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Adv Patho & Pharm 2018 > Adv Pharm Quiz 1 > Flashcards

Adv Pharm Quiz 1 Flashcards

1
Q

Antibiotics that inhibit cell wall function

A

Beta-lactams: PCNs and Cephalosporins

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2
Q

Live-attenuated virus vaccines (4)

A

MMR

Varicella

Rota

Shingles

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

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3
Q

Antibiotics that inhibit PRO synthesis

A

Macrolides

Tetracyclines

Aminoglycosides

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4
Q

general AEs of NSAIDS (4)

A

ulcers/GI bleed

anemia

renal impairment

edema/HTN

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5
Q

First Pass Effect

A

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

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6
Q

treatment for acute gout exacerbation (3)

A
  1. short term course of Indomethacin/Naproxen
  2. Colchicine to inhibit inflammatory response to urate crystals
  3. Push fluids
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7
Q

Phase 2 metabolism

A

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

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8
Q

Fluoroquinolones and AEs

A

Ciprofloxacin, Levaquin, Moxifloxacin

tendon rupture <18 yrs

CNS effects-DZNS, confusion, seizures Photosensitivity

Preg Cat C

*Save for when needed*

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9
Q

Glucocorticoid AEs

A

inc bg

thickened trunk with thin extremities and face

thin skin, easy bruising

edema, HTN

poor wound healing

abd striation

mood swings, excitability—>>>psychosis

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10
Q

temporary antagonists are

A

competitive antagonists

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11
Q

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

A

metronidazole (Flagyl)

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12
Q

Do not use ASA in kids b/c

A

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

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13
Q

DOC for dermatophytes (tinea infections)

A

Terbinafine *baseline and monitor LFTs

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14
Q

Why is ASA used for MI/CVA prophylaxis

A

dec risk MI by 50%

dec atherosclerosis, an inflammatory process

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

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15
Q

DOC for tinea capitus, scabies

A

griseofulvin PO only, with hi fat food

*baseline and monitor LFTs

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16
Q

AEs of NSAIDS in pregnancy

A

impaired contractions (late pregnancy)

miscarriage (early pregnancy)

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17
Q

amount of drug that reaches systemic circulation

A

bioavailability

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18
Q

acetominophen mechanism

A

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

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19
Q

Acetominophen

A

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

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20
Q

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

A

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

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21
Q

Leukotriene modifier indications

A

allergic rhinitis

PO adjunct for asthma (when already using ICS)

Singulair good for EI asthma

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22
Q

The two ways the liver metabolizes drug

A
  1. Partial or complete inactivation
  2. Activation of prodrug
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23
Q

Abx with a beta lactamase inhibitor

A

Augmentin - Amox and clavulinic acid

Zosyn

Unasyn

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24
Q

Fluoroquinolones indication

A

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

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25
Q

AEs of 1st gen H1RB antihistamines (2)

A

sedation and can prolong QTc

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26
Q

need PCN coverage but pt has true PCN allergy

A

Macrolides (erythromycin, azithromycin)

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27
Q

Functions of Cox-1 Prostaglandins (6)

A

“housekeeping”

protects gastric mucosa

inhibits gastric acid secretion

stimulates plt aggregation

renal vasodilation (protective)

stimulation of uterine contractions

cardioprotective

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28
Q

Toxoid vaccines-use pathogen toxin

A

Diptheria

tetanus

boosters needed

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29
Q

Daily maintenance -gout

A

allopurinol–prevents formation and deposition of urate crystals

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30
Q

Bactrim indications

A

Go to for MRSA

Go to for UTI (Gm- enterococcus coverage)

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31
Q

Phase 1 metabolism

A

Oxidation, reduction, hydrolysis

CYP450 oxidation enzyme family

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32
Q

treatment of atypical bacteria (Mycoplasma and Chlymidia)

A

Macrolides or doxycycline

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33
Q

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

A

sedation

hypotension

falls/fractures

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34
Q

Macrolide indications

A

atypicals (mycoplasma walking PNA, chlymidia)

Go to drug to replace PCN in true PCN allergy

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35
Q

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

A

first pass effect

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36
Q

temporary interaction b/t drug and receptor

A

reversible agonist/antagonist

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37
Q

Flagyl indications

A

anaerobic infections

protozoal infections

C. diff

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38
Q

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

A

hydroxychloroquine (Plaquenil) anti-malarial

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39
Q

Tetracyclines and AEs of them

A

tetracycline

doxycycline

minocycline

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

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40
Q

four molecules that highly bind plasma proteins

A

warfarin

calcium

thyroxine

steroids

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41
Q

permanent antagonists are

A

non-competitive inhibitors

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42
Q

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

A

outer PM (GM+ have no outer PM)

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43
Q

caused by chronic use of an antagonist

A

hyper-sensitization = up-regulating

44
Q

old age has this effect on first pass effect

A

decreased–more available drug

45
Q

70% of east asian carry a CYP450 variant which can

A

slow drug metabolism, prolonging effect and half life

46
Q

1 cause of liver failure

A

acetominophen

47
Q

CYP450 ultra metabolizers exist in these ethnicities

A

Ethiopian, Arabic

48
Q

Aminoglycosides indication

A

active against GM- enterococci; poor PO absorption

PO neomycin before bowel Sx for cleanout

topicals (ear, eye) gtts for Pseudomonas

49
Q

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

A

4 to 5

50
Q

Avoid these meds in gout-worsen it

A

Bactrim and Sulfonylureas

51
Q

Antibiotics that inhibit nucleic acid synthesis

A

Fluoroquinolones

Antivirals

Flagyl

52
Q

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

A

less Gm+ activity and more Gm-

53
Q

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

A

acetominophen

54
Q

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

A

therapeutic index

55
Q

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

A

pharmacokinetics

56
Q

Drugs can be excreted through

A

Kidneys (non-albumin bound)

Bile–>feces

Lungs (EtOH)

Skin/Sweat (can cause rash)

Saliva/Tears (metallic taste)

57
Q

why Warfarin is the worst drug ever

A

multiple interactions due to CYP450 pathway and small therapeutic window

58
Q

pts with malnutrition on warfarin are at risk for

A

bleeding–lack of albumin means more free, unbound warfarin

59
Q

Major AEs of “azole” antifungals

A

Teratogenic

Hepatotoxic (least so is fluconazole)

60
Q

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

A

Cox-2 enzyme

61
Q

Black Box warning on NSAIDS to caution use in

A

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

62
Q

Antibiotics that inhibit folic acid synthesis

A

Sulfonamides–Bactrim (TMP/SMX)

63
Q

Mast cell stabilizer indications

A

seasonal allergies and mild and EI asthma

64
Q

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

A

benzodiazepines

65
Q

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

A

enterohepatic recycling

Consider affects of gut bacteria

66
Q

time to eliminate one half of drug from body

A

half life

67
Q

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

A

narrow therapeutic index

68
Q

ASA mechanism of action

A

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

69
Q

decreasing renal clearance in elderly increases risk of

A

adverse reactions

70
Q

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

A

Hib

HepB

HPV

Pertussis

Prevnar

Meningococcus

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

71
Q

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

A

antihypertensives

thyroid medications

72
Q

all HTN meds except these are antagonized by NSAIDS

A

CCBs

73
Q

NSAIDS should be discouraged in elderly d/t

A

diminishing renal function, r/f GI bleed

74
Q

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

A

antagonist

75
Q

caution with anesthesia and sedation during pregnancy because

A

upward pressure can cause atelectasis and dec TLC

76
Q

tetracycline indications

A

atypicals

Lyme disease/prophylaxis

minocycline-acne

77
Q

These NSAIDS are nonselective, block Cox 1 and 2

A

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

78
Q

metronidazole (Flagyl) mechanism

A

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

79
Q

H1RB anti-histamine indications (4)

A

allergies

vertigo/motion sickness, nausea

drug-induced parkinson’s s/s

sedation/insomnia

80
Q

competes with full agonist and reduces effect of full agonist along

A

partial agonist

81
Q

Nystatin indications

A

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

82
Q

Cautions using Plaquenil to treat SLE

A

baseline eye exam and annual– r/f retinopathy

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

83
Q

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

A

Cox-1 enzyme

84
Q

example of an irreversible agonist

A

aspirin

85
Q

ASA indications

A

Rheumatological d/o–RD, RA –hi dose

MI/CVA prophylaxis–low dose

Pre-eclampsia; HTN of pregnancy

86
Q

Anitbiotics that disrupt PM

A

Antifungals

87
Q

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

A

lipotechoic acid

88
Q

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

A

desensitization; may progress to become refractory

89
Q

inactivated (killed) pathogen, whole vaccines (4)

A

HepA

Flu

IPV

Rabies

Not as strong as live atten, boosters needed

90
Q

Aminoglycosides and AEs

A

Gentamicin

Neomycin

ototoxicity and nephrotoxicity

91
Q

Macrolides

A

erythromycin

azithromycin (Zithromax)

clarithromycin (Biaxin)

92
Q

Bactrim is contraindicated for use in

A

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

93
Q

beta lactams include

A

PCN G (natural)

aminopenicillins (Amox and ampicillin)

carbapenems Cephalosporins

94
Q

taper steroids when

A

used over 2 weeks, dose over 5 mg

95
Q

smooth muscle relaxation during pregnancy leads to increased risk of

A

UTI

reflux, delayed gastric emptying

96
Q

Gm- have more beta lactamases because they have

A

a larger periplasmic space

97
Q

H1 receptor blockers mechanism and effects

A

compete with histamine for H1 receptor sites

Dec mucus, dec edema, anticholinergic effects

98
Q

study of the effects of drugs on the body

A

pharmacodynamics

99
Q

Abx for Strep pharyngitis

A

PCN-V

if true PCN allergy, Macrolide

100
Q

Abx Haemophilus influenzae URI, sinusitis, or OM

A

Augmentin

101
Q

Abx for Mycoplasma PNA (walking PNA)

A

Macrolide or doxycycline

102
Q

Abx E. coli UTI

A

Bactrim

103
Q

Abx tinea capitus

A

griseofulvin, with hi fat food

104
Q

Abx Staph aureus skin infection

A

Augmentin or 1st gen CS (Keflex)

105
Q

Strep pneumoniae PNA

A

Amoxicillin or Augmentin

106
Q

Chlymidia

A

Azithromycin 1 gm PO

Rocephin 250 mg IM (treat for gono)

107
Q

Abx for Adenovirus/rhinovirus

A

Adv Patho & Pharm 2018 (5 decks)

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