Pneumonia, DVT, PE, pHTN Pharm

Question 1

What is the suffix of endothelin antagonists?

Answer 1

-ntan

Question 2

What is a guanylate cyclase sensitizer?

Answer 2

riociguat

Question 3

When to give CCB with PAH?

Answer 3

if positive vasopressor test

–> NIFEDIPINE, diltiazem, amlodipine

Question 4

What happens if you give CCB to a pt with negative vasopressor test?

Answer 4

makes it way worse, don’t give

Question 5

Define PAH

Answer 5

sustained MAP (arterial pressure) of lungs over 25mmHg at rest

normal= 14 +/- 3

Question 6

Is PAH more common in males or females?

Answer 6

females, especially young but can occur at any age

Question 7

Describe process of pulmonary vascular resistance

Answer 7

vasoconstriction d/t PAH

inflammation

localized thrombosis formation

obstructive remodeling of the pulmonary vessel wall

Question 8

What does increased pulmonary vascular resistance lead to?

Answer 8

right ventricular overload
right heart failure
premature death

death 2.8 years if not treated

Question 9

What type of lesion is pathognomonic of PAH

Answer 9

plexiform lesion

Question 10

What common drug is a risk factor for PAH?

Answer 10

weight loss pills

fenfluramine and phentermine

Question 11

What was the first gene linked to PAH but is seen less than 25% in idiopathic PAH?

Answer 11

BMPR2

Question 12

Describe WHO classification system for PAH

Answer 12

I: without limitation of activity

II: slight limitation, comfortable at rest

III: marked limitation, comfortable at rest, less than ordinary activity causes sx

IV: inability to carry out physical activity, sx RHF, sx present at rest

Question 13

Describe vasopressor test

Answer 13

given to group 1 patients to see how severe PAH is

short-acting vasodilator given (adenosine, NO)

positive if artery pressure falls more than 10mmHg, MAP is less than 40mmHg, CO is unchanged or increased

less than 13% have positive response

Question 14

What treatment has little impact of PAH progression

Answer 14

anticoagulants
diuretics
oxygen therapy

Question 15

Epoprostenol

Answer 15

Prostanoid

promotes vascular relaxation

inhibits platelet aggregation

generates cAMP

use in PAH to decrease resistance, pressure

increase exercise tolerance

very short half-life–> IV infusion

SEPSIS d/t chronic catheter

flushing, ha, N, V, jaw pain d/t vasodilation

Question 16

Treprostinil

Answer 16

Prostanoid

mimics prostacyclin, binds G coupled receptor–> cAMP–> vasodilation

subq infusion, causes pain

longer half-life c/t epoprostenol, no refrigeration

extended release oral available

Question 17

iloprost

Answer 17

mimics prostacyclin

inhalation 6-9 times per day

Question 18

selexipag

Answer 18

mimics prostacyclin

orally BID, hella expensive

Question 19

bosentan

Answer 19

nonspecifically blocks endothelin A and B receptors

improves exercise intolerance, slow sx progression

oral

hepatotoxic, teratogenesis

accelerates metabolism of warfarin and oral contraceptives (must use 2 birth control forms)

Question 20

ambrisentan

Answer 20

selectively blocks endothelin A

teratogenesis

does not damage liver like bosentan

doesn’t accelerate metabolism of warfarin or oral contraceptives like bosentan

Question 21

macitentan

Answer 21

nonselective endothelin blocker

18 hour half life–>qd dosing

similar CYP450 effects as bosetan

Question 22

sildenafil

Answer 22

selectively blocks PDE V
->normally breaks down cGMP to stop relaxation, blocking it causes more relaxation/vasodilation

4 hour half life, well tolerated

Viagra for ED, Revatio for PAH

Question 23

tadalafil

Answer 23

Cialis for ED, Adcirca for PAH

longer half-life compared to sildenafil

PDE 5 blocker to increase cGMP and vasodilation

Question 24

riociguat

Answer 24

sensitizes sGC to NO and directly stimulates it independent of NO

increased generation of cGMP–>increased vasodilation

12 hours half life

FETAL HARM

DONT GIVE WITH PDE V inhibitors

Question 25

treatment of PAH

Answer 25

start with combo ambrisentan (endothelin inhibitor) and tadalafil (PDE V inhibitor) then add prostacyclin if worsening add second and third class as gets worse-->lung transplant or palliative care

Question 26

heparin

Answer 26

blocks generation of thrombin, inactivates it, prevents red clots, inhibits factor 10a rapid onset safe in pregnancy protamine antidote must be given IC or subq monitor via aPTT

Question 27

enoxaparin (LMWH)

Answer 27

selectively blocks factor 10a and prevents red clots prevent DVT, PE, ischemic complications SAFE IN PREGNANCY first choice tmt for DVT, longer half-life protamine antidote heparin-induced thrombocytopenia neuro injury in spinal anesthesia or puncture

Question 28

warfarin

Answer 28

vitamin K antagonist--> decreases production of 2, 7, 9, 10 and protein C and S long-term prophylaxis of thrombosis not useful in emergencies 100% oral bioavailability slow onset and offset, monitor INR antidote vitamin K, no pregnancy, many drug interactions

Question 29

rivaroxaban

Answer 29

direct inhibitor of 10a (activated factor X) directly inhibits production of thrombin rapid onset, fixed dose, lower bleeding risk, fewer interactions, no INR monitoring (c/t warfarin) prevent DVT and PE, stroke with nonvalvular a-fib antidote-->andexanet alfa oral high bioavailability bleeding renal and hepatic impairment, no pregnancy, no anticoagulants interacts with CYP3A4

Question 30

dabigatran

Answer 30

reversible direct thrombin inhibitor rapid onset, no need to monitor (c/t warfarin), fewer drug and food interactions, lower risk of bleeding prevent stroke and embolism with nonvalvular a-fib dont give with mechanical heart valves pills unstable bleeding major concern -->antidote idarucizumab

Question 31

idarucizumab

Answer 31

antidote for DOAC- direct thrombin inhibitors

Question 32

what is INR used to assess?

Answer 32

PT assess warfarin levels

Question 33

what is INR used to assess?

Answer 33

PT assess warfarin levels

Question 34

amoxicillin +- clavulanate

Answer 34

inhibits cell wall synthesis and beta lactamases gram + and - bacteria not active against Pseudomonas CAP

Question 35

piperacillin + tazobactam

Answer 35

inhibits cell wall synthesis and beta lactamases gram + and - and anaerobic active against Pseudomonas CAP and HAP/VAP

Question 36

ceftriaxone

Answer 36

3rd generation gram - not eliminated by kidney, no dosage adjustment needed bleeding tendencies oral

Question 37

cefepime

Answer 37

4th generation gram - and + IV

Question 38

cefpodoxime

Answer 38

3rd generation gram - and + oral COPD, otitis media, CAP, strep pharyngitis, UTI multiple drug interactions, increased half-life with decreased renal fxn don't use with beta-lactam allergy superinfection risk

Question 39

cefditoren

Answer 39

acute bacterial exacerbation of chronic bronchitis CAP pharyngitis, tonsillitis, uncomplicated skin infections gram - and + oral multiple drug interactions, increased half-life with decreased renal fxn don't use with beta-lactam allergy superinfection risk can increase INR

Question 40

doxycycline

Answer 40

tetracycline, bacteriostatic (30s) drug of choice in CAP stain kids teeth esophageal irritation and ulceration photosensitivity don't combine with bactericidal drugs (penicillins)

Question 41

clarithromycin

Answer 41

macrolide, bacteriostatic (50s) drug of choice in CAP aerobic and anaerobic gram + not gram - except pasteurella, haemophilus, neisseria effective against legionella, mycoplasma less GI upset, CYP450 inhibitor

Question 42

azithromycin

Answer 42

macrolide, bacteriostatic (50s) drug of choice in CAP aerobic and anaerobic gram + not gram - except pasteurella, haemophilus, neisseria effective against legionella, mycoplasma doesn't disrupt CYP450 concentrates in cells as azalide, slowly release bacteriostatic levels of drug

Question 43

ciprofloxacin

Answer 43

inhibit DNA gyrase--> gram negative bacteria also active against Pseudomonas

Question 44

levofloxacin

Answer 44

fluoroquinolone 3rd generation gram - reserve d/t tolerance but more effective than tetracyclines or macrolides for pneumonia don't give to ambulatory CAP patients unless high prevalence or comorbid conditions (often given anyway, not good for resistance) Achilles tendon rupture, GI upset

Question 45

moxafloxicin

Answer 45

fluoroquinolone 4rd generation gram - reserve d/t tolerance but more effective than tetracyclines or macrolides for pneumonia don't give to ambulatory CAP patients unless high prevalence or comorbid conditions (often given anyway, not good for resistance) Achilles tendon rupture, GI upset

Question 46

gemifloxacin

Answer 46

fluoroquinolone gram - reserve d/t tolerance but more effective than tetracyclines or macrolides for pneumonia don't give to ambulatory CAP patients unless high prevalence or comorbid conditions (often given anyway, not good for resistance) Achilles tendon rupture, GI upset

Question 47

vancomycin

Answer 47

given IV serious infections (MRSA) given with allergy to penicillins C diff red man syndrome with fast infusion

Question 48

linezolid

Answer 48

binds ribosomal A-->prevent RNA binding gram + CAP caused by strep pneumo HAP caused by Staph aureus oral or IV

Question 49

aztreonem

Answer 49

inhibits cell wall synthesis gram - aerobes including Pseudomonas

Question 50

imipenem

Answer 50

inhibits bacterial cell wall synthesis wide spectrum against gram - and + active against many multiresistant strains LRTI

Question 51

gentamicin

Answer 51

binds 30S gram - including Pseudomonas gram + staph nephrotoxicity and ototoxicity