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Pharmacology > EXAM 3 - Just the Basics of Everything > Flashcards

EXAM 3 - Just the Basics of Everything Flashcards

1
Q

atropine

A

Organophosphate and carbamate insecticide poisonings antidote for the PNS symptoms.

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2
Q

Pralidoxime

A

Organophosphate and carbamate insecticide poisonings antidote for the nicotinic symptoms.

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3
Q

Heavy Metal antidotes

A

dimercaprol and succimer

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4
Q

Organic mercury salts

A

The symptoms are neurologic and include visual disturbances, paresthesias, muscle tremors and ataxia. These symptoms can lead to a misdiagnosis of Alzheimerﾒs or Parkinsonﾒs disease in the elderly.

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5
Q

Cyanide poisoning antidote

A

Hydroxocobalamin and a kit containing amyl nitrite, sodium nitrite and sodium thiosulfate.

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6
Q

Acetaminophen antidote

A

N-Acetylcysteine (Mucomyst)

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7
Q

Benzodiazepine antidote

A

Flumazenil

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8
Q

Digitalis antidote

A

Digoxin-imune Fab

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9
Q

Methanol & Ethylene glycol antidote

A

Fomepizole

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10
Q

Heparin antidote

A

Protamine sulfate

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11
Q

Opiate antidote

A

Naloxone

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12
Q

Organophosphate, Carbamate, and Nerve Gas Antidote

A

Atropine; Pralidoxime

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13
Q

The nationwide telephone number for poison control centers. WILL BE ON EXAM!!!

A

(800)222-1222

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14
Q

Rheumatoid Arthritis - Drug Treatment

A

Aspirin, NSAIDs, Glucocorticoids; DMARDs -nonbiologic; DMARDs - biologic

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15
Q

Osteoarthritis - Drug Treatment

A

Aspirin, NSAIDs, Acetaminophen, Glucocorticoids

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16
Q

Gouty Arthritis - Drugs Used

A

NSAIDs, Glucocorticoids, Uricosurics, Xanthine oxidase inhibitors, Cholchicine, Acetaminophen

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17
Q

NSAIDs - MoA - Anti-inflammatory

A

Reversibly inhibits cyclooxygenase (enzyme that converts arachidonic acid to prostaglandins)

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18
Q

NSAIDs - MoA - Analgesic actions

A

Peripheral inhibition of PG production & possible inhibition of pain stimuli

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19
Q

NSAIDs - MoA - Antipyretic actions

A

Inhibition of PG synthesis in the thermoregulatory center in anterior hypothalamus

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20
Q

NSAIDs - Adverse Effects

A

GI complaints (Most common AE); GI ulcers/bleeding; Renal dysfunction; hypersensitivity; AVOID IN LATE PREGNANCY

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21
Q

NSAIDs - Black Box Warnings

A

Increase risk of adverse cardiovascular events (including MI, CVA, HTN)
Increase risk of GI irritation, ulceration, bleeding, perforation
GI irritation/ulceration
May occur at anytime during therapy

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22
Q

NSAIDs - Aspirin - MoA

A

Irreversible inhibitor of COX

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23
Q

NSAIDs - Aspirin - Excretion & Secretion

A

Excreted into urine, but can affect uric acid secretion. Low dose-decreased uric acid secretion. High dose-increased uric acid secretion. Not preferred treatment in patients with gout because it can precipitate a gouty attack.

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24
Q

NSAIDs - Aspirin - Kids

A

Avoid in children w/fever due to risk of Reye’s Syndrome. Results in fulminating hepatitis w/cerebral edema that is often fatal with viral illnesses (chickenpox, influenza). Avoid use in individuals under 21 years old.

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25
Q

Acetaminophen - MoA

A

Not considered an NSAID; Blocks prostaglandins, but not peripherally

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26
Q

Acetaminophen - Adverse Effects - High Doses

A

Overdose can cause hepatic necrosis, a potentially life-threatening condition. Depletion of glutathione causes buildup of toxic metabolite. Most common cause of liver failure in US.

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27
Q

Rheumatoid Arthritis - Cause

A

Key inflammatory mediators found in synovium: TNF alpha, Interleukins 1 beta, 8, 15 and 18

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28
Q

Immunosuppressants

A

TNFa Inhibitors (Etanercept); IL-1 Antagonists; Decrease T-Cells(Methotrexate); Decrease B-cells; Other

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29
Q

Non-Biologic DMARDs

A

Methotrexate - Mainstay of treatment of RA; Response within 3-6 weeks; Doses required are much lower than for cancer

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30
Q

Biologic DMARDs

A

TNFa inhibitors have been shown to decrease signs and symptoms of RA, decrease structural damage, and improve physical function

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31
Q

Colchicine - Class

A

Anti-inflammatory, Anti-gout

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32
Q

Colchicine - Use

A

Does not prevent the progression of gout to acute gouty arthritis, but it does reduce the frequency of acute attacks and relieves pain

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33
Q

Colchicine vs. NSAIDs

A

NSAIDs have largely replaced colchicine in the treatment of acute gouty attacks

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34
Q

Colchicine for Prophylaxis

A

Colchicine is currently used for prophylaxis of recurrent attacks; Prevents attacks in 80% of patients

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35
Q

Indomethacin (Indocin)

A

PREFERRED OVER CHOLCHICINE. All the same MoA, Cautions, Side effects, and drug interactions as any NSAID. As effective as colchicine in acute attacks for many patients (with less GI toxicity).

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36
Q

Allopurinol (Zyloprim) - MoA

A

Inhibits xanthine oxidase (the enzyme that converts xanthine to uric acid), reduces production of uric acid

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37
Q

Allopurinol (Zyloprim) - Use

A

Prevention of acute gout; Drug of Choice in history of urinary stones or impaired renal function

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38
Q

Estradiol

A

Most potent estrogen produced

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39
Q

Ethinyl estradiol

A

Synthetic estrogen; undergoes less 1st pass metabolism

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40
Q

Estrogen - Therapeutic Uses

A

Contraception; post-menopausal hormone replacement therapy (HRT); Primary hypogonadism

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41
Q

Estrogen Therapy in HRT - Cotherapy

A

Must be combined w/progestogen if patient has not had hysterectomy

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42
Q

Estrogen - Adverse Effects

A

Most common: nausea & breast tenderness;

More severe, but less common: Thromboembolic events

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43
Q

Estrogen Therapy in HRT

A 
Vasomotor instability (hot flashes) & vaginal atrophy; 
Also help with maintenance of bone mass; 
Lower doses are required for HRT (compared with contraceptives)
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44
Q

Tamoxifen - MoA

A

Competes with estrogen for receptors in breast tissue

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45
Q

Tamoxifen - Adverse Effects

A

Hot flashes, nausea, menstrual irregularities, vaginal bleeding; Oral tablets; not IV

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46
Q

2 Main Types of Contraceptives

A

Combined oral contraceptive pills (OCPs) = Estrogen + progestin; OR
Progestin-only

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47
Q

Forms of OCPs

A

Monophasic, Triphasic, Extended Use

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48
Q

Progestin-only “mini-pills”

A

Low continuous dose of progestin; Less effective than combined OCPs; Greater risk of pregnancy & more menstrual cycle irregularities; More dependent on patient compliance

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49
Q

Progestin-only “mini-pills” - Use

A

Contraindications to estrogen; Breastfeeding

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50
Q

Postcoital Contraception (Plan B)

A

For maximum effectiveness, should be administered within 72 hours or sooner after unprotected intercourse; eat a meal with it because it will cause nausea; will cause vaginal bleeding/spotting; prevents implantation of sperm; not abortive therapy

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51
Q

Androgens - Therapeutic Uses

A

Androgenic Effects: used in males with inadequate androgen secretion
Anabolic Effects: used for wasting associated with HIV or cancer;
Endometriosis: (Danazol) mild androgen used for endometriosis and fibrocystic breast disease

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52
Q

Androgens - Kinetics

A

ineffective orally (inactivated by 1st pass metabolism); administered IM; transdermal patches; topical gel (can rub off on partner, so it should be covered before contact)

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53
Q

Androgens - Adverse Effects - Women

A

Females: masculinizing effects; Acne, growth of facial hair, deepening of voice, male pattern baldness, excessive muscle development, menstrual irregularities

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54
Q

Androgens - Adverse Effects - Men

A

Priapism or impotence, decreased spermatogenesis, gynecomastia, growth of the prostate, cosmetic changes

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55
Q

Androgens - Adverse Effects - Kids

A

Abnormal sex maturation, growth disturbances

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56
Q

Androgens - Adverse Effects - General effects

A

Increased LDL, decreased HDL (premature coronary heart disease); Fluid retention (edema)

57
Q

Osteoporosis - Treatment

A

Bisphosphonates; SERMs

58
Q

Bisphosphonates - Adverse Effects

A

GI upset, esophagitis or esophageal ulceration; To decrease risk, remain upright for 30 ? 60 minutes after taking and take with a full glass of plain water; NOT FOR BEDRIDDEN PATIENTS

59
Q

SERMs for Osteoporosis

A

Calcitonin; Recombinant parathyroid hormone; Monocolonal Antibodies

60
Q

Bacterial Cell Wall Inhibitor Classes

A

1) Penicillins; 2) Cephalosporins; 3) Carbapenems; 4) Other; 4a) Monobactams; 4b) Beta Lactamase Inhibitors; 4c) Vancomycin; 4d) Daptomycin; 4e) Televancin

61
Q

Bactericidal Antibiotics

A

Peter Vampire Can Drink Til Any Sun Rise Fries. Penicillins, Vancomycin, Cephalosporins, Daptomycin, Telavancin, Aminoglycosides, Synercid, Rifamin, Fluoroquinolones (Cipro),

62
Q

Bacteriastatic Antibiotics

A

TTMCZSE = Tetracyclines; Tigecycline, Macrolides, Clindamycin, Zyvox, Sulfonamides, Ethambutol

63
Q

Antibiotics for Pseudomonas

A

Aminoglycosides

64
Q

Antibiotics for MRSA

A

Vancomycin (drug of choice!), Tigecycline, Zyvox, Cotrimoxazole

65
Q

Antibiotics for VRE

A

Zyvox

66
Q

Antibiotics for Gram (+)

A

Penicillins, Vancomycin, Tetracycline (Doxycycline), Tigecycline,

67
Q

Antibiotics for Gram (-)

A

Tetracyclines; Tigecyclines, Aminoglycosides,

68
Q

Antibiotics for Anaerobic

A

Tigecycline, Clindamycin

69
Q

Empiric Antibiotics

A

Carbapenems

70
Q

Non-empiric antibiotics

A

Monobactams

71
Q

Antibiotics affecting ribosomes

A

30S = Tetracyclines, Tigecycline, Aminoglycosides; 50S = Macrolides, Chloramphenicol, Zyvox

72
Q

Folate Antagonists - Classes

A

Sulfonamides; Trimethoprim

73
Q

Antistaphylococcal Penicillins - Drugs

A

DICLOXACILLIN

74
Q

Extended-Spectrum Penicillins - Drugs

A

AMOXICILLIN (Amoxil)

75
Q

Antipseudomonal Penicillins - Drugs

A

TICARCILLIN

76
Q

Penicillin - Hypersensitivity

A

CROSS-ALLERGENICITY MAY OCCUR WITH OTHER BETA-LACTAM ANTIBIOTICS

77
Q

Cephalosporins - Adverse Effects

A

CROSS-ALLERGENICITY BETWEEN PENICILLINS & CEPHALOSPORINS; 3-5%; Highest with 1st generation

78
Q

Beta Lactamase Inhibitors - Combination therapy

A

AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN)

79
Q

Vancomycin - Adverse Effects - Infusion reaction

A

Red man syndrome

80
Q

Protein Synthesis Inhibitors

A

1) Tetracyclines; 2) Aminoglycosides; 3) Macrolides; 4) Others; 4a) Choloramphenicol; 4b) Clindamycin; 4c) Linezolid; 4d) Quinupristin/Dalfopristin

81
Q

Tetracyclines - Drugs

A

Doxycycline;

82
Q

Aminoglycosides (AGs) - Drugs

A

Gentamicin;

83
Q

Macrolides - Drugs

A

Erythromycin;

84
Q

Chloramphenicol - Adverse Effects

A

Anemia; Gray Baby Syndrome;

85
Q

Chloramphenicol - Antimicrobial Spectrum

A

BROAD SPECTRUM, but limited to life-threatening infections due to toxicity;

86
Q

Fluoroquinolones (FQs) - 2nd Gen Drugs

A

Ciprofloxin (Cipro)

87
Q

Fluoroquinolones (FQs) - Interactions

A

Decreased absorption
Ingestion with antacids (Al, Ca, Mg)
Dietary supplements with iron or zinc, Ca (supplements or food)

88
Q

Urinary Tract Antiseptics/Antimicrobials - Nitrofurantoin (Macrobid) - Antimicrobial Spectrum

A

Most effective for E. coli

89
Q

Isoniazid (INH) - Indications

A

1st line treatment for M. Tuberculosis (in combination therapy)

90
Q

Mycobacteria-Tuberculosis (TB) - Treatment Regimen

A

Treatment is usually started with a 4 drug regimen; Isoniazid, Rifampin, Pyrazinamide, Ethambutol

91
Q

Rifampin - Use

A

Mycobacteria; Used for prophylaxis in patients exposed to bacterial meningitis; Leprosy

92
Q

Rifabutin - Indications

A

Preferred drug in TB-infected HIV patients; Less P450 induction and drug interactions with HIV treatments

93
Q

Importance of Determining Microbes

A

Sensitivity; Important to obtain samples before initiating treatment; determines susceptibility to treatment

94
Q

Empiric Therapy

A

Immediate administration of therapy prior to bacterial identification; treatment of infection

95
Q

When is empiric therapy used?

A

treat infections in acutely ill patients

96
Q

How to select drugs in empiric therapy

A

1) Location of infection; 2) Endogenous bacteria of the area of infection; 3) Patterns of infection in the population; 4) Signs & symptoms suggestive for certain strains of bacteria; 5) Empiric therapy is started immediately after cultures are taken while awaiting culture & sensitivity results

97
Q

Prophylactic Therapy - general use

A

Prevention of infection

98
Q

Reasons for Prophylactic Therapy

A

1) Prevention of recurrent infections; 2) Prevention of infections that are likely (Immunocompromised pt); 3) Surgical prophylaxis

99
Q

Bacteriostatic drugs

A

Arrests the growth and replication of bacteria while the immune system destroys organism

100
Q

Bacteriocidal drugs

A

Causes direct death of bacteria

101
Q

Narrow-spectrum

A

coverage limited to small group of microorganisms

102
Q

Extended-spectrum

A

coverage includes gram-positive and a significant number of gram-negative bacteria

103
Q

Broad-spectrum

A

coverage includes wide range of microorganisms, but also most likely to alter natural flora

104
Q

Complications of Antibiotic Therapy: Super-infection

A

Particularly with broad-spectrum antimicrobials due to alterations of the normal microbial flora; Upper respiratory, intestinal, genitourinary tracts

105
Q

Cell-cycle specific

A

Chemotherapeutic agents that are only effective on high growth fraction cancer cells.

106
Q

Cell-cycle nonspecific

A

Chemotherapeutic agents that are effective on both low growth fraction and high growth fraction cancer cells.

107
Q

When is chemotherapy the only treatment option?

A

cancer that is disseminated and not amenable to surgery and/or radiation

108
Q

Adjuvant Chemotherapy

A

Supplemental chemotherapy that is given following surgery and/or radiation to eliminate undetected micrometastases.

109
Q

Neoadjuvant Chemotherapy

A

Chemotherapy that is given prior to surgery and/or radiation to decrease the size of a solid tumor.

110
Q

Maintenance Chemotherapy

A

continued after initial ‘cure’ to prevent recurrence or, in advanced cancer, to keep it from growing and spreading.

111
Q

Myelosuppressant

A

A chemotherapeutic agent that affects bone marrow and inhibits the formation of mature blood cells, particularly white blood cells, red blood cells and platelets.

112
Q

Vesicant

A

A chemotherapeutic agent that causes redness and blistering on the skin. If such an agent is extravasated during intravenous administration, there will be severe damage to the tissue in the extravasation area.

113
Q

Growth Fraction

A

The fraction of tumor cells that are in the replicative cycle (i.e., growth fraction)&raquo_space; influences their susceptibility to most chemotherapeutic agents.

114
Q

High growth fraction vs. Low growth fraction

A

Cells that are rapidly dividing have a high growth fraction and are typically more susceptible to chemo than cells with a low growth fraction.

115
Q

Significance of 1-g Tumor Mass

A

A total of 10^9 cells is the smallest tumor burden that is physically detectable; these 1 billion cells represent a tumor weighing about 1 g or about the size of a small grape; clinical symptoms usually first appear at this stage

116
Q

Palliative Chemotherapy

A

Initial remissions are transient, with symptoms recurring between txs. Survival is extended, but the patient eventually dies of the disease.

117
Q

Curative Chemotherapy (for disseminated cancers, such as leukemia)

A

Combination-drug chemo reduces the chance of drug resistance. Each drug chosen to have different cellular site of action or different cell-cycle specificity. Each drug chosen to have different organ toxicity.

118
Q

Curative Chemotherapy (for solid cancers, such as testicular carcinoma)

A

Tumor burden is initially reduced by surgery and/or radiation; tx of occult micrometastases is continued after clinical signs of cancer have disappeared.

119
Q

Normal cells most affected by chemo

A

1) Buccal mucosa
2) Upper GI tract (mouth, throat and esophagus)
3) Hair follicles
4) Bone marrow
5) Small intestine
6) Treatment-induced cancermo agents cause cancer years later.
7) Extravasation

120
Q

Why are chemotherapy adjuncts used?

A

1) THEY HELP ALLEVIATE CHEMOTHERAPY-INDUCED SIDE EFFECTS.

121
Q

Chemotherapy adjuncts for stomatitis & mucositis

A

various medications alone or in compounded ‘magic mouthwash’ combinations

122
Q

Chemotherapy adjunct for alopecia

A

Cryotherapy (cold caps)

123
Q

Combination vs. single agent chemo

A

Treating cancer with a combination of chemo agents is typically more effective than using a single agent.

124
Q

Using chemoagents with different toxicities/mechanisms

A

Can often be combined at full doses and result in higher response rates due to additive and/or potentiated cytotoxic effects and nonoverlapping toxicity to the patient.

125
Q

Using chemoagents with similar toxicities

A

Can only be combined safely by reducing the doses of each.

126
Q

Adverse Effects: Anthracyclines

A

IRREVERSIBLE, DOSE-DEPENDENT CARDIOTOXICITY. This is due to the effects of superoxide radicals on the myocardium.

127
Q

Adverse Effects: Bleomycin

A

BLEOMYCIN CAN CAUSE PULMONARY TOXICITY that progresses from rales, cough and infiltration to potentially fatal PULMONARY FIBROSIS.

128
Q

Adverse Effects: ALKYLATING AGENTS - Cyclophosphamide & Ifosfamide

A

HEMORRHAGIC CYSTITIS AND FIBROSIS IN THE BLADDER. Adequate hydration and the drug MESNA help lessen those effects in the bladder.

129
Q

Interferons

A

EFFECTS INCLUDE SUPPRESSION OF CELL PROLIFERATION, ACTIVATION OF MACROPHAGES, AND INCREASED CYTOXICITY OF LYMPHOCYTES

130
Q

Adverse Effects: Microtubule inhibitor - Vincristine

A

NEUROTOXICITY - Peripheral neuropathy, paresthesias and neuropathic pain.

131
Q

Aromatase Inhibitors

A

DECREASE THE PRODUCTION OF ESTROGEN by blocking the activity of aromatase. This helps slow or stop the growth of hormone dependent tumors such as breast cancer.

132
Q

Actions: Steroid hormones - GnRH (LHRH) analogs

A

DECREASED PRODUCTION OF ESTROGEN AND TESTOSTERONE

133
Q

Monoclonal antibody Production

A

produced using BIOTECHNOLOGY to INTERACT WITH SPECIFIC TARGETS in or on cancer cells

134
Q

Specific Actions of Topisomerase Inhibitors

A

1) PREVENT THE REJOINING OF STRANDS; 2) RENDER DNA strands SUSCEPTIBLE TO IRREVERSIBLE BREAKS.

135
Q

GnRH Analogs

A

goserelin and leuprolide

136
Q

Hormone Responsive Tumors

A

tumor regresses after treatment with a specific hormone

137
Q

Hormone Dependent Tumors

A

removal of a specific hormone causes tumor regression

138
Q

3 Specific Actions of Chemotherapeutic Antibiotics

A

1) interfering with RNA enzyme functions;
2) intercalating between DNA base pairs;
3) producing superoxide free radicals that cause DNA strands to break.

Pharmacology (12 decks)

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