Respiratory, GI, and Infectious Diseases Flashcards
(112 cards)
1
Q
In what ways can drug therapy help respiratory conditions in relation to PT
A
- Breath more easily
- Become more engaged in respiratory muscle training & various exercises
- Reduce anxiety
2
Q
What is the goal of respiratory drugs
A
- Maintain airflow
- Control secretions & irritation
3
Q
Acute problems associated with respiratory drugs
A
- Nasal congestion
- Coughing
- Seasonal allergies
4
Q
Chronic problems associated with respiratory drugs
A
- Asthma
- Chronic bronchitis
- Emphysema
5
Q
List drugs used for respiratory irritation & secretion control
A
- Anti-tussives
- Decongestants
- Mucolytics/Expectorants
- Anti-histamines
6
Q
Describe anti-tussives
A
- Help to suppress cough associated with a cold or other throat irritations
7
Q
Side effects of anti-tussives
A
- Sedation
- Dizziness
- GI upset
- Dependence on opioids
8
Q
List some anti-tussives
A
- Benzonatate: local anesthetic
- Codeine, Hydrocodone, & Hydromorphone: suppression of cough reflex
- Dextromethorphan: inhibition of cough reflex
- Diphenhydramine: anti-histamine
9
Q
Describe decongestants
A
- Help to relieve runny nose & stuffy head feeling
10
Q
Side effects of decongestants
A
- More apparent at high doses or during prolonged use
- Headaches
- Dizziness
- Nausea
- Insomnia
- Increased BP
11
Q
Lists the nasal sprays and oral dosages of decongestants
A
- Nasal sprays: Oxymetazoline & Phenylephrine
- Oral: Ephedrine, Pseudoephedrine, & Phenylephrine
- They bind alpha receptors in blood vessels of nasal mucosa = vasoconstriction
12
Q
Lists 1st and 2nd generation anti-histamines
A
- 1st gen: Diphenhydramine, Doxylamine, & Hydroxyzine
- 2nd gen: Cetirizine, Loratadine, & Fexofenadine
13
Q
Side effects of 1st generation anti-histamines
A
- Sedation
- Fatigue
- Dizziness
- GI distress
14
Q
Describe mucolytics and expectorants
A
- Mucolytics: decrease viscosity of secretions
- Expectorants: Help to eject mucus
15
Q
Side effects of mucolytics and expectorants
A
- Mucolytics: Nausea, vomiting, oral mucosa inflammation
- Expectorants: GI upset
16
Q
List chronic respiratory problems and the goal
A
- COPD
- Asthma
- Cystic fibrosis
- Goal is to maintain airway patency
17
Q
Describe beta adrenergic drugs
A
- Beta agonists that stimulate beta 2 receptors
- Cause relaxation of bronchiole smooth muscle
18
Q
List short and long acting beta adrenergic drugs
A
- Short: Albuterol & Levalbuterol
- Long: Salmeterol, Formoterol, & Vilanterol
19
Q
Side effects of beta adrenergic drugs
A
- Excessive use = airway irritation
- Tolerance
- Cardiac irregularities
- Nervousness, tremor
20
Q
Ways to administer beta adrenergic drugs
A
- MDI (metered dose inhalers): inhalation technique is critical
- Nebulizers: may be beneficial for patients who cannot master the technique needed for MDI delivery
- DPI (dry powder inhalers)
21
Q
Describe xanthine derivative
A
- No longer recommend due to weak efficacy & side effects
- Produce bronchoodilation by inhibiting PDE in bronchial smooth muscle
- PDE inhibition = decreased function of inflammatory cells & mediators
22
Q
List xanthine derivatives and their side effects
A
- Theophylline & Aminophylline
- Side effect: toxicity
23
Q
Describe anti-cholinergic drugs
A
- Have large role in COPD
- Drugs: Ipratropium & Tiotropium
- Vagus nerve releases Ash into respiratory smooth muscle and blocks stimulus which prevents bronchoconstriction
24
Q
Side effects of anti-cholinergic drugs
A
- Dry mouth
- Constipation
- Tachycardia
- Confusion
25
Describe glucocorticoids
- Stop inflammation
- IV: for severe acute episodes of bronchoconstriction
- Oral: for more prolonged use
- Inhaled: prolonged use, less systemic exposure
26
Side effects of glucocorticoids
- Psychiatric disturbances
- HTN
- Hyperglycemia
- Long term: muscle wasting, osteoporosis, loss of adrenal function, skin breakdown
27
Describe Cromones
- Help prevent bronchospasm
- Taken prophylactically
- Prevent release of histamine
- Cromolyn (Nasalcrom)
28
Describe leukotriene inhibitors
- Leukotrienes are inflammatory mediators
- Zileuton (Zyflo): inhibits production of leukotrienes
- Montleukast (Singular): blocks receptor for leukotrienes
29
Describe management for asthma
- Bronchial smooth muscle spasm, airway inflammation, & mucous plugging of airways
- Traditional Tx: bronchodilators, Xanthine derivatives, & steroids only in severe cases
- Current Tx: 1st line is inhaled glucocorticoids (fluticasone, budesonide, beclomethasone), can be combined with bronchodilators
30
Describe management of COPD
- Chronic respiratory symptoms (cough, SOB, sputum production), persistent airflow obstruction
- Long acting anti-cholinergics
- Long acting beta agonists
- Short acting rescue inhalers
- Inhaled glucocorticoids in severe disease
- Bronchodilators are the primary treatment
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Slide 21
32
Describe the uses and the harms of gastric acidity & secretion
- Acidity helps to activate protease & controls growth of bacteria in the intestine
- Harmful: if produced in excessive amounts can cause ulcers & hemorrhage of the stomach lining; peptic ulcers can occur
33
Describe antacids
- Help control acidity & secretion
- Contain a base which helps to neutralize acid by binding H+ in the stomach
- Aluminum containing, magnesium containing, calcium carbonate containing, sodium bicarbonate containing
34
Side effects of antacids
- Constipation
- Electrolyte imbalances
- Altered PH in body fluids
35
Describe H2 receptor blockers
- Help control acidity & secretion
- Histamine stimulates stomach cells to increase gastric acid secretion
- H2 blockers bind receptor & prevent histamine from stimulating stomach cells
- Famotidine, Mizatidine, Cimetidine
36
Side effects of H2 receptor blockers
- Headache
- Dizziness
- Discontinuation can cause acid rebound
- Electrolyte imbalances
37
Absorption of some antibiotics is decreased by _______-_______ in the presence of aluminum or magnesium antacids
- 50-90%
38
Describe proton pump inhibitors
- Help control acidity & secretion
- Drugs: Omeprazole, Lansoprazole, Pantoprazole, & Esomeprazole
39
Side effects of proton pump inhibitors
- Acid rebound if discontinued
- Decreased bone mineralization
- Increased risk of C. diff
- Decrease absorption
- Pneumonia risk
40
Describe helicobacter pylori
- Gram negative bacteria
- Research suggests it can cause gastroduodenal ulcers
41
Lists drugs that help control acidity & secretion
- Anticholinergics: decrease the release of gastric acid & no longer used due to side effects; SE = dry mouth, constipation, urinary retention
- Metoclopramide: stimulates motility in upper GI tract; SE = restlessness, drowsiness, fatigue
- Prostaglandins: stimulates gastric mucus secretion & inhibits gastric secretion, not often used; SE = diarrhea
- Sucralfate: forms protective gel in stomach & sticks to ulcers & shields them from stomach acid; SE = constipation
42
What causes diarrhea
- Fast movement of food through GI tract which can lead to dehydration
- Normal movement of food through GI tract = absorption of nutrients & water
43
List and describe antidiarrheal agents
- Opioid Derivatives: Decrease GI motility, Reduce fluid loss through absorption of salt and water, Drugs = Diphenoxylate, Loperamide; SE = nausea & constipation
- Bismuth salicylate: Stimulates water and electrolyte reabsorption, Also decreases gastric acid secretion; SE = no serious SE
- Bile acid Sequestrants: Useful for diarrhea caused by excessive bile acid secretion
44
Describe laxatives & the different forms
- Promote evacuation of bowel when no obstruction exists in GI system
- Bulk forming: absorb water & swell in GI tract, stretches GI tract & stimulates peristalsis
- Stimulants: irritate gastric mucosa
- Hyperosmotic laxatives: draws mater into bowel & small intestine, stimulating peristalsis
- Lubricants & softeners: helps water enter still which softens stool & allows for easier defecation
45
Describe Emetics
- Induce vomiting
- Given for poisonings or toxic ingestions
- Stimulate emetic center in the brain
- Ipecac, apomorphine
46
Describe Antiemetics
- Antihistamines (meclizine)
- Anticholinergics (scopolamine)
- Dopamine blockers
- Serotonin receptor blockers
47
Describe digestants
- Help to digest food
- Pancreatic enzymes (amylase, lipase)
- Bile salts: help with lipid digestion & absorption
48
Describe Cholelitholytics
- Ursodiol- helps to decrease cholesterol content of bile, can aid in dissolution of gallstones
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Slide 33
50
Describe bacteria
- Unicellular organisms
- Depend on nourishing medium to survive
- Gram positive: Staph, Strep, & Enterococcus
- Gram negative: E. coli, Pseudomonas, & Klebsiella
51
Describe antibiotics
- Used to treat many different bacteria
- Many different classes of antibiotics, each with their own spectrum of activity
- Choose based on: Comorbidities/Allergies, Bacterial strain, Physician/patient preference, Cost, Inpatient vs outpatient
- Usually start broad & narrow based on culture
52
Define selective toxicity, bactericidal, & bacteriastatic
- Selective toxicity: drug kills the bacteria but not the hosts own cells
- Bactericidal: ability to kill or destroy bacteria
- Bacteriostatic: ability to limit growth & proliferation of bacteria but does not kill
53
How do antibiotics work
- Inhibition of cell wall formation & function: Penicillins, cephalosporins, carbapenems, vancomycin
- Inhibition of bacterial protein synthesis: Tetracyclines, aminoglycosides, clindamycin, linezolid
- Inhibition of bacterial DNA/RNA synthesis & function: Sulfonamides, fluoroquinolones
54
Describe Penicillins
- 1st antibiotic invented
- Many forms of natural & semisynthetic penicillin: all share common structure called beta lactate ring
- MOA: impairs construction of bacterial cell wall
- 1st line for ear infections & strep
- SE: rash, GI distress, & allergic reactions
55
Describe Cephalosporins
- MOA: Similar to penicillins in that they impair cell wall formation
- Divided into 1st, 2nd, 3rd and 4th generation depending on spectrum of activity
- Useful for UTIs, intra-abdominal infections, skin infections (earlier generations)
- SE: allergic reactions with small chance of cross reactivity with penicillins, GI distress
56
Other agents that inhibit cell wall synthesis
- Carbapenems: Slightly broader spectrum of activity than penicillins or cephalosporins
- Vancomycin: Good gram positive coverage, Can be nephrotoxic
- Colisitin, Cycloserine, Ethambutol: Not commonly used due to serious side effects
57
Describe Aminoglycosides
- Bactericidal
- Effective against gram negatives
- Tobramycin, gentamicin
- SE: oototxicity & nephrotoxicity
58
Describe Macrolides
- Bacteriostatic
- Covers both gram + and gram -
- Azithromycin= used for pneumonia and COPD
- SE: GI distress
59
Describe Tetracyclines
- Bacteriostatic
- Gram + and gram - coverage
- Doxycycline: useful in tick borne disease, skin infections
- SE: Gi distress, Calcium binding in teeth, sensitivity to UV rays
60
Describe Linezolid
- Effective against gram positives including MRSA
- Can cause serotonin syndrome when used with other agents
- SE: Thrombocytopenia
61
Describe Clindamycin
- Covers both gram + and some gram -
- Good for penetrating wounds, infection in the female genitourinary tract
- SE: GI distress & C. diff infection
62
Describe Fluoroquinolones
- Coverage of both gram + and gram -
- Good for respiratory tract, UTIs, bone infections
- SE: GI distress, insomnia, tendonitis
63
Describe Sulfamethoxazole-trimethoprim
- Covers both gram + and gram - bacteria
- SE: hepatotoxicity & nephrotoxicity
64
Describe Metronidazole
- Coverage of anaerobic bacteria
- SE: GI distress & confusion
65
Side effects of Rifampin, Dapsone, & Clofazimine
- Change in urine color
- Liver dysfunction
- Blood dyscrasias
66
Describe Daptomycin
- Binds to cell membrane and depolarizes cell
- Used for skin and other infections
- Activity against MRSA
- SE: GI distress & myopathy
67
Describe Nitrofurantoin
- Reduced to toxic metabolite that inhibits bacterial function
- Both gram + and gram - coverage
- Used for UTIs
- SE: GI distress & neurotoxicity
68
Describe the types of skin & soft tissue infections
- Impetigo: red sores on the face, normally caused by staph, treated with topical mupirocin
- Cellulitis: most common bacteria (staph & strep), Cephalexin, amoxicillin for treatment
- Abscess: coverage for staph & strep with addition of MRSA, Tx drugs = Doxycycline, Bactrim, Vancomycin
69
Describe the types of pneumonia
- Bacteria in the lungs, causes inflammation of lung parenchyma
- Aspiration: coverage for strep & anaerobic, Tx drugs = Augmentin, Zosyn
- Community acquired: coverage for strep & some gram -, Levofloxacin, Cefdinir + azithromycin
- Hospital acquired: coverage for gram + and gram -, concerns for MRSA & pseudomonas, Vancomycin, Cefepime
70
Describe the types of urinary tract infection
- Cystitis: Lower urinary tract infection, Most common bacteria: E. coli, Fluoroquinolone, cephalosporins, bactrim, nitrofurantoin
- Pyelonephritis: Infection of kidney, Can lead to long term damage if not treated,
Fluoroquinolone, cephalosporins, bactrim
71
Guidance of antibiotics
- Try to pick an antibiotic that covers normal causative bacteria: Need to consider patient allergies and co-morbidities
- If inpatient, will typically obtain a culture: This helps you to narrow antibiotics
- Try to narrow antibiotics as soon as possible
72
Describe antibiotic resistance
- Bacteria can have natural or acquired defense mechanisms that make them resistant to some antibiotics
- Beta Lactamase enzyme: found in some bacteria and helps the bacteria destroy penicillins and cephalosporins
- Bacteria can also modify the drug binding site, prevent drug absorption, or develop pumps that expel the drug
73
Examples of resistance
- MRSA: methicillin resistant staph aureus
- VRE: vancomycin resistant enterococcus
- MDRO: multiple drug resistant organism
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How do we treat resistant bacteria
- Switch to an antibiotic the bacteria is susceptible to
- For some resistance, we have developed drugs to overcome the resistance
- Beta-lactamase inhibitors- prevent bacterial enzyme from breaking down the drug: Augmentin- amoxicillin + clavulanic acid
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Slide 55
76
List in order the contact precautions
- Perform hand hygiene
- Wear gloves
- Wear gown
- Used for MRSA, VRE, & scabies
77
List in order the contact special enteric precautions
- Used for C. diff infections
- Hand hygiene must be with soap & water
- Wera gloves
- Wear gown
78
List in order the airborne isolation precautions
- Used for tuberculosis & chicken pox
- Perform hand hygiene
- Wear N95 respirator
- Keep door closed at all times
79
List in order the droplet isolation precautions
- Used for influenza, mumps, & pertussis
- Perform hand hygiene
- Wear gloves
- Wear surgical mask
- Wear face shield or goggles
80
List in order the enhanced precautions
- Used for COVID-19
- Perform hand hygiene
- Wear gown
- Wear respirator (N95, PAPR, P100)
- Wear face shield or goggles
- Wear gloves
- Keep door closed
- Visitation should be limited
81
Describe the structure and function of viruses
- Unicellular micro-organisms
- Nucleic acid core + protein shell
- Can't replicate or synthesize proteins
- Relies on host metabolic process to function
82
Describe ways viruses transmit
- Inhaled droplets
- Contaminated food & water
- Direct contact from infected people
- Direct inoculation by bites
83
Describe antiviral drugs
- Target specific steps in the viral replication process
- Limited number of approved drugs
- Hard to design because you need to kill the virus without killing the human cells
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Describe the process of viral replication
- Adsorption: virus attaches to host cell surface
- Penetration/Uncoating: enters host cells & coating on virus is removed
- Biosynthesis: virus takes control of cells machinery to initiate synthesis for new viral enzymes & proteins
- Maturation & release: parts of virus are assembled into mature virus & released from host cell
85
Describe herpes
- Creeping or spreading skin lesions caused by virus
- 8 types but most common include: HSV type 1, HSV type 2, Varicella-Zoster, Epstein-Barr, & Cytomegalovirus
- Once infected the virus stays for life
86
Describe Acyclovir and Valacyclovir
- Used to treat herpes & varicella-zoster
- SE: GI upset, Headaches, Dizziness, Kidney crystallization if given IV
87
List anti-herpes drugs
- Acyclovir
- Valacyclovir
- Cidofovir
- Docosanol
- Foscarnet
- Ganciclovir
- Valganciclovir
- Imiquimod
- Trifluridine
88
Describe Cidofovir
- Used to treat cytomegalovirus retinitis in people with AIDS, severe adenovirus, acyclovir resistant HSV
- SE: Nephrotoxicity, neutropenia, GI upset, headache
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MOA of Cidofovir, Acyclovir, and Valacyclovir
- Taken into virus infected cells & converted in acyclovir triphosphate: this inhibits DNA polymerase enzyme & impairs replication
- Virus also incorporates drug into DNA strands which stops further DNA production
90
Describe Docosanol
- Topical drug used to treat herpes lesions around the mouth
- MOA: Acts on host cells to prevent virus from absorbing; needs to be applied early in course
- SE: local skin irritation & headache
91
Describe Foscarnet, Ganciclovir and Valganciclovir, Imiquimod, and Trifluridine
- Foscarnet: For CMV retinitis, Work similar to acyclovir
- Ganciclovir and Valganciclovir: Treats CMV and other problems in AIDs patients
Imiquimod: Topical agent, Enhances production of interferons
- Trifluridine: Eye drops for herpes keratitis
92
Describe the 3 strands of influenza
- A: fevers, chills, malaise, headache, & sore throat
- B: fevers, chills, malaise, headache, & sore throat
- C: minor illness
93
List anti-influenza drugs
- Oseltamivir
- Baloxavir
94
Describe Oseltamivir
- Effective against influenza A & B
- Best if given within 48hrs of symptom onset
- MOA: inhibits neuraminidase, interferes with biosynthesis
- SE: CNS effects (hallucinations) & GI problems
95
Describe Baloxavir
- Used to prevent & treat influenza A & B
- MOA: Inhibits endonuclease activity of selective polymerase acid protein, inhibits viral gene transcription, results in inhibition of virus replication
- SE: diarrhea & vomiting
96
HIV and AIDS treatments
- HIV is a retrovirus: impairs function of certain cells in the immune system, can lead to immune system compromise & increased risk of opportunistic infection
- AIDS: life threatening as immune system can't defend against invasive micro-organisms, can also have neuromuscular involvement
97
Goals of treatment for HIV and AIDS
- Control Proliferation: highly active antiretroviral therapy (HAART), aggressive drug regimens, very effective but does not cure HIV, adherence can be difficult as non-adherence = resistance
- Treat/kill opportunistic infections
98
Describe HIV-Integrase inhibitors
- Drugs: Dolutegravir, Elvitegravir, Raltegravir
- MOA: Inhibits enzyme required for HIV to splice viral DNA
- SE: fever, headache, GI problems
99
Describe HIV-Protease inhibitors
- Drugs: Ataznavir, Ritonavir, Lopinavir
- MOA: inhibits enzyme needed to manufacture specific HIV proteins, prevents HIV from maturing
- SE: alterations in fat deposition, increases in cholesterol & triglycerides, diarrhea, headache, fatigue
100
Describe HIV-Nucleoside reverse transcriptase inhibitors
- Drugs: Zidovudine, Abacavir, Emtricitabine, Tenofivir
- MOA: Inhibit replication and proliferation of HIV-type I, act on HIV reverse transcriptase and inhibit step in replication
101
Side effects of HIV-Nucleoside reverse transcriptase inhibitors
- Anemia, Granulocytopenia
- Fevers/Chills
- Nausea, dizziness
- Headache, Fatigue
- Peripheral neuropathies
- Liver dysfunction
- CNS toxicity
- Allergies: Abacavir
102
Describe HIV-Nonnucleoside reverse transcriptase inhibitors
- Drugs: Nevirapine, efavirenz
- MOA: inhibit transcription of RNA into DNA
- SE: GI distress & skin rashes
103
Describe treating of opportunistic infections
- Maintaining good immune function is the best defense
- Antimicrobial can be prescribed if immunocompromised progresses & infection develops
104
Describe Hepatits
- Long incubation period between infection & symptoms
- 5 types: A-E with C the most common
105
Describe interferons
- Group of proteins that have several effects: demonstrate non-specific antiviral activity
- Divided into 3 major classes: Type I = alpha & beta, used to treat chronic HBV & HCV, Type II = gamma, and Type III = lambda
- SE: Flu like symptoms, mood disturbances, and autoimmune disorders
106
Describe Ribavirin
- Used against several viruses including RSV, secondary for influenza
- Combined with interferons for treatment of chronic HCV
- MOA: not fully understood, impairs viral messenger RNA synthesis
- SE: anemia, alopecia, GI upset, mood disorders
107
Describe direct acting anti-virals
- Used to treat Hepatitis C
- All are combination medications
- Drugs: Harvoni, Zepatier, Epclusa, Mavyret, Vosevi
- MOA: depending on the drug, target either polymerase or protease to inhibit viral replication
- SE: flu like symptoms, arthritic pain, GI upset, anemia
108
Describe Nirmatrelvir and ritonavir
- Treatment for mild to moderate COVID-19
- MOA: inhibits SARS-COV-2 main protease, resulting in inhibition of viral replication
- SE: diarrhea & dyspepsia
109
Describe Molnupiravir
- Treatment of mil to moderate COVID-19
- MOA: becomes incorporated into SARS-COV-2 RNA, resulting in errors in viral genome & inhibition of replication
- SE: hypersensitivity reactions, diarrhea, & vomiting
110
Describe viral resistance
- Viruses can mutate and make pharmacologic agents ineffective
- Antivirals should be used judiciously
- Overcoming viral resistance continues to be a research focus
111
Describe viral vaccines
- Stimulate production of immune factors: Expose the body to a piece of the virus, but not the actual virus
- Drawbacks: Can be only partially effective, May require boosters
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