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236 Cards in this Set

  • Front
  • Back
What is Km?
Km = (K-1 + K2)/K1

Reflects affinity of enzyme for its substrate

Lower Km --> higher affinity
What is Vmax proportional to
Vmax is directly proportional to enzyme concentration
Linewoever-Burke Plot

eq?

x.-int?
y-int?
slope?
(1/Vo) = (Km/Vmax)(1/S) + (1/Vmax)

x-int = 1/-Km

y-int = 1/Vmax

Slope = Km/Vmax
What happens on a Linewoever Burke plot when you add
a. competitive inhibitor

b. non-competitive inhibitor
a. x-int moves right (Km increases), y-int stays same

b. Y-int shifts up (Vmax decreases), x-int stays

"competitive inhibitors cross, noncompetitives do not"
at 1/2 Vmax, Km = ?
Km = [S]
Competitive inhibitor vs. non-competitive

a. does it resemble substrate

b. overcome by increasing [S]

c. Bind active site
a. C = yes
U = No

b. C = yes
U = No

c. C = yes
U = No
Competitive inhibitor vs. non-competitive
d. effect on Vmax
e. effect on Km
f. pharmacodynamics (potency/efficacy)
d. C = none
U = decreases

e. C = decreases
U = none

f. C = decreased potency
U =decrease efficacy
What is Volume of distribution

equation?
Volume in which the total drug would need to be uniformly distributed to produce desired blood concentration

Vd = amount in body/plasma drug concentration
If drugs are bound by plasma proteins, how is their volume of distribution affected by liver or kidney disease?
Liver disease --> altered protein and body fluid --> higher Vd

Kidney disease --> fluid retention --> higher Vd
where do the drugs distribute

a. Vd = 4-8 L (low)
b. Vd = medium
c. Vd > body wt.
a. distribute in blood

b. distribute in extracellular space or body water

c. distribute in all tissues, sequester in fat
What is clearance?

How is it calculated
Relates rate of elimination to plasma concentration

CL = (rate of elimination of drug) / (plasma drug conc) = Vd * Ke (elimination constant) = Vd * 0.7/t^1/2
What is half life

What type of kinetics does t1/2 apply to?
t = (0.7)(Vd) / CL

Time required to change the amount of drug in the body by 1/2 during elimination or constant infusion

applies to first order elimination
Infusing a drug at a constant rate, what is the concentration at
a. 1 half life
b. 2
c. 3
d. 4
a. 50%
b. 75%
c. 87.5%
d. 93.75%
How do you calculate loading dose
Loading dose = Cp * (Vd/F)

Cp = target plasma conc
Vd = vol of dist
F = bioavailability
How do you calculate maintenance dose
Maintenance dose = Cp * (CL/F)

Cp = target plasma conc
CL = clearance
F = bioavail
In liver or renal disease, how do the maintenance and loading dose change
loading = unchanged

maintenance = decrease
What is bioavailability?
F = fraction of dose of unchanged drug that reaches systemic circulation

F=1 if IV infusion
What are the characteristics of zero order elimination

3 drugs that have this
Rate of elimination is constant regardless of Cp (constant amount of drug lost per time, linear)

PEA =
Phenytoin, Ethanol, Aspirin (at high/toxic conc)
What is first order elimination
Rate of elimination proportional to drug conc (constant fraction of drug elimnated per time)

plasma conc decreases exponentially
What happens to ionized species in urine?

Neutral foms?
Ionized - trapped and cleared quickly

neutral - reabsorbed
Phenobarbitol, methotrexate, aspirin

pH?
how do you trap these?

Treat overdose?
weak acids

trap in basic environment

Treat with bicarbonate
Amphetimines

pH?
how do you trap these?
how do you treat overdsoe?
pH = weak bases

trap in acidic

treat overdose with ammonium chloride
Phase I metabolism
a. where
b. what happens
a. cyt P45-

b. reduction, oxidation, hydrolysis to yeield a slightly polar, water-soluble molecule
Phase II metabolism
a. where
b. what happens
a. conjugation

b. acetylate, glucuronidate, sulfation to yield polar, inactive metabolites that are renally excreted
Phase I or Phase II metab

which one do geriatric patients lose first
Phase I
Efficacy = ?

Potency?
Efficacy = max effect of a drug

Potency = amount of drug needed for a given effect
Effect on efficacy and potency of
a.partial agonist
efficacy = goes down (less max effect)

potency = goes up or down
Effect on efficacy and potency of
a. competitive antagonist
potency goes down, efficacy no change
Effect on efficacy and potency of
a. noncompetitive antagonist
Potency no change, efficacy down
What type of interaction do these drugs have

diazepam and flumazenil
competitive antag
What type of interaction do these drugs have

NE and phenoxybenzamine on a-receptor
noncompetitive inhibitor
What type of interaction do these drugs have

morphine + burenorphine at opioid mu-receptor
partial agonist
What is physiologic antagonism

an example that counters muscarinic overactivity in asthma
substance that produces opposite effects of an agonist but works at a different receptor

epinepherine stimulates B2 receptor --> bronchodilator
What is therapeutic index

what is a "safer drug"
Measures drug safety

(TILE)
TI = LD50/ED50 = median lethal dose/effective dose

Safer drugs have higher TI
Where would you find nicotinic ACh receptors?

What kind of receptors are these?
Autonomic ganglia (symp and parasymp, adrenal medulla)

NMJ
receptors on sweat glands?
ACh muscarinic
Receptors on cardiac and smooth muscle, gland cells, and nerve terminals
NE (alpha, beta)
Receptors on renal vascular smooth muscle
D1
Receptors on adrenal medulla?
ACh nicotinic
2 organs that are part of the sympathetic nervous system that are innervated by cholinergic fibers

what type of receptor does each have?
sweat glands (Ach muscarinic)

adrenal medulla (Ach Nicotinic)
how does signal transduction take place form a muscarinic receptor
Gprotein --> 2nd messenger
Receptor: a1

a. G-protein?

b. Major functions
a. Gq

b. Vascular smooth muscle contract, mydriasis (pupillary dilator), increases intestinal and bladder sphincter contraction
Receptor: a2

a. G-protein?

b. Major functions
a. Gi

b. Decreases sympathetic outflow, dec. insulin release
Receptor: b1

a. G-protein?

b. Major functions
a. Gs

b. increase heart rate, contractility, renin release, lipolysis
Receptor: b2

a. G-protein?

b. Major functions
a. Gs

b. vasodilation, bronchodilation, increase heart rate, contractility, renin release, lipolysis, insulin release, decreases uterine tone
Receptor: M1

a. G-protein?

b. Major functions
a. Gq

b. CNS, enteric NS
Receptor: M2

a. G-protein?

b. Major functions
a. Gi

b, decrease ht rate and contractility of aorta
Receptor: M3

a. G-protein?

b. Major functions
a. Gq

b. increase sweat and gastric acid (exocrine gland), gut peristalsis, bladder contraction, bronchoconstriction, miosis (pupillary sphincter contraction), accomodation (ciliary muscle contract)
Receptor: D1

a. G-protein?

b. Major functions
a. Gs

b. relaxes renal vascular smooth muscle
Receptor: D2

a. G-protein?

b. Major functions
a. Gi

b. Modulates transmitter release, especially in brain
Receptor: H1

a. G-protein?

b. Major functions
a. Gq

b. increases nasal and bronchial mucus production, contraction of bronchioles, pruritis, pain
Receptor: H2

a. G-protein?

b. Major functions
a. Gs

b. increases gastric acid secretion
Receptor: V1

a. G-protein?

b. Major functions
a. Gq

b. increases vascular smooth muscle contraction
Receptor: V2

a. G-protein?

b. Major functions
a. Gs

b. increases H20 permeability and reabsorption in the collecting tubules of the kidney (V2 in the 2 kidneys)
5 receptors that use Gq
H1, a1, V1, M1, M3

HAVe 1 M&M
5 receptors that use Gs
b1, b2, D1, H2, V2
3 receptors that use Gi
M2, a2, D2

MAD 2's
function of hemicholinium

function of vesamicol
inhibits transporter that brings choline into presynaptic terminal

inhibits Ach transport into vesicle in presynaptic terminal
Function of
a. metyrosine
b. reserpine
c. guanethidine
a. Inhibits Tyrosine --> Dopa in presynaptic terminal (NE pathway)


b. Inhibits dopamine transport into presynaptic vesicle (where it will made to NE)

c. inhibits release of NE-containing vesicle
effect on NE

a. amphetimine
a. increases NE release into synapse
3 agents that inhibit NE reuptake to presynaptic terminal
Cocaine
TCAs
Amphetamine
Role of Choline acetyltransferase
converts choline + acetyl CoA --> acetylcholine
2 receptors on the presynaptic terminal that inhibit NE release

1 receptor that increases release
M2 (Ach). a2 (NE)

Angiotensin II receptor
Cholinomimetics

Drug used in postop and neurogenic ileus, urinary retention
Bethanechol

Beth Anne, Call me if you want to activate your Bowel and Bladder
Cholinomimetics

Drug used in glaucoma, pupillary contraction, and in relief of intraocular pressure
Carbachol

CARBon copy of Ach
Cholinomimetics

Drug used as a challenge test for asthma
Methacholine

Stimulates muscarinic receptors --> bronchoconstriction
Indirect agonist of Ach (anticholinesterases)

Drug used in postoperative and neurogenic ileus, urinary retention, myasthenia gravis, reversal of NMJ blockade (postop)

does it go into CNS
Neostigmine

NEO CNS = NO CNS
Indirect agonist of Ach (anticholinesterases)

Drug used in myasthenia gravis (long acting) that does not penerate CNS
Pyridostigmine --> increases strength in myasthenia patients

quarternary, no CNS
Indirect agonist of Ach (anticholinesterases)

Extremely short acting drug that is used to diagnose myasthenia gravis
Edrophonium

Tensilon test - if endrophonium can reduce weakness, you know the problem is lack of Ach --> indicates myasthenia gravis
Indirect agonist of Ach (anticholinesterases)

Drug used for glaucoma (crosses bbb) and atropine overdose
Physostigmine

"Phys for eyes"
Indirect agonist of Ach (anticholinesterases)

drug used only in glaucoma
echotiophate
Cholinemimetic agents can exacerbate which 3 underlying conditions
COPD
Asthma
Peptic ulcers
Farmer working with insecticides now has
-Diarrhea
-Urination
-Miosis
-Bronchoconstriction
-Bradycardida
-Excitaiton of skeletal muscle and CNS
-Lacrimation
-Sweating
-Salivation


What happened? What is the agent?
How do you treat?
DUMBBELSS = symptoms of cholinesterase inhibitor poisoning, often due to organophosphates (parathion) found in insecticides

Antidote = atropine + pralidoxime (regenerates active AchE)
Muscarinic anatgonists

3 used to produce mydriasis and cycloplegia
Atropine
homatropine
tropicamide

apply to eyes
Muscarinic anatgonists

Treatment for Parkinsons
Benztropine

PARKinson's my BENZ
Muscarinic anatgonists

used for motion sickness
scopalamine
Muscarinic anatgonists

drug used for asthma, COPD
ipratropium

(I PRAY I can breathe soon)
Muscarinic anatgonists

2 Drugs used to reduce urgency in mild cystitis and reduce bladder spasms
oxybutinin

glycopyrrolate
Muscarinic anatgonists

3 drugs used to treat peptic ulcer
methscopalamine
pirenzepine
propantheline
Effect of Atropine (muscarinic antagonist)
a. eyes
b. airway
c. stomach
d. gut
e. bladder
a. cycloplegia, mydriasis

b. decreased secretions

c. decrease acid secretion

d. decrease motility

e. decrease urgency in crisis
Patient has
-high body temp (no sweating)
-Rapid pulse
-dry mouth
-dry, flushed skin
-cycloplegia
-constipation
-disorientation

what has happened?
Atropine toxicity

Hot as a Hare
Dry as a Bone
Red as a Beet
Blind as a Bat
Mad as a Hatter
Special effect of atropine toxicity in
a. elderly
b. men with BPH
c. infants
a. acute angle closure glaucoma

b. urinary retention

c. hyperthermia
Drug used to prevent vagal reflex responses to changes in blood pressure (prevents reflex bradycardia caused by NE)

4 symptoms of toxicity
hexamethonium - nicotinic antagonist --> blocks ganglion
"Put a HEX on smokers (NICOTINE))"

-severe orthostatic hypotension
-blurred vision
-constipation
-sexual dysfunction
Sympathomimetics

Drug you use for:
-anaphylaxis
-open angle glaucoma
-asthma
-hypotension

Receptors?
low doses are selective for which receptor?
epinepherine

a1. a2, b1, b2 (low doses selective for b1)
Sympathomimetics

Drug you use for:
-hypotension, but causes decreased renal perfusion
Receptors?
NE

a1, a2>b1
Sympathomimetics

Drug you use for:
-AV block
Receptors?
Isoproterenol

B1 = B2
"ISO to b"
Sympathomimetics

Drug you use for:
-Shock (increases renal perfusion)
-heart failure

Receptors?
effect on heart?
Dopamine

D1 = D2 > b > a
inotropic and chronotropic
Sympathomimetics

Drug you use for:
-pupillary dilation
-vasoconstriction
-nasal decongestion

Receptors?
phenylepherine

a1 > a2
Sympathomimetics

Drug you use for:
-acute asthma
Receptors?
Metaproterenol and albuterol

b2
Sympathomimetics

Drug you use for:
-Long-term asthma
Receptors?
salmeterol

B2>B1 agonists
Sympathomimetics

Drug you use for:
-reduce premature uterine contractions
Receptors?
Terbutaline

B2 agonist
Sympathomimetics

Drug you use for:
-Heart failure, cardiac stress testing
Receptors?
dobutamine

b1 > b2, inotropic but not chronotropic
4 b2 agonists
MAST
metaproterenol
albuterol
salmeterol
terbutaline
Sympathomimetics

Drug you use for:
Reduce premature uterine contractions
Receptors?
Ritodrine

B2
Indirect sympathomimetics

drug used for
-Narcolepsy
-Obesity
-ADD
how does it work?
Amphetamine

Indirect agonist, releases stored catecholamine
Indirect sympathomimetics

drug used for
-Nasal decongestion
-Urinary incontinence
-Hypotension
how does it work?
Ephedrine

Indirect general agonist, releases stored catecholamines
Indirect sympathomimetics

drug used for
-Vasoconstriction
-Local anesthesia

how does it work?
Cocaine

Indirect general agonist, uptake inhibitor
2 sympathoplegics that are used in hypertension with renal disease

how do they work?
Clonidine, a-methyldopa (no decrease in blood flow to kidney)

a2 agonists --> decreases central adrenergic outflow
a-blockers

2 drugs used to treat
-Pheochromocytoma

What does the toxicity cause?
Phenoxybenzamine (irreversible, use before removing tumor), phentolamine (reversible)
- nonselective

orthostatic hypotension, reflex tachycardia
a-blockers

drug used to treat
-HTN
-Urinary retention in BPH

What does the toxicity cause
Prazosin, terazosin, doxazosin
(a1 selectives)

-First dose orthostatic hypotension
-dizziness
-headache
a-blockers

drug used to treat
-depression

What does the toxicity cause
mirtazapine (a2 selective)

-sedation
-increased serum cholesterol
-increased appetite
Im the presence of an a-blocker, what is the effect of
a. epinepherine

b. phenylephrine
a. decreased bp due to b2 activity

b. suppression, but not reversal of bp because phenyepherine is a pure alpha agonist
Type of drugs

Acebutolol, betaxolol, esmolol, atenolol, metoprolol, propanolol. timolol pindolol, labetalol
b-blockers
Effect of b-blockers on HTN? (renal means)
Lowers CO, lowers renin secretion (blocks b1-receptor on JGA cells)
Effect of b-blockers on angina pectoris
decrease HR and contractility --> decreased O2 consumption
Effect of b-blockers on MI
decrease mortality
2 b-blockers used to treat supraventricular tachycardia

effect?
propanolol, esmolol

decreases AV conduction velocity (class I antiarrhythmic)
Effect of b-blockers on CHF
Slows progression of chronic failure
1 b-blocker used to treat glaucoma

effect
timolol

decreases secretion of aqueous humor
If you have b-blocker toxicity, what are some symptoms

should be used with caution in which patients?
-impotence
-asthma exacerbation
-CV = bradycardia, AV block, CHF
-CNS = sedation, sleep alterations
-use w/caution in diabetics
propanolol, timolol, nadolol, pindolol

type of drugs
non-selective b-blockers (b1 = b2)
Acebutolol (partial agonist)
Betaxolol
Esmolol (short acting)
Atenolol
Metoprolol

when are these better to use
A BEAM of b1 blockers

5 b1-selective antagonists

use in patients with comorbid pulmonary disease
Carvedilol, labetalol

type of drug
non-selective a- and b-antagonist
pindolol, acebutolol

type of drug
partial b-agonist
Toxin: acetaminophen

Antidote?
N-acetylcysteine
Toxin: salicylates

Antidote?
NaHCO3 (alkanize urine), dialysis
Toxin: Amphetamines (basic)

Antidote?
NH4Cl (acidify urine)
Toxin: AchE inhibotrs, anticholinergic agents

Antidote?
Atropine, pralidoxime
Toxin: antimuscarinic, anticholinergics

Antidote?
physostigmine salicylate
Toxin: b-blockers

Antidote?
glucagon
- ^ cAMP (bypass beta adrenergic second messenger system)
Toxin: digitalis

Antidote?
Stop digitalis, normalize K, lidocaine, anti-dig Fab fragments, Mg
Toxin: Iron

Antidote?
Deferoxamine
Toxin: Lead

Antidote?
CaEDTA, dimercaprol, succimer, penicillamine
Toxin: Mercury, aresenic, gold

Antidote?
Dimercaprol (BAL), succimer
Toxin: Lead

Antidote?
CaEDTA, dimercaprol, succimer, penicillamine
Toxin: Copper, arsenic, gold

Antidote?
Penicillamine
Toxin: Mercury, aresenic, gold

Antidote?
Dimercaprol (BAL), succimer
Toxin: Cyaide

Antidote?
Nitrite, hydroxocobalamin, thiosulfate
Toxin: Copper, arsenic, gold

Antidote?
Penicillamine
Toxin: Methemoglobin

Antidote?
Methylene blue, vitamin C

METHemoglobin --> METHylene blue
Toxin: Cyanide

Antidote?
Nitrite, hydroxocobalamin, thiosulfate
Toxin: CO

Antidote?
100% O2, hyperbaric O2
Toxin: Methemoglobin

Antidote?
Methylene blue, vitamin C

METHemoglobin --> METHylene blue
Toxin: Methanol, ethylene glycol (antifreeze)

Antidote?
Ethanol, dialysis, fomepizole
Toxin: CO

Antidote?
100% O2, hyperbaric O2
Toxin: opiods

Antidote?
naloxone/naltrexone
Toxin: Methanol, ethylene glycol (antifreeze)

Antidote?
Ethanol, dialysis, fomepizole
Toxin: benzodiazepines

Antidote?
flumenazil
Toxin: opiods

Antidote?
naloxone/naltrexone
Toxin: TCAs

Antidote?
NaHCO3 (plasma alkalinzation)
Toxin: benzodiazepines

Antidote?
flumenazil
Toxin: TCAs

Antidote?
NaHCO3 (plasma alkalinzation)
Toxin: Heparin

Antidote?
Protamine
Toxin: Warfarin

Antidote?
Vit. K, fresh frozen plasma
Toxin: tPA, streptokinase

Antidote?
aminocaproic acid
Toxin: theophylline

Antidote?
b-blocker
Drug reactions - what reaction in the CV system do these cause?

TCA
atropine-like side effects
Drug reactions - what reaction in the CV system do these cause

Cocaine, sumatriptan
Coronary vasospasm
Drug reactions - what reaction in the CV system do these cause

VANC
Vancomycin
Adenosine
Niacin
Ca-channel blockers
Cutaneous flushing
Drug reactions - what reaction in the CV system do these cause

Doxorubicin, daunorubicin
dilated cardiomyopathy
Drug reactions - what reaction in the CV system do these cause

class III (sotalol), class IA (quinidine) antiarrhythmics
torsades de pointes
Drug reactions - what reaction in the hematologic system do these cause

Clozapine, carbamazepine, colchicine, propylthiouracil, methimazole, dapsone
agranulocytosis
Drug reactions - what reaction in the hematologic system do these cause

Chloramphenicol, benzene, NSAIDS, propylthiouraci, methimazole
aplastic anemia
Drug reactions - what reaction in the hematologic system do these cause
Methyldopa
Direct coombs-positive hemolytic anemia
Drug reactions - what reaction in the hematologic system do these cause

Chloramphenicol
Gray baby syndrome
Drug reactions - what reaction in the hematologic system do these cause

Isoniazid, sulfonamides, primaquine, aspirin, ibuprofen, nitrofurantoin
Hemolysis in G6PD-deficient patients

hemolysis IS PAIN
Drug reactions - what reaction in the hematologic system do these cause

Phenytoin, Methotrexate, Sulfa
MegaloBLASTic anemia

have a BLAST with PMS
Drug reactions - what reaction in the hematologic system do these cause

OCPs (estrogen and progestins)
Thrombotic complications
Drug reactions - what reaction in the respiratory system do these cause

ACE inhibitors
Cough
Drug reactions - what reaction in the respiratory system do these cause

BLeomycin
Amiodarone
Busulfan
Pulmonary fibrosis

hard to BLAB when you have pulmonary fibrosis
Drug reactions - what reaction in the GI system do these cause

macrolides
Acute cholestatic hepatitis
Drug reactions - what reaction in the GI system do these cause

Halothane
Valproic acid
Acetaminophen
Amanita phalloides
Focal to massive hepatic necrosis
Drug reactions - what reaction in the GI system do these cause

INH
hepatitis
Drug reactions - what reaction in the GI system do these cause

Clindamycin, ampicillin
Pseudomembranous colitis
Drug reactions - what reaction in the reproductive/endocrine system do these cause

glucocorticoid withdrawal (HPA suppression)
Adrenocortical insufficiency
Drug reactions - what reaction in the reproductive/endocrine system do these cause

Spironolactone
Digitalis
Cimetidine
chronic Alcohol use
Estrogens
Ketoconazole
Gynecomastia

Some Drugs Create AwesomE Knockers
Drug reactions - what reaction in the reproductive/endocrine system do these cause


Tamoxifen
Climphene
Hot flashes
Drug reactions - what reaction in the reproductive/endocrine system do these cause

Lithium
Amiordarone
hypothyroidism
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

phenytoin
gingival hyperplasia
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

furosemide, thiazides
Gout
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

Corticosteroids, heparin
Osteoperosis
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

Sulfonamides, Amiodarone, Tetracycline
Photosensitivity (SAT for a PHOTO)
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

Ethosuximide
Lamotrigine
Carbamazepine
Phenobarbital
Phenytoin
Sulfa drugs
Penicillin
Allopurinol
Rash (stevens-johnson syndrome)
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

Hydralazine
INH
Procainamide
Phenytoin
SLE-like syndrome

"it's not HIPP to have lupus"
Drug reactions - what reaction in the musculoskeletal/CT system do these cause

fluoroquinolones
tendonitis, tendon rupture, cartilage damage (kids)
Drug reactions - what reaction in the renal/GU system do these cause

Expired tetracycline
Fanconi's syndrome
Drug reactions - what reaction in the renal/GU system do these cause

Methicillin, NSAIDS, furosemide
Interstitial nephritis
Drug reactions - what reaction in the renal/GU system do these cause

Cyclophosphamide, ifosfamide (prevent by coadministering with mesna)
- cancer drugs: nitrogen mustard alkylating agent
Hemorrhagic cystitis
Drug reactions - what reaction in the neuro system do these cause

quinidine, quinine
cinchonism
Drug reactions - what reaction in the neuro system do these cause

Lithium, demeclocycline
Diabetes insibidus
Drug reactions - what reaction in the neuro system do these cause

halperidol
chlorpromazine
reserpine
metoclopramide
Parkinson-like syndrome
Drug reactions - what reaction in the neuro system do these cause

bupropion, imipenem/cilastatin, isoniazid
seizures
Drug reactions - what reaction in the neuro system do these cause

antipsychotics
tardive dyskinesia
Drug reactions - what reaction in the multiorgan system do these cause

metronidazole, certain cephalosporins, procarbazine, first gen sulfaonylureas
disulfiram-like rxn
Drug reactions - what reaction in the multiorgan system do these cause

polymyxins
nephrotoxicity, neurotoxicity
Drug reactions - what reaction in the multiorgan system do these cause

aminoglycosides
vancomycin
loop diuretics
cisplatin
nephrotoxicity, ototoxicity
Inducers of cyt P450
Quinidine
Barbituates
St. john's wart
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
CHRONIC alcohol use

Queen Barb Steals Phen-phen and Refuses Greasy Carbs CHRONICally
Inhibitors of P-450
HIV protease inhibitors
Ketoconazole
Erythromycin
Grapefruit juice
ACUTE alcohol use
Sulfonamides
Isoniazid
Cimetidine

INHIBIT ourself from drinking beer from a KEG because it makes you ACUTEly SICk.
3 competitive substrates for alcohol dehydrogenase
ethylene glycol
methanol
ethanol
metabolism of ethylene glycol
ethylene glycol --> oxalic acid (ADH) --> acidosis, nephrotixicity
Metabolism of methanol
Methanol --> formaldehyde and formic acid (ADH) --> severe acidosis, retinal damage
Metabolism of ethanol
Ethanol --> Acetaldehyde (ADH) can cause nausea, vomiting, headache hypotension

--> acetaldehyde dehydrogenase --> acetic acid
Alcohol metabolism depletes NAD. what is the effect?
cannot do fatty oxidation in liver or convert lactate to pyruvate --> fatty liver, lactic acidosis
Why do some people get a 'glow' after drinking
polymorphism in a gene encoding for acetaldehyde dehydrogenase --> buildup of acetaldehyde --> facial flushing
Celecoxib
furosemide
probenecid
thiazides
TMP-SMX
sulfasalazine
sulofonylureas
acetazolamide
sulfonamide

type of drugs
sulfa drugs
Patient took furosemide, now has
-fever
-pruritic rash
-stevens-johnson syndrome
-hemolytic anemia
-thrombocytopenia
-agranulocytosis
-urticaria (hives)

what happened?
sulfa drug allergy
Category of drug that ends with:
-afil
erectile dysfunction

sildenafil
Category of drug that ends with: -ane
Inhalation general anesthetic

halothane
Category of drug that ends with: -azepam
benzodiazepine

diazepam
Category of drug that ends with: -azine
phenothiazine (neuroleptic, antiemetic)

chlorpromazine
Category of drug that ends with: -azole
antifungal

ketoconazole
Category of drug that ends with:

-barbital
barbituate

phenobarbital
Category of drug that ends with:
-caine
local anethetic

lidocaine
Category of drug that ends with:

-cillin
penicilin

methicillin
Category of drug that ends with:

-cycline
antibiotic, protein synthesis inhibitor

tetracycline
Category of drug that ends with:

-etine
SSRI

fluoxetine
Category of drug that ends with:

-ipramine
TCA

imipramine
Category of drug that ends with:

-navir
protease inhibitor

saquinavir
Category of drug that ends with:
-olol
b-antagonist

propanolol
Category of drug that ends with:

-operidol
butyrophenone (neuroleptic)

haloperidol
Category of drug that ends with:
-oxin
cardiac glycoside (inotropic agent)

digoxin
Category of drug that ends with:

-phylline
methylxanthine

theophylline
Category of drug that ends with:

-pril
ACE inhibitor

captopril
Category of drug that ends with:

-terol
B2 agonist

albuterol
Category of drug that ends with:

-tidine
H2 antagonist

cimetidine
Category of drug that ends with:

-triptan
5-HT1B/1D agonist (migraine)

Sumatriptan
Category of drug that ends with:

-triptyline
TCA

Amitryptiline
Category of drug that ends with:

-tropin
pituitary hormone

somatotropin
Category of drug that ends with:

-zolam
benzodiazepine

alprazolam
Category of drug that ends with:

-zosin
a1 antagonist

prazosin
4 drugs with a narrow TI
Phenobarbitol
Lithium
Digoxin
Coumadin

Please Detach Lid Carefully
7 drugs that inhibit Cyt P450
PICK EGS
Protease inhibitors
Isoniazid
Cimetidine
Ketoconazole
Erythrmycin
Grapefruit juice
Sulfonamides
3 drugs used for Alzheimer's that affect ACh

What is their affect
Alzheimers --> low ACh, so these drugs work as anticholinesterases

Donepazil
Galantamine
Rivastigmine
4 anticholinergics used to treat urge incontinence
darifenacin/solifenacin
oxybutinin
tolterodine
trospium

- muscarinic antagonists
dott (constantly pee out little DOTT's)
Pharm endings

-dronate

use?
mechanism?
bisphosphonate

prevent bone breakdown
- inhibit osteoclasts
- benefit osteoblasts (inhibit apoptosis)
Pharm endings

-sartan
AII receptor antag
Pharm endings

-chol
Cholinergic agonist
Pharm endings

-stigmine
Anticholinesterase
Pharm endings

-Mustine
Nitrosureas (brain tumor meds)
Pharm endings

Curium, curonium
non-depolarizing neurmuscular antagonists
Pharm endings

-statin
HMG CoA reductase inhibitor
Pharm endings

-glitazone
increases target cell response to insulin
Pharm endings

bendazole
antihelminth
Pharm endings

-dipine
dihydropyridine Ca channel blockers
Pharm endings

-prost
Prostaglandin analog
Pharm endings

-mab
monoclonal Ab