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Flashcards in Pharmacology Deck (219):
1

Gentamycin
Neomycin
Amikacin
Tobramycin
Streptomycinn
Paromycin

Aminoglycosides

Bactericidal, inhibit 30S, only works in aerobes

2

What effect does Omeprazole have on various drugs?

Omeprazole is a PPI which lowers the acidity of the stomach (increases pH)

This can affect the absorption of some drugs.

3

-Diphenhydramine
-Dimenhydrinate
-Chlorpheniramine

First generation H1 blockers (antihistamines)

anti-allergy, induce drowsiness, anti-motion sickness

4

-Loratadine
-Fexofenadine
-Desloratadine
-Cetirizine

Second generation H1 blockers (antihistamines)

do not cross BBB

anti-allergy only

5

Cyclophosphamide mechansim of action

cross-links DNA at guanine N-7 -> inhibiting DNA replication

6

-Sertraline
-Paroxetine
-Fluoxetine
-Citalopram

SSRI - blocks re-uptake of serotonin only

7

-Venlafaxine
-Duloxetine

SNRI - blocks re-uptake of serotonin and NE

8

Urinary urgency means =

What do you give to treat?

Urinary urgency means the bladder is over-contracting.

Give them a muscarinic receptor antagonist to relax the detrusor contraction.
ex)atropine, oxybutamine, tolterodine, solifenacin

9

Excess urination - elevated Ach or decreased Ach

elevated Ach

Parasympathetics make you Pee

10

Cilostazol =

phosphodiesteraes inhibitor - inhibits platelet aggregation + direct vasodilation

11

Reye syndrome of the liver on light microscopy =

microvesicular steatosis + reduced number of mitochondria + decreased amount of glycogen

12

acetaminophen toxicity on LM

centrilobular hepatic necrosis

13

Treatment for TCA overdose =

Sodium bicarbonate

Treats the cardiac toxicity by increasing pH and increasing intracellular Na therefore alleviating the VG Na blockade
(fixes the widening of the QRS)

14

D-penacillamine is a treatment for?

Copper overload

used for chelation

15

Deferoxamine is a treatment for?

Iron overload

used for chelation

16

EDTA and Dimercaprol are treatments for?

Lead overload

17

3 drugs for Absence seizures =

-Ethosuximide = inhibits thalamic T type Ca channels
-Valproate = increased Na channel inactivation + inhibits GABA transaminase
-Lamotrigine = inhibits VG Na channels

18

Status Epilepticus treatments (first, second)

First: IV lorazepam = increased frequency of GABA-A channel opening - increases inward Cl current

Second: Phenytoin = increased Na channel inactivation - decreased Na current

19

How do opioids hyperpolarize neurons?

Increased K out, Decreased Ca in

20

Is glutamate excitatory or inhibitory?

excitatory!

21

Succimer is used for?

Lead chelation for children with lead toxicity

22

Clopidogrel, Parasugrel, Ticagrelor, Ticlopidine

ADP receptor inhibitors (P2-Y12 R)

Irreversible inhibition of platelet degranulation

23

Abciximab
Eptifibatide
Tirofiban

GPIIb/IIIa inhibitors -> inhibition of platelet aggregation

24

ACE inhibitor - hyperkalemia or hypokalemia?

Hyperkalemia due to inhibition of aldosterone - increased Na out, increased K in

25

K sparing diuretics = (4)

Spironolactone - mineralocorticoid antagonist
Eplerenone - mineralocorticoid receptor antagonist
Triamterene - inhibits ENaC
Amiloride - inhibits ENaC

26

Losartan
Candesartan
Valsartan

Angiotensin II Receptor Blockers (ARBs)

27

Diltiazem, Verapamil

Nondihydropyridine calcium channel blockers (L-type)

28

toxicity of: Cisplatin/Carboplatin

-acoustic nerve damage
-nephrotoxicity

mechanism of drug: cross links DNA

29

toxicity of: Vincristine

-peripheral neuropathy

mechanism of drug: vinca alkaloid, binds beta-tubulin -> inhibits polymerization into microtubules -> inhibits formation of mitotic spindle

30

toxicity of: Bleomycin, Busulfan

-pulmonary fibrosis

mechanism of Bleomycin: induces free radical formation -> DNA breaks
mechanism of Busulfan: cross links DNA

31

toxicity of: Doxorubicin

_ is used to prevent toxicity

-cardiotoxcity (dilated cardiomyopathy)

mechanism of drug: generates free radicals + intercalates DNA -> breaks in the DNA -> inhibits replication

Dexrazoxane (iron chelating agent) is used to prevent cardiotoxicity

32

toxicity of: Trastuzumab

-cardiotoxicity

mechanism of drug: monoclonal antibody against HER-2 (c-erbB2)

33

toxicity of: Cyclophosphamide

toxicity is reversible via administration of _ or _

-hemorrhagic cystitis (hematuria + suprapubic pain)

mechanism of drug: cross links DNA at N7 guanine

Partially reversible via mensa and N-acetylcystine

34

toxicity of: 5-FU, 6-MP, Methotrexate

-myelosuppression

5FU = pyrimidine analog -> (-)thymidylate synthase
6MP = purine analog
Methotrexate = folic acid analog -> (-)dihydrofolate reductase

35

What do you give to someone who has urinary retention?

Urinary retention means their bladder is not contracting.

Give them a muscarinic agonist to help the detrusor contract.

36

Function of: mensa

Partially reverses toxicity of cyclophosphamide

37

Function of: Dexrazoxane

Iron chelating agent. Also to prevent cardiotoxicity from Doxorubicin.

38

Glusine
Aspart
Lispro

used for?

Rapid acting insulin

used for postprandial control

39

Neutral Protamine Hagedorn (NPH)

Intermediate acting insulin

40

Detemir
Glargine

used for?

Long acting insulin

Used for basal control

41

Chlorpropamide
Tolbutamide

First generation sulfonylureas = close the K+ channel on pancreatic beta cells -> -> release endogenous insulin (+ C peptide)

42

Disulfiram-like reaction occurs with what class of drugs? (5)

-First generation sulfonylureas (Chlorpropamide, Tolbuamide)
-Metronidazole
-Certain Cephalosporins
-Griseofulvin
-Procarbazine

Do not drink alcohol while taking these drugs.

Disulfiram inhibits acetaldehyde dehydrogenase in the ethanol metatbolism pathway. Therefore, acetaldehyde accumulates resulting in the "hangover" symptoms.
Disulfiram is given to alcoholics to condition them to stop drinking alcohol.

43

Glimepiride
Glyburide
Glipizide

Second generation syulfonylureas = close the K+ channel on pancreatic beta cells -> -> release endogenous insulin (+ C peptide)

44

Repaglinide
Nateglinide

Meglitinides = close the K+ channel on pancreatic beta cells -> -> release endogenous insulin (+ C peptide)

Works just like sulfonylureas except these can be given to people with sulfa allergies

45

Pioglitazone
Rosiglitazone

Binds to PPAR-gamma (a nuclear transcription regulator)

46

Exenatide
Liraglutide

GLP-1 analogs = increase endogenous insulin release, decrease glucagon release

47

Linagliptin
Saxagliptin
Sitagliptin

Dipeptidyl Peptidase-4 inhibitors (DPP4) = increase endogenous insulin release, decrease glucagon release

48

Pramlintide

used for?

Amylin analog = decreases gastric emptying, decreases glucagon release

controls postprandial glucose spike

49

Canagliflozin

SGLT-2 inhibitor - works at the PCT

50

Acarbose
Miglitol

inhibitors of what enzyme?
used for?

alpha-glucosidase inhibitors - work at the intestinal brush border

controls postprandial glucose spike

51

Pegvisomant

Growth hormone receptor antagonist

52

Anastrozole
Letrozole
Exemestane

Inhibits aromatase enzyme -> decreases the peripheral conversion of androgens to estrogens

Used in the treatment of ER+ breast cancers.

53

Misoprostol (3 main uses)

PGE1 agonist

-increased production and secretion of gastric mucous
-maintains PDA
-off-label use of labor induction (ripens cervix) or pregnancy termination

54

Fomepizole

Inhibits alcohol dehydrogenase

antidote for methanol or ethylene glycol poisoning

55

Rotenone

-inhibits complex I in the electron transport chain

decreases proton gradient and thus blocks ATP synthesis indirectly

rotenONE

56

Antimycin A

-inhibits complex 3 in the electron transport chain

decreases proton gradient and thus blocks ATP synthesis indirectly

"an-3-amycin"

57

Cyanide (CN) and CO

-inhibit complex IV (cytochrome oxidase) in the electron transport chain

decreases proton gradient and thus blocks ATP synthesis indirectly

58

Oligomycin

Directly inhibits the mitochondrial ATP synthase -> increases proton gradient but no ATP is produced

59

2,4-Dinitrophenol

Increases permeability of the mitochondrial membrane therefore causing a decreased proton gradient but an increased O2 consumption as the electrons continue to travel down the chain to try to build up the proton gradient. No ATP synthesis due to the decreased proton gradient.

60

Calcitriol

active Vitamin D

given to patients who are hypocalcemic

61

Alendronate, Risendronate

Bisphosphonates - structurally similar to pyrophosphate

-inhibits osteoclasts -> decreases calcium release from bone

62

Cinacalcet

Calcimimetic - stimulates Calcium sensing receptor which decreases PTH release

63

ADHD treatment (2)

Stimulants (Methylphenidate, Dextroamphetamine, Methamphetamine)
Clonidine (alpha-2 agonist)

64

Alcohol withdrawal treatment (1)

Long acting benzodiazepines

65

Bipolar disorder treatment (3)

Lithium
Valproate
Atypical anti-psychotics

66

Bulimia Nervosa treatment (1)

SSRI (Fluoxetine)

67

Depression treatment (1)

SSRI

68

Generalized anxiety disorder (2)

SSRI
SNRI

69

Obsessive Compulsive Disorder (2)

SSRI
Clomipramine (TCA)

70

Panic Disorder (3)

SSRI
Venlafaxine (SNRI)
Benzodiazepine

71

PTSD (2)

SSRI
Venlafaxine (SNRI)

72

Social phobias (4)

SSRI
Venlafaxine (SNRI)
To improve preformance: Beta-blockers, benzodiazepine

73

Tourette syndrome (3)

First generation anti-psychotics (Fluphenazine, Pimozide)
Tetrabenazine (inhibits VMAT -> decreased availability of dopamine)
Clonidine (alpha-2 agonist)

74

Haloperidol
Triflupoerazine
Fluphenazine
Chlorpromazine
Thioridazine

high potency vs low potency

First generation anti-psychotics (typicals)

High potency = Triflupoerazine, Fluphenazine, Haloperidol
"Try to Fly High"

Low potency = Chorpromazine, Thioridazine
"Cheating Thieves are Low"

75

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

Second generation anti-psychotics (atypicals)

76

Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine

Tricyclic antidepressants - block re-uptake of NE and Serotonin, blocks H1 receptors, block alpha-1 receptors

77

-Tranylcypromine
-Phenelzine
-Isocarboxazid
-Selegiline

Monoamine oxidase inhibitors - increases levels of amine neurotransmitters in the synaptic cleft (NE, Serotonin, Dopamine)

Selegiline - is MOA-B selective

MAO-A also breaks down tyramine in the GI tract

78

Cyproheptadine

5HT-2 receptor antagonist

-treats serotonin syndrome

79

treatment for major depressive disorder that does NOT have sexual side effects

Buproprion - NE and dopamine reuptake inhibitor

80

Buspirone

-mechanism
-used to treat what

-Stimulates 5HT-1A receptors (non-benzodiazapine anoxytic)
-Used to treat Generalized Anxiety Disorder

Takes up to 2 weeks to take effect (slow onset)
No risk of tolerance, dependence or withdrawal

81

Benzodiazepines that do not need the liver to be metabolized (3)

-Lorazepam
-Oxazepam
-Temazepam

"LOT"

These drugs undergo glucoronidation directly and therefore can be given to patients with impaired liver function

82

Long acting benzodiazepines (3)

-Chlordiazepoxide
-Diazepam
-Flurazepam

Requires the liver to be metabolized

83

Short acting benzodiazepines (1)

-Triazolam

Requires the liver to be metabolized

84

Statins mechanism of action

-inhibits HMG-CoA Reductase enzyme so less cholesterol is synthesized
-increases LDL-receptors to pull more LDL molecules out of the serum (to try to get more cholesterol that way)

best at lowering LDL levels out of all the lipid lowering agents

MOST effective at preventing future cardiovascular events

85

Cholestyramine
Colestipol
Colesevelam

Bile acid resigns

-prevents intestinal absorption of bile acids
(so now the cells have to make more bile acids via cholesterol. the cholesterol-stores get used up quickly)
-increases LDL-receptors to pull more LDL molecules out of the serum (to try to get more cholesterol that way)

86

Ezetimibe

-prevents intestinal absorption of cholesterol
(so now the cells have to make more cholesterol. the cholesterol-stores get used up quickly)
-increases LDL-receptors to pull more LDL molecules out of the serum (to try to get more cholesterol that way)

87

Gemfibrozil
Clofibrate
Bezafibrate
Fenofibrate

Fibrates

-activates PPAR-alpha -> upregulates LPL at extra-hepatic sites -> increased metabolism of VLDL and chylomicrons -> decreasing serum triglyceride levels

-decrease VLDL released from the liver -> decreases circulating serum triglyceride levels

-directly upregulates synthesis of HDL

88

Niacin (Vitamin B3)

-decrease VLDL released from the liver -> decreases circulating serum triglyceride levels

-raises HDL levels

MOST effective at raising HDL levels

89

Volatile anesthetics increase or decrease cerebral blood flow?

Increase cerebral blood flow

but that is a bad thing because it increases intracerebral pressures

90

-Imipenem
-Meropenem
-Ertapenem
-Doripenem

Carbapenem
-broad spectrum beta-lactamase resistant
-binds to PBPs
-always administered with cilsastin

91

Cilastin

inhibitor of renal dihydropeptdiase I

-administered with Carbapenems to decrease their inactivation

92

Aztreonam

Monobactams
-beta-lactamase resistant
-binds to PBP-3

93

-Cefazolin
-Cephalexin

First-generation Cephalosporins
-beta-lactam drug - binds to PBPs

94

-Cefoxitin
-Cefaclor
-Cefotetan
-Cefuroxime

Second-generation Cephalosporins
-beta-lactam drug - binds to PBPs

95

-Cefotaxime
-Ceftazidime
-Ceftriaxone

Third-generation Cephalosporins
-beta-lactam drug- binds to PBPs
-resistant to beta-lactamases

96

-Cefepime

Fourth-generation Cephalosporins
-beta-lactam drug- binds to PBPs
-resistant to beta-lactamases
-broad-spectrum

97

-Ceftaroline

Fifth-generation Cephalosporins
-beta-lactam drug- binds to PBPs
-broad-spectrum

98

Amoxicillin

-beta-lactam drug - binds to PBPs
-beta-lactamase sensitive - can be combined with beta-lactamase inhibitors (Clavulanic Acid) to prevent this

99

-Dicloxacillin
-Nafcillin
-Oxacillin

-beta-lactam drug - binds to PBPs
-beta-lactamase resistant due to their bulky R groups

100

-Piperacillin
-Ticarcillin

-beta-lactam drug - binds to PBPs
-beta-lactamase sensitive - can be combined with beta-lactamase inhibitors to prevent this
-good to use against Pseudomonas and anaerobic bugs (Bacterioides)

101

Clavulanic Acid
Sulbactam
Tazobactam

Beta-lactamase inhibitors

102

-Levofloxacin
-Moxifloxacin

Respiratory fluoroquinolones
-treat community-acquired pneumonia and walking pneumonia

103

Atazanavir
Darunavir
Fosamprenavir
Indinavir
Lopinavir
Ritonavir
Saquinavir

Protease inhibitors - prevent maturation of new viruses

-end in "navir"

104

Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenoforvir
Zidovudine

NTRI - competitively inhibits nucleotide binding to reverse transcriptase and terminates chain elongation because these agents (nucleosides) lack a 3'OH group
-requires phosphorylation to be active

Tenofovir - nucleotide, therefore it does not need to be phosphorylated to be active

105

Delavirdine
Efavirenz
Nevirapine

NNRTI - allosteric inhibition of reverse trascriptase therefore terminating chain elongation

-do not require phosporylation to be active

106

Raltegravir

Integrase inhibitor - inhibits HIV integrating into the host cell chromosome

107

Simepravir

HCV protease inhibitor (NS3/4A protease inhibitor)
-do not use as monotherapy

108

Sofosbuvir

Inhibits HCV RNA-dependent RNA polymerase -> terminates chain elongation
-nucleoside analog
-do not use as monotherapy

109

Adenosine

rapid coronary dilation

110

Medication classes that should be avoided in hypertrophic cardiomyopathy (2)

-Vasodilators: Dihydropyridine calcium channel blockers, Nitroglycerine, ACE inhibitors

-Diuretics

111

DVT treatment in pregnancy =

Enoxaparin (LMWH)

112

High risk drugs for drug-induced lupus =

“Low grade fever + multiple joint pains + well demarcated erythematous rash on face and trunk + ANA positive + anti-histone positive”

-Hydralazine
-Procainamide
-Isoniazid
-Minocycline
-Quinidine

113

Patient who is aspirin intolerant is given _ to prevent further cardiovascular events

Clopidogrel - P2Y12 R inhibitor -> prevents platelet aggregation

114

Tetrodotoxin

Binds fast VG Na channels in cardiac and nerve tissue
-inactivates channels
-does not change the resting potential

Poisoning - poorly prepared puffer fish

115

Ciguatoxin

Main sfx

Opens VG Na channels -> depolarizaion

Temperature-related dysthesia (cold feels hot and hot feels cold) is specific

Poisoning - consumption of reef fish (barracuda, snapper, moray eel)

116

Scombroid poisoning

Bacterial histinide decarboxylase turns histidine -> histamine

Histamine is not degraded by heat/cooking

acute onset burning of the mouth, flushing, erythema, anaphylais-like

117

Scombroid poisoning treatment

anti-histamines

caused by a histamine overload

118

Phenylephrine

alpha1 agonist > alpha2 agonist

-increases MAP -> reflex bradycardia
-increases diastolic P
-increases systolic P

used to treat hypovolemic/distributive shock

119

Norepinephrine

alpha1 agonist > alpha2 agonist > beta1 agonist

-increases diastolic P
-increases systolic P
-increases MAP -> reflex bradycardia
-increases cardiac contractility

used to treat hypovolemic/distributive shock

120

Isoproterenol

beta1 agonist = beta2 agonist

-increases cardiac contractility
-decreases SVR
-decreases diastolic P
-decreases MAP
-increases PP
-increases HR

121

Dobutamine

beta1 agonist > beta2 agonist

-increases systolic P
-decreases diastolic P
-increases PP
-decreases SVR
-increases HR
-increases cardiac contractility
-increases CO

used to treat cardiogenic shock

122

Epinephrine

beta agonist > alpha agonist
(at low doses)

-increased cardiac contractility
-increased HR
-increased systolic P
-decreased diastolic P
-increased MAP
-decreased SVR
-increased PP

(at high doses) alpha agonist > beta agonist

123

Amphetamines mechanism of action

-release stored catecholamines into the synapse

124

Reserpine

inhibits VMAT -> neurotransmitters cannot be stored in pre-synaptic vesicles -> depletion of neurotransmitter stores

125

Cocaine mechanism

inhibits DAT and NET -> increased concentration of NE and dopamine in the synapse

126

-Clonidine
-alpha methyldopa
-tizanidine

alpha2 agonists -> decreases sympathetic outflow

127

beta blockers from a-m

beta1 > beta 2

"cardioselective"

128

beta blockers from n-z

beta1 = beta2

"nonselective"

129

alpha + beta blockers (2)

-Carvedilol
-Labetalol

130

Beers Criteria (5 main categories)

Anticholinergics:
-First generation antihistamines
-GI antispasmodics

Cardiovascular:
-Antithrombotics
-alpha blockers
-central alpha agonists
-antiarrythmics

CNS:
-TCA
-Anti-psychotics
-Barbiturates
-Benzodiazepine

Endocrine:
-Sliding scale insulins
-Sulfonylurease

Pain:
-Indomethacin
-Muscle relaxants
-Meperidine

131

Ranolazine

Used to treat angina refractory to other medical therapies

Mechanism: inhibits the late phase of Na current -> decreasing the diastolic wall tension and O2 consumption
No effect on HR or contractility

May prolong QT interval

132

MI that is treated with coronary stenting is now in recovery. Patient keeps having repeated ventricular arrhythmias caused by the ischemic tissue. What drug is given? (2)

Class IB antiarrhythmics - Lidocaine - works especially well in ischemic ventricular tissue

Class III antiarrhythmics - Amiodarone - has class I, II, III, IV activity

133

Antiarrhythmics that prolong QT

Class IA and Class III - Due to their effect on prolonging the ventricular action potential

This is why these classes have an increased risk for Torsades des Pointes

134

What antiarrhythmic drugs can be used to treat WPW?

Class IA or III antiarrhythmics

The drugs that decrease AV node conduction (II, IV) will not have an effect due to the WPW being an accessory pathway

135

Metolazone =

thiazide-type diuretic -> inhibits Na/Cl reabsorption in the early distal convoluted tubule

136

What diuretic is given to treat altitude sickness?

Acetazolamide - inhibits CA

Causes metabolic acidosis (removal of HCO3) to counteract the respiratory alkalosis that occurs at high altitudes

137

Bumetadine
Torsemide

Loop diuretics - inhibits Na/K/2Cl cotransporter

Also, in this class: Furosemide

138

Aliskiren

Direct renin inhibitor (blocks conversion of angiotensinogen to angiotensin I)

Contraindicates in patients taking ACE-I or ARBs.

139

oxybutamine, tolterodine, solifenacin

Reduce bladder spasms and urge incontenence

M3 antagonists -> decreases Ach activity

140

Guaifenesin

Expectorant - thins respiratory secretions, does not suppress cough reflex

141

What does N-acetylcysteine do in CF patients?

Mucolytic - loosens mucous plugs by disrupting disulfide bonds

142

Dextromethorphan

Antitussive
-antagonizes NMDA glutamate receptors
-synthetic codeine analog
-mild abuse potential
-may cause serotonin syndrome

143

Bosentan

endothelin receptor atangoinst -> decreases pulmonary vascular resistance -> vasodilation

treats pulmonary hypertenon

144

Epoprostenol
Iloprost

Prostacyclin analogs - PGI2

145

Albuterol - beta1 or beta2 agonist?

Beta2 agonist -> relaxes bronchial smooth muscle

146

Ipratoprium
Tiotropium

muscarinic antagonist
-used to prevent bronchoconsriction

147

Zileuton

5-lipoxygenase inhibitor -> decreased production of leukotrienes

148

Timeline of glucocorticoid function in the treatment of asthma

Takes a few weeks to work

The good thing is oral glucocorticoids do not have the same sfx profile as systemic glucocorticoids (weight gain, etc)

149

Side effect of albuterol for asthma treatment

Skeletal muscle tremors

150

Pramiprexole
Bromocriptine
Ropinirole

Dopamine receptor agonists
-First line parkinsons treatment
-Restless leg treatment

Bromocriptine - Ergot
Pramiprexole (DR-3), Ropinirole (DR-2) - Non-ergot

151

Amantadine

Increases dopamine release and decreases dopamine reuptake - Parkinson's treatment for motor symptoms
Also used as an antiviral against Influenza A and Rubella

152

Pralidoxime

Given to patients with organophosphate poisoning to reverse the Muscarinic and Nicotinic receptor overstimulation. Only works if given early after the exposure.

Mechanism: restores cholinesterases therefore they can breakdown Ach

153

Baclofen

GABA-B receptor antagonist

Used in the treatment of spasticity seen in MS

154

Treatment and cause of Neuroleptic Malignant Syndrome

Cause: overdose of antipsychotic medications
-diffuse muscle rigidity, high fever, hypertension, tachycardia, altered sensorium, rhabdomyolysis (elevated CK)

Treatment: Dantrolene

155

Treatment resistant Schizophrenia is treated with

Clozapine - second generation antipsychotic

156

Treatment for the behavioral and psychotic manifestations of delerium?

Low dose antipsychotics (Haloperiodol)

157

Majority of overdose deaths in the U.S. are caused by _

Opioids - heroin and prescription analgesics

158

Function of methadone

-Long half life
-Mu full agonist
-Good oral bioavailability
-Suppresses withdrawal and cravings

159

N-methyl-D-aspartate Receptor antagonist =

PCP (Phencyclidine)

160

TNF-alph inhibitors - used for OA or RA treatment?

RA

161

Treatment for dermatomyositis or polymyositis

steroids followed by long-term immunosuppressants (methotrexate)

162

Inhibition of xanthine oxidase by _a_, increases the concentration of the active metabolite of of _b_.

a = allopurinol
b = azathioprine

azathioprine -> 6MP -> active metabolite -> inhibition of purine synthesis

163

Tubocurrarine
Atracurium
Micacurium
Pancuronium
Vecuronium
Rocuronium

Competitive nondepolarizing antagonist of Nicotinic R
-compete with Ach for receptors
-to reverse blockade - cholinesterase inhibitors

164

Depolarizing neuromuscular blocking drug (1)

Succinylcholine
-Ach R agonist -> sustained depolarization prevents muscle contraction
-Phase I - prolonged depolarization, no antidote
-Phase II - reploarized but blocked, receptors are available but desensitized, cholinesterase is antidote
-sfx: hypercalcemia, hyperkalemia, malignant hyperthermia

165

HLAB57O1 allele corresponds with a negative reaction to _

Abacavir - stimulates a delayed type IV hypersensitivity reaction

166

Why is celecoxib better than other NSAIDs?

GI protective. Does not block COX1 therefore the Gastric mucosa protection (via prostaglandins) is maintained.

Good for people who have a history of peptic ulcer disease.

167

What hyperlipidemia drug has the sfx of gouty arthritis?

Niacin (B3) -> decreases the renal excretion of uric acid

168

Main side effect of sulfonylureas? (2)

-weight gain
-hypoglycemia - dangerous in the elderly

2nd generation glyburide and glimepiride are long acting - have a higher risk for hypoglycemia
2nd generation glipizide is short acting - has a slightly less risk for hypoglycemia

169

Is tamoxifen used to treat a post-menopausal woman with osteoporosis?

NO

Tamoxifen is a SERM - can provide some bone protection in post-menopausal women who are also fighting ER+ breast cancer but due to its bad effects on the endometrium, it is not given as a first line osteoporosis treatment to non-breast cancer women

-antagonist in breast
-agonist in bone
-partial agonist in endometrium

170

What drugs can be given to treat osteoporosis in post-menopausal women? (4)

Bisphosphonates - inhibit osteoclast activity

Raloxifene - SERM
-antagonist in breast
-agonist in bone

Denosumab - RANK-L monoclonal antibody

Teraparatide - PTH analog

171

Patient with grave’s disease on long term antithyroid medication presents with a fever + sore throat. What is the main sfx concern?

Main SFX of thionamides (propylthiouracil/methimazole) is agranulocytosis
-absolute neutrophil count is less than 500

172

Oral fidaxomicin

recurrent cases of C. diff infections

(part of the macrolide family)

173

Sulfasalazine

Combination drug of sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

First line for ulcerative colitis

174

Arsenic poisoning/overload treatment?

Dimercaprol chelation

175

Carcinoid treatment

-Octreotide - somatostatin analog
-Surgery

176

Treatment of lyme disease in pregnancy

Amoxicillin

Normal (non-pregnancy) treatment of Lyme Disease is doxycycline but this has teratogenic effects (teeth staining)

177

Mifepristone (RU-486)

-progesterone antagonist (->necrosis of the uterine decidua)
-glucocorticoid antagonist

178

Flutamide

competitive inhibitor at androgen receptors

used in the treatment of prostate cancer

179

Minodixil

Direct arteriolar vasodilator
Used for androgenic alopecia or severe refractory HTN

sfx: sympathetic activation and RAAS activation

180

Clot busting of an ST elevated MI

Fibrinolytic drugs - useful if given within 6 hours of onset

Two classes fibrin specific (attacks fibrin that is attached to a clot only) or non-fibrin specific (ex: Streptokinase)

SFX: may cause re-perfusion arrhythmia but these are usually benign

181

Argatroban
Lepirudin
Hirudin

Direct thrombin inhibitors (Factor II)

-Used to treat Heparin Induced Thrombocytopenia

182

Rasburicase

recombinant version of urate oxidase
(uric acid -> allantoin)

given to help prevent the hyperuricemia of tumor lysis syndrome

183

Antidote for cyanide poisoning

Inhaled amyl/sodium nitrite

Cyanide inhibits cytochrome c oxidase in the ETC.

Amyl nitrite oxidizes Hb Fe2+ -> Fe3+ (methemoglobin) which has a high affinity for cyanide and can bind it up so that the cyanide cannot bind to the ETC.

184

Triptans
-mechanism
-contraindications

serotonin (5HT 1b/1d) agonists)
-inhibit release of vasoactive peptides
-promote vasoconstriction
-block pain pathways in brainstem

should be avoided in patients with cardiac or cerebrovascular disease

185

Nitroprusside toxicity

Cyanide poisoning leading to sulfur depletion

-CN -> (-) ETC cytochrome oxidase
-altered mental status, seizures, cardovascular collapse, lactic acidosis, bright red blood
-CN metabolism occurs by transferring a sulfur group onto it
-Eventually sulfur stores are depleted, give sodium thiosulfate for antidote

186

Valproate teratogenicity

neural tube defects

187

Ramelteon

melatonin receptor agonist
-safe in older adults
-few side effects
-melatonin receptors are in the chiasmatic nucleus

188

Phenylephrine
Xylometazoline
Oxymetazoline

topical treatment of allergic rhinitis

alpha-agonists

189

Flumazenil

Antidote for Benzodiazepine, Nonbenzodiazepine hypnotic overdose
-competitive antagonist at GABA benzodiazepine receptor
-may precipitate seizures

190

Beta blocker overdose treatment?

Glucagon

191

Copper, Arsenic, Gold OD treatment?

Penacillamine

192

Methemoglobin toxicity treatment

Methylene blue, Vitamin C

193

Salicylates toxicity treatment

NaHCO3 + dialysis
-alkalinizes the urine

194

Aminocaproic acid is used for?

tPA, Streptokinase, Urokinase reversal

195

Warfarin reversal?

-Vitamin K - delayed effect
-Fresh frozen plasma - immediate

196

Timolol acts where when treating open-angle glaucoma?

Acts on the the ciliary epithelium.
-nonselective beta-blocker
-decreases aqueous humor production

197

Acetazolamide works via what mechanism to treat open-angle glaucoma?

Decreases aqueous humor production from the ciliary epithelium

198

Lantanoprost, Travoprost work via what mechanism to treat open-angle glaucoma?

Prostaglandin agonists (PG2-alpha)

Increase aqueous humor outflow and therefore decreases intraocular pressure

199

Pilocarpine, Carbachol work via what mechanism to treat open-angle glaucoma?

(direct) Cholinomemetics

Increase aqueous humor outflow via contraction of ciliar muscles and opening of trabecular meshwork, therefore decreases intraocular pressure

sfx: miosis, cyclospasm

200

Brimonidine's mechanisim for treatment of open-angle glaucoma

alpha-2 agonist
-acts at ciliary body - decreases aqueous humor synthesis

201

IL-2 can be used as treatment for what 2 cancers?

-Renal cell carcinoma
-Melanoma

202

Infliximab

-chimeric human/mouse antibody to TNF-alpha
-used in treatment of RA, ankylosing spondylitis, Crohn's disease
-anti-TNF-alpha

203

Gabapentin

Inhibits (active) VG Ca channels
-GABA analogue
-used to treat painful diabetic neuropathy, fibromyalgia, post-herpetic neuralgia, simple seizures
-sfx: ataxia, confusion

204

First line treatment for trigeminal neuralgia

Carbamazepine = increaes Na channel inactivation
-sfx: myelosuppression/agranulocytosis

205

Etanercept

recombinant TNF receptor fusion protein (anti-TNF-alpha)

206

How does lactulose work?

acidifies the contents of the GI tract -> NH3 diffuses into GI and turns into NH4+ and now gets trapped

207

Mechanism: Inhibition of peptidoglycan synthesis via the blockade of transpeptidation enzymes
Use: to prevent PID

What drug?

Ceftriaxone

transpeptidation enzymes = PBPs

208

Cyclosporine

Calcineurin inhibitor - blocks IL-2 transcription
-binds to cyclophilin
-used for transplant rejection prophylaxis, psoriasis, RA
-sfx: nephrotoxic (dose dependent)

209

Tacrolimus (FK506)

Calcineurin inhibitor - blocks IL-2 transcription
-binds to FKBP
-used for transplant rejection prophylaxis
-sfx: nephrotoxic

210

Metoclopramide
mechanism?
contraindications?

D2 receptor antagonist
-prokinetic agent, does not influence colonic transport time
-contraindicated in parkison's patients or patients with small bowel obstruction

211

Calcipotriol

Vitamin D analog used to treat psoriasis
-topical

212

Acitretin

Retinoid
-used to treat psoriasis, acne, photoaging, some skin neoplasms
-this is preferred for psoriasis
-teratogenic - should not conceive for up to 3 years after stopping

213

Orlistat

Inhibits pancreatic and gastric lipase -> decreases breakdown and absorption of dietary fats
Used for weightloss
sfx: diarrhea, steatorrhea,

214

danazol

androgen used to suppress FSH and LH release by the pituitary

215

Treatment of sexual dysfunction caused by mumps induced orchitis

Testosterone

orchitis -> leydig cell atrophy -> decreased production of T -> sexual dysfunction

216

Paclitaxel coated stent does what?

causes cell cycle arrest in the M phase -> inhibits cellular division -> prevents stent re-stenosis by preventing intimal hyperplasia

217

patient on furosemide who experiences excessive urination and occasional weakness and cramps

Furosemide sfx
-increased dilute urine production
-hypokalemia (and contraction metabolic alkalosis)

218

Vemurafenib

BRAF kinase inhibitor
-used to treat metastatic or unresectable melanoma
-specific for BRAF V600E

219

direct arterial vasodilators (2)
-sfx

-Hydralazine
-Minodixil

sfx:
-reflex sympathetic and RAAS activation -> increases Na and fluid retention