PHARM Flashcards
What is the pharmacologic treatment for active TB infection?
INH, RIF, EMB, PZA fro 2 months
Cut EMB if sensitive strain
Cut PZA after 2 months
Continue INH, RIF for 6-9 month (include EMB if necissary; due to MDR-TB)
INH-isoniazid
RIF-Rifampin
EMB-Ethambutol
PZA- pyrazinamide
What is the DOT program in relation to TB treatment?
Direct observed therapy- watch the patient take their pills to avoid MDR TB
What are the MOA for INH, RIF, PZA, and EMB?
INH-decrease mycolic acid synthesis
RIF- Inhibit RNA polymerase and thus synthesis
PZA-unclear
EMB- inhibits CW synthesis
The M2 protein is found on which strain of influenza? What type of virus is this? What do you know about the M2 ion channel blockers?
Influenza A
orthomyxovirus
They are not recommended due to quickly acquired resistance
What drug is used as a neuraminidase inhibitor? Which strains cover? How does it work?
oseltamivir oral
influenza strains A and B
It prevents viral budding by binding to neuraminidase which is used by the virus to cleave receptors on the cell surface containing sialic acid. This prevents virions from leaving and clumps together those that have left.
What does the -VIR stem indicate ?
Anti-viral drug though its not specific to any one virus
How is oseltamivir used?
As therapy or chemo prophylaxis.
Therapeutically: It really only shortens flue symptoms for about 1 day if taken within the first 48 hrs and is recommended for otherwise healthy adults and children.
you can still administer it to patients will severe illness in a hospital setting
Prophylactic- prevent influenza for patients at high risk of complication from influenza that can’t get vaccinated.
What are the adverse effects of oseltamivir?
nausea and vomiting skin reactions
Whats the strategy behind anti-tuberculosis chemotherapy?
kill the bacteria rapidly using multiple drugs to prevent resistance
What are some latent TB infection treatment regimens?
Isoniazid 6-9 months
Isoniazid with Rifapentine 3 months
RIfampin 4 months
Using DOT therapy
T or F Rifampin is associated with hepatitis ?
True, both RIF and INH are associated with either hepatitis, or hepatotoxicity
What should you determine (among other things) when deciding whether to administer a CCB to a patient?
If they’re vasoreactive or not
What are some side effects and contraindications of CCB?
SE: Hypotension and reflex tachycardia
Contra: Right Heart Failure
PG12 (prostacyclin) has what MOA; list some drugs.
MOA binds PGI2 receptor and promotes vasodilation (also inhibits platlet aggregation)
Epoprostenol
IIoprost
Treprostinil
(prost like endings) Used to treat pulmonary htn
What are some adverse effects of PGI2?
GI problems and jaw pain or headache
What are some uses of Sildenafil; MOA, side effects, contraindications?
Treat ED or pulmonary htn.
MOA inhibits phosphodiesterase 5 (which degrades cGMP)=muscle relaxation.
Side Effects: epistaxis and cephalgia
Contraindications: Nitrates (cause unsafe drop in bp)
Whats the MOA of Riociguat; side effects and contraindications?
Stimulates Guanylate Cyclase (used in pulmonary hypertension)
SE: Fetal toxicity, hypotension, bleeding
Contra: pregnancy, Nitrates, PDE inhibitors (Sildenofil)
Describe the uses and side effects of the Endothelin receptor antagonists
Works as a vasodilator (inhibits ET-1 a potent vasoconstrictor) used for pulmonary htn
-entan
Side effects- Fatal hepatotoxicity (monthly liver test)
Contra: Pregnancy (must take pregnancy test prior to being given the drug)
Describe a basic asthma algorithm
Albuterol (SABA) as needed, unless greater than 2x wk
Next step: use inhaled corticosteroid (ICS) for control, and albuterol as needed
Add: Leukotriene modifyer/inhibitor or long acting beta agonist (LABA)
short acting beta agonists (SABA) and Long acting beta agonists (LABA) have what suffix? What’s their MOA?
SABA -buterol bronchodilator (Beta 2 stimulation)
LABA -terol
Why would you want to stay away from non specific beta agonists? Name a few of these drugs
You’ll get Beta 1 effects like tachycardia ect that are undesirable.
Isoproterenol and metaproterenol
How do LABA work and why? side effects?
Bronchodilation similar to SABA except they’re lipid soluble so they can get into cells better and stay in the lung tissue longer; lengthening their effects
side effects similar to SABA except Black Box warning
increased risk of severe asthma exacerbation and related death (rare). Also, down regulation of receptors and long term binding of LABA can make short term therapy with albuterol problematic due to competition and receptor availability.
Anticholenergics have what MOA, suffix, and side effects? What type of patients use these the most?
bronchodilation via inhibition of acetylcholine stimulation of muscarinic receptors in bronchial smooth muscle which cause constriction.
–ium i.e. ipratropium
can’t see, pee, spit or shit (opposite cholenergics-dryed out)
Corticosteroids: MOA, suffix, clinical and adverse effects. Important FYI requiring use of albuterol for rescue inhailer.
MOA- Decrease inflammation of respiratory tract to help breathing. Inhibit pro-inflammatory mediators
-one or -onide i.e fluticasone (flovent)
Improve FEV1, Peak flow rate, decrease hypersensitivity. Shown to reduce disease progression and airway remodling.
DOES NOT CAUSE BRONCHODILATON. Use albuterol for that during an attack.
