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176 Cards in this Set
- Front
- Back
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antidote?
acetaminophen |
n-acetylcysteine
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antidote?
anticholinergics |
physiostigmine
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antidote?
anticholinesterases; organophosphates |
atropine, pralidoxime
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antidote?
arsenic, mercury, gold |
dimercaprol
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antidote?
aspirin |
sodium bicarb
alkalinzation of urine dialysis |
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antidote?
benzos |
flumazenil
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antidote?
B-blockers |
glucagon
calcium gluconate dextrose-insulin therapy |
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antidote?
CO |
hyperbaric 100% o2
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antidote?
copper |
D-penicillamine
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antidote?
cyanide |
amyl nitrite
sodium thiosulfate hydroxocobalamin |
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antidote?
digitalis |
anti-digoxin FAB antibodies
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antidote?
methanol |
ethanol
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antidote?
heparine |
protamine
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antidote?
iron |
deferoxamine
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antidote?
isoniazid |
pyridoxine (vit B6)
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antidote?
lead |
EDTA, dimercaprol
(if kid, give succimer) |
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antidote?
drugs causing methemoglobinemia |
methylene blue
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antidote?
opioids |
naloxone/naltrexone
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antidote?
quinidine |
sodium bicarb
lidocaine magnesium sulfate |
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antidote?
strychnine |
benzos, neuromuscular blocade
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antidote?
theophylline |
Benzos, B-blockers
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antidote?
tPA |
aminocaproic acid
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antidote?
tricyclic antidepressants |
sodium bicarb, benzos
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antidote?
warfarin |
vitamin K,
fresh frozen plasma |
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mechanism of toxicity, effects, and antidote
CO |
binds to Hb with greater affinity
headahces, seizure, death 100% hyperbaric O2 |
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mechanism of toxicity, effects, and antidote
cyanide |
reacts with iron in cytochrome oxidase in mitochondria, thereby stopping electron transport and ATP formation
hypotension, lactic acidosis, coma, rapid death. venous O2 level is elevated because O2 UTILIZATION IS DIMINISHED AT TISSUE LEVEL. blood is bright red b/c cyanie affects mitochondria and rRBCs dont have mitochondria, amyl nitrate (reverses binding of CN to cytochrome oxidase) or thiosulfate (thiocyanate, excreted) |
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antidotes for ethanol toxicity (there are 3)
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acute withdrawal = benzos
prevent wernicke's = thiamine chronic alcoholism = disulfiram |
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mechanism of toxicity, effects, and antidote
methanol |
methanol is converted to formaldehyde via alcohol dehydrogenase. then it forms formic acid via aldehyde dehydrogenase. formic acid accumulates and causes retinal toxicity.
blindness, metaboilic acidosis, death tx = ethanol |
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mechanism of toxicity, effects, and antidote
strychinine |
it is a competitive antagonist of glycine in CNS (loss of normal inhibitory tone and causes excitation)
may cause seizure, contraction of all voluntary muslces tx = benzos or neuromuscular blockade |
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P450 inducers... what is pneumonic and what are the drugs?
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Barb uses pfhe-phen, cigarettes, and ethanol, but refuses greasy carbs
Barbituates phenytoin smoking ethanol rifampin griseofulin cabamazepine ALSO = omepraxole, gemfibrozil, doxorubicni, nefazodone, valproic aci, zileuton |
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Side effect(s) of:
doxorubicin/daunorubicin |
cardiac toxicity
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Side effect(s) of:
quinidine, quinine, aspirin |
cinchonism (flushed skin, sweating, confusion, tinnitis, vomiting, headache, rash, etc)
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Side effect(s) of:
haloperidol, chlorpromazine, reserpine, MPTP |
parkonsonism (tremor, rigidity, difficulty moving)
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Side effect(s) of:
antipsychotics; metoclopramide |
tardive dyskinesia
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Side effect(s) of:
chlorpromaiine, thioridazine, haloperidol |
extrapyrimidal side effects (problems with movement/posture etc.
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Side effect(s) of:
halothane, isoniazid |
hepatitis
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Side effect(s) of:
valproic acid, acetaminophen, halothane |
focal or massive hepatic necrosis
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Side effect(s) of:
broad spectrum antibiotics eg. clindamycin |
pseudomembranous colitis
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Side effect(s) of:
phenytoin |
gingival hyperplasia
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Side effect(s) of:
metformin |
lactic acidosis
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Side effect(s) of:
lithium, demeclocycline |
diabetes insipidus
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Side effect(s) of:
heavy metals |
fanconis' sydnrome (Fanconi Syndrome (also known as Fanconi's syndrome) is a disorder in which the proximal tubular function of the kidney is impaired,[1] resulting in decreased reabsorption of electrolytes and nutrients back into the bloodstream. Compounds involved include glucose, amino acids, uric acid, phosphate and bicarbonate.)
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Side Effect of:
Three C's: clozapine, carbamazepine, colchicine, and propylthiouracil |
agranulocytosis
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Side Effect of:
spironolactone digitalis cimetidine estrogen alcohol abuse ketoconazole |
gynecomastia
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Side Effect of:
lithium |
hypothyroidism
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name some drugs that cause gynecomastia
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spironolactone
digitalis cimetidine estrogen alcohol abuse ketoconazole |
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what causes gray baby?
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chloramphenicol
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what does heparin do to bones?
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osteoporosis
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what is side effect of:
hydralazine isoniazid procainamide phenytoin penicillamine chlorpromazine, methyldopa, quinidien |
SLE-like symptoms
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name some drugs that cause SLE like syndrome
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hydralazine
isoniazid procainamide phenytoin penicillamine chlorpromazine, methyldopa, quinidien |
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name 3 drugs that cause photosensitivity
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sulfonamides
amiodarone tetracycline |
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name four drugs taht cause cutaneous flushing
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vancomycin
niacin adenosine ca channel blockers |
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what drugs cause the two side effects of ototoxiisty and nephrotoxicity
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aminoglycosides
loop diuretics cisplain |
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what drugs cause neurotoxiity and neprhotoxidicty
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polymyxins (may be used for strains of pseudomonas that are resistant to cephalosporins)
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why is acetominophen extra dangerous in an alcoholic?
what is antedote? |
chronic alcoholics have upregulation of CYP450. this speeds the metabolism of acetominophen, and hence the formation of the toxic metabolite NAPQI. Also, chronic alcohol use can deplete glutathione stores.
Tx = n-acetylcysteine |
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what happens to bilirubin levels in acetominophen toxicity?
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total bili increases due to increase in indirect bili (impaired conjugation of bilirubin in liver)
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psychotic patient comes in with whitish plaques on tongue. What is going on? what is it? what will her blood count look like? what is Tx?
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she has oral candidiasis (thrush). She is psychotic, and likely toaking CLOZAPINE which is an antipsychotic that causes agranulocytosis. this disposes pts to infection because it causes neutropenia.
tx = stop the drug treat oral thrush with nystatin "swish and swallow" |
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what are two mechanisms that drugs can cause agranulocytosis?
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1 direct toxicity to neutrophils and precursor cells (eg cyclophospamide)
2. drugs can act as haptens, bind to neutrophils and cause autoimmune destruction of neutrophils |
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man with chronic anxiety and suicide attempt. decreased RR. BP is 100/65. He is ataxic and speech is slurred.
what kind of drug did he OD on? |
benzos (loraxepam, alpraxolam, diazepam)
benzos bind to GABA receptors in CNS, increasing affinity of GABA for receptor, thus increaing conductance of the assoicated chloride channel. this causes hyperpolarization of membrane and inhibition of firing. |
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what is antidote to benzo overdose and what is that mech?
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flumazenil is given in benzo overdose. it is competitive inhibitor at GABA receptor. must be given freq. because it has short half life.
*flumazenil may decrease seizure threshold by blocking GABA* so be careful in pt who took something that may cause seizure activity |
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what is mech of action of benzos? name some benzos?
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benzos (loraxepam, alpraxolam, diazepam)
benzos bind to GABA receptors in CNS, increasing affinity of GABA for receptor, thus increaing conductance of the assoicated chloride channel. this causes hyperpolarization of membrane and inhibition of firing. |
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what is effect of sudden withdrawal from benzo?
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GI upset, anxiety, confusiton, agitation
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what are benzos often used to treat?
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panic disorders
status epilepticus (diazepam is choice) sleep disorders (insomnia) alcohol withdrawal (diazepam is choice) |
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name 4 B2-adrenergic agonists
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albuterol
terbutaline metaprotenerol ritodrine |
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type of drug:
albuterol |
B2- agonist
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type of drug:
ritodrine |
B2-agonist
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type of drug:
diazepam |
benzo
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type of drug:
terbutaline |
B2- agonist
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type of drug:
metaprotenerol |
B2-agonist
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what is effect of B2 agonist on bronchiloles?
blood vessels? pancreatic (____) cells? parietal cells of gastric mucosa uterine myometrium? |
what is effect of B2 agonist on bronchiloles -= bronchodilation
blood vessels = vasodilation pancreatic (____) cells = pancreatic alpha cells, increases glucagon secretion parietal cells of gastric mucosa = increased gastic acid secretion uterine myometrium = uterine muscle relaxation |
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what class of G proteins are B2 receptors linked to?
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S class
(B1 and B2 are both linked to S class) increased cAMP, increased PKA |
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what class of G protein receptors has decreased cAMP?
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Gi
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what class of G protein receptors has increased cAMP?
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Gs
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what class of G protein receptors has increased Ip3? what is calcium level?
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Gq
increased calcium level |
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what class of G protein receptors are a2 receptors?
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Gi (decreased cAMP, decreased PKA)
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what class of G protein receptors are B1, B2, B3?
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Gs (increased cAMP, increased PKA)
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what class ofG proteins are alpha 1 receptors?
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Gq (increased IP3 = increased calcium
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Class of G protein:
M2, D2, a2 |
Gi
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Class of G protein
B1, B2, B3, D1, H2, V2 |
Gs
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Class of G protein
a1, M1, M3, H1, V1 |
Gq
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what phase of trial?
small group of patients between 100-300. usually compare drug to placebo and/or current standard drug |
`phase 2
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what is phase 1 of clinical trial?
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20-30 healthy volunteers. determine if humans have diff. response than animals, and to determine dosage
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phast is phase 3?
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hundreds - thoushands of pts, usually double blindd. after phase 3 is successful, comapany can submit new drug application.
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phase 4:
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drug is used in real conditions in lg number of patients. look for any toxicities. Only occurs after approval from FDA
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what are organophosphates and who usually overdoses from them?
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they are cholinesterase inhibitors - found in insecticides. usually farmers
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name symptoms of organophosphate OD
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sweting, slurred speech, abdominal pain, SOB, confusion, urinary incontinence
-they are cholinesterase inhibitiors |
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name some cholinesterase inhibitors
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neostigmine
physiostigmine, edrophonium (short half life) |
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name one drug used to treat glaucoma
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physiostigmine (cholinesterase inhibitor)
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what do you use to diagnose Myasthenia gravis?
what do you use to treat MG? |
edrophonium to diangose (short half life)
neostigmine or pyriodostigmine to treat both are cholinesterase inhibitors) |
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what can reverse cholinsterase inhibitor poisoning?
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atropine or pralidoxime (2PAM)
atropine works by inhibiting muscarinic receptrso, thereby decreaseing affect of Ach 2-PAM works by inhibitng the binding of organophospahtes to cholinesterase. |
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what does atropine overdose cause
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mydriasis, decreased GI motility, increased body temp, dry mouth, dry skin, constipation, disorientations, rapid HR
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treatment with what drug can cause symptoms of myasthenia gravis?
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penicillamine (but they disappear if drug is stopped)
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besides medication, how can you treat MG pts?
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THYMECTOMY. 75% of pts with MG have some abnormality of thymus gland (25% are thymoma)
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half life of drug is 5 hrs;
renal clearance is 2ml/min what is volume of distribution? |
t(1/2) = (0.7 * Vd)/clearance
convert hours to minutes: 5 hrs = 300 minutes 300 = (0.7 * X)/2 600 = 0.7X X = 857 ml |
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half life of a drug is directly proportional to what?
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volume of distribution
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what is relationship between half life and voume of distribution?
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they are directly proportional
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if you have a larger Vd, is there MORE or LESS drug in the plasma?
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LESS... it means there is more in the rest of the body.
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what side effect with hydralazine cause?
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drug induced lupus
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pt presents with rash, arthralgias, antihistone antibodies... what is dx?
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drug induced lupus
(recall antihistone abs!!) |
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what is side effect of these drugs:
procainamide isoniazid, methyldoapa, peicillamine, chlorpromazine, dilitiazem, miocycline |
lupus like syndrome
(drug induced lupus) |
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how are lipid soluble meds metabolized?
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phase i rxn will convert lipophilic dru into more polar molecule (oxidation, reduction, hydrolysis, many involve P450). Phase II will make it water soluble to be excreted (glucuronic acid conjugation, acetylation etc.)
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what is mech of action of hydralazine, what side effect?
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causes drug induced lupus
hydralazine is direct vasodilator that acrts on arteries and arterioles more than on venous side. vasodilation causes reflex tachycardia and stimulation of RAS pathway. SO, hydralazine is ALWAYS GIVEN WITH A BETA BLOCKER AND A DIURETIC |
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what is difference between efficacy and potency?
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efficacy = total maximum effect of the drug
potency = amount of drug required for a specific response (measured by ED50) the lower the ED50, the more potent the drug |
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what kind of antagonist will affect the ED50?
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competitive antagoinst will because they increase the amount of drug needed to achieve a certain effect
noncompetitive won't affect eD50, but will affect teh maximum effect a drug can ellicit |
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what drug do you use with aminoglycosides to increase coverage if you don't know the bacterial pathogen?
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extended spectrum penicillins;
they are inactivated by B-lactamases |
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what drug is commonly used as prophylaxis for endocarditis before major procedures
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amoxicillin
(amoxicillin is diff from ampicillin bc it has better oral absorption) |
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what drug is particularly affective against pseudomonas?
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pipperacillin
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1st vs 3rd gen cephalos?
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1st = mostly gram +, some gram -
3rd = mostly gram -, some gram + 3rd generation enters CNS |
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what cephalo would you use for pseudomonas?
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3rd (ceftriaxone) or 4th gen
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what cephalo for e. coli, klebsiella, proteus miribilis?
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1st gen (cefalexin, cefazolin,
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imipenem is what kind of drug?
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broad spectrum cephalo; used fro gram negative organisms, enters CNS
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what drugs are #1 cause of c. difficile infxns in hospitals?
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cephalosporins
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mech of aminoglycosides?
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inhibit bacterial protein synthesis.
BACTERIOSTATIC bind to 30s ribosomal subunit. must be given parenternally DO NOT PENETRATE CSF |
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what type of bact are aminoglycosides normally used against?
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gram (-) aerobic bacteria
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how do aminoglycosides develop resistance to drugs?
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plasmids that are transmitted by conjugation
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do aminoglycosides penetrate CNS?
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no
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what 3 conditions do you use streptomycin for?
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1. plague (yersina pestis)
2. severe cases of brucellosis 3. recalcitrant mycobacterial infections |
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what is major side effect of aminoglycosides?
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ototoxicity; neprhortoxic,
at high doses, may cause neuromuscular blockade (reversed using neostimine and calcium gluconate |
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how does vancomycin work?
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it inhibits bact. cell wall synthesis by bindig to terminal end of growing peptidoglycan to prevent elngation and cross linking; active against gram (+)
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what is famous syndrome caused by vancomycin
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red man syndrome
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how does bacitracin work?
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inhibits dephosphorylation and reuse of phospholipids in making cell wall. only used topically for minor infections.
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how do tetracyclins work
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bind 30 s submunit
prevent binding of aminoacyl tRNA to the acceptor site on the mRNA-ribosome complex; inhibitn bacterial protein synthesis. good for gram + and gram - infxns |
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what is the drug type and name used to treat SIADH> how does it work?
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demeclocycline
it is a tetracycline inhibits action of ADH at tubules by imparing cAMP action |
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what is demeclocycline specifically used for?
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treating SIADH
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what drugs cause tooth discolorations?
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tetracyclines
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how does chloramphenicol work?
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inhibits 50s subunit
prevetns bacterial protein synthesis by blocking action of peptidyl transferase; high concentrations will also affect eukaryotic mitochondrial protein synthesis |
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chloramphenicol is used to treat what 4 diseases in particular?
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1. typhoid fever
2. meningitis due to H. Influenza in pts allergic to penicillin 3. anaerobic infxns of brain (B. fragilis) in combination with penicillin 4. alternative to tetracycline in treating rickettsial disease |
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major side effect of chloramphenicol
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dose related bone marrow suppression
irreversible aplastic anemia; hemolytic anemia in pts with G6PD deficiency gray baby syndrome |
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how does erythromycin work?
gram + or - |
binds 50 s subunit and prevents protein synthesis.
penetrates all body except CSF inactivated by stomach acid, so given in coated tabs gram + |
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what do you use to treat Leigonnaires disease
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erythromycin
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what do you use to treat syphilis, Mycoplasma pneumonia, corneybacterium, bordetella pertussus (whooping cough)
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erythromycin
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Name a drug useful against MAC (avium cellulare) in AIDS pts
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clarithromycin
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what is effect of erythromycin on CYP450?
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inhibition, so you may get toxic accumulation of other drugs that are metabolized by CYP450
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when erythromycin is given IV, what is side effect you're worried about?
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thrombophlebitis
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clindamycin works the same way as ________
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erythromycin
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when do you use clindamycin?
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anaerobic infections (B. Fragilis); and topical use for acne
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what drug puts you at risk for pseudomembranous colitis
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clindamycin
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sulfonamides are analogs of what?
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para-amniobenzoic acid (PABA)
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sulfonamides prevent syntehsis of what? which is needed for what?
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sulfonamides prevent production of dihydrofolic acid, which is normally reduced by dihydrofolate reductase and then used to produce purines and pyrimidines and amino acids
these drugs inhibit bacterial growth |
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do sulfonamides penetrate CSF:
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yes
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what drug is used to treat UTIs (E coli) and as prophylaxis for recurrent otitis media?
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sulfonamides
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what drugs are used to treat toxoplasmosis and norardiosis (actinomyces)
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sulfonamides
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when do you use TMPSMX?
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uncomplicated UTIs, GI infections (particularly shigellosis), travelers diarrhea
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what drug is used as phrophylaxis for Pneumocystis jirovecii in AIDS pts? and as a tx at high doses?
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TMP SMX
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what drug combo is used to treat malaria caused by plasmodium falciparum
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sulfadoxine/pyrimethamine
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what drug is used to treat ulcerative colitis
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sulfsalazine (poorly absorbed sulfonamide)
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topical silver sulfadiazine is used to treat what?
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burn infxns
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what drug is used topically to tx burn/wound infxns
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silver sulfadiazine
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what drugs may cause Steven Johnson syndrome
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sulfonamides
steven johnson syndrome = erythema multiforme with lesions and ulcers on skin and mucous membranes may involve oral mucosa or conjunctiva in eye |
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what is another name for erythema multiforme? name one drug and one pathogen that can cause theis
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steven johnson syndrome
can be caused by sulfonamides can be caused by herpes simplex |
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what drug may cause hemolytic aplastic anemia in pts with _________ deficiency
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sulfonamides
G6PD |
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how does rifampin work?
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RNA synthesis inhibitor; binds B subunit of bacteria DNA dependedn RNA polymerase
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does rifampin go to CNS?
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yes
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is rifampin used for gram + or -
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gram +
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name some pathogens that rifampin is used against
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gram + organisms
neisseria mycobacteria (M. tuberculosis) atypical mycobacteria M. leprae prophylactic use for meningitis by H flu or menngococci |
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what is mech of quinolones?
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inhibit DNA gyrase; useful against UTI infectsion bc they concentrate in urine.
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what do you use against bacillus anthracis?
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ciproflozacin
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metronidaxole is used for aerobic or anerobic pathogens?
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anaerobic
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what drug is useful to treat c difficile
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metronidazole
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metronidazole has a ________ like effect therefore should be avoided by those who use ___________
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disulfiram like effect
avoided by alcoholics |
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isoniazid is analog of what?
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vit B6
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most effective drug against m. tuberculosis?
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isoniazid
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isoniazid is given with _________
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pyridoxine (b6)
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ethambutol is used to treat ______________. it caues ______ disturbances
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m tuberculosis
visual |
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what drug decreases urate acid secretion and may precipitate gout?
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ethambutol
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name the two drugs used to treat Mycobacterium Leprae
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Dapsone (similar to sulfonamides bc it inhibits folic acid biosynthesis; may cause methembolboginemia and hemolysis as side effect) and rifampin
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what is ususally used to treat MAC?
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azitrhomycin and ethambutol with addition of ciproflozin in some cases
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amphoteracin b is used to tx what?
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severe funal infections; it binds to ergosterol major component of fungal cell membrantes; it forms ampoteracin pores that allow leakage of cellular contents. does not bind to bacteria bc they don't have ergosterol. Binds to mammaian cholesterol but with much lower affinity (explains side effects)
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ketoconazole is used to treat what?
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disseminated blastomycosis; histoplasmosis and paracoccidiomycosis.
seborrheic dermatities. |
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side effects of ketaconazole
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may cause gynecomastia; ihibits p450 metabolism
gatric upset, itching |
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miconazole is used to treat what
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tinea pedis
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what is used to treat tinea pedis
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micronazole
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what drug is used to treat cruptococcal meningitis, disseminated histoplasmosis, coccidiodomycosis, systemic candidiasis; penetrates CNS
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Fluconazole
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Nystatin is used for waht?
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skin infections of mouth, mucus membrantes. it is too toxic for systemic use. similar mech to amphoteracin B
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griseofulvin mechanism? use?
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bind micrtotubuesl and prevent spindle formation in fungi. also binds keratin; accumulates in hair nails skin
used for hair/nail infections |
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what drug is choice for pneumocistis jirovecii
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TMP SMX
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