Pharmacology Onco + Renal + Dermato

1. Vincristine causes neurotoxic effects such as peripheral neuropathy due to failure of

microtubule polymerization in neuronal axons. It is a chemotherapy agent.
2. Amphotericin B is the most toxic antifungal and is nephrotoxic (renal tubular
dysfunction) causing both anemia and electrolyte abnormalities (hypokalemia and
hypomagnesia)
3. Cladribrine is a purine analog that is resistant to degradation by adenosine deaminase.
Drug of choice for hairy cell leukemia.
4. Methotrexate (similar to folic acid) given to pregnant women for ectopic pregnancy
causes dihydrofolate polyglutamate to accumulate in embryonic tissue. Methotrexate
inhibits dihydrofolate reductase, which catalyzes the synthesis of tetrahydrofolate.
Failure of dihydrofolate reductase causes the intermediate dihydrofolic acid
polyglutamate to accumulate in treated cells.
5. Acetazolamide treats acute angle-closure glaucoma. It is a diuretic that inhibits carbonic
anhydrase, which is found in the proximal tubule.
6. Para-aminobenzoic acid containing sunscreens protect skin from UVB rays.
7. Methotrexate and 5-FU inhibit thymidylate formation, but methotrexate is overcome by
Leucovorin (N^5-formyl-tetrahydrofolate)
8. Acyclovir Is nephrotoxic and symptoms can be prevented by adequate hydration
9. Etoposide targets topoisomerase II (blocks it from sealing strand breaks it causes leading
to chromosomal breaks
10. Nafcillin is a penicillinase-resistant penicillin that treats skin and soft tissue infections
11. Tumor cells resist anticancer agents via MDR1 gene which produces a P-glycoprotein, a
transmembrane protein that functions as an ATP-dependent efflux pump (removes
chemotherapeutic agents)
12. Calcineurin activates IL-2, which promotes the growth and differentiation of T cells.
Cyclosporine and tacrolimus work by inhibiting calcineurin activation.
13. Corticosteroids decrease the production of ECM collagen and GAG causing dermal
atrophy
14. Thiazides prevent calcium stone formation by decreasing urine Ca2+ excretion (increase
Ca2+ reabsorption by inhibiting the Na/Cl cotransporter and by hypovolemia induced by
thiazides.
15. Loop diuretics are used to treat volume overload due to CHF. Work in thick ascending
loop of Henle
16. Thiazide diuretics cause hyponatremia, hypokalemia, and hypercalcemia
17. ACE-inhibitor (prevents efferent arteriole from constricting more than afferent) side
effects include decreased glomerular filtration rate, cough and angioedema
18. Spironolactone is an aldosterone antagonist and is similar to steroids it causes endocrine
effects such as gynecomastia, decreased libido, and impotence.
19. Finasteride (5a-reductase inhibitor) treats BPH (decreases prostate volume)
20. Vincristine is a vinca alkaloid that inhibit microtubule formation during the M phase of
the cell cycle (replicated chromosomes unable to align and separate)
21. Mannitol an osmotic diuretic side effects include headache, nausea and vomiting. High
doses can cause excessive volume depletion and hypernatremia and pulmonary edema.
22. Thiazides cause hypercalcemia and work in the distal convoluted tubule
23. Mesna (2-mercaptoethanesulfonate) prevents the hemorrhagic cystitis associated with
nitrogen mustard-based chemotherapy. Cyclophosphamide causes hemorrhagic cystitis
24. Cidofovir is a nucleoside monophosphate that requires only cellular kinases for
activation. Treats varicella zoster virus in HIV infected patients also foscarnet
25. Baldness in males is due to 5a-reductase activity. Finasteride inhibits these effects
26. Lithium induced diabetes insipidus (treatment for bipolar disorder) causes low urine
specific gravity with trace ketones. ADH (vasopressin) is antagonized in collecting duct
27. Isotretinoin (Accutane) is teratogenic so must test for pregnancy (serum b-HCG levels)
before prescribing to female
28. Ondansetron (5-HT3) receptor antagonist prevent chemo-induced vomiting
29. Calcipotriene used to treat psoriasis activates a nuclear transcription factor (vitamin D
receptor)
30. Terbinafine is used to treat dermatophytosis by inhibiting synthesis of ergosterol of the
fungal membrane by inhibiting the enzyme squalene epoxidase
31. Furosemide is ototoxic
32. Addition of low dose spironolactone to standard therapy reduces morbidity and
mortality in CHF patients
33. Leucovorin (folinic acid) can reverse methotrexate toxicity
34. Visual impairment in HIV infected patient caused by CMV induced retinitis. Foscarnet,
ganciclovir and cidofovir used to treat this, but foscarnet can cause seizures due to
hypomagnesemia and hypocalcemia
35. Digoxin is cleared by the kidneys and causes renal insufficiency in older patients
36. Amphotericin B is used to treat mucormycosis and causes renal toxicity so serum
potassium and magnesium should be monitored
37. The pathophysiology of EML4-ALK NSCLC is similar to the pathophysiology of CML
38. 6-mercaptopurine is degraded in the liver by xanthine oxidase
39. Amifostine is a thiol-based cytoprotective free-radical scavenging agent that decreases
nephrotoxicity due to platinum containing agents (cisplatin).

Renal Physiology

40. Constriction of efferent arteriole causes increase of GFR and FF

41. Diabetic ketoacidosis triad: polydipsia, polyuria and fruity odor to the breath and/or
urine. DKA yields a low pH, low serum bicarbonate and a low PaCO2.
42. Potassium levels in bowmans capsule is 100%. In collecting duct it is 110%. In proximal
tubule 65% of K is filtered out leaving 35% in the proximal tubule. In thick ascending
loop of Henle there is 10 % of K.
43. End-stage renal disease causes hypocalcemia via renal retention of phosphate and
decreased renal synthesis of 1,25-dihydroxycholecalciferol vitamin D. Both hypocalcemia
and the resultant hyperparathyroidism contribute to renal osteodystrophy.
44. PCT reabsorption of glucose occurs via Na+/glucose co-transporter. Inulin is a substance
that is not filtered so it is used to calculate GFR.
45. Serum creatinine rise as GFR declines to less than 60 ml/min
46. Increase to capillary hydrostatic pressure will increase GFR due to constriction of
efferent arteriole
47. Rate of dialysis with semipermeable membrane is increased by increasing surface area
of the membrane
48. Filtration fraction of healthy individual is 20%. Creatine estimates GFR and PAH estimates
RPF
49. In aspirin overdose, blood pH is acidic (METABOLIC ACIDOSIS) or results in respiratory
alkalosis
50. PAH is not reabsorbed and has lowest concentration in Bowmans capsule.
Concentration increases as it moves through tubules
51. Elevated aldosterone causes HTN, hypokalemia, and muscle weakness. Increased levels
of aldosterone and renin caused by renin-secreting tumors (juxtaglomerular tumor)
52. Water is impermeable to the ascending limb of the loop of Henle regardless of serum
vasopressin levels
53. Chronic renal failure causes secondary hyperparathyroidism. PTH and phosphate are
high and calcium and calcitriol are low.
54. In DKA, metabolic acidosis is compensated by respiratory alkalosis. When PaCO2 levels
are above range from Winters formula, the patient has respiratory acidosis and failure.
55. Fluid filtered in the glomerulus is reabsorbed in the proximal tubules
56. Spironolactone is an aldosterone receptor inhibitor. Na is removed from the tubular
fluid. Also, K and H ions are lost in the tubular fluid.
57. ADH is released during dehydration and acts on collecting ducts. In presence of ADH, the
collecting ducts contain concentrated fluid, while thick ascending limp of loop of Henle
and distal convoluted tubule contain most dilute fluid
58. In DKA, pH, HCO3, and CO2 are low. Titratable acids like H2PO4 are high.
59. PAH, creatinine, inulin, and urea increase as fluids flows along proximal tubule. Bicarb.,
glucose and amino acids decrease
60. Dehydration leads to decrease in RPF and GFR and FF increases.
61. Urea concentration increases ADH concentrating urine in the medullary segment of the
collecting duct
62. Ureteral constriction or obstruction acutely decrease the GFR and glomerular filtration
fraction
63. PAH secretion can be saturated at high blood concentrations
64. ADH acts on the collecting ducts increasing their permeability to water. When ADH is
absent, the tubular fluid is most concentrated between the descending and ascending
limps of the loop of Henle and most dilute in the collecting ducts.
65. FF calculated by GFR/ (1-Hct)(RBF).
66. ADH injection reduces urea
67. Loop diuretics stimulate prostaglandin release and NSAIDs inhibit prostaglandin
68. Net excretion= (inulin clearance)(plasma conc. of A) (tubular reabsorption of A)
69. RBF= PAH clearance= (urine PAH x urine flow rate)/plasma PAH / 1 hematocrit
70. Glucose is completely reabsorbed at low concentrations and high fractional excretion is
observed at high plasma concentrations
Anatomy CVS
71. Left atrium is anterior to esophagus
72. Descending aorta is posterior to the esophagus
73. Left ventricular leads course through the coronary sinus which resides in the AV groove
74. IVC is formed by right and left common iliac veins
75. Staph affects tricuspid valve
76. Inferior wall of left ventricle forms diaphragmatic surface of heart. Posterior descending
artery supplies this area and derives from the right coronary artery
77. Coronary sinus dilation due to HTN
78. Left heart failure shows pulmonary edema, pleural effusions, Kerley B lines and vascular
shadowing
79. Saphenous vein harvested at inferolateral area to the pubic tubercle
80. Right ventricle at LSB 4th intercostal space
81. Aortic rupture common in motor vehicle accidents and aortic isthmus (connects
ascending and descending aorta) is usually injured
82. IVC filter used to prevent DVT from traveling to lungs
83. Pathology Reproductive