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ABOS Part 1-Malcolm > Medications > Flashcards

Medications Flashcards

1
Q

Fluoroquinolones

A

Inhibits DNA gyrase

Examples: Ciprofloxacin, levofloxacin

Clinical importance: Ppx for leech treatment ( can–> hydromonas infection), and open fractures associated with water (pseudomonas); increased tendon rupture risk, may inhibit fracture healing

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2
Q

Penicillins

A

inhibit cell wall synthesis via transpeptidase inhibition

Clinical Importance: add for open fractures with farm/gross contamination –> prevent clostridium infection

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3
Q

Cephalosporins

A

inhibit cell wall synthesis via transpeptidase inhibition

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4
Q

Miscellaneous Cell Wall Inhibotors

A

Vanco, carbapenems

MOA: vanco inhibits peptidoglycan crosslinking

Clinical importance: vanco–>redman syndrome, nephrotoxicity

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5
Q

aminoglycosides (tobra and gent), tetracyclines (doxy)

A

anti 30s ribosome

Irreversible inhibitor. gent is notable for OTOtoxicity, limited evidence to suggest adding for grade III open fractures, tetracylcines can cause skin and tooth discoloration (avoid in kids <8 and pregnancy)

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6
Q

macrolides (azithromycin), clinda, linezolid

A

anti 50s ribosome

clinda can cause pseudomembranous colitis from c diff. D- zone test tests for inducible resistance to clinda. If positive must change to another abx.

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7
Q

Direct Thrombin (factor IIa) inhibitor

A

Dabigatran (Pradaxa)
Argatroban
Hirudins

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8
Q

Hirudins

A

Hirudins from leeches. Antidote is Praxbind (idarucizumab) or activated prothrombin complex concentrates (aPCC)

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9
Q

Direct Xa inhibitor

A

RivaroXaban (Xarelto)
ApiXaban (Eliquis)
EdoXaban (Savaysa)

Renal excretion. Antidote is andexanet

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10
Q

Indirect Xa inhibitor

A

Fondiparinux (Arixtra)
Enoxaparin (Lovenox)
Heparin

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11
Q

Fondiparinux (Arixtra)

A

activates antithrombin III, highly selective for factor X

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12
Q

Enoxaparin (Lovenox)

A

activates antithrombin III; intermediate selectivity for factor X (some thrombin inhibition)

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13
Q

Heparin

A

activates antithrombin III–> inhibit thrombin; but also indirectly inhibits inhibits factor IX, X, XI as well (not very discriminant)

Classic reversal agent for heparin is protamine sulfate.

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14
Q

Fondiparinux (Arixtra)
Enoxaparin (Lovenox)
Heparin

A

Beware of HIT (delayed onset thrombocytopenia plus arterial and venous hypercoaguable state) w/ heparin (risk far lower w/ fond and enox). This is due to development of antibodies to PF4 (platelet factor 4)

Classic reversal agent for heparin is protamine sulfate.

Enox and fonda are renally excreted (beware w/ CrCl<30), heparin is hepatically cleared.

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15
Q

Coumadin (warfarin)

A

Inhibits the vitamin K dependent enzyme epoxide reductase in the liver impairing the activation of clotting factors 2, 7, 9, 10, as well as ANTI-clotting factors protein C and S.

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16
Q

Coumadin Info

A

Efficacy monitored w/ INR (target 2-3). Extremely long half life. Reverse fx w/ vitamin K injection or w/ FFP for rapid INR correction. Multiple drug interactions (green tea and st johns wort–>clots; omega 3 fish oil–>bleeding).

17
Q

Herbals causing bleeding

A

gingko
gingsing
garlic

All three have antiplatelet effects and can increase bleeding risk

18
Q

Tranexamic acid

A

FIBRINOLYTIC

Competitive inhibitor of plasminogen (precursor to plasmin which lyses fibrin-factor Ia-clots) at lower dose and direct plasmin inhibitor at high dose

Most commonly used in arthroplasty and now spine. Few adverse events. Can be used intravenously and topically in severe renal dz (renally excreted).

19
Q

Non-nitrogen containing bisphosphonate

A

Etindronate, Clodronate

Bind to bone minerals and taken up by osteoclast DIRECTLY and cause apoptosis via formation of toxic ATP analogue

Original bisphosphonate. 1000x LESS potent than current agents (N-containing).

20
Q

Nitrogen containing bisphosphonate

A

Pamindronate, Alendronate, Zolendronic acid, Rosendronate

MOA: Inhibits N-farnesyl pyrophosphate Synthase–>loss of GTPase function and osteoclast cell death

In general, side effects include GI upset/GERD (most common), osteonecrosis of the jaw (rare), and atypical subtroch fractures (low energy, hypertrophic lateral cortex, no comminution, medial spike, transverse pattern). Zolendronate given as IV infusion once yearly. Should only be given for 5-8 years before stopping.

21
Q

Raloxifene

A

Estrogen receptor agonist

Less commonly used for osteoporosis. Acts directly on osteoclasts.

22
Q

Teriparatide

A

PTH analogue that acts directly on osteoblast –> reduced RANKL production (when used at pulsed intervals)

Contraindicated in Pagets disease owing to risk of secondary osteosarcoma.

23
Q

Denosumab

A

OPG mimic that inhibits RANKL binding by binding and sequestering RANKL. (as opposed to competing for it’s binding site)

Used also in GCT (in addition to osteoporosis)

24
Q

Romosozumab

A

Sclerostin antibody

Early phases, may aid fixation into osteoporotic bone.

25
Q

infliximab, etanercept, adalibumab

A

TNFa blocker

“Used in ankylosing spondy, psoriasis and RA (3rd line in RA)

Infliximab - monocolonal antibody that binds to TNFa receptor
EtanerCEPT - Binds to floating TNFa (acting as a decoy receptor i.e. it interCEPTs TNFa)”

When to stop before surgery: 1-4 weeks prior depending on half life (etanercept 1 week per MRC, orthoB says 2 weeks; adalibumab 3 weeks)

26
Q

Anakinra

A

IL-1 blocker

4th line RA agent

When to stop before surgery: 2 days prior

27
Q

Tocilizumab

A

IL-6 blocker

alternative in RA if nonresponsive to TNFa blockers

28
Q

Rituximab

A

Anti-B cell (CD20)

Alternative in RA for refractory cases.

When to stop before surgery: 7 months prior

29
Q

methotrexate, leflunomide

A

Folate synthesis inhibitors

2nd line after steroids for RA

When to stop before surgery: continue

30
Q

hydroxychloroquine

A

TLR blocker

2nd line in RA. Reduces activity of antigen presenting dendritic cells.

When to stop before surgery: continue

31
Q

Sulfasalazine

Azathioprine

A

Unknown mechanism of action

2nd line for RA

When to stop before surgery: Day of surgery

32
Q

Abatacept

A

MHC Receptor Blocker

Binds to CD80 and CD86, Blocks T cell activation

33
Q

Glucocorticoids

A

Prednisone

1st line in RA

Wean to <10mg (wound healing issues)

No need to stress dose for arthroplasty

ABOS Part 1-Malcolm (1 decks)

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