Pharm-Fa

Front 1

Vd= ?

-drugs with low Vd distribute where?
-medium Vd?
-high Vd?

Back 1

Vd=(amt of drug in body)/(plasma drug conc)

-low Vd==>plasma
-med Vd==>extracellular space
-high Vd==>tissue

Front 2

Clearance of drug =

Back 2

Cl of drug

= (drug elimination rate)/(plasma drug conc)

=Vd x Ke (elimination constant)

Front 3

drug half-life

Back 3

=time req to change amt of drug in body by 1/2 during elimination or during constant infusion

half-life = (0.7 x Vd)/Cl

Front 4

how fast does drug infused at constant rate reach steady state?

Back 4

drug infused at constant rate will reach 94% of steady state in 4 half-lives.

1 half life= 50%
2 half lives=75%
3 half lives=87.5%
3.3 half lives=90%
4 half-lives=94%

Front 5

loading dose=

-what happens in pts w/impaired renal or hepatic fxn?

Back 5

[target plasma] * Vd/F

(F=bioavailability=1 via iv)

-in pts w/impaired renal or hepatic fxn, loading dose is the same (b/c Vd is the same), but maintenance dose is decr (b/c Cl is decreased)

Front 6

maintenance dose=

-what happens in pts w/impaired renal or hepatic fxn?

Back 6

[target plasma] * Cl/F

(F=bioavailability=1 via iv)

-in pts w/impaired renal or hepatic fxn, loading dose is the same (b/c Vd is the same), but maintenance dose is decr (b/c Cl is decreased)

Front 7

drugs w/zero-order elimination?

Back 7

(at high/toxic doses) ethanol, phenytoin, aspirin

Front 8

most drugs are elimination by zero or first order elimination?

Back 8

first order (constant FRACTION (vs. amount) eliminated per unit time)

zero order=(at high/toxic doses) ethanol, phenytoin, aspirin

Front 9

what receptor and G protein:

increases VSM contraction

Back 9

a1 & V1

q (for both)

"HAV 1 M&M3, q"

Front 10

what receptor and G protein:

decr sympathetic outflow?

Back 10

a2

i (MAD2's "i"nhibit cAMP)

Front 11

what receptor and G protein:

decr insulin release

Back 11

a2

i (think "i" for "i"nhibit):

"MAD 2's [M2, A2, D2] inhibit cAMP"

Front 12

what receptor and G protein:

incr HR

Back 12

B1

s (think "s" for "s"timulate)

Tip: if the receptor not in the other mneumonics ["HAVe 1 M&M3, 'q' "==>Gq] or [MAD2's==>Gi], then the receptor is linked to Gs

Front 13

what receptor and G protein:

incr cardiac contractility

Back 13

B1

s (think "s" for "s"timulate)

Front 14

what receptor and G protein:

incr renin release?

Back 14

B1

s

Tip: if the receptor not in the other mneumonics ["HAVe 1 M&M3, 'q' "==>Gq] or [MAD2's==>Gi], then the receptor is linked to Gs

Front 15

what receptor and G protein:

incr lipolysis

Back 15

B1

s (think "s" for "s"timulate)

Front 16

what receptor and G protein:

aq humor formation

Back 16

B1

s (think "s" for "s"timulate)

Front 17

what receptor and G protein:

vasodilate

Back 17

B2

s

Front 18

what receptor and G protein:

bronchodilate

Back 18

B2

s

Front 19

what receptor and G protein:

incr glucagon release

Back 19

B2

s

Front 20

what receptor and G protein:

CNS

Back 20

M1 (muscarinic): q

D2: i

Front 21

what receptor and G protein:

decr HR

Back 21

M2 (muscarinic)

i (MAD2's "i"nhibit)

Front 22

what receptor and G protein:

incr exocrine gland secretions

Back 22

M3

q

Front 23

what receptor and G protein:

relax renal VSM

Back 23

D1

s

Tip: if the receptor not in the other mneumonics ["HAVe 1 M&M3, 'q' "==>Gq] or [MAD2's==>Gi], then the receptor is linked to Gs

Front 24

what receptor and G protein:

modulates transmitter release, esp in brain

Back 24

D2

i

Front 25

what receptor and G protein:

incr nasal and bronchial mucus production

Back 25

H1

q

Front 26

what receptor and G protein:

contract bronchioles

Back 26

H1

q

Front 27

what receptor and G protein:

pruritis

Back 27

H1

q

Front 28

what receptor and G protein:

pain

Back 28

H1

q

Front 29

what receptor and G protein:

incr gastric acid secretion

Back 29

H2

s

Front 30

what receptor and G protein:

incr VSM contraction

Back 30

a1: q

V1: q

Front 31

what receptor and G protein:

incr H2O permeability and reabs in kidney CT

Back 31

V2

s

Front 32

which G-proteins linked to which autonomic receptor

Back 32

"HAV 1 M&M3, queer"==>Gq
(H1, A1, V1, M1, M3)

"MAD 2's"==>Gi (MAD2's "i"nhibit cAMP)
(M2, A2, D2)

the other receptors are Gs


a1: q
a2: i
B1: s
B2: s
M1: q
M2: i
M3: q

D1: s
D2: i
H1: q
H2: s
V1: q
V2: s

menum: "qiss" (kiss) and "qiq" (kick) til you're "siq" (sick) of "sqs" (sex)

"kiss & kick" refer to a1,a2,B1,B2,M1,M2,M3

"sick & sex" refer to D1,D2,H1,H2,V1,V2

Front 33

Tx postoperative and neurogenic ileus

Back 33

1. bethanochol (-Direct muscarinic agonist, resistant to AchE)

"B"ethanochol stimulates "B"ladder (Tx urinary retention) & "B"owel SmM


2. Neostigmine

Front 34

carbachol

Back 34

-Direct muscarinic agonist

CHOL=PSNS effect

Tx (eye stuff):

-glaucoma/release IOP
-cause pupillary contraction (makes sense; PSNS effect)

Action:
-contracts ciliary muscle (open angle) & pupillary sphincter (narrow angle)
==>incr AH outflow
-resistant to AchE

mneum: Tell a diabetic, "Don't eat too many CARBs, or you'll get glaucoma!

Front 35

challenge test to Dx asthma

Back 35

-Direct muscarinic agonist

an asthmatic "MET COLE" (Methacholine) and he took her breath away (Dx asthma)

action: stimulates muscarinic receptors==>contract bronchial SmM==>asthmatics can't breathe

Front 36

pilocarpine

Back 36

-Direct muscarinic agonist

potent stimulator of tears, saliva, sweat

Action: stimulates muscarinic receptors in airway when inhaled

mneum: when I smell a PILE OF CARP (carp=fish), it makes me salivate, sweat, and cry

Front 37

cholinomimetics that are resistant to AchE

Back 37

direct cholinomimetics:

-Bethanochol
-Carbochol
-Methacholine
-Pilocarpine

(see FA for my narrative)

Front 38

Anticholinesterases

Back 38

=Indirect Muscarinic Agonists
(Anticholinesterases==>incr endogenous Ach)

-NeoSTIGMINE (Tx MG/NMB reversal)
-PyridoSTIGMINE (Tx MG)
-Edrophonium (Dx MG)
-PhysoSTIGMINE (Tx Glaucoma (cross BBB==>CNS) & atropine OD; PHYSostigmine is PHYSically fit and can cross BBB AND overpower atropine, defeating NEO)
-Echothiophate (Echothiophate is a huge admirer of physostigmine and "ECHOes" what physostigmine does: Tx glaucoma)

Front 39

Neostigmine

Back 39

NEO from The Matrix stays, "I will "STIck MINE" ("stigmine") my great manhood/penis into 3 situations to defeat the great AchE:
1. the NMJ: to rescue the poor person with MG
2. the NMJ: to reverse NMB (postoperative)
3. the GI/urinary tract (he really goes all out): to get the bowel and bladder going (Tx post-op/neurogenic ileus & urinary retention)

-sadly, Neo is actually impotent, so he cannot PENETRATE (ha!) the CNS

Front 40

Tx MG

Back 40

(both are indirect ACh agonists AKA they are anticholinesterases)

1. neostigmine (does not penetrate CNS; NEO is impotent, so he can't penetrate)

2. Pyridostigmine: DOES penetrate CNS==>incr strength
(the PYRAmids are STRONG enough to penetrate the CNS and give some of their STRENGTH to ppl with MG)

Front 41

Dx MG

Back 41

Edrophonium (extremely short acting)

=indirect ACh agonist AKA anticholinesterase

Front 42

Tx glaucoma

Back 42

I. alpha agonists:
1. Epi--incr AH outflow
2. Brimonidine--decr AH syn
("Ramona" (~BRIMONIdine), the lazy child (DECR AH synthesis) took her grandma's EPI and is now hyper (INCR AH outflow.)

II. B-blockers (decr AH secretion)
1. timOLOL
2. betaxOLOL
3. carteOLOL

III. Acetozolamide (inhibit CA==>decr bicarb==>decr AH secretion)

IV. PROSTAGLANDIN= LatanoPROST (incr AH outflow)
-S/E= darkens color of iris (browning) [mneum: "Latins" (Latano) have brown skin]

V. ACH AGONISTS (all incr AH outflow; contract ciliary muscle==>open canal of Schlemm)

IVa. Carbachol & Pilocarpine (direct Ach agonists; use Pilocarpine in emergencies)

IVb. Physostigmine & Echothiophate (indirect ACh agonists AKA anticholinesterase==>incr endogenous ACh)

Front 43

Tx parathion poisoning

Back 43

parathion=OP poison (anti-cholinerase==>incr PSNS)

Tx with atropine (musc antag) + pralidoxime (regenerates active cholinesterase)

Front 44

Rx that produce mydriasis and cycloplegia

Back 44

these are SNS effects, so what causes this are Ach-R blockers:

1. aTROPIne
2. homaTROPIne
3. TROPICamide

Atropine and his HOMO gay twin brother, HOMOatropine, went to the TROPICs together to do ecstasy==>mydriasis and cycloplegia==>awesome gay sex

Front 45

Tx Park

Back 45

benztropine (poor Ben Brenners has Parkinson's).

[benzTROPINE~aTROPINE, so it's a Ach-R blocker==>incr SNS)

Front 46

Tx motion sickness

Back 46

scopolamine (you get seasick on a SHIP (~SCOP))

=Ach-R blocker

Front 47

Tx Asthma, COPD

Back 47

Ipratropium

(Ipra, a young black girl slave, went with the white family to the TROPICs: the old, fat white father with COPD & the bratty white boy with asthma)

Front 48

-reduce urgency in mild cystitis
-reduce bladder spasms

Back 48

(all are Ach-R blockers):

1. methscopolamine:
scopolamine prevents stuff from coming out your mouth (prevents vomiting; Tx motion sickness), so methscopolamine prevents stuff from coming out your pee-hole

2. oxybutin (an old medical method of Tx urinary incontinence is to stick OXYgen IN your BUTt; I guess they got the holes confused)

3. glycopyrrolate


Narrative for Ach-R blockers:
Ship ("scop") covered with methyls (thus "methscop", which is ~scopalamine, which we know is an Ach-R blocker) puts OXYgen up INto its ship BUTt hole (OXYBUTIN) to prevent "sugar pirates" (GLYCOPYROlate; GLYCO=sugar, PYRO=pirate) from leaking out (like pee)

Front 49

what can cause:

-acute angle-closure glaucoma in eldery
-urinary retention in BPH
-hyperthermia in infants

Back 49

atropine (musc antag)

Hot as a Hare
Dry as a Desert
Red as a Beet
Blind as a Bat (gluacoma; cycloplegia)
Mad as a hatter (disorientation)

Front 50

what drug prevents reflex bradycardia d/t NE

Back 50

hexamethonium (ganglion blocker; Nicotinic Ach-R blocker)

Front 51

isoproterenol

Back 51

stim B1=B2

Tx: AV block (rare)

Front 52

dobutamine

Back 52

stim B1 > B2

(doBUTAmine: BUTA ~ BETA (B1 > B2)

Uses:
-shock
-cardiac stress testing

Front 53

amphetamine Tx what

Back 53

-ADHD (I want)
-obesity (I want)
-narcolepsy

Front 54

ephedrine

Back 54

(~pseudophedrine=Sudafed)

=indirect general SNS agonist: releases stored catecholamines
(~amphetamines)

Tx:
-nasal decongestant (Sudafed)
-urinary incontinence
-hypotension

Front 55

phenylephrine

Back 55

stim a1 > a2

Tx:
-pupil dilator (ophthalmologist)
-vasoconstriction (b/c alpha)
-nasal decongestant (a1: decr bronchial gland secretions)

Front 56

Tx asthma

Back 56

alBUTerol & terBUTaline (B2 > B1)

ipratropium (Ach-R blocker)

Front 57

Tx HTN, esp w/renal dz

Back 57

-clonidine
-alpha-methyldopa

*centrally acting alpha-agonists
==>DECR adrenergic outflow
==>thus decr BP without decr RBF (b/c adrenergic outflow incr BP & decr RBF)

Front 58

alpha blockers
-nonselective
-selective

Back 58

alpha blockers:

I. Nonselective (Tx pheochromocytoma)

1. phenoxybenzamine (PBZ)=irrevers

2. phentolamine=revers


II. A1-selective (Tx HTN & urinary retention in BPH)

-prAZOSIN, terAZOSIN, doxAZOSIN


III. A2-SELECTIVE:
-Mirtazapine (Tx depression)

Front 59

Tx pheochromocytoma

Back 59

*Nonselective alpha blockers

1. phenoxybenzamine (PBZ)=irrevers

2. phentolamine=revers

S/E:
-orthostatic hypotension
-reflex tachycardia

Front 60

S/E:

orthostatic hypotension
reflex tachycardia

Back 60

*Nonselective alpha blockers

1. phenoxybenzamine (PBZ)=irrevers

2. phentolamine=revers