Final Exam Flashcards
zolpidem (ambien)
MOA: non benzo, short acting hypnotic
Uses: short term use for insomnia
Side effects: dizziness, drowsiness, headaches, anxiety, cognitive dysfunction, hepatic encephalopathy; potential for misuse; dependence
zopiclone
MOA: short acting Benzo like drug
uses: short term use for insomnia
side effects: dizziness, drowsiness, headaches, anxiety, cognitive dysfunction, amnesia, anxiety, agitation, restlessness, worsening depression, respiratory depression; potential for misuse; dependence; withdrawal effects
dayvigo (lemborexant)
MOA: newer sleep aid, blocks orexin and suppresses wakefulness
Uses: insomnia
side effects: abnormal dreams, drowsiness, headache, worsening depression; potential for misuse
-no dependence**
dantrolene (direct acting muscle relaxant)
MOA: Acts directly on skeletal muscle by interfering with release of calcium ion
Uses: short term muscle spasms and pain, MS, CP, rheumatic disorders, huntington’s, parkinsons, trigeminal neuralgia, malignant hyperthermia
- side effects: euphoria, CNS depression, lightheadedness, dizziness, drowsiness, fatigues, confusion
contraindications: alcohol, CNS depressants, active liver disease
baclofen (central muscle relaxants)
-MOA: works centrally on the CNS; reduces tonic somatic motor activity influencing both alpha and gamma motor neurons –> depresses the CNS
contraindications: heart failure, arrhythmias, hyperthyroidism, use of MAOIs
amphetamine salts
MOA: stimulates cerebral cortex and thalamus. causes mood elevation, euphoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness, and prolonged wakefulness. relaxation of bronchial smooth muscle, increased respiration, and dilation of pulmonary arteries
Uses: ADHD, narcolepsy
side effects: hypertension, tachycardia, agitation, anxiety, insomnia, loss of appetite, dry mouth, abdominal pain
contraindications: hypertension, heart failure, PVD, CAD, hyperthyroidism, glaucoma, agitation
Methylphenidate (concerta, ritalin)
uses: ADHD, narcolepsy
Side effects: same as amphetamines + temporary slowing of growth in prepubescent children
Contraindications: same as amphetamines
Atomoxetine (strattera)
-Uses: ADHD, narcolepsy
Side effects: hypertension, urinary retention; increased suicide risk; excessive sweating, dry mouth, constipation, reduced appetite, nausea, vomiting, erectile dysfunction, drowsiness, headache, insomnia, agitation, worsening psychiatric symptoms, prolonged QT
contraindications: narrow-angle glaucoma; history of adrenal gland cancers; severe cardiovascular disease; severe hypertension; uncontrolled hyperthyroidism
orlistat
MOA: binds to lipase and blocks them → reduces fat absorption. reduces fat absorption by 30%
-uses: obesity
-side effects: oily spotting, flatulence, and fecal incontinence. decreased absorption of vitamin A,D,E
-limiting dietary intake of fat can help with side effects
Triptans
MOA: serotonin receptor agonists, work by stimulating serotonin receptors in the brain. stimulate 5-HT receptors in cerebral arteries → causes vasoconstriction → reduces headache. take at first sign of headache
Indications: migraines
side effects: vasoconstriction effects, serotonin syndrome
contraindications: heart disease or symptoms of heart disease, peripheral vascular diseases; CAD, uncontrolled hypertension;
cardiac arrthymias, sepsis, impaired renal or hepatic function
barbiturates
-MOA: CNS depressant
-Uses: pre-op sedation, anesthesia adjunct, anticonvulsant (prevention of generalized tonic–clonic seizures and fever-induced convulsions)
- side effects: dizziness, drowsiness, lethargy, paradoxical restlessness, thrombocytopenia, hypotension, bradycardia, CNS depression
memory impairment, respiratory depression
contraindications: pregnancy, severe respiratory difficulties, severe liver disease
Hydantoins (Dilantin)
- MOA: Therapeutic range = 10-20
- Uses: tonic-clonic and focal seizures
- side effects: lethargy, abnormal movements, ataxia, mental confusion, cognitive changes (suicidal thoughts) gingival hyperplasia, thrombocytopenia, hepatitis
contraindications: liver failure, bradycardia
Iminostilbenes (Tegretol)
uses: focal onset seizures, general onset seizures, bipolar disorder and neuropathic pain
side effects: Nausea, headache, dizziness, unusual eye movements, visual change,
minor anticholinergic effects
Contraindications: bone marrow depression;
severe hepatic disease; concurrent use of certain anti-fungals; may worsen myoclonic or absent seizures
succinimide (zarontin)
uses: uncomplicated absence seizures (children)
side effects: Nausea, abdominal pain, dizziness, drowsiness
GABA analogs (gabapentin)
- Uses: neuropathic pain, adjunctive treatment for seizures; chronic pain; pruritus; restless leg syndrome
side effects: weight gain, drowsiness, dizziness, nausea, visual and speech changes, edema
lamotrigine
uses: simple or complex focal seizures, generalized seizures, tonic-clonic seizures, bipolar
side effects: relatively minor CNS and GI symptoms, drowsiness, ataxia, headache, skin rashes, nausea, blurred vision
levetiracetam (Keppra)
-uses: adjunct for focal seizures
- side effects: generally well tolerated, Dizziness; drowsiness; suicidal ideation
Topiramate (Topomax)
Uses: adjunct for seizures, migraine prophylaxis, eating disorders, tremors
-side effects: weight loss (4-17%), GI upset, dizziness, drowsiness, ataxia, decreased bone density
Valproic Acid
Uses: seizures, migraine prophylaxis, bipolar
Side effects: Dizziness, drowsiness, gastrointestinal upset, tremor, weight gain, hair loss, hepatotoxicity, pancreatitis
Contra: liver impairment, urea cycle disorders, use in women of child bearing potential
anti metabolite side effects
fever, malaise
-hair loss
-nausea, vomiting, diarrhea, myelosuppression
-neurological, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary (GU), dermatological, ocular, otic, and metabolic toxicity
-tumour lysis syndrome
folic acid antagonist (methotrexate0)
MOA: interferes with folic acid, works on S phase
Uses: solid tumours (breast, head, neck, lung), acute lymphocytic leukemia, non-hodgkins lymphoma, RA, psoriasis
side effects: stomatitis, black tarry stools, hair loss
contra: NSAIDs
purine antagonists
- interrupts metabolic pathways of purine nucleotides → interrupts DNA/RNA synthesis → tumour cells die
-Uses: leukemia
pyrimidine antagonism
MOA: interrupts metabolic pathways of pyrimidine bases → interrupts DNA/RNA synthesis
mitotic inhibitors (vincristine)
MOA: Can work in various phases of the cell cycle. All work shortly before or during mitosis and thus retard cell division.
Uses: combination therapy, solid tumours (testicular, breast, ovarian, small cell lung), leukaemia
side effects: neurotoxic, hair loss, nausea and vomiting, and myelosuppression
topoisomerase 1 inhibitors (topotectan)
MOA: inhibits proper DNA function
uses: ovarian and colorectal cancer
side effects: bone marrow suppression
cholinergic diarrhea, N,V,D
Antineoplastic enzymes (Erwinase)
- MOA: Synthesized using cultures of bacteria and recombinant DNA technology
- uses: Acute lymphocytic leukaemia
- side effects: impaired pancreatic function,
alkylating drugs
-MOA: Used to treat various types of cancer by preventing cancer cells from reproducing (alter DNA)
- uses: ovarian, testicular, lymphoma, leukemia, breast, retinoblastoma
- side effects: nephrotoxicity (hydration important ++), neuropathy, ototoxicity, hemorrhagic cystitis
cytotoxic antibiotics
- MOA: -Natural substances produced by the mold Streptomyces. cell cycle non-specific and blocks DNA synthesis
- uses: combination therapy
- side effects: Bone marrow suppression & heart failure (cardiomyopathy), pulmonary fibrosis, pneumonitis
aromatase inhibitors
- MOA: inhibits aromatase → conversion of certain hormones is prevented → decreases or delays tumour mass growth, responsive to hormones
Uses: post therapy for breast cancer
Side effects: hot flashes, osteoporosis, hypertension, mood disorders, weakness, arthralgia
SERMs (tamoxifen)
MOA: binds to estrogen receptors to inhibit estrogen effects & decrease DNA synthesis
-Tamoxifen is cytostatic rather than cytocidal
-inhibits cancer growth (vs kills the cells)
Uses: treatment and risk reduction of breast cancer for 5-10 years (post initial treatment)
Side effects: Hypertension, peripheral edema, mood disorders, depression, hot flashes, nausea, weakness, and osteoporosis
estrogen receptor antagonists
MOA: binds to estrogen receptors to inhibit tumour growth
Uses: breast cancer
Side effects: Vasodilation, pharyngitis, headache, hot flashes, pain, N&V
anti androgens (bicalutamide)
MOA: blocks androgens
Uses: prostate cancer
Side effects: anemia, peripheral edema, muscle aches , gynecomastia, hot flashes, nausea, diarrhea
gonadotropin releasing hormone agonists
MOA: decreased LH and FSH and subsequent testosterone and estrogen decrease
Uses: gender transitioning, prostate, breast, endometrial cancer, endometriosis, fibroids
Side Effects: hair loss, increased body odour, headaches, flushing, hot flashes, nausea, vomiting, weight changes
antineoplastic hormones
MOA: causes marked decrease in plasma testosterone and increases estrogen
Uses: male tumours
Side effects: edema, SOB, leg cramps, chest wall tenderness, anorexia, nausea, diarrhea
NSAIDs
MOA: Works by blocking the chemical activity of the cyclooxygenase (COX) enzymes; can also inhibit the leukotriene pathway, prostaglandin pathway or both
Uses: various inflammatory conditions, mild to moderate pain
Side Effects: dyspepsia, heartburn, GI bleed, hepatotoxicity, AKI, tinnitus, altered hemostasis
Contra: risk for bleeding, vitamin K deficiency, peptic ulcer disease, current hemorrhagic stroke, and severe kidney or liver disease
Aspirin
Uses: secondary prevention of blood clots associated with MI or stroke. pain, inflammatory conditions, fever, and for certain autoimmune conditions
Side effects: increased risk of bleeding
Contra: children with flu like symptoms → can cause Reye’s syndrome
Indomethacin
MOA: NSAID derivative (analgesic, antipyretic and anti-inflammatory, anti-rheumatic properties)
Uses: acute gouty arthritis, RA, OA, bursitis, tendonitis, and ankylosing spondylitis
Ketorolac (Toradol)
MOA: anti-inflammatory, with strong analgesic properties (comparable to opioids)
Uses: moderate-to-severe acute pain resulting from orthopedic injuries, surgeries or severe migraines
-should be used for limited intervals
Side effects: kidney impairment, edema, GI pain, dyspepsia, and nausea
ibuprofen
Uses: pain, fever, RA, OA, dental pain, MSK disorders, dysmenorrhea
Side effects: increase risk or stroke and bleeding, can increase blood pressure and at high doses/long periods of time
Cox-2 inhibitors
MOA: COX-2 inhibitors allow for anti-inflammatory effects while reducing the prevalence of adverse effects such as GI upset, ulceration/bleeding
Uses: OA, RA, acute pain, ankylosing spondylitis, dysmenorrhea
Side Effects: headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, and hypertension
Contra: hypersensitivity to celecoxib, sulfonamides, aspirin, other NSAIDs, 3rd trimester, breastfeeding, heart failure
Enolic Acid Derivatives (meloxicam)
MOA: potent NSAIDs, better GI tolerance
Uses: mild to moderate OA, RA, and gouty arthritis
Allopurinol
MOA: helps prevent excessive uric acid production in individuals with gout
Uses: gout, tumour lysis syndrome
Side effects: acute gout attacks, agranulocytosis, aplastic anemia, serious and potentially fatal skin conditions
Colchicine
MOA: reduces the inflammatory response to deposits of urate crystals in joint tissue
-second line
Uses: gout
side effects: N,V,D
-take on empty stomach
Probenecid
MOA: inhibits the reabsorption of uric acid in the kidney and thus increases the excretion of uric acid
-ineffective in clients with kidney impairment
Uses: gout
immunosuppressants (general)
MOA: selectively suppress certain T lymphocyte cell lines to suppress the immune system
Uses: helps to reduce organ rejection, MS, RA
side effects: increased risk for opportunistic infections
signs of organ rejection
-flu like symptoms
-fever
-weight gain
-decreased urine output
-fatigue
-muscle pain
-tenderness over area
Basiliximab
uses: prevention of organ rejection in kidney transplants, give with methylprednisolone
side effects: cytokine release syndrome (fever, dyspnea, tachycardia, sweating, chills, headache, nausea, vomiting, diarrhea, muscle and joint pain, and general malaise)
sirolimus
uses: prevention of organ rejection in kidney transplant
Azathioprine
uses: prevention of organ rejection in kidney transplants, RA
side effects: leukopenia, thrombocytopenia, hepatotoxicity
Mycophenolate
Uses: prevention of organ rejection in kidney, liver, and heart transplantation
tacromilus
Uses: prevention of organ rejection in liver, kidney, heart transplants, rejection in bone marrow, pancreas, pancreatic islet cells, and small intestine transplants, autoimmune diseases, psoriasis
Side effects: agitation, anxiety, confusion, hallucinations neuropathy, albuminuria, dysuria, AKI, ATN, DM
cyclosporin
MOA: prevention and treatment of graft rejection following solid organ (liver, pancreas, spleen) and bone marrow transplant, RA & psoriasis
Side effects: hepatotoxicity (cholestasis, hyperbilirubinemia), neurotoxicity, nephrotoxicity, hypertension, DM, gingival hyperplasia, hirsutism
Fingolimod
Uses: MS
Glatiramer
uses: MS
Biological Response Modifying Drugs (anti-rheumatic drugs)
MOA: alter the body’s response to diseases such as cancer and autoimmune, inflammatory, and infectious diseases
-enhance or restrict the patient’s immune response to disease, can stimulate a patient’s hematopoietic (blood-forming) function, and can prevent disease
-requires adequate hydration
Uses: DMARDs –> RA, hematopoietic drugs, immunomodulating drugs (interferons, monoclonal antibodies, interleukin receptor agonists)
side effects: hypertension
contra: uncontrolled hypertension
Biological response modifiers
consists of hematopoietic drugs, & immunomodulating drugs
MOA:
1) enhancement of host’s immune system
2) direct toxic effects on tumour cells
3) adverse modification of the tumours biology (makes it harder for tumour cells to survive and reproduce)
Uses: anemia, neutropenia
Hematopoietic drugs
MOA: colony stimulating factor (CSF)
-stimulate the production, maturation, and activation of neutrophils
decrease bone marrow recovery time
-stimulate immune cells to kill cancer cells, and viral or fungus infected cells
-start use 24 hrs after completion of chemo
Uses: chemotherapy related anemia and neutropenia, reduce bone marrow recovery time after transplant
side effects: fever, muscle aches, bone pain, flushing, nausea (very common); thrombocytopenia, increased ALP, inflammation of the aorta, nephrotoxicity, respiratory distress,
interferons
MOA: immunomodulators, antitumoral, antivirals, antineoplastic, identical to interferon cytokines naturally found in the body
-prevent cancer cells from dividing
-increase the activity of other cells in the immune system
Uses: hep B, hep C, myelogenous leukemia, multiple myeloma, non hodgkin’s lymphoma, melanoma, hairy cell leukemia, basal cell carcinoma, MS
side effects: flu like symptoms
contra: concurrent use of immunosuppressant drugs
Monoclonal Antibodies
MOA: can specifically target cancer cells and have minimal effects on healthy cells
Uses: cancer, rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, multiple sclerosis, reducing risk of certain respiratory illnesses in high risk individuals
- side effects: flu like symptoms
contra: AIDS
Adalimumab (humira)
antibody
RA
Bevacizumab (avastin)
antibody
metastatic colorectal cancer
Infliximab (Remicade)
antibody
ankylosing spondylitis, crohn’s, ulcerative colitis, RA, psoriatic arthritis
Trastuzumab (herceptin)
antibody
breast cancer
BCG vaccine
localized bladder cancer
Etanercept (Enbrel)
RA, ankylosing spondylitis, plaque & psoriatic arthritis
Disease Modifying Antirheumatic Arthritis Drugs (DMARDs)
MOA:
-exhibit anti-inflammatory, antiarthritic, and immunomodulating effects
-inhibit cell movement into inflamed areas
-reduces the progression of the disease by modulating the inflammation and body’s autoimmune destruction of the joints
-non-biological or biological
Uses: RA
Contra:
-active infection (bacterial, viral, TB)
-should be avoided in pregnancy/women of childbearing age and during lactation
-should not be given with live vaccines
Virulence
degree to which an organism is pathogenic
severity of harmfulness of a disease
median infectious dose (ID50)
the number of pathogen cells or virions required to cause active infection in 50% of inoculated species
median lethal dose (LD50)
the number of pathogenic cells, virions, or amount of toxin required to kill 50% of infected species
normal flora
- commonly colonized on the host but does not cause disease under normal conditions and healthy immune system
- some normal flora is acquired before birth
- Many are provided to baby by mother (ie breast milk, through vaginal opening during birth)
- helps to inhibit the growth of pathogenic bacteria through various processes (ie pH, compete for nutrients, environmental changes, limited attachment sites, etc)
- Other benefits include: Producing vitamins in the body & metabolize undigested materials
symbiosis
the relationship between normal microbiota and the host
commensalism
One organism benefits, and the other is unaffected
mutualism
both organisms benefit
parasitism
one organism benefits at the expense of the other
Louis pasteur
discovered that various microbes have unique properties and invented the process of pasteurization (kill microbes responsible for spoilage), and developed new vaccines
Koch
demonstrated the connection between a single microbe and a known human disease - discovering the bacteria that causes anthrax, cholera and tuberculosis
John snow
- discovered evidence that suggested that contaminated water from a water pump was a source of the cholera epidemic
- he did this by surveying individuals and plotting the information on a map, discovering that cases were high near a particular water pump
communicable disease
a disease that is spread from one host to another (ie measles, mumps, COVID19)
contagious disease
diseases that are easily and rapidly spread from one host to another (chicken pox,COVID19, rhinovirus)
- Some communicable diseases can also be considered contagious
non-communicable disease
a disease that is not spread from one host to another (tetanus toxoid from an old nail)
endemic disease
disease constantly present in a population
epidemic disease
disease acquired by many people in a given area in a short time
pandemic disease
worldwide epidemic
focal infection
a localized infection that spreads systemically or to another location (ie an infection that started on the finger that became septic)
secondary infection
an infection that occurs during or after treatment for another infection (CDiff)
Structures that make gram-positive C. difficile more virulent includes:
- spore forming ability
- ability to move and penetrate the mucous layer
- toxin A and B that damage cells
- its ability to mutate and become more resistant to treatments
periods of disease
1) Incubation period - time between the initial start of infection and onset of symptoms
2) Prodromal period - early mild symptoms (malaise, fatigue)
3) Period of illness - disease is most severe, lots of signs and symptoms
4) Period of decline - symptoms start to improve
5) Period of convalescence - body returns back to pre disease state
contributing factors to emerging infections
Rapid population growth
Globalization
Climate change
Antibiotic resistance
Human behaviour changes
Aging population
chain of infection
1) Causative Agent - bacteria, virus, fungi (microorganism)
2) Reservoir (source) – Humans, animals and the environment can all be reservoirs for microorganisms to grow and multiply
3) Portal of Exit - the path for the microorganism to escape from the host. The blood, respiratory tract, skin and mucous membranes, GU tract and GI tract are all examples (many more exist)
4) Mode of Transmission - how microorganisms are transferred (to other organisms, locations)
5) Portal of Entry - a path for the microorganism to get into a new host, similar to the portal of exit (ie nasal passages, broken skin, eyes, GU system, GI tract and many more) - “exposure”
6) Susceptible Host - a person susceptible to the microorganism.
ID50: infectious Dose
- one of the important indicators for virulence (degree of ability to cause disease)
- ID50 is the number of pathogen cells or virions required to cause active infection in 50% of inoculated animals/persons
- Microorganisms with smaller infectious doses have greater virulence
LD50: Lethal Dose
- LD50 is the number of pathogenic cells, virions, or amount of toxin required to kill 50% of infected animals/persons
- Measures lethality of a toxin
adhesions (colonization)
- Adhesins = molecules that microbes use to attach
- adhesion refers to the capability of pathogenic microbes to attach to the cells of the host
- Following the initial exposure, the pathogen adheres at the portal of entry
- Pathogen is limited to only those cells (and organisms) to which it can bind.
adhesion mechanisms
Fimbriae (pili)
Surface proteins
glycocalyces (slime layers and capsules), biofilms
Viruses attach by certain receptors
Parasitic worms fastened by suckers, hooks, and barbs
microbial invasion
- Once adhesion is successful, invasion can proceed
- involves the spread of a pathogen throughout the host
- may produce exoenzymes or toxins which will contribute to the spread and severity of infection
toxin
- a specific chemical product of microbes, plants, and some animals that is poisonous to other organisms
- Named according to target (eg. neurotoxic)
- can be categorized as endotoxins or exotoxins
exoenzymes
- Enzymes secreted by microbes that break down and inflict damage on tissues
- Dissolve the host’s defense barriers to promote the spread of disease to other tissues
- Eg. Mucinase, coagulase, kinase
exotoxins
- Exotoxins are generally significantly more lethal than endotoxins
- This means that the LD50 would generally be significantly lower for exotoxins than an endotoxins
- source: gram positive (mostly)
- composition: protein
- effect: specific damage to the cells dependent upon receptor mediated targeting of cells and specific MOA
- not heat stable
antitoxins
antibodies against specific exotoxins
endotoxins
- Lipopolysaccharide (LPS), part of the outer membrane of gram-negative bacterial cell walls
- Example of endotoxin: A-B toxins - promotes fever and inflammation
- Can also produce chills, weakness, aches, shock and even death
- source: gram negative bacteria
- effect: general systemic inflammation and fever
- heat stable
- UTI, meningococcal meningitis, typhoid fever
mesophiles
preferring temperatures ranging from 20C to 45C
psychrotrophs
Bacteria who prefer cooler environments 4C-25C
pyschrophiles
Bacteria who can survive in extremely cold (arctic environments, 0C and below)
thermophiles
Organisms that grow at optimum temperatures of 50 °C to a maximum of 80 °C
hyperthermophiles
growth ranges from 80 °C to a maximum of 110 °C
neutrophiles
meaning they grow optimally at a pH within one or two pH units of the neutral pH of 7
halophiles
require high salt concentrations for growth – think the ocean
halotolerant
do not require high salt environments to thrive
decimal reduction time (DRT) or D-Value
The amount of time it takes for a specific treatment to produce the death of 90% of the population
bactericidal
treatments that kill bacteria
bacteriostatic
treatments that inhibit bacterial growth
methods to control microorganisms
- heat (pasteurization)
- heat and pressure (autoclaves)
- desiccation (ie dehydrating foods such as raisins)
- Filtration (ie high efficiency particulate air (HEPA) filters)
- Radiation (ie UV light or sunlight to disinfect)
- Low temperature (ie refrigeration and freezing); method generally bacteriostatic than bactericidal
- High pressure (ie food industry uses high-pressure processing (also called pascalization) to kill bacteria, yeast, molds, parasites, and viruses in foods while maintaining food quality and extending shelf life)
- Osmotic pressure (ie adding salt or sugars to food to create a hypertonic environment)
- Metals / antimicrobial surfaces (ie copper has antimicrobial properties and was installed throughout the Vancouver International Airport; silver-infused dressings)
anti-virals
- inhibiting DNA/RNA synthesis
- prevent it from building proteins
- prevent the virus from either binding to or entering the host cell
- fusion inhibitors, that prevent the binding of HIV to the host cell co-receptor
- Are only available for a small number of viruses including: influenza, COVID-19, herpes viruses, cytomegaloviruses, hepatitis C, and HIV
Overactive bladder drugs
Fesoterodine, oxybutynin, solifenacin, tolterodine, trospium
