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USMLE

Pharm 1

QuestionAnswer
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
Created by: Asclepius