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102 Cards in this Set

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What neurotransmitter is depleted in a 28 y/o chemist with MPTP exposure?
Dopamine
What are the clinical manifestations of someone taking tetracycline with photosensitivity?
Rash on sun-exposed regions
What is the enzyme deficiency in someone who develops hemolytic anemia while on chloroquine?
G6PD defeciency
What causes a farmer to develop dyspnea, salivation, miosis, diarrhea, cramping and blurry vision?
pesticides, inhibit AChE
How do you treat a female with a Hx of psychiatric illness who has urinary retention from a neuroleptic?
Bethanechol
A patient with a kidney transplant is on cyclosporine for immunosuppresion. and needs an antifungal, what would cause cyclosporine toxicity?
Ketoconazole
What routine workup should be done on a patient with carbamazepine?
LFTs
Why would a girl on rifampin get pregnant despite her birth control?
Rifampin augments egen metabolism in the liver. OCs are less effective.
How do you calculate volume of distribution?
Vd=amount of drug in the body/plasma drug concentration
How do you calculate clearance?
CL=rate of elimination/plasma drug concentration
How do you calculate t1/2?
t/2=.7xVd/CL
3.3 1/2 lives-> 90% concentration
How do you calculate loading dose?
CpxVd/F
Cp is the target plasma concentration
F is the bioavailability
Renal failure does not change the loading dose
How do you calculate Maintenance dose?
CpxCL/F
Cp is the target plasma concentration
F is the bioavailability
Renal Failure decreases the maintenance dose
What is the difference between zero-order elimination and first-order elimination?
zero-order- constant rate of elim regardless of C. Ethanol, phenytoin and aspirin

First-order- Rate is dependant on concentration.
What are three drugs that are eliminated with zero-order kinetics?
EtOH
Phenytoin
Aspirin
breakdown phase I vs. phase II metabolism
Phase I- reduction, oxidation, hydrolysis-> polar, water-soluble metabolites- can be active
C-p450. Geris lose phase I first

Phase 2= acetylation, glucuronidation, sulfation- polar, inactive metabolites- renally excreted
conjugation.
How do thses affect the curve of drug action?
competative antagonist
non-competative antagonist
competative- kicks the curve to the right. decreases potency
non-competative- kicks the curve downward. decreases efficacy
Breakdown drug development.
In Vitro Studies- 2 years
Animal testing- 2 years
Clinical testing- 4 yrs
Marketing and surveillance- 10 yrs
Generics
What are the differences between Phase 1, 2, 3, 4 trials?
1- is it safe?
2- does it work in patients?
3- does it work , double blind?
4- postmarketing surveillance
What type of G-protein is alpha1?
q- increased vascular smooth muscle contraction
What is the type of G-protein is alpha2?
i- decreased outflow, decreased insulin
What is the type of G-protein is B1?
s- increase heart rate, contractility, renein release, lipolysis, aqueous humor formation
What is the type of G-protein is B2?
s- Vasodilation, bronchodilation, Increase glucagon release
What is the type of G-protein is M1?
q- CNS
What is the type of G-protein is M2?
i- Decreased heart rate
What is the type of G-protein is M3?
q- Increased exocrine gland secretions
What is the type of G-protein is D1?
s- relaxes renal vascular smooth muscle
What is the type of G-protein is D2?
i- modulates transmitter release in the brain
What is the type of G-protein is H1?
q- Increase nasal and bronchial mucus production, contraction of bronchiles, pruritus, and pain
What is the type of G-protein is H2?
s- increase gastric acid secretion
What is the type of G-protein is V1?
q- increase vascular smooth muscle contraction
What is the type of G-protein is V2?
s- increase of H2O permeability and reabsorption in the collecting tubules of the kidney
What is the mechanism of action of Gq?
Phospho C-> PIP-> IP3->increased Ca
or DAG->protein kinase C
What is the mechanism of action of Gs?
Adenylcyclase-> increase cAMP -> Protein kinase A
What is the mechanism of action of Gi?
inhib of Adenylcyclase-> decrease in cAMP-> decreased Protein kinase A
Which receptors are Gq?
every1 but DB
a1, M1, H1, V1
M3
Which receptors are Gs?
B1, B2, D1
H2, V2
Which receptors are Gi?
A2, M2, D2
What drugs end in afil?
erectile dysfunction drugs
sildenafil
What drugs end in ane?
inhalation general anesthetics
halothane
What drugs end in azepam?
Bezodiazepines
What drugs end in Azole?
antifungals
what drugs end in barbital?
Barbituates
what drugs end in cycline?
AAbtics, protein synthesis inhibitors
What drugs end in ipramine
TCA
What drugs end in navir?
protease inhibitors
What drugs end in olol?
B-antags
What drugs end in operidol?
Butyrophenone (neuroleptic)
Haloperidol
What drugs end in oxin?
cardiac glycoside
What drugs end in phylline?
methylxanthine
Theophylline
what drugs end in pril?
ace inhibitors
what drugs end in terol
B2 agonists
albuterol
what drugs end in tidine?
H2 antagonists
what drugs end in triptyline?
TCA
what drugs end in tropin?
pituitary hormone
what drugs end in zosin
alpha1 antagonists
What is Echinacea used for?
What toxicities does it have?
Common cold
GI distress, dizziness, headache
What is Ephedra used for?
What toxicities does it have?
ephedrine
CNS adn CV stimulation, arrythmias, stroke, seizures
What is Feverfew used for?
What toxicities does it have?
Migraines
GI distress, mouth ulcers, antiplatelets
What is Ginkgo used for?
What toxicities does it have?
Intermittent claudication
GI distress, anxiety, insomnia, headache, antiplatelet actions
What is Kava used for?
What toxicities does it have?
Chronic Anxiety
GI distress, sedation, ataxia, hepatotoxicity, phototoxicity, dermatotoxicity
What is Milk Thistle used for?
What toxicities does it have?
Viral hepatitis
loose stools
What is Saw palmetto used for?
What toxicities does it have?
Benign prostatic hyperplasia
GI distress, decreased libido, hypertension
What is St. John's wort used for?
What toxicities does it have?
depression
GI distress, phototoxicity, serotonin syndrome, inhibits p450
What is Dehydroepiandrosterone used for?
What toxicities does it have?
Sx of SLE and AIDs for females
Androgenization (premenopausal)
estrogenic (post menopausal)
feminization (young men)
What is melatonin used for?
What toxicities does it have?
Jet lag, insomnia
Sedation, suppresses midcycle LH,
HypoPRL
What drugs induce cP450?
Queen Barb takes Phen-phen and Refuses Greasy Carbs
Quinidine
Barbiturates
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
What drugs inhibit cP450?
Ihibitors Stop Cyber-Kids from Eating GrapefruitS
Isoniazid
Sulfonamides
Cimetidine
Ketoconazole
Erythromycin
Grapefruit juice
St. Johns wort
What is the antidote for Acetaminophen OD?
N-acetylcysteine
What is the antidote for Salicylates OD?
Alkalinize urine, dialysis
What is the antidote for Anticholinesterases, organophosphates OD?
Atropine, pralidoxime
What is the antidote for Antimuscarinic, anticholinergic OD?
Physostigmine salicylate
What is the antidote for B-blockers OD?
Glucagon
What is the antidote for Digitalis OD?
Stop dig, normalize K, lidocaine, anti dig Fab fragments, Mg2+
What is the antidote for Iron OD?
Deferoxamine
What is the antidote for Lead OD?
CaEDTA, dimercaprol, succimer, penicillamine
What is the antidote for Arsenic, mercury, gold OD?
Dimercaprol, succimer
What is the antidote for Copper, arsenic, gold?
Penicillamine
What is the antidote for Cyanide?
Nitrite, hydroxocobalamin thiosulfate
What is the antidote for Methemoglobin?
Methylene blue
What is the antidote for CO?
100% O2, hyperbaric O2
What is the antidote for Methanol, ethylene glycol
Ethanol, dialysis, fomepizole
What is the antidote for Opioids?
Naloxone/naltrexone
What is the antidote for benzodiazepines
Flumazenil
What is the antidote for TCAs?
NAHCO3
What is the antidote for Heparin?
Protamine
What is the antidote for Warfarin?
Vit K, plasma
What is the antidote for tPA, streptokinase?
Aminocaproic acid
What are signs of lead poisoning?
LEAD
Lead Lines on gingivae and epiphyses of long bones on x-ray
Encephalopathy and Erythrocyte basophilic stippling
Abdominal colic and sideroblastic Anemia
Drops- wrist and foot drop. Dimercaprol and EDTA 1st line of treatment.

Sucks to be a kid
Succimer for kids
What are the effects of urine pH on drug elimination?
Weak acids- phenobarbital, methotrexate, aspirin
clearance can be increased if urine is alkalinized with bicarbinate to increase clearance.

Weak bases (amphetamines) acidify urine to increase clearance (give NH4Cl)
What is the role of alcohol dehydrogenase?
converts ethylene glycol to Oxalic acid-> Acidosis, nephrotoxicity

converts methanol to formaldehyde and formic acid-> Severe acidosis, retinal damage

converts ethanol to Acetaldehyde-> nausea, vomiting, headache, hypotension

These all compete for ADH, Ethanol has the highest affinity.
What happens to Acetaldehyde in alcohol breakdown?
Acetaldehyde dehydrogenase breaks it down into acetic acid

This is inhibited by disulfiram
What are the Sx of salicylate toxicity?
dizziness, hearing impairment, tinnitus
leads to vomiting, hyperventilation, flushing, sweating, tachycardia, etc

Acidic urine decreases the elimination of salicylate. NH3Cl is one that acidifies urine
what changes would CaCO3 do to urine?
alkanize
What would bicarb do to urine?
alkanize
what would sodium lactate do to urine?
alkanize
What is the mechanism of action of erythromycin?
translocation of a growing peptide chain along the mRNA
What is the mechanism of action of chloramphenicol?
inhibs ribosomal peptidyl transferase
what is the mechanism of action of cyclohexamide?
inhibs ribosomal peptidyl transferase
What is the mechanism of action of puromycin?
ihibits elongation by binding to the A site
What is the mechanism of action of streptomycin?
causes misreading of the code in prokaryotes
what is the mechanism of action of tetracyclines?
acts on prokaryotes to prevent binding of the t-RNA to the ribosome