What are the four "must

know" Pharm equations?

1a

1. Volume of Distribution
2. Clearance
3. Loading Dose
4. Maintenance Dose
1b

What is the equation for

Volume of Distribution?
2a

Vd= (amt drug given IV)/

(drug plasma concentration)
2b

What is the equation for

Clearance?
3a

Cl= (0.7 x Vd) / t1/2

3b

What is the equation for

loading dose?
4a

LD= Css x Vd

4b

What is the equation for

maintenance dose?
5a

MD= Css x Cl

5b

What happens to a basic drug

if the urine pH is low and less
than the pKa?
6a

The drug gets trapped in the

urine.
6b

What happens to an acidic

drug if the urine pH is high
and more than the pKa?
7a

The drug gets trapped in the

urine.
7b

What effects does the

sympathetic nervous system
have on the heart? The
parasympathetic nervous
system effects?
8a

Symp= increased HR &

contractility
Para= decreased HR &
contractility (vagus nerve)
8b

What effects does the

sympathetic nervous system
have on the eye? The
parasympathetic nervous
system effects?
9a

Symp=mydriasis (dilates
pupil)
Para= miosis (constricts
pupil)
9b

What effects does the

sympathetic nervous system
have on salivary glands? The
parasympathetic nervous
system effects?
10a

Symp= viscous secretion

Para= watery secretion
10b

What effects does the sympathetic

nervous system have on bronchiolar
smooth muscle? The
parasympathetic nervous system
effects?
11a

Symp= relaxation
Para= constriction
11b

What effects does the

sympathetic nervous system
have on the bladder? The
parasympathetic nervous
system effects?
12a

Symp= prevents urination

Para= urination
12b

What effects does the

sympathetic nervous system
have on the male GU? The
parasympathetic nervous
system effects?
13a

Symp= ejaculation
Para= erection
13b

What effects does the

sympathetic nervous system
have on the GI tract? The
parasympathetic nervous
system effects?
14a

Symp= decreased digestion,

smooth mm. relaxation,
increased sphincter tone &
decreased secretion
Para= Opposite of above
14b

What are the sx of excess

parasympathetic activity?
15a

DUMBBELSS: Diarrhea, Urination,

Miosis, Bronchospasm, Bradycardia,
Excitation (sk mm. & CNS),
Lacrimation, Sweating, Salivation
15b

What drugs can cause excess

parasympathetic activity?
16a

1. Direct muscarinic agonists:

Bethanechol, Pilocarpine,
Carbechol, methacholine
2. Anti-chonlinesterases:
Neo/Pyrido/Physostigmine,
Edrophonium, Echothiophate
16b

What three
anticholinesterases used to
treat Alzheimer's disease?
17a

Donepezil
Galantamine
Rivastigmine
17b

What causes Myasthenia

Gravis? Symptoms? How is it
diagnosed?
18a

1. Antibodies to Ach Receptors

2. Common sx= ptosis or diploplia
that worsens throughout the day
3. Dx with edrphonium. If strength
temporarily increases.
18b

What are 3 asssociated

pathologies for Myasthenia
Gravis?
19a

1. Thymic hyperplasia
2. Thymic atrophy
3. Thymoma
19b

What is Myasthenic crisis?

What is used to treat MG?
20a

1. Rapidly progressing weakness->

respiratory difficulty
2. Tx: Ach-esterase inhibitors
(Pyridostigmine), Corticosteroids,
Thymectomy, Plasmapheresis
20b

What drug regenerates

acetylcholinesterases after
organophosphate poisoning?
21a

Pralidoxime

21b

What are the symptoms of

inhibited parasympathetic
activity?
22a

Hot as a Hare; Dry as a bone; Red as

a beet; Blind as a bat; Mad as a
hatter; Bloated as a toad;
"The patient gets leaky everywhere"
22b

What drugs inhibit

parasympathetic activity and
what is their use?
23a

1. Atropine, hmoatropine, tropicamide,

ipratroprium= eye
2. Benztropine= CNS for Parkinson's
3. Scopalomine= CNS motion sickness, end of life
to decrease secretions and control
nausea/vomiting
4. Ipratroprium= Lung for asthma and COPS
5. Oxybutynin= GU for urge incontinence
23b

What anticholinergics are

used in the treatment of urge
type urinary incontinence?
24a

Oxybutynin
Tolterodine
Darifenacin & Solifenacin
Trospium
24b

In what patient
populations/disease is
atropine contraindicated?
25a

Glaucoma
BPH
GI obstruction
Dementia
Infant with fever
25b

What other medications have

anticholinergic side effects?
26a

1. 1st generation H1 blockers:

benadryl, doxylamine (Unisom),
chlorpheniramine
2. Traditional neuroleptics
3. TCA's
4. Amantadine
26b

Name 3 direct cholinergic

agonists.
27a

Pilocarpine
Bethanechol
Carbechol
27b

Name 7 anti-Ach-esterases.

28a

Physostigmine, Neostigmine,
Pyridostigmine
Echothiophate
Edrophonium
Donepezil & Rivastigmine
(Alzheimer's)
28b

Name 9 anti-muscarinic
drugs.
29a

Oxybutynin
Atropine
Darifenacin
Ipratropium
Tropicamide
Benztropine
Scopalomine
Tolteridine
Trospium
29b

Name the cholinesterase

regenerator.
30a

Pralidoxime

30b

A gardener presents with

SOB, salivation, miosis and
diarrhea. What caused this
and what is the MOA?
31a

1. Cause= parathion/
organophosphate poisoning
2. MOA= increased parasympathetic
stimulation by inhibiting Achesterase--> Muscarinic receptor
stimulation
31b

Atropine is not effective in

reversal of organophosphate
poisoning. What drug would
best help this patient?
32a

Parlidoxime (Tupam) to
regenerate Ach-esterase
32b

What drug would help

improve FEV1 in a patient
with COPD?
33a

Ipratropium

33b

A 30yo patient with

schizophrenia now has
urinary retention due to his
neuroleptic drug. What do
you treat it with?
34a

Bethanechol

34b

In the dark, both pupils are dilated.

In the light, the control pupil is
miotic with the pupil given drug X
remains mydriatic. What type of
drug is drug X?
35a

Pilocarpine, muscarinic
antagonist, anti-cholinergic
drug or a sympathetic
agonist.
35b

What toxin stimulates Ach

release from presynaptic
cholinergic neurons?
inhibits?
36a

Stimulates= Black widow

toxin
Inhibits= Botulinum
36b

What is the general

byproduct of phase I
metabolism and what
reactions take place during
this phase?
37a

1. Byproduct- generally yields

slightly polar water-soluble
metabolites that may still be active
2. Reduction, oxidation & hydrolysis
reactions (cyto P450)
37b

What is the general

byproduct of phase II
metabolism and what
reactions take place during
this phase?
38a

1. Usually yields very polar inactive

emtabolites that are renally excreted
2. acetylation, glucouronidation,
sulfation (conjugations)
38b

What phase of liver

metabolism do geriatric
patients tend to lose first?
39a

Phase I metabolism

39b

What questions are asked

during the 4 clinical phases
of drug development?
40a

Phase 1- Is it safe
Phase 2- Does it work
Phase 3- Is it more effective
Phase 4- Long-term
monitoring
40b

Name 5 drugs that inhibit

Ach-esterase and the clinical
application for each drug.
41a

1. Edrophonium- to dx Myasthenia Gravis

(tensilon test)
2. Neostigmine- post-op ileus reversal & post-op
NM blockade reversal, urinary retention
3. Pyridostigmine- Myasthenia Gravis
4. Physostigmine- Glaucoma and Atropine O/D
5. Echothiophate- Glaucoma
41b

What are the various clinical

applications of atropine?
42a

1. Eye= to dilate and cycloplegia

2. Airway= decrease secretion
(anesthesia)
3. Bladder= decrease bladder
spasms
4. Organophosphate poisoning
42b

What G-protein classes do

alpha and beta receptors
stimulate?
43a

alpha-1= Gq
alpha-2= Gi
Beta-1= Gs
Beta-2= Gs
43b

What G-protein classes to

muscarinic and dopamine
receptors stimulate?
44a

M1= Gq
M2- Gi
M3- Gq
D1- Gs
D2- Gi
44b

How many half-lives does it

take for a drug infused at a
constant rate to reach 94% of
steady state? What variables
determine the t1/2?
45a

1. 4 half lives
2. Vd & Clearance
45b

How does Hexamethonium

affect BP, CO, Urine output,
the eye and GI motility? How
does it affect heart rate?
46a

1. It decreases BP, CO, Urine

output, GI motility and
causes mydriasis
2. It increases Heart Rate
46b

Which receptors are

stimulated by Clonidine?
47a

alpha-2

47b

Which receptors are

stimulated by dopamine?
48a

D1=D2

48b

Which receptors are

stimulated by
phenylephrine?
49a

alpha-1 > alpha-2

49b

Which receptors are

stimulated by albuterol and
terbutaline?
50a

Beta-2

50b

Which receptors are

stimulated by norepi?
51a

alpha-1/alpha-2 > B1

51b

Which receptors are

stimulated by isoproterenol?
52a

Beta-1 = Beta-2

52b

Which receptors are

stimulated by epinephrine?
53a

All alpha and Betas

53b

Which receptors are

stimulated by dobutamine?
54a

Beta-1 > Beta-2

54b

Which sympathomimetic is
given as a nebulizer for
asthma?
55a

Albuterol and epi (in extreme

cases)
55b

Which sympathomimetic is
the drug of choice for
anaphylaxis?
56a

Epinephrine

56b

Which sympathomimetic is
the most common first line
agent for pts in cardiogenic
shock?
57a

Dobutamine

57b

Which sympathomimetic is
most common first line agent
for pts in septic shock?
58a

NE

58b

Which sympathomimetic is
given subQ for asthma?
59a

Terbutaline

59b

Which sympathomimetic is
used by ENT to vasoconstrict
nasal vessels?
60a

Cocaine or phenylphrine

60b

Which sympathomimetic is
used to tx ADHD?
61a

Amphetamine

61b

Which of the following drugs

would be most appropriate in
a pt in shock because it
maintains renal blood flow?
62a

Dopamine

62b

Outline the flow of aqueous

humor.
63a

Formed in capillary bed of ciliary

body-> secreted into posterior
chamber-> flows between the angle
of lens and iris diaphragm->
anterior chamber-> reabsorbed by
canal of Schlemm
63b

What is the pathogenesis of

glaucoma?
64a

Blocked canal of Schlemm->

aqueous humor not
reabsorbed-> increased
pressure-> atrophy of optic
nerve
64b

What is Open angle

glaucoma? Risk factors?
65a

1. Common, insidious form,

almost always bilateral
2. Risks- >40yo, black,
diabetes
65b

What are the sx in the early

stage of Open angle
glaucoma? Late stage?
66a

Early= asymptomatic
Late= areas of
reduced/absent vision,
contraction of visual field
from peripheral->central
66b

What is acute angle-closure

glaucoma? Symptoms?
67a

It's an emergency.
Sx= abrupt onset of pain, nausea,
colored halos and rainbows around
light
Signs= red, teary eye with hazy
cornea, fixed mid-dilated pupil that is
film to palpation
67b

How is glaucoma diagnosed?

68a

Via tonometry;
Opthalmoscopy with cupping
of optic disc (cup:disc ratio
>1:2)
68b

A 60yo male has a hard time

driving at night because of
eye pain with oncoming
headlights. What is the dx?
69a

Cataracts

69b

What drug category ends in ane?

70a

Inhaled anesthetics

70b

What drug category ends in azine?

71a

Neuroleptics/ Anti-emetics

71b

What drug category ends in barbital?

72a

Barbiturates

72b

What drug category ends in cillin?

73a

Penicillins

73b

What drug category ends in ipramine?

74a

TCA's

74b

What drug category ends inolol?

75a

Beta blockers

75b

What drug category ends in oxin?

76a

Cardiac glycosides (inotropic

agents)
76b

What drug category ends in pril?

77a

ACE inhibitors

77b

What drug category ends in tidine?

78a

H2 antagonists

78b

What drug category ends in tropin?

79a

Pituitary hormones

79b

What drug category ends in dronate?

80a

Bisphosphonates for
osteoporosis
80b

What drug category ends in chol?

81a

Cholinesterase inhibitors

81b

What drug category ends in mustine?

82a

Notrosurea (crosses BBB to

tx brain tumors)
82b

What drug category ends in statin?

83a

HMG-CoA reductase
inhibitors
83b

What drug category ends in bendazole?

84a

Anti-helminths

84b

What drug category ends in azepam?

85a

Benzos

85b

What drug category ends in azole?

86a

Anti-fungals

86b

What drug category ends in caine?

87a

Local anesthetics

87b

What drug category ends in cycline?

88a

Antibiotics (protein synthesis

inhibitors)
88b

What drug category ends in navir?

89a

Protease inhibitors

89b

What drug category ends in operidol?

90a

Haldol/neuroleptics

90b

What drug category ends in phylline?

91a

Methylxanthines

91b

What drug category ends in terol?

92a

Beta-2 agonist

92b

What drug category ends in triptyline?

93a

TCA's

93b

What drug category ends in zosin?

94a

Alpha-1 antagonists

94b

What drug category ends in sartan?

95a

Angiotensin-II receptor
antagonist
95b

What drug category ends in stigmine?

96a

Anti-cholinesterase

96b

What drug category ends in curium/curonium?

97a

Non-depolarizing NM
blockers
97b

What drug category ends in glitazone?

98a

Diabetes drugs that increase

target cell response to insulin
98b

What drug category ends in dipine?

99a

Calcium channel blockers

99b

What does the proximal

radial nerve innervate and
what is seen if this nerve is
damaged?
100a

1. Triceps and skin of posterior arm.

2. Damage-> cannot extend
forearm, lose triceps reflex and wrist
drop
100b

What is innervated by the

deep branch of the radial
nerve and what is seen if this
nerve is damaged?
101a

1. BEST muscles: Brachioradialis

,Extensors of wrist and fingers,
Supinator and Triceps, abductor
pollicus longus, skin of post. forearm
2. loss of brachioradialis reflex, wrist
drop, loss of sensation of posterior
forearm
101b

What is innervated by the

superficial branch of the
radial nerve and what is seen
if this nerve is damaged?
102a

1. Skin of lateral and

posterior hand
2. loss of sensation of lateral
and posterior hand
102b

What is Saturday Night

Palsy?
103a

Radial nerve compression against the

spiral groove of the humerus-> weak
wrist and finger extension, weak
brachioradialis reflex, but normal
triceps. From passing out with your
arms over the back of a chair or
bench.
103b

What is innervated by the

ulnar nerve and what is seen
if this nerve is damaged?
104a

1. Flexor carpi ulnaris and the

medial 1/2 of flexor digitorum
profundus & lumbricles (PAD/DAB)
2. CLAW HAND, cannot adduct
thumb, cannot ab/aduct fingers and
loss of sensation of medial hand
104b

What is innervated by the

median nerve and what is
seen if this nerve is
damaged?
105a

1. Flexor muscles, thumb muscles

and pronators
2. Loss of pronation, wrist flexion,
HAND OF BENEDICTION, APE
HAND, loss of sensation on lateral
palm and distal first 3.5 digits
105b

What is carpal tunnel

syndrome?
106a

Median nerve entrapment at the

carpal tunnel (enclosed by inelastic
flexor retinaculum ventrally and the
carpal bones dorsally.
106b

An elderly woman with chronic

osteoarthritis and diffuse pain now
presents with numbness and tingling
over the lateral digits of her right
hand that sometimes radiated up to
the elbow. Exam reveals wasting of
the thenar eminence. What is the dx?
107a

Carpal tunnel syndrome

107b

What is innervated by the

musculocutaneous nerve and
what is seen if this nerve is
damaged?
108a

1. Biceps, brachialis,
coracobrachialis and skin of lateral
forearm
2. Weak arm and forearm flexion
and weak supination and loss of
sensation of the lateral forearm
108b

What nerve is damaged when

a patient presents with claw
hand? Ape hand? Wrist
drop? Scapular winging?
109a

1. Claw hand= ulnar nerve

2. Ape hand= median nerve
3. Wrist drop= radial nerve
4. Scapular winging= long
thoracic n. (serratus anterior)
109b

What nerve is damaged when a

patient presents with the inability to
wipe butt? Loss of forearm
pronation? Cannot ab- or adduct
fingers? Loss of arm abduction?
110a

1. Wipe butt= Thoracodorsal

nerve (lats dorsi)
2. Forearm pronation=
median nerve
110b

What nerve is damaged when

a patient presents with weak
lateral rotation of arm? Loss
of arm and forearm flexion?
Loss of forearm extension?
111a

1. Lateral rotation= suprascapular

nerve
2. Arm/forearm flexion=
musculocutaneous nerve
3. Forearm extension= radial nerve
111b

What nerve is damaged when a

patient presents with trouble
initiating arm abduction? Inability
to abduct arm beyond 10 degrees?
Inability to raise arm above
horizontal?
112a

1. Initiate arm abduction= Suprascapular

nerve (supraspinatus m)
2. Arm abduction >10 degrees= Axillary
nerve (deltoid m)
3. Raise arm above horizontal= Long
thoracic nerve (serratus ant) + spinal
accessory nerve (trapezius m)
112b

What nerve runs with the

posterior circumflex artery?
113a

Axillary nerve

113b

What nerve runs with the

deep brachial artery?
114a

Radial nerve

114b

What nerve runs with the

brachial artery?
115a

Median nerve

115b

What nerve runs with the

posterior interosseous
artery?
116a

Deep branch of the radial

nerve
116b

What nerve is most at risk of

injury with a fracture to the
shaft of the humerus?
117a

Radial nerve

117b

What nerve is most at risk of

injury with a fracture to the
surgical neck of the
humerus?
118a

Axillary artery

118b

What nerve is most at risk of

injury with a fracture to the
supracondyle of the
humerus?
119a

Median nerve

119b

What nerve is most at risk of

injury with a fracture to the
medial epicondyle?
120a

Ulnar nerve

120b

What nerve is most at risk of

injury with an anterior
shoulder dislocation?
121a

Axillary nerve

121b

What nerve is most at risk of

injury with injury to the
carpal tunnel?
122a

Median nerve

122b

A gymnast sustains an
anterior shoulder dislocation.
What nerve is most likely to
have been injured?
123a

Axillary nerve (+ posterior

circumflex artery)
123b

An adolescent falls while

skateboarding and injures his elbow.
He can't feel the medial part of his
palm. Which nerve is damaged and
what is the injury?
124a

Ulnar nerve and medial

epicondyle fracture of
humerus
124b

A high-school athlete falls on his

arm during practice. In the ER a
radiograph shows a mid-shaft break
of the humerus. Which nerve and
which artery have the highest risk of
being damaged?
125a

Radial nerve and deep

brachial artery
125b

What are the 5 classes of

drugs used to tx glaucoma?
126a

1. alpha agonists (Epi, brimonidine)

2. beta-blockers (-olol)
3. Diuretics (CA inhibitors, mannitol)
4. Cholinomimetics (pilocarpine,
carbachol, physostigimine, echothiophate)
5. Prostaglandins (latanaprost=
PFF2alpha)
126b

How does blood pressure response to

phenylephrine administration change
if an alpha-blocker is administered
before hand? Why is this different
than the change seen when epi is
used rather than phenylephrine?
127a

With PE+alpha-agonist, BP is
suppressed but not reversed
With Epi+ alpha agonist, there is a
net decrease in BP because of
unopposed beta-2 action
127b

What are common side

effects of beta-blockers?
128a

Impotence, asthma
exacerbation, sedation, sleep
alterations, Bradycardia ann
AV block
128b

Which pt populations should

use caution when taking
beta-blockers?
129a

1. Diabetics-masks sx of hypoglycemia
2. Asthmatics- only if non-selective is used
3. Heart block or on calcium channel
blockers
4. Pt with Pheochromocytoma
5. Cocaine abusers
129b

What are the various clinical

uses for the
sympathomimetic
dopamine?
130a

Hypovolemic shock and

heart failure
130b

What are the various clinical

uses for the
sympathomimetic clonidine?
131a

HTN in renal disease

131b

What are the various clinical

uses for the
sympathomimetic
amphetamine?
132a

ADD/ADHD, narcolepsy and

depression (while waiting for
SSRI to kick in)
132b

What are the various clinical

uses for the
sympathomimetic
terbutaline?
133a

Tocolysis to prevent
premature uterine
contractions and subQ in
asthma
133b

What are the various clinical

uses for the
sympathomimetic
epinephrine?
134a

Anaphylaxis, use with local

anesthetics for
vasoconstriction, Open angle
glaucoma
134b

What pathology is associated

with the following key words:
bilateral hilar
lymphadenopathy?
135a

Sarcoidosis

135b

What pathologies are

associated with the following
key words: cherry-red spot
on macula?
136a

Tay-Sachs
Niemann-Pick's
Central retinal artery
occlusion
136b

What pathology is associated

with the following key
words:slapped cheeks rash
on a child?
137a

Fifth's disease/ Parvo B-19

137b

What pathology is associated

with the following key
words:organism from dog or
cat bite?
138a

Pasturella multocida

138b

What pathology is associated

with the following key words:
facial muscle spasm upon
tapping the cheek?
139a

Chvostek's sign for

hypocalcemia
139b

What pathology is associated

with the following key words:
cough, conjunctivitis, coryza?
140a

Measles

140b

What pathology is associated

with the following key words:
nephritis, hearing loss,
cataracts?
141a

Alport's Syndrome (Type IV

collagen mutation) "Can't
see, Can't pee, Can't hear"
141b

What primary hormone is

increased or decreased in
Cushing's syndrome?
142a

Increased cortisol

142b

What primary hormone is

increased or decreased in
Conn's syndrome?
143a

Increased aldosterone

143b

What primary hormone is

increased or decreased in
Addison's disease?
144a

Decreased aldosterone and

cortisol
144b

What primary hormone is

increased or decreased in
Grave's disease?
145a

Decreased TSH, Increased

T3/4
145b

What is the function of

MacConkey's agar?
146a

Selective medium for Gram() and lactose ermenters

146b

Your patient has facial

angiofibroma, ash-leaf spots of skin
depigmentation, hx of seizures and
MR. What condition does this pt
have? What neoplasms is this pt at
risk of developing?
147a

Dx= Tuberous Sclerosis

Risk= Cardiac
rhabdomyoma, astrocytoma
and angiomyolipoma
147b

What is the cause of

achalasia? How is it dx?
148a

Loss of myenteric/Auerbach
plexus
Dx= Barium swallow with
bird's beak or manometry
148b

Compare the leading COD in

ages 15-24 to those in ages
25-64.
149a

15-24= Injuries, homicide,

suicide, cancer, heart dz
25-64= Cancer, heart dz,
injuries, suicide, stroke
149b

In which glomerular disease

would you expect to see the
following changes: anti-GMB
Abs on IF?
150a

Goodpasture Syndrome

150b

In which glomerular disease

would you expect to see the
following
changes:Kimmelstiel-Wilson
lesions on LM?
151a

Diabetic nephropathy

151b

In which glomerular disease

would you expect to see the
following changes: 'spike and
dome' appearance on EM?
152a

Membranous
glomerulonephritis
152b

In which glomerular disease

would you expect to see the
following changes: 'tram
track' of subendothelial
humps on EM?
153a

Membranoproliferative
glomerulonephritis
153b

In which glomerular disease

would you expect to see the
following changes:
subepithelial humps on EM?
154a

Acute post-streptococcal
glomerulonephritis
154b

What are the clinical uses for

metronidazole?
155a

"GET GAP on the Metro":

Giardia
Enatamoeba
Trichamonas
Gardnerella
Anaerobes
H. Pylori
155b

What are the two most

common complications after
an MI? What is Dressler's
Syndrome?
156a

1. Arrhythmia and V-fib (and

LV failure)
2. Dressler's= autoimmune
dz weeks post-MI that leads
to fibrinous carditis
156b

What is the WAGR complex?

157a

Mnemonic for what is seen with

Wilm's Tumor (2-4yo)
Wilm's
Aniridia
Genitourinary malformation
Retardation
157b