pharm 2 exam 4 (without HIV ad cancer info) Flashcards
Tuberculosis treatment challenges
- Adherence
- Drug resistance (have to use 2 or more antibiotics)
- Toxicities
- Cost
- Grows slowly
Isoniazid
Antituberculosis med
Pyrazinamide
Antituberculosis med
Ethambutol
Antituberculosis med
Rifampin
Antituberculosis med
Tuberculosis high yield concepts
- Usually requires multiple antibiotics for 6 months to 2 years
- Watch out for hepatotoxicity
- Numerous CYP interactions
- Isoniazid can cause peripheral neuropathy (give pyridoxine (Vitamin B6))
- Rifampin causes red-orange secretions (urine, saliva, sweat, tears)
- Ethambutol causes red-green color blindness
Amphotericin B
Antifungal med
Ketocanazole
Antifungal med
Fluconazole
Antifungal med
Miconazole
Antifungal med
Amphotericin B mechanism of action
Binds to a substance on fungal membranes called ergosterol (also binds to the cholesterol on our cell membranes and can have toxic effects on us) This causes the membrane to become more permeable, allowing important cations like potassium to leak out
Azoles mechanism of action
Interfere with the production of ergosterol, an essential component of fungal cellular membranes. Without a sturdy cellular membrane, fungi die
Amphotericin B problems
- Infusion reaction (fever, chills, rigors, HA)
- Phlebitis
- Nephrotoxicity
- Hypokalemia
- Anemia
Azoles problems
- Better tolerated than amphotericin B
- Hepatotoxicity
- Numerous CYP interactions
Acyclovir
Herpes simplex virus med
Valacyclovir
Herpes simplex virus med
Absorption rate for Acyclovir and Valacyclovir
- Acyclovir: 20% PO absorption (take 3-5 times/day)
- Valacyclovir: 50% PO absorption (1-2 times a day)
Herpes simplex virus med themes
- Very well tolerated
- Headache
- Nausea/vomiting
- Phlebitis (IV acyclovir)
Herpes simplex virus rare side effects
- Crystal urea (kidneys) (drink lots of water)
- Altered mental status
Scenarios with Herpes
- Pregnant: C-section, the drug, or no action if there is no outbreak
- Eczema herpeticum: IV
- Recurrent, painful HSV-2 outbreaks: prophylactic
- Encephalitis- IV acyclovir
- Shingles: IV acyclovir or high dose PO
HSV med teaching
- The earlier, the better
- Not a cure; still contagious
- Drink plenty of fluids
Influenza vaccines
- Protections begins in 1-2 weeks
- Lasts about 6 months (4 if older)
- They do not cause the flu
Oseltamivir
Influenza med
Oseltamivir adverse effects
- Extremely well tolerated
- Nausea
- Vomiting
Oseltamivir benefits
- Must take within 48 hours
- Decreases duration of symptoms (16 hours)
- Effective at preventing influenza (not a substitute for vaccination)
Three major groups of Rheumatoid arthritis meds
- NSAIDs (rapid relief)
- Glucocorticoids (rapid relief)
- Disease-modifying anti-rheumatic drugs (DMARDs)
Methotrexate
Disease-modifying anti-rheumatic drugs (DMARDs) (drug of choice)
Hydroxychloroquine
Disease-modifying anti-rheumatic drugs (DMARDs)
TNF blockers
Disease-modifying anti-rheumatic drugs (DMARDs)
Methotrexate adverse effects
- Nausea, diarrhea
- GI ulceration
- decreased bone marrow
- pneumonitis
- Hepatotoxicity
- Renal failure
- Infection
- Severe rash
Take once a week
Hydroxychloroquine themes
- MOA unknown
- usually combined with methotrexate
- Take with food
- Risk of retinal damage
- Less effective but more tolerated
- regular eye appointment
infliximab
TNF blocker (Disease-modifying anti-rheumatic drugs (DMARDs)) (IV or SubQ)
Adalimumab
TNF blocker (Disease-modifying anti-rheumatic drugs (DMARDs)) (IV or SubQ)
Etanercept
TNF blocker (Disease-modifying anti-rheumatic drugs (DMARDs)) (IV or SubQ)
TNF blockers problems
- Injection-site reactions
- Infections
TNF blockers rare adverse effects
- Severe allergic reactions
- heart failure
- hepatotoxicity
- cancer
Allopurinol
Gout medication
Colchicine
Gout medication
Allopurinol themes
- Gout prevent and treatment
- Full effect in 1-2 months
- Goal is uric acid < 6 mg/dL
- Indicated for certain cancers
Allopurinol adverse effects
- Acute gouty attack
- Hypersensitivity syndrome (rare)
- Hepatotoxicity
Colchicine themes
- MOA poorly understood
- Gout prevention and treatment
Colchicine adverse effects
- Diarrhea (25%)
- Myopathy
- Bone marrow suppresion
Alendronate
Bisphosphonate (Osteoporosis med)
Ibandronate
Bisphosphonate (Osteoporosis med)
Risedronate
Bisphosphonate (Osteoporosis med)
Bisphosphonates adverse effects
- heartburn
- abdominal pain (very irritating to GI tract)
- Diarrhea
- Hypocalcemia
- Osteonecrosis of jaw (ONJ)
Bisphosphonates client teaching
- Take in the AM
- Completely empty stomach
- Full glass of water
- Stay upright for 30-60 min.
Raloxifene
Osteoporosis med
Raloxifene themes
- Mimics estrogen (bones)
- Blocks estrogen (uterus and breasts)
- decrease cancer risk
Raloxifene adverse effects
- Hot flashes
- Leg cramping
- Edema, weight gain
Raloxifene black box warning
- Thromboembolism
- Stroke
