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200 Cards in this Set

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  • Back
A patient is tx w beta-blocker for angina then d/c drugs then increased cardiac beta receptor stimulation then increased O2 demand then angina and MI; what is this indicative of?
Beta-blocker withdrawal syndrome (tachycardia, palpitations, tremor, chest pain)
How to treat patient with hyperthyroidism?
Tx with propranolol to tachycardia and tremor and
prevent the peripheral conversion of T4 to T3
Type I diabetic patient treated with glaucoma drug which causes hypoglycemia. Which drug?
What is the main MOA of ACEI in tx of CHF?
Increase CO by decreasing preload and afterload;
reverses cardiac remodeling caused by angiotensin II (ang II)
Treat HTN in patient with DM?
W/ ACEI to dec BP and dec proteinuria (protects kidneys)
Patient tx with OCP containing estrogen + norethindrone develops hirsutism - why? how to tx?
Hirsutism results from androgenic effects of the progestin norethindrone which is a derivative of 19-nortestosterone; tx with spironolactone
Postmenopausal female develops hirsutism - how to tx?
Patient with an adrenal tumor has inc BP and plasma bicarb, dec plasma postassium and PRA; plasma sodium is normal what is the dx? and tx?
Conn's syndrome = aldosterone-secreting adrenal tumor; tx with spironolactone
Pat w atrial fibrillation given quinidine to slow ventricular rate, but ventricular rate inc
soon after quinidine. Why? What to do about it?
Immediate atropine-like effect of quinidine inc AV conduction; Tx w verapamil or diltiazem to dec AV conduction and slow ventricular rate.
Patient with atrial fibrillation and no HF has palpitations and dizziness? MOA?
Tx with verapamil
MOA? Inc ERP of AV node slows ventricular rate leads to improved AV filling and inc CO
A patient requires an antiplatelet drug after MI or stroke, but the patient has aspirin hypersensitivity. How to Tx?
Use ticlopidine or clopidogrel
Patient OD's with warfarin are attempts suicide with rat poison, which clotting factors and lab tests affected?
Dec activity of factors 2,7,9 and 10; Inc aPTT and PT; no effect of factors 8 or 13 or bleeding time
Which type of cardiac dysrhythmia requires tx with warfarin?
Atrial fibrillation
Pat with MI treated with several drugs then develops intracranial bleeding, which drug caused it?
Patient passes tape worm segments (proglottids) - most likely Taenia saginata (beef tapeworm) or a patient who likes to eat sushi passes tapeworm segments - most likely
to be Diphyllobothrium latum (fish tapeworm) - treat with?
Niclosamide or praziquantel
Fish tapeworm causes megaloblastic anemia because the worm takes up all the vitamin B12 in the gut, always worry that patient may have Taenia solium, pork tapeworm, which may produce cysticercosis (larval cysts) in the brain, orbit, muscles, liver and lungs.
Tx cysticercosis w albendazole
DOC if identity of the type of tapeworm is uncertain?
Baby w anal itching (pruritis) and a positive “cellophane tape” test = pinworm infestation, Tx?
Tx w/ mebendazole or pyrantel pamoate
Patient w mixed infestation = cestode (tapeworm) + trematode (fluke), Tx?
Immunocompromised patient w mucocutaneous HSV infection, Tx?
Patient w HSV encephalitis
Patient w genital HSV infection
Keratoconjunctivitis caused by HSV is treated with?
Trifluridine (trifluororthymidine)
Immunocompromised patient w CMV infection
Why is ketoconazole contraindicated in a patient receiving tx w amphoterecin B?
Because ketoconazole will BLOCK the antifungal actions of amphoterecin B
Which drug is selectively toxic to fungi because mammalian cells are unable to catalyze its deamination?
Patient w gonorrhea - tx w penicillin for 8 weeks - patient returns with similar
symptoms but no diplococci in urine (no longer has gonorrhea), what is the dx?
Patient has Chlamydia
infection - tx w tetracycline unless patient is a PG female, then tx w erythromycin
Patient has Streptococcus infection and is allergic to PCNs, tx?
Patient with clindamycin - patient develops seudomembranous colitis –
caused by Clostridium dificile, tx?
Oral metronidazole (or oral vancomycin)
Schizophrenic patient w depression, tx?
SSRI like fluoxetine
Depressed pat w hypotension tx?
SSRI like fluoxetine
Depressed patient being tx w antidepressant suffers from sedation and hypotension? Which drugs could cause this?
Could be MAOI or TCA since both cause sleepiness and hypotension, but pick TCA bx
TCA’s cause greater orthostatic hypotension than do MAOI’s
Small child w nocturnal enuresis, tx?
TCA for atropine-like effect in urinary bladder
Which NT involved in OCD?
5-HT; tx for OCD = clomipramine or SSRI
A depresssed patient w CHF tx w digoxin is given TCA- what would you see on an ECG?
Inverts or flattens T-wave,
slows conduction in fast fibers so QRS increased
What is a (tertiary amine which blocks 5-HT & NE uptake) converted to desipramine(2 secondary amine which blocks NE uptake)?
Sx of OD with imipramine?
Usual effects are dec BP from alpha-blockade; inc HR from dec BP and anticholinergic effects; decreased AV conduction with inc Q-T interval
What is serotonin syndrome?
Results from excessive stimulation of central 5-HT receptors = inc BP, HR and respiration; increased muscle activity (muscle twitching, shivering, myoclonus) causing hyperthermia and sweating; pupillary dilation; confusion, agitation, hallucinations
What causes serotonin syndrome?
Serotonin syndrome is caused by an SSRI (e.g., fluoxetine) or a TCA whch blocks both NE and 5-HT uptake, e.g., imipramine), especially in patients taking an MAOI. MAOI (e.g., phenelzine) prevent the degradation of 5-HT in the CNS, and 5-HT accumulates in the cytoplasm of central 5-HT neurons
Patient being treated for Giardia + some other infection (e.g., bacterial) develops n/v and headache after drinking a beer. Which drug causes this rx?
Morphine is DOC for pain and pulmonary edema caused by acute MI bx it acts in CNS to dec SNS activity therefore it:
Dec preload and afterload
Tx of female w acute pain from gallstones w morphine causes greater pain. Why?
Morphine contracts smooth muscle of gall bladder
Female on methadone has emergent surgery and is tx w butorphanol; patient experiences S/S of opiate withdrawal. Why?
Butorphanol is a partial agonist at mu receptors. The partial agonists pentazocine, nalbuphine and buprenorphine can also cause S/S of opiate withdrawal in a patient taking methadone.
Which opiate does not cause a dose-related inhibition of respiration
The partial agonists pentazocine, butorphanol and nalbuphine
Newborn baby has respiratory depression bx mom received an ? during labor
Patient with MI tx with morphine, why?
Chest & arm pain inc the activity of the sympathetic nervous system which constricts arterioles and venules to increase preload and afterload. The damaged heart cannot pump the increased venous return, especially in the face of an increase in afterload. Morphine acts centrally to decrease pain and to decrease sympathetic outflow. Decreased activity of the SNS decreases preload and afterload and improves CO. The analgesic effects of morphine also make the patient more comfortable.
Question re: potency or MAC
Most potent drug has the smallest MAC gas with lowest MAC (most potent) = gas with the highest oil/gas partition coefficient. Gas with the highest MAC (least potent) = gas with lowest oil/gas coefficient
Which of the following drugs decreases BP and respiration when given i.v.? Opiate? Ketamine? Etomidate? Thiopental?
1) Opiate - BP = nc, dec respir; 2) ketamine – inc BP, respir = nc;
3) etomidate - BP & respir = nc; 4) thiopental – dec BP and respir
A patient exposed to poison oak is given?
Both diphenhydramine (H1-blocker) and cimetidine (H2-blocker) to prevent itching and pain
A patient w GERD is being treated with cimetidine requires allergen testing by a dermatologist. What are two things you must do?
Must d/c cimetidine to ensure accuracy of skin tests, and tx GERD w omeprazole during allergy testing.
Patient has insomnia from depression; tx with a TCA but patient still has insomnia, tx?
Give an antihistamine (e.g., diphenhydramine) to induce sleep, and patient gets urinary retention from combined atropine-like effect of the drug combination
What drug induces emesis by stimulating D2-receptors in the CTZ?
A patient with S/S (confusion/coma) of hepatic portal encephalopathy needs tx
Drug = lactulose which acidifies the bowel to trap ammonia as ammonium ion; ammonium lost in feces; plasma [ammonia] falls; coma and confusion disappear
Which antiulcer drug does not alter stomach pH?
Patient on propranolol takes cimetidine for heartburn and develops severe bradycardia. Why?
Bx cimetidine inhibits CYP450 and thus blocks the metabolism of propranolol
Antacids and GI tract: Aluminum and Magnesium?
AlOH = constipation; MgOH = diarrhea
Pat being tx w doxycycline; which drug contraindicated
Al/Mg antacids
Patient needs emergency surgery; need to empty stomach/prevent reflux. Drug = ?
Metoclopramide = prokinetic in stomach and bowel and tightens the LES
Cancer chemo patient has n/v and noctural acid reflux Tx w = ?
Patient has post-operative paralytic ileus Tx w = ?
Metoclopramide, bethanechol, cisapride
Patient treated with drug for Crohn’s disease or ulcerative colitis develops hepatic damage or bone marrow depression. Drug = ?
Sulfasalazine; patient is a slow acetylator.
S/S of laxative abuse w castor oil or bisacodyl
Constipation, hypokalemia, muscle weakness, abnormal architecture inner GI wall
Half-life of aspirin as only 1 h, why does it inhibit platelet inhibition for a longer period?
Aspirin irreversibly acetylates active site of COX-1 in platelets
How does aspirin prevent platelet aggregation when it is not taken in doses large enough to maintain a steady-state plasma concentration?
Aspirin irreversibly acetylates active site of COX-1 in platelets
Patient has intermittent episodes of hemiplegia which resolve spontaneously; would like to treat with aspirin, but patient has aspirin “hypersensitivity”;
Tx w? = ticlopidine
What is the causative compound in aspirin hypersensitivity?
DOC for menstrual cramps
Baby has patent ductus arteriosus
Close with indomethacin
Want to keep ductus open prior to surgery: what drug will do this ?
Alprostadil = PGE1 analog dilates the ductus arteriosus
Pat tx with NSAID develops GI ulceration, MOA?
MOA = inhibition of gastric PG synthesis
A patient with nasal polyps who has wheezing with aspirin needs a antipyretic drug
Acetaminophen,is antipyretic but not antiinflammatory
OD rxn w/ Acetominophen? Tx?
Drug OD; initially blood chemistries normal, but 36 h later see increase in AST and ALT. Treat with n-acetylcysteine to replenish glutathione
Patient on NSAID for tendonitis for 2 weeks develops fever and hematuria: diagnosis?
Acute interstitial nephritis
Histologic photo of kidney tissue with lots of lymphocytes: diagnosis?
Interstitial nephritis caused by aspirin or another NSAID
Patient with CHF takes ibuprofen; effect on kidney = ?
Constriction of afferent arteriole lowers RBF and GFR to cause salt\water retention; no PG's to partially inhibit the effects of ADH in the collecting duct = water retention
Patient tx with NSAID for arthritis exhibits dec [Hb] and Hct and has occult blood in his stool. Which drug could be addded to tx to reverse this pathology?
Patient with a renal transplant is taking the immunosuppressant drug azathioprine. Patient develops gout. Which gout drug is contraindicated?
Allopurinol bx azathioprine is converted to the cytotoxic agent 6-mercaptopurine (6-MP) which kills antigen presenting cells and T- and B-lymphocytes, and 6-MP is inactivated (metabolized) by xanthine oxidase.
Patient with lymphoma tx with chemo. Which drug will prevent dec in renal function?
Allopurinol. Chemo kills lymphoma cells which release nucleic acids which are converted to urate; excessive urate in urine crystalizes to occlude the collecting ducts, pelvis and ureters; rapid, progressive renal dysfunction develops;
Which drug is not uricosuric?
Allopurinol and colchicine
DOC for severe hyperuricemia
Patient with gout treated w probenecid gets remineralization of bone. Why?
Increased urinary excretion of urate
Patient takiing a small daily dose of aspirin may develop gout whereas a large daily dose of aspirin is used to treat gout. Why the discrepancy?
Small doses of aspirin enhance urate reabsorption in the renal tubule whereas large doses of aspirin are uricosuric
Patient being tx for gouty arthritic develops leukopenia. Which drug ?
Pg woman develops hyperthyroidism. How to treat?
What are the usual causes of hyperprolactinemia and their treatment?
Blockade of D2 dopamine receptors and increased TRH in hypothyroidism cause hyperprolactinemia. A: in hypothyroidism, tx w thyroxine to suppress plasma [prolactin]
Patient w recurrent v. tach/v. fib. develops hyper- of hypothyroidism while taking amiodarone. Why?
Amiodarone is 37% iodide by weight. This iodide can either prevent the conversion of T4 to T3 (hypothyroidism), or it can serve as a substrate for the synthesis of T3 by thyroid peroxidase
Patient treated with propranolol; which drug will still bronchodilate?
Theophylline or aminophylline act via intracellular inhibition of PDEase
Patient treated with theophylline develops a sinus infection which requires tx w an AB; Which AB would require adjustment of the daily dose of theophylline?
Patient treated with theophylline develops a sinus infection which requires
tx w an AB; Which AB would require adjustment of the daily dose of theophylline?
Asthmatic patient taking theophylline develops seizures after taking an OTC drug for heartburn. drug = ?
Cimetidine which blocks the CYP450 which metabolizes theophylline
Which drug causes the greatest increase in FEV1 with the smallest increase in HR?
Patient w exercise-induced asthma uses cromolyn prophylactically. MOA ?
Cromolyn prevents Ca++ influx into mast cells when IgE bridges form = no mast cell degranulation
Which drug suppresses cellular immunity, blocks the synthesis of PG’s and LT’s and increases neutrophil count in blood?
A glucocorticoid NB: Glucocortiocoids decrease the number of B & T lymphocytes, monocytes, eosinophils and basophils by stimulating their movement from the blood into lymphoid tissue.
Patient with vitamin D toxicity exhibits: hypercalcemia with hypercalcinuria; hyperphosphatemia; anorexia, nausea, weight loss, weakness; dehydration develops because hypercalcemia impairs the renal concentrating ability of the kidney, tx?
Tx of vitamin D toxicity: aggressive hydration w isotonic saline, furosemide to enhance urinary Ca++ excretion and plicamycin (mithramycin) = a cytotoxic antibiotic drug that inhibits bone resorption
Patient w renal failure has low plasma Ca Tx w ?
Tx with 1,25 diOH-Vit D
Patient w Paget’s disease exhibits hearing loss, bone pain, bone deformity, increased serum alkaline phosphatase, increased urinary hydroxyproline, high output HF and immobilization hypercalcemia. TX w ?
Tx w calcitonin to decrease bone pain, bone deformity, hearing loss and hypercalcemia.
A post-menopausal woman requires tx to maintain bone mass, but cannot take estrogen bx her mother and sister had breast cancer. Tx w ?
Alendronate or etidronate
A patient tx with steroids develops hypocalcemia. Why?
Steroids antagonize the effects of vitamin D on the GI absorption of Ca
A patient with normochromic, macrocytic anemia has distal paresthesias. The patient is treated with p.o. folate and the anemia disppears, but the neurological S/S worsens. What happened?
Folate will correct the megaloblastic anemia, but the neurological syndrome results from B12 deficiency because B12 is needed for the synthesis of myelin
patient being treated with phenytoin, isoniazid, pyrimethamine, trimethoprim or methotrexate develops normochromic, macrocytic anemia. Why?
Phenytoin and isoniazid interfere with the GI absorption of folate. Pyrimethamine, trimethoprim and methotrexate inhibit DHF reductase.
A patient on hemodialysis develops normochromic, macrocytic anemia. Why and what to do about it?
Hemodialysis removes plasma folate. Patients on hemodialysis must be treated with erythropoetin (EPO), folate and ferrous iron
: A patients with a Hct. 24 is started on hemodialysis. After tx with EPO, folate and ferrous iron, the patient develops HT. Why?
As the Hct is increased by increased production of RBC's, the viscosity of blood rises. According to Poiseuille's law, resistance is directly related to viscosity. The increase in Hct increases the resistance to flow, so BP increases
Which drug could be used for "blood doping" (i.e., increased Hct) in competitive cycling?
EPO, epoetin alfa, darbepoetin
Patient with malar (buterfly) rash, arthritis, polyserositis: urine shows proteinuria and microscopic hematuria Dx = ?
SLE Tx w ? A: prednisone or any other –sone or –lone drug
Which synthetic glucocorticoid is used to differentiate bilateral adrenal hyperplasia from adrenal carcinoma?
Dexamethasone because it will depress serum cortisol by 50% in adrenal hyperplasia caused by a pituitary adenoma (Cushing’s dx) but have no effect on serum cortisol in adrenal carcinoma.
Which drug will increase the urinary excretion of 17-ketosteroids (testosterone) in a patient with bilateral adrenal hyperplasia (i.e., Cushing’s dx) wo affecting urinary 17-OH-steroids (cortisol) in a patient with adrenal carcinoma?
Metyrapone blocks the CYP45011 that converts 11-deoxycortisol ( a 17-OH-steroid) to cortisol so there is no cortisol to feedback inhibit the pituitary.
Which drug will suppress plasma cortisol in a patient with normal pituitary/adrenal function?
Ketoconazole blocks the CYP450scc
Which drug can cause a “medical adrenalectomy”?
Aminoglutethimide blocks all adrenal and extra-adrenal steroid synthesis bx it prevents the conversion of cholesterol to pregnenolone; it can be used to tx Cushing's syndrome
A patient tx wih steroids develops a GI ulcer. MOA?
Inhibition of gastric PG synthesis
A patient with S/S of hyperestrogenism (breast tenderness) is on a drug to enhance fertility. Drug = ?
A: clomiphene. Clomiphene blocks CNS estrogen receptors causing increased putsatile release of GnRH which enhances the secretion of FSH – ovulation
Estradiol contraindicated in a patient w a history of thromboembolic dx (DVT's). Why?
Bx estradiol increases the synthesis of clotting factors.
Patient has breast cancer. TX = ?
Tamoxifen which blocks estrogen receptors
Why do OCP's which contain an estrogen also contain a progestin?
The progestin prevents the endometrial hyperplasia caused by the estrogen
Which compound can be used to maintain bone mass in a postmenopausal woman who has had breast cancer?
Raloxifene (a SERM) or alendronate (a bisphosphonate)
What are two conditions tx with an estrogen can decrease?
Tx with an estrogen decreases the risk of osteoporosis and colorectal cancer
Why give progestin with estrogen in OCP's?
Progestins prevents endometrial hyperplasia caused by estrogen
A body builder treats himself w fluoxymesterone (an anabolic steroid). How his spermatogenesis be affected?
Spermatogenesis is suppressed bx the fluoxymesterone stimulates hypothalamic androgen receptors which inhibit the release of GnRH so no FSH is secreted by the pituitary
A body builder has an enlarged heart and spleen, borderline DM and mild HT, but androgenic steroids are not present in his urine. What drug is he abusing?
Growth hormone which increases the production of insulin-like growth factors (IGF's)
Older man has arthralgia, fluid retention and hyperglycemia. What drug has the effect?
Growth hormone (GH)
What drug will suppress the secretion of GH hormone in a patient with acromegaly?
Bromocriptine or octreotide
Patient with BPH or hair loss. Tx w ?
Finasteride blocks the synthesis of dihydrotestosterone (DHT) by inhibiting 5-reductase
Which drugs is a androgen receptor antagonists?
How to tx a young boy w cryptorchidism?
Human chorionic gonadotropin (hCG)
Patient with diabetic ketoacidosis. Tx with?
Lispro or regular insulin i.v., i.v. fluids for rehydration, potassium to prevent hypokalemia as insulin drives glucose into liver, skeletal muscle and fat cells.
A patient with type 2 DM develops lactic acidosis while taking a drug. drug = ?
Metformin bx metformin increases glucose utilization via anaerobic pathways (glucose leads to lactate leads to lactic acidosis)
Which drug decreases hepatic glucose production in a type 2 diabetic patient without enhancing the pancreatic secretion of insulin?
Pat tx w chemo for Hodgkins develops symptoms of schizophrenia - which drug? Vincristine, nitrogen mustard, prednisone, combination or another drug?
Vincristine = neurotoxicity (areflexia, peripheral neuritis) limits usefulness nitrogen mustards = alkylate DNA = M2C2 = mechlorethamine, melphalan, cyclophosphamide, chlorambucil A; prednisone = CNS toxicity = psychosis
Cancer cells lacking hypoxanthine-guanine phosphoribosyl transferase (HGPRTase)are resistant to ?
6-mercaptopurine and 6-thioguanine The enzyme HGPRTase converts 6-MP
and 6-TG to a nucleotide form which inhibits purine synthesis and thus blocks
DNA/RNA synthesis
Patient to be treated w chemo w cyclophosphamide. Patient is receiving a drug for gout. Which gout drug would increase the toxicity of cyclophosphamide?
Allopurinol prolongs the half-life of cyclophosphamide, how = unknown ?
A patient tx w methotrexate develops bone marrow depression. How to tx?
“Leucovorin rescue” = tx w leucovorin (folinic acid) to reverse bone marrow depression. Normal cells can take up leucovorin, but tumor cells cannot, so
leucovorin rescues normal cells but not tumor cells
Pat on chemo has cough w crackles, X-ray shows diffuse basilar infiltrates, drug =?
Drug w antiestrogenic effects for tx of breast cancer = ?
Which type of receptors must be present for the tx a breast cancer w the GnRH
analogs leuprolide and goserelin?
Estrogen receptors in the tumor tissue
T:Alkylating agents
Moderate bone marrow depression, large doses cause severe depression with leukopenia, thrombocytopenia and bleeding
Skin pigmentation, pulmonary fibrosis, adrenal insufficiency
Hemorrhagic cystitis
Renal damage, acoustic nerve dysfunction
CNS depression
Prednisone -Immunosuppression, adrenal suppression, psychosis
cytarabine - megaloblastosis
Oral and GI ulceration
T:Mercaptopurine (6-MP)
Toxicity potentiated by allopurinol
Oral and GI ulceration, bone marrow depression
Pulmonary fibrosis
Bone marrow suppression
Cardiac toxicity, bone marrow depression, red urine (not hematuria)
Bone marrow depression
Areflexia, peripheral neuritis, muscle weakness, paralytic ileus, alopecia
Loss of reflexes, bone marrow depression, alopecia
T:Paclitaxel (taxol)
Bone marrow depression, peripheral neuropathy
Bone marrow depression
Increased risk of endometrial cancer, menopausal symptoms
What is the S-phase-specific drug that inhibits DNA polymerase after metabolic
Cytarabine (cytosine arabinoside)
Do not induce emesis w poisoning caused by ?
Petroleum distillates, alkali/acids, convulsants
What birth defects are caused by Phenytoin tx of pregnant female?
Baby born w cleft lip & palate and seizures
Tx organophosphate poisoning
Atropine (first drug given) + pralidoxime (2-PAM)
Carbamate insecticides. e.g., aldicarb - tx w atropine alone
Mercury (Hg) toxicity S/S
tx w dimercaprol (BAL) or penicillamine = chelating
agents gingivitis. loose teeth, neuropathy (tremor in fingers, arms & legs), Hg deposits in lens,personality changes, fearful, irritable, can’t concentrate
Lead (Pb) toxicity S/S
Tx with EDTA (a chelating agent)lead interfers with heme synthesis, so precursors of heme accumulate
Arsenic (Ar) toxicity S/S
Tx w dimercaprol (BAL)
garlic odor or sweet breath; anemia; cutaneous dilation (“milk and roses” complexion), hyperkeratosis of palms and soles, transverse white lines in fingernails (Mee’s lines)
Fe overdose - seen in children whose mother is taking Fe during pregnancy
Severe gastric distress w bleeding, including bloody diarrhea, Tx w gastric lavage, deferoxamine into stomach, deferoxamine i.v.
Antidotes to heavy metal poisoning? Fe? Hg and Ar? Pb? Hg and Cu?
1. Fe = deferoxamine 2.Hg and Ar = dimercaprol (BAL)3.Pb = EDTA 4.Hg and Cu = penicillamine
Toxicity of plant materials: S/S excessive ACh stimulation
Tx w/ atropine
Toxicity of Plant materials: S/S atropine poisoning (hot, red, dry skin, fever, dry)
Tx w/ physostigmine
Bone marrow depression=aplastic anemia or leukemia
Cyanide Toxicity- smoke from burning plastic, fumigants, metal polishes, electroplating solutions; S/S lactic acidosis, inc respiratory rate/depth, venous blood bright red, cytotoxic hypoxia, convulsions, respiratory arrest
Tx: Nitrate plus thiosulfate rapidly
Acetominophen OD
Assoc w/ inc AST/ALT, Tx w/ N-acetylcysteine (which is a precursor for glutathione)
Keratoconjunctivitis caused by HSV is treated w ?
Trifluridine (trifluororthymidine)
DOC for tx of neuroletptic malignant syndrom and anesthesia induced malignant hyperthermia (hyperpyrexia)
Dantrolene- blocks internal Ca channels of SR which prevents the release of trigger Ca (causes generalized weakness because it relaxes all skeletal muscle, not just the spastic muscle)
DOC for Tapeworms (Cestodes)
Niclosamide on exams, Praziquantal in real world
DOC for Threadworm (Strongyloides stercoralis)
Ivermectin-Releases GABA and inc GABA binding faciliates the opening of chloride channels in NM junction which causes flaccid paralysis in helminths, insects and ectoparasites. May also cause tonic paralysis of musculatrue of nematodes via glutamate gated Cl channels found only in invertebrates
DOC for Filariae: Onchocerca volvulus
Ivermectin-Releases GABA and inc GABA binding faciliates the opening of chloride channels in NM junction which causes flaccid paralysis in helminths, insects and ectoparasites. May also cause tonic paralysis of musculatrue of nematodes via glutamate gated Cl channels found only in invertebrates
DOC if identity of tapeworm is uncertain
Praziquantal- opens Ca channels to cuase muscular tetany; spastic paralysi; causes tegmental damage which activates the host immune system
DOC Trematodes (Schistosoma)flukes
Praziquantal-opens Ca channels to cuase muscular tetany; spastic paralysi; causes tegmental damage which activates the host immune system
DOC for Giardia, Trichomonas and C. dificile infections
Metronidazole- reduced to active nitroderivative that inhibits DNA replication
DOC for tx of PJP (old PCP) in patients with AIDS
Trimethoprim-sulfamethoxazole: bacteriostatic, blocks sequential enzymes. See pg. 5 part 3
DOC for tx of chloroquine resistant malaria bc has a different MOA
Sulfadoxine-pyrimethamine: inhibits dihydropteroate synthase (as opp to chloroquine: blocks DNA/RNA synthesis)
DOC for prophylaxis for areas with chloroquine-resistant malaria
DOC for Coccidiodes immitis and Aspergillus infections
Amphotericin B- binds to ergosterol in fungal membranes to form pores which increases the permeability of the fungal membrane, cells lose ions and macromolecules; enhances penetration of other antifungal drugs such as flucytosine
DOC for Ringworm
Griseofulvin for test, "conazole" for real world
DOC for generalized tonic clonic seizures
Phenytoin- prolong the state of inactivations of Na channels
DOC for status epilepticus
Diazepam- enhance GABAa receptor mediated increase in Cl conductance to hyperpolarize neurons, enhances rate of channel opening (frequency)
DOC for trigeminal neuralgia
Carbamazepine- prolongs the state of inactivation of the Na channel, no impulse propagation
DOC for absence seizures (blank stare, eyelids flutter, 3/sec spike wave rhythms from thalamus)
Ethosuximide- blocks T-type Ca channels in thalamus
DOC for Tourette's syndrome (vocal and motor tics, coprolalia)
Haloperidol- blocks D2 receptors
DOC for Tx of Meniere's disease (hearing loss, vertigo, tinnitus from nonsuppurative disease of the labyrinth)
Meclizine- blocks central muscarinic ACh receptors
MOA of Praziquantal
Opens Ca channels to cause muscular tetany; spastic paralysis; causes tegmental damage which activatesthe host immune system
MOA of Albendazole and Mebendazole
Inhibits synthesis of microtubules needed for glucose uptake leads to decreased glycogen and ATP which leads to death
MOA of Thiabendazole
Thiabendazole inhibits mitochondrial fumurate reductase
MOA of Ivermectin
Releases GABA and inc GABA binding faciliates the opening of chloride channels in NM junction which causes flaccid paralysis in helminths, insects and ectoparasites. May also cause tonic paralysis of musculatrue of nematodes via glutamate gated Cl channels found only in invertebrates
Drugs used for all roundworms (roundworm, pinworm, hookworm, whipworm, trichinosis)
Albendazole and Mebendazole (except pinworm is Meb only)
If a patient gets acute hemolysis when treated with primaquine for malaria what disease process is involved?
Glucose-6-phosphate deficiency
What causes resistance of HSV to acyclovir?
A mutation which causes a deficiency of thymidine kinase
What causes resistance of Amphotericin B?
Decreased membrane ergosterol or altered structure of ergosterol
How to treat Athlete's foot? (2 drugs)
Griseofulvin- disrupts mitotic spindle by interacting w/ polymerized microtubules; fungal mitosis is inhibited. Miconazole- inhibits fungal CYP450 to block the synthesis of ergosterol
Penicillins resistant to Beta-lactamase (producing Staph): Acid labile and Acid stabile
Methcillin, nafcillin are acid labile. Oxacillin, cloxacillin, dicloxacillin are acid stable.
Why do phenytoin and phenobarbital cause osteomalacia?
Induction of CYP450 increases the metabolism of Vit D and Vit K; dec Vit D lowers the GI absorption of Ca. In order to maintain plasma Ca bone is resorbed.
What is the best antipsychotic drug for treating negative symptoms?
Clozapine- measure CBC weekly (agranulocytosis)
What prevents emetic effects of D2 receptor stimulation at CTZ?
In a female pt w/ Bipolar why do you dec Lithium during the first trimester?
To prevent teratogenesis- cardiac anomalies
S/S of Methanol toxicity and Tx?
Visual disturbances, HA, dyspnea, cold digits, GI pain, breath smells of formaldehye. Tx w/ ethanol to saturate enzymes which degrade EtOH and MeOH
What is the MOA of Ethylene Glycol toxicity (antifreeze)?
Converts to aldehydes, acids and oxalate. Oxalate causes acute renal failure.
What is used to normalize breathing in neonatal apnea?
Theophylline, aminophylline and caffeine.