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Pharm 2 > exam 2 > Flashcards

exam 2 Flashcards

1
Q

1) B2 adrenergic agonists (sympathomimetics)

2) Antimuscarinics/Anticholinergics

Relax airway smooth muscle (bronchodilators)

A

asthma RELIEVERS

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2
Q

o 1) Glucocorticoids
o 2) Leukotriene Modifiers
o 3) Cromones
o 4) Biologic Therapies

Decrease underlying inflammation

A

controllers

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3
Q

Methylxanthines (Theophylline)

A

Both Relievers and Controllers

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4
Q

MOA

B2 receptor couples to a “Gs” protein  activation of adenylyl cyclase  increased cAMP  increased PKA  increased bronchodilation

A

B2 Adrenergic Agonists (Sympathomimetics)

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5
Q

Major effector tissues: smooth muscle including bronchiolar, liver, skeletal muscle

Major functions: relaxes/dilates smooth muscle + gluconeogenesis + glycogenolysis

A

B2 Adrenergic Agonists (Sympathomimetics)

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6
Q
  • Terbutaline: SC and oral
  • Albuterol: oral and nebulizer
A

Short Acting Beta2 Agonists (SABAs)

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7
Q
  • Formoterol* (this has rapid onset for inhaler, can be used as rescue inhaler)
  • Salmeterol
  • Indacaterol (only used for COPD)

all of these MUST be combined with glucocorticoid

A

Long Acting Beta2 Agonists (LABAs)

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8
Q

MOA:
Normally: Ach stimulates M3  couple with Gq  increases IP3  intracellular calcium  calmodulin binding  myosin and actin contract  bronchoconstriction + increased pulmonary secretions

^^ _________________/__________________ block this!

A

Anticholinergics/antimuscarinics

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9
Q

Ipratropium (Atrovent)
Also used for rhinorrhea

A

Short Acting Muscarinic Antagonists (SAMAs)

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10
Q
  • Tiotropium (Spiriva): once daily
  • Glycopyrrolate: once daily
A

Long-Acting Muscarinic Antagonists (LAMAs)

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11
Q

B2 agonists > Antimuscarinics: _________
B2 agonists = Antimuscarinics: ______

A

B2 agonists > Antimuscarinics: ASTHMA
B2 agonists = Antimuscarinics: COPD

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12
Q

MOA

Inflammatory stimuli  increase in inflammatory proteins

________________ binds to intracellular receptors  goes to cell nucleus  decreases expression of genes encoding for inflammatory proteins

A

Glucocorticoids

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13
Q

Inhalers
 Beclomethasone (QVAR)
 Budesonide (Pulmicort)
 Fluticasone (Flovent)

Oral/IV
 Hydrocortisone: short acting (½ life: <12 hours)
 Prednisone: intermediate acting (½ life: 12-36 hours)
 Methylprednisone: intermediate acting (½ life: >48 hours)
 Dexamethasone: long acting (½ life: >48 hours)

all have “SON” in them

A

glucocorticoids

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14
Q

________________ _____________: existing in the cell membrane

Types
1) CysLT1 Antagonists
* Not as effective as glucocorticoids
2) 5-Lipoxygenase Inhibitor

A

Leukotriene Modifiers

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15
Q

Mild persistent asthma
Exercise induced bronchospasm/asthma
Allergic rhinitis
May reduce the need for glucocorticoids in select patients

A

CysLT1 Antagonists
Montelukast (Singulair)

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16
Q

What drug class decreases both COX (prostaglandins) + lipoxygenase (leukotrienes) pathways*

A

Glucocorticoids

NSAIDS will block COX, which will shunt over to the lipoxygenase/leukotriene pathway (this will cause “aspirin exacerbated respiratory disease”; more bronchoconstriction

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17
Q

MOA

Elevated IgE antibodies and sensitivity to perennial allergens (pollen)

Anti-IgE Therapy: anti-IgE antibody binds to circulating IgE and INHIBITS its interaction with receptors on mast cells and other effector cells

A

biologic therapies
(OmalizuMAB)

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18
Q

MOA

Increase in cAMP = increase in bronchodilation

Increases cAMP by:
1) Inhibiting phosphodiesterase
AND
2) Blocks adenosine receptor, thereby, INCREASING adenylyl cyclase
AND
Enhances histone deacetylation, decreasing inflammation

A

Methylxanthines (Theophylline)

Both a Reliever and a Controller

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19
Q

Narrow therapeutic index!
Large variation in ½ life (due to it being metabolized in the liver)

o Very similar to caffeine
o CNS excitation (can cause seizures)
o Weak diuretic
o CV stimulation (chronotropy, inotropy, arrhythmias)
o N/V

A

theophylline

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20
Q

Inducers = ______________ blood levels of theophylline

A

DECREASED

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21
Q

Inhibitors = ______________ blood levels of theophylline (toxicity risk)

A

INCREASED

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22
Q

major triggers of asthma attack (4)

A

beta adrenergic receptor antagonists

aspirin/NSAIDS

histamine (morphine, demerol, Sch, atracurium)

preservatives

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23
Q

______________ is a reliever + controller of asthma but is 2nd line therapy due to risk of AEs

A

Theophylline

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24
Q

_______________________ is used in select patients to decrease need or dose of glucocorticoid inhaler

A

Montelukast (Singular)

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25
Q

COPD best treatment option

A

Long-Acting Muscarinic Antagonists (LAMAs)

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26
Q

MOA
o Mild mucolytic activity via inhalation or intratracheal instillation
o Thins secretions, reduces risk of exacerbations

A

N-acetylcysteine

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27
Q

 Nasocort
 Flonase

A

Intranasal glucocorticoids
used for allergic rhinitis

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28
Q

 Chlorpheniramine
 Hydroxyzine (Vistaril)

A

1st gen “sedating” antihistamines

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29
Q

Impaired cognition (caution with elderly) *

Antimuscarinic effects (opposite of DUMBBELSS)

A

1st gen “sedating” antihistamines

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30
Q

MOA

Primarily stimulates alpha adrenergic (A1) receptors, causing vasoconstriction

Some also release NE

A

decongestants (sympathomimetics)

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31
Q
  • Direct + indirect (NE release): mixed acting
  • Can create meth, that is why you show your license
A

Pseudoephedrine

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32
Q
  • Direct acting only
  • Not as effective
A

 Phenylephrine

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33
Q

____________ route is preferred for decongestants (does not go systemic) however, overuse can cause rebound vasodilation

A

topical (limit to < 5 days!)

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34
Q
  • Ipratropium (Atrovent)
A

short acting muscarinic agent (SAMA)

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35
Q
  • Tiotropium (Spiriva): once daily
  • Glycopyrrolate: once daily
A

long acting muscarinic agent (LAMA)

best treatment for COPD!

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36
Q

the only methylxanthine

A

theophylline

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37
Q

select drug triggers of asthma attack

A

morphine
meperidine
atracurium
Sch

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38
Q

you notice the presence of oral candidiasis in a patient with asthma. Which of the following is most likely the cause?

A

fluticaSONe (flovent)
more common with AEROSOL use!
(flovent, pulmicort, QVAR)

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39
Q

man with history of BPH, asthma, and allergic rhinitis has developed urinary retention following surgery. Which drug contributed to the urinary retention?

A

Diphenhydramine (Benadryl)

antimuscarinic! (trop)

this is because it is oral! it is NOT TIOTROPIUM because that is an inhaler

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40
Q

Ach and monoamines come from

A

biogenic amines

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41
Q

serotonin and catecholamines (NE, Epi, Dopamine) come from

A

monoamines

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42
Q

3 ways of termination of NT activity

A

reuptake
enzymatic degradation
diffusion

Drugs can block everything except diffusion

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43
Q

BLOCKING muscarinics/cholinergic (aka antimuscarinics) receptors causes:

A

opposite of DUMBBELSS
* Hypomania
* Constipation
* Urinary retention (especially BPH)
* Blurred vision, glaucoma
* Bronchodilation
* Tachycardia
* Dry mouth/eyes
* Overheating/hypohidrosis
Altered cognition

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44
Q

BLOCKING dopaminergic receptors causes*

A

there is LESS dopamine

Extrapyramidal symptoms (parkinsonian-like)
Prolactin release (lactation, impotence)

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45
Q

BLOCKING histaminergic receptors causes*

A

sedation
impaired cognition

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46
Q

BLOCKING alpha1 adrenergic receptors causes*

A

orthostatic hypotension
reflex tachycardia

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47
Q

major antidepressant drug targets (4)

A

NET
SERT
MAO
DAT

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48
Q

antidepressant drug classes (6)*

A

Most Commonly Used/Frontline Therapy:
1) SSRIs: increases serotonin
2) SNRIs: increases serotonin + NE
3) Atypical antidepressants: increases NE and dopamine
4) Serotonin modulator

Least Commonly Used/Secondary Therapy:
1) TCAs: tricyclic antidepressants: increases serotonin + NE + additional actions
2) MAOIs: monoamine oxidase inhibitors

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49
Q

MOA

Blockage/inhibition of serotonin-5HT reuptake transporter (SERT) only

NO blockage of H1, Ach, or NE!

A

SSRIs

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50
Q

o Sertraline (Zoloft)
o Fluvoxamine (Luvox)
o Fluoxetine (taken once a week)
o Paroxetine
o Citalopram
o Escitalopram

A

SSRIs

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51
Q

o Serotonin Syndrome
o Hyponatremia
o Withdrawal Syndrome
o Bleeding

A

SSRIs

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52
Q

Inhibition of CYP2D6 (codeine, hydrocodone effectiveness would be decreased)

A

Fluvoxamine
Fluoxetine
Bupropion

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53
Q

MOA

Increases serotonin + NE activity; blocks SERT + NET activity

NET blockade: treats multiple pain syndromes

NO blockage of H1, Ach, or muscarinic receptors!

A

SNRIs

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54
Q

o Effexor
o Cymbalta
 Often used for fibromyalgia and pain associated with neuropathy*

A

SNRIs

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55
Q

o Increase in BP* (this is unique to _______)
with Effexor only !

o Serotonin Syndrome
o Hyponatremia
o Bleeding

A

SNRIs

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56
Q

MOA
o Increase NE + dopamine (DA) activity; blocks NET and DAT

o Noncompetitive antagonist/blocker of nicotinic receptors

A

atypical antidepressants
Buproprion

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57
Q

bupropion

A

atypical antidepressant

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58
Q

Use:
Individuals who do not want any sexual dysfunction*
o Depression
o Smoking cessation

A

bupropion; atypical antidepressant

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59
Q

MOA
o Low doses: hypnotic/sedation/sleep aid

o High doses: increases serotonin activity; blocks serotonin (5HT2)
Blocks H1, and adrenergic receptors

A

serotonin modulator (trazadone)

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60
Q

Hypnotic/sedation/sleep aid

A

serotonin modulator (trazadone)

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61
Q

MOA:

MAOIs will block MAO enzyme, leading to _______________ of monoamines:
 MAOI-A
 MAOI-B

A

MAOIs
ACTIVATION of monoamines

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62
Q

MAOI-A: an increase in: ____________________
MAOI-B: an increase in: _____________

A

MAOI-A: tyramine + NE +serotonin

MAOI-B: dopamine only

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63
Q

Only Refractory/Severe/Atypical Depression due to adverse effects*

Exception: Selegiline: patch/SQ is less likely to cause adverse effects

A

MAOIs (nonselective, irreversible)

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64
Q

what drugs can cause
Life-threatening HYPERtensive crisis due to interactions with foods + drugs

Orthostatic hypotension (normal doses)

A

MAOIs

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65
Q

MOA

Blocks NE + serotonin (5HT) reuptake into presynaptic nerve terminal, increased NT activity at postsynaptic neuron and increased subsequent neurological events

and blocks H1, A1, muscarinic receptors

A

TCAs

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66
Q

o AmiTRIptyline
o NorTRIptyline

A

TCAs

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67
Q

Life threatening arrythmias is main reason not to use them! (QT prolongation)

Cardiotoxicity, caution with other cardiac depressive drugs

A

TCAs

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68
Q

Hyperreflexia, clonus (of the muscles), agitation, AMS, diaphoresis, autonomic instability, fever, death

A

serotonin syndrome

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69
Q

4 opioids that can cause serotonin syndrome

A

tramadol
meperidine (demerol)
methadone
fentanyl

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70
Q

drug classes that can cause serotonin syndrome (4)

A

Direct 5HT Stimulators: triptans (sumatriptan)

SSRIs, SNRIs, TCAs

Opioids: Tramadol, Meperidine, Methadone, Fentanyl

Zofran

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71
Q

what is the direct serotonin stimulator

A

sumatriptan

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72
Q

only SSRI that can be used for OCD

A

fluvoxamine

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73
Q

lithium

A

bipolar disorder

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74
Q

chlorpromazine
promethazine
haldol
droperidol
phenergan* (actually an antiemetic)

A

conventional (1st gen) antipsychotics

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75
Q

risperidone
ziprasidone (geodon)
seroquel
zyprexa
abilify (partial dopamine agonist)

A

atypical (2nd gen) antipsychotics

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76
Q

dantrolen
bromocriptine (parlodel)
benzos

A

TREATMENT for neuroleptic malignant syndrome

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77
Q

benztropine (cogentin)
benadryl

A

TREATMENT for antipsychotic acute dystonia

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78
Q

o Narrow therapeutic index
o Renal excretion

contraindications to ___________ use:
o Hyponatremia (dehydration, diarrhea, diuretics): can cause lithium levels to increase
o Renal impairment
o Pregnancy and lactation (teratogenic)

A

lithium

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79
Q

Monitor thyroid levels, __________ level, fluid, and electrolytes (hyponatremia)!

may prolong NMBs

A

lithium

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80
Q

positive symptoms, high dopamine =

A

1st generation OR 2nd generation

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81
Q

Negative symptoms + cognitive symptoms = low dopamine =

A

2nd generation

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82
Q

o Schizophrenia
o Delusional disorders
o Bipolar disorder
o Psychoses (depressive, drug-induced reaction)
o Drug-resistant depression

Other Uses
 ANTIEMETICS
 Tourette’s syndrome
 Huntington’s chorea

A

Antipsychotics

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83
Q

HIGHER risk of:
sedation
hypotension
antimuscarinic effects

Chlorpromazine

A

LOW potency antipsychotics

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84
Q

phenergen

A

medium potency antipsychotic/antiemetic

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85
Q

LOWER risk of sedation
HIGHER risk of extrapyramidal symptoms

A

haldol
droperidol

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86
Q

With LOW levels of synaptic DA: increases activity

With HIGH levels of synaptic DA: decreases activity

A

Abilify

DA system stabilizer/2nd gen

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87
Q

Least amount of side effects of all antipsychotics

A

abilify (DA system stabilizer)

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88
Q

severe muscle spasm including torticollis, oculogyric crisis, trismus

A

Acute dystonic reaction

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89
Q

treatment for acute dystonic reaction

A

antimuscarinic

Benadryl, Benztropine

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90
Q

Lower risk of extrapyramidal symptoms

A

2nd Generation/Atypicals

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91
Q

Block A1 adrenergic, muscarinic, H1 receptors (leads to adverse effects discussed earlier)

Decreased seizure threshold (increased risk of seizures)

Prolonged QT interval/arrythmias

Neuroleptic malignant syndrome

A

antipsychotics

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92
Q

“lead-pipe” muscle rigidity, dysautonomia, AMS, fever

cause: blocking dopamine receptors

A

neuroleptic malignant syndrome

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93
Q

what drugs BLOCK dopamine, leading to a DECREASE in dopamine

A

1st generation antipsychotics (most common)

2nd generation antipsychotics

DA2 antagonist/blockers: antiemetics (Droperidol)

prokinetics (REGLAN)

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94
Q

what drugs INCREASE dopamine

A

drugs used for parkinsons

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95
Q

 Benzodiazepines
 Dantrolene
 Bromocriptine (dry up lactation)

A

treatment for neuroleptic malignant syndrome

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96
Q

causes of prolonged QT interval (6)

A

TCAs (high doses)

Antipsychotics/antiemetics
High risk: Haldol (especially IV), Droperidol, Geodon

Methadone

Zofran

Perioperative Drugs
* Sevoflurane, Desflurane, Isoflurane
* Amiodarone

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97
Q

A patient that receives promethazine (Phenergan) for post-operative nausea suddenly develops a sustained, involuntary muscle contraction involving the neck. Which of the following would most likely be used to treat this reaction?

A

Benadryl

98
Q

man with a history of bipolar disorder is scheduled for surgery. He is currently treated with lithium. If lithium is continued perioperatively, which of the following drugs is most likely to increase his lithium serum concentration?

A

Ibuprofen

99
Q

man with a history of BPH develops urinary retention following surgery. Which of the following home medications most likely contributed to his condition?

A

Amitriptyline

100
Q

which class of antidepressants is least likely to triggers symptoms of serotonin syndrome

A

atypical antidepressants (NE + dopamine)

101
Q

can cause hyponatremia

A

SSRIs and SNRIs

102
Q

MOA
o Partial serotonin 5HT-1A agonist (increases serotonin)

used for anxiety (no sedative effects)

A

Buspirone

103
Q

o Muscle relaxant
o Anticonvulsant

A

benzos

104
Q

Midazolam/Versed: _______-acting

Lorazepam/Ativan: ____________-acting
No metabolite

Diazepam/Valium: long-acting

A

versed=short

ativan=intermediate (DRUG OF CHOICE, less lipophilic)

105
Q

Insomnia (appear to induce more normal sleep patterns; however, less restful)

anxiolytic

sedative-hypnotic

A

z compounds

106
Q

o Zolpidem (Ambien)
o Zaleplon (Sonata)

A

z compounds

107
Q

Hepatotoxicity

Pancreatitis

Exfoliative dermatitis (Steven’s Johnson Syndrome, Toxic Epidermal Necrolysis)

Blood dyscrasias (agranulocytosis, aplastic anemia, etc.)

A

idiosyncratic reactions
epileptic drugs

Phenobarbital, phenytoin, carbamazepine, valproic

108
Q

Phenytoin (Dilantin)
Carbamazepine (Tegretol)

A

sodium channel targets (anti-epileptics)

109
Q

All forms of epilepsy (except absence seizures)

Narrow therapeutic index + variable metabolism: monitor levels

Induces multiple CYPs

Many drug interactions (>100)

Metabolized by CYP2C9/19

NON-linear kinetics

A

phenytoin

110
Q

Asian ancestry with polymorphism increased risk

monitor blood count

A

carbamazepine

111
Q

o Benzodiazepines
o Barbiturates (Phenobarbital)

A

chloride channel (anti-epileptics)

112
Q

calcium channel target
Block calcium influx channels
+ ___________ ___ _________

A

Decrease NT release

113
Q

Gabapentinoids:
Gabapentin and Pregabalin/Lyrica

A

calcium channel targets (anti-epileptics)

114
Q

Uses
* Neuropathic pain
* Fibromyalgia

A

gabapentinoids
fibromyalgia=lyrica

115
Q

Valproate Sodium/Valproic Acid (Divalproex)
Topamax
Lamictal

A

mixed channel targets

116
Q

the only inhibitor of multiple CYPs
for anti-epileptics

toxicity risk for other drugs!

hepatotoxicity (monitor LFTs!)

A

Valproate Sodium/Valproic Acid (Divalproex)

117
Q

Uses
 Seizures
 Bipolar disorder
 Migraine prophylaxis

A

Valproate Sodium/Valproic Acid (Divalproex)

118
Q

Uses
 Seizures
 Migraine prophylaxis
 Weight loss programs

A

topamax

119
Q

Antiepileptic therapy + antiparkinson’s therapy is usually _____________ perioperatively

A

continued

120
Q

What is the most teratogenic (avoid pregnant patients) AED?

A

Valproate Acid

121
Q

What AED drugs are potent inducers?

A

Phenytoin, phenobarbital, carbamazepine

122
Q

Adverse Effects
o N/V
o Dyskinesias (tics, grimacing)
o CV: postural hypotension, arrhythmias
o Psychosis (may treat with atypical antipsychotic)

Indications/Uses
o Advanced PD and >70 years of age

A

levodopa (increases synthesis of dopamine)

123
Q

o Mild to moderate PD
o Restless leg syndrome

dopamine agonists

A

o ROPinirole
o PramiPEXole

(BOXING)

124
Q

MOA
o Inhibits peripheral COMT

Indications/Uses
o _____________ + Levodopa + Carbidopa = improved motor fluctuations

o Never used alone

A

Entacapone

125
Q

o Selegiline
o Rasagiline

A

MAOI-B

Mao’s styling with GEL

126
Q

o Benztropine (Cogentin)
o Trihexyphenidyl (Artane)

MILD parkinson’s, 1st line therapy

A

Antimuscarinics/Anticholinergics (Centrally-Acting)

127
Q

2 drug classes for alzheimers

A

Centrally acting acetylcholinesterase inhibitors (AchE-I)

NMDA type glutamate (excitatory) antagonists

128
Q

most effective treatment for alzheimers

A

NMDA type glutamate antagonists

(memantine)

129
Q

o GALantamine
o DONepezil
o RIVastigmine

A

Acetylcholinesterase Inhibitors (AchE-I)

130
Q

treatment for alzheimers:
AchE-I works to ___________ ACh

A

INCREASE ACh (this is what we want!)

can have dumbelss effect

131
Q

increases DA release

Antiparkinson’s drug

A

amantadine

132
Q

high therapuetic index = _________ toxic for the patient

A

less toxic

133
Q

what are the top 2 safest antibiotic classes

A

penicillins + cephalosporins

134
Q

More clinically relevant!

Determined in vitro (the lab)

Drug + microbe specific

A

minimum inhibitory concentration (MIC)

135
Q

The MIC is higher and cannot be achieved at therapeutic or non-toxic doses

A

resistant

136
Q

Test tubes have different concentrations of the antibiotic, MIC has been determined

A

serial dilution susceptibility testing

137
Q

antibiotics are added to a plate after an organism is streaked onto the agar

A

disk diffusion (kirby-bauer method)

138
Q

Trends in antibacterial resistance for an institution*

Aids in selecting EMPIRIC treatment, monitor resistance trends over time

A

antibiogram

139
Q

Primarily acts on the cell wall, cell membrane and/or DNA synthesis:
bacteri_______

A

CIDAL

140
Q

Primarily acts through inhibition of protein synthesis; works with host/patient’s defenses:
bacteri_______

A

STATIC

141
Q

true or false:
bacteriCIDAL is overall the best option for all patients (especially those immunocompromised)

A

true

142
Q

name the 5 antibiotics that are bacterioSTATIC

A

Bactrim
Tetracyclines
Macrolides
Clindamycin
Linezolid

“Banking The Money, Can’t Love”

143
Q

how long the concentration is maintained above MIC

A

TIME dependent

144
Q

increases with increasing concentration (AUC:MIC)

A

CONCENTRATION dependent

145
Q

TIME dependent
examples (4)

A
  • Beta-lactams
  • Vancomycin
  • Linezolid
  • Clindamycin
    “Beta’s Can’t Love Vanc”
146
Q

CONCENTRATION dependent
examples (4)

A

Aminoglycosides
Fluroquinolones
Daptomycin
Metronidazole
“AF, Dab Men”

147
Q

3 post antibiotic effects*

A

Aminoglycosides
Fluoroquinolones
Fidaxomicin

“AFF”

148
Q

How are NAM + NAG “linked” together?

A

Glycosyltransferase (GT) enzyme

149
Q

How are the murein chains cross-linked to one another, removing the terminal d-alanine?

A

Transpeptidases TP)/Penicillin Binding Proteins (PBP)

150
Q

antibiotic MOA:
bind covalently to transpeptidase/PBP and prevent cross-linking (NO effect on the murein chain)*

A

Beta-lactams

151
Q

antibiotic MOA:
binds to d-alanine, prevents cross-linking + polymerization (the making of the NAM and NAG chain)
(NO effect on the enzyme)*

A

vancomycin

152
Q

4 major subclasses of beta-lactams

A

penicillins
carbapenems
cephalosporins
monobactams

153
Q

Hydro________ agents can penetrate the GN via membrane pores

A

philic

(phobic can still do it, just lower ability, they canNOT penetrate pores)

154
Q

beta-lactamases:
inactivate penicillins + cephalosporins + monobactams

A

extended-spectrum b-lactamases (ESBL)

155
Q

beta-lactamases:
inactivate all B-lactams + inactivate B-lactamase inhibitors

A

Carbapenemases

156
Q

beta-lactamase inhibitors end in

A

____________bactam

157
Q

what are the 3 major differences between subclasses

A

1) pH (gastric acidity) + oral bioavailability
2) Porins/penetration of GN
3) Stabilize liability by beta lactamases

158
Q

4 types of penicillins

A

natural: pen G + V
anti-staph: NOD
aminopenicillins: amoxicillin, ampicillin
anti-psuedomonal: zosyn

159
Q

true or false
NO PENICILLINS cover MRSA or ATYPICAL bacteria

A

true

160
Q

what drug is IM ONLY

A

procaine or benzathine (from pen G)

161
Q

which penicillins are the most RESISTANT to b-lactamases

A

anti-staph penicillins

162
Q

which class of penicillins are best for bile elimination

A

anti-staph penicillins
Nafcillin
Oxacillin
Dicloxacillin

163
Q

which penicillin is good for psuedomonas

A

zosyn

164
Q

increased CNS penetration in penicillins if:

A

 1) If meninges inflamed
 2) High doses
 3) Reduced renal elimination
 4) More frequent doses

165
Q

most important thing to determine cross reactivity

A

if the side chain (R-group) is not similar

166
Q

which cephalosporin is NOT renally eliminated

A

ceftriaxone

167
Q

which 10 drugs cover pseudomonas

A
  • Zosyn (penicillin)
  • Cefepime, Ceftazidime (cephalosporins)
  • Doripenem, Imipenem, Meropenem
  • Aztreonam (monobactam)

Polymyxins B + E (not a b-lactam)
Ciprofloxacin and Levofloxacin (fluroquinolones, NOT b-lactams)

168
Q

What is the only B-LACTAM that covers MRSA?

A

Ceftaroline “think of Caroline from work”

169
Q

What is the best cephalosporin for anaerobes?

A

Cefotetan

170
Q

which cephalosporins barely cover GN

A

cefazolin (ancef)
cephalexin

171
Q

which cephalosporin is contraindicated in neonates due to biliary sludging (interacts with calcium containing products)

A

ceftriaxone

172
Q

which b-lactam has the broadest coverage (GP, GN, beta-lactamases, ANaerobes)

A

carbapenems

173
Q

what is the only monobactam, and what is it good for

A

aztreonam
aerobic GN (pseudomonas), cystic fibrosis

174
Q

do any b-lactams cover atypical bacteria

A

no

175
Q

Blocks 1st step in bacterial cell wall synthesis by inhibiting the enzyme “UDP-N-acetylglucosamine enolpyruvyl transferase” (MurA), inhibiting the formation of N-acetylmuramic acid (NAM)

o Mainly for uncomplicated UTIs

A

fosfomycin

176
Q

drug of choice for MRSA and C diff (and some VRE)

A

vancomycin

177
Q

MOA
1) Same as Vancomycin +
2) Destabilizes/disrupts the inner cell membrane

A

lipoglycopeptides (vancomycin derivatives)

telaVANCIN, oritaVANCIN, dalbaVANCIN

178
Q

which lipoglycopeptide does NOT effect coagulation tests

A

dalbavancin

179
Q

lipoglycopeptides target what

A

GP bacteria (MRSA), GP ANaerobes

180
Q

MOA
1) Causes rapid depolarization of bacterial cell membrane
and
2) Affects synthesis of DNA, RNA & protein synthesis

A

daptomycin

181
Q

which drug causes
Myopathy/rhabdomyolysis*

Monitor creatine kinase levels
Additive/increased risk when used with statins

good for MRSA + VRE + some GP anaerobes

A

daptomycin

182
Q

MOA
Bind to lipopolysaccharides in the membrane of GN bacteria
and
Detergent-like effect on the membrane
Causes cell lysis

A

polymyxin B + E
(think, “detergent MYXes”)

183
Q

very old antibiotic
good for MDROs, GN bacteria, cystic fibrosis (pseudomonas)

A

polymyxin B + E

184
Q

Which 3 drugs can affect coagulation tests?

A
  • Telavancin, Oritavancin (lipoglycopeptide)
  • Daptomycin (lipopeptide)
185
Q

5 drug classes for antibiotics that target PROTEIN synthesis

A

1) macrolides
2) aminoglycosides
3) clindamycin
4) linezolid
5) tetracyclines

186
Q

MOA
o Binds to the 50s ribosomal subunit near the peptidyl transferase center
o Blocks the polypeptide exit tunnel and prevents peptide chain elongation

2 classes!

A

macrolides (ACE) + clindamycin

azithromycin
clarithromycin
erythromycin

187
Q

what are 2 antibiotics that are cyp3a4 inhibitors

A

clarithromycin
erythromycin

188
Q

what 3 classes cover atypical bacteria

A

macrolides
tetracyclines
fluroquinolones

189
Q

which macrolide is the best option, great for mycobacterium (MAC) in HIV

A

azithromycin

190
Q

which macrolide stimulates gut motility the most, is cheap, needs frequent dosing

A

erythromycin

191
Q

alters the macrolide ITSELF

A

esterases

192
Q

alters the methylate binding site on the RIBOSOME

A

methylases

193
Q

Highest risk of c-diff super infections! Boxed warning*

A

clindamycin

194
Q

double disk diffusion test compares what 2 antibiotics

A

clindamycin and erythromycin

195
Q

MOA
o Binds to 50s subunit blocking formation of the initiation complex (ribosomal complex) with the 30s

A

linezolid

196
Q

what are the 4 side effects of linezolid

A

o Bone marrow suppression
o HYPOglycemia
o Mitochondrial dysfunction (peripheral + optic neuropathy, lactic acidosis)
o Reversible MAO inhibitor (MAOI)

197
Q

which antibiotic can lead to serotonin syndrome*

A

linezolid

198
Q

MOA
Irreversibly bind to 30s subunit to block the initiation complex
and
Causes misreading of mRNA
and
Premature termination of protein synthesis
and
“Garbage” protein chain; causes cell lysis

A

aminoglycosides

199
Q

6 examples of aminoglycosides

A

amikacin
gentamicin
tobramycin
streptomycin
plazomicin
neomycin

200
Q

ototoxicity, nephrotoxicity*, prolongs NMB, teratogenic

use infrequent, high doses

A

aminoglycosides

201
Q

MOA
o Reversibly bind to the 30s ribosomal subunit, prevents “tRNA” binding

A

Tetracyclines

202
Q

doxycycline (more common)
minocycline

A

tetracyclines

203
Q

true or false
tetracyclines are bile elimination

A

true

204
Q

Oral: epigastric pain, N/V, & anorexia
MUST sit upright with a full glass of water, wait at least 10-15 minutes

o Photosensitivity reactions

o Suppresses bone growth related to calcium; permanently discolors teeth (NO CHILDREN)

A

doxycycline (tetracycline)

205
Q

what are the 2 drug classes that target NUCLEIC ACID synthesis

A

1) fluroquinolones
2) metronidazole (flagyl)

206
Q

enzyme that:
RELAXES bacteria DNA
and
GN

A

dna gyrase

207
Q

enzyme that:
UNLINKS/DECATENATION
and
GP

A

topoisomerase IV

208
Q

what is the only fluroquinolone that is NOT renally eliminated

A

moxifloxacin

209
Q

o Tendon inflammation or rupture!
o Neurotoxicity
o Photosensitivity
 Chelation
o Hyper/hypoglycemia
o Aortic aneurysm + dissection
o Hepatotoxicity, crystalluria
o Exacerbation of muscle weakness in Myasthenia gravis
o Joints: pain, stiffness
o QT prolongation

A

fluroquinolones

210
Q

MOA
o Nitro group reduced by bacterial ferredoxin reductase
o Activated radical binds to DNA, causes strand breaks

A

metronidazole (flagyl)

211
Q

ANaerobic GN + ANaerobic GP
 GI parasites
 Intra-abdominal/colorectal surgeries

A

metronidazole (flagyl)

212
Q

what 3 things are affected by alcohol

A

disulfiram
cefotetan
metronidazole

213
Q

MOA
o Inhibits bacterial RNA polymerase + prevents protein synthesis

used for Cdiff

post antibiotic effect

A

fidaxomicin

214
Q

MOA
o Metabolized by bacteria to reactive metabolites that disrupt ribosomes
o Prevents protein synthesis, DNA, and citric acid cycle

o Uncomplicated UTIs

A

Nitrofurantoin

215
Q

MOA
Inhibits bacterial FOLATE synthesis
and
Affects DNA, RNA, and protein synthesis

A

bactrim

216
Q

o Staph
o Community only acquired MRSA
o Strep
o Opportunistic HIV infections: Pneumocystis and Toxoplasmosis*

A

bactrim

217
Q

Last 2 months of pregnancy (teratogenic), breastfeeding and newborns
 Kernicterus risk: bilirubin crossing the BBB, causing brain damage*

A

bactrim

218
Q

best drug for appendectomy

A

cefazolin (ancef) + metronidazole
or
cefotetan
or
cefoxitin

219
Q

best drug for hernia repair

A

cefazolin (ancef)

220
Q

best drug for
total joint replacement
or
breast cancer procedures

A

cefazolin (ancef)

If patient is allergic or has MRSA:
Vancomycin
Clindamycin

221
Q

which drugs do NOT require renal dose adjustments*

A

Nafcillin
Oxacillin
Dicloxacillin

Ceftriaxone

Doxycline + Minocyline (tetracyclines)

Moxifloxacin

222
Q

which 2 drug classes are good for AEROBIC GN

A

aminoglycosides
and
monobactam (aztreonam)

223
Q

What is the best way to improve a penicillin’s GN coverage?

A

Add a beta lactamase inhibitor (the best option)

2nd best: add an aminoglycoside

224
Q

What 2 aminoglycosides are good to use for colorectal surgeries

A
  • Neomycin and erythromycin
225
Q

What is propanidid used for?

A
  • Increases CNS penetration for penicillins
226
Q

What 3 antibiotics can cause photosensitivity*

A

Tetracyclines,
fluroquinolones,
bactrim

227
Q

What 2 drugs can chelate?

A

Tetracyclines
fluroquinolones

228
Q

What is the ideal drug for syphilis?

A
  • Benzathine salt (pen G)

IM ONLY

229
Q

What is most common cause of UTIs?

A

E coli (GN)

230
Q

What is most common cause of SSI (infection) post appendectomy?

A

Bacteroides (especially b fragilis)

e coli (GN)

231
Q

What is the most common bacteria post c-section?

A

staph aureus (GN)

232
Q

What drugs cause bone marrow suppression?

A

linezolid and bactrim

tetrocyclines= NOT THIS, only suppress bone growth

233
Q

what are the 2 drugs for c diff

A

vancomycin
fidaxomicin

234
Q

What 2 drug classes have QT prolongation?

A

macrolides
fluroquinolones

235
Q

With time-dependent abx, your goal is to keep the abx concentration above the MIC for as long as possible

A

true

236
Q

Administration of an additional dose of abx during a surgical procedure is determined by 3 things

A

length of surgery
half life of abx
blood loss

237
Q

What is Avibactam

A

beta lactamase inhibitor
__________bactam

238
Q

Which antibiotics can prolong the effects of neuromuscular blockade during surgery?

A

clindamycin
aminoglycosides

239
Q

What drug is good with MRSA?

A
  • Vancomycin
240
Q

which drug can be used for GN and GP (NOT MDR)

A

cefazolin (ancef)

if MDR, use ertapenem

241
Q

true or false:
all of the ____________mycins cover ONLY GP bacteria

A

true

Pharm 2 (3 decks)

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