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101 Cards in this Set

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mode of administration of all aminoglycosides
parenteral
activation of INH
must be converted to active metabolite within mycobacterial cells by mycobacterial catalase-peroxidase
mechanism of INH
decreased mycolic acid synthesis
mech of ethambutol
interferes with mycobacterial peptidoglycan cell wall synthesis
theophylline mech of action
inhibits PDE ==> inc cAMP, prevents degranulation; v. narrow TI: acts as a general stimulator --> seizures, arrythmias, GI diarrhea/vom
tx for theophylline tox
tox is overstimulation, so give beta-blockers (eg esmolol) for arrythmias, benzos for seizures
etanercept
humanized monoclonal AB; binds TNF (anti-inflam); used in RA, psoriasis/psoriatic arthritis
capsofungin mech, use
blocks cell WALL synthesis, aspergillis/candida
None
amphotericin B mech
"punches holes" in fungal cell MEMBRANE
azoles mech
inhibit fungal cell MEMBRANE synthesis (ergosterols)
nystatin mech
binds ergosterol, disrupts fungal MEMBRANES
terbinafine mech, use
inhibits membrane synthesis one step down (--| squalene epoxidase); tx dermatophytes (along w/ griseofulvin)
flucytosine mech, use, tox
inhibits DNA synth (nucleotide analog); used for systemic fungal infections (esp candida and cryptococcus); can cause BM suppression
rifampin propylaxis used for ______
neisseria or HIB
Griseofulvin mech
binds microtubules, inhibits mitosis (other drugs that act on microtubules: taxol, vincristine/vinblastine, colchicine, mebendazole/thiabendazole)
omalizumab
monoclonal antibody against IgE (prevents IgE from binding to mast cells)
muscarinic effects in airways
bronchoconstriction (that’s why ipratroprium, antimuscarinic, helps in asthma)
drugs contraindicated with cations (eg antacids)
tetracycline (chelates cations) and fluoroquinolones (reduced absoroption too?)
trastuzumab
monoclonal Ab against HER-2 (useful against some breast cancers)
warfarin vs heparin in pregnant women
warfarin crosses placenta, heparin doesn't
ticlopidine
like clopidegril -- blocks ADP-mediated aggregation
main tox of cyclophosphamide
hemorrhagic cystitis
how to prevent main tox of cyclophosphamide
give Mesna as adjunct tx
uses of N-Acetylcysteine
1) Acetominophen antidote (increases glutathione reserves); 2) mucolytic agent (eg CF, bronchitis); 3) reno-protective agent (in pts with renal insufficiency who need radio contrast)
main use of ondansetron
inhibits 5-HT3 receptors, tx n/v following chemo
Two drugs that inhibit thymidylate formation + differences
MTX + 5-FU; MTX can be recovered by Folinic acid, 5-FU cannot, b/c 5-FU blocks further down pathway (beyond folinic acid entry)
role of HIV gp41 and gp120
gp120 facilitates attachment, gp41 facilitates fusion via conformational change
low crit in elderly woman -- what's the deficiency?
usu B12: elderly patients become achloridic --> impaired B12 absorption; adminster B12 parenterally
4 main classes of antifungals
1) polyenes: bind ergosterol in cell membrane(nystatin, amphotericin B); 2) Triazoles: inhibit ergosterol synth (ketoconazole, itraconozole); 3) Echinocandins: inhibit glucan synthesis -- component of fungal cell wall (capsofungin, micafungin); 4) pyrimidines: flucytosine -- converted to 5-FU in fungal membrane;
Ethambutol
inhibits carbohydrate polymerization; can cause optic neuritis --> decreased visual acuity, central scotoma (the ethan butane torch! It burns my eyes!)
Wilms Tumor sx
WAGR complex (Wilms tumor, Aniridia, GU malformation, mental and motor Retardation)
prazosin
competitive alpha 1 antagonist
phenoxybenzamine
only non-competitive alpha 1 blocker (used to tx pheo and malignant htn)
which tetracycline in renal failure?
doxycycline or minocycline -- excreted in feces
mycophenolate mofetil (MMF)
converted to mycophenolic acid (MPA) --| de novo guanine synth ==> blocks lymphocyte proliferation
early presentation of salicylate tox
tinnitus (followed by: acidosis, gastric irritation, elevated BT, and hyperventilation, not necessarily in that order)
warfarin tox:
can cause necrosis of the skin (by depletion of protein C --> aberrent thrombosis in cutaneous microvasculature): sharply demarcated, erythematous, purpuric lesions which either resolve or progress to large, irregular hemorrhagic bullae
acute tx of amphetamine-induced agitated/psychotic state
ammonium chloride (hastens amphetamine excretion, b/c amphetamine is a weak base and ammonium chloride acidifies the urine)
tx of CF mucus plugs
N-acetylcysteine (mucolytic, splits disulfide linkages)
clubbing
a/w heart and lung dz, incl: cancer, cf, interstitial lung dz., NOT COPD
warfarin: monitor PT or PTT?
"the EX-PaTriot went to WAR(farin)" --> monitor PT, extrinsic pathway
lepirudin
direct thrombin inhibitor; used in HIT; (hirudin class)
tx for HIT
lepirudin or other members of hirudin class (direct thrombin inhibitor)
vincristine vs paclitaxel
vincristine prevents microtubule formation, paclitaxel prevents microtuble degradation
eqn for half life
halflife= 0.7Vd/CL
tx for AML
"caramel": c-ara AML (cytarabine) + daunorubicin
omalizumab
monoclonal Ab that binds to IgE -- used in asthma that is not well controlled by steroids
infliximab
binds TNF-alpha; used in crohn's and RA
ipratropium
muscaranic antagonist with minimal systemic side effects; usedin asthma (esp with COPD)
theophylline
inhibits PDE --> increases cAMP; narrow TI (cardiotox, neurotox)
antineoplastics with cardiac tox
doxorubicin, daunorubicin
antineoplastics with pulm fibrosis
bleomycin, busulfan
antineoplastics with CNS Tox (periph neuropathy, ileus)
vincristine
antineoplastics with renal and acoustic nerve tox
cisplatin
tx of klebsiella
cephalosporins
tx for legionella
erythromycin ("a wreath on legionairre's grave")
tx for anaerobes above the diaphragm
clindamycin
tx for anaerobes below the diaphragm
metronidazole
tx of oral candidiasis
"nystatin, swish and swallow" + fluconazole
nystatin
antifungal, punches holes in ergosterol (like amphoteicin-B); too toxic for IV, but not absorbed thru GI; main use: CANDIDIASIS
penicillin cross allergy
amoxicillin, cephalosporins
cyclosporine + {tacrolimus | sacrolimus}
NEPHROTOXICITY! Additive toxicity, so don’t give within 24 hrs
OC metabolism
p450
avoid OCs with
p450 inducers (Quinidine, Barbiturates, Phenytoin, Rifampin, Griseofulvin, Carbemazepine)
cyclophosphamide mech, use
alkylating agent, causes dna cross-linking; used for non-hodgkin's lymphoma (C in CHOP)
6-mp mech
inhibits purine synthesis (6-mercaptoPURINE), requires conversion by HGPRT
vinca alkaloids
bind tubuilin, prevent polymerization (unlike taxol: prevents degradation)
dna intercalators
bleomycin, doxorobucin
6-MP contraindicated with what drug?
allopurinol --| xanthine oxidase, which is needed for metabolism of 6-MP ==> allopurinol causes increased 6-MP levels --> hepatotox
Chvostek sign
tapping face in front of ear elicits tetany --> hypocalcemia
trousseau sign
BP cuff occludes brachial artery --> carpal spasm (indicates hypocalcemia)
ergocalciferol
vit d2 (used for hypocalcemia)
cyclosporine mech
ihbits production and release of IL-2 by binding cyclophillin, inhibtiting calcineurin, thereby inhibiting NF-kB activity
bethanechol
muscarinic agonists (like methacholine, carbachol, pilocarpine) -- Bethnechol stimulates Bowel and Bladder; AChE resistant
glaucoma drugs
PETA: Pilocarpine (ACh agonist), Echothiophate (AChEi), Timilol (Beta blocker), Acetazolamide (CA inhibitor)
ACh agonist and AChEi combinations
Carbechol/Pilocarpine + Echothiophate/Physostigmine for Glaucoma; Bethanechol + Neostigmine for post-surgical/neurological ileus or urinary retention
tx for myasthenia gravis
AChEi (neostigmine, pyridostigmine)
physostigmine
AChEi used for glaucoma; has good CNS penetrance, so also used for atropine overdose
benztropine
Centrally acting anticholinergic --> used for parkinsons
scopolamine
Centrally acting anticholinergic --> used for motion sickness
dx of myasthenia gravis
edrophonium: extremely short acting AChEi (10mins), see if it relieves sx
nervous control of ciliary muscle
cholinergic (carbechol/pilocarpine = cholinomimetics, activate ciliary muscle --> relieve openangle glaucoma; also, atropine causes ciliary muscle paralysis --> cycloplegia:no accomodation)
NE selectivity
a1,a2 > B1
Epi selectivity
B1,B2 (low dose) > a1,a2 (high dose)
Dopamine Selectivity
D1=D2>B>a AGONIST
dobutamine
B1>B2 (no alpha activity) AGONIST
isoproterenol
B1=B2 AGONIST
phenylephrine
a1>a2 AGONIST
terbutaline
like albuterol, b2>b1 AGONIST; used to reduce contractions in premature labor
drug used for hypertension with renal disease
a2 agonist (clonidine or alpha-methyldopa) b/c no decrease in blood flow to renal vasculature
adrenergic agent used in pregnancy-induced hypertension
alpha-methyldopa
nonselective alpha antagonists (2) + uses and differences
phenoxybenzmine (irreversible) and phentolamine (reversible); both used for pheo
alpha1 blocker
prazosin, terazosin, doxazosin -- used for BPH urinary retention or HTN
alpha2 blocker
mirtazapine: anti-depressent; causes weight gain (inc appetite, inc cholesterol)
drug of choice for shock
Dopamine: inc BP via B1/a1, while D1 and D2 also vasoconstricts (but vasodilates renal vasculature, preserves renal function)
beta blockers used in SVT
propanolol, esmolol
lead poisoning
LEAD (Lead lines on gingivae and epypheses on xray; Encephalopathy and Erythrocyte basophilic stippling; Anemia (sideroblastic) and Abdominal colic; Drop (foot, wrist), eDta and Dimercaprol = firstline tx)
alkalinization of urine helps clearance of which drugs?
weak acids -- aspirin, phenobarbital, methotrexate
acidification of urine helps clearance of which drugs?
weak bases -- amphetamines
misoprostol
PGE1 analog; used to protect GI, maintain *patent* PDA, and induce labor (increases uterine tone -- opposite of terbutaline)
how to close PDA
give indomethacin (NSAID --| PGE --> sustains PDA, along with hypoxia)