pharm exam 2 Flashcards
Quinolones/Fluroquinolone examples
ciprofloxacin besifloxacin gatifloxacin levoflaxacin moxifloxacin
Quinolones/Fluroquinolone black box warning
increased risk of tendon rupture; tendonitis
may exacerbate MG
Lincosamide BB warning
(clindamycin)
BB warn for severe colitis
Long acting beta 2 agonists BB warnings
do not use salmeterol or formeterol singly in asthma for all ages; two-fold increase in catastrophic events
step 1 asthma therapy
- SABA prn
- s/s when exposed to triggers
- exercise can be mild intermittent
step 2 asthma therapy
- one long term control med daily
- low dose ICS (mainstay for all ages)
- cromolyn or leukotriene modifier are alternatives
step 3 asthma therapy
-medium dose ICS or low dose ICS plus LABA
OR
-medium dose ICS plus leukotriene receptor modifier
- exacerbations may require oral steroids
- consider allergy therapy/allergist referral
step 4 asthma therapy
-medium dose ICS plus: LABA or medium dose corticosteroid or leukotriene modifier or theophylline
step 5 asthma therapy
- consult pulmonology or immunology
- high dose ICS plus LABA
step 6 asthma therapy
-high dose ICS plus LABA and oral corticosteroids
asthma exacerbation
- treat with oral steroids to regain control, if not effective step up therapy
- increase inhaled beta agonist (2-6 puffs q20min)
ICS reduction recommendation
dose of ICS should be reduced 25-50% every 2-3 months to lowest possible dose to maintain control
pregnant patients with asthma
- inhaled beta agonists are drug of choice during pregnancy
- ICS are long term drug of choice
transient wheezing
caused by prematurity or smoking during pregnancy, children usually outgrow by age 3
persistent early onset wheezing
carries on with kids through school age and early adolescence
late onset wheezing
often associated with eczema
LABA should not be prescribed without what?
ICS
Theophylline
a methalyxanthine derivative that causes;
- bronchial smooth muscle relaxation
- SNS stimulants
- CV effects
- increased gastric acid production
- stimulates skeletal muscle
- increase renal blood flow and GFR
theophylline dosage
- 2nd or 3rd line drug for asthma or COPD
- adult start at 6mg/kg/day
- dose is increased by 25% q3days until serum levels are 10-20mcg/ml
theophylline ADRs
irritability, restlessness, seizures, insomnia, dyspepsia, palpitations, tachycardia, hypotension, arrhythmias
theophylline toxicity greater than 20mcg/ml
NVD, HA, vomiting, diarrhea, insomnia, irritability
theophylline toxicity greater than 35mcg/ml
hyperglycemia, hypotension, cardiac arrythmias, tachycardia, seizures, brain damage, death
what increases clearance of theophylline
- smoking tobacco
- low carb/high protein diet
- charcoal broiled foods accelerate hepatic metabolism of theo
when to draw theophylline levels
- Q 6-12 months when steady state reached
- when a new drug is added or deleted from regimen
1st line for AOM and sinusitis
amoxicillin
1st line for infection following bites, including human
amoxicillin/clavulanate
1st line for MRSA, and in special populations (children, pregnancy)
Lincosamides (clindamycin)
1st line for C. trachomatis and ureaplasma urealyticum
doxycycline
COPD exacerbation
- Augmentin
- double strength sulfamethoxazole/trimethoprim
- macrolide abx
macrolide antibiotics
erythromycin
azithromycin
clarithromycin
healthy adult with CAP
macrolide (or doxy if allergic) and treat for 5 days
adult CAP with comorbidities, or risk of DRSP
fluroquinolone
beta lactam
macrolide
CAP in pregnancy
macrolide; azithromycin 1st choice pregnancy category B
abx for AOM is PCN allergy
Lincosamide (clindamycin) plus 3rd generation cephalosporin
what bugs cause otitis media?
S. pneumoniae, nontypeable H. influenza (HIB), M. catarrhalis
ADR’s of sulfonamides, nitrofurantoin, and trimethoprim
anorexia, NVD, stomatitis, rashes, increased hypersensitivity reactions, photosensitivity, HA, dizziness, drug interactions
long term nitrofurantoin complication
fibrosis- check CXR
sulfonamides, nitrofurantoin, and trimethoprim used to treat what?
Most commonly used with UTI infections
MRSA is susceptible in some areas
pharmacodynamics of tetracyclines
tetracycline and doxycycline
Bind reversibly to the 30S subunit of the bacterial ribosome
pharmacokinetics of tetracyclines
food, milk, and calcium decrease absorption
beta lactam contraindications
pregnancy category B
not for hypersensitive reactions to pcn
macrolide contraindications
most are safe in pregnancy and children
tetracycline contraindications
do not give in pregnancy, lactating women, or children less than 8
1st and 2nd line for group A strep
- 1st line PCN/amoxicillin/augmentin
- macrolides if pcn allergy
- cephalosporins if PCN doesn’t work
meds to avoid in COPD patients
beta blockers (produce bronchial spasms) antitussives
first line for asthma
SABA
- albuterol
- metaproterenol
- terbutaline
- bitolterol
- pirbuterol
- levalbuterol
LABA
- salmeterol
- formeterol
- indacaterol
- arformoterol
safe SABA for kids less than 4?
albuterol and metaproterenol
Buproprion contraindicated in patients with?
- sz disorder
- bulimia
- anorexia
- use of MAOI within 14 days
- hx of stroke, brain tumor, brain surgery, or closed head injury
- use cautiously in hepatic cirrhosis
PCN increases what drugs?
methotrexate (dont give)
warfarin (monitor INR)
what beta blocker is contraindicated with ampicillin
atenalol
1st generation cephalosporin used for?
- Used for skin and soft tissue infections
- Primarily active against gram-positive bacteria, S. aureus and S. epidermidis
2nd generation cephalosporin used for?
- Active against same as first generation(gram positive, S. aureua, and S. epidermidis)
- plus Klebsiella, Proteus, E. coli
3rd generation cephalosporin used for?
- Used for broader indications
* More active against gram-negative bacteria
4th generation cephalosporin used for?
- Resistant to beta-lactamase
* Primarily active against gram-positive bacteria
valcyclovir ADRs
thrombocytopenia purpura
hemolytic uremic syndrome
FDA warning about Levaquin
psych reactions
hypoglycemia –> coma
tendon rupture
vancomycin SE
ototoxicity
nephrotoxicity
red man syndrome
neutropenia
abx for perforated TM?
contraindicated for perforated TM?
ciprofloxacin is contraindicated
Ofloxacin can be given
