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Flashcards in Pharma Deck (333)
1

Short acting Frenzodiazepams TOM

Triazolam Oxazepam Midazolam

2

1st line for Pseudomonas

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

3

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

aminoglycoside

4

synergistic antibiotics

Beta lactam plus aminoglycoside

5

Drugs that cause coronary vasospasm

Cocaine Sumatriptan Ergot alkaloid

6

Drugs that cause cutaneous flushing VANC

Vancomycin Adenosine Niacin Ca channel blocker

7

Drugs that cause dilated cardiomyopathy

Doxorubicin (adriamycin) Daunorubicin

8

Cause torsade de pointes

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

9

Cause agranulocytosis

Clozapine Carbamazepine Colchicine Propylthiouracil Methimazole Dapsone

10

Cause aplastic anemia

Chloramphenicol Benzene NSAIDs PTU Methimazole

11

Direct Coombs test positive

Methodopa Penicillin

12

SE
Gray baby syndrome

Chloramphenicol

13

SE
Hemolysis in G6PD. IS PAIN

Isoniazid Sulfonamide Primaquine ASA Ibuprofen
Nitrofurantoin

14

SE
MegaloBLASTic anemia

Phenytoin Methotrexate Sulfa drugs

15

SE thrombotic complications

OCP

16

SE pulmonary fibrosis

Bleomycin Amiodarone Busulfan

17

SE
Acute cholestatic hepatitis , jaundice

Erythromycin

18

SE
Focal to massive hepatic necrosis

Halothane Amanita phylloides Valproic acid Acetaminophen

19

Hepatitis

Isoniazid

20

Pseudomembranous colitis cause

Ampicillin clindamycin

21

SE
Adrenocortical suppression

Withdrawal of steroids

22

SE
Gynecomastia
Some Drugs Create Awkward Knockers

Spirinolactone digitalis cimetidine alcohol ketoconazole

23

SE
Hot flashes

Tamoxifen clomiphene

24

SE
Hyperglycemia

Niacin , tacrolimus ,protease inhibitors, hctz, steroids

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)