Exam 1: Pharm (Analgesics and Antimicrobials)

Question 1

Aspirin

Answer 1

NSAID (Analgesic, anti-inflammatory, antipyretic); prevention of platelet aggregation

**Not in peds because of reye’s syndrome

GI effects, bleeding, renal impairment, salicyclate toxicity

Drug interactions with other NSAIDs, glucocorticoids, anticoagulants

May take with food, ringing in ears may be result of too much aspirin

Question 2

Oxycodone

Answer 2

Opioid analgesic

Mimics action of endogenous opioids at Mu receptors (Analgesia, reps depression, euphoria, sedation, decreased GI motility, physical dependence) and Kappa receptors (analgesia, sedation, decreased GI motility) Still learning about Delta

AE: Resp depression, constipation, sedation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis, sedation, euphoria

Drug Interactions: CNS depressants, anticholinergics, hypotensive drugs

Monitor: RR, SPO2, AMS

Question 3

Morphine

Answer 3

Opioid analgesic

Mimics action of endogenous opioids at Mu receptors (Analgesia, reps depression, euphoria, sedation, decreased GI motility, physical dependence) and Kappa receptors (analgesia, sedation, decreased GI motility) Still learning about Delta

AE: Resp depression, constipation, sedation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis, sedation, euphoria

Drug Interactions: CNS depressants, anticholinergics, hypotensive drugs

Monitor: RR, SPO2, AMS

Question 4

Amoxicillin (amoxil)

Answer 4

Antimicrobial, beta-lactam antibiotic (penicillin) (aminopenicillin)

Cell wall synthesis inhibitor; inhibits transpeptidase (enzyme critical for cell wall synthesis)

AEs: hypersensitivity reactions and diarrhea

Drug interactions: caustic with oral contraceptive use (use backup method)

Renally eliminated; adjust dose in renal dysfunction

May take with food

Question 5

Amoxicillin & clavulanic acid (Augmentin)

Answer 5

Antimicrobial, beta-lactam antibiotic (penicillin) and beta-lactamase inhibitor (aminopenicillin)

Cell wall synthesis inhibitor; inhibits transpeptidase (enzyme critical for cell wall synthesis)

AEs: hypersensitivity reactions and diarrhea

Renally eliminated; adjust dose in renal dysfunction

May take with food; taking with food may reduce GI upset

Question 6

Piperacillin & tazobactam (Zosyn)

Answer 6

Antimicrobial; beta-lactam antibiotic (penicillin) and beta-lactamase inhibitor (extended -spectrum PCN)

Cell wall synthesis inhibitor; inhibits transpeptidase (enzyme critical for cell wall synthesis)

AEs: Hypersensitivity reactions, diarrhea

Adjust dose for renal dysfunction

Question 7

Ceftriaxone (Rocephin)

Answer 7

Antimicrobial; beta-lactam antibiotic, third gen. cephalosporin

Cell wall synthesis inhibitor; inhibits transpeptidase; some gram +/-

Excellent for S. pneumoniae and N. gonorrhea

Not good for S. aureas or Enterococcus

AEs: hypersensitivity, may increase bleeding tendencies

Avoid in neonates (displaces bilirubin from albumin binding sites); contraindicated for concomittant use with IV calcium-containing solutions/products in neonates <28 days

If sensitive to penicillin, 5% chance will also be sensitive

Question 8

Cephalexin (Keflex)

Answer 8

Antimicrobial; beta-lactam antibiotic, first gen. cephalosporin.

Cell wall synthesis inhibitor; inhibits transpeptidase; mainly active against gram + bacteria (skin flora, usually normal cellulitis)

AEs: N/V/D

Adjust dose in renal dysfunction

If sensitive to penicillin, 5% chance will be sensitive; may take with food

Question 9

Azithromycin

Answer 9

Protein synthesis inhibitor (macrolide)

Reversibly binds to 50s ribosomal subunit inhibiting protein synthesis; can cover “atypical” organisms (mycoplasma, legionella, challmydia species)

AEs: N/V, abdominal pain, some risk of QT prolongation on EKG

Monitor EKG in women/general for QT prolongation

Question 10

Doxycycline

Answer 10

Protein synthesis inhibitor (tetracycline)

Used to treat Gram+/- bacteria; activity against mycoplasma pneumoniae, chlamydia species, tick borne illness

AEs: phototoxicity, tooth discoloration, associated with development of C. diff associated diarrhea

Avoid in pregnancy or in children <8

Drug interactions: bind to cations (avoid admin with milk, antacids, etc) and oral contraceptives; admin separate at least 2 hours fro m cation ingestion

Question 11

Metronidazole

Answer 11

Antibiotic, nitroimidazole

Spectrum: protozoa (systemic amebiasis trichomoniasis, giardiasis); anaerobic bacteria.

**Inhibits nucleic acid synthesis = cell death (drug of choice for C. diff)

AEs: Nausea, H/A, metallic taste, hypersensitivity reactions

Drug interactions: Ethanol (disulfiram reaction; facial flushing, tachycardia, vomiting, dyspnea), CYP 3A4 susbtrate (Warfarin, phytoin, phenobarbital, rifampin, cyclosporine, tacrolimus)

Question 12

Fluconazole

Answer 12

Antifungal; subcutaneous and systemic infections; membero of the -azole family

Inhibition of CYP450 dependent synthesis of ergosterol (results in damage to cytoplasmic membrane and accumulation of ergosterol precursors/halts fungus formation)

Most commonly used for Candida infections (vaginal)

AEs: Nausea, H/A, Rash, abdominal pain (rare: hepatic necrosis)

Drug interactions: inhibition of CYP3A4

Monitor liver functions