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248 Cards in this Set

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What is associated with ostium primum heart defects?
Down's syndrome
What heart murmur results from acute rheumatic fever vs chronic rheumatic heart disease?
Acute: mitral regurg; chronic: mitral stenosis, possibly aortic stenosis
Which endocarditis causes vegetations on both sides of the mitral vs only one side?
Libman-Sacks causes vegetations onboth sides; marantic endocarditis on one side
What type of cardiomyopathy is associated with pregnancy?
DCM
What is a common cause of pneumonia superimposed on COPD?
H. flu, Moraxella catarrhalis, Legionella
What condition increases the risk of necrotizing enterocolitis in a neonate?
Neonatal respiratory distress syndrome
What is the most common lung tumor in male smoker? Female smoker? Nonsmoker?
Male = squamous, female = adenocarcinoma, nonsmoker= adenocarcinoma
What cell does bronchioalveolar carcinoma arise from?
Clara cell
What is the most common tumor of the lung?
Metastasis
Who gets allergic bronchopulmonary aspergillosis and what are the symptoms?
CF or asthmatic with bronchiectasis; have cough, dyspnea, and foul smelling sputum
What is the CD4/CD8 ratio in hypersensitivity pneumonitis? What type of hypersensitivity is it?
Low; type III/IV
What patients get hypersensitivity pneumonitis? What is the long term effect of exposure?
Farmers, people who work with birds; granulomas with eosinophils leading to pulmonary fibrosis
What is dysplastic kidney and how is it inherited?
Cartilage, cysts in kidney; not inhertiable
What is the BUN/creatinine ratio in prerenal, intrinsic, and postrenla failure?
Prerenal it is >20, intrinsic is 10-15, postrenal is >20 initially and then <15 in long standing damage
What type of nephrotic syndrome develops in sickle cell patients?
FSGS
What cell produces erythropoietin?
Renal peritubular interstitial cells
What cell creates 1,25 vitamin D?
Proximal tubule
What type of transitional cell carcinoma has early p53 mutations?
Flat pathway (not papillary)
Where does cervical cancer spread to first?
Spreads locally; invades bladder and results in hydronephrosis
What type of acid/base imbalance is present in pulmonary embolism? Why does this happen?
Respiratory alkalosis; irritation of lung stimulates the J receptor, which increases breathing rate
What is the associated risk for endometriosis of the ovary?
Increases risk of endometrioid ovarian tumor (or any other tissue that the endometrial tissue is attached to)
What is the most common malignant and benign germ cell tumor?
Malignant: dysgerminoma; benign: cystic teratoma
What type of ovarian tumor is in Meig's syndrome? What two other symptoms are present?
Fibroma (+ right sided pleural effusion, ascites)
What is the time definition for sudden infant death syndrome?
1 month to 1 year
What type of choriocarcinoma does and does not respond well to chemotherapy?
Germ cell choriocarcinoma does not respond well; complete hydatidiform mole choriocarcinoma does respond well
What symptoms can elevated beta-HCG levels in choriocarcinoma cause? Why?***
Hyperthyroidism, gynectomastia; because the alpha subunit is similar because it can activate the TSH, FSH, and LH receptors
Most common cause of testicular tumor in a male age 3-15? 15-40? 60+?
Yolk sac tumor, seminoma, lymphoma
Does prostatic adenocarcinoma produce free or bound PSA?
Bound PSA
Is prostatic adenocarinoma based on architecture or nuclear atypia?
Architecture (Gleason's grading scale)
What type of bone lesions does metastatic prostatic adenocarcinoma cause? What lab values are associated with this metastasis?
Osteoblastic lesions; elevated alkaline phosphatase, PAP, PSA
What is the effect of hypo/hyper thyroidism on blood glucose and cholesterol levels?
Hyperthyroid: hyperglycemia, hypocholesterolemia; hypothyroid: hypoglycemia, hypercholesterolemia
Patient presents with arrhythmia, h yperthyermia, vomiting, and hypovolemic shock; dx?
Thyroid storm (massive hormone excess)
What are Hurthle cells?
Eosinophilic cells in hashimoto's thyoriditis
What thyroid cancer can cause dysphagia or respiratory compromise?
Anaplastic carcinoma
What is the effect of high levels of PTH on urinary cAMP levels? Why?
High cAMP levels; PTH binds G(s) in kidney, activates adenylate cyclase, and increases cAMP!
What tumor results in achlorhydria, cholelithiasis, and steatorrhea?
Somatostatinoma (due to inhibition of CCK, gastrin)
What ion distrubance occurs in VIPoma?
Hypokalemia, achlorhydria
What bacteria likes to cause chronic adrenal insufficiency?
TB
What metastatic cancer likes to cause chronic adrenal insufficiency?
Lung cancer
Where is the fasiculus gracilis and fasiculus cuneatus found?
Gracilis central, cuneatus is lateral
What enzyme is deficient in Krabbe disease? What compound builds up in the macrophages?
Galactocerebroside beta-galactosidase; galactocerebroside
What type of virus is HPV? (enveloped/non? ssDNA/dsDNA?)
Non-enveloped dsDNA
What is the effect of ApoE2 and ApoE4 on Alzheimer's progression?
E2 is protective, E4 results in late onset
What is pseudotumor cerebri?
Also called idiopathic intracranial hypertension. Incresed ICP due to drugs => headache, nausea, vomiting, tinnitus, double vision.
What protein makes up a Lewy body? Neurofibrillary tangle? Pick body?
Lewy body = alpha synuclein; neurofib & pick = tau
How does medulloblastoma metastasize?
"Seeding"; drop metastases to the spinal cord and brain stem
What brain tumor is characterized by perivascular pseudorosettes?
Ependymoma
What ion imbalance leads to acute pancreatitis?
Hypercalcemia
What is the MOA of ezemitibe?
Inhibits cholesterol absortion in the gut
What is the other name for eczema?
Atopic dermatitis
What is melasma? What causes it?
Hyperpigmentation of cheeks associated with pregnancy ("mask of pregnancy") or oral contraceptive use.
What's the difference between impetigo vs cellulitis?
Cellulitis is a deeper infection of the dermis; has fever, soreness, erythema, etc.
What is the most common cancer in immunosuppressed individuals?
Squamous cell carcinoma (HPV, etc.)
What are the three symptoms of Gardner's syndrome?
Familial adenomatous polyposis, osteomas and soft tissue tumors, retinal hyperplasia, epidermal inclusion cysts, fibromatosis, and impacted/supernumerary teeth.
What two factors cause immediate vasoconstriction of a damaged vessels?
Endothelin, neural reflex
What is the most common cause of secondary chronic ITP?
SLE
Boy presents with hemarthrosis with no family history of clotting disorders; DX? Why?
Hemophilia A; commonly arises due to de novo mutations
How do you distinguish between a factor 8 inhibitor and hemophilia A?
Mixing study; add normal plasma to patient's plasma; hemophilia A PTT will be corrected (reduced) while factor 8 inhibitor PTT will not be corrected
What two examples can cause an acquired disorder of fibrinolysis?
Cirrhosis (decreased antiplasmin 2-alpha production), radical prostatectomy (release of tPA)
What is the patient presentation of fibrinolysis defect?
DIC WITHOUT any production of D-dimer
What is the effect of a prothrombin 20210A mutation?
Increases production of prothrombin, leads to hypercoagulable state
Patient is given heparin but does not have an increase in PTT, what condition do they have?
Antithrombin III deficiency
If a drug has a high blood/gas solubility, what is its time of onset?
Slow (insoluble gases have fast onset time; nitous oxide!)
What is the presentation of M4 acute monocytic leukemia?
Bloody / swollen gums
What leukemia do Down's syndrome patient present with prior to age 5 and after age 5?
M5: Acute megakaryoblastic leukemia (pre age 5); acute lymphoblastic leukemia (post age 5)
What WBC neoplasia is caused by alkylating chemotherapuetic agents?
AML
Two CD markers for CLL
CD5 and CD20
What is the treatment for hairy cell leukemia?
2-CDA (adenosine deaminase inhibitor)
What leukemia presents with rash, lymphadenopathy, lytic bone lesions with hypercalcemia?
HTLV-1
What part of the lymph node is enlarged with carcinoma?
Sinus histiocytes
What does Cyclin D do?
Promotes G1 to S phase
What chormosome is Cyclin D found on?
11
What lymphoma is associated with chronic inflammatory states? (RA, Hashimoto's, Sjogren's)
Marginal cell lymphoma
Is hairy cell leukemia a B or T cell?
B cell
Besides phlebotomy, what drug can be used to tx polycythemia vera?
Hydroxyurea
What part of the lymph node is enlarged with early HIV and RA?
Follicles
What chormosome is IgH found on?
14
What chromosome is bcl2 found on ?
18
What is the normal kappa to lambda ratio? What does an abnormality suggest?
3:1; monoclonality (lymphoma)
Most common type of NHL is most common? Prognosis?
Diffuse large B-cell lymphoma; poor, it is clinically aggressive
What are classic CD markers for Hodgkin's lymphoma?
CD15, CD30 and no CD20 despite being a B cell
What causes masses in Hodgkins' lymphoma?
Reed sternberg cells secrete cytokines, that attract NORMAL cells to make the mass (eosinophils, monocytes, lymphcytes, etc)
What is the most common tumor of bone?
Metastasis
What is the most common primary tumor of bone?
Multiple myleoma
What is the most common cause of death in multiple myeloma?
Infection! (monoclonal antibodies do not provide for a strong immune system…)
What is Litterer-Siwe disease
Malignant proliferation of Langerhans cells; skin rash and cystic skeletal defects in an infant <2 yrs, multiple organ failure
What is eosinophilic granuloma?
Benign proliferation of Langerhans cells; pathlogical fractures in an adolescent
Hand-Schuller-Christian disease
Malignant proliferation of Langerhans cells; diabetes insipidus, exopthalmos, skin rash and lytic skeletal defects >3 year olds
What molecule prevents macrophages from utilizing iron in anemia of chronic disease?
Hepcidin
What happens to the TIBC in anemia of chronic disease?
Decreases because transferrin decreases when ferritin is high
What is HbH? What causes it?
3 deletion alpha-thalassemia; tetramer of beta globulin (B4)
What is hemeglobin barts? What causes it?
4 deletion alpha-thalassemia; tetramer of gamma globulin
What is a consequence of chronic beta thalassemia major treatment?
Secondary hemochromatosis
What is the most common cause of death in kids and adults with sickle cell anemia?
Kids: encapsulated organism infections; adults: acute chest syndrome
What is acute chest syndrome?
Vaso-occulsion in pulmonary microcirculation; presents with chest pain, shortness of breath, lung infiltrates that is precipiated by penumonia
What is the mutation in hemoglobin C?
Glutamic acid is substituted with lysine
What is the characteristic finding in hemoglobin C?
Hemoglobin C crystals on peripheral smear
What is the most common cause of death in paroxysmal noctural hemoglobinuria?
Thrombosis of hepatic, portal, or cerebral veins
What cancer is associated with proxysmal noctural hemoglobinuria? Why?
AML; it's because the lack of CD55 is due to a mutation in stem cells, increases risk of other cancers
What are intravascular hemolytic anemias?
PNH, G6PD deficiency, cold agglutinin hemolytic anemia, babesia/malaria
What type of hemolytic anemia is caused by warm agglutinin hemolytic anemia?
Extravascular
What are causes of warm agglutinin hemolytic anemia?
SLE, CLL
What are causes of cold agglutinin hemolytic anemia?
Infectious mononucleosis, mycoplasma pneumonia
What does a congenital parvovirus infection result in?
Hydrops fetalis
What is the function of CD14?
Toll like receptor on macrophages, recognizes LPS
What does toll-like receptor activation upregulate?
NF-kB, which leads to the acute inflammatory response
What are the three actions of LTC4,LTD4, LTE4?
Vasoconstriction, bronchospasm, increased vascular permeability
How and where does increased vascular permeability occur?
Via contraciton of pericytes, that result in spaces between the endothelial cells; occur at post-capillary venule
What activates the classical vs alternative complement pathway?
Classical: C1 binds to IgM/IgM (GM makes classic cars); Alternative: microbial products direclty activate complement
Is C4 seen in classic or alternative?
Only classic
What two inflammatory factors mediate pain?
Bradykinin and PGE2
At what point on the blood vessel does a neutrophil marginate and enter the tissue?
Post capillary venule
What is the result of the NTB test with MPO deficeincy?
Normal (you can make superoxide, but not HOCl-
What are the three IL's produced by TH2 cells?
IL4,5,10
What is the function of IL-10?
Inhibits TH1 response
What is the function of IL-5?
IgA class switching, eosinophil chemotaxis
What is the function of IL-4?
IgE and IgG class switch
Non-caseating stellate granuloma in the neck; dx?
Bartonella henselae (cat scratch disease)
What interleukin induces CD4 cells to switch to TH1 subtype?
IL-12
What three infections are characterized by Bruton's agammaglobulinemia?
Bacterial, enteroviruses, Giardia
What causes common variable immunodeficiency?
Defect in plasma cell / B cell maturation
Symptoms of common variable immunodeficiency? What are they at increased risk of?
Acquired in the 20-30s; increased risk of auotimmune disease, lymphoma, sinopulmonary infections
What type of immunodeficiency is present in Wiskott-Aldrich syndrome?
Combined
What is the function of PDGF?
Endothelium, smooth muscle, and fibroblast growth factor
What is the function of FGF?
Angiogensis, skeletal development
What is the difference between primary and secondary intention?
Primary: edges approximated, minimal scar formaiton; secondary: edges not approximated, granulation tissue fills defect
What ion is the cofactor of lysyl oxidase?
Copper
What type of hypersensitivity is Sjogren's?
Type IV
What serotonin drug is a 5-HT1a agonist, 5-HT1d agonist, 5-HT1a antagonist?
Buspirone, sumatriptan, olanzapine
What is the MOA and use of hydroxychloroquine?
Stabilizes lysosomes and decreases chemotaxis; mild rheumatoid arthritis
What is the side effect of hydroxychloroquine?
Cinchonism, G6PD deficiency hemolytic anemia
What NSAID can't be used with gout?
Aspirin - it inhibits uric acid secretion
What is the drug of choice for asthma if you are on beta blockers?
Ipratroprium
What is the effect of stimulating M3 receptors on blood vessels?
Stimulates nitric oxide synthase => vasodilation
Why don't indirect M3 agonists work on blood vessels?
Because there is no innervation
What is xerostomia?
Dry mouth
What drug should you use for an atropine overdose?
Physostigmine because it cross the BBB
What is the effect of low level chronic acetylchoinesterase toxicity?
Peripheral neuropathy; demyelination
What is the effect of atropine on an EKG?
Widens QRS complex, QT prolongation
What are the three C's of atropine overdose?
Cardiotoxicity, coma (sedation), convulsions
What is the effect of alpha 2 agonists on platelets?
Aggregation
What is the effect of alpha 2 and beta 2 agonists on insulin?
Alpha 2 inhibits, beta 2 increases
What is the effect of beta 2 receptors on the liver and skeletal muscle?
Increase gluconeogenesis and glycogenolysis
What is the MOA of methyldopa?
Alpha 2 agonist used in hypertension for pregnancy
What is the MOA of dobutamine?
Beta 1 agonist
What drug do you use to treat a depressed person with anorexia?
Mirtazapine
What two beta blockers have intrinsic sympathomimetic activity?
Pindolol, acebutalol
What is an ISA?
Partial agonist
What is the effect of beta blockers on lipids?
Increase lipids b/c of inhibited lipolysis
Which beta blocker has the most sedative effect? Which beta blocker can be used safely in patietns taking benzodiazepines?
Propanolol; atenolol
Are beta 1 or beta 2 receptors responsible for aqueous humor production?
Beta 1
What two diuretics do you use in glaucoma?
Carbonic anhydrase inhibitors, mannitol
How does hydrochlorothiazide and furosemide lower blood pressure?***
HCTZ: opens K+ channels causing vasodilation, furosemide: increases prostaglandin synthesis, vasodilating kidneys
What diuretics increase uric acid levels in the blood?
HCTZ and furosemide
What is the effect of quinidine on muscarinic and alpha receptors?
Antagonist to both
What antirrythmic is used o treat digoxin toxicity?
Lidocaine
What are some class Ic drugs?
Flecinide, propafenone
What are some class Ib drugs?
Phenytoin, lidocaine, mexlitene, tocainamide
What two drugs display digoxin from plasma binding proteins and increase its toxicity?
Quinidine, verapamil
What autonomic drug is used for opiate withdrawal? Why does it work?
Clonidine; it decreases the sympathetic outflow so that the upregulated alpha/beta adrenergic receptors are not stimulated
What is the method of guanethidine action?
Inhibits norepinephrine vesicle fusion
What drug could block the action of guanethidine?
TCAs/cocaine
What antihypertensive drug would you use for insulinomas?
Diazoxide
What two drugs can cause gingival hyperplasia
Phenytoin, verapamil/diltiazem
What antihypertensive drugs would not be used in someone with dyslipidemia?
Beta blocker
What ion does GABA(B) increase the permeability of?
K+ efflux
What muscarinic receptor is coupled to a potassium channel?
M2 in heart
What is the MOA of eszopiclone?
BDZ1 agonists
What is a non-sedating anti-anxiety drug? What is its MOA?
Buspirone; partial HT-1A agonist
What are all the drugs that have disulfiram like effects?
Griseofulvin, cefotetan, cefoperazone, chlorpropamide, metronidazole
What is the MOA of carbamazapine?
Blocks fast sodium channels in their inactivated states
What is an example of a zero order drug?
Phenytoin, alcohol
What anticonvulsant can interfere with folate and vitamin D absorption?
Phenytoin, barbituates, carbamazapines
What congenital defect is associated with phenytoin vs carbamazapine/valproic acid?
Phen: cleft palate, carb/val: NTDs
What anticonvulsant inhbiits GABA transaminase?
Valproic caid
What are all of the drugs that are associated with acute pancreatitis?
Valproic acid, asparaginase, alcohol, didanosine, zalcitabine
What anticonvuslant is assocaited with alopecia, hepatotoxicity, and thrombocytopenia?
Valproic acid
What anticonvuslant is associated with hirsutism?
Phenytoin
What anesthetic is great for an older patient with compromised cardiovascular function? Why?
Ketamine, increases CV function
What antiasthestic looks like milk and is used for its antiemetic effect?
Propofol
What is the MOA of fentanyl?
Opiate
What anesthetics increase intracranial pressure?
Fentanyl, ketamine
What pH is necessary to allow local anesthetic to enter neurons?
High pH (local anesthetics are weak bases, need alkaline pH to be unioninzed)
What form of a local anesthetic is active?
Ionized
What type of nerves are most affected by local anesthetics?
Type B&C (non myelinated)
What is a contraindication for ester anesthetics?
Slow plasma and tissue esterase genotypes
What is a contraindication for amide anesthetics?
Poor liver function
What type of anesthetic is more likely to have allergies via PABA formation?
Esters
Why is atracurium special? What is its major side effect?
Safe in hepatic or renal imapirment; breaks down to laudanosine which causes seizures
Why does mivacurium have such a short half life? What is the major contraindication?
Esterase; if patient is a slow metabolizer you must contraindicate
What is a contraindication for succinylcholine? Why does this occur? What conditions does this result in ?
Slow metabolizer (atypical pseudocholinesterase); hyperkalemia and malignant hyperthermia
How does morphine cause vomiting?
Stimulates D2 receptors at the CTZ
How does moprhine cause increasd IOP?
Increased histamine release
How does morphine metabolism make it more active? How is it cleared?
Glucuronidation; normally by the kidneys; contraindicate with renal dysfunction or decrease dose
What opioid has antimuscarinic effects? What does that mean?
Meperidine; it doesn't cause pinpoint pupils and it can cause torsades du pointes
Why would meperidine cause seizures?
It is metabolized into normeperidine, a SSRI
What is an example of a partial agonist opioid? What is a major concern with opioid partial agonists?
Buprenoprhine; induces withdrawal
What are two kappa agonists?
Nalbuphine, pentazocine
What is the method of signal transduction in opiates?
G(i); lowers cAMP
What is the method of tolerance in opiates?
Pharmacodynamics; increase cAMP levels to counteract the G(i)!
Which MAO inhibitor will NOT cause a hypertensive crisis with tyramine? Why?
Selegiline; it doesn't break down NE and 5-HT like MAO-A inhibitors
What is the MOA of pramipexole?
Dopamine agonists
What is the only drug associated with livedo reticualris?
Amantadine
What is the effect of antipsychotics on weight and temperature?
Hyperthermia and weight gain
Which antipsychotic is most associated with retinal deposits?
Thioridazine
What is the MOA of aripiprazole?
Parital D2 agonist; 5HT2 antagonist
How does imipramine treat enuresis?
Decreases phase 4 slow wave sleep
What two side effects of trazodone are important? Why?
Priapism, cardiac arrhythmia; alpha 1 blocker
What is the MOA of mirtazapine?
Alpha 2 antagonist
What is the MOA of venlafaxine? What's its advantage?
Nonselective NA/5-HT reuptake inhibitor; devoid of ANS side effects (like a TCA, but less side effects)!
What is the MOA of buproprion?
Dopamine reuptake inhibitor
What is the MOA of lithium?
Degrades PIP2, decreases cAMP
What diuretics increase and decrease lithium toxicity?
Furosemide/HCTZ increase toxicity, amiloride/triamterene decrease toxitiy
How do you treat bipolar disease in a pregnant woman?
Gabapentin, clonazepam
What is used to treat trypanosoma cruzi?
Nifurtimox
Which NNRTI induces CYT P450?
Nevirapine
What bugs does aztreonam work on?
ONLY gram negative rods
What is the main antibiotic that increases QT interval?
Fluoroquinolones
What are the side effects of vancomycin?
Red man syndrome, ototoxicity, nephrotoxicity
What is the MOA of isoniazid?
Mycolic acid synthesis
What TB drug is contraindicated in G6PD deficiency?
Isoniazid
What ist he MOA of ethambutol?
Arabinogalactan
What are the three antibiotics that cause photosensitivity?
Sulfonamides, tetracyclines, floroquinolones
What drug is good to use osteomyelitis?
Clindamycin, fluoroquinolones
What two enzymes do fluoroquinolones inhibit?
Topoisomerase II and IV
What macrolide does NOT inhibit cytochrome P450?
Azithromycin
What macrolide should be used for macrolide resistant S. pneumoniae?
Talithromycin
What enzyme activates 6-MP?
HGPRT
What is the MOA of procarbazine? What is its unique side effect?
Alkylating agent; causes AML
What is the best treatment for lead toxicity in children?
Succimer
What is the major side effect of gingko baloba?
Antiplatelet action; caution in patient who are taking anticoagulant
What herbal supplement can cause serotonin syndrome? Why does it do it?
St. John's wort; it is similar to 5-HT
V(d) = ?
Dose / [Concentration in plasma at time 0]
Loading dose formula = ?
V(d) * [concentration in plasma at time 0] / F
What is a phase I reaction?
Cyt P450 (oxidation, reduction, hydrolysis)
What is a phase II reaction?
Transferase reactions (glucoronidation, acetylation, glutathione)
Why do you see gray baby syndrome with chloramphenicol?
Because neonates have low levels of glucuronasyl transferase (phase II)
How does a zero and first order graph look like in [units of drug vs time] and [log units of drug vs time]
Zero order: linear, expontential decline; first order: exponential decline, linear
Half life formula = ?
0.7 * Vd/Clearance
Maintenance dose formula = ?
Cp x CL / F (Cp = target plsama conc, CL = clearance, F = bioavailability)
Infusion rate equation (k0) = ?
Clearance * C(ss)
What are five common irreversible antagonists?
Phenoxybenzamine, digoxin, allopurinol, PPIs, aspirin
Do you prefer a high or low therapeutic index? What is the equation?
Prefer a high; Toxic dose divided by effective dose
What are four high yield drugs with low therapuetic index?
Digoxin, warfarin, lithium, theophylline
What type of singaling mechanism do cytokines like erythropotein, somatotropin, and interferons use?
JAK/STAT
What is the purpose of phase 1, phase 2, phase 3, phase 4 trials?
1: safety and dosage in healthy pts; 2: effectiveness in disease patients; 3: effectivenessa nd common side efects in larger disease patient ; 4: post market surveillance, look for rare side effects
What are CYP 450 inhibitors?
Macrolides, amiodarone, grape fruit, isoniazid, cimetitidne, indiavior, ciprofloxacin, ketoconazoles
Symptoms of theophylline toxicity?
Abdominal pain, seizures, tachycardia/cardiotoxicity