First Aid Pharmacology -- Drug Reactions & General Principles

Front 1

What is Km?

What is Vmax?

Back 1

Km - affinity of the enzyme for its substrate...as Km decreases...affinity increases

Vmax - enzyme concentration; maximum velocity that an enzyme can breakdown substrate...adding more substrate past this point will NOT speed up a reaction...since the enzymes are saturated

Front 2

Competative Inhibition causes a change in Km or Vmax?

Noncompetative Inhibition causes a change in Km or Vmax?

Back 2

KoMpetative Inhibition = Km Increases (no change in Vmax)

NOn-Kompetative inhibition = NO Km increase (but increase in Vmax

Front 3

What does the mnemonic ENVY mean?

Back 3

E - efficacy DECREASES
N - non-competative
V - Vmax DECREASES
Y - y-intercept (1/Vmax)

Front 4

Volume of distribution (Vd) of plasma protein-bound drugs can be altered by ______ and ______ disease.

Back 4

Kidney (proteinuria = decrease protein in body)
Liver (decrease protein synthesis)

Front 5

Low Vd (4-8L) distrubutes in the ______

High Vd (>body weight) distrubutes into _______

Back 5

blood

all tissues

Front 6

How many half lives does it take to reach steady state?

Back 6

Usually 5! (FA said 4-5....Goljan says 5)

Front 7

What is the clearance (CL) rate equation?

Back 7

(rate of drug elimination)/(plasma drug concentration)

Front 8

In renal and/or liver disease...how are maintenance and loading doses adjusted?

Back 8

Maintenance dose = decreased***

Loading dose = unchanged

Front 9

A drug with a high Vd will require a high or low loading dose?

A drug with a high clearance rate will require a high or low maintenance dose?

Back 9

HIGH

HIGH

Front 10

1st order drug elimination = constant ________ of drug eliminated per unit time

Zero order drug elimination = constant ________ of drug eliminated per unit time

Back 10

fraction

amount

Front 11

Weak acids are get trapped in acidic or basic environments? Tx overdose of a weak acid with ________

Weak bases are get trapped in acidic or basic environments? Tx overdose of a weak base with ______

Back 11

trapped in basic environments - tx overdose with bicarbonate (ionized = trapped in urine and cleared quickly)

Trapped in acidic environments - tx overdose with ammonium chloride (ionized = trapped in urine and cleared quickly)

Front 12

Reduction, Oxidation, Hydrolysis .... phase I or II metabolism?

Acetylation, Glucuronidation, Sulfation .... phase I or II metabolism?

Back 12

Phase I

Phase II

Front 13

Geriatric patients lose phase I or phase II metabolism first?

Back 13

Phase I first (reduction, oxidation, hydrolysis)

Front 14

Most important component of Phase I metabolism is _________

Most important component of Phase II metabolism is _________

Back 14

cytochrome P450

conjugation

Front 15

What is the difference between efficacy and potency?

Back 15

Efficacy - maximal effect a drug can produce

Potency - amount of drug needed for a given effect

Front 16

A competitive antagonist decreases efficacy or potency?

Back 16

potency

Front 17

A noncompetitive antagonist decreases efficacy or potency?

Back 17

efficacy

Front 18

Give an example of a physiologic antagonism

Back 18

Pt who has asthma d/t muscarinic overactivity (contracts smooth m), EPI can act as a bronchodilator by stimulating B2 receptors

Front 19

Sweat glands are part of the SNS & are innervated by _______ fibers

Back 19

cholinergic (ACh binding to Mreceptors)

Front 20

What do these agents have in common?

Hemicholinium
Vesamicol
Botulinum

Back 20

All act to decrease cholinergic activity:

Hemicholinium - blocks reuptake of choline at the presynaptic nerve
Vesamicol - blocks uptake of ACh into presynaptic vesicles
Botulinum - blocks release of ACh from presynaptic nerve

Front 21

What drug is used for postoperative and neurogenic ileus and urinary retention?

Back 21

Bethanechol ("activates Bower and Bladder smooth muscle"!)

Front 22

What is pilocarpine used for?

Back 22

potent stimulator of sweat, tears and saliva

Front 23

What is methacholine used for?

Back 23

Methacholine Challenge Test for dx of asthma!

-stimulates muscarinic receptors in airway when inhaled

Front 24

What do the -stigmine drugs (ie. neostigmine) do?

Back 24

Indirect cholinomimetic agonists....work by blocking acetylcholinesterases

Front 25

Which drug is used for diagnosis of asthma?

Back 25

Methacholine

Front 26

Which drug is used for diagnosis of myasthenia gravis?

Which drug is used for treatment of myasthenia gravis?

Back 26

Edrophonium (extremely short acting)

Pyridostigmine (long acting)

-both drugs block acetylcholinesterase!

Front 27

With all cholinomimetic agents, what do you have to watch for?

Back 27

exacerbation of:
COPD
asthma
peptic ulcers

(when giving to susceptible pt's)

Front 28

Which two anticholinesterases are used for glaucoma?

Back 28

Physostigmine (crosses BBB)
Echothiophate

Front 29

What's the antidote for an anticholinesterase drug?

Back 29

Atropine (M blocker) + pralidoxime (regenerates active AChE) -- remember 2PAM!?

Front 30

Atropine, homatropine, tropicamide are a muscarinic blocker that works in what organ system?

Also..what is it's clinical use?

Back 30

Organ system: eye

Clinical use: produce mydriasis (block PNS..so more SNS effect) and cycloplegia (loss of accomidation)

Front 31

Benztropine is muscarinic blocker that works in what organ system?

Also..what is it's clinical use?

Back 31

CNS

Parkinson's dz ("PARK my BENZ")

Front 32

Scopolamine is muscarinic blocker that works in what organ system?

Also..what is it's clinical use?

Back 32

CNS

motion sickness

Front 33

Ipratroprium (bromide) is muscarinic blocker that works in what organ system?

Also..what is it's clinical use?

Back 33

Respiratory

Asthma, COPD ("I pray I can breath soon!")

Front 34

Oxybutynin & glycopyrrolate are muscarinic blockers that works in what organ system?

Also..what is it's clinical use?

Back 34

Genitourinary system

reduce urgency in mild cystitis & reduce bladder spasms

Front 35

Methscopolamine & propantheline are muscarinic blockers that works in what organ system?

Also..what is it's clinical use?

Back 35

Genitourinary system

Peptic ulcer treatment

Front 36

Drug reactions:

Atropine-like side effects (antimuscarinic)

Back 36

Tricyclic Antidepressants (TCA)
- major SE is antimuscarinic...largely with amitriptyline

Front 37

Drug reactions:

dilated cardiomyopathy

Back 37

the -RUBICIN's

Doxorubicin
Daunorubicin

Front 38

Drug reactions:

Coronary vasospasm

Back 38

cocaine
sumatriptan (migrane drug which vasoconstricts - 5HT2 agonist)

Front 39

Drug reactions:

Cutaneous flushing

Back 39

VANC

Vancomycin
Adenosine
Niacin
Ca channel blockers

Front 40

Drug reactions:

Torsades de pointes

Back 40

Class III (sotalol) antiarrhtym.
Class IA (quinidine) antiarrhtym.

Front 41

Drug reactions:

Gray baby syndrome

Back 41

Chloramphenicol

Front 42

Drug reactions:

Pseudomembranous colitis

Back 42

Clindamycin
ampicillin

Front 43

Drug reactions:

Hepatitis

Back 43

Isoniazid (INH)

Front 44

Drug reactions:

Adrenocortical insufficiency

Back 44

Glucocorticoid withdrawl (HPA suppression)

Front 45

Drug reactions:

Hot falshes

Back 45

tamoxifen
clomiphene

Front 46

Drug reactions:

Hypothyroidism

Back 46

Lithium
Amiadarone

Front 47

Drug reactions:

Gingival hyperplasia***

Back 47

Phenytoin

Front 48

Drug reactions:

Gout

Back 48

Furosemide
Thiazides

Front 49

Drug reactions:

Osteoporosis

Back 49

corticosteroids
Heparin

Front 50

Drug reactions:

tendonitis, tendon rupture, cartilage damage (kids)

Back 50

Fluoroquinolones

Front 51

Drug reactions:

Fanconi syndrome

Back 51

Expired tetracyclines

Front 52

Drug reactions:

Hemorrhagic cystitis

ALSO...what is coadministered to prevent this?

Back 52

Cyclophosphamide
Ifosfamide

(coadministered with MESNA!)

Front 53

Drug reactions:

Cinchonisms

Back 53

Quinidine
Quinine

Front 54

Drug reactions:

Diabetes Insipidus

Back 54

Lithium
Demeclocycline

Front 55

Drug reactions:

Parkinson-like syndromes (those that block dopamine)

Back 55

Haloperidol
Chlorpromazine
Reserpine
metoclopramide

Front 56

Drug reactions:

Seizures

Back 56

buproprion
Imipenem/cilastatin
Isoniazid (INH)

Front 57

Drug reactions:

Tardive dyskinesia

Back 57

Antipsychotics!!!

Front 58

Drug reactions:

Disulfiram-like reactions

Back 58

METRONIDAZOLE
Certain cephalosporins
Procarbazine
1st-generation sulfonylureas

Front 59

Drug reactions:

Nephrotoxicity/neurotoxicity

Back 59

Polymyxins

Front 60

Drug reactions:

Nephrotoxicity/ototoxicity

Back 60

Aminoglycosides
Vancomycin
Loop diuretics
Cisplatin

Front 61

What drug is used to tx chronic alcoholism? Why? What is it's MOA?

Back 61

Disulfiram
- used to tx chronic alcoholism, since it causes nasty SE like nausea, vomiting, headache & hypotension with even a little bit of alcohol.
-MOA: blocks acetaldehyde dehydrogenase, which prevents the normal breakdown of acetylaldehyde into acetic acid..and thus acetylaldehyde builds up & causes SE

Front 62

Drug name ending..name category:

-afil (sildenafil)

Back 62

erectile dysfunction

Front 63

Drug name ending..name category:

-ane (halothane)

Back 63

inhalational general anesthetic

Front 64

Drug name ending..name category:

-azepam (diazepam)

Back 64

benzodiazepine

Front 65

Drug name ending..name category:

-azine (chlorpromazine)

Back 65

phenothiazine (neuroleptic, antiemetic)

Front 66

Drug name ending..name category:

-azole (ketoconazole)

Back 66

antifungal

Front 67

Drug name ending..name category:

-barbital (phenobarbital)

Back 67

barbituates

Front 68

Drug name ending..name category:

-caine (lidocaine)

Back 68

local anesthetic

Front 69

Drug name ending..name category:

-cillin (methicillin)

Back 69

penicillin

Front 70

Drug name ending..name category:

-cycline (tetracycline)

Back 70

antibiotic (protein synthesis inhibitor)

Front 71

Drug name ending..name category:

-etine (Fluoxetine)

Back 71

SSRI

Front 72

Drug name ending..name category:

-ipramine (imipramine)

Back 72

TCA

Front 73

Drug name ending..name category:

-navir (saquinavir)

Back 73

Protease inhibitor

Front 74

Drug name ending..name category:

-olol (propranolol)

Back 74

beta-blocker

Front 75

Drug name ending..name category:

-operidol (haloperidol)

Back 75

butyrophenone (neuroleptic)

Front 76

Drug name ending..name category:

-oxin (digoxin)

Back 76

cardiac glycoside (inotropic agent)

Front 77

Drug name ending..name category:

-phylline (theophylline)

Back 77

methylxanthine

Front 78

Drug name ending..name category:

-pril (captopril)

Back 78

ACEI

Front 79

Drug name ending..name category:

-terol (albuterol)

Back 79

Beta2 agonists

Front 80

Drug name ending..name category:

-tidine (cimetidine)

Back 80

H2 blockers

Front 81

Drug name ending..name category:

-triptan (Sumatriptan)

Back 81

5HT(1B/1D agonists) migrane

Front 82

Drug name ending..name category:

-triptyline (amitriptyline)

Back 82

TCA

Front 83

Drug name ending..name category:

-tropin (somatoptropin)

Back 83

pituitary hormone

Front 84

Drug name ending..name category:

-zolam (alprazolam)

Back 84

benzodiazepine

Front 85

Drug name ending..name category:

-osin (prazosin)

Back 85

alpha1 blockers