Kpharm

Front 1

Basic Pharmacokinetics

Front 2

Way to increase the renal elimination of a weak acid

Back 2

Alkalinize the urine

Front 3

1. volumes of plasma, blood, ECF, total body water for 70 kg. person?
2. Eq. for Vd, half life, Cl, Infusion rate, loading dose, maintanence dose?

Back 3

1. 3, 5, 12-14, 40-42

2. Vd=Dose/Conc. at time 0

half life=.7/k k=Cl/Vd it is the elimination constant

Cl=k x Vd or elimination rate/plasma conc.

Infusion rate (k0)=Cl x Steady state concentration

LD= V(d) x steady state conc.

MD= Cl x steady state conc. x dosing interval

Hint 3

None

Front 4

Way to inc. the renal elimination of a weak base

Back 4

Acidify the urine

Front 5

1. Time to 50, 90, 95, 100 percent steady states?
2. What is the normal GFR?

Back 5

1. 1x half life, 3.3x half life, 4-5x half life, >7 half life
2. 120 ml/min.

Hint 5

None

Front 6

Weak acid % ionized at pH-pKa of -2,-1,0,1,2

Back 6

1, 10, 50, 90, 99

Front 7

List 4 phases of clinical testing?

Back 7

1. small group volunteers w/o disease test safety. PHARMOCOKINETICS at different levels.
2. 100 or more pt. with disease COMPARE AGAINST PLACEBO to see effectiveness
3. 1000 or more pt. with disease compare with placebo. how well work with common SE. DOUBLE BLIND. Compare against gold standard.
4. out market. post market surveilance for AE. Less common and possible more severe toxicities. not rigidly regulated by FDA.

Hint 7

None

Front 8

% weak base ionized at pH-pKa of -2, -1, 0, 1, 2

Back 8

99, 90, 50, 10, 1

Front 10

Time it takes for amount of drug to fall to half of its value, when is it constant, which kinetics? (majority of drugs)

Back 10

Half-life (T1/2)
first order kinetics constant

Hint 10

None

Front 11

Relates the amount of drug in the body to the plasma concentration

Back 11

Volume of distribution (VD) VD=dose/plasma level

Front 12

Plasma concentration of a drug at a given time

Back 12

Cp

Front 13

The ratio of the rate of elimination of a drug to its plasma concentration

Back 13

Clearance (CL)

Front 14

The elimination of drug that occurs before it reaches the systemic circulation

Back 14

First pass effect

Front 15

The fraction of administered dose of a drug that reaches systemic circulation

Back 15

Bioavailability (F)

Front 16

When the rate of drug input equals the rate of drug elimination, # half lives it takes

Back 16

Steady state: math=7, clinically 4-5

Front 17

Measurement used to determine the safety and eficacy of generic drugs

Back 17

Bioequivalence

Front 18

Metabolism

Front 19

This step of metabolism makes drug more hydrophilic and hence augments elimination

Back 19

Phase I

Front 20

Different steps of Phase I

Back 20

Oxidation, reduction, hydrolysis

Front 21

Inducers of Cytochrome P450 (CYP450)

Back 21

Barbiturates, phenytoin, carbamazepine, and rifampin, ethanol, St. Johns Wart, isoniazid

Hint 21

None

Front 22

Inhibitors of CYP450

Back 22

Cimetidine, ketoconazole, erythromycin, isoniazid and grapefruit, Adenavir, ethanol, Ritonavir

Hint 22

None

Front 23

Products of Phase II conjugation

Back 23

Glucuronate, acetic acid, and glutathione sulfate
so put on glucuronic acid, acetic acid, sulfuric acid

Hint 23

None

Front 24

Constant percentage of substrate metabolized per unit time, directly proportional to plasma conc.

Back 24

First order kinetics

Front 25

Drug elimination with a constant amount metabolized regardless of drug concentration

Back 25

Zero order kinetics

Front 26

Target plasma concentration times (volume of distribution divided by bioavailability)

Back 26

Loading dose (Cp*(Vd/F))

Front 27

Concentration in the plasma times (clearance divided by bioavailability)

Back 27

Maintenance dose (Cp*(CL/F))

Front 28

Pharmacodynamics

Front 29

Strength of interaction between drug and its receptor, compare 2 which better

Back 29

Affinity, closest to Y axis

Front 30

Selectivity of a drug for its receptor

Back 30

Specificity

Front 31

Amount of drug necessary to elicit a biologic effect, compare 2 which better

Back 31

Potency, closest Y axis

Front 32

Ability of drug to produce a biologic effect, compare two which better

Back 32

Efficacy, maximal height of curve

Front 33

A drug that will produce 100% of the maximum response regardless of the potency

Back 33

Full agonist

Hint 33

None

Front 34

Will produce less than 100% of the response

Back 34

Partial agonist

Hint 34

None

Front 35

Ability to bind reversibly to the same site as the drug and without activating the effector system

Back 35

Competitive antagonist

Front 36

Ability to bind to either the same or different site as the drug

Back 36

Noncompetitive antagonist

Front 37

Mechanism of action (MOA) utilizes intracellular receptors

Back 37

Thyroid and steroid hormones

Front 38

MOA utilizes transmembrane receptors

Back 38

Insulin

Front 39

MOA utilizes ligand gated ion channels

Back 39

Benzodiazepines and calcium channel blockers and Acetylcholine

Hint 39

None

Front 40

Median effective dose required for an effect in 50% of the population

Back 40

ED50

Front 41

Median toxic dose required for a toxic effect in 50% of the population

Back 41

TD50

Front 42

Dose which is lethal to 50% of the population

Back 42

LD50

Front 43

Window between therapeutic effect and toxic effect and equation

Back 43

Therapeutic index TD50/ED50

Hint 43

None

Front 44

Receptors linked to GS

Back 44

B1, B2, D1

Front 45

Receptors linked to Gq

Back 45

M1, M3, a1

Front 46

Receptors linked to Gi

Back 46

M2, A2

Front 47

Drug with a high margin of safety

Back 47

High therapeutic index

Front 48

Drug with a narrow margin of safety

Back 48

Low therapeutic index

Front 49

Antidotes and agents used in drug overdose

Front 50

Antidote used for lead, arsenic, mercury poisoning

Back 50

Dimercaprol, EDTA
a chelating agent

Hint 50

None

Front 51

Antidote used for cyanide poisoning

Back 51

Nitrites: convert Hgb to methgb which cyanides bind stronger to rather than cytochrome oxidase

Hint 51

None

Front 52

Antidote used for anticholinergic poisoning

Back 52

Physostigmine: cholinesterase inhibitor.

Hint 52

None

Front 53

Antidote used for organophosphate/anticholinesterase poisoning (2)

Back 53

Atropine(antimuscarinic), pralidoxime (reactivates inhibited acetylcholinesterase by breaking bond of insecticide and enzyme) (2-PAM)

Hint 53

None

Front 54

Antidote used for iron salt toxicity

Back 54

Deferoxamine, a chelating agent

Hint 54

None

Front 55

Antidote used for acetaminophen (APAP) toxicity

Back 55

N-acetylcysteine (Mucomyst), inc. glutathione, inhibits formation metabolite, directly interacts with metabolite

Hint 55

None

Front 56

Antidote for arsenic, mercury, lead, and gold poisoning

Back 56

Dimercaprol

Heavy metals act by chemically reacting with adjacent sulfhydryl residues on metabolic enzymes, creating a chelate complex that inhibits the affected enzyme's activity. Dimercaprol competes with the sulfhydryl groups for binding the metal ion, which is then excreted in the urine.

Hint 56

None

Front 57

Antidote used in poisonings: copper (Wilson's disease), lead, mercury, and arsenic

Back 57

Penicillamine, a chelating agent or dimercaprol

Hint 57

None

Front 58

Antidote used for heparin toxicity

Back 58

Protamine sulfate, a base

Hint 58

None

Front 59

Antidote used for warfarin toxicity

Back 59

Vitamin K and Fresh frozen plasma (FFP)

Hint 59

None

Front 60

Antidote for tissue plasminogen activator (t-PA), streptokinase

Back 60

Aminocaproic acid, inhibits plasminogen activation

It binds reversibly to the kringle domain of plasminogen and blocks the binding of plasminogen to fibrin and its activation to plasmin

Hint 60

None

Front 61

Antidote used for methanol and ethylene glycol (2)

Back 61

Ethanol, which has higher affinity for alcohol dehydrogenase.
Fomepizole: alcohol dehydrogenase inhibitor.

Hint 61

None

Front 62

Antidote used for opioid toxicity

Back 62

Naloxone (IV), naltrexone (PO)

Front 63

Antidote used for benzodiazepine toxicity

Back 63

Flumazenil: a GABA receptor antagonist

Hint 63

None

Front 64

Antidote used for tricyclic antidepressants (TCA)

Back 64

Sodium bicarbonate to correct acidosis

Hint 64

None

Front 65

Antidote used for carbon monoxide poisoning

Back 65

100% O2 and hyperbaric O2

Front 66

Antidote used for digitalis toxicity. What if they have become arrythmic

Back 66

Digibind: antibody fragments against digoxin (also need to d/c digoxin, normalize K+, and lidocaine if pt. Is arrhythmic)

Hint 66

None

Front 67

Antidote used for beta agonist toxicity (eg. Metaproterenol)

Back 67

Esmolol

Front 68

Antidote for methotrexate toxicity

Back 68

Leucovorin: Folinic acid is a 5-formyl derivative of tetrahydrofolic acid. It is readily converted to other reduced folic acid derivatives (e.g. tetrahydrofolate). Since it does not require the action of dihydrofolate reductase for its conversion, it will be unaffected by inhibition of this enzyme by drugs such as methotrexate.

Hint 68

None

Front 69

Antidote for beta-blockers and hypoglycemia

Back 69

Glucagon

Glucagon binds to the glucagon receptor, a G protein-coupled receptor located in the plasma membrane. The conformation change in the receptor activates G proteins, alpha subunit specifically activates the next enzyme in the cascade, adenylate cyclase.

Adenylate cyclase manufactures cAMP (cyclical AMP) which activates cAMP-dependent protein kinase. This enzyme in turn activates phosphorylase B kinase, which in turn, phosphorylates phosphorylase B. Phosphorylase B is the enzyme responsible for the release of glucose-1-phosphate from glycogen polymers

in heart can inc. cAMP without having to use Beta receptor

Hint 69

None

Front 70

Antidote useful for some drug induced Torsade de pointes

Back 70

Magnesium sulfate

Front 71

Antidote for hyperkalemia

Back 71

sodium polystyrene sulfonate (Kayexalate): it binds K+ in the gut

Hint 71

None

Front 72

Antidote for salicylate intoxication

Back 72

Alkalinize urine, dialysis

Front 73

Cancer Chemotherapy

Front 74

Constant proportion of cell population killed rather than a constant number

Back 74

Log-kill hypothesis

Front 75

Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously

Back 75

Pulse therapy

Front 76

Toxic effect of anticancer drug can be lessened by rescue agents

Back 76

Rescue therapy

Front 77

Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates

Back 77

Allopurinol

Front 78

Pyrimidine analog that causes "Thiamine-less death" given with leucovorin. Used for solid tumors.

Back 78

5-flouracil (5-FU): When goes into cells converted into 5-fDUMP which blocks thymidylate synthase

Hint 78

None

Front 79

Drug used in cancer therapy causes Cushing-like symptoms

Back 79

Prednisone

Front 80

Side effect of Mitomycin and MOA

Back 80

SEVERE myelosuppression

Changed into alkylating agent so it crosslinks DNA to fight hypoxic tumors

Hint 80

None

Front 81

MOA of cisplatin + use of

Back 81

Alkylating agent. Used for bladder, lung, ovary, testis

Hint 81

None

Front 82

Common toxicities of cisplatin

Back 82

Nephro and ototoxicity

Front 83

Analog of hypoxanthine, needs HGPRTase for activation: INHIBITS purine metabolism. Used for acute leukemia.

Back 83

6-mercaptopurine (6-MP): after HGPRTase metabolite inhibtis enzymes of purine synthesis

Hint 83

None

Front 84

Interaction with this drug requires dose reduction of 6-MP

Back 84

Allopurinol, because xanthine oxidase metabolized 6-MP

Hint 84

None

Front 85

May protect against doxorubicin toxicity by scavenging free radicals and MOA of doxorubicin

Back 85

Dexrazoxane: inhibitor of iron mediated free radical generation to protect against cardiotoxicity.

It intercalates between base pairs, inhibitis topoisomerase II, generates free radicals

Hint 85

None

Front 86

Breaks DNA via free redicals, Used for Hodgkins, squamous cell, testicular. What is the drug and what is limiting SE?

Back 86

Bleomycin
limiting SE is pulmonary fibrosis.

Hint 86

None

Front 87

This regimen if used for testicular cancer produces near 100% response

Back 87

Bleomycin (free radicals) +vinblastine (prevent microtubule assembly)+etoposide (inc. degradation DNA via topo II and inhibts electron transport)+cisplatin (alkylating) produce almost a 100% response when all agents are used for this neoplasm

Hint 87

None

Front 88

MOPP regimen used in Hodgkin's disease (HD) + MOA of each

How each work?

Back 88

Mechlorethamine (alkylating agent) + oncovorin (vincristine) (prevent assembly of microtubles) + procarbazine (forms hydrogen peroxide=free radicals and a alkylating agent), and prednisone

Hint 88

None

Front 89

ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP

Back 89

Adriamycin (doxorubicin) (intercalates between bases of DNA) +bleomycin (free radicals), vinblastine (prevents formation of microtubules) +dacarbazine (alkalating agent)

Hint 89

None

Front 90

Regimen used for non-Hodgkin's lymphoma

Back 90

COP (cyclophosphamide (alkylating agent), oncovorin(vincristine, prevents formatoin of microtubules), and prednisone)

Hint 90

None

Front 91

Regimen used for breast cancer

Back 91

CMF (cyclophosphamide (alkylating agent), methotrexate (inhibits dihydrofolate reductase), and fluorouracil (thiamine less death) and tamoxifen if ER+

Hint 91

None

Front 92

Alkylating agent, vesicant that causes tissue damage with extravasation.
What cancer used for?

Back 92

Mechlorethamine: spontaneously converts in body to reactive cytotoxic product.

Hodgkin disease

Hint 92

None

Front 93

Anticancer drug also used in RA, SE is hemorrhagic cystitis. What cancers used for? what is this SE due to and how can you prevent it?

Back 93

non hodgkin, ovary, breast

Cyclophosphamide: The main effect of cyclophosphamide is due to its metabolite phosphoramide mustard. This metabolite is only formed in cells which have low levels of ALDH.

Phosphoramide mustard forms DNA crosslinks between and within DNA strands. This leads to cell death.

SE due to acrolein formation in the kidney. Give hydration and MESNA

Hint 93

None

Front 94

Prevention of cyclophosphamide induced hemorrhagic cystitis

Back 94

Hydration and mercaptoethanesulfonate (MESNA): Mesna assists to neutralise these metabolites by binding through its sulfhydryl-moieties, and also increases urinary excretion of cysteine.

Hint 94

None

Front 95

Microtubule inhibitor that causes peripheral neuropathy, foot drop (eg. ataxia), and "pins and needles" sensation. Used for acute leukemia, lymphomas, Kaposi, neuroblastoma, testicular.

Back 95

Vincristine and vinblastine

Hint 95

None

Front 96

Interact with microtubules (but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and cells remain frozen in metaphase. Advanced breast and ovarian cancer.

Back 96

Paclitaxel (taxol)

Hint 96

None

Front 97

Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides

Back 97

Cisplatin

Front 98

Agent similar to cisplatin, less nephrotoxic, but what at more risk for?

Back 98

Carboplatin

Myelosuprresion

Hint 98

None

Front 99

Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA (asparagine)

Back 99

L-asparaginase

Front 100

Used for hairy cell leukemia; MOA

Back 100

Interferon alpha
activates NK cells

Hint 100

None

Front 101

Anti-androgen used for prostate cancer

Back 101

Flutamide (Eulexin): androgen receptor antagonist

Hint 101

None

Front 102

Anti-estrogen used for estrogen receptor + breast cancer

Back 102

Tamoxifen

Front 103

SERM used only for metastatic breast cancer. No risk of endometrial cancer.

Back 103

Toremifene (Fareston)

Hint 103

None

Front 104

Some cell cycle specific anti-cancer drugs

Back 104

Bleomycin, vinca alkaloids, antimetabolites (eg., 5-FU, 6-MP, methotrexate, etoposide)

Front 105

Some cell cycle non-specific drugs

Back 105

Alkylating agents (eg., mechlorethamine, cyclophosphamide), antibiotics (doxorubicin, daunorubicin), cisplatin, nitrosourea

Front 106

Anti-emetics used in association with anti-cancer drugs. How do they work?

Back 106

Odansetron, granisetron

They are 5-HT3 (serotonin receptor subtype ) antagonist

Hint 106

None

Front 107

Nitrosoureas with high lipophilicity, used for brain tumors

Back 107

Carmustine (BCNU) and lomustine (CCNU): alkylating agents

Hint 107

None

Front 108

Produces disulfiram-like reaction with ethanol, also blocks MAO

Back 108

Procarbazine: alkylating agent also forms hydrogen peroxide generating free radicals

Hint 108

None

Front 109

Endocrine drugs: hypothalamic and pituitary hormones

Front 110

Somatostatin (SRIF) analog used for acromegaly, carcinoid, glucagonoma and other GH producing pituitary tumors

Back 110

Octreotide

Front 111

Somatotropin (GH) analog used in GH deficiency (dwarfism)

Back 111

Somatrem

Front 112

GHRH analog used as diagnostic agent

Back 112

Sermorelin

Front 113

GnRH agonist used for infertility or different types of CA depending on pulsatile or steady usage respectively Name 2.

Back 113

Leuprolide or goserelin

Hint 113

None

Front 114

GnRH antagonist with more immediate effects, used for infertility

Back 114

Ganirelix, to prevent premature LH surge. Also cetrorelix.

Hint 114

None

Front 115

Dopamine (DA) agonist (for Parkinson's disease), used also for hyperprolactinemia
Name 3

Back 115

Bromocriptine or pergolide or Cabergoline

Pergolide is in decreasing use, as it has been associated with fibrotic heart disease since 2003 [1]. This problem is thought to be due to pergolide's action at the 5-HT2B serotonin receptors of cardiac myocytes

Hint 115

None

Front 116

Hormone inhibiting prolactin release

Back 116

Dopamine

Front 117

ACTH analog used for diagnosis of patients with corticosteroid abnormality

Back 117

Cosyntropin

Front 118

Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis

Back 118

Desmopressin (DDAVP)

Front 119

Thyroid and anti-thyroid drugs

Front 120

Most widely used thyroid drugs contain this thyroid hormone. Name 2.

Back 120

L-thyroxine (T4)
Synthroid and Levoxyl

Hint 120

None

Front 121

T3 compound less widely used

Back 121

Cytomel

Unlike synthroid, cytomel results in a rapid elevation in thyroid hormone levels that result in supraphysiological levels 2 to 6 hours after ingestion and a rapid clearance.

Hint 121

None

Front 122

Anti-thyroid drugs

Back 122

Thioamides, iodides, radioactive iodine, and ipodate

Front 123

Thioamide agents used in hyperthyroidism

Back 123

Methimazole and propylthiouracil (PTU)

Front 124

Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and should be used with extreme caution in pregnancy

Back 124

PTU

Front 125

PTU (propylthiouracil) MOA
does PTU affect the iodide transporter in and if not who could

Back 125

PTU inhibits many steps in the synthesis of thyroid hormones, including the addition of iodide to thyroglobulin by the enzyme thyroperoxidase, a necessary step in the synthesis of thyroxine, and by inhibiting the enzyme 5'-deiodinase which converts T4 to T3.

PTU does not inhibit the action of the sodium-dependent iodide transporter located on follicular cells' basolateral membranes. Inhibition of this step requires competitive inhibitors such as perchlorate and thiocyanate.

Hint 125

None

Front 126

Can be effective for short term therapy of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism

Back 126

Iodide salts

Front 127

Permanently cures thyrotoxicosis, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy

Back 127

Radioactive iodine

Front 128

Radio contrast media that inhibits the conversion of T4 to T3

Back 128

Ipodate

Front 129

Block cardiac adverse effects of thyrotoxicosis such as tachycardia, inhibits the conversion of T4 to T3 in peripheral how?

Back 129

Beta-blockers such as propranolol

via 5' deiodinase

Hint 129

None

Front 130

Adrenocorticosteroid and adrenocortical antagonists

Front 131

3 zones of adrenal cortex and their products

Back 131

Glomerulosa (mineralocorticoids), fasciculata (glucocorticoid=GC), and reticularis (adrenal androgens)

Front 132

Pneumonic for 3 zones of adrenal cortex

Back 132

GFR

Front 133

Used for Addison's disease, Congenital Adrenal Hyperplasia (CAH), inflammation, allergies, and asthma (as a local inhalation)

Back 133

Glucocorticoids

Front 134

Short acting GC's

Back 134

Cortisone and hydrocortisone (equivalent to cortisol)

Front 135

Intermediate acting GC's (4)

Back 135

Prednisone, methylprednisolone, prednisolone, and triamcinolone

Hint 135

None

Front 136

Long acting GC's

Back 136

Betamethasone, dexamethasone, and paramethasone

Front 137

Mineralocorticoids

Back 137

Fludrocortisone and deoxycorticosterone

Front 138

Some side effects of corticosteroids

Back 138

Osteopenia, impaired wound healing, inc. risk of infection, inc. appetite, HTN, edema, PUD, euphoria, psychosis

Front 139

Period of time of therapy after which GC therapy will need to be tapered

Back 139

5-7 days

Front 140

Inhibitors of corticosteroids biosynthesis

Front 141

Used for Cushing's syndrome (increased corticosteroid) and sometimes for adrenal function test + MAO of drug

Back 141

Metyrapone: Metyrapone blocks cortisol synthesis by inhibiting 11B hydroxylase. this stimulates ACTH secretion, which in turn increases plasma 11- deoxycortisol levels. When excess ACTH secretion is the cause of hypercortisolism, the metyrapone test helps clarify if the source of the ACTH is pituitary or ectopic (non-pituitary).

Hint 141

None

Front 142

Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis

Back 142

Aminoglutethimide

Since cortisol helps break down muscle, aminoglutethimide is used by bodybuilders in a steroid cycle.

Hint 142

None

Front 143

Antifungal agent used for inhibition of all gonadal and adrenal steroids

Back 143

Ketoconazole

Front 144

Antiprogestin used as potent antagonist of GC receptor

Back 144

Mifepristone

Front 145

Diuretic used to antagonize aldosterone receptors

Back 145

Spironolactone

Front 146

Common SE of spironolactone

Back 146

Gynecomastia and hyperkalemia

Front 147

Gonadal hormones and inhibitors

Front 148

Slightly increased risk of breast cancer, endometrial cancer, heart disease (questionable), has beneficial effects on bone loss

Back 148

Estrogen

Front 149

Antiestrogen drug used for fertility
antiestrogen drug used for breast cancer

Back 149

Clomiphene (acts by inhibiting the action of estrogen on the gonadotrope cells in the anterior pituitary gland "Sensing" low estrogen levels, follicle-stimulating hormone (FSH) release is increased, leading to a higher rate of ovulation ) and tamoxifen

Hint 149

None

Front 150

Common SE of tamoxifen and raloxifene

Back 150

Hot flashes

Front 151

Selective estrogen receptor modulator (SERM) used for prevention of osteoporosis and currently being tested for treatment of breast cancer (Stars study)

Back 151

Raloxifene

Front 152

Non-steroidal estrogen agonist causes clear cell adenocarcinoma of the vagina in daughters of women who used it during pregnancy

Back 152

Diethylstilbestrol (DES)

Front 153

Estrogen mostly used in oral contraceptives (OC) (2)

Back 153

Ethinyl estradiol and mestranol which is metabolized to ethinyl estradiol

Hint 153

None

Front 154

Anti-progesterone used as abortifacient

Back 154

Mifepristone (RU-486)

Front 155

Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)

Back 155

Combination oral contraceptives (OC)

Front 156

Oral contraceptive available in a transdermal patch

Back 156

Ortho-Evra

Front 157

Converted to more active form DHT and by what enzyme?

Back 157

Testosterone: 5 alpha reductase

Hint 157

None

Front 158

5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness

Back 158

Finasteride (Proscar and Propecia respectively)

Front 159

Anabolic steroid that has potential for abuse

Back 159

Nandrolone and stanozolol

Front 160

Anti-androgen used for hirsutism in females (2)

Back 160

Cyproterone acetate or Spironolactone

Hint 160

None

Front 161

Drug is used with testosterone for male fertility

Back 161

Leuprolide: GnRH agonist

Hint 161

None

Front 162

Pancreatic hormones, antidiabetics, and hyperglycemics

Front 163

Alpha cells in the pancreas

Back 163

Produce glucagon

Front 164

Beta cells in the pancreas

Back 164

Produce insulin

Front 165

Beta cells are found. What type of compounds can increase the release of its product?

Back 165

Islets of Langerhans

Increased by glucose, sulfonylureas, M-activators, B2 agonists
**Decreased by alpha 2 agonist

Hint 165

None

Front 166

Delta cells in the pancreas

Back 166

Produce Somatostatin

Front 167

Product of proinsulin cleavage used to assess insulin abuse

Back 167

C-peptide

Front 168

Exogenous insulin

Back 168

Little C-peptide

Front 169

Lab measurement to determine source of insulin.

Back 169

C-peptide

Hint 169

None

Front 170

Very rapid acting insulin, having fastest onset and shortest duration of action. Describe peak, duration

Back 170

Lispro (Humalog)

Peaks at 15-30 minutes and duration is 3-4 hours

Hint 170

None

Front 171

Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia? Peak and duration? How treat diabetic ketoacidosis?

Back 171

Regular (Humulin R): Peak 30 min - 3 hours duration 5-7 2-4 min. IV,

Regular IV, fluids and electrolytes

Hint 171

None

Front 172

Long acting insulin

Back 172

Ultralente (humulin U)
onset 3-4 hr, peak 8-16 hr, dur. 24-36 hr.

Hint 172

None

Front 173

Ultra long acting insulin, has over a day duration of action

Back 173

Glargine (Lantus): has no peak and works greater 24 hr

Hint 173

None

Front 174

Major SE of insulin

Back 174

Hypoglycemia

Front 175

Receptor for glucose found in the liver and pancreas and kidney

Describe the other receptors

Back 175

GLUT 2

1=RBC
3=neurons, placenta
4=muscle and adipose

Hint 175

None

Front 176

Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation

Back 176

GLUT 4

Front 177

Examples of alpha-glucosidase inhibitors (AGI)

Back 177

Acarbose, miglitol

Front 178

MOA of AGI's

Back 178

Act on intestine, delay absorption of glucose

Front 179

SE of AGI's. What do you not want to give these pt.?

Back 179

Flatulence (do not use beano to tx, Beano is an enzyme-based dietary supplement that is alleged by its manufacturer to reduce gas in the digestive tract, thereby preventing flatulence. It contains the enzyme alpha galactosidase. It is claimed that the human digestive tract does not contain alpha galactosidase; however acarbose may work against alpha galactosidase ), diarrhea, abdominal cramps

Hint 179

None

Front 180

Alpha-glucosidase inhibitor associated with elevation of LFT's

Back 180

Acarbose

Front 181

Amino acid derivative with MOA similar to sulfonylureas but a shorter DOA

Back 181

Nateglinide, a phenylalanine derivative

Hint 181

None

Front 182

MOA of nateglinide

Back 182

Insulin secretagogue, closes K+ channels causing depolarization

Hint 182

None

Front 183

The only biguanide approved for treating type 2 diabetes?

Back 183

Metformin

Hint 183

None

Front 184

Drugs available in combination with metformin (4)

Back 184

Glyburide, glipizide, and rosiglitazone, and pioglitazone

Hint 184

None

Front 185

MOA of metformin

Back 185

Decreases hepatic glucose production and intestinal glucose absorption; increase insulin sensitivity. Works via gene expression.

Hint 185

None

Front 186

Most important potential SE of metformin

Back 186

Lactic acidosis due to more glucose uptake by the cells. By blocking gluconeogenesis may impair hepatic metabolism of lactic acidosis esp. with renal insufficiency

Hint 186

None

Front 187

Name a Meglitinide and use of.

Back 187

Repaglinide: use just before meals due to short half life.
Also Nateglinide.

Hint 187

None

Front 188

MOA of repaglinide

Back 188

Insulin release from pancreas. It achieves this by closing ATP-dependent potassium channels in the membrane of the beta cells. This depolarizes the beta cells, opening the cells' calcium channels, and the resulting calcium influx induces insulin secretion.; faster and shorter acting than sulfonylurea

Hint 188

None

Front 189

First generation sulfonylureas. Which is ok with renal dysfunction? Which is most potent?

Back 189

Chlorpropamide (most potent), tolbutamide (ok with renal dysfunction), tolazamide, Acetohexamide.

Hint 189

None

Front 190

Second generation sulfonylureas. Which is dec. in dose with renal problems. Which with hepatic problems?

Back 190

Glyburide (dec. with renal), glipizide (dec. with hepatic), glimepiride, etc.

Hint 190

None

Front 191

MOA of both generations

Back 191

Insulin release from pancreas by modifying K+ channels

Front 192

Common SE of sulfonylureas, repaglinide, and nateglinide

Back 192

Hypoglycemia

Front 193

Sulfonylurea NOT recommended for elderly because of very long half life

Back 193

Chlorpropamide

Front 194

Name three Thiazolidinediones

Back 194

Pioglitazone, Rosiglitazone, Troglitazone (withdrawn/d from market)

Hint 194

None

Front 195

Reason troglitazone was withdrawn from market

Back 195

Hepatic toxicity

Front 196

MOA of thiazolindinediones

Back 196

Stimulate PPAR-gamma receptor involved in transcription in insulin responsive genes. Senstitizes target tissues to insulin.

Hint 196

None

Front 197

SE of Thiazolindinediones

Back 197

Edema, mild anemia; interaction (they are inducers) with drugs that undergo CytP450 3A4 metabolism

Hint 197

None

Front 198

Hyperglycemic agent to treat low serum glucose that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycemia, also used to reverse severe beta-blocker overdose and smooth muscle relaxation

Back 198

Glucagon

Hint 198

None

Front 199

Drugs used in bone homeostasis

Front 200

Available bisphosphonates

Back 200

Alendronate, etidronate, risedronate, pamidronate, tiludronate, and zoledronic acid

(PARTE)

Hint 200

None

Front 201

MOA of Bisphosphonates

Back 201

Inhibits osteoclast bone resorption and stabalize hydroxyapatite structure

Hint 201

None

Front 202

Only bisphosphonates available IV

Back 202

Etidronate

Front 203

Uses of bisphosphonates

Back 203

Osteoporosis, Paget's disease, and osteolytic bone lesions, and hypercalcemia from malignancy
**Alendronate DOC with HRT or for steroid induced osteoperosis

Hint 203

None

Front 204

Major SE of bisphosphonates

Back 204

Chemical esophagitis esp. with alendronate when pt. has inadequate water intake

Hint 204

None

Front 205

1. Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia
2. Recombinant DNA PTH analog used used one time daily to stimulate osteoblasts. Name drug and major SE?

Back 205

1.Etidronate and Pamidronate
2. Teriparatide, with continous infustion stimulates osteoclasts. Also used more 2 years inc. risk of osteosarcoma.

Hint 205

None

Front 206

Used for prevention of postmenopausal osteoporosis in women

Back 206

Estrogen (HRT-Hormone replacement therapy)

Front 207

Increase bone density, also being tested for breast CA tx.

Back 207

Raloxifene (SERM-selective estrogen receptor modulator)

Front 208

Used intranasally and decreases bone resorption

Back 208

Calcitonin (salmon prep)

Front 209

Used especially in postmenopausal women, dosage should be 1500 mg

Back 209

Calcium

Front 210

Vitamin given with calcium to ensure proper absorption

Back 210

Vitamin D

Front 211

Drugs with important actions on smooth muscle

Front 212

Disease caused by excess ergot alkaloids

Back 212

St. Anthony's Fire: The symptoms can be roughly divided into convulsive symptoms and gangrenous symptoms.

Hint 212

None

Front 213

Endogenous substances commonly interpreted as histamine, serotonin, prostaglandins, and vasoactive peptides

Back 213

Autocoids: local hormones made many places, not just endocrine glands. Formed by the tissues where they act.

Hint 213

None

Front 214

Syndrome of hypersecretion of gastric acid and pepsin usually caused by gastrinoma; it is associated with severe peptic ulceration and diarrhea

Back 214

Zollinger-Ellison Syndrome

Front 215

Endogenous Drug that causes contraction of the uterus

Back 215

Oxytocin

Hint 215

None

Front 216

Distribution of histamine receptors H1, H2, and H3

Back 216

Smooth muscle; stomach, heart, and mast cells; nerve endings, CNS respectively

Front 217

Prototype antagonist of H1 and H2 receptors respectively

Back 217

Diphenhydramine and impromidine or cimetidine respectively

Hint 217

None

Front 218

1st generation antihistamine that is highly sedating

Back 218

Diphendydramine

Front 219

1st generation antihistamine that is least sedating (2)

Name all 1st generation antihistamines

Back 219

Chlorpheniramine or cyclizine

Chlorpheniramine, cyclizine, diphenydramine, dimenhydrinate, doxepin, doxylamine, hydroxyzine, meclizine, promethazine

Hint 219

None

Front 220

2nd generation antihistamines, name 3

Back 220

Fexofenadine, loratadine, and cetirizine

Hint 220

None

Front 221

Generation of antihistamine that has the most CNS effects

Back 221

First generation due to being more lipid-soluble

Front 222

Major indication for H1 receptor antagonist

Back 222

Use in IgE mediated allergic reaction

Front 223

Antihistamine that can be used for anxiety and insomnia and is not addictive

Back 223

hydroxyzine (Atarax)

H1 receptor antagonist and piperazine derivative used primarily as an antihistamine for the treatment of itches and irritations, an antiemetic for the reduction of nausea, as a weak analgesic and as an anxiolytic. Good for people with drug abuse who have anxiety.

Hint 223

None

Front 224

H1 antagonist used in motion sickness (5)

Back 224

Dimenhydrinate, Diphenhydramine, cyclizine, meclizine, hydroxyzine

Hint 224

None

Front 225

Most common side effect of 1st generation antihistamines

Back 225

Sedation

Front 226

Lethal arrhythmias resulting from concurrent therapy with azole fungals (metabolized by CYP 3A4) and these antihistamines which inhibit the 3A4 iso-enzyme.

Back 226

Terfenadine and astemizole (have been removed from the market)

Front 227

H2 blocker that causes the most interactions with other drugs

Back 227

Cimetidine

Front 228

Clinical use for H2 blockers

Back 228

Acid reflux disease, duodenal ulcer and peptic ulcer disease

Front 229

Receptors for serotonin are located. How do they work? MOA?

Back 229

5 HT-1D : Mostly in the brain, and they mediate synaptic inhibition via increased K+ conductance

5 HT-2 : Smooth muscle and platelets.

5 HT-3 : CNS. chemoreceptor area and vomiting center.

Hint 229

None

Front 230

5HT-1d agonist used for migraine headaches (3)

Back 230

Sumatriptan, naratriptan, and rizatriptan

Hint 230

None

Front 231

Triptan available in parenteral and nasal formulation

Back 231

Sumatriptan

Front 232

1.H1 blocker that is also a serotonin antagonist, what used for?

2. Two serotonin antagonists that have alpha 1 blocking properties?

Back 232

Cyproheptadine

antihistaminic and antiserotonergic agent. It acts as a 5-HT2 receptor antagonist and also blocks calcium channels.

Cyproheptadine is used in the treatment of allergies (specifically Hay fever) and is also used to stimulate appetite in underweight people (e.g. anorexia nervosa).

Cyproheptadine may also be used to combat SSRI-induced sexual dysfunction, but is used cautiously in this manner due to the fact that it may reverse the effects of the SSRI.

Cyproheptadine is also used for the treatment of Cushing's Syndrome, the treatment of serotonin reactions secondary to meperidine, and may be used, though rarely, as a prophylactic drug for migraine headaches.

2. Ketanserin and Phenoxybenzamine

Hint 232

None

Front 233

5HT2 antagonist mediate synaptic excitation in the CNS and smooth muscle contraction (3)

Back 233

Ketanserin, cyproheptadine, phenoxybenzamine and ergot alkaloids (partial agonist of alpha and serotonin receptors)

Hint 233

None

Front 234

Ergot Alkaloids
1. agent used for postpartum bleeding
2. agents for migraines, one for acute, one for prophylaxis

Back 234

1. ergonovine
2. acute=ergotamine: alpha VC
prophylaxis=methysergide or ergonavine

Hint 234

None

Front 235

Serotonin or ergots:
Agents used in treatment of carcinoid tumor

Back 235

Ketanserin cyproheptadine, and phenoxybenzamine (all HT-2 antagonist) + methysergide

Hint 235

None

Front 236

Serotonin antagonist used in chemotherapeutic induced emesis and which receptor do they work on? (4)

Back 236

Ondansetron, granisetron, dolasetron and alosetron
5HT-3

Hint 236

None

Front 237

5ht-3 antagonist that has been associated with QRS and QTc prolongation and should not be used in patients with heart disease

5 HT-3 antagonist Associated with fatal bowel complications

Back 237

Dolasetron

Alosetron

Hint 237

None

Front 238

DOC of chemo induced nausea and vomiting

Back 238

Odansetron

Front 239

Drug used in ergot alkaloids overdose, ischemia and gangrene

Back 239

Nitroprusside: counteracts the alpha and HT VC of the ergot alkaloids

Hint 239

None

Front 240

Reason ergot alkaloids are contraindicated in pregnancy

Back 240

Uterine contractions

Front 241

SE of ergot alkaloids

Back 241

Hallucinations resembling psychosis (LSD), others see GI distress and prolonged vasoconstriction

Hint 241

None

Front 242

Ergot alkaloid used as an illicit drug

Back 242

LSD

Partial dope agonist and The hallucinogenic effects of LSD are attributed to its strong partial agonist effects at 5-HT2A receptors as specific 5-HT2A agonist drugs are hallucinogenic and largely 5-HT2A specific antagonists block the hallucinogenic activity of LSD.[14] Exactly how this produces the drug's effects is unknown, but it is thought that it works by increasing glutamate release and hence excitation in the cortex, specifically in layers IV and V

Hint 242

None

Front 243

Dopamine agonist used in hyperprolactinemia

Back 243

Bromocriptine

Front 244

Peptide causing increased capillary permeability and edema (2)

Back 244

Bradykinin and histamine

Hint 244

None

Front 245

Mediator of tissue pain, edema, inactivated by ACE, and may be a contributing factor to the development of angioedema

Back 245

Bradykinin

Front 246

Drug causing depletion of substance P (vasodilator)

Back 246

Capsaicin

Front 247

Prostaglandins that cause abortions

Back 247

Prostaglandin E1 (misoprostol) PGE2, and PGF2alpha

Front 248

Difference between COX 1 and COX 2 "

Back 248

COX 1 is found throughout the body and COX 2 is only in inflammatory tissue

Front 249

3 Drugs that selectively inhibits COX 2

Back 249

Celecoxib, valdecoxib, and rofecoxib

Hint 249

None

Front 250

Inhibitor of lipoxygenase that can help treat asthma

Back 250

Zileuton: selective and specific inhibitor of 5-lipooxygenase

Hint 250

None

Front 251

Major SE of zileuton

Back 251

Liver toxicity

Front 252

Inhibitor of leukotrienes (LTD4) receptors and used in asthma prophylaxis

Back 252

Zafirlukast and montelukast

Hint 252

None

Front 253

Used in pediatrics to maintain patency of ductus arteriosis

Back 253

PGE1

Front 254

Prostaglandin Approved for use in severe pulmonary HTN

Back 254

PGI2 (epoprostenol)

Prostacyclin acts chiefly to prevent platelet formation and clumping involved in blood clotting. It is also an effective vasodilator.

Hint 254

None

Front 255

Prostaglandin used in the treatment impotence

Back 255

Alprostadil (PGE1)

Hint 255

None

Front 256

Irreversible, nonselective COX inhibitor

Back 256

Aspirin

Front 257

Class of drugs that reversibly inhibit COX

Back 257

NSAIDS

Front 258

Primary endogenous substrate for Nitric Oxidase Synthase

Back 258

Arginine

Front 259

MOA and effect of nitric oxide

Back 259

Stimulates cGMP which leads to vascular smooth muscle relaxation
mechanism: cGMP facilitates the dephosphorylation and inactivation of myosin light chains

Hint 259

None

Front 260

Long acting beta 2 agonist used in asthma (2)

Back 260

Salmeterol and Formoterol

Hint 260

None

Front 261

Muscarinic antagonist used in asthma for people unable to tolerate adrenergic agonists. (2)

Back 261

Ipratropium and Tiotropium

Hint 261

None

Front 262

MOA action of cromolyn

Back 262

Mast cell stabilizer

Front 263

Enzyme which theophylline inhibits

Back 263

Phosphodiesterase this leads to an inc. of cAMP which causes smooth muscle dilation

Hint 263

None

Front 264

Methylxanthine derivative used as a remedy for intermittent claudication

Back 264

Pentoxifylline

Front 265

Antidote for severe CV toxicity of theophylline

Back 265

Beta blockers

Front 266

MOA of corticosteroids"

Back 266

inhibit phospholipase A2

Front 267

SE of long term (>5 days) corticosteroid therapy and remedy

Back 267

Adrenal suppression and weaning slowly, respectively

Front 268

Antimicrobials

Front 269

MOA of quinolones

Back 269

Inhibit Topoisomerase II (DNA gyrase) blocking relaxation of supercoiled DNA. Also block Topo 4 which is required for DNA seperation.

Hint 269

None

Front 270

MOA of penicillin

Back 270

Block cell wall synthesis by inhibiting peptidoglycan cross-linkage

Front 271

Drug used for MRSA

Back 271

Vancomycin

Front 272

Vancomycin MOA

Back 272

Blocks peptidoglycan synthesis, the D-ala-D-ala pentapeptide linkage

Hint 272

None

Front 273

Type of resistance found with vancomycin

Back 273

Point mutation: Terminal D-ala replaced by D-lactate

Hint 273

None

Front 274

N. Meningitidis prophylaxis in exposed patients and drug MOA

Back 274

Rifampin: inhibits DNA-dependent RNA polymerase

Hint 274

None

Front 275

Technique used to diagnose perianal itching, and the drug used to treat it. MOA of drug

Back 275

Scotch tape technique and mebendazole (selectively inhibits microtubule synthesis and glucose uptake in nematodes)

Hint 275

None

Front 276

Two toxicities of aminoglycosides

Back 276

nephro and ototoxicity

Front 277

DOC for Legionnaires' disease

Back 277

Erythromycin

Front 278

Complete MOA of sulfonamides

Back 278

Competes with PABA, Inhibiting dihydropteroate synthase

PABA uses dihydropteroate synthase to go to dihydrofolic acid. This uses dihydrofolate reductase to go to tetrahydrofolic acid. This is used to make purines

Hint 278

None

Front 279

Penicillins active against penicillinase secreting bacteria

Back 279

Methicillin, nafcillin, and dicloxacillin

Front 280

Cheap wide spectrum antibiotic DOC of otitis media and backup drug for Lyme disease

Back 280

Amoxicillin

Hint 280

None

Front 281

Class of antibiotics that have 10% cross sensitivity with penicillins

Back 281

Cephalosporins

Front 282

PCN active against pseudomonas

Back 282

Carbenicillin, piperacillin and ticarcillin

Front 283

Antibiotic causing red-man syndrome, and prevention

Back 283

Vancomycin, infusion at a slow rate and antihistamines

Front 284

Drug causes teeth discoloration

Back 284

Tetracycline

Front 285

MOA of tetracycline

Back 285

Decreases protein synthesis by inhibiting 30S ribosome

Front 286

Drug that causes gray baby syndrome and aplastic anemia

Back 286

Chloramphenicol (50S)

Hint 286

None

Front 287

Drug notorious for causing pseudomembranous colitis

Back 287

Clindamycin (50S)

Hint 287

None

Front 288

DOC for tx of pseudomembranous colitis + MOA

Back 288

Metronidazole: good for anaerobes

Metronidazole is selectively taken up by anaerobic bacteria and sensitive protozoal organisms because of the ability of these organisms to reduce metronidazole to its active form intracellularly. The nitro group of metronidazole is chemically reduced by ferredoxin (or ferredoxin-linked metabolic process) and the products are responsible for disrupting the DNA helical structure, thus inhibiting nucleic acid synthesis

Hint 288

None

Front 289

Treatment of resistant pseudomembranous colitis

Back 289

ORAL vancomycin: It is a large hydrophilic molecule which partitions poorly across the gastrointestinal mucosa

Hint 289

None

Front 290

Anemia caused by trimethoprim

Back 290

Megaloblastic anemia: it may inhibit dyhdrofolate in humans also

Hint 290

None

Front 291

Reason fluoroquinolones are contraindicated in children and pregnancy

Back 291

Cartilage damage

Front 292

Name 4 bugs that metronidazole is the DOC for?

Back 292

DOC for giardia, bacterial vaginosis, pseudomembranous colitis, and trichomonas

Hint 292

None

Front 293

Treatment for TB patients

Back 293

Rifampin, Isoniazid, Pyrazinamide, and Ethambutol

I saw a red pyre burning the liver

Hint 293

None

Front 294

Metronidazole SE if given with alcohol and mechanism

Back 294

Disulfiram-like reaction because it inhibits acetaldehyde dehydrogenase

Hint 294

None

Front 295

Common side effect of Rifampin

Back 295

Red urine discoloration: metabolites are red-orange color

Hint 295

None

Front 296

MOA of nystatin

Back 296

nystatin binds to ergosterol, a major component of the fungal cell membrane. When present in sufficient concentrations, it forms pores in the membrane that lead to K+ leakage and death of the fungus

Hint 296

None

Front 297

Neurotoxicity with isoniazid (INH) prevented by

Back 297

Administration of Vit. B6 (pyridoxine) as this drug inc. excretion of pyridoxine in slow acetylators

Hint 297

None

Front 298

Toxicity of amphotericin

Back 298

Nephrotoxicity

Front 299

SE seen only in men with administration of ketoconazole

Back 299

Gynecomastia because it blocks steroid synthesis

Hint 299

None

Front 300

Topical DOC in impetigo + MOA

Back 300

Topical mupirocin (Bactroban)

It has a unique mechanism of action, which is selective binding to bacterial isoleucyl-tRNA synthetase, which halts the incorporation of isoleucine into bacterial proteins. Because this mechanism of action is not shared with any other antibiotic, mupirocin has few problems of antibiotic cross-resistance

Hint 300

None

Front 301

DOC for influenza A

Back 301

Amantadine: prevents uncoating of influenza A

The drug interferes with a viral protein, M2 (an ion channel), which is needed for the viral particle to become "uncoated" once it is taken inside the cell by endocytosis.

Hint 301

None

Front 302

DOC for RSV

Back 302

Ribavirin: inhibits viral RNA polymerase

Hint 302

None

Front 303

DOC for CMV retinitis

Back 303

Ganciclovir: block RNA polymerase of virus

Hint 303

None

Front 304

SE for ganciclovir

Back 304

Neutro, leuko and thrombocytopenia

Front 305

Anti-viral agents associated with Stephen Johnson syndrome

Back 305

Nevirapine, amprenavir

Front 306

HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism

Back 306

Protease inhibitors

Front 307

Antivirals that are teratogens

Back 307

Delavirdine, efavirenz, and ribavirin

Front 308

Antivirals associated with neutropenia

Back 308

Ganciclovir, zidovudine, saquinavir, and interferon

Front 309

HIV med used to reduce transmission during birth

Back 309

AZT (zidovudine)

Front 310

Drug used for African sleeping sickness

Back 310

Suramin

Front 311

Drug used in Chagas disease

Back 311

Nifurtimox: T cruzi lacks catalase and this drug makes oxygen free radicals

Hint 311

None

Front 312

Cephalosporins able to cross the BBB

Back 312

Cefixime (2nd) and 3rd generation

Front 313

Drug used for N. gonorrhea in females

Back 313

Ceftriaxone because most gonorrhea resistant to penicillin

Hint 313

None

Front 314

Cephalosporin causes kernicterus in neonates

Back 314

Ceftriaxone or cefuroxime; these may cause hemolytic anemia

Hint 314

None

Front 315

SE of Isoniazid

Back 315

Peripheral neuritis due to pyridoxine deficiency and hepatitis due to toxic metabolite

Hint 315

None

Front 316

Aminoglycoside that is least ototoxic

Back 316

Streptomycin

Front 317

Drug used in exoerythrocytic cycle of malaria

Back 317

Primaquine

Front 318

Oral antibiotic of choice for moderate inflammatory acne

Back 318

Minocycline

Front 319

Drug of choice for leprosy and MOA

Back 319

Dapsone: PABA antagonist to inhibit folate synthesis.

Hint 319

None

Front 320

DOC for herpes and its MOA

Back 320

Acylovire

It is selectively converted into a monophosphate form by viral thymidine kinase, which is far more effective (3000 times) in phosphorylation than cellular thymidine kinase. Subsequently, the monophosphate form is further phosphorylated into the active triphosphate form, aciclo-GTP, by cellular kinases. Aciclo-GTP is a very potent inhibitor of viral DNA polymerase; it has approximately 100 times higher affinity to viral than cellular polymerase. Its monophosphate form also incorporates into the viral DNA, resulting in chain termination

Hint 320

None

Front 321

Anti-microbials that cause hemolysis in G6PD-deficient patients

Back 321

Sulfonamides

Front 322

MOA of erythromycin

Back 322

Inhibition of protein synthesis at the 50s subunit of ribosome

Front 323

Anti-biotic frequently used for chronic UTI prophylaxis and MOA

Back 323

sulfamethoxazole/ trimethoprim

sulf inhibits incorporation of PABA into folic acid, tri prevents reduction of dihydrofolate to tetrahydrofolate. Both excreted in urine.

Hint 323

None

Front 324

Lactam that can be used in PCN allergic patients

Back 324

Aztreonam

Front 325

SE of imipenem
What drug should you combine with this?

Back 325

Seizures
Cilastin

Hint 325

None

Front 326

Anti-viral with a dose limiting toxicity of pancreatitis

Back 326

Didanosine

Front 327

Sedative Hypnotics

Front 328

Common side effect of hypnotic agents

Back 328

Sedation

Front 329

Occurs when sedative hypnotics are used chronically or at high doses

Back 329

Tolerance

Front 330

The most common type of drug interaction of sedative hypnotics with other depressant medications

Back 330

Additive CNS depression

Front 331

Name Benzodiazepines (8)

Back 331

Diazepam, Alprazolam, chlordiazepoxide, clonazepam, flurazepam, lorazepam, oxazepam, triazolam

Hint 331

None

Front 332

Major effect of benzodiazepines on sleep at high doses

Back 332

REM is decreased

Front 333

Neurologic SE of benzodiazepines

Back 333

Anterograde amnesia: why at high doses can be used as date rape drug

Hint 333

None

Front 334

Reason benzos are used cautiously in pregnancy

Back 334

Ability to cross the placenta

Front 335

Main route of metabolism for benzodiazepines

Back 335

Hepatic

Front 336

Benzodiazepines (3) that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)

Back 336

Lorazepam, oxazepam, and temazepam

Hint 336

None

Front 337

MOA for benzodiazepines (key word)

Back 337

increase the FREQUENCY of GABA-mediated chloride ion channel opening

Hint 337

None

Front 338

Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)

Back 338

Flumazenil: benzodiazepine receptor antagonist

Hint 338

None

Front 339

Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin

Back 339

Diazepam

Front 340

Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia

Back 340

Clonazepam

Front 341

Benzodiazepines that are the most effective in the treatment of panic disorder

Back 341

Alprazolam and Clonazepam

Front 342

Benzodiazepine that is used for anesthesia. It is the shortest acting benzo.

Back 342

Midazolam

Hint 342

None

Front 343

Name two drugs useful with status epelepticus. Which one is the preffered agent for a child with a febrile seizure?

Back 343

Diazepam and Lorazapam
febrile=diazepam

Hint 343

None

Front 344

Two Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs

Back 344

Chlordiazepoxide and Diazepam

Hint 344

None

Front 345

Agents having active metabolites, long half lives, and a high incidence of adverse effects (4)

Back 345

Diazepam, Flurazepam, chlordiazepoxide, and clorazepate

Hint 345

None

Front 346

Name 5 Barbiturates

Back 346

Phenobarbital, Amobarbital, Pentobarbital, Secobarbital, thiopental

Hint 346

None

Front 347

Barbiturates may precipitate this hematologic condition

Back 347

Acute intermittent porphyria

Front 348

Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property

Back 348

Liver enzyme INDUCTION

Front 349

Barbiturates MOA KEY WORD

Back 349

Increase the DURATION of GABA-mediated chloride ion channels

Hint 349

None

Front 350

Barbiturate used for the induction of anesthesia

Back 350

Thiopental

Front 351

Alcohols

Front 352

Important drug interaction with chloral hydrate

Back 352

May displace coumadin from plasma proteins

Front 353

Others

Front 354

Site of action for zaleplon and zolpidem and their advantage

Back 354

Benzodiazepine receptor BZ1 (although are not considered benzodiazepines). Bind more specifically to this receptor. Cause less daytime impairment and do not effect sleep as much.

Hint 354

None

Front 355

Good hypnotic activity with less CNS SE than most benzodiazepines

Back 355

Zolpidem, zaleplon

Front 356

Agent that is a partial agonist for the 5-HT1A receptor but that may not be reason it helps you sleep

Back 356

Buspirone

Hint 356

None

Front 357

Drug of choice for generalized anxiety disorder, NOT effective in acute anxiety

Back 357

Buspirone

Front 358

Alcohols

Front 359

Two systems that will metabolize ethanol

Back 359

metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)

Hint 359

None

Front 360

Is ethanol first order or zero order

Back 360

Zero order

Hint 360

None

Front 361

Rate limiting step of alcohol metabolism

Back 361

Aldehyde dehydrogenase

Front 362

System that increases in activity with chronic exposure and may contribute to tolerance

Back 362

MEOS

Front 363

Agent that metabolize acetaldehyde to acetate

Back 363

Aldehyde dehydrogenase

Front 364

Agents that inhibit aldehyde dehydrogenase

Back 364

Disulfiram, metronidazole, certain sulfonylureas and cephalosporins

Hint 364

None

Front 365

Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension

Back 365

Disulfiram

Front 366

The most common neurologic abnormality in chronic alcoholics

Back 366

Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)

Front 367

Agent that is teratogen and causes a fetal syndrome

Back 367

Alcohol

Front 368

Agent that is the antidote for methanol overdose

Back 368

Alcohol

Front 369

Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure

Back 369

Fomepizole

Front 370

Name Anti seizure Drugs by seizure type and back up drugs

Back 370

1. TC and Partial = carbamazepine, phenytoin, valproic acid
2. abcense = ethosuximibe, valproic acid, clonazepam
3. myoclonic = valproic acid, clonazepam
4. back up = felbamate, gabapentin, lamotrigine, phenobarbital, tiagabine, topiramate,

Hint 370

None

Front 371

Most frequent route of metabolism

Back 371

Hepatic enzymes

Front 372

Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine

Back 372

Sodium blockade in neuron = prolongation of inactivated state of Na+ channel

Hint 372

None

Front 373

MOA for benzodiazepines and barbiturates

Back 373

GABA-related targets

Front 374

MOA for Ethosuximide

Back 374

T type Calcium channels esp. in thalamic neurons that act as pacemakers

Hint 374

None

Front 375

MOA for Valproic acid at high doses

Back 375

Affect calcium, potassium, and sodium channels

Front 376

Three Drugs of choice for generalized tonic-clonic and partial seizures

Back 376

Valproic acid and Phenytoin and Carbamezepine

Hint 376

None

Front 377

DOC for seizures in infants

Back 377

Phenobarbital

Hint 377

None

Front 378

Drugs of choice for absence seizures

Back 378

Ethosuximide and valproic acid

Front 379

Drug of choice for myoclonic seizures

Back 379

Valproic acid

Front 380

Drugs of choice for status epilepticus

Back 380

IV diazepam or phenytoin (for prolonged therapy not acute)

Front 381

Drugs that can be used for infantile spasms

Back 381

Corticosteroids

Front 382

Anti-seizure drugs used also for bipolar affective disorder (BAD) (4)

Back 382

Valproic acid, carbamazepine, phenytoin and gabapentin

Hint 382

None

Front 383

Anti-seizure drug of choice used also for Trigeminal neuralgia

Back 383

Carbamazepine

Hint 383

None

Front 384

Anti-seizure drugs used also for pain of neuropathic orgin
ex. postherpetic neuralgia

Back 384

Gabapentin

Hint 384

None

Front 385

Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism

Back 385

Phenytoin

Front 386

SE of phenytoin

Back 386

Gingival hyperplasia, nystagmus, diplopia and ataxia

Front 387

Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida

Back 387

Carbamazepine

Front 388

Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress

Back 388

Valproic acid

Front 389

Laboratory value required to be monitored for patients on valproic acid

Back 389

Serum ammonia and LFT's

Front 390

SE for Lamotrigine

Back 390

Stevens-Johnson syndrome

Front 391

SE for Felbamate

Back 391

Aplastic anemia and acute hepatic failure

Front 392

Anti-seizure medication also used in the prevention of migraines

Back 392

Phenytoin and Gabapentin

Hint 392

None

Front 393

Antiseizure medicine that may cause agranulocytosis

Back 393

Carbamazepine

Hint 393

None

Front 394

Anti-seizure drugs used as alternative drugs for mood stabilization (4)

Back 394

Carbamazepine, gabapentin, phenytoin, and valproic acid

Hint 394

None

Front 395

General Anesthetics: inhaled and IV

Back 395

Halothane, Enflurane, desflurane, isoflurane, sevoflurane, nitrous, theopental, fentanyl, propofol, midazolam, ketamine, etomidate

Hint 395

None

Front 396

MOA of general anesthetics

Back 396

Unclear, thought to increase the threshold for firing of CNS neurons

Front 397

Inhaled anesthetic with a low blood/gas partition coefficient

Back 397

Nitrous oxide

Front 398

Inversely related to potency of anesthetics

Back 398

Minimum alveolar anesthetic concentration (MAC): alveolar conc. req to eliminate the response to a painful stimuli in 50% of pt.

Hint 398

None

Front 399

2 Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

Back 399

Halothane and methoxyflurane

Hint 399

None

Front 400

Most inhaled anesthetics SE

Back 400

Decrease arterial blood pressure

Front 401

Inhaled anesthetics are myocardial depressants

Back 401

Enflurane and halothane

Front 402

Inhaled anesthetic causes peripheral vasodilation

Back 402

Isoflurane

Front 403

Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis

Back 403

Halothane

Front 404

Inhaled anesthetics, less likely to lower blood pressure than other agents, and has the smallest effect on respiration

Back 404

Nitrous oxide

Front 405

Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

Back 405

Methoxyflurane

Front 406

Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia

Back 406

Nitrous oxide

Front 407

Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm

Back 407

Desflurane

Front 408

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

Back 408

Dantrolene: prevents release of calcium from sarcoplasmic reticulum

Hint 408

None

Front 409

IV barbiturate used as a pre-op anesthetic

Back 409

Thiopental

Front 410

Benzodiazepine used adjunctively in anesthesia

Back 410

Midazolam

Front 411

Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose

Back 411

Flumazenil

Front 412

This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery

Back 412

Ketamine

Front 413

Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia

Back 413

Fentanyl

Front 414

State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide

Back 414

Neuroleptanesthesia

Front 415

Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension

Back 415

Propofol

Front 416

Local Anesthetics

Back 416

ester: tetracaine, procaine, benzocaine, cocaine
amides: bupivacaine, ropivacaine, lidocaine, prilocaine

Hint 416

None

Front 417

MOA of local anesthetics (LA's)

Back 417

Block voltage-dependent sodium channels

Front 418

This may enhance activity of local anesthetics

Back 418

Hyperkalemia

Front 419

This may antagonize activity of local anesthetics

Back 419

Hypercalcemia

Front 420

Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity

Back 420

Vasodilation

Front 421

Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery

Back 421

Cocaine

Front 422

Longer acting local anesthetics which are less dependent on vasoconstrictors

Back 422

Tetracaine and bupivacaine

Front 423

These LA's have surface activity

Back 423

Cocaine and benzocaine

Front 424

Most important toxic effects of most local anesthetics

Back 424

CNS toxicity

Front 425

Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage, cardiac arrhythmias, and myocardial infarction

Back 425

Cocaine

Front 426

LA causing methemoglobinemia

Back 426

Prilocaine

Front 427

Skeletal Muscle Relaxants

Back 427

depolarizing: succinylcholine
non: tubocurarine, pancuronium, vecuronium, atracurium, mivacurium

Hint 427

None

Front 428

Structurally related to acetylcholine, used to produce muscle paralysis in order to facilitate surgery or artifical ventilation. Full doses lead to respiratory paralysis and require ventilation

Back 428

Neuromuscular blocking drugs

Front 429

These drugs strongly potentiate and prolong effect of neuromuscular blockade (NMB)

Back 429

Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmic

Front 430

These prevent the action of Ach at the skeletal muscle endplate to produce a "surmountable blockade," effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)

Back 430

Nondepolarizing type antagonists

Front 431

Agent with long duration of action and is most likely to cause histamine release

Back 431

Tubocurarine

Hint 431

None

Front 432

Non-depolarizing antagonist has short duration x2. Why?

Back 432

Mivacurium: because it is metabolized by plasma cholinesterase
Atracurium: Hoffman

Hint 432

None

Front 433

Agent can block cardiac muscarinic receptors

Back 433

Pancuronium

Hint 433

None

Front 434

Agent undergoing Hofmann elimination (breaking down spontaneously)

Back 434

Atracurium

Front 435

One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis. SE?

Back 435

Succinylcholine: causes muscle pain postoperatively and myoglobinuria may occur

Hint 435

None

Front 436

During Phase I these agents worsen the paralysis by succinylcholine, but during phase II they reverse the blockade produced by succinylcholine

Back 436

Cholinesterase inhibitors

Front 437

Spasmolytic drugs

Back 437

diazepam, baclofen, cyclobenzaprine, dantrolene, tizanidine, botulinum,

Hint 437

None

Front 438

Agents acting in the CNS or in the skeletal muscle, used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease

Back 438

Spasmolytic drugs

Front 439

Spasmolytic drug that Facilitates GABA presynaptic inhibition

Back 439

Diazepam

Hint 439

None

Front 440

GABA agonist in the spinal cord

Back 440

Baclofen

Front 441

Similar to clonidine and may cause hypotension

Back 441

Tizanidine

Front 442

DOC for malignant hyperthermia by acting on the sacroplasmic reticulum or skeletal muscle

Back 442

Dantrolene

Front 443

Agent used for acute muscle spasm

Back 443

Cyclobenzaprine

Front 444

Drugs Used in Parkinsonism & Other Movement Disorders

Back 444

levodopa, benztropine, selegiline, trihexyphenidyl, amantadine, pergolide, bromocriptine, pramipexole, entacapone

Hint 444

None

Front 445

What drugs can cause drug induced Parkinsonism?

Back 445

Antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog) and is irreversible

Hint 445

None

Front 446

Agent used in drug therapy of Parkinson's instead of Dopamine which has low bioavailability and does not cross the BBB

Back 446

L-dopa

Front 447

This is combined with L-dopa, and mechanism of.

Back 447

Carbidopa

inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)

Hint 447

None

Front 448

Clinical response that may fluctuate in tx of Parkinson's dx

Back 448

"On-off-phenomenon"

Front 449

Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma

Back 449

Levodopa

Front 450

2 Ergot alkaloids that is are used for patients who are refractory or cannot tolerate levodopa, Common SE?

Back 450

Bromocriptine or Pergolide: work at D2 agonist
Erythromelalgia: a rare disorder in which blood vessels, usually in the extremities and especially in the feet, are blocked and inflamed, causing a painful burning and throbbing sensation and red skin

Hint 450

None

Front 451

Non ergot dopamine receptor agonists agents used as first-line therapy in the initial management of Parkinson's

Back 451

Pramipexole and ropinirole

Hint 451

None

Front 452

Enhances dopaminergic neurotransmission. SE's include CNS excitation, acute toxic psychosis and livedo reticularis

Back 452

Amantadine

Hint 452

None

Front 453

Inhibitor of MAO type B which metabolizes dopamine, used adjunct to levodopa or as sole agent in newly diagnosed pt's

Back 453

Selegiline

Front 454

Inhibitors of catechol-O-methyltransferase (COMT), used as adjuncts in Parkinson's dx and cause acute hepatic failure (monitor LFT's)

Back 454

Entacapone and Tolcapone

Front 455

2 Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on what?. Atropine-like side effects

Back 455

Benztropine or trihexyphenidyl both antimuscarinics

Little effect on bradykinesia

Hint 455

None

Front 456

Agent effective in physiologic and essential tremor

Back 456

Propranolol

Front 457

Agents used in Huntington's Disease

Back 457

Tetrabenazine + reserpine (both amine depleting drug), Haloperidol (antipsychotic that is a dopamine receptor antag.)

Hint 457

None

Front 458

Agents used in Tourette's dx and why they work

Back 458

Haloperidol or pimozide
both block dopamine 2 receptor

Hint 458

None

Front 459

Chelating agent used in Wilson's disease

Back 459

Penicillamine

Front 461

Antipsychotics

Back 461

older: haloperidol, chlorpromazine, fluphenazine, tribluoperazine, thioridazine
newer: clozapin, olanzapine, quetiapine, risperidone, ziprasidone

Hint 461

None

Front 462

Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor

Back 462

Older antipsychotic agents, D2 receptors

Front 463

Side effects occuring in antipsychotics that block dopamine

Back 463

Hyperprolactinemia, menorrhea, galactorrhea, confusion, mood changes, decreased sexual interest, and weight gain

Front 464

Antipsychotics that reduce positive symptoms only

Back 464

Older antipsychotics

Front 465

Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation

Back 465

Clozapine, Risperidone, Olanzapine, aripiprazole, and sertindole

Hint 465

None

Front 466

Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia

Back 466

Risperidone

Front 467

Atypical antipsychotic causing high prolactin levels

Back 467

Risperidone

Front 468

Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes

Back 468

Olanzapine

Front 469

Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker

Back 469

Haloperidol

Front 470

Drug used in neuroleptic malignant syndrome

Back 470

Dantrolene

Front 471

Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)

Back 471

Muscarinic blockers

Front 472

Antipsychotic having the strongest autonomic effects

Back 472

Thioridazine

Front 473

Antipsychotic having the weakest autonomic effects

Back 473

Haloperidol

Front 474

Antipsychotic that does not block muscarinic or histamine receptors, and it prolongs the QT interval

Back 474

Sertindole

Front 475

Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias

Back 475

Thioridazine

Front 476

Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause agranulocytosis

Back 476

Clozapine

Front 477

Anti-psychotic not shown to cause tardive dyskinesia

Back 477

Clozapine

Front 478

Anti-psychotics available in depot preparation

Back 478

Fluphenazine and haloperidol

Front 479

Reduced seizure threshold

Back 479

Low-potency typical antipsychotics and clozapine

Front 480

Orthostatic hypotension and QT prolongation

Back 480

Low potency older agents (esp ziprasidone) and risperidone

Hint 480

None

Front 481

Increased risk of developing cataracts

Back 481

Quetiapine

Front 482

Lithium

Front 483

Major route of elimination for Lithium

Back 483

Kidneys

Front 484

Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop

Back 484

Lithium toxicity

Front 485

Drug increases the renal clearance hence decreases levels of lithium

Back 485

Theophylline

Front 486

Lithium is associated with this congenital defect

Back 486

Cardiac anomalies and is contraindicated in pregnancy or lactation

Front 487

DOC for bipolar affective disorder

Back 487

Lithium

Front 488

SE of lithium

Back 488

Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus

Front 489

Antidepressants

Back 489

TCA: amytriptyline, doxepin, nortriptyline, imipramine, clomipramine, desipramine
SSRI: paroxetine, fluoxetine, sertraline, fluvoxemine, citolapram,
Heterocyclics: 2= maprotiline, buproprion, trazadone, amoxapine 3=mirtazapine, venlafaxine, nefazadone
MAO : moclobemide, isocarboxazid, phenelzine, tranylcypromine

Hint 489

None

Front 490

Example of three antidepressants that are indicated for obsessive compulsive disorder

Back 490

Clomipramine, fluoxetine and fluvoxamine

Front 491

Neurotransmitters affected by the action of antidepressants

Back 491

Norepinephrine and serotonin

Front 492

Usual time needed for full effect of antidepressant therapy

Back 492

2 to 3 weeks

Front 493

Population group especially sensitive to side effects of antidepressants

Back 493

Elderly patients

Front 494

All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion

Back 494

Side-effect profile and prior pt response

Front 495

Well-tolerated and are first-line antidepressants (3)

Back 495

SSRI's, bupropion, and venlafaxine

Hint 495

None

Front 496

Monoamine oxidase inhibitors (MAOI)

Front 497

Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression

Back 497

Monamine oxidase inhibitors

Front 498

Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)

Back 498

Hypertensive crisis

Front 499

MAOI should not be administered with SSRI's or potent TCA's due to development of this condition

Back 499

Serotonin syndrome: muscle rigidity, myoclonus, hyperthermia, cardio instability, seizures

Hint 499

None

Front 500

Tricyclic antidepressants (TCA)

Front 501

Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly

Back 501

Tricyclic antidepressants (TCA)

Front 502

Three C's associated with TCA toxicity

Back 502

Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)

Front 503

Agents having higher sedation and antimuscarinic effects than other TCA's

Back 503

Tertiary amines: amitriptyline and doxepin

Hint 503

None

Front 504

TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects

Back 504

Amitriptyline

Front 505

TCA used in chronic pain, enuresis, and ADD

Back 505

Imipramine

Front 506

TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep

Back 506

Doxepin

Front 507

TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms

Back 507

Clomipramine

Front 508

Secondary amines that have less sedation and more excitation effect

Back 508

Nortriptyline, Desipramine

Front 509

Heterocyclics

Front 510

Antidepressant associated with neuroleptic malignant syndrome

Back 510

Amoxapine

Front 511

2 Antidepressant associated with seizures and cardiotoxicity

Back 511

Maprotiline + amoxapine

Hint 511

None

Front 512

Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure

Back 512

Venlafaxine

Front 513

Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake

Back 513

Venlafaxine

Front 514

Antidepressant also used for sleep that causes priapism

Back 514

Trazodone

Front 515

2 Antidepressants which is inhibitor of CYP450 enzymes and may be associated with hepatic failure

Back 515

Nefazodone + venlafaxine

Hint 515

None

Front 516

Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures

Back 516

Bupropion

Front 517

Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating

Back 517

Mirtazapine

Front 518

SE of mirtazapine

Back 518

Liver toxicity, increased serum cholesterol
sedation and WG

Hint 518

None

Front 519

Selective serotonin reuptake inhibitors (SSRI)

Front 520

Except for these agents all SSRI have significant inhibition of CytP450 enzymes

Back 520

Citalopram and its metabolite escitalopram

Front 521

SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx

Back 521

Fluoxetine

Front 522

SSRI indicated for premenstrual dysphoric disorder

Back 522

Fluoxetine (Sarafem)

Front 523

Some of SSRIs' therapeutic effects beside depression (name 5 others)

Back 523

Panic attacks, social phobias, bulimia nervosa, and PMDD premenstrual dysphoric disorder), OCD

Hint 523

None

Front 524

SSRI's less likely to cause a withdrawal syndrome

Back 524

Fluoxetine

Front 525

Opioid Analgesics & Antagonists

Back 525

agonists: morphine, fentanyl, heroin, methadone, meperidine, codeine, oxycodone, propoxyphene
mixed: buprenorphine, nalbuphine, pentazocine
antagonists: naloxone, naltrexone, nalmefene

Hint 525

None

Front 526

Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons

Back 526

Ascending pathways

Front 527

Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release

Back 527

Presynaptic mu, delta, and kappa receptors

Front 528

Activation of these receptors open K+ ion channels to cause membrane hyperpolarization

Back 528

Postsynaptic Mu receptors

Front 529

Tolerance to all effects of opioid agonists can develop except

Back 529

Miosis and constipation

Front 530

All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction

Back 530

Meperidine

Front 531

Name SE of opioid analgesics?
Name 10!

Back 531

dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone

Hint 531

None

Front 532

Strong opioid agonists

Back 532

Morphine, methadone, meperidine, and fentanyl

Front 533

Opioids used in anesthesia

Back 533

Morphine and fentanyl

Front 534

Opioid used in the management of withdrawal states

Back 534

Methadone

Front 535

Opioid available trans-dermally

Back 535

Fentanyl

Front 536

Opioid that can be given PO, by epidural, and IV, which helps to relieve the dyspnea of pulmonary edema

Back 536

Morphine

Front 537

Use of this opioid with MAOI can lead to hyperpyrexic coma, and with SSRI's can lead to serotonin syndrome

Back 537

Meperidine

Front 538

Moderate opioid agonists

Back 538

Codeine, hydrocodone, and oxycodone

Front 539

Weak opioid agonist, poor analgesic, its overdose can cause severe toxicity including respiratory depression, circulatory collapse, pulmonary edema, and seizures

Back 539

Propoxyphene

Front 540

Partial agonist or mixed antagonists

Back 540

Partial=buprenorphine

mixed=pentazocine, nalbuphine, butorphanol

Hint 540

None

Front 541

Partial opioid agonist, considered a strong analgesic, has a long duration of action and is resistant to naloxone reversal

Back 541

Buprenorphine

Front 542

Opioid antagonist that is given IV and had short DOA

Back 542

Naloxone

Front 543

Opioid antagonist that is given orally in alcohol dependency programs

Back 543

Naltrexone

Front 544

These agents are used as antitussive

Back 544

Dextromethorphan, Codeine

Front 545

These agents are used as antidiarrheal

Back 545

Diphenoxylate, Loperamide: Loperamide is an opioid receptor agonist and acts on the μ-opioid receptors in the myenteric plexus large intestines; it does not affect the central nervous system like other opioids.

Hint 545

None

Front 546

Drugs of Abuse

Front 547

Inhalant anesthetics

Back 547

NO, chloroform, and diethyl ether

Front 548

Toxic to the liver, kidney, lungs, bone marrow, peripheral nerves, and cause brain damage in animals, sudden death has occurred following inhalation

Back 548

Fluorocarbons and Industrial solvents
found in gasoline, paint thinner, glues, cements

Hint 548

None

Front 549

Cause dizziness, tachycardia, hypotension, and flushing

Back 549

Organic nitrites such as amyl nitrite, isobutyl nitrite "poppers"

Hint 549

None

Front 550

Causes acne, premature closure of epiphyses, masculinization in females, hepatic dysfunction, MI, and increases in libido and aggression

Back 550

Steroids

Front 551

Readily detected markers that may assist in diagnosis of the cause of a drug overdose include

Back 551

Changes in heart rate, blood pressure, respiration, body temperature, sweating, bowel signs, and pupillary responses

Front 552

Opioid Analgesics

Front 553

5 Most commonly abused in health care professionals

Back 553

Heroin, morphine, oxycodone, meperidine and fentanyl

Hint 553

None

Front 554

This route is associated with rapid tolerance and psychologic dependence

Back 554

IV administration

Front 555

Leads to respiratory depression progressing to coma and death

Back 555

Overdose of opioids

Front 556

Describe abstinence syndrome of the opoids

Back 556

Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea, and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome

Hint 556

None

Front 557

Treatment for opioid addiction

Back 557

Methadone, followed by slow dose reduction

Front 558

This agent may cause more severe, rapid and intense symptoms to a recovering addict

Back 558

Naloxone

Front 559

Sedative-Hypnotics

Front 560

Sedative-Hypnotics action

Back 560

Reduce inhibition, suppress anxiety, and produce relaxation

Front 561

Additive effects when Sedative-Hypnotics used in combination with these agents

Back 561

CNS depressants

Front 562

Common mechanism by which overdose result in death

Back 562

Depression of medullary and cardiovascular centers

Front 563

"Date rape drug" (3)

Back 563

Flunitrazepam (rohypnol): a potent rapid onset benzo with marked amnestic properties

also chloral hydrate or gamma hydroxybutyrate

Hint 563

None

Front 564

The most important sign of withdrawal syndrome

Back 564

Excessive CNS stimulation (seizures)

Front 565

Treatment of withdrawal syndrome involves

Back 565

Long-acting sedative-hypnotic or a gradual reduction of dose, clonidine or propranolol

Front 566

These agents are CNS depressants

Back 566

Ethanol, Barbiturates, and Benzodiazepines

Front 567

Stimulants

Front 568

Withdrawal from this drug causes lethargy, irritability, and headache

Back 568

Caffeine

Front 569

W/D from this drug causes anxiety and mental discomfort

Back 569

Nicotine

Front 570

Treatments available for nicotine addiction

Back 570

Patches, gum, nasal spray, psychotherapy, and bupropion

Front 571

Chronic high dose abuse of nicotine leads to

Back 571

Psychotic state, overdose causes agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and seizures

Front 572

Tolerance is marked and abstinence syndrome occurs

Back 572

Amphetamines

Front 573

Amphetamine agents

Back 573

Dextroamphetamines and methamphetamine


effects by binding to the monoamine transporters and increasing extracellular levels of the biogenic amines dopamine, norepinephrine and serotonin. It is hypothesized that d-amphetamine acts primarily on the dopaminergic systems, while l-amphetamine is comparatively norepinephrinergic. The primary reinforcing and behavioral-stimulant effects of amphetamine, however, are linked to enhanced dopaminergic activity, primarily in the mesolimbic DA system. Amphetamine binds to the dopamine transporter (DAT) and blocks the transporters ability to clear DA from the synaptic space. In addition, amphetamine is transported into the cell which leads to dopamine efflux (DA is transported out of the cell and into the synaptic space via reverse transport of the DAT

Hint 573

None

Front 574

These agents are congeners of Amphetamine

Back 574

DOM, STP, MDA, and MDMA "ecstasy"

Serotonin is a neurotransmitter believed to play a role in the regulation of mood and pleasure. MDMA causes serotonin vesicles in the neurons to release quantities of serotonin into the synapses. Although popular press accounts focus on the role of serotonin release, the mechanism by which MDMA causes its unusual psychoactivity is largely unknown. In vitro and nonhuman animal studies have established that MDMA also induces dopamine, norepinephrine, and acetylcholine release, and can act directly on a number of receptors, including a2-adrenergic (adrenaline) and 5HT2A(serotonin) receptors. MDMA promotes the release of several hormones including prolactin and the antidiuretic hormone vasopressin, which may be important in its occasional production of water intoxication or hyponatremia

Hint 574

None

Front 575

Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias, seizures, respiratory depression, or severe HTN (MI and stroke)

Back 575

Cocaine "super-speed"

Front 576

Hallucinogens

Front 577

Most dangerous of the currently popular hallucinogenic drugs, OD leads to nystagmus, marked hypertension, and seizures, presence of this which is pathognomonic

Back 577

PCP: phencyclidine or angel dust.

both horizontal and vertical nystagmus is pathognomonic

NMDA antagonist

Hint 577

None

Front 578

Removal of PCP may be aided

Back 578

Urinary acidification and activated charcoal or continual nasogastric suction

Front 579

THC is active ingredient, SE's include impairment of judgment, and reflexes, decreases in blood pressure and psychomotor performance occur

Back 579

Marijuana

Front 580

Cholinoreceptor-Activating & Cholinesterase-Inhibiting Drugs

Back 580

Activating: Acetylcholine, carbachol, bethanechol, pilocarpine
Indirect: Neostigmine, pyridostigmine, physostigmine, edrophonium, echothiophate, parathion and malathion

Hint 580

None

Front 581

Direct-Acting Cholinomimetic Agonists

Front 582

Muscarinic agonists or parasympathomimetic

Front 583

This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic ileus and urinary retention

Back 583

Bethanechol

Front 584

Only direct acting agent that is very lipid soluble and used in glaucoma

Back 584

Pilocarpine also carbachol

Hint 584

None

Front 585

These agents are used to treat dry mouth in Sjögren's syndrome

Back 585

Cevimeline + pilocarpine

Hint 585

None

Front 586

Indirect-Acting ACh Agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis

Back 586

Edrophonium

Front 587

Carbamate with intermediate action postoperative and used for neurogenic ileus and urinary retention

Back 587

Neostigmine

Hint 587

None

Front 588

Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions

Back 588

Physostigmine

Front 589

Treatment of myasthenia gravis

Back 589

Pyridostigmine

Front 590

2 drugs used in the treatment of Alzheimers

Back 590

Donepezil, tacrine

Front 591

Organophosphates

Front 592

Antiglaucoma organophosphate

Back 592

Echothiophate

Front 593

Associated with an increased incidence of cataracts in patients treated for glaucoma

Back 593

Long acting cholinesterase inhibitors

Front 594

Scabicide organophosphate

Back 594

Malathion

Front 595

Organophosphate anthelmintic agent with long DOA

Back 595

Metrifonate

Front 596

Toxicity of organophosphate:

Back 596

DUMBELSS (diarrhea, urination, miosis, bronchoconstriction, excitation of skeletal muscle and CNS, lacrimation, salivation, and sweating)

Front 597

The most important cause of acute deaths in cholinesterase inhibitor toxicity

Back 597

Respiratory failure

Front 598

The most toxic organophosphate

Back 598

Parathion

Front 599

Treatment of choice for organophosphate overdose

Back 599

Atropine and/or pralidoxime

Hint 599

None

Front 600

This agent regenerates active cholinesterase and is a chemical antagonist used to treat organophosphate exposure

Back 600

Pralidoxime

Front 601

Cholinoreceptor Blockers & Cholinesterase Regenerators

Back 601

blockers: atropine, scopolamine, glycopyrrolate, ipratropium, tropicamide, oxybutynin, benztropine

Regenerator: Pralidoxime

Hint 601

None

Front 602

Prototypical Nonselective Muscarinic Antagonists

Back 602

Atropine

Hint 602

None

Front 603

Treat manifestations of Parkinson's disease and EPS

Back 603

Benztropine, trihexyphenidyl

Front 604

Treatment of motion sickness, may cause short term memory block

Back 604

Scopolamine

Front 605

Antispasmodic, antisecretory, antiulcer, does not enter the CNS

Back 605

Glycopyrrolate

Front 606

Treatment of Antimuscarinic toxicity

Back 606

Symptomatic + physostigmine(blocks acetylcholinesterase)

Front 607

Name 6 other classes of drugs that have antimuscarinic effects as a SE

Back 607

Antihistamine, Tricylic Antidepressants, Antipsychotics, Quinidine, Amantadine, Meperidine

Front 608

Produce mydriasis and cycloplegia (4)

Back 608

Atropine, homatropine, tropicamide, cyclopentolate

Hint 608

None

Front 609

Bronchodilation in asthma and COPD

Back 609

Ipratropium

Front 610

Reduce transient hyper GI motility (3)

Back 610

Dicyclomine, methscopolamine, glycopyrrolate

Hint 610

None

Front 611

Cystitis, postoperative bladder spasms, or incontinence (4)

Back 611

Oxybutynin, dicyclomine, glycopyrrolate, tolterodine

Hint 611

None

Front 612

Toxicity of anticholinergics

Back 612

block SLUD (salivation, lacrimation, urination, defecation

dry as a bone, red as a beet, mad as a hatter

Hint 612

None

Front 613

Another pneumonic for anticholinergic toxicity

Back 613

"dry as a bone, red as a beet, mad as a hatter, hot as a hare, blind as a bat"

Front 614

Atropine fever is the most dangerous effect and can be lethal in this population group

Back 614

Infants

Front 615

Contraindications to use of atropine

Back 615

Infants, closed angle glaucoma, prostatic hypertrophy

Front 616

Nicotinic Antagonists

Front 617

Prototype ganglion blocker

Back 617

Hexamethonium and Mecamylamine

Front 618

Limiting adverse effect of ganglion blockade that patients usually are unable to tolerate

Back 618

Combined block of sympathetics and parasympathetics ex. postureal hypotension, dry mouth, blurred vision, constipation, sexual dysfunction

Hint 618

None

Front 619

Main use for ganglionic blocker

Back 619

Block ANS reflexes, allowing to see if change HR direct or autonomic

Front 620

Will reverse the blockade by neuromuscular blockers

Back 620

Cholinesterase inhibitors

Hint 620

None

Front 621

Tubocurarine is the prototype, pancuronium, atracurium, vecuronium are newer short acting agent, produce competitive block at end plate nicotinic receptor, causing flaccid paralysis

Back 621

Nondepolarizing Neuromuscular Blockers

Front 622

Only member of depolarizing neuromuscular blocker, causes fasciculation during induction and muscle pain after use

Back 622

Succinylcholine

Front 623

Chemical antagonists that bind to the inhibitor of ACh Estrace and displace the enzyme (if aging has not occurred)

Back 623

Cholinesterase Regenerators

Front 624

Used to treat patients exposed to insecticides such as parathion

Back 624

Pralidoxime

Front 625

Sympathomimetics

Back 625

1. epinephrine: general agonist
2. norepe: a1,a2,b1
3. phenylephrine, methoxamine, a1>a2
4. clonidine: a2>a1
5. isoproterenol: b1=b2
6. dobutamine b1>b2
7. terbutaline, albuterol: b2>b1
8. dopamine and bromocriptine: dop agonist

Hint 625

None

Front 626

Which beta receptor does heart and which does lungs

Back 626

You have 1 heart (Beta 1) and 2 lungs (Beta 2)

Hint 626

None

Front 628

Location of alpha 1 receptors (name at least 5)

Back 628

Eye(myd), arterioles +veins = constrict, inhibits bladder, male sex organs, kidney(dec. renin), prostate(contract)

Hint 628

None

Front 629

Location of alpha 2 receptors (name at least 3)

Back 629

Prejunctional nerve terminals, aggregates platelets, pancreas(dec. insulin), fat cells to inhibit lipolysis

Hint 629

None

Front 630

Location B1 receptors

Back 630

nodes, heart muscle, kidney(inc. renin)

Front 631

As increase dose of dopamine from low to high name receptor changes occuring

Back 631

Low=D1, mid=also B1, high also a1

Front 632

MAO of the liver

Back 632

A

Front 633

MAO of the brain

Back 633

B

Front 634

Locatoin B2 receptors (name at least 5)

Back 634

all BV(dil), uterus, bronchioles, skeletal muscle get tremor, liver glycogenolysis, pancreas(inc. insulin)

Hint 634

None

Front 635

This is the drug of choice for anaphylactic shock

Back 635

Epinephrine

Front 636

Differ high dose epinephrine with norepinephrine

Back 636

Alpha 1 blocker. See hypotension with epi.

Front 637

Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction

Back 637

Amphetamines

Front 638

At low dose epi is alpha or beta effect more prominent? High dose?

Back 638

Low dose beta more responsive as more senstitive. High dose alpha due to being more numerous.

Front 639

Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia

Back 639

Phenylephrine

Front 640

Epinephrine and dipivefrin are used for and MOA

Back 640

Glaucoma: increase outflow via the uveoscleral veins

Hint 640

None

Front 641

Newer alpha 2 agonist mechanism to treat glaucoma and name the two drugs

Back 641

Reduce aqueous synthesis

(apraclonidine and brimonidine)

Hint 641

None

Front 642

Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis, name two others that would work

Back 642

Albuterol

two others: terbutaline, metaproterenol

Hint 642

None

Front 643

Longer acting Beta 2 agonists is recommended for prophylaxis of asthma

Back 643

Salmeterol

Front 644

These agents increase blood flow and may be beneficial in treatment of acute heart failure and some types of shock

Back 644

Beta1 agonists

Front 645

These agents decrease blood flow or increase blood pressure, are local decongestant, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion

Back 645

Alpha1 agonists

Front 646

Shock due to septicemia or myocardial infarction is made worse by

Back 646

Vasoconstrictors because Increasing afterload and tissue perfusion declines

Hint 646

None

Front 647

Often mixed with local anesthetic to

Back 647

Reduce the loss from area of injection

Front 648

Chronic orthostatic hypotension can be treated with

Back 648

Midodrine a new oral a1 agonist or ephedrine

Hint 648

None

Front 649

2 Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus

Back 649

Terbutaline or ritodrine (relax smooth muscle)

Hint 649

None

Front 650

Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis

Back 650

Ephedrine

Front 651

Alpha 1 agonist toxicity

Back 651

Hypertension

Front 652

Beta 1 agonist toxicity

Back 652

Sinus tachycardia and serious arrhythmias

Front 653

Beta 2 agonist toxicity

Back 653

Skeletal muscle tremor

Front 654

The selective agents loose their selectivity at

Back 654

high doses

Front 655

Adrenoceptor Blocker

Back 655

1. nonselective alpha blocker: phentolamine and pehnoxybenzamine
2. alpha 1 selective: prazosin, terazosin, doxazosin
3. alpha 2 selective: yohimbine
4. nonselective beta blocker: propranolol, carvedilol, labetalol, nadolol, timolol
5. beta 1 selective: metoprolol, atenolol, esmolol

Hint 655

None

Front 656

Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis

Back 656

Phenoxybenzamine

Front 657

Nonselective alpha-blocking drug, short acting and reversible, used for rebound HTN from rapid clonidine withdrawal, and Raynaud's phenomena

Back 657

Phentolamine

Front 658

Selective Alpha 1 blocker used for hypertension, BPH, may cause first dose orthostatic hypotension

Back 658

Prazosin, terazosin, doxazosin

Front 659

Selective Alpha 2 blocker used for impotence (controversial effectiveness)

Back 659

Yohimbine

Front 660

Beta-Blocking Drugs

Front 661

SelectiveB1 Receptor blockers that may be useful in treating patients that you have to worry about asthma in

Back 661

Acebutolol, atenolol, esmolol, metoprolol

Hint 661

None

Front 662

Combined alpha and beta blocking agents that may have application in treatment of CHF

Back 662

Labetalol and carvedilol

Front 663

Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma

Back 663

Pindolol and acebutolol

Front 664

This beta blocker lacks local anesthetic activity (decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma

Back 664

Timolol: decreases aqueous secretion

Hint 664

None

Front 665

This parenteral beta blocker is a short acting

Back 665

Esmolol

Front 666

This beta blocker is the longest acting

Back 666

Nadolol

Front 667

These beta blockers are less lipid soluble

Back 667

Acebutolol and atenolol and nadolol

Hint 667

None

Front 668

This beta blocker is highly lipid soluble and may account for side effects such as nightmares

Back 668

Propranolol

Front 669

Clinical uses of these agents include treatment of HTN, angina, arrhythmias, and chronic CHF

Back 669

Beta blockers

Front 670

Why is B1 selective blockers CI with diabetes

Back 670

Block the symp reflexes (tachycardia, tremor and anxiety) seen with hypoglycemia

Hint 670

None

Front 671

Contraindications to beta blockers

Back 671

Asthma, vasospastic disorders, diabetes

Front 672

B blockers ok to give to hyperlipidemia patients

Back 672

Acebutolol, Pindolol

Front 673

Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF, signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)

Back 673

Beta blockers

Front 674

Glaucoma (all agents topical except for diuretics)

Front 675

Cholinomimetics that increase outflow, open trabecular meshwork, and cause ciliary muscle contraction

Back 675

Pilocarpine, carbachol, physostigmine

Front 676

Nonselective alpha agonists that increases outflow, probably via the uveoscleral veins

Back 676

Epinephrine, dipivefrin

Front 677

Selective alpha agonists that decreases aqueous secretion

Back 677

Apraclonidine, brimonidine: both alpha 2 selective agents

Hint 677

None

Front 678

These Beta blockers decrease aqueous secretion

Back 678

Timolol (nonselective), betaxolol (beta 1 selective)

Hint 678

None

Front 679

Pt. with dilated pupil. Symp agonist or parasympathetic antagonist?

Back 679

Ask about blurred vision

Front 680

Treatments for angle closure glaucoma

Back 680

Pilocarpine or Mannitol

Front 681

This diuretic decreases aqueous secretion due to lack of HCO3- ion. Causes drowsiness and paresthesias, alkalinization of the urine may precipitate calcium salts, hypokalemia, acidosis. Only oral treatment.

Back 681

Acetazolamide

Front 682

This agent cause increased aqueous outflow

Back 682

Prostaglandin PGF2a (Latanoprost)

Front 683

Antihypertensive Agents

Front 684

Inhibit angiotensin-converting enzyme (ACE)

Back 684

Ace inhibitors

Front 685

Captopril and enalapril (-OPRIL ending) are

Back 685

Ace inhibitors

Front 686

SE of ACE inhibitors (2)

Back 686

Dry cough, hyperkalemia (due to dec. aldosterone)

Hint 686

None

Front 687

Ace inhibitors are contraindicated in

Back 687

pregnancy (renal toxicity to baby) and with K+

Hint 687

None

Front 688

Name two drugs that block the angiontensin receptor

Back 688

Losartan and valsartan

Hint 688

None

Front 689

Angiotensin receptor blockers do NOT cause

Back 689

Dry cough

Front 690

Block L-type calcium channel

Back 690

Calcium channel blockers

Front 691

CCB contraindicated in CHF

Back 691

Verapamil

Front 692

CCB with predominate effect on arteriole dilation

Back 692

Nifedipine

Front 693

SE of CCB (3)

Back 693

Constipation, edema, and headache

Hint 693

None

Front 694

Reduce heart rate, contractility, and O2 demand

Back 694

Beta-blockers

Front 695

B-blockers that are more cardioselective

Back 695

Beta 1-selective blockers

Hint 695

None

Front 696

Cardioselective Beta 1-blockers

Back 696

Atenolol, acebutolol, and metoprolol, esmolol

Hint 696

None

Front 697

Beta-blockers should be used cautiously in (3)

Back 697

Asthma (bronchospastic effects), diabetes (block signs of hypoglycemia) and peripheral vascular disease

Hint 697

None

Front 698

Non-selective Beta-blocker also used for migraine prophylaxis

Back 698

Propranolol

Front 699

SE of beta blockers (3-4)

Back 699

Bradycardia, SEXUAL DYSFUNCTION, decrease in HDL, and increase in Triglycerols (TG)

Hint 699

None

Front 700

Alpha 1selective blockers

Back 700

Prazosin, terazosin and doxazosin (-AZOSIN ending)

Front 701

Non-selective Alpha1blockers use to treat pheochromocytoma

Back 701

Phenoxybenzamine

Front 702

For rebound HTN from rapid clonidine withdrawal

Back 702

Phentolamine: nonselective alpha blocker

Hint 702

None

Front 703

A1a-selective blocker used for BPH

Back 703

Tamsulosin (Flomax)

Front 704

SE of alpha blockers

Back 704

Orthostatic hypotension (especially with first dose) and reflex tachycardia

Front 705

Presynaptic Alpha 2 agonist used in HTN

Back 705

Clonidine, and methyldopa

Front 706

SE of methyldopa

Back 706

Positive Comb's test, depression

Front 707

Methyldopa is contraindicated in

Back 707

Geriatrics due to its CNS (depression) effects

Front 708

SE of clonidine

Back 708

Rebound HTN, sedation, dry mouth

Front 709

Ganglionic blockers formerly used in HTN

Back 709

Trimethaphan, and hexamethonium

Front 710

Direct vasodilator of arteriolar smooth muscle

Back 710

Hydralazine: release of nitric oxide from endothelial cells

Hint 710

None

Front 711

SE of hydralazine

Back 711

Lupus-like syndrome

Front 712

Arterial vasodilator that works by opening K+ channels

Back 712

Minoxidil

Front 713

SE of minoxidil

Back 713

Hypertrichosis

Front 714

IV Drug used Hypertensive Crisis

Back 714

Nitroprusside

Front 715

Nitroprusside vasodilates

Back 715

Arteries and veins

Front 716

Toxicity caused by nitroprusside and treatment

Back 716

Cyanide toxicity treated with sodium thiosulfate

Front 717

Diuretics

Front 718

Carbonic anhydrase inhibitor

Back 718

Acetazolamide

Front 719

Diuretic used for mountain sickness and glaucoma

Back 719

Acetazolamide

Front 720

SE of acetazolamide

Back 720

Paresthesias, alkalization of the urine (which may ppt. Ca salts: alkalinization = precipitation), hypokalemia (due to inc. sodium in tubules), acidosis (cannot exchange sodium and Hydrogen), and encephalopathy in patients with hepatic impairment (may have inc. ammonia reabsorption)

Hint 720

None

Front 721

MOA of loop diuretics

Back 721

inhibits Na+/K+/2Cl- cotransport

Front 722

Site of action of loop diuretics

Back 722

Thick ascending limb

Front 723

SE of loop (furosemide) diuretics

Back 723

Hyperuricemia, hypokalemia and ototoxicity, hypomagnesemia (may enhance digoxin), hypocalcemia, alkalosis, sulfur allergy

Hint 723

None

Front 724

Aminoglycosides used with loop diuretics potentiate adverse effect

Back 724

Ototoxicity

Front 725

Loops lose and thiazide diuretics retain

Back 725

Calcium: lower intracellular sodium increased Basolateral sodium/calcium transporter

Hint 725

None

Front 726

MOA of thiazide diuretics

Back 726

Inhibit Na+/Cl- cotransport

Front 727

Site of action of thiazide diuretics

Back 727

Work at early distal convoluted tubule

Front 728

Class of drugs that may cause cross-sensitivity with thiazide diuretics

Back 728

Sulfonamides: carbonic anhydrase inhibitors, loops except EA, sulfa ab, celexocib

Hint 728

None

Front 729

SE of thiazide (HCTZ) diuretics

Back 729

Hyperuricemia, hypokalemia and hyperglycemia (high calcium opens K+ channels), sulfur allergy, alkalosis, hyperlipidemia (due to less insulin),

Hint 729

None

Front 730

Potassium sparing diuretics inhibit

Back 730

Na+/K+ exchange

Front 731

Diuretic used to treat primary aldosteronism

Back 731

Spironolactone

Front 732

SE of spironolactone

Back 732

Gynecomastia (also block steroid receptors), hyperkalemia, and impotence

Hint 732

None

Front 733

Osmotic diuretic used for increased intracranial pressure

Back 733

Mannitol

Front 734

Antidiuretic hormone (ADH) agonist and antagonist

Front 735

ADH agonist used for pituitary diabetes insipidus

Back 735

Desmopressin (DDAVP)

Front 736

Used for SIADH

Back 736

Demeclocycline (antagonist of ADH at V2 receptor)

Hint 736

None

Front 737

SE of demeclocycline

Back 737

Bone marrow and teeth discoloration (chelate with cations) for children under 8 years of age

Hint 737

None

Front 738

Antiarrhythmic agents

Front 739

MOA of class I A, class IB, and class IC antiarrhythmics
+ prototype of each class

Back 739

Ia: blocks fast Na channels in open state and K+ channels-quinidine + procainamide
Ib: block fast Na channels that are inactivated- lidocaine
Ic: block fast Na channels esp. Purkinje-Flecainide and Encainide

Hint 739

None

Front 740

SE of procainamide

Back 740

Lupus-like syndrome (slow acetylator)

Front 741

Limiting side effect of Quinidine

Back 741

Prolongs QT interval (Torsad)

Front 742

Other side effects of Quinidine

Back 742

Thrombocytopenic purpura, and CINCHONISM (autonomic side effects from M2 and alpha block)

Hint 742

None

Front 743

Major drug interaction with Quinidine

Back 743

Increases concentration of Digoxin (will displace digoxin from tissue binding sites)

Hint 743

None

Front 744

MOA of class 1a

Back 744

blocks activated Na channels and also blocks K channels

Front 745

Treating Pt. for A fib with quinidine, what needs to be done first

Back 745

Initial digitalization to slow AV conduction becuase due to M2 block quinidine inc. heart rate and AV conduction

Hint 745

None

Front 746

Proarrythmic effects of quinidine

Back 746

M block, alpha block

Front 747

Class 1a effect on AP and ERP

Back 747

Increase both

Front 748

DOC for management of acute Ventricular arrhythmias

Back 748

Lidocaine, least cardiotoxic of all

Front 749

MOA class 1B drugs

Back 749

Block inactivated Na channels, preferring hypoxic tissue (minor affect on normal)

Front 750

Affect of 1B on APD

Back 750

decrease, bringing ischemic tissue back to speed

Front 751

IB drugs given orally

Back 751

Mexiletine and Tocainide

Front 752

DOC for digoxin induced arrhythmias

Back 752

Phenytoin: sometimes classified as a class IB antiarrhythmic agent

Hint 752

None

Front 753

SE of phenytoin

Back 753

Gingival hyperplasia

Front 754

Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial), therefore are used as last line agents

Back 754

Class IC (flecainide, encainide, propafenone, moricizine)

Front 755

Class II antiarrhythmics are

Back 755

B-blockers

Front 756

Antiarrhythmic that exhibits Class II and III properties

Back 756

Sotalol: has two enantiomers one for beta and one for potassium channels

Hint 756

None

Front 757

Side effect of sotalol

Back 757

prolongs QT and PR interval

Front 758

Used intravenously for acute arrhythmias during surgery

Back 758

Esmolol: by dec. cAMP decreases sodium and calcium currents and AV node particularly sensitive

Hint 758

None

Front 759

Anti-arrhythmics that decrease mortality

Back 759

B-blockers

Front 760

MOA of class III antiarrhythmics

Back 760

Potassium channel blockers, slow phase 3

Front 761

Class III antiarrhythmic that exhibits properties of all 4 classes

Back 761

Amiodarone

Front 762

Specific pharmacokinetic characteristic of amiodarone

Back 762

Prolonged half-life, up to six weeks (iodine slowly metabolized, may become antigenic)

Front 763

Antiarrhythmic effective in most types of arrhythmia

Back 763

Amiodarone

Front 764

SE of Amiodarone

Back 764

Dysfunction, photosensitivity, skin (blue smurf syndrome) because iodine reacts withs starches, Pulmonary fibrosis, thyroid and corneal deposits

Hint 764

None

Front 765

MOA of class IV antiarrhythmics

Back 765

Calcium channel blockers, dec. activity nodes, dec. slope phase 4

Front 766

SE of class IV agents

Back 766

Constipation, dizziness, AV block, CI with Beta blocker or digoxin and hypotension

Hint 766

None

Front 767

Class IV drugs used

Back 767

Verapamil, Diltiazem

Front 768

Life threatening cardiac event that prolong QT leads to

Back 768

Torsades de pointes

Front 769

Agent to treat torsades de pointes

Back 769

Magnesium sulfate

Front 770

Drug used supraventricular arrhythmias

Back 770

Digoxin: due to parasympathomimetic effect

Hint 770

None

Front 771

DOC for paroxysmal supraventricular tachycardia (PSVT) + AV nodal arrythmias

Back 771

Adenosine: activates A receptors = Gi coupled dec. in cAMP = inc. K + efflux = membrane hyperpolarization

Hint 771

None

Front 772

Adenosine's MOA

Back 772

Activates acetylcholine sensitive K+ channels in SA and AV node causing hyperpolarization

Front 773

Anti-arrhythmic with 15 second duration of action

Back 773

Adenosine

Front 774

Vasodilators and treatment of angina

Front 775

MOA of sildenafil (Viagra)

Back 775

Inhibits phosphodiesterase-5, enhancing effects of nitric oxide-activated increases in cGMP because it prvents PD5 from converting cGMP to GMP

Hint 775

None

Front 777

Drugs used in the management of angina

Back 777

Aspirin, Nitrates, CCB, and Beta blockers

Front 778

Aspirin reduces mortality in unstable angina by

Back 778

Platelet aggregation inhibition

Front 779

MOA of nitrates

Back 779

Relax vascular smooth muscle by activating guanylyl cyclase to from cGMP = promotes the dephosphorylation of myosin light chani phosphate preventing interaction with actin.

at low doses dilate veins and at high doses dilate arterioles

Hint 779

None

Front 780

Nitrate used for acute anginal attacks

Back 780

Nitroglycerin sublingual tablets

Front 781

Nitrate used to prevent further attacks

Back 781

Oral and transdermal forms of nitroglycerin

Front 782

Nitrate free intervals are needed due to

Back 782

Tolerance: cysteine gets used up

Hint 782

None

Front 783

SE of nitrates

Back 783

Postural hypotension, reflex tachycardia, hot flashes, and throbbing headache due to meningeal artery dilation

Front 784

CCB are DOC for

Back 784

Prinzmetal's angina

Front 785

Beta blockers are used for which type of anginal attack

Back 785

Classic

Front 786

Drugs used to treat CHF

Front 787

MOA of Cardiac glycosides (eg. digoxin)

Back 787

Indirectly increase intracellular calcium and cardiac contractility by inhibit Na+/K+ ATPase, this keeps higher Na in the cell so Ca/Na pump will not work

Hint 787

None

Front 789

Digoxin is used in

Back 789

Atrial fibrillation and CHF

Front 790

Digoxin toxicity can be precipitated by

Back 790

Hypokalemia: Potassium complets with digoxin for binding spots
also hypomagnesemia, hypercalcemia, quinidine, NSAID, amiodarone, verapamil, sympathomimetics, erthromycin

Hint 790

None

Front 791

Antidote for digoxin toxicity

Back 791

Digibind: antibody to digoxin

Hint 791

None

Front 792

Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects

Back 792

Amrinone and milrinone

Front 793

SE of amrinone

Back 793

Thrombocytopenia

Front 794

Beta 1 agonists used in acute CHF

Back 794

Dobutamine and dopamine: inc. cAMP = protein kinase A activatoin of Calcium channel

Hint 794

None

Front 795

Diuretics work in CHF by

Back 795

Reducing preload

Front 796

Beta blockers work in CHF by

Back 796

Reducing progression of heart failure (never use in acute heart failure)

Front 797

Agent used in CHF that is a selective alpha and nonselective beta blocker

Back 797

Carvedilol

Front 798

Agent used in acutely decompensated CHF resembling natriuretic peptide

Back 798

Nesiritide (Natrecor): recombinant BNP. has guanylate cyclase activity, inc. cGMP, relaxes SM of arterioles and veins. Also causes diuresis.

Hint 798

None

Front 799

Drugs used in coagulation disorders

Front 800

Vitamin K dependent anticoagulant

Back 800

Warfarin (PT)

Front 801

Warfarin is contraindicated in

Back 801

Pregnancy

Front 802

Anticoagulant of choice in pregnancy

Back 802

Heparin

Front 803

Heparin (PTT) increases activity of

Back 803

Antithrombin 3

Front 804

Route of administration of warfarin

Back 804

Oral

Front 805

Routes of administration of heparin

Back 805

IM (only LMW) and IV

Front 806

SE of both warfarin and heparin

Back 806

Bleeding

Front 807

SE of heparin

Back 807

Heparin induced thrombocytopenia (HIT): some people produce an Ab that binds to complex heparin + platelet factor 4

Hint 807

None

Front 808

Alternative anticoagulant used if HIT develops

Back 808

Lepirudin and argatroban: binds to the active sites of thrombin and sthrombin substrates.

Hint 808

None

Front 809

Antidote to reverse actions of warfarin

Back 809

Vitamin K or fresh frozen plasma

Front 810

Antidote to reverse actions of heparin

Back 810

Protamine sulfate: is a basic compound so binds to acidic heparine (high arginines)

Hint 810

None

Front 811

MOA of aspirin

Back 811

Irreversibly blocking cyclooxygenase

Front 812

Agent used to treat MI and to reduce incidence of subsequent MI

Back 812

Aspirin

Front 813

SE of Aspirin

Back 813

GI bleeding

Front 814

Antiplatelet drug reserved for patients allergic to aspirin

Back 814

Ticlopidine + Clopdogrel: irreversible inhibition of ADP receptor and ADP mediated platelet aggregation

Hint 814

None

Front 815

SE for ticlopidine

Back 815

Neutropenia and agranulocytosis

Front 816

Effective in preventing TIA's

Back 816

aspirin, Clopidogrel and ticlopidine

Hint 816

None

Front 817

Prevents thrombosis in patients with artificial heart valve

Back 817

Dipyridamole

Front 818

Block glycoprotein IIb/IIIa involved in platelet cross-linking

Back 818

Abciximab, tirofiban and eptifibatide

Front 819

MOA of thrombolytics

Back 819

Degradation of fibrin clots (takes plasminogen to plasmin) and are administered

Hint 819

None

Front 820

Thrombolytics are used for

Back 820

Pulmonary embolism and DVT

Front 821

Thrombolytic that can cause allergic reaction

Back 821

Streptokinase: Pt. with previous streptokinase infection may have made antibodies

Hint 821

None

Front 822

Thrombolytic used for acute MI and ischemic (non hemorrhagic) CVA

Back 822

Tissue plasmin activator

Front 823

SE of tPA

Back 823

Cerebral hemorrhage

Front 824

Antidote for thrombolytics

Back 824

Aminocaproic acid: inhibit plasminogen activation

Hint 824

None

Front 825

Agents used in anemias and hematopoietic growth factors

Front 826

Agent to treat hypochromic microcytic anemias

Back 826

Ferrous sulfate

Front 827

Chelating agent used in acute iron toxicity

Back 827

Deferoxamine

Front 828

Agent for pernicious anemia

Back 828

Cyanocobalamin (Vit B12)

Front 829

Agent used for neurological deficits in megaloblastic anemia

Back 829

Vitamin B12

Front 830

Agent used for megaloblastic anemia (but does NOT reverse neurologic symptoms) and decrease neural tube defects during pregnancy

Back 830

Folic acid

Front 831

Agent used for anemias associated with renal failure

Back 831

Erythropoietin

Front 832

Agent used neutropenia especially after chemotherapy

Back 832

G-CSF (filgrastim) and GM-CSF (sargramostim)

Front 833

Treatment of patients with prior episodes of thrombocytopenia after a cycle of cancer chemotherapy

Back 833

Interleukin 11 (oprelvekin)

Interleukin eleven (IL-11) is a thrombopoietic growth factor that directly stimulates the proliferation of hematopoietic stem cells and megakaryocyte progenitor cells and induces megakaryocyte maturation resulting in increased platelet production

Hint 833

None

Front 834

Antihyperlipidemics

Front 835

Decrease intestinal absorption of cholesterol

Back 835

Bile acid-binding resins:cholestyramine, colestipol, colesevelam

Ezetimibe

Hint 835

None

Front 836

Cholestyramine and colestipol are

Back 836

Bile acid-binding resins

Front 837

Major nutritional side effect of bile acid-binding resins

Back 837

Impair absorption of fat soluble vitamin absorption (A,D,E,K)

Front 838

Mechanism of statins

Back 838

inhibits HMG COA reductase

Hint 838

None

Front 839

Name the important statins

Back 839

Prodrugs: lovastatin and simvastatin
others: atorvastatin, pravastatin, fluvastatin

Hint 839

None

Front 840

HMG CoA reductase inhibitors are contraindicated in

Back 840

Pregnancy

Front 841

Drug or foods (grapefruit juice) that increase statin effect mechanism of

Back 841

Inhibit Cytochrome P450 3A4

Hint 841

None

Front 842

SE of HMG COA reductase inhibitors

Back 842

Rhabdomyolysis and Hepatotoxicity

Front 843

Monitoring parameter to obtain before initiation of STATINS

Back 843

LFT's

Front 844

Decreases liver triglycerol synthesis

Back 844

Niacin

Front 845

SE of niacin

Back 845

Cutaneous flush: can pretreat with NSAID

Hint 845

None

Front 846

Name the fibrates

Back 846

Gemfibrozil, Fenofibrate, Clofibrate

Hint 846

None

Front 847

Fibrates (gemfibrozil) increase activity of

Back 847

Lipoprotein lipase by activating PPAR

Hint 847

None

Front 848

Most common SE of fibrates

Back 848

Nausea

Front 849

Fibrates are contraindicated in

Back 849

Pregnancy

Front 850

Concurrent use of fibrates and statins increases risk of

Back 850

Rhabdomyolysis

Front 851

New class of drugs that works by inhibiting absorption of intestinal cholesterol and can be given concurrently with the Statins

Back 851

Ezetimibe (Zetia)

Front 852

NSAIDS and DMARDS

Front 853

MOA of NSAIDS

Back 853

inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)

Front 854

Difference between aspirin and other NSAIDS

Back 854

Aspirin irreversibly inhibits cyclooxygenase

Front 855

Four main actions of NSAIDS

Back 855

Anti-inflammatory, analgesia, antipyretic and antiplatelet activity

Front 856

Agent used for closure of patent ductus arteriosus

Back 856

Indomethacin

Front 857

Aspirin is contraindicated in children with viral infection

Back 857

Potential for development of Reye's syndrome

Front 858

SE of salicylates

Back 858

Tinnitus, GI bleeding

Front 859

NSAID also available as an ophthalmic preparation

Back 859

Diclofenac

Front 860

NSAID available orally, IM and ophthalmically

Back 860

Ketoralac: used mainly for analgesia not for anti-inflammatory

Hint 860

None

Front 861

NSAID that is used for acute condition, such as pre-op anesthesia and has limited duration (<5 days) of use due to nephrotoxicity

Back 861

Ketoralac

Front 862

Newer NSAIDs that selectively inhibit COX-2

Back 862

Celecoxib and rofecoxib

Front 863

COX 2 inhibitors may have reduced risk of

Back 863

Gastric ulcers and GI Bleeding

Front 864

COX 2 inhibitors should be used cautiously in pts with

Back 864

Pre-existing cardiac or renal disease

Front 865

Acetaminophen only has

Back 865

Antipyretic and analgesic activity

Front 866

SE of acetaminophen

Back 866

Hepatotoxicity

Front 867

Antidote for acetaminophen toxicity

Back 867

N-acetylcysteine: Acetylcysteine is the N-acetyl derivative of the amino acid L-cysteine, and is a precursor in the formation of the antioxidant glutathione in the body. The thiol (sulfhydryl) group confers antioxidant effects and is able to reduce free radicals.

Hint 867

None

Front 868

Drugs-Modifying Anti-Rheumatic Agents (DMARDS)

Front 869

DMARDs are slow acting drugs for

Back 869

Rheumatic disease

Front 870

MOA of gold salts

Back 870

Alter activity of macrophages and suppress phagocytic activity of PMNs

Front 871

SE of gold salts

Back 871

Dermatitis of the mouth aplastic anemia and agranulocytosis

Front 872

Causes bone marrow suppression

Back 872

Methotrexate

Front 873

SE of penicillamine

Back 873

Aplastic anemia and renal

Front 874

Interferes with activity of T-lymphocytes

Back 874

Hydroxychloroquine

Front 875

Anti-malarial drug used in rheumatoid arthritis (RA)

Back 875

Hydroxychloroquine

Front 876

SE of hydroxychloroquine

Back 876

Retinal destruction and dermatitis

Front 877

MOA of Leflunomide (newer agent)

Back 877

Inhibiting Dihydroorotate Dehydrogenase which leads to decreased pyrimidine synthesis

Cell is stuck in G1 phase

Hint 877

None

Front 878

Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)

Back 878

Infliximab and etanercept and Adalimumab

Hint 878

None

Front 879

Anti-rheumatic agent also used for ulcerative colitis

Back 879

Sulfasalazine: dec. rheumatoid factor

Hint 879

None

Front 880

Drugs used in Gout

Front 881

NSAIDS used in gout

Back 881

Indomethacin and phenylbutazone

Front 882

NSAID contraindicated in gout

Back 882

Aspirin: can inhibit the secretion of uric acid

Hint 882

None

Front 883

SE of phenylbutazone

Back 883

Aplastic anemia and agranulocytosis

Front 884

MOA of Colchicine (used in acute gout)

Back 884

Selective inhibitor of microtubule assembly by binding to tubulin

Hint 884

None

Front 885

SE of colchicine

Back 885

Kidney and liver toxicity

Front 886

Agent used to treat chronic gout by increasing uric acid secretion

Back 886

Probenecid and sulfinpyrazone: these are weak organic acids that inhibit the urate-anion exchanger in the prox convuluted tubule

Hint 886

None

Front 887

Allopurinol treats chronic gout by inhibiting

Back 887

Xanthine oxidase: xanthine and hypoxanthine are more soluble

Hint 887

None