Spring 2013 Pharm review for Reddy Flashcards Preview

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Flashcards in Spring 2013 Pharm review for Reddy Deck (141):
1

Name the Excitatory NT in the CNS

Glutamate, Substance P

* dopamine, serotonin, NE, Ach depending on the receptor involved

2

Name the Inhibitory NT in the CNS

GABA, Enkephalins, Glycine (SC)

* dopamine, serotonin, NE, Ach depending on the receptor involved

3

What are the four dopaminergic pathways in the brain

1. Nigrostriatal System
2. Mesolimbic System
3. Mesocortical System
4. Tuberinfidibulum System

4

The Nigrostriatal system regulates

movement

5

The Mesolimbic system regulates

emotion, love

6

The Mesocortical system regulates

cognition, motivation

7

The Tuberinfindibulum system regulates

pituitary

8

Dopamine, NE are both released at nerve terminals, How is the action of these NT terminated

1. Reuptake (about 90%)
2. MAO-metabolism
3. COMT-metabolism

9

Name three drug strategies to increase the amount of NT

1. Inhibit reuptake
2. Inhibit MAO
3. Inhibit COMT

10

Name two examples of drugs used to inhibit NT reuptake

cocaine
TCA- Imipramine

11

Name a drug used to inhibit MAO

Selegiline

*used in alzheimer's dx to inhibit MAO B

12

Alzheimer's is characterized by loss of many neurons, especially

cholinergic

*Too little Ach

13

Alzheimer's results in impairment of

memory and cognitive functions

14

Name a drug used to increase AcH in the brain

Donepezil

15

What NT is implicated in destruction of cholinergic nerve death

Glutamate

16

What drug is used to address glutamates effect on patient's with alzheimers

Memantine

17

Attention-deficit/Hyperactivity disorder is characterized by

Persistent pattern of frequent, severe inattention and/or hyperactivity

18

What drugs are most frequently used to tx ADHD

stimulants

19

What secondary drug is used to tx ADHD

nonstimulant

* Atomoxetine- given to patient's refractory to stimulant therapy

20

Atomoxetine is a

selective NE reuptake inhibitor

21

Name two stimulants used to tx ADHD

methylphenidate (ritalin)
amphetamine (adderrall)

* both work in RAS

22

methylphenidate's MOA includes

blocking reuptake of dopamine in CNS

23

amphetamine's MOA includes

increases release of dopamine & NE

24

Name the three main drug categories used to tx anxiety

1. Benzodiazepine
2. Non-Benzo Benzos
3. 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