Pharmacology Flashcards Preview

USMLE Step 1 Random Facts > Pharmacology > Flashcards

Flashcards in Pharmacology Deck (303):
1

inhibitors of ACh synthesis, storage, release

hemicholinium-3, vesamicol, botulinum toxin

2

inhibitors of ACh degradation (AChE inhibitors)

edrophonium, neostigmine, pyridostigmine, ambenonium, physostigmine
diisopropyl flurophosphate
tacrine, donepezil, rivastigmine, galantamine

3

muscarinic receptor AGONISTS

methacholine (asthma challenge test)
carbachol, bethanechol, cevimeline, pilocarpine

4

nicotinic receptor AGONISTS

succinylcholine

5

muscarinic recept ANTAGONISTS

atropine
scopolamine
pirenzepine, methscopolamine, glycopyrrolate
ipratropium, tiotropium
oxybutynin, propantheline, terodiline, tolterodine, fesoterodine, trospium, darifenacin, solifenacin

6

nicotinic recept ANTAGONISTS

pancuronium, tubocurarine, vecuronium, rocuronium, mivacurium
trimethaphan, mecamylamine

7

sodium channel inhibitors (antiepileptics)

phenytoin
carbamezepine
lamotrigine
lacosamide

8

Ca channel inhibitors (antiepileptics)

ethosuxamide, valproic acid (inhib T-type Ca channel)
gabapentin, pregabalin (inhib HVA Ca channel)

9

GABA channel potentiators (antiepileptics)

Benzos (diazepam, lorazepam, midazolam, clonazepam) [increase amount of Cl influx]
barbiturates (phenobarbital) [increase duration of Cl influx]
vigabatrin (irrev inhibit GABA transaminase)

10

glutamate recept inhibitors (antiepileptics)

felbamate
rufinamide

11

other antiepileptic drugs under investigation

tiagabine
topiramate
levetiracetam
zonisamide

12

drug of choice for focal seizures

carbamazepine

13

drug of choice for idiopathic generalized seizures (and mixed seizures)

valproic acid

14

drugs of choice for absence seizures

ethosuxamide > valproic acid > lamotrigine > clonazepam

15

glucocorticoid receptor AGONISTS

prednisone (preggos), prednisolone, methylprednisolone, dexamethasone (fetal), hydrocortisone (replacement therapy)
fluticasone, beclomethasone, flunisolide, triamcinolone, budesonide [inhaled]

16

GC recept ANTAGONISTS

mifepristone (for ectopic ACTH synd)

17

Inhibitors of GC synthesis

mitotane (DDT)
aminoglutethimide
metyrapone (dx of hypo-pit-adrenal axis)
trilostane
ketoconazole (inhib P450 enzymes)

18

Minerocorticoid receptor AGONISTS

fludrocortisone

19

MC recept ANTAGONISTS

spironolactone
eplerenone

20

Adrenal sex steroid

Dehydroepiandrosterone (DHEA)

21

inhibitor of fungal nucleic acid synthesis

flucytosine

22

inhibitor of fungal MITOSIS

griseofulvin

23

inhibitors of squalene epoxidase

terbafine, naftinfine (allylamines)
butenafine (benzylamines)

24

inhibitors of 14-alpha sterol demethylase

Imidazoles:
ketoconazole
butoconazole, clotrimazole, econazole, miconazole, oxiconazole, sertaconazole, sulconazole [topical]

Triazoles:
fluconazole, itraconazole (inhibit P450)
posaconazole, terconazole, voriconazole

25

inhibitors of fungal membrane stability: polyenes

amophotericin B
nystatin

26

inhibitors of fungal wall synthesis: echinocandins

caspofungin, micafungin, anidulafungin

27

tx of acute cryptococcal meningitis in HIV-positive patient

flucytosine + amphotericin B

28

tx of fungal inf of hair, skin, nails

griseofulvin

29

drug of choice for tx of candidiasis and cryptococcal meningitis

fluconazole

30

drug of choice for tx of invasive aspergillosis

voriconazole

31

only triazole whose absorption NOT affected by gastric acid

fluconazole

32

drug of choice for vulvovaginal candidiasis

terconazole

33

prophylaxis tx of invasive fungal infection

posaconazole

34

tx of mucocutaneous candidiasis

nystatin

35

tx of esophageal candidiasis

caspofungin, (micafungin, anidulafungin)

36

inhib of viral attachment/entry (and mechanism)

maraviroc (only blocks CCR5, not CXCR4)
enfuvirtide (T-20) [inhib gp41-med fusion by binding HR1]

37

inhibitors of viral uncoating

block M2 channel proton
amantidine (also for Parkinson's)
rimantidine

38

Antiherpesvirus nucleoside and nucleotide analogues (plus dz/tox if applicable)

phosphorylated by viral kinases:
acyclovir, valacylovir (HSV, VZV)
pencicyclovir, famcicyclovir (HSV, VZV - shingles)
ganciclovir, valganciclovir (CMV) (neutropenia)

phosphorylated by cellular kinase:
cidofovir - must be coadmin w/ probenicid (CMV retinitis in those w/ HIV) (NEPHROtox)

vidarabine, idoxuridine, trifluridine (HSV keratitis)

39

anti-HIV and -HBV nucleoside/nucleotide analogues/SE

zidovudine (AZT)
stavudine (d4T)
zalcitabine (ddC)
Lamivudine (3TC) - [HBV]
emtricitabine (FTC) - 1x daily
didanosine (ddl)
Abacivir
^^all these ass. w/ neutropenia, anemia

tenofovir (HIV) (hepatotoxicity)
adefovir (HBV) (renal toxicity)
entecavir (HBV) (dose adjust in pts w/ mod renal insuff)

40

nonnucleoside DNA polymerase inhibitors/SE

foscarnet (renal impairment = dose-limiting)

41

NNRTIs/SE

efavirenz (1x daily), nevirapine, delavirdine, etravirine [rash!!]

42

inhib of viral integration - inhib HIV INTEGRASE!

raltegravir

43

inhib of viral integration - inhib HIV PROTEASE!/SE

saquinavir, ritonavir, amprenavir, fosamprenavir, indinavir, nelfinavir, lopinavir, atazanavir, tipranavir, darunavir
SE = fat distrib and metabolic abnormalities

44

inhibitors of viral release

inhib neuraminidase!! - Flu A, B
zanamivir
oseltamivir (prophylaxis/tx)

45

antiviral drugs w/ UNKNOWN mech of action (+ dz)

fomivirsen (2nd line CMV retinitis)
Ribavirin (RSV, HCV w/ IFN-alpha)
docosanol (HSV) - lacks cytotoxicity

46

antiviral drugs that modulate immune system

IFN-alpha
IFN-beta (tx of MS)
Imiquimod (w/ TLR-7 + 8 to boost innate immunity)

47

alpha1 receptor functions

Gq
increase vasc SM contraction (vasoconstriction) --> increases systolic/diastolic BP --> reflex bradycardia (DECREASED HR)
increase pupillary dilator muscle contraction (mydriasis - dilation)
increase intestinal and bladder sphincter muscle contraction

48

alpha2 receptor functions

Gi
decrease sympathetic outflow (inhib NE release)
decrease insulin release
decrease lipolysis
increase platelet aggregation

49

beta1 receptor functions

Gs
increase heart rate
increase contractility and conductance
increase renin release
increase lipolysis

50

beta2 receptor functions

Gs
vasodilation (decrease diastolic BP)
bronchodilation
increase HR
increase contractility
increase lipolysis
increase insulin release
decrease uterine tone (tocolysis)
ciliary muscle relaxation
increase aqueous humor production

51

M1 receptor functions

Gq
CNS, enteric NS

52

M2 receptor functions

Gi
decrease HR and contractility of atria at SA node (bradycardia)

53

M3 receptor functions

Gq
increase exocrine gland secretions (lacrimal, gastric gland, bronchial secretions, etc.)
increase gut peristalsis
increase bladder contraction
bronchoconstriction (increase airflow resistance)
increase pupillary sphincter muscle contraction (miosis)
ciliary muscle contraction (accomodation)

54

D1 receptor functions

Gs
relaxes renal vasc SM

55

D2 receptor functions

Gi
modulates transmitter release (esp in brain)

56

H1 receptor functions

Gq
increase nasal and bronchial mucus prod (allergy symptoms)
contraction of bronchioles
pruritus
pain

57

H2 receptor functions

Gs
increase gastric acid secretion

58

V1 receptor functions

Gq
increase vasc SM contraction

59

V2 receptor functions

Gs
increase water permeability and reabsorption in collecting tubules of kidney

60

CCB used on vasc SM

amlodipine, nifedipine

61

first line therapy for HTN in preg

hydralazine w/ methyldopa

62

can cause cyanide toxicity (releases cyanide)

nitroprusside

63

drugs of choice in pts w/ CAD and CHF w/ HTN

cardioselective beta blockers
A BEAM of beta-1 blockers

64

DOC in pts w/ isolated systolic HTN

CCB + thiazide diuretics (in non-diabetics)
ACE inhib or ARB (diabetics)

65

CCB used on heart

verapamil

66

partial beta agonists contraindicated in angina

pindolol, acebutolol

67

decrease GI absorption of statins

bile acid resins (cholestyramine, colestipol, colesevelam)

68

class IA antiarrhythmics

quinidine, procainamide, disopyramide
increases AP duration, ERP, QT interval

"the Queen Proclaims Diso's Pyramid"

69

class IB antiarrhythmics

lidocaine, mexiletine, tocainide; (phenytoin can also fall into this class)
decreases AP duration
BEST POST-MI!! + in digitalis-induced arrhythmias

70

class IC antiarrhythmics

flecainide, propaferone
no change in AP duration
last-ditch drug

71

class II antiarrhythmics

metoprolol, propanolol, esmolol, atenolol, timolol

72

class III antiarrhythmics

amiodarone, ibutilde, dofetilide, sotalol
"AIDS"

73

class IV antiarrhythmics

verapamil, diltiazem

74

"other" antiarrhythmics

adenosine, Mg

75

does not presdisp to Torsades de Pointes even though prolongs QT interval

amiodarone (half life > 80 days)

76

DOC in dx/abolishing paroxysmal SVT

adenosine

77

effects blocked by theophylline and caffeine

adenosine

78

DM tx: no risk of hypoglycemia

metformin, pioglitazone, rosiglitazone, acarbose, miglitol, voglibose

79

sulfa drugs

probenecid
furosemide
acetazolamide
celecoxib
thiazides
sulfonamide AB
sulfasalazine
sulfonylureas

"Sulfa Pills Frequently Cause Terrible Acute Symptoms"

pts w/ sulfa allergies --> fever, UTI, pruritic rash, Stevens-Johnson synd, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria (hives)

80

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

dantrolene

81

DOC for Pneumocystis jirovecii, Toxoplasma gondii, Nocardia, Stenotrophomonas meltophilia

TMP-SMX

82

Vd =

amount of drug in body/plasma drug concentration

83

half life =

0.7 x Vd / CL

84

loading dose =

Css x Vd/F (F=1 for IV dose)

85

maintenance dose =

Css x CL/F

86

reduces pain by decreasing levels of substance P in PNS

capsaicin

87

DOC for type II DM

metformin

88

P450 inducers

Momma Bear Steals Phen-phen and Refuses Greasy Carbs Chronically

modafinil
barbiturates
St.John's wort
phenytoin
rifampin
griseofulvin
carbamezapine
chronic alcohol use

89

P450 inhibitors

MAGIC RACKS in GQ

macrolides
amiodarone
grapefruit juice
isoniazid
cimetidine
ritonavir
acute alcohol abuse
ciprofloxacin
ketoconazole
sulfonamides
gemfibrozil
quinidine

90

AB to avoid in preg

Sulfonamides - Kernicterus
Aminoglycosides - otoxicity
Fluoroquinolones - cartilage damage
Clarithromycin - embryotoxic
Tetracyclines - discolored teeth, inhibition of bone growth
Ribavirin (antiviral) - teratogenic
Griseofulvin (antifungal) - teratogenic
Chloramphenicol - "gray baby"

"SAFe Children Take Really Good Care"

91

DOC for DVT and pulmonary thromboembolism

warfarin

92

DOC for Legionella

erythromycin

93

DOC for Treponema

penicillin

94

DOC for Mycoplasma

erythromycin or tetracyclines

95

drug infused at constant rate achieves steady state in?

4-5 half-lives

96

DOC for hairy cell leukemia

cladribine (adenosine analog that is resistant to adenosine deaminase)

97

best agent to increase HDL levels?

niacin

98

best tx for high LDL

statins + ezetimibe

99

best agent for hypertriglyceridemia

fibrates

100

SE = increases TG levels

cholestyramine, colestipol, colesevelam

(bile acid resins)

101

MOA of cromolyn

prevents mast cell degranulation

102

cromolyn used for?

PROPHYLAXIS of asthma, allergies, aspirin HST

103

anti-TB drug most effective in acidic environments + most useful against INTRAcellular organisms

pyrazinamide

104

pyrazinamide most effective against?

M.tuberculosis engulfed by macrophages

105

what is needed to convert INH to active metabolite?

KatG (bacterial catalase-peroxidase)

106

solo prophylaxis against TB?

INH

107

meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ H.influenzae type B?

rifampin

108

toxicity = blurry yellow vision (think Van Gogh)

digoxin

109

thiazide diuretics cause what SE?

-hypokalemic metab alkalosis (bc increased aldost secretion)
-hyponatremia, hypomagenesemia
-sulfa allergy

hypergGlycemia
hyperLipidemia
hypercCalcemia
hyperUricemia
("Hyper Girls Like Crushing Uppers")

110

mannitol (osmotic diuretic) can cause what SE?

hypernatremia, pulmonary edema

111

mannitol is CI in pts w/ what?

anuria, CHF

112

carbidopa decreases what SE of L-dopa?

nausea, vomiting

113

carbidopa increases what SE of L-dopa?

anxiety, agitation, insomnia, confusion, delusions, hallucinations

114

leucovorin is a?

tetrahydrofolate derivative that does NOT req activation by dihydrofolate before it can function as cofactor for thymidylate synthase

N5-formyl-tetrahydrofolate

115

drug whose chemo effects overcome by leucovorin

methotrexate

116

drug whose chemo effects potentiated by leucovorin

5-FU

117

bortezomib MOA and indications?

proteasome inhibitor

tx for multiple myeloma and Waldenstrom's macroglobulinemia

118

tx for mod-severe allergic asthma?

omalizumab (anti-IgE Ab)

119

this drug has increased toxicity w/ allopurinol

azathioprine (6-MP, 6-TG)
bc both metab by xanthine oxidase

120

antimetabolite not S-phase specific

gemcitabine (pyramidine analog)

121

methotrexate inhibits

dihydrofolate reductase

122

5-FU complexes w/ ________ that inhibits _______?

w/ folic acid (THF)
inhibits thymidylate synthase

123

5-FU overdose rescue =

thymidine

124

malignant hyperthermia a SE of what drugs?

inhalation anesthetics (except N2O)
succinylcholine

125

chronotropic effects

increase RATE of contraction (HR)

126

inotropic effects

increase FORCE of contraction

127

inhibits dihydropteroate SYNTHASE

sulfonamides

128

inhibits dihydrofolate REDUCTASE

trimethoprim, pyrimethamine, methotrexate

129

tx for mild UTI that is safe in pregnancy?

nitrofurantoin (p.267 DIT)

130

most common medication used for UTI prophylaxis

TMP-SMX

131

cisplatin toxicity/prophylactic tx used to reduce toxicity?

nephrotoxicity;
amifostine or chloride diuresis (bc cisplatin stays in nonreactive state when in higher chloride concentration)

132

1st line therapy in trigeminal neuralgia?

carbamazepine

133

1st line tx for acute gouty arthritis?

NSAIDs
also Glucocorticoids in pts for whom NSAIDs are CI (ex. elderly pts w/ renal failure)

134

uricosuric drugs + xanthine oxidae inhibitors (allopurinol) used for?

PROPHYLACTIC therapy for prevention of acute gouty attacks (used in pts w/ more than 3 episodes of acute gouty arthritis and those w/ macroscopic tophi)

135

why can't allopurinol be used in acute gouty attacks?

can exacerbate acute arthritis!

136

antiarrhyhtmics that can cause Torsades de Pointes

quinidine
procainamide
disopyramide
ibutilide
dofetilide
sotalol

137

drugs that prolong PR interval

verapamil
metoprolol

138

drugs that act on microtubules

vincristine/vinblastine
griseofulvin
mebendazole/albendazole/thiabendazole
paclitaxel/docetaxel
colchicine

139

DOC in cluster HA

inhaled 100% oxygen

140

competitive inhib do what to potency/efficacy?

DECREASE potency (increase Km)

141

noncompetitive inhib do what to potency/efficacy?

DECREASE efficacy (decrease Vmax)

142

the lower the Km

the higher the potency

143

the higher the Vmax

the higher the efficacy

144

high efficacy drugs classes?

analgesic
antibiotics
antihistamines
decongestants

145

highly potent drug classes?

chemotherapeutic
antiHTN
antilipid

146

drug w/ low therapeutic index

digoxin
lithium
theophylline
warfarin

147

phase I drug metabolism?

reduction
oxidation
hydrolysis

can result in still active metabolite (can be more toxic)
uses CYP450!!

148

phase II drug metabolism?

conjugation: glucuronidation, acetylation, sulfation)

renally excreted

149

tx of OD of beta-blockers in arrhythmias

glucagon

150

1st gen cephalosporins

cefazolin
cephalexin

"PEcK"

151

2nd gen cephalosporins

cefoxitin
cefaclor
cefprozil
cefuroxime

"HENS PEcK"

152

3rd gen cephalosporins

ceftriaxone
cefotaxime
cefdinir
ceftazidime

153

4th gen cephalosporins

cefapime

154

ceftriaxone treats what?

meningitis and gonorrhea
excreted in bile and long acting

155

ceftazidime treats what?

Pseudomonas

156

3rd gen cephalosporins cover what?

serious gram neg bacteria
also S.pneumo!!

157

cefepime treats what?

Pseudomonas and gram +

158

aztreonam binds to?

PBP3

159

drug that inhibits ribonucleotide reductase

hydroxyurea

160

drug that inhibits dihydrofolate reductase

trimethoprim
methotrexate

161

drug that inhibits thymidylate synthase

5-FU

162

drug that inhibits IMP dehydrogenase

mycophenolate

163

drug that inhibits PRPP amidotransferase

6-MP

164

drug aiding in dx of Prinzmetal's variant angina

ergonovine

165

low potency typical antipsychs

chlorpromazine
thioridazine

166

high potency typical antipsychs

trifluperazine
fluphenazine
haloperidol

167

drugs used to tx Tourette's synd

fluphenazine, pimozide (high potency antipsychs)
tetrabenazine (help degrade dopamine)

168

typical antipsychs block what receptor?

D2 receptors (which increases cAMP)

169

clozapine acts on what receptors?

D4

170

DOC for tx of psychosis induced by Parkinson meds

quietapine

171

specific sympt of chlorpromazine

corneal deposits

172

specific sympt of thioridazine

retinal deposits

173

lithium MOA?

inhib IP3 (phosphoinositol cascade)

174

buspirone facts?

stim 5-HT1A receptors
no addiction, tolerance or sedation!
no interaction w/ alcohol
takes 1-2 wks to take effect

175

SSRIs

fluoxetine
paroxetine
sertraline
citalopram

176

SNRIs

venlafaxine
duloxetine (greater effect on NE)

177

SNRI MOA

inhib serotonin and NE reuptake

178

tx for fibromyalgia?

milnacipran or amitriptyline

179

can tx diabetic periph neuropathy

duloxetine

180

indication for imipramine

bedwetting

181

indication for clomipramine

OCD

182

which TCA has most anticholinergic SE?

3rd gen (amitriptyline)

use nortryptilline in elderly to decrease confusion, hallucination SE

183

which TCA is less sedating; but increases ________?

desipramine
increases seizure threshold

184

TCA MOA

block reuptake of NE and serotonin

185

TCAs

amitriptyine, nortriptyline
imipramine, desipramine, clomipramine
doxepin
amoxapine

186

MAOIs

tranylcypromine
phenelzine
isocarboxazid
selegiline

187

selegiline inhibits what selectively?

MAO-B - used for dopamine (Parkinson's)

188

MAOI MOA/use

increased levels of NE, serotonin and dopamine by inhibiting MAO

can be used to tx atypical depression

189

ingestion of tyramine w/ MAOIs causes?

Hypertensive crisis

190

bupropion MOA + benefit

inhib NE and dopamine reuptake w/ greater effect on dopamine
no sexual SE!

191

mirtazapine MOA

alpha2-antag (increases release of NE and serotonin)
also potent 5-HT2 and 5-HT3 recept antag

192

trazodone MOA/use/SE

inhibit serotonin reuptake
used primarily for insomnia
SE = priapism

193

demeclocycline is used in

SIADH bc ADH antagonist

194

Na-channel binding strength for Class I antiarrhythmics

IC > IA > IB
IC = increased incidence of use dependence

195

class II antiarrhythmics MOA

decrease cAMP, Ca
decreases slope of phase 4 (slows HR)
increases PR interval

196

metoprolol can cause what SE

dyslipidemia

197

class II antiarrhythmics OD tx

glucagon

198

beta-blocker that can exacerbate prinzmetal's angina

propanolol

199

used in tx of WPW

procainamide
amiodarone

200

class III antiarrhythmics MOA

increases AP, ERP, QT interval
works on phase 3!!

201

class I antiarrhythmics MOA (as a class!)

decreases slope of phase 0

202

class IV antiarrhythmics MOA

decrease depolarization of latter part of phase IV
decreases depolarization of phase 0 --> increases ERP
decreases SA/AV nodal activity
increases PR

203

class IV antiarrhythmics CI in

pts w/ HF exacerbation

204

adenosine MOA

increases K+ out of cells --> hyperpolarization
decreases Ca
prolong PR interval

205

adenosine effects blocked by

theophylline (pts w/ COPD/asthma)
caffeine

206

drug CI in closed-angle glaucoma

epinephrine

207

baclofen MOA

GABAb agonist

208

H1 blockers - 1st gen

can cross BBB - sedation!
diphenydramine, dimenhydrinate, chlorpheniramine

209

H1 blockers - 2nd gen

can't cross BBB
loratadine, fexofenadine, desloratadine, cetirizine

210

beta-2 agonists for prophylaxis of asthma

salmeterol
formoterol

211

theophylline characteristics

inhib PDE --> decreases cAMP hydrolysis --> brochodil
narrow therapeutic index: cardiotox, neurotox (seizures)
blocks action of adenosine
tx OD w/ beta-blockers

212

inhaled GC effects/use

inhib synth of cytokines (by inhib phospholipase A2)
inactivate NF-KB --> decreased TNF-alpha prod (bc it's the TF that activates this cytokine)
1st line for CHRONIC asthma

213

montelukast, zafirlukast MOA/use

block leukotriene recept (D4 recept antagonists)
aspirin-induced asthma!!
also chronic asthma prophylaxis

214

zileuton MOA/use

5-LOX inhib (no leukotriene synth)
chronic asthma prophylaxis

215

omalizumab MOA/use

Monoclonal anti-IgE Ab
used in allergic asthma resistant to other tx

216

N-acetylcysteine in asthma/CF use:

mucolytic by cleaving disulfide bonds in mucus glycoproteins
also prevents contrast-induced nephropathy

217

how does dextromethorphan cause cough suppression

antag NMDA glutamate receptors

218

bosentan MOA/use

for pulmonary arterial HTN
competitively antag endothelin-1-receptors

219

pseudoephedrine, phenylephrine resp uses

constrict dilated arterioles in nasal mucosa (via alpha-agonist properties) --> reduce nasal congestion
open obstructed Eustachian tubes
pseudoephedrine --> also a stimulant

220

pseudoephedrine, phenylephrine resp SE

HTN, rebound nasal congestion if taken long term (all)
CNS stim/anxiety (pseudoephedrine)
tachyphylaxis - due to decreased NE from neg feedback causing vasodil + congestion (phenylephrine)

221

acetazolamide used in glaucoma by

blocking bicarb formation --> decreases formation of aqueous humor

222

acetazolamide SE

hyperchloremic metab acidosis, sulfa allergy, paresthesias

223

loop diuretics SE

Ototox
Hypokalemia/hypocalcemia
Dehydration
Allergy (sulfa)
Nephritis (acute)
Gout

"OH DANG!"

224

2 classes of diuretics causing ACIDEMIA

-acetazolamide
-K+-sparing (hyperkalemia causing --> H/K exchange in plasma)

225

2 classes of diuretics causing ALKALEMIA

loop and thiazides
-vol contraction (bicarb reabsorb --> Cl- secreted)
-K+ loss
-low K+ states (H exchanged for Na, instead of K exchanged)

226

increased aldosterone can have what effect on heart

cardiac remodeling --> can worsen LV dysfunct in HF pts

227

ACE inhib 2 unique clinical applications

diabetic renal disease
used Post-MI + in CHF pts (to prevent unfav heart remodeling as a result of chronic HTN)

228

ACE inhib SE

"CATCHH"
Cough (dry!!)
Angioedema
Teratogen
Creatinine increase (bc of decreased GFR --> decreased FF)
Hyperkalemia
Hypotension

229

methotrexate indications/SE

cancers
ectopic preg
hydatidiform mole
RA
psoriasis

SE: myelosuppression (reversed w/ leucovorin), macrovesicular fatty change in liver, mucositis, teratogen

230

cyclophosphamide MOA/SE

covalently X-link DNA @ guanine N-7
bioactivated by liver
SE - hemorrhagic cystitis prevented w/ mesna (thiol groups bind acrolein)

231

used against brain tumors

nitrosureas (carmustine, other -mustines, streptozocin)
cross BBB --> CNS!!! (therefore, CNS toxicity also)

232

busulfan

used in CML
used to ablate pt bone marrow before BMT

SE = pulm fibrosis, hyperpigmentation!

233

vinca alkaloids bind?

beta-tubulin in M phase + block polymerization of microtubules

234

vincristine SE

neurotox (periph neuritis)

235

vinblastine SE

bone marrow suppression

"vinblastine BLASTS bone"

236

paclitaxel MOA/indications

MOA - HYPERSTABILIZE polymerized microtubules --> can't break down spindles
**ANAPHASE can't occur

used for: ovarian/breast carcinomas

237

cisplatin SE

nephrotox (acute tubular injury; prevent w/ amifostine)
acoustic nerve damage
Chloride diuresis

238

etoposide, teniposide MOA

inhib topo II

239

hydroxyurea MOA/use

inhib ribonucleotide reductase
used in melanoma, sickle cell

240

irinotecan, topotecan MOA

inhib topo I

241

trastuzumab aka ...

herceptin
Mab against HER2 (c-erbB2)
SE = cardiotox

242

bevacizumab

Mab against VEGF --> inhib angiogenesis

243

vemurafenib

inhib B-raf kinase w/ V600E mut
for metastatic melanoma

244

cimetidine SE

inhib CYP450
antiandrogenic effects
crosses BBB (confusion, dizziness, HA)
decreases renal excretion of creatinine (also seen w/ ranitidine)

245

sucralfate req?

acidic environment to polymerize

246

misoprostol indications

NSAID-induced PUD
maintains PDA
induces labor (ripens cervix)

247

octreotide (somatostatin analog) indications

acute variceal bleeds
acromegaly
VIPoma
carcinoid tumors

248

hypercalcemia can stim what?

G-cells to produce gastrin

249

terbutaline

Beta2-agonist used to reduce premature uterine contractions

250

tx HTN in pt w/ renal dz?

clonidine
methyldopa

these are alpha2-agonists

251

give to pts on MAOIs who eat tyramine containing food

phentolamine

252

vascular alpha receptors are mostly what type

1B

253

tamsulosin blocks

alpha-1A, 1D receptors on prostate + does not reduce blood pressure as much

254

beta agonists do what to BP?

DECREASE (bc of beta2 effect)

255

drug class used cautiously in diabetics

beta-blockers (can mask hypoglycemia); use beta1-blockers instead!

256

beta-blockers effects:

1) decrease O2 consumpt (by decreasing HR, contractility)
2) reduce mortality in MI
3) decrease AV conduction (metoprolol, esmolol)
4) decrease CO
5) decrease renin secretion
6) slow progression of HF in CHF (but make sure not to decrease HR too much!!)
7) decrease aqueous humor secretion (timolol)

257

tx for pts w/ HTN and bradycardia

partial beta blockers!
pindolol, acebutolol

258

non-selective beta blockers w/ alpha1-blocking ability too:

labetalol
carvedilol

259

hydroxychloroquine

tx for SLE
SE = permanent retinal damage, myopathies

260

direct cholinergic agonists

bethanechol
carbachol
pilocarpine
methacholine

261

AChE inhibitors

neostigmine
physostigmine
pyridostigmine
donepezil
edrophonium
echothiophate
diisopropyl flurophosphate

262

stim alpha1, 2 + beta1, 2

epinephrine

263

stim alpha1, 2 + SOME beta1

epinephrine

264

beta agonist (beta1 = beta2)

isoproterenol

265

beta1-agonist

dobutamine

266

alpha-agonist (alpha1 > alpha2)

phenylephrine

267

beta2-agonist for premature contractions

ritodrine

268

ephedrine MOA

releases stored catechol
-used for nasal decongest, urinary incontinence

269

alpha2-agonists

clonidine
methyldopa

270

alpha-blockers

phenoxybenzamine
phentolamine

271

alpha2-blocker

mirtazapine

272

tx of opioid withdrawal

methadone, buprenorphine
suboxone (a combo of naloxone + buprenorphine; harder to abuse)
neonatal opioid withdrawal - diluted tincture of opium solution

273

tx cocaine OD

benzos
haloperidol
NEVER BETA BLOCKERS!!

274

tx nicotine withdrawal (meds)

bupropion
varenicline

275

tx for PCP, LSD

benzos

276

tx for heroin addiction

methadone (long-acting oral opiate)
naloxone + buprenorphine = partial agonist; oral naloxone not easily abused

277

tx for delirium tremens w/ alcohol withdrawal

long-acting benzos preferred (unless pt has liver disease --> use short-acting benzos)

278

tx for anxiety

SSRI, SNRI, buspirone

279

tx for ADHD

methylphenidate, amphetamines

280

tx for bipolar disorder

Lithium
valproic acid, carbamazepine
atypical antipsych

281

tx for bulimia

SSRIs (fluoxetine esp)

282

tx for depression

SSRI, SNRI, TCA, buspirone
mirtazapine (esp w/ insomnia)

283

tx for OCD

SSRI, clomipramine

284

tx for panic disorder

SSRI, venlafaxine, benzos

285

tx for PTSD

SSRI

286

tx for schizophrenia

antipsych

287

tx for social phobias

SSRIs

288

tx for Tourette's synd

antipsych

289

tx for drug-induced Parkinsonism

benztropine
trihexyphenidyl

290

ziprasidone SE

prolong QT interval

291

lithium excretion

exclusively by kidney; most reabsorbed @ PCT following Na reabsorption

292

cyclosporine SE

nephrotox (by vasoconstriction of aff + eff arterioles), HTN, hyperlipidemia, hyperglycemia

293

drug used in lupus nephritis

azathioprine

294

alemtuzumab

anti-CD52 humanized Mab for tx of CLL

295

beta2 > beta1 agonist

terbutaline

296

probenecid actions

inhib reabsorpt of uric acid @ PCT
inhib secretion of penicillin

297

TZD w/ increased risk of bladder cancer

pioglitazone

298

adiponectin does what?

is released by activation of PPAR-gamma (site of action of TZDs)
decreases insulin resistance

299

TZDs metabolized where?

liver

300

sitagliptan use req monitoring of what drug?

digoxin

301

drugs w/ anticholinergic properties

-ANTIHISTAMINES (H1 BLOCKERS)
chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine

-ANTIDEPRESSANTS
amoxapine, amitriptyline, clomipramine, desipramine,
doxepin, nortriptyline, paroxetine, imipramine, protriptyline

-CARDIOVASCULAR MEDICATIONS
furosemide, digoxin, nifedipine, disopyramide

-Antidiarrheal Medications
diphenoxylate, atropine

-Antispasmodic Medications
belladonna, clidinium, chlordiazepoxide, dicyclomine, hyoscyamine, propantheline

-Antiulcer Medications
cimetidine, ranitidine

-ANTIPARKINSON MEDICATIONS
amantadine, benztropine, biperiden, trihexyphenidyl

-MUSCLE RELAXANTS
cyclobenzaprine, dantrolene, orphenadrine

-ANTIVERTIGO MEDICATIONS
meclizine, scopolamine

-ANTIPSYCHOTIC MEDICATIONS
chlorpromazine, clozapine, olanzapine, thioridazine

-URINARY INCONTINENCE
oxybutynin, probantheline, solifenacin, tolterodine, trospium

-PHENOTHIAZINE ANTIEMETICS
prochlorperazine, promethazine

302

DOC for myoclonic seizures

vaproic acid

303

DOC for simple/complex partial seizures

carbamazepine