Usmle Step 1 Flashcards - Pharmacology

Front 1

Sulfa drugs?

Back 1

Celecoxib, furosemide, sulfadiazine, sulfonylureas, probenecid, thiazides, TMP-SMX, acetazolamide, sulfonamide antibiotics

Front 2

Drug that causes acute cholestatic hepatitis?

Back 2

Macrolides

Front 3

Drugs that cause focal to massive hepatic necrosis?

Back 3

Halothane, valproic acid, acetaminophen, Amanita phalloides

Front 4

Drugs that cause hot flashes?

Back 4

Tamoxifen, clomiphene

Front 5

Drugs that cause hypothyroidism?

Back 5

Lithium, amiodarone

Front 6

Drugs that cause gynecomastia?

Back 6

Spironolactone, Digitalis, Cimetidine, chronic Alcohol use, estrogens, Ketoconazole
("Some Drugs Create Awesome Knockers")

Front 7

Drug that causes direct Coombs-positive hemolytic anemia?

Back 7

Methyldopa

Front 8

Hemolysis in G6PD?

Back 8

INH, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin
(hemolysis "IS PAIN")

Front 9

Drugs that can cause megaloblastic anemia?

Back 9

Phenytoin, methotrexate, sulfa drugs.

Phenytoin inhibits intestinal conjugase (decreases absorption of folic acid).

Front 10

TCAs have what kind of general side effects?

Back 10

Atropine-like side effects

Front 11

Drugs that can cause Torsades de pointes?

Back 11

Class III (sotalol), class IA (quinidine) antiarrhythmics

Front 12

Drugs that cause dilated cardiomyopathy?

Back 12

Doxorubicin (adriamycin), daunorubicin

Front 13

Drugs that cause cutaneous flushing?

Back 13

Vancomycin, Adenosine, Niacin, Ca channel blockers

Front 14

Drugs that cause coronary vasospasm?

Back 14

Cocaine, sumatriptan

Front 15

Drugs that cause agranulocytosis?

Back 15

Clozapine, carbamazepine, colchicine, propylthiouracil, methimazole, dapsone

Front 16

Drugs that cause aplastic anemia?

Back 16

Chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole

Front 17

Drugs that cause seizures?

Back 17

Bupropion, imipenem/cilastatin, INH

Front 18

Drugs that cause Parkinson-like syndrome?

Back 18

Haloperidol, chlorpromazine, reserpine (blocks VMAT), metoclopramide

Front 19

Drug that causes nephro/neurotoxicity?

Back 19

polymyxins

Front 20

Drugs that cause nephro/ototoxicity?

Back 20

Aminoglycosides, vancomycin, loop diuretics, cisplatin

Front 21

Drug that causes Fanconi's syndrome?

Back 21

Expired tetracycline

Front 22

Drugs that cause interstitial nephritis?

Back 22

NSAIDs, methicillin, furosemide

Front 23

Drug that causes gingival hyperplasia?

Back 23

Phenytoin

Front 24

Drugs that cause Lupus-like syndrome?

Back 24

Hydralazine, INH, Procainamide, Phenytoin (not "HIPP" to have lupus)

Front 25

Drugs that cause photosensitivity?

Back 25

Sulfonamides, Amiodarone, Tetracycline ("SAT" for a photo)

Front 26

Drugs that cause osteoporosis?

Back 26

Heparin, corticosteroids

Front 27

Drugs that cause rash (SJS)?

Back 27

Ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol

Front 28

CYP-450 inducers?

Back 28

Quinidine, Barbiturates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, chronic alcohol use

Front 29

CYP-450 inhibitors?

Back 29

HIV protease inhibitors, ketoconazole, erythromycin, grapefruit juice, acute alcohol use, sulfonamides, INH, cimetidine

Front 30

Antidote to theophylline?

Back 30

Beta-blocker (can also give activated charcoal and cathartics)

Front 31

Antidote to tPA/streptokinase?

Back 31

Aminocaproic acid

Front 32

Antidote to TCAs?

Back 32

NaHCO3 (plasma alkalinization)

Front 33

Antidote to methanol or ethylene glycol (antifreeze)?

Back 33

Ethanol, dialysis, fomepizole

Fomepizole inhibits alcohol dehydrogenase.

Front 34

Antidote to cyanide?

Back 34

nitrite, hydroxocobalamin, thiosulfate

Front 35

Antidote to copper, arsenic, or gold?

Back 35

Penicillamine (chelating agent)

Front 36

Antidote to mercury, arsenic, or gold?

Back 36

Dimercaprol (BAL), succimer

Front 37

Antidote to lead?

Back 37

CaEDTA, dimercaprol, succimer, penicillamine

Front 38

Antidote to iron?

Back 38

deferoxamine

Front 39

Antidote to beta blockers?

Back 39

glucagon

Front 40

Antidote to salicylates?

Back 40

NaHCO3 (alkalinize urine to trap deprotonated acid) (also for methotrexate, phenobarbital)

Front 41

Antidote to amphetamines (basic)?

Back 41

NH4Cl (acidify urine to trap them in protonated form)

Front 42

Antidote to acetylcholinesterase inhibitors, organophosphates?

Back 42

Atropine, pralidoxime (removes organophosphate from AChE)

Front 43

Antidote to antimuscarinic, anticholinergic agents?

Back 43

Physostigmine salicylate

Front 44

Antidote to digitalis?

Back 44

Stop dig, normalize K+, lidocaine, anti-dig Fab fragments, Mg

Front 45

Effect on efficacy and potency of competitive vs non-competitive inhibitors?

Back 45

Competitive: decrease potency
Noncompetitive: decrease efficacy

Front 46

Clearance equations?

Back 46

Rate of elimination of drug/plasma drug concentration
OR
Vd (volume of distribution) x Ke (elimination constant)

Front 47

Which phase of metabolism is lost first with aging?

Back 47

Phase I (ox/redox, hydrolysis) is lost first in geriatric patients.

Front 48

Drugs with zero order elimination?

Back 48

Phenytoin, Ethanol, Aspirin

Front 49

Maintenance dose equation?

Back 49

Cp x CL/F
CL = rate of elim/Cp
--> maintenance dose = rate of elim

Front 50

Loading dose equation?

Back 50

Cp x Vd/F

Front 51

Effect of alkylating agents on fetus?

Back 51

Absence of digits, multiple other anomalies

Front 52

Contraindications of atropine?

Back 52

glaucoma, prostatic hypertrophy, heart disease

Front 53

Mechanism and uses of buspirone?

Back 53

5-HT1A partial AGONIST.

Used for functional dyspepsia with impaired accommodation AND as an anxiolytic for treatment of anxiety disorders.

Front 54

Mechanism and uses of erythromycin?

Back 54

Macrolide antibiotic (inhibit 50S) AND motilin agonist.

Used to treat infections AND gastroparesis.

Front 55

Fluoxetine mechanism and AEs?

Back 55

SSRI antidepressant (blocks SERT in CNS and PNS) --> GI discomfort, nausea, diarrhea, anxiety, insomnia, etc

Front 56

Mechanism and uses of metoclopramide?

Back 56

5-HT3 ANTAGONIST and 5-HT4 agonist (prokinetic effect). Indirectly increases ACh release in gut. D2 antagonist in CNS and PNS.

Used for reflux esophagitis, pre-op gastric emptying, reduce chemo nausea (antiemetic).

Front 57

Misoprostol mechanism and use?

Back 57

PGE1 analog.

Used for prevention of gastric ulcers secondary to NSAIDs.

Front 58

Mechanism and uses of neostigmine?

Back 58

Carbamate-type peripheral cholinesterase inhibitor.

Used for dx/tx of MG, paralytic ileus, lack of bladder tone, reverse of NM blockade after anesthesia.

Front 59

Uses of somatostatin analog (octreotide)?

Back 59

Diarrhea (reduce motility), VIP tumor, metastatic carcinoid tumor, acromegaly, variceal bleeding (reduce liver blood flow), orthostatic hypotension

Front 60

Uses of omeprazole, lansoprazole, rabeprazole, pantoprazole?

Back 60

GERD, duodenal ulcer, hypersecretory states (Zollinger-Ellison)

Front 61

Mechanism and use of ondansetron?

Back 61

5-HT3 antagonist. Acts both in periphery and at CTZ to treat nausea and vomiting after chemo.

Front 62

Action and side effects of sumatriptan?

Back 62

5-HT1B/1D/1P agonist.

Causes vasoconstriction, fundal relaxation, and antral motility.

AEs: flushing, dizzy, weak, nausea, drowsy, stiff, tingling

Front 63

Side effect of sucralfate, antacids, and PPIs?

Back 63

Constipation

Front 64

What is simethicone usually added to and why?

Back 64

Often included in antacic preparations. Acts as an antiflatulent agent/surfactant that decreases foaming (change surface tension of gas bubbles that otherwise quickly coalesce)

Front 65

Bladder muscle relaxants (anticholinergic/antimuscarinic)?

Back 65

Oxybutynin and Tolterodine.

Inhibit detrussor contractions caused by instability (non-neurogenic) or muscle hyperreflexia.

Front 66

TCA that functions as a bladder relaxant?

Back 66

Amitriptyline.

NE/5-HT reuptake blocker. Decreases bladder contractility and increases outlet resistance.

Front 67

Besides ED, what do sildenafil, vardenafil, and tadalafil all treat?

Back 67

Pulmonary arterial hypertension.

Front 68

Side effects of 5-alpha-reductase inhibitors (Finasteride, Dutasteride)?

Back 68

Sexual dysfunction, gynecomastia, hirsutism

Front 69

"Second" action and most common/severe AE of allopurinol?

Back 69

Acts as muscarinic antagonist in addition to inhibiting xanthine oxidase.

AE: dermatologic (skin rash/hypersensitivity) --> can be severe and even fatal

Front 70

What part of the kidney does probenecid work in? AE?

Back 70

Proximal convoluted tubule: competitively inhibits reabsorption of uric acid.

AE: NOT effective for acute gout attack. Can actually increase attack in first few months of therapy. (same for sulfinpyrazone)

Front 71

Mechanism and AEs of sulfinypyrazone?

Back 71

Uricosuric (inhibit reabsorption of uric acid) - used for chronic or intermittent gout.

AE: GI (avoid in patients with peptic ulcer disease). Can also precipitate uric acid kidney stone formation.

Front 72

Nonselective alpha and beta antagonists?

Back 72

Carvedilol, Labetalol

Front 73

Partial beta agonists?

Back 73

Pindolol, Acebutolol
("P, A" - "Partial Agonist")

Front 74

Beta1 selective antagonists?

Back 74

Acebutolol (partial), Betaxolol, Esmolol (short acting), Atenolol, Metoprolol
("A BEAM" of beta-1)

Front 75

Applications of beta blockers?

Back 75

HTN, angina pectoris, MI, SVT (propranolol, esmolol) (class II anti-arrhythmic), CHF, glaucoma (timolol)

Front 76

Nonselective beta antagonists?

Back 76

Propranolol, Timolol, Nadolol, Pindolol

Front 77

Benefit of alpha2 agonists (clonidine, alpha-methyldopa) in renal disease?

Back 77

For treatment for HTN, there's no decrease in blood flow to the kidney.

Front 78

What type of interaction is diazepam + flumazenil on GABA receptors?

Back 78

Competitive antagonism

Front 79

What type of interaction is NE + phenoxybenzamine on alpha receptors?

Back 79

Noncompetitive antagonist (phenoxybenzamine is irreversible)

Front 80

What type of interaction is morphine + buprenorphine at opioid mu-receptor?

Back 80

Partial agonism

Front 81

Definition of therapeutic index?

Back 81

LD50/ED50
(median lethal dose divided by median effective dose)
(Higher TI --> safer drug)

Front 82

Equation for half life of drug with first order metabolism?

Back 82

0.7 x Vd / CL

Front 83

Nicotinic vs muscarinic receptors?

Back 83

Nicotinic: ligand-gated (Na/K). NN found in autonomic ganglia, NM found in NMJ.

Muscarinic: G-protein coupled. M1, 2, 3, 4, 5.

Front 84

What is physiologic antagonism?

Back 84

Substance that produces the opposite physiologic effect of an agonist but does not act at the same receptor.

Ex: Pt w/ asthma due to muscarinic overactivity --> epinephrine can help by vasodilating at beta-2 receptors

Front 85

Negative and positive feedback at noradrenergic nerve terminal?

Back 85

Negative: alpha 2 (NE), M2 (ACh)
Positive: AII (angiotensin II)

Front 86

Neostigmine, Pyridostigmine, Physostigmine: which ones cross the BBB?

Back 86

Physostigmine crosses BBB and is used for glaucoma and atropine overdose.
("PHYS" for "eyes")

Neostigmine and Pyridostigmine: do not penetrate CNS, both used for MG

Front 87

Use of echothiophate?

Back 87

Used for glaucoma
-AChE inhibitor

Front 88

What should be watched for in patients receiving AChEIs?

Back 88

Peptic ulcer disease, COPD exacerbation, and asthma

Front 89

Use and mechanism of methacholine?

Back 89

Used as a challenge test for asthma diagnosis.

Stimulates muscarinic receptors in airway when inhaled.

Front 90

Which cholinomimetic agents are resistant to AChE?

Back 90

Pilocarpine and Bethanechol

Front 91

Use of Bethanechol?

Back 91

Postoperative and neurogenic ileus and urinary retention
- cholinomimetic agent
("B" for "bowel" and "bladder")

Front 92

Common uses of pilocarpine and carbachol?

Back 92

Glaucoma, pupillary contraction, relief of intraocular pressure
- contract ciliary muscle of eye (open angle) and pupillary sphincter (narrow angle)

Front 93

Use and mechanism of hexamethonium?

Back 93

Nicotinic antagonist
- Used to prevent vagal reflex responses to change in blood pressure (ie: prevent reflex bradycardia caused by NE)

Front 94

Antimuscarinic used for motion sickness that works in the CNS?

Back 94

Scopolamine

Front 95

Antimuscarinic that can be used as adjunct med for Parkinson's?

Back 95

Benztropine (acts in CNS)

Front 96

Oxybutynin and glycopyrrolate are anti-muscarinics used in what organ system?

Back 96

Genitourinary
- used to reduce urgency in mild cystitis and reduce bladder spasms

Front 97

3 antimuscarinics that produce mydriasis and cycloplegia in the eye?

Back 97

Atropine, homatropine, tropicamide

Front 98

What are antimuscarinics in the GI system used for and what are their names?

Back 98

Methscopolamine, pirenzepine, propantheline
- used for peptic ulcer treatment

Front 99

Toxicities of atropine?

Back 99

- Acute angle-closure glaucoma in the elderly
- Urinary retention in men with BPH
- Hyperthermia in infants (decreases sweating, inc body temp)

Front 100

Alpha blocker used for pheochromocytoma?

Back 100

Phenoxybenzamine (irreversible nonselective)
- Especially use before removing tumor, since high levels of released catecholamines will not be able to overcome blockage

Front 101

Beta-2 agonists used to reduce premature uterine contractions?

Back 101

Ritodrine and Terbutaline

Front 102

Beta-2 agonists used for acute and long term asthma?

Back 102

Acute: Metaproterenol and Albuterol

Long-term: Salmeterol

Front 103

Receptor selectivities of Epi vs NE?

Back 103

NE: alpha 1, then alpha 2 > beta 1

Epi: Low dose = beta 1, 2
High dose = alpha 1, 2

Front 104

Dobutamine receptor selectivity and action?

Back 104

Beta 1 > Beta 2
- inotropic but not chronotropic
- used for heart failure and cardiac stress testing

Front 105

Dopamine receptor selectivity and action?

Back 105

D1 = D2 > beta > alpha
- inotropic and chronotropic
- used for shock (increases renal perfusion) and heart failure

Front 106

Use of isoproterenol?

Back 106

AV block (rare)
- has equal affinity for beta 1 and beta 2 receptors

Front 107

Uses of ephedrine?

Back 107

Nasal decongestion, urinary incontinence, hypotension
- Indirect general sympathomimetic, releases stored catecholamines

Front 108

Antidote to CO poisoning?

Back 108

100% O2, hyperbaric O2
- CO competitively binds Hb

Front 109

Antidote to Methemoglobin?

Back 109

Methylene blue, vitamin C

Front 110

How can hemorrhagic cystitis be prevented with cyclophosphamide or ifosfamide?

Back 110

Co-administer the drug with mesna

Front 111

Cinchonism refers to the side effects of what?

Back 111

Quinidine, quinine

Front 112

Which meds cause disulfiram-like reactions?

Back 112

Metronidazole
certain Cephalosporins
Procarbazine
1st-generation sulfonylureas

Front 113

What can bleomycin, amiodarone, and busulfan cause?

Back 113

Pulmonary fibrosis

Front 114

Enzyme that disulfiram inhibits?

Back 114

Acetaldehyde dhase
- buildup of acetaldehyde --> unpleasant side effects

Front 115

How does ethylene glycol cause oxalate kidney stones?

Back 115

Ethylene glycol is metabolized by alcohol dehydrogenase to oxalic acid, which can cause acidosis and nephrotoxicity

Front 116

Side effects of mirtazapine (used for depression)?

Back 116

Sedation, increased serum cholesterol, increased appetite

Front 117

Receptors that work through Gi second messenger system?

Back 117

M2, alpha2, D2
"MAD 2's"

Front 118

V1 vs V2 receptor mechanism?

Back 118

V1: Gq
- increases vascular smooth muscle contraction

V2: Gs
- increases H2O permeability and reabsorption in collecting tubules

Front 119

H1 vs H2 mechanism?

Back 119

H1: Gq
- contraction of bronchioles, nasal/bronchial mucus production, pruritis, pain

H2: Gs
- increase gastric acid secretion

Front 120

Receptors that work through Gs second messenger system?

Back 120

Beta1, Beta2, D1, H2, V2

Front 121

Receptors that work through Gq second messenger system?

Back 121

H1, Alpha1, V1, M1, M3
("HAVe 1 M & M")

Front 122

D1 receptor action?

Back 122

Relaxes renal vascular smooth muscle
- works through Gs pathway

Front 123

Beta 1 and 2 receptors both work through what pathway?

Back 123

Gs pathway

Front 124

M2 receptor action?

Back 124

Decreases heart rate and contractility of atria
- works through Gi pathway

Front 125

M3 receptor action?

Back 125

Increases exocrine gland secretions (sweat, gastric acid), increase gut peristalsis, increase bladder contraction, bronchoconstriction, increase pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accommodation)
- works through Gq pathway

Front 126

Beta 2 actions and mechanism?

Back 126

Vasodilation, bronchodilation, increase heart rate and contractility, lipolysis, increase insulin release, decrease uterine tone
- works through Gs pathway

Front 127

Vesamicol action?

Back 127

Reduces ACh uptake into vesicles and reduces its release
- experimental drug (?)

Front 128

Hemicholinium action?

Back 128

Blocks reuptake of choline at cholinergic nerve terminals
- choline reuptake = rate limiting step in ACh synthesis

Front 129

Metyrosine action?

Back 129

Inhibits tyrosine hydroxylase --> depletes levels of dopamine, NE, and Epi
- used for treatment of pheo

Front 130

Guanethidine action?

Back 130

Taken up in noradrenergic terminals by NET and replaces NE in transmitter vesicles --> reduces release of NE
- used as an anti-hypertensive

Front 131

Ergot vs non-ergot dopamine agonists?

Back 131

Ergot: bromocriptine and pergolide
Non-ergot: ropinirole and pramipexole

Front 132

Bosentan mechanism and use?

Back 132

Endothelin antagonist used for treatment of primary pulmonary HTN

Front 133

Meds that can cause hyperuricemia and gout flares?

Back 133

Niacin, Pyrazinamide, Thiazide diuretics, Cyclosporine

Front 134

How do MAO-B, COMT, and dopa decarboxylase inhibitors affect dopamine levels in Parkinson's?

Back 134

MAO-B inhib: prevents dopamine breakdown in brain
COMT and dopa decarboxylase inhib: prevent peripheral conversion of levodopa (more levodopa available to enter brain)

Front 135

Best antidote for arsenic poisoning?

Back 135

Dimercaprol
- displaces arsenic from sulfhydryl groups of enzymes

Front 136

Shortest acting benzos?

Back 136

Triazolam, Oxazepam, Midazolam, Alprazolam

Front 137

Long acting benzos?

Back 137

Diazepam, Flurazepam, Chlordiazepoxide

Front 138

Beta blocker effects in hypoglycemia?

Back 138

BBs mask adrenergic symptoms of hypoglycemia AND inhibit gluconeogenesis (--> worsen hypoglycemia as well)
- Avoid non-selective BBs in diabetic patients

Front 139

Effect of Vitamin B6 + levodopa?

Back 139

B6 enhances peripheral conversion of levodopa and decreases amount reaching CNS
- Don't take B6/multivitamin with levodopa

Front 140

What does Fenoldopam do and who is it good for?

Back 140

Selective D1 agonist (increases cAMP)
- causes arterial vasodilation and improved renal flow
- good for hypertensive emergencies and patients with renal insufficiency

Front 141

How can nitro make a patient with coronary artery thrombosis feel worse?

Back 141

Causes "coronary steal syndrome"
- Dilated arteries steal blood from the thrombotic one (that can't dilate) --> can make angina worse

Front 142

DHP Ca channel blockers and effect?

Back 142

DHPs: Nifedipine and Amlodipine
- more selective for vasculature
- can cause reflex tachycardia
- DON'T use in pts with ACS

Front 143

Non-DHP Ca channel blockers?

Back 143

Verapamil (most selective for the heart) and Diltiazem

Front 144

Verapamil AEs?

Back 144

Constipation, heart block

Front 145

Relationship of vWF and DDAVP?

Back 145

DDAVP can be used to stimulate release of vWF from endothelial cells and stop bleeding during surgical procedures
- can be helpful in hemophilia A
- does NOT affect V1 receptors like vasopressin does

Front 146

What mediates the flushing with niacin use? Vancomycin?

Back 146

Niacin: Prostaglandins (Aspirin can help prevent it)
Vancomycin: Histamine ("red man syndrome")

Front 147

What are trihexyphenidyl and benztropine used for?

Back 147

Mainly drug-induced Parkinsonism
- both are muscarinic antagonists

Front 148

Tolcapone vs entacapone?

Back 148

Both are COMT (methylation) inhibitors
- Entacapone only inhibits peripheral COMT
- Tolcapone inhibits both central and peripheral

Front 149

How does N-acetylcysteine work as a mucolytic agent?

Back 149

Cleaves disulfide bonds of mucus glycoproteins

Front 150

Signs of atypical depression and treatment?

Back 150

Hyperphagia and hypersomnia are characteristic.
Treat with MAO inhibitors (phenelzine, tranylcypromine)

Front 151

Why do serum thiopental levels fall rapidly after administration?

Back 151

Thiopental is very lipid soluble, distributes in brain rapidly but then accumulates in skeletal muscle and adipose
- falling levels result of redistribution NOT metabolism

Front 152

2 effects of Cilostazol?

Back 152

Phosphodiesterase inhibitor:
1. Increases cAMP in platelets and decreases platelet aggregation
2. Direct arterial vasodilator

Good to use for intermittent claudication

Front 153

Effect of caspofungin and other echinocandins?

Back 153

Inhibit synthesis of fungal cell WALL (1,3-beta-D-glucan) NOT cell membrane (ergosterol)
- effective against Candida and Aspergillus

Front 154

Drugs that cause fatty change in the liver?

Back 154

Tetracycline, Amiodarone, Methotrexate

Front 155

Drugs that block protein synthesis at the 50S ribosomal subunit?

Back 155

Chloramphenicol
Macrolides
Clindamycin
Streptogramins (quinupristin, dalfopristin)
Linezolid

Front 156

Bacteriostatic drugs?

Back 156

Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracyclines
Chloramphenicol

Front 157

Bactericidal drugs?

Back 157

Vancomycin
Fluoroquinolones
Penicillin
Aminoglycosides
Cephalosporins
Metronidazole

Front 158

What is similar to but has greater oral bioavailability than ampicillin?

Back 158

AmOxicillin

Front 159

Which class of penicillins are resistant to penicillinase?

Back 159

Penicillinase-resistant (Methicillin, Nafcillin, Dicloxacillin)
- resistant because of bulkier R group

Front 160

Anti-pseudomonal penicillins?

Back 160

Ticarcillin
Carbenicillin
Piperacillin

Front 161

Vancomycin toxicity with high infusion rate?

Back 161

Nephrotoxicity
Ototoxicity
Thrombophlebitis
Diffuse flushing ("red man syndrome")

Front 162

How do bacteria develop resistance to aminoglycosides?

Back 162

Transferase enzymes inactivate drug by acetylation, phosphorylation, or adenylation.
- Also decreased influx of drug
- Mutation of 30S ribosome

Front 163

Toxicity of cephalosporins?

Back 163

Hypersensitivity
Vitamin K deficiency
Nephrotoxicity (w/ AGs)
Disulfiram-like rxn with ethanol (some of them)

Front 164

Names and coverage of 1st vs 2nd generation cephalosporins?

Back 164

1st gen: Cefazolin, Cephalexin
- Gm(+) cocci + PEcK (proteus, e coli, klebsiella)

2nd gen: Cefoxitin, Cefaclor, Cefuroxime
- gm (+) cocci + HEN PEcKS (haemophilus, enterobacter, neisseria)

Front 165

What is Imipenem co-administered with and why?

Back 165

Cilastatin: inhibits renal dihydropeptidase I --> decreases inactivation of drug in renal tubules

- Meropenem: stable to dihydropeptidase I

Front 166

Mechanism of resistance to sulfonamides?

Back 166

Altered bacterial dihydropteroate synthetase
Decreased uptake
Increased PABA synthesis

Front 167

Bacterial THF synthesis pathway?

Back 167

Pteridine + PABA --> dihydropteroic acid --> DHF --> THF

Front 168

Phase I metabolism actions?

Back 168

Reduction
Oxidation
Hydrolysis

Front 169

Phase II metabolism actions?

Back 169

Acetylation
Glucuronidation
Sulfation

Front 170

Vesamicol and hemicholinium work at what type of synapse?

Back 170

Cholinergic.

Both result in decreased ACh release.

Front 171

Selective beta2 agonists?

Back 171

"MAST"
Metaproterenol
Albuterol
Salmeterol
Terbutaline

Front 172

Bactericidal antibiotics?

Back 172

Penicillins
Cephalosporins
Vancomycin
AGs
FQs
Metronidazole

Front 173

What are ampicillin and amoxicillin (aminopenicillins) affective against?

Back 173

Certain gram positive bacteria and gram negative rods

- Haemophilus, E. coli, Listeria, Proteus, Salmonella, enterococci
("HELPS" kill Enterococci)

Front 174

1st generation cephalosporins?

Back 174

Cefazolin, Cephalexin

Front 175

What does chloramphenicol inhibit?

Back 175

Peptidyl transfer

Front 176

Which antibiotics inhibit translocation on the ribosomes?

Back 176

Erythromycin
Clindamycin
Lincomycin

Front 177

What does tetracycline inhibit?

Back 177

A-site tRNA binding

Front 178

Mechanism of aminoglycoside resistance?

Back 178

Enzymes that inactive the drug by acetylation, phosphorylation, or adenylation

Front 179

Which tetracycline can be used in patients with renal failure and why?

Back 179

Doxycycline.

Fecally eliminated.

Front 180

Aminoglycoside used in bowel surgery?

Back 180

Neomycin

Front 181

How do macrolides block translocation of protein synthesis?

Back 181

They bind to the 23S rRNA of the 50S subunit.

Bacteriostatic.

Front 182

Cardiac AE of erythromycin?

Back 182

Prolonged QT interval.

Front 183

What drugs do macrolides increase the serum concentration of?

Back 183

Theophyllines
Oral anticoagulants

Front 184

Mechanism of resistance to macrolides?

Back 184

Methylation of 23S rRNA binding site

Front 185

Mechanism of resistance to chloramphenicol?

Back 185

Plasmid-endoed acetyltransferase that inactivates the drug.

Front 186

Mechanism of resistance to sulfonamides?

Back 186

Altered bacterial dihydropteroate synthetase
Decreased uptake
Increased PABA synthesis

Front 187

Polymyxin mechanism and use?

Back 187

Cationic/basic proteins that act like detergents and bind to cell membranes of bacteria and disrupt their osmotic properties.

Used for resistant gram negative infections.

Front 188

3 treatments for M. leprae?

Back 188

Dapsone
Rifampin
Clofazimine

Front 189

Mechanism of metronidazole?

Back 189

Forms free radical toxic metabolites in the bacterial cell that damage DNA.

Front 190

Treatment for VRE?

Back 190

Linezolid
Streptogramins (quinupristin/dalfopristin)

Front 191

Prophylaxis for PCP?

Back 191

TMP-SMX

or Aerosolized pentamidine.

Front 192

2 prophylaxis options for meningococcal infection?

Back 192

Rifampin
Minocycline

Front 193

Increased activity of arabinosyltransferase would mean resistance to what drug?

Back 193

Ethambutol

- TB treatment

Front 194

2 things that can reduce amphotericin toxicity?

Back 194

Hydration reduces nephrotoxicity.

Liposomal formulation reduces toxicity.

Front 195

Administration of nystatin?

Back 195

"Swish and swallow" for oral candidiasis.

Topical for diaper rash or vaginal candidiasis.

Front 196

What are Terbinafine and Griseofulvin both used to treat?

Back 196

Dermatophytes.

Terbinaphine: especially onychomycosis

Griseofulvin: oral treatment of superficial infections

Front 197

AEs of griseofulvin?

Back 197

Teratogenic
Carcinogenic
Confusion, headaches
Induce P-450 (and warfarin metabolism)

Front 198

Invasive aspergillus --> use?

Back 198

Caspofungin

Front 199

Invasive candida or cryptococcus --> use?

Back 199

Flucytosine
- often incombination with amphotericin B
- could also use azoles

Front 200

Topical fungal infections --> use?

Back 200

Clotrimazole or Miconazole