Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharm exam 3 > pharm exam 3 > Flashcards

pharm exam 3 Flashcards

1
Q

dopamine blockade at mesolimbic-mesocortical pathway

A

antipsychotic efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DA blockade at nigrostriatal pathway

A

parkinsonian side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DA blockade at tuberoinfundibular pathway

A

hyperprolactinemia (weight gain, sexual dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DA blockade at medullary-periventricular pathway

A

anti-emetic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DA hypothesis

A

excess DA @ mesolimbic –> + symptoms

deficit DA @ mesocortical –> - symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

antipsychotics mechanism

A

DA D2 receptor antagonists!!

EXCEPT atypical higher affinity for 5-HT2A than D2 (why it’s better at treating - symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the neuroleptic malignant syndrome tetrad?

A
  1. mental status change (confusion, stupor)
  2. hyperthermia
  3. extreme muscle rigidity (increase CK)
  4. autonomic dysfunction (tachycardia, HTN, sweating)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

high potency antipsychotic characteristics

A

higher risk EPSE but less sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

high potency antipsychotic prototype

A

haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

low potency antipsychotic characteristics

A

lower risk of EPSE but more sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

low potency antipsychotic prototype

A

chlorpromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

second generation antipsychotic protoype

A

clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what’s unique about clozapine?

A

efficacy for recalcitrant schizophrenia & suicidal behavior; reserved for cases where other antipsychotics have failed due to agranulocytosis; nearly absent risk of EPSE/TD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

list the four 5-HT2A > D2 antagonists

A

risperidone
olanzapine
quetiapine
ziprasidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

the partial D2 receptor agonist

A

aripiprazole (abilify); its partial agonism of D2 receptors blocks full agonist effect of DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

atypical vs typical antipsychotics

A

atypical better at treating NEGATIVE symptoms, have lower risk EPSE/TD, but higher risk of weight gain & more expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MIC definition

A

lowest conc. of an agent that PREVENTS VISIBLE BACTERIAL GROWTH in 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are innately resistant to aminoglycosides?

A

anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are innately resistant to metronidazole?

A

aerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are gram negative innately resistant to?

A

LIPOPHILIC– standard penicillins & high MW hydrophilic– vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ways a bug can ACQUIRE resistance?

A
  1. inactivation of the antibiotic
  2. decreased uptake of the antibiotic
  3. increased efflux of the antibiotic
  4. altered target site (so it can’t bind)
  5. bypass target process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mechanisms of acquiring resistance

A

enzyme induction (increasing expression of existing resistance genes), vertical transfer (spontaneous mutation), horizontal transfer (conjugation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

do abx cause mutations?

A

NO! they promote resistance by exerting selective pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

classic mech. of MDR

A

gram neg. doing horizontal transfer (conjugation, plasmid transferring R factor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

highest risk for c dif

A

clindamycin, cephalosporins (broad spectrum), fluoroquinolones, carbapenems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

tx c dif

A

NOT antidiarrheal agents. abx: metronidazole, vancomycin, fidaxomicin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

downside of bacteriostatics

A

reliant on competent host immune system (so don’t use in immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what agent would you use for locations that are difficult for abx to penetrate?

A

bactericidal! esp. in endocarditis, meningitis, osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

ideal or actual body weight for aminoglycosides

A

ideal! bc hydrophilic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

abx whose dose should be reduced in pts with decreased kidney fxn

A 
Cephalosporins (1 & 2 gen)
Aminoglycosides
Vancomycin
Ethambutol
Sulfonamides/trimethoprim
Carbapenems
Extended spectrum penicillins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

abx whose dose should be reduced in pts with decreased liver fxn

A 
Clindamycin
Chloramphenicol
Metronidazole
Macrolides
Rifampin
Isoniazid
Tetracylclines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

category D abx

A

DON’T USE IN PREGNANT! Aminoglycosides & tetracyclines (and sulfonamide-induced kernicterus during nursing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

most common abx that provoke sensitivity rxn’s

A

beta lactams
sulfonamides
trimethoprim
erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

significance of gram neg. OM

A

hinders transport of many abx; small hydrophilic drugs can cross via transport through porins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

list the bactericidal agents

A

aminoglycosides, beta-lactams, daptomycin, fluoroquinolones, isoniazid, metronidazole, polymyxins, pyrazinamide, rifampin, vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

list the bacteriostatic agents

A

(the CCEMOSTT ones!)

chloramphenicol, clindamycin, ethambutol, macrolides, oxazolidinones, sulfonamides, tetracyclines, trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what class inhibits cell wall synthesis?

A

beta lactams! & glycopeptides (vancomycin), fosfomycin (treats uncomplicated UTIs in women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

beta lactam subclasses

A

penicillins, cephalosporins, carbapenems, monobactams

39
Q

which bugs are innately resistant to B lactams and why?

A

chlamydia, mycoplasma, & legionella! bc they lack a peptidoglycan-based cell wall (b lactam mech. binds PBPs & inhibits cross linking of peptidoglycan)

40
Q

beta lactam mechanism

A

irreversibly inhibits PBPs –> inhibits cross-linking of cell wall NAM-NAG polymers & peptidoglycan buildup activates autolysins –> mediate cell wall disassembly

41
Q

penicillin structure

A

B-lactam ring fused to a FIVE member thiazolidine ring

42
Q

4 classifications penicillin

A
  1. standard (penicillin G, penicillin V): g +
  2. anti-staph (nafcillin): protects against B lactamase; MSSA
  3. aminopenicillins (amoxicillin): adds activity against g - bc + charged R group allows it to get through porins
  4. anti-pseudomonal (ticarcillin, piperacillin)
43
Q

which penicillin is orally effective?

A

pen V! it is acid-stable in stomach (unlike G)

44
Q

clavulanic acid use?

A

B-lactamase inhibitor so combine with aminopenicillins & anti-pseudomonals (i.e. amoxicillin, ticarcillin, piperacillin)

45
Q

what is pen G benzathine used for?

A

repository preparation; single dose given IM for treatment of syphilis & prevention of rheumatic fever. example of time dependence (absorbed for several weeks & produces persistent but low blood levels)

46
Q

least toxic of all abx?

A

penicillins

47
Q

standard penicillin clinical uses

A

syphilis–benzathine, group A strep (pharyngitis, endocarditis), oral infections

48
Q

antistaph penicillins clinical uses

A

pen G resistant MSSA (endocarditis, skin & soft tissue infections), osteomyelitis; superior to vancomycin

49
Q

aminopenicillins clinical uses

A

URI (strep pharyngitis, otitis media); enterococcal infections

50
Q

antipseudomonal penicillin uses

A

empiric treatment nosocomial infections, mixed infections, URI with suspected beta lactamase resistance

51
Q

cephalosporin structure

A

b lactam ring fused to SIX membered ring

52
Q

progression of 5 cephalosporin generations

A

increasing activity against gram negative bacteria, decreasing inactivation by beta lactamases, increasing CNS penetration

53
Q

first generation cephalosporin

A

cefazolin–commonly used to prevent surgical site infections

54
Q

second generation cephalosporin

A

cefoxitin–prophylaxis in abdominal surgery

55
Q

third glass cephalosporin

A

ceftriaxone–widely used; treats gram - meningitis & gonorrhea

56
Q

fourth generation cephalosporin

A

cefepime–empiric treatment nosocomial infections

57
Q

fifth generation cephalosporin

A

ceftaroline–only cephalosporin active against MRSA

58
Q

what is imipenem-cilastatin?

A

beta lactam, very broad spectrum; used in MDR infections, anaerobic & mixed infection

59
Q

aztreonam structure

A

beta lactam ring NOT fused with a second ring

60
Q

aztreonam:

A

beta lactam, narrow spectrum, GRAM NEGATIVE AEROBES (including pseudomonas); inhaled by CF patients w/ p. aeruginosa

61
Q

glycopeptide prototype

A

vancomycin

62
Q

glycopeptide mech

A

(vancomycin)–prevents polymerization of cell wall precursors; only active against gram + (strep & staph); reserved for serious resistant infections

63
Q

vancomycin adverse rxn’s

A

ototoxic, nephrotoxic, “red man syndrome”

64
Q

fosfomycin use

A

cytosol (prevents NAG to NAM); uncomplicated UTIs in females

65
Q

aminoglycoside required drugs

A

gentamicin, amikacin

66
Q

aminoglycoside MOA

A

bactericidal, conc. dependent; binds to 30s ribosomal subunit which causes misreading of mRNA

67
Q

aminoglycoside uses

A

combine w/ beta lactam for serious gram negative infections (septicemia), w/ beta lactam or vancomycin for endocarditis, & plague, TB

68
Q

adverse rxn aminoglycosides

A

ototoxicity, nephrotoxicity, neuromuscular blockade (why it’s contraindicated in pts with myasthenia gravis)

69
Q

how is gentamicin given?

A

once-daily high doses! bc conc. dependent

70
Q

tetracyclines required drugs

A

doxycycline, tigecycline

71
Q

abx that inhibit protein synthesis

A

aminoglycosides (gentamicin, amikacin), tetracyclines (doxycycline, tigecycline), macrolides (azithromycin, clarithromycin), clindamycin, chloramphenicol, linezolid, quinupristin-dalfopristin

72
Q

how are tetracyclines given?

A

lipid soluble so orally; except tigecycline is given parenterally

73
Q

tetracyclines form what?

A

chelates with multivalent cations (don’t administer w/ dairy, pepto bismol, iron supplements)

74
Q

doxycycline uses

A

broad spectrum against gram + & -

75
Q

tigecycline use

A

IV for highly resistant gram - infections

76
Q

macrolide required drugs

A

azithromycin, clarithromycin

77
Q

macrolide MOA

A

bacteriostatic; binds 50S subunit & inhibits translocation

78
Q

COMBO TO AVOID

A

macrolide w/ clindamycin or chloramphenicol (binding sites overlap so would result in abx antagonism)

79
Q

macrolide uses

A

upper & lower respiratory tract infections (pertussis, pneumonias, diphtheria, sinusitis, bronchitis, pharyngitis), atypicals (chlamydia, myco. avium) & PUD (H pylori)

80
Q

clindamycin MOA & use

A

binds 50S subunit, most effective against g + & anaerobe; used for skin & soft tissue infections (i.e. gas gangrene)

81
Q

major concern for clindamycin?

A

CDAD!

82
Q

chloramphenicol use

A

broad spectrum used mainly outside US due to toxicity

83
Q

isoniazid MOA

A

prodrug that inhibits synthesis of mycolic acid by inhibiting InhA and KasA enzymes

84
Q

what would reduce risk of peripheral neuropathy while being treated for TB?

A

taking vitamin B6!!

85
Q

what TB drug doesn’t have an effect on the liver?

A

ethambutol

86
Q

what can be used as second line for TB treatment?

A

streptomycin

87
Q

what would give someone with active TB?

A

INH + rifampin + pyrazinamide + ethambutol

88
Q

active TB treatment phases include:

A

induction: 2 months of INH, rifampin, pyrazinamide, ethambutol
continuation: next 4 months or longer of INH and rifampin

89
Q

prophylaxis for latent TB consists of:

A

1st line = daily monotherapy for 9 months with INH

2nd line = daily monotherapy for 4 months with rifampin

90
Q

drug that can cause unpredictable aplastic anemia

A

chloramphenicol

91
Q

what is an adverse effect of fluoroquinolones?

A

tendon rupture in kids

92
Q

three drugs that can be used to treat c dif?

A

metronidazole, vancomycin, fidaxomicin

93
Q

1 drug for UTI

A

SMX-TMP

94
Q

what are the 2 formulations of colistin and how are they given?

A
  1. colistin sulfate–topical & oral (GI)

2. colistimethate–parenteral (prodrug)

pharm exam 3 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions