1A: Dt 1 - 1

Front 1

Hormone Imbalance:
Cushing's Syndrome

Back 1

High Cortisol

Front 2

Hormone Imbalance:
Conn's Syndrome

Back 2

High Aldosterone

Front 3

Hormone Imbalance:
Addison's Disease

Back 3

Low Cortisol and aldosterone

Front 4

Hormone Imbalance:
Graves' Disease

Back 4

High T4

Front 5

MacConkey's Agar

Back 5

-Selects out Gram (+)
-Distinguishes lactose/non-lactose fermenters
Pink colonies = lactose fermenters
White = non-lactose fermenters

Front 6

Drug classes for treating glaucoma.

Back 6

alpha-agonists
beta-blockers
Diuretics
Cholinergic agonists
Prostaglandins

Front 7

Tuberous Sclerosis:
Symptoms
Risk of developing which neoplasms

Back 7

Ash leaf spots, seizures, MR

Risk:
Cardiac rhabdomyoma
Astrocytoma
Angiomyolipoma

Front 8

Achalasia:
Cause
What is it?

Back 8

Lose myenteric (Auerbach's) plexus

Lower esophageal sphincter unable to relax

Front 9

Leading cause of death in 15y-24y (top 5)

Back 9

Injuries
Homicide
Suicide
Cancer
Heart Disease

Front 10

Leading cause of death in 25y-64y (top 5)

Back 10

Cancer
Heart Dz
Injuries
Suicide Stroke

Front 11

Which glomerular disease:
anti-GBM ab's

Back 11

Goodpasture's Syndrome

Front 12

Which glomerular disease:
Kimmelstiel-Wilson lesions

Back 12

Diabetic Nephropathy

Front 13

Which glomerular disease:
spike and dome appearance

Back 13

Membranous glomerulonephritis

Front 14

Which glomerular disease:
tram track of subendothelial humps

Back 14

Membroproliferative glomerulonephritis

Front 15

Which glomerular disease:
subepithelial humps

Back 15

Acute poststrep glomerulonephritis

Front 16

Clinical uses for metronidazole.

Back 16

GET GAP on the METRO

Giardia
Entameoba
Trichomonas
Gardenerella vaginalis
Anaerobes
H. pylori

Front 17

2 Mot Common Post-MI Complications

Back 17

Arrhythmia (V fib most lethal)

LV failure (pulm edema, R-sided HF)

Front 18

What is Dressler's Syndrome?

Back 18

Autoimmune dz
Occurs weeks post-MI
Results in fibrinous pericarditis

Front 19

Chronic Granulomatous Disease:
Cause

Back 19

Lack of NADPH oxidase activity

Results in impotent nphils/phagocytes, lysosome doesn't work

Front 20

WAGR Syndrome

Back 20

Wilms' Tumor
Aniridia
GU malformation
Retardation

Front 21

Metronidazole:
Dietary restriction

Back 21

Metronidazole has disulfiram-like effects

AVOID ETOH

Front 22

Km

Back 22

Substrate required for enzyme to achieve V1/2

Decreasing Km-->Higher enzyme affinity for substrate

Front 23

Competitive inhibitor:
Effect on Km
Effect on Vmax
Changes in Lineweaver–Burk Plot

Back 23

Need more substrate to get V1/2 max

Effect on Vmax: None

Changes in L-B Plot:
Changes x-intercept (Km)

Front 24

Noncompetitive inhibitor:
Effect on Km
Effect on Vmax
Lineweaver–Burk Plot

Back 24

No effect on Km
Dec'd Vmax

Changes y-intercept (Vmax)

Front 25

Vd =

Back 25

amount of drug given (IV)/[drug] in plasma

MUST BE A NUMBER, not L/kg!!

Front 26

CL =

Back 26

(0.7 x Vd)/t1/2

Where Vd = amount of drug given/plasma concentration of drug

Front 27

Loading Dose =

Back 27

Loading Dose-

Css x Vd

Vd = amt of drug amin'd/plasma concentration

Css = desired [ ]

Front 28

MD =

Back 28

Maintenance Dose

Css x CL

CL = (0.7 x Vd)/t1/2

Css = desired [ ]

Front 29

How many half-lives to reach steady state [ ] ? To get rid of a drug?

Back 29

4 half-lives for both!

Front 30

Assuming constant infusion, [ ] of drug at:
1 half-life
2 half-lives
3 half-lives
4 half-lives

Back 30

1 half-life: 50%
2 half-lives: 75%
3 half-lives: 87.5%
4 half-lives: 93.75%

Front 31

Zero-order elimination:
What is it?
Rate of elimination (exponential/linear)
Drug examples

Back 31

Rate of elimination constant regardless of concentration in plasma

PEA: pea is round, like the number 0.

Phenytoin
EtOH
ASA

Front 32

First-order elimination:
What is it?
Rate of elimination (exponential/linear)

Back 32

Elimination proportional to drug plasma concentration

Exponential elimination (more drug-->faster elmination)

Front 33

Effect of ionization on drug elimination.

Back 33

Ionized species are trapped in urine and excreted quickly.

Front 34

Weak acids:
Examples
Treatment of OD

Back 34

ASA
Methotrexas
Phenobarbital

Get trapped in basic environments, tx with bicarbonate (makes urine basic)

Front 35

Weak bases:
Examples
Treatment of OD

Back 35

Ex: amphetamines
Tx w/acidic environments (ammonium chloride)--makes urine acidic

Front 36

Phase I Elimination:
What is it?
Product characteristics.
Where is it happening?

Back 36

RedOx, hydrolysis
Yields polar, water-soluble metabolites that are still active

Hepatic: cyp-450

Front 37

Phase II Elimination:
What is it?
Product characteristics.

Back 37

Phase II: GAS
Glucuronidation
Acetylation
Sulfation

Yields very polar, inactive metabolites that are renally excreted

Involves conjugation

Front 38

Phase I vs Phase II metabolism:
Which do geriatric patients employ?

Back 38

Geriatric pts lose phase I first; geriatric pts have GAS (phase II)

Front 39

Patients who are slow acetylators have greater side effects from drugs because _____.

Back 39

Lower rate of phase II metabolism

Front 40

Efficacy vs Potency:
General
Km or Vmax

Back 40

Efficacy: Vmax; max effect drug can produce

Potency: Km; amt drug needed for given effect. high potency-->high affinity for receptor

Front 41

__________ inhibition is irreversible.

Back 41

Noncompetitive

Front 42

Partial agonist:
Effects on Vmax

Back 42

Partial agonist will always decrease Vmax (compared to full agonist) and change efficacy

Front 43

Therapeutic index =
Safer vs Dangerous values

Back 43

LD50/ED50 = Lethal Dose50/Effective Dose50

Safe = higher TI value (lower ED50)

Front 44

ED50 vs LD50

Back 44

LD50 = lethal dose to 50% of populn

ED50 = effective dose to 50% of populn

Front 45

Drugs with Low TI:
Safe or Dangerous
Examples

Back 45

Dangerous.

Phenobarbital
Lithium
Digoxin
Coumadin

Front 46

Drugs that inhibit cyp450

Back 46

PICK EGS

Protease inhibitors
Isoniazid
Cimetidine
Ketoconazole
Erythromycin
GRAPEFRUIT JUICE
Sulfonamides

Front 47

Phases of clinical trials

Back 47

Drug I: is it safe? use healthy volunteers

Phase II: does it work? people with disease

Phase III: does it work better? compare with standard of care

Phase IV: post-market surveillance

Front 48

Effects of Symp NS:
Heart
Eye
Salivary Glands
Bronchiolar SM
Bladder
Male GU
GI tract

Back 48

Inc HR, inc contractility
Mydriasis (d for dilate)
Viscous secretions from salivary glands
Bronchial relaxation
Ejaculation (Point and Shoot)
Dec digestion

Front 49

Effects of Psymp NS:
Heart
Eye
Salivary Glands
Bronchiolar SM
Bladder
Male GU
GI tract

Back 49

Dec HR, dec contractility
Miosis (contraction of iris)
Watery secretions
Bronchial constraction
Cause urination
Erection (Point and Shoot)
Inc digestions

Front 50

Psymp nerve to heart is ______.

Back 50

Vagus

Front 51

Syx of excess Psymp activity.

Back 51

Psymp drugs make you leaky!

DUMBBELLS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal muscle/CNS
Lacrimation
Sweating
Salivation

Front 52

Direct vs Indirect Cholinomimetic Agents:
General Mechanism

Back 52

Direct: activates M-receptor
Indirect: inhibits acetylcholinesterase

Front 53

Bethanechol:
Drug Class
Use

Back 53

Urinary retention

Direct muscarinic agonist

Front 54

Carbachol:
Drug Class
Use

Back 54

Glaucoma

Direct muscarinic agonist

Front 55

Pilocarpine:
Drug Class
Use

Back 55

Glaucoma

Direct muscarinic agonist; cry, drool on your PILOw.

Front 56

Methacholine:
Drug Class
Use

Back 56

Challenge test for asthma

Direct muscarinic agonist

Front 57

Neostigmine:
Drug Class
Use

Back 57

Post op neurogenic ileus; urinary retention, myasthenia gravis

REVERSE anesthesia effects

STIGMINE = anti-cholinesterase

Front 58

Pyridostigmine:
Drug Class
Use

Back 58

-STIGMINE = anticholinesterase
RID gets RID of Myasthenia Gravis

Front 59

Myasthenia Gravis:
Pathophys
Presentation
Diagnostics
Pathology

Back 59

Abs to Ach receptor

Ptosis or diplopia that worsen throughout day

Tensilon Test

Pathology:
Thymic hyperplasia (50% of the time), atrophy, thymoma

Front 60

What is a myasthenic crisis?

Treatment.

Back 60

Rapidly progressing weakness esp in resp muscles

Tx: anticholinesterases
Neostigmine, pyridostigmine

Corticosteroids

Thymectomy (often curative)

Plasmepheresis to remove Ab's from plasma

Front 61

Physostigmine:
Drug Class
Use

Back 61

Anticholinesterase

PHysostigmine PHixes atropine overdose.

Front 62

Donepezil:
Drug Class
Use

Back 62

Anticholinesterase

AD

Front 63

Insecticide Poisoning:

Symptoms
Treatment

Back 63

Parathion, organophosphates--irreversibly inhibit AchE

Syx: Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skel muscle, Lacrimation, Sweating, Salivation

Tx:
Atropine (reverses syx)
Pralidoxime (regenerates AchE)

Front 64

Symptoms of inhibiting psymp activity.

Possible cause.

Back 64

Hot as a hare (inc'd temp)
Dry as a bone (dry mouth, dry skin)
Red as a beet (flushed)
Blind as a bat (cycloplegia--paralysis of ciliary muscle; blurry vision)
Mad as a hatter (delerium)
Bloated as a toad (urinary retention)

Possible cause: atropine

Front 65

Atropine:
Use
Drug Class

Back 65

Muscarinic antagonist
Produce mydriasis, cyclopegia

TROP

Front 66

Homatropine

Back 66

Muscarinic antag
Produce mydriasis, cyclopegia

TROP

Front 67

Tropicamide

Back 67

Musc antag
Produce mydriasis, cyclopegia

TROP

Front 68

Benztropine:
Drug Class
Use

Back 68

Musc antag

Parkinson's dz
PARK my BENZ

Front 69

Scopolamine:
Drug Class
Use

Back 69

Musc antag

Motion sickness

Front 70

Ipratropium:
Drug Class
Use

Back 70

Musc antag

Asthma, COPD

Front 71

Oxybutynin:
Drug Class
Use

Back 71

GU; reduce urgency in mild cystitis

Front 72

Drugs used in urge type urinary incontinence.

Back 72

Oxybutynin
Tolterodine
Darifenacin, solifenancin
Trospium

Front 73

Metscopolamine:
Drug Class Use

Back 73

Musc antag

GI; peptic ulcer treatment

Front 74

Contraindications of atropine

Back 74

Glaucoma--don't want to dilate eyes

BPH, urinary retention (will exacerbate retention)

GI retention (ileus)

Dementia (atropine can cause delerium on its own)

Infant with fever; atropine can cause hyperthermia