Adv Pharm Quiz 1 Flashcards by Nicole LaValle

Antibiotics that inhibit cell wall function

Beta-lactams: PCNs and Cephalosporins

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Live-attenuated virus vaccines (4)

MMR

Varicella

Rota

Shingles

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

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Antibiotics that inhibit PRO synthesis

Macrolides

Tetracyclines

Aminoglycosides

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general AEs of NSAIDS (4)

ulcers/GI bleed

anemia

renal impairment

edema/HTN

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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

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treatment for acute gout exacerbation (3)

short term course of Indomethacin/Naproxen
Colchicine to inhibit inflammatory response to urate crystals
Push fluids

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Phase 2 metabolism

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

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Fluoroquinolones and AEs

Ciprofloxacin, Levaquin, Moxifloxacin

tendon rupture <18 yrs

CNS effects-DZNS, confusion, seizures Photosensitivity

Preg Cat C

*Save for when needed*

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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

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temporary antagonists are

competitive antagonists

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

metronidazole (Flagyl)

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Do not use ASA in kids b/c

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

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DOC for dermatophytes (tinea infections)

Terbinafine *baseline and monitor LFTs

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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%

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DOC for tinea capitus, scabies

griseofulvin PO only, with hi fat food

*baseline and monitor LFTs

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AEs of NSAIDS in pregnancy

impaired contractions (late pregnancy)

miscarriage (early pregnancy)

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amount of drug that reaches systemic circulation

bioavailability

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acetominophen mechanism

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

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Acetominophen

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

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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

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Leukotriene modifier indications

allergic rhinitis

PO adjunct for asthma (when already using ICS)

Singulair good for EI asthma

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The two ways the liver metabolizes drug

Partial or complete inactivation
Activation of prodrug

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Abx with a beta lactamase inhibitor

Augmentin - Amox and clavulinic acid

Zosyn

Unasyn

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Fluoroquinolones indication

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

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AEs of 1st gen H1RB antihistamines (2)

sedation and can prolong QTc

need PCN coverage but pt has true PCN allergy

Macrolides (erythromycin, azithromycin)

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

Toxoid vaccines-use pathogen toxin

Diptheria tetanus boosters needed

Daily maintenance -gout

allopurinol--prevents formation and deposition of urate crystals

Bactrim indications

Go to for MRSA Go to for UTI (Gm- enterococcus coverage)

Phase 1 metabolism

Oxidation, reduction, hydrolysis CYP450 oxidation enzyme family

treatment of atypical bacteria (Mycoplasma and Chlymidia)

Macrolides or doxycycline

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

sedation hypotension falls/fractures

Macrolide indications

atypicals (mycoplasma walking PNA, chlymidia) Go to drug to replace PCN in true PCN allergy

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

first pass effect

temporary interaction b/t drug and receptor

reversible agonist/antagonist

Flagyl indications

anaerobic infections protozoal infections C. diff

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

hydroxychloroquine (Plaquenil) anti-malarial

Tetracyclines and AEs of them

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

four molecules that highly bind plasma proteins

warfarin calcium thyroxine steroids

permanent antagonists are

non-competitive inhibitors

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

outer PM (GM+ have no outer PM)

caused by chronic use of an antagonist

hyper-sensitization = up-regulating

old age has this effect on first pass effect

decreased--more available drug

70% of east asian carry a CYP450 variant which can

slow drug metabolism, prolonging effect and half life

#1 cause of liver failure

acetominophen

CYP450 ultra metabolizers exist in these ethnicities

Ethiopian, Arabic

Aminoglycosides indication

active against GM- enterococci; poor PO absorption PO neomycin before bowel Sx for cleanout topicals (ear, eye) gtts for Pseudomonas

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

4 to 5

Avoid these meds in gout-worsen it

Bactrim and Sulfonylureas

Antibiotics that inhibit nucleic acid synthesis

Fluoroquinolones Antivirals Flagyl

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

less Gm+ activity and more Gm-

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

acetominophen

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

therapeutic index

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

pharmacokinetics

Drugs can be excreted through

Kidneys (non-albumin bound) Bile--\>feces Lungs (EtOH) Skin/Sweat (can cause rash) Saliva/Tears (metallic taste)

why Warfarin is the worst drug ever

multiple interactions due to CYP450 pathway and small therapeutic window

pts with malnutrition on warfarin are at risk for

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

Major AEs of "azole" antifungals

Teratogenic Hepatotoxic (least so is fluconazole)

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

Cox-2 enzyme

Black Box warning on NSAIDS to caution use in

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

Antibiotics that inhibit folic acid synthesis

Sulfonamides--Bactrim (TMP/SMX)

Mast cell stabilizer indications

seasonal allergies and mild and EI asthma

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

benzodiazepines

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

time to eliminate one half of drug from body

half life

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

narrow therapeutic index

ASA mechanism of action

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

decreasing renal clearance in elderly increases risk of

adverse reactions

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

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

antihypertensives thyroid medications

all HTN meds except these are antagonized by NSAIDS

CCBs

NSAIDS should be discouraged in elderly d/t

diminishing renal function, r/f GI bleed

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

antagonist

caution with anesthesia and sedation during pregnancy because

upward pressure can cause atelectasis and dec TLC

tetracycline indications

atypicals Lyme disease/prophylaxis minocycline-acne

These NSAIDS are nonselective, block Cox 1 and 2

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

metronidazole (Flagyl) mechanism

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

H1RB anti-histamine indications (4)

allergies vertigo/motion sickness, nausea drug-induced parkinson's s/s sedation/insomnia

competes with full agonist and reduces effect of full agonist along

partial agonist

Nystatin indications

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

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

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

Cox-1 enzyme

example of an irreversible agonist

aspirin

ASA indications

Rheumatological d/o--RD, RA --hi dose MI/CVA prophylaxis--low dose Pre-eclampsia; HTN of pregnancy

Anitbiotics that disrupt PM

Antifungals

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

lipotechoic acid

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

desensitization; may progress to become refractory

inactivated (killed) pathogen, whole vaccines (4)

HepA Flu IPV Rabies Not as strong as live atten, boosters needed

Aminoglycosides and AEs

Gentamicin Neomycin ototoxicity and nephrotoxicity

Macrolides

erythromycin azithromycin (Zithromax) clarithromycin (Biaxin)

Bactrim is contraindicated for use in

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

beta lactams include

PCN G (natural) aminopenicillins (Amox and ampicillin) carbapenems Cephalosporins

taper steroids when

used over 2 weeks, dose over 5 mg

smooth muscle relaxation during pregnancy leads to increased risk of

UTI reflux, delayed gastric emptying

Gm- have more beta lactamases because they have

a larger periplasmic space

H1 receptor blockers mechanism and effects

compete with histamine for H1 receptor sites Dec mucus, dec edema, anticholinergic effects

study of the effects of drugs on the body

pharmacodynamics

Abx for Strep pharyngitis

PCN-V if true PCN allergy, Macrolide

Abx Haemophilus influenzae URI, sinusitis, or OM

Augmentin

Abx for Mycoplasma PNA (walking PNA)

Macrolide or doxycycline

Abx E. coli UTI

Bactrim

Abx tinea capitus

griseofulvin, with hi fat food

Abx Staph aureus skin infection

Augmentin or 1st gen CS (Keflex)

Strep pneumoniae PNA

Amoxicillin or Augmentin

Chlymidia

Azithromycin 1 gm PO Rocephin 250 mg IM (treat for gono)

Abx for Adenovirus/rhinovirus

Adv Pharm Quiz 1 Flashcards

(107 cards)