kettering pharmacology Flashcards
1
Q
list antiviral agents
A
- ribavirin
- RSV-IVIG (RSV immune globulin, human (intravenous route)
- palivizumab
2
Q
what is palivizumab?
A
human-made RSV antibody–inhibits action of virus and helps prevent infection
3
Q
Synagis is the trade name for
A
palivizumab
4
Q
trade name for palivizumab
A
Synagis
5
Q
primary anti-tb drugs
A
isoniazid
rifampin
ethambutol
6
Q
secondary anti-tb drugs
A
streptomycin
cycloserine
ethionamide
7
Q
serious, life-threatening infections caused by gram-positive cocci indicate which antibiotic?
A
vancomycin
8
Q
what antibiotic do you give someone with mrsa?
A
vancomycin
9
Q
side effects of vancomycin
A
hypotension
nephrotoxicity
ototoxicity
flushed skin
10
Q
what are fluroquinolones?
A
broad-spectrum antibiotic
effective against respiratory, GI, urinary tract, and abdominal infections
11
Q
examples of fluoroquinolones
A
levofloxacin (levaquin)
ciprofloxacin (cipro)
12
Q
examples of aminoglycosides
A
amikacin
gentamicin
tobramycin
13
Q
what class of antibiotic is tobramycin?
A
aminoglycoside
14
Q
generic name of Rocephin
A
ceftriaxone
15
Q
ceftriaxone and ceftazidime are what class of antibiotics?
A
third-generation cephalosporins
16
Q
which class of antibiotic has generations?
A
cephalosporins
17
Q
what percentage of people are allergic to penicillin?
A
15-20%
18
Q
how long does it take to get culture and sensitivity results?
A
24-36 hours
19
Q
how long does it take to get results from a gram stain?
A
immediately
20
Q
treatment for methemoglobin
A
methylene blue
ascorbic acid
21
Q
what drugs predispose a patient to MetHb?
A
- nitrates and nitrites (nitroglycerine, nitroprusside, INO)
- topical anesthetics (benzocaine, lidocaine, novocaine, cetacaine)
- Dapsone (for acne)
- acetaminophen overdose
22
Q
normal concentration of MetHb
A
<1%
23
Q
How does MetHb color the blood?
A
brownish (chocolate-brown) to blue
24
Q
What med for torsades de pointes?
A
magnesium
25
side effect of amiodarone
pulmonary toxicity--inflammation, pneumonitis, fibrosis
26
Indications for amiodarone
```
Tach
SVT
Afib
Aflutter
Vfib
```
27
Generic name for Cardizem
diltiazem
28
Commercial name for diltiazem
Cardizem
29
Indications for diltiazem
```
HTN
Angina
Arrhythmia
AFib
Aflutter
paroxysmal SVT
```
30
digitalis qualities
antiarrthmic; slows AV conduction in Afib and Aflutter
31
big acute care calcium channel blockers
lidocaine
procainamide
nicardipine
32
indications for atropine
bradycardia
AV nodal block
asystole
33
Name synthetic anti-diuretic agent
Desmopressin
34
what is Desmopressin?
a synthetic replacement for vasopressin
35
name major vasodilators
milrinone
nitroprusside
nitroglycerin
prostacyclins
36
facts for milrinone
* inotrope & vasodilator
* reduces preload and afterload
* indication: short-term management of heart failure
* side effects: hypotension and thrombocytopenia
37
facts for nitroprusside
decreases afterload
can increase cardiac output
indications: hypotension
side effects: HTN, vomiting, hyperventilation, tachycardia
38
indications for nitroglycerin
```
sublingual: angina pectoris
IV:
- CHF associated with acute MI
- pulmonary HTN
- hypertensive emergencies perioperatively, especially during cardiovascular surgery
```
39
name a prostacylin
Iloprost (epoprostenol)
40
what drug class is epoprostenol?
prostacyclin/prostaglandin
41
uh, what vasodilators do—and relevant clinical effects
decrease vascular smooth muscle tone
decrease BP and SVR
treat HTN
42
name the pressors
```
epinephrine
norepinephrine
isoproterenol
phenylephrine
dopamine
dobutamine
vasopressin
hydrocortisone
```
43
Commonly prescribed antiplatelet meds
aspirin
clopidogrel
ticlopidine (no longer available in US--says Lexicomp 20200710)
44
name the beta blockers
atenolol, propranolol, labetalol
45
name three classes of diuretics
loop diuretics
osmotic diuretics
carbonic anhydrase inhibitors
(why are spirolactones not named?)
46
Name the carbonic anhydrase inhibitor
acetazolamide
47
acetazolamide info
uses: cerebral edema, peripheral edema
| adverse effects: causes excretion of bicarbonate ions (so contraindicated for renal or respiratory failure)
48
action of pentobarbital
depresses activity in brain cells
49
indications for pendobarbital
sedation
increased ICP (pts with TBI)
insomnia
50
Side effects of pentobarbital
CNS depression
respiratory depression
laryngospasm
bronchospasm
51
Indications for precedex
```
intubated and mechanically ventilated patients
uncontrolled shivering (which increases metabolism, O2 consumption, CO2 production)
```
52
What's the onset of dexmedetomidine?
< 5 minutes
53
What's the duration of dexmedetomidine?
10 minutes
54
What are the side effects of dexmedetomidine?
```
hypotension & hypertension
bradycardia, esp in elderly patients
a fib
pulmonary edema
pleural effusion
```
55
how to administer dexmedetomidine?
continuous IV infusion
56
indications for haloperidol
delerium
agitation
confusional anxiety
57
advantage of haloperidol
little to no risk for respiratory depression; could facilitate weaning from ventilator
58
onset of haloperidol
10-20 minutes
59
duration of haloperidol
lasts for hours
60
how to administer haloperidol
not recommended for IV infusion
61
side effects of haloperidol
seizures
tachycardia
laryngospasm
62
side effects of propofol
```
bradycardia
hypotension
hypoventilation
decreased ICP
impaired cerebral blood flow
seizures
```
63
onset of propofol
(by IV bolus) 1 minute
64
duration of propofol
5-8 minutes
65
how to administer propofol
continuous IV drip
66
How quickly does a patient get over a propofol drip?
Awakening occurs 10-15 minutes after stopping, even after prolonged administration
67
What are the advantages of propofol for neurological injury?
reduces cerebral O2 consumption
| reduces ICP
68
where would propofol be contraindicated?
patients in hemorrhagic shock because of risk of hypotension
69
how are benzodiazepines cleared?
metabolized in liver
| excreted in urine
70
danger of benzodiazepines
causes respiratory depression in some patients
71
side effects of benzodiazepines
hypotension
respiratory depression
excessive sedation
72
what conditions should adjust doses of benzodiazepines?
lower dosage should be used in elderly patients
| and those with heart or hepatic insufficiency
73
things to know about midazolam
sedative of choice for short-term sedation
shortest duration of action
IV infusion for more than a few hours can produce prolonged sedation
74
things to know about lorazepam
slowest onset of action
long duration of action
ideal for ventilated patients
should not be used when rapid awakening is desired
75
things to know about diazepam
least preferred IV benzo
higher risk of oversedation
continuous diazepam should be avoided
76
name drugs and commercial names for benzos
midazolam/Versed
lorazepam/Ativan
diazepam/Valium
77
benzo reversal agent
flumazenil
78
commercial name for flumazenil
Romazicon
79
what does BIS stand for?
bispectral index
80
what is BIS monitor used for?
monitor level of *anesthesia*
81
To what level on Modified Ramsey Scale would you want to sedate a ventilated patient?
Level 3: Responds to verbal commands
82
phosphodiesterase inhibitors includes this class of respiratory stimulants
methylxanthines
83
name the methylxanthines
theophylline/aminophylline
oxtriphylline
(caffeine)
84
side effects of methylxanthines
```
anxiety
insomnia
nausea, vomiting
tremors
tachycardia
arrhythmias
hypotension
```
85
what's the therapeutic blood level of theophylline
10-20 mcg/mL
86
why do we need to target a specific level of methylxanthines?
to optimize bronchodilation
| minimize side effects
87
what do methylxanthines do?
relax smooth muscle--bronchodilation, as far as we're concerned
88
what is the off-label use of methylxanthines?
respiratory stimulant
89
name the respiratory stimulants
doxapram
| methylxanthines
90
what does doxapram do?
activates peripheral carotid chemoreceptors
| at higher doses, stimulates medulary respiratory center
91
where can doxapram be useful?
copd
post-anesthesia respiratory depression
acute hypercapnea
92
side effects of doxapram
```
hypertension
tachycardia
arrhythmias
seizures
laryngospasm
bronchospasm
```
93
contraindications for doxapram
severe acute asthma
severe cardiac disorders
seizure disorders
94
what is omalizumab?
monoclonal antibody that binds to IgE and is used for asthmatics who find insufficient control of symptoms with ICS
95
what is trade name for omalizumab?
Xolair
96
what is the generic name for Xolair?
omalizumab
97
How does egophony work again?
Patient says “E”—to auscultation sounds like “A” to suggest consolidation of lung tissue.
98
What does an increase in volume of the spoken voice during auscultation suggest?
Consolidation.
99
What does a decrease in the volume of the spoken voice upon auscultation suggest?
Obstructed bronchi
Pneumothorax
Emphysema
100
What conditions cause tracheal deviation away from pathology?
Tension pneumothorax
Massive pleural effusion
Neck or thyroid tumors
Large mediastinal mass
101
What conditions push trachea toward pathology?
Pulmonary atelectasis
Pulmonary fibrosis
Pneumonectomy
Diaphragmatic paralysis
102
For Kettering, how much does the heart rate have to push up to count as an adverse reaction?
20 bpm
103
Characterize apneustic breathing.
Prolonged gasping inspiration
| Extremely short, insufficient expiration
104
What causes apneustic breathing?
Problems with respiratory center
Trauma
Tumor
105
Characterize Kussmaul’s breathing.
Increased respiratory rate (usually >20bpm)
Increased depth
Irregular rhythm
Breath sounds labored
106
What causes Kussmaul’s breathing?
Metabolic acidosis
Renal failure
Diabetic ketoacidosis
107
Characterize Biot’s breathing.
Increased respiratory rate
Increased depth
Uniform depth
Irregular periods of apnea
108
What causes Biot’s breathing?
CNS problem
109
What causes Cheyne-Stokes breathing?
Increased intracranial pressure
Meningitis
Drug overdose
110
Characterize hyperpnea.
Increased respiratory rate
Increased depth
Regular rhythm
111
What causes tachypnea?
Hypoxia
Fever
Pain
CNS problem
112
What is the mechanism of action of nitroprusside?
Direct action on arteriolar and venous smooth muscle produces peripheral vasodilation
- -thus reduces peripheral resistance
- -decreases afterload
- -increase cardiac output (Lexicomp accessed 20200525)
113
What is the pharmacologic category of nitroprusside?
* Antihypertensive
| * Vasodilator (Lexicomp accessed 20200525)
114
What are the labeled indications for nitroprusside?
* Acute decompensated heart failure
| * Acute hypertension (Lexicomp accessed 20200525)
115
Name select adverse effects of nitroprusside
* Cyanide toxicity
* Hypotension
* Elevated ICP
* Methemoglobinemia (Lexicomp accessed 20200525)
116
Name select side effects of nitroprusside
* Confusion
* Fast breathing
* Fast/abnormal heartbeat
* Vomiting
* Headache (Lexicomp accessed 20200525)
117
What are the labeled indications for verapamil?
* Angina
* Afib or Aflutter (requiring rate control)
* Hypertension
* SVT (Lexicomp accessed 20200525)
118
What are possible adverse effects from verapamil?
* Conduction abnormalities (can lead to 1st degree heart block or sinus bradycardia)
* Adverse hepatic effects
* Hypotension/syncopy (Lexicomp accessed 20200525)
119
What are the pharmacologic categories for verapamil?
* Antianginal agent
* Antiarrhytmic agent
* Calcium channel blocker, nondihydropyridine
120
How does clopidogril work?
Blocks a glycoprotein receptor on the membrane surface of platelets that effectively prevents platelet aggregation. Platelets blocked by clopidogril are blocked for the remainder of their ~7-10-day lifespan. (Lexicomp accessed 20200710)
121
To what pharmacological category does roflumilast belong?
Phosphodiesterase-4 Enzyme Inhibitor (Lexicomp accessed 20201021)
122
Use for roflumilast.
“To reduce the risk of COPD exacerbation in patients with severe COPD associated with chronic bronchitis and a history of exacerbations.” (Lexicomp accessed 20201021)
123
What is the brand name for roflumilast?
* Daliresp (US)
| * Daxas (Canada) (Lexicomp accessed 20201021)
124
What is the generic name for Daliresp?
Roflumilast
125
How does roflumilast work for severe COPDers prone to exacerbations?
* Suppresses cytokines release
* Inhibits infiltration of the lung by neutrophils and other leukocytes
* Attenuates pulmonary remodeling and mucociliary malfunction (Lexicomp accessed 20201021)
126
What does the SGLT-2 in SGLT-2 inhibitor stand for?
Sodium-glucose co-transporter 2
127
The mechanism of action of midodrine.
"Midodrine forms an active metabolite, desglymidodrine, which is an alpha1-agonist. This agent increases arteriolar and venous tone resulting in a rise in standing, sitting, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension." Lexicomp, accessed 20210212
128
Name four
| off-label uses for midodrine per Lexicomp.
* Ascites, cirrhotic, diuretic resistant or with hypotension
* Hepatorenal syndrome (type 1)
* Hypotension in the ICU, vasopressor sparing
* Hemodialysis-induced hypotension, prevention Lexicomp, accessed 20210212
129
Commercial name for midodrine
Proamatine
130
What is the mechanism of action of warfarin?
Paraphrased--an active form of vitamin K is required to produce clotting factors II, VII, IX and X. As vitamin K is spent in producing these clotting factors, the body reactivates it. Warfarin inhibits the reactivation--and thereby depletes total vitamin K stores and so inhibits productive of clotting factors. (Lexicomp, accessed 20210215)
131
Again--what tests monitor warfarin therapy?
Prothrombin time and INR
132
Achilles tendon rupture is a famous adverse effect of what medication?
Ceftriaxone (fluoroquinolone) (Hasudungan on bronchiectasis accessed 20211215)
