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USMLE
Comprehensive Pharm 7
| Question | Answer |
|---|---|
| which leukotriene is a neutrophil attractant? | LTB4 |
| which LT --> bronchoconstriction | LTC4, D4, E4 |
| what reaction does phospholipase A2 catalyze | phospholipids --> arachidonic acid |
| what rxn does COX catalyze? | arachidonic acid --> PGG, PGH (endoperoxides) |
| what rxn does lipoxygenase catalyze? | arachidonic acid --> HPETEs (hydroperoxides) |
| what drug blocks lipoxygenase | zileuton |
| what drug blocks COX | NSAIDS acetominophen cox-2 inhibitors |
| what drugs block the effects of leukotrienes? | zafirleukast montelukast |
| actions of PGE? | increased uterine tone decreased bronchial tone decreased vascular tone |
| examples of nsaids | ibuprofen naproxen indomethacin ketorolac |
| mech of nsaids | reversibly inhibits cox 1 and 2, blocking PG synth |
| uses for nsaids | antipyretic analgesic anti-inflammatory |
| what drug is used to close PDA | indomethacin |
| toxicity of nsaids | renal damage aplastic anemia GI distress ulcers |
| MOA cox2 inhibitors | reversibly inhibits cox2, maintaining gastric mucosa (cox2 is found only in inflammatory cels that mediate inflamm and pain) |
| risks associated with cox 2 inibitors | thrombosis less gi risk |
| MOA actaminophen | reversibly inhibits cox (mostly in cns) inactivated peripherally |
| uses of acetaminophen | antipyretic analgesic NOT AN ANTI INFLAMMATORY!!!!!!! |
| toxicity of acetaminophen how? | hepatic necrosis a metabolite of acetaminophen depletes glutathione and forms toxic tissue adducts in liver |
| how is toxic hepatic damage from acetaminophen treated moa? | n-acetylcysteine - it regenerates glutathione |
| drugs that treat gout | colchicine allopurinol probenecid indomethacin |
| NSAIDS | And said: "I be napping in Keto" ibuprofin naproxen indomethacin ketorolac |
| which gout drugs are used to treat chronic gout? | allopurinol probenecid |
| which gout drugs are ued to treat acute gout | colchicine indomethacin |
| MOA colchicine | depolymerizes MT, impairing WBC chemotaxis and degranuation |
| side effects of colchicine | gi |
| what drug is a good alternative to colchicine? | indomethacin (less toxic, more commonly used) |
| MOA probenecid | inhibits resorption of uric acid |
| MOA allopurinal | inhibits xanthine oxidase, so less formation of uric acid |
| aside from gout, what else can allopurinal be used to treat? | can help with sx of tumor lysis syndrome, seen in lymphoma/leukemia following chemo |
| what is the original source of uric acid | purines from diet and broken down nucleic acids |
| fxn of xanthine oxidase | hypoxanthine --> xanthine --> uric acid (blocked by allopurinol) |
| describe interference of probenecid and penicillin | inhibits secretion of penecillin |
| what promotes tubular secretion of uric acid | diuretics and low dose salicylates |
| MOA etanercept | recombinant form of TNF receptor that binds TNF-alpha |
| uses for etanercept | RA psoriasis ankylosing spondylitis |
| MOA infliximab | TNF-alpha AB |
| uses for infliximab | crohns dz RA ankylosing spondylitis |
| toxicity of infliximab | predisposes to infection (reactivates latent TB) |
| MOA cyclosporine | binds to cyclophilins, blocking differentiation and activiation of t cells by inhibiting calcineruin (prevents the production of IL2 and receptor) |
| fxn of calcineurin | phosphatase that activates IL2 |
| use for cyclosporine | suppress organ transplants treats some autoimmune d/o |
| toxicity of cyclosporine | predisp to viral infx and lymphoma NEPHROTOXIC (prevent w mannitol diuresis) |
| MOA tacrolimus | binds FK-binding protein, inhibiting the secretion of IL2 and other cytokines |
| uses of tacrolimus | immunosuppression following organ transplant |
| toxicity of tacrolimus | nephrotoxic peripheral neuropathy HTN pleural effusion hyperglycemia |
| moa azathioprine | interferes with metabolism and synth of nucleic acids toxic to prolif wbc |
| uses of azathioprine | kidney transplant autoimmune d/o glomerulonephritis hemolytic anemia |
| toxicity of azathioprine | bone marrow suppression |
| what is the active metabolite of azathioprine how is it metabolized implication | mercaptopurine xanthine oxidase toxic effects may be increased by allopurinol |
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Asclepius
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