Pharm Exam 2 Flashcards by Maddy Golem

Penicillin(s):
properties, adverse effects, renal impact, and what it treats/highlights

Beta-lactam ring (antibacterial property)

Common antibiotic allergy
Renal excretion/dose dependent

Narrow spectrum for general penicillin’s (treats syphilis)

Covers gram(+)
*most commonly prescribed antibiotic

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Amoxicillin- clavulanate (Augmentin) and Piperacillin-tazobactam (Zosyn):
properties, adverse effects, renal impact, and what it treats/highlights

Beta-lactam inhibitor Females: interaction with birth control

Common antibiotic allergy

Renal dosing

Broad spectrum coverage *adds gram (-) that lives in GI (dark places)
Used in sepsis patients (specifically Zosyn)
Great treatment for diverticulitis

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Cephalosporins:
properties, adverse effects, renal impact, and what it treats/highlights

Interacts w/ beta-lactam so be cautious w/ penicillin allergies (we still give it though)

Allergies, bleeding, thrombophlebitis, hemolytic anemia

Nephrotoxicity (depending on the drug)

Penetrates CSF (class 3+), can be given for meningitis

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Cefepime:
properties, adverse effects, renal impact, and what it treats/highlights

Interacts w/ beta-lactam so be cautious w/ penicillin allergies (we still give it though)

Allergies, bleeding, thrombophlebitis, hemolytic anemia

Monitor neuro status in geriatric patients

Used for hospital-acquired pneumonia and pseudomonas

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Ceftriaxone:
properties, adverse effects, renal impact, and what it treats/highlights

Interacts w/ blood thinners, NSAIDS, and calcium

EXCRETED BY LIVER

Given IM or IV, lasts 24hrs.

Interacts w/ beta lactam so be cautious w/ penicillin allergies (we still give it though)

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Cephalexin:
properties, adverse effects, renal impact, and what it treats/highlights

Choice treatment for UTIs in pregnancy

Prophylaxis in surgical patients (good for skin infections)

Kidney excretion

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Carbapenem(s):
properties, adverse effects, renal impact, and what it treats/highlights

Can cause super infection
(can also treat super infections)**
Rare: seizures

Low toxicity, still renal dosed (based off patient GFR)

Can be given PO
No alcohol (:

Extremely broad antimicrobial

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Ertapenem:
properties, adverse effects, renal impact, and what it treats/highlights

Once daily dosing

Can be given IM
Not active against MRSA

Resistant ESBL (extended spectrum beta lactamase; ex. resistant e. coli)

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Vancomycin:
properties, adverse effects, renal impact, and what it treats/highlights

Infused for at least 60min

No beta lactam rings Red Man Syndrome
Renal failure
Thrombophlebitis
Ototoxicity
Nephrotoxicity

Monitor VS, renal, and trough level (we dose based off this)

If we see Red Man Syn., slow infusion, give Benadryl and steroids

Covers MRSA when given IV

Covers C. diff when given PO

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Aztreonam:
properties, adverse effects, renal impact, and what it treats/highlights

Renal dosed

Go-to for penicillin allergies

Narrow spectrum of use

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Fosfomycin:
properties, adverse effects, renal impact, and what it treats/highlights

Urinalysis to check for UTI

Renal dosed

Only for non-complicated UTI (enterococcus)

Single dose (so we ed. that it stays in the bladder for 6 days)

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Tetracycline (Doxycycline):
properties, adverse effects, renal impact, and what it treats/highlights

causes Discoloration of teeth
Super infection

Renal dosing

Interacts w. birth control

DO NOT take w. milk

Class X = teratogenic (give cephalosporins instead)

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Macrolides:
properties, adverse effects, renal impact, and what it treats/highlights

D/V/N

Liver dosing

Broad spectrum antibiotic

Given for Penicillin allergy

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Azithromycin:
properties, adverse effects, renal impact, and what it treats/highlights

QT prolongation
(Intervention: EKG monitoring)

EKG Lasts for 10 days, take for 3

For community-acquired pneumonia (covers legionella)

Common STD treatments (gono, chlamydia)

Give with food!!! (prevents GI upset)

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Aminoglycosides (Gentamicin):
properties, adverse effects, renal impact, and what it treats/highlights

Blood sample 30min after to check for peak, and trough must be checked before giving dose

Ototoxicity
Nephrotoxicity

Renal dosing

Not absorbed in GI, easy to reach toxic levels

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Fluoroquinolones (Ciprofloxacin):
properties, adverse effects, renal impact, and what it treats/highlights

Tendon rupture (Achilles) Tendon pain
Muscle weakness
Neuro status

Only renal dosed if in full failure, otherwise its well tolerated

Cipro is the only oral med to cover Pseudomonas (because it grows in urine)

not a 1st line med for any treatment (unless it is pseudomonas)

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Metronidazole:
properties, adverse effects, renal impact, and what it treats/highlights

Ed. to not drink alcohol -> disulfiram reaction (vomiting, sick)
Dry mouth
Metallic tasting mouth
Darkened urine

Renal dosing

Mainly used for gut infections

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Silver Sulfa:
properties, adverse effects, renal impact, and what it treats/highlights

causes SJS (steven johnson syndrome = skin peeling) s/s allergic reaction

Used for 2nd and 3rd degree burns

Not recommended for use on newborns/infants

Lots of resistance :/

topical

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Bactrim (TMP/SMZ):
properties, adverse effects, renal impact, and what it treats/highlights

Drug interactions: blood thinners
Rash
Hypersensitivity

Renal dosing

Prostatitis: take for 3 weeks

Common use: UTIs

Good for skin infections (Cheap = access to care!)

Acyclovir:
properties, adverse effects, renal impact, and what it treats/highlights

Topical: keep skin clear (ex. Herpes)

Nephrotoxicity (IV)
Vertigo

Renal dosing (PO method)

Resistance rare

Used as prophylactic in immunocompromised patients (AIDS, cancer)

Oseltamivir (Tamiflu):
properties, adverse effects, renal impact, and what it treats/highlights

Take with food
Nausea/ vomitting
Anaphylaxis (possible)

Renal dosing

Monitor for delirium

One is sick, the rest of the house gets the med (prophylaxis)
Key takeaway: don’t need symptoms to take the med

Rifampin (for TB):
properties, adverse effects, renal impact, and what it treats/highlights

Give on an empty stomach***

Nephrotoxic
Hepatotoxic
Body fluid discoloration

Rapid resistance* (bc it has to be taken w. other meds for TB)

Renal dosing

**RUL cavitary lesions = TB until proven otherwise (also hemoptysis, night sweats, fatigue, unintentional weight loss)

Amphotericin B (aka. Amphoterrible):
properties, adverse effects, renal impact, and what it treats/highlights

Keep hydrated (all times)

Renal dosing

Monitor infusion site IV only; used for fungal infections

Interacts w. basically everything

Azoles:
properties, adverse effects, renal impact, and what it treats/highlights

Take full course

Hepatotoxic
QT prolongation
Monitor ALT and AST
Monitor EKGs

Topical: skin peeling

Go to for fungal (topical and oral)

interacts badly w. warfarin (blood thinner)

Ambien: properties, adverse effects, renal impact, and what it treats/highlights

you become dependent on it to sleep Preferred for insomnia, short-term use only

Benzodiazepines and reversal: properties, adverse effects, renal impact, and what it treats/highlights

CNS depression (must monitor) Most common use: anxiety Reversal: flumazenil (only if in pain) Class X IM only for seizures Rate of absorption = variable

Barbiturates (Phenobarbital): properties, adverse effects, renal impact, and what it treats/highlights

Avoid given w/ other CNS depressants High abuse potential and risk for suicide Renal toxicity (dosing) treats Seizure disorders and used for anesthesia

SSRIs: properties, adverse effects, renal impact, and what it treats/highlights

Taper off Big teaching: takes 1-2 weeks, after 1 month we consider other options sexual dysfunction weight gain Serotonin Syndrome (know. what. that. is.) Behavioral changes Antidepressant (can also be used to gain weight) Used for Pulm embolism?

Mirtazapine: properties, adverse effects, renal impact, and what it treats/highlights

Give at bedtime! Monitor weight and cholesterol Off-label use: appetite stimulant (and weight gain) Mechanism: inc. release of serotonin (antidepressant)

MAOI: properties, adverse effects, renal impact, and what it treats/highlights

Reacts w. everything (zombie drug) Avoid eating dietary tyramines (cheese, pickles, meats) HTN crisis from tyramine (monitor BP) Must review medications!!! Antidepressants

Seroquel: properties, adverse effects, renal impact, and what it treats/highlights

Telemetry (prolonged QT) Neuroleptic Malignant Syndrome (MUST KNOW) Metabolic risks (especially diabetics) Use: bipolar/schizophrenia Given PO Class C If you give antipsychotics to geriatrics, a black box warning for risk of death

Haloperidol: properties, adverse effects, renal impact, and what it treats/highlights

EPS NMS BP ECG monitoring Give em a shot, check their QT Off label use: given IV High potency Mixed w/ benadryl to combat A.E. (EPS)

Levodopa/carbidopa (Sinemet): properties, adverse effects, renal impact, and what it treats/highlights

Avoid high protein diet Avoid aspiration Dyskinesia (ticks, tremors) Psychosis Depression (suicide screening) Most common med for parkisons, activates dopamine

Anticholinergics: properties, adverse effects, renal impact, and what it treats/highlights

Encourage oral fluids Dehydration, can’t see, can’t pee, can’t shit, can’t spit Dry mouth Anuria Manages Parkinson's Used for controlling EPS symptoms in psychiatric medications. Reduces tremors

Donepezil: properties, adverse effects, renal impact, and what it treats/highlights

High. Fall. Risk. Initial drug Use in demented patients

Namenda: properties, adverse effects, renal impact, and what it treats/highlights

Dizziness Headache Confusion Constipation Better tolerated than cholinesterase inhibitors; not as effective MAY help w. dementia

Phenytoin: properties, adverse effects, renal impact, and what it treats/highlights

Monitor cardiac b/p and rhythm CNS (GCS monitoring) Liver function testing Decreases effect of warfarin Teratogenic (bad fetus side effects)

Gabapentin: properties, adverse effects, renal impact, and what it treats/highlights

Mainly used for neuropathic pain Not initial drug for seizures Can cause somnolence (sleepy) Kidney function testing will need lower dose if bad kidneys Off label use for hot flashes

Levetiracetam: properties, adverse effects, renal impact, and what it treats/highlights

Choice drug for seizures Drowsiness Weakness Is dose effective? If not titrate Very few interactions choice drug for seizures and prevention of head injury

Adderall: properties, adverse effects, renal impact, and what it treats/highlights

High abuse potential Acute Toxicity, hallucinations , delusions , dysrhythmias This is a stimulant , increased heart rate and BP Used an ADHD High abuse Potential among college students

Management of UTI

-Take the full course (bacterim and phosphomycin; Keflex for pregnant women)

Management of neuroleptic malignant syndrome

- Dantrolene (choice drug) - How do they present? Hot, stiff, unconscious - We can also just give ‘em ice

what is neuroleptic malignant syndrome

adverse reaction to antipsychotic (neuroleptic) drugs or dopamine-receptor antagonist medications. (such as Seroquel)

HIV general management

- Must be on 2 meds! - Labs: CD4 (AIDS <200) - Everyone gets retroviral therapy regardless CD4 count - Watch for opportunistic infections: hepatomegalovirus, thrush (candidiasis), PJP

opportunistic infections during HIV management:

hepatomegalovirus, thrush (candidiasis), PJP

Super infection (ESBL) -What antibiotics work for those?

carbapenems

Serotonin Syndrome

caused by SSRIs symptoms: fever, tachycardia, and diaphoresis (sweaty) mechanism: too much serotonin = cells can't keep up