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Last min Pharma > Jumble > Flashcards

Jumble Flashcards

1
Q

Drugs only effective against gram positive bacteria

A

Penicillinase resistant penicillins (cloxacillin)
Vancomycin
Linezolid
Trimethoprim

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2
Q

Drugs only effective against gram negative bacteria

A

Aztreonam
Ciprofloxacin (mostly)

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3
Q

What drugs are effective against atypicals

A

Tetracyclines, macrolides
Levofloxacin

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4
Q

What drugs are effective against MRSA

A

Ceftaroline, ceftobiprole
Vancomycin
Macrolides, clindamycin, linezolid
Sulfonamides, trimethoprim, cotrimoxazole
Fluoroquinolones not used due to resistance

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5
Q

Drugs with oral bioavailability

A

NP V, PRP, aminopenicillins, 1st and 2nd gen cephalosporins
Vancomycin (CDAD)
Tetracyclines
Macrolides esp azithromycin
Clindamycin, linezolid
Neomycin for bowel prep
Fluoroquinolones, sulfonamides, trimethoprim, cotrimoxazole, nitrofurantoin
Amphotericin B, 5-flucytosine, metronidazole
NRTI, NNRTI, integrase inhibitors
Acyclovir, valacyclovir, ganciclovir, valganciclovir

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6
Q

Drugs that can be administered for pregnancy

A

Penicillins, cephalosporins, carbapenems, aztreonam
Oral vancomycin for CDAD
Azithromycin, erythromycin
Amphotericin B, itraconazole, voriconazole, terbinafine
Metronidazole (Avoid first trimester)
PEP - Tenofovir + emtricitabine
Integrase inhibitors (with folic acid)
Acyclovir, valacyclovir

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7
Q

Drugs effective against anaerobes

A

Aminopenicillins, piperacillin + tazobactam, carbapenems
Clindamycin
Levofloxacin, moxifloxacin
Metronidazole (first line)

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8
Q

Simple UTI drugs

A

Nitrofurantoin, cotrimoxazole are first line
Amoxicillin, cephalexin
Fluoroquinolones (but may have resistance)

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9
Q

Good CSF penetration

A

Penicillins
3-5th gen cephalosporins
Meropenem
Aztreonam
Vancomycin
Linezolid
Aminoglycosides
Fluconazole, voriconazole

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10
Q

MRSA orally

A

Clindamycin, linezolid, doxycycline
Sulfonamides, trimethoprim, cotrimoxazole

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11
Q

Pregnancy orally

A

NPV, PRP, aminopenicillins, 1-2 gen cephalosporins
Oral vancomycin for CDAD
Azithromycin, erythromycin
Amphotericin B, metronidazole (Avoid first trimester)
Tenofovir, emtricitabine, integrase inhibitors (with folic acid)
Acyclovir, valacyclovir

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12
Q

Anaerobes orally

A

Aminopenicillins
Clindamycin
Levofloxacin, moxifloxacin
Metronidazole (first line)

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13
Q

Atypicals pregnant

A

Azithromycin, erythromycin

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14
Q

MRSA pregnant

A

Ceftaroline, ceftobiprole

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15
Q

Anaerobes pregnant

A

Aminopenicillins, piperacillin + tazobactam, carbapenems
Metronidazole (AVoid first trimester)

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16
Q

UTI pregnant

A

Amoxicillin, cephalexin

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17
Q

Endocarditis

A

Gentamicin + penicillin first line
Streptomycin + penicilin

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18
Q

LA administered for procaine allergy

A

Bupivacaine
Lidocaine
Etidocaine
Mepivacaine
Prilocaine

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19
Q

Mechanisms of LAs

A

Bind to sodium channels to prevent opening and influx of Na+ causing depolarization
Prevents AP generation
Binds preferentially to small unmyelinated rapidly-firing and peripheral nerves
Binds more to nociceptive fibers to block noxious stimuli from generating pain signals

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20
Q

What local factors can affect LA action

A

Fiber positioning in nerve bundle, size and myelination, frequency of firing
Dosage
Site of injection (acidity, blood supply)
Acidity

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21
Q

What is a potential adverse effect when administering LA? How to prevent?

A

Systemic adverse effects like vasovagal syndrome, depressed CNS syndrome, restlessness, lightheadedness, dizziness, cyanosis, hypersensitivity, nausea, vomiting, liver damage

Administer with vasoconstrictor

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22
Q

Inhaled vs IV GA

A

Inhaled
- Maintenance, sometimes induction in children
- Surgical anesthesia, loss of consciousness
- Slower onset and offset
- Most excretion via lungs
- Can cause respiratory and cardiac depression (variable effect on heart rate but SV and systemic resistance typically fall)

IV
- Induction, adjunct to inhaled
- Cannot achieve surgical anesthesia (except ketamine) or loss of consciousness
- Faster onset and offset
- Dose controlled more accurately
- Does not require expensive vaporizer equipment or disposal equipment
- Most metabolism via liver and excretion via kidneys
- Respiratory and cardiac depression

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23
Q

Ester LAs

A

Procaine
Cocaine
Chloroprocaine
Tetracaine

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24
Q

PK of LA

A

PK does not affect onset

PK affects offset
- A and D into systemic bloodstream causes drop in [LA] to below MEC
- A and D into tissues slows excretion
- A depends on acidity –> more acidic = more charged, less penetration
- A and D depends on vasoconstrictor usage
- M via liver or butyrylcholinesterases
- E renally

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25
Q

Isoflurane VS Nitrous oxide

A

Isoflurane
- Inhaled GA
- Liquid, has to be vapourized
- Anxiolysis, amnesia, analgesia, sedation
- Loss of consciousness, surgical anesthesia
- Used for maintenance of GA
- Metab in body
- Excreted primarily via lungs
- Higher solubility, slower onset and offset
- Dose dependent respiratory depression
- MOA via increasing brain Cl- opening times, hyperpolarization

Nitrous oxide
- Inhaled GA
- Gaseous
- Anxiolysis, amnesia, analgesia, sedation
- Loss of consciousness, surgical anesthesia
- Used as adjunct to labour pain and adjunct to other inhaled GAs
- Metab in GI bacteria
- Excreted primarily via lungs
- Lower solubility, faster onset and offset
- Lowest risk of increasing ICP
- MOA via increasing brain Cl- opening times, hyperpolarization

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26
Q

LA for 1h long procedure

A

Procaine

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27
Q

LA administration

A

Infiltrative plexus block
Topical

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28
Q

Advantages of using LA with adrenaline

A

Longer duration of action
Lower risk of systemic side effects

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29
Q

MOA of IV GAs

A

Bind to GABA receptors and potentiate GABA in the brain
Prolongs Cl- opening time and increases frequency of opening, hyperpolarizing the cell
Prevents AP generation, block motor and autonomic responses to noxious stimuli
Analgesic, amnesic, anxiolytic, sedative

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30
Q

Adverse effects of IV GAs

A

Generally decrease respiration, cardiac output and can cause hypotension, anterograde amnesia, increased ICP
Excitement phase associated with amnesia but not delirium, vomiting + retching upon stimulation
Ketamine causes post-op disorientation, illusions, dreams
Post-op nausea
Malignant hyperthermia (hyperthermia, muscle rigidity, tachycardia, hypertension, acidosis, death)

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31
Q

Balanced anesthesia?

A

IV induction
Inhaled maintenance
LA pre- and perioperative analgesia
Muscle relaxants for tracheal intubation and efficiency of surgery
CVS drugs to control transient autonomic responses to noxious stimuli

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32
Q

NSAID mechanism of action

A

COX enzyme inhibition
COX1 constitutive, COX2 inducible (except kidneys, female repro tract, CNS, joints)

COX1 produces TXA2, PGE2, PGI2
COX1 inhibition causes antiplatelet effect, cardioprotection, hypernatremia, hypertension, easy bruising, increased risk of hyperkalemia and acute liver failure, nausea, vomiting, abdominal discomfort, gastric ulcers, exacerbate existing wounds, contraindicated in pregnancy

COX2 produces PGE2, PGI2
COX2 inhibition causes increased thrombosis, decreases inflammation and pain, hypernatremia, hypertension, increased risk of hyperkalemia and acute renal failure

Inhibition of prostanoids reduces sensitization of nociceptive fibers, analgesic effect with analgesic ceiling
Inhibition of COX2 prostaglandins reduces inflammation

NSAIDs also associated with hypersensitivity, SJS, TEN

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33
Q

NSAIDs in 30 year old pregnant woman

A

Third trimester = premature closure of ductus arteriosus
Gastric ulcer, hypertension, thrombosis, bleeding

34
Q

NSAIDs in 75 year old woman with history if ischemic heart disease

A

Coxibs cause thrombosis, hypertension
Aspirin is antiplatelet but gastric ulcer, hypertension and prolonged bleeding time

35
Q

Paracetamol overdose

A

CYP450 conversion in minor pathway to NAPQI, reactive metabolite that causes damage to surrounding liver tissues and cells
Depletes glutathione
Exacerbated by alcohol
Reversed by N-acetyl cysteine

36
Q

Adverse effects of steroids

A
  • Immunodeficiency
    • Moon face, buffalo hump, truncal obesity
    • Aseptic necrosis of femoral head
    • Osteoporosis
    • Muscle wasting
    • Myopathy
    • Diabetes, hyperglycemia
    • Hypokalemia, hyponatremia
    • Thin skin
    • Impaired wound healing
    • Hirsutism, hair growth
    • Impaired growth in children
    • Posterior subcapsular cataracts
    • Glaucoma
    • Easy bruising
37
Q

Transcriptional MoA of corticosteroids

A

Enters cell, binds to nuclear receptors, inducing removal of inhibitory components, homodimerizes to enter nucleus, binds to specific DNA binding sites to induce transcriptional effects to reduce inflammation

38
Q

How do corticosteroids achieve anti-inflammatory effects at different levels

A

○ Activation of antiinflammatory genes
§ Annexin A1
§ Endonucleases
§ IL-1 antagonist
§ IkB-a (TNF-a antagonist)
§ Beta-2 adrenoceptor expression
§ IL-B1 antagonist
○ Suppression of proinflammatory genes
§ Cytokines(TNF-a, INF-y)
§ Chemokines (RANTES)
§ Inflammatory enzymes (COX2, PA2, 5-LOX)
§ Adhesion molecules (VCAM1)
§ Receptors (T cell receptors)

39
Q

Why would triamcinolone be prescribed over hydrocortisone

A

More potent
Used in situations where corticosteroids are needed for longer term
More selectivity for glucocorticoid instead of mineralocorticoid action

40
Q

Metformin MoA

A

Decrease hepatic glucose production
Decrease intestinal glucose uptake
Increase insulin receptor density at tissues

41
Q

Precautions in scheduling appts for diabetics

A

Last mealtime
Duration of insulin effect

42
Q

Side effect of metformin, how to prevent it

A

Increased risk of lactic acidosis
Dont use in pts with history of renal dysfunction

43
Q

Side effect of short acting insulins, how to prevent it

A

Lipodystrophy
Rotate site of injection

44
Q

MoA of glibenclamide

A

Sulfonylureas bind to SU sites on Katp channels, prevent opening and cause depolarization, calcium channels open and cause insulin vesicle exocytosis

45
Q

Adverse effects of glibenclamide

A

Weight gain, hypoglycemia (esp in pts with irregular eating habits, elderly, hepatic/renal dysfunction)

46
Q

Extra benefits of metformin

A

Cardioprotective
Weight loss

47
Q

Chronic facial pain drugs

A

Antidepressants (amitriptyline)
Anticonvulsants (phenytoin, carbamazepine)
Anxiolytics/muscle relaxants (benzodiazepines)

48
Q

Warfarin usage + anticonvulsants

A

Anticonvulsants (phenytoin and carbamazepine) induce CYP450
Less warfarin = thrombosis

49
Q

Amitriptyline MoA

A

Inhibit 5HT and NET
Increase serotonin and norepinephrine in synaptic cleft
Interneurons modulate pain signaling

50
Q

Amitriptyline adverse effects

A

Dry mouth, tachycardia, arrhythmia, blurring of vision, postural hypotension, constipation, sedation, serotonin syndrome if used with SSRIs or MAOs

51
Q

Amox vs Azithromycin

A

Amox no effectiveness against atypicals, pseudomonas and klebsiella

52
Q

Amox MoA

A

Transpeptidase inhibitor
Blocks peptidoglycan cell wall synthesis
Cell death

53
Q

Azithromycin MoA

A

Macrolide, 50S ribosomal subunit inhibitor
Prevents translocation of tRNA from A to P site
Inhibits protein synthesis and cell division

54
Q

Nystatin systemic effects

A

No, no systemic absorption via swish and swallow/spit

55
Q

Nystatin MoA

A

Polyene
Ergosterol, pores in cell wall
Leakage of electrolytes and small molecules
Cell swelling and death

56
Q

Amoxicillin adverse effects

A

CDAD, hypersensitivity, neurotoxicity, hepatotoxicity, anosmia

57
Q

Ciprofloxacin MoA

A

Fluoroquinolone
DNA gyrase in gram neg, topoisomerase IV in gram pos
Inhibits DNA synthesis
Cell death

58
Q

Ciprofloxacin PK

A

Administered orally
Avoid taking with milk or antacids as heavy metal ions form chelates to reduce absorption
Distributes well into bone, urine, kidneys, lungs, prostate
Cleared renally

59
Q

Effectiveness of ciprofloxacin

A

P aeruginosa
Travellers diarrhoea
Food poisoning
Bacillus anthracis
Typhoid fever
Not first line for UTI and MRSA due to resistance

60
Q

Adverse effects of ciprofloxacin

A

Phototoxicity
Tendonitis
QT prolongation
GI disturbances
Peripheral neuropathy
Arthropathy
Increased risk of CDAD
Headaches, dizziness, lightheadedness
Contraindicated in G6PD deficiency, children, breastfeeding and pregnancy
May cause neuromuscular paralysis if given with myasthenia gravis drugs
DDIs increase warfarin and cyclosporine

61
Q

MoA of cotrimoxazole

A

Inhibits folic acid synthesis
Dihydropteroate synthase and dihydrofolate reductase

62
Q

PK of cotrimoxazole

A

Taken orally with full cup of water
IV in severe infection
Good CSF pen, crosses BBB well
Excreted in urine

63
Q

Adverse effects of cotrimoxazole

A

Glossitis
Rash
Photosensitivity
Haematological disturbances like leukopenia, megaloblastic anemia, thrombocytopenia
Contraindicated in pregnancy and G6PD deficency

64
Q

Clindamycin for odontogenic infections

A

Good effectiveness against oral bacteria and anaerobes
Good distribution into salivary gland fluids and bone

65
Q

Adverse effects of clindamycin

A

CDAD, pseudomembranous colitis

66
Q

Suspension > lozenge for pt with xerostomia

A

Lack of saliva to dissolve lozenge

67
Q

Nystatin > fluconazole for oral candidiasis w/ kidney disease

A

Nystatin less side effects as not absorbed
Nystatin targeted via swish and swallow
Nystatin eliminated unchanged in faeces, fluconazole excreted renally so dose adjustment required

68
Q

Adverse effects of nystatin

A

Skin irritation if administered topically

69
Q

Precautions of fluconazole prescription

A

Kidney dysfunction
Hepatic dysfunction (azoles cause hepatotoxicity)
CYP450 drugs like warfarin (azoles inhibit CYP450)

70
Q

Adverse effects of fluconazole

A

GI disturbances
Hepatotoxicity
QT prolongation

71
Q

Azole resistance types

A

Efflux pumps
Alterations to C-14-a-demethylase reducing affinity

72
Q

Combination therapy?

A

Less drug needed due to synergism, less side effects, less resistance
Broader spectrum of activity

73
Q

Metronidazole DDIs?

A

Metronidazole inhibits CYP450, can affect drugs like warfarin

74
Q

Adverse effects of metronidazole

A

Gastric disturbances, unpleasant metallic taste, oral moniliasis, peripheral neuropathy

75
Q

Clindamycin MoA

A

Bind to 50s ribosomal subunit to inhibit protein synthesis, bacteriostatic

76
Q

Macrolide suitability for odontogenic infections

A

Slightly broader activity than penicillins
Can be used but may cause oral candidiasis or secondary infection, not selective

77
Q

Adverse effects of macrolides

A

Ototoxicity
Hepatotoxicity
May cause QT prolongation
GI distress

78
Q

Patient related factors for antibiotic planning

A

Comorbidities - renal failure
Concomitant drug usage - warfarin
Pregnancy
Age - children
Genetics - G6PD deficiency
Hypersensitivity - beta lactams

79
Q

Antibiotic related factors for antibiotic planning

A

Side effects - penicillins?
Resistance - clindamycin?
Distribution - clindamycin?

80
Q

Vancomycin adverse effects

A

Nephrotoxicity
Ototoxicity
Red man syndrome

81
Q

Aminoglycoside adverse effects

A

Nephrotoxicity
Ototoxicity
Neuromuscular paralysis w myasthenia gravis
Contraindicated in pregnancy

Last min Pharma (1 decks)

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