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185 Cards in this Set

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Botulinum Toxin A (Botox)
mechanism of action?
prevents the release of ACh by cleaving the vesicular fusion apparatus SNAP-2
how it prevents the release of ACH?
Baclofen mechanism of action?
Binds and activates GABAb to reduce tonal neural stimulation to muscles.
it is a muscle relaxant
Indications for Baclofen?
a spasmolytic for patients with multiple sclerosis or spinal cord lesions
its mechanism of action is to bind and activate inhibitory GABAb channels in the CNS
Dantrolene mechanism of action
A muscle relaxant that works by blocking calcium release from the SER to reduce skeletal muscle contraction
it isu sed in the treatment of malignant hyperthermia
Dantrolene - indications
treatment of malignant hyperthermia or neuroleptic malignant syndrome
its mechanism of action is to block the release of calcium from the SER of skeletal muscles.
Minoxidil
mechanism of action
it is an arterial vasodilator used as an adjuct for hypertension but more useful for its side effect of hair growth (Rogaine)
effects on smooth muscle cells
Minoxidil - effect on the pancreatic beta cells
it causes a decrease in insulin response to glucose = hyperglycemia?
this is also known as rogaine and has an antihypertensive effect
Atenolol - mechanism of action
selective B-1 blocker
it reduces contractility and heart rate
it causes reduced renin secretion
selective or non selective? how does it work as an antihypertensive?
Clonidine - Class
alpha-2 agonist
acts to reduce sympathetic tone by down regulating NE release (presynaptic). Also vasoconstricts (postsynaptically)
Clonidine - Indications (2)
Hypertension and treatment of opioid withdrawal
Even though it acts as a vasoconstrictor on postsynaptic cells, the predominant action of lowering sympathetic tone allows it to work as this.
Losartan - class
ARB
good to use when someone cannot tolerate an ACEi
Phentolamine
Mechanism of Action
nonslective alpha-blocker
used to control pheochromocytoma
Name two drugs that are ideal treatment for pheochromocytoma
phentolamine and phenoxybenzamine
they are alpha blockers
5-FU
Mechanism of Action
antimetabolite that inhibits thymidylate synthetase
5-FU
Major Side Effects (2)
bone marrow suppression
GI mucositis
5-FU
Indications
solid tumors (i.e. colon, breast) and topical for some skin issues
Acetaminophen
Treatment of Overdose
N-acetylcysteine
causes liver toxicity in high doses
Acetazolamide
Class
Diuretic: Carbonic Anhydrase Inhibitor
acts on the PCT
Carbonic Anhydrase inhibitors
Site of Action
PCT
Acetazolamide
Indications
alkalosis (Alkalinization of urine)
glaucoma (decr. aqueous humor)
high altitude sickness
Which (2) classes of antiarrhythmics are contraindicated in long QT syndrome?
Class IA and III.
Antiarrhythmic that is used for diagnostic and theraputic purposes for SVTs and also for pharm. cardiac stress tests.
Adenosine
Mechanism of action of class III antiarrhthmics.
Potassium channel blocker (prolongs repolarization)
Amiodarone
Class
Class III
Amiodarone
Side Effects (4)
pulmonary fibrosis
increases QT interval
thyroid dysfunction
sometimes liver dysfunction
Flecanide
Class
Antiarrhthmic class IC (potent sodium channel blockers)
Mechanism of Action
Antiarrhthmics Class IC
potent sodium channel blockers
decrease slope of phase 4 and raise threshold
Metoprolol
Class of antiarrhythmic
Class II
Flecanide
Indications
only to be used on people with structurally normal hearts ("flec and die") with SVT
Verapamil
Antiarrhythmic class
Class IV (Calcium Channel Blockers)
Zileuton
Mechanism of Action
inhibits 5-lipoxygenase
Name the drug that is a prostacyclin used to treat pulmonary hypertension. It acts by stimulating PGI2 receptors
Epoprostenol
Misoprostol
Indications (2)
ulcers
miscarriages
Misoprostol
Mechanism of Action
agonist of PGE1
Zarfirlukast
Mechanism of Action
blocks leukotriene receptors (LTD4)
monteluklast
Mechanism of Action
leukotriene antagonist
Alprostadil
Indications (2)
impotency
maintain ductus arteriosis
Alprostadil
Mechanism of Action
Agonist of PGE1
Dinoprostone
Indication
softening/ripening of cervix and induction of labor
Dinoprostone
Mechanism of Action
PGE2 agonist (oxytocin agonist)
Glyburide and glipizide are what class?
sulfonylureas
Mechanism of action of sulfonylureas?
Secretogogues - stimulate pancreatic beta cells to release insulin. Also may help insulin bind to its receptor and/or increase the number of receptors.
Which organ clears sulfonylureas (glyburide and glipizide)?
The liver. Thus do not use in folks with liver issues. Is a good choice in folks with renal issues.
Which class is metformin?
Biguanide
Mechanism of action of metformin? (2)
decreases liver gluconeogenesis and increases tissue glucose uptake
Major side effect of metformin? Who is at most risk?
Lactic acidosis - increase risk of this in those with heart disease or renal failure
Class: Rosiglitazone, pioglitazone
Thiazolidinediones
Mechanism of action of Thiazolindinediones?
Bind PPAR-gamma receptor to increase tissue sensitivity to insulin (increase glucose uptake) and inhibit liver from making more glucose
Side effect of Thiazolidinediones
Liver toxicity (think about how it inhibits the liver from making more glucose)
Acarbose and miglitol are what class?
Alpha-glucosidase inhibitors
Mechanism of action of alpha-glucosidase inhibitors (acarbose and miglitol)
Inhibition of the enzyme decrease glucose absorption in the GI tract.
Useful in the treatment of carcinoid syndrome since it inhibits release of tumor hormones and aids the symptoms of flushing and diarrhea.
Octreotide (somatostatin analogue)
Serotonin (5-HT3) blocker used for diarrhea predominant IBS?
Alosetron
Orally active cannibanoid that is used as an antiemetic in chemotherapy?
Dronabinol
Class of Famotidine
H2-blocker
Class: Lansoprazole
PPI
An amphetamine derivitive used to decrease appetite
Phentermine
Sulfasalazine is an anti-inflammatory used in the treatment of what?
Ulcerative colitis.
What is ursodiol used for?
to break up gallstones.
Theophylline
Drug-drug interactions?
theophylline is extensively metabolized by the liver P450 enzyme system so be careful not to mix with enzyme inhibitors like erythromycin.
Which macrolide is a potent inhibitor of the P450 enzyme system so must be used with caution in patients on meds like Warfarin or Theophylline?
Erythromycin
Mycoplasma, which have no cell wall, are inherently resistant to this drug.
Amoxicillen - because it has an amino group that makes it hydrophilic so it can cross cell walls of G(-) bugs
This second-generation cephalosporin is associated with serum sickness.
Cefaclor
Gray baby syndrome
chloramphenicol
Which electrolyte may get dangerously high in the treatment of hypertension with an ACEi such as enalapril?
Potassium. You get hyperkalemia because you don't have as much aldosterone made therefore the kidney is not stimulated to pee out all of the K.
This drug is used in the tx of AML. Its MA is to inhibit DNA polymerase. Its ADE are leukopenia and anemia.
Cytarabine.
MOA of Bleomycin
intercalates DNA
Mechanism of Action of Doxorubicin.
breaks DNA, intercalates DNA, oxidizes free radicals
Topoisomerase inhibitor used for the treatment of testicular cancer, small cell lung cancer, and leukemia.
etoposide
Mechanism of action of Paclitaxil
Binds tubulin and prevents it from depolymerizing.
Mechanism of Action of Ticlopinide
inhibits ADP-induced platelet aggregation
Mechanism of Action of the chemotheraputic agent mycophenolate mofetil?
inhibits de novo synthesis of purine (Guanine)
Which immunosuppressant drug has the mechanism of action of inhibiting calcineurin-mediated transcription of IL-2?
tacrolimus or cyclosporine (they have the same mechanisms)
Which migraine medication has the rare but deadly side effect of malignant HTN?
sumatriptan (Imitrex)
Diclofenac - class?
NSAID
Ergotamine - Mechanism of Action?
Vasoconstrictor used to treat migraines. It acts on multiple receptors. Contraindicated in preggers or CAD pts.
Class - Methylsergide
anti-migraine
seratonin antagonist and weak vasoconstrictor
Mechanism of Action
Sumatriptan
5-HT d1 agonist
Mechanism of Action
Chlorambucil
DNA alkylating agent (nitrogen mustard)
The primary (2) indications for use of chlorambucil are
CLL and ovarian cancer
Mechanism of Action
Cisplatin
cross-links DNA (alkylating)
Mechanism of Action
Vinblastine
depolymerizes microtubles
Main Indication for Vinblastine
Hodgkins
Main side effect of vinblastine
peripheral neuritis
Immunosuppressive agent used esp. in kidneys that works as a purine antagonist and is metabolized by xanthine oxidase
azathioprine - so take care if you give allopurinol, an inhibitor of xanthine oxidase, because you can get azathioprine toxicity (myelosuppression)
Treatment of Wilson's disease
penicillamine
Clonidine - class
alpha-2 receptor AGONIST
What action do alpha-2 receptors have on pancreatic beta cells?
directly inhibit insulin secretion
Class - terbutaline
beta-2 agonist
What action do beta-2 agonists have on pancreatic beta cells?
stimulate the release of insulin
Why do patients on digoxen therapy often develop arrhythmias? Hint - concurrent meds.
Diruetics such as furosemide that cause them to become hypokalemic or mypomagnesismic.
What is colestipol?
A bile acid binding resin that is used for hypercholesterolemia.
Effect of drugs with sulfa components on digoxin?
Lower digoxin levels
Effect of phenytoin on digoxin
lowers its levels
effect of sulfasalazine on digoxin?
lowers its levels (remember all sulfa components do this).
Site of Action of potassium sparing diuretics
collucting duct
class - ethacrynic acid
loop diuretic
mechanism of action and site of action of loop diuretics
inhibit the Na K Cl cotransporter
thick ascending loop of henle
site of action of thiazide diuretics
DCT
mechanism of action of thiazide diuretics
inhibit the action of the Na Cl pump in the DCT
Treatment of choice for pneumonia caused by strep pneumo
penicillin G
Ceftazidine (3rd gen ceph) is effective against
psuedomonas and gram negatives, not really good for gram positives even compared to other 3rd genners
class - ciprofloxacin
fluoroquinolone
Is cipro, a fluoroquinolone, effective against strep pneumo?
no - although it does have gram negative activity
can you use macrolides or TMP-SMX to treat CAP?
no - there are high numbers of resistant orgs of strep pneumo
class of drugs that binds reversibly to 50S ribosome
macrolides
Tizanadine
Mechanism of Action
alpha 2 agonist (like clonidine) - is used as a centrally-acting muscle relaxant
Tizanadine
Indications
Muscle relaxant used for muscle spasms from spinal cord injury, MS, cerebral palsy, stroke, etc. It acts as an alpha-2 agonist like clonidine.
Name a drug used to increase appetite
Megestrol (Megace)
Loperimide
Indications
OTC antidiarrheal
Ondansetron
Class/Mechanism of action
anti-emetic
5-HT3 (serotonin) blocker
Sibutramine
Class
MAO inhibitor (decreases appetite because it reuptakes serotonin)
Which class of antibiotics, when taken with antacids, has its bioavailability drastically reduced?
fluorquinolones
Name as many drug classes as you can that are known to cause AIN (7)
NSADS
beta-lactam antibiotics
diuretics
phenytoin
cimetidine
methyldopa
Name the side effects of loop diuretics
ototoxicity
hypokalemia
metabolic alkalosis
hyperglycemia
*the reduced sodium stimulates the renin-angiotensin-aldosterone axis
Which class of antibiotics should be avoided in people with MG and why?
aminoglycosides have some antinicotinic (curare-like) effects.
mechanism of action of aminoglycosides
clock formation of initiation complex by binding the 30S subunit of bacterial ribosomes
class: gentamycin
aminoglycoside
class - neomycin
aminoglycoside
class: tobramycin
aminoglycoside
class: streptomycin
aminoglycoside
aminoglycosides are effective against
gram negatives.
OD on which drug would cause tachycardia, elevated body temperature, mydriasis, and skeletal muscle weakness?
botulinum toxin - note that many other drugs would cause all of these symptoms except for the muscle weakness (due to lack of ACh on NMJ sites)
Doxepin is indicated for the treatment of
depression
Two common side effects of the TCA doxepin are
anticholinergic effects of dry mouth and tachycardia (it blcks muscarinics)
Once a head CT reveals no hemmorhage, you can treat a cerebral stroke with
tPA
What is the mechanism by which estrogen replacement helps osteoporosis?
it inhibits osteoclastic activity and aids in osteoblastic activity
Treatment of tinea corporis?
antifungals: clotrimazole cream (miconazole or econazole also work)
Describe what contraction alkalosis is as a side effect of loop diuretic therapy.
Loop diuretics cause lots of salt and water to be lost from the ECF which in turn causes an increase in the relative bicarb concentration.
Mechanism of action of thiazolidinediones
increase insulin sensitivity and therefore have a moa most similar to that of diet and exercise
Which antiarrhythmic drug (class) acts by decreasing SA node automaticity, increasing AV node refractiveness, and decreasing AV nodal conduction velocity
propanolol (class II antiarrhythmic
Mechanism of Action
Amiodarone
Class III antiarrhythmic
prolongs action potential duration
Disopyramide
class
Ia antiarrhythmic
Mechanism of Action
Disopyramide
sodium channel blocker
reduces phase 0 depolarization'
increases action potential duration
Lidocaine
class
IB antiarrhythmic
Mechanism of Action
Chloramphenicol
inhibits ribosomal peptidyl transferase
Although it is no longer used much in the USA because of the risk of aplastic anemia, chloramphenicol was indicated for
typhoid fever and salmonella
Mechanism of Action of Phenytoin
Class IB antiarrhythmic - blocks sodium channels
Tocainide
Class
Class IB antiarrhthmic
Mechanism of Action
Digoxin
increases cardiac contractility by acting on the K/Na ATPase on cell membranes
Sotalol
Class
Class III antiarrhthmic
Mechanism of Action
acyclovir
inhibits viral DNA polymerase
Symptoms of OD of Jimson Weed
an anticholinergic
dry as a bone, red as a beet, mad as a hatter, hot as hades, inactive BS, tachycardia
Which two medications are most commonly used to treat Chlamydia?
Azithromycin or doxycycline
Cisplatin and cyclophosphamide, isofosphamide are what level emetics?
level 5 - bad
decarbazine is what level emetic?
level 5
Bleomycin and Vincristine are what level entiemetics?
level 1
mercaptupurine is what level antiemetic?
level 1 -good
What are the side effects of cyclobenzaprine?
anticholinergic effects such as dry mouth. It is a centrally acting muscle relaxant structurally related to TCAs.
Which neurotransmitter is important in the induction of REM sleep?
ACh
Mechanism of Action
Vincristine
blocks the formation of microtubules
Mechanism of Action
Paclitaxil
prevents the depolymerization of microtubules
Mechanism of Action
Doxirubicin
inserts between DNA to cause strand breakage
Mechanism of Action
Bleomycin
intercalates DNA, causing strand breakage
Which class of diabetic drugs works by decreasing hepatic gluconeogenesis and increase muscle glucose uptake?
thiazolidinediones
chlorpropamide
class
sulfonylurea derivative that stimulates insulin secretion from the pancreas
glyburide
class
sulfonylurea derivative that stimulates insulin secretion from the pancreas
mechanism of action
miglitol
decreases absorption of glucose in the GI tract
tolbutamide
class
sulfonylurea derivative that stimulates insulin secretion from the pancreas
How can you tell apart the amides from the esters of local anesthetics?
amides have two i's and esters have one i
where are local anesthetic amides metabolized?
liver
where are local anesthetic esters metabolized?
plasma cholinesterases
mechanism of action of local anesthetics
block voltage-gated sodium channels from the inside
how can you increase the duratino of action of a local anesthetic?
administer it with a vasoconstrictor such as epi in order to reduce blood flow
Lidocaine, an amide local anesthetic, is also
class IB antiarrhythmic
mode of use of benzocaine
topical only
which local anesthetic is most notable for CV toxicity as a side effect?
benzocaine
Which immunosuppressant drug has the mechanism of action of being a monoclonal antibody directed at the IL-2 receptor on activated T cells?
daclizumab
(also basiliximab)
Merperdine
class
Opioid agonist
drug of choice with acute cholecystitis because it is least likely to cause spasm of sphincter of oddi
Drug of choice for myoclonic jerking syndromes - because it is very effective and non-sedating
valproic acid
Enzyme that activates mercaptopurine?
HGPRT
Main ADE of mercaptopurine
hyperuricemia (avoid allopurinol in this special case because it inhibits the enzyme that metabolizes this drug) and myelosuppression
hepatotoxicity with long term use
anastrozole
estrogen antagonist used to treat breast cancer
the anticholinergic side effects of TCAs such as amitryptiline can have this sever outcome
attack of acute angle glaucoma (blocked muscarinic receptors on constrictor puppilae muscel result in dilation which narrows the angle)
Cimetidine
class
H2 blocker
malothion
class
organophosphate
cholinesterase inhibitor (increases ACh levels)
used as pesticide
Treatment of HCM
beta blockers
Antibiotic that has serum sickness as a side effect more prominently in children than adults
cefaclor
Treatment of serum sickness caused by cefaclor
prednisone and benadryl
sodium stibogluconate and meglumine antimonate are used to treat
leshmaniasis
Side effects of sirolimus
HYPERLIPIDEMIA
avoid high fat meals
(thrombocytopenia and leukopenia)
Sirolimus
Mechanism of action
inhibits T-cell proliferation
(binds mTOR, a serine-threonine kinase crucial for cell replication)
major side effect
muromonab CD3
cytokine release syndrome
cyclosporine and tacrolimus are limited by
nephrotoxicity
Treatment of HIT
bivalirudin or lepirudin (these are direct thrombin inhibitors) (protamin is not enough for HIT)