Pharmacology Flashcards
(139 cards)
1
Q
Natural PCNs (Drugs)
A
Penicillin G
Penicillin V
2
Q
Natural PCNs (Spectrum)
A
Gram +, cocci and bacilli, some gram -
3
Q
Penicillinase resistant PCN (Drugs)
A
Nafcillin, methacillin, cloxacillin, dicloxacillin, oxacillin
4
Q
Penicillinase resistant PCN (Spectrum)
A
Staph. Aureus
5
Q
Extended spectrum (Drugs)
A
Ampicillins, amoxicillin, bacampicillin
6
Q
Extended spectrum (Spectrum)
A
Gram +/-, cocci and bacilli
7
Q
Antipseudomonals (Drugs)
A
Ticarcillin, piperacillin, carbenicillin, mezlocillin
8
Q
Antipseudomonals (Spectrum)
A
Gram (-) plus pseudomonas
9
Q
Penicillin/Beta lactamase inhibitors (Drugs)
A
amoxicillin clavulanate (Augementin)
ampicillin/sulbactam (Unasyn)
piperacillin/tazobactam (Zosyn)
ticarcillin/clavulanate (Timentin)
10
Q
1st generation cephalosporins (drugs)
A
“Cefa” “Cepha” “Cephra”
Except Cefaclor which is 2nd gen
11
Q
2nd generation cephalosporins (drugs)
A
Cefuroxime, Cefoxitin, Cefotetan, Cefaclor
12
Q
3rd generation cephalosporins (drugs)
A
“ime” “one” “ten”
Cefdinir
Moxalactam
Except Cefuroxime which is 2nd gen
13
Q
4th generation cephalosporins (drugs)
A
“pi”
Cefepime, Cefepirole
14
Q
5th generation cephalosporins (drugs)
A
“rol”
Ceftaroline
15
Q
1st generation (spectrum)
A
Gram +, Ok Gram -, anaerobes +/- (not B. fragilis)
16
Q
2nd generation (spectrum)
A
Gram +, Good Gram -, anaerobes +/-
17
Q
3rd generation (spectrum)
A
Weak Gram +, Better Gram -, anaerobes +/-, ceftazidime active against pseudomonas
18
Q
4th generation (spectrum)
A
Gram +, Best Gram -, anaerobes +/-, pseudomonas
19
Q
5th generation (spectrum)
A
Gram +, Gram -, anaerobes +/-, MRSA
20
Q
1st generation (Role)
A
- S. aureus infections
- Skin, soft tissue infections
- Preoperative antibiotic prophylaxis for clean procedures
- Uncomplicated, community acquired UTIs
21
Q
2nd generation (Role)
A
- Surgical prophylaxis in GI surgery
- PID
- Community-acquired pneumonia
- Otitis media
- Sinusitis
- Quinolone, TMP/SMX-resistant E. coli UTI
22
Q
3rd generation (Role)
A
- Predominantly GRAM NEGATIVE AGENT
- Community acquired pneumonia
- ECF-acquired pneumonia where Pseudomonas is not suspected
- UTIs with gram (-)
- Meningitis
- Gonorrhea
CEFTAZIDIME = ANTIPSEUDOMONAL
23
Q
4th generation (Role)
A
Overly broad
24
Q
5th generation (Role)
A
MRSA pneumonia?
Community acquired pneumonia (CAP)
Cellulitis with CANVAS 1 in CANVAS 2
25
Procaine Pencillin
Formulation of Penicillin G
- Delays peak serum and last 12 hours in serum and tissue
- Common allergy to procaine (injection anesthetic)
26
Benzathine Penicillin
Formulation of Penicillin G
- Drug of choice for latent syphilis
- Provides long lasting serum levels (15-30 days)
- Not effective against CNS infections
27
Ampicillin-sulbactam
Common name: Unasyn
Penicillin with Beta-lactamase
28
Amoxicillin-clavulanate
Common name: Augmentin
Penicillin with Beta-lactamase
29
Unasyn/Augmentin (spectrum)
Gram +: MSSA
Gram -
Anaerobes: B. fragilis
30
Unasyn/Augmentin (Role)
- Pneumonia
- Intraabdominal infections
- Skin and soft tissue infections
31
Piperacillin-Tazobactam
Common name: Zosyn
Penicillin with beta-lactamase
32
Piperacillin-Tazobactam (Spectrum)
- MSSA
- Beta-lactamase producing Enterobacteriaceae
- B. fragilis
33
Piperacillin-Tazobactam (Role)
- Nosocomial pneumonia
- Intra-abdominal infections
- Complications infections
- Pseudomonal infections
34
Cephalosporins (adverse effects)
- Stomach discomfort.
- Nausea or vomiting.
- Diarrhea.
- Thrush (white fungus in the mouth), yeast infection, or other fungal infection.
- Blood abnormalities.
- Rash or itching
35
Penicillin (adverse effects)
- Oxacillin, nafcillin (Elevated AST/ALT, neutropenia, rash, allergic interstitial nephritis)
- Ampicillin/amoxicillin (Rash, diarrhea)
36
KPCs
K pneumoniae carbapenemase
Klebsiella and other Enterobacteriaceae produce carbapenemases, which are enzymes that hydrolyze the carbapenems
37
Aztreonam (Role)
No cross reactivity if patient has a PCN allergy
Gram (-)
Antipseudomonal
38
Aztreonam (Adverse effects)
Extremely expensive ($150/day)
39
Imipenem (Adverse effects)
Rapid renal excretion leading to higher incidence of seizures in renal insufficiency patients (A dehydropeptidase inhibitor is added to try to reduce issue)
40
Imipenem/Meropenem (activity)
Gram +
Gram (-)
Anaerobic activity
Quick resistance from Acinetobacter baumannii
41
Ceftolozane/Tazobactam (indications)
Use reserved for multi-drug resistant Pseudomonas aeruginosa
42
Ceftolozane/Tazobactam (disadvantages)
Expensive
43
Ceftazidime/Avibactam (Indications)
Treatment of carbapenem-resistant Enterobacteriaceae that have Klebsiella producing carbapenemases activity
44
Ceftazidime/Avibactam (Disadvantages)
Extremely expensive
45
Hydrocortisone
Common names: Cortenema, Cortifoam
Topical corticosteriod or enema
IBD management
46
Budesonide
Common names: Uceris, entocort (oral only)
Topical foam or oral corticosteroid
IBD management
47
Prednisone
Oral corticosteriod
IBD management
48
Sulfasalazine
Common names: Azulifidine
Class: Aminosalicylate
IBD Management
49
Mesalamine
Common names:
Canasa (suppository)
Rowasa (enema)
Asacol, apriso, lialda, pentasa, delzicol (oral)
Class: Aminosalicylate
IBD Management
50
Olsalazine
Common name: Dipentum
Class: Aminosalicylate
IBD management
51
Balsalazide
Common name: Colazal
Class: Aminosalicylate
IBD management
52
IBD Management Sequence
```
Aminosalicylates
Corticosteriods
Immunomodulators
TNF alpha inhibitors
Natalizumab
Vedolizumad
Antibiotics
```
53
Immunomodulators for IBD
Azathioprine
Mercaptopurine
Cyclosporine
Methotrexate
54
Sodium Bicarbonate
Common name: Alka-Seltzer
Antacid
GERD Management
55
Calcium Carbonate
Common name: Tums
Antacid
GERD Management
56
Magnesium hydroxide + Aluminum hydroxide
Common name: Mylanta
Antacid
GERD Management
57
Cimetidine
Common name: Tagamet
H2 Blocker
GERD Management
58
Famotidine
Common name: Pepcid
H2 Blocker
GERD Management
59
Ranitidine
Common name: Zantac
H2 Blocker
GERD Management
60
Nizatidine
Common name: Axid
H2 Blocker
GERD Management
61
Omeprazole
Common name: Prilosec
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
62
Esomeprazole
Common name: Nexium
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
63
Pantoprazole
Common name: Protonix
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
64
Lansoprazole
Common name: Prevacid
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
65
Dexlansoprazole
Common name: Dexilant
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
66
Rabeprazole
Common name: Aciphex
PPI
```
GERD Management (1x day)
PUD/H. Pylori (Multiple times a day)
```
67
Misoprostol
Analogue of PGE, stimulates secretion of mucus and bicarbonate
GERD Management of patients on NSAIDs
Contraindicated in pregnancy
68
Sucralafate
Salt of sucrose complexed to aluminum hydroxide which forms viscous past that binds selectively on ulcers or erosions
GERD Management
69
Triple therapy
H. Pylori Management
High dose PPI plus
Antibiotics (Clarithromycin and [Amoxicillin or Metronidazole])
70
Prevpac
Triple therapy combination product for H. Pylori
Lansoprazole, amoxicillin, clarithromycin
71
Pylera
Triple therapy combination product for H. Pylori
Bismuth subcitrate potassium, metronidazole, tetracycline
72
Quadruple Therapy
H. Pylori management
High dose PPI plus
Bismuth subsalicylate plus
Metronidazole and [tetracycline or doxycycline]
73
Bethanechol
Cholinomimetic agent (stimulates muscarinic receptors and increases smooth muscle tone)
Motility Disorders
74
Neostigmine
```
Cholinomimetic agent
(Acetylcholinesterase inhibitor and blocks destruction of ACh)
```
Motility Disorders
75
Metoclopramide
D2 receptor blocker
Requires renal adjustment
Motility Disorders
76
Domperidone
D2 receptor blocker
NOT FDA approved
Motility Disorders
77
Erythromycin
Macrolides (antibiotic)
Motility Disorders
78
Erythromycin (side effects)
- QTc prolongation, ventricular arrhythmias
- Abdominal pain/cramping, diarrhea
- Decreased efficacy with long term use (4+ weeks)
79
Erythromycin (Drug interactions)
Numerous, major CYP3A4 inhibitor
80
Macrolides (MOA)
- Mimics motilin, a potent contractile agent
| - Cholinergic facilitation
81
Domperidone (Side effects)
- QTc prolongation, cardiac arrest
| - Abdominal cramps
82
Domperidone (Drug interactions)
- CYP3A4 inhibitors
| - QTc prolonging medications
83
Metoclopramide (Side effects)
Drowsiness, dystonic reaction, restlessness, bronchospasms, prolactin elevation
84
Metoclopramide (Drug interactions)
Antipsychotic agents
Atovaquone (antimalarial)
Droperidol
85
D2 Receptor Blockers (MOA)
Blockade of D2 receptors which leads to increased smooth muscle stimulation
- increased esophageal peristalsis
- increased lower esophageal sphincter pressure
- increased gastric emptying
86
D2 Receptor Blockers
*Common for diabetic gastroparesis*
Metoclopramide
Domperidone
87
Neostigmine (Drug Interactions)
Beta blockers
Corticosteroids
Succinylcholine
88
Neostigmine (Side Effects)
AV block, bradycardia
Dizziness
Diaphoresis
Bronchospasms
89
Bethanechol (Side Effects)
Abdominal pain, diarrhea
Urinary urgency
Asthma, bronchoconstriction
Flushing, headache, bradycardia
90
Bethanechol (Drug interactions)
Acetylcholinesterase inhibitors
| Beta blockers
91
Misoprostol (Side Effects)
Diarrhea, abdominal pain
| Detrimental to pregnancy
92
Misoprostol (Side Effects)
Antacids, magnesium containing
93
Sucralafate (Side Effects)
Constipation, aluminum toxicity (CKD patients)
94
Sucralafate (Drug Interactions)
Binds to multiple medications
95
PPIs (MOA)
Travel systemically to form irreversible disulfide bonds with proton pumps inactiving them
Taken on empty stomach
96
PPIs (Side Effects)
- Decreased B12, Ca and magnesium absorption
- Increased risk of bone fractures
- Increased risk of C. diff and pneumonia
- Increased risk of dementia and CKD
- Rebound acid hypersecretion with discontinuation
97
PPIs (Drug Interactions)
Drugs process via CYP2C19
Clopidogrel (Plavix): decreased antiplatelet activity
98
H2 Blockers (MOA)
Acid inhibition via reversible H2 receptor blockade on parietal cells
99
H2 Blockers (Side Effects)
Diarrhea, headache, fatigue, constipation, CNS effects (confusion, hallucinations, delirium)
Gynecomastia/impotence (cimetidine only)
100
H2 Blockers (Drug interactions)
Cimetidine (CYP2C9, CYP2D6, CYP1A2, CYP3A4 inhibitor)
101
Antacids (MOA)
Neutralize gastric acid by reacting with HCl
102
Sodium bicarbonate (Side effects)
Belching, metabolic alkalosis, fluid retention
103
Calcium carbonate (Side effects)
Belching, hypercalcemia, metabolic alkalosis
104
Magnesium hydroxide + Aluminum hydroxide (Side effects)
Diarrhea, constipation, aluminum accumulation in CKD
105
Sodium bicarbonate (Drug Interactions)
Elvitegravir (v)
Amphetamines (^)
Calcium-containing dairy products (v)
106
Calcium carbonate and Magnesium hydroxide + Aluminum hydroxide (Drug interactions)
```
Tetracyclines (v)
Fluoroquinolones (v)
Itraconazole (v)
Iron (v)
Calcium-containing dairy (^)
Elvitegravir (v)
```
107
Acyclovir (Spectrum)
Anti-viral (15-21% bioavailability)
Herpes simplex (HSV) 1 and 2
Varicella-zoster (VZV)
EBV
*Not CMV*
108
Famciclovir (Spectrum)
Anti-viral (77% bioavailability)
Herpes simplex (HSV) 1 and 2
*Varicella-zoster (VZV)*
EBV
*Not CMV*
109
Ganciclovir (Spectrum)
Active against cytomegalovirus (CMV)
Poor bioavailability (5-9%)
110
Foscarnet (Spectrum)
Anti-viral
GCV resistant CMV,
ACV-resistant HSV 1&2, VZV
Intolerable myelosuppression with GCV
111
Valacyclovir
Prodrug of Acyclovir combined with valine
Improved bioavailability to 54% but 5x more expensive
112
Famciclovir
Prodrug of penciclovir
Improved oral bioavailability over ACV of 77%
Oral treatment of VZV
113
Valaganciclovir
Prodrug, valine ester of Ganciclovir
Improved bioavailability to 60%
114
Foscarnet (MOA)
Inorganic pyrophosphate analog
Directly inhibits viral DNA polymerase (Reversibly blocks pyrophosphate binding site of viral DNA polymerase)
Renal metabolism
115
Acyclovir (MOA)
Deoxyguanosine nucleotide analog that inhibits transcription by viral DNA polymerase
Renal metabolism
116
Ganciclovir (MOA)
Deoxyguanosine nucleotide analog that inhibits transcription by viral DNA polymerase
Renal metabolism
117
Acyclovir (Toxicity)
*Rare, not significant*
Nephrotoxicity: can crystallize in renal tubules
Neurotoxicity: lethargy, confusion, delirium
118
ACV Resistance
Due to loss of viral thymidine kinase, altered TK activity, or DNA polymerase mutants
ACV-R HSV or VSV will be cross-resistant to famciclovir and ganciclovir
119
Ganciclovir (Toxicity)
```
Myelosuppression (Neutropenia and thrombocytopenia)
CNS toxicity (Headache, change in mental status)
```
120
Ganciclovir Resistance
Reduced intracellular phosphorylation due to point mutations/deletions in the UL97 gene
Point mutations in the viral DNA polymerase
Cross resistance to Foscarnet
121
Foscarnet (Toxicity)
*Very significant*
Nephrotoxicity (usually 2nd week of therapy)
- Reversible
Metabolic abnormalities
- Hypocalcemia
- Hypomagnesemia
- Hypokalemia
CNS abnormalities
- Headache, irritability, seizures
Painful genital ulcerations
122
Hep B Therapy Drugs
Lamivudine/emtricitabine (Least potent)
Entecavir
Tenofovir (Most potent)
123
Hep B Drugs (MOA)
Nuceloside analogs: inhibits hepatitis B DNA polymerase via chain termination
Suppresses replication, not a cure
124
Interferon alpha 2a or 2b (MOA)
Hep C
Induce interferon-stimulated genes which establish an antiviral state within cells, though the response is not virus specific; inhibit viral protein synthesis
125
Interferon alpha 2a or 2b (Side effects)
- Fever, myalgia
- Neutropenia, thrombocytopenia
- Hypothyroidism
- Depression
126
Ribavirin (MOA)
Hep C
Nuceloside analog
127
Ribavirin (Side effects)
- Hemolytic anemia
- Teratogenic
- Flu-like symptoms
- Depression/irritability
- Rash
- Nausea/diarrhea
128
Interferon + ribavirin (response rates)
```
Most responsive to least:
2 and 3
4
5
6
1
```
129
Interferon + ribavirin (Limitations)
Not well tolerated
Poor response rates
Long duration of therapy (up to 48 weeks)
130
Hep C Direct Acting Agents
Protease inhibitors
- Boceprevir
- Telaprevir
- Simeprevir
*Only used for Genotype 1*
131
Protease Inhibitors benefits
Increase response rates of Interferon and ribavirin therapy
Decreased length of therapy
132
Harvoni (MOA)
Sofosbuvir (Nucleoside analog against HCV NS5B polymerase)
Ledipasvir (NS5A inhibitor)
133
Harvoni (Spectrum)
HCV genotypes 1, 4, 5, and 6
134
Zapatier (MOA)
Elbasvir (NS5A inhibitor)
| Grazoprevir (NS3/NS4A inhibitor)
135
Zapatier (Spectrum)
HCV Genotypes 1 and 4
136
Epclusa (MOA)
Sofosbuvir (Nucleoside analog against HCV NS5B polymerase)
| Velpatsavir (NS5A inhibitor)
137
Epclusa (Spectrum)
Pan-Genotypic
| HCV Genotypes 1, 2, 3, 4, 5, 6
138
Mayret (MOA)
Glecabrevir (NS3/4A protease inhibitor)
| Pribrentasvir (NS5A inhibitor)
139
Mayret (Spectrum)
Pan-Genotypic
| HCV Genotypes 1, 2, 3, 4, 5, 6
