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old. 232 > Module 2: infection Pharmacology readings > Flashcards

Module 2: infection Pharmacology readings Flashcards

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1
Q

nonopioid analgesic given for fever

A

acetaminophen

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2
Q

Mechnism of action: acetaminophen

A
  • Inhibits transmission of peripheral pain impulses by inhibiting prostaglandin synthesis
  • Lowers febrile body temperature by acting on the hypothalamus. Heat is dissipated through resulting vasodilation and inc peripheral blood flow
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3
Q

is acetaminophen used to treat inflammation?

A

no. it has weak anti-inflammatory properties

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4
Q

what has worse side effects, acetaminophen or NSAIDS? like what?

A

NSAIDS. Acetaminophen is usually not assoc w carviovascular effects eg edema, or platelet effects eg bleeding like aspirin and NSAIDS are

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5
Q

What effects does aspirin cause that acetaminophen doesnt?

A

aspirin causes GI irritiation and bleeding and acid-base changes

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6
Q

Acetaminophen indications:

A

treatment of mild pain and fever

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7
Q

?what is the antipyretic of choice in kids and adolescents with flu syndromes and why

A

acetaminophen. Aspirin is avoided in those populations because of Reye’s syndrome (brain wasting condition)

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8
Q

Contraindications: acetaminophen

A 
allergy 
hypersensitivity
anemia
severe liver disease
kidney disease
genetic disease (glucose 6 phosphate dehydrogenase enzyme deficiency)
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9
Q

Acetaminophen: adverse effects

A 
generally well tolerated
-rash
-nausea
-vomiting
less common but more severe:
-nephrotoxicities
-blood disorders or dyscrasias
-if taken as acute overdose may cause liver necrosis
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10
Q

?who commonly ODs on acetaminophen

A

adolescents who are depressed, depressed people

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11
Q

?how might a pt receive a dose thats too high of acetaminophen other than taking too much pure acetaminophen

A

combination tablets eg hydrocodone plus acetaminophen that have some acetaminophen contained within them

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12
Q

Max dose acetaminophen for adults

A

4000mg

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13
Q

if pt comes in w acetaminophen OD what do you do?

A
  • they may not tell you accurately how much they took, get a serum level ASAP (no sooner than 4hrs after ingestion)
  • count the pills left in the bottle
  • if cant obtain serum acetaminophen level give acetylcysteine
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14
Q

antidote to acetaminophen. How does it work?

A

acetylcysteine. Prevents the hepatotoxic metabolites of acetaminophen from forming

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15
Q

? how do you give antidote to acetaminophen? what if they vomit?

A

give every four hours in 17 doses. if pt vomits within an hr of a dose then give it again. must give all doses

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16
Q

Interactions: acetaminophen

A

alcohol (persistent alcoholism).

avoid other hepatotoxic drugs ideally

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17
Q

patho of fever

A

Body is invaded
Phagocytes release&raquo_space; endogenous pyrogens
Prostoglandins reset Hypothalmic thermostat to a higher setpoint
We make & conserve heat…this is the chill phase
Body reaches temperature setpoint
Stress is removed & thermostat is reset to normal
We lose & produce less heat…this is the desverescence phase
Body returns to normal temperature

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18
Q

?when should fever be treated?

A

over 38.5

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19
Q

gram positive

A

• Gram positive (purple) have cell walls with peptidoglycan and a thick outer cell capsule

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20
Q

is it easier to treat gram negative or positive? why?

A

easier=gram +

gram - is more difficult to treat because of the molecules difficulty in penetrating the complex wall of the microorg

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21
Q

gram negative=

A

• Gram negative (stain red) cell wall struct more complex has two cell membrane, smaller outer capsule

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22
Q

signs and symptoms of infection

A

• Signs and symptoms of infection: fever, chills, redness, pain, and swelling, fatigue, weight loss, inc WBC count, formation of pus

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23
Q

do all pts exhibit signs of infection?

A

no, esp older adults and immunocompromised

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24
Q

?what is empirical antibiotic therapy?

A

admin of an antibiotic on the Drs judgement of the pathogens most likely to be causing an apparent infection.
Its presumptive Tx of an infection to avoid treatment delay that occurs before specific bacterial culture information is obtained

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25
when should bacterial cultures be obtained in relation to antibiotic Tx?
before antibiotics because they may obfuscate the results
26
prophylactic antibiotic therapy is given when...
to prevent infection | eg before abdominal Sx
27
what is a therapeutic response to antibiotics?
when theres a dec in the specific signs and symptoms of infection compared w the baseline findings
28
if pt is having diarrhea and Gi discomfort should they stop taking antibiotics?
no, unless severe. these are common side effects.
29
SUBTHERAPEUTIC ANTIbIOTIC THERAPY
when the signs & symptoms don’t improve
30
SUPERINFECTIONS | 2 examples
- can occur when antibiotics completely or reduce normal bacterial flora. eg vaginal yeast infection. occurs when theres an imbalance in vaginal bacterial flora. - Or the normal flora will be replaced by other negative ones eg when a second infection thats bacterial (from an external source) closely follows the first which was viral
31
what colour sputum indicates viral respiratory infection?
green or yellow
32
? two things that contribute to in antibiotic resistance
- pts not finishing their antibiotic regimens | - inappropriate prescription
33
? antibiotic interactions. food-drug and drug-drug
food-drug=milk or cheese with tetracycline | drug-drug=quinolone and antacids
34
what are host specific factors? | 7 exmples
factors that relate to a patient and can hav a significant impact on the success or failure of treatment - age - allergy hx - kidney and liver fx - pregnancy - genetic char - site of infection - host defenses
35
antibiotics; age related host factors for kids
-infants and kids cant take: some (eg tetracycline) affects teeth or bones, fluoroquinolones affect bone or cartilage , sulfonamides can cause hyperbiliruninemia in neonates
36
antibiotics; age related host factors for older adult
the decline in liver and kidney fx means they should get dec dose
37
? which two classes of antibiotics are people often allergic to?
penicillins and sulfonamides
38
what is the worst reaction to an antibiotic?
anaphylactic shock
39
4-5 common severe rxns to antibiotics that must be charted
• Common severe rxns to medication= diff breating, (skin reaction)significant rash, hives, severe gi intolerance im sure anaphylaxis is too but its not common
40
two most common genetic host factors that can adversely affect drug actions (antibiotics)
both of these are a lack in enzymes: - slow acetylators-metabolize the drug more slowly and this leads to toxic buildup - G6PD-admin of sulfonamides, nitrofurantoin, and dapsone may result in hemolysis
41
4 most common mechanisms of action for antibiotics
- interference with bacterial cell wall synthesis - interference with protein synthesis - interference with replication of DNA and RNA - antimetabolite action that disrupts critical metabolic reactions inside the bacterial cell
42
T or F: most antimicrobial drugs only have activity against one TYPE of microbe
true, most only work on one. eg they only work on bacteria or on fungi or protozoans
43
?when you have a question/concern regarding an antibiotic:what should you keep in mind in terms of sources
that the source is up to date because drug indications change frequently as bacterial species become resistant
44
all viruses are obligate intracellular parasites means:
viruses can replicate inside host cells
45
? structure of a virus
- genome (|DNA or RNA but not both), - capsid (protein coat for protection), - envelope (lipoprotein w cell surface antigen proteins which facilitates fusion(when the viral cell attaches to a host cell)
46
viruses can enter the body through 4 routes:
viruses can enter the body through 4 routes: - inhalation, - GI tract, - transplacentally - inoculation via skin or mucous membranes
47
?CYTOPATHIC EFFECT
• CYTOPATHIC EFFECT=the reproduction of viruses etc that usually results in destruction of the host cell
48
?what is VIRAL TRANSFORMATION and what kind of virus would do this?
• VIRAL TRANSFORMATION=involves mutation of the host cell DNA or RNA which can resut in cancerous host cells. This would be done by ONCOGENIC VIRUS.
49
?what is another name for a "silent" viral infection? What is it? An example
• LATENT or dormant infection-more common that transformation =eg HIV that can lay dormant 10yrs before becoming AIDS
50
?VIRULENCE=
the strength of the virus
51
do antivirals generally eradicate the virus within the host?
no probably not, they weaken the virus enough that the hosts immune system can take over
52
how rampant is a viral infection before symptoms appear? how does this affect treatment?
• Often the virus has replicated thousands to millions of times before symptoms appear-makes it hard to treat
53
are their antivirals for most viruses?
no. there are relatively few viruses that can be controlled by current drug therapy
54
how do antivirals work?
they either kill or suppress the virions (mature virus particle) or they inhibit their ability to replicate - they inhibit the virus fusing with or entering the host cell - or interfere w viral nucleic acid synthesis
55
?viruses that can be controlled by drug therapy (6)
``` o cytomegalovirus o hepatitis virus o herpes virus o HIV o Influenza virus o Respiratory syntcytial (RSV) ```
56
why are viruses difficult to treat?
- active viral infections take place within host cells and the antiviral must get inside the cell to attack the virus - it has been historically difficult to develop antiviral drugs that are not overly toxic tothe host cell - the virus has usually replicated millions of times before symptoms are apparent
57
an immunocompromised pt is at greater risk of: | who is at greater risk examples
opportunistic infections | -AIDS, cancer with leukemia or lymphoma, organ transplant recipients
58
antiviral medications are broadly divided into what 2 major categories?
antiviral drus | antiretroviral drugs: for \hiv treatment
59
NSAIDS are generally taken for-
inflammation
60
• Signs and symptoms of inflammation
``` o Redness o Warmth o Pain o Fever o Loss of function ```
61
what are NSAIDS also taken for other than inflammation | ?how is this disorder characterized
rheumatism (characterized by inflammation, degeneration or metabolic derangement of connective tissue struct, esp joints and related struct such as muscles, tendons, bursae, fibrous tissue, and ligaments)
62
Nsaids produce what effects
o Analgesic o Anti-inflammatory o Antiarthritic o Antipyretic activities
63
negative effects of aspirin
- GI intolerance and bleeding | - kidney impairment
64
?how is arachidonic acid implicated in inflammation?
its released from phospholipids in cell membranes in response to a triggering event eg injury. Its then metabolized by either prostaglandin pathway or leukotriene pathway which are both part of the arachidonic pathway. This results in: - inflammation - edema - headache - other pain characteristics fo the body's response to injury or inflammatory illnesses eg arthritis
65
NSAIDS: 4 major categories of carboxylic acids
o Acetic acids o Propionic acids o Pyranocarboxylic acids o Pyrrolizine acids
66
acetic acids eg
acetylsalicylic acid aka aspirin | indomethacin
67
?aspirin comes in:
solid oral dosage forms, chewing gum, enteric coated, rectal suppositories
68
?what has an adjunctive analgesic effect with aspirin?
caffeine
69
?aspirin was first introduced in the
late 1800s
70
a 325mg or 81mg dose of aspirin is used for?
prophylactic therapy for adults w strong risk of dev coronary artery disease or stroke
71
if a pt has strong risk factors for stroke or CAD but no history of either will they be prescribed something for it?
yes. they might be
72
contraindication for salicylates | Why is this?
kids with flulike symptoms | it is strongly assoc w Reye's syndrome
73
what is Reye's syndrome?
acute and potentially life-threatening condition involving progressive neurological deficits that can lead to coma and may involve liver damage -believed to be triggered by viral illnesses like the flu and by salicylate therapy itself in the presence of a viral illness
74
ibuprofen is a type of _______ acid
propionic acid
75
ibuprofen aka
motrin or advil or naproxen or oxaprozin
76
ibuprofen is often used for:
- rheumatoid arthritis - osteoarthritis - primary dysmennorhea - dental pain - musculoskeletal disorders
77
the second most commonly used proprionic acid NSAID is________ does it have gentler side effects than ibuprofen?
naproxen | yes. it has fewer interactions with Ace inhibitors given for HTN
78
tylenol aka
acetaminophen
79
signs of allergic reaction:
hives, swelling, heat, urticaria, rash, pruritus
80
how can you treat a local allergic reaction?
give antihistamines for local. Cold cloths are good as well.
81
pregnancy categories of a drug
* A-no risk to fetus of any abn. Has been tested on pregnant women. * B-can give. No adverse effects typically. Tested on pregnant animals. * C-not enough adequately controlled studies. Not sure if good to give. * D-definite risk to fetus. But benefits may outweigh the risks. * X- do not use. Causes fetal abn.
82
what drug do you use to treat a fever in a child? | how do you dose them?
acetaminophen | mg/kg
83
ibuprofen is pregnancy category__ | can you give it to kids?
C-not enough adequately controlled studies. Not sure if good to give. yes
84
diagnostics done for infection
``` White blood cell count Differential C-Reactive Protein Procalcitonin Identification of an organism Gram stain Culture ```
85
what kills viruses
-disinfectants and immunoglobulins kill viruses | some antivirals may

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