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70 Cards in this Set

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Ramipril
ACEI

NB: also increases [bradykinin] because ACE's break down bradykinin
Clopidogrel
clopidogrel: blocks surface ADP receptors, essential for platelet activation and fibrin binding

synergistic with aspirin and DOC: preventing thromboemboli in pts with aspirin intolerance
DOC: preventing thromboemboli in pts with aspirin intolerance
clopidogrel: blocks surface ADP receptors, essential for platelet activation and fibrin binding
DOC: DVT prophylaxis

Mechanism?
Warfarin

blocks the glutamate residue on factors 2, 7, 9 and X

prevents kitamin K dependent carboxylation

[takes a few days to build up: use heparin for immediate treatment]
Warfarin
blocks the glutamate residue on factors 2, 7, 9 and X

prevents kitamin K dependent carboxylation

DOC: DVT prophylaxis

[takes a few days to build up: use heparin for immediate treatment]
DOC: HIT
Heparin Induced Thrombocytopenia: Antibodies to heparin which cross react with platelet factor 4

Usual presents as thrombus formation rather than bleeding

First Stop All Forms of Heparin
DOC: Direct Thrombin inhibitors ie Argatroban
Argatroban
Heparin Induced Thrombocytopenia: Antibodies to heparin which cross react with platelet factor 4

Usual presents as thrombus formation rather than bleeding

First Stop All Forms of Heparin
DOC: Direct Thrombin inhibitors ie Argatroban
Abcixumab
antibody vs. glycoprotein IIB/IIIa important for platelet binding with fibrinogen and fibronectin
Probenecid
↓ proximal tubular uric acid reabosprtion

NB: contraindicated in gouty attack, may precipitate/worsen
Rx: ↓ proximal tubular uric acid reabsorption
Probenecid

NB: contraindicated in gouty attack, may precipitate/worsen
Rx: inhibition of xanthine oxidase
allopurinol, ↓ serum [uric acid]

NB: contraindicated in gouty attack, may precipitate/worsen
Allopurinol
inhibition of xanthine oxidase

NB: contraindicated in gouty attack, may precipitate/worsen
Tiagabine
inhibitor of GABA uptake

anticonvulsant predominatnly used for refractory partial seizures
Topiramate
anticonvulsant used predominantly for refractory partial seizures

blocks Na channels and enhances effect of GABA
Vigabatrin
inhibits GABA transaminase and increases GABA concentration

anticonvulsant preodminantly used for refractory partial sieuzres
Gabapentin
increases brain GABA concentration

used for refractory partial seizures
Lamotrigine
anticonvulsant used for refractory partial seizures

life threatening skin rash
Anticonvulsants used for refractory partial seizrues
lamotrigine: life threatening skin rash

TiaGABine: inhibits GABA uptake
Topiramate: blocks Na channels and ↑ GABA effect
ViGABAtrin: inhiibts GABA transaminase and ↑ [GABA]
GABApentin: ↑ [GABA]
β1 selective blockers
primarily affect the heart

used in pts with both heart condition and Lung condition (ie for whom non-selective β blockers are contraindicated)

metoprolol
atenolol
acebutolol
esmolol
metoprolol
β1 selective blocker: primarily affects the heart
-no bronchocontriction

used in pts with both heart condition and Lung condition (ie for whom non-selective β blockers are contraindicated)

metoprolol
atenolol
acebutolol
esmolol
atenolol
primarily affect the heart
-no bronchocontriction

used in pts with both heart condition and Lung condition (ie for whom non-selective β blockers are contraindicated)

metoprolol
atenolol
acebutolol
esmolol
acebutolol
primarily affect the heart
-no bronchocontriction

used in pts with both heart condition and Lung condition (ie for whom non-selective β blockers are contraindicated)

metoprolol
atenolol
acebutolol
esmolol
esmolol
primarily affect the heart
-no bronchocontriction

used in pts with both heart condition and Lung condition (ie for whom non-selective β blockers are contraindicated)

metoprolol
atenolol
acebutolol
esmolol
Metformin
↑ glycolysis
↓ GI glucose abosrption
↓ GnG
∅ risk hypoglycemia

Major side effect: GI upset & Lactic acidosis ( ↑ Glycolysis)

Contraindications: Renal Failure, Hepatic Dysfnx, Hypersensitivity
Lactic Acidosis Prone: Alcoholics, CHF
Tx for allergic rhinitis causes flushed cheeks and dilated pupils

what is the physiologic mechanism
Muscarinic antagonism

Atropine
TCA's
H1 antagonists like diphenylhydramine
Neuroleptics
Antiparkinsonian drugs
IL2 Tx
FDA approved for Renal Cell Carcinoma and Melanoma
Hydroxyurea
↑ HgF synthesis (α2γ2)

used for sickle cell anemia
Gardos Channel Blockers
Gardos Channels: Ca2+ dependent K+ channels

when blocked K+ and water efflux is ↓

prevents cell dehydration and reduces polymerization of HbS

(used for sickle cell anemia)
Rx: Sickle Cell Anemia
Hydroxyurea: ↑ HgF synthesis (α2γ2)

Gardos Channel Blockers:
--Gardos Channels: Ca2+ dependent K+ channels;
when blocked K+ and water efflux is ↓, prevents cell dehydration and reduces polymerization of HbS
Ketamine

Mechanism of Action
NMDA Antagonist
Phenelzine
a MAOI

phenelzine, tranylcypromine, selegiline

DOC: atypical depression [hyperphagia, hypersomnia, rejection hypersensitivity, leaden fatigue] & tx-resistant depression
Tranylcypromine
MAOI

phenelzine, tranylcypromine, selegiline

DOC: atypical depression[hyperphagia, hypersomnia, rejection hypersensitivity, leaden fatigue] & tx-resistant depression
DOC: Atypical Depression
[hyperphagia, hypersomnia, rejection hypersensitivity, leaden fatigue]

MAOI's

phenelzine, tranylcypromine, selegiline

also used for Tx-Resistant Depression
Tx: Opiod Tolerance
Opiod tolernace through unknown mechanism

tolerance seems to be enhanced by glutamate-NMDA action

rx: Ketamine, blocks Glutamate-NMDA
Brain Natriuretic Peptide
Nesiritide is a recombinant BNP

like ANP, activates guanylate cyclase → vasodilation, diruesis/natriureses, and a decrease in BP
Nesiritide
recombinant Brain Natriuretic Peptide

like ANP, activates guanylate cyclase → vasodilation, diruesis/natriureses, and a decrease in BP
Bradykinin
hormoned produced by the Kidney when RAAS activated

bradykinin causes angioedema

ACE metzm Bradykinin to its inactive product

Pts with ACEI's predisposed to angioedema
Endothelin
potent vasoconstrictor

endothelin release mediated by AT2, ↓ by ACEI's
Foscarnet
pyrophosphate analoge which fnx vs. Herpesvirus

particularly useful in salvage therapy vs. CMV retinitis

Chelates calcium and induces magneium wasting

hypomagenia → ↓PTH (?) → worsened hypocalcemia

hypocalcemia & hypomagensia both ↑ seizures
Toxicity of Acyclovir
Crystal nephropathy
Delerium/Tremor Neurotoxicity
beta blockers and glaucoma
act on ciliary epithlium to ↓ aqueous humor prodxn
pilocarpine
cholinergic agonist used for glaucoam induces miosis making trabecular meshwork more accesible

like pilocarpine
carbachol
cholinergic agonist used for glaucoam induces miosis making trabecular meshwork more accesible

like carbachol
Prostaglandins vs glaucoma
F2α agonists

latanoprost
unoprostone
travoprost
Carvedilol
nonsepcific antagonist of β1, β2 and α1 receptors
Benztropine
centrally acting anti-cholinergic used for drug induced parkinson's dz
centrally acting anti-cholinergic used for drug induced parkinson's dz
Benztropine
Physostigmine
cholinesterase inhibitor used to correct atropine OD
Theophylline toxicity & Tx
vomitting, tachyarrhytmias, & fatal seizures

tx: gastric lavage + activated charcoal
β-blockers vs tachyarrhytmias
BZDs/barbituates vs Seizures
Oral Iron Poisoning
Directly toxic to gastric mucosa

hemetemesis and melena
6 Mercaptopurine is metabolized by what?
Converted to active cytotoxic purine analogue by HGPRT (X linked)

removed/detoxed by xanthine oxidase (inhibited by allopurinol)
Nicardipine
dihydropyridine ca2+ channel blocker works on VSMC and Myocardium

arterial dilation w/ rebound tachy, flushing, HA
Diazoxide
like Hydralazine, arterial vasodilator w/ reflex SNS upregulation (Tachy/RAAS)

Not recommended for hypertensive emergencies

Hydralazine at least considered safe in pregnant hypertensive emergencies
Nitroprusside
Potent arterial and venous vasodilator

most effective agent for hypertensive emergencies

metabolized to cyanide and thiocyanate, limiting factor is cyanide toxicity
Hydralazine
like Diazoxide, arterial vasodilator w/ reflex SNS upregulation (Tachy/RAAS)

Not recommended for hypertensive emergencies

Hydralazine considered safe in pregnant hypertensive emergencies
Fenoldopam
Dopamine derivative, but selective for D1 receptor with no effect on α or β receptors

↑ cAMP → vasodilation
& also ↑ GFR w/o ↑ RAAS activation

(normally vasodilation → reflex SNS activation → ↑ RAAS)

Can safely be used in all hypertensive emergencies.
Most orally bioavailable nitrite
Isosorbide Mononitrite nearly 100% bioavailable
Adenosine vs. Arrhythmias
Phase 4: ↓ If

Phase 3: ↑ K+ flux & duration

Phase 0: inhibits L type Ca2_ channels: prolonging phase 0
Treating DVT in Pregnant Women
Heparin

[warfarin = teratogenic
asprin, clopidogril ≠ anti-DVT]
DOC: Heroine Addiction
Methadone

mu agonist with extremely long λ prevents withdrawal sx
Ribavirin
guanine nucleoside analogue

RSV & HepC

used in RSV pts with complicating conditions as RSV is normally self limiting
Oseltamvir
taimful

vs. influenza A and B neuraminidases
Dofetilide
Class 3 antiarrhytmic: K+ blocking, prolongs phase 3 (repolarization)
Anti-seizure med with gingival hyperplasia
phenytoin
via PDGF mediator
Thiopental pharmacokinetics
Highly lipid soluble
rapidly enters brain from blood
rapidly redistributes out of brain to skeletal muscles

rapid ↓ in fnx ≠ metzm

fast on-fast off
used for induction
Dopamine Effects
Low doses stimulate D1 receptors → vasodilation in renal & mesenteric vasculature

Medium Doses: Stimulate β1 receptors

High Doses: Stimulate α1 receptors
Antidote for Rat Poisoning
Most Rat Poisons contain a coumadin derivative

2, 7, 9 and X

Antidote: Fresh frozen plasma
Protamine
antidote for heparin OD
P glycoprotein
MDR1 in humans

transmembrane ATP dpendent pump, thwarts chemotheraputics
Aspirin Poisoning
Initially causes respiratory alkalosis via direct CNS stimulation

after a few hours produces metablic acidosis from metabolic processes activated

combined respiratory alkalosis + metabolic acidosis: ↓ pCO2, ↓ HCO3, ↑↓ pH (unpredictable)