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108 Cards in this Set

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nortryptyline: class, s/e
TCA, hyperprolactinemia --> galactorrhea
drugs that cause galactorrhea
things that affect dopamine/norepi pathways: TCAs, tranquilizers, methyldopa, narcotics, phenothiazines (chlorpromazine, fluphenazine, etc.)
contraindications for sulfonylureas
hepatic dysfunction
metformin class, tox
biguanide; tox: lactic acidosis (esp in pts with HF, liver dz, acidosis, or renal insufficiency)
oral hypoglycemics contra-indicated in heart failure
metformin (lactic acidosis); glitizides (exacerbated CHF)
HSV histo findings
ground glass nuclei, intranuclear inclusions (Cowdry bodies), multinucleated giant cells
tx of cryptococcus
amphotericin B + flucytosine
tx of candida
fluconazole, nystatin
antiemetic, prokinetic; used for n/v, GERD; MECH: DA antagonist --> s/e include exacerbation of parkinsonian sx
antiemetic, 5-HT3 antagonist, used esp after chemo / gen anesthesia
aluminium salt --> can cause constipation (aluMINIMUM feces)
glitizone mech
PPAR-gamma --> increased insuiln sensitivity (just like exercise)
uterus smooth muscle receptors
alpha1: contraction; beta2: relaxation
somatostatin analog; USES: gastrinoma/glucagonoma, acromegaly, variceal bleeding (decreases blood flow to portal system)
tx for estrogen-dependent breast cancer; MECH: androstenedione analog --> inhibits aromatase
eukaryotic analog of fluoroquinolones: inhibits topoisomerase; used for testicular cancer, small cell lung carcinoma, and leukemia
primary bile acid -- reduces cholesterol secretion into bile, helps dissolve cholesterol gallstones
tx for duodenal ulcer (caused by h.pylori)
Triple Therapy: Bizmuth + Metronidazole + {amoxicillin | tetracycline} (some ppl also use PPI)
PGF2 derivative, used topically for glaucoma (smooth muscle relaxation --> facilitates aqueous humor outflow)
tx for variceal bleeding
octreotide or vasopressin (both decrease blood flow to splanchnic vessels)
obesity management; inhibits pancreatic lipase; mimics pancreatitis --> fat malabsorption --> steatorrhea, ADEK defic, OBESITY MANAGEMENT
obesity management; 5-HT/NE reuptake inhibitor --> satiety
propylthiouracil vs methimazole
both used for hyperthyroidism: inhibit iodine organification (inhibit TPO); PTU also inhibits peripheral T4-->T3(active) conversion; Methimazole is more dangerous -- teratogen
glucose entry without insulin into____
BRICKL (Brain, RBCs, Intestine, Cornea, Kidney, Liver)
SS analog; ss --| {GH, glucagon, insulin} ==> can be used to stop tumors secreting any of the above
stimulates milk letdown and labor --> can be used as an abortificant
desmopressin (DDAVP)
V1: vasoconstrict, esp splanchnic (stops variceal bleeds); V2: H2O reabsoroption (tx central DI); V3: releases vWF and factor VIII (tx Hemophilia A and vWD)
cimetidine vs other H2 blockers
cimetidine has more tox: gynecomastia, p450 inhibition (Inhibitors Keep Some Crazy Kids from Eating Grapefruit RindS)
misoprostol tox
diarrhea, abortifacient
RU-486; partial agonist of progesterone: abortifacient in first 2 mos of preg
antacids, s/e
MgOH:diarrhea (MustGo to bathroom); AlOH3:constipation (aluMINIMUM feces); CaCO3: hypercalcemia; all cause hypokalemia (as antacid works, H+ comes out of cells while K+ goes into cells)
Tx for IBD
Infliximab (anti-TNFa) and Sulfasalazine (metabolized to 5-ASA and sulfapyridine by colonic bacteria --> especially good for UC); both can be used for RA; sulfasalazine can cause reversible oligospermia
pirenzapine, propantheline
antimuscarinic antacids: two actions: 1) --| M1 (ECL cells) --> histamine; 2) --| M3 (parietal cells) --> H+
DA antagonist antiemetics
phenothiazine, metoclopramide, prochlorperazine; can cause parkinsonion exacerbation
opiod antidiarrheals
loperamide, diphenoxylate
fibrates vs niacin
fibrates increase VLDL excretion, niacin blocks VLDL synthesis; both cause decreased VLDL --> decreased LDL; fibrates cause muscle tox, niacin causes flushing and pruritis
what receptor do glitizones act on?
ppar-gamma (intranuclear transcription factor) --> adiponectin; takes days-weeks to see reduction in glucose levels
propanolol in hyperthyroidism
2 effects: 1) Blocks adrenergic overstim; 2) prevents T4->T3 convesion by unknown meck; used to tx acute symptoms: tachycardia, hypertension, tremor, mood swings, fatigue; (NOT exophthalmos -- caused by fibroblast proliferation in bony orbit soft tissue mass)
aromatase inhibitor (tx breast cancer)
monoclonal antibody against HER2/neu receptors --> tx certain brest cancers
opiod anti-diarrheal (combined with atropine to prevent abues by overdose)
tx of hyperthyroidism (3)
1) anion inhibitors (perchlorate, pertechnetate): compete w/ iodine for uptake by thyroid gland; 2) thionamides (methimazole, propylthiouracil): inhibit TPO, preventing synthesis; 3) iodide salts: inhibit synthesis and relase of TH
tx of choice in gestational DM
insulin (oral hypoglycemics cross placenta and put fetus at risk of hypoglycemia)
metformin tox
NOT HYPOGLYCEMIA! Lactic acidosis (esp in hepatic / renal damage, CHF, alcoholism, or sepsis)
manifestation of adrenal crisis + tx
hypocortisol --> hypotension, hypoglycemia, reflex tachycardia; elevated ACTH --> hyperpigmentation; often treated with glucocorticoids
acute tx for hypoglycemic attack causing loss of consciousness
IM glucagon or IV glucose (can't give enough glucose IM)
Cortisol effects
predominantly catabolic: gluconeogenesis in liver and proteolysis in skel muscle; --| fibroblasts / collagen formation in skin ==> thin skin --> striae; immunosuprpression ( --| circulating T-cells ) + demargination of PMNs (acutely); osteoporosis
main cause of serum sickness
hypersensitivity to drugs
common signs of serum sickness
fever, urticaria, lymphadenopathy, arthralgias, sometimes erythema multiforme
tx for serum sickness
steroids for arthralgias/skin rash, antihistamine for urticaria
side effects of neuroleptics (and their time of onset)
4h: acute dystonia--sustained contractions, twisting motions; 4d: akinesia--absence of movement, parkinsonian sx; 4wks: akathisia--restlessness; 4mo: tardive disknesia--irreversible choreoathetoid movements
signs of parkinsonism
mask-like facies, drooling, tremors, pill-rolling, cogwheel rigidity, shuffling gait
neurotransmitters in parkinson's disease
dopamine depletion --> impalance between dopamine and acetylcholine --> tx by replacing dopamine or decreasing acetylcholine.
mab against IL-2 receptor
Ab for HER2/neu -- used in specific breast cancer
ring-shaped lesions with central clearing and advancing scaly border, hyphae on KOH
tinea corporis (ring worm), tx w/ topical antifungal cream (-azole)
1st line tx for general anxiety disorder
buspirone -- fewer side effects than TCAs or benzos (both traditionally used for GAD)
lithium s/e
LMNOP: Lithium, Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy problems
drugs toxic in pregnancy
lithium, doxycycline, oral hypoglycemics (use insuilin), ….
classes of anesthetics, how to differentiate, usefulness
amide (two 'I's), esters (one 'I'); no cross allergy, so if allergic to drug in one class, give drug from other class
DA release: increase DA
Amantadine (anti-Influenza antiviral) -- increases DA release or inhibits reuptake, used w/ L-DOPA
Anticholinergic tx for Parkinsons
benztropine -- central antimuscarinic, helps resolve ACh/DA imbalance --> improves rigidity and tremor (but doesn't affect bradykinesia)
L-DOPA tox, short and long term
short-term: arryhthmias (peripheral conversion to DA, prevented by combining tx with carbidopa); long-term: on/off phenomenon as therapeutic window narrows
sumatriptan: mech, use, tox
5-HT1 antagonist; causes vasoconstriction --> used for migraines; s/e: coronary vasopasm (contraindicated in Prinzmetal's angina -- "Suma's a princess")
drugs that cause hirsutism
phenytoin, minoxidil
tx for absence seizure
ethosuccimide, valproic acid (both have some T-Type Ca++ channel blocking?)
uses of ethosuccimide
absence seizure (along w/ valproic acid)
antiepileptic uses of benzos
status epilepticus (acutely; use phenytoin for prophylaxis)
main drugs for tonic clonic seizures (3)
Carbamazepine, Phenytoin, Valproic Acid (all block Na+ channels)
anti-epileptics that block sodium channels
phenytoin, valproic acid, carbemazepine, lamotrigine
valproic acid tox
"george costanza syndrome:" alopecia, weight gain, hepatotoxicity, neural tube defects, nystagmus
phenytoin tox
gingival hyperplasia, hirsutism, megaloblastic anemia (dec B12), p450 induction (Queen Barb uses Phenphen and Refuses Greasy Carbs)
newer na+ blocker with fewer side effects; can cause stevens-johnson syndrome
antiepileptic uses of barbiturates
tonic-clonic seizures; 1st line for pregnant women and kids
topiramate toxicity
kidney stones
antiepileptic causes of stevens-johnson syndrome
ethosuccimide and lamotrigine
carbemazepine tox
blood dyscrasias (agranulocytosis, aplastic anemia) + "carbomb:" diplopia, ataxia, liver tox, teratogenesis + induces p450
uses of phenytoin
first line for tonic-clonic, long-term prophylaxis for status-epilepticus
barbiturates mechanism
barbiDURATes increase DURATion of GABA_A channel opening
mech of benzodiazepams
increase frequency of GABA_A channel opening
benzos uses
anxiety, spasticity, acute tx of status epilepticus--lorazepam+diazepam (phenytoin for longterm prophylaxis), nightterrors/sleepwalking (decrease stage 4 sleep)
short-acting benzos
Triazolam, Oxazepam, Midazolam ("TOM thumb was short")
valproic acid uses
everything except status epilepticus (benzos + phenytoin), incl 1st line for tonic-clonic and ONLY tx for myoclonic seizures
only tx for myoclonic seizures
valproic acid
first line for simple partial, complex partial, and tonic-clonic
carbamazepine and phenytoin
antiepileptic in pregnant women and kids
diff in mechanism between typical and atypical antipsychotics
typicals --| D2-R; atypicals --| 5-HT2 and D2-D4
olanzepine uses
(atypical uses: schizophrenia) + OCD, anxiety, depression, mania, Tourettes
TCA used for bedwetting
TCA used in elderly
nortryptiline (others are more anticholinergic --> confusion, hallucinations in elderly)
TCA used for OCD
TCA used for neuropathic pain
amitryptiline (can also use gabapentin, an anticonvulsant)
least sedating TCA
desipramine (NET blocker?)
TCA toxicities
"3 Cs:" Coma, Cardiotox (arrhythmias), Convulsions
drugs used for OCD
olanzapine, clomipramine, and SSRIs
name the heterocyclic antidepressants
Bupropion, Venlafaxine (SNRI), Mirtazapine (alpha2 blocker), Maprotiline, Trazadone
NET blocker?; also used in smoking cessation; can cause 'stimulant' effects, including seizures in bulemic patients; no sexual side effects (unlike SSRIs)
blocks NET and 5HTT, maybe DAT; 'stimulant' side effects. Used in GAD
alpha2 antagonist --> increases NE, also blocks 5-HT2R and 5-HT3R; tox: sedation, weight gain
blocks NET; tox: sedation
blocks 5-HTT and 5-HT2R; tox: sedation and priapism
serotonin syndrome caused by:
MAOi + {SSRi | beta-agonist}
anesthetics: effect of blood solubility
decreased blood solubility --> increased speed of induction and recovery
anesthetics: effect of lipid solubility
increased lipid solubility --> increased potency
inhaled anesthetic tox
hepatotox (halothane), nephrotox (methoxyflurane), proconvulsant (enflurane), malignant hyperthermia (rare)
use of barbiturates in anesthesia
IV anesthetic, used for INDUCTION [high lipid solubility ( --> high potency), rapid entry into brain]
benzo used as an IV anesthetic
midazolam (one of the short-acting ones: TOM -- Triazolam, Oxazepam, Midazolam)