Pharmacology Flashcards by Natsumi Seki

Q

Drugs easily displaced from albumins –> ____ plasma drug level

A

INCREASE

Sulfonamides
Phenylbutazone
Tolbutamide
Coumarin

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Q

Drugs that induce P450 –> _____ plasma drug levels

A

DECREASE

Alcohol
Barbiturates
Phenytoin
Rifampicin

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Q

Drugs that inhibit P450 –> ______ plasma drug levels

A

INCREASE

Chloramphenicol
Sulfonamides
Phenylbutazone

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Q

Drugs that compete for renal transporters –> ______ plasma drug levels

A

INCREASE

Uric acid
Probenecid
Penicillins
Sulfonamides
Salicylates
Thiazides

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Q

Risk of severe hemorrhage if coumarins are combined with

A

any other drug that competes for albumin

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Q

_______ displace sulfonureas from albumin leading –> hypoglycemia

A

Sulfonamides

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Q

What is the effect of Barbiturates on MAO-I?

A

induce P450 enzymes –> enhanced metabolism of MAO inhibitors –> ineffective tx of depression

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Q

What effect does P450 induction have on estrogen?

A

It enhances estrogen metabolism, which reduces oral contraceptive effects

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Q

What effect do steroids have on MAO-I?

A

they compete with MAO-I for P450 enzymes –> reduced metabolism of MAO-I –> risk of OD

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Q

NEVER combine aminoglycosides with:

A

Neuromuscular blockers (enhanced block)

- Loop diuretics (compounds ototoxicity)

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Q

NEVER combine MAO-I with:

A

Levadopa (HTN crisis)
Amphetamine (HTN crisis)
Tricyclic antidepressants

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Q

Famous SE of Penicillin

A

Anaphylactic shock

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Q

Famous SE of Isoniazid

A

Hepatotoxicity

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Q

Famous SE of Cyclosporin

A

Renal toxicity

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Q

Famous SE of Aminoglycosides (Neomycin)

A

Ototoxicity

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Q

Famous SE of Hydralazine

A

Drug-induced Lupus

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Q

Famous SE of Tetracyclines (Doxycycline, Minocycline)

A

Photosensitivity (skin)

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Q

Cutaneous flushing is a famous SE cz’d by

A

Niacin

Niacins is also HEPATOTOXIC

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Q

Famous SE of Zidovudine aka Azidothymidine (AZT)

A

Bone marrow suppression

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Q

Antidote to Acetominophen intoxication

A

NAC

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Q

Antidote to Opiate intoxication

A

Naloxone

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Q

Antidote to Benzo intoxication

A

Flumazenil

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Q

Antidote to Methanol or Ethylene Glycol intoxication

A

Ethanol

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Q

Antidote to CO intoxication

A

100% O2

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Antidote to Cyanide intoxication

Amyl nitrate

Antidote to Organophosphate intoxication

- Atropine | - Pralidoxime

Antidote to iron intoxication

deferoxamine

Antidote to lead intoxication

EDTA

Antidote to coumarin intoxication

Vitamin K

Antidote to Heparin intoxication

Protamine

What does alpha-1 do?

- Tubules - Tightening/contraction of b.v. - Paralysis/relaxation of GI tube

What does alpha-2 do?

- Affects CNS | - Emergency break on SNS

What does Beta-1 do?

- Pro-sympathetic | - Affects heart

What does Beta-2 do?

- Pro-sympathetic | - Affects lungs

What ADR can B6 cause?

peripheral neuropathy

MOA of statins

HMG-CoA reductase inhibitors

Simvastatin and Atorvastatin

- Class: Statins (lipid-lowering agent) - MOA: HMG-CoA reductase inhibitors - give CoQ10! - ADR: rhabdomyolysis

What labs should you check with statins rx?

Check AST and ALT prior to Rx and 6 weeks post-Rx

Common and serious ADR of statins

Rhabdomyolysis *d/c statins if pt. has mm. pain, even if LFTs are normal

Colesevelam

- Class: Bile sequesterant (lipid-lowering agent) - MOA: combines w/ bile to form insoluble compound that is then excreted - ADR: constipation, fecal impaction, abdominal pain, nausea

Gemfibrozil

- Class: Fibrates (lipid-lowering agent) - MOA: inhibits peripheral lypolysis, decr. hepatic FFA extraction, inhibits synthesis and incr. clearance of VLDL carrier Apo B - ADR: often hepatotoxic (so falling out of favor)

When would you use carbonic anhydrase inhibitors? MOA?

Emergency situations This diuretic works by blocking HCO3 reabsorption in the proximal convoluted tubule --> resorbs 67% Na and H20 (A LOT!)

Furosemide

- Class: Loop Diuretic - MOA: works at ascending loop of Henle and resorbs 25% Na - ADR: hypokalemia (K+ wasting) and hyperglycemia

Hydrochlorothiazide

- Class: Thiazide diuretic - MOA: works at the distal tubule/collecting duct via Na-Cl transporter and resorbs 8% Na - ADR: hypokalemia (K+ wasting) and hyperglycemia

Hydrochlorothiazide is C/I in pt with a hypersensitivity to _____

sulfonamide drugs

1st line drugs for HTN

HCTZ (thiazide diuretics)

How to loop diuretics and thiazide diuretics affect blood sugar?

cause hyperglycemia

Triamterene

- Class: Potassium sparing diuretic - MOA: acts on distal tubules - ADR: HYPERkalemia

Why do you commonly use HCTZ and Triamterene together?

HCTZ is a potassium wasting diuretic and Triamterene is a potassium sparing diuretic so they can balance each other out

Spironolactone

- Class: Potassium sparing diuretic - MOA: Acts on distal tubule; aldosterone receptor antagonist - ADR: HYPERkalemia Note: also used for PCOS

Atenolol

- Class: Beta blocker (selective) - MOA: acts on B1 adrenergic receptor - ADR: fatigue, bronchospasm, hypotension, bradycardia **Abrupt discontinuation is dangerous

Carvedilol

- Class: Beta blocker (non-selective) - MOA: acts on B1 and B2 adrenergic receptors - ADR: fatigue, hypotension, bradycardia **Abrupt discontinuation is dangerous

Propanolol

- Class: Beta blocker (non-selective) - MOA: acts on B1 and B2 adrenergic receptors - ADR: fatigue, hypotension, bradycardia **Abrupt discontinuation is dangerous

Carvedilol

- Class: Beta blocker (non-selective) - MOA: acts on B1 and B2 adrenergic receptors - ADR: fatigue, hypotension, bradycardia **Abrupt discontinuation is dangerous

Propanolol

- Class: Beta blocker (non-selective) - MOA: acts on B1 and B2 adrenergic receptors - ADR: fatigue, hypotension, bradycardia **Abrupt discontinuation is dangerous

Timolol

- Class: Beta blocker (non-selective) - MOA: acts on B1 and B2 adrenergic receptors - ADR: fatigue, hypotension, bradycardia **Abrupt discontinuation is dangerous

What is a common off-label use for B1 and B2 adrenergic receptor blockers?

migraines

Diltiazem

- Class: CCB - MOA: makes Ca++ plateau shorter --> weakening the pump - ADR: CHF

Verapamil

- Class: CCB - MOA: makes Ca++ plateau shorter --> weakening the pump - ADR: CHF

Amlodipine

- Class: CCB - MOA: makes Ca++ plateau shorter --> weakening the pump - ADR: CHF

If a pt with CHF needs to be put on an antihypertensive drug, which drug class should be avoided?

CCB

What drug interaction do the CCBs have?

increase levels of cimetidine (H2 receptor antagonist)

What affect to all of the angiotensin agents (ACE-I and ARBs) have on potassium?

the sequester potassium | K+ sparing

Lisinopril

- Class: ACE-I - MOA: inhibit angiotensin converting enzyme in the lungs - ADR: dry, persistent cough; hyperkalemia

What is a big C/I for ACE-I?

Pregnancy (b/c it can affect fetal lung development)

Ramipril

- Class: ACE-I - MOA: inhibit angiotensin converting enzyme in the lungs - ADR: dry, persistent cough; hyperkalemia

Irbesartan

- Class: ARB - MOA: inhibit ANG-2 receptors - ADR: hyperkalemia **exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

Losartan

- Class: ARB - MOA: inhibit ANG-2 receptors - ADR: hyperkalemia **exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

Clonidine

- Class: Alpha-2 Agonist Anti-hypertensive - MOA: alpha-2 is an emergency break SNS **this drug is used in emergency HTN crisis situations!

What is the typical dose of Reserpine?

0. 1 - 0.25 mg BID * impt to know this because they may asl question about how to dose Rauwolfia serpentina tincture (the extract will be standardized to mg reserpine)

Famous SE of NSAIDs

*Renal toxicity | Hepatotoxicity

Famous SE of Sulfonamides (Sulfamethoxazole, Sulfacetamide)

Photosensitivity (skin) | Hemolysis in pt. with G6PD-deficiency

Famous SE of Sulfonylureas (Glyburide)

Photosensitivity (skin)

Valsartan

- Class: ARB - MOA: inhibit ANG-2 receptors - ADR: hyperkalemia **exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

Do not give ________ to pt with G6PD-deficiency because it may cause hemolysis

Sulfonamides (Sulfamethoxazole, Sulfacetamide)

Warfarin

- Class: Anti-thrombotic, Anti-coagulation - MOA: Vit K antagonist; acts on EXTRINSIC factors 2, 7, 9, 10 - ADR: Prolonged bleeding, hemorrhage

What do you need to monitor when pt is on warfarin?

prothrombin time (PT) *from PT you can derive prothrombin ratio (PR) and international normalized ratio (INR)

Heparin

- Class: Anti-thrombotic, Anti-coagulation - MOA: inhibits clotting factors by binding to antithrombin III (AT3); affects thrombin and fibrin; works downstream and doesn't affect Vit K - ADR: Hemorrhage * MC injection (SC) - IV is given to tx thromboembolism

Clopidogrel

- Class: Anti-thrombotic, Anti-coagulation - MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2) - ADR: Bleeding, Neutropenia, TTP

Aspirin

- Class: Anti-thrombotic, Anti-coagulation, NSAID - MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2) - ADR: Bleeding and salicylism (OD)

What is salicylism and how does it present?

OD of aspirin characterized by acid-base disturbances, electrolyte imbalance and CNS effects s/sx: tinnitus, deafness, N/V; early CNS stimulation (hyperkinetic agitation, excitement, mania, delirium, convulsions); later CNS depression (stupor and coma)

Digoxin

- Class: Class I Antiarrhythmic - MOA: cardiac glycoside that inhibits Na-K pump and increases intracellular Ca++ --> contraction is stronger; also increase PNS flow and SA and AV nodes --> decreased HR - ADR: death (problem is digoxin works everywhere in body so if dose is too high or brain is affected it can result in death)

Sx of Digoxin toxicity

fatigue, mm. weakness, agitation, anorexia, nausea, *yellow halos around vision

If a pt presents on digitalis/digoxin what should you always choose as an answer if available?

monitor their blood levels of digitalis/digoxin this should be done first!

Quinine/Quinidine toxicity

Cinchonism S/Sx: tinnitus, hearing loss, HA, nausea, dizziness, vertigo, visual changes

What are the 3 primary indications for Beta blockers in cardiology?

Antihypertensive, Antiarrhythmic, Antianginal

What are the 3 primary indications for CCB in cardiology?

Antihypertensive, Antiarrhythmic, Antianginal

Class I antiarrhythmics

Digoxin

Class II antiarrhythmics

BB

Class III antiarrhythmics

Amiodarone

Class IV antiarrhythmics

CCB

Amiodarone

Class: Class III Antiarrhythmic MOA: delays repolarization and prolongs AP ADR: VERY toxic w/ many ADR; most severe is lung toxicity (often leads to death); rare, fatal liver toxicity

If NTG relieves chest pain, what does that indicate?

Anginal pain is the only thing relieved by NTG and will be relieved w/in 2-3 min of taking SL NTG

Nitroglycerin (NTG)

Class: Anti-anginal MOA: increases blood supply to heart ADR: MAJOR headache

Pt. went to ER for angina and was prescribed a bunch of new meds. A week later the start having new-onset, severe HA. What is the most likely cause?

NTG

Anti-anginal drugs

- NTG - BB: Atenolol, Metoprolol, Carvedilol, Propranolol, Timolol - CCB: Diltiazem, Verapamil, Amlodipine

Fexofenadine

- Class: OTC antihistamine - MOA: H1C receptor antagonist - Non-sedating (doesn't cross BBB)

Loratadine

- Class: OTC antihistamine - MOA: H1 receptor antagonist - Non-sedating (doesn't cross BBB)

Cetirizine

- Class: OTC antihistamine - MOA: H1 receptor antagonist - Non-sedating (doesn't cross BBB)

Diphenhydramine

- Class: OTC antihistamine - MOA: H1 receptor antagonist - ADR: SEDATION (b/c crosses BBB), seizures, thrombocytopenia, agranulocytosis *can also use for insomnia

Promethazine

- Class: OTC antihistamine - MOA: H1 receptor antagonist - ADR: SEDATION (b/c crosses BBB) * *BB warning = respiratory distress and gangrene (if injected) *also used for motion sickness and N/V

It is C/I to combine Fexofenadine with

erythromycin, ketoconazole, or itraconazole d/t potential of FATAL arrhythmias

It is C/I to combine Diphenhydramine with

CNS depressants or MAO-I

Hydroxyzine

- Class: Antihistamine; Anxiolytic; Sedative/Hypnotic - MOA: H1 Receptor Antagonist - ADR: Drowsiness, xerostomia, blurred vision - also used for preoperative sedation

It is C/I to combine Hydroxyzine with

CNS depressants *also C/I in pregnancy and lactation

Epinephrine

- Class: Sympathomimetic (bronchodilator) - MOA: vasoconstriction via alpha-1 receptor and vasodilation via beta-2 receptor - ADR: cerebral hemorrhage, CVA, Vfib *although it can be used for acute asthma, it is less preferred b/c it has such global action on ANS

Epinephrine is C/I with

Acute-closure glaucoma

What are the only two drugs that can be used acute asthma attack?

Albuterol (preferred) | Epinephrine

Dextroamphetamine

- Class: Sympathomimetic - MOA: Release NE and Dopa For ADD, PD, Narcolepsy. Used to be used for respiratory stuff but isn't best option anymore.

Pseudoephedrine

- Class: Sympathomimetic (Decongestant) - MOA: Stimulates alpha-1 receptor --> vasoconstriction - ADR: HTN, anxiety, palpitations, HA, insomnia (not as bad as amphetamines)

Pseudoephedrine is C/I with

MAO-I

Oxymetazoline

- Class: Sympathomimetic (Decongestant) - MOA: Stimulates alpha-1 receptor --> vasoconstriction - ADR: anaphylaxis, arrhythmia, asthmatic episode; REBOUND CONGESTION **Primarily used at OTC nasal spray or eye drop

Phenylephrine

- Class: Sympathomimetic (Decongestant and Hypotension) - MOA: Stimulates alpha-1 receptor --> vasoconstriction - ADR: arrhythmia, anaphylaxis, asthmatic episodes, HA

The decongestant Phenylephrine is C/I with

MAO-I and also in severe HTN | FYI: in addition to being a decongestant it is used to tx HYPOtension

Albuterol

Class: Bronchodilator (SABA) MOA: B2 adrenergic agonist --> bronchodilation ADR: nervousness, tremor, tachycardia, HA, palpitations, N/V, BRONCHOSPASM

Albuterol should not be used with

CNS stimulants

Onset of albuterol is _______ and it lasts ______

Onset: 15 min Lasts: 3-4 hr

Atropine

Class: Bronchodilator (parasympatholytic) MOA: Muscarinic antagonist ADR: dry mouth, tachycardia, some CNS effects **used for EMERGENCY bronchodilation as an injectable

When do you use atropine as a bronchodilator?

in an EMERGENCY to back up epinephrine... Epi is a sympathomimetic and Atropine is a parasympatholytic

Guaifenesin

Class: Mucolytic MOA: decreases viscosity of secretions (OTC)

Fluticasone

- Class: Corticosteroid (Respiratory inhalent) - MOA: potent vasoconstrictive and anti-inflammatory - ADR: oropharyngeal candidiasis - nasal tx and prophylaxis of allergic rhinitis, nasal polyps

MC inhaled steroid

Fluticasone

Fluticasone C/I

- Hypersensitivity to milk proteins (may result in anaphylaxis, angioedema, rash, urticaria) - Status asthmaticus, acute bronchospasms

Mantoux test/PPD skin test

inject 0.1 mL intradermally and result is read 48-72 hr after administration; positive in 10 mm induration MOA: antigenic purified protein derivative (PPD) of Mycobacterium tuberculosis

Isoniazid (INH)

- Class: Isonicotinic acid; Antitubucular Agents - MOA: mycolic acid synthesis inhibition - ADR: hepatotoxicity (10-20%)

Isoniazid inhibits _______ and decreases metabolism of _______.

P450 | Phenytoin

Cromolyn Sodium

- Class: Mast cell stabilizers, Inhaled - MOA: prevents degranulation of mast cells - ADR: throat irritation **ONLY used for prophylaxis, NOT in an acute situation

Ipatropium Bromide

- Class: Anticholinergic Bronchodilator (parasympatholytic), Inhaled - MOA: Muscarinic antagonist - ADR: arrhythmia (not used much anymore d/t high risk of this SE) - Primarily for maintenance in COPD and asthma; NOT for acute attack

Tiotropium Bromide

- Class: Anticholinergic Bronchodilator (parasympatholytic), Inhaled - MOA: Muscarinic antagonist - ADR: arrhythmia - Primarily for maintenance in COPD and asthma; NOT for acute attack

Salmeterol

- Class: Bronchodilator, Inhaled - MOA: LABA(agonist) - ADR: asthma-related DEATH (huge issue w/ LABA if pt misses a dose - SUDDEN REBOUND ASTHMA ATTACK)

Montelukast Sodium

- Class: Antiasthmatic - MOA: Leukotriene receptor antagonist - maintenance of asthma and prophylaxis of exercise-induced asthma; allergic rhinitis (2nd line)

Metabolism of Montelukast Sodium is increased with

Phenytoin

Peripheral edema may occur if Montelukast Sodium is mixed with _______

Prednisone

Name two opiate cough suppressants and what their primary ADR is

Codeine and Hydrocodone (in cough syrup) ADR: respiratory distress

Dextromethorphan

Class: non-narcotic central antitussive MOA: suppresses medullary cough center ADR: robo-trippin' if OD

If Dextromethorphan is mixed with Fluoxetine it can cause

serotoninergic syndrome

If Dextromethorphan is mixed with Trazadone it may cause

serotonin syndrome

If Dextromethorphan is mixed with Phenelzine it may cause

Hypertensive crisis

Drugs that can cause Hemolytic Uremic Syndrome

Chemo, Tacrolimus, Oral contraceptives

Pentoxifylline

- Class: Hematologic agent - MOA: reduces blood viscosity by increasing deformability of leukocytes and erythrocytes; improves microcirculation - ADR: angina, arrhythmias, hepatitis, blood dyscrasias, hypotension

Combining Pentoxifylline with ________ can increase the risk of ADRs

Ciprofloxacin ADR: N/V, dizziness, HA, flushing, angina, palpitations, arrhythmias, hepatitis, jaundice, blood dycrasias, sleep disturbance, hypotension, thrombocytopenia, intrahepatic cholestasis

Deferoxamine

- Class: Iron Chelating Agent - MOA: forms a complex with iron and is excreted through kidneys - ADR: blue fingernails, lips, skin

ADRs of Deferoxamine are more likely when combine with _______ or ________

Prochlorperazine or Vitamin C ADR: blue nails/lips/skin, blurred vision, seizures, dyspnea, tachypnea, tachycardia, hearing problems, flushing of skin

Nystatin

- Class: Antifungal - MOA: disrupts fungal cell wall - ADR: contact derm - Candida **Good topical/GI agent but not absorbed well into systemic circulation

Fluconazole

- Class: Systemic antifungal - MOA: decreases ergosterol synth by inhibiting fungal P450, degrading fungal cell wall - ADR: liver damage (b/c we also have P450) **do not take this with any other hepatotoxic drugs

Ketoconazole

- Class: Systemic antifungal - MOA: decreases ergosterol synth by inhibiting fungal P450, degrading fungal cell wall - ADR: liver damage (b/c we also have P450) **do not take this with any other hepatotoxic drugs

Terbinafine

- Class: Antifungal - MOA: inhibits squalene epoxidase, reducing fungal cell membrane ergosterol synthesis - For toenail fungus - Oral or topical

Permethrin

- Class: Antiparasitic - MOA: disrupts Na++ current in parasite --> paralysis - ADR: seizures*, irritation, CNS toxicity - Lice and scabies *not a typical SE but if kiddo drinks this topical medication they can die

Mebendazole

- Class: Antihelminthic - MOA: starves worms of nutrients - ADR: abdominal pain, diarrhea, fever (dead worms are antigenic, which is actual cz of SE- fiber helps move worms along) - pinworms, roundworms, hook works *Need to repeat drug a second round to also get cyst forms

Metronidazole

- Class: Antiprotazoal - MOA: inhibits DNA synthesis of microorganisms - ADR: GI distress, seizures, ataxia, jt pn - Amoebas, Trichomoniasis, Giardia, Bacterial vaginosis

You should NEVER take Metronidazole with _______

EtOH Will make pt VERY ill, vomiting, can lead to liver failure **This is a COMMON board question

Hydroxychloroquine

- Class: Antiprotazoal, DMARD - MOA: impairs complement-dependent antigen-antibody rxn - ADR: Cinchonism (vertigo, tinnitus, vision change, dizziness) - tx malaria, SLE, RA

What antibiotics are safe during lactation/in kiddos?

- Penicillin: penicillin, ampicillin, amoxicillin, amoxicillin + clavulanate - Macrolides: erythromycin, clarithromycin, azithromycin - Cephalosporins: cephalexin, cefuroxime, cefdinir, ceftriaxone

What antibiotics should you avoid during lactation/in kiddos?

- Tetracyclines: doxycycline, minocycline | - Fluoroquinolones: ciprofloxacin, levofloxacin

Which antibiotics should be avoided in infants with G6PD deficiency?

- Sulfonamides: Sulfamethoxazole/Trimethoprine | - Nitrofurantoin

Gentamicin

- Class: Aminoglycosides (antibiotic) - MOA: Bactericidal; binds 30S subunit inhibiting protein synthesis - ADR: Severe ototoxicity - internal or eye drops - Used in 'hospital-severe' infx cz'd by gram negative, Pseudomonas auerginosa

Cephalexin

- Class: 1st Gen Cephalosporin (B-lactam antibiotic) - MOA: Bactericidal, inhibits cell wall synthesis - Broad spectrum. Work esp. well against Staph aur. and Strep. infx *1st Gen are active against most Gm+ and some Gm- bacteria

Cephalexin interacts with ________ results in _________

Metformin | Sx of low blood sugar

Pt should not take Cephalosporins if they are allergic to _______

Penicillins | esp. if they have had an anaphylactic rxn to Penicillin

Cefuroxine

- Class: 2nd Gen Cephalosporin (B-lactam antibiotic) - MOA: Bactericidal, inhibits cell wall synthesis - Drug of choice to tx H. influenza and lower respiratory tx infx *2nd Gen are active against are less active against Gm+ than 1st Gen but have broader Gm- action

Cefdinir

- Class: 3rd Gen Cephalosporin (B-lactam antibiotic) - MOA: Bactericidal, inhibits cell wall synthesis *3rd Gen have widest Gm- activity of cephalosporins

Ceftriaxone

- Class: 3rd Gen Cephalosporin (B-lactam antibiotic) - MOA: Bactericidal, inhibits cell wall synthesis - commonly used to tx serious infx at home *3rd Gen have widest Gm- activity of cephalosporins

Penicillin VK

- Class: Penicillins (B-lactam antibiotic) - MOA: Inhibit cell wall synthesis - ADR: diarrhea, oral candidiasis, black hairy tongue - 1' works on Gm+: Strep., Pneumococcal, Staph.

Amoxicillin

- Class: Penicillins (B-lactam antibiotic) - MOA: Inhibit cell wall synthesis - ADR: hyperactivity, insomnia, rash, exfoliative dermatitis, hypersensitivity vasculitis - Listeria meningitis, otitis media, peptic ulcers (H. pylori), UTI's, Salmonella

Ampicillin

- Class: Penicillins (B-lactam antibiotic) - MOA: Inhibit cell wall synthesis - ADR: hypersensitivity, SJS, hemolytic anemia, thrombocytopenia purpura - Bacterial infx, meningitis, endocarditis (tx and prophylaxis), typhoid fever, anthrax

Amoxicillin + Clavulanate

- Class: Penicillin (B-lactam antibiotic) - MOA: inhibits cell wall synthesis and Clav. is effective against B-lactamase producing organisms - bacterial infx, community acquired pneumonia, bacterial sinusitis

Erythromycin

- Class: Macrolide antibiotic - MOA: interferes with bacterial DNA synthesis - ADR: abdominal pn, N/V, diarrhea - M. pneumo, pertussis, neonatal C. pneumo, Strep throat, URI

Are macrolides safe in pregnancy?

- Erythromycin is C/I - Clarithromycin is Class C - Azithromycin is Class B

Clarithromycin

- Class: Macrolide antibiotic - MOA: interferes with bacterial DNA synthesis - Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid

Azithromycin

- Class: Macrolide antibiotic - MOA: interferes with bacterial DNA synthesis - Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid (

Doxycycline

- Class: Tetracycline antibiotic - MOA: interferes with bacteria protein synthesis - ADR: intracranial HTN, photosensitivity, dental staining, affects bone development - Chlamydia, Lyme dz, Sebulytic (acne)...and everything covered by macrolides, penicillins, B-lactams

Minocycline

- Class: Tetracycline antibiotic - MOA: interferes with bacteria protein synthesis - ADR: intracranial HTN, photosensitivity, dental staining, affects bone development - Chlamydia, Lyme dz, Sebulytic (acne)...and everything covered by macrolides, penicillins, B-lactams

Are tetracyclines C/I in pregnancy?

Use during 1st trimester is controversial

Are tetracyclines C/I in children?

Try to avoid using them in lactation and kids d/t risks of dental staining and adverse effects on bone development

Sulfamethoxazole/Trimethoprine

- Class: Sulfonamide Antibiotic - MOA: Bacteriostatic (not -cidal); interfere with bacterial folic acid synthesis - oldest antibiotic and lots of people are sensitive to it, MANY ADR (SJS, toxic epidermal necrolysis) - UTI, OM, URI, Pneumocystis carinii, Traveler's diarrhea

Nitrofurantoin

- Class: Nitrofurantoin Antibiotic | * only used for UTI (kills E. coli very well)

Is Nitrofurantoin safe in pregnancy?

Absolute C/I in 3rd trimester b/c if baby is born with Nitro in system it can cz hemolysis of the newborn However, it's used all the time in the 1st trimester

Clindamycin

- Class: Lincosamide Antibiotic - MOA: interferes w/ process of peptide elongation in bacterial protein synthesis * Alternative to penicillin

Ciprofloxacin

- Class: Fluoroquinolones - MOA: Bactericidal; interferes w/ DNA synthesis - ADR: tendon pathology, Achilles tendon rupture - Wide spectrum

Levofloxacin

- Class: Fluoroquinolones - MOA: Bactericidal; interferes w/ DNA synthesis - ADR: tendon pathology, Achilles tendon rupture - Wide spectrum

Is it safe to use fluoroquinolones in kids?

do NOT use in kids < 18 y/o d/t risk of arresting growth plates

Isoniazid

- Class: Antituberculosis (antibiotic) - MOA: inhibit cell wall synthesis of Mycobacterium tuberculosis - ADR: Hepatotoxic; **Many serious SE but better than dying from TB - 1st line - take drug for 6-18 mo.

Rifampin

- Class: Antituberculosis (antibiotic) - MOA: impaires RNA synthesis - ADR: Hepatotoxic; **Many serious SE but better than dying from TB - 2nd line - take drug for 6-18 mo.

1st line tx for TB

Isoniazid

2nd line tx for TB

Rifampin

What nutrient should you give when txing TB with Isoniazid or Rifampin?

B6 (Pyridoxine) both drugs deplete it

Mupirocin

- Class: Topical antibiotic - MOA: bacterial RNA inhibition - Impetigo, MRSA

What is a common risk with neomycin?

Contact dermatitis

Triple antibiotic (Neomycin, Polymyxin B, Bacitracin)

- Class: Topical antibiotic | - ADR: allergic contact dermatitis and hypersensitivity (do not use in eyes or on large areas of body)

Amantadine

- Class: Antiviral, Antiparkinsonian (anticholinergic) - MOA: weak dopamine agonist; non-competitive inhibition of NMDA; prevents release of infectious viral nucleic acid - ADR: Anti-SLUDE; seizures, psychosis, hallucination - Herpes zoster in immunocompromised; Parkinson's dz

Amantadine is C/I with

CNS stimulants, narrow-angle glaucoma, seizure d/o, lactation, Pregnancy C

Acyclovir

- Class: Antiviral, Nucleoside analogue - MOA: Inhibits viral multiplication by interfering w/ DNA synthesis - only enters cells with surface markers for HHV family

Which antivirals are safe in lactating women?

Acyclovir and Valacyclovir

Which antivirals are not safe in lactating women?

Amantadine

Valacyclovir

- Class: Antiviral, Nucleoside analogue - MOA: Inhibits viral multiplication by interfering w/ DNA synthesis - only enters cells with surface markers for HHV family * metabolizes into acyclovir but requires lower doses b/c of the reverse 1st pass effect

Interferon, Alpha

- Class: Antiviral, Antineoplastic - MOA: bind to cell surface receptors and block viral protein synthesis - ADR: "INF ALPHA" (Inhibit bone marrow, Neurotoxicity, Flu-like sx, Autoimmune d/o, Liver enzyme elevations, Proteinuria, Hypotn, Alopecia). **Tx Hep B and C, genital warts (HPV), CA (leukemia, AID-related Kaposi's sarcoma, Malignant melanoma)

Interferon, Beta

- Class: Antiviral, Antineoplastic | * Pretty much just used to tx multiple sclerosis

Although Interferon-Alpha is indicated in chronic Hep B and C tx, it is C/I in ________

AI hepatitis and hepatic decompensation

Oseltamivir

- Class: Antiviral - MOA: selective competitive inhibitor of neuraminidase (enzyme needed for viral replication) of Influenza A and B - prevention and tx of Influ A and B; although resistant to H1N1 strain

Zidovudine

- Class: Antiretroviral - MOA: Nucleotide Reverse Transcriptase Inhibitor; inhibits DNA replication - HIV infx and prophylaxis of HIV infx

Azidothymidine (AZT)

other name for the HIV drug Zidovudine

Adalimumab

- Class: TNF blocker, Immunosuppressive, DMARD - MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha - ADR: increases chance of getting other infx and of getting CA - Inflammatory dz (RA, AS, Psoriatic Arth, Crohn's, UC, Plaque psoriasis, Juvenile Arth)

When is Adalimumab C/I?

Active TB Severe infx Concomitant use w/ live vaccines

Infliximab

- Class: TNF blocker, Immunosuppressive, DMARD - MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha - ADR: increases chance of getting other infx and of getting CA - Inflammatory dz (RA, AS, Psoriatic Arth, Crohn's, UC, Plaque psoriasis, Juvenile Arth)

Enteracept

- Class: TNF blocker, Immunosuppressive, DMARD - MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha - ADR: increases chance of getting other infx and of getting CA - Inflammatory dz (RA, AS, Psoriatic Arth, Crohn's, UC, Plaque psoriasis, Juvenile Arth)

Tofacitinib

- Class: Immunosuppressive, Janus kinase (JAK) inhibitor - MOA: inhibits JAK which prevents the body from responding to cytokine signals - ADR: increases chance of getting other infx and of getting CA - RA

When is Tofacitinib C/I?

Acute TB | Severe infx

Tacrolimus

- Class: Cell-Mediated Immunity Suppressor - MOA: suppresses CMI rxn and some humoral immunity - Developed to prevent organ rejection

Cyclosporine

- Class: Cell-Mediated Immunity Suppressor * *Not commonly used as a CMI inhibitor but is VERY commonly used as eye drops for dry eyes (doesn't seem to have systemic effects when used in eye, but cautions around use if there is viral infx in eye)

Triamcinolone

- Class: Corticosteroid (anti-inflammatory) - MOA: potent glucocorticoid with minimal mineral corticoid activity - ADR: joint swelling, contusions, sinusitis, cough - RA, dermatoses, MS, inflammatory and allergic conditions

When is Triamcinolone C/I?

systemic fungal infx idiopathic thrombocytopenic purpura live or live, attenuated vaccine

Anastrozole

- Class: Oncologic; Biologic type drug - MOA: aromatase inhibitor (decreases estrogen formation) - ADR: menopausal sx - Tx estrogen positive cancers

Doxorubicin

- Class: Chemotherapeutic agent; Anthracycline antibiotic - MOA: DNA blocker (intercalates DNA) - ADR: LIFE-THREATENING heart damage, bone marrow suppression - IV drug

If you have pt on Doxorubicin, what should be your first goal?

Protect the heart! | this chemo agent can cz life-threatening heart damage

Paclitaxel

- Class: Taxane, Chemotherapeutic agent - MOA: Mitotic inhibitor - ADR: purplish, painless vesicular lesions onf tongue; also think of rapidly dividing cells of the body

What is Paclitaxel derived from?

Pacific Yew tree (Taxus brevifolia)

Vinblastine

- Class: Chemotherapeutic agent - MOA: Binds tubilin inhibiting assembly of microtubules - ADR: bone marrow suppression; also think of rapidly dividing cells of the body

What is Vinblastine derived from?

vinca alkaloid from Madagascar periwinkle (Catharanthus roseus)

Methotrexate

- Class: Chemotherapeutic Agent; Abortifacient - MOA: inhibits dihydrofolate reductase - ADR: ulcerative stomatitis, low WBC count - used for chemo, pregnancy termination, and AI d/o (psoriasis, psoriatic arth, Crohn's, RA, etc.)

5-Fluorouracil

- Class: Chemotherapeutic agent, Pyrimidine Analog - MOA: inhibits DNA and RNA synthesis - ADR: darkening of the tongue and purplish, painless vesicular lesions on tongue

Penicillamine

- Class: Chelator (oral) - MOA: chelates copper - ADR: very hard on GI tract (many ppl can't tolerate) - tx Wilson's dz

EDTA

- Class: Chelator (1' IV) - MOA: chelate metals, lead, Ca++, aluminum - ADR: hypocalcemia if using Na-EDTA (doesn't happen with Ca-EDTA) - Tx lead poisoning

Deferoxamine

- Class: Chelator (IV/IM/SQ) - MOA: Primarily chelates iron; also chelates some aluminum - Tx iron overload and s/t aluminum toxicity

DMPS

- Class: Chelator (1' IV) - MOA: chelates mercury - ADR: hypomagnesemia, hypotn (-->LOC)

DMSA

- Class: Chelator (oral) - MOA: chelates mercury, lead, and other heavy metals - ADR: hypomagnesemia, hypotn/LOC (same as DMPS but less acute and severe d/t oral dosing)

Which OTC drug can precipitate an acute gout attack?

Aspirin (salicylates)

Drugs that interfere with renal excretion of uric acid and can precipitate acute gout attack?

*EtOH, *diurectics, salicylates, nicotinic acid, cyclosporine, levodopa, cytotoxic agents

Rapid lowering of uric acid via _____ can lead to 'drug-induced gout'

Allopurinol