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Flashcards in Pharmacology Deck (228)
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1
Q

Drugs easily displaced from albumins –> ____ plasma drug level

A

INCREASE

  • Sulfonamides
  • Phenylbutazone
  • Tolbutamide
  • Coumarin
2
Q

Drugs that induce P450 –> _____ plasma drug levels

A

DECREASE

  • Alcohol
  • Barbiturates
  • Phenytoin
  • Rifampicin
3
Q

Drugs that inhibit P450 –> ______ plasma drug levels

A

INCREASE

  • Chloramphenicol
  • Sulfonamides
  • Phenylbutazone
4
Q

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

A

INCREASE

  • Uric acid
  • Probenecid
  • Penicillins
  • Sulfonamides
  • Salicylates
  • Thiazides
5
Q

Risk of severe hemorrhage if coumarins are combined with

A

any other drug that competes for albumin

6
Q

_______ displace sulfonureas from albumin leading –> hypoglycemia

A

Sulfonamides

7
Q

What is the effect of Barbiturates on MAO-I?

A

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

8
Q

What effect does P450 induction have on estrogen?

A

It enhances estrogen metabolism, which reduces oral contraceptive effects

9
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

10
Q

NEVER combine aminoglycosides with:

A
  • Neuromuscular blockers (enhanced block)

- Loop diuretics (compounds ototoxicity)

11
Q

NEVER combine MAO-I with:

A
  • Levadopa (HTN crisis)
  • Amphetamine (HTN crisis)
  • Tricyclic antidepressants
12
Q

Famous SE of Penicillin

A

Anaphylactic shock

13
Q

Famous SE of Isoniazid

A

Hepatotoxicity

14
Q

Famous SE of Cyclosporin

A

Renal toxicity

15
Q

Famous SE of Aminoglycosides (Neomycin)

A

Ototoxicity

16
Q

Famous SE of Hydralazine

A

Drug-induced Lupus

17
Q

Famous SE of Tetracyclines (Doxycycline, Minocycline)

A

Photosensitivity (skin)

18
Q

Cutaneous flushing is a famous SE cz’d by

A

Niacin

Niacins is also HEPATOTOXIC

19
Q

Famous SE of Zidovudine aka Azidothymidine (AZT)

A

Bone marrow suppression

20
Q

Antidote to Acetominophen intoxication

A

NAC

21
Q

Antidote to Opiate intoxication

A

Naloxone

22
Q

Antidote to Benzo intoxication

A

Flumazenil

23
Q

Antidote to Methanol or Ethylene Glycol intoxication

A

Ethanol

24
Q

Antidote to CO intoxication

A

100% O2

25
Q

Antidote to Cyanide intoxication

A

Amyl nitrate

26
Q

Antidote to Organophosphate intoxication

A
  • Atropine

- Pralidoxime

27
Q

Antidote to iron intoxication

A

deferoxamine

28
Q

Antidote to lead intoxication

A

EDTA

29
Q

Antidote to coumarin intoxication

A

Vitamin K

30
Q

Antidote to Heparin intoxication

A

Protamine

31
Q

What does alpha-1 do?

A
  • Tubules
  • Tightening/contraction of b.v.
  • Paralysis/relaxation of GI tube
32
Q

What does alpha-2 do?

A
  • Affects CNS

- Emergency break on SNS

33
Q

What does Beta-1 do?

A
  • Pro-sympathetic

- Affects heart

34
Q

What does Beta-2 do?

A
  • Pro-sympathetic

- Affects lungs

35
Q

What ADR can B6 cause?

A

peripheral neuropathy

36
Q

MOA of statins

A

HMG-CoA reductase inhibitors

37
Q

Simvastatin and Atorvastatin

A
  • Class: Statins (lipid-lowering agent)
  • MOA: HMG-CoA reductase inhibitors
  • give CoQ10!
  • ADR: rhabdomyolysis
38
Q

What labs should you check with statins rx?

A

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

39
Q

Common and serious ADR of statins

A

Rhabdomyolysis

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

40
Q

Colesevelam

A
  • 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
41
Q

Gemfibrozil

A
  • 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)
42
Q

When would you use carbonic anhydrase inhibitors?

MOA?

A

Emergency situations

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

43
Q

Furosemide

A
  • Class: Loop Diuretic
  • MOA: works at ascending loop of Henle and resorbs 25% Na
  • ADR: hypokalemia (K+ wasting) and hyperglycemia
44
Q

Hydrochlorothiazide

A
  • 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
45
Q

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

A

sulfonamide drugs

46
Q

1st line drugs for HTN

A

HCTZ (thiazide diuretics)

47
Q

How to loop diuretics and thiazide diuretics affect blood sugar?

A

cause hyperglycemia

48
Q

Triamterene

A
  • Class: Potassium sparing diuretic
  • MOA: acts on distal tubules
  • ADR: HYPERkalemia
49
Q

Why do you commonly use HCTZ and Triamterene together?

A

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

50
Q

Spironolactone

A
  • Class: Potassium sparing diuretic
  • MOA: Acts on distal tubule; aldosterone receptor antagonist
  • ADR: HYPERkalemia

Note: also used for PCOS

51
Q

Atenolol

A
  • Class: Beta blocker (selective)
  • MOA: acts on B1 adrenergic receptor
  • ADR: fatigue, bronchospasm, hypotension, bradycardia

**Abrupt discontinuation is dangerous

52
Q

Carvedilol

A
  • Class: Beta blocker (non-selective)
  • MOA: acts on B1 and B2 adrenergic receptors
  • ADR: fatigue, hypotension, bradycardia

**Abrupt discontinuation is dangerous

53
Q

Propanolol

A
  • Class: Beta blocker (non-selective)
  • MOA: acts on B1 and B2 adrenergic receptors
  • ADR: fatigue, hypotension, bradycardia

**Abrupt discontinuation is dangerous

54
Q

Carvedilol

A
  • Class: Beta blocker (non-selective)
  • MOA: acts on B1 and B2 adrenergic receptors
  • ADR: fatigue, hypotension, bradycardia

**Abrupt discontinuation is dangerous

55
Q

Propanolol

A
  • Class: Beta blocker (non-selective)
  • MOA: acts on B1 and B2 adrenergic receptors
  • ADR: fatigue, hypotension, bradycardia

**Abrupt discontinuation is dangerous

56
Q

Timolol

A
  • Class: Beta blocker (non-selective)
  • MOA: acts on B1 and B2 adrenergic receptors
  • ADR: fatigue, hypotension, bradycardia

**Abrupt discontinuation is dangerous

57
Q

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

A

migraines

58
Q

Diltiazem

A
  • Class: CCB
  • MOA: makes Ca++ plateau shorter –> weakening the pump
  • ADR: CHF
59
Q

Verapamil

A
  • Class: CCB
  • MOA: makes Ca++ plateau shorter –> weakening the pump
  • ADR: CHF
60
Q

Amlodipine

A
  • Class: CCB
  • MOA: makes Ca++ plateau shorter –> weakening the pump
  • ADR: CHF
61
Q

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

A

CCB

62
Q

What drug interaction do the CCBs have?

A

increase levels of cimetidine (H2 receptor antagonist)

63
Q

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

A

the sequester potassium

K+ sparing

64
Q

Lisinopril

A
  • Class: ACE-I
  • MOA: inhibit angiotensin converting enzyme in the lungs
  • ADR: dry, persistent cough; hyperkalemia
65
Q

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

A

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

66
Q

Ramipril

A
  • Class: ACE-I
  • MOA: inhibit angiotensin converting enzyme in the lungs
  • ADR: dry, persistent cough; hyperkalemia
67
Q

Irbesartan

A
  • Class: ARB
  • MOA: inhibit ANG-2 receptors
  • ADR: hyperkalemia

**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

68
Q

Losartan

A
  • Class: ARB
  • MOA: inhibit ANG-2 receptors
  • ADR: hyperkalemia

**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

69
Q

Clonidine

A
  • Class: Alpha-2 Agonist Anti-hypertensive
  • MOA: alpha-2 is an emergency break SNS

**this drug is used in emergency HTN crisis situations!

70
Q

What is the typical dose of Reserpine?

A
  1. 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)
71
Q

Famous SE of NSAIDs

A

*Renal toxicity

Hepatotoxicity

72
Q

Famous SE of Sulfonamides (Sulfamethoxazole, Sulfacetamide)

A

Photosensitivity (skin)

Hemolysis in pt. with G6PD-deficiency

73
Q

Famous SE of Sulfonylureas (Glyburide)

A

Photosensitivity (skin)

74
Q

Valsartan

A
  • Class: ARB
  • MOA: inhibit ANG-2 receptors
  • ADR: hyperkalemia

**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I

75
Q

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

A

Sulfonamides (Sulfamethoxazole, Sulfacetamide)

76
Q

Warfarin

A
  • Class: Anti-thrombotic, Anti-coagulation
  • MOA: Vit K antagonist; acts on EXTRINSIC factors 2, 7, 9, 10
  • ADR: Prolonged bleeding, hemorrhage
77
Q

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

A

prothrombin time (PT)

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

78
Q

Heparin

A
  • 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
79
Q

Clopidogrel

A
  • Class: Anti-thrombotic, Anti-coagulation
  • MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2)
  • ADR: Bleeding, Neutropenia, TTP
80
Q

Aspirin

A
  • Class: Anti-thrombotic, Anti-coagulation, NSAID
  • MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2)
  • ADR: Bleeding and salicylism (OD)
81
Q

What is salicylism and how does it present?

A

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)

82
Q

Digoxin

A
  • 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)
83
Q

Sx of Digoxin toxicity

A

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

84
Q

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

A

monitor their blood levels of digitalis/digoxin

this should be done first!

85
Q

Quinine/Quinidine toxicity

A

Cinchonism

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

86
Q

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

A

Antihypertensive, Antiarrhythmic, Antianginal

87
Q

What are the 3 primary indications for CCB in cardiology?

A

Antihypertensive, Antiarrhythmic, Antianginal

88
Q

Class I antiarrhythmics

A

Digoxin

89
Q

Class II antiarrhythmics

A

BB

90
Q

Class III antiarrhythmics

A

Amiodarone

91
Q

Class IV antiarrhythmics

A

CCB

92
Q

Amiodarone

A

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

93
Q

If NTG relieves chest pain, what does that indicate?

A

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

94
Q

Nitroglycerin (NTG)

A

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

95
Q

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?

A

NTG

96
Q

Anti-anginal drugs

A
  • NTG
  • BB: Atenolol, Metoprolol, Carvedilol, Propranolol, Timolol
  • CCB: Diltiazem, Verapamil, Amlodipine
97
Q

Fexofenadine

A
  • Class: OTC antihistamine
  • MOA: H1C receptor antagonist
  • Non-sedating (doesn’t cross BBB)
98
Q

Loratadine

A
  • Class: OTC antihistamine
  • MOA: H1 receptor antagonist
  • Non-sedating (doesn’t cross BBB)
99
Q

Cetirizine

A
  • Class: OTC antihistamine
  • MOA: H1 receptor antagonist
  • Non-sedating (doesn’t cross BBB)
100
Q

Diphenhydramine

A
  • Class: OTC antihistamine
  • MOA: H1 receptor antagonist
  • ADR: SEDATION (b/c crosses BBB), seizures, thrombocytopenia, agranulocytosis

*can also use for insomnia

101
Q

Promethazine

A
  • 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

102
Q

It is C/I to combine Fexofenadine with

A

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

103
Q

It is C/I to combine Diphenhydramine with

A

CNS depressants or MAO-I

104
Q

Hydroxyzine

A
  • Class: Antihistamine; Anxiolytic; Sedative/Hypnotic
  • MOA: H1 Receptor Antagonist
  • ADR: Drowsiness, xerostomia, blurred vision
  • also used for preoperative sedation
105
Q

It is C/I to combine Hydroxyzine with

A

CNS depressants

*also C/I in pregnancy and lactation

106
Q

Epinephrine

A
  • 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

107
Q

Epinephrine is C/I with

A

Acute-closure glaucoma

108
Q

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

A

Albuterol (preferred)

Epinephrine

109
Q

Dextroamphetamine

A
  • Class: Sympathomimetic
  • MOA: Release NE and Dopa

For ADD, PD, Narcolepsy. Used to be used for respiratory stuff but isn’t best option anymore.

110
Q

Pseudoephedrine

A
  • Class: Sympathomimetic (Decongestant)
  • MOA: Stimulates alpha-1 receptor –> vasoconstriction
  • ADR: HTN, anxiety, palpitations, HA, insomnia (not as bad as amphetamines)
111
Q

Pseudoephedrine is C/I with

A

MAO-I

112
Q

Oxymetazoline

A
  • 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

113
Q

Phenylephrine

A
  • Class: Sympathomimetic (Decongestant and Hypotension)
  • MOA: Stimulates alpha-1 receptor –> vasoconstriction
  • ADR: arrhythmia, anaphylaxis, asthmatic episodes, HA
114
Q

The decongestant Phenylephrine is C/I with

A

MAO-I and also in severe HTN

FYI: in addition to being a decongestant it is used to tx HYPOtension

115
Q

Albuterol

A

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

116
Q

Albuterol should not be used with

A

CNS stimulants

117
Q

Onset of albuterol is _______ and it lasts ______

A

Onset: 15 min
Lasts: 3-4 hr

118
Q

Atropine

A

Class: Bronchodilator (parasympatholytic)
MOA: Muscarinic antagonist
ADR: dry mouth, tachycardia, some CNS effects

**used for EMERGENCY bronchodilation as an injectable

119
Q

When do you use atropine as a bronchodilator?

A

in an EMERGENCY to back up epinephrine…

Epi is a sympathomimetic and Atropine is a parasympatholytic

120
Q

Guaifenesin

A

Class: Mucolytic
MOA: decreases viscosity of secretions

(OTC)

121
Q

Fluticasone

A
  • Class: Corticosteroid (Respiratory inhalent)
  • MOA: potent vasoconstrictive and anti-inflammatory
  • ADR: oropharyngeal candidiasis
  • nasal tx and prophylaxis of allergic rhinitis, nasal polyps
122
Q

MC inhaled steroid

A

Fluticasone

123
Q

Fluticasone C/I

A
  • Hypersensitivity to milk proteins (may result in anaphylaxis, angioedema, rash, urticaria)
  • Status asthmaticus, acute bronchospasms
124
Q

Mantoux test/PPD skin test

A

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

125
Q

Isoniazid (INH)

A
  • Class: Isonicotinic acid; Antitubucular Agents
  • MOA: mycolic acid synthesis inhibition
  • ADR: hepatotoxicity (10-20%)
126
Q

Isoniazid inhibits _______ and decreases metabolism of _______.

A

P450

Phenytoin

127
Q

Cromolyn Sodium

A
  • Class: Mast cell stabilizers, Inhaled
  • MOA: prevents degranulation of mast cells
  • ADR: throat irritation

**ONLY used for prophylaxis, NOT in an acute situation

128
Q

Ipatropium Bromide

A
  • 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
129
Q

Tiotropium Bromide

A
  • Class: Anticholinergic Bronchodilator (parasympatholytic), Inhaled
  • MOA: Muscarinic antagonist
  • ADR: arrhythmia
  • Primarily for maintenance in COPD and asthma; NOT for acute attack
130
Q

Salmeterol

A
  • Class: Bronchodilator, Inhaled
  • MOA: LABA(agonist)
  • ADR: asthma-related DEATH (huge issue w/ LABA if pt misses a dose - SUDDEN REBOUND ASTHMA ATTACK)
131
Q

Montelukast Sodium

A
  • Class: Antiasthmatic
  • MOA: Leukotriene receptor antagonist
  • maintenance of asthma and prophylaxis of exercise-induced asthma; allergic rhinitis (2nd line)
132
Q

Metabolism of Montelukast Sodium is increased with

A

Phenytoin

133
Q

Peripheral edema may occur if Montelukast Sodium is mixed with _______

A

Prednisone

134
Q

Name two opiate cough suppressants and what their primary ADR is

A

Codeine and Hydrocodone (in cough syrup)

ADR: respiratory distress

135
Q

Dextromethorphan

A

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

136
Q

If Dextromethorphan is mixed with Fluoxetine it can cause

A

serotoninergic syndrome

137
Q

If Dextromethorphan is mixed with Trazadone it may cause

A

serotonin syndrome

138
Q

If Dextromethorphan is mixed with Phenelzine it may cause

A

Hypertensive crisis

139
Q

Drugs that can cause Hemolytic Uremic Syndrome

A

Chemo, Tacrolimus, Oral contraceptives

140
Q

Pentoxifylline

A
  • Class: Hematologic agent
  • MOA: reduces blood viscosity by increasing deformability of leukocytes and erythrocytes; improves microcirculation
  • ADR: angina, arrhythmias, hepatitis, blood dyscrasias, hypotension
141
Q

Combining Pentoxifylline with ________ can increase the risk of ADRs

A

Ciprofloxacin

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

142
Q

Deferoxamine

A
  • Class: Iron Chelating Agent
  • MOA: forms a complex with iron and is excreted through kidneys
  • ADR: blue fingernails, lips, skin
143
Q

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

A

Prochlorperazine or Vitamin C

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

144
Q

Nystatin

A
  • Class: Antifungal
  • MOA: disrupts fungal cell wall
  • ADR: contact derm
  • Candida

**Good topical/GI agent but not absorbed well into systemic circulation

145
Q

Fluconazole

A
  • 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

146
Q

Ketoconazole

A
  • 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

147
Q

Terbinafine

A
  • Class: Antifungal
  • MOA: inhibits squalene epoxidase, reducing fungal cell membrane ergosterol synthesis
  • For toenail fungus
  • Oral or topical
148
Q

Permethrin

A
  • 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

149
Q

Mebendazole

A
  • 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

150
Q

Metronidazole

A
  • Class: Antiprotazoal
  • MOA: inhibits DNA synthesis of microorganisms
  • ADR: GI distress, seizures, ataxia, jt pn
  • Amoebas, Trichomoniasis, Giardia, Bacterial vaginosis
151
Q

You should NEVER take Metronidazole with _______

A

EtOH

Will make pt VERY ill, vomiting, can lead to liver failure

**This is a COMMON board question

152
Q

Hydroxychloroquine

A
  • Class: Antiprotazoal, DMARD
  • MOA: impairs complement-dependent antigen-antibody rxn
  • ADR: Cinchonism (vertigo, tinnitus, vision change, dizziness)
  • tx malaria, SLE, RA
153
Q

What antibiotics are safe during lactation/in kiddos?

A
  • Penicillin: penicillin, ampicillin, amoxicillin, amoxicillin + clavulanate
  • Macrolides: erythromycin, clarithromycin, azithromycin
  • Cephalosporins: cephalexin, cefuroxime, cefdinir, ceftriaxone
154
Q

What antibiotics should you avoid during lactation/in kiddos?

A
  • Tetracyclines: doxycycline, minocycline

- Fluoroquinolones: ciprofloxacin, levofloxacin

155
Q

Which antibiotics should be avoided in infants with G6PD deficiency?

A
  • Sulfonamides: Sulfamethoxazole/Trimethoprine

- Nitrofurantoin

156
Q

Gentamicin

A
  • 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
157
Q

Cephalexin

A
  • 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

158
Q

Cephalexin interacts with ________ results in _________

A

Metformin

Sx of low blood sugar

159
Q

Pt should not take Cephalosporins if they are allergic to _______

A

Penicillins

esp. if they have had an anaphylactic rxn to Penicillin

160
Q

Cefuroxine

A
  • 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

161
Q

Cefdinir

A
  • Class: 3rd Gen Cephalosporin (B-lactam antibiotic)
  • MOA: Bactericidal, inhibits cell wall synthesis

*3rd Gen have widest Gm- activity of cephalosporins

162
Q

Ceftriaxone

A
  • 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

163
Q

Penicillin VK

A
  • Class: Penicillins (B-lactam antibiotic)
  • MOA: Inhibit cell wall synthesis
  • ADR: diarrhea, oral candidiasis, black hairy tongue
  • 1’ works on Gm+: Strep., Pneumococcal, Staph.
164
Q

Amoxicillin

A
  • 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
165
Q

Ampicillin

A
  • 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
166
Q

Amoxicillin + Clavulanate

A
  • 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
167
Q

Erythromycin

A
  • Class: Macrolide antibiotic
  • MOA: interferes with bacterial DNA synthesis
  • ADR: abdominal pn, N/V, diarrhea
  • M. pneumo, pertussis, neonatal C. pneumo, Strep throat, URI
168
Q

Are macrolides safe in pregnancy?

A
  • Erythromycin is C/I
  • Clarithromycin is Class C
  • Azithromycin is Class B
169
Q

Clarithromycin

A
  • Class: Macrolide antibiotic
  • MOA: interferes with bacterial DNA synthesis
  • Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid
170
Q

Azithromycin

A
  • Class: Macrolide antibiotic
  • MOA: interferes with bacterial DNA synthesis
  • Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid (
171
Q

Doxycycline

A
  • 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
172
Q

Minocycline

A
  • 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
173
Q

Are tetracyclines C/I in pregnancy?

A

Use during 1st trimester is controversial

174
Q

Are tetracyclines C/I in children?

A

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

175
Q

Sulfamethoxazole/Trimethoprine

A
  • 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
176
Q

Nitrofurantoin

A
  • Class: Nitrofurantoin Antibiotic

* only used for UTI (kills E. coli very well)

177
Q

Is Nitrofurantoin safe in pregnancy?

A

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

178
Q

Clindamycin

A
  • Class: Lincosamide Antibiotic
  • MOA: interferes w/ process of peptide elongation in bacterial protein synthesis
  • Alternative to penicillin
179
Q

Ciprofloxacin

A
  • Class: Fluoroquinolones
  • MOA: Bactericidal; interferes w/ DNA synthesis
  • ADR: tendon pathology, Achilles tendon rupture
  • Wide spectrum
180
Q

Levofloxacin

A
  • Class: Fluoroquinolones
  • MOA: Bactericidal; interferes w/ DNA synthesis
  • ADR: tendon pathology, Achilles tendon rupture
  • Wide spectrum
181
Q

Is it safe to use fluoroquinolones in kids?

A

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

182
Q

Isoniazid

A
  • 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.
183
Q

Rifampin

A
  • 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.
184
Q

1st line tx for TB

A

Isoniazid

185
Q

2nd line tx for TB

A

Rifampin

186
Q

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

A

B6 (Pyridoxine)

both drugs deplete it

187
Q

Mupirocin

A
  • Class: Topical antibiotic
  • MOA: bacterial RNA inhibition
  • Impetigo, MRSA
188
Q

What is a common risk with neomycin?

A

Contact dermatitis

189
Q

Triple antibiotic (Neomycin, Polymyxin B, Bacitracin)

A
  • Class: Topical antibiotic

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

190
Q

Amantadine

A
  • 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
191
Q

Amantadine is C/I with

A

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

192
Q

Acyclovir

A
  • Class: Antiviral, Nucleoside analogue
  • MOA: Inhibits viral multiplication by interfering w/ DNA synthesis
  • only enters cells with surface markers for HHV family
193
Q

Which antivirals are safe in lactating women?

A

Acyclovir and Valacyclovir

194
Q

Which antivirals are not safe in lactating women?

A

Amantadine

195
Q

Valacyclovir

A
  • 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
196
Q

Interferon, Alpha

A
  • 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)

197
Q

Interferon, Beta

A
  • Class: Antiviral, Antineoplastic

* Pretty much just used to tx multiple sclerosis

198
Q

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

A

AI hepatitis and hepatic decompensation

199
Q

Oseltamivir

A
  • 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
200
Q

Zidovudine

A
  • Class: Antiretroviral
  • MOA: Nucleotide Reverse Transcriptase Inhibitor; inhibits DNA replication
  • HIV infx and prophylaxis of HIV infx
201
Q

Azidothymidine (AZT)

A

other name for the HIV drug Zidovudine

202
Q

Adalimumab

A
  • 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)
203
Q

When is Adalimumab C/I?

A

Active TB
Severe infx
Concomitant use w/ live vaccines

204
Q

Infliximab

A
  • 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)
205
Q

Enteracept

A
  • 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)
206
Q

Tofacitinib

A
  • 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
207
Q

When is Tofacitinib C/I?

A

Acute TB

Severe infx

208
Q

Tacrolimus

A
  • Class: Cell-Mediated Immunity Suppressor
  • MOA: suppresses CMI rxn and some humoral immunity
  • Developed to prevent organ rejection
209
Q

Cyclosporine

A
  • 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)
210
Q

Triamcinolone

A
  • 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
211
Q

When is Triamcinolone C/I?

A

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

212
Q

Anastrozole

A
  • Class: Oncologic; Biologic type drug
  • MOA: aromatase inhibitor (decreases estrogen formation)
  • ADR: menopausal sx
  • Tx estrogen positive cancers
213
Q

Doxorubicin

A
  • Class: Chemotherapeutic agent; Anthracycline antibiotic
  • MOA: DNA blocker (intercalates DNA)
  • ADR: LIFE-THREATENING heart damage, bone marrow suppression
  • IV drug
214
Q

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

A

Protect the heart!

this chemo agent can cz life-threatening heart damage

215
Q

Paclitaxel

A
  • Class: Taxane, Chemotherapeutic agent
  • MOA: Mitotic inhibitor
  • ADR: purplish, painless vesicular lesions onf tongue; also think of rapidly dividing cells of the body
216
Q

What is Paclitaxel derived from?

A

Pacific Yew tree (Taxus brevifolia)

217
Q

Vinblastine

A
  • Class: Chemotherapeutic agent
  • MOA: Binds tubilin inhibiting assembly of microtubules
  • ADR: bone marrow suppression; also think of rapidly dividing cells of the body
218
Q

What is Vinblastine derived from?

A

vinca alkaloid from Madagascar periwinkle (Catharanthus roseus)

219
Q

Methotrexate

A
  • 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.)
220
Q

5-Fluorouracil

A
  • Class: Chemotherapeutic agent, Pyrimidine Analog
  • MOA: inhibits DNA and RNA synthesis
  • ADR: darkening of the tongue and purplish, painless vesicular lesions on tongue
221
Q

Penicillamine

A
  • Class: Chelator (oral)
  • MOA: chelates copper
  • ADR: very hard on GI tract (many ppl can’t tolerate)
  • tx Wilson’s dz
222
Q

EDTA

A
  • 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
223
Q

Deferoxamine

A
  • Class: Chelator (IV/IM/SQ)
  • MOA: Primarily chelates iron; also chelates some aluminum
  • Tx iron overload and s/t aluminum toxicity
224
Q

DMPS

A
  • Class: Chelator (1’ IV)
  • MOA: chelates mercury
  • ADR: hypomagnesemia, hypotn (–>LOC)
225
Q

DMSA

A
  • 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)
226
Q

Which OTC drug can precipitate an acute gout attack?

A

Aspirin (salicylates)

227
Q

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

A

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

228
Q

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

A

Allopurinol