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Pharmacology Flashcards

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1
Q

Predicts the RATE of movement of molecules

A

Fick’s law of diffusion

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2
Q

Increase lipid solubility means increased absorption

A

True

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3
Q

Increased aqueous solubility means increased clearance

A

True

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4
Q

Pharmacokinetics is the?

A

Interaction of the body to the drug

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5
Q

Pharmacodynamics is the?

A

Interaction of the drug to the body

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6
Q

Relationshipd between ph and charge of molecule is predicted by?

A

Henderson-hasselbach equation

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7
Q

Which drugs are not given via IM due to the risk of causing hematomas?

A

Anticoagulants

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8
Q

Which route has partial bypass?

A

Rectal route cause the superior rectal vein absorptive n leads to bypass

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9
Q

Slowest route of drug administration

A

Topical route (local effect)

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10
Q

What route of administration undergoes first pass effect?

A

Oral route

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11
Q

Drug distribution is dependent on 4 factors which are?

A

Blood flow
Organ size
Protein binding
Solubility

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12
Q

Metabolic fate of the Drug?

A

A CITVATED
T ERMINATED
E LIMNATED

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13
Q

What Is the mode of elimination for drugs that are not metabolized?

A

Excretion

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14
Q

Rate of elimination is PROPORTIONATE to the CONCENTRATION

A

Rate of elimination decreases by 50% everytime

FIRST ORDER ELIMINNATION (most common)

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15
Q

Rate of elimination is CONSTANT regardless of concentration

A

Zero-order elimination

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16
Q

Concentration decreases linearly overtime

A

Zero-order elimination

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17
Q

What drugs display zero order kinetics?

A

WHAT PET (TOL BUTA ka naa sa sIDE o?)

Warfarin
Heparin
Aspirin
Tolbutamide
Phenytoin
Ethanol
Theophylline
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18
Q

Properties of a receptor

A

PMS

Most are PROTEINS
must be MODIFIED
must be SELCTIVE

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19
Q

_______ is the concentration required to bind 50% of the receptors

A

Kd

Smaller kd greater affinity

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20
Q

Concentration of a drug wherein half of the maximal effect is achieved

A

EC50

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21
Q

Maximal effect of a drug is defined by

A

EMAX

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22
Q

Maximal number of receptors bound are called

A

BMax

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23
Q

How do we compute for a THERAPEUTIC INDEX?

A

TI = TD50 / ED50

Higher TI the safer the drug

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24
Q

What is the therapeutic window?

A

It is the dose RANGE between the MEC and MTC

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25
Drugs that display tachyphylaxis
MED Loves to watch CNN in HD M etoclopramide E phedrine D obutamine L SD C alcitonin N itroglycerin N icotine H ydralazine D esmopressin
26
Most important pharmacokinetic parameter to be considered in defining a rational study state during dosage regimen
Clearance
27
Steady state is achieved in how many half lives?
4-5 half lives
28
Condition where administration is equal to elimination
Steady state - amt of drug in the body does not change
29
What are phase I reActions?
HORDe Hydrolysis Oxidation Reduction Deamination
30
Drugs that are cytochrome P450 inducers
ETHel Booba takes PHEN-PHEN and Refuses Greasy Carb Shakes ``` Ethanol Barbiturates except secobarbital Phenytoin Phenobarbital Rifampicin Griseofulvin Carbamazepine Smoking and st.john's wort ```
31
Cytochrome p450 inhibitors
GRACE IS QVACK ``` Grapefruit juice Ritonavir Amiodarone Cimetidine Erythromycin ``` Isoniazid Sulfonamides ``` Quinidine Valproic acid Allopurinol Chloramphenicol/chlorpromazine Ketoconazole ```
32
Suicide inhibitors
PASS PTU Allopurinol Spironolactone Secobarbital
33
Teratogenic effects ``` ACE INHIBITORS:___________ Antiepileptic drug:__________ Phenytoin:__________________ OHA: _______________________ Barbiturates:_______________ ```
``` ACE INHIBITORS: fetal renal damage Antiepileptic drug: neural tube defects Phenytoin: FETAL HYDANTOIN SYNDROME OHA: neonatal hypoglycemia Barbiturates: neonatal dependence ```
34
DIETHYLSTILBESTROL (DES) if given in a pregnant patient can cause?
VAGINAL CLEAR CELL ADENOCARCINOMA
35
Teratogenic effects ``` Ethanol:____ Lithium:____ Isotretinoin:_____ Iodide:_______ Misoprostol:______ ```
``` Ethanol: fetal alcohol syndrome Lithium: ebstein's anomaly Isotretinoin: caraniofacial malformations Iodide: congenital hypothyroidism Misoprostol: mobius sequence ```
36
Teratogenic effects ``` Penicillamine:_____ Thalidomide:______ Streptomycin:_____ Methimazole:______ Sulfonamide:______ Flourquinolones:_______ Smoking:____ Tetracycline:______ ```
Teratogenic effects ``` Penicillamine:cutis laxo Thalidomide: phocomelia Streptomycin: ototoxicity Methimazole: aplasia cutis congenita Sulfonamide: kernicterus Flourquinolones: cartilage damage Smoking:IUGR Tetracycline: tooth discoloration ```
37
Induction of changes in the genetic material
Mutagenesis
38
Induction of developmental defects in the somatic tissues
Teratogenesis
39
An ANS drug used as a miotic during ocular surgery
Acetylcholine
40
ANS DRUG used in Bladder and Bowel atony?
BETANECHOL SE: Diarrhea and urinary urgency
41
ANS drug that increases aqueous humor outflow and increased salivation
Pilocarpine
42
Drug used for glaucoma, sjogren syndrome and sicca syndrome
Pilocarpine SE: miosis, bov and increased salivation
43
Triad of sjogren syndrome
Xerostomia, xerophthalmia and rheumatoid arthritis | Dry
44
Drug used for smoking cessation activating autonomic post ganglionic neurons
Nicotine
45
Drug used to test Myasthenia Gravis in TENSILON TEST. It differentiates cholinergic crisis and myasthenic crisis.
EDROPHONIUM DOA: 5-15 minutes
46
A cholinomimetic that is used to TREAT Myasthenia Gravis
NEOSTIGMINE ALT : Pyridostigmine
47
Cholinomimetic drugs for ALZHEIMER'S DISEASE
Rivastigmine - available as a transdermal patch Galantamine Donepezil --- combined with MEMANTINE (NMDA receptor blocker) for ALZHEIMER'S dementia
48
Signs and symptoms of ORGANOPHOSPHATE POISONING
DUMBBELSS ``` diarrhea urination miosis Bronchospasm Bradycardia Excitation of skeletal muscles and CNS Lacrimation Salivation Sweating ```
49
What do you give in a patient with organophosphate poisoning?
Atropine - antidote DOC Notable SE: hyperthermia
50
Drug for organophosphate poisoning that should be given 6-8 hours after exposure to be rendered effective
PRALIDOXIME - antidote for early stage | This binds to phosphorus of organophosphate regenerating active acetylcholinesterase
51
Prototype nonselective muscarinic blocker
Atropine
52
Anticholinergics used for PARKINSON'S disease that reduces tremors
Muscarinic antagonists Try Benz BEEP BEEP trihexyphenidyl Benztropine BIPERIDEN
53
Ipratropium MOA
Its a muscarinic receptor antagonist that blocks receptors in bronchial smooth muscles preventing bronchoconstriction USES: Acute asthma and COPD
54
Bronchodilator of choice for patients with COPD AND HEART DISEASE
Ipratropium bromide (less likely to cause arrhythmias and tachycardia)
55
Transdermal patch used for motion sickness
SCOPOLAMINE SE: drowsiness, BOV, dry eyes, dry mouth, urinary retention and constipation
56
A muscarinic antagonist used in IBS
Dicyclomine / dicycloverine
57
A cholinergic antagonist used for urge incontinence by reducing detrusor muscle tone
Oxybutynin patch
58
Signs and symptoms of atropine toxicity
``` Hot as a hare (hyperthermia) Dry as a bone (decreased secretion) Red as a beet (cutaneous vasodilation) Blind as a bat (blurred vision) Mad as a hatter (CNS toxicity) ```
59
Contraindications to muscarinic blockers
ABCs of muscarinic receptor use Acute angle closure glaucoma Benign prostatic hyperplasia Cautious use in infants
60
Only depolarizing neuromuscular blocker
Succinylcholine
61
DOC for anaphylaxis
Epinephrine
62
If epinephrine is given n a pregnant patient, the OB should watch out for?
Fetal anoxia
63
Given in neurogenic shock and the last resort for caridiogenic shock
Norepinephrine
64
Epinephrine can cause hyperglycemia or hypoglycemia?
Hyperglycemia
65
Toxic effects of norepinephrine
RATEE! ``` Reflex bradycardia Arrhythmias Tissue necrosis Excessive increase in BP Extreme vasospasm ```
66
Dose dependent action of dopamine
Low dose (1-5 mcg/kg/min) - D1 receptors increasing renal blood flow and urine output Medium dose (5-15 mcg/kg/min) - B1 receptors increasing heart rate and contractility High dose (>15 mcg/kg/min) - A receptors causing vasoconstriction thus increasing blood pressure
67
This is a synthetic catecholamine that is a beta nonselective sympathomimetic used in ASTHMA
Isoproterenol
68
An Alpha 1 selective sympathomimetic used for nasal decongestion
Phenylephrine Notable SE: piloerction
69
Patient took 100 tablets of a sympathomimetic nasal decongestant. What can be given as antidote?
Phentolamine is the DOC for alpha 1 agonist overdose
70
Patient had rebound hypertension after abrupt withdrawal of clonidine. What can be given?
Phentolamine
71
An alpha 2 selective agonist given in opoid withdrawal?
Clonidine *also given in cancer pain and hpn
72
Methyldopa is an alpha 2 agonist that is given in gestational hypertension and preeclampsia. What is a notable side effect of this drug?
Sedation and HEMOLYTIC ANEMIA (positive coomb's test)
73
Alpa 2 agonist that decreases SECRETION of aqueous humor used in GLAUCOMA
Apraclonidine (C) Brimonide (B) SE: hyperemia, eye discomfort, pruritus,BOV and dry mouth
74
Beta 1 agonist used in cardiac stress testing
DOBUTAMINE
75
Drug of choice for acute asthma attack
Beta 2 selective agonist causing bronchodilation Albuterol/ Salbutamol
76
Uses of ISOXUPRINE
Tocolysis for preterm labor | Vasodilator in Raynaud's phenomenon
77
Beta 2 agonist drugs
``` S albutamol T erbutaline A lbuterol I soxuprine R itodrine ``` *TIR used for tocolysis
78
A sympathomimetic drug that causes appetite suppression and nasal vasoconstriction
Phenylpropanolamine Tox: HEMORRHAGIC STROKE
79
An alpha nonselective antagonist used in the treatment of PHEOCROMOCYTOMA by IRREVERSIBLE blockage of alpha adrenergic receptors
PHENOXYBENZAMINE
80
An alpha nonselective antagonist used in the treatment of PHEOCROMOCYTOMA by REVERSIBLE blockage of alpha adrenergic receptors
Phentolamine, tolazoline
81
Uses of PHENTOLAMINE
Rebound hypertension Antidote for alpha 1 agonist overdose pheochromocytoma (presurgical)
82
Used for benign prostatic hyperplasia
Tamsulosin which is an alpha 1 selective antagonist that is most selective for prostatic smooth muscles Other drugs: pazosin, terazosin "osin"
83
Pharmacologic advantage of a1 selectivity
Reflex tachycardia is less common and less severe
84
Beta blockers with intrinsic sympathomimetic activity
ISA PA PINDOLOL Acebutolol
85
Beta blocker with longest half life
NADOLOL =NAsa DOLO
86
Beta blocker with shortest half life
ESMOLOL = "esmol"
87
Beta blocker that treats Supraventricular tachycardia
Esmolol
88
Target BP of patients with no comorbidities
<140/90 JNC8
89
Target BP of patients with DM or CKD
<130/80
90
First line drug in a pregnant woman with hypertension
Methyldopa
91
2nd line treatment in a pregnant patient with hypertension
Labetalol
92
3 acceptable drugs that can be given in pregnancy for hpn control
Methydopa Labetalol Nifedipine
93
First line drug for hypertension
Thiazide diuretics
94
MOA of hyDroChloroThiazide
Inhibit Na/Cl transporter in Distal Collecting tubules causing diuresis
95
MOA of furosemide
This is a loop diuretic what inhibits NA/K/Cl transporter in thick ascending limb of loop of Henle *can cause ototoxicity
96
Patient indicated for a loop diuretic with sulfa allergy. What can be given?
Ethacrynic acid
97
Diuretics can cause what acid base imbalance?
Hypokalemic metabolic alkalosis
98
Drugs used to control blood pressure in patients with PHEOCHROMOCYTOMA
Phenoxybenzamine PHENTOLAMINE Labetalol
99
Medications that may cause drug induced lupus
HIPP Hydralazine Isoniazid Procainamide Penicillamine
100
Treatment for alopecia
Minoxidil
101
Patient given a antihypertensive drug and developed pretibial edema. What drug could have been given?
Calcium channel blockers
102
benefits of ACE inhibitors and ARBs
HPN - decrease BP Heart failure - slows ventricular remodeling and increases survival Diabetic nephropathy - delays progression by decreasing albumin excretion
103
Most notable side effects of ACE inhibitors
Cough Taste disturbance Angioedema
104
Why do ARBs and ACE inhibitors cause hyperkalemia?
Decrease in aldosterone levels leads to potassium retention
105
Antidote for cyanide poisoning?
Lily cyanide kit Inhaled AMYL NITRATE IV SODIUM NITRITE IV SODIUM THIOSULFATE
106
Why do patients taking nitrates complain of throbbing headache?
Due to meningeal blood vessel dilation
107
Drugs that cause gingival hyperplasia
NapaCa Pangit ng gingiVa mo Nifedipine Cyclosporine Phenytoin Verapramil
108
Drugs that are metabolism modifiers
Trimetazidne is fatty (beta oxidation) Ranolazine is salty (na-ca rxchange) Ivabradine is FUNNY (funny Na current in SA node)
109
Drugs with Narrow therapeutic index
WALA C Phen-phen VasTeD Warfarin Aminoglycosides Lithium Amphotericin B Carbamazepine Phenobarbital Phenytoin Vancomycin Theophylline Digixin
110
How do you treat digitalis toxicity?
Correct k and magnesium deficiency Antiarrythmic drugs : DOC IS LIDOCAINE Digoxin antibodies : digibind
111
First line of therapy for bith systolic and diastolic failure
FUROSEMIDE
112
What drugs have shown to improve survival in cases of heart failure?
ABS improve survival ;) ACE INHIBITORS BETA BLOCKERS SPINOROLACTONE
113
What improves the quality of life?
Digitalis | Furosemide
114
Effects of class 1 antiarrythmics on action potential duration
Class 1a - "Ayyyee" = prolonges AP duration Class 1b - "b" = shortens AP duration Class 1c - no effect
115
Class IA antiarrythmics
Quinidine Procainamide Disopyramide
116
Class Ia antiarrythmic than can cause ITP AND TORASADES
Quinidine
117
Antidote for class IA antiarrythmics?
Sodium lactate
118
DOC for ventricular arrhythmias post MI
Lidocaine or any class I b antiarrythmics
119
Drugs that can cause agranulocytosis
CCCAPPIT Me! ``` Clozapine Co-trimoxazole Colchicine Amine pyrine Phenylbutazone PTU Indomethacin Tocainide Methimazole ```
120
Class I C antiarrythmics are contraindicated in?
POST MI PATIENTS WITH ARRHYTHMIAS propafenone, flecainide, encainide
121
DOC antiarrythmics for WPW
Procainamide and amiodarone
122
Used for refractory arrthmias
Class IC Propafenone Flecainide Encainide
123
Beta blocker with low lipid solubility
ATENOLOL
124
Beta blockers with Combined alpha and beta blockade
Carvedilol and labetalol
125
Beta blockers Lacking local anesthetic effect
Timolol
126
Beta blockers that are partial agonist
PINDOLOL AND ACEBUTOLOL
127
Antiarrythmics with a hallmark of prolongation of action potential duration
Class 3
128
Treatment and prophylaxis for atrial fibrillation
Class 3 antiarrythmics DofeTILIde IbuTILIde
129
Amiodarone toxicity signs and symptoms
``` Corneal deposits Skin deposits Thyroid dysfunction Pulmonary fibrosis Parestheisa Tremors ```
130
DOC for paroxysmal Supraventricular tachycardia
Adenosine
131
Major site for sodium chloride and sodium bicarbonate reabsorption
proximal convoluted tubules (60-70%) Also site of uric acid transport and site of action of carbonic anhydrase
132
Site of action for calcium and magnesium reabsorption
Thick ascending loop of henle Also site of loop diuretics
133
Loop diuretics toxicity
OH DANGS! Ototoxicity Hypokalemia ``` Dehydration Alkalosis Nephritis Gout Sulfa allergy ```
134
Side effects of thiazide diuretics
Hyper GLUC HYPERGLYCEMIA HYPERLIPIDEMIA HYPERURICEMIA HYPERCALCEMIA
135
Site of action of thiazide diuretics?
Distal convoluted tubules
136
Site of action for potassium sparing diuretic
Cortical collecting duct | -last tubular site for sodium reabsorption and potassium excretion
137
Primary site for urine acidification
Cortical collecting duct
138
Drugs that can cause gynecomastia
DACKS ``` Digoxin Alcohol Cimetidine Ketoconazole Spironolactone ```
139
Site of action of mannitol
Osmotic diuretics act on the proximal tubule, descending limb of loop of Henle and collecting ducts
140
Site of action of ADH agonist
Vasopressin acts on the collecting tubule
141
DOC for lowering LDL cholesterol
Statins
142
DOC for high triglycerides and VLDL
Fibrates
143
EZETEMIBE +STATIN =?
Hepatotoxicity
144
STATIN + FIBRATES =?
rhabdomyolysis
145
If statins are to be given with resins how will the drugs be taken?
Statins should be given one hour before or 4 hours after resin intake
146
Why are statins given in patients with CAD?
For stabilization of atherosclerotic plaques
147
Fibrates + Bile resins =
Cholesterol stones
148
CI in cholestyramine
Patients with HIGH TG and Diverticulitis
149
Common SE of bile acid resins like cholestyramine
CONSTIPATION BLOATING GRITTY TASTE STEATORRHEA
150
Most effective drug to increase HDL levels
NIACIN
151
Drugs that causes FLUSHING
VANC Vancomycin Adenosine Niacin Calcium channel blockers
152
When giving NIACIN what can be given as pre treatment to avoid flushing?
ASPIRIN
153
Endogenous molecules with powerful pharmacologic effects
Autacoids | Histamine and serotonin are important amine autacoids
154
Triple response of Lewis
Wheal flush and flare
155
Cimetidine notable side effects
Gynecomastia and CYP450 inhibitor | Decrease hepatic blood flow
156
Drug of choice for ACUTE MIGRANE
Sumatriptan-5Ht1D agonist NSE: coronary vasospasm and chest pain
157
Indication for Ondansteron given in cancer patients and post surgery patients
For chemotherapy and post operative vomiting 5HT3 antagonist
158
Indications for MISOPROSTOL
NSAID INDUCED BPUD and Abortifacient
159
Indications for use of ALPROSTADIL
For maintenance of a PDA | For ERECTILE DYSUNCTION (injected in the cavernosa)
160
A Prostaglandin E2 analog given for induction of labor and cervical ripening
Dinoprostone / Sulprostone
161
A Prostaglandin F2 analog that is given for postpartum bleeding
BUTCH BIMATORPOST UNOPROSTONE TRAVOPROST CARBOPROST
162
Prostaglandin I2 analog that reduces platelet aggregation in dialysis machines and for pulmonary hypertension
Epoprostenol
163
Prostaglandin F2 analog sed to increase outflow of aqueous humor in glaucoma
Latanoprost SE: change eye color
164
Indications for SILDENAFIL, a PDE5 inhibitor
PRE! Pulmonary arterial hypertension Reynaud's phenomenon Erectile dysfunction
165
Doc in acute asthma attacks
SABA - PAST Procaterol Albuterol Salbutamol Terbutaline
166
DOC in asthma prohylaxis
Corticosteroids Fluticasone Mometasone Budesonide Beclomethasone
167
Muscarinic antagonist used in ACUTE ASTHMA AND COPD
Ipratropium
168
Prophylactic against NOCTURNAL ASTHMA ATTACKS
Aminophyline and theophylline
169
Antidote for overdose of theophylline
Beta blockers
170
Mast cell stabilizer for asthma prophylaxis and ophthalmic allergies
Cromolyn
171
DOC for prophylaxis of severe , refractory asthma not responsive to all other drugs
Omalizumab - anti IgE antibody
172
Iron supplement with greatest iron content
Ferrous fumarate
173
Chronic Iron overdose may lead to?
Hemochromatosis-> organ failure ->death
174
Acute Iron intoxication can be chelated by?
DEFEROXAMINE *intox common in children from accidental ingestion
175
Hemochromatosis triad
CIRRHOISIS DIABETES MELLITUS SKIN PIGMENTATION
176
Neurologic manifestations of vitamin B12 deficiency
Ataxia Impaired position and vibratory sense Spasticity
177
Toxic dose of ASA? Lethal dose?
Toxic at 150mg/kg | Lethal at 500mg/kg
178
Triad for ASPIRIN HYPERSENSITIVITY
SAMTER TRIAD asthma Aspirin sensitivity Nasal polyps
179
What is the expected metabolic abnormality in salicylate poisoning?
RESPIRATORY ALKALOSIS WITH HIGH ANION GAP METABOLIC ACIDOSIS (HAGMA)
180
Difference between adults and children in presentation of ASA intoxication
Adults = mixed acid base disorder (respi alka with HAGMA) Children= will have HAGMA purely
181
A GIIa/IIIa inhibitor used during PCI and adjunct to thrombolysis. This also prevents VESSEL RESTENOSIS AND REINFARCTION
Abciximab
182
Heparin ``` Site of axn? Route? MOA? Monitoring? Antidote? ```
``` Site of axn? Blood Route? Parenteral MOA? Activates ANTITHROMBIN III Monitoring? PTT Antidote? PROTAMINE ```
183
Warfarin ``` Site of axn? Route? MOA? Monitoring? Antidote? ```
``` Site of axn? LIVER Route? ORAL MOA? impairs post-translational modifications of FACTORS 2,7,9,10 Monitoring? PT Antidote? Vitamin K , FFP ```
184
Lab tests to assess the extrinsic and intrinsic coagulation pathways
PiTT and PeT PiTT for intrinsic PeT for extrinsic
185
DOC for anticoagulation in pregnancy
Heparin
186
Anticoagulant of choice for patients with HEPARIN-INDUCED THROMBOCYTOPENIA
Lepirudin Argatroban Desirudin DABIGATRAN (po)
187
Given for DABIGATRAN toxicity
IDARUCIZUMAB
188
MOA of APixaban / Rovaroxaban
Oral direct factor Xa inhibitor in the final common pathway Use: prevention of VTE and stroke in AF
189
This drug inhibits VIT K EPOXIDE REDUCTASE and is used for chronic anticoagulation
WARFARIN NSE: warfarin induced skin necrosis for pts with protein C and S deficiency
190
Initial anticoagulatant of choice in patient management?
Heparin
191
Antidote for overdose of THROMBOLYTIC AGENTS such as streptokinase, urokinase and alteplase
AMINOCAPROIC ACID
192
A drug that can increase factor VIII activity of patients with vonWillebrand disease
Desmopressin / vasopressin
193
What are the features of tricyclic antidepressant overdose?
3 Cs of TCA coma Convulsions Cardiotoxicity
194
Symptoms of SEROTONIN syndrome
FAT CHD ``` Fever Agitation Tremors Clonus Hyperreflexia Diaphoresis ```
195
Triad of OPIOD overdose
PCR Pupillary constriction Comatose state Respiratory depression
196
What drug of abuse can lead to a dream-like state, RED conjunctiva, tachycardia and dry mouth?
Marijuana
197
What drug of abuse can cause psychedelic effects, mind raveling effects and bad trips?
LSD
198
Most dangerous hallucinogen with psychomimetic effects
Phencyclidine
199
Ecstasy can cause?
Sexual enhancement and hyponatremia
200
Amphetamine can cause?
Euphoria, sleeplessness and self confidence
201
Can cause crack lung and mydriasis
Cocaine
202
Patient receiving cyclophosphamide should also be given
MESNA
203
Patient given with methotrexate should also be given
Leucoverin
204
Patients given with isoniazid should also be given
Pyridoxine
205
Alcoholics should take _____ as supplements
Thiamine
206
Dissociative amnesia is effectively achieved by combination of
Ketamine Nitrous oxide Fentanyl

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