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USMLE STEP 1 PHARM
| Question | Answer |
|---|---|
| Penicillin G,V toxicity | sulfa allergy; Ig-E mediated hemolytic anemia; interstitial nephritis |
| m.o.a. of penicillin | inhibits bacterial peptidoglycan cross-linking |
| Aminopenicillins (ampi, amoxi) penicillinase sens. or insensitive? | Penicillinase sensitive. |
| aminopenicillins toxicity | hypersensitivity, rash, pseudom. colitis |
| Penicillinase-resistant penicillins. toxicity | nafcillin, oxacillin, dicloxacillin. allergy, int. nephritis. |
| Antipseudomonas. penicillinase sens. or insens? | ticarcillin, piperacillin. penicillinase sens. |
| b-lactamase inhibitors | clavulanic acid, sulbactam, tazobactam |
| which cephalosporin covers MRSA? | ceftaroline (5th gen) |
| cephalosporin used prior to surgery to prevent s.aureus | cefazolin (1st gen) |
| cephalosporins + aminoglycosides (toxicity) | nephrotoxicity |
| cephalosporins cause which vit. deficiency? | vit. K |
| monobactam. used against ___ | aztreonam. against G negatives, ONLY |
| carbapenems, penicillinase sens. or insens? | Penicillinase Insensitive |
| Carbapenems are administered with ____ to decrease ____ | cilastatin, to decrease renal inactivation by dihidropeptidasese |
| why don't we give carbapenems often? | seizures (less with meropenem) |
| Vancomycin m.o.a. | cell wall synth. inhibitor, by inhibiting transglycosylation NOT transpeptidation |
| vanco toxicity | Red man syndrome (face flushing) + nephrotoxicity, ototoxicity, thrombophlebitis. |
| Vanco resistance | D-ala modification to D-lac. |
| Protein synth. inhibitors. 30S, 50S. | buy AT (aminoglycosides, Tetracyclins) 30, CCEL (chloramphenicol, clindamycin, erythromycin (macrolides) Linezolid) 50 |
| Aminoglycosides (names) | GNATS - gentamicin, neomycin, amikacin, tobramycin, streptomycin |
| Aminoglycosides are ineffective against _________, because ___ | anaerobes. Need O2 for uptake |
| Aminoglycosides treat | Severe G- infections. D.o.c. for bubonic plague and tularemia |
| Aminoglycosides toxicity | NNOT - Nephro, Neuromuscular block, Oto, Taratogen |
| Resistance to Aminoglycosides | Transferase enzymes inactivate by acetylation, phosphorylation, adenylation |
| Tetracyclins cannot be taken with | Milk (Ca), Antacids (Mg,Ca) Iron - divalent cations inhibit absorption in gut |
| Tetracyclins toxicity | Teeth discoloration, inhibition of bone growth, photosensitivity |
| Which drugs have photosensitivity? | Tetracyclins, sulfonamides, quinolones |
| Tetracyclin Resistance | Decrease uptake or pump it out |
| Macrolides (names) | azithromycin, clarithromycin, erythromycin |
| aminoglycosides block | Initiation (A - first letter in alphabet) |
| Tetracyclins block | Elongation (attachment of aa-tRNA) |
| Macrolides block----. which other drug does this? | Translocation (macroSLIDES) Clindamycin |
| Chloramphenicol blocks | Peptide bond formation |
| Which tetracyclin can be given to patients w/ renal F.? | Doxycycline. excreted in bile |
| Macrolides Toxicity | MACRO: gi MOTILITY, Arrhythmia (prolonged QT), Cholestatic hepatitis, Rash, Eosinophillia |
| Macrolides increase serum concentration of -_________ | Theophyllines and oral anticoagulants. Erythromycin - statins. |
| Resistance to macrolides | Methylation of rRna binding site |
| Which antibiotics cause interstitial nephritis? | Penicillin G, V. Oxicillin, nafcillin, dicloxacillin, sulfonamides (tubulointerstitial nephritis) |
| m.c. side effect of streptokinase | hemorrhage |
| potassium sparing duretics | amiloride, triamterene, spironolactone |
| usage of fenoldopam | hypertensive emergency. Dopamine analog. acts on D1 |
| Bile acid binding resins | cholestiramine, colestipol, colesevelam |
| bile acid binding resins side effects | hypertriglyceridemia, gallstones |
| side effects of statins | hepatotoxicity, myopathy |
| cyp 450 inducers | CRAP GPS induce me to madness!! - Carbemazepines Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas |
| cyp450 inhibitors | SICKFACES.COM Group - Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol..binge drinking Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole Grapefruit juice |
| Tx for ONLY systolic hypertension | Thiazide diuretics, dihydropyridine ca antagonists. if the patient has DM d.o.c. is ACE/ARB |
| Dihydropyridine Ca Channel blockers | amlodipine, nimodipine, nifedipine (DIPINES) |
| non-dihydropyridine Ca ch. blockers | diltiazem, verapamil |
| drug used in subarachnoid hemrg. to prevent cerebral vasospasm | nimodipine |
| Rx for benign prostatic hyperplasia | a-blockers - Tamsulosin, 5-a-reductase inhibitors - Finasteride |
| Rx for Panic disorder | Benzo - alprazolam |
| decreases nicotine craving | bupropion |
| Baclofen | GABAb drug, used in spasticity |
| management of status epilepticus | 1. Benzo (lorazepam) 2. Add phenytoin to prevent recurrance 3. If all fails, intubate |
| Prevent peripheral neuropathy with isoniazid | add pyridoxine |
| d.o.c. in absence seizure. moa | ethosuximide, Ca ch.blocker |
| Drug most commonly causing tardive dyskinesia; least commonly causing | Risperidone. Clozapine |
| Treat drug-induced parkinsonism | benztropine |
| Rx for acute dystonia | antihistamines (diphenhydramine), trihexyphenydil, benztropine |
| Ca ch. blockers Toxicity | Cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia, constipation |
| Hydralazine moa | increases cGMP -> SM relax. -> vasodilation (arterioles>veins) = decreased afterload |
| Hypertension in pregnancy Rx | Hydralazine, methyldopa |
| Prevent reflex tachycardia w/ b-blockers | hydralazine |
| Lupus-like syndrome - which antihypertensive was used? | hydralazine |
| Hydralazine is contraindicated in___ | angina/CAD |
| Hypertensive emergency | Nitroprusside, fenoldopam, nicardipine, labetalol |
| Nitroprusside moa | increases cGMP via direct release of NO |
| Nitroprusside can cause _______- toxicity. treatment? | cyanide. Rx - nitrites + thiosulfate |
| Monday disease | industrial exposure to nitrates |
| minoxidil & diazoxide | Direct acting vasodilators, opens ATP-d-K channels -> hyperpolarization. acts on arterioles and pancreatic B-cells ->less insulin -> hyperglycemia. Use in emergencies |
| Minoxidil use (non-cardiac) | baldness |
| Diazoxide use (non-cardiac) | insulinoma |
| Digoxin use | CHF, atrial fibr. |
| Digoxin toxicity | cholinergic (via vagus) - nausea vomiting diarrhea BLURRY VISION arrhythmia, T-inversion, AV block, hyperkalemia |
| Hypertension + angina | b blockers |
| Hypertension + diabetes | ACEI ARBs |
| Hypertension + Post-MI | BBs |
| Hypertension + BPH | a-blockers |
| Hypertension + Dyslipidemias | a-blockers, CCBs, ARBs,ACEIs. NOT bbs and thiazides |
| Class I antyarrhytmics effect which phase? | Phase 0 - Na channels |
| Class IA drugs | Queen Proclaims Diso's Pyramide - Quinidine, Procainamide, Disopyramide |
| Class IA drugs toxicity | cinchonism (headache, tinnitus w/ quinidine) SLE - procainamide. HF - Disopyramide. Torsades. |
| Give ___ before quinidine to _______ | Digoxin. to slow down HR |
| Class IB drugs | Lodicaine, mexiletine, tocainide |
| Class IA drugs close what kind of channels | ACTIVE Na ch. |
| Class IB - type of channel | INACTIVE, REFRACTORY Na ch. |
| Class IC - type of channel | ALL KINDS OF NA CHANNELS |
| Best antiarrythmic Post-MI | Class IB |
| Least cardiotoxic ant.arrh | Class IB |
| Class IA - AP duration | increases |
| Class IB - AP duration | decreases |
| Class IC - AP duration | no change |
| SLE-like syndrome - drugs | Hydralazine, Isoniazid, Procainamide, Methyl-dopa. + ANA, + Anti-histone <- drug-induced specific |
| Class IC drugs | Flecainide Propafenone - last option. ticket to heaven. |
| Class II antiarrythmics | Beta Blockers - metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol |
| Class II moa | deacreases node activity by decreasing cAMP, Ca currents. |
| Class II phase | Phase 4 |
| Class II toxicity | IMPOTENCE, exacerbation of COPD/ASTHMA, bradycardia, AV block, CNS |
| which drug masks signs of hypoglycemia | BBs |
| which BB can cause dyslipidemia | metoprolol |
| Treat BB overdose | glucagon |
| antiarrhythmic contraindicated in cocaine users | BBs (unopposed a-agonist activity) |
| Class III antiarrhythmics | K channel blockers - AIDS - Amiodarone, Ibutilide, Dofetilide, Sotalol. used when others fail. |
| drugs causing torsades | Class IA, Class III (sotalol, ibutilide), antihistamines, TCAs, antipsychotics (thioridazine) |
| Amiodarone toxicity | Pulmonary fibrosis, hepatotox, thyroid, Blue deposits (smurf skin) Ridiculously long half life - 80 days |
| Drugs causing pulmonary fibrosis | amiodarone and bleomycin |
| Class IV antiarrhythmics | Verapamil, diltiazem (non-dihydropyridine Ca blockers). Used to prevent nodal arrhythmias |
| Adenosine moa | Gi -> low cAMP -> low PKA -> K goes out -> hyperpolarization -> low Ca current. very short acting. causes bad bronchospasm |
| Adenosine use | DOC in diagnosing/abolishing SUPRAVENTRICULAR TACHYCARDIA. |
| Mg2+ use in heart | Torsades and digoxin toxicity (competes with Ca) |
| which antidepressant causes painful, long-lasting erection? | trazodone |
| brimonidine | A2-agonist. decrease AH production. used in glaucoma. SE: foreign object sensation, blurry vision |
| B-blockers used in glaucoma | timolol, betaxolol, carteolol. decrease AH production |
| which diuretic is used in glaucoma. moa | acetazolamide. decease carbonic anhydrase, decrease AH synth. |
| moa of cholinomimetics in glaucoma | increase outflow of AH |
| cholinomimetics in glaucoma | pilocarpine, carbachol, physostigmine, echothiphate |
| glaucoma emergency | pilocarpine |
| prostaglandin in glaucoma. moa. SE | letanoprost (PGF2a). increase AH outflow. SE: dark iris |
| moa of opioid analgestics | act at mu, delta, kappa receptors. open K, close Ca channels -> decrease synaptic transmission -> inhibit release of ACh, norepi, 5-HT, glutamate, substance P |
| opioid an. for cough suppression | dextromethorphan |
| opioid for diarrhea | loperamide, diphenoxylate |
| opioid OD rx | naloxone, naltrexone |
| Butorphanol | partial mu agonist. full kappa agonist. less resp depression than full agonists. used in migraine, labor pains. not reversed with naloxone |
| tramadol | very weak opioid agonist. can cause SEROTONIN SYNDROME. used in chronic pain |
| which epilepsy drugs cause Stevens-Johnson? | Ethosuximide, phenytoin, carbamazepine, lamotrigine. |
| Stevens Johnson | fever, bulla, necrosis, sloughing of skin. Eye, lips. |
| 1st line for trigeminal n. | carbamazepine |
| 1st line epilepsy drug in neonates | phenobarbital |
| epilepsy drug causing kidney stones | topiramate |
| epilepsy drugs effecting Na channels | phenytoin, valproic, topiramate, lamotrigine |
| epilepsy drugs effecting Ca channels | ethosuximide, gabapentin |
| barbiturates moa | GABAa. increase DURATION of Cl channels. decrease neuron firing. |
| barbs contraindicated in | porphyria |
| benzos moa | GabaA, increase FREQUENCY of CL channel opening. decrease REM |
| OD of benzos, Rx | FLUMAZENIL |
| Insomnia rx | Nonbenzo hypnotics. ZZZZs - Zolpidem, Zaleplon, esZopiclone |
| Rx for High cholesterol | Resins or ezetimibe |
| Rx for high triglycerides | gemfibrozil (fibrates) |
| High trigl + cholesterol | statins + ezetimibe |
| which lipid lowering agent causes face flushing? and how to minimize this? | niacin. give aspirin |
| which lipid lowering agent causes hyperuricemia? | niacin |
| resins are contraindicated in | hypertriacylglycideremia |
| fibrates are contraindicated in | hypercholesterolemia |
| orlistat moa and use | decreased pancreatic lipase. weight loss |
| sibutramine moa and use | increase NE, 5-HT -> anorexic -> weight loss |
| medication that decreases HR but has no effect on contractility and relaxation. which phase? | Ivabradine. Phase 4 |
Created by:
anamakharashvili
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