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Pharmacology exam 1 > Final > Flashcards

Final Flashcards

1
Q

Atripla

A

NRTI
Triplets! Emtricitabine + tenofovir + Efavirens NNRTI
HIV

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2
Q

Stribild

A

Great strides! SO LONG USE 4
Emtricitabine + tenofovir + ELVITEGRAVIR (INTEGRASE INHIBITORS) + Cobicistat
HIV

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3
Q

Tenofavir

A

NRTI
NucleoTide T for tenofavir
BACKBONE for HIV

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4
Q

Emtricitabine

A

NRTI
HIV
EEEK! HYPERpigmentation of palms + skin discoloration

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5
Q

Zidovudine

A

NRTI
HIV
Zido like vedo so wipe out cells causing anemia
Since it wipes everything out its good for Prophylaxis + Pregnancy

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6
Q

NRTIs moa

A

Competitively inhibit nucleotide binding to reverse transcriptase + terminate the DNA chain

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7
Q

Toxicity of NRTIs

A

bm suppression reverseed w/G-CSF
peripheral neuropathy
Lactic acidosis
the d didansonosine cause the p pancreatitis

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8
Q

MOA of NNRTIs

A

Bind to reverse transcriptase @ different site from NRTIs

Don’t require phosphorylation like nucleosides

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9
Q

Efaviranz

A

What the ef I have to take this on an empty stomach
And i get vivid dreams + CNS sx, a false positive cannabinoid test, + I’m teratogenic! FUCKKK
NNRTI
HIV

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10
Q

Rilpivirine

A

My pivots (rilPIVrine) not too high so I can’t use with high viral loads
Since those PPIs can pivot high can’t use w/rilpivarine b/c its a CYP450 Inducer!
NNRTI
HIV

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11
Q

What are common s/e of all NNRTIs

A

Rash + hepatotoxicity

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12
Q

Nevirapine

A

Never again I got hepatitis! Shits fatal w/necrosis
NNRTI
HIV

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13
Q

NRTI drugs

A

Emtricitabine FTC
Lamivudine 3TC
Tenofovir TDF
Zidovudine ZDV

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14
Q

Lamivudine 3TC

A

Lame!!!!
LamEpivir HBV
NTRI
HIV

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15
Q

NNRTI drugs

A

Efavirenz
Nevirapine
Rilpivirine

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16
Q

Protease inhibitor drugs

A

Atanzanavir
Darunavir
Ritanovir

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17
Q

Protease inhibitors MOA

A

Assembly of virions depends on HIV1 protease

PREVENT maturation of new viruses

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18
Q

Ritonavir

A

RIGHT ON! Boost other drugs by inhibiting CYP450
also with a c is CAPSULE which you must REFRIGERATE
protease inhibitor
HIV

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19
Q

All Protease inhibitors end in

A

navir! NEVER tease a PROTEASE

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20
Q

Truvada

A

NRTI
T is for two so emtricitabine + tenofovir
HIV

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21
Q

Kaletra

A

Lopnavir + Ritonavir
Kara wants to get prego so Drug of choice!
Protease inhibitor
HIV

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22
Q

Integrase inhibitor drugs

A

Raltegravir

Elvitegravir

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23
Q

Atanavir

A

att ooohh!!! need Acidic environment don’t use PPIs!
Indirect hyperbilirubinemia, lack of effect on lipids!!!
AAAA OKAYYYY w/the LIPIDSS
Protease inhibitors
HIV

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24
Q

Darunavir

A

DARN! i get a rash w/sulfa allergies
Protease inhibitor
HIV

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25
Q

Integrase inhibitor MOA

A

Inhibit HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase

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26
Q

Elvitegravir

A

COMBO Stribilid! An NRTI
Integrase inhibitor
HIV

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27
Q

Toxicity of integrase inhibitors

A

H/a, nausea, diarrhea, inc. cr kinase, + exacerbation of depression
Integrase inhibitor
HIV

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28
Q

Tenofavir s/e

A

renal insufficiency- do us a FAVIR + CHECK CREATANINE!

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29
Q

What can tenofovir be used w/Emtricitabine for?

A

Pre-exposure prophylaxis (PrEP) + post exposure prophylaxis (PEP)

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30
Q

S/E of zidovudine

A

Bone marrow suppression z is at the end of the alphabet and bum is at the end of the torso so bm suppression

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31
Q

Which two things that are used to clean things may become contaminates w/spores/bacteria + actually transmit infection

A

Disinfectants + antiseptics

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32
Q

Avoid use of what in neurosurgery

A

Chorhexidine gluconate hibiclens

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33
Q

Povidone-iodine betadine use

A

ointments, swabs, spray, SURGICAL SCRUB

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34
Q

What can be used on burn wounds

A

silver sulfadiazine SSD, silvadene

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35
Q

MOA of acyclovir, famciclovir, + valcyclovir

A

Phosphorylated into active triphosphate incorporated into viral DNA
PSYC! (cyclovir) viruses you can’t replicate!
HSV

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36
Q

The prodrug of acyclovir

A

Valacyclovir has better oral availability…like walah!!!! we made a prodrug for acyclovir so much better

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37
Q

When can you use acyclovir, famciclovir, + valacyclovir for VZV + HSV?

A

48-72 hrs of rash onset
(2-3 days b/c 3 drugs and 3 letters in HSV + HSV)
Prophylaxis in immunocompromised

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38
Q

Drugs used to treat CMV

A

Ganciclovir
Foscarnet
Cidofivir

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39
Q

Special considerations for Gancyclovir

A

IV ONLY
Black box warning for bone marrow toxicity gan is part of the gang which is bad so black box warning
Hydration, renal fxn, avoid direct contact w/skin
CMV

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40
Q

Valganciclovir

A 
PO only 
valgan sounds like vegan which has to do with eating so only oral
DRUG OF CHOICE for TX + PROPHYLAXIS
vegan is healthy so drug of choice
CMV
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41
Q

Foscarnet

A

HIGHLY NEPHROTOXIC
N + T in foscarNeT so nephro-toxic
CMV

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42
Q

HBV antivirals

A

PO HBV is bad so definitely need oral
Adefovir, lamivudine, entecavir, telbivudine, tenofovir

subcutaneously
Interferon alfa! Alpha is a so beginning of alphabet so start on skin

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43
Q

First line for HBV?

A

TENOFAVIR!

yess the same as HIV b/c its a 10.0

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44
Q

Lamivudine

A

HBV use lower dose than for HIV….lammmmmeee

resistance is common

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45
Q

Adverse effects of entecavir

A

Dizziness + fatigue
looks like entering the cave + the cave is dark so causes fatigue + the cave could be the brain so cause dizziness
GREAT FOR LAMIVUDINE RESISTANT HBV

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46
Q

Side effects of interferon

A

FLU! interferes w/your life b/c interferon but improves as tx continues
HBV

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47
Q

Interferon CI

A

Hepatic decompensation, autoimmune, arrythmia, + pregnancy
like i said interferes w/a ton of shit
HBV

48
Q

Tx for HCV

A

Ribavirin
Sofosbuvir
simeprevir

49
Q

Ribavirin

A

Active against HCV, RSV, influenza A + B, + HSV

CATEGORY X!!! teratogenic, hemolytic anemia, gi upset, + depression

50
Q

Sofosbuvir

A

pangenotypic activity
HCV
1000 dollars a tablet!!!!

51
Q

Simeprevir

A

Directly acting antiviral b/c its SIMPLE (SIMEprevir)
HCV
DIs
TAKE W/FOOD need some (SIMeprevir) food

52
Q

Best method for routine prevention of influenza

A

Inactivated influenza vaccine!

53
Q

Drugs for influenza virus

A

Amantadine
Rimantadine
Oseltamivir tamiflu
zanamivir

54
Q

Amantadine

A

MEN are toxic so aMANtadine risk for CNS toxicity + used for parkinsons + drug induced EPS
NO LONGER RECOMMENDED FOR PROPHYLAXIS AMENNNNNN
Influenza

55
Q

What has less CNS effects than amantadine

A

rimantadine…..righhhhttt choice!

influenza ONLY A

56
Q

First line for Influenza

A

Oseltamivir alllll set (Oselt) to kick influenzas ass
Must be used w/in 48hrs of sx
n/v + abdominal pain

57
Q

Inhaler formulation for influenza

A

Zanamivir

Same as tamaflu

58
Q

Infection

A

isolated organisms CAUSE infection

59
Q

Colonization

A

isolated organism NOT causing sx

60
Q

Contamination

A

Isolated organism from PTS SKIN/ENVIRONMENT

61
Q

Susceptible

A

get enough drug into pts system to tx infection

MIC

62
Q

Intermediate

A

MAY NOT be able to get enough drug into pt to tx infection unless safe enough to give high doses/drug concentrations exceptionally well @ infection site
MIC = attainable serum levels

63
Q

Resistant

A

CAN’T get enough drug into pt to tx infection

MIC> attainable serum levels

64
Q

MIC

A

lowest abx concentration to prevent visible growth of an organism

65
Q

What are the drug factors for abx

A 
Clinical efficiency
Pharmacokinetic + dynamics
Time dependent killers
Synergy
Post abx effect
ABX spectrum
Route of admin
bactericidal vs. bacteriostatic
66
Q

Time dependent killers

A

Killing is dependent on the time an organism is in contact w/drug
Duration that drug concentrations are above the MIC (Time>MIC)
Beta lactams, vancomycin

67
Q

Concentration dependent killers

A

Killing dependent on concentration of drug
Higher conc. the greater the killing
MIC=peak serum drug concentration
Fluoroquinolones, aminoglycosides

68
Q

Post abx effect

A

Organism growth is suppressed for a period of time after the drug concentration falls below MIC

69
Q

Two types of abx resistance

A

intrinsic + acquired

70
Q

Intrinsic resistance

A

naturally occurring

Drug cant penetrate organisms cell wall/no receptor site available

71
Q

Acquired resistance

A

Normally sensitive organism becomes resistant

72
Q

Mechanisms of acquired resistance

A

Detoxifying enzymes alter structure + fxn
Beta lactamase breaks down ring of PCN
Alteration of target site like pcn binding protein
Dec. cellular accumulation impaired/enhanced influx/efflux

73
Q

Advantages/disadvantages of PO/IV

A

IV severe infection
ALL else PO b/c excellent bioavailability
Oral decc. cost, less resources, pts prefer, reduce exposure nosocomial pathogens, reduce risk phlebitis, earlier discharge, inc. mobility, + dec. personnel time

74
Q

What are the penicillins? (beta lactams)

A

Natural (G/VK)
Aminopenicillins (ampacillin/amoxacillin)
penicillinase resistant (nafcillin, oxacillin, dicloxacillin)
extended spectrum (ticarcillin/clavulanate, piperacillin/tazobactam)

75
Q

Natural PCNs (beta lactams) VK/G spectrum

A

POSITIVE + NEGATIVE

Strep/treponema

76
Q

Aminopenicillins (beta lactams) Ampacillin/amoxacillin spectrum

A

POSITIVE + NEGATIVE + ANAEROBES (A for all!)

77
Q

Spectrum for penicillinase resistant penicillin (beta lactams) nafcillin, oxacillin, + dicloxacillin

A

ONLY GRAM + (resistant in the name so only covers 1)

Staph/strep

78
Q

Spectrum of extended spectrum penicillin (beta lactams) ticarcillin/clavulante, piperacillin/tazobactam

A

POSITIVE NEGATIVE + ANAEROBES
ALL b/c extended spectrum
Staph/strep, enterobacteriaceae, bacteriodes

79
Q

Two pcns that cover all organisms

A

extended spectrum

aminopenicillins

80
Q

What are natural pcns used for?

A

pharyngitis, erysipelas, + syphilis

81
Q

What are aminopenicillins used for?

A

URIs, susceptible enterococcal infections, UTI, CAP, lymphadenitis, Amoxacillin clavulante used for skin

82
Q

What are penicillinase resistant penicillins used for

A

B-lactamase producing staph, cellulitis, + endocarditis

83
Q

What are extended spectrum penicillins used for

A

Nosocomial pneumonia
Intrabdominal infections
Skin + soft tissue infections

84
Q

Beta lactamase inhibitors

A

Enhance abx activity against certain beta lactamase producing organism extending the abx spectrum
Clavulanate, tazobactam, + sulbactam

85
Q

What are the s/e of PCNS?

A

Leukocytopenia/thrombocytopenia
Jarisch-herxheimer rxn: w/spirochetes like treponema pallidum/lime release toxins after killing bacteria causing chills, myalgia, + fever
GI upset/diarrhea clavulanate
hepatitis for nafcillin/oxacillin

86
Q

Desensitization for PCN allergy

A

Administer cephalosporin if non-life threatening
Non beta lactam abx like macrolides, quinolones, sulfonamides, vancomycin
PCN desensitization in. every 15-30m in ICU
PN skin test

87
Q

Drug interactions of PCNs

A

Propenicid- decreases renal tubular secretions of PCns so co-administration causes inc. serum levels of abx
Methotrexate- PCN inhibits renal tubular secretion of it + may result in high levels of methotrexate
OCPs-rifampin dec. levels of hormones b inc. metabolism through liver enzymes

88
Q

MOA for beta lactams

A

Bind to pcn binding proteins + inhibit cell wall synthesis causing death

89
Q

What is the drug of choice for infections caused by ESBLs?

A

Carbapenems

90
Q

Clinical uses of carbapenems

A

UTI, LRI, intraabdominal + gynecological infections, skin, soft tissue, bone + jt. infections (like extended spectrum pcns)

91
Q

Special consideration of carbapenems

A

CROSS REACTIVITY W/PCN

92
Q

Names of carbapenems

A

Impenem/cilastin, meropenem, doripenem, ertpenem

ALL HAVE PENEM

93
Q

Imipenem a carbapenem is combined w/ cilastatin to

A

prevent breakdown y renal dihydropeptdase

c is used w/ impenem for the d

94
Q

Spectrum of carbapenems

A

POSITIVE NEGATIVE + ANAEROBES

staph/strep, listeria, + pseudomonase EXCEPT ERTAPENEM

95
Q

Monobactams spectrum (Aztreonam)

A

ONLY GRAM - including pseudomonas (penicillinase resistant pcn only gram +)

96
Q

Glycopeptides drugs

A

vancomycin
telavancin
dalbavancin
oritavancin

97
Q

MOA of glycopeptides

A

Prevent cross linking of the cell wall peptidoglycan during cell wall syntheisis

98
Q

Spectrum of vancomycin

A

GRAM + ONLY

MRSA (oral form not absorbed-only for c-diff)

99
Q

S/E of vancomycin

A

RED MAN’S syndrome!
Infusion related rxn by histamines so looks like allergic rxn
Erythmatous urtiarial flushing, tachycardia, + hypo tension
STOP INFUSION! wait till subside then slow infusion rate no more than 1gm/hr + can give benadryl
double infusion time

100
Q

Telavancin indications

A

soft tissue, skin + nosocomial infections (similar to extended spectrum penicillin, + carbamapens)

101
Q

S/E of televancin (glycopeptide)

A

Red mans syndrome, nephrotoxicity, gi upset, metalllic taste (more s/e than vancomycin)
BB warning in pregnancy!

102
Q

What are the four generations of cephalosporins?

A 
Cephalexin PO, cefazolin IV
Cefuroxime PO, cefoxitin IV
Cefdoxime PO, ceftriaxone IV
Cefeptime IV
NEWER: cetazimide/avibactam + ceftolozane/tazobactam, ceftaroline IV against MRSA/VRSA/VISA SO RESERVED
103
Q

First generation cephalexin PO + cefazolin IV cephalosporin uses

A

+/-
SPecK (staph/strep, proteus, ecoli, klebsiella
Mild skin/soft tissue infections

104
Q

2nd generation cefuroxime PO, cefoxitin IV cephalosporin uses

A

+/-
HMSpecK: H. flu, moraxella catarrhalis, staph/strep, proteus, e.coli, + klebsiella
Replaced by third generation

105
Q

3rd generation Cefpoxime PO, ceftriaxone IV cephalosporin uses

A

+/-
HEMS: h.flu, enterobacteriaceae, moraxella catarrhalis, strep
CAP, otitis media, URI

106
Q

4th generation Cefeptime IV cephalosporin uses

A

+/-/anaerobes

Nosocomial infections

107
Q

Cephalosporins are ______ susceptible to B-lactamases giving them a ____ spectrum of action compared to pcns includin staphylococcus

A

less, broader

108
Q

Earlier generations of cephalosporins have better gram ____ coverage than later generations

A

positive

109
Q

Later generations of cephalosporins have better gram ____ coverage than earlier generations

A

NEGATIVE

110
Q

S/E of cephalosporins

A 
Caution in pts w/pcn allergy
CROSS SENSITIVITY (higher for 1st gen)
Cefotetan has mtt side chain that can cause hypoprothrombinemia + bleeding
MONITOR RENAL FXNN
PROBENICID also inc. Drug interaction
111
Q

Which drugs are cell all inhibitors?

A

monobactams
carbapenems
glycopeptides

112
Q

Other cell wall/membrane active agents

A

daptomycin
fosfomycin
bacitracin cycloserine

113
Q

daptomycin

A

VRE + VISA/VRSA
Skin + soft tissue infections, bacteremia, NOOOOOTTT PNEUMONIA
if muscle aches monitor CPK + if elevated dixc. drug

114
Q

Fosfomycin

A

Gram + and -

UTIs

115
Q

Bacitracin

A

HIGHLY nephrotoxic so only used topically

Surface lesions on skin/irrigation wounds/jts.

116
Q

Cycloserine

A

Gram + and -
used for RESISTANT TB
SERIOUS h/a, tremors, acute psychosis

Pharmacology exam 1 (3 decks)

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