Pharm3 - Week 1

Front 1

Weird side effect of aspirin

Back 1

Tinnitus

Front 2

Ticlopidine

Back 2

Hypercoagulability

Anti-PLATELET

Inhibits ADP from binding to platelet receptors -> v activation of GPIIb/IIIa

Front 3

Dipyridamole

Back 3

Hypercoagulability

Anti-platelet

^ platelet cAMP levels -> inhibits platelet activation

Front 4

Clopidogrel

Back 4

Hypercoagulability

Anti-platelet

Inhibits ADP from binding to platelet receptors -> v activation of GPIIb/IIIa

Front 5

Abciximab

Back 5

monoclonal antibody to GP IIb/IIIa receptor

Front 6

What can Vitamin E and Garlic cause in proper circumstances?

Back 6

Bleeding

Front 7

Warfarin MOA

Back 7

Antagonize Vitamin K, which makes Factors II, VII, IX, and X nonfuctional

Front 8

What rate is used to measure monitor Warfarin?

What should the range be?

Back 8

INR (internal Normalized Ratio) = (partient's Prothrombin Time/mean normal PT in seconds)

2-3

Front 9

What interferes with Warfarin?

Back 9

Foods with Vitamin K and ginseng

Front 10

Heparin MOA

Back 10

potentiate antithrombin III

inactivates IIa, IXa, Xa, XIa & XIIa

act in many steps to not get crosslinked fibrin

Front 11

Enoxaparin

Back 11

Anticoagulant

Low Molecular Weight Heparin

Only inhibits Xa to inactivate thrombin

Front 12

Major SE of Heparin (less so w/ LMWH)

Back 12

Heparin-Induced Thrombocytopenia (HIT)

v amount of platelet count

Front 13

Lepirudin

Back 13

Direct Thrombin Inhibitor

1st line for HIT

Front 14

Argatroban

Back 14

Direct Thrombin Inhibitor

1st line for HIT

Front 15

Streptokindase

Back 15

Plasminogen Activator

Front 16

Urokinase

Back 16

Thrombolytic

Plasminogen Activator

Front 17

Tranexamic Acid

Back 17

Procoagulant

Fibrinolysis inhibitors

Front 18

Essential Nutrients for RBC production (erythropoiesis)?

Back 18

Folate, B12 & iron

Front 19

What nutrient is key for AA and purine synthesis?

Back 19

Folate

Front 20

Where is folate absorbed, stored and for how long?

Back 20

proximal jejunum; liver; 1-6 months

Front 21

Folate deficiency leads to?

Back 21

1) MACROcytic/megaloblastic Anemia

2) Slow down nuclear replication

Front 22

*Methotrexate blocks what nutrient?

also oral contraceptives, Isoniazid, and Phenytoin and Trimethoprim block as well

Back 22

Folate

Front 23

Wernicke-Korsakoff has what deficiency?

Back 23

Thiamine (B1)

Front 24

Pernicious Anemia

Back 24

Vitamin B12 deficiency

Front 25

Difference b/w Folate and Vitamin B12 (cobalamine) Megaloblastic anemia?

Back 25

Vitamin B12 = neuroloical syndrome

-paresthesias
-weakness
-ataxia

Folate: no neurologic syndromes

Front 26

Iron deficiency causes?

Back 26

MICROcytic anemia (too little cytoplasm

Front 27

What is an adequate measure of total body iron stores?

Back 27

Plasma Ferritin

Front 28

Do sickle cell patients have iron deiciency?

Back 28

No

Front 29

Transferrin

Back 29

^ during v storage iron to ^ import of more iron from GI mucosa

Front 30

Weird SE of oral iron

Back 30

Black stool

Front 31

Acute iron toxicity causes?

Back 31

Necrosis of gut

Front 32

Do you give sickle cell patients iron?

Back 32

No, they do not have an Iron deficiency

Front 33

Erythropoietin

Back 33

Main growth factor for Hematopoiesis

Produced by peritubular system of the kidney

Epo level drop = red cell production drop

Travels to BM & v apoptosis to ^ RBC

Front 34

Thyroid System is directly triggered/impacted by what?

Back 34

Temperature

Front 35

Liothyronine

Back 35

T3

Used only in acute situations (ie Myxedema coma) b/c faster acting than T4

Front 36

Levothyroxine

Back 36

T4

Almost always the DOC for Hypothyroidism (except for acute situations -> T3)

Front 37

Iodide

Back 37

Anthi-thyroid @ HIGH doses

Inhibits 1)iodide uptake & 2) release of T3 and T4

High dose useful b/f surgery

Front 38

Propothiouracil (PTU)

Back 38

Anti-thyroid

Inhibits iodide organification

AND

Coupling of MIT & DIT

Conversion of T4 -> T3

FASTER onset than Methimazole but take 3x daily

Front 39

Methimazole

Back 39

Anti-thyroid

ONLY Inhibits iodide organification (iodination of tyrosine in thyroglobulin)
SLOWER onset than Propothiouracil but only give 1x daily

Front 40

B-Blockers' and Corticosteroids hormonal action

Back 40

Antagonize effects of thyroid hormone

Front 41

Expression of Na/K ATPase is regulated hormonally by?

Thereby important in the metabolsm of ALL cells

Back 41

T3

Front 42

Cretinism (short stature) is caused by?

Back 42

Lack of thyroid hormone during development

Front 43

Give high dose of iodide therapy 2 weeks prior to surgical storm?

Back 43

YES, shrinks thyroid making surgery easier

Front 44

Give high dose of iodide therapy prior to implantation of radioactive iodide?

Back 44

NO, b/c it would block the uptak of the radioactive iodide

Front 45

Calcitriol

Back 45

1, 25-dihydroxy D3 (renal-activated form of Vitamin D)

stimulates the intestine to increase absoprtion of phosphate and calcium (esp in intestine, kidney, & bone

Front 46

For Hypocalcemia w/

Hepatic Failure

Back 46

Give 25-Hydroxy D3

Front 47

For Hypocalcemia w/

Renal failure

Back 47

Give 1,25-Dihydroxy D3

Front 48

For Hypocalcemia w/

Normal Renal and Hepatic fxn

Back 48

Give vitamin D3

Front 49

Unlike thyroid hormone, effects of 1,25-Dihydroxy D3 not found all over the body but mostly in?

Back 49

Gut

Front 50

Calcitonin synthesized in?

Back 50

Thyroid gland

Front 51

Net affect of Vit D and Parathyroid hormone?

Back 51

increasing Ca in

1)intestine
2)kidney
3)bone

Front 52

Biphosphonates are a class of drugs useful for? **ALENDRONATE**

Etidronate
Pamidronate
Pyrophosphate

Back 52

Treatment of Osteoporosis

**SE: Esophageal erosion**

Front 53

Penicillin most useful for what bacteria?

Back 53

Gram +

Front 54

Main difference b/w Cycloserine and Penicillin?

Back 54

Cycloserine is REVERSIBLE and Penicillin is IRREVERSIBLE

Front 55

What are the 5 classes of immunosuppressnt agents?

Back 55

1)T Cell blockers
2)Glucocorticoids
3)Cytotoxic drugs
4)Antibody reagents
5)Cytokine inhibitors

Front 56

Cyclosporine

Back 56

Immunosuppressant - T-cell Blocker

Organ transplant, Autoimmune Dz (RA), & Psoriasis



Binds cyclophilin, and the cyclosporine=cyclophilin complex inhibits calcineurin (decrease in IL-2 production which is a T cell growth factor)

Narrow TI

SE: Nephrotoxicity, HT, CYP450 ACTIVATION!

Front 57

Tacrolimus

Back 57

Immunosuppressant - T-cell Blocker

Organ Transplant

Binds FKBP, complex then inhibits calcineurin (decrease in IL-2 production which is a T cell growth factor)

MORE potent than cyclosporine

Narrow TI

SE: Nephrotoxicity, Neurotoxicity, Diarrhea, CYP450 ACTIVATION!

Front 58

Sirolimus

Back 58

Immunosuppressant - T-cell Blocker

Organ Transplant, Antifungal agent

Binds FKBP, complex but DOES NOT inhibit calcineurin It inhibits signal pathway from IL-2 recepor to the DNA transcription --> decresed IL-2 responsiveness (v T cell
AND B cells growth)

SE: CYP450 ACTIVATION!

LESS NEPHROTOXICITY than Cyclosporine and Tacrolimus

Front 59

Prednisone

Back 59

Immunosuppressant - Glucocorticoid

Organ trasplant & Autoimmune Disease

Converts to Prednisolone

Antiinflammatory: ^ Neutrophils & v lymphocytes (B AND T cells) & cytokines in circulation

Pharmadynamic effect is longer than its pharacokinetic effect (short 1/2 life, longer effective duration)

SE: Adrenal insufficiency

Front 60

Azathioprine

Back 60

Immunosuppresant - Cytotoxic Agent - PURINE

Organ Transplants, Auntoimmune DX (RA)

Adenine Analog - ANTAGONIST TO PURINE SYN which lymphocytes need for proliferation

Pharmadynamic effect is longer than its pharacokinetic effect

SE: v Renal and Hepatic fxn

** AVOID ALLOPURINOL Interaction -> inhibits xanthine oxidase which inactivates activity; THUS Allopurinol causes ^ levels of azathioprnie -> PANCYTOPENIA

Front 61

Mycophenylate Mofetil

Back 61

Immunosuppresant - Cytotoxic Agent - PURINE

Organ Transplants

Inibits IMP Dehydrogenase -> inhibits de novo synthesis of Purines

Undergoes enterohepatic circulation --> inactive metabolites activated in liver

SE: GI upset, BM suppression & Infection risk

Front 62

Cyclophosphamide

Back 62

Immunosuppresant - Cytotoxic Agent - Alkalating Agent

Interferes with DNA replication and transcription of RNA, thus disrupting nucleic acid function

SE: GI upset, cardiotoxicity BM suppression & NEOPLASIA (esp BLADDER cancer)

Front 63

Leflunomide

Back 63

Immunosuppressant - Cyotoxic Agent - PYRIMIDINE

Used mainly for RA

SE: alopecia, N/V, diarrhea, rash

Front 64

Antithymocyte Globulin

Back 64

Immunosuppresant - Antibody Reagent

Organ transplants

Purified Animal Gamma Globulin (mailinly IgG) against T lymphocytes

SE: Allergic Rxn

Front 65

OKT3

Back 65

Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Murine monoclonal T3 antibody --> blocking fxn of all T cells

SE: Flu-like symptoms, HA, seizures, aseptic meningitis and encephalopathy

Front 66

Basiliximab

Back 66

Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Monoclonal antibody from Human recombinant DNA - blocks CD 25 -> inhibits T Lymphocytes

SE: Hypersensitivity

Front 67

Daclizumab

Back 67

Immunosuppresant - Antibody Reagent

Organ transplants (ACUTE REJECTION)

Used in conjunction with Azahioprine & Corticosteroids

Monoclonal antibody from Human recombinant DNA - blocks CD 25 -> inhibits T Lymphocytes

SE: Gi effects, HA, dizziness, otherwiise well tolerated compared to other agents

Front 68

Etanercept

Back 68

Immunosuppressant: Cytokine Inhibitor

Autoimmune Dz (RA, Crohn's Dz)

Monoclonal IgG antibody from recombinant human DNA that binds specifically to TNF alpha --> Inhibition of inflammatory cascade

"EI EI LUPUUUUUUS"
"TNF-alpha now!"

SE: Infusion reactions, Upper respiratory infecions, LUPUS-llike syn

Front 69

Infliximab

Back 69

Immunosuppressant: Cytokine Inhibitor

Autoimmune Dz (RA, Crohn's Dz)

Monoclonal IgG antibody from recombinant human DNA that binds specifically to TNF alpha --> Inhibition of inflammatory cascade

SE: Infusion reactions, Upper respiratory infecions, LUPUS-llike syn

"EI EI LUPUUUUUUS"
"TNF-alpha now!"

Front 70

IV Immunoglobulin

Back 70

Immunostimulant

Used for Primary immune deficiency (ie AIDS)

Contain no IgM, variable IgA, and normal IgG

SE: allergic rxn -> anaphylaxis

Front 71

INF Gamma 1B

Back 71

Immunostimulant

Prevention of infection in Chronic Granulomatous Dz

Front 72

INF Beta 1a/b

Back 72

Immunostimulant

Used to reduce the severity of MS attacks

Front 73

INF Alpha 2a/b

Back 73

Immunostimulant

Used in Hepatitis, HPV, Kaposi's sarcoma

Front 74

IL-2

Back 74

Immunostimulant

stimulates T helper and T cytotoxic cells

HIGHLY TOXIC w/ life-threatening cardiotoxicity, pulmonary edema and renal toxicity

Front 75

Levamisole

Back 75

Immunostimulant

Used in Hodgkin's Dz, RA, & Colorectal cancer

Causes macrophages and T cells to secrete cytokines and other factors suppressing tumor growth

Front 76

St John's Wort

Back 76

Treat Depression

Can bind FXR receptor and activate CYP450 system - ^ metabolism of drugs such as cyclosporin & theophylline

DO NOT TAKE with MAO INHIBITORS

Front 77

Echinacea

Back 77

Common Cold

DO NOT TAKE with IMMUNOSUPPRESSANTS (ie corticosteriods)

Front 78

Saw Palmetto

Back 78

Treat BPH

Front 79

Cranberry Exract

Back 79

Treat UTI

Front 80

Ginkgo Biloba

Back 80

Treat Anxiety/Stress & Memory Loss

Front 81

Black Cohosh

Back 81

Treat Menopause

Contains isoflavones

Front 82

*Grape Seed Extract

Back 82

Neuroprotective

high antioxidants

Front 83

Garlic

Back 83

Contains *INDOLE-3-CARBINOL (found in broccili; anticancer properties) & *ALLICIN - both antioxidants

DO NOT TAKE with NSAIDs

Front 84

Evening Primrose

Back 84

DO NOT TAKE with Anti-convulsants

Front 85

Ginseng

Back 85

Energy

DO NOT TAKE with NSAIDs

Front 86

Yohimbe

Back 86

Depression

MAO inhibitor

TOXIC - PSYCHOSIS

Front 87

Comfrey

Back 87

Demulcent

TOXIC - Hepatotoxicity

Front 88

Chaparral

Back 88

Antibiotic

contains anti-oxidants

TOXIC - Hepatotoxicity

Front 89

*Genistein

Back 89

also Red Clover & Kudzu

Soy products

An isoflavone resembling 17B-estradiol binding estrogen receptor SELECTIVELY in bone, brain, and CV system

Polyphenols have ANTIOXIDANT properties; may enhance cell viablilty/logevity by enhancing certian de-acetylases

Front 90

Chinese Red Rice

Back 90

Treat hypercholesteremia

fungus that contains statins -> inhibition of HMG CoA Reductase

Front 91

Tissue Plasminogen Activator

Back 91

U: Hypercoagulability

Thrombolytic (most common)
-specific for clot-bound plasma

Front 92

What kind of iron is direcly absorbed?

Back 92

Meat iron

Iron from other food sources must be reduced to ferrous to form Fe2+ before it can be actively tranproted into intestinal mucosa