Exam 1 Flashcards
1
Q
Volume of distribution
A
Amount of drug in the body/plasma drug concentration
2
Q
High volume of distribution
A
Means that the drug is not highly protein bound
3
Q
Clearance of a drug
A
0.693(Vd)/half life
4
Q
Bioavailability
A
How much of the drug will reach the blood after metabolism
5
Q
What form of drug route will have greatest bioavailability
A
IV and sublingual
6
Q
Fastest route of absorption
A
Inhalation
7
Q
What will make urine more acidic
A
Cranberry juice, vitamin C, NH4Cl
8
Q
What will make urine more basic
A
Aspirin
9
Q
What types of drugs will cross placenta and blood brain barrier
A
Small, lipid soluble, non-protein bound
10
Q
Inhibition of CYP450 leads to
A
Drug toxicity
11
Q
General inducers of CYP450
A
GPCRABS
Glucocorticoids, phenytoin, carbamazepine, rifampin, alcohol, barbiturates, st johns wort
12
Q
General inhibitors of CYP450
A
GPACMANS
Grapefruit, protease inhibitors, proton pump inhibitors, azoles, cimetidine, macrolides, amiodarone, non-dihydropyridines, SSRIs
13
Q
Drugs that undergo zero order elimination
A
Phenytoin, salicylates, aspirin, alcohol
14
Q
Drugs that have a small therapeutic index
A
Have a higher chance of toxicity–need to monitor drug levels
15
Q
Water percentage in neonates
A
75-80%, less body fat
16
Q
When do kidneys and liver reach maturation in infants
A
2 years old
Before this, drug toxicity can occur more frequently
17
Q
When does gastric output levels reach adult levels in children
A
2 years old
18
Q
Gastric emptying in infants/children
A
prolonged
19
Q
Pulmonary absorption in children
A
Decreased due to increased RR and larger tidal volume
20
Q
Volume of distribution in children
A
Larger due to increased total body water and less albumin
21
Q
Body water and fat in elderly
A
Less body water and more body fat
Half life of drugs may increase if higher volume of distribution
22
Q
Drugs that have increased CNS effects in elderly
A
Anticholinergics, TCAs, antihistamines, antispasmodics, benzodiazepines, analgesics
23
Q
Allosteric site
A
A binding site for substrates not active in initiating a response; may induce a conformational change in the structure of the active site, rendering it more or less susceptible to response from a substrate
24
Q
Downregulation
A
Decreased availability of drug receptors
25
Enterohepatic recirculation
Process by which a drug excreted in the bile flows into the GI tract, where it is reabsorbed and returned to the general circulation
26
Hepatic extraction ratio
A comparison of the percentage of drug extracted and the percentage of drug remaining active after metabolism of the liver
27
Pharmacodynamics
Process through which drugs affect the nody
28
Pharmacokinetics
process through which the body affects the drug
29
Prodrug
A drug that is transformed from an inactive parent drug to an active metabolite
30
Penicillin's
- Method of action
- SE
- Coverage
Bactericidal--interfere with cell wall synthesis
SE: hypersensitivity, GI distress, seizures, encephalopathy
Mostly G+ coverage
Some G- coverage
31
Cephalosporins
- Method of action
- SE
- Coverage
Bactericidal--interfere with cell wall synthesis
SE: hypersensitivity, GI distress
As you progress from 1st to 4th generation, has more G- and less G+ coverage
32
Monobactams
- Method of action
- SE
- Coverage
Bactericidal--interfere with cell wall synthesis
SE: GI distress, usually no cross-sensitivity with penicillin or cephalosporin
Primarily against G-
33
Carbapenems
- Method of action
- SE
- Coverage
most broad spectrum agents available
Bactericidal--interfere with cell wall synthesis
SE: neurotoxicity, GI distress
G+ , G-,
34
Fluoroquinolones
- Method of action
- SE
- Coverage
Bactericidal--Inhibit DNA gyrase and topoisomerase IV
SE: GI distress, dizziness, confusion, tendon rupture, QT prolongation
G+ and G-
DOC for UTI
35
Macrolides
- Method of action
- SE
- Coverage
Erythromycin, azithromycin, clarithromycin
Bacteriostatic--binds to 50S
SE: GI distress, hepatotoxicity, ototoxicity
Broad spectrum: G+, G-, Atypical
36
Aminoglycosides
- Method of action
- SE
- Coverage
Gentamicin, Neomycin, Streptomycin, Tobramycin
Bacteriostatic--binds to 30S
SE: Nephrotoxicity and ototoxicity
Mainly active against G-
Can combine with beta lactams for G+ coverage
37
Tetracyclines
- Method of action
- SE
- Coverage
Bacteriostatic--binds to 50S
SE: GI distress, gray-brown discoloration of the teeth
Broad spectrum--G+, G-, atypical
38
Sulfonamides
- Method of action
- SE
- Coverage
Bacteriostatic--inhibits folic acid
SE: GI distress, rash, fever, steven johnson syndrome and vasculitis
G+ and G- (except pseudomonas)
39
Vancomycin
- Method of action
- SE
- Coverage
Bactericidal--inhibits d-alanyl-d-alanine portion of cell wall
SE: fever, chills, phlebitis, red man syndrome, nephrotoxicity
Active mostly against MRSA
40
Oxazolidinones
- Method of action
- SE
- Coverage
```
Linezolid + Tedizolid
Oral tx for MRSA
Bacteriostatic--bind to 50S
se: GI distress, thrombocytopenia, leukopenia
G+ only--MRSA, VRE
```
41
Clindamycin
- Method of action
- SE
- Coverage
Bacteriostatic--binds to 50S
SE: diarrhea and C. DIff colitis
Active against G+ and G- anaerobic
42
Metronidazole
- Method of action
- SE
- Coverage
Bactericidal--inhibition of DNA protein synthesis
SE: GI distress, seizures, peripheral neuropathy
G- coverage only
DOC for abdomen and GU system (H Pylori, C. Diff, bacterial vaginosis, trich)
43
Chloramphenicol
- Method of action
- SE
- Coverage
Variably bactericidal--binds to 50S
SE: Gray baby syndrome, optic neuritis, fatal aplastic anemia
Broad spectrum: G+, G-, anaerobic
44
Rifampin
- Method of action
- SE
- Coverage
Variably bactericidal--inhibits DNA
SE: GI distress, headache, fever, discolors body fluids to orange
Mostly against G+ with some G- coverage
DOC for TB
45
Nitrofurantoin
Variably bactericidal--interfers with cell wall synthesis
SE: N/V and pulmonary reactions, hepatotoxicity, peripheral neuropathy
G+ only
Only used for uncomplicated UTI
46
Dermatitis
Alteration in skin reactivity caused by exposure to external agent; usually on inflammatory process
Diaper dermatitis, atopic dermatitis, irritant dermatitis
Linear streaks of papules, vesicles, and blisters that are very pruritic
47
First line therapy for dermatitis
Low potency topical steroid 2x a day
Alclometasone, flucinolone, hydrocortisone, triamcinolone
Prolonged use can cause skin atrophy
48
Second line therapy for dermatitis
Increase protency of topical steroid or increase to oral steroid
-Use in tapering dose for 2-3 weeks
49
Topical immunosuppressants for dermatitis
Primecrolimus + Tacrolimus
Used if patient can not tolerate steroids
Decreases cytokine transcription
50
Relief of itching in dermatitis
Antihistamines
51
Tinea
Group of fungi infections on skin
| Pruritus, burning, stinging
52
First line therapy for tinea capitis
Griseofulvin
| Systemic terbinafine or itraconazole
53
First line therapy for tina corporis, cruris and pedis
Topical azoles first
| Systemic terbinafine or fluconaozle if no relief
54
First line therapy for tinea uriguium
Systemic terbinafine or itraconazole
55
Griseofulvin
Fungistastic
May aggravate SLE
SE: N/V, diarrhea, headache, photosensitivity
56
Tinea versicolor
Opportunistic superficial yeast infection; chronic; asymptomatic
Well-demarcated scaling patches of varied color due to overgrowth of yeast
57
DOC for tinea versicolor
Selenium sulfide
58
Candidiasis
Superficial fungal infection of skin and mucus membranes
| Found commonly in diaper area, oral cavity, nails, vagina, penis
59
First line therapy for oral thrush
Nystatin--swish and swallow 3x a day for 10-14 days
60
First line therapy for skin candidiasis
Cool soaks with burrow solution, topical azole
| If no relief, can use a systemic azole
61
Topical antivirals
Acyclovir, Penciclovir
62
Systemic antivirals
Acyclovir, Famciclovir, Valacyclovir
63
First line treatment for HSV-1
Topical acyclovir or penciclovir
| Can use systemic if no releif
64
First line treatment for VZV
Systemic antiviral if <72 hours from outbreak, patient >50 years old, or immunocompromised
7 day treatment
65
First line treatment of warts
Salicyclic acid
| -Keratolytic peeling agent; leave patch on 5-6 days a week for 12 weeks
66
Salicyclic acid CI in
Patients with DM or impaired circulation
67
Skin infections are primarily due to
Staph aureus, GAS, GBS
68
Impetigo
Superficial skin infection due primarily to staph aureus
| Spread between close quarter living environments, poor hygiene, schools, daycare centers
69
Treatment of impetigo
```
Topical Mupirocin (Bactraban) for 7-10 days
If more major, can give a broad spectrum penicillin or 1st generation cephalosporin
```
70
Cellulitis
Infection involving skin and subcutaneous layers and can spread systemically
Mostly due to staph aureus or GAS
71
Erysipelas
Superficial form of cellulitis that occurs in children due to GAS
72
Treatment of cellulitis without systemic symptoms or purulence
Penicillin or Augmentin
73
Treatment of cellulitis with purulent infection
Bactrim, minocycline, clindamycin, linezolid (covers MRSA)
74
Folliculitis
Superficial infection of hair follicle usually due to staph aureus
May be due to pseudomonas in hot tubs
75
Treatment for superficial folliculitis
Warm compresses, topical mupirocin ointment or topical gentamicin
76
Treatment for deeper folliculitis
Oral dicloxacillin, cephalexin, clindamycin
77
Necrotizing fasciitis
Serious infection of subcutaneous tissues that can be life threatening
Usually polymicrobial
78
Bactrim is not active against
GAS
79
Mupirocin ointment active against
Staph aureus and some strep
80
Topical gentamicin active against
Staph aureus, GAS, pseudomonas
81
Psoriasis
Autoimmune-mediated process driven by abnormally activated helper T cells
Well-demarcated, erythematous papules/plaques surrounded by silvery or whitish scales
82
First line treatment for psoriasis
Moisturizers + topical steroids
| If no relief, can add a vitamin D analog
83
Topical corticosteroids for psoriasis
Hydrocortisone
Decreases redness, itching and scaling and promotes vasoconstriction
Rapid onset
84
Coal tars for psoriasis
Decrease DNA synthesis and has anti-inflammatory and anti-pruritic properties
Adjunct therapy to steroids
Has an unpleasant odor, staining and photosensitivity
85
Anthralin
Coal tar derivative used for psoriasis
Slow onset of action
Can irritate skin and stain clothing
86
Topical Vitamin D analogs for psoriasis
Calcipotrient + Calcipotriol
Mild-moderate psoriasis
Decreases cell proliferation and is anti-inflammatory
Can cause dry skin, peeling and rash
87
Retinoid
```
Vitamin D derivative
Topical format for mild to moderate psoriasis
Decreases inflammation
Promotes longer remission
May get worse before it improves
```
88
Systemic retinoids
Acitretin
Long term therapy for psoriasis
Decreases inflammation
Can cause liver and lipid problems, alopecia, skin peeling, dry skin and pruritus
89
Methotrexate for psoriasis
Treats generalized psoriasis
| Inhibits folic acid reductase
90
Cyclosporine for psoriasis
Immunosuppressant
Used short term for exacerbation
May cause gingival hyperplasia, htn, nephrotoxicity, tremor
91
Acne Vulgaris
Excess androgen causes increased sebum production
92
Open comedones
Blackheads
93
Closed comedones
White heads
94
Comedolytics for Acne
Retinoic Acid (Tretinoin)
Adapalene Gel
Tazarotene Gel
95
Comedolytic bactericidals for Acne
Benzoyl peroxide
| Azelaic acid
96
Topical antibiotics for acne
Clindamycin or erythromycin
97
Oral antibiotics for acne
Tetracycline
Erythromycin
Indicated for inflammatory acne
98
Isotretinoin
Reserved for severe nodulocystic acne when other treatments fail
Therapy usually occurs for 15-20 weeks
Severely teratogenic
99
First line therapy for acne
Topical antibiotics of comedolytics
100
Second line therapy for acne
Oral antibiotics and topical medications
| Oral contraceptives
101
Third line therapy for acne
Isotretinoin
102
Who should not use tetracyclines
Children <12 years old
| Pregnant women
103
Rosacea
Acneiform disorder that begins in midlife
| Symmetric rash on central part of face
104
Treatment of rosacea
Topical metronidazole, sodium sulfacetamide, and acelaic acid first line
Oral doxycycline, erythromycin, bactrim for second line
105
Blepharitis
Eyelid margin infections usually due to staph aureus
| Irritated red eyes, burning sensation, increased tearing
106
Treatment of blepharitis
Topical ophthalmic antimicrobials:
- Erythromycin ointment
- Bacitracin ointment
- Fluoroquinolone solution
107
Most common bacterial organisms of conjunctivitis
Staph, strep, moraxella, Haemophilus
| N. gonorrhoeae and C. trach (for neonates)
108
Conjunctivitis usually due to
Virus
| Profuse watery discharge
109
Treatment of bacterial conjunctivitis
Erythromycin or bacitracin ointment first line
| ophthalmic fluoroquinolones for second line
110
Treatment of seasonal conjunctivitis
Topical antihistamines first line
Low potency topical corticosteroids for second line
T
111
Treatment of viral conjunctivitis
Topical antihistamines for first line
| Low potency topical steroids for second line
112
Topical antibiotics for bacterial conjunctivitis
Erythromycin or bacitracin-polymyxin B ointment
| Ophthlamic fluoroquinolones
113
Treatment of gonococcal conjunctivitis
IM ceftriaxone and oral azithromycin
114
Treatment of chlamydial conjunctivitis
Azithromycin or 7 days of doxycycline
115
Cromolyn for allergic conjunctivitis
Decreases inflammation and inhibits hypersensitivity
| Mast cell stabilizer
116
Dry eye syndrome
Bilateral disruption of tear film on ocular surface can be due to decreased tear production, increased tear evaporation or combination
117
First line treatment for dry eye syndrome
Artificial tears 4x a day
| If no relief, topical cyclosporine emulsion 2x a day
118
Cholinergic agonists for dry eye
Pilocarpine
| Increased secretions
119
Glaucoma
Irreversible damage to optic nerve and retinal ganglion cells
Results in loss of visual sensitivity and field
Increased IOP due to increased aqueous humor
120
Treatment of glaucoma
Topical prostaglandins first line
Topical beta blocker + prostaglandin second line
Carbonic anhydrase inhibitor third line
121
Topical prostaglandins for glaucoma
-prost
Increases aqueous outflow
Can cause discoloration of iris
122
Topica Beta blockers for glaucoma
Decreases production of aqueous humor
| May be absorbed systemically and cause bradycardia, hypotension, heart block and bronchospasm
123
Otitis media most frequent organisms
H. influenzae, S. pneumoniae, M. Catarrhalis
| Less commonly due to s. aureus or GAS
124
DX of otitis media
Fever, otalgia, irritability, tympanic membrane is red, bulging and immobile
125
First line treatment for symptomatic otitis media
high dose amoxicillin or Augmentin
126
Recurrent otitis media
>3 episodes within 6 months of >4 episodes in 12 months
| Antibiotic prophylaxis not recommended
127
Vaccines important for prevention of acute otitis media
Pneumococcal, H. influenzae B, influenza
128
Otitis externa treatment
Topical antibiotics usually adequate: Fluoroquinolone drops (first line due to anti-pseudomonal coverage), Neomycin/Polymyxin combo second line
129
Do not use neomycin combo in otitis externa if
Tympanic membrane not in tact
130
1st line treatment for viral or bacterial upper airway infection
Decongestant
131
1st line treatment for allergic rhinitis
Antihistamines
| Leukotriene inhibitors can also be used but they take longer
132
Decongestants
Stimulate alpha adrenergic receptors and cause vasoconstriction
Pseudoephedrine--can also relax the bronchi by agonizing B2
133
Do not give decongestants to
glaucoma patients, hypertension, CAD, BPH
134
Antihistamines
Used to treat IgE mediated allergies
Decreases redness, swelling, mucus production
Anticholinergic properties
Do not use for lower respiratory infections
135
Intranasal cromolyn
Decreases inflammation
Takes longer--not for acute cases
Does not have antihistamine, bronchodilator, vasoconstrictor or glucocoritcoid activity
136
Montelukast
leukotriene receptor inhibitor
| Effective when exposure not avoidable
137
Antitussives
Codeine and dextromethorphan
| Act on cough center of the medulla
138
Tessalon Perles
Anesthetize stretch receptors in the respiratory passages reducing cough reflex
139
Antitussives CI in
Productive cough, history of substance abuse, COPD
140
SE of antitussives
Dizziness, nausea, drowsiness, sedation
141
Expectorants
Guaifenesin
Increased respiratory tract fluid secretions
Loosen bronchial secretions
142
70% of URI are
Viral
Educate about hand washing, increasing fluids
Can give benzonatate for antitussive
143
First line treatment for cough
Decongestant and 1st generation antihistamine
Naproxen may decrease inflammation and cough
Do not use codeine for URI, only bronchitis
144
First line therapy for bacterial rhinosinusitis
Augmentin for 14 days
| If no relief in 8 days can change to doxycycline, or fuoroquinolone
145
1st line treatment for URI
Topical decongestants for first 3 days, antipyretics, NSAIDS (naproxen)
If not better in 8-10 days, can try an antibiotic
146
What medications should be avoided in children
Sustained release, cough medicine <6 years old, 1st generation antihistamines, intranasal corticosteroids
147
What medications should be avoided in pregnant women
Decongestants, antitussives, expectorants
| Antihistamines are category B
148
Most common pathogen of common cold
Rhinovirus
149
FEV1 concerning number
<80% treat
| <50% emergency care
150
What can exacerbate asthma
Inhaled allergens, food, NSAIDs, cold air, exercise, airway irritants
151
Intermittent asthma
Symptoms <2 days per week
| FEV >80%
152
Mild persistent asthma
Symptoms >2 days per week
| FEV >80%
153
Moderate persistent asthma
Daily symptoms
| FEV >60%
154
Severe persistent asthma
Continuous daily
| FEV <60%
155
Initial treatment for asthma
inhaled corticosteroid
| Then try leukotriene modifier or LABA
156
When having an acute asthma attack,
Use SABA
157
Long term control of asthma
inhaled corticosteroids
Lowest dose possible
2-4 inhalations 2-4 times per day
Takes 2 weeks of continuous therapy to achieve maximum effectiveness
158
SE of inhaled corticosteroids
Oral candidiasis, dysphonia, hoarseness, headache
159
Systemic corticosteroids
Used for severe exacerbations for 5 days-2 weeks
160
Short acting Beta agonist
albuterol
161
Long acting beta agonist
Formeterol, Aformeterol, salmeterol
162
SE of systemic corticosteroids
Sodium and water retention, hyperglycemia, increased appetite, weight gain, fractures in elderly
163
SE of leukotriene modifier drugs
Headache is common
164
Methylxanthines
Theophylline + Aminophylline
| Relaxes bronchial smooth muscle, anti-inflammatory
165
Vaccines for patients with asthma
Annual influenza vaccine, 23 valent and 13 valent pneumococcal vaccine
166
COPD s/s
Morning cough with yellow sputum, frequent URI, prolonged expiration with wheezes and may hear crackles
167
Bronchodilators for COPD
SABA, LABA, Short acting anticholinergic (ipatropium), long acting anticholinergic (tiatropium)
168
Medications for maintenance of COPD
Anticholinergics, beta agonists, methylxanthines, corticosteroids (last effort)
169
Stage 1 COPD tx
Short acting bronchodilator
170
Stage 2 COPD tx
Regular use of long acting bronchodilator in addition to SABA
171
Stage 3 COPD tx
Add an ICS for frequent exacerbation
172
Stage 4 COPD tx
Add long term oxygen
173
Category B respiratory medications
Ipatropium, mast cell stabilizer, budesonide, montelukast, terbutaline
174
When are antibiotics indicated for COPD
If increased dyspnea, increased sputum, purulent sputum
| Most commonly due to H. influenzae, S. pneumoniae, m/ catarrhalis
175
Acute bronchitis
95% due to virus
Edamatous mucus membranes, increase in bronchial secretions, crackles, rhonchi, wheezing, normal chest x ray
Treatment supportive
176
Only give antibiotics for acute bronchitis if
COPD, purulent sputum, respiratory symptoms >4-6 days
177
Chronic bronchitis
>3 months every year in the past 2 years
178
Tx of bacterial cause of exacerbation of uncomplicated chronic bronchitis
Ampicillin first line
179
Tx of complicated chronic bronchitis
Augmentin, 2nd or 3rd generation cephalosporin, doxycycline
180
Tx of severe chronic bronchitis
Levo or cipro
181
Most common cause of community acquired pneumonia
S. Pneumoniae
182
Empiric treatment for CAP
Should always cover S. Pneumoniae and treat for 7-14 days
183
1st line treatment for CAP
Macrolide
| Doxycycline or fluoroquinolone if recent antibiotic
184
1st line treatment for influenza
Oseltamivir or Zanamivir
185
Preventive measures for patients with asthma
Flu vaccine, pneumococcal vaccine, avoid smoking and allergens
186
If patient comes in with influenza..
Appropriate to give antivirals within 48 hours
| More than that time is ineffective
187
SE of corticosteroids
Moon face, high blood pressure, high glucose, fractures, immunosuppression, growth issues in children
188
DOC for bacterial rhinosinusitis
Amoxicillin or Augmentin
| If allergies--Macrolide
189
If you give a bronchodilator to an asthma patient, look out for
Tachychardia
190
SE of a beta blocker
Bradycardia, bronchoconstriction
191
How to distinguish viral from bacterial
Type of sputum, length of time, fever presence
192
How long to treat bacterial sinusitis
14 days
193
which drugs warrant monitoring drug levels due to narrow therapeutic index
Dilantin, warfarin, vancomycin, digoxin
194
How many half lives are needed on average to get rid of a drug from the body
5
195
If an elderly person has liver disease..
Concerned with drug toxicity due to less albumin so more free drug
196
When should you treat otitis media
If purulent discharge, fever, getting worse
| Don't need to treat if no exudate, tympanic membrane visible, no fever
197
Isoniazid SE
Neurotoxicity
| Can give Vitamin B6 to prevent nerve damage
198
Fluorescein test
Eye exam to look for foreign object
| Use a wood lamp to look into the eye
