General Pharmacology

General Pharmacology Sean Murphy

Study Tools • Pharmacology Cards • PharmCards • Anki • Kaplan • Katsung & Trevor Board Review • Vary your study fonts

Why people think pharmacology is hard… • I have to memorize all these drugs, thereswaaaayyy too many • Pharm cards are too detailed, how can I memorize everything? • I thought Step 1 wasn’t clinical? • Dude…

WARNING: You will get the following question on your exam.

You do a 6 month stint in Cameroon with MSF and a rural farmer presents to your emergency tent with dyspnea and diarrhea. On physical exam patient is diaphoretic with fasiculations. Miosis and lacrimation are noted. What are the kinetics of the first-line treatment?

Lineweaver Burke Plots

Do not memorize…Conceptualize

Eye Pharmacology

Glaucoma Pharmacology • Is the trabecular meshwork open or closed?

Key Equations • Vd = amt of drug/[plasma] • CL = rate of elimination (will be given)/[plasma] • t1/2 = 0.7 x Vd / CL • Parameters must be given in the stem • When does steady state occur?

Urine pH Elimination“If you’re charged with a crime, you go to prison.” • Weak acids: Give bicarbonate • Aspirin • Penicillins and Cephalosporins • Thiazide and Loop diuretics • Phenobarbital • Methotrexate • Weak bases: Give ammonium chloride • EpinephrineNorepinephrineMorphineAcetazolamadeQuinidineCaffieneZalcitabineTheophyllineErythromycinAmphetamine

Beta Blockers • -olol • All beta blockers beginning with letters A-M are B1 selective • Why would this be better in some patients? • Any other suffix indicates it is mixed alpha/beta blockade

Question 1 • 75 year old obese Caucasian male with PMH of hypercholesterolemia and HTN presents to his primary care practitioner complaining of a 4 month history of non-productive cough. His vital signs are T 96.8 BP 128/86 HR 88 RR 14. Physical exam is unremarkable. What would be an appropriate change in his drug regimen? • A. Simvistatin -> Entezimbe • B. Verapamil -> Amlodipine • C. Atenolol -> Methyldopa • D. Lisinopril -> Losartan

Question 2 • A 28 year old Egyptian medical student presents to an addiction clinic for opiate dependency. He is prescribed clonidine for withdrawl symptoms. What effect will this treatment have on the targeted nerve endings? • A. Activation of adenylylcyclase • B. Decrease in cAMP formation • C. Increase in IP3 and DAG • D. Inhibition of protein kinase C • E. Opening of Na+/K+ cation channels

Question 3 • A 19 year old pre-medical student is hiking in the woods with his girlfriend and finds a mushroom. He ingests it hoping to increase his spiritual awareness and becomes acutely ill. His girlfriend carries him to the nearest park medic station with a mushroom for identification. A paramedic identifies the mushroom as containing pilocarpine. What effect would NOT be seen in the patient? • A. Bradycardia • B. Bronchospasm • C. Diarrhea • D. Hypertension • E. Lacrimation

Question 4 • A 35 year old anethesiologist is brought to the emergency department after ingesting an unknown quantity of phenobarbital, the plasma level drawn was 50mg/L on admission. Phenobarbital’s pharmacokinetic parameters are: Vd = 40 L, CL = 6L/day, t(1/2)=4 days F =1. What quantity of the drug that the patient ingested must have been close to: • A. 100mg • B. 500mg • C. 1g • D. 2g • E. 5g

Question 5 • A 23 year old medical student at UMMSM is on rifampin for TB prophylaxis while on the wards in Jackson. She had an appendectomy when she was 14, otherwise no past medical history, is taking birth control pills and is sexually active with multiple partners. What adverse effect is her current regimen likely to have? • A. Liver toxicity • B. Urinary incontinence • C. Constipation • D. Unwanted pregnancy • E. Cinchonism

Quick High Yields • African-American physician visits sub-Saharan Africa on a medical mission and develops hemolytic anemia. Why? • Woman is given a post-abortion prophylactic antibiotic, goes to the beach and gets a rash. What antibiotic? • Post-surgical patient cannot urinate. What do you give?

General Pharmacology