Last Minute Review Flashcards
What drug class would you use for treatment of Zollinger-Ellison syndrome?
PPI - PEORL (“-prazole”)
Treating gastric ulcers, what should not be give with Sucralfate?
Antacids
What is Pirenzepine?
M1 selective antagonist used in the treatment of peptic ulcers, as it reduces gastric acid secretion and reduces muscle spasm.
What are the two mu opioid agonist used as antidiarrheals?
Loperamide and diphenoxylate
**note that diphenoxylate has a little bit of atropine added to it to inhibit potential for abuse
What is Pentazocine?
Mixed k Agonist and mu partial agonist/Antagonist
Potent analgesic in opioid naive patients but precipitate withdrawal in pts that are physically dependent on opioids. It has a ceiling effect and illicit psychomimetic effects.
What mixed agonist/antagonists used as opioids have psychotomimetic effects?
Pentazocine
Butorphanol
Nalbuphine
**note that the last one is buprenorphine and this does not have a pyschotomimetic effect as it is a kappa antagonist whereas the others are kappa agonists
Adverse effects of TCA?
constipation, dry mouth, blurred vision,
tachycardia, urinary retention
What channels do gabapentin and carbamazepine block?
Gabapentin - VG Ca2+ channels
Carbamazepine - VG Na+ channels
What are the first line drugs used to PREVENT migraines?
- B-blockers
- Valproate
- Topiramate
Valproate – indicated for bipolar disorder, epilepsy and migraine prophylaxis. It functions by inhibiting VG Na+ channels and T-type Ca2+ channels. AE - GI side effects, thrombocytopenia, hepatotoxicity (rare), teratogenic
Topiramate – indicated for epilepsy and migraine prophylaxis. It inhibits VG-Na+ channels, acts as a GABAa receptor agonist and glutamate receptor antagonist. AE - somnolence, fatigue, cognitive slowing, nervousness, confusion, acute myopia, glaucoma, hyperthermia, renal stones, teratogenic [CNS AE are the most common]
Which NSAID can precipitate acute gout attacks?
NSAIDs
DOC for postherpetic neuralgia and trigeminal neuralgia?
Trigeminal neuralgia - carbamazepine
Postherpetic neuralgia - lidocaine
Adverse effects of glucocorticoids?
[short term] – HTN, HYPERGLYCEMIA, immunosupression, psychotic reactions, cognitive impairment
[long term] – myopathy, Cushing’s syndrome, osteoporosis
What is Leflunomide?
Prodrug that is converted to teriflunomide leading to an inhibition of pyrimidine synthesis. [inhibits dihydroorotate dehydrogenase]
Uses…
- RA
- SLE
- Myasthenia gravis
**do not use in pregnancy
DOC chlamydia?
Doxycycline
Organisms that Vancomycin treats?
Gram positive - multi drug resistance!
**s. epidermidis, enterococcus species, oral dose for c. diffe
When should Nitrofurantoin not be used in pregnancy?
After 38 weeks, or within the 1st month of life
Empiric therapy for life threatening sepsis?
Cefepime + vancomycin – empiric therapy for
life‐threatening infections – IV, broad spectrum
& effective against MDR bacteria
Empiric therapy for Severe Febrile Neutropenia?
USE BROAD SPECTRUM (ex. Cefipime)
Tx severe acne?
Docycycline
When should you not give tetracyclines?
Pregnant women and growing children! - inhibits bone growth and causes discoloration of teeth
1 yo with Otitis media with minor PCN allergy?
mild PCN - you can use carbapenems so Cetriaxone
Severe PCN -
What categories of drugs should you not give to pts with SEVERE PCN allergies?
PCN, amoxicillin, ampicillin, pseudomonas and staph -cillins, carbapenems, monobactams (Aztreonam), cephalosporins
DOC syphillis?
Benzathine PCN G
What is mupirocin?
Antibiotic belonging to monoxycarbolic acid glass that has activity against most gram positive cocci, including MRSA and streptococci (but not enterococci). It is the only topical/intranasal agent with activity against MRSA.
Mucpirocin binds bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis.
Intranasal - eradicats nasal colonization of MRSA in healthcare workers
Topically - treats impetigo or secondary infected traumatic skin lesion due to S. aureus or S. pyogenes
AE - resistance develops if used for long periods, local and dermatologic effects (burning, edema, tenderness, dry skin, pruritus)
What are Quinupristin and Dalfopristin?
These medications are given in combination as they act synergistically to have bactericidal action. They bind to separate sites on the 50S bacterial ribosome and leave a long post-antibiotic effect. Resistance with these drugs are uncommon as at least 2 mutations needs to occur for drug resistance to be achieved.
- Administration - IV only
- Penetrates macrophages and polymorphonucleocytes
- inhibits CYP3A4
These medications are effective against gram-positive cocci and target multi-drug resistant bacteria (streptococci, PRSP, MRSA, E. faecium). – because they are effective towards these bacteria, treatment with Streptogramins is restricted to treatment of infections caused by drug-resistant staphylococci or VRE.
AE - usually infusion related (venous irritation, arthralgia and myalgia), GI effects, CNS effects (headache, pain)
What are the common causes of resistance to cipro and other fluoroquinolones?
- chromosome-encoded mutation in DNA GYRASE
- plasmid-mediated resistance
- efflux pump
How is resistance with macrolides achieved?
methylation of 23S rRNA-binding site therefore drug can no longer bind
What is linezolid?
Binds 50S subunit preventing proteins synthesis by inhibiting formation of initiation complex.
used for gram positive species with MDR
AE - BM suppression, peripheral neuropathy, SEROTONIN SYNDROMES
Which cephalosporins may cause a disulfiram reaction?
Cefamandole
Cefotetan
Cefaperazone
AE of ganciclovir?
Myelosuppression
What is foscarnet?
Organic analog of inorganic pyrophosphate thereby selectively inhibiting pyrophosphate binding site of viral DNA polymerase. Does not require phosphorylation and is used in resistant herpes.
Resistance - pt mutations in polymerase
Administered via IV - last resort drug
AE - nephrotoxicity is extremely significant and problematic, electrolyte disturbance, anemia, genital ulceration (in men), CNS (hallucinations seizures, headache)
When treating CMV colitis, what should be administered with Cidofovir?
Probenecid - this prevents nephrotoxicity
Most common adverse effect of cyclosporine?
Nephrotoxicity
Which medication increased HDL the most? Decreases TAGs the most?
Increases HDL - niacin
Decreases TAGs - fibrates
D2 receptor antagonists used as anti-emetics?
Phenothiazines, promethazine, droperidol
Phenothiazines (prochlorperazine) - antagonist at D2 receptors and muscarinic receptors [AE - extrapyramidal symptoms, hypotension, sedation]
Promethazine - anti-dopaminergic and anticholinergic used as antiemetic, antipsychotic effects and sedative
Droperidol - anti-dopinergic, antiemetic, antipsychotic and neuroleptic analgesic agent
DOC toxo? What if Toxo encephalitis?
Toxo - TMP-SMX
Toxo encephalitis - pyrimethamine+clindamycin or SMX or folinic acid
AE of quinine?
prolonged QT interval, hypotension, hypoglycemia, cinchonism, uterine contractions
Action of terbinafine?
Inhibition of squalene epoxide
DOC echinococcus granulosus?
Albendazole
DOC taenia solium?
Albendazole
DOC leishmaniasis?
Sodium stibogluconate OR Amphotericin B
DOC hemolymphatic stage of trypanosomiasis?
Pentaminide
DOC trypanosomiasis?
Melarsoprol or suramin
AE chloroquine?
retinopathy and hemolysis due to G6PD deficiency
AE mefloquine?
neuropsychiatric toxicity
NSAIDs and GI risks?
celecoxib has lowest GI risk (aspirin, ibuprofen and diclofenac have low risk, prioxicam has high risk!)
Alternative treatments to PCP?
clinamycin+primaquine
dapsone+trimethoprim
atovaquone
pentamidine
H. pylori tx regimes
Treatment regimens…
PPI+Clarithromycin+amoxicillin = 10-14 days
PPI+Clarithromycin+metronidazole = 10-14 days
Bismuth subsalicylate+metronidazole+tetracycline+Ranitidine or PPI = 10-14 days
Tx of infective endocarditis in pts with native valve vs prosthetic valve.
Native valve - PCN G + gentamicin
Prosthetic valve - Vancomycin + gentamicin
