Pharmacology Flashcards
(195 cards)
1
Q
As ppl age, gastric pH goes up or down? and what does it affect?
A
Goes up (achloridia)/drug absorption
2
Q
As ppl age, total body water/lean body mass/fat storage go up or down? What do that affect?
A
Total body water/lean body mass go down
Fat storage goes up
Drug absorption
3
Q
What are phase I and phase II drug metabolic pathways?
A
Phase I—>metabolize the drug into similar compound
Phase II —>metabolize the drug into inactive form
4
Q
What should we consider if we see a elderly pt with normal serum creatinine level?
A
Maybe the normal level is masking a decreased GFR and a decreased lean body mass (lower creatinine production)
5
Q
Why is adverse drug effects especially detrimental for elderlies?
A
Elderlies have lower physiological reserve to respond and recover from/they are on so many other drugs that might also have side effects
6
Q
Why is anticholinergic drugs has potential harmful affect to elderly?
A
Potentiate the decline of cholinergic nerve—>increase risk of delirium and confusion
7
Q
What is adverse side effect prescribing cascade?
A
Adverse side effect—>misinterpreted as new medical condition—>give additional drugs—>adverse side effect…
8
Q
Why should elderly avoid NSAID?
A
Reduce renal blood flow/increase risk for stroke and MI/HoTN with increase risk of falling
9
Q
What is the strategy when it comes to dosing elderly?
A
Start slow, go slow/avoid starting 2 drugs at the same time
10
Q
How does iron supplement affect GI?
A
Constipation
11
Q
Actue gastroenteritis/HoTN/rice water diarrhea/torsades, think what metal poisoning?
A
Arsenic
12
Q
What symptoms do you see with Thallium poisoning?
A
Painful neuropathy/alopecia
13
Q
What is the mechanism of chelating agents?
A
Form complex with heavy metal—>form chelate—>excrete
14
Q
What is dimercaprol mixed with and how is it injected?
A
Peanut oil/IM
15
Q
What is needed to be done to prevent metal induced renal toxicity when using dimercaprol?
A
Urine alkalization
16
Q
What heavy metal poisoning do you use for Succimer?
A
Lead/cadmium/mercury
17
Q
What poisoning is Prussian blue used for? and is it absorbed orally?
A
Cesium and thallium/no even though it is given orally
18
Q
How to treat adult with high/mild/low (no symptoms) lead poisoning?
A
High—>dimercaprol/EDTA
Mild—>succimer
Low (no symptoms/lead level less than 70)—>remove from exposure
19
Q
How to treat children with high/mild/low (no symptoms) lead poisoning?
A
High—>dimercaprol/EDTA
Mild (over 40)—>succimer
Low (under 40)—>remove from exposure
20
Q
How is iron poisoning lethal?
A
It is a uncoupler of oxidative phosphorylation—>stop aerobic respiration
Ionic gap metabolic acidosis
21
Q
Iron has positive or negative inotropic effect? vasoconstrictor or vasodilator?
A
Negative—>HoTN
Vasodilator—>HoTN
22
Q
When is vomiting occur during iron poisoning?
A
Within 6 hours
23
Q
Deferoxamine (IV) can only chelate what kind of iron and how long can you use it for and why?
A
Free iron/less than 24 hours, because it causes acute lung injury
24
Q
What would stimulate the production of acid from parietal cells? and what are their second messengers?
A
Gastrin/histamine/ACh
ACh/gastrin—>Ca2+—>stimulate proton pump
Histamine—>Gs coupled—>stimulate proton pump
25
How does prostaglandin E2 analog affect acid production?
It binds to Gi--->inhibit proton pump
26
Are PPI competitive or noncompetitive?
Noncompetitive (unlike antiACh or antihistamine)
27
If a pt is getting refractory ulcers with H2 blockers, use what drug next?
PPl
28
What happens to the acid production if you suddenly stop H2 blockers? and what should you do instead?
Acid production increase more than normal (rebound hypersensitivity)/should taper
29
What are the 4 causes of GERD?
Reduced LES tone/increase acid production/not enough water intake to wash acid down/reduce the emptying of stomach into duodenum
30
What is topical phenylephrine used for?
Hemorrhoids--->vasoconstrictor
31
What side effect does prochlorperazine has and what drug should we use to counter that?
Torticollis/anticholinergic
32
Which 2 anti emetic drugs are used for anesthesia related vomiting?
Granesitron/dolasetron
33
What to use to treat gastroparesis?
Stomach pacemaker/promotility agent
34
What is the mechanism of toxin mediated diarrhea?
Toxin--->increase cAMP--->increase Cl- secretion into stomach/decrease Na, Cl-, glucose absorption from the stomach--->osmotic diarrhea
35
What is the mechanism of atropine for diarrhea?
Relax bowel smooth muscle/decrease secretion
36
Which pain killer can be use for diarrhea as well?
Codeine
37
What to give pt if loperamide doesn't work?
Diphenoxylate (opioid agonist + atropine)
38
Pectin reduces ___ but not ___?
Water in the stool/but not the frequency of bowel movement
39
Why do we need to add additional drugs with stool softener?
Stool softener does not push stool, it just soften it
40
What do we use for chronic constipation pt?
Bulk forming colloid
41
How do lubiprostone/linaclotide/naloxegol work and what do they treat?
Lubiprostone--->stimulate Cl- channel
Linaclotide--->increase cGMP
Naloxegol--->mu receptor antagonist (for opioid induced constipation)
They all treat constipation
42
What drugs are used to manage constipation/diarrhea from irritable bowel syndrome?
Osmotic cathartics/loperamide or diphenoxylate
43
What does it mean when a bacteria has a high MIC (minimal inhibitory con.)?
I means it's harder to kill it
44
Difference in structures of gram - and + bacteria?
Gram - : outer membrane with LPS
| Gram + : thick cell wall
45
Beta lactam binds ___ and inhibit ___?
PBP/transpeptidation
46
What is a significant cause of resistance to beta lactam in gram negative bacteria?
Beta-lactamase
47
Can we use penicillin for staph?
No (resistance)
48
What are the 3 mechanism of resistance to antibiotics?
Enzyme destruction (beta lactamase)/reduce permeability(alteration in channel)/altered target site (low affinity binding to PBP)
49
Would beta lactam work on mycoplasma or chlamydia pneumoniae?
No, they don't got no cell walls
50
What is the only beta lactam that works on MRSA?
Ceftaroline (5th gen cephalosporin)
51
How is ceftriaxone excreted?
Through bile
52
How long do you want to exceed the MIC when giving antibiotics?
At least half of the time during dosing interval (e.g. give drug for 8 hours, want at least 4 hours to exceed MIC)
53
What are some side effect of beta lactam?
Anaphylaxis (rare)/acute interstitial nephritis/rash/diarrhea
54
What bacteria does natural penicillin (G and V) treat?
Mostly gram + :
| Strep/enterococcus/anaerobe/N. menigitidis/T. pallidum
55
What are the anti staph penicillins and what do they treat?
Oxacillin/nafcillin/dicloxacilllin
| Gram + only (MSSA--->methicillin sensitive S. aureus)
56
What's the mechanism of aminopencillin?
Ampicillin and amoxicillin--->improved penetration into gram - bacteria
57
What is the drug of choice for enterococcus and listeria?
Ampicillin
58
What is amoxicillin usually used for?
Otitis media
59
What are the side effects of ampicillin and amoxicillin?
Rash if given during viral infection (like EBV)
60
How is ampicillin usually given?
IV (bad oral absorption)
61
Does penicillin work on H. influenza?
No--->H. influenza produces beta lactamase
62
What are the extended spectrum penicillins?
Piperacillin/ticarcillin
63
Penicillin can combine with ___ to extend gram - coverage?
Beta lactamase inhibitor
64
What combination of penicillin are active against pseudomonas?
Piperacilloin + tazobactam
| Ticarcillin + clacvulanate
65
What are the 2 cephalosporins that treat pseudomonas?
Ceftazidime/cefepime
66
Which has a lower risk of hypersensitivity reaction, penicillin or cephalosporin?
Cephalosporin
67
What is the side effect of ceftriaxone in neonate?
biliary sludging/kernicterus
68
What are the side effects of cephalosporin?
Coagulopathy/disulfiram like reaction with alcohol
69
What are first gen cephalosporin active against?
Gram + : strep and staph (MSSA)/PEK
70
Hypersensitivity reaction of penicillin or 1st gen cephalosporin is better tolerated?
1st gen cephalosporin
71
Which 2 cephalosporins are for prophylaxis colon surgery?
Cefoxitin and cefotetan
72
3rd gen cephalosporin has correlation with ___ infection?
C. diff
73
Side effect of cefepime?
Akinetic seizure (altered mental status)
74
Does ceftaroline cover pesudomonas?
No
75
What is ceftaroline used for?
Skin and soft tissues infection (cellulitis)
| CAP
76
What drug does ceftaroline has a synergistic interaction with?
Daptomycin
77
Ceftazidime is combined with ___ to cover CRE and ESB: bacteria
Avibactam
78
Ceftolozane + ___ is another alternative for ESBL
Tazobactam
79
Carbapenems treats? and does it treat MRSA?
ESBL and pseudonomas
| No
80
Use meropenem specifically for?
Bacterial meningitis
81
Carbapenems decresae which drug's con.?
Valproic acid
82
Which carbapenem has the longest half life and what bacteria can't it treat?
Ertapenem--->no activity against pseudonomas
83
Imipenems is avoided in ___ treatment?
Meningitis--->in case of seizure
84
What group of bacteria does aztreonam treat?
Gram - ONLY
| Pseudomonas
85
Aztreonam has cross activity with __?
Ceftazidime
86
Upper respiratory infection from S. peunomiae or H. influneza, start with ___, if not resolved, add ___?
Amoxicillin
| Amoxicillin + clavulanate (augmentin)
87
Vancomycin has activity against?
Gram + bacteria including MRSA and MSSA/S. epidermidis
88
How is VRE resistant to vancomycin?
Change D-ala-Dala to D-ala-D-lac in its cell wall
89
What are VISA and VRSA?
vanco intermediate resistance S. aureus
| vanco resistance S. aureus (MIC >16)--->obtain resistance from VRE
90
S. epidermidis has significant resistance to ___?
beta lactam
91
Why do we treat S. aureus bacteremia for 6 weeks now?
To cover potential endocarditis
92
80% of S. pneumoniae is resistant to ___ so use ___ instead
Cephalosporin/vanco
93
Daptomycin is inactivated by ___?
Pul surfactant
94
What are the 3 lipoglycopeptides (similar to vanco)? and what are their mechanism
Telavancin
Dalbavancin (super long half life 257hrs)
Ortiavancin (super long half life 195hrs)
Bind to cell wall precursors like vanco--->cell membrane depolarization
95
What is the spectrum for telavancin?
Vanco's spectrum + VISA and VRSA
96
Which aminoglycosides is used for CF?
Aerosolized tobramycin
97
Why do you have to take tetracycline upright? and what is other side effect of tetracycline?
It might cause erosive esophagitis/hyperpigmentation
98
Which tetracycline cause vertigo?
Minocycline
99
What is tigecycline? and what does it treat?
Derivative of minocycline/broad spectrum including MRSA and VRE
Not used for bacteremia
100
What is macrolides usually treat?
Uncomplicated upper and lower respiratory infection
101
Clindamycin is given with penicillin for ___?
Toxic shock syndrome
102
Linezolid and tedizolid are alternative to what drug?
Daptomycin
103
Linezolid and tedizolid inhibit ___ and cause serotonin syndrome?
MAO
104
What is the only PO drug that treats pseudomonas?
Fluoroquinolones
105
Which fluoroquinolones has activity against anaerobe?
Moxifloxacin
106
Can you use cipro or levofloxacin alone for intraabdominal infection?
No. gotta pair them with metronidazole
107
What kind of pt tend to have tendon rupture with fluoroquinolone?
Old pt who is on steroid
108
Which fluoroquinolone most likely causes prolonged QT?
Moxifoxacin
109
What is the mechanism of metronidazole?
Inhibit protein synthesis
110
What are the 2 antibiotics used for anaerobic treatment?
Clindamycin above the diaphragm and metronidazole below
111
What is the mechanism of rifamycin and ethambutol?
Rifampin--->bind bacterial DNA dependent RNA polymerase
| Ethambutol--->blocks arabinosyl transferase--->inhibiting carbohydrate formation of the wall
112
What is rifampin used for besides prophylaxis?
Prothetic valve endocarditis/prosthetic join infection (antibiofilm)
113
What drug does isoniazid?
Potentialte phenytoin
114
What else covers listeria besides ampixcillin? And does it cover anaerobe?
Bactrim/no
115
What is trimethoprim's affect on kidney?
It is a K sparing diuretics--->hyperkalemia
116
What is the drug interaction with bactrim?
Warfarin--->increase INR
117
Can antiretroviral kill the HIV virus?
No
118
What is the HIV infection process?
Virus bind and enter the cell--->HIV RNA is converted to DNA via reverse transcriptase--->integrates into host genome via integrase--->transcription--->protein is cleaved via protease--->bud off
119
What are the 5 major classes of antiretroviral drugs?
NRTI--->nucleoside reverse transcriptase inhibitor
NNRTI--->non nucleoside reverse transcriptase inhibitor
Protease inhibitor
Entry inhibitor
Integrase inhibitors
120
What is the mechanism of NRTI? and its major side effect?
```
DNA analogs (e.g. adenosine/guanine)--->termination of DNA chain
Lactic acidosis
```
121
What are the side effects of tenofovir/abacavir/zidovudine?
Tenofovir--->nephrotoxicity
Abacavir--->hypersensitivity reaction
Zidovudine--->anemia
122
What is the mechanism of NNRTIs? and their common side effects?
Bind directly to reverse transcriptase--->inhibit its action
Rash
123
What are the side effects for efavirenz
Efavirenz--->CNS symptoms (vivid dream etc.)/teratogen
124
What is the mechanism of protease inhibitors? and their side effects?
Bind to protease--->prevent it from cleaving proteins to function subunits
Metabolic toxicities---->dyslipidemia/hyperglycemia/lipodystrophy
125
What is Ritonavir Boosting?
Ritonavir is a potent CYP450 inhibitor--->use in low dose with other drugs to increase their half life
126
What is the only HIV drug that is not orally administered? side effect? and when is it used?
Enfuvirtide--->entry inhibitor
Increase rate of bacterial pneumonia
When you ran out of other options
127
What is the only HIV drug that targets the host cell?
Maraviroc--->CCR5 antagonist
128
Why integrase inhibitors have become the first line treatment?
Very effective and low side effects
129
When and who should we start ART (antiretroviral therapy) to?
Everyone that has HIV
130
What is HAART and what is its concept?
HAART--->high active antiretroviral therapy (combo therapy)
| Combine at least 3 drugs with different mechanisms
131
What is the combo of HAART?
2 NRTIs + something else like integrase inhibitor/PI/NNRTIs
| Preferably with integrase inhibitor or PI
132
What are the HAART goals?
Reach undetectable viral load
133
If the resistance is developed against one of the NRTI, can you use another NRTI instead? and is the resistance permanent? and what is the best way to reduce resistance?
No because of cross resistance within class
It is permanent
Best way is to adhere to drug treatments--->resistance only develop during replication--->low viral load--->low rate of resistance development
134
Most ppl who got Hep C clear it out or develop chronic Hep C? and is it curable?
Most people develop into chronic hep C
| It is curable
135
How is Hep C infect cells?
Gain entry--->translate RNA into protein--->protease cleave protein into function subunits
136
What is the equivalent to viral cure for Hep C treatment? and what is the definition of SVR
SVR (sustained virologic response)--->Hep C remain undetectable 12 weeks after completion of the therapy
137
Why is interferon and ribavirin are no longer used for Hep C treatments?
Lower efficacy and a lot of side effects
138
What are the 3 new classes of drugs that treat Hep C? and how are they used?
NS (nucleoside) 5B polymerase inhibitors
NS5A inhibitors
NS3/4A protease inhibitors
Combo therapy like HIV
139
What are the mechanisms of NS5B polymerase inhibitor and NS5A inhibitor?
NS5B--->compete with nucleotide and cause RNA chain termination like NRTI
NS5A--->inhibit viral phosphoprotein
140
How does HSV replicate?
DNA virus enter cell--->use DNA polymerase to make mRNA
141
How is foscarnet used?
IV use for acyclovir/ganciclovir resistance HSV/CMV
| Lots of side effects
142
What is the mechanism of acyclovir and penciclovir?
Need to be phosphorylated by viral thymidine kinase--->only effective in infected cells--->compete with DNA analogue--->terminate DNA chain
143
Why do we use valacyclovir or famciclovir for oral therapy for HSV or VZV instead of acyclovir?
Valacyclovir and famciclovir are prodrug that are converted to acyclovir and penciclovir respectively--->higher bioavailability than just acyclovir
144
Side effects of acyclovir?
CNS toxicity
| Renal dysfunction with high dose
145
What is the PO form of ganciclovir? and side effect of ganciclovir?
Valganciclovir
| Myelosuppression
146
What is the mechanism of foscarnet?
Directly inhibit HSV DNA polymerase/HIV reverse transcriptase
147
What is the mechanism for neuraminidase inhibitors? and what is their greatest benefits of usage?
Inhibit neuraminidase--->prevent release of virus from host cell
To reduce rates of complications from influenza with severe disease
148
When should you start neuraminidase inhibitors? and what is their major side effect?
Within 48 hours
| Neuropsychiatric events--->agitation/anxiety
149
What dose a fungal cell has that we dont?
Cell wall and ergosterol
150
What are the MOA of triazoles?
Inhibit production of ergosterol by inhibiting 14-alpha-sterol-demethylase
151
What is the spectrum of coverage from least to most of the triazoles?
Fluconazole--->voriconazole/itraconazole--->posaconazole
152
What is the side effect of triazoles and which triazoles cause visual disturbance?
Liver toxicity
| Voriconazole
153
Which triazole has the lowest interaction potency?
Fluconazole
154
What is intraconazole used for nowadays?
Treatment and prophylaxis for histoplasmosis
155
What is posaconazole mainly used for?
Prophylaxis for immunocompromised pt
156
Are triazoles CYP450 inducer or inhibitor?
Inhibitor
157
What is the MOA of amphotericin B? side effect?
Bind to ergosterol and form pores in the cell wall
| Kidney toxicity/acute infusion reaction (fever/rigor)/electrolyte abnormalities
158
How to prevent acute infusion reaction with amphotericin B?
Pre treat with H1 blocker or meperidine
159
How to limit amphotericin B side effect?
Mix it with lipid
160
MOA of echinocandin? side effect and drug interaction?
```
Inhibit beta(1.3)-D-glucan synthase--->decrease production of beta(1.3)-D-glucan--->inhibit cell wall formation
Minimal side effect and drug interaction
```
161
What is echinocandin most effective against?
Candida
162
MOA of flucytosine? what route of administration is is used?
pyrimidine analog that inhibit RNA and DNA synthesis/oral only
163
What happens with flucytosine monotherapy and what is the solution?
Resistance develops/combo with azole or ampho B
164
Side effect of flucytosine?
Bone marrow toxicity
165
Bile acid facilitate excretion of ?
Cholesterol/copper/bilirubin
166
First line tx for MRSA?
Vanco/dapto/Linezolid
167
What is the mechanism of fentanyl and what is it similar to?
Mu agonst--->heroin
168
Pt comes in with altered mental status, the first thing you should think of is?
Hypoglycemia
169
What are the 2 natural opioids?
Morphine and codeine
170
What is withdraw of opioid caused by naloxone?
Flu like symptoms
171
Benzo overdose produce what kind of vital signs? what about barb or alcohol?
Normal/respiratory depression
172
What would happen if you give flumazenil to a pt with benzo overdose who takes benzo everyday?
Cause acute withdraw--->possible seizure
173
How is overdose acetaminophen toxic?
Metabolized by CYP450--->produce NAPQI (toxic)--->glutathione neutralize it-->overwhelm the system--->central lobular necrosis of the liver
174
When should N-acetylcysteine be given?
Within 8 hours
175
What else does TCA block besides DA reuptake/M/alpha 1? and which one can kill the pt?
Block GABA and Na channel
| Na channel blocker--->wide QRS--->ventricular arrhythmia--->death
176
What is the antidote for ventricular arrhythmia caused by TCA overdose?
Sodium bicarb
177
Physostigmine should not given to count anti M resulted from the over dose of ___?
TCA
178
What else can you give to a pt with anti M besides physostigmine?
Benzo to sedate
179
How do methanol and ethylene glycol kill the pt?
Metabolites cause acidosis
180
What can you give for pt with non dihydropyridine?
Beta agonist/glucagon (like a beta agonist)/insulin/Ca
181
What beta blocker overdose causes the most problems? and why?
Propranolol--->lipophilic (CNS effect)/cause wide QRS complex
182
What predicts the severity of digoxin overdose?
Level of hyperkalemia
183
What has a higher chance to cause seizure, cocaine or amphetamines?
Cocaine
184
Do Cephalosporins has activity against MSSA?
Yes
185
Is amoxicillin resistant to beta lactamase?
No
186
Gram positive cocci in pairs, what kind of organism is it?
S peumoniae
187
Trimethopram acts like what kind of diuretics and cause what?
K sparing/hyperkalemia
188
Complicated UTI tx?
Gentamicin
189
When do you test for drug resistance for HIV pt?
Before starting tx (transmitted resistance) and when tx fails
190
Which class of HIV drugs has the least amount of cross resistance?
PI
191
How long is HCV tx usually?
12-24wks
192
Is seizure part of opioid overdose?
No
193
How is naloxone given for opioid overdose?
Continous IV infusion
194
Why don't we use long acting paralytic agents?
Paralytic would stop the seizure in the body but not the brain--->masking brain seizure-->on going brain seizure--->ischemia--->cerebral edema--->death
195
NE has predominately alpha or beta activity?
Alpha
