0 - USMLE Step 1 > Pharmacology > Flashcards

Pharmacology Flashcards

(49 cards)

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1
Q

Which type of diuretic can be useful in preventing the formation of calcium stones by causing increased Ca2+ reabsorption?

A

Thiazides —> decrease urine Ca2+ excretion

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2
Q

Which drug can be used to decrease the risk of uric acid kidney stones?

A

Acetazolamide

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3
Q

The SERM, Tamoxifen, is a prodrug used in breast cancer treatment that metabolized by what CYP and to what active metabolite?

A

CYP2D —> active metabolite, endoxifen

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4
Q

Which 3 drugs can be used for venous thromboembolism and atrial fibrillation in pt’s with heparin-induced thrombocytopenia?

A
  • Bivalirudin
  • Argatroban
  • Dabigatran

*Direct thrombin inhibitors; used when heparin is BAD for the pt

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5
Q

What is the MOA of cyclosporine?

A

Binds cyclophilin in lymphocytes and inhibits calcineurin –> ↓ IL-2

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6
Q

What is the MOA of Tacrolimus?

A

Binds FK506-binding protein and Inhibits IL-2 through a calcineurin-dependent mechanism

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7
Q

What are the most common mechanisms of aminoglycoside resistance?

A

Antibiotic-modifying enzymes adding chemical groups i.e., acetyl ,adenyl, phosphate

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8
Q

What is the MOA and use for Flutamide?

A
  • Nonsteroid anti-androgen that competitively inhibits testosterone receptors
  • Used in tx of prostate cancer –> improves sx’s of bone pain and urinary obstruction
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9
Q

List the 4 preferred agents used for bipolar maintenance tx?

A
  • Lithium
  • Anticonvulsants: Valproate and Lamotrigine
  • Quetiapine (2nd gen. antipsychotic)
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10
Q

List 5 medication classes which prolong the QT and can induce torsades.

A
  • Macrolides
  • Fluoroquinolones
  • Anti-psychotics: haloperidol and risperidone
  • Antiemetics: ondansetron and metoclopramide
  • Azoles
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11
Q

What is phenylephrine and what is its effect on peripheral vascular resistance, systolic BP, pulse pressure, and HR?

A
  • Selective alpha-1 AR agonist
  • ↑ PVR and ↑ systolic BP
  • ↓ pulse pressure and ↓ HR
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12
Q

What is the most frequently used agent for the chemoprophylaxis of meningococcal disease?

A

Rifampin

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13
Q

Which 3 classes of drugs act on the ciliary epithelium to decrease aqueous humor secretion and can be used for glaucoma?

A
  • Non-selective beta-blockers: Timolol
  • Alpha-2 AR agonists
  • Carbonic anhydrase inhibitors: Acetazolamide
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14
Q

What is the MOA of administering Amyl Nitrite to pt with Cyanide poisoning?

A
  • Oxidizes Fe2+ –> Fe3+ generating methemoglobin
  • Methemoglobin has a high affinity for cyanide, freeing it from cytochrome oxidase and limiting its toxic effects
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15
Q

What are 2 monoclonal antibodies against PD-1 and which is against PD-L1?

A
  • Pembrolizumab and Nivolumab are against PD-1
  • Atezolizumab is against PD-L1

*Used for advanced melanoma, some lung cancer, and RCC

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16
Q

How can mycobacteria develop resistance to both isoniazid and ethambutol?

A
  • Isoniazid: decreased activity of bacterial catalase-peroxidase
  • Ethambutol: increased activity of enzymes involved in cell wall polysaccharide synthesis
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17
Q

Digoxin slows ventricular rate during AF primarily by causing what?

A
  • Increased parasympathetic tone –> inhibition of the AV nodal conduction
  • Used in HF due to positive inotropic effect; accomplished through inhibition of Na/K-ATPase pump
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18
Q

What is the MOA of the stimulant drugs (methylphenidate and amphetamines) used to treat ADHD?

A

Blocking NE and dopamine re-uptake at synapses in the prefrontal cortex

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19
Q

Clozapine is a 2nd-gen. antipsychotic that is used for what?

A

Treatment-_refractory_ Schizophrenia

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20
Q

Which 2 second-gen. antipsychotics carry the greatest risk of metabolic syndrome and require pt’s to undergo routine monitoring of weigh, waist circumference, BP, fasting glucose and lipid profiles?

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A

Olanzapine and Clozapine

21
Q

Which laboratory test should be obtained before starting patient on Metformin?

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A
  • Serum creatinine level to evaluate to estimate GFR and evaluate kidney function
  • Patients with recent IV contrast administration may have suppressed renal function
22
Q

Which 2 medications require routine thyroid function tests?

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A

Lithium and Amiodarone

23
Q

Which 2 antiseizure meds work by blocking Na+ channels?

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A

Phenytoin and Carbamazepine

24
Q

What is the 1st line tx for absence seizures and what is the MOA?

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A
  • Ethosuximide
  • Blocks T-type Ca2+ channels in thalamic neurons
25
Which antiseizure med works by blocking Na+ channels and increasing GABA levels?
**Valproic acid**
26
What are 2 important AE's associated with Carbamazepine?
- **Bone marrow suppression** --\> anemia, agranulocytosis, and thrombocytopenia - **SIADH** ---\> hyponatremia
27
What is th drug of choice for tx of Bulimia Nervosa?
**Fluoxetine** (SSRI)
28
Why are ACEI's and ARBs containdicated during pregnancy?
- Leads to _low_ levels of **angiotensin II**, which is necessary for **_fetal renal_ development** - This leads to **Potter sequence** due to **oligohydramnios** --\> **pulmonary hypoplasia** and **skeletal defects**
29
What are 4 characteristics of a drug which would cause it to be trapped in the plasma compartment resulting in a low Vd (3-5L)?
- **High molecular weight** - **High plasma protein binding** - **High charge** - **Hydrophilicity**
30
What can be a potential limiting factor when starting a patient on an ACE inhibitor?
- **First-dose HYPOtension** - Most likely in pt's w/ **high renin** activity, such as those w/ **volume depletion** (i.e., from diuretic use) or **heart failure**
31
What are the 2 positive effects of using the PDE-3 enzyme inhibitor, Milrinone for heart failure?
- In **cardiomyocytes**, intracellular Ca2+ is **increased** --\> increases **contractility** (positive inotropy), improving **SV** and **cardiac output** - In **vascular smooth m.**, increases uptake of **Ca2+** by the **SR** = **relaxation** and **vasodilation** = decreases **preload** and **afterload**
32
What are the drugs of choice for treating heparin-induced thrombocytopenia (HIT)?
**Direct thrombin inhibitors** = Hirudin, Lepirudin, and Argatroban
33
Which 2 drugs are commonly used to tx spasticity secondary to both brain and spinal cord disease, including MS; what are their MOA's?
- **Baclofen**: an **_agonist_** at the **GABA-B receptor** - **Tizanidine**: an **_agonist_** at the **alpha-2 AR**
34
Which 3 anticonvulsants can be used as mood stabilizers in tx of bipolar disorder?
- **Valproate** - **Lamotrigine** - **Carbamazepine**
35
Which AE's are associated with the first-line tx for CMV colitis and retinitis, Gangciclovir?
**Neutropenia**, **thrombocytopenia**, and **anemia**
36
What is the MOA of the non-benzodiazepine hypnotic agents, Zolpidem, Zaleplon, and Eszopiclone?
_Agonist_ at **GABAA receptor** at the **benzodiazepine receptor site**
37
What is the MOA of Cromolyn and Nedocromil?
**_Inhibit_ mast cell degranulation** and prevent release of _preformed_ mediators
38
Methylation is an important drug biotransformation method to consider when prescribing drugs such as?
**Azathioprine** and **6-mercaptopurine**
39
Which drug is as effective as aspirin for prevention of cardiovascular events and should be used in pt's with an aspirin allergey; what's the MOA?
**Clopidogrel**: irreversibly blocks the **P2Y12 component** of **ADP receptors** on the platelet surface and _prevents_ **aggregation**
40
Which 5 drugs are commonly implicated in drug-induced lupus?
- **Hyrdralazine** - **Procainamide** - **Isoniazid** - **Minocycline** - **Quinidine**
41
Why do ACE inhibitors cause an increase in creatinine levels within the first few days of starting tx; who might this cause serious problems in?
- Due to _decreased_ **angiotensin II** --\> _decreased_ **efferent** arteriole constriction - Pt's with **bilateral renal artery stenosis** (heavily dependent on angiotensin II to maintain GFR) can experience a precipitous fall in GFR and develop **acute renal failure**
42
After stabilization, long term use of which medications have been shown to improve survival in pt's with heart failure due to LV systolic dysfunction (decompensated HF)?
- **Beta-blockers** i.e., Carvedilol or Metoprolol - **ACE inhibitors** - **ARBs** - **Aldosterone antagonists**: Spironolactone and Eplerenone
43
What are the 3 aromatase inhibitors which can be used to slow the progression of ER-positive tumors?
- **Anastrozole** - **Letrozole** - **Exemestane**
44
Sinus bradycardia is the most common arrhythmia in those with inferior wall MI, which drug should be given IV to correct this?
**Atopine**: counteracts the enhanced vagal tone to _increase_ **HR**
45
How can mu-opioid agonists such as morphine cause biliary colic?
Cause **contraction** of the **SMOOTH M. cells** in the **sphincter of Oddi**, leading to **spasm** and _increase_ in **common bile duct pressures**
46
Which agents used for skeletal muscle relaxation during surgery are pt's with Myasthenia Gravis extremely sensitive to and which are they often resistant to?
- Extremely **_sensitive_** to **NON-depolarizing** agents: **Vecuronium** or **Rocuronium** = competitive **_antagonist_** at **nAChRs** - Often **_resistant_** to **depolarizing agents** --\> **Succinylcholine** = competitive **_agonist_** at **nAChRs**
47
What are the 4 broad spectrum anti-seizure drugs which can be used as first-line tx of generalized tonic-clonic and myoclonic seizures?
- **Valproic acid:** block Na+ channels and increases GABA - **Levetiracetam****:** modulates GABA and glutamate release - **Topiramate** and **Lamotrigine**: increases Na+ channel inactivation
48
What is the MOA of Cilostazol and Dipyridamole and what are they used for; what are the AE's?
- Reduce platelet activation by _inhibiting_ platelet **PDE**, which normally breaks down **cAMP** and also act as _direct_ arterial **vasodilators** - Used to decrease **claudication** sx's in pt's with **peripheral artery disease** - **AE's:** facial flushing and abdominal pain
49
Which drug classes are effective in tx OCD?
- **SSRIs** = tx of choice - **TCA's** use **clomipramine** for cases unresponsive to SSRIs
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