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BECOM III - Exam 3 > Dr. Lees Drugs > Flashcards

Dr. Lees Drugs Flashcards

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1
Q

what do you worry about with SABA and LABAs?

A

systemic effects w/ overdose or long term use -tachycardia, hyperglycemia, hypokalemia, and hypomagnesemia
-minimized when inhaled

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2
Q

treatment strategies in ASTHMA

A

acute - albuterol (go to SABA)
chronic - beclamethasone (go to ICS)
increase combo therapy as severity increases -> omalizumab

SABA > low dose ICS > LABA > high dose ICS

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3
Q

management of COPD

A

Roflumilast (go to) -> PDE4 inhibitor in lungs -> increase cAMP -> bronchodilator

  • reduce inflammation & exacerbation of COPD
  • improve pulmonary function

ICS used last resort bc have risk of bacterial pneumonia

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4
Q

SABA

A
  1. albuterol
  2. levalbuterol
  • rapid action -> treat ACUTE asthma
  • systemic symptoms w/ overdose
  • muscle tremors
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5
Q

LABA

A
  1. salmeterol
  2. formoterol
  3. indacaterol
  • not for mono therapy or acute asthma attacks
  • long acting bronchodilaton (12hr.)
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6
Q

LABA that has hypersensitivity to milk proteins

A

salmeterol

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7
Q

indacaterol

A
  • longest acting LABA (24hr)

- for COPD long term maintenance (masks inflammation)

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8
Q

theophylline

A
  • narrow therapeutic index

- risk of SEIZURES (neurotoxic), and ARRHYTHMIAS (cardiotoxic)

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9
Q

Ipratropium

A
  • muscarinic receptor antagonist

- AE -> dry mouth, bitter taste

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10
Q

Roflumilast

A
  • PDE4 inhibitor in lungs
  • main one for COPD exacerbations
  • reduce inflammation like ICS
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11
Q

inhaled corticosteroids

A
  1. beclamethasone (go to)
  2. budesonide
  3. fluticasone
  • prophylaxis/prevent long term asthma
  • anti-inflammatory
  • worry about ORAL CANDIDIASIS
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12
Q

Fluticasone

A
  • ICS that has VASOCONSTRICTIVE & anti-inflammatory properties
  • hypersensitivity to milk proteins (lactose)
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13
Q

Cromolyn

A

mast cell stabilizer -> prevent release of leukotrienes & histamine

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14
Q

omalizumab

A

monoclonal Ab against IgE -> inhibit binding to mast cells

-slow onset of action (12-16 weeks) -> longer effect

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15
Q

Montelukast

A

leukotriene receptor antagonist (cysteine leukotriene-1 receptor)

-prophylaxis of chronic asthma & relieve rhinitis

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16
Q

Zileuton

A

5-LO inhibitor

  • prophylaxis of chronic asthma
  • risk of HEPATOTOXICITY
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17
Q

side effects of penicillins & cephalosporins

A
  1. Hypersensitivity - urticaria most common
  2. GI distress (diarrhea)
  3. Nephritis (interstitial)
  4. Neurotoxicity (seizures)
  5. Hematologic toxicities - decreased coagulation & cytopenia
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18
Q

Pencillin G & V

A

drug of choice for SYPHILIS and ACTINOMYCES

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19
Q

MOA of penicillins & cephalosporins

A

bind to PBP –> inhibit transpeptidation rxn –> lesions in cell walls

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20
Q

what can cause diarrhea when combined with cluvalonic acid in children?

A

Amoxicillin

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21
Q

piperacillin & ticarcillin

A

the 2 antipseudomonal penicillins -> treat Pseudomonas infections

-synergistic nephrotoxicity when piperacilin-tazobactam is used in combo with VANCOMYCIN

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22
Q

adverse effect of ticarcillin

A

CHF/volume overload (high Na+), thrombocytopenia, hypokalemia

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23
Q

Dicloxacillin, Nafcillin, Oxacillin

A

drugs of choice for MSSA

  • beta lactamase resistance
  • Nafcillin AE -> leukopenia, inflammation at injection site
  • Oxacillin AE -> high liver enzymes
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24
Q

which 2 cephalosporins treat pseudomonas?

A

ceftazidime (3rd/4th) and cefepime (4th)

cefepime -> also cross blood brain barrier to treat CNS infections

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25
2nd generation cephalosporin for respiratory infections, occasional UTIs
cefaclor
26
2nd generation cephalosporin that has a disulfuram rxn when combined w/ ETHANOL
Cefotetan
27
3rd generation cephalosporins
-WORKHORSE group -> respiratory infections, UTIs, meningitis) 1. ceftriaxone 2. cefotaxime 3. ceftazidime
28
5th generation cephalosporin w/ MRSA coverage
ceftaroline
29
carbapenems
- treat pseudomonas along with Monobactams - ANAEROBES - reserved for resistant gram neg rod infections
30
Imipenem-cilastatin
cilastatin prevents imipenem degradation by DEHYDROPEPTIDASE in the renal tubule -high risk of SEIZURES
31
what carbapenem has a higher mortality when used for gram neg rod pneumonia
doripenem
32
monobactam (Aztreonam)
- AEROBIC gram neg rods - NO cross allergenicity - AE -> NEUTROPENIA in children
33
vancomycin
- blocks glycopeptide polymerization - gold standard for MRSA - RED MAN SYNDROME, ototoxicity
34
Daptomycin
- binds to cell membrane -> depolarization & rapid cell death**** (lipid tail) - for MRSA & VRE -inactivated by SURFACTANT
35
adverse effects of all tetracyclines & glycylcyclines
1. GI disturbance 2. deposition in bone/teeth 3. liver failure 4. phototoxicity 5. vertigo -all avoided during pregnancy
36
tetracyclines MOA
prevent tRNA binding to ribosome inhibiting protein synthesis
37
what tetracycline is used for SIADH
demeclocycline
38
most commonly used tetracycline
doxycycline
39
what tetracycline has skin pigmentation issues w/ long term use
minocycline
40
tigecycline
- A glycylcycline - reversible bind to 30S ribosome & inhibit protein synthesis -has HIGHER MORTALITY
41
aminoglycosides MOA
bind to and distort 30S ribosome -> misreading and disrupt protein synthesis - POST antibiotic effect - SINGLE large dose (less toxic)
42
aminoglycoside used for more gram neg resistant rod infections
amikacin
43
aminoglycoside used for pre op bowel prep or hepatic encephalopathy
neomycin
44
aminoglycoside that is most active against pseudomonas
tobramycin
45
macrolide
- bind to the 50S ribosome -> inhibit TRANSLOCATION - treat respiratory tract infections - risk of jaundice/hepatic dysfunction, prolonged QT, P450 inhibition
46
macrolide NOT used with myasthenia gravis
Telithromycin
47
A macrocyclic that treats C. difficile in adults
Fidaxomicin -inhibits RNA polymerase & protein synthesis -> cell death (bactericidal)
48
Clindamycin (lincosamide)
- bind to 50S ribosome -> inhibit TRANSLOCATION - inhibit bacterial toxin production - increase risk of C. difficile colitis
49
Linezolid (Oxazolidinones)
- bind to 23S subunit of 50S ribosome -> inhibit formation of 70S initiation complex - not used with MAO inhibitors - SEROTONIN SYNDROME if used w/ SSRIs
50
what is used for SEVERE infections (meningitis, Rickettsia) and can cause GRAY SYNDROME & OPTIC NEURITIS?
chloramphenicol -binds to the 50S ribosome -> prevent AAs transfer by inhibiting peptidyl transferase
51
Quinipristin-dalfopristin (streptogramins)
- can cause arthralgia-myalgia syndrome | - inhibit CYP3A4
52
cotrimoxazole (TMP + SMX)
- bactericidal - NOT used in pregnancy, renal damage, G6PD deficiency - used for UTIs & PJP - drug of choice for NOCARDIOSIS
53
Sulfonamides
- inhibit DIHYDROPTERATE SYNTHASE - HYPERSENSITIVITIES due to sulfur -> PAN, SJS - compete with WARFARIN/methotrexate for sites on albumin -> excess anticoagulation
54
Trimethoprim
- inhibit DIHYDROFOLATE REDUCTASE | - risk of folate deficiency in pregnancy and Hyperkalemia
55
fluoroquinolones
- inhibit TOPOISOMERASE - topo I (DNA gyrase) -> gram neg org. - topo IV -> gram + org. -for respiratory tract, skin/soft tissue infections - avoided in patients w/ prolonged QT* - risk of TENDON RUPTURE*
56
what fluoroquinolone is not used with Tizanidine?
Ciprofloxacin
57
isoniazid
- inhibits acyl carrier protein reductase & beta-ketoacyl-ACP synthase enzyme -> prevent mycolic acid synthesis - NOT used with rapid/fast acetylators
58
the 2 most important TB drugs
rifampin and isoniazid
59
rifampin
- blocks RNA transcription by interacting w/ beta subunit of mycobacterial DNA-dependent RNA polymerase - ORANGE sweat, urine, tears - CYP3A4 INDUCER -> enhance elimination rate of many drugs -> problem w/ HIV & pregnancy
60
what TB drug is preferred for TB patients with HIV+
Rifabutin
61
what TB drug can lead to acute GOUT & severe hepatic damage?
Pyrazinamide -increased uric acid levels
62
ethambutol
- inhibit arabinosyl transferase involved in protein synthesis of arabinogalactan (cell wall) - AE -> OPTIC NEURITIS & red/green COLORBLINDNESS
63
what drug is used in combo with the major 4 if TB is severe?
streptomycin -for resistant TB
64
what is the preventative treatment for latent TB?
isoniazid for 9 months
65
most common leprosy drug
dapsone - inhibits dihydropterate synthase in folate synthesis path - hemolysis in G6PD deficient patients, methemoglobinemia, agranulocytosis, peripheral neuropathy
66
clofazimine
- leprosy drug - treat LEPROMATOUS LEPROSY and ERYTHEMA NODOSUM LEPROSUM -AE -> pink to brownish-black discoloration of skin
67
MOA of azoles - antifungals
inhibit 14-alpha demethylase (cyp51A1) -> block demethylation of lanosterol to ergosterol -all azoles are TERATOGENIC
68
what azole is the drug of choice for cryptococus neoformans?
fluconazole
69
what azole is used to treat DIMORPHIC fungi? (blasto, histo, sporothrix, paracocci)
itraconazole
70
Ketoconazole
- ONLY topical - treat TINEA, cutaneous candidiasis, SEBORRHEIC dermatitis -NOT used on scalp that is broken or inflamed
71
azole used for vulvovaginal candidiasis
miconazole -can have vulvovaginal burning/pruritis
72
Voiconazole
- treat invasive ASPERGILLOSIS - more CYT450 inhibition than others - can have visual/auditory HALLUCINATIONS & hepatotoxicity
73
Amphotericin B & Nystatin MOA
bind to ergosterol -> form pores in membrane -> electrolyte leakage
74
amphotericin B adverse effects
-low TI (toxic), "bake and shake", kidney failure, hypotension, anemia
75
Nystatin
- treats mucocutaneous/vaginal/oropharyngeal CANDIDA | - "swish and swallow"
76
Flucytosine
- 5-FC enters fungi via PERMEASE transporter -> converted to 5-FU -> inhibit nucleic acid synthesis - used for CHROMOBLASTOMYCOSIS, meningitis, candida UTIs - can lead to dose-related BONE MARROW SUPPRESSION
77
Griseofulvin
- disrupt mitotic spindles -> inhibit fungal mitosis - treat dermatophytosis of SCLAP/HAIR (tinea capitis) - NOT used with PORPHYRIA - induce CYP450 -> decrease warfarin effects - many effects with ETOH
78
Terbinafine
- inhibit squalene epoxidase -> build up toxic squalane - treat ONYCHOMYCOSES - AE -> HEADACHE
79
Echinocandins
-inhibit synthesis of B(1,3)-D glucan in cell wall - slow IV infusion prevents FLUSHING - treat ASPERGILLUS & CANDIDA
80
Caspofungin
- 1st line for invasive Candidiasis | - do NOT give w/ cyclosporine
81
Micafungin
PROPHYLAXIS of invasive Candida

BECOM III - Exam 3 (8 decks)

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