8-2 Pharmacology

q123456's version from 2016-06-01 18:50

Joints, Bone and Gouts

Question Answer
6- mercaptopurinexanthine oxidase breaks down mercaptopurine.
Allopurinol inhibits xanthine oxidase
allopurinol increase the plasma level of 6MP

Mercaptopurine (6-MP) competes with hypoxanthine and guanine for the enzyme HGPRT and is itself converted to thio inosine monophosphate (TIMP)

12 year old male with acute lymphoblastic leukemia is treated with 6 mercaptopurine for maintenance of remission. the drug used in this patients is mostly inactivated by which of enzyme?xanthine oxidase
joint painknee pain and swelling+high WBC>>>septic arthritis>>>ceftriaxone.

swelling, stiffness and pain in hands>>>RA>>>NSAID, prednisone and Methotrexate
anti gout1) celecoxib: selective COX-2 inhibitor (not COX-1)
2) aspirin: nonselective COX inhibitors
3)colchicine: inhibition of microtubular polymerization, inhibition of leukocyte migration and phagocytosis. reduces the formation of leukotriene B4,
SE: nausea, abdominal pain and diarrhea
chronic gout is managed by
1) probenecid and sulfinpyrazone: increasing excretion of uric acid
2) allopurinol and febuxostat: xanthine oxidase inhibition
alendrONATEosteoporosis, BisphosphONATEs are analogues of pyrophosphate, an important component of hydroxyapatite. >>>osteoclasts, not used in patients with renal failure
etanerceptRA, TNF-a inhibitor( a decoy receptor: TNFa receptor+IgG Fc), PPD skin test to screen for latent tuberculosis
drugs induced lupushydralazine and procainaide, who are slow acetylators are at greater risk for developing lupus. liver acetylation
a 56 year old female begins treatment for severe joint pain and swelling, several weeks later, she presents to her physician complaining of cough and hemoptysis. sputum stains reveal acid fast bacilli. the medication used to treat this patient's joint pain inhibits which of the processes?TNFalpha action
ethinyl estradiolosteoporosis not breast cancer
medroxyprogesteroneestrogen replacemnt therapy
alendronatebisphosphonate analog
cisplatinreactive oxygen species that can form DNA crosslinks, SE: NEPHROTOXICITY, acute tubular injury. treatment: amifostine(free radical scavenging agent)
raloxifeneselective estrogen receptor modulator (SERM)
congetive heart failurestandard therapy (ACEi+digoxin+diuretic)+spironolactone
leucovorin (folinic acid)+methotrexateprevented methotrexate induced fever, painful mouth ulcers and pancytopenia
RA therapymethotrexate+leflunomide+TNFa inhibitors. methotrexate: inhibition of dihydrofolate reductase to block folinic acid synthesis. SE: painful mouth ulcers and hapatotoxicity, myelosuppression, increase risk for infections
cisplatinreactive oxygen species that can form DNA crosslinks, SE: NEPHROTOXICITY, acute tubular injury. treatment: amifostine(free radical scavenging agent)
methotrexatepsoriasis, rheumatoid arthritis, ectopic pregnancy and cancer
inhibiting the metabolism of folic acid via dihydrofolate reductase
Leucovorin+methotrexate: prevented methotrexate induced fever, painful mouth ulcers and pancytopenia
RA treatmentsNSAIDs
methotreaxate SEStomatitis and oral ulcers
isotretinoinvitamin A
psoriasisvitamin D (Calcipotriene: calcipotriol), calcitriol and tacalcitol>>>binds to vitD receptor (nuclear transcription factor)>>>inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation.


Question Answer
Megestrola progesterone derivative that increases appetite KA26/24
prevent constipationdocusate
stool softener
ammonium chlorideacidify the urine, decrease salicylate excretion and increase salicylic acid blood levels
lansoprazoleH+/k+ ATPase proton pump
cimetidine histamine H2 receptor
HCV treatmentinterferon alpha and ribavirin
1) IMP dehydrogenase
2) ribavirin also direct inhibit RNA dept RNA polymerase
3) incorporated into RNA, pair with uracil or cytosin>>>hypermutation of RNA
acute arsenic poisoningnausea vomiting, GI pain and diarrhea>>>garlic odor on breath
treatment: dimercaprol
osmotic laxativepolyethlene glycol and magnesium hydroxide
lron aborpotion duodenum and proximal jejunum, gastrojejunostomy>>>supply iron, B12, folate, fat souluble vitamin D and calcium
elderly patients with chronic anemia withOUT any identifiable underlying causevitamin B12 malabsorption


Question Answer
CFTherapyN-Acetylcysteine containg aerosol
reducing intermolecular dislfide bridges
treatment of asthmaIpratropium

asthma therapy

Question Answer
asthma therapycromolyn and nedocromil
inhibit mast cell degranulation.
zafirlukast and montelukast
leukotriene D4 receptor antagonists,
Omalizumab: anti igE
aerosol fluisolideasthma, SE:oropharygeal candidiasis, oral rinsing after glucocorticoid inhalation.
the acute effects of corticosteroids on the CBSIncreased neutrphil count due to demargination of neutrophils attached to the vessel wall.
patient with asthma takes prednisonestimulator of liver gluconeogenesis (phosphoenolpyruvate carboxykinase and glucose 6 phophatase)
increase glycogenesis (glycogene synthetase)
A 42 year old caicasian male dies. autopsy shows hyperinflated lungs, airway mucus plugging and cellular infiltration of the bronchial wall. which of the following drugs, taken over the logn term, would have best prevented the cellualr reaction in this patients's airways?fluticasone
theophylline intoxicationtheophyllline is a phosphodiesterase inhibitor/abdominal pain and seizure. treatment: charcoal


Question Answer
alcoholics aspiration pneumonia, Gram negative, clindamycin

B blockers

Question Answer
adrenergic symptoms of hypoglycemia (tremor and palpitations) are blunted by _____?non selective B blockers (B2), Selective B1 antagonists should be used instead if necessory
B blockersdo not use it in patients with COPD and diabetes
sudden onset chest pain in patients with COPDMetoprolol B1 selective blockers not non-selective b blockers


Question Answer
hyperpigmentationadrenal crisis
treatment for adrenal crisiscorticosteroids
Hyperthyroidism treatmentantithyroid drugs, radioactive iodine and surgical thyroidectomy
antithyroid drugspropylthiouracil PTU: KA26-36
Interferes with the first step in thyroid hormone biosynthesis: inhibiting the enzyme peroxidase-->inability of oxidation of iodide to iodine
methimazole>>>iodine organification and coupling of iodotyrosines

SE: WBC count
PTU: pregnancy, decrease the peripheral conversion of T4 to T3,
triangle of treatment for thyrotoxicosisthyroid hormone synthesis and release
peripheral conversion of T4 to the more active T3
sympathetic outflow and or its actions on target organs
beta receptor blockerPropranolol control tachycardia and tremors associated with thyroid storm
propranolol inhibit conversion of T4 to T3
can be used before, during and after RAI therapy without interfering with radioiodine uptake into the thyoid gland
antithyroid drugs do not improve ophthalmopathyhigh dose glucocorticoids>>>severe graves' ophthalmopathy
perchlorate uptake of radioactive iodine will decrease due to competitive inhibition

benign prostatic hyperplasia

Question Answer
Leuprolidelong acting GnRH analog>>>continuous GnRH activity>>>increase in both testosterone and DHT during the initial flare up period>>>testosterone and DHT are suppressed to castrate levels
pulsatile release of GnRHIf GnRH levels are constantly elevated, rather than pulsed , the secretion of LH and FSH will be suppressed.
treatment of benign prostatic hyperplasiaflutamide (comptitiive inhibitor of antdrgens at the testosterone receptor)
ketonazole (inhibits steroid synthesis, desmolase)
spironolactone (interacinting with the androgen receptor)
finasteride(5-a reductase inhibitor)
leuprolide (GnRH agonists)


Question Answer
combination oral contraceptives (OCPs) mechanismsestrgen and progesterone>>>suppression of synthesis of the gonadotropins FSH and LH.
SE of oral contraceptivesdeep vein thrombosis and pulmonary embolism
misoprostol:endogenous prostaglandin causes uterine contaraction and cervical dilatation>>>termination of pregnancy
mifepristone: anti-progestin, affinity for the progesterone receptor
ectopic pregnancymethotrexate>>>DHF redctase>>>folic acid and DHF accumulate
tamoxifento breast: anti-estrogenic;
to endometrial tissue: stimulatory, endometrial polyps, endometrial hyperplasia and cancer>>>abnormal vaginal bleeding
anastrozolearomatase inhibitor>>>inhibit the synthesis of estrogen from its androgenic substrate