Block Two Flashcards
(216 cards)
1
Q
What do anti-microbial drugs treat?
A
Infections
2
Q
What does bactericidal mean?
A
Antibacterials that may kill the organism
3
Q
What does bacteriostatic mean?
A
Antibacterials that may retard the growth of the organism
4
Q
What does narrow spectrum mean?
A
Effective against a limited range of organisms
E.g. Penicillin G is effective against Gram-positive
5
Q
What does broad spectrum mean?
A
Effective against a wide range of species
E.g. Tetracyclines and cephalosporins are effective against both Gram-positive and negative organisms
6
Q
What are the four basic mechanisms of action by which antimicrobial agents affect microbes?
A
- Inhibit cell wall synthesis
- Alter cell membrane permeability
- Inhibits protein synthesis
- Interfere with cellular metabolism
7
Q
What is the effect and an example of antimicrobial agents that inhibit cell wall synthesis?
A
- Enzyme breakdown of the cell wall.
- Inhibition of enzyme involved in synthesis of cell wall
Bactericidal effect.
E.g. Penicillins
8
Q
What is the effect and examples of antimicrobial agents that alter cell membrane permeability?
A
Increased membrane permeability and loss of cellular substances causes lysis of the cell.
Bacteriostatic/fungistatic or bactericidal/fungicidal effect.
E.g. Amphotericin B, azoles, and terbinafine
9
Q
What is the effect and examples of antimicrobial agents that inhibits protein synthesis?
A
Interferes or inhibits steps of protein synthesis without affecting normal cells.
Bacteriostatic or bactericidal effect.
E.g. Aminoglycosides, macrolides, andtetracyclines
10
Q
What is the effect and examples of antimicrobial agents that interfere with cellular metabolism?
A
Inhibit nucleic acid synthesis at an early stage or later stage.
Bacteriostatic effect.
E.g. Quinolones, sulphonamides, and trimethoprim
11
Q
What are common adverse effect of microbial drugs?
A
- Allergic reactions
- Superinfection
- Organ toxicity
12
Q
What are allergic or hypersensitivity reactions?
A
- Can be mild reactions (e.g. rash, pruritis, hives) and treated with antihistamines
- Severe reactions (e.g. anaphylactic shock) will occur within 20 minutes and treatment will involve adrenaline (epinephrine), bronchodilators and antihistamines
13
Q
What are superinfection or opportunistic infections?
A
Secondary infection that occurs when the normal microbial flora of the body is disturbed during antibiotic therapy
14
Q
What is organ toxicity?
A
Damage to liver and kidneys
15
Q
Why has anti-microbial resistance occurred?
A
- Improper and overuse of antimicrobials
- Failure to follow dosage regimen
- Using broad spectrum antibiotics to treat infections when the causative microbe is sensitive to a narrow spectrum drug
- The use of only one antimicrobial drug used in circumstances when cocktail therapy would be the better option
16
Q
What are antibiotics?
A
Substances which kill or inhibit the growth of microorganisms
17
Q
What type of drugs are Penicillins and what are examples?
A
Antibiotics
- Penicillin
- Amoxicillin
- Augmentin
- Flucloxacillin
18
Q
What type of drug is cephalexin - Cephalosporin?
A
Antibiotic
19
Q
What type of drug is gentamicin – Aminoglycoside?
A
Antibiotic
20
Q
What type of drugs are Macrolides and what are examples?
A
Antibiotics
- Erythromycin
- Clarithromycin
21
Q
What type of drug is doxycycline – Tetracycline?
A
Antibiotic
22
Q
What type of drug is ciprofloxacin - Quinolone?
A
Antibiotic
23
Q
What is resistance usually a result of?
A
Production of penicillinase (beta-lactamase)
24
Q
What is acid labile Penicillin?
A
Sensitive to acid
25
How does Augmentin counteract resistance to penicillins?
Augmentin contains clavulanic acid which inhibits penicillinase and prolongs the action of amoxicillin
26
What are examples of Cephalosporins?
- Cefalexin
- Cefaclor
- Cefuroxime
27
What do Cephalosporins do?
Bactericidal, broad spectrum and contain a beta-lactam ring like penicillins
28
What are common adverse reactions of Cephalosporins?
- GI disturbance
- Hypersensitivity reactions
- Pain in muscle
- Superinfections
29
What are examples of Aminoglycosides?
- Gentamicin
- Neomycin
- Tobramycin
30
What do Aminoglycosides do?
Bacterial antibiotics that misread mRNA causing abnormal proteins
31
What are adverse reactions of Aminoglycosides?
- Nephrotoxicity
| - Ototoxicity
32
What are examples of Macrolides?
- Erythromycin
- Clarithromycin
- Azithromycin
33
What do Macrolides do?
Affect function of the larger microbial ribosomal subunit and therefore affect protein synthesis
34
What are adverse reactions of Macrolides?
- GI disturbances
| - Superinfections
35
What are examples of Tetracyclines?
- Doxycycline
| - Tetracycline
36
What do Tetracyclines do?
Broad spectrum and bacteriostatic and work by binding to the smaller ribosomal subunit thereby interfering with protein synthesis
37
What are adverse reactions of Tetracyclines?
- GI upset
- Superinfection
- Renal impairment
- Discolourisation
- Deformity in growing teeth and bones
38
What are interactions to be aware of with Tetracyclines?
Binding of calcium ions and other divalent and trivalent ions can lead to a low amount of tetracycline being absorbed
39
What are examples of Quinolones?
- Ciprofloxacin
| - Norfloxacin
40
What do Quinolones do?
Broad-spectrum antibiotics and bacteriostatic which inhibit DNA synthesis
41
What are adverse reactions of Quinolones?
- GI disturbances
- Rash
- Headache
- Dizziness
- Superinfections
42
What are antiseptics?
Kill or inhibit the growth of microorganisms on human beings
43
What is the mode of action of oxidising agents?
The -SH group of proteins in cells can be oxidised to form a S-S bond which inactivates the protein
44
What are examples of oxidising agents?
- Povidone-iodine
- Iodine and alcohol
- Hydrogen peroxide
45
What are uses of oxidising agents?
- Skin disinfection
| - Solution, cream
46
What is the mode of action of cationic surfactants?
Penetrate the cell membrane of bacteria and other microorganisms and disrupts its permeability
47
What is an example of cationic surfactants?
Cetrimide solution
48
What are uses of cationic surfactants?
Skin disinfection on its own or in combination with chlorhexidine
49
What is the mode of action of biguanides?
Acts on bacterial cell membrane of bacteria and other microorganisms and disrupts its permeability
50
What is an example of biguanides?
Chlorhexidine
51
What are uses of biguanides?
Used on its own or in combination in a wide range of products including - antiseptic creams, surgical scrubs, solutions, lozenges, mouthwashes
52
What is the mode of action of phenolics?
- Disrupts permeability of cell membranes
| - Triclosan at lower concentration appears to be bacteriostatic inhibiting bacterial fatty acid synthesis
53
What is an example of phenolics?
Triclosan
54
What are uses of phenolics?
Liquid soap, hand and body wash, pre-op wash
55
What is the mode of action of alcohols?
Denatures the proteins in cells and can dissolve membrane lipids
56
What are examples of alcohols?
- Ethanol
| - Isopropanol
57
What are uses of alcohols?
- Slow acting when applied to skin surface
- Activity of other antiseptics is enhanced when dissolved in alcohol
- Alcohol swaps used in the preparation of skin prior to injection
58
What is the mode of action of heavy metals?
Combines with –SH group in the proteins and denatures the cells proteins
59
What is an example of heavy metals?
Silver sulphadiazine
60
What are uses of heavy metals?
Cream for prophylaxis and treatment of infection in burn wounds and other wounds
61
What are anti-protozoal drugs?
Drugs are used to treat or prevent infection caused by microorganisms called protozoa
62
What is Giardiasis?
- One of the most common protozoal infections
| - Caused by Giardia lamblia
63
What are symptoms of giardiasis?
- Chronic diarrhoea
- Dehydration
- Nausea
- Flatulence
- Abdominal pain
- Weight loss
64
What are treatments of giardiasis?
- Fluid and electrolyte replacement
- No food
- Metronidazole
65
What is the mode of action of metronidazole?
Enters the protozoal cell and interferes with DNA replication thereby killing the protozoa
66
What are the pharmacokinetics of metronidazole?
- Metronidazole is well absorbed after oral, rectal or IV administration
- It is metabolised in liver but majority of drug eliminated unmetabolised in the urine
67
What are adverse effects of metronidazole?
- Nausea
- Headaches
- Abdominal cramping
- A metallic taste in the mouth
- Fatigue
68
What are important interactions of metronidazole?
- Can potentiates some drugs e.g. warfarin, phenytoin
- Since cimetidine decreases microsomal liver enzyme activity, metronidazole half-life is increased with plasma clearance of metronidazole decreased
69
What are effects of alcohol on metronidazole?
- Nausea
- Abdominal cramps
- Headaches
- Flushing
70
What are anti-fungal drugs?
- Drugs that kill or deactivate fungi and are used to treat fungal (including yeast) infections
- Majority work in a way to interfere with ergosterol in fungal cell membrane
71
What are the two categories of anti-fungals with examples ?
- Antifungal antibiotics (e.g. amphotericin; nystatin)
| - Synthetic antifungal agents (e.g. azoles; terbinafine).
72
What is Amphotericin B used for?
- Candida yeast infections within mouth and lining of the gut
- Used for potentially lethal fungal and yeast infections of blood, lung, bone, brain
73
What are the pharmacokinetics of Amphotericin B?
- Taken orally (available as a lozenge) or parenterally
- Poorly absorbed in GI
- Excreted very slowly via kidney
74
What is Nystatin use for?
Treatment of candida yeast infections
75
What are the pharmacokinetics of Nystatin?
- Taken orally or topically
| - Excreted in faeces
76
What is Clotrimazole used for?
Candida or thrush in vagina and skin or nail folds; tinea as well
77
What are the pharmacokinetics of Clotrimazole?
- Topically 1%
| - Vaginal creams and pessaries
78
What is Miconazole used for?
Candida or thrush in vagina, mouth and skin or nail folds; tinea as well
79
What are the pharmacokinetics of Miconazole?
- 2% cream
- Oral gel
- Given IV as well
80
What is Ketoconazole used for?
Candida, histoplasmosis etc
81
What are the pharmacokinetics of Ketoconazole?
- Well absorbed and widely distributed
- Oral and topical
- Undergoes extensive first pass metabolism
82
What is Terbinafine used for?
Fungal infections of skin and nails
83
What are the pharmacokinetics of Terbinafine?
- Drug given orally (tablet) or topically (cream)
- Taken up by skin and adipose tissue
- Metabolised in liver
- Excreted in urine
84
What are side effects of Amphotericin B?
- Irritation
- Burning at site of administration
- Mild gastric upset
85
What are side effects of Nystatin?
- Diarrhoea
| - Nausea
86
What are side effects of Clotrimazole?
- Allergy
- Stinging
- Burning
- Itching
- Redness
87
What are side effects of Miconazole?
- Nausea
- Vomiting
- Fever and chills
- IV – inflammation at site of entry
88
What are side effects of Ketoconazole?
- Vomiting
- Diarrhoea
- Rashes
- Hepatotoxic
89
What are side effects of Terbinafine?
- Rashes
- Headaches
- Dizziness
- Altered taste
- Drowsiness
90
What do antiretroviral drugs do?
- Suppress viral activity in the body
| - Used to treat infections caused by retroviruses E.g. HIV
91
What is a retrovirus?
Any of a group of RNA viruses which insert a DNA copy of their genome into the host cell in order to replicate
92
What is the role of the enzyme reverse transcriptase?
Catalyses the transcription of retrovirus RNA into DNA
93
What are the principal cells attacked by HIV?
CD4 helper cell or T cell
94
What is the standard care for people with HIV infection?
- Cocktail or combination therapy
| - ART (antiretroviral therapy)
95
What are limitations upon antiretroviral drugs?
- Only work in actively replicating viruses
| - Administered orally
96
What are examples of nucleoside reverse transcriptase inhibitors (NRTI)?
- Zidovudine (AZT)
- Lamivudine
- Abacavir
97
What do nucleoside reverse transcriptase inhibitors (NRTI) do?
Inhibit the enzyme reverse transcriptase
98
What are examples of non-nucleoside reverse transcriptase inhibitors (NNRTI)?
- Efavirenz
| - Nevirapine
99
What do non-nucleoside reverse transcriptase inhibitors (NNRTI) do?
Bind and inhibit the enzyme reverse transcriptase, therefore inhibiting viral DNA replication
100
What are examples of protease inhibitors?
- Atazanavir
| - Ritonavir
101
What do protease inhibitors do?
Bind and inhibit HIV-1 protease, stopping the formation of functional proteins needed for viral replication and maturation
102
What are examples of integrase inhibitors?
- Dolutegravir
| - Raltegravir
103
What do integrase inhibitors do?
- Inhibit the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cells
- Work with other antiretroviral drugs for the treatment of HIV infection resistant to multiple antiretrovirals
104
What is the goal of HIV treatment?
To keep the level of HIV in the body as low as possible
105
What are common adverse reactions of anti-HIV drugs?
- Liver toxicity
- Nausea
- Vomiting
- Diarrhoea
- Liver function problems
106
What are two problems associated with anti-HIV drugs?
- Compliance
| - Drug drug interactions
107
What are drug interactions between protease inhibitors and cytochrome P-450 enzymes?
Inhibit P-450 drug-metabolising enzymes
108
What are drug interactions between non-nucleoside reverse transcriptase inhibitors and cytochrome P-450 enzymes?
Induces P-450 drug-metabolising enzymes
109
What are antiviral (non-retroviral) drugs used for?
Treatment of viral infections due to DNA and RNA viruses (not retroviruses)
110
What is an example of an antiviral (non-retroviral) drug?
Aciclovir
111
What is a cytotoxic drug?
- Drug that damages or destroys cells
| - Destroy cancer cells by inhibiting cell division
112
What groups can the majority of cytotoxic drugs can be divided into?
- Cell-cycle specific
| - Cell-cycle non-specific drugs
113
What are cell-cycle specific (CCS) drugs and what are examples?
Drugs that act on a specific phase of the cell cycle
| E.g. plant alkaloids and antimetabolites
114
What are plant alkaloids and what are examples?
- Active in the M phase of the cell cycle
| - E.g. vinblastine and vincristine
115
What are antimetabolites and what are examples?
- Active in the S phase of the cell cycle
| - E.g. methotrexate and 5-fluorouracil
116
What are cell-cycle non-specific (CCS) drugs and what are examples?
- Alkylating drugs
| - Cytotoxic antibiotics
117
What are alkylating drugs and what are examples?
- Act on all phases of the cell cycle but are more effective in the G1 and S phase
- Damage DNA therefore interfering with cell replication
- E.g. cyclophosphamide, chlorambucil and melphalan
118
What are cytotoxic antibiotics and what are examples?
- Active in all phases of the cell cycle
- Interfere with cells ability to reproduce and grew
- E.g. bleomycin, dactinomycin and mitomycin
119
What is a cause of anticancer drug resistance?
When the anticancer drug is used too infrequently
120
What are the basic principles of chemotherapy?
- Drugs should be administered in courses which are interspersed with gaps of varying duration to allow for the recovery of normal cells
- Drug combinations should be used to reduce risk of cancer cell resistance and enable anticancer drugs to act on different parts of the cell cycle and kill more cancer cells than one drug alone
121
What are common adverse effects of anticancer drugs?
- Nausea
- Vomiting
- Hair loss
- Disturbances to GI tract
- Neutropenia (low WBC count)
- Thrombocytopenia (low platelet count)
- Mouth ulcers
122
What is pain?
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
123
What is nociceptive pain?
- Most common
| - Caused by potentially harmful stimuli (physical, chemical or thermal) being detected by nociceptors around the body
124
What are the steps of nociceptive pain?
1) Initial stimulation by peripheral pain receptors (nociceptors)
2) Transmission along neuron fibres to the CNS and ultimately specific areas of the brain, including the cortex (where pain perception occurs) and limbic system involved in the emotional response to pain
125
What is neuropathic pain?
Pain generated by damage to the nerves
126
What is acute pain?
Relatively short-term pain with a recognised cause
127
What is chronic pain?
Pain that last lasts longer that 3 months
128
What is analgesia?
Controlling pain by blocking pain pathways without loss of sensation
129
What is the three step ladder?
1) Non-opioid analgesic E.g. paracetamol or NSAIDs
2) Weak opioids E.g. codeine or tramadol
3) Strong opioids E.g. morphine or fentanyl
130
What are adjuvant medications?
Medications given in addition to the primary analgesic medications to provide additional benefits to assist in pain management
131
What strength of medications are administered first for acute pain?
Strongest to weakest
132
What strength of medications are administered first for chronic pain?
Weakest to strongest
133
What are the effects of using multi-modal analgesia?
- Improved analgesic effectiveness
- Reduced the dose of opioids (if these are needed)
- Reduced adverse effects
134
What are opioid analgesics?
Drugs derived from opium which are collectively referred to as opiates
135
What are examples of opioid analgesics used for analgesia?
- Morphine
- Oxycodone
- Pethidine
- Fentanyl
- Codeine
- Tramadol
- Naloxone
136
What is the antidote for opioid analgesic overdose?
Naloxone
137
How do opioid drugs work?
By mimicking the actions of the neuropeptides called endorphins, enkephalins and dynorphins which are the body’s natural painkillers
138
How do opioid analgesics relieve pain?
Opioid drugs bind to opioid receptors and reduce the release of Substance P, therefore blocking signals of pain
139
Where are opiate receptors found in the CNS?
- Limbic system
- Peraqueductal grey (pag) region of the midbrain
- Spinal cord
- Cough centre
- Respiratory centre
- Chemoreceptor trigger zone (CTZ)
140
Where are opiate receptors found in the peripheral system?
- GI tract
- Biliary tract, ureter
- Eye - miosis
- Cardiovascular system
141
What are effects of opioid analgesics on the CNS?
- Impairs the perception of pain
- Alters the patient’s response to pain
- Sedation is dose dependent
- Respiratory depression (usual cause of death with overdose)
- Cough suppression
- Nausea; vomiting
- Miosis
142
What are effects of opioid analgesics on the cardiovascular system?
- Peripheral arteriodilation
- Venodilation
- Drop in blood pressure with reduced blood volume
143
What are effects of opioid analgesics on the GI tract?
Reduction in gut motility causing possible constipation
144
What are things that cause drug interactions for opioids?
- CNS depressants
- Alcohol
- Other opioids all give enhanced sedation
145
What are contraindications to give opioids?
- Acute or chronic respiratory disease
- Shock patients
- Head injury patients
146
What is tolerance?
- Represents decreased response to a drug
| - Seen clinically when a dose of a drug must be increased to achieve the same effect
147
What is dependence?
- Occurs when a patient needs a drug to ‘function normally’
- There are two types of dependence: physical dependence and psychological dependence
148
What is physical dependence?
A result of ongoing exposure to a drug and can be thought of as involving a type of tolerance
149
What is psychological dependence?
When in your mind you say to yourself ‘I need that drug to carry on’
150
What is withdrawal?
When a drug is no longer administered to a dependent patient
151
What is addiction?
The continued compulsive use of drugs despite adverse health or social consequences
152
What are withdrawal symptoms of opioids?
- CNS irritability
- Tachycardia
- Hypertension
- Diarrhoea
- Restlessness
- Insomnia
153
What are some analgesics that are not opioid?
- Paracetamol
- Aspirin
- Diclofenac
- Ibuprofen
- Naproxen
- Celecoxib
- Corticosteroids
154
What are prostaglandins?
A group of locally produced molecules which mediate a variety of different effects in different tissues including:
- Inflammatory response
- Pain stimulus
- Fever
155
What are prostaglandin synthesis inhibitors?
Drugs which block the production of prostaglandins by inhibiting enzymes involved in the production process
156
What are non-steroidal anti-inflammatory drugs (NSAIDs)?
- Prostaglandin synthesis inhibitors
- Drugs which block production of prostaglandins by inhibiting the activity of COX-1 and COX-2 enzymes involved in their production
157
What are key clinical uses of non-steroidal anti-inflammatory drugs (NSAIDs)?
- Anti-inflammatory
- Analgesic – particularly if associated with inflammation
- Antipyretic
- Antiplatelet (decrease platelet aggregation and inhibit thrombus formation)
158
How can NSAIDs cause gastric and duodenal ulcers?
NSAIDs block prostaglandin production causing increased levels of acid and a reduction in the formation of a protective mucous layer
159
How to prevent NSAIDs causing gastric and duodenal ulcers?
- Appropriate use of NSAIDs
- Taking NSAIDs with food
- Enteric coated formulations
- Co-administration of proton pump inhibitors (very common) or prostaglandins
- Using a selective COX-2 inhibitor
160
How can NSAIDs cause kidney injury?
Inhibition of vasodilating prostaglandins causing constriction of the arterioles which reduces blood flow to glomerulus. This reduces glomerular pressure and filtration rate which can lead to renal impairment
161
How can NSAIDs cause haemorrhage?
They suppress blood clotting
162
What are adverse effects of NSAIDs?
- GI upset
- Ulceration
- Bronchospasm in asthmatics
- Tinnitus
- Drowsiness
- Dizziness
- Sodium and water retention
- Renal impairment
163
What are some possible drugs that can interact with NSAIDs?
- Anticoagulants
- Diuretics
- Antihypertensives
164
What effect does paracetamol provide?
Analgesic and antipyretic but not anti-inflammatory or anti-platelet
165
What are adverse effects of paracetamol?
Overdose can cause hepatoxicity
166
What is therapeutic use of acetylsalicyclic acid (aspirin)?
- Antipyretic analgesic
- Fast release - enteric coated-slow release forms
- Low dosage formulations
167
What is therapeutic use of methylsalicylate?
Liniment used in muscle and joint injuries
168
What is therapeutic use of Naproxen?
- Anti-inflammatory analgesic
- Longer half-life - allows longer interval between dosage
- Sustained release form available
- Rheumatic conditions, acute gout
169
What is therapeutic use of Ibuprofen?
- Anti-inflammatory, analgesic, and antipyretic properties, possibly fewer adverse effects than other non- selective NSAIDs
- Weak anti-inflammatory properties
170
What is therapeutic use of Diclofenac?
Muscle and connective tissue injuries, rheumatoid arthritis, osteoarthritis
171
What is therapeutic use of Celecoxib?
Acute rheumatic pain or other acute musculoskeletal pain and inflammation
172
What is therapeutic use of Mefanamic Acid?
- Anti-inflammatory analgesic
| - Uterus - dysmenorrhoea
173
What other drugs are used for inflammatory conditions?
- DMARDs (disease-modifying anti-rheumatic drugs)
| - Corticosteroids
174
What are disease-modifying anti-rheumatic drugs (DMARDs)?
- Affect the immune response and suppress the disease process
- Can affect the progression of the disease
175
What are the different types of disease-modifying anti-rheumatic drugs (DMARDs)?
- cs-DMARDs
| - b-DMARDs
176
What are cs-DMARDs?
Conventional synthetic disease-modifying anti- rheumatic drugs
177
What are b-DMARDs?
- Biological disease-modifying anti-rheumatic drugs
| - Target different immune-related factors reducing the immune response that generates pain and inflammation
178
What are the different types of chemotherapeutic drugs?
- Anti-microbial
| - Anti-cancer
179
What are the different types of anti-microbial drugs?
- Anti-protozoal
- Anti-fungal
- Anti-viral
- Anti-bacteria
180
What does -cidal mean?
- Kill organism or call
| - Drugs that inhibit cell wall synthesis or disrupt the cell membrane are
181
What does -static mean?
- Retard growth of organism or cell and allow host to get rid of the organism or cell
- Drugs that inhibit protein synthesis or interfere with nucleic acid synthesis are
182
What type of bacteria have a thin barrier and are harder to kill?
Gram-negative bacteria due to their membrane
183
What type of bacteria have a thick barrier and are easier to kill?
Gram-positive bacteria
184
What are common adverse effects of penicillin?
- Allergic or hypersensitivity reactions
- Superinfection
- Organ toxicity
- Diarrhoea
185
What are principles of antimicrobial therapy?
1. Identify if infection is ‘real’.
2. Take appropriate specimens.
3. Are drugs necessary?
4. Need for urgent therapy before lab results are
known?
5. Use appropriate drug, dose and route of administration.
6. Monitor success of therapy.
7. Combinations of antimicrobials to be used?
8. Can use antibiotics prophylactically occasionally e.g. isoniazid in TB, doxycycline in malaria prophylaxis.
186
What are the different severity's of fungal infections?
- Superficial infections e.g. thrush, athlete’s foot
are common
- Severe systemic infections occur most frequently when the host’s immunity is low (opportunistic infections)
187
What are the drugs used for HIV treatment?
- Nucleoside reverse transcriptase inhibitors (NRTI)
- Non-nucleoside reverse transcriptase inhibitors (NNRTI)
- Protease inhibitors
- Integrase inhibitor
188
What is chemotherapy?
- Often combined with radiotherapy or surgery or both
| - Chemotherapy may be given with a curative intent or it may aim to prolong life
189
What is neoadjuvant treatment?
Treatment o help shrink the primary tumour before the main treatment e.g. surgery
190
What is adjuvant treatment?
- Treatment which follows the main treatment to reduce the risk of metastatic disease
- Treatment/medications given in addition to the primary therapy to maximise effectiveness or provide additional benefits
191
What is anaesthesia?
Prevention of pain by causing loss of sensation
192
What are advantages of cocktail therapy?
- Decreases drug resistance
- Increases destruction of cancer cells
- Reduces drug toxicity
193
What is the pathway of pain messages?
1. Nociceptors
2. Pain fibres
3. Dorsal Horn
4. Brain
194
What are opiates?
- Collective term used for opium and drugs derived from it
| - Also included are structurally different drugs but which act on opiate receptors
195
What can increased amounts of a narcotic cause?
Analgesia, sedation, hypnosis, coma and finally death
196
What are the pharmacokinetics of opioids?
- Fast absorption with widespread distribution
- Metabolism in the liver therefore high first pass effect
- Excretion in the kidney and some in bile
197
What other drugs can cause drug drug interactions for opioids?
Any other CNS depressants
198
What is morphines half-life and effects on this?
- Short half life (4 hrs)
| - Frequent dosing but tolerance can develop
199
What is pethidine used for and what are some effects of this?
- Used in child birth and surgery for mild to severe pain
- Causes less respiratory depression than morphine
- Does not cause constipation
200
What are some examples of opioids?
- Codeine
- Oxycodone
- Fentanyl
- Tramadol
- Methadone
201
What are some care considerations for opioids?
- Monitor vital signs - do not administer if less than 12 breaths/min or systolic < 110 mmHg
- Monitor urinary output
- Check for signs of overdose
- Check for adverse effects
202
What is drug misuse?
- The taking of a drug in damaging quantities - or inappropriately - overall harm rather than benefit
- In quantities other than the prescribed dosage
203
What is metabolic tolerance?
Increase in the number and activity of liver
| enzymes that metabolise/remove the drug
204
What is physiological tolerance?
Neurons in the brain adapt to the continued presence of a drug - neural plasticity (blunting of response)
205
What are withdrawal/rebound symptoms?
Generally the opposite of the drug effects
206
What does tolerance develop against and what can it not develop against?
Tolerance develops to analgesia, euphoria, respiratory depression, hypotension but not to miosis (narrowing of the pupil) and constipation
207
Who is going to be at increased risk when using codeine - ultra-rapid or poor metabolisers?
Ultra-rapid metaboliser
208
What is the gene that causes variation between individuals in the metabolism of codeine to morphine?
CYP2D6 gene
209
What is the half-life span of Naloxone and what is the effects of this?
- Short life-span (one hour)
- Individuals can overdose again if they have extremely high levels therefore they must be monitored 2-3 hours following treatment
210
What do NSAIDS inhibit?
Cyclooxygenase enzymes (COX-1 and COX-2)
211
What do COX-2 inhibit?
Cyclooxygenase 2 enzyme (COX-2)
212
What are COX-1 iso-enzymes?
- Widely distributed but are concentrated in cells of the stomach, kidney, endothelium & platelets
- COX-1 catalysed PGs provide gastroprotection, control renal perfusion, & promote platelet aggregation
213
What are COX-2 iso-enzymes?
- Induced by inflammation
| - COX-2 catalysed PGs mediate pain, inflammation, fever and inhibit platelet aggregation
214
What are the functions of AKI (triple whammy)?
- ACE inhibitor dilates the efferent arteriole and reduces GFR
- Diuretics reduce plasma volume and GFR
- NSAIDs constrict blood flow into the glomerulus via the afferent arteriole and reduce GFR
215
What is a AKIs?
Taking three drugs that all lower GFR
216
What are Celecoxib used for?
- COX-2 inhibitor
- Lesser adverse effect on COX-1
- Used for rheumatoid arthritis, chronic inflammation and musculoskeletal pain
- Can cause milder GI disturbances
