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USMLE - Pharm

Kaplan Section 3 Drugs Review

What are the two drugs used for pheochromocytoma Phentolamine and Phenoxybenzamine
What is cinchonism and what drugs is it associated with? flushed skin, ringing of the ears (tinnitus), blurred vision, confusion, lichenoid photosensitivity, vertigo, dizziness, dysphoria (feeling uneasy), nausea and vomiting, and diarrhea. Quinidine (class 1A antiarrhythmic) and quinine (anti-malarial)
When should you use quinidine? afib, post MI prophylaxis against cardiac arrhythmias
Which of the following actions is characteristic of amiloride? A. Alkalosis, B. Block of Na reabsorption in proximal conv tubule, C. hyperK, D. inc tubular reabsorption of Ca, E. Bicarbonaturia C. hyperK
The most common manifestation of lidocaine toxicity is…. CNS dysfunction
Why is the use of propranolol especially good for hyperthyroid patients with cardiac arrhythmia? In addition to its decreased SANS effects on the heart, it also inhibits 5' deiodinase --> prevents conversion of T4 to T3
Metropolol B1 selective inhibitor
75 yo with CHF ingests toxic dose of digoxin. Clinical consequences to the toxic fx of digoxin LEAST likely to include: A. bigeminy, B. hypoK, C. nausea, vomiting, D. premature ventricular beats, E. visual disturbances B. hypoK -- hypoK makes facilitates digoxin's effects and therefore increases its toxicity
Digoxin cardiac glycoside --> inhibit Na/K ATPas --> increase contractility
In a pt weighing 70 kg, the Vd of lidocaine is 80L and clearance is 28 L/h. Elimination half life of lidocaine in this pt is…. t1/2 = (0.7 x Vd)/(Cl) = 2 hrs
High dose dopamine effects felt where? D1 - vasodilation of mesenteric and renal vascular beds
What is the one drug FDA-approved for usage in subarachnoid hemorrhage? Why? Nimodipine - CaCB --> vasodilation selective for cerebral vascular beds --> prevent post-hemorrhagic vasospasm
Which is LEAST likely to occur after treatment with cholestyramine? A. inc elim of bile salts, B. dec circulating cholesterol, C. enhanced receptor-mediated endocytosis of LDL, D. dec plasma HDL, E. inc plasma TG's Bile acid sequestration. D. Increases, not decreases, HDL.
What drug am I describing? Increases urine volume, dec urinary Ca, increases body pH, decreases serum K. Thiazide diuretics, blocks NaCl cotransporter in DCT
Which drugs block K channels? Class IA and Class III (inc APD and ERP --> torsades)
What is niacin? What is it used for? nicotinic acid; treatment of hyperlipidemic pts
Treatment with niacin results in what? A. inc VLDL, B. dec plasma chol and TG's, C. inhib of HMG-CoA reductase, D. dec HDL, E. no change in total chol in plasma B - decreases plasma cholesterol and TG's
What happens with the abrupt discontinuation of clonidine? Clonidine is a2 agonist --> dec NE. Abrupt discontinuation will cause rebound HTN and tachycardia.
What is a common reason a pt suffering from HTN would discontinue their meds? HTN meds can cause sexual dysfunction.
What would discontinuation of a thiazide result in? fluid retention and weight gain
What is the general effect of EtOH? Vasodilator, decreases BP
Which of the following drugs is most likely to cause severe depression in treatment of HTN pts? Captopril, hydrochlorothiazide, prazosin, nifedipine, reserpine? reserpine --> block packaging of NE --> dec NE. Also cause dose-dependent depletion of brain amines (NE and serotonin) --> serious depression leading to suicide.
Name the three actions of ACEi's 1. inhibit ANG I conversion to ANG II --> dec aldosterone --> dec volume retention --> dec BP. 2. block ANGII action at AT-1 receptors on vessels --> vasodilation, 3. inhibit metabolism of bradykinin (BK) --> BK not broken down --> BK causes vasodilation
What should you give a pt in ER if he develops ventricular tachycardia post-MI? lidocaine
For post-MI pt suffering from pulm edema, what effect would amrinone, digoxin, and med/high dose dopamine have in common if given separately? Amrinone - bipyridine (inc contractility and vasodilation); digoxin - cardiac glycoside, block Na/K ATPase --> inc contractility; high dose dopamine --> B1 activator --> inc contractility and CO. In common: increased ventricular contractility --> improve
Which of the following is most appropriate? A. captopril (60yo w diabetic nephrop), B. nitroprusside (50yo man w BP140/95), C. Losartan (29yo pregnant woman), D. Propranolol (40yo w perpiph vasc dz), E. reserpine (37yo w pheochromocytoma) A. ACEi's slow progression of diabetic nephropathy and treats HTN.
Would you prescribe nitroprusside to 50 yo male pt with BP 140/95? no because Nitroprusside is for severe HTN - not mild to mod HTN
Would you prescribe losartan to 29 yo pregnant woman? AT-1 antag and ACEi's are teratogens
Would you prescribe propranolol for 40 yo pt with peripheral vascular disease? No because nonselective B blockers not good for periph vasc dz, diabetes, or asthma patients.
Would you prescribe reserpine to patient with pheochromocytoma? No because reserpine causes release of amines (i.e. NE) from tumor, making pheochromocytoma worse.
True or false - loop diuretics cause hyperurecimia, which can lead to syncope (fainting) False. Loops can cause hyperuricemia, but no connection of hyperuricemia to fainting.
True or false - Spironolactone is proven to increase survival when used to treat HTN. False. Spironolactone + ACEi's for CHF pts shown to improve survival. Nothing to do with HTN patients.
Which of these drugs increase AV node transmission/conduction? Adenosine, digoxin, esmolol, quinidine, verapamil. Quinidine (class IA) also blocks M receptors in heart --> only one in list to increase AV conduction. Digoxin and verapamil decrease AV conduction. Adenosine and esmolol decrease AV conduction, but IV and short-acting.
Created by: christinapham
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