Flashcards
Pharmacology V (100 Flash Cards)
Cards in this deck (100)
- 1describe the mechanism of action of local anesthetics on the nerve axon.decreases sodium uptake through sodium channels of the axon. this decreases the nerves excitability below a critical level and nerve impulses fail to propagate along the axon.
**** local anesthetics have no effects on potassium at the nerve axon. - 2what are some adverse side effects of local anesthetic?toxicities and allergies.
toxicity: too much leads to toxicities to the cns and cardiovascular system. CNS effects include restlessness, stimulation, tremors, convulsive seizures, followed by cns depresion, slowed respiration and even coma. Cardiovascular effects include bradycardia and reduction of cardiac output.
allergy: hypersensitivities or allergic reactionsot local anesthetics, particularly from amides are rare. usually manifested as dermatological reactions and edema at injection site. asthmatic wheezing syndromes have occured. allergic reaction are more prevalent with ester-type rahter htan amide-type.
- ester local anesthetic allergic manifestations include nasolabial swelling, itchinga nd oral mucosal swelling. - 3the amide local anesthetics are metabolized primarily in the ?liver - use with caution for all patients with compromised liver function.
- 4which amide type local anesthetic has the longest duration of action?bupivacaine (marcaine) has the longest duration of action of any dental local anesthetic presently available.
carbocaine (mepivacaine) 3% has 20 minutes or 40 minutes duration depending on route (infiltration and IAN block)
citanest plain (prilocaine) 4% has 20 min & 2.5 hr.
citanest forte w/ epi (prilo) 4% has 2.25 hrs and 3 hrs.
lido 2% w/ epi has 60 and 90 minutes
marcaine (bupivacaine) 0.5% w/ epi has 60 min and 5-7 hrs.
articaine 4% w/ epi has 60 min and 60 min. - 5the following drugs belong to what pharmaceutical class of agents: darbepoetin alfa, pegfilgrastim, and sargramostinanswer: colony stimulating factors
darbeoetin: induces erythropoiesis by stim division and differentiation of erythroid progenitor cells. used to treat anemia associated with chronic renal failure
pegfilgrastim: stim production, maturation, and activation of neutrophils. decreases the incidence of infection by stimulation of granulocyte production in patients iwth nonmyeloid malignancies.
sargramostin: used for myeloid reconstitution after autologous bone marrow transplantation.
(myeloid cells describe any cells that are leukocytes but not lymphocytes) - 6exemestane (Aromasin) and letrozole (Femara) are anticancer drugs classified under what category?aromatase inhibitors
-- exemestane is an irreversible steroidal aromatase inactivator. prevents the conversion of androgens to estrogens by tying up the enzyme aromatase. in breas cancers wehre the growth is estrogen dependent, this drug will lower circulating estrogens.
--- letrozole (Femara) works like exemestane. it is used as a first line treatment of hormone receptor positive or metastatic breast cancer in postmenopausal women. it is also indicated as an extend adjuvant treatment of early breast cancer in post menopausal women who hae received 5 years of adjuvant tamoxifen therapy. - 7your patient has a history of breast cancer and is undergoing chemotherapy with a drug called cisplatin (platinol). What are the drug's expected adverse effects?nausea and vomiting (75-100% dose related)
hair lose (alopecia)
xerostomia
changes within the tissues of hte oral cavity such as mucositis.
mucosisits is a common reaction to cancer chemotherapy. it is an inflammation of hte mucousmembranes. during chemo and radiation therapy, mucosal tissues begin to desquamate and develop into ulcerations. the mucosal integrity is broken and is secondarily infected by the oral flora.
palliative tx is indicated for mucositis. - 8What type of drugs are methotrexate, doxorubicin, and 5-fluorouracil?anti-neoplastics
*** these are commonly associated with the development of oral mucositis - 9which complication is most likely seen with chemotherapy treatment?alopecia.
this occurs one to two weeks after treatment. other common side effects include GI upset, increaed incidence of infection (especially candidiasis) and degeneration of lymphatic tissue.
most chemotherapy agents have shown to be teratogenicin humans and should be avoided by pregnant women - 10name the 8 classes of drugs used in cancer chemotherapy.1. alkylating agents - alkylate DNA so it can't replicate.
--- ie Cisplatin and cyclophosphamide.
2. anthracyclines - destroy DNA so ca'nt replicate
--- ie daunorubicin and doxorubicin
3. antibiotics
--- ie dactinomycin
4. antimetabolites - interfere with biochem rxn needed for cell growth.
--- ie 5-FU (fluorouracil), 6-Mercaptopurine and methotrexate.
5. antimicrotubular inhibits cell mitosis
--- ie pupular agent is paclitaxel (taxol)
6. antiestrogen - blck tumors on which estrogen has a stimulatory effect.
--- ie tamoxifen (Nolvadex)
7. vinca alkaloids - these are mitotic spindle posons
-- ie vinblastine and vincristine
8. gonadotropin hormone releasing antigen - inhibits gonadotropin secretion which is effective in reducing certain carcinomas.
-- ie leuprolide.
- asparaginase deprievs tumor cells of certain amino acids such that protein production is blocked.
- interferon boos the immune system. - 11antimetabolites are cell cycle specific drugs acting primarily in which phase of the cell cycle?S phase of the cell cycle. The S phase of the cell cycle = DNA synthesis.
- these antimetabolites attack the cells in the S phase of reproduction cycle by interfering with the biosynthesis of the purine and pyrimidine bases.
Go phase is the resting phase of the cell cycle.
methotrexate is a folic acid analog - choriocarcinoma, leukemia in spinal fluid, osteogenic sarcoma, beast cancer and head and neck cancer.
flurorouracil (5-FU) and floxuridine are pyrimidine analogs. 5-FU used in some head and neck cancers.
mercaptopurine and thioguanine are purine analogs. used to treat leukemias. - 12alkylating agents are most effective in treating?chronic leukemias, lymphomas, myelomas, and carcinomas of the breast and ovary.
- alkylating agents are a diverse group of compoundswhich all form alkyl bonds to nucleic acids. these agents share similar mech of action and mech of resistance.
- the alkylating agents form covalent bonds with nucleic acids and prtien. the N7 position of guanine is a common binding site.
- mechlorethamine, cyclophosphamide, chlorambucil, and melphalan are nitrogen mustards.
- carmustine, lomustine, and semustine are nitrosureas.
- myleran is a busulfan - 13name the common pharmalogic antagonist of aldosterone in the collecting tubule.spironolactone (aldactone)
- potassium-sparing diuretcs result in increased sodium and decreased potassium concentrations at hte end ofhte distal convuluted tubules. there are two categories of potassium spariing diuretics.
1. antagonist of aldosterone in the collecting tubules. spironolactone has been found to be effective in the treatment of primary aldosteronism. it may be useful in the treatment of heart failure because hyperaldosteronism is commonly seen in this condition.
2. block the osdium channels in the collecting tubules. triamterene (dyrenium) and amiloride (midamor)
*** toxic side effect of these potassium sparing diuretics is hyperkalemia.
Aldosterone is a hormone that increases the reabsorption of sodium ions and water and the release (secretion) of potassium in the collecting ducts and distal convoluted tubule of the kidneys' functional unit, the nephron. This increases blood volume and, therefore, increases blood pressure. Drugs that interfere with the secretion or action of aldosterone are in use as antihypertensives. One example is spironolactone, which lowers - 14name the three categories of widely used diuretics- treats chf by relieving edema and symptoms of dyspnea arising from pulmonary congestion.
1. thiazides - inhibit soidum reabsorption in the distal portion of hte rneal tubule within the kidney causing increaed excretion of sodium and water.
--- ie hydrochlorothiazide (HCTZ)
2. loop diuretics - inhibits reabsorption of sodium and chloride in the ascending loop of henle, thus causing increased secretion of water, sodium, and chloride.
--- prototype agent is flurosemide (lasix)
3. potassium sparing diuretics - conserve potassium while causing diuresis. thus no potassium is lost from the body as is the case with other diuretics such as the thiazides and the "loops."
--- ie spironolactone (aldactone) and triamterene (dyrenium)
- triamterene promotes sodium and water excretion while retaining potassium.
- spironolactone (aldactone) which competes with aldosteone receptor sites in renal tubules causing increased secretion of sodium, chloride, and water while conserving potassium. - 15what type of drug is dyazidebrand name for the combination of triamterene (Dyrenium) and hydrochlorothiazide (HCTZ)
- 16how does insulin affect protein synthesis?insulin increases protein synthesis.
(also increases triglyceride storage, increases glycogen synthesis, and decreases gluconeogenesis).
insulin is secreted by the pancreatic beta-cells of hte islets of Langerhans an dis essential for hte metabolism of glucose and for hte homeostasis of blood glucose.
the four types of insulin are ultra-rapid acting, rapid acting, immediate acting, and long acting. - 17How do most drugs travel through the blood stream?Most drugs travel through the blood steram by binding to ALBUMIN PROTEIN. this is abundant in plasma. this way drugs are carried toall the tissues and organs.
- a drug which is bound to plasma albumin always has some fraction which is not bound. the unbound portion is free to leave the blood compartment and to be taken up by tissues wehre they elicit hte pharmacological effect. the reamining bound fraction of hte drug then coninuously releases mroe free drug to be taken up by the tissues.
- this is important to understand for drug interactions!. if drug A is administered first and then drug B (which hhas a stronger binding affinity to albumin than A) is administered later it will displace drug A from albumin resulting in large amounts of UNBOUND drug A whihc could lead to adverse reactions. - 18oral contraceptives block ovulation by inhibiting which anterior pituitary hormones?follicle stimulating hormone (FSH) and luteinizing hormone (LH).
- they also produce alterations in the genital tract, including changes in cervical mucus, rendering it unfavorable for sperm penetration even if ovulation occurs. changes in the endometrium also occur rendering it unfavorable for nidation (implantation of the fertilized ovum) - 19oral contraceptive agents usually contain both an ______ agent and a _______ agent.estrogenic agent and a progestational agent.
- estrogenic are ethinyl estradiol and mestranol.
- progestational agents include levonorgestrel, norethindrone, norgestimate, and norgestrel - 20all of the following are central neurotransmitters. which elicit major excitatory effects within the cns? - acetylcholine - dopamine - norepinephrine - serotonin - gamma-aminobutyric acid - opioid pepieds like beta-endorphin, enkephalins, dynorphin - glutamate - aspartate- glutamate and aspartate
*** both of these amino acids have powerful excitatory effects on neurons in virtually every region ofhte cns.
- GABA is the major inhibitory transmitter in the cns.
- dopamine, norepinphrine, and epinephrine are all CATECHOLAMINEs. - 21list the prominent toxic effects of mercury.- loosened teeth, excessive saliva, gum disorders, slurred speech, tremors, and irritability.
- these are all the chronic form!
- Hg in body is determined by urien test.
British Antie-Lewisite (BAL) or Dimercaprol forms a stable complex with mercury and allows it to be excreted as an inactive compound.
- mercury is not collected irreversibly in human tissues.
average half life of 55 days for transport through the body to the point of excretion. - 22name a drug used to treat diarrhea (reduce GI motility)- Loperamide (Imodium) and Diphenoxylate and atropine (lomotil)
- Loperamide (Imodium) is an anti-diarrheal which acts on the intestinal muscles to inhibit peristalsis. It is a member of the OPIOID family. It does NOT cross the blood brain barrier like codeine.
- Lomotil requires a prescription due to the atropine.
atropine It is a competitive antagonist for the muscarinic acetylcholine receptor.
Atropine increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart, opposes the actions of the vagus nerve, blocks acetylcholine receptor sites, and decreases bronchial secretions.
In general, atropine lowers the parasympathetic activity of all muscles and glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system). Therefore, it may cause swallowing difficulties and reduced secretions. - 23dexmethylphenidate and atomoxetine (Strattera) is used to treat what condition?attention deficity hyperactivity disorder (ADHD)
- Methylphenidate (Ritalin) - mild cns stimulant. rsults in an increase in attention psan, reduction in hyperactivity, and improvement in behavior.
- focalin - a new form of methylphenidate called dexmethylphenidate
- concerta - a long acting form of methyphenidate
- adderall -brand name for mixed amphetamine salts which as the same as methylphenidate in treating adhd
- strattera - brand name for atomoxetine, first non-stimulant approved for treating adhd.
- metadate cr - brand name for a controlled delivery methylphenidate, another long acting form of the drug. - 24amphetamine description from wikipediaSubstituted amphetamines are a chemical class of stimulants, entactogens, hallucinogens, and other drugs. They feature a phenethylamine core with a methyl group attached to the alpha carbon resulting in amphetamine, along with additional substitutions. Examples of amphetamines are amphetamine (itself), methamphetamine, ephedrine, cathinone, MDMA ("Ecstasy"), and DOM ("STP").
Amphetamine derivatives occur in nature, for example in the leaves of Ephedra and khat plants. These have been used since antiquity for their pharmacological effects. Amphetamines were first produced synthetically at the end of the 19th century. By the 1930s such synthetic amphetamines found use as decongestants in the symptomatic treatment of colds and also occasionally as psychoactive agents. Their effects on the central nervous system are diverse, but can be summarized by three overlapping types of activity: psychoanaleptic, hallucinogenic and empathogenic. Various amphetamines may cause these actions either separately or in combination. Improper consumption of amphetamine derivatives may result in addiction - 25chronic caffeine consumption can cause the following symptoms:- feelings of anxiety and nervousness
- sleep disruption
- irritability
- diuresis
- stomach complaints
- palpitations and arrhythmias
Caffeine toxicity is thought to occur if intake is around 600-750 mg/day. A cup of coffee has 100-150 mg of caffeine. A soda has abotu 50 mg. Vivarin has around 200 mg per serving. - 26all are CNS stimulants except: pentylenetetrazol (metrazol) doxapram (dopram) phenobarbital nikethamide (coramine) picrotoxin strychnineanswer : phenobarbital!
***** phenobarbital is a barbituate (sedative -hypnotic)
the others listed are analeptics and respiratory stimulants (pulmonary disease or hasten recovery form general anesthetic) - 27define the term analepticrefers to a cns stimulant which has the ability to overcome drug-induced respiratory depression and hypnosis. In the past cns stimulants were widely used, but today limited clinical application.
- 28caffeine, theophylline, and theobromine are all what type of drug?xanthines.
- stimulants that improve mental alertness, reduce the urge to sleep and elevate mood.
- theophylline and theobromein are weaker cns stimulants than caffeine.
- theophylline is hte only xanthine impoortnat i the treatme of asthma...stimulates respiratory centers of the medulla nad is able to cause bronchial dilation in patients w/ asthma.
sympathomimetic amines include amphetamines and other related agents like methylphenidate and phennmetrazine which are potent cns stimulants. used to treat narcolepsy, obesity and attention deficit disorder. - 29Bromocriptine (Parlodel) and Pergolide (Permax) are prescribed to treat?Parkinson's disease.
- In parinson's - nerve cells in the basal ganglia degenerate, resulting in lower production of dopamine. Treated but not cured.
- levodopa is the precursor to dopamine. It is the MAIN treatment for pt's with Parkinson's diseae. It is given in combination with carbidopa.
- bromocriptine or pergolide are dopamine agonsits which are often given in additio to levodopa early in tx to enhancelevodopa..or alter when levodopa's side effects are more of a problem.
- selegiline is a selective inhibitor of MAO type B , this enzyme is responsible for the oxidative deamination of dopamine in the brain.
- amantadine - appears to potentiate dopaminergic responses.
- anticholineric drugs like benztropine and trihexyphenidyl . - 30all of the following are skeletal muscle spasmolytic drugs except: - methocarbamol (Robaxin) - cyclobenzaprine (Flexeril) - Baclofen (Lioresal) - Succinylcholine (Anectine) - Carisoprodol (Soma)all except : succinylcholine
*** this is the prototype depolarizing neuromuscular blocking drug.
spasmolytic drugs relieve muscle spasms wihtout paralysis. they act in the cns or in the skeletal muscle cell rather then the neuromuscular end plate!!!
- they are used in certain chronic diseases of hte cns like ms, cerebral palsy and cerebrovascular accidents. the drugs used to treat chronic and acute muscle spasms.
chronic
- baclofen is a derivative of gaba..reduce spasms in spinal cord...tx ms and other spinal cord diseases.
- carisoprodol (soma) used to treat ms spasms and pain associated with acute temporomandiublar joint pain.
acute muscle spasms
- cyclobenzaprine - central action ...relieves acute, painful musculoskeltal conditions. it is NOT effective for muscle spasms secondary to cerebral or spinal cord disease.
- methocarbamol - used in mgnt of tetanus and used ot relieve acute, painful musculoskeletal conditons. - 31name a popular drug to help relieve acute, painful musculoskeletal pain associated with acute temporomandibular joint pain:carisoprodol (Soma)
- for chronic pain that has acute tmj affects. - 32define and list catecholamines.catecholamines are any one of a group of symapthomimetic compounds composed of a catechol molecule and the aliphatic portion of an amine. some are produced naturally and are calle dendogenous (epi, norepi, dopa).
*** epinephrine, norepinephrine and isoproterenol are considered to be direct acting catecholamines.
sympathomimetics that ar ecatecholamines are:
epi, norepi, dopamine, dobutamine, and isoproterenol.
sympathomimetics that are not catecholamines are:
amphetamine/phenmetrazine, ephedrine, phenylephrine, albuterol / metaproterenol / terbutaline, and oxymetazoline / xylometazoline. - 33the following drugs are useful in the treatment of what medical condition? - colchicine, probenecidGOUT
gout meds are colchicine, indomethacin, sulfinpyrazone, probenecid, allopurinol.
- three aspects of disease
1. reduce inflammation during acute attacks.
- colchicine may be used (serious side effects) and nsaid's like indomethacin may be used.
2. decrease uric acid production..... allopurinol ( Zyloprim) drug of choice for chronic gout. it inhibits xanthine oxidase, an enzyme that converts hypoxanthine to xanthine, and xanthine to uric acid....
3. enhance uric acid clearane
-- probenecid (Benemid) and sulfinpyrazone (anturane). act on kidney and inhibit the secretion of other weak acids and inhibit reabsorption of uric acid. - 34a pt needs antibiotics for an oral infection. this pt also has chronic gout. what concerns might you have?one concern is if the patient is taking the drug probenecid (Benemid) to increase uric acid clearance. While this helps clear uric acid, it inhibits secretion of other weak acids like penicillin. Normally cephalosporins and penicillins have to be given in high and frequen doses due to their high rate of elimination by the kidneys. Their excretion is SLOWED by giving probenecid!
- 35somatotropin is produced by?somatotropin (aka growth hormone GH) is produced by and secreted form the anterior pituitary gland.
- inc rate of protein synthesis
- decreased rate of carbo utilization
- inc mobilization of fats and use of fat for energy.
- gh usually given subcut inj or intramuscular injection 3x/week - 36ethyl alcohol cuases a well-marked diuresis by inhibiting the production of which hormone?vasopressin .... aka antidiuretic hormone (ADH).
- ADH decreases urine y inc reabsorption of water by the renal tubules. w/out adh there would be extreme loss of water into the urine.
- ethanol (ethyl alcohol) inhibits the adh production.
- ethyl alcohol also dilates blood vessels of hte skin and depresses the cns. - 37inhaled ammonia is the drug of choice for acting against?syncope
- it irritates the trigeminal nerve sensory endings, resulting a reflex stimulation of medullary respiratory and vasomotor centers.
*** oxygen will aid in combating tisue anoxia
symptoms of syncope include beads of sweat on the upper lip, a weak thready pulse, cold clammy skin, pallor and dzzy feeling. loss of norma vasomotor tonus produces pooling of blood peripherally so normal blood volume becomes insufficient.
*** place patietn in a supine position and elevate the feet to give the pt a transfusion of whole blood . - 38list the types of syncope-vasovagal
- neurogenic
- orthostatic
- hyperventilation syndrome
----- tx vaasovagal, neurogenic, and orthostatic with 100% high flowing oxygen!
----- 100% oxygen is contraindicated for a person who suffers from copd.
In healthy people, high levels of carbon dioxide is what triggers respiration (to help get rid of the carbon dioxide), but because people with COPD are used to having high levels of carbon dioxide their bodies become immune to it and respiration in this case is triggered by low levels of oxygen. Therefore if you give a person with COPD high concentrations of oxygen, you are removing their trigger to breath, leading to respiratory depression or even arrest (stop breathing completely). This is known as hypoxic drive (hypoxia means low levels of oxygen)
The respiratory drive is normally largely initiated by PaCO2 but in chronic obstructive pulmonary disease (COPD) hypoxia can be a strong driving force and so if the hypoxia is corrected then the respiratory drive will be reduced. There will also be a loss of physiological hypoxic vasoconstriction which is partly protect - 39list the aluminum salts used as antacids:hydroxide
carbonate
phosphate
aminoacetate
*** aluminum hydroxide is themsot potenet of these but has less neutralizing capacity than calcium carbonate or sodium bicarbonate (the only systemic antacid).
sodium bicrabonate - alka-seltzer
calcium carbonate - tums
aluminum hydroxide - amphojel
magnesium hydroxide - milk of magnesia
bismuth salt products - pepto biasma
magnesium and aluminum - Maalox and Mylanta - 40disulfiram is used in the mgmt of ?ETHANOL ABUSE
- it isn't a cure for alcoholism, but a deterrent. it is an antioxidant that interferes with hepatic oxidation of acetaldehyde metabolized from alcohol. it inhibits aldehyde dehydrogenase (mitochondrial enzyme found in the liver). it is a deterrent....even small amounts of ethanol results in high concentrations of acealdehyde and unpleasant reaction called disulfiram-ethanol reaction or DER...... throbbing headache, dyspnea, throbbin in neck, nausea, copious vomiting, thirst, tachycardia, and hypotension. metronidazole also inhibits aldehyde dehydrogenase.
ethanol is a sedative...other alcohols are methanol and ethylene glycol.
drugs synergistic with ethanol include diazepam, meperidine, pentobarbital and chlorpromazine.
diazepam - aka valium - a benzodiazepam
meperidine -aka demerol - fast acting opioid analgesic
pentobarbital - short acting barbituate (seizures/sedation)
chlorpromazine - first phenothiazine antipsychotic (sedates) - 41which substance is an enzyme formed in the kidney and released into the bloodstream where it has an important role in the formation of angiotensin?renin
- reniin is a proteolytic enzyme produced by and stored in the juxtaglomerular apparatus that surrounds each arteriole as it enters a glomerulus. Renin acts on the precursor substance angiotensinogen, which is manufactured by the liver and is present in the blood.
- Renin converts angiotensinogen to angiotensin 1. In turn, angiotensin 1 is converted to angiotensin II by a converting enzmye associated with the walls of capillaries, paricularly in the lungs (ACE) .
- Angiotensin II is a POTENT VASOPRESSOR. It is note only increases in total peripheral resistance but, by stimulating aldosterone release, leads to an increase in plasma volume, venous return, stroke volume, and ultimately cardiac output.
- wrong answers were plasmin, lysozyme, and heparin. Heparin come from the word "hepar .... liver....coagulation stuff."
Heparin is a naturally occurring anticoagulant produced by basophils and mast cells.[10] Heparin acts as an anticoagulant, preventing the formation of clots and extension of existing clots within the blood. While heparin does not break down clots that have alrea - 42name the high molecular weight heteropolysaccharide that is found especially in the lungs and inactivates thrombin and other coagulation factors and thus prevents blood clotting.heparin
- wrong answers were prothrombin, fibrin, and plasmin.
- Heparin is contained within mast cells and basophils. these cells occur in connective tissue and in extracellular spaces near blood vessels, particularly the lungs. Heparin neutralizes tisue thromboplastin and blocks thromboplastin generation.
- administering heparin to a pt increases bleeding time (antithrombin III inactivates thrombin so prevents fibrinogen to fibrin.
- Plasmin is a serine protease that acts to dissolve fibrin blood clots. Apart from fibrinolysis, plasmin proteolyses proteins in various other systems: It activates collagenases, some mediators of the complement system and weakens the wall of the Graafian follicle (leading to ovulation). It cleaves fibrin, fibronectin, thrombospondin, laminin, and von Willebrand factor. Plasmin, like trypsin, belongs to the family of serine proteases. - 43Your pt's medication history includes modafinil (Provigil) ......why is your patient taking this drug ?- improve wakefulness during daytime sleepiness
- a cns stimulant. also treats atha (attention deficit/hyperactivity disorder)
- mechanism unknown...likely decreases GABA mediated neurotransmission.
- it is also thought to increase high frequency alpha waves while decreasing both delta and theta activity, thus increasing mental alertness. - 44The following drugs belong to what pharmaceutical class of agents: adalimumab, alefacept, infliximab, trastuzumab- monoclonal antibodies
adalimumab (Humira) is a recombinant monoclonal antibody that binds to human tumor necrosis factor alpha receptor sites. it is used to treat active rheumatoid arthritis.
alefacept (amevive) treats severe plaque psoriasis - 45the following drugs belong to what pharmaceutical class of agents: pimecrolimus; sirolimus, tacrolimus?immunosuppressants
- Pimecrolimus (Elidel) tx mild to moderate atopic dermatitis
- Sirolimus (rapamune) tx prophylaxis of organ rejection in patients receiving renal transplants.
- tacrolimus (protopic) is an imunosuppressant agent used to treat mod to severe atopic dermatitis in patients not responsive to conventional therapy. - 46Granisetron (Kytril) and ondansetron (Zofran) are selective 5-HT3 receptor antagonists used to treat what condition?- emesis caused by cancer chemotherapy.
- 5-HT3 receptor is a serotonin receptor which when activated during chemo for cancer, causes emesis (nausea and vomiting). Both granisetron and ondansetron are indicated for proophylaxis chemo related emesis,
- also treats PONV ----- post operative nausea and vomiting.
- 5HT3 stands for 5-hydroxytrypamine type 3 receptor. - 47carbidopa is used to treat what disease? what must it be used with.Carbidopa us used in conjuction with levodopa to treat Parkinson's disease.
- carbidopa reduces the levodopa needed because levodopa would be quickly metabolized before it could reach the brain. carbidopa inhibits the peripheral decarboxylation of levodopa. this reducs likelihod of peripheral side effects and allows more levodopa to reach the brain.
- carbidopa does not cros the blood-brain barrier. levodopa is converted to dopamine in the brain. - 48which antiarrhythmic agent is effective only on the ventricle and is often administered IV to treat life threatening ventricular arrhythmias?lidocaine utilized IV
- acts on fibrillating ventricles to decrease the cardiac excitability and spares the atria. it can effectively reverse a life threatening situation.
- Quinidine is a prototype anti-arrhythmic used primarily to treat atrial fibrillation. it is not effective in treating life threatening ventricular fibrillation. - 49Triazolam (Halcion) is a pre-operative sedative used in dentistry, it is metabolized in theliver by the P-450 isoform CYP3A4 enzyme. Drugs which inhibit the actions of CYP3A4 would affect triazolam in which way? (hint - relate to serum levels)- cause in increase in serum levels of triazolam
- drugs that inhibit hte metabolic pathway may have a profound effect on the clearance of triazolam. could result in unexpected increase in actions of triazolam. - 50which drugs are common contraindications for triazolam?antifungal agents can significantly elevate the serum levels of triazolam resulting in toxicity with therapeutic doses. these antifungal agents inhibit the cyp3a4 isoform responsible for hepatic metabolsim of triazolam.
(ie itraconazole, ketoconazole, fluconazole, miconazole, and voriconazole) - 51procaine, cocaine, tetracaine3 main esters
- 52lidocaine, articaine, mepivacaine, prilocaine, bupivacaine5 amides
- 53high levels of local anesthetics in blood streamtoxic reactions from local anesthetics are mostly due to what?
- 54what are lethal side effects from toxic levels of local anesthetics?cardiovascular collapse from myocardial depression
hypotensive shock
methemoglobinemia - 55prilocainelocal anesthetic that causes methemoglobinemia
- 56prevent generation of of nerve impulses by interfering with sodium transportation into the neuronMOA of local anesthetics
- 57only the non-ionized form of local anesthesia can penetrate tissues.... inflamed tissue has low pH which decreases amount of non-ionized form of local anesthesia.Main reason why there may be difficulty achieving profound anesthesia in inflamed tissue
- 58Penicillin V vs penicillin G which one is more sensitive to acid degradation?penicillin G
- 59Which penicillin has the best gram negative spectrum?ampicillin
- 60Which antibiotics will show cross allergic reactions with penicillin?cephalosporin, cephalaxin and ampicillin.
(erythromycin is okay to take with penicillin) - 61Which penicillin is useful against penicillinase-producing bugs such as staphylococcus?Dicloxacillin
- 62What abx is specific for pseudomonas infections?carbenicillin
- 63penicillin kills rapidly growing cellsMOA of penicillin
- 64binds to ergosterol to weaken cell wallMOA of antifungals
- 65bacteriostatic via competition w/PABA in folic acid synthesis--> folic acid deficiencyMOA of sulfonamides
- 66dermatitis, stomatitis, bronchoconstriction, cardiovascular collapseside effects or toxicities of antibiotics
- 67Which agents are most likely or least likely to cause superinfection?most broad spectrum agents like tetracyclines
(least likely are narrow spectrums like penicillins) - 68Aplastic anemia is associated with what antibiotic?chloramphenicol
- 69liver damage or hepatoxicity associated with what antibiotic drug class?tetracycline
- 70antibiotic associated with allergic cholestatic hepatitis?erythromycin estolate
- 71Which 2 antibiotics cancel each other out?tetracycline and penicillin
(opposing actions) - 72What uricosuric agent alters rate of renal clearance of penicillin?probenicid
- 73ingesting antacids or dairy products will reduce effectiveness of what class of antibiotics?tetracyclines
- 74broad spectrum antibiotics enhance the action of COUMADIN because of the reduction of what?vitamin k sources
- 75ampicillinantibiotic that decreases the effectiveness of oral contraceptives due to suppression of normal GI flora involved
- 76macrolides (erythromycin)drug class that inhibits metabolism of drugs such as seldane and digoxin.
- 77acyclovirantiviral for herpes
- 78fluconazole or ketoconazolesystemic antifungals useful for treating candidiasis
- 79What antibitoic is able to achieve higher concentrations in bone than in serum?clindamycin
(that's why it's used for osteomyelitis) - 80What antibitoic achieves high concentration in gingival fluid than in serum?tetracycline
- 81What antibiotic can cause damage to cranial nerve 8, affecting both balance and hearing?streptomycin
(not associated with liver damage) - 82T/F: cephalosporins, other than allergic reactions like penicillin, are very safe with little side effects.true
- 83amphotericin Bantifungal that causes nephrotoxicity and hypokalemia but not liver toxicity
- 84What antibiotic chelates with calcium?tetracyclin
- 85tetracyclineantibiotic that deals with 30s ribosomal subunit
- 86penicillin G and probenicid. (renal excretion of penicillin G is decreased)2 drugs together that decreases renal excretion of 1
- 87erythromycin is contraindicated with what 2 medications?digoxin and seldane
(erythromycin block metabolism of seldane and causes arrhythmias) - 88alpha-1 blockerdrug class of prazosin
- 89central acting adrenergic drugsdrug class of methyldopa and clonidine
- 90neuronal blocker for severe hypertensionguanethidine
- 91nitroglycerin, sometimes propranolol, and calcium channel blockers3 drugs for angina
- 92—drug for ventricular arrhythmia
- 93phenytoindrug to reverse digitalis induced arryhthmias
- 94verapamildrug for supraventricular tachyarryhthmias, paroxymsal arrhythmias, atrial fibrillation
- 95digitalisdrug for atrial fibrillation and paroxysmal arrhythmias
- 96propranololdrug for just paroxysmal arrhthmias
- 97digitalis and digoxin2 glycosides
- 98glycosides and ACE inhibitors2 drug classes for congestive heart failures
- 99quinidine and lidocaine are used to treat arryhthmias.... what's the difference between them?quinidine increases refractory period of cardiac muscle
lidocaine decreases excitability - 100decreasing rate of A-V conductionMOA of digitalis
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- Praxis Flashcards: Pharmacology Flashcards on Pharmacology V (100 Flash Cards), created by ACAPUN INSTITUTE on 13/07/2021.
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