EXAM 3 - Just the Basics of Everything Flashcards
atropine
Organophosphate and carbamate insecticide poisonings antidote for the PNS symptoms.
Pralidoxime
Organophosphate and carbamate insecticide poisonings antidote for the nicotinic symptoms.
Heavy Metal antidotes
dimercaprol and succimer
Organic mercury salts
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.
Cyanide poisoning antidote
Hydroxocobalamin and a kit containing amyl nitrite, sodium nitrite and sodium thiosulfate.
Acetaminophen antidote
N-Acetylcysteine (Mucomyst)
Benzodiazepine antidote
Flumazenil
Digitalis antidote
Digoxin-imune Fab
Methanol & Ethylene glycol antidote
Fomepizole
Heparin antidote
Protamine sulfate
Opiate antidote
Naloxone
Organophosphate, Carbamate, and Nerve Gas Antidote
Atropine; Pralidoxime
The nationwide telephone number for poison control centers. WILL BE ON EXAM!!!
(800)222-1222
Rheumatoid Arthritis - Drug Treatment
Aspirin, NSAIDs, Glucocorticoids; DMARDs -nonbiologic; DMARDs - biologic
Osteoarthritis - Drug Treatment
Aspirin, NSAIDs, Acetaminophen, Glucocorticoids
Gouty Arthritis - Drugs Used
NSAIDs, Glucocorticoids, Uricosurics, Xanthine oxidase inhibitors, Cholchicine, Acetaminophen
NSAIDs - MoA - Anti-inflammatory
Reversibly inhibits cyclooxygenase (enzyme that converts arachidonic acid to prostaglandins)
NSAIDs - MoA - Analgesic actions
Peripheral inhibition of PG production & possible inhibition of pain stimuli
NSAIDs - MoA - Antipyretic actions
Inhibition of PG synthesis in the thermoregulatory center in anterior hypothalamus
NSAIDs - Adverse Effects
GI complaints (Most common AE); GI ulcers/bleeding; Renal dysfunction; hypersensitivity; AVOID IN LATE PREGNANCY
NSAIDs - Black Box Warnings
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
NSAIDs - Aspirin - MoA
Irreversible inhibitor of COX
NSAIDs - Aspirin - Excretion & Secretion
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.
NSAIDs - Aspirin - Kids
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.
Acetaminophen - MoA
Not considered an NSAID; Blocks prostaglandins, but not peripherally
Acetaminophen - Adverse Effects - High Doses
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.
Rheumatoid Arthritis - Cause
Key inflammatory mediators found in synovium: TNF alpha, Interleukins 1 beta, 8, 15 and 18
Immunosuppressants
TNFa Inhibitors (Etanercept); IL-1 Antagonists; Decrease T-Cells(Methotrexate); Decrease B-cells; Other
Non-Biologic DMARDs
Methotrexate - Mainstay of treatment of RA; Response within 3-6 weeks; Doses required are much lower than for cancer
Biologic DMARDs
TNFa inhibitors have been shown to decrease signs and symptoms of RA, decrease structural damage, and improve physical function
Colchicine - Class
Anti-inflammatory, Anti-gout
Colchicine - Use
Does not prevent the progression of gout to acute gouty arthritis, but it does reduce the frequency of acute attacks and relieves pain
Colchicine vs. NSAIDs
NSAIDs have largely replaced colchicine in the treatment of acute gouty attacks
Colchicine for Prophylaxis
Colchicine is currently used for prophylaxis of recurrent attacks; Prevents attacks in 80% of patients
Indomethacin (Indocin)
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).
Allopurinol (Zyloprim) - MoA
Inhibits xanthine oxidase (the enzyme that converts xanthine to uric acid), reduces production of uric acid
Allopurinol (Zyloprim) - Use
Prevention of acute gout; Drug of Choice in history of urinary stones or impaired renal function
Estradiol
Most potent estrogen produced
Ethinyl estradiol
Synthetic estrogen; undergoes less 1st pass metabolism
Estrogen - Therapeutic Uses
Contraception; post-menopausal hormone replacement therapy (HRT); Primary hypogonadism
Estrogen Therapy in HRT - Cotherapy
Must be combined w/progestogen if patient has not had hysterectomy
Estrogen - Adverse Effects
Most common: nausea & breast tenderness;
More severe, but less common: Thromboembolic events
Estrogen Therapy in HRT
Vasomotor instability (hot flashes) & vaginal atrophy; Also help with maintenance of bone mass; Lower doses are required for HRT (compared with contraceptives)
Tamoxifen - MoA
Competes with estrogen for receptors in breast tissue
Tamoxifen - Adverse Effects
Hot flashes, nausea, menstrual irregularities, vaginal bleeding; Oral tablets; not IV
2 Main Types of Contraceptives
Combined oral contraceptive pills (OCPs) = Estrogen + progestin; OR
Progestin-only
Forms of OCPs
Monophasic, Triphasic, Extended Use
Progestin-only “mini-pills”
Low continuous dose of progestin; Less effective than combined OCPs; Greater risk of pregnancy & more menstrual cycle irregularities; More dependent on patient compliance
Progestin-only “mini-pills” - Use
Contraindications to estrogen; Breastfeeding
Postcoital Contraception (Plan B)
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
Androgens - Therapeutic Uses
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
Androgens - Kinetics
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)
Androgens - Adverse Effects - Women
Females: masculinizing effects; Acne, growth of facial hair, deepening of voice, male pattern baldness, excessive muscle development, menstrual irregularities
Androgens - Adverse Effects - Men
Priapism or impotence, decreased spermatogenesis, gynecomastia, growth of the prostate, cosmetic changes
Androgens - Adverse Effects - Kids
Abnormal sex maturation, growth disturbances
Androgens - Adverse Effects - General effects
Increased LDL, decreased HDL (premature coronary heart disease); Fluid retention (edema)
Osteoporosis - Treatment
Bisphosphonates; SERMs
Bisphosphonates - Adverse Effects
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
SERMs for Osteoporosis
Calcitonin; Recombinant parathyroid hormone; Monocolonal Antibodies
Bacterial Cell Wall Inhibitor Classes
1) Penicillins; 2) Cephalosporins; 3) Carbapenems; 4) Other; 4a) Monobactams; 4b) Beta Lactamase Inhibitors; 4c) Vancomycin; 4d) Daptomycin; 4e) Televancin
Bactericidal Antibiotics
Peter Vampire Can Drink Til Any Sun Rise Fries. Penicillins, Vancomycin, Cephalosporins, Daptomycin, Telavancin, Aminoglycosides, Synercid, Rifamin, Fluoroquinolones (Cipro),
Bacteriastatic Antibiotics
TTMCZSE = Tetracyclines; Tigecycline, Macrolides, Clindamycin, Zyvox, Sulfonamides, Ethambutol
Antibiotics for Pseudomonas
Aminoglycosides
Antibiotics for MRSA
Vancomycin (drug of choice!), Tigecycline, Zyvox, Cotrimoxazole
Antibiotics for VRE
Zyvox
Antibiotics for Gram (+)
Penicillins, Vancomycin, Tetracycline (Doxycycline), Tigecycline,
Antibiotics for Gram (-)
Tetracyclines; Tigecyclines, Aminoglycosides,
Antibiotics for Anaerobic
Tigecycline, Clindamycin
Empiric Antibiotics
Carbapenems
Non-empiric antibiotics
Monobactams
Antibiotics affecting ribosomes
30S = Tetracyclines, Tigecycline, Aminoglycosides; 50S = Macrolides, Chloramphenicol, Zyvox
Folate Antagonists - Classes
Sulfonamides; Trimethoprim
Antistaphylococcal Penicillins - Drugs
DICLOXACILLIN
Extended-Spectrum Penicillins - Drugs
AMOXICILLIN (Amoxil)
Antipseudomonal Penicillins - Drugs
TICARCILLIN
Penicillin - Hypersensitivity
CROSS-ALLERGENICITY MAY OCCUR WITH OTHER BETA-LACTAM ANTIBIOTICS
Cephalosporins - Adverse Effects
CROSS-ALLERGENICITY BETWEEN PENICILLINS & CEPHALOSPORINS; 3-5%; Highest with 1st generation
Beta Lactamase Inhibitors - Combination therapy
AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN)
Vancomycin - Adverse Effects - Infusion reaction
Red man syndrome
Protein Synthesis Inhibitors
1) Tetracyclines; 2) Aminoglycosides; 3) Macrolides; 4) Others; 4a) Choloramphenicol; 4b) Clindamycin; 4c) Linezolid; 4d) Quinupristin/Dalfopristin
Tetracyclines - Drugs
Doxycycline;
Aminoglycosides (AGs) - Drugs
Gentamicin;
Macrolides - Drugs
Erythromycin;
Chloramphenicol - Adverse Effects
Anemia; Gray Baby Syndrome;
Chloramphenicol - Antimicrobial Spectrum
BROAD SPECTRUM, but limited to life-threatening infections due to toxicity;
Fluoroquinolones (FQs) - 2nd Gen Drugs
Ciprofloxin (Cipro)
Fluoroquinolones (FQs) - Interactions
Decreased absorption
Ingestion with antacids (Al, Ca, Mg)
Dietary supplements with iron or zinc, Ca (supplements or food)
Urinary Tract Antiseptics/Antimicrobials - Nitrofurantoin (Macrobid) - Antimicrobial Spectrum
Most effective for E. coli
Isoniazid (INH) - Indications
1st line treatment for M. Tuberculosis (in combination therapy)
Mycobacteria-Tuberculosis (TB) - Treatment Regimen
Treatment is usually started with a 4 drug regimen; Isoniazid, Rifampin, Pyrazinamide, Ethambutol
Rifampin - Use
Mycobacteria; Used for prophylaxis in patients exposed to bacterial meningitis; Leprosy
Rifabutin - Indications
Preferred drug in TB-infected HIV patients; Less P450 induction and drug interactions with HIV treatments
Importance of Determining Microbes
Sensitivity; Important to obtain samples before initiating treatment; determines susceptibility to treatment
Empiric Therapy
Immediate administration of therapy prior to bacterial identification; treatment of infection
When is empiric therapy used?
treat infections in acutely ill patients
How to select drugs in empiric therapy
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
Prophylactic Therapy - general use
Prevention of infection
Reasons for Prophylactic Therapy
1) Prevention of recurrent infections; 2) Prevention of infections that are likely (Immunocompromised pt); 3) Surgical prophylaxis
Bacteriostatic drugs
Arrests the growth and replication of bacteria while the immune system destroys organism
Bacteriocidal drugs
Causes direct death of bacteria
Narrow-spectrum
coverage limited to small group of microorganisms
Extended-spectrum
coverage includes gram-positive and a significant number of gram-negative bacteria
Broad-spectrum
coverage includes wide range of microorganisms, but also most likely to alter natural flora
Complications of Antibiotic Therapy: Super-infection
Particularly with broad-spectrum antimicrobials due to alterations of the normal microbial flora; Upper respiratory, intestinal, genitourinary tracts
Cell-cycle specific
Chemotherapeutic agents that are only effective on high growth fraction cancer cells.
Cell-cycle nonspecific
Chemotherapeutic agents that are effective on both low growth fraction and high growth fraction cancer cells.
When is chemotherapy the only treatment option?
cancer that is disseminated and not amenable to surgery and/or radiation
Adjuvant Chemotherapy
Supplemental chemotherapy that is given following surgery and/or radiation to eliminate undetected micrometastases.
Neoadjuvant Chemotherapy
Chemotherapy that is given prior to surgery and/or radiation to decrease the size of a solid tumor.
Maintenance Chemotherapy
continued after initial ‘cure’ to prevent recurrence or, in advanced cancer, to keep it from growing and spreading.
Myelosuppressant
A chemotherapeutic agent that affects bone marrow and inhibits the formation of mature blood cells, particularly white blood cells, red blood cells and platelets.
Vesicant
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.
Growth Fraction
The fraction of tumor cells that are in the replicative cycle (i.e., growth fraction)»_space; influences their susceptibility to most chemotherapeutic agents.
High growth fraction vs. Low growth fraction
Cells that are rapidly dividing have a high growth fraction and are typically more susceptible to chemo than cells with a low growth fraction.
Significance of 1-g Tumor Mass
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
Palliative Chemotherapy
Initial remissions are transient, with symptoms recurring between txs. Survival is extended, but the patient eventually dies of the disease.
Curative Chemotherapy (for disseminated cancers, such as leukemia)
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.
Curative Chemotherapy (for solid cancers, such as testicular carcinoma)
Tumor burden is initially reduced by surgery and/or radiation; tx of occult micrometastases is continued after clinical signs of cancer have disappeared.
Normal cells most affected by chemo
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
Why are chemotherapy adjuncts used?
1) THEY HELP ALLEVIATE CHEMOTHERAPY-INDUCED SIDE EFFECTS.
Chemotherapy adjuncts for stomatitis & mucositis
various medications alone or in compounded ‘magic mouthwash’ combinations
Chemotherapy adjunct for alopecia
Cryotherapy (cold caps)
Combination vs. single agent chemo
Treating cancer with a combination of chemo agents is typically more effective than using a single agent.
Using chemoagents with different toxicities/mechanisms
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.
Using chemoagents with similar toxicities
Can only be combined safely by reducing the doses of each.
Adverse Effects: Anthracyclines
IRREVERSIBLE, DOSE-DEPENDENT CARDIOTOXICITY. This is due to the effects of superoxide radicals on the myocardium.
Adverse Effects: Bleomycin
BLEOMYCIN CAN CAUSE PULMONARY TOXICITY that progresses from rales, cough and infiltration to potentially fatal PULMONARY FIBROSIS.
Adverse Effects: ALKYLATING AGENTS - Cyclophosphamide & Ifosfamide
HEMORRHAGIC CYSTITIS AND FIBROSIS IN THE BLADDER. Adequate hydration and the drug MESNA help lessen those effects in the bladder.
Interferons
EFFECTS INCLUDE SUPPRESSION OF CELL PROLIFERATION, ACTIVATION OF MACROPHAGES, AND INCREASED CYTOXICITY OF LYMPHOCYTES
Adverse Effects: Microtubule inhibitor - Vincristine
NEUROTOXICITY - Peripheral neuropathy, paresthesias and neuropathic pain.
Aromatase Inhibitors
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.
Actions: Steroid hormones - GnRH (LHRH) analogs
DECREASED PRODUCTION OF ESTROGEN AND TESTOSTERONE
Monoclonal antibody Production
produced using BIOTECHNOLOGY to INTERACT WITH SPECIFIC TARGETS in or on cancer cells
Specific Actions of Topisomerase Inhibitors
1) PREVENT THE REJOINING OF STRANDS; 2) RENDER DNA strands SUSCEPTIBLE TO IRREVERSIBLE BREAKS.
GnRH Analogs
goserelin and leuprolide
Hormone Responsive Tumors
tumor regresses after treatment with a specific hormone
Hormone Dependent Tumors
removal of a specific hormone causes tumor regression
3 Specific Actions of Chemotherapeutic Antibiotics
1) interfering with RNA enzyme functions;
2) intercalating between DNA base pairs;
3) producing superoxide free radicals that cause DNA strands to break.
