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kettering pharmacology Flashcards

1
Q

list antiviral agents

A
  • ribavirin
  • RSV-IVIG (RSV immune globulin, human (intravenous route)
  • palivizumab
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2
Q

what is palivizumab?

A

human-made RSV antibody–inhibits action of virus and helps prevent infection

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3
Q

Synagis is the trade name for

A

palivizumab

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4
Q

trade name for palivizumab

A

Synagis

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5
Q

primary anti-tb drugs

A

isoniazid
rifampin
ethambutol

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6
Q

secondary anti-tb drugs

A

streptomycin
cycloserine
ethionamide

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7
Q

serious, life-threatening infections caused by gram-positive cocci indicate which antibiotic?

A

vancomycin

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8
Q

what antibiotic do you give someone with mrsa?

A

vancomycin

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9
Q

side effects of vancomycin

A

hypotension
nephrotoxicity
ototoxicity
flushed skin

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10
Q

what are fluroquinolones?

A

broad-spectrum antibiotic

effective against respiratory, GI, urinary tract, and abdominal infections

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11
Q

examples of fluoroquinolones

A

levofloxacin (levaquin)

ciprofloxacin (cipro)

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12
Q

examples of aminoglycosides

A

amikacin
gentamicin
tobramycin

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13
Q

what class of antibiotic is tobramycin?

A

aminoglycoside

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14
Q

generic name of Rocephin

A

ceftriaxone

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15
Q

ceftriaxone and ceftazidime are what class of antibiotics?

A

third-generation cephalosporins

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16
Q

which class of antibiotic has generations?

A

cephalosporins

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17
Q

what percentage of people are allergic to penicillin?

A

15-20%

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18
Q

how long does it take to get culture and sensitivity results?

A

24-36 hours

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19
Q

how long does it take to get results from a gram stain?

A

immediately

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20
Q

treatment for methemoglobin

A

methylene blue

ascorbic acid

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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
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22
Q

normal concentration of MetHb

A

<1%

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23
Q

How does MetHb color the blood?

A

brownish (chocolate-brown) to blue

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24
Q

What med for torsades de pointes?

A

magnesium

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25
Q

side effect of amiodarone

A

pulmonary toxicity–inflammation, pneumonitis, fibrosis

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26
Q

Indications for amiodarone

A 
Tach
SVT
Afib
Aflutter
Vfib
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27
Q

Generic name for Cardizem

A

diltiazem

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28
Q

Commercial name for diltiazem

A

Cardizem

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29
Q

Indications for diltiazem

A 
HTN
Angina
Arrhythmia
AFib
Aflutter
paroxysmal SVT
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30
Q

digitalis qualities

A

antiarrthmic; slows AV conduction in Afib and Aflutter

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31
Q

big acute care calcium channel blockers

A

lidocaine
procainamide
nicardipine

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32
Q

indications for atropine

A

bradycardia
AV nodal block
asystole

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33
Q

Name synthetic anti-diuretic agent

A

Desmopressin

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34
Q

what is Desmopressin?

A

a synthetic replacement for vasopressin

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35
Q

name major vasodilators

A

milrinone
nitroprusside
nitroglycerin
prostacyclins

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36
Q

facts for milrinone

A
  • inotrope & vasodilator
  • reduces preload and afterload
  • indication: short-term management of heart failure
  • side effects: hypotension and thrombocytopenia
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37
Q

facts for nitroprusside

A

decreases afterload
can increase cardiac output
indications: hypotension
side effects: HTN, vomiting, hyperventilation, tachycardia

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38
Q

indications for nitroglycerin

A 
sublingual: angina pectoris
IV: 
- CHF associated with acute MI
- pulmonary HTN
- hypertensive emergencies perioperatively, especially during cardiovascular surgery
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39
Q

name a prostacylin

A

Iloprost (epoprostenol)

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40
Q

what drug class is epoprostenol?

A

prostacyclin/prostaglandin

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41
Q

uh, what vasodilators do—and relevant clinical effects

A

decrease vascular smooth muscle tone
decrease BP and SVR
treat HTN

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42
Q

name the pressors

A 
epinephrine
norepinephrine
isoproterenol
phenylephrine
dopamine
dobutamine
vasopressin
hydrocortisone
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43
Q

Commonly prescribed antiplatelet meds

A

aspirin
clopidogrel
ticlopidine (no longer available in US–says Lexicomp 20200710)

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44
Q

name the beta blockers

A

atenolol, propranolol, labetalol

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45
Q

name three classes of diuretics

A

loop diuretics
osmotic diuretics
carbonic anhydrase inhibitors
(why are spirolactones not named?)

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46
Q

Name the carbonic anhydrase inhibitor

A

acetazolamide

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47
Q

acetazolamide info

A

uses: cerebral edema, peripheral edema

adverse effects: causes excretion of bicarbonate ions (so contraindicated for renal or respiratory failure)

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48
Q

action of pentobarbital

A

depresses activity in brain cells

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49
Q

indications for pendobarbital

A

sedation
increased ICP (pts with TBI)
insomnia

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50
Q

Side effects of pentobarbital

A

CNS depression
respiratory depression
laryngospasm
bronchospasm

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51
Q

Indications for precedex

A 
intubated and mechanically ventilated patients
uncontrolled shivering (which increases metabolism, O2 consumption, CO2 production)
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52
Q

What’s the onset of dexmedetomidine?

A

< 5 minutes

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53
Q

What’s the duration of dexmedetomidine?

A

10 minutes

54
Q

What are the side effects of dexmedetomidine?

A 
hypotension &amp; hypertension
bradycardia, esp in elderly patients
a fib
pulmonary edema
pleural effusion
55
Q

how to administer dexmedetomidine?

A

continuous IV infusion

56
Q

indications for haloperidol

A

delerium
agitation
confusional anxiety

57
Q

advantage of haloperidol

A

little to no risk for respiratory depression; could facilitate weaning from ventilator

58
Q

onset of haloperidol

A

10-20 minutes

59
Q

duration of haloperidol

A

lasts for hours

60
Q

how to administer haloperidol

A

not recommended for IV infusion

61
Q

side effects of haloperidol

A

seizures
tachycardia
laryngospasm

62
Q

side effects of propofol

A 
bradycardia
hypotension
hypoventilation
decreased ICP
impaired cerebral blood flow
seizures
63
Q

onset of propofol

A

(by IV bolus) 1 minute

64
Q

duration of propofol

A

5-8 minutes

65
Q

how to administer propofol

A

continuous IV drip

66
Q

How quickly does a patient get over a propofol drip?

A

Awakening occurs 10-15 minutes after stopping, even after prolonged administration

67
Q

What are the advantages of propofol for neurological injury?

A

reduces cerebral O2 consumption

reduces ICP

68
Q

where would propofol be contraindicated?

A

patients in hemorrhagic shock because of risk of hypotension

69
Q

how are benzodiazepines cleared?

A

metabolized in liver

excreted in urine

70
Q

danger of benzodiazepines

A

causes respiratory depression in some patients

71
Q

side effects of benzodiazepines

A

hypotension
respiratory depression
excessive sedation

72
Q

what conditions should adjust doses of benzodiazepines?

A

lower dosage should be used in elderly patients

and those with heart or hepatic insufficiency

73
Q

things to know about midazolam

A

sedative of choice for short-term sedation
shortest duration of action
IV infusion for more than a few hours can produce prolonged sedation

74
Q

things to know about lorazepam

A

slowest onset of action
long duration of action
ideal for ventilated patients
should not be used when rapid awakening is desired

75
Q

things to know about diazepam

A

least preferred IV benzo
higher risk of oversedation
continuous diazepam should be avoided

76
Q

name drugs and commercial names for benzos

A

midazolam/Versed
lorazepam/Ativan
diazepam/Valium

77
Q

benzo reversal agent

A

flumazenil

78
Q

commercial name for flumazenil

A

Romazicon

79
Q

what does BIS stand for?

A

bispectral index

80
Q

what is BIS monitor used for?

A

monitor level of anesthesia

81
Q

To what level on Modified Ramsey Scale would you want to sedate a ventilated patient?

A

Level 3: Responds to verbal commands

82
Q

phosphodiesterase inhibitors includes this class of respiratory stimulants

A

methylxanthines

83
Q

name the methylxanthines

A

theophylline/aminophylline
oxtriphylline
(caffeine)

84
Q

side effects of methylxanthines

A 
anxiety
insomnia
nausea, vomiting
tremors
tachycardia
arrhythmias
hypotension
85
Q

what’s the therapeutic blood level of theophylline

A

10-20 mcg/mL

86
Q

why do we need to target a specific level of methylxanthines?

A

to optimize bronchodilation

minimize side effects

87
Q

what do methylxanthines do?

A

relax smooth muscle–bronchodilation, as far as we’re concerned

88
Q

what is the off-label use of methylxanthines?

A

respiratory stimulant

89
Q

name the respiratory stimulants

A

doxapram

methylxanthines

90
Q

what does doxapram do?

A

activates peripheral carotid chemoreceptors

at higher doses, stimulates medulary respiratory center

91
Q

where can doxapram be useful?

A

copd
post-anesthesia respiratory depression
acute hypercapnea

92
Q

side effects of doxapram

A 
hypertension
tachycardia
arrhythmias
seizures
laryngospasm
bronchospasm
93
Q

contraindications for doxapram

A

severe acute asthma
severe cardiac disorders
seizure disorders

94
Q

what is omalizumab?

A

monoclonal antibody that binds to IgE and is used for asthmatics who find insufficient control of symptoms with ICS

95
Q

what is trade name for omalizumab?

A

Xolair

96
Q

what is the generic name for Xolair?

A

omalizumab

97
Q

How does egophony work again?

A

Patient says “E”—to auscultation sounds like “A” to suggest consolidation of lung tissue.

98
Q

What does an increase in volume of the spoken voice during auscultation suggest?

A

Consolidation.

99
Q

What does a decrease in the volume of the spoken voice upon auscultation suggest?

A

Obstructed bronchi
Pneumothorax
Emphysema

100
Q

What conditions cause tracheal deviation away from pathology?

A

Tension pneumothorax
Massive pleural effusion
Neck or thyroid tumors
Large mediastinal mass

101
Q

What conditions push trachea toward pathology?

A

Pulmonary atelectasis
Pulmonary fibrosis
Pneumonectomy
Diaphragmatic paralysis

102
Q

For Kettering, how much does the heart rate have to push up to count as an adverse reaction?

A

20 bpm

103
Q

Characterize apneustic breathing.

A

Prolonged gasping inspiration

Extremely short, insufficient expiration

104
Q

What causes apneustic breathing?

A

Problems with respiratory center
Trauma
Tumor

105
Q

Characterize Kussmaul’s breathing.

A

Increased respiratory rate (usually >20bpm)
Increased depth
Irregular rhythm
Breath sounds labored

106
Q

What causes Kussmaul’s breathing?

A

Metabolic acidosis
Renal failure
Diabetic ketoacidosis

107
Q

Characterize Biot’s breathing.

A

Increased respiratory rate
Increased depth
Uniform depth
Irregular periods of apnea

108
Q

What causes Biot’s breathing?

A

CNS problem

109
Q

What causes Cheyne-Stokes breathing?

A

Increased intracranial pressure
Meningitis
Drug overdose

110
Q

Characterize hyperpnea.

A

Increased respiratory rate
Increased depth
Regular rhythm

111
Q

What causes tachypnea?

A

Hypoxia
Fever
Pain
CNS problem

112
Q

What is the mechanism of action of nitroprusside?

A

Direct action on arteriolar and venous smooth muscle produces peripheral vasodilation

  • -thus reduces peripheral resistance
  • -decreases afterload
  • -increase cardiac output (Lexicomp accessed 20200525)
113
Q

What is the pharmacologic category of nitroprusside?

A
  • Antihypertensive

* Vasodilator (Lexicomp accessed 20200525)

114
Q

What are the labeled indications for nitroprusside?

A
  • Acute decompensated heart failure

* Acute hypertension (Lexicomp accessed 20200525)

115
Q

Name select adverse effects of nitroprusside

A
  • Cyanide toxicity
  • Hypotension
  • Elevated ICP
  • Methemoglobinemia (Lexicomp accessed 20200525)
116
Q

Name select side effects of nitroprusside

A
  • Confusion
  • Fast breathing
  • Fast/abnormal heartbeat
  • Vomiting
  • Headache (Lexicomp accessed 20200525)
117
Q

What are the labeled indications for verapamil?

A
  • Angina
  • Afib or Aflutter (requiring rate control)
  • Hypertension
  • SVT (Lexicomp accessed 20200525)
118
Q

What are possible adverse effects from verapamil?

A
  • Conduction abnormalities (can lead to 1st degree heart block or sinus bradycardia)
  • Adverse hepatic effects
  • Hypotension/syncopy (Lexicomp accessed 20200525)
119
Q

What are the pharmacologic categories for verapamil?

A
  • Antianginal agent
  • Antiarrhytmic agent
  • Calcium channel blocker, nondihydropyridine
120
Q

How does clopidogril work?

A

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
Q

To what pharmacological category does roflumilast belong?

A

Phosphodiesterase-4 Enzyme Inhibitor (Lexicomp accessed 20201021)

122
Q

Use for roflumilast.

A

“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
Q

What is the brand name for roflumilast?

A
  • Daliresp (US)

* Daxas (Canada) (Lexicomp accessed 20201021)

124
Q

What is the generic name for Daliresp?

A

Roflumilast

125
Q

How does roflumilast work for severe COPDers prone to exacerbations?

A
  • Suppresses cytokines release
  • Inhibits infiltration of the lung by neutrophils and other leukocytes
  • Attenuates pulmonary remodeling and mucociliary malfunction (Lexicomp accessed 20201021)
126
Q

What does the SGLT-2 in SGLT-2 inhibitor stand for?

A

Sodium-glucose co-transporter 2

127
Q

The mechanism of action of midodrine.

A

“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
Q

Name four

off-label uses for midodrine per Lexicomp.

A
  • 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
Q

Commercial name for midodrine

A

Proamatine

130
Q

What is the mechanism of action of warfarin?

A

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
Q

Again–what tests monitor warfarin therapy?

A

Prothrombin time and INR

132
Q

Achilles tendon rupture is a famous adverse effect of what medication?

A

Ceftriaxone (fluoroquinolone) (Hasudungan on bronchiectasis accessed 20211215)

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