HY Pharmacology. Do not miss it!!

( SUPER HY Exam Qs)

chebli .

Characteristic Disease
1st line tx for a fibrillation is : Digoxin
how does digoxin help in a fibrillation ? decreases conduction through AV node
treatment for C. difficile metronidazole
why doesn't gentamicin work for C. diff? gentamicin = aminoglycoside that only works for gram (-)
infections
most common cause of drug-induced thrombocytopenia : heparin
anticoagulant associated with development of ProC deficiency : warfarin
kernicterus can result when pregnant women are given (TMS)___ in the third trimester TMP-sulfa
associated with "gray baby syndrome" when given to pregnant women : chloramphenicol
topical ointment often used in the prophylaxis of infections in burn patients: silver sulfadiazine cream
appropriate pharmacologic tx for DIC : heparin
antidote for acetaminophen OD : acetylcysteine
chelating agent used to treat OD with copper, lead, gold, and other metals: penacillamine
given to people who OD( overdose) on heparin protamine Sulfate.
acetylcholinesterase reactivator used in organophosphate poisoning : pralidoxime
antiarrythmic which can cause drug-induced lupus: procainamide
other drugs that can cause drug-induced lupus : hydralazine, quinine, INH, methyldopa
drug that causes release of factor VIII from storage sites: desmopressin
drug that specifically inhibits the translocation in CML: imanitib mesylate (Gleevac)
neurotransmitter affected by sertraline : serotonin (SSRI)
type of antibiotic likely to exacerbate MG( Myastenia Gravis) aminoglycosides (risk for neuromuscular
blockade)
drug used to diagnose MG : edrophonium
most appropriate treatment of Klebsiella pneumonia : cefotaxime IV
most appropriate treatment of Legionella pneumonia : erythromycin IV
drugs that potentiate the effects of warfarin : quinolones, erythromycin, sulfas, and metronidazole
mucolytic used in the treatment of CF( Cystic Fibrosis) : N-acetylcysteine
tricyclic antidepressant which may cause hyperprolactinemia: nortriptyline
anti-Parkinson's drug that affects dopamine: selegiline
mechanism of selegiline:Monoamine Oxidase B inhibitor( MAO-B inhibitor ) _ (slows metabolism of
dopa)
β- 1 blocker which does NOT exacerbate asthma (3) atenolol, metoprolol, esmolol
Atenolol - Clinical Pharmacology
Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent without
membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities. This preferential effect is
not absolute, however, and at higher doses, Atenolol inhibits beta2-adrenoreceptors, chiefly located in
the bronchial and vascular musculature.
two main Abx used for anaerobes metronidazole and clindamycin. Abx( Antibiotics).
streptokinase binds to : plasminogen
mechanism of cocaine blocks reuptake of NE
two drugs that increase the activity of lipoprotein lipase gemfibrozil and clofibrate
two drugs that act as bile acid sequestrants cholestyramine and colestipol
aminocaproic acid is indicated for : control of bleeding by hyperfibrinolysis, and prophylaxis in
hemophiliacs undergoing a surgical procedure
what causes hemolysis in G6PD deficient individuals? oxidative stress (low NADPH means glutathione
cannot scavenge free radicals)
1st-line rx for panic disorder SSRI
reserved for refractory cases of schizophrenia due to risk of agranylocytosis clozapine
inappropriate laughter, scleral injection, tachycardia, and paranoia are typical of a person using what
illicit substance? cannabis
1st-line rx for DVT IV heparin
1st-line rx for hypothyroidism levothyroxine
contraindication for levothyroxine use CAD (enhances β-adrenergic effects; may precipitate MI)
toxicities of methotrexate liver, renal, BM
after CLL chemotherapy, patients are at risk for what type of kidney stones? uric acid
alcoholics have (increased/decreased) levels of theophylline decreased (EtOH induces P450)
name the K+ sparing diuretics spironolactone, triamterene, amiloride
drug class of salsalate NSAID (salicylate)
effect of ammonium chloride on the urine acidifies
interaction of ammonium chloride and salicylates salicylate toxicity (amm chloride inhibits excretion)
mechanism of flutamide comp antagonist at androgen receptors
mechanism of finasteride 5- α reductase inhibitor
Class I antiarrhythmics block ___ sodium channels
Name some class I antiarrhythmics quinidine (A), amiodarone (A, III), procainamide (A), lidocaine (B),
flecainide ©
Class II antiarrhythmics block ___ beta-adrenergic receptors
Class III antiarrhythmics block ____ potassium channels
Name some class III antiarrhythmics sotalol (also β), amiodarone, bretylium
Class IV antiarrhythmics block ___ calcium channels
Name some class IV antiarrhythmics verapamil, diltiazam
mechanism of metoclopromide antagonist at D receptors
use of metoclopromide prokinetic agent used in GERD and diabetic gastroparesis
contraindication for metoclopromide (2) bowel obstruction, Parkinson's
necrosis of the skin can be a toxicity of what anticoagulant? warfarin
drug given for acute gouty attacks colchicine
xanthine oxidase inhibitor used in gout allpurinol
increases the excretion of uric acid (2) probenacid, sulfinpyrazone
define REM rebound some drugs steal REM; when removed, body has more REM, including vivid dreams
drugs that cause REM rebound when withdrawn barbiturates, EtOH, MAOI, phenothiazines
mechanism of caffeine inhibition of phosphodiesterase (prevent cAMP degradation)
carbonic anhydrase inhibitors can lead to what acid-base disturbance? metabolic acidosis
close a PDA with : indomethacin
class of drugs that must be given to a patient in a fib and WHY anticoagulants; because the flow in the
atrium is nonlaminar and predisposes to mural clots
inhaled corticosteroids are associated with ___ in asthmatic patients (microbial infxn) candidiasis
these cardiac drugs "mask" the initial sx of hypoglycemia and are thus contraindicated in diabetics β
blockers
analgesic of choice for acute cholecystitis and WHY meperidine; least likely to cause spasm of sphincter
of Oddi
initial drug of choice for acute status epilepticus diazepam
indications for carbamazepine prophylaxis and treatment of tonic-clonic, focal, and complex partial
seizures
drug of choice for absence seizures ethosuximide
NSAID that is contraindicated in patients with sulfa allergy celecoxib
location of action of spironolactone collecting tubule
Name some drugs associated with the development of SIADH tricyclics, carbamazepine, SSRI, MAOI,
neuroleptics, antineoplastics
post-MI drugs that cause dry cough ACE-I (captopril, enalapril)
two β1-selective antagonists metoprolol and atenolol. Atenolol is a beta1-selective (cardioselective)
beta-adrenergic receptor blocking agent.
Metoprolol - Clinical Pharmacology
Metoprolol tartrate is a beta-adrenergic receptor blocking agent. In vitro and in vivo animal studies have
shown that it has a preferential effect on beta1 adrenoreceptors, chiefly located in cardiac muscle. This
preferential effect is not absolute, however, and at higher doses, Metoprolol also inhibits beta2
adrenoreceptors, chiefly located in the bronchial and vascular musculature.
Clinical pharmacology studies have confirmed the beta-blocking activity of Metoprolol in man, as shown
by (1) reduction in heart rate and cardiac output at rest and upon exercise, (2) reduction of systolic
blood pressure upon exercise, (3) inhibition of isoproterenol-induced tachycardia, and (4) reduction of
reflex orthostatic tachycardia.
Relative beta1 selectivity has been confirmed by the following: (1) In normal subjects, Metoprolol is
unable to reverse the beta2-mediated vasodilating effects of epinephrine. This contrasts with the effect
of nonselective (beta1 plus beta2) beta blockers, which completely reverse the vasodilating effects of
epinephrine. (2) In asthmatic patients, Metoprolol reduces FEV1 and FVC significantly less than a
nonselective beta blocker, propranolol, at equivalent beta1-receptor blocking doses.
Metoprolol has no intrinsic sympathomimetic activity, and membrane-stabilizing activity is detectable
only at doses much greater than required for beta blockade. Metoprolol crosses the blood-brain barrier
and has been reported in the CSF in a concentration 78% of the simultaneous plasma concentration.
Animal and human experiments indicate that Metoprolol slows the sinus rate and decreases AV nodal
conduction.
In controlled clinical studies, Metoprolol tartrate has been shown to be an effective antihypertensive
agent when used alone or as concomitant therapy with thiazide-type diuretics, at dosages of 100 to 450
mg daily. In controlled, comparative, clinical studies, Metoprolol has been shown to be as effective an
antihypertensive agent as propranolol, methyldopa, and thiazide-type diuretics, and to be equally
effective in supine and standing positions.
The mechanism of the antihypertensive effects of beta-blocking agents has not been elucidated.
However, several possible mechanisms have been proposed: (1) competitive antagonism of
catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac
output; (2) a central effect leading to reduced sympathetic outflow to the periphery; and (3) suppression
of renin activity.
By blocking catecholamine-induced increases in heart rate, in velocity and extent of myocardial
contraction, and in blood pressure, Metoprolol reduces the oxygen requirements of the heart at any
given level of effort, thus making it useful in the long-term management of angina pectoris. However, in
patients with heart failure, beta-adrenergic blockade may increase oxygen requirements by increasing
left ventricular fiber length and end-diastolic pressure.
Although beta-adrenergic receptor blockade is useful in the treatment of angina and hypertension,
there are situations in which sympathetic stimulation is vital. In patients with severely damaged hearts,
adequate ventricular function may depend on sympathetic drive. In the presence of AV block, beta
blockade may prevent the necessary facilitating effect of sympathetic activity on conduction. Beta2-
adrenergic blockade results in passive bronchial constriction by interfering with endogenous adrenergic
bronchodilator activity in patients subject to bronchospasm and may also interfere with exogenous
bronchodilators in such patients.

mechanism of propythiouracil inhibits peripheral conversion of T4 to T3 (aka inhibit deiodination of

thyroxine)
general class of 5HT3 antagonists the -setrons
use for the -setrons antiemetics
indications for dimenhydrinate motion sickness (Dramamine ©)
what is dronabinol? active substance in marijuana
type of leukemia for which chlorambucil is used CLL
the "better drug" than tamoxifen raloxifene
mechanism of amphetamines induce release of dopa and NE
side effects associated with steroid use hypernatremia, hypocalcemia, fluid retention, hypocalcemia,
hyperglycemia
indication for bethanechol urinary retention (as in BPH)
oxybutynin is indicated in urinary incontinence and urgency
α1 agonist indicated for both BPH and HTN terazosin
1st drug of choice for community-acquired S. pneumo pneumonia Pen G
lactic acidosis is the most severe complication of this diabetes drug metformin
what is the effect of cimetidine on hepatic enzymes? inhibits them
what is the effect of cimetidine on phenobarbital levels? increases them (inhibits metabolism)
do proton-pump inhibitors affect hepatic enzymes? no
in a patient with ulcers and RA, use … COX-2 inhibitors
what neurotransmitter system do benzodiazepines affect? GABA
drug to treat T. cruzi Nifurtimox
what drug is used for immediate lowering of intracranial pressure? high-potency steroid
(dexamethasone, prednisolone)
mechanism of action of amiodarone potassium-channel blocker (also Class IA)
big toxicity of amiodarone pulmonary disease
mechanism of action of warfarin inhibit synthesis of clotting factors (2, 7, 9, 10)
high doses of ____ will reduce morbidity and mortality in measles infxn vitamin A
children DAG + IP3 > pro kin C + increased Ca
what is the second messanger associated with beta receptors? inc adenylate cyclase > cAMP > pro kin C
how does the second messanger system of alpha-2 receptors differ from that associated with beta
receptors? both use adenylate cyclase; alpha is inhibitory, beta is stimulatory
D2 receptors have a second messanger system similar to what other receptor? alpha2 (inhibit adenylate
cyclase)
what is ergocalciferol? synthetic Vitamin D (for lack of PTH)
antibacterial agent which will be not absorbed if taken with antacids tetracycline
neurotransmitter used at the NMJ Ach
are charged or uncharged drugs more readily taken up? uncharged
illicit drug that causes nystagmus PCP
illicit drug that causes perceptual changes, but not behavioral changes LSD
mechanism of action of losartan competitively inhibits angiotensin II
used in the rx of HTN in diabetic patients ACEI
the effect of enalapril on sodium & potassium balance hyperkalemia and mild hyponatremia
drug of choice for pneumococcal pneumonia Penicillin
two drugs used in pneumococcal pneumonia in patients with sulfa allergies erythromycin or vancomycin
recessed, darkened rings w/o enamel on new teeth can be caused by excess of what mineral? flouride
what class of antidepressants cause delayed ejaculation? SSRI
cancer antimetabolites act during which phase of the cell cycle? S (synthesis) phase
lab studies in a patient given T3 supplementation low TSH, high T3, low T4 (b/c T3 not peripherally
converted to T4)
Ca channel blocker that is associated with acceleration of CHF in some patients verapamil
is verapamil a - or + inotrope? -
which antidepressant can cause spontaneous priapism? trazodone
the bug that causes granuloma formation in utero Listeria
leukocytoclastic angiitis is also known as … hypersensitivity angiitis
leukocytoclastic angiitis has been linked to the use of what drug? penicillin
mechanism of action of methoxamine alpha-1 agonist
side effects of methotrexate BM suppression, pulm toxicity, renal toxicity
significant side effect of vinblastine BM suppression, hemmorrhagic colitis
significant side effect of vincristine neurotoxicity
most common cause of drug-induced hypothyroidism lithium carbonate
lente insulins have best effect between __ and __ hours 10 and 16
insulin preparations with long (i.e. 16-24 hours) duration of action ultralente or protamine zinc
peak effect of regular insulin 4 hours
what other insulin preparation has a peak effect similar to regular insulin? semilente
mechanism of action of carvedilol like labetolol - beta and alpha-1 antagonist with longer half-life
ACEI are contraindicated in what type of hypertension? renovascular
local anesthetics block ___ channels while (charged/uncharged) (inside/outside) the cell Na channels
when charged inside the cell
livedo reticularis is a common side effect of what anti-Parkinson's drug? amantidine
sx of livedo reticularis purplish-red mottling of the LE which intensifies with standing
cardioprotective agent used to protect pt against doxorubicin dexrazoxane
clozapine's advantage over the typical antipsychotics fewer EPS and good for (-) sx
NSAID with the greatest renal toxicity indomethacin
synthetic PG used to prevent NSAID-induced ulcers misprostol
appropriate initial therapy for septic shock dopamine
mechanism of dobutamine alpha-1 and beta-1 agonist
treat pinworm with … mebendazole
orally active lead chelator succimer
mechanism of action of glycopyrrolate anticholinergic (like atropine)
preferred class of drug for panic disorder benzodiazepine
antidepressant used in OCD( Obsessive Compulsive Disorder): clomipramine, SSRIs
Rx for pyelonephitis in patients allergic to sulfa : aminoglycosides
cephalosporins have cross-allergenicity with : penicillins
buspirone: is most often used for the generalized anxiety disorder
why isn't buspirone used for stage fright or performance anxiety? it takes a long time to take effect
increased zinc protophoryin indicates poisoning with : lead
the effect of aspirin on warfarin displaces warfarin; makes warfarin more potent
drugs that often lead to orthostatic hypotension alpha-1 blockers
nitroprusside works due to what second messanger? NO, which increases cGMP to relax smooth muscle
Is it often or rare that tetracycline resistance accompanies methicillin resistance in S. aureus? often
(>75%)
what do we use for methicillin- and tetracycline-resistant S. aureus? use vancomycin
chemotherapeutic agent associated with peripheral neuropathy vincristine
antibiotic which will NOT be absorbed in the presence of antacids tetracycline
overuse of a thiazide diuretic will induce a ____ in aldosterone increase
effect of physostigmine on the eye accomodation and niosis
when acyclovir fails, try … foscarnet
one major side effect of IM fluphenazine is : severe orthostatic hypotension
hyperprolactinemia can be reduced with : bromocriptine
treatment for methemoglobinemia methylene blue
best agent for lowering intracranial pressure mannitol
histologic feature of measles infection syncytia formation
treatment for PCP SMX-TMP
increased amounts of sER indicate that the patient has been taking : a drug that induces P450
mechanism of tolbutamide blocks ATP-sensitive K channels, leading to the release of insulin
pharacologic treatment for enuresis imipramine
maintaining the patency of a ductus arteriosis is done with : misoprostol
schedule of cortisol replacement 20 mg in am and 10 mg in pm
mechanism of finasteride 5-alpha reductase inhibitor
skeletal mm relaxant associated with decreases in BP tubocurarine
mm rigidity, diaphoresis, hyperpyrexia, and altered mental status are typical of what reaction caused by
antipsychotics? neuroleptic malignant syndrome (caused by antipsychotics and amoxipine)
common side effects of erythromycin Gi discomfort
which adrenergic receptor best stimulates protein kinase A? beta-1
which beta blocker has weak adrenergic agonist activity? pindolol
the most effective adrenergic drugs for increases intracellular Ca are … alpha-1 agonists
mechanism of action of tyramine releases catecholamines
acute mastitis is treated with … dicloxacillin
strep pneumo is treated with : Penicillin G
treat Clostrium difficile : with metronidazole , vancomycin.
the diuretic class that inhibits Cl transport in the loop of henle loop diuretic (inhibits Na-K-Cl transporter
in thick ascending limb)
what type of drug would enhance the reflex change in HR produced by IV norepi? cholinergics, e.g.
neostigmine
the mechanism of contraceptive effect in testosterone is : inhibition of LH release from the pituitary
drug of choice for trichuriasis mebendazole
drug of choice for OCD clomipramine, SSRIs
long-term use of broad-spectrum Abx can cause a deficiency in what vitamin? vitamin K
what cell produces NO? capillary endothelium
why is PenG ineffective against most gram (+) organisms? outer cell membrane acts as a sieve to keep
out large molecules like Pen G
non-pharmacologic tx for patient with stress incontinence strengthen the urogenital diaphragm
mechanism of action of belladonna alkaloids muscarinic antagonists
what is cycloplegia? paralysis of the ciliary mm (accomodation affected)
the radial mm is innervated by : alpha-1 adrenergics
the ciliary mm is innervated by : muscarinics
role of the radial mm changes pupil size
expected effect of phenylephrine on accomodation and pupil size no affect on accomodation (ciliary mm
= muscarinics); mydriasis
the tx for neostigmine overdose is : atropine (pralidoxime won't work because neostigmine irreversibly
carbamoylates)
effect of dig on intracellular Na and K levels Na increases; K decreases
main virulence factor of group B strep capsule to prevent phagocytosis
how does one eradicate spores? autoclaving (wet heat for 15 minutes)
effect of TMP-SMX on warfarin displaces warfarin; makes warfarin more potent
most rational drug regimen for fast metabolizers normal loading dose, increased maintenance dose
10% of patients taking ___ show increased CK and myalgias after exercise statins
how to distinguish propanolol, nadolol, and pindolol YOU CAN'T! They are all the same.
used to prevent bone loss in a 30 yo woman with recent oophorectomy/hysterectomy estrogens (oral
Ca not as effective)
drug of choice for iron poisoning deferoxamine
EtOH use increases the serum concentration of what lipoprotein? HDL (this is why it is cardioprotective)
diuretics often trigger what acid-base abnormality? metabolic alkalosis (with low K and high HCO3)
the appropriate therapeutic interventions for a patient who stepped on a nail but who has not had a
tetanus shot in over 10 years both toxoid (booster) and antitoxin
the intervention for a patient who stepped on a nail who has current tetanus shots booster toxoid shot
treatment for AIDS patient (taking RT inhibitors and protease inhibitors) with anemia EPO