Pharm Part 2

Front 1

what inhibits activated X?

Back 1

1) LMWHeparin
2) fondaparinux

Front 2

what is HIT?

Back 2

type 2:
heparin assoc. with platelet factor 4 protein--> IgG binds with this and forms immune complexes --> causes platelet degranulation and more PF4 release-->more IC's form=> THROMBOCYTOPENIA and THROMBOSIS

Front 3

Heparin (UFH) MOA?

Back 3

stimulates ANTITHROMBIN III to work faster and inhibit thrombin

* doesn't inhibit thrombin thats already bound to fibrin =DTI's can do that

Front 4

how do you monitor heparin vs warfarin levels?

Back 4

Heparin =PPT
Warfarin= PT

Front 5

what two drug classes work on thrombin?

Back 5

Heparin- works thru ATIII to inhibit thrombin and therefore coagulation; no effect on fibrin bound thrombin

DTI's-(lepriudin,bivalirudin, argatroban) directly inhibit thrombin including fibrin-bound thrombin

Front 6

what do you treat HIT (heparin induced thrombocytopenia type II) with?

Back 6

DTI ==> can inactivate fibrin bound thrombin (can break down already formed clots)

* i.e. lepirudin, bivalirudin, argatroban

Front 7

heparin vs warfarin

Back 7

Heparin: parenteral;effective in seconds; doesn't cross placenta; , use PTT to moniter patients; both PT and PTT increased; antagonist is protamine sulfate; LMWH inhibts Xa more than ATIII

Warfarin: Oral; effective 8-12 hours later; crosses placenta; monitor with PT (think PeT="war" dog); both PT and PTT increase; antagonist is Vit.K; narrow TI

Front 8

causes of B12 def?

Back 8

pernicious anemia, partial-taotal gasterectomy; malabsorption or resection in distal ileum where B12 absorbed

Front 9

causes of folate def.?

Back 9

1) pregnancy
2) alcoholics
3) hemolytic anemia
4) liver dz
5) pts on dialysis
6) drugs (medical)

Front 10

drugs that cause folic acid def.

Back 10

1) Methotrexate, Trimethoprim, Pyrimethamine (all inhibit dihydrofolate reductase)
2)long term phenytoin use (rarely causes anemia tho)

Front 11

ferrous sulfate..oral or parenteral?

Back 11

Oral
1) ferrous sulfate
2) ferrous gluconate
3) ferrous fumarate

Parenteral
1) iron dextram
2) sodium ferric gluconate complex
3) iron sucrose

Front 12

Hydroyurea is used to treat ?

Back 12

1) Sickle Cell
2) CML
3) Polycythemia vera

*increases Fetal Hb and inhibits DNA synthesis

Front 13

Filgrastim MoA?

Back 13

G-CSF (stimulates PMN production)

Front 14

Sargramostin MoA?

Back 14

GM-CSF ( stimulates myeloid and megakaryocyte progenitors via JAK/STAT receptors)

Front 15

IL-11...?

Back 15

Megakaryocyte growth factor

Front 16

Hydroxycobalamin...?

Back 16

B12 --> cofactor for many rxns
-treats B12 megaloblastic anemia

Front 17

Adverse effects of
1) aluminum hydroxide
2) magnesium hydroxide
3) calcium carbonate

Back 17

1) AlOH -constipation
2)MgOH - diarrhea (Must Go)
3)CaCO3 - kidney stones

Front 18

which H2 blocker inhibits P450?

Back 18

Cimetidine

AE-cimetidine binds and inhibits androgen receptors- causes gynecomastia and decreases sperm count (men) and galactorrhea (women)

Front 19

Omeprazole inhibits metabolism of which drugs?

Back 19

1)Warfarin
2)Phenytoin
3)Diazepam
4)Cyclosporine

Front 20

name the Proton Pump Inhibitors

Back 20

1)Omeprazole
2)Esomeprazole

Front 21

DOC for erosive gastritis, active duodenal ulcers, long term tx of ZE syndrome?

Back 21

PPI
1)esomeproazole
2)omeprazole

Front 22

H2 antagonist MoA?

Back 22

Competitive and Reversibly blocks the H2 receptor

*histamine receptor on parietal cells of stomach; blocks 90% of acid production with single dose

Front 23

name cytoprotective drugs?

Back 23

1) Sucralfate
2) Bismuth Subsalicylate

3) Misoprostol (PGE1 analog)

*all stimulate prostaglandin, mucus and bicarb secretion

Front 24

what is contraindicated for cytoprotective agents?

Back 24

-don't take antacids or H2 antagonists b/c cytoprotective agents like bismuth subsalicylate (pepto-bismol) and sucralfate need a low (ACIDIC) pH to become activated

Front 25

where are PPI absorbed?

Back 25

- pill has an acid-resistant coat that is removed in alkaline duodenum- pro-drug is absorbed and transported into parietal cell canaliculi --> conversion to active drug

* any enteric coated tablet shouldn't be taken with antacids- coat dissolves too early causing irritation- H2 and PPI)

Front 26

GPII/III receptor antagonists?

Back 26

1)Abciximab
2)Eptifibatide
3)Tirofiban

Front 27

Tirofiban MoA?

Back 27

-blocks GPII/III receptor on platelets

*receptor normally bind fibronectin, fribrinogen, vitronectin and vWF=>for platelet aggregation

Front 28

Eptifibatide?

Back 28

GP II/III recpetor antagonist (blocks platelet aggregation)

Front 29

name ADP receptor blockers?

Back 29

1)Clopidogrel
2)Ticlopidine

Front 30

PDE Inhibitor in platelets?

Back 30

1)Dipyridamole

Front 31

Dipyridamole and Warfarin are used together in what condition/situation?

Back 31

Prophylaxis of thromboemboli in pts with prothetic heart valves

*vaso-dilation and prevention of clot formation respectively

Front 32

NSAID induced gastric ulcer tx?

Back 32

1) PPI's
2)H2 blockers
3)misoprostol

Front 33

PGE1 analog?

Back 33

Misoprostol--> PGE inhibits secretion of HCL and stimulates mucus and bicarb secretion

Front 34

what medication that is given for NSAID ulcers is C/I for pregnant patients?

Back 34

Misoprostol

* causes uterine contractions; often used as an abortive medication

Front 35

what is used to maintain PDA?

Back 35

Prostaglandins!

-misoprostol (PGE analog)

Front 36

name muscarinic agonists used to suppress acid secretion?

Back 36

1) pirenzepine
2) dicyclomine

*dont confuse dicyclomine with dipyridamole (PDE inhibitor-vasodilator)

Front 37

irreversible inhibitors of P2Y 12?

Back 37

ADP receptors (PY2 12) are blocked by
1)Clopidogrel
2)Ticlopidine

Front 38

when do you use muscarinic antagonists to prevent acid secretion?

Back 38

pirenzipine -peptic ulcers in refractory cases

dicyclomine- used in IBS

Front 39

H.Pylori regimens?

Back 39

1) PPI + clarithromycin+amoxicillan
2)PPI + clarithromycin+metronidazole
3)PPI/Ranitidine + Bismuth+ metronidazole+ tetracycline

* all 10-14 day course

Front 40

Name the Prokinectic drugs...

Back 40

1) Metoclopramide
2) Cisapride

Front 41

Metoclopramide MoA?

Back 41

D2 receptor antagonist; also mixed 5HT3 antag/5HT4 agonist

*speeds up GI
-used for diabetic gastroparesis; anti-emetic; GERD
-can cause inc. parkinsonian effects;
-C/I in pts with SI obstruction

Front 42

Cisapride ?

Back 42

-release Ach in myenteric plexus to increase muscle tone in esophageal sphincter

*used for diabetic gastroparesis (inc. gastric emptying); GERD; bowel constipation
AE: long QT syndrome ->arrthymias
with ketoconazole or erythromycin; diarrhea

Front 43

name a D2 antagonist that work in the GI?

Back 43

1)Metoclopramide

Front 44

Name a drug that increases release of ACH in the myenteric plexus of GI

Back 44

1) Cisapride

Front 45

Which GI muscarinic antagonist has poor CNS penetration?

Back 45

Pirenzepine

*muscarinics work through the M receptors on the parietal cell

Front 46

What is the difference between pirenzipine and cisapride?

Back 46

pirenzipine - muscarinic antagonist; used for refractory ulcers

cisapride - prokinectic drug that releases Ach in myenteric plexus

Front 47

what drugs are given to increase gastric emptying in diabetics?

Back 47

1) Metoclopramide
2) Cisapride

Front 48

1) which drug has long QT syndrome?
2) which added drugs predispose these pt to arrthymias?

Back 48

1)Cisapride
2) Cisapride with erythromycin or ketoconazole

*erthyro and keto are p450 inhibitors

Front 49

what treats opiod induced constipation?

Back 49

senna (with docusate)

* stimulant

Front 50

which laxative is an irritant?

Back 50

castor oil-->rincinoleic acid-->increases peristalsis

*C/I in pregnant pts

Front 51

lactulose,PEG, Mg citrate?

Back 51

osmotic laxatives

PEG- polyethylene gycol is used as coloni lavage for endoscopy/rediological procedures

Front 52

CHRONIC INGESTION OF THIS ANTACID WITH MILK CAN INDUCE MILK-ALKALI SYNDROME

Back 52

CALCIUM CARBONATE

(can result in hypercalcemic alkalosis with development of renal calculi)

Front 53

USED IN THE TX OF GERD, THIS HISTAMINE BLOCKER IN ASSOCIATED WITH GYNECOMASTIA AND GALACTORRHEA

Back 53

CIMETIDINE

(the stronger blockers, ranitidine and famotidine, don't inhibit P450 system and therefore dont cause anti-androgenic effects)

Front 54

mechanism of vomiting

Back 54

1) CTZ of area postrema->outside BBB so can respond to chemicals in blood/CSF
2)vomiting center in medulla-->coordinates motor mechanism of vomiting-->responds from afferent imput from vestibular system,GI, pharynx

Front 55

HI antagonists..?

Back 55

1)dimenhydrinate
2)meclizine
3)cyclizine

Front 56

Procholoroperazine MoA?

Back 56

class of drug: phenothiazines
- D2 blocker (also metoclopramide)

Front 57

Emetic Neurotransmitters..?

Back 57

1)dopamine -->D2 receptors
2) Serotonin --> 5HT3
3)Vagal --> Ach
4)Neurokinin/Sub P in CNS

Front 58

what do metoclopromide and prochorperazine have in common?

Back 58

both are D2 blockers

*metoclopromide--> effective against cisplastin which is highly emetogenic; also GERD,Diabetic gastroparesis
prochloroperazine--> used for low/moderate CHEMO vomiting

Front 59

Tx of motion sickness?

Back 59

1)scopolamine
2)dimenhydrinate
3)meclizine
4)cyclizine

Front 60

Chemotherapy anti emetics?

Back 60

1)5HT3 blockers (Ondansetron, Granisetron, Dolasetron)

2)Phenothiazines (Procholorperazine)

3)Corticosteroids (Dexamethasone, Methyl-prednisolone)

4)Marijuana derivative (Dronabinol, Nabilone)

Front 61

butyrophenones?

Back 61

1)Droperidol (prolongs QT)
2)Haloperidol

*block D2 receptors; for refractory cases

Front 62

benzodiazepines?

Back 62

1)Lorazepam
2)Alprazolam

(anticipatory vomiting-->low potency)

Front 63

what blocks Neurokinin/ substance P?

Back 63

Aprepitant

(usu administered with dexamethasone and palonsetron; extensive CYP3A4 metabolism;can induce it too)

Front 64

COMMONLY USED ANALGESIC AND ANTI-PYRETIC BUT UNLIKE NSAIDS, HAS NO ANTI-INFLAMMATORY PROPERTIES

Back 64

ACETAMINOPHEN

(weak inhibitor of COX, it inhibits prstaglandin synthesis in the CNS; a related rpo-drug PHENACITIN, is no longer avaiable due to nephrotoxicity)

Front 65

USED INT EH MANAGEMENT OF CHRONIC GOUT AND AS AN ADJUNCT TO CANER CHEMO, TO SLOW THE PRODUCTION OF URIC ACID

Back 65

ALLOPURINOL

(results in suicide inhibition of xanthine oxidase with resultant increase of xanthine and hypoxanthine, both of whihc are more soluable and less likely to for m crystals than uric acid)

Front 66

NSAID WITH ANTI-PYRECTIC, ANALGESIC, ANTI-PLATELET, AND ANTI-INFLAMMATORY PROPERTIES THAT IRREVERSIBLY INHIBIT COX

Back 66

ASPRIN

(inhibits the formation of PGE, decreases paina nd fever, and decreases snthesis of PGE in stomach, predisposing to acute gastritis)

Front 67

USED TOPICALLY FOR THE TREATMENT RHEUMATOID ARTHRITIS BECAUSE IT DEPLETES SUBSTANCE P

Back 67

CAPSAICIN

(component of chili peppers that impairs release of sub P, the potent neurotranmitter for pain sensation)

Front 68

NEWLY AVAILABLE NSAID, USED IN THE TX OF RHEUMATOID ARTHRITIS AND OTHER CHRONIC CONDITIOS, WITH A DECREASED RISH OF ULCERS AND OTHER GI BLEEDS

Back 68

CELECOXIB

(celecoxib and a similar drug, rofecoxib, selectively inhibit cox-2 present only in leukocytes; these agents don't inhibit cox-1 that produces protective prostaglandins int eh stomach; as sulfa drugs they can both cause hypersenitivy reactions)

Front 69

USED FOR TX OF ACUTE ATTACKS OF GOUTY ARTHRITIS, BECAUSE IT IMPAIRS LEUKOCYTE FUNCTION

Back 69

CHOLCHICINE

(inhibits microtuble assembly, and therefore leukocyte migration and phagocytosis of uric acid crytals)

Front 70

USED IN THE TX OF TRANSPLANT PATIENTS AND PATIENTS WITH AUTOIMMUNE DZ'S, AS IT IMPAIRS T CELL PRODUCTION OF IL-2

Back 70

CYCLOSPORINE

(binds to cyclophilins and inhibits the tanscription of cytokine genes; a similar agent, tacrolimus, binds to the immunophilin FK-binding protein (FKBP) and functions similarly;both display a dose-limiting nephrotoxicity)

Front 71

A BACTERIAL PRODUCT OF STREP PYOGENES, USED IN THE TX OF CORONARY ARTERY THROMBOSIS

Back 71

STREPTOKINASE

(complexes with and catalyzes the conversion of plasminogen to plasmin; it is cheaper, although debatably equivalent, agent to tPA)

Front 72

PLATELET ANTI-AGGREGANT, USED FOR THE PREVENTION OF TRANSIENT ISCHEMIC ATTACKS IN PATIENTS WITH ASPRIN SENSITIVITY

Back 72

TICLOPIDINE

(interferes with the binding of fibrin to the GPIIa/IIIb receptor blocker (class notes=> ADP blocker))

Front 73

CREATED THROUGH THE USE OF RECOMBINANT DNA TECHNOLOGY, THIS AGENT IS USED FOR CORONARY ARTERY THROMBOSIS AND ISCHEMIC STROKE

Back 73

TISSUE PLASMIOGEN ACTIVATOR (tPA) ALTEPLASE/RETEPLASE

(converts fibrin bound plasminogen to plasmin resulting in the dissolution of thrombi)

Front 74

ORALLY ADMINISTERED ANTICOAGULANT USED IN THE MANAGEMENT AND PROPHYLAXIS OF VENOUS THROMBOSIS, MI AND STROKE

Back 74

WARFARIN

(coumadin compound that interferes with the vit.k dependent carboxylation of clotting factors 2,7,9,10)

Front 75

MONOCLONAL ANTIBODY USED AS AN ANTICOAGULANT, PREVENTING RE-STENOSIS AFTER CORONARY ANGIOPLASTY

Back 75

ABCIXIMAB

(antibodies against the GPII/III receptor on platelets, preventing platelet aggregation)

Front 76

USED IN THE TREATMENT OF ACUTE BLEEDING IN PATIENTS WITH HEMOPHILIA AND OTHER COAGULAPATHIES

Back 76

AMINOCAPROIC ACID

(orally active inhibitor of plasminogen activation, thereby inhibiting fibrinolysis, tranexamic acid is a similar agent)

Front 77

RECOMBINANT PRODUCT USED IN THE TX OF ANEMIA ASSOCIATED WITH RENAL FAILURE

Back 77

ERYTHROPOIETIN (DARBOPOIETIN/EPOETIN ALPHA)

( also used to tx anemia assoc with bone marrow transplants or toxic drug reactions)

Front 78

WILL CORRECT THE ANEMIA BUT NOT THE NEUROLOGICAL DEFICITS ASUED BY VIT B12 DEF.

Back 78

FOLIC ACID

Front 79

RAPID ACTING IV ADMINISTERED ANTI-COAGULANT USED FOR ACUTE MYOCARDIAL INFARCTION AND PREVENTION OF DVT FOLLOWING PROLONGED IMMOBILIZATION

Back 79

HEPARIN

(bind to and activate ATIII, resulting in inactivation of thrombin and other clotting factors)

Front 80

USED IN THE MANAGEMENT OF SICKLE CELL ANEMIA AS WELL AS FOR VARIOUS MYELOID NEOPLASMS

Back 80

HYDROXYUREA

(increases HbF and als inhibits DNA synthesis by blocking conversion of ribonucleotides to deoxyribinucleotides)

Front 81

RECOMBINANTLY PRODUCED GRANULOCYTE-MACROPHAGE COLONYSTIMULATIONG FACTOR, USED IN THE MANAGEMENT OF PATIENTS UNDERGOING CHEMO

Back 81

SARGRAMOSTIM

(similar agent G-CSF filgrastim is used for similar applications but affects on granulocytes)

Front 82

PROKINETIC DRUF USED TO TX UPPER GI DYSFUNCTION SUCH AS GERD OR GASTROPARESIS WITH DELAYED GASTRIC EMPTYING

Back 82

CISAPRIDE (aka Propulsid)

(stimulates peristalsis by promoting the release of Ach from post-ganglionic nerves of the myenteric plexus, high does have been assoc with long QT syndrome)

Front 83

OPIOD DERIVATIVE USED IN TX OF DIARRHEA, B/C THEY SUPPRESS GI MOTILITY

Back 83

DIPHENOXYLATE, LOPERIMIDE


whereas diphenoxylate is formulated with anti-muscarinic alkaloids; both preparations have minimal abuse potential)

Front 84

THIS PREPARATION IS USED TO TREAT EMESIS AND NAUSEA ASSOC, WITH CHEMO, AND CONTAINS THE ACTIVE INGREDIENT IN MARIJUANA

Back 84

DRONABINOL

Front 85

commonly used pro-emetic agent used in cases of ingestion of caustic substances or mineral oils

Back 85

ipecac syrup

(orally administered drug that acts directly on the chemoreceptor trigger zone (CTZ) in the medulla)

Front 86

AMONG THE MOST POPULAR ANTACIDS USED IN THE U.S. NEITHER ABSORBED AND THEREFORE CAUSES NO SYSTEMIC EFFECTS

Back 86

MG OH or AL OH


(MgOH has a strong laxative effect, AlOH causes constipation

Front 87

THIS PRO-KINECTIC AGENT IS USED TO PREVENT EMESIS ( I.E. POST-ANESTHESIA OR D/T CHEMO), BECAUSE IT BLOCKS D2 RECEPTORS INT HE AREA POSTREMA THAT TRIGGER VOMITING

Back 87

METOCLOPRAMIDE

(facilitates Ach, while antagonizing the action of dopamine on teh enteric nervous system. side effects include sedation, diarrhea, and extrapyramidal symptoms)

Front 88

EICOSANOID PREPARATION USED TO PREVENT PEPTIC ULCERS IN PATIENTS TAKING HIGHER DOSES OF NSAIDS FOR CONDITIONS SUCH AS RHEUMATOID ARTHRITIS

Back 88

MISOPROSTOL

(PGE analog decreases gastric acid production and increases mucus production, protecting the lining of the stomach)

Front 89

PPI USED IN THE TX OF GERD, GASTRIC AND DUODENAL ULCERS, H.PYLORI GASTRITIS, AND ZE SYNDROME

Back 89

OMEPRAZOLE

(irreversibly inhibits the H+/K+ ATPase on the luminal side of the parietal cells)

Front 90

CENTRAL ACTING ANTI-EMETIC USED TO CONTROL POST-OPERATIVE VOMITING in CHEMO PATIENTS

Back 90

ONDANSETRON

(5HT3 inhibitor that function at the chemorecoetive area of the area postrema)

Front 91

USED TO TX PEPTIC ULCERS, BECAUSE IT POLYMERIZES AND SELECTIVELY COATS NECROTIC ULCERATED TISSUE

Back 91

SUCRALFATE

(requires and acidic envoronment to polymerize, and therefore, can't be used in the presence of antaacids or H2 blockers

Front 92

USED FOR THE TX OF TRAVELER'S DIARRHEA

Back 92

BISMUTH SUBSALICYLATE

(helps decrease fluid secretion by the bowel, also used with metronidazole and tetracycline for the tx of H.pylori associated PUD

Front 93

INHIBITS THE RATE-LIMITING ENZYME OF CHOLESTEROL SYNTHESIS, HMG-CoA REDUCATASE, RESULTING IN DRAMATICALLY DECREASED LDL LEVELS

Back 93

STATINS (LOVASTATIN,PRAVASTATIN/SIMVASTATIN/ATORVASTATIN)

(may cause elevated liver enzymes, myositis with increased creatine kinase from skeletal muscle and rarely rhabdomyolysis)

Front 94

ANTI-HYPERLIPIDIDEMIC AGENT THAT MAY PREVENT ATHEROSCLEROSIS BY ACTING AS AN ANTIOXIDANT

Back 94

PROBUCOL

(rarely used for tx of hyperlipidemia because it decreases HDL's as well as LDLs;may be efficacious in preventing restenosis after angioplasty

Front 95

LIPID LOWERING AGENT CAUSES CUTANEOUS FLUSHING, WHICH CAN BE AVOIDED BY ADMINISTERING CONCURRENTLY WITH ASPIRIN

Back 95

NIACIN

(directly reduces secretion of VLDL's from and apoliprotein synthesis by the liver, while increasing HDL's)

Front 96

AGENTS THAT DECREASE TRIGLYCERIDES DRAMATICALLY BY STIMULATING LIPOPROTEIN LIPASE

Back 96

GEMFIBROZIL,FENOFIBRATE, CLOFIBRATE


(clofibrate has been associated with gallstones and hepatobiliary neoplasms)

Front 97

BILE ACID-BINDING RESINS USED IN THE MANAGEMENT OF HYPERLIPIDEMIA

Back 97

CHOLESTYRAMINE, COLESTIPOL

(bind bile acids, preventing enterohepatic recycling, thus diverting hepatic efforts to renew bile acids, instead of producing plasma lipids)