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BECOM III - Exam 3 > Dr. Lees Drugs > Flashcards

Dr. Lees Drugs Flashcards

1
Q

what do you worry about with SABA and LABAs?

A

systemic effects w/ overdose or long term use -tachycardia, hyperglycemia, hypokalemia, and hypomagnesemia
-minimized when inhaled

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2
Q

treatment strategies in ASTHMA

A

acute - albuterol (go to SABA)
chronic - beclamethasone (go to ICS)
increase combo therapy as severity increases -> omalizumab

SABA > low dose ICS > LABA > high dose ICS

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3
Q

management of COPD

A

Roflumilast (go to) -> PDE4 inhibitor in lungs -> increase cAMP -> bronchodilator

  • reduce inflammation & exacerbation of COPD
  • improve pulmonary function

ICS used last resort bc have risk of bacterial pneumonia

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4
Q

SABA

A
  1. albuterol
  2. levalbuterol
  • rapid action -> treat ACUTE asthma
  • systemic symptoms w/ overdose
  • muscle tremors
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5
Q

LABA

A
  1. salmeterol
  2. formoterol
  3. indacaterol
  • not for mono therapy or acute asthma attacks
  • long acting bronchodilaton (12hr.)
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6
Q

LABA that has hypersensitivity to milk proteins

A

salmeterol

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7
Q

indacaterol

A
  • longest acting LABA (24hr)

- for COPD long term maintenance (masks inflammation)

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8
Q

theophylline

A
  • narrow therapeutic index

- risk of SEIZURES (neurotoxic), and ARRHYTHMIAS (cardiotoxic)

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9
Q

Ipratropium

A
  • muscarinic receptor antagonist

- AE -> dry mouth, bitter taste

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10
Q

Roflumilast

A
  • PDE4 inhibitor in lungs
  • main one for COPD exacerbations
  • reduce inflammation like ICS
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11
Q

inhaled corticosteroids

A
  1. beclamethasone (go to)
  2. budesonide
  3. fluticasone
  • prophylaxis/prevent long term asthma
  • anti-inflammatory
  • worry about ORAL CANDIDIASIS
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12
Q

Fluticasone

A
  • ICS that has VASOCONSTRICTIVE & anti-inflammatory properties
  • hypersensitivity to milk proteins (lactose)
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13
Q

Cromolyn

A

mast cell stabilizer -> prevent release of leukotrienes & histamine

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14
Q

omalizumab

A

monoclonal Ab against IgE -> inhibit binding to mast cells

-slow onset of action (12-16 weeks) -> longer effect

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15
Q

Montelukast

A

leukotriene receptor antagonist (cysteine leukotriene-1 receptor)

-prophylaxis of chronic asthma & relieve rhinitis

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16
Q

Zileuton

A

5-LO inhibitor

  • prophylaxis of chronic asthma
  • risk of HEPATOTOXICITY
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17
Q

side effects of penicillins & cephalosporins

A
  1. Hypersensitivity - urticaria most common
  2. GI distress (diarrhea)
  3. Nephritis (interstitial)
  4. Neurotoxicity (seizures)
  5. Hematologic toxicities - decreased coagulation & cytopenia
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18
Q

Pencillin G & V

A

drug of choice for SYPHILIS and ACTINOMYCES

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19
Q

MOA of penicillins & cephalosporins

A

bind to PBP –> inhibit transpeptidation rxn –> lesions in cell walls

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20
Q

what can cause diarrhea when combined with cluvalonic acid in children?

A

Amoxicillin

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21
Q

piperacillin & ticarcillin

A

the 2 antipseudomonal penicillins -> treat Pseudomonas infections

-synergistic nephrotoxicity when piperacilin-tazobactam is used in combo with VANCOMYCIN

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22
Q

adverse effect of ticarcillin

A

CHF/volume overload (high Na+), thrombocytopenia, hypokalemia

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23
Q

Dicloxacillin, Nafcillin, Oxacillin

A

drugs of choice for MSSA

  • beta lactamase resistance
  • Nafcillin AE -> leukopenia, inflammation at injection site
  • Oxacillin AE -> high liver enzymes
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24
Q

which 2 cephalosporins treat pseudomonas?

A

ceftazidime (3rd/4th) and cefepime (4th)

cefepime -> also cross blood brain barrier to treat CNS infections

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25
Q

2nd generation cephalosporin for respiratory infections, occasional UTIs

A

cefaclor

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26
Q

2nd generation cephalosporin that has a disulfuram rxn when combined w/ ETHANOL

A

Cefotetan

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27
Q

3rd generation cephalosporins

A

-WORKHORSE group -> respiratory infections, UTIs, meningitis)

  1. ceftriaxone
  2. cefotaxime
  3. ceftazidime
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28
Q

5th generation cephalosporin w/ MRSA coverage

A

ceftaroline

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29
Q

carbapenems

A
  • treat pseudomonas along with Monobactams
  • ANAEROBES
  • reserved for resistant gram neg rod infections
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30
Q

Imipenem-cilastatin

A

cilastatin prevents imipenem degradation by DEHYDROPEPTIDASE in the renal tubule

-high risk of SEIZURES

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31
Q

what carbapenem has a higher mortality when used for gram neg rod pneumonia

A

doripenem

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32
Q

monobactam (Aztreonam)

A
  • AEROBIC gram neg rods
  • NO cross allergenicity
  • AE -> NEUTROPENIA in children
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33
Q

vancomycin

A
  • blocks glycopeptide polymerization
  • gold standard for MRSA
  • RED MAN SYNDROME, ototoxicity
34
Q

Daptomycin

A
  • binds to cell membrane -> depolarization & rapid cell death** (lipid tail)
  • for MRSA & VRE

-inactivated by SURFACTANT

35
Q

adverse effects of all tetracyclines & glycylcyclines

A
  1. GI disturbance
  2. deposition in bone/teeth
  3. liver failure
  4. phototoxicity
  5. vertigo

-all avoided during pregnancy

36
Q

tetracyclines MOA

A

prevent tRNA binding to ribosome inhibiting protein synthesis

37
Q

what tetracycline is used for SIADH

A

demeclocycline

38
Q

most commonly used tetracycline

A

doxycycline

39
Q

what tetracycline has skin pigmentation issues w/ long term use

A

minocycline

40
Q

tigecycline

A
  • A glycylcycline
  • reversible bind to 30S ribosome & inhibit protein synthesis

-has HIGHER MORTALITY

41
Q

aminoglycosides MOA

A

bind to and distort 30S ribosome -> misreading and disrupt protein synthesis

  • POST antibiotic effect
  • SINGLE large dose (less toxic)
42
Q

aminoglycoside used for more gram neg resistant rod infections

A

amikacin

43
Q

aminoglycoside used for pre op bowel prep or hepatic encephalopathy

A

neomycin

44
Q

aminoglycoside that is most active against pseudomonas

A

tobramycin

45
Q

macrolide

A
  • bind to the 50S ribosome -> inhibit TRANSLOCATION
  • treat respiratory tract infections
  • risk of jaundice/hepatic dysfunction, prolonged QT, P450 inhibition
46
Q

macrolide NOT used with myasthenia gravis

A

Telithromycin

47
Q

A macrocyclic that treats C. difficile in adults

A

Fidaxomicin

-inhibits RNA polymerase & protein synthesis -> cell death (bactericidal)

48
Q

Clindamycin (lincosamide)

A
  • bind to 50S ribosome -> inhibit TRANSLOCATION
  • inhibit bacterial toxin production
  • increase risk of C. difficile colitis
49
Q

Linezolid (Oxazolidinones)

A
  • bind to 23S subunit of 50S ribosome -> inhibit formation of 70S initiation complex
  • not used with MAO inhibitors
  • SEROTONIN SYNDROME if used w/ SSRIs
50
Q

what is used for SEVERE infections (meningitis, Rickettsia) and can cause GRAY SYNDROME & OPTIC NEURITIS?

A

chloramphenicol

-binds to the 50S ribosome -> prevent AAs transfer by inhibiting peptidyl transferase

51
Q

Quinipristin-dalfopristin (streptogramins)

A
  • can cause arthralgia-myalgia syndrome

- inhibit CYP3A4

52
Q

cotrimoxazole (TMP + SMX)

A
  • bactericidal
  • NOT used in pregnancy, renal damage, G6PD deficiency
  • used for UTIs & PJP
  • drug of choice for NOCARDIOSIS
53
Q

Sulfonamides

A
  • inhibit DIHYDROPTERATE SYNTHASE
  • HYPERSENSITIVITIES due to sulfur -> PAN, SJS
  • compete with WARFARIN/methotrexate for sites on albumin -> excess anticoagulation
54
Q

Trimethoprim

A
  • inhibit DIHYDROFOLATE REDUCTASE

- risk of folate deficiency in pregnancy and Hyperkalemia

55
Q

fluoroquinolones

A
  • inhibit TOPOISOMERASE
  • topo I (DNA gyrase) -> gram neg org.
  • topo IV -> gram + org.

-for respiratory tract, skin/soft tissue infections

  • avoided in patients w/ prolonged QT*
  • risk of TENDON RUPTURE*
56
Q

what fluoroquinolone is not used with Tizanidine?

A

Ciprofloxacin

57
Q

isoniazid

A
  • inhibits acyl carrier protein reductase & beta-ketoacyl-ACP synthase enzyme -> prevent mycolic acid synthesis
  • NOT used with rapid/fast acetylators
58
Q

the 2 most important TB drugs

A

rifampin and isoniazid

59
Q

rifampin

A
  • blocks RNA transcription by interacting w/ beta subunit of mycobacterial DNA-dependent RNA polymerase
  • ORANGE sweat, urine, tears
  • CYP3A4 INDUCER -> enhance elimination rate of many drugs -> problem w/ HIV & pregnancy
60
Q

what TB drug is preferred for TB patients with HIV+

A

Rifabutin

61
Q

what TB drug can lead to acute GOUT & severe hepatic damage?

A

Pyrazinamide

-increased uric acid levels

62
Q

ethambutol

A
  • inhibit arabinosyl transferase involved in protein synthesis of arabinogalactan (cell wall)
  • AE -> OPTIC NEURITIS & red/green COLORBLINDNESS
63
Q

what drug is used in combo with the major 4 if TB is severe?

A

streptomycin

-for resistant TB

64
Q

what is the preventative treatment for latent TB?

A

isoniazid for 9 months

65
Q

most common leprosy drug

A

dapsone

  • inhibits dihydropterate synthase in folate synthesis path
  • hemolysis in G6PD deficient patients, methemoglobinemia, agranulocytosis, peripheral neuropathy
66
Q

clofazimine

A
  • leprosy drug
  • treat LEPROMATOUS LEPROSY and ERYTHEMA NODOSUM LEPROSUM

-AE -> pink to brownish-black discoloration of skin

67
Q

MOA of azoles - antifungals

A

inhibit 14-alpha demethylase (cyp51A1) -> block demethylation of lanosterol to ergosterol

-all azoles are TERATOGENIC

68
Q

what azole is the drug of choice for cryptococus neoformans?

A

fluconazole

69
Q

what azole is used to treat DIMORPHIC fungi? (blasto, histo, sporothrix, paracocci)

A

itraconazole

70
Q

Ketoconazole

A
  • ONLY topical
  • treat TINEA, cutaneous candidiasis, SEBORRHEIC dermatitis

-NOT used on scalp that is broken or inflamed

71
Q

azole used for vulvovaginal candidiasis

A

miconazole

-can have vulvovaginal burning/pruritis

72
Q

Voiconazole

A
  • treat invasive ASPERGILLOSIS
  • more CYT450 inhibition than others
  • can have visual/auditory HALLUCINATIONS & hepatotoxicity
73
Q

Amphotericin B & Nystatin MOA

A

bind to ergosterol -> form pores in membrane -> electrolyte leakage

74
Q

amphotericin B adverse effects

A

-low TI (toxic), “bake and shake”, kidney failure, hypotension, anemia

75
Q

Nystatin

A
  • treats mucocutaneous/vaginal/oropharyngeal CANDIDA

- “swish and swallow”

76
Q

Flucytosine

A
  • 5-FC enters fungi via PERMEASE transporter -> converted to 5-FU -> inhibit nucleic acid synthesis
  • used for CHROMOBLASTOMYCOSIS, meningitis, candida UTIs
  • can lead to dose-related BONE MARROW SUPPRESSION
77
Q

Griseofulvin

A
  • disrupt mitotic spindles -> inhibit fungal mitosis
  • treat dermatophytosis of SCLAP/HAIR (tinea capitis)
  • NOT used with PORPHYRIA
  • induce CYP450 -> decrease warfarin effects
  • many effects with ETOH
78
Q

Terbinafine

A
  • inhibit squalene epoxidase -> build up toxic squalane
  • treat ONYCHOMYCOSES
  • AE -> HEADACHE
79
Q

Echinocandins

A

-inhibit synthesis of B(1,3)-D glucan in cell wall

  • slow IV infusion prevents FLUSHING
  • treat ASPERGILLUS & CANDIDA
80
Q

Caspofungin

A
  • 1st line for invasive Candidiasis

- do NOT give w/ cyclosporine

81
Q

Micafungin

A

PROPHYLAXIS of invasive Candida

BECOM III - Exam 3 (8 decks)

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