A common side effects of Interferon

Neutropenia (INF) treatment is?

Antimicrobial prophylaxis for a

TMP-SMZ history of recurrent UTIs

Antimicrobial prophylaxis for

Ceftriaxone Gonorrhea

Antimicrobial prophylaxis for

Rifampin (DOC), minocycline
Meningococcal infection

TMP-SMZ (DOC), aerosolized

Antimicrobial prophylaxis for PCP
pentamidine

1
 Antimicrobial prophylaxis for
Benzathine penicillin G Syphilis

Yes Are Aminoglycosides Teratogenic?

Are Ampicillin and Amoxicillin

No penicillinase resistant?

No Are Carbenicillin, Piperacillin, and Ticarcillin

penicillinase resistant?

No, but they are less susceptible than the other Beta Are Cephalosporins resistant to
lactams penicillinase?

2
 Yes Are Methicillin, Nafcillin, and Dicloxacillin
penicillinase resistant?

Mycobacterium tuberculosis, the only agent used as

solo prophylaxis against TB Clinical use of Isoniazid (INH)?

Pseudomembranous colitis (C. Common side effects associated with

difficile), fever, diarrhea Clindamycin include?

GI upset, Superinfections, Skin Common toxicities associated with

rashes, Headache, Dizziness Fluoroquinolones?

Teratogenic, Carcinogenic, Common toxicities associated with

Confusion, Headaches Griseofulvin?

3
Glycoproteins from leukocytes that block various Describe the MOA of Interferons
stages of viral RNA and DNA synthesis (INF)

Only in limited Do Tetracyclines penetrate the CNS?

amounts

AmOxicillin has greater Oral Does Ampicillin or Amoxicillin have a greater oral
bioavailability bioavailability?

No Does Amprotericin B cross the BBB?

Does Foscarnet require activation by

No a viral kinase?

4
 Nephrotoxicity Foscarnet toxicity?

Leukopenia, Neutropenia,
Ganciclovir associated toxicities?
Thrombocytopenia, Renal toxicity

Chronic Hepatitis A and B, Kaposi's How are Interferons (INF) used

Sarcoma clinically?

Gram +, Gram -, Norcardia, How are Sulfonamides employed

Chlamydia clinically?

Triple Therapy' 2 Nucleoside RT Inhibitors with a How are the HIV drugs used
Protease Inhibitor clinically?

5
 Primaquine How are the Latent Hypnozoite (Liver) forms of
Malaria (P. vivax, P.ovale) treated?

How can Isoniazid (INH)-induced

Pyridoxine (B6) administration
neurotoxicity be prevented?

Fast vs. Slow Acetylators How can the t1/2 of INH be altered?

How can the toxic effects of TMP be

With supplemental Folic Acid
ameliorated?

Pretreat with antihistamines and a How can Vancomycin-induced 'Red

slow infusion rate Man Syndrome' be prevented?

6
 As PABA antimetabolites that inhibit How do Sulfonamides act on
Dihydropteroate Synthase, Bacteriostatic bacteria?

Inhibt Assembly of new virus by How do the Protease Inhibitors

Blocking Protease Enzyme work?

Ganciclovir is more toxic to host How does Ganciclovir's toxicity relate to that of
enzymes Acyclovir?

With an amino acid change of D-ala How does resistance to Vancomycin

D-ala to D-ala D-lac occur?

HSV, VZV, EBV, Mucocutaneous and Genital Herpes

Lesions, Prophylaxis in Immunocompromised pts How is Acyclovir used clinically?

7
 Prophylaxis for Influenza A,
How is Amantadine used clinically?
Rubella; Parkinson's disease

How is Amphotericin B
Intrathecally administered for fungal meningitis?

Wide spectrum of systemic mycoses: Cryptococcus, How is Amphotericin B used

Blastomyces, Coccidioides, Aspergillus, Histoplasma,
Candida, Mucor clinically?

Meningitis (H. influenza, N. meningitidis, S. How is Chloramphenical used

pneumoniae), Conserative treatment due to toxicities clinically?

CMV Retinitis in IC pts when

How is Foscarnet used clinically?
Ganciclovir fails

8
Phosphorylation by a Viral Kinase How is Ganciclovir activated?

CMV, esp in Immunocompromised

How is Ganciclovir used clinically?
patients

Oral treatment of superficial

How is Griseofulvin used clinically?
infections

Pentavalent Antimony How is Leishmaniasis treated?

for RSV How is Ribavirin used clinically?

9
1. Mycobacterium tuberculosis 2. Delays resistance
to Dapsone when used of Leprosy 3. Used in How is Rifampin used clinically?
combination with other drugs

Used in combination therapy with SMZ to How is Trimethoprim used

sequentially block folate synthesis clinically?

For serious, Gram +

How is Vancomycin used clinically?
multidrug-resistant organisms

Suramin How would you treat African Trypanosomiasis

(sleeping sickness)?

Premature infants, because they lack In what population does Gray Baby
UDP-glucuronyl transferase Syndrome occur? Why?

10
 Is Aztreonam cross-allergenic with
No penicillins?

Is Aztreonam resistant to
Yes penicillinase?

No Is Aztreonam usually toxic?

Is Imipenem resistant to
Yes penicillinase?

No - duh Is Penicillin penicillinase resistant?

11
 G IV Penicillin

Foscarnet = pyroFosphate analog

Mnemonic for
Foscarnet?

1)Binds penicillin-binding proteins 2) Blocks

transpeptidase cross- linking of cell wall 3) Activates MOA for Penicillin (3 answers)?
autolytic enzymes

Penicillin, Cephalosporins, Vancomycin,

Aminoglycosides, Fluoroquinolones, Metronidazole MOA: Bactericidal antibiotics

Penicillin, Ampicillin, Ticarcillin, Pipercillin, MOA: Block cell wall synthesis by inhib.
Imipenem, Aztreonam, Cephalosporins Peptidoglycan cross-linking (7)

12
 Quinolones MOA: Block DNA topoisomerases

Rifampin MOA: Block mRNA synthesis

Sulfonamides, Trimethoprim MOA: Block nucleotide synthesis

Bacitracin, MOA: Block peptidoglycan synthesis

Vancomycin

MOA: Block protein synthesis at 30s

Aminoglycosides, Tetracyclines
subunit

13
Chloramphenicol, Erythromycin/macrolides, MOA: Block protein synthesis at 50s
Lincomycin, Clindamycin, Streptogramins
(quinupristin, dalfopristin) subunit

MOA: Disrupt bacterial/fungal cell

Polymyxins membranes

Amphotericin B, Nystatin, MOA: Disrupt fungal cell

Fluconazole/azoles membranes

Polymyxin B, Name common

Polymyxin E Polymyxins

Erythromycin, Azithromycin, Name several common Macrolides

Clarithromycin (3)

14
Sulfamethoxazole (SMZ), Sulfisoxazole, Triple sulfas, Name some common Sulfonamides
Sulfadiazine (4)

Tetracycline, Doxycycline, Name some common Tetracyclines

Demeclocycline, Minocycline (4)

Gentamicin, Neomycin, Amikacin, Name the common Aminoglycosides

Tobramycin, Streptomycin (5)

Fluconazole, Ketoconazole, Clotrimazole, Name the common

Miconazole, Itraconazole
Azoles

Ciprofloxacin, Norfloxacin, Ofloxacin, Grepafloxacin, Name the common

Enoxacin, Nalidixic acid Fluoroquinolones (6)

15
 Nevirapine, Name the common Non-Nucleoside Reverse
Transcriptase Inhibitors
Delavirdine

Zidovudine (AZT), Didanosine (ddI), Zalcitabine Name the common Nucleoside

(ddC), Stavudine (d4T), Lamivudine (3TC) Reverse Transcriptase Inhibitors

Saquinavir, Ritonavir, Indinavir,

Name the Protease Inhibitors (4)
Nelfinavir

Protease Inhibitors and Reverse Name two classes of drugs for HIV
Transcriptase Inhibitors therapy

Staphlococcus aureus and Clostridium difficile Name two organisms Vancomycin is

(pseudomembranous colitis) commonly used for?

16
 V Oral Penicillin

Modification via Acetylation, Adenylation, or Resistance mechanisms for

Phosphorylation Aminoglycosides

Beta-lactamase cleavage of Resistance mechanisms for

Beta-lactam ring Cephalosporins/Penicillins

Resistance mechanisms for

Modification via Acetylation
Chloramphenicol

Methylation of rRNA near Erythromycin's ribosome Resistance mechanisms for

binding site Macrolides

17
 Altered bacterial Dihydropteroate Synthetase, Resistance mechanisms for
Decreased uptake, or Increased PABA synthesis Sulfonamides

Decreased uptake or Increased Resistance mechanisms for

transport out of cell Tetracycline

Terminal D-ala of cell wall replaced with D-lac; Resistance mechanisms for
Decreased affinity Vancomycin

Hemolysis (if G6PD deficient), Neurotoxicity,

Hepatotoxicity, SLE-like syndrome Side effects of Isoniazid (INH)?

Binds to the Pyrophosphate Binding Specifically, how does Foscarnet

Site of the enzyme inhibit viral DNA pol?

18
 Inhibition of 50S peptidyl
The MOA for Chloramphenicol is?
transferase, Bacteriostatic

Megaloblastic anemia, Leukopenia,

Toxic effects of TMP include?
Granulocytopenia

Hormone synthesis inhibition (Gynecomastia), Liver

dysfunction (Inhibits CYP450), Fever, Chills Toxic side effects of the Azoles?

Delirium, Tremor, Nephrotoxicity Toxicities associated with Acyclovir?

What additional side effects exist for

Rash, Pseudomembranous colitis
Ampicillin?

19
 What antimicrobial class is
Aminoglycosides Aztreonam syngergestic with?

What are Amantadine-associated

Ataxia, Dizziness, Slurred speech
side effects?

What are Aminoglycosides

Beta-lactam antibiotics synergistic with?

What are Aminoglycosides used for

Severe Gram - rod infections.
clinically?

Nephrotoxicity (esp. with Cephalosporins), What are common serious side effects of
Ototoxicity (esp. with Loop Diuretics) Aminoglycosides and what are these associated with?

20
 Fever/Chills, Hypotension, What are common side effects of
Nephrotoxicity, Arrhythmias Amphotericin B?

GI intolerance (nausea, diarrhea), Hyperglycemia, What are common side effects of

Lipid abnormalities, Thrombocytopenia (Indinavir) Protease Inhibitors?

BM suppression (neutropenia, What are common side effects of RT

anemia), Peripheral neuropathy Inhibitors?

-Hypersensitivity reactions -Hemolysis

-Nephrotoxicity (tubulointerstitial nephritis) What are common toxic side effects
-Kernicterus in infants Displace other drugs from of Sulfonamides? (5)
albumin (e.g., warfarin)

GI discomfort, Acute cholestatic hepatitis, What are common toxicities

Eosinophilia, Skin rashes associated with Macrolides? (4)

21
 GI distress, Tooth discoloration and Inhibition of What are common toxicities
bone growth in children, Fanconi's syndrome,
Photosensitivity associated with Tetracyclines?

Well tolerated in general but occasionally, What are common toxicities related
Nephrotoxicity, Ototoxicity, Thrombophlebitis,
diffuse flushing='Red Man Syndrome' to Vancomycin therapy?

1.Gram - rods of the Urinary and GI tracts (including What are Fluoroquinolones
Pseudomonas) 2.Neisseria 3. Some Gram +
organisms indicated for? (3)

What are major side effects of Methicillin, Nafcillin,

Hypersensitivity reactions and Dicloxacillin?

What are Methicillin, Nafcillin, and Dicloxacillin

Staphlococcus aureus used for clinically?

22
 Resistant Gram - infections What are Polymyxins used for?

Rifampin, Ethambutol, Streptomycin, Pyrazinamide,

Isoniazid (INH) What are the Anti-TB drugs?

What are the clinical indications for

Systemic mycoses Azole therapy?

Gram + cocci, Proteus mirabilis, E. coli, Klebsiella What are the clinical uses for 1st Generation
pneumoniae (PEcK) Cephalosporins?

Gram + cocci, Haemophilus influenza, Enterobacter

What are the clinical uses for 2nd Generation
aerogenes, Neisseria species, P. mirabilis, E. coli, K.
Cephalosporins?
pneumoniae, Serratia marcescens ( HEN PEcKS )

23
1) Serious Gram - infections resistant to other Beta What are the clinical uses for 3rd Generation
lactams 2) Meningitis (most penetrate the BBB) Cephalosporins?

Gram - rods: Klebsiella species, Pseudomonas What are the clinical uses for
species, Serratia species Aztreonam?

Gram + cocci, Gram - rods, and What are the clinical uses for
Anerobes Imipenem/cilastatin?

-Upper respiratory tract infections -pneumonias

-STDs: Gram+ cocci (streptococcal infect in pts What are the Macrolides used for
allergic to penicillin) -Mycoplasma, clinically?
Legionella,Chlamydia, Neisseria

Cephalosporin: 1) has a 6 member ring attached to

the Beta lactam instead of a 5 member ring 2)has an What are the major structural differences between
extra functional group ( attached to the 6 member Penicillin and Cephalosporin?
ring)

24
 GI distress, Skin rash, and Seizures What are the major toxic side effects of
at high plasma levels Imipenem/cilastatin?

1) Hypersensitivity reactions 2) Increased

nephrotoxicity of Aminoglycosides 3) Disulfiram-like What are the major toxic side effects of the
reaction with ethanol (those with a Cephalosporins?
methylthiotetrazole group, e.g., cefamandole)

Neurotoxicity, Acute renal tubular What are the side effects of

necrosis Polymyxins?

Minor hepatotoxicity, Drug What are the side effects of

interactions (activates P450) Rifampin?

Disulfiram-like reaction with EtOH, What are toxic side effects for
Headache Metronidazole?

25
Aplastic anemia (dose independent), What are toxicities associated with
Gray Baby Syndrome Chloramphenicol?

Giardiasis, Amoebic dysentery (E. histolytica), What conditions are treated with
Bacterial vaginitis (Gardnerella vaginalis),
Trichomonas Metronidazole?

What do Aminoglycosides require

Oxygen for uptake?

Mebendazole/Thiabendazole, What do you treat Nematode/roundworm (pinworm,

Pyrantel Pamoate whipworm) infections with?

What drug is given for Pneumocystis

Pentamidine carinii prophylaxis?

26
 AZT, to reduce risk of Fetal What drug is used during the pregnancy of an HIV+
Transmission mother?, Why?

What drug is used to treat Trematode/fluke (e.g.,

Praziquantel Schistosomes, Paragonimus, Clonorchis) or
Cysticercosis

What is a common drug interaction associated with

Increases coumadin metabolism Griseofulvin?

Blocks Influenza A and RubellA; causes problems What is a mnemonic to remember

with the cerebellA Amantadine's function?

It must be Phosphorylated by Viral What is a prerequisite for Acyclovir

Thymidine Kinase activation?

27
 Hemolytic anemia What is a Ribavirin toxicity?

What is an acronym to remember

RESPIre Anti-TB drugs?

What is an additional side effect of

Interstitial nephritis Methicillin?

What is an occasional side effect of

GI upset Aztreonam?

Anaerobic infections (e.g., B. fragilis, What is Clindamycin used for

C. perfringens) clinically?

28
 Pseudomonas species and Gram - What is clinical use for Carbenicillin, Piperacillin,
rods and Ticarcillin?

Recurrent UTIs, Shigella, Salmonella, Pneumocystis What is combination TMP-SMZ

carinii pneumonia used to treat?

What is combined with Ampicillin, Amoxicillin,

Clavulanic acid Carbenicillin, Piperacillin, and Ticarcillin to enhance
their spectrum?

Cryptococcal meningitis in AIDS patients and What is Fluconazole specifically

Candidal infections of all types used for?

What is Imipenem always

Cilastatin administered with?

29
Blastomyces, Coccidioides, Histoplasma, C. albicans; What is Ketoconazole specifically
Hypercortisolism used for?

Bismuth and Amoxicillin or Tetracycline; against What is Metronidazole combined with for 'triple
Helobacter pylori therapy'? Against what organism?

Antiprotozoal: Giardia, Entamoeba, Trichomonas, What is Metronidazole used for

Gardnerella vaginalis Anaerobes: Bacteroides,
Clostridium clinically?

Cestode/tapeworm (e.g., D. latum, Taenia species

Except Cysticercosis What is Niclosamide used for?

Chagas' disease, American Trypanosomiasis What is Nifurtimox administered

(Trypanosoma cruzi) for?

30
DHPG (dihydroxy-2-propoxymethyl What is the chemical name for
guanine) Ganciclovir?

Extended spectrum penicillin: certain Gram + What is the clinical use for
bacteria and Gram - rods Ampicillin and Amoxicillin?

Topical and Oral, for Oral

What is the clinical use for Nystatin?
Candidiasis (Thrush)

Bactericidal for: Gram + rod and cocci, Gram - cocci, What is the clinical use for
and Spirochetes Penicillin?

What is the major side effect for Ampicillin and

Hypersensitivity reactions Amoxicillin?

31
 What is the major side effect for Carbenicillin,
Hypersensitivity reactions Piperacillin, and Ticarcillin?

What is the major toxic side effect of

Hypersensitivity reactions
Penicillin?

What is the memory aid for subunit distribution of

Buy AT 30, CELL at 50' ribosomal inhibitors?

INH: Injures Neurons and What is the memory key for

Hepatocytes Isoniazid (INH) toxicity?

What is the memory key for

GET on the Metro Metronidazole's clinical uses?

32
 VACUUM your Bed What is the memory key for organisms treated with
Tetracyclines?
Room'

1. RNA pol inhibitor 2. Revs up P450 3. Red/orange What is the memory key involving
body fluids 4. Rapid resistance if used alone the '4 R's of Rifampin?'

Inhibit viral DNA polymerase What is the MOA for Acyclovir?

Binds Ergosterol, forms Membrane Pores that What is the MOA for Amphotericin
Disrupt Homeostatis B?

Same as penicillin. Extended What is the MOA for Ampicillin and

spectrum antibiotics Amoxicillin?

33
 Same as penicillin. Extended What is the MOA for Carbenicillin, Piperacillin, and
spectrum antibiotics Ticarcillin?

Blocks Peptide Bond formation at the 50S subunit,

Bacteriostatic What is the MOA for Clindamycin?

Same as penicillin. Act as narrow What is the MOA for Methicillin, Nafcillin, and
spectrum antibiotics Dicloxacillin?

Forms toxic metabolites in the

What is the MOA for Metronidazole?
bacterial cell, Bactericidal

Binds ergosterol, Disrupts fungal

What is the MOA for Nystatin?
membranes

34
 Inhibits DNA dependent RNA
What is the MOA for Rifampin?
polymerase

Inhibits formation of Initiation Complex, causes What is the MOA for the
misreading of mRNA, Bactericidal Aminoglycosides?

Inhibit Ergosterol synthesis What is the MOA for the Azoles?

Beta lactams - inhibit cell wall What is the MOA for the
synthesis, Bactericidal Cephalosporins?

Inhibit DNA Gyrase (topoisomerase What is the MOA for the

II), Bactericidal Fluoroquinolones?

35
 Blocks translocation, binds to the 23S rRNA of the What is the MOA for the
50S subunit, Bacteriostatic Macrolides?

Binds 30S subunit and prevents attachment of What is the MOA for the
aminoacyl-tRNA, Bacteriostatic Tetracyclines?

Inhibits bacterial Dihydrofolate What is the MOA for Trimethoprim

Reductase, Bacteriostatic (TMP)?

Inhibits cell wall mucopeptide

What is the MOA for Vancomycin?
formation, Bactericidal

Blocks viral penetration/uncoating; may act to buffer

the pH of the endosome What is the MOA of Amantadine?

36
Inhibits cell wall synthesis ( binds to
What is the MOA of Aztreonam?
PBP3). A monobactam

Inhibits Viral DNA polymerase What is the MOA of Foscarnet?

Inhibits CMV DNA polymerase What is the MOA of Ganciclovir?

Interferes with microtubule function, disrupts

mitosis, inhibits growth What is the MOA of Griseofulvin?

Acts as a wide spectrum carbapenem What is the MOA of Imipenem?

37
 What is the MOA of Isoniazid
Decreases synthesis of Mycolic Acid
(INH)?

Bind cell membrane, disrupt osmotic properties, Are

Cationc, Basic and act as detergents What is the MOA of Polymyxins?

Inhibits IMP Dehydrogenase (competitively), and

therefore blocks Guanine Nucleotide synthesis What is the MOA of Ribavirin?

Inhibit RT of HIV and prevent the incorporation of What is the MOA of the RT
viral genome into the host DNA Inhibitors?

GI discomfort What is the most common cause of Pt

noncompliance with Macrolides?

38
 What is treated with Chloroquine,
Malaria (P. falciparum) Quinine, Mefloquine?

Anaerobes What microorganisms are Aminoglycosides

ineffective against?

Vibrio cholerae Acne Chlamydia Ureaplasma

What microorganisms are clinical indications for
Urealyticum Mycoplasma pneumoniae Borrelia
Tetracycline therapy?
burgdorferi (Lyme's) Rickettsia Tularemia

What microorganisms is Aztreonam

Gram + and Anerobes not effective against?

What musculo-skeletal side effects in Adults are

Tendonitis and Tendon rupture associated with Floroquinolones?

39
Dopamine; causes its release from What neurotransmitter does Amantadine affect?
intact nerve terminals How does it influence this NT?

Enterobacter What organism is Imipenem/cilastatin the Drug of

Choice for?

What organisms does Griseofulvin

Dermatophytes (tinea, ringworm)
target?

Giant Roundworm (Ascaris), Hookworm What parasites are treated with Pyrantel Pamoate
(Necator/Ancylostoma), Pinworm (Enterobius) (more specific)?

Onchocerciasis ('river What parasitic condition is treated

blindness'--rIVER-mectin) with Ivermectin?

40
Pregnant women, Children; because animal studies What populations are Floroquinolones
show Damage to Cartilage contraindicated in? Why?

Milk or Antacids, because divalent cations inhibit What should not be taken with
Tetracycline absorption in the gut Tetracyclines? / Why?

What Sulfonamides are used for

Triple sulfas or SMZ simple UTIs?

When pts have Low CD4+ (< 500 cells/cubic mm) or

a High Viral Load When is HIV therapy initiated?

1. Meningococcal carrier state 2. Chemoprophylaxis When is Rifampin not used in

in contacts of children with H. influenzae type B combination with other drugs?

41
Keratin containing tissues, e.g., nails Where does Griseofulvin deposit?

Which Aminoglycoside is used for

Neomycin Bowel Surgery ?

1) Aminoglycosides = bactericidal 2) Tetracyclines = Which antimicrobial classes inhibit protein synthesis

bacteriostatic at the 30S subunit? (2)

1) Chloramphenical = bacteriostatic 2) Erythromycin

Which antimicrobials inhibit protein synthesis at the
= bacteriostatic 3) Lincomycin = bacteriostatic
50S subunit? (4)
4)cLindamycin = bacteriostatic

Which individuals are predisposed to

G6PD deficient individuals Sulfonamide-induced hemolysis?

42
 Which RT inhibitor causes
AZT Megaloblastic Anemia?

Non-Nucleosides Which RT inhibitors cause a Rash?

Which RT inhibitors cause Lactic

Nucleosides Acidosis?

Doxycycline, because it is fecally Which Tetracycline is used in patients with renal

eliminated failure? / Why?

Due to the presence of a bulkier R Why are Methicillin, Nafcillin, and Dicloxacillin
group penicillinase resistant?

43
 To inhibit renal Dihydropeptidase I and decrease Why is Cilastatin administered with
Imipenem inactivation in the renal tubules Imipenem?

-S-phase anti-metabolite Pyr analogue -Colon, solid List the mechanism, clinical use, &
tumors, & BCC/ -Irreversible myelosuppression toxicity of 5 FU.

-inhibits HGPRT (pur. Syn.) - Luk, List the mechanism, clinical use, &
Lymph, toxicity of 6 MP.

-DNA intercalator -testicular & lymphomas List the mechanism, clinical use, & toxicity of
-Pulmonary fibrosis mild myelosuppression. Bleomycin.

-Alkalates DNA -CML -Pulmonary List the mechanism, clinical use, & toxicity of
fibrosis hyperpigmentation Busulfan.

44
-Alkalating agent -testicular,bladder,ovary,& lung List the mechanism, clinical use, & toxicity of
-Nephrotoxicity & CN VIII damage. Cisplatin.

-Alkalating agent -NHL, Breast, ovary, & lung. - List the mechanism, clinical use, & toxicity of
Myelosuppression, & hemorrhagic cystitis. Cyclophosphamide.

-DNA intercalator -Hodgkin's, myeloma, sarcoma, List the mechanism, clinical use, & toxicity of
and solid tumors -Cardiotoxicity & alopecia Doxorubicin.

-Topo II inhibitor(GII specific) -Oat cell of Lung &

List the mechanism, clinical use, & toxicity of
prostate, & testicular -Myelosuppression & GI
Etoposide.
irritation.

-S-phase anti-metabolite folate analogue -Luk,

List the mechanism, clinical use, & toxicity of
Lymp, sarc, RA, & psoriasis / -Reversible
Methotrexate.
myelosuppression

45
-Alkalate DNA -Brain tumors -CNS List the mechanism, clinical use, & toxicity of
toxicity Nitrosureas.

-MT polymerization stabilizer -Ovarian & breast CA List the mechanism, clinical use, & toxicity of
-Myelosupperession & hypersensitivity. Paclitaxel.

-Triggers apoptosis -CLL, Hodgkin's in MOPP List the mechanism, clinical use, & toxicity of
-Cushing-like syndrome Prednisone.

-Estrogen receptor antagonist -Breast CA -increased List the mechanism, clinical use, & toxicity of
endometrial CA risk Tamoxifen.

-MT polymerization inhibitor(M phase) -MOPP,

List the mechanism, clinical use, & toxicity of
lymphoma, Willm's & choriocarcinoma
Vincristine.
-neurotoxicity and myelosuppression

46
 -Alkalating agents+cisplatin Which cancer drugs effect nuclear
-Doxorubicin+Dactinomycin -Bleomycin -Etoposide DNA (4)?

- Methotrexate - 5 FU - 6 Which cancer drugs inhibit

mercaptopurine nucleotide synthesis(3)?

Which cancer drugs work at the level

-Steroids -Tamoxifen of mRNA(2)?

-Vinca alkaloids(inhibit MT) Which cancer drugs work at the level

-Paclitaxel of proteins(2)?

hypertension, CHF, diabetic renal

ACE inhibitors- clinical use?
disease

47
 reduce levels of Angiotensin II, thereby preventing
the inactivation of bradykinin (a potent vasodilator); ACE inhibitors- mechanism?
renin level is increased

fetal renal damage, hyperkalemia, Cough,

Angioedema, Proteinuria, Taste changes,
hypOtension, Pregnancy problems, Rash, Increased ACE inhibitors- toxicity?
renin, Lower Angiotensin II (CAPTOPRIL)

glaucoma, urinary alkalinization, metabolic alkalosis,

altitude sickness Acetazolamide- clinical uses?

acts at the proximal convoluted tubule to inhibit

carbonic anhydrase. Causes self-limited sodium
bicarb diuresis and reduction of total body bicarb Acetazolamide- mechanism?
stores.

proximal convoluted tubule acetazolamide- site of action?

48
hyperchloremic metabolic acidosis, neuropathy, Acetazolamide-
NH3 toxicity, sulfa allergy
toxicity?

ACIDazolamide' causes acidosis Acetazolamide causes?

DOC in diagnosing and abolishing Adenosine- clinical

AV nodal arrhythmias
use?

collecting ducts ADH antagonists- site of action?

cyanide toxicity (releases CN) adverse effect of Nitroprusside?

49
impotence, asthma, CV effects (bradycardia, CHF,
AV block), CNS effects (sedation, sleep alterations) adverse effects of beta-blockers?

fetal renal toxicity, hyperkalemia, Cough,

Angioedema, Proteinuria, Taste changes,
hypOtension, Pregnancy problems, Rash, Increased adverse effects of Captopril?
renin, Lower Angiotensin II (CAPTOPRIL)

dry mouth, sedation, severe rebound

adverse effects of Clonidine?
hypertension

severe orthostatic hypotension, blurred vision, adverse effects of ganglionic

constipation, sexual dysfunction blockers?

orthostatic and exercise hypotension, sexual

dysfunction, diarrhea adverse effects of Guanethidine?

50
 nausea, headache, lupus-like syndrome, reflex
tachycardia, angina, salt retention adverse effects of Hydralazine?

hypokalemia, slight hyperlipidemia, hyperuricemia, adverse effects of

lassitude, hypercalcemia, hyperglycemia Hydrochlorothiazide?

K+ wasting, metabolic alkalosis,

adverse effects of Loop Diuretics?
hypotension, ototoxicity

fetal renal toxicity, hyperkalemia adverse effects of Losartan?

sedation, positive Coombs' test adverse effects of Methyldopa?

51
 hypertrichosis, pericardial effusion, reflex
tachycardia, angina, salt retention adverse effects of Minoxidil?

dizziness, flushing, constipation adverse effects of Nifedipine,

(verapamil), nausea verapamil?

first dose orthostatic hypotension,

adverse effects of Prazosin?
dizziness, headache

sedation, depression, nasal

adverse effects of Reserpine?
stuffiness, diarrhea

pulmonary fibrosis, corneal deposits, hepatotoxicity,

skin deposits resulting in photodermatitis,
neurologic effects, consitpation, CV (bradycardia, Amiodarone- toxicity?
heart block, CHF), and hypo- or hyperthyroidism.

52
 sedation, sleep alterations Beta Blockers- CNS toxicity?

bradycardia, AV block, CHF Beta Blockers- CV toxicity?

Beta adrenergic receptors and Ca2+

Beta Blockers- site of action?
channels (stimulatory)

decrease Beta Blockers- BP?

new arrhythmias, hypotension Bretyllium- toxicity?

53
 hypertension, angina, arrhythmias Ca2+ channel blockers- clinical use?

block voltage dependent L-type Ca2+ channels of

cardiac and smooth muscle- decreasing contractility Ca2+ channel blockers- mechanism?

Cell membrane Ca2+ channels of Ca2+ channel blockers- site of

cardiac sarcomere action?

cardiac depression, peripheral edema, flushing,

dizziness, constipation Ca2+ channel blockers- toxicity?

troponin-tropomyosin system Ca2+ sensitizers'- site of action?

54
 check PFTs, LFTs, and TFTs Cautions when using Amiodarone?

increased AP duration, increased ERP increased QT

interval. Atrial and ventricular. Antiarrhythmic class IA effects?

post MI and digitalis induced Antiarrhythmic class IB- clinical

arrhythmias uses?

decrease AP duration, affects ischemic or depolarized

Purkinje and ventricular system Antiarrhythmic class IB- effects?

local anesthetic. CNS stimulation or depression. CV

depression. Antiarrhythmic class IB- toxicity?

55
 NO AP duration effect. useful in V-tach that
progresses to V-fib and in intractable SVT LAST Antiarrhythmic class IC- effects?
RESORT

proarrhythmic Antiarrhythmic class IC- toxicity?

decrease the slope of phase 4, increase PR interval

(the AV node is particularly sensitive) Antiarrhythmic class II- effects?

blocking the beta adrenergic receptor leads to Antiarrhythmic class II-

decreased cAMP, and decreased Ca2+ flux mechanism?

impotence, exacerbation of asthma, CV effects, CNS

effects, may mask hypoclycemia Antiarrhythmic class II- toxicity?

56
 increase AP duration, increase ERP, increase QT
interval, for use when other arrhythmics fail Antiarrhythmic Class III- effects?

prevention of nodal arrhythmias Antiarrhythmic class IV- clinical

(SVT) use?

decrease conduction velocity, increase ERP, increase

PR interval Antiarrhythmic class IV- effects?

Antiarrhythmic class IV- primary

AV nodal cells site of action?

constipation, flushing, edema, CV effects (CHF, AV

block, sinus node depression), and torsade de Antiarrhythmic class IV- toxicity?
pointes (Bepridil)

57
diuretics, sympathoplegics, vasodilators, ACE
inhibitors, Angiotensin II receptor inhibitors classes of antihypertensive drugs?

decrease Digitoxin dose in renal

NO failure?

decrease Digoxin dose in renal

YES failure?

Na/K ATPase Digitalis- site of action?

Digitoxin>95% Digoxin 75% Digoxin v. Digitoxin: bioavailability?

58
Digoxin=urinary Digitoxin=biliary Digoxin v. Digitoxin: excretion?

Digitoxin 168hrs Digoxin 40 hrs Digoxin v. Digitoxin: half life?

Digoxin v. Digitoxin: protein

Digitoxin 70% Digoxin 20-40%
binding?

very short acting Esmolol- short or long acting?

Diuresis in pateints with sulfa

Ethacrynic Acid- clinical use?
allergy

59
 not a sulfonamide, but action is the
Ethacrynic Acid- mechanism?
same as furosemide

NO HYPERURICEMIA, NO SULFA ALLERGY; same

as furosemide otherwise Ethacrynic Acid- toxicity?

Sulfonamide Loop Diuretic. Inhibits ion co-transport

system of thick ascending loop. Abolishes
hypertonicity of the medulla, thereby preventing Furosemide- class and mechanism?
concentration of the urine.

edematous states (CHF, cirrhosis, nephrotic

syndrome, pulm edema), HTN, hypercalcemia Furosemide- clinical use?

Ototoxicity, Hypokalemia, Dehydration, Allergy

(sulfa), Nephritis (interstitial), Gout Furosemide- toxicity? (OH DANG)

60
 Furosemide increases the excretion
Ca2+ (Loops Lose calcium)
of what ion?

decrease myocardial O2 consumption by:

1-decreasing end diastolic volume 2- decreasing BP how do we stop
3- decreasing HR 4-decreasing contractility
5-decreasing ejection time angina?

vasodilator- increases cGMP to induce smooth

muscle relaxation (arterioles>veins; afterload Hydralazine- class and mechanism?
reduction)

severe hypertension, Hydralazine- clinical use?

CHF

compensatory tachycardia, fluid retention, lupus-like

syndrome Hydralazine- toxicity?

61
 HTN, CHF, calcium stone
Hydrochlorothiazide- clinical use?
formation, nephrogenic DI.

Inhibits NaCl reabsorption in the early distal tubule.

Decreases Ca2+ excretion. Hydrochlorothiazide- mechanism?

Hypokalemic metabolic alkalosis, hyponatremia, Hydrochlorothiazide- toxicity?

hyperGlycemia, hyperLipidemia, hyperUricemia,
hyperCalcemia, sulfa allergy. (hyperGLUC, plus others)

torsade de pointes Ibutilide- toxicity?

depresses ectopic pacemakers, especially in digoxin

toxicity K+- clinical use?

62
hyperaldosteronism, K+ depletion,
K+ sparing diuretics- clinical use?
CHF

cortical collecting tubule K+ sparing diuretics- site of action?

hyperkalemia, endocrine effects (gynecomastia,

anti-androgen) K+ sparing diuretics- toxicity?

loop diuretics (furosemide)- site of

thick ascending limb action?

ARF, shock, drug overdose, decrease

intracranial/intraocular pressure Mannitol- clinical use?

63
 anuria, CHF Mannitol- contraindications?

osmotic diuretic- increase tubular fluid osmolarity,

thereby increasing urine flow Mannitol- mechanism?

proximal convoluted tubule, thin descending limb,

and collecting duct mannitol- site of action?

pulmonary edema, dehydration Mannitol- toxicity?

effective in torsade de pointes and

digoxin toxicity Mg+- clinical use?

64
 propanolol, esmolol, metoprolol, name five Antiarrhythmic drugs in
atenolol, timolol class II?

Lovastatin, Pravastatin, Simvastatin, name four HMG-CoA reductase

Atorvastatin inhibitors.

Quinidine, Amiodarone, name four Antiarrhythmic drugs in

Procainamide, Disopyramide class IA.

Sotalol, Ibutilide, Bretylium, name four Antiarrhythmic drugs in

Amiodarone class III.

Captopril, Enalapril, Lisinopril name three ACE inhibitors?

65
 name three calcium channel
Nifedipine, Verapamil, Diltiazem
blockers?

name three Antiarrhythmic drugs in

Lidocaine, Mexiletine, Tocainide
class IB.

name three Antiarrhythmic drugs in

Flecainide, Encainide, Propafenone
class IC.

name three Antiarrhythmic drugs in

Verapamil, Diltiazem, Bepridil
class IV.

Spironolactone, Triamterene,
name three K+ sparing diuretics?
Amiloride (the K+ STAys)

66
 cholestyramine, colestipol name two bile acid resins.

Gemfibrozil, Clofibrate name two LPL stimulators.

Nitrates Nifedipine has similar action to?

cardiac muscle: preferential action of the Ca2+ channel blockers at

Verapamil>Diltiazem>Nifedipine cardiac muscle?

vascular sm. Mus.: preferential action of the Ca2+ channel blockers at

Nifedipine>Diltiazem>Verapamil vascular smooth muscle?

67
 reversible SLE-like syndrome
Procainamide-
toxicity?

cinchonism: HA, tinnitus, thrombocytopenia,

torsade de pointes due to increased QT interval Quinidine- toxicity?

blocks SR Ca2+ Ryanodine- site of action?

channels

torsade de pointes, excessive Beta

block Sotalol- toxicity?

competitive inhibirot of aldosterone in the cortical

collecting tubule Spironolactone- mechanism?

68
 distal convoluted tubule (early) thiazides- site of action?

block Na+ channels in the cortical Triamterene and amiloride-

collecting tubule mechanism?

Beta Blockers Verapamil has similar action to?

what two vasodilators require simultaneous

Hydralazine and Minoxidil treatment with beta blockers to prevent reflex
tachycardia and diuretics to prevent salt retention?

carbonic anhydrase inhibitors, K+

which diuretics cause acidosis?
sparing diuretics

69
 loop diuretics, thiazides which diuretics cause alkalosis?

which diuretics decrease urine

thiazides, amiloride Ca2+?

loop diuretics, spironolactone which diuretics increase urine Ca2+?

all except the K+ sparing diuretics Spironolactone,

Triamterene, Amiloride which diuretics increase urine K+?

all of them which diuretics increase urine NaCl?

70
 Acetaminophen has antipyretic and analgesic Acetaminophen has what two clinical uses and lacks
properties, but lacks anti-inflammatory properties. what one clinical use of the NSAIDs?

Can Heparin be used during

Yes, it does not cross the placenta.
pregnancy?

No, warfarin, unlike heparin, can Can Warfarin be used during

cross the placenta. pregnancy?

Does Heparin have a long, medium,

Short. or short half life?

Does Warfarin have a long, medium,

Long. or short half life?

71
Large anionic polymer, acidic For Heparin what is the Structure

For Heparin what is the Route of

Paranteral (IV, SC) administration

For Heparin what is the Onset of

Rapid (seconds) action

For Heparin what is the Mechanism

Activates antithrombin III
of action

For Heparin what is the Duration of

Acute (hours) action

72
 Yes For Heparin what is the Ability to inhibit coagulation
in vitro

For Heparin what is the Treatment

Protamine sulfate for overdose

aPTT (intrinsic For Heparin what is the Lab value to

monitor
pathway)

For Heparin what is the Site of

Blood action

Small lipid-soluble molecule For Warfarin what is the Structure

73
 For Warfarin what is the Route of
Oral administration

Slow, limited by half lives of clotting For Warfarin what is the Onset of
factors action

Impairs the synthesis of vitamin K-dependent For Warfarin what is the Mechanism
clotting factors of action

For Warfarin what is the Duration of

Chronic (weeks or months)
action

No For Warfarin what is the Ability to inhibit

coagulation in vitro

74
 IV vitamin K and fresh frozen For Warfarin what is the Treatment
plasma for overdose

For Warfarin what is the Lab value

PT to monitor

For Warfarin what is the Site of

Liver action

Rare. Is toxicity rare or common whith Cromolyn used in

Asthma prevention?

1. Hydrocortisone 2. Predisone 3. Triamcinolone 4.

Dexamethasone 5. Beclomethasone List five common glucocorticoids.

75
 Penicillin. Secretion of what drug is inhibited by Probenacid
used to treat chronic gout?

The COX-2 inhibitors should not have the corrosive The COX-2 inhibitors (celecoxib, rofecoxib) have
effects of other NSAIDs on the gastrointestinal similar side effects to the NSAIDs with what one
lining. exception?

Sulfonylureas are oral hypoglycemic agents, they are

What are are the Sulfonylureas (general description)
used to stimulate release of endogenous insulin in
and what is their use?
NIDDM (type-2).

1. Reliable (<1% failure) 2. Lowers risk of

endometrial and ovarian cancer 3. Decreased What are five advantages of Oral Contraceptives
incidence of ectopic pregnancy 4. Lower risk of (synthetic progestins, estrogen)?
pelvic infections 5. Regulation of menses

1. Taken daily 2. No protection against STDs 3.

What are five disadvantages of Oral Contraceptives
Raises triglycerides 4. Depression, weight gain,
(synthetic progestins, estrogen)?
nausea, HTN 5. Hypercoagulable state

76
1. Gastric ulceration 2. Bleeding 3. Hyperventilation What are five possible toxic effects
4. Reye's syndrome 5. Tinnitus (CN VIII) of Aspirin therapy?

1. Significant: nephrotoxicity 2. Peripheral

What are five toxicities associated with Tacrolimus
neuropathy 3. Hypertension 4. Pleural effusion 5.
(FK506)?
Hyperglycemia.

1. Better bioavailability 2. 2 to 4 times longer half life

What are four advantages of newer
3. Can be administered subcutaneously 4. Does not
low-molecular-weight heparins (Enoxaparin)?
require laboratory monitoring

1. Antipyretic 2. Analgesic 3. Anti-inflammatory 4. What are four clinical activities of

Antiplatelet drug. Aspirin?

1. Addison's disease 2. Inflammation 3. Immune What are four clinical uses of

suppression 4. Asthma glucocorticoids?

77
 1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. What are four conditions in which H2 Blockers are
Zollinger-Ellison syndrome used clinically?

1. Cimetadine 2. Ranitidine 3.
What are four H2 Blockers?
Famotidine 4. Nizatidine

1. Tolbutamide 2. Chlorpropamide 3.
What are four Sulfonylureas?
Glyburide 4. Glipizide

1. Streptokinase 2. Urokinase 3. tPA (alteplase),

APSAC (anistreplase) What are four thrombolytics?

1. Hot flashes 2. Ovarian enlargement 3. Multiple What are four unwanted effects of
simultaneous pregnancies 4. Visual disturbances Clomiphene use?

78
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4.
Muscle wasting 5. Thin skin 6. Easy bruisability 7. What are nine findings of Iatrogenic Cushing's
Osteoporosis 8. Adrenocortical atrophy 9. Peptic syndrome caused by glucocorticoid therapy?
ulcers

Headache, flushing , dyspepsia, What are signs of Sildenafil (Viagra)

blue-green color vision. toxicity?

Acute coronary syndrome; coronary stenting. What are the clinical uses for
Decreases the incidence or recurrence of thrombotic
stroke. Ticlopidine, Clopidogrel?

1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. What are the four conditions in which Omeprazole,
Zollinger-Ellison syndrome Lansoprazole is used?

1. Infertility (pulsatile) 2. Prostate cancer What are three clinical uses of the
(continuous: use with flutamide) 3. Uterine fibroids Leuprolide?

79
 1. Antipyretic 2. Analgesic 3. What are three clinical uses of the
Anti-inflammatory NSAIDs?

Ibuprofen, Naproxen, and What are three common NSAIDS

Indomethacin other than Aspirin?

1. Bleeding 2. Teratogenicity 3. What are three complications of

Drug-drug interactions Warfarin usage?

1. Bleeding 2. Thrombocytopenia 3. What are three possible

Drug-drug interactions complications of Heparin therapy?

1. Renal damage 2. Aplastic anemia What are three possible toxicities of

3. GI distress NSAID usage?

80
 1. Antiandrogen 2. Nausea 3. What are three toxicities of
Vomiting Leuprolied?

1. Skin rash 2. Agranulocytosis (rare) What are three toxicities of

3. Aplastic anemia Propylthiouracil?

1. Aluminum hydroxide: constipation and

hypophosphatemia 2. Magnesium hydroxide: What are three types of antacids and the problems
diarrhea 3. Calcium carbonate: Hypercalcemia, that can result from their overuse?
rebound acid increase - All may cause hypokalemia

1. Heavy bleeding 2. GI effects (n/v, anorexia) 3. What are three unwanted effects of
Abdominal pain Mifepristone?

What are two Alpha-glucosidase

1. Acarbose 2. Miglitol inhibitors?

81
1. Kidney transplantation 2. Autoimmune disorders What are two clinical uses of
(including glomerulonephritis and hemolytic
anemia) Azathioprine?

What are two conditions in which COX-2 inhibitors

Rheumatoid and osteoarthritis. might be used?

1. Pioglitazone 2. Rosiglitazone.
What are two
Glitazones?

Inhibits organification and coupling of thyroid What are two mechanisms of action
hormone synthesis. Also decreases peripheral
conversion of T4 to T3. of Propythiouracil?

1. Phospholipase A2 is prevented from releasing

What are two processes Corticosteroids inhibit
arachidonic acid 2. Decreases protein synthesis thus
leading to decreased inflammation?
lowering amount of Cyclooxygenase enzymes

82
 1. Predisposes to viral infections and lymphoma 2. What are two toxicities associated
Nephrotoxic (preventable with mannitol diuresis) with Cyclosporine?

1. Weight gain 2. Hepatotoxicity What are two toxicities of the

(troglitazone) Glitazones?

1. Hypoglycemia (more common with

2nd-generation drugs: glyburide, glipizide) 2. What are two toxicities of the
Disulfiram-like effects (not seen with 2nd-generation Sulfonylureas?
drugs).

Sucralfate cannot work in the presence of antacids or

What are two types of drugs that interfere with the
H2 blockers because it requires an acidic
action of Sucralfate and why?
environment to polymerize.

Can affect absorption, bioavailability, or urinary What can result due to antacid
excretion of other drugs by altering gastric and
urinary pH or by delaying gastric emptying. overuse?

83
 Lipoxygenase What enzyme does Zileuton inhibit?

What enzymes are inhibited by NSAIDs,

Cyclooxygenases (COX I, COX II). acetaminophen and COX II inhibitors?

GI side effects. (Note: Indomethacin is less toxic, What is a common side effect of Colchicine used to
more commonly used.) treat acute gout, especially when given orally?

What is a common side effect of

Diarrhea Misoprostol?

Overdose produces hepatic necrosis; acetaminophen What is a possible result of overdose

metablolite depletes glutathione and forms toxic
tissue adducts in liver. of Acetaminophen?

84
 What is a possible toxicity of Alpha-glucosidase
GI disturbances. inhibitors used in type-2 diabetes?

Neutropenia (ticlopidine); reserved for those who What is a possible toxicity of Ticlopidine, Clopidogrel
cannot tolerate aspirin. usage?

What is a sign of toxicity with the

Bleeding. use of thrombolytics?

1. In liver, increases storage of glucose as glycogen. 2.

In muscle, stimulates glycogen and protein synthesis, What is action of insulin in the liver, in muscle, and
and K+ uptake. 3. In adipose tissue, facilitates in adipose tissue?
triglyceride storage.

1. Suppresses organ rejection after transplantation 2. What is are two clinical uses of
Selected autoimmune disorders. Cyclosporine?

85
Antileukotriene; blocks leukotriene What is the category and mechanism of action of
receptors. Zafirlukast in Asthma treatment?

Antileukotriene; blocks synthesis by What is the category and mechanism of action of

lipoxygenase. Zileuton in Asthma treatment?

What is the category of drug names ending in -ane

Inhalational general anesthetic. (e.g. Halothane)

What is the category of drug names ending in

Benzodiazepine. -azepam (e.g. Diazepam)

Phenothiazine (neuroleptic, What is the category of drug names ending in -azine

antiemetic). (e.g. Chlorpromazine)

86
 Antifungal. What is the category of drug names ending in -azol
(e.g. Ketoconazole)

Babiturate. What is the category of drug names ending in

-barbital (e.g. Phenobarbital)

What is the category of drug names ending in -caine

Local anesthetic. (e.g. Lidocaine)

Penicillin. What is the category of drug names ending in -cillin

(e.g. Methicillin)

Antibiotic, protein synthesis What is the category of drug names ending in

inhibitor. -cycline (e.g. Tetracycline)

87
 What is the category of drug names ending in
Tricyclic antidepressant. -ipramine (e.g. Imipramine)

What is the category of drug names ending in -navir

Protease inhibitor. (e.g. Saquinavir)

What is the category of drug names ending in -olol

Beta antagonist. (e.g. Propranolol)

What is the category of drug names ending in

Butyrophenone (neuroleptic). -operidol (e.g. Haloperidol)

What is the category of drug names ending in -oxin

Cardiac glycoside (inotropic agent). (e.g. Digoxin)

88
 What is the category of drug names ending in
Methylxanthine. -phylline (e.g. Theophylline)

ACE inhibitor. What is the category of drug names ending in -pril

(e.g. Captopril)

What is the category of drug names ending in -terol

Beta-2 agonist. (e.g. Albuterol)

H2 antagonist What is the category of drug names ending in -tidine

(e.g. Cimetidine)

What is the category of drug names ending in

Tricyclic antidepressant. -triptyline (e.g. Amitriptyline)

89
 What is the category of drug names ending in -tropin
Pituitary hormone. (e.g. Somatotropin)

What is the category of drug names ending in -zosin

Alpha-1 antagonist (e.g. Prazosin)

Nonspecific beta-agonist; desired effect is the

What is the category, desired effect, and adverse
relaxation of bronchial smooth muscle (Beta 2).
effect of Isoproterenol in the treatment of Asthma?
Adverse effect is tachycardia (Beta 1).

Beta 2 agonist; desired effect is the relaxation of

What is the category, desired effect, and period of
bronchial smooth muscle (Beta 2). Use during acute
use of albuterol in the treatment of Asthma?
exacerbation.

Methylzanthine; desired effect is bronchodilation,

may cause bronchodilation by inhibiting What is the category, desired effect, and possible
phosphodiesterase, enzyme involved in degrading mechanism of Theophylline in treating Asthma?
cAMP (controversial).

90
 Muscarinic antagonist; competatively blocks
What is the category, mechanism of action, and effect
muscarinic receptors, preventing
of Ipratroprium in Asthma treatment?
bronchoconstriction.

Corticosteroids; prevent production of leukotrienes

What is the category, mechanism of action, and
from arachodonic acid by blocking phospholipase
particular use of beclomethasone and prednisone in
A2. Drugs of choice in a patient with status
Asthma treatment?
asthmaticus (in combination with albuterol.)

Beta 2 agonist; used as a long-acting agent for

What is the category, method of use, and adverse
prophylaxis. Adverse effects are tremor and
effects of Salmeterol in Asthma treatment?
arrhythmia.

Prevention of NSAID-induced peptic What is the clincial use for

ulcers, maintains a PDA. Misoprostol?

What is the clinical use for

Treatment of infertility.
Clomiphene?

91
Immediate anticoagulation for PE,
What is the clinical use for Heparin?
stroke, angina, MI, DVT.

What is the clinical use for Sildenafil

Erectile dysfunction. (Viagra)?

What is the clinical use for

Peptic ulcer disease. Sucralfate?

Chronic What is the clinical use for

Warfarin?
anticoagulation.

What is the clinical use of

Abortifacient. Mifepristone (RU486)?

92
Potent immunosuppressive used in organ transplant What is the clinical use of
recipients. Tacrolimus (FK506)?

Increase target cell response to What is the effect of the Glitazones

insulin. in diabetes treatment?

Finasteride inhibits 5 Alpha-reductase, this What is the enzyme inhibited, the effect of this
decreases the conversion of testosterone to inhibition, and the clinical use of the antiandrogren
dihydrotestosterone, useful in BPH Finasteride?

The PTT. What is the lab value used to monitor the

effectiveness of Heparin therapy?

The PT. What is the lab value used to monitor the

effectiveness of Warfarin therapy?

93
 What is the main clinical use for the
Early myocardial infarction.
thrombolytics?

Aluminum sucrose sulfate polymerizes in the acid

environment of the stomach and selectively binds What is the mecanism of action of
necrotic peptic ulcer tissue. Acts as a barrier to acid, Sucralfate?
pepsin, and bile.

Selectively inhibit cyclooxygenase (COX) isoform 2,

which is found in inflammatory cells nad mediates What is the mecanism of action of the COX-2
inflammation and pain; spares COX-1 which helps inhibitors (celecoxib, rofecoxib)?
maintain the gastric mucosa.

Prevents release of mediators from mast cells. What is the mecanism of action, effective period, and
Effective only for the prophylaxis of asthma. Not ineffective period of use for Cromolyn in treating
effective during an acute attack. Asthma?

Flutamide is a nonsteroidal competitive inhibitor of

What is the mechanism of action and clinical use of
androgens at the testosterone receptor, used in
the antiandrogen Flutamide?
prostate carcinoma.

94
 Inhibit steroid synthesis, used in the treatment of What is the mechanism of action and clinical use of
polycystic ovarian syndrome to prevent hirsutism. the antiandrogens Ketoconazole and Spironolactone?

Reversibly inhibits cyclooxygenase, mostly in CNS. What is the mechanism of action of

Inactivated peripherally. Acetaminophen?

Inhibits xanthine oxidase, decresing conversion of What is the mechanism of action of Allopurinol used
xanthine to uric acid. to treat chronic gout?

Acetylates and irreversibly inhibits cyclooxygenase What is the mechanism of action of

(COX I and COX II) to prevent the conversion of
arachidonic acid to prostaglandins. Aspirin?

Clomiphene is a partial agonist at estrogen receptors

in the pituitary gland. Prevents normal feedback What is the mechanism of action of
inhibition and increses release of LH and FSHfrom Clomiphene?
the pituitary, which stimulates ovulation.

95
Depolymerizes microtubules, impairing leukocyte What is the mechanism of action of Colchicine used
chemotaxis and degranulation. to treat acute gout?

Binds to cyclophilins (peptidyl proline cis-trans

isomerase), blocking the differentiation and What is the mechanism of action of
activation of T cells mainly by inhibiting the Cyclosporine?
production of IL-2 and its receptor.

Heparin catalyzes the activation of What is the mechanism of action of

antithrombin III. Heparin?

Competitive inibitor of progestins at progesterone What is the mechanism of action of

receptors. Mifepristone (RU486)?

Misoprostol is a PGE1 analog that increases the What is the mechanism of action of
production and secretion of the gastic mucous
barrier. Misoprostol?

96
Reversibly inhibit cyclooxygenase (COX I and COX What is the mechanism of action of NSAIDs other
II). Block prostaglandin synthesis. than Aspirin?

Irreversibly inhibits H+/K+ ATPase in stomach What is the mechanism of action of Omeprazole,
parietal cells. Lansoprazole?

What is the mechanism of action of Probenacid used

Inhibits reabsorption of uric acid. to treat chronic gout?

Inhibits cGMP phosphodiesterase, casuing increased

cGMP, smooth muscle relaxation in the corpus What is the mechanism of action of
cavernosum, increased blood flow, and penile Sildenafil (Viagra)?
erection.

Inhibit intestinal bursh border Alpha-glucosidases;

delayed hydrolysis of sugars and absorption of What is the mechanism of action of the
sugars leading to decresed postprandial Alpha-glucosidase inhibitors?
hyperglycemia.

97
 Decrease the production of leukotrienes and What is the mechanism of action of
protaglandins by inhibiting phospholipase A2 and
expression of COX-2. the glucocorticoids?

Reversible block of histamine H2 What is the mechanism of action of

receptors the H2 Blockers?

Close K+ channels in Beta-cell membrane leading to What is the mechanism of action of

cell depolarization causing insulin release triggered
by increase in Calcium ion influx. the Sulfonylureas?

Directly of indirectly aid conversion of plasminogen

to plasmin which cleaves thrombin and fibrin clots. What is the mechanism of action of
(It is claimed that tPA specifically converts the thrombolytics?
fibrin-bound plasminogen to plasmin.)

Inhibits platelet aggregation by irreversibly What is the mechanism of action of

inhibiting the ADP pathway involved in the binding
of fibrinogen. Ticlopidine, Clopidogrel

98
 Warfarin interferes with the normal synthesis and
gamma-carboxylation of vitamin K-dependent What is the mechanism of action of
clotting factors II, VII, IX, and X, Protein C and S via Warfarin (Coumadin)?
vitamin K antagonism.

Antimetabolite derivative of 6-mercaptopurine that What is the mechanism of

interferes with the metablolism and synthesis of
nucleic acid. Azathioprine?

GnRH analog with agonist properties when used in

pulsatile fashion and antagonist properties when What is the mechanism of
used in continuous fashion, causing a transient Leuprolide?
initial burst of LH and FSH

Similar to cyclosporine; binds to FK-binding protein, What is the mechanism of

inhibiting secretion of IL-2 and other cytokines. Tacrolimus (FK506)?

What is the memory key for the action of Sildenafil

Sildenafil fills the penis (Viagra)?

99
 What is the memory key for the effect of aluminum
AluMINIMUM amount of feces. hydroxide overuse?

What is the memory key for the effect of magnesium

Mg = Must go to the bathroom. hydroxide overuse?

What is the memory key to remember which

WEPT: Warfarin affects the Extrinsic pathway and
pathway (extrinsic vs. intrinsic) and which lab value
prolongs the PT.
Warfarin affects?

Mechanism unknown; possibly inhibits

What is the possible mechanism and effect of
gluconeogenesis and increases glycolysis; effect is to
Metformin in treating diabetes?
decrease serum glucose levels

Indomethacin is used to close a What is the specific clinical use of Indomethacin in

patent ductus arteriosus. neonates?

100
 Protamine Sulfate is used for rapid reversal of What is used to reverse the action of
heparinization (positively charged molecule that
binds to negatively charged heparin). Heparin?

Those patients who are taking What patients are at risk for life threatening
nitrates. hypotension when taking Sildenafil (Viagra)?

Leukotrienes increasing bronchial What process does Zafirlukast

tone. interfere with?

What type of gout is treated with

Chronic gout. Allopurinol?

What type of gout is treated with

Acute gout. Colchicine?

101
 What type of gout is treated with
Chronic gout. Probenacid?

Misoprostol is contraindicated in women of What type of patient should not take

childbearing potential because it is an abortifacient. Misoprostol and why?

Cimetidine is a potent inhibitor of P450; it also has

an antiandrogenic effect and decreases renal Which H2 Blocker has the most toxic effects and
excretion of creatinine. Other H2 blockers are what are they?
relatively free of these effects.

Because they require some residual Why are the Sulfonylureas inactive
islet function. in IDDM (type-1)?

-Disulfram & also sulfonylureas, Acetaldehyde is metabolized by Acetaldehyde

metronidazole dehydrogenase, which drug inhibs this enzyme?

102
-Weak Acids>Alkinalize urine(CO3) to remove more Explain pH dependent urinary drug
-Weak bases>acidify urine to remove more elimination?

-Airway -Breathing -Circulation -Dextrose (thiamine How do you treat coma in the ER
& narcan) -ABCD (4)?

-Infections -Trauma -Seizures -CO -Overdose In coma situations you rule out what
-Metabolic -Alcohol (IT'S COMA) (7)?

-A57Blue lines in gingiva & long bones List some specifics of lead
-Encephalopathy & Foot drop -Abdominal colic /
-Sideroblastic anemia poisoning(4)?

List the specific antidote for this

-N-acetylcystine toxin: Acetaminophen

103
 List the specific antidote for this
-Ammonium Chloride toxin: Amphetamine

List the specific antidote for this toxin:

-Atropine & pralidoxime Anticholinesterases (organophosphate.)

List the specific antidote for this toxin:

-Physostigmine salicylate Antimuscarinic (anticholinergic)

-Dimercaprol, List the specific antidote for this toxin: Arsenic (all
heavy metals)
succimer

List the specific antidote for this

-Flumazenil toxin: Benzodiazepines

104
 List the specific antidote for this
-Glucagon toxin: Beta Blockers

-100% oxygen, List the specific antidote for this

toxin: Carbon monoxide
hyperbaric

List the specific antidote for this

-Penicillamine toxin: Copper

-Nitrate, hydroxocobalamin List the specific antidote for this

thiosulfate toxin: Cyanide

-Normalize K+, Lidocaine, & List the specific antidote for this
Anti-dig Mab toxin: Digitalis

105
 List the specific antidote for this
-Protamine toxin: Heparin

List the specific antidote for this

-Deferoxamine toxin: Iron

-EDTA, dimercaprol, succimer, & List the specific antidote for this
penicillamine toxin: Lead

List the specific antidote for this toxin: Methanol &

-Ethanol, dialysis, & fomepizole Ethylene glycol

List the specific antidote for this

-Methylene blue toxin: Methemoglobin

106
 List the specific antidote for this
-B51Naloxone / naltrexone (Narcan)
toxin: Opioids

List the specific antidote for this

-Alkalinize urine & dialysis
toxin: Salicylates

List the specific antidote for this toxin: TPA &

-Aminocaproic acid Streptokinase

-NaHCO3 List the specific antidote for this toxin: Tricyclic

antidepressants

List the specific antidote for this

-Vitamin K & fresh frozen plasma
toxin: Warfarin

107
-Acetaldehyde -Nausea, vomiting, headache, & What are the products and their toxicities of the
hypotension metabolism of ethanol by / alcohol dehydrogenase?

-Oxalic acid -Acidosis & What are the products and their toxicities of the
metabolism of Ethylene Glycol by / alcohol
nephrotoxicity dehydrogenase?

What are the products and their toxicities of the

-Formaldehyde & formic acid -severe acidosis &
metabolism of Methanol by / alcohol
retinal damage
dehydrogenase?

Which drug(s) cause this reaction: Adrenocortical

-Glucocorticoid withdrawal Insufficiency

-Cloazapine -carbamazapine Which drug(s) cause this reaction:

-colchicine -PTU Agranulocytosis (3)?

108
 Which drug(s) cause this reaction:
-Penicillin Anaphylaxis?

-Chloramphenicol -benzene Which drug(s) cause this reaction:

-NSAIDS -PTU -phenytoin Aplastic anemia (5)?

Which drug(s) cause this reaction: Atropine-like side

-Tricyclic antidepressants effects?

Which drug(s) cause this reaction:

-Daunorubicin & Doxorubicin
Cardiac toxicity?

Which drug(s) cause this reaction:

-Quinidine -quinine Cinchonism (2)?

109
-ACE inhibitors (Losartan>no Which drug(s) cause this reaction:
cough) Cough?

-Niacin -Ca++ channel blockers Which drug(s) cause this reaction:

-adenosine -vancomycin Cutaneous flushing (4)?

Which drug(s) cause this reaction:

-Lithium Diabetes insipidus?

-Metronidazole -certain cephalosporins Which drug(s) cause this reaction: Disulfram-like

-procarbazine -sulfonylureas reaction (4) ?

-Haloperidol -chlorpromazine Which drug(s) cause this reaction: Drug induced

-reserpine -MPTP Parkinson's (4) ?

110
 -Chlorpromazine -thioridazine Which drug(s) cause this reaction: Extrapyramidal
-haloperidol side effects (3)?

Which drug(s) cause this reaction:

-Tetracycline Fanconi's syndrome?

-Halothane -Valproic acid -acetaminophen -Amantia Which drug(s) cause this reaction: Focal to massive
phalloides hepatic necrosis (4)?

-Sulfonamides -INH -ASA -Ibuprofen -primaquine Which drug(s) cause this reaction:
-nitrofurantoin /-pyrimethamine -chloramphenicol G6PD hemolysis(8)?

Which drug(s) cause this reaction:

-Phenytoin Gingival hyperplasia?

111
 Which drug(s) cause this reaction:
-Chloramphenicol Gray baby syndrome?

-Cimetidine -ketoconazole -spironolactone -digitalis Which drug(s) cause this reaction:

-EtOH -estrogens Gynecomastia (6)?

Which drug(s) cause this reaction:

-Isoniazid Hepatitis?

Which drug(s) cause this reaction:

-Tamoxifen Hot flashes?

Which drug(s) cause this reaction:

-polymyxins Neuro and Nephrotoxic?

112
 Which drug(s) cause this reaction:
-Corticosteroids -heparin
Osteoporosis (2)?

-aminoglycosides -loop diuretics Which drug(s) cause this reaction: Oto and
-cisplatin Nephrotoxicity (3)?

-Barbiturates -phenytoin -carbamazipine -rifampin Which drug(s) cause this reaction:

-griseofulvin -quinidine P450 induction(6)?

-Cimetidine -ketoconazole -grapefruit juice Which drug(s) cause this reaction:

-erythromycin -INH -sulfonamides P450 inhibition(6)?

-Tetracycline -amiodarone Which drug(s) cause this reaction:

-sulfonamides Photosensitivity(3)?

113
 -Clindamycin Which drug(s) cause this reaction:
Pseudomembranous colitis?

Which drug(s) cause this reaction:

-Bleomycin -amiodarone -busulfan
Pulmonary fibrosis(3)?

-Hydralazine -Procainamide -INH Which drug(s) cause this reaction:

-phenytoin SLE-like syndrome?

-Ethosuxamide -sulfonamides Which drug(s) cause this reaction: Stevens-Johnson

-lamotrigine syn. (3)?

Which drug(s) cause this reaction:

-Antipsychotics Tardive dyskinesia?

114
 Which drug(s) cause this reaction:
-Fluoroquinolones Tendonitis and rupture?

Which drug(s) cause this reaction: Thrombotic

-Oral Contraceptives complications?

-Class III antiarrhythmics (sotalol) Which drug(s) cause this reaction:

-class IA (quinidine) Torsade de pointes (2)?

-Sulfonamides -furosemide -methicillin -rifampin Which drug(s) cause this reaction: Tubulointerstitial
-NSAIDS (ex. ASA) Nephritis (5)?

Constant FRACTION eliminated per

Describe first-order kinetics?
unit time.(exponential)

115
-reduction, oxy, & hydrolysis -H2O sol. Polar product Describe Phase I metabolism in
-P450 liver(3)?

-acetylation, glucuron., & sulfation -Conjugation Describe Phase II metabolism in

-Polar product liver(3)?

- Act on same receptor - Full has Explain differences between full and
greater efficacy partial agonists(2).

- partial agonist can have increased, decreased,

Explain potency in relation to full and partial
/A21or equal potency as full agonist. - Potency is an
agonists(2).
independent factor.

- ED 50 is less than the Km (less How do spare receptors effect the

than 50% of receptors) Km?

116
 Md= (CpxCL)/F Cp= plas. Conc. How do you calculate maintenance
CL=clear. F=bioaval. dose?

-Shifts the curve to the right How does a competitive antagonist

-increases Km effect an agonist?

- Shifts the curve down -reduces How does a noncompetitive

Vmax antagonist effect an agonist?

-Phase I (clinical tests) -Phase II -Phase III -PhaseIV

(surveillance) Name the steps in drug approval(4)?

In 4 half-lifes= (94%) T1/2 = (0.7x Steady state concentration is reached in __ number

Vd)/CL of half-lifes

117
-Constant AMOUNT eliminated per What is the definition of zero-order
unit time. -Etoh & ASA kinetics? Example?

CL= (rate of elimination of drug/ What is the formula for Clearance

Plasma drug conc.) (CL)

Vd= (Amt. of drug in body/ Plasma What is the formula for Volume of
drug conc.) distribution (Vd)

Ld= (CpxVd)/F Cp=plasma conc. F=

What is the loading dose formula?
Bioaval.

A 12yo patient was treated for a reaction to a bee

Epinephirine(Alpha1,2 and Beta 1,2) sting, what drug provides the best coverage of
sympathomimetic receptors?

118
 A 57 yo heart failure pt develops cardiac

Dopamine decompensation, what drug will give you adequate

perfusion of his kidneys as well as tx for his
Hypotension

A fellow passenger on a Carnival cruise ship looks

scopolamine pale and diaphoretic, what antimuscarinic agent
would you give them?

A group of pts are rushed into the ER complaining of

Atropine pts are suffering from Cholinestrase
excessive sweating, tearing, salivation, HA, N and V,
inhibitor poisining (Nerve gas/Organophosphate
muscle twitching, difficulty breathing and diarrhea.
poisining)
What drug would be the most effective immediate tx

As an Anes you want to use a depolarizing

Succinylcholine neuromuscular blocking drug on your pt, what do
you use

Prevents the release of Ca from SR MOA of

of skeletal muscle
Succinylcholine

119
 Centrally acting alpha agonist, thus causing a
Clonidine is the preferred sym pathomimetic tx of
decrease in central adrenergic outflow, spairing renal
HTN in pts with renal disease, why??
blood flow

Cocaine casues vasoconstriction and local anesthesia

Indirect agonist, uptake inhibitor by what mechanism

TCA Cocaine shares is mechanism of action with what

antidepressant

Dobutamine used for the tx of shock

Beta1 more than B2 acts on which receptors

Guanethidine enhances the release

No, it inhibits the release of Nor Epi
of Norepi?

120
 It acts presynaptically to increase How does angiotensin II affect NE
NE release. release?

Prevents the release of ACh, which results in muscle How does botulinum toxin result in
paralysis. respiratory arrest?

Prevents the release of calcium from the

sarcoplasmic reticulum of skeletal muscle. How does dantrolene work?

NE acts presynaptically on alpha-2 receptors to

How does NE modulate its own release? What other
inhibit its own release. ACh also acts presynaptically
neurotransmitter has this same effect?
through M1 receptors to inhibit NE release.

Hemicholinium inhibits the transport of choline into How would hemicholinium treatment affect
the nerve, thus inhibiting formation of ACh. cholinergic neurons?

121
 Give an antichloinesterase - How would you reverse the effect of a neuromuscular
neostigmine, edrophonium, etc blocking agent?

It would increase to ~ 100 beats/min. Both

sympathetic and vagal stimulation would be knocked
If a patient is given hexamethonium, what would
out, but the SA node has an intrinsic pace of 100
happen to his/her heart rate?
beats/min, which is normally checked by vagal
stimulation.

Isopoterenol was given to a patient with a developing

Stimulates beta adrenergic receptors AV block, why?

Binding to the presynaptic alpha 2 release Norepi feedbacks and inhibits the presynaptic
modulating receptors receptor by what mechanism

Reserpine will block the syntheis of this drug and but

Blocks Norepi, but not Dopamine not its precursor.

122
 These drugs acts indirectly by releasing strored
Amphetamine and Ephedrine catecholamines in the presynaptic terminal

What anticholinesterase crosses the

physostigmine blood-brain-barrier?

What antimuscarinic agent is used

Ipratropium in asthma and COPD?

What antimuscarinic drug is useful

Ipratropium for the tx of asthma

Diarrhea, Urination, Miosis, Bronchospasm,

What are the classic symptoms of cholinesterase
Bradycardia, Excitation of skeletal muscle and CNS,
inhibitor poisoning (parathion or other
Lacrimation, Sweating, and Salivation =
organophosphates)?
DUMBBELS; also abdominal cramping

123
Activates cholinergic receptors on bladder and bowel What are the clinical indications for
smooth muscle, alleviating post-op and neurogenic
ileus and urinary retention. bethanechol?

Post-op and neurogenic ileus and urinary retention,

myasthenia gravis, and reversal of neuromuscular What are the clinical indications for
junction blockade (post-op) through neostigmine?
anticholinesterase activity.

narcolepsy, obesity, and attention deficit disorder (I What are the indications for using
wouldn't recommend this) amphetamine?

Tubocurarine, atracurium, mivacurium, What are the nondepolarizing

pancuronium, vecuronium, rapacuronium neuromuscular blocking drugs?

Phase 1 = prolonged depolarization, no antidote,

effect potentiated by anticholinesterase; Phase 2 = What are the phases of succinylcholine
repolarized but blocked, an anticholinesterase is the neuromuscular blockade?
antidote for this phase.

124
 What are two indirect acting
amphetamine and ephedrine
adrenergic agonists?

What beta 2 agonist will help your

Albuterol, tertbutaline 21yo Astma pt?

Botulinum What cholinergic inhibitor acts by directly inhibiting

Ach release at the presynaptic terminal

Edrophonium What cholinomimetic is useful in the diagnosis of

Myasthenia Gravis

Carbachol, pilocarpine, What cholinomimetics might your pt be taking for

physostigmine, echothiophate his glaucoma

125
 What class of drug is echothiophate? What is its
anticholinesterase glaucoma indication?

In treatment of malignant hyperthermia, due to

concomitant use of halothane and succinylcholine. What conditions would you use
Also in neuroleptic malignant syndrome, a toxicity of dantrolene?
antipsychotic drugs.

edrophonium (extremely short What drug is used to diagnose

acting anticholinesterase) myasthenia gravis?

Neostigmine, pyridostigmine edrophonium,

physostigmine echothiophate What drugs target anticholinesterase

Theoretically it could be used to block the cephalic What effect would atropine have on a patient with
phase of acid secretion (vagal stimulation). peptic ulcer disease?

126
 None. No, because atropine would block the What effect would atropine have on the
postganglionic muscarinic receptors involved in preganglionic sympathetic activation of sweat
sweat gland stimulation. glands? Would this person sweat?

Acetylcholinesterase; ACh is broken down into What enzyme is responsible for the breakdown of
choline and acetate. ACh in the synaptic cleft?

What enzyme is responsible for the

Acetylcholine esterase degredation of Ach

What enzyme is responsible for the production of

Choline acetyltransferase Ach from Acetyl CoA and Choline

Treatment of hypertension, especially with renal What is the clinical utility of

disease (lowers bp centrally, so flow is maintained to
kidney). clonidine?

127
 The only local anesthetic with What is the clinical utility of
vasoconstrictive properties. cocaine?

Dobutamine has more of an affintiy for beta-1 than

What is the difference between the affinity for beta
beta-2, and is used for treating heart failure and
receptors between albuterol/terbutaline and
shock. Albuterol and terbutaline is the reverse, and is
dantroline?
used in treatment of acute asthma.

Prefers beta's at low doses, but at higher doses alpha What is the difference in receptor affinity of
agonist effects are predominantly seen. epinephrine at low doses? High doses?

Increased systolic and pulse pressure, decreased

What is the effect of epinephrine infusion on bp and
diastolic pressure, and little change in mean
pulse pressure?
pressure.

What is the effect of guanethidine on adrenergic NE

It inhibits release of NE. release?

128
 Increases mean, systolic, and diastolic bp, while What is the effect of norepinephrine on bp and pulse
there is little change in pulse pressure. pressure?

They inhibit reuptake of NE at the nerve terminal (as What is the effect of TCA's on the
does cocaine). adrenergic nerve?

What is the only depolarizing

Succinylcholine neuromuscular blocking agent?

It affects beta receptors equally and is used in AV What is the receptor affinity and clinical use of
heart block (rare). isoproterenol?

SLUD (salivation, Lacrimation, urination,

What physiological effects was the Anes using
Defecation)as well as airway secretion, GI motility,
Atropine to tx
acid secretions

129
 Bethanechol, Neostigmine, What reversal agent could a Anes give to reverse the
physostigmine effects of Atropine

Atropine would also block the receptors in the ciliary

What side effect of using atropine to induce pupillary
muscle, causing an impairment in accommodation
dilation would you expect?
(cycloplegia).

Norepinephrine (Alpha1,2 and beta What sympathomimetic would you not prescribe for
1) hypotension in a pt with renal artery sclerosis.

Hexamethonium is a nicotinic antagonist, and thus What type of neurological blockade would
is a ganglionic blocker. hexamethonium create?

Initially vasoconstriction would increase bp, but then

What would be the effect on blood pressure with
it acts on central alpha-2 receptors to decrease
infusion of the alpha -2 agonist clonidine?
adrenergic outflow resulting in decreased bp.

130
 Which antimuscarinic agents are used in producing
atropine, homatropine, tropicamide mydriasis and cycloplegia?

Which drug increases Sys BP w/o

Epinephrine affecting Pulse Pressure

Norepinephrine Which of epi, norepi, or isoproterenol results in

bradycardia?

Dry flushed skin, due to inhibition of sympathetic

Which of the following would atropine
post-ganglionic blockade on muscarinic receptors of
administration cause? Hypothermia, bradycardia,
sweat glands. All others are opposite of what would
excess salivation, dry flushed skin, or diarrhea
be expected.

Which of these three drugs will cause a reflex

Norepinephrine bradycardia in your pt (Norepi, Epi, or
Isoporterenol)

131
 alpha-1 > alpha-2; used as a pupil dilator, Which receptors does phenylephrine
vasoconstrictor, and for nasal decongestion act upon?

While at a tail gait party, you bite into a sandwich

Epinephrine to treat anaphylaxis. Also useful if you
that a yellow jacket is also enjoying. Knowing your
have open angle glaucoma, asthma, or hypotension.
allergy to this creature, what should you do?

These B-2 agonists cause respiratory smooth muscle Why are albuterol and terbutaline effective in tx of
to relax. acute asthmatic attacks?

Blocking muscarinic receptors in the circular fibers

of the eye, results in unopposed action of radial Why does atropine dilate the pupil?
muscles to dilate.

NE increases bp, which stimulates baroreceptors in

the carotid sinus and the aorta. The CNS signals Why does NE result in bradycardia?
through vagal stimulation to decrease heart rate.

132
 They activate the ciliary muscle of the eye (open Why is carbachol and pilocarpine useful in treatment
angle) and pupillary sphincter (narrow angle). of glaucoma?

As an anticholinesterase it increases endogenous Why is pyridostigmine effective in the treatment of

ACh and thus increases strength. myasthenia gravis?

Reserpine inhibits dopamine transport into vesicles, Why is reserpine effective in treating
attenuating its conversion to NE by dopamine
beta-hydroxylase. HTN?

Stimulating beta receptors stimulates heart rate, but

Why is there a drop in systolic, mean, and diastolic
beta receptor induced vasodilation reduces
bp with infusion of isoproterenol?
peripheral resistance.

Parkinson patients benefit from antimuscarinic

Why would a patient with cog-wheel rigidity and a
agents through its inhibitory action within the
shuffling gait be given benztropine?
indirect pathway.

133
 Receptors = D1=D2>beta>alpha, thus increasing
heart rate (beta) and blood pressure (alpha Why would dopamine be useful in
vasoconstriction) while maintaining kidney treating shock?
perfusion (dopamine receptors)

Useful in muscle paralysis during surgery or Why would you give a drug like pancuronium or
mechanical ventilation. succinylcholine?

Pralidoxime regenerates active Why would you use pralidoxime after exposure to an
cholinesterase. organophosphate?

No, hemicholinum block the uptake of Choline and Will Hemicholinum affect the release of stored Ach
thus Ach synthesis during Cholinergic Stimulation

No. Atropine is used to reduce urgency in mild Would blockade of muscarininc receptors in the
cystitis. So it would aggravate the urinary retention. bladder be useful in treating urinary retention?

134
Scopolamine Your patient wants an effective drug to treat his
motion sickness, what would you prescribe

135