Exam 4 Drugs Flashcards
1
Q
What type of drug is prednisone?
A
Anti-inflammatory agent: Glucocorticoids
2
Q
What type of drug is Zafirlukast?
A
Anti-inflammatory agent: Leukotriene Modifiers
3
Q
What type of drug is Cromolyn?
A
Anti-inflammatory agent: Mast Cell Stabilizers
4
Q
What type of drug is albuterol?
A
Bronchodilators: Beta2 agonists
5
Q
What type of drug is Theophylline?
A
Bronchodilators: Methylxanthines
6
Q
What type of drug is Atrovent?
A
Bronchodilators: Anticholinergics
7
Q
What type of drug is Budesonide (Plumicort)?
A
Anti inflammatory drugs: Glucocorticoids
8
Q
What type of drug is Fluticasone (Flovent)?
A
Anti inflammatory drugs: Glucocorticoids
9
Q
Most effective anti-asthma drugs available for long term use
A
Glucocorticoids
10
Q
Function of glucocorticoids
A
Reduce airway mucous production
Increase number of bronchial beta2 receptors
Increase beta2 receptor responsiveness to beta2 antagonists
11
Q
How are glucocorticoids administered
A
Usually inhalation
IV for acute conditions
PO for long term preventative use
12
Q
Mechanism of action of glucocorticoids
A
Suppress inflammation:
- Decrease synthesis/production & release of inflammatory mediators
- Decrease infiltration & activity of inflammatory cells
- Decrease edema of the airway mucosa
13
Q
What are glucocorticoids used for?
A
Prophylaxis of chronic asthma and managing COPD
14
Q
What should dosing of glucocorticoids be like?
A
Must be on a fixed schedule, not PRN
15
Q
Adverse effects of PO glucocorticoids
A
Adverse effects are minor when taken acutely
Long term effects:
- Adrenal suppression
- Osteoporosis
- Hyperglycemia
- PUD
16
Q
Adverse effects of inhaled glucocorticoids
A
If pt does not gargle after use:
- Oropharyngeal candidiasis
- Dysphonia hoarseness
Promotion of bone loss
Increased risk of cataracts
Increased risk of glaucoma
In children/adolescents: can slow growth
17
Q
Action of leukotriene modifiers
A
Suppress effects of leukotrienes
(to prevent process of bronchoconstriction and inflammatory responses - such as edema and mucous secretion)
18
Q
Most commonly used leukotriene modifier
A
*Montelukast (Singulair)
19
Q
Other types of leukotriene modifiers
A
Zileuton (Zyflo)
Zafirlukast (Accolate)
20
Q
Adverse effects of leukotriene modifiers
A
Neuropsychiatric effects:
- Depression
- Suicidal thinking
- Suicidal behavior
21
Q
Most common type of mast cell stabilizer
A
Cromolyn
22
Q
What is Cromolyn used for?
A
Prophylaxis, not quick relief of:
- Chronic asthma
- Exercise-induced bronchospasm
- Allergic rhinitis
23
Q
Action of Cromolyn
A
*Suppresses bronchial inflammation (not a bronchodilator)
24
Q
Routes for Cromolyn
A
Inhalation
Nebulizer
MDI
25
Adverse effects of Cromolyn
Cough
Bronchospasm
26
Safest of all anti asthma medications
Cromolyn
27
Used for symptomatic relief of asthma or COPD flare ups
Bronchodilators
28
Types of beta2 adrenergic agonist bronchodilators
Albuterol
Salmeterol
Terbutaline
29
What are beta2 adrenergic agonists most effective for?
Relief of acute bronchospasm
Prevention of exercise-induced bronchospasm
30
How are beta2 adrenergic agonists used for asthma?
For quick relief and long term control
31
Mechanism of action of beta2 adrenergic agonists
Activate beta2 receptors in smooth muscle of the lung
Promote *bronchodilation, relieving bronchospasm
32
Two types of beta2 adrenergic agonists
Short acting beta 2 agonists (SABAs)
Long acting beta 2 agonists (LABAs)
33
What are SABAs used for?
PRN for attacks
34
What are LABAs used for?
For long term control
35
Types of SABAs
Albuterol
Proventil
36
Adverse effects of SABAs
Tachycardia
Angina
Tremor
37
Types of LABAs
Acilidinium bromide (Tudorza)
Salmeterol (Serevent diskus)
38
Adverse effects of LABAs
May increase asthma (because of LABAs)
39
Adverse effects of inhaled beta2-adrenergic agonists
Tachycardia
Angina
Tremor
40
Adverse effects of oral beta2 adrenergic agonists
Angina pectoris
Tachydysrhythmias
Tremor
41
Prototype Methylxanthines
Theophylline
42
Therapeutic window for theophylline
10-20 mcg/mL
43
Other Methylxanthines
Aminophylline
Dyphylline
44
Brand names of glucocorticoid/LABA combinations
Advair
Symbicort
45
Prototype anticholinergic drug
Ipitropium (Atrovent)
46
Adverse effect of Ipratropium (Atrovent)
Dry mouth
Sore pharynx
47
Initial therapy for acute severe exacerbations of asthma
Oxygen
Systemic glucocorticoid
Nebulizer high dose SABA
48
Drugs used for exercise induced asthma
SABAs (first choice)
Or Cromolyn
49
Drugs used to manage stable COPD
Bronchodilators
Glucocorticoids
Phosphodiesterase 4 inhibitors
50
Drugs used to manage acute COPD
SABAs (inhaled)
Alone or with inhaled Anticholinergics
Systemic glucocorticoids
Antibiotics
Supplemental oxygen
51
Class that Aspirin belongs to
First generation NSAIDs
52
Action of aspirin
Nonselective inhibitor of cyclooxygenase
53
Uses of aspirin
Analgesic
Antipyretic
Anti inflammatory
Suppression of platelet aggregation
Protects from MI and stroke
54
Adverse effects of aspirin
GI upset
GI bleeding
Renal impairment
Salicylism
Reye’s syndrome
Risk during pregnancy
Hypersensitivity reaction
55
Drug interactions with aspirin
Anticoagulants
Glucocorticoids
Alcohol
Ibuprofen
ACE inhibitors and ARBs
56
Principle uses for non aspirin first generation NSAIDs
Rheumatoid arthritis
Osteoarthritis
57
Class for ibuprofen
First generation NSAID
58
How does ibuprofen work?
Inhibits cyclooxygenase
59
Functions of ibuprofen
Anti inflammatory
Analgesic
Antipyretic
60
Uses of ibuprofen
Fever
Mild to moderate pain
Arthritis
61
Adverse effects of ibuprofen
Risk of GI bleeding
62
Use for second generation NSAIDs
Suppression of inflammation and pain
63
Adverse effects of second generation NSAIDs
Lower risk for GI bleeding
Impaired renal function
Hypertension
Edema
*Increased risk for MI & stroke
64
What class does Celecoxib (Celebrex) belong to?
Second generation COX2 inhibitor
65
Uses for Celebrex
Osteoarthritis
Rheumatoid arthritis
Acute pain
Dysmenorrhea
Familial adenomatious polyposis
66
Adverse effects of Celebrex
GI ulceration
Renal impairment
Sulfonamide allergy
*Increased risk of stroke, MI)
*Contraindicated in pregnancy
67
Drug interactions of Celebrex
*Warfarin
Decrease effects of furosemide
Decrease effect of ACE inhibitors
Increase lithium levels
Levels may be increased by fluconazole
68
Therapeutic uses of acetaminophen
Analgesic
Antipyretic
69
Action of acetaminophen
Inhibits prostaglandins in CNS
70
Adverse effects of acetaminophen
Hepatotoxicity with overdose
Hepatic necorisis
71
Treatment for overdose of acetaminophen
Acetylcysteine (Mucomyst)
72
Drug interactions of acetaminophen
Alcohol
Warfarin
73
Are penicillins Bactericidal or bacteriostatic?
Bactericidal
74
How do penicillins work?
Weaken cell wall
Cause bacteria to take up excessive water and rupture
75
Prototype penicillin
Penicillin G (Benzylpenicillin)
76
Bacteria penicillin G is effective against
Gram positive
And some gram negative
77
Adverse effects of penicillin G
Least toxic of all antibiotics
*Allergy
78
Types of broad spectrum penicillins
Ampicillin (Principen)
Amoxicillin
79
Adverse effects of broad spectrum penicillins
Rash
Diarrhea
80
How can broad spectrum penicillins be administered
PO
IV
81
Prototype for extended spectrum penicillins
Piperacillin
82
Most widely used group of antibiotics
*Cephalosporins
83
How are cephalosporins usually administered
Parenterally
84
How do cephalosporins work?
Bind to penicillin-binding proteins (PBPs)
Disrupt cell wall synthesis
Cause cell lysis
85
Difference between the generations of cephalosporins
Generations 3-5 can get into CSF and are stronger
86
Medication for patient to take if they had a mild reaction to penicillin
1st generation cephalosporin
87
Use of first generation cephalosporins
Prophylaxis against infection in surgical patients
88
Use of second generation cephalosporins
Gram negative bacteria
89
Use of third generation cephalosporins
*Meningitis (because can penetrate to CSF)
90
Use of forth generation cephalosporins
Healthcare and hospital acquired pneumonias
91
What are fifth generation cephalosporins used for?
MRSA
92
Drug interactions of cephalosporins
Probenecid
Alcohol
Drugs that promote bleeding
Calcium
Ceftriaxone
93
Adverse effects of cephalosporins
Allergy - hypersensitivity, rash
Bleeding
Thrombophlebitis
94
Class for Imipenem (Primaxin)
Carbapenems
95
Class for Meropenem (Merrem IV)
Carbapenems
96
Class for Ertapenem (Ivanz)
Carbapenems
97
Prototype for carbapenems
Imipenem (Primaxin)
98
Bacteria Imipenem is most effective against
Anaerobic bacteria
99
Administration of Imipenem
IV
100
Adverse effects of Imipenem
GI interactions
Rash
101
Action of vancomycin
Inhibits cell wall synthesis
102
Uses for vancomycin
*Severe infections only
MRSA
Staphylococcus epidermidis
C diff
103
Administration of vancomycin
IV (must be given slowly over 2 hours)
104
Adverse effects of vancomycin
Renal failure
Ototoxicity
Red man syndrome
Thrombophlebitis
Thrombocytopenia
Allergy
105
Class for Aztreonam (Azactam)
Monobactam
106
How does Aztreonam (Azactam) work?
Binds to benicillin-binding protein 3
107
What bacteria is Aztreonam effective against?
Narrow antimicrobial spectrum
Gram-negative aerobic bacteria only
108
Administration of Aztreonam
Parenterally
109
Class of telavancin (Vibativ)
Lipoglycoproteins
110
Bacteria that Telavancin (Vibativ) is effective against
Gram positive
111
Administration of Telavancin (Vibativ)
IV
112
Use of V+Telavancin (Vibativ)
Vent acquired pneumonia (VAP)
Skin infections
113
Adverse effects of Telavancin (Vibativ)
Prolonged QT interval
114
How do tetracyclines work?
Broad spectrum antibiotics
Inhibit protein synthesis
115
Uses of tetracyclines
Acne
Rickettsial disease
Chlamydia
Brucellosis
Cholera
Mycoplasma pneumoniae
Lyme disease
Anthrax
Helicobacter pylori
PUD
Perio
116
Adverse effects of tetracyclines
GI irritation
Effects of bone and teeth
Superinfection
Hepatotoxicity
Renal toxicity
Photosensitivity
117
Food interactions with tetracyclines
Milk product
Calcium suppliments
Iron supplements
Magnesium containing laxatives
Most antacids
118
What class does erythromycin belong to?
Macrolides
119
How does erythromycin work?
Broad spectrum antibiotic
Inhibition of protein synthesis
Usually bacteriostatic but can be bactericidal
120
Uses of erythromycin
If allergic to penicillin
Whooping cough
Acute diphtheria
Chlamydia
M. Pneumonia
Group A strep
121
Adverse effects of erythromycin
GI issues (diarrhea)
QT prolongation and sudden cardiac death
Superinfection
122
What class does clarithromycin (Biaxin) belong to?
Macrolides
123
What class does Azithromycin (Zithromax) belong to?
Macrolides
124
How does clindamycin (Cleocin) work?
Inhibits protein synthesis
125
Bacteria Clindamycin is effective against
Most anaerobic bacteria (gram pos and neg)
126
Uses of clindamycin
Only for certain anaerobic infections located outside of the CNS
127
Adverse effects of clindamycin
Clostridium difficile - associated diarrhea (CDAD)
Hepatic toxicity
Blood dyscrasias
Diarrhea
Hypersensitivity reactions
128
Which class does Linezolid (Zyvox) belong to?
Oxazolidinones
129
Types of bacteria Linezolid (Zyvox) is affective against
Against multi drug-resistant gram positive pathogens
Aerobic and gram positive bacteria
130
Examples of pathogens Linezolid (Zyvox) is effective against
VRE
MRSA
131
Side effects of Linezolid (Zyvox)
Diarrhea
Nausea and vomiting
Headache
132
Drug interactions of Linezolid (Zyvox)
MAOIs
133
Uses of Trimethoprim
*Acute and uncomplicated urinary tract infections
134
Adverse effects of Trimethoprim
Hematologic effects
Hyperkalemia
Use in pregnancy and lactation
135
Uses of trimethoprim-sulfamethoxazole
UTIs
Otitis media
Bronchitis
Shigellosis
Pneumonia
GI infection
136
Brand names of trimethoprim-sulfamethoxazole
Bacteria
Septra
137
Adverse effects of trimethoprim-sulfamethoxazole
GI: N&V
Rash
Hyperkalemia
Hypersensitivity reactions (Stevens-Johnson syndrome)
Blood dyscrasias
Kernicterus
Renal damage: crystalluria
138
Most commonly used aminoglycosides
Gentamicin
Tobramycin
Amikacin
139
Are aminoglycosides narrow or broad spectrum?
Bactericidal or bacteristatic?
Narrow
Bactericidal
140
Use of aminoglycosides
Aerobic gram negative bacilli
141
Adverse effects of aminoglycosides
*Nephrotoxicity
*Ototoxicity
Hypersensitivity reactions
Neuromuscular blockade
Blood dyscrasias
Rare, can cause paralysis or deadly respiratory depression
142
Use of Gentamicin (Garamycin)
Used to treat serious infections caused by aerobic gram-negative bacilli
*Pseudomonas aeruginosa
*Escherichia coli
143
Adverse effects of Gentamicin (Garamycin)
Nephrotoxicity
Ototoxicity
144
What group of antibiotic are antibiotics in that end in -mycin?
Aminoglycosides
145
What class does Ciprofloxacin belong to?
Fluoroquinolones
146
Is Ciprofloxacin narrow or broad spectrum?
Broad
147
Administration of Ciprofloxacin
PO
IV
148
Types of bacterial that Ciprofloxacin is used for
Gram negative and some gram positive
149
Uses of Ciprofloxacin
Drug of choice for anthrax
Respiratory infections
UTIs
GI infections
Bone, joint, skin, and soft tissue infections
150
Adverse effects of Ciprofloxacin
GI: N&V, diarrhea, abdominal pain
CNS: dizziness, headache, restlessness, confusion, rarely seizures
*Tendon rupture
Photosensitivity
Candida infections: pharynx and vagina
Increased risk of c. Diff
*Contraindicated for adults over 60 yrs
151
Adverse effects of Ciprofloxacin in older adults
Confusion
Somnolence
Psychosis
Visual disturbances
Myasthenia gravis
152
Drug and food interactions of Ciprofloxacin
Cationic compounds reduce absorption:
Aluminum antacids
Magnesium antacids
Iron salts, zinc salts, sucralfate
Milk and dairy products
Elevates drug levels of:
Theophylline
Warfarin
Tinidazole
153
Is metronidazole (Flagyl) Bactericidal or bacteristatic?
Bactericidal
154
Uses of Metronidazole (Flagyl)
Protozoan infections
Infections caused by obligate anaerobes
H. Pylori
CDI
155
Adverse effects of Metronidazole (Flagyl)
Neurotoxicity
Allergy
Superinfections
156
Which class does Daptomycin (Cubicin) belong to?
Cylic lipopeptides
157
What type of bacteria does Daptomycin (Cubicin) belong to?
Gram positive bacteria
158
Use of Daptomycin (Cubicin)
Bloodstream infections caused by staph aureus (MRSA) and other skin infections caused by staph
Streptococcus
159
Adverse effects of Daptomycin (Cubicin)
GI related
Headache
Rash
Myopathy
160
What is Rifampin?
Broad spectrum drug mainly used to treat TB
161
Class of Amphotericin B
Polyene antibiotics
162
What is Amphotericin B used for?
Broad spectrum antifungal agent (also used against some Protozoa)
163
Administration of Amphotericin B
IV
No oral admin
164
Uses of Amphotericin B
Drug of choice for most systemic mycoses
165
How does Amphotericin B work?
Binds to ergosterol in fungal cell membrane
Increases cell permeability
Cell leaks intracellular cations (esp potassium)
Is fungistatic or fungicidal
166
Adverse effects of Amphotericin B
*Highly toxic - Infusion reactions
*Nephrotoxicity
Hypokalemia
Bone marrow suppression
167
Symptoms of an infusion reaction when given Amphotericin B
Fever
Chills
Rigors
Nausea
Headache
168
Dose of Amphotericin B that is likely to cause nephrotoxicity
>4g
169
Contraindications for Amphotericin B
Nephrotoxic drugs (aminoglycosides, cyclosporines)
NSAIDs
170
What should be monitored when giving Amphotericin B?
Serum creatinine every 3-4 days
Need to reduce dosage if >3.5mg/dL
Serum levels for hypokalemia
Hematocrit for bone marrow suppression (anemia)
171
Which class does Itraconazole (Sporanox) belong to?
Azoles
172
Uses of Itraconazole (Sporanox)
Lower toxicity level (alternative to ampho B)
Used for systemic mycoses
173
Side effects of Itraconazole (Sporanox)
Well tolerated in usual doses
Cardiosuppression (transient decrease in ventricular ejection fraction)
Liver damage
GI effects: nausea, vomiting, diarrhea
Can inhibit drug-metabolizing enzymes
174
When taking Itraconazole (Sporanox), lab work needs to be monitored if also on which drugs?
Digoxin
Coumadin
Cyclosporin
