pass pharm drills

7/26/2019 PASS Pharm Drills

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PASS Pharm Drills

What is the MOA of Aztreonam? AzTHREEonam*Binds to PBP #3

What is the c/u for Imipenem/Cilastatin? DOC for Enterobacter

What is the MOA of Vancomycin? Inhibition of D-ala D-ala*t/f it can't make peptidoglycan

What are the peptidoglycan synthesis Inhibitors? Bacitracin*Vancomycin*Cycloserine

What is the c/u for Vancomycin? MRSA*Pseudomembranous Colitis (Vanco & Metro)*Anynosocomial infection

Vancomycin is the TX for Pseudomembranous Colitis secondaryto what?

C. Difficile

Why is Vancomycin used for nosocomial infections? Nosocomial is defined as any infection that is picked up whilehospitalized; it is t/f assumed that it is probably drug-resistent

What is the TX for VRSA? Linezolid*Streptogramins

What are the Streptogramins? Dalfopristin*Quinopristin

What is the MOA of Linezolid? Inhibition of 50s

What is the MOA of Streptogramins? Inhibition of 50s

What is the TX for linezolid-Resistent Staph Aureus? Call the clergyman to pray for the pt b/c there is nothing else

What is the toxicity of Vancomycin? There is NOT toxicity*Neurotoxic*Ototoxic*Thrombophlebitis

What are the Ototoxic-causing drugs? AMG's*Loops(Furosemide)*Vancomycin*Quinidine*Chloroquine

What is the MOA of AMG's? Inhibits initiation complex of N-acetyl formation causingmisreading of mRNA

What is the toxicity of AMG's? There is NNO toxicity*Neurotoxic(teratogenic)*Nephrotoxic*Ototoxic

What is the c/u of AMG's? G- Rods

For what are AMG's used 1st line? Pseudomonas infections

What is the order of TX for Pseudomonas? 1. AMG's (1st line for any G- rod)*2. 3rd Gen Cephalosporins(i.e. Ceftazidime)*3 4th Gen Pen's (i.e. Anti-PseudomonaPenicillins)

What is the c/u of Aztreonam? G- rods in pt's who cannot tolerate AMG's*OR*Pt's allergic toPenicillin*OR*Pt's with Renal Failure

Why is Aztreonam used in pt's with Renal Failure? AMG's are Nephrotoxic

MOA of Tetracyclines? Protein synthesis inhibition by preventing amino acyl tRNAattachment

What is the function of amino acyl tRNA? It charges the tRNA molecule

Why does tRNA need to be charged? Charging provides energy to pick up the next nucleotide

What is the c/u for Tetracyclines? VACUuM The BR*Vibrio Cholerea*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmaUrealyticum*Mycoplasm*Tularemia*H.Pylori*Borrelia *Rickettsia

What are the anti-Staph Penicillins? CONDM*Cloxacillin*Oxacillin*Nafcillin*Dicloxacillin*Methicilli

n*(Anti-Staph Pen's = 2nd Gen Pen's)What are the anti-Pseudomonas Penicillins? PTC of Pseudomonas in the

AM*Piperacillin*Ticarcillin*Carbenicillin*Azlocillin*Mezlocillin*(Anti-Pseudomonas = 4th Gen Pen's)

What is the order of TX for Pseudomonas? 1) AMG's (1st line for any G- rod)*2) 3rd Gen Cephalosporins(i.e. Ceftazidime)*3) 4th Gen Pen's (i.e. Anti-PseudomonaPenicillins)

What is the c/u of Ampicillin/Amoxicillin? HELPS Enterococci*H. Influenza*E.Coli*Listeria*Proteus*Salmonella*Enterococci*(Ampicillin/Amoxicillin = 3rd Gen Pen's)


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What is co-administered with Ampicillin/Amoxicillin? Clavulonic Acid

What is the MOA of clavulonic acid? Inhibition of Penicillinase

What are the anti-Penicillinase's? 1) 2nd Gen Pen's (Anti-Staph Pen's):*CONDM*Cloxacillin*Oxacilllin*Nafcillin*Dicloxacillin*Methicillin**2) 3rd Gen Pen's: Ampicillin/Amoxicillin w/ClavulonicAcid**3) All Cephalosporin

What are the Penicillinase/B-Lactamase inhibitors? AIM*Aztreonam*Imipenem/Cilastatin*Meropenem

What is the c/u for the Penicillinase/B-Lactamase inhibitiors? G- RodsWhat does Ampicillin/Amoxicillin toxicity cause? Hypersensitivity*Ampicillin rash*Pseudomembranous colitis

Which antibiotics cause Pseudomembranous Colitis? Ampicillin/Amoxicillin*Clindamycin

What is the TX for Pseudomembranous Colitis? Metronidazole*Vancomycin

What are the 50s Inhibitors? CCELLS (Buys AT 30 CCELLS at50)*Chloramphenicol*Clindamycin*Erythromycin (i.e.Macrolides)*Lincomycin*Linezolid*Streptogramins

What are some 1st Gen Cephalosporins? Cephalosporin that begin with Cefa- or Cepha-prefixes*Cefazolin*Cephalexin**Exception: Only a few 1st GenCephs do not start w/one of these 2 prefixes*Exception:Cefaclor & Cefamandole are 2nd Gen Cephalosporins

What is the c/u for 1st Gen Cephalosporins? PEcK (c = cocci)*Proteus*E. Coli*Klebsiella*G+ cocci

What are the G+ cocci? Staphyloccoci*Streptococci

What are some 2nd Gen Cephalosporins? A FAMily of FOXes has FURry TETs*Cefamandole (exceptionto 1st Gen Cephalosporinsrule)*Cefoxitin*Cefuroxime*Cefotetan*Cefaclor (exception to1st Gen Cephalosporins rule)

What is the c/u for 2nd Gen Cephalosporins? HEN PEcKS (c = cocci)*H.Influenza*Enterobacter*Neisseria*Proteus*E.Coli*Klebsiella*Serratia*G+ cocci

What are some 3rd Gen Cephalosporins? Cefixime*Ceftriaxone*Ceftazidime*Cefotaxime*Cefeparazone

What is a 3rd Gen Ceph used to TX Pseudomona? Ceftazidime

What is a 3rd Gen Cephs used to TX Gonorrhea? Ceftriaxone & Cefixime

What are the Cephalosporins that TX Gonorrhea? TRI to FIX a FOX*Ceftriaxone (3rd Gen)*Cefixime (3rdGen)*Cefoxitin (2nd Gen)

What is the one-dose TX for Chlamydia? Azithromycin

What are the Cephalosporins that cause a Disulfram-like reactionwith Etoh?

PAIR of FAMily TETS (tits)*Cefeparazone (3rdgen)*Cefamandole (2nd gen)*Cefotetan (2nd gen)

What are some 4th Gen Cephalosporins? Cefipime



What are the Macrolides? ACE*Azithromycin*Clarithromycin*Erythromycin


What are the 30s Inhibitors? AT (Buys AT 30 CCELLS at 50)*AMG's*Tetracyclines

What are the AMG's? STANG*Streptomycin*Tobramycin*Amikacin*Neomycin*Gentamicin

What are the Nucleotide Synthesis Inhibitors? Sulfonamides*Trimethoprim*Pyrimethamine*Methotrexate

What is the MOA of Sulfonamides? Inhibition of Dihydropterate Synthase

What is the MOA of Trimethoprim? Inhibition of Dihydrofolate Reductase

What is the MOA of Pyrimethamine? Inhibition of Dihydrofolate Reductase

What drugs inhibit DHF Reductase? Trimethoprim*Pyrimethamine*Methotrexate


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What blocks DNA Topoisomerase II? Quinolones

What blocks DNA Gyrase? Quinolones*(DNA Topoisomerase II & DNA Gyrase are thesame)

What blocks mRNA Synthesis

Rifampin

How does Rifampin's MOA work? Inhibition of DNA-dependent RNA polymerase, therebyblocking mRNA synthesis

What drugs bind bacterial & fungal membranes? Polymixins (Polymixin B & Polymixin E)**FA: Polymixins bindto membranes and disrupt their osmotic properties; they mix upmembranes like a detergent.

What drugs destroy fungal membranes? Amphotericin B*Nystatin

What is the MOA of Penicillins? 1) Bind PBP's*2) Activate autolytic enzymes*3) Inhibitstranspeptidase cross-linking (does NOT block PG synthesis -->Q #1)

What is the end-result of transpeptidase cross-linking? Formation of peptide bonds between nucleotides


What is the c/u of Penicillins? G+ rods & cocci*G- cocci*Spirochetes*(Penicillins = 1st GenPen's)

What does Penicillin toxicity cause? Hypersensitivity*Hemolytic anemia

What does Methicillin toxicity cause? Interstitial nephritis

What is the c/u for Methicillin? Staph Aureus

What is used for MRSA? Vancomycin

If 75% of the drug is eliminated from the body, how many half-lifes have occured?

2 half-lifes

How is half-life calculated? T1/2 = (Vd/Cl) x .7

How is Loading Dose calculated? LD = (Css x Vd) / f

How is Maintenance Dose calculated? MD = (Css x Cl) / f

What is the function of a Maintenance Dose? To replace the amount of drug that has been eliminated

3 Drugs that undergo 1st order elimination: All drugs except:**EPA*Ethanol*Phenytoin*Asparin (high dose)

What direction does a noncompetitive antagonist shift thepotency curve (right, left, up, or down)? It doesn't: potency (Km) is not affected (the drug is just as potentas before, but some receptors are turned off)*However, efficacy(Vmax) is decreased and therefore the EFFICACY curve isshifted downward

What question is answered by Phase II drug development? Does it work?

Which phase do we calculate Therapeutic Index? Phase II

How do we calculate Therapeutic Index? TILE*TI = LD50 / ED50

What are the peptidoglycan synthesis inhibitor? Bacitracin*Vancomycin*Cycloserine

What are the 50s Inhibitors? CCELLS (Buys AT 30 CCELLS at50)*Chloramphenicol*Clindamycin*Erythromycin*Lincomycin*linezolid*Streptogramins





What are the Nucleotide Synthesis Inhibitors? Sulfonamides*Trimethoprim*Methotrexate*pyrimethamine


What is the MOA of Trimethoprim? Inhibition of DHF Reductase

What is the MOA of Methotrexate? Inhibition of DHF Reductase

What is the MOA of Pyromethamine? Inhibition of DHF Reductase


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What Blocks Topoisomerase II? Quinilones

What Blocks DNA Gyrase? Quinilones

What inhibits mRNA synthesis? Rifampin

How does Rifampin inhibit mRNA synthesis? Inhibition of DNA-Dependent RNA Polymerase

What is the c/u for Penicillins? G+ cocci & rods*G- cocci*Spirochetes

What is the toxicity of Penicillins? Hypersensitivity*Hemolytic anemia

What is the toxicity of Methicillin? Interstitial Nephritis

What is the c/u for Methicillin? S. Aureus

What are the anti-Staph Penicillins? CONDM*Cloxacillin*Oxacilllin*Nafcillin*Dicloxacillin*Methicillin

What are the anti-Pseudomonas Penicillins? PTC of Pseudomonas in theAM*Piperacillin*Ticarcillin*Carbenicillin*Azlocillin*Mezlocillin*(Anti-Pseudomonal Pen's = 4th Gen Pen's)

What is the c/u of Ampicillin/Amoxicillin? HELPS Enterococci*H. Influenza*E.Coli*Listeria*Proteus*Salmonella*Enterococci

What is the toxicitiy of Ampicillin/Amoxicillin? Hypersensitiity*Ampicillin rash*Pseudomembranous colitis

What drugs cause Pseudomembranous Colitis? Ampicillin/Amoxicilin & Clindamycin

What is the MOA of Clindamycin? Inhibits peptide bond formation b/w nucleotides at the P site

What is the c/u of Clindamycin? Anaerobes above the diaphram

What is the TX for Pseudomembranous Colitis secondary to C.Difficile?

Vancomycin*Metronidazole

What is the MOA of Vancomycin? Inhibits D-ala D-ala (t/f can't make peptidoglycan)

What is the c/u for Vancomycin? MRSA*C. Difficile (Pseudomembranous Colitis)*Nosocomialinfections (presumeably drug-resistent infections)


What is a 3rd Gen Ceph used for the TX of Pseudomona? Ceftazidime

What is a 3rd Gen Ceph used for the TX of Gonorrhea? Ceftriaxone & Cefixime



What are the Cephalosporins that cause a Disulfram-like reactionwith Etoh?

PAIR of FAMily TETS (tits)*Cefeparazone (3rdgen)*Cefamandole (2nd gen)*Cefotetan (2nd gen)

What are the anti-Penicillinase's? 1) 2nd Gen Pen's (Anti-Staph Pen's):*CONDM*Cloxacillin*Oxacilllin*Nafcillin*Dicloxacillin*Methicillin**2) 3rd Gen Pen's: Ampicillin/Amoxicillin w/ClavulonicAcid**3) All Cephalosporin


How can any drug be altered to become Penicillinase-Resistent? Add Clavulonic Acid


What is the c/u of Aztreonam? G- Rods

What pt's is Aztreonam used to TX? Pt's who cannot tolerate AMG's (1st line for any G-)*OR*Pt'swho are allergic to Penicillin*OR*Pt's in Renal Failure

With what is imipenem co-administered? Why? Cilistatin*Prevents breakdown of imipenem by inhibiting renaldihydropeptidase-1

What is the c/u of imipenem/cilistatin? Enterobacter (DOC)

What are the Ototoxicity-causing drugs? AMG's*Loops(Furosemide)*Vancomycin*Quinidine*Chloroquine


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What is the MOA of AMG's? Inhibits initiation complex of N-Acetyl formation causingmisreading of mRNA

What is the MOA of Tetracyclines? Inhibition of tRNA charging by preventing attachement ofamino acyl tRNA, thereby inhibiting protein synthesis

What is the MOA of Macrolides? Blocking translocation from the A --> P site by binding the 23ssubunit of the 50s ribosome

What is the MOA of Chloramphenicol? Inhibits Peptidyltransferase, the enzyme responsible fortransferring nucleotides from A --> P site

What is the MOA of Clindamycin? Inhibits peptide bond formation b/w nucleotides at the P site

What is the c/u for Macrolides? UPS Lost My Brand New Car*URI's (caused by G+cocci)*Pneumonia (caused by G+ cocci)*STD's (caused by G+cocci)*Legionella*Mycoplasma*Bordatella*Neisseria*Chlamydia

What is the clinical use for AMG's? Any G- rod

What drug is used if a pt cannot tolerate AMG's? Aztreonam

What is the c/u for Tetracyclines? VACUuM THe BR*Vibrio*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmUrealytica*Mycoplasm*Tularemia*H. Pylori*Borrelia*Rickettsia

What is the toxicity of Tetracyclines? Discoloratio of teeth (kids)*Abnormal bone growth (kids) -->teratogenic*Photosensitivity*Drug-induced pancreatitis*Fanconi

syndrome (old Tetracyclines)What is the toxicity of Macrolides? Acute cholestatic hepetatis*Eosinophilia



What is an alternative MOA of Erythromycin? Binds to motilin receptors, causing hypermotility motility --> GIupset

What class of drug is Demeclocycline? Tetracycline

What is the MOA of Tetracyclines? Inhibition of tRNA charging by preventing attachement ofamino acyl tRNA

What is the primary MOA of Demeclocycline? Prevents attachment of amino acyl tRNA

What is an alternative MOA of Demeclocycline? Blocks ADH receptorsWhat drugs block ADH receptors? Demeclocycline*Lithium

What is the c/u for Chloramphenicol? Bacterial meningitis


What else is Lamuvidine AKA? What class of drug is it? Lamivudine or 3CT is an NRTI

What is the SE of any NRTI

Lactic Acidosis

What is the c/u of INF-beta? MS

What is the c/u of INF-gamma? CGD (NADPH oxidase deficiency)

Summarize the functions of INF-a, INF-B, INF-gamma. INF-alpha: Hep B & Hep C (ABC --> aBC or alpha B C)*INF-B: MS*INF-gamma: CGD

What is the MOA of Acyclovir? Inhibition of viral DNA polymerase when phosporylated by theVIRAL thymidine kinase

What is the c/u of Acyclovir? Any HSV except HSV III and HSV V

What are HSV I thru HSV VIII? HSV I = Oral herpes*HSV II = Genital herpes*HSV III =VZV*HSV IV = EBV*HSV V = CMV*HSV VI =Roseola*HSV VII = Pyteriasis Rosie*HSV VIII = Kaposi'sSarcoma

What is HSV III? What is the TX for HSV III? HSV III = VZV**Little VALerie and the whole FAMily*ChickenPox Tx = Valcyclovir*Herpes Zoster Tx = Famciclovir


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What is HSV V? What is the TX for HSV V? HSV V = CMV**CMV is sooo large it takes a GANG to fightit*Tx with Ganciclovir or Foscarnet

What is the MOA of Ganciclovir? Inhibits CMV viral DNA polymerase when phosphorylated byVIRAL thymidine kinase

What is the MOA of Foscarnet? Binds to pyrophosphate binding site;*Does NOT REQUIREphosphorylation by VIRAL thymidine kinase

What is the DOC for CMV Retinitis? Ganciclovir followed by Foscarnet

What are the viral protease inhibitors? SIR AN (NAVIR separate aprotease)*Saquinavir*Indinavir*Rotinavir*Amprenavir*Nelfinavir

What is the specific MOA of the viral protease inhibitors? NAVIR separate a protease*Inhibition of aspartate protease

What is the SE of Indinavir? Crystal-induced Nephropathy*Thrombocytopenia

What are the NNRTI's? Nevada/Deleware/E-Fuck Virus or NEVIR Efir (ever) DELivernucleosides*Nevirapine*Delavirdine*Efavirenz

What is the toxicity of NNRTI's? SJS

What is the SE of Nevirapine? SJS*Hepatotoxicity

What are all of the NRTI's and their 3-letter acronyms? AZT/ZDV --> Ziduvidine*DDI --> Didanosine*DDC -->Zalcytobine*3TC --> Lamuvidine*D4T --> Stavudine*ABC -->Abacavir

What are the SE's of the NRTI's? All NRTI's: Lactic acidosis**Ziduvidine (AZT/ZDV)*--Aplasticanemia*--Megaloblastic anemia*Didanosine (DDI)*--Drug-induced pancreatitis*Zalcytobine (DDC):*--SJS*--Peripheralneuropathy*Lamuvidine (3TC)*--only lactic acidosis*Stavudine(D4T)*--Peripheral neuropathy*Abacavir (ABC)*--Hypersensitivity syndrome

What is the MOA of Enfurvitide? Binds to GP41 & prevents VIRAL & CELLULAR membranefusion

What is the TX for African Trypanosomiasis (aka AfricanSleeping Sickness)?

Suramin

What is the TX for Chagas? Nifurtimox

What is the TX for PCP? PCP is one BAD-ass bug*1st: B = Bactrim (TMP/SMX)*2nd: A

= Aerosolized Pentamidine*3rd: D = Dapsone**NOTE: PCP =PneumoCystis Pneumonia *BUG: Pneumocystis Jiroveci(formerly Pneumocystis Carinii)

What is the MOA of Clindamycin? Inhibits peptide bond formation

What drugs INHIBIT Fungal DNA SYNTHESIS? Flucytosine*Griseofulvin (interfers with microtubule formationthereby inhibiting mitosis)

What drugs INHIBIT Fungal MEMBRANE SYNTHESIS? CAT*Caspofungin (inhibits synthesis of Beta-13-Delta-Glucan)*Azoles (inhibit the final step in ergosterolsynthesis)*Terbinafine (inhibits ergosterol synthesis by blockingthe enzyme squalene epoxidase)

What drugs DESTROY fungal MEMBRANES? Amphotericin B*Nystatin

What is the c/u for Amphotericin B? Under what conditions? Systemic fungal infections*Severe sepsis ( > 103 F)

What is the c/u for Azoles? Under what conditions? Systemic fungal infections that are neither severe nor septic*Alltopical fungal infections

What is the c/u for Nystatin? Oral Candidiasis*Topical

What is the specific MOA for Flucytosine? Changes uracil to fluro-uracil

What is the c/u for Flucytosine? Any systemic fungal infection

What is the MOA of Caspofungin? Inhibits Beta-13 Delta-Glucan

What is the c/u for Caspofungin? CASPofungin*ASPergillosis (invasive)*Systemic Candidiasis

What is the MOA of Terbinafine? Inhibits cell wall synthesis by blocking squaline epoxidase

What is the c/u of Terbinafine? Superficial fungal infections*Dermatophytes


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What is another drug that has the same c/u's as Terbinafine? Griseofulvin

What is the MOA of Griseofulvin? Binds microtubules, arresting the cell in mitosis

What is the general division of fungal drugs by c/u? Which drugsfall under each division?

Severe &/or septic SYSTEMIC fungal infections:*--Amphotericin B*SYSTEMIC fungal infections:*--Azoles*--Flucytosine*--Caspofungin*TOPICAL fungal infections --> *Topical TANG*--Terbinafine*--Azoles*--Nystatin*--Griseofulvin

What is the MOA of Amantidine? Prevents viral uncoating*Prevents viral penetration*IncreasesDA

What is the c/u for Amantidine? Influenza A, RubellA & the CerebellA*InfluenzaA*RubellA*Parkinson's (the CerebellA)

What is the TX for Influenza B? Oseltamivir*Zanamivir

What is the MOA of Oseltamivir/Zanamivir? Inhibits viral influenza neuraminidase, decreasing the release ofviral progeny

What is the TX for Influenza C? Acetaminophen**Full Name: N-Acetyl-Para-Aminophenol(APAP)*Other Names: Tylenol (U.S.)*Paracetamol (outsideNorth America)

What is the MOA of Ribavirin? Inhibits Guanine nucleotide synthesis by competitively inhibitingIMP Dehydrogenase

What is the c/u of Ribavirin? Chronic Hepatitis C*RSVWhat is the TX for chronic Hepatitis C? Ribavirin*INF-alpha

What is the TX for Hepatitis B? INF-alpha*Lamuvidine

If 75% of a drug remains in the body, how many half-lifes haveoccurred?

< 1 half-life

If 90% of the drug is eliminated from the body, how many half-lifes have occured?

3.3 half-lifes

How is half-life calculated? T1/2 = (Vd/Cl) x .7


3 Drugs that undergo 1st order elimination: All drugs except:**EPA*Ethanol*Phenytoin*Asparin (high dose)

Which phase do we calculate Therapeutic Index? Phase II

How do we calculate Therapeutic Index? TILE*TI = LD50 / ED50What direction does a competitive antagonist shift the efficacycurve (right, left, up, or down)?

It doesn't: efficacy (Vmax) is not affected*However, potency isdecreased (Km is increased) and therefore the POTENCY curveis shifted to the right

What direction does a noncompetitive antagonist shift thepotency curve (right, left, up, or down)?

It doesn't: potency (Km) is not affected (the drug is just as potentas before, but some receptors are turned off)*However, efficacy(Vmax) is decreased and therefore the EFFICACY curve isshifted downward


What are the Nucleotide Synthesis Inhibitors? Sulfonamides*Trimethoprim*Methotrexate*Pyrimethamine

What is drug inhibits Topoisomerase II/DNA Gyrase? QuinolonesWhat is the c/u for 2nd Gen Cephalosporins? HEN PEcKS (c = cocci)*H.

Influenza*Enterobacter*Neisseria*Proteus*E.Coli*Klebsiella*Serratia*G+ cocci


What is the c/u of imipenem/cilistatin? Enterobacter

What pt's is Azitreonam used to TX? Pt's who cannot tolerate AMG's*OR*Pt's who are allergic toPenicillin*OR*Pt's in Renal Failure

What is the c/u for AMG's? Any G- rod


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What is the c/u for Tetracyclines? VACUuM THe BR*Vibrio*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmUrealytica*Mycoplasm*Tularemia*H. Pylori*Borrelia*Rickettsia

What is the c/u for Macrolides? UPS Lost My Brand New Car*URI's (caused by G+cocci)*Pneumonia (caused by G+ cocci)*STD's (caused by G+cocci)*Legionella*Mycoplasma*Bordatella*Neisseria*Chlamydia

What is the c/u of Chloramphenicol? Bacterial Meningitis


What is the MOA of AMG's? Inhibits initiation complex at 30S causing misreading of mRNA


What is an alternative MOA of Demeclocycline? Blocks ADH receptors







What drug blocks Topoisomerase II/DNA Gyrase? Fluoroquinolones


What drug inhibits mRNA synthesis? Rifampin

What is the MOA of Rifampin

Blocking mRNA synthesis by inhibiting DNA-Dependent RNAPolymerase

What is the MOA of Penicillins? 1. Bind PBP's*2. Activate autolytic enzymes*3. Inhibitstranspeptidase cross-linking

What is the c/u of Ampicillin/Amoxicillin? HELPS Enterococci*H. Influenza*E.

Coli*Listeria*Proteus*Salmonella*Enterococci

What is the c/u of methicillin? Staph Aureus

What are the anti-Staph Penicillins? CONDM*Cloxacillin*Oxacillin*Nafcillin*Dicloxacillin*Methicillin

What are the anti-Pseudomonas Penicillins? PTC of Pseudomonas in theAM*Piperacillin*Ticarcillin*Carbenicillin*Azlocillin*Mezlocillin

What is the TX for local impetigo? Topical Mupirocin*Oral Erythromycin


What is a 3rd Gen Cephs used to TX Gonorrhea? Ceftriaxone & Cefixime



What is the MOA of Azithromycin? Blocking translocation from the A --> P site by binding the 23ssubunit of the 50s ribosome

What is the c/u for Azithromycin? UPS Lost My Brand New Car*URI's (caused by G+cocci)*Pneumonia (caused by G+ cocci)*STD's (caused by G+cocci)*Legionella*Mycoplasma*Bordatella*Neisseria*Chlamydia

What is the toxicity of Azithromycin? Acute cholestatic hepetatis*Eosinophilia

What is an alternative MOA for Erythromycin? Binds motilin receptors, causing hypermotility of the gut


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What is the primary and alternative MOA of Demeclocycline? Inhibition of protein sysnthesis by preventing amino acyl tRNAattachment*Inhibition of ADH receptors

What drugs block ADH receptors? Demeclocycline*Lithium

What is the c/u for Demeclocycline? VACUuM THe BR (Demeclocycline =Tetracycline)*Vibrio*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmUrealytica*Mycoplasm*Tularemia*H. Pylori*Borrelia*Rickettsia

What is the toxicity of Demeclocycline? Discoloratio of teeth (kids)*Abnormal bone growth (kids) -->teratogenic*Photosensitivity*Drug-induced pancreatitis*Fanconisyndrome (old Tetracyclines)

What are all of the NRTI's, their 3-letter acronyms, and SE's? All NRTI's: Lactic acidosis**Ziduvidine (AZT/ZDV)*--Aplasticanemia*--Megaloblastic anemia*Didanosine (DDI)*--Drug-induced pancreatitis*Zalcytobine (DDC):*--SJS*--Peripheralneuropathy*Lamuvidine (3TC)*--only lactic acidosis*Stavudine(D4T)*--Peripheral neuropathy*Abacavir (ABC)*--Hypersensitivity syndrome

What is the SE of Neveripine? Hepatotoxicity

What HIV drug causes Thrombocytopenia? Indinavir

What is the Toxicity of Indinavir? Crystal-induced nephropathy*Thrombocytopenia

What is the MOA of Indinavir? Inhibiton of aspartate protease

Name all aspartate protease inhibitors? SIR AN (NAVIR separate aprotease)*Saquinavir*Indinavir*Rotinavir*Amprenavir*Nelfinavir

What is the MOA of Enfurvitide? Binds to GP41 & prevents VIRAL & CELLULAR membranefusion

What is the TX for African Trypanosomiasis (aka AfricanSleeping Sickness)?

Suramin


What is the TX for PCP? PCP is one BAD-ass bug*1st: B = Bactrim (TMP/SMX)*2nd: A= Aerosolized Pentamidine*3rd: D = Dapsone**NOTE: PCP =PneumoCystis Pneumonia *BUG: Pneumocystis Jiroveci(formerly Pneumocystis Carinii)

What is the c/u of Metronidazole? GETGAP*Giardia*Entamoeba*Trichamona*Gardnerella*Anaerobes*H. Pylori

What is the toxicity of Metronidazole? Disulfram-like reaction with alcohol*Dysguzia*Drug-inducedpancreatitis*Teratogenic

What is the TX for bacterial vaginosis for pregnant pt's? Metro cream*Clindamycin cream

What is the TX for latent Hypnozytes (ovale & vivax) ? Primaquine for latent vivax & ovale (otherwise TX =Chloroquine)

How do you TX a patient with Malaria who has just returnedfrom Libya?

Chloraquine (Libya is above the Sahara Desert)**Note: Malariafrom the indian subcontinent/subsahara is assumed to beresistent to Chloraquine & therefore, Methloquin is used instead

What is meant by Indian Subcontinent? Source = Wikipedia*Indian Subcontinent aka SouthAsia*Typically includes: Sometimes Includes:*India*Afganastan*Pakistan Myanmur (formerly Burma)*BangladeshTibet*Sri Lanka*Nepal*Bhutan*Maldives***New Dehli is thecapital of the Republic of India

What is meant by Subsahara? Source = Wikipedia*Subsahara or Southern Africa aka BlackAfrica includes:*Nubia (formerly Sudan andEthiopia)*Zimbabwe*Mozambique*Botswana*Kenya*Uganda*Tanzania*Sahul* ***Sahul runs from the west coast to the eastcoast, forming the transition from N. Africa to SubsaharanAfrica; Sahul includes: Mali, Niger, Chad, & Sudan


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What is the TX for Leishmaniasis ? Pentavir Antimony*Na+ Stipigluconate

What is the TX for Diphyllobothrium Latum? Niclosemide

What is the TX for Schistosoma Mansoni? Praziquental

What is the TX for Ascaris Lumbricoides? Pyrantal Pamoate

What is the TX for Necator Americanis? Pyrantal Pamoate followed by Mebendazole

What is the TX for Nematodes? Mebendazole

What is the TX for Onchocerca (River Blindness)? Ivermectin

What is the drug that inhibits the conversion of Acetyl CoA toACh?

Vesimicol

What drug inhibits the release of ACh? Botulinum Toxin

What drug inhibits the uptake of choline? Hemicholinium

What drug inhibits the conversion of DA to NE? Reserpine

What drug inhibits the release of NE? Guanethidine

What drug stimulates the release of NE? Amphetamine

What drug inhibits the re-uptake of NE? Cocaine*TCA's

What receptor stimulates NE release? Angiotensin II

What receptor inhibits NE release? M1 & a2

What is the MOA of Epinephrine? B1 > B2 > a1 > a2What is the MOA of NE? a1/a2 > B1**Note: on day 4 he said a1/a2 > B2, however, on

days 10 & 11 he said a1/a2 > B1

What is the MOA of Isoproterenol? B1 = B2

What is the MOA of Dobutamine? Dobutamine has a B*B1 > B2

What is the MOA of DA? DA has a D*D1 = D2 > B > a

What is the MOA of Methylphenidate? Stimulates release of stored Catecholamines (i.e. NE)

What is the MOA of Phenylephrine (PE)? a1 > a2

What is the MOA of Terbutaline? B2 > B1

What is the MOA of a-Methyldopa? Centrally acting a-agonist decreases central adrenergic outflow

What is the MOA of Fenooldepam? D1 agonist

What are the non-selective a-blockers? Phenoxybenzamine*Phentolamine

How do you tell the non-selective a-blockers apart? Phenoxybenzine is irreversible (both words have moreletters)*Phentolamine is reversible (both words have less letters)

What is the c/u of the non-selective a-blockers? Pheochromacytoma

What is the SE's of the non-selective a-blockers? Orthostatic Hypotension*Reflex Tachycardia

What are the a1-blockers? Prazosin*Terazosin*Doxazosin

What are the a1-A-blockers? Tamsulosin (less SE's than a1-blockers)



What are the Phase II elimination reactions? GAS (you get flatualance when you have to go#2)*Glucoronidation*Acetylation*Sulfonation



What are all of the NRTI's, their 3-letter acronyms, and SE's? All NRTI's: Lactic acidosis**Ziduvidine (AZT/ZDV)*--Aplasticanemia*--Megaloblastic anemia*Didanosine (DDI)*--Drug-induced pancreatitis*Zalcytobine (DDC):*--SJS*--Peripheralneuropathy*Lamuvidine (3TC)*--only lactic acidosis*Stavudine(D4T)*--Peripheral neuropathy*Abacavir (ABC)*--Hypersensitivity syndrome


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What is the MOA of AMG's? Inhibits initiation complex causing inhibition of mRNA




What is the MOA of Clindamycin? Inhibits peptide bond formation b/w nucleotides at the P siteWhat are the general categories of MOA for all the anti-fungaldrugs & which drugs fall under each category?

Inhibit DNA Synthesis*--Flucytosine*--Griseofulvin (interfersw/micro-T formation thereby inhibiting mitosis)*InhibitsMembrane Synthesis***CAT*--Caspofungin*--Azoles*--Terbinifine*Destroys Fungal Membranes*--Amphotericin B*--Nystatin

What does Neuroleptic mean? TYPICAL Antipsychotics = 1st Gen Antipsychotics

What are the Neuroleptics? Fluphenazine*Thioridazine*Haloperidol*Chlorpromazine*Promazine

What is the MOA of the Neuroleptics? Inhibition of D2 receptors

What is the c/u for Neuroleptics? Psychosis*Schizophrenia

What are the 2 main SE's of the Neuroleptics? EPS Sx's*Neuroleptic Malignant Syndrome

What are 4 features of EPS and the timeline involved for eachfeature?

4 Hrs: Dystonia (sustained muscle contractions causing twisting& repetitive *movements or abnormal postures)*4 Days:Akinesia (inability to initiate movement due to difficultyselecting *&/or activating the movement pathway)*4 Wks:Akathisia (unpleasant sensations of inner restlessnessthat *manifests itself with an inability to sit still or remainmotionless)*4 Mos: Tardive Dyskinesia (disorder resulting ininvoluntary, repetitive body *movements having a slow orbelated onset)

What is the TX for Dystonia? Diphenhydramine*Benztropine*Trihexyphenidyl

What are 3 features of Neuroleptic Malignant Syndrome? Autonomic Instability*Hyperthermia*Muscle Rigidity

What are 3 features of Serotonin Syndrome? CV Collapse*Hyperparexia*Muscle Rigidity

Compare & Constrast Neuroleptic Malignant Syndrome (NMS)with Serotonin Syndrome (SS).

Neuroleptic Malignant Syndrome SerotoninSyndrome*Autonomic Instability CVCollapse*HYPERTHERMIA HYPERPYREXIA*Muscle rigidityMuslce rigidity

What is the difference between Hyperthermia and Hyperpyrexia? Hyperthermia: body temperature rises above its setpoint*Hyperpyrexia: the body's temperature regulationmechanism changes the body's set point above normal and thengenerates heat to achieve this increased temperature

What is the Tx for Neuroleptic Syndrome? Dantrolene (TX sx's) AND Dopamine Agonist (neurolepticreversal)

What are the DA agonists? CPRLAB*Cabergoline*Promipexole*Ropinerole*Levadopa/Carbidopa*Amantidine*Bromocriptine

What is the toxicity of Fluphenazine? Hyperthermia due to disruption of the thermo-regulatory center

What is the toxicity of Thioridazine? Pigmented Retinopathy

What is the MOA of Dantrolene? Inhibition of Ca2+ release by blocking Rhanidodine receptors atthe cytoplasmic reticulum


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What are the Atypical Anti-Psychotics? Its ATIPical for OLd CLOZets to Risper QUiETly *(they usuallysqueakloudly!)*ATIPamezole*OLanzapine*CLOZapine*RISPERidone*QUETiapine*Ziprasidone

What is the MOA of the Atypical Anti-Psychotics? Block 5-HT-2 & D2 receptors*Olanzapine also blocks D4receptors

What is the c/u for Atypical Anti-Psychotics? Psychosis*Schizophrenia

What is/are an additional(s) c/u(s) for Olanzapine? TOAD*Tourettes*OCD*Anxiety*Depression

What is the TX for Tourette's? Olanzapine*Promazine

What is the TX for OCD? Paroxetine (DOC)*Chlormipramine*Olanzapine

What is the MOA of Chlormipramine? Block the reuptake of NE & 5-HT (TCA's)

What is the MOA of Lithium? Inhibition of Phosphoinositol Cascade

What is an alternative MOA of Lithium? ADH receptor antagonist

What is the c/u for Lithium? Mood Stabilizer

What are the mood stabilizer drugs? Lithium*Valproic Acid*Carbamazepine

What is the toxicity of Lithium? LMNOP*L = Lithium*M = Muscle rigidity = tremors*N =Nephrogenic Diabetes Insipidus (b/c it antagonizes ADHrec's)*O = HyOthyroidism*P = Pregnancy = Ebstein'sAnomaly*P = Psoriasis Exacerbation (added day 9)

What are the SSRI's? Sertraline*Fluoxetine*Citalopram*Paroxetine

What is the c/u of SSRI's? P-LOAD*Premature Ejactulation*Long-term TX of PanicAttacks*OCD (DOC = Paroxetine)*Anxiety*Depression (SSRI'sMC drug Rx'd)

What are the TCA's? CANDID (PASS Program uses DDCAIN)*Clomipramine*Amitriptyline*Nortriptyline*Desipramine*Imipramine*Doxepin

What is the MOA of the TCA's? Block the reuptake of NE & 5-HT

Which TCA is LEAST sedating? Desipramine

Which TCA has the most anti-cholinergic SE's? Amitriptyline

Which TCA has the LEAST anti-cholinergic SE's? Nortriptyline

What is the TX for enuresis (bedwetting)? DOC = Desmopressin (similar to ADH --> H2ORetention)*TCA = Imipramine

What is the DOC for bedwetting in a pt < 5 y/o? NONE! It is expected at 5 years of age!

What is the toxicity of TCA's? The 4 C's*Cardiotoxicity*Confusion*Convulsion*Coma

What type of Cardiotoxicity develops with TCA toxicity? Torsades De Pointes

What is Torsades De Pointes? Ventricular Tachycardia associated with Prolonged QTSyndrome

What is the TX for Desipramine toxicity? Na+ Bicarbonate (Tx for toxicity of all TCA's)

What is the MOA of TCA's? Block the reuptake of NE & 5-HT

What are the heterocyclic Anti-Depressants (5) & what class ofdrug do they fall under?

The Very Big Med's*Trazodone (atypical anti-depressant)*Venlafaxine (SNRI)*Bupropion (atypical anti-

depressant)*Mirtazapine (atypical anti-depressant)*Maprotiline(atypical anti-depressant)

What is the MOA of Maprotiline? Block the reuptake of NE

What is the MOA of Trazodone? Block the reuptake of 5-HT

What is the MOA of Venlafaxine? Block the reuptake of NE, 5-HT, & DA

What is the DOC for generalized anxiety? Buspirone*Benzodiazapines

What is the indication for Benzodiazepines over Buspirone? Generalized anxiety in a pt with a hx of Etoh addiction

What Heterocyclic is used for generalized anxiety? Venlafaxine


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What are 2 anti-depressants used to TX a pt w/sleepdisturbances?

Trazodone*Mirtazapine

What is the DOC for a pt w/depression & sexual dysfunction? Bupropion

What are the indications for Bupropion? Smoking Cessation*Depression (DOC if pt also has sexualdysfunction)

When is Bupropion contraindicated & why? Bulemia hx (bulemia causes electrolyte imbalance = incr'd risk ofseizures)*Epileptic pt's*Bupropion lowers the seizure threshhold

What is the MOA of Mirtazapine? a2-antagonist*5-HT-2 & 5-HT-3 antagonistWhat other drugs are a2-antagonists? Mirtazapine*Yohimbine

What is the toxicity of Mirtazapine? 1 causes 2 causes 3 causes 4 (not literally; just a mnemonic)*1.Incr'd appetite*2. Wt gain*3. Incr'd Cholesterol*4. Sedation

What is the MOA of Tranylcypromine? Non-selective MAO-I

What are the MAO-I's? PITS*P = Phenelzine*I = Isocarboxazid*T =Tranylcypromine*S = Selegiline

What is the difference in selectivity between the MAO-I's? Non-selective = MAO-IA (A forAnywhere)*Phenelzine*Isocarboxazid*Tranylcypromine**Selective = MAO-IB (B for Brain)*Selegiline

What is the c/u for the Non-selective MAO-I's? Atypical Depression*Anxiety*Hypochondriasis*(Non-selectiveMAO-I's = Phenelzine , Isocarboxazid, & Tranylcypromine)

What is the c/u for the selective MAO-I? Selective MAO-I = Selegiline*c/u = Anti-Parkinsonian

What is Atypical Depression? Depression with mood disorders and/or wt gain

With which drugs are MAO-I's contraindicated? SSRI's*Meperidine

What is the toxicity of Vancomycin? There is NOTtoxicity*Nephrotoxic*Ototoxic*Thrombophlebitis

What are the Ototoxicity-causing drugs? AMG's*Loops(Furosemide)*Vancomycin*Quinidine*Chloroquine

What is the toxicity of AMG's? There is NNO toxicity*Neurotoxic(teratogenic)*Nephrotoxic*Ototoxic

What is the toxicity of Tetracyclines? Discoloration of teeth (children)*Abnormal bone growth(children)*Photosensitivity*Drug-induced Pancreatitis*Fanconi

Syndrome (old Tetracyclines)What are the SE's of Macrolides? Acute Cholestatic Hepatitis*Eosinophilia

What is the toxicity of Chloramphenicol? Dose-dependent Anemia*Dose-independent Aplasticanemia*Grey Baby Syndrome (premature infants)

What is the toxicity of Clindamycin? Pseudomembranous Colitis

What is the TX for Pseudomembranous Colitis secondary to C.Difficile?

Vancomycin*Metronidazole

What is the toxicity of Sulfonamides? Displaces drugs from albumin (e.g. Warfarin)*Hemolytic Anemia(G6PD Def Pt's)*Kernicteris(children)*Hypersensitivity*Photosensitivity*TubulointerstitialNephritis

What is the toxicity of Trimethoprim? Megaloblastic Anemia

What is the toxicity of Quinolones? Tendonitis (adults)*Cartilage rupture (children)What is an additional SE of Moxifloxicin? Screws with K+ leading to Torsades de Pointes (aka Prolonged

QT Syndrome)


What is the toxicity of Polymyxins? ATN (acute tubular necrosis)*Neurotoxicity

What is the toxicity of INH? INHH*Induces SLE*Neurotoxicity (that's why we giveconcomittant Vit B6)*Hepatotoxicity*Hemolytic anemia (G6PDPt's)


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What is the toxicity of Ethambutol? Optic Neuritis*Central Scotoma

What is the toxicity of Dapsone? HAMbone from Dapsone*HemolyticAnemia*Agranulocytosis*Methemoglobinemia

What are the drugs that cause Agranulocytosis? Clozapine*Colchicine*Carbamazepine*PTU*Dapsone*Ticlopidine*Methimazole

What is/are the SE(s) of Amphotericin B? Fever/Chills*Hypotension*Phlebitis*Arrhythmias*Nephrotoxicity

What is/are the SE(s) of Fluconazole? Torsades de Pointe (aka Prolonged QT Syndrome)What is/are the SE(s) of Flucytosine? Bone marrow suppression

What is/are the SE(s) of Griseofulvin? Incr'd metabolism of Warfarin*Teratogenic*Carcinogenic

What is/are the SE(s) of Amantidine? Ataxia*Dizziness*Slurred speech*(SE's due to skrewed upcerebellum)

What is/are the SE(s) of Foscarnet? Nephrotoxicity

What is/are the SE(s) of Indinavir? Crystal-induced Nephropathy*Thrombocytopenia

What is/are the SE(s) of all of the NRTI's (& 3-letter acronyms)? All NRTI's: Lactic acidosis**Ziduvidine (AZT/ZDV)*--Aplasticanemia*--Megaloblastic anemia*Didanosine (DDI)*--Drug-induced pancreatitis*Zalcytobine (DDC):*--SJS*--Peripheralneuropathy*Lamuvidine (3TC)*--only lactic acidosis*Stavudine(D4T)*--Peripheral neuropathy*Abacavir (ABC)*--

Hypersensitivity syndromeWhat is/are the SE(s) of Efavirenz? SJS

What is/are the SE(s) of Nevirapine? SJS*Hepatotoxicity

What is/are the SE(s) of Atropine? Dry as a Bone: Dry eyes/skin (dec'd lacrimation/dec'dsweat)*Hot as a Hare: Warm skin (dec'd sweat --> reflexvasodilation)*Red as a Beet: Flushing (dec'd sweat --> reflexvasodilation)*Blind as a Bat: Mydriasis/Cycloplegia (dec'dPS's)*Mad as a Hatter: Confusion/Disorientation (CNS effectson M4/M5 rec's)

What is/are the SE(s) of Phentolamine? Orthostatic Hypotension*Reflex Tachycardia

What is/are the SE(s) of Prazosin? 1st-dose Orthostatic Hypotension*Priapism

What is/are the SE(s) of Mirtazapine? 1 causes 2 causes 3 causes 4 (not literally; just a mnemonic)*1.

Incr'd appetite*2. wt gain*3. Incr'd Cholesterol*4. Sedation

What is/are the SE(s) of Pindalol? Impotence*Exacerbates asthma*Masks hypoglycemia inDM*Cardiovascular efffects (bradycardia, AV block, CHF)*CNSeffects (sedation, sleep alteration)

What is/are the SE(s) of L-Dopa? Arrythmia*Dyskinesia

When & Why is Sumatriptan contraindicated? Due to risk of vasospasm, Sumatriptan is contraindicatedin:*Prinzmetal angina*CAD*Pregnancy (must order pregnacy testfirst)

What is/are the SE(s) of Topiramate? Mental dulling*Renal stones*Wt loss

What is/are the SE(s) of Gabapentin? Movement disorders*Nystagmus*Wt loss

What is/are the SE(s) of Lamotrigine? SJS

What is/are the SE(s) of Ethosuxamide? SJS*SLE*Urticaria = mild form of SJSWhat is/are the SE(s) of Phenobarbital? Sedation*Tolerance*Dependence*Induces P-450

What is/are the SE(s) of Benzodiazepine? Sedation*Tolerance*Dependence

What are the SE's of Valproic Acid (one of the top 10 drugstested on USMLE)?

Fetal Hepatotoxicity*Neural Tube Defects*Drug-InducedPancreatitis


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What are the SE's of Phenytoin (one of the top 10 drugs testedon USMLE)?

Indian men want a wife who is LIGHT-skinned ANDMMPSS*Lymphadenopathy*Induces P450*GingivalHyperplasia*Hirsutism*Teratogenic (Fetal HydantoinSyndrome)*Ataxia*Nystagmus*Diplopia*Megaloblasticanemia*Malignant Hyperthermia*PeripheralNeuropathy*SLE*Sedation

What are the contraindications of Barbiturates? Porphyrias

What is the TX for Benzodiazepine overdose? Flumazenil

What can abrupt cessation of Olprazelam cause? Generalized seizures

What is the TX for alcohol withdrawal? Chlordiazepoxide

What is/are the SE(s) of Chlorpromazine? EPS SE's*NMS


What is the TX for Neuroleptic Malignant Syndrome? Dantrolene (TX sx's) + DA Agonist (NMS reversal)


4 Hrs: Dystonia (sustained muscle contractions causing twistingand repetitive *movements or abnormal postures)*4 Days:Akinesia (inability to initiate movement due to difficultyselecting *and/or activating the movement pathway)*4 Wks:Akathisia (unpleasant sensations of inner restlessness thatmanifests *itself with an inability to sit still or remainmotionless)*4 Mos: Tardive Dyskinesia (disorder resulting ininvoluntary, repetitive body *movements having a slow orbelated onset)

What is the TX for Acute Dystonia? Diphenhydramine*Benztropine*Trihexyphenidyl

What is the toxicity of Thioridazine? Pigmented Retinopathy

What is the toxicity of Fluphenazine? Hyperthermia due to disruption of the thermo-regulatory center

What is/are the SE(s) of Clozapine? Agranulocytosis

What is/are the SE(s) of Olanzapine? Weight gain

What is/are the SE(s) of Quetiapine? Cataracts

What is/are the SE(s) of Lithium? LMNOP*L = Lithium*M = Muscle rigidity = tremors*N =Nephrogenic Diabetes Insipidus*O = HyOthyroidism*P =Pregnancy = Ebstein's Anomaly*P = Psoriasis Exacerbation

(added day 9)What is/are the SE(s) of Fluoxetine? Sexual retardation

What is the c/u for Fluoxetine? Premature ejaculation

What are the contraindications of Fluoxetine? Concomittant use with MAOI's will cause Serotonin Syndrome

What is/are the SE(s) of Doxepin? The 4 C's*Confusion*Cardiotoxicity*Convulsion*Coma

What are the contraindications of Fenalzine? Concomittant use with SSRI's or Meperidine

What are the 2 rules of Anesthetics? 1) Solubility in BLOOD tells me:*a. Induction time*b. Recoverytime*(directly related)*2) Solubility in LIPIDS tells me:*a.Potency*b. Minimum Alveolar Concentration (MAC)*(inverselyrelated)

If Halothane is highly soluble in lipids & therefore goes intotissues quickly, is the induction time fast or slow?

Cannot be determined; LIPID solubility indicates Potency &MAC

If Nitrous Oxide is poorly soluble in blood & therefore must gointo tissues, is potency high or low?

Cannot be determined; BLOOD solubility indicates Induction &Recovery time

What is/are the SE(s) of Halothane? Hepatotoxic

What is/are the SE(s) of Enflurane? Convulsions (lowers seizure threshhold)

What is/are the SE(s) of Methoxyflurane? Nephrotoxic

What is/are the SE(s) of Sevoflurane? Malignant Hyperthermia

If Thiopental is highly soluble in lipids & therefore goes intotissues quickly, is the induction time fast or slow?

Cannot be determined; LIPID solubility indicates Potency &MAC


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What is the c/u for Midazolam? Why? Endoscopic anesthesia b/c it causes anterograde amnesia

With anesthetics, is the goal to increase or decrease cerebralblood flow? Why?

Decrease b/c we want them to sleep

What are the significant CV features of Ketamine that makes itindicated in certain pt's?

Increased cerebral blood flow*Stimulates the heart --> increasedcardiac output

What is the c/u for Ketamine? Why? Anesthesia for pt's in heart trouble b/c it increases cardiac outpu

What is the TX for African Trypanosomiasis (aka African

Sleeping Sickness)?

Suramin


What is the TX for PCP? PCP is one BAD-ass bug*1st: B = Bactrim (TMP/SMX)*2nd: A= Aerosolized Pentamidine*3rd: D = Dapsone**NOTE: PCP =PneumoCystis Pneumonia *BUG: Pneumocystis Jiroveci(formerly Pneumocystis Carinii)

What is the SE of Aerosolized Pentamidine? Drug-induced pancreatitis

What is the TX for Entamoeba Histolytica? Metronidazole

What is the TX for P. vivax? Primaquine for latent P. vivax & P. ovale to prevent relapse(otherwise TX = Chloroquine)

How do you TX a patient with Malaria who has just returnedfrom New Dehli?

Methloquine; Malaria from the indian subcontinent/subsahara isassumed to be resistent to Chloraquine**NOTE: New Dehli is

the capital of the Republic of IndiaWhat is the TX for Kala-azar? Pentavir Antimony*Na+ Stipigluconate**NOTE: Kala-azar (aka

Dumdum Fever) is Visceral Leishmaniasis, the most severe formof Leishmaniasis

What is the TX for Taenia Solium? Niclosamide

What is the TX for Clonorchis Sinensis? Praziquental

What is the TX for Enterobius Vermacularis? Praziquental & Mebendazole (on day 11 he says PyrantalPamoate & Mebendazole)

What is the TX for Onchocerca (River Blindness)? Ivermectin

What are the Neuroleptics? Fluphenazine*Thioridazine*Haloperidol*Chlorpromazine*Promazine

What is the TX for Tourette's? Olanzapine*PromazineWhat is the MOA of Quetiapine? Quetiapine = Atypical Neuroleptic*Block 5-HT-2 & D2

receptors

What drug blocks 5-HT-1D receptors? Nothing, h/w Sumitriptan is a 5-HT-1D AGONIST

What drug blocks 5-HT-2, 5-HT-3, & a2 receptors? Mirtazipine

What drug blocks 5-HT-3 receptors only? Ondansetron

What is/are the SE(s) of Quetiapine? Cataracts

What drug has a SE profile of Pigmented Retinopathy? Thioridazine

What is/are the SE(s) of Fluphenazine? Hyperthermia due to disruption of the thermo-regulatory center

What is the DOC for OCD? Paroxetine

What is the MOA of Clomipramine? TCA's: Block 5-HT & NE re-uptake

What drugs block NE re-uptake? Cocaine*TCA's*MaprotilineWhat heterocyclic inhibits only 5-HT re-uptake? Trazadone

What is the DOC for Generalized Anxiety in a pt who is analcoholic?

Busparone

What is the MOA of Phenalzine? Non-selective MAO inhibitor

What is/are the SE(s) of Chlortalidone? Hyper-GLUC:*HyperGlycemia*HyperLipidemia*HyperUricemia*HyperCalcemia

What are the 4 main Thiazide Diuretics? Hydrochlorothiazide*Indapamide*Metolazone*Chlortalidone


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What is/are the SE(s) of Quinidine? Severe rebound HTN

What is/are the SE(s) of Methyldopa? Positive Coomb's Test

What is/are the SE(s) of Hexamethonium? Sympatholytic *Severe orthostatic Hypotension*SexualDysfunction*Parasympatholytic*Constipation*Blurred Vision

What is/are the SE(s) of Reserpine? Depression*Diarrhea

What is/are the SE(s) of Guanethidine? Sexual Dysfunction*Diarrhea

What is/are the SE(s) of Prazosin? 1st-dose Orthostatic Hypotension*Priapism

What is/are the SE(s) of B-Blockers? Impotence*Exacerbates asthma*Masks hypoglycemia inDM*Cardiovascular efffects (bradycardia, AV block, CHF)*CNSeffects (sedation, sleep alteration)

What is/are the SE(s) of Hydralazine? SARS*SLE-like sx's*Angina*Reflex tachycardia*Salt retention

What is/are the SE(s) of Minoxidil (OTC Rogaine)? SHARP*Salt retention*Hypertrichosis (too muchhair)*Angina*Reflex tachycardia*Pericardial effusion

What is/are the SE(s) of Verapimil? Constipation

What is/are the SE(s) of Captopril? CHAPTOPRIL where H = Hyperkalemia*C = Cough*H =Hyperkalemia (b/c decr'd aldosterone)*A = Angioedema*P =Proteinuria*T = Taste change*O = HypOtension*P =Pregnancy problems (fetal renal damage)*R = Rash*I = Incr'drenin*L = Lowers Ang II & Aldosterone

What happens to EDV when Nitrates are given? Decreased

What happens to BP when Nitrates are given? Decreased

What happens to Contractility when Nitrates are given? Reflexively Increased

What happens to HR when Nitrates are given? Reflexively Increased (reflex tachycardia)

What happens to Ejection time when Nitrates are given? Decreased

What happens to MVO2 when Nitrates are given? Decreased

What happens to EDV when B-Blockers are given? Increased (incr'd time in diastole = incr'd filling time)

What happens to BP when B-Blockers are given? Decreased

What happens to Contractility when B-Blockers are given? Decreased

What happens to HR when B-Blockers are given? Decreased

What happens to Ejection Time when B-Blockers are given? IncreasedWhat happens to MVO2 when B-Blockers are given? Decreased

What happens to EDV when Nitrates AND B-Blockers aregiven?

No change

What happens to BP when Nitrates AND B-Blockers are given? Decreased

What happens to Contractility when Nitrates AND B-Blockersare given?

Decreased

What happens to HR when Nitrates AND B-Blockers are given? Decreased (b/c B-Blockers = direct response, while Nitrates =reflexive response)

What happens to Ejection Time when Nitrates AND B-Blockersare given?

No change

What happens to MVO2 when Nitrates AND B-Blockers are

given?

Decreased

What is the 1st line TX for Cocaine-related MI? Benzodiazepines to TX HTN*Nitrates to TXVC/Vasospasm*Aspirin to decrease thrombus formation

What is the TX for symptomatic premature atrial contraction? B-Blockers

What is the Na+, K+, & Ca2+ ion normal physiology of theheart?

1) The Na+/K+ pump exchanges 2K+ (moves inward) & 3Na+(moves outward)*2) The Na+/Ca2+ antiporter exchanges 3 Na+(moves inward) & 1 Ca2+ (moves outward)*3) K+ leak channelsslowly allow K+ to diffuse (moves outward) to be used again bythe Na+/K+ pump (exchanger)*4) If the resting membranepotential reaches threshhold (approx +90mv) an AP occurs


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What is the MOA and physiology leading to the effects ofDigoxin?

MOA 1:*a) Digoxin binds the K+ on the Na+/K+ pumppreventing Na+/K+ exchange; K+ therefore stays outside thecell while Na+ stays inside the cell;*b) Na+ is then no longerexchanged with Ca2+; Ca2+ accumulates inside the cell;*c) Oncethreshhold is finally reached and an action potential does occur,the accumulated Ca2+ is released; release of an increased amountof Ca2+ results in an increased ionotropic effect (i.e. increasedcontractility due to increased ions, Ca2+ in this case)*MOA

2:*Stimulates CN X in the MedullaWhat is the c/u and rationale for Digoxin? Digoxin has 2 diff't c/u's b/c it has 2 diff't MOA's:*1)

CHF*MOA = Inhibition Na+/K+ ATPase --> incr'dintracellular Ca2+ -->*incr'd contractility*2) AtrialFibrillation*MOA = Stimulation of CN X in the medulla -->decr'd AV node stimulation --> *decr'd HR**NOTE: *I usedDr. Francis's explanation (Physio notes p. 60) b/c Shahzad'sexplanation is clearly wrong!*1) He said that ventricularcontraction is due to Na+ h/w ALL muscle contractions is dueto Ca2+ while ventricular DEPOLARIZATION (notcontraction) is due to Na+.*2) He also said that the reasonslowed conduction through the AV-node is helpful for A-fib isthat it gives time for Na+ accumulation that leads to incr'dventricular contractility h/w changing ventricular contractility will

have no affect on the atrium or A-Fib.

What is the toxicity of Digoxin? Torsades De Pointes Arrhythmia (i.e. prolonged QT) b/c of itseffects on K+*Yellow vision

What is the TX for Digoxin toxicity? 1) STOP DIGOXIN ADMINISTRATION!*2) Slowly normalizeK+*3) Lidocaine*4) Mg2+*5) Digifab/Digibind*6) Pacemakeronce stable (~2wks later)

What effects does Digoxin have on the EKG? Decr'd Na+/K+ Pump action --> Incr'd intracellular CA2+accumulation:*PR Interval: Increased*QT Interval: Decreased(i.e shorter/faster) *b/c repolarization requires K+*ST segment:Depression*T wave: Inversion (i.e. U wave)

What are the Class III anti-arrhythmics? Ibutilide*Sotalol*Bretylium*Amiodarone*Dofetilide

What is the MOA and effects of Class III Anti-arrhythmics? Blocks K+ leading to:*AP duration: Increased*QT interval:

Increased (i.e longer/slower) *b/c intracellular K+ is incr'd &repolarization requires K+*ERP: Increased (b/c blocked K+)

What is the break-down metabolite of Amiodarone? Procainamide

What class of Anti-Arrhythmic is Procainamide? Class IA

Why is Amiodarone listed as a Class IA AND Class III anti-arrhythmic?

Class IA: Amiodarone's metabolite, Procainamide, is a ClassIA*Class III: Amiodarone's MOA is to block K+

What is the MOA & effects of Class IA Anti-arrhythmics? Blocks Na+ AND K+ [leak] Channels leading to:*AP duration:Increased*QT interval: Increased (i.e longer/slower) *b/crepolarization requires K+*ERP: Increased (b/c blocked K+)

What are the Class IB Anti-arrhythmics? Lidicaine*Mexlotine*Tocanimide*Phenytoin

What is the c/u for Phenytoin? Treatment: Tonic-clonic seizures*Phrophylaxis: Status-epilepticusseizures

What is the MOA of Phenytoin? Blocks Na+ channels

What direction does a competitive antagonist shift the efficacycurve (right, left, up, or down)?

It doesn't: efficacy (Vmax) is not affected*However, potency isdecreased (Km is increased) and therefore the POTENCY curveis shifted to the right




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What is the c/u of Ampicillin/Amoxicillin? HELPS Enterococci*H. Influenza*E.Coli*Listeria*Proteus*Salmonella*Enterococci

A patient who was in a bar fight and was bit in the hand comesinto the ER, what is the proper TX?

Amoxicillin/Clavulonic Acid*(there are no dogs in the bar; hegot bit by a person)

A patient presents to your office with an infection in which labsshow G+ aerobic rods in long, branching filaments.what isTX?

Bug = Actinomyces*Tx = 6-12 wks IV Penicillin

What is the profile for Norcardia? G+ rods in long branching filaments, anaerobic, partially acid fast

What is initial TX for infective endocarditis? Emperical TX = Vancomycin + Gentomycin

What is the TX for infective endocarditis that is culture positivefor S. Viridans?

Iv Penicillin G*Ceftriaxone

A patient comes to you office; has a fever of 102 F; CBC showsWBC of 500; negative U/A; neg CXR; pt is on chemotherapy,denies cough & diarrhea; what is the next step in themanagement of this pt?

Dx = Febrile Neutropenia*Pt @ risk of Pseudomonas*Tx forG+'s = IV Ceftazidime or IV Cefipime

A patient comes to you office; has a fever of 102 F and ishypertensive; CBC shows WBC of 500; negative U/A; neg CXR;pt is on chemotherapy, denies cough & diarrhea; what is the nextstep in the management of this pt?

Dx = Febrile Neutropenia with HTN*Pt @ risk ofPseudomonas*Tx for G+'s = IV Ceftazidime or IVCefipime *PLUS *Tx for G-'s = Vancomycin

A patient comes to you office; has a fever of 102 F and ishypertensive; CBC shows WBC of 500; negative U/A; neg CXR;pt is on chemotherapy, denies cough & diarrhea; The pt is TX'dwith IV Cefipime plus Vancomycin, but the fever persists; whatis the next step in the managment of this pt?

Dx = Febrile Neutropenia with HTN*Pt @ risk ofPseudomonas*Tx for G+'s = IV Ceftazidime or IVCefipime *PLUS *Tx for G-'s = Vancomycin*PLUS*Tx forFungi = Flucytosine

After taking a hiking vacation to the upper NEern US, a ptcomes to your office with autoimmune polyarthiritis chronicamigrans; what is the TX?

Dx = Tertiary Lyme Ds*Tx = IV Ceftriaxone

With what sx's does a pt with primary Lyme's Disease present? Flu-like sx's*Erythema chronicum migrans (bull's eye rash)

What is the TX for primary Lyme's Disease? Doxycycline

With what sx's does a pt with secondary Lyme's Disease present? Migrating pain in muscles, joint, and tendons*Changes inheartbeat --> cardiac manifestations:*Heartpalpitations*Dizziness*Neurological manifestations*Bell's

Palsy*Meningitis*Encephalitis*ChoreaWhat is the TX for secondary Lyme's Disease? Doxycycline

What is the initial TX for a pregnant woman with Lyme'sDisease?

Ampicillin/Amoxicillin b/c Doxycycline is Teratogenic

What is the DOC of a 7 y/o male with severe acute exacerbationof Cystic Fibrosis lung disease?

1 AMG (DOC for any G- rod)*AND 1 Other Drug:*Anti-Pseudomonal Penicillin (e.g. Piperacillin, Ticarcillin)*3rd GenCephalosporins (e.g. Ceftazidime)**NOTE: MC infection in CFis Pseudomonas (G- rod); you always cover for Pseudomonaswith 2 drugs

What are the causes of community-aquired pneumonia (CAP)?How does this effect medical management?

Causes of CAP include bacteria, viruses, fungi, and parasites,therefore, broad-spectrim antiboitics (covers G+ AND G-) isused to TX CAP

What is the in-house TX for community-aquired pneumonia(CAP)?

Fluoroquinolones (aka Quinolones): broad-spectrum (i.e. G+AND G-)*Levofloxacin*Gatifloxicin

What is the c/u for Quinolones? G- rods in GI/GU track*CAP

What is out-pt TX for community-aquired pneumonia? Azithromycin (Macrolides)*Intracellular organisms*G+cocci*Doxycycline (Tetracyclines)*Intracellularorgnaisms*Mycoplasm --> walking pneumonia

What is the c/u of Macrolides? UPS Lost My Brand New Car*URI's (caused by G+cocci)*Pneumonia (caused by G+ cocci)*STD's (caused by G+cocci)*Legionella*Mycoplasma*Bordatella*Neisseria*Chlamydia


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What is the c/u of Tetracyclines? VACUuM The BR*Vibrio Cholerea*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmaUrealyticum*Mycoplasm*Tularemia*H.Pylori*Borrelia*Rickettsia

What is the DOC for bacterial vaginosis in a non-pregnantwoman?

DOC = Tinidazole*2nd = Metronidazole (more SE's thanTinidazole)

A diabetic pt comes to your office with a rhinocerebralinfectionwhat is the next step in management?

Dx'd bug = Mucor Rhizopus = HIGHLY FATALDISEASE!!!*Treatment:*1) Debridement of necrotic tissue*2)

Amphotericin B (direct injection)

An HIV pt comes to your office with dysphagia, what is the nextstep in management?

Fluconazole (b/c in HIV pt's, dysphagia has 90% correlationw/Candida)

An HIV pt comes to your office with dysphagia; the initial TXwith Fluconazole doesn't work; what is the next step inmanagement?

Endoscopy

An HIV pt comes to your office with dysphagia; the initial TXwith Fluconazole doesn't work so you do an endoscopy; biopsyreveals large, shallow ulcers; what is the next step inmanagement?

Dx = CMV (b/c lg shallow ulcers)*Tx = Ganciclovir

An HIV pt comes to your office with dysphagia; the initial TXwith Fluconazole doesn't work so you do an endoscopy; biopsy

reveals multiple small vesiculated ulcers; what is the next step inmanagement?

Dx = HSV (b/c multiple small vesiculated ulcers)*Tx =Acyclovir

What is the MOA and target of Statins? Inhibition of HMG CoA reductase in liver

What is the MOA and target of Niacin? Inhibits the uptake of Ch'ol as VLDL from hepatocytes intocirculation

What is the MOA and target of Cholestepol? It is a bile acid resin that inhibits the uptake of everything in thegut into the liver (works in the gut)

What is the MOA and target of Izentamide? Ch'ol absorption blocker in the gut

What is the MOA and target of Fibrates? Stimulates LPL in the circulation on the endothelial cells

What are the Fibrates? Bezafibrate*Ciprofibrate *Clofibrate (largely obsolete due to side-effect profile, e.g. gallstones) *Gemfibrozil*Fenofibrate

What effect do Statins have on LDL, HDL, & TG's? LDL: Decreased*HDL: Increased*TG's: Decreased

What effect does Niacin have on LDL, HDL, & TG's? LDL: Decreased*HDL: Increased*TG's: Decreased

What effect does Cholestepol have on LDL, HDL, & TG's? LDL: Decreased*HDL: No effect (b/c works in gut)*TG's:Slightly incr'd (indirect action: b/c decr'd GI absorption = LES --> incr'd lipolysis --> incr'd vLDL --> incr'd TG's)

What effect does Izentamide have on LDL, HDL, & TG's? LDL: Decreased*HDL: No effect (b/c works in gut)*TG's: Noeffect (b/c still absorb proteins, carbohydrates, and fats)

What effect do Fibrates have on LDL, HDL, & TG's? LDL: Decreased*HDL: Increased (1st line drug)*TG's:Decreased

What effect do Probucol have on LDL, HDL, & TG's? LDL: Decreased (increases LDL metabolism in last step of ch'olelimination)*HDL: No effect*TG's: No effect

In a pt with CAD, what should his/her LDL be less than? 130 (TX starts when LDL reaches 1 levelhigher than target, 100)

In a pt with 2 RF's for CAD, when do I begin medicalmanagement?

When their LDL is >160 (TX starts when LDL reaches 1 levelhigher than target, 130)


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In a pt with 0 - 1 RF's for CAD, when do I begin medicalmanagement?

When their LDL is >190 (TX starts when LDL reaches 1 levelhigher than target, 160)

What is the drug of choice for high LDL? Lifestyle Management until they reach 1 level higher than theirtarget LDL*Medical Management once they reach 1 level higherthan their target LDL

What is the MOA of Doxylamine? H1 receptor blocker

What is the c/u for Doxylamine? Hyperemesis Gravidarum*Morning sickness

What is the difference between Hyperemesis Gravidarum andmorning sickness? Morning sickness occurs in the 1st trimester*HyperemesisGravidarum can occur in 1st, 2nd, or 3rd trimester

What is Hyperemesis Gravidarum? Can be a severe form of morning sickness*Can be due to agestational mole

With what drug is Doxylamine co-administered? B6

What is the MOA of Dimenhydrinate? REVERSIBLY inhibits H1 receptors in tissues

What type of histamine receptors are present on gastric parietalcells?

H2 receptors

What do gastric parietal cells secrete? Intrinsic Factor*Hydrochloric Acid (HCl)

How are gastric parietal cells involved in allergies? Though they have histaminic receptors, they are NOT involvedin allergies

What is the MOA of Fexofenadine? 2nd Generation H1 Blocker

Why do we use 2nd Gen H1 blockers instead of 1st Gen H1blockers?

Because it has fewer SE's

A pt comes to your office has mild intermittent asthma; what isthe 1st step in management?

Albuterol

What is the MOA of Albuterol? B2 agonist leading to bronchidilation

A pt comes to your office has moderate persistent asthma; pt iscurrently taking asthma but is having night time flare-ups morethan 3 times a week; what is the 1st step in management?

Low-dose steroids

What are the 6 actions of steroids? KIIISS*1) Kills T-cells & eosinophils*2) Inhibit macrophagemigration*3) Inhibit phospholipase A*4) Inhibit mast celldegranulation*5) Stabalizes endothelium*6) Stiumulates protein

synthesis**Also according to FA: activates NF-!B therefore

don't make any TNF-a

Where does TNF-a come from? Macrophages

What are all the things that Macrophages secrete? IL-1, IL-6, IL-12, TNF-a

What do Th-1 cells secrete? IL-2 & IF-gamma

What do Th-2 cells secrete? IL-4, IL-5, and IL-10

What do Cytotoxic T-cells secrete? IL-3 and TNF-B

A pt comes to your office with severe persistent asthma; the pt iscurrently taking Albuterol and low-dose prednisone; he iscurrently having an acute exacerbation; what is the next step inmanagement?

Give a dose of Albuterol

A pt comes to your office with severe persistent asthma; the pt is

currently taking Albuterol and low-dose prednisone; he iscurrently having an acute exacerbation & he has already rec'dONE dose of Abluterol; what is the next step in management?

Give a 2nd dose of Albuterol

A pt comes to your office with severe persistent asthma; the pt iscurrently taking Albuterol and low-dose prednisone; he iscurrently having an acute exacerbation & he has already rec'dTWO doses of Abluterol; what is the next step in management?

Give a 3rd dose of Albuterol


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A pt comes to your office with severe persistent asthma; the pt iscurrently taking Albuterol and low-dose prednisone; he iscurrently having an acute exacerbation & he has already rec'dTHREE doses of Abluterol; what is the next step inmanagement?

Give high-dose inhaled corticosteroids**NOTE: For acuteexacerbation of asthma you try 3 consecutive doses of Albuterol& if that doesn't work you turn to high-dose corticosteroids?

An asthmatic pt currently on Albuterol, comes to your officecomplaining that everytime he work out, he become short ofbreath; what is the next step in management?

Tx: Albuterol prior to working out

What is the c/u for drugs that block transpeptidase crosslinking? Drug = Penicillins*G+ cocci & rods*G- cocci*Spirochetes

What is/are the SE(s) for drugs that block transpeptidasecrosslinking?

Drug = Penicillins*Hypersensitivity*Hemolytic Anemia

What does Methicillin toxicity cause? Interstitial nephritis

What is the c/u for Methicillin? S. Aureus

What are the anti-Staph Penicillins? CONDM*Cloxacillin*Oxacillin*Nafcillin*Dicloxacillin*Methicillin*(Anti-Staph Pen's = 2nd Gen Pen's)

What are the anti-Pseudomonas Penicillins? PTC of Pseudomonas in theAM*Piperacillin*Ticarcillin*Carbenicillin*Azlocillin*Mezlocillin*(Anti-Pseudomonas = 4th Gen Pen's)

What is the c/u of Ampicillin/Amoxicillin? HELPS Enterococci*H. Influenza*E.Coli*Listeria*Proteus*Salmonella*Enterococci*(Ampicillin/Amoxicillin = 3rd Gen Pen's)

What does Ampicillin/Amoxicillin toxicity cause? Hypersensitivity*Ampicillin rash*Pseudomembranous colitis

What other antibiotic causes Pseudomembranous Colitis? Clindamycin

What is the MOA of Clindamycin? Inhibits peptide bond formation


What is the TX for Pseudomembranous Colitis? Metronidazole*Vancomycin

What is the MOA of Metronidazole? Form toxic metabolites in the bacterial cell wall that damageDNA


What is the c/u for Metronidazole? GET

GAP*Giardia*Entomeba*Trichamonas*Gardnerella*Anaerobes*H. Pylori

What is the TX for bacterial vaginosis for pregnant pt's? Metro cream*Clindamycin cream

What is the MOA of Vancomycin? Inhibits D-ala D-ala (t/f can't make peptidoglycan)


What is the c/u for Vancomycin? MRSA*C. Difficile*Nosocomial infections (presumeably drug-resistent infections)

What is the TX for VRSA? Linezolid*Streptogramins

What is the MOA of Linezolid? Inhibition of 50s

What are the 50s Inhibitors? CCELLS (Buys AT 30 CCELLS at50)*Chloramphenicol*Clindamycin*Erythromycin (i.e

Macrolides)*Lincomycin*Linezolid*StreptograminsWhat are the Streptogramins? Dalfopristin*Quinopristin


Rifampin

How does Rifampin's MOA work? Inhibition of DNA-dependent RNA polymerase, therebyblocking mRNA synthesis

What is the c/u of Rifampin? TB*Meningiococcal Prophylaxis*Close contacts of Pt's withHib*Delays Dapsone resistence in the TX of Leprosy



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What is the c/u of Aztreonam? G- Rods

What pt's is Aztreonam used to TX? Pt's who cannot tolerate AMG's*OR*Pt's who are allergic toPenicillin*OR*Pt's in Renal Failure

With what is Imipenem co-administered? Why? Cilistatin*Prevents breakdown of Imipenem by inhibiting renaldihydropeptidase-1

What is the c/u of Imipenem/cilistatin? Enterobacter



What is a 3rd Gen Ceph used for the TX of Gonorrhea? Ceftriaxone & Cefixime

What are the Cephalosporins used for the TX of Gonorrhea? TRI to FIX a FOX*Ceftriaxone (3rd Gen)*Cefixime (3rdGen)*Cefoxitin (2nd Gen)


What is the MOA of Azithromycin? Inhibits Macroslide (macro = 50s; slide = translocation)*Blockstranslocation from the A --> P site by binding the 23s subunit ofthe 50s ribosome

What is the c/u of Macrolides? UPS Lost My Brand New Car*URI's (caused by G+cocci)*Pneumonia (caused by G+ cocci)*STD's (caused by G+cocci)*Legionella*Mycoplasma*Bordatella*Neisseria*Chlamydia

What is an alternative MOA of Erythromycin? Binds to motilin receptors, causing hypermotility motility --> GIupset

What is the toxicity of Macrolides? Acute cholestatic hepetatis*Eosinophilia

MOA of Tetracyclines? Protein synthesis inhibition by preventing amino acyl tRNAattachment

What is the c/u for Tetracyclines? VACUuM The BR*Vibrio Cholerea*Acne (PropionibacteriumAcnes)*Chlamydia*UreaplasmaUrealyticum*Mycoplasm*Tularemia*H.Pylori*Borrelia*Rickettsia

What is the toxicity of Tetracyclines? Discoloration of teeth (children)*Abnormal bone growth

(children)*Photosensitivity*Drug-induced Hepatitis*FanconiSyndrome (old Tetracyclines)

What is an alternative MOA of Demeclocycline? Blocks ADH receptors

What drugs block ADH receptors? Demeclocycline*Lithium

What is the MOA of Lithium? Inhibition of Phosphoinositol Cascade

What is the c/u for Lithium? Mood Stabilizer

What is the toxicity of Lithium? LMNOP*L = Lithium*M = Muscle rigidity = tremors*N =Nephrogenic Diabetes Insipidus*O = HyOthyroidism*P =Pregnancy = Ebstein's Anomaly*P = Psoriasis Exacerbation


What is the c/u for Chloramphenicol? Bacterial meningitisWhat is the toxicity of Chloramphenicol? Dose-dependent Anemia*Dose-independent Aplastic

anemia*Grey Baby Syndrome (premature infants who lack UDP-glucuronyl transferase)

What drugs inhibit Fungal DNA Synthesis? Flucytosine*Griseofulvin (interfers with microtubule formationthereby inhibiting mitosis)

What drugs INHIBIT Fungal Membrane Synthesis? CAT*Caspofungin*Azoles*Terbinafine

What drugs DESTROY fungal Membranes? Amphotericin B*Nystatin

What is the MOA of Caspofungin? Inhibits Beta-13-Delta-Glucan


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What is the c/u for Caspofungin? CASPofungin*ASPergillosis (invasive)*Systemic Candidiasis

What is the MOA of Terbinafine? Inhibits cell wall synthesis by blocking squaline epoxidase

What is the c/u of Terbinafine? Dermatophytes*Superficial fungal infections

What drugs can be used for Dermatophytes? Terbinafine*Griseofulvin

What is the MOA of Griseofulvin? Binds microtubules, arresting the cell in mitosis

What is the MOA of Amantidine? Prevents viral uncoating*Prevents viral penetration*IncreasesDA

What is the c/u for Amantidine? Influenza A, RubellA & the CerebellA*InfluenzaA*RubellA*Parkinson's (the CerebellA)

What is the MOA of Oseltamivir and Zanamivir? Inhibits viral influenza neuraminidase, decreasing the release ofviral progeny

What is the c/u of Oseltamivir and Zanamivir? Influenza A and B

What is the TX for Influenza C? Acetaminophen**Full Name: N-Acetyl-Para-Aminophenol(APAP)*Other Names: Tylenol (U.S.)*Paracetamol (outsideNorth America)

What is the MOA of Acetaminophen? Tylenol = Acetaminophen*MOA: REVERSIBLY blocks Cox I& Cox II**Full Name: N-Acetyl-Para-Aminophenol(APAP)*Other Names: Tylenol (U.S.)*Paracetamol (outsideNorth America)

What is the TX for acetaminophen toxicity? Tylenol = Acetaminophen*N-Acetylcysteine

What is the MOA of N-Acetylcysteine? Regenerates glutithione & binds toxic metabolite NAPQI

What is the MOA of Ribavirin? Inhibits Guanine nucleotide synthesis by competitively inhibitingIMP Dehydrogenase

What is the c/u of Ribavirin? Chronic Hepatitis C*RSV

What is the TX for chronic Hepatitis C? Ribavirin*INF-alpha

What is the TX for Hepatitis B? INF-alpha*Lamuvidine

What are the SE's of the Lamuvidine? Lactic acidosis

What is the c/u of INF-beta? MS

What is the drug that inhibits Acetyl CoA to ACh? Vesimicol

What drug inhibits the uptake of choline? Hemicholinium

What drug inhibits the release of ACh? Botulinum Toxin

What drug inhibits the conversion of DA to NE? Reserpine

What drug inhibits the release of NE? Guanethidine

What drug stimulates the release of NE? Amphetamine

What drug inhibits the re-uptake of NE? Cocaine*TCA's

What receptor stimulates NE release? Angiotensin II

What receptor inhibits NE release? M1 & a2

What are the direct-acting cholinomimetics? Methanacol*Bethanacol*Carbichol*Pilocarpine

What are the indirect-acting cholinomimetics? Neostigmine*Pyridostigmine*Physostigmine*Edrophonium*Echothiophate*Rivastigmine*Galantamine*Tacrine*Donepezil

What are the indirect cholinomimetics used in the TX ofGlaucoma?

Physostigmine*Echothiophate

What indirect cholinomimetic crosses the BBB? Physostigmine

What indirect cholinomimetic is used to reverse NMJ blockade? Neostigmine

What drug caused the NMJ blockade? SuccinylCholine

What drug reverses Phase I of SuccinlyCholine? None; Phase I is IRREVERSIBLE

Why can't Phase I of depolaring muscular blockade be reversed? It CAN'T be reversed b/c post synaptic membranes are stuck indepolarization

What drug reverses Phase II of SuccinlyCholine? Neostigmine


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For what is N-Acetylcysteine used to reverse? Acetaminophen toxicity

How does AChE-I poisoning present? ADDUMBBELSS*Abdominalcramping*Diaphoresis*Diarrhea*Urination*Miosis*Bradycardia*Bronchospasm*Excitation of skeletalmuscle*Lacrimation*Secretion*Salvation

What is the TX for AChE-I poisoning? Atropine followed by...*Pralidoxime (2-PAM)

What is the MOA of Atropine? AChE-Inhibitor

What are the affects of Atropine? Blocks SLUD (anti-PS):*Salivation*Lacrimation*Urination*Defication

What is toxicity of Atropine? Dry as a Bone: Dry eyes/skin (dec'd lacrimation/dec'dsweat)*Hot as a Hare: Warm skin (dec'd sweat --> reflexvasodilation)*Red as a Beet: Flushing (reflex vasodilationsecondary to dec'd sweat)*Blind as a Bat: Mydriasis/Cycloplegia(dec'd PS's)*Mad as a Hatter: Confusion/Disorientation (CNSeffects on M4/M5 rec's)**NOTE: Decr'd sweating (SS responseunder PS control) --> *incr'd body temp --> compensatorycutaneous vasodilatory response --> *REFLEXVASODILATION

What is the MOA of Fenoldopam

D1 Agonist

What is the TX for Type II Heart Block? Atropine followed by*Pacemaker

What is the MOA of Epinephrine? B1 > B2 > a1 > a2

What is the MOA of Isoproterenol? B1 = B2

What is the MOA of NE? a1/a2 > B1

What is the MOA of Dobutamine? Dobutamine has a B*B1 > B2

What is the MOA of DA? DA has a D*D1 = D2 > B > a

What is the MOA of PE? a1 > a2

What is the MOA of Terbutaline? B2 > B1

What is the MOA of Cocaine? Inhibits reuptake of NE

What is the MOA of TCA's? Block the reuptake of NE & 5-HT

What is a heterocyclic that inhibits the reuptake of 5-HT? TrazadoneWhat is a heterocyclic that inhibits the reuptake of NE? Maprotiline

What is the MOA of Mirtazapine? a2-antagonist*5-HT-2 & 5-HT-3 antagonist

What drug blocks 5-HT-3 receptors only? Ondansetron

What drug blocks 5-HT-1D receptors? Nothing, h/w Sumitriptan is a 5-HT-1D AGONIST

What is the MOA of Venlafaxine? Block the reuptake of NE, 5-HT, & DA

What are 2 anti-depressants used to TX a pt w/sleepdisturbances?

Trazodone*Mirtazapine

What is the DOC for a pt w/depression & sexual dysfunction? Bupropion

What is the TX for generalized anxiety in a pt with a hx of Etohaddiction?

Buspirone

What is the TX for generalized anxiety in a pt with no hx of Etohaddiction?

Benzodiazapines

What is the MOA of Tranylcypromine? Non-selective MAO-I

What are the MAO-I's? PITS*P = Phenelzine*I = Isocarboxazid*T =Tranylcypromine*S = Selegiline

What is the difference in selectivity between the MAO-I's? Non-selective = MAO-IA (A forAnywhere)*Phenelzine*Isocarboxazid*Tranylcypromine**Selective = MAO-IB (B for Brain)*Selegiline

What is the c/u for the Non-selective MAO-I's? Atypical Depression*Anxiety*Hypochondriasis*(Non-selectiveMAO-I's = Tranylcypromine & Phenelzine)


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What is the c/u for the selective MAO-I? Selective MAO-I = Selegiline*c/u = Anti-Parkinsonian

What is the DOC for OCD? Paroxetine

What is the 2nd line TX for OCD? Chlormipramine

What is the MOA of Chlormipramine? Block the reuptake of NE & 5-HT (TCA's)

What are the TCA's? CANDID (PASS Program uses DDCAIN)*Clomipramine*Amitriptyline*Nortriptyline*Desipramine*Imipramine*Doxepin

Which TCA is LEAST sedating? DesipramineWhich TCA has the MOST anti-cholinergic SE's? Amitriptyline

Which TCA has the LEAST anti-cholinergic SE's? Nortriptyline

What is the TX for enuresis (bedwetting)? DOC = Desmopressin (similar to ADH --> H2ORetention)*TCA = Imipramine

What is the DOC for diabetic neuropathy? Any TCA

What is 2nd line TX for diabetic neuropathy? Gabapentin

What is the MOA of Gabapentin? GABA Agonist

What are the GABA-Agonists? GBPTV*Gabapentin*Benzodiazepines*Phenobarbital*Topiramate*Valproic Acid

What NT's &/or ions does Topiramate and Valproic Acid affect?What direction?

Inrease GABA*Decrease Na+

What drugs decrease Na+ & is used for the TX of epilepsy? Long-TermCPA*Lamotrigine*Topiramate*Carbamazepine*Phenytoin*Valproic Acid (A = Acid)

What is the DOC for a pt with upper limb spasticity and lowerlimb flaccidity?

Riluzole

What is the MOA of Riluzole? Glutamate Inhibitor

What are the drugs that cause Agranulocytosis? Clozapine*Colchicine*Carbamazepine*PTU*Dapsone*Ticlopidine*Methimazole

What is the TX for Restless Leg Syndrome? DA Agonist

What are the DA Agonists? CPR

LAB*Cabergoline*Promipexole*Ropinerole*Levadopa/Carbidopa*Amantidine*Bromocriptine

What are the D2 Antagonists? D2 Antagonists =Neuroleptics:*Fluphenazine*Thioridazine*Haloperidol*Chlorpromazine*Promazine

What are the SE(s) of D2 Antagonists? EPS Sx's*Neuroleptic Malignant Syndrome


What are 3 features of Serotonin Syndrome? CV Collapse*Hyperparexia*Muscle Rigidity

What is the Tx for Neuroleptic Syndrome? Dantrolene AND Dopamine Agonist


4 Hrs: Dystonia (sustained muscle contractions causing twistingand repetitive *movements or abnormal postures)*4 Days:Akinesia (inability to initiate movement due to difficultyselecting *&/or activating the movement pathway)*4 Wks:Akathisia (unpleasant sensations of inner restlessness thatmanifests *itself with an inability to sit still or remainmotionless)*4 Mos: Tardive Dyskinesia (disorder resulting ininvoluntary, repetitive body *movements having a slow orbelated onset)

If 87.5% of a drug has been eliminated from the body, how manyhalf-lifes have occurred?

3 half-lifes

If 50% of a drug remains in the body, how many half-lifes haveoccurred?

1 half-life


27/36

27

How is half-life calculated? T1/2 = Vd/Cl x 0.7

How is Loading Dose calculated? LD = (Css x Vd) / f


How is Clearance calculated? Cl = Amount eliminated / Css

What are 3 drugs that undergo zero-order elimination? EPA*Ethanol*Phenytoin*Aspirin (high dose)

What are the Phase II elimination reactions? GAS (you get flatualance when you have to go#2)*Glucoronidation*Acetylation*Sulfonation

What are the Phase I elimination reactions? HOR*Hydrolysis*Oxidation*Reduction

Which elimination phase (I or II) is lost first? Phase I

What question is answered by Phase I drug development? Is it safe?


What question is answered by Phase III drug development? FDA double-blind study

What question is answered by Phase IV drug development? Post-market surveillance: What SE's exist?



It doesn't: potency (Km) is not affected

What direction does a competitive antagonist shift the efficacycurve (right, left, up, or down)?

It doesn't: efficacy (Vmax) is not affected


What are the 50s Inhibitors? CCELLS (Buys AT 30 CCELLS at50)*Chloramphenicol*Clindamycin*Erythromycin(macrolides)*Lincomycin*Linezolid*Streptogramins







Rifampin

What blocks DNA Topoisomerase II? Quinolones

What drugs destroy fungal AND bacterial membranes? Polymixins (Polymixin B & Polymixin E)

What is the toxicity of Polymyxins? ATN (acute tubular necrosis)*Neurotoxicity

What is the MOA of Penicillins? 1) Bind PBP's*2) Activate autolytic enzymes*3) I

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