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Miscellaneous Meds Flashcards

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1
Q

2 classes of antineoplastic agents and how they are used:

A

1) cell cycle-specific (useful in hematological malignancies or tumors with large # of cells in proliferation)
2) cell cycle-nonspecific (slowly proliferating tumors)

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2
Q

Cell cycle-specific antineoplastics:

A

Methotrexate
Bleomycin
Vincristine

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3
Q

Cell cycle-nonspecific antineoplastics:

A

Cyclophosphamide
Doxorubicin
Cisplatin

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4
Q

2 alkylating chemotherapeutics:

A

Cyclophosphamide
Cisplatin

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5
Q

Antimetabolite chemotherapeutic:

A

Methotrexate

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6
Q

Natural product chemotherapeutic:

A

Vincristine

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7
Q

Antitumor antibiotics:

A

Bleomycin
Doxorubicin

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8
Q

Metabolite of Cyclophosphamide:

A

Acrolein

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9
Q

Uses of Cyclophosphamide:

A

breast CA
ovarian CA
non-Hodgkin’s
neuroblastoma

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10
Q

s/s of toxicity of Cyclophosphamide:

A
  • cardiac dysfxn
  • pulmonary toxicity
  • SIADH
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11
Q

How to reduce build-up of acrolein:

A

good hydration

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12
Q

Uses of cisplatin:

A
  • testicular CA
  • bladder CA
  • lung CA
  • ovarian CA
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13
Q

s/s of toxicity of cisplatin:

A
  • acoustic nerve damage
  • nephrotoxicity
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14
Q

MOA of methotrexate:

A

inhibits dihydrofolate reductase –> interferes with nucleic acid and protein metabolism

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15
Q

Uses of Methotrexate:

A
  • choriocarcinoma
  • bladder CA
  • non-hodgkin’s
  • leukemia
  • RA
  • psoriasis
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16
Q

s/s of methotrexate toxicity:

A
  • hepatotoxicity
  • pulmonary fibrosis
  • lymphoma
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17
Q

Cyclophosphamide is metabolized through which method?

A

CYP450

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18
Q

Uses of vincristine:

A
  • neuroblastoma
  • Wilms tumor
  • non-small cell lung CA
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19
Q

s/s of toxicity of vincristine:

A

peripheral neuropathy

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20
Q

Bleomycin is part of a series of antineoplastic abx produced from which organism?

A

Streptomyces verticillus

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21
Q

Which 3 drugs have synergistic actions in treating testicular CA?

A
  • Bleomycin
  • Vincristine
  • Cisplatin
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22
Q

Uses for bleomycin:

A
  • testicular CA
  • squamous cell CA of head, neck, cervix, penis, rectum
  • ovary and breast intracavitary therapy
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23
Q

What fatal adverse effect can be seen with bleomycin?

A
  • pulmonary fibrosis
  • older patients
  • worse when exposed to high O2 levels
  • (use <30% O2 to maintain sats >90%)
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24
Q

Uses for doxorubicin:

A
  • many cancers
  • sarcomas
  • hematologic CA
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25
Adverse effects of doxorubicin:
- bone marrow suppression - cardiac toxicity
26
How does cardiac toxicity occur with doxorubicin?
excessive intracellular production of free radicals within the myocardium
27
The adrenal cortex synthesizes 3 main types of hormones:
1) mineralcorticoid (aldosterone) 2) glucocorticoid (cortisol) 3) adrenergic hormone
28
How do steroids move and work in the body?
- bind to corticosteroid-binding globulin in plasma - unbinds when it reaches a cell - crosses through the cell membrane and binds to an intracellular receptor - alter gene transcription - create tissue-specific responses
29
List the effects that steroids have on the body:
- stimulate gluconeogenesis - muscle protein breakdown - stimulate insulin secretion - increase lipolysis & lipogenesis - osteoporosis - immunosuppression - anti-inflammatory - behavior changes
30
Natural glucocorticoids: Synthetic glucocorticoids:
natural: cortisol synthetic: prednisone, dexamethasone
31
Daily cortisol production:
15-30mg
32
What substance regulates (and is regulated by) cortisol?
adrenocorticotropin (ACTH)
33
Which hormone functions to control the body's response to stress?
cortisol
34
Natural mineralcorticoid: Synthetic mineralcorticoid:
natural: aldosterone synthetic: fludocortisone
35
Aldosterone maintains BP through which 2 mechanisms?
1) retention of Na+ and H2O by the kidney 2) excretion of K+ and H+ ions by the kidney
36
Definition, s/s, and tx of acute adrenal crisis:
- definition: sudden onset or exacerbation of several adrenal insufficiency - s/s: weakness, nausea, hypotension, fever, CNS changes tx: steroids, electrolyte correction, fluids, inotropic support
37
What is the standard method of perioperative steroid replacement?
mixed glucocorticoid/mineralcorticoid (cortisone/hydrocortisone) - 0.8 glucocorticoid / 1.0 mineralcorticoid activity - 25-150mg based on stress/type of surgery
38
Give the dosages for weight-based dosing of Ancef:
<80kg = 1g 80-120kg = 2g >120kg = 3g
39
Define an allergic response to an abx:
delayed reaction characterized by maculopapular rash or fever
40
Describe an immediate hypersensitivity to an abx:
IgE mediated and medical emergency including laryngeal edema, bronchospasm, and CV collapse
41
MOA of beta-lactams:
target the cell wall to kill or inhibit bacteria
42
What types of bacteria are beta-lactams effective against? List some examples:
- effective against gram + and gram - - Examples = PCN, cephalosporin, carbapenem, monobactam
43
SE of beta-lactams:
- severe allergic reactions - seizures
44
Important things about Ancef:
- mostly g- but also some g+ - kills skin flora - dose adjusted for renal fxn - 10% cross reactivity with PCN - give within 60min of incision and re-dose Q3h during sx
45
MOA of beta-lactamase inhibitors: 2 examples?
bind irreversibly to beta-lactamase 1) Vancomycin 2) Bacitracin
46
How is Vanco dosed? What are some side effects?
body weight dosing (adjusted for renal fxn) SE = Red Man's Syndrome, hypotension (infuse slowly)
47
What type of bacteria do aminoglycosides target?
gram -
48
Examples of aminoglycosides
1) Streptomycin 2) Gentamicin
49
SE of aminoglycosides:
- ototoxicity - nephrotoxicity - prolong NMBAs!
50
What types of procedures is Ancef given for?
- cardiac - thoracic - GI - gyn - neuro
51
What drug do you add to ancef for a GI obstruction?
metronidazole
52
Cipro is given for which procedure type?
Cystoscopy
53
3 questions for asthmatic patients:
1) What inhalers do they take and how often? 2) Last time they used their inhaler? 3) Been to ED for asthma in last 6 months?
54
2 things to remember before administering an albuterol inhaler via the vent:
1) needs a filter to be used with vent tubing 2) remove CO2 line before administrating
55
MOA of nitric oxide:
- direct vasodilator of pulmonary arteries - decreases intrapulmonary shunt *monitor methemoglobin levels if used >24 hours
56
MOA/uses/SE of albuterol:
- MOA: short-acting B2 agonist - uses: rapid relief of wheezing, bronchospasm, airflow obstruction - SE= tremors, tachycardia
57
Albuterol can be used to correct which electrolyte imbalance? How?
- hyperkalemia - agonist effect on B2 receptors and stimulation of Na+/K+ pump
58
MOA of Saleterol/Formoterol:
- long-acting B2 agonist - recommended when short-acting used >2x/wk
59
MOA/uses/SE of ipatropium:
- MOA: short-acting inhaled cholinergic antagonist; acts on muscarinic receptors in airway to reduce tone - uses: maintenance for COPD, rescue for COPD & asthma - SE: dry mouth, urinary retention, pupillary dilation, blurred vision
60
List the anesthetics that have a favorable effect on bronchomotor tone:
- Sevo - Iso - Propofol - Midazolam - Ketamine
61
Define hypoxic pulmonary vasoconstriction
intrinsic response within the lungs that occurs with hypoxia; vasculature in a hypoxic area will constrict to direct more blood flow to the well-ventilated areas - all volatiles cause this in a dose-dependent fashion - also caused by systemic vasodilators nitroglycerine, nitroprusside

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