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