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USMLE HY notes > Pharma > Flashcards

Pharma Flashcards

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
Q

What is niacin famous side effect? what can we give to prevent?

A

Flushing

prevent:
Pre-treatment with Aspirin

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25
Q

how does Gemfibrozil induce gallstone formation?

to treat hyperTG

A

by reduce cholestraolsolubility and bile acid synthesis

G for Gallstones

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26
Q

how to Fish oil effect LDL metabolism

A

reduce VLDL + APO B production

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27
Q

what is the mechanism of PCSK9

A

reduce LDL receptor degradation = more LDL is uptake by the liver

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28
Q

how do Ezetimibe reduce LDL levels in blood

A

by reducing interstital absorbation&raquo_space; more LDL receptors on the liver

eze ti iem= איזה טעים = קשור לקיבה= ירידה בספיגה של LDL

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29
Q

What is the MOA for Resins?

A

inhibit enterohepatic circulation of bile acids&raquo_space; increase cholesterol uptake&raquo_space; hyperTG

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30
Q

Which family belongs this two medications

Cilostazol
Sildenafil

A

PDE inhibitors

31
Q

What is the MOA of Cilostazol

and in what indication we will give

A

reduce PLT aggregation + Direct atriel vasodilator

use for Peripheral artery disease (should also get secondary prevention - Aspirin or clopidogrel)

32
Q

Which second messenger NO/ ANP / BNP elevate and what it the outcome

A

cGMP&raquo_space; Vasodilation

33
Q

what is the MOA of Slidenafil

A

PDE -5 inhibitor (all ends will fil)

reduce cGMP degradation&raquo_space; smooth muscle relaxation

exception- Slidenfail also inhibit PDE-6 Six for Sindanefil=cyanopia, blue tinted vision

34
Q

Whats the treatment for Mucocutaneous candidasis?

A

Nystatin&raquo_space; bind ergosterol&raquo_space; pores formation&raquo_space; leakage of fungal content&raquo_space; Swish and swallow

NOT PO. not absorb by the GI

לערבב בפה ואז לבלוע

35
Q

Whats the trestment for Dermatophytosis

A

Terbinafine&raquo_space; reduce sqalene poxidase&raquo_space; reduce shyntesis of glucose membrane ergosterol

36
Q

Which type of food should not be taken with Levothyroxine and why?

A

Soy products and chelators (Iron, Ca, Antacids)&raquo_space; poor interstitnal reabsorbation&raquo_space; persisitent hypothyroidisim symptoms

37
Q

Whats the treatment for prolactinemia

A

Dopamin agonist

Carbegolin, Bromocriptin

38
Q

Acromegly treatment?

A

Octrerotide (long acting somatostatin analoug&raquo_space; inhibit GH secretion&raquo_space; less IGF-1 realese from liver

not first line. first line resection

39
Q

Which type of medication
X-trozole or X- estane

A

Aromatase inhibitors = reduce synthsis of of estrogen from androgens&raquo_space; less cancer formation in HER2

40
Q

Which family is Tamoxifen and what is a risk while using it?

A

SERM (selective estrogen receptor modulator)&raquo_space; inhibit estrogen effect on breast tissue&raquo_space; reduce breast tissue&raquo_space; less cancer

also for prostate cancer pt&raquo_space; reduce gnycomastia

risk factor: hyperplasia of uterus&raquo_space; endometrium hyperplasia / cancer

41
Q

What can we gave to males with symptomatic hypogonadism

A

Testosterone replacment thrapy

42
Q

What is Raloxifene MOA

A

SERM

Agonist on the bone = less bone reabsorption

R in raloxifene like R in reabsorbtion , X = prevent

43
Q

What is the MOA of Leuprolide

A

GnRH agonist: reduce LH relase&raquo_space; resuce testosterone release&raquo_space; osteoporsis

44
Q

In which cancer Leuprolide is given

A

prostate cancer

long affect of making the hypophysis less responsive

leu de caprio have prostate

45
Q

What improve exopthalmos in hyperthyroidism

A

Cortisol

46
Q

Which Teratogenic medication cause NTD, Microcephaly, orofical cleft, dysmorophic facial feature, distal digit/ nail hypoplasia?

A

Phenytoin

47
Q

Which Teratogenic medication cause Ebtain anomaly, Nephrogenic DI, hypothyrodisim?

A

Lithium

48
Q

Which Teratogenic medications cause NTD

A

Valporate - only NDT

Phyntoin

MTX

49
Q

Which Teratogenic medication cause Microcephaly + thymic hypoplasia, small ears, hydrocephalus?

A

Isotretinoin

50
Q

Which Teratogenic medication cause Limb & craniofacial abnormalies, NTD, abortion

A

MTX

51
Q

Which Teratogenic medication cause renal dysgenesis, oligohydramnius

A

ACEi

52
Q

Which Teratogenic medication cause nasal hypoplasia, stippled epiphysis

A

Warfarin

53
Q

Which medication can be given to CMV colitis

A

Foscarnet (not require intracellular activation like Gan/Acyclovir)

54
Q

What are the 3 main side effect of Histamines

A
  1. Cholinergic/ Muscarinic- blurry vision, urine retention, consipation
  2. alpha-adrenergic- postural diziness, falls
  3. Seratonergic- appietite stimulaiton, weight gain
55
Q

What is the main adverse effect of Nitrates?

A

Headaches, Cutaneous flashing, hypotension

56
Q

Which class is Milirinone and What is the MOA

A

class- PDE-3 inhibitor

MOA:
vasodilaiton in smooth muscle (increase Ca uptake by the SR)
positive ionotropy in cardiac muscle (Ca cahnnel activation)

57
Q

What is the option of treatment for Drug- indcue parkinsonism?

A

Anti-cholinergic : Benztropine, Trihexyphenydil

58
Q

What is the MOA of Doxycycline?

A

inhibit protein synthesis by binding to 30S bacterial subunit

59
Q

What is the MOA of Digoxin?

A

Slow conduction through the AV node by increase parasymphathetic (vagal) tone = control HR

60
Q

What is the MOA of Loop diuretics?

A

inhibit Na-K-2CI transportert in Ascending loop of henle&raquo_space; potent excretion of Na and water

61
Q

Which medication treat COPD by blocking Ach at muscarinic receptors
(inhibit parasymphatetic)

A

Ipratropium- anticholinergic ( der. of atropine)

62
Q

Which Acid-base disturbace happend in loop diuretics?

A

Metabolic alkelosis:
1. by renal excretion of H and K
2. Kidney retain more HCO3- (due to loss of CI)

63
Q

Which Diuretics elevate Uric acid?

A

loop, Thiazide

64
Q

Which Diuretics can cuause Hyperkalemia?

A

Pottasium sparing (aldosterone antagonist)

65
Q

Which medication can be added if theres metabolic alkelosis due to loop diuretics?

A

Carbonic anhydrase inhibitor (acetazolamide)

66
Q

What is the muscarinic effect of Cholinergic toxicity?

A

DUMBLES
Diarrhea/diaporhesis
Urination
Miosis
Bronchospasm, Bradycardia
Emesis
Lacrimination
Salivation

67
Q

What is the nicotinic effect of Cholinergic toxicity?

A

Muscle weakness
paralysis & fasciculations

68
Q

Which medicaiton is giving in organophosphate toxicity to inhibit both nictonic effects and muscarinic effects

A

Pralidoxime- cholineeaterase reactivating agent

69
Q

MOA of Organophosphate

A

Cholinesterase inhibitor = cholinergic toxicity

70
Q

Atropine MOA

A

Block connection of Ach connection to M2 receptors (inhibit para-sympathetic stimulation)

71
Q

Which site is predominantly affeced by Nitrates? and how it effect the heart?

A

Large veins&raquo_space; smooth muscle relaxation lead to venodilation&raquo_space; pre-load reduce = less O2 needed by myocard

72
Q

Which medication cuased smooth muscle vasodilation in small arteries and arterioles?

A

CCB.

73
Q

What is the MOA of urgency incontinence (overactive bladder) and what is the Tx?

A

unhibited bladder contractions = detrosur instability

Tx- Beta-3 Adrenergic agonist (Mirabegron) promote detrosur relaxation = more pee is stored
or
Oxybutrin (M3 antagonist)

74
Q

Omeprazole is a ————- medication which can decrease absorbation of ———- leading to————-

A

PPI agent, Decrease Ca absorpation&raquo_space; lead to osteoporotic fructures

75
Q
A

USMLE HY notes (24 decks)

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