Exam 2 Flashcards
Penicillin drug class?
beta lactam antibiotic
cephalosporin drug class?
beta lactam antibiotic
monobactam drug class?
beta lactam antibiotic
carbapenem drug class?
beta lactam antibiotic
what do all beta lactam antibiotics share?
the same beta lactam ring
penicillin VK drug class?
penicillin (beta lactam)
amoxicillin drug class?
penicillin (beta lactam)
amoxicillin/clavulanate drug class?
penicillin (beta lactam)
penicillins- bactericidal or bacteriostatic?
bactericidal
penicillins- mechanism of action?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
streptococcal infection, meningococcal infection, neurosyphilis- indications for what drug class?
penicillin (beta lactam)
cephalosporin- mechanism of action?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
cephalosporin- bactericidal or bacteriostatic?
bactericidal
example of 1st gen cephalosporin?
cephalexin
example of 2nd gen cephalosporin?
cefuroxime
example of 3rd gen cephalosporin?
ceftriaxone
example of 4th gen cephalosporin?
cefepime
example of 5th gen cephalosporin?
ceftaroline
soft tissue infections, UTI- indications for which gen cephalosporins?
1st gen cephalosporins
indications for 1st gen cephalosporins?
soft tissue infections, UTI
indications for 2nd gen cephalosporins?
improved acuity versus pneumococcus and H. influenzae
indications for 3rd gen cephalosporins?
pneumonia, meningitis, pyelonephritis, gonorrhea
PMPG
pneumonia, meningitis, pyelonephritis, gonorrhea- indications for what class? PMPG
3rd gen cephalosporins
indications for 4th gen cephalosporins?
broad activity, improved stability to chromosomal beta lactamases
indications for 5th gen cephalosporins?
methicillin-resistant staph, broad gram negative activity (not including p aeruginosa)
methicillin-resistant staph, broad gram negative activity not including p aeruginosa? Which gen cephalosporins
5th gen cephalosporins
example of a carbapenem drug?
imipenem
imipenem- drug class?
carbapenem
carbapenems- bactericidal or bacteriostatic?
bactericidal
carbanemens- broad drug class?
beta lactam antibiotic
carbapenem- mechanism of action?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
indications for carbapenems?
serious infections like pneumonia and sepsis
example of glycopeptide?
vancomycin
vancomycin- MOA?
inhibits bacterial cell wall synthesis
infections caused by gram positive bacteria; sepsis, endocarditis, meningitis, c diff colitis
glycopeptides
indication for oral vanc?
c diff colitis
example drug of monobactams?
aztreonam
aztreonam- drug class?
monobactam
monobactam drug class?
beta lactam antibiotic
monobactam- MOA?
prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases
infections caused by aerobic, gram negative bacteria in patients with immediate hypersensitivity to PCNs
monobactam
indication for monobactams?
infections caused by aerobic, gram negative bacteria in patients with immediate hypersensitivity to penicillins
what does addition of clavulanate do?
broadens spectrum of coverage and reduces resistance
what causes resistance to penicillins?
resistance comes from bacteria that produce betalactamase as well as alterations in penicillin binding sites
penicillin spectrum of coverage?
gram positive, gram negative cocci, non beta lactactamase-producing anaerobes
are penicillins safe in pregnancy?
yes
when should oral penicillins be given?
1-2 hours before or after a meal (except amoxicillin)
why should oral pencillins be given 1-2 hours before or after a meal?
to minimize binding to food proteins and acid inactivation
large doses of pencillins may cause what?
GI upset, especially N/V/D
what two drugs can be associated with skin rashes when prescribed in viral illness? (From penicillin class)
ampicillin and amoxicillin
Epstein-barr virus infection and prescription of what drugs can cause rash?
ampicillin and amoxicillin
ampicillin and amoxicillin are associated with what adverse effect?
skin rash in setting of viral infection, esp with EBV
drugs that end in -icillin?
penicllins
what is a limiting factor in using a pencillin derivative to treat an infection?
bacterial production of beta lactamases
what drug is the exception to giving pencillins 1-2 hours before or after a meal?
amoxicillin
brand name for amoxicillin/clavulanate?
augmentin
generic name for augmentin?
amoxicillin/clavulanate
patient education for penicillins?
GI upset especially with high doses (pneumonia)
what percentage of the population will report a penicillin allergy?
0.1
how many generations of cephalosporins?
5
coverage of 1st gen cephalosporins?
gram positive- staph and strep
cephalexin and cephazolin- what generation?
1st gen cephalosporins
cefaclor and cefotetan- what generation?
2nd gen cephalosporins
cefdinir and ceftriaxone- what generation?
3rd gen cephalosporins
cefepime- what generation?
4th gen cephalosporins
ceftaroline- what generation?
5th gen cephalosporins
3rd gen cephalosporins?
more gram negative coverage
some of what generation of cephalosporins are able to cross BBB?
3rd gen cephalosporins
broad gram-negative coverage and effective against MRSA and enterococci? (ceph gen?)
5th gen cephalosporins
action of cephalosporins?
inhibits cell wall mucopeptide synthesis
cephalosporins- bactericidal or bacteriostatic?
bactericidal
what percentage of patients with pencillin allergy may have a cephalosporin allergy?
0.01
cephalosporins are more stable to what?
many beta lactamases
which has a better spectrum of coverage- penicillins or cephalosporins?
cephalosporins
cephalosporins- drug class?
beta lactam antibiotic
penicillins and cephalosporin cross-sensitivity, why?
same beta lactam ring
is a rash to penicillin ok to prescribe cephalosporin?
yes, just avoid if airway issues (anaphylaxis)
example of monobactam drug?
aztreonam
monobactams- bactericidal or bacteriostatic?
bactericidal
monobactam- spectrum of coverage?
aerobic, gram negative organisms
monobactam- covers aerobic or anaerobic?
aerobic
monobactam- covers gram positive or gram negative?
gram negative
monobactams have NO coverage against what?
gram positive orgs or anaerobes
monobactams- coverage against gram positive? Yes/no
no
monobactams- coverage against anaerobes? Yes/no
no
monobactams- stable to many beta lactamases? Yes/no
yes
do monobactams penetrate CSF? Yes/no
yes
monobactams- ok to give with pencillin allergy?
yes
do monobactams cross BBB?
yes
imipenem- drug class?
carbapenem
doripenem- drug class?
carbapenem
meropenem- drug class?
carbapenem
carbapenem- MOA- bactericidal or bacteriostatic?
bactericidal
imipenem- spectrum of coverage?
gram-negative rods, gram positive organisms, anarobes
doripenem and meropenem have slightly less what?
slightly less gram positive coverage and slightly more gram-negative aerobe coverage
do carbapenems penetrate CSF?
yes
when are carbapenems used?
difficult to treat infections
what lab should be monitored with carbapenem?
renal function
common side effects of carbapenems? (3)
nausea, vomiting, skin rash
what beta lactam class penetrates body fluids very well?
carbapenems
renal function should be monitored with which beta lactam?
carbapenems
glycopeptide- what class?
Inhibits cell wall and RNA synthesis
example of beta lactam glycopeptide?
vancomycin
vancomycin- bactericidal or bacteriostatic?
bactericidal
vancomycin- MOA?
inhibits cell wall and RNA synthesis
which antibiotic? Inhibits cell wall and RNA synthesis
vancomycin
Glycopeptide
when is vancomycin used?
difficult to treat infections including MRSA and c diff
monitoring for vancomycin?
renal dosing, peak and trough levels
red man syndrome- which antibiotic?
vancomycin
refers to redness and flushing due to infusing too quickly?
red man syndrome
why is vancomycin usually given IV?
poor oral absorption
oral absorption of vancomycin?
poor
MRSA and cdiff- what antibiotic?
vancomycin
MRSA?
methicillin resistant staph aureus
oral versus IV for MRSA?
consider appropriate route based on severity of symptoms
most common folate antagonist?
trimethoprim-sulfamethoxazole
ciprofloxacin, levofloxacin- drug class?
fluoroquinolones
tetracycline, doxycycline- drug class?
tetracyclines
doxycycline- drug class?
tetracyclines
erythromycin, drug class?
macrolides
azithromycin, drug class?
macrolides
clindamycin- drug class?
lincosamide
lincosamide- example?
clindamycin
tetracycline- bactericidal or bacteriostatic?
bacteriostatic
tetracycline- MOA?
inhibits protein synthesis
tetracyclines- spectrum of coverage?
gram positive and gram negative
do not give to children under 8 or in pregnancy- drug class?
tetracyclines
may affect tooth enamel or impair bone growth- drug class?
tetracyclines
tetracyclines safe in pregnancy?
no
tetracyclines safe in children?
no
tetracyclines and antacids?
do not given within 2 hours of antacids
doxycycline- common problem?
causes photosensitivity
three examples of macrolides?
erythromycin, azithromycin, clarithromycin
macrolides- MOA?
protein synthesis inhibitor
macrolides- bactericidal or bacteriostatic?
bacteriostatic; may be bactericidal at higher concentrations
macrolides- spectrum of coverage?
gram positive (pneumococci, strep, staph), gram negative (h influenzae) and atypical bacteria (mycoplasma)
risk with macrolides?
QT prolongation
what class has coverage against M pneumoniae?
macrolides
back up for strep in patients allergic to penicillin?
macrolides
erythromycin- common ADE?
diarrhea and cramping
why does erythromycin cause diarrhea and cramping?
stimulates the motilin receptors of the GI tract
why is erythromycin rarely used?
diarrhea and cramping; other macrolides are better tolerated
why is there increasing resistance to macrolides?
due to overuse of azithromycin
QT prolongation high risk antibiotic class?
macrolides (look at other meds the patient is on)
zofran risk?
QT prolongation
do SSRIs cause QT prolongation?
yes
clindamycin- bactericidal or bacteriostatic?
bacteriostatic; may be bactericidal at higher concentrations
clindamycin- MOA?
inhibits protein synthesis
clindamycin- spectrum of coverage?
gram positive (strep, staph, pneumococci), some MRSA coverage, some anaerobe coverage
used in treatment of severe infections like necrotizing fasciitis or toxic shock syndrome
clindamycin + penicillin
clindamycin + penicillin used when?
necrotizing fasciitis or toxic shock sydrome
high risk antibiotic for c diff?
clindamycin
clindamycin adverse effect?
GI upset; c diff colitis
oxazolidinones- example?
linezolid
linezolid- drug class?
oxazolidinones
linezolid- MOA?
inhibits protein synthesis
linezolid- bactericidal or bacteriostatic?
can be bacteriostatic or bactericidal (Against strep)
linezolid- spectrum of coverage?
gram positive (staph, strep, enterococci), gram-positive anaerobes, MRSA
when is linezolid used?
very resistant infections such as vancomycin resistant
med for vent associated pneumonia?
linezolid
med used as part of anthrax regimen?
linezolid
off label use of linezolid?
tuberculosis
what antibiotic increases risk of serotonin syndrome?
linezolid
adverse effect of linezolid?
hematologic abnormalities- anemia, neutropenia
anemia, neutropenia, what antibiotic?
linezolid
what are the hematologic abnormalities with linezolid?
anemia, neutropenia
SNRIs and SSRIs, problem with linezolid?
risk for serotonin syndrome
lab monitoring- linezolid?
heme abnormalities
examples of folate antagonists?
sulfonamides, trimethoprim
drug class- sulfonamides, trimethoprim?
folate antagonists
sulfonamides and trimethoprim- bactericidal or bacteriostatic?
bactericidal when used together
sulfonamides and trimethoprim- MOA?
inhibits folic acid synthesis
sulfonamides and trimethoprim- spectrum of coverage?
gram positive, gram negative, and MRSA
skin infection, UTI- indications for what drug?
sulfonamides, trimethoprim
contraindication for sulfa/trimethoprim? (Drug interaction)
do not use with coumadin
coumadin should not be used with which antibiotic?
sulfonamides, trimethoprim
common side effect of sulfa/trimethoprim?
sun sensitivity
high risk of rash/SJS- which antibiotic?
sulfonamides, trimethoprim
severe skin reaction to antibiotics, life-threatening complications? Skin slough
stevens johnsons syndrome
SJS- blistering around mouth, eyes, mucosal membranes- which antibiotic?
sulfonamides, trimethoprim
rash on bactrim?
SJS- can present late in course of treatment, STOP THE DRUG
levofloxacin- drug class?
fluoroquinolones
ciprofloxacin, drug class?
fluoroquinolones
fluoroquinolones- MOA?
DNA synthesis inhibitor
spectrum of coverage- fluoroquinolones?
excellent gram-negative coverage, moderate gram-positive coverage, atypical bacteria
UTI, soft tissue, bones, joints, respiratory tract- indications for what class?
fluoroquinolones
effective against multi-drug resistance organisms?
fluoroquinolones
puncture wounds?
fluoroquinolones
cipro interactions with what drug?
warfarin
cipro interaction with warfarin?
increased INR
pseudomonas and enterobacter- what class?
fluoroquinolones
respiratory tract infections/pneumonia, which fluoroquinolones?
levofloxacin
antibiotic class with high risk of tendon rupture?
fluoroquinolones
fluoroquinolones- safe in pregnancy?
no
fluoroquinolones- safe in children?
no
fluoroquinolones- QT prolongation? Yes/no
yes
four classes of antibiotics with prolonged QT interval?
macrolides, fluoroquinolones, clindamycin, TMP-SMX
age risk for antibiotic QT prolongation?
> 65
gender risk for antibiotic QT prolongation?
women
bradycardia or tachycardia- risk for antibiotic QT prolongation?
bradycardia
left ventricular failure- risk for what with antibiotics?
QT prolongation
electrolyte abnormalities- risk for what with antibiotics?
QT prolongation
hepatic dysfunction- risk for what adverse effect of antibiotics?
QT prolongation
congenital prolonged QT- risk for what with antibiotics?
further QT prolongation
polypharmacy- risk for what with antibiotics?
QT prolongation
less EPS with typical or atypical Aps?
atypical Aps
anticholinergic effects, less with typical or atypical AP?
atypical AP
neuroleptic malignant syndrome, less with typical or atypical AP?
atypical AP
do EPS always resolve with typical AP?
no
OCD off label use for what class?
atypical AP
psychosis associated with dementia- off label use for what class?
atypical AP
schizophrenia and other causes of psychosis- indication for what class?
atypical AP
bipolar, mania- indication for what class?
atypical AP
atypical AP- MOA?
cortical blockade of serotonin receptors, serotonin not blocking dopamine release, more dopamine sent to prefrontal cortex
weight gain, diabetes mellitus, dyslipidemia, cardiovascular disease predisposition- what class?
atypical AP
insulin resistance- what class?
atypical AP
adverse effect profile- worse with what atypical AP?
olanzapine
EPS, TD, NMS- worse with which AP?
typical
increased risk of mortality in patients with dementia-related psychosis- what class
atypical AP
orthostatic hypotension, syncope, falls with head injury- what class?
atypical AP
hyperprolactinemia- what class?
atypical AP
QT prolongation risk with atypical AP?
yes
atypical AP (2) with QT prolongation?
ziprasidone and quetiapine
ziprasidone and quetiapine risk?
QT prolongation
atypical AP- pregnancy safe?
no
atypical AP- children?
no
avoid use of atypical AP in what population?
older population
caution prescribing atypical AP in what?
hepatic or renal dysfunction
alcohol use in atypical AP?
do not use
lactation- atypical AP?
do not use
patients should avoid all simple carbohydrates?
atypical AP
aerobic and strength training and lean/normal body weight?
atypical AP
extreme caution with dementia?
atypical AP
nearly all drugs with CNS effects act on what?
specific receptors that modulate synaptic transmission
five NTs of CNS drugs?
GABA, acetylcholine, serotonin, dopamine, norepinephrine
depression and anxiety often what?
coexist
benzodiazepine- drug class?
anxiolytic
chlordiazeproxide, chlorazepate- what class?
benzodiazepine
augment the binding of GABA- drug class?
benzodiazepine
indications for benzodiazepines?
anxiety-related disorders, muscle relaxation, status epilepticus, irritable bowel syndrome, nausea/vomiting, restless leg syndrome
anxiety-related disorders, muscle relaxation, status epilepticus, irritable bowel syndrome, chemo N/V, RLS- drug class?
benzodiazepine
what is the chief inhibitory neurotransmitter in CNS?
GABA
CNS depression, reduction in anxiety, muscle relaxation, anticonvulsant activity
benzodiazepine
adverse effects due to CNS depression with benzodiazepines?
sedation
when is sedation worst with benzodiazepines?
initiation
hypotension, visual blurring, dizziness, confusion- what class?
benzodiazepine
paradoxical anxiety, agitation, acute rage- what class?
benzodiazepine
clonazepam causes increased production of what?
saliva
what drug causes increased production of saliva?
clonazepam
BZD with longer half-life?
clonazepam
longer half life of BZD helps avoid what?
physical and psychological dependence
alprazolam half life?
rapid onset, shorter, more potent
how should BZD be stopped?
gradually
withdrawal syndrome with BZD? Yes/no
yes
BZD- pregnancy?
no
BZD- lactation?
no
children < 6 y/o? yes/n
Atypical AP
no (relative contraindication)
hepatic/renal disease- BZD?
contraindication
elderly- BZD?
relative contraindication
lorazepam- long or short acting?
short acting
more potent BZDs? (2)
alprazolam and lorazepam
serotonergic anxiolytic example?
buspirone
buspirone drug class
serotonergic anxiolytic
indication for buspirone?
generalized anxiety disorder
main action of buspirone?
full agonist at the presynaptic serotonin receptor (serotonin binds there after buspirone)
where is buspirone a full agonist?
presynaptic serotonin receptor
where is buspirone a partial agonist?
at the serotonin postsynaptic receptor
buspirone dopamine actions?
minor dopamine action
buspirone effect on GABA?
no effect on GABA
buspirone cause drowsiness?
potentially
lightheadedness, headache, insomnia, nervousness, dry mouth- what drug?
buspirone
lightheadedness, headache, insomnia, nausea, nervousness, dry mouth- what to tell patient?
usually mild and resolve with ongoing therapy
rare side effects of buspirone? (2)
akathisia and involuntary movements
buspirone risk of dependence?
low
should buspirone be taken with food?
yes
why should buspirone be taken with food?
decrease the liver first pas effect
half life of buspirone?
short
onset of action of buspirone?
slow
how long for effects of buspirone?
weeks
advise patients of nonpharmacologic interventions for anxiety? What drug
buspirone
metabolism of buspirone?
oxidation in the liver
is buspirone safe in severe renal or hepatic dysfunction?
no
why should buspirone not be used in panic disorder?
due to adrenergic effects of one metabolite
buspirone in lactating patient?
avoid use
buspirone in pregnant patient?
use only if favorable risk/benefit ration
buspirone risk when used with other serotonergic drugs?
serotonin syndrome
where is buspirone excreted?
urine
is buspirone used in panic disorder? Yes/no
no
which antidepressant- anticholinergic effects?
tricyclic antidepressants
depression, anxiety-related disorders, enuresis, chronic neuropathic pain, insomnia (lower doses) eating disorders
tricyclic antidepressants
imipramine- drug class?
tricyclic antidepressants
amitriptyline- drug class?
tricyclic antidepressants
doxepin- drug class?
tricyclic antidepressants
TCA- MOA?
inhibit the reuptake of serotonin and norepinephrine at the presynaptic neuron
where are serotonin and norepinephrine inhibited with TCA?
presynaptic neuron
what are the four neurotransmitters involved with TCA?
serotonin, norepinephrine, histamine, acetylcholine
what often negates the use of TCA?
adverse effects
TCA therapeutic index?
narrow therapeutic index
overdose can be fatal, what drug class?
TCA
can you stop TCA suddenly?
no because of CNS withdrawal syndrome (nausea, vomiting, vertigo, malaise, nightmares)- can be severe
dry mouth, dry eyes, orthostatic hypotension, constipation, hesitancy/retention- drug class?
TCA
why should TCA be avoided in older population?
anticholinergic effects
nausea, vomiting, vertigo, malaise, nightmares
CNS withdrawal syndrome (TCA)
why do TCA cause sedation?
action on histamine receptors
high risk of suicide?
TCA
cardiac conduction disorder- seen with what class of antidepressants?
TCA
sinus tachycardia- what antidepressant class?
TCA
why do TCA cause cardiac conduction disorder?
NE reuptake inhibition and anticholinergic effects
decreased seizure threshold- what antidepressant class?
TCA
TD and NMS common or rare with TCA?
rare
rare ADE with TCA?
TD and NMS; TD may not resolve
when should ECG be obtained with TCA?
at baseline and at 3 weeks or dose change
why should TCA be titrated slowly?
to avoid CNS adverse effects such as those seen with abrupt withdrawal
pregnancy use- TCA?
only if risk benefit ratio is favorable
TCA in lactation?
excreted in breast milk
pre-existing cardiac conduction disorder- contraindication to what antidepressants?
TCA
TCA should not be combined with what class?
MAOI
what are the TCA contraindications associated with blocking of acetylcholine?
glaucoma, BPH, urinary incontinence
alpha-adrenergic blocking and quinidine-like effect- what class?
TCA
MAOI
monoamine oxidase inhibitors
treatment-resistant depression use what?
MAOI
phelezine- what class?
MAOI
tranylcypromine- what class?
MAOI
inactivate the enzymes that break down norepinephrine, dopamine, serotonin?
MAOI
prevent the breakdown of tyramine?
MAOI
tyramine is a precursor to what?
norepinephrine, serotonin, dopamine
what are the adverse effects related to with MAOIs?
delayed metabolism of dopamine
what is an example of anticholinergic effects of MAOI?
orthostatic hypotension
food and drink interactions that can result in severely elevated BP- drug class?
MAOI
most common side effects of MAOI?
dizziness, headache, insomnia, restlessness, and hypotension
MAOIs are NOT what?
first line therapy
what kind of foods should be avoided with MAOIs?
tyramine-containing
examples of problematic foods with MAOIs?
fermented and aged foods, pickled foods, kim chi, sauerkraut, soy sauce
caffiene should be avoided with which antidepressants?
MAOI
what antidepressant may suppress myocardial pain?
MAOI
do not use MAOIs within 3 weeks of what medications?
SSRI or SNRI (risk for serotonin syndrome)
how long is wash out period with MAOI?
3 weeks
do MAOI have liver first pass effect? Yes/no
yes
MAOI in liver or renal disease?
no
arteriosclerotic disease- avoid which antidepressant?
MAOI
pregnancy use- MAOI?
no
lactation- MAOI?
no
depression states, anxiety-related disorders, OCD, bulimia, PTSD- class?
SSRI
citalopram- class?
SSRI
fluoxetine- class?
SSRI
paroxetine- class?
SSRI
sertraline- class?
SSRI
SSRI- MOA?
presynaptic neuronal reuptake inhibition of serotonin
where does SSRI act?
presynaptic neuron
what SSRI also affects dopamine?
fluoxetine
SSRI effects on NE?
weak
patient teaching about SSRI adverse effects?
usually diminish over time and not serious
nausea/vomiting, dizziness/lightheadedness, dry mouth, diaphoresis, weight gain/loss, diarrhea, constipation
SSRI
SSRI most likely to cause diarrhea?
sertraline
SSRI most likely to cause constipation?
paroxetine
which patients at greater risk for suicide with SSRIs?
younger patients
can SSRI be safely stopped suddenly?
NO
half life of fluoxetine?
long
what should I assess for if major depression?
bipolar disorder
how long for SSRI to take effect?
therapeutic effect as long as 6 weeks
pregnancy- SSRI?
avoid if possible
severe hepatic/renal dysfunction- SSRI?
contraindication
depressive disorders (BPD), anxiety, social phobia, PTSD, neuropathic pain, overactive bladder, fibromyalgia?
SNRI
duloxetine- class?
SNRI
venlafaxine- class?
SNRI
two examples of SNRI drugs?
duloxetine and venlafaxine
where are serotonin and NE inhibited with SNRI?
presynaptic neuron
MOA- SNRI?
serotonin and NE transporters are blocked from taking these NTs back to presynaptic neuron
more serotonin and NE available to act where with SNRI?
postsynaptic neuron (more available)
elevated BP seen with higher doses of what antidepressant?
SNRI (due to norepinephrine)
why can BP elevate with SNRIs?
norepinephrine
pregnancy- SNRI?
avoid if possible
lactation- SNRI?
avoid (Excreted in breast milk)
worsening narrow-angle glaucoma? Antidepressant
SNRI
duloxetine has worsened what?
narrow angle glaucoma
duloxetine in liver dysfunction?
don’t use
bupropion- drug class?
atypical antidepressant
mirtazapine- drug class?
atypical antidepressant
two indications for bupropion?
depression and smoking cessation
what antidepressant can cause insomnia?
bupropion
uptake of NE and DA are weakly inhibited- what antidepressant?
bupropion
mirtazapine- MOA?
antagonism of central presynaptic alpha 2 adrenergic receptors
antagonism of central presynaptic alpha-2 adrenergic receptors? Drug?
mirtazapine
mirtazapine- indications?
depression, insomnia, can improve appetite
increased noradrenergic and serotonergic activity? Drug
mirtazapine
why does mirtazapine help with insomnia?
antihistamine effect
anxiolytic, sedative-hypnotic, antiseizure?
barbiturates
pentobarbital- class?
barbiturates
phenobarbital- class?
barbiturates
cause CNS depression via inhibiting transmission of stimuli to reticular activating system
barbiturates
where is reticular activating system located?
brainstem
do barbiturates bind to gaba?
yes but in different area than BZD
adverse effects of barbiturates?
CNS depression or agitation
ataxia seen with what class?
barbiturates
what can happen if not tapering off barbiturates?
status epilepticus
respiratory and CV system depression- what class?
barbiturates
schedule class of short-acting barbiturates?
schedule II
therapeutic index- barbiturates?
narrow
are barbiturates first line for status epilepticus or seizures related to meningitis or tetanus?
no
alcohol use with barbiturates?
no- risk of death
younger than 6- barbiturates?
no
avoid barbiturates if history of what?
drug-misuse disorder
zolpidem indication?
insomnia
zapelon indication?
insomnia
eszopiclone indication?
insomnia
suvorexant indication?
insomnia
ramelton?
insomnia
suvorexant MOA?
orexin receptor antagonist- promote sleep
zolpidem- MOA?
at gaba receptor in diff area than BZD
ramelton- MOA?
selective melatonin receptor agonist
loss of muscle tone with full cognition intact?
sedative hypnotics other than barbs or bzd
sleep paralysis- what class?
sedative hypnotics other than barbs or bzd
sleep walking and sleep driving
sedative hypnotics other than barbs or bzd
anterograde amnesia- what class?
sedative hypnotics other than barbs or bzd
can sedative hypnotics other than barbs or bzd be stopped suddenly?
no, taper d/t CNS withdrawal syndrome
suvorexant- abuse potential?
yes
uses of CNS stimulants?
ADHD, narcolepsy, exogenous obesity
CNS stimulant- MOA?
sympathomimetic amines that act as dopamine agonists
indirectly release and prevent the reuptake of DA, serotonin, and NE at the presynaptic neuron?
CNS stimulants
CNS stimulants activate where?
reticular activating system
hypertension, sweating, tachycardia- what class?
CNS stimulants
hyperthyroidism- contraindication to what CNS class?
CNS stimulants
esophageal dysmotility/obstruction- what drug?
concerta brand of methylphenidate
how many hours of bedtime should CNS stimulant be avoided?
6
pregnancy- CNS stimulant?
no
lactation- CNS stimulant?
no
glaucoma and motor tics- contraindication of what class?
CNS stimulants
avoid MAOI overlap with CNS stimulants for how long?
14 days
short term in patients with desired weight loss?
anorexiants
phentermine- class?
anorexiants
lorcaserin- class?
anorexiants
where do anorexiants act?
satiety center (hypothalamus and limbic reas)
possible valvular heart disease- what class?
anorexiants
hyperprolactinemia- seen with CNS class?
anorexiants
hypoglycemia in type 2 dm- what CNS drug?
anorexiants
can anorexiants be stopped suddenly?
no
can CNS stimulants be suddenly stopped?
no
two drugs used in bipolar disorder?
lithium and valproate
mood stabilizer used in seizure disorders?
valproate
drug for migraine prophylaxis?
valproate
interchangeable with sodium and has no metabolism, drug?
lithium
may take place of sodium in neurons during depolarization, drug?
lithium
decreased transmission of electrical impulses, drug?
lithium
may cause down-regulation of second messenger systems, drug?
lithium
lithium may cause down-regulation of what?
second messenger system
valproate leads to increased availability of what NT?
GABA
may contribute to more GABA action at the receptor or act like GABA; blocks voltage-dependent sodium channels
valproate
ultimate action of valproate?
less neuronal firing
inhibitory neurotransmitter?
GABA
may minimize adverse effects of lithium by what?
taking with food
what form of lithium may help with adverse effects?
sustained release form
fine tremors, nausea and dry mouth, headache, drowsiness
lithium
thyroid function with long-term lithium?
hypothyroidism
increased TSH may be seen with what drug?
lithium (hypothyroidism)
fine tremors- SE of what drug?
lithium
long-term problem with thyroid with lithium?
hypothyroidism
CV effects of lithium?
ECG changes and arrhythmias
side effects of valproate are usually what?
transient
heartburn, dyspepsia- what med?
valproate
alopecia can occur and hair will grow back but may have different texture, what drug?
valproate
may increase bleeding time due to inhibition of platelet aggregation
valproate
bone marrow suppression
valproate
what lab should be monitored with valproate?
CBC
hepatic toxicity prevalence with valproate?
rare
therapeutic index- lithium?
narrow
tremors, nausea, dizziness are signs of what with lithium?
toxicity
signs of lithium toxicity?
tremors, nausea, dizziness
lab that should be monitored with Lithium?
renal function
what age can have extended-release lithium?
12 years and older
what trimesters of pregnancy avoid lithium?
first and third
lithium- lactation?
avoid
what states should avoid lithium?
sodium and fluid depletion (will increase lithium levels)
what will happen to lithium levels if sodium/fluid depletion?
levels will increase
what happens to lithium level with excessive water intake?
levels will decrease
what causes lithium levels to decrease?
excessive water intake
when does lithium become therapeutic?
14 days
why is lithium not used in acute mania?
long half life, takes 14 days for therapeutic effect
is lithium metabolized?
no
how is lithium excreted in the urine?
essentially unchanged
primary concern with valproate?
CNS depression esp when first starting
liver dysfunction- valproate?
contraindication
pregnancy- valproate?
contraindication
what happens with valproate in pregnancy?
neural tube defect
when can toxicity of valproate occur?
even at therapeutic levels
dizziness, hypotension, tachy/bradycardia, drowsiness, visual hallucinations, respiratory depression
valproate toxicity
monitor lab for valproate?
drug level
how is valproate excreted?
in the urine as ketone metabolite
why can valproate cause false positive for urine ketone tests?
excreted in urine as ketone metabolite
can valproate be used for acute mania?
yes
can lithium be used for acute mania?
no
what causes the clinical manifestations of parkinson?
dopamine deficiency
what two NTs should be balanced for musculoskeletal performance?
dopamine and acetylcholine
bradykinesia and gait should be considered in decision to treat what?
parkinson disease
what is the main problem in parkinson?
dopamine deficiency
what are dopaminergic drugs used for?
to treat the dopamine depletion that occurs in parkinson disease
amantadine- class?
dopaminergic
bromocriptine- class?
dopaminergic
carbidopa-levodopa- class?
dopaminergic
pramipexole- class?
dopaminergic
rasaligine- class?
dopaminergic
ropinirole- class?
dopaminergic
pergolide- class?
dopaminergic
tolcapone- class
dopaminergic
MOA- dopaminergics?
cause release of dopamine
what do dopaminergic drugs cause?
release of dopamine
what drugs act as dopamine precursors?
dopaminergics
what drugs act as dopamine agonists?
dopaminergic
what does a drug do if it is a dopamine agonist?
stimulates the dopamine receptor
drugs that inhibit MAO lead to what? (PD)
less breakdown of dopamine
levodopa- think what?
pharmacokinetic enhancement
selegiline- class?
dopaminergic
how should dopaminergic agents be started?
low and slow titration
dizziness and postural hypotension in dopaminergics more common in who?
older adults
confusion and hallucinations with dopaminergics, more common in who?
older adults
what two dopaminergics can cause sleep attacks?
pramipexole and ropinirole
pramipexole and ropinirole can cause what?
sleep attacks
dyskinesia worsening or dyskinesia can be caused by what dopaminergics?
carbidopa and levodopa
what two labs should be monitored with dopaminergic drugs?
hepatic and renal
what labs should be monitored with dopaminergic drugs?
hepatic and renal
carbidopa-levodopa is contraindicated in what two conditions?
narrow angle glaucoma and malignant melanoma
cautious use of dopaminergics in patients with what four conditions?
cardiac, psychiatric, renal, or ulcer disease
pregnancy use- dopaminergics?
weigh risk benefit
lactation- dopaminergics?
safety not established
pediatrics- dopaminergics?
safety not established
what dopaminergic is associaed with severe hepatocellular injury?
tolcapone
what to do if patient cannot tolerate a dopaminergic drug?
try another
can you stop dopaminergic drugs suddenly?
no
beta lactams do what?
inhibit cell wall synthesis
what do beta lactams inhibit?
cell wall synthesis
four classes of beta lactams that I need to know?
penicillins, cephalosporins, carbapenems, monobactams
what should happen if a patient develops a rash while taking a pencillin?
they should be examined
what generation of cephalosporins has the best gram positive coverage?
first generation
what two organisms are covered by first generation cephalosporins?
staph and strep
what route of admin are the higher generations of cephalosporins given?
IV (more complicated, gram negative)
drug? Glycopeptide antibiotic with wide spectrum of gram positive-coverage
vancomycin
vancomycin- gram positive and/or gram negative?
only gram positive
macrolides block what?
protein production
tetracyclines- MOA?
block protein production
rifampin- MOA?
block protein production
clindamycin- MOA?
block protein production
aminoglycosides- MOA?
block protein production
streptogamins- MOA?
block protein production
oxlodinones- MOA?
block protein production
mupirocin- MOA?
block protein production
erythromycin- class?
macrolide
azithromycin, class?
macrolide
clarithromycin, class?
macrolide
minocycline, class?
tetracycline
what class of antibiotic covers rickettsiae (tick)?
tetracycline
what is the drug of choice for Lyme disease?
doxycycline
can teeth staining of fetus happen with tetracycline use in pregnancy?
yes
milk and dairy with tetracyclines?
not within two hours (heavy metals/calcium)
why does clindamycin have similar action to macrolides?
their binding sites overlap
what percentage of patients on clinda develop c diff?
0.066
loose, watery, bloody stools, what med?
clindamycin c diff
sulfa drugs- MOA?
target DNA and replication
fluoroquinolones- MOA?
target DNA and replication
metronidazole- MOA?
target DNA and replication
ofloxacin- drug class?
fluoroquinolones
ciprofloxacin is more effective against gram negative or gram positive?
gram negative
levofloxacin is more effective against gram positive or gram negative?
gram positive, especially strep pneumoniae
fluoroquinolones when taken with prednisone can lead to what?
tendon rupture
TB drugs must be taken how?
regularly
what is the usual minimum for TB treatment duration?
9 months
isoniazid- MOA?
inhibits bacterial cell wall synthesis
what drug can lead to peripheral neuropathy?
isoniazid
how to prevent peripheral neuropathy with isoniazid?
take vitamin B6
ethambutol- MOA?
inhibits bacterial cell wall synthesis
main problem if taking ethambutol?
optic neuritis
blurred vision, decreased peripheral vision, and color blindness are symptoms of what?
optic neuritis
what should a patient do if they have signs of optic neuritis?
stop medication immediately and notify physician
rifampin- MOA?
blocks bacterial protein production
rifampin- protein binding?
highly protein bound
what is the problem with rifampin being highly protein bound?
several drug to drug interactions
other than TB, what can rifampin be used for?
bacterial meningitis
what TB drug causes orange/red discoloration of urine, saliva, and tears?
rifampin
what are the four may mechanisms of antimicrobial resistance?
decreased permeability, limiting drug uptake; antibiotic efflux pump; drug inactivation; altered target site
decreased permeability/limiting drug uptake is due to loss of what?
porins (ABX cannot enter bacterial cells)
what pumps antibiotic directly out of the cell?
antibiotic efflux pump
bacterial enzymes destroy antibiotics or prevent binding to target site?
drug inactivation
structurally modified antibiotic target site
altered target site (ABX no longer able to bind to the modified binding proteins on the bacterial cell surface, so they cannot attach)
two types of antiviral drugs?
neuramidase inhibitors and nucleoside analogs
oseltamivir- class?
neuramidase inhibitors
zanamivir/relenza- class?
neuramidase inhibitors
xofluza/valoxavir- class?
neuramidase inhibitors
neuraminidase inhibitors- MOA?
act by breaking the bond that attaches the viral particles to the host cell
oseltamivir- oral?
well absorbed orally
how is zanamivir admin?
inhalation
when should antivirals be started?
within 72 hours but 48 hours is ideal
acyclovir- class?
nucleoside analogs
valacyclovir- class?
nucleoside analogs
which nucleoside analog achieves higher serum levels?
valacyclovir
what drug class is indicated for the treatment of herpes simplex?
nucleoside analogs
what drug class is indicated for the treatment of varicella zoster?
nucle
how do nucleoside analogs work?
block an enzyme essential for viral replication
who has a higher risk of postherpetic neuralgia?
older adults/elderly with shingles
protein binding of oral antifungal drugs?
highly protein bound when given orally
why do oral antifungals have multiple drug-drug interactions?
because they are highly protein bound
what is the long-term risk with oral antifungals?
hepatotoxicity
what labs should be monitored with oral antifungals?
LFTs
what do antihelmintic drugs treat?
parasitic infections caused by worms
what drug is used to treat pinworms/threadworms?
mebendazole
mebendazole- class?
antihelmintic drugs
what is the main adverse effect with mebendazole?
GI upset especially with high doses (pneumonia)
what is the OTC treatment for pinworms?
pyrantel
what are the three adverse effects with antihelmintics?
nausea, diarrhea, stomach pain
where do benzodiazepines act on GABA?
at the synaptic cleft
what effect do benzodiazepines have on the action of GABA?
increase the action of GABA
what does increased action of GABA do with BZDs?
decreases the effect of neuronal excitation (Decreased firing of the neuron)
four therapeutic effects of benzodiazepines?
reduced anxiety, muscle relaxation, ataxia, anticonvulsant activity (Adjuvant)
buspirone is sometimes called what?
an atypical anxiolytic
what is buspirone approved for?
the treatment of GAD
alprazolam brand name?
xanax
lorazepam brand name?
ativan
temazepam brand name?
restoril
clonazepam brand name?
klonopin
where does the primary action of buspirone take place?
serotonin receptors
what other receptor does buspirone act on?
dopamine
buspirone absorption orally?
well-absorbed
why should buspirone be taken with food?
to decrease the first-pass effect
what is the most common class of antidepressant prescribed?
SSRIs
paroxetine- brand name?
paxil
fluoxetine- brand name?
prozac
sertraline- brand name?
zoloft
citalopram- brand name?
celexa
escitalopram- brand name?
lexapro
where to SSRI act?
presynaptic
do SSRIs have a class effect?
yes
what type of side effects of SSRIs are very common in males?
sexual side effects
what to do if a patient is having sexual side effects?
try another SSRI in the same group
how long for SSRIs to take effect? (to start)
at least two weeks
SSRI absorption?
well absorbed orally
SSRI first pass effect?
significant first past effect
how are SSRIs metabolized?
CYP450 system
where are most SSRIs eliminated?
the urine
do sexual side effects tend to improve with continued use of SSRIs?
no
does nausea tend to improve with continued use of SSRIs?
yes
how should SSRIs be taken?
same time every day
what two SSRIs interact with linezolid?
paroxetine and fluoxetine
venlafaxine- brand name?
effexor
duloxetine- brand name?
cymbalta
at lower doses, venlafaxine predominantly effects uptake of which NT?
serotonin
urinary retention is a contraindication for which antidepressant class?
TCA
cardiovascular disease is a contraindication for which antidepressant class?
TCA
angle-closure glaucoma is a contraindication for which antidepressant class?
TCA
patients with seizure disorders should NOT be given which antidepressant?
bupropion
is bupropion a first line drug for depression?
no
carbamazepine- class?
anticonvulsant
carbamazepine- brand name?
tegretol
carbamazepine- MOA?
inhibits neuronal firing by blocking sodium channels
carbamazepine is most effective against what type of seizures?
partial
carbamazepine, protein binding?
highly bound to plasma proteins
carbamazepine metabolism?
completely metabolized, induces its own metabolism
autoinduction of metabolism with carbamazepine leads to?
increased clearance, shortened half life, progressive decrease in serum levels (increase dose)
aplastic anemia is rare ADE with what drug?
carbamazepine
cardiac arrhythmias, blurred/double vision, decreased blood cells or platelets- what drug?
carbamazepine
gabapentin- class?
anticonvulsant
gabapentin- brand name?
neurontin
gabapentin- MOA?
inhibits the release of excitatory neurotransmitters in the presynaptic area to decrease seizure activity
where does gabapentin work?
presynaptic area
four indications for gabapentin?
seizures, RLS, postherpetic neuralgia, neuropathic pain
carefully monitor for what side effects with gabapentin?
psychiatric
what anticonvulsant can cause depression and suicidal ideation?
gabapentin
fine tremors seen with toxicity of what?
lithium
nausea and dry mouth, seen what toxicity of what?
lithium
headache and drowsiness, seen with toxicity of what?
lithium
labs to monitor with lithium?
CBC with diff, CMP, TSH, baseline/annual ECG
severe vomiting, diarrhea, prolonged high fever, heat stroke– these are concerning things to watch with what med?
lithium
two most common ADEs with levetiracetam?
drowsiness, asthenia
lack of strength, weakness (Term)
asthenia
neuropsychiatric ADEs seen with what drug?
levetiracetam
agitation, anxiety, depression, psychosis, hallucinations, depersonalization (ADE what drug)
levetiracetam
anticonvulsant that does not impair speech, concentration, or other cognitive function
levetiracetam
benzodiazepines are contraindicated with what condition?
acute narrow angle glaucoma
anticholinergic effects seen with which antidepressant?
TCAs
what is the black box warning for carbamazepine?
SJS and TEN
what two conditions have a strong association with HLAB1502?
SJS and TEN
patients most at risk for the HLAB1502 allele are of what ethnicity?
asian
HLAB1502 allele is problematic with what drug?
carbamazepine
what post marketing adverse effect of levetiracetam is reversible when the drug is stopped?
alopecia
what is the black box warning on all antidepressants?
suicidal thoughts and behaviors
is famciclovir safe in pregnancy?
not enough data
is acyclovir safe in pregnancy?
yes, category B
is valganciclovir safe in pregnancy?
not ideal, category C
what condition is a major side effect of oral ketoconazole?
hepatotoxicity
dry mouth and metallic taste are side effects of what medication?
metronidazole
heart failure is associated with which antifungal?
itraconazole
what four medications are included in the 6 month regimen to treat tuberculosis? RIPE
isoniazid, rifampin, pyrazinamide, ethambutol
ethambutol is toxic to what?
optic nerve
pyrazinamide can cause increase in what?
uric acid (gout)
cardiac arrhythmias are associated with which antibiotic class?
macrolides
does bactrim cover MRSA?
yes
