Final Exam Flashcards
1
Q
principal endogenous estrogen
A
estradiol
2
Q
principal progestational hormone
A
progesterone
3
Q
days 1-14 of cycle
A
follicular phase, dominated by estrogen
4
Q
days 14-28 of cycle
A
luteal phase, dominated by progesterone
5
Q
raloxifene effects on bone density, breast cancer, CV, & uterine cancer
A
raloxifene- SERM
positive effects on bone density and breast cancer risk
increases risk of CV events
does not increase risk of uterine cancer
6
Q
estrogen/bazedoxifine
A
combined estrogen and estrogen receptor agonist/antagonist
prescribed for vasomotor symptoms, osteoporosis prevention
PROTECTS ENDOMETRIUM
7
Q
effects of adding progestin to HRT
A
protects against endometrial cancer
stimulates breast cancer risk
depression
breast tenderness
8
Q
Women who still have a uterus must have what added to their estrogen HRT therapy?
A
progestin
9
Q
chlorphiramine
A
first gen antihistamine
10
Q
clemastine
A
first gen antihistamine
11
Q
fexofenadine (allegra)
A
second generation antihistamine
12
Q
cetirizine
A
second generation antihistamine
13
Q
budesonide
A
glucocorticoid drug for asthma
14
Q
fluticasone
A
glucocorticoid drug for asthma
15
Q
adverse effects of inhaled glucocorticoid therapy for asthma
A
dysphonia and oropharyngeal candidiasis
16
Q
Montelukast
A
leukotriene modifier for asthma
oral administration
17
Q
cromolyn
A
used for prophylaxis of asthma symptoms. Suppresses inflammation.
18
Q
principal bronchodilators in asthma treatment
A
Beta 2 adrenergic agonists-
19
Q
salmeterol
A
longer-acting beta agonist for asthma treatment. Not effective for immediate rescue therapy.
20
Q
adverse effects of beta2 adrenergic agonists
A
tachycardia, angina, tremor— dose dependent, should not occur unless pt is overdosing on inhaler.
21
Q
fluticasone/salmeterol and budesonide
A
glucocorticoid/LABA combinations for long-term asthma maintenance in adults and children who have failed treatment with SABA. LABA should never be taken alone- should always be taken with glucocorticoid
22
Q
How long to wait between 2 puffs of beta agonist? How much to wait between SABA and glucocorticoid?
A
1 minute between puffs of albuterol
5 minutes between SABA and glucocorticoid
23
Q
Therapy of severe asthma exacerbations
A
oxygen
systemic, IV glucocorticoid
nebulized high-dose SABA
nebulized ipratropium (anticholinergic med) to reduce airflow obstruction
24
Q
ipratropium
A
anticholinergic receptor that further reduces bronchoconstriction in acute asthma exacerbations
Adverse effects: dry mouth, irritation of pharynx, increase in eye pressure in those with glaucoma, and rare possible CV events.
25
What drugs are used to treat H. pylori with ulcer?
Antibiotics and antisecretory agents (H2 blockers, prilosec)
26
Antibiotics for PUD and H. pylori
```
Amoxicillin
Clarithromycin
Bismuth compounds
Tetracycline
Metronidazole (flagyl)
```
Use a minimum of 2 antibiotics, up to 3
27
Cimetidine
H2-receptor antagonist for PUD
May cross BBB and cause CNS side effects
Cannot be taken within 1 hour of an antacid, best on an empty stomach.
Antiadrogenic effects.
IV bolus: can cause hypotension and dysrhythmias.
28
Ranitidine
H2-receptor antagonist for PUD
| Newer generation— few side effects and fewer interactions
29
Famotidine
H2-receptor antagonist for PUD
30
H2-receptor antagonists
First-choice drugs for treating gastric and duodenal ulcers. Suppress secretion of gastric acid
31
What should not be ingested while taking Metronidazole (Flagyl)
alcohol
32
sucralfate (Carafate)
Sucralfate creates a protective, mucous like barrier for up to six hours. It does nothing to acid secretions and is not absorbed and thus has minimal side effects. Constipation occurs in about 2% of patients. Because it is not absorbed, systemic effects are absent.
33
Proton pump inhibitors
most effective drugs for suppressing secretion of gastric acid
Increase the risk of fracture, pneumonia, acid rebound, and C. diff infection.
34
Omeprazole (prilosec)
Proton pump inhibitor- inhibits gastric secretion
Irreversible proton pump inhibitor- effects last several days
Short half life
Should be used short term
35
misoprostol
used to treat gastric ulcers caused by NSAIDs
side effect: dose-related diarrhea
pregnancy test necessary
36
Anatacids (calcium, magnesium, aluminum compounds)
React with gastric acid to produce neutral salts
| Use with caution in pts with renal impairment
37
contraindications for laxative use
abdominal pain, nausea, cramps, guarding
acute surgical abdomen- rebound, etc- workup needed before laxative
fecal impaction, bowel obstruction
habitual use
Use with caution in pregnancy and lactation
38
psyllium (metamucil and citrucel)
bulk-forming laxative
Functions similarly to dietary fiber
preferred treatment for temporary treatment of constipation
39
docusate sodium (colace)
surfactant laxative— commonly used for pts on opiates
40
bisacodyl (dulcolax)
stimulant laxative
stimulate intestinal motility
increase quantities of water and electrolytes in the intestinal lumen
good for opioid-induced constipation
41
milk of magnesia and polyethylene glycol (miralax)
osmotic laxatives
poorly absorbed salts that draw water into the intestinal lumen
low doses- work in 6-12 hours
high dose- results in 2-6 hours (cathartic effect)
cause substantial water loss and dehydration, renal toxicity
may cause sodium retention and exacerbate HF, HTN, edema (sodium phosphate compounds are worst for this)
42
Bowel-cleansing products for colonscopy
Sodium phosphate- hypertonic
Polyethylene glycol plus electrolytes (GoLYTELY)— isotonic with body fluids, no major loss of electrolytes, but requires large volume of bad-tasting liquid.
43
Which laxatives are commonly used long-term use and seem safe in children?
???
44
Which laxative is preferred to prevent opioid-induced constipation?
Bisacodyl (dulcolax)
45
Penicillin
narrow-spectrum penicillin that is effective only on gram-positive bacteria. It works on strep that can’t make the enzyme penicillinase. Penicillin can produce a mild allergic reaction or even a life-threatening anaphylactic reaction.
46
Ampicillin
a broad-spectrum penicillin that is effective on some gram negative bacteria as well as gram positive.
Adverse effects include rash (common side effect) and diarrhea (common side effect).
47
2 main gram positive bacteria
strep and staph
48
#1 drug for group A strep
penicillin
49
nafcillin
narrow spectrum penicillin
| pencilinase-resistant- works against staph aureus drugs that make penicilinase
50
ticarcillin
extended-spectrum
effective against pseudomonas
still will not kill MRSA
risk of sodium overload (given as a salt)
51
penicillin G (benzylpenicillin)
effective against gram positive organisms
least toxic of all antibiotics
most common cause of drug allergy
52
nafcillin, oxacillin, and dicloxacillin- what are they useful for?
useful against most staph aureus
| NOT USEFUL AGAINST MRSA
53
ampicillin and amoxicillin
cover gram negative and gram positive organisms
may help for an infection like an ear or urinary infection with multiple organisms
SE: rash or diarrhea- common rxn
54
clavulanic acid
beta-lactamase inhibitor- blocks penicillinase.
55
ampicillin/sulbactam and amoxicillin/clavulanic acid
extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics
56
how to prescribe for pt with penicillin allergy hx
if mild rxn hx: consider cephalosporin
| if severe rxn hx: avoid administration of penicillin or cephalosporins
57
symptoms of penicillin allergy severe rxn
laryngeal edema
bronchoconstriction, wheezing
severe hypotension
urticaria
58
What happens when penicillins and aminoglycoside antibiotics (gentamicin, amikacin) are mixed in IV solution? How should these drugs be administered if both are ordered for your patient?
Penicillins can inactivate aminoglycosides. Therefore, penicillins and aminoglycosides should never be mixed in the same IV solution. They should be administered separately.
59
How do the cephalosporins work?
Bind to penicillin binding proteins thereby disrupting cell wall synthesis and activate enzymes that damage the cell wall causing it to lyse.
60
Third Generation Cephalosporins
Highly active against gram-negative organisms
More resistant to beta-lactamase
Able to penetrate CSF / BBB → treatment for encephalitis, meningitis
61
Fourth Generation
Highly resistant to beta-lactamase
Extensive gram-negative coverage
Pseudomonas coverage (found in immunocompromised hosts)
62
ceftaroline
Fifth generation Cephalosporin
| active against MRSA!
63
cefotetan (what side effects?)
Cephalosporin
Do not take with alcohol,
Interferes with vitamin K- can cause bleeding. Should not be used with warfarin, aspirin, etc.
64
first and second generation cephalosporins
used for prophylaxis and against gram positives
| rarely used for active infections
65
Imipenem
carbapenem
not effective against MRSA
extremely broad spectrum with low toxicity
might give to very sick pt with multiple organisms— chemo or similar situation
66
vancomycin
effective against MRSA
good drug if serious infection and very penicillin allergic
Good for C. diff is metronidazole was ineffective, or for severe cases.
typically given IV, but sometimes given orally through NG tube.
toxicity: ear (careful with aminoglycosides, loop diuretics). red man syndrome- infuse slowly (1 hr) to prevent, renal toxicity
67
food/drug/tetracycline interactions
```
Absorption of tetracyclines is decreased if given with
Milk products
Calcium supplements
Iron supplements
Magnesium-containing laxatives
Most antacids
```
68
What is the principle limiting adverse effect of erythromycin? What is different about azithromycin?
Erythromycin's most common adverse effect is GI pain → nausea, gastric pain, diarrhea, vomiting. Azithromycin does not produce this adverse effect.
69
Who should not take tetracyclines and why?
Due to the risk of discoloration of teeth in children, pregnant women and children under the age of 8 should not use tetracyclines. Specifically, tetracycline & demeclocycline are eliminated in the urine and should not be used in a patient with renal compromise. If patient needs to be on a tetracycline, doxycycline or minocycline are better choices as they are eliminated by the liver.
70
What happens when erythromycin is combined with an -azole antifungal?
-azole antifungal drugs can inhibit erythromycin metabolism → raising plasma erythromycin levels which can cause QT prolongation & sudden cardiac death. Also be careful with cardiac pts
Erythromycin is a P450 inhibitor and can raise the plasma levels of other drugs: theophylline (used for asthma), carbamazepine (used for seizures and BPD), and warfarin.
71
erythromycin
broad spectrum macrolide antibiotics
| severe GI side effects
72
azithromycin & clarithromycin
does not cause severe GI effects.
73
clindamycin
broad spectrum, treats anaerobic infections outside the CNS— often GI bugs
associated with C. diff!
74
which -mycin is assoiated with C. diff?
clindamycin
75
linezolid (zyvoxx)
```
new class of antibiotics called oxazolidinones
Active against VRE: vancomycin resistant enterococci & MRSA
```
76
Why is the drug chloramphenicol rarely used? Be familiar with a dangerous toxicity that occurs in infants.
```
It is rarely used due to lack of safety and is only used for life-threatening infections. It can produce “Gray Syndrome” where they infant takes on a grey pallor and has a protruding abdomen. It is also associated with:
Reversible bone marrow depression
Fatal aplastic anemia
GI effects
Peripheral neuropathy
```
77
Tetracycline and doxycycline. How do these drugs work? What is their spectrum of action?
Tetracycline & doxycycline are in the “tetracycline” family of drugs which are broad-spectrum antibiotics for systemic therapy. They suppress bacterial growth by inhibiting protein synthesis. They are bacteriostatic → preventing growth, not necessarily killing bacteria. Because they can suppress growth of healthy bacteria as well, they can cause a “superinfection” or the proliferation of fungus in the patient.
78
a common immunization-preventable infection for which erythromycin is the first-line drug
Bordetella pertussis → Whooping cough
79
aminoglycocides
gentamicin, tobramycin and amikacin
narrow spectrum bactericidal antibiotics. They are used to kill aerobic, gram-negative bacilli
Must be given IV or parenterally
80
Which aminoglycocide drug will be used in your hospital, or are they all the same?
Regional resistance to certain agents has occurred. For example, in Maine, patients are started first on gentamicin and in NYC, they might first be started on amikacin.
81
aminoglycoside adverse effects and interactions
```
nephrotoxicity
ototoxicity
neuromuscular blockade
interactions:
lood diuretics, vanco (ototoxic)
nephrotoxic drugs
skeletal muscle relaxants (succinylcholine, anesthetics)- increased risk of neuromuscular blockade
```
82
What is the treatment for aminoglycoside-induced neuromuscular blockade?
calcium glutamate
83
gentamicin
narrow spectrum drug for aerobic gram negative bacilli
ototoxic
nephrotoxic
84
sulfamethoxazole and trimethoprim
broad spectrum antibiotics
suppress bacterial growth by inhibiting tetrahydrofolic acid
inhibit the synthesis of folic acid (folate)
85
sulfonamides (sulfamethoxazole and trimethoprim) adverse effects
hypersensitivity rxns, including SJ syndrome- blistering, sloughing, fever
hematologic effects- anemia
kernicterus- bilirubin in the CNS, bad in newborns
renal damage from crystalluria
86
sulfamethoxazole and trimethoprim drug interactions
raises levels of oral hypoglycemic drugs, may cause hypoglycemia
displaces warfarin from albumin- increases bleeding risk
87
sulfamethoxazole and trimethoprim
bilirubin in the CNS due to sulfonamides, may cause permanent neurological damage in newborns
88
trimethoprim
inhibits dihydrofolate reductase for folic acid production
hematologic effects
avoid in pregnancy
89
sulfamethoxazole and trimethoprim
inhibits 2 different steps in bacteria folic acid synthesis- much more effective than either one alone.
use for UTI, otitis media, bronchitis, shigellosis, pneumonia
90
What should we consider when giving sulfonamides to African-American patients? Recall G6PD deficiency.
Sulfonamides can cause hemolytic anemia in patients with G6PD deficiency, most common among African Americans and people of Mediterranean origin.
91
Induction phase of TB treatment
2 months
| use four drugs
92
continuation phase of TB treatment— what length, which drugs?
4 months
| use two drugs: isoniazid and rifampin
93
intermittent dosing of TB treatment
easier to accomplish
higher compliance
2-3 times a week
94
what ppd sign is considered positive?
1 cm induration around the injection site in moderate risk pts
95
latent TB treatment
INH- 9 months. treatment of choice
or isoniazid with rifapentine for 3 months
96
first-line anti TB drugs
isoniazid and rifampin
97
isoniazid (INH)
only used to treat TB
adverse effects:
peripheral neuropathy- paresthesias and weakness of hands and feet, pyroxidine (B6) is given to reverse
hepatotoxicity- drug should be stopped if lfts 3x baseline
optic neuritis
98
rifampin
broad-spectrum antibiotic but mainly used for TB
SE:
hepatotoxicity
discoloration of body fluids
P450 inducer- do not use with oral contraceptives
lowers warfarin levels, HIV drug levels
increases hepatotoxicity of INH and other TB drugs
99
fluoroquinolones (-floxacin)
broad-spectrum agents with multiple applications
disrupt DNA replication
mild side effects, can cause tendon rupture- usually effects achilles tendon- discontinue med and avoid weight bearing. this occurs more often in older pts who are taking steroids
100
cipro
broad-spectrum- inhibits bacterial DNA gyrase and topoisomerase II
use for respiratory, UTI, GI, joints, bones, skin, soft tissue, GU
SE: GI, CNS- dizziness, confusion, headache, restlessness, confusion- especially in elderly.
interacts with calcium, zinc, magnesium, etc
101
metronidazole (flagyl)
bactericidal for anaerobes
drug of choice for c. diff
protozoal infections- giardia, trichomonas
helicobacter pylori
adverse effects: GI upset, neurotoxicity
drug interaction: alcohol: DISULFURAM-LIKE RXN!
102
daptomycin (cubicin)
kills virtually all gram positive bacteria, including MRSA and VRE
no significant drug interactions
adverse effects- possible muscle injury
monitor CK for muscle damage
103
drugs to kill MRSA
daptomycin (cubicin), vancomycin, linzolid (zyvoxx)
104
amphotericin B
broad spectrum antifungal agent
binds to ergosterol in fungal cell membrane
drug of choice for most systemic mycoses
highly toxic:
-infusion rxn- occurs 1-3 hours after starting infusion
-nephrotoxicity
-hypokalemia
-must be given IV- no oral administration
105
treatment for amphotericin B infusion rxn
diphenhydramine, acetaminophen, meperidine
mepiridine works best for muscle jerks
106
nephrotoxicity of amphotericin
extent related to dose
if you reach 4g, you will have some permanent kidney damage
infuse 1 L of saline on days of treatment
avoid concurrent administration of aminoglycosides- loop diuretics, antivirals, NSAIDs.
monitor serum creatinine.
107
what antifungal can be given with amphotericin B to minimize toxicity?
flucytosine can be added to amphotericin b to reduce toxicity- a dose of the 2 drugs together can reduce toxicity by lowering amphotericin dose
108
-azoles
broad spectrum antifungals
lower toxicity than amphotericin
can be given orally
hepatotoxic- inhibit P450 drug enzymes
109
itraconazole
used for systemic mycoses, alternative to amphtotericin b
SE:
cardiosuppression in patients with heart failure- decrease in ventrical ejection fraction
liver damage
can inhibit drug metabolizing enzymes- levels of many drugs go up
110
fluconazole
often given orally
given for yeast infections
GI effects common
111
onychomycosis
nail infection- difficult to treat
| 3-6 months of oral treatment needed- terbinafine (lamisil) is preferred treatment
112
clotrimazole
topical antifungal
113
griseofulvin
oral antifungal
114
terbinafine (lamisil)
topical and oral- preferred treatment for nails
115
how long should antifungal treatment be continued
a week after symptoms have cleared
116
nystatin (mycostatin)
antifungal
used only for candidiasis in skin, mouth, esophagus, and vagina
can be used orally or topically
117
Acyclovir (zorivax)
active only against members of herpesvirus family- HSV and VZV
suppresses recurrences, shorterns duration of infection- does not eradicate virus
some resistance occurs
adverse effects:
IV: phelbitis, nephrotoxicity (administer with fluids)
oral: GI, vertigo
118
oseltamivir (tamiflu)
must be given within 2 days of exposure, given to pts with high risk of serious illness
neuraminidase inhibitor
119
What is the G0 phase of the cell cycle? Are tumors in this phase responsive to chemotherapy?
G0 phase is resting phase → tumors in this phase are not susceptible to chemo drugs, which are targeted at DNA synthesis, etc, aspects of cell proliferation.
Chemo often affects drugs in the synthesis (S) phase, the mitosis (M) phase, or the G1 or G2 phases
120
What lab parameters must be carefully monitored during chemotherapy?
Neutropenia - if ANC (absolute neutrophil count) drops below 500 cells/ mm3, therapy should be stopped.
Thrombocytopenia - low platelets
Anemia - low RBC count
121
What is the principal earliest sign of infection in a patient on chemotherapy?
fever- Be very cautious of neutropenic patients with fever, even low grade- 38°C or 100.4°F
122
What does filgrastim (G-CSF) do?
Stimulates neutrophil production. Can be administered.
123
What does erythropoietin (epoetin, Epogen) do?
It’s a hormone that stimulates RBC production. May stimulate cancer growth so generally only given in palliative care. Given as SubQ injection.
124
How do we treat chemotherapy-induced thrombocytopenia?
platelet therapy
125
What is hyperuricemia? Hyperuricemia commonly results from after chemotherapy for which cancers?
Hyperuricemia is excess uric acid in the blood → caused by the breakdown of DNA after cell death. It is most common in treatment for leukemia and lymphomas due to the massive cell death.
126
allopurinol
prevents hyperuricemia in cancer patients by inhibiting xanthine oxidase, an enzyme involved in converting nucleic acids to uric acid.
127
Vomiting/GI symptoms treatments for cancer
Glucocorticoid like dexamethasone and Zofran (Ondansetron) or other -setron drug
