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USMLE - Pharm

Kaplan Section 8 - Review

What does PT measure? Prothrombin Time. Extrinsic coag pathway. Measures clotting tendency of blood, using levels of warfarin dosage, liver damage, and VitK status.
How is PT conducted? blood + citrate in the tube (binds Ca2+) --> prevent coag. Separate blood cells from plasma. Ca2+ + plasma + tissue factor --> clotting. PT is time of plasma to clot after addition of tissue factor.
What is the reference range for PT? 12 to 15 seconds
What factor is the extrinsic pathway most dependent upon? Factor 7 (short half life, requires VitK for synthesis)
What happens to PT if patient is deficient in VitK? lengthened PT time
How can a pt become VitK deficient? warfarin, malabsorption or lack of intestinal colonization by bacteria (such as in newborns), liver dz (poor synthesis of factor 7), increased consumption of Factor 7 (DIC)
What is INR? international normalized ratio: ratio of patient's PT to a normal control sample, raised to the power of the ISI sample, which is the tissue factor sensitivity index, used in the PT assay
What is the reference range for INR? 0.8-1.2
What does PTT measure? Intrinsic Pathway. Partial Thromboplastin Time. Measures time to clot in the intrinsic and common coag pathways. Monitors heparin therapy.
How is PTT conducted? blood + citrate in the tube (binds Ca2+) --> prevent coag. Separate blood cells from plasma. Ca2+ + plasma + phospholipid --> clotting. PPT is time of plasma to clot after addition of Ca nd phospholipid.
What is the reference range for PTT? 25 to 39 seconds
What factors lengthen a PTT? Heparin, deficiency in coag factors (hemophilia), antiphospholipid antibody (lupus anticoag --> more tendency toward thrombus)
Patient is on warfarin. Will Cimetidine increase or decrease that patient's PT? Cimetidine inhibits CYP450. Warfarin is metabolized by CYP450. Cimetidine ----| CYP450 --> dec warfarin metabolism --> more warfarin in blood --> PT time increases
What do selective COX2 inhibitors do to prothrombin time? increase PT time when used with warfarin. Inhibit EC fxn --> less coag.
What happens to warfarin if used in conjunction with ASA/cimetidine/metronidazole/phenytoin/sulfonamides? warfarin's actions increased (they bind to plasma proteins with greater affinity, so they displace the bound warfarin --> more unbound, active warfarin)
What happens to warfarin if used in conjunction with barbiturates/carbamazepine/cholestyramine/rifampin/thiazides/vitamin K? warfarin's actions decreased!
T or F: alpha1 blockers improve sx's of BPH and urinary flow rate TRUE; e.g. doxazosin; relaxes sphincters
What is aminocaproic acid? anti-fibrinolytic! binds to plasminogen --> prevent its activation to plasmin --> can't break up fibrin clots. Used to treat bleeding disorders.
What is used to increase thyroid gland vascularity peroperatively? KI + Iodine (Lugol's solution)
Thyroxine is…. T4
Deferoxamine antidote to Fe poisoning (chelates Fe)
Can you combat oral Fe poisoning with activated charcoal? no you can't
How long does it take to reach the peak effect of heparin? several hours
What is the cause of megaloblastic anemia? Vit B12 or folate deficiency (give folic acid for treatment)
What is protamine? Antidote to heparin
Someone on chemotherapy complains of bladder irritation with hematuria. What are they on? Cyclophosphamide - hemorrhagic cystitis (cyclophosphamide --> cyp450 --> acrolein produced --> irritates bladder epith
Why do patients on methotrexate also complain of urinary tract problems? methotrexate has low water solubility --> crystalluria
NEUROgenic diabetes insipidus decreased response of ADH receptors
What is used to treat NEUROgenic diabetes insipidus? desmopressin - replaces ADH, but selective V2 activator in the kidney (V1 activation in smooth muscle leads to vasoconstriction, which we don't want)
What is used to treat NEPHROgenic diabetes insipidus? What is the exception? thiazides except when induced by Lithium (in that case, prefer amiloride because thiazides increase blood levels of lithium!)
Misoprostol PGE1 analog; abortifacient
Dinoprostol PGE2 analog; abortifacient
Flutamide androgen receptor antag; used in prostate CA
Garlic breath arsenic poisoning
wrist drop lead poisoning
red/black feces lead poisoning
rice water stool arsenic poisoning
tinnitus lead poisoning
Skin pigmentation arsenic poisoning
stocking glove neuropathy arsenic poisoning
In Type 2 diabetes patient, which is most likely to cause hypoglycemic rxns? Acarbose, glucagon, glyburide, metformin, and rosiglitazone Acarbose - prevent post prandial hyperglycemia; glucagon - hyPERglycemia; metformin & rosiglitazone - euglycemic - bring blood sugar to normal; sulfonylureas stimulate insulin release & therefore more likely to cause hyPOglycemia
abciximab bind glycoprotein receptors 2a/3b on platelets--> prevent fibrinogen cross-linking --> antiplatelet action
IFN alpha bind mu opioid receptors --> analgesic and release PGE2 --> fever
aldesleukin IL2 --> stimulate T cell growth
filgrastim G-CSF --> stimulate proliferation and differentiation of granulocytes --> increase neutrophils (used to treat neutropenia)
trastuzumab (Herceptin) monoclonal antibody that binds the HER2/neu receptor --> arrests cells in G1 --> decrease proliferation. Inhibits angiogenesis --> regression in breast cancer.
What to give to protect against the toxicity of methotrexate? Leucovorin rescue (folinic acid) -- provides active form of folate to non-neoplastic cells
What to give to protect against the toxicity of cyclophosphamide? Mercaptoethanesulfonate (mesna) -- inactivates acrolein --> protect against hemmorrhagic cystitis
What to give to protect against the toxicity of doxorubicin? Dexrazoxane (free radical trapping agent) -- reduces the cardiotoxicity of doxorubicin
How does the level of extracellular K+ affect insulin requirement? inc extracellular K+ (e.g. spironolactone --> hyperK+) --> doesn't interfere w insulin release from pancreatic B cells. Dec extracellular K+ --> drive K+ out of cells --> maintain hyperpolarization --> prevent insulin release --> inc insulin requirement.
Stress situations increase or decrease insulin requirement? increase
Furosemide increase or decrease insulin requirement in diabetic patient? increase (K+ wasting because loop diuretic -- acts in TAL)
Hydrochlorothiazide increase or decrease insulin requirement in diabetic patient? increase (K+ wasting because thiazide diuretic -- acts in DCT)
Prednisone increase or decrease insulin requirement in diabetic patient? glucocorticoids increase insulin requirement (like stress)
Bleomycin Acts in G2; anti-cancer cytotoxic; causes blisters on hands and feet (palms and soles); BLeo - BListers!
HGPRT hypoxanthine guanine phosphorybosyl transferase --> activates purine synthesis as well as 6-mercaptopurine (drug that blocks purine synthesis); resistance to this drug = decrease in HGPRT activity
Created by: christinapham
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