step II

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step II
2010-06-23 11:46:19

HY facts
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  1. allopurinol
    inhibits xanthine oxidase
  2. isoniazid
    • B6 pyridozine deficiency leading to peripheral neuropathy and sideroblastic anermia
    • MOA nicotinic acid derivative that inhibits synthesis of mycolic acid in mycobacterial cell wall
  3. succinylcholine
    • depolarizing agent/muscle relaxant during sugery
    • binds to nicotinic receptors in skeletal muscle causing persistent depolarizaiotn at motor end plate
    • hydrolyzes plasma cholinesterase
    • initial fasciculations followed by muscle paralysis
    • duration of action 5-10min
    • effects not reversed by cholinesterase inhibitors, no pharmacologic antidote to overdose
    • soem pts ahve atypical cholinesterase and canot metabolize the drug - malignant hyperthermia -tx dandrolene?
  4. acetylcholine
    • activates muscarinic and nicotinic receptors.
    • muscariniceffects -
    • pupillary miosis (constracts iris sphincter),
    • accommondation of lens for near vision (contracts ciliary muscles),
    • bronchoconstrictor,
    • slow HR (SA node effect),
    • increase PR inverval (AV node affect),
    • sitmulate GI secretions and motility
    • micturation (stimulate detrusor muscle which relaxes internal sphincter of bladder)
  5. nitric oxide
    • potent casodilator synthesized in endothelial cells
    • activates cGMP - which inactivates myosin light chain kinase in sm muscle cells leading to vasodilation
    • Ach can lead to its synthesis when injected into vessels
  6. Premature contractions
    terbutaline - selective B2 adrenergic agonist tha tinhibits uterine contractions
  7. aspirin effects on kidney
    • decrease PGE2 synthesis (vasodialator) leading to unopposed AT II effect
    • renal papillary necrosis
  8. methotrexate
    • blocks dihydrofolate reductase, S phase inhibitor
    • leucovorin rescue
    • side effects :
    • macrocytic anemia due to folate deficiency
    • intersitital fibrosis in lung
  9. peripheral neuropathy and cancer drug
  10. MOA sucralfate
    • ciscous polymer of sucrose octasulfate +aluminum hydroxide that adheres to ulcer crater
    • stimulates PGE2 in mucous cells - responsible for mucus barrier
  11. statin + niacin
    rhabdomyolysis - remember each drug on its own can produce rhabdomyolysis
  12. amphotericin B
    • binds ergosterol in fungal cell membrane which increases its permeability
    • nystatin has same mechanism
  13. clotrimazole
    • inhibits ergosterol synthesiss
    • other azole compounds have similar action
  14. flucytosine
    inhibits nucleic acid synthesis
  15. griseofulvin
    inhibits microtubule function and mitosis
  16. propylthiouracil
    • DOC for decreasing synthesis of thyroid hormone in graves disease
    • only drug that can be used in pregnancy
    • side affect - agranulocytosis
  17. fastest drugs that increases HR in shock
    • isoproterenol
    • dobutamin
    • dopamine - in low dose best for renal vasodilation
  18. dapsone
    • sulfone that inhibits synthesis of folic acid by M leprae
    • side effects
    • hemolytic anemia in G6PD pts
    • methemoglobinemia
    • nephrotic syndrome
    • peripheral neuropathy
  19. prolong QRS
  20. anticonvulsant /antiepileptic wiht effect on epiphyseal plate
    phenytoin via revving up cytochrome system in liver and causing vit D deficiency - increased metabolism of 25 hydroxy vit D
  21. ondansetron
    • selective serotonin 5ht3 receptor antagonist
    • useful in bocking chemoreceptor trigger zone nausea in the area postrema
  22. opioid overdose
    • respiratory depression - respiratory acidosis
    • miotic pupils - pin point
  23. alcoholic in ER
    IV thiamine to prevent acute wernickes encephalopathy
  24. heparin
    • mcc of thombocytopenia in hospital
    • MOA - binds antithrombin III catalyzing inactivation of thrombin and other clotting factors
  25. coumadin overdose
    • fresh frozen plasma if serious
    • IM vitamin K for less serious bleeds
  26. nitrofurantoin
    • concentrated in urine
    • urinary tract antiseptic
  27. cyclophosphamide
    • activated in the liver
    • side effects
    • hemorrhagic cystitis
    • transitional cell carcinoma
  28. doxorubicin and prednisone
    metabolized in the liver
  29. gout after cancer therapy
    • prevent by giving allopurinol - xanthine oxidase inhibitor
    • danger of urate nephropathy
  30. muscle fasciculations after neuromuscular block
    initial effect of succinylcholine
  31. levodopa
    MOA blocks peripheral dopa decarboxylase
  32. bronchial asthma
    • albuterol inhaler most often for mild to moderate
    • corticosteroid inhaler next
    • then add long acting B2 agonist
  33. paroxysmal supraventricular tachycardia
    • tx adenosine
    • including its association with WPW syndrome
  34. clonidine
    activates a2adrenergic and imidazole receptors in the CNS which reduces sympathetic outflow from the vasomotor center in the medulla
  35. captopril
    • blocks ACE which breaks down bradykinin
    • bradykinin side effects - cough and angioedema
  36. hydralazine
    • HTN tx during pregnancy
    • better tolerated in fast acetylators
    • cause of drug induced SLE - antihistone antibodies . ( also procainamide)
  37. HTN, Hypernatremia and hypokalemia
    • tx: ARB - losartan a AT II receptor antagonist ....blocks aldo
    • blocking aldo causes NA to be lost and K retained
  38. tx of pulmonary edema
    loop diuretics...decreases preload
  39. tx of opiod overdose
    naloxone - competative opioid receptor antagonist
  40. urinary retention due to BPH
    • selective alpha 1 blocker - relax sm muscle in bladder neck and prostate
    • prazosin, terazosin
  41. saw palmetto
    antiandrogen effect - blocks androgen uptake and availability without alerting serum levels, shrinks transitional zone of prostate around urethra
  42. narcolepsy
  43. premature labor an must deliever
    before 32 wks ?, glucocorticoids to increase surfactant synthesis
  44. hypercalcemia
    loop diuretics
  45. decrease calcium in urine in stone former
  46. cause of respiratory alkalosis and then metabolic acidosis
    salicylate intoxication
  47. s phase drug ued in tx of ALL
  48. analog of hypoxanthine requiring HGPRTase for bioactivation
    6 mercaptopurine, allopurinol could cause toxicity since th drug is a purine
  49. drug that competes with dUMP for thymidylate synthase
    5 flurorocuracil
  50. tx wilms tumor
    actinomycin D (dactinomycin)