Cardiovascular

Front 1

antiarrhythmic with negative inotropic effects

Back 1

ca channel blockers
b blockers
class 1a drugs (sodium channel blockers)

Front 2

what two things increase gastric acid secretion? How?

Back 2

-increased levels of ca++ ( gastrin + Ach increase levels of Ca++)
-increased levels of camp (histamine increases camp, pgi2 and pge2 decrease camp)
- all act on the protein pump inhibitor

Front 3

to lower renin release, give

Back 3

clonidine (centrally acting)
beta blocker or an angiotensin converting enzyme (ACEI)

Front 4

what type of arrhythmias (ventricular) do you get with reentry?

Back 4

-extra single systoles
-sustained types of tachycardia

Front 5

treatment of lepra reactions (erythema nodosum & leprosum reactions)

Back 5

-steroids
-thalidomides
-clofazimine

Front 6

What drug do you give to treat cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL)?

Back 6

Thalidomide

Front 7

Thalidomide MOA

Back 7

-immunomodulatory agent
-down-regulation of both TNF-alpha and adhesion molecules involved in leukocytes migration

Front 8

Which bile acid binding drug causes increased hepatic uptake of LDL?

Back 8

colestipol

Front 9

What's the difference between bile acids & niacin?

Back 9

Bile binding acids = for isolated increases in LDL. Bile acid binding in lumen and prevent reabsorption

Niacin - for familal hypercholestemia, inhibits VLDL secretion

Front 10

High TG, what drugs to treat?

Back 10

Gemfibrozil

Front 11

What's the difference between colestyramine and colestipol?

Back 11

different indications: CTYRAMINE is used to treat pts with an isolated increase in LDL, COLESTIPOL treats pts with elevated serum total and LDL

Front 12

treatment of lepra reactions
reversal reactions

Back 12

-steroids
-clofazimine

Front 13

a side effect of this antimycobacterium is optic neurotis (a decrease in visual activity)

Back 13

Ethambutol

Front 14

drugs used for MAC

Back 14

-Clarithromycin
-Azithromycin
-Ethambutol, clofazimide, ciprofloxacin, or rifampin

Front 15

phentolamine for CHF

Back 15

- predominant effect on arteriorlar vascular bed

- H failure, decrease afterload, increase CO

Front 16

active tuberculosis (possibly resistnat organisms & HIV patients)

Back 16

Isoniazid, Rifampin, pyrazinamide, ethambutol or streptomycin

Front 17

Diuretic used for glaucoma

Back 17

Acetazolamide

Front 18

Name two drug combos used for angina

Back 18

- nitrates and b-blockers - can prevent a reflex tachycardia, reduce each others undesired SE

- CCB + B blockers + nitrates - all

Front 19

This diuretic is indicated for treating edema used to CHF, centercephalic epilepsies, glaucoma, acute mountain sickness

Back 19

Acetazolamide

Front 20

When do you use captopril?

Back 20

-useful in cases where elevated renin release causes
-produces hypotension plus reduced sodium retention

Front 21

Name long-acting renin-angiotensin inhibitors

Back 21

Enalapril & lisinopril

Front 22

To maintain sinus rhythum in chronic atrial fibrillation

Back 22

-class IC or Ia
-amiodarone
-sotalol

Front 23

Kinins - effect on renal glands

Back 23

-potent vasodilation
- increase prostaglandin synthesis
-no2 release
-increase cGMP and increased Camp

Front 24

Dipyridamole MOA

Back 24

- vasodilator -dilates resistance vessels in coronary beds to increase flow without increasing O2 demand

- thromboembolism - lengthens abnormally shortened platelet survival time

Front 25

What drug is used for the detection of renin -dependent hypertension

Back 25

saralasin

Front 26

What effects do organic nitrates have on the redistribution of coronary blood flow?

Back 26

-organic nitrates can selectively increase blood flow to ischemic areas (note: total coronary flow is not reduced)

Front 27

Bile acid binding resin not effective in pts with homozygous familial hypercholesterolemia?

Back 27

cholestyramine

Front 28

antimycobacterium causes severe birth defects

Back 28

thalidomide

Front 29

hypolipidemic may impair carbohydrate tolerance

Back 29

niacin

Front 30

diazoxide MOA

Back 30

- a long acting arteriolar dilator
-prevents smooth muscle contraction by opening potassium channels + stabilizing the membran potential at a more hyperpolarized voltage
- lowers tpr and arterial blood pressure

Front 31

I have a life threatening ventricular arrhythmia. Give me a drug

Back 31

Treatment = Procainamide

To prevent the reoccurance of life-threatening ventricular arrhythmias: amiodarone

Front 32

What regulates GFR

Back 32

GFR is cappillaries is regulated by the amount of tone contractivity in arterioles

Front 33

What's the difference between abciximab and Eptifibatide and Tirofiban?

Back 33

-abciximab - monoclomal antibody that binds IIb/iiia complex on platelets

-Eptifibatide - a fibrinogen sequence analog that binds GP iib/iiia receptors prevents aggregtion

Front 34

I'm pale (pallor), what might I have?

Back 34

Iron deficiency (comon presentation)

Front 35

What's the difference between Thrombopotetin and GM-CSF?

Back 35

-Thrombopoietin - increases size + number of megakarocytes

GM-CSF (w/ IL3 increases activity of mature granulocytes)

Front 36

What drug is reserved for pts with no significant/structural heart disease but with atrial fibrillation or atrial flutter?

Back 36

-quinidine

Front 37

a broad spectrum - antiarrhythmics
name it which channels does it effect.

Back 37

-amiodarone
-predominantly K channel blockade
-B-blockers, ca channels blocker, and Na channel block

Front 38

What is the difference between Vit B12 and Folic acid?

Back 38

FA: essential cofactor for synthesis of aa, purines, & DNA

VB12: a cofactor for several essential biochemical rxns

FA: treat FA deficiency
VB12: treat VB12 deficiency

Notes: VB12 deficiency causes neurological abnormalities

Front 39

Urokinase and streptokinase MOA

Back 39

urokinase : human enzyme
streptokinase: bacterial protein (not enzyme)

- combines with plasminogen and increases its conversion to active plasmin. Plasmin formed inside a thrombus allows them to lyse a thrombis from within

Front 40

t-PA MOA

Back 40

t-PA binds fibrin in a thrombus, which convers the entrapped plasminogen --> plasmin. This initiates fibrinolysis and some systemic proteolysis

Front 41

what's the difference in mechanism between urokinase and t-PA

Back 41

Urokinase combines with plasminogen to activate conversion to plasmin

t-PA combines with fibrin to activate plasminogen --> plasmin

Front 42

SE causes hypothroidism or hyperthyroidism?

Back 42

amidarone

Front 43

What is the difference in Rx between atrial fibrillation, atrial flutter, and atrial tachycardia

Back 43

They are all essentially the same, only use adenosisne top choice for atrial flutter in addition to regular therapy

Front 44

Thrombolytic that is more fibrin-specific that t-PA

Back 44

Tenecteplase

Front 45

Less fibrin-specific that t-PA?

Back 45

Reteplase

Front 46

Less expensive than t-PA (also a thrombolytic

Back 46

Reteplase

Front 47

Ventricular tachycardia after MI, what is it?

Back 47

Reentry near the rim of healed infarction

Front 48

What factors stimulate renin release

Back 48

-hypotension
-decreased blood volume
-NA depletion
-increased sympathetic outflow

Front 49

Pharmacokinetics of Abciximab?

Back 49

Must be given parenteraly not orally effective

Front 50

antiplatelet drug used in percutaneous coroncary intervention (e.g. angioplasty, placement of coronary stints) & in acute coronary syndromes

Back 50

Abciximab

Front 51

Active tuberculois (susceptible)

Back 51

-isoniazid and rifampin for 6 months
add pyrazinamide after 2 months

Front 52

Why do you not give sotalol with class 1a antiarrhythmics? Or Class III aa?

Back 52

B/c of the potential to prolong refractoriness (QT)

Front 53

Ventricular tachycardia after MI
acute treatment?
chronic treatment?

Back 53

acute - lidocaine, procainamide, DC cardioversion

chronic - amiodarone, class III, ICD

Front 54

What is a partial Thromboplastin time (PTT) for?

Back 54

PTT monitors the intrinsic coagulation system and is abnormal in deficiencies of factor i, ii, v, ix, x, xi, xii.

Front 55

What is the difference between a PT test and a PTT test

Back 55

PT measures deficienceis in factors I, ii, V, Vii, X
(more warfarin like)
PTT measures deficiencies in factors v, viii, ix, x, xi, xii (more heparin like)

Front 56

NSAIDS on plasma renin activity?

Back 56

NSAIDS decrease plasma renin activity, decrease renin

Front 57

SE include weak ganglionic blocking, reduction in vagal tone

Back 57

procainamide

Front 58

Acute Rx for AV node reentry? PSVT?

Back 58

-adenosine

-increase vagal tone with carotid sinus pressure
-digitalis
-edrophonium
-phenylephedrine

Front 59

Use short term to treat erosive esophagitis, active duodenal ulcers, and GERD

Back 59

proton pump inhibitors

Front 60

antacids MOA

Back 60

They are weak bases that react with gastric acid to form water and a salt and in the process neutralize the acid

Front 61

nitrogen major effects

Back 61

decrease preload
decrease venous rtn
decrease SV
decrease cardiac work
decrease O2 demand

Front 62

How are atrial flutter and atrial tachycardia different from atrial fibrillation

Back 62

atrial fibrillation: disorganized atrial reentry

atrial flutter: stable reentrant circuit in right atrium

atrial tachycardia: enhanced automaticity, DAD related automaticity or reentry

Front 63

what drug is used for control of ventricular rate + prophylaxis for repetitive PSVT
-angina
-hypertension

Back 63

Verapamil
Diltiazim also - only less good for angina and hypertension

Front 64

name plasminogen activators

Back 64

t-PA
Reteplase
Tenecteplase

Front 65

To inhibit acid secretion, give ...

Back 65

- histamine H2 antagonists
- prostaglandins
-proton pump inhibitors

Front 66

name: platelet GP IIa/IIIa receptors blockers

Back 66

Abciximab
Eptifibtide
Tirofiban

Front 67

What's the difference between reteplase, t-PA, and tenecteplase?

Back 67

They are all plasminogen activates (bind to fibrin & activate plasminogen --> plasmin)

Reteplase is a recombinant human t-PA with some aa's deleted (it is less fibrin specific that t-PA and cheaper to make)

Tenecteplase is a mutant form of t-PA with that is more fibrin specific

Front 68

What's the difference in indications between

(1) histamine H2 antagonists
(2) Proton pump inhibitors

Back 68

(1) Histamine H2 antagonists for prophylaxis of peptic ulcers, acute stress ulcers, and GERD

(2) proton pump inhibitors = short term treatment of erosive esophagitis, ulcers, and GERD

Front 69

This antimycobacterium drug may cause peripheral neuropathy

Back 69

Isoniazid

Front 70

Name three drugs used to accelerate food through through the GI tract. Explain the difference between the three types

Back 70

(1) bulk laxatives
(2) irritants/stimulants
(3) stool softeners

Bls are hydrophylic collids that form gels and cause water retention and intestinal distention. Whereas, stool softeners become emulsified with stool to make feces soft. Stimulates produce nicinoleic acid

Front 71

What's the difference between urokinase and fibronolysis?

Back 71

Both thrombolytics, but urokinase/streptokinase works on old clots

Fibrinolysins only works on young clots (< 3 days)

Front 72

What is streptokinase used for?

Back 72

2nd line of defense
used in pts with myocardial infarctions in cases where coronary catherization is not readily available (coronary catherization is better reduces mortality)

Front 73

name a fibrinolytic

Back 73

the thrombolytics
Urokinase + streptokinases

Front 74

Which drugs are used to treat edema caused by CHF?

Back 74

Loop diuretics - Ethacynic acid + torsemide

Front 75

What type of diuretic is used to treat pulmonary edema or other edematous conditions?

Back 75

Furosemide

Front 76

Angiotensin II - vasoconstriction or vasodilate renal

Back 76

renal vasoconstriction

Front 77

major side effects of all loop diuretics

Back 77

hypokalemia

Front 78

catecholamines - vasodilators or vasoconstricors renal

Back 78

vasoconstrictors

Front 79

Which loop diuretics inhibits the Na + 2CL K+ carrier system?

Back 79

torsemide

Front 80

which loop diuretic reduces pulmonary congestion and left ventricular filling pressure in heart failure?

Back 80

furosemide

Front 81

What is a toxicity of folate definiciency?

Back 81

folate deficiency in pregnant woman can cause congential malformations in newborns

Folate deficiency may also not prevent the development of vascular disease (ischemic heart disease & stroke)

Front 82

major SE of potassium sparing diuretics

Back 82

-abnormal elevation of serum potassium levels
-hyperkalemia may be fatal

Front 83

name K sparing diuretics

Back 83

triamterene
amiloride
spironolactone

Front 84

alpha agonists on plasma renin activity?

Back 84

decrease renin activity

Front 85

what do B-blockers do to plasma renin activity

Back 85

b-blockers lower plasma renin activity decrease renin activity

Front 86

Folic acid MOA

Back 86

essential cofactor for the synthesis of amino acids, purines, and DNA

Front 87

Which type of diuretics causes NaCl to be excreted and Ca++ to be reabsorbed?

Back 87

Thiazides

Front 88

drugs used for short term anticoagulent therapy associated with acute primary embolism and disseminated intravascular coagulation

Back 88

heparin

Front 89

what are the most efficacious diuretics?

Back 89

loop diuretics
(furosemide, ethacrynic acid, torsemide)

Front 90

What diuretics cause impaired carbohydrate intolerance and hyperkalemia?

Back 90

Thiazides - chlorothiazides and hydrochlorothiazides

Front 91

What drug can be given to neutralize the action of heparin?

Back 91

protamine sulfate

Front 92

this antiplatelet drug increase intracellular camp inhibiting phosphodiesterase activity and by blocking adenosine uptake

Back 92

Dipyridamote MOA

Front 93

In the prothrombin time test, you test for deficiencies in factors ----

Back 93

i, ii, v, vii, and x

Front 94

To restore sinus rhythum for an acute atrial fibrillation

Back 94

DC cardioversion
ibutilide

Front 95

What is a toxicity of vit b12 deficiency?

Back 95

leads to neurological abnormalities including degeneration of myelin sheaths in axons of the spinal cord and peripheral nerves

Front 96

what are cardiac toxicities of digoxin

Back 96

1) 2nd and 3rd degree AVN block
2) various arrhythmias (premature beats, bigeminy)
3) changes in ECG ( increased PR, decreased ST, and decreased QT)

Front 97

PSVT acute conversion to sinus rhythum use --- which drugs are used for prophylaxis of PSVT (avn reentry)?

Back 97

1) use adenosine
2) class IV - calcium channel blockers (verapamil & diltiazem)

Front 98

side effects of iron dextran, how administered too?

Back 98

hypersensitivty reactions given by deep IM or IV

Front 99

vasoconstriction or vasodilate TXA2

Back 99

vasoconstrict

Front 100

1st drug for control of ventricular rate in pts with atria flutter or fibrillation?

Back 100

-verapamil, diltiazim

Front 101

Which antiarrhythmic is not associated with an increase in mortality in pts with coronary artery disease or heart failure?

Back 101

amiodarone

Front 102

what drug can : acute sinus conversion to sinus rhythum of PSVT? including when its associated with Wolff-Parkinson White syndrome?

Back 102

Adenosine

Front 103

Common treatments for atrial fibrillation(acute rxn) to control ventricular rate

Back 103

verapamil or diltiazem
b bockers
digoxin

Front 104

what is the difference between atenolol and metoprolol

Back 104

indications: atenolol has more indications (management of hemodynamically stable pts iwth definite of suspected myocardial infacrction) in addiiton to hypertension + angina?

Front 105

main use of sotalol

Back 105

Ventricular arrhythmias?

Front 106

Which type of drug is used for the healing of duodenal ulcers and peptic ulcers? how?

Back 106

mucosal protective agents

MOA binds + charged groups on proteins and glycoproteins of abnormal and necrotic tissue
acts as a barrier to HCL acid and pepsin

Front 107

Which drugs complicate the effects of PGs on renal glands

Back 107

NSAIDS
non-steroidal anti-inflammatory drugs

Front 108

which prostaglandins, increase renal blood flow, promote diuresis, and natriuresis

Back 108

PGE2
PGI2

Front 109

for immediate reduction of stomach pain (cheap alternative) use

Back 109

antacids

Front 110

abciximab MOA

Back 110

a humanizeed monoclonal antibody directly against IIb/IIIa complex. it binds to the receptor complex on platelet and prevents platelet aggregation

Front 111

difference between 1st generation and 2nd generation sulfonylureas?

Back 111

-fewer side effects & drug interactions, more commonly prescribed

contraindicated in hepatically impaired pts

Front 112

What does Erythropoietin do? Where does it act?

Back 112

stimulates maturation of erythrocyte precursors

It has two sites of action
(1) BFU-E --> CFU-E
(2) CFU-GEMM --> BFU-E (acts synergistically with IL3 and GIN-CSF

Front 113

4 mechanisms of vasodilation

Back 113

(1) block L-type calcium channels
(2) increased cAMP
(3) increased cGMP
(4) hyperpolarized cell membrane

Front 114

Which loop diuretic is effective in patients with renal insufficiency

Back 114

The loop diuretic Ethacrynic acid

Front 115

What's the difference between loop diuretics and thiazides?

Back 115

Place they act: Loop diuretics: loop of Henle
Thiazides - distal convoluted tubule

Transport they block
Thiazides: block NaCl reabsorption, increase Ca++ reabsorption

Loop diuretis - inhibit NaCl reabsorption (some act on the Na2Cl-K+ pump)

Front 116

What type of diuretics is not used in patients with renal insufficiency?

Back 116

Thiazides

Front 117

Kinins - renal vasoconstrictor or vasodilators

Back 117

renal vasodilators

Front 118

This angina occurs during exercise (climbing stairs, etc)

Back 118

External angina

Front 119

Name renal vasoconstrictors

Back 119

-Thromboxane A2, TXA2
-Catecholamines
-Angiotensin II

Front 120

Name loop diuretics

Back 120

Furosemide
Ethacrynic acid
Torsemide

Front 121

SE fatal pulmonary fibrosis

Back 121

Amiodarone

Front 122

Congenital long QT MOA :

Back 122

EAD related triggered activity

Front 123

Class II MOA (antiarrhythmics)

Back 123

-B-blockers terminate tachyarrhythmias caused by increased sympathetic tone, increase catecholamines, tissue supervision to catecholamines

- reduces pacemaker automaticity (blocks catecholamine stimulation of Ih and Ica)
-reduces delayed after depolarization (DADs) by antagonizing B-adrenergic increase in Ca flux

Front 124

Drug of first choice for treating pts with AVN reentry (PSVT)

Back 124

-Adenosine
first drug choice for acute treatment

Front 125

Antidote + treatment for warfarin overdose

Back 125

-stop giving warfarin
-give fresh plasma
-give Vitamin K

Front 126

Aspirin MOA

Back 126

prevents production of thromboxane A2, Irreversible

Front 127

Indications for spironolactone

Back 127

-hyperaldosterone
-hypokalemia
-reduced edema & mortality in patients with CHF

Front 128

Most renal vasodilators promote ----

Back 128

diuresis

Front 129

mild CHF treatment (mild peripheral edema on exertion) normal GFR

Back 129

thiazides, ACEI

Front 130

Treatment of Heparin overdose:

Back 130

(1) stop giving heparin
(2) antidote: protamine sulfate

Front 131

Deficiency of what compound can make warfarin toxicity worse?

Back 131

a vitamin K deficiency

Front 132

Transport that occurs at collecting duct

Back 132

sodium is exchanged for potassium + hydrogen ions

Front 133

Where in the nephron is the fluid isotonic?
hypertonic?
hypotonic?

Back 133

isotonic - proximal tubule
hypertonic - descending limb loop of henle
hypotonic - ascending limb, loop of henle

Front 134

Where does ADH act>

Back 134

on the distal convoluted tubule and collecting duct

ADH increases water reabsorption

Front 135

Which effects predominate at low doses of nitrates? nitroglycerin

Back 135

venous effects predominate at low doses, but nitroglycerin does cause dilation of both arterial and venous beds

Front 136

which coagulation drug should you never give IV?

Back 136

Thrombin

Front 137

What % of NaCl is reabsorped in the proximal tubule?
in the loop of Henle?
in the distal convoluted tubule?

Back 137

-proximal tubule - 60% -70%
-loop of henle --> 15-25%
-distal convoluted tubule --> 8% - 5 %

Front 138

diuretics are ...
natriuresis is ...

Back 138

- agents that impair the reabsorption of sodium from tubular contents

-natriuresis is the excretion of sodium in the urine

Front 139

what is the undesirable side effects of all vasodilator agents especially over administrated by intravenous infusion

Back 139

-extreme hypotension

Front 140

What's the difference between typical (exertional angina and variant angina)?

Back 140

-typical (exertional)
-coronary insufficiency due to vessel occlusion (atherosclerosis)
-attacks usually occur during exercise (climbing stairs, etc.)
-variant prinzmetal's rest angina
-coronary insufficiency due to vasospasm?
-attacks occur during rest unstable

Front 141

name 3 calcium channel blockers

Back 141

-nifedipine
-verapamil
-diltiazam

Front 142

which anticoagulent do you never give IV?

Back 142

Thrombin

Front 143

Thiazide MOA

Back 143

thiazide increase NaCl excretion in the distal convoluted tubule. Loss of potassium and bicarbonate can result

Front 144

anticoagulent test used to diagnosis deficiency in factors I,ii, v, vii, and x

Back 144

prothrombin time test

Front 145

Name one type of antianginal that can eb used for both vasopastic & effort - associated angina

Back 145

-ca channel blockers
verapamil
diltiazem
nifedipine

Front 146

Where do carbonic anhydrase inhibitors work?

Back 146

proximal tubule

Front 147

Treatment for warfarin overdose

Back 147

(1) stop giving warfarin
(2) give fresh plasma
(3) give Vitamin K

Front 148

What's the difference between cotting time and bleeding time?

Back 148

clotting time - the time it takes blood in vitro to clot sufficiently so that the table containg the sample can be inverted

bleeding time- after you cut the ear, the length of time you cna collect blood

Front 149

what;s the difference between thromus and embolism?

Back 149

-thrombus -an intravascular blood clot obstructing a blood vessel or cavity of the heart

-embolism - obstruction of a blood vessel by a foreign substance or a blood clot that has been carried by the blood to a site distant from its point of origin

Front 150

What's the difference between anticoagulents and thrombolytic agents?

Back 150

-anticoagulents prevent the formation of fibrin clots

-thrombolytic agents remove and break fibrin deposits in blood vessels

Front 151

hair growth

Back 151

minoxidil

Front 152

NO mechanism

Back 152

No increase gCMP, decrease ca++ (becasue it goes into the SR

Front 153

overdose of coumarin/ warfarin, what do you give me? why?

Back 153

Vitamin K2 - cofactor required for the synthesis of factors Viii, IX, and x

Front 154

major SE of heparin

Back 154

SE include hemorrhage (especially ovarian hemorrhage can be potentially fatal

Front 155

Dispersion of refractoriness may occur during ...

Back 155

(1) an unequal ischemic lesion
(2) an extra conduction pathway

Front 156

what is the effect of dopamine on glomular filtration rate, renal blood flow, and Na+

Back 156

-stimulates alpha, beta, and dopamine receptors

-increase renal blood flow
-increase glomerular filtration rate
-increase Na+ excretion

Front 157

Treat my hypokalemia

Back 157

1. Kive K+Cl-
2. give a potassium sparing agent
3. combo drug

Front 158

DC valsartan

Back 158

ARB, antihypertensive

Front 159

major SE of heparin

Back 159

hemorrage

Front 160

What's the difference between chlorothiazide + hypochlorothiazide?

Back 160

chlorothiazides can also be used for kidney stones and diabetes insipidus

Front 161

What ending signifies and ARB?

Back 161

-sartan as in

iorbesartan
losartan
valsartan

Front 162

anticoagulent which causes increased neutralization of factors II, IX, X, XI, XII, and Xiii

Back 162

heparin

Front 163

Why do diuretics help CHF

Back 163

reduce preload and afterload
also counteract sodium retention forces ( at a max CHF) by causing natruersis

Front 164

diuretics class used for CHF

Back 164

loop diuretic (thiazides also work)

Front 165

class of diuretics chiefly associated with hypertension

Back 165

thiazides

Front 166

which type of diuretic blocks the Na+2CL-K+ transporter

Back 166

loop diuretics

Front 167

which durgs act on the NaCl cotransporter? Where is this int he nephron?

Back 167

thiazides in the early distal convoluted tubule

Front 168

which drugs cause the induction of LDL receptors thereby decreasing LDL in serum?

Back 168

statins - lovastatin, simvastatin

Front 169

amiloride acts on?
where?

name a drug like amiloride

Back 169

-amiloride blocks sodium channels in the distal convoluted tubule

triamterene

Front 170

What type of drug acts on mineralocorticoid receptors?
Where? name 2

Back 170

-aldosterone antagonists bind to mineralocorticoid receptors in the distal convoluted tubule (spironolactone epelerone)

Front 171

MOA of drugs that work and hte loop of Henle

Back 171

interferes with Na+2Cl-K+ cotransporter

Front 172

why are proximal active agents only mildly potent

Back 172

Na+ ions not absorbed here have multiple opportunities downstream to be absorbed

Front 173

How do carbonic anhydrase inhibitors work> MOA?

Back 173

-inhibits reabsorption of sodium bicarbonate

-reduce availability of cellular protons ions for exchange with luminal sodium

Front 174

Where in the nephron does bulk reabsorption occur?

Back 174

proximal tubule (60-70%

Front 175

why are loop diuretics so powerful

Back 175

-large amounts (15-25%) of NaCl are reabsorbed at this site

-nephron transport sites distal to the loop of henle have limited capabilities to reabsorb NaCl ions rejected in the loop

Front 176

injudicious results of potassium sparing diuretics -->

Back 176

-hyperkalemia
-metabolic acidosis

-b/c diuretic inhibits K+ and H+ secretion

Front 177

which part of the nephron is under control of the mineralcorticoid systems?
How much sodium reabsorption occurs here?

Back 177

-the late distal convoluted tubule and collected duct
-about 2-3% of the filtered load is absorbed here (sodium)

Front 178

what types of transport occurs in the late distal convoluted tubule?

Back 178

Na+ is reabsorbed in exchane for hydrogen and potassium ions

Front 179

What type of ion transport is found in the loop of henle? ascending limb

Back 179

an active electroneutral sodium 2 chloride potassium

Front 180

how is bicarbonate reabsorbed in the proximal tubule

Back 180

1. an Na/H causes secretion of H ions
2. H ions + bicarbonate = carbonic acid
3. dehydration of carbonic acid - H20 + CO2
4. CO2 diffuses into cell
5. in cell, co2 combines with H20 --> H2CO3
6. net movement. H2CO3 is moved from lumen ot the cells of the proximal tubule

Front 181

where is most bicarbonate reabsorbed in the nephron?

Back 181

in the proximal tubule

Front 182

what can reduce the action of diuretics?

Back 182

a reduction in GFR (glomerular filtration rate) rduces the supply of ions and water to the tubular system

- it also can decrease renal plasma flow

Front 183

drug used to treat CHF acts on aldosterone

Back 183

spironolactone

Front 184

Don't use this hypolipidemic in pregnant women

Back 184

statins

Front 185

this type of angina is unstable - attacks oftern occur during rest

Back 185

variant angina

Front 186

DC losartan

Back 186

ARB, antihypertensive

Front 187

drugs used for combined dyslipedemias

Back 187

niacin decreases TG, decreases VLDL and decreases LDL

Front 188

These HMG-Coa reductase inhibitors have the SE of ...

Back 188

hepatotoxicity and myopathy

Front 189

what's the difference in effect between ACEI and ARBS?

Back 189

(1) ARBS are more specific. They only block Ang II and ATI receptors
(2) ARBS have no effect on Bradykinin, whereas ACEI increase bradykinin
(3) ARBS more completely inhibit ang II action (ACEI only blocks some ang II production becasue there are other ways to make it

Front 190

What's the difference in mechanism between drugs acting in the early distal convolution and the distal convoluted tubule?

Back 190

-early distal convolution- sodium chloride cotransporter (thiazides block)

- distal convoluted tubule - exchange Na for K+ and H+ aldosterone antagnonist block)

Front 191

What is the consequence of adminsitering amiloride or triamtere

Back 191

mild natriuresis (increase Na+ in urine) inhibit potassium and hydrogen secretion

Front 192

main use of anticoagulents

Back 192

pulmonary embolism
coronary thrombosis
with myocardial infarction
peripheral vascular thrombosis

Front 193

the side effects - hepatotoxicity and myopathy are characteristic of what type of hyperlipidemic?

Back 193

hmg-coa inhibitors

Front 194

pharmacokinetics of heparin

Back 194

should be given by intermittent intravenous injections, intravenous infusion or deep subcutaneous injection

Front 195

how do all vasodilators affect sodium?

Back 195

All vasodilators cause sodium retention

Front 196

why is hydralazine a bad antihypertensive?

Back 196

-must be used with b-blockers (b/c of reflex tachycardia)
-must be used with diuretics for sodium retnetion

Front 197

name 2 centrally acting drgus used to treat hypertension

Back 197

clonidine & methyldopa

Front 198

What are the best type of diuretics to use for hypertension?

Back 198

-thiazide diuretics
-potassium sparing diuretics
-loop diuretics (high celeing) -->
can be used for edema reduction decreases volume and decreases bp

Front 199

drug given to patients undergoing placement of a coronary stint

Back 199

clopidogrel main indication

Front 200

protamine sulfate MOA

Back 200

PS forms a stable salt with acidic heparin. It neutralizes its affect. The anticoagulent activity of both drugs is lost

Front 201

how should vitamin K be administered?

Back 201

not by IV

b/c anaphylaxis and fatalitis have occured when it is given iv

Front 202

what is the advantage of enoxaparin over heparin?

Back 202

better bioavailabiiltya dn longer half life (SC injection instead of intravenous

Front 203

what shoudl be monitored when giving heparin?

Back 203

monitor platelet counts - perform frequently

Front 204

name renal vasodilators

Back 204

-dopamine
-pgs, pge2, pgi2
-kinins

Front 205

what do b-blockers do to treat angina?

Back 205

b-blockers block cardiac b1 receptors. thereby decreasing hr, decreasing contractility (negative inotropic effet) and decrease myocardial o2 requirements at rest and during exercise
-reduce silent ischemic

Front 206

severe CHF, peripheral edema, dyspnea, and pulmonary congestion

Back 206

combination diuretic therapy
loop diuretics
ACEI

Front 207

What drugs can you use to treat primary triglyceruridemias?

Back 207

niacin and fibric acid

Front 208

heparin MOA

Back 208

-anticoagulent
-straight chained anlonic mucopolysacchards called glycosaminoglycans have anticoagulent properties
-acts at multiple sites in the coagulation system
-heparin interacts with antithrombin (a cofactor) it enhances its ability to inhibit thrombosis
-inactivates clotting factors - iia, ixa, and xa by complexing with them

Front 209

ca++ antagonists

Back 209

-selective effects on blood vessels but not on the heart
-reduces vasospasm, reduces preload + afterload

Front 210

side effects and complications of diuretics

Back 210

-volume depletion (loop diuretics
-hypokalemia
-lipid elevation
-glucose intolerance
-metabolic alkalosis
-hyponatremia
-hyperuricemia
-hypomagnesia

Front 211

major drug interactions with warfarin

Back 211

increase warfarins effect (inhibit P450 cimetidine and amiodarone)

- decrease warfarin's effect (induce p450)

Front 212

warfarin is contraindicated in

Back 212

pregnancy

Front 213

heparin blocks which factors

warfarin blocks which factors

Back 213

heparin II, IX, X, XI, XII, XiII

warfarin II, Vii, IX, X

Front 214

NSAID effects on ACEI effects?

Back 214

-NSAIDS block PG synthesis
-NSAIDS also block bradykinin mediated vasodilation, therefore they impair the hypotensive effects of ACEI

Front 215

how do diuretics treat hypertension?

Back 215

1. decrease blood volume (decrease Bp and pressure )

2. with continued use, diuretics decrease TPR even when blood volume returns to normal

Front 216

What does the PT test mean?

Back 216

Test the extrinsic thromboplastin system, tests for deficiencies in factor I,II, V, VII, and X

Front 217

When treating hyperlipedemia in diabetes, which drug should you be careful about giving and why?

Back 217

niacin b/c one of the side effects is glucose intolerance

Front 218

which factors does enoxaparin block?

Back 218

inhibits clotting factors IIa (prothrombin) and Xa

Front 219

With atorvastatin, you must monitor levels of ...

Back 219

alanine and aspartate

Front 220

dipyridamole drug class

Back 220

DC: vasodilatior
platelet adhesion inhibitor

Front 221

Name the major groups of drugs acting at the proximal tubule

give an example

Back 221

carbonic anhydrase inhibitors (acetazolamide)

Front 222

treat dyastolic dysfunction with ...

Back 222

B-blockers
calcium channel blockers

Front 223

therapeutic uses of coumadin/warfarin

Back 223

-prophyalaxysis + treatment of venous thromboses + pulmonary embolism
-treatment of thromboembolic complication sto reduce the risk of death, recurrent myocardial infarction + thromboembolic events

Front 224

heparin effects

Back 224

-has little or no effect except on blood coagulation + blood lipid metabolism

- increases activity of antithrombin III (antithrombin III) neutralizes activated clotting factors II,IX, X, XI, XII, and XIII

Front 225

What are the three main types of drugs used to treat angina>

Back 225

(1) organic nitrates compounds
(2) propranolol and other B-blockers
(3) calcium antagonists

Front 226

What's the difference between thrombolytic agents and antiplatelet agents

Back 226

-thromboembolytic agents = remove and break fibrin deposits which occur in bood vessels

whereas
-antiplatelet agents are used to reduce atherosclerosis

Front 227

used for pulmonary embolism, coronary thrombosis associated with myocardial infarction, peripheral vascular thrombosis, severe injury to the extremities and rheumatic heart disease

Back 227

anticoagulent agents

Front 228

aldosterone MOA

Back 228

works in the distal parts
-genomic mechanism (increased expression of ENOC channels

old antagonists increases Na+ and decreases K+ (wasting)

Front 229

which drugs blocks PDE5?
original purpose of drugs

Back 229

-sibenafil
-vardenafil
-tadalofil

-pulmonary hypertension

Front 230

What's the difference between heparin indications and warfarin indications

Back 230

heparin is for short term anticoagulent therapy, while warfarin is more long term

both for prophylaxis treatment of venous thrombosis and thromboembolics associated with atrial fibrilation

pharm: warfarin: 100% bioavailability
Heparin: intermitt intravenous injections

Front 231

ACEI MOA for CHF

Back 231

ACEI reduce angiotensin II and aldosterone levels, decrease Left ventricular filling pressure, decrease TPR, increase CO

Front 232

What is a side effect of guanethidine, reserpine, MAOI, and ganglionic blockers

Back 232

postural hypertension

Front 233

which antihypertensive can be used as monotherapy?

Back 233

calcium entry blocking agents + ACEI

Front 234

prostaglandin effects on renal excretion?

Back 234

-increase renal blood flow
- promote diuresis
-promote natriuresis

Front 235

What's the difference in renal effect between prostaglandin PGE2 and prostaglandin PGI2?

Back 235

PGE2 - causes vasodilation blocks H20 reabsorption and increases diuresis

PGI2 - increases renin secretion, increases cAMP levels

Front 236

What is the difference between Verapamil and Diltiazim?

Back 236

- Verapamil is better for angina & hypertension.
-has a longer half life (7.4 hours max)
-different side effects - constipation + asystole in addition to bradycardia + AV node conduction block

Front 237

stepwise approach versus monotherapy
- mild hypertension

Back 237

1. weight reduction
2. sodium intake reduction
3. thiazide diuretics or B-adrenergic blockers
4. ACEI
5. Calcium channel blocker
6. angiotensin receptor blocker

Front 238

clinical indications for B-blockers (antiarrhythmics

Back 238

-prevent re-infarction & sudden death following an MI
-treat exercised induced arrhythmias
-prevent reoccurance of AVN reentry (pts with PSVT)
-control ventricular rate, increase AVN ERP

Front 239

What type of drug class do you give to treat deep vein thrombosis, leading to pulmonary embolism - and in pts undergoing surgery?

Back 239

think anticoagulents
(warfarin, heparin, enoxaparin)

Front 240

2 indications for warfarin

Back 240

1) prophylaxis and treatment of venous thrombosis
2) for the treatment of thromboembolic complications associated with atrial fibrilation and cardiac value replacement

Front 241

which antianginal not only dilates resistance vessels in the coronary beds but also inhibits platelet aggregation?

Back 241

Dipyridamole

Front 242

pharmacokinetics of warfarin

Back 242

-100% bioavailability
99% becomes bound to plasma albumin

- there is an 8-12 hour delay in warfarin action

-small Vd

Front 243

what's the difference in indications between ACEI and ARBS?

Back 243

-both work for hypertension, ACEI can also be used for CHF and to prevent glomerular daage in diabetes

Front 244

difference between heparin's indication and warfarin's indication?

Back 244

-heparin - for short term with acute pulmonary embolim

vs. warfarin is for pulmonary embolism + thromboembolic complications

Front 245

what can you combine vasodilators with to improve treatment of CHF?

Back 245

-vasodilators + inotropic agents

Front 246

What tests should be monitored when going an anticoagulent?

Back 246

-check prothrombin time and bleeding time measurements

Front 247

Moderate hypertension therapy

Back 247

1. thiazide diuretics
2. b-blockers + centrally-acting agent
3. ACE inhibitors
4. calcium entry blockers
5. angiotension receptor blocker

Front 248

sodium nitroprusside MOA

Back 248

short acting vasodilators
-decreases arterial impedence
-decreased venous pooling

Front 249

which cofactor must be activated in both the intrinsinic and extrinsic coagulation pathways what is the role of this factor?

Back 249

factor x -
(in intrinsic pathways - factors IX and XI are also activated)
Factor X cleaves two peptide bonds in prothrombin to form thrombin

Front 250

name 2 antiplatelet drugs ---

Back 250

1) aspirin
2) clopidogrel

Front 251

what are the indications for nifedipine?

Back 251

prophylactic treatment
1) typical (effort associated) stable (angina)
2) Prinzmetal's (variant) angina pectoris
3) hypertension

Front 252

what drugs should you avoid while taking propranolol (b/c of drug interactions)

Back 252

-reserpenine
-calcium channel blockers
-combination with haloperidol causes hypotension & cardiac arrest
-phenytoin& & rifampin increases propanolol's clearance

Front 253

what's the effect of warfarin on vitamin K?

Back 253

-warfarin prevents the reductive metabolism of the inactive form of vitamin K back to its active form by Vitamin K epoxide reductase

Front 254

which antiplatelet drug irreversibly blocks the ADP receptor on platelets, thereby reducing platelet aggregation

Back 254

clopidogrel MOA

Front 255

drugs used to treat familal dyslipidemia

Back 255

use niacin and or atorvastatin

Front 256

what d b-blockers do to angina vs. arrhythmias

Back 256

angina - decrease myocardial oxygen requirements by decreaseing heart rate, contractility, and bp

arrhythmia - reduce mortality and sudden death after MI

Front 257

which type of angina is b-blockers not used for
contraindicated

Back 257

b-blockers are not used for variant angina

Front 258

what antianginal is used for acute attacks?

Back 258

nitroglycerin (nitric oxide) sublingual

Front 259

this anticoagulent is used for prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation and cardiac valve replacement

Back 259

warfarin

Front 260

verapamil can be used for angina, but if the pt has --- don't use it!

Back 260

don't use in patients with systolic CHF

Front 261

b-blockers are often combined with --- to treat angina

Back 261

organic nitrates

Front 262

what's the difference between sublingual nitroglycerin tablets and nitroglycerin tablets?

Back 262

nitroglycerin tablets (sublingual) are used for acute attacks

nitroglycerin patches - are used for prophylaxis against typical angina

Front 263

tell me about digoxins TI

Back 263

relatively low TI ( approx. 2 )

Front 264

do organic nitrates have a bigger effect on the reduction of preload or the reduction of afterload?

Back 264

have a greater effect on the reduction of preload

Front 265

what's the difference between hydralazine and sodium nitroprusside

Back 265

MOA: hydralazine - dilates arterioles not veins
sodium nitroprusside --> dilates arterioles +/- vessels

Indications -
hydralazine - essential hypertension
sodium nitroprusside - hypertensive emergencies and severe heart failure

Front 266

blocks the carboxylation of several glutamate residues in prothrombin & factors VII, IX, X

Back 266

warfarin

Front 267

fatigue, anorexia, nausea, vomiting, diarrhea, dreams, muscle weakness, 2nd or 3rd degree AV conduction block, and various arrhythmias

Back 267

digoxins famous side effects

Front 268

what is the primary indication for digoxin?

Back 268

What drugs do you use to treat A fib (pts have stretched atria Afib) (atrial fibrilation) and systolic CHF)

Front 269

What deficiencies are seen in pregnant women?

How do you treat these conditions

Back 269

(1) megalopblastic anemia due to a deficiency of folic acid --> use folic acid to treat

(2) iron deficiency due to blood loss during pregnancy --> use ferrous sulfate

Front 270

AA classification

sotalol (DC & MOA)

Back 270

DV: DC III
MOA: prolong action potential duration (K channel blockers)

Front 271

atenolol DC + MOA

Back 271

DC: DC II
MOA: B1 adrenergic receptor antagonist

Front 272

quinidine MOA

Back 272

Mixed Na + K channel blocker

Front 273

lidocaine DC + MOA

Back 273

DC: 1b
MOA: Na channel blocker

Front 274

what drugs are used to treat pernicious anemia ?
what type of anemia is PA?

Back 274

-folic acid and vitamin B12 are used to treat pernicious anemia (megaloblastic anemias due to folic acid deficieny)
-PA is a type of megaloblastic anemia

Front 275

when would you use iron dextran instead of ferrous sulfate?

Back 275

-pts with iron deficiency in whom oral administration is unsatisfactory or impossible (malabsorptions syndrome, dialysis pt)

Front 276

warfarin MOA

Back 276

-block carboxylation of many glutamate residues in prothrombin factors VII, IX, and X
-since these factors are not carboxylated, they are inactive coagulation

Front 277

how does sodium nitroprusside reduces severe heart failure?

Back 277

-in patients with heart failure & low CO, the CO often increases due to a reduction in afterload

Front 278

What antimycobacterium do you give for resistant organisms?

Back 278

pyrazinamide

Front 279

antimycobacteria used as a preventive therapy (true chemoprophylaxis

Back 279

isoniazid for 3 months if skin test + or subclinical infection isoniazid for 12 months

Front 280

what is a potentially life threatening siutation resulting from treatment of atrial flutter

Back 280

-if you treat w a class ia drug you can get a potentially life-threatening acceleration of ventricular rate b/c drug knock out AVN filtration ability

Front 281

angina caused by coronary insufficiency due to vasospasm is called ...

Back 281

variant rest angina

Front 282

pulmonary fibrosis

Back 282

major side effect of amiodarone

Front 283

which drug interactions with digoxin? What is the effect?

Back 283

-quinidine
-decrease cl and increases vd of digoxin, resulting in a doubling of p digoxin

- amiodarone

Front 284

short half life 1-4 minutes
tolerance can develop

Back 284

nitroglycerin pharmacokinetics

Front 285

give folic acid (pts with Will's disease have a deficiency of folic acid)

Back 285

i have wil's disease. Give me a drug. Tell me about my disease.

Front 286

common treatments for CHF? the improtant one

Back 286

-Ace INHIBITORS
-b-blockers
-diuretics
-vasodilators
-digoxin(only for systolic effects)

Front 287

ventricular cardiac arrhythmias man (especially post MI) b/c class 1b, not effective against STVA

Back 287

what do you use lidocaine for?

Front 288

What's the difference between hydralazing vs. minoxidil

Back 288

-both dilate only arteries but
hydralazine is used for essential hypertension and minoxidil is used only for treating hypertension that is sympatomatic or associated with target organ damage

Front 289

what is the difference between ferrous sulfate and iron dextran

Back 289

1) name an oral (absorable) iron preparation

2) name a parental iron preparation

Front 290

antiarrhythmics that interact with digoxin

Back 290

-quinidine
-amiodarone

Front 291

atrial/ventricular tachycardia MOA

Back 291

-DAD related
atrial enhanced automaticity
ventricular --> DADs triggered by sympathetic tone

Front 292

difference betewen adenosine & amiodarone

Back 292

amiodarone -broad spectrum antiarrhythmic

adenosine - endogenous nucleotide antiarrhythmic

Front 293

where is ih most commonly found, If you block ih, what happens?

Back 293

In plays a critical role in regulating automaticity in purkinje fibers, but play only a minor role in the SA node. Blocking Ih reduces automaticity in ectopic pacemaker

Front 294

ACEI are contraindication

Back 294

pregnancy

Front 295

nitroglycerin indications

Back 295

(1) effort-associated (classic) angina
(2) variant angina
(3) unstable forms of angina pectoris

Front 296

causes antihypertensive causes excessive hiresutism (hair growth)

Back 296

minoxidil

Front 297

drug sometimes used to treat antihypertensive emergencies (after sodium nitroprusside )

Back 297

diazoxide

Front 298

minoxidil MOA

Back 298

dilates arterioles but not veins
-opens potassium channels in smooth muscle membranes --> makes contractions less likely

Front 299

hydralazine

Back 299

which drug is used to treat essential hypertension

Front 300

what are the primary effects of orgnaic nitrates on angina?

Back 300

- dilation of arterial (resistance) and venous (capitance) vessels

-increased exercise tolerance

Front 301

which antianginals are used as prophylaxis

Back 301

for both typcial + variant angina :
--> nitroglycerin patches (not sublingual)
--> isosorbide dinitrate

For typical angina only
-b-blockers (propranolol)

Front 302

what are b-blockers used for? in angina

Back 302

B-blockers are only used for prophylaxis of typical angina

Front 303

what;s the difference between nitroglycerin and isosorbide dinitrate

Back 303

The 1/2 life + route of administration

nitroglycerin - sublingual half life 1-4 minutes

isosorbide dinitrate - oral dosing half life 1 hour

Front 304

Irbesartan

Back 304

ARB

Front 305

This antihypertensives shoUdl not be given to patients with coronary artery disease

Back 305

hydralazine

Front 306

hydralazine MOA

Back 306

-dilates arterioles, not veins
-results in decreased arterial blood pressure
-decreased peripheral vascular resistance
-causes a reflex increase in HR, SV and CO

Front 307

name antihypertensives

Back 307

1. minoxidil
2. sodium nitroprusside
3. diazoxide
4. hydralazine
5. ACEI

Front 308

This antihypertensive is subject to polymorphic acetylation. Slow acetylaters metabolize this drugs at a different rate than fast acetylators

Back 308

hydralazine

Front 309

diuretics for edema associated with CHF

Back 309

-all loop diuretics (Furosemide less than ethacrynic acid + Torsemide)

- Triamterene (K sparing diuretics)
-acetazolamide (carbonic anhydra. inhibitors

Front 310

which antihypertensive causes a reflex increase in heart rate

Back 310

hydralazine

Front 311

which antihypertensive agent is given for hypertensive emergencies & severe heart failure

Back 311

sodium nitroprusside

Front 312

which antihypertensive agent dilates both arterial vessels and venous vessels

Back 312

sodium nitroprusside

Front 313

which antihypertensive is a long acting arteriolar dilatior?

Back 313

diazoxide

Front 314

which antihypertensive dilates arterioles but not veins?

Back 314

hydralazine
minoxidil

Front 315

Side effects of this antihypertensive include a reversible lupus-like syndrome

Back 315

hydralazine

Front 316

sildenafil

Back 316

-for erectile dysfunction
-a selective inhibitor of phosphodiesterase type 5 (PDE5) results in increased cGMP, blood flow into penis

Front 317

digoxin immune fab MOA + DC

Back 317

DC: digoxin antidote

MOA: antibodies that bind to digoxin. The complex is then excreted through the kidneys

indications: used for life-threatening digoxin toxicity

Front 318

Therapy for vasoplastic angina

Back 318

-nitrates
-calcium channels blockers

Front 319

what's the difference between papaverine + sildenafil

Back 319

Papaverine: vasodilarot
sildenafil: erectile dysfunction drug

Papaverine: inhibitors phosphodiesterases
sildenafil: inhibitors phosphodiesterase type 5

Front 320

name that carbonic anhydrase inhibitors

Back 320

Acetazolamide

Front 321

aspirin MOA

Back 321

-aspirin irreversibly inhibits both isoforms of COX
-reduces formation of TXA2

-also interferes with chemical modulators of the kallikren system inhibits granulocyte adherence to damage vascular

Front 322

why is niacid useful for treating familal dyslipidemia

Back 322

it is useful b/c it reduces VLDL levels

Front 323

What are saralasin and losartan?

Which is better?

Back 323

They are both angiotensin II inhibitors
only Losartan has few side effects - therefore its better
(sarlasin may cause hypertension )

Front 324

What do vasoconstrictors do to GFR?

Back 324

-vasoconstrictors
-decrease hydrostatic pressure
-decreases GFR decreases glomerular filtration rate

Front 325

what do vasodilators do to GFR in capillaries

Back 325

-vasodilators decrease pressure in the afferent arterioles

-increases raise GFR
-increases raises hydrostatic pressure in capalliaries

Front 326

3 major factors in peptic ulcer disease and treatment

Back 326

1. infection with H. Pylori
2. Increased HCL acid secretion
3. Inadequate mucosal defenses against acid

Treatment
1. antimycobacterials
2. 2 week course of triple therapy, with a proton pump inhibitors and antibiotics

Front 327

name an antidote used to reverse digoxin toxicity

Back 327

digoxin immune Fab

Front 328

major drug interactions of quinidine

Back 328

hepatic eliminartion is increased by drygs that induce P450 (phenobarbital, phenytoin & rifampin)

Front 329

What's the international normalized ratio?

Back 329

INR = a more sensitive test of prothrombin time using human thromboplastia measures relative PTT

INR = (PT test/ PT normal)

Front 330

Pharmacokinetics of sodium nitroprusside

Back 330

given IV drugs

Front 331

Effects of ACE on bradykin and on ang II

Back 331

ACE --] inhibits bradykinin
ACE increases Ang II levels

Front 332

ACEI MOA -->
effect on bradykinin

Back 332

ACEI =
-inhibits peptidyl dipeptidase (ACE)
-prevents conversion of ang I --> ang II
-elevates levels of bradykinin
-lowers ang II levels

Front 333

if it ends in pril it's a ...

Back 333

an ACEI

Front 334

Name ACE inhibitors

Back 334

-Benazepril
-Captopril
-Enalapril
-Fosinopril
-Lisinopril
-quinapril
-ramipril

Front 335

sodium nitroprusside MOA

Back 335

-dialates both venous & arterial vessels
- results in reduced TPR & venous return
-releases NO = incresed intracellular cGMP, decrease Ca++ and relaxes vasulars smooth muscles

Front 336

what is the advantage of the international normalized ration over the PT test?

Back 336

INR is more sensitive
- it also is relative (between labs)

Front 337

Why are other vasodilators agents (other than nitroglycerin and dipyridamole, etc is not sed to treat angina?

Back 337

because they increase blood flow, but also increses O2 demand on heart

Front 338

antimycobacterial used for both tuberculosis and leprosy

Back 338

Rifampin

Front 339

Tuberculosis - MDR

Back 339

use combination of 3 drugs to which the organisms is susceptible

Front 340

this anticoagulent is used to treat venous thrombosis (it is also used for prophylaxis purposes)

Back 340

Warfarin

Front 341

name the 2 types of angina and tell me the difference

Back 341

-exertional angina - attacks occur during exercise

-variant rest angina --> attacks occur during rest

Front 342

what drug metabolism sidenafil?

Back 342

metabolized by cyt p450

Front 343

which part of the nephron has NaCl Cotransporters (major transport mechanism here

Back 343

NaCl cotransporters @ early distal convoluted tubule

Front 344

how does nitroglycerin effects myocardial o2 consumption and delivery

Back 344

myocardial O2 consumption demand is decreased bc of the arterial + venous effect of nitroglycerin
nitrals may increase mo2 delivery in variant angina

Front 345

What is the only current use of verapamil

Back 345

-not used for antihypertensive events
-used only for PSVT
-blocks Ca++ entry into the AV node

Front 346

How do thiazide diuretics help hypertension

Back 346

appear to alter arteriolar tone

Front 347

2 drugs used to treat familal dyslipidemia

Back 347

niacin + atorvastatin

Front 348

What;s the difference between traimterene and amiloride?

Back 348

place of action

triamtere - collecting tubule
amiloride - distal convoluted tubule & collecting duct

action - same action but amiloride also reduces H+ secretion

indications - triamtere is used mainly for edema associated with heart failure

Front 349

which diuretics block na entry through na selective ion channels

Back 349

k sparing diuretics - triamtere + amiloride

Front 350

what's different about ethacrynic acid compared to other loop diuretics

Back 350

-acts on the ascending loop of henle + the proximal and distal tubules
torsemide + Furosemide only work on the ascending limb of the loop of henle

Front 351

What compound promotes prostaglandin synthesis ( a potent vasodilator)

Back 351

kinins

Front 352

how do organic nitrates (nitroglycerin) help angina

Back 352

-these drugs release nitic oxide
-these drugs result in decreased O2 demand by
-reducing preload and afterload

Front 353

1. how do organic nitrates reduce preload

2. How do they reduce afterload

Back 353

1. They reduce preload by causing venous dilation (big effect)

2. They reduce afterload by dilating the arteries (small effect

Front 354

which calcium antagonists is used for both typical + variant angina

Back 354

diltiazem

Front 355

name to obsolete antianginal drugs illicitly used to prolong erections

Back 355

sodium nitrate + amyl nitrites

Front 356

inhibits RNA synthesis by inhibiting DNA dependient RNA polymerase

Back 356

Rifampin MOA

Front 357

Isoniazid MOA

Back 357

antimycobacterium that inhibits biosynthesis of mycolic acids which are important for mycobacterial cell wall synthesis

Front 358

Rifampin

Back 358

antimycobacterium that makes you piss red orange

Front 359

warfarin/coumadin, coumarins

Back 359

anticoagulent that blocks synthesis of factors II, VII, IX, X

Front 360

The effects of prostaglandins on renin excretion

Back 360

prostaglandins increses renin, thereofre COX2 inhibitors decrese renin

Front 361

severe hypertension therapy

Back 361

1. thiazide diuretics
2. direct vasodilators
3. B-blocker to block reflex tachy
4. guanethidine or clonidine
5. calicum entry blocker
6. calcium channel blocker
7. alpha receptor blocker
8. angiotensin receptor blocker

Front 362

SE = lupus erythematosus syndrome (antihypertensive)

Back 362

hydralazine

Front 363

if i have chronic renal failure, what drug is safe to give me (antianemic drug) and which is not safe?

Back 363

-you can give me Epoetin alpha

-do not give me deferoxamine (an iron chelator)

Front 364

don't take --- with sildenafil

Back 364

nitrates - b/c can cause profound hypotension if injected together

Front 365

coumarin activity MOA

Back 365

-antagonizes vit Ks role
-blocks synthesis of factors II, VII, IX, X

Front 366

hypolipidemic should be avoided in pregnancy

Back 366

statins

Front 367

use of this hypolipidemic increses the risk of gout

Back 367

niacin

Front 368

through what factors does heparin influence factors II, IX< X, XI, XII, XIII

Back 368

Antithromin III

Front 369

Competitive inhibitors of HMG-CoA reductase are called ....

Back 369

statins (lovastatin & simvastatin)

Front 370

what type of transport occurs at the distal convoluted tubule?

Back 370

sodium reabsorption is active, cl- follows passively

Front 371

Name 2 thiazides

Back 371

-hydrochlorothiazide
-chlorothiazide

Front 372

class 1b antiarrhythmics are effective against ...

class 1b antiarrhythmics are not effective against

Back 372

-think, b only works on the bottom half the heart effective only against ventricular arrhythmias, not effective against supraventricular arrhythmias

Front 373

acetazolamide MOA

Back 373

-carbonic anhydrase inhibitors
-acts at the proximal tubule
-inhibits proton source (Na/H exchanger) necessary for absorption of sodium bicarbonate can K+ indicrectly

Front 374

which drug used in the treatment of CHF must be given by continuous infusion intravenous infusion

Back 374

sodium nitroprusside

Front 375

niacin MOA

Back 375

decrease TG
decrease VLD esp LDL

Front 376

what are the two important things about digitoxin

Back 376

-hepatic metabolism
-half life is approx 1 week

Front 377

is used for the treatment of normal & high renin hypertension, CHF, and may prevent glomerular damage in diabetes

Back 377

ACEI

Front 378

what transport processes maintain the volume and composition of body fluid in the kidney?

Back 378

-glomerular filtration
-tubular transport (anionic + cationic transport systems
-passive transports

Front 379

This drug is competitively antagonized by caffine, theophylline, and dipyridamol

Back 379

adenosine

Front 380

how do you block 2nd and 3rd degree AVN block caused as a SE of digoxin , Why?

Back 380

atropine - a muscarinic antagonists, blocks parasympathetic b/c AVN block is due to excessive increase in vagal tone

Front 381

to control ventricular rate in chronic atrial fibrillation

Back 381

-verapamil or diltiazem
-b-blockers
-digoxin
-warfarin
(don't use in pts with evidence of myocardial damage

Front 382

what is the difference between nifedipine + verapamil

Back 382

does the opposite to the heart?
nifedipine reduces afterload and preload via peripheral vasodilation

Front 383

diuretics used for symptoms of a cute mountain sickness

Back 383

acetazolamide

Front 384

how do digoxin effects the heart

Back 384

- increase vagal tone (through barorreceptors mediated - central vagal stimulation

-positive inotropic effect (due to inhibition of the Na/K pump - enhance ica, increse SR release

Front 385

digoxin MOA

Back 385

-binds to Na/K ATPases
-increases vagal tone, therefore increase AVN ERP and decrease automaticity

esp in SAN + atria (vagal inervation is big here)

Front 386

what drugs should you not give with digoxin? Why

Back 386

-quinidine
-verapamil
-amidarone (antiarrhythmics)
they inhibit digoxin secretion in urine through p-glycoprotein pump competition

Front 387

side effects include teratogenicity and eripheral neuropathy

Back 387

-thalomide

Front 388

when do you use a PT

Back 388

drug tests used:

-useful in measuring Vit K
-useful in liver disease
-monitor oral anticoagulation therapy to ensure a decrease in factors II, VII, X

Front 389

therapy for unstable angina

Back 389

-aspirin, herparin
-anticoagulents and antiplatelet drgus

Front 390

clofazimine MOA

Back 390

builds to DNA and inhibits template function

Front 391

competitively inhibits the enzyme dihydropteroate synthase - thus blocking folic acid synthesis

Back 391

dapsone MOA

Front 392

papaverine

Back 392

vasodilator inhibits phosphodiesterase increases cAMP
used for cerebal + peripheral ischemia with arterial spasm

Front 393

side effect in acute renal failure in pts with bilateral renal artery stenosis

Back 393

ACEI

Front 394

which calcium channel antagonists is used mainly for variant angina because of its antispasmotic effects

Back 394

-nifedipine

Front 395

therapy for chronic stable angina of effort

Back 395

-long acting nitrates
-b-blockers
-calcium channel blocerks

Front 396

reflex tachycardia results from hypotension caused by which drug used to treat CHF

Back 396

sodium nitroprusside

Front 397

what two drugs shoudl digoxin be given with if possible

Back 397

-use with a diuretic and an ACEI

Front 398

bile acid binding resin useful in treating pts with isolated increases in LDL

Back 398

cholestyramine

Front 399

name binding acid binding resins (hypolipidemics)

Back 399

cholestyramine + colestipol

Front 400

prodrug hypolipedimics

Back 400

the statins - lovastatins and simvastatins

Front 401

these drugs decrease TP and increase HDL

Back 401

fibric acid derivates gemfibrixil and fenofibrate

Front 402

used to treat conditions with hypertriglyceridemias _ dysbetalipoprotenima

Back 402

fibric acid derivatives

Front 403

indapamide

Back 403

drug interactions include
-additive effects with other antihypertensives
-enhanced lithium toxicity
-may decrese response to catecholamines

Front 404

diuretics only indication is antihypertension

Back 404

indapamide

Front 405

congenital long QT acute Rx and chronic Rx

Back 405

acute - pacing, magnesium, isoproteronol

chronic - b-blockers, pacers

Front 406

ventricular fibrillation acute treatment chronic treatment

Back 406

acute: DC caridoversion
Lidocaine
procainamide

chronic:
ICD4
amiodarone

Front 407

don't give during pregnancy

Back 407

1. acei - angiotensin converting enxyme inhibitors

2. indapamide
3. ANG II receptors blockers
4. warfarin

Front 408

acetazolamide

Back 408

diuretics used for centripencephalic epilepsies
petit mal
-unlocalized seizures

Front 409

name and MOA of diuretics that act at the early distal convolution

Back 409

block NaCl cotransporters

chlorothiazide
metolazone
indapamide

Front 410

which drugs bin bile acids in the intestines and cause and upregulation of LDL receptors

Back 410

-chloestyramine
-colestipol

Front 411

cholestyramine

Back 411

-hypolipedimic increases TG and increase VLDL most

Front 412

diuretic class primarily associated with edema from CHF

Back 412

-potssium sparing diuretics
-loop diuretics also work

Front 413

this bild acid binding resin may delay or reduce absorption of concoitant oral medication

Back 413

cholestyrarmine

Front 414

4 main uses of diuretics

Back 414

A) nephrotic syndrome
B) CHF
C) advanced liver disease
D) hypertension

Front 415

most common important complication of diuretics usage

Back 415

hypokalemia
metabolic disturbances (alkalosis, acidosis
glucose intolerance
hyperuricemia

Front 416

name two other drugs act at the same site as indapamide

Back 416

chlorothiazide
metolazone (early distal convoluted tubule)

Front 417

side effects include acute renal failure, hyperkalemia, and drug cough

Back 417

ACEI

Front 418

what is one of the most potent vasoconstrictors

Back 418

one of the most potent vasoconstrictors in ang II

Front 419

pyrazinamide MOA

Back 419

inhibits ETC in mycobacterial (Not sure

Front 420

name drugs used for leprosy

Back 420

-dapsone
-clofazimine
-rifampin
-thalidomide

Front 421

drugs used for prophylaxis for prophylaxis of peptic ulcers acute stress ulcers and GERD

Back 421

cimetidine, rantidine, famotidine, and nizatidine

Front 422

how do you control gastric acid secretion in patients with peptic ulcer

Back 422

histamine is the major factors controlling gastric acid release

can give a histamine H2 antagonist to block gastric acid secretion

Front 423

what drug is ineffective in treating familal dyslipideMia

Back 423

binding resins don't work

Front 424

what diseases cause a reduction in GFR

Back 424

-organic diseases
-congestive heart failure
- antihypertensive

Front 425

drug interactions with ACEI

Back 425

-potassium sparing diuretics - b/c may cause hyperkalemia

-NSAIDs b.c they block the hypotensive effects of ACEI by blocking bradykinin - mediated vasodilation

Front 426

nephrotic syndrome

Back 426

excrete greater than 3-3.5 g of protein/ 24 hrs

--> hypoalbuminemia, hyperlipidemia

Front 427

ACEI indications

Back 427

-normal L high resin hypertension
-CHF
-may prevent glomerular damage in diabetes

Front 428

cholestyramine MOA

Back 428

-binds bile acids in the intestinal lumen & prevents reabsorption

-upregulation of LDL receptors

Front 429

best for chronic asthma

Back 429

-corticosteroids - beclamethasone, bidesonide, fluticasone

Front 430

i am a patient who requires more than occasional inhalations of b2 agonists for symptoms relief

Back 430

use corticosteroids aersol

Front 431

cromolyn sodium MOA nedocromil sodium

Back 431

- inhibiory effect on mast cell + eosinophils

-prevents release of cell mediators

Front 432

Respiratory drug

-can be affected by liver disease, cigarette smoking _ diet changes

-narrow therapeutic index

Back 432

theophylline

Front 433

theophylline side effects

Back 433

high dose
(1) convulsions
(2) cardiac arrhythmias
(3) death

lots of drug interactions

Front 434

hansen's disease

Back 434

use WHO short course antibacterial regiments

Front 435

who treatment of for leprosy

Back 435

rifampin, dapsone, clofazimine (X2 year minimum

Front 436

drugs used in reversing the lepra reaction and erythema nodossum leprossum

Back 436

lepra rxn - steroids, clofazimine

ENL- steroids, thalidomide, clofazimine

Front 437

antimycobacterial used for H. pylori infections

Back 437

bismuths + metronidazole , tetracycline, amox, clarithromycin

Front 438

theophylline MOA

Back 438

-inhibit cell surface receptors for adenosine
-causes direct bronchodilator and has anti-inflammatory acts
-adenosine receptor modulate - adenylate cyclase activity

Front 439

belcamethasone MOA -->
which drugs share the same MOA

Back 439

-budesonide + fluticasone
-inhibits phosphotipase A2, thereby inhibiting production of inflammatory cytokinesis
-inhibit lymphocytic + eosinophilic mediated airway inflammation in asthmatics not curative

Front 440

prophylaxis of chronic asthmas

Back 440

- 1 degranulating inhibitors cromolyn sodium _ nedocromil sodium

-leukotrienes (monteleukast _ zileuton)

Front 441

ipratroprium bromide MOA

Back 441

-degree of muscarinic involvemtn in bronchomotor responses varies among patients

Front 442

pharmacokinetcs of ipratropium bromide

Back 442

can be given in high doses b/c is poorly absorbed

Front 443

a bronchodilators used for maintaines treatment of bronchospasm associated with chronic obstructive pulmonary disease

Back 443

ipratropium bromide antimuscarinic bronchodilator

Front 444

long term treatment - along actign B2 selective sympathetic

Back 444

salmeterol

Front 445

asthma & pulmonary disease medications can reduce fluid congestion b/c of alpha effects

Back 445

epinephrine/adrenaline

Front 446

acute asthma

Back 446

-use short acting b2 agonists
-epinephrine (unwanted side effects)

-albuterol (B2 selective)

Front 447

what's the difference between monteleukast and zileuton

Back 447

-different pats of the pathway -
monteleukast and leukotriene inhibitor

- zileuton - leukotriene pathway inhibitor

different mechanism - monte - LTD4 receptor antagonists
zileuton - 5-lipoxygenasese inhibitor

Front 448

an LTD4 receptor antagonists

Back 448

monteleukast

Front 449

name a

1. leukotriene inhibitors
2. leukotriene pathway inhibitors

Back 449

1. monteleukast
2. zileuton

Front 450

what is the advantage of azithromycin over clarithromycin

Back 450

-less likely to efffect the QT interval than clarithromycin

-only taken once a day

Front 451

which antimycobacterial cannot be administered pimozide

Back 451

clarithromycin b/c prolongs the QT interval

Front 452

What's the difference between dapsone + clofazimine?

Back 452

-dapsone --> first line of defense
clofazimine --> 2nd defense

different MOA

Dapsone - competitively inhibits enzyme dihydropteroate synthetase block folic acid synthesas

clofazimine --> binds to DNA + inhibits template function

Front 453

red colored urine

Back 453

rifampin
clofazimine

Front 454

dapsone indications

Back 454

-mycobacterium leprae
-pneumocystis pneumonia in AIDS

Front 455

leprosy drugs

Back 455

clofazimine
rifampin
dapsone

Front 456

what is an alternative to dapsone for treating resistant leprosy

Back 456

clofazimine

Front 457

This type of hypolipidemic drug activates lipoprotein lipase

Back 457

fibric acid derivatives
gemfibrozil and fenotibrate

Front 458

-antimycobacterial used as a sterilizing agent against residual intercellular organisms for tuberculosis bacilli

Back 458

-pyrazinamide

Front 459

side effects of isoniazid

Back 459

-hepatotoxicity
-peripheral neuropathy
-may indice hemolytic anemia in pts iwth G6P dehydrogenase deficiency

Front 460

ethambutol MOA

Back 460

-inhibits the synthesis of arabinogalactan (a component of mycobacterial cell walls) bacteirostatic

Front 461

side effects of this antimycobacterial include
hepatoxicity, peripheral neuropathy, can ay indice hemolytic anemia in pts iwth G6P dehydrogenase deficiency

Back 461

isoniazid

Front 462

which antimycobacterials are bacteriocidal

Back 462

-cidal

-isoniazid in dividing cells
-rifampin

Front 463

antimycobacterials that are bacteriostatic

Back 463

-isoniazid in resting cells
-ethambutol
-dapsone

Front 464

inhibits ETC in mycobacteria

Back 464

pyrazinamide

Front 465

different acetylators - fast acetylators and slow acetylators metabolize at different speeds

Back 465

isoniazid

Front 466

dopamine MOA

Back 466

-reduce afterload combined with inotropic stimulation
-acts on D, a, b receptors

Front 467

primary action of this vasodilator for CHF is reduced preload

Back 467

torsemide

Front 468

foresemide and torsemide drug interactions

Back 468

NSAIDs interfere with prostaglandin synthesis

Front 469

carbohydrate tolerance --> hypolipidemic, vasodilators for CHF?

Back 469

niacin
hydrochlorotriazide

Front 470

if worried about cyt p450 drug interactions, which statin can you give?

Back 470

pravastatin

Front 471

side effects of this hypolipidemic is elevations of serum aminotransferase

Back 471

statins- HMG-Coa reductase inhibitors

Front 472

lovastatin MOA

Back 472

-specific inhibitors of HMG-Coa reductase which catalyzes conversion - HMG-CoA --> mevalonate
-mevalonates is a precursor of cholesterol
-decreases cholesterol synthesis + upregulation of LDl
-decreased oxidative stress + vascular influentia

Front 473

which hypolipidemic do you use after MI?
irrespective of lipid levels?

Back 473

statins

Front 474

hypolipidemic - decreases cholesterol synthesis and upregulates LDl

Back 474

-HMG-CoA reductase inhibitors
-statins

Front 475

which of the statins is not a prodrug

Back 475

pravastatin

Front 476

for high ldl to treat use

Back 476

isolated: cholestyramine

Front 477

what's the difference bteween niacin and gemfibrozil

Back 477

both decrease triglycerides, decrease LDl, and decrease VLDL
but ...

niacin - familial hyperlipidemia
gemfibrozil - hypertriglyceridemas and dyslipoproteienma

Front 478

used for hypertriglyceridemia snad dysbetalipoproteinemia

Back 478

gemfibrozil

Front 479

gemfibrozil 0 ligand for nuclear Tx receptor PPAR alpha

Back 479

PPAR - alpha is asociated with which hypolipidemic?

Front 480

gemfibroxil MOA

Back 480

-functions as a ligand for nuclear transcription receptors - peroxisome proliferator- activated receptor alpha (PPAR-alpha)

Front 481

name fibric acid derivatives

Back 481

gemfibrozil

Front 482

niacin MOA

Back 482

-inhibit VLDL secretions in hepatocytes
-inhibits intracellular lipase of adipose tissue via receptor mediated signaling
-decrease catabolic rate for HDL
-reduce VLDL by decreaseing influx of free fatty acids into the liver

Front 483

what is the most effective hypolipidemic for increasing HDL levels

Back 483

niacin

Front 484

used for familal hypercholesterolemia in combination with a resin or reductase inhibitor

Back 484

niacin

Front 485

side effects of hypolipidemic - cutaneous vasodilation

Back 485

niacin

Front 486

ethambutol MOA

Back 486

not well understood - but inhibits syntehsis of arabinogalacan, an essential component of mycobacterial cell walls. Enhance activity of lipophilic drugs such as rifampin

Front 487

tuberculosis resistant isoniazid

Back 487

rifampin and ethambutol

Front 488

atrial fibrillaiton and atrial flutter can be treated by ...

Back 488

ca channel blockers
b-blockers
-digoxin

b/c these drugs increase AV node ERP

Front 489

Ca channel blockers MOA

Back 489

slow AVN conduction
increas AVN ERP

this prevents reoccurances of AVN reentry (increase AVN ERP)
PSVT

control ventricular rate in pts with atrial tachyarrhythmias (increase AVN ERP)

Front 490

vitamin K

Back 490

drug used to treat hypoprothrombinemia secondary to factors limiting absorption of synthesis of vitamin K

Front 491

moderate CHF treatment, decrease GFR, moderate peripheral edema vascular congestion

Back 491

-digitalis/digoxin
-loop diuretics (thiazides)
-ACEI

Front 492

which antihypertensives have SE - interferes with glucose metabolism & risk of diabetes and uricoic acid, increase plasma lipid levels

Back 492

thiazide diuretics

Front 493

antiseizure med nystagmus, gingival hyperplasia and hirustrism

Back 493

phenytoin

Front 494

--- receptors mediate long term potentiation when stimulated by glutamate

Back 494

NMDA receptors

Front 495

I have acute pain, pulmonary edema, dyspnea, and I need a preanesthetic medication

Back 495

morphine

Front 496

of maximal analgesia is 12-15% of morphine - used for moderate pain

Back 496

codeine

Front 497

fentanyl

Back 497

80X more potent than morphine, used for general anesthesia

Front 498

2 most important excitatory transmitters used for the transmission of pain

Back 498

-glutamate
-substance p

Front 499

GABA MOA

Back 499

1. GABAa -= binding opens CL ion channesl caused hyperpolarization and inhibiton of neuronal firing
2. GABAb - metabotropic receptors decrease spasticity
3. GABA c -inotropic

Front 500

testosterone DEA schedule

Back 500

Schedule III

Front 501

Antipsychotic drugs for which extrapyramidal symptoms are a side effect

Back 501

-haloperidol
-risperidone

Front 502

name 3 atypical antipsychotics and the main receptor they inhibit

Back 502

1. rieperidone - blocks D2 and 5HT2 - schizo and dementia

2. clozapine - blocks D4 and a1 -used for resistant schizo

3. olanzapine - block 5-HT2 > DI - D4 - used for bipolar disorder

Front 503

lithium MOA

Back 503

-antimanic drugs
-prevents mood swings - mood stability in pts with manic depressive orders

-resembles sodium, enters the cell using Na + channels --> accumulates intracellulary b/c not pumped out by Na/K atpase
-causes partial depolarization of cells
-reduces hormone ADH induced cAMP production
-inhibis depolarization evolved NT release
-inhibits several enzymes involved in normal recycling of membrane phosophoinositol decreas PIP2, decrease IP3, decrease DAG

Front 504

Benzodiazepine is used for insomina

Back 504

flurazepam (a hypnotic)

Front 505

drugs used to treat heroin withdrawal

Back 505

methadone (agonist)
naltrexone (antagonist)
buprenophine - more potent long acting

Front 506

what are the three opioid receptor types
what's the difference between them>?

Back 506

u, k,s

u - most important responsible for analgesic effects + major side effects
k = responsible for some analgesic effects

Front 507

which type of pain do opioids work for? WHich type of pain are they ineffective against?

Back 507

opiods are for acute pain, not chronic pain

Front 508

used for insomnia

Back 508

-sedating
-benzodiazepine like drugs (zolpidem & zaleplon

Front 509

1st line of defence for OCD

Back 509

SSDRI (fluoxetine (Prozac))

Front 510

if you have a family history of hypothermai, don't give this skeletal muscle relaxant

Back 510

succinylcholine

Front 511

diazepam (valium) is a DEA schedule --- what is it>?

Back 511

scheudle IV
diazepam is an anxiolytic and an antiepileptic

Front 512

primary NTS at the dorsal horn fo the spinal cord

Back 512

glutamate + substance p

Front 513

endogenous compounds with u >> dk selectivity

Back 513

endomorphins

Front 514

teat seizures associated with alcohol withdrawal with ...

Back 514

short acting lorazepam

Front 515

for anxiety (long term)

for anxiety (short term)

Back 515

- diazepam (long term)

- alprazolam (short term)

Front 516

DOC muscular disorders especially cerebral palsy and MS

Back 516

diazepam

Front 517

detoxification druring withdrawal from physiological dependence of barbituates, BZs, and ethanol - use -->

Back 517

long acting sedative hypnotics with dose tapering

- chlordiazepoxide
-diazepam

Front 518

idosyncratic blood dyscrasias, aplastic anemia

Back 518

carbamazepine

Front 519

anesthetic but not analgesic

Back 519

thiopental sodium

Front 520

local amide with higher incidence of cardiac arrhythmias

Back 520

bupivacatine

Front 521

DOC - tonic clonic & grand mal

Back 521

phenytoin and carbamezipine

Front 522

DOC partial seizure

Back 522

phenytoin and carbamezipine

Front 523

DOC status epilepticus q

Back 523

phenytoin and diazepam

Front 524

DOC myoclonic seizures

Back 524

clonazepam + valproic acid

Front 525

DOC absence seizures

Back 525

Ethosuzimide (alternative clonazepam and valproic acid)

Front 526

buprenorphine

Back 526

long duration opioids

Front 527

don't give with meperdine

Back 527

MAOI probably shoudl avodi TCAS and antipsychotics

Front 528

facilitates surgical amnesia

Back 528

diazepam

Front 529

name an antidepressant that inhibits cyt p450

Back 529

fluxoetine

Front 530

-slower onset of action than BZ
-no muscle relaxation or anticonvulsant activity

Back 530

busprione --> for chronic anxiety with symptoms of irritabilitya dn hostility especially in ex-drug abusers

Front 531

treatment of generalized anxiety disorders --> acts on the 5-h-t receptors

Back 531

buspirone

Front 532

1. epilepsy DOC
2. DOC for grand mal
3. status epilepticus

Back 532

1. clonazepam
2. diazepam
3. diazepam

Front 533

DOC for alcohol withdrawal

Back 533

-chlordiazepoxide
-diazepam
-oxazepam

Front 534

SE of THC

SE of LSD

Back 534

THC - amotivational syndrome

LSD- alters users sense of time and self may change

Front 535

Blocks NMDA-type glutamate receptors

Hallucinogens

Back 535

-PCP - dangerous hallucinogen
-ketamine - anesthetic agent used for diagnostics & surgical procedures

Front 536

endogenous compounds with d> uk selectivity

Back 536

enkephalins

Front 537

major side effects of morphien

Back 537

decreased respiration

also: miosis, block of cough reflex, emesis, GI distress, cardiovascular effects, constipation, nausea, depressed renal function, pruitis and tolerance

Front 538

a centrally acting analgesic (not chemically related to opiates

Back 538

tramadol

Front 539

difference between hydrocodone and tramadol?

Back 539

hydrocodone is an antitussive and a narcotic analgesic, while tramadol is a centraly acting analgesic

hydrocodone shoudl eb used with caution in pts iwth head injuries

tramadol should not be used with naloxone

Front 540

inhalation GA MOA

Back 540

may activate GABA-A receptors _ depress spontaneous evoked activity of neurons in the brain

Front 541

amide local anesthetics associated with high incidences of cardiac arrhythmias

Back 541

bupivacaine

Front 542

name amide local anesthetics

Back 542

-remember the i before caine rule

-lidocaine
-bupivacaine
-ropivacaine

Front 543

hallucingoen (angel dust, heroin) are DEA shedule

Back 543

one

Front 544

antipsychotic contraindicated in pts with long QT

Back 544

haloeridol

Front 545

tranylcypromiae pharm

Back 545

fast recovery of MAO due to weak bond to enzyme

Front 546

antipsychotic used to treat dementia

Back 546

Risperidone

Front 547

name 2 drugs under DEA schdule 1

Back 547

PCP & heroin

Front 548

contraindicated with SSRI fluoxetine

Back 548

-drugs metabolized by cyt p450
-MAOI presumably also

Front 549

antiepileptic drug - highly bound to plasma protein

Back 549

phenytoin
-valproate
-carboanzapene also strongly bound

Front 550

the most common most dangerous hallucinogen is

Back 550

PCP

Front 551

antiepileptic used only for partial seizures

Back 551

GABA pentin

Front 552

opioid administration

Back 552

-oral administration of opioids
-huge first pass effect but the amount that can get into the blood is still sufficient

Front 553

what should not be administered with meperidine?

Back 553

tricyclics

Front 554

lithium MOA

Back 554

-alters sodium transport in nerve and muscle cells
-inhibits the recycling of neuronal membrane phosphoinositides involved in the generation of secondary messengers

Front 555

antidepressants that shoudl not be given to the elderly

Back 555

TCAs becasue of the severe side effects

Front 556

DOC for atypical depression

Back 556

phenelzine

Front 557

amide local anesthetic s
-medium duration of action
-long duration of action

Back 557

medium - mepivacaine
long- ropivacaine

Front 558

Which inhaled GA is an incomplete anesthetic

Back 558

nitrous oxide
MAC > 100%

Front 559

what type of patients can thiopental sodium and methohexital not be used for ?

Back 559

-contraindicated in pts with porphyria

Front 560

hypnotic used for short term treatment of insomnia

Back 560

zolpidem

Front 561

has a long half life and a longer duration of action than morphine

Back 561

methadone

Front 562

what's the difference between glycine and gaba>

Back 562

they are both inhibitory NTS but glycine increases Cl permeability, while GABA works on GABA A and GABA B

Front 563

DEA schedule I

Back 563

heroin

Front 564

acute opioid poisioning
signs and symptoms
treatment

Back 564

1. comatose, miosis, cyanosis
2. treatment - artificial respiration and give naloxone

Front 565

what's the difference between inotropic receptrs and metabotropic receptors

Back 565

inotropic: ligand gated ion channels, fast

metabotropic: g protein coupled receptors, slow

Front 566

name 2 areas of the brain, regions, where opioids work

Back 566

PAG and RVM - regions of the brain with lots of opioid receptors

Front 567

skeletal muscle relaxant used for allievation of severe spasticity resulting from multiple sclerosis & in patients with spinal cord injuries

Back 567

baclofen

Front 568

durham - humphrey admendment

Back 568

define what drugs are prescripiton and which are over the counter

Front 569

kefauver-Harris amendment

Back 569

establishes stronger drug-saftey regulation establishes clinical testing phase i-IV

Front 570

1. DEA schedule III drug
2. DEA schedule IV drug
3. DEA schedule V drug

Back 570

1. testosterone
2. diazepam
3. codeine

Front 571

name a narcotic antagonist

Back 571

-naltrexone
-naloxone

Front 572

opioid MOA - where does it block?

Back 572

1. presynaptic SP receptors
2. opioids can also effect calcium release in the presynaptic terminal, so that the SP NTS are not released

Front 573

used for ADD in children greater than 6 years old? Other uses of this drug?

Back 573

methamphetamine

other uses - short term treatment of obesity

Front 574

can be used for post-traumatic stress & premenstrual dysphoric disorder + social anxiety disorder

Back 574

sertraline (zoloft)

Front 575

blocks 5-HT2 > D1- D4 etc. Uses?

Back 575

olNZAPINE
USED FOR bipolar disorder

Front 576

antagonizes action of benzodiazepines - with what result?

Back 576

flumazenil - reverses the sedative effects of benzodiazepines

Front 577

phenobarbital MOA

Back 577

antiepileptic
-potentiates GABAergic stimulus
-inhibits Ca++ channels
-blocks AMPA receptors

Front 578

used for partial seizures and absence seizures

Back 578

lamotrigine

Front 579

pharmacological action of morphine

Back 579

1. analgesia
2. euphoria

Front 580

4 uses of diazepam

Back 580

1. anxiolytic
2. alcohol withdrawl
3. muscle spasm
4. seizure

Front 581

what are tricyclic antidepressants used for now?

Back 581

-as an alternative for enuresis and chronic pain

Front 582

epinephrines effect on LA

Back 582

-vasoconstriction
-decrease systemic toxicity
-decrease bleeding (local)
-increase duration of action of LA

Front 583

cocaine MOA

Back 583

Mechanism of Action: blocks monoamine reuptake transport into nerve terminals; Na channel blocker

Front 584

cocaine indications

Back 584

Indications: topical anesthesia of the upper respiratory tract (due to its combined vasoconstrictor & local anesthetic properties); use in EM as an ingredient in TAC (tetracaine, adrenaline & cocaine) prior to wound cleaning & suturing.

Front 585

tell me about cocaine mixed with alcohol

Back 585

Major drug Interactions: MAOI inhibitors would be expected to increase cocaine's effects & toxicity. Ethanol consumption will convert cocaine to cocaethylene, a derivative that has a half life of 3-4 hours and shares a similar pharmacology as cocaine. Most cocaine abusers consume ethanol to prolong their high. This may also increase cocaine's cardiotoxicity.

Front 586

for ADD or narcolepsy

Back 586

-ritalin methylphenidate
-dextroamphetamine

ADD - also methamphetamien & pemoline

Front 587

drug interactions with MAO inhibitors

Back 587

diuretics
NSAIDS
ACEI

Front 588

pregnant and head injury, what do you not give?

Back 588

morphine

Front 589

THC acts on (MOA)

Back 589

cannabinoid receptors CB1 and CB2

Front 590

antiepileptic used for all seizure types

Back 590

valproate

Front 591

most important side effect that can kill is decreased respiration

Back 591

opioids

Front 592

NSAID used for short term management of acute pain requiring analgesia at the opiate level

Back 592

ketorolac (can be used in place of opioids in patients whom nausea and vomiting is a problem

Front 593

used in hospital for severe and chronic pain

Back 593

fentanyl
narcotic analgesic morphine types (mu receptor agonists)

Front 594

what compound is a benzodiazepine receptor antagonist

Back 594

flumazenil

Front 595

used for both partial seizures and tonic clonic, grand mal seizures

Back 595

-phenytoin
-carbamazepine
-phenobarbital

Front 596

antiepileptic given IV or rectally to stop continous seizure activity

Back 596

diazepam

Front 597

valproate MOA

Back 597

antiepileptic enhanves GABA mediate inhibitors
-blocks Na channels
-blocks K currents
-blocks T types Ca++ channels

Front 598

partial agonist @ alpha adrenergic receptors in blood vessels resulting in vasoconstriction

SE = Saint Anthony;s fire

Back 598

Ergotamine MOA

Front 599

possibly live threatenting hepatic failure - why its used as a 2nd line of defense for ADD

Back 599

pemoline major toxicity

Front 600

chemical structures unrelated to benzodiazepines and barbituates

Back 600

tell me about the chemical structure of zolopidem

Front 601

for which antidepressant is it especially important to avoid an abrupt withdrawal

Back 601

paroxetine

Front 602

name SSRIs

Back 602

- fluoxetine
- sertraline
- citalopram
- paroxetine

Front 603

newer designer antidepressants that target more than one NT

Back 603

multiple mechanism:

- venlafaxime
-nefazodone

i.e. inhibit neuronal uptake or serotoin & norepinephrine + antagonizes central 5-Ht 2 receptors + alpha 1 adrenergic receptors

Front 604

local anesthetic effects
1. what increses duration of action
2. what decreases LA effects

Back 604

1. increase duration of action - hydrophobicity
2. decrease LA effects
inflammation (extracellular acidosis)

Front 605

fluoxetines (norfluoxetine) metabolite is active and has an 8 day half life

Back 605

pharmacokinetics of fluoxetines - length of action

Front 606

This inhaled anesthetic sensitizes the heart to epi-induced arrhythmias
-rare but can induce hepatitis

Back 606

halothane

Front 607

which drugs cause an increase in CO2
what does it mean>
what drug can you give to treat

Back 607

opioids can cause an increase in Co2
give Dantrolene to treat
may eb headed for malignant hypothermia

Front 608

cause less sexual dysfunction than selective serotonin reuptake inhibitors

Back 608

-nifazodone
-bupropion

Front 609

MAOI MOA

Back 609

- increased amine levels by interfereing wtih metabolism
- increased vesicle stores of NE+ serotonin
-irreversible + non-selective

Front 610

Antidepressant used for bulima nervosa (list drug type/classification )

Back 610

-fluoxetine
-SSRI

Front 611

I have bipolar disorder (mania -depression)
I need drugs now.

Back 611

- lithium
-carbamezepine
-valproic acid
olanzapine

Front 612

manic depression drugs

Back 612

0lithium
-carbamazepines
-valproic acid

Front 613

fluoxetine (prozac)

Back 613

#1 drug choice for depression, OCD, panic disorder

Front 614

MAOI - contraindication don't give with ---

Back 614

-sympathetic drugs
- SSRIs
-tyramine - rich foods

Front 615

#1 treat the mania of bipolar disorder

Back 615

lithium

Front 616

typical antipsychotic drugs

Back 616

-blocks D2> D1
-typical drus include chlorpromazine & Haloperidol

Front 617

Bupropion (contraindicated in patients suffering from seizure disorders)

Back 617

used in pts trying to break their addiction to smoking cigarettes

Front 618

this drugs has direct depressants effects on monosynaptic reflex pathways in the spinal cord - thus it can produce skeletal relaxation without sedation

Back 618

diazepam

Front 619

benzodiazepines used for panic + phobia

Back 619

-alprazolam
-clonazepam

buspirone can also be used - the advantages are less likely to get addicted.

Front 620

increased risk of seizures if nalaxone is used to treat --- overdose

Back 620

tramadol

Front 621

only local anesthetic that causes vasoconstriction

Back 621

cocaine

Front 622

bulima - 1st line of defense

Back 622

SSRI (Fluoxetine)

Front 623

more lipid soluble + crosses the BBB better than morphine

Back 623

Heroin

Front 624

drugs that block neuromuscular transmission are either

Back 624

-competitive (non-depolarizing)
-cholinomimetics (depolarizing)

Front 625

migraine (mild) pharmacological strategy

Back 625

1. NSAIDS
2. Acetaminophen
3. Caffeine
4. sumatriptan

Front 626

Two series of alkaloids in opium?

Back 626

Phenanthrenes + Benzylisoquinolines

Front 627

which opioid receptor is responsible for most of the opioids analgesic effects?

Back 627

u receptors (also responsible for side effects)

Front 628

Lamotrigine MOA
(Carbamazepine too)

Back 628

antiepileptic blocks Na channels

Front 629

Phenytoin MOA

Back 629

-blocks Na channels
-increases GABA-mediated
-decreases Ca++ influx

Front 630

for generalized tonic-clonic (grand-mal) seizures

Back 630

-phenytoin
-carbamazepine
-phenobarbital

Front 631

antiseizure drug has SE

Nystagmus, gingival hyperplasia, hirsutism

Back 631

Phenytoin

Front 632

carbamazepine MOA

Back 632

antiseizure
blocks sodium channels

Front 633

antiseizure drug has SE idiosyncratic blood descrasis, aplastic anemia

Back 633

carbamazepine SE

Front 634

antiseizure drug blocks t-type ca++ channels

Back 634

Ethosuximide MOA

Front 635

for absence (petit mal) seizures

Back 635

-Ethosuximide
-Lamotrigine

Front 636

partial seizures

Back 636

-phenytoin
-carbamazepine
-phenobarbital
-valproate
-GABApentin
-Lamotrigine

Front 637

for status epilepticus

Back 637

-diazepam
-lorazepam both benzodiazepam/ antiepileptic

Front 638

name 2 benzodiazepines that are antiepileptic

Back 638

diazepam + lorazepam

Front 639

which inhaled antiesthetic may cause megaloblastic anemia?

Back 639

nitrous oxide

-from prolonged exposure due to a decrease in methionine synthase activity

Front 640

what's the difference between methanol and ethanol?

Back 640

methanol and its metabolites are much more potent toxins than ethanol

Front 641

inhibitory NTs

Back 641

glycine + GABA

Front 642

difference between glutamate and GABA?

Back 642

glutamate is a primary excitatory NT, while GABA is the primary inhibitory NTs.

Front 643

serotonin and catecholamines are ...

Back 643

monoamines

Front 644

SE of propofol

Back 644

-marked hypotensions (greater than that causes by barbs

Front 645

this drug is used primarily in patients with limited cardiac or respiratory reserves

Back 645

Etomidate: short duration of action little effect on CV or respiration

Front 646

a dissociative anesthetic used for shock states (hypotensive, pts at risk for bronchospasm) and children + young adults for short procedures

Back 646

ketamine

Front 647

benzodiazepines vs. barbituates (clinical uses)

Back 647

benzodiazepines = anxiety, panic attacks, insomnia, muscle spasm

barbituates = anesthesia + seizures

Front 648

buprenorphine

Back 648

for the relief of moderate to severe pain

Front 649

tramadol

Back 649

+ analgesic effects of this drug is only potentially antagonized by naloxone

Front 650

meperidine

Back 650

this opioids has no antitussive effects

Front 651

anti-histamine and anti-serotonergic agent

SE= sedative & weight gain

Back 651

prophylaxis of severe migraine (cyproheptadine MOA)
side effects

Front 652

treatment of alcohol withdrawal
1. without hepatic dx
2. with hepatic dx

Back 652

w/o hepatic dx
1. diazepam + chlorodiazepoxide

w/ hepatic dx

1. oxazepam + lorazepam

Front 653

name a sedative -- hypnotic & antiepileptic

Back 653

phenobarbital

Front 654

have selective anticonvulsant effect without marked sedation

Back 654

phenobarbital & clonazepam

Front 655

methylphenidate MOA
compared to Dextroamphetamine MOA

Back 655

Methylphenidate: blocks reuptake of dopaminergic neurons (mild effects)

Dextroamphetamines: causes releases of monoamine and competes for reuptake with monoamine (stronger CNS effects)

Front 656

What are the advantages of codeine over morphine?

Back 656

-causes less respiratory depression
-less addiction
-less euphoria
-slower developement of tolerance

Front 657

a longer duration of action compared to naloxone & therefore more appropriate drugs for long-term treament of addiction to heroin r other opioids

Back 657

naltrexone

Front 658

most widely used antitussive

Back 658

dextromethorphan

Front 659

what is a problem of giving morphine? (not respiratory distress)

Back 659

tolerance
psychological + physical dependence

Front 660

give an example of a full agonist + partial agonists + weak agonists antagonists

Back 660

full - morphine
partial - oxycodone
weak - codeine
antagonist - naloxone

Front 661

antagonist that blocks all receptors (u, k, d)

Back 661

naloxone

Front 662

a non-narcotic antitussive

Back 662

dextromethorphan

Front 663

only for a short term relief of muscle spasms associated with acute, painful, musculoskeletal conditions

Back 663

cyclobenzaprine

Front 664

dantrolene MOA

Back 664

-produces skeletal muscle relaxation by interfering with relaxation by interfereing with release of calcium from the sarcoplasmic reticulum through SR calcium channel complex

Front 665

succinylcholine MOA
what type of skeletal muscle relaxant

Back 665

- a depolarizing NMJ blocker

MOA - 1. phase I : excites skeletal muscle by binding nicotinic receptors

2. phase II = then prevents connection by prolonging the time that receptors at the NMJ cannot respond to Ach

Front 666

Skeletal muscle relaxant that's contraindicated if you have a genetic disorder of plasma pseudocholinisterases

Back 666

succinylcholine

Front 667

selectively depresses the cough center in the medulla

Back 667

dexomethorphan

Front 668

opioid that makes your pupils dilate

Back 668

meperidine

Front 669

a narcotic antagonist used as an antidote against resporatory depression resulting from overdosage or sensitivity to narcotics

Back 669

naloxone hydrochloride

Front 670

side effects include constipation, nausea, vomiting (emesis), dizziness, sedation, respiratory distress, sedation, respiratory distress , miosis, circulatory depression, shock apnea

Back 670

morphine

Front 671

used for morphine or fentanyl dose

Back 671

naloxone: short duration of action

Front 672

chronic ethanol consumption can ---

Back 672

induce cyt p450. This can increase hepatoxicity of acetaminophen

Front 673

side effects include blurred vision, retinal damage, and metabolic acidosis with an evaluated anion gap

Back 673

methanol

Front 674

what are endomorphins, b-endomorphines, enkephalins,and dynomorphins, and what's the difference?

Back 674

they are all endogenous opioids

endomorphins = u> dk
b-endomorphins - u> dk
enkephalins = d> uk
dynomorphins = k> ud

Front 675

in acute pain, which pain are opioids effective at blocking? Which fibers mediate this pain?

Back 675

opoids block dull second pain mediated by c-fibers
it is less effective at blocking sharp, first pain mediated by alpha delta fibers

Front 676

opioid antagonists used to treat respiratory depression induced by natural + synthetic narcotics like butorphanol, methadone, nalbuphine, pentazocine + propoxyphene. DOC when nature of depressant drug is unknown

Back 676

naloxone

Front 677

what drugs are used with oxycodone for a synergistic effects

Back 677

synergistic effects
oxycodone + acetaminophen = percoset

oxycodone + aspirin = percodan

Front 678

arrange codeine, morphine, oxycodone in order of potency

Back 678

morphine> oxycodone > codeine

Front 679

a CNS depressants

Back 679

ethanol

Front 680

this opioid gets into the CNS fast and then is converted to morphine, why?

Back 680

heroin
b/c its more lipid solubule and crosses the BBB better

Front 681

what is the one type of chronic pain that opioids have some action agonists?

Back 681

-opioids are sometimes useful against cancer pain

Front 682

dangerous pharmacodynamic interactions between MAO inhibitors and

Back 682

SSRIs (selective serotonin reuptake inhibitors)

Front 683

what's the difference between

1. neurotransmitters
2. neuromodulators
3. neurohormones

Back 683

1. NTs exert effects within a single synapse (fast)

2. neuromodulators act on multiple synapses (slower onset)

3. neurohormones - released into blood, act globaly (slowest onset)

Front 684

what is the primary excitatory NT in the CNS?

Back 684

glutamate

Front 685

considerable crossover pharmacology, specific NTs

Back 685

monoamines

Front 686

difference between morphine + codeine?

Back 686

morphine : full agonists PAIN RELIEF?

codeine : partial agonists mild to moderate pain relief

tolerance can also develops with morphine use, much less likely with codeine

Front 687

cocaine is a DEA schedule ---

Back 687

Two
DEA schedule 2

Front 688

chronic pain is a --- disease of the CNS

Back 688

pathological

Front 689

competitive antagonist of skeletal muslce nicotinic receptors

Back 689

tubocurarine MOA

Front 690

difference between tubocurarine & succinylcholine

Back 690

tubocurarine - non-depolarizing succinylcholine - depolarizing NMJ blocker

MOA
T -competitive antagonist of nicotinic antagonists of nicotonic receptors in skeletal muscle

S - D excites skeletal muscle prevents contraction by prolonging NMJ responses time to Ach

Front 691

skeletal muscle relaxant used to treat malignant hypothermia

Back 691

dantrolene

Front 692

MOA of analgesia?

Back 692

basically the spinal cord mediates transmission of pain signals to the brain --> if you block anywhere in this pathway you get an analgesic effet

Front 693

Name a DEA schedule II drug its drug class + utility

Back 693

cocaine = CNS stimulant

uses: topical anesthetic for the upper respiratory tract
and int he TAC prior to wound cleaning and suturing

Front 694

1. short acting opoid antagonist
2. long acting opoid antagonist

Back 694

1. naloxone
2. naltrexene

Front 695

succinylcholine contraindications

Back 695

-genetic disorders of plasmacholinesterases

-family hisotry of malignant hypothermia

Front 696

at high blood contraceptives, the rale of oxidation (of ethanol) follows ---

Back 696

zero order kinetics for ethanol

Front 697

Name a depolarizing neuromuscular blocking drug

Back 697

tubocurarine

Front 698

for mild to moderate pain. major effects on CNS and bowel

Back 698

codeine

Front 699

give an example of a DEA schedule III drug + its uses

Back 699

testosterone (Androgen)
-abuses use this drug to increase muscle mass & strength

Front 700

produces opioid only mild euphoria

Back 700

methadone that's why they're used to treat heroin withdrawal

Front 701

weak acting opioid agonist with actions like codeine shoudl be used with caution in patient wtih head injuries

Back 701

hydrocodone

Front 702

vd of this drug is similar to body water content

Back 702

ethanol vd
lithium

Front 703

irreversible MAO Inhibitors
selective for MAO-B

Back 703

selegiline

Front 704

social anxiety disorder used

Back 704

-zoloft (sertraline)
-paroxetine

Front 705

pharm of lithium

Back 705

-narrow therapeutic window
-distribution space of lithium approximates that of total body water

Front 706

phenobarbital indications

Back 706

1. sedation
2. hypnosis

Front 707

what do you use for
-surgical relaxation
-control of ventillation
-treatment of convulsion

Back 707

NMJ blocking drugs

Front 708

controlled substances act

Back 708

legal foundation of gov't fight against drug abuse

Front 709

establishes DEA schedules

Back 709

controlled substances act

Front 710

prophylaxis of severe migraine

Back 710

1. b-blockers (propranolol, timolol)
2. calcium channel blockers (verapamil)
3. TCA 5-HT2 receptor antagonists
4. H1 antagonists
5. anticonvulsants (valproate)

Front 711

1. skeletal muscle relaxant used during surgery to set fractures + dislocations

2. skeletal muscle relaxants used as an adjunct to facilitates ET tubation

Back 711

1. d-tubocurarine
2. succinylcholine

Front 712

a partial agonist of morphine, it will precipitates an abstinence syndrome in morphine abusers

Back 712

pentazocine

Front 713

2 mechanisms by which opioids work

Back 713

1. presynaptically - decrease opioids decrease calcium influx, decrease NT release

2. postsynaptic - opioids block receptors in spinal cord, by increasing k+ conductance --> IPSP

Front 714

indicated only for opiate tolerant clients

Back 714

oxycodone

Front 715

if you have malignant hypothermia - don't use these drugs

Back 715

-succinylcholine
-inhaled general anesthetics

Front 716

narcotic analgesic used for indication, maintenacne and an analgesic of postoperative care

Back 716

Remifentanil

Front 717

--- receptors exhibit molecular heterogeneity

Back 717

GABAa receptors

Front 718

most common therapeutic uses of morphine

Back 718

adjuvant to anesthesia
-analgesia

Front 719

opoid act centrally bind to receptors and inhibit reuptake.

May be used for chronic pain

Back 719

Tramadol

Front 720

Percodan vs. Vicodin

Back 720

Percodan - oxycodone + aspirin
vicodin - hydrocodone + acetaminophen

Front 721

a depolarizing NMJ blocking drug

Back 721

succinylcholine

Front 722

don't give this skeletal muscle relaxant to clients in whom histamine release is hazardous

Back 722

tubocurarine

Front 723

acute pain is what type of a signal?

Back 723

a physiological signal

Front 724

pure food and drug act

Back 724

prohibits mislabeling and adulteration of food, establishes official agencies that monitor food and drug manufacturing

Front 725

harrison-narcotic act

Back 725

identifies what a narcotic is and establishes classes of abusable drugs

Front 726

NT only acts on metabotropic receptors

Back 726

monoamines

Front 727

short acting (24 hours) duration reversible Inhibits MOA-a

Back 727

mocolbemide

Front 728

NT excites both inotropic and metabotropic

Back 728

glutamate

Front 729

ingestion is potentially fatal, call poision control immediately, treat with activated charcol, gastric lavage, breathing difficulties

Back 729

isopropyl alcohol (rubbing alcohol)

Front 730

morphine contraindications

Back 730

1. head injury or craniotomy
2. pregnancy
3. hepatic failure

Front 731

inotropic receptors

Back 731

are ligand gated ion channels when open allow movement of specific ions down their electrochemical gradient

Front 732

what's the difference between cyclobenzaprine + diazepram + baclofen?

Back 732

cyclobenzaprine : for short term relief of muscle spasm

diazepram: for relief of skeletal muscle spasm caused by local pathology (inflammation, trauma, or cerebral palsy)
baclofen: for severe spaticity from MS or spinal cord injury
+ baclofen?

Front 733

panic disoorder - 1st line of defense

Back 733

MAOI & SSRIs (benzodiazepines might also work)

Front 734

Name monoamines

Back 734

histamine, norepinephrine, dopamine, and serotonin

Front 735

name TCAs

Back 735

-Amitryptyline
-imipramine

Front 736

monoamines type of receptors

Back 736

all receptors are metabotropic

Front 737

nicotonic, 5-ht3, glycine, + GABA-A receptors are ...

Back 737

ionotropic receptors

Front 738

baclofen MOA

Back 738

- a GABA- B receptor agonist. Activation of receptors increases K conductance (hyperpolarization) that produces a presynaptic inhibitory effect to reduce the release of excitatory NTs by decreasing Ca influx

Front 739

Phenobarbital MOA

Back 739

-potentiates GABAergic stimulates by incresing duration of GAB-gated Cl channel opening
-compared to benzodiazepines, barbs are less selective
-also suppresses exulatory NTs (glutamate) + exert non-synaptic membrane effects

-lowers margin of safety compared to BZs

Front 740

morphine metabolism

Back 740

hepatic conjugation to glucuronides

Front 741

1. short opoid duration of action

2. long duration of action compared to morphine (full agonists)

Back 741

fentanyl - short acting
methadone - long acting

Front 742

A GABA-B receptors antagonists ( a skeletal muscle relexant

Back 742

baclofen

Front 743

sumatriptan/triptans

1. contraindications
2. side effects

Back 743

1. contraindications : cardiac ischema, cerebrovascular or peripheral vascular disease

2. side effects: coronary artery spasm

Front 744

benzodiazepine anxiolytic - sedatives

Back 744

lorazepam

Front 745

2nd line antidepressive with incidence of sometimes fatal hypertensive crisis

Back 745

tranylcypromide

Front 746

endogenous compound with k > ud

Back 746

dynomorphin

Front 747

used for tetanus

Back 747

diazepam

Front 748

name MAOI

Back 748

phenlzine, selegiline, tranylcyromine, mocolbemide

Front 749

caffine MOA and indications

Back 749

MOA: adenosine receptor antagonists (increase intracellular camp)

indications: sleep retardant, migraine, apnea of prematurity

Front 750

antidepressants - SE is prolong QRS

Back 750

TCA amitryptyline can lead to potentially fatal cardiac arrhythmias

Front 751

name hypnotics with chemical structures unrelated to BZ and barbituates

Back 751

zolpidem & hydroxyzine

Front 752

what's the difference between selegiline and mocolbemide?

Back 752

selegiline: irreversibel MAO inhibitor selective for MAO-B (less likely to cause cheese reaction)
mocolbemide - short acting reversible inhibitors of MAO-A

Front 753

Name a glycine antagonist

Back 753

strychnine

Front 754

what's the difference between hydrocodone and oxycodone

Back 754

strength
hydocodone - weak aagonist
oxycodone - full agonist

MOA - hydrocodone = narcotic analgesic + antitussive

oxycodone - narcotic analgesic only

Front 755

what's the difference between the two intravenous anesthetics

Back 755

thiopental sodium - repeated intravenous doses lead to prolonged anesthetics becasue fatty tissues act as a reservoir

methohexital - duration of action 1/2 as long as thiopental
doesn't concentrate in fatty tissue

Front 756

what's the difference between the two intravenous anesthetics

Back 756

thiopental sodium - repeated intravenous doses lead to prolonged anesthetics becasue fatty tissues act as a reservoir

methohexital - duration of action 1/2 as long as thiopental. doesn't concentrate in fatty tissues

Front 757

a potent, long acting partial agonist. can be used for heroin addiction

Back 757

buprenorphine - naltrexone can also be used for heroin addiction (long acting) but its an antagonist

Front 758

name classes of NTs

Back 758

-peptides (neuromodulators, neuropeptide y)
-Excitatory amino acids (glutamate)
-inhibitory amino acids (GABA, glycine)
-Ach
-purines
-monoamines

Front 759

NMDA receptors involved in learning & memory

Back 759

glutamate

Front 760

glutamate interacts with ...

Back 760

AMPA, Kainate, + NMDA

Front 761

NT involved in regulation of pain, asthma, psoriasis, inflammatory bowel disease into CNS, emesis, migraine, schizophrenia, depression & anxiety

Back 761

substance p

Front 762

where is substance p found?

Back 762

in the periphery and in the CNS

Front 763

treatment for methanol poisioning

Back 763

1. suppress metabolism by alcohol dehydrogenase to toxic products by giving ethanol

2. hemodialysis
3. treat acidosis with bicarbonate

Front 764

used for the relief of skeletal muscle spasm due to reflex spasm caused by local pathology (inflammation or trauma or upper motor neuron disorders - (cerebral palsy) tetanus

Back 764

diazepam

Front 765

ester local anesthetic

Back 765

- esters
-tetracaine (long duration)
-2-chloroprocaine (short onset, short dur)
-procaine (short duration)

Front 766

naloxone may not be effective in reversing respiratory depression by this drug

Back 766

buprenorphine

Front 767

cyclobenzaprine vs. baclofen

Back 767

baclofen can be used in patients with spinal cord injuries, cyclobenzaprine is ineffective in patients with spinal cord injuries

Front 768

more potent + addicting than codeine

Back 768

oxycodone (Percodan)

Front 769

food, drug, and cosmetic act

Back 769

no drugs can be marketed until proven safe

Front 770

name spasmolytics

Back 770

-dantrolene
-baclofen
-diazepam
-cyclobenzaprine

Front 771

nausea management

Back 771

1. metoclopromide (dopamine antagonists)
2. diphenydramine + dimenhydrinate (H1 antagonists)
3. Ketoralac

Front 772

Lithium toxicity

Back 772

-narrow therapeutic windows
-SE includes polydypsia, polyuria, + diabetes insipidus
-highly toxic levels include seizure, circulartory collapse and coma
-don't be dehydrated or you can get severe toxicity

Front 773

benzodiazepine used as an antiseizure med?

Back 773

clonazepam
diazepam
lorazepam

Front 774

benzodiazepine used for anxiety disorder or the treatment of panic disorders

Back 774

-Alprazolam (an anxiolytic)

Front 775

Benzodiazepine used for mild anxiety

Back 775

chlordiazepoxide (an anxiolytic)

Front 776

ondanseteron MOA

Back 776

-antiemetic
-serotonin receptor 5-HT3 antagonists serotonin binding to 5-HT3 receptors stimulates vagal effererent nerves, stimulating vomiting

Front 777

barbiutates MOA

Back 777

-increase duration of GABA mediated chloride channel opening
-block glutamate (excitatory)
-block sodium channels
-exert GABA-mimetic effects

Front 778

triptans (e.g. sumatriptans) MOA

Back 778

-activation of the serotonin receptors 5HT1 B-D inhibits activation of the trigeminal nerve & mennigal vasodilation
-produce vasoconstriction

Front 779

treat acute attack of moderate or severe migraine headache

Back 779

1. ergotamines (alpha-receptor blockers)
2. MAOI (phenylzine)
3. anticonvulsants (valproate)
4. 5HT antagonists (methylsergide)
5. opioids (reserved)
6. Triptans

Front 780

ethanol MOA

Back 780

-CNS depressants
-ethanol effects a # of membrane proteins involved involved in neurotransmissions, includes enhancement of GABA + GABA-A receptors + inhibiton of glutamate in opening NMDA receptor channels

Front 781

narcotic analgesic + an antitussive agent

Back 781

hydrocodone

Front 782

TCA side effects

Back 782

-antimuscarinic effects = dry mouth, constipation, urinary retention, aggravation of glaucoma
-antihistamine: sedation
-NA channel blockers increase QRS arrhythmics
-alpha blockade : orthostatic hypertension
-tachycardia
-erectile dysfunction

Front 783

TCA MOA

Back 783

-blocks 5-HT (serotonin) and NE reuptake
-antimuscarinic
-antihistamine effects
-NA channel block
- SE orthostatic hypertension + weight gain

Front 784

benzodiazepines for anxiety

Back 784

-chlordiazepoxide (mild anxiety)
- alprazolam (management of anxiety disorder)

Front 785

buspirone MOA

Back 785

a partial agonist of the 5-HT a serotonin receptor

Front 786

diazepam MOA

Back 786

skeletal muscle relaxant
-acts on the limbic system, the thalamus and the hypothalamus
-induces a calming effect

Front 787

LSD MOA

Back 787

- agonism & antagonism (partial agonist) at 5-HT receptor subtypes

Front 788

short acting benzodiazepine sedative; used as an adjunct to general anesthesia
what are it's 3 clinical indications>

Back 788

1. preoperative sedation
2. amnesia
3. anxiolysis

midazolam (BZ)

Front 789

anxiolytic drug + 5-HT1a partial agonist

Back 789

buspirone

Front 790

social phobia

Back 790

SSRI

Front 791

angel dust side effects

Back 791

phenyclidine - most dangerous hallucinogen

1. psychosis
2. dissociation
3. disorientation
4. loss of pronociception
5. catatonic posturing
6. aggressive behavior

Front 792

adverse effects of depolarizing blockade

Back 792

-hyperkalemia
-increased ocular pressure
-increased intagastric pressure
-muscle pain

Front 793

opioid used to treat alcohol dependence

Back 793

naltrexone

Front 794

drug used for severe pain and detoxification + maintenance of narcotic dependence

Back 794

methadone

Front 795

one tenth as potent as morphine - used in minor surgeries

Back 795

meperidine

Front 796

what are NMJ blocking drugs used for?

Back 796

-surgical relaxation
-control of ventilation
-treatment of convulsion

Front 797

monoamine MOA

Back 797

-receptors are metabotropic
-receptors are G-protein coupled (when stimulated, they effect CA or K channels)
-considerable cross over pharmacology

Front 798

1. what tye of receptors does morphine act on
2. where does morphine act?

Back 798

1. morphine acts on all receptors subtypes
2. morphine acts
a. in the spinal cord to inhibit NT release and neuron activity
b. at opioid receptors in the brain (PAG + RVM)
c. at site of injury to inhibit nociceptors

Front 799

glutamate MOA

Back 799

excites inotropic receptors (ligand gated ion channels - NMDA, AMPA, & kainate) + metabotropic (G protein coupled) receptors - basically does both

Front 800

SSRI side effects

Back 800

-sexual dysfunction
-weight gain

Front 801

Metabotropic receptors

Back 801

- g protein coupled
-leads to ion channel activation
transduction of phospholipases, guanyl cyclase, and protein kinase activation
-slow response

Front 802

MDMA (exstasy) MOA

Back 802

CNS stimulant and hallucinogen
MOA: release of serotonin, dopamine, and NE
-distorts perception of time, facilitates intrapersonal communication
-acts as a sexual enhancer

Front 803

metoclopramide MOA vs. diphenhydramine MOA

Back 803

metoclopramide
-antiemetic: D2 receptor antagonist in the chemoreceptor trigger zone to reduce

diphenydramine
-antihistamine + antiserotonergic agent
-H1 receptor inhibitor, muscarinic, alpha adrenoceptor
-decrease GI hyperactivity

Front 804

acute alcohol use may ...

Back 804

metabolism of drugs due to decreased metabolism & decreased liver blood flow (tricyclic antidepressants, phenothiazines, sed-hypnotic drugs)

Front 805

cyclobenzaprine MOA

Back 805

-not clear but
-acts within the CNS and the brain stem to reduce tonic somatic motor activity

Front 806

-metabotropic receptor subfamily

Back 806

muscarinic Ach receptors monoamine receptors histamine

Front 807

anesthesia (MOA)

Back 807

1. enhance GABA effects
2. block nicotinic receptors (analgesia)
3. activate K+ channels hyperpolarize
4. block NMDA glutamate)
5. inhibit synaptic proteins
6. enhance glycine effects

Front 808

drug interactions with morphine

Back 808

-sedative hypnotics
-antipsychotic drugs
-MAO inhibitors

Front 809

benzodiazepine hypnotics

Back 809

-tenezepam (short term managemetn of insomnia)
-flurazepam (insomnia)

Front 810

name an anticonvulsant used for prophylaxis of severe migraines

Back 810

-valproic acid
-blocks neuronal Na channels and reduces the repetive firing of neurons

Front 811

hypnotics - actions are due to suppression of activity in certain key regions of the subcortical area of the CNS

Back 811

hydroxyzine

Front 812

pharmacokinetics naloxone vs. naltrexone

Back 812

naloxone: t1/2 1-4 hours
iv use only

naltrexone : t1/2 = 10 hours
oral use only

Front 813

used for moderate pain - acts on k receptorsa and u receptors

Back 813

pentazocine

Front 814

benign, reversible thyroid enlargemetn is a SE

Back 814

lithium b/c decrease tyrosine iodination

Front 815

possible life-threatening hepatotoxicity is a side effects

Back 815

MAOI
tranylcypromide

Front 816

doctor treat my hunnington's disease

Back 816

haloperidol

Front 817

used to treat chronic generalized anxiety

Back 817

buspirone

Front 818

short term treatment of anxiety
also has hypnotic activity

Back 818

zolpidem uses

Front 819

#1 seizure med?
alternative meds?

Back 819

diazepam
alternatives - lorazepam
also clonozepam

Front 820

contraindicated in pts with porphyria

Back 820

phenobarbital

Front 821

levodopa MOA

Back 821

MOA - symptoms of parkinsons related to depletion of scriatal dopamine
-dopamine is a metabolic precursor of dopamine but crosses the BBB

Front 822

- carbidopa

Back 822

- a dopa decarboxylase inhibitor in the periphery
-an aromatic amino acid decarbozylation inhibitor
carbidopa reduces peripheral dopamine formation

Front 823

what is sinement?

Back 823

-levodopa + carbidopa
- don't give to pts with history of melanoma

Front 824

drug of first choice for parkinsons disease

Back 824

bromocriptine (sinemet also works)

Front 825

bromocriptine MOA

Back 825

- D2 agonist
ergot derivative activates D2 receptors
-does not require enzymatic conversion ot an active metabolite have no potential toxic metabolites

Front 826

atropine MOA

Back 826

1. improves rigidity and tremor in parkinsons by decreasing Ach activation
2. preanesthetic med , decrease respiration and secretion
3. restor cardiac rate when vagal stimulation is produced by intra-abdominal surgical traction
4. decrease AV block produced by digitalis
5. overcome severe bradycardia
6. antidote for CV collapse

Front 827

drug like atropine may improve tremor and rigidity of parkinsonism, no effect on bradykinesia

Back 827

benzotropine

Front 828

effects of selegiline on dopamine? why?
effect on amatadine of dopamine

Back 828

selegilline : retards breakdown of dopamine prolongs antiparkinson effect, allows reduction of dose of L-dopa needed
MAO-B inhibitor

amantidine - potentiates dopaminergic function by influencing synthesis/ release of reuptake of dopamine

Front 829

major side effect of levodopa limitating factor in therapy

Back 829

dyskinesias (repetive involuntary gross movemetn of face + limbs , treat by decreaseing levodopa dose

Front 830

don't use levodopa with ....

Back 830

non selective MAOI like tranylcypromine b/c it can cause a severe hypertensive crisis

Front 831

half life of carbamazepine is ---

Back 831

12-18 hours

Front 832

antiepileptic used to treat trigeminal neuralgia _ other pain syndromes

Back 832

carbamazepine

Front 833

the lower the MAC the ---

the higher the partition oil-gas coefficient the ----

Back 833

more potent the anesthetic agent

Front 834

how can you increase the rate of anesthetic induction?

Back 834

- increase anesthetic concentration
-increase rate and depth of ventillation
-change pulmonary blood flow

Front 835

which inhaled anesthetics can cause cardiovascular system depression?

Back 835

halothane isoflurane too

Front 836

what is neuroleptic malignant syndromes - treat me

Back 836

results from too rapid block of dopamine in pts with highly sensitive to extrapyramidal effects

treat with dantrolene or diazepam

Front 837

1. prostatic hypertropy also avoid in pts with angle-closure glaucoma

Back 837

benztropine shoudl eb used in caution with patient swith ....

Front 838

verapamil DC and MOA

Back 838

class IV
MOA: calcium channel blockers

Front 839

iron poisoning due to multiple transformations

Back 839

deferoxamine is the answer

Front 840

CHF with EF < 40 %
what type?
what drug?

Back 840

systolic type of CHF
(weakened force of ejection)
can used digoxin

Front 841

which drugs should not be given as monotherapy becasue they can increase ventricular rate?

Back 841

class Ia agents including procainamide and quinidine

Front 842

what is the difference between the class 1a antiarrhythmics quinidine and procainamide

Back 842

quinidine : for atrial flutter and fibrillation

procainamide: for life threatening ventricular arrhythmias (is also effective against atrial arrhythmias

Front 843

metroprolol DC and MOA

Back 843

dc: DC II
MOA: B1 selective adrenergic receptor antagonists

Front 844

what is Ih

Back 844

ih is a nonselective Na/K pacemaker current

Front 845

what is ferritin?

Back 845

ferritin is the stored form of iron - stores iron in the liver and the heart

Front 846

if a pregnant woan has a folic acid deficiency, the baby might have a ...
what drug would you use to treat this?

Back 846

ans: a neural tube defect
in megaloblastic anemia
treat with IL-11

Front 847

i overdosed in ferrous sulfate. what's my antidote?

what's its drug class and MOA

Back 847

1. deferoxamine - what's it used for?

2. drug class - iron chelator
MOA> binds iron avidly (loosely bound iron)
it can't compete with already bound iron (biologically chelated iron

Front 848

drug used for life threating ventricular arrhythmias

Back 848

procainamide

Front 849

i have microcytic anemia - what drug should you give me and why

Back 849

give me ferrous sulfate
iron deficiency causes microcytic anemia due to the formation of small erythrocytes with insufficient hemoglobin, By giving ferrous sulfate, you give a iron source so that erythrocytes will be normal sized (with porphyrin ring)

Front 850

what is the only class II and class III antiarrhythmic we've studied?

Back 850

-sotalol - blocks K channels and b-adrenergic receptors

Front 851

ventricular fibrillation MOA

Back 851

disorganized reentry

Front 852

what is the difference between

epotein a
ferrous sulfate and iron dextran
vitamin B12 and folic acid

Back 852

epotein a - stimulates RBC production in normocytic anemia pts

2. ferrous sulfate - iron source in pts with microcytic anemia
3. drugs used to treat megalopblastic anemia (vitamin B12 treats pernicious anemia, folic acid should only be given to pts with pernicious anemia

Front 853

what is atrial fibrillation? the MOA

Back 853

disorganized atrial reentry

Front 854

verapamila dn diltizim DC and MOA

Back 854

DC: calcium channel blockers
mOA: blocks L-type calcium channels

Front 855

permature atrial nodal or ventricular beat

Back 855

don't treat don't do anything

Front 856

how do you promote GI motility
wich receptors, which action

Back 856

-antidopanergic (D2)
-activates serotonin receptors (5 HT3

Front 857

i have a left main coronoary artery leion, what should I do ?

Back 857

get bypass surgery
if you don't have serious lesions in the left main coronary artery you shoudl use drug treatments

Front 858

can we use NO to treat calcified flow limiting lesions of the coronary artery?

Back 858

no - cannot dilate a plaque or plaque area

Front 859

which side does nitroglycerin act on

Back 859

effects arterial side

Front 860

major SE of nitroglycerin

Back 860

hypotension

Front 861

variant angina treatment

Back 861

-give nitroglycerin first
-give ca++ blockers to maintain

don't give B-blockers

Front 862

ventricular tachycardia without structural heart dx what is it?

Back 862

DAD's triggered by increase in sympathetic tone

Front 863

quinidine DC and MOA

Back 863

class ia , na + channel blocker

Front 864

which clas sof antiarrhythmias has anticholinergic SE b/c they block m2 receptors and block autonomic ganglia

Back 864

major side effect of class 1a drugs?

Front 865

what is unusual about the pharmacokinets of amiodarone?

the pharmacokinetics of adenosine?

Back 865

-amiodarone has a very long half-life (10-50 days)

adenosine has a t1/2 of ten seconds

Front 866

which drugs reduce mortality and sudden death after MI

Back 866

b-blockers propranolol

Front 867

atrial/ ventricular fibrillation

Back 867

disorganized reentry

Front 868

in what type of patients can deferozamine not be used to treat iron poisioning

Back 868

in pts with severe renal disease (iron chelators are excreted by the kidney)

Front 869

SE includes lupus erythromatosus-like syndrome after prolonged use

Back 869

procainamide

Front 870

propafenone DC + MOA

Back 870

DC: 1c
MOA: Na channel blocker

Front 871

CHF with Ef > 45%

Back 871

diastolic type of CHF
weakened cells replaced by fibrous tissue)

do not use digoxin

Front 872

which antiarrhythmic is administred in a stenle solution for rapid bolus injection and has a half life of less than 10 seconds

Back 872

adenosine

Front 873

propranolol DC+ MOA

Back 873

DC: class II
MOAL b1 receptors antagonists (non-selective)

Front 874

prostaglandins PGE2 and PGI2
renal vasodilator or vasoconstritors

Back 874

renal vasodilators

Front 875

prevents reoccurance life threating ventricular arrhythmias

Back 875

amiodarone

Front 876

which test measures extrinsive thromboplastin and
which test measures intrisic thromboplastin?
which test is used to monitor coumarin/ warfarin or heparin

Back 876

extrinsic thromb = Pt coumarin/ warfarin
intrinsic thromb = PTT heparin

Front 877

deficiency that cuases macrocytic anemia and peripheral neuropathy

Back 877

vit b12 deficiency

Front 878

in addition to being used for CHF what type of arrhythmia is digoxin also used for?

Back 878

atrial fibrillation and atrial flutter

Front 879

procainamide DC + MOA

Back 879

DC: 1a
MOA = Na channel blockers

Front 880

list the major drug categories. Tell me their MOA give me an example

Back 880

1 - sodium channel blockers
II - b blockers
III - potassium channel blockers prolonged APD
IV - calcium channel blockers
IV - multiple MOA

Front 881

another name for AVN reentry

Back 881

PSVT Paroxysmal supra ventricular tachycardia

Front 882

Amiodarone DC + MOA

Back 882

class I - IV - multiple MOA (sometimes listed as class III

Front 883

what do diuretics do to digoxins effects ? why ?

Back 883

diuretics cause hypokalemia (a SE) which oeduces the activity of ATPase. which can increase digoxin's effects

Front 884

what's the difference between treating a pt with atrial fibrillation or flutter with ca channels blockers or b blockers compared to digoxin?

Back 884

ca channel blockers + B-blockers also have a negative iontropic effects and harmful to pts with systolic CHF )low EF < 45

digoxin has a postiive inotropic and can be used in pts with low EF

Front 885

I have hypertension
what antianemic drug should not give me

Back 885

Epoetin a

Front 886

which drugs has SE cinchonism, torsades de pointes , syncope, antimuscarinic effects, diarrhea?

Back 886

quinidine

Front 887

why do we not give folic acid alone to treat pernicious anemia

Back 887

b/c you need to determine if the patients also has a vit b12 deficiency. folic acid supplements mask the signs of vitamine B12 deficiency but not prevent the development of irreversible neurological disease due to vitamine b12 deficiency

Front 888

fatigue, visual complaints, muscular weakness, nausea, anorexia, psychic complaints, adominal painjs, dizziness, dreams, headache, diarrhea, vomiting

Back 888

signs of digitalis toxicity

Front 889

1. name a glycoprotein that stimulates red blood cell production

2. normocytic anemia - erythrocytes are normal, there just aren't enough of them

Back 889

how does epoetin alpha help anemia?

what type of anemia does epoetin a cure?

Front 890

what drug is used mainly to treat
digoxin -induced arrhythmias

Back 890

phenytoin

Front 891

what type of angina is due to coronary insufficiency due to vessel occlusion

Back 891

exertional (typical angina)

Front 892

amiodarone drug interactions

Back 892

many review careful amiodarone is a p450 substrate
am inhibits most cytochrome enzymes can elevate digoxin plasma levels

Front 893

class III drugs MOA

Back 893

-prolong APD by blocking K channels
-indirectly results in increase ERP b.c of increase APD
- increase in ERP abolishes reentry b/c ERP > CT

Front 894

what does transferrin do?

Back 894

transferrin transports iron around the body

Front 895

name 1b drus what are not effective agains?

Back 895

-lidocaine
-phenytoin
-tocainide
-mexiletine

No good for SVTA

Front 896

which class of antiarrhythmics can have nerologic side effects (stimulation of depression and convulsions

Back 896

class 1b drugs (lidocaine, phenytoin, and mexiletine)

Front 897

what do you use to treat methotrexate overdose?
what is the advantage of this drugs over other available drugs?

Back 897

-citrovorum factor (leukovorin)
to replinish endogenous folic acid bec methotrxate inhibits DHFR

Front 898

what's the difference betwene quinidine, procainamide, and disopyramide

Back 898

the side effects

quinidine --> syncope, torsades de pointes, cinchonism (tinnitus, visual disturbances, hearing loss, GI upset)

procainamide - much weaker vagal effect than quinidine - SE - systemic lupus erythematosus-like syndrome in 1/5 patients on drug for > 1 year

disopyramid - anticholinergic effects

Front 899

pharmacokinetics of lidocaine

Back 899

DC - 1b

administered iv or im due to extensive 1st pass hepatic metabolism and short half life adminsitered in the ICU generally

Front 900

these drugs cause irreversible inhibitor of the H+ K+ and ATPase proton pump in the parietal cells

Back 900

proton pump inhibits

Front 901

how are subclasses of drug class 1 determined

Back 901

1a, 1b, 1c are distinguished based upon the magnitude of their effect on conduction (decrease upstroke velocity - QRS) and repolarixation (APD in vitro or increased QT

Front 902

antimycobacterial that induces p450

Back 902

rifampin

Front 903

difference between heparin _ warfin ?

Back 903

herparin is a direct acting drug
warfarin is an indirect acting drug?

heparin is given iv, warfarin is oral

Front 904

ang II effects on vasculature

Back 904

causes vasoconstriciton, increase rise in BP

Front 905

renins effect on bp, why?

Back 905

end results increases bp and increase blood volume

Front 906

b-agonists on plasma renin activity

Back 906

increased renin activity

Front 907

symptoms include paresthesias, and eweakness in peripheral nerves, progressing to spasticity, ataxia and CNS dysfunction

What drug to treat?

Back 907

neurological abnormalities from vit b12 deficiency

treat with vitamin B12

Front 908

adenosine drug class

Back 908

endogenous nucleotide antiarrhythmics

Front 909

i have normocytic anemia, what type of patient am I likely to be?
what drug would you give me?

Back 909

-give me epoetin a b/c it stimulates red blood cell production

I am a
1. cancer pt - chemotherapy pts
2. AZTs treatment AIDS pt (HIV pts)
3. chronic renal failure
4. anemia b/c I didn't get a bood transfusion following surgery for whatever reason

Front 910

drugs (antiarrhythmics contraindicated in asthma

Back 910

sotalol and propranolol

Front 911

when are b1 selective blockers contraindicated?

Back 911

-sinus bradycardia
-heart block
-cardiogenic shock
-overt cardiac failure

Front 912

3 antidiarrheals types

Back 912

1. antimotility agents - inhibits parasympathetics activation. block ach release

2. adsorbents - absorbs intestinal toxins + microorganisms

3. agents modifying fluid + e transports decreases fluid secretion

Front 913

name trmbolytics

Back 913

urokinase
streptokinase
t-pa
reteplase

Front 914

name an angiotensin II
antagonist

Back 914

losartan - oral competitive ang II antagonist

Front 915

difference between v. tachycardia after MI, v. tacycardia without structural heart dx ventricular fibrillation

Back 915

v. tachycardia after MI - reentry near rim of healed infarction

v. tachycardia without structural heart dx.
DAD triggered by increase sympathetic tone

ventricular fibrillation disorganized reentry

Front 916

dopamine renal vasodilator or constrictor

Back 916

renal vasodilator

Front 917

aspirin indications

Back 917

what drug is used for

1. antiplatelet effects
2. antiinflammatory effects
3. MI prophylaxis
4. transients ischemic attacks

Front 918

class I antiarrhythymics MOA used for?

Back 918

4. selective block of early extrasystoles effects

1. increse ERP
2. class 1a prolongs APD by blockign K+ channels
3. selective depression of conduction in depolarized tissure - bidirectional block

used for multifocal premature beats
-sustained tachycardia
-sustained flutter and fibrillation

Front 919

side effects include hyperkalemia

Back 919

ACEI
potassium sparing diuretics

Front 920

indapamide

Back 920

this diuretic is contraindicated in pregnancy

Front 921

ventricular tachycardia without structural heart dc

Back 921

acute - b-blocker
verapamil
adenosine

chronic
verapamil and b-blockers

Front 922

why are calcium antagonists used to treat angina?

Back 922

-mechanism blockage of calcium influx via l-type channels into cardiac and vascular smooth muscle --->

produces decreased contractility, vasodilation, etc ...

Front 923

chronic Rx
AV nodal reentry treatment (PSVT)

Back 923

-verapamil or diltiazem
-b-blockers
-digoxin
-ablation

Front 924

renal excretion of digoxin is proportional to glomerular filtration rate

Back 924

pharmacokinetcs of digoxin

Front 925

digoxins famous drug interactions

Back 925

-potassium depleting diuretics
-calcium
-quinidine
-verapamil
-amiodarone
-erythromycin, clarithromycin
-tetracycline

Front 926

how does nifedipine effect chronic (effort associated) stable angina differently than prinzmetal's variant on vasospastic angina (think MOA)

Back 926

effort associated - nifedipine decreases arterial pressure at rest by dilating peripheral arterioles and decreasing afterload (TPR). THis reduces myocardial O2 consumption.

variant associated - dilates the main coronary arteries + inhibits coronary artery spasm

Front 927

name prodrugs

Back 927

-mercaptopurine
-fluorouracil
-thioguanine
-cytarabine

cycloplos
methotrexate

Front 928

interactions with cyt p450

Back 928

-metabolized by cyt p450
imatinib

p450 biactivation
-dacarbazine
-tamoxifen

Front 929

actinomycin D indications

Back 929

-Wilm's tumor, choriocarcinoma

Front 930

Topotecan indications

Back 930

advanced ovariaran
cancer + small cell lung cancer

Front 931

burkitts lymphoma

Back 931

cyclophosphamide
vincristine
methotrexate

Front 932

treat my acute lymphocytic leukemia (ALL)

Back 932

induction: Vincristine
Prednisone
doxorubicin

maintenance: methotrexate mercaptopurine

Front 933

which drug is M phase specific?

Back 933

paceitaxel (the spiderman poision, spiderman like Mary Jane)

Vinblastine is also m-phase specific

Front 934

which drug is s phase specific

Back 934

cytarabine

Front 935

which drug blocks cell dividion in the late s-G2 phase of the cell cycles

Back 935

etoposide

Front 936

treatment for small cell lung cancer?

Back 936

1. etoposide + PEB
2. Topotecan
3. Paclitaxel

Front 937

what drugs are used to treat choriocarcinoma?

Back 937

1. methotrexate
2. Dactinomycin or Actinomycin D

Front 938

What does procarbazine interact with? (2 drug) (drug interaction)?

Back 938

interacts with ethanol for anautabuse rxn

procarbazine is a MAO inhibitors and potentiates drug effects that are MAO substrates

Front 939

drugs used for osteogenic sarcoma?

Back 939

1. doxorubicin
2. cisplatin
3. high doses of methotrexate

(use leucovorin to balance against high doses of methotrexate

Front 940

primary indications of mercaptopurine?

Back 940

acute lymphocytic leukimia (ALL)
+
acue myelocytic leukemia (AML)

Front 941

when is mercaptopurine contraindicated?

Back 941

-contraindicated in renal failure

Front 942

what compound can be found in high concentrations in smokers urine?

Back 942

radioactive polonium-210

Front 943

what compounds are present in second hand smoke?

Back 943

dimethylnitrosamide (DMNA) and nornitrosinicotine carcinogen

Front 944

which two drugs need to be activated by cyt p450 to be active (alkylating agents)

Back 944

1. cyclophosphamide
2. dacarbazine

Front 945

what do thiolated purine analogs do? name two? what type are they?

Back 945

-inhibit glutamine dependent synthesis
-inhibit xanthine oxidase

agents - mercaptopurine
thioguanine --> guanine analogs

Front 946

lethal synthesis type I mechanisms?

Back 946

1. type 1: (purine) mercaptopurine + thioguanine

Front 947

lethal synthesis type II mechanism?

Back 947

type 2: pyrimidine
5-fluorouracil
hydroxyurea

Front 948

which drugs used in testicular cancer are cell cycle specific

Back 948

-bleomycin - G2
-Vincristine
-Etoposide

Front 949

what is high dose-intermittent therapy called?

what diseases is it especially good for?

Back 949

1. pulse therapy - for acute leukemia testicular cancer + Wilm's tumor

2. recruitment therapy

Front 950

1. burkitts?

Back 950

1. methotrexate + cyclophosphamide

Front 951

2. ALL?

Back 951

cyclophosphamide

Front 952

3. AML?

Back 952

danuorubicin

Front 953

4. Breast cancer?

Back 953

tramoxifen doxorubicin

Front 954

5. ovarian?

Back 954

paclitaxel + cisplatin

Front 955

6. lung?

Back 955

cisplatin + paclitaxel + docltaxel

Front 956

which drug helps shorter neutropenia?

Back 956

1. growth factor G-CSF

Front 957

2. which drug(s) affect platelets more than white blood cells for toxicity

Back 957

2. nitrosoureas (cisplatin affects red blood cells more)

most drugs decreased white BC > decreases platelets > decreases RB

Front 958

treatment options for advanced ovarian cancer

Back 958

1. cisplatin
2. topotecan

Front 959

dacarbazine side effects

Back 959

hepatic necrosis

Front 960

methotrexate indications

1. mercaptopurine indications

Back 960

methotrexate ALL, chlorocarcinoma, burkitts, lymphoma, breast cancer

2. ALL + AML

Front 961

trastuzumab side effects

tamoxifen is metabolized by?

Back 961

1. cardiomyopathy
2. tamoxifen is met by cyt p450

Front 962

side effects st. cisplatin

Back 962

-nephrotoxicity + ototoxicity

Front 963

side effects of imatinib

Back 963

imatinib = hepatotoxicity + edema

Front 964

which drugs causes cardiomyopathy as a side effects?

Back 964

trastuzumab (a monoclonal antibody to EGF receptors)

doxorubicin --> causes cardiotoxicity leading to CSF

Front 965

name 4 plant alkaloids

Back 965

1. Irinotecan
2. topotecan
3. paclitaxel
4. etoposide

Front 966

which antitumor agents have broad spectrum aplications of solid tumors

Back 966

1. doxorubicin --> solid tumors
2. paclitaxel --> breast, ovarian, bladder, head, neck, small + non-small cell lung cancer

Front 967

indications for methotrexate?

Back 967

ALL (acute lymphoeytic leukemia
-chlorocarcinoma
-burkitt's lymphoma
-breast cancer

Front 968

what's the difference between complete response to chemotherapy, partial respons and muinor response?

Back 968

1. complete --> disappearance of tumor by physiological examination + radiography studies
2. partial --> greater than 50% decrease
3. minor --> greater than 25% but less than 50% decrease

Front 969

what scales are used to measure performance status in cancer pts?
what do the numbers mean?

for what numbers are chemotherapy likely to work?

Back 969

ECOG and karnofsky
0 = normal
1= symptomatic
2 = out of bed
3 = in bed > 50% of the time
4 = bedridden

Pts with ECOG > 2 have very little chance of responding to therapy

Front 970

name alkylating agents

Back 970

1. busulfan
2. cyclophosphamide
3. dacarbazine
4. mechlorethamine
5. melphalan
6. nitrosoureas

Front 971

1. thioguanine MOA?

2. thioguanine can be combined with this drug to give a synergistic effect against /// ?

Back 971

1. MOA = inhibits several enzymes in the purine nucleotide pathway, decrease guanine nucleotides interfere with DNA & RNA synthesis

2. combine with cytarabine to treat adult acute leukemia

Front 972

what is the primary indications for 5-fluorouracil

Back 972

-colorectal cancer
-solid tumor

Front 973

what is the mechanism of 5-fluorouracil

Back 973

Mechanism of Action: a prodrug that undergoes a complex series of biotransformations to ribosyl and dexoxyribosyl nucleotide metabolites. One of these (FdUMP) forms a covalently bound ternary complex with thymidylate synthase and the reduced folate N5-N10-methylenetetrahydrofolate, a reaction critical for the synthesis of thymidylate. This results in an inhibition of DNA synthesis through a "thymineless death". 5-FU is also converted to FUTP, which is incorporated into RNA, where it interferes with RNA processing & mRNA translation. In addition, 5-FU is converted FdUTP, which can be incorporated into DNA, resulting in inhibition of DNA synthesis & function. Its cytotoxicity is therefore due to effects on both DNA- and RNA-mediated events.

Front 974

what is methotrexat activated to

Back 974

Must be bioactivated intracellularly to polyglutamate derivatives, which are selectively retained within cancer cells & have increased inhibitory effects on enzymes involved in folate metabolism, making them important determinants of the duration of action of methotrexate.

Front 975

what is the mechanism of drug resistance to methotrexate

Back 975

Drug Resistance: tumor cell resistance has been attributed to: 1) decreased cellular uptake (which may be related to incresed activity of P-glycoprotein), 2) decreased polyglutamate formation, 3) synthesis of increased levels of DHFR through gene amplification, and 4) altered DHFR with reduced affinity for methotrexate.

Front 976

what is the similarity and the difference between thioguanine and mercaptopurine MOA

Back 976

thioguanine and mercaptopurine both inhibit DNA and RNA synthesis by inhibiting DNA and RNA synthesis by inhibiting enzymes in the purine pathway

thioguanine - purine nucleotide pathway, decrease GMP

mercaptopurine - purien nucleotide interconversion, decrease AMP

Front 977

the most likely mechanism of drug resistance to cytarabine?

Back 977

increased levels of non-specific phosphatases

Front 978

name 2 anthracycline antibiotics

Back 978

1. daunorubicin
2. doxorubicin

Front 979

3 MO drug resistance to alkylating agents

Back 979

Drug Resistance: Cancer cells can acquire a resistance to alkylating agents by at least 3 mechanisms including: 1) increased ability to repair DNA lesions; 2) decreased permeability to the alkylating drug; 3) increased production of glutathione or increased glutathione S-transferase which catalyzes the conjugation of the drug to gluathione.

Front 980

name 2 natrual products used as antitumor drugs

Back 980

1. bleomycin
2. actinomycin D or dactinomycin

Front 981

what is the difference between leukemia and lymphoma?

Back 981

leukemia: progressive disease of blood forming organs, characterized by distorted proliferation of leukocytes in blood and bone marrow

lymphoma: any neoplastic dissorder of lymphoid tissues

Front 982

What is the difference between daunorubicin and doxorubicin?

Back 982

danuorubicin: Indications: acute myelocytic leukemia (AML) "only"

Drug: Doxorubicin (Indications: broad spectrum of clinical indications including solid tumors (e.g. breast cancer) and hematoligic malignancies.

side effects
daunorubicin: Side Effects: dose-limiting myelosuppression & cardiotoxicity

doxorubicin: Side Effects: myelosupression and cardiotoxicity including acute transient ECG changes (reversible) and chronic cardiomyopathy leading to the development of congestive heart failure. The development of CHF is related to the cumulative dose taken over time: ~1% at 450-500 mg/m2; ~11% at 500-600 mg/mm2; ~33% at >600 mg/mm2.

Front 983

name 5 antimetabolites (cancer drugs)

Back 983

1. cytarabine
2. 5-FU
3. Methotrexate
4. Thioguanine
5. Mercaptopurine

Front 984

what is the difference between vinblastin and vincristine?

Back 984

diff side effects: vincristine : allopecia and peripheral neuropathy

vincristine has a wider spectrum of clinical activity than vinblastine

vincristine is used for acute lymphoblastic leukemia (ALL)

vincristine is also used to treat hematological malignancies (hodgkin, non-hodkin lymphoma, multiple lymphoma)

Front 985

what are the two break down products of cyclophosphamide?

Back 985

1. acrolein - break down of aldophosphamide
2. an inactive metabolite (carboxyphosphamide)

Front 986

what enzyme is responsible for bioactivation

Back 986

--> the enzyme responsible for bioactivation is cyt p450

Front 987

what drug is used against kaposis sarcoma?

Back 987

(tumor in connective tissue)

vinblastine

Front 988

what is a pitfall of using actinomycin D or Dactinomycin to treat wilms tumor choriocarcinoma

what is it's MOA

Back 988

/1. a highly toxic drug

2. inhibits transcription resulting in cell death by intercolating into DNA

Front 989

what alkylating agent is used to treat brian tumors and metastatses?

what other alkylating agent crosses the BBB?

Back 989

1. nitrosoureas - penetrate BBB

Busulfan also penetrates the BBB can lead to seizures as a side effect.

Front 990

5-fluorouracil MOA

what enzyme does 5-fluorouracil inhibit majro SE?

Back 990

Mechanism of Action: a prodrug that undergoes a complex series of biotransformations to ribosyl and dexoxyribosyl nucleotide metabolites. One of these (FdUMP) forms a covalently bound ternary complex with thymidylate synthase and the reduced folate N5-N10-methylenetetrahydrofolate, a reaction critical for the synthesis of thymidylate. This results in an inhibition of DNA synthesis through a "thymineless death". 5-FU is also converted to FUTP, which is incorporated into RNA, where it interferes with RNA processing & mRNA translation. In addition, 5-FU is converted FdUTP, which can be incorporated into DNA, resulting in inhibition of DNA synthesis & function. Its cytotoxicity is therefore due to effects on both DNA- and RNA-mediated events.

inhibits target enzyme thymidylate synthetase

major SE : myelosuppression

Front 991

Describe the chenucak structural requirements for carcinogenicity of polycyclic aromatic hydrocarbons (PA)

Back 991

1. compound must be coplanar
2. methyl substitution can enhance or detract from cardiogenicity
3. a plenanthrene nucleus must be present is a tricyclic aromatic hydrocarbon occuring in coal tar
4. Requires bioactivation by cyt p450 to the epoxide form

Front 992

which one of the following agents can produce hearing loss and removal impairment

a. cisplatin
b. nitrogen mustard
c. melphalan
d. mercaptopurine
e. vinblastine

Back 992

a. cisplatin

Front 993

which of the following cancer chemotherapeutic agents is least likely to exhibit cross resistance to other agents listed?
a. actinomycin D
b. doxorubicin
c. 6-mercaptopurine
d. vincristine
e. bleomycin

Back 993

c. mercaptopurine is a small molecule. All the others listed are bulky natural products transported out of the cells, adn multidrug resistance phenyotype can confer cross resistance

Front 994

which of the following anitcancer drugs inhibit DNA dependate RNA synthesis marks as a result of intercalculation between adjacent guanine cytosine base pain in double standardred DNA?
a. dactinomycin
b. flutamide
c. methotrexate
d. paclitaxel
e. vinblastine

Back 994

a. dactinomycin binds tightly to double stranded DNA interferes with RNA synthesis

Front 995

Which of the following classes of anticancer drugs is used in the treatmetn of this pateint is cell cycle specific and is used in MOPP + ABVD

Back 995

Bleomycin and V+O (plant alkaloids) are cell cycle specific

Front 996

What are the side effects of most alkylating agents

Back 996

1. myleosuppression (Busulfan has the most myleosuppresion)
2. GI side effects
3. Nausea and Vomiting

Front 997

Which cells are susceptibles to alkylating agents

Back 997

1. alkylating agents are not cell cycle specific

2. rapidly dividing cells are most susceptible to alkylating agents

Front 998

name (2) vinca alkaloids

Back 998

1. Vinblastine
2. Vincristine

Front 999

EWhat is the only indication of daunorubicin

Back 999

AML only acute myelocytic leukemia

Front 1000

what type of anti tumor agent is it?

MOA?

Back 1000

2. anthacycline antibiotic
3. MOA inhibit Topo II intercalcates into DNA, thereby blocking DNA and RNA synthesis

Front 1001

What drugs inhibit the proliferation of human tumor cells that overeexpress HER2

Back 1001

Trastuzumab

Front 1002

which drug(s) inhibit Topoisomerase II?

Which drugs inhibit topo I?

Back 1002

1. topo II = 1. daunorubicin, 2. doxorubicin 3. etoposide

2. Top I : 1. irinotecan, 2. topotecan

Front 1003

Which alkylating agent is frequently given orally (most are given IV

Back 1003

cyclophosphamide

Front 1004

which drug can be used to treat ALL and AML?

Back 1004

mercaptopurine

Front 1005

what is the difference in MOA between the antimetabolite 5-Fluorouracil, methotrexate, and thioguanine

Back 1005

1. Mechanism of Action: a prodrug that undergoes a complex series of biotransformations to ribosyl and dexoxyribosyl nucleotide metabolites. One of these (FdUMP) forms a covalently bound ternary complex with thymidylate synthase and the reduced folate N5-N10-methylenetetrahydrofolate, a reaction critical for the synthesis of thymidylate. This results in an inhibition of DNA synthesis through a "thymineless death". 5-FU is also converted to FUTP, which is incorporated into RNA, where it interferes with RNA processing & mRNA translation. In addition, 5-FU is converted FdUTP, which can be incorporated into DNA, resulting in inhibition of DNA synthesis & function. Its cytotoxicity is therefore due to effects on both DNA- and RNA-mediated events.

2. methotrexate: Mechanism of Action: a folic acid antagonist that inhibits dihydrofolate reductase (DHFR), interfering with the synthesis of thymidylate, purine nucleotides & the amino acids serine & methionine, thereby interfering with the formation of DNA, RNA and proteins. Must be bioactivated intracellularly to polyglutamate derivatives, which are selectively retained within cancer cells & have increased inhibitory effects on enzymes involved in folate metabolism, making them important determinants of the duration of action of methotrexate.

3. Thioguanine: Mechanism of Action: inhibits several enzymes in the the purine nucleotide pathway (denovo purine biosynthesis), resulting in inhibition of nucleotide interconversion (e.g. IMP --> GMP), resulting in a decrease of intracellular guanine nucleotides, interference in DNA & RNA synthesis.

Front 1006

Which cells are susceptible to alkylating agents?

Back 1006

1. alkylating agents are not cell cycle specific
2. rapidly dividing cells are most susceptible to alkylating agents

Front 1007

name 2 vinca alkaloids

Back 1007

1. vinblastine
2. vincristine

Front 1008

what is the only indication of daunorubicin

Back 1008

AML only

Front 1009

what type of antitumor agent is it

MOA?

Back 1009

anthacycline antibiotic
3. MOA inhibit TOPO II intercalates into DNA, thereby blocking DNA and RNA synthesis

Front 1010

What drug inhibits the proliferation of human tumor cells that overexpress HER2

Back 1010

Trastuzumab

Front 1011

which drugs inhibit ToPO II

Back 1011

etoposide
daunorubicin
doxorubicin

Front 1012

What drugs inhibit TOPO I

Back 1012

irinotecan
topotecan

Front 1013

which alkylating agetn is frequently given orally (most are given IV)

Back 1013

cyclophosphamide

Front 1014

which drug can be used to treat AML and ALL?

Back 1014

Mercaptopurine

Front 1015

What is the difference in MOA betwene the antimetabolites 5-FU, methohexate, and thioguanine

Back 1015

1. 5-FU - thymine less death DNA and RNA effects + Proteins

2. Methotrexate - folic acid antagonists inhibit dihydrofolate reductase DNA, RNA and proteins

3. Thioguanine inhibit enzyme in purine nucleotide pathway , decrease guanine nucleotide

Front 1016

which drug has side effects leading to congestive heart failure?
What are the other side effects of these drugs?

Back 1016

doxorubicin

other side effecs: myelosuppression
cardiotoxicity
chronic cardiomyopathy and CHF
releated to cumulative dose over tome

Front 1017

Alkylating agent MOA

Back 1017

Mechanism of Action: Aklylating agents have a chemical structure that contain a bifunctional nitrogen mustard moiety which includes two reactive alkyl groups (hence the term aklylation). These groups can cyclize in an aqueous environment to form a highly electrophilic "immonium ion" that can covalently bind to any nucleophilic compound, including the N-7 nitrogen position on guanine, which therapeutically is a major site of action. Consequently they can produce a cross-linking of DNA when both akyl groups react with pairs of guanine residues in DNA (intrastrand or interstrand). Crosslinking of DNA ultimately results in breaks of the DNA sequence, and cell death. FWIW: these agents can also react chemically with other cellular components containing nucleophilic groups (sulfhydryl, amino, hydroxyl, carboxyl & phosphate groups). Although aklylating agents are not cell cycle specific, rapidly dividing cells are most susceptible to their effects.

Front 1018

What is diferent about the MOA of 5-FU compared to methotrexate?

Back 1018

5-fu : Mechanism of Action: a prodrug that undergoes a complex series of biotransformations to ribosyl and dexoxyribosyl nucleotide metabolites. One of these (FdUMP) forms a covalently bound ternary complex with thymidylate synthase and the reduced folate N5-N10-methylenetetrahydrofolate, a reaction critical for the synthesis of thymidylate. This results in an inhibition of DNA synthesis through a "thymineless death". 5-FU is also converted to FUTP, which is incorporated into RNA, where it interferes with RNA processing & mRNA translation. In addition, 5-FU is converted FdUTP, which can be incorporated into DNA, resulting in inhibition of DNA synthesis & function. Its cytotoxicity is therefore due to effects on both DNA- and RNA-mediated events.

Methotrexate: Mechanism of Action: a folic acid antagonist that inhibits dihydrofolate reductase (DHFR), interfering with the synthesis of thymidylate, purine nucleotides & the amino acids serine & methionine, thereby interfering with the formation of DNA, RNA and proteins. Must be bioactivated intracellularly to polyglutamate derivatives, which are selectively retained within cancer cells & have increased inhibitory effects on enzymes involved in folate metabolism, making them important determinants of the duration of action of methotrexate.

Front 1019

What two drugs cause mitotic arrest? What is the difference in their mechanism ?

Back 1019

1. vinblastin and paclitaxel

2. diffference in mechanism
paclitaxel enhances tubulin polymerization
vinblastine promotes depolymerization its blastin away all MTs this interferes with chromosome segregation

Front 1020

what drugs can kill cells in all stages of the cell cycle?

Back 1020

cisplatin

Front 1021

what drug can eb given to protect the body from the side effects of cyclophosphamide

Back 1021

mensa - the Na+ salts of methylethyl sulfonate can be given to protect the bladder from the toxic effects of cyclophospamide

Front 1022

allopurinol

Back 1022

uricosic agent (adjuvant in Rx of blood dyscrasias

MOA: reduces uric acid syntehsis from purines by inhibiting xanthine oxidase

-treatment of pts with blood dyscrasias (leukemia, lymphoma) and other maligancies with cancer chemotherapy resulting from elevated levels of serum purines

Front 1023

G-CSF or Filgrastin

Back 1023

-recombinant GCSF
- regulates the production of neutrophils

indicatoins: decreases the incidence of infection especially in patients with nonmyeloid malidancies on myelosuppressive drugs

-reduce the time to neutrophil recovery

Front 1024

trastuzumab

Back 1024

-HER2 is observed in 25-30% of primary breast cancer

-monoclonal antibody to EGF receptor

-inhibits the proliferation of human tumor cells that overexpress HER2

-indications for pts with metastatic breast cancer whose tumors overexpress the HER2 protein SE cardiomyopathy

Front 1025

procarbazine

Back 1025

-inhibits the syntehsis of DNA, RNA + protein, produces chromosomal breaks

-used in MOPP for Hodgekin's

Front 1026

Tamoxifen

Back 1026

Drug Class: Antiestrogen
Mechanism of Action: a competitive partial agonist-inhibitor of estrogen and binds to the estrogen receptor of estrogen-sensitive tumors. It has a 10 fold lower affinity for ER than does estradiol, indicating the importance of ablation of endogenous estrogen for optimal antiestrogen effect.
Indications: Exteremly effective useful for: 1) treament of both early-stage and metastatic breast cancer, 2) as a chemopreventative agent in women at high risk for breast cancer; 3) treatment of endometrial cancer.

Front 1027

cyclophospamide

Back 1027

Drug Class: Antineoplastic (Alkylating Agent)

Indications: One of the most widely used alkylating agents. A broad spectrum anticancer drug that can be given alone, but is more commonly given in combination with other drugs (e.g. CHOP, CAF or CMF). Major indications include non-Hodgkin's lymphoma, leukemias, multiple myeloma, breast & ovarian cancer.

Side Effects: Hemorrhagic cystitis occurs occasionally (& common side effects listed above). Mensa (Na salt of methylethylsulfonate) can be given to protect the bladder from the toxic effects of cyclophosp

Front 1028

rituximab

Back 1028

Drug Class: Monoclonal Antibody

Mechanism of Action: a genetically engineered chimeric murine/human monoclonal IgG1 (human Fc) antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. The CD20 antigen is expressed on > 90% of B-cell non-Hodgkin's lymphomas. The mechanism of action includes complement-mediated lysis, antibody-dependent cellular cytotoxicity, and induction of apoptosis in the malignant lymphoma cells. This drug appears to be synergistic with chemotherapy for lymphoma.

Indications: therapy of patients with relapsed or refractory B cell non-Hodgkin's lymphoma.

Front 1029

cisplatin

Back 1029

Mechanism of Action: an inorganic metal complex that kills cells in all stages of the cell cycle, inhibits DNA synthesis, and binds DNA through the formation of interstrand cross-links similar to other alkylating agents. The primary binding site is N7 of guanine, but may form covalent interactions with other nucleotides. Platinum complexes appear to synergize with certain other anticancer drugs (cisplatin is the P in PEB drug combinations).

Indications: testicular carcinoma, breast, ovarian & bladder cancer.

SE: Nephrotoxicity and Ototoxicity

Front 1030

Imatinib

Back 1030

Drug Class: Antineoplastic "designer drug"
Mechanism of Action: an inhibitor of the tyrosine kinase domain of the Bcr-Abl oncoprotein. Imatinib prevents the phosphorylation of the kinase substrate by ATP. (see Notes below).
Indications: treatment of chronic myelogenous leukemia (CML).
Side Effects: hepatotoxicity, edema, fluid retention. tyrosine kinases associated with the platelet-derived growth factor receptor, stem cell factor and c-kit are also inhibited by Imatinib.

Front 1031

Bleomycin

Back 1031

Drug Class: Antitumor Peptide

Mechanism of Action: bleomycin is a small peptide that contains a DNA binding region & an iron-binding domain at opposite ends of the molecule. It acts by intercollating into DNA & reacts with ferous ions (Fe2+) to produce free radicals that cause DNA fragmentation, resulting in single & double strand breaks, and inhibition of DNA biosynthesis. Bleomycin is a cell-cycle specific drug that causes accumulation of cells in the G2 phase of the cell cycle.

Indications: Hodgkin's disease , Non-Hodgkin's lymphoma, testicular carcinoma

Side Effects: little myelosuppression (unusual for antineoplastics), and as a result it can be combined with other drugs that do produce myelosuppression (e.g. BACOP, ABVD, PEB). Lung toxicity

drug interactions - metabolized by cyt p450

Front 1032

compare drug mechanism of antimetabolites vs. anticancer antibiotics

Name them

Back 1032

antimetabolites: compete for utilization of normal metabolites
1. mercaptopurine - exhibits feedback inhibition of all purine biosynthesi and incroporated into DNA

2. thioguanine - inhibits enzyme sin purine synsthesis pathways
3. 5- Fu - inhibits thymidylate synthase anticancer antibiotics --> inhibit nucleic acid synthesis by blocking DNA replication of transcriptions

Front 1033

what is the advantages of ifosfamide over cyclophosphamide?

Who contains a phenylalanine?

Back 1033

ifosfamide --> hemorrhagic cystitis --> cyclosphosphamide analog

--> melphalan

Front 1034

The m is MOPP is for ...

toxicities you forget - secondry

1. bleomycin
2. cisplatin
3. cyclophosphamide
4. Etoposide
5. Mercaptopurine
6. Paclitaxel

Back 1034

m is for mechlorethamine

1. alopecia
2. ototxicity, BMS
3. Alopecia
4. alopecia
5. GI disturbances
6. peripheral neuropathy + alopecia

Front 1035

which alkylating agent causes profound myelosuppression in all patient ?

Back 1035

busulfan

Front 1036

differences in mechanism between irinotecan and imatinib?

Back 1036

irnotecan - topo I inhibitor
used for colonorectal cancer

imatinib - inhibits tyrosinekinase domain of Bcr-Abl oncoprotein
-used for CML

Front 1037

when do you use intermittent, high dosing?

Back 1037

1. drugs acting on all phases fo the cell cycle

b. tumors in which a majority of cells are actively proliferating

c. toxicity effects schedule

Front 1038

Two reason to give a drug contious infusion or with frequent dose administration?

Back 1038

1. drug is rapidly metabolized or excreted

2. drugs are phase specific + act only on one potion of the cell cycle

Front 1039

what chemical mediator is responsible for nausea + vomiting? why? which drugs produce this effects?

Back 1039

serotonin interacts with there receptors in the chemoreceptors trigger zone to produce vomiting

dacarbazine, doxorubicin, high dose cyclophosphamide nitrogen mustard, dactinomycin

Front 1040

what are three major toxicities of bleomycin

Back 1040

1. acute pneumonitis
2. pulmonary fibrosis
3. oxygen toxicity

Front 1041

1. drugs causing nephrotoxicity
2. drugs that cause neurotoxicity

Back 1041

1. cisplatin - acute renal failure

2. methotrexate - acute tubular necrosis

neurotoxicity - vinca alkaloids = peripheral neuropathy

Front 1042

most important side effects of

1. adriamycin
2. methotrexate
3. cyclophosphamide

Back 1042

1. adriamycin - cardiotoxicity
2. methotrexate - cirrhosis of the liver
3. cyclophosphamide - hemorrhagic cystitis

Front 1043

what side toxicities (i.e. what other cells) does chemotherapy effect?

Back 1043

chemotherapy effects rapidly proliferating cells, therefore chemo effects gastrointestinal mucosa hair follicles and bone marrow

Front 1044

what type of anticancer drug most commonly causes alopecia

Back 1044

rapid turn over of hair follicles

alkylating agents etoposides authracyclines (doxorubicin), dactinomycin, and the vinca alkaloids

Front 1045

what is another name for adriamycin

Back 1045

doxorubicin

Front 1046

define doubling time

define growth fraction

tumors most susceptible to a chemotherpay curve have a high or low growth fraction

Back 1046

1. doubling time - time required for a neoplasm to double its cell numbers

2. growth fraction - the fraction of cells actively proliferating

3. high

Front 1047

explain log kill & log kill hypothesis

Back 1047

chemotherapeutic agents: work by first-order kinetics - the drugs kill a constant fraction of tumor cells rather than a fixed # of cells

log kill --> the killing of a fraction f cells rather than an absolute number. in adjuvant chemotherapy --> concept remove detectable tumor (109) the body removed eradicates remaining cells

Front 1048

why is combination chemotherapy used?

Examples

Back 1048

- use drugs with different mechanisms of action and or which act on different phases of the cell cycle to delay the development of resistanct cells and to maximize cell kill
-MOPP + PEB
-choose drugs with differing non-overlapping toxicities.

Front 1049

1. adjvant chemotherapy
2. neoadjuvant chemotherapy

Back 1049

1. chemotherapy used in addition to another treatmment modality, such as surgery or radiotherapy witht he goal of eridacting micrometastasis prevent relapse

2. neoadjuvant - use chemotherapy prior to surgery or radiation - organize reduce load

Front 1050

Why do we use bone marrow transplant in chemotherapy patients

Back 1050

we can't give high enough doses of chemo therapy drugs b/c of myleosuppresion

by getting a bone marrow transplant resure allows us to give a higher previously lethal doses of chemotherapy by allowing means to repopulate the bone marrow

Front 1051

3 type of bone marrow transplant

Back 1051

allogenic - bone marrow from an HLA matching donor transfer to another pts

autologous: graft individual marrow to himself collect before remission --> give after

peripheral stem cell transplants = harvest progenitor cells by plasma-pharesis

Front 1052

what immunotherapy can be used to help cancer pts with infections

Back 1052

1. BCG
2. Interferons
3. Interleukin-2
4. Differentiating agent retinoids
5. monoclonal antibodies
6. amgiogenesis inhibitors

Front 1053

Describe the three steps in the progession from DNA damage to cancer

Back 1053

initation: DNA damage

promotion: cell with DNA damage encounters (often chemical) incourage cell multiplication + cell division)

progession = developing tumor becomes malignant

Front 1054

list regiments

1. hodgekins
2. non-hodgekins
3. testicular carcinoma
4. AML
5. ALL
6. CML

Back 1054

list regiments

1. hodgekins = ABVD or MOPP
2. non-hodgekins = CHOP and BACOP
3. testicular carcinoma = PVB
4. AML = Cytarabine
5. ALL = MOPP
6. CML

Front 1055

A cancer cells that is resistant to the effects of both vincristine + methotrexate probably has developed that resistance

a) changes in the properties of the target enzymes
b) decreased activity of an activing enzyme
c) increase in expression of p-glycoprotein transporter
d) Increase in proteins that are involved in DNA repair
e) increase in production of drug trapping molecules

Back 1055

c) p-glycoprotein transporters more foreign cells (increased expression)

Front 1056

what drug cause significant peripheral neuropathy

Back 1056

vincristine

Front 1057

what is a complete carcinogen

Back 1057

drug containing both a initiator and a prometer

Front 1058

which drugs are safe to be given intrathecally to treat meningial + brain cancer

Back 1058

1. cytarabine
2. methotrexate

Front 1059

what are the three classes of chemotheraoy? and give examples

Back 1059

class 1: non-cell cycle dependent
e.g. radiation, mechlorethamine, carmustine

class 2: phase specific
e.g. cytarabine (s phase), bleomycin (G2/M)

class 3: Kill proliferating cells prefrentially to resting cells (non0cell cycle specific ) e.g. cyclophosphamide, dactinomycin, 5- FU

Front 1060

What do you ave to do if you are giving an s-phase specific or G2/M phase specific drugs? Why? which ones?

Back 1060

cytarabine + bleomycin

b/c they affect only a small proportion of the cells population at a given time they are often given at very frequent intevals or by continous infusion

Front 1061

treat my breast carcinoma

Back 1061

cyclophosphamide , methortrexate, cyclophosphamide + doxorubicin = fluorouracil or paclitaxel . doxorubicin + paclitaxel, Tamoxifen

Front 1062

wHAT TWO ALKYLATING AGENTS ARE used to treat multiple myeloma ?
What is the benefit of one over the other?

Back 1062

multiple myeloma = mechlorethamine
melphalan

The advantage of melphalan over, mechlorethamine is that it is less carcinogen

Front 1063

Treat my non-Hodgkins Lymphoma

Back 1063

BACOP (Bleomycin, Doxorubicin, cyclophosphamide, vincristine, prednisone)

CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)

Front 1064

What drug is used to treat Wilm's tumor?

Back 1064

Actinomycin D or Dactinomycin + Vincristine

Front 1065

What compounds are good for cancer prevention

Back 1065

1. BHA + BHT in cereal promote glutathione, which destroys dangerous electrophiles

2. Antioxidants are good - destroys free radicals that might damage DNA

3. Differentiating agents promote differeentiation

Front 1066

what is common of many carcinogen?

Back 1066

1. Many needs to be bioactivated by cyp-450 to be carcinogen in the body

most are prodrugs externally

most carcinogens are activated to reactive, electrophilic compounds

Front 1067

Which alkylating agent is used primarily to treat Hodgkin's disease?
What are the side effects?

Back 1067

1. Dacarbazine in combination with other drugs (bleomycin can also be used)

2. side effectss - hepatic necrosis (MOPP + ABVD) (Bleomycin SE = lung toxicity and some myelosuppression)

Front 1068

treat my hodgekins

Back 1068

MOPP (Mechlorethamine, vincristine, procarbazine, predisone)

ABVD (Doxorubicin, bleomycin, vinblastine, dacarbazine

Front 1069

DOC and secondary drugs for testicular cancer

Back 1069

1. Etoposide + PEB (Cisplatin + etoposide + bleomycin)

2. Bleomycin

Front 1070

What is the primary drugs used to treat colorectal cancer? other choices

Back 1070

1. irinotecan with 5-FU & leucovorin

2. Irinotecan by itself if 5-FU is ineffective

Front 1071

Compare drug used for
1. acute myelogenous leukemia?
2. chronic myelogenous leukemia ?

Back 1071

1. AML --> cytarabine + daunorubicin + mercaptopurine

2. CML --> Imatinib (treatment) Busulfan + cyclophosphamide --> a conditoning regement used before cell transplantation

Front 1072

What is the DOC for AML?

a secondary drug choice used?

Back 1072

daunorubicin + cytarabine
1. cytarabine is the DOC. It inhibits DNA polymerase, & blocks DNA synthesi. Cytarabine can be incorporated into DNA and RNA and leads to chain elongation interference

2. 2nd drug: mercaptopurine

Front 1073

what drugs do you give to treat chronic myelogenous leukemia (CML)
What drugs do you give as a condition regimen prior to cell transplant

Back 1073

1. give busulfan (conditioning regiment)with cyclophosphamide

2. imatinib = treatment

Front 1074

a chemopreventative agent for women at high risk for breast cancer?

Back 1074

tamoxifen

Front 1075

1. paclitaxel MOA

2. what semisynthetic analog of paclitxael is approved for a second-line therapy therapy of various cancer

Back 1075

MOA: a mitotic spindle poision that binds microtubules & enhances tubulin polymerization. M-phase specific

uses: breast, ocarian, bladder, head and neck , small cell lung cancer.

2. docetaxel

Front 1076

a competitive partial agonist - inhibitor of estrogen used for early-stage and metastatic breast cancer?

Back 1076

tamoxifen

Front 1077

what is another name for F-CSF?

Back 1077

What is another name for filgrastin?

Front 1078

Antibody that binds to the CD20 antigen formal on B lymphocytes

Back 1078

Rituximab

Front 1079

What phase is cytarabine most active against?
2. What is the mayor indications for cytarabine?
3. cytarabine MOA?
4. What's special about its pharmacokinetics?

Back 1079

1. cytarabine is s phase specific

2. acute myelogenous leukemia (AML)

3. competitively inhibits DNA polymerase incorporate into DNA strands leading to chain termination

4. metabolized rapidly, must be given by continous infusion

Front 1080

regulates the production of neutrophils

Back 1080

G-CSF or Filgrastin

Front 1081

CMF -->
COP -->

Back 1081

COP - cyclophosphamide, vincristine, prednisone

CMF - cyclophosphamide, methotrexate, fluorouracil

Front 1082

name the disease?

abnormal chromosomal translocation that results in the formation

Back 1082

--> CML

non-hodgkins --> rituximab

Front 1083

i have renal problems are macrolides, safe for me?

Back 1083

yes. b/c biliary excretion

Front 1084

name 4th generation cephalosporin + list incations

Back 1084

cefepime - better for gram negative bacteria (lower MIC values) active against enterobacter

Front 1085

can erythromycin be used systemically?
for meningitis?

Back 1085

1. non, not absorbed
2. no, doesn't cross the BBB

Front 1086

macrolides should not be used in ----

Back 1086

HIV or cancer patients, no immunocompromised pts - need better drugs

Front 1087

macroide MOA

Back 1087

inhibits translocation step

Front 1088

how are macrolides excreted?

Back 1088

biliary + fecal

Front 1089

name 3rd generation cephalosporins

Back 1089

-cefotaxime
-ceftriaxone
-ceftazidime

Front 1090

what is special about 3rd generations cephalosporins

Back 1090

-penetrate the CSF (useful for meningitis)
-also active against gram negative bacilli

Front 1091

carbapenem MOA

Back 1091

imipenem is structurally related to b-lactam antibiotics

Front 1092

can macrolides be used for bilary infections?

Back 1092

yes b/c high [] in bile

Front 1093

what are extended & broad spectrum penicills more effective against _ why?

Back 1093

-gram negative bugs b/c of an enhanced ability to penetrate the gram negative outer membrane

Front 1094

side effects of cephalosporins

Back 1094

hypersensitivity

Front 1095

hypersensitivity to penicillin
what don't use?
what do you use?

Back 1095

Don't use cephalosporins
use vancomycin

Front 1096

meningitis

Back 1096

penetrates CSF
3rd gen ceph and ceftriaxone

Front 1097

penicillins MOA

Back 1097

-bind and inactivating PBPs inhibits transpeptidation reaction and block cross-linking of the cell walls cell wall tysis results b/c of high internal osmotic pressure inactivation of the inhibitor of autolysins

Front 1098

penicillinase resistant penicillins MOA

Back 1098

same as pen G + resistant to B-lactamase

Front 1099

repository penicillins

Back 1099

penicillins G procaine -
IM + adequate serum levels for 12 hours
penicillin G benzathine
-IM adequate serum levels for 1 month

Front 1100

anaerobic infections in boxes + joints (B. fragilis)

Back 1100

clindamycin penetrates into bones and joints

Front 1101

what are the two major advantages of extended & broad specrum penicillins?

Back 1101

1. inactivated by B-lactamase
2. greater activity against gram negative bugs

Front 1102

benefits of fourth gen ceph

Back 1102

-greater activity against organisms (lower MIC)
- active against enterobacter
-more resistant to b-lactamase

Front 1103

clindamycin MOA

Back 1103

binds 50 s ribosomal subunits inhibits peptidyl transferase no more peptide

Front 1104

MRSA - vancomycin resistant I have staph or strep

Back 1104

streptogramins (combo drugs)

Front 1105

multi drug resistant gram + cocci

Back 1105

streptogramins

Front 1106

steptogramins MOA? USes?

Back 1106

-proteins synthesis inhibitor
-used for staph + strep
when vancomycin resistant _ MRSA multidrug resistant gram + cocci

Front 1107

are they oral? macrolides

Back 1107

yes

Front 1108

which drug side effects cardiac arrhythmias

Back 1108

erythromycin

Front 1109

what is a toxicity of erythromycin and clarithromycin but not azithromycin

Back 1109

interaction with cyp-p450

Front 1110

legionnaires

Back 1110

macrolide erythromcyin

Front 1111

streptomcyin

Back 1111

old, mainly used for tuberculosis

Front 1112

what type for meningitis?
bacteriostatic?
or bacteriocidal?

Back 1112

-cidal

Front 1113

list aminoglycosides

Back 1113

-gentamycin
-netilmycin
-amikacin
-tobramycin
-streptomycin

Front 1114

-vancomycin
toxicities

Back 1114

-nephrotoxicity
-phleboscelerotic (vein enlargement)
-ototoxicity (hearing loss)

Front 1115

two reasons to use vancomycin

Back 1115

-pts allergic to penicillin (especially for endocarditis)

- indications --> b-lactamases producing MRSA

Front 1116

why shoudl you be carful about administering vancomycin (CWI) with an aminoglycoside

Back 1116

hard on renal b/c renal excretion + similar toxicity
nephrotoxicity and ototoxicity

Front 1117

how is vancomycin excreted?

Back 1117

renal

Front 1118

side effect of fast administration of vancomycin

Back 1118

hypotension, red man syndrome from histamine release

Front 1119

2nd line of defense from staph infection + strep ?

3rd?
last?

Back 1119

1. penicillinase resistant penicillins
2. clindamycin
3. streptogramins
4. linozolid

Front 1120

lifethreatening bacterium

Back 1120

3rd generation ceph and aminoglycoside

Front 1121

klebsiella UTI

Back 1121

1st generation ceph, cephalexin and cefaclor

Front 1122

typhoid fever, samonella, and typhoid

Back 1122

ceftriaxone is DOC

ampicillin is used in the 3rd world (cheap)

Front 1123

main use of ceftriaxone

Back 1123

meningitis

Front 1124

meningicocal meningitis

Back 1124

ceftriaxone

Front 1125

meningicocal bacteriamia use ...

Back 1125

use 3rd generation ceph ceftriaxone

Front 1126

difference between 1st and 2nd generation cephalosporins

Back 1126

increased activity against gram negative bascillae, greater stability against b-lactamase inactivation

Front 1127

used for surgical prophylaxis

Back 1127

cefazolin

Front 1128

in general --> UTIs are resporatory infections -->

Back 1128

Use 1st generation cephalosoporins, cephalexin or cefazolin

Front 1129

UTI Klebsiella pneumoniae

Back 1129

cephalexin

Front 1130

To treat pneumonia Klebsiella pneumoniae respiratory infections

Back 1130

Ans. use piperacillin (mega penicillins) or better yet or better yet use a 1st generation cephalosporins - cephalexin or cefazolin

Front 1131

which penicillin are susceptibles to B-lactamases and which aren't

Back 1131

ans. all susceptibles

Front 1132

ceftriaxone

Back 1132

-drug choice for gonorrhea
-parentarlly
long half-life

Front 1133

Why is the use of CWSI with aminoglycosides synergistics

Back 1133

CWSI breaks down cell walls, making it easier for amino glycosides to penetrate even gram + cocci with staph infections

Front 1134

i have a serious infection life threatening

Back 1134

synergistics combination CWSI + aminoglycosides

Front 1135

what are cephalosporins ineffective against

Back 1135

enterococci --> use penicillins

Front 1136

can you use 3rd generation cephs to treat staph or strep

Back 1136

no, use penicillinase resistant penicillins

Front 1137

cefaclor

Back 1137

-oral
-h. influenza

Front 1138

aminoglycoside MOA

Back 1138

bind 30s ribosome inhibit protein synthesis

frozen @ elongation step
miscoding results if made

Front 1139

resistance to aminoglycosides MOA

Back 1139

acylation
adenylation
decreased drug uptake

Front 1140

why are aminoglycosides ineffective against anerobes? Which ones?

Back 1140

bacteroides fragilis closterium
need oxygen for oxygen dependant active transport process

Front 1141

which aminoglycoside is least resistant

Back 1141

amikacin
(b/c less ways to activate)

Front 1142

aminoglycoside toxicity

Back 1142

nephrotoxicity + irreversible + ototoxicity

Front 1143

what can aminoglycosides not be used for?

Back 1143

gram positive anaerobes strep pneumonia

Front 1144

aminoglycosides cross BBB?

Back 1144

no don't cross BBB

not useful for meningitis

Front 1145

where do aminoglycosides distribute

Back 1145

small vd

vd = 1/4 of body weight b/c vd is all extracellular fluid - doesn't distribute into tissues

Front 1146

pseudomonas aeruginosa

Back 1146

ceftazidime (can't use carbenicillin b/c of b-lactamase)

Front 1147

if B-lactamase is present use --

Back 1147

-use carbapenems (imipenem/ cilastatin)

- or cephalosporin

Front 1148

treat my staph aureus infection

Back 1148

use penicillinase resistant penicillins - oxacillin, cloxacillin, dicloxacillin

Front 1149

treat my strep infection

Back 1149

use a macrolide like erythromycin

Front 1150

cephalexin

Back 1150

-oral
-esp klebsiella pneumonia
-relatively stable against b-lactamase
-for gram + except enterotococci

Front 1151

UTI with pseudomonas with B-lactamases

Back 1151

cephedrine (3rd)

Front 1152

what is penicillin G active against?
inactive against?

Back 1152

active against gram negative cocci (gonococci + meningococcus and al gram + bacteria)

inactive against : gram negative bascilla (gram negative rods)

Front 1153

name gram + rods

Back 1153

staph aureus + streptococcus

Front 1154

what are cephalosporins not generally used for?

Back 1154

enterobacter (except cefepime) and staph aureus and strep

Front 1155

GI infection from bacteroides fragilis

Back 1155

ticarcillin

Front 1156

staph aureus is a ...

Back 1156

gram + cocci

Front 1157

I am a streptococcus, I am a ---- bacterian

Back 1157

gram + cocci

Front 1158

oral cephs

Back 1158

-cephalexin
-cefprozil
-cefaclor
whad do they have in common?

Front 1159

do aminoglycosides work in pelvic infections

Back 1159

no, use cefoxitin

Front 1160

pelvic infection likely bacteria?
antibiotic treatment?

Back 1160

b. fragilis anaerobic
use cefoxitin for abdominal + pelvic infections

Front 1161

1 have gonorrehea, give me an antibiotic

Back 1161

or cefoxitin possibly or amoxicillin + clauvanic acid possible

ceftriaxone

Front 1162

antibiotic used to treat anaerobic infections

Back 1162

use cefoxitin

Front 1163

tonsilitis

Back 1163

use amoxicillin if B-lactamase use clauvalinic acid

Front 1164

BAD side effect of clindamycin

Back 1164

can lead to superinfection overgrowth

Front 1165

excretion - clindamycin - okay in renally compromised

Back 1165

renal and biliary
yes, can be used in renally compromised

Front 1166

These drugs ending in -udine are this type of drug

one drug ends with -iridine, what type of drug is it? What about uridine?

Back 1166

-uridine - NRTI = lamvudine, stavudine, zidovudine

-iridine - delavirdine - NNRTI (non-nucleoside reverse transcriptatse inhibitor)

-uridine - thymidine analogs

Front 1167

what does probenecid do?

Back 1167

probenicid blocks the secretory pump which for instance can inhibit the rapid ecretion of Pen G by the renal acid secretory mechanism

Front 1168

MOA of nucleoside reverse transcriptase inhibitors NRTI

Back 1168

-competitively inhibits HIV-1 reverse transcriptase & can be incrorporated into the growing viral DNA chain to cause DNA chain termination. Each requires intracytoplasmic activation as a result of phosphorylation by cellular enzymes to the triphosphate form

Front 1169

differences between NRTIS and NNRTIS

Back 1169

NRTI - compete with nucleoside triphosphates require intracellular activation to be active

NNRTI - do not compete with nucleoside triphosphates, do not require phosph to be active

resistance to NNRTIs is generally rapid

Front 1170

non-nucleoside reverse transcriptase inhibitors (NNRTIS)

Back 1170

MOA: NNRTIs bind directly to a side on the HIV-1 RT, resulting in blockade of the RNA and DNA dependent DNA polymerase activities. The bidning side is near to but distinct from that of the NRTI

Front 1171

common side effects of NNRTI

Back 1171

- drug hypersensitivity
-seriou possibly life-threatening skin rashes. (Steven-Johnson syndrome can occur)

Front 1172

pyrophosphate analog MOA

name that pyrophosphate

Back 1172

MOA : an inorganic phosphate compound that inhibits

1. viral DNA polymerase
2. RNA polymerase
3. HIV reverse transcriptase
(competes for the pyrophosphate binding = "Fos"carnet is a pyrophosphate

Front 1173

which drugs inhibit Peptidyl transferase?

Back 1173

Clindamycin and chloramphenicol

Front 1174

herpes simplex (Acyclovir resistant)

Back 1174

Foscarnet

Front 1175

CMV DOC + alternative

Back 1175

ganciclovir + valganciclovir

alternatives: Foscarnet + vidarabine

Front 1176

Herpes simplex (encephalitis) DOC + alternative

Back 1176

acyclovir and vidarabine

Front 1177

which antifungals penetrate the CSF?

Back 1177

fluconazole
flucytosine

"flu" gets to your head man all the other antifungals such

Front 1178

dermatophyte infection DOC and second line of defense

Back 1178

griseofulvin then ketoconazole

Front 1179

antifungals that interact with cyt p450

Back 1179

griseofulvin - induces Cyt p450

ketoconazole - inhibits mammalian cyt p450

Front 1180

which drugs are fungicidal

which drugs are fungiostatic?

Back 1180

fungicidal - polyene antifungals - amphotericin B and nystatin (azoles can reach fungicidal effect at high concentrations)

fungistatic -
azoles - ketoconazole , itraconazole, fluconazole, fluycytosine, griseofulvin, caspofungin

Front 1181

systemic candida treatment

Back 1181

-amphotericin B + flucytosine

2nd line of defense - Fluconazole

Front 1182

what are the pharmacokinetics advantages of fluconazole?

Back 1182

1. oral bioavailability
2. good CSF penetration - cna be used for meningitis
3. has fewer hepatic interacting a wide therapeutic index and permitting aggressive dosing

Front 1183

which antifungal has antiandrogenic side effects? what are other side effects?

Back 1183

ketoconazole

1. hepatoxicity
2. hypersensitivity - anaphylaxis
3. antiandrogenic effect (lower testerone effect)

Front 1184

name 3 NNRTIS

Back 1184

1. nevirapine
2. delavirdine
3. efavirenz

Front 1185

name nucleoside reverse transcriptase inhibitors (NRTIS)

Back 1185

1. Lamivudine
2. Didanosine
3. AZT
4. Stavudine
5. Abacavir

Front 1186

AZT zidovudine

Back 1186

-antiretroviral , NRTI
-deoxythymidine analog for HIV 1 infections
-avoid giving with other myelosuppressive drugs

Front 1187

what drugs cause myelosuppresion> or bone marrow suppression?

Back 1187

1. myleo - common SE for NRTIs - zidovudine, didanosine, lamivudine, stavudine (ganciclovir, ribavirin)

2. BMS - vidarabine (purine analog) antiviral

Front 1188

imipenem

Back 1188

-used as a last resort not used for common infections
-rapidly metabolism in the kidneys
-highly resistant against B-lactamase
-a carbapenem used against staph aureus, streptococcus, gram - cocci + anaerobes

Front 1189

flucytosine

Back 1189

-converted to F-dUMP + FUTP, which inhibit DNA and RNA synthesis

-narrow spectrum
-for serious infections caused by candid and cryptococcus

-not good in patients without renal function
oral only

Front 1190

DOC for clostridium perfringens - type of bug?

Back 1190

peniciillin G
gram positive bacilli

Front 1191

DOC for penicilin resistant infections

Back 1191

vancomycin + ceftriacxone + rifampion + levofloxocin

Front 1192

DOC for streptococcus pneumonia (pneumococcus

Back 1192

penicillin G or Penicillin V

Front 1193

DOC for escherichia coli? type of bug?

Back 1193

ceftriaxime, ceftizoxime, ceftriaxone, ceftazidime, or cefepine

enteric gram negative baascilla

Front 1194

DOC for proteus mirabilis? type of bug?

Back 1194

ampicillin

enteric gram negative bascillae

Front 1195

DOC for proteus, indole positive (includes proteus vulgaris) type of bug?

Back 1195

cefotaxime, ceftizoxime, ceftriaxone, ceftazidime, or cefepine

enteric gram negative bascili

Front 1196

DOC for salmonella typhi

type of bug?

Back 1196

ceftriaxone or a fluoroquinolone

Front 1197

DOC for Haemophilus influenzae?

1. meningitis, epiglotitis, arthritis, and other infections

2. upper respiratory infections and bronchitis

Back 1197

1. cefotaximine or ceftriaxone
2. Trimethoprim -sulfamethoxazole

Front 1198

DOC for pseudomonas aeruginosas? UTI

Type of bug?

Back 1198

ciprofloxacin

enteric gram negative bascillae

Front 1199

DOC for pseudomonas pseucloniallel?

Type of bug?

Back 1199

ceftazidime

gram negative bascillae

Front 1200

ketoconazole

Back 1200

SE : causes torsades de pointes
MOA: impairs the synthesis of ergosterol (a component of cell membranes)
-poor penetration into the CSF
-causes fatalities
-contraindicated when terfenadine and astemizole are administered together.
-inhibits mammalian cytp450

Front 1201

pseudomonas aeruginosa

Back 1201

piperacillin or carbenicillin, ceftazidime
Taz like pseudo mona

Front 1202

common SE fo NRTIS

Back 1202

1. myelosuppresion, including neutropenia and severe anemia
2. lactic acidosis and severe hepatomegaly

Front 1203

give me a drug to treat herpes simplex keratitis

Back 1203

idoxuridine or trifluridine given in eye drops

vidarabine will also work

Front 1204

pseudomonas aeruginosa

Back 1204

carbenicillin (if no B-lact)
ceftazidime if B-lactamase

Front 1205

H. influenzae - no B-lactamase
yes B-lactamase

Back 1205

1. no B-lact = ampicillin

2. yes B-lact - Ceftriaxone or cefaclor

Front 1206

b. fragilis

Back 1206

ticarcillin
cefoxitin

Front 1207

what spectrum does ampicillin have not covered by pen g?

Back 1207

-covers e coli, proteus mirabilis, H. influenza

Front 1208

antacids + H2 antihistamines interferes wtih ___ 's bioavailability

Back 1208

ketoconazole

Front 1209

antifungals contraindicated in pregnancy

Back 1209

griseofulvin - because of teratogenicity

Front 1210

varicella-zoster (DOC + alternate)

Back 1210

acyclovir
alternate - foscarnet

Front 1211

differentiate between ganciclovir + valgancicloir in terms of therapeutic indications

Back 1211

ganciclovir : DOC for CMV (cytolomegalovirus)

valganciclovir: prodrug used primarily for CMV retinitis in immunocompromised pts and transplant pts
(retinitis - inflammation of the retina)

Front 1212

Interferons alpha MOA

Back 1212

- a polypeptide cytokine

MOA: activates ribonucleases, which degrade viral mRNA

- blocks protein synthesis by inhibiting the translation initiation complex, resulting in suppression of the new viral particle generation

Front 1213

Ribavirin MOA -

Back 1213

- a synthetic triazine riboside analog, has a two prong effect

- converted intracellularly to 5' triphosphate derivative which inhibits viral RNA polymerase

-also inhibits capping of viral mRNA at the 5' position

Front 1214

cryptococcal (fungal) meningitis DOC treatment and prophylaxis

Back 1214

-fluconazole - secondary prophylaxis

-flucytosine - used with amphotericin B for cryptococcal meningitis

why good? b/c both F's penetrate the BBB

Front 1215

DOC for oropharyngeal candida

Back 1215

fluconazole

2nd line of defense : nystatin or ketoconazole

Front 1216

hypokalemia and hypomagnesemai are side effects of which antifungal drugs?

Back 1216

amphotericin B

Front 1217

8 drug sthat work on anaerobes

Back 1217

1. clindamycin
2. piperacillin & mezlocillin (extended spectrum)
3. ticarcillin
4. metronidazole
5. penicillin G
6. cefoxitin
7. chlroamphenicol
8. imipenem

Front 1218

SE of flucytosine administration

Back 1218

-dose dependent bone marrow suppression

neutropenia, thrombocytopenia, and anemia

Front 1219

I have complete renal failure and I'm allergic to penicillin, give me a drug

Back 1219

macrolides
clofaximine

Front 1220

which antiviral does not require activation to block DNA polymerase actiivty?

Back 1220

foscarnet is a trisodium salt of phosphonoformate
It completes for pyrophosphate binding side on DNA polymerase and blocks cleavage of the pyrophosphate group rom nucleotides during DNA synthesis

Front 1221

I need a drug for respiratory syncytial virus

Back 1221

RSV - use ribavirin

Front 1222

Antivirals with CNS toxicity side effects

Back 1222

amantadine
some rimantadine, ganciclovir

Front 1223

antivirals with drug interactions with zidovudine (AZT)

Back 1223

-Acyclovir
-Valganciclovir
-Interferon alpha

Front 1224

avoid drug interactions with nephrotoxic drugs (Antivirals)

Back 1224

Foscarnet - avoid aminoglycosides amphotericin B)

Valganciclovir

Front 1225

Drug interactions with probenecid (antiviral)

Back 1225

-acyclovir, valacyclovir
-valganciclovir

Front 1226

Drug interactions with coricosteroids (antiviral)

Back 1226

vidarabine

Front 1227

oral second generation cephalosporin active against B-lactamase producing H. influenza, primarliy used for sinusitis otitis and lower respiratory tract infections

Back 1227

cefprozil

Front 1228

gram + penicillinase producing staphylococci infections

Back 1228

1. use cloxacillin or dioxacillin (oral)

2. if severe use parental admin of oxacillin or nafcillin

Front 1229

drugs to treat B fragilis

Back 1229

-ticarcillin
-cefoxitin

Front 1230

Drug used to treat pseudomembranous colitis?
What is pc?

Back 1230

Vancomycin

(pseudomembranous colitis associated with the use of clindamycin, due to an overgrowth of clostridium difficile

Front 1231

treat staphylococcal enterocolitis , streptococcal or enterococcal endocarditis

Back 1231

-use vancomycin

Front 1232

what enzyme converst valganciclovir to ganciclovir?

Back 1232

stomach esterases

Front 1233

antivirals
-iv administration only?
-subcutaneously only?
-topical only?

Back 1233

IV - foscarnet + vidarabine + ganciclovir

subcutaneously - interfereon alpha

topical - Idoxuridine + trifluridine (thymidine analogs)

Front 1234

I have Hep C , what durg combination would you give me?

Back 1234

ribavirin with interferons alpha-2beta

Front 1235

interferon alpha-2 b

Back 1235

-antiviral, antihepatitis virus B and C

-MOA - a recombinant cytokine with a host of antiviral properties
= inhibits RNA and DNA viral replication
=activates ribonucleases that degrade mRNA
=inhibits translation initiation complex

-DOC for Hep B and Hep C

SE flu like symptoms

Front 1236

acyclovir

Back 1236

-not effective against CMV
-antiviral, anti-herpes and varicella zoster virus

- an acyclic guanosine derivative that causes DNA chain termination, inhibits the viral DNA polymerases by preventing chain elongation

-CI DOC for herpes zoster (shingles) and recurrent genital herpes (HSV-2). HSV-encephalitis and varicella zoster

Front 1237

what's the difference between acyclovir and valacyclovir?

Back 1237

valacyclovir is a prodrug activated by stomach acid, acyclovir is just eh drug

acyclovir can be used for herpes encephalities and varicella zoster, they both work for herpes zoster and genital herpes

Front 1238

what si the difference between ganciclovir and valganciclovir

Back 1238

1. valganciclovir - can be used in transplant pts in addiiton to immunocompromised pts
-valganciclovir to produg of ganciclovir, oral administration results in higher plasma levels

2. different side effects (ganciclovir causes bone marrow toxicity, myelosuppresion, and CNS toxcitiy)

Valganciclovir hematologic dysfunction + renal function impariment

Front 1239

zidovudine

Back 1239

-AZT
-Antiretroviral, NRTI
-a deoxythymidine analog
-HIV infections (give with HAART)
-avoid concurrent myelosuppresion

Front 1240

drug of choice for enterobacter?
type of bug

Back 1240

imipenem

enteric gram negative bugs

Front 1241

Drug: Chloramphenicol

Back 1241

Drug Class: Antibiotic (wide spectrum & bacteriostatic)

Mechanism of Action: Binds to 50S ribosomal subunit and inhibits peptidyl transferase and blocks protein synthesis

Indications: Used outside of the United States.

Side Effects: Bone marrow suppression and idiosyncratic aplastic anemia. Gray baby syndrome. Superinfection.

Front 1242

sulfonamides MOA

Back 1242

Mechanism of Action: Competitively inhibit incorporation of para-aminobenzoic acid (PABA) into dihydropteroic acid, a precursor of folic acid. Bacteriostatic. Resistance can occur due to decreased drug uptake, altered target enzyme and escape mechanism by alteration in cell permeability.

Front 1243

Which drugs bind ot eh 50s ribosomal subunit

Back 1243

chloramphenicol
macrolides
azithromycin
clindamycin

Front 1244

which drugs bind to the 30 s subunit

Back 1244

aminoglycosides
tetracyclines

Front 1245

ciprofloxacin

Back 1245

Mechanism of Action: Interference with the activity of DNA gyrase Bactericidal. Chromosomally mediated acquired resistance.

Indications: Methicillin susceptible and methicillin resistant strains of Staph. aureaus, Streptococcus.

Side Effects: GI (nausea & vomiting), CNS (mainly at high concentrations), skin reactions, cartilage toxicity and joint swelling in children, tendonitis (not recommended in pregnant woman and infants < 8 yr old).

Front 1246

amantadine

Back 1246

Drug Class: Antiviral, anti-influenza-A virus

Mechanism of Action: Interferes with uncoating of the viral RNA of influenza A within infected host cells, thus preventing viral replication.

Clinical Indications: A Prophylactic DOC for influenza-A virus. Is not as effective if taken after viral infection.

Contraindications: Contraindicated in pregnancy due to teratogenic effects in animals.

Front 1247

name two non-specific anti-influenza A and B

Back 1247

zanamivir and oseltamivir

Front 1248

sulfonamides are contraindicated, when?

Back 1248

newborns
during the last two months of pregnancy

Front 1249

foscarnet

Back 1249

Clinical Indications:A DOC for acyclovir resistant HSV or VZV infections. Alternative drug against CMV infections.

Major drug Interactions: Nephrotoxic drugs (e.g. aminoglycoside, amphotericin B, pentamidine).

Front 1250

What is the HAART and why do we use it?

Back 1250

Highly Active Antiretroviral Therapy. A cocktail of 3 or 4 drugs used to produce a more effective reduction in plasma HIV as well as an increase in CD4 cell counts. Typical drug combinations include 2 "acceptable" NRTI's plus either an NNRTI or a PI.
Note: Not all NRTI's can be combined to produce adequate antiviral efficacy, e.g. don't combine stavudine with zidovudine (see below).

Front 1251

DOC for neisseia meningitis (meningococcus) type of bug?

Back 1251

penicillin G

gram negative cocci

Front 1252

DOC for neisseria gonorrhoeae (gonococcus)

what type of bug?

Back 1252

ceftriaxone
ciproflozacin

gram negative cocci

Front 1253

DOC for clostridium difficle

type of bug?

Back 1253

metronidazole

gram positive bacilli

Front 1254

DOC for klebsiella pneumoniae?

Type of bug?

Back 1254

cefotaximine, ceftizoxime, ceftriaxone, ceftazidime, or cefapime

enteric gram negative bascila

Front 1255

zanamivir

Back 1255

Drug Class: Antiviral, anti-influenza virus (A and B)

Mechanism of Action: Inhibits influenza neuraminidase which blocks the cellular release of the virus particle

Clinical Indications: Treatment of acute uncomplicated influenza A and B (oral inhalation).

Front 1256

which enzyme activates ganciclovir, valganciclovir, valacyclovir, and acyclovir (guanosine analogs)

Back 1256

viral thymidine kinase (TK)

Front 1257

what does the ending -dine indiccate? Name two drugs with this ending and indicate their MOA

Back 1257

-dine indicates a thymidine analog

-antiviral thymidine analgos are idoxuridine and trifluridine

Mechanism of Action: Tri-fluoro thymidine analog, activated intracellularly to tri-phosphates which then inhibit DNA polymerases.

Front 1258

Name two thymidine analogs (2)

Back 1258

idoxuridine and trifluridine

Front 1259

name a purine analog

Back 1259

vidarabine

Front 1260

name guanosine analogs

Back 1260

acyclovir, valacylovir, ganciclovir, valganciclovir

Front 1261

what is the difference between oseltamivir and zanamivir?

and what aer they classified as?

Back 1261

zanamivir is orally inhaled with no systemic absorption

Oseltamivir is administrered orally and is readily absorbed

2. they are both non-specific anti-influenza anti-virals that block neuroamidaze

Front 1262

rimantadine

Back 1262

Mechanism of Action: Interferes with uncoating of virus

Indications: Prophylactic for influenza-A virus. Preferred over amantadine due to lower CNS toxicity & increased metabolism.

Contraindications: Contraindicated in pregnancy due to teratogenic effects in animals.

-prefered over amantatdine because of less CNS toxicity

Front 1263

why is rimantadine prefered over amantadine as a prophylactic

and what is it a prophylactic for?

Back 1263

less CNS toxicity than amantadine

prophylactic for influenzae-A

Front 1264

which drugs can treat CMV? cytolomegalovirus


which drugs cannot be used against CMV? MOA for drugs (2)?

Back 1264

1. CAN - ganciclovir and valganciclovir -alternative is foscarnet

2. CANNOT - acyclovir cannot be used

3. MOA - DNA chain termination also inhibtis viral DNA polymerase

Front 1265

name two anti-influenza A antivirals (specific)

Back 1265

amantadine and rimantadine

Front 1266

ribavirin

Back 1266

Drug Class: Antiviral, anti Respiratory Syncytial Virus (RSV).

Mechanism of Action: A triazine riboside analog. Converted intracellularly to a 5'-triphosphate derivative that inhibits viral RNA polymerase and capping of viral mRNA at the 5' position.

Clinical Indications: Used as an aerosol DOC for treating infections by the respiratory syncytial virus (RSV) and as a DOC in combination with Interferon-alpha-2b for hepatitis-C virus infection.

Front 1267

what is the difference between idoxuridine and trifluridine?

Back 1267

Idoxuridine can eb incorporated into viral DNA, resulting in faulty DNA and the inability of the virus to infect tissue and reproduce

Both are topically applied but trifluridine is the DOC for the topical treatment of HSV keratitis and is used to treat cutaneous infections by acyclovir resistant HSV strains

Front 1268

trifluridine

Back 1268

-antiviral, antiherpes, HSV 1 and 2

-phosphyorylated to trifluoro thymidine analog which then inhibit DNA polymerase

-DOC for topical treatment of HSV Keratitis and cutaneous infections by acyclovir resistant strains of HSV

- topically applied in eye drops ophthalmic preps

Front 1269

MOA for non selective (A+B) antiinfluenza virus

Back 1269

zanamivir and oseltamivir are anti-influenza virus antivirals

MOA - blocks virus particle release and aggregation

-inhibits influenza neuraminidase

Front 1270

vidarabine

Back 1270

-purine analog, antiviral, antiherpes simplex virus (HSV 1 and 2

-purine analog is phosphorylated and activated intracellularly which inhibits DNA polymerase activity

SE toxicity = bone marrow toxicity

Front 1271

name two guanosine prodrug analogs

name two guanosine analogs

Back 1271

prodrugs : valacyclovir + valganciclovir

regular drug: acyclovir and ganciclovir

Front 1272

name two non-specific influenza anti-virals

Back 1272

zanamivir and oseltmavir

Front 1273

which antifungals can be used to treat candida fungi

Back 1273

nystatin & flucytosine

difference: flucytosine has diff mechanism and also inhibits cryptococcus

Front 1274

amphotericin B

Back 1274

-selective fungal effect - binds to ergosterol in the cell membrane with a resultant change in permeability allowing leakage of intracellular components

infusion related toxicity and slower onset of toxicity

IV admin

Front 1275

What is a pharmacokinetic advantage of administratering fluconazole compared to itraconazole or ketoconazole

Back 1275

it has fewer hepatic enzyme interactions and the widest therapeutic index, therefore you can aggressively dose

Front 1276

SE of amphotericin B

Back 1276

Infusion - related toxicity: fever chills, muscle spasm, vomiting, headache & hypotension

slower onset of toxicity: some degree fo renal damage If above > 4 g cucmulative

Front 1277

which antifungal agent has a large impact on mammalian cells? What is the drug interactions

Back 1277

ketoconazole

(some mammalian cell toxicity if high concentration of amphotericin B

-inhibit mammalian cyt p450

Front 1278

what is special about fluconazole that is not true of itraconazole or ketoconazole

Back 1278

-fluconazole crosses the BBB, and is therefore the azole of choice int eh treatment and secondary prophylaxis of cryptococcal meningitis

itraconazole + ketoconazole have poor CSF penetration

Front 1279

what are the three mechanisms of action for antifungal agents?
name examples from each type

Back 1279

1. binds ergosterols or sterols in the cell membrane results in a change in membrane permeability and leakage of intracellular components e.g. amphotericin B and nystaitin

2. prodrug gets converted to FUTP& FdUMP which inhibits RNA and DNA synthesis e.g. flucytosine

3. inhibit cyt-p450 dependant synthesis of ergosterol, a vital coponent of cell membranes e.g. ketoconazole, itraconazole and fluconazole

Front 1280

what is the difference between nystatin and amphotericin B?

Back 1280

roughly the same mechanism but

amphotericin B has selective fungal effects, amphotercin B binds to ergosterol, resulting in a change in membrane permeability
(leaky intracellular contents). Nystatin binds to sterols in also not effective against bacteria, protozoa, viruses, wheras amphotericin B has a broad spectrum

Front 1281

which drugs inhibit cyt p450?

which drugs inhibits induces cyt p450

Back 1281

inhibit - erythromycin, clarithromycin & ketoconazole

-induce rifampin

Front 1282

name 2 synergistic drug combinations and explain why they are synergistic

Back 1282

-CWSI + aminoglycosides --> CWSI weakens cell wall allowing easier penetratition penetration by aminoglycosides

-trimethoprim + sulfa drugs (block two steps in the synthesis of folic acid, which bacterial cells need

Front 1283

alterative drugs in patients with a history of severe (anaphylatic) penicillin allergry

Back 1283

-aztreonam
-macrolides
-vancomycin
-clindamycin

Front 1284

drugs contraindicated in pregnancy + children

Back 1284

-tetracycline (bone growth retardation, teeth stain)
-fluoroquinoles (cartilage toxicity)
-thalidomide (teratogenic birth defects)
-metronidazole (mutagenic & carcinogenic potential)
-chloramphenicol (gray baby syndrome)
-sulfonamides (contraindication in new borns + late)
- amantadine
-rimantadine

Front 1285

what drug is associated with gray baby syndrome

Back 1285

chlorampheniol (infant doesn't make enough glucoronyl transferase )

Front 1286

mupirocin

Back 1286

topical antibacterial

MOA: inhibit isolucyl tRNA synthetase

Indication : topical treatment of minor skins infections, such as impetigo, also indicated for intranasal application for elimination of methicillin-resistant s. aureus

Front 1287

1. whcih produgs and drug guanosine analog are used to treat HSV (herpes simplex virus) and VZV (varicella zoster virus)

2. prodrugs and drug used to treat HSV and CMV cytomegalo virus

Back 1287

1. acyclovir and valacyclovir
2. ganciclovir and valganciclovir

Front 1288

1. route of administration for ZORA
2. which has a different administration

Back 1288

1. ORAL MAN!
2. zanamivir has oral inhalation

Front 1289

nitrofurantoin

Back 1289

urinary antiseptic

lower urinary tract infection --> exerts antibacterial activity in urine but little systemic antibacterial action

Front 1290

what is the one drug that ends in -avir but is not an antiretroviral protease inhibitor?

what type of drug is it?

Back 1290

abacavir

it is an NRTI antiretroviral nucleoside reverse transcriptase inhibitor

Front 1291

antiviral that cause bone marrow toxicity?

that cause serious nephrotoxicity

Back 1291

-idoxuridine + trifluridine
high doses of interferon alpha
-vidarabine
-ganciclovir

foscarnet: serious nephrotoxicity

Front 1292

antiviral with severe teratogenic effects?

Back 1292

-Amantadine + rimantadine
-ganciclovir
-ribavirin

Front 1293

the side effects of this antiviral are flu-lke symptoms

Back 1293

interferon alpha used for hepatitis B and C infections

Front 1294

side effects if fatal dysfunction such as pancreatitis, sepsis, and multiple organ failure

Back 1294

valganciclovir

Front 1295

difference between (doxcyclin + minocyclin) and tetracycline

Back 1295

-doxycyclin and minoccline are more lipophilic therefore they have alonger serum 1/2 life

-they are give 1X day
-eliminated biliary route --> treat biliary infection

contrast : tetracyclin = 2X day + renal elimination

Front 1296

what are doxycyclin and minocyclin NOT useful for?

Back 1296

UTIs

Front 1297

what interferes with tetracyclin absorption and why?

Back 1297

calcium or magnesiu, salts in antacids chelate tetracylins forming an insoluble complex metal

Front 1298

can tetracyclins be used to treat meningitis

Back 1298

no, tetracyclins do not cross the BBB

Front 1299

can chloramphenicol be used to treat meningitis caused by H. influenzae

Back 1299

yes, bacteriocidal effects against H. influenzae

b/c highly sensitive at low concentration

Front 1300

how is chloramphenicol metabolized?

Back 1300

metabolized by hepatic metabolism via the enzyme glucuronyl transferase

--> puts glucuronic acid olecule @ hydroxyl group of chloramphenicol --> more polar --> more elimination

Front 1301

which organisms are sensitive to chloramphenicol

Back 1301

-clostridium perferingens

-bacteroides
-h influenzae

Front 1302

are fluoroquinolenes bacteriostatic or bacteriocidal

Back 1302

bacteriocidal inhibits DNA gyrase

Front 1303

what should not be taken concurrently with fluoroquinoles? why?

Back 1303

don't take antacids
they reduce bioavailability of fluoroquinoles

Front 1304

can fluoroquinoolones be used for prostatitis?

for meningitis

Back 1304

yes - concentrates in prostate

no-does not cross the BBB

Front 1305

enterobacter

Back 1305

-imipenem
-2nd line, 3rd gen cephs and carbenicillin

Front 1306

DOC for staph

Back 1306

1. pen G
2. penicillinase producing if MRSA
3. vancomyin or cephalosporins (1st gneration) if allergic rxn --> vancomycin or fluoroquinolones (oral, better)

Front 1307

can fluoroquinolones be used on anaerobes ? which ones?

Back 1307

no ineffective against clostridium and bacteroides

Front 1308

indications for fluoroquinolones?

Back 1308

UTI with gram-organisms
STDs gonorrhea - gonococcal organisms are b-lactamase prodrugs

Front 1309

fluoroquinolone side effects

Back 1309

-GI discomfort
-CNS toxicity
-cartilage toxicity

-long QT elongation (like erythromycin)

Front 1310

c. difficle

Back 1310

metronidazole

Front 1311

therapeutic indications of metronidazole

Back 1311

anaerobes
closterium difficle

closterium perfringes
bacteoides
h. pylori

Front 1312

do sulfonamides cross the BBB?

Back 1312

yes crosses the BBB

Front 1313

how are antifungial drugs delivered

Back 1313

lysomes are used to carry antifungal drugs directly to the infections site which reduces cellular toxicity

Front 1314

what fungal species are typically seen in HIV patients?

Back 1314

-candidiasis, cyptococcosis + histoplamosis
-opportunisitc fuckers

Front 1315

toxicity of protease inhibitors

Back 1315

1. dyspepsia, nausea, vomitting, diarrhea
2. insulin resistance, glucose intolerance, diabetes mellitus
3. hyperlipidemia: hypertriglyceridemia, hyperchlolesterolemica
4. liver toxicity

Front 1316

antiretroviral drug interactions

Back 1316

1. PI+ NNRTI - liver metabolized
ritonavir = PI-booster
2. NNRTI induces + nevirapine induce + inhibits efavirenz

(e.g. ritonavir + saquinavir)

Front 1317

feever + confusion : pts has dental disease with history of heart murmur no penicillin allergy, echocardiogram shows vegitatins on the calcified aortic arch

Back 1317

ampicillin and gentamicin

Front 1318

symptoms: urinary frequency, dysurea, low grade fever, pyuria and bacilli

Back 1318

sulfamethoxazole + trimethoprim

Front 1319

fever , pumlent wound drainage with gram + cocci 5 days post-colostomy for diverticular abscess

Back 1319

ampicillin and gentamicin

Front 1320

symptoms and severe headache rigid neck, sensitivity to bright lights

Back 1320

symptoms of meningitis

use 3rd gen ceph ceftrioxone

Front 1321

most suitable for a pts with renal insufficiency
1. chlortetracycline
b. demedocycline
c. doxycycline
d. methacycline
e. oxytetracycline

Back 1321

doxycyline

Front 1322

dentist is going to remove toooth in patient with abnormal heart valve

Back 1322

ampicillin

Front 1323

prostatic infection

Back 1323

trimethoprim

Front 1324

which two bacteria cannot be treated by aminoglycosides and why?

Back 1324

B. fragilis and clostridium their anaerobic

Front 1325

didanosine

Back 1325

-deoxyadenosine analog
antiretroviral, NRTI

-fatal & non-fatal pancreatitis
-myelosuppression, neutropenia, severe anemia, lactic acidosis + severe hepatomegaly

Front 1326

which antivirals when activated inhibit DNA polymerases?
inhibit RNA polymerase?
inhibit both

Back 1326

DNA polymerase:
idoxuridine (thymidine analog)
vidarabine (purine analog)

RNA polymerase
ribavirin - riboside analog
foscarnet (HIV reverse transcriptast)

Front 1327

ganciclovir and valganciclovir

MOA: indications, major drug interactions

Back 1327

MOA: activated by tK, inhibits viral DNA polymerases. Produces DNA chain termination

CI: DOC for CMV retinitis in immuno-compromised patients

SE: can results in organfailure, sepsis, etc. fatal dysfunction

Front 1328

which antiviral inhibits RNA polymerase instead of DNA polymerase?

Back 1328

ribavirin acts on RNA polymerase insterads of DNA polymerase

Front 1329

which antivriral acts on DNA polymerases, RNA polymerase and HIV reverse transcriptase

Back 1329

foscarnet

Front 1330

metronidazole

Back 1330

-ANTIPROTOZOAL and antibacterial against anaerobes

-selective for bacteria and protozoa
-forms nitro anion radical and hydroxylazine which binds with DNA causing single strand breaks. Bacteriocidal

-contraindicated in pregnacy
-SE: GI discomfort, metallic taste, disulfiram like reactions

Front 1331

pharmacokinetics of sulfonamides

Back 1331

metabolism of hepatic acetylation

Front 1332

side effects of sulfonamides ]

name sulfonamides and the drug they are administered with

Back 1332

SE: stevens johnson syndrome, hemolytic anemia, kernicterus (a toxic encephalopathy in infants)), contraindicated in new borns and last two months

2. sulisoxazole, sulfamethoxazole, and pregnancy, trimethoprim, administered with

Front 1333

sulfonamides MOA

Back 1333

use of sulfamethoxazole clinically is in combination with trimethoprim in a 5:1 ratio, known as cotrimoxazole, trimethoprim is an inhibitor of dihydrofolate reductase and provides a sequneital blockade of synthesis of tetrahydrofolate

Front 1334

aminoglycosides-how excreted?

Back 1334

renal

Front 1335

salmonella typh in bile duct

Back 1335

ans. ampicillin, why? ampicillin achieves high [] in bile ducts

Front 1336

enterobacter UTI

Back 1336

carbenicillin (not covered by ampicillin + amoxicilllin)

Front 1337

when would you use carbenicillin instead of amoxicillin & ampicillin

Back 1337

pseudomona & enterbacter UTI

Front 1338

therapeutic indications for aminoglycosides

Back 1338

-UTI pseudomonas
-prophylaxis for endocarditis
-primarily for gram negative bugs
-when combined with CWI - uses --> staph, strep, viridans, MRSA, enterococcal

Front 1339

i'm going in for surgery - need surgery prophylaxysis but allergic to penicillin

Back 1339

vancomycin

Front 1340

gram + bascilla (rods)

Back 1340

-anthrax
-castilium perfringens
-castilium difficle

Front 1341

pharmacokinetics of aminoglycosides (3 things)

Back 1341

1. administered only in a hospital with therapeutic monitoring must monitor co
2. minimal metabolism
3. extracellular distribution

Front 1342

vancomycin MOA

Back 1342

vancomycin inhibits peptidoglycan synthase thereby inhibiting cell wall cross linking

peptidoglycan synthase - brings peptidoglycans outside membrane cross-linking

Front 1343

pharmacokinetics of vancomycin

Back 1343

-parental
-can be given orally to treat for local GI tract infection because not absorbed

Front 1344

when is oral vancomycin used?

Back 1344

i have a growth of c difficule in my GI tract

Front 1345

not useful against gram negative

Back 1345

what is vancomycin not useful for

Front 1346

MRSA

Back 1346

-use penicilllin resistant penicillins

cephalosporins don't work

Front 1347

macrolide toxicity

Back 1347

GI upset esolate salt of erythromycin causes cholestatic jaundice
-cyp450 inhibit (not azithromycin)

Front 1348

advantage of clarithromycin over erythromycin

Back 1348

-respiratory infections more effective against gram negative

-h. influenza
-MAC mycobacterium avium complex in HIV patients

Front 1349

erythromycin macrolide indications

Back 1349

1. upper respiratory with staph and strep
2. legionnaires
3. alternative to penicillin hypersensitive pts

Front 1350

pen V

Back 1350

first oral penicillin

Front 1351

which penicillin is often combined with clavulanate acid and why?

Back 1351

ticarcillin - we combine for inhibition of b-lactamases

Front 1352

plasma mediated alteration of binding site

Back 1352

macrolide mech of resistance

Front 1353

erythromycin

Back 1353

drug used in colonrectal surgery b/c no absorption

Front 1354

clindamycin crossess BBB?

Back 1354

no, no, meningitis

Front 1355

alternative prophylaxis for endocarditis

Back 1355

clindamycin

Front 1356

bacterial endocarditisi use

Back 1356

1st generation ceph like cephalexin or cefazolin
or penicillin G benzatnin

Front 1357

i have siphilus, give me an antibiotic

Back 1357

ceftriaxone

Front 1358

antibiotic for abdominal surgical operations

Back 1358

use cefoxitan

Front 1359

gram positive rod

Back 1359

anthrax is a ...

Front 1360

gram + rod

Back 1360

clostilum difficile is a ...

Front 1361

gram negative cocci

Back 1361

gonococcus & meningococcus

Front 1362

castilium perfringens is a ...

Back 1362

gram + rod

Front 1363

what type of bacteria is meningococcus?

Back 1363

gam negative cocci?

Front 1364

gram negative cocci

Back 1364

what type of bacteria gonococci

Front 1365

list extended and broad spectrum penicillins

Back 1365

-ampicillin
-amoxicillin
-carbenicillin
-ticarcillin
-piperacillin

Front 1366

PEN G is adminstered

Back 1366

IV or IM (parental)

Front 1367

what are three isoxazole penicillins?

Back 1367

oxacillin, cloxacillin, dicloxacillin

Front 1368

penicillinase resistant penicillins name them

Back 1368

methicillin (not used clinically)
isoxazole penicillins
naficillin

Front 1369

h. influenzae respiratory infections

Back 1369

ampicillin or amoxicillin

Front 1370

2 carbapenems

Back 1370

imipenem
cilastatin

Front 1371

name a monobactam and what is it used for?

Back 1371

aztreonam active against gram negative rods

Front 1372

first generation cephalosporins

Back 1372

cephalexin
cefazolin

Front 1373

second generation cephalosporins

Back 1373

cefoxitin
cefaclor
cefprozil
cefuroxime axetil

Front 1374

infection with castilium perfringens

Back 1374

pen G

Front 1375

UTI with pseudomonas

Back 1375

carbenicillin or cephedrine (3rd genration), can't use amoxicillin or ampicillin

Front 1376

infections with pseudomonas no b-lactamases

Back 1376

carbenicillin

Front 1377

pneumonococcal pneumonia use

Back 1377

cephalexin

Front 1378

difference between penicilins and cephalosporins

Back 1378

penicilins are effective against enterococci, cephalosporins don't work on enterococci

Front 1379

h. influenza with b-lactamaze resistnat what is no longer useful and what do you use?

Back 1379

cefaclor

Front 1380

proteus mirabilis UTI

Back 1380

ampicillin and amoxicillin

Front 1381

e coli UTi

Back 1381

ampicillin or amoxicillin (extended spectrum)

Front 1382

reflex tachycardia

Back 1382

non selective alpha 1 and alpha 2 blockers

b2 agonists

Front 1383

phenylephrine

Back 1383

a1 agonist

Front 1384

hypertension treatment

Back 1384

ace inhibitors
b blockers
diuretics

Front 1385

clonidine

Back 1385

a2 agonist (antihypertensive)

Front 1386

albuterol

Back 1386

B2 agonist

Front 1387

Terbutyline

Back 1387

B2 agonist

Front 1388

dobutamine

Back 1388

b1 agonist

Front 1389

doxazosin

Back 1389

long activng a1 selective blocker

Front 1390

ends in sin

Back 1390

alpha 1 selective blocker

Front 1391

treatment of pheochromocytoma

Back 1391

phentolamine or pehnoxybenzamine (nonselective irreversible alpha 1 and alpha2 blocker)

Front 1392

methoxamine

Back 1392

alpha one agonist

Front 1393

Reserpine

Back 1393

antihypertensive
SE+ suicidal tendencies
inhibitor of catecholamines vesicular uptake transporter
resulting in depletion of neuronal catecholamine stores, decreased CO, decreased PVR

Front 1394

imipramine

Back 1394

antidepressant
-tricyclic amine
blocks repuptake of norepinephrine serotonin

Front 1395

edrophonium

Back 1395

-anticholinesterase
-short and rapid-acting
diagnosis of myasthemia gravis & whenever need curare antagonist for cholinergic reactions

Front 1396

methyldopa

Back 1396

-antihypertensive
-alpha 2 agonist prodrug
-lowers arterial pressure
decrease false neurotransmission

Front 1397

phenoxybenzamine

Back 1397

alpha non-selective antagonist
irreversible binder, binder, binds convalently vasodilator
for pheochromocytoma for hypertension

Front 1398

propranolol

Back 1398

nonselective beta blocker
block b1 & B2 competitive
for hypertension arrhytmias angina prevents sudden death + reinfarction & migraine

Front 1399

guanethidine

Back 1399

antihypertensive, adrenergic neuron-blocking agents
4 - mech -> tyramine-like, reserpine-like cocaine-like, betrylium-like

Front 1400

alpha blockers

Back 1400

terazosin
tamsulosin
doxazosin
prazosin

Front 1401

yohimibine

Back 1401

alpha 2 blockers
increased sympathetic outflow
increased bp, no clinical role

Front 1402

antihypertensive

Back 1402

reserpine, bretylium, guanethidine, methyldopa, prazosin, clonidine

Front 1403

prazosin

Back 1403

alpha 1 bocker antihypertensive
not accompanied by reflextachy cardia

Front 1404

phenylephrine

Back 1404

synthetic alpha, agonist, vasal constriction, nasal decongestion, pressor agent, maintain bp

Front 1405

bretylium

Back 1405

-antihypertensive & antiarrhythmics
-interferes with release of catecholamines for attempted resentation from vfib

Front 1406

Terbutaline

Back 1406

b2 adrenergic agonist prevent bronchospasm in pts with asthma
SC administration

Front 1407

doxazosin

Back 1407

alpha selective blocker
once a day dosing

Front 1408

succinylcholine

Back 1408

-nicotinic cholinomimetic and NMJ blocker (depolarizing type)
uses: adjunct to general anesthesia
contraind: genetic disorders of pseudocholinesterase from history of malignant hyperthermia

Front 1409

dopamine

Back 1409

low dose d, intermed b, increases HR, high d1 = vasoconstriction including renal

for: shock due to ML, septic, surgery, with MAOI lasts longer

Front 1410

phentolamine

Back 1410

non-selective alpha antagonist blocks alpha 1 &2 - leads to tachycardia IM or IV

Front 1411

physostgmine

Back 1411

-reversible cholisterase inhibitor
-to reverse effects upon CNS caused by toxic doses of drugs
-crosses BBB

Front 1412

tubocurarine

Back 1412

-nondepolarizing neuromuscular blocking agent
- muscle relaxant during surgery for setting fractures & dislocations
-most likely to cause histamine release

Front 1413

ipratropium

Back 1413

-antimuscarinic (like atropine)
-treatment of bronchospasm associated with asthma, COPD
-inhalation, aerosol,
- a local site specific effect

Front 1414

origin of preganglionic parasympathetic

Back 1414

craniosacral

Front 1415

sympathetic

Back 1415

thoracolumbar

Front 1416

trimethaphan

Back 1416

-nondepolarizing ganglionic blockers, + doesn't cross BBB
-blocks nicotinic receptor for hypertnsive emergencies & discesting aortic aneurysim
SE= cyclopegia, decrease BP and increase HR decrease GI

Front 1417

zerostygmia

Back 1417

dry mouth - symptoms of atropine salivary glands are blocked

Front 1418

side effects of nicotinic antagonists

Back 1418

orthostatic hypertension postural hypertension, urinary retension, sexual dysfunction

Front 1419

metoprolol

Back 1419

b1 selective blocking agent
for hypertension + angina ectoris following abrupt cessation of therapy

Front 1420

cocaine

Back 1420

-CNS stimulant blocks monamines reuptake channels
-blocks Na channels + cardiac K

Front 1421

tyramine

Back 1421

indirect acting sympathomimetic
-MAO I prolongs affects
-cocaine blocks reuptake
dopamine in fermented food cheese and beer

Front 1422

ephedrine

Back 1422

direct + indrectly act sympath
-dierect a + B indirect tyramine like
-diet supression, bronchodilator

Front 1423

what's in a dense core vesicle

Back 1423

NE, DOP, dop B-hydroxylase,
chromaranin
ATP
loop b-hydronon converts DOP --> NE

Front 1424

isoproterenol

Back 1424

nonselective Beta agonist B1, B2
for heart blocker or cardiac arrests
SE: tachycardia

Front 1425

CNS effects

Back 1425

sedation, confusion, ataxia, (decreased pathway), loss of reflex, slurred speech, convulsion

Front 1426

angiotensin II

Back 1426

vasoactive peptide a potent pressor agent

Front 1427

atropine

Back 1427

-preanesthetic medication
- to restore cardiac rate
and arterial pressure during
anesthesia
-muscarinic blockers