Exam 2 Flashcards
(696 cards)
1
Q
Penicillin drug class?
A
beta lactam antibiotic
2
Q
cephalosporin drug class?
A
beta lactam antibiotic
3
Q
monobactam drug class?
A
beta lactam antibiotic
4
Q
carbapenem drug class?
A
beta lactam antibiotic
5
Q
what do all beta lactam antibiotics share?
A
the same beta lactam ring
6
Q
penicillin VK drug class?
A
penicillin (beta lactam)
7
Q
amoxicillin drug class?
A
penicillin (beta lactam)
8
Q
amoxicillin/clavulanate drug class?
A
penicillin (beta lactam)
9
Q
penicillins- bactericidal or bacteriostatic?
A
bactericidal
10
Q
penicillins- mechanism of action?
A
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
11
Q
streptococcal infection, meningococcal infection, neurosyphilis- indications for what drug class?
A
penicillin (beta lactam)
12
Q
cephalosporin- mechanism of action?
A
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
13
Q
cephalosporin- bactericidal or bacteriostatic?
A
bactericidal
14
Q
example of 1st gen cephalosporin?
A
cephalexin
15
Q
example of 2nd gen cephalosporin?
A
cefuroxime
16
Q
example of 3rd gen cephalosporin?
A
ceftriaxone
17
Q
example of 4th gen cephalosporin?
A
cefepime
18
Q
example of 5th gen cephalosporin?
A
ceftaroline
19
Q
soft tissue infections, UTI- indications for which gen cephalosporins?
A
1st gen cephalosporins
20
Q
indications for 1st gen cephalosporins?
A
soft tissue infections, UTI
21
Q
indications for 2nd gen cephalosporins?
A
improved acuity versus pneumococcus and H. influenzae
22
Q
indications for 3rd gen cephalosporins?
A
pneumonia, meningitis, pyelonephritis, gonorrhea
PMPG
23
Q
pneumonia, meningitis, pyelonephritis, gonorrhea- indications for what class? PMPG
A
3rd gen cephalosporins
24
Q
indications for 4th gen cephalosporins?
A
broad activity, improved stability to chromosomal beta lactamases
25
indications for 5th gen cephalosporins?
methicillin-resistant staph, broad gram negative activity (not including p aeruginosa)
26
methicillin-resistant staph, broad gram negative activity not including p aeruginosa? Which gen cephalosporins
5th gen cephalosporins
27
example of a carbapenem drug?
imipenem
28
imipenem- drug class?
carbapenem
29
carbapenems- bactericidal or bacteriostatic?
bactericidal
30
carbanemens- broad drug class?
beta lactam antibiotic
31
carbapenem- mechanism of action?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
32
indications for carbapenems?
serious infections like pneumonia and sepsis
33
example of glycopeptide?
vancomycin
34
vancomycin- MOA?
inhibits bacterial cell wall synthesis
35
infections caused by gram positive bacteria; sepsis, endocarditis, meningitis, c diff colitis
glycopeptides
36
indication for oral vanc?
c diff colitis
37
example drug of monobactams?
aztreonam
38
aztreonam- drug class?
monobactam
39
monobactam drug class?
beta lactam antibiotic
40
monobactam- MOA?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
41
infections caused by aerobic, gram negative bacteria in patients with immediate hypersensitivity to PCNs
monobactam
42
indication for monobactams?
infections caused by aerobic, gram negative bacteria in patients with immediate hypersensitivity to penicillins
43
what does addition of clavulanate do?
broadens spectrum of coverage and reduces resistance
44
what causes resistance to penicillins?
resistance comes from bacteria that produce betalactamase as well as alterations in penicillin binding sites
45
penicillin spectrum of coverage?
gram positive, gram negative cocci, non beta lactactamase-producing anaerobes
46
are penicillins safe in pregnancy?
yes
47
when should oral penicillins be given?
1-2 hours before or after a meal (except amoxicillin)
48
why should oral pencillins be given 1-2 hours before or after a meal?
to minimize binding to food proteins and acid inactivation
49
large doses of pencillins may cause what?
GI upset, especially N/V/D
50
what two drugs can be associated with skin rashes when prescribed in viral illness? (From penicillin class)
ampicillin and amoxicillin
51
Epstein-barr virus infection and prescription of what drugs can cause rash?
ampicillin and amoxicillin
52
ampicillin and amoxicillin are associated with what adverse effect?
skin rash in setting of viral infection, esp with EBV
53
drugs that end in -icillin?
penicllins
54
what is a limiting factor in using a pencillin derivative to treat an infection?
bacterial production of beta lactamases
55
what drug is the exception to giving pencillins 1-2 hours before or after a meal?
amoxicillin
56
brand name for amoxicillin/clavulanate?
augmentin
57
generic name for augmentin?
amoxicillin/clavulanate
58
patient education for penicillins?
GI upset especially with high doses (pneumonia)
59
what percentage of the population will report a penicillin allergy?
0.1
60
how many generations of cephalosporins?
5
61
coverage of 1st gen cephalosporins?
gram positive- staph and strep
62
cephalexin and cephazolin- what generation?
1st gen cephalosporins
63
cefaclor and cefotetan- what generation?
2nd gen cephalosporins
64
cefdinir and ceftriaxone- what generation?
3rd gen cephalosporins
65
cefepime- what generation?
4th gen cephalosporins
66
ceftaroline- what generation?
5th gen cephalosporins
67
3rd gen cephalosporins?
more gram negative coverage
68
some of what generation of cephalosporins are able to cross BBB?
3rd gen cephalosporins
69
broad gram-negative coverage and effective against MRSA and enterococci? (ceph gen?)
5th gen cephalosporins
70
action of cephalosporins?
inhibits cell wall mucopeptide synthesis
71
cephalosporins- bactericidal or bacteriostatic?
bactericidal
72
what percentage of patients with pencillin allergy may have a cephalosporin allergy?
0.01
73
cephalosporins are more stable to what?
many beta lactamases
74
which has a better spectrum of coverage- penicillins or cephalosporins?
cephalosporins
75
cephalosporins- drug class?
beta lactam antibiotic
76
penicillins and cephalosporin cross-sensitivity, why?
same beta lactam ring
77
is a rash to penicillin ok to prescribe cephalosporin?
yes, just avoid if airway issues (anaphylaxis)
78
example of monobactam drug?
aztreonam
79
monobactams- bactericidal or bacteriostatic?
bactericidal
80
monobactam- spectrum of coverage?
aerobic, gram negative organisms
81
monobactam- covers aerobic or anaerobic?
aerobic
82
monobactam- covers gram positive or gram negative?
gram negative
83
monobactams have NO coverage against what?
gram positive orgs or anaerobes
84
monobactams- coverage against gram positive? Yes/no
no
85
monobactams- coverage against anaerobes? Yes/no
no
86
monobactams- stable to many beta lactamases? Yes/no
yes
87
do monobactams penetrate CSF? Yes/no
yes
88
monobactams- ok to give with pencillin allergy?
yes
89
do monobactams cross BBB?
yes
90
imipenem- drug class?
carbapenem
91
doripenem- drug class?
carbapenem
92
meropenem- drug class?
carbapenem
93
carbapenem- MOA- bactericidal or bacteriostatic?
bactericidal
94
imipenem- spectrum of coverage?
gram-negative rods, gram positive organisms, anarobes
95
doripenem and meropenem have slightly less what?
slightly less gram positive coverage and slightly more gram-negative aerobe coverage
96
do carbapenems penetrate CSF?
yes
97
when are carbapenems used?
difficult to treat infections
98
what lab should be monitored with carbapenem?
renal function
99
common side effects of carbapenems? (3)
nausea, vomiting, skin rash
100
what beta lactam class penetrates body fluids very well?
carbapenems
101
102
103
104
105
renal function should be monitored with which beta lactam?
carbapenems
106
glycopeptide- what class?
Inhibits cell wall and RNA synthesis
107
example of beta lactam glycopeptide?
vancomycin
108
vancomycin- bactericidal or bacteriostatic?
bactericidal
109
vancomycin- MOA?
inhibits cell wall and RNA synthesis
110
which antibiotic? Inhibits cell wall and RNA synthesis
vancomycin
Glycopeptide
111
when is vancomycin used?
difficult to treat infections including MRSA and c diff
112
monitoring for vancomycin?
renal dosing, peak and trough levels
113
red man syndrome- which antibiotic?
vancomycin
114
refers to redness and flushing due to infusing too quickly?
red man syndrome
115
why is vancomycin usually given IV?
poor oral absorption
116
oral absorption of vancomycin?
poor
117
MRSA and cdiff- what antibiotic?
vancomycin
118
MRSA?
methicillin resistant staph aureus
119
oral versus IV for MRSA?
consider appropriate route based on severity of symptoms
120
most common folate antagonist?
trimethoprim-sulfamethoxazole
121
ciprofloxacin, levofloxacin- drug class?
fluoroquinolones
122
tetracycline, doxycycline- drug class?
tetracyclines
123
doxycycline- drug class?
tetracyclines
124
erythromycin, drug class?
macrolides
125
azithromycin, drug class?
macrolides
126
clindamycin- drug class?
lincosamide
127
lincosamide- example?
clindamycin
128
tetracycline- bactericidal or bacteriostatic?
bacteriostatic
129
tetracycline- MOA?
inhibits protein synthesis
130
tetracyclines- spectrum of coverage?
gram positive and gram negative
131
do not give to children under 8 or in pregnancy- drug class?
tetracyclines
132
may affect tooth enamel or impair bone growth- drug class?
tetracyclines
133
tetracyclines safe in pregnancy?
no
134
tetracyclines safe in children?
no
135
tetracyclines and antacids?
do not given within 2 hours of antacids
136
doxycycline- common problem?
causes photosensitivity
137
three examples of macrolides?
erythromycin, azithromycin, clarithromycin
138
macrolides- MOA?
protein synthesis inhibitor
139
macrolides- bactericidal or bacteriostatic?
bacteriostatic; may be bactericidal at higher concentrations
140
macrolides- spectrum of coverage?
gram positive (pneumococci, strep, staph), gram negative (h influenzae) and atypical bacteria (mycoplasma)
141
risk with macrolides?
QT prolongation
142
what class has coverage against M pneumoniae?
macrolides
143
back up for strep in patients allergic to penicillin?
macrolides
144
erythromycin- common ADE?
diarrhea and cramping
145
why does erythromycin cause diarrhea and cramping?
stimulates the motilin receptors of the GI tract
146
why is erythromycin rarely used?
diarrhea and cramping; other macrolides are better tolerated
147
why is there increasing resistance to macrolides?
due to overuse of azithromycin
148
QT prolongation high risk antibiotic class?
macrolides (look at other meds the patient is on)
149
zofran risk?
QT prolongation
150
do SSRIs cause QT prolongation?
yes
151
clindamycin- bactericidal or bacteriostatic?
bacteriostatic; may be bactericidal at higher concentrations
152
clindamycin- MOA?
inhibits protein synthesis
153
clindamycin- spectrum of coverage?
gram positive (strep, staph, pneumococci), some MRSA coverage, some anaerobe coverage
154
used in treatment of severe infections like necrotizing fasciitis or toxic shock syndrome
clindamycin + penicillin
155
clindamycin + penicillin used when?
necrotizing fasciitis or toxic shock sydrome
156
high risk antibiotic for c diff?
clindamycin
157
clindamycin adverse effect?
GI upset; c diff colitis
158
oxazolidinones- example?
linezolid
159
linezolid- drug class?
oxazolidinones
160
linezolid- MOA?
inhibits protein synthesis
161
linezolid- bactericidal or bacteriostatic?
can be bacteriostatic or bactericidal (Against strep)
162
linezolid- spectrum of coverage?
gram positive (staph, strep, enterococci), gram-positive anaerobes, MRSA
163
when is linezolid used?
very resistant infections such as vancomycin resistant
164
med for vent associated pneumonia?
linezolid
165
med used as part of anthrax regimen?
linezolid
166
off label use of linezolid?
tuberculosis
167
what antibiotic increases risk of serotonin syndrome?
linezolid
168
adverse effect of linezolid?
hematologic abnormalities- anemia, neutropenia
169
anemia, neutropenia, what antibiotic?
linezolid
170
what are the hematologic abnormalities with linezolid?
anemia, neutropenia
171
SNRIs and SSRIs, problem with linezolid?
risk for serotonin syndrome
172
lab monitoring- linezolid?
heme abnormalities
173
examples of folate antagonists?
sulfonamides, trimethoprim
174
drug class- sulfonamides, trimethoprim?
folate antagonists
175
sulfonamides and trimethoprim- bactericidal or bacteriostatic?
bactericidal when used together
176
sulfonamides and trimethoprim- MOA?
inhibits folic acid synthesis
177
sulfonamides and trimethoprim- spectrum of coverage?
gram positive, gram negative, and MRSA
178
skin infection, UTI- indications for what drug?
sulfonamides, trimethoprim
179
contraindication for sulfa/trimethoprim? (Drug interaction)
do not use with coumadin
180
coumadin should not be used with which antibiotic?
sulfonamides, trimethoprim
181
common side effect of sulfa/trimethoprim?
sun sensitivity
182
high risk of rash/SJS- which antibiotic?
sulfonamides, trimethoprim
183
severe skin reaction to antibiotics, life-threatening complications? Skin slough
stevens johnsons syndrome
184
SJS- blistering around mouth, eyes, mucosal membranes- which antibiotic?
sulfonamides, trimethoprim
185
rash on bactrim?
SJS- can present late in course of treatment, STOP THE DRUG
186
levofloxacin- drug class?
fluoroquinolones
187
ciprofloxacin, drug class?
fluoroquinolones
188
fluoroquinolones- MOA?
DNA synthesis inhibitor
189
spectrum of coverage- fluoroquinolones?
excellent gram-negative coverage, moderate gram-positive coverage, atypical bacteria
190
UTI, soft tissue, bones, joints, respiratory tract- indications for what class?
fluoroquinolones
191
effective against multi-drug resistance organisms?
fluoroquinolones
192
puncture wounds?
fluoroquinolones
193
cipro interactions with what drug?
warfarin
194
cipro interaction with warfarin?
increased INR
195
pseudomonas and enterobacter- what class?
fluoroquinolones
196
respiratory tract infections/pneumonia, which fluoroquinolones?
levofloxacin
197
antibiotic class with high risk of tendon rupture?
fluoroquinolones
198
fluoroquinolones- safe in pregnancy?
no
199
fluoroquinolones- safe in children?
no
200
fluoroquinolones- QT prolongation? Yes/no
yes
201
four classes of antibiotics with prolonged QT interval?
macrolides, fluoroquinolones, clindamycin, TMP-SMX
202
age risk for antibiotic QT prolongation?
> 65
203
gender risk for antibiotic QT prolongation?
women
204
bradycardia or tachycardia- risk for antibiotic QT prolongation?
bradycardia
205
left ventricular failure- risk for what with antibiotics?
QT prolongation
206
electrolyte abnormalities- risk for what with antibiotics?
QT prolongation
207
hepatic dysfunction- risk for what adverse effect of antibiotics?
QT prolongation
208
congenital prolonged QT- risk for what with antibiotics?
further QT prolongation
209
polypharmacy- risk for what with antibiotics?
QT prolongation
210
less EPS with typical or atypical Aps?
atypical Aps
211
anticholinergic effects, less with typical or atypical AP?
atypical AP
212
neuroleptic malignant syndrome, less with typical or atypical AP?
atypical AP
213
do EPS always resolve with typical AP?
no
214
OCD off label use for what class?
atypical AP
215
psychosis associated with dementia- off label use for what class?
atypical AP
216
schizophrenia and other causes of psychosis- indication for what class?
atypical AP
217
bipolar, mania- indication for what class?
atypical AP
218
atypical AP- MOA?
cortical blockade of serotonin receptors, serotonin not blocking dopamine release, more dopamine sent to prefrontal cortex
219
weight gain, diabetes mellitus, dyslipidemia, cardiovascular disease predisposition- what class?
atypical AP
220
insulin resistance- what class?
atypical AP
221
adverse effect profile- worse with what atypical AP?
olanzapine
222
EPS, TD, NMS- worse with which AP?
typical
223
increased risk of mortality in patients with dementia-related psychosis- what class
atypical AP
224
orthostatic hypotension, syncope, falls with head injury- what class?
atypical AP
225
hyperprolactinemia- what class?
atypical AP
226
QT prolongation risk with atypical AP?
yes
227
atypical AP (2) with QT prolongation?
ziprasidone and quetiapine
228
ziprasidone and quetiapine risk?
QT prolongation
229
atypical AP- pregnancy safe?
no
230
atypical AP- children?
no
231
avoid use of atypical AP in what population?
older population
232
caution prescribing atypical AP in what?
hepatic or renal dysfunction
233
alcohol use in atypical AP?
do not use
234
lactation- atypical AP?
do not use
235
patients should avoid all simple carbohydrates?
atypical AP
236
aerobic and strength training and lean/normal body weight?
atypical AP
237
extreme caution with dementia?
atypical AP
238
nearly all drugs with CNS effects act on what?
specific receptors that modulate synaptic transmission
239
five NTs of CNS drugs?
GABA, acetylcholine, serotonin, dopamine, norepinephrine
240
depression and anxiety often what?
coexist
241
benzodiazepine- drug class?
anxiolytic
242
chlordiazeproxide, chlorazepate- what class?
benzodiazepine
243
augment the binding of GABA- drug class?
benzodiazepine
244
indications for benzodiazepines?
anxiety-related disorders, muscle relaxation, status epilepticus, irritable bowel syndrome, nausea/vomiting, restless leg syndrome
245
anxiety-related disorders, muscle relaxation, status epilepticus, irritable bowel syndrome, chemo N/V, RLS- drug class?
benzodiazepine
246
what is the chief inhibitory neurotransmitter in CNS?
GABA
247
CNS depression, reduction in anxiety, muscle relaxation, anticonvulsant activity
benzodiazepine
248
adverse effects due to CNS depression with benzodiazepines?
sedation
249
when is sedation worst with benzodiazepines?
initiation
250
hypotension, visual blurring, dizziness, confusion- what class?
benzodiazepine
251
paradoxical anxiety, agitation, acute rage- what class?
benzodiazepine
252
clonazepam causes increased production of what?
saliva
253
what drug causes increased production of saliva?
clonazepam
254
BZD with longer half-life?
clonazepam
255
longer half life of BZD helps avoid what?
physical and psychological dependence
256
alprazolam half life?
rapid onset, shorter, more potent
257
how should BZD be stopped?
gradually
258
withdrawal syndrome with BZD? Yes/no
yes
259
BZD- pregnancy?
no
260
BZD- lactation?
no
261
children < 6 y/o? yes/n
Atypical AP
no (relative contraindication)
262
hepatic/renal disease- BZD?
contraindication
263
elderly- BZD?
relative contraindication
264
lorazepam- long or short acting?
short acting
265
more potent BZDs? (2)
alprazolam and lorazepam
266
serotonergic anxiolytic example?
buspirone
267
buspirone drug class
serotonergic anxiolytic
268
indication for buspirone?
generalized anxiety disorder
269
main action of buspirone?
full agonist at the presynaptic serotonin receptor (serotonin binds there after buspirone)
270
where is buspirone a full agonist?
presynaptic serotonin receptor
271
where is buspirone a partial agonist?
at the serotonin postsynaptic receptor
272
buspirone dopamine actions?
minor dopamine action
273
buspirone effect on GABA?
no effect on GABA
274
buspirone cause drowsiness?
potentially
275
lightheadedness, headache, insomnia, nervousness, dry mouth- what drug?
buspirone
276
lightheadedness, headache, insomnia, nausea, nervousness, dry mouth- what to tell patient?
usually mild and resolve with ongoing therapy
277
rare side effects of buspirone? (2)
akathisia and involuntary movements
278
buspirone risk of dependence?
low
279
should buspirone be taken with food?
yes
280
why should buspirone be taken with food?
decrease the liver first pas effect
281
half life of buspirone?
short
282
onset of action of buspirone?
slow
283
how long for effects of buspirone?
weeks
284
advise patients of nonpharmacologic interventions for anxiety? What drug
buspirone
285
metabolism of buspirone?
oxidation in the liver
286
is buspirone safe in severe renal or hepatic dysfunction?
no
287
why should buspirone not be used in panic disorder?
due to adrenergic effects of one metabolite
288
buspirone in lactating patient?
avoid use
289
buspirone in pregnant patient?
use only if favorable risk/benefit ration
290
buspirone risk when used with other serotonergic drugs?
serotonin syndrome
291
where is buspirone excreted?
urine
292
is buspirone used in panic disorder? Yes/no
no
293
which antidepressant- anticholinergic effects?
tricyclic antidepressants
294
depression, anxiety-related disorders, enuresis, chronic neuropathic pain, insomnia (lower doses) eating disorders
tricyclic antidepressants
295
imipramine- drug class?
tricyclic antidepressants
296
amitriptyline- drug class?
tricyclic antidepressants
297
doxepin- drug class?
tricyclic antidepressants
298
TCA- MOA?
inhibit the reuptake of serotonin and norepinephrine at the presynaptic neuron
299
where are serotonin and norepinephrine inhibited with TCA?
presynaptic neuron
300
what are the four neurotransmitters involved with TCA?
serotonin, norepinephrine, histamine, acetylcholine
301
what often negates the use of TCA?
adverse effects
302
TCA therapeutic index?
narrow therapeutic index
303
overdose can be fatal, what drug class?
TCA
304
can you stop TCA suddenly?
no because of CNS withdrawal syndrome (nausea, vomiting, vertigo, malaise, nightmares)- can be severe
305
dry mouth, dry eyes, orthostatic hypotension, constipation, hesitancy/retention- drug class?
TCA
306
why should TCA be avoided in older population?
anticholinergic effects
307
nausea, vomiting, vertigo, malaise, nightmares
CNS withdrawal syndrome (TCA)
308
why do TCA cause sedation?
action on histamine receptors
309
high risk of suicide?
TCA
310
cardiac conduction disorder- seen with what class of antidepressants?
TCA
311
sinus tachycardia- what antidepressant class?
TCA
312
why do TCA cause cardiac conduction disorder?
NE reuptake inhibition and anticholinergic effects
313
decreased seizure threshold- what antidepressant class?
TCA
314
TD and NMS common or rare with TCA?
rare
315
rare ADE with TCA?
TD and NMS; TD may not resolve
316
when should ECG be obtained with TCA?
at baseline and at 3 weeks or dose change
317
why should TCA be titrated slowly?
to avoid CNS adverse effects such as those seen with abrupt withdrawal
318
pregnancy use- TCA?
only if risk benefit ratio is favorable
319
TCA in lactation?
excreted in breast milk
320
pre-existing cardiac conduction disorder- contraindication to what antidepressants?
TCA
321
TCA should not be combined with what class?
MAOI
322
what are the TCA contraindications associated with blocking of acetylcholine?
glaucoma, BPH, urinary incontinence
323
alpha-adrenergic blocking and quinidine-like effect- what class?
TCA
324
MAOI
monoamine oxidase inhibitors
325
treatment-resistant depression use what?
MAOI
326
phelezine- what class?
MAOI
327
tranylcypromine- what class?
MAOI
328
inactivate the enzymes that break down norepinephrine, dopamine, serotonin?
MAOI
329
prevent the breakdown of tyramine?
MAOI
330
tyramine is a precursor to what?
norepinephrine, serotonin, dopamine
331
what are the adverse effects related to with MAOIs?
delayed metabolism of dopamine
332
what is an example of anticholinergic effects of MAOI?
orthostatic hypotension
333
food and drink interactions that can result in severely elevated BP- drug class?
MAOI
334
most common side effects of MAOI?
dizziness, headache, insomnia, restlessness, and hypotension
335
MAOIs are NOT what?
first line therapy
336
what kind of foods should be avoided with MAOIs?
tyramine-containing
337
examples of problematic foods with MAOIs?
fermented and aged foods, pickled foods, kim chi, sauerkraut, soy sauce
338
caffiene should be avoided with which antidepressants?
MAOI
339
what antidepressant may suppress myocardial pain?
MAOI
340
do not use MAOIs within 3 weeks of what medications?
SSRI or SNRI (risk for serotonin syndrome)
341
how long is wash out period with MAOI?
3 weeks
342
do MAOI have liver first pass effect? Yes/no
yes
343
MAOI in liver or renal disease?
no
344
arteriosclerotic disease- avoid which antidepressant?
MAOI
345
pregnancy use- MAOI?
no
346
lactation- MAOI?
no
347
depression states, anxiety-related disorders, OCD, bulimia, PTSD- class?
SSRI
348
citalopram- class?
SSRI
349
fluoxetine- class?
SSRI
350
paroxetine- class?
SSRI
351
sertraline- class?
SSRI
352
SSRI- MOA?
presynaptic neuronal reuptake inhibition of serotonin
353
where does SSRI act?
presynaptic neuron
354
what SSRI also affects dopamine?
fluoxetine
355
SSRI effects on NE?
weak
356
patient teaching about SSRI adverse effects?
usually diminish over time and not serious
357
nausea/vomiting, dizziness/lightheadedness, dry mouth, diaphoresis, weight gain/loss, diarrhea, constipation
SSRI
358
SSRI most likely to cause diarrhea?
sertraline
359
SSRI most likely to cause constipation?
paroxetine
360
which patients at greater risk for suicide with SSRIs?
younger patients
361
can SSRI be safely stopped suddenly?
NO
362
half life of fluoxetine?
long
363
what should I assess for if major depression?
bipolar disorder
364
how long for SSRI to take effect?
therapeutic effect as long as 6 weeks
365
pregnancy- SSRI?
avoid if possible
366
severe hepatic/renal dysfunction- SSRI?
contraindication
367
depressive disorders (BPD), anxiety, social phobia, PTSD, neuropathic pain, overactive bladder, fibromyalgia?
SNRI
368
duloxetine- class?
SNRI
369
venlafaxine- class?
SNRI
370
two examples of SNRI drugs?
duloxetine and venlafaxine
371
where are serotonin and NE inhibited with SNRI?
presynaptic neuron
372
MOA- SNRI?
serotonin and NE transporters are blocked from taking these NTs back to presynaptic neuron
373
more serotonin and NE available to act where with SNRI?
postsynaptic neuron (more available)
374
elevated BP seen with higher doses of what antidepressant?
SNRI (due to norepinephrine)
375
why can BP elevate with SNRIs?
norepinephrine
376
pregnancy- SNRI?
avoid if possible
377
lactation- SNRI?
avoid (Excreted in breast milk)
378
worsening narrow-angle glaucoma? Antidepressant
SNRI
379
duloxetine has worsened what?
narrow angle glaucoma
380
duloxetine in liver dysfunction?
don't use
381
bupropion- drug class?
atypical antidepressant
382
mirtazapine- drug class?
atypical antidepressant
383
two indications for bupropion?
depression and smoking cessation
384
what antidepressant can cause insomnia?
bupropion
385
uptake of NE and DA are weakly inhibited- what antidepressant?
bupropion
386
mirtazapine- MOA?
antagonism of central presynaptic alpha 2 adrenergic receptors
387
antagonism of central presynaptic alpha-2 adrenergic receptors? Drug?
mirtazapine
388
mirtazapine- indications?
depression, insomnia, can improve appetite
389
increased noradrenergic and serotonergic activity? Drug
mirtazapine
390
why does mirtazapine help with insomnia?
antihistamine effect
391
anxiolytic, sedative-hypnotic, antiseizure?
barbiturates
392
pentobarbital- class?
barbiturates
393
phenobarbital- class?
barbiturates
394
cause CNS depression via inhibiting transmission of stimuli to reticular activating system
barbiturates
395
where is reticular activating system located?
brainstem
396
do barbiturates bind to gaba?
yes but in different area than BZD
397
adverse effects of barbiturates?
CNS depression or agitation
398
ataxia seen with what class?
barbiturates
399
what can happen if not tapering off barbiturates?
status epilepticus
400
respiratory and CV system depression- what class?
barbiturates
401
schedule class of short-acting barbiturates?
schedule II
402
therapeutic index- barbiturates?
narrow
403
are barbiturates first line for status epilepticus or seizures related to meningitis or tetanus?
no
404
alcohol use with barbiturates?
no- risk of death
405
younger than 6- barbiturates?
no
406
avoid barbiturates if history of what?
drug-misuse disorder
407
zolpidem indication?
insomnia
408
zapelon indication?
insomnia
409
eszopiclone indication?
insomnia
410
suvorexant indication?
insomnia
411
ramelton?
insomnia
412
suvorexant MOA?
orexin receptor antagonist- promote sleep
413
zolpidem- MOA?
at gaba receptor in diff area than BZD
414
ramelton- MOA?
selective melatonin receptor agonist
415
loss of muscle tone with full cognition intact?
sedative hypnotics other than barbs or bzd
416
sleep paralysis- what class?
sedative hypnotics other than barbs or bzd
417
sleep walking and sleep driving
sedative hypnotics other than barbs or bzd
418
anterograde amnesia- what class?
sedative hypnotics other than barbs or bzd
419
can sedative hypnotics other than barbs or bzd be stopped suddenly?
no, taper d/t CNS withdrawal syndrome
420
suvorexant- abuse potential?
yes
421
uses of CNS stimulants?
ADHD, narcolepsy, exogenous obesity
422
CNS stimulant- MOA?
sympathomimetic amines that act as dopamine agonists
423
indirectly release and prevent the reuptake of DA, serotonin, and NE at the presynaptic neuron?
CNS stimulants
424
CNS stimulants activate where?
reticular activating system
425
hypertension, sweating, tachycardia- what class?
CNS stimulants
426
hyperthyroidism- contraindication to what CNS class?
CNS stimulants
427
esophageal dysmotility/obstruction- what drug?
concerta brand of methylphenidate
428
how many hours of bedtime should CNS stimulant be avoided?
6
429
pregnancy- CNS stimulant?
no
430
lactation- CNS stimulant?
no
431
glaucoma and motor tics- contraindication of what class?
CNS stimulants
432
avoid MAOI overlap with CNS stimulants for how long?
14 days
433
short term in patients with desired weight loss?
anorexiants
434
phentermine- class?
anorexiants
435
lorcaserin- class?
anorexiants
436
where do anorexiants act?
satiety center (hypothalamus and limbic reas)
437
possible valvular heart disease- what class?
anorexiants
438
hyperprolactinemia- seen with CNS class?
anorexiants
439
hypoglycemia in type 2 dm- what CNS drug?
anorexiants
440
can anorexiants be stopped suddenly?
no
441
can CNS stimulants be suddenly stopped?
no
442
two drugs used in bipolar disorder?
lithium and valproate
443
mood stabilizer used in seizure disorders?
valproate
444
drug for migraine prophylaxis?
valproate
445
interchangeable with sodium and has no metabolism, drug?
lithium
446
may take place of sodium in neurons during depolarization, drug?
lithium
447
decreased transmission of electrical impulses, drug?
lithium
448
may cause down-regulation of second messenger systems, drug?
lithium
449
lithium may cause down-regulation of what?
second messenger system
450
valproate leads to increased availability of what NT?
GABA
451
may contribute to more GABA action at the receptor or act like GABA; blocks voltage-dependent sodium channels
valproate
452
ultimate action of valproate?
less neuronal firing
453
inhibitory neurotransmitter?
GABA
454
may minimize adverse effects of lithium by what?
taking with food
455
what form of lithium may help with adverse effects?
sustained release form
456
fine tremors, nausea and dry mouth, headache, drowsiness
lithium
457
thyroid function with long-term lithium?
hypothyroidism
458
increased TSH may be seen with what drug?
lithium (hypothyroidism)
459
fine tremors- SE of what drug?
lithium
460
long-term problem with thyroid with lithium?
hypothyroidism
461
CV effects of lithium?
ECG changes and arrhythmias
462
side effects of valproate are usually what?
transient
463
heartburn, dyspepsia- what med?
valproate
464
alopecia can occur and hair will grow back but may have different texture, what drug?
valproate
465
may increase bleeding time due to inhibition of platelet aggregation
valproate
466
bone marrow suppression
valproate
467
what lab should be monitored with valproate?
CBC
468
hepatic toxicity prevalence with valproate?
rare
469
therapeutic index- lithium?
narrow
470
tremors, nausea, dizziness are signs of what with lithium?
toxicity
471
signs of lithium toxicity?
tremors, nausea, dizziness
472
lab that should be monitored with Lithium?
renal function
473
what age can have extended-release lithium?
12 years and older
474
what trimesters of pregnancy avoid lithium?
first and third
475
lithium- lactation?
avoid
476
what states should avoid lithium?
sodium and fluid depletion (will increase lithium levels)
477
what will happen to lithium levels if sodium/fluid depletion?
levels will increase
478
what happens to lithium level with excessive water intake?
levels will decrease
479
what causes lithium levels to decrease?
excessive water intake
480
when does lithium become therapeutic?
14 days
481
why is lithium not used in acute mania?
long half life, takes 14 days for therapeutic effect
482
is lithium metabolized?
no
483
how is lithium excreted in the urine?
essentially unchanged
484
primary concern with valproate?
CNS depression esp when first starting
485
liver dysfunction- valproate?
contraindication
486
pregnancy- valproate?
contraindication
487
what happens with valproate in pregnancy?
neural tube defect
488
when can toxicity of valproate occur?
even at therapeutic levels
489
dizziness, hypotension, tachy/bradycardia, drowsiness, visual hallucinations, respiratory depression
valproate toxicity
490
monitor lab for valproate?
drug level
491
how is valproate excreted?
in the urine as ketone metabolite
492
why can valproate cause false positive for urine ketone tests?
excreted in urine as ketone metabolite
493
can valproate be used for acute mania?
yes
494
can lithium be used for acute mania?
no
495
what causes the clinical manifestations of parkinson?
dopamine deficiency
496
what two NTs should be balanced for musculoskeletal performance?
dopamine and acetylcholine
497
bradykinesia and gait should be considered in decision to treat what?
parkinson disease
498
what is the main problem in parkinson?
dopamine deficiency
499
what are dopaminergic drugs used for?
to treat the dopamine depletion that occurs in parkinson disease
500
amantadine- class?
dopaminergic
501
bromocriptine- class?
dopaminergic
502
carbidopa-levodopa- class?
dopaminergic
503
pramipexole- class?
dopaminergic
504
rasaligine- class?
dopaminergic
505
ropinirole- class?
dopaminergic
506
pergolide- class?
dopaminergic
507
tolcapone- class
dopaminergic
508
MOA- dopaminergics?
cause release of dopamine
509
what do dopaminergic drugs cause?
release of dopamine
510
what drugs act as dopamine precursors?
dopaminergics
511
what drugs act as dopamine agonists?
dopaminergic
512
what does a drug do if it is a dopamine agonist?
stimulates the dopamine receptor
513
drugs that inhibit MAO lead to what? (PD)
less breakdown of dopamine
514
levodopa- think what?
pharmacokinetic enhancement
515
selegiline- class?
dopaminergic
516
how should dopaminergic agents be started?
low and slow titration
517
dizziness and postural hypotension in dopaminergics more common in who?
older adults
518
confusion and hallucinations with dopaminergics, more common in who?
older adults
519
what two dopaminergics can cause sleep attacks?
pramipexole and ropinirole
520
pramipexole and ropinirole can cause what?
sleep attacks
521
dyskinesia worsening or dyskinesia can be caused by what dopaminergics?
carbidopa and levodopa
522
what two labs should be monitored with dopaminergic drugs?
hepatic and renal
523
what labs should be monitored with dopaminergic drugs?
hepatic and renal
524
carbidopa-levodopa is contraindicated in what two conditions?
narrow angle glaucoma and malignant melanoma
525
cautious use of dopaminergics in patients with what four conditions?
cardiac, psychiatric, renal, or ulcer disease
526
pregnancy use- dopaminergics?
weigh risk benefit
527
lactation- dopaminergics?
safety not established
528
pediatrics- dopaminergics?
safety not established
529
what dopaminergic is associaed with severe hepatocellular injury?
tolcapone
530
what to do if patient cannot tolerate a dopaminergic drug?
try another
531
can you stop dopaminergic drugs suddenly?
no
532
beta lactams do what?
inhibit cell wall synthesis
533
what do beta lactams inhibit?
cell wall synthesis
534
four classes of beta lactams that I need to know?
penicillins, cephalosporins, carbapenems, monobactams
535
what should happen if a patient develops a rash while taking a pencillin?
they should be examined
536
what generation of cephalosporins has the best gram positive coverage?
first generation
537
what two organisms are covered by first generation cephalosporins?
staph and strep
538
what route of admin are the higher generations of cephalosporins given?
IV (more complicated, gram negative)
539
drug? Glycopeptide antibiotic with wide spectrum of gram positive-coverage
vancomycin
540
vancomycin- gram positive and/or gram negative?
only gram positive
541
macrolides block what?
protein production
542
tetracyclines- MOA?
block protein production
543
rifampin- MOA?
block protein production
544
clindamycin- MOA?
block protein production
545
aminoglycosides- MOA?
block protein production
546
streptogamins- MOA?
block protein production
547
oxlodinones- MOA?
block protein production
548
mupirocin- MOA?
block protein production
549
erythromycin- class?
macrolide
550
azithromycin, class?
macrolide
551
clarithromycin, class?
macrolide
552
minocycline, class?
tetracycline
553
what class of antibiotic covers rickettsiae (tick)?
tetracycline
554
what is the drug of choice for Lyme disease?
doxycycline
555
can teeth staining of fetus happen with tetracycline use in pregnancy?
yes
556
milk and dairy with tetracyclines?
not within two hours (heavy metals/calcium)
557
why does clindamycin have similar action to macrolides?
their binding sites overlap
558
what percentage of patients on clinda develop c diff?
0.066
559
loose, watery, bloody stools, what med?
clindamycin c diff
560
sulfa drugs- MOA?
target DNA and replication
561
fluoroquinolones- MOA?
target DNA and replication
562
metronidazole- MOA?
target DNA and replication
563
ofloxacin- drug class?
fluoroquinolones
564
ciprofloxacin is more effective against gram negative or gram positive?
gram negative
565
levofloxacin is more effective against gram positive or gram negative?
gram positive, especially strep pneumoniae
566
fluoroquinolones when taken with prednisone can lead to what?
tendon rupture
567
TB drugs must be taken how?
regularly
568
what is the usual minimum for TB treatment duration?
9 months
569
isoniazid- MOA?
inhibits bacterial cell wall synthesis
570
what drug can lead to peripheral neuropathy?
isoniazid
571
how to prevent peripheral neuropathy with isoniazid?
take vitamin B6
572
ethambutol- MOA?
inhibits bacterial cell wall synthesis
573
main problem if taking ethambutol?
optic neuritis
574
blurred vision, decreased peripheral vision, and color blindness are symptoms of what?
optic neuritis
575
what should a patient do if they have signs of optic neuritis?
stop medication immediately and notify physician
576
rifampin- MOA?
blocks bacterial protein production
577
rifampin- protein binding?
highly protein bound
578
what is the problem with rifampin being highly protein bound?
several drug to drug interactions
579
other than TB, what can rifampin be used for?
bacterial meningitis
580
what TB drug causes orange/red discoloration of urine, saliva, and tears?
rifampin
581
what are the four may mechanisms of antimicrobial resistance?
decreased permeability, limiting drug uptake; antibiotic efflux pump; drug inactivation; altered target site
582
decreased permeability/limiting drug uptake is due to loss of what?
porins (ABX cannot enter bacterial cells)
583
what pumps antibiotic directly out of the cell?
antibiotic efflux pump
584
bacterial enzymes destroy antibiotics or prevent binding to target site?
drug inactivation
585
structurally modified antibiotic target site
altered target site (ABX no longer able to bind to the modified binding proteins on the bacterial cell surface, so they cannot attach)
586
two types of antiviral drugs?
neuramidase inhibitors and nucleoside analogs
587
oseltamivir- class?
neuramidase inhibitors
588
zanamivir/relenza- class?
neuramidase inhibitors
589
xofluza/valoxavir- class?
neuramidase inhibitors
590
neuraminidase inhibitors- MOA?
act by breaking the bond that attaches the viral particles to the host cell
591
oseltamivir- oral?
well absorbed orally
592
how is zanamivir admin?
inhalation
593
when should antivirals be started?
within 72 hours but 48 hours is ideal
594
acyclovir- class?
nucleoside analogs
595
valacyclovir- class?
nucleoside analogs
596
which nucleoside analog achieves higher serum levels?
valacyclovir
597
what drug class is indicated for the treatment of herpes simplex?
nucleoside analogs
598
what drug class is indicated for the treatment of varicella zoster?
nucle
599
how do nucleoside analogs work?
block an enzyme essential for viral replication
600
who has a higher risk of postherpetic neuralgia?
older adults/elderly with shingles
601
protein binding of oral antifungal drugs?
highly protein bound when given orally
602
why do oral antifungals have multiple drug-drug interactions?
because they are highly protein bound
603
what is the long-term risk with oral antifungals?
hepatotoxicity
604
what labs should be monitored with oral antifungals?
LFTs
605
what do antihelmintic drugs treat?
parasitic infections caused by worms
606
what drug is used to treat pinworms/threadworms?
mebendazole
607
mebendazole- class?
antihelmintic drugs
608
what is the main adverse effect with mebendazole?
GI upset especially with high doses (pneumonia)
609
what is the OTC treatment for pinworms?
pyrantel
610
what are the three adverse effects with antihelmintics?
nausea, diarrhea, stomach pain
611
where do benzodiazepines act on GABA?
at the synaptic cleft
612
what effect do benzodiazepines have on the action of GABA?
increase the action of GABA
613
what does increased action of GABA do with BZDs?
decreases the effect of neuronal excitation (Decreased firing of the neuron)
614
four therapeutic effects of benzodiazepines?
reduced anxiety, muscle relaxation, ataxia, anticonvulsant activity (Adjuvant)
615
buspirone is sometimes called what?
an atypical anxiolytic
616
what is buspirone approved for?
the treatment of GAD
617
alprazolam brand name?
xanax
618
lorazepam brand name?
ativan
619
temazepam brand name?
restoril
620
clonazepam brand name?
klonopin
621
where does the primary action of buspirone take place?
serotonin receptors
622
what other receptor does buspirone act on?
dopamine
623
buspirone absorption orally?
well-absorbed
624
why should buspirone be taken with food?
to decrease the first-pass effect
625
what is the most common class of antidepressant prescribed?
SSRIs
626
paroxetine- brand name?
paxil
627
fluoxetine- brand name?
prozac
628
sertraline- brand name?
zoloft
629
citalopram- brand name?
celexa
630
escitalopram- brand name?
lexapro
631
where to SSRI act?
presynaptic
632
do SSRIs have a class effect?
yes
633
what type of side effects of SSRIs are very common in males?
sexual side effects
634
what to do if a patient is having sexual side effects?
try another SSRI in the same group
635
how long for SSRIs to take effect? (to start)
at least two weeks
636
SSRI absorption?
well absorbed orally
637
SSRI first pass effect?
significant first past effect
638
how are SSRIs metabolized?
CYP450 system
639
where are most SSRIs eliminated?
the urine
640
do sexual side effects tend to improve with continued use of SSRIs?
no
641
does nausea tend to improve with continued use of SSRIs?
yes
642
how should SSRIs be taken?
same time every day
643
what two SSRIs interact with linezolid?
paroxetine and fluoxetine
644
venlafaxine- brand name?
effexor
645
duloxetine- brand name?
cymbalta
646
at lower doses, venlafaxine predominantly effects uptake of which NT?
serotonin
647
urinary retention is a contraindication for which antidepressant class?
TCA
648
cardiovascular disease is a contraindication for which antidepressant class?
TCA
649
angle-closure glaucoma is a contraindication for which antidepressant class?
TCA
650
patients with seizure disorders should NOT be given which antidepressant?
bupropion
651
is bupropion a first line drug for depression?
no
652
carbamazepine- class?
anticonvulsant
653
carbamazepine- brand name?
tegretol
654
carbamazepine- MOA?
inhibits neuronal firing by blocking sodium channels
655
carbamazepine is most effective against what type of seizures?
partial
656
carbamazepine, protein binding?
highly bound to plasma proteins
657
carbamazepine metabolism?
completely metabolized, induces its own metabolism
658
autoinduction of metabolism with carbamazepine leads to?
increased clearance, shortened half life, progressive decrease in serum levels (increase dose)
659
aplastic anemia is rare ADE with what drug?
carbamazepine
660
cardiac arrhythmias, blurred/double vision, decreased blood cells or platelets- what drug?
carbamazepine
661
gabapentin- class?
anticonvulsant
662
gabapentin- brand name?
neurontin
663
gabapentin- MOA?
inhibits the release of excitatory neurotransmitters in the presynaptic area to decrease seizure activity
664
where does gabapentin work?
presynaptic area
665
four indications for gabapentin?
seizures, RLS, postherpetic neuralgia, neuropathic pain
666
carefully monitor for what side effects with gabapentin?
psychiatric
667
what anticonvulsant can cause depression and suicidal ideation?
gabapentin
668
fine tremors seen with toxicity of what?
lithium
669
nausea and dry mouth, seen what toxicity of what?
lithium
670
headache and drowsiness, seen with toxicity of what?
lithium
671
labs to monitor with lithium?
CBC with diff, CMP, TSH, baseline/annual ECG
672
severe vomiting, diarrhea, prolonged high fever, heat stroke-- these are concerning things to watch with what med?
lithium
673
two most common ADEs with levetiracetam?
drowsiness, asthenia
674
lack of strength, weakness (Term)
asthenia
675
neuropsychiatric ADEs seen with what drug?
levetiracetam
676
agitation, anxiety, depression, psychosis, hallucinations, depersonalization (ADE what drug)
levetiracetam
677
anticonvulsant that does not impair speech, concentration, or other cognitive function
levetiracetam
678
benzodiazepines are contraindicated with what condition?
acute narrow angle glaucoma
679
anticholinergic effects seen with which antidepressant?
TCAs
680
what is the black box warning for carbamazepine?
SJS and TEN
681
what two conditions have a strong association with HLAB1502?
SJS and TEN
682
patients most at risk for the HLAB1502 allele are of what ethnicity?
asian
683
HLAB1502 allele is problematic with what drug?
carbamazepine
684
what post marketing adverse effect of levetiracetam is reversible when the drug is stopped?
alopecia
685
what is the black box warning on all antidepressants?
suicidal thoughts and behaviors
686
is famciclovir safe in pregnancy?
not enough data
687
is acyclovir safe in pregnancy?
yes, category B
688
is valganciclovir safe in pregnancy?
not ideal, category C
689
what condition is a major side effect of oral ketoconazole?
hepatotoxicity
690
dry mouth and metallic taste are side effects of what medication?
metronidazole
691
heart failure is associated with which antifungal?
itraconazole
692
what four medications are included in the 6 month regimen to treat tuberculosis? RIPE
isoniazid, rifampin, pyrazinamide, ethambutol
693
ethambutol is toxic to what?
optic nerve
694
pyrazinamide can cause increase in what?
uric acid (gout)
695
cardiac arrhythmias are associated with which antibiotic class?
macrolides
696
does bactrim cover MRSA?
yes
