pharmacology 1-30 38% 2-10 48% 3-50% Flashcards Preview

STEP I 2014 > pharmacology 1-30 38% 2-10 48% 3-50% > Flashcards

Flashcards in pharmacology 1-30 38% 2-10 48% 3-50% Deck (94):
1

treatment for Lyme and other rickettsial infections (Rocky mount spotted fever and typhus)

doxycycline-can also be used to treat acne

2

pt with Lyme, end-stage renal disease and severe rxn to penicillin and macs should be given doxycycline and not methacycline because

methacycline is excreted by liver (containidicated in renal dz) vs doxycycline (and minocycline) which are eliminated in feces unchanged.

3

potency

amount of drug needed to reach 50% effect

4

treatment for UTIs that can cause tendon rupture and arthropathy in children. mech of action

fluroquinolones-inhbiits DNA gyrase (maes negative supercoils during DNA replication)

5

blood dycraias, avoid in women in 2nd or 3rd trimester due to risk of kernicterus

sulfonamindes

6

tooth discoloration, bone abnormalities, and hepatic problems in fetus if taken by mother-mechanism

tetracyclines- blocks aminoacyl-tRNA

7

neprotoxcity and ototoxity, used for severe gram-negative UTIs

aminoglycosides

8

parathesias and peripheral nephropathy-prevent how?

isoniazid, prevent by giving pyridoxime

9

action of benzodiazepems on GABA A channel increases frequency and not duration of channel opening because

benzo works on receptor
barbiturates increase duration of GABA A channel opening

10

name 2 endings of tricyclic anti-depressants. 2 exceptions

all end in "-iptyline and -ipramine except doxepin and amoxapine"

imipramine amitriptyline, nortriptyline and doxepin

11

inhibit biogenic amine (NE and 5-HT) reuptake at presynaptic neuron

antidepressants (amitriptyline, nortripttyline, and doxepin)

12

drug that causes orange urine and used for TB inhibits DNA-dependent RNA polymerase and not mycolic acid synthesis because

rifampin inhibits RNA synthesis, it also blocks RNA transcription. isoniazid disrupts cell wall synthsis in TB but doesn't cause urine color change.

13

inhibits mycobacterial arabinsoyl transferase, use if isonazid is not working

ethambutol

14

used as adjunctive therapy in very early TB

streptomycin

15

two drugs that can cause urine color changes

rifampin-orange
pyridoxine-bright yellow (used to prevent neuropathy effect of isonazid)

16

side effect of treatment for parkinson's (trihexyphenidyl and benztropine) is dry mouth and not diarrehea becuase

these dugs are muscarinic antagonists (decrease Ach which is increased in Parkinson's) effects of anit-muscarinics are- red as a beet, dry as a bone, blind as a bad, mad as a hatter, and hot asa hare

17

mecanhism of overdose of acetaminophen

overdose overloads liver's normal metabolies enzymes and rest is shunted over to P-450 which converts acetaminophen to NAPQI (toxic-centrilobular necrosis). glutathinone is conjugated with NAPQI to become nontoxic, give NAC N-acetylcysteine to replenish glutathione levels

18

copper overload in Wilson's disease, other metallic poisons, and treatment for severe rheumatoid arthritis

penicillamine-metal chelator

19

cyanide overdose

sodium thiosulfate

20

anti-depressant to avoid in pts with eating disorder is bupropion and not fluoxetine because

bupropion can cause seizures in pts with eating disorder, wheras fluoxetine is the only anti-depressant approved for bulimmia bervosa

21

-well tolerated antianxiety used for co-morbid depression and anxiety
-causes weight gain, dry mouth, and somnolence
-serotonin syndrome, CNS stimulation and sexual dysfunction
-can be used with eating disorders
-causes seizures if used with eating disorders

buspirone
mirtazapine
sertraline SSRIs
fluoxetine
buspirone

22

pt with ulcerative colitis (UC) needs mesalamine and not infliximab because

mesalamine. infliximab is a monoclonal antibody that bind TNF alpha to reduce inflammation- used for Crohn's disease.

23

Crohn's disease vs ulcerative colitits (UC)

UC-bloody diarrhea, abdominal paon, fecal urgency. inflammation of colonic mucosa
C-transmural inflammation and relapsing and remitting remission

24

treatment for GERD

lansoprazole, proton pump inhibitor (similar to omeprazole)

25

pt with BPH and HTN needs a drug that selectively blocks alpha 1 receptors and not a drug that inhibits 5-alpha reductase because

5-alpha reductase inhibitors (finasteride) only treats BPH. whereas alpha-1 receptor blockers (terazosin and doxazosin) treat both HTN and BPH

26

drug used for child with Wilm's tumor that can lead to peripheral neuropathy

vincristine-inhibits spindle formation during mitosis.

27

drugs with Cushinoid syndrome as side effect

prednisone and dexamethasone

28

tox=hemorrhagic cystitis

cyclophosphamide

29

tox=pulmonary fibrosis

bleomycin

30

tox=hyperpigmentation and treatment

busulfan treats chronic myelocytic leukemia

31

another name for tPA

alteplase

32

use alteplase and not warfarin for pt with ischemic stroke b/c

tPA is great for breaking down clots that have already formed. Warfarin is good for long time prophylaxis against clot formation but won't break down clots that have already formed

33

-alpha adrenergic receptor blocker that lowers systemic vascular resistance and increases HR via baroreceptor reflex
beta1 and beta 2 agonist that lowers TPR and increases HR via beta 2 and baroreceptor reflex
-alpha and beta agonist that increases MAP and lowers HR
-non selective beta blocker that lowers HR

alpha-adrenrgic receptor blocker (phentolamine)
-isoproterenol
-NE (alpha is greater than beta is why HR goes down instead of going up with beta 1 activation)
-non selective beta-adrenergic receptor blocker (propanolol)


34

in a patient with hepatic encephalopathy a drug that decreases serum ammonia levels is one that acidifies intestinal contents and not a bile acid sequestrant or chelator b/c

chelator used for metal toxicities, cholestryamine lowers LDL by sequestering bile.

35

mecahism of losartan? effects on arterial pressure, TPR, Na excretion and plasma aldosterone levels?

ANG II inhibitor
-decrease, decrease, increase, decrease

36

name of mutation seen in CML (chronic myelogenous leukemia)? treatment drug and mechanism

Philadelphia chromosome (bcr-abl transcript), imatinib, protein kinase inhbitor (bcr-abl is a constitutively active tyrosine kinase)

37

anastrozole

aromatase inhibitor used to treat breast cancer

38

busulfan

alkylating agent used to treat chronic myeloid leukemia

39

carmustine

alkylating agent used to treat brain tumors, myeloma, and lymphomas

40

cisplatin-myeosupression effects

platinum compound binds and crosslinks DNA, anticancer with less severe myelosupression effects

41

ALS treatment (supportive/symptoms)

riuzole-inhbits gluamate release/blocks Na channel. glutamate can cause excitatory toxicity to neurons
baclofen (GABA-B agonist)-treats spacisity
tizanidine (alpha 2 receptor agonist, increases inhibition of motor neurons)-treats spacisity

42

why give a monoclonal TNF-alpha antibody toa patient suffering from jarisch Herxheimer reaction?

J-H rxn is when endotoxin released from any spirochete (techinally gram negative bacteria) leads to direct stimulation of macrophages leading to inceased production of mac mediators such as IL-1, IL-6, and TNF-alpha. (micro-immunology)

43

how does glucose regulate insulin release. what is role of diazoxide

glucose enters beta cell is metabolize to create ATP-causes closure of K+ channel-delpolarizing the cell and promoting exocytosis of insulin. diazoxide opens K+ on smooth muscle and can hyperpolarize and vasodilation (decreasing insulin response to glucose)

44

which generation of anti-histamines can cause sedation

1st generation H1 blockers- (diphehydramine, chlorpheniramine, hydroxyine), cross BBB

45

why are 2nd generation antihistamines drug of choice for allergic disorders but not 1st generation

2nd generation can't cross BBB.
cetirizine, loratadine, delosratadine

46

intranasal antihistamine

azelastine

47

in ventricular vol vs pressure curve:
-height=
-widght
-slope from (0,0) to top of end systolic volume

-MAP
-SV
-Contractility

48

question 4 this is from exam 2. the questions below are from exam 3

answer

49

name 6 drugs known to increase QT interval

quinidine, procainamide, sotalol, amiodarone, dofetilide, pheothiazines, and TCAs

50

How does zileuton treat asthma?

it inhibits 5-lopoxygenase, prevents leukotriene synthesis from arachidonic acid. also inhibits binding of LTD4 to target tissues. LTD4 can cause asthma symptoms.

51

inhibits phosphlipase A
inhibits cyclooxygenase
stimulates PGI2
stimulates prostaglandins
leukotriene agonists

glucocorticoids
NSAIDS (specific for COX-2)=celecoxib and glucocorticoids
epoprostenol (treats pulmonary HTN)
misoprostol PGE1, alprostadil PGE1, dinoprostone PGE2, carboprost PGF2alpha, lantoprost PGF2 alpha
zafrilukast and montelukast

52

salmeterol (mech, use, side effects)

long acting beta-2 receptor agonist-treats asthma and COPD. side effects-insomnia, tremor, and anxiety

53

a drug with 1st order kinetics will kill what number of cancer cells?
zero order kinetics?
does it depend on 1/2 life?

-constant portion
-constant number
-no. the number of cells eliminated per unit time is independent of the actual number of cancer cells

54

log kill hypothesis

magnitude of killing a by ac cytotoxic agent is a log function. i.e. a drug producint a 3-log kill will reduce 10^12 cells to 10^9 to 10^6 etc...

55

mechanism of drugs used to treat PID?

treat chlamydia with doxy (bind 30S and prevent amnioaclyl-transferase from entering A site) or azithromycin (macrolide that prevents protein synthesis by blocking translocation-binds to 50S)
treat nesseria gonnorrhea with 3rd gen cef-ceftriaxone (inhibits peptidoglycan synthesis through blockage of transpeptidation enzymes).

56

binds to microtubules and causes mitotic arrest in metaphase

podophyllum resin in tincture of benzoin- treats condylomata acuminatum (genital warts)

57

methimazole is used to treat? side effect?

hyperthyroidism, inhbits formation of thyyroid hormone by inhbiting thryoid peroxidase. can cause agranulocytosis. if pt has fever or sore throat give a human granulocyte stimulating factor (fligrastm)

58

treatment for congenital toxoplasmosis gondii

pyrimethamine and sulfadiazine
can give leucovorin to replenish folate that doesn't need dihydrofolate reductase-to improve pt outcome and still kill bacteria

59

sirolimus (mech, uses, toxicity)

inhibits T-cell activation and proliferation by binding mTOR, has minimal nephrotoxicity and neurotoxicity vs other immunosupressants. mc tox are hypercholestermia and hypertriglyceridemia

60

cytokine release syndrome is associated with?

muromonab-CD3 therapy

61

overdose of anticholingerics vs stimulants

skin- dry with anticholingerics and sweaty with stimulants

62

diphenhydramine

over the counter anti-histamine that can cause profound anticholingeric effects in high doses

63

antacids that cause diarrhea vs constipation

D-MG2+
C-aluminium and Ca2+

64

famotidine (mechanism)

suppress acid secretion

65

metoclopramide effect on GI tract. contraindications?

prokinetic agent that stimulates intestinal tract. contraindicated in pt in bowl obstruction

66

treatment of choice for legionella pneuomonia?

erythromycin

67

treatment of choice for PCP or pneumocystis jiroveci?

pentamidine

68

end systolic volume depends on

aortic blood pressure. if MAP is high then end systolic is high and vs versa

69

end diastolic vol=

end systolic vol +filling vol per beat

70

filing vol=

venous return/heart rate

71

glucocorticoids do what to glucose levels?
how do they lead to osteoporosis?

increases them. glucocorticoid-induced diabetes
lowers intestinal calcium absorption, no need to measure 1,25 vit D levels

72

symptoms of and ways to diagnose multiple myeloma

bone pain, renal impairment, fatigue, and anemia. use serum protein electrophoresis

73

drugs that can decrease cardiac remodeling and increase lifespan of CHF pts

ACE inhbitors, ARBS, aldosterone antagonists, and beta blockers

74

hypertrophic cardiomyopathy is treated with

beta blockers and calcium channel blockers (verapamil)

75

drugs used to treat metabolic syndrome: effect on triglycerides, HDL, C-reactive protein, glucose, and BP
-ACE inhibitors
-ARBS
-Niacin
-Statins
-Thiazolidinediones

-none,none,+/-, kidney benefits no effect on glucose levels, decrease
-same as ACE Inhibitors
-decrease, increase, none, increase, none
-decrease, increases, decrease, none, none
-decrease, increase, decrease, decrease, +/- (acts via PPAR-gamma-found in adipose and endothelium)

76

CRP

important marker of inflammation. increased in metabolic syndrome

77

signs of high potassium

no P waves and tall peaked T waves. don't give spironolactone

78

NSAIDS effect on kidney?

decrease prostaglandin production which results in decreased blood flow to the kidneys, this exacerbating renal failure

79

what effect does corticosteroids have on fluid and electrolyte imbalances?

associated with water retention, hypernatremia, hypokalemia, and hypocalcemia

80

sucralfate (aka, mech, uses)

aluminum sucrose sulfate- works as a protective coat. stress ulcers, duodenal ulcers, and GERD

81

severe pain along dermatone followed by grouped vesicular lesions

VZV shingles, treat with famciclovir, acyclovir or valacyclovir

82

mechanisms of ACE inhibitors and ARF. NSAIDS and ARF?

catopril can prevent efferent renal arteriolar constriction to a great extent than of the afferent arteriole, decreasing GFR. also NSAIDS can do this too (renal vasoconstrictors- block PG production and prevent dilation of afferent arteriole)

83

mechanism of methamphetamine and amphetamines

increased dopamine-cause of addiction
increased NE-cause of increased BP

84

effect of hydrochlorothiazide on calcium levels

increases ca2+ levels

85

risk of corticosteroids and postmenopausal women

can cause various musculoskeletal alteration including bone matrix atrophy (osteoporosis) and bone fractures (vertebral compression fractures or fractures of long bone and avascular necrosis of femoral or humeral heads or both)

86

age to switch over from aspirin to warfarin

75, also look for anyone with past history of embolic or cardiac disease.

87

large binucleated cells with prominent nucleoli with an eosinophilic cytoplasm

Reed-Sternberg cells, Hodgkin lymphoma

88

how to treat Hodgkin's? mech of drug? toxicities? treatment?

cyclophasphamide, alkylating agent, can lead to hemorrhagic cystitis (treat with mensa), bone marrow suppression, and hepatotoxicity. can also be used to treat non-hodgkin, breast and ovarian cancer

89

mech of succinylcholine and K+ levels. pt pop at risk for this effect? how to screen for this effect?

depolarizes skeletal muscle and opens nicotinic cholinergeric receptor caused K+ efflux.
succinylcholine-induced hyperkalemia is more commonly seen in burn pts b/c tissue damage causes K+ leak out of cells. measure K+ levels or see no P waves and spiked T waves on ECG

90

serum-sickness

immune complexes are formed by binding of specific antigens to circulating antibodies (type III)
mc symptoms are fever, pruritiusm and arthropathy
treat with antihistamines (itching) and corticosteroids (immune)

91

class of histamine drugs that are not sedating?

second generation-choise of treatment for allergic disorders (fexofenadine)

92

ring shaped lesions with an advancing scaly border and central clearin or scaly patches with a distinct border on the exposed skin surfaces or the trunk

tinea corporis

93

treatment for tinea corporis. how long?

topical antfungals- clotrimazole, use 1-2 weeks after clinical clearing of the lesions

94

digitoxin effect on K+ levels. effect of loop diuretics on K+ and digitoxin toxicity.

hypokalemia, leading to cardiac arrhythimias. loop diuretics make this worse.