navir" drugs NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation Integrase inhibitor: Raltegravir
145
Prevent maturation of new virus
Protease inhibitor
146
Inhibit HIV genome integration into host cell
Integrase inhibitor - Raltegravir
147
Allergic to TMP SMX, what is the alternative for P jirovenci
Pentamidine or dapsone
148
Blocks peptidoglycan synthesis Vs Blocks cell wall synthesis by inhibiting peptidoglycan cross linking
Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN
149
Hepatitis B medication
Lamivudine + interferon alpha
150
Cephalosporin effective against Pseudomonas aeruginosa 3
1 cefoPERAzone 3 gen 2 ceftaziDIME 3 gen 3 CEFEpime 4 gen CE FE ang PERA DIME
151
Anti HIV drug tha decrease mother to fetus transmission of HiV
Zidovudine
152
MOA clindamycin
Blocks peptide bond formation at the 50sS ribosomal subunit Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC Indication: methicillin resistant Staph aureus
153
Inhibits 50s peptidyltransferase
Chloramphenicol Meningitis: H influenza, N meningitidis, S pneumonia SE Gray baby syndrome - lack of liver UDP glucuronyl transferase Anemia/Aplastic anemia
154
Medication for Alzheimer's that inhibits cholinesterase ie indirect cholinomimetic.
Donepezil Not a cure, slows down disease but does not alter course.
155
Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG. Enveloped ds DNA virus.
HSV Tzank smear
156
CYP 450 Inhibitors Quin V inhibited was SICK with RAGE
``` Quinidine V inhibited was Sulfonamides Isoniazid Cimetidine Ketoconazole Riot avid Amniodarone Grapefruit Erythromycin ```
157
CYP 450 Inducers Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp
``` Modafinil Ethanol Barbidurates Phenytoin aka phenobarbiedoll Rifampicin Smoking or St. John's wort Griseofulvin Carbamazepine ```
158
Bactericidal antibiotics Very Finely Proficient At Murder
``` Vancomycin - binds D ala D ala Fluroquinolone - inhibits DNA gyrase PCN - bind transpeptidase Aminoglycoside - inhibits initiation complex , 30s Metronidazole - ```
159
Bacteriostatic antibiotics BacteriostaTTECCS
``` Trimethoprim Tetracycline Erythromycin Clindamycin Chloramphenicol Sulfamethoxazole ```
160
Antifungal: disrupts membrane function
Amphotheracin B | Nystatin
161
Antifungal: disrupts cell wall synthesis
Caspofungin | Anidulfungin
162
Antifungal: disrupts ergosterol synthesis
Fluconazole Itraconazole Voriconazole
163
Antifungal: disrupts lanosterol synthesis
Terbinafine | Naftifine
164
SE of protease inhibitors "navir"s used in HIV tx
Lipodystrophy - fat redistribution Hyperglycemia GI intolerance, Nephropathy, Hematuria (indinavir) Lopinavir, Atazanavir, Ritonavir, Indinavir, etc
165
Nucleoside reverse transcriptase inhibitors NRTI side effect.
Bone marrow suppression Peripheral neuropathy Anemia - zidovudine Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,
166
Effect of drug on body
PharmacoDynamics
167
Effect of body on the drug
Pharmacokinetics
168
of hours max for pralidoxime to work
6 to 8 hrs Used like atropine for organophosphate poisoning
169
Used to alkalinize or acidify urine
alkalinize urine - make it Basic with Bicarbonate acidify urine - make it Acidic with Ammonium chloride
170
Sublingual hypertensive meds pathway
Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA
171
Rectal route of meds partial first pass because
Superior rectal vain -> IMV -> portal system FIRST PASS Middle rectal vein -> IIV -> IVC Inferior rectal vein -> IPV -> IIV -> IVC
172
Best topical preparation
Ointment > foam > cream Slowest drug route
173
Routes of administration Significant first pass effect ? Partially bypasses first pass effect ? Completely bypasses first pass effect ?
Significant first pass effect ? Oral Partially bypasses first pass effect ? Rectal Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)
174
Soluble drugs are _____ & ________
Non ionized and non polar aka lipid soluble
175
Drugs that have zero order kinetics ie constant elimination rate over time / Linear WHAT PET
``` Warfarin Heparin Aspirin Tolbutamide Phenytoin Ethanol Theophylline ``` Note. NO Half life in zero order!!!
176
Dosage required to have 50% efficacy aka amount needed to produce a given effect.
Potency Efficacy is the height of the curve, potency is concentration in x axis
177
Concentration required to bind 50% of receptors
Kd High Kd, low affinity etc
178
Measures of potency
ED50 median effective TD50 median toxic LD50 median lethal
179
Agonist + competitive antagonist
Dec potency but same efficacy. Lower Kmax, same Vmax Shift to the right. You need more to obtain same effect in presence of competitive antagonist.
180
Agonist plus concompetitive antagonist
DECrease efficacy, with same potency. Lower Vmax, same Kd
181
Idiosyncratic effect of allopurinol
Cataract
182
First order kinetics. Drugs metabolized 1, 2, 3 half life
1st half life 50% 2nd half life 75 % 3rd half life 87.5% It takes 4 to 5 half lives to reach 100 %
183
Area under the plasma concentration curve AUC Aka the amount of drug that reached systemic circulation
Bioavailability
184
Phase 1 reactions To make drug more polar / water soluble for excretion as urine HOaRD water
``` Hydrolysis Oxidation a Reduction Deamination ``` Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation
185
Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.
Foscarnet
186
Inhibition of neuraminidase which is necessary to release virions. Works against influenza A and B
Zanamivir | Oseltmivir
187
Nucleoside analogue that inhibits the synthesis of Guanine nucleotides. Used in RSV and Hep C (+ interferon alpha)
Ribavirin
188
Regimen for HIV
2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor NRTI: zidovudine, didanosine, lamivudine, abacavir, stavudine, emricitabine, tenofovir - no activation reqd Protease inhibitors: "-navir" drugs NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation Integrase inhibitor: Raltegravir
189
Prevent maturation of new virus
Protease inhibitor
190
Inhibit HIV genome integration into host cell
Integrase inhibitor - Raltegravir
191
Allergic to TMP SMX, what is the alternative for P jirovenci
Pentamidine or dapsone
192
Blocks peptidoglycan synthesis Vs Blocks cell wall synthesis by inhibiting peptidoglycan cross linking
Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN
193
Hepatitis B medication
Lamivudine + interferon alpha
194
Cephalosporin effective against Pseudomonas aeruginosa 3
1 cefoPERAzone 3 gen 2 ceftaziDIME 3 gen 3 CEFEpime 4 gen CE FE ang PERA DIME
195
Anti HIV drug tha decrease mother to fetus transmission of HiV
Zidovudine
196
MOA clindamycin
Blocks peptide bond formation at the 50sS ribosomal subunit Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC Indication: methicillin resistant Staph aureus
197
Inhibits 50s peptidyltransferase
Chloramphenicol Meningitis: H influenza, N meningitidis, S pneumonia SE Gray baby syndrome - lack of liver UDP glucuronyl transferase Anemia/Aplastic anemia
198
Medication for Alzheimer's that inhibits cholinesterase ie indirect cholinomimetic.
Donepezil Not a cure, slows down disease but does not alter course.
199
Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG. Enveloped ds DNA virus.
HSV Tzank smear
200
CYP 450 Inhibitors Quin V inhibited was SICK with RAGE
``` Quinidine V inhibited was Sulfonamides Isoniazid Cimetidine Ketoconazole Riot avid Amniodarone Grapefruit Erythromycin ```
201
CYP 450 Inducers Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp
``` Modafinil Ethanol Barbidurates Phenytoin aka phenobarbiedoll Rifampicin Smoking or St. John's wort Griseofulvin Carbamazepine ```
202
Bactericidal antibiotics Very Finely Proficient At Murder
``` Vancomycin - binds D ala D ala Fluroquinolone - inhibits DNA gyrase PCN - bind transpeptidase Aminoglycoside - inhibits initiation complex , 30s Metronidazole - ```
203
Bacteriostatic antibiotics BacteriostaTTECCS
``` Trimethoprim Tetracycline Erythromycin Clindamycin Chloramphenicol Sulfamethoxazole ```
204
Antifungal: disrupts membrane function
Amphotheracin B | Nystatin
205
Antifungal: disrupts cell wall synthesis
Caspofungin | Anidulfungin
206
Antifungal: disrupts ergosterol synthesis
Fluconazole Itraconazole Voriconazole
207
Antifungal: disrupts lanosterol synthesis
Terbinafine | Naftifine
208
SE of protease inhibitors "navir"s used in HIV tx
Lipodystrophy - fat redistribution Hyperglycemia GI intolerance, Nephropathy, Hematuria (indinavir) Lopinavir, Atazanavir, Ritonavir, Indinavir, etc
209
Nucleoside reverse transcriptase inhibitors NRTI side effect.
Bone marrow suppression Peripheral neuropathy Anemia - zidovudine Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,
210
Effect of drug on body
PharmacoDynamics
211
Effect of body on the drug
Pharmacokinetics
212
of hours max for pralidoxime to work
6 to 8 hrs Used like atropine for organophosphate poisoning
213
Used to alkalinize or acidify urine
alkalinize urine - make it Basic with Bicarbonate acidify urine - make it Acidic with Ammonium chloride
214
Sublingual hypertensive meds pathway
Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA
215
Rectal route of meds partial first pass because
Superior rectal vain -> IMV -> portal system FIRST PASS Middle rectal vein -> IIV -> IVC Inferior rectal vein -> IPV -> IIV -> IVC
216
Best topical preparation
Ointment > foam > cream Slowest drug route
217
Routes of administration Significant first pass effect ? Partially bypasses first pass effect ? Completely bypasses first pass effect ?
Significant first pass effect ? Oral Partially bypasses first pass effect ? Rectal Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)
218
Soluble drugs are _____ & ________
Non ionized and non polar aka lipid soluble
219
Drugs that have zero order kinetics ie constant elimination rate over time / Linear WHAT PET
``` Warfarin Heparin Aspirin Tolbutamide Phenytoin Ethanol Theophylline ``` Note. NO Half life in zero order!!!
220
Dosage required to have 50% efficacy aka amount needed to produce a given effect.
Potency Efficacy is the height of the curve, potency is concentration in x axis
221
Concentration required to bind 50% of receptors
Kd High Kd, low affinity etc
222
Measures of potency
ED50 median effective TD50 median toxic LD50 median lethal
223
Agonist + competitive antagonist
Dec potency but same efficacy. Lower Kmax, same Vmax Shift to the right. You need more to obtain same effect in presence of competitive antagonist.
224
Agonist plus concompetitive antagonist
DECrease efficacy, with same potency. Lower Vmax, same Kd
225
Idiosyncratic effect of allopurinol
Cataract
226
First order kinetics. Drugs metabolized 1, 2, 3 half life
1st half life 50% 2nd half life 75 % 3rd half life 87.5% It takes 4 to 5 half lives to reach 100 %
227
Area under the plasma concentration curve AUC Aka the amount of drug that reached systemic circulation
Bioavailability
228
Phase 1 reactions To make drug more polar / water soluble for excretion as urine HOaRD water
``` Hydrolysis Oxidation a Reduction Deamination ``` Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation
229
Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.
Foscarnet
230
Inhibition of neuraminidase which is necessary to release virions. Works against influenza A and B
Zanamivir | Oseltmivir
231
Nucleoside analogue that inhibits the synthesis of Guanine nucleotides. Used in RSV and Hep C (+ interferon alpha)
Ribavirin
232
Regimen for HIV
2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor NRTI: zidovudine, didanosine, lamivudine, abacavir, stavudine, emricitabine, tenofovir - no activation reqd Protease inhibitors: "-navir" drugs NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation Integrase inhibitor: Raltegravir
233
Prevent maturation of new virus
Protease inhibitor
234
Inhibit HIV genome integration into host cell
Integrase inhibitor - Raltegravir
235
Allergic to TMP SMX, what is the alternative for P jirovenci
Pentamidine or dapsone
236
Blocks peptidoglycan synthesis Vs Blocks cell wall synthesis by inhibiting peptidoglycan cross linking
Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN
237
Hepatitis B medication
Lamivudine + interferon alpha
238
Cephalosporin effective against Pseudomonas aeruginosa 3
1 cefoPERAzone 3 gen 2 ceftaziDIME 3 gen 3 CEFEpime 4 gen CE FE ang PERA DIME
239
Anti HIV drug tha decrease mother to fetus transmission of HiV
Zidovudine
240
MOA clindamycin
Blocks peptide bond formation at the 50sS ribosomal subunit Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC Indication: methicillin resistant Staph aureus
241
Inhibits 50s peptidyltransferase
Chloramphenicol Meningitis: H influenza, N meningitidis, S pneumonia SE Gray baby syndrome - lack of liver UDP glucuronyl transferase Anemia/Aplastic anemia
242
Allergic to TMP SMX, what is the alternative for P jirovenci
Pentamidine or dapsone
243
Blocks peptidoglycan synthesis Vs Blocks cell wall synthesis by inhibiting peptidoglycan cross linking
Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN
244
Hepatitis B medication
Lamivudine + interferon alpha
245
Inhibits 50s peptidyltransferase
Chloramphenicol Meningitis: H influenza, N meningitidis, S pneumonia SE Gray baby syndrome - lack of liver UDP glucuronyl transferase Anemia/Aplastic anemia
246
MOA clindamycin
Blocks peptide bond formation at the 50sS ribosomal subunit Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC Indication: methicillin resistant Staph aureus
247
Anti HIV drug tha decrease mother to fetus transmission of HiV
Zidovudine
248
Cephalosporin effective against Pseudomonas aeruginosa 3
1 cefoPERAzone 3 gen 2 ceftaziDIME 3 gen 3 CEFEpime 4 gen CE FE ang PERA DIME
249
Medication for Alzheimer's that inhibits cholinesterase ie indirect cholinomimetic.
Donepezil Not a cure, slows down disease but does not alter course.
250
Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG. Enveloped ds DNA virus.
HSV Tzank smear
251
CYP 450 Inhibitors Quin V inhibited was SICK with RAGE
``` Quinidine V inhibited was Sulfonamides Isoniazid Cimetidine Ketoconazole Riot avid Amniodarone Grapefruit Erythromycin ```
252
Inhibit HIV genome integration into host cell
Integrase inhibitor - Raltegravir
253
Prevent maturation of new virus
Protease inhibitor
254
Regimen for HIV
2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor NRTI: zidovudine, didanosine, lamivudine, abacavir, stavudine, emricitabine, tenofovir - no activation reqd Protease inhibitors: "-navir" drugs NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation Integrase inhibitor: Raltegravir
255
Nucleoside analogue that inhibits the synthesis of Guanine nucleotides. Used in RSV and Hep C (+ interferon alpha)
Ribavirin
256
Inhibition of neuraminidase which is necessary to release virions. Works against influenza A and B
Zanamivir | Oseltmivir
257
Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.
Foscarnet
258
Phase 1 reactions To make drug more polar / water soluble for excretion as urine HOaRD water
``` Hydrolysis Oxidation a Reduction Deamination ``` Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation
259
Area under the plasma concentration curve AUC Aka the amount of drug that reached systemic circulation
Bioavailability
260
First order kinetics. Drugs metabolized 1, 2, 3 half life
1st half life 50% 2nd half life 75 % 3rd half life 87.5% It takes 4 to 5 half lives to reach 100 %
261
Idiosyncratic effect of allopurinol
Cataract
262
Agonist plus concompetitive antagonist
DECrease efficacy, with same potency. Lower Vmax, same Kd
263
Agonist + competitive antagonist
Dec potency but same efficacy. Lower Kmax, same Vmax Shift to the right. You need more to obtain same effect in presence of competitive antagonist.
264
Measures of potency
ED50 median effective TD50 median toxic LD50 median lethal
265
Concentration required to bind 50% of receptors
Kd High Kd, low affinity etc
266
Dosage required to have 50% efficacy aka amount needed to produce a given effect.
Potency Efficacy is the height of the curve, potency is concentration in x axis
267
Drugs that have zero order kinetics ie constant elimination rate over time / Linear WHAT PET
``` Warfarin Heparin Aspirin Tolbutamide Phenytoin Ethanol Theophylline ``` Note. NO Half life in zero order!!!
268
Soluble drugs are _____ & ________
Non ionized and non polar aka lipid soluble
269
Routes of administration Significant first pass effect ? Partially bypasses first pass effect ? Completely bypasses first pass effect ?
Significant first pass effect ? Oral Partially bypasses first pass effect ? Rectal Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)
270
Best topical preparation
Ointment > foam > cream Slowest drug route
271
Rectal route of meds partial first pass because
Superior rectal vain -> IMV -> portal system FIRST PASS Middle rectal vein -> IIV -> IVC Inferior rectal vein -> IPV -> IIV -> IVC
272
Sublingual hypertensive meds pathway
Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA
273
Used to alkalinize or acidify urine
alkalinize urine - make it Basic with Bicarbonate acidify urine - make it Acidic with Ammonium chloride
274
of hours max for pralidoxime to work
6 to 8 hrs Used like atropine for organophosphate poisoning
275
CYP 450 Inducers Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp
``` Modafinil Ethanol Barbidurates Phenytoin aka phenobarbiedoll Rifampicin Smoking or St. John's wort Griseofulvin Carbamazepine ```
276
Effect of body on the drug
Pharmacokinetics
277
Effect of drug on body
PharmacoDynamics
278
Nucleoside reverse transcriptase inhibitors NRTI side effect.
Bone marrow suppression Peripheral neuropathy Anemia - zidovudine Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,
279
SE of protease inhibitors "navir"s used in HIV tx
Lipodystrophy - fat redistribution Hyperglycemia GI intolerance, Nephropathy, Hematuria (indinavir) Lopinavir, Atazanavir, Ritonavir, Indinavir, etc
280
Antifungal: disrupts lanosterol synthesis
Terbinafine | Naftifine
281
Antifungal: disrupts ergosterol synthesis
Fluconazole Itraconazole Voriconazole
282
Bactericidal antibiotics Very Finely Proficient At Murder
``` Vancomycin - binds D ala D ala Fluroquinolone - inhibits DNA gyrase PCN - bind transpeptidase Aminoglycoside - inhibits initiation complex , 30s Metronidazole - ```
283
Antifungal: disrupts cell wall synthesis
Caspofungin | Anidulfungin
284
Antifungal: disrupts membrane function
Amphotheracin B | Nystatin
285
Bacteriostatic antibiotics BacteriostaTTECCS
``` Trimethoprim Tetracycline Erythromycin Clindamycin Chloramphenicol Sulfamethoxazole ```
286
DOC for PCP ? If with sulfa allergy?
DOC for PCP ? TMP-SMX (tx and prophylaxis) If with sulfa allergy? Pentamidine Prophylaxis for CD<200 in HIV
287
Antibiotics versus Pseudomonas aeruginosa
Ce Fe Pera Dime - CEFEpime - CefoPERAzime - CeftaziDIME Extended spectrum PCN + Aminoglycoside -Aminoglycoside + Ticarcillin/Carbenicillin/Piperacillin
288
Long term medication for chronic atrial fibrillation
Warfarin INT 2-3
289
Prevents further clot formation? Breaks down existing clots? Interferes with the binding of fibrinogen to platelets? Binds glycoprotein receptor IIb/IIIa on activated platelets?
Prevents further clot formation? Heparin and ASA - does NOT break down existing clots!!! - Heparin: catalyzed activation of anti thrombin III - ASA side effect: tinnitus Breaks down existing clots? Thrombolytics: streptokinase/tissue plasminogen activator tPA - converts plasminogen to PLASMIN which cleaves thrombin and fibrin clots Interferes with the binding of fibrinogen to platelets? Clopidogrel and ticlopidine - via inhibiting the ADP pathway Binds glycoprotein receptor IIb/IIIa on activated platelets? Abciximab: prevents platelet aggregation
290
Blocks leukotriene receptors? Inhibits the 5 lipoxygenase pathway preventing conversion of arachidonic acid to leukotrienes?
Blocks leukotriene receptors? Zafirlukast Inhibits the 5 lipoxygenase pathway? Zileuton
291
Epinephrine vs Phentolamine
Epinephrine : nonselective agonist of Alpha and Beta receptors Phentolamine : nonselective Alpha antagonist if you give Epi alone, net inc in BP - B1 HR,inc contractility - A1 inc TPR (B mediated vasodilation negligible compared to A1 effects) If you give Phentolamine alone, net inc BP - B1 HR,inc contractility - Normal Beta mediated vasodilation, no alpha action If you give Epi then Phentolamine, net effect: Dec BP - No Alpha actions, Increased Beta action from Epi - arterioles: only Beta acting so massive vasodilation = Dec BP - Inc HR and Contractility
292
Epi vs NorE vs Isoproterenol vs Dopa vs DoBu vs Phenylephrine vs Ritodrine vs Salmetrol/Terbutaline/Albuterol
A1 A2 B1 B2 D1 Epi +++ +++ ++++ ++++ 0 NorE ++++ ++++ ++ 0 0 Isoproterenol 0 0 ++++ ++++ 0 Dopa +++ H +++H +++M ++M +++L DoBu + + ++++ + 0 Phenylephrine +++ ++ 0 0 0 Ritodrine 0 0 0 ++++ 0 Salmetrol/ 0 0 ++ ++++ 0 Terbutaline/ Albuterol
293
Un intended effect of Norepinephrine
Decrease HR - NorE inc venous return to heart, via vasoconstriction and inc HR causing Inc SV. Since heart no longer needs to beat fast to maintain sufficient CO (SV x HR), there is REFLEX Bradycardia
294
Oncology drugs Induces formation of free radicals during the G2 phase? Cross links chloride group during active and resting phase? Inhibits topoisomerase II during the late S and early G2 phase?
Induces formation of free radicals at G2 phase causing DNA strand breaks? - Bleomycin: pulmonary fibrosis: testicular Ca : lymphoma Cross links chloride group during active and resting phase? - Cisplatin: alkylating agent: cell cycle non specific : ototoxicity Inhibits topoisomerase II ( unwinds DNA) during the late S and early G2 phase? - Etoposide: increases DNA degradation SE leukopenia/neutropenia/alopecia
295
Antifungals Disrupts microtubule function? Forms pores in the cell membrane? Inhibit DNA synthesis? Inhibits conversion of lanosterol to ergosterol? Inhibits conversion of squalene to lanosterol?
Disrupts microtubule function? Griseofulvin Forms pores in the cell membrane? AmPOREthericin - binds to ergosterol in cell membrane and creates pores Inhibit DNA synthesis? Flucystosine - Pyrimidine anti metabolite like 5FU - competes with uracil Inhibits conversion of lanosterol to ergosterol? Azoles - inhibit 14 alpha due methylation of lanosterol - ketoconazole, fluconazole Inhibits conversion of squalene to lanosterol? Terbinafine - inhibits squalene epoxidase
296
Indication for Cox 2 inhibitors
Patients with known inflammation who are at high risk for GI ulceration and are at LOW RISK for CARDIOvascular ds COX 1 gastric cytoprotection COX 2 inflammatory state - in general , non specific COX inhibitors block conversion of AA to endoperoxides precursor of Prostaglandin, Prostacyclin, Thromboxane. - Prostacyclin is a powerful vasodilator and inhibitor of platelet aggregation. Thromboxane is a powerful vasoconstrictor and promoter of platelet aggreation. - COX 2 inhibitor increases CVS risk because it decreases Prostacyclin without corresponding decrease in Thromboxane
297
Pulmonary fibrosis causing drugs
Bleomycin Busulfan Methotrexate Nitrofurantoin
298
P450 inducers
Momma Bar Steals Phen phen and Refuses Greasy Carbs Chronically ``` Modanifil Barbidurates St Johns wort Phenytoin Griseofulvin Carbamazepine Chronic alcohol use ```
299
Drugs that precipitate hemolysis in G6PD
``` Sulfonamides Isoniazid Aspirin Ibuprofen Primaquine Nitrofurantoin ```
300
Monoamine oxidase inhibitors "MAO Takes Pride In Shanghai"
``` MAO inhibitors inc NE, Serotonin, Dopamine Tranylcypromine Phenelzine Isocarboxazid Selegiline ``` Toxicity: serotonin syndrome on exposure to certain food Toxicity of TCA: excess acetylcholine symptoms
301
MOA of Doxorubicin and Daunorubicin
DNA intercalators that act by binding to DNA and disrupting nucleic acid synthesis. Via " no covalent intercalation with DNA" SE dilated cardiomyopathy
302
MOA of 6 Mercaptopurine
Acts as a false metabolite and blocks purine synthesis SE myelosupression, gastrointestinal effects, liver toxicity
303
SE Cinchonism Cutaneous flushing Hemolytic anemia Photosensitivity Thrombocytopenia
Cinchonism (blurred vision,tinnitus,HA,disorientation) : Quinidine Cutaneous flushing : vancomycin, adenosine, niacin, Ca blockers Hemolytic anemia: ribavirin Photosensitivity: sulfonamide s, Amiodarone, tetracycline Thrombocytopenia/neutropenia/leukopenia/nephrotoxicity: Ganciclovir
304
Causes of folic acid deficiency
1 diet | 2 phenytoin
305
Site of action ``` Bleomycin Etoposide 5 Fluorouracil Methotrexate Paclitaxel Vincristine ```
Bleomycin : G2 phase : causes DNA strand breaks Etoposide : late S and G2 phase : inhibits topoisomerase II 5 Fluorouracil : S phase : inhibit thymidylate synthase Methotrexate : S phase : inhibit dihydrofolate reductase Paclitaxel : Metaphase Vincristine : Metaphase
306
Chemo drugs Causes covalent interstrand cross links in DNS? Generates free radicals that intercalated DNA?
Causes covalent interstrand cross links in DNS? - cyclophosphamide Generates free radicals that intercalated DNA? - Doxorubicin/Adriamycin
307
Used in post renal transplant to inhibit Interleukin 2 secretion
Tacrolimus
308
Chemo drugs Cross links DNS? Intercalates DNA?
Cross links DNS? Cisplatin Intercalates DNA? Doxorubicin, et al
309
SE. Ganciclovir vs Ribavirin
Ganciclovir : leukopenia, neutropenia, thrombocytopenia Ribavirin : hemolytic anemia (Coombs negative)
310
DOC for PCP ? If with sulfa allergy?
DOC for PCP ? TMP-SMX (tx and prophylaxis) If with sulfa allergy? Pentamidine Prophylaxis for CD<200 in HIV
311
Antibiotics versus Pseudomonas aeruginosa
Ce Fe Pera Dime - CEFEpime - CefoPERAzime - CeftaziDIME Extended spectrum PCN + Aminoglycoside -Aminoglycoside + Ticarcillin/Carbenicillin/Piperacillin
312
Long term medication for chronic atrial fibrillation
Warfarin INT 2-3
313
Prevents further clot formation? Breaks down existing clots? Interferes with the binding of fibrinogen to platelets? Binds glycoprotein receptor IIb/IIIa on activated platelets?
Prevents further clot formation? Heparin and ASA - does NOT break down existing clots!!! - Heparin: catalyzed activation of anti thrombin III - ASA side effect: tinnitus Breaks down existing clots? Thrombolytics: streptokinase/tissue plasminogen activator tPA - converts plasminogen to PLASMIN which cleaves thrombin and fibrin clots Interferes with the binding of fibrinogen to platelets? Clopidogrel and ticlopidine - via inhibiting the ADP pathway Binds glycoprotein receptor IIb/IIIa on activated platelets? Abciximab: prevents platelet aggregation
314
Blocks leukotriene receptors? Inhibits the 5 lipoxygenase pathway preventing conversion of arachidonic acid to leukotrienes?
Blocks leukotriene receptors? Zafirlukast Inhibits the 5 lipoxygenase pathway? Zileuton
315
Epinephrine vs Phentolamine
Epinephrine : nonselective agonist of Alpha and Beta receptors Phentolamine : nonselective Alpha antagonist if you give Epi alone, net inc in BP - B1 HR,inc contractility - A1 inc TPR (B mediated vasodilation negligible compared to A1 effects) If you give Phentolamine alone, net inc BP - B1 HR,inc contractility - Normal Beta mediated vasodilation, no alpha action If you give Epi then Phentolamine, net effect: Dec BP - No Alpha actions, Increased Beta action from Epi - arterioles: only Beta acting so massive vasodilation = Dec BP - Inc HR and Contractility
316
Epi vs NorE vs Isoproterenol vs Dopa vs DoBu vs Phenylephrine vs Ritodrine vs Salmetrol/Terbutaline/Albuterol
A1 A2 B1 B2 D1 Epi +++ +++ ++++ ++++ 0 NorE ++++ ++++ ++ 0 0 Isoproterenol 0 0 ++++ ++++ 0 Dopa +++ H +++H +++M ++M +++L DoBu + + ++++ + 0 Phenylephrine +++ ++ 0 0 0 Ritodrine 0 0 0 ++++ 0 Salmetrol/ 0 0 ++ ++++ 0 Terbutaline/ Albuterol
317
Un intended effect of Norepinephrine
Decrease HR - NorE inc venous return to heart, via vasoconstriction and inc HR causing Inc SV. Since heart no longer needs to beat fast to maintain sufficient CO (SV x HR), there is REFLEX Bradycardia
318
Oncology drugs Induces formation of free radicals during the G2 phase? Cross links chloride group during active and resting phase? Inhibits topoisomerase II during the late S and early G2 phase?
Induces formation of free radicals at G2 phase causing DNA strand breaks? - Bleomycin: pulmonary fibrosis: testicular Ca : lymphoma Cross links chloride group during active and resting phase? - Cisplatin: alkylating agent: cell cycle non specific : ototoxicity Inhibits topoisomerase II ( unwinds DNA) during the late S and early G2 phase? - Etoposide: increases DNA degradation SE leukopenia/neutropenia/alopecia
319
Antifungals Disrupts microtubule function? Forms pores in the cell membrane? Inhibit DNA synthesis? Inhibits conversion of lanosterol to ergosterol? Inhibits conversion of squalene to lanosterol?
Disrupts microtubule function? Griseofulvin Forms pores in the cell membrane? AmPOREthericin - binds to ergosterol in cell membrane and creates pores Inhibit DNA synthesis? Flucystosine - Pyrimidine anti metabolite like 5FU - competes with uracil Inhibits conversion of lanosterol to ergosterol? Azoles - inhibit 14 alpha due methylation of lanosterol - ketoconazole, fluconazole Inhibits conversion of squalene to lanosterol? Terbinafine - inhibits squalene epoxidase
320
Indication for Cox 2 inhibitors
Patients with known inflammation who are at high risk for GI ulceration and are at LOW RISK for CARDIOvascular ds COX 1 gastric cytoprotection COX 2 inflammatory state - in general , non specific COX inhibitors block conversion of AA to endoperoxides precursor of Prostaglandin, Prostacyclin, Thromboxane. - Prostacyclin is a powerful vasodilator and inhibitor of platelet aggregation. Thromboxane is a powerful vasoconstrictor and promoter of platelet aggreation. - COX 2 inhibitor increases CVS risk because it decreases Prostacyclin without corresponding decrease in Thromboxane
321
Pulmonary fibrosis causing drugs
Bleomycin Busulfan Methotrexate Nitrofurantoin
322
P450 inducers
Momma Bar Steals Phen phen and Refuses Greasy Carbs Chronically ``` Modanifil Barbidurates St Johns wort Phenytoin Griseofulvin Carbamazepine Chronic alcohol use ```
323
Drugs that precipitate hemolysis in G6PD
``` Sulfonamides Isoniazid Aspirin Ibuprofen Primaquine Nitrofurantoin ```
324
Monoamine oxidase inhibitors "MAO Takes Pride In Shanghai"
``` MAO inhibitors inc NE, Serotonin, Dopamine Tranylcypromine Phenelzine Isocarboxazid Selegiline ``` Toxicity: serotonin syndrome on exposure to certain food Toxicity of TCA: excess acetylcholine symptoms
325
MOA of Doxorubicin and Daunorubicin
DNA intercalators that act by binding to DNA and disrupting nucleic acid synthesis. Via " no covalent intercalation with DNA" SE dilated cardiomyopathy
326
MOA of 6 Mercaptopurine
Acts as a false metabolite and blocks purine synthesis SE myelosupression, gastrointestinal effects, liver toxicity
327
SE Cinchonism Cutaneous flushing Hemolytic anemia Photosensitivity Thrombocytopenia
Cinchonism (blurred vision,tinnitus,HA,disorientation) : Quinidine Cutaneous flushing : vancomycin, adenosine, niacin, Ca blockers Hemolytic anemia: ribavirin Photosensitivity: sulfonamide s, Amiodarone, tetracycline Thrombocytopenia/neutropenia/leukopenia/nephrotoxicity: Ganciclovir
328
Causes of folic acid deficiency
1 diet | 2 phenytoin
329
Site of action ``` Bleomycin Etoposide 5 Fluorouracil Methotrexate Paclitaxel Vincristine ```
Bleomycin : G2 phase : causes DNA strand breaks Etoposide : late S and G2 phase : inhibits topoisomerase II 5 Fluorouracil : S phase : inhibit thymidylate synthase Methotrexate : S phase : inhibit dihydrofolate reductase Paclitaxel : Metaphase Vincristine : Metaphase
330
Chemo drugs Causes covalent interstrand cross links in DNS? Generates free radicals that intercalated DNA?
Causes covalent interstrand cross links in DNS? - cyclophosphamide Generates free radicals that intercalated DNA? - Doxorubicin/Adriamycin
331
Used in post renal transplant to inhibit Interleukin 2 secretion
Tacrolimus
332
Chemo drugs Cross links DNS? Intercalates DNA?
Cross links DNS? Cisplatin Intercalates DNA? Doxorubicin, et al
333
SE. Ganciclovir vs Ribavirin
Ganciclovir : leukopenia, neutropenia, thrombocytopenia Ribavirin : hemolytic anemia (Coombs negative)

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