stuff Arsh probably should memorize but won't

Question 1

Provide drugs that can be used for urinary incontinence.

Answer 1

• Treatment
  
  • Medications – oxybutynin (muscarinic (M3) antagonist → treats OAB), tolteridine (muscarinic (M3) antagonist → treats OAB), flavoxate (anticholinergic → relax smooth muscles), imipramine (beta agonist → treats OAB)

Question 2

What are the two treatments for bacterial vaginosis?

• For each, provide MOA, SOA, SE

Answer 2

• Tx (both cause NVD)
  
  • Metronidazole (po, topical)
    
    • MOA: inhibits nucleic acid synthesis → disrupts bacterial DNA → bacteriostatic
    • SOA: anaerobes, protozoa, and microaerophilic bacteria
    • SE: disulfiram reaction (no alcohol), metallic taste, CYP2C9 inhibitor (increases warfarin levels)
  • Clindamycin (topical)
    
    • MOA: binds 50s rRNA → inhibits translocation → bactericidal
    • SOA: gram positive bacteria and anaerobes
    • SE: pseudomembranous colitis (C. Diff)

Question 3

SERMS

• MOA?
• 2 examples?
• SE?

Answer 3

• SERMs – competitive inhibitors of estrogen binding to estrogen receptors on tumor tissue
  
  • i.e. Tamoxifen, Raloxifene
  • SE: hot flashes, endometrial hyperplasia/cancer, DVT, cataracts (due to agonist effects)

Question 4

Aromatase inhibitor

• MOA?
• SE?

Answer 4

• Aromatase inhibitors – blocks conversion of androgens to estrogen
  
  • SE: decreased bone density, joint pains, vaginal atrophy, hyperlipidemia

Question 5

Trastuzamab

• MOA?
• SE?

Answer 5

• Trastuzumab (Herceptin) – MAB that binds to the extracellular domain of HER2 → inhibiting HER1 and HER2 dimerization → blocking cellular proliferation and angiogenesis
  
  • SE: LV dysfunction → CHF, hypersensitivity, pulmonary toxicity

Question 6

what are the functions of the following Placental peptide hormones

Leptin, neuropeptide Y, inhibin & activan

Answer 6

• Leptin: anti-obesity hormone normally secreted by adipocytes → decreased food intake
• Neuropeptide Y: secreted from cytotrophoblasts → increase in CRH release
• Inhibin and Activin:
  
  • Inhibin: secreted by ovarian granulosa cells → ceases possibility of ovulation

Question 7

define the following

threatened, inevitable, incomplete, complete, missed abortion

how to treat missed abortion

Answer 7

• Threatened abortion (miscarriage): bleeding in first trimester without loss of fluid or tissue
• Inevitable abortion (miscarriage): bleeding or rupture of membranes in the presence of cervical dilatation (>2 cm – can put speculum in cervix)
• Incomplete abortion (miscarriage): documented pregnancy where passage of some blood and some tissue occurs, but some products of conception remain within the uterus
• Complete abortion (miscarriage): documented pregnancy that ends with the spontaneous passage of all of the products of conception
• Missed abortion (miscarriage): the retention of a failed intrauterine pregnancy with a gestational age less than 28 weeks, for 8 weeks or more
  
  • Expectant Tx, Dilation and curettage, and misoprostol (painful)

Question 8

what are the FDA drug classifications

Answer 8

Question 10

FAS

patho? abnormalities?

Answer 10

• Pathogenesis: failure of cell migration during gestation
• Congenital abnormalities: growth restriction, facial abnormalities (shortened palpebral tissues, low-set ears, midfacial hypoplasia, smooth philtrum, and thin upper lip) and CNS dysfunction (microcephaly, mental retardation, and ADD)

Question 11

Leading cause of low birth weight, pre-term labor, placental problems, IUGR, SIDS

Answer 11

Nicotine (vasoconstriction) and CO (impaired O2 delivery)

Question 12

Associated with low birth weight, pre-term birth, IUGR, and placental abruption

Answer 12

Cocaine (vasoconstriction)

Question 13

Most common teratogen that causes birth defects, intellectual disability, fetal alcohol syndrome (FAS)***

Answer 13

Alcohol

Question 14

• Exposure to less than 5 rads is not associated with fetal anomalies

If exposed to more leads to microcephaly and intellectual disability

Answer 14

Radiation

Question 15

Associated with irreversible arthroapthies and cartilage erosion

Answer 15

Aminoglycosides

Question 16

Associated with yellow-brown discoloration of teeth and inhibited bone growth

Answer 16

Tetracycline

Question 17

Ototoxicity

Answer 17

Aminoglycosides

Question 18

Avoid near delivery as they are associated with hyperbilirubinemia

Answer 18

Sulfa drugs

Question 19

Often used in pregnancy, but is associated with hemolytic anemia in G6PD deficiency

Answer 19

Nitrofurantoin

Question 20

Avoid near delivery as they are associated with thrombocytopenia, bleeding, and electrolyte disturbances

Answer 20

Thiazide diuretics

Question 21

Associated with fetal growth restriction, neonatal hypoglycemia, possible transient hypotension

Answer 21

Beta blockers

Question 22

Renal damage → polyhydramnios (growth restriction, limb contractures, abnormal skull/calvarium development)

Answer 22

ACEi/ARBs

Question 23

Only SSRI with an increased risk of ventral/atrial septal cardiac defects

Answer 23

Paroxetine (SSRI)

Question 24

Avoid use late in pregnancy as it is associated with neonatal behavioral syndrome (increased muscle tone, irritability, jitteriness, & respiratory distress)

Answer 24

SSRIs

Question 25

Associated with Ebstein anomaly (apical displacement of the tricuspid valve → atrialization of the RV)

Answer 25

Lithium (depression med)

Question 26

Associated with spina bifida/neural tube defects with exposure during embryogenesis → Tx: folate supplements before sex

Answer 26

Valproic acid and carbamazepine

Question 27

Associated with abnormal facies, cleft lip/palate, microcephaly, growth deficiency, and hypoplasia of nails/DIPs

Answer 27

Phenytoin

Question 28

Severe fetal malformation → contraception is mandatory with use

Answer 28

Isotretinoin (acne med) /VitA

Question 29

* Methotrexate is used in ectopic pregnancy Contraindicated in normal pregnancy due to neural tube defects

Answer 29

Methotrexate/ Trimethoprim (folate antagonists)

Question 30

* Easily crosses the placenta Contraindicated in first trimester as it is associated with bone deformities, fetal abnormalities, abortion, ophthalmologic abnormalities

Answer 30

Warfarin

Question 31

Long-term use usually avoided as it can be associated with ductus arteriosus constriction → pulmonary HTN

Answer 31

NSAIDS

Question 32

Associated with aplasia cutis congenita (absence of skin à hole in head)

Answer 32

Methimazole (hyperthyroidism med)

Question 33

Associated with flipper limb defects

Answer 33

Thalidomide

Question 34

Can result in caudal regression syndrome, congenital heart defects, macrosomia, and neonatal hypoglycemia

Answer 34

Diabetes

Question 35

Associated with absence of digits and other anomalies

Answer 35

Alkylating agents (cancer drug)

Question 36

Associated with vaginal clear cell carcinoma and congenital Müllerian anomalies

Answer 36

Diethylstilbestrol (DES)

Question 37

Associated with congenital goiter or hypothyroidism (causes cretinism: stunted physical/mental growth)

Answer 37

Iodine (lack/excess)

Question 38

explain the following drugs oxytocin, misoprostol, mehtylergonovine, prostaglandin F2/E2 MOA? SE? and contraindiactions

Answer 38

Question 39

Found in swordfish, shark, tilefish, king mackerel → neurotoxicity Fish is safe when less than 12oz/week

Answer 39

Methylmercury

Question 40

Provide the MOA of the two hormones involved in contraceptives?

Answer 40

* Progestin (prevents ovulation and fertilization) * Suppresses LH surge, thickens cervical mucus, reduces ovum motility, thins endometrium * Estrogen * Suppresses FSH, potentiates progestin

Question 41

Provide the following generally: * half-life of each hormone * where are they metabolized * which two drugs do not have a rapid return to fertility? * what is the effect on obese patients? * What are general side effects of all?

Answer 41

* General pharmacokinetics/pharmacology * Half-life: estrogen (long), progestin (short * Metabolism: liver (P450s) * Return to fertility: rapid except for depo (9-10 months) and Nexplanon (1-2 months) * Effect in obese patients: Nexplanon and OCPs may be slightly less effective (others are equally effective) * General side effects: all can cause spotting of blood except copper IUD (can cause heavy bleeding)

Question 42

For Surgical sterilization (vasectomy, tubal ligation, Essure): * MOA * Benefits * Risks

Answer 42

Question 43

For Levonorgestrel (LNG) intrauterine device (IUD) (mirena, Skyla, kyleena): * MOA * Benefits * Risks

Answer 43

Question 44

For Copper IUD (ParaGard): * MOA * Benefits * Risks

Answer 44

Question 45

For Levonorgestrel implant (nexplanon): * MOA * Benefits * Risks

Answer 45

Question 46

For Depot medroxyprogesterone acetate (aka Depo-provera): * MOA * Benefits * Risks

Answer 46

Question 47

For Combined hormonal methods (oral contraceptive pill, ring, patch): * MOA * Benefits * Risks

Answer 47

Question 48

For Progestin only pills (POP): * MOA * Benefits * Risks

Answer 48

Question 49

For Barrier methods (condom, cervical cap, diaphragm): * MOA * Benefits * Risks

Answer 49

Question 50

For Fertility awareness methods (calendar, temperature, cervical mucus): * MOA * Benefits * Risks

Answer 50

Question 51

For Emergency contraception (Plan B/levonorgestrel): * MOA * Benefits * Risks

Answer 51

Question 62

Two meds for medication induced abortion? Provide MOA and SE if any? When are these indicated?

Answer 62

* Medication-induced abortion (indicated up to 70 days with ~70% success) * Prostaglandin E1 analog – Misoprostol (given at very high dose on day 2) * MOA: cervical ripening and uterine contractions * SE: severe cramping, heavy bleeding * Antiprogesterone – Mifepristone (given day 1) * MOA: lack of progesterone à lack of uterine maintenance à abortion

Question 63

* Phentermine (Adipex/Fastin)

Answer 63

* MOA: inhibits reuptake of monoamines (i.e. HT, DA, NE) → satiety * SE: tachycardia, palpitations, tremors, mood swings

Question 64

* Orlistat (Xenical/Alli)

Answer 64

* MOA: lipase inhibitors → decreased fat absorption * SE: diarrhea, steatorrhea

Question 65

* Lorcaserin (Belviq)

Answer 65

* MOA: selective serotonin agonist → stimulates POMC production → appetite suppression * SE: same as Phentermine (tachycardia, tremors, mood swings)

Question 66

* Phentermine/Topiramate (Qysmia) – most effective

Answer 66

* MOA: diminishes appetite via unknown mechanism in hypothalamus * SE: fatigue, cognitive decline

Question 67

* Buproprion/Naltrexone (Contrave)

Answer 67

* MOA: * Buproprion (anti-depressant): dopamine/norepinephrine reuptake inhibitor → stimulates POMC production → appetite suppression * Naltrexone: opioid antagonist → suppresses POMC inhibition → appetite suppression * SE: N/V, constipation

Question 68

* Liraglutide (Saxenda) – same as Victoza (used to treat DM-2)

Answer 68

* MOA: injected GLP-1 (glucagon-like peptide) → increases insulin production and activates parts of brain involved in appetite suppression → weight loss * SE: C-cell hyperplasia (thyroid), nausea, abdominal pain, bloating

Question 69

PCOS treatment talk about OCP, letrozole, clomiphene and metformin

Answer 69

* Overall treatment: metformin * Treats insulin resistance, some benefit to infertility/hirsutism * Letrozole (aromatase inhibitor) \> clomiphene (SERM) \> metformin * MOA (treats infertility): aromatase inhibitor → interferes with estrogen feedback at the hypothalamus → increased release of FSH from pituitary * Clomiphene * MOA (treats infertility): SERM → decreases estrogen feedback at the hypothalamus → increased release of FSH from pituitary * Risk: exacerbates metabolic dysfunction (increases BMI) * OCP: * Treats hirsutism and acne; prevents diabetes, CVD, and endometrial cancer * Risk: can worsen insulin resistance * Diet and exercise * Decreases incidence of diabetes

Question 70

Glipizide

Answer 70

MOA:Blocks ATP-sensitive K-channels → membrane depolarization → influx of Ca → insulin release SE:Hyperinsulinemia, weight gain, hypoglycemia OTHER: Long acting

Question 71

Repaglinide

Answer 71

MOA:Blocks ATP-sensitive K-channels → membrane depolarization → influx of Ca → insulin release SE:Hyperinsulinemia, weight gain, hypoglycemia OTHER: rapid acting

Question 72

metformin

Answer 72

MOA: 1. Inhibits gluconeogenesis in liver (increased production of lactic acid instead of pyruvate) 2. Reduce insulin resistance via increased AMPK → increased GLUT4 expression SE:Diarrhea, decreased absorption of B9/B12, lactic acidosis OTHER: Contraindicated in renal dx due to lactic acidosis

Question 73

Pioglitazone

Answer 73

MOA:Activates peroxisome proliferator-activator receptor gamma (PPAR-gamma) → activates insulin responsive genes → increase glucose uptake SE: Edema, fractures (due to decreased aromatase) OTHER:

Question 74

acarbose

Answer 74

MOA:Inhibit alpha glucosidase → decreased breakdown of complex carbs → decreased glucose absorption in gut SE:Diarrhea (osmotic), abdominal pain OTHER:

Question 75

Pramlintide

Answer 75

MOA:Synthetic analog of amylin (usually co-secreted with insulin) → enhances satiety, slows gastric emptying, suppresses glucagon (mirrors insulin effects) SE: N/V (slowed gastric emptying), hypoglycemia OTHER:

Question 76

Exena**_tide_** Lirglu**_tide_**

Answer 76

MOA:GLP-1 receptor analog → increases insulin secretion → slows gastric emptying, suppresses glucagon (effects of GLP-1) SE:Nausea, bloating (delayed gastric emptying) OTHER: Take 60min BEFORE meal Risk of c-cell thyroid CA

Question 77

Sitagliptin

Answer 77

MOA:Prevents degradation of GLP-1 → increases insulin secretion → slows gastric emptying, suppresses glucagon (effects of GLP-1) SE:Nausea, bloating (delayed gastric emptying) OTHER:

Question 78

Canaglifozin

Answer 78

MOA: Reduces absorption of glucose from kidney → increase in urinary glucose, SGLT2i SE:UTI/yeast infection, dehydration, AKI, ketoacidosis OTHER:

Question 79

difference between insulins * humulog/novolog * novolin * long acting

Answer 79

Question 80

What are some treatments of thyrotoxicosis?

Answer 80

* Treatment: beta blockers, thionamides (methimazole, propylthiouracil), radioactive iodine (I-131 ablation), surgery (thyroidectomy)

Question 81

Oxytocin MOA, SE, Use, other fun facts

Answer 81

**MOA:** Peptide binds Gq → release of Ca → contractions **SE:** Mom: Fluid retention (vasopressin is structurally similar to oxytocin) **USE:** Uterine contractions **OTHER:** Fetus: Uterine rupture, distress

Question 82

Desmopressin MOA, SE, Use, other fun facts

Answer 82

**MOA:** ADH analog → fluid retention **SE:** Rhinitis, hyponatremia **USE:** Central diabetes insipidus (too little ADH) **OTHER:** Contraindicated: HF, uncontrolled HTN

Question 83

Aquaretics: Coni**_vaptan_** MOA, SE, Use, other fun facts

Answer 83

**MOA:** ADH antagonist → water excretion **SE:** **USE:** Hyponatremia (too much ADH) **OTHER:** Used in patients with CHF

Question 84

Dopamine receptor agonists: Bromocriptine MOA, SE, Use, other fun facts

Answer 84

**MOA:** Inhibits prolactin secretion and decreases GH release (unsure MOA) **SE:** Postural hypotension, N/V (CTZ), hallucinations **USE:** Hyperprolactinemia, acromegaly **OTHER:**

Question 85

Dopamine receptor antagonists: Metoclopramide MOA, SE, Use, other fun facts

Answer 85

**MOA:** Inhibits dopamine → prolactin secretion occurs **SE:** **USE:** Hyperprolactinemia, acromegaly **OTHER:**

Question 86

Pegvisomant (subQ) MOA, SE, Use, other fun facts

Answer 86

**MOA:** Growth hormone receptor antagonist **SE:** Infection (subQ), elevated LFTs **USE:** acromegaly **OTHER:**

Question 87

Growth hormone replacement: Somatotropin, Somatrem MOA, SE, Use, other fun facts

Answer 87

**MOA:** Exogenous GH **SE:** Kids: elevated HbA1c, eosinophilia, increased risk of secondary malignancies Adults: fluid retention, myalgia **USE:** Dwarfism (GH deficiency) **OTHER:** Drug interactions: estrogens, androgens, thyroid hormones

Question 88

GHRH injection: Sermorelin MOA, SE, Use, other fun facts

Answer 88

**MOA:** Exogenous GHRH → GH **SE:** Kids: elevated HbA1c, eosinophilia, increased risk of secondary malignancies Adults: fluid retention, myalgia **USE:** Dwarfism (GH deficiency) **OTHER:** Drug interactions: estrogens, androgens, thyroid hormones

Question 89

Mecasemerin MOA, SE, Use, other fun facts

Answer 89

**MOA:** Exogenous IGF-1 → acts at insulin-like receptor → growth **SE:** Tonsillar hypertrophy, lipohypertrophy, hypoglycemia **USE:** IGF-1 deficiency in children (not GH deficient, but resistant to effects of GH) **OTHER:**

Question 90

Fludrocortisone MOA, SE, Use, other fun facts

Answer 90

**MOA:** Aldo agonist → Na/H20 reabsorption **SE:** Fluid retention, hypokalemia **USE:** CAH: 11-beta hydroxylase deficiency, adrenal insufficiency **OTHER:**

Question 91

Spironolact**_one_**, Epleren**_one_** MOA, SE, Use, other fun facts

Answer 91

**MOA:** Aldo antagonist → blocks Na/H20 reabsorption **SE:** Gynecomastia, menstrual issues (block androgen/ glucocorticoid receptors) **USE:** HTN, hypokalemia **OTHER:**

Question 92

Aminoglutethemide MOA, SE, Use, other fun facts

Answer 92

**MOA:** Cholesterol desmolase inhibitor (rate-limiting step) **SE:** Extreme sedation, nausea, severe skin rashes **USE:** Cushing’s syndrome **OTHER:**

Question 93

Metyrapone MOA, SE, Use, other fun facts

Answer 93

**MOA:** Inhibits 11-hydroxylase activity **SE:** Hirsutism (increased androgens), acne, HTN, N/V, sedation **USE:** Cushing’s syndrome **OTHER:**

Question 94

Ketoconazole (antifungal) MOA, SE, Use, other fun facts

Answer 94

**MOA:** Inhibits 11-hydroxylase activity **SE:** Gynecomastia, low testosterone levels, elevates LFTs, CYP450 inhibitor **USE:** Cushing’s syndrome **OTHER:**

Question 95

Mitotane MOA, SE, Use, other fun facts

Answer 95

**MOA:** Causes degeneration of zona fasiculata and reticularis cells → atrophy of adrenal gland **SE:** Lethargy and extreme sedation, CNS effects **USE:** Cushing’s syndrome **OTHER:** Use: Inoperable cortical carcinoma

Question 96

Mifepristone MOA, SE, Use, other fun facts

Answer 96

**MOA:** Progesterone and glucocorticoid receptor antagonist **SE:** Vaginal bleeding, pregnancy termination, nausea **USE:** Cushing’s syndrome **OTHER:**

Question 97

Hydrocortisone MOA, SE, Use, other fun facts

Answer 97

**MOA:** Activates cytosolic glucocorticoid receptors → release of cortisol **SE:** Cushingoid effects **USE:** Adrenal insufficiency, inflammation, asthma, eczema, etc **OTHER:** Metabolism slowed by estrogens, liver disease, age, pregnancy, hypothyroidism

Question 98

Iodides MOA, SE, Use, other fun facts

Answer 98

**MOA:** Iodine analog → negative feedback of T3/T4 synthesis **SE:** Hypothyroidism SE **USE:** Short term hyperthyroidism (pre-operatively) **OTHER:**

Question 99

Propylthiouracil (PTU) MOA, SE, Use, other fun facts

Answer 99

**MOA:** Substrate for TPO, inhibits MIT/DIT coupling to thyroglobulin, blocks peripheral conversion of T4/T3 **SE:** Hypothyroidism, rashes, arthralgias, SLE-like syndrome, hypersensitivity reactions, hepatotoxicity **USE:** Thyroid storm, hyperthyroidism, when methimazole is not tolerated **OTHER:** Indicated: pregnancy

Question 100

Methimazole MOA, SE, Use, other fun facts

Answer 100

**MOA:** Substrate for TPO, inhibits MIT/DIT coupling to thyroglobulin, **SE:** Hypothyroidism, rashes, arthralgias, SLE-like syndrome, hypersensitivity reactions, birth defects **USE:** Hyperthyroidism **OTHER:**

Question 101

Synthroid, Levothroid, Levothryxine MOA, SE, Use, other fun facts

Answer 101

**MOA:** Synthetic T4 (protein bound, can be converted to T3, slow onset) **SE:** Cardiac events **USE:** Hypothyroidism **OTHER:** Drug interactions: warfarin (TH reduces clotting factors), beta blockers Increased T4 clearance by: Rifampin, Phenytoin

Question 102

Natural desiccated thyroid MOA, SE, Use, other fun facts

Answer 102

**MOA:** Animal T4 **SE:** Allergic reactions **USE:** Hypothyroidism **OTHER:** Drug interactions: warfarin (TH reduces clotting factors), beta blockers Increased T4 clearance by: Rifampin, Phenytoin

Question 103

Liothyronine (Ctyomel) MOA, SE, Use, other fun facts

Answer 103

**MOA:** Synthetic T3 (fast onset, not protein bound) **SE:** Cardiac events **USE:** Hypothyroidism, myxedena **OTHER:** higher cost

Question 104

Liotrix MOA, SE, Use, other fun facts

Answer 104

**MOA:** T4/T3 **SE:** Cardiac events **USE:** Hypothyroidism **OTHER:** EXPENSIVE