Frog Parker presents: The Pharm Shelf review aka Big Boss Review

1. vincristine/vinblastine=Vinka Alkaloids (Natural Alkaloids CCS at M Phase MOA: Spindle Poisons -inhibit microtubule asse Vincristine (very neurotoxic Never Intrathecal route) -Pediatric Leukemia/Rhabdomyosarcoma/Lymphoma/Neuroblastoma AE: UPN Neuropathy/Peripheral Nerve Neuropathy/Sensory & Motor Parasthesia/Areflexia/Paralytic Ileum Vinblastin (Reversibly Myelotoxic) -Testicular CA/Hodgikin Dz AE: Alopecia/Bone Marrow depression/Luecopenia/GI distress 2. theophylline(Methyl Xanthine) MOA: Inhibit Phospodiesterase Increase cAMP -Asthma AE: Cardiotoxic/Neurotoxic 3. erythromycin (Macrolide antibiotic) MOA: Inhibit prt. Synthesis by blocking translocation bind to 23S rRNA of 50S/ Bacteriostatic -Mycoplasma/Legionella/Chlamydia/Neisseria/Strep infections in pt allergic to PG AE: GI discomfort/Acute Cholestatic Hepatitis/Eosinophilia/Skin Rashes 4. Fe overdose (necrotising gastroenteritis/shock/Met.Acidosis/coma) TX: desferroxamin (Fe chelator) AE: Skin rxnBlushing/Erythema/Urticaria 5. Strongyloides=ivermectin MOA: Intensifies GABA in nematodes causing immobilization of parasitesremoved by RE system DOC for Onchocerca Volvulus (Onchocerciasis)/Strongyloides Stercoralis /Alternative for Filariasis

AE: Mazzotti Rxn (fever/headache/dizziness/puritus/tachycardia/hypotension/pain in muscles joints lymph glands) controlled w/ Antihistamine or NSAID 6. Drug used for both giardia and gonorrhea? Metronidazole GET on Metro Giardia/Entamoeba/Trichomonas/Gardanella Vaginalis/anaerobes (Bacteroides/Clostridium) -For H.Pylori w/ bismuth & amoxicillin or tetracycline MOA: Forms toxic metabolites in bacterial cell/Bactericidal AE: Disulfram-like rxn w/ Alcohol/Headache Ceftriaxone or Fluoroquinolone (Ciprofloxacin/Norfloxacin) or Spectomycin N. Gonorrhea Ceftraxone 2nd generation cephalosporin HEN PEK MOA: inhibit cell wall synthesis/Bactericidal AE: Disulfram-like rxn w/ alcohol (cefoperazone/cefamandole)/Hypers. Rxn/Increased nephrotoxicity of Aminoglycosides Fluoroquinolone (Ciprofloxacin/Norfloxacin) / Quinolones (Nalidixic Acid) MOA: Inhibit DNA gyrase (Topoisomerase II)/Bactericidal G- rods of urinary & GI including Pseudomonas/Neisseria/some G+ AE: GI upset/superinfection/skin rashes/headache/dizziness CONTRAINDICATED in Pregnant & Children Damages CARTILAGE/ Tendonitis and Tendon rupture in adults 7. Valproic acid=HEPATOTOXICITY MOA: Irreversible inactivation of GABA transaminase/Block inactivated NA channels/Increase K permHyperpolarize neurons/Inhibit low threshold Ca channels Myoclonic Seizures (DOC)/Simple & Complex Partial/Tonic Clonic w/ Absence (DOC)/Infantile Spasm AE: Hepatotoxicity/Thrompbocytopenia/Inhibit pt. aggregation/ photosensitvity 8. Yohimbine= selective alpha 2 blocker (Rauwolscine also) 9. Captopril (Enalpril)=decreases pre and after load MOA: ACE inhibitor Dec Angiotensin II & Inc Renin HTN/CHF/Diabetic Renal DZ

AE: CAPTOPRIL Cough/Angioedema/Proteinuria/Taste Changes/hypOtension/Pregnancy problems (fetal renal damage)/Rash/Increased rennin/Lower AII/Hyperkalemia 10. Furosemide=ototoxic MOA: Inhibit Na/K/Cl contansport in TALH / Abolishes hypertonicity of Medulla prevents concentration of urine Loops Lose Ca Edematous states (CHF/Cirrhosis/Nephritic Sx/Pul Edema)/HTN/HyperCa AE: OH DANG Ototoxicity/Hypokalemia/Dehydration/Allergy (sulfa)/Nephritis (interstitial)/Gout 11. acetazolamide=mountain sickness. Ans:decreases HCO3 MOA: Carbonic Anhydrase inhibitor in Proximal Convoluted tubule Glaucoma/Urinary Alkalinization/Metabolic Alkalosis/Altitude Sickness 12. 6MP(Mercaptupurine) =inhibits HGPRT MOA: Inhibits HGPRT blocks purine synthesis Leukimia/Lymphoma (not CLL or Hodgkins) AE: Bone marrow, GI, Liver toxicities/metabolized by Xanthine oxidase increased toxicity w/ Allopurinol 13. Misoprostol=NSAID induced peptic ulcers MOA: PGE1 analog/ Increase production & secretion of gastric mucous barrier NSAID induced peptic ulcer/ Maintain PDA/Induce Labor 14. Indomethacin closes PDA MOA: Reversible inhibition of COX I & COX II/ Block PG synthesis 15. Metformin=lactic acidosis MOA: Unknown/ Decrease blood glucose Oral Hypoglycemic (Type II DM)/ Can be used in pt w/out islet fx 16. Seven year old with undescended testes=? Drug=drug for cryptorchidism Leuprolide/Buserelin (Look up GH) AE : Lactic Acidosis AE: Diarrhea/ Abortifacient contraindicated in women childbearing age AE: Hyperchloremic Met Acidosis/Neuropathy/NH3 toxicity/Sulfa allergy

MOA: GnRH analogs/ agonist when pulsatile/ antagonist when continuous Infertility/Cryptochirdism/ HypogonodotropicHypogonadism Pulsatile Prostate Cancer (w/ Flutamide)/Endometriosis Uterine FibroidsContinuous 17. Probenecid inhibits secretion of PCN MOA: Inhibits reabsorption of Uric Acid/ Inhibits secretion of PG Chronic Gout 18. cholestyramine or colestipol works in gut (picture where it works) 19. hypertensive crises=what drug in an emergency? Nitroprusside MOA: Release NO Vasodilate arterioles & veins HTN Emergency/Acute Dissecting Aortic Aneurysm(w/ Beta blockers or Verapamil)/To induce controlled hypotension(Dec blood ) during surgery AE:Postural Hypotension/Cyanide toxicity releases CNMet.Acidosis/Arrhytmoas/Cardiac collapse Give w/ NaThiosulphate or Hydroxocobalamin (Vit.B12) to prevent Amyl Nitrate to tx Cyanide poisoning CONTRAINDICATED: Impaired Cerebral Circulation/Compensatory HTN(Aortic Stenosis)/Toxic Amblyopia(Rhodanase inhibitor) 20. Prazosin=first orthostatic hypotension MOA: Selective Alpha 1 blocker HTN/Urinary retention in BPH 21. drug for cestodes and trematodes=praziquantel 22. clozapine=measure leokocyte levels regularly (Agranulocytosis) Atypical Antipsychotics : Clozapine/Olanzapine/Risperidone MOA: Block 5HT2 & D receptors Tx Schizophrenia +&- symptoms/ Olanzapine for OCD/Anxiety Disorder/depression AE:Extrapyramidal &Anticholinergic Clozapine AGRANULOCYTOSIS 23. which drug for OCD=fluoxetine/SSRI MOA: Serotonin-specific reuptake inhibitor (SSRI) [Sertraline/Paroxetine/Citalopram] Endogenous Depression AE: 1st dose Orthostatic Hypotension/Dizziness/Headache

AE: SEROTONIN SYNDROME w/ MOAIS ( hyperthermia/muscle rigidity/CV collapse) / CNS Stimulation anxiety/insomnia/tremor/anorexia/nausea/vomiting 24. bethanechol=bladder, bowel incontinence MOA: Cholinergic direct agonist/ Activates bowel and bladder smooth muscle - Postoperative & neurogenic Ileus/Urinary Retention 25. pilocarpine=glaucoma MOA: Cholinergic direct agonist/Activates ciliary muscle of eye (open angle)/Pupillary sphincter (narrow angle) 26. tetracycline = divalent cation interaction. Find out if it should be taken with or without food and whether or not alcohol interferes with bioavailability. MOA: Bind to 30S & prevent attachment of Aminocyl-tRNA/Bacteriostatic/limited CNS penetration Vacuum your BedRoom Vibrio Cholera/Acne/Chlamydia/Ureoplasma Ureolyticum/Mycoplasma pneumonia/Rickettsia/tularemia AE: GI distress/ Discolor teeth & inhibit bone growth in children/Fanconis SX/ Photosensitivity 27. carbidopa=why is it administered with levodopa? (Benserazide also) MOA: Inhibit peripheral L-Dopa Carboxylase 28. ketoconazole = decreases p450 MOA: Inhibits Steroidogenesis / Inhibit Ergosterol (Fungal steroid) synthesis Hypercortisolism/Systemic Mycoses/ Blastomyces/Coccidiodes/Histoplasma/ Candida Albicans Fluconazole for Cryptoccocus Neoformus meningitis in AIDS 29. swimmer with red, scaly skin on foot=griseofulvin MOA: Interferes w/ Microtubule Fx/Disrupts Mitosis - Oral Tx of Superficial infection/ Inhibits growth of Dermatophytes (tinea/ringworm) AE: Teratogenic/Carcinogenic/Confusion/Headache/Inc Warfarin Met/Deposits in keratinin-containig tissue (nails) 30. amphotericin B and flucytosine are synergistic. Why? Cuz amph B creates pores when binding to membrane ergosterol

Amphoterecin B MOA: binds ergasterol forms membrane pores leakage of electrolytes & disrupt homeostasis Cryptococcus/Balstomyces/Coccidiodes/Asperigillus/Histoplasma/Candida/ Mucor(systemic mycoses)/Fungal Meningitis intrathecally(doesnt cross BBB) AE: Fever/Chills/Hypotension/Nephrotoxicity/Arrhythmias (AMPHOTERRIBLE) 31. female with hypokalemia and GI problems=laxative abuse 32. fast-acting insulin drug = Insulin Lispro or (Crystaline Zinc Insulin) 33. quinidine-phase? Choose on the action potential graph..know its phases Class Ia Antiarrhythmic Quinidine/Amiodarone/Procainamide/Disopyramide (Queen Amy Proclaims Disoss Pyramide) MOA: Inhibit activated Na channels Inc AP Duration & Effective Refractory Period (ERP) & QR interval AE: Quinidine headache/tinnitus)/Thrombocytopenia/Torsades de Pointes Procainamide SLE-like sx Disopyramide anticholinergic effects 34. MI-what drug in emergency = Aspirin 35. lithium and pregnant female=what do you do DISCONTINUE in 1st trimester - Mood Stabilizer for Bipolar Affective Disorder AE: Tremor/Hypothyroidism/Polyuria(ADH antagonist causing Nephrogenic DI)/ Teratogenesis 36. Thyrotoxicosis and pregnant female=what do you do (propranolol or Propylthiouricil) 37. imipenem/cilastatin Imipenem broad-spectrum, Beta lactamse resistant Carbapenem Given w/ Cilastatin (inhibitor of renal Dihydropeptidase) to decrease inactivation in renal tubules - DOC for Enterobacter/G+ cocci/G- rods/ anaerobes 38. which drug inhibits topoisomerase 2? Nalidixic Acid (Quinolone) MOA: Inhibit DNA Gyrase (TopoisomeraseII)/Bactericidal G- rods of GU & GI (including Pseudomonas)/Neisseria

AE: GI upset/Superinfection/Skin Rash/Headache/Dizziness/ Tendonitis & Tendon rupture in adults CONTRAINDICATED in children and pregnant d/t Damage to Cartilage 39. acyclovir=herpes MOA: Inhibits viral RNA polymerase when plated by viral Thymidine Kinase HSV/VZV/EBV/Mucocutaneous & genital Herpes 40. magnesium hydroxylate (antacid) = Diarrhea 41. perimenopausal female with breast cancer and estrogen/progesterone receptors=treat with tamoxifen (Vit D and Calcium) MOA: Estrogen antagonist in breast tissue/ estrogen agonist in Uterus & Bone AE: Uterine hyperplasia Endometiral CA/ HyperCa/Vaginal Bleed/Ovular Dysfx/ Peripheral Edema/N/V/Hot flashes/Inc risk of Venous Embolism Raloxifen Estrogen antagonist in breast tissue/ estrogen agonist in bone Prevention of Osteoporosis in post-menopausal women 42. man with arthritis=treatment DMARDS (Gold/Penicillamine/Sulfasalazine/Chloroquine) 43. person whose aspirin v blood values fall: 138-90-45-30 = Zero Order Kinetics Low doses 1st order kinetics High Doses Zero order kinetics (inc toxicity) constant amount excreted instead of constant proportion) 44. person whose bioavailabilty increased by 2, but clearance decreased by 50%=what is the new plasma concentration? Answer: increase by 4 ? 45. naltrexone=alcoholism and drug overdose MOA: Opiate antagonist 46. dantrolene=neuroleptic malignant syndrome (hyperthermia) d/t Halothane w/ Succinylcholine Tx Neuroleptic Malignant Syndrome d/t antipsychotics/ Seratonin syndrome 47. close a patent ductus arterioussus=indomethacin MOA: Prevents release of Ca form SR of skeletal muscle AE: Hot Flashes/inc risk of Venous Osteoporosis AE: Delirium/Tremor/Nephrotoxicity

48. tx for ascaris=mebendazole Mech of action/resistance 49. labetalol=both alpha 1 and Beta 1,2 blocker Intrinsic Sympathomimetic Activity (ISA) Alpha vasodilation of vascular smooth muscle NO Change in HR/CO 50. tx for benzodiazepine overdose=flumazenil MOA: Competitive GABA receptor antagonist 51. rifampin=increases p450 MOA: Inhibit DNA-dependant RNA Polymerase Mycobacterium Tuberculosis/Meningococcal infection prophylaxis (DOC) /H.Influenza B AE: Red/Orange body fluids/ Hepatotoxicity (minor) 52. What 3 cephalosporins together can produce disulfiram like reactions?=cefamandole, cefoperazone and moxalctam 53. Serotinin syndrome=find: hyperthermia, muscle rigidity, and cv collapse=caused by ssris (Fluoxetine/Sertraline/Paroxeyine/Citalopram) taken w/ MOAIs (Phenelzine/Tranylcypromine) SSRIs for Endogenous Depression MOA : Serotonin-specific reuptake inhibitors MOIAs for Atypical Depression (w/ psychotic or phobic features)/Anxiety/ Hypochondriasis 54. Know M and S phase chemo specific drugs S Phase Methotraxate Dihydrofolate Reductase Inh ALL (kids)/ ChorioCa/ Sarcoma/ Tx RA/Psoriasis 5-Fluorouracil Thymidylate Synthase Inh Floxuridine Cytarabine Mercaptopuri Thymineless death of cells DNA Polymerase inh no elongation of DNA strand Inhibit PRPP block purine syn Acute Leukemia/ Colon cancer/Solid tumors AML

ne (6MP) Thioguinine Pentostatin G2 Phase Bleomycin Inhibit PRPP Block Adenosine Deaminase (ADA) no DNA repl Fragments DNA

CML Hairy Cell Leukemia Testicular CA/ Squamous CA head, neck, lings/Lymph.

M Phase

Vincristine Vinblastin Paclitaxel

Spindle poison Spindle Poison Inhibit microtubule disassembly Estrogen antagonist in breast/ Agonist in uterus & bone Stabilizes Topoisomerase II DNA complex dsDNA breaks

Pediatric Leukemia/ Hodgkins (MOPP) Testicular (VBC/VBE) Ovarian/Breast CA Breast CA Testicular (VBE)/ Oat cell CA of lung & prostate Wilms tumor (kids)/ Ewing tumor/ Kaposis SA/Rhabdomysa

G1 Phase B/W S & G2

Tamoxifen Etoposide

Dactinomycin

Prevents transcript/Casuses ss breaks by free radical formation

Doxorubicin

Topoisomerase poison/Free radical form

DOC for metastatic CA of Thyroid

55. Prednisone tox immunosuppression, cataracts, OSTEOPORSIS, hyperglycemia, etc. 56. Cyclophosphamide tox 1.hemorrhagic cystitis 2. Renal cell CA ?? 2 Qs Prodrug converted to active Nitrogen Mustard (nephrotoxic) & Acrolein (Hem or chemical Cystitis) MOA: Alkylating agent becomes strong electrophile by forming Carbonium Ion w/ target cell AE: Myelosuppression/Permanent Amenorrhea & Azoospermia/

Leukemogenic/Interstitial Fibrosis MESNA conjugates Acrolein in urine prevents chem.. Cystitis DEMECLOCYCLINE blocks effect of ADH in inappropriate secretion occurs since drug is given w/ High H2O load 57. Cog-Wheel rigidity parkinsonism cause Antipyscotics Neuroleptics (block D2) : Thioridazine/Haloperidol/Fluphenazine/Chlorpromazine Atypicals (block 5HT & D receptors): Clozapine/Risperidone/Olanzapine 58. Desipramine NE, NE, NE, NE think DE=NE Tricyclic Antidepressant: Imipramine/Amitryptyline/Desipramine/Nortriptylin/Clomipramine/Doxepin MOA: block NE & 5HT reuptake AE: Convulsions/Coma/Cardiotoxicity/Resp.Depr/Hyperpyrexia/Anticholinergic effects 59. Statin drug tox Rhabdomyolisis 60. Hyperkalemia Triamterene (K+ sparing diuretic) Spironolactone/Amiloride all work in CCT Hyperaldosteronism/K depletion/CHF 61. Heparin works on Antithrombin III 62. Pt presents with a unilateral HA Sumatriptan MOA: 5HT agonist Acute migraine/ Chronic Headache attacks 63. Nasal stuffiness-T(x) = pseudoephedrine 64. NO works on guanylyl cyclase Inc. cGMP vasodilation 65. Nitroglycerin withdrawal Tachycardia/MI/sudden death 66. Pt has an acute MI drug to give Fentanyl or Meperdine(Nardells choice) 67. Cause of Decrease Erythropoeisis Blood Balloting, Doting? Athletes? 68. AZT (Zidovudine) MOA undergoes phosphorylation by host cell kinases to form nucleotide analogs that may inhibit viral DNA polymerases, thus inhibiting reverse transcriptase (baby katsung chapter 49) // HIV Therapy 69. MOA of Insulin works via tyrosine kinases (review it in BRS physio) Contraindicated in CAD & Prinzental/s angina

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In liver inc. storage of glucose as glycogen/ In musclestimulates glycogen & protein synthesis & K uptake/ In adipose facilitates triglyceride storage 70. Beta-Blockers : cause decrease in myocardial O2 consumption Propranolo/Metoprolol/Atenolol/Nadolol/Timolol/Pindonol/Esmolol/Labetalol 71. T(x) for MG(myasthenia gravis) Pyridostigmine (also Neostigmine) Diagnose it with Edrophonium Anticholinesterases increase Ach 72. Pt has MS w/spinal cord injury Baclofen (Spasmolytic Drug) MOA: GABAb agonist 73. Methicillin is PCN resistant Used for Staph. Aureus 74. Insectisides Overdose (gardner) Prolidoxine was not an optionAtropine was the answer 75. Lovatostatin Toxicity Hepatotoxicity 76. Photosensitivity = Tetracycline 77. Nephrogenic Diabetes Insipidus = txt/thiazide/indomethacine/amiloride. Will see GFR increase. 78. Pentazocine = K receptor agonist 79. Hyperkalemia = due to Digoxin 80. Pnt on Digoxin and Quidine => in 2 weeks double digoxin in plasma. Why? Quinidine displaces digoxin 81. Female 75, 60kg, critinine 1.1, digoxin .125 Male 46 , 70kg, .9, .25 Digoxin 1. volume distribution 2. Biovalobil 3. Renal Excretion 4. Bound to plasma 5. hepatic excretion 82. Barbituates -> how enter->LOOK UP AE: Hypersensitivity rxn. / Interstitial Nephritis

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1. Fat/brain/muscle 2. brain/fat/muscle 3. fat/muscle/brain 83. Morphin has active metabolite 84. Enalapril (Ace inhibitor) know e/th about it. 85. Give ibuprofen -> pt with peptic ulcer = answer inhibit prostaglandin 86. pt. taking thiazide for a month, has HPN gave Prazosin. Pnt had Syncope :Hypokalemia,or hypovalemia (possible answer look up? 87. Orthostatic HypoTN can be caused by tricyclic antidepress 88. Cromolyn:MOA : prevent release of mediators from mast cells used for asthma 89. Look up graphs of NE/E, interactions of isoprotezol, prazosin 90. Acyclovir MOA 1st phosphorylation by thymidine kinase by virus 91. clondine MOA 92. non depolarizing relaxants MOA 93. Metronadazole causes disulfam like rxn w/ alcohol 94. Aspirin decrease in Thromboxane A2 release from platelets 95. Why use Dopamine in CHF dilates renal vessels 96. Fluoxetine DOC for major depression 97. Digoxin overdose use Lidocaine or Phenytoin both block inactivated Na chan 98. Pt HTN gave Ca channels blockers= ans Negative inotropic effect Verapamil/Diltiaxem know detail 99. Colchicine toxicity = ans Leukopenia 100.Resistance of Mycobacterium to tx 101.Graph X is NE/ Y is NE + cocaine (graph 1st aid beg of pharm section) Agonist w/ agonist 102.Know factors affecting inhaled anesthetics (graph question) 103.Anesthetics + Epi Epi decreases distribution in tissue prolongs effect (Nardel notes) 104.Isoserbide Denitrate (Isordil) anti-aniginal look up interaction w/ other drugs Isocarboxazid antidepressant MOAI look up interactions 105.Pt had decrease Arterial Oxygen by 50%/ pO2 normal/Arterio-venous O2 normal

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ans: met acidosis or resp alkalosis or hyperthermiaor 2,3 DPG (phsio resp) 106.Blocking D2/ personality dysfunction is influenced by = ans Mesolimbic tract dysfunction

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