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168 Cards in this Set

  • Front
  • Back
what is serotin involved in normally
sleep and depression
Symptoms of Carcinoid Syndrome
-GI cramping and diarrhea
-"odd" flushing of the skin
-increased urinary excretion of 5-HIAA
TX for carcinoid
Tx with Cyproheptadine (blocks 5-HT1 and 5-HT2 receptors) or the somatostatin analog octreotide which inhibits the release of 5-HT from the tumor
Serotonin Drugs
1.blocks D2 receptors in CTZ--prevents nausea, but causes EPS and hyperprolactinemia
2.blocks 5HT3 receptors in CTZ and at vagal affs--prevents nausea/emesis
3.Stimulates 5HT4 on pre-j cholinergic neurons to amplify the release of ACh-> ACh stimulates musc. in GI tract
4.used to tx GERD and empty stomach prior to SX
antiemetic drug which blocks 5HT3 receptors in the CTZ and at vagal affs
-agonist of 5HT4 receptors on pre-j choli neurons
-amplifies the release of ACh to inc. tone in the LES
-used to tx GERD and empty stomach prior to SX
-agonist at 5HT1b and 5HT1a receptors to inhibit release of inflammtory peptides
-used to tx migraine and cluster h/a
Antihistamines (woohoo)!!!
-can work at H1 or H2 receptors
histamine H1 receptors
H1 receptors:
-dilate arterioles
-contracts vascular endo cells to inc cap perm
-contract GI sm->diarrhea
-contracts bronchial sm-> asthma
-stimulates aff pain receptors-> pain/itch
hist H2 receptors
-dilates arterioles
-inc gastric H+ secretion
cromolyn sodium
inhibits mast cell degranulation by preventing inc in intracellular ca2+
inhibits mast cell degranulation and blocks h1
-used in tx of conjunctivits and seasonal allergy
Sedating Antihistamines
Non-sedating antihistamines
drugs for prophylaxis of motion sickness (need to block central Musc ACh receptors)
DOC for tx of meniere's DZ (hearing loss, vertigo, tinnitus from non-suppurative dz of the labyrinth)
H2 receptor blockers
what do you give a pt exposed to poison oak?
-give diphenhydramine (h1 blocker) and cimetidine (h2 blocker) to prevent itching and pain
your pt is taking cimetidine for GERD, but he must go to the allergist for some skin rxn shit...what do you put him on?
TX GERD with omeprazole during allergy testing
random clinical pearl that i cannot put in decent question form...
pt has insomnia from depression
-tx with TCA, but patient still has insomnia-> give an antihistamine to induce sleep
-oops, now ur pt has urinary retention from the combined atropine-like fx of the drug combo
GI drugs
-induces vomiting by and action at the CTZ and by an irritant in the stomach which is NOT BLOCKED by antihistamines
what drug induces emesis by stimulating D2 receptors in the CTZ?
-apomorphine induces emesis by D2 receptors in the CTZ
lactulose (synthetic dissacharide)
-slow-acting laxative which is conveted to small organix acids in the bowel
-these acids exert an osmotic effect to slowly draw water into the feces
A pt with S/S (confusion/coma) of hepatic portal encepholapathy needs tx...?
-use lactulose
-acidifies bowel to trap ammonia and ammonium ions
-ammonium lost in feces-> plasma ammonia falls-> coma and confusion dissappear
docusate sodium
-stool softener
-an anionic surfactant: detergent allows water to enter feces
-soften the stoll w/o increasing its bulk
how to treat diarrhea (and dizzlerhea)
-tx w/loperamide or diphenoxylate which stimulate mu opiate receptors
pt with ULCERS
-tx with H2 blockers (cimetidine)
-antacids (Al or Mg hydroxides)
-PGE receptor agonists (misoprostol)
-ppi (omeprazole)
-sulcralfate (mixture of AlOH and sucrose which forms a viscous gel at acidic pH->gel coats ulcerated tissue
more pt with ULCERS
-modern tx is to eradicate H.pylori w/triple Ab tx
what antiulcer drug does not alter stomach pH?
pt on propranolo takes cimetidine for heartburn and develops bradycardia...why?
-cimetidine inhibits cyp450 and thus blocks the metabolism of propranol
antacids and GI tract...

pt. being tx with doxycycline...which drug is contraindicated?
Al/Mg antacids
pt needs emergency surgery; need to empty stomach with the quickness and prevent reflux...what drug?
-use metoclopramide
-prokinetic in stomach (moves stuff out) and tightens the LES (doesn't let stuff go back)
chemo pt with n/v and noctural acid reflux...what drug?
pt has post-op paralytic ileus...what drug?
pt is being tx for Crohn's or for UC...develops hepatic damage/bone marrow suppression. what drug is this homebay taking?
-homeboy is a slow acetylator
-sulfasalazine is sulfapyridine conjugated to 5-aminosalicylic acid
-5-asa is an NSAID
-sulfapyridine->metabolized by acetylation->suppresses bone marrow
signs and symptoms of laxative abuse w/castor oil or bisacodyl...?
-muscle weakness
-abnl architecure of inner GI wall
NSAID time is really fine and DON'T YOU FORGET IT!!!
Aspirin (this will go on forever, i promise)
1.inhibits platelet agg by irreversible inhibiting COX1 in plets via acetylation to prevent the synthesis og TXA2
-inc bleeding time
2. aspirin blocks plet agg caused by arachidonic acid but not the agg caused by PGG2 and PGH2 (cyclic endoperoxidases)
3. inhibition of plet agg relieves CP in unstable angina: plet count is NORMAL, but INCREASED bleeding time
aspirin (what happend during 1st pass metabolism?)
4. converted to salicylate during 1st pass metabolism
Aspirin (kinetics)
5.Lg doses exhibit non-linear kinetics--how to recognize? use disappearance of plasma salicylate
aspirin (more kinetics)
-plasma salicylate during po dosing?
-when the dose is doubled, the plasma conc should double
-if the doubling causes salicylate conc to inc more than two-fold, the hepatic enzymes will become saturated and elimination will change from 1st order to zero-order
-the dec Clearance will cause the t1/2 to increase
Aspirin OD (OH NO!!)
-n/v, tinnitus
-resp alkalosis:aspirin uncouples oxidative phosphorylation in Sk M
-inc pCO2 from increased respirations
-metabolic acidosis->as CO2 production increases
-children skip the alkalosis step and go straight toacidosis with low blood pH and low bicarb
TX of aspirin OD
-make urine alkaline
-acetazolamide or NaHCO3 to enhance the renal clearance of salicylate
-infuse bicarb to correct acidosis
-an inhibitor of PDEase in plets
-potentiates the antiplatelet effect of aspirin and PGI2
t1/2 of aspirin is only 1hr, why does it inhibit platelet agg for a longer period?
-aspirin irreversibly acetylates active site of COX1 in plets
how does aspirin prevent plet agg when it is not taken in doses large enough to maintain a steady-state plasma conc?
-irreversibly acetylates active site of COX1
pt has intermittent episodes of hemiplegia which resolve spontaneously; would like to tx with aspirin, but pt has aspiring hypersensnitvity..what drug do you use?
what is the causative compound in aspirin hypersensitivity?
DOC for menstrual cramps
baby has patent ductus arteriosus...?
close with indomethacin
what if you wanted to keep the PDA open prior to surgery (such is in TOF) what drug will do this?
-alprostadil (PGE1 analog)
-dilated the ductus arteriosus
pt with NSAID tx develops GI ulceration...what is the MOA
-MOA is inhibition of gastric PG synthesis
pt with nasal polyps who has wheezing with aspirin needs an antipyretic?
-acetominophen is antipyretic, but not antiinflammatory
Drug OD pt, initially blood chemistry is normal...36hr in AST and ALT. what is the drug?
-tx with n-acetylcysteine to replenmish glutathione
-binds to tubulin to block formation of microtubules and thus inhibit phagocytosis of urate crystals by WBCs
-used to tx the pain of acute attacks
-inhibits xanthine oxidase to block synthesis of uric acid purines
pt with renal transplant is taking the immunosupressnt azathioprine. pt dev gout. which gout drug is contraindicated?
-allopurinol is c/i b/c azathioprine is converted to the cytotoxic agent 6-mercaptopurine (6mp)
-6-mp kills antigen presenting cells and T/B lymphs
lymphoma pt is tx with chemo. which drug will prevent decrease in renal function?
-chemo kills lymphoma cells which release nucleic acids that are converted to urate
-excessive urate in urine crystallizes to occlude the collecting ducts, pelvis and ureters
-rapid progressive renal dysfxn develops
Probenecid+large dose aspirin
-probenecid and aspirin enhance the renal clearanc eof urate
-urate stones may form, so keep the urine alkaline with sodium citrate
which drugs are not uricosuric?
-allopurinol and colchicine
DOC for hyperuricemia?
pt with gout tx w/probenicid get remineralization of bone. why?
-inc urinary excretion rate of urate
pt taking a small daily dose of aspirin may develop gout, whereas lg dose is used to tx gout...what's the deal?
-small doses of aspirin enhance urate absorption in the renal tubule whereas lg doses are uricosuric
pt tx for gouty arthritis develops luekopenia. which drug is he on?
-colchicine can cause leukopenia
Adverse effects of NSAIDS
-gastric ulceration:results from dec PG synthesis in stomach; prevent or tx w/misoprostol (PGE1)
-interstitial nephritis: hematuria, proteinuria, flank pain, dec RBF and dec GFR->oliguria
pt on NSAID for tendonitis for 2 weeks develops fever and hematuria. Dx?
-acute interstitial nephritis
pt with CHF takes ibuprofen; effect of kidney?
-constriction of aff arteriole lowers RBF and GFR to cause Na+/H20 retention
-no PG's to partially inhibit the effects of ADH in the collecting duct=water retention
histologic photoof kidney tissue with lots of lymphs. Dx?
-interstitial nephritis caused by apirin or another NSAID
pt tx w/NSAID for arthritis has decHb and HCT and has occult blood in his stool. Which drug will reverse this pathology?
Thyroid crap
Preg woman develops hyperthy...tx?
What are the usual causes of hyperprolactinemia and their tx?
-blockade of D2 receptors and inc TRH in hypothy can cause hyperprolactinemia
-in hypothy, tx w/thyroxine to suppress plasma prolactin conc
pt w/recurrent v-tach/fib develops recurrent hyper/hypothy while taking amiodarone. WHY?
-amiodarone is 37% iodide by weight
-this iodide can either prevent the conversion of T4 to T3 (hypothy), or it can serve as a substrate for the synthesis of T3 by thyroid peroxidase
-i hate myself
Central DI
-tx with desmopressin
-has long t1/2 but it is resistant to degradation bu peptidases
-very selective for renal V2-receptors
Nephrogenic DI
-tx w/HCTZ
-if that doesn't work try indomethacin
Lithium induced DI
-tx w/amiloride
-prevents entry of LI+ into principal cells of LDT/CD)
-can also try HCTZ
-tx w/demeclocycline
-inhibits action of ADH in LDT/CD
Respiratory Drugs
Resp Drugs
just another back in case that f-ing chart thing is to f-ing big!
pt tx w/propranol; which drug will still bronchodilate?
-theophylline or aminophylline act via inctracellular inhibition of PDEase
asthmatic pt tx w/theophylline develops a sinus infxn which requires tx w/ an AB. which AB would require adjustment of his theoph doses?
-inhibits cyp450 which is the enxyme that metabolizes theophylline
asthmatic pt taking theopylline has a seizure after taking otc drug for Heartburn...what is this stupid-ass drug?
-blocks cyp450 which metablozies theoph
which drug causes the greatest increase in FEV1 with the smallest increase in HR?
pt w/excercise-induced asthma uses cromolyn prophylactically. MOA?
-cromolyn prevents Ca2+ influx into mast cells when IgE bridges form
-=no mast cell degranulation
-cytotoxic immunosuppresants
-my white ass
1.inhibit the production of IL-1 and IL-6 by macros and monos
2.inhibit Antibody synthesis by B-cells
3.Prevent fxns of cytotoxic t-cells
4. NO bone marrow depression
which drug suprresses cellular immunity, blocks the synthesis of PGs and LTs and inc neutrophil count in the blood?
-glucocorticoids dec the # of B/T lymphs,monos,eos,basos by stimulating their mvmt from the blood into lymphoid tissue
-however, glucocoritcoids acutely inc the release of PMNs from bone marrow and prevent their migration out of the blood and into tissue
-inhibits calcineurin to prevent the production of IL-2 by Helper T-cells
-inhibits inosine monophosphate dehydrogenase which prevents the synth of purines in T/B lymphs
-unlike other cells from the bone marroaw T/B lymphs lack the enzyme HGPRTase for purine synthesis
Cytotoxic Immunosuppressants
-Azathioprine:converted to 6-maercaptopurine, which interferes with the nucleic acid synthesis that is needed for prolif of B/T cells
-Cyclophosphamide:alkylates DNA; S/E=hemorrhagic cystitis
-Vit D
Ca2+ Metabolism
-Vit D acts via gene trxn and ion channels in the Gi brush border
-Osteocalcin reflects the activity of osteoblasts (i have no clue what that means!!^%@#$!%@#!^#)
what does pt with VitD toxicity exhibit?
-hypercalcemia w/hypercalcinuria; hyperphosphatemia
-dehydration b/c renal conc ability is impaired
Tx for VitD toxicity
-aggreissive hydration w/isotonic saline
-furosemide to enhance urinary Ca2+ excretion
-plicamycin (mithrmycin=a cytotoxic antibiotic drug that inhibits bone resorption
Pt w/renal failure has low plasma do you tx them?
-tx w/1,25 diOH-VitD
pt w/pagets dz exhibits hearing loss, bone pain, bone deformity, inc serum alkaline phosphatase, inc urinary hydroxyproline, high output HF and immobilization hypercalcemia...tx w?
-tx w/calcitonin to dec bone pain,deformity,hearing loss, and hypercal
-calcitonin will dec serum Ca2+ and PO4- by inhibition of osteoclastic bone resorption and dec resorption of Ca2+ and PO4- by the kidney
Alendronate and Etidronate (bisphosphonates)
-bisphosphs inhibit the resorption of bone by inhibiting the ability of osteoclasts to dissolve hydroxy appatite crystals
-bis's inc bone mass and dec fracture's
-used to prevent glucocorticoid-induced osteoporosis and used with calcitonin to tx paget's dz
-used as an alternative to HRT to prevent post-meno bone loss
post-meno women requires tx to maintain bone mass, but cannot take estrogen b/c her mother and sister had breast cancer...tx with?
-alendronate or etidronate
pt tx w/steroids develops hypocalcemia. why?
-steroids antagoniza the effects of vitD on the GI absoprtion of Ca2+
->less ca2+ absorption-> inc PTH conc-> inc bone resorption-> inc renal excretion of Ca2+->hypocalcemia and osteoporosis
Therapies of Anemia
1. hypochromic, microcytic anemia= Fe deficiency anemia
2.normochromic,macrocytic (megaloblastic anemia)
Hypochromic, Microcytic Anemia= Fe deficiency anemia
1.caused by inc FE req, dec GI absorption or blood loss
Hypochromic, Microcytic Anemia= Fe deficiency anemia
2.signs and symptoms
-pallor, fatigue, light-headed
-pica=craving for clay, laundry starch, ice
Hypochromic, Microcytic Anemia= Fe deficiency anemia
-decreased serum ferritin conc
-inc TIBC
Hypochromic, Microcytic Anemia= Fe deficiency anemia
-ferrous iron
-vitC enhances the GI absorption of ferrous iron
Normochromic, Macrocytic (Megaloblastic) anemia
-deficiency of folate (lack of dietary intake)
-def of vitB12 (no GI absorption)
Normochromic, Macrocytic (Megaloblastic) anemia
2. Blood Cells
-all blood cells affected
-large RBCs
-segmented neutrophils
-abnml platelets
Normochromic, Macrocytic (Megaloblastic) anemia
3.S/S of folate deficiency
S/S (dec folate)
-sore tongue
Normochromic, Macrocytic (Megaloblastic) anemia
4.S/S of vitB12 deficiency
S/S (dec B12)
-same as folate +neuro symptoms
-parasthesias of distal extremities
-sensory disturbances my progress
caused by demyelination of nerve fibers in the dorsolateral spinal column
-B12 is necessary for the conversion of methylmalony coA to succinyl CoA which is needed for the syntheseis of myelin
Normochromic, Macrocytic (Megaloblastic) anemia
5.peripheral blood smears
-peripheral blood smears CANNOT be used to differentiate b/t the two
Normochromic, Macrocytic (Megaloblastic) anemia
6. folate intake
-folate intake is gauged by measuring RBD folate
-this reflects dietary intake over the past 2-3mos
Normochromic, Macrocytic (Megaloblastic) anemia
7.vitB12 GI stuff
-B12 deficiency usually occurs from lack of GI absoption
-a schilling's test is used to measure the efficiency of B12 absoprtion from the GI tract
Normochromic, Macrocytic (Megaloblastic) anemia
8.Folate Def tx
-tx folate deficiency with...po FOLATE!!!
-some pts cannot absorb folate from the GI tract and must be tx with iv folate
Normochromic, Macrocytic (Megaloblastic) anemia
9.B12 def tx
-tx B12 def w/im injection of cyanocobalamin or hydrocxycobalamin
-this tx is continued for LIFE
pt w/normochromic,macrocytic anemia has distal paresthesias. pt is tx with po folate and the anemia dissapears, but the neuro S/S worsen. WHat happened?
-folate will correct the megaloblastic anemia
-neuro symptoms must be tx with B12
pt tx with phenytoin,isoniazid, pyrimethamine, trimethoprim or methotraxate develops normochromic, macrocytic anemia. WHY?
-phenytoin and isoniazid interfere with GI absorption of folate
-pyrimethamine,trim, and methotrexate inhibit DHF reductase
pt on hemodialysis develops normo,macro anemia. Why and what to do about it?
-hd removes plasma folate
-pts on hd must be tx with EPO, folate and ferrous iron
pt w/HCT 24 is started on hd. After tx w/EPO, folate and ferrous iron, the pt develops HTN. WHY?
-the HCT is inc by inc production of RBC's-> viscosity of blood rises.
-accoring to Poiseulle's law, resistance is directly related to viscosity
-BP increases
which drug could be used for "blood doping" (inc HCT) in competitive cycling?
-EPO, epoetin alfa, darbepoetin
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pt with malar rash, arthritis, polyserositis, proteinuria and hematuria. Dx and TX?
-a prednisone or any other -sone or -lone drug
Which synthetic glucocorticoid is used to differentiate bilateral adrenal hyperplasia from adrenal carcinoma?
-DEXAMETHASONE: b/c it will depress serum cotisol by 50% in adrenal hypeerplais caused by pituitary adenoma, but have no effect on serum cortisol in adrenal carcinoma
which drug will inc the urinary excretion of 17-ketosteroids (testosterone) in a pt w/bilatyeral adrenal hyperplasia (Cushings dz) w/o affecting the urinary 17-OH-steroids (cortisol) in a pt with adrenal carcinoma?
-Metyrapone blosck the cyp45011 that converts 11-DOC to cortisol so there is no cortisol feedback to inhibit the pituitary
-ACTH rises and stimulates adrenal steroid synthesis causing even more 11-DOC to be prodeuced
-this generalized inc in adrenal steroid synth also inc the synth of testosterone which is metabloized to 17ketosteroids->so the urinary excretion of 17ks also inc
-in a pt with adrenal CA, cortisol produced by the tumor suppresses ACTH release so the nml adrenal cortex atrophies and thus cannot respond to the inc in ACTH
which drug will suppress plasma cortisol in a pt with normal pituitary/adrenal fxn?
-ketoconazole blocks the cyp450scc
which drug can cause a "medical adrenalectomy"?
-aminogluthemide blocks all adrenal and extra-adrenal steroid synthesis
-prevents the conversion of cholesterol to pregenelone
-can be used to tx cushings
pt txw/steroids develops a GI ulcer. MOA?
-inhibition of gastric PG synthesis
estro crap
estro crap
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estro crap
estro crap
MOA of RU486 (mifepristone)
-progesterone receptor antagonist
pt with S/S hyperestrogenism (breast tenderness) is on a drug to enhance fertility. Drug?
-clomiphene blocks CNS estrogen receptors causing increased pulsatile release of GnRH which enhances the secretion of FSH->ovulation
estradiol contrindicated in a pt w/a hx of thromboembolic dz. WHy?
-b/c extradiol inc the synthesis of clotting factors
pt has breast cancer. Tx?
-tamoxifen: blocks estrogen receptors
Why do OCPs which contain estrgen also contain a progestin?
-the progestin prevents the endometrial hyperplasia caused by estrogen
which compound can be used to maintain bone mass in a postmeno woman who has had breats cancer?
raloxifene (a SERM) or alendronate (a bisphosphonate)
tx with an estrogen decreases the risk of osteoporosis and colorectal cancer
poopy pants
-Fluoxymesteron and Nandrolone are androgens which are used for their anabolic effects
-they act by preventing the catabolic actions of cortisol
-they stimulate protein synthesis and erythropoiesis
a body builder treats himself with fluoxymesterone. how is his spermatogensis affected?
-spermatogensis is suppressed b/c the fluoxystimulates hypothalamic androgen recptrs 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 HTN...BUT, steroids are not present in his urine. What drug is he using (and how can i get some)?
-he is using a growth hormone
-increases the production of IGFs
older man has arthralgia, fluid retention, and hyperglycemia. What drug has this affect?
-growth hormone
what drug will suppres the secretion of GH in a pt with acromegaly?
-bromocriptin or octreotide
pt w/BPH or hair loss. Tx?
-finasteride blocks the synthesis of DHT by inhibiting 5-alpha-reductase
which drug is an androgen receptor antagonist?
how to tx a young boy w/cryptorchidism?
Leuprolide, goserelin and nafarelin
-used to tx prostate cancer, endometriosis and leiomyomas
-their continuous administration via im depot injxn desenstizes the GnRH receptors of the pituitary-> shuts off release of LH and FSH
Leuprolide, goserelin and nafarelin
-used in protocals for IVF
-used to suppress ovarian fxn followed by tx w/exogenous gonadotropins (hCG) to achieve synchronous follicular development
synthesized by pancreatic alpha-cells
-a 29 AA polypeptide
metabolic effects
metabolic effects:inc plasma glucose at the expense of liver glycogen stores
-inc hepatic cAMP to activate phosphorylase activity and the enzymes of gluconeogenesis.
-NO effect on glycogen stores in Sk M
Cardiac Effects
Cardiac effect
-increased contractility and inc HR via cAMP
Medical Uses
-tx of hypoglycemia
-tx of poisoning w/beta-blocker
-dx of DM, lg dose of glucagon inc insulin and c-peptide release from beta-islet cells:to c-pep release in TIDM
TX of DM
put chart here
pt w/DKA. Tx?
-lispro or regular insulin Iv
-iv fluids for rehydration
-K+ to prevent hypokalemia as insulin drives glucose into liver,Sk m, and fat cells
-MOA: depolarize beta-islet cells by blocking ATP-sensitive K+ channels; insulin released
-Used to tx T2DM
-S/E: hypoglycemia
Metformin and Rosiglitazone
-the glitazones dec insulin resistance primarily in Sk m and fat cells
-used to tx T2DM
pt w/T2DM develops lactic acidosis while taking a drug. what drug is it?
-b/c metformin increases glucose utilization via anaerobic pathways
which drug decreases hepatic glucaose production in T2DM w/o enhancing the pancreatic secretion of insulin?