PHARM EXAM 3 Flashcards

Question

Antibiotic Admin:

Answer 1

- ora: sc food if possible IV: med calculations - complete full course - use only when necessary

Answer 2

-GI: N/V (recommend- Probiotics/ yougurt), diarrhea

Answer 3

- C-diff: liquid diarrhea/ smell (oral Vanco) - gloves and gowns before entering and off before leaving - Fungal - Mouth : Oral thrush, white pathces, change in taste, stinky breath - Vagina: Drainage cottage cheese like (fungal infection)

Answer 4

Antibiotics kill some bacteria and allow drug resistant bacteria to grow unrestrained. - develops mutation

Answer 5

Stops from replicating

Answer 6

Kills Bacteria

Answer 7

-Angio edema -anaphylaxis Skin reactions: -Steve Johns Syndrome: Starts with upper resp.. then pimple rash -Toxic epidermal Necrosis

Answer 8

Remove the mask before you have left the room and then close the door

Answer 9

Remove the mask after you have left the room outside the closed door

Answer 10

A mask is not needed for this type of percaution

Answer 11

- Binds to bacterial cell wall, weakening the wall allowing water to enter, killing the cell. - has beta-lactum ring that cuts cells wall and fluid rushes in

Answer 12

**Resistance to PCN develops when bacteria secrete betalacamase which destroys the beta lactam ring. -Some drugs inhibit bacterial betalactamase and can be combined with penicillin (clavulanate, sulbactam, tazobactam) Kills Bactalactamase

Answer 13

- Diarrhea, nausea and vomiting - Supra-infections (pseudo-colitis - blood in stool) - Allergy is the most common adverse event - Decrease effectiveness of oral contraceptives - Cannot be used with aminoglycosides

Answer 14

Prototype: Cefazolin* -Useful against gram negative infections. Has a beta-lactam ring (cross allergy with PCN 5-10%) (if they have Anaphylactic to PCN they may react to this med) -Binds to cell wall and stops cell wall synthesis -Five generations, each generation widening the spectrum of targets and attempting to decrease resistance to betalacamase.

Answer 15

allergy, rash, GI complaints. Renal toxicity decreases with subsequent generations (esp with early gen) Labs: BUUN/ CR S&S decreased OU/ Increased BP/ fluid retention/ edema

Answer 16

CR: 1.2 – 1.5 BUN: 10-25

Answer 17

Doxycycline* Give with full glass of water - try to take it sc food if you can - avoid GERD -Inhibit bacterial protein synthesis, bacteriostatic -Lipid soluble and can cross the blood brain barrier Wide spread resistance -Should take with food but not metal ions like calcium of iron. ( will bind + make med unuseful)

Answer 18

Effect fetal bone growth and teeth development should not be given to pregnant women or children (8 or younger) ** DISCOLORATION of TEETH Grey/ Brown GERD, irritation of the esophagus Supra-infection

Answer 19

Give with full glass of water on an empty stomach, not with fruit juice Inhibit protein synthesis by binding to bacterial ribosome Bacteriostatic Extended half lives allow for shorter durations of therapy (eg Z-pack)- long half life & loading dose ** can take amirarone because it will prlong the heart contraction**

Answer 20

mild GI upset, diarrhea and abd pain | Adverse effects: hearing loss (can be permanent) , vertigo and dizziness. Cardiac dysrhythmia.

Answer 21

- Narrow Spectrum -IV medication (peak and trough levels drawn) -Can be used against gram negative bacteria, mycobacteria and protozoans Inhibit protein synthesis, bactericidal, powerful -Normally reserved for serious gram negative infection and must give IV as poorly absorbed. -Sometimes given orally to sterilize the GI tract prior to intestinal surgery

Answer 22

Possible serious ototoxicity/neurotoxicity (decrease LOC, change in mental status, confusion, seizures, HA, peripheral neuropathy)/nephrotoxicity - tinitus - vertigo

Answer 23

Peak: Highest concentration of the med in the blood Trough: Lowest point = drawn 30 min prior to the next dose (before the med start)

Answer 24

Bactericidal, inhibit DNA synthesis Good action against gram negative species (UTIs) Good agents against anthrax and other agents of biologic warfare Good absorption (can be oral or IV) **No first pass effect* Can give with food but not with MVI or mineral supplements (separate by 4 hours or 1 hour before)

Answer 25

Mild side effects: nausea, vomiting, diarrhea Dysrhythmia, hepatotoxicity(AST/ALT/Bilirubin), cartilage toxicity and rupture, insomnia, agitation/anxiety/ mood change/ *psychotic change*

Answer 26

Full glass of water Bacteriostatic Inhibit synthesis of folic acid. Combined with trimethoprim reduces resistance

Answer 27

Side effects include nausea and vomiting, urinary crystal formation, photosensitivity.- sensitive to sun ( long sleeves) Adverse effects: SJS, hepatic necrosis, hyperkalemia(tachy, mucle cramps), severe anemia (Fatigue/SOB)

Answer 28

*Widest spectrum* Bactericidal with super strong beta-lactam ring and destruction of the cell wall. **Can only be given IV**

Answer 29

Adverse effects: confusion and seizures

Answer 30

Flagyl-reaction with alcohol, metal taste Synercid-treatment of VRE Linezolid-treatment of MRSA, thrombocytopenia. Serotonin reaction causing HTN. Vancomycin-when taken GI there is no systemic absorprtion, IV can be nephrotoxic. Needs peak, trough. Daptomycin

Answer 31

Oral- no systemic absorption, treatment of Cdiff IV must be given dilute over 60 minutes to prevent flushing (redman syndrome) Adverse effects: nephrotoxicity, otoxicity Peak/ Trough measurements needed.

Answer 32

M. Tuberculosis causes hypersensitivity reaction in the body creating walls around microbes called tubercles. Infection can be re-activated. Needs prolonged, multi drug treatment. Active and latent doses S&S: Cough/ fever/ malaise/ Bloody Spetum(hemaptosis) /night sweats

Answer 33

Adverse Events: peripheral neuropathy, optic neurtitis, hepatotoxicity, blood dyscrasia (change to RBC in bone)

Answer 34

side effect: orange discoloration of body fluids. Adverse effect: renal failure, hepatotoxicity, hyperuricemia, blood dyscrasias (change to RBC in bone)

Answer 35

Systemic: Lungs/ abd/ blood stream | (old treatment) toxic medicine with multiple side effects pancytopenia, cardiac arrest, liver and kidney failure

Answer 36

headache, nausea, rash, phlebitis, leukopenia allergic reactions, delirium

Answer 37

*Broad spetrum* Interfere with biosynthesis of ergosterol which is essential to fungal cell membranes. Broad spectrum and can be used for systemic, cutaneous and superficial infections.

Answer 38

Severe nausea and vomiting, allergy *Liver failure* with ketoconazole (rare with diflucan) Medication interactions (*increased bleeding with warfarin, hypoglycemia with diabetic meds, increased effect of some narcotics*)

Answer 39

Malaria is caused by infection of RBC in Liver. Mosquito illness. Parasite-> RBC-> RBC Burst-> More parasite S&S: Fever/ chills/ bones and joint/ anemia SE: Visual Change/ photo phobia

Answer 40

Chloroquine* heme complexing agent, prevent transmission into red blood cells. Treatment or prevention Hydroxycholorquine like Side effects: photophobia, visual changes Adverse: hemolytic anemia, irreversible retinal damage

Answer 41

Other protozoa infection - Cryptosporidiosis- diarrhea/ cramping - Giardiasis-drinking contaminated water-iarrhea alternating with greasy stools. Fatigue, cramps - Trichomoniasis STD-> Red/ burning/ white and running discharge Disulfram reaction with alcohol ** Cause severe N/V + abd pain* Side effect: metallic taste Adverse effect: seizures, peripheral neuropathy

Answer 42

-Can be used against multiple types of warms Used during adult and larvae stage High concentration in the intestines Chew and take with fatty meal As worms die will experience abd pain, distention and diarrhea

Answer 43

Intracellular parasite Contain DNA or RNA information and a protein coat or capsid Find a target cell and use that cell for replication Anti-viral: Used as treatment or prophylaxis After exposure could receive treatment with vaccine. Some treatment decreases length or severity of symptom.

Answer 44

Worm species: water/ soil continimation | Related to proper sanitation / GI: wt loss- worm absorbs nutrients in body

Answer 45

Single celled organisms Parasites Water, soil, and animal hosts

Answer 46

S&S: Blistering/ fluid filled + hurts -Used to shortened the length Administer around the clock with food (oral) IV administration can be painful to vein Topical use gloves PO no side effects IV nephron (hydration)(make sure to drink a lot of fluids), neurotoxicity, thrombophlebitis, vesicant

Answer 47

*Oseltamivir Prophylaxis or treatment Must be given within 48 hours (24-48 hours trying to tshorten 7 days - 5days) Adverse effects: neuro-psychosis, SJS

Answer 48

**If mom has HIV will used mets when prego and IV in labor to prevent transfer from mother to baby** Oral or IV Bone marrow suppression (may need therapy interruption) Fever/muscle aches GI side effects CNS side effects

Answer 49

PO, TID, can be dissolved, no antacids Rash SJS GI can be severe Liver disease

Answer 50

PO with or without food Liver disease GI CNS

Answer 51

``` PO with snacks Hyperglycemia, diabetes Fat redistribution Elevated cholesterol and triglycerides Osteoporosis Liver disease GI ```

Answer 52

Controls growth and metabolism Secretes hormones that travel to target tissues

Answer 53

Connects to brain by nerves Connects to pituitary by nerves and blood vessels Secretes releasing or inhibiting hormones for the pituitary

Answer 54

Hypothalamus secretes thyroid releasing hormone (TRH). Anterior pituitary produces thyroid stimulating hormone (TSH). TSH stimulates the follicular cells of thyroid to produce thyroxine (T4) and triiodothyronine (T3). Iodine is needed for production of T3 and T4

Answer 55

IM or SQ - used in Growth hormone deficiencies, such as Turner’s syndrome in children - Growth hormone deficiency in adults to increase lean muscle mass - AIDS wasting syndrome * Stimulates release of insulin-like growth factor-1 (IGF-1) from liver/other tissues*

Answer 56

Hyperglycemia Myalgia (pain in a muscle or group of muscles.) Hypercalciuria- kidney stones

Answer 57

Inadequate secretion during childhood – Short stature Excessive secretion during adolescence – Gigantism Excessive secretion during adulthood – Acromegaly Somatostatin Inhibits release of growth hormone by the pituitary.

Answer 58

Produced by hypothalamus and stored in posterior pituitary -Produces effects on kidneys *Works on renal collecting tubules to increase reabsorption of water * -Short half life, need to give 4-5x per day. Formulated with peanut oil -Increases reabsorption of water -Decreases urine volume

Answer 59

Admin: Spray latteraly Side effects: drying/ irritation/ bloody nose *fluid retention- low NA+* Follow up: Labs: renal fx, UA, specific gravity, NA+ (135-145 me 2/L) Contraindications: Peanut allergy

Answer 60

When body hypo-secretion | S&S: alor of pee/ excessive urnation

Answer 61

In response to increased osmolarity (highly concentrated blood, dehydration) the pituitary releases ADH ADH causes the kidney to retain water and decreases water excretion. Once the concentration of the blood (hydration status) returns to normal the stimulus for release of ADH goes away and the pituitary stops releasing ADH.

Answer 62

- waxy/ faatigue/ wt gain/ cold intolerance/ hair + nail change/ decreased in hair/ Brady/ consitipation/ depressed * *if severe can lead to myexedima coma**

Answer 63

irritability/ heat intolerance/ anxiety/ tachy/ sweaty/ diarrhea/ Bugs eye(graves disease)/ increased HR **if severe can lead to thyroid storm --> cardiac arress*

Answer 64

Thyroid replacement -Synthetic T4 then converts to T3 in the body -Can take 1-3 weeks for full benefit, usually increased at 4-6 week intervals. Side effects: Hyperthyroidism (over treatment) Follow up: Labs: TSH/ T3 + T4 - life long therapy/ take in AM on empty stomach before breakfast

Answer 65

Hypothalamus produces -> TRH (Thyrotropin-releasing hormone)…this causes the Anterior Pituitary Gland to produce ->TSH (thyroid-stimulating hormone)….this cause the thyroid gland to produce-> T3 & T4

Answer 66

-When there are too much Thyroid Hormone and this med will Interferes with synthesis of T3 and T4 in the thyroid gland as well as conversion of T4 to T3 in the peripheral tissues. *Can lead to hypothyroidism symptoms* -Given orally several times per day (one tablet q 8 hours) TID Follow up: Labs; CBC/ TSH Pregnancy Category D *during pregnacy hyper-thyroid can clear up and then come back*

Answer 67

``` Multiple Hormones including cortisol, aldosterone and androgen *Cortisol- Stress response: Increase blood sugar Increase breakdown of lipid and protein Suppress inflammation Increase sensitivity to the SNS Increase breakdown of bones Dilates bronchial smooth muscle ``` *Aldosterone- increase fluid retention & decrease K+ which increase BP

Answer 68

Treatment of adrenal insufficiency Many treatment targets (Inflammation, allergy, autoimmune disorders) Excessive, prolonged use leads to Cushing’s like syndrome Cannot stop suddenly **If stop cortisone suddenly: adrenal insufficiency, hypotension, lethargy, renal failure, nausea and vomiting. Gradual withdrawal allows the adrenal gland to resume normal function. ** Anxiety, vertigo, insomnia, confusion, depression, HTN, peptic ulcer disease.

Answer 69

Body excrete excessive water/ sodium and keeps K+ | which contributes to dangerous fluid and electrolyte imbalances

Answer 70

too much fluid retention/ sodium and low K+

Answer 71

Replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease, primary hypoaldosteronism, congenital adrenal hyperplasia) usually along with hydrocortisone If Addison’s disease effects aldosterone production Taken with hydrocortisone PO every day, or three times per week SE: too much fluid retention/ sodium and low K+ FU: Labs/ kidney check/ BMP + weight gain

Answer 72

Stim pancreas to release insulin *biggest worry= hypoglycemia Persistent hypoglycemia, GI distress, hepatotoxicity - decreased BS + take 30 min pre breakfast ETOH= Disulfran- N/V + Flushing

Answer 73

Increase insulin sensitivity / decrease absorption in intestine SE: abd cramping dirrhea- but will go away -Nausea, vomiting, diarrhea, anorexia, headache, dizziness, agitation, fatigue. **Does not cause hypoglycemia ** ** has to be help pre procedures (SX or Scans with IV dyes)-> poss. Lactic acidosis - eats BID- do not take when you are sick / dehydrated

Answer 74

Stimulate the pancreas to release insulin. 3x per day 30 min or less pre meals. Skip if not eating, add if eating extra, no more than 4 per day. SE: hypoglycemia/ Nausea/ diarrhea/ No grape fruit juice with increase toxicity

Answer 75

- Helps cells use insulin better - Decreases insulin resistance at the tissues - Taken every day with or without food - Side effects:hepatotoxicity/ liver hurt/ increase chol * Does not need to worry about hypoglycemia

Answer 76

- works in intestine/ TAKE before eating up to 3X a day - Stops the breakdown of carbohydrates in the intestine and decreases absorption of carbohydrates. - Side effects: Stomach Pain/ liver dysfunction/ anemia - Treatment of hypoglycemia: Dextrose tabs- can not give sugar because med will get rid of it and can not self correct hypoglycemia

Answer 77

Increase release of insulin and decreases available glucagon. **SLows gastric emptying* Taken daily with or without food. Side effects:HA/ symptoms of upper resp/ pancreatitis hypoglycemia

Answer 78

Fasting blood sugar greater than 125 mg/dL on two separate occasions. Hemoglobin A1C (greater than 6.5%) Normal BS: 70-100

Answer 79

Thirsty/ Dry/ increased urniation/ increased hunger and can lead to change in mental status

Answer 80

lethargic/ dizzy/ altered mental status/ HA/ * SWEATY & SHAKY

Answer 81

insulin Cannot give orally (does not absorb) Only regular can be given IV Most given subcutaneously

Answer 82

Treatment depends on stores of blood sugar and level of consciousness and ability to swallow. - Awake: (need 15 gm of sugar) 4oz of OJ, 15 saltines, 1 tbsp. honey - Unable to swallow but able to follow direction: Glucagon SQ (need glucose storage, takes 30 minutes) Altered LOC, very low sugar: D50 IV **if pt is anorexia they do not have storage and can not give them glucagon**

Answer 83

Maintain blood sugar Usual side effects are hypoglycemia, hypokalemia, and Lipohypertrophy Steroids, thyroid, and epinephrine antagonize effects Furosemide and thiazide diuretics can increase glucose hypoglycemia with beta blockers (hypoglycemia pt can not feel when they have Tachy so it is dangerous)

Answer 84

Proper storage: out of heat/light. Opened lasts one month. *ROOM TEMP* When to check blood sugar

Answer 85

Regular Insulin: Onset 30 minutes, peak in 2 hours, lasts 5 hours GIVE 30 MINUTES PRIOR TO MEAL. NPH: Onset 1 hours, peak 4 hours, lasts 18 hours GIVE 30 MINUTES BEFORE FIRST MEAL OF DAY, SOMETIMES 30 MINUTES BEFORE SUPPER TOO. Can mix in same syringe. R first than N

Answer 86

Glargine: gradual onset, begins in 1 hour, no peak, lasts up to 24 hours. CANNOT BE MIXED WITH OTHER INSULINS Lispro: Onset 5-10 minutes, peak 30 minutes to an hour, duration 3-4 hours. Given 5-10 minutes before a meal. *Lispro give at the time of meal- give it with tray infront of them**

Answer 87

-give between meals- Decreased gastric emptying, decrease glucagon, increased feelings of fullness- helps u eat less Proper storage: store like insulin can be left out / SQ injection Onset: 60 min prior to meals - start working in 60 min Side effects: Nausea/ hypoglycemia/ pancreatitis located with RUQ + back **amylin mimetic, if used with insulin can cause severe hypoglycemia**

Answer 88

``` **incretin mimetic, if used with insulin can cause severe hypoglycemia** Similar to glucagon Decreased gastric emptying Increase release of insulin SQ 60 minutes prior to meals Peaks in 2 hours ```

Answer 89

Better at prevention then relief/reverse Have anticholinergic effects as well: dry membranes Can cause drowsiness esp older versions. CNS depressants add to this. Other uses: Vertigo/Motion sickness Parkinson’s Disease Insomnia Urticaria and other skin rashes

Answer 90

Dry mouth, headache, drowsy, bitter taste. (dizzy, urinary retention, thickening of secretions, nausea, vomiting, paradoxical excitation, EPS, agranulocytosis, respiratory depression-First generation) **ANTICHOLINERGIC Side effects**

Answer 91

-Glucocoricoid applied directly to the nasal mucosa -Topical so no serious side effects, not systemic -Decrease secretion of inflammatory mediators, reduce edema, and cause vasocontriction *No immediate benefit (1-3 weeks)** Side effects: Drying, burning, epistaxis

Answer 92

Viral infections of the URT No cure or effective prevention Treatment is symptom management

Answer 93

``` Relieve congestion, oral or intranasal Can be combined with antihistamines Sympathomimetic, alpha-adrenergic Oxymetazoline (Afrin)*, no systemic absorption so no side effects but rebound congestion. Should not used longer than 3-5 days. ```

Answer 94

* DO not give to ppl with heart problems* - Taken orally there is no rebound congestion but there is systemic absorption (insomnia, excitability, and HTN) - Pseudoephedrine (Sudafed)-phenylephrine - Can be made into methamphetamine so must register at pharmacy. - Phenylephrine is an alternative decongestant but not as effective

Answer 95

*DO not give to a productive cough* -Can suppress cough if viral, dry and hacking If cough is r/t removal of excess secretions and foreign material, aspiration or emphysema then cough suppression is not advised. -Opioids raise the cough threshold at low doses but can lead to CNS/respiratory depression, bronchocontriction in ashtma

Answer 96

Dextromethorphan*(Rubutisin), non opioid but chemically similar. Work by raising the cough threshold. There is some abuse potential Side effects are drowsiness, Headache, GI upset, paradoxical excitation, tremors, euphoria, insomnia *if given with opioids it will make it more potent* *SYNERGISTIC*

Answer 97

Increase mucus flow by reducing the thickness of secretions. Guaifenesin (Mucinex) helps with dry and productive cough. Should not be used with children under 6 *take with a lot of water*

Answer 98

Directly loosens thick viscous bronchial secretions. Break down chemical structure of mucus, makes thinner and easier to cough up. Bad odor, rotten eggs Inhalation Can cause bronchospasm so should not be used with asthmatics. **Reverses acetaminophen (Tylenol) overdose** **can not take if pt has asthma**

Answer 99

Bronchial Smooth Muscle and Autonomic Nervous System | Treatment of Asthma: Open up airways and decrease inflammation

Answer 100

Activate sympathetic nervous system to relax bronchial smooth muscle. Nonselective (beta 1 and 2) Selective (beta 2) Acute Bronchoconstriction, bronchospasm but no anti-inflammation component

Answer 101

Rescue- fast acting Last only 2-6 hours Prn no more than 12 inhalations per day Headache, dizziness, tremor, nervousness, throat irritation, tolerance Tachycardia, dysrhythmia, hypokalemia, hyperglycemia, paradoxical bronchoconstriction, increased risk for asthma related death. *do not use with a Beta blocker* -wait 1 min between puffs & hold in puff for 5-10 sec * can take 15-30 before exercise

Answer 102

Alternative to bronchodilators Slower and less intense Block the parasympathetic nervous system Can be used in asthma, copd more commonly Ipratropium (Atrovent)*, Tiotropium (Spiriva) Can combine atrovent and albuterol for longer bronchodilation Spiriva has a longer duration of action and used as prophylaxis for bronchospasm in COPD *Anticholinergic side effects = Anti sludge - dry mouth,Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Distress and Emesis **SOY PEANUT ALLERGY **

Answer 103

Hoarseness, dry mouth, cough, sore throat Candida- fungal infection in mouth - pt must rinse and spit Systemic absorption (risks ** IF TAKEN WITH Abuterol** Abuterol goes first THEN THE SEROID**

Answer 104

Bitter after taste- Take 15-30 min prior exercise

Answer 105

Leukotrienes are mediators involved in allergic and asthmatic reactions. Leukotrienes in the airway cause edema, inflammation and bronchoconstriction Montelukast (Singulair)* blocks leukotriene receptors Reduce inflammation, effect on bronchioles minimal Headache, cough, nasal congestion, GI upset, increased infection in the elderly. Contraindicated with alcohol use or hepatic dysfunction *liver dysfunction esp in elderly*

Answer 106

- Smooth muscles/ arteries - Prostate - Brain

Answer 107

- Heart - lungs - kidney * Pupil dilate/increase HR/ increase RR/ decrease urine formation/ prostate contract