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USMLE
Pharm 1
| Question | Answer |
|---|---|
| 28 year old chemist presents with MPTP exposure. What NT is depleted? | Dopamine |
| Woman taking tetracycline exhibits photosensitivity. What are the clinical manifestations? | Rash on sun-exposed regions of body |
| Nondiabetic patient presents with hypoglycemia but low levels of C peptide. What is the diagnosis | Surreptitious insulin injection |
| African American male who goes to Africa develops hemolytic anemia after taking malaria prophylaxis. What is the enzyme defficiency | Glucose 6 phosphate dehydrogenase |
| 27 year old female with history of psychiatric illness now has urinary retention due to neuroleptic. What do you treat it with? | Bethanechol |
| Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping and blurry vision. What caused this and what is the mechanism | Insecticide poisoning, inhibition of acetylcholinesterase |
| Patient with recent kidney transplant is on cyclosporine for immunosuppresion, he requires antifungal agent for candidiasis. What antifungal drug would result in cyclosporine toxicity? | Ketoconazole |
| Man on several medications including antidepressants and antihypertensives, has mydriasis and becomes constipated. What is the cause of symptoms? | TCA |
| 55 year old postmenopausal woman on tamoxifen therapy. What is she at increased risk of acquiring? | Endometrial carcinoma |
| Woman on MAO inhibitor has hypertensive crisis after meal. What did she ingest? | Tyramine (wine or cheese) |
| After taking clindamycin, patient develops toxic megacolon and diarrhea. What is the mechanism of diarrhea? | Clostridium difficile overgrowth |
| Man starts a medication for hyperlipidemia. He then develops rash, pruritus and GI upset. What drug was it? | Niacin |
| Patient is on carbamazepine. What routine workup should be done? | LFT's |
| 23 year old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why? | Rifampin augments estrogen metabolism in liver rendering it less effective |
| Patient develops cough and must discontinue captopril. WHat is a good replacement drug and why doesnt it have the same side effects? | Losartan - an angiotensin II receptor antagonist, does not increase bradykinin as captopril does |
| Relates the amount of drug in the body to plasma concentration | Vd - volume of distribution |
| Formule for volume of distribution | Vd = amount of drug in the body/plasma drug concentration |
| Vd of plasma protein-bound drugs can be altered by what disease? | Liver and kidney |
| Relates the rate of elimination to plasma concentration | CLEARANCE |
| Formula for clearance | Cl = rate of elimination of drug/plasma drug concentration |
| The time required to change the amount of drug in the body by 1/2 during elimination (or during constant infusion) is called _ | Half life T1/2 |
| After 1 half life concentration of drug equals _ % | 50% |
| After 2 half lifes concentration of drug equals_ | 75% |
| A drug infused at constant rate reaches about _ % of steady state after 4 T1/2 | 94 |
| Formula for T1/2 | T1/2 = 0.7 * Vd/CL |
| Loading dose formula | Loading dose = Cp * Vd/F, Cp= target plasma concentration, F = bioavailibility |
| Formula for maintenance dose | Cp * CL / F, Cp = target plasma concentration, F = bioavailibility |
| In patients with impaired renal or hepatic function, the loading dose decreases, increases or remains unchanged? Maintenance dose? | Loading dose remains unchanged, Maintenance dose decreases |
| Rate of elimination is constant (constant amount of drug is eliminated per unit time) - what order elimination? What happens to target plasma concentration? | Zero order elimination, Target plasma concentration decreases linearly with time |
| Rate of elimination is proportional to drug concentration (constant fraction of drug eliminated per unit time) - what order elimination? What happens to target plasma concentration? | First order elimination, Cp decreases exponentially with time |
| Give examples of drugs with zero order elimination | Ethanol, Phenytoin, Aspirin (at high or toxic concentration) |
| Phase I metabolism (reduction, oxidation, hydrolysis) yields _ metabolites (often still active) | Slightly polar, water soluble |
| What phase of metabolism associated with cytochrome P450 | Phase I |
| What phase of metabolism associated with conjugation | Phase I |
| Phase II metabolism (acetylation, glucoronidation, sulfation) yields _ metanolites (renally excreted) | Very polar, inactive |
| Geriatric patients lose which phase of metabolism first? | Phase I |
| Is it safe? Pharmacokinetics? - which phase of clinical testing of the drug | Phase I |
| Does it work in patients?- which phase of clinical testing of the drug | Phase II |
| Does it work? Double blind - which phase of clinical testing of the drug | Phase III |
| What happens in phase IV of clinical testing of the drug | Postmarketing surveillance |
| A competitive antagonist shifts agonist curve where? | To the right |
| A noncompetitive antagonist (irreversible) shifts agonist curve where? | Downward |
| Name antibiotics that block cell wall synthesis by inhibition of peptidoglycan cross linking | Penicillin, Ampicillin, Ticarcillin, Pipercarcillin, Imipenem, Aztreonam, Cephalosporins |
| Name antibiotics that block peptidoglycan synthesis | Bacitracin, Vancomycin, Cycloserine |
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Asclepius
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