Exam 2 ID

Question 1

Recognize word roots of the major structures of the urinary system.

Answer 1

• Major structures • Related combining form
Kidney Nephr/ o, ren/ o
Renal Pelvis Pyel/ o
Urine Ur/ o, urin/ o
Ureters Ureter/o
Urinary Bladder Cyst/o
Urethra Urethr/o
Prostate Prostat/o

Question 2

Distinguish menarche, menopause and perimenopause.


Answer 2

a. Menarche-beginning of menstrual function
b. Menopause-normal termination of menstrual function
c. Perimenopause-transition phase between regular menstrual periods and no periods at all

Question 3

Differentiate Type 1 and Type 2 diabetes

Answer 3

a. Type 1-
i. Autoimmune,
ii. Beta cell in pancreas destroyed.
b. Type 2-
i. Insulin resistance
ii. Insulin deficient

Question 4

Differentiate hyper- and hypothyroidism.

Answer 4

A. Hyperthyroidism-
i. Excessive release of thyroid hormones (T3 and T4)
ii. Accelerated metabolism
B. Hypothyroidism-
i. Increased thyroid stimulation hormone (TSH)
ii. Slowing in physical & mental activity
iii. Weight gain
iv. Cold intolerance

Question 5

Biguanides

Answer 5

i. MOA
1. Decrease hepatic glucose production
2. Decreases intestinal absorption of glucose
3. Increasing peripheral glucose uptake & metabolism

ii. Drug
1. Metformin (glucophage)

iii. Indications
1. Type 2 diabetes mellitus
2. PCOS
3. Antipsychotic-induced weight gain

iv. Common Adverse Effects
1. Diarrhea, vomiting, weight loss

v. Key Facts
1. Temporarily withhold in patients undergoing radiologic procedures that utilize iodinated contrast.

vi. Patient Counseling
1. Discontinue immediately if have symptoms of lactic acidosis.
(Myalgia, malaise, hyperventilation, unusual somnolence)

Question 6

Di-Peotidyl Peptidase-4 Inhibitor

Answer 6

i. MOA
1. Increases glucose-dependent insulin secretion
2. Decreases glucagon secretion
3. Decreases hepatic glucose production

ii. Drug
1. Sitagliptin (januvia)

iii. Indications
1. Type 2 Diabetes mellitus

iv. Common Adverse Effects
1. Nausea, diarrhea, vomiting, nasopharyngitis

v. Key Facts

vi. Patient Counseling
1. Discontinue immediately if experience unexplained persistent nausea and vomiting
2. Signs of acute pancreatitis​

Question 7

Insulin

Answer 7

i. MOA
1. Lowers blood glucose
2. Stimulate peripheral glucose uptake
3. Inhibit hepatic glucose production

ii. Drug
1. Insulin

iii. Indications
1. Type 1 diabetes mellitus
2. Type 2 diabetes mellitus
3. Hyperkalemia
4. Diabetic ketoacidosis

iv. Common Adverse Effects
1. Hypoglycemia
2. Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating
3. Weight gain

v. Key Facts

vi. Patient Counseling
1. Rotate injection site (prevent lipodystrophy)
2. Insulin requirements will increase during times of stress (physical sickness and emotional stress)
3. Treatment of hypoglycemia
4. Mild: treat with oral glucose or simple carbohydrates
5. Can be stored at room temperature

Question 8

Sulfonylureas

Answer 8

i. MOA
1. Lowers blood glucose
2. Stimulates insulin release from beta cells of pancreas

ii. Drug
1. Glipizide

iii. Indications
1. Type 2 diabetes mellitus

iv. Common Adverse Effects
1. Hypoglycemia

v. Key Facts

vi. Patient Counseling
1. Always eat after taking medication
2. Monitor blood glucose as directed
3. Be aware of signs and symptoms of hypoglycemia

Question 9

ThIazolidinedIonEs

Answer 9

i. MOA
1. Increase insulin sensitivity
2. Enhance insulin-receptor sensitivity

ii. Drug
1. Pioglitazone (Actos)

iii. Indications
1. Type 2 diabetes metellis

iv. Common Adverse Effects
1. Weight gain, edema, hypoglycemia (when used with insulin or other oral antidiabetic drugs that can cause hypoglycemia)

v. Key Facts
1. Contraindications-NYHA class III and IV heart failure
2. Active liver disease

vi. Patient Counseling
1. Report signs of liver dysfunction and/or shortness of breath immediately

Question 10

Biphosphonates (jaw)

Answer 10

i. MOA
1. Inhibits osteoclastic-mediated bone resorption

ii. Drug
1. Alendronate

iii. Indications
1. Osteoporosis
2. Paget’s disease

iv. Common Adverse Effects
1. Abdominal pain
2. Diyspepsia
3. Nausea
4. Hypocalcaemia

v. Key Facts
1. Take at least 30 minutes before first food or beverage of day
2. Take with 6 – 8 oz. plain water only
3. Do not lie down for 30 minutes after taking
4. Do not chew or crush
5. Notify healthcare provider if new symptoms of heartburn, difficulty or pain on swallowing develop

vi. Patient Counseling
1. Osteonecrosis of jaw has been observed

Question 11

Calcitonin-Salmon

Answer 11

i. MOA
1. Directly inhibits osteoclastic bone resorption
2. Decreases renal tubular resorption of calcium, phosphate, sodium, magnesium, and potassium
3. Increase jejunal secretion of water, sodium, potassium, and chloride

ii. Drug
1. Calcitonin

iii. Indications
1. Osteoporosis
2. Paget’s disease
3. Hypercalcemia

iv. Common Adverse Effects
1. Allergic reactions,
2. Nasal mucosal alterations
3. Rhinitis

v. Key Facts
1. Usually used when bisphosphonates are not tolerated

vi. Patient Counseling
1. Prime pump when using new bottle
2. Allow it to be at room temperature before use
3. Store unassembled bottles in refrigerator
4. Once pump activated, store at room temperature for up to 35 days

Question 12

Glucocorticoids

Answer 12

i. MOA
1. Inhibit cytokines that mediate inflammatory responses
2. Suppress migration of polymorphonuclear leukocytes
3. Decrease capillary permeability

ii. Drug
1. Methylprednisolone/prednisone

iii. Indications
1. Multiple inflammatory conditions

iv. Common Adverse Effects
1. Gastrointestinal irritation,
2. Increased appetite,
3. Nervousness/restlessness,
4. Weight gain,
5. Acne,
6. Glucose intolerance (transient),
7. Lipid abnormalities (transient)

v. Key Facts
1. Contraindications-Systemic fungal infections
2. Contraindications-Administration of concomitant live vaccines
3. Too rapid withdrawal of therapy especially with prolonged use can cause acute, possibly life threatening adrenal insufficiency

vi. Patient Counseling
1. Take oral tablets in morning with food

Question 13

Thyroid Hormones

Answer 13

i. MOA
1. Synthetic T4

ii. Drug
1. Levothyroxine

iii. Indications
1. Hypothyroidism

iv. Common Adverse Effects
1. Fatigue
2. Increased appetite
3. Weight loss
4. Heat intolerance

v. Key Facts
1. T3 and T4 blood concentrations obtained every 6 – 8 weeks initially, then every 6 – 12 months until stable and annually thereafter.

vi. Patient Counseling
1. Take on empty stomach in the morning at least 30 minutes prior to eating
2. Report any signs or symptoms of thyroid hormone toxicity
3. Chest pain, increased pulse rate, palpitations, excessive sweating, heat intolerance, nervousness

Question 14

Correctly list the steps of ophthalmic ointment and solution/suspension administration

Answer 14

1. Wash hands
2. Tilt head back
3. Pull lower lid down with index finger
4. Apply 0.25–0.5 inch of ointment in sweeping motion inside the lower eyelid
5. Close eyes and roll eye in all directions for 1 minute

Do NOT touch medication bottle to eye!

Solution or suspension

1. ​Wash hands
2. Tilt head back
3. Pull lower lid down with index finger
4. Apply medication into conjunctival sac
5. Close eyes and apply pressure to lacrimal sac for 1 minute

Question 15

Define commonly used medication terminology and abbreviations as reviewed in class (ophthalmic)

Answer 15

Ophthalm - eye

Opthamology - Ophthalmology is the branch of medicine which deals with the anatomy, physiology and diseases of the eye.

Ophthalmic - Of or relating to the eye and its diseases.

Miosis - Excessive constriction of the pupil of the eye

mydriasis - Dilation of the pupil of the eye

aqueous humour - aqueous humor: the limpid fluid within the eyeball between the cornea and the lens

conjunctiva - The mucous membrane that covers the front of the eye and lines the inside of the eyelids

blepharitis - Inflammation of the eyelid

cataract - Opacity of the lens or capsule of the eye, causing impairment of vision or blindness.

Question 16

Ophthalmic Beta Blockers (info)

Answer 16

Mechanism of Action
•Reduces aqueous humor production
•Decreases IOP

Indications
•Glaucoma
•Ocular hypertension

Adverse Effects
•Stinging/burning on application
•Dry eye
•Blepharitis
•Corneal anesthesia

Contraindications to Therapy
•Asthma/COPD
•Bradycardia
•Second or third degree AV block
•Overt heart failure
•Cardiogenic shock

Patient Counseling
•Use proper technique of nasolacrimal occlusion to decrease risk of side effects and increase efficacy
•For ophthalmic use only
•Remove contact lenses prior to use. Do not reinsert for 15 minutes
•Gel solution only:
•Shake once prior to use. Administer other ophthalmic medications at least 12 minutes prior

Question 17

Ophthalmic Beta Blockers (drugs) ** know them Oll**

Answer 17

•Generic •Brand •Formulation
Timolol Timoptic Solution, Gel forming solution
Timoptic-XE

Betaxolol Betoptic Solution

Carteolol Ocupress Solution

Levobunolol Betagan Solution

Question 18

Ophthalmic Prostaglandins (drugs) Prost

Answer 18

•Generic         •Brand                      
Latanoprost    Xalatan
Travoprost      Travatan
Bimatoprost    Lumigan, Latisse
Tafloprost       Zioptan

Question 19

Ophthalmic Prostaglandins (info)

Answer 19

Mechanism of action
•Increases aqueous humor outflow
•Decreases IOP

Indications
•Glaucoma

Adverse Effects
•Increased pigmentation of the iris
•Eyelash changes
•Eyelid skin darkening
•Transient burning and stinging upon instillation
•Blurred vision

Question 20

Neomycin/Polymyxin/Gramicidin

Ophthalmic

Answer 20

Mechanism of Action
•Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits
•Binds to phospholipids and alters permeability of the bacterial membrane permitting leakage of intracellular contents

Indications
•Treatment of superficial infections

Adverse Effects
•Superinfection
•Transient burning, stinging, irritation

Patient Counseling
•For ophthalmic use only
•To avoid contamination, do not touch tip of container to eye or any other surface

Question 21

Fluoroquinolone’s (drugs) xacin

Ophthalmic

Answer 21

•Generic •Brand •Formulation
Ciprofloxacin Ciloxin Solution, Ointment
Besifloxacin Besivance Suspension shake well before
administering
Gatifloxacin Zymar Solution
Levofloxacin Quixin, Iquix Solution
Moxifloxacin Vigamox, Moxeza Solution
Ofloxacinb Ocuflox Solution

Question 22

Fluoroquinolone’s (info) xacin

Ophthalmic

Answer 22

Mechanism of Action
•Inhibits the activity of DNA gyrase
•Bacterial DNA is unable to replicate

Indications
•Treatment of superficial ocular infection involving the conjunctiva or cornea

Adverse Effects
•Localized discomfort and irritation
•Transient burning
•Stinging

Patient Counseling
•Do not touch tip of container to eye or any other surface
•For ophthalmic use only
•Remove contact lenses during treatment for conjunctivitis

Question 23

Estrogen: Estradiol (Estrace)

Answer 23

Estrogen: Estradiol (Estrace)

MOA:

• Developing and maintaining female reproductive system and secondary sex characteristics
• Involved in shaping skeleton and inhibiting bone reabsorption

Indication:

• Treatment of moderate to severe vasomotor symptoms
• Prevention of osteoporosis

Adverse effects:
-vaginal bleeding, breast tenderness, nausea and vomiting

Key facts:
-contraindications: pregnancy, undiagnosed vaginal bleeding, known/suspected breast cancer, severe liver disease

Patient counseling:

• Increase risk of endometrial carcinoma in postmenopausal women
• women with uterus should also should also receive monthly progestins

Question 24

Progestins: Medroxyprogesterone (Provera, DepoProvera)

Answer 24

MOA:
Inhibit secretion of gonadtropins

Indications:

• Prevention of pregnancy
• abnormal uterine bleeding due to hormonal imbalance

Common adverse effects:
-breakthrough bleeding, nausea

Key facts:
Deep-Provera injection: may lose significan bone mineral density; use as long term birth control method (>2 years) only if other birth control methods are inadequate

Patient counseling:
-progestin withdrawal bleeding occurs within 3-7 days after discontinuing oral therapy

Question 25

Monophasic: Norgestrel/ethinyl estradiol (Lo-Ovral) (see pic below for complete list)

Answer 25

MOA: -Inhibit ovulation by suppressing gonadotropin, follicle stimulating hormone (FSH) and luteinizing hormone Indication: -prevention of pregnancy in women, treatment of menorrhagia, pain associated with endometrosis, dymenorrhea Adverse reaction: Nausea, vomiting,bloating, migraine headaches, edema, breast tenderness, breakthrough bleeding change in menstrual flow, weight gain, tiredness, fatigue, depression Key facts: - prescribed with caution if ever, to smokers >35 years of age - smokers < 30 years of age who are otherwise healthy generally can be use combined oral contraceptives Patient counseling: - Take same time each day, spotting or breakthrough bleeding during the first few months of therapy - use add methogd of birth control during 1st week of pills during initial cycle of OC pills contact Dr. if –sudden headache, visual disturbance, numbness in arm or leg, severe abdominal pain, prolonged episodes of bleeding or amenorrhea

Question 26

Biphasic: Desogestrel/ ethinyl estradiol (Mircette)

Answer 26

MOA: -Inhibit ovulation by suppressing gonadotropins, FSH, LH Indication: -prevention of pregnancy in women

Question 27

Triphasic: Norethindrone/ ethinyl estradiol (Ortho-Novum 7/7/7)

Answer 27

MOA: -Inhibit ovulation by suppressing gonadotropins, FSH, LH Indication: - prevention of pregnancy in women - treatment of moderate acnes vulgaris in women >= 15 years of age

Question 28

Norethindrone (Micronor)

Answer 28

MOA: Suppresses ovulation in approx 50% of users Indication: Prevention of pregnancy in women Adverse reaction: Breathrough bleeding, nausea Patient counseling: - Effectiveness may be dramactically reduced when taken > 3 hrs late - appropriate action if one or more progestin-only pills are missed - if 3hrs late take pill ASAP and use add. Contraceptive for 48 hrs - take as soon as remember- take todays pill at its regular time even if it means taking 2 pills in 1 day; use add contraception for 48 hrs

Question 29

SERMs- Raloxifene (Evista)

Answer 29

MOA: -Inhibits bone reabsorption Indication: - reduces biochemical markers of bone turnover - prevention and treatment of postmonopausal osteoporosis Adverse reaction: -risk reduction of invasive breast cancer in: post menopausal women w/ osteoporosis and postmenopausal women with high risk of invasive breast cancer Key facts: Hot flashes, nausea Patient counseling: Avoid in patients with history of thromboembolic disorders -discontinue at least 72 hors prior to and during prolonged immobilization to prevent clot formations

Question 30

Define hypertension, hypotension, systolic BP, diastolic BP, cardiac output, total peripheral resistance, heart rate, stroke volume, tachycardia, bradycardia, hyperkalemia, hypokalemia, positive/negative inotrope, positive/negative chronotrope, heart failure, angina, myocardial infarction, and arrhythmia.

Answer 30

Hypertension - persistently elevated arterial blood pressure Hypotension - Low blood pressure Systolic BP - the force of blood in the arteries as the heart beats Diastolic BP - force of blood in the arteries as the heart relaxes Cardiac output - the volume of blood pumped by the heart per/min Total peripheral resistance - sum of the resistance of all peripheral vasculature in the systemic circulation heart rate - how many times your heart contracts & relaxes per/min stroke volume - amount of blood pumped by left ventricle in one contraction tachycardia - faster than normal heart rate bradycardia - slower than normal heart rate hyperkalemia - high levels of potassium in the blood Hypokalemia - low levels of potassium in the blood Positive/negative inotrope - inotropes is an agent that alters the force or energy of muscular contractions. Positive inotropes usually increase this level, while negative inotropes decrease it. positive/negative chronotrope - chronotrope change the heart rate. may effectuate to either slow (negative) or accelerate (positive) the rate of a functional system (usually the heart). heart failure - can't pump enough blood to meet your body's needs angina - chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. myocardial infarction - irreversible necrosis of heart muscle secondary to prolonged ischemia arrhythmia - problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm

Question 31

Recognize and understand the blood pressure equation.

Answer 31

``` •Blood pressure equation: –BP = CO x TPR •CO = cardiac output (SBP) •TPR = total peripheral resistance (DBP) –CO = SV x HR •SV = stroke volume •HR = heart rate ```

Question 32

List common diuretics, ACEIs, ARBs, Direct Renin Inhibitor, Beta-Blockers, Alpha-1 Blockers (prostate), Alpha-2 Agonists(prostate), Vasodilators, Nitrates, CCBs, and anti-arrhythmics(heart).

Answer 32

Hypertension Agents •Diuretics –Thiazide Diuretics •Hydrochlorothiazide (HCTZ) –Loop Diuretics •Furosemide (Lasix) –Potassium Sparing Diuretics/ Aldosterone Antagonists •Spironolactone (Aldactone) •Others: bendroflumethiazide, chlorothiazide, chlorthalidone, methyclothiazide ``` •Renin-Angiotensin-Aldosterone System (RAAS) –Angiotensin-Converting Enzyme (ACE) Inhibitors •Benazepril •Captopril •Enalapril •Fosinopril •Lisinopril •Quinapril •Ramipril ``` ``` –Angiotensin II Receptor Blockers (ARBs) •Irbesartan •Losartan •Valsartan –Direct Renin Inhibitors •Aliskiren (Tekturna) ``` •Beta-Blockers –Selective •Atenolol •Metoprolol –Non-Selective •Carvedilol •Labetolol •Propranolol ``` –Others: •Betaxolol •Bisoprolol •Esmolol •Nadolol •Nebivolol •Timolol ``` ``` •Alpha-1 Blockers –Non-Selective •Doxazosin (Cardura, Cardura XL) •Terazosin (Hytrin) –(Prostate Selective) •Tamsulosin (Flomax) •Alfuzosin (Uroxatral) ``` Alpha-2 Agonists Clonidine (Catapres, Catapres-TTS, Duraclon) Vasodilator Hydralazine Nitrates •Isosorbide mononitrate (Imdur, Ismo, Monoket) •Nitroglycerin (Nitrostat) •Others: Isosorbide dinitrate Calcium Channel Blockers •Dihydropyridine –Amlodipine (Norvasc) –Others: nifedipine, felodipine, clevidipine, isradipine, nicardipine, nimodipine, nisoldipine •Non-Dihydropyridine –Diltiazem (Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Taztia XT, Tiazac) –Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM) Anti-arrhythmics Amiodarone Digoxin (Lanoxin)

Question 33

List common Phosphodiesterase Inhibitors, Alpha-Adrenergic Blockers, Alpha-Reductase Inhibitors, and Anticholinergics/Antispasmodics.

Answer 33

Phosphodiesterase Inhibitors: Sildenafil, Vardenafil, Tadalafil “afil” Alpha-Adrenergic Blockers: Doxazosin, Terazosin, Alfuzosin, Tamsulosin Alpha-Reductase Inhibitors: Finasteride, Dutasteride Anticholinergics/Antispasmodics: Tolterodine, Oxybutinin

Question 34

Lincomycins | • Clindamycin (Cleocin®)

Answer 34

• Bacteriostatic or bactericidal depending on concentration and specific bacteria • Binds to 50s ribosomal subunit inhibiting translation • Gram positive organisms • Anaerobes • Pseudomembranous colitis by C. difficile

Question 35

Monobactams | • Aztreonam (Azactam®)

Answer 35

``` • Bactericidal • Binds to penicillin binding proteins Narrow spectrum of activity • Gram negative bacteria – Hemophilus – Enterobacteriaceae – P. aeruginosa • Minor GI, hematologic and hepatic effects • Hypersensitivity reactions ```

Question 36

• Outline the MOA for Phosphodiesterase Inhibitors, Alpha-Adrenergic Blockers, Alpha-Reductase Inhibitors, and Anticholinergics/Antispasmodics.

Answer 36

- Phos Inhib: Inhibit phosphodiesterase (PDE) 5 leading to increased levels of cyclic guanosine monophosphate (cGMP) and enhancing the effects of nitric oxide (NO) and smooth muscle relaxation in the corpus cavernosum of the penis. Also cause relaxation of smooth muscle of the pulmonary vasculature - Alpha-Adrenergic Blockers: Antagonists of α₁-adrenergic receptors; Relaxes prostatic smooth muscle; ± peripheral vasculature - Alpha-Reductase Inhibitors: Interfere with testosterone’s stimulatory effect on prostate gland size; Block conversion of T to DHT; Slow disease progression & decrease risk of complications - Anticholinergics/Antispasmodics: Antagonize muscarinic cholinergic receptors; Relaxation of detrusor muscle; Reduction in frequency and intensity of bladder contractions

Question 37

Distinguish between selective and non-selective Alpha-Adrenergic Blockers.

Answer 37

Selective for BPH and prostate (Uroselective): Tamsulosin and Alfuzosin Non-selective: Terazosin and Doxazosin

Question 38

``` • Recognize indications for: Phosphodiesterase Inhibitors: Alpha-Adrenergic Blockers: Alpha-Reductase Inhibitors: Anticholinergics/Antispasmodics: ```

Answer 38

Phosphodiesterase Inhibitors: Erectile dysfunction and Pulmonary arterial hypertension Alpha-Adrenergic Blockers: BPH and ± HTN Alpha-Reductase Inhibitors: Moderate to severe BPH disease with enlarged prostate glands and male pattern baldness Anticholinergics/Antispasmodics: UI/Overactive bladder

Question 39

Recognize dosing strategies forPhosphodiesterase Inhibitors (i.e. know which PDE-Is are dosed prior to anticipated sexual activity and which can be administered daily for ED).

Answer 39

Sildenafil: 30 minutes to 4 hours before sexual activity Vardenafil: 60 minutes before sexual activity Tadalafil: 30 minutes before sexual activity or once daily for ED.

Question 40

``` List notable adverse effects/contraindications/warnings of: Phosphodiesterase Inhibitors Alpha-Adrenergic Blockers Alpha-Reductase Inhibitors Anticholinergics/Antispasmodics ```

Answer 40

Phosphodiesterase Inhibitors: AE: HA, flushing, dizziness, visual abnormalities, priapism. Contraindications: Concomitant use of nitrates. NO WARNINGS Alpha-Adrenergic Blockers: AE: Dizziness, hypotension, orthostatic hypotension, weakness, somnolence, impotence, decreased libido. NO CONTRA OR WARNINGS Alpha-Reductase Inhibitors: AE: Breast tenderness and swelling, neoplasm of male breast, decreased libido, ejaculation disturbances, erectile dysfunction, testicular pain. Contraindications: Pregnancy, female gender, children. WARNINGS: Pregnancy category X Anticholinergics/Antispasmodics: AE: Dry mouth, constipation, xerophthalmia, blurred vision, mydriasis, tachycardia, sedation, dizziness, hallucinations, delirium. Contraindications: Uncontrolled narrow-angle glaucoma, Urinary retention, Gastric retention/conditions with severely decreased GI motility. NO WARNINGS

Question 41

Describe the benefits to using each of the classes discussed to treat BPH (i.e. know the benefits to using Alpha-Adrenergic Blockers, as well as the benefits to using Alpha-Reductase Inhibitors).

Answer 41

Alpha-Adrenergic Blockers benefits: Relieves LUTS in moderate to severe patients. Relieve of symptoms much faster than other drugs (Tamsulosin). Treats mostly BPH, some HTN. Alpha-Reductase Inhibitor benefits: Takes about 6 months to see full effects. Treats male baldness. BPH with enlarged prostate gland.

Question 42

Recognize notable drug interactions: | Phosphodiesterase Inhibitors, Alpha-Adrenergic Blockers, Alpha-Reductase Inhibitors, Anticholinergics/Antispasmodics

Answer 42

Phosphodiesterase Inhibitors:Nitrates, Antihypertensives, CYP-450 3A4 Inhibitors. Alpha-Adrenergic Blockers: Anti-hypertensive agents Alpha-Reductase Inhibitors: No drug Interactions listed in slides Anticholinergics/Antispasmodics: Anticholinergic agents, Tolterodine-CYP34A and 2D6 inhibitors and inducers.

Question 43

List patient counseling points and other key points for 1. Phosphodiesterase Inhibitors 2. Alpha-Adrenergic Blockers 3. Alpha-Reductase Inhibitors 4. Anticholinergics/Antispasmodics

Answer 43

Phosphodiesterase Inhibitors:Ineffective in the absence of sexual arousal. Do not engage in sex if clinically inadvisable. No protection against STDs. Do not take if on nitrates. Be aware of low blood pressure. Seek medical attention if priapism occurs. Alpha-Adrenergic Blockers: Be aware of s/sx of low blood pressure. Results of therapy may take several days to weeks. Alpha-Reductase Inhibitors: Pregnant women should avoid contact. Pharmacists(women) should use rubber gloves when handling. Results may take several months Anticholinergics/Antispasmodics: Drink plenty of water. Caution while driving due to possibility of sedation. ER: Do not crush or chew. Select new sites for gel and transdermal oxybutin, also: apply to clean, dry, intact skin on abdomen, thighs, or upper arms/shoulders.

Question 44

``` Outline the MOA for diuretics ACEIs ARBs Direct Renin Inhibitor Beta-Blockers Alpha-1 Blockers Alpha-2 Agonists Vasodilators Nitrates CCBs anti-arrhythmics ```

Answer 44

Thiazide Diuretics: Diuresis-Decreased renal reabsorption (distal tubule) and increased urinary excretion of Na, Cl, and H2O Loop Diuretics: Diuresis-Decreased renal reabsorption (loop of Henle) and increased urinary excretion of Na, Cl, Ca, Mag, and H2O Potassium-Sparing Diuretics: Diuresis-Inhibition of aldosterone binding to aldosterone R in distal tubule, increased urinary excretion of Na and H2O ACEIs: Suppression of RAAS-Inhibition of ACE leading to inhibition of conversion of AI to AII (involved in vasoconstriction and Na and H2O retention via aldosterone) ARBs: Suppression of RAAS-Block binding of AII to R leading to inhibition of the effects of AII (inhibition of vasoconstriction, and Na and H2O retention) Direct Renin Inh: Suppression of RAAS – Inhibition of rennin leading to inhibition of the conversion of angiotensinogen to AI, ultimately leading to inhibition of the effects of AII (inhibition of vasoconstriction, and Na and H2O retention) Beta-Blockers: Block response to β stimulation ↓HR, BP, contractility, and myocardial oxygen demand Alpha-1 Blockers: -Antagonists of α₁-adrenergic receptors - smooth muscle relaxation and vasodilation - ↓ BP (also relax smooth muscle of the prostate) Alpha-2 Agonists: -Stimulation of α-2 receptors in the brainstem -↓ sympathetic outflow from the CNS, TPR, HR, and BP Vasodilators: -Directly relaxes vascular smooth muscle -Vasodilation, ↓TPR and BP Nitrates: -Stimulate cGMP production leading to vascular smooth muscle relaxation -Vasodilation and ↓TPR, BP, and myocardial oxygen demand and ↑supply CCBs:(DHP) -Inhibit movement of calcium ions across cell membranes leading to relaxation of coronary vascular smooth muscle and vasodilation - ↓ TPR and BP - ↑ myocardial oxygen supply CCBs (non-DHP): -Inhibit movement of calcium ions across cell membranes leading to relaxation of coronary vascular Anti-arrhythmics(Amiodarone): -↓HR -Antiarrhythmic (blocks Na channels, K channels, Ca channels, and Beta-receptors) Anti-arrhythmics(Digoxin): -Antiarrhythmic (Inhibits Na/K ATPase ↑ intracellular Ca) -↑ contractility -↓HR

Question 45

Distinguish between selective and non-selective Beta-Blockers, selective and non-selective Alpha-1 Adrenergic Blockers, and dihydropyridine and non-dihydropyridine CCBs.

Answer 45

Beta-Blockers: - Selective for Beta-1 – Atenolol and Metoprolol - Non-selective – Propranolol (B1 and B2), and Labetalol and Carvedilol (B1, B2, alpha-1) Alpha-1 Adrenergic Blockers: - Prostate Selective: Tamsulosin, Alfuzosin - Non-selective: Doxazosin, Terazosin DHP and NON-DHP - DHP: Amlodipine - Non-DHP: Diltiazem and Verapamil

Question 46

``` • Recognize indications for Outline the MOA for diuretics ACEIs ARBs Direct Renin Inhibitor Beta-Blockers Alpha-1 Blockers Alpha-2 Agonists Vasodilators Nitrates CCBs anti-arrhythmics ```

Answer 46

Thiazide Diuretics: Mainly for HTN, less used for Edema Loop Diuretics: Mainly for Edema, less used for HTN Potassium Diuretics: HTN, Edema, HF ACEIs: HTN, DM nephropathy, HF, s/p MI ARBs: HTN, DM nephropathy, HF, s/p MI Direct Renin Inh: HTN, DM nephropathy Beta-Blockers: HTN, HF, s/p MI, Angina, Arrhythmias, NON-CV (migraine, anxiety) Alpha-1 Blockers: HTN(not 1st line), BPH Alpha-2 Agonists: HTN(not 1st line), withdrawal from C1 drugs Vasodilators: HTN, HF Nitrates: HTN, HF, Angina, Pulmonary HTN, Esophageal, Spastic disorders CCBs(DHP): HTN, Angina, Pulmonary HTN CCBs(non-DHP): HTN, Angina, Arrhythmias Anti-Arrhythmics(Amiodarone): Arrhythmias Anti-Arrhythmics(Digoxin): Arrhythmias, HF

Question 47

Distinguish between the most common use of thiazide diuretics and loop diuretics.

Answer 47

Thiazide: Mainly for HTN, less used for Edema | ​​Loop: Mainly for Edema, less used for HTN

Question 48

Distinguish between the uses and dosing strategies of Isosorbide Mononitrate and Nitroglycerin.

Answer 48

Iso Mono: Daily for chronic angina | Nitro: For angina attacks (Use up to 3 times in 5 minute intervals)

Question 49

Recognize which agents discussed commonly require loading doses and/or pharmacokinetic monitoring.

Answer 49

Anti-arrhythmics-Amiodarone and Digoxin

Question 50

``` List notable adverse effects/contraindications/warnings of Diuretics ACEIs ARBs Direct Renin Inhibitor Beta-Blockers Alpha-1 Blockers Alpha-2 Agonists Vasodilators Nitrates CCBs Anti-arrhythmics ```

Answer 50

Thiazide Diuretics: -Hypotension; ELYTE abnormalities (hypokalemia); increased urination (transient) Loop Diuretics: -Hypotension; ELYTE abnormalities (hypokalemia) - BBW – water and ELYTE imbalances; increased urination (consistent) - Renal function impairment; Ototoxicity Potassium-Sparing Diuretics: HypERkalemia, Gynecomastia ACEIs: -BBW – pregnancy (CI) - Hypotension; Hyperkalemia; Angioedema; Increased SCr (marker of renal function) - COUGH ARBs: -BBW – pregnancy (CI) ​-Hypotension; Hyperkalemia; Angioedema; Increased SCr (marker of renal function) Direct Renin Inh: -BBW – pregnancy (CI) ​-Hypotension; Hyperkalemia; Angioedema; Increased SCr (marker of renal function) ​ Beta-Blockers: CV: Hypotension, bradycardia CNS: Dizziness, fatigue, lethargy, depression, decreased sexual ability Beta-2: Bronchoconstriction (especially non-selective) Alpha-1 Blockers: Vasodilation: orthostatic hypotension, dizziness, syncope, headache Alpha-2 Agonists: -CV: Orthostatic hypotension, bradycardia, Withdrawal syndrome/rebound hypertension - CNS: CNS depression, dizziness, drowsiness - Other: Constipation, dry mouth, contact dermatitis Vasodilators: -Vasodilation: Tachycardia, angina, headache; Lupus-like syndrome Nitrates: -Vasodilation: Hypotension, headache, lightheadedness, syncope, flushing -CI: PDE Inhibitors within 24 hours CCBs(DHP): -Vasodilation: Hypotension, dizziness, lightheadedness, flushing, headache -Peripheral edema CCBs(non-DHP): -Vasodilation: hypotension, dizziness, lightheadedness, flushing, headache - Bradycardia - Verapamil – constipation and gingival hyperplasia Anti-Arrhythmics(Amiodarone): -CV: Bradycardia, hypotension -Other: Blue/grey skin discoloration, hyper/hypothyroidism, liver toxicity, pulmonary toxicity Anti-Arrhythmics(Digoxin): -GI toxicity ; Visual disturbances; Cardiac toxicity

Question 51

``` Recognize notable drug interactions of Diuretics ACEIs ARBs Direct Renin Inhibitor Beta-Blockers Alpha-1 Blockers Alpha-2 Agonists Vasodilators Nitrates CCBs Anti-arrhythmics ```

Answer 51

Thiazide Diuretics: Loop diuretics, Digoxin, NSAIDS Loop Diuretics: Thiazide diuretics, Digoxin, NSAIDS, Aminoglycosides Potassium-Sparing Diuretics: Potassium supplements, ACEIs, ARBs, Direct Renin Inh. ACEIs: Antihypertensive agents and diuretics, NSAIDS, ARBs, Direct Renin Inh., Potassium sparing diuretics, potassium supplements ARBs: Antihypertensive agents and diuretics, NSAIDS, ACEIs, Direct Renin Inh., Potassium sparing diuretics, potassium supplements Direct Renin Inh: Antihypertensive agents and diuretics, NSAIDS, ACEIs, ARBs, Potassium sparing diuretics, Potassium supplements. Beta-Blockers: Negative chronotropes-Digoxin, diltiazem, verapamil. Anti-diabetic agents, NSAIDS, decongestants Alpha-1 Blockers: Anti-hypertensive agents Alpha-2 Agonists: Anti-hypertensive agents, CNS-depressants, Beta-blockers Vasodilators:N/A Nitrates: Antihypertensive agents, PDE Inhibitors, Avoid/CI within 24 hours CCBs: Antihypertensive agents, CYP3A4 inhibitors/inducers**Non-DHP also Negative chronotropes Anti-arrhythmics: (Amiodarone)- Negative chronotropes, Drugs that prolong QT interval, Digoxin(reduce digoxin dose 50%), Warfarin (reduce warfarin dose 50%) Anti-arrhythmics:(Digoxin)-Amiodarone, Dronedarone (reduce digoxin dose 50%), Diuretics, Negative chronotropes.

Question 52

``` List patient counseling points and other key points for Diuretics ACEIs ARBs Direct Renin Inhibitor Beta-Blockers Alpha-1 Blockers Alpha-2 Agonists Vasodilators Nitrates CCBs Anti-arrhythmics ```

Answer 52

Thiazide Diuretics: Take in the morning. Anti-hypertensive effect may take several days.Key Notes: Ineffective in poor renal function. 50mg dose increased AEs without added efficacy Loop Diuretics: Take in the morning, diet, monitor labs. Key Notes: Wide dosing range, monitor for ELYTE abnormalities. Potassium-Sparing Diuretics: Diet(avoid salt subs) Key Notes: Monitor for hyperkalemia ACEIs: Pregnancy, monitor labs, diet(avoid salt subs), angioedema, dry cough. Key Notes: Enalaprilat injection, widely used for many CV diseases ARBs: Pregnancy, monitor labs, diet (avoid salt subs), angioedema. Key Notes: No Cough, often used in patients intolerant to ACEIs. Direct Renin Inh: Pregnancy, monitor labs, diet(avoid salt subs), angioedema. Key Notes: No cough Beta-Blockers: Do not abruptly stop. May mask symptoms of hypoglycemia. Dizziness, lightheadness, difficulty breathing. Key Notes: Very effective for the treatment of CV disease. Off-label uses not associated directly with CV disease. Caution in asthma and COPD Alpha-1 Blockers: Dizziness and drowsiness. Caution when getting up from a sitting or lying position. Key Notes: Also selective for prostate. Alpha-2 Agonists: Do not abruptly stop. PO and TD may overlap for 1 to 2 days. TD patch application, metal-Remove prior to MRI. Key Notes: Often used in resistant HTN, High risk of rebound HTN if discontinued abruptly. TD takes 2-3 days for full therapeutic effect. Applied once weekly Vasodilators: Must be taken 3-4 times daily. Lupus-like symptoms. Key Notes: Often used in resistant HTN. Patient compliance may be an issue. Nitrates: Treat headaches with aspirin, APAP. Formulation administration. Key Notes: Many different formulations. Iso Mono for chronic angina. Nitrate-free interval(3-5 minute intervals), NTG for angina attacks. Store in original container. CCBs (DHP): Peripheral edema Key Notes: used primarily for HTN. Also in agina CCB (non-DHP):Diltiazem-empty stomach. Verapamil-food or milk. May cause constipation. Can open capsules. Anti-arrhythmics(Amiodarone): Sunscreen; Monitor PFTs, TFTs, and LFTs. Key Notes: Most commonly used. Loading dose followed by maintenance dosing. Anti-arrhythmics(Digoxin): Notify physician if any signs of toxicity occur. Key Notes: Often used if symptomatic HF. Loading dose followed by maintenance dose. Narrow therapeutic index. PK monitoring levels.

Question 53

OU

Answer 53

Both eyes

Question 54

OD

Answer 54

Right eye

Question 55

OS

Answer 55

Left eye

Question 56

UNG

Answer 56

Ointment

Question 57

Gtt

Answer 57

Drop

Question 58

IOP

Answer 58

Intraocular pressure

Question 59

PERRLA

Answer 59

Pupils are Equal, Round, Responsive to Light and Accommodation

Question 60

AA

Answer 60

Affected area

Question 61

Crm

Answer 61

Cream

Question 62

Cmpd

Answer 62

Compound

Question 63

UD

Answer 63

As directed

Question 64

Prn

Answer 64

As needed

Question 65

Which organism does the 2nd generation cephalosporin cover that the 1st generation doesn't in terms of Gram (-)?

Answer 65

• Hemophilus influenzae

Question 66

What does cephamycins cover that the 2nd generation cephs do not?

Answer 66

Anaerobes (found commonly in gut, GI tract, vaginal tract)

Question 67

3rd generation cephs cover

Answer 67

Ceftazidime (Fortaz) | Cover P. aeruginosa

Question 68

List antibiotics that belong to the beta-lactam group

Answer 68

Cephalosporin, Carbapenems, & Penicillins

Question 69

List the various classes of penicillin antibiotics, be able to list individual

Answer 69

Penicillin: Penicillin V&G, Benzathine Penicillin G, Procaine Penicillin G Aminopenicillins: Amoxicillin(+/-) Clavulanate, Ampicillin (+/-) Sulbactam Penicillinase resistant penicillins: Dicloxacillin, Nafacillin, Oxacillin Extended spectrum penicillins: Carbenicillin, Ticarcillin, Piperacillin

Question 70

Antibiotics within each group and describe the spectrum of activity for each group

Answer 70

Penicillin: Penicillin V&G, Benzathine Penicillin G, Procaine Penicillin G-Spectrum: Gram + and some anaerobes Aminopenicillins: Amoxicillin(+/-) Clavulanate, Ampicillin (+/-) Sulbactam Spectrum: Gram + & - and Enterococci Penicillinase resistant penicillins: Dicloxacillin, Nafacillin, Oxacillin Spectrum: Gram + & - that produce penicllinase Extended spectrum penicillins: Carbenicillin, Ticarcillin, Piperacillin Spectrum: Gram + & -, anaerobes, Enterbacteriaceae, P. Aeruginosa.

Question 71

List common anti-infective agents (antibiotics, antifungals, anti-tuberculosis drugs and antivirals) in their respective drug class

Answer 71

``` Antibiotics; Aminoglycosides • Gentamicin • Tobramycin • Amikacin * Aerobes ``` Cephalosporins • Cefazolin (Ancef) • Cephalexin (Keflex) • Cefaclor (Ceclor) • Cefuroxime (Zinacef) * Hemophilus influenzae ** Cephamycins • Cefoxitin (Mefoxin) • Cefotetan (Cefotan) * anaerobes • Cefotaxime (Claforan) • Ceftazidime (Fortaz) * Cover P. aeruginosa • Ceftriaxone (Rocephin) * Cefepime (Maxipime) * Ceftaroline (Teflaro) ``` Carbapenems • Imipenem w/ cilastatin (Primaxin) • Meropenem (Merrem) * Broad-spectrum * Gram (+) * Gram (-) * Anaerobes ``` Glycopeptides • Vancomycin (Vancocin) * Gram (+) organism (MRSA) * Anaerobes Lincomycins • Clindamycin (Cleocin) * Gram (+) organisms * Anaerobes ``` Monobactams • Aztreonam (Azactam) * Narrow spectrum of activity * Gram (-) bacteria o Hemophilus o Enterobacteriaceae o P. aeruginosa ``` ``` Macrolides • Erythromycin base (Ery-tab, Erythrocin, E-mycin) • Erythromycin estolate (Ilosone) • Erythromycin ethylsuccinate (EES) • Azithromycin (Zithromax) • Clarithromycin (Biaxin) * Often used in pts allergic to penicillin (may give to pts with syphilis) * Relatively broad-spectrum * Gram (+) organisms * Gram (-) organisms * Atypical organisms (e.g. Mycoplasma) ``` ``` NATURAL PENICILLINS • Penicillin V • Penicillin G • Benzathine penicillin G • Procaine penicillin G * Gram (+) organisms * Some anaerobes (above the diaphragm) ``` AMINOPENICILLINS * Spectrum includes both Gram (+) and Gram (-) bacteria * Ampicillin may also be effective against Enterococci • Amoxicillin (+/- clavulanate) DOES NOT COVER ENTEROCOCCUS • Ampicillin (+/- sulbactam) DOES COVER ENTEROCOCCUS ``` PENICILLINASE RESISTANT PENICILLINS * Gram (+) and Gram (-) bacteria that produce penicillinases • Dicloxacillin • Nafcillin • Oxacillin ``` ``` EXTENDED SPECTRUM PENICILLINS (UREIDO PENICILLINS) • Carbenicillin • Ticarcillin (+ clavulanate = Timentin) • Piperacillin (+ tazobactam = Zosyn) * Gram (+) organisms * Gram (-) organisms * Anaerobes - either above or below the diaphragm * Enterobacteriaceae * P. aeruginosa (piperacillin) ``` ``` Quinolones (fluoroquinolones) * Very broad spectrum of activity * Gram (+) organisms * Gram (-) organisms * Limited anaerobic coverage * Activity against enterococci * Activity against P. aeruginosa (ciprofloxacin) • Ciprofloxacin (Cipro) • Levofloxacin (Levaquin) • Ofloxacin (Floxin) • Gemifloxacin (Factive) • Gatifloxacin (Tequin) • Moxifloxacin (Avelox) ``` Sulfonamides o Sulfamethoxazole inhibits dihydropteroate synthase o Trimethoprim inhibits dihydrofolate reductase (inhibits tetrahydrofolic acid synthesis) • (Sulfamethoxazole/Trimethoprim (Bactrim or Septa)) ``` Tetracyclines * Gram (+) * Gram (-) * Spirochetes (Borrelia & Treponema) * Atypical bacteria • Tetracycline • Doxycycline ``` Anti-fungals; Allylamines • Terbinafine (Lamisil) * Dermatophytic infections (Trichophyton) * Filamentous infections (Aspergillis) ``` Imidazoles • Clotrimazole • Miconazole • Ketoconazole * Broad-spectrum antifungal * Candidiasis *Cryptococcal infections * Coccidiomycosis * Histoplasmosis * Aspergillosis * Dermatophytes ``` ``` Triazoles • Fluconazole • Itraconazole * Broad-spectrum antifungal * Candidiasis *Cryptococcal infections * Coccidiomycosis * Histoplasmosis * Aspergillosis * Dermatophytes ``` ``` Polyenes • Amphotericin B * Aspergillosis * Blastomycosis * Candidiasis * Coccidiomycosis * Cryptococcal infections * Histoplasmosis ``` Anti-tuberculosis drugs; • Isoniazid (INH) • Rifampin ``` Antivirals; Adamantanes • Amantadine (Symmetrel) • Rimantidine (Flumadine) * Influenza A infections ``` Neuraminidases • Oseltamivir (Tamiflu) • Zanamivir (Relenza) * Influenza A infections ``` Anti-herpesvirus Drugs • Acyclovir (Zovirax) • Valacyclovir (Valtrex) * Herpes simplex * Herpes varicella zoster * CMV ``` ``` Nucleosides reverse transcriptase inhibitors o Zidovudine (Retrovir) o Didanosine (Videx) o Stavudine (Zerit) o Lamivudine (Epivir) o Abacavir (Ziagen) ``` ``` Non-nucleoside reverse transcriptase inhibitors o Nevirapine ( Viramune) o Efavirenz (Sustiva) o Etravirine (Intelence) ``` ``` Protease inhibitors o Saquinavir (Invirase) o Indinavir (Crixivan) o Ritonavir (Norvir) o Nelfinavir (Viracept) ``` * Nucleosides reverse transcriptase inhibitors * Non-nucleoside reverse transcriptase inhibitors * Protease inhibitors * Fusion inhibitors * CCR5 antagonists * Integrase strand transfer inhibitors

Question 72

Differentiate between antibiotics that have a broad spectrum of activity against those that have a narrow spectrum of activity

Answer 72

Broad Spectrum: Cephalosporins, Carbapenems, Macrolides, Quinolones, Sulfonamides Narrow Spectrum: Monobactams

Question 73

Phosphodiesterase Inhibitors | Urinary Drugs

Answer 73

Drugs Sildenafil, Vardenafil, Tadalafil Uses Erectile Disfunction MOA Inhibit PDE 5 leading to increased levels of cGMP and enhancing the effect of NO & smooth muscle relaxation in the corpus cavernosum of the penis. AE Headache, flushing, dizziness, visual abornmalities, priapism CI/Warnings/Special Info Nitrates, antihypertensives, CYP-450 3A4 Inhibitors

Question 74

Describe the mechanism of action for each class of anti-infective agents

Answer 74

MOA’s Binds to ribosomal 30s: Aminoglycosides, Tetracyclines Binds to ribosomal 50s: Lincomycins, Macrolides PBP: Cephalosporins, Carbapenems, Monobactams, Penicillins, Blocks glycopeptide polymerization: Glycopeptides Inhibits DNA enzymes topoisomerare and gyrase: Quinolones Sulfamethaxzole inhibits dihydropteroate synthase; Trimethoprim inhibits dihydrofolate reductase

Question 75

List common or serious adverse reactions associated with various anti-infective agents and be able to match specific ADRs with specific agents

Answer 75

GI upset antibiotics: Monobactams, Macrolides, Penicillins, Quinolones, Sulfonamides, Tetracyclines. Hypersensitivity antibiotics: Cephalosporins, Carbapenems, Glycopeptides, Monobactams, Penicillins, Quinolones, Sulfonamides, and Tetacyclines Nephrotoxicity and Ototoxicity: Aminoglycosides, Glycopeptides Pseudomembranous colitis: Lincomycins

Question 76

``` List drugs with activity against specific pathogens Anaerobes Pseudomonas aeruginosa Atypical organisms M. tuberculosis ```

Answer 76

Anaerobes: Cephamycins (Cefoxitin, Cefotetan), Carbapenems (Imipenem, Meropenem), Glycopeptides (Vancomycin), Lincomycins (Clindamycin), Penicillins (Carbenicillin, Ticarcillin, Piperacillin) Tuberculosis: Antituberculosis (Isoniazid, Rifampin) P. Aeruginosa: Aminoglycosides (Gentamicin, Tobramycin, Amikacin), Cephalosporins 3rd and 4th generations (Cefotaxime, Ceftazidime, Ceftriaxone, Cefepime), Monobactams (Aztreonam), Extended spectrum Penicillins (Carbenicillin, Ticarcillin, Piperacillin), Quinolones (Cipro, Levo, Oflo, Gemi, Gati, Moxi) Atypical Organisms: Macrolides (Azithromycin), Tetracyclines (Tetracycline, Doxycycline) Enterococci: Aminopenicillins (Amoxicillin+Clav, Ampicillin +Sulb), Quinolones, Enterobacteriaceae: 4th generation Ceph (Cefepime), Monobactams (Aztreonam), Extended spectrum penicillins

Question 77

``` Alpha-Adrenergic Blockers Prostate drugs (symptom relief) ```

Answer 77

Drugs Terazosin, Doxazosin, Alfuzosin, Tamsulosin Use Benign Prostate Hyperplasia (some HTN) MOA Antagonists of A-Adrenergic receptors, Relaxes prostatic smooth muscle and some peripheral vasculature. AE Dissiness, hypertension, orthostatic hypotension, weakness, somnolence, impotence, decreased libido CI/Warnings/Special Info Antihypertensive Agents. Results of therapy may take several days to week.

Question 78

``` Alpha-Reductase Inhibitors Prostate drugs (long term use) ```

Answer 78

Drug Finasteride, Dutasteride (Avodart) Use Moderate to Severe Benign Prostate Hyperplasia. Male pattern baldness. MOA Interfere with testosterone’s stimulatory effect on the prostate gland. Block conversion of T to DHT. AE Breast tenderness/swelling, neoplasm of male breast, decreased libido, ejactulaton disturbances, ED, testicular pain. (more sexual dysfunction, so 2nd line agent for younger males) CI/Warnings/Special Info Pregnancy (category X), female gender, children. Can cause pseudo-hermaphroditic offspring.

Question 79

Anticholinergic | Urinary Drugs

Answer 79

Drug Tolterodine, Oxybutynin Use Urinary Incontinence MOA Antagonize muscarinic cholinergic receptors AE Dry mouth, constipation, xerophthalmia, blurred vision, mydriasis, tachychardia, sedation, dizziness, hallucinations CI/Warnings/Special Info Uncontrolled narrow-angled glaucoma, Urinary Retention, Gastric retention/conditions with severely decreased GI motility.

Question 80

``` Beta Blockers (-olo) Eye Drugs ```

Answer 80

Drug Timolol, Betaxolol, Carteolol, Levobunolol Use Glaucoma, Ocular HTN MOA Reduces aqueous humor production decreasing interocular pressure AE Stinging/burning, dry eye, blepharitis, corneal anesthesia CI/Warnings/Special Info Asthma/COPD, Bradycardia, 2nd or 4rd degree AV block, overt heart failure, cariogenic shock.

Question 81

``` Prostaglandin Agonist (-Prost) Eye Drugs ```

Answer 81

Drug Latanoprost, travoprost, bimatoprost, tafloprost Use Glaucoma MOA Increases aqueous humor outflow decreasing IOP AE Increased pigmentation of the iris, eyelash changes, eyelid skin darkening, burning/stinging upon instillation, blurred vision CI/Warnings/Special Info Remove contacts before, reinsert 15mins after. If more than one type of eye soln is used, wait at least 5 minutes before using 2nd agent.

Question 82

Carbonic Anhydrous Inhibitors (-amide) | Eye Drugs

Answer 82

Drugs Acetazolamide, Brinzolamide, Dorzolamide Use Glaucoma MOA Decreases inner ocular pressure by decreasing aqueous humor production.

Question 83

``` Alpha Blockers (-idine) Eye Drugs ```

Answer 83

Drug Brimonidine Use Glaucoma MOA Decreases IOP by decreasing aqueous humor production and increasing outflow.

Question 84

Anti-infective (- Neosporin) | Eye Drugs

Answer 84

Drug Neomycin/Polymyxin/Gramicidin Use Superficial Infections MOA Interferes with bacterial protein synthesis by binding to 30S ribosomal subunit. Binds to phospholipids and alters permeability of the bacterial membrane permitting leakage of intracellular contents. AE Superinfection, transient burning, stinging, irritation.

Question 85

Fluoroquinolones (-xacin) | Eye Drugs

Answer 85

Drug Ciprofloxacin, Besifloxacin, Gatifloxacin, Levofloxacin, Moxifloxacin, Ofloxacin Use Superficial ocular infections involving the conjunctiva or cornea. MOA Inhibits the activity of FNA gyrase so bacterial DNA cannot replicate. AE Localized discomfort/irritation, transient burning, stinging

Question 86

Anti-infective (-mycin) | Eye Drugs

Answer 86

Drug Erythromycin Use Superficial ocular infections involving the conjunctiva or cornea. MOA Inhibits RNA dependent protein synthesis AE Blurred vision, transient irritation/redness CI/Warnings/Special Info Remove contacts during treatment of conjunctivitis.

Question 87

Analgesics | Topical Drugs

Answer 87

Drug Lidocaine Use Treatment/relief of pain MOA stabilizing neuronal membranes AE Site irritation CI/Warnings/Special Info Anti-arrhythmic agents & local anesthetics

Question 88

Corticosteroids | Topical

Answer 88

Drug Clobetasol, Fluocinonide, hydrocortisone, momentasone, triamcinolone Use Psoriasis and Dermatitis MOA produces anti-inflammartory, antipruritic, and vasoconstrictior actions AE Dryness, Burning, Itching, and Irritation CI/Warnings/Special Info Applying heavily can cause systemic absorption.

Question 89

Antibiotic/Antiseptic | Topical

Answer 89

Drug Metrondiazole Use Acne, rosacea, and bacterial vaginosis (BV) MOA Inhibits protein synthesis. Causes cell death in susceptible organisms. AE Burning, skin irritation, dryness, headache. Vuvlva/vaginal irritation, discharge, fungal infection. *Leukopenia* CI/Warnings/Special Info Warfarin Alcohol Do not reuse applicator. Discontinue use and notify physician if skin rash occurs.

Question 90

Antibiotic/Antiseptic | Topical

Answer 90

Drug Mupirocin Uses 2ndary infected skin lesions, Impetigo, nasal MRSA MOA Inhibits protein synthesis. AE Burning, stinging, and Erythema

Question 91

Antibiotic/Antiseptic | Topical

Answer 91

Drug Chlorhexidine Use Skin cleanser, germicidal hand rinse MOA Binds to bacterial cell walls and extramicrobial complexes. Bactericidal effect. AE Ertheman, roughness/dryness, and sensitization. CI/Warnings/Special Info Do not swallow soln. Avoid hairy areas, which affect drying time. Avoid deep wounds and lumbar puncture sites.

Question 92

Antibiotic/Antiseptic | Topical

Answer 92

Drug Clindamycin Use Acne, Bacterial Vaginosis, susceptible bacterial infections MOA Inhibits protein synthesis by binding to 50S ribosomal subunits. AE Dryness, Burning, Itching, scaliness/peeling, erythema, and oiliness. CI/Warnings/Special Info Vaginal candidiasis, vaginitis, pruritis, vaginal pain. Vaginal products may weaken condoms/contraceptive diaphragms.

Question 93

Antifungal | Topical

Answer 93

Drug Ketoconazole Use Cutaneous fungal infections MOA Disrupts cell wall permeability AE Severe skin irritation, pruritis, stinging CI/Warnings/Special Info External use ONLY. Continue treatment for total recommended time period.

Question 94

Antifungal | Topical

Answer 94

Drug Terconazole Use Uncomplicated vulvovaginal candidiasis MOA Disrupts cell wall permeability AE Burning, irritation, and itching CI/Warnings/Special Info Vaginal use only. Refrain from intercourse during treatment period. Finish entire therapy.

Question 95

Erythromycin and benzoyl peroxide | Topical

Answer 95

Generic Benzamycin Type of drug Gel Use Acne

Question 96

Clotrimazole and betamethasone | Topical

Answer 96

Generic Lotrisone Type of drug Cream, lotion Use Treatment of topical fungal infections

Question 97

Adapalene | Topical

Answer 97

Generic Differin Type of drug Solution, cream, gel Use Acne

Question 98

Tretinoin | Topical

Answer 98

Generic Retin-A Type of drug Solution, cream, gel Use Acne

Question 99

Clindamycin/Benzoyl Peroxide | Topical

Answer 99

Generic Benzaclin Type of drug Gel Use Acne

Question 100

Permethrin | Topical

Answer 100

Generic Elimite Type of drug Cream Use Scabies

Question 101

Silver sulfadiazine | Topical

Answer 101

Generic SSD Cream, Silvadene Type of drug Cream Uses Prevention and treatment of infection in burns

Question 102

Nystatin | Topical

Answer 102

Generic Mycostatin Type of drug Cream, ointment, powder Use Treatment of topical fungal infections

Question 103

List antibiotics that belong in the beta lactam group

Answer 103

cephalosporin, carbapenems, penicellins