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Pharmacology Flashcards

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1
Q

Why did FDA issue a black box warning against the use of SPS for treating hyperkalemia?

A

It can cause serious GI side effects such as colonic necrosis, colonic perforation.
The incidence of colonic perforation with SPS use has been estimated at 0.14%–1.8%, and a large retrospective cohort study showed a 1.9-fold higher risk of hospitalization for GI complications with SPS use compared with non-use.

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2
Q

SPS is contraindicated in patients with ____? (3)

A

Obstructive bowel disease, hypersensitivity to SPS, hypokalemia

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3
Q

SPS should be used in caution with ___? (3)

A

Gut dysmotility, constipation or those who cannot handle a large sodium load

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4
Q

What are causes of diuretic resistance? (7)

A
  1. nonadherence to salt and water restriction
  2. intestinal edema
  3. reduced tubular uptake in advanced CKD
  4. nephron adaptation by upregulation of sodium transporters
  5. RAAS activation
  6. NSAIDs
  7. low intravascular volume
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5
Q

what is the management for a patient who developed a standard infusion to rituximab?

A

Decrease the rate of rituximab at 50% of the initial rate

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6
Q

3 Drugs a/w retroperitoneal fibrosis (bonus: 7)

A
  1. Bromocriptine
  2. Beta blockers
  3. Hydralazine*
  4. Ergot alkaloids
  5. Methyldopa*
  6. Etanercept
  7. Infliximab
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7
Q

what is the antidote for anticholinergic overdose?

A

physostigmine

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8
Q

What is the antidote for warfarin toxicity?

A

Vitamin K or phytonadione

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9
Q

What is the antidote for unfractionated heparin?

A

Protamine sulfate

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10
Q

Antidote to DOAC toxicity

A

Andexanet alfa

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11
Q

Name 5 drugs that require dialysis when toxic levels are detected. (bonus: 12)

A
  1. methanol 2. lithium 3. salicylate 4. ethylene glycol
  2. isopropanol 6. theophylline 7. procainamide 8. phenobarbital 9. methaqualone 10. valproate 11. methotrexate 12. metformin
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12
Q

what is the treatment for BZD overdose?

A

Flumazenil (a BZD antagonist)

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13
Q

what is the treatment for acetaminophen overdose?

A

N-Acetylcysteine

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14
Q

What is the treatment for carbon monoxide poisoning?

A

hyperbaric oxygen

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15
Q

What is the treatment for digoxin toxicity?

A

specific Fab fragment (digibind or digoxin immune Fab)

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16
Q

what is used to reverse opiate overdose?

A

naloxone

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17
Q

What are the nephrotoxic effects of tenofovir? (3)

A

AKI, fanconi’s and nephrogenic DI

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18
Q

Nonoliguric AKI from aminoglycosides usually occur after how many days from exposure?

A

after 7-10 days

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19
Q

what is the pathophysiology of Bartter like syndrome related to aminoglycoside use?

A

Activation of the CaSR
A/w lower aminoglycoside use

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20
Q

What is the pathophysiology of Fanconi syndrome related to aminoglycoside use?

A

reduced expression of NHE expression
A/w higher aminoglycoside use

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21
Q

Ciprofloxacin is associated with AKI from various causes (4):

A
  1. AIN
  2. Necrotizing vasculitis
  3. ATN
  4. Crystalluria (starburst needle crystals)
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22
Q

Name 3 drugs that can cause pRTA or Fanconi syndrome?

A

Tenofovir, ifosfamide, cisplatin

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23
Q

What is the formula for modified maintenance dose in renal failure?

A

[patient GFR/120] x std maintenance dose

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24
Q

What is the formula for modified drug frequency for reduced kidney function?

A

[120/patient eGFR] x frequency (hrs)

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25
Why do tacrolimus levels increase with diarrhea?
Tacrolimus is a P-glycoprotein substrate; P-glycoproteins help in drug secretion in the gut; P-glycoprotein activity is reduced during diarrhea, which explains why Tac levels increase during diarrhea
26
Is lipid amphotericin B used to treat fungal UTI?
No.
27
How does TMP cause hyperkalemia and metabolic acidosis?
TMP blocks ENaC.
28
How does cimetifine, dolutegravir and TMP increase serum creatinine?
It inhibits the tubular secretion of creatinine via OCT2
29
Are ARBS generally dialyzable or non-dialyzable?
Non-Dialyzable
30
Name 2 ACEi that are dialyzable?
Lisinopril, captopril
31
In general, are CCBs dialyzable or non-dialyzable?
Non-dialyzable
32
Name 4 BB that are non-dialyzable?
Carvedilol, labetalol, propanolol, timolol
33
Name 4 BB that are dialyzable
Metoprolol, atenolol, sotalol, nadolol (MASoN)
34
What is the mechanism of nephrotoxicity of ACEI/ARBS?
efferent vasodilation
35
What is the mechanism of nephrotoxicity of NSAIDs?
Afferent vasoconstriction, direct tubular toxicity, TIN,
36
What is the mechanism of nephrotoxicity of amphotericin?
Afferent vasoconstriction, direct tubular toxicity
37
What is the mechanism of nephrotoxicity of CNIs?
Afferent vasoconstriction
38
Drugs that can crystallize and cause obstructive uropathy
1. Methotrexate 2. Acyclovir 3. Sulfadiazine 4. Indinavir, nelfinavir 5. Acetazolamide 6. Topiramate 7. Triamterene 8. Zonisamide 9. Methoxyflurane 10. Ciproflaxin 11. Sodium phosphate bowel prep
39
3 drugs that cause drug-induced ANCA vasculitis
1. Hydralazine 2. PTU 3. cocaine Others: methimazole, allopurinol, TNF-alpha inhibitors (e.g. infliximab, etanercept, adalimumab)
40
Rhabdomyolysis seen with TAC and statin therapy is seen only with concomitant ____ use?
Diltiazem
41
CsA + ____ = high risk for rhabdomyolysis
gemfibrozil
42
Most common electrolyte disorder associated with cisplatin?
Hypomagnesemia
43
What are the top 4 side effects of cyclophosphamide?
hyponatremia, hemorrhagic cystitis, premature ovarian failure, bladder cancer
44
what is the max lifetime cumulative dose of cyclophosphamide to minimize malignancy risk?
< 36g
45
What is the max lifetime cumulative dose of cyclophosphamide for those who wish to conceive?
< 10g
46
What is given with cyclophosphamide to detoxify acrolein and reduce the risk of hemorrhagic cystitis?
MESNA
47
What are the 4 renal side effects of ifosfamide?
pRTA, fanconi syndrome, nephrogenic DI, ATN
48
What is the max cumulative lifetime dose of ifosfamide?
< 90g
49
High dose of ____ has shown to reduce the nephrotoxicity of Methotrexate
folinic acid
50
Cetuximab and panitumumab is associated with what electrolyte disorder?
Hypomagnesemia
51
Cranberry can cause ____?
Nephrolithiasis, oxaluria
52
Bladder wrack (brown algae) from Japan can cause?
chronic interstitial nephritis
53
Cat claw can cause
Acute interstitial nephritis
54
Chaparral tea, from a native american shrub, can cause
Renal cysts and renal cell carcinoma
55
Djenkol can cause
Nephrolithiasis
56
Aristolochic acid/chinese herbal tea can cause
Chronic interstitial nephritis, renal cell carcinoma, fanconi syndrome
57
Black licorice can cause
hypertension; hypokalemia;
58
Yohimbe can cause
Lupus nephritis
59
Star fruit, rhubarb leaves can cause
Nephrolithiasis, interstitial nephritis
60
Ma huang (ephedra) can cause
HTN, nephrolithiasis
61
Willowbark can cause
renal papillary necrosis
62
Wormwood oil can cause
Rhabdomyolysis
63
Chronic lead exposure can cause a triad of?
CKD, gout, hypertension
64
Accumulation of allopurinol can cause
tubulointerstitial nephritis
65
Accumulation of meperidine can cause
Seizures
66
Accumulation of morphine can lead to
Seizure
67
Accumulation of nitroprusside can lead to
Cyanide toxicity
68
Accumulation of tramadol can lead to
Seizures, altered mentation
69
Venlafaxine accumulation can lead to
Prolonged QT, orthostatic hypotension, accelerated HTN, altered mentation
70
Given to reverse alcohol poisoning
Fomepizole It inhibits alcohol dehydrogenase
71
HD is indicated at what level of alcohol?
alcohol > 50 mg/dL in the setting of severe metabolic acidosis or end-organ damage Note: use large surface area dialyzer (> 1.5m2) and high Qb > 300 ml/min
72
In methanol poisoning, what is given to convert formic acid to CO2 and water?
Folinic acid
73
HD is indicated in isopropyl alcohol poisoning at what level of alcohol and what level of osmolal gap?
Alcohol > 500 mg/dL and osmolal gap of > 100
74
HD is indicated at what lithium level?
Lithium is > 3.5 mmol/L OR Lithium > 2.5 but with CNS issues, hemodynamically unstable, or AKI
75
What is the acid-base disorder of salicylate overdose?
Combined HAGMA + respiratory alkalosis
76
Should we alkalinize or acidify the urine in salicylate (aspirin) poisoning?
Alkanize the urine (pH > 7.5) to ionize salicylate and promote excretion
77
What are the indications of HD in salicylate poisoning?
1. Levels > 90 mg/dL 2. Arterial pH < 7.2 3. Noncardiogenic pulmonary edema 4. Neuro (seizures, altered mentation, hyperthermia)
78
Digoxin is not dialyzable but HD is indicated of this is present
Hyperkalemia

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