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Pharmacology
From Kaplan's USMLE Pharmacology and Treatment Flashcards
| Question | Answer |
|---|---|
| MoA Acarbose/Miglitol | Alpha glucosidase inhibitors (decrease posprandial glucose and demand for insulin) |
| MoA Metformin | Decreases hepatic gluconeogenesis and increases peripheral sensitivity to insulin. Apparently surpasses receptor so it doesn't require functional beta cells. |
| AE Metformin | Lactic acidosis (CI in renal failure) |
| OSU | 1G Chlorpropamide, tolbutamide 2G Glimepiride, glipizide, glyburide |
| MoA OSU | Block K channels in beta cell membrane -> depolarization -> increased Ca++ influx ->insulin release |
| AE OSU | Hypoglycemia, weight gain, teratogenesis, SIADH, disulfiram-like effects (1G) |
| Interferon alpha uses | Chronic hep C and hep B Melanoma Cryoglobulinemia (+ribavirin) |
| Interferon beta uses | MS |
| AE interferons | Flu-like symptoms, myalgia, arthralgia, depression, thrombocytopenia, leukopenia |
| MoA Ribavirin | RNA polymerase inhibitor (when tri P) Inhibits IMP dehydrogenase (when mono P) |
| Ribavirin uses | Hep C (+interferon alpha) RSV Lassa fever, hantavirus |
| AE Ribavirin | Hematotoxicity Upper airway irritation Teratogenesis |
| Rx MoA for acute variceal bleeding | Octreotide (somatostatin) Decreases portal pressure and splanchnic blood flow Propranolol for prevention |
| Rx MoaA hepatic encephalopathy | Lactulose (lower pH of bowel, changes NH3 to NH4+ which is more readily excreted) |
| Uses of penicillamine | Copper (Wilson's), iron, lead, mercury, arsenic poisoning. Acts as a chelator. |
| AE Penicillamine | Nephrotic syndrome Bone marrow suppression |
| Eryhromycin as a prokinetic | Increases the release of motilin |
| GP IIB/IIIA inhibitors | Abciximab Eptifibatide Tirofiban |
| SGLT-2 inhibitor | Canagliflozin (PCT) |
| MoA Exenatide | GLP-1 receptor agonist (inc insulin release, dec glucagon release) |
| MoA Sitagliptin | Inhibits DPP-4 (thereby inhibiting inactivation of GLP-1) |
| Causes of sideroblastic anemia | Chronic alcoholism B6 deficiency (INH) Lead poisoning |
| Lead poisoning in heme synthesis | Blocks Delta ALA in plasma Blocks Protoporphyrin IX in RBC |
| Pruritus, alk phos elevated, AST-ALT minimally elevated. Anti-mitochondrial Abs (++) | Primary biliary cirrhosis. treat w/ursodeoxycholic acid (dec plasma and endogenous bile acid concentrations, dec eos activation and dec destruction of hepatocytes) |
| Hemochromatosis tx | Hereditary -> Periodic phlebotomies Aqcuired (i.e. repeated transfusions) -> Chelation therapy w/ deferasirox PO or Deferoxamine IV |
| Young woman, multiple consults of abd pain, periods of diarrhea and constipation, abd CT & colonoscopy are normal Dx Tx | Irritable bowel syndrome. Dietary modifications, antispasmodics (hyoscyamine). If uneffective -> TCA |
| BPH tx | Finasteride (5 alpha-reductase inh-> blocks production of DHT) -osin (peripheral alpha blocker->relax internal urinary sphincter) |
| MoA AE Ezetimibe | Inhibits absorption of cholesterol at the brush border blocking sterol transporter Diarrhea, abd pain |
| Overactive bladder or urge incontinence tx moa ae | Tolterodine, oxybutinin, trospium, darifenacin, solifenacin Muscarinic receptor antagonists Dry mouth, dry eyes, constipation |
| Smoking cessation Rx | Verenicicline ->nicotinic Ach receptor partial agonist, blocks nicotine from binding Bupropion -> antidepressant, inh reuptake of NE and DA |
| HIT Rx | Argatroban (IIa inh, ae bleeding, monitor through aPTT) |
| Sickle cell crisis Rx AE | Hydroxyurea (inc HbF, inc H2O in RBC preventing sickling) Myelosuppression and leukemia |
| MoA Acyclovir, famciclovir, valacyclovir | Mono P by thymidine kinase (TK) Tri P inhibits viral DNA polymerase by chain tarmination |
| Use of acyclovir, famciclovir, valacyclovir | HSV and VZV, weak against EBV, NO CMV |
| Use of Ganciclovir | CMV, especially in immunocompromised patients |
| Dog bite... Human bite... | D-> Pasteurella multocida H->Eikenella corrodens |
| MCC of retinal lesions in patients w/AIDS | CMV retinitis |
| Prophylaxis for tetanus | Any wound if more than 10 years since last vaccination w/ tetanus toxoid. (lean wounds protected for 10 years, dirty for 5) If never vaccinated, tetanus toxoid and tetanus immune globulin. |
| Indications for pneumococcal vaccioation | Over 65yo, chronic heart, lung, liver, or kidney disease, diabetes, HIV, no spleen, use of steroids, resides in a chronic care facility, alocholics, cochlear implants |
| Contraindications for pneumococcal vaccination | NONE! |
| MoA uses AE Clindamycin | Blocks translocation at 50S. Bacteriostatic ANAEROBIC infections in aspiration pneumonia, lung abscesses and oral infection (above the diaphragm. vs metronidazole) Pseudomembranous colitis, fever, diarrhea |
| What organism is not affected by echinocandins? | Criyptococcus |
| MoA uses Echinocandins | Blocks 1,3 D-glucan Candida, aspergillus in pts w fever and neutropenia still febrile after bacterial atb |
| Next step of PPD >10 mm w/no symptoms and normal CXR | INH for 9 months |
| Tx for urethral discharge | Chlamydia and gonorrhea C->single-dose azithromycin or doxycycline for a week G->single-dose ceftriaxone |
| AE Protease inhibitors | -navirs Hyperlipidemia, hyperglycemia, hepatotoxic Indinavir ->nephrolithiasis |
| MoA uses AE Dapsone | Folic acid synthesis inhibitor (sulfonamide) PCP and toxoplasmosis PROPHYlAXIS when pt intolerant to SMX/TMP Leprosy Autoimmune skin disorders (bullous pemphigoid,, lichen planus, dermatitis herpetiformis) |
| MC affected valve in IVDU's endocarditis | Tricuspid (tx empiric w/vancomycin and gentamicin) |
| Onychomycosis Rx | Terbinafine (6w for fingernails, 12w for toenails) |
| MoA Terbinafine | Inhibits squalene epoxidase |
| Is metronidazole safe in pregnancy? | Yes (having bacterial vaginitis is not) |
| Oral candidiasis in AIDS Rx | Fluconazole |
| Criteria and Rx for spontaneous bacterial peritonitis (SBP) | WBC >500 or PMN >250 Cefotaxime |
| Dopamine agonists uses AE | Cabergoline, bromocriptine, pramipexole Parkinson's, restless leg syndrome, prolactinoma Naussea, vomiting, sleepines, orhostatic hypotension, fconfusion, hallucinations |
| Amantadine uses | Acute influenza A (inferior to oseltamivir) Mild parkinson's |
| Amantadine AE | Confusion, hallucinations, nightmares, depression. LIVEDO RETICULARIS |
| Fasciculations, muscle wasting, hyperreflexia,weakness, intact congnition | ALS. Riluzole to slow down. Inhibits glutamate release presynaptically |
| CBZ AE | Diplopia, ataxia, hyponatremia, aplastic anemia (rarely) |
| Phenytoin AE | Gingival hyperplasia, hirsutism |
| Topiramate AE | Glaucoma |
| Lamotrigine AE | Stevens-Johnson |
| Initial therapy for peripheral neuropathy (DM or HIV) | Gabapentin or pregabalin |
| MoA TCA | Block reuptake of NE and 5HT |
| AE TCA | Dry mouth, urinary retention, constipation, orthostatism. QT prolongation, arrythmias and seizure @ toxic levels |
| COMT inhibitors | Tolcapone Entacapone Prevent degradation of levodopa ALWAYS W/LEVODOPA REPLACEMENT Fatal hepatic failure |
| Ethosuximide MoA | Reduces low-threshhold CA2+ currents in thalamic neurons. Abscences |
| Alzheimer's dementia Rx | Donepezil, galantamine, rivastigmine (inc levels of ACh) |
| (+) anti-cholinesterase AB | Myasthenia gravis |
| CML Rx | Imatinib (small-molecule inhibitor of the bcr-abl tyrosine kinase -> Philadelphia chromosome fusion gene) |
| Aromatase inhibitors | Letrozole, Anastrozole |
| Cyclophosphamide AE | Hemorrhagic cystitis |
| Calcineurin inhibitors | Cyclosporine Tacrolimus Block T-cell activation by preventing IL-2 transcription |
| Initial therapy for back pain from metastatic prostate CA w/spinal lesions with no compression of cord | Androgen blockade w/ flutamide, then GnRH agonists |
| Acute closd-angle glaucoma Rx | Timolol, pilocarpine,acetazolamide, latanoprost |
| Cilostazol, dipyridamole MoA uses AE | PDE III inh -> inc cAMP in platelets, inh of platelet aggregation Intermittent claudication, coronary vasodilation, prevention of strokes or TIAs Nausea, headache, flushing, hypotension, abd pain |
| GP IIb/IIIa inh | Abciximab, tirofiban, eptifibitide |
| Decrease mortality in CHF | BB, ACEI, ARB, spironolactone |
| Magnesium sulfate best for | Pre-exlampsia,eclampsia, torsades |
| WPW w/SVT or VT Rx | Procainamide Amiodarone |
| Prostacyclin analogs | Epoprostenol Treprostinil Iloprost Severe PHT |
| Endothelin-1 inhibitor | Bosentan (hepatotoxic and teratogenic) |
| IgE blocker | Omalizumab |
| Rx SIADH | Conivaptan tolvaptan Demeclocycline (tetracycline) |
| Preop medication Pheochromocytoma | Phenoxybenzamine (nonspecific alpha blocker) |
| TNF inhibitors | Infliximab Etanercept Adalimumab |
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10156092587025131
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