EXAM 3 - Just the Basics of Everything Flashcards
(138 cards)
1
Q
atropine
A
Organophosphate and carbamate insecticide poisonings antidote for the PNS symptoms.
2
Q
Pralidoxime
A
Organophosphate and carbamate insecticide poisonings antidote for the nicotinic symptoms.
3
Q
Heavy Metal antidotes
A
dimercaprol and succimer
4
Q
Organic mercury salts
A
The symptoms are neurologic and include visual disturbances, paresthesias, muscle tremors and ataxia. These symptoms can lead to a misdiagnosis of Alzheimerﾒs or Parkinsonﾒs disease in the elderly.
5
Q
Cyanide poisoning antidote
A
Hydroxocobalamin and a kit containing amyl nitrite, sodium nitrite and sodium thiosulfate.
6
Q
Acetaminophen antidote
A
N-Acetylcysteine (Mucomyst)
7
Q
Benzodiazepine antidote
A
Flumazenil
8
Q
Digitalis antidote
A
Digoxin-imune Fab
9
Q
Methanol & Ethylene glycol antidote
A
Fomepizole
10
Q
Heparin antidote
A
Protamine sulfate
11
Q
Opiate antidote
A
Naloxone
12
Q
Organophosphate, Carbamate, and Nerve Gas Antidote
A
Atropine; Pralidoxime
13
Q
The nationwide telephone number for poison control centers. WILL BE ON EXAM!!!
A
(800)222-1222
14
Q
Rheumatoid Arthritis - Drug Treatment
A
Aspirin, NSAIDs, Glucocorticoids; DMARDs -nonbiologic; DMARDs - biologic
15
Q
Osteoarthritis - Drug Treatment
A
Aspirin, NSAIDs, Acetaminophen, Glucocorticoids
16
Q
Gouty Arthritis - Drugs Used
A
NSAIDs, Glucocorticoids, Uricosurics, Xanthine oxidase inhibitors, Cholchicine, Acetaminophen
17
Q
NSAIDs - MoA - Anti-inflammatory
A
Reversibly inhibits cyclooxygenase (enzyme that converts arachidonic acid to prostaglandins)
18
Q
NSAIDs - MoA - Analgesic actions
A
Peripheral inhibition of PG production & possible inhibition of pain stimuli
19
Q
NSAIDs - MoA - Antipyretic actions
A
Inhibition of PG synthesis in the thermoregulatory center in anterior hypothalamus
20
Q
NSAIDs - Adverse Effects
A
GI complaints (Most common AE); GI ulcers/bleeding; Renal dysfunction; hypersensitivity; AVOID IN LATE PREGNANCY
21
Q
NSAIDs - Black Box Warnings
A
Increase risk of adverse cardiovascular events (including MI, CVA, HTN)
Increase risk of GI irritation, ulceration, bleeding, perforation
GI irritation/ulceration
May occur at anytime during therapy
22
Q
NSAIDs - Aspirin - MoA
A
Irreversible inhibitor of COX
23
Q
NSAIDs - Aspirin - Excretion & Secretion
A
Excreted into urine, but can affect uric acid secretion. Low dose-decreased uric acid secretion. High dose-increased uric acid secretion. Not preferred treatment in patients with gout because it can precipitate a gouty attack.
24
Q
NSAIDs - Aspirin - Kids
A
Avoid in children w/fever due to risk of Reye’s Syndrome. Results in fulminating hepatitis w/cerebral edema that is often fatal with viral illnesses (chickenpox, influenza). Avoid use in individuals under 21 years old.
25
Acetaminophen - MoA
Not considered an NSAID; Blocks prostaglandins, but not peripherally
26
Acetaminophen - Adverse Effects - High Doses
Overdose can cause hepatic necrosis, a potentially life-threatening condition. Depletion of glutathione causes buildup of toxic metabolite. Most common cause of liver failure in US.
27
Rheumatoid Arthritis - Cause
Key inflammatory mediators found in synovium: TNF alpha, Interleukins 1 beta, 8, 15 and 18
28
Immunosuppressants
TNFa Inhibitors (Etanercept); IL-1 Antagonists; Decrease T-Cells(Methotrexate); Decrease B-cells; Other
29
Non-Biologic DMARDs
Methotrexate - Mainstay of treatment of RA; Response within 3-6 weeks; Doses required are much lower than for cancer
30
Biologic DMARDs
TNFa inhibitors have been shown to decrease signs and symptoms of RA, decrease structural damage, and improve physical function
31
Colchicine - Class
Anti-inflammatory, Anti-gout
32
Colchicine - Use
Does not prevent the progression of gout to acute gouty arthritis, but it does reduce the frequency of acute attacks and relieves pain
33
Colchicine vs. NSAIDs
NSAIDs have largely replaced colchicine in the treatment of acute gouty attacks
34
Colchicine for Prophylaxis
Colchicine is currently used for prophylaxis of recurrent attacks; Prevents attacks in 80% of patients
35
Indomethacin (Indocin)
PREFERRED OVER CHOLCHICINE. All the same MoA, Cautions, Side effects, and drug interactions as any NSAID. As effective as colchicine in acute attacks for many patients (with less GI toxicity).
36
Allopurinol (Zyloprim) - MoA
Inhibits xanthine oxidase (the enzyme that converts xanthine to uric acid), reduces production of uric acid
37
Allopurinol (Zyloprim) - Use
Prevention of acute gout; Drug of Choice in history of urinary stones or impaired renal function
38
Estradiol
Most potent estrogen produced
39
Ethinyl estradiol
Synthetic estrogen; undergoes less 1st pass metabolism
40
Estrogen - Therapeutic Uses
Contraception; post-menopausal hormone replacement therapy (HRT); Primary hypogonadism
41
Estrogen Therapy in HRT - Cotherapy
Must be combined w/progestogen if patient has not had hysterectomy
42
Estrogen - Adverse Effects
Most common: nausea & breast tenderness;
| More severe, but less common: Thromboembolic events
43
Estrogen Therapy in HRT
```
Vasomotor instability (hot flashes) & vaginal atrophy;
Also help with maintenance of bone mass;
Lower doses are required for HRT (compared with contraceptives)
```
44
Tamoxifen - MoA
Competes with estrogen for receptors in breast tissue
45
Tamoxifen - Adverse Effects
Hot flashes, nausea, menstrual irregularities, vaginal bleeding; Oral tablets; not IV
46
2 Main Types of Contraceptives
Combined oral contraceptive pills (OCPs) = Estrogen + progestin; OR
Progestin-only
47
Forms of OCPs
Monophasic, Triphasic, Extended Use
48
Progestin-only "mini-pills"
Low continuous dose of progestin; Less effective than combined OCPs; Greater risk of pregnancy & more menstrual cycle irregularities; More dependent on patient compliance
49
Progestin-only "mini-pills" - Use
Contraindications to estrogen; Breastfeeding
50
Postcoital Contraception (Plan B)
For maximum effectiveness, should be administered within 72 hours or sooner after unprotected intercourse; eat a meal with it because it will cause nausea; will cause vaginal bleeding/spotting; prevents implantation of sperm; not abortive therapy
51
Androgens - Therapeutic Uses
Androgenic Effects: used in males with inadequate androgen secretion
Anabolic Effects: used for wasting associated with HIV or cancer;
Endometriosis: (Danazol) mild androgen used for endometriosis and fibrocystic breast disease
52
Androgens - Kinetics
ineffective orally (inactivated by 1st pass metabolism); administered IM; transdermal patches; topical gel (can rub off on partner, so it should be covered before contact)
53
Androgens - Adverse Effects - Women
Females: masculinizing effects; Acne, growth of facial hair, deepening of voice, male pattern baldness, excessive muscle development, menstrual irregularities
54
Androgens - Adverse Effects - Men
Priapism or impotence, decreased spermatogenesis, gynecomastia, growth of the prostate, cosmetic changes
55
Androgens - Adverse Effects - Kids
Abnormal sex maturation, growth disturbances
56
Androgens - Adverse Effects - General effects
Increased LDL, decreased HDL (premature coronary heart disease); Fluid retention (edema)
57
Osteoporosis - Treatment
Bisphosphonates; SERMs
58
Bisphosphonates - Adverse Effects
GI upset, esophagitis or esophageal ulceration; To decrease risk, remain upright for 30 ? 60 minutes after taking and take with a full glass of plain water; NOT FOR BEDRIDDEN PATIENTS
59
SERMs for Osteoporosis
Calcitonin; Recombinant parathyroid hormone; Monocolonal Antibodies
60
Bacterial Cell Wall Inhibitor Classes
1) Penicillins; 2) Cephalosporins; 3) Carbapenems; 4) Other; 4a) Monobactams; 4b) Beta Lactamase Inhibitors; 4c) Vancomycin; 4d) Daptomycin; 4e) Televancin
61
Bactericidal Antibiotics
Peter Vampire Can Drink Til Any Sun Rise Fries. Penicillins, Vancomycin, Cephalosporins, Daptomycin, Telavancin, Aminoglycosides, Synercid, Rifamin, Fluoroquinolones (Cipro),
62
Bacteriastatic Antibiotics
TTMCZSE = Tetracyclines; Tigecycline, Macrolides, Clindamycin, Zyvox, Sulfonamides, Ethambutol
63
Antibiotics for Pseudomonas
Aminoglycosides
64
Antibiotics for MRSA
Vancomycin (drug of choice!), Tigecycline, Zyvox, Cotrimoxazole
65
Antibiotics for VRE
Zyvox
66
Antibiotics for Gram (+)
Penicillins, Vancomycin, Tetracycline (Doxycycline), Tigecycline,
67
Antibiotics for Gram (-)
Tetracyclines; Tigecyclines, Aminoglycosides,
68
Antibiotics for Anaerobic
Tigecycline, Clindamycin
69
Empiric Antibiotics
Carbapenems
70
Non-empiric antibiotics
Monobactams
71
Antibiotics affecting ribosomes
30S = Tetracyclines, Tigecycline, Aminoglycosides; 50S = Macrolides, Chloramphenicol, Zyvox
72
Folate Antagonists - Classes
Sulfonamides; Trimethoprim
73
Antistaphylococcal Penicillins - Drugs
DICLOXACILLIN
74
Extended-Spectrum Penicillins - Drugs
AMOXICILLIN (Amoxil)
75
Antipseudomonal Penicillins - Drugs
TICARCILLIN
76
Penicillin - Hypersensitivity
CROSS-ALLERGENICITY MAY OCCUR WITH OTHER BETA-LACTAM ANTIBIOTICS
77
Cephalosporins - Adverse Effects
CROSS-ALLERGENICITY BETWEEN PENICILLINS & CEPHALOSPORINS; 3-5%; Highest with 1st generation
78
Beta Lactamase Inhibitors - Combination therapy
AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN)
79
Vancomycin - Adverse Effects - Infusion reaction
Red man syndrome
80
Protein Synthesis Inhibitors
1) Tetracyclines; 2) Aminoglycosides; 3) Macrolides; 4) Others; 4a) Choloramphenicol; 4b) Clindamycin; 4c) Linezolid; 4d) Quinupristin/Dalfopristin
81
Tetracyclines - Drugs
Doxycycline;
82
Aminoglycosides (AGs) - Drugs
Gentamicin;
83
Macrolides - Drugs
Erythromycin;
84
Chloramphenicol - Adverse Effects
Anemia; Gray Baby Syndrome;
85
Chloramphenicol - Antimicrobial Spectrum
BROAD SPECTRUM, but limited to life-threatening infections due to toxicity;
86
Fluoroquinolones (FQs) - 2nd Gen Drugs
Ciprofloxin (Cipro)
87
Fluoroquinolones (FQs) - Interactions
Decreased absorption
Ingestion with antacids (Al, Ca, Mg)
Dietary supplements with iron or zinc, Ca (supplements or food)
88
Urinary Tract Antiseptics/Antimicrobials - Nitrofurantoin (Macrobid) - Antimicrobial Spectrum
Most effective for E. coli
89
Isoniazid (INH) - Indications
1st line treatment for M. Tuberculosis (in combination therapy)
90
Mycobacteria-Tuberculosis (TB) - Treatment Regimen
Treatment is usually started with a 4 drug regimen; Isoniazid, Rifampin, Pyrazinamide, Ethambutol
91
Rifampin - Use
Mycobacteria; Used for prophylaxis in patients exposed to bacterial meningitis; Leprosy
92
Rifabutin - Indications
Preferred drug in TB-infected HIV patients; Less P450 induction and drug interactions with HIV treatments
93
Importance of Determining Microbes
Sensitivity; Important to obtain samples before initiating treatment; determines susceptibility to treatment
94
Empiric Therapy
Immediate administration of therapy prior to bacterial identification; treatment of infection
95
When is empiric therapy used?
treat infections in acutely ill patients
96
How to select drugs in empiric therapy
1) Location of infection; 2) Endogenous bacteria of the area of infection; 3) Patterns of infection in the population; 4) Signs & symptoms suggestive for certain strains of bacteria; 5) Empiric therapy is started immediately after cultures are taken while awaiting culture & sensitivity results
97
Prophylactic Therapy - general use
Prevention of infection
98
Reasons for Prophylactic Therapy
1) Prevention of recurrent infections; 2) Prevention of infections that are likely (Immunocompromised pt); 3) Surgical prophylaxis
99
Bacteriostatic drugs
Arrests the growth and replication of bacteria while the immune system destroys organism
100
Bacteriocidal drugs
Causes direct death of bacteria
101
Narrow-spectrum
coverage limited to small group of microorganisms
102
Extended-spectrum
coverage includes gram-positive and a significant number of gram-negative bacteria
103
Broad-spectrum
coverage includes wide range of microorganisms, but also most likely to alter natural flora
104
Complications of Antibiotic Therapy: Super-infection
Particularly with broad-spectrum antimicrobials due to alterations of the normal microbial flora; Upper respiratory, intestinal, genitourinary tracts
105
Cell-cycle specific
Chemotherapeutic agents that are only effective on high growth fraction cancer cells.
106
Cell-cycle nonspecific
Chemotherapeutic agents that are effective on both low growth fraction and high growth fraction cancer cells.
107
When is chemotherapy the only treatment option?
cancer that is disseminated and not amenable to surgery and/or radiation
108
Adjuvant Chemotherapy
Supplemental chemotherapy that is given following surgery and/or radiation to eliminate undetected micrometastases.
109
Neoadjuvant Chemotherapy
Chemotherapy that is given prior to surgery and/or radiation to decrease the size of a solid tumor.
110
Maintenance Chemotherapy
continued after initial 'cure' to prevent recurrence or, in advanced cancer, to keep it from growing and spreading.
111
Myelosuppressant
A chemotherapeutic agent that affects bone marrow and inhibits the formation of mature blood cells, particularly white blood cells, red blood cells and platelets.
112
Vesicant
A chemotherapeutic agent that causes redness and blistering on the skin. If such an agent is extravasated during intravenous administration, there will be severe damage to the tissue in the extravasation area.
113
Growth Fraction
The fraction of tumor cells that are in the replicative cycle (i.e., growth fraction) >> influences their susceptibility to most chemotherapeutic agents.
114
High growth fraction vs. Low growth fraction
Cells that are rapidly dividing have a high growth fraction and are typically more susceptible to chemo than cells with a low growth fraction.
115
Significance of 1-g Tumor Mass
A total of 10^9 cells is the smallest tumor burden that is physically detectable; these 1 billion cells represent a tumor weighing about 1 g or about the size of a small grape; clinical symptoms usually first appear at this stage
116
Palliative Chemotherapy
Initial remissions are transient, with symptoms recurring between txs. Survival is extended, but the patient eventually dies of the disease.
117
Curative Chemotherapy (for disseminated cancers, such as leukemia)
Combination-drug chemo reduces the chance of drug resistance. Each drug chosen to have different cellular site of action or different cell-cycle specificity. Each drug chosen to have different organ toxicity.
118
Curative Chemotherapy (for solid cancers, such as testicular carcinoma)
Tumor burden is initially reduced by surgery and/or radiation; tx of occult micrometastases is continued after clinical signs of cancer have disappeared.
119
Normal cells most affected by chemo
1) Buccal mucosa
2) Upper GI tract (mouth, throat and esophagus)
3) Hair follicles
4) Bone marrow
5) Small intestine
6) Treatment-induced cancermo agents cause cancer years later.
7) Extravasation
120
Why are chemotherapy adjuncts used?
1) THEY HELP ALLEVIATE CHEMOTHERAPY-INDUCED SIDE EFFECTS.
121
Chemotherapy adjuncts for stomatitis & mucositis
various medications alone or in compounded 'magic mouthwash' combinations
122
Chemotherapy adjunct for alopecia
Cryotherapy (cold caps)
123
Combination vs. single agent chemo
Treating cancer with a combination of chemo agents is typically more effective than using a single agent.
124
Using chemoagents with different toxicities/mechanisms
Can often be combined at full doses and result in higher response rates due to additive and/or potentiated cytotoxic effects and nonoverlapping toxicity to the patient.
125
Using chemoagents with similar toxicities
Can only be combined safely by reducing the doses of each.
126
Adverse Effects: Anthracyclines
IRREVERSIBLE, DOSE-DEPENDENT CARDIOTOXICITY. This is due to the effects of superoxide radicals on the myocardium.
127
Adverse Effects: Bleomycin
BLEOMYCIN CAN CAUSE PULMONARY TOXICITY that progresses from rales, cough and infiltration to potentially fatal PULMONARY FIBROSIS.
128
Adverse Effects: ALKYLATING AGENTS - Cyclophosphamide & Ifosfamide
HEMORRHAGIC CYSTITIS AND FIBROSIS IN THE BLADDER. Adequate hydration and the drug MESNA help lessen those effects in the bladder.
129
Interferons
EFFECTS INCLUDE SUPPRESSION OF CELL PROLIFERATION, ACTIVATION OF MACROPHAGES, AND INCREASED CYTOXICITY OF LYMPHOCYTES
130
Adverse Effects: Microtubule inhibitor - Vincristine
NEUROTOXICITY - Peripheral neuropathy, paresthesias and neuropathic pain.
131
Aromatase Inhibitors
DECREASE THE PRODUCTION OF ESTROGEN by blocking the activity of aromatase. This helps slow or stop the growth of hormone dependent tumors such as breast cancer.
132
Actions: Steroid hormones - GnRH (LHRH) analogs
DECREASED PRODUCTION OF ESTROGEN AND TESTOSTERONE
133
Monoclonal antibody Production
produced using BIOTECHNOLOGY to INTERACT WITH SPECIFIC TARGETS in or on cancer cells
134
Specific Actions of Topisomerase Inhibitors
1) PREVENT THE REJOINING OF STRANDS; 2) RENDER DNA strands SUSCEPTIBLE TO IRREVERSIBLE BREAKS.
135
GnRH Analogs
goserelin and leuprolide
136
Hormone Responsive Tumors
tumor regresses after treatment with a specific hormone
137
Hormone Dependent Tumors
removal of a specific hormone causes tumor regression
138
3 Specific Actions of Chemotherapeutic Antibiotics
1) interfering with RNA enzyme functions;
2) intercalating between DNA base pairs;
3) producing superoxide free radicals that cause DNA strands to break.
