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Pharm 2 > Last Minute Review > Flashcards

Last Minute Review Flashcards

1
Q

What drug class would you use for treatment of Zollinger-Ellison syndrome?

A

PPI - PEORL (“-prazole”)

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2
Q

Treating gastric ulcers, what should not be give with Sucralfate?

A

Antacids

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3
Q

What is Pirenzepine?

A

M1 selective antagonist used in the treatment of peptic ulcers, as it reduces gastric acid secretion and reduces muscle spasm.

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4
Q

What are the two mu opioid agonist used as antidiarrheals?

A

Loperamide and diphenoxylate

**note that diphenoxylate has a little bit of atropine added to it to inhibit potential for abuse

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5
Q

What is Pentazocine?

A

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.

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6
Q

What mixed agonist/antagonists used as opioids have psychotomimetic effects?

A

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

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7
Q

Adverse effects of TCA?

A

constipation, dry mouth, blurred vision,

tachycardia, urinary retention

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8
Q

What channels do gabapentin and carbamazepine block?

A

Gabapentin - VG Ca2+ channels

Carbamazepine - VG Na+ channels

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9
Q

What are the first line drugs used to PREVENT migraines?

A
  1. B-blockers
  2. Valproate
  3. 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]

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10
Q

Which NSAID can precipitate acute gout attacks?

A

NSAIDs

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11
Q

DOC for postherpetic neuralgia and trigeminal neuralgia?

A

Trigeminal neuralgia - carbamazepine

Postherpetic neuralgia - lidocaine

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12
Q

Adverse effects of glucocorticoids?

A

[short term] – HTN, HYPERGLYCEMIA, immunosupression, psychotic reactions, cognitive impairment

[long term] – myopathy, Cushing’s syndrome, osteoporosis

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13
Q

What is Leflunomide?

A

Prodrug that is converted to teriflunomide leading to an inhibition of pyrimidine synthesis. [inhibits dihydroorotate dehydrogenase]

Uses…

  1. RA
  2. SLE
  3. Myasthenia gravis

**do not use in pregnancy

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14
Q

DOC chlamydia?

A

Doxycycline

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15
Q

Organisms that Vancomycin treats?

A

Gram positive - multi drug resistance!

**s. epidermidis, enterococcus species, oral dose for c. diffe

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16
Q

When should Nitrofurantoin not be used in pregnancy?

A

After 38 weeks, or within the 1st month of life

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17
Q

Empiric therapy for life threatening sepsis?

A

Cefepime + vancomycin – empiric therapy for
life‐threatening infections – IV, broad spectrum
& effective against MDR bacteria

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18
Q

Empiric therapy for Severe Febrile Neutropenia?

A

USE BROAD SPECTRUM (ex. Cefipime)

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19
Q

Tx severe acne?

A

Docycycline

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20
Q

When should you not give tetracyclines?

A

Pregnant women and growing children! - inhibits bone growth and causes discoloration of teeth

21
Q

1 yo with Otitis media with minor PCN allergy?

A

mild PCN - you can use carbapenems so Cetriaxone

Severe PCN -

22
Q

What categories of drugs should you not give to pts with SEVERE PCN allergies?

A

PCN, amoxicillin, ampicillin, pseudomonas and staph -cillins, carbapenems, monobactams (Aztreonam), cephalosporins

23
Q

DOC syphillis?

A

Benzathine PCN G

24
Q

What is mupirocin?

A

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)

25
Q

What are Quinupristin and Dalfopristin?

A

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)

26
Q

What are the common causes of resistance to cipro and other fluoroquinolones?

A
  1. chromosome-encoded mutation in DNA GYRASE
  2. plasmid-mediated resistance
  3. efflux pump
27
Q

How is resistance with macrolides achieved?

A

methylation of 23S rRNA-binding site therefore drug can no longer bind

28
Q

What is linezolid?

A

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

29
Q

Which cephalosporins may cause a disulfiram reaction?

A

Cefamandole
Cefotetan
Cefaperazone

30
Q

AE of ganciclovir?

A

Myelosuppression

31
Q

What is foscarnet?

A

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)

32
Q

When treating CMV colitis, what should be administered with Cidofovir?

A

Probenecid - this prevents nephrotoxicity

33
Q

Most common adverse effect of cyclosporine?

A

Nephrotoxicity

34
Q

Which medication increased HDL the most? Decreases TAGs the most?

A

Increases HDL - niacin

Decreases TAGs - fibrates

35
Q

D2 receptor antagonists used as anti-emetics?

A

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

36
Q

DOC toxo? What if Toxo encephalitis?

A

Toxo - TMP-SMX

Toxo encephalitis - pyrimethamine+clindamycin or SMX or folinic acid

37
Q

AE of quinine?

A

prolonged QT interval, hypotension, hypoglycemia, cinchonism, uterine contractions

38
Q

Action of terbinafine?

A

Inhibition of squalene epoxide

39
Q

DOC echinococcus granulosus?

A

Albendazole

40
Q

DOC taenia solium?

A

Albendazole

41
Q

DOC leishmaniasis?

A

Sodium stibogluconate OR Amphotericin B

42
Q

DOC hemolymphatic stage of trypanosomiasis?

A

Pentaminide

43
Q

DOC trypanosomiasis?

A

Melarsoprol or suramin

44
Q

AE chloroquine?

A

retinopathy and hemolysis due to G6PD deficiency

45
Q

AE mefloquine?

A

neuropsychiatric toxicity

46
Q

NSAIDs and GI risks?

A

celecoxib has lowest GI risk (aspirin, ibuprofen and diclofenac have low risk, prioxicam has high risk!)

47
Q

Alternative treatments to PCP?

A

clinamycin+primaquine

dapsone+trimethoprim

atovaquone

pentamidine

48
Q

H. pylori tx regimes

A

Treatment regimens…
PPI+Clarithromycin+amoxicillin = 10-14 days
PPI+Clarithromycin+metronidazole = 10-14 days
Bismuth subsalicylate+metronidazole+tetracycline+Ranitidine or PPI = 10-14 days

49
Q

Tx of infective endocarditis in pts with native valve vs prosthetic valve.

A

Native valve - PCN G + gentamicin

Prosthetic valve - Vancomycin + gentamicin

Pharm 2 (18 decks)

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