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Pharmacology

From Kaplan's USMLE Pharmacology and Treatment Flashcards

QuestionAnswer
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