Pharmacology Flashcards
(128 cards)
1
Q
How do 1st generation antihistamines cause acute angle closure glaucoma?
A
they are anti-cholinergic»_space; mydrasis > acute closure glaucoma
2
Q
what class do the following drugs belong to?:
-adine
-cetirizine
Ketotifen
A
2nd gen antihistamine
3
Q
Cilostazol is a phosphodiesterase inhibitor (like dypyridamole) that is marketed in JAPAN to treat what arterial diease?
A
PAD/intermittent claudication
4
Q
what is the antidote for anti-cholinergic (mad hatter) toxicity?
A
Physostigmine; inhibits ach-esterase
5
Q
what is the antidote for cholinergic toxicity? (dumbells/organophosphate)
A
atropine
6
Q
what adverse affect do PPIs have on the kidneys?
A
allergic interstitial nephritis
7
Q
early vs Late phase of ASA
A
early = resp alkalosis
late = AGMA
8
Q
What drugs cause gingival hyperplasia?
A
Phenytoin, cyclosporine, CCBs
9
Q
Symptomatic management of neuropathic pain can be achieved with what:
- SNRI
- antiepileptics
- TCA
A
- Duloxetine
- Gabapentin, pregabalin, carbamazepine (helps trigeminal NEURALGIA)
- amitriptyline
10
Q
management of septic cavernous sinus thrombosis (very similar to CRBSI)
A
anticoagulants (regardless if the pt is actively bleeding or not)
ABs
- VANC
- Ceftriaxone/Cefepine
- Metronidazole (should be added if anaerobic bacterial infection is suspected; dental or sinus infection)
+/- amphotericin B (if origin is fungal)
11
Q
Niacin flushing/itching can be controled with what medication & why?
A
Aspirin; it decreases the prostaglandins made from Niacin
12
Q
pt with a + PPD skin test but a negative CXR have latent TB infection (LTBI). what is the pharm tx & duration for LTBI
A
weekly rifapentine & isoniazid for three months
if latent = R+I
if active = RI+PE
13
Q
are vaccination doses weight dependent?
A
NOOO. you never have to weigh a person to determine what dose to give!!
*also, Restarting the immunization series (i.e., from the first dose) is NEVER necessary for routine immunizations, regardless of how much time has passed since the last dose.
14
Q
what is the first line treatment for CMV retinitis?
A
Valganciclovir, ganciclovir, foscarnet, and cidofovir
“Eating fos food with the CMV gan”
15
Q
what are the 1st & 2nd line meds for essential tremor?
A
1st line = Primidone (barbituate)
2nd line = propanolol
essentially a primadoma pro
16
Q
what essential tremor drug is Contraindicated in pt with asthma?
A
propanolol
17
Q
what drugs kill bugs that don’t show on gram stains (“shows no organisms”) bc they have no cell wall?
ie Chlamydia, Ureaplasma, mycoplasma, mycobacterium
A
doxycycline
erythromycin & azithromycin (macrolides)
18
Q
what classes of medications are used to treat pituitary adenomas?
A
dopamine AGONISTS (cabergoline) somatostatin analogs (octreotide)
19
Q
what drug class is Demeclocycline?
what condition does it therefore tx?
A
Demeclocycline is an ADH antagonist== a super diuretic
tx SIADH where there’s too much ADH & not enough diuresing
20
Q
what drug treats nephrogenic DI? (when ADH is produced, but isnt being accepted @ the kidneys> diuresis)
A
indomethacin.
it decreases diuresis in patients with nephrogenic DI by inhibiting the synthesis of renal prostaglandins— which physiologically inhibit the action of ADH on the collecting ducts.
21
Q
what is the alternative tx for AOM when pt has allergy to oral amoxicillin-clavulante
A
oral macrolide (azithromycin)
22
Q
what anti-CD20 drug is used to treat AIHA and why?
A
Rituximab, tx the cause of AIHA= CLL & non-Hodgkin lymphoma
23
Q
what is the first line tx for Pagets disease of the bone?
what is the MOA?
A
IV zoledronate (bisphosphonate)
- inhibits osteoclast activity = nor more bone remodeling *
24
Q
when are adjuvant steroids indicated in the treatment of PCP?
A
in HIV pts with PCP; you must give them the standard TMP/SMX ++++ steroids
25
Filgrastim drug class & use?
= a form of recombinant G-CSF
= used in the management of neutropenia in patients receiving chemotherapy.
Filgrastim Flintstones
26
what drug toxicity presents with wheezing, hypoglycemia, & hypotension?
what is the antidote
beta blocker overdose/toxicity!!
glucagon
27
what drug toxicity presents with nause/vomiting, & yellowing tint of vision?
what is the antidote?
digoxin toxicity
Digoxin-specific antibody fragments (Fab)
28
what is the time cut off for administering activated charcoal for drug overdose?
<2 hours
29
what is the 2 step protocol for managing LARGE brain abscess?
1) aspirate/drain the abscess (= culture + decompression to decrease papilledema/ICP)
THEN
2) start ABs (decreasing pressure in brain is priority)
30
which 3 ABs are used to tx brain abscesses?
Metronidazole
3rd/4th gen cephalosporin (ceftriaxone, cefotaxime, ceftazidime, 4= cefepime)
Vancomycin (if abscess is from Staph blood stream infection- IE, neurosurgery, penetrating trauma )
31
do immunoglobulins prevent disease exposure or post-exposure?
POST-exposure!
| example: Tetanus immunoglobulin (TIG) is given after pt is exposed w/ a dirty wound
32
what is the vaccine for tetanus composed of?
Denatured C. tetani toxoid
33
when is the only time you administer TIG with the TDaP vaccine?
only with a DIRTY wound & insufficient vaccine hx (never vaccinated/status unknown)
34
what is the GOLD standard test for acute closed angle glaucoma dx?
Gonioscopy = direct visualization of the angle
35
What 1st line drug is used to treat insulinoma?
Diazoxide (thiazide diuretic used for its power to stop insulin secretion from pancreas & tumors!)
2nd line = somatostatin analogs
Diaz was like insulinoma bc he had no sugar/glucose in his home
36
what is the drug of choice to treat Jarisch-Herxheimer reaction (even though its self limiting)
NSAIDs
37
at what blood pressure do you administer vasopressorsssssssss?
<90/<60
38
what is the pathophys of IDA vs ACD?
IDA is caused by low iron + high TIBC.
on the other hand,
ACD is caused by a CHRONIC inflammatory state (> low Fe and low TIBC) by inflammatory marker, hepcidin (the guardian of ferritin storage; wont let iron out/destroys ferroportin when it tries to transfer iron)
39
how do you treat IDA vs ACD
IDA = iron supplements
ACD = treat disease + steroids
40
what drug is known for causing RTA 2?
what is it used for treating?
Acetazolamide
used in IIH & glaucoma
41
what is the classic adverse side affect of Demeclocycline (a tetracycline)?
causes a photoTOXIC drug rxn of blistering skin within minutes of sun exposure?
42
true or false:
aspirin-exacerbated respiratory disease (AERD) causes a T1HS rxn when pt is admin aspirin?
FALSE
AERD > Pseudoallergy bc its caused by inhibition of Cox> flushing & wheezing NOT IgE crosslink (thats why theres no urticaria)
43
which ART drug for HIV causes urolithiasis?
Indinavir
| = poor solubility and significant renal excretion, which leads to crystallization and stone formation (urolithiasis)
44
what 3 drugs cause allergic interstitial nephritis?
PPIs, Sulfas, Penicillins
45
Rasburicase MOA?
metabolizes high levels of uric acid into byproducts: Allantoin + Hydrogen peroxide
== no more hyperuricemia :)
46
why is Rasburicase absolutely contraindicated in pts w/ G6PD deficiency?
Rasburicase converts uric acid into a byproduct, Hydrogen Peroxide + allantoin
G6PD pts have an absent Reduced Glutathione; usually produces NADPH (fights pathogens w/ oxidative burst) AND protects RBCs from hydrogen peroxide (>> oxidative stress & hemolytic anemia)
47
Pts with hypomagnesium are at increased risk of nephrotoxicity via what 2 drugs?
aminoglycosides
| cisplatin
48
before a patient starts Eculizumab, they must be vaccinated for what bug?
why?
Eculizumab blocks C5a> incomplete complement cascade
must be vaccinated for meningococcal bc body uses C5a to fight meningococcal diseases
49
If the first line treatment for severe/symptomatic SIADH fails, what are the second line pharm tx options?
Vaptans (work @ brain)
Demeclocycline (work @ kidney)
loop diuretics (e.g., furosemide)
*only use this if urine osm if 2xxxxx GREATER than serum osm*
50
what drugs are used in a hypertensive crisis?
what drugs are used in eclampsia HTN?
IV Hydralazine, Labetalol, Nitroprusside, Fendolapam
Moms Love Healthy Neonates:
methyldopa, labetalol, hydralazine, nifedipine
51
how is Metyrapone used to dx PANHYPOPITUITARISM?
Metyrapone inhibits inhibits 11-beta hydroxylase> no cortisol produced.
a decrease in cortisol should trigger + FBL for pit to release ACTH.
PANHYPOPITUITARISM= no increase in ACTH
52
what is the purpose of an arginine infusion test?
to dx PANHYPOPITUITARISM
arginine infusion suppresses endogenous somatostatin- the inhibitor of GH- should normally see rise in GH
if no rise in GH = panhypopituitarism
53
which hormones does Dopamine inhibit & how?
Dopamine inhibits the pituitary gland from produced Prolactin.
when Prolactin decreases, GH and TSH decrease with it bc that always move in motion <3
54
MOA of Pegvisomant
what does it treat?
== GH ANTtagonist; tx Acromegaly
55
what antibiotic causes gynecomastia?
how does it do this?
Ketoconazole !
inhibits 17,20-desmolase, the first step of steroid synthesis
56
which calcium imbalance causes prolonged QT?
hypocalcemia
*HIPPOcalcemia; hippos have prolonged bodies*
57
hypomagenesium causes a decrease in which hormone?
PTH. magnesium controls PTH levels
58
Adenosine is a Class ___ anti-arrhythmic drug.
IV adenosine is 1st line tx for what arrhythmia that is common in infant/pediatric pts?
Class 5
paroxysmal SVT & AVNRT
59
Digoxin is a Class ___ anti-arrhythmic.
It is used for the rate control of which arrhythmia?
Class 5
AFib & Flutter
60
what nerve does Digoxin stimulate to inhibit atrial rate?
Vagus nerve
61
Magnesium treats what arrhythmia?
what drug toxicity does magnesium treat?
Torsades de Pointes
Magnesium treats Digoxin toxicity!!!
62
How does Adenosine work?
If adenosine fails, what are other options for stoping SVT/AVNRT?
binds & activates Gi receptors> inhibits adenylate cyclase = decreased in cAMP=== INC potassium efflux & dec Ca influx = hyperpolarization = AV nodal block that eliminates SVT
63
If adenosine fails, what are second line options for stoping SVT/AVNRT in children?
what is the 3rd line?
vagal maneuvers to naturally block the AV node (ex. putting ice water on eyes and neck will stop a SVT)
IV propanolol if adenosine & vagal maneuvers fail
64
what are the 3 absolute contraindications to adenosine?
Asthma
hx of AV nodal block
pre-excitation tachycardia = WPW (will worsen this arrhythmia by converting it to VFib!)
65
Adenosine can dx what underlying arrhythmia when a pt has SVT/AVNRT?
A fib! it hides in SVT/AVNRT
66
Why is adenosine used during cardiac stress tests?
Adenosine acts on A1 receptors in heart (blocks AV node), BUTS also on A2 receptors in heart vessels >>> vasodilators
Giving a CAD pt Adenosine for a cardiac stress test will allow us to open the arteries to examine blood flow through them (see if theres a clog or not) :)
67
Caffeine and methyxanthines (theophyllines) decrease activity of what drug by blocking A1 receptors?
decrease Adenosine efficacy :)
68
what drug causes a visual phenomenon where things appear painfully BRIGHTER than they actually are?
Ivabradine (antiaarythmic used when BBlockers cant be tolerated in CHF)
69
what drug is used as a backup for CHF or stable CHD pts who cant tolerate B-blockers?
Ivabradine
70
what 2 drugs are used to manage opioid intoxification?
Naloxone = high affinity, but short acting (immediately antagonizes opiod effects at the Mu receptor, but falls off fast>> relapse in symptoms)
followed by Naltrexone (also a Mu antagonist, but is longer acting so prevents relapse in overdose symptoms)
71
what AB treats C.diff pseudomembranous colitis?
what Ab causes pseudomembranous colitis?
metronidazole treats it
clindamycin causes pseudomembranous colitis
72
what drug is used to treat polymicrobial female GU infections located in the endometrium (endometritis, retained material from D&C, IUD infection)
Clindamycin
73
best drug for clostridium perfringes "road scrape" skin infection?
clindamycin
74
1st ine tx for asplenia?
IV ceftriaxone
75
tx for severe (high fever, peritonitis), inpatient PID?
target BOTH neisseria and chlamydia
- Cefoxitin or cefotetan PLUS doxycycline
76
tx for stable/outpatient PID?
One single dose of IM ceftriaxone PLUS oral therapy with doxycycline
77
what is the nl inpatient PID regimen ?
what drug(s) is added when there is a suspected complicated tubo-ovarian abscess ?
nl regimen can be a combination of:
- IV Cefoxitin/cefotetan +++ doxycycline
- IV clindamycin + gentamicin
If abscess suspected:
add oral clindamycin or metronidazole
78
what is the treatment for the following vaginal infections:
candida
BV
trichomonas
candida: fluconazole
BV: clindamycin or metronidazole
Trich: PARTNERS w/ metronidazole
79
examples of fibrinolytics/thrombolytics
TPA
rTPA
Streptokinase
Urokinase
80
what 2 antifibrinolytics reverse the effects of tPA?
Aminocaproic acid and tranexamic acid
they stop plasminogen from becoming plasmin= no fibrin degraded = stops bleeding
81
Rifampin delays the body's resistance to what drug ?
Rifampin is used in combination with this drug for tx of what disease?
Dapsone.
They are used in combination for tx of Leprosy
82
what drug is used as prophylaxis for children/people exposed to H. influenza & meningococcal meningitis ?
Rifampin
83
Why is Rifampin contraindicated in treating HIV pts infected with TB?
what drug(s) therapy is used instead?
```
RifAMPin INDUCES (*AMPS up*) cytochromeP450 = increased metabolism/excretion of protease inhibitors & NNRTs used in HIV ART drugs.
- so giving HIV pt on ART Rifampin will decrease the ART effectiveness.
```
9 months of Isoniazid only. ORRRR Use Rifabutin (because the effect of rifabutin to induce cytochrome P-450 is less potent than that of rifampicin)
84
what is the only TB drug that can be used as monotherapy for LTBI?
Isoniazid
85
How does TB become resistant to INH?
mutations causing decreased KatG == decreased expression of catalase-peroxidase → less/no biologically active INH
86
what are the adverse effects of I-NH?
neurotoxicity
- seizures that are refractory to benzos
- peripheral neuropathy (decreased B6/pyridoxine)
hepatotoxicity
- drug induced hepatitis in genetically slow N-acetyltransferase (NAT) acetylators (bc INH is metabolized via liver by NAT)
87
what TB therapy drug causes drug induces LUPUS?
Isoniazid
88
what serum pH imbalance does isoniazid cause?
AGMA
89
which TB drug inhibits cytochromeP450?
Isoniazid
90
what drug produces orange/red body fluids?
Rifampin
91
MOA for rifampin
inhibits DNA-dependent RNA Polymerase = stops transcription of mRNA= no protein synthesis
(bactericidal effect)
92
what is the 1st & second line therapy in treating hepatic encephalopathy?
#1 = lactulose
#2 = Rifaximin (May be added to lactulose to PREVENT RECURRENT episodes of hepatic encephalopathy after a second episode)
93
what drug causes decreased visual acuity and red-green color blindness which may result in irreversible blindness?
Ethambutol
94
Ethambutol is contraindicated in pts with ______
optic neuritis
| visual problems
95
what TB drug is contraindicated in pts with gout?
Py-ra-zina-mide
96
Dapsone has the SAME MOA as Sulfonamindes which is...
inhibition of dihydropteroate synthetase = no conversion of PABA to Dihydropteroate> Dihydrofolate
== no folate production
97
Dapsone is used in combination with TMP as an alternative to sulfa drugs to treat:
P. jiroveci pneumonia
- Prophylaxis and
- Treatment: used in combination with TMP as an alternative to TMP/SMX
Toxoplasmosis:
you can use Dapsone (instead of sulfadiazine) + Pyrimethamine + leucorovin
98
what skin condition does Dapsone tx?
dermatitis herpetiformis
99
How does long term use of Dapsone cause dose-dependent Methemoglobinemia?
Dapsone is metabolized in the liver via cytochromeP450 (breaks down drugs via powerful OXIDANTs)
increase in oxidants/ROS while using Dapsone>> the oxidation of ferrous Fe2+ to ferric Fe3+ == meth-hemoglobinemia (Fe3+--Hgb)
100
what local anesthetics cause acquired Methemoglobinemia?
lidocaine & benzocaine
101
How does Dapsone> agranulocytosis?
Dapsone has the same mechanism as Sulfa> decreased folate production > agranulocytosis & anemia
102
what topical drug is first line for mild rosacea?
what oral drug is used for severe rosacea
mild = topical metronidazole
severe= oral (systemic) tetracycline
103
diuretics thiazides, furosemide, acetazolamide are all apart of what drug class?
what NSAID is also a part of this dug class?
sulfonamides!!
Celecoxib
104
another term used for Bactrim (SMX/TMP) is :
co-trimoxazole
105
what is the prophylaxis vs tx for toxoplasmosis?
Prophylaxis when <100 with SMX/TMP
TREAT with sulfadiazine/pyrimethamine + leucovorin
106
what is the prophylaxis vs tx for P. jiroveci?
BOTH prophylaxis (<200) & tx = SMX/TMP
107
what kind of anemia do Diaminopyrimidine derivatives (ie Pyrimethamine & Trimethoprim) cause?
if given in high doses, these drugs cause what electrolyte imbalance?
Megaloblastic anemia (-penia)
Hyperkalemia!
108
what drug displaces warfarin from albumin >> increased free/circulating warfarin == increased bleeding/anticoagulation?
SMX
109
first line pharm tx for bulimia nervosa? (Bc first line tx in general = CBT)
Fluoxetine. It stops binging AND purging behavior
110
what are the strongest opioids used for severe pain relief ?
```
fentanyl
hydro-morphone
oxycodone
-morphine
methadone
```
*MORPH into a STRONG beast*
111
Pregnant women <18weeks can NOT be treated with Pyrimethamine for Toxoplasmosis bc its teratogenic.
What drug is replaces Pyrimethamine to prevent congenital Toxoplasmosis in the 1st trimester?
Spiramycin
if maternal infection before the 18th week of pregnancy is suspected/confirmed and infection of the fetus is not suspected/documented
112
what 3 medications are avoided in pre-excitation WPW syndrome & why?
Avoid CCBs, Digoxin & Adenosine in patients with pre-excitation because of the risk of the arrhythmia converting to ventricular fibrillation
113
what is the tx for:
normal HUS
vs
Atypical HUS (recurring/refractory)
normal HUS = supportive bc HUS is in children
Atypical HUS = still in children, but since its recurring, tx w/ Eculizumab
114
what antipsychotic causes primary hyperparathyroidism?
How?
Lithium
It blocks the CaSR's ability to sense calcium. Since it cant sense calcium, it tells the parathyroid to release PTH> hypercalcemia & hypophosphatemia
115
what are the TOP drugs for MRSA?
Vancomycin
Daptomycin
Linezolid
116
drug for ATYPICAL PNA (mycoplasma & chlamydia)
Tetracyclines (doxy id prefered)
117
what drug, if taken when expired, leads to Fanconi syndrome (RTA 2)?
Tetracycline
118
tetracyclines work intracellularly so the are used in what diseases?
ALL intracellular bacteria (chlam) & parasites/ticks
119
1st line med for restless leg syndrome that is affecting sleep & daily function?
2nd line?
Gapapentin/pregabalin
dopamine agonists (2nd line bc causes rebound symptoms)
120
first line tx for symptomatic bradycardia?
Atropine
121
2nd line options if Atropine fails in treating symptomatic bradycardia?
epinephrine & dopamine
122
purpose of glucagon?
glucagon = tx B-blocker OVERDOSE
123
what tx for cataplexy is used at NIGHT bc it is a dangerous sedative?
sodium oxybate (salts)
124
warfarin is used as prophylaxis for DVT/PE after:
hip/fracture surgery
Afib
VALVULAR surgery
125
how do you tx Tinea capitis?
ORALLLLL terbinafine or griseofulvin
*tinea CAPITIS & UNGUINUM (nail) are the only fungal infections treated ORALLY*
126
what 2 vitamins MUST be included in a vegetarian diet?
B12 = meats only
| Vit D= sun & meats
127
what is the firstline drug for bacterial endocarditis PROPHYLAXIS (before dental procedures)?
what do you use when pt is allergic to the first line drug?
Amoxicillin
MacrolideeEEE!!!!!
128
acute & maintenance tx for Whipple dx
acute = IV ceftriaxone
maintenance = SMX/TMP
