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Master PA Deck > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Natural PCNs (Drugs)

A

Penicillin G

Penicillin V

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2
Q

Natural PCNs (Spectrum)

A

Gram +, cocci and bacilli, some gram -

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3
Q

Penicillinase resistant PCN (Drugs)

A

Nafcillin, methacillin, cloxacillin, dicloxacillin, oxacillin

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4
Q

Penicillinase resistant PCN (Spectrum)

A

Staph. Aureus

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5
Q

Extended spectrum (Drugs)

A

Ampicillins, amoxicillin, bacampicillin

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6
Q

Extended spectrum (Spectrum)

A

Gram +/-, cocci and bacilli

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7
Q

Antipseudomonals (Drugs)

A

Ticarcillin, piperacillin, carbenicillin, mezlocillin

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8
Q

Antipseudomonals (Spectrum)

A

Gram (-) plus pseudomonas

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9
Q

Penicillin/Beta lactamase inhibitors (Drugs)

A

amoxicillin clavulanate (Augementin)
ampicillin/sulbactam (Unasyn)
piperacillin/tazobactam (Zosyn)
ticarcillin/clavulanate (Timentin)

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10
Q

1st generation cephalosporins (drugs)

A

“Cefa” “Cepha” “Cephra”

Except Cefaclor which is 2nd gen

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11
Q

2nd generation cephalosporins (drugs)

A

Cefuroxime, Cefoxitin, Cefotetan, Cefaclor

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12
Q

3rd generation cephalosporins (drugs)

A

“ime” “one” “ten”
Cefdinir
Moxalactam

Except Cefuroxime which is 2nd gen

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13
Q

4th generation cephalosporins (drugs)

A

“pi”

Cefepime, Cefepirole

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14
Q

5th generation cephalosporins (drugs)

A

“rol”

Ceftaroline

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15
Q

1st generation (spectrum)

A

Gram +, Ok Gram -, anaerobes +/- (not B. fragilis)

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16
Q

2nd generation (spectrum)

A

Gram +, Good Gram -, anaerobes +/-

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17
Q

3rd generation (spectrum)

A

Weak Gram +, Better Gram -, anaerobes +/-, ceftazidime active against pseudomonas

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18
Q

4th generation (spectrum)

A

Gram +, Best Gram -, anaerobes +/-, pseudomonas

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19
Q

5th generation (spectrum)

A

Gram +, Gram -, anaerobes +/-, MRSA

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20
Q

1st generation (Role)

A
  • S. aureus infections
  • Skin, soft tissue infections
  • Preoperative antibiotic prophylaxis for clean procedures
  • Uncomplicated, community acquired UTIs
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21
Q

2nd generation (Role)

A
  • Surgical prophylaxis in GI surgery
  • PID
  • Community-acquired pneumonia
  • Otitis media
  • Sinusitis
  • Quinolone, TMP/SMX-resistant E. coli UTI
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22
Q

3rd generation (Role)

A
  • Predominantly GRAM NEGATIVE AGENT
  • Community acquired pneumonia
  • ECF-acquired pneumonia where Pseudomonas is not suspected
  • UTIs with gram (-)
  • Meningitis
  • Gonorrhea

CEFTAZIDIME = ANTIPSEUDOMONAL

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23
Q

4th generation (Role)

A

Overly broad

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24
Q

5th generation (Role)

A

MRSA pneumonia?

Community acquired pneumonia (CAP)

Cellulitis with CANVAS 1 in CANVAS 2

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25
Q

Procaine Pencillin

A

Formulation of Penicillin G

  • Delays peak serum and last 12 hours in serum and tissue
  • Common allergy to procaine (injection anesthetic)
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26
Q

Benzathine Penicillin

A

Formulation of Penicillin G

  • Drug of choice for latent syphilis
  • Provides long lasting serum levels (15-30 days)
  • Not effective against CNS infections
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27
Q

Ampicillin-sulbactam

A

Common name: Unasyn

Penicillin with Beta-lactamase

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28
Q

Amoxicillin-clavulanate

A

Common name: Augmentin

Penicillin with Beta-lactamase

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29
Q

Unasyn/Augmentin (spectrum)

A

Gram +: MSSA
Gram -
Anaerobes: B. fragilis

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30
Q

Unasyn/Augmentin (Role)

A
  • Pneumonia
  • Intraabdominal infections
  • Skin and soft tissue infections
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31
Q

Piperacillin-Tazobactam

A

Common name: Zosyn

Penicillin with beta-lactamase

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32
Q

Piperacillin-Tazobactam (Spectrum)

A
  • MSSA
  • Beta-lactamase producing Enterobacteriaceae
  • B. fragilis
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33
Q

Piperacillin-Tazobactam (Role)

A
  • Nosocomial pneumonia
  • Intra-abdominal infections
  • Complications infections
  • Pseudomonal infections
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34
Q

Cephalosporins (adverse effects)

A
  • Stomach discomfort.
  • Nausea or vomiting.
  • Diarrhea.
  • Thrush (white fungus in the mouth), yeast infection, or other fungal infection.
  • Blood abnormalities.
  • Rash or itching
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35
Q

Penicillin (adverse effects)

A
  • Oxacillin, nafcillin (Elevated AST/ALT, neutropenia, rash, allergic interstitial nephritis)
  • Ampicillin/amoxicillin (Rash, diarrhea)
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36
Q

KPCs

A

K pneumoniae carbapenemase

Klebsiella and other Enterobacteriaceae produce carbapenemases, which are enzymes that hydrolyze the carbapenems

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37
Q

Aztreonam (Role)

A

No cross reactivity if patient has a PCN allergy

Gram (-)
Antipseudomonal

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38
Q

Aztreonam (Adverse effects)

A

Extremely expensive ($150/day)

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39
Q

Imipenem (Adverse effects)

A

Rapid renal excretion leading to higher incidence of seizures in renal insufficiency patients (A dehydropeptidase inhibitor is added to try to reduce issue)

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40
Q

Imipenem/Meropenem (activity)

A

Gram +
Gram (-)
Anaerobic activity

Quick resistance from Acinetobacter baumannii

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41
Q

Ceftolozane/Tazobactam (indications)

A

Use reserved for multi-drug resistant Pseudomonas aeruginosa

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42
Q

Ceftolozane/Tazobactam (disadvantages)

A

Expensive

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43
Q

Ceftazidime/Avibactam (Indications)

A

Treatment of carbapenem-resistant Enterobacteriaceae that have Klebsiella producing carbapenemases activity

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44
Q

Ceftazidime/Avibactam (Disadvantages)

A

Extremely expensive

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45
Q

Hydrocortisone

A

Common names: Cortenema, Cortifoam

Topical corticosteriod or enema

IBD management

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46
Q

Budesonide

A

Common names: Uceris, entocort (oral only)

Topical foam or oral corticosteroid

IBD management

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47
Q

Prednisone

A

Oral corticosteriod

IBD management

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48
Q

Sulfasalazine

A

Common names: Azulifidine

Class: Aminosalicylate

IBD Management

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49
Q

Mesalamine

A

Common names:
Canasa (suppository)
Rowasa (enema)
Asacol, apriso, lialda, pentasa, delzicol (oral)

Class: Aminosalicylate

IBD Management

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50
Q

Olsalazine

A

Common name: Dipentum

Class: Aminosalicylate

IBD management

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51
Q

Balsalazide

A

Common name: Colazal

Class: Aminosalicylate

IBD management

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52
Q

IBD Management Sequence

A 
Aminosalicylates
Corticosteriods
Immunomodulators
TNF alpha inhibitors
Natalizumab
Vedolizumad
Antibiotics
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53
Q

Immunomodulators for IBD

A

Azathioprine
Mercaptopurine
Cyclosporine
Methotrexate

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54
Q

Sodium Bicarbonate

A

Common name: Alka-Seltzer

Antacid

GERD Management

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55
Q

Calcium Carbonate

A

Common name: Tums

Antacid

GERD Management

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56
Q

Magnesium hydroxide + Aluminum hydroxide

A

Common name: Mylanta

Antacid

GERD Management

57
Q

Cimetidine

A

Common name: Tagamet

H2 Blocker

GERD Management

58
Q

Famotidine

A

Common name: Pepcid

H2 Blocker

GERD Management

59
Q

Ranitidine

A

Common name: Zantac

H2 Blocker

GERD Management

60
Q

Nizatidine

A

Common name: Axid

H2 Blocker

GERD Management

61
Q

Omeprazole

A

Common name: Prilosec

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
62
Q

Esomeprazole

A

Common name: Nexium

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
63
Q

Pantoprazole

A

Common name: Protonix

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
64
Q

Lansoprazole

A

Common name: Prevacid

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
65
Q

Dexlansoprazole

A

Common name: Dexilant

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
66
Q

Rabeprazole

A

Common name: Aciphex

PPI

GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
67
Q

Misoprostol

A

Analogue of PGE, stimulates secretion of mucus and bicarbonate

GERD Management of patients on NSAIDs

Contraindicated in pregnancy

68
Q

Sucralafate

A

Salt of sucrose complexed to aluminum hydroxide which forms viscous past that binds selectively on ulcers or erosions

GERD Management

69
Q

Triple therapy

A

H. Pylori Management

High dose PPI plus
Antibiotics (Clarithromycin and [Amoxicillin or Metronidazole])

70
Q

Prevpac

A

Triple therapy combination product for H. Pylori

Lansoprazole, amoxicillin, clarithromycin

71
Q

Pylera

A

Triple therapy combination product for H. Pylori

Bismuth subcitrate potassium, metronidazole, tetracycline

72
Q

Quadruple Therapy

A

H. Pylori management

High dose PPI plus
Bismuth subsalicylate plus
Metronidazole and [tetracycline or doxycycline]

73
Q

Bethanechol

A

Cholinomimetic agent (stimulates muscarinic receptors and increases smooth muscle tone)

Motility Disorders

74
Q

Neostigmine

A 
Cholinomimetic agent 
(Acetylcholinesterase inhibitor and blocks destruction of ACh)

Motility Disorders

75
Q

Metoclopramide

A

D2 receptor blocker

Requires renal adjustment

Motility Disorders

76
Q

Domperidone

A

D2 receptor blocker

NOT FDA approved

Motility Disorders

77
Q

Erythromycin

A

Macrolides (antibiotic)

Motility Disorders

78
Q

Erythromycin (side effects)

A
  • QTc prolongation, ventricular arrhythmias
  • Abdominal pain/cramping, diarrhea
  • Decreased efficacy with long term use (4+ weeks)
79
Q

Erythromycin (Drug interactions)

A

Numerous, major CYP3A4 inhibitor

80
Q

Macrolides (MOA)

A
  • Mimics motilin, a potent contractile agent

- Cholinergic facilitation

81
Q

Domperidone (Side effects)

A
  • QTc prolongation, cardiac arrest

- Abdominal cramps

82
Q

Domperidone (Drug interactions)

A
  • CYP3A4 inhibitors

- QTc prolonging medications

83
Q

Metoclopramide (Side effects)

A

Drowsiness, dystonic reaction, restlessness, bronchospasms, prolactin elevation

84
Q

Metoclopramide (Drug interactions)

A

Antipsychotic agents
Atovaquone (antimalarial)
Droperidol

85
Q

D2 Receptor Blockers (MOA)

A

Blockade of D2 receptors which leads to increased smooth muscle stimulation

  • increased esophageal peristalsis
  • increased lower esophageal sphincter pressure
  • increased gastric emptying
86
Q

D2 Receptor Blockers

A

Common for diabetic gastroparesis

Metoclopramide
Domperidone

87
Q

Neostigmine (Drug Interactions)

A

Beta blockers
Corticosteroids
Succinylcholine

88
Q

Neostigmine (Side Effects)

A

AV block, bradycardia
Dizziness
Diaphoresis
Bronchospasms

89
Q

Bethanechol (Side Effects)

A

Abdominal pain, diarrhea
Urinary urgency
Asthma, bronchoconstriction
Flushing, headache, bradycardia

90
Q

Bethanechol (Drug interactions)

A

Acetylcholinesterase inhibitors

Beta blockers

91
Q

Misoprostol (Side Effects)

A

Diarrhea, abdominal pain

Detrimental to pregnancy

92
Q

Misoprostol (Side Effects)

A

Antacids, magnesium containing

93
Q

Sucralafate (Side Effects)

A

Constipation, aluminum toxicity (CKD patients)

94
Q

Sucralafate (Drug Interactions)

A

Binds to multiple medications

95
Q

PPIs (MOA)

A

Travel systemically to form irreversible disulfide bonds with proton pumps inactiving them

Taken on empty stomach

96
Q

PPIs (Side Effects)

A
  • Decreased B12, Ca and magnesium absorption
  • Increased risk of bone fractures
  • Increased risk of C. diff and pneumonia
  • Increased risk of dementia and CKD
  • Rebound acid hypersecretion with discontinuation
97
Q

PPIs (Drug Interactions)

A

Drugs process via CYP2C19

Clopidogrel (Plavix): decreased antiplatelet activity

98
Q

H2 Blockers (MOA)

A

Acid inhibition via reversible H2 receptor blockade on parietal cells

99
Q

H2 Blockers (Side Effects)

A

Diarrhea, headache, fatigue, constipation, CNS effects (confusion, hallucinations, delirium)
Gynecomastia/impotence (cimetidine only)

100
Q

H2 Blockers (Drug interactions)

A

Cimetidine (CYP2C9, CYP2D6, CYP1A2, CYP3A4 inhibitor)

101
Q

Antacids (MOA)

A

Neutralize gastric acid by reacting with HCl

102
Q

Sodium bicarbonate (Side effects)

A

Belching, metabolic alkalosis, fluid retention

103
Q

Calcium carbonate (Side effects)

A

Belching, hypercalcemia, metabolic alkalosis

104
Q

Magnesium hydroxide + Aluminum hydroxide (Side effects)

A

Diarrhea, constipation, aluminum accumulation in CKD

105
Q

Sodium bicarbonate (Drug Interactions)

A

Elvitegravir (v)
Amphetamines (^)
Calcium-containing dairy products (v)

106
Q

Calcium carbonate and Magnesium hydroxide + Aluminum hydroxide (Drug interactions)

A 
Tetracyclines (v)
Fluoroquinolones (v)
Itraconazole (v)
Iron (v)
Calcium-containing dairy (^)
Elvitegravir (v)
107
Q

Acyclovir (Spectrum)

A

Anti-viral (15-21% bioavailability)

Herpes simplex (HSV) 1 and 2
Varicella-zoster (VZV)
EBV

Not CMV

108
Q

Famciclovir (Spectrum)

A

Anti-viral (77% bioavailability)

Herpes simplex (HSV) 1 and 2
Varicella-zoster (VZV)
EBV

Not CMV

109
Q

Ganciclovir (Spectrum)

A

Active against cytomegalovirus (CMV)

Poor bioavailability (5-9%)

110
Q

Foscarnet (Spectrum)

A

Anti-viral

GCV resistant CMV,
ACV-resistant HSV 1&2, VZV
Intolerable myelosuppression with GCV

111
Q

Valacyclovir

A

Prodrug of Acyclovir combined with valine

Improved bioavailability to 54% but 5x more expensive

112
Q

Famciclovir

A

Prodrug of penciclovir

Improved oral bioavailability over ACV of 77%

Oral treatment of VZV

113
Q

Valaganciclovir

A

Prodrug, valine ester of Ganciclovir

Improved bioavailability to 60%

114
Q

Foscarnet (MOA)

A

Inorganic pyrophosphate analog

Directly inhibits viral DNA polymerase (Reversibly blocks pyrophosphate binding site of viral DNA polymerase)

Renal metabolism

115
Q

Acyclovir (MOA)

A

Deoxyguanosine nucleotide analog that inhibits transcription by viral DNA polymerase

Renal metabolism

116
Q

Ganciclovir (MOA)

A

Deoxyguanosine nucleotide analog that inhibits transcription by viral DNA polymerase

Renal metabolism

117
Q

Acyclovir (Toxicity)

A

Rare, not significant
Nephrotoxicity: can crystallize in renal tubules
Neurotoxicity: lethargy, confusion, delirium

118
Q

ACV Resistance

A

Due to loss of viral thymidine kinase, altered TK activity, or DNA polymerase mutants

ACV-R HSV or VSV will be cross-resistant to famciclovir and ganciclovir

119
Q

Ganciclovir (Toxicity)

A 
Myelosuppression (Neutropenia and thrombocytopenia)
CNS toxicity (Headache, change in mental status)
120
Q

Ganciclovir Resistance

A

Reduced intracellular phosphorylation due to point mutations/deletions in the UL97 gene

Point mutations in the viral DNA polymerase

Cross resistance to Foscarnet

121
Q

Foscarnet (Toxicity)

A

Very significant

Nephrotoxicity (usually 2nd week of therapy)
- Reversible

Metabolic abnormalities

  • Hypocalcemia
  • Hypomagnesemia
  • Hypokalemia

CNS abnormalities
- Headache, irritability, seizures

Painful genital ulcerations

122
Q

Hep B Therapy Drugs

A

Lamivudine/emtricitabine (Least potent)
Entecavir
Tenofovir (Most potent)

123
Q

Hep B Drugs (MOA)

A

Nuceloside analogs: inhibits hepatitis B DNA polymerase via chain termination

Suppresses replication, not a cure

124
Q

Interferon alpha 2a or 2b (MOA)

A

Hep C

Induce interferon-stimulated genes which establish an antiviral state within cells, though the response is not virus specific; inhibit viral protein synthesis

125
Q

Interferon alpha 2a or 2b (Side effects)

A
  • Fever, myalgia
  • Neutropenia, thrombocytopenia
  • Hypothyroidism
  • Depression
126
Q

Ribavirin (MOA)

A

Hep C

Nuceloside analog

127
Q

Ribavirin (Side effects)

A
  • Hemolytic anemia
  • Teratogenic
  • Flu-like symptoms
  • Depression/irritability
  • Rash
  • Nausea/diarrhea
128
Q

Interferon + ribavirin (response rates)

A 
Most responsive to least:
2 and 3
4
5
6
1
129
Q

Interferon + ribavirin (Limitations)

A

Not well tolerated
Poor response rates
Long duration of therapy (up to 48 weeks)

130
Q

Hep C Direct Acting Agents

A

Protease inhibitors

  • Boceprevir
  • Telaprevir
  • Simeprevir

Only used for Genotype 1

131
Q

Protease Inhibitors benefits

A

Increase response rates of Interferon and ribavirin therapy

Decreased length of therapy

132
Q

Harvoni (MOA)

A

Sofosbuvir (Nucleoside analog against HCV NS5B polymerase)

Ledipasvir (NS5A inhibitor)

133
Q

Harvoni (Spectrum)

A

HCV genotypes 1, 4, 5, and 6

134
Q

Zapatier (MOA)

A

Elbasvir (NS5A inhibitor)

Grazoprevir (NS3/NS4A inhibitor)

135
Q

Zapatier (Spectrum)

A

HCV Genotypes 1 and 4

136
Q

Epclusa (MOA)

A

Sofosbuvir (Nucleoside analog against HCV NS5B polymerase)

Velpatsavir (NS5A inhibitor)

137
Q

Epclusa (Spectrum)

A

Pan-Genotypic

HCV Genotypes 1, 2, 3, 4, 5, 6

138
Q

Mayret (MOA)

A

Glecabrevir (NS3/4A protease inhibitor)

Pribrentasvir (NS5A inhibitor)

139
Q

Mayret (Spectrum)

A

Pan-Genotypic

HCV Genotypes 1, 2, 3, 4, 5, 6

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