Spring 2013 Pharm review for Reddy Flashcards
(141 cards)
1
Q
Name the Excitatory NT in the CNS
A
Glutamate, Substance P
- dopamine, serotonin, NE, Ach depending on the receptor involved
2
Q
Name the Inhibitory NT in the CNS
A
GABA, Enkephalins, Glycine (SC)
- dopamine, serotonin, NE, Ach depending on the receptor involved
3
Q
What are the four dopaminergic pathways in the brain
A
- Nigrostriatal System
- Mesolimbic System
- Mesocortical System
- Tuberinfidibulum System
4
Q
The Nigrostriatal system regulates
A
movement
5
Q
The Mesolimbic system regulates
A
emotion, love
6
Q
The Mesocortical system regulates
A
cognition, motivation
7
Q
The Tuberinfindibulum system regulates
A
pituitary
8
Q
Dopamine, NE are both released at nerve terminals, How is the action of these NT terminated
A
- Reuptake (about 90%)
- MAO-metabolism
- COMT-metabolism
9
Q
Name three drug strategies to increase the amount of NT
A
- Inhibit reuptake
- Inhibit MAO
- Inhibit COMT
10
Q
Name two examples of drugs used to inhibit NT reuptake
A
cocaine
TCA- Imipramine
11
Q
Name a drug used to inhibit MAO
A
Selegiline
*used in alzheimer’s dx to inhibit MAO B
12
Q
Alzheimer’s is characterized by loss of many neurons, especially
A
cholinergic
*Too little Ach
13
Q
Alzheimer’s results in impairment of
A
memory and cognitive functions
14
Q
Name a drug used to increase AcH in the brain
A
Donepezil
15
Q
What NT is implicated in destruction of cholinergic nerve death
A
Glutamate
16
Q
What drug is used to address glutamates effect on patient’s with alzheimers
A
Memantine
17
Q
Attention-deficit/Hyperactivity disorder is characterized by
A
Persistent pattern of frequent, severe inattention and/or hyperactivity
18
Q
What drugs are most frequently used to tx ADHD
A
stimulants
19
Q
What secondary drug is used to tx ADHD
A
nonstimulant
- Atomoxetine- given to patient’s refractory to stimulant therapy
20
Q
Atomoxetine is a
A
selective NE reuptake inhibitor
21
Q
Name two stimulants used to tx ADHD
A
methylphenidate (ritalin)
amphetamine (adderrall)
- both work in RAS
22
Q
methylphenidate’s MOA includes
A
blocking reuptake of dopamine in CNS
23
Q
amphetamine’s MOA includes
A
increases release of dopamine & NE
24
Q
Name the three main drug categories used to tx anxiety
A
- Benzodiazepine
- Non-Benzo Benzos
- Buspirone
25
Benzos agonize what receptor
GABA
* opens chloride channels
26
Non-Benzo benzos agonize what receptor
GABA
27
Name some benzos
"zepam" or "zolam"
Diazepam, Lorazepam, Midazolam
28
Buspirone partially agonizes what serotonin subtype
5-HT 1A
29
What is the difference b/t Buspirone and Benzos
Benzos onset immediate
Buspirone onset takes weeks
Buspirone increases risk for seizures, increased HR (stimulant)
30
Non-Benzo benzo's major difference from Benzos is that
it is less addictive
31
Name three major non-benzo benzos
Zolpidem
Zaleplon
Eszopiclone
32
What is the GABA antagonist used to treat overdose of benzos and non-benzo benzos
Flumazemil
33
Name a drug used to inhibit COMT
****capone
34
What two drugs help with insomnia
Melatonin (released by pineal gland)
| RaMELTeon
35
Parkinson's is characterized by
too little dopamine in the nigrostriatial pathway
36
What 1st line drug combination is used to tx parkinsons
levadopa and carbidopa
37
Why is carbidopa added to L-dopa therapy
to inhibit L-aa carboxylase from converting L-dopa to Dopamine in the periphery
38
What is the on-off phenomenon seen with parkinson treatment with L-dopa/carbidopa
normal movement followed by resting tremors, rigidity, bradykinesia, etc
* caused by continued loss of dopamine neurons
39
Name three other strategies besides replacing dopamine used to tx parkinsons
block metabolism of dopamine
dopamine agonism
anti-Ach drugs
40
name two drugs used to block dopamine metabolism via inhibition of COMT
talCAPONE
| entaCAPONE
41
name a drug used to block dopamine metabolism via inhibition of MAO
selegiline (MAO B)
42
Name a dopamine agonist used to tx parkinsons
Bromocriptine
43
Name an anti-cholinergic drug used to tx parkinsons
benztropine
44
Huntington's disease is characterized by loss of
GABA neurons- loss of inhibition
*Too much movement (chorea)
45
What is the tx strategy for Huntington's disease
control symptoms, support therapy
46
List the four primary drugs used to tx epilepsy
Valproic acid
Ethosuximide
Phenytoin
Carbamazepine
47
Name the generalized seizures
Generalized tonic-clonic (grandMal)
Absence (PetitMal)-originating in occipital area
Myoclonic (muscle involvement)
48
Name two drugs used to treat generalized tonic-clonic seizures
carbamazepine
| valproic acid
49
Name two drugs used to tx absence seizures
Ethosuximide-blocks ca2+ current in thalmus
| valproic acid
50
Name the three partial seizures
simple partial - No LOC
complex partial - LOC
partial seizures with secondary generalization
51
Name a drug used to tx all three partial seizures
carbamazepine
52
What is the MOA of most antiepileptic drugs
blocking or hyperpolarizing ion channels
53
What two antiepileptics work by blocking sodium channels
Carbamazepine
| Phenytoin
54
What two antiepileptics work by blocking calcium channels
Ethosuximide
| Valproic acid
55
What four antiepileptics work by hyperpolorizing neurons
Carbamazepine
Benozs
Phenobarbital
Valproic Acid
56
Name two other strategies used to tx epilepsy
enhancement of GABA
| reduction of excitatory NT
57
Name four SSRI used to tx depression
Fluoxetine
Sertaline
Citalopram
Escitalopram
58
Name four TCAs used to tx depression
Amytryptiline, Nortryptiline
| Imipramine, Clomipramine
59
TCAs MOA is
nonspecific blockers of serotonin and NE
60
Why is SNRI considered better than TCAs even though they both target the same transporters
SNRIs have no SE common to TCAs
61
What are the SE of TCA administration
Anticholinergic- urinary retention, dry eyes, constipation, dry mouth
Antihistamine- sedation
alpha 1 blockade-dizziness, orthostatic hypotension
62
What are cholinergic AE
DUMB BELSS
```
D-Diarrhea
U-Urination
M-Miosis
B-Bradycardia
E-Excitation (CNS & Skeletal muscles)
L-Lacrimation
S-Salivation
S-Sweating
```
63
Schizophrenia is characterized by
too much dopamine in the mesolimbic system
64
List the Positive symptoms of schizophrenia
Hallucination
Delusions
Bizzare behavior
65
List the Negative symptoms of schizophrenia
Affective flattening - dec. in emotional expression
Alogia- decr. in fluency in speech
Avolition- decr. in goal-oriented behavior
66
What are the strategies used to tx schizophrenia
Block dopamine receptors
Block Acetylcholine receptors
Block alpha receptors
Block Histamine receptors
67
What are the AE associatesd with tx of schizophrenia
face/neck muscle spasms (tx with antichol)>>Akathisia (motor restlessness)>>>parkinsonism>>>>tardive dyskinesia
68
Name two "typical" antipsychotics
Chlorpromazine
Haloperidol
* Possess more extrapyramidal SE than atypical
* Strictly blocks D2 receptors
69
Name two "atypical" antipsychotics
Clozapine
| Risperidone
70
What is the advantange of using atypical antipsychotics
D2 and 5 HT blockers
Atypicals block the inhibitory 5-HT 2A (presynaptically) in the nigrostriatal pathway and mesocortical pathways yielding less extrapyramidal SE and improvement of negative symptoms
71
How does adding 5-HT antagonism improve the antipsychotics
By reducing the SE- mostly motor and endocrine
72
What is Neuroleptic Malignant Syndrome
is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs
* dopaminergic system in hypothalamus is disturbed. Loss of ability to control temperature
73
What are symptoms associated with NMS
```
F – Fever
A – Autonomic instability
L – Leukocytosis
T – Tremor
E – Elevated enzymes (elevated CPK)
R – Rigidity of muscles
```
74
How is NMS treated
Supportive care
Dantrolene- Skeletal muscle relaxant
Bromocriptine-DA receptor agonist
75
What is Atomoxetine
Non-stimulant drug used to tx ADHD that blocks NE reuptake and is given to patients who cannot tolerate stimulants
76
What is Benztropine
Benzatropine is a centrally acting anticholinergic/antihistamine agent used in the tx of Parkinsons
77
What is Entacapone
COMT inhibitor used sometimes in patient's tx for Parkinsons to prevent degradation of L-Dopa or Dopamine
78
What is Eszopicclone
Eszopiclone is a short acting nonbenzodiazepine sedative hypnotic used to tx anxiety or insomnia
79
What is Duloxetine
SNRI used to tx depression
80
What is Enfuviritide
HIV fusion inhibitor
81
What is Fluoxetine
SSRI used to tx depression
82
What is Flumazenil
Benzodiazepine antagonist used to reverse overdose of benzos/nonbenzos.
83
What is Lamotrigine
Antiepileptic
84
What is Memantine
used in the tx of Alzheimers to act on the glutamatergic system by blocking NMDA-type glutamate receptors.
*Glutamate neurons thought to play a role in cholinergic neuron destruction
85
What is Oseltamivir
is an antiviral drug, which may slow the spread of influenza (flu) virus
86
What is Ramelteon
Drug used to tx insomnia (Melatonin-like)
87
What is Rifampin
A bacteriocidal drug that inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase
88
What is Amphoteracin B
A polyene macrolide antifungal drug that binds with ergosterol, a component of fungal cell membranes, forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl−) leakage, which is the primary effect leading to fungal cell death
*Broadest antifungal spectrum so often used as first choice for mycotic infections
89
What is Metronidazole
Mixed amebicide (luminal and systemic tx) for treating protozoal or bacterial infections
* Prodrug that must be acitvated once inside pathogen cells
* Activating enzyme= Nitroreductase found ONLY in anaerobic organisms
* Once induced, it inhibits DNA replicaton and kill cells
*Tx: Trichomoniasis, Ambiasis Giardiasis M-(TAG)
90
What is Mebendazole
Used to treat Nematodes (round, whip, pin,hook, ascaris worms) found in GI tract by interfering with microtubules and blocking glucose uptake- Worm can't move and has no energy>>>defecated out in feces
91
What is Terbinafine
Antifungal drug used to tx dermatophytes by inhbiting squalene epoxidase and decreasing ergosterol syntheis
92
What is Donepezil
a centrally acting acetylcholinesterase inhibitor. Its main therapeutic use is in the palliative treatment of Alzheimer's disease
93
What is Echothiophate
Irreversibly binds to plasma cholinesterase. Once bound, the enzyme is permanently inactive and the cell has to make new enzymes
94
What is Artimisinin
Antiprotozoa drug used to tx the most severe and resistant form of malaria caused by Plasmodium Falciparum
*Targets Blood schizonides
95
What is Chloroquine
Drug of choice for prophylaxis and tx of uncomplicated attacks of malaria. It binds to heme, preventing its growth in RBC resulting in membrane damage and cell lysis
96
What is Pyrimethamine
Antiprotozoa drug used to tx malaria by inhibiting folate needed for DNA/RNA synthesis
97
What is Quinine
Antiprotozoal drug used to tx malaria by interfering with polymerization (growth) within heme
98
What is Sulfadoxine
is an ultra-long-lasting sulfonamide often used in combination with pyrimethamine to treat or prevent malaria by interfering with folate synthesis
99
What class is Azithromycin
protein synthesis inhibitor
100
What class is Cefuroxime
second generation cephalosporin
101
What class is Ciprofloxacin
Inhibits bacterial DNA synthesis
102
What class is Sulfamethoxazole
inhibits folate synthesis
103
What class is Tobramycin
Aminoglycoside that inhibits protein synthesis
104
What class is Vancomycin
Glycopeptide that inhibits cell wall synthesis
105
What class is Linezolid
Protein synthesis inhibitor
106
What class is Rifampin
RNA syntheis inhibitor
107
What is the function of adding Clavulonic acid to amoxicillin (Augmentin)
Clauvulonic acid B-lactamase while amoxicillin (PCN) inhibit cell wall biosynthesis
108
T/F- Most first generation cephalosporins begin with "ceph"
True
109
What is post-antibiotic effect
Long after antibiotic is administered, effects linger
110
Name a drug or class that exhibits post-antibiotic effects
Aminoglycosides
*Oto, nephro, neuro toxic
111
Name the four mechanism of drug resistance
1. Alter their metabolic pathway
2. Alter target protein (enzyme)
3. Alter target site
4. Decreased membrane permeability
112
Drugs used to tx herpes infections are classifed as
Nuceloside analogs VS. Non-nucleoside analogs
113
What drug class is most effective for tx herpes
Nucleoside analogs
114
Name two nucleoside analogs
Acyclovir
| Ganciclovir
115
Name a non nucleoside analog
Foscarnet
116
What anti-viral is most effective at treating respiratory infections
Ribivarin
*PalvizuMAB: monoclonal antibiody used tx
117
What is the reason for combination tx for HIV
Therapy with RT inhibitors and Protease inhibitors can reduce the emergence of resistance and produce additive effects
118
What are the classes of drugs used to tx HIV
Reverse Transcritase inhibitors
Protease Inhibitors
Fusion Inhibitors
Integrase Inhibitors
119
Reverse Transcriptase Inhibitors are further classified as
Nucleoside inhibitors
| Nonnucleoside inhibitors
120
Name three nucleoside RT inhibitors
Didanosine
Abacavir
Zidovudine
121
Name one nonnucleoside RT inhibitor
Efavirenz
122
Name two protease inhibitors used to tx HIV
Indinavir
Ritonavir
"NAVIR"
123
Name two fusion inhibitor used to tx HIV
Maraviroc
| EnFuviritde
124
Name one integrase inhibitor used to tx HIV
RalTEGravir
125
What is the drug of choice to tx Giardia (common cause of diarrhea)
Metronidazole
126
What is the drug of choice to tx big round worms found in stool
Mebendazole
| Albendazole
127
Name two drugs used to tx Influenza A
Amantadine
Rimantidine
*must be started within 48 hours to be effective
128
Name two drugs used to tx Influenza A & B
Zanamivir
Oseltamivir (Tamiflu)
* If given within 30 hours of onset of flu, both drugs can shorten the duration of illness
* Neuramindase inhibitors that are prophylactic for flu
129
Zanamivir is given via what route
Inhalation ONLY
130
Oseltamivir is given via what route
Orally
131
What drug is used to treat Parkinsons as well as Influenza
Amantadine
* blocks NMDA receptor>Incr. glutamate
* Txs Influenza A
132
What Cancer drug is unique for targeting cancer-specific tyrosine kinase
Imatinib (Gleevec)
133
How does Imatinib work
works by preventing a central tyrosine kinase enzyme, in this case BCR-Abl, from phosphorylating subsequent proteins and initiating the signaling cascade necessary for cancer development, thus preventing the growth of cancer cells and leading to their death by apoptosis
134
What is the major AE of Cyclophosphamide
Myelosuppression-rate limiting
*alkylating agent (N. Mustard)
135
What is the major AE for Methotrexate
Myelosuppression-rate limiting
* Antimetabolite-Inhibits folate
136
What is the major AE for Taxol
Myelosuppression-rate limiting
*binds to tubulin PREVENTING microtubule disassembly
137
What is the major AE for Doxorubicin/Daunorubicin
Cardiotoxicity
*Anthracycline: intercalating agent that inserts b/t DNA base pairs
138
What is the major AE for Cisplatin
Renal toxicity
*Platinum Coordination Complexes with DNA (guanine)
139
What is the major AE of Vincristine
neurotoxicity
* binds to microtubule and blocks assembly
140
Give an example of combination chemotherapy
CHOP
C-cyclophoshamide (crosslinks DNA)
H-Hydroxydaunorubicin (Intercalates with DNA)
O-Oncovin(Vincristine)(mitotic spindle poison)
P-Prednisone (anti-inflammatory steroid, binds tubulin)
141
Name receptors involved in N/V with anti-cancer drugs and the drugs used to antagonize them
```
5 HT 3 (ondansetron)
D 2 (Promethazine) & Phenothiazine
```
*Phenothiazine should be avoided in patient's with Parkinson's disease
