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*USMLE* > Pharma > Flashcards

Pharma Flashcards

1
Q

maintenance dose formula

what unit will MD be in?
and what if certain dosing interval is given?

A

MD = Cpss x CL / [bioavailability fraction]

MD unit is mg/min

If dosing interval given, can calc. MD based on that
(eg, 2 mg/min x 60 min/hr x 6 hrs for an MD of 2 and an interval of 6 hrs)

Cpss is steady-state plasma conc.
CL is clearance
bioavailability is 1 if IV

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2
Q

half life formula + how many half-lives to reach Cpss

A

Vd x 0.7 / CL

steady state conc reached in 4-5 half lives

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3
Q

loading dose formula

changes in loading dose based on organ function?

A

Vd x Cpss / [Bioavailability fraction]

loading dose stays say, but maintenance dose changes in case of renal/liver issue affecting elimination

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4
Q

anastrozole, letrozole, exemestane

MOA, uses

A

aromatase inhibitor

postmenopausal breast cancer (blocks aromatization of androstenedione in liver, muscle, fat)

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5
Q

flutamide, cyproterone acetate + spironolactone

MOA, uses

A

androgen receptor antagonists

tx of metastatic prostate cancer

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6
Q

Cytarabine + Gemcitabine

MOA, differences

A

both pyrimidine analog antimetabolites; incorporated into DNA > strand termination (no effect on folate metab.)

cytarabine is S-phase specific; gemcitabine is NOT + also has ribonucleotide reductase inhibition

(“cyt” has S sound; “gem” is a real gem… works better)

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7
Q

Fludarabine

MOA, indication

A

deamination-resistant purine nucleotide analog

inhibits DNA polymerase, primase, ligase and ribonucleotide reductase

used for CLL

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8
Q

5-Fluorouracil

MOA, leucovorin effect

A

pyrimidine analog that inhibits thymidylate synthetase (after conversion to floxuridine monophosphate)

binds thymidylate synthetase in presence of reduced folate > leucovorin actually INCREASES its toxicity

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9
Q

Interleukin-2

MOA and indications as a drug

A

activation + differentiation of T-cells to help tumor destruction

approved for renal cell carcinoma and melanoma

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10
Q

Abciximab

MOA + indication

A

anti-GpIIb/IIIa receptor mAb; blocks final step in platelet aggregation (GpIIb/IIIa binds fibrinogen)

used during angioplasty in ACS

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11
Q

Colchicine

MOA, use, sfx

A

binds TUBULIN and prevents microtubule polymerization (impairs WBC migration + phagocytosis to reduce gout inflammation)

2nd line in gout, for pt with renal failure, PUD, other NSAID contraindications

GI microtubule disruption > diarrhea (less common nausea, vomiting + pain)

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12
Q

Hepatitis 2-3 days after surgery with anesthesia

cause, s/s, histo

A

Halothane Hepatitis - halothane is hi-risk, fluranes lower, but still some risk; CYP450 metab > intermediates > immune-mediated hepatitis

fever, nausea, jaundice, tender hepatomegaly OR liver atrophy if severe, anorexia, my-/arthralgia, rash

high LFTs and bilirubin, prolonged PT (may have leukocytosis and eosinophilia, probably and HS rxn)

centrilobular hepatic necrosis (like viral hep)
inflammation of portal tracts and parenchyma

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13
Q

Nitrous Oxide

MOA and toxicity

A

NMDA antagonism

prolonged exposure > inhibits methionine reductase > megaloblastic anemia

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14
Q

Succinylcholine

MOA, toxicity

A

depolarizing NMJ blocker

hyperkalemia (esp. burn or SC injury pt)

malignant hyperthermia (ANS issues, rigidity, high temp)

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15
Q

First-line for absence seizures

Detailed MOA, SFX, and 2nd line

A

Ethosuximide

blocks T-type Ca channels > inhibits rhythmic burst discharges in thalamic neurons

sfx are nausea, vomit, fatigue + hyperactivity

valproate is 2nd line

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16
Q

4 drugs assoc. with acute pancreatitis

A

azathioprine
sulfasalazine
furosemide
valproate

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17
Q

vinca alkaloids

MOA, phase specificity?

A

vincristine / vinblastine

inhibit microtubule FORMATION by binding beta-tubulin and preventing polymerization of microtubules

specific to M phase of cell cycle (chromosomes can’t align and segregate)

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18
Q

vincristine

side effect

A

peripheral neuropathy

disruption of neuronal microtubules > disrupts axonal transport

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19
Q

Cell Cycle + its related chemo drugs

each phase

A

G1 - cells prepare building blocks for DNA synth
G0 - resting phase

S - DNA replication; topoisomerase I + II inhibitors (etoposide, irinotecan, topotecan) and antimetabolites (MTX, 5-FU, etc.)

G2 - DNA checked for errors + corrections made or apoptosis occurs; intercalators + ROS formers work here (bleomycin, doxorubicin, etc.)

M - division; vinca alkaloids + taxanes

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20
Q

Thiazolidinediones

MOA + effects

A

PPARy agonist

increased: FA uptake
adiponectin (adipokine that increases adipocyte insulin response + stimulates FA oxidation)
insulin sensitivity

decreased: TNF-alpha and leptin (adipokine that acts on hypothalamus to decrease appetite)

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21
Q

Succinylcholine side effects

A

Malignant Hyperthermia - especially with halothane co-admin; in genetically susceptible patients

Severe hyperkalemia + life-threatening arrhythmia - in patients with burns, myopathies, denervation or crush injuries
(upregulation of nAChR in denervation > great drug effect)

Bradycardia (PSNS stim) -or- tachycardia (SNS stim)

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22
Q

UFH binds both ATIII and thrombin, increasing ATIII inactivation of thrombin AND factor X

LMWH primarily affects inactivation of which factor?

A

Mostly just factor X

it has the AT-III binding pentasaccharide, but is shorter and doesn’t bind thrombin

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23
Q

inhibitor of ALCOHOL DEHYDROGENASE

inhibitor(s) of ACETALDEHYDE DH

A

fomepizole (alcohol DH)

disulfiram (acetaldehyde DH)
metronidazole (acetaldehyde DH)

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24
Q

heparin induced thrombocytopenia mechanism + tx

A

heparin-PLATELET FACTOR 4 complex causes IgG autoantibodies (about 3-5 days after heparin initiation)

Ab then binds Fc receptor on platelets > activation and clot formation > platelet consumption causes -penia

stop heparin and give direct thrombin inhibitors (bivalirudin or ARGATROBAN) or LMW heparinoids (fondaparinux, danaparoid) to control thrombosis

(don’t give warfarin because necrosis risk is high when thrombosis is already present!)

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25
Q

Trastuzumab

MOA, toxicity

A

anti-EGFR-2 (HER-2) mAb

cardiotoxicity - HER2 plays role in minimizing cardiomyocyte oxidative stress > antagonism causes DECREASED CONTRACTILITY without signs of destruction or fibrosis

usually ASYMPTOMATIC LV EF REDUCTION, but heart failure can occur

not related to cumulative dose and is often reversible with discontinuation (unlike anthracyclines)

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26
Q

Cholestyramine, Colesevelam, Colestipol

MOA, effects on LDL, VLDL, TAGs

A

bind GI bile acids > hepatic cholesterol diverted to new bile acid synth > increased LDL uptake > lower LDL

hepatic TAG production increases > HIGHER TAGs and VLDL in circ

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27
Q

Common drug class associated with OLIGOHYDRAMNIOS? why?

results in fetus/child?

A

ACE inhibitors and ARBs

AT-II is important in fetal renal development > renal maldevelopment > reduced diuresis

results in PULMONARY HYPOPLASIA, skeletal defects, impaired cranial vascularization + hypocalvaria

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28
Q

A patient with epilepsy also has osteoporosis

Why?

A

Some anticonvulsants (phenobarbital, phenytoin, carbamazepine) also INDUCE CYP450

this can result in INCREASED VITAMIN D CATABOLISM and thus impaired calcium homeostasis

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29
Q

Mechanisms of Isoniazid Resistance (2)

when can isoniazid monotherapy be used?

A

Decreased catalase-peroxidase - mycobacterial enzyme for activation of drug

Modified protein binding site for isoniazid

Pt with positive PPD but a negative chest x-ray + no other evidence of clinical disease

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30
Q

Bupropion

MOA, most significant side effect + pts at higher risk of it

A

NE and DA reuptake inhibitor for major depression

SEIZURE - especially at high doses, or in patients with epilepsy or EATING DISORDER

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31
Q

Terbinafine

MOA, uses

A

inhibits squalene epoxidase

common for dermatophytosis; topical or oral; accumulates in skin/appendages

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32
Q

Theophylline

toxicity effects? tx of toxicity?

A

nausea/vomiting, abd. pain, diarrhea, ARRHYTHMIA or SEIZURE (seizure is main COD)

activated charcoal
beta blockers
BZD / barbiturate for seizures

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33
Q

DOCs for bacterial vaginosis

their MOAs?

A

Clindamycin - binds 50s ribosomal subunit; bacteriostatic

Metronidazole - damages DNA of facultative anaerobes; bactericidal

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34
Q

DRESS syndrome

when + how? general sx? other organs affected? labs?

A

Drug Reaction with Eosinophilia and Systemic Symptoms

2-8 wks after exposure to ANTICONVULSANTS (carbamazepine, phenytoin), ALLOPURINOL, SULFONAMIDES and ABX (minocycline, vanco)

drug-induced HERPESVIRUS reactivation with clonal T-cell expansion cross-reacting with drug

FEVER
generalized LAP
FACIAL EDEMA
generalized morbilliform SKIN RASH (may progress to confluent erythema with follicular accentuation)

may have…
hepatomegaly + jaundice
acute interstitial nephritis
cough + dyspnea

labs - EOSINOPHILIA, atypical lymphocytes, high ALAT

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35
Q

Drug-Induced ANCA vasculitis

which drugs? sx?

A

propylthiouracil, methimazole, hydralazine

generalized sx, arthralgia/-itis, cutaneous vasculitis

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36
Q

Pharma tx for alcoholism

3 drugs, 3 mechanisms

A

Naltrexone - mu atg; blocks rewarding effects of alcohol + reduces cravings; depot injection available

Disulfiram - acetaldehyde DH inhibitor; aversion tx

Acamprosate - NMDA modulation

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37
Q

Side effects of maternal terbutaline use in newborn

4

A

B2 agonist > delays preterm labor

increases risk of…

  1. neonatal intraventricular hemorrhage (vasodilation)
  2. hypoglycemia (insulin secretion)
  3. hypocalcemia
  4. ileus (relaxes GI SM)
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38
Q

Complications of surfactant treatment in premature newborn (4)

A
  1. transient hypoxia (diffusion limitation)
  2. hypotension
  3. endotracheal tube blockage (obstruction)
  4. pulmonary hemorrhage
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39
Q

Thiazides

MOA, mechs of Ca reabs. (2), uses for Ca reabs.

A

blocks Na-Cl cotransporter in DCT

  1. Less Na-Cl reabs. apically > more Ca-Na exchange basally (Na into cell, Ca into circ.) > more Ca reabs. via apical channel
  2. Hypovolemia induced by drug > more Na/water abs. in PCT > more paracellular Ca reabs. in PCT

Ca reabs. by thiazides can…

  1. Improve osteoporosis
  2. PREVENT CALCIUM STONES
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40
Q

Linezolid

important drug interaction

A

Linezolid has MAOI activity > interaction with SSRIs, TCAs, other MAOIs can cause serotonin syndrome!

tx with cyproheptadine

(ex: pt with depression history tx for cellulitis; linezolid is good for Gram+)

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41
Q

hydroxyurea

indication, MOA

A

sickle cell anemia

increases production of HbF via unknown mech

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42
Q

MOA of non-hydroxyurea sickle cell anemia tx

A

Gardos channel blockers

Ca-dependent K channels regulate K and water flow across RBC membrane > block them and prevent RBC dehydration

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43
Q

Acyclovir

MOA, activation, resistance

A

guanosine analog for HSV1/2 and VZV

P-ated by viral THYMIDINE KINASE then double P-ated by host kinases > inhibits DNA polymerase

EBV and CMV do not have the same thymidine kinase

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44
Q

Maraviroc blocks what?

Enfuvirtide blocks what?

A

Maraviroc - CCR5 antagonist; blocks entry

Enfuvirtide - gp41 antagonist; blocks fusion

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45
Q

MOA of systemic progestins in birth control?

examples

A

suppress GnRH > FSH/LH > inhibit ovulation

Combined hormonal contraceptives (pill, patch, ring)
Progestin implants/injections

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46
Q

MOA of locally-acting progestins in birth control?

examples (2 categories, one with diff MOA)?

A

Thicken cervical mucus, impair sperm penetrations

Progestin-only pill (norethindrone)
Levonorgestrel IUD

(Copper IUD - cytotoxic inflammatory response in uterus impairs sperm migration)

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47
Q

Clomiphene citrate

what is it? MOA?

A

selective estrogen receptor modulator

stimulates FSH + LH production

used as a fertility drug, or to help ovulation occur in PCOS

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48
Q

SPECIFIC mechanism of action of NRTIs

not just chain termination / reverse transcriptase inhibition

A

NRTIs are nucleoside/-tide analogs that LACK A 3’ OH GROUP

this means they can not form a PHOSPHODIESTER BOND with the next nucleotide > chain termination

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49
Q

Tx for Wilson disease

A

D-penicillamine, trientine (copper chelators)

Zinc (decr. Cu absorption)

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50
Q

Cyanide poisoning

mechanism?

A

binds FERRIC (3+) iron > inhibition of CYTOCHROME C OXIDASE in mitochondria

disrupts oxidative phosphorylation > severe LACTIC ACIDOSIS and death

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51
Q

Cyanide poisoning

presentation?
labs?

A 
REDDISH SKIN
tachypnea
HA
tachycardia
nausea/vom
confusion + weakness

progress to seizure + CV collapse

severe LACTIC ACIDOSIS
NARROW AVPO GRADIENT - tissues can’t use O2

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52
Q

Cyanide poisoning

tx? (3 things)

A

inhaled AMYL NITRATE - makes METHEMOGLOBIN (Fe2+ becomes Fe3+) with high affin. for CN

HYDROXYCOBALAMIN and SODIUM THIOSULFATE create non-toxic metabolites with CN that are excreted in urine

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53
Q

What is Doxepin?

A

a TCA

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54
Q

Tx for delirium-associated agitation and psychosis in elderly

(Delirium is acute-onset confusion state secondary to infection etc.; more common in elderly or cognitive disorder)

A

first-gen antipsych (HALOPERIDOL)

some second gen antipsychs

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55
Q

Status epilepticus tx

first + fastest? good for maintenance?

A
  1. IV Benzo - lorazepam or diazepam, fast onset
  2. Phenytoin - slower onset, for maintenance
  3. Valproate
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56
Q

Mechanism and tx of TCA arrhythmias

A

FAST SODIUM CHANNEL blockade causes QRS and QT prolongation

SODIUM BICARBONATE tx - increases serum Ph > favors non-ionized, neutral form of the tca > can’t access sodium channels

(also increases EC sodium > overcomes the competitive blockade by tcas)

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57
Q

What are the 3 types of EPS that occur with antipsychotics?

A

ACUTE DYSTONIA - sudden-onset sustained muscle contraction

AKATHISIA - subjective restlessness; unable to sit still

DRUG-INDUCED PARKINSONISM - tremor, rigidity, bradykinesia

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58
Q

Aside from the 3 EPS (dystonia, akathisia, parkinsonism), and neuroleptic malignant syndrome…

what is the other movement-related side effect of antipsychotics?

when does it present?

A

TARDIVE DYSKINESIA

involuntary movements such as LIP SMACKING, biting, grimacing, tongue protrusion or CHOREOATHETOID movements (migrating contractions with twisting/writhing movements)

occurs after CHRONIC use of anti-psychs

59
Q

What is the first (earliest) EPS that might present in a patient on anti-psych drugs?

tx?

A

in HOURS to DAYS…

ACUTE DYSTONIA may present with acute-onset involuntary contraction of NECK, MOUTH, TONGUE or EYE muscles (esp. with high dose first-gens)

tx with ANTICHOLINERGICS (diphenhydramine, benztropine)

60
Q

What is a minor EPS that might present later than acute dystonia via anti-psych tx?

tx?

A

AKATHISIA presents in DAYS to WEEKS after tx start

from mild subjective tension to marked physical restlessness

tx is lower dose, or give BETA BLOCKER or BZD

61
Q

Caspofungin + other -fungins (echinocandins)

MOA, indications

(resistant fungi)

A

inhibits GLUCAN synthesis > fungal cell wall inhibition

good for CANDIDA and ASPERGILLUS

(bad for Crypto, limited activity for Mucor/Rhizopus)

62
Q

OCPs in treatment of PCOS

mechanism

A

oral contraceptives work by inhibiting GnRH > inhibiting LH secretion > decreasing androgen synthesis

also increased SHBG synth in liver > less free testo

63
Q

Med for decreasing FACIAL HAIR GROWTH in hirsutism

mechanism?

A

Eflornithine (topical)

ornithine decarboxylase inhibitor > affects DNA stabilization and repair > decr. cell growth + increased apoptosis

64
Q

Fibrates

MOA (3)? effects?

A
  1. activate PPAR-alpha > induces HDL synth
  2. increase LPL activity > clears TAGs
    (3. decrease VLDL production)

decrease TAGs by 25-50%
increase HDL by 5-20%

65
Q

new onset htn and elevated creatinine in pt on immunosuppression

likely drug cause? mechanism?

possible reason for new toxicity from this drug?

A

CALCINEURIN INHIBITOR NEPHROTOXICITY (cyclosporin, tacrolimus)

dose-dependent RENAL VASOCONSTRICTION and TUBULAR CELL DAMAGE > may cause ARF

toxicity may suddenly develop due to CYP inhibition (metab’d by CYP3A; eg, drinking grapefruit juice)

66
Q

Pharma tx for restless leg syndrome?

behavioral / environmental tx?

deficiency of what seen in RLS? + other causes?

A

Dopamine agonists - ropinirole, pramipexole

avoid triggering factors - alcohol, sleep deprivation

IRON defic. seen often; also uremia, and diabetic nephropathy

67
Q

Oseltamivir

MOA?

A

Neuraminidase inhibition (both flu A and B)

inhibits VIRAL RELEASE from infected cells
also slows viral penetration into mucous of respiratory epithelium

68
Q

Amantadine for flu

MOA?

A

impairs UNCOATING or DISASSEMBLY of virion of INFLUENZA A ONLY after endocytosis

via M2 CHANNEL inhibition (H+ ion channel)

69
Q

Ganciclovir

structure/MOA?

side effects (think of the MOA)

A

guanine nucleoside analog (competitive inhibition of GTP incorporation by CMV DNA polymerase)

also slightly inhibits human DNA polymerase > hematologic side effects

NEUTROPENIA, ANEMIA + THROMBOCYTOPENIA

70
Q

Buspirone

mechanism? onset? indication?

advantages?

A

5HT-1A partial ag

slow onest (up to 2 weeks)

for generalized anxiety disorder
(NOT for panic disorder)

fewer sedative/hypnotic effects than BZDs
no euphoria, tolerance, dependence or withdrawal

71
Q

common CYP450 inhibitors

9 items on list, a couple of em have 2-3 drugs/classes

A 
Alcohol - acute use
Amiodarone
Azoles
Cimetidine
Diltiazem, verapamil 
Grapefruit juice
Isoniazid, macrolides (not azithro!), quinolones
Protease inhibitors
SSRIs

(AaaahK! DaG! IPS!)

72
Q

common CYP450 inducers

A

ABC GoMPeRS

Alcohol - chronic
Barbiturates
Carbamazepine
Griseofulvin
Modafinil
Phenytoin
Rifampin
St. John's wort
73
Q

most use dependent class of antiarrhythmic?

A

Class IC - propafenone and flecainide

slowest to dissociate, and do so mostly during diastole > bind longer at faster HR

(QRS duration normally reduced during exercise but these will increase it)

74
Q

which antiarrhythmics show “reverse use dependence”?

consequence?

A

Class III - K channel blockers

slower heart rate = longer QT interval prolongation

75
Q

Labetalol

receptors affected?

A

alpha 1 - competitive, reversible atg
beta 1 - atg
beta 2 - PARTIAL AG

76
Q

Praziquantel

MOA, indications

A

increased Ca++ perm > paralysis, dislodgement + death

cestodes (tapeworms) and trematodes (flukes)

(incl. schistosomiasis, clonorchis, cysticercosis etc.)

77
Q

Bithionol

moa, indication

A

inhibits adenylyl cyclase

fasciola hepatica (liver fluke)

78
Q

Diethylcarbamazine

MOA, indication

A

inhibits arachidonic acid metabolism in filariae

lymphatic filariasis (elephantiasis)
Wuchereria bancrofti infection (pulmonary eosinophilia)
Loa loa infection

79
Q

Niclosamide

MOA, indication

A

inhibits glucose uptake and both aerobic + anaerobic metabolism by worms

TAPEWORMS:
diphyllobothrium latum
taenia spp.
hymenolepis nana (dwarf tapeworm)

80
Q

-bendazole anthelmintics

MOA, indications

A

binds B-tubulin > inhibits microtubule polymerization
cell motility and metabolism disruption

flatworms (trematodes)
roundworms (nematodes)

incl. trichuriasis (whipworm), enterobius (pinworms), echinococcus (hydatid disease), neurocysticercosis (T solium) and ascariasis

81
Q

3 drugs used to lower portal hypertension in acute variceal hemorrhage pts

2 are use more, 1 has limited use due to unwanted effects

A
  1. SOMATOSTATIN - inhibit release of endogenous hormones (glucagon, VIP, etc.) that induce splanchnic vasodilation; less splanchnic blood flow > less portal blood flow
  2. OCTREOTIDE - sst analog; longer acting
  3. VASOPRESSIN - induces splanchnic vasoconstriction… but also systemic vasoconstriction
82
Q

What is Pentagastrin and why is it used?

A

synthetic gastrin analog - used diagnostically

induces CALCITONIN secretion from MEDULLARY THYROID CANCER and…

SEROTONIN release from CARCINOID tumors

83
Q

Main pharma tx for pulmonary arterial hypertension?

MOA

A

BOSENTAN

an endothelin receptor antagonist

decreases pulmonary arterial pressure and lessens progression of vascular remodeling + RV hypertrophy

(but lung transplant is the definitive tx for PAH)

84
Q

pharma tx for anorexia nervosa if CBT and nutritional rehab don’t work

A

Olanzapine

85
Q

pharma tx for bulimia nervosa

A

SSRI

in combo with CBT and nutritional rehab

86
Q

pharma tx for binge eating disorder (2)

A

SSRI, or…

Lisdexamfetamine

87
Q

Suffix of protease inhibitors for HIV

examples

A

-navir

indinavir, ritonavir, darunavir, atazanavir, lopinavir

88
Q

3 main sfx of HIV protease inhibitors

A
  1. Lipodystrophy - buffalo hump
  2. Hyperglycemia - increased insulin resistance; may cause DM
  3. CYP inhibition
89
Q

Main important drug interaction of HIV protease inhibitors + the solution to it

(not just CYP inhibition, but a specific drug-drug interaction)

A

If HIV pt has TB…

Rifampin will INDUCE CYP450 and DECREASE SERUM LEVELS of protease inhibitors

Rifabutin can be used instead, and will not induce CYP450

90
Q

Side effects of fluranes by system

CV? Resp (one positive sfx)? CNS? Kidney? Liver?

A
  1. CV - myocardial depression > low CO, high atrial + ventricular pressures, hypotension
  2. Resp - low Vt and minute V > hypercapnia; impair mucociliary clearance > post-op atelectasis; BRONCHODILATION by halothane/sevoflurane good for asthmatics
  3. CNS - increase cerebral blood flow > INCREASE ICP
  4. Kidney - lower GFR, RPF; increase resistance
  5. Liver - decrease blood flow; HALOTHANE HEPATITIS
91
Q

drug used for depressive phase and maintenance phase of bipolar treatment

A

lamotrigine

92
Q

drugs used for acute mania tx and maintenance of bipolar (3)

A

carbamazepine
valproate

lithium - not great for acute, takes time

93
Q

Which diuretics IMPROVE SURVIVAL in patients with HF with lowered EF?

A

Mineralocorticoid antagonists - SPIRONOLACTONE and EPLERENONE

decrease remodeling and myocardial fibrosis

94
Q

Contraindication for SGLT2 inhibitors

test what before prescribing?

A

moderate to severe kidney failure

test creatinine and BUN

95
Q

Anti-retroviral drug with an adverse reaction connected to a certain HLA haplotype

what’s the drug? what’s the haplotype?

A

ABACAVIR - an nrti

HLA-B*57:01

(negative test for this allele has near 100% NPV)

96
Q

Anti-retroviral drug with an adverse reaction connected to a certain HLA haplotype

what’s the drug + what’s the reaction?

A

ABACAVIR hypersensitivity reaction

abacavir binds directly to HLAB*57:01 > alters presentation of self-peptides > TYPE 4 HYPERSENSITIVITY

fever, malaise, GI sx and DELAYED RASH

97
Q

two 2nd gen anti-psychs with worst risk for metabolic syndrome?

A

olanzapine
clozapine

(test BMI, abd. circumference, glucose, lipids, and BP)

98
Q

Nitrate mechanism for angina relief

A

VENODILATION > increased venous capacitance

decreases preload and LVEDP > reduces systolic wall stress and O2 demand + increases myocardial perfusion

99
Q

Dopamine antagonists are best used for what kind of nausea / emesis?

A

“central nausea” as seen in migraines (they also reduce migraine pain)

also any nausea caused by emetogenic substances affecting the AREA POSTREMA (“chemoreceptor trigger zone”) in the medulla

100
Q

5-HT3 atgs are best used for what kind of nausea / emesis?

A

mechanical or chemical irritants in the GI tract

as sensed by the glossopharyngeal and vagus nerves

101
Q

What is the PG analog used to treat glaucoma?

MOA? Sfx?

A

Lanaprost

prodrug converted by esterases in cornea > INCREASE OUTFLOW in the uveoscleral pathway by decreasing collagen content

increase pigment in eyelashes and iris

102
Q

What is the mechanism by which carbonic anhydrase inhibitors treat glaucoma?

A

inhibit BICARBONATE formation in ciliary body > decrease Na and fluid transport

103
Q

What two adrenergic actions affect aqueous humor production? Drug names?

A

Brimonidine - alpha1 > ciliary body vasoconstriction

Timolol - beta2 > decreased production

104
Q

Milrinone

MOA? Effects?

Indications? Contra?

A

Selective PDE3 inhibitor

  • decrease cAMP degradation > cAMP promotes Ca++ influx > increased contractility
  • also inhibits SM PDE > vasodilation
  • Refractory heart failure with LV systolic dysfunction
  • CI in hypotension
105
Q

HIV drugs that can cause myopathy?

A

integrase inhibitors

raltegravir, dolutegravir

106
Q

GI side effect of opiates other than constipation and nausea

A

BILIARY COLIC

mu agonists can cause contraction of SM in sphincter of Oddi > increased common bile duct pressure

severe pain + cramping in RUQ

(discontinue drug and give NSAIDs)

107
Q

Aside from ophthalmological exams…

what eye-related indication does ATROPINE have? (2 names)

A

IRIDOCYCLITIS aka UVEITIS

reduces pain and prevents adhesions

108
Q

Tx for beta blocker overdose with hypotension?

Mechanism?

A

Glucagon

Gs on cardiac myocytes > increased cAMP > increased IC Ca++ release + contractility

109
Q

Metyrapone MOA

A

11-beta-hydroxylase inhibitor

blocks cortisol synthesis

110
Q

what is the MOA/use of filgrastim?

A

recombinant G-CSF

increases neutrophil count

111
Q

what is darbepoietin?

A

EPO with longer half life

112
Q

blood-gas partition coefficient

what is it? how does it relate to induction rate?

A

the ratio of an inhaled anesthetic that is DISSOLVED in blood (and thus can bind plasma proteins + stay in blood) to the amount that is UNDISSOLVED/GAS (and thus can diffuse into the CNS)

a high BGPC = higher solubility = slower induction (halothanes + isoflurane)

a low BGPC = lower solubility = faster induction (sevoflurane > N2O > desflurane)

113
Q

taxanes - paclitaxel and docetaxel

MOA

A

inhibit microtubule DISASSEMBLY - chromosomes can not segregate

114
Q

Niacin MOA in hyperlipidemias (2)

A
  1. Inhibits HORMONE SENSITIVE LIPASE in adipose tissue

2. Reduces hepatic VLDL synthesis + secretion

115
Q

PCSK9 inhibitor names

plus sfx

A

Alirocumab and evolocumab

(Al and Ross Evolved to have less LDL)

Myalgia, delirium + other neurocognitive sx

(main decr. is LDL, slight HDL rise and TG drop)

116
Q

Drug indicated for both HIV and Hep B?

A

Lamivudine

aka 3TC … a cytidine analog NRTI

117
Q

which 4 drugs can cause Fanconi syndrome?

A
  1. cisplatin
  2. ifosfamide
  3. EXPIRED tetracyclines
  4. tenofovir

these drugs CITT in the tubules n fuck em up

118
Q

Other than PTU and beta blockers, what blocks 5’ deiodinase?

A

glucocorticoids

119
Q

What should be measured to assess efficacy of EPO tx?

A

Plasma Hb concentration

(O2 saturation doesn’t necessarily change in anemia, because the Hb that is there is still saturated well; sat mainly changes in CO poisoning, which displaces O2 from Hb)

120
Q

how do fibrates increase risk of myopathy with statins?

A

via CYP inhibition

121
Q

Macrolides MOA - bind what and do what?

A

bind 50s and interfere with translocation

122
Q

Drugs causing gout (5)

A

“Painful Tophi and Feet Need Care”

Pyrazinamide
Thiazides
Furosemide
Niacin
Cyclosporine
123
Q

OTC cough suppressant with possible constipation as a side effect

A

Dextromethorphan - NMDA atg with some opiate receptor effects

can give naloxone for OD; can cause serotonin syndrome in combo with other drugs

124
Q

What are the SELECTIVE ARTERIOLAR VASODILATORS (2) ?

what side effects do they have BASED ON PHYSIOLOGICAL COMPENSATORY MECHANISMS that counteract their action?

how does this affect their usefulness?

A

hydralazine + minoxidil

vasodilation > reflex sympathetic activation > TACHYCARDIA

raas activation > sodium and fluid retention with PERIPHERAL EDEMA

they are not useful long-term due to these compensatory side effects

125
Q

Hydralazine MOA and indications (3)

A

increases cGMP > arteriolar vasodilation (decr. afterload)

  1. SEVERE htn - used acutely
  2. heart failure - with an organic nitrate
  3. Htn in pregnancy
126
Q

Hydralazine

sfx (with 1 related contraindication + 1 sfx treatment)

A
  1. Reflex TACHY - CI in angina/CAD; co-admin w BB
  2. Fluid retention
  3. HA
  4. Angina
  5. LUPUS-LIKE SYNDROME (anti-histone Abs)
127
Q

Mefloquine

kills what form of plasmodium?

inactive against what + clinical consequence of this?

A

a SCHIZONTICIDE that kills REPLICATING parasites WITHIN RBCs

is INACTIVATED IN LIVER so does not kill liver schizonts > they rupture over 8-30 days so mefloquine must be taken 4 WEEKS AFTER RETURN FROM ENDEMIC AREA

128
Q

Which malarial spp. are usually chloroquine resistant?

A

P. falciparum in Africa

129
Q

Delirium tremens tx

A

BZD

specifically LONG-ACTING with active metabolites such as DIAZEPAM or CHLORDIAZEPOXIDE because they self-taper

130
Q

BZDs for pts with liver disease

acronym

A

these BZDs do not undergo oxidative metab. in liver

the “LOT” bzds

Lorazepam
Oxazepam
Temazepam

131
Q

What illicit drug is assoc. with NYSTAGMUS?

A

PCP - phencyclidine

an NMDA atg

132
Q

6 medication classes that can cause hyperkalemia

A
  1. K-sparing Ds - amiloride, triamterene, eplerenone
  2. ACE-I - decrease aldo
  3. Non-selective BB - inhibit B2-mediated K uptake
  4. ARB - decrease aldo via AT1 atg
  5. Digoxin - inhibit ATPase
  6. NSAIDs - decr. local PGs > decreases renin/aldo secretion

KANADN

133
Q

two NON-SELECTIVE and IRREVERSIBLE mao inhibitors

A

phenelzine

tranylcypromine

(“try a sip” and “funnel” hooks from sketchy)

(also isocarboxazid … “boxed wine”)

134
Q

a REVERSIBLE MAO-A inhibitor

A

Moclobemide

for tx resistant depression / anxiety

135
Q

2 short-acting (< 6 hour) BZDs

A

Triazolam
Midazolam

(“try me” i dont last long)

136
Q

4 medium-acting (6-50 hr) BZDs

A

Lorazepam
Oxazepam
Clonazepam
Alprazolam

(for when yr feelin a bit “LOCA”)

137
Q

3 long-acting (>50 hr) BZDs

A

DIAzepam
Flurazepam
ChlorDIAzepoxide

(lasts todo el “Dia”)

138
Q

Significant risk associated with Tamoxifen

A

Endometrial hyperplasia > endometrial cancer risk

blocks breast ERs but is an agonist on endometrial ER

139
Q

Drugs that can cause AGRANULOCYTOSIS

6, with mnemonic

A

Can Cause Pretty Major Collapse of Granulocytes

  1. Carbamazepine
  2. Clozapine
  3. Propylthiouracil
  4. Methimazole
  5. Colchicine
  6. Ganciclovir
140
Q

Drugs that can cause APLASTIC ANEMIA

(6, with mnemonic)

(causes PANcytopenia as opposed to “aplastic crisis” which is RBCs only via impaired reticulocytes by parvo B19 etc.)

A

Can’t Make New Blood Cells Properly

  1. Carbamazepine
  2. Methimazole
  3. NSAIDs
  4. Benzene
  5. CHLORAMPHENICOL
  6. Propylthiouracil

(note carbamazepine, PTU and methimazole can cause both aplastic anemia + granulocytosis)

141
Q

What 3 categories of abx bind the 30s ribosomal subunit?

A
  1. Aminoglycosides
  2. Tetracyclines
  3. Glycylcyclines - tigecycline
142
Q

1 adverse effect and MAJOR neuro complication possible

Suffix for thrombolytics

A

“-plase” as in alteplase or tenecteplase - plasminogen activators

HEMORRHAGE is #1 sfx and intracerebral hemorrhage (decr. consciousness, asymmetric pupils, irregular breathing) is main neuro complication

143
Q

What organisms are resistant to cephalosporins? 5

A

Altered PBPs - Listeria, Enterococcus, MRSA

No cell wall - Chlamydia and Mycoplasma

*USMLE* (28 decks)

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