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183 Cards in this Set
- Front
- Back
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blood vessels
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ACE inhibitors have what 2 effects
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↓ BP
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ACE inhibitors are CI in pt with
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bilateral renal artery stenosis
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what is the perfusion of the kidney with ACE
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ACE → efferent arteriole constriction → ↑ perfusion
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what is the perfusion of the kidney with an ACE inhibitor
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ACE inhibitor → ↓ perfusion → possible renal failure if the renal artery is stenotic
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niacin is a tx for
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hyperlipidemia
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what are the SE of niacin
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flushing, warmth, itching
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niacin, the flushing SE is mediated by
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prostaglandins
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how would you prevent the flushing SE with niacin
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aspirin pre-treatment
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the body synthesizes histamine from the amino acid
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histamine
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histamine is released from _____ cells
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mast cells (H1)
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the body synthesizes serotonin from the amino acid
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tryptophan
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where is serotonin stored in the body
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GI tract 90%
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what is substance P
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pain neurotransmitter in both PNS and CNS
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what is the function of “capsaicin”
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decreases pain by ↓ level of substance P in the PNS
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what is the most recognized SE of ACE inhibitors?
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cough
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what is the mechanism behind ACE inhibitor induced cough?
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accumulation of:
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what is the effect of low dose dopamine?
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D1: kidney perfusion ↑
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what is the effect of high dose dopamine?
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A1: peripheral vasoconstriction (inc renal vasoconstriction)
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what drug characteristics would trap a drug in the plasma compartment
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↑ MW fat, water loving, protein-hugging and charged!
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would the volume of distribution of the above drug be?
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low
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Equation for distribution
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Vd = amount of drug given/ plasma [drug]
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how is bioavailibility related to drug distribution?
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they are not related
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bioavailability is a measure of _____
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absorption
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in a pt with diabetes, what kind of antihypertensive will you prescribe?
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ACE-I and ARB
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what are the effects of ACE-I and ARB in addition to anti-HTN action
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↓ ESRD (end stage renal disease)
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what antihypertensives should be selected for a pt with BPH (benign prostatic hyperplasia)?
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alpha-1 blockers:
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what antihypertensives should be selected for a pt with CAD and CHF
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cardioselective beta blockers:
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what antihypertensive should be selected for a pt with osteoporosis?
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hydrochlorothiazide
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what is the first line medication for tx of essentiao HTN in the general population
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hydrochlorothiazides
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what antihypertensive should be selected for a pt with a state of hyperaldosteronism (aldosterone-secreting tumor)
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spironolactone
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which one affects the vasculature and which one affects the heart?
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nifedipine: vascular sm. M. (slit your wrists with a knife)
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how would you alter the systolic blood pressure?
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alpha 1 agonist → ↑ systolic bp
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how would you alter the diastolic blood pressure?
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beta 2 agonist → ↓ diastolic bp
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SE of
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cardiology
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litium is linked to what anomaly in utero
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Ebsteins anomaly
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what is Ebsteins anomaly
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apical displacement of the tricuspid valve leaflets, ↑ volume of the RV, and atrialization of the RV
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what drugs can cause drug-induced lupus syndrome?
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procainamide
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what drug causes blue/grey skin discoloration
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amiodarone
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what are the other side effects of amiodarone
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thyroid disease, lung fibrosis and liver toxicity
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what is the most common SE of beta blockers
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negative inotropy
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SE of lidocaine
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nonfocal neurologic signs:
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SE of adenosine
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chest burning
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SE quinidine
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weakness, GI effects
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isosorbide dinitrate: what load does it affect
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↓ cardiac work ← ↓ preload ← venodilation
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digoxin: effect on K
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digoxin toxicity → hyperkalemia
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hepatobiliary system
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↓ warfarmin conc
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phenytoin and other P450 inducers
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↑ warfarin conc
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trimethroprim
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↑ warfarin conc
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cimetidine
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hypercholesterolemia = ↑ _____
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↑ LDL
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what is the TOC for hypercholestrolemia
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statins
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SE of statins
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myopathy
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statins + _____ → ↑ risk of myopathy
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statins + fibrates
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why is the risk of myopathy increased in the above scenario
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because fibrates increase the concentration of statins
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what is the most likely statin to cause myopathy
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simvastatin
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GI
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what stimulates gastric acid secretion from parietal cells?
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Histamine
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what stimulates the acetylcholine → gastric acid secretion
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vagal stimulation
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atropine blocks the gastric parietal cell _____ receptor
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M3 acetylcholine receptor
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cimetidine blocks the gastric parietal cell _____ receptor
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histamine H2 receptor
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sucralfate – action?
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binds to base of mucosal ulcers, providing physical protection against acid
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musculoskeletal
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chronic use of corticosteroids like prednisone has what effect on bones
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osteoporosis
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TOC for rheumatoid arthritis (moderate to severe)
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methothrexate
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TOC for mild, early seronegative rheumatoid arthritis
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sulfasalazine
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is raloxifene an estrogen-agonist or antanist?
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both
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alendronate belongs to what class of drugs
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bisphosphonate
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alendronate: action on bones
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bone resorption inhibitor; prevents and treats osteoporosis
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leuprolide: it’s effects on bones if given in a pusatile fashion
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[estrogen antagonism]
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leuprolide: it’s effects on bones if given in a continous fashion
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[estrogen antagonism]
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prolonged use of parenteral medroxyprogesterone is associated with _____ bone mineral density in women of all ages
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decreased
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finasteride: effect on bone
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none
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finasteride: MOA
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inhibits 5alpha reductase
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TNF-alpha inhibitor: clinical use
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tx for rheumatoid arthritis
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name the TNF-alpha inhibitors
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vowels: AEI
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TNF-alpha inhibitor: SE
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infections ← ↓ macrophage function
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name the RA txs that inhibit purine and pyrmidine synthesis
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go to the mall, you will see a lot of RA
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name the RA tx that inhibits phospholipid degradation?
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corticosteroids
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name the RA tx that inhibits prostaglandin synthesis
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NSAIDS
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neurology
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reserpine used for _____ in disadvantaged countries
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as an antihypertensive that ↓ BP through sympatholytic effects
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reserpine MOA
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binds irreversibly to presynaptic vesicles and blocks the tranpsort of neuropeptides like NE, dopamine, and serotoinin INTO these vesicles
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what happens to the neurotransmitters if they can’t be packaged into vesicles?
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they are degraded by MOAs within the cytoplasm
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what are the SE of reserpine
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depression
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what is reserpine used for in our country?
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guanethidine MOA
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prevents NE release into the synaptic cleft by
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cocaine MOA
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prevents NE reuptake from the synaptic cleft by presynaptic neuron
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what other drugs act like cocaine at the synaptic cleft?
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older TCAs
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pulmonology
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theophylline MOA
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inhibits phosphodiesterase
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what does the blockage of phosphodiesterase do?
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prevents cAMP → AMP
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SE of theophylline … the most dangerous
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seizures and arrhythmias
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what is tx for theophylline-induzed arrhythmia
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beta blockers
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what is the tx for theophylline-induced seizures
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benzodiazepines
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why?
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hematemesis and melena
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when would you see bradycardia, hypotension, and cardiovascular collapse
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beta blocker toxicity
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why?
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glucagon → ↑ [cAMP] intracellular and cardiac contractility
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when would you see severe sedation, respiratory depression, and constricted pupils
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opioid intoxication
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who would you treat opioid intoxication?
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naloxone
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renal
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thiazide diuretics: location of action
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DCT
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thiazide diuretic: SE regarding K, Na, Mg
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hypokalemia
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thiazide diuretics vs. loop diuretics regarding Ca
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thiazide → ↑ Ca 2+ = hypercalcemia
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what is the mechanism of hypercalcemia in with the use of thiazide diuretics
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unknown;
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when do you use thiazide diuretics?
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tx for edema secondary to:
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carbonic anhydrase inhibitors: location of action
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PCT
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what are the most potent diuretics?
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loop diuretics
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loop diuretics: location of action
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ascending limb
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why are thiazide diuretics more potent than loop diuretics?
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only a small amount of filtered Na reaches DT; loop has access to it first
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potassium sparing diuretics: location of action
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collecting duct
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oncology
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folinic acid (leucovorin): clinical use
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can reverse the toxicity of methotraxate in non-cancerous cells in the GI mucosa and bone marrow (if given at the appropriate time)
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allopurinol: clinical use
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tx of gout and prevention of tumor lysis syndrome
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allopurinol: MOA
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inhibit xanthine oxidase
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filgrastim: clinical use
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tx of neutropenia
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filgrastim: MOA
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analog of G-CSF (granulocyte colony-stimulating factor), used to simulate the proliferation and differentiation of granulocytes in pt with neutropenia
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mesna: clinical use
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prevents hemorrhagic cystitis in pt receiving cyclophosphamide or ifosfamide
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mesna: MOA
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binds acreolin , the toxic metabolite that is formed by cyclophosphamide and ofosfamide
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dexrazoxane: clinical use
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prevents anthracycline-induced cardiotoxicity
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dexrazoxane: MOA
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iron-chelating agent
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amifostine: clinical use
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↓ cumulative nephrotoxicity associated with platinum-containing and alkylating chemotherapeutic agents
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amifostine: MOA
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free-radical scavenger
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vinca alkaloids: name an example
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vincristine
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vinca alkaloids: MOA
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inhibit micrtubule formation
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vinca alkaloids: SE
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neurotoxicity
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what are the four main stages of the cell cycle?
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G1 → S → G2 → M
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when would the cell be in G0?
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G1 → S → G2 → M → G0 → G1
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genitourinary
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what are the absolute contraindications to OCP use
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1.
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2.
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hx of estrogen-dependent tumor
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3.
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smokers > 35 y/o
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4.
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hypertriglyceridemia
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5.
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liver problems (would impair steroid metab)
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6.
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pregnancy
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hematology
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t-PA (tissue plasminogen activator): clinical use
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mgmnt of:
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t-PA: MOA
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plaminogen → plasmin = thrombi breaks down
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clopedigrel: clinical use
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tx of CAD, peripheral vascular disease, cerebrovascular disease
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would you use clopedigrel for a DVT?
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no
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in pregnancy, what anti-coagulant should you use?
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heparin
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can warfarin be used in pregnancy?
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no
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heparin: MOA
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↑ antithrombin III activity
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what is the DOC for DVT?
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warfarin
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microbiology
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tx for N. gonorrhoeae
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ceftriaxone
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tx for C. trachomatis
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doxycycline or azithromycin
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metronidazle: clinical use
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infx caused by anaerobic bacteria or protozoa
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fluconazole: clincial use
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antifungal to tx:
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what are NNRTIs
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nonnucleoside reverse transcriptase inhibitors
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do NNRTIs require activation via intracelllar phosphorylation
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no
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name the common NNRTIs
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nevirapine
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what are NRTIs
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nucleoside reverse transcriptase inhibitors
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do NRTIs require activation via intracelllar phosphorylation
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yes; must be converted by thymidine kinase from current form → monophosphate form before it can be converted into a pharmacologically active triphosphate form
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ritonavir: MOA
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HIV protease inhibitor; prevents assembly and maturation fo the virus
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enfuvirtide: MOA
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HIV fusion inhibitor; prevents HIV genome from entering uninfected CD4+ T cells
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indinavir: belongs to what drug class?
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protease inhibitor class of antiretroviral drugs
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what are the important SE of ALL protease inhibitors
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1.
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2.
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lipodystrophy
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3.
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P450 inhibition
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what rx is used in HIV pt for prevention and tx of pneumonia caused by Pneumocystis jiroveci?
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TMP-SMX
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TMP-SFX: SE
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1.
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2.
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Steven-Johnson syndrome
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3.
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toxic epidermal necrolysis
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zidovudine: what group does it belong to?
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NRTI
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zidovudine: SE
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bone marrow toxicity → anemia
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acyclovir is an anti-viral rx against _____
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HSV-1 and HSV-2
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acyclovir: SE
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renal toxicity
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what rx is used in HIV pt for prevention and tx of Mycobacterium avium intracellulare (MAC) infections?
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azithromycin
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what rx is used for tx of CMV in HIV pt?
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foscarnet
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foscarnet SE
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nephrotoxicity
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protease inhibitors are anti-HIV medications that _____ inot mature viral proteins
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inhibit cleavage of polypeptide precursor
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define:odynophagia
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