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Pharmacology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Pharmacotherapeutics

A

Study of therapeutic uses and effects of drugs

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2
Q

Mechanism of actions of antibacterials

A

Inhibit cell wall synthesis, inhibit translation/transcription, inhibit DNA synthesis and integrity, inhibit folate synthesis and function

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3
Q

Inhibitors of cell wall synthesis

A

Beta-lactams penicillins, cephalosporins, glycopeptides, TB meds

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4
Q

Inhibitors of translation and transcription

A

Tetracyclines, macrolides, clindamycin, oxazolidinones, ahminoglycosides, TB meds

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5
Q

Inhibition of DNA/inhibitors of folate synthesis and function

A

Sulfonamides, trimethoprim, quinolones

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6
Q

Bactericidal

A

Inhibition of cell wall synthesis
Time dependent killing (serum level above MIC-beta lactase and vancomycin) or concentration dependent killing (higher concentration determines rate and extent of killing-aminoglycosides and quinolones)

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7
Q

Bacteriostatic

A

Inhibition of protein synthesis

Tetracyclines, macrolides, sulfonamides

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8
Q

Bacteriostatic agents

A

Chloramphenicol, Clindamycin, ethambutol, macrolides, nitrofurantoin, novobiocin, oxazolidinone, sulfonamides, tetracyclines, tigecycline, trimethoprim

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9
Q

Post-antibiotic Effect

A

Persistent suppression of bacterial growth after limited exposure to antimicrobial agent

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10
Q

Mechanism of post-antibiotic effect

A

Slow recovery after reversible damage to cell structures, persistence of drug at binding site, need to synthesize new enzymes before microorganism growth can resume

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11
Q

Narrow Spectrum Penicillin

A

Penicillinase-susceptible: G, VK*
Penicillinase-resistant: Nafcillin*, Oxacillin
Staph/strep/meningococcal infections and syphillis

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12
Q

Wide Spectrum Penicillin

A

Penicillinase inhibitor
Ampicillin, amoxicillin*, piperacillin, ticarcillin
Greater activity vs. gram neg bacteria

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13
Q

Cephalosporins (1st gen)

A

Cephalexin
Skin, soft tissue, UTI
Partial cross-reactivity with penicillin-done give to Pen allergic

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14
Q

Cephalosporins (2nd gen)

A

Cefotetan, cefoxitin, cefuroxime*

S pneumoniae, H flu, B fragilis

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15
Q

Cephalosporins (3rd gen)

A

Ceftriaxone, cefixime, ceftoaxime, ceftazidime
Pneumonia, meningitis, gonorrhea; broad activity, beta lactase stable
Enter CNS

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16
Q

Cephalosporins (4th gen)

A

Cefipime

Pseudomonas coverage

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17
Q

Cephalosporins (5th gen)

A

Ceftaroline

Skin, soft tissue, com acquired pneumonia

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18
Q

Carbapenems (beta-lactam)

A

Imipenem-cilastatin
Broad spectrum: PCN resistant strains-not MRSA, gram- rods, pseudomonas
Can cause confusion and seizures (CNS effects)

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19
Q

Monobactam (beta-lactam)

A

Aztreonam
No cross allergies w/ other beta lactams
Active against Klebsiella, pseudomonas, serratia sp
Headache, vertigo

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20
Q

Glycopeptides

A

Vancomycin
MRSA and PSRP strains (gram +)
IV for systemic, oral for C difficile colitis
Toxicities: red neck/man syndrome; rare nephrotoxicity

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21
Q

Lipopeptide

A

Daptomycin
Gram+ activity: endocarditis/sepsis, MSSA/MRSA, Off-label (osteomyelitis, prosthetic joint infections)
Toxicities: myopathy-monitor CPK

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22
Q

Tetracylines

A

Bind to 30s ribosomal subunit
Doxycycline
Uses: acne, CAP, bronchitis, cellulitis, Lyme disease, periodontal, acute bacterial rhinosinusitis
AE: GI upset, photosensitivity

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23
Q

Macrolides

A

Bind to 50s ribosomal subunit
Azithromycin (zpak)
Uses: Pertussis, diphtheria (corynebacteria), Chlamydia, CAP
AE: Hepatic dysfunction,QT elongation

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24
Q

Lincosamides

A

Bind to 50s ribosomal subunit
Clindamycin
Uses: skin/soft tissue infections, anaerobic infections
AE: C. difficile colitis

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25
Q

Chloramphenicol

A

Bind to 50s ribosomal subunit
Chloramphenicol
Uses: Serious infection due to resistant bacteria (incl. vanc. resistant), H flu, N meningitides, salmonella, rickettsia
AE: aplastic anemia, Gray baby syndrome

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26
Q

Oxazolidinone

A

Bind to 23s RNA of 50s subunit
Linezolid
Uses: MRSA, PRSP, VRE strains
AE: dose related anemia, neuropathy, optic neuritis, serotonin syndrome w/ SSRIs

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27
Q

Aminoglycosides

A

Inhibit protein synthesis via binding to 30s ribosomal subunit
Gentamycin (but tobramycin most common)
Uses: aerobic gram- bacteria, Hflu, M catarrhalis, shigella, often in combo w/ betalactams
AE: nephrotoxicity, ototoxicity (irreversible), neuromuscular blockade

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28
Q

Antifolates

A

Blockade of folic acid synthesis: Sulfonamide (interferes w/ folic acid synthesis/growth) and Trimethoprim (inhibits dihydrofolic acid reduction to tetrahydrofolate>inhibition of enzymes of folic acid pathway)

Interfere w/ bacterial DNA synthesis by inhibiting DNA gyrase: fluoroquinolone (inhibits transcription and duplication)

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29
Q

Sulfonamides with Trimethoprim (TMP-SMX)

A

Trimethoprim-sulfamethoxazole
Sequential blockade (bactericidal-bacteriostatic when separate)
Uses: UTI, MSSA/MRSA of skin/soft tissues, respiratory infections, ear infections
AE: Rash, bone marrow suppression, hyperkalemia-dont use in 1st trimester or after 32 weeks (toxic to newborns)

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30
Q

Quinolones

A

Ciprofloxacin: urogenital (UTI)
Levofloxacin: respiratory and atypical (chlamydia, mycoplasma)
Other uses: GI tract infections, conjunctivitis
AE: CNS (dizzy/headache), tendinitis, peripheral neuropathy, neuromuscular blocking, QT prolongation (levo)
Absorption impaired by cations (calcium, mag, aluminum)

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31
Q

Synergism

A

Inhibitory/killing effects of 2+ antimicrobials used together are significantly greater than their individual effects
Marked by 4fold or greater reduction in MIC of each drug

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32
Q

Antibiogram

A

Provides info about local resistance patterns; used to determine empiric treatment options

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33
Q

Pharmacology

A

Study of substances that interact with living systems, beneficial and toxic effects of drugs

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34
Q

Toxicology

A

Undesirable effects of chemicals on living systems

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35
Q

Administration Routes

A

Oral, buccal/sublingual (direct tovenous circulation), inhalation (rapid absorption for respiratory), topical (local), transdermal (slow systemic effect)

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36
Q

Pharmacokinetics

A

Absorption, distribution, metabolism and elimination of drugs (what the body does to the drug)

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37
Q

Absorption

A

Peds: IM impossible to predict, gastric pH high at birth, low after 24 hours, skin time increased due to underdeveloped stratum corneum
Pregnant: Oral has delayed emptying, increased gastric pH affecting absorption, nausea/vomitting
Geriatric: Decreased first pass effect>increased bioavailability and higher plasma concentrations of drugs

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38
Q

Distribution

A

Passive transport (paracellular/diffusion) and active transport (facilitated diffusion/drug transporters)
Peds: ^body water/ECF, decreased protein binding/body fat
Pregnant:^body fat, decreased plasma albumin increasing Vd
Geriatric:^ body fat and glycoprotein, decreased body water, lean body mass, cardiac output, serum albumin

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39
Q

Elimination

A

Primary organ is kidney

Others: lungs, skin, GI, biliary, salivary, mammary

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40
Q

Agonist

A

Drug that binds to and activates receptor, directly or indirectly producing effect

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41
Q

Partial Agonist

A

binds to receptor but produces smaller effect at full dosage than a full agonist

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42
Q

Clearance

A

Determines steady state concentration for given dosage rate; determined by blood flow to organ that metabolizes or eliminates the drug

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43
Q

Steady State

A

Condition in which the average total amount of drug in the body does not change over multiple dosing cycles-most drugs follow linear pharmacokinetics which serum drug concentrations change proportionally with long term daily dosing

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44
Q

Half-life

A

Time required for serum concentrations to decrease by one-half after absorption and distribution are complete-determines time required to reach steady state and dosage interval

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45
Q

Metabolization of drugs

A

5 ways, example of med done by each

Unchanged, excreted as is

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46
Q

Agonist

A

Drug that binds to and activates receptor, directly or indirectly producing effect
When working alone 2nd highest response

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47
Q

Inducer

A

Drug that can increase activity of CYP450 enzyme (smoking increases CYP1A2)

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48
Q

Competitive Inhibitor

A

binds to receptor in same “hole” as agonist-decreases effect of agonist

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49
Q

Allosteric Activator

A

binds to receptor and increases response of agonist (synergy)-highest/fastest response

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50
Q

Efficacy vs Potency

A

Potency is the dose required to produce response, efficacy is the maximal response a drug can produce

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51
Q

Metabolization of drugs

A

Most important organ is liver, kidneys also important

Some drugs metabolized by tissues (blood, intestinal wall)

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52
Q

Cockroft-Gault Equation

A

standard for drug dosing, uses body weight

((140-age)IDWkg)/72SCr*0.85

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53
Q

Adrenergic

A

nerve ending that releases norepinephrine as primary transmitter
also a synapse which norepinephrine is the primary transmitter

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54
Q

Cholinergic

A

Nerve ending that releases acetylcholine or synapse which primary transmitter is acetylcholine

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55
Q

Sympathetic

A

Preganglionic fibers originate in thoracic/lumber segments

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56
Q

Parasympathetic

A

Preganglionic fibers originate in CN nuclei 3, 7, 9 and 10 and sacral segment of cord

57
Q

Anatomical differences of PNS and SNS

A

(3)

58
Q

PNS neurotransmitters

A

M2, M3

59
Q

SNS neurotransmitters

A

alphas and betas

60
Q

M2

A

Heart and some nerve endings; decreased cAMP, activates K channels

61
Q

M3

A

Effector cells, smooth muscle, glands, endothelium

62
Q

Alpha1

A

Effector tissues, smooth muscle, glands

63
Q

Alpha2

A

Nerve endings, some smooth muscle

64
Q

Beta 1

A

Cardiac muscle, juxtaglomerular apparatus

65
Q

Beta 2

A

Smooth muscle, liver, heart

66
Q

Beta 3

A

Adipose cells

67
Q

Dopamine 1

A

Smooth muscle

68
Q

Baroreceptor

A

Maintains blood pressure

69
Q

Eye Nerve activity

A

B receptor relaxes ciliary muscle, M3 contracts it

70
Q

Heart Nerve Activity

A

B1/2 accelerate SA node/contractility, M2 decelerates them

71
Q

Blood vessel nerve activity

A

a receptor contracts splanchnic in skin;
B2 relaxes skeletal m vessels;
b2 relaxes smooth broncho muscle M3 contracts it

72
Q

GI nerve activity

A

M1 activates myenteric plexus

73
Q

Bacterial Pharyngitis

A

1st gen PCN (beta-lactams-inhibit cell wall synthesis)

1st gen cephalosporins

Erythromycin/macrolides (inhibit translation and transcription)

74
Q

Acute Laryngitis

A

Erythromycin
Cefuroxime (2nd gen ceph.)
Amoxicillin-clavulanate (augmentin)

75
Q

Herpes Simplex

A

Acyclovir

76
Q

Aphthous Ulcer

A

Topical lidocaine

diphenhydramine w/ magnesium-aluminum 1:1

77
Q

Fungal-Oral Candidiasis

A

Cell membrane disruption

1st line topicals: Nystatin swish, clotrimazole (dissolves), itraconazole suspension, fluconazole (oral)

78
Q

Conjunctivitis

A

bacterial: Macrolides, fluorquinolines, -myxins, bacitracin

79
Q

Blepharitis

A

Erythromycin or bacitracin ophth ointment, oral doxycycline, TCN or azythromycin
Viral: trifluridine drops, ganciclovir gel, acyclovir oint. oral-cyclovirs

80
Q

Periorbital Cellulitis

A

MSSA: amoxicillin, cefpodoxime or cefdinir
MRSA: trimethoprim-sulfa, clindamycin, doxycycline

81
Q

Orbital Cellulitis

A

Vancomycin + ceftriaxone

82
Q

Corneal Abrasion

A

Erythromycin, sulfa10%, polytrim, cipro/ofloxacin

Aminoglycosides (mycins) avoided unless contact lens related

83
Q

Corneal Ulcer

A

Fluroquinolones

84
Q

Keratitis

A

Antivirals: ganciclovir, trifluridine, acyclovir oint., corticosteroids

85
Q

Erythromycin/Azithromycin Ointment Mechanism

A

Inhibits RNA-dependent protein synthesis at chain elongation; binds to 50s ribosomal subunits blocking transpeptidation

86
Q

Erythromycin/Azithromycin Ointment AEs

A

Hypersensitivity, ocular irritation, redness

87
Q

Sulfacetamide 10% Solution Mechanism

A

Inhibits bacterial folic acid synthesis interfering w/ bacterial growth

88
Q

Sulfacetamide 10% Solution Dosage

A

1-2 drops Q2-3 hours 7-10 days

89
Q

Sulfacetamide 10% Solution AEs

A

Irritation, burning, stinging

90
Q

Poly-trim Ophth Solution Mechanism

A

Binds to phospholipids-alters permeability and damages cytoplasmic membrane allowing leaking of intracellular constituents
Inhibits Folic acid reduction inhibiting microbial growth

91
Q

Poly-trim Ophth Solution AEs

A

Burning, itching, edema, rash, increased redness, stinging, tearing

92
Q

Fluoroquinolone Mechanism

A

DNA gyrase inhibitor-stops DNA replication and transcription

93
Q

Fluoroquinolone AEs

A

Blurry vision, burning, discomfort, dryness, edema, eye pain, itching, foreign body sensation

94
Q

Aminoglycosides

A

Gentamicin/tobramycin
Abrasion from contacts (pseudomonas)
AEs: burning, irritation, can destroy epithelial layer
Dosage: strip or dropsQ3-4 hours

95
Q

Topical NSAIDs Mechanism

A

Ketorolac-used for allergies in eyes (only one used outside of postop)
Inhibits COX1/2 enzymes decreasing prostaglandin precursors; anti-inflammatoryy

96
Q

Topical NSAIDs AEs/Dose

A

Ocular inflammation, irritation, pain, ocular pressure increase, tearing
1gtt QID

97
Q

Ganciclovir Ophth Gel mech/AEs/dose

A

Inhibition of viral DNA synthesis
AE: blurred vision, irritation
Dose: 5x/day

98
Q

Trifluridine Ophth Solution Mech/AEs

A

Interferes with viral replication by inhibiting thymidylate synthesase
AE: irritation of conj and cornea

99
Q

Corticosteroids

A

-one’s
Decrease inflammation
May mask infection
AEs: cataract formation, glaucoma, burning

100
Q

Otitis Externa

A

Aminoglycosides (ophth solution), fluoroquinolones (Cipro 500mg PO BID 1 week for pseudomonas; or otic 0.25mL BID 1 week-pain, fungal superinfection, pruritus)

101
Q

VoSol Otic

A

Decreases moisture in Otitis externa
Acetic acid, propylene and hydrocortisone
3-5gtt every 4-6H
AEs: burning/stinging after instillation

102
Q

Neomycin/poly/hydrocortisone mix

A

Interferes with bacterial protein synthesis by binding to 30s ribosomal subunits

103
Q

Otitis Media

A

Amoxicillin high dose (80-90mg.kg), erythromycin+sulfa, cefaclor, augmentin (1st line in adults)
If PCN allergy but not anaphylactic: 2-5 gen cephalosporins

104
Q

Bacterial Sinusitis

A

Only if sx 10-14 days (or worse after 5-7)

Amoxicillin, augmentin, TMP-SMX

105
Q

TMP-SMX mechanism/AE/Interactions

A

folate antagonist anti-invectives
AEs: GI, rash, Stevens-Johnson syndrome
interactions: inhibits warfarin clearance, increased digoxin, decreased efficacy of tricyclic antidepressant

106
Q

Doxycycline

A

Inhibits protein synthesis
AEs: photosensitivity, vomiting, tooth discoloration, hepatotoxicity
Interactions: antacids/vitamins decrease absorption (take w/ soda)

107
Q

Fluoroquinolones (nose)

A

Inhibit DNA synthesis
Levo/moxifloxacin
AEs: headache, insomnia, dizziness

108
Q

Prostaglandin analogues

A

Open angle glaucoma
Increase outflow of aq. humor (increase drainage)
AE: blurred vision, stinging, hyperemia, foreign body, itching

109
Q

Topical a andrenergics (brimonidine)

A

Open angle glaucoma
Reduces aq. humor production (alpha2 receptors)
AEs: allergic conjunctivitis, htn, hypotension,hypercholesterolemia

110
Q

Topical cholinergenics (pilocarpine)

A

Open angle glaucoma
Stimulate cholinergic receptors causing miosis (constriction) and lowering IOP
AEs: htn, tachy, GI, decreased VA

111
Q

Topical B blockers (timolol)

A

Open angle glaucoma
blocks B1/2 receptors reducing aq humor production, reducing IOP
LOTS of AEs

112
Q

Carbonic anhydrase inhibitors (dorzolamide+timolol, diamox)

A

Mechanism: decreases bicarb ion formation>less aq humor production>lowers IOP
AE: taste perversion, GI and all AEs from timolol

113
Q

Histamine h1 receptor agonists mechanism

A

Mechanism: antagonist of histamine, prevents binding/action
More effective at prevention
Reversal caused by anticholinergic properties

114
Q

Histamine h1 receptor agonists AEs

A

CNS depression* (dizzy/sedation), paradoxical excitement, anticholingeric* effects (dry mouth, constipation, urinary retention)

*=interactions increase side effects

115
Q

Histamine h1 receptor agonists Examples

A

Intranasal/ophthalmic: azelastine, olopatadine

Topical: diphenhydramine

116
Q

Decongestant Mechanisms

A

stimulates alpha-adrenergic receptors (vasoconstriction), pseudoephedrine stimulates beta-adrenergic receptors (bronchial relaxation/increased HR)
Overuse can cause rebound congestion

117
Q

Decongestant Examples

A

Intranasal/ophthalmic: phenylephrine, tetrahydrolozine, naphazoline, oxymetazoline
Oral: pseuephedrine, phenylephrine

118
Q

Decongestant AEs

A

Hypertension, tachycardia, rebound congestion (after 3-5 days of nasal)

119
Q

Decongestant Interactions

A

SNRIs (venlafaxine)-enhance tachycardic effects

Sympathomimetics-enhance adverse effects

120
Q

Inhaled corticosteroid mechanisms

A

Reduces inflammation by reducing mediator release, reverses dilation causing vasoconstriction, inhibits mast cell mediated late phase reactions
not immediate response, peaks in 2-3 weeks

121
Q

Inhaled corticosteroids AEs

A

Headache, pharyngitis, cough, epistaxis

122
Q

Leukotriene Receptor Antagonists Mechanism

A

Selective antagonist; inhibits cysteine leikotriee receptor, releases leukotrienes from mast cells, LOX inhibitor

123
Q

Leukotriene Receptor Antagonist Examples

A

Montelukast, Zafirlukast

124
Q

Leukotriene Receptor Antagonist AEs

A

Headache, mental status change, dyspepsia, dizziness

125
Q

Leukotriene Receptor Antagonist Interactions

A

CYP3A4 and CYP2C9

126
Q

Hydrocodone/Codeine Mechanism

A

Direct central action in medulla, cough suppression

127
Q

Hydrocodone/Codeine AEs

A

CNS depressant toxicity, drug abuse/dependency, nausea

128
Q

Hydrocodone/Codeine Interactions

A

CNS depressants may enhance toxicity

129
Q

Benzonatate Mechanism

A

Cough suppression by topical anesthetic action on respirator stretch receptors, relative to tetracaine

130
Q

Benzonatate AEs

A

Mental confusion, visual hallucinations, sedation

131
Q

Dexomethorphan (DXM) Mechanism

A

Decreases sensitivity of cough receptors, suppresses medullary cough center

132
Q

DXM Interactions/contraindications

A

Interactions: SSRIs enhance serotonergic effect
Contraindications: MAOI administration w/in 2 weeks

133
Q

DXM AEs

A

Confusion, potential serotonin syndrome

134
Q

Guaifenesin Mechanism

A

Irritating gastric mucosa and simulating respiratory tract secretions-increase respiratory fluid volume, decrease mucous viscosity

135
Q

Guaifenesin AEs

A

Dizziness, drowsiness, headache, nausea, vomiting

Monitor hydration status

136
Q

Dosage adjustment for renal impairment

A

Aminoglycosides, carbapenems, cephalosporins, PCN, trimethoprim-sulfa, vanc

137
Q

Dosage adjustment for hepatic impairment

A

Nitrofurantoin, sulfas, tetracyclines

138
Q

Contraindications in renal impairment

A

chloramphenicol, clindamycin, erythromycin, metronidazole

139
Q

Penicillin AEs/Elimination

A

rapid renal elimination, some biliary

AEs: hypersensitivity, maculopapular rash

Pharmacology (7 decks)

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