Exam 1 Flashcards
Volume of distribution
Amount of drug in the body/plasma drug concentration
High volume of distribution
Means that the drug is not highly protein bound
Clearance of a drug
0.693(Vd)/half life
Bioavailability
How much of the drug will reach the blood after metabolism
What form of drug route will have greatest bioavailability
IV and sublingual
Fastest route of absorption
Inhalation
What will make urine more acidic
Cranberry juice, vitamin C, NH4Cl
What will make urine more basic
Aspirin
What types of drugs will cross placenta and blood brain barrier
Small, lipid soluble, non-protein bound
Inhibition of CYP450 leads to
Drug toxicity
General inducers of CYP450
GPCRABS
Glucocorticoids, phenytoin, carbamazepine, rifampin, alcohol, barbiturates, st johns wort
General inhibitors of CYP450
GPACMANS
Grapefruit, protease inhibitors, proton pump inhibitors, azoles, cimetidine, macrolides, amiodarone, non-dihydropyridines, SSRIs
Drugs that undergo zero order elimination
Phenytoin, salicylates, aspirin, alcohol
Drugs that have a small therapeutic index
Have a higher chance of toxicity–need to monitor drug levels
Water percentage in neonates
75-80%, less body fat
When do kidneys and liver reach maturation in infants
2 years old
Before this, drug toxicity can occur more frequently
When does gastric output levels reach adult levels in children
2 years old
Gastric emptying in infants/children
prolonged
Pulmonary absorption in children
Decreased due to increased RR and larger tidal volume
Volume of distribution in children
Larger due to increased total body water and less albumin
Body water and fat in elderly
Less body water and more body fat
Half life of drugs may increase if higher volume of distribution
Drugs that have increased CNS effects in elderly
Anticholinergics, TCAs, antihistamines, antispasmodics, benzodiazepines, analgesics
Allosteric site
A binding site for substrates not active in initiating a response; may induce a conformational change in the structure of the active site, rendering it more or less susceptible to response from a substrate
Downregulation
Decreased availability of drug receptors
Enterohepatic recirculation
Process by which a drug excreted in the bile flows into the GI tract, where it is reabsorbed and returned to the general circulation
Hepatic extraction ratio
A comparison of the percentage of drug extracted and the percentage of drug remaining active after metabolism of the liver
Pharmacodynamics
Process through which drugs affect the nody
Pharmacokinetics
process through which the body affects the drug
Prodrug
A drug that is transformed from an inactive parent drug to an active metabolite
Penicillin’s
- Method of action
- SE
- Coverage
Bactericidal–interfere with cell wall synthesis
SE: hypersensitivity, GI distress, seizures, encephalopathy
Mostly G+ coverage
Some G- coverage
Cephalosporins
- Method of action
- SE
- Coverage
Bactericidal–interfere with cell wall synthesis
SE: hypersensitivity, GI distress
As you progress from 1st to 4th generation, has more G- and less G+ coverage
Monobactams
- Method of action
- SE
- Coverage
Bactericidal–interfere with cell wall synthesis
SE: GI distress, usually no cross-sensitivity with penicillin or cephalosporin
Primarily against G-
Carbapenems
- Method of action
- SE
- Coverage
most broad spectrum agents available
Bactericidal–interfere with cell wall synthesis
SE: neurotoxicity, GI distress
G+ , G-,
Fluoroquinolones
- Method of action
- SE
- Coverage
Bactericidal–Inhibit DNA gyrase and topoisomerase IV
SE: GI distress, dizziness, confusion, tendon rupture, QT prolongation
G+ and G-
DOC for UTI
Macrolides
- Method of action
- SE
- Coverage
Erythromycin, azithromycin, clarithromycin
Bacteriostatic–binds to 50S
SE: GI distress, hepatotoxicity, ototoxicity
Broad spectrum: G+, G-, Atypical
Aminoglycosides
- Method of action
- SE
- Coverage
Gentamicin, Neomycin, Streptomycin, Tobramycin
Bacteriostatic–binds to 30S
SE: Nephrotoxicity and ototoxicity
Mainly active against G-
Can combine with beta lactams for G+ coverage
Tetracyclines
- Method of action
- SE
- Coverage
Bacteriostatic–binds to 50S
SE: GI distress, gray-brown discoloration of the teeth
Broad spectrum–G+, G-, atypical
Sulfonamides
- Method of action
- SE
- Coverage
Bacteriostatic–inhibits folic acid
SE: GI distress, rash, fever, steven johnson syndrome and vasculitis
G+ and G- (except pseudomonas)
Vancomycin
- Method of action
- SE
- Coverage
Bactericidal–inhibits d-alanyl-d-alanine portion of cell wall
SE: fever, chills, phlebitis, red man syndrome, nephrotoxicity
Active mostly against MRSA
Oxazolidinones
- Method of action
- SE
- Coverage
Linezolid + Tedizolid Oral tx for MRSA Bacteriostatic--bind to 50S se: GI distress, thrombocytopenia, leukopenia G+ only--MRSA, VRE
Clindamycin
- Method of action
- SE
- Coverage
Bacteriostatic–binds to 50S
SE: diarrhea and C. DIff colitis
Active against G+ and G- anaerobic
Metronidazole
- Method of action
- SE
- Coverage
Bactericidal–inhibition of DNA protein synthesis
SE: GI distress, seizures, peripheral neuropathy
G- coverage only
DOC for abdomen and GU system (H Pylori, C. Diff, bacterial vaginosis, trich)
Chloramphenicol
- Method of action
- SE
- Coverage
Variably bactericidal–binds to 50S
SE: Gray baby syndrome, optic neuritis, fatal aplastic anemia
Broad spectrum: G+, G-, anaerobic
Rifampin
- Method of action
- SE
- Coverage
Variably bactericidal–inhibits DNA
SE: GI distress, headache, fever, discolors body fluids to orange
Mostly against G+ with some G- coverage
DOC for TB
Nitrofurantoin
Variably bactericidal–interfers with cell wall synthesis
SE: N/V and pulmonary reactions, hepatotoxicity, peripheral neuropathy
G+ only
Only used for uncomplicated UTI
Dermatitis
Alteration in skin reactivity caused by exposure to external agent; usually on inflammatory process
Diaper dermatitis, atopic dermatitis, irritant dermatitis
Linear streaks of papules, vesicles, and blisters that are very pruritic
First line therapy for dermatitis
Low potency topical steroid 2x a day
Alclometasone, flucinolone, hydrocortisone, triamcinolone
Prolonged use can cause skin atrophy
Second line therapy for dermatitis
Increase protency of topical steroid or increase to oral steroid
-Use in tapering dose for 2-3 weeks
Topical immunosuppressants for dermatitis
Primecrolimus + Tacrolimus
Used if patient can not tolerate steroids
Decreases cytokine transcription
Relief of itching in dermatitis
Antihistamines
Tinea
Group of fungi infections on skin
Pruritus, burning, stinging
First line therapy for tinea capitis
Griseofulvin
Systemic terbinafine or itraconazole
First line therapy for tina corporis, cruris and pedis
Topical azoles first
Systemic terbinafine or fluconaozle if no relief
First line therapy for tinea uriguium
Systemic terbinafine or itraconazole
Griseofulvin
Fungistastic
May aggravate SLE
SE: N/V, diarrhea, headache, photosensitivity
Tinea versicolor
Opportunistic superficial yeast infection; chronic; asymptomatic
Well-demarcated scaling patches of varied color due to overgrowth of yeast
DOC for tinea versicolor
Selenium sulfide
Candidiasis
Superficial fungal infection of skin and mucus membranes
Found commonly in diaper area, oral cavity, nails, vagina, penis
First line therapy for oral thrush
Nystatin–swish and swallow 3x a day for 10-14 days
First line therapy for skin candidiasis
Cool soaks with burrow solution, topical azole
If no relief, can use a systemic azole
Topical antivirals
Acyclovir, Penciclovir
Systemic antivirals
Acyclovir, Famciclovir, Valacyclovir
First line treatment for HSV-1
Topical acyclovir or penciclovir
Can use systemic if no releif
First line treatment for VZV
Systemic antiviral if <72 hours from outbreak, patient >50 years old, or immunocompromised
7 day treatment
First line treatment of warts
Salicyclic acid
-Keratolytic peeling agent; leave patch on 5-6 days a week for 12 weeks
Salicyclic acid CI in
Patients with DM or impaired circulation
Skin infections are primarily due to
Staph aureus, GAS, GBS
Impetigo
Superficial skin infection due primarily to staph aureus
Spread between close quarter living environments, poor hygiene, schools, daycare centers
Treatment of impetigo
Topical Mupirocin (Bactraban) for 7-10 days If more major, can give a broad spectrum penicillin or 1st generation cephalosporin
Cellulitis
Infection involving skin and subcutaneous layers and can spread systemically
Mostly due to staph aureus or GAS
Erysipelas
Superficial form of cellulitis that occurs in children due to GAS
Treatment of cellulitis without systemic symptoms or purulence
Penicillin or Augmentin
Treatment of cellulitis with purulent infection
Bactrim, minocycline, clindamycin, linezolid (covers MRSA)
Folliculitis
Superficial infection of hair follicle usually due to staph aureus
May be due to pseudomonas in hot tubs
Treatment for superficial folliculitis
Warm compresses, topical mupirocin ointment or topical gentamicin
Treatment for deeper folliculitis
Oral dicloxacillin, cephalexin, clindamycin
Necrotizing fasciitis
Serious infection of subcutaneous tissues that can be life threatening
Usually polymicrobial
Bactrim is not active against
GAS
Mupirocin ointment active against
Staph aureus and some strep