Midterm 1 Flashcards
What are Teratogens? what drug brought this to life?
What happens during the first and third trimesters?
-Drugs& other agents that can disrupt the development of the fetus/halt pregnancy
-Thalidomine disaster
Not all drugs are teratogens
First:
-Period of greatest danger for drug-induced development defects
Third:
-More free drug in mothers blood (free drug is unbound to any receptor sites and ready to elicit a pharmacological response
-Mental health defects/deficits
What are the adverse effects of Quinolones?
*GI:
Nausea, vomiting, diarrhea *
Skin-Rashes
CNS-Headace, dizziness
What are Cephalosporins adverse Effects
-Similar to penicillins
-Patients with a history of allergy to penicillin
-Cross-hypersensitivity
-BUT does not exclude its use
Agonist
drug that binds to receptor and activates it to cause a response
What is pseudomonas Aeruginoas? What is used to treat it? and how does it treat it?
-They are Opportunistic infections (Commonly on us without causing problems until we become immunocompromised)
1.) Penicillins enter the bacteria
2.) Inside the cell they bind to penicillin-binding proteins
3.) Prevent normal cell wall prudction/synthesis
4.) Bacteria cells rupture
Penicillins do not kill other cells in the body
Bactericidal Vs Bacteriostatic (what is important bacteriostatic)
Bactericidal: Drugs are directly lethal to bacteria at clinically achievable concentrations
Bacteriostatic: Drugs can slow down bacterial growth but do not cause cell death (slows it down but doesn’t kill it)
-Host defences is important for bacteriostatic antibiotics
What are drug concentrations affected by?
Doseage and time
What are Anti-pseudomonal penicillins? What do the affect most?
-They are the extended spectrum of penicillins
-Ticarcillin, piperacillin
-even against Pseudomonas aeruginosa
-affects mostly ill people eg immumocompromized, cystic fibrosis
Drug products include?
-prescription and non-prescription
-pharmaceuticals
-disinfectants
-sanitizers with disinfectant claims
What is the increased risk for Aminoglycosides interactions?
Increased risk for nephrotoxicity (additive effect) if used with
Vancomycin (antiinfective)
Cyclosporine (immunosuppressant)
Amphotericin B (antifungal)
What Class Cefazolin part of? how is it administered? What kind of bacteria does it work best on?
Cephalosporins
IV administration
prototype for 1st generation - excellent on gram positive
What class is Demeclocycline apart of? What does it treat?
Treat SIADH (syndrome of inappropriate ADH)
-Non-bacterial action
-Tetracyclines
Why are immunosuppressive (glucocorticoids) doses large?
To prevent organ rejection and to treat episodes of organ rejection
What is a paradoxical effect?
Opposite of intended drug response
Insomnia & excitement that may occur when some children & older adults are given benzodiazepines for sedation
What is a Carcinogenic effect?
The ability of certain medications/environmental chemicals to cause cancers
What does toxicity mean/relate to?
The degree of detrimental physiologic effects caused by excessive drug dosing
Profound respiratory depression from an overdose of morphine & severe hypoglycemia from an overdose of insulin
Infection Vs Colonization?
Colonization of body by normal flora, not usually harmful, can help in controlling growth of potentially pathogenic organisms
Infections:
Invavation and multiplication of organisms and can be caused by foreign bacteria
What are the adverse effects to penicillins?
-Generally, well tolerated
-GI problems – disturb normal gut flora most common)
-Allergic reactions (Can be fatal)
-most common cause of drug allergy
Pharmacokinetics
What the body does to the drug (ie metabolism)
4 steps: absorption, distribution, metabolism, and excretion.
What are the negative interactions with Quinolones? (what is oral absorption reduced by)What are they used to treat? What is their mechanism of action?
Oral absorption is reduced by:
-Antacids
-Iron, zinc, calcium containing preparations
-Urinary tract infections
-Anthrax
-Bactericidal
What class is Gentamicin apart of?
It is a Aminoglycosides
ADE
Adverse drug event - Harm associated with any dose of drug
What is Sulfamethoxazole? What class is it apart of? What drug is it combined with? Where does this drug reach effective concentrations?
It is a Bacteriostatic drug and Prevents synthesis of folic acid
It is combined with trimethoprim (used for UTI and otitis media infections (middle ear infections)
-It reaches effective concentrations in the urinary tract
-It is apart of the sulfonamides class (antibacterial)
Duration
Time for which a drug concentration is sufficient to elicit a therapeutic response
What are Quinolones also referred to as?
Fluoroquinolones
What is an adverse (side) effect?
A nearly unavoidable secondary drug effect produced at therapeutic doses
What class is Ciprofloxcin apart of? What is the most common administration?
Quniolones
Very effective and most commonly used
Oral administration
“oxacin*
How are Aminoglycosides given? When are they given a certain way?
poorly absorbed through the GI tract = given parenterally (IV or IM)
Note:
given orally to decontaminate the GI tract before surgical procedures
or enema
What are the adverse effects of erythromycin, Azithromycin and clarithromycin? WHat class are they apart of?
Adverse Effects:
GI disturbances:
-primarily with erythromycin
-Nausea, vomiting, diarrhea, hepatotoxicity, anorexia
-Erythromycin and clarithromycin compete for hepatic metabolism (CYP)with other drugs
theophylline, warfarin, cyclosporine, digoxin
interfere with each other (interactions)
Azithromycin and clarithromycin:
fewer adverse effects
better tissue penetration
Macrolides
How can we prevent medication errors? (11 different methods)
1.) Minimize verbal or telephone orders
2.) Repeat order to provider
3.) Spell drug name aloud
4.) Speak slowly & clearly
5.) List indications next to each order
6.) Be aware of dangerous abbreviations, symbols, & dose designations
7.) NEVER ASSUME ANYTHING ABOUT ITEMS NOT SPECIFIED IN A DRUG ORDER
Ex: route, dosage, frequency
8.) Do not hesitate to question a medication order for any reason when in doubt
9.) DO NOT TRY TO DECIPHER ILLEGIBLY WRITTEN ORDERS
Contact prescriber for clarification
10.) NEVER use “trailing zeros” with medication orders
do not use “1.0mg”; use 1mg
“1.0mg” could be misread as 10mg
Resulting in a tenfold dose increase
11.) ALWAYS use a “leading zero” for decimal dosages
NEVER USE “.25”; use “0.25mg”
“.25mg” may be misread a “25 mg”
“.25mg” is sometimes called a “naked decimal”
ALWAYS LEAD, NEVER FOLLOW
Cephalosporins: Fifth Generation? What drug is here? what is it good against?
Ceftaroline – MRSA infections
What are Carbapenems?What are they effective against? What are they?How are they administered? where are they given?
ends with “-penem” for identification
-Broad-spectrum antibacterial agents
Gram-positive, -negative, and anaerobic
effective for mixed infections
Not MRSA
all parentally given – not orally active
always given in a hospital setting
What are some adverse effects to sulphonamides? What is the most common side effect?
1.) Integumentary (skin) allergies
-photosensativity
-Stevens-johnsin syndrome
-Hard time breathing/swallowing
-severe swelling of oral mucosa
2.) Bone marrow depression
granulocytosis, thrombocytopenia, aplastic anemia
Prone to infections – drop in white blood cells
Drop in platelet blood count
Drop in RBC production
3.) GI
-Nausea, vomiting, and diarrhea
What are antibacterial drugs effective against?
Gram-positive (easier to treat) and Gram-negative (lack of entry, more difficult to treat) bacteria
Before the approval of the sale health canada reviews drug products to asses?
Safety (safe to use)
Efficacy (it works; efficient)
Quality (brings no harm; little adverse effects as possible)
What is enreral administration? What is it good and bad for?
-Entry of drug through the GI tract via through the mouth to anus
-Convient but first pass effect for PO
What is Parenteral Administation?
-Not by the GI tract
-Bypasses the liver
-More drug reaches circulation
Trough
lowest blood level – if too low drug is ineffective
What are other clinical uses of sulphonamides beside bacterial infeactions?
-Upper respiratory tract infections (Not much usage of sulfonamides; rare for this situatuion)
-Others eg malaria, chlamydia (sexually transmitted)
What are antibacterial drugs? What do we need to bear in mind/do before we use them?
-Medications used to treat bacterial infections
-exploit differences between human cells and bacteria
-Ideally, identify causative organism before beginning antibacterial therapy
-potential antibacterial susceptibilities
-What bacteria causes what problem/infection > which drugs are best against that particular organism
Drugs are administered based on?
Route of administration, time, course of actions, and active drug concentration
What are cytotoxic drugs? What are they harmful to? How do they act? What are the adverse effects?
Alkylating agents Vs Antimetabolite drugs?
Drugs used in cancer therpay
They are harmful to ALL growing cells (good and bad)
Cytotoxic anticancer drugs act directly on cancer cells and healthy cells to produce cell death.
Alkylating agents – drug forms chemical bond to DNA
Thus prevent DNA replication, & causes cell death
Antimetabolite drugs
Prevent synthesis of metabolites required for growth
Nearly all cytotoxic drugs cause significant adverse effects:
-Severe vomiting & nausea
-Bone marrow suppression
-Neutropenia (infection risk)
-Loss of circulating platelets (bleeding risk)
Anemia
What are Aminoglycosides affective against?
Active against gram-negative bacteria
Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.
Often used in combination with other antibacterials for synergistic
What are drug concentrations affected by?
They are affected by dosage and time
Divided into 4 stages – “ADME”
Absorption from site of administration
Distribution within the body
Metabolism
Excretion
What is the downside to use of OTC’s? and what is an advantage to them?
May delay effective treatment of more chronic disease states
May delay treatment of serious and/or life-threatening disorders
May relieve symptoms of a disorder but not the cause
Advantage of OTC – convenient, effective with MD appointment – often MD recommend
What are the 4 groups of B-Lactam Antibacterials? How are they characterized?
They are characterized by the B-Lactam Ring structures
1.) penicillins
2.)Cephalosporins
3.)Monobactams (not covered in class)
4.)Carapenems
What is a Metastasis?
secondary lesion, in a new and remote part of the body
(cancer therapy)
What are aminopenicillins? What are they able to effect more of?
-They are a broad spectrum penicillin
-Able to affect more gram negative bacteria while still impacting gram positive bacteria
Ex.)Amoxicillin (more acid-stable – used as p.o.), ampicillin (very sensitive to low pH- not good for p.o.)
What is a drug?
-a drug includes any substance or mixture of substances manufactured, sold or represented for use in:
1.) the diagnosis, treatment, mitigation (eases symptoms) or prevention of a disease, disorder, abnormal physical state, or its symptoms, in human beings or animals
2.)Restoring, correcting or modifying organic functions in human beings or animals
3.) disinfection in premises in which food is manufactured, prepared or kept.
What is a Iatrogenic Disease? What are they identical to?
A disease that occurs because of medical care/treatment
-Also used to denote a disease produced by drugs
-Idnetical to idiopathic diseases- naturally occuring
Minimum Effective Concentration?
Minimum Effective Concentration is the plasma drug level that must be reached for a therapeutic effect
What is Clavulanic Acid?ow does it effect penicillin?
(e.g., amoxicillin (has molecules to breakdown cell wall synthesis)+ clavulanic
acid (prevents the breakdown of amoxicillin by bacteria, leaving more amoxicillin molecules to do its job))
It is a B-lactmase inhibitor
How is Vancomycin administered? What is it the choice of treatment for?
IV administration:
-Treatment of choice for MRSA, and other Gram-positive infections
What are opportunistic Infections? When do we start to see the consequences?
Infections that would not normally harm an immunocompetent person
occur in immunocompromised patients
existing colonization become infections
-We start to see the consequences when they increase in number
What are the adverse effects to
-Increased risk of infection (greatest risk)
-Thinning of skin
-Osteoporosis w/ fractures
-Impaired growth in children
-Suppression of the hypothalamic-pituitary-adrenal axis
What are glucocorticoids? What kind of drug are they? what are they used for?
-They are immunosuppressant drugs that are used widely to suppress immune responses
_They are used for suppression of allograft (tissue from organ donars) rejection
-Treatment of asthma
-Therapy of autoimmune disorders
What is drug resistance to penicillins?
-Some bacteria produce enzymes capable of destroying penicillins
-Bacteria make b-lactamases (split the β-lactam ring)
-β-lactamase inhibitors (used in combination with penicillins)
Why isn’t bored spectrum always the best?
You can create drug resistance
What is topical administration?
Apply on top of skin, eyes, ears, nose vagina
What are Cephalosporins? How are they devided? What are they similar to?
-all start with “Cef-“ to identify them
-Mostly widely used antibacterial drugs
-Semisynthetic derivatives from a Cephalosporium fungus
-Structurally and pharmacologically related to penicillins (β-lactam antibiotics)
-First to Fifth generation
-Divided into groups according to their introduction to clinical use:
1.)increased permeability to Gram-negative cell wall
2.) increased stability against β-lactamases
What are the adverse effects for Tetracylines?
Strong affinity for calcium
-Discoloration of permanent teeth and tooth enamel in fetuses and children
-May retard fetal skeletal development if taken during pregnancy
-NOT advised in pregnancy or during lactation for the above reasons
-GI disturbances-
direct irritation
gut flora
Alteration in intestinal flora may result in:
-Superinfection (overgrowth of new, non-susceptible organisms such as Candida)
-Diarrhea
-Pseudomembranous colitis (Clostridium difficile) - Colon infection
-Antagonistic to bactericidal antibiotics so must be timed for use usually at least an hour apart
Potentiate warfarin effect (oral anticoagulant)
Photosensitivity
