1St Pharm Test

Front 1

tyrosine hydroxylase

Back 1

tyrosine -> DOPA
(-)metyrosine

Front 2

Dopa Decarboxylase
(aromatic L-aminoacid decarboxylase)

Back 2

DOPA -> dopamine
(-) carbidopa

Front 3

Dopamine b hydroxylase

Back 3

dopamine -> NE
(-) disulfiram (antabase)

Front 4

momoamine oxidase

Back 4

breaks down catecholmines to aldehydes

Front 5

catechol O methyltransferase

Back 5

NE -> normetanephrine

Front 6

Unfractioned heparin

Back 6

indirect thromnin and Xa inhibitor

Front 7

LMW heparin

Back 7

Indirect Xa inhibitor
Less variability and monitoring than heparin
slower clearance than heparin

Front 8

Protamine

Back 8

tx for heparin overdose

Front 9

Fondaparinux

Back 9

pentasaccharide factor Xa inhibitor

Front 10

Lepirudin

Back 10

direct thrombin inhibitor
tx HIT
renal clearance

Front 11

Argatroban

Back 11

Direct thrombin inhibitor (active site only), tx HIT, liver metab

Front 12

Bivalrudin

Back 12

Direct thrombin inhibitor, tx angioplasty, renal clearance

Front 13

Hirudin

Back 13

Direct thrombin inhibitor, leech recombinant protein

Front 14

Warfarin (Coumadin)

Back 14

Vitamin K antagonist -- ↓post-translational carboxylase, ↓factor 2,7,9,10,C,S, INR

Front 15

Aspirin

Back 15

Irreversibly acylates cyclooxygenase, blocking TxA2 synth

Front 16

Dipyridamole (Persantine)

Back 16

Inhibits PDE -> ↑cAMP

Front 17

ASA w/ Dipyridamole (Aggrenox)

Back 17

good stroke preventing combination

Front 18

Ticlopidine (Ticlid)

Back 18

Inhibit ADP platelet activation, more potent

Front 19

Clopidogrel (Plavix)

Back 19

Inhibit ADP platelet activation, less potent

Front 20

Abciximab (Reopro)

Back 20

GP IIb/IIIa antagonist prevents fibrinogen binding

Front 21

Ibopamine

Back 21

ORAL AGENT FOR ↑ CONTRACTILITY
Dopaminergic agonist

Front 22

Inamrinone (Amrinone)

Back 22

ORAL AGENTS FOR ↑ CONTRACTILITY
PDE inhibitor ↑cAMP -> ↑CO and ↓SVR, short-term CHF tx, ↑AV cond, ARR, oral ↑toxic

Front 23

Milrinone (Primacor)

Back 23

ORAL AGENTS FOR ↑ CONTRACTILITY
Shorter τ (30 min vs 2.5 h), more selective, fewer side fx (e.g. thrombocytopenia, gi, liver, fever)

Front 24

Pimobendan

Back 24

ORAL AGENTS FOR ↑ CONTRACTILITY
PDE inhibitor w/ Ca sensitizing properties

Front 25

Nesiritide

Back 25

ORAL AGENTS FOR ↑ CONTRACTILITY
Natriuretic peptide

Front 26

Omapatrilat

Back 26

ORAL AGENTS FOR ↑ CONTRACTILITY
Neutral endopeptidase inhibitor—blocks both ACE and natriuretic peptide degradation

Front 27

Digoxin

Back 27

INHIBITS NAKATPASE -> ↑ CALCIUM; TREAT CHF, ARRHYTHMIAS;

Preferred, Renal excretion, shorter τ (1.6d), SS@1 wk, metabolized by gut bacteria (10%)

Front 28

Digitoxin

Back 28

INHIBITS NAKATPASE  ↑ CALCIUM; TREAT CHF, ARRHYTHMIAS;

No 12-OH, Hepatic metab, longer τ (7d), ss@1 mo

Front 29

Streptokinase (SK)

Back 29

Plasminogen activator

1° Non-enzymatic protein from streptococci, indirect, antibodies to drugy -> agg

Front 30

Urokinase (UK)

Back 30

Plasminogen activator

1° Trypsin-like enzyme, LMW, direct, (-) PAI-1, non-antigenic

Front 31

Aniosylated Plasminogen Streptokinase Complex (APSAC)

Back 31

PLASMINOGEN ACTIVATOR

2° SK and human plasminogen complex -> spontaneous deacylation, long τ (60m), IV bolus, Ab

Front 32

t-PA (Alteplase)

Back 32

PLASMINOGEN ACTIVATOR

2° Fibrin/clot-specific binding (1000x), glycosylation, short τ (6m), (-) PAI-1

Front 33

Reteplase

Back 33

PLASMINOGEN ACTIVATOR

3° t-PA derivative, kringle #2 and protease domain, non-glycosylated, no EGF -> longer τ (15m)

Front 34

TNK-t-PA (Tenecteplase)

Back 34

PLASMINOGEN ACTIVATOR

3° no glycosylation, less PAI-1 effect, ↑ fibrin specificity

Front 35

Amicar (ε-aminocaproic acid)
Tranexamic acid

Back 35

PLASMINOGEN ACTIVATOR

Antifibrinolytic – inhibits plasmin to stop bleeding

Front 36

Quinidine

Back 36

Intermediate recovery (1-5s), ↑ QRS, QT, APD, blocks Na and K channels;

α receptor block and vagal inhibition; ↑[DIG]

Front 37

Procainamide -> N-acetylprocainamide (NAPA)

Back 37

Intermediate recovery (1-5s), ↑ QRS, QT, APD, blocks Na and K channels;

Metabolite blocks K channels only, renal dose adjustment, lupus syndrome

Front 38

Disopyramide

Back 38

Intermediate recovery (1-5s), ↑ QRS, QT, APD, blocks Na and K channels;

Aggravates CHF and prostatism, effect ↑ with dose

Front 39

Lidocaine

Back 39

Fast recovery (<1s), shorten repolarization

IV, ↓ v-fib, ↑ mortality, CNS toxicity, dose adjustment (CHF and liver)

Front 40

Mexiletine, Tocainide

Back 40

Fast recovery (<1s), shorten repolarization

Oral ,CNS toxic

Front 41

Phenytoin

Back 41

Fast recovery (<1s), shorten repolarization

Anticonvulsant, effective for digitalis intoxication

Front 42

Flecainide

Back 42

Slow recovery, marked ↑PR, ↑QRS, ± QT

Very long τ from block, very effective for isolated PVC, RSVT, ↑DIG

Front 43

Encainide

Back 43

Slow recovery, marked ↑PR, ↑QRS, ± QT

↑ mortality post-MI, FDA removed

Front 44

Propafenone

Back 44

Slow recovery, marked ↑PR, ↑QRS, ± QT

~ Flecainide, Weak ß blocker (↑ at high conc),

Front 45

Moricizine

Back 45

Slow recovery, marked ↑PR, ↑QRS, ± QT

Phenothiazine analog, unique, weaker version, multiple metabolites

Front 46

Esmolol

Back 46

Ultra short acting (τ = 9m), nonselective ß blocker, good for testing

Front 47

Amiodarone

Back 47

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

Class I,II,III,IV actions, effective most arr, multiple toxic (esp lung), LONG τ (50d), ↑DIG

Front 48

Bretylium

Back 48

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

No longer marketed, still available – biphasic NE effects (↑ then ↓)

Front 49

Dofetilide

Back 49

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

Pure class III, Renal dose adjustment, causes TdP (1-3%)

Front 50

Sotalol

Back 50

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

Non-selective ß blocker, causes TdP

Front 51

Ibutilide

Back 51

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

Acute IV, stop A-flutter (60%) and A-fib (40%), block K, opens Na, Causes TdP (6%)

Front 52

*N-acetylprocainamide

Back 52

K CHANNEL BLOCKERS, ↑ AP DURATION, ↑ QT

Might have some class III effects

Front 53

Verapamil (phenylalkylamine)

Back 53

CA CHANNEL BLOCKERS, ↓ HR AND ↑ PR

Most potent AV blocking, hypotensive; AVOID: wide-complex tachy,WPW,CHF,AVblock,DIG

Front 54

Diltiazem (benzothiazepines)

Back 54

CA CHANNEL BLOCKERS, ↓ HR AND ↑ PR

IV, AV node blocking w/o hypotension, great for A-fib

Front 55

Adenosine

Back 55

Purinergic receptor blocker, ultra-short acting AV blocker (seconds) – acute tx, rapid IV, short Sx

Front 56

Captopril

Back 56

↑ BRADYKININ, RENIN, ANG I, ↓ANGIOTENSION II

Sulfhydryl, shorter τ, prostaglandin effect

Front 57

Fosinopril

Back 57

↑ BRADYKININ, RENIN, ANG I, ↓ANGIOTENSION II

Phosphinyl, L&K

Front 58

Trandolapril

Back 58

↑ BRADYKININ, RENIN, ANG I, ↓ANGIOTENSION II

Carboxyl, L&K

Front 59

Saralasin

Back 59

ANGIOTENSIN RECEPTOR BLOCKERS, ↑ ANGIOTENSIN II, FETOTOXIC

Original, IV, partial agonist

Front 60

Losartan -> EXP-3174

Back 60

ANGIOTENSIN RECEPTOR BLOCKERS, FETOTOXIC

Non-peptide, short τ, normal-high renin levels, uricosuric effect

Front 61

Mannitol

Back 61

MOST OF TUBULE: IV VOLUME EXPANSION (FILTERED, NOT REABSORBED)

IV

Front 62

Acetazolamide (Diamox)

Back 62

Proximal tubule: ↓NAHCO3 REABSORPTION (METABOLIC ACIDOSIS), SULFONAMIDES

Tx glaucoma

Front 63

Furosemide (Lasix)

Back 63

Thick acending loop: NAKCL2 SYMPORT INHIBITOR, MOST POTENT, CA AND MG LOSS

Releases vasodilator prostaglandin from kidneys  ↑ venous capacitance

Front 64

Ethacrynic Acid (Edecrin)

Back 64

Thick acending loop: NAKCL2 SYMPORT INHIBITOR, MOST POTENT, CA AND MG LOSS

Non-sulfamide

Front 65

Hydrochlorothiazide (HCTZ, Esidrex)

Back 65

DCT: NACL COTRANSPORT INHIBITOR, ↑ GLU,UREA,CA; ↓ K,H,NA

Sulfonamide, hyperuricemia  gout; tx diabetes insipidus

Front 66

Amiloride

Back 66

Collecting Tube: NA CHANNEL INHIBITORS, ↓ K EXCRETION; CAREFUL! (ACEI, ↑K, ARF)

Partially absorbed; inhibits NaH antiporter (lumen) and NaK ATPas (basal); tx Liddle’s

Front 67

Triamterene

Back 67

Collecting Tube: NA CHANNEL INHIBITORS, ↓ K EXCRETION; CAREFUL! (ACEI, ↑K, ARF)

Well absorbed, renal and metabolism

Front 68

Spironolactone -> Canrenone

Back 68

STEROID ANALOGUES COMPETE WITH ALDOSTERONE, BEST FOR CIRRHOSIS

Affects estrogen receptors (gynecomastia), tx Cohn’s

Front 69

Nifedipine (1,4-dihydropyridine)

Back 69

↓ CA -> VASODILATION, LONG ACTING, INHIBIT CYP3A4

L channel, ↑ chronotropy and CO, ↑ symp, variable partition coefficients, oral > sublingual

Front 70

Verapamil (phenylalkylamine)

Back 70

L channel, ↓ino, chrono, dromotropy, SVT, L isomer more active, PGP inhibition->DIGItoxic

Front 71

Diltiazem (benzothiazepines)

Back 71

L channel, ↓ino, chrono, dromotropy, SVT, PGP inhibition->DIGItoxic

Front 72

Dantrolene

Back 72

↓ Ca release -> relax muscles, tx malignant hyperthermia

Front 73

Nitroglycerin (TNG)

Back 73

Nitrate ester, Sublingual, high clearance (minutes)

Front 74

IsoSorbide DiNitrate (Isordil)

Back 74

Nitrate ester, Oral, variable τ of metabolites, intermediate clearance

Front 75

Isosorbide MonoNitrates (2-IMN > 5-IMN)

Back 75

Nitrate ester, 100% bioavailable, less variable, low clearance

Front 76

**Sildenafil (Viagra)

Back 76

Inhibits cGMP phosphodiesterase V  ↑postural hypotension

Front 77

Nitroprusside (Nipride)  NO + CN

Back 77

Spontaneous conversion to NO + CN, Thiocyanate toxicity (tx Na thiosulfate), no light, short τ

Front 78

Hydralazine (Apresoline)

Back 78

Arterial vasodilator, tx HT & CHF

Front 79

Minoxidil (Loniten)

Back 79

Arterial vasodilator, tx HT