Midterm #1 605 review Flashcards
Why is pregabalin (Lyrica) NOT recommended in the elderly?
Risk of falls
What is duloxetine?
Cymbalta
delayed release capsule 30-60mg OD
Tx: fibromyalgia, DPN, chronic lower back pain, OA of the knee
Max dose= 60mg OD
What is Lamotrigine?
Anti-epileptic drug
Mood stabilizer
Tx: bipolar, schizophrenia
First line tx for cystitis?
Nitrofurantoin (Macrobid) 100mg po bid
Nitrofurantoin 50mg-100mg po QID (96% effective, low resistance potential*)
CrCl < 40ml - 60/min, intolerance/allergy to nitrofurantoin= Fosfomycin 3g PO
Drugs to avoid in pyelonephritis?
Nitrofurantoin: doesn’t achieve high enough tissue or renal concentrations
Foscomycin: (same as above)
Moxifloxacin: inadequate urinary levels
Amoxicillin and cephalexin: high e. coli resistance.
E. coli is most likely the culprit!
Acne treatment options:
Improvement can take 2-3 months with topical and systemic tx. If better, consider stopping the systemic tx.
- Benzoyl peroxide and clindamycin= topical choices
doxycycline, minocycline (drug induced lupus/ hepatitis) and tetracycline are effective first-line options when systemic antibiotics are indicated
Due to increased resistance macrolides and SMX should be reserved
Can take 6 weeks to work
Oral abx x 3 months and topical benzylperoxide = decreased drug resistance
Oral contraceptive =effective
Treatment for inflammatory pustules in Rosacea?
In practice, treatment is often started with metronidazole, as it is less irritating; however, using moisturizer before or after azelaic acid may lessen any associated irritation. Treatment duration will depend upon the severity of symptoms, but improvement can generally be expected in 4–6 wk. Counsel patients that topical treatment may need to be continued indefinitely;
topical ivermectin improves rosacea by decreasing the number of Demodex mites present. The exact mechanism of action in rosacea has not been elucidated but is thought to involve an immunomodulatory effect. Topical ivermectin has shown continued improvement in papulopustular lesions and long-term safety with up to 1 y of therapy
Abx that react with cations?
Fluoroquinolones
Tetracyclines
Treatment for group A Pharyngitis?
PCN VK 600mg PO bid x 10 days
PCN VK 300mg PO tid x 10 days
malaria drug tx options?
- Mefloquine
- Quinine
- Primaquine
- Doxycycline
- Hydroxychloroquine
• pyrimethamine
- Chloroquine (Aralen)
Nikolsky sign
is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
Characteristics of Gram -
Stains RED
Outer lipopolysaccharide LPS membrane (outer membrane that blocks the passage of PCN, lysosomal abx).
Thin Peptidoglycan layer
Inner cytoplasmic membrane
characteristics of Gram +
Stains Blue/Violet
Thick outer peptidoglycan cell wall (doesn’t block Abx from passing through their cytoplasmic membranes)
Inner cytoplasmic membrane
Vulnerable to lysosomal and PCN attacks
Isoniazid (INH):
Treats TB Give Pyridoxine (Vit B6) to reduce peripheral neuropathy.
What is dapsone?
A nucleic acid synthesis inhibitor
Sulfonamide abx
Pharmacodynamics (complex definition)
what a drug does to the body
involves receptor binding, postreceptor effects, and chemical interactions.
Pharmacokinetics of a drug depends on:
- patient-related factors (renal function, genetic makeup, sex, age)
- drug’s chemical properties.
This determines the:
onset
duration
intensity of a drug’s effect.
Pharmacodynamics
If giving Duloxetine with TCAs do this:
Monitor plasma levels and adjust dose accordingly
Duloxetine is a ?
Tricyclic antidepressant (Cymbalta) that is supported for use in neuropathic pain
Contraceptive considerations for men and women on isotretinoin?
must be stopped at least 1 month prior to becoming pregnant.
Small amounts of isotretinoin are found in semen; however, safety reporting has not indicated any risk of harm to a fetus due to paternal exposure to isotretinoin, and special precautions are not required.
Minocycline versus doxycycline and tetracycline for systemic acne tx?
minocycline does not appear to be more effective and is associated with an increased risk of drug-induced lupus or hepatitis
More drug resistance with macrolides and sulfonamides
Allow at least 6 weeks to see effectiveness
Bacterial resistance can be reduced by using oral antibiotics in combination with benzoyl peroxide
Isotretinoin considerations for women of child-bearing age
Baseline and monthly pregnancy tests
Women must use 2 reliable methods of contraception until off isotretinoin for 1 month.
sulfamethoxazole/trimethoprim, as trimethoprim during pregnancy:
antifolate teratogenicity when administered in the first trimester
may increase risk of kernicterus in hyperbilirubinemic neonates if given after 32 weeks of pregnancy
TMP/SMX facts:
Trimethoprim is available as a single drug or in combination with sulfamethoxazole (a sulfonamide antibiotic). The drugs act synergistically to block sequential steps in bacterial folate metabolism:
Trimethoprim prevents reduction of dihydrofolate to tetrahydrofolate.
Sulfamethoxazole inhibits conversion of p-aminobenzoic acid to dihydropteroate.
This synergy results in maximal antibacterial activity, which is often bactericidal.
Trimethoprim/sulfamethoxazole (TMP/SMX) is available as a fixed combination consisting of a 1:5 ratio (80 mg TMP plus 400 mg SMX or a double-strength tablet of 160 mg TMP plus 800 mg SMX).
embryo-fetal toxicity and death can be caused by this drug. Need contraceptive during tx and 6 months after in females, 3 months after in males
Methotrexate
Side effects of Valproic acid? (3)
Hepatitis (liver failure in the first 6 months)
Pancreatitis
Cognitive dysfunction
Pin worm treatement
Treatment with anthelmintics: mebendazole (prescription only) or pyrantel pamoate (nonprescription) results in a high cure rate with minimal side effects
do not reliably kill pinworm eggs= repeat treatment 2 weeks later
