2007 First Aid Ch 07 General Pharmacology

Front 1

28-year-old chemist presents
with MPTP exposure. What neurotransmitter is depleted?

Back 1

Dopamine.

Front 2

Woman taking tetracycline
exhibits photosensitivity.

Back 2

Rash on sun-exposed regions of
the body.

Front 3

African-American man who
goes to Africa develops a
hemolytic anemia after taking
malarial prophylaxis.

Back 3

Glucose-6-phosphate
dehydrogenase deficiency

Front 4

Farmer presents with dyspnea,
salivation, miosis, diarrhea,
cramping, and blurry vision.

Back 4

Insecticide poisoning; inhibition of acetylcholinesterase.

Front 5

27-year-old female with a history of psychiatric illness now has urinary retention due to a neuroleptic. What do you treat it with?

Back 5

Bethanechol.

Front 6

Patient with recent kidney
transplant is on cyclosporine for
immunosuppression. Requires
antifungal agent for candidiasis. What antifungal drug would result in cyclosporine toxicity?

Back 6

Ketoconazole.

Front 7

Patient is on carbamazepine. What routine workup should always be done?

Back 7

LFTs.

Front 8

23-year-old female who is on
rifampin for TB prophylaxis and
on birth control (estrogen) gets
pregnant. Why?

Back 8

Rifampin augments estrogen
metabolism in the liver, rendering it less effective.

Front 9

Km reflects

Back 9

the affinity of the
enzyme for its substrate.

Front 10

Vmax is directly proportional

Back 10

to
the enzyme concentration.

Front 11

The lower the Km, the

Back 11

The lower the Km, the higher
the affinity.

Front 12

The ???? the Km, the higher
the affinity.

Back 12

lower

Front 13

Competitive inhibitors
vs
Noncompetitive inhibitors

WRT Resemble substrate

Back 13

Competitive-- Yes

Noncompetitive-- NO

Front 14

Competitive inhibitors
vs
Noncompetitive inhibitors

WRT Overcome by ↑ [S]

Back 14

Competitive-- Yes

Noncompetitive-- NO

Front 15

Competitive inhibitors
vs
Noncompetitive inhibitors

WRT Bind active site

Back 15

Competitive-- Yes

Noncompetitive-- NO

Front 16

Competitive inhibitors
vs
Noncompetitive inhibitors

WRT Effect on Vmax

Back 16

Competitive-- no change

Noncompetitive-- decrease

Front 17

Competitive inhibitors
vs
Noncompetitive inhibitors

WRT Effect on Km

Back 17

Competitive-- increase

Noncompetitive-- no change

Front 18

Volume of
distribution (Vd)

describe and altered by

Back 18

Relates the amount of drug in the body to the plasma concentration.

Vd of plasma
protein–bound drugs can be altered by liver and kidney disease.

Front 19

Vd equation

Back 19

amount of drug in the body /
plasma drug concentration

Front 20

Vd ranges and what the mean for where the drug is

Back 20

low Vd distribute in plasma

medium Vd distribute in extracellular space

high Vd distribute in tissues

Front 21

t1/2 =

Back 21

0.7 × Vd/CL

Front 22

0.7 × Vd/CL =

Back 22

half life

Front 23

concentration after # of half-lives

Back 23

1 - 50%
2 - 75%
3 - 87.5
3.3 - 90%
4 - 94%

Front 24

Loading dose =

Back 24

Cp × Vd/F.

Front 25

28 year old chemist presents with MPTP exposure What NT is depleted?

Back 25

Dopamine

Front 26

Woman taking tetracycline exhibits photosensitivity What are the clinical manifestations?

Back 26

Rash on sun-exposed regions of body

Front 27

Nondiabetic patient presents with hypoglycemia but low levels of C peptide What is the diagnosis

Back 27

Surreptitious insulin injection

Front 28

African American male who goes to Africa develops hemolytic anemia after taking malaria prophylaxis What is the enzyme defficiency

Back 28

Glucose 6 phosphate dehydrogenase

Front 29

27 year old female with history of psychiatric illness now has urinary retention due to neuroleptic What do you treat it with?

Back 29

Bethanechol

Front 30

Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping and blurry vision What caused this and what is the mechanism

Back 30

Insecticide poisoning, inhibition of acetylcholinesterase

Front 31

Patient with recent kidney transplant is on cyclosporine for immunosuppresion, he requires antifungal agent for candidiasis What antifungal drug would result in cyclosporine toxicity?

Back 31

Ketoconazole

Front 32

Man on several medications including antidepressants and antihypertensives, has mydriasis and becomes constipated What is the cause of symptoms?

Back 32

TCA

Front 33

55 year old postmenopausal woman on tamoxifen therapy What is she at increased risk of acquiring?

Back 33

Endometrial carcinoma

Front 34

Woman on MAO inhibitor has hypertensive crisis after meal What did she ingest?

Back 34

Tyramine (wine or cheese)

Front 35

After taking clindamycin, patient develops toxic megacolon and diarrhea What is the mechanism of diarrhea?

Back 35

Clostridium difficile overgrowth

Front 36

Man starts a medication for hyperlipidemia. He then develops rash, pruritus and GI upset What drug was it?

Back 36

Niacin

Front 37

Patient is on carbamazepine What routine workup should be done?

Back 37

LFT's

Front 38

23 year old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant Why?

Back 38

Rifampin augments estrogen metabolism in liver rendering it less effective

Front 39

Patient develops cough and must discontinue captopril WHat is a good replacement drug and why doesnt it have the same side effects?

Back 39

Losartan - an angiotensin II receptor antagonist, does not increase bradykinin as captopril does

Front 40

Relates the amount of drug in the body to plasma concentration

Back 40

Vd - volume of distribution

Front 41

Formule for volume of distribution

Back 41

Vd = amount of drug in the body/plasma drug concentration

Front 42

Vd of plasma protein-bound drugs can be altered by what disease?

Back 42

Liver and kidney

Front 43

Relates the rate of elimination to plasma concentration

Back 43

CLEARANCE

Front 44

Formula for clearance

Back 44

Cl = rate of elimination of drug/plasma drug concentration

Front 45

The time required to change the amount of drug in the body by 1/2 during elimination (or during constant infusion) is called _

Back 45

Half life T1/2

Front 46

After 1 half life concentration of drug equals _ %

Back 46

50%

Front 47

After 2 half lifes concentration of drug equals_

Back 47

75%

Front 48

A drug infused at constant rate reaches about _ % of steady state after 4 T1/2

Back 48

94

Front 49

Formula for T1/2

Back 49

T1/2 = 0.7 * Vd/CL

Front 50

Loading dose formula

Back 50

Loading dose = Cp * Vd/F

Cp= target plasma concentration F = bioavailibility

Front 51

Formula for maintenance dose

Back 51

Cp * CL / F

Cp = target plasma concentration F = bioavailibility

Front 52

In patients with impaired renal or hepatic function, the loading dose decreases, increases or remains unchanged? Maintenance dose?

Back 52

Loading dose remains unchanged Maintenance dose decreases

Front 53

Rate of elimination is constant (constant amount of drug is eliminated per unit time) - what order elimination? What happens to target plasma concentration?

Back 53

Zero order elimination Target plasma concentration decreases linearly with time

Front 54

Rate of elimination is proportional to drug concentration (constant fraction of drug eliminated per unit time) - what order elimination? What happens to target plasma concentration?

Back 54

First order elimination Cp decreases exponentially with time

Front 55

Give examples of drugs with zero order elimination

Back 55

Ethanol Phenytoin Aspirin (at high or toxic concentration)

Front 56

Phase I metabolism
products, what happens and how eliminated

Back 56

(reduction, oxidation, hydrolysis) yields _ slightly polar, water-soluble metabolites (often still active) not yet eliminated

Front 57

What phase of metabolism associated with cytochrome P450

Back 57

Phase I

Front 58

What phase of metabolism associated with conjugation

Back 58

Phase II

Front 59

Phase II metabolism
products, what happens and how eliminated

Back 59

acetylation, glucoronidation, sulfation) yields Very polar, inactive metanolites (renally excreted)

Front 60

Geriatric patients lose which phase of metabolism first?

Back 60

Phase I

Front 61

Is it safe? Pharmacokinetics? - which phase of clinical testing of the drug

Back 61

Phase I

Front 62

Does it work in patients?- which phase of clinical testing of the drug

Back 62

Phase II

Front 63

Does it work? Double blind - which phase of clinical testing of the drug

Back 63

Phase III

Front 64

What happens in phase IV of clinical testing of the drug

Back 64

Postmarketing surveillance

Front 65

A competitive antagonist shifts agonist curve where?

Back 65

To the right

Front 66

A noncompetitive antagonist (irreversible) shifts agonist curve where?

Back 66

Downward

Front 67

Urine pH and drug elimination

what is trapped

Back 67

Ionized species get trapped.

Front 68

Urine pH and drug elimination

Ionized species

Back 68

Ionized species get trapped.

Front 69

Urine pH and drug elimination

Weak acids what and Tx

Back 69

Trapped in basic environments. Treat overdose with bicarbonate.

Front 70

Urine pH and drug elimination

Weak bases what and Tx

Back 70

Trapped in acidic environments. Treat overdose with
ammonium chloride.

Front 71

Urine pH and drug elimination

Trapped in basic environments.

Back 71

Weak acids

Front 72

Urine pH and drug elimination

Trapped in acidic environments.

Back 72

Weak bases

Front 73

dose response curves and

different antagonists

Back 73

A. A competitive antagonist shifts curve to the right, decreasing potency and ↑ EC50.

B. A noncompetitive antago-
nist shifts the agonist curve downward, decreasing efficacy.

Front 74

dose response curves and

shifts curve to the right, decreasing potency and ↑ EC50.

Back 74

competitive antagonist

Front 75

dose response curves and

shifts the curve downward, decreasing efficacy.

Back 75

noncompetitive antago-
nist

Front 76

dose response curves and

in a system with spare receptors

Back 76

the EC50 is lower than the Kd, indicating that to achieve 50% of maximum effect, < 50% of the receptors must be activated. EC50: dose causing 50% of maximal effect. Kd: concentration ofdrug required to bind 50% of receptor sites.

Front 77

dose response curves and

different agonists

Back 77

1. The partial agonist acts on the same receptor system as the full agonist but has a lower maximal efficacy no matter the dose.

A partial agonist
may be more potent (as in the figure), less potent, or equally potent; potency is an independent factor.

Front 78

dose response curves and

may be more potent (as in the figure), less potent, or equally potent; potency is an independent factor.

Back 78

A partial agonist

Front 79

Efficacy

Back 79

= maximal effect

Front 80

Potency

Back 80

= amount needed for a given effect

Front 81

= amount needed for a given effect

Back 81

Potency

Front 82

= maximal effect

Back 82

Efficacy

Front 83

Therapeutic index

Back 83

TILE

LD50/ED50

Front 84

pre and postsynaptic nervous system neurotransmitters

Parasymp

Back 84

ACh
(nicotinic)

ACh
(muscarinic)

Front 85

pre and postsynaptic nervous system neurotransmitters

Somatic

Back 85

only one
ACh (nicotinic)

Front 86

pre and postsynaptic nervous system neurotransmitters

Sympathetic

Back 86

pre = ACh (nicotinic)

Ach (muscarinic)- sweat glands

NEα,β - Cardiac and smooth
muscle, gland cells,
nerve terminals

D1 - Renal vascular smooth muscle

Front 87

nicotinic receptor mech

Back 87

ACh ligand gated Na+/K+ channels

Front 88

muscarinic receptor mech

Back 88

ACh G- protein coupled receptors that act through 2nd messengers

Front 89

ACh ligand gated Na+/K+ channels

Back 89

nicotinic receptor

Front 90

ACh G- protein coupled receptors that act through 2nd messengers

Back 90

muscarinic receptor

Front 91

G-protein-linked 2nd messengers
give G protein and major function

α1 Receptor

Back 91

q

↑ vascular smooth muscle contraction

Front 92

G-protein-linked 2nd messengers
give G protein and major function

α2 Receptor

Back 92

i

↓ sympathetic outflow, ↓ insulin release

Front 93

G-protein-linked 2nd messengers
give G protein and major function

β1 Receptor

Back 93

s

↑ heart rate, ↑ contractility, ↑ renin release, ↑ lipolysis, ↑ aqueous
humor formation

Front 94

G-protein-linked 2nd messengers
give G protein and major function

β2 Receptor

Back 94

s

Vasodilation, bronchodilation, ↑ glucagon release

Front 95

G-protein-linked 2nd messengers
give G protein and major function

M1 Receptor

Back 95

q

CNS

Front 96

G-protein-linked 2nd messengers
give G protein and major function

M2 Receptor

Back 96

i

↓ heart rate

Front 97

G-protein-linked 2nd messengers
give G protein and major function

M3 Receptor

Back 97

q

↑ exocrine gland secretions

Front 98

G-protein-linked 2nd messengers
give G protein and major function

D2 Receptor

Back 98

i

Modulates transmitter release, especially in brain

Front 99

G-protein-linked 2nd messengers
give G protein and major function

D1 Receptor

Back 99

s

Relaxes renal vascular smooth muscle

Front 100

G-protein-linked 2nd messengers
give G protein and major function

H1 Receptor

Back 100

q

↑ nasal and bronchial mucus production, contraction of bronchioles,pruritus, and pain

Front 101

G-protein-linked 2nd messengers
give G protein and major function

H2 Receptor

Back 101

s

↑ gastric acid secretion

Front 102

G-protein-linked 2nd messengers
give G protein and major function

V1 Receptor

Back 102

q

↑ vascular smooth muscle contraction

Front 103

G-protein-linked 2nd messengers
give G protein and major function

V2 Receptor

Back 103

s

↑ H2O permeability and reabsorption in the collecting tubules of
the kidney

Front 104

Given the major function and G-protein class name the receptor

q
↑ vascular smooth muscle contraction

Back 104

α1

Front 105

Given the major function and G-protein class name the receptor

i
↓ sympathetic outflow, ↓ insulin release

Back 105

α2

Front 106

Given the major function and G-protein class name the receptor

s
↑ heart rate, ↑ contractility, ↑ renin release, ↑ lipolysis, ↑ aqueous
humor formation

Back 106

β1

Front 107

Given the major function and G-protein class name the receptor

s
Vasodilation, bronchodilation, ↑ glucagon release

Back 107

β2

Front 108

Given the major function and G-protein class name the receptor

q
CNS

Back 108

M1

Front 109

Given the major function and G-protein class name the receptor

i
↓ heart rate

Back 109

M2

Front 110

Given the major function and G-protein class name the receptor

q
↑ exocrine gland secretions

Back 110

M3

Front 111

Given the major function and G-protein class name the receptor

s
Relaxes renal vascular smooth muscle

Back 111

D1

Front 112

Given the major function and G-protein class name the receptor

i
Modulates transmitter release, especially in brain

Back 112

D2

Front 113

Given the major function and G-protein class name the receptor

q
↑ nasal and bronchial mucus production, contraction of bronchioles,

Back 113

H1

Front 114

Given the major function and G-protein class name the receptor

s
↑ gastric acid secretion

Back 114

H2

Front 115

Given the major function and G-protein class name the receptor

q
↑ vascular smooth muscle contraction

Back 115

V1

Front 116

Given the major function and G-protein class name the receptor

s
↑ H2O permeability and reabsorption in the collecting tubules of the kidney

Back 116

V2

Front 117

G-protein-linked 2nd messengers
Receptor G-protein class

how to remember which goes with which

Back 117

α1, α2, β1, β2, M1, M2, M3, D1, D2, H1, H2, V1, V2

"QISS (kiss) and QIQ (kick) till you're SIQ (sick) of SQS (sex)."

Front 118

G-protein-linked 2nd messengers
Receptor G-protein class

3rd messengers... for Gq

Back 118

HAVe 1 M&M (H1, α1, V1, M1, M3)

↑ Phospholipase C to IP3 (↑Ca2+) and DAG (Protein Kinase C)

Front 119

G-protein-linked 2nd messengers
Receptor G-protein class

3rd messengers... for Gs

Back 119

β1, β2, D1 H2, V2

↑ Adenylcyclase (↑ATP to cAMP [ ↑ Protein kinase A])

Front 120

G-protein-linked 2nd messengers
Receptor G-protein class

3rd messengers for... Gi

Back 120

MAD 2's (M2, α2, D2)

↓Adenylcyclase (↓ATP to cAMP [ ↑ Protein kinase A])

Front 121

Release of NE from a sympathetic nerve ending is modulated by

with mech

Back 121

by NE itself, acting on presynaptic α2 autoreceptors, and by ACh,

angiotensin II, and other substances.

Front 122

Cholinomimetics
direct
names

Back 122

Bethanechol
Carbachol
Pilocarpine
Methacholine

Front 123

Cholinomimetics
indirect
names

Back 123

Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
Echothiophate

Front 124

Bethanechol

Mech

Back 124

Cholinomimetics: Direct agonist

Front 125

Carbachol

Mech

Back 125

Cholinomimetics: Direct agonist

Front 126

Pilocarpine

Mech

Back 126

Cholinomimetics: Direct agonist

Front 127

Methacholine

Mech

Back 127

Cholinomimetics: Direct agonist

Front 128

Neostigmine

Mech

Back 128

Cholinomimetics: inirect agonist (anticholinesterase)

↑ endogenous ACh

Front 129

Pyridostigmine

Mech

Back 129

Cholinomimetics: inirect agonist (anticholinesterase)

↑ endogenous ACh

Front 130

Edrophonium

Mech

Back 130

Cholinomimetics: inirect agonist (anticholinesterase)

↑ endogenous ACh

Front 131

Physostigmine

Mech

Back 131

Cholinomimetics: inirect agonist (anticholinesterase)

↑ endogenous ACh

Front 132

Echothiophate

Mech

Back 132

Cholinomimetics: inirect agonist (anticholinesterase)

↑ endogenous ACh

Front 133

Which Cholinergic Activates Bowel and Bladder smooth muscle;

Back 133

Bethanechol

Front 134

Which Cholinergic Contracts ciliary muscle of eye (open angle), pupillary sphincter (narrow angle)

Back 134

Carbachol

Front 135

Which Cholinergic Stimulates muscarinic receptors in airway when inhaled.

Back 135

Methacholine

Front 136

Which Cholinergic

Potent stimulator of sweat, tears, saliva

Back 136

Pilocarpine

Front 137

Which Cholinergic resistant to AChE

Back 137

Bethanechol and Pilocarpine

Front 138

Which Cholinergic ↑ endogenous ACh No CNS penetration

Back 138

Neostigmine

Front 139

Which Cholinergic ↑ endogenous ACh; ↑ strength

Back 139

Pyridostigmine

Front 140

Which Cholinergic is used for Postoperative and neurogenic ileus and urinary
retention

Back 140

Bethanechol
and
Neostigmine

Front 141

Which Cholinergic is used for Glaucoma, pupillary contraction, and release of intraocular pressure

Back 141

Carbachol, Echothiophate and Physostigmine

Front 142

Which Cholinergic is used for Potent stimulator of sweat, tears, saliva

Back 142

Pilocarpine

Front 143

Which Cholinergic is used for Challenge test for diagnosis of asthma

Back 143

Methacholine

Front 144

Which Cholinergic is used for reversal of
neuromuscular junction blockade (postoperative)

Back 144

Neostigmine

Front 145

Which Cholinergic is used for Myasthenia gravis

Back 145

Neostigmine

Pyridostigmine does penetrate CNS

Front 146

Which Cholinergic is used for Diagnosis of myasthenia gravis

Back 146

Edrophonium

Front 147

Which Cholinergic is used for atropine overdose

Back 147

Physostigmine

Front 148

Clinical applications of

Bethanechol

Back 148

Postoperative and neurogenic ileus and urinary
retention

Front 149

Clinical applications of

Carbachol

Back 149

Glaucoma, pupillary contraction, and release of
intraocular pressure

Front 150

Clinical applications of

Pilocarpine

Back 150

Potent stimulator of sweat, tears, saliva

Front 151

Clinical applications of

Methacholine

Back 151

Challenge test for diagnosis of asthma

Front 152

Clinical applications of

Neostigmine

Back 152

Postoperative and neurogenic ileus and urinary
retention, myasthenia gravis, reversal of
neuromuscular junction blockade (postoperative)

Front 153

Clinical applications of

Pyridostigmine

Back 153

Myasthenia gravis; does penetrate CNS

Front 154

Clinical applications of

Edrophonium

Back 154

Diagnosis of myasthenia gravis (extremely short
acting)

Front 155

Clinical applications of

Physostigmine

Back 155

Glaucoma (crosses blood-brain barrier → CNS)
and atropine overdose

Front 156

Clinical applications of

Echothiophate

Back 156

Glaucoma

Front 157

which anticholinesterase is extremely short acting

Back 157

Edrophonium

Front 158

Cholinesterase inhibitor poisoning

symps

Back 158

DUMBBEL ASS.

Diarrhea, Urination, Miosis,
Bronchospasm, Bradycardia, Excitation of skeletal
muscle and CNS, Lacrimation, Abdominal cramping, Sweating, and Salivation

Front 159

Cholinesterase inhibitor poisoning

Tx

Back 159

Atropine (muscarinic antagonist) plus pralidoxime

Front 160

chemical antagonist used to regenerate active cholinesterase

Back 160

pralidoxime

Front 161

pralidoxime

uses and mech

Back 161

Cholinesterase inhibitor poisoning

chemical antagonist used to regenerate active cholinesterase

Front 162

Parathion

Back 162

organophosphate

Front 163

organophosphate toxicity mech

Back 163

Irreversible Cholinesterase inhibitor poisoning

Front 164

Atropine,

mech

Back 164

Muscarinic antagonist

Front 165

Benztropine

mech

Back 165

Muscarinic antagonist

Front 166

Scopolamine

mech

Back 166

Muscarinic antagonist

Front 167

Ipratropium

mech

Back 167

Muscarinic antagonist

Front 168

Methscopolamine,
oxybutin,
glycopyrrolate

mech

Back 168

Muscarinic antagonist

Front 169

Atropine

clinical use

Back 169

Produce mydriasis and cycloplegia

Front 170

Benztropine

clinical use

Back 170

Parkinson’s disease

Front 171

Scopolamine

clinical use

Back 171

Motion sickness

Front 172

Ipratropium

clinical use

Back 172

Asthma, COPD

Front 173

Methscopolamine,
oxybutin,
glycopyrrolate

clinical use

Back 173

Reduce urgency in mild cystitis and reduce bladder spasms

Front 174

Glaucoma drugs mech and side effects

Epinephrine

Back 174

↑ outflow of aqueous humor

Mydriasis, stinging; do not use
in closed-angle glaucoma

Front 175

Glaucoma drugs mech and side effects

Brimonidine

Back 175

↓ aqueous humor synthesis

No pupillary or vision changes

Front 176

Glaucoma drugs mech and side effects

β-blockers

Back 176

↓ aqueous humor secretion

No pupillary or vision changes

Front 177

Glaucoma drugs mech and side effects

Acetazolamide

Back 177

↓ aqueous humor secretion due to
↓ HCO3− (via inhibition of carbonic anhydrase)

No pupillary or vision changes

Front 178

Glaucoma drugs mech and side effects

Cholinomimetics

Back 178

↑ outflow of aqueous humor; contract ciliary muscle and open trabecular meshwork;

Miosis, cyclospasm

Front 179

Glaucoma drugs mech and side effects

Latanoprost (PGF2α)

Back 179

↑ outflow of aqueous humor

Darkens color of iris (browning)

Front 180

which glaucoma drug ↑ outflow of aqueous humor

Back 180

Epinephrine

Cholinomimetics

Prostaglandin (Latanoprost
(PGF2α))

Front 181

which glaucoma drug ↓ aqueous humor synthesis

Back 181

Brimonidine

Front 182

which glaucoma drug ↓ aqueous humor secretion

Back 182

β-blockers: Timolol, betaxolol,
carteolol

Diuretics: Acetazolamide

Front 183

which glaucoma drug causes Mydriasis, stinging; do not use
in closed-angle glaucoma

Back 183

Epinephrine

Front 184

which glaucoma drug causes Miosis, cyclospasm

Back 184

Cholinomimetics

Front 185

which glaucoma drug causes Darkens color of iris (browning)

Back 185

Prostaglandin: Latanoprost
(PGF2α)

Front 186

Atropine effects

Back 186

dilates pupils and Blocks SLUD:
↓Salivation
↓Lacrimation
↓Urination
↓Defecation

Front 187

Atropine Toxicity

Back 187

Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter

Front 188

Can cause acute angle-closure glaucoma in elderly, urinary retention in men with prostatic hypertrophy, and hyperthermia
in infants.

Back 188

Atropine

Front 189

Hexamethonium

Mechanism

Back 189

Nicotinic ACh receptor antagonist. Ganglionic blocker.

Front 190

Hexamethonium

Clinical use

Back 190

Ganglionic blocker. Used in experimental models to prevent vagal reflex responses to
changes in blood pressure– –e.g., prevents reflex bradycardia caused by NE.

Front 191

prevents reflex bradycardia caused by NE

Back 191

Hexamethonium

Front 192

Used in experimental models to prevent vagal reflex responses to
changes in blood pressure

Back 192

Hexamethonium

Front 193

selectivity for Sympathomimetics

Epinephrine

Back 193

α1, α2, β1, β2, low doses selective for β1

Front 194

selectivity for Sympathomimetics

NE

Back 194

α1, α2 >β1

Front 195

selectivity for Sympathomimetics


Isoproterenol

Back 195

β1 =β2

Front 196

selectivity for
Sympathomimetics

Dopamine

Back 196

D1 = D2 >β >α

Front 197

selectivity for Sympathomimetics

Dobutamine

Back 197

β1 >β2

Front 198

Mechanism for Sympathomimetics

Amphetamine

Back 198

Indirect general agonist, releases stored
catecholamines

Front 199

Mechanism for Sympathomimetics

Ephedrine

Back 199

Indirect general agonist, releases stored
catecholamines

Front 200

Mechanism forSympathomimetics

Cocaine

Back 200

Indirect general agonist, uptake inhibitor

Front 201

Mechanism for Sympathomimetics

Clonidine, α-methyldopa

Back 201

Centrally acting α-agonist, ↓ central
adrenergic outflow

Front 202

selectivity for Sympathomimetics

Phenylephrine

Back 202

α1 >α2

Front 203

selectivity for Sympathomimetics


Albuterol

Back 203

β2 >β1

Front 204

Mechanism/selectivity for Sympathomimetics

terbutaline

Back 204

β2 >β1

Front 205

name the Sympathomimetic

α1, α2, β1, β2, low doses selective for β1

Back 205

Epinephrine

Front 206

name the Sympathomimetic

α1, α2 >β1

Back 206

NE

Front 207

name the Sympathomimetic

β1 =β2

Back 207

Isoproterenol

Front 208

name the Sympathomimetic

β1 >β2

Back 208

Dobutamine

Front 209

name the Sympathomimetic

D1 = D2 >β >α

Back 209

Dopamine

Front 210

name the Sympathomimetic

Indirect general agonist, releases stored catecholamines

Back 210

Amphetamine

and

Ephedrine

Front 211

name the Sympathomimetic

α1 >α2

Back 211

Phenylephrine

Front 212

name the Sympathomimetic

β2 >β1

Back 212

Albuterol,

terbutaline

Front 213

name the Sympathomimetic

Indirect general agonist, uptake inhibitor

Back 213

Cocaine

Front 214

name the Sympathomimetic

Centrally acting α-agonist, ↓ central adrenergic outflow

Back 214

Clonidine,
α-methyldopa

Front 215

effect on BP and HR of

Norepinephrine

Back 215

(α > β)

↑ BP

↓ HR (reflex bradycardia)

Front 216

effect on BP and HR of


Epinephrine

Back 216

nonselective

NC BP( increases systolic, but decreases diastolic)

Front 217

effect on BP and HR of

Isoproterenol

Back 217

(β > α)

↓ BP

↑ HR

Front 218

Applications of Sympathomimetics

Epinephrine

Back 218

Anaphylaxis, glaucoma (open
angle), asthma, hypotension

Front 219

Applications of Sympathomimetics

NE

Back 219

Hypotension (but ↓ renal
perfusion)

Front 220

Applications of Sympathomimetics

Isoproterenol

Back 220

AV block (rare)

Front 221

Applications of Sympathomimetics

Dopamine

Back 221

Shock (↑ renal perfusion),
heart failure

Front 222

Applications of Sympathomimetics

Dobutamine

Back 222

Shock, heart failure cardiac
stress testing

Front 223

Applications of Sympathomimetics

Amphetamine

Back 223

Narcolepsy, obesity, ADHD

Front 224

Applications of Sympathomimetics

Ephedrine

Back 224

Nasal decongestion, urinary
incontinence, hypotension

Front 225

Applications of Sympathomimetics

Phenylephrine

Back 225

Pupil dilator, vasoconstriction,
nasal decongestion

Front 226

Applications of Sympathomimetics

Albuterol,
terbutaline

Back 226

Asthma

Front 227

Applications of Sympathomimetics

Cocaine

Back 227

Causes vasoconstriction and
local anesthesia

Front 228

Applications of Sympathomimetics

Clonidine,
α-methyldopa

Back 228

Hypertension, especially with
renal disease (no ↓ in blood
flow to kidney)

Front 229

name the Nonselective α-blockers

Back 229

Phenoxybenzamine

phentolamine

Front 230

name the α1 selective α-blockers

Back 230

Prazosin, terazosin,
doxazosin

Front 231

name the α2 selective α-blockers

Back 231

Mirtazapine

Front 232

Nonselective α-blockers

Application and Toxicity

Back 232

-Pheochromocytoma

-Orthostatic hypotension,
reflex tachycardia

Front 233

α1 selective α-blockers

Application and Toxicity

Back 233

-Hypertension, urinary retention in BPH

-1st-dose orthostatic hypotension, dizziness, headache

Front 234

α2 selective α-blockers

Application and Toxicity

Back 234

-Depression

-Sedation, ↑ serum cholesterol, ↑ appetite

Front 235

Nonselective α-blockers

names and differences

Back 235

Phenoxybenzamine (irreversible)


phentolamine (reversible)

Front 236

effects of an α-blocker (e.g., phentolamine) on BP responses to epinephrine and phenylephrine.

Back 236

The epinephrine response exhibits reversal of the mean blood pressure change, from a net increase (the α response) to a net decrease (the β2 response). The response to phenylephrine is suppressed but not reversed because phenylephrine is a “pure” α-agonist without β action.

Front 237

β-blockers

non selective ones

Back 237

Nonselective (N or later)(β1 = β2)––propranolol, timolol, nadolol, pindolol (partial agonist), and

labetalol (partial agonist, and exception to the after N rule and the olol rule)

Front 238

β-blockers

selective ones

Back 238

Before N

β1 selective (β1 > β2)–– Betaxolol, Esmolol (short acting), Atenolol,
Metoprolol

Acebutolol (partial agonist hes and Ass),

Front 239

β-blocker effect WRT

Hypertension

Back 239

↓ cardiac output, ↓ renin secretion

Front 240

β-blocker effect WRT

Angina pectoris

Back 240

↓ heart rate and contractility, resulting in ↓ O2 consumption

Front 241

β-blocker effect WRT

MI

Back 241

β-blockers ↓ mortality

Front 242

β-blocker effect WRT

SVT

Back 242

↓ AV conduction velocity

Front 243

β-blocker effect WRT

CHF

Back 243

Slows progression of chronic failure

Front 244

β-blocker effect WRT Glaucoma

Back 244

↓ secretion of aqueous humor

Front 245

which β-blockers

Tx for Glaucoma

Back 245

timolol

Front 246

which β-blockers

Tx for SVT

Back 246

propranolol, esmolol

Front 247

β-blockers

Toxicity (non cardiac)

Back 247

1. Impotence,
2. exacerbation of asthma,
3. CNS adverse effects (sedation, sleep alterations);
4. diabetics can't feel low sugar

Front 248

β-blockers

Toxicity (cardiac)

Back 248

-bradycardia,
-AV block,
-CHF

Front 249

antidote for

Acetaminophen

Back 249

1. N-acetylcysteine

Front 250

antidote for

Salicylates

Back 250

2. Alkalinize urine, dialysis

Front 251

antidote for

Anticholinesterases, organophosphates

Back 251

3. Atropine, pralidoxime

Front 252

antidote for

Antimuscarinic, anticholinergic agents

Back 252

4. Physostigmine salicylate

Front 253

antidote for

β-blockers

Back 253

5. Glucagon

Front 254

antidote for

Digitalis

Back 254

6. Stop dig, normalize K+,
lidocaine, anti-dig Fab
fragments, Mg2+

Front 255

antidote for

Iron

Back 255

7. Deferoxamine

Front 256

antidote for

Lead

Back 256

8. CaEDTA, dimercaprol,
succimer, penicillamine

Front 257

antidote for

Arsenic, mercury, gold

Back 257

9. Dimercaprol (BAL),
succimer

Front 258

antidote for

Copper, arsenic, gold

Back 258

10. Penicillamine

Front 259

antidote for

Cyanide

Back 259

11. Nitrite, hydroxocobalamin,
thiosulfate

Front 260

antidote for

Methemoglobin

Back 260

12. Methylene blue

Front 261

antidote for

Carbon monoxide

Back 261

13. 100% O , hyperbaric O

Front 262

antidote for

Methanol, ethylene glycol (antifreeze)

Back 262

14. Ethanol, dialysis, fomepizole

Front 263

antidote for

Opioids

Back 263

15. Naloxone/naltrexone

Front 264

antidote for

Benzodiazepines

Back 264

16. Flumazenil

Front 265

antidote for


TCAs

Back 265

17. NaHCO3 (nonspecific)

Front 266

antidote for

Heparin

Back 266

18. Protamine

Front 267

antidote for

Warfarin

Back 267

19. Vitamin K, fresh frozen
plasma

Front 268

antidote for

tPA, streptokinase

Back 268

20. Aminocaproic acid

Front 269

antidote for

Basic amphetamines

Back 269

NH4CL (acidify urine)

Front 270

This antidote is used for

NH4CL (acidify urine)

Back 270

Basic amphetamines

Front 271

This antidote is used for

Aminocaproic acid

Back 271

tPA, streptokinase

Front 272

This antidote is used for

Vitamin K, fresh frozen
plasma

Back 272

Warfarin

Front 273

This antidote is used for

Protamine

Back 273

Heparin

Front 274

This antidote is used for

NaHCO3 (nonspecific)

Back 274

TCAs

Front 275

This antidote is used for

Flumazenil

Back 275

Benzodiazepines

Front 276

This antidote is used for

N-acetylcysteine

Back 276

1. Acetaminophen

Front 277

This antidote is used for

Alkalinize urine, dialysis

Back 277

2. Salicylates

Front 278

This antidote is used for

Atropine, pralidoxime

Back 278

3. Anticholinesterases, organophosphates

Front 279

This antidote is used for

Physostigmine salicylate

Back 279

4. Antimuscarinic, anticholinergic agents

Front 280

This antidote is used for

Glucagon

Back 280

5. β-blockers

Front 281

This antidote is used for

Stop dig, normalize K+,
lidocaine, anti-dig Fab
fragments, Mg2+

Back 281

6. Digitalis

Front 282

This antidote is used for

Deferoxamine

Back 282

7. Iron

Front 283

This antidote is used for

CaEDTA, dimercaprol,
uccimer, penicillamine

Back 283

8. Lead

Front 284

This antidote is used for

Dimercaprol (BAL),
succimer

Back 284

9. Arsenic, mercury, gold

Front 285

This antidote is used for

Penicillamine

Back 285

10. Copper, arsenic, gold

Front 286

This antidote is used for

Nitrite, hydroxocobalamin,
thiosulfate

Back 286

11. Cyanide

Front 287

This antidote is used for

Methylene blue

Back 287

12. Methemoglobin

Front 288

This antidote is used for

100% O2, hyperbaric O2

Back 288

13. Carbon monoxide

Front 289

This antidote is used for

Ethanol, dialysis, fomepizole

Back 289

14. Methanol, ethylene glycol (antifreeze)

Front 290

This antidote is used for

Naloxone/naltrexone

Back 290

15. Opioids

Front 291

signs of Lead poisoning

Back 291

LEAD.

-Lead Lines on gingivae and on epiphyses on x-ray.
-Encephalopathy and RBC basophilic stippling.
-Abdominal colic and sideroblastic Anemia.
-Drops––wrist and foot drop.

Front 292

Drug reaction by system

Cardiovascular Atropine-like side
effects

Back 292

-Tricyclics

Front 293

Drug reaction by system

Cardiac toxicity

Back 293

-Doxorubicin (Adriamycin), -daunorubicin

Front 294

Drug reaction by system

Coronary vasospasm

Back 294

Cocaine

Front 295

Drug reaction by system

Cutaneous flushing

Back 295

-Niacin,
-Ca2+ channel blockers,
-adenosine,
-vancomycin

Front 296

Drug reaction by system

Torsades des pointes

Back 296

-Class III (sotalol),
-class IA (quinidine)
-cisapride

Front 297

Drug reaction by system

Agranulocytosis

Back 297

-Clozapine,
-carbamazepine,
-colchicine

Front 298

Drug reaction by system

Aplastic anemi

Back 298

-Chloramphenicol,
-benzene,
-NSAIDs

Front 299

Drug reaction by system

Gray baby syndrome

Back 299

Chloramphenicol

Front 300

Drug reaction by system

Hemolysis in G6PD-
deficient patients

Back 300

IS PAIN

isoniazid (INH),
Sulfonamides,

primaquine,
aspirin,
ibuprofen,
nitrofurantoin

Front 301

Drug reaction by system

Thrombotic complications

Back 301

OCPs (e.g., estrogens and progestins)

Front 302

Drug reaction by system

Cough

Back 302

ACE inhibitors

Front 303

Drug reaction by system

Pulmonary fibrosis

Back 303

Bleomycin,
amiodarone,
busulfan

Front 304

Drug reaction by system

Acute cholestatic
hepatitis

Back 304

Macrolides

Front 305

Drug reaction by system

Focal to massive
hepatic necrosis

Back 305

Halothane,
valproic acid,
acetaminophen,
Amanita phalloides

Front 306

Drug reaction by system

Hepatitis

Back 306

INH

Front 307

Drug reaction by system

Pseudomembranous
colitis

Back 307

Clindamycin, ampicillin

Front 308

Drug reaction by system

Gynecomastia

Back 308

(Some Drugs Create Awesome, Excellent Knockers)

Spironolactone,
Digitalis,
Cimetidine,
Alcohol chronicuse,
Estrogens,
Ketoconazole

Front 309

Drug reaction by system

Hot flashes

Back 309

Tamoxifen

Front 310

Drug reaction by system

Gingival hyperplasia

Back 310

Phenytoin

Front 311

Drug reaction by system

Osteoporosis

Back 311

Corticosteroids, heparin

Front 312

Drug reaction by system

Photosensitivity

Back 312

(SAT for a photo)

Sulfonamides,
Amiodarone,
Tetracycline

Front 313

Drug reaction by system

SLE-like syndrome

Back 313

(it’s not HIPP to have lupus)

Front 314

Drug reaction by system

Tendonitis, tendon rupture, and cartilage damage (kids)

Back 314

Fluoroquinolones

Front 315

Drug reaction by system

Fanconi’s syndrome

Back 315

Expired tetracycline

Front 316

Drug reaction by system

Interstitial nephritis

Back 316

Methicillin

Front 317

Drug reaction by system

Hemorrhagic cystitis

Back 317

Cyclophosphamide,
ifosfamide

Front 318

Drug reaction by system

Cinchonism

Back 318

Quinidine,
quinine

Front 319

Drug reaction by system

Diabetes insipidus

Back 319

Lithium,
demeclocycline

Front 320

Drug reaction by system

Tardive dyskinesia

Back 320

Antipsychotics

Front 321

Drug reaction by system

Disulfiram-like
reaction

Back 321

Metronidazole,
certain cephalosporins,
procarbazine,
sulfonylureas

Front 322

Drug reaction by system

Nephrotoxicity/
neurotoxicity

Back 322

Polymyxins

Front 323

Drug reaction by system

Nephrotoxicity/
ototoxicity

Back 323

Aminoglycosides,
loop diuretics,
cisplatin

Front 324

P-450 Inducers

Back 324

"Queen Barb takes Phen-phen
and Refuses Greasy Carved Steak"

Quinidine (can inhibit too), Barbiturates, Phenytoin, Rifampin, Griseofulvin, Carbamazepine,
St. John’s wort

Front 325

P-450 Inhibitors

Back 325

Inhibitors Stop Cyber-Kids
from Eating Grapefruit.

Isoniazid
Sulfonamides
Cimetidine
Ketoconazole
Erythromycin
Grapefruit juice

Front 326

Iron Poisioning

Mech

Back 326

Cell death due to peroxidation of membrane lipids

Front 327

Iron Poisioning

Symps

Back 327

acute - gastric bleeding

chronic - metabolic acidosis, scarring (leading to GI obstruction)

Front 328

INHIBITED BY DISULFIRAM

Back 328

Acetaldehyde dehydrogenase

Front 329

COMPETITIVE SUBSTRATES
FOR Alcohol
dehydrogenase

Back 329

-Ethylene glycol
-Methanol
-Ethanol

Front 330

Alcohol toxicity

Ethylene glycol

Back 330

Acidosis,
nephrotoxicity

Front 331

Alcohol toxicity

Methanol

Back 331

Severe acidosis,
retinal damage

Front 332

Alcohol toxicity

Ethanol

Back 332

Nausea, vomiting,
headache,
hypotension

Front 333

which Alcohol toxicity

Acidosis, nephrotoxicity

Back 333

Ethylene glycol

Front 334

which Alcohol toxicity

Severe acidosis, retinal damage

Back 334

Methanol

Front 335

which Alcohol toxicity

Nausea, vomiting, headache,
hypotension

Back 335

Ethanol

Front 336

Alcohol toxicity

what causes the problem in Ethylene glycol

Back 336

Build up of Oxalic acid

Front 337

Alcohol toxicity

what causes the problem in Methanol

Back 337

Build up of Formaldehyde
and formic acid

Front 338

Alcohol toxicity

what causes the problem in Ethanol

Back 338

Build up of Acetaldehyde

Front 339

which Alcohol toxicity

Oxalic acid is the problem

Back 339

Ethylene glycol

Front 340

which Alcohol toxicity

Formaldehyde and formic acid is the problem

Back 340

Methanol

Front 341

which Alcohol toxicity

Acetaldehyde is the problem

Back 341

Ethanol

Front 342

Drugs that cause problems in patients with sulfa allergies

Back 342

Celecoxib, furosemide, thiazides, TMP-SMX, sulfonyureas,
sufasalazine

Front 343

Herbal agents Clinical uses and Toxicities

Echinacea

Back 343

Common cold

no major

Front 344

Herbal agents Clinical uses and Toxicities

Ephedra

Back 344

As for ephedrine

CNS and cardiovascular stimulation; arrhythmias,
stroke, and seizures at high doses

Front 345

Herbal agents Clinical uses and Toxicities

Feverfew

Back 345

Migraine

mouth ulcers, antiplatelet actions

Front 346

Herbal agents Clinical uses and Toxicities

Ginkgo

Back 346

Intermittent claudication

anxiety, insomnia, antiplatelet actions

Front 347

Herbal agents Clinical uses and Toxicities

Kava

Back 347

Chronic anxiety

sedation, ataxia, hepatotoxicity,
phototoxicity, dermatotoxicity

Front 348

Herbal agents Clinical uses and Toxicities

Milk thistle

Back 348

Viral hepatitis

Loose stools

Front 349

Herbal agents Clinical uses and Toxicities

Saw palmetto

Back 349

Benign prostatic hyperplasia

↓ libido, hypertension

Front 350

Herbal agents Clinical uses and Toxicities

St. John’s wort

Back 350

Mild to moderate depression

phototoxicity; serotonin syndrome
with SSRIs; induces P-450 system

Front 351

Herbal agents Clinical uses and Toxicities

Dehydroepiandrosterone

Back 351

Symptomatic improvement in females with SLE or AIDS

Androgenization (premenopausal women), estrogenic effects (postmenopausal), feminization (young men)

Front 352

Herbal agents Clinical uses and Toxicities

Melatonin

Back 352

Jet lag,

Sedation, suppresses midcycle LH,
hypoprolactinemia

Front 353

Drug name Ending / Category

-afil

Back 353

Erectile dysfunction

Front 354

Drug name Ending / Category

Erectile dysfunction

Back 354

-afil

Front 355

Drug name Ending / Category

-ane

Back 355

Inhalational general anesthetic

Front 356

Drug name Ending / Category

Inhalational general anesthetic

Back 356

-ane

Front 357

Drug name Ending / Category

-azepam

Back 357

Benzodiazepine

Front 358

Drug name Ending / Category

Benzodiazepine

Back 358

-azepam

Front 359

Drug name Ending / Category

-azine

Back 359

Phenothiazine (neuroleptic, antiemetic)

Front 360

Drug name Ending / Category

Phenothiazine (neuroleptic, antiemetic)

Back 360

-azine

Front 361

Drug name Ending / Category

-azole

Back 361

Antifungal

Front 362

Drug name Ending / Category

Antifungal

Back 362

-azole

Front 363

Drug name Ending / Category

-barbital

Back 363

Barbiturate

Front 364

Drug name Ending / Category

Barbiturate

Back 364

-barbital

Front 365

Drug name Ending / Category

-caine

Back 365

Local anesthetic

Front 366

Drug name Ending / Category

Local anesthetic

Back 366

-caine

Front 367

Drug name Ending / Category

-cillin

Back 367

Penicillin

Front 368

Drug name Ending / Category

Penicillin

Back 368

-cillin

Front 369

Drug name Ending / Category

-cycline

Back 369

Antibiotic, protein synthesis inhibitor

Front 370

Drug name Ending / Category

Antibiotic, protein synthesis inhibitor

Back 370

-cycline

Front 371

Drug name Ending / Category

-ipramine

Back 371

TCA

Front 372

gjkgjh

Back 372

ghjkghjkgh

Front 373

Drug name Ending / Category

Protease inhibitor

Back 373

-navir

Front 374

Drug name Ending / Category

-navir

Back 374

Protease inhibitor

Front 375

Drug name Ending / Category

-olol

Back 375

β-antagonist

Front 376

Drug name Ending / Category

β-antagonist

Back 376

-olol

Front 377

Drug name Ending / Category

-operidol

Back 377

Butyrophenone (neuroleptic)

Front 378

Drug name Ending / Category

Butyrophenone (neuroleptic)

Back 378

-operidol

Front 379

Drug name Ending / Category

-oxin

Back 379

Cardiac glycoside (inotropic agent)

Front 380

Drug name Ending / Category

Cardiac glycoside (inotropic agent)

Back 380

-oxin

Front 381

Drug name Ending / Category

-phylline

Back 381

Methylxanthine

Front 382

Drug name Ending / Category

Methylxanthine

Back 382

-phylline

Front 383

Drug name Ending / Category

-pril

Back 383

ACE inhibitor

Front 384

Drug name Ending / Category

ACE inhibitor

Back 384

-pril

Front 385

Drug name Ending / Category

-terol

Back 385

β2 agonist

Front 386

Drug name Ending / Category

β2 agonist

Back 386

-terol

Front 387

Drug name Ending / Category

-tidine

Back 387

H2 antagonist

Front 388

Drug name Ending / Category

H2 antagonist

Back 388

-tidine

Front 389

Drug name Ending / Category

TCA

Back 389

-triptyline

or

-ipramine

Front 390

Drug name Ending / Category

-ipramine

Back 390

TCA

Front 391

Drug name Ending / Category

-tropin

Back 391

Pituitary hormone

Front 392

Drug name Ending / Category

Pituitary hormone

Back 392

-tropin

Front 393

Drug name Ending / Category

-zosin

Back 393

α1 antagonist

Front 394

Drug name Ending / Category

α1 antagonist

Back 394

-zosin