pharma Flashcards Preview

Patho flash cards > pharma > Flashcards

Flashcards in pharma Deck (179):
1

Difference between Pharmacokinetics and Pharmacodynamics

Pharmacokinetics - actions of the body on the drug. Pharmacodynamics - actions of the drug on the body.

2

Heparin is the anticoagulant used for pregnancy due to its large size (unable to cross the placenta). What is it's MOA?

Increases antithrombin III, monitored using PTT, antidote is Protamine Sulfate

3

Which quadrant of the buttocks is the safest for IM drug administration?

Superolateral

4

What is drug is contraindicated to be given via IM?

Anticoagulants - may cause hematomas

5

Through which BV do drugs administered SL pass before reaching the heart?

Lingual vein > IJV > Brachiocephalic/Innominate vein > SVC > RA

6

Route that has partial avoidance of the first pass effect

Rectal or Suppository route

7

DOC for Parkinsons

Levodopa - Dopamine will not cross the BBB

8

Acidic drugs bind to Albumin, Basic drugs bind to?

Orosomucoid

9

DOC for biolar disorder

Lithium

10

Antiemetic that is contraindicated for patients with seizures

Meperidine - active metabolite Normeperidine exacerbates seizures

11

Cholinergic antagonist used in the treatment of Parkinson's disease

Benztropine - reduces tremors

12

Colinergic antagonist, applied as a transdermal patch, used for motion sickness

Scopolamine - antagonizes histamine and serotonin

13

Competitively blocks Nn nicotinic Ach receptors. Used for hypertensive emergencies. SE of postural HTN.

Hexamethonium

14

Drugs that are important for producing complete skeletal muscle relaxation in surgery

Neuromuscular blockers

15

Norepinehrine comes from what AA?

Tyrosine

16

Sympathomimetic (non-selective, direct acting). Last resort drug for cardiogenic shock

Norepinephrine

17

Non-selective, direct acting sympathomimetic used for shock and heart failure

Dopamine

18

Beta non selective sympathomimetic used for asthma

Isoproterenol

19

Treatment for rebound hypertension caused by Clonidine

Phentolamine

20

Alpha 2 selective sympathomimetic for the treatment of Pre-eclampsia

Methyldopa - decreases central sympathetic outflow

21

Alpha 2 selective sympathomimetic that decreases secretion of aqueous humor

Apraclonidine (Brimonidine) - for glaucoma

22

Beta 1 selective sympathomimetic used to treat acute heart failure

Dobutamine - may also be used in cardiac stress testing

23

Beta 2 selective sympathomimetic, DOC for acute asthma attacks

Albuterol/Salbutamol

24

Beta 2 selective sympathomimetic that is used for tocolysis of preterm labor

Terbutaline and Ritodrine

25

Drug used for Pheochromocytoma (pre-surgical)

Phenoxybenzamine - alpha non selective, irreversible adrenergic antagonist

26

Alpha 1 selective adrenergic antagonist that is most selective for prostatic smooth muscle

Tamsulosin (Prazosin)

27

SE of Propanolol

Masks symptoms of hypglycemia in diabetics

28

Non selective beta blocker (adrenergic antagonist) with the longest half life

Nadolol

29

Selective B1 blocker (adrenergic antagonist) used for supraventricular tachycardia

Esmolol - also has the shortest half life

30

Muscle that controls accommodation of the eye

Ciliary muscle (parasympathetic)

31

Prostaglandin that increases outflow through Canal of Schlemm

Latanoprost

32

Diuretic that inhibits Na/Cl transporter in distal convoluted tubule

Hydrochlorothiazide

33

Loop diuretic that inhibits Na/K/Cl transporter in the thick ascending limb of the Loop of Henle

Furosemide

34

Obsolete drug for HTN, may cause suicidal ideation

Reserpine - nerve terminal blocker

35

3 drugs used to control HTN in pheochromocyta

Phenoxybenzamine, Phentolamine, Labetalol

36

DOC for heart failure in African patients. May also be used for pre-eclampsia

Hydralazine

37

Marker for drug induced lupus

Anti-histone antibodies

38

Vasodilator for HTN and alopecia

Minoxidil - can cause hypertrichosis or excessive hair growth

39

Block voltage gated L type calcium channels in the heart. For supraventricular tachycardia. Has a side effect of gingival hyperplasia

Verapamil (Diltiazem)

40

Vasodilator that may cause cyanide toxicity

Nitroprusside

41

Most common cause of bradykinin induced cough. Also delays progression of diabetic nephropathy

Captopril - ACE inhibitor

42

Hyperkalemia and ACE inhibitors/ARBs

Drugs reduce aldosterone levels and cause potassium retention

43

Renin antagonist. Drug for HTN

Aliskiren

44

DOC for Prinzmetal's angina

CCB - Diltiazem

45

Why are antilipid drugs given to patients with unstable angina?

Statins stabilize the plaques

46

Which portion of the ETC is affected by cyanide poisoning?

Complex IV (cytochrome oxidase)

47

Antidote for cyanide poisoning

Inhaled amyl nitrite + IV sodium nitrite + IV sodium thiosulfate

48

Short acting nitrate that affects veins more

Nitroglycerin

49

Nitrate induced headache

Meningeal artery vasodilation

50

Non-dihydropyridine CCB used to treat angina and Raynaud's phenemenon

Diltiazem

51

Beta blocker that has erectile dysfunction as a side effect

Propanolol

52

Cardiac glycoside with a narrow therapeutic index

Digoxin - inhibits Na/K ATPase, increasing intracellular Ca, drug for heart failure with systolic dysfunction

53

DOC in antiarrhythmic treatment of digitalis toxicity

Lidocaine

54

Digitalis toxicity is increased by:

Hypokalemia, hypomagnesemia, and hypercalcemia

55

These drugs are of no value in CHF

Calcium channel blockers

56

Diuretic that can be used for immediate reduction of pulmonary congestion and severe edema in HF

Furosemide (loop diuretic)

57

These drugs reduce progression of heart failure

Beta blockers - Carvedilol, Labetolol and Metoprolol

58

Condition induced by antiarrhythmics where there is polymorphic ventricular tachycardia on ECG

Torsades de pointes

59

Class 1 antiarrhythmic with Lupus like syndrome as a side effect

Procainamide - used especially after an MI

60

Class 1 antiarrhythmic that can cause marked antimuscarinic effects

Disopyramide

61

Class 1 antiarrhythmic that can also be used for malaria. SEs of cinchonism and autoimmune reactions (ITP)

Quinidine

62

Drug for class 1A antiarrhythmics to reverse drug induced arehythmias

Sodium lactate

63

Least cardiotoxic anti-arrhythmic. DOC for ventricular arehythmias post MI and digoxin induced arrhythmias.

Lidocain - Class 1B antiarrhythmic

64

Contraindicated for post MI arrhythmias

Flecainide - Class 1C antiarrhythmic. Used for refractory arrhythmias.

65

Post MI prophylaxis against sudden death, can also be used for thyrotoxicosis

Propanolol - class 2 anti arrhythmic

66

Usually given for A-fib, hallmark is prolongation of AP duration and increase in QT interval

Class 3 antiarrhythmics

67

Beta blocker antiarrhythmic that has class 3 properties

Sotalol

68

A super antoarrhythmic with a SE of microcrystalline deposits in cornea and skin

Amiodarone - Class 3 anti arrhythmic. Used for refractory arrhythmias

69

Effective in arrhythmias that must traverse calcium dependent cardiac tissue (AV node)

Class 4 antiarrhythmics - PR interval consistently increased

70

Evoke a compensatory sympathetic discharge which facilitates arrhythmias rather than terminating them

Dihydropyridine CCBs

71

Miscellaneous antiarrhythmic which is the DOC for paroxysmal SVT

Adenosine

72

Site of action of carbonic anhydrase inhibitors (Acetazolamide)

Proximal Convoluted Tubule

73

Why is acetazolamide used in treating mountain sickness

Acetazolamide causes metabolic acidosis resulting to increased respiration

74

Site of uric acid transport

Proximal convoluted tubule

75

Site of action of loop diuretics, site of Ca and Mg reabsorption

Thick ascending limb of the loop of henle

76

Site of action of thiazide diuretics, pumps Na and Cl out of the lumen via the Na/Cl carrier

Distal convoluted tubule

77

Calcium is reabsorbed in this segment under the control of PTH

Distal convoluted tubule

78

Site of action of potassium sparing diuretics

Cortical collecting duct

79

Steroid inhibitors of cytoplasmic aldosterone receptor in CCD. Can cause gynecomastia

Spironolactone - potassium sparing diuretic

80

Retains water in tubule by reducing reabsorption in proximal tubules, descending limb of the loop of Henle and collecting ducts

Mannitol - osmotic diuretic

81

Site of action of ADH agonists and antagonists

Medullary collecting duct

82

Condition that occurs with rapid correction of hyponatremia

Central pontine myelinolysis

83

Increase number of high affinity LDL receptors which clear LDL and VLDL remnants from the blood

Statins

84

Reversible competitive inhibitor of HMG COA reductase

Simvastatin - given before bedtime

85

Binds bile acids, preventing their reabsorption and increasing cholesterol utilization for replacement

Cholestyramine - bile acid binding resin, modestly lowers LDL levels

86

A transport process in jejunal enterocytes that mediates GI uptake of cholesterol and phytosterols. Inhibited by Ezetimibe

NPC1L1 transporter

87

Cholesterol analog. Takes the place of dietary and biliary cholesterol, decreasing intestinal absorption

Sitosterol

88

Most effective agent for increasing HDL levels

Niacin

89

Pre treatment with this drug reduces Niacin associated flushing

Aspirin

90

Activates PPAR alpha and increases expression of lipoprotein lipase and apolipoproteins. DOC for hypertriglyceridemia.

Gemfibrozil - lowers triglycerides, increases HDL

91

Disadvantage of Fibrate + Resin

Increased risk of cholelithiasis

92

Disadvantage of Statin + Fibrate

Increased risk of myopathy and rhabsomyolysis

93

Combinations for familial hypercholesterolemia

Niacin + Statin, Statin + Ezetimibe

94

Histamine is formed from what amino acid?

Histidine

95

How do you detect an excess production of histamine?

Measurement of Imidazole acetic acid in the urine

96

Triple response effect of histamine

Wheal, flush and flare

97

Histamine receptor in stomach, heart and mast cells

H2

98

Histamine receptor in smooth muscle

H1

99

Histaminergic agent with anti-motion sickness effect

Meclizine - H1 receptor antagonist (1st generation)

100

Histaminergic agent that reduces gastric acid secretion

Cimetidine - H2 receptor antagonist

101

Serotonin is produced from what amino acid?

Tryptophan

102

How is excess production of serotonin detected?

5-HIAA in urine

103

Serotonin receptor in the brain

5 - HT 1D

104

Serotonin receptor in the sensory and enteric nerves

5-HT 3

105

DOC for acute migraine

Sumatriptan - 5-HT 1D agonist, causes vasoconstriction

106

DOC for chemotherapy and post-operative vomiting

Ondansetron - 5-HT 3 receptor antagonist

107

Antidote for ergotamine (5 HT2 receptor antagonist)

Nitroprusside

108

5 HT2 receptor antagonist that has a SE of retroperitoneal fibrosis

Methysergide

109

2nd line treatment for migraine and cluster headache

Ergotamine - 5 HT2 receptor antagonist

110

5 HT2 receptor antagonist with uteroselective effects

Ergonovine (Methylergonovine) - postpartum bleeding

111

Eicosanoid receptor that acts as a slow reacting substance of anaphylaxis

LTC4, LDT4

112

Eicosanoid receptor that maintains PDA

PGE1 and PGE2

113

Eicosanoid receptor for platelet aggregation

TXA2

114

PGE1 analog that maintains PDA. Can also be used for erectile dysfunction

Alprostadil - vascular smooth muscle relaxation and vasodilation

115

Prostaglandin I2 analog used for pulmonary HTN

Epoprostenol

116

Prostaglandin F2 alpha analog used in the treatment of Glaucoma

Latanoprost - can alter color of the eyelid causing permanent eye color change

117

DOC for acute asthma attacks

Albuterol/Salbutamol - short acting beta 2 selective agonist with a SE of tachycardia

118

Long acting beta 2 selective agonist used for asthma prophylaxis

Salmeterol

119

Muscarinic receptor antagonist used for asthma and COPD

Ipratropium - SE of dry mouth

120

Methylxanthine used as a prophylaxis for asthma nocturnal attacks

Theophylline - SE of seizures, beta blockers can be used as an antidote in overdosage

121

Mast cell stabilizer used as an asthma prophylaxis and for allergies. No bronchodilator action

Cromolyn

122

DOC for asthma prophylaxis

Fluticasone - corticosteroid that inhibits phospholipase A2

123

SE of Fluticasone

Oropharyngeal candidiasis (oral thrush) - gargle after inhaling

124

Treatment of severe refractory asthma (status asthmaticus)

IV hydrocortisone

125

Blocks cysteinyl leukotriene 1 receptor for leukotrienes CD4, D4 and E4. Used as asthma prophylaxis

Montelukast - no bronchodilator action

126

Prophylaxis of severe, refractory asthma not responsive to all other drugs

Omalizumab - anti IgE antibody

127

Anemia caused by a deficiency of Vit B12 or Folic Acid

Megaloblastic anemia - pernicious anemia most common type

128

Intrinsic factor is made from?

Parietal cells

129

Side effect of ferrous sulfate

Black stools - may obscure acute GI loss

130

Heavy metal chelator used in the treatment of acute iron poisoning and hemachromatosis not adequately treated by phlebotomy

Deferoxamine - chelates excess iron

131

State of chronic iron overload. Triad?

Hemochromatosis / "Bronze Diabetes" - cirrhosis, DM, skin pigmentation

132

Neurologic defects in Vit B12 deficiency

Ataxic gait, impaired position and vibratory sense, spasticity

133

Plasma transport of Vit B12 is accomplished by binding to?

Transcobalamin II

134

What are the 2 available forms of Vit B12?

Cyanocobalamin and Hydroxocobalamin

135

Large amounts of Vit B12 is stored in the?

Liver - 5 year supply

136

Where is folic acid readily absorbed?

Proximal jejunum - modest amounts stored in the body

137

Performance enhancing drugs in athletes. Production is stimulated by hypoxia

Epoetin Alfa - hematopoietic growth factor . Used for anemia associated with chronic renal failure

138

Used for neutropenia associated with chemotherapy

G CSF - myeloid growth factor, accelerates neutrophil recovery

139

For secondary prevention o thrombocytopenia in patients undergoing cytotoxic chemotherapy

Oprelvekin - megakaryocyte growth factor that activates IL 11 receptors

140

Nonselective, irreversible COX 1 and 2 inhibitor. Reduces platelet production of Thromboxane A2

Aspirin - toxic dose of 150mg/kg, lethal dose of 500mg/kg

141

What is the triad of aspirin hypersensitivity?

Samter triad - asthma, aspirin sensitivity, nasal polyps

142

Mechanism of aspirin intoxication that leads to HAGMA

Uncoupling of oxidative phosphorylation

143

What is the presentation of aspirin intoxication in adults? Children?

Adults - respiratory alkalosis with HAGMA, Children - HAGMA only

144

Drug that is next in line if the patient has an aspirin allergy

Clopidogrel - irreversibly inhibits binding of ADP to platelet receptors

145

Antiplatelet drug that interferes with GPIIb/IIIa binding to fibrinogen

Abciximab - used during PCI to prevent thrombosis

146

Antiplatelet drug that inhibits phosphodiesterase III and increases cAMP, can also cause vasodilation

Dipyridamole - by itself has little or no benefit, contraindicated in heart failure

147

Drugs use mainly for the prevention and treatment of venous thrombosis

Anticoagulants - inhibit formation of fibrin clots

148

Heparin vs Warfarin: onset?

Heparin - rapid (minutes), Warfarin - slow (days)

149

Heparin vs Warfarin: site of action

Heparin - blood, Warfarin - liver

150

Heparin vs Warfarin: MOA

Heparin - activates antithrombin III, Warfarin - impairs post translational modification of factors X IX VII II (1972)

151

Heparin vs Warfarin: antidote

Heparin - protamine, Warfarin - vit K or FFP

152

Heparin vs Warfarin: monitoring

Heparin - PTT, Warfarin - PT

153

DOC for anticoagulation during pregnancy

Heparin - activates antithrombin III which inactivates thrombin or factor IIa, IXa, Xa by forming stable complexes with them

154

Anticoagulant that binds and potentiates effect of abtithrombin III on factor Xa (more selective)

Enoxaparin - less risk of thrombocytopenia (vs heparin), does not require monitoring with PTT

155

Anticoagulation in patients with heparin induced thrombocytopenia

Lepirudin - binds to thrombin's active site and inhibits its enzymatic action

156

Anticoagulant that inhibits vit K epoxide reductase, used for chronic anticoagulation

Warfarin - SE of warfarin induced skin necrosis, has a narrow therapeutic window

157

Thrombolytic drug that has a SE of cerebral hemorrhage

Alteplase (streptokinase) - converts plasminogen to plasmin, degrades the fibrin and fibrinogen

158

Antidote to Alteplase

Aminocaproic acid (Tranexamic acid) - competitively inhibits plasminogen activation

159

Causes a severe infusion reaction when administered too fast (dyspnea, chest and back pain)

Vit K - antidote to warfarin, can also prevent hemorrhagic diatheses in newborns

160

Drug that increases the factor VIII activity of patients with mild Hemophilia A or von Willebrand disease

Desmopressin - vasopressin V2 receptor agonist (ADH agonist)

161

NSAID and antiplatelet drug that is contraindicated in gout

Aspirin - prevents uric acid excretion

162

At what doses do aspirin produce anti-inflammatory effects?

High doses (2400-4000 mg/d)

163

Drug used for post surgical analgesic control. The only IV NSAID, use restricted to 72hrs only

Ketorolac - nonselective reversible COX 1 and 2 inhibitor, inhibits prostaglandin synthesis

164

NSAID used to close PDA

Indomethacin - nonselective reversible COX 1 and 2 inhibitor, inhibits prostaglandin synthesis

165

N-acetylcysteine is the antidote for?

Paracetamol - selectively inhibits COX 3, mild analgesic and antipyretic

166

Cytotoxic intermediate in paracetamol overdose

NAPQI - centrilobar region (zone III) preferentially involved

167

DMARD of first choice to treat rheumatoid arthritis

Methotrexate - inhibits AICAR transformylase and thymidylate synthetase, may cause a pseudolymphomatous reaction

168

Drug for Crohn's disease but may cause reactivation of latent TB

Infliximab - DMARD that binds to TNF alpha

169

DMARD used to treat RA and IBD but may cause bone marrow suppression, increased risk of infections. Never give with Allopurinol.

Axathioprine - forms 6 Thioguanine, suppressing B and T cell function and immunoglobulin production

170

DMARD and cancer chemotherapeutic drug that may cause hemorrhagic cystitis. Rescue agent is MESNA

Cyclophosphamide - forms phosphoramide mustard, which cross links DNA to prevent cell replication. Also suppresses T and B cell function

171

DMARD used during tissue transplantation

Cyclosporine - inhibits IL 1 and 2 receptor and T cell responsiveness

172

DMARD that may cause reversible myelosuppression

Mycophenolate mofetil - inhibits inosine monophosphate dehydrogenase and T cell lymphocyte proliferation

173

DMARD that may cause hemolytic anemia, methemoglobinia and reversible infertility in men

Sulfasalazine - sulfapyridine inhibits the release of inflammatory cytokines

174

MOA of Colchicine

Inhibits microtubule assembly - may cause agranulocytosis, hepatic necrosis

175

NSAID that is commonly used in the initial treatment of gout as the replacement for Colchicine

Indomethacin - inhibit urate crystal phagocytosis

176

Uricosuric agent that competes with uric acid for reabsorption in the proximal tubules

Probenecid - may precipitate acute gout during early phase of drug administration (co administer with colchicine)

177

First line treatment for chronic gout

Allopurinol - alloxanthine irreversibly inhibits xanthine oxidase and lowers production of uric acid

178

Side effect of Allopurinol

Cataracts

179

Xanthine oxidase inhibitor used if the patient has an Allopurinol intolerance

Febuxostat