Pharm Flashcards
(171 cards)
1
Q
multidrug-resistant TB
A
TB resistant to INH and RIF
high risk for treatment failure and further acquired drug resistance
refer them to ID specialists and state health departments
2
Q
extensive drug resistant TB
A
MDR (INH and RIF) plus resistance to FQN and at least one other injectable (amikacin, kanamycin, capreomycin)
relatively rare
3
Q
cell wall comparison
A
inner leaflet of outer membrane composed of arabinogalactan and mycolic acids
outer leaflet is composed of extractable phospholipids
4
Q
principles for TB treatment
A
use multiple drugs
prolonged treatment required for successful eradication
patients must be followed closely
5
Q
therapeutic failure
A
positive sputum cultures after 4 months compliant therapy
6
Q
goals of TB treatment
A
convert sputum cultures to negative
prevent the emergence of resistance
assure a complete cure without relapse
7
Q
MOA rifampin
A
inhibits DNA dependent RNAP
suppression of initiation of chain formation in RNA synthesis
bactericidal-kills within macrophages and in caseating granulomas
8
Q
synergism for rifampin
A
isoniazid
shortens course of therapy
9
Q
distribution of rifampin
A
widely distributed
excellent tissue distribution
10
Q
metabolism of rifampin
A
metabolized by deacetylation
autoinduction of metabolism occurs-maximum at 6 doses
11
Q
adverse effects of rifampin
A
transient elevation in serum transaminases
hepatotoxicity (higher risk in alcoholics)
GI upset
hypersensitivity
discoloration of bodily fluids
12
Q
drug interactions for rifampin
A
increase in P450 increased metabolism of warfarin theophylline narcotics oral hypoglycemics steroids (oral contraceptives)
13
Q
place of rifampin in therapy
A
treatment of active TB
2nd line for preventative therapy
14
Q
mechanism of action isoniazid
A
inhibits synthesis of mycolic acid
transported into bacterium-kills actively growing in extracellular, inhibits dormant organisms in macrophages and caseating granulomas
15
Q
metabolism isoniazid
A
primarily by acetylation
monoacetyl hydrazine-important metabolite
16
Q
source of hepatotoxic effects in isoniazid
A
hydroxylated to an electrophilic intermediate
17
Q
rates of acetylation of isoniazid
A
slow or rapid acetylators
slow-higher chance of adverse reactions
Egyptians-slow
Eskimos and Japanese-rapid
18
Q
elimination of isoniazid
A
elimination dependent on acetylator phenotype
19
Q
adverse effects of isoniazid
A
transient elevation in serum transaminases
hepatotoxicity
neurotoxicity
hypersensitivity
20
Q
avoiding neurotoxicity from isoniazid
A
pyridoxine (B6) to reduce incidence
particularly important in alcoholics, children, malnourished, slow acetylators
21
Q
use of isoniazid in therapy
A
treatment of active TB
preventative therapy for patients with +PPD
22
Q
mechanism of action for pyrazinamide
A
not documented
bactericidal toward dormant organisms in acidic environment within macrophages
23
Q
metabolism of pyrazinamide
A
hydrolyzed in liver to active pyrazinoic acid
24
Q
elimination of pyrazinamide
A
5-hydroxypyrazinoic acid excreted by kidneys
25
adverse effects of pyrazinamide
hepatotoxicity
hyperuricemia (decreased renal excretion)
GI upset
hypersensitivity (photosensitivity, rash)
26
mechanism of action for ethambutol
bacteriostatic
27
elimination of ethambutol
elimination of parent compound+inactive metabolite excreted in urine
28
adverse effects ethambutol
optic neuritis (decreased red-green acuity)
monitor every 4-6 weeks
use caution in young children
29
mechanism of action for streptomycin
aminoglycoside antibiotic
bactericidal through protein inhibition
inactive against intracellular organism
alternative to ethambutol
30
absorption of streptomycin
poorly absorbed in GI tract
| administer IV or IM
31
adverse effects for streptomycin
nephrotoxicity (less than other aminoglycosides)
impairment of 8th cranial nerve function (vertigo>hearing)
pain on injection
32
second line agents
```
para-aminosalicylate
ethionamide
cycloserine
capreomycin
kanamycin
amikacin
```
33
rifabutin
rifamycin derivative
used in TB patients who have experienced intolerance to rifampin or experiencing interactions
more active against MAC
34
adverse reactions to rifabutin
```
rash
GI
arthralgias
myalgias
discoloration of urine/sweat/tears
neutropenia
hepatotoxicity
```
35
requirements for rifapentine
with INH in continuation phase
must be HIV negative
must have non-cavitary, drug susceptible pulmonary TB with negative sputum smears at completion of initial phase of treatment
36
mechanism of action clofazamine
causes inhibition of transcription
| used as an antileprosy agent
37
clofazamine adverse reactions
GI upset
severe and life threatening abdominal pain and organ damage from crystal deposition
discoloration of skin and eyes
38
macrolides in TB
unlikely to be effective against TB
| clarithromycin and azithromycin against MAC
39
quinolones in TB
ciprofloxacin and ofloxacin effective against TB
40
RIPE or RIPS
use if >4% resistance
| 6 months for general TB treatment
41
avoid in renal failure
avoid streptomycin, kanamycin, and capreomycin
42
avoid in children
avoid ethambutol
43
suspected treatment failure
add >2 new TB agents
44
lepromatous leprosy
loss of specific cell mediated immunity
45
tuberculoid leprosy
strong cell mediated immunity
46
diagnosis of leprosy
acid-fast stain and cytologic examination of skin
| response to lepromin skin test
47
treatment of leprosy
dapsone/rifampin/clofazimine
| duration for 3-5 years
48
mechanism of action dapsone
competitive inhibitor of folic acid synthesis
inhibition of dihydropteroate synthase which prevents utilization of PABA
bacteriostatic
49
adverse reactions to dapsone
hemolytic anemia
| hypersensitivity
50
MAI
symptoms usually when CD4 <100
prophylaxis at <50
fever, night sweats, weight loss, anemia
51
macrolides in MAC
clarithromycin better than azithromycin
| usually one with ethambutol
52
inflammatory mechanism of asthma
increase mast cells, eosinophils, Th2 cells
| increase histamine, D4, D2 in airway
53
inflammatory mechanism of COPD
increase neutrophils, macrophages, CD8T cells
54
role of space chamber
increase proportion of drug entering airway
| used to decrease oropharyngeal deposition of inhaled corticosteroids
55
albuterol, levalbuterol
B2 agonist with quick onset
| used to reverse asthma/bronchospasm
56
adverse effects of albuterol, levalbuterol
overuse indicates worsening asthma
airway tolerance
tremor, restlessness, tachycardia, hypokalemia
57
epinephrine MOA
A1, A2, B1, B2 agonist
58
adverse effects of epinephrine
palpitations, pale complexion, sweating, tremor, anxiety
59
adverse effects isoproterenol
cardiac stimulation
| non-selective B agonist not used in US
60
salmeterol, formoterol, indacterol
long acting B2 agonists
61
uses for LABA
prophylaxis
not used in acute asthma attack
have to be given with inhaled corticosteroid
62
combination inhalers
more effective than corticosteroids or LABA alone
| increase B2 receptor numbers
63
ipratropium, tiotropium
muscarinic receptor antagonists
do not cross BBB (quaternary amines)
ipra 4x, tio 2x
64
adverse effects ipratropium, tiotropium
```
bitter taste
dry mouth
glaucoma
urinary retention
paradoxical bronchospasm
```
65
methacholine
agonist that is used to diagnose bronchial airway hyperactivity in patients that have asthma
66
theophylline
weak inhibitor of PDE isoforms, bronchodilator, anti-inflammatory activity, inhibits A1
67
metabolism of theophylline
metabolized by p450
| large variations in clearance (intra and inter-individual variability)
68
toxicity of theophylline
headache, nausea, vomiting and restlessness at low dose toxicity
high concentration-cardiac arrhythmias (PDE3), seizurs (A1)
69
beclomethasone, flunisolide, fluticasone, mometasone, triaminolone
maximal benefit may take weeks
| front line therapy for asthma
70
local effects of corticosteroids
dysphonia, cough, oropharyngeal candidiasis
| spacer decreases local adverse effects
71
leukotriene inhibitors
cysteinyl leukotrienes are produced during asthma
72
zafirlukast, montelukast, pranlukast
selective leukotriene receptor antagonist (C4/D4/E4)
73
zileuton
inhibits 5-lipoxygenase (rate limiting enzyme in leukotriene biosynthesis)
74
use of leukotriene inhibitors
reduce occurrence of bronchospasm in response to allergens, cold air, and exercise
75
timing of leukotriene antagonists
monte 1x
| zafir 2x
76
frequency for zileuton
4x/day
77
adverse effects leukotriene inhibitors
hepatic toxicity
HA in zafirlukast
fever and chills in Zileuton
78
MOA cromolyn and nedocromil
mast cell stabilizers
| inhibit mast cell degranulation and histamine release
79
use of cromolyn
asthma and allergic rhinitis
80
MOA omalizumab
anti-IgE
| inhibits binding of IgE to IgE receptors on mast cells
81
adverse effects omalizumab
anaphylaxis
82
use omalizumab
severe asthma not controlled by corticosteroids
83
use alpha-1-proteinase inhibitor
used to inhibit the activity of elastase (due to alpha-1-antitrypsin deficiency)
leads to early onset emphysema
84
opioids for cough
bind mu, suppress in medullary cough center to suppress cough
85
adverse effects from opioids
sedation, constipation, opioid-induced respiratory depression could be troublesome in asthma
86
dextromethorphan MOA
centrally active N-methyl-D-aspartate antagonist
| acts in medullary cough center to suppress cough
87
adverse effects dextromethrophan
hallucinations at high concentrations
88
MOA benzonatate
acts peripherally by inhibiting stretch receptors in respiratory passages and lungs to suppress cough
89
adverse effects benzonatate
dizziness
90
MOA guaifenesin
increase volume and reducing viscosity of secretions in trachea and bronchi
91
adverse guaifenesin
nausea
92
MOA N-acetylcysteine
free sulfhydryl group opens disulfide bond in mucus proteins and lowers mucus viscosity
93
use N-acetylcysteine
acetaminophen overdose
| COPD, CF
94
MOA dornase alpha
DNAse that reduces viscoelasticity of sputum in patients with CF by breaking long extracellular DNA molecules into smaller fragments
95
adverse effects dornase alpha
dyspnea
96
first generation anti-histamines
diphenhydramine, brompheniramine, chlorphenamine
97
second generation anti-histamines
loratidine, cetirizine
98
uses for anti-histamines
allergic rhinitis, sleep aid, urticaria, motion sickness
99
adverse effects for anti-histamines
dizziness, sedation
100
use of diphenhydramine
sleep aid and motion sickness
101
nasal spray ipratropium
rhinorrhea, allergic rhinitis
102
oxymetazoline
alpha1 agonist
103
phenylephrine
selective alpha1 agonist
104
pseudoephedrine
alpha and beta agonist that may also enhance release of norepinephrine
105
indications for adrenergic agonists
decongestants
106
adverse effects of adrenergic agonists
rebound nasal congestion
hypertension
ischemia, peripheral ischemia, angina
107
synthesis of histamine
from histidine by histidine decarboxylase
108
basophils with histamine
blood
109
mast cells with histamine
skin
intestinal mucosa
lung
around blood vessels and nerves
110
non-mast cells with histamine
gastric enterochromaffin cells
epidermis
CNS neurons
111
complex with histamine
```
heparin
chondroitin sulfate
eosinophilic chemotactic factor
neutrophilic factor
proteases
```
112
metabolism of histamine
methylation to from N-methylhistamine
converted to N-methylimidazoleacetic acid by MAO
oxidative deamination by diamine oxidase to imidazole acetic acid
113
metabolites of histamine
imidazole acetic acid
| N-methylhistamine
114
substances that release histamine from mast cells
curare
morphine
venoms
inflammatory mediators
115
histamine from gastric ECL cells
released by acetylcholine and gastrin
116
H1 receptor
smooth muscle, endothelium, brain
Gq
chlorpheniramine antagonist
117
H2 receptor
gastric mucosa, cardiac muscle, mast cells, brain
Gs
ranitidine antagonist
118
H3 receptor
presynaptic brain, myenteric plexus
Gi
thioperamide, clobenpropit antagonist
119
H4 receptor
eosinophils, neutrophils, CD4 T cells
Gi
thioperamide
120
result of histamine in blood vessels
vasodilation-flushing, decrease BP
| indirect-release of NO and PGI2
121
result of histamine in capillary permeability
increase permeability leading to edema
| responsible for urticaria
122
result of histamine in heart
increase rate and force of contraction
123
result of histamine in lungs
bronchoconstriction
124
result of histamine in gastric mucosa
increase acid secretion from parietal cells
125
result of histamine from nerve endings
pruritis from epidermis
| pain and itching from dermis
126
result of histamine from CNS
increased wakefulness and suppresses appetite
127
triple response
red spot-vasodialtion
wheal-increase capillary permeability
flare-axon reflex leading to vasodilation
128
metabolism of loratadine
cyp3A4
129
duration of anti-histamines
second generation longer acting
active metabolites of older drugs
prolonged duration of action and excreted unchanged
130
effects of H1 antagonism
```
reversible competitive
little effect on bronchoconstriction
vasoconstriction
no permeabiltiy
decreased HR
suppresses flare
some relief of atopic dermatitis and contact dermatitis
```
131
strongest muscarinic effect
promethazine
132
muscarinic effect of second generation
none
133
adverse reactions to antihistamines
CNS stimulation seen in poisoning
depression seen in first generation (potentiated by alcohol and CNS depressants)
antimuscarinic effects for 1st generation
GI for 1st generation
134
uses of antihistamines
exudative allergy-rhinitis, urticaria, conjunctivitis
bronchial asthma
systemic anaphylaxis
135
prevent motion sickness
promethazine
136
H2 receptor antagonists
cimetidine
ranitidine
famotidine
137
effects of H2 antagonists
decrease gastric acid secretion
138
adverse effects of H2 antagonists
HA
GI
fatigue, drowsiness
139
pharmacokinetics H2 antagonists
renal excretion
| drug interactions from Cimetidine (inhibits p450)
140
use H2 antagonists
promote healing of peptic or duodenal ulcer
uncomplicated GERD
prophylaxis of stress ulcers
141
use H2 antagonists
promote healing of peptic or duodenal ulcer
uncomplicated GERD
prophylaxis of stress ulcers
142
tidal volume
volume of air inspired and expired during normal quiet breathing
143
inspiratory reserve volume
maximum amount of air that can be inahled after a normal tidal volume inspiration
144
expiratory reserve volume
maximum amount of air that can be exhaled from the resting expiratory level
145
residual volume
volume of air remaining in the lungs at the end of maximum expiration
146
vital capacity
volume of air that can be exhaled from lungs after a maximum inspiration
VC=IRV+TV+ERV
147
inspiratory capacity
maximum amount of air that can be inhaled from the end of a tidal volume
IC=IRV+TV
148
functional residual capacity
volume of air in lungs at the end of TV expiration
elastic force of chest wall balanced by elastic force of lungs
FRC=ERV+RV
149
total lung capacity
volume of air in lungs after maximum inspiration
| TLC=IRV+TV+ERV+RV
150
kussals
rapid shallow breathing
151
emaciation cachectic
malignancy
TB
pulmonary cachexia syndrome
152
obese
sleep apnea syndrome
153
clubbing
widening of AP and lateral diameter of terminal portion of fingers
angle between the nail and skin is greater than 180
periungual skin is stretched and shiny
154
causes of clubbing
```
intrathoracic malignancy (lung, pleural, mediastinal)
suppurative lung disease (abscess, bronchiectasis, empyema)
interstitial fibrosis (alveolar capillary block syndrome)
```
155
atelectasis shift
towards affected side
156
plerual effusion shift
to unaffected side
157
pneumothorax shift
to unaffected side
158
asymmetrical chest expansion
abnormal side expands less
| lags behind the normal side
159
vocal fremitus increased
alveolar consolidation
160
vocal fremitus decreased
increased distance between lung and chest wall
| pneumothorax, pleural effusion
161
increased dullness
atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis
162
hyperresonance
hyperinflation, pneumothorax
163
normal inspiration:expiration ratio
3:1
164
rhonchi
obstruction to airways
| diffuse-asthma or COPD
165
crackles
sound generated from collapsed state
chronic bronchitis, pneumonia, CHF, atelectasis
on inspiration-secretions in bronchi
166
wheezes
correspond to degree of airway obstruction
167
extrathoracic lesion stridor
on inspiration
| laryngomalacia/vocal cord lesions/edema after extubations
168
intrathoracic lesion stridor
on expiration
| tracheomalacia/bronchomalacia/extrinsic compression
169
fixed lesions stridor
croup
paralysis of both vocal cords
laryngeal mass or webs (like Plummer-Vinson?)
170
obstructive ratio
decreased
DLCO may be normal
TLC and RV might be high
171
restrictive ratio
normal
| decreased DLCO
