Pharmacology Block 6

Front 1

Calcineurin inhibitors are (immunosuppressive/immune stimulating) and include _

Back 1

Immunosuppressive

cyclosporine, tacrolimus, sirolimus

Hint 1

Biggest side effect is nephrotoxicity

Front 2

Mycofenolate mofetil and Azathioprine are considered _

Back 2

anitproliferative/antimetabolic agents

Front 3

MC cytotoxic drug?

Back 3

Cyclophosphamide

SE?

Hint 3

hemorrhagic cystitis

Front 4

Classic example of immune modulating biologic agent?

Back 4

Anti- IL2R mAbs - Daclizuman, Basiliximan
block IL2 mediated T cell activation

Front 5

All biologics have an increased risk of _

Back 5

infection and cancer

Front 6

Major side effect of CD-3 therapy is _

Back 6

cytokine release syndrome

typically begins 30 min after treatment

causes high fever, chills, HA, rigor, htn, N/V/D

can also cause pulmonary edema, ARDS, cardiac arrest

How can cytokine release be prevented?

Hint 6

administration of glucocorticoids before the injection on CD3

Front 7

Cyclosporine binds to _
Tacrolimus binds to _

Both of these are considered _

Back 7

cyclophilin
FKBP (and cyclophilin - more potent)

calcineurin inhibitors - they inhibit the transcription of IL2

Front 8

MOA of Sirolimus

Back 8

blocks downstream signlaing through TCR and inhibits proliferation

Does NOT block IL2 (despite being considered a calcineurin inhibitor - it actually isn't)

SE?

Hint 8

myelosuppression

Front 9

DoC for ITP?

Back 9

Prednisone

Front 10

DoC for autoimmune hemolytic anemia?

Back 10

Prednisone

Front 11

DoC for AGN?

Back 11

Prednisone

Front 12

Binds to both TNF alpha and TNF beta?

Back 12

Etanercept -

used in arthritis

Front 13

Binds to TNF alpha and suppresses inflammatory cytokines IL1 and IL6

Back 13

Infliximab

(also adalimumab)

Front 14

Inhibits T cell Costimulation by blocking secondary binding of CD80/86 (APC) with CD 28 (TC)

Back 14

Abatacept

Front 15

Treatment of MS?

Back 15

INFbeta 1-a and INF beta 1b

And what if the patient becomes refractory to INFb?

Hint 15

Glatiramer acetate

or Mitoxantrone

Front 16

Use of Levamizole?

Back 16

Colorectal cancer

se?

Hint 16

severe agranulocytosis

Front 17

Treatment of multiple myeloma?

Back 17

Thalidomide

inhibits TNFa and angiogenesis

Front 18

Nonspecific adjucant or immunostimulant used in bladder cancer

Back 18

Bacillus Calmette Guerin (BCG)

Front 19

Tx of chronic granulomatous disease?

Back 19

INF gamma

Front 20

Approved in treatment of several neoplasma such as hairy cell leukemia, HTLV, CML, malignant melanoma, Kaposi's sarcoma, Hep B and C

Back 20

INF alpha

Front 21

Binds to CD20 triggering complement mediated lysis of the cell

Back 21

Rituximab

uses

Hint 21

follicular B cell or non Hodgkin;s lymphoma

Front 22

Binds to GPIIb/IIIa receptor on activated platelets, preventing aggregation.

Back 22

Abciximab

Front 23

Tx of OD of acetominophen?

Back 23

Charcoal, Nacetylcysteine (supplies sulfhydryl groups that replete glutathione)

Front 24

Calcium oxalate crystalluria is a/w _

Back 24

ethylene glycol ingestion (antifreeze)

Front 25

Treatment of organiophosphates exposure? (Ie a farmer wearing short sleeves)

Back 25

atropine for sx

pralidoxime (2-PAM) breaks covalent bond

Front 26

Treatment of lead poisoning? (seizures, abdominal cramping, anemia, hepatitis,)

Back 26

EDTA (chilation) + dimecaprol

Front 27

Tx of Arsenic poisoning? (garlic breath, rice water stools)

Back 27

Dimecaprol

Front 28

Treatment of Iron OD?

Back 28

deferoxamine mesylate

Front 29

Treatment of CN poisoning?

Back 29

sodium nitrite, sodium thiosulfate

Front 30

Sustained rapid eye mvmnt, confusion, euphoria, clumsiness, overreaction of reflexes, relaxation of jaws & ankles is indicative of

Back 30

serotonin syndrome

how do you antagonize?

Hint 30

Cyproheptadine!
-specific 5HT2 antagonist

Front 31

You should NOT administer charcoal or induce emesis with _ ingestion.

Back 31

corrosives (acids and alkalines)

what should you do?

Hint 31

dilute with milk or water

Front 32

Antivenom for snack bite?

Back 32

crotaline polyvalent fab

Front 33

What drugs are known for their side effects of cytokine release syndrome 30 min post transfusion? (fever, chills, NVD, arthralgias, and fatigue)?

Back 33

Muromonab CD3 Ab

Use and MOA?

Hint 33

Acute organ transplant rejection

decreases T cells by cell death and also by T cell margination to vascular endothelial wall

Front 34

MOA of Daclizumab and Basiliximab?

Back 34

Bind IL-2 receptors, blocking binding from activated lymphocytes

Front 35

Calcineurin Inhibitors Include _ , what is there MOA?

Back 35

Cyclosporin, Tacrolimus, Sirolimus

C: binds cyclophilin, T: binds cyclophilin and FKBP, S: blocks FKBP. Ultimately inhibits transcription of IL2

Front 36

MOA of mycophenolate mofetil?

Back 36

inhibits de novo synthesis of purines

Use?

Hint 36

Steroid refractory GVHD, solid organ transplant

Front 37

Azathioprine MOA?

Back 37

Prototypical Antimetabolite, Gets metabolically activated interferes with purine metabolic and lymphoid cell proliferation.


Use ?
Dose should be reduced if the patient is on what other drug?

Hint 37

Renal allografts, actue GN,

Allopurinol (needs xanthine oxidase)

Front 38

What drug causes hemorrhagic cystitis?

Back 38

Cyclophosphamide

Front 39

MOA of Vincristine?

Back 39

prevents mast cell degraulation, binds microtubules in cells preventing the release of histamine

Use?

Hint 39

ITP refractory to prednisone

Front 40

MOA of Infliximab?

Back 40

binds TNF a, suppression of downstream cytokines

Hint 40

Used in crohn's, RA

Front 41

MOA of Etanercept?

Back 41

binds both TNFa and TNFb,

Hint 41

Used in RA and psoriatic arthritis

Front 42

MOA of adalimumab?

Back 42

blocks interaction of TNF with TNF receptors - similar to infliximab

Front 43

MOA of Abatacept?

Back 43

binds CD80/86 on APC and inhibits T cell activation and cytokine release

Use?

Hint 43

RA

Front 44

How do you treat MS?

Back 44

INF beta (interferes with T cell adhesion to endothelium)

and if that doesn't work?

Hint 44

Glatiramer acetate, or Mitoxantrone

Front 45

Levamisole is an immuno(depleting/stimulating) drug

Back 45

stimulating, activates macrophages

Use

Hint 45

colorectal cancer

Front 46

MOA of Thalidomide?

Back 46

Inhibits TNFa and angiogenesisis, reduces phagocytosis by neutrophils and increases production of IL-10.

Use?

Hint 46

Mutltiple Myeloma, erythema nodosum

Front 47

What is IFNy used for?

Back 47

Chronic granulomatous disease

SE?

Hint 47

fever, flu sx, anorexia, fatigue, malaise (all cytokines share these SE)

Front 48

What is GMCSF used for?

Back 48

pre term neonates and neutropenic patients, to help them fight infections

Front 49

What is IL2 used for?

Back 49

metastatic renal cell carcinoma and malignant melanoma

SE?

Hint 49

fever, flu sx, anorexia, fatigue, malaise

All cytokines share these side effects

Front 50

Trastuzamab MOA and use?

Back 50

Binds her-2/neu in breast cancer

Front 51

MOA of Rituximab?

Back 51

Binds CD20 on B lymphocytes,

Use?

Hint 51

B cell or non-hodgkins lymphoma

Front 52

MOA of Abciximab?

Back 52

binds GP IIb/IIIa receptor on platelets, preventing aggregation

Used as an adjunct to heparin

Front 53

What are the 4 main mechanisms of acne?

Back 53

1) hyperkeratinization- inc in loose cells in follicle, responsive to androgens
2) sebum production- responsive to androgens
3) bacterial component- P. acnes- G+ anaerobic rod; produces lipasesform FFA from sebum
4) inflammatory- irritation from FFA, immune response to P. acnes

Front 54

What mechanism of acne production does salicylic acid target?

Back 54

Specifically it is Keratolytic

(it decreases coryneocyte adhesion

Front 55

What mechanisms of acne production does Azelic Acid target?

Back 55

Inflammation (oxygen free radical scavenger), antibacterial ( inhibits thioredoxin reductase), and keratolytic

Side effects?

Hint 55

Hypopigmentation

Front 56

Which has more mild side effects. 1st, 2nd, or 3rd generation retinoid receptors?

Back 56

3rd generation, interact with fewer retinoid receptors allowing for a milder side effect profile

Front 57

What mechanism of acne production do retinoids target?

Back 57

keratolytic (they increase mitosis, increasing turnover and decreasing cell adhesion), lower inflammation

SE?

Hint 57

appearance of worsening acne, takes of the top layer of skin and exposes all the acne that hadn't made its way up get, anti wrinkle, yields pink smooth skin

Front 58

What mechanisms of acne production are targets by oral isoretinoin?

Back 58

(accutane) All 4!
Keratolytic
Antibiotic
Antiinflammatory
Decrease Sebum production

SE?

Hint 58

inflammatory bowel disease

Front 59

Erythromycin when given for acne is given (orally/topically/both)

Back 59

both

MOA?

Hint 59

Inhibits 50s RNA inhibiting translation

Front 60

Clindamycin when given for acne is given (orally/topically/both)

Back 60

both

MOA

Hint 60

binds 50s ribosome, (different site than erythromycin)

Front 61

Tetracycline when given for acne is given (orally/topically/both)

Back 61

both

MOA?

Hint 61

binds 30 s ribosomal subunit, inhibits Elongation

SE include photosensitivity (worse with dairy), tooth and bone effects,

Front 62

Minocycline when given for acne is given (orally/topically/both)

Back 62

orally

MOA?

Hint 62

its a tetracycline which inhibits elongation by binding 30s

Front 63

Used in moderate to severe chronic plaque psoriasis and acts my reducing active T cells involved in psoriasis leaving other T cells largely unaffected

Back 63

Alefacept

Front 64

What drug inhibits dihydrofolate reductase?

Back 64

Methotrexate (used in RA, transplants, and psoriasis)

Ultimately it decreases IL-1

Front 65

Which is more likely to lead to skin cancer? UVB or PUVA?

Back 65

PUVA - it has a longer wavelength and therefore is a lot stronger

Front 66

Where is the reward system?

Back 66

ventral tegmental area

Front 67

facilitates action of GABA and inhibits activation of NMDA receptors

Back 67

alcohol

Front 68

Patient with history of alcohol abuse presents with memory loss, dementia, anterograde amnesia, confabulation. What's this called?

Back 68

Korsakoff syndrome

Front 69

How do you treat alcohol addiction?

Back 69

disulfiram - inhibits acetaldehyde dehydrogenase - causes an adverse rxn when the patient drinks, they get really sick to stomach

For maintenance?

Hint 69

Acamprosate - lowers activity of receptors for glutamate

A - without +(pro) Camp ate - glutamate
Without glutamate receptors, which are Gs so they trigger and increase in cAMP

Front 70

How do you treat alcohol withdrawal?

Back 70

Propanolol for tremors, and reduction of HR and BP

Benzos to prevent delirium and seizures

Front 71

Blocks dopamine transporter, blocks NE and 5-HT reuptake

Back 71

cocaine

Front 72

What is an adverse drug event?

Back 72

any drug related incident that causes harm to the patient (doesn't mean there was an error)
Ex: patient has seizure, is given a benzo. When they wake up they stand up and fall down

Risk factors?

Hint 72

polypharmacy, multiple prescribers, age, female gender, cognitive impairment, prior adverse drug rxns

Front 73

What is a drug error?

Back 73

inappropriate or incorrect omission of drug, even if it doesn't cause harm

Front 74

"Lead pipe" muscle rigidity, autonomic dysregulation, hyperthermia, and altered mental status are signs of what condition?

Back 74

Neuroleptic Malignant Syndrome - due to dopaminergic antagonist (onset within days to weeks)

How do you treat this?`

Hint 74

BZD (mild)
Dopamineric agonist - Bromocriptine (if moderate)
Dantrolene (severe)

Front 75

Elevated temperature, increased pulse, increased blood pressure, constricted pupils, hyperactive bowel sounds are all signs of what condition?

Back 75

Serotonin syndrome caused by serotoniergic drugs (opioids, SSRIs) - onset within minutes to hours

Front 76

MOA of mycophenolate mofetil?

Back 76

Inhibits de novo synthesis of purines, thus inhibits B and T lymphocytes ( acts on inosine monophosphate dehydrogenase)
 Selectively targets Inosine monophosphate dehydrogenase, which is required to make IMP (the first purine) de novo. Lymphocytes (unlike other rapidly proliferating cells) RELY solely on the de novo synthesis of purines as opposed to the salvage pathway. As such, this drug specifically targets LYMPHOCYTES.

Use?

Hint 76

Refractory rejection and GVHD (steroid resistant)

Front 77

How do you treat ITP refractory to prednisone?

Back 77

Vincristine

Front 78

MOA of methotrexate?

Back 78

interferes with thymidine synthesis --> blocks DNA synthesis

(specifically inhibits dihydrofolate reductase)

Front 79

How should you approach patients who are likely to have a rejection to a transplant (for instance, those with high levels of anti-HLA abs)?

Back 79

Plasmapheresis every other day, modify humoral rejection mediated by B cells

IV immunoglobulin - to suppress Ab production

Front 80

Maintenance therapy consists of

Back 80

calcineurin inhibitor, GCs, and an antimetabolite

Front 81

Infliximab binds _

Back 81

TNFa (which suppresses IL1, IL5, and adhesion molecules involved in leukocyte activation and migration)

Used in

Hint 81

crohns and RA

CI in CHF patients

Front 82

Treatment of follicular B cell or non Hodgkins lymphoma?

Back 82

CD20

Front 83

Alefacept is used for

Back 83

Psoriasis

Front 84

What drug is notorious for delayed toxicity?

Back 84

Amiodarone

Front 85

90% of Acetominophen is metabolized via _ with _ or _

Back 85

hepatic conjugation with sulfate or glucoronide

5 % does P450 oxidation and produces _

Hint 85

N-acetyl para benzoquinonemine (NAPQI) , which then reacts with glutathione (GSH) to form an inactive product.

If is NAPQI that destroys hepatocytes and renal tubular cells. GSH depletion --> excess NAPQI and hepatotoxicity!!! Thus why antidote to acetominophen OD is N acetyl cysteine - it repletes the glutathione

Front 86

What toxicity can cause irreversible blindness?

Back 86

methanol (--> formic acid)
- found in paint thinners, wood strippers
How do you treat?

Hint 86

Fomepizole (antidote) - competes with Alcohol dehydrogenase

then Leucovorin q 4 hours x 6

if that's not available give them ethanol (competes with AD)

Front 87

How do you treat a patient who ingested a bunch of antifreeze?

Back 87

Specific antidote = Fomepizole, competes with AD

Then... pyridoxine (100mg) + thiamine (100 mg) IV daily

If that's not available, then give them Ethanol!!!

Front 88

MOA of pralidoxime? What is it used for ?

Back 88

Used for tx of organophosphate poisoning.

Breaks the covalent bond between the organophosphates and acetylcholinesterase

Front 89

Patient presents with htn, tachycardia, fever, dry mouth, dry eyes, urinary retention, hallucinations, and confusion. What does this look like, and how do you treat?

Back 89

(dry as a bone, hot as a pistol, blind as a bat, mad as a hatter) --> Anticholinergic OD

Treat with Physostigmine

Front 90

Patient presents with hypotension, abdominal pain, N/V, convulsions, delirium. You find out that he is a landscaper and spend all day spraying insecticides. How do you treat?

Back 90

(Arsenic poisoning)

Endotracheal tube if unstable, IV fluids, gastric lavage, DIMECAPROL,

If it was organophosphate poisoning - such as parathion, malathion also seen in insecticides and the pt has DUMBBLESS how would you treat?

Hint 90

Atropine to control sx, 2 pralidoxine to regenerate the AchE

Front 91

What is the urinary metabolite of cocaine?

Back 91

benzoylecgonine

Front 92

Which acne medication has a se of the appearance of worsening acne?

Back 92

Tretinoin - it is exfoliative, increases mitosis, increasing cell turnover. It takes off the top layer of skin and exposes all the acne that hasn't come to the surface yet.

At what time of the day is this applied and why

Hint 92

Night time, because the compound degrades in UV light, so side effects are worse

Front 93

_ is converted to it's active form by esterases in the skin

Back 93

Tazarotene

binds RARs, and is keratolytic and has anti-inflammatory

Front 94

The one acne medication that targets all four of the abnormalities found in acne?

Back 94

Isotretinoin

sideeffects?

Hint 94

super teratogenic, - 2 forms of birth control,

dry skin, peeling, dry eyes, nosebleeds, alopecia.

Interacts with tetracyclines and can cause pseudotumor cerebri

Front 95

Hormone based therapy for acne?

Back 95

ethinyl estradiol and norgestimate
increases sex hormone binding globulin and decreases free testosterone. Decreases sebum production, and decreases hyperkeratinization.

Used for moderate inflammatory acne in females

Front 96

What schedule has the highest abuse risk, and has no safe medical use in US?

Back 96

Schedule 1 (C-1)

This includes heroin, marijuana, LSD, PCP, cocaine

Front 97

What are some example of Schedule II drugs?

Back 97

(high abuse risk, but have a safe and accepted med use) includes Morphine, oxycodone, dextroamphetamine

Front 98

What are examples of schedule III drugs?

Back 98

(accepted med use)

Acetominophen/Codeine - Vicodin

Front 99

Examples of Schedule IV drugs?

Back 99

Diazepam, phenobarbital, darvocet

Front 100

Schedule V drugs?

Back 100

involve preps containing limited quantities of certain stimulant or narcotic drugs

Front 101

Every practitioner who prescribes controlled substances must register with _ and _

Back 101

DEA and DPS
- exemptions: all of the following may prescribe CIII-CV drugs if acting in the course of employment for a DEA registered hospital
• Interns or residents
• Physicians on staff at VA hospital
• Individual practitioner

Front 102

When do CIII-IV drugs expire?

Back 102

6 mo from date of issue

Front 103

When do CII drugs expire?

Back 103

7 days after issue

require an official rx form or triplicate

Front 104

Contents of a Prescription?

Back 104

Date, Patient Name and Address, DOB (not required), Drug (brand vs generic), Name of Drug (w/o abbreviation), Strength (concentration AND dose), Quantity, Directions for use, Practicioner's name address and phone #, Refills,

Front 105

Sig

Back 105

directions to the pt that you want to be printed on the prescription bottle.

Front 106

abbreviation for drop or drops

Back 106

gtt (s)

both eyes, left eye, right eye?

Hint 106

o.u.
o.s
o.d (dexter)

Front 107

abbreviation for

three times a day

Back 107

tid

four times a day?

Hint 107

qid

Front 108

What does qid stand for?

Back 108

four x a day

qhs?

Hint 108

once at bedtime

Front 109

Abb for 'every other day'?

Back 109

qod - but DONT use this, write it out!!!

qod gets confused

Front 110

abb for microgram?

Back 110

mcg (NOT ug) -

don't confuse with mg - milligram

Front 111

Abb for three times a week?

Back 111

TIW - DON"T USE, write it out!!

Front 112

Abb for subcutaneous?

Back 112

sub-Q (NOT sc or sq)

Front 113

Where is the DA reward pathway?

Back 113

Ventral Tegmental Area

Front 114

At what blood alcohol level will someone experience impaired motor function, ataxia, slurred speech?

Back 114

100-200 mg / dL

Front 115

What drug used in the treatment of alcoholism causes severe ha, n, and v when combined with small amounts of alcohol?

Back 115

Disulfiram - inhibits acetaldehyde dehydrogenase

these patients will have adverse rxns when they consume alcohol

Front 116

Which drug used in the treatment of alcoholism decreases the craving for alcohol and is therefore used to maintain abstinence?

Back 116

Acamprosate (decreases activity of receptors for glutamate)

Front 117

What drugs are used to treat acute alcohol withdrawal?

Back 117

BZDs - to prevent delirium or seizures

Propanolol - to decrease tremors, HR and BP -- remember this is the only beta blocker that is highly lipophilic and gets into the CNS

Front 118

What illegal drug when ingested can cause severe bowel gangrene?

Back 118

Cocaine

Front 119

What illegal drug stimulates pre and post synaptic 5HT receptors?

Back 119

LSD (hallucinogenic)

Front 120

What illegal drug blocks NMDA type glutamate receptors in cortex and limbic structures, slowing down excitation in brain causing distorted perceptions of sight and sound, producing an "out of body" experience?

Back 120

PCP and ketamine

Front 121

How do you treat opioid withdrawal?

Back 121

Methadone (for short or long term detox)

for initial treatment: Buprenoprhine

For maintenance treatment: Buprenorphine + Naloxone

Front 122

How do you treat quinidine overdose (GI disorder, tinnitus and deafness; usually a patient on a heart drug takes an OTC antacid)?

Back 122

Acidify the urine by giving them cranberry juice or vitamin C

Front 123

If the patient develops anuria, and you need to increase urinary output without changing electrolytes, which diuretic do you use?

Back 123

Mannitol!

Front 124

What antidote contains sulfhydryl groups and what do they do?

Back 124

N -acetyl cystein,

replete Glutathione!!! (conjugates NAPQI to make it nontoxic and excretable by the kidneys)

Front 125

Fomepizole is used for

Back 125

antidote for Ethylene glycol or methanol poisoning

If this is not available, what should you give the pt?

Hint 125

Ethanol!

competition for alcohol dehydrogenase

Front 126

A farmer who was working all day in his tank top comes in complaining of diarrhea, frequent urination, sweating, and watery eyes. PE shows he is bradycardic, and has excessive salivation and lacrimation. Dx and Tx to control symptoms?

Back 126

organophosphate exposure - parathion, malathion - in insecticides


Atropine controls symptoms
What if you wanted to regenerate the Acetylcholinesterase?

Hint 126

2-Pralidoxime!

Front 127

A patient OD's on her TCA she's taking for depression while being high on mushrooms. She presents with tachycardia, confusion, elevated temperature. How do you treat?

Back 127

OD on anticholinergics, treat with Physostigmine!

Front 128

If you see rice water stools and garlic breath in the vignette, what are they talking about?

Back 128

Arsenic exposure

how do you treat?

Hint 128

dimecaprol

Front 129

A painter presents with seizures,abdominal cramping, neuropathy, and fatigue. Lab shows he is anemic. How do you treat the seizures?

How would you treat if he had increased intracranial pressure?

Back 129

(lead poisoning)
Diazepam - for seizures
Mannitol - for increased ICP

What is the specific antidote for lead poisoning?

Hint 129

Dimecaprol + EDTA

Front 130

Parents bring their child in who is in who has nausea, vomiting, and diarrhea with bloody stools. They believe she ate her mom's prenatal pills that were on the counter. How do you tx?

Back 130

(Iron overdose)

Deferoxamine!

Front 131

A patient presents to the ER with a bp of 210/130 and is infused with a nitrate to relax the blood vessels. He presents 24 hours later with a headache, generalized confusion, bizarre behavior, and shortness of breath. Shortly after his arrival he has a seizure. What is the dx and tx?

Back 131

(Sodium Nitroprusside was given to the patient --> cyanide poisoning )

Treat with Sodium nitrate and sodium thiosulfate (N promotes formation of methemoglobin - cyanide binds to it, T breaks bond and forms the less toxic cyan ion which can be excreted)

What if IV access is unavaiable right away?

Hint 131

hold amyl nitrite pearls under nose (assuming the patient is spontaneously breathing)

Front 132

confused, psychotic episodes, DAMAGED nasal septum, running of nose, what should you NOT give this patient?

Back 132

A beta blocker - You will cause signif alpha-adrenergic overdrive

If necessary, give one dose benzodiazepine

(This is Cocaine)

Front 133

The ideal drug for older adults undergoes _

Back 133

Phase II metabolism (doesn't change much with age)

Front 134

best predictor of an anticoagulant response?

Back 134

age

Front 135

Lead pipe muscle rigidity, hypertension, hyperthermia and altered mental status are sx of ...

How do you treat?

Back 135

Neuroleptic Malignant Syndrome

Mild: benzo, Moderate: bromocriptine (da agonist), Severe: dantrolene - for mm rigidity

What meds should you use in the future for this patient?

Hint 135

Atypical antipsychotics
-questiaptine/seroquel

Front 136

Muscle dystonia, hypertension, hyperthermia and altered mental status are sx of ...

Back 136

Baclofen withdrawal (mm relaxant) looks a lot like NMS except dystonic instead of rigid

this is life threatening

Front 137

Volume of distribution =

Back 137

TD (total drug dose)/Plasma Concentration

Front 138

Infants typically require a (larger/smaller) loading dose for lipophilic drugs and a (larger/smaller) loading dose for hydrophillic drugs

Back 138

Smaller

Larger

(remember babies have more water...also remember that highly lipid soluble meds are deposited in breast milk)

Front 139

Why does chloramphenicol cause gray baby syndrome?

Back 139

baby's have decreased metabolism by glucuronyltransferases

Front 140

What metabolism pathway is well developed in infants?

What pathway(s) are delayed up to 1 year?

Back 140

Sulfation is well developed

glucuronidation and oxidation is delayed

What about elimination??

Hint 140

Toddlers may have shorter elimination half lives due to increased renal elimination

----think about it, toddlers are peeing all the time

Front 141

If quinolones are given to a patient younger than one year, they may cause...

Back 141

permanent lesions in the cartilage of weight bearing joints, and reversible arthralgia

Front 142

The facial abnormalities seen in fetal alcohol syndrome are a/w heavy consumption of alcohol during what part of the pregnancy?

Back 142

first trimester

Front 143

Decreased appetite, mental alertness, increased heart rate, increased BP, increased temperature, and dilated pupils are signs that someone is under the influence of _

Back 143

cocaine

Front 144

Rapid emotional swings can be produced by what class of addictive drugs?

Back 144

hallucinogens - LSD, Mescaline, Psilocybin

stimulation of presynaptic and postsynaptic serotonin receptors

Front 145

Pupillary dilation, increased BP, pulse, flushing salivation, lacrimation, hyperreflexia, prominent visual effects, intense color are signs of what illegal drug?

Back 145

LSD

Front 146

Intoxication of benzodiazepines is managed with ....

Back 146

Flumazenil

Front 147

For CIII-V prescription drugs, what do you need to know about the quantity?
Refills?
Expiration?

Back 147

Quantity much be written numerically and as a number!
Limit of 5 refills within 6 months
expires in 6 months

Front 148

How many refills are allowed for CII prescription drugs?

Back 148

Zero

Front 149

If you don't have a DEA number, in what circumstances can you still prescribe CIII-V drugs?

CII?

Back 149

If you are employed at a DEA registered hospital and are interns or residents, an individual practicioner, or on staff at a VA hospital

No exceptions for CII

Front 150

Mechanisms of benzoyl peroxide?

Back 150

antibacterial and keratolytic

Front 151

Inhibitor of thioredoxin reductase and tyrosinase

Back 151

Azelaic Acid (Azelex®)

SE?

Hint 151

hypopigmentation

Front 152

T retinoin?

Back 152

increases TuRnover of cells --> keratolysis

causes appearance of worsening acne

Front 153

whats different about the structure of isotretinoin? (the one that inhibits all 4 mechanisms of acne prod)

Back 153

It is cis as opposed to trans

Front 154

Absorption of tetracyclines is inhibited by concurrent use of _

Back 154

antacids

Front 155

What antibiotic used in acne treatment can cause ototoxicity and vestibular effects?

Back 155

minocycline

Front 156

Acitretin MOA

Back 156

normalizes proliferation of keratinocytes (psoriasis)

Front 157

Tx of Beta blocker OD?

Back 157

glucagon - to increase inotropy of heart

Front 158

Tx of Digitalis OD?

Back 158

Anti-digitalis Fab fragments

Front 159

Tx of copper poisoning?

Back 159

penicillamine

(this is also treatment

Front 160

Tx of TCA overdose?

Back 160

IV NaHCO3

Front 161

Tx of heparin toxicity?

Back 161

Protamine

Tx of Warfarin OD?

Hint 161

Vitamin K, fresh frozen plasma (contains factors II, VII, IX, X protein C and protein S)

Front 162

-afil

Back 162

Erectile dysfunction
ie Sildenafil

Front 163

-ane

Back 163

Inhalational general anesthetic (halothane)

Front 164

-azepam
-zolam

Back 164

Benzodiazepine

Front 165

-azine

Back 165

Phenthiazine (neuoroleptic, antiemetic)

- Chlorpromazine

Front 166

-azole

Back 166

antifungal

Front 167

-etine

Back 167

SSRIs

Front 168

-oxin

Back 168

cardiac glycoside

Front 169

-pril

Back 169

ACE inhibitor

Front 170

-triptan

Back 170

5 HT agonists (migraines)

Front 171

-tidine

Back 171

H2 antagonist

cimetidine