Pharm Exam 3 Flashcards
(51 cards)
Isoniazid
ANTI TUBERCULAR
Action:
-disrupts cell wall synthesis (inhibits mycotic acid which is the causative agent for TB) and blocks pyridoxine (B6)
-bactericidal
Uses:
-most useful for antitubercular drug
-may be used alone for prophylaxis (preventative measure)
-always included in the treatment plan
Pharmacokinetics:
-well absorbed after oral administration
-rate of acetylation differs among populations
-slow metabolism (less likely to build up)
ADRs:
-peripheral neuropathy (give vitamin B6)
-blood dyscrasias
-hepatitis
-allergic reactions
-GI upset
Implications:
-assess for peripheral neuropathy
-monitor CBC and WBC
-stress importance of completing entire course of drug therapy and taking pyridoxine (B6)
-avoid alcohol
Rifampin
ANTI TUBERCULAR
Action:
-inhibits RNA polymerase = no protein synthesis = metabolic activity in bacteria is stopped
-bactericidal, broad spectrum
-synergistic in combination with Isoniazid (INH)
ADRs
-may turn body fluids orange (salive, urine, teras, sputum)
-flu-like symptoms
-hepatitis (no alcohol)
-allergic reactions
-GI upset
Implications:
-take on empty stomach with full glass of water
-warn patient about change in body fluids
-stress importance of completing entire course
-oral contraceptive may not be effective
Zidovudine
ANTIVIRAL FOR HIV
Action:
-inhibits reverse transcriptase
-NRTIs
-RNA cannot convert to DNA
-no incorporation in host DNA
P. kinetics:
-short-acting
-high fast-pass effect
-fatty meals decrease absorption
ADR:
-GI distress (take w/ food, not fatty food)
-peripheral neuropathy
-hepatotoxicity (check for yellowing, liver size)
-bone marrow suppression (low neutrophils)
-lactic acidosis
TENOFORIR
-new Nuke
-less ADRs
-more potent
Efavirenz
ANTIVIRAL FOR HIV
Action:
-inhibit reverse transcriptase = inhibit viral replication
-NNRTI
-different mechanism to NRTIs -> additive or synergistic effects
-resistance develops rapidly
P. Kinetics:
-oral, 12 hour half life
ADRs:
-GI distress
-CNS (sleep disorders)
-skin rashes
Atazanavir
ANTIVIRAL FOR HIV
Action:
-inhibit protease enzymes that are important for replication
-large precursor proteins are cleaved to shorter, mature protein by an enzymes
-block the enzyme = precursor proteins are not convert to mature proteins
-> immature non-effective virus
-resistance develops rapidly
ADRs:
-GI distress (do not take w/ food)
-hepatoxic
-Metabolic effects
1.hyperglycemia/diabetes
2.fat maldistribution
3.hyperlipidemia
-osteoporosis
-drug to drug interactions (inhibit liver enzymes)
Acyclovir
ANTIVIRAL FOR HERPES
Action:
-activated by viral enzymes (selective action)
-inhibits DNA polymerase = halts viral production
Pharmacokinetics:
-iv, oral, topical
ADR:
-NV
-phlebitis at injection site
-renal damage, nephrotoxicity
Implications:
-teach client to complete full course of therapy
-avoid sexual intercourse if genital herpes are being treated
Oseltamivir
ANTIVIRAL FOR INFLUENZA
Action:
-neuraminidase inhibitor
1.stops viral entry/spread (mucus barrier stays in tact)
2.stops viral release from infected host cell
Pharmacokinetics:
-dosing must begin early (reduces the duration of illness)
ADR:
-NVD
Amphotericin B
ANTI-FUNGAL
Action:
-targets ergosterol of fungal cell membrane (vs host cholesterol)
-fungistatic or fungicidal (depends on concentration)
Use:
-only used in treating progressive and potentially fatal systemic infections due to severe adverse effects (very limited drug, dangerous reactions)
P. kinetics:
-iv, or by slow infusion
ADR:
-patient must start on low doses (build up slow b/c of toxicity)
-fever (give acetaminophen 30 mins prior)
-headache
-NV (give antiemetic 30 mins prior to keep it down)
-renal damage- nephrotoxicity (occurs in 80% of patients)
-anemia, leukopenia
-electrolyte imbalances
Ketoconazole (fungarest)
ANTI-FUNGAL (skin, nails)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Miconazole
ANTI-FUNGAL (superficial like athletes foot, ringworm)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Clotrimazole
ANTI-FUNGAL (superficial like yeast infection)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
-can be used during pregnancy
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Chloroquine
ANTI-MALARIA
Action:
-causes build up of heme within parasitized erythrocytes = parasite death
-can be used for prophylaxis
P. kinetics:
-orally active
-start 1 week before and continue 4 weeks after
ADRs:
-gastric distress
-loss of appetite
-skin rash
-diarrhea
-neurological and psychiatric reactions (headaches, agitation, excitement that can be psychotic/paranoia)
Quinine
ANTI-MALARIA
-used if there is chloroquine-resistant strains
-older drug
ADR
-cinchonism (tinnitus, headache, NV, cardiac irregularities/abnormalities)
Poliomyelitis
KILLED/INACTIVATED VACCINE
Action:
-inactivated -> not virulent but still antigenic
-advantages: very safe, no risk of mutating to virulent form, no need to refrigerate (attenuated = safe)
-disadvantages: weaker response, need larger doses, boosters
P. Kinetics:
-series of shots (2,4,6 mo, 4-6 y)
-pathogen is artificially introduced in modified for to prime immune system -> future protection
-practically eliminated globally
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
MMR
LIVE ATTENUATED VACCINE (LAV)
Action:
-live (still has ability to reproduce), attenuated (weakened)
-low or no virulence but still antigenic
-good immune response since it is still alive -> increased virulence = enhanced immunity
-B and T cell immunity, few boosters needed
Disadvantages:
-risk for reversion to virulent form (mutation = virus is back)
-not suitable for weak immune system (care in corticosteroids, cancer chemotherapy, leukemias, lymphomas, advanced HIV)
-not in pregnancy
-need for refrigeration (to maintain ability to reproduce)
-CI for immunocompromised
P. Kinetics:
-at 12-15 months, second dose 4-6 years
-CI for immunocompromised
-does NOT cause autism
-check for allergies to eggs, gelatin, neomycin
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
Hep B
SUBUNIT VACCINE
Action:
-newer
-only use antigenic part of microbe, eg. proteins in the viral envelope (take sub-unit of pathogen)
-very safe (only protein is being injected)
Disadvantages:
-difficult to develop
-usually weaker response
-low immunological memory, need boosters
P. Kinetics:
-protein from viral envelope
-at birth and boosters (0, 2, 4 mo)
-baker’s yeast (be careful if allergic to yeast)
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
COVID-19
mRNA VACCINE
P. Kinetics:
-mRNA that codes for the spike protein, nucleotides/sequence is reversed -> immunity
-need boosters
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
DTap
TOXOID VACCINE
Action:
-some bacteria release a toxin that creates a problem, rather than the bacteria being the problem
-toxoids take toxins and alter them, so that they are no longer toxic but still antigenic
-diphtheria toxoid: creates covering of throat -> difficulty breathing
-tetanus toxoid (paralyzes jaw -> lock jaw)
-acellular pertussis vaccine (whooping cough)
P. Kinetics:
-series of shots (2,4,6,18 mo, 4-6 yrs)
-then tetanus booster every 10 years
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
Hydrochlorothiazide
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-thiazide diuretic (promotes urine)
-inhibits reabsorption of sodium, so it gets excreted
-for hypertension and edema
-decreased BV = decreased BP/afterload/work
-inhibits tubular reabsorption of sodium
-sodium excreted, water follows, causing dieresis
-monotherapy
-also used in combination with other antihypertensives to prevent rebound fluid retention
ADRs:
-hypotension/postural hypotension
-hyponatremia, hypokalemia, dehydration
-hyperglycemia, hyperuricemia, hypercholesterolemia
-take in morning for easy urination throughout day
-GI upset (take with food)
Captopril
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II
ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)
Enalapril
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II
-longer acting than captopril
ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)
Losartan
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-blocks angiotensin II receptors = blocked vasoconstriction and blocked aldosterone release
ADRs:
Hypotension/postural hypotension
Aliskiren
ANTI-HYPERTENSIVE
Action:
-direct renin inhibitors (blocks angiotensinogen from converting to angiotensin I)
-PO, do not take with food
ADRs:
-generally well tolerated but hypotension/postural hypotension
Propranolol
ANTI-HYPERTENSIVE
Action:
-non-selective beta blocker
-act on BOTH lungs and heart
CI:
-asthma, COPD, smokers b/c of the bronchoconstriction
ADRs:
-hypotension/postural hypotension
-bradycardia (HR<60, report! decrease dose, increase interval)
-impaired exercise tolerance
-edema, monitor weight (fluid retention) +thiazide
-NVD, take w/ food
-CNS (fatigue, depression, nightmares, sexual dysfunction)
-bronchospasm (narrowed airways)
-diabetes
-allergic reactions
