USMLE High-Yield Systems & Pharmacology Review

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48 vocabulary-style flashcards covering menstrual disorders, adrenal crisis, antiretroviral toxicities, fructose metabolism, drug contraindications in pregnancy, antiemetics, lipid-lowering agents, antipsychotic adverse effects, aspiration syndromes, and biotin-dependent enzymes.

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40 Terms

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Endometriosis

Ectopic endometrial tissue causing dysmenorrhea, pelvic pain, dyspareunia, and infertility.

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Uterine Fibroids (Leiomyomas)

Benign smooth-muscle tumors producing heavy menses with clots, pelvic pain/heaviness, constipation or urinary frequency, and an enlarged, irregular uterus.

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Adenomyosis

Endometrial tissue in the myometrium leading to dysmenorrhea, heavy menses, and a bulky, globular, tender uterus.

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Endometrial Cancer/Hyperplasia

Malignant or premalignant endometrium presenting with irregular, intermenstrual, or post-menopausal bleeding; risk factors include obesity, nulliparity, and chronic anovulation.

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Acute Adrenal Crisis – Etiology

Triggered by adrenal hemorrhage/infarction or stress (illness, injury, surgery) in chronic adrenal-insufficient or long-term steroid patients.

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Acute Adrenal Crisis – Clinical Features

Hypotension or shock, nausea/vomiting, abdominal pain, weakness, and fever.

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Acute Adrenal Crisis – Treatment

Immediate IV hydrocortisone or dexamethasone plus high-flow intravenous fluids.

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Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

Antiretroviral class (e.g., abacavir, tenofovir, zidovudine) associated with lactic acidosis as a class effect.

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Abacavir – Adverse Effect

HLA-B*57:01–mediated hypersensitivity reaction (fever, rash, GI & respiratory symptoms).

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Didanosine – Adverse Effect

Dose-related pancreatitis.

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Zidovudine – Adverse Effect

Bone-marrow suppression leading to anemia or neutropenia.

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Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Efavirenz, nevirapine; class adverse effects include rash (SJS) and hepatotoxicity.

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Efavirenz – Unique Toxicity

Vivid dreams, depression, dizziness (neuropsychiatric) and teratogenicity.

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Protease Inhibitors (PIs)

Atazanavir, darunavir, indinavir, ritonavir; cause metabolic complications (lipodystrophy, dyslipidemia, insulin resistance).

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Integrase Strand Transfer Inhibitors (INSTIs)

Dolutegravir, raltegravir; adverse effect: myopathy or ↑CK.

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Aldolase B

Splits fructose-1-phosphate into DHAP and glyceraldehyde; deficiency causes hereditary fructose intolerance.

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Tetracyclines in Pregnancy

Contraindicated due to permanent fetal teeth discoloration and bone growth inhibition.

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Chloramphenicol in Pregnancy

Causes “gray baby” syndrome (cyanosis, hypotension) from immature hepatic glucuronidation.

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Trimethoprim-Sulfamethoxazole in Pregnancy

Risk of folate antagonism leading to neural tube defects.

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Aminoglycosides in Pregnancy

Fetal ototoxicity and vestibulotoxicity.

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Scopolamine

Antimuscarinic patch used for motion sickness prevention.

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Antihistamine Antiemetics

Diphenhydramine, meclizine, promethazine; promethazine useful for hyperemesis gravidarum.

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Dopamine Receptor Antagonist Antiemetics

Prochlorperazine, metoclopramide; block D₂ receptors to relieve nausea.

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5-HT₃ Receptor Antagonists

Ondansetron, granisetron; first line for chemotherapy-induced vomiting.

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NK₁ Receptor Antagonists

Aprepitant, fosaprepitant; prevent delayed chemotherapy-induced emesis.

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Statins

Inhibit HMG-CoA reductase → major ↓LDL; side effects: hepatotoxicity, myopathy.

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Ezetimibe

Blocks intestinal cholesterol absorption, lowering LDL; may raise hepatotoxicity with statins.

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Bile Acid Sequestrants

Cholestyramine, colestipol: prevent bile-acid reabsorption to lower LDL; cause GI upset & impair fat-soluble vitamin/drug absorption.

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Niacin (Vitamin B3)

↓VLDL synthesis & ↑HDL; causes flushing/pruritus, hepatotoxicity, and hyperuricemia/gout.

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Fibrates

Activate PPAR-α → large ↓triglycerides, ↑HDL; adverse: myopathy (worse with statins), gallstones.

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Fish Oil / ω-3 Fatty Acids

↓VLDL & apolipoprotein B synthesis → lower triglycerides; side effect: fishy aftertaste.

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Extrapyramidal Side Effects (EPS)

Acute dystonia, akathisia, and drug-induced parkinsonism from dopamine-blocker antipsychotics.

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Tardive Dyskinesia

Late, involuntary oral-facial or choreiform movements after chronic antipsychotic use.

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Neuroleptic Malignant Syndrome

Life-threatening fever, rigidity, autonomic instability, and altered mental status with antipsychotics.

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Aspiration Pneumonia

Anaerobic lung infection occurring days after aspiration; treated with clindamycin or β-lactam/β-lactamase inhibitor.

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Aspiration Pneumonitis

Chemical lung injury hours after gastric content aspiration; managed supportively without antibiotics.

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Biotin (Vitamin B7)

Cofactor for carboxylase enzymes in gluconeogenesis, fatty-acid synthesis, and odd-chain fatty-acid oxidation.

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Pyruvate Carboxylase

Biotin-dependent enzyme converting pyruvate → oxaloacetate in gluconeogenesis.

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Acetyl-CoA Carboxylase

Biotin-dependent enzyme converting acetyl-CoA → malonyl-CoA for fatty-acid synthesis.

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Propionyl-CoA Carboxylase

Biotin-dependent enzyme converting propionyl-CoA → methylmalonyl-CoA in odd-chain fatty-acid metabolism.