Adv Pharm Quiz 1 Flashcards Preview

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Flashcards in Adv Pharm Quiz 1 Deck (107):
1

Antibiotics that inhibit cell wall function

Beta-lactams: PCNs and Cephalosporins

2

Live-attenuated virus vaccines (4)

MMR

Varicella

Rota

Shingles

Can confer lifetime immunity in less doses but inc risk with weak immune systems

3

Antibiotics that inhibit PRO synthesis

Macrolides

Tetracyclines

Aminoglycosides

4

general AEs of NSAIDS (4)

ulcers/GI bleed

anemia

renal impairment

edema/HTN

5

First Pass Effect

PO drugs absorbed from gut pass through liver before going into general circulation and can be metabolized/inactivated there to varying degrees

6

treatment for acute gout exacerbation (3)

1. short term course of Indomethacin/Naproxen

2. Colchicine to inhibit inflammatory response to urate crystals

3. Push fluids

7

Phase 2 metabolism

Conjugation-drug combines with another molecule to increase water solubility for better elimination

8

Fluoroquinolones and AEs

Ciprofloxacin, Levaquin, Moxifloxacin

tendon rupture <18 yrs

CNS effects-DZNS, confusion, seizures Photosensitivity

Preg Cat C

*Save for when needed*

9

Glucocorticoid AEs

inc bg

thickened trunk with thin extremities and face

thin skin, easy bruising

edema, HTN

poor wound healing

abd striation

mood swings, excitability--->>>psychosis

10

temporary antagonists are

competitive antagonists

11

No EtOH with this antibiotic as it causes an Antabuse-like reaction

metronidazole (Flagyl)

12

Do not use ASA in kids b/c

risk of Reye's syndrome if used during a viral infection

13

DOC for dermatophytes (tinea infections)

Terbinafine *baseline and monitor LFTs

14

Why is ASA used for MI/CVA prophylaxis

dec risk MI by 50%

dec atherosclerosis, an inflammatory process

use 50-59 yrs old if 10 yr risk is >10%

15

DOC for tinea capitus, scabies

griseofulvin PO only, with hi fat food

*baseline and monitor LFTs

16

AEs of NSAIDS in pregnancy

impaired contractions (late pregnancy)

miscarriage (early pregnancy)

17

amount of drug that reaches systemic circulation

bioavailability

18

acetominophen mechanism

inhibits Cox 2 in CNS, not in periphery--good for pain and fever but not antiinflammatory

19

Acetominophen

safer than NSAIDS for pain/fever without inflammation IF no liver or kidney disease--Ex. OA

20

Celebrex carries this risk, even more than non selective NSAIDS Use Celebrex in these patients

MI, CVA, HF (inhibition of cardioprotection from Cox2 with no inhibition of plt agg in COX-1)

Use in young pt, no CV disease, with an inflammatory process like arthritis

21

Leukotriene modifier indications

allergic rhinitis

PO adjunct for asthma (when already using ICS)

Singulair good for EI asthma

22

The two ways the liver metabolizes drug

1. Partial or complete inactivation

2. Activation of prodrug

23

Abx with a beta lactamase inhibitor

Augmentin - Amox and clavulinic acid

Zosyn

Unasyn

24

Fluoroquinolones indication

Effective for multi-purpose but save for when needed due to AEs

25

AEs of 1st gen H1RB antihistamines (2)

sedation and can prolong QTc

26

need PCN coverage but pt has true PCN allergy

Macrolides (erythromycin, azithromycin)

27

Functions of Cox-1 Prostaglandins (6)

"housekeeping"

protects gastric mucosa

inhibits gastric acid secretion

stimulates plt aggregation

renal vasodilation (protective)

stimulation of uterine contractions

cardioprotective

28

Toxoid vaccines-use pathogen toxin

Diptheria

tetanus

boosters needed

29

Daily maintenance -gout

allopurinol--prevents formation and deposition of urate crystals

30

Bactrim indications

Go to for MRSA

Go to for UTI (Gm- enterococcus coverage)

31

Phase 1 metabolism

Oxidation, reduction, hydrolysis

CYP450 oxidation enzyme family

32

treatment of atypical bacteria (Mycoplasma and Chlymidia)

Macrolides or doxycycline

33

elderly are increasingly sensitive to (2) and this puts them at risk for

sedation

hypotension

falls/fractures

34

Macrolide indications

atypicals (mycoplasma walking PNA, chlymidia)

Go to drug to replace PCN in true PCN allergy

35

If a drug needs a much higher PO dose than IV dose it is most likely due to

first pass effect

36

temporary interaction b/t drug and receptor

reversible agonist/antagonist

37

Flagyl indications

anaerobic infections

protozoal infections

C. diff

38

SLE med to start first at diagnosis and use daily to dec flares, slow progression; does not impair immune function

hydroxychloroquine (Plaquenil) anti-malarial

39

Tetracyclines and AEs of them

tetracycline

doxycycline

minocycline

Not for kids and preggos d/t tooth discoloration and interference with tooth development

40

four molecules that highly bind plasma proteins

warfarin

calcium

thyroxine

steroids

41

permanent antagonists are

non-competitive inhibitors

42

Gm- organisms release endotoxins/LPS from here when they die--->sepsis

outer PM (GM+ have no outer PM)

43

caused by chronic use of an antagonist

hyper-sensitization = up-regulating

44

old age has this effect on first pass effect

decreased--more available drug

45

70% of east asian carry a CYP450 variant which can

slow drug metabolism, prolonging effect and half life

46

#1 cause of liver failure

acetominophen

47

CYP450 ultra metabolizers exist in these ethnicities

Ethiopian, Arabic

48

Aminoglycosides indication

active against GM- enterococci; poor PO absorption

PO neomycin before bowel Sx for cleanout

topicals (ear, eye) gtts for Pseudomonas

49

number of half lives to reach steady state or be eliminated from body

4 to 5

50

Avoid these meds in gout-worsen it

Bactrim and Sulfonylureas

51

Antibiotics that inhibit nucleic acid synthesis

Fluoroquinolones

Antivirals

Flagyl

52

as you go from 1st gen to 5th gen cephalosporins, you get

less Gm+ activity and more Gm-

53

Pts of certain ethnicies (African, Asian, Middle Eastern) can have G6PD deficiency (a CYP450 enzyme), normal dose of this med can cause hemolysis

acetominophen

54

difference b/t drug's effective concentration and its toxic level

therapeutic index

55

ability to absorb, distribute, metabolize, and eliminate a drug

pharmacokinetics

56

Drugs can be excreted through

Kidneys (non-albumin bound)

Bile-->feces

Lungs (EtOH)

Skin/Sweat (can cause rash)

Saliva/Tears (metallic taste)

57

why Warfarin is the worst drug ever

multiple interactions due to CYP450 pathway and small therapeutic window

58

pts with malnutrition on warfarin are at risk for

bleeding--lack of albumin means more free, unbound warfarin

59

Major AEs of "azole" antifungals

Teratogenic

Hepatotoxic (least so is fluconazole)

60

inducible in macrophages and at sites of tissue injury, produces inflammatory prostaglandins that cause fever and pain

Cox-2 enzyme

61

Black Box warning on NSAIDS to caution use in

patients with CV disease--blocks cardioprotection so inc r/f NI, CVA, HF

62

Antibiotics that inhibit folic acid synthesis

Sulfonamides--Bactrim (TMP/SMX)

63

Mast cell stabilizer indications

seasonal allergies and mild and EI asthma

64

increased body fat percentage in elderly makes prolonged effects from fat soluble meds possible--example

benzodiazepines

65

when drugs are secreted into bile which is dumped back in to GI tract, where they could be reabsorbed

enterohepatic recycling

Consider affects of gut bacteria

66

time to eliminate one half of drug from body

half life

67

there is not much range of the blood level of a drug in which it is safe if it has a

narrow therapeutic index

68

ASA mechanism of action

irreversibly inhibits plt thromboxane for life of plt (8-11d)

69

decreasing renal clearance in elderly increases risk of

adverse reactions

70

Recombinant/Conjugate/Polysacc Pieces of the pathogen vaccines (6)

Hib

HepB

HPV

Pertussis

Prevnar

Meningococcus

Strong, targeted immune response, safe on immunocompromised people, boosters needed

71

these medications need to be titrated throughout a pregnancy (2)

antihypertensives

thyroid medications

72

all HTN meds except these are antagonized by NSAIDS

CCBs

73

NSAIDS should be discouraged in elderly d/t

diminishing renal function, r/f GI bleed

74

drug that binds a receptor to interfere with a naturally occuring agonist

antagonist

75

caution with anesthesia and sedation during pregnancy because

upward pressure can cause atelectasis and dec TLC

76

tetracycline indications

atypicals

Lyme disease/prophylaxis

minocycline-acne

77

These NSAIDS are nonselective, block Cox 1 and 2

First generation-- ASA, Ibuprofen, Mobic, Naproxen, indomethacin

78

metronidazole (Flagyl) mechanism

Causes DNA breakage in bacteria and protozoa--Clostridia, Giardia, Trich

79

H1RB anti-histamine indications (4)

allergies

vertigo/motion sickness, nausea

drug-induced parkinson's s/s

sedation/insomnia

80

competes with full agonist and reduces effect of full agonist along

partial agonist

81

Nystatin indications

topical only d/t toxicity candida of mouth, eso, vag

82

Cautions using Plaquenil to treat SLE

baseline eye exam and annual-- r/f retinopathy

Caution in liver disease-monitor liver function and no EtOH or hepatotoxic meds

83

found in all tissues, stimulated by normal physiological processes, produces housekeeping" prostaglandins

Cox-1 enzyme

84

example of an irreversible agonist

aspirin

85

ASA indications

Rheumatological d/o--RD, RA --hi dose

MI/CVA prophylaxis--low dose

Pre-eclampsia; HTN of pregnancy

86

Anitbiotics that disrupt PM

Antifungals

87

found in Gm+ only, CW rigidity, induces IL-1 and TNFa (pro-inflammatory mediators)

lipotechoic acid

88

can results when receptor is constantly stimulated by a drug, causing a decrease in responsiveness

desensitization; may progress to become refractory

89

inactivated (killed) pathogen, whole vaccines (4)

HepA

Flu 

IPV

Rabies

Not as strong as live atten, boosters needed

90

Aminoglycosides and AEs

Gentamicin

Neomycin

ototoxicity and nephrotoxicity

91

Macrolides

erythromycin

azithromycin (Zithromax)

clarithromycin (Biaxin)

92

Bactrim is contraindicated for use in

newborns and last two months of pregnancy d/t inc r/f NTDs

93

beta lactams include

PCN G (natural)

aminopenicillins (Amox and ampicillin)

carbapenems Cephalosporins

94

taper steroids when

used over 2 weeks, dose over 5 mg

95

smooth muscle relaxation during pregnancy leads to increased risk of

UTI

reflux, delayed gastric emptying

96

Gm- have more beta lactamases because they have

a larger periplasmic space

97

H1 receptor blockers mechanism and effects

compete with histamine for H1 receptor sites

Dec mucus, dec edema, anticholinergic effects

98

study of the effects of drugs on the body

pharmacodynamics

99

Abx for Strep pharyngitis

PCN-V

if true PCN allergy, Macrolide

100

Abx Haemophilus influenzae URI, sinusitis, or OM

Augmentin

101

Abx for Mycoplasma PNA (walking PNA)

Macrolide or doxycycline

102

Abx E. coli UTI

Bactrim

103

Abx tinea capitus

griseofulvin, with hi fat food

104

Abx Staph aureus skin infection

Augmentin or 1st gen CS (Keflex)

105

Strep pneumoniae PNA

Amoxicillin or Augmentin

106

Chlymidia

Azithromycin 1 gm PO

Rocephin 250 mg IM (treat for gono)

107

Abx for Adenovirus/rhinovirus

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