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134 Cards in this Set

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  • Back
  • 3rd side (hint)
half life as a function of Vd and Cl
halflife = (Vd*ln2/Cl
what drug is used for long term anticoag to prevent DVT?
WARFARIN -- inhibits vit K-dependent carboxylation of glutamic acid residues on factors 2,7,9,10
give an example of a direct thrombin inhibitor
role of alpha and beta adrenergic receptos in insulin control
alpha receptors --> INHIBIT insulin release; beta --> STIMULATE insulin secretion
TMP vs MTX vs pyrimethamine
all --| DHFR ==> inhibit folic acid synthysis; TMP used for microbials, MTX for cancer, and pyrimethamine for malaria / toxo (parasites)
tx of hyperpyrexia (temp > 40'C)
emergently: facilitate heat loss (cooling blankets, saline bags, cold water enemas); also give oral antipyretics (NSAIDs to adults, acetaminophen to kids) --| PGE2
chance of causing EPS among atypical antipsychotics
RISPERIDONE: greatest risk; CLOZAPINE: least risk (but a/w agranulocytosis --> last resort)
chronlogic evolution of EPS w/ neuroleptics
4h: dystonia; 4d: akinesia; 4d: akathisia; 4m: tardive dyskinesia
side effect profile of high potency vs low potency antipsychotics
high potency (eg HALOPERIDOL, FLUPHENAZINE) cause more EPS, fewer anticholinergic/antihistamine; low potency (eg CHLORPROMAXINE) are opposite: fewer EPS, more anticholinergic/antihistamine
effectiveness of typical vs atypical neuroleptics
typical good only for positive sx (hallucinations, delusions, disorganized speech/behavior): Atypical also good for negative sx (dec emotional range, poverty of sleepch, loss of interest in living)
systemic side effects of general anesthesia
shuts tihings down (myocardial depression --> hypotension; respiratory depression --> hypercapnia; dec mucociliary clearance --> postop atelectasis; dec cerebral vascular resistance -> inc cerebral blo blood flow --> inc ICP; kidney: dec GFR and RPF; liver: dec hepatic blood flow
chlorpromazine s/e
anti-muscarinic (dry mouth, VISION [probs w/ accomodation]), anti-alph1 (orthostatic hypotension), anti-histaminic (sedation)
muscarinic receptors on endothelial cells
M3 -- normally not innervated, but can be stimed by cholinergic agonsits; cause relase of NO (EDRF) --> vasodilation
what is No mechanism of endothelial relaxtiaion?
NO --> guanylate cyclase --> inc cGMP -- Ca pump --> Ca efflux --> dec MLCK --> myosin dephosphorylation
how is acetaminophen metablolized in the liver?
sulfation and glucorn
how is acetaminophen metabolized?
1) sulfation/glucornide conjugationo in liver; 2) p450 in liver; 3) urinary excretion (un-metabolized)
what anti-arrhythmic is associated with "chest burning"
adenosine (also flushing)
selective B1 agonist; increass heart rate, contractility, conduction, and myocardial oxygen consumption
what routine workup with carbemazepine?
examples of zero-order drugs
EtOH, phenytoin, aspirin (at high conc)
what reactions constitute Phase II metabolism?
acetylation, sulfation, glucoronidation
phase 1 to phase 4 clinical trials
1: pharmacokinetics, safety; 2: efficacy; 3: double blind studies; 4: postmarketing surveillance
methscopolamine, oxybutin, glycopyrrolate
same mech as SCOPOLAMINE (central antimuscarinic used for motion sickness), but diff USE (tx urinary urgency in mild cystitis, reduces bladder spasms)
how to tx bladder urgency in cystitis?
ATROPINE, METHSCOPOLAMINE, oxybutin, glycopyrrolate
effects of D1 receptor, application
D1: relaxes renal vasculature; ==> Dopamine (D>B>a) can be used to protect kidneys in shock (increases renal perfusion)
name two alpha blockers and the difference between them
phenoxybenzamine (irreversible), phentoalmine (reversible)
alpha2 blocker, use, tox
mirtazapine; USE: depression; TOX: sedation(??), inc serum cholesterol, inc appetite
beta-1 selective beta blockers
BEAM: betaxolol, esmolol (short acting), atenolol, metoproplol
beta blocker effect on AV node
decreases conduction speed --> used for SVTs, tox can cause AV BLOCK
which beta blockers are partial agonists
pindolol. Labetalol -- useful in hypertension with bradycardia (prevents complete cardiac depression)
what agents are used in glaucoma to reduce aqueous humor production and secretion?
what agents are used to increase aqueous humor outflow in glaucoma?
acidify urine to clear what drugs?
weak bases (eg amphetamines)
which antiepileptics cause stevens johnson?
ethosuccimide and lamotrigine
p450 inducers
p450 inhibitors
"Inhibitors Stop Crazy Kids from Eating Grapefruit Rinds:" INH, Sulfonamides, Cimetidine, Ketoconazole, Erythromycin, Grapefruit Juice, Ritonavir
what herbal agent can cause serotonin syndrome SSRIs?
st. john's wort
venous anticoag in pregnancy
heparin/couamdin (doesn’t cross placenta -- warfarin does)
mAb against GP IIb/IIIa --> used for acute coronary syndromes or angioplasty
ticlodipine: mech, use, tox
MECH: inhibits plt aggregation (blocks ADP receptors irreversibly); USE: acute coronary syndrome, stents, thrombotic stroke; TOX: NEUTROPENIA (not a s/e of clopidegrel, which has same mech)
which chemotherapeutics cause DNA strand breaks? What phase of the cell cycle do they work in?
ETOPOSIDE, BLEOMYCIN (also causes DNA intercalation, anytime); both in G2;
DNA intercalating agents and cell cycle specificity
Dactinomycin, doxorubicin, bleomycin; only bleomycin is cell-cycle specific (G2) because it also causes DNA strand breaks
synergy w/ MTX
5-FU: both block dTMP synthesis; MTX can be rescued by folinic acid (LEUKOVORIN); 5-FU cannot
MTX tox
HEPATITIS, pulm fibrosis, bone marrow suppression, stomatitis
what chemotherapeutic is contraindicated with allopurinol?
6-Mercaptopurine (6-MP), an antimetabolite; acts just like a purine -- activated by HGPRTase, inactivated by xanthine oxidase; ALLOPURINOL --| metabolism --> tox (GI, Liver)
what's tox of c-ara
used to tx AML (c-ARAMEL) ==> "must stop RBC synth" ==> MEGALOBLASTIC ANEMIA
whats tox of cyclophosphamide, how can it be prevented?
tox = hemorrhagic cystitis; prevent by coadministering MESNA
tx for non-hodgkin's lymphoma
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
which DNA alkylators can cross BBB; what does that suggest about their use/tox
NITROSOUREAS (eg. -mustine + streptozocin); USE: brain tumors, eg GLIOBLASTOMA MULTIFORME; TOX: CNS (ataxia, dizziness); ["NITROgen goes straight to your BRAIN"]
tx for hodgkin's lymphoma
ABVD: adriomycin (doxorubicin), bleomycin, vinblastine, dacarbazine (alkylator)
which CTX require bioactivation?
cyclophosphamide and nitrosoureas (both ALKYLATORS)
CTX with cardiotox
doxorubicin, daunorubicin, traztuzumab
pacliaxel mech and use
hyperstabalizes microtubles -- can't break down -- anaphase can't occur; use: breast and ovarian carcinomas
what drug contraindicated with loop diruetics?
NSAIDs -- in diuresis, probably have elevated ACE --> efferent vasoconstriction; if you give NSAID --| PG ==> afferent vasoconstriction --> renal failure; use ACETAMINOPHEN instead if you need anti-pyretic
use of primaquine
LATENT hypnozoite (liver) forms of malaria (Vivax and Ovale); for active, use quinine, mefloquine, chloroquine, etc.
what ABx are cephalosporins contraindicated with?
aminoglycosides (increase nephrotox); no AMP-GENT sweetness here
trazodone tox
use of cromylyn
only for PROPHYLAXIS of asthma (not useful in acute setting)
s/e of long-term salmeterol use
beta-agonist, so get "hyperactivity" s/e: tremor, arrhythmias
theophylline use
PDE inhibitor ==> prevents breakdown of cAMP ==> bronchodilation (asthma); use limited by NARROW TI: cardiotox (arrhythmias) and neurotox (seizures) ["hyperactivity" tox, just like salmeterol]
1st line tx for asthma
corticosteroids, esp BECLOMETHASONE and PREDNISONE
effect of PGI on platelets and SMC
INHIBITS aggregation, vasodilates, bronchodilates (opposite of TxA2)
ACEi tox
CAPTOPRIL (Cough, Angioedema, Proteinuria, Taste Changes from electrolyte shifts, hypOtension, Pregnancy problems, Rash, Increased Renin, Lower ATII)
antiandrogen used in PCOS, why?
ketoconazole / spironolactone -- impair steroid synth (spironolactone also inhibits androgen receptor); PCOS ==> excess androgens ==> HIRSUTISM
sildenafil tox, complications
can cause blue-green COLOR VISION changes; life-threatening HYPOTENSION if taken with NITRATES
drugs a/w color vision changes
DIGOXIN: yellow; SILDENAFIL: blue-green ("van gogh painted starry starry night with epilepsy--digoxin and a massive erection--sildenefil)
BPH vs Prostate cancer tx
BPH: finasteride (BPH caused by inc estrogen or DHT); PROSTATE CANCER: flutamide, leuprolide
AZT tox
non-b12/folate macrocytic anemia
tx for malaria
CHLOROQUINE -- kills ACITVE form; for vivax/ovale, need to also give PRIMAQUINE -- kills LATENT form (in liver)
tx of schistosomiasis and clonorchiasis
praziquantel (also can tx paragonimus [all TREMATODES/FLUKES])
uses of cephalosporins (1-3 gen)
1: surg prophylaxis; 2: sinusitis, anaerobes; 3: meningitis, gonorrhea
uses of fluconazole
cryptococcal meningitis in aids; CANDIDA (all kinds, use w/ nystatin)
most common antibiotic used to prevent endocarditis in patients w/ valvular disease
amoxicillin (all but MVP)
which chlamydia drug can also tx gonorrhea?
drugs that discolor skin
QUINACRINE (antimalarial): yellow; CHLORPROMAZINE/ARSENIC: blue-grey
best tx for open-angle glaucoma
beta-blocker (eg timolol); can also use pilocarpine (cholinomimetic)
tx of malignant hypertension
nitroprusside (arterio and veno dilator)
thioridazine: class, tox
typical antipsychotic; can cause arrhythmias and RETINITIS PIGMENTOSA
what is ribavirin used for?
how to tx seizures of eclampsia?
benzos; prevent w/ MgSO4
what drugs used for peripheral neuropathy
gabapentin, amitriptyline
phenytoin tox
EYES (nystagmus, diplopia); FOLATE/B12 (megaloblastic anemia, teratogenesis); GROWTH (gingival hyperplasia, hirsutism); SLE-like syndrome, P450 induction
antiepileptics and folate deficiency
both phenytoin and valproic acid cause folate deficiency --> neural tube defects
liver tox with which anti-epileptics?
carbamazepine, VALPROIC ACID
TCA tox
"Tri-Cs:" Coma, Convulsions, Cardiotox (arrhythmias); + resp depression + hyperpyrexia
which TCA in elderly?
nortryptiline -- least sedating (elderly susceptible to confusion and hallucinations)
name the 5 heterocyclics and their special toxicities
STIMULANT: Bupropion (seizures in bulemics), Venlafaxine; SEDATION: Mirtazapine (inc appetite --> inc weight), Maprotiline, Trazodone (priapism)
name the 5 heterocyclics and their mechanisms
BUPROPION (mech unk., also used for smoking cessation); VENLAFAXINE (SNRI: --| 5-HTT, NET), MIRTAZAPINE (--|a2, 5-HT2R, 5-HT3R), MAPROTILINE (--|NET), TRAZADONE (--| 5-HTT, 5-HT2R)
what opiod causes hypertensive crisis with MAOis?
glitizone tox
weight gain, hepatotox, (CARDIOVASCULAR problems)
which hypoglycemic to use in gestational DM?
INSULIN -- others can harm fetus
how to tx hyperthyroidism? 3 classes
1) ANION INHIBITORS: perchlorate, pertechnetate; block I- uptake by thyroid gland; 2) IODIDE SALTS: inhibit synthesis and release of TH; 3) THIONAMIDES: ptu, methimazole; inhibit organification of iodine
tx of Turner syndrome
GH (somatotropin)
how to control uterine hemorrhage?
which h2 blocker has s/e, and what are they?
cimetidine, p-450 inhibitor, antiandrogen effects, dec creatinine excretion
drug used n/v following chemotx; + mech
ondansetron (5-HT3 antagonist)
pirenzapine, propantheline
muscarinic antagonists used for peptic ulcers (--| M1 on ECL cells ==> dec histamine; --| M3 on parietal cells ==> dec gastrin)
opiods used as anti-diarrheals
lopiramide, diphenoxylate
mech and use of etanercept
soluble tnf-a receptor; used in RA + seronegative arthritides (HLA-B27): psoriasis, ankylosing spondylitis
infliximab: mech, use, and drugs used with
monoclonal Ab against tnf-a; used in IBD, RA, ankylosing spondylitis; often used w/ MTX
what are the s/e of cyclosporine and how can they be prevented?
immunosuppression --> viral infections, lymphoma; nephrotoxicity (PREVENTABLE w/ MANNITOL diuresis)
recombinant IL-2, used for RCC and metastatic melanoma
uses of alpha-interferon
HBV, HCV, Kaposi's sarcoma, leukemias, malignant melanoma
use of gamma-interferon
chronic granulomatous disease
what are uses and risks of mannitol diuresis?
used for shock (pulls fluid out of third space), drug OD, and to decrease intracranial pressure; can also be used to prevent cyclosporine nephrotox; should NOT be used in CHF (can cause pulmonary edema)
which diuretics are sulfa derivatives?
acetazolamide, HCTZ, furosemide;
what loop diuretic is not a sulfa derivative?
ethacrynic acid (otherwise almost identical to furosemide)
when to use thiazides vs ACEi?
thiazides normally used for essential HTN, unless CHF/DM present -- in that case, use ACEi (mortality benefit + nephroprotective)
use, s/e of methyldopa
alpha2 agonist, used for HTN in renal failure; interesting s/e -- causes positive coombs test
reserpine sfx
opposite of cocaine (sedation, depression)
what cardiac drugs can cause headache?
vasodilators (esp nitroglycerin)
beta blockers vs nitrates
beta-blockers decrease AFTERLOAD; nitrates decrease PRELOAD; both decrease BP
what precipitates digoxin tox?
1) hypokalemia; 2) renal failure; 3) quinidine
amiodarone tox
Check PFTs, LFTs, and TFTs (lung, liver, thyroid)
class III antiarrhythmics and TDP
sotalol (also a class II agent) carries TDP risk, amiodarone does not
drug of choice for tx of anaphylactic shock
epinephrine (stims a1 --> inc BP; stims B1 --> inc contractility; stims B2 --> bronchodilation)
why are elderly pts at increased risk of atropine tox?
inc half life due to reduced clearance
rare s/e of hyperthyroid tx
PTU and methimazole can (rarely) cause agranulocytosis / aplastic anemia (Abs against neutrophils)
alpha1 selective vs nonselective alpha blockers
alpha1 selective blockers cause less reflex tachycardia (alpha2 blockers increase NE)
what drugs cause lipid redistribution from extremities to trunk (lipodystrophy)
protease inhibitors and glucocorticoids -- buffalo hump
why is tolcapone useful in parkinson's?
used as an adjunct to L-dopa / carbidopa; prevents PERIPHERAL L-dopa degradation
sfx of tolcapone
severe hepatitis (must monitor LFTs); ("capone = organized crime = prohibition LIQUOR --> hepatotox")
amantadine use in parkinson's
main role is anti-influenza (prevents uncoating); in PD, enhances endogeneous DA (inc synth, release, and reuptake)
tolcapone vs selegeline in PD
tolcapone inhibits PERIPHERAL degradation of L-dopa; selegeline prevents CENTRAL degradation of DA
which benzo to give to help with sleep disturbance in elderly?
SHORT ACTING (wears off by morning, prevents daytime drowsiness --> fall risk); short acting benzos: TOM (triazolam, oxazepam, midazolam)
PABA sunscreens protect against which kind of UV light?
what drug to give in pt with angina with aspirin allergy?
rifampin used as prophylaxis for what bugs?
meningococcus, HIB
definition of premature menopause
menopause < 35yo
usu age of onset of PCOS
NO mechanism
NO --> guanylate cyclase --> inc cGMP -- Ca pump --> Ca efflux --> decreased activity of myosin light chain kinase --> myosin dephosphorylation
what class of drugs is sertraline?
name 4 SSRIs
Fluoxetine, Sertraline, Paroxetine, Citalopram