patho test 2 drugs Flashcards
1
Q
bacteriostatic
A
inhibit growth of bacteria
2
Q
MOA of sulfonamides
A
inhibits bacterial synthesis of folic acid (DNA)
3
Q
what cells are not affected by sulfonamides
A
cells requiring exogenous b-9
4
Q
sulfonamides are highly concentrated in the
A
kidneys
5
Q
example of sulfonamides
A
bactrim (Sulfamethoxazole/trimethoprim)
6
Q
adverse effect of bactrim
A
integumentary considerations and immune mediated
7
Q
what drugs/disease process can have potential interactions with sulfanomides
A
DM when taking sulfonylureas which can cause hypoglycemia and epilepsy when taking phenytoin which can cause nystagmus, encephalopathy, dysarthria, and ataxia
8
Q
examples of sulfonylureas
A
glipizide
9
Q
MOA of glipizide
A
stimulate beta cells (insulin)
10
Q
phenytoin does what to clearance
A
reduces it which can increase effects of other drugs
11
Q
bactericidal
A
enter cell wall and lyse bacteria - work on gram positive bacteria
12
Q
penicillin is a
A
bactericidal
13
Q
when is PCN IV used
A
for HF, card dys, FVO, CKD - added to Na and/or K
14
Q
adverse effects of penicillin
A
urticaria, pruritus, angioedema, rash, anaphylaxis
15
Q
PCN G
A
IM penicillin - used for uncomplicated syphilis
16
Q
if patient is allergic to penicillin they could also be allergic to
A
cephalosporins
17
Q
antibiotic used for meningitis
A
ceftriaxone
18
Q
phenazopyridine also called
A
pyridium
19
Q
phenazopyridine for
A
topical analgesic. can buy over the counter. for pain, during, and urgency of urination
20
Q
bacteria that has evolved with beta lactamase
A
E. coli - has figured out how to break the beta lactam ring so we needed to figure out a way to inhibit that actions
21
Q
antibiotics that bacteria can’t break the beta-lactam ring
A
ampicillin and pipercillin
22
Q
beta lactase inhibitors are considered
A
time dependent killers in which we have to meet a minimum inhibitory concentration
23
Q
cephalosporin beta lactams are similar to
A
penicillins
24
Q
cephalosporin beta lactams spectrum
A
broad spectrum
25
how many generations of cephalosporin beta lactams are there
5 and gram negative coverage increases with each generation
26
cefazolin
(ancef) - first generation cephalosporin - most gram positive coverage
27
what is cefazolin used for
surgical prophylaxis
28
ceftriaxone
(Rocephin) third generation cephalosporin- can cross the blood brain barrier
29
how often do you give ceftriaxone
long acting (every 24 hr dose)
30
what is ceftriaxone given for
since it can cross the blood brain barrier it is given for meningitis but also broad spectrum so can be given for UTIs
31
cefepime
(Maxipime) 4th generation cephalosporin
32
what is cefepime used for
complicated UTI, skin infections, and community acquired PNA
33
ceftaroline
(Teflaro) 5th generation cephalosporin
34
what is ceftaroline effective against
MRSA and used for C-A PNA
35
carbapenems MOA
inhibits cell wall synthesis
36
carbapenems spectrum
broadest spectrum
37
carbapenems are used for
acutely ill and complicated infection
38
carbapenems have cross sensitivity with
penicillins
39
carbapenems need to be infused over
60 mins
40
carbapenems can cause drug induced
seizure activity that is more likely in geriatrics and those with CKD and is dependent on dosing
41
carbapenems example
imipenem/cilastatin (Primaxin), meropenem (Merrem), Ertapenem (Invanz)
42
cilastatin inhibits _________ from breaking down ________
cilastatin inhibits dehydropeptidase from breaking down imipenem
43
imipenem/cilastatin (Primaxin) is effective against
evolved bacteria
44
imipenem/cilastatin (Primaxin) indication
endocarditis (MRSA), hospital acquired pneumonia, intraabdominal infection, sepsis, UTI
45
Macrolides MOA
antibiotic - bacteriostatic that inhibits RNA protein synthesis
46
Macrolides indication
chlamydia, gonorrhea, syphilis, infection of eye, skin, and respiratory infection
47
Macrolides example
erythromycin and azithromycin
48
erythromycin side effects
it stimulates GI motility so N/V/D
49
azithromycin dosed
every 24 hours
50
aminoglycocides
antibiotic used for virulent gram negative bacteria
51
aminoglycocides example
gentamicin and tobramycin
52
aminoglycocides has what type of effect
synergistic effect
53
synergistic effect
the effect of 2 antibiotics used together is greater than each of them used alone. using beta lactams to break down cell wall makes it easier to get another antibiotic in
54
aminoglycocides side effects
ototoxic, nephrotoxic, and neurotoxic
55
aminoglycocides ototoxicity can cause
damage to CN 8, dizziness, tinnitus, hearing loss that is permanent
56
aminoglycocides nephrotoxicity can cause
proteinuria, urine casts, and reversible abnormal renal labs
57
aminoglycocides should be dosed based off
renal function
58
aminoglycocides neurotoxicity can cause
altered level of conscious to paralysis
59
clindamycin IND
sepsis, PNA, and bone, skin, respiratory, GU infection
60
clindamycin contraindicated in
ulcerative colitis
61
clindamycin can enhance
vecuronium which can lead to respiratory paralysis
62
linezolid also called
Zyvox
63
zyvox has been created to treat
VRE and also affective against MRSA
64
zyvox indication
skin and PNA with resistant bacteria
65
zyvox availability
great oral availability
66
side effects of zyvox
N/V/D, decrease platelets, serotonin toxicity
67
eating tyramine finds with zyvox can
increase blood pressure
68
zyvox can interact with what drugs
it can strengthen vasopressors
69
vancomycin
used to treat MRSA, gram positive, and severe bone/skin infections
70
oral form of vancomycin used for
C. diff
71
vancomycin side effects
ooo-nephron-neuro toxic, can cause additive neuromuscular blockade effects
72
if vancomycin infused too fast it can cause
hypotension or red man syndrome
73
how fast should vancomycin be administered
over more than 60 minutes
74
corticosteroids example
methylprednisolone and prednisone
75
biologics include
anti-cancer and anti-TNF drugs
76
anti-TNF drug
adalimumab (Humira) and infliximab (Remicade)
77
TNF is a
pro inflammatory cytokine
78
IND for humira
RA, psoriasis, inflammatory bowel disease
79
BBW of humira
infection and cancer risk
80
infliximab (Remicade)
anti-TNF drug contraindicated in HF and has BBW of risk of infection and cancer
81
immunomodulator examples
methotrexate and cyclosporine
82
cyclosporine is for
organ rejection prevention
83
what antibiotics should you take for inflammatory bowel disease
ciprofloxacin or metronidazole (flagyl)
84
ciprofloxacin BBW
tendon rupture
85
anticholinergics do what
slow peristalsis and have a drying effect on secretions
86
anticholinergics example
belladonna alkaloids also called donnatal elixir
87
belladonna alkaloids onset
1-2 hours
88
side effect of anticholinergics
urinary retention
89
opiates for diarrhea
slows peristalsis and has anticholinergic effects
90
example of opiates used for diarrhea
diphenoxylate with atropine (Lomotil) and loperamide (Imodium A-D)
91
diphenoxylate with atropine (Lomotil) onset
45-60 minutes
92
loperamide (Imodium A-D) onset
1-3 hours
93
bulk forming laxatives
absorb water into the intestines
94
bulk forming laxatives example
psyllium (Metamucil)
95
psyllium (Metamucil) is made from
seeds
96
emollient laxatives
help water and fat into the the stool to soften it and to lubricate intestinal wall
97
emollient laxatives example
decusate (colace) and oil enema
98
decusate (colace) useful for
fecal impactions and hemorrhoids
99
hyperosmotic laxative
draws water into colon
100
hyperosmotic laxative example
lactulose
101
lactulose can be given
orally or rectally
102
lactulose does what
sugar draws water into bowel, converts ammonia into ammonium which cannot be reabsorb so it leaves with the stool
103
stimulant laxative
stimulates nerves that innervate intestines to increase peristalsis and inhibits water reabsorption
104
what laxative is most likely to cause dependence
stimulant laxative
105
stimulant laxative example
bisacodyl (dulcolax) and Senna (senokot)
106
bisacodyl (dulcolax)is given
oral or rectal suppository
107
Senna (senokot) does what
causes bowel evacuation within 6-12 hours - may cause abd pain and is used for surgery if they want the bowels completely empty
108
most misused over the counter drugs
laxatives
109
laxatives are contraindicated in
fecal impaction, intestinal obstruction, and abdominal pain
110
what can restore normal flora balance
lactobacillus
111
if patient is on _____ of glucocorticoids they will need____
taking 10 mg or more of glucocorticoids daily they will need stress dosing in times of trauma
112
exogenous administration of glucocorticoids causes
endogenous secretions to stop
113
glucocorticoids do what
control inflammatory response by decreasing capillary permeability, decreases migration of WBC, and stabilizing mast cells. they also promote glycogenesis and stimulate bone demineralization
114
glucocorticoids cause a risk for
circulatory collapse
115
increased sodium and water cause K+ and H+ to
decrease
116
glucocorticoids examples
hydrocortisone, solu-medrol, prednisone, and dexamethasone
117
solu-medrol is for
rescue IV drug
118
glucocorticoids IND
LUPUS, MS, ulcerative colitis, crohns, skin disorders, asthma, COPD, organ transplant, spinal cord injuries
119
glucocorticoids considerations
```
HF because of sodium and water retention
psychosis
poor wound healing
hyperglycemia
osteoporosis
```
120
mineralocorticoid example
fludrocortisone
121
fludrocortisone IND
adrenocortical insufficiency (Addison disease)
122
adverse effects of fludrocortisone
fluid volume overload, HF, HTN, increased intracranial pressure
123
fludrocortisone dosing
PO only, small dose of 0.1 mg
124
hydrocortisone has what type of effect
effect on mineralocorticoids because t is most similar to cortisol
125
anti-emetic classes
anticholinergics, antihistamines, pro kinetics, anti-dopaminergic, serotonin blockers, tetrahydrocanabinoids
126
anticholinergics do what
block ACh receptors, antisecretory, antispasmodic
127
anticholinergics examples
scopolamine, dicyclomine, atropine, oxybutynin
128
antihistamines do what
H1 blockers and anticholinergic effects
129
examples of antihistamines
meclizine, diphenhydramine, hydroxyzine
130
adjunct for antiemetics
dexamethasone and lorazepam
131
antidopaminergics
block dopamine in the brain
132
antidopaminergics have risk for
extrapyramidal effects and CNS depression
133
antidopaminergics adverse effects
urinary retention, constipation, dry mouth
134
cardiac considerations for antidopaminergics
monitor for prolonged QT
135
example of antidopaminergics
promethazine (phenergan) and prochlorperazine (compazine)
136
promethazine (phenergan) considerations
extreme care with IV route so dilute it
137
promethazine (phenergan) BBW
res depression and tissue necrosis
138
how do you administer promethazine (phenergan)
deep IM injection and PR
139
prochlorperazine (compazine) BBW
geriatric death
140
prokinetics do what
dopamine antagonist at the chemo receptor zone and stimulates peristalsis which enhances gastric motility and emptying
141
example of pro kinetics
metoclopromide (reglan)
142
metoclopromide (reglan)
is a prokinetic and has extrapyramidal effects with long term use
143
is metoclopromide (reglan) okay with pregnancy
yes you can use for N/V in pregnancy
144
metoclopromide (reglan) considerations
slow IV push or can cause hypotension or Supraventricular tachycardia
145
metoclopromide (reglan) BBW
tardrive dyskinesia
146
serotonin does what
stimulates vasodilation in GI, secretion, mobility, and sensation of intestine
147
serotonin (5-HT3) blockers do what
block receptors in GI tract and brain
148
serotonin (5-HT3) blockers examples
granisetron (kytril) and ondansetron (Zofran)
149
when should you give serotonin (5-HT3) blockers
30 minutes before surgery ends and 30-60 minutes prior to chemo receptor
150
adverse effects of serotonin (5-HT3) blockers
long QT and cardiac dysrhythmias if pushed too fast and headache
151
what should you check before administering serotonin (5-HT3) blockers
liver function test
152
how do you administer serotonin (5-HT3) blockers
IV push slow for 2-5 minutes
153
examples of tetrahydrocannabinoid
Dronabinol (Marinol)
154
what does tetrahydrocannabinoid do
inhibitory effects of cerebral cortex and reticular formation
155
is tetrahydrocannabinoid intoxicating
no it is nonintoxicating
156
what can tetrahydrocannabinoid stimulate
appetite and weight gain
157
adverse effect of tetrahydrocannabinoid
drowsiness, anxiety, dry mouth, and dizziness
158
tetrahydrocannabinoid most commonly used for
HIV/AIDs, cancer, and 2nd line when other antiemetics fail
159
when should tetrahydrocannabinoid be given
1 hour before therapy
160
proton pump inhibitor example
omeprazole and pantoprazole
161
proton pump inhibitor does what
inhibits all H+ (HCL) secretion for 24 hour
162
proton pump inhibitor is used for
stress ulcer prophylaxis
163
achlorhydria
absence of hydrochloric acid
164
what can achlorhydria cause
bacterial overgrowth, intestinal metaplasia, and speed up of bone mineral loss
165
intestinal metaplasia
change the cells within the stomach lining
166
why do proton pump inhibitors speed up bone mineral loss
because calcium is used for digestive process so when there is no acid it starts pulling from bones
167
does proton pump inhibitors effect food absorption
no
168
proton pump inhibitors put you at risk for
osteoporosis and C. diff
169
omeprazole should be given
30-60 minutes before meals to prepare stomach for digestion
170
omeprazole can mask
symptoms of serious underlying disease
171
omeprazole and NG tube
can block tube so ask for liquid form
172
pantoprazole is given for
IV infusion for GI bleeding
173
how is pantoprazole given
bolus and continuous
174
antithyroid drugs
methimazole (tapazole) and propylthiouracil PTU
175
antithyroid drugs impedes
formation of TH but does not act on circulating hormone so can take approximately 2 weeks to work
176
widespread side effects of antithyroid drugs
bone marrow and liver toxicity and loss of stamina and weight gain
177
levothyroxine
works like thyroid hormone which increases metabolism, increase cardiac output, increase blood flow to kidneys
178
side effect of levothyroxine
based on giving too much or too little
179
contraindications for levothyroxine
MI, cardiac considerations
180
onset of levothyroxine
3-5 days usually oral but IV available for myxedema coma
181
elimination of levothyroxine
1/2 life of 6-10 days so risk for toxicity
182
levothyroxine is highly
protein bond
183
increased metabolism from levothyroxine does what
increase oxygen consumption and overall cell reproduction
184
red man syndrome
hypotension and erythema
185
extrapyramidal symptoms
twitching
186
tardive dyskinesia
permanent twitching
