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USMLE HY notes > Pharma > Flashcards

Pharma Flashcards

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1
Q

Drug of choice for anapylaxis?

A

Epinephrine

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2
Q

what is the mehanism for anaphylaxis in epinephrine?

A

counteracts mast cells

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3
Q

2 drugs that can lead to aquierd angioedema

A

ACEi + Sacubitril

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4
Q

C/I for ACEi+ sacubitril

A

Heradetiry angioedema (low C1 inhibition)

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5
Q

What the diagnosis?
Vancomycin&raquo_space; few minute after rash & flushing & pruritus

how to manage?

A

RED MAN SYNDROME

stop drug + antihistamine
if stops&raquo_space; return to low infusion rate

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6
Q

What is the mechanism of Red man syndrome?

A

Psuedoallergy, Non IgE mediated = direct mast cell activation

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7
Q

Which drugs can cause DIRECT mast cell activation (psuedoallergy)

A

Vancomycin + opiods

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8
Q

What is the pre and post synaptic mechanism of opiods?

A

pre synaptic- closing of voltage gated Ca channels&raquo_space; decrease excitatory neurotrasnmitters

Post synaptic- opening of K chaneels&raquo_space; membrane hypopolarization

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9
Q

Which 2 side effects of downregulation by chronic opiod use is not exhibit tolerance?

A

miosis + constipation

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10
Q

Why opiods cuase
constipation
Respiratory acidosis
and how we treat

A

constipation- decrease GI motility (mu)&raquo_space; fluid & laxatives
Respiratory acidosis- reduce RR and TV

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11
Q

How do chronic opiod use effect the hypothalmus

A

primary hypogonadism - low GRH = low LH + FSH

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12
Q

Which Hormones from thr ant. pituatry produce form POMC procursour

A

ACTH, MSH, beta endrophins

endrophins balance cortisol

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13
Q

Which population have high risk for opiods overdose?

CHF
COPD
CKD

A

CKD

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14
Q

What is the treatment for acute aortic dissection

A

beta 1 blocker (Esmolol) essss like tearing

reduce the aortic wall shear stress

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15
Q

What are Statins direct and inderct mechanism

A

Direct- inhibtion of HMG-Coa reductase
Indirect- Increase LDL receptors&raquo_space; more uptake by hepatocytes

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16
Q

Common side effect of statins?

clue: which 2 organs

A

Myopathy and hepatotoxicity

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17
Q

How does statins metabolized? (by which molecule)

A

CYP3A4

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18
Q

What is the diagnosis?
Diffuse muscle pain + elevated CK (rabhdo) in a pt under statins

A

Statin induce myopathy

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19
Q

Why fibrates increase risk for statin myopathy?

A

impair hepatic statin clearance

fibrates- lower LDL

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20
Q

What is the sinergistic effect of Statin and Cholestyramine?

A

low plasma LDL levels

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20
Q

Which drugs can increase statin levels?

A

Macrolides, Ketoconazole, CCB, Amiodarone

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21
Q

What is the best treamtent for hypertriglyceridemia?

A

Fibrates (Fenofibrate)

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22
Q

What is Fenofibrate mechanism
(low TG)

A

activation of PPAR-alpha&raquo_space; low VLDL + incresre LPL activity

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23
Q

How niacin (b3) work?

HLD, LDL, TG

A

increase HDL + Decrease LDL + TG

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24
What is niacin famous side effect? what can we give to prevent?
Flushing prevent: Pre-treatment with Aspirin
25
how does Gemfibrozil induce gallstone formation? | to treat hyperTG
by reduce cholestraolsolubility and bile acid synthesis ## Footnote G for Gallstones
26
how to Fish oil effect LDL metabolism
reduce VLDL + APO B production
27
what is the mechanism of PCSK9
reduce LDL receptor degradation = more LDL is uptake by the liver
28
how do Ezetimibe reduce LDL levels in blood
by reducing interstital absorbation >> more LDL receptors on the liver ## Footnote eze ti iem= איזה טעים = קשור לקיבה= ירידה בספיגה של LDL
29
What is the MOA for Resins?
inhibit enterohepatic circulation of bile acids >> increase cholesterol uptake >> hyperTG
30
Which family belongs this two medications Cilostazol Sildenafil
PDE inhibitors
31
What is the MOA of Cilostazol | and in what indication we will give
reduce PLT aggregation + Direct atriel vasodilator use for Peripheral artery disease (should also get secondary prevention - Aspirin or clopidogrel)
32
Which second messenger NO/ ANP / BNP elevate and what it the outcome
cGMP >> Vasodilation
33
what is the MOA of Slidenafil
PDE -5 inhibitor (all ends will fil) reduce cGMP degradation >> smooth muscle relaxation ## Footnote **exception- Slidenfail also inhibit PDE-6 Six for Sindanefil=**cyanopia, blue tinted vision
34
Whats the treatment for Mucocutaneous candidasis?
Nystatin >> bind ergosterol >> pores formation >> leakage of fungal content >> Swish and swallow | NOT PO. not absorb by the GI ## Footnote לערבב בפה ואז לבלוע
35
Whats the trestment for Dermatophytosis
Terbinafine >> reduce sqalene poxidase >> reduce shyntesis of glucose membrane ergosterol
36
Which type of food should not be taken with Levothyroxine and why?
Soy products and chelators (Iron, Ca, Antacids) >> poor interstitnal reabsorbation >> persisitent hypothyroidisim symptoms
37
Whats the treatment for prolactinemia
Dopamin agonist Carbegolin, Bromocriptin
38
Acromegly treatment?
Octrerotide (long acting somatostatin analoug >> inhibit GH secretion >> less IGF-1 realese from liver | not first line. first line resection
39
Which type of medication X-trozole or X- estane
Aromatase inhibitors = reduce synthsis of of estrogen from androgens >> less cancer formation in HER2
40
Which family is Tamoxifen and what is a risk while using it?
SERM (selective estrogen receptor modulator) >> inhibit estrogen effect on breast tissue >> reduce breast tissue >> less cancer also for prostate cancer pt >> reduce gnycomastia **risk factor:** hyperplasia of uterus >> endometrium hyperplasia / cancer
41
What can we gave to males with symptomatic hypogonadism
Testosterone replacment thrapy
42
What is Raloxifene MOA
SERM Agonist on the bone = less bone reabsorption | R in raloxifene like R in reabsorbtion , X = prevent
43
What is the MOA of Leuprolide
GnRH agonist: reduce LH relase >> resuce testosterone release >> osteoporsis
44
In which cancer Leuprolide is given
prostate cancer long affect of making the hypophysis less responsive leu de caprio have prostate
45
What improve exopthalmos in hyperthyroidism
Cortisol
46
Which Teratogenic medication cause NTD, Microcephaly, orofical cleft, dysmorophic facial feature, distal digit/ nail hypoplasia?
Phenytoin
47
Which Teratogenic medication cause Ebtain anomaly, Nephrogenic DI, hypothyrodisim?
Lithium
48
Which Teratogenic medications cause NTD
Valporate - only NDT Phyntoin MTX
49
Which Teratogenic medication cause Microcephaly + thymic hypoplasia, small ears, hydrocephalus?
Isotretinoin
50
Which Teratogenic medication cause Limb & craniofacial abnormalies, NTD, abortion
MTX
51
Which Teratogenic medication cause renal dysgenesis, oligohydramnius
ACEi
52
Which Teratogenic medication cause nasal hypoplasia, stippled epiphysis
Warfarin
53
Which medication can be given to CMV colitis
Foscarnet (not require intracellular activation like Gan/Acyclovir)
54
What are the 3 main side effect of Histamines
1. **Cholinergic/ Muscarinic**- blurry vision, urine retention, consipation 2. **alpha-adrenergic**- postural diziness, falls 3. **Seratonergic**- appietite stimulaiton, weight gain
55
What is the main adverse effect of Nitrates?
Headaches, Cutaneous flashing, hypotension
56
Which class is Milirinone and What is the MOA
class- PDE-3 inhibitor MOA: vasodilaiton in smooth muscle (increase Ca uptake by the SR) positive ionotropy in cardiac muscle (Ca cahnnel activation)
57
What is the option of treatment for Drug- indcue parkinsonism?
Anti-cholinergic : Benztropine, Trihexyphenydil
58
What is the MOA of Doxycycline?
inhibit protein synthesis by binding to 30S bacterial subunit
59
What is the MOA of Digoxin?
Slow conduction through the AV node by **increase parasymphathetic (vagal) tone** = control HR
60
What is the MOA of Loop diuretics?
inhibit Na-K-2CI transportert in Ascending loop of henle >> potent excretion of Na and water
61
Which medication treat COPD by blocking Ach at muscarinic receptors (inhibit parasymphatetic)
Ipratropium- anticholinergic ( der. of atropine)
62
Which Acid-base disturbace happend in loop diuretics?
Metabolic alkelosis: 1. by renal excretion of H and K 2. Kidney retain more HCO3- (due to loss of CI)
63
Which Diuretics elevate Uric acid?
loop, Thiazide
64
Which Diuretics can cuause Hyperkalemia?
Pottasium sparing (aldosterone antagonist)
65
Which medication can be added if theres metabolic alkelosis due to loop diuretics?
Carbonic anhydrase inhibitor (acetazolamide)
66
What is the muscarinic effect of Cholinergic toxicity?
DUMBLES Diarrhea/diaporhesis Urination Miosis Bronchospasm, Bradycardia Emesis Lacrimination Salivation
67
What is the nicotinic effect of Cholinergic toxicity?
Muscle weakness paralysis & fasciculations
68
Which medicaiton is giving in organophosphate toxicity to inhibit **both** nictonic effects and muscarinic effects
Pralidoxime- cholineeaterase reactivating agent
69
MOA of Organophosphate
Cholinesterase inhibitor = cholinergic toxicity
70
Atropine MOA
Block connection of Ach connection to M2 receptors (inhibit para-sympathetic stimulation)
71
Which site is predominantly affeced by Nitrates? and how it effect the heart?
Large veins >> smooth muscle relaxation lead to venodilation >> pre-load reduce = less O2 needed by myocard
72
Which medication cuased smooth muscle vasodilation in small arteries and arterioles?
CCB.
73
What is the MOA of urgency incontinence (overactive bladder) and what is the Tx?
unhibited bladder contractions = detrosur instability Tx- Beta-3 Adrenergic agonist (Mirabegron) promote detrosur relaxation = more pee is stored or Oxybutrin (M3 antagonist)
74
Omeprazole is a ------------- medication which can decrease absorbation of ---------- leading to-------------
PPI agent, Decrease Ca absorpation >> lead to osteoporotic fructures
75

USMLE HY notes (34 decks)

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