Mueller Old Content - Final Flashcards
What is Digoxin used to treat?
- Heart Failure
- Atrial Fibrillation
What is the relationship between Digoxin and Potassium?
Due to Digoxin + Potassium competing, we must have normal potassium levels
What can cause Digoxin toxicity?
hypokalemia
How to treat Digoxin toxcity?
Digibind ®- Digoxin specific Antibody Fab fragments
What does Acetaminophen treat?
- Pain or Fever
- This is NOT an NSAID, does NOT work for inflammation
What are adverse effects of Acetaminophen?
Hepatotoxicity: extremely rare at therapeutic dosages
What is an antidote to acetaminophen overdose?
Acetylcysteine
What are the two groups of NSAIDs?
- Salicylates/Irreversible NSAIDS
- ASPIRIN ONLY - Non-Salicylates/ Reversible NSAIDS
- All other NSAIDS are in this category
Why use aspirin?
used for its artery benefits (STROKE AND MI PREVENTION)
What are symptoms of salicylism toxicity?
- Tinnitus
- Respiratory Alkalosis (rapid breathing)
What are adverse effects of aspirin?
- Asthma
- Salicylism poisoning (N/V/D, breathing)
- Premature closure of ductus arteriosus/Platelet disaggregation/ Peptic Ulcer Disease
- Intestinal bleeding
- Reye Syndrome/Renal Impairment/Rapid breathing
- Idiosyncratic Reaction
- Noise (Tinnitus)/Nephropathy(kidneys)
What are some reversible NSAIDs?
- ibuprofen
- naproxen
- ketorolac
What are some concerns for reversible NSAIDs?
- Take with food or water/milk
- Contra-indicated to use in people with Chronic Kidney Disease (acute or chronic)
- Avoid in history of heart disease/MI (Contra-indication)
- Increased risk for bleeding
What are some examples of pure opioid agonists?
Morphine Prototypes
- Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone
Non-morphine Prototypes
- Methadone, Fentanyl, Meperidine, Tramadol
What are some examples of mixed opioid agonists?
- Buprenorphine
- Butorphanol
- Nalbuphine
- Pentazocine
Name an Opioid Antagonist (Antidote).
Naloxone
Name Anti-diarrheal Drugs (Opioid).
- Loperamide
- diphenoxylate-atropine
What are adverse effects of morphine-like drugs?
- Miosis (constriction of the pupil)
- Out of it (sedated)
- Respiratory depression
- Pruritus (common)
- Hypotension (dizzy) & Head injury(avoid!)
- Infrequency of urination and bowel movements (referring to urinary retention or constipation)
- Nausea/Narcotics
- Emesis
Describe muscarinic response during a cholinergic crisis.
SLUDGE (M) and the Killer B’s
- Salivation/Secretions (mouth, GI tract, lungs)
- Lacrimation (tear production)
- Urination (voiding)
- Defecation/Diarrhea
- GI Motility and Gastric Acid production, can lead to abdominal cramping
- ‘Emesis (vomiting)
- Miosis (pinpoint pupils)
- Bradycardia, Bronchospasm, Bronchorrhea, Blood pressure Drops
What is an antidote for cholinergic crisis?
Atropine
Describe the two types of cholinergic drugs.
- Direct Acting Agents
~ Work DIRECTLY at a RECEPTOR
~ Produce effects that mimic Acetylcholine (ACh)
~ Are typically agonists at Muscarinic receptors - Indirect Acting Agents (pyridostigmine)
~ Do NOT work at RECEPTORs
~ Instead, they inhibit acetylcholinesterase, an enzyme that breaks down acetylcholine
acetylcholinesterase inhibitors and pyridostigmine is what you need to know
What are some acetylcholinesterase inhibitors?
- Organophosphates/Carbamates
~ Insecticides
~ Nerve Gas
What are adverse effects of pyridostigmine?
- Minor SLUDGE (M)
- drop in BP and/or HR
- Cholinergic Crisis!
What are the four adverse effects of ALL antibiotics?
- Allergic Reactions
- Super/Supra Infection
- Always Finish the Therapy
- Antibiotics can Interfere with lots of Drugs
What is vancomycin used to treat?
- Gram + only
- MRSA (IV only)
- Clostridium difficile (C.diff) (PO only)
- pneumonia, meningitis, osteomyelitis, UTIs, sepsis, etc.
What are the big three adverse effects of vancomycin?
- Nephrotoxicity
- Ototoxicity
- Histamine release / flushing syndrome
What is penicillin used to treat?
- Strep
- Piperacillin- Pseudomonas, Klebsiella
When should you not give penicillin?
A History of a BETA-LACTAM allergy (cross-reactivity)
- This means penicillins, cephalosporins, carbapenems, monobactams
Current infection with EBV (Mononucleosis)
- Common to see a rash if a patient has Mono (EBV)
- Specifically seen with amino-penicillins (like amoxicillin)
Describe penicillin G benzathine + penicillin G procaine.
- given via IM injection
- thick white paste appearance
- NEVER GIVE IV
Takeaway
all antibiotics today are called BETA-LACTAMS
- penicillins - “cillin”
- cephalosporins - “cef”, “ceph”
- carbapenems - “penem”
- monobactams - aztreonam
Abx for Acute Otitis Media
Amoxicillin
Abx for Pseudomonas
Aminoglycosides, Carbapenems, FQs, Some “cefs”
