Pharm Final Flashcards
1
Q
typical dosage of inhaled glucocortocoids for asthma treatment
A
200-400 mcg/day
2
Q
what is the risk of treatment with amphotericin B
A
they are toxic, cause fever, chills, hypotension, anemia, thrombophlebitis
3
Q
EC100
A
the concentration at which Emax is achieved
4
Q
antistaph penicillin
what are they used against
A
methicilin
cloxacin
nafcillin
oxacillin
staph infections except MRSA
5
Q
G+ cocci to know
A
staph, strep, entero
6
Q
what is the target INR for warfarin
A
2-3.5
7
Q
goals of menopausal hormone support
A
reduce/prevent hot flashes
improve sleep to improve cognition and reduce depression
prevent bone loss
maintain healt of the GI system
8
Q
aminopenicillins (ampicillin, amoxicilin) are used on what
A
Otitis media
strep
UTI (where ther isk of resistant e coli is low
9
Q
what is the action of heparin
A
enhances the action of antithrombin III (inhibits activation of factor X)
10
Q
strategy for dosing estrogen for HRT pills
A
start with a moderate dose that can be titrated up or down based on relief of symptoms
11
Q
typical methods of adminstration for corticosteroids
A
inhaled aerosol (most common)
oral or parenteral (emergency situation)
12
Q
issues with fourth generation progestin contraception
A
13
Q
what is the method of action for IUDs
A
inflammatory response that blocks the passage of sperm
14
Q
possible etiology of COPD
A
¤Cigarette smoking (99%)
¤Other toxins (such as coal dust, silica)
¤Genetic (Cystic fibrosis, A-1antiproteinase (anti-trypsinase) deficiency)
15
Q
T/F aminoglycosides are absorbed well in oral form
A
false, they are for parenteral use only
16
Q
amphotericin B is significantly effective against what bugs
A
Candida,
Histoplasma,
Cryptococcus,
Coccidioides,
Blastomyces
17
Q
isoniaizd is bacteriostatic or cidal
A
both
18
Q
special contraindications for tetracycline
A
pregnancy and children under 9 due to dental enamal dysplasia and discoloration, growth inhibition, bone deformities
photosensitive, so wear sin screen
19
Q
dietary strategies to combat BPH
A
decreased fatty food intake
saw palmetto
20
Q
what is the prognosis of avtive TB
A
100% cure rate if the patient is compliant and the strain isnt resistant
without treatment only 35% of patients will live beyond 5 years
21
Q
what percent of TB is resistant to all 1st line drugs
A
10-15%
22
Q
anti hep toxicity lamivudine
adefovir
entecavir
A
usually wel tolerated
renal toxic at high dose
renal toxic at usualy doses
23
Q
describe in vitro immune enhancement
A
in cancers with a specific antigen, lymphocytes can be cultured with that antigen and reinfused to target those cells
24
Q
how long does it take for warfarin to have an effect
how should it be monitored
A
8-12 hours with no loading dose
prothrombin time ratio (INR)
25
at what point in using estrogen contraceptives is the risk of venous thrombosis minimal
2 years
26
five classes of HIV drugs
* I. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
* II. Nonnucleoside RT Inhibitors (“NNRTIs”)
* III. Protease Inhibitors
* IV. Fusion inhibitors
* V. Integrase inhibitor
27
folate deficiency is caused by what
diet (↓ fruits and veg)
↓absorption (sprue, drugs)
↑increased need (pregnancy, hemolytic anemia)
28
T/F carbapenems are not cross reactive with penicillin/ceph allergies
false, they can be
29
differentiate allergic asthma from idiosyncratic
allgeric asthma often has a personal of FHx of allergic disease and commonly present at an early age
idiosyncratic has no Hx, negative skin tests, normal serum IgE
30
action of bezoyl peroxide for acne
what is it tpically paired with
opening skin pores with some intrinsic antibiotic effect
clindamycin or erythromycin
31
T/F a culture needed to treat a UTI
false, culture is useful but you can start treatment without it
32
cautionary statements of long acting beta2's
not effective for acute attacks
15% of patients will not respond as predicted
increased mortality if used as the sole treatment
33
what is the advantage of arixta over lovenox
daily dosing
better at DVT prevention with equal prevention of thrombosis
34
what is the bioavailibilty (f) of IV drugs
oral
how is this determined
100%
1-f
determined by comparing the AUC of oral to iv administration
35
cell wall active drugs are generally \_\_\_\_\_
protein synthesis inhibitors are usually \_\_\_\_\_
bacteriocidal
bacteriostatic
36
what type of azole has the least impact one CYP
other benefits
fluconazole
good CNS penetration for fungal menigitis
Oral or IV
single dose treatment for vaginitis
low risk for hepatotoaxicity
37
when can a patient be switched from lovenox to warfarin
INR \> 2 for two consecutive days
38
what leukotriene is 1000x more potent than histamine
LLTD4
39
compliance issues with iron supplements
GI upset very common
black stools
might need a creative dosing schedule
40
why is dietary deficiency of vitamin B 12 rare
small daily needs with large stores
41
common methods of estrogen replacement
estradiol (tablets, patch, spray)
conjugated estrogens
+ progesins (combipatch, prempro, fem HRT)
42
other than isoniazide and rifampin, what types of drugs are used against TB
fluoroquinolones, typically moxifloxacin and gatifloxacin
43
clinical pharmacokinetics
the application of PK princiles to the management of drug therapy in an individual patient
44
four beta lactam ABx
´Penicillins
´Cephalosporins
´Carbapenems
´Monobactams
45
theraputic drug monitoring assumes what?
that decreasing the amount of a drug in the blood will decrease the amount at the receptor site and therefore decrease the effect of the drug
46
two good glucocortcoid inhalers that have high compliance
¤Fluticasone (Flovent) or budesonide (Plumicort)
47
types of emergency asthma therapy
1st line: beta2 inhlaers
subQ epi is useful
corticosteroid IV or oral
48
five determinants of distribution
chemical polarity
affinty for transport proteins
binding to tissue components or proteins
binding to blood components
volume of disstribution
49
typical drugs for UTI
bactrim
nitrofurantonin
2nd gen cephalosporins
amoxicilin
fluoroquinolones
50
what accelerates the action of antithrombin III
heparin
51
why are most fixed dose/time drugs administered less than 5 half lives
so exponential elimination can't eliminate all the drug so it will accumulate on the next dose
52
4th genetation cephalosporin to know
cefepime (esp against pseudomonas)
53
advantages of 5-alpha reductase inhibitors
treats BPH and male pattern baldness
can also lower prostate cancer risk
54
side effects of thiazide drugs
**_HYPOKALEMIA_**
**postural hypotension**
change in glucose tolerance
hypercalcemia, uricemia
hyponatremia
55
dapsone is useful against leprosy and what
adverse effects
pneumocystis
hemolysis
peripheral nephropathy
56
amoxicillin with clavulanic acid = \_\_\_\_\_
ticarcillin + clavulanic acid = \_\_\_\_
augmentin
timentin
57
what is the function of mineralocorticoid receptor antagonists
blocks the effect of aldosterone, preventing retention of NA and water, prevents excretetion of K and H+
58
duration and utility of long acting beta2's
duration: 12 hours
utility: preventing recurrent acute attacks
59
what is the use of PD-1 blockade in cancer patients
allow cytotoxic t cells to recognize cancer cells and kil them
60
Cmin
the minimum plasma concentration that a drug achieves in a tested area after the drug has been adminstered and prior to the adminstration of a subsequent does
61
four factors that can alter drug absorption
sugery, food, drugs, disease
62
notable drug in lincomycin class
clindamyvcin
63
T/F doxycycline is not affected by renal disease
true it is almost entirely metabolized in the liver
64
how does contraception block ovulation
what drugs use this method
suppression of FSH
steroid contraceptives, GnRH analogs (lupron)
65
theraputic index
the range of doses at which a medication was effective in clinical trials for a median of participants
66
describe the chemical process of a clot
fibrinogen is convered to thrombin by prothombin and then is converted to fibrin
plasmin starts to break the clot down into d-dimer and spllit fiborin products
67
what is action of coumadin drugs
why is it still used today
interferes with the action of Vitamin K in clot formation
cheap, welll understood, reversible
68
inpt treatment of prostatitis
out patient
IV ampicillina and aminoglycoside (gent)
cipro or other fluoroquinolone
69
bioavailability (f)
the fraction of an adminstered dose of unchanged drugs that reaches the systemic circulation that characterizes the extent of absorption
70
sulfonamides is a generic term for what
PABA analogs
71
typical pathogens for UTI
80-85% come from coliforms
15-20% from strep or enterococcus
hematogenous seeding is rare
72
reversal agents for fibrinolytics (streptokinase)
aminocaproic acid (amicar)
73
adverse effects associated with cephalosporin
allergic cross reactive with penicillin (3-5%)
1-2% allergic reaction with no pen allergy
can also cause bleeding due to anti vitamine K action
74
causes of respiratory acidosis
respiratory failure
75
hitchhiker mutation
mutations found in cancerous cells that don't necessarily contribute to the disease
76
mortality related to estrogen use
MI
venous thrombosis
77
what is responsible to non-linear kinetics
phase I CYP enzymes
78
two primary systemic antifungal drugs
* Amphotericin B (Amphotec, AmBisome)
* Fluconazole (Diflucan)
79
indications for the use of carbonic anhydrase inhibitors
open angle glaucoma
epilepsy
acute mountain sickness
80
contraindications for thrombolytics
\<10days post op
serious GI bleed
HTN (diastolic \>110)
pregnant
81
concentration at steady state for continuous infusion is proportional to what
the rate of infusion
82
advantages of carbapenems
adverse effects
broad spectrum
expensive, nausea, diarrhea, can cause sz
83
T/F it is possible to take OC continuously without time off for menstruation
true
84
two good glucocortcoid inhalers that have high compliance
¤Fluticasone (Flovent) or budesonide (Plumicort)
85
choices for long acting reversible contraception (LARC)
injectable progestins
implantable progestins
IUDs
injectable GnRH analogs
86
two types of anti-inflammatory agents for the skin
topical corticosteroids and tar compounds
87
what a challenges are found with women over 35 and contraceptive use
they never want to quit, but if they are smoking or have HTN, DM, etc they need to stop
88
types of emergency asthma therapy
1st line: beta2 inhlaers
subQ epi is useful
corticosteroid IV or oral
89
facts about voriconazole
* Newer azole (trazole) antifungal agent
* Indications:Candida septicemia, Invasive aspergillosis
* Side effects:
Visual changes (blurred vision, increased light sensitivity
90
risks of unopposed estrogen
how to fix this
endometrial hyperplasia and carcinoma
if there is a uterus you must add progestin
91
vancomycin toxicity
´Nephrotoxicity
´Ototoxicity
´Flushing due to histamine release
´“Red Man Syndrome”
92
why do 1st generation anti-histamines cause drowsiness
they can cross the blood brain barrier
93
uses of leukotriene inhibitors in asthma treatment
lowered glucorticoid dose
94
pros and cons of chloramphenicol
excellent G+/G- coverage
causes bone marrow supression, neonatal toxicity (Gray baby syndrome), drug interaction
95
what do we refer to as "latent TB"
TB in 90-95% of peole that is kept in check by the immune system
96
what is the advange to factor X inhibitors in anticoagulation
what are the drawbacks
oral, no monitoring, no diet restriction
expensive, not easily reverible
97
what is the action of alpha adrenergic agonists in treatment of allergic rhinitis
vasoconstriction to reduce hyperemia
98
how can cancer cells develop resistance to treatment
what can be done to prevent this
genetic mutations continue after malignant transformation
use the correct amount of the correct drug
99
other uses of quinolones
* Gonorrhea (ciprofloxacin, ofloxacin)
* Mycoplasma, ureaplasma, chlamydia
* Legionella
* Some mycobacteria (TB, avium)
* Anaerobes (Avelox, Trovan)
* Anthrax prophylaxis
100
what is the action of alkylating agents
three examples
what are three ADRs
damages the DNA in dividing cells
cyclophosphamide, ifosfamide
nausea, germ cell destructon, bone marrow suppression
101
effect of beta-2 agonists
adverse drug reactions
bronchdilation
hyperglycema, tachycardia, poss HTN
102
natural anticoagulants
antithrombin III
protein s and c
103
what is 5-alpha reductase
the enzyme that converts T to DHT
104
are aminocylcosides bacteriostatic or cidal
cidal
105
should HRT be used for every
no, focus on those with significant hot flashes for 3-5 years
106
what type of autonomic receptor is found in the bladder sphincter
alpha receptors
107
action of microtubule inhibitors
ADRs
interrupts mitotic spindle
bone marrow suppression, hypersensitivity
108
T/F genetic backgroun of isoniazid can lead to slow of fast clearance
treu
109
two examples of muscarinic receptor blockers used in asthma treatment
action
ipratropium, tiotrpoium
helps relieve bronchospasm, reduces airway secretion
110
what is the goal of a bacteriocidal drug
to allow the immune system to catch up
111
common uses for tyrosine kinase inhibitors
ADRs
leukemia, lung cancer, renal cell carcinoma
drug interactions, bone marrow suppression
112
in drugs with first order elimination time required to reach concentration at steady state is dependent on what
half life
113
three types of nasal corticosteroids
¨Beclomethasone (Beconase, Vancenase)
¨Fluticasone (Flonase)
¨Flunisolide (Nasalide)
114
multistep theory of oncogensis
there must be an activated oncogene and a deactivated or overwhelmed tumor suppressor gene
115
symptoms of acute prostatitis
Fever is common
Perineal, sacral, suprapubic pain/discomfort
Irritative voiding symptoms
116
what is the most powerful antipseudomonal penicillin
piperacillin
used in intrabdominal infections but is susceptible to beta lactamase
117
toxicity related to aldosterone antagonsists
hyperkalemia
antiandrogenic effects (gynecomastia, ↓hirsuitism)
118
how do you decide to use bacteriostatic vs cidal
healthy patients can use either, but immunocompromised patients bacteriocidal agents should be used
119
what determines the pharmacodynamic effect of a drug
the relationship between drug concentration and at the site of action and the effect
time course and intensity of theraputic and adverse effects
120
four types of fungal pathology
superifical infection
pulmonary infections
CNS infections
systemic
121
pharmacodynamics
the study of what the drug does to the body
122
driver mutations
oncogenic mutations that drive the cancer process, tend to be the same in the same types of cancer
123
why is vancomysin important
because it works for most bacteria and is controlled to prevent resistance
124
asthma
chronic pulmonary disorder characterized by episodic reversible airflow obstruction
125
what will a superfincetion of C diff cause
pseudomembranous colitis
126
nonbeta lactams
´Vancomycin (Vancocin)
´Bacitracin (ointment, Neosporin, Polysporin)
´Fosfomycin (Monurol): UTI treatment
´Cycloserine (Seromycin)
127
what is the advantage of Alpha 1 blockers (tamsulosin, silodosin) over alpha 1 and 2 blockers (doxazosin, terazosin)
alpha 1 blockers will only work on the prostate and bladder
alpha 1 and 2 wil work on vascular smooth muscle as well
128
systemic antifungals new to market, only IV use, inhibits fungal cell walls
echinocandins
129
three types of non-cyclic OCs
seasonale (7 placebos that give 3 periods)
seasonique (only one period at the end)
Lybrel (no periods, continuous
130
how does gonadotropin based male contraception work
what is the failure rate
testosterone enanthate/undeconoate injections to suppress FSH and cause azosperima or oligospermia
2-3%
131
side effects related to estrogen oral contraceptives
progestin
breast tenderness, nausea, fluid retention
dysphoria, breast tenderness, oily skin, fat gain
132
describe VEGF therayo for cancer therapy
inhibits the BRAF gene, improves outcomes in melanoma, colon, lung cancer
133
most common genetic cause of hypercoagulability
what does it do
abnormal factor V (Leiden)
factor V Leiden cannot be inactivated by protein C
134
T/F many drugs have pH dependant absorption
false, many are altered by pH but not many are absorbed into the blood stream
135
T/F abx are always needed for cystitis and pyelonephritis
false, they are usually necessary for cystitis but always for pyelonephritis
136
two main types of asthma
which is more prevalent
allergic and idosyncratic
allergic
137
useful combination in the treatment of allergic rhinitis
¨Inhaled glucocorticoids as main preventative
¨Cromolyn/nedocromil added if needed to keep steroid dose low
¨Inhaled antihistamine
138
how do phase II enzymes create polor compounds
add a functional group
139
where is most Na reaborbed in euvolemia
expanded volume
dehydration
proximal tubule
less in the proximal tubule, increases Na excretion to urine
significant increase in Na reabsorption in PT
140
outpatient devices for inhalation treatment of asthma
metered dose inhalers
dry powder inhaler
141
methods for reducing bronchospasm assocaited with asthma
relax bronchial smooth muscle by stimulating Beta2 sympathetic receptors
block parasympathetic muscarinic receptors
142
concerns related to injectable progestins
CV/lipid concerns
probably bone loss (Low E2)
female sexual dysfunction from low androgens and dysphoria
143
common respiratory viruses
FLu A and B
RSV
144
DEA drug schedule class III
less abuse potential than I and II, all have accepted medical uses (codeine, steroids, marinol)
145
parasite drug to know
metronidazole
146
causes of metabolic acidosis
renal failure
ketoacidosis
ingestion of acid (aspirin overdose)
147
ADRs with tazarotene
\<20% of body surface is treated
can be teratogenic
also photosensitizing
148
what challenges are there in prescribing OCs to women under 30
there are compliance issues due to side effects
the side effects don't outweigh the risk of getting pregnant
149
how is lupron used in chemo
down regulation of FSH receptors produces low androgen levesl
150
Anti-IgE Monoclonal Antibody treatment for asthma
why is it saved for difficult cases
¨Omalizumab (Xolair)
it is costly
151
factors affecting prognosis of cancer
cancer type
differentiation
staging at Dx
age
quality of medical care
152
G+ bacilli
bacilus anthracis, clostridium diptheria
153
LMW heparin preparations
enoxaprin (lovenox)
154
significant differences between chronic and acute prostatitis
chronic prostatitis is more common in ment between 40-60
no fever with chronic
155
five examples of times when theraputic drug monitoring is not needed
clinical outcome is unrelated to dose or plasma concentration
dosage does not need to individual
the pharmacological effects can be clinically quantified
the relationship between concentration and effect remains unestablished
drugs with a wide theraputic range
156
excretion
the process by which a body ultimately eliminates a partent drug
157
treatment strategies for BPH
Observation
Herbs, dietary
Medical treatment
Surgical treatment
158
anti hep interereon toxicity
* Neuropsychiatric: Contraindicated in psychosis, depression
* Flu-like syndromes
* Marrow suppression
* Hepatic toxicity
159
action of methenamine
can it be used against proteus?
what is their main use
converts formaldehyde to acid in urine
proteus can split urea and neutralize the acid
only against uncomplication LUTIs
160
indications for heparin use
prophylaxis (surgery, ICU)
theraputic (DVT, PE)
161
what is the most common use of sulfonamidea
UTIs (co-trimoxazole)
162
pathophysiological hallmarts of COPD
¤Airflow obstruction
¤Alveolar dilation and destruction
¤Airway infection (chronic and acute)
163
typical UA results with UTI
cloudy or bloody
increased WBCs, bacturia, RBCs
casts = pyelonephtitis)
164
four penicillin types
natural
anti staphyolococcal
extended spectrum
anti pseudomona;
165
isoniazid toxicity
peripheral neuritis
heptatis (linked to age and ETOH)
drug interactions
166
treatment of allergic conjunctivitis
systemic antihistamines work
topical is better
167
anti flu drugs
amantidine and rimantidine prophylaxis against flu A
neuraminase inhibitors (Inhaled Zanamivir, oral.parenteral oseltamivir)
ribavirin
168
what is the effect of blood flow on instestinal absorption
more absorption happens because there is more blood flow, specifically in lipoholic drugs
169
facts about herpes simplex
teratogenic in early pregnancy
potentially fatal in new borns
severe infection possible with immunocompromised patients
170
T/F erythromycin are safe for kids and pregnancy
true
171
when would an abnormal bacteria or fungus be suspected for a UTI
indwelling catheter
bed ridden
immunosuppresedd
172
anti pseudomonal penicllin
´Carbenicillin (Geocillin)
´Mezocillin (Mezlin)
´Piperacillin (Pipracil)
´Ticarcillin (Ticar)
173
most common tetracycline complaint
gastric distress, but that can be combated by taking it with food
174
what are 2nd generation quinolines used for
examples
* Expanded gram negative coverage
* Atypical coverage (chlamydia, mycoplasma)
* Some gram + coverage
norfloxicin, ciprofloxicin
175
clincal causes of decreased half life (reasons to increase dose)
increased hepatic blood flow
decreased protein binding
increased metabolism
176
less common ADRs with alpha receptor blockers
CYP interaction
ejaculatory dysfunction
177
function of loop diuretics
blocks tubule reabsorption of Na
significantly increases Na+ and Cl-
venous dilation
178
anti CMV agents
* Ganciclovir (Cytovene)
* Cidofovir (Vistide)
* Foscarnet (Foscavir)
179
Nonnucleoside RT Inhibitors
* Nevirapine (Viramune)
* Delavirdine (Rescriptor)
* **Efavirenz (Sustiva)**
180
when is cromolyn the first line treatment of asthma
mild to moderate cases
181
clinical causes of increased half life (reason to reduce dose)
decreased blood flow to liver and kidneys
decreased renal function that lowers elimination
decreased metabolism
182
treatments safe for asthma and pregnancy
¤Beta 2 agonists
¤Glucocorticoids
¤Cromolyn
¤Ipratropium, tiotropium
183
diruetic drug classes
carbonic anhydrase inhibitors
osmotic agents
thiaizide and thiazide-like agents
loop agents
potassium sparing
ADH antagonists
184
what is the risk of introducing substances that act against non-mammalian metabolism
there will be an allergic event
185
types of inhaled antihistamines
benefit of use
¨Azelastine nasal spray (Astelin)
¨With fluticasone: Dymista
¨Risks of sedation seem very low
186
what inhibits absorption of tetracylcline
dairy
187
rules for thrombolytic therapy
sooner is better
its not always effective
can cause hemorrhage
188
when might fluoroquinolones be contraindicated due to risk factors
when a person is at risk for tendon rupture due to age \>60 or steroids
189
notable 1st generation quniolines
nalidixic acid, used for UTIs
190
Emin
the minimum concentration below which no effect is observed
191
192
health risks associated with menopause HRT
cardiovascular risk
breast cancer risk increase
probably no help in cognition
193
main mycobacterium pathogens
tuberculosis, mycobacterium bovis, mycobacterium leprae
194
indications for thrombolytics
DVT, PE, ischemic stroke, clotted shunts/catheters
195
how can penicillins be used to fight beta lactam producing bacteria
add a beta lactamase inhibitor (clavulanic acid)
196
T/F most patients will benefit from some level of corticosteroid therapy for asthma
true
197
integrase inhibitors
* Raltegravir (Isentress)
* No interference by CYP450 inhibitors or inducers
* Generally well tolerated
* Headache, nausea, diarrhea
198
three inhaled glucocorticoids
¨Flunisolide (Aerobid)
¨Budesonide (Plumicort)
¨Fluticasone (Flovent)
199
three factors that can alter metabolism or elimination of a drug
genetic differences in the number and/or function of phase 1 and/or 2 enzymes
drugs or xenobiotics
diesese
200
cautionary statements of long acting beta2's
not effective for acute attacks
15% of patients will not respond as predicted
increased mortality if used as the sole treatment
201
types of inhaled antihistamines
benefit of use
¨Azelastine nasal spray (Astelin)
¨With fluticasone: Dymista
¨Risks of sedation seem very low
202
causes of ED
medical disorders (vascular compromise, DM, androgen insufficiency)
iatrogenic (ADRs from HTNdrugs, sequela from surgery)
pysch
203
ingeneral how much of an aersol asthma medication is inhaled vs swallowed
2-10%
204
derivatives of atropine used as anticholinergic/muscarinic drugs in management of secretions in asthma
side effects
¨Ipratropium (Atrovent), ¨Tioptropium (Spiriva)
urinary retention, constipation, glaucoma
205
two types of vaginal estrogen creams
what are they used for
estradiol and conjugated estrogens
treatment of vaginal atrophy (dysparenunia, urinary incontinence/urgency)
206
T/F most patients will benefit from some level of corticosteroid therapy for asthma
true
207
how is EPO used in cancer treatment
helps prevent anemia in the presence of bone marrow suppression
208
obstructive BPH symptoms
Decreased force & caliber of urine stream
Difficulty initiating flow (“hesitancy”)
Sensation of incomplete emptying
Double voiding (2nd void within 2 hours)
Straining to urinate
Post-void dribbling
209
Protease Inhibitors
* Saquinavir (Invirase)
* Ritonavir (Norvir)
* Ritonavir/lopinavir (Kaletra)
210
G- cocci
neiseria gonnorhoeoa, meningitides
211
issues with fourth generation progestin use
blocks to effect of aldosterone that prevents fluid retention but increases the risk of hyperkalemia
drospirenone seems to increase thrombosis risk
212
five possible treatments of hot flashes
estrogen (high efficacy)
SSRI (moderate to good)
gabapentin (moderate)
progestin (moderate)
clonidine (some help)
213
PDE-5 inhibitor examples
sildenafil (PRN)
tadalafil (daily)
214
which method of treating bronchospams is associated with asthma is more effective
beta2 agonists
215
limitation of nitrofurantoin
common issue
rare complications
only useful against UTI caused by non-resistant E Coli
brown urine
pneumonitis/fibrosis, peripheral nephtitis
216
monobactum to know
azetronam
217
Cmax
what pharmacokinetic concept is characterized byt his
maximum concentration, the max serum concentration the drug achieves in a specific test area after the drug has been administered
extent of absorption
218
evidence for airway inflammation as the primary underlying cause of asthma
increased inflammatory cells (eosinophils, basophils, etc) on bronchial washings and lung biopsy even when assymptomatc
219
linear kinetics
what is the proportion of concentration to eliminate in linear kinetics
first order kinetics, where a constant fraction of drug is cleared per unit of time
1:1, increase concentration increase elimination
220
short acting beta2 onset
duration
benefits
1-5 minutes
2-6 hours
bronchodilation with minimal anti-inflammatory effects
221
three types of urinary antiseptics
methenamine
nitrofuratoin
nitrofurantoin monohydrate
222
why is inhibition of folate a good method to kill bacteria
folate is needed to make DNA
humans are able to take in folate but bacteria need to convert it from other substances
if we can block conversion the bacteria will die and spare our cells
223
toxicicty to penicilin
hypersensitivity (rash, angioedema, anaphylaxsis)
diarrhea
nephritis (exp mthicillin)
224
two examples of muscarinic receptor blockers used in asthma treatment
action
ipratropium, tiotrpoium
helps relieve bronchospasm, reduces airway secretion
225
treatment of an acute thrombic event
thrombolysis
anticoagulation
thrombectomy
226
psoriasis defined
females \<\>=males?
symptoms
chronic relapsing skin disorder
no bias
itching, joint inflammation, depression
227
antiprostaglandin approach to anticoagulation
asipirin to prevent CVD
can cause GI bleeds
228
what is the function of cromolyn
stabilizes mast cells to prevent antigen induced broncospasm but has no bronchdilating properties
229
Tmax
time to max concentration, the time after adminstration when the maximum plasma concentration is reached
230
what types of cells are most susceptible to cytotoxic chemo
rapidly dividing cells
231
three ingredients of triple abx ointment
neomycin, bacitracin, polymyxin
232
adverse drug reactions related to corticosteroid treatment of asthma
pituitary-adrenal suppression \>1600 micrograms/day
bone loss
hyperglycemia significant \>1000mcg/day
233
duration and utility of long acting beta2's
duration: 12 hours
utility: preventing recurrent acute attacks
234
what causes airflow obstruction in asthma
smooth muscle contraction, vascular congestion, edema, thick sputum
brought on by airway inflammation
235
why is HTN related to estrogen contraception not as common anymore
because pills used to be much high dose and the risk of HTN is dose dependany
236
fluoroquinoline toxicity
GI distress
CNS symptoms
liver toxicity
photosensitivity
generally well tolerated
237
T/F luminal membrane postassium sparing diuretics are very effective
false, they are not very effective and are usually combined with thiazides or loops
238
how is the FDA safe in pregnancy list changing as of 2015
239
toxicity with oxazolindnones
hematologic toxicity from thrombocytopenia
inhibit monoamine oxidase (parkinsons treatment)
240
drug interactions with AZT
•Cimetidine, indomethacin, lorazepam, acetoaminophen
241
what is the action of alpha adrenergic agonists in treatment of allergic rhinitis
vasoconstriction to reduce hyperemia
242
distribution
how a drug is disseminated through out the body
243
reactive hyperemia
after 2 or three days of alpha adrenergic use your nose will swell up due to compensatory mechcanisms activated in response to ischemia
244
DEA drug schedule class V
lowest abuse potential (low dose codeine, opium, pregabalin
245
natural penicillin is used against what
Gram + except staph
syphilis
246
what constitutes a narrow theraputic window
if the difference between ED50 and TD50 is 2x or less
247
irritative symptoms of BPH
Urgency
Frequency
Nocturnal voiding
All due to bladder pressure changes from partial outflow tract obstruction
248
what is the advantage of ketolides over macrolides
one example of a ketolide
broader spectrum of action with less antibacterial resistance
telithromycin
249
what is the value of ABx use in COPD treatment
they are valuble to prevent acute flare of bronchitis but have dubious value in long term treatment
250
beta-1 agonist effects from Beta-2 crossover
HTN, tachycardia
251
absorption
how fast a drug is absorbed into the blood
252
enzymes that peform metabolic elimination
blood esterases
phase I enzymes (oxidative, reduction, hydrolysis)
phase II (conjugative enzymes)
253
how can the autonomic influences of the destrusor muscle be modified
cholinergic drugs can cause urgency and frequency
anitcholinergics will cause urinary retention
254
two factor X inhibitors
rivaroxaban (xarelto) and apixaban(eliquis)
255
rhinitis treatment strategies
avoid allegerns
desensitize the immune system
prevent mast cell degranulation
block histamine
reduce nasopharyngeal hyperemia
block/reduce inflammtion
256
when are oral corticosteroids used in asthma treatment
dose?
goal?
taper?
in severe attacks
40-60 mg prednisone/day 5-10days or 1mg/kg/day
prevent hospitalization
not if the course lasts less than 14 days
257
what is oral terbinifine used for
how long is the treatment
what must be monitored
onychomycosis
3-6mo
can be liver toxic
258
treatment strategies for asthma
reduce inflammation
increase airway diameter
improve airway secretions
259
inhibition of carbonic anhydrase causes what
alkaline urine
metabolic acidosis
minimal sodium loss
260
non linear kinetics
drug elimination is disproportionate to dose (2x concentration leads +/- 2x change in concentration)
261
262
asthma treatment principles
preventing inflammation is key
use Beta-2 agoninsts for acute episodes
prevent recurrence with anti-inflammatories and long actings Beta-2
263
clearnace (CL, Cl, Cl/f)
a measure of the volume of plasma from which drug is removed per time
264
theraputic range
the concentration of a drug, typically in plasma, where efficacy is maximized and the risk of toxicity is low
265
T/F use of diuretics can completely eliminate Na from the body
false, the body will eventually reach a new equilibrium
266
typical ADR of methotrexate
bone marrow suppression, mucosal ulcers, hepatotoxic
267
what is one method to reach steady state concentration faster
adminster a loading dose
268
types of implantable progestins
side effects
implanon, nexplanon
risks and side effects similar to progestins
269
diuretic combinations
loop+thiazide (useful in pts who are refractory to loop diuretics)
loop/thiazide + potassium sparing
270
why do 1st generation anti-histamines cause drowsiness
they can cross the blood brain barrier
271
what should be done when prescribing warfarin or with a patient who is on warfarin
check for drug interactions
272
what is the function of leukotriene inhibitors
decrease action to prevent bronchoconstriction
273
ingeneral how much of an aersol asthma medication is inhaled vs swallowed
2-10%
274
three types of nasal corticosteroids
¨Beclomethasone (Beconase, Vancenase)
¨Fluticasone (Flonase)
¨Flunisolide (Nasalide)
275
possible use of aromatase inhibiors in BPH treatment
might able to improve the estrogen/test ratio in overweight men
276
causes of chronic prostatitis
very few are due to low grade infections
some are due to atypical infections
the majority are due to non-pecific inflammtion
277
2nd generation antihisamines
are 1sts or 2nd gen better
Loratadine (Claritin), cetirizine (Zirtek), Fexofenadine (Allegra)
2nd gens
278
what happens to drug concetration with muliple drug injections
plasam concentration increases until Css is reached
some of the drug will be eliminated
some will remain leading to accumulation
279
rifampin + pyrazinamide will result in what adverse effect
liver toxicity
280
cystitis symptoms
irritative voiding symptoms (frequency, urgency, pain)
hematura
fever (commonly in kids)
281
disadvantages of oral administration
lag time to reach plasma
plasma concentration is influenced by absorption and elimination
282
tetracyclines are most often used in what setting
outpatient
283
what are retinoids made of
what are they used for
vitamin A derivatives
acne and psoriasis
284
what is the value of ABx use in COPD treatment
they are valuble to prevent acute flare of bronchitis but have dubious value in long term treatment
285
what is the function of clinically useful diuretics
why do they work
causes an increased secretion of Na
water follows Na
286
what is the major complication of CMV
can infect fetus
causes retinitis and encephalitis in immunocompromised pateints
287
what is the important clinical challenge for HIV
how do we lengthen the HIV latent phase
288
what two values are equal at Tmax
what pharmacokinetic concept is characterized by this
when the rate of absorption = rate of elimination
the rate of absorption
289
what is the issue with in vitro lymphcyte training
it doesn't add much to life span an costs a lot
290
what is the action of theophylline
inhibits phosphodiesterase to decrease muscarinic receptor function
some anti-inflammatory effect
291
proteinuria is usually = what
renal disease
292
T/F mineralocorticoid rececptor agonists can prevent cardiac remodeling
T/F they are typically not used as a sole medication
true, maybe
true
293
sterptogramin use
two types, with use
bacteriocideal against most organsisms
quinupristin and dalfopristin (synercid), vancomycin resistance
294
typical topical azoles
miconazole
clotrimazole
295
why might BPH symptoms spontaneously remit
lifesyle changes or ↓androgens
296
ADRs with coumadin
hemorrhage
fetotoxic
multiple drug interactions
dietary restrictions
297
adverse drug reactions related to corticosteroid treatment of asthma
pituitary-adrenal suppression \>1600 micrograms/day
bone loss
hyperglycemia significant \>1000mcg/day
298
steroid components of contraceptives:
estrogens
progestins
estrogens: ethinyl estradiol (most common), estradiol valerate, mestranol
progestins: \>8 forms, 21 carbon deriviatives, 19-notestosterone dervitives, estranes, gonanes
299
what are the advantages of combined estrogen/progestin OC
what is the function of progestin
estrogen
highly effective
progestin blocks ovulation and makes cervical unimplantable
estrogen controls uterine bleeding with a 3 weeks on, 1 wk off
300
carbonic anhydrase
enzyme responsible for splitting H+ off H2CO3 or synthesizing H2O and CO2 f
301
advantages of OC
reduced quantity and duration of menstrual bleeding
reduced dysmenorrhea
predictable periods or no periods
reduced risk of uterine and ovarian cancer
302
two leukotriene receptor agonists
5-lipooxygenase inhibitor
¤Zafirucast (Accolate)
¤Montelukast (Singulair)
¤Zileuton (Zyflo)
303
evidence for airway inflammation as the primary underlying cause of asthma
increased inflammatory cells (eosinophils, basophils, etc) on bronchial washings and lung biopsy even when assymptomatc
304
antagonistic drugs with penicillin
bacteriostatic agents will decrease the effective ness of bacteriocidals, so macrolides and tetracyclines dont work with penicillin
305
adverse effects of leukotriene inhibitos
liver toxicity (esp zilueton) that requires peroidic liver enzyme testing
306
how can the same drug be bacteriocidal and bacteriostatic
at a low dose it might just kill enough microbes to keep the net colony growth to zero
a higher dose might kill all the colonies faster than they can be replaced
307
usual treatment for Vit B 12 deficienct
IM injections daily, then weekly, then monthly
OR massive oral doses
308
what is the choke point between the intrinsic and extrinsic pathways for clotting
factor x or thrombin
309
two main symptoms of chronic bronchitis
¤Chronic productive cough
¤Mucopurulent sputum
310
what is the main phase I enzyme
cytochrome P450
311
what type of drugs will pass into the ICF
how will it effect Vd
low molecular weight and lipophilic drugs
the Vd will equal about 60% of body weight
312
100% necessity for retinoid therapy
must be on oral contraceptives because they cause birth defects
313
when are oral corticosteroids used in asthma treatment
dose?
goal?
taper?
in severe attacks
40-60 mg prednisone/day 5-10days or 1mg/kg/day
prevent hospitalization
not if the course lasts less than 14 days
314
asthma treatment principles
preventing inflammation is key
use Beta-2 agoninsts for acute episodes
prevent recurrence with anti-inflammatories and long actings Beta-2
315
inhibitors of folate metabolism
sulfonamide
trimethoprim
co-trimoxazole
316
Drug A and Drug B both occupy 100% of receptors but Drug B has less intrinsic activity
which will have a higher efficacy
Drug A
317
common systemic fungal pathogens
* Candida albicans
* Histoplasma capsulatum
* Coccidioides immitis
* Blastomyces dermatitidis
* Cryptococcus neoformans
* Pneumocystis jirovecii (formerly: P. carninii)
318
benefits of the azole drugs
fungistatics effective for superficial and systemic infections
teratogenic when given systemically in high doses
CYP3A4-5 inhibition leading to ADR
319
most important loop diuretic
furosemide (lasix)(
320
how is the theraputic index expressed
as the range between the median effective dose (ED50) and the median toxic dose (TD50)
321
trends in worldwide contraception, what is used most
sterilization 20%
IUD 15%
oral 8%
condom 5%
322
what is the goal of corticosteroid treatment for asthma
to reduce underlying inflammation related to chronic asthma
323
T/F OC does not effect future fertility
true
324
what is the rationale of chemotherapy in cancer treatment
because cancer cells are genetically fragile and rapidly dividing they are susceptble to chemo, allowing therapy to kill the tumor without killing the patient
325
seven classes of drugs that are common candidates for theraputic drug monitoring
cardiovasculars
antibacterials
anti-depressants or psychotics
antiepileptics
antifungals
antineoplastics
immunosuppresives
326
factors affecting absorption
pH
gastric emptying
blood flow
intestinal surface area
intestinal transport
transport proteins
intestinal CYP
327
beta-1 agonist effects from Beta-2 crossover
HTN, tachycardia
328
why are elderly men at higher risk for UTI
atrophy of urinal muscosa
BPH
329
what issues are found with triphasic OCs
some individuals will have menstrual migrains and PMS
330
excretion
how rapidly the drug is eliminated from the body usually through urine, feces
331
lipid changes associated with progestin
Triglycerides and LDL go up, HDL goes down
332
which method of treating bronchospams is associated with asthma is more effective
beta2 agonists
333
two common anti herpes drugs
acyclovir
valacyclovir
334
pramoxine for dermal itching
topical anesthetic, **not going to fix the issue!**
can be used with hydrocortisone
may cause burning
335
sprichetes
treponema pallidum
336
ADRs with NI
zanamivir: air way irritation, dangersous with people with asthma or COPD
oseltamivir: GI upset, cramps, nausea, fixed taken with food
337
what issues are associated with vaginal ring contraceptive use
the ring can fall out
if the ring isn't inserted on day 1 after the break it can cause failure
338
what is needed to use the dry powder inhalers
a good inspiratory effort, because inspiration is what breaks up the powder
339
weaknesses on cancer cells that can be exploited by chemo
outgrows blood supply
decreased ability to repair themselves
multiple mutations
most cancers have unique antigens
340
synergistic drugs with penicillins
aminoglycosides, but can be mixed in the same vial
341
what is the major risk of metronidazole
* Disulfiram (Antabuse)-like reaction possible
* Avoid ethanol
342
horseshoe kidney
kidneys are linked and wrap around the aorta
343
what is the function of leukotriene inhibitors
decrease action to prevent bronchoconstriction
344
important safety rule regarding folate and B12 for anemia
**NEVER** prescribe folate for megaloblastic anemia **UNLESS** you are sure the patient’s B-12 level is normal
345
what types of contraception are considered (SC) steroid contraception
oral
patches
nuvaring
intramuscular
progestin IUD
346
factors that impact bioavailiblity
diet, physiology, first pass, genetics, age
347
what is the function of PDE-5 inhibitors in treating ED
limits the action of phosphodiesterase, increasing duration of nitric oxide effect
nitric oxide increases blood flow to corpus cavernosum
348
renal compensation of acidosis
alkalosis
acidosis: HCO3 is retained, H+ is excreted
alkalosis: HCO3 is secreted, H+ is retained
349
how is letrozole or armidex used in chemo
anti aromatases, used to prevent breast cancer
350
complications of hypokalemia
muscle weakness
muscle soreness
heart arrhytmia
death
351
progestine blockers for emergency contraception uses
mirepristone
ulipristal
will terminate a pregnancy before 7 wks; contraception; used to treat cushings
352
thrush prevention in corticosteroid treatment of asthma
treatment
use a spacer to catch larger particles that would deposit in the mouth
rinse mouth with water after dose
nystatin
353
how long does injected male contraception take to work
what are the draw backs
8-12 weeks to reach 90% azoospermia
requires frequent follow up for injections and semen analysis
354
DEA drug schedule class IV
low potential for abuse, accepted medical uses (benzodiazepines, phenobarbitol)
355
why does long term corticosteroid therapy cause adrenal suppression
because the pituitary-adrenal axis takes time to adjust when corticosteroid therapy is disonctinued
356
types of human herpes viruses
* HHV 1 & 2: herpes simplex (HSV) types 1 & 2
* HHV 3: Varicella-zoster virus (VZV)
* HHV 4: Epstein-Barr virus (EBV)
* HHV 5: Cytomegalovirus (CMV)
* HHV 6 & 7: Roseolovirus
* HHV 8: Kaposi Sarcoma associated HV (KSHV)
357
wqhat are 4th generation quinolones used for
examples
* gram + and anaerobic coverage
* Less useful against atypicals
moxifloxacin
358
signficant ADRs with PDE-5 inhibitors
most common
other
priapism (contraindicates with organic nitrates)
headache, flushing, nasal congestion
color vison, hearing loss
359
¨Ipratropium (Atrovent) and Tioptropium (Spiriva) are synergistic with what other asthma treatments
beta 2 inhalers (ipratropium + albuterol)
360
non-steroid anti-inflammatory choices
leukotriene inhibitors
cromolyn
anti-IgE monoclonal antibodies
361
four basic criteria for theraputic drug monitoring
good correlation between concentration and effect
drug posses a narrow theraputic range
there is a defined theraputic range
significant interpatient variabilty in plasma concentration
362
what are the most common routes for excretion of drugs
other routes
how are most polar drugs eliminated
biliary and renal
lungs, skin
through the kidneys
363
how likley is breakthrough bleeding to occur with OC use
what should you do if this occurs
5-30% in the first two cycles
warn them ahead of time, reassure them
change to a different pill with more estradiol or add a short course of extra extrogen
364
what are nasal glucoortcoids used for in treating allergic rhinitis
how often are they dosed
how long will it take to get effective
what is their most effecitve use
block or reduce inflammation
1-2x daily
1-2 wks
most effective for seasonal allergic rhinitis
365
what might cause loss of intrinsic factor leading to anemia
pernicious anemia, gastric surgery, gastric atophy
366
how is the pharmacodynamic effect of a drug measured
physiologic (HR, RR, LOC, analgesia)
laboratory (change in cholesterol)
367
T/F aminoglycosides are usualyl used alone and are effect against G+ infections
false, they are almost always used with a specific G+ agent (cilin or cephalosporin) and work well against G-
368
three tetracylcines to know
tetracycline
doxycycline
minocyclin
369
Protease Toxicity
* Common:
* Diarrhea, Nausea, fatigue, headache
370
regulators of sodium homeostasis
Hypothalamus/pituitary: ADH
Baroreceptors in the atria: Atrial natrietic peptide
sympathetic nervos system
RAAS
371
anti hepatitis drugs
interferon alfa-2a
ribvirin
ledipasvir + sofosbuvir
372
typical superficial antifungal agents
* Clotrimazole (Lotrimin)
* Miconazole (Monistat)
* Econazole (Spectazole)
* Nystatin (Mycostatin)
* Grieseofulvin (Grifulvin)
373
ADRs with calcipotriene
hypercalcemia, but rare
374
what is the risk with treatment for refludan
since it comes from leechs it can cause an allergic reaction
375
four targets of ABx action
cell wall synthesis
protein synthesis
nucleic acid synthesis
inhibitor of folate biosynthesis (inhibitors of metabolism)
376
types of antimetabolite chemo drugs
folic acid analogs (methotrexate)
purine analogs (mercaptopurine)
pyrimidine (flurouracil)
377
what is the advantage of immune therapy
it has targeted treatment against specific mutations in cancer cells that uses that patients own immune system
378
what are 3rd generation quinolines used for
examples
* Expanded gram negative coverage
* Atypical coverage (chlamydia, mycoplasma)
* better G+ coverage than 2nd gen
levofloxacin
379
advantages of continuous infusion
rate of entry is constant
results of drug accumulation until steady state is reached
380
COPD treatment strategies are preventing new damange and improve airways
how to improve airways
¤Bronchodilators
¤Glucocorticoids
¤Other anti-inflammatory drugs (leukotriene inhibitors)
¤Improve or reduce airway mucus (Respiratory therapy, Drugs such as ipratropium (Atrovent))
381
descrive fusion or entry inhibitors
* Enfuvirtide (Fuzeon); Maraviroc (Selzentry)
* Part of multi-drug strategy
* Problems:
* Rash, injection reaction, hypersensitivity
* Eosinophilia
* Hepatotoxicity (maraviroc)
382
what is the best use for amantidine/rimantidine
symptomatic treatment in the first 24-48 hrs
prevention
383
most important carbonic anhydrase inhibitor
what is this most used for
what does it do
acetazolamide (diamox)
acute mountain sickness
speeds acclimation process and treats symptoms
384
wht causes psoriasis
rapid turnover of skin cells
385
causes of vitamin b 12 deficient anemia
diet deficient
loss of intrisic factor
386
what types of drugs will tend to stay dissolved in plasma
what will be the effect on Vd? why
drugs witha high molecular weight and/or have a high affinity for transport proteins
it will have a high concentration in blood so Vd will be low, about 4L
387
causes of respiratory alkalosis
hyper ventillation
388
what is the action of topoisomerase
commonly used for what?
ADR
blocks enzyme for DNA supercoiling
lung, ovarian, colorectal
bone marrow suppression
389
two types of heparin
unfractionated and LMW
390
rhinitis treatment strategies
avoid allegerns
desensitize the immune system
prevent mast cell degranulation
block histamine
reduce nasopharyngeal hyperemia
block/reduce inflammtion
391
facts about ketoconazole
* Broad spectrum antifungal
* Best use: Histoplasmosis
* Food impairs absorption, Coca-cola improves!
392
sulfonamide choices for systemic disease
IBD
sulfamethoxazole
sulfisoxazole
sulfadizaine
sulfasalazine
393
risk factors for pseudomembranous colitis
ABx use
hospitialization
PPI
394
what is the function of 5-lipooxygenase
it converts arachadonic acid to leukotrienes
395
treatment strategy for an acute thrombus
thombolysis
anticoagulation
thrombectomy
396
when is cromolyn the first line treatment of asthma
mild to moderate cases
397
what is telavancin used for
similar to daptomycin
reserved for mrsa
can prolong QT interval
interferes with some blood tests
398
are contraceptive patches safe
yes, early studies show a higher risk of DVT and PE due to higher estradiol levels but recent studies don't bear that out
399
anti cmv toxicity
ganciclovir causes myelosuppression additive with HIV drugs
cidofovir causes renal toxicity
400
what is a patient controlled adverse effect of short acting Beta2 treatment of asthma
patient mange deteriorating asthma due to progressive inflammation with more frequent doeses
401
medical treatment of BPH
alphablockers
5-alpha reductase blockers
402
primary Nucleoside/Nucleotide Reverse Transcriptase Inhibitors “NRTIs” drugs
* Zidovudine (Retrovir, AZT)
* Zalcitabine (Hivid, ddC)
* Stavudine (Zerit, d4T)
403
typical causes of iron deficient anemia
poor diet
increased need
chronch blood loss
404
what is the advantage of PD-1 blockade
20-25 durable response rate, especially useful in difficult to treat cancers (renal cell, melanoma)
405
four factors that can alter drug distribution
genetic differences in transport proteins
body composition
drugs
disease
406
two important 1st gen cephalosporins
cefazolin, cephalexin
407
what is the risk of putting patients on a drug regimine that is at the low end of the theraputic window
the high end
there won't be an appreciable effect
they are at risk for complications
408
two types of platinum corrdination complexes used in chemo
ADRs
cisplatin, carboplatin
severe nausea, ototoxicity
409
Dx of UTI requires what
clinical suspcion + 100,000mL in voided samples or 1,000-10,000 in catheter samples
410
how is COPD related to asthma
smoke damaged epithelium, leading to frequent infection, chronic inflammtion, and asthma like reactive airways
411
what is the cheapest thrombolytic drug
streptokinase
412
specific tactics of immune cancer therapy
prevent evasion of apoptosis
increased immune response
monoclonal antibodes against specific targets
413
two long term complications of asthma
airway remodeling in response to chronic inflammation leading to gradual decline in pulmonary function
414
macrolide toxicity
GI distress
drug interactions fomr CYP3A4 inhibitors
415
Anti-IgE Monoclonal Antibody treatment for asthma
why is it saved for difficult cases
¨Omalizumab (Xolair)
it is costly
416
methods of oral contraception adminstration
cyclic with a fixed dose or triphasic dose
continuous
417
doxepin is a what?
what is its method of action
ADRs?
tricyclic antidepressant
not sure, possible antihistamine effect
drowsiness, exacerbate narrow angle glaucoma
418
first pass metabolism
when the drug is metabolized in the intestine before going into the blood
419
what is the action of interferon therapy in cancer treatment
notable ADRs
stimulation of NK cells
neuropsyciatric
420
T/F osmotic diuretics are useful in decreasing blood volume and Na
false
421
what is the mode of action of azelaic acid
common side effect
antibacterial and may ↓test conversion ot DHT
erythema and dryness
422
adverse drug ractions with rifampin
generally well tolerated
commonly causes nausea and rash
CYP induction will interact with oral contraception, warfarin
423
issues with non-cyclic OC use
more total hormone doses mean more exposure and cost
breakthrough bleeding
424
luminal diuretic toxicity
GI upset
increase urinary calcium
hyperkalemia, especially with Ace inhibitors or NSAIDs
425
PE and lab findings associated with acute prostatitis
enlarged and painful prostate
leukocytosis with left shift
UA with pyuria, bacturia, hematuria
positive cultures for G- bacteria
426
what is the role of vitamin C in iron therapy
500mg taken with iron sulfate can help absorption
427
anti hep toxicity ribavirin
* Hemolytic anemia (10-20%)
* Teratogenic in animals
428
¨Ipratropium (Atrovent) and Tioptropium (Spiriva) are synergistic with what other asthma treatments
beta 2 inhalers (ipratropium + albuterol)
429
how are lipophilic drugs typically exlcuded
they and their metabolites are eliminated through biliary, renal, or both after biotransformation
430
red man syndrome
flushing diue to histamine release realted to vancomycin
431
how is tamoxifen used in chemo
reduced risk of breast cancer recurrenct
432
if a patient presents a medication for oral contraception called mestranol 1/50, what does the 1/50 mean
1 is the dose of progestin, 50 is to dose of estradiol
433
where do most drugs fall on the FDA use in pregnancy list
category B and C
434
drugs that can have a dangerous interaction with erythromycin due to CYP inhibition
astemizole
carbamazepine
warfarin
435
deliniate where particles of varying sizes can be used in aerosol therapy fo asthma
\>10 microns
1-5 microns
\>10microns: mouth and oropharynx
1-5: smaller airways
\<0.5: minimal deposition (in and out)
436
what will increase risk of fungal disase
large exposure to pathogen
reduction in normal bacterial flora
immunosuppression (HIV, chemo, malnutrition)
437
Emax
the concentration of a drug which will fully bind to all the available receptors and increasing dose will not increase effect
438
what is the advantage to starting OC on the first sunday after a period
disadvantage
you will have your period on a monday or tuesday vs the weekend
you have to use condoms for the first month
439
classes of antiviral drugs
* Anti-Human Herpes Virus
* Anti-hepatitis
* Anti-influenza
* Anti-retrovirus
440
what is the time difference between symptomatic relief of BPH beteween alpha 1 blockers vs 5-alpha reductase inhibitors
7-10 days vs 6-12 months
441
what are the functions of thiazide diuretics
inhibitors of Na/Cl symport in the tubule (increases Na/Cl excretion)
come inhibit carbonic anhydrase
some have a direct vascular effect
442
T/F androgens are needed for BPH
true, specifically DHT
443
two factors that will reduce OC efficacy
large body size and drug interactions
444
useful combination in the treatment of allergic rhinitis
¨Inhaled glucocorticoids as main preventative
¨Cromolyn/nedocromil added if needed to keep steroid dose low
¨Inhaled antihistamine
445
ADRs related to HER2 therapy
cardiac toxicity, especially between trastuzumab and doxorubicin
446
side effects of 5 alpha reductase inhibitors
diminished libido
erectile dysfunction
gynecomastia
447
are tetracylcines bacteriostatic or cida
static, but not against gram negative UTIs
448
antibiotic strategies
employ a substances that attacks a non-mammalian part of the growth process
slow growth so the immune system gains the upper hand
employ agents to kill log order growth in immune compromised patients
449
contraindications for methenamine
hepatic insufficiency
renal insufficiency
sulfa drugs
Upper UTI
450
hallmark signs of bacterial chronic prostatitis
Urine and blood culture negative with leukocytes and bacteria in prostatic secretions
451
goals of HSV 1 and 2 treatment
* Shorten length and severity of primary infection
* Prevent or abort recurrences
* Life-saving in immunocompromised patients
452
when would prostaglandin E analog be used to treat ED
example
fucntion
when pts can't use PDE-5 inhibitors
alprostadil by urethral suppository or injection
probably relaxes corpus cavernosum smooth muscle
453
pathophysiological hallmarts of COPD
¤Airflow obstruction
¤Alveolar dilation and destruction
¤Airway infection (chronic and acute)
454
complications of a UTI
untreated cystitis can lead to pyelonephritis
poorly treated pyelonephritis can produce kidney damage
455
anticoagulation strategies
block platelet function
inhibit thrombin directly
inhibit thrombin indirectly (vit K or ↑antithrombin III)
inhibit factor X
456
T/F progestins are more effective than other OCs
issues related
false, they are slightly less effective
irregular bleeding, metabolic changes
457
typical dosage of azithromycin
500mg on day one, 250mg on days 2-5
458
what is a patient controlled adverse effect of short acting Beta2 treatment of asthma
patient mange deteriorating asthma due to progressive inflammation with more frequent doeses
459
types of drugs used for acne
retinoids
benzoyl peroxide
azelaic acid
ABx
460
effect of beta-2 agonists
adverse drug reactions
bronchdilation
hyperglycema, tachycardia, poss HTN
461
drug tolerance
reduced effect from repeated exposure to the same concentration of a drug
462
new approach to HIV treatment
* Extract CD4 cells
* Disable CCR5 by in vitro gene editing
* Return the CD4 cells back to the patient
463
when should iron supplements be avoided
men with normal diets
non-menstruating women with normal diets
464
reactive hyperemia
after 2 or three days of alpha adrenergic use your nose will swell up due to compensatory mechcanisms activated in response to ischemia
465
osmotic diuretics
primary uses
complications iwth use
**Mannitol** glycerin, isosorbide
acute renal failure, increased ICP
may worse pulmonary edema, not useful for anuria
466
conditons related to Hep B and C
chronic infection
liver failure
hepatoma
467
what is dabigatran (predexa) used for
what is the advantage over other drugs
issues
thombin inhibitor
better at preventing stroke and afib, no monitoring
non-reversible, more GI upset, expense
468
what is the advantage of fixed time and dose regimens
what is the disadvantge
more convenient
results in fluctuating concentration
469
what is used to reverse heparin
protamine sulfate
470
off label use of PDE-5 inhibitors
BPH (tadalafil)
pulmonary HTN (sildenafil, tadalafil)
471
T/F patients with pulmonary edema related to CHF will have almost immediate relief with lasix due to decreased heart workload
true, lasix will cause vasodilation
472
COPD treatment strategies are preventing new damange and improve airways
how to prevent new damage
reducing exposure to irritants
ABx to control infetion
473
describe what makes triphasic OCs unique
estrogen and progestins vary during the cycle
mimics a normal cycle
474
examples of long acting Beta2's with glucocortcoids
¨Fluticasone + salmeterol (Advair)
¨Mometasone + formoterol (Dulera)
¨Budesonide + formoterol (Symbicort)
475
consequences of hyponatremia
hypernatremia
hypotension, cardvascular collapse, death
hypertension, pulmonary edema, death
476
efficacy is dependant on what
what is the assumption made when determining efficacy
the number of drug receptor complexes formed and the intrinsic activity of the drug
it assumes that all receptors are occupied and the drug is at Emax
477
ABx most likely to produce a C diff superinfection
Clindamycin
amoxicillin, ampicillin
cephalosporin
fluoroquinolines
478
adverse side effects of estrogen contraception
increased clotting (increased risk of DVT, MI, CVA)
activaion of RAA cycle (5% risk of HTN, poss fluid retention)
increase in cholestasis
increased risk of endometrial hyperplasia if not given with progestins
479
two main types of asthma
which is more prevalent
allergic and idosyncratic
allergic
480
new ABx class
what is it useful against
teixobactin
all G+, mycoplasma, mycobacterium
481
what would indicate high clinical suspcion of UTI in peds
unexplained fever in female \<5
482
physologic factors that impact gastric emptying time
physiochemical factors
pH, baroreceptors
particle size
483
why do macrolides cause GI distress
macrolides mimic the structure of a natural chemical called motilin that triggers peristalsis
484
what is the action of granulocyte colony stimulating factors
one notable ADR
helps prevent neutropenia
can cause bone pain
485
typical superficial fungal infections
* Tinea pedis (athlete’s foot)
* Tinea cruris (jock itch)
* Tinea corporis (ringworm)
* Onychomycosis (nail bed infection)
* Vaginal infections (yeast infection)
* Oral cavity infections (thrush)
486
cautionary statements of using beta2 agonists in asthma treatment
frequen use may reduce effectiveness due to down regulation
bronchospasm may worse in some patients with long acting beta2
487
how does a clinician know when to stop chemotreatment
Biochemical markers (HCG, CEA, PSA)
clinical markers (palpable nodes, imaging)
488
1st generation antihistamines
drawbacks
Chlortrimeton, Benadryl
effective but cause drowsiness
489
anti itching drugs
steroids
doxepin
pramoxine
490
how to deal with breakthrough bleeding related to non-cyclic OC use
if its mild reassure that patient that all is well
persistent, withdraw treatment for 1 wk then resume
491
absorption is characterized by what two things
rate and extent (how much)
492
what is folate used for
what will low folate do to a fetus
essential cofactor for AAs, purines, DNA
↑ risk for ancephaly and spina bifida
493
derivatives of atropine used as anticholinergic/muscarinic drugs in management of secretions in asthma
side effects
¨Ipratropium (Atrovent), ¨Tioptropium (Spiriva)
urinary retention, constipation, glaucoma
494
common steroid contracptive doses:
estrogen
progestin
estrogen: 10-50mcg
progestin: 0.15-1mg
495
strategy to block secretions in asthmatic patients
¨Decrease bronchial secretions with anticholinergic/ anti-muscarinic agents
496
what type of bacteria are macrolides useful against
good against G+, useful against "Others" like chlamydia
weak against G-
497
three SERMs and their uses
tamoxifen (nolvadex) breast cancer prevention and treatment
raloxifene (evista) osteoporosis
bazedoxifene (duavee) SERM + estrogen for HRT
498
5th geneation cephalosporin to know
ceftaroline
only beta lactam useful against MRSA
499
respiratory compensation of acidosis
alkalosis
acidosis: ventilation increases, takes away CO2, shifts the equation to CO2 and H2O
alkalosis: decreases ventilation, retains CO2, shifts equation to H and HCO3
500
absolute vs relative bioavailbility
absolute is compared to IV
relative is set to an imaginary number because there is no IV formulation
501
advantages of non-cyclic OCs
less dysmenorrhea and issues with endometriosis
fewer hormone flucuations lead to less premenstrual dysphoria and menstrual migranes
502
non-selective ADH antagonists
lithium
demeclocycline
503
what types of contraception are used most in developing nations
injectable contraceptives and IUDs
504
what is the treatment for syphilis in the penicillin allergic patient
erythromycin
505
long acting beta2s
¨Salmeterol (Servent)
¨
¨Formoterol (Foradil)
506
examples of short acting beta 2 agonists
¨Albuterol (Proventil, Ventolin)
¨Metaproterenol (Alupent)
¨Terbutaline (Brethine, Bricanyl)
507
Major Protease Drug Interactions
* Quinidine
* Ergots
* Rifampin
* Some benzodiazepines
* Inhaled steroids
* St. John’s wort
* Many statins
* Fentanyl
508
1st generation antihistamines
drawbacks
Chlortrimeton, Benadryl
effective but cause drowsiness
509
describe lymphocyte gene therapy
lymphocytes are removed and exposed to a retrovirus that will force expression of CD19nreceptors (b cells)
reinfused T cells will then go kill b cells (used for B cell leukemia/lymphoma)
510
how do dietary factors influence gastric emptying
changing gastric pH and the caloric load
511
main superficial fungal pathogens
* Trichphyton
* Microsporum
* Epidermophyton
512
where can OC patches NOT be placed
over bony prominences or on your breasts
513
Anti-ADP approach to anticoagulation
drugs
primary use
side effects
plavix
adjunct to stent, used chronically to prevent MI or CVA
nausea, diarrhea, leukopenia
514
blocking alpha 1 receptors leads to...
blocking alpha 2 leads to...
relaxation of the bladder sphincter
relaxation of the bladder and vascular smooth muscle, lowering BP
515
general causes of anemia
nutritional deficiency (folate, iron, B12)
EPO ↓ (CKD)
hemolysis (genetic, drug induced, autoimmune)
bone marrow suppression (drugs, cancer, aplastic anemia)
516
6 month regimen for TB treatment
first 2 months: isoniazid, rifampin, pyrazinamide, ethambutol
3-6 months: isoniazid, rifampin
517
methods for reducing bronchospasm assocaited with asthma
relax bronchial smooth muscle by stimulating Beta2 sympathetic receptors
block parasympathetic muscarinic receptors
518
Classes of Drugs
estrogens
SERMs
progestogens
progesterone agonist/antagonist
androgens
anti-androgens
519
two instances where mannitol is particularly useful
how can you determine mannitol is a good therapy
acute renal failure due to hemoylsis or rhabdomyolysis
Mannitol IV increases urine flow, good response to test dose indicates it will work well
520
risks of clindamycin
C diff
liver impairment
neutropenia
521
COPD treatment strategies are preventing new damange and improve airways
how to prevent new damage
reducing exposure to irritants
ABx to control infetion
522
Ke (elimation rate constant)
a secondary parameter that is mathmatically derived value describing the rate at which a drug is eliminated from the body
523
how is COPD related to asthma
smoke damaged epithelium, leading to frequent infection, chronic inflammtion, and asthma like reactive airways
524
strategies to combat repeat UTI
◦Hydrate well
◦Empty bladder before/after intercourse (IC)
◦Antibiotic before IC
◦Apply antibiotic ointment to urethral meatus before IC
◦Long term low dose antibiotic therapy
525
iron toxicity in pediatrics can becaused by how many pills
what is the risk
\>10
neocrotizing enteritis
526
Nonnucleoside RT Inhibitors toxicity
* Rash
* Fever
* Headache
* Elevated Liver Enzymes
* Epidermal Reactions
527
uses for daptomycin
disadvantages
G+ coverave for resistant staph, strep, enterococcus
parenteral only, not useful in pneumonia, must stop statins
528
where does most absorption happen
does pH affect this
in the small intestine because of large surface area and permeable membranes
529
describe interferons
Immune cell produced cytokines which Are anti-viral and anti-neoplastic because They activate key immune system components:
## Footnote
* Macrophages
* Natural killer cells
* Assist with antigen presentation to T cells
530
Amantadine/Rimantadine
Minor ADRs
Major ADRs
caution
insomnia, dizziness, ataxia
hallucination, seizures
renal failure, sz
531
what is the function of 5-lipooxygenase
it converts arachadonic acid to leukotrienes
532
psoriasis treatment options
high potency topical steroids and tar
acitretin
tazarotene
calcipotriene
533
what clindamycin used best against
anaerobes except C diff
534
two main symptoms of emphysema
¤Shortness of breath (dyspnea) with exertion
¤Shortness of breath at rest
535
types of goals of two asthma intervention
acute: relieave acute bronchspasm
chronic: reduce frquency of acute episodes
536
chronic hemochromatosis can come from what
iron toxicity leading to organ failure
537
are fluoroquinolines safe for pregnancy
no, they are Grade C but they should be avoided because they can damage growing cartilage
538
drugs used to prevent IgE activation in the treatment of allerigc rhinitis
cromolyn nose spray before allergen exposure
omalizumab as an anti-IgE monoclonal antibody
539
types of goals of two asthma intervention
acute: relieave acute bronchspasm
chronic: reduce frquency of acute episodes
540
what is the most important determinant of cancer biology
cancer genomics, not organ of origin
541
best treatment for chronic bacterial prostatitis
bactrim for 6-12 weeks
542
DEA drug schedule class I
high abuve potential with no accepted medical use \*heroin, LSD
543
how is dexamethasone used in chemo
anti emesis, blocks hypersentivity reactions
544
types of male contraceptives
permanent (vasectomy)
reversible (barrier contraception, gonadotropin suppression)
545
most important thiaizide like diuretic
chlorthalidone
546
macrolides to know
erythromycin
azithromycin
clarithromycin
thelthromycin
547
treatments safe for asthma and pregnancy
¤Beta 2 agonists
¤Glucocorticoids
¤Cromolyn
¤Ipratropium, tiotropium
548
examples of short acting beta 2 agonists
¨Albuterol (Proventil, Ventolin)
¨Metaproterenol (Alupent)
¨Terbutaline (Brethine, Bricanyl)
549
typical dosage of inhaled glucocortocoids for asthma treatment
200-400 mcg/day
550
sites of metabolic elimination
liver, GI, lungs, kidneys, skin
551
contrinducations for sulfonamides
new borns (cause kernicterus)
late pregnancy (dtto)
antagonistic with methaminde
552
long acting beta2s
¨Salmeterol (Servent)
¨
¨Formoterol (Foradil)
553
adverse effects of leukotriene inhibitos
liver toxicity (esp zilueton) that requires peroidic liver enzyme testing
554
macrolide derivative used against C diff
what is its mode of action
fidaxomicin
acts gainst bacterial DNA transcriptions
555
what is the action of antibiotic chemo
one example
Three ADRs
disrupt DNA
dactinomycin
bone marrow suppression, cardiac toxicicity (adriamycin), pulmonary toxicity (blenoxane)
556
treatment strategies for asthma
reduce inflammation
increase airway diameter
improve airway secretions
557
four facts about ketoconazole toxicity
* Hepatic toxicity is possible
* Strong inhibitor of gonadal and adrenal steroids:
* Can not be given with Amphotericin B
* Rarely used systemically in USA
558
how is heparin therapy monitored
what is the goal
activated protamine titration (PTT)
goal is 2-2.5 x control
559
what is the goal of extended spectrum penicillins
improve gram negative coverage
560
differentiate between azole and prazole
azoles are antifungal
prazoles are PPIs
561
flu treatment
vaccination
anti flu drugs
supportive care
562
wht are vaptans
selective vasopressin receptor blockers
563
two leukotriene receptor agonists
5-lipooxygenase inhibitor
¤Zafirucast (Accolate)
¤Montelukast (Singulair)
¤Zileuton (Zyflo)
564
pyelonephritis symptoms
fever, nausea, vomiting, diarrhea
flank pain
with or without voiding symptoms
565
cautionary statements of using beta2 agonists in asthma treatment
frequen use may reduce effectiveness due to down regulation
bronchospasm may worse in some patients with long acting beta2
566
are anti herpes drugs commonly toxic
usually very well tolerated
acyclovir has been used constantly for 10 years with minimal ADR, can have transient renal function
famciclovir linked to cancer and testicle toxicity
567
AUC (area under the curve)
what drugs will have a lower AUC
the area under a plasma concentration/time curve that reflect actually exposure to the drug
ones that are cleared rapidly
568
metabolism
to what extent a drug is modified by enzymes in the body
569
what two things will cause megaloblastic anemia
vit B and folic acid deficiency
570
general strategies used to make contraceptives work
block sperm
block ovulation
block sperm access to the cervix
block sperm transit through the uterus
block fallopian tubes
block embryo implantation
571
NRTI toxicity
* Pancreatitis
* Renal Impairment
* Peripheral neuropathy
* Bone marrow toxicity (esp. AZT)
* Drug Interactions (esp. AZT)
572
what causes pernicious anemia
DX by what
treatment consideration
intrinsic factor autoantibodes that ↓folate absorption
megaloblastic anemia and progressively declining neurologic function
treating the folate ↓ will fix anemia but not the the neuro issues
573
macrolides are CYP3A4 inhibitors
why is that relevant
it stops many drugs from being broken down and can cause the circulating blood levels of some othe rmedications to increase to dangerous leveslk
574
guidelines to decide which OC to use
match estrogen to body size
use 2nd, 3rd, 4th generation progestin
be familiar with 4-5 brands with different progestins
go with what the patient tells you
575
metabolic elimination of a drug
the chemical modification of a drug to a more polar compound and facilitate clearance
576
what is the advantage of LMW heparin
↓risk of thrombocytopenia or osteopenia
usually no monitoring needed
can be used at home
577
what is the function of cromolyn
stabilizes mast cells to prevent antigen induced broncospasm but has no bronchdilating properties
578
advantage of monobactum
what is it used for
relatively beta lactamase resistant, low allergic reaction potential with penicillin allergy
usually against enterobacter and other G-. not G +
579
how does the renal system regulate pH
adding or taking away HCO3
580
half-life (T1/2Beta)
what does this assume
the time required for a drug to fall to 50% of its current value
that the drug is eliminated linearly
581
typical methods of adminstration for corticosteroids
inhaled aerosol (most common)
oral or parenteral (emergency situation)
582
what is mupirocin used for
atabax
gram + (impetigo)
also impetigo
583
two long term complications of asthma
airway remodeling in response to chronic inflammation leading to gradual decline in pulmonary function
584
long and short acting alpha agonists used in the treatment of allergic rhinitis
¨Phenylephrine (Neosynephrine) - Short acting drops/spray
¨Oxymetazoline (Afrin) - Longer action (12 hours)
585
what are nasal glucoortcoids used for in treating allergic rhinitis
how often are they dosed
how long will it take to get effective
what is their most effecitve use
block or reduce inflammation
1-2x daily
1-2 wks
most effective for seasonal allergic rhinitis
586
factors that will trigger conversion from latent to active TB
HIV
corticosteroid therapy
chemo
immunosuppresive therapy
587
2nd generation antihisamines
are 1sts or 2nd gen better
Loratadine (Claritin), cetirizine (Zirtek), Fexofenadine (Allegra)
2nd gens
588
toxicity associated with streptogramins
arthralgia and myalgia
hyperbilirubinema
589
why are obese men at increased risk to BPH
because they have higher levels of estradiol because they have more aromatase to convery T into E
590
3rd genetation cephalosporin to remember
rocephin
591
differentiate allergic asthma from idiosyncratic
allgeric asthma often has a personal of FHx of allergic disease and commonly present at an early age
idiosyncratic has no Hx, negative skin tests, normal serum IgE
592
two groups of cell wall inhibitors
beta lactams
others
593
why is prevention of bone marrow suppression important to chemotherapy
better bone marrow function increased tolerance to additional chemotherapy
594
three factors to fight ABx resistance
long enough treatment
only use Abx when necessary
use a combination of Abx when needed
595
Most important ADR for alpha1 blockers
how to prevent issue
orthostatic hypotension more common in volume/salt depleted patients
educate them on what is happening and give them their first dose in the office
596
T/F nearly all asthma treatments can be used with COPD and are very effective
false, asthma treatment for COPD is less effective depending on how extensive the damage is
597
five drugs with narrow theraputic windows
warfarin
lithium
digoxin
phenytoin
zidovudine
598
aminoglycocide toxicity (2+1)
ototoxic
nephrotoxic
exacerbated by loop diurectics (furosimide/lasix or bumetanide/bumex)
599
typical coliforms in UTI
enterobacter
escherichia
klebsiella
serratia
600
what is the action of theophylline
inhibits phosphodiesterase to decrease muscarinic receptor function
some anti-inflammatory effect
601
types of hep viruses
A B C D E
602
EPO toxicity issues
increase viscosity can cause HTN or DVT
↑risk of CVA or MI with chronic don't come
can ↓cancer surviability
603
causes of metabolic alkalosis
prolonged vomiting
ingestion of large amounts of bicarbonate
604
adverse drug reactions from cotrimoxazole
allergry (5%)
hemolytic anemia with G6PD deficienct
can cause aplastic anemia
605
T/F Pregnancy is safer than usings OC
false, OC is much safer than pregnancy
606
outpatient devices for inhalation treatment of asthma
metered dose inhalers
dry powder inhaler
607
long and short acting alpha agonists used in the treatment of allergic rhinitis
¨Phenylephrine (Neosynephrine) - Short acting drops/spray
¨Oxymetazoline (Afrin) - Longer action (12 hours)
608
thrush prevention in corticosteroid treatment of asthma
treatment
use a spacer to catch larger particles that would deposit in the mouth
rinse mouth with water after dose
nystatin
609
T/F ledipasvir + sofosbuvir are well tolerated and cheap
false, they are well tolerated but wildly expensive
610
how is fluid volume controlled
sodium
611
how are theophyllines used in treatment of ashtma in kids
adults
kids: in place of inhaled glucocortcoids
adults: time release for nocturnal asthma
612
issues with hyperkalemia
malaise
palpitation
muscle weakness
fatal arrhytmia
613
typical causes of hay fever (allergic rhinitis)
¤Pollens, animal dander, dust, molds, etc.
¤Hyperemia, enhanced secretions
¤IgE involved in inflammatory cascade
¤Histamine & other mediators
614
what is the goal of corticosteroid treatment for asthma
to reduce underlying inflammation related to chronic asthma
615
what is HER2 therapy for breast cancer
monoclonal antibodies (herceptin) with or without (herceptin + mertansine) will attack cells with mutated human endothelial growth receptor, improving prognosis for HER2 cancer
616
T/F selective alpha blockers are 100% selective
false, they can still cross react
617
T/F period are necessary to maintain health
false, estrogen flucuaton is
618
absolute contraindications for OC
smokers after age 35
undiagnosed breast tumors
undiagnosed vaginal bleeding
acute liver disease
history of DVT or hypercoagulation
619
how are theophyllines used in treatment of ashtma in kids
adults
kids: in place of inhaled glucocortcoids
adults: time release for nocturnal asthma
620
what type of drugs will stay dissolved in the extracellluar fluid
how will this effect Vd
drugs with low molecular weight that can pass through the capillary junctions into interstitial fluid but are too polar to cross the cell mambrane
Vd will be high, about the sum of the interstitial fluid (20% of body weight(
621
why is ethinyl estradiol the most commonly used estrogenn for OC
because it is well absorbed orally
622
fwhat is the action of fluoroquinolones
inhibits DNA synthesis
623
tetracycline is especially useful against what
chlamydia
mycoplasma
rickettsia
cholera
anthrax
acne
624
how is predinosne used in chemo
acute leukemia and lymphoma
625
Treatment of UTI
fluids
vitamin C/cranberry juice
Abx
626
what percent of pregnancy are the result of contraceptive failures
how many women miss 1 pill/mo
3/mo
when is it most dangerous to miss a pill
50%
50%
30%
at the beginning of a pill pack
627
general guidelines to match estrogen to body size
15-20 mcg for small to average size women
30-35 mcg for larger women
628
two types of potassium sparing diuretics
luminal membrane agents (triameterene)
mineralcorticoid antagonist (spirolactione)
629
common brand name of co-trimoxazole (combination fo trimethoprim and sulfamethazone)
used for
bactrim
UTI
Prostatitis
adjunct to H flu, listeria, legionella
630
possible issues with contraceptive patches
some patch adhesive reactions
less effective in women over 200lvs
631
rate of IV infusion adminstration equation
rate of drug adminstration = steady state - rate of drug elimination
632
why would you use vaginal vs oral estrogen
vaginal creams for vagina atrophy, orals for hot flashes
633
EC50
the concentration at which 50% concentration is achieved
634
two main symptoms of emphysema
¤Shortness of breath (dyspnea) with exertion
¤Shortness of breath at rest
635
what skin conditions are coal tar used for
issues
psoriasis, lichenified dermatitis for anti-itch effect
messy, can be irritating
636
what is the action of thrombolytic drugs
activates plasminogen to become plasmin
637
FDA use in pregnancy ratings category A
B
C
D
X
controlled studies show no risk
no evidence of risk in humans but no controlled studies
risk cannot be ruled out OR animal studies show risk to fetus
positive evidence of risk but benefits may outweigh risks
contraindicated in pregnancy
638
drugs that will have a dangerous interaction with chloramphenocol
chlorpropamide
phenytoin
tolbutamide
warfarin
639
asthma
chronic pulmonary disorder characterized by episodic reversible airflow obstruction
640
what is the best use for neuraminase inhibitors
how long will zanamavir and oseltamivir reduce symptoms
reduce symptoms when started \<48hrs after onset
zanamavir 1-2 days
oseltamivir 0.5-4 days
641
non beta lactam ABx that target cell walls
´Vancomycin
´Daptomycin
´Bacitracin
642
Heparin Toxicity
hemorrhage
thrombocytopenia
osteopenia
643
Why are estrogen contraceptives contraindicated for smokers over 35
there is a significant increased risk of MI compared to non-smokers
644
when is vancomycin used
MRSA
enterococcus
clostridium (oral)
645
2 21 carbon progestin choices
how many 19-nortestosterone progestins are there
provera, progesterone
four generations with over dozens of choices
646
ADRs of acitretin
no blood donation, requires 3 years to clear system
no alcohol (liver toxic)
647
what determines a drugs half life
clearance and Vd
648
side effects related to injectable progestin contraception
bleeding, weight gain, dysphoria
649
epidermal reactions assocaited with NNRTIs
* Toxic Epidermal Necrolysis
* Stevens-Johnson Syndrome
650
total clearance
the exponential effect of hepatic, biliary, and urinary elimination to decrease plasma concentration
651
two factors that effect the chemical polarity and partitioning of a drug as it relates to distribution
lipophilicity (increases permability through lipid bilayers)
particle size (influences how the body handles the drug)
652
functions of osmotic diuretics
increase tubule osmolality
increase renal ultrafiltrate
increase urine flow
preferential to water but electrolytes are also lost
653
what leukotriene is 1000x more potent than histamine
LLTD4
654
three methods for reversing warfarin
vitamin K, FFP, prothrombin concentrats
655
what is the coverage of oxazolidinones
common type and what it is used for
works well against G+, G-, anaerobes, aerobes
linezolid, used against vancomsycin resistant bugs
656
COPD treatment strategies are preventing new damange and improve airways
how to improve airways
¤Bronchodilators
¤Glucocorticoids
¤Other anti-inflammatory drugs (leukotriene inhibitors)
¤Improve or reduce airway mucus (Respiratory therapy, Drugs such as ipratropium (Atrovent))
657
ciclopirox is good for what
in lotion its good for tinea
in nail polish its good for onychomycosis
658
how is potency determined
testing two drugs in the same patient or pool of patients and comparing their EC50 to find which requires a lower concentration
659
most common presentation of thrombosis
MI, ischemic stroke, DVT
660
T/F tetracycline has anti-inflammatory effect
true, which makes it useful in acne treatment
661
theraputic drug monitoring
using an assay to determine drug concentrations in plasma then using that concentration to develop safe and effective drug protocols
662
5-alpha reductase inhibiors
dutasteride
finasteride
663
types of protein inhibiting ABx to know
tetracyclines
aminoglycosides
macrolides
664
HIV treatment strategies
* Inhibit Reverse Transcriptase (RT)
* Inhibit Viral Protein Production
* Prevent viral entry into cell
* Prevent integration of HIV into host DNA
* Prevent/Treat Opportunistic Infections
665
is there an advantage to used in progestin on a daily vs cyclic schedule
no, in fact you take a lower total dose with continuous scheduling
666
T/F the boundaries for the theraputic range of a drug are absolulte
false
667
what is the benefit of giving a SERMs with estrogen for HRT
blocks estrogen receptors in the breast and uterus so there is no need for progestin
668
how is estrogen used in chemo
prostate cancer
669
DEA drug schedule class II
high potential for abuse, some medical indications with high restrictions (morphine, cocaine, oxycodone)
670
three inhaled glucocorticoids
¨Flunisolide (Aerobid)
¨Budesonide (Plumicort)
¨Fluticasone (Flovent)
671
gram- bacilli
e coli, proteus, enterobacter, salmonema
672
pharmacokinetics
four parts
the study of what the body does to a drug
absorption, distribution, metabolism, excretion
673
drugs used to prevent IgE activation in the treatment of allerigc rhinitis
cromolyn nose spray before allergen exposure
omalizumab as an anti-IgE monoclonal antibody
674
autoinduction
adminsration of a drug causes a increase in metabolism that requires an increased amount of the drug to get the same effect
675
three notable aminoglycosides
amikacin, gentamicin, tobramycin
676
what are cephalosporins used for
treating mainly gram + with some gram - coverage depending on generation
677
typical causes of hay fever (allergic rhinitis)
¤Pollens, animal dander, dust, molds, etc.
¤Hyperemia, enhanced secretions
¤IgE involved in inflammatory cascade
¤Histamine & other mediators
678
deliniate where particles of varying sizes can be used in aerosol therapy fo asthma
\>10 microns
1-5 microns
\>10microns: mouth and oropharynx
1-5: smaller airways
\<0.5: minimal deposition (in and out)
679
two main symptoms of chronic bronchitis
¤Chronic productive cough
¤Mucopurulent sputum
680
what is needed to use the dry powder inhalers
a good inspiratory effort, because inspiration is what breaks up the powder
681
differentiate between chronic bronchitis and emphysema
chronic bronchitis is caused by airway obstruction that destroys alveoli
emphysema is cause by alveolary loss that least to air way obstruction
682
common treatment for the prevention of MI
clipidogrel (plavix) + aspirin (↑risk for GI bleeds, but relatively small)
683
treatment for iron deficient anemia
ferrous sulfate
ferrous glucaonate
IM or IV iron
684
differentiate between chronic bronchitis and emphysema
chronic bronchitis is caused by airway obstruction that destroys alveoli
emphysema is cause by alveolary loss that least to air way obstruction
685
general guidelines for retinoid use in acne
8-12 weeks to max benefit
may make acne look worse to start
avoid mucous membranes and eyes
use sunscreen after treatment ↑risk of skin cancer
686
ADRs related to isoretinoin
chapped lips
dry skin
nose bleeds
dry eyes
687
how does the respiratory system regulate pH
by adding or taking away CO2
688
if contraception starts on cycle day 1 or 2, when will they take effect
what if you start whenever you want
contraception starts immediately
restart with a new pack after the first period and use condoms until the second pack
689
examples of long acting Beta2's with glucocortcoids
¨Fluticasone + salmeterol (Advair)
¨Mometasone + formoterol (Dulera)
¨Budesonide + formoterol (Symbicort)
690
why does pH effect absorption
most drugs are weak bases
691
acid fast bacteria
mycobacterium tuberculosis, bovis, leprae
692
what causes airflow obstruction in asthma
smooth muscle contraction, vascular congestion, edema, thick sputum
brought on by airway inflammation
693
uses of leukotriene inhibitors in asthma treatment
lowered glucorticoid dose
694
what is the last resort for iron deficient anemia
why should you refer
parenteral
anaphylaxsis risk warrants refereal
695
why do we have phase I and phase II of elimination
because often phase one will produce a metabolite that will be processes against in phase II
696
concentration at steady is inversely proportional to what
clearance
697
drug interactions associated with decreasd OC efficacy
st johns wort
some anti convulsants
anti fungal agents
698
issues related to progestin contraception
lipid changes
some are androgenic
can cause dysphoria
699
what type of drugs can have a Vd in excess of total body water
how is that possible
non-polar, unionized drugs
suggests tissue distribution
700
analgesics for cystitis
useed for
side effection
pryridium
pain relief for the first 1-2 days of UTI
orange urine, 10% incidence of GI upset
701
treatment for leprosy
dapsone, colfazamine, rifampin
702
three thiazide drugs
hydrochlorothiazide
benzathiazide
bendroflumethazide
703
possible etiology of COPD
¤Cigarette smoking (99%)
¤Other toxins (such as coal dust, silica)
¤Genetic (Cystic fibrosis, A-1antiproteinase (anti-trypsinase) deficiency)
704
what happens that makes missing OC pills risky
follicular development is still happening, if the pill isn't resumed fast enough the follicle may survive and they may ovulate
705
examples of thromblytic agents
what is their universal method of adminstration
streptokinase, urokinase, etc
all given IV
706
T/F nearly all asthma treatments can be used with COPD and are very effective
false, asthma treatment for COPD is less effective depending on how extensive the damage is
707
Abx for acne treatment
systemic: tetracycline or erythromycin
topical: clindamycin, erythromycin, metronidazole
708
heparin induced thrombocytopenia type II
what is the reactive measure for this
Two types, Type II is an immunte related drop in platelets that leads to thombosis
immediately stop thrombin and start something else
709
what determines the EC50/potency of a drug
affinity for receptors and the number of receptors available
710
why does HIT cause thrombosis with thrombocytopenia
because all the platelets are being take up by clots
711
why are GnRH analogs not used to for contraception
because it would cause an extreme loss of estrogen and put women at risk for heart disease and osteoporosis if they aren't added back
712
four pillars of cancer treatment
surgery
chemo
radiation
immunetherapy
713
antiplatelet approaches for anticoagulation
block prostaglandin
inhibit ADP pathway
block IIb/IIIa platelet receptors
714
new standard of care for chronic hep C
ledipasivr + sofosbuvir
previously was interferon + ribavirin
715
how does plan B prevent or dely ovulation
disrupting follicle growth or blunting the LH surge
716
T/F a more potent drug (lower EC50) will have a longer effect
false
717
tetracycline derivative that can be used against resistant staph and strep in IV formuation
adverse effects?
tigecycline
similar to tetracycline with more nausea and vomitting
718
drug efficacy
the relationship between concentration and dose that takes into account the maximum effect that a drug can have regardless of dose
719
short acting beta2 onset
duration
benefits
1-5 minutes
2-6 hours
bronchodilation with minimal anti-inflammatory effects
720
importnt 1st line TB drugs
isoniazid
rifamycins
721
volume of distribtion (Vd)
equation
the theoretical volume that would be necessary the contain the total amount of an adminstered drug at the same concentration observed in blood plasma
Vd = (amount of drug in body)/(concentration at time zero)
722
low potency topical steroid
intermiediate
high
highest
triamcinolone
hydrocortisone
desoximetasone
clobetasol
723
non-steroid anti-inflammatory choices
leukotriene inhibitors
cromolyn
anti-IgE monoclonal antibodies
724
why does long term corticosteroid therapy cause adrenal suppression
because the pituitary-adrenal axis takes time to adjust when corticosteroid therapy is disonctinued
725
two common extended spectrum penicillins
common probelms
ampicilin (oral and parenteral)
amoxicilin (oral only)
rash
726
ADRs of loop diuretics
ototoxicity (deafness, vertigo, usually reversible)
excessive fluid and Na loss (hypotension, postural hypotension)
loss of electrolytes (K, Cl, Ca, Mg)
727
three amphotericin B formulations
most important
Cholesteryl sulfate complex, Lipid complex, Lipsomal
liposomal
•Reduces toxicity, particularly renal
728
treatment of allergic conjunctivitis
systemic antihistamines work
topical is better
729
variation on steroid transdermal absorption based on region
high: face, scalp, armpits, groind
medium: chest, back, abdomen
low: hand, feet, arms, legs
730
kinetic homogeneity
a predictable relationship between plasma drug concentration and concentration at the receptor site where the drug produces its pharmacologic effect
731
strategy to block secretions in asthmatic patients
¨Decrease bronchial secretions with anticholinergic/ anti-muscarinic agents
732
eight indications for theraputic drug monitoring
low theraputic index
poorly defined clinical end point
non-adherence
theraputic failure
drugs with saturable metabolism
wide variation in drug metabolism
major organ failure
prevention of ADE
733
new standard for when to initiate HIV treatment
at first diagnosis
