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Pharmacology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Penicillin is ______ and inhibits bacterial cell wall synthesis by______.

A

bacteriocidal; causing cell lysis

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2
Q

Penicillinase Inhibitors (4)

A

clavulanic acid
tazobactam
sulbactam
avibactam

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3
Q

structurally related to PCN with only 5-15% of PCN allergic pts showing cross sensitization.

A

cephalosporin

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4
Q

Large macro molecules

A

Macrolides

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5
Q

Macrolides are ____ in usual doses and ____ in higher doses

A

static; cidal

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6
Q

Side effects of macrolides (3)

A

GI upset
cramping
diarrhea

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7
Q

Aminoglycosides are for gram ____ infections and be both static and tidal depending on the dose

A

negative

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8
Q

Aminoglycosides can exhibit ___ ___ __ , persistent suppression of bacterial growth after brief exposure to abx.

A

Post antibiotic effect (PAE)

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9
Q

Antibiotic with poor CNS penetration.

A

ahminoglycosides

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10
Q

Quinolones are ____ spectrum antimicrobials and are _____.

A

broad; cidal

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11
Q

Quinolones are good for pneumonia because ______.

A

they have excellent tissue penetration

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12
Q

A side effect of quinolone are that they inhibit _________

A

cartilage synthesis

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13
Q

What are the quinolone medications for 2, 3, and 4th generations?

A

2nd: cipro every 6 hours
3rd: levofloxacin
4th: moxifloxacin

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14
Q

Metroconidazole is used for _____ infections

A

protozoal

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15
Q

Not true abx but antimetabolites but can be cidal or static based on the dose by inhibiting ____ biosynthesis.

A

sulfonamides; folate

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16
Q

Minimal concentrations in the blood and tissue but can result in pulmonary toxicity with long use especially in the elderly

A

Urinary Antiseptics (nitrofurantoin)

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17
Q

How much of the world population is affected by TB?

A

1/3

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18
Q

How long is the minimum treatment for TB?

A

6 months if active

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19
Q

What are the target sites of antiviral medications? (3)

A
  1. reverse transcriptase inhibitors (NRTIs & NNRTIs)
  2. protease (inhibitors)
  3. fusion inhibitors
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20
Q

Numbers of bacteria in voided urine that excess numbers commonly seen due to contamination of urethra.

A

significant bacteriuria (10^5/ml)

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21
Q

Clinical syndrome of flank pain

A

acute pyelonephritis

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22
Q

Infection if a structurally & neurologically normal urinary tract

A

uncomplicated UTI

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23
Q

Complicated UTIs

A

Men
pregnancy
children

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24
Q

95% of UTI infections are _____

A

mono bacterial

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25
Q

_____ is the most common cause of UTI

A

e.coli

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26
Q

Diagnostic techniques for UTI (3)

A

dipstick leukocyte esterase (LE)
dipstick urine nitric (UN)
urine culture ***

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27
Q

Streptococcus progenies commonly causes

A

pharyngitis (strep throat)

respiratory and skin infection

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28
Q

Streptococcus pneumoniae commonly causes____

A

penumonia
sepsis
otitis media
meningitis

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29
Q

Strep pneumoniae is ______

A

diplococci

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30
Q

80-90% of clinical isolates; major enterococcal organism of the GI tract

A

E. faecalis

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31
Q

5-15% of clinical isolates; increasingly vancomycin resistant

A

E. Faecium

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32
Q

Inhibit gram (+) cell wall synthesis and demonstrate time-dependent killing (time above the MIC)

A

PCN

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33
Q

How long does Bicillin C-R last?

A

24 hours

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34
Q

Used to treat serious MSSA blood stream infections

A

Nafcillin

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35
Q

Types of carboxypenicillins (2)

A

Carbenicillin (Geocillin)

Ticarcillin (Ticar)

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36
Q

1st PCN with activity towards P. aeruginosa

A

Carbenicillin (Geocillin)

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37
Q

2-4 times more activity against p. aeruginosa, rarely used alone due to beta lactase hydrolysis and usually given with IV clavulanate

A

Ticarcillin (Ticar)

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38
Q

Type of ureidopenicillin that inhibits 60-90% P seruginosa strains and used with beta lactase inhibitor, tazobactam (zosyn)

A

Piperacillin (Pipracil)

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39
Q

MRSA is resistant to all current _______

A

cephalosporins

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40
Q

phenoxymethyl penicillin; acid stable

A

Pen V

(only for oral use in Na+ or K+ salts

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41
Q

Used to identify MRSA

A

methicillin/Oxacillin

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42
Q

used to treat serious MSSA bloodstream infections, that is HEPATICALLY metabolized and no adjustment for renal impairment

A

Nafcillin

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43
Q

-OH at para position improves oral absorption (oral equivalent of ampicillin)

A

Amoxacillin (Amoxil)

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44
Q

Most are active against staph and strep; increasing generations have higher Gram (-) activity, decreasing Gram (+) activity

A

cephalosporins

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45
Q

Which generation of cephalosporins have significant activity vs anaerobes (Bacteroides fragilis) and is useful in abdominal and GI surgical prophylaxis

A

Second generation (Cefotetan and cefoxitin)

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46
Q

Name of 3rd generation IV cephalosporin

A

cefitriaxone (rocephin)

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47
Q

Where is cefitriaxone metabolized?

A

hepatic metabolism

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48
Q

What population is 3rd generation ORAL cephalosporin used?

A

children

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49
Q

What are the 3rd generation IV Cephalosporins? (3)

A

cefotaxamine (claforan)
ceftazidime (fortaz)
ceftriaxone (rocephin)

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50
Q

What 3 rd generation IV cephalosporin has the best activity against P-aeruginosa but may accelerate acquires resistance?

A

ceftazidime (fortaz)

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51
Q

What 3rd generation IV cephalosporin with used with Azithromycin for community acquires pneumonia?

A

ceftriaxone (rocephin)

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52
Q

What generation of cephalosporins have the widest spectrum and why?

A

4th generation; enhanced activity against many gram (-)

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53
Q

Why are the 4th generation cephalosporins useful against many multi drug resistant gram negative bacteria?

A

70-80% gram negative bacili resistant to ceftazidime are sensitive to 4th generations

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54
Q

What is the 4th generation cephalosporins available in the US?

A

Cefepime (maxipime)

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55
Q

Broadest activity of the beta lactam class due to improved beta lactamase stability

A

Carbapenems

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56
Q

What does carbapenems have excellent coverage for?

A

gram (+), (-) and anaerobic

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57
Q

What carbapenem has the better gram (+) coverage?

A

Imipenem

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58
Q

Which carbapenems have better gram (-) coverage?

A

Merropenem & Ertapenem

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59
Q

Which carbapenem is used in combo with cilastin, prevents renal absorption and has higher incidence of seizures?

A

Imipenem (Primaxin)

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60
Q

What carbapenems have a lower incidence of seizures?

A

Meropenem (Merrum)

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61
Q

What carbapenems have excellent anaerobic coverage for diabetic foot ulcers?

A

Ertapenem (Invaz)

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62
Q

What carbapenem is the newest agent with little coverage against P.aeruginosa?

A

Doripenem (doribax)

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63
Q

What monobactam has no cross reactivity with PCN?

A

Aztreonam (Azactam)

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64
Q

Concentration dependent ‘cidal’ acticity (peak concentration above MIC) effected against most gram (-) organisms including pseudomonas

A

Aminoglycosides

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65
Q

Common agents of aminoglycosides?

A

Gentamycin, Tobramycin, Amikacin

66
Q

Traditional dosing of ahminoglycosides?

A

q8-12 h

67
Q

High dose extended interval (HDEI) of aminoglycosides

A

q24hr

68
Q

When are aminoglycosides trough levels drawn?

A

prior to next dose

69
Q

What are the peak levels of aminoglycosides?

A

IM injections: 1 hour after injection
60 min infusion: immediately after infusion
30 min infusion: 30 mins after infusion

70
Q

bacteriocidal for most anaerobic agents with good oral absorption (same PO/IV dosing)

A

Metronidazole (flagyl)

71
Q

How is Metronidazole absorbed?

A

hepatically metabolized (no renal adjustment)

72
Q

What is metronidazole effective for?

A

C. difficile colitis

73
Q

Side effect of clindamicin?

A

Diarrhea occurs in 20% patients (oral >IV)

74
Q

What are the macrocodes (3)?

A

erythromycin
clarithrmycin
azithromycin

75
Q

What is the erythromycin frequency and a common AE?

A

QID; significant GI upset

76
Q

What is the frequency of clarithrmycin?

A

BID; less GI upset

77
Q

What is the frequency of azithrymycin? What is significant about this med?

A

q 24h, least GI upset

78
Q

What is a class of macrocodes that has the initial agent of telithromycin (Ketek)?

A

Ketolides

79
Q

What was the black box warning for Ketolides in 2007?

A

Increased risk of hypoglycemia in type 2 DM

80
Q

What are the ketolides still approved for?

A

Community acquires pneumonia

81
Q

What is the glycopeptide that was initially relegated to PCN allergic patients?

A

Vancomycin

82
Q

What glycopeptide had increased use in the 1980s due to MRSA?

A

Vancomycin

83
Q

What is the side effect of the streptogramins (Quinipristin-Dalfoprstin(Synercid))?

A

30% experience irritation of the venous site
9% experience arthalgias
6% experience myalgias
RARELY USED

84
Q

Is the lipopeptide-Daptomycin(Cubicin) bacteriostatic or cidal?

A

bacterioCIDAL

85
Q

Which Oxazolidinone is used for gram (+) organisms including MRSA and vanco resistant E. faecium(VRE faecium)

A

Linezolid (Zyvox)

86
Q

What forms is linezolid available? where is it metabolized? Is it bacteriostatic or cidal

A

IV and PO
Hepatically metabolized
BacterioSTATIC

87
Q

What is the method in which TMP/SMX works?

A

blocks consecutive steps in bacterial folate synthesis

88
Q

What is TMP/SMX extensively used for and what is the PO dose?

A

UTIs

1 DS tab q12h

89
Q

Fluorine derivatives greatly improved potency

A

quinolones

90
Q

What is the mechanism of quinolones?

A

MOA: cidal, inhibition of DNA gyrase and topoisomerase IV

91
Q

Quinolones are most active against gram _____ organisms and ______ resistance emerges if used as mono therapy

A

negative; pseudomonas

92
Q

What is the adverse effect of quinolones with «1%

A

achilles tendon rupture

93
Q

What are 2 things to note about quinolones?

A

not recommended for peds

all prolong the QT-interval

94
Q

What is the dosing for cipro for cystitis?

A

250mg q12h x 3 days

IV 200mg

95
Q

What is the dosing of cipro for lower respiratory tract infection?

A

500-750mg q12h v 7-14 days

IV 400mg

96
Q

What is the quinolone that is hepatically metabolized that is recently FDA approved for UTIs

A

Moxifloxacin (Avelox)

97
Q

What are the IV to PO criteria?

A 
Afebrile > 24 hours
WBC normal or normalizing 
tolerating oral diet
NO N/V
No contraindications to PO therapy
98
Q

What type of clearance method if Cockcroft? And what are the 2 things it assumes?

A

calculated
“stable” renal. function
“normal” muscle mass

99
Q

What is the Cockcroft formula for males?

A

(140-age x IBW (kg))/ (72kg x serum creatinine))

100
Q

What type of clearance method is creatinine clearance?

A

Measures

101
Q

How do you calculate female creatine clearance?

A

(CrCl Male) x 0.85

102
Q

In AKI prevention what are the nephrotoxic agents that should be avoided? (6)

A 
amoniglycosides
amphotericin B
Radiocontrast agents
Cyclosporin & Tacrolimus
ACE & ARBs
NSAIDs
103
Q

What are the kidney functions? (3)

A

excretory (fluid, electrolytes, solutes)
Metabolic (vitamin D, some drugs, insulin & beta lactase)
Endocrine (EPO)

104
Q

What are the diuretic classes? (5)

A 
thiazides
carbonic anhydrase inhibitors
potassium-sparing
osmotic
loop
105
Q

What do thiazide diuretics INCREASE the EXCRETION of

A

Na, CL, K, & Mg (decrease serum levels)

supplement with oral K &Mg

106
Q

what do thiazides DECREASE the EXCRETION of?

A

CA & uric acid (increase serum levels)

use with caution in gout; useful in osteoporosis

107
Q

Are thiazides potent?

A

NO only moderately efficacious

108
Q

What is the CrCl for which thiazides are mostly not effective?

A

CrCl < 30 **exceptions are Indapamide(Lozol) and Metolazone (Zaroxylyn)

109
Q

Which med is has limited usefulness as diuretic but is occasionally used for edema of HF and for open-angle glaucoma

A

carbonic anhydrase inhibitors- Acetazolamide (Diamox)

110
Q

Postassium sparing diuretics are usually used with what medications to minimize potassium loss?

A

K+ losing thiazides

111
Q

Potassium sparing diuretics, both Na channel blockers (late distal tubule) and aldosterone antagonists can cause what?

A

hyperkalemia

112
Q

What are the Na channel inhibits that are K sparing?

A

amiloride & triamterene

113
Q

What is a aldosterone antagonist that is K sparing?

A

spironolactone (aldactone)

114
Q

What are the side effects of spironolactone?

A

gynecomastia and impotence

115
Q

What is the diuretic of choice for hepatic cirrhosis?

A

spironolactone

116
Q

What is the CrCl for spironolactone and dose?

A

CrCl 10-50mL/min: q24 hour

117
Q

When do you avoid spironolactone?

A

CrCl<10

118
Q

What is an IV osmotic diuretic?

A

Mannitol

119
Q

What is the osmotic diuretic used for cerebral edema?

A

mannitol

120
Q

Why does mannitol have to be stored at room temperatures?

A

It will crystalize at low temps

121
Q

What are the other types of osmotic diuretics that are rarely used clinically?

A

Glycerine
Isosorbide
Urea

122
Q

Why do you have to individualize therapy with loop diuretics?

A

most potent class of diuretics

123
Q

What are the 4 major loop diuretics available?

A

furosemide (lasix)
bumetanide (bumex)
ethacrynic avid (Edecin)
Torsemide (demanadex)

124
Q

What are the adverse effects of loop diuretics?

A

ototoxity (tinnitus, deafness and vertigo-usually reversible)
hyperuricemia (rarely gout)
hyperglycemia

125
Q

Why is the loop diuretic, lasix is good for oral absorption?

A

excellent bioavailability

126
Q

When is the risk of ototoxicity increased with lasix?

A

if given IV at 4mg/min (high dose)

127
Q

What is lasix used for mostly and what is the dose?

A

acute pulmonary edema

40mg IVP over 1-2 min, increase to 80mg IVP in inadequate response

128
Q

What thiazide can be added with lasix for refractory for synergistic effect every 24 hours?

A

metolazone (zaroxlyn)

129
Q

What is different with IV vs PO lasix?

A

IV may use less furosemide than intermittent dosing

130
Q

What is the ceiling effect?

A

inability of a drug to produce additional effects ABOVE a certain maximum effect dose (in diuretics)

131
Q

What is the preferred loop diuretic in patients with persistent fluid retention despite high doses of other loops?

A

torsemide

132
Q

What is a urinary acidifying agent?

A

ammonium chloride

133
Q

What do urinary alkalizing agents eliminate?

A

increase elevation of asa

134
Q

What are the urinary alkalinizing agents? (2)

A

Na Bicarbonate

K Citrate

135
Q

What are the first line agents of phosphate binders? (4)

A 
calcium carbonate (tums)
calcium acetate (phoslo)
Sevelamer HCL (Renagel)
Sevelamer Carbonate (Renvela)
136
Q

What is the second line agent for phosphate binding?

A

lanthanum (Fosrenol)

137
Q

What is the target serum of PO4 for calcium acetate and sevelamer (phosphate binder)?

A

< 6mg/dL

138
Q

What are the adverse effects of mild hypercalcemia (>10.5mg/dL)

A

constipation, anorexia, N/V

139
Q

What are the adverse effects of severe hypercalcemia (>12 mg/dL)?

A

delirium, stupor, coma

140
Q

What patients is sevelamer (Renagel) useful?

A

patients with hypercalcemia

141
Q

What phosphate binder may reduce Vit D, E and K and folate absorption?

A

Sevelamer (Rengel)

142
Q

What phosphate binder is anion-exchange resin, and may induce metabolic acidosis in patients on HD?

A

Sevelamer (Renagel)

143
Q

What is beginning to replace Sevelamer (Renagel)?

A

Sevelamer Carbonate (Renvela)

144
Q

What is the newest phosphate binder that is expensive with little advantage?

A

lanthanum carbonate (fosrenol)

145
Q

What is a potassium binding agent?

A

sodium polystyrene sulfonate (Kayexalate)

146
Q

What are the adverse effects of sodium polystyrene sulfonate (kayexalate)?

A 
hypocalcemia
hypokalemia
hypomagnesemia
consitpation- impaction
N&amp;V
147
Q

What is important to monitor with potassium binding agent, sodium, polystyrene sulfonate?

A

electrolytes and EKG!

148
Q

What is the beginning treatment for CKD anemia? Why is it important to titrate dose?

A

elemental Fe; to minimize GI upset

149
Q

Why is it important to be careful with using IV iron for CKD?

A

iron accumulation/overload is associated with increased mortality

150
Q

What are the IV iron formulations (2)?

A 
ferric gluconate (ferrlecit)
Iron sucrose (venofer)
151
Q

Water-soluble complex iron salt that is added to the hemodialysate soliution?

A

Ferric Pyrophosphate Citrate (FPC, Triferic)

152
Q

What are the advantages of ferric pyrophosphate citrate (FPC, Triferic)?

A

progressive iron accumulation does not occur
reduces the use of costly ESAs
inexpensive- can treat multiple pets

153
Q

What are the erythropoiesis-stimulating agents?

A

Epoetin Alfa (Epogen & Procrit)

154
Q

What are the ESAs?

A

recombinant human erythropoietin

155
Q

What are the benign prostatic hyperplasia(BPH) medication classes?

A

alpha 1-antagonists

5 alpha-reductase inhibitors

156
Q

What are the alpha 1-antagonists for BPH? (3)

A

tamsulosin (climax)
Alfuzosin (Uroxatral)
Soldosin (Rapaflo)

157
Q

What catalyzes conversion of testosterone to dihydrotestosterone (DHT)?

A

5 alpha-reductase inhibitors

158
Q

What is mainly is prostate and hair follicles?

A

Type II 5 alpha reductase (5AR)

159
Q

What are the 5 alpha reductase inhibitors?

A

proscar

propecia

160
Q

Selective for type II 5AR and category X for pregnant females- SHOULD NOT HANDLE TABS

A

5 alpha reductase inhibitors: finasteride (proscar, propecia)

161
Q

Selective for both type I & II 5-alpha reductase( nonselective) and a category X for pregnancy

A

Dutasteride (avodart)

Pharmacology (17 decks)

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