Midterm 1 Flashcards
1
Q
What are Teratogens? what drug brought this to life?
What happens during the first and third trimesters?
A
-Drugs& other agents that can disrupt the development of the fetus/halt pregnancy
-Thalidomine disaster
Not all drugs are teratogens
First:
-Period of greatest danger for drug-induced development defects
Third:
-More free drug in mothers blood (free drug is unbound to any receptor sites and ready to elicit a pharmacological response
-Mental health defects/deficits
2
Q
What are the adverse effects of Quinolones?
A
*GI:
Nausea, vomiting, diarrhea *
Skin-Rashes
CNS-Headace, dizziness
3
Q
What are Cephalosporins adverse Effects
A
-Similar to penicillins
-Patients with a history of allergy to penicillin
-Cross-hypersensitivity
-BUT does not exclude its use
4
Q
Agonist
A
drug that binds to receptor and activates it to cause a response
5
Q
What is pseudomonas Aeruginoas? What is used to treat it? and how does it treat it?
A
-They are Opportunistic infections (Commonly on us without causing problems until we become immunocompromised)
1.) Penicillins enter the bacteria
2.) Inside the cell they bind to penicillin-binding proteins
3.) Prevent normal cell wall prudction/synthesis
4.) Bacteria cells rupture
Penicillins do not kill other cells in the body
6
Q
Bactericidal Vs Bacteriostatic (what is important bacteriostatic)
A
Bactericidal: Drugs are directly lethal to bacteria at clinically achievable concentrations
Bacteriostatic: Drugs can slow down bacterial growth but do not cause cell death (slows it down but doesn’t kill it)
-Host defences is important for bacteriostatic antibiotics
7
Q
What are drug concentrations affected by?
A
Doseage and time
8
Q
What are Anti-pseudomonal penicillins? What do the affect most?
A
-They are the extended spectrum of penicillins
-Ticarcillin, piperacillin
-even against Pseudomonas aeruginosa
-affects mostly ill people eg immumocompromized, cystic fibrosis
9
Q
Drug products include?
A
-prescription and non-prescription
-pharmaceuticals
-disinfectants
-sanitizers with disinfectant claims
10
Q
What is the increased risk for Aminoglycosides interactions?
A
Increased risk for nephrotoxicity (additive effect) if used with
Vancomycin (antiinfective)
Cyclosporine (immunosuppressant)
Amphotericin B (antifungal)
11
Q
What Class Cefazolin part of? how is it administered? What kind of bacteria does it work best on?
A
Cephalosporins
IV administration
prototype for 1st generation - excellent on gram positive
12
Q
What class is Demeclocycline apart of? What does it treat?
A
Treat SIADH (syndrome of inappropriate ADH)
-Non-bacterial action
-Tetracyclines
13
Q
Why are immunosuppressive (glucocorticoids) doses large?
A
To prevent organ rejection and to treat episodes of organ rejection
14
Q
What is a paradoxical effect?
A
Opposite of intended drug response
Insomnia & excitement that may occur when some children & older adults are given benzodiazepines for sedation
15
Q
What is a Carcinogenic effect?
A
The ability of certain medications/environmental chemicals to cause cancers
16
Q
What does toxicity mean/relate to?
A
The degree of detrimental physiologic effects caused by excessive drug dosing
Profound respiratory depression from an overdose of morphine & severe hypoglycemia from an overdose of insulin
17
Q
Infection Vs Colonization?
A
Colonization of body by normal flora, not usually harmful, can help in controlling growth of potentially pathogenic organisms
Infections:
Invavation and multiplication of organisms and can be caused by foreign bacteria
18
Q
What are the adverse effects to penicillins?
A
-Generally, well tolerated
-GI problems – disturb normal gut flora most common)
-Allergic reactions (Can be fatal)
-most common cause of drug allergy
19
Q
Pharmacokinetics
A
What the body does to the drug (ie metabolism)
4 steps: absorption, distribution, metabolism, and excretion.
20
Q
What are the negative interactions with Quinolones? (what is oral absorption reduced by)What are they used to treat? What is their mechanism of action?
A
Oral absorption is reduced by:
-Antacids
-Iron, zinc, calcium containing preparations
-Urinary tract infections
-Anthrax
-Bactericidal
21
Q
What class is Gentamicin apart of?
A
It is a Aminoglycosides
22
Q
ADE
A
Adverse drug event - Harm associated with any dose of drug
23
Q
What is Sulfamethoxazole? What class is it apart of? What drug is it combined with? Where does this drug reach effective concentrations?
A
It is a Bacteriostatic drug and Prevents synthesis of folic acid
It is combined with trimethoprim (used for UTI and otitis media infections (middle ear infections)
-It reaches effective concentrations in the urinary tract
-It is apart of the sulfonamides class (antibacterial)
24
Q
Duration
A
Time for which a drug concentration is sufficient to elicit a therapeutic response
25
What are Quinolones also referred to as?
Fluoroquinolones
26
What is an adverse (side) effect?
A nearly unavoidable secondary drug effect produced at therapeutic doses
27
What class is Ciprofloxcin apart of? What is the most common administration?
Quniolones
Very effective and most commonly used
Oral administration
"oxacin*
28
How are Aminoglycosides given? When are they given a certain way?
poorly absorbed through the GI tract = given parenterally (IV or IM)
Note:
given orally to decontaminate the GI tract before surgical procedures
or enema
29
What are the adverse effects of erythromycin, Azithromycin and clarithromycin? WHat class are they apart of?
Adverse Effects:
GI disturbances:
-primarily with erythromycin
-Nausea, vomiting, diarrhea, hepatotoxicity, anorexia
-Erythromycin and clarithromycin compete for hepatic metabolism (CYP)with other drugs
theophylline, warfarin, cyclosporine, digoxin
interfere with each other (interactions)
Azithromycin and clarithromycin:
fewer adverse effects
better tissue penetration
Macrolides
30
How can we prevent medication errors? (11 different methods)
1.) Minimize verbal or telephone orders
2.) Repeat order to provider
3.) Spell drug name aloud
4.) Speak slowly & clearly
5.) List indications next to each order
6.) Be aware of dangerous abbreviations, symbols, & dose designations
7.) NEVER ASSUME ANYTHING ABOUT ITEMS NOT SPECIFIED IN A DRUG ORDER
Ex: route, dosage, frequency
8.) Do not hesitate to question a medication order for any reason when in doubt
9.) DO NOT TRY TO DECIPHER ILLEGIBLY WRITTEN ORDERS
Contact prescriber for clarification
10.) NEVER use “trailing zeros” with medication orders
do not use “1.0mg”; use 1mg
“1.0mg” could be misread as 10mg
Resulting in a tenfold dose increase
11.) ALWAYS use a “leading zero” for decimal dosages
NEVER USE “.25”; use “0.25mg”
“.25mg” may be misread a “25 mg”
“.25mg” is sometimes called a “naked decimal”
ALWAYS LEAD, NEVER FOLLOW
31
Cephalosporins: Fifth Generation? What drug is here? what is it good against?
Ceftaroline – MRSA infections
32
What are Carbapenems?What are they effective against? What are they?How are they administered? where are they given?
ends with “-penem” for identification
-Broad-spectrum antibacterial agents
Gram-positive, -negative, and anaerobic
effective for mixed infections
Not MRSA
all parentally given – not orally active
always given in a hospital setting
33
What are some adverse effects to sulphonamides? What is the most common side effect?
1.) Integumentary (skin) allergies
-photosensativity
-Stevens-johnsin syndrome
-Hard time breathing/swallowing
-severe swelling of oral mucosa
2.) Bone marrow depression
granulocytosis, thrombocytopenia, aplastic anemia
Prone to infections – drop in white blood cells
Drop in platelet blood count
Drop in RBC production
3.) GI
-Nausea, vomiting, and diarrhea
34
What are antibacterial drugs effective against?
Gram-positive (easier to treat) and Gram-negative (lack of entry, more difficult to treat) bacteria
35
Before the approval of the sale health canada reviews drug products to asses?
Safety (safe to use)
Efficacy (it works; efficient)
Quality (brings no harm; little adverse effects as possible)
36
What is enreral administration? What is it good and bad for?
-Entry of drug through the GI tract via through the mouth to anus
-Convient but first pass effect for PO
37
What is Parenteral Administation?
-Not by the GI tract
-Bypasses the liver
-More drug reaches circulation
38
Trough
lowest blood level – if too low drug is ineffective
39
What are other clinical uses of sulphonamides beside bacterial infeactions?
-Upper respiratory tract infections (Not much usage of sulfonamides; rare for this situatuion)
-Others eg malaria, chlamydia (sexually transmitted)
40
What are antibacterial drugs? What do we need to bear in mind/do before we use them?
-Medications used to treat bacterial infections
-exploit differences between human cells and bacteria
-Ideally, identify causative organism before beginning antibacterial therapy
-potential antibacterial susceptibilities
-What bacteria causes what problem/infection > which drugs are best against that particular organism
41
Drugs are administered based on?
Route of administration, time, course of actions, and active drug concentration
42
What are cytotoxic drugs? What are they harmful to? How do they act? What are the adverse effects?
Alkylating agents Vs Antimetabolite drugs?
Drugs used in cancer therpay
They are harmful to ALL growing cells (good and bad)
Cytotoxic anticancer drugs act directly on cancer cells and healthy cells to produce cell death.
Alkylating agents – drug forms chemical bond to DNA
Thus prevent DNA replication, & causes cell death
Antimetabolite drugs
Prevent synthesis of metabolites required for growth
Nearly all cytotoxic drugs cause significant adverse effects:
-Severe vomiting & nausea
-Bone marrow suppression
-Neutropenia (infection risk)
-Loss of circulating platelets (bleeding risk)
Anemia
43
What are Aminoglycosides affective against?
Active against gram-negative bacteria
Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.
Often used in combination with other antibacterials for synergistic
44
What are drug concentrations affected by?
They are affected by dosage and time
Divided into 4 stages – “ADME”
Absorption from site of administration
Distribution within the body
Metabolism
Excretion
45
What is the downside to use of OTC's? and what is an advantage to them?
May delay effective treatment of more chronic disease states
May delay treatment of serious and/or life-threatening disorders
May relieve symptoms of a disorder but not the cause
Advantage of OTC – convenient, effective with MD appointment – often MD recommend
46
What are the 4 groups of B-Lactam Antibacterials? How are they characterized?
They are characterized by the B-Lactam Ring structures
1.) penicillins
2.)Cephalosporins
3.)Monobactams (not covered in class)
4.)Carapenems
47
What is a Metastasis?
secondary lesion, in a new and remote part of the body
(cancer therapy)
48
What are aminopenicillins? What are they able to effect more of?
-They are a broad spectrum penicillin
-Able to affect more gram negative bacteria while still impacting gram positive bacteria
Ex.)Amoxicillin (more acid-stable – used as p.o.), ampicillin (very sensitive to low pH- not good for p.o.)
49
What is a drug?
-a drug includes any substance or mixture of substances manufactured, sold or represented for use in:
1.) the diagnosis, treatment, mitigation (eases symptoms) or prevention of a disease, disorder, abnormal physical state, or its symptoms, in human beings or animals
2.)Restoring, correcting or modifying organic functions in human beings or animals
3.) disinfection in premises in which food is manufactured, prepared or kept.
50
What is a Iatrogenic Disease? What are they identical to?
A disease that occurs because of medical care/treatment
-Also used to denote a disease produced by drugs
-Idnetical to idiopathic diseases- naturally occuring
51
Minimum Effective Concentration?
Minimum Effective Concentration is the plasma drug level that must be reached for a therapeutic effect
52
What is Clavulanic Acid?ow does it effect penicillin?
(e.g., amoxicillin (has molecules to breakdown cell wall synthesis)+ clavulanic
acid (prevents the breakdown of amoxicillin by bacteria, leaving more amoxicillin molecules to do its job))
It is a B-lactmase inhibitor
53
How is Vancomycin administered? What is it the choice of treatment for?
IV administration:
-Treatment of choice for *MRSA*, and other Gram-positive infections
54
What are opportunistic Infections? When do we start to see the consequences?
Infections that would not normally harm an immunocompetent person
occur in immunocompromised patients
existing colonization become infections
-We start to see the consequences when they increase in number
55
What are the adverse effects to
-Increased risk of infection (greatest risk)
-Thinning of skin
-Osteoporosis w/ fractures
-Impaired growth in children
-Suppression of the hypothalamic-pituitary-adrenal axis
56
What are glucocorticoids? What kind of drug are they? what are they used for?
-They are immunosuppressant drugs that are used widely to suppress immune responses
_They are used for suppression of allograft (tissue from organ donars) rejection
-Treatment of asthma
-Therapy of autoimmune disorders
57
What is drug resistance to penicillins?
-Some bacteria produce enzymes capable of destroying penicillins
-Bacteria make b-lactamases (split the β-lactam ring)
-β-lactamase inhibitors (used in combination with penicillins)
58
Why isn't bored spectrum always the best?
You can create drug resistance
59
What is topical administration?
Apply on top of skin, eyes, ears, nose vagina
60
What are Cephalosporins? How are they devided? What are they similar to?
-all start with “Cef-“ to identify them
-Mostly widely used antibacterial drugs
-Semisynthetic derivatives from a Cephalosporium fungus
-Structurally and pharmacologically related to penicillins (β-lactam antibiotics)
-First to Fifth generation
-Divided into groups according to their introduction to clinical use:
1.)increased permeability to Gram-negative cell wall
2.) increased stability against β-lactamases
61
What are the adverse effects for Tetracylines?
*Strong affinity for calcium*
-Discoloration of permanent teeth and tooth enamel in fetuses and children
-May retard fetal skeletal development if taken during pregnancy
-NOT advised in pregnancy or during lactation for the above reasons
-GI disturbances-
direct irritation
gut flora
*Alteration in intestinal flora may result in:*
-Superinfection (overgrowth of new, non-susceptible organisms such as Candida)
-Diarrhea
-Pseudomembranous colitis (Clostridium difficile) - Colon infection
-Antagonistic to bactericidal antibiotics so must be timed for use usually at least an hour apart
Potentiate warfarin effect (oral anticoagulant)
Photosensitivity
62
Cephalosporins: Third Generation,What is it? How does it work?
-More broad spectrum
-better against gram-negative than previous generations
Cefotaxime
Ceftriaxone
cefixime
63
What are Tetracyclines? What do they inhibit? How do they destory cells? What was the first compound ever discovered?
all end with “-cycline for identification
-Broad spectrum antibiotics
Inhibit protein synthesis – like macrolides
-Bacteriostatic
Tetracycline – first compound discovered
64
When are carbapenems given?
Reserved for severe, complicated body cavity and connective tissue infections
a “last resort” antibiotic
cannot be treated by narrower drug
65
What are Contraindicated Conditions of sulfonamides? When are they not advised for use?
Known allergy: applies to other derivatives of the sulfa-like drugs:
-antidiabetic agents sulfonylureas
-thiazide and loop diuretics (increase urine production)
Pregnant women
-linked to birth defects (1st trimester)
-close to end of pregnancy may increase fetal bilirubin
-may lead to kernicterus (brain damage)
Not advised during breastfeeding
Infants less than 2 months of age
66
Cephalosporins: Second generation, What is their uses? What do they have poor coverage over? What do they have good coverage over? What are they used for?
-Good gram-positive coverage
-Better gram-negative coverage than first generation
-Cefuroxime (Ceftin or Zinacef)
Uses:
-cefuroxime: PO-
surgical prophylaxis
does not kill anaerobes
cefoxitin: IV and IM – mostly IV & IM drugs rather than PO for cephalosporins
used prophylactically for abdominal or colorectal surgeries
also kills anaerobes
67
What does the term "physical dependance" refer to?
Body has adapted to drug exposure and would go through abstinence syndrome if use is discontinued (withdrawals)
Develops during long-term use of certain drugs – opioids, alcohol, barbiturates, & amphetamines
68
What are the theraputic uses for macrolides? What kind of infections do they treat?
Used for Infections of:
Respiratory, skin and soft tissue
Therapeutic Uses:
azithromycin and clarithromycin:
-They are now being used in combination for people with HIV /AIDS for opportunistic infections
immunocompromised
-patients allergic to B-lactam antibiotics
69
What are the indications of use (how do they work) for Aminoglycosides? What bacteria are they effective against? What were they the first of?
*Bactericidal*
*Prevents/abnormal protein synthesis*
-Against mostly Gram-negative and some Gram-positive
-First antibacterial effective against gram-negative bacteria
70
What is the safety profile and practicality for the use of OTC's?
Safety profile:
Favourable adverse event profile
Limited drug-interaction
Low potential for misuse
Use:
Easy to use
Easy to monitor
71
What are Narrow and Broad spectrum antibacterials used against?
Narrow-spectrum’ antibacterials are selective against one class of bacteria
One or the other – less damaging to the ecosystem
‘Broad-spectrum’ antibacterials are effective against both classes of bacteria
Affect +/- grams (both) – not as good since it could affect harmless bacteria
72
Cephalosporins fourth generation? What is it effective against?
Broader spectrum of antibacterial activity than third generation
(especially against gram-positive bacteria)
Cefepime (Maxipime)
73
What is one way in which we can reduce free drugs in a geriatric body?
We can reduce the dose size/frequency to reduce the amount of free drugs in a geratric body
74
What kind of drug are sulphonamides? How do they work/act? What grouping do they belong to?
1.) They are a broad class of antibacterial drugs and act as Bacteriostatic drugs
2.) They prevent synthesis of folic acid
3.) Part of the "sulfa Grouping"
75
What are the indicators of use for tetracyclines? What non-bacterial drug action drug is in this class? What does it treat?
Gram-negative and Gram-positive
Mycoplasma, Rickettsia, Chlamydia, syphilis
Demeclocycline
treat SIADH (syndrome of inappropriate ADH)
76
Why is multidrug therapy used in cancer/chemotherapy treatments? Ideally, the drugs used in combination therapy should have?
-Multiple drug therapy is used to avoid drug resistance & for increased effectiveness
-Multidrug chemotherapy is generally much more effective than single-drug therapy. Why? Because combination therapy can
(1) suppress drug resistance
(2) increase cell kill, and
(3) reduce injury to normal cells (at any given level of anticancer effect).
(1) different mechanisms of action
(2) minimally overlapping toxicities, and
(3) good efficacy when used alone.
77
What class is imipenem-cilastatin apart of? how does it work? What kind of drug is it?
They are part of the Carbapenems class
They are used as a combination drug
Cilastatin – inhibits the breakdown of imipenem in kidne
78
Cephalosporins: First Generation, What is their uses? What do they have poor coverage over? What do they have good coverage over? What are they used for?
Cefazolin (Ancef)
Cefadroxil
Cephalexin (Keflex)
Good gram-positive coverage**
-best generation for these bacteria
-Poor gram-negative coverage-
Uses:
Used for surgical prophylaxis, URIs, otitis media
cefazolin (Ancef) – very commonly used
IV administration
prototype for 1st generation - excellent on gram positive
Cephalexin (Keflex): PO
79
What is the difference between cyclosporine and tacrolimus?
cyclosporine & tacrolimus is that cyclosporine needs to bind to cyclophilin to act – tacrolimus must bind to an intracellular protein > FKBP-12
80
What is Tacrolimus?What are its therapeutic uses? What are the adverse effects? and how can it be administered? What is typically given concurrently? What is it theraputic index?
-It is a calcineurin inhibitor
Theraputic:
-Alternative to cyclosporine for preventing allograft rejection
-Pts experience less acute transplant rejections than cyclosporine but Tacrolimus has a narrow therapeutic index = more dangerous
-Used for rheumatoid arthritis
Adverse:
1.) Nephrotoxicity is the major concern – incidence is 33-40%
2.) Neurotoxicity – headache, tremor, insomnia
3.) GI effects – diarrhea, nausea, vomiting
4.) Hypertension, hyperkalemia, hyperglycemia, hirsutism, & gum hyperplasia
5.) Anaphylaxis can occur in IV administarion
6.) Can increase risk for infections and lymphomas
-Given IV or orally
81
What is a Neoplasm?
Mass of new cells;tumour
82
What is Tetracycline? What class is it apart of?
Tetracyclines
-First compound ever discovered
83
How do we name drugs?
1.) Chemical name – based on chemistry
Acetyl-para-aminophenol
2.) Generic name – less complex name assigned by drug developer
Acetaminophen
3.) Brand /Trade name- the marketing name
Tylenol
84
What class is imipenem-cilastatin and meropenem part of?
Carbapenems
85
Pharmacodynamics
What the drug does to the body (ie drug effect)
86
Antagonist
drug that binds to receptor and stops it from causing a response
87
What kind of bacteria do broad/extended penicillins kill?
Gram-Negative bacteria
88
What class is azithromycin and clarithromycin apart of? What are they being used to treat in combination with one another?
They are now being used in combination for people with HIV /AIDS for opportunistic infections
immunocompromised
-patients allergic to B-lactam antibiotics
Macrolides
89
What generation is Cefixime a part of? What does it treat?
Third generation of cephalosporins
only oral third-generation agent
best of available oral cephalosporins against gram-negative
tablet and suspension
90
What is cyclosporine? What are its therapeutic uses? What are the adverse effects? and how can it be administered? What is typically given concurrently?
-It is a calcineurin inhibitor
Theraputic:
-Drug of choice in preventing organ rejection of kidney, liver and heart transplants
-Prednisone (gluccocortiod) is usually given cincurrently
Adverse effects:
1.) Nephrotoxicity- recuced renal blood flow and reduced glomerular filtration rate
2.) Infection-Increases risk for infections
-Can be given orally (preferd) or IV
-Dies not use bone marrow suppression
91
What does Vancomycin inhibit?
Cell wall synthesis
-Bactericidal
92
What are penicillins? What are they sensitive to?
-all end in “-cilin” to identify them**
-Naturally occurring
-sensitive to b-lactamase
-Semi-synthetic – starts off natural w/ something added onto it
-b-lactamase-resistant
93
What class is Erythromycin apart of?
Macrolide?
94
Onset
The time it takes for the drug to elicit a therapeutic response
95
What is polypharmacy?
concurrent multiple medications
96
What are immunosuppressants? and what are they used for?
Immunosuppressants: Drugs that decrease or prevent an immune response, thus suppressing the immune system
used to prevent or treat rejection of transplanted organs
autoimmune diseases
-They reduce lymphocyte cell division
97
What are the 3 types of medication errors? and what causes them?
Direct = dose is too high
Indirect = dose is too low
Fatal medication errors
Human factors (in order):
Performance deficits – wrong route
Knowledge deficits
Miscalculation of dosage
Communication mistakes
Drug name confusion
98
What do tetracyclines bind to? What reduces their absorption? What do they form? Who are they not given to?
-Bind to metal ions
-Ca2+ , Mg2+ , iron, aluminium
-milk products, supplements, some laxatives, most antacids
-form insoluble complexes = chelation
-If taken with dairy products, antacids, and iron salts
reduce absorption of tetracyclines
-Pregnant women and children under 8
99
What are the mechanisms of action (how do they work) for Quinilones? What bacteria do they effect the most?
*They are Bactericidal*
Gram-negative organisms (major use) and some Gram-positive organisms
*Broad Spectrum*
Alters DNA of bacteria
prevents proper supercoiling
Do not affect human DNA
100
What is a Idiosyncratic effect
An uncommon drug response resulting from a genetic predisposition
Occurs in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency
X-linked inherited condition that when ingesting sulfonamides or aspirins, they develop varying degrees of red blood cell hemolysis – which can be life-threatening
101
Cancer therapy drugs affect?
Cell division
102
What are some adverse affects of Aminoglycosides? When are they made worse? What must we monitor when giving this drug? Why? Which one is reversible?
* They are drugs with SERIOUS toxicities*
Toxicities:
*Ototoxicity (ear) Irreversible*
-Auditory impairment eg ringing (tinnitus), deafness
-Vestibular eg balance problems, dizziness, vertigo
-Made worse if other ototoxic drugs are given eg loop diuretics (see diuretics class)
-Nephrotoxicity (kidney) - Reversible
-extreme in neonates and pre-existing renal conditions
-measure proteinuria, serum creatinine levels, BUN
-must monitor plasma drug levels to prevent toxicities
-Rarely, neuromuscular blockade
103
What are the indications of use for Quinolones? (What are they used to treat)
UTI
Anthrax
Also used in:
-Lower respiratory tract infections
-Bone and joint infections
-Infectious diarrhea
-Skin infections
-Sexually transmitted diseases
104
What are Macrolide? How do they work? What do they work best against? How do you identify them?
They are Big – identify by ending “-mycin”
Erythromycin
Mechanism of Action:
-Inhibits protein synthesis
*binds to ribosomes
*Most Gram-positive, some Gram-negative
*Bacteriostatic (mostly) and bactericidal (Depending on concentration and bacterial susceptibility)
105
Peak
Time it takes for a drug to reach its maximum therapeutic response
106
how are penicillins administered?
PO, IM, IV
Penicillin G is IV or IM – sensitive to low pH; Penicillin V is PO
107
What does penicllins attack? What is their spectrum dependent on? what does it kill best?
Bactericidal
spectrum effect depends on type of penicillin
Active against most Gram-positive bacteria & Some Gram-negative
108
What is cefoxitin used to treat? How is it administered? WHat class is it apart of?
cefoxitin: IV and IM – mostly IV & IM drugs rather than PO for cephalosporins
used prophylactically for abdominal or colorectal surgeries
also kills anaerobes
109
What are Aminoglycosides? What are they produced from? What do they fight? What were they the first of?
-Natural and semisynthetic drug
-produced from Streptomyces
First antibacterial effective drugs against gram-negative bacteria
110
ADR
adverse drug reaction - Any noxious, unintended, & undesired effect that occurs at normal drug doses
111
What are the 4 mechanisms of action for antibacterials?
1.) Disruption of critical metabolic reactions
-Disrupt specific biochemical reactions
Results in decrease in the synthesis of essential cell constituents/synthesis of non-functional analogs of normal metabolites
2.) Interference with cell wall synthesis
-Interrupts enzymes used to fortify wall
-Weaken cell wall & promotes bacteria lysis/death
3.)Interference with protein synthesis
-Metabolic process, transport methods, & receptors of the membrane
4.)Interference with DNA replication
Transcription interuption
Inhibit synthesis of DNA/RNA by binding directly to nucleic acids/by interacting w/ enzymes required for nucleic acid synthesis
Also bind w/ DNA to disrupt its function
112
What is cefuroxime? How is it used? how is it administered?
It is a second generation cephalosporin
cefuroxime: PO-
surgical prophylaxis
does not kill anaerobes
Good gram-positive coverage
Better gram-negative coverage than first generation
113
What is a primary lesion?
Original site of growth
114
What is cefepime (maxipime) apart of?
Fourth generation cephalosporins
-Will have good gram positive bacteria coverage then the third generation
115
What is cefotaxime? What does it treat? How is it administered?
Third generation of cephalosporins
-IV and IM
-easily passes meninges and diffused into CSF to treat CNS infections eg meningitis
116
What are the adverse effects of Vancomycin?What syndrome is possible with this drug?
Ototoxicity
Nephrotoxicity
Red man or neck syndrome is possible
117
What is Zidovudine used for? What kind of drug is it? What is its major adverse effect?
It is used to treat AIDS, it is a reverse transcpription Inhibitor
-Major adverse effect is bone marrow suppresion
118
What do protease inhibitors do?
nhibit the retroviral protease enzyme, preventing viral protein preparation
119
What is Ritonvair used for? What kind of drug is it? What is a major adverse effect?
It is a protease inhibitor, it is used to treat AIDS, a major adverse effect is that it can inhibit cyp50 inhibitor to produce more enzymes (can be used with other drugs to assist with first pass metabolsim)
120
What is the goal with antivirals and the treatment of AIDS?
Combination therapy is essential
Goal is to reduce HIV in plasma-Viral load
121
What is BIKTARVY used for?
It is a drug combination treatment for HIV in a single pill
122
What is Pre-Exposure Prophylaxis (PrEP) used for? what kind of combination is it? What are the two drugs used in it?
It is a pre exposure medication to prevent acquisition of HIV infection by uninfected persons
2 rti combination
tenofovir and emtricitabine
123
What is Post-Exposure Prohylaxis (PEP used for? when do you need to start taking them?
Drugs taken very soon after possible exposure to HIV
Start within 3 days, lasts 28 days
124
What kind of drug is oseltamivir? What is it used for? What are the adverse effects? When should it be taken?
-It is used for the treatment of flu infections, it is good against influenza A and B
-It should be taken as soon as symptoms develop (within 2 days of symptom onset)
-GI adverse effects
-It is a Neuraminidase Inhibitor
125
What kind of drug is Amantadine? What is it effective against?
It was an antiviral that was used in the past to treat influenza A but not used anymore for this because of antiviral resistance
126
What kind of drug is acyclovir? What does it treat? What does it do? How is it administered?
It is an antiviral that stops the viral DNA synthesis and is used for the treatment of chickenpox, shingles and herpes
-It is a synthetic nucleoside analogue
-Very few adverse effects
-PO, topical and parenteral forms
127
What kind of drug is Ganciclovir? What is it used to treat?
It is a DNA polymerase Inhibitor
-Used to treat cytomegalovirus (CMV can affect brain, eye, lung and GI tract)
128
What is a cytomegalovirus?
Member of the herpes family, spread by bodily fluids
129
What kind of drug is Ribavirin? What is it used to treat?
It is used to treat respiratory syncytial virus (RSV)
-Mechanism is unclear
130
Superficial Vs Systemic infections?
On the surface of the body VS in the body systems (immunocompromise more at risk)
131
What is amphotericin B used to treat? How is it administered? Is it natural occurring or synthetic? Ketoconazole?
-Used to treat Systemic fungal Infections
-Is naturally occurring
-Given in SLOW IV injection
K: Used for more superfical infections
132
What kind of drug is Nystatin used to treat?
Used to treat superficial ingections
Oral infections - suspension should be swished thoroughly in the mouth as long as possible before swallowing
133
What are the drugs and mechanisms for poylenes drugs?
-amphotericin B and nystatin
-Bind to sterols in cell membrane lining
-Makes holes in fungi cell membranes
-Fungal cell death (mostly)
-Higher concentrations bind to cholesterol of human cells to cause toxicities
134
What are the drugs and mechanisms of action for the Azoles? What does it lead to?
-ketoconazole
-Inhibit sterol-altering enzyme
Cyp P450 enzymes (stops the production inside the cells)
-Less ergosterol in membranes
-Lead to altered cell membrane
-Inhibits growth/kills cells (slows down the growth)
135
What is amphotericin B used to treat?
severe systemic mycoses
136
What are the adverse effects of Amphotericin B?
-Renal toxicity (if a person can tolerate this and the toxicity isnt to bad treatment can continue)
Impairs hepatic functions
Asses kidney and liver functions before systemic administration
137
What is Ribavirin used to treat? How is it administered?
Given orally or nasal inhalation
Used to treat respiratory syncytial virus (RSV)
138
What class is Cefepime (Maxipime) apart of? What is it effective against?
Cephalosporins: Fourth Generation and is effective against gram positive bacteria
139
What is Diuresis? What do diuretic drugs do?
Diuresis is increased water loss and diuretic drugs increase urine output and remove excess fluid
140
Diuretics are first line defence drugs for?
Heart failure and hypertention
141
How do Diuretics accelerate the rate of urine formation?
Most by excretion of SODIUM and water
142
What can small blockage Na reabsorption produce?
Excessive fluid loss
acid-base imbalances
alter electrolytes levels
143
What kind of drug is Furosemide(Lasix)? Where does it act? What does it inhibit? How can it be given?
It is an loop antidiuretic
It acts in the ascending limb of the loop of Henle
it inhibits sodium and chloride transporter secreted into nephron fluid
Can be given PO, IV it depends on how fat you want to drug to come into effect
144
What are the indications of use for Furosemide? What are the adverse effects of furosemide?
-Edema associated with heart failure or hepatic renal disease
-Control of hypertension
-Increase renal excretion of calcium in clients with hypercalcemia
Excessive fluid loss (dehydration, low Na, CL)
Potassium depletion
*Hypokalemia (3.5-5mmo/L)
*Hyperglycemia (high glucose levels)*
145
What are the symptoms of Hypokalemia caused by Furosemide?
irregular heartbeat
potentially fatal dysrhythmias
muscle weakness/lethargy
leg cramps
GI disturbances (constipation
146
Patients using digoxin need to be monitored for?(interaction)
Hypokalemia
Can increase digoxin toxicity
*Digoxin makes the heartbeat stronger, if potassium levels fall it can make the drug stronger)
147
What can Furosmide do with antidiabetic drugs?
May decrease hypoglycemic effect of antidiabetic drugs = hyperglycemia
and can create ototoxicity with aminoglycosides
148
What are Thiazide Diuretic drugs? what is their mechanism of action? Where in the nephron do they target?
-inhibit reabsorption of sodium and chloride ions
-action primarily in the distal convoluted tubule
-different protein target to loop diuretics
-They are less powerful than loop diuretics (low ceiling)
149
What kind of drug is hydrochlorothiazide? What is its indication of use?
It is a Thiazide diuretic
Is used for high blood pressure
*Hypertention*(single or combination therpay
150
What are the adverse effects of Thiazide diuretics? and what interactions do we need to bear in mind?
Hypokalemia (below normal of 3.5-5mmol/l)
Impotence
Digoxin
Antidiabetic drugs (reduces effect from diabetic drugs so it may lead to hyperglycemia)
151
What class is spironolactone apart of? What does is do? What is its Peak and onset?
Potassium-sparing diuretics and it acts as a aldosterone receptor blocker
Peak: 2-3 days (wont see an immediate response, it is very slow acting)
Onset: 24-48
152
What is Spironolactone mechanism of action?How does it work? When can it be used?
-Antagonist at aldosterone receptors (steriod-like structure)
-blocks the reabsorption of sodium and water usually induced by aldosterone
-Reduces sodium-potassium exchange
-body retains K+ – ‘K-sparing’
-Reversing the potassium loss caused by potassium-losing drugs (combination therapy) (good for retaining potassium)
-Edema associated with heart failure
-Hypertention
153
What are the adverse effects for potassium-sparing diuretics? What are the normal ones? What are the symptoms?
*Hyperkalemia*
above normal of 3.5 – 5 mmol/L
withhold if above upper level
Hyperkalemia symptoms:
Cardiac dysrhythmias eg tachycardia (more then 100bpm)
Muscle weakness
GI - Cramps, nausea, vomiting, diarrhea
Sex hormones-like effects:
Amenorrhea
Irregular menses
Postmenopausal bleeding
Gynecomastia – concern males
