Will's pharm Flashcards
(305 cards)
1
Q
Nifedipine
A
dihydropyridine
L-type CCB
vasodilator
2
Q
Verapamil
A
non-dihydropyridine
L-type CCB
anti-arrythmic
little vasodilation
3
Q
Diltiazem
A
non-dihydropyridine
L-type CCB
anti-arrythmic
mild vasodilateion
4
Q
Amlodipine
A
dihydropyridine
L-type CCB
vasodilator
5
Q
Milrinone
A
Phosphodiesterase-3 inhibitor
inotropic
Rx; Acute HF where other tx failed, chronic use is associated with INCREASED mortality
6
Q
Vasopressin (desmopressin)
A
Gq/s
vasoconstriction (esp. high levels)
inserts aquaporins
Rx; cardiac arrest, vwb disease, poor adh release, hemophilia A (not B)…bc it realeases factor 8from endoth cells
7
Q
Hydralazine
A
increase cGMP vasodilate arteries > veins; afterload reduction
Co administer with B-blocker to prevent reflex tachycardia. B blocker is considered safe in pregnancy
Rx; HTN in pregnancy, used with methyldopa and BB
Alternate is CCB
8
Q
methyldopa
A
CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)
Used in HTN during pregnancy 1st line with hydralazine
Alternate is CCB
SE: decreased libido
9
Q
HTN drugs to avoid in pregnancy
A
ACE-inhibitor, ARB’s, nitroprusside
10
Q
Nitroprusside
A
Short acting, increase cGMP through NO release. may cause cyanide toxicity. Onset within 30seconds
Mixed
arterioles > venules (even though “nitro”)
Rx; malignant HTN
SE: Cyanide poisoning
11
Q
Fenoldopam
A
D1 agonist -> vasodilation of coronary, peripheral, renal, splanchnic.
->decrease BP increase natriuresis
Rx; malignant HTN
12
Q
Nitroglycerine
A
NO release, increase cGMP
venodilator»_space; arteriolar
Rx; Angina, pulmonary edema
SE: hypotension, flushing, headache, reflex tach,
- *MONDAY DISEASE.
- -Anti anginal’s need period of drug free to prevent resistance
13
Q
Isosorbide dinitrate
A
NO release, increase cGMP
venodilator»_space; arteriolar
Rx; Angina, pulmonary edema, fairly long acting
SE: hypotension, flushing, headache, reflex tach, MONDAY DISEASE.
–Anti anginal’s need period of drug free to prevent resistance
14
Q
Rifampin
A
RNA Polymerase OF PROKARYOTES
Rx;
- Tb
- Monotherapy prophylaxis neisseria meningitites and H.Flu
- Induce P450 in liver
- *Makes body fluid yellow/orange
15
Q
Denosumab
A
RANKL monoclonal antibody on osteoblasts.
RANK receptor is on osteoclasts
RANKL induces osteoclast growth/maturation
Rx; osteoporosis, tumors of bone
16
Q
Alendronate
A
Bisphosphonate
binds calcium and taken up into osteoclast… inhibits them
Rx; osteoporosis (T score <-2.5)
17
Q
Osteopenia T score
A
T score -1 -> -2.5
18
Q
Actinomycin D
A
Inhibits RNA polymerase II
Used in
- Choriocarcinoma
- rhabdomyosarcoma
- wilms tumor
- ewing sarcoma
19
Q
Pioglitazone
-glitazones
A
Binds/activates PPAR-gamma transcription factor
-> regulates fatty acid storage and glucose metabolism. Increases insulin sensitivity and lvl of adiponectin
Rx; DMII
20
Q
Fibrates
A
Believed to Bind/activates PPAR-gamma transcription factor
-> regulates fatty acid storage –> increased LPL
Most powerful Triglyceride lowering agent
21
Q
Chloroquine
A
BLOCKS Plasmodium HEME polymerase
Acute Tx for malaria (vivax, ovale, malariae)
Falciparium is resistant everywhere except north of panama canal
** Always combine with a second drug if treating falciparum (like mefloquine)
22
Q
Mefloquine
A
Works against M. Falciparum resistant to Chloroquine.
**Always combine two drugs to tx falciparum
23
Q
Quinidine/Quinine
A
Used for severe malarial infections IV
24
Q
Mebendazole
A
Rx; Intestinal Nematodes
“Round worms are BENDY”
25
Praziquantel
Rx; Cestodes (tapeworms) and Trematodes (flukes)
26
Toxoplasma gondii Tx in general and when prophylaxis in AIDS
Sulfadiazine + pyrimethamine
Prophylaxis if CD4 < 100
**CMV more likely below 100 as well
27
PCP/ Pneumocystis jirovecii pneumonia Tx in general and when prophylaxis in AIDS
TMP-SMX
AIDS Proph CD4 < 200
**It's a yeast but with cholesterol cell membrane instead of ergosterol
28
Mycobacterium Avium Tx in general and when prophylaxis in AIDS
MACROLIDE: azithromycin or clarithromycin
AIDS Proph CD4 < 50
29
MOA Streptomycin
(An aminoglycoside) Inhibit initiation complex binding at Prokaryotic 30S subunit (P site)
30
MOA Tetracycline
inhibits tRNA binding at Prokaryotic 30s subunit (A site)
*doxycycline, minocycline are tetracyclines
31
Chloramphenicol
MOA
USE
SE
inhibits peptidyl transferase at prokaryotic 50S subunit
USE:
SE: dose dependent (reversible) anemia, thrombocytopenia, and/or leukopenia. OR DOSE INDEPENDENT irreversible aplastic anemia -> death/disability without tx (bone marrow transplant)
Grey baby syndrome (poor glucuronidation -> excretion)
32
MOA Macrolide
Inhibits translocation at 50S Prok. Subunit
| clarithromycin, azithromycin, erythromycin
33
MOA Shiga, EHEC, or ricin toxin
Inhibit tRNA binding Eukaryotic 60S subunit by removing ONE single adenine residue
34
MOA Diptheria
Inhibit translocation binding at EF-2 eukaryotes, by adp ribosylation
35
MOA pseudomonas
Inhibit translocation binding at EF-2 eukaryotes by adp ribosylation
36
Linezolid
Inhibit initiation complex binding at Prokaryotic 50S subunit (P site), for Vanco resistant staph/enterococci
37
Clindamycin
MOA
USE
Inhibits transpeptidation = translocation at 50S Prok. Subunit
USE: Anaerobic above diaphragm, aerobic gram positive
SE: Pseudomembranous colitis (C diff overgrowth with cytotoxin B actin cytoskeleton destruction)
38
Perchlorate
Blocks Sodium-Iodide cotransporter in Hyperthyroidism
39
Pertechnetate
Blocks Sodium-Iodide cotransporter in Hyperthyroidism
**99mmTc-pertechnetate used to dx ectopic gastric mucosa (in meckels diverticulum)
40
Propylthiouracil
Blocks Conversion of Iodide to Iodine (via thyroid peroxidase) in apical colloid in hyperthyroidism
AND
Blocks 5'-deiodinase conversion of T4->T3 in peripheral tissues
**T3 being the more active form
41
Methimazole
Blocks conversion of iodide to iodine (thyroid peroxidase) in apical colloid during hyperthyroidism
42
Lithium
Tx
SE's
also, why does it work in brain if it's Li+?
Tx; Bipolar disorder (manic episode +maintenance) augments antidepressives
SE: Diabetes insipidus (goes through Na channel to block aquaporin), hypothyroid, sometimes hyperthyroid... watch renal function, thyroid lvls, lithium lvls, arrhythmia's, ebstein's anomaly, TREMOR
Li+ is the smallest drug we have -> can penetrate BBB even though it's charged. (EtOH is similar)
43
Lamotrigine
Tx
SE
MOA: blocks Na channels
tx; seizures and bipolar disorder (depressive symptoms)
SE Rash, Steven-johnson syndrome
SJS milder form of Toxic epidermal necrolysis. Epidermis separates from dermis. Immune complex deposition disorder.
44
Medications that cause seizures
buproprion (antidepressant), clozapine (anti-psychotic), isoniazid, cipro, imipenem
45
Potassium citrate use
Used to prevent calcium stones. The citrate binds calcium and lets you pee it out
46
Treatment for Alzheimers Dz
1) cholinesterase inhibitors (Donepezil = Aricept)
- only one to cross BBB besides physostigmine
2) Anti-oxidants (Vitamin E)
3) NMDA receptor antagonists (memantine)
47
Traztuzimab
"Herceptin"
Tx for erb2 positive breast cancer, it is a monoclonal antibody
48
Tamoxifen
| Tx and SE
ER antagonist in breast tissue, agonist in endometrium
Tx for ER positive breast cancer
SE: proestrogenic in endometrium -> endometrial polyp and endometrial carcinoma
**associated with increased density bone (agonist on bone)
49
Diazoxide
Potassium channel opener. Causes hyperpolarization -> smooth muscle relaxation/ vasodilation.
Diazoxide is Drug of choice in INSULINOMA's
SE: Hyperglycemia bc opens ATP-potassium channel in pancreatic beta cells
50
WHy don't we use thiazides in diabetics?
Because they open K channels on pancreatic B cells -> hyperglycemia
thiazides: hyper GLUC
hyperglycemia, lipidemia, uremia, calcemia
+ hyponatremia, hypokalemia, metabolic alkalosis
51
minoxidil
Potassium channel opener. Causes hyperpolarization -> smooth muscle relaxation/ vasodilation.
-used 2nd line for refractory HTN bc reflex tachy and glycemic effects
SE: Hyperglycemia bc opens ATP-potassium channel in pancreatic beta cells
52
Fomepizole
Used to tx methanol/ethylene glycol toxicity
Mech: Inhibits alcohol dehydrogenase, which converts methanol to formaldehyde.
**Also need to dialize patients to get rid of methanol
53
-Azoles as related to alcohol
All -azoles inhibit alcohol metabolism (think fluconazole and fomepizole)
54
Disulfiram
Inhibits acetaldehyde dehydrogenase -> build up of acetaldehyde which is quite toxic.
acetaldehyde -> acetic acid(acetate)
55
JAK-STAT pathway
| -what promotes it?
GH, EPO, cytokines
| --> dimerize an intracellular tyrosine kinase
56
Methylene Blue
Reduces Iron from Ferric -> Ferrous (2+ state)
As in nitrite poisoning
57
Deferoxamine
Used in acute/chronic iron overload, especially when phlebotomy is contraindicated. Chelates Iron
58
Statin, why rhabdomyolysis/muscle aches?
Statin interferes with cholesterol synthesis, in this instance Farnesyl isn't made, which is needed for Coenzyme Q of electron transport. If CoQ not around, cannot do ETC very well in aerobic tissues where statins distributed to.
59
In ETC, match drugs with complex inhib
```
Barbituates
Doxorubicin
Rotenone
Antimycin A
Daunorubicin
Oligomycin
Cyanide
CO
Nitroprusside
```
IN ORDER
Complex I: Barbituates, Rotenone (insecticide), MPP from meperidine
(Complex II), only in FADH2 electron transport
CoQ: Doxo/Daunorubicin (Anti cancer, cause dilated cardiomyopathy, don't penetrate CNS
Complex III: Antimycin A (produced by streptomyces bacteria)
cytC (apoptosis)
Complex IV: Cyanide (nitroprusside) , CO
Complex V: Oligomycin (from streptomyces) inhibits Fo of ATP synthase
60
Two uncouplers of ETC?
High does Aspirin
2,4-DNP: Dinitrophenol => used to lose weight
61
Mipomersen
USE
MOA
Used ONLY for homozygous type II dyslipidemia (Familial hypercholesterolemia)
MOA: It is anti-sense mRNA for B100, will bind B100 mRNA in liver, prevent translation, and prevent it from releasing VLDL
WOW
62
In cancer, what do alkylating agents do?
Cross link DNA
63
Hydroxyurea
MOA
USE
Inhibits ribonucleotide reductase (which removes an OH from ribose - > Deoxyribose) such that DNA cannot be formed
USE Polycythemia Vera
-Sickle cell (increases fetal hgb)
64
6-mercaptopurine (6-MP) MOA
Blocks de novo purine synthesis (along line of PRPP -> IMP)
65
5-Flourouracil (5-FU)
Inhibits thymidylate synthase (can't make dTMP from dUMP bc flourine group on 5' position)
66
Methotrexate (MTX)
Inhibits dihydrofolate reductase (DHF->THF) --> leads to decreased de novo synthesis of dTMP, AMP, GMP
USE: RA, malignancy, vasculitis
67
Trimethoprim (TMP)
Inhibits BACTERIAL dihydrofolate reductase (DHF->THF) --> decreased de novo synthesisdTMP, AMP, GMP
68
etoposide MOA/use
anti-cancer, blocks topoisomerase
69
Bleomycin MOA/use
THE ONLY G2 phase specific anticancer;
MOA: complexes iron, forming ROS -> DNA strand breakage
***cause interstitial fibrosis
70
Vincristine
MOA
USE
MOA: Prevents microtubule formation (arrests M phase as a mitotic spindle toxin)
USE: Hodgkin's lymphoma, wilms tumor, and others
SE: paresthesia's, loss of DTR (particularly ankle)
71
Doxorubicin
MOA
USE
Special SE
An anthracycline
MOA: Inserts btw DNA bases-> Strand breakage
USE: Breast, bladder, ovarian cancer, leukemia
SE: Inhibits CoQ formation (not in CNS) --> dilated cardiomyopathy by disruption ETC
72
cana(gliflozin)
dapa(gliflozin)
MOA
USe
Inhibit SGLT-2 (so it's in the kidney's) theraby increasing glucose excretion
USE: DMII
* * Assess renal function prior to administration
* ** "Glucose-is-a-flozin through the urine"
73
Bromocriptine
```
D2 agonist (need to add info)
USE: prolactinoma, Parkinsons
```
74
Octreotide
MOA
USES
Somatostatin analogue with higher activity
Rx;
- acromegally (Inhibits GH release)
- carcinoid tumor ( symptomatic relief: many carcinoids have somatostatin receptors, activation of which decreases it's activity)
- Esophageal varices rupture (somehow decreases portal vein pressure)
75
Cyclosporine
MOA
USE
Calcineurin inhibitor: Calcineurin is a calcium dependent serine-threonine phosphatase, activates specific transcription factor (NFATc) -> induces expression of IL-2 ->activation of CTL, helper T cells, reg. t cells.
USE:
-Transplant rejection
-RA
-Psoriasis
-Eye drops: keratoconjunctivitis sicca (Sjogren's syndrome)
keratitis being involvement of cornea, conjunctiva the protection over sclera
76
Tacrolimus/tacralimus
MOA
USE
Calcineurin inhibitor: Calcineurin is a calcium dependent serine-threonine phosphatase, activates (by dephosphorylating) specific transcription factor (NFATc) -> induces expression of IL-2 ->activation of CTL, helper T cells, reg. t cells.
USE: Transplant rejection and...
77
ergonavine
MOA
USE
An ergot alkaloid that stimulates alpha adrenergic and seratonergic vascular smooth muscle receptors -> vasoconstriction
USE: Used at low doses to diagnose prinzmetal's angina
78
Amiloride
```
Blocks ENaC (epithelial sodium channel)
Used as K sparing diuretic
```
79
Triamterene
```
BLocks ENaC (epithelial sodium channel)
Used as K sparing diuretic
```
80
cabergoline
MOA
USE
D2 agonist
| USE: Prolactinoma, Parkinsons
81
Anaerobe rule
Above diaphragm
Below Diaphragm
Above: Clindamycin
Below: Metronidazole
82
Paclitaxel
MOA
USE
Binds B-tubulin, enhances Microtubule polymerization leading to disarray and death in metaphase
USE: Anti-cancer
83
Clopidogrel
MOA: Irreversible ADP receptor blocker, prevents platelet aggregation
USE: Alterntive or synergestic with aspirin as anti-platelet
84
Ticlopidine
MOA: As above
85
Terbutaline
MOA: B2 agonist
USE: asthma
offlabel- tocolytic (uterine relaxation)
86
Phenoxybenzamine
MOA
USE
Irreversible nonselective alpha antagonist
| USE: Give prior to B blockers and Surgery for pheochromocytoma to prevent massive vasoconstriction/htn crisis
87
Trazodone
MOA
USE
SE
MOA: inhibit serotonin reuptake
Serotonin antagonist and reuptake inhibitor
USE: Highly sedating anti-depressant often used as adjunct therapy with SSRI's
SE: Priaprism
88
Phenelzine
MOA
USE
SE
Monoamine oxidase inhibitor: (MAO-I ) A mitochondrial enzyme that deaminates neurotransmitters (seratonin, melatonin, NE, Epi, Dopamine)
USE: Antidepressent, especially ATYPICAL DEPRESSION combined with SSRI's
SE: Tyramines( cheese, red wine, beer, fish) --> HTN crisis somehow, having to do with tyramine not broken down by MAO
HTN crisis = malignant htn, blurred vision, neurologic signs
89
Monoamine oxidase
| What is it?
Enzyme that deaminates monoamines. Monoamines being carbon structures with ONE amine group attached to an aromatic ring by a two carbon chain. Monoamines are derived from aromatic rings (ie tryptophan, tyrosine, phenylalanine)
ie: think serotonin, melatonin, Dopamine, NE, Epi
90
Ivermectin
MOA
USE
Somehow increases inhibitory neurotransmission in worms -> paralysis
USE: Strongyloides Stercorais
91
Mebendazole
MOA
USE
MOA: inhibits microtubules ->>> eventually leads to immobilization -> excretion of that shit
USE: Nematodes (roundworms)
92
Praziquantel
| USE
MOA: unknown
USE: Cestodes (tapeworms) and trematodes (flukes)
93
Ethosuximide
MOA
USe
MOA: block T-type calcium channels (3hz)
USE: Absence seizures
**if fails -> valproic acid
94
Barbituates
MOA: prolong Cl- channel opening. AND can open ion channel alone (dose dependent)
USE:
OVERDOSE Tx; supportive and diurese with alkaline urine
+complex I inhibition -> low ATP
95
Valproic Acid
BLocks NA channels (prevent depolarization and increase refractory period
USE: Generalized seizures, 2nd for absence seizure, mania
SE: hepatotoxic, spina bifida
96
Phenytoin (Dilantin)
USE
unique SE
Na channel blocker, for seizures
unique SE: gingival hyperplasia, hirsutism, teratogen, megaloplastic anemia, drug induced lupus, SJS, aplastic anemia, fetal hydantoin syndrome
97
Carbamazepine
NA channel blocker
USE: generalized seizures, trigeminal neuralgia (works 80% of time), mania (mood stabilizer)
SE: Aplastic anemia, p450 inducer, hepatotoxic, fetal hydantoin syndrome
98
Volume of distribution
| low, medium, high Vd
Vd= amount of drug in body/plasma concentration
- Large charged molecules or protein bound have low Vd
- small hydrophillic molecules => ECF => medium Vd
- small lipophillic; high
Total body water = 42L
Extracellular= 14L (1/3)
Intracellular= 28L (2/3)
99
Half Life
A first order elimination property
t1/2= (0.7xVd)/CL
**The higher the Vd, the longer the half life (bc drug must get back into plasma to be cleared)
100
How long does it take for a drug infused at constant rate to reach steady state?
4-5 half lives
101
Therapeutic Index
| equation/meaning of high/low
"TILE"
TI= Lethal dose(50)/Effective Dose(50)
or
TI= Toxic dose(50)/Effective Dose(50)
**These are using Medians
High TI means safer than low TI
102
4 Drugs with low therapeutic index
- Digoxin
- Lithium
- Theophylline (phosphodiesterase inhib used in COPD/asthma)
- Warfarin
"The Drugs With Low therapeutic index"
103
5 drugs that are noncompetitive antagonists (a relatively rare occurrence in pharm)
```
Phenoxybenzamine (for alpha 1&2 receptors)
ASA
Digoxin
Allopurinol (xanthine oxidase inhib)
PPI's
```
104
Allopurinol
MOA
USE
MOA: Xanthine oxidase inhibitor
USE: To treat conditions of hyperuricemia
-Chronic Gout (useless or bad for acute gout)
-Tumor lysis syndrome
-Lesch-Nyhan
105
Potentiation is also rare
| what's an example?
Potentiation = less drug/molecule -> higher response
| Benzo's, which increase frequency of Cl channel opening in presence of GABA
106
Benzodiazapines
MOA: Benzo's, which bind gamma site and increase frequency of Cl channel opening in presence of GABA(a)
BZ1-sedation
BZ2-cognitive
Anterograde amnesia
Reverse: flumazenil
rarely coma/death without more stimuli bc we rely on the natural gaba to stimulate
**they are metabolized from active -> still active form in liver
Diazepam is super long acting, it's P450 metabolites have t1/2 60 hrs, use for anxiety
107
Zero order drugs (3)
PEA
Phenytoin
Ethanol
ASA
108
weak acids (6)
R-COOH R-OO' + H
ASA, cephalosporins, PCN, loop, thiazide, barbituate
**trap in basic env: bicarbonate, (historically acetazolamide)
109
weak bases (4)
R-NH3 R-NH2
morphine, local anesthetics, amphetamines (NMDA antagonist with dissociative properties), PCP
**trap in acidic env: ammonium chloride (NH4-Cl), vitamin C, cranberry juice
110
Acetamenophen overdose and antidote
Overdose = 250mg/kg
N-Acetylcysteine (NAC) reduces hepatic damage. Has a thiol (sulfer group) that it can donate for normal sulfation, or it can act as a direct binder of the toxic metabolite of tylenol NAPQI.
- acetamenophen overdose saturates glucuronidation and sulfation, and exhausts glutathione stores (so you have to use phase 1 metabolism).
- -> Without glutathione to bind the toxic metabolite --> fucked
***N-Acetylcysteine is also used for renal protection during iodine contrast radiographic studies
111
```
Warfarin
MOA
USE
Reversal
distribution
```
MOA: Inhibit VKORc = Inhibit vit K epoxide reductase which is necessary to recycle vit k to be used with vit k dependent gamma carboxylation of glutamic acid residues of 279 10 C S
USE: Afib, recurrent dvts, ect.
Reversal: acute: fresh frozen plasma
-longer, use vit K
Distribution: 98% bound to proteins, so giving a drug that displaces it (like sulfonamide for infection) will increase active coumadin in the blood
112
1)Are sulfonamides highly protein bound in blood?
2)Effect on coumadin/
bilirubin (in neonate esp)
3) Serious hematologic SE?
Sulfonamides will displace coumadin from protein bound in blood in elderly -> bleeding
Also, displace bilirubin -> kernicterus
SE: may cause aplastic anemia
113
levodopa/carbidopa
MOA
USE
Levodopa MOA: Replaces some dopamine in CNS to counteract loss of dopaminergic neurons in substantia nigra pars compacta.
** Note that levodopa (L-Dopa) is more liphophillic than dopamine so it crosses BBB. Also, carbidopa inhibits peripheral degradation of levodopa.
USE: Parkinson's
114
Theophylline
| aminophylline
methylxanthine= phosphodiesterase inhibitor,
Tx; asthma, COPD
-Antidote: Beta blocker
Low TI, P450 substrate as well
SE: blocks adenosine -> arrhythmias
115
ASA
MOA
USE
SE
weak acid
Irreversible acetylator of COX1 (low lvl) and COX1/2 (higher lvl)
Prevents platelet production of Thromboxane A2 which has the effects of promoting platelet aggregation, vasoconstriction, and PROLIFERATION of vascular smooth muscle cells
USED: Analgesic, antipyretic, antiplatelet, kawasaki, prevention colorectal cancer
SE:
- resp alkalosis, metabolic acidosis (ETC uncoupler)
- GI bleeding
- low dose risk of gout (increase uric acid), but not at high dose
**FOR overdose: alkalize urine (bicarb), correct electrolyte imbalances, gastric vacuum
116
Digoxin
Inhibit Na/K ATPase by binding K+ site, some cholinergic/vagal action
- > inotropic (increased Ca intracellular)
- > use in atrial fib bc depresses AV and SA node
SE: visual changes, GI upset
- potassium chl (to treat hypokelemia)... but can have hyperkalemia which is poor prognostic indicator
- There are anti-dig antibody Fab fragments
117
Flumazenil
Antidote for Benzodiazepine overdose Bz1/2
118
TCA overdose
S/S?
Treatment?
MOA&S/S: Blocks Na fast channels in heart -> QRS/QT prolongation and arrythmias.
-Hypotension, confusion, hallucination, flushed face, dry mouth
Tx; with Bicarbonate
119
Organophsphate/cholinesterase inhibitor poisoining
S/S
Tx;
SS: DUMBBELSS
diarrhea, urination, miosis, bronchoconstriction, bradycardia, excitation of skeletal muscle, lacrimation, sweating, salivation
Tx; Atropine + pralidoxime(2-PAM)
120
Atropine/anticholinergic toxicity
```
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat (mydriasis)
Mad as a hatter
```
* *Jimson weed is a rare cause from the plant alkaloid
* **Can cause acute andle-closure glaucoma in elderly
121
Infliximab
Monoclonal antibody to TNF-alpha used in autoimmune diseases like
- psoriasis
- RA
- ankylosing spondylitis
- UC
- crohns
122
benztropine
Anti-muscarinic
Tx; treat drug induced parkinsonism in psychotics
-also can be used for Regular parkinsons
SE: dry as a bone, mad as a hatter, blind as a bat, red as a beet, full as a flask, hot as a hare
**retro-orbital pain from glaucoma induced by anti-muscarinic action
123
Haldol
MOA
USE
SE
MOA: Potent D2 blocker as a reverse agonist (produces the opposite effect on a receptor than a normal agonist would) => a (-) efficacy
```
USE: 1st gen antipsychotic
Schizo
hyperactive delirium
hyperactive aggression
2nd line huntington's
```
SE:
extra-pyramidal symptoms: tarditive dyskinesia(irregular jerky movements) , drug induced-parkinsonism (rigidity/bradykinesia(decreased body movement)/tremor), akathisia (inner restlessness/desire to move)
124
Leuprolide
MOA
USE
MOA: Altered for longer t1/2, GnRH analogue used to suppress LH/FSH
USE: Androgen dependent cancers cancers (like prostate)
- infertility (pulsatile)
- fibroids (continuous)
- precocious puberty (continuous)
125
Finasteride
MOA
USE
MOA: 5alpha-reductase inhibitor (cannot testosterone -> DHT)
USE: BPH, male pattern baldness, male->female transexual
126
Hemicholinium
| MOA
MOA: Block reuptake of choline from (Acetate+choline= Acetylcholine) on neurons
USE: NO CLINICAL USE
127
Lispro action
Rapid action (peaks within an hour)
"lisp bro"
128
Aspart action
Rapid action (peaks within an hour)
"Aspartially Glutinous need to use quick acting insulin"
129
Glulisine action
Rapid action (peaks within an hour)
"Aspartially Glutinous need to use quick acting insulin"
130
Glargine action
Long acting 24hr
| "Gargle with glargine so it's a long time till you go to the Detemir Dentist"
131
Detemir action
Long acting 24 hr
"Detemir Dentist"
Gargle with glargine so it's a long time till you go to the Detemir Dentist
132
3 molecules that act through activating NUCLEAR receptors vs cytoplasmic (most steroids you think of are cytoplasmic)
Retinoids (vit A), PPAR, T3/T4
133
Phentolamine
MOA
USE
Reversible nonselective alpha antagonist (as apposed to the irreversible phenoxybenzamine)
USE: Pheochromocytoma surgery(better to use phenoxy). Epinephrine necrosis of digits. Give to PPL who are on MAO inhibitors who eat tyramine-containing foods.
134
Clonidine
CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)
USE: HTN(rare), ADHD
135
-Zosins
Prazosin
Tarazosin
Doxazosin
Peripheral Alpha 1 selective antagonists = vasodilation
Less reflex tachycardia than nonselective alpha antagonists bc preserved alpha 2 feedback (physiologic inhibition of NE release)
USE: Rarely used for HTN Tarazosin/doxazosin used for BPH because they relax the prostatic smooth muscle
136
Tamsulosin
MOA
USE
Peripheral Alpha 1 selective antagonist but especially for A,D receptors on prostate vs 1B on vasculatire
USE: for BPH because it relaxes the prostatic smooth muscle
137
Atenolol
Beta1 selective Beta blocker
USE: HTN
**doesn't cause vasoconstriction from blocking B2 activity. Doesn't cause bronchoconstriction by the same mechanism
138
Metoprolol
Beta1 selective Beta blocker
-HTN, stable-acute MI, HF
**doesn't cause vasoconstriction from blocking B2 activity. Doesn't cause bronchoconstriction by the same mechanism
139
Pindolol
Nonselective Beta blocker with Beta agonist activity.
USE: HTN
** never use pindolol, acebutolol, or any other B blocker with B agonist activity in angina, CHF, or prinzmetal (angina)
140
B-blockers for heart failure
Metoprolol ( Beta 1)
Carvedilol, (nonselective Beta BUT also blocks alpha 1)
* ***NEVER USE
propranolol: bc it reduces cardiac output (b1) AND increases peripheral resistance (B2 blockade). often used in Essential tremor
Pindolol : intrinsic sympathomimetic activity should be avoided
141
labetolol
nonselective Beta BUT also blocks alpha 1
| USE: HTN
142
Carvedilol
nonselective Beta BUT also blocks alpha 1
| USE: HTN, HF, Left ventricular dysfunction post MI
143
Isoproterenol
| MOA
MOA: B1,B2 agonist, causes OVERALL decrease in MAP bc of B2 agonist, but increase in HR from B1 and reflex tachy
Can create same effect with Epi and phentolamine/phenoxybenzamine
This is in contrast to Giving NE (a>b): alpha 1 asoconstriction -> reflex bradycardia that is not overcome by B1 activity
Epi by itself increases HR and MAP
144
Mirtazapine
CNS alpha-2 antagonist centrally -> increase release of NE and serotonin NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)
USE: Depression...
SE weight gain
145
Phenylephrine
Pure alpha-1/2 agonist
| USED: hypotension, ocular procedures (mydriatic), rhinitis (decongestant)
146
bethanechol
MOA
USE
Muscarinic agonist
| USE: Postoperative ileus, neurogenic ileus, urinary retention
147
edrophonium
```
Cholinesterase inhibitor (short acting)
USE: used to diagnose myasthenia gravis
```
148
Open angle glaucoma tx
Timolol: B blocker(nonselective), actually decreases aqueous humor production
M3 agonist (pilocarpine)- opens angle by causing miosis/stretching of tissue
Latanoprost: Prostaglandin F analogue Increases outflow (canal of schlemm)
149
Contraindicated drugs in glaucoma
```
alpha 1 agonists (closes angle)
Beta agonists (increases aqueous production)
Muscarinic antagonists (closes angle)
```
150
Acute angle closure glaucoma
carbonic anhydrase inhibitors (acetazolamide) : decreases aquous humor production
pilocarpine (M3 agonist)
Timolol (nonselective B antagonist)
151
ecothiophate
IRREVERSIBLE AChE-inhibitor
152
Risperidone
atypical antipsychotic
USE: schizo, bipolar, OCD, mania, depression, tourrette
SE: fewer extrapyramidal and antichoinergic SE, Weight Gain
153
Amantadine
MOA is strange: blocks NMDA and MAO
| Tx; parkinsons
154
Colchicine
MOA
USe
MOA: Blocks Tubulin polymerization leading to impaired leukocyte migration/phagocytosis -> decreased inflammation
USE: acute gouty arthritis, prophylaxis of gout
155
```
Vancomycin
MOA
USE
SE
Resistance profiles
```
MOA: Inhibit
USE:
SE: Histamine release with rapid administration (red man syndrome)
Resistance profiles:
156
```
Metronidazole
MOA
USE
SE
Resistance profiles
```
sdfsf
157
What class of antibiotics is Gentamicin?
Aminoglycoside
158
Cholestyramine
MOA
USE
SE
MOA: Bile acid resin: binds and prevents reabsorption of bile acids, liver must make more cholesterol
USE: Hypercholesterolemia
SE: Pateints hate the taste and GI discomfort, decreased absorption of fat soluble vitamins, Cholesterol gallstones
159
Niacin (B3)
MOA
USE
SE
MOA: Inhibits HSL which leads to less TG's broken down in fat. Liver holds onto VLDL--> lowers LDL, TG, and increases HDL
USE: Hypertriglyceride, hypercholesterolemia
SE: Red, flushed face (tx with asa)
- Hyperuricemia
- Hyperglycemia (insulin resistance)
* *has vasodilatory effects -> may need to decrease vasodilation
160
Ezetimibe
| MOA
BLocks cholesterol absorption at small intestine brush border
161
Dantrolene
MOA
USE
Binds and prevents ryanodine receptor in SR/ER, as such prevents skeletal muscle excitation contraction coupling
USE: malignant hyperthermia with some inhaled anesthetics (halothane, and others) + succinylcholine
**malignant hyperthermia susceptibility is autosomal dominant, usually a defect in RYR
162
Serotonin syndrome (overdose SSRI)
S/s
hyperthermia, hyperreflexia, myoclonas, diarrhea, flushing, autonomic instability (tachycardia)
1) Benzos + supportive care
| 2) Cyproheptadine (serotonin antagonist), not used that much
163
Rituximab
Monoclonal antibody against CD20
| Tx; B cell lymphoma's
164
odynophagia vs dysphagia
dysphagia: difficulty swallowing
odonynophagia: pain on swallowing
165
muromonab-CD3
Antibody
targets CD3, blocks T cell interaction with MHCI/II on presenting cells
prevents acute transplant rejection, especially KIDNEY
166
rapamycin
MOA
USE
Inhibits mTOR. This inhibits T-cell proliferation in response to IL2
USED: kidney transplant
-- In combination with cyclosporine and corticosteroids. **Also used with drug-eluting stents
167
3 drugs used in kidney transplant
cyclosporin (calcineurin inhibitor: block Ca dependent inducement of IL-2 production and it's receptor)
rapamycin (mTOR inhibitor: block response to IL2)
Corticosteroids
168
Azathioprine
MOA
USE
MOA: antimetabolic precursor to 6-mercaptopurine; interferes with nucleic acid synthesis. Toxic to proliferating t cells
USE: organ transplant, autoimmune disorders
169
Abciximab
MOA
USE
MOA: Ab against gpIIb/IIIa
USE: antiplatelet
170
Eculizumab
MOA
USE
MOA: Ab against C5 convertase (which does C5->C5a&C5b)
USE: PNH
**C5 convertase is a conglomeration of complement factors C4b2a3b
171
Palivizumab
MOA: blocks fusion protein on RSV paramyxovirdae
USE: Prevent pneumonia in premature infants
172
phencyclidine
MOA
USE
SE
PCP (street drug)
MOA: NMDA receptor antagonist -> release of excitatory neurotransmitters
USE: hallucinogen
SE: violent behavior, dissociation, amnesia, NYSTAGMUS (horizontal and vertical), ataxia
**dissociation = drastic changes in memory, personality, motor activity; associated with multiple personality disorder. mental processes that split from one another. behaviors of attatchement and Withdrawal
173
Lysergic Acid Diethylamide
USE
SE
LSD (street drug)
USE: hallucinogen
SE: VISUAL HALLUCINATIONS, euphoria, dysphoric/panic, tachycardia, HTN, FLASHBACKS
**Dysphoria = profound sense of unease or dissatisfaction
174
Cocaine
MOA
USE
SE
MOA: Inhibits reuptake of CNS neurotransmitters (via NET) (Dopamine, NE, Seratonin)
USE: Stimulant, euphoria
SE: Agitation, CHEST PAIN, SEIZURES, tachycardia, HTN, mydriasis
*** Acute intoxication lasts less than an hour
Withdrawal: psychomotor retardation (crash)
175
Methamphetamine
MOA
USE
SE
MOA: Causes neurotransmitter release AND blocks reuptake of CNS neurotransmitters
USE: Stimulant
SE: psychosis, diaphoresis, tachycardia, HTN, choreiform movements, tooth decay
**Acute intocivation lasts for up to 20hrs
176
Heroin
Opioid, euphoria
SE: Depressed mental status, Miosis, Respiratory depression, constipation
withdrawal: dilated pupils, yawning, lacrimation, abdominal cramping
177
cromolyn sodium
| USE
2nd line after steroids: Prevents mast cell degranulation independent of stimuli present (prophylaxis for asthma)
**nedocromil is another of the same class
178
Demeclocycline
Shit antibiotic that causes nephrogenic DI, can use for SIADH
179
ambrisenton
| bosentin
MOA: endothelin receptor blocker
Tx; pulmonary HTN
180
Scopolamine
MOA
USE
Selective Muscarinic antagonist
USED: tx symptoms (diarrhea, sweating, cramping) in MG without affecting nicotinic receptors
181
-nib suffix
| like imatinib
kinase inhibitor
182
-cept suffix
receptor molecule
183
Etanercept
MOA
USE
MOA: TNF-alpha receptor linked to Fc for removal by body macrophages
Tx for RA as adjunct to methotrexate
184
certolizumab
Ab against TNF-alpha, pegylated and without the Fc portion
185
Isotretinoin
Vitamin A derivative used in acne, promotes cell differentiation
SE: birth defects
186
Benzoyl peroxide
Antibiotic used against acne
187
Tx for psoriasis
PUVA
Psoralen(improves UVA absorption) + UVA light to dmg and decrease production of keratinocytes
- corticosteroids
- immune modulating therapy
- Topical vitamin D: inhibits keratinocyte proliferation and promotes differentiation. (calcipotriene, calcitriol, tacalcitol)
188
Dexrazoxane
MOA: iron chelating agent that prevents formation of oxygen free radicals as caused by...
USE coadministration with
Doxo/dauno- rubicin (and other anthracyclines)
189
Vemurafenib
inhibitor of BRAF for BRAF + melanoma
190
enoxaparin
lmwh, binds and activates ATIII
191
fondaparinox
INDIRECT: factor 10a inhibitor
| binds to ATII since it is indirect
192
Cyanide poisoning antidote
Nitrite to cause met-hgb and bing up CN -> thiosulfate which donates sulfer to rhodanase in liver -> convert cyanide to thiocyanate
193
Heparin antidote
Protamine sulfate
194
tPA, streptokinase(nonfibrin specific), urokinase(prostate remember?) overdose antidote
reteplase, tenecteplase... as well
Aminocaproic acid (analogue of lysine), inhibits conversion of plasminogen -> plasmin
195
lead poisoning antidote
dimercaprol, succimer, CaNaEDTA (drug of choice), penicillamine
196
Mercury, arsenic, gold poisoning
Dimercaprol, succimer
CaNaEDTA (drug of choice for mercury)
197
Copper poisoning
penicillamine
198
cyanide conversion by liver
rhodanase converts cyanide to thiocyanate, which though still toxic, can be excreted by kidneys
199
lepiruden
Direct thrombin inhibitor, doesn't require antithrombin III, used in heparin induced thrombocytopenia
200
Argatroban
Direct thrombin inhibitor, doesn't require AT-III, used in heparin induced thrombocytopenia
201
what antibiotic increases risk of tendon rupture
floroquinolones, esp. the achilles tendon
202
What's a predisposing factor for poorly/agenic development of lumbar/sacral spine with flaccid paralysis in a fetus?
Relatively rare, DM is a risk factor for this
203
Signs of neonatal hypothyroidism
```
5 P's
Pot belly
Pale
Puffy face
protruding umbilicus
protuberant tongue
```
**mild jaundice, floppy baby, myxedema of skin
204
Sign of vitamin A toxicity from fetal exposure in a neonate
```
Digeorge like S/S
craniofacial abnormalities
great vessel abn
auditory defects
posterior fossa defects
```
205
what is osteocalcin?
A marker of bone formation (secreted with osteoid)
206
medication given to decrease ICP in short term
Mannitol
MOA: osmotically draws fluid into vasculature (also diureses patient)
SE: can cause a fairly acute PULMONARY EDEMA by increaseing pressure within the vasculature by fluid overload. originally will cause hyponatremia -> hypernatremia as kidneys pull sodium back in/become fluid depleted.
**Contraindicated in anuria and CHF
207
what is paradoxical disinhibition?
It is the disinhibition caused by GABA agonists like alcohol and benzos, and barbituates at low doses.
208
where is the natural subunit receptor for GABA cells?
the alpha subunit, bc there is alpha, beta, gamma, and other sites
209
which site does barbituate bind?
GABA(a) Beta site (allosteric binding) with
210
which site does benzo bind?
GABA(a) gamma site (allosteric binding)
211
GABA(a) vs GABA(b)
GABA(a) does Cl- influx, GABA(b) does K efflux through a G protein
212
Why is Baclofen special?
the only GABA(b) drug
rx; spasticity
213
Name the 3 non benzo drugs used for sleep
zolpidem (ambien), zaleplon, eszoplicone
BZ1 agonists (sedation)
vs NOT BZ2(cognition
Flumazenil can reverse
214
barbituate suffix
- barbital
| - pental
215
buspirone
MOA
USE
MOA:
5-Ht partial agonist, has a ceiling effect (no sedative effect but will also not induce anxiety and overactivity)
USE: used for general anxiety ONLY
1-2 weeks for effect
216
Maintenance dose
(Desired plasma concentration x clearance) /bioavailability
**make sure to adjust for time
217
Loading dose
(Desired plasma concentration x Vd)/ bioavailability
Vd= dose in body/concentration in plasma
218
drug used fof vasospasm prevention after subarachnoid hemorrhage
nimodipine
CCB
spasm usually occurs 2-4 days after bleed
219
treat status epilpticus
Tx; with benzo
1) lorazepam(ativan)
2) diazepam (valium, long half life)
220
treat eclampsia
1) IV magnesium sulfate
| 2) benzo
221
anti epileptic teratogens
phenytoin
valproic acid (folate inhibition of absorption)
carbamazapine
PVC
also these are what you use for generalized tonic clonic seizures
222
SJS drugs
seizure drugs: lamotrigene, carbamazepine, phenytoin, phneobarb
allopurinol
PCN
Sulfonamides
223
agranulocytosis
carbamazapine (antiseizure
clozapine (antipsychotic)
colchicine
PTU and methimazole
224
Dabigatran
Direct (oral) thrombin inhibitor
others: argabotran, bivalirudin
225
Rivaroxaban
Direct 10a inhibitor (oral)
226
tetrodotoxine
from puffer fish
| binds Na channel and prevents action potential
227
action of opioids
on mu receptor increases K efflux through G protein signalling -> hyperpolarization
228
Parkinson's tx
BALSA
```
#bromocriptine,
#amantadine
#levodopa/cabidopa
#selegiline, rasagiline (inhibit MAO-b breakdown of dopamine), helpful in MPTP exposure
#entacapone/tolcapone (COMT inhibitor which breaks down dopamine as well)
```
Anticholinergic (benztropine)
Can lesion/overstimulate subthalamic nucleus with deep brain stimulation dbs
229
tetrabenazine/reserpine
MOA
USE
blocks dopamine release through vesicular monoamine transporter (VMAT) inhibition. LESS dopamine vessicle packaging
USE: huntingtons chorea
230
ergots in general
vasoconstrict
231
multiple sclerosis tx
B-IFN (actually not common now)
steroid immunosuppression
natalizumab (also used for crohns), block integrins
rituximab
others
+
symptomatic (muscarinic antagonist oxybutinin)
232
natalizumab
humanized monoclonal antibody against integrins, used in MS and crohns disease
233
oxybutinin
```
muscarinic antagonist used for genitourinary;
#urgency and bladder spasms (as might occur in UMN lesion or MS)
```
234
Riluzole
Tx ALS, decreases presynaptic glutamate release
ri(LOU)zole for LOU Gehrig disease
235
methylphenidate
MOA: DNRI; Stimulant, dopamine, norepi reuptake inhibitor
USE: ADHD (most common)
*others include dexmethylphenidate, dextroamphetamine
236
acamprosate
moa unknown, affects flutamate receptors
USE: prevent alcohol relapse
237
suboxone
buprenorphone (partial agonist mu receptors) with naloxone (antagonist )
USE: opioid addiction tx
238
is opioid withdrawal lethal? what do you treat it with?
opioid withdrawal is NOT lethal
tx; methadone (relieve symptoms)
+suboxone (naloxone + buprenorphone)
239
chlorpromazine
| thioridazine
```
-zine = traditional neuroleptics
low potency antipsychotics (neuroleptics)
-high anticholinergic SE
-antidopaminergic in mesolimbic area
-antiadrenergic
```
USE: Schizo
**every other neuroleptic is high potency with fewer anticholinergic SE, but extrapyramidal effects/tardive dyskinesia
"Cheating Thieves are LOW"
240
clozapine
-pine = atypical antipsychotic
MOA: complicated; anti dop, antiadren, antiserotonin
USE: schizo(helps + and - symptoms), bipolar, ocd,
SE: agranulocytosis (weekly WBC monitoring), seizures; less EPS and antichoinergic than traditional
olanzapine is another atypical, as is risperidone
**Clozapine is the gold standard for TREATMENT RESISTANT schizophrenia, must fail 2 antipsychotics prior to use
241
Extrapyramidal side effects of neuroleptics
hrs: acute dystonia (muscle spasm, stiffness, oculogyric crisis(upward deviation of eyes)
days: akathisia (restless)
wks: bradykinesia (parkinsonism)
months: tardive dyskinesia )smack lips, stereotyped facial movements
242
High potency neuroleptics (3)
"Try Fly High"
trifluoperazine
fluphenazine
haldol
antipsychotics, mostly of positive symptom control
SE: Extrapyramidal rxn
243
neuroleptic malignant syndrome
from typical antipsychotics; rigidity, myoglobinuria, autonomic instability(tachycardia), hyperpyrexia, rhabdomyolisis
tx; dantrolene or d2 agonist
244
leukovorin
used as a folate supplement with methotrexate
245
tricyclic antidepressant
MOA
USE
SE
MOA: block NE/serotinin
USE: major depression, bedwetting, ocd, fibromyalgia
```
3C's
cardiotoxicity (tachy, hypotension
cns (obtundended, coma, seizure)
antiCholinergic (mydriasis, pyrexia, anhidrosis)
-hyperpyrexia
-respiratory depression
```
tx overdose with benzo and bicarb
*imipramine and others...
246
Bupropion
MOA: NDRI (norepi dopamine reuptake inhibitor)
USE: antidepressant, smoking cessation
SE: seizures (NO SEXUAL Dysfunction), stimulant
247
Clonidine
CNS alpha-2 agonist centrally -> prevent presynaptic neuron release of NE/sympathetic release from medullary outflow tracts. (preganglionic neurons)
Used in HTN
SE: decreased libido
248
triazolam
SHORT acting benzo 24hrs
249
Use for IFN-alpha, IFN B, IFN gamma
IFN alpha= Chronic Hep B,C and kaposi's sarcoma
IFN B = MS
IFN gamma = NADPH oxidase deficiency
250
ATRA
All trans retinoic acid
tc of PML to mature the myeloblasts
251
cladribine (2-cda)
adenosine deaminase inhibitor used in hairy cell leukemia
252
cerebrform nuclei
leukemic spread of mycosis fungoides into blood. called sezary cells
253
pautrier microabscesses
cd4 aggregates in epidermis from mycosis fungoides neoplasm
254
Class I, II, III, IV antiarrythmics
Anesthetics, Block, Knife, Cuts
I: sodium channel blockers -> slow/block conduction, decrease slope phase 0 (increase QRS duration)
- variable potassium block
II: Beta Blockers: decrease cAMP -> lower Ca currents (increase PR) interval, lower phase 4 slope (decrease If)
III: K channel blockers: increase effective refractory period (increased QT)
IV: Calcium channel blockers: increase ERP, decrease conduction velocity SA/AV, increase PR
255
amiodarone
```
antiarrhythmic (class III)
Class I, II, III, IV effects because it alters lipid membrane of cell
```
Major therapeutic effect: prolong action potential and refractoriness. + everything =
=> decrease SA firing, suppress automaticity, interrupt reentrant circuits, prolong PR, QRS, QT
+ vasodilation (alpha and CCB effects) and negative inotrope (B-block and CCB). usually without CO decrease bc vasodilate > inotrope
SE: PULMONARY FIBROSIS, HEPATOTOXICITY, HYPERTHYROIDISM (it's 40% iodine by weight), corneal deposits, skin deposits (blue/grey) -> phorodermatitis, contipation, neurologic probs, bradycardia, heart block, CHF.
256
leucovorin
Folate supplement used for "rescue" during tx with methotrexate to supply some folate
can also help the cancer cells, but cancer is often necrotic with poor vascularization and can sometimes not take up as much as normal cells....
257
Sulfonamides
MOA: BLock dihydropderoate synthase which converts PABA + pteridine -> dihydropderoic acid -> DHF
dihydropderoate only in bacteria
258
iloprost
| epoprostenol
tx of pulm htn to vasodilate
also use sildanefil, boesenan/ambrisentan/nifedipine
259
dapsone
antibiotic for acne
260
benzoate
MOA
USe
MOA: binds amino acids for secretion in urine
USE: hyperammonemia and its intoxication
261
phenylbutyrate
MOA
USE
MOA: binds amino acids for secretion in urine
USE: hyperammonemia
262
lactulose
MOA
USE
MOA: insoluble (diarrhea), or bacterial fermentation -> acidifiy intestinal contents
USE: Constipation
hyperammonemia (traps NH4+ in acidified intestines)
263
tuberculosis treatment
Treat with RIPE before they RIP
rifampin (RNA polymerase the pooper)
isoniazid (block mycolic acid synth ) bacterial catalase peroxidase (KatG) converts INH to active metabolite. resistance if decrease production of KatG
pyrazinamide (uncertain mechanism of inhibiting cell wall synthesis), works in macrophage phagolysosomes with low pH
ethambutol (block arabinosyltransferase carbohydrate polymerization of cell wall)
or replace P or E with flouroquinolone or streptomycin
264
Ustekinumab
USE: psoriasis (and other prob)
inhibits IL12, IL23 and inhibits differentiation into Th1 and Th17 cells
265
sotalol, ibutilide, dofetilide, amiodarone
```
class III antiarrhythmic K channel blockers
potassium
```
266
omalizumab
MOA
USE
Anti-IgE antibody. binds mostly unbound serum IgE
USE: allergic asthma refractory to steroids and B2agonists
267
guafenesin
| USE
expectorant: thins respiratory secretions, doesn't suppress cough reflex
268
N-acetylcysteine
* loosens mucous plugs in CF patients by cleaving disulfide bonds.
* also used as antidote for acetamenophen overdose
* renal protective with iodine contrast studies
269
dextromethorphan
MOA
USE
MOA: NMDA antagonist. synthetic codeine analog with mild opioid effects
USE: antitussive
Naloxone used for overdose
270
loperamide (and diphenoxylate)
opioid agonists that work on myenteric plexus to decrease GI motility.
271
echinocandins (caspofungin/ micafungin)
inhibit B1,3D-glucan synthesis, a component of fungal cell wall
USE: candida and aspergillus
272
topiramate
anticonvulsant also used for migraine prophylaxis
273
buprenorphone
partial mu opioid agonist
USE: opioid addiction
274
Varenicline
partial nicotinic agonist used to give some pleasure, decrease withdrawal, and decrease reward from smoking.
works within nervous system at alpha4beta2-nicotinic receptor...whatever
275
Tx for hyperK
calcium gluconate (cardioprotective/prevents depolarization from hyperkalemia)
bicarb/beta agonist
Insulin
Glucose
Kayexalate (potassium binder)
276
amphotericin B
MOA
USE
SE
MOA: binds and makes holes in ergosterol membranes
USE: for invasive fungal infections
SE: many; especially renal -> vasoconstriction decreases GFR + RTN from direct toxicity
-> hypokalemia and hypomagnesemia
277
acyclovir
MOA: phosphorylated by thymidine kinase from virus (guanosine analogue). Chain termination of DNA polymerase
USE: HSV 1,2 and VZV
SE: crystalization in kidneys if high concentration -> renal tubular damage. Prevent with adequate saline infusion.
278
bumetanide
loop diuretic
OH DANG
- ototoxicity
- hypokalemia, hypocalcemia,
- dehydration
- sulfa Allergy (except ethacrynic acid)
- nephritis (interstitial)
- Gout
+hypocalcemia
**also torsemide, bumetinide, furosemide
279
ethacrynic acid
NON SULFA loop diuretic
280
tolvaptan
competitive V2 antagonist
USE: hyponatremia to block insertion of aquaporins
281
Beta 1 on kidneys
agonist increases renin release
282
cyclophosphamide
MOA: cross links DNA at guanine-7 residues
USE: cancer and autoimmune diseases
SE: hemorrhagic cystitis, prevent with mesna (2mercaptoethansulfonate)
283
are thiazides or loops more likely to give you hyponatremia?
thiazides, they retain the corticomedullary gradient so when vasopressin increases they can have massive free water reabsorption
because loops abolish the corticomedullary gradient water is absorbed in proximal tubule and collecting ducts isotonically and with less free water
284
alemtuzumab
antibody against CD52tx; CLL
| directly cytotoxic/induces complement killing
285
enfuvirtide
binds gp41 and prevents HIV fusion
286
clomiphene
USED in PCOS patients that want to get pregnant
estrogen receptor modulator that works in hypothalamus to prevent negative feedback of estrogen -> promote GnRH cycles/FSH&LH production/ovulation
287
Plan B action
Large dose of progesterone
- feedback inhibits LH -> inhibits ovulation
- inhibits luteal stage
288
Mifepristone
use
MOA
abortion pill
partial agonist but essentially anti-progesterone -> blocks corpus luteum progesterone from maintaining placenta
*coadministered with misoprostol which encourages contractions/effacement of cervix
289
anastrazole
aromatase inhibitor
| used in ER positive cancers
290
flutamide
competitive inhibitor of androgens at testosterone receptor
used in prostate cancer
291
raloxifene
SERM
USE: agonist on bone to reduce resorption of bone (osteoporosis)
* *antiestrogen breast and endometrium
* **increases blood lipoproteins
292
terbinafine
oral antifungal (squalene epoxidase inhibitor)
bocks squalene -> lanosterol
(azoles block lanosterol -> ergosterol)
293
HIV protease inhibitor SE
-navir tease a protease inhibitor
fat redistribution (they're not really sure of MOA)
294
mercury or lead poisoning DRUG of choice
CaNaEDTA: though dimercaprol can also be used
295
syrup of ipecac
emetic used to throw up poisons
296
foscarnet
MOA
USE
MOA: viral DNA polymerase inhibitor binds to pyrophosphate-binding site
USE: CMV retinitis when ganciclovir fails, acyclovir resistant HSV
SE: nephrotoxicity: hypocalcemia, hypomagnesemia => may promote seizures
* *Think of HIV <50CD4 count treated for eye problems
* *cidofovir is similar, no pyrophospate binding site.
297
Ribavirin
MOA
USE
SE
MOA: inhibits IMP dehydrogenase
USE: RSV, chronic hep C
SE: hemolytic anemia. TERATOGEN
298
```
NRTI SE's
general
and
Tenofovir
zdv (zidovudine)
```
bone marrow suppression: reverse with G-CSF and EPO
nucleosides -> lactic acidosis
tenofovir -> rash
ZDV-> megaloblastic anemia. ZDV is used as prophylaxis and during pregnancy to reduce transmission
**assoc with mitochondrial toxicity
299
mesna
| (2-mercaptoethansulfate
used to inactivate chemo products in the urine
300
filgrastim
G-CSF
used to differentiate granulocytes in conditions like death from chemo or zidovudine
301
bipolar mood stabilizer
Lithium (manic and depressive)
Valproic acid (hepatotoxicity, neural tube defects) depressives/s
carbamazepine (agranulocytosis) depressive s/s
Lamotrigine (SJS): used for depressive s/s
302
glyburide
MOA: sulfonylurea, blocks K channels -> depolerize and release insulin
+
mild diuresis
USE: DMII
SE: hypoglycemia, heartburn
303
Fluconazole
MOA: inhibit fungal p450, prevents ergosterol synthesis -> prevents cell membrane synthesis
USE: mycotics
304
Felodipine
MOA: dihydropyridine Ca channel blocker, higher selectivity for vascular channels than cardiac. weakly diuretic
USE: HTN
305
trihexyphenidyl
MOA: antispasmotic; relaxes smooth muscle directly and also indirectly inhibits parasympathetic nervous system. Anticholinergic type effects
USE: parkinsonism
SE: see benztropine
