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Pharm Final 1 Flashcards

1
Q

bacteriostatic drugs might not be effective in a patient that is

A

immunocompromised

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2
Q

4 categories of antibiotics

A

Cell Wall
Cell Membrane
Protein
DNA

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3
Q

Cell wall synthesis prototypes

A

Ampicillin
Amoxicillin
Cephalexin

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4
Q

Ampicillin

A

Cell Wall antibiotic

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5
Q

Amoxicillin

A

Cell Wall antibiotic

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6
Q

Cephalexin

A

Cell Wall antibiotic

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7
Q

Gram positive bacteria

A

Thick peptido layer

easier to kill

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8
Q

Gram negative bacteria

A

Thin peptido layer

Outer membrane

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9
Q

Cephalosporins and penicillins are b___ ___ antibiotics

A

beta lactam antibiotics

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10
Q

Cephalosporins and penicillins work by binding to

A

PBPs

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11
Q

Cephalosporins and penicillins work by binding to PBPs which inhibits transpeptidation, and therefore changes the cell wall

A

rigidity

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12
Q

In addition to binding to PBPs, Cephalosporins and penicillins activate

A

autolytic enzymes in the cell wall

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13
Q

Because of an outer membrane, Cephalosporins and penicillins have a tougher time penetrating

A

gram negatives

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14
Q

Cephalosporins and penicillins are bacter___

A

bactericial

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15
Q

Transpeptidation is linking of

A

AAs by sugar, forming a cell wall

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16
Q

Bacteria resist Cephalosporins and penicillins in 3 ways

A

Beta lactamase
Lacking a cell wall
being metabolically inactive

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17
Q

We respond to beta lactamase with ____ acid

A

clavulonic acid

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18
Q

Augmentin

A

amoxicillin plus clavulonic acid

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19
Q

C dif infection is called

A

pseudomembranosis colitis

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20
Q

C dif treatment

A

stop antibiotic

sometimes give vancomycin or metronidazole

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21
Q

Penicillin G route and use

A

IM or IV

narrow spectrum

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22
Q

Penicillin V route and use

A

Oral

Strep

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23
Q

In addition to augmetin, B-lactamase resistant drugs are

A

cloxacillin and methicillin

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24
Q

Spectrum of ampicillin and amoxicillin

A

broad

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25
Q

Penicillin uses

A

pneumoniae
pyogenes
gonococcal
strep

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26
Q

Penicillin side effects

A
  • Allergic reaction (rash all the way up to anaphylaxis)
  • GI
  • Superinfection (i.e. yeast infection and C dif)
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27
Q

Cephalexin

A
  • 1st generation cephalosporin
  • treats gram positive cocci
  • treats UTI
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28
Q

Because penicillins and cephalosporins have similar structure, you may have similar

A

allergic reaction

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29
Q

Someone allergic to penicillin can take cephalosporin if

A

the penicillin allergy is mild

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30
Q

Cephalosporin generations

A

narrow to broad

peripheral to central

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31
Q

Cephalosporin side effects

A

Allergy (very common, 6 to 18%)
Bleeding (don’t take with warfarin or heparin)
Superinfection

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32
Q

Polymyxin B

A

Cell membrane inhibitor

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33
Q

Polymyxin B is selective for

A

bacterial cell walls, not animal cells

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34
Q

Polymyxin B act like

A

detergents, disrupting the cell wall

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35
Q

some Polymyxin B inhibiting

A

synthesis of lipids

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36
Q

Polymyxin B side effect

A

major nephrotoxicity

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37
Q

Polymyxin B are effective against

A

gram negative bacteria

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38
Q

The only Polymyxins used clinically are

A

B and E

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39
Q

Polymyxin B is bacter___

A

bactericidal

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40
Q

Polymyxin B route

A

IM or intrathecal

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41
Q

Polymyxin B use is mostly confined to

A

topical (doesn’t cross the BBB to go central)

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42
Q

Polymyxin B is the drug of choice for

A

aeruginosa

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43
Q

drug of choice for aeruginosa

A

Polymyxin B

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44
Q

Protein inhibitor prototypes

A 
Tetracylcine
Doxycycline 
Gentamycin
Erythromycin
Chloramphenicol
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45
Q

tetracyclines are bacter___

A

bacteriostatic

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46
Q

Protein inhibitors effect

A

gram positive and negative (they’re broad because everyone needs protein)

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47
Q

Protein inhibitor mechanism

A

bind to 50s or 30s on the ribosome to block peptide formation

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48
Q

3 kinds of resistance against protein synthesizers

A
  • alter ribosomal binding sites
  • block the drug from entering
  • enzymes to deactivate the drug
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49
Q

Protein inhibitors are divided into

A

tetracyclines
aminoglycosides
macrolides
chloramphenicols

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50
Q

tetracyclines (protein inhibitor) prototype

A

tetracycline

doxycycline

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51
Q

aminoglycoside (protein inhibitor) prototype

A

gentamycin

streptomycin

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52
Q

macrolide (protein inhibitor) prototype

A

erythromycin

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53
Q

tetracyclines are the drug of choice for

A 
mycoplasma pneumoniae 
chlamydiae
rickettsia
Lyme disease (doxycycline only)
Rocky mountain
Q fever
Acne
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54
Q

tetracycline side effects

A
  • binds to calcium in newly forming teeth/bones (which can stunt children’s growth and discolor teeth)
  • liver
  • photosensitivity (wear sunblock)
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55
Q

Tetracycline NI

A

Eat yogurt to help with GI

Avoid during pregnancy because it crosses the placenta

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56
Q

Gentamycin/strepomycin uses

A

gram negative

Only for serious conditions like bacturemia, sepsis, endocarditis.

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57
Q

C dif infection is called

A

pseudomembranosis colitis

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58
Q

Gentamycin/strepomycin are bacter___

A

bactericial

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59
Q

Gentamycin/strepomycin route

A

parenteral because they have poor bioavailability

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60
Q

Gentamycin/strepomycin side effects

A

major problem with resistance
ototoxicity
nephrotoxicity

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61
Q

Erythromycin route

A

oral

62
Q

Erythromycin treats (general overview)

A

gram positive and negative
aerobes
atypicals (clamydiae, mycoplasmae)

63
Q

Erythromycin needs to be coated because its

A

acid-labile

64
Q

Erythromycin treats (more specific)

A

HIV related mcyobacterium

skin, soft tissue infection
respiratory
STDs

65
Q

Erythromycin side effects

A

inhibits the P450 which increases theophylline

More rare:
GI
Liver
Plebitis

66
Q

Chloramphenicol use

A
  • limited use because it toxic
  • treats meningitis if the patient is allergic to penicillin
  • Rocky Mountain
  • Typhus
67
Q

Chloramphenicol has a broad spectrum against

A 
positive
negative
anaerobic
aerobes
atypicals
68
Q

Chloramphenicol penetrates

A

all the way into the CNS

69
Q

Chloramphenicol side effects

A

Gray baby
Blood Dsycrasias
aplastic anemia
optic neuritis

70
Q

DNA blocker prototype

A

Sulfanilamide

71
Q

Sulfanilamide

A

DNA blocker

72
Q

benefits of Sulfanilamides

A

cost effective

can be used in someone allergic to penicillin

73
Q

Sulfanilamide mechanism

A
  • mimic PABA

- block production of folic acid which is needed for DNA

74
Q

Sulfanilamide may be used

A

with other drugs

75
Q

Sulfanilamide is bacter___

A

bacteriostatic

76
Q

Sulfanilamide route

A

oral

77
Q

Sulfanilamide clinical uses

A

UTI
Chlamydia
Respiratory infections

78
Q

Sulfanilamide side effects

A

allergic reaction

fever, photosentivity, rash, UT disturbance

79
Q

NI implication for antibiotics

A
  • determine pencillin/cephalosporin allergy
  • Do C and S test, but don’t wait to start the first dose
  • Compliance
  • report superinfection (black furry tongue, vaginal discharge, diarrhea)
80
Q

superinfection signs

A

black furry tongue, vaginal discharge, diarrhea

81
Q

Cholesterol prototypes

A

Atrovastatin
Cholestryamine
Gemfib
Nicotinic acid

82
Q

Total cholesterol

A

desired: below 200
high: 240

83
Q

LDL

A

desired: below 130
High: 160

84
Q

4 types of cholesterol drugs

A

HMG inhibitor
Bile-acid sequestering
Fibric acid
nicotinic acid

85
Q

HMG inhibitor prototype

A

atorvastatin

86
Q

bile-acid sequestering prototype

A

cholestyramine

87
Q

cholestyramine

A

bile-acid sequestering prototype

88
Q

atorvastatin

A

HMG inhibitor prototype

89
Q

Fibric acid prototype

A

gemfib

90
Q

gemfib

A

Fibric acid prototype

91
Q

Atorvastatin absorption

A

better if taken with food, but most of the drug is excreted with bile

Also helps if you take it at night

92
Q

newest and most popular cholesterol drugs

A

Atorvastatin

93
Q

Atorvastatin block HMG from becoming

A

meva

94
Q

In addition to blocking HMG, Atorvastatin increases

A

LDL receptors, which means more LDL is destroyed

95
Q

In addition to decreasing LDL, Atorvastatin

A

modestly helps with HDL and trigylcerides

96
Q

Atorvastatin can be used alone or

A

in combination with acid-binding resin or niacin

97
Q

Atorvastatin is contraindicated for

A

pregnant/breast feeding women

should only be used for children if they have family h/o cholesterol

98
Q

Atorvastatin toxicity

A

normally an elevation in aminotransferase isn’t that signficant, but if the patient has pre existing liver risks, the elevation could be serious.

Stop the drug if the aminotransferase is high twice in a row (2 or 3 times the normal level)

You could also have Myopathy

99
Q

Atorvastatin interactions

A

erythromycin, niacin, gemfib, and cycolspoine can increase risk for myopathy

100
Q

Cholestryamine is useful for

A

treating LDL, but not triglycerides

101
Q

Cholestryamine mechanism

A

prevents bile-acids from being reabsorbed, which decreases cholesterol

102
Q

Cholestryamine side effects

A

constipation and bloating

interferes with absorption of:

  • vitamin K and folic acid
  • digitalis glycosides
  • thiazides
  • WARFARIN
  • tetracycline
  • thyroxine
  • statins
103
Q

Gemfib mechanism

A
  • decrease triglycerides (when there’s a lot of vdl)
  • decrease VLDL
  • only works on LDL a little bit
104
Q

Gemfib side effects

A

dermatitis

increases oral anticoagulants

105
Q

Nicotinic acid mechanism

A
  • decrease VLDL

- decrease LDL

106
Q

how is Nicotinic acid administered

A

high dose

in combo with other drugs

107
Q

Nicotinic acid side effects

A

flushing
GI
rash

108
Q

NI for all lipid drugs

A
  • assess lipid levels regularly
  • assess liver function periodically
  • in addition to meds, they should go on a diet (put down the donut)
109
Q

Asthma drugs aimed at Bronchospasm

A 
Cromolyn/Nedocromil
B-agonists 
CCBs
Anticholinergics 
Sympathomimetics
110
Q

Asthma drugs aimed at Inflammation

A

Cromolyn/Nedocromil

Corticosteroids

111
Q

Cromolyn/Nedocromil use

A
  • most be taken prophylactically
  • reduces overall level of bronchial activity
  • good for exercise and antigen asthmas
  • inhl
112
Q

Cromolyn/Nedocromil must be taken

A

prophylactically

113
Q

Cromolyn/Nedocromil reduces overall

A

level of bronchial activity

114
Q

Cromolyn/Nedocromil is especially good for

A

exercise and antigen asthma

115
Q

Cromolyn/Nedocromil route

A

inhl

116
Q

Cromolyn/Nedocromil side effects

A

minor stuff like sore throat, cough, dry mouth

117
Q

Theophylline

A
  • Methyxanthine drug
  • related to caffeine
  • most common one is aminophylline
118
Q

aminophylline is the most

A

most common theophylline

119
Q

Theophylline effects

A 
alertness
tremor
HR
weak diuresis
bronchodilation
120
Q

Asthma mechanism of sympathomimetics (specific and non specific)

A

relax smooth muscle

decrease secretions from mast cells

121
Q

non specific sympathomimetics for asthma

A

epinephrine, ephedrine, isoproterenol

122
Q

specific (aka B-2 selective) sympathomimetics for asthma

A

albuterol, terbutaline, metroproteronol

123
Q

Asthma sympathomimetic side effects

A

restless/anxiety
termors
palpitations
tachycardia

124
Q

the Ipra category IN TERMS OF ASTHMA is

A

muscarinic anantagonist

125
Q

muscarinic anantagonist prototype

A

Ipra

126
Q

Ipra mechanism (in terms of asthma)

A

block ACH at the muscarinic receptors

127
Q

asthma corticosteroid prototype

A

beclo

and if there’s time, bude, triam

128
Q

beclo mechanism

A

reduce inflammation

129
Q

beclo administration

A

can be taken orally, but inhaling decreases side effects

inhalation can be used for chronic therapy

130
Q

inhalation of belco can be used for

A

chronic therapy

131
Q

Beclo side effect

A

oropharyngeal candidiasis

132
Q

NI for all bronchodialators

A

Monitor ECG is they have CV problems
No OTCs without talking to doctors
Avoid smoke and other irritants

133
Q

Symbicort

A

bude + formoterol (corticosteroid + B-2)

134
Q

Monte and Zafir

A

Leukotriene antagonists

135
Q

Leukotriene antagonists

A

Monte and Zafir

136
Q

blocks D4 and E4 which are part of the part of the slow reacting substance of anaphylaxis

A

Monte and Zafir (Leukotriene antagonists )

137
Q

Monte and Zafir absorbtion qualities

A

rapidly absorbed orally

high protein binding

138
Q

Monte and Zafir side effects

A

flu symptoms
infection
liver

139
Q

Monte and Zafir contraindications

A

breast feeding or over 55 years old (increases infections)

140
Q

nicotinic acid prototype

A

niacin

141
Q

niacin

A

nicotinic acid

142
Q

aka Vit B 3

A

niacin

143
Q

antibody that inhibits PCSK9 which is a protein that attacks LDL receptors

A

Evolocumab

144
Q

Salmeterol

A

not used to abort acute attacks it is a long acting beta agonist. It is a medication that is used as a last line defense drug once other medications have not worked. It is not recommended to suddenly stop taking this medication due to a possible deadly reaction.

145
Q

What advantage does Combivent have over Atrovent

A

Combivent contains albuterol (short acting beta 2 agonist) in addition to ipratropium (anticholinergic), the combination relieves symptoms for a longer period of time.

146
Q

theophylline is not commonly used because

A

narrow safety margin

147
Q

___ is a trade name for the beta 2 agonist drug levalbuterol, which is the R enantiomer of the drug albuterol

A

Xopenex

148
Q

The advantages of using Xopenex over albuterol include fewer episodes of transient

A

tachycardia, better tolerability, and similar or greater efficacy

149
Q

Combivent contains albuterol (short acting beta 2 agonist) in addition to ipratropium (anticholinergic), the combination

A

relieves symptoms for a longer period of time

150
Q

albuterol + ipra

A

combivent

151
Q

combivent

A

albuterol + ipra

152
Q

Albuterol and Xopenex are both medications used in the treatment of acute asthma and they are both

A

long-acting beta agonists

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