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Pharmacology > Test 4 > Flashcards

Test 4 Flashcards

1
Q

Ondansetron (zofran)

A
  • Anti-emetic
  • Serotinin receptor antagonist
  • Indications
  • Chemotherpay induced nasua and vomiting
  • Nausea and vomiting related to radiotherapy and anesthesia
  • MOA: Blocks tyoe 3 serotonin receptors (5HT3) on afferent vagal nerve
  • Adverse effects: Headache, dizziness, prolonged QT interval, risk of torsades de pointes, diarrhea
  • Dosing: PO, IV. SL
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2
Q

Metoclopramide (Reglan)

A
  • Anti-emetic
  • Dopamine antagonist
  • MOA: Blocks dopamine and serotonin receptors in the CTZ (chemoreceptor trigger zone found in the medulla), causing an increase in upper GI motility, thereby suppressing emesis
  • Dosing: PO/IV,suppository
  • Adverse effects:

High dose: Sedation, diarrhea

Long term high dose: Irreversible tardive dyskinesia (makes sence bas on its MOA)

-Nursing considerations: Drug should be taken 30 min before each meal and at bedtime. Can also be used to treat hiccups

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3
Q

Psyllium (Metamucil)

A
  • Bulk-forming laxative
  • Group III laxative
  • Act slowly (1-3 days)
  • Soft, formed stool
  • Uses: Diverticulosis and IBD
  • MOA: Acts on stool. Swells the stool with water to form gel-like material, softening and increasing fecal mass
  • Adverse effects: Intestinal and esophageal obstruction (makes sense due to MOA)
  • Nursing considerations: Must be taken with a large glass of water
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4
Q

Docusate sodium (Colace)

A
  • Surfactant laxative
  • Group III laxative
  • Act slowly (1-3 days)
  • Soft, formed stool
  • MOA: Lowers surface tension, allowing penetration of water into feces
  • Inhibits fluid absorption by the intestine
  • Stimulates scretion of water and electrolytes into the intestinal lumen for absoprtion by the stool
  • Adverse effects: Laxative dependence, dehyrdation, electrolyte abnormalities
  • Nursing considerations: To be taken with a large glass of water
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5
Q

Bisacodyl (dulcolax), Senna (senakot), and castor oil

A
  • Stimulant laxatives
  • Group II laxative
  • Intermediate acting (6-12 hours)
  • Semi-fluid stool
  • Indications: Opioid-induced constipation and constipation from slow intestinal transit (makes sense based on the MOA)
  • MOA: Acts on the intestines to increase intestinal motility
  • Increase secretion of water and electrolytes into intestinal lumen and reduces absorption
  • This is similar to docusate (surfactant laxative) but docusate does not stimulate intestinal motility

-Widely used and abused

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6
Q

Milk of magnesia, polyethylene glycol (Miralax), and lactulose

A
  • Osmotic laxatives
  • Both group I (preparation for diagnostic procedures) and II laxative depending on dose
  • Uses:
  • Hig doses
  • Preparation for diagnostic procedures/surgery
  • Purging poisons
  • Evaluatino of parasites
  • Constipation (low doses)
  • Adverse effects: Dehydration, acute renal railure due to magnesium toxicity, and sodium retention which can exacerbate heart failure, hypertension, and edema

PEG-ELS is an electrolyte isotonic solution osmotic laxative that won’t cause dehydration or electrolyte imbalance

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7
Q

Mineral oil

A
  • Poorly absorbed hydrocarbons which produced lubrication for feces to more easily slide through the intestines
  • Very useful when administered by enema to treat fecal impaction
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8
Q

Glycerin suppositroy

A
  • Osmotic laxative
  • MOA: Soften/lubricates impacted feces within 30 minutes
  • Uses: Reestablishing normal bowel function aftern termination of chroinic laxative use
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9
Q

Cimetidine (tagamet) and Fametidine (pepcid)

A
  • Histamine 2 blocker
  • Anti-secretory agent
  • MOA: Suppressions secretion of gastric acid via H2 blockage
  • Dosing: PO, IV 30 min before meals
  • Adverse effects
  • Anti-adrenergic: Gyneccomastia and reduced libido
  • CNS: Headache and somnolence
  • Drug interactions: Warfarin, lidocain
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10
Q

Omeprazole (prilosec), esomeprazole (nexium)

A
  • Proton pump inhibitor
  • Anti-secretory agent
  • MOA: Inhibition of H+ K+ ATPase proton pump, inhibiting gastric secretion
  • Adverse effects: Headache, pneumonia, Cdiff
  • Drug interactions: Elevated gastric pH results in reduced absorption of HIV and fungal medication
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11
Q

Magnesium, calcium, sodium, and aluminum compounds

A
  • Antacids
  • MOA: React with gastric acid to produce neutral salts or salts of low acidity
  • Reduced destruction of gut wall
  • Enhanced mucosal protection via stimulated production of prostaglandins
  • Produce long acting effects
  • Adverse effects: Diarrhea and constipation (both?)
  • Drug interactions: Cimetidine and ranitidine (H2 blockers)
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12
Q

Misoprostol (cytotec) and sucralfate (carafate)

A
  • Mucosal protectants
  • MOA: Create a physical barrier that protect the GI tract for 6 hours

Indications: Acute ulcers and maintenance therapy. GERD

  • Adverse effects: Constipation
  • Drug interactions: Antacids may interfere with effects of sucralfate
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13
Q

Interferon Alpha

A
  • Hep C treatment
  • MOA: Blocks viral entry and replication
  • Dosing: SQ and IM
  • Side effects: Flu-like syndrome, neuropsychiatric disorder (depression)
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14
Q

Ribavirin (rebetol)

A
  • Hep C medication
  • MOA: Unclear, must be combined with Interferon-alpha
  • Dosing: Oral
  • Adverse effects: Hemolytic anemia, fetal injury
  • Contraindications: Avoid in patinets with heart disease
  • Nursing considerations: Minitor CBC 1-2 weeks after beginning therapy (makes sense considering hemolytic anemia is a symptom)
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15
Q

DAAs

A
  • Four categories, with some active against HIV too
  • MOA: Prevent replication of HCV
  • Dosing: SQ, PO
  • Side effects: Flu like symptoms
  • Nursing considerations: Monitor liver functions (LFTs)
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16
Q

Amphotericin B

A
  • Ampho-Terrible
  • Anti-fungal, quasi anti-protozoa
  • Indications: Progressive or potentially fatal fungal infections
  • Not to be given willy nilly due to extreme adverse effects and easily achieved toxicity
  • MOA: Fungicidal or fungistatic based on dose and susceptibility of fungi
  • Binds to sterols in fungal cell membrane which increases permeability, thus reducing cell viability
  • Prevents reproduction
  • Low risk for resistance
  • Administration: Poort absorption in GI tract means it must be given IV in 5% dextrose over 2-6 hours
  • Adverse effects:
  • Highly toxic, must be given in hospital
  • Infusion reactions begin in 1-3 hours
  • Fever, chill, nausea, rigors, headache due to release of pro-inflammatory cytokines
  • Pretreat with diphenhydramine (antihistamine), aspirin, and antiemetic
  • Hypokalemia: Must give vitamin K supplements
  • Bone marrow suppression
  • Nephrotoxicity
  • Experienced in all patients
  • Damage is dose dependent
  • Avoid other nephrotoxic drugs like NSAIDS
  • Nursing considerations: Renal function testing!
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17
Q

Fluconazoles (and other “azoles”)

A
  • Most common antifungal
  • Indications: Drugs of choice for
  • Localized candida infections (UTI and thrush)
  • Systemic candidiasis
  • Suppression of cryptococcal meningitis in HIV after ampho B
  • Cryptococcal is a type of fungus, not a bacteria
  • MOA: Similar to ampho (bind to sterols in cell membrane and increase permeability)
  • Route: IV, PO with food, topical
  • Adverse effects: Generally well tolerated
  • Skin rash, GI effects
  • Hepato toxicity
  • Prolongation of QT interval
  • Nursing considerations: Monitor renal function weekly
18
Q

Penicillin

A
  • Beta-lactam antibiotic: Named for the beta-lactam ring in the structure
  • Weaken bacterial cell wall 1
  • Generally bacteriocidal vs bacteriostatic
  • MOA: PCN bind to PCN-binding proteins
  • Weaken cell wall by inhibiting transpeptidases (enzymes that maintain wall structure)
  • A weakend cell wall is more permeable and the cell eventually bursts

-Only works against bacteria that are undergoing growth and division

  • Adverse reaction: Allergic reaction
  • Bacterial resistance
  • Inability of penicillin to reach target (gram negative cell wall more difficult to penetrate)
  • Inactivation of penicillin by
  • Beta-lactamases
  • Penicillinases
  • Production of penicillin-binding proteins that have a low affinity for penicillin
  • Classifications
  • Narrow spectrum pencillinase sensitive
  • Narrow spectrum penicillinase resistant
  • Broad spectrum
  • Extended-spectrum
19
Q

Penicillin G (Benzylpenicillin)

A

-Narrow spectrum penicillin

-Weaken bacterial cell wall I

  • Bactericidal to most gram positive and some gram negative
  • Generally ineffective for gram neg
  • Indications:
  • Streptococcal infections
  • Staph pharyngitis
  • Gas gangrene
  • Syphilis
  • Administration: IM or IV (IV when needed urgently)
  • Adverse effects: Least toxic of all antibiotics
  • Allergic reaction
  • Drug interactions
  • Aminoglycosides
  • PCN weakens cell walls and promotes action of aminoglycosides but in high concentration it can inactive aminoglycosides
  • Never administer in same solution
  • Probenecid (uric acid reducer)
  • Delays renal excretion
20
Q

Nafcillin, Oxacillin, Dicloxacillin

A
  • Narrow specturm penicillins
  • Resistant to penicillinase
  • Still ineffective against Methicillin-resistant Staphylococcus aureus
21
Q

Aminopenicillins

Ampicillin (principin), amoxicillin (amoxil, moxatag)

A
  • Broad spectrum penicillin
  • Administration:
  • Ampicillin: Oral, IV
  • Amoxicillin: Oral
  • MOA: PCN bind to PCN-binding proteins
  • Weaken cell wall by inhibiting transpeptidases (enzymes that maintain wall structure)
  • A weakend cell wall is more permeable and the cell eventually bursts
  • Only works against bacteria that are undergoing growth and division

-Unlike Penicillin G, also effective against some gram negative bacteria like E. coli

-Easily inactivated by beta lactamases, so ineffective against staph aureas

-Adverse effects: Rash, diarrhea

22
Q

Augmentin

A

-A combination of beta-lactamase sensitive antibiotics and a beta-lactamase inhibitor

Amoxicillin + Clavulanic acid = Augmentin

Ampicillin + sulbactam = Unasyn

Piperacillin + Tazobactam = Zosyn

  • Extends the antimicrobial spectrum
  • Minimal toxicity
23
Q

Cephalosporins

A

-Weaken bacterial cell wall II

-Classifications: Progressing from 1-5 results in great activity against gram negative bacteria and anaerobies, increased resistance to destruction by beta lactamases, increased ability to reach CSF

-Gen 1: Cefazolin (Ancef)

-Gen II: Cefuroxime (Zinacef)

-Gen III: Ceftriaxone (Rocephin)

-Gen IV: Cefepime (maxipime)

-Gen V: Cefaroline (Teflaro)

-MOA: Binds to PBPs (penicillin binding proteins), disrupt cell wall synthesis, cause cell lysis

-Most effective against cells undergoing active growth and division

  • Administration: Poorly absorbed in GI tract (just like Ampho B), so rarely given orally
  • Can be given to people with mild penicillin allergy
  • Adverse effects: Hypersensitivity reactions, allergy, bleeding (cefotetan and ceftriaxone interfere with vitamin K metabolism)
  • Drug interactions: Probenecid (delays renal excretion just like penicillin), alcohol, and calcium (ceftriaxone can interact with it when place in the same tubing and cauze fatal precipitates)
24
Q

Vancomycin (Vancocin, vancoled)

A

-Weakens bacterial cell wall II

  • Indications: Only severe infections against gram positive bacteria
  • MRSA
  • Staphylococcus aureus
  • S. epidermidis
  • Clostridium difficile
  • Oral dosing
  • Only if metronidazole doesn’t work
  • Pneumococcal, streptococcal infections
  • MOA: Inhibits cell wall synthesis
  • Binds to molecules that contribute to cell wall synthesis
  • Inhibits the process and promotes bacterial lysis/death
  • Adverse effects:
  • Renal failure
  • Do not mix with other cytotoxic drugs (aminoglycosides, NSAIDS)
  • Monitor serum creatinine and peak/trough levels
  • Ototoxicity: Rare and reversible

-Redman syndrome: If given rapidly theremay be flushing, rash, pruritis (itchy skin), tachycardia, hypotension

-Nursing considerations:

-Must monitor peak and trough levels

  • Most infections: 10-15mg/L
  • Serious infections: 15-20 mg/L
25
Q

Tetracyclines (end in cycline)

A
  • Inhibit protein synthesis (as opposed to damaging layers of the cell wall)
  • Indications:
  • Rickettsial disease (rocky mountain fever, typhus)
  • Chlamydial disease
  • Cholera
  • Lyme disease
  • Anthrax
  • H. pylori
  • MOA: Bind to 30S ribosomal subunit to penetrate microbial cells and inhibit bacterial protein synthesis
  • Adverse effects:
  • Permanent discoloration of teeth
  • Inhibition of C++ absorption in long term use
  • Suppression of bone growth
  • Photosensitivity
  • C.diff
  • Renal impairment
  • Interactions
  • Decreased absorption when given with milk products, calcium supplements, iron supplements, magnesium containing laxatives, antacids, digoxin
  • Chelate formation
  • Nursing considerations: Do not give to pregnant or lactating women, or kids (decreased growth)
26
Q

Erythromycin

A
  • Macrolide
  • Bacteriostatic inhibitor of protein synthesis
  • MOA: Binds to 50S ribosomal subunit (vs 30S like in tetracyclines) and inhibits protein synthesis
  • Typically bacteriostatic
  • Indications
  • B. pertussis (whooping cough)
  • Acute diphtheria (corynebacterium)
  • Chlamydial infections (like tetracyclines)
  • M. pneumonia
  • Adverse effects
  • GI
  • Superinfection of the bowel
  • Thrombophlebitis
  • QT prolongation/sudden cardiac death
  • Interactions
  • Food (decreases absorption)
  • Warfarin
  • Antiarrhythmics
27
Q

Clindamycin (cleocin)

A
  • Inhibits protein synthesis
  • Indications: Active against most anaerobic bacteria (both gram negative and positive)
  • Only used for certain anareobic infections located outside the CNS
  • Can induce severe antibiotic-associated Clostridium difficile associated diarrhea
  • Superinfection of the bowel
  • Probably why it’s only indicated for certain anaerobic infections outside the CNS
  • Can be fatal
28
Q

Gentamicin

A
  • Aminoglycoside
  • Bactericidal inhibitor of protein synthesis
  • Indications: Treatment of serious infections caused by aerobic gram-negative bacilli
  • Narrow spectrum
  • Types of bacteria
  • Pseudomonas aeruginosa
  • E coli
  • Klebsiella
  • Serratia
  • Proteus mirabilis
  • MOA: Inhibits protein synthesis by binding to 30S ribosomal subunit (just like tetracyclines)
  • Dosing:
  • Single large dose each day

or

  • 2-3 smaller doses
  • Adverse effects: Ototoxicity, nephrotoxicity
  • Nursing considerations: Monitor serum levels
  • The same aminoglycoside dose can produce different effects in different patients
  • Peak levels must be high enough to be effective but low enough to reduce toxicity
29
Q

Trimethoprim-Sulfamethoxazole

A
  • Info about both drugs
  • Broad spectrum antibiotics
  • MOA: Inhibit folic acid and DNA synthesis
  • Indications: Treatment of choice for UTI
  • Bacteriostatic
  • TMP-SMZ combo
  • Inhibits sequential steps in bacterial folic acid synthesis (same as individual drugs)
  • Much more potent
  • Indications:
  • Uncomplicated urinary tract infections
  • Pneummocystis carinii (a fungus. Think carinii-carnivorous because fungii eat shit or something)
  • GI infections
  • Administration: IV, IM, PO
  • Excreted via pee
  • Adverse effects:
  • GI upset
  • Hypersensitivity (rash, photosensitivity, Stevens-Johnson syndrom but that’s rare af)
  • Hemolytic anemia on G6PD deficiency
  • An enzyme that promotes the function of red blood cells
  • Kernicterus in newborns
  • Kernicterus = brain damage from high levels of bilirubin in the blood
  • Crystalluria
  • Cloudy pee from crystals
  • Rare
30
Q

Fluoroquinolones

A
  • Broad spectrum antibiotic
  • Effective against
  • Aerobic gram -
  • Some gram +
  • Bacteriocidal
  • MOA: Inhibits bacterial DNA replication
  • Side effects: Mild
  • Contraindications: Avoid use in children due to rare risk of tendon damage
  • Drug interactions: Absorption reduced by aluminum and magnesium antacids, iron and zinc salts, and dairy products
31
Q

Ciprofloxacin

A
  • 2nd gen fluoroquinolone
  • Broad spectrum antibiotic
  • Bacteriocidal
  • MOA: INhibits two bacterial enzymes needed for DNA replication and cell division
  • Indications: Most gram -, some gram +
  • UTI
  • GI
  • Respiratory
  • Bone
  • Skin
  • Antrhax prevention
  • Some serious infections
  • Complicated UTI (gram - E. coli)
  • High risk of resistance, so not used for staph infx
  • Routes: IV, PO
  • Adverse effects:
  • Mild GI
  • CNS effects (dizziness and confusion, especially in the elderly)
  • Phototoxicity (risk of sunburn)
  • Blackbox warning: Tendon rupture
  • Avoid in children and elderly
  • Increased risk of clostridium difficile
  • Increased risk for candida infections
  • Contraindications: Avoid in children <18 y/o except in cases of complicated UTI or post anthrax inhalation
32
Q

Monurol (fosfomycin)

A
  • UTI treatment
  • Bacteriocidal
  • MOA: Inhibits bacterial cell wall synthesism, resulting in bacterial lysis and death
  • Dosing: Single 3 gm dose in uncomplicated UTIs
  • Symptoms resolve in 2-3 days
  • If symptoms don’t improve, giving another dose does not help and only increases risk of side effects
  • Side effects: Diarrhea, headache, vaginitis
33
Q

Isoniazid (Hydra)

A
  • Antimycobacterial agents
  • Prodrug (metabolized into active drug after administering)
  • Indications: Active and latent TB
  • 1st line aginst TB due to superior efficacy, low toxicity, ease of use, patient acceptance, and affordability
  • MOA: Inhibits synthesis of mycolic acid, a fatty acid in the mycobacterial cell wall
  • Adverse effects: Hepatotoxicity, peripheral neuropathy, seizures, dizziness
  • Drug interactions: Inhibits P450 isozymes (enzymes essential for drug metabolism)
34
Q

Rifampin (Rifadin)

A
  • Broad spectrum antibiotic
  • Indications: TB and leprosy
  • 1st line drug for TB
  • MOA: Inhibits protein synthesis by suppressing RNA synthesis
  • Adverse effects: Hepatitis, discoloration of body fluids
35
Q

Metronidazole (Flagyl)

A
  • Antiprotozoal and antibacterial drug
  • Indications:
  • Drug of choice for symptomatic intestinal amebiasis (an infection of the intestines with a parasite called Entamoeba histolytica) and systemic amebiasis, giardiasis (a diarrheal disease caused by the microscopic parasite Giardia duodenalis), and trichomoniasis (a very common STD)
  • Anaerobic infections
  • MOA: Interacts with DNA causing strand breakage that results in impairment of DNA function
  • Adverse effects: Metallic taste in mouth, darkened urine, nausea, headache, neurologic injury, SJS, dry mouth
  • Drug interactions: Alcohol (increased sensitivity)
36
Q

Abacavir

A
  • Nucleoside reverse transcriptase inhibitor (NRTI)
  • Antiretroviral drug
  • MOA: Suppresses synthesis of viral DNA
  • Prodrug: Must be converted to active form
  • Competitively binds to viral reverse transcriptase (RT)
  • Once incorporated into growing DNA strand, it prevents RT from adding more bases, thus blocking further growth
  • Adverse effects:
  • Impairment of mitochondrial function resulting in
  • Lactic acidosis: Hyperventilation resulting from increased CO2, nausea, makaise, fatigue
  • Fatty/enlarged liver
  • Pancreatitis
  • Hypersensitivity: 1-6 weeks, 5-8% of patients
  • Contraindications:
  • People who test positive for HLA-B 5701 (an antigen that increases the risk for hypersensitivity reactions to abacavir)
  • CAD
  • Interactions: Alcohol increases ABC levels
37
Q

Efavirenz (Sustiva)

A
  • Non-nucleoside reverse trasncriptase inhibitor
  • Only NNRTI recommended for first line HIV therapy
  • Dosing: PO once daily
  • Adverse effects:
  • Teratogenicity: Fetal defects. Avoid use in pregnancy
  • CNS effects in 50% of patients: They feel drunk
  • Maculopapular rash
38
Q

Darunavir

A
  • Protease inhibitor
  • MOA: Prevent maturation of HIV by blocking protease
  • High HIV resistance
  • Should never be the sole medication
  • Adverse effects
  • Hyperglycemia/ diabetes
  • Lipodystrophy
  • Hyperlipidemia
  • Elevated liver enzymes
  • Prolongation of P-R interval
  • Elevated blood lipid (25% of patients)
  • Rash (1-% of patients)
  • CYP (cytochrome P450) system interactions
  • Decreased serum levels of ARTs, b blockers, CCBs, amiodarone, lidocaine
  • Increased serum levels of ABC
39
Q

Ritonavir

A
  • Protease inhibitor booster
  • MOA: Induces CYP 450
  • Increased serum concentration of other protease inhibitos
  • Allows lower dosing of boosted drug and decreases pill burden
  • Side effects: GI intolerance, hyperlipidemia
  • Dose related
40
Q

Raltegravir

A
  • HIV Integrase Strand Transfer Inhibitor (INSTIs)
  • MOA: Inhibits integrase so that HIV cannot insert DNA into hist cells
  • Better viral suppression than NNRTI or PI
  • High risk for HIV resistance
  • Dolutegravir (another drug) has a lower risk for HIV resistnace
  • Adverse effects: Generally very well tolerated
  • Insomnia, fatigue, dizziness, headache
  • Diarrhea, nausea
  • FDA pregnancy risk
41
Q

Enfuvirtide (Fuzeon)

A
  • Fusion inhibitor
  • Prevents fusion between viral and target cell (no entrance of HIV into cell)
  • Never used alone
  • Seldom used at that
  • EXPENSIVE (BID subQ dosing costs $20,000 a year)
  • Adverse effects
  • Injection site reactions
  • Pneumonia
  • Hypersensitivity reactions

Pharmacology (11 decks)

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