Материал: 2016_Kaplan_USMLE_Step_1_Lecture_Notes_Pharmacology

USMLE Step I λ Pharmacology

Affinity, defined, 19

agents affecting glucagon-like peptide-1, 276 Agonists

defined, 19 full, 20

in dose-response curves, 19–22 partial, 20, 21

Ag sulfadiazine, characteristics/uses, 188 Albuterol, as beta adrenergic agonist, 59

in treating asthma, 242 Alcohol

and pregnancy, 138 as antidote, 317

as drug of abuse, 163 common toxic syndromes, 315 metabolism, 11

metabolism and pharmacologic actions, 138 withdrawal signs, 135

Aldesleukin (IL-2), clinical uses, 303 Aldosterone

as adrenal steroid antagonist, 279 in hormonal feedback loop, 41

Alendronate, 289

Aliskiren, 92, 121 Alkalinization of urine, 5 Alkalosis, 84

carbonic anhydrase inhibitors for, 84 diuretics causing, 88

Alkylating agents, cell-cycle specificity, 301 Allergic reactions

drugs for treating, 221–222

to sulfonamide-containing drugs, 85 Allopurinol

characteristics/uses, 237

drug interaction with 6-mercaptopurine, 237 All-trans retinoic acid (ATRA), characteristics/uses, 301 Alpha adrenergic receptors

activators, 57, 58, 71, 93 blockers. See Alpha blockers

Alpha blockers, 61–62, 72 as antihypertensives, 94

Alprazolam characteristics/uses, 134 grapefruit juice and, 10

Alprostadil, 230

Alteplase (tPA) actions, 264

characteristics/uses, 263 Alzheimer disease, drugs for treating

acetylcholinesterase inhibitors, 48 characteristics of illness, 48

Amantadine

as antiparkinsonian drug, 148 as M blocker, 48 characteristics/uses, 204–205 mechanism of action, 200

Amebiasis, metronidazole for, 207 Amides, 155

324

Amikacin, 185, 191

mechanism of resistance, 179 Amiloride

as diuretic, 87

modes of action/effects, 88 Amine hypothesis, 139 Aminocaproic acid, 264 Aminoglycosides, 191

characteristics/uses, 185–186 daily dosage, 185

drug list, 209

loop diuretics interaction with, 85 mechanism of action, 179, 185 mechanism of resistance, 179 pregnancy risk, 186

Aminophylline VI, in treating asthma, 242 Amiodarone, characteristics/uses, 108 Amitriptyline, 140

for migraine headaches, 228 Amoxicillin, 181

for treating H. pylori ulcers, 190 Amphetamines

as drugs of abuse, 165

as indirect-acting adrenergic agonist, 61 Amphotericin B (Amp B), characteristics/uses, 195–196 Ampicillin, 181

Amyl nitrite, for cyanide poisoning, 94 Anakinra, characteristics/uses, 235 Analgesics

for migraine headache, 228

nonsteroidal antiinflammatory drugs, 231–233 opioid. See Opioid analgesics

Anastrozole, 280 mechanism of action, 280

Androgens

characteristics/uses, 282–283 drug list, 291

Androstenedoine, 280 Anesthetics, 153–155, 157

compartmentalization in body, 153 drug list, 167

general, 153–154

inhaled, 153, 153–154, 167 intravenous, 154

local, 155, 167

skeletal muscle relaxants, 156–157, 167 Angina, antihypertensive use in, 95 Angiotensin-converting enzyme inhibitors (ACEIs)

for heart failure, 97

for hypertension, 92, 92–93 Angiotensin I, 92

Angiotensin II, 92

in hormonal feedback loop, 41 receptors for, 24

Angiotensin-receptor blockers (ARBs), 92 for heart failure, 97

for hypertension, 92, 92–93 Angiotensin system, 92

Anion overdose, drugs for treating, 85 Antacids

absorption and, 225

for peptic ulcer disease, 225 quinidine absorption and, 106

Antagonists

antagonism and potentiation, 21, 21–22 chemical, 22

competitive, 22 defined, 19 noncompetitive, 22 partial agonists as, 20 physiologic, 22

Antianginal drugs, 111–114 beta-blockers, 62, 113 calcium channel blockers, 113 carvedilol, 113

drug list, 121

for stable and vasospastic angina, 111 nitrates, 111, 111–112

rationale for use, 111

smooth muscle contraction/relaxation, 115 Antiarrhythmic drugs, 101–110

and cardiac action potential, 102–105 beta-blockers, 62, 107 calcium-channel blockers, 108

drug list, 121

K+ channel blockers, 108

Na+ channel blockers, 106–107 unclassified, 108–109

Antiasthmatic drugs characteristics/uses, 241–243

drug actions on bronchiolar smooth muscle, 241 drug list, 245

M blockers as, 50 Antibacterial agents, 179–194

antitubercular drugs, 191 drug list, 209

inhibitors of bacterial protein synthesis, 180, 184–188 inhibitors of cell-wall synthesis, 180, 180–184 inhibitors of folic acid synthesis, 180

inhibitors of nucleic acid synthesis, 180, 188, 188–190 metronidazole, 190

pregnancy risk, 186, 190

principles of antimicrobial chemotherapy, 179–180 Anticancer drugs, 299–302

cell-cycle specificity, 299 characteristics/uses, 301 clinical uses of cytokines, 303 principles and definitions, 299 “thymineless” death of cells, 301 toxicity, 302

Anticholinergics antidote for, 317

as drugs of abuse, 164 Anticoagulants, 259–262

direct thrombin inhibitors, 262 drug list, 267

Index

heparins, 260 overview, 259 warfarin, 260, 261

Anticonvulsants, 150–153 characteristics/uses, 150–152 drug list, 167

seizure states/drugs of choice, 149 Antidepressants, 139–140

characteristics/uses, 139–140 drug list, 167

Antidiarrheal drugs, M blockers as, 50

Anti-D immunoglobulin, characteristics/uses, 309 Antidotes

for common toxic syndromes, 315 for heavy metal poisoning, 316 summary table, 317

Antiemetics characteristics/uses, 225 drug list, 245

emetic pathways, 225 mechanisms of action, 225

Antifibrinolysins, 264 Antifolates, drug list, 209 Antifungal agents, 195–198

azoles, 196–197 drug list, 209

mechanism of action, 195 other, 197

polyenes, 195–196 Antiherpetics, 200–201, 205

acyclovir, 200 drug list, 209 foscarnet, 201 ganciclovir, 201

Antihistamines, 221–222 antidote for, 317

as M blocker, 50 drug list, 245 properties, 222

Anti-HIV agents drug list, 209

HIV prophylaxis, 203

reverse transcriptase inhibitors, 202–203 side effects, 202

zidovudine, 202 Antihyperlipidemics, 117–120

bile acid sequestrants, 118, 121 drug list, 121

ezetimibe, 119, 121 fenofibrate, 119, 121 gemfibrozil, 118, 121

HMG-CoA reductase inhibitors, 118–119 nicotinic acid, 118, 121

orlistat, 119, 121 usage summary, 119

Antihypertensive drugs, 91–96 adrenoceptor agonists and, 58

angiotensin-converting inhibitors, 92, 92–93

325

USMLE Step I λ Pharmacology

angiotensin-receptor blockers, 92, 92–93 autonomic feedback loop, 40–41 beta-blockers, 62

calcium-channel blockers, 93–94 direct-acting vasodilators, 94 diuretics, 83–89, 84. See also Diuretics drug list, 121

drugs altering sympathetic activity, 93 drug strategy, 91

endocrine feedback loop, 42 feedback loops invoked by, 42

for pulmonary hypertension, 95, 231 in chronic hypertension, 95

in comorbid conditions, 95 thiazides, 86–87

Antileukotrienes, in treating asthma, 243 Antimalarial drugs, 207, 207–208 Antimetabolites, 188

Antimicrobial agents

antibacterial agents, 179–194, 210 antifungal agents, 195–198, 209 antiprotozoal agents, 207–208, 210 antiviral agents, 199–205, 210 mechanism of action, 179 mechanism of resistance, 179

Anti-motion sickness drugs antihistamines, 222

M blockers as, 50 Antimycobacterials, drug list, 209 Antiparkinsonian drugs, 143–145, 148

antidote for, 317 characteristics/uses, 144 CNS targets, 143

dopaminergic neural pathways and, 143 drug list, 167

M blockers as, 50 Antiplatelet drugs

characteristics/uses, 265–266 drug list, 267

platelet activation, 265 platelet aggregation, 265 Antiprotozoal agents, 207–208

antimalarial, 207, 207–208 helminthic infections, 208 infections/drugs of choice, 207

Antipsychotic drugs, 146–147, 148 as M blockers, 50 characteristic properties, 147 drug list, 167

parenteral formulations, 147 Antisecretory drugs, M blockers as, 50 Antispasmodic drugs, M blockers as, 50 Antithyroid agents

characteristics/uses, 286 drug list, 291

effects, 285

thyroid hormone synthesis and, 286

326

Antitubercular drugs, 191, 194 characteristics/uses, 191

mechanisms of actions/resistance, 191 side effects, 191

Antitumor antibiotics, cell-cycle specificity, 299 Antiviral agents, 199–205

antiherpetics, 200–201 anti-HIV, 199–201, 209 drug list, 209

fusion inhibitors, 204 mechanism of action, 200 other, 204

sites of drug actions, 199

Apparent volume of distribution (Vd), 8 equation, 16

Aprepitant, 225

Araranavir, in HIV prophylaxis, 203 Argatroban, 262

Aripiprazole, characteristic properties, 147 Aromatase, 280

Arsenicals, as antiprotozoal agents, 207 Arsenic poisoning, 316

antidote for, 317 Arteriodilators, for heart failure, 98 Asparaginase, toxicity, 302 Aspartate protease, 203

Aspirin

characteristics/uses, 231–232 for migraine headaches, 228 platelet activation, 265

Asthma, drugs for treating, 50, 241–243, 246 Atenolol, characteristics, 62

Atomoxetine, 141 Atorvastatin, 118–119

grapefruit juice and, 10 Atovaquone-proguanil, 208 Atracurium, 156

Atrial fibrillation, 108 Atropine

as antidote for AChE inhibitor poisoning, 317 characteristics/uses, 50–51, 51

common toxic syndromes, 315 poisoning with, antidote for, 317

Attention deficit hyperactivity disorder (ADHD), drugs for treating, 141, 164

Automaticity, cardiac action potentials, 103 Autonomic feedback loop, 40–41 Autonomic nervous system (ANS), 39–44

anatomy, 39, 39–40

blood pressure control mechanisms, 40–42 dominance, 50

feedback loop, 40–41

pupillary size and accommodation mechanisms, 43 receptors, 24

regulation of heart rate, 106 Autonomic pharmacology

adrenergic receptor activators/antagonists, 55–64, 71 autonomic nervous system, 39–44

cholinergic receptor activators/antagonists, 45–53, 71 drug list, 71

in glaucoma, 65, 66

Azathioprine, characteristics/uses, 309 Azithromycin, mechanism of resistance, 180 Azoles, 196–197

AZT. See Zidovudine (azidothymidine, ZDV, AZT) Aztreonam

characteristics/uses, 183 mechanism of action, 179, 183

B

Baclofen, as centrally acting skeletal muscle relaxant, 157 Bacterial protein synthesis, 184

Bacterial ptotein synthesis, inhibitors of. See Protein synthesis inhibitors

Baldness, drugs for treating, 94 Barbiturates

as drugs of abuse, 165 characteristics/uses, 133–135 CNS effects based on dosage, 133 withdrawal signs, 135

Barorecptor reflexes, 41 Batrachotoxin, 155

Benign prostatic hypertrophy (BPH), antihypertensive use in, 94 Benzocaine, as local anesthetic, 155

Benzodiazepines (BZs) antidote for, 317

as centrally acting skeletal muscle relaxants, 157 as drugs of abuse, 165

biotransformation, 9 characteristics/uses, 133–135, 154 CNS effects based on dosage, 133 withdrawal signs, 135

Benztropine

as antiparkinsonian drug, 148 characteristics/uses, 50

Beta blockers, 62–63 as antianginal, 111

as antiarrhythmics, 107 as antihypertensives, 94

characteristics/uses, 62, 62–63, 92, 107 chronic use, 62

drug lists, 62

for heart failure, 97 general uses, 62–63

in glaucoma treatment, 66 Beta-lactam antibiotics

chemical structure, 180 mechanism of resistance, 181

Betamethasone, 239 Beta-receptor agonists, 242

activators, 57, 71 antidote for, 317

blockers versus. See Beta blockers Beta-receptor antagonists. See Beta blockers

Index

Bethanechol, cholinergic properties, 47 Bevacizumab, 302

Bile acid sequestrants, 118, 121 Bilirubin, protein-binding capacity, 8 Bioavailability (f), 7, 10

Biodisposition of drugs, in pharmacokinetics, 3 Biotransformation, 9

classification, 10–11 types, 10–11

Bipolar disorders, lithium for treating, 140, 167 Bismuth subsalicylate, 224

Bisoprolol, for heart failure, 98 Bisphosphonates, 289 Bivalirudin, 262

Bladder, muscarinic receptor activation and, 46 Bleomycin

cell-cycle specificity, 299 characteristics/uses, 301 toxicity, 302

Blood-brain barrier (BBB), 8, 9

Blood disorders, drugs for treating, 259–262 actions of blood drugs, 260 anticoagulants, 259–262, 267 antiplatelet drugs, 265–266, 267

drug lists, 267 thrombolytics, 263–264, 267

Blood pressure

control mechanisms, 40–42 autonomic feedback loop, 40, 40–41 blood pressure/heart rate tracings, 42 hormonal feedback loop, 41, 42

effect of adrenergic activators on mixed-acting agonists, 59–60, 61–62

tracings, 42

Blood vessels (endothelium), muscarinic receptor activation and, 46 “BMT” regimen, in peptic ulcer disease, 190

Bone and mineral disorders, drugs for treating characteristics/uses, 289

drug list, 291

Bone marrow suppression (BMS), 302 Bosentan, for pulmonary hypertension, 95 Botulinum toxin, 46

Bromocriptine

as antiparkinsonian drug, 148 Bupivacaine, as local anesthetic, 155 Buprenorphine, characteristics/uses, 160 Bupropion, 140

Buspirone, characteristics/uses, 135, 227 Busulfan, toxicity of, 302

Butabarbital, for migraine headaches, 228 Butorphanol, for migraine headaches, 228

C

Caffeine, for migraine headaches, 228 Calcium (Ca2+), 25f

excretion of, loop vs/ thiazide diuretics, 86

327

USMLE Step I λ Pharmacology

Calcium (Ca+) channels, slow-response fibers, 103–104 Calcium-channel blockers (CCBs)

as antianginal, 111, 113 as antiarrhythmic, 108

as antihypertensive, 91–92 cardiac/vascular selectivity, 93

Calculations, in pharmacokinetics, 16 cAMP (cyclic-AMP), 24, 25

ANS regulation of heart rate and, 106 Canagliflozin, 276

Cancer, drugs for treating, 299–302 Capecitabine, characteristics/uses, 301 Capreomycin, 191

Captopril, 92

Carbamazepine characteristics/uses, 150

seizure states/drugs of choice, 149 Carbonic anhydrase inhibitors, 84–85

actions, 84

Carbon monoxide poisoning, 315 antidote for, 317

Carboprost, 230 Cardiac action potential

fast-response fibers, 101, 101–102 slow-response fibers, 103, 103–104

Cardiac output (CO), 40, 41 Cardiac pharmacology

action potential, 101–104

ANS regulation of heart rate, 106 antianginal drugs, 111–114, 121 antiarrhythmic drugs, 101–110, 121 antihyperlipidemics, 119, 121 antihypertensive drugs, 42–44, 91–96, 121 cytochrome P450 isozymes, 10

diuretics, 83–89, 121 heart failure drugs, 121 Na+ channels, 105

Cardioselectivity, beta blockers and, 62 Carmustine, cell-cycle specificity, 299 Carvedilol, 63

as antianginal, 111 for heart failure, 97

Caspofungin, 197

Catecholamines receptors for, 24

synthesis/action/degradation, 55, 56 Catechol-O-methyltransferase (COMT), 57 Cefaclor, 182

Cefazolin, 182

Cefdinir, 182

Cefepime, 182

Cefixime, 182

Cefotaxime, 182

Cefotetan, 182

Ceftriaxone, 182

Cefuroxime, 182 Celecoxib, 85

characteristics/uses, 233

328

Cell-cycle specificity (CCS) anticancer drugs, 299 of anticancer drugs, 299

Cell-wall synthesis inhibitors, 180–184, 192 drug list, 209

mechanism of action, 179 Cephalexin, 182 Cephalosporins

characteristics/uses, 182 chemical structure, 180 drug list, 209

mechanism of action, 179, 183 mechanism of resistance, 179, 183 organisms not covered by, 182

Cetirizine, properties of, 222 Cetuximab, 302

cGMP (cyclic GMP) signaling, 25 Chemical antagonism, 22 Chemoreceptor trigger zone

antiparkinsonian drugs and, 143 opioid analgesics and, 159

Chloramphenicol characteristics/uses, 186 mechanism of action, 179, 185 mechanism of resistance, 179 metabolism, 11

Chloroquine, 207, 207–208 Chlorpheniramine, properties of, 222 Chlorpromazine, characteristic properties, 147 Chlorpropamide, 138

Chlorthalidone, 86

modes of action/effects, 88

Cholestyramine, as bile acid sequestrant, 118, 119, 121 Choline, 45

Choline acetyltransferase (ChAT), 46 Cholinergic neuroeffector junctions, 45, 45–47 Cholinergic pharmacology, 45–53

cholinergic neuroeffector junctions, 45, 45–47 muscarinic receptor activators, 47, 47–49, 71 muscarinic receptor antagonists, 49–50, 71 nicotinic receptor antagonists, 50–51, 72

Cholinergic receptor activators, 47 AChE inhibitors, 46, 48–49, 71 direct, 71

drug list, 71

Cholinergic receptor antagonists drug list, 71

ganglionic blockers, 71 M blockers, 49–50, 71

Cholinomimetics direct-acting, 47 indirect-acting, 46, 48 mechanism of action, 66

Chronic obstructive pulmonary disease (COPD), M blockers and, 50 Ciguatoxin, 155

Cimetidine

characteristics/uses, 224–225 cytochrome P450 isozymes and, 224