Pharm Final 1 Flashcards
1
Q
bacteriostatic drugs might not be effective in a patient that is
A
immunocompromised
2
Q
4 categories of antibiotics
A
Cell Wall
Cell Membrane
Protein
DNA
3
Q
Cell wall synthesis prototypes
A
Ampicillin
Amoxicillin
Cephalexin
4
Q
Ampicillin
A
Cell Wall antibiotic
5
Q
Amoxicillin
A
Cell Wall antibiotic
6
Q
Cephalexin
A
Cell Wall antibiotic
7
Q
Gram positive bacteria
A
Thick peptido layer
easier to kill
8
Q
Gram negative bacteria
A
Thin peptido layer
Outer membrane
9
Q
Cephalosporins and penicillins are b___ ___ antibiotics
A
beta lactam antibiotics
10
Q
Cephalosporins and penicillins work by binding to
A
PBPs
11
Q
Cephalosporins and penicillins work by binding to PBPs which inhibits transpeptidation, and therefore changes the cell wall
A
rigidity
12
Q
In addition to binding to PBPs, Cephalosporins and penicillins activate
A
autolytic enzymes in the cell wall
13
Q
Because of an outer membrane, Cephalosporins and penicillins have a tougher time penetrating
A
gram negatives
14
Q
Cephalosporins and penicillins are bacter___
A
bactericial
15
Q
Transpeptidation is linking of
A
AAs by sugar, forming a cell wall
16
Q
Bacteria resist Cephalosporins and penicillins in 3 ways
A
Beta lactamase
Lacking a cell wall
being metabolically inactive
17
Q
We respond to beta lactamase with ____ acid
A
clavulonic acid
18
Q
Augmentin
A
amoxicillin plus clavulonic acid
19
Q
C dif infection is called
A
pseudomembranosis colitis
20
Q
C dif treatment
A
stop antibiotic
sometimes give vancomycin or metronidazole
21
Q
Penicillin G route and use
A
IM or IV
narrow spectrum
22
Q
Penicillin V route and use
A
Oral
Strep
23
Q
In addition to augmetin, B-lactamase resistant drugs are
A
cloxacillin and methicillin
24
Q
Spectrum of ampicillin and amoxicillin
A
broad
25
Penicillin uses
pneumoniae
pyogenes
gonococcal
strep
26
Penicillin side effects
- Allergic reaction (rash all the way up to anaphylaxis)
- GI
- Superinfection (i.e. yeast infection and C dif)
27
Cephalexin
- 1st generation cephalosporin
- treats gram positive cocci
- treats UTI
28
Because penicillins and cephalosporins have similar structure, you may have similar
allergic reaction
29
Someone allergic to penicillin can take cephalosporin if
the penicillin allergy is mild
30
Cephalosporin generations
narrow to broad
| peripheral to central
31
Cephalosporin side effects
Allergy (very common, 6 to 18%)
Bleeding (don't take with warfarin or heparin)
Superinfection
32
Polymyxin B
Cell membrane inhibitor
33
Polymyxin B is selective for
bacterial cell walls, not animal cells
34
Polymyxin B act like
detergents, disrupting the cell wall
35
some Polymyxin B inhibiting
synthesis of lipids
36
Polymyxin B side effect
major nephrotoxicity
37
Polymyxin B are effective against
gram negative bacteria
38
The only Polymyxins used clinically are
B and E
39
Polymyxin B is bacter___
bactericidal
40
Polymyxin B route
IM or intrathecal
41
Polymyxin B use is mostly confined to
topical (doesn't cross the BBB to go central)
42
Polymyxin B is the drug of choice for
aeruginosa
43
drug of choice for aeruginosa
Polymyxin B
44
Protein inhibitor prototypes
```
Tetracylcine
Doxycycline
Gentamycin
Erythromycin
Chloramphenicol
```
45
tetracyclines are bacter___
bacteriostatic
46
Protein inhibitors effect
gram positive and negative (they're broad because everyone needs protein)
47
Protein inhibitor mechanism
bind to 50s or 30s on the ribosome to block peptide formation
48
3 kinds of resistance against protein synthesizers
- alter ribosomal binding sites
- block the drug from entering
- enzymes to deactivate the drug
49
Protein inhibitors are divided into
tetracyclines
aminoglycosides
macrolides
chloramphenicols
50
tetracyclines (protein inhibitor) prototype
tetracycline
| doxycycline
51
aminoglycoside (protein inhibitor) prototype
gentamycin
| streptomycin
52
macrolide (protein inhibitor) prototype
erythromycin
53
tetracyclines are the drug of choice for
```
mycoplasma pneumoniae
chlamydiae
rickettsia
Lyme disease (doxycycline only)
Rocky mountain
Q fever
Acne
```
54
tetracycline side effects
- binds to calcium in newly forming teeth/bones (which can stunt children's growth and discolor teeth)
- liver
- photosensitivity (wear sunblock)
55
Tetracycline NI
Eat yogurt to help with GI
Avoid during pregnancy because it crosses the placenta
56
Gentamycin/strepomycin uses
gram negative
Only for serious conditions like bacturemia, sepsis, endocarditis.
57
C dif infection is called
pseudomembranosis colitis
58
Gentamycin/strepomycin are bacter___
bactericial
59
Gentamycin/strepomycin route
parenteral because they have poor bioavailability
60
Gentamycin/strepomycin side effects
major problem with resistance
ototoxicity
nephrotoxicity
61
Erythromycin route
oral
62
Erythromycin treats (general overview)
gram positive and negative
aerobes
atypicals (clamydiae, mycoplasmae)
63
Erythromycin needs to be coated because its
acid-labile
64
Erythromycin treats (more specific)
HIV related mcyobacterium
skin, soft tissue infection
respiratory
STDs
65
Erythromycin side effects
inhibits the P450 which increases theophylline
More rare:
GI
Liver
Plebitis
66
Chloramphenicol use
- limited use because it toxic
- treats meningitis if the patient is allergic to penicillin
- Rocky Mountain
- Typhus
67
Chloramphenicol has a broad spectrum against
```
positive
negative
anaerobic
aerobes
atypicals
```
68
Chloramphenicol penetrates
all the way into the CNS
69
Chloramphenicol side effects
Gray baby
Blood Dsycrasias
aplastic anemia
optic neuritis
70
DNA blocker prototype
Sulfanilamide
71
Sulfanilamide
DNA blocker
72
benefits of Sulfanilamides
cost effective
| can be used in someone allergic to penicillin
73
Sulfanilamide mechanism
- mimic PABA
| - block production of folic acid which is needed for DNA
74
Sulfanilamide may be used
with other drugs
75
Sulfanilamide is bacter___
bacteriostatic
76
Sulfanilamide route
oral
77
Sulfanilamide clinical uses
UTI
Chlamydia
Respiratory infections
78
Sulfanilamide side effects
allergic reaction
fever, photosentivity, rash, UT disturbance
79
NI implication for antibiotics
- 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
superinfection signs
black furry tongue, vaginal discharge, diarrhea
81
Cholesterol prototypes
Atrovastatin
Cholestryamine
Gemfib
Nicotinic acid
82
Total cholesterol
desired: below 200
high: 240
83
LDL
desired: below 130
High: 160
84
4 types of cholesterol drugs
HMG inhibitor
Bile-acid sequestering
Fibric acid
nicotinic acid
85
HMG inhibitor prototype
atorvastatin
86
bile-acid sequestering prototype
cholestyramine
87
cholestyramine
bile-acid sequestering prototype
88
atorvastatin
HMG inhibitor prototype
89
Fibric acid prototype
gemfib
90
gemfib
Fibric acid prototype
91
Atorvastatin absorption
better if taken with food, but most of the drug is excreted with bile
Also helps if you take it at night
92
newest and most popular cholesterol drugs
Atorvastatin
93
Atorvastatin block HMG from becoming
meva
94
In addition to blocking HMG, Atorvastatin increases
LDL receptors, which means more LDL is destroyed
95
In addition to decreasing LDL, Atorvastatin
modestly helps with HDL and trigylcerides
96
Atorvastatin can be used alone or
in combination with acid-binding resin or niacin
97
Atorvastatin is contraindicated for
pregnant/breast feeding women
should only be used for children if they have family h/o cholesterol
98
Atorvastatin toxicity
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
Atorvastatin interactions
erythromycin, niacin, gemfib, and cycolspoine can increase risk for myopathy
100
Cholestryamine is useful for
treating LDL, but not triglycerides
101
Cholestryamine mechanism
prevents bile-acids from being reabsorbed, which decreases cholesterol
102
Cholestryamine side effects
constipation and bloating
interferes with absorption of:
- vitamin K and folic acid
- digitalis glycosides
- thiazides
- WARFARIN
- tetracycline
- thyroxine
- statins
103
Gemfib mechanism
- decrease triglycerides (when there's a lot of vdl)
- decrease VLDL
- only works on LDL a little bit
104
Gemfib side effects
dermatitis
increases oral anticoagulants
105
Nicotinic acid mechanism
- decrease VLDL
| - decrease LDL
106
how is Nicotinic acid administered
high dose
| in combo with other drugs
107
Nicotinic acid side effects
flushing
GI
rash
108
NI for all lipid drugs
- assess lipid levels regularly
- assess liver function periodically
- in addition to meds, they should go on a diet (put down the donut)
109
Asthma drugs aimed at Bronchospasm
```
Cromolyn/Nedocromil
B-agonists
CCBs
Anticholinergics
Sympathomimetics
```
110
Asthma drugs aimed at Inflammation
Cromolyn/Nedocromil
| Corticosteroids
111
Cromolyn/Nedocromil use
- most be taken prophylactically
- reduces overall level of bronchial activity
- good for exercise and antigen asthmas
- inhl
112
Cromolyn/Nedocromil must be taken
prophylactically
113
Cromolyn/Nedocromil reduces overall
level of bronchial activity
114
Cromolyn/Nedocromil is especially good for
exercise and antigen asthma
115
Cromolyn/Nedocromil route
inhl
116
Cromolyn/Nedocromil side effects
minor stuff like sore throat, cough, dry mouth
117
Theophylline
- Methyxanthine drug
- related to caffeine
- most common one is aminophylline
118
aminophylline is the most
most common theophylline
119
Theophylline effects
```
alertness
tremor
HR
weak diuresis
bronchodilation
```
120
Asthma mechanism of sympathomimetics (specific and non specific)
relax smooth muscle
decrease secretions from mast cells
121
non specific sympathomimetics for asthma
epinephrine, ephedrine, isoproterenol
122
specific (aka B-2 selective) sympathomimetics for asthma
albuterol, terbutaline, metroproteronol
123
Asthma sympathomimetic side effects
restless/anxiety
termors
palpitations
tachycardia
124
the Ipra category IN TERMS OF ASTHMA is
muscarinic anantagonist
125
muscarinic anantagonist prototype
Ipra
126
Ipra mechanism (in terms of asthma)
block ACH at the muscarinic receptors
127
asthma corticosteroid prototype
beclo
| and if there's time, bude, triam
128
beclo mechanism
reduce inflammation
129
beclo administration
can be taken orally, but inhaling decreases side effects
inhalation can be used for chronic therapy
130
inhalation of belco can be used for
chronic therapy
131
Beclo side effect
oropharyngeal candidiasis
132
NI for all bronchodialators
Monitor ECG is they have CV problems
No OTCs without talking to doctors
Avoid smoke and other irritants
133
Symbicort
bude + formoterol (corticosteroid + B-2)
134
Monte and Zafir
Leukotriene antagonists
135
Leukotriene antagonists
Monte and Zafir
136
blocks D4 and E4 which are part of the part of the slow reacting substance of anaphylaxis
Monte and Zafir (Leukotriene antagonists )
137
Monte and Zafir absorbtion qualities
rapidly absorbed orally
| high protein binding
138
Monte and Zafir side effects
flu symptoms
infection
liver
139
Monte and Zafir contraindications
breast feeding or over 55 years old (increases infections)
140
nicotinic acid prototype
niacin
141
niacin
nicotinic acid
142
aka Vit B 3
niacin
143
antibody that inhibits PCSK9 which is a protein that attacks LDL receptors
Evolocumab
144
Salmeterol
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
What advantage does Combivent have over Atrovent
Combivent contains albuterol (short acting beta 2 agonist) in addition to ipratropium (anticholinergic), the combination relieves symptoms for a longer period of time.
146
theophylline is not commonly used because
narrow safety margin
147
___ is a trade name for the beta 2 agonist drug levalbuterol, which is the R enantiomer of the drug albuterol
Xopenex
148
The advantages of using Xopenex over albuterol include fewer episodes of transient
tachycardia, better tolerability, and similar or greater efficacy
149
Combivent contains albuterol (short acting beta 2 agonist) in addition to ipratropium (anticholinergic), the combination
relieves symptoms for a longer period of time
150
albuterol + ipra
combivent
151
combivent
albuterol + ipra
152
Albuterol and Xopenex are both medications used in the treatment of acute asthma and they are both
long-acting beta agonists
