Exam 2 Flashcards

Question

Magnesium Hydroxide (Milk of Magnesia) Polyethylene glycol (MiraLax) Lactulose

Answer 1

Osmotic Laxatives **Mech:** poorly absorbed salts or carbs that pull water into intestines Softens fecal mass Feces expand & stretch colon Stimulates peristalsis **Effects:** **SE:** Loss of water, nausea, flatulence, Mg Hyd contraindicated in renal failure pt due to risk of tox (hyperMag) **General:**

Answer 2

Bulk-forming laxative **Mech:** acts like natural fiber, swells in water, transforms into a gel, softens stool & increases bulk, swelling stretches colon stems peristalsis **Effects:** laxative **SE:** Rare, constipation & impaction if GI motility is interrupted **General:** PT SHOULD DRINK FULL GLASS OF WATER!

Answer 3

Surfactant laxatives **Mech:** lowers surface tension of stool, allows water into stool, inhibits reabsorption of water from colon **Effects:** laxative **SE:** Rare **General:** PT SHOULD DRINK FULL GLASS OF WATER!

Answer 4

Stimulant Laxatives **Mech:** stim intestinal motility, increase secretion of water & electrolytes into colon **Effects:** laxatives **SE:** Dependency, proctitis (inflamm of the anus) *typically only seen w/ repeated use* **General:**

Answer 5

Antiemetic **Mech:** exerts effect by block serotonin in the pathway to the vomiting center **Effects:** anti-nausea **SE:** dizziness, risk for arrhythmia (Torsades de pointes) **General:**

Answer 6

Antieme*tic & Prokinetic **Mech:** Suppresses emesis by blocking serotonin AND dopamine in emesis pathway. Also enhances effect of ACh in upper GI tract (increases upper GI motility) **Effects:** **SE:** *usually only w/ high dose & prolonged use* Tardive dyskinesia & possible neuroleptic malignant syndrome (NMS, v similar to malignant hyperthermia) Sedation **General:**

Answer 7

Antiemetic **Mech:** Blocks muscarinic receptors on pathway to vomiting center **Effects:** Used for motion sickness! **SE:** anti-cholinergic effects (dry mouth, constipation, blurry vision) **General:**

Answer 8

Antiemetic **Mech:** Blocks histamine receptors on pathway to vomiting center Also blocks muscarinic receptors to a lessor degree **Effects:** Used for motion sickness! **SE:** Anti-cholinergic & ant-histamine SE’s **General:**

Answer 9

5-aminosalicylates **Mech:** Reduces inflamm by suppressing prostaglandin synthesis by inhibiting COX **Effects:** Used for Tx of acute IBS attack **SE:** Nausea, fever, rash **General:**

Answer 10

Glucocorticoids **Mech:** Inhibits protein synthesis, inhibits synth of chem mediators (prosta, Leuko, histamine) **Effects:** anti-inflamm, reduce swelling (decreases vasodilation), reduces pain **SE:** *usually only in long term use or high doses* CHAOS, psychologic disturbances **General:**

Answer 11

Immunomodulators **Mech:** Binds to & neutralizes TNF-a , reduces inflamm **Effects:** IV Admin only! **SE:** Immunosuppression increases risk of infection, infusion reaction risk! **General:** Tell pt to report sore throat or fever!

Answer 12

Immunomodulator **Mech:** Binds to & neutralizes TNF-a, reduces inflamm **Effects:** SQ ADMIN **SE:** Risk of infection, injection site reaction **General:** Tell pt to report sore throat or fever! Pt edu on how to admin SQ injection

Answer 13

Immunomodulator **Mech:** Suppresses prod of interleukens & other cytokines, reduces prolif of B and cyto T cells **Effects:** Used to prevent organ transplant rejection **SE:** increased risk of infection, *nephrotoxicity* **General:** tell pt to report sore throat or fever

Answer 14

**Mech:** increases the activity of anti-thrombin! -> inactivates thrombin & factor Xa Works very quick! **Effects:** Admin parenteral ONLY! Best for venous thrombi Good for conditions that require rapid response (PE, DVT, MI) Doesn’t cross placenta or BBB *preferred in preg* **SE:** Hemorrhage!! (Dark stools, lumbar/abdominal/pelvic pain), spinal/epidural hematoma Heparin-induced thrombocytopenia (prod of abs against heparin-plt complex) **General:** PROTAMINE SULFATE IS ANTIDOTE!! Admin slow IV push 1mg neutralizes 100u heparin Monitor aPTT labs Normal Essex Therapeutic 1.5-2.5x normal (60-80sec)

Answer 15

**Mech:** Neutralizes factor Xa better! Increases the activity of anti-thrombin resulting in less thrombin & Xa. Fast acting! **Effects:** Long half-life (only admin 1-2x/day) Good for DVT prev post op or Tx of estab DVT Given prophylactic for CV issues **SE:** Bleeding! Risk much lower than heparin **General:** more expensive! Pre-filled syringes. TX OVERDOSE W/ PROTAMINE SULFATE!

Answer 16

Anticoag **Mech:** binds to anti-thrombin, complex inactivates factor Xa, prevents Xa from converting prothrombin to thrombin **Effects:** Admin SQ **SE:** Bleeding! Use caution in renal failure pts! Pt w/ epidural cath may experience hematoma! **General:** pre-filled syringes

Answer 17

**Mech:** Blocks activation of vit K! Reduces synthesis of 4 vit K dependent clotting factors (specifically prothrombin) Delayed onset of action cus it does not affect clotting factors already in circulation!! 99% protein bound on first dose! **Effects:** Admin PO. Long term prophylaxis of thrombosis in aFIB, art valves, hx of PE. Peak effect not seen until 3-5 days. Long half life! Remains effective up to 5 days after cessation **SE:** bleeding! Risk much lower than heparin! Monitor labs for INR! Weekly to start, once therapeutic levels, monthly. Therapeutic INR = 2-3 Mech heart valve = 3-4.5 **General:** ANTIDOTE IS VIT K!! Admin PO or IV MUST BE ADMIN SLOWLY OVER 1HR TO PREVENT ANAPHYLAXIS! Pt goes for labs to check INR every month Change in Vit K intake can influence how well it works. Edu pt to not change vit K habits

Answer 18

Direct Thrombin Inhibitor (DTI) **Mech:** Binds to thrombin, prevents it from converting fibrinogen to fibrin Faster onset than warfarin! **Effects:** Admin PO. No need to monitor drug levels!! Fewer food-drug interactions! Same dose given regardless of weight or age Used to prev recurrent DVT or PE **SE:** Bleeding but lower risk! GI disturbances in 35% of pts!! Can produce GERD, gastric ulcer (reduce risk by taking w/ food) **General:** PRAXBIND IS ANTIDOTE! (Mono ab) always a risk for anaphylaxis!

Answer 19

Direct Factor Xa Inhibitors **Mech:** binds to factor Xa, prevents conversion of prothrombin to thrombin **Effects:** admin PO. Faster onset than warfarin. Used for DVT prev following knee/hip sx. Tx or prev of DVT/PE **SE:** much lower bleeding risk than warfarin! Spinal/epidural hema, (hold meds for sev hours before & after lumbar puncture) **General:** No need to monitor labs! ANDEXXA IS ANTIDOTE!!

Answer 20

ADP receptor antagonists , anti-plt med **Mech:** Blocks P2Y12 ADP receptors on plts! Prevents ADP from binding & activating plt! *Irreversible! Lasts for life of plt!* Pro-drug, activated by CYP450! **Effects:** Admin PO, prev occlusion of Coronary Artery Stents! **SE:** Bleeding! (Risk lower than ASA) GI & Intracranial bleeds most common! Abdominal pain Use caution w/ other ACs MUST BE STOPPED 5DAYS PRIOR TO SX! **General:** PPIs can inhibit CYP450 which would inactivate these drugs!

Answer 21

Glycoprotein IIb/ IIIa receptor antagonists **Mech:** Blocks Gp IIb/IIIa receptors on plts & prev fibrinogen from attaching -> prev plt agg **Effects:** Admin IV, used for short term Tx of ischemic events in pts w/ ACS s/p PCI **SE:** Bleeding! **General:**

Answer 22

Thrombolytic Med “clot buster” **Mech:** Binds to plasminogen, promotes conversion to Plasmin, Plasmin digests fibrin clots! **Effects:** admin w/ IV cath place RIGHT at the clot! Used for MI, PE, ischemic stroke! **SE:** Bleeding! Especially in intracranial area! Hemostasis restored w/ blood products (packed RBCs, FFP) If that doesn’t work, antidote is Amicar! **General:** Reduce IV and SQ injections to reduce risk of bleeding! Minimize invasive procedures! Use caution if used w/ warfarin or anti-plt meds!

Answer 23

Inhaled corticosteroids **Mech:** reduces synth of inflamm mediators (leukotrienes, histamine, etc) Reduces recruitment of inflamm cells **Effects:** Used for prophylaxis against inflammation in asthma! Common controller med! **SE:** Oropharyngeal candidiasis (thrush) *pts should rinse mouth & gargle warm water after to minimize risk* Systemic: CHAOS **General:** small pop develops neuropsychiatric effects

Answer 24

Leukotriene Receptor Antagonists (LTRA) **Mech:** suppress effects of leukotrienes = less inflamm **Effects:** Admin PO, Controller med! **SE:** Headache & GI most common, small pop develops neuropsychiatric effects **General:**

Answer 25

Mast Cell Stabilizer **Mech:** Prevents mast cell from releasing histamine! **Effects:** SAFEST OF ALL ASTHMA MEDS!! Admin inhalation. Used for prophylaxis NOT immed tx **SE:** tolerated very well **General:** Very expensive!

Answer 26

Bronchodilators Reliver/rescue meds Short-acting beta agonists (SABA) **Mech:** Stim Beta 2 receptors, causes bronchodilation **Effects:** Usually only taken PRN **SE:** Usually tolerated well, minimal systemic absorption unless taken PO = tachy & tremor (beta 2 activation on skeletal muscle) **General:**

Answer 27

Long-acting beta agonists (LABA) **Mech:** Stim beta 2 receptors , causes bronchodilation **Effects:** Taken on a fixed sched! Preferred over SABA for COPD tx! Must be combined w/ GC for tx of asthma. Tx asthma & COPD **SE:** IF LABAs ARE NOT COMBINED W/ INHALED CORTICOSTERIOD, MORE LETHAL! **General:**

Answer 28

Methylxanthines **Mech:** Promotes relaxation of bronchial smooth muscle **Effects:** occasionally used to tx asthma. Admin PO or IV, narrow Thera range 10-20mcg/mL **SE:** Overall well tolerated, GI disturbances, CNS excitation **General:** Educate pt that **caffeine** may intensify effects!

Answer 29

Long acting muscarinic antagonists (LAMA) **Mech:** Prevents ACh from binding, causes unopposed bronchodilation (& other anti-cholinergic effects if systemic) **Effects:** Used for tx of asthma! Often admin w/ a beta 2 agonist! **SE:** Anti-cholinergic SE’s (dry mouth, nasal congestion, headache, cough) **General:**

Answer 30

Antihistamines **Mech:** Bind to H1 receptors & prevent them from being activated by histamine, when H1 receptors in brain are blocked causes drowsiness! 2nd Gens do NOT cross BBB **Effects:** 1st line tx for allergic rhinitis **SE:** Mild sedation w/ Benadryl, urinary retention, dry mouth, constipation **General:** best when taken prophylactically

Answer 31

Intranasal Glucocorticoids **Mech:** Bind to glucocorticoid receptors on cell surface. Promotes prod of proteins that suppress immune system. **Effects:** Most effective Tx of seasonal rhinitis!! **SE:** Drying of the nasal mucosa, Epistaxis (bloody nose), sore throat Systemic = CHAOS s&s **General:** pts may report unpleasant taste in mouth

Answer 32

Opioid antitussive Most effective cough suppressant available!* **Mech:** bind to opioid receptors in CNS to elevate cough threshold **Effects:** cough suppressant **SE:** Resp depress **General:** Not rec for children or people w/ reduced resp capacity

Answer 33

Non-opioid anti-tussives **Mech:** Works in CNS to elevate cough threshold Derivative of opioids **Effects:** cough suppressant **SE:** may cause mild inebriation **General:** advise pt to avoid activities that require mental alterness

Answer 34

Expectorant **Mech:** believed to improve water retention in resp tract , reduces viscosity of mucous **Effects:** **SE:** Nausea/vomiting, dizziness, drowsiness **General:**

Answer 35

Mucolytic **Mech:** binds directly to mucous to reduce viscosity **Effects:** Admin by nebulizer **SE:** Nausea/vomiting, chest tightness, bronchospasm, urticaria **General:** Use w/ caution in people w/ asthma!!

Answer 36

Nicotine replacement therapy **Mech:** deliver nicotine at a lower dose and slower rate than tobacco containing products, reduces nicotine withdrawal symptoms **Effects:** Rec for people who smoke > 20 cigs/day, who smoke within 30min of awakening, who have failed to quit in the past. **SE:** Skin irritation common for patch! Contraindicated in pregnancy! **General:** Gum improves cessation rates 40-60%

Answer 37

**Mech:** Partial agonist at nicotinic receptors! Minimizes withdrawal symptoms, nicotinic receptor cannot Stim release of dopamine = less stimulus of reward center!! **Effects:** **SE:** Nausea, disturbed sleep **General:** Very expensive!! Typically not covered by cessation programs

Answer 38

Calcineurin inhibitors *Most effective immunosuppressants available!* **Mech:** inhibit calcineurin, suppress prod of IL-2 (activates cytotoxic T cells & B cells) **Effects:** drug of choice for prev of organ rejection from donor! **SE:** Nephrotoxicity!! (Monitor BUN & creatinine) Infection Grapefruit juice inhibits metabolism, can increase levels by 200%! **General:** Pt should report sore threat / fever immed! Highly influenced by drugs that influence metabolism of CYP450

Answer 39

**Mech:** Inhibits calcineurin, suppresses prod of IL-2 (activates cytotoxic T cells & B cells) **Effects:** More effective than Cyclosporine BUT more TOXIC! Used for prophylaxis or organ rejection **SE:** NEPHROTOXICITY, Infection, Neurotoxicity (headache, tremor, insomnia), GI effects , HTN, HyperK **General:** Pt should report sore throat, fever immediately! Highly influenced by drugs that influence CYP450

Answer 40

Disease-modifying anti-rheumatic drugs (DMARDs) *TNF antagonists* **Mech:** binds to TNF-a & neutralizes it, prevents from Stim inflamm **Effects:** Used to tx rheumatoid arthritis Admin IV or SQ (often auto inject pen) **SE:** Injection site reactions, risk for serious infections (fungal, TB, legionella, pneumonia, react of latent HepB) **General:** Pt needs to report any S&S of infection, avoid live vaccines, edu about latent disease going active

Answer 41

DMARDs *B-lymphocyte depleting agents* **Mech:** monoclonal abs that bind to a receptor exclusive to B-lymphocytes, promotes immune attack against b-lymph = b-lymph destroyed **Effects:** IV ADMIN ONLY! **SE:** SEVERE INFUSION REACTIONS (HypoT, bronchospasm, angioedema, shock) **Pre-med w/ antihistamine & acetaminophen** Skin reactions including Stevens-Johnson syndrome (SJS, rare cutaneous reaction to meds. cells take portion of med & bind it to MHC 1, targeted & destroyed by body) **General:**

Answer 42

**Mech:** inhibits replication by suppressing synthesis of viral RNA **Effects:** 1st choice for infections by HSV, VZV, CMV. Admin many routes **SE:** IV: phlebitis & inflamm @ injection site, Nephrotoxicity! Pt needs to stay hydrated!!! Neuro tox (tremors) esp in renal fail pts PO: mild, GI & headache **General:** resistance is possible in immunocompromised pts!

Answer 43

*Prodrug of Acycolvir* **Mech:** Inhibits replication by suppressing synth of viral RNA **Effects:** ONLY USE IN IMMUNOCOMPETENT INDIVIDUALS! **SE:** Same as Acyclovir PLUS Thrombotic thrombocytopenic purpura (TTP) in immunocomp pt! **General:**

Answer 44

**Mech:** suppresses rep of viral DNA **Effects:** used for prev & tx of CMV in immunocompromised host **SE:** Bone marrow suppression!!! Can cause granulocytopenia & thrombocytopenia Reproductive tox is big concern! **General:** 85% of pop are carriers of CMV

Answer 45

Hepatitis Drug **Mech:** prev viral entry into cell, prev synth of viral mRNA, prev synth of viral proteins, protein assemb, and protein release **Effects:** synthetic version of nat occur compound. Almost always SQ! PEGinterferon is the long-acting version of the drug! **SE:** Flu like syndrome!! Depression & suicidal ideation Thyroid dysfunction Heart damage **General:**

Answer 46

**Mech:** unknown, nucleoside analog? Joins growing nucleotide chain, blocks the continuation of forming DNA **Effects:** Commonly given w/ PEGinterferon, broad spectrum of antiviral activity **SE:** Hemolytic anemia, fetal injury!! **General:** **Contraindicated in preg, use 2 forms of BC!!**

Answer 47

**Mech:** Inhibits protease (enzyme nec for maturation of a virus) **Effects:** Given in conjunction with/ PEGinterferon & ribavirin, GREATLY enhances overall antiviral effects **SE:** Generally well tolerated, mild fatigue, nausea, chills, altered taste **General:**

Answer 48

**Mech:** Block 2 enzymes necessary for viral rep! **Effects:** Tx hepatitis **SE:** Headache & fatigue! Brady if taken with amiodarone! **General:**

Answer 49

**Mech:** Blocks 2 enzymes necessary for viral rep **Effects:** Used to Tx hep **SE:** Headache & fatigue PLUS react of latent hep B **General:** Brady if taken w/ amiodarone

Answer 50

Neuraminidase inhibitor **Mech:** Inhibits neuraminidase (respon for seaparation of virus from host cell) Newly formed viruses cannot bud off! **Effects:** MUST be taken WITHIN 48HRS after symptom onset! Also shown to be effective in PREVENTING influenza **SE:** HALLUCINATION AND SI HAVE BEEN REPORTED IN CHILDREN!!! **General:**

Answer 51

**Mech:** given inactivated virus to develop immunity **Effects:** protection begins 1-2 weeks after inoculation, lasts 6 months Admin IM or intradermal **SE:** soreness at site, fever, malaise if not vaxx in past Small risk of Guillain-Barré syndrome (ascending paralysis, destruction of myelin sheath) **General:** instruct pt to get vaxx in Oct/Nov to be covered for heigh of flu season. Need to know if pt has egg allergy CANNOT GET VAXX IF CURRENT FEVER!

Answer 52

**Mech:** introduced to live, weakened virus **Effects:** Protection begins 1-2 weeks post inoculation, lasts 6mo **SE:** CANNOT BE GIVEN TO IMMUNOCOMPROMISED! Runny nose, nasal congestion, cough **General:** CANNOT GET VAXX IF CURRENT FEVER

Answer 53

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) **Mech:** Chem relatives of nucleosides & nucleotides. Suppresses synth of viral DNA by incorporating into chain, blocking further growth **Effects:** mainstay of HIV therapy **SE:** BONE MARROW SUPPRESSION!! May need blood transfusions Lactic acidosis (enzyme that breaks down LA can’t form) and hepatomegaly **General:** use of additional drugs that suppress bone marrow can increase risk of anemia & neutropenia

Answer 54

Non-NRTIs (NNRTIs) **Mech:** Binds DIRECTLY to HIV reverse transcriptase, inactivating enzyme! **Effects:** no structural relationship to nucelosides **SE:** If rash **STOP IMMEDIATELY!** CNS symp like dizziness, drowsiness Teratogenic!! **General:**

Answer 55

Protease Inhibitors (PIs) **Mech:** prev HIV protease from cleaving the long protein chain into the individual enzymes & structural proteins = virus remain immature & non-infectious! **Effects:** Often combined with NRTIs to reduce viral load to undetectable levels! **SE:** INHIBITS CYP450! We’ll tolerated, diarrhea, nausea, headache, prolongs segments of EKG **General:**

Answer 56

Integrase strand transfer inhibitor (INSTI) aka Integrase inhibitor **Mech:** Inhibits integrase, HIV DNA cannot be incorporated into DNA of host! **Effects:** only drug in this cat! **SE:** Insomnia, headache, severe hypersensitivity (SJS) rare **General:**

Answer 57

HIV Fusion Inhibitor **Mech:** Prev HIV envelope from fusing w/ cell membrane of host cell. Blocks entry of HIV into host cell **Effects:** 2x/day SQ Injections! Expensive! **SE:** Injection site reaction in 98% of pts!! Teratogenic Increased pneumonia risk Hypersensitivity **General:**

Answer 58

PrEP **Mech:** Both drugs are nucleotide/nuceloside reverse transcriptase inhibitors Prevents conversion of viral RNA to viral DNA **Effects:** Descovy only approved for people AMAB **SE:** Nephrotoxicity, Hepatotoxicity! Lactic acidosis Osteoporosis **General:**

Answer 59

**Mech:** PCNs are bactericidal! Bind to PCN binding protein (PBPs) in cell membrane Inhibit enzymes that synth cell walls! Activates autolysins ! **Effects:** PCN G tends to be very safe, cannot be given PO! All PCNs can be administered IM but vary in absorption Benzathine PCN G abosrbed SLOWLY over weeks Amox & Amp have additional SEs of diarrhea **SE:** ALLERGIC REACTION IS #1 CONCERN! Reaction ranges from rash-anaphylaxis. Tx for reaction is Epi 1:1000 concentration IM! IF ANAPHYL TO PCNs, WILL NOT GIVE CEPHALOSPORINS! **General:** Bacteria can be resistant to PCNs, thick outer membrane of Gram Neg cannot be pen by PCN Beta lactamase, enzyme prod by bacteria that destroys betal-lactamase ring of PCN MRSA creates PBPs w/ poor affinity to PCN

Answer 60

PCN combine w/ B-Lactamse inhibitor **Mech:** Prev destruction of b-lactam ring by binding to b-lactamase **Effects:** if pt doesn’t improve after starting w/ abx, you switch to one of these! **SE:** **General:**

Answer 61

Cephalosporins (Cef- or ceph-) **Mech:** As gen’s increase: better at resisting b-lactamase, better activity against gram neg bacteria & anaerobes, increased ability to cross BBB **Effects:** Need to consider pts renal fx! **SE:** **BAT** = Bleeding (increases Vit K metab) Allergic reaction (usually rash, Ana is rare) Thrombophelbitis (rotate IV infusion sites) **General:** Interaction with Acl!!! Disulfiram reaction (strong adverse reaction to alc, makes pt sick)

Answer 62

Carbapenems (-penem) **Mech:** Bactericidal , binds to PBPs = weakens cell wall & causes lysis **Effects:** Must be given IV! **SE:** GI effects most common! **General:**

Answer 63

Monobactams **Mech:** Binds to PBPs = bactericidal, *highly resistant to b-lactamase* **Effects:** can only be given IV or IM **SE:** pain at injection site Thrombophelbitis at IV site **General:**

Answer 64

**Mech:** Binds to molecules that are precursors to cell wall synth **Effects:** **Most widely used antibiotic in US hospitals!** Typically used to Tx C.diff infections (admin PO) and MRSA Admin by slow IV infusion except for Tx of c.diff (PO) **SE:** Renal failure, “Vanco flushing syndrome” stim release of histamine, vasodilation and flushing Thrombophelbitis **General:**

Answer 65

Aminoglycosides *Bactericidal inhibitors of protein synthesis* **Mech:** Bind to ribosome w/ 3 effects: Inhibit onset of protein synthesis Premature term of protein synthesis Prod of abnormal code leading to cell membrane lysis/failure **Effects:** monitoring of drug levels is important!! **elevated TROUGH is assoc w/ toxicity!!** Peak measure 1hr after admin Trough 30min before admin **SE:** Serious tox!!! Especially in kidney & ear! Ototoxicity = high pitched tinnitus Nephrotox = acute tubular necrosis, usually reversible **General:** HIGHLY polar so not absorbed in gut, can’t cross BBB! AMNO = Aerobic organisms only Mostly bactericidal Inhibits protein synthesis/IV only Nephrotox/Neuro musc block Ototoxicity

Answer 66

Tetracyclines (-cycline) **Mech:** Bind to ribosome, prevents binding of tRNA, chain of amino acids cannot be built , growth of bacteria is stopped **Effects:** **1st LINE TX FOR: CHALMYDIA TRACHOMATIS, LYME DISEASE, BACILLUS ANTRACIS, ROCKY MOUNTAIN SPOTTED FEVER, H. PYLORI** **SE:** Binds to Ca in developing teeth causing GREY STAINING! DO NOT GIVE TO CHILDREN UNDER 8yo! Hepato * Nephrotox Suprainfection **General:** Binds to Ca products (dairy) and inactivates abx! Edu pt to not take w/ milk or dairy, don’t take with Ca supplements, or iron supplements

Answer 67

Macrolides (-thromycin) **Mech:** broad spectrum similar to PCNs Binds to ribosome and prevents chain of amino acids being built **Effects:** **1st LINE DRUG FOR: LEGIONELLA PNEUMONIA, BORDETELLA PERTUSSIS, CORYNEBACTERIUM DIPHTHERIAE **SE:** GI irritation, prolong QT **General:** INHIBITS CYP450!! Can lead to Dig tox, increased bleeding w/ warfarin!

Answer 68

**Mech:** Binds to ribosome & prev chain of amino acids **Effects:** **SE:** POTENTIALLY FATAL C.DIFF ASSOC DIARRHEA!!!! SUPRAINFECTION! **General:**

Answer 69

**Mech:** Binds to ribosome prev chain of amino acids **Effects:** RESERVED FOR MULTI-DRUG RESISTANT ORGANISMS !!! Like MRSA, VRE! **SE:** GI irritation **General:**

Answer 70

Sulfonamides (Sulfa drugs) **Mech:** Structurally similar to PABA, Sulfonamide is incorporated into molecule instead of PABA, stops prod of folic acid!! **Effects:** usually used to Tx UTIs **SE:** Hypersensitivity = mild rash & fever most common **Photosensitivity** Hemolytic anemia! Kernicterus (bilirubin in brain) SJS can occur **General:** Inhibits hepatic metab of some drugs like warfarin, cross hypersensitivity with other sulfur-based drugs

Answer 71

**Mech:** Interfers w/ consecutive steps in synth of folic acid **Effects:** Used for UTIs + pneumocystis pneumonia **SE:** Fetal malformation!! Hemolytic anemia! HyperK! GI disturb , itching & rash **General:**

Answer 72

Fluoroquinolones (-floxacin) **Mech:** inhibits 2 bacterial enzymes responsible for DNA rep & cell division **Effects:** CYP450 inhibitor!!! **SE:** TENDON RUPTURE!! ACHILLES TENDON!! Phototoxicity! Mild GI **General:** tell pt to not take with milk, dairy, Ca supplements, iron, antacids

Answer 73

**Mech:** Prodrug is taken in by anaerobic organisms, converted into active form, breaks DNA strands **Effects:** ONLY EFFECTIVE AGAINST ANAEROBES!!! **SE:** Metallic taste in mouth, Hypersensitivty reaction (SJS) **General:** Disulfiram like reaction w/ alc!

Answer 74

TB Drug **Mech:** Not clear, believed to reduce prod of important component of cell wall **Effects:** **SE:** Hepatox , peripheral neuropathy, CNS effects (Seizures) **General:**

Answer 75

TB Drug **Mech:** Inhibits DNA dependent RNA polymerases , blocks RNA synthesis , Blocks protein synthesis **Effects:** INDUCES CYP450!!! Lower warfarin level Lower dig level Lower BC level **SE:** DISCOLORATION OF BODY FLUIDS : red/orange color to urine, sweat, saliva, tears, harmless. hepatox **General:**

Answer 76

Polyene anti-fungal **Mech:** binds to ergosterol on the surface of fungal cell membrane, increased permeability **Effects:** must be admin IV (poor GI absorption) **SE:** Binds to sterols on mammalian cells like cholesterol!! Infusion reactions Nephrotox HypoK **General:** reduce SEs by pre-Tx w/ Benadryl & acetaminophen! **Nystatin (Mycostatin)** is in the same fam but MUCH less toxic (topical)

Answer 77

Azole antifungals (-conazole) **Mech:** inhibits prod of ergosterol, necessary for fungal cell membranes Results in leakage & rupture **Effects:** better alt to Ampotericin B for SYSTEMIC fungal infections! Slightly less toxic and admin PO! **SE:** INHIBITS CYP450!!! GI Disturbances **General:**