Pharm Final Flashcards
typical dosage of inhaled glucocortocoids for asthma treatment
200-400 mcg/day
what is the risk of treatment with amphotericin B
they are toxic, cause fever, chills, hypotension, anemia, thrombophlebitis
EC100
the concentration at which Emax is achieved
antistaph penicillin
what are they used against
methicilin
cloxacin
nafcillin
oxacillin
staph infections except MRSA
G+ cocci to know
staph, strep, entero
what is the target INR for warfarin
2-3.5
goals of menopausal hormone support
reduce/prevent hot flashes
improve sleep to improve cognition and reduce depression
prevent bone loss
maintain healt of the GI system
aminopenicillins (ampicillin, amoxicilin) are used on what
Otitis media
strep
UTI (where ther isk of resistant e coli is low
what is the action of heparin
enhances the action of antithrombin III (inhibits activation of factor X)
strategy for dosing estrogen for HRT pills
start with a moderate dose that can be titrated up or down based on relief of symptoms
typical methods of adminstration for corticosteroids
inhaled aerosol (most common)
oral or parenteral (emergency situation)
issues with fourth generation progestin contraception
what is the method of action for IUDs
inflammatory response that blocks the passage of sperm
possible etiology of COPD
¤Cigarette smoking (99%)
¤Other toxins (such as coal dust, silica)
¤Genetic (Cystic fibrosis, A-1antiproteinase (anti-trypsinase) deficiency)
T/F aminoglycosides are absorbed well in oral form
false, they are for parenteral use only
amphotericin B is significantly effective against what bugs
Candida,
Histoplasma,
Cryptococcus,
Coccidioides,
Blastomyces
isoniaizd is bacteriostatic or cidal
both
special contraindications for tetracycline
pregnancy and children under 9 due to dental enamal dysplasia and discoloration, growth inhibition, bone deformities
photosensitive, so wear sin screen
dietary strategies to combat BPH
decreased fatty food intake
saw palmetto
what is the prognosis of avtive TB
100% cure rate if the patient is compliant and the strain isnt resistant
without treatment only 35% of patients will live beyond 5 years
what percent of TB is resistant to all 1st line drugs
10-15%
anti hep toxicity lamivudine
adefovir
entecavir
usually wel tolerated
renal toxic at high dose
renal toxic at usualy doses
describe in vitro immune enhancement
in cancers with a specific antigen, lymphocytes can be cultured with that antigen and reinfused to target those cells
how long does it take for warfarin to have an effect
how should it be monitored
8-12 hours with no loading dose
prothrombin time ratio (INR)
at what point in using estrogen contraceptives is the risk of venous thrombosis minimal
2 years
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
folate deficiency is caused by what
diet (↓ fruits and veg)
↓absorption (sprue, drugs)
↑increased need (pregnancy, hemolytic anemia)
T/F carbapenems are not cross reactive with penicillin/ceph allergies
false, they can be
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
action of bezoyl peroxide for acne
what is it tpically paired with
opening skin pores with some intrinsic antibiotic effect
clindamycin or erythromycin
T/F a culture needed to treat a UTI
false, culture is useful but you can start treatment without it
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
what is the advantage of arixta over lovenox
daily dosing
better at DVT prevention with equal prevention of thrombosis
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
cell wall active drugs are generally _____
protein synthesis inhibitors are usually _____
bacteriocidal
bacteriostatic
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
when can a patient be switched from lovenox to warfarin
INR > 2 for two consecutive days
what leukotriene is 1000x more potent than histamine
LLTD4
compliance issues with iron supplements
GI upset very common
black stools
might need a creative dosing schedule
why is dietary deficiency of vitamin B 12 rare
small daily needs with large stores
common methods of estrogen replacement
estradiol (tablets, patch, spray)
conjugated estrogens
+ progesins (combipatch, prempro, fem HRT)
other than isoniazide and rifampin, what types of drugs are used against TB
fluoroquinolones, typically moxifloxacin and gatifloxacin
clinical pharmacokinetics
the application of PK princiles to the management of drug therapy in an individual patient
four beta lactam ABx
´Penicillins
´Cephalosporins
´Carbapenems
´Monobactams
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
two good glucocortcoid inhalers that have high compliance
¤Fluticasone (Flovent) or budesonide (Plumicort)
types of emergency asthma therapy
1st line: beta2 inhlaers
subQ epi is useful
corticosteroid IV or oral
five determinants of distribution
chemical polarity
affinty for transport proteins
binding to tissue components or proteins
binding to blood components
volume of disstribution
typical drugs for UTI
bactrim
nitrofurantonin
2nd gen cephalosporins
amoxicilin
fluoroquinolones
what accelerates the action of antithrombin III
heparin
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
4th genetation cephalosporin to know
cefepime (esp against pseudomonas)
advantages of 5-alpha reductase inhibitors
treats BPH and male pattern baldness
can also lower prostate cancer risk
side effects of thiazide drugs
HYPOKALEMIA
postural hypotension
change in glucose tolerance
hypercalcemia, uricemia
hyponatremia
dapsone is useful against leprosy and what
adverse effects
pneumocystis
hemolysis
peripheral nephropathy
amoxicillin with clavulanic acid = _____
ticarcillin + clavulanic acid = ____
augmentin
timentin
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+
duration and utility of long acting beta2’s
duration: 12 hours
utility: preventing recurrent acute attacks
what is the use of PD-1 blockade in cancer patients
allow cytotoxic t cells to recognize cancer cells and kil them
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
four factors that can alter drug absorption
sugery, food, drugs, disease
notable drug in lincomycin class
clindamyvcin
T/F doxycycline is not affected by renal disease
true it is almost entirely metabolized in the liver
how does contraception block ovulation
what drugs use this method
suppression of FSH
steroid contraceptives, GnRH analogs (lupron)
theraputic index
the range of doses at which a medication was effective in clinical trials for a median of participants
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
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
inpt treatment of prostatitis
out patient
IV ampicillina and aminoglycoside (gent)
cipro or other fluoroquinolone
bioavailability (f)
the fraction of an adminstered dose of unchanged drugs that reaches the systemic circulation that characterizes the extent of absorption
sulfonamides is a generic term for what
PABA analogs
typical pathogens for UTI
80-85% come from coliforms
15-20% from strep or enterococcus
hematogenous seeding is rare
reversal agents for fibrinolytics (streptokinase)
aminocaproic acid (amicar)
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
causes of respiratory acidosis
respiratory failure
hitchhiker mutation
mutations found in cancerous cells that don’t necessarily contribute to the disease
mortality related to estrogen use
MI
venous thrombosis
what is responsible to non-linear kinetics
phase I CYP enzymes
two primary systemic antifungal drugs
- Amphotericin B (Amphotec, AmBisome)
- Fluconazole (Diflucan)
indications for the use of carbonic anhydrase inhibitors
open angle glaucoma
epilepsy
acute mountain sickness
contraindications for thrombolytics
<10days post op
serious GI bleed
HTN (diastolic >110)
pregnant
concentration at steady state for continuous infusion is proportional to what
the rate of infusion
advantages of carbapenems
adverse effects
broad spectrum
expensive, nausea, diarrhea, can cause sz
T/F it is possible to take OC continuously without time off for menstruation
true
two good glucocortcoid inhalers that have high compliance
¤Fluticasone (Flovent) or budesonide (Plumicort)
choices for long acting reversible contraception (LARC)
injectable progestins
implantable progestins
IUDs
injectable GnRH analogs
two types of anti-inflammatory agents for the skin
topical corticosteroids and tar compounds
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
types of emergency asthma therapy
1st line: beta2 inhlaers
subQ epi is useful
corticosteroid IV or oral
facts about voriconazole
- Newer azole (trazole) antifungal agent
- Indications:Candida septicemia, Invasive aspergillosis
- Side effects:
Visual changes (blurred vision, increased light sensitivity
risks of unopposed estrogen
how to fix this
endometrial hyperplasia and carcinoma
if there is a uterus you must add progestin
vancomycin toxicity
´Nephrotoxicity
´Ototoxicity
´Flushing due to histamine release
´“Red Man Syndrome”
why do 1st generation anti-histamines cause drowsiness
they can cross the blood brain barrier
uses of leukotriene inhibitors in asthma treatment
lowered glucorticoid dose
pros and cons of chloramphenicol
excellent G+/G- coverage
causes bone marrow supression, neonatal toxicity (Gray baby syndrome), drug interaction
what do we refer to as “latent TB”
TB in 90-95% of peole that is kept in check by the immune system
what is the advange to factor X inhibitors in anticoagulation
what are the drawbacks
oral, no monitoring, no diet restriction
expensive, not easily reverible
what is the action of alpha adrenergic agonists in treatment of allergic rhinitis
vasoconstriction to reduce hyperemia
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
other uses of quinolones
- Gonorrhea (ciprofloxacin, ofloxacin)
- Mycoplasma, ureaplasma, chlamydia
- Legionella
- Some mycobacteria (TB, avium)
- Anaerobes (Avelox, Trovan)
- Anthrax prophylaxis
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
effect of beta-2 agonists
adverse drug reactions
bronchdilation
hyperglycema, tachycardia, poss HTN
natural anticoagulants
antithrombin III
protein s and c
what is 5-alpha reductase
the enzyme that converts T to DHT
are aminocylcosides bacteriostatic or cidal
cidal
should HRT be used for every
no, focus on those with significant hot flashes for 3-5 years
what type of autonomic receptor is found in the bladder sphincter
alpha receptors
action of microtubule inhibitors
ADRs
interrupts mitotic spindle
bone marrow suppression, hypersensitivity
T/F genetic backgroun of isoniazid can lead to slow of fast clearance
treu
two examples of muscarinic receptor blockers used in asthma treatment
action
ipratropium, tiotrpoium
helps relieve bronchospasm, reduces airway secretion
what is the goal of a bacteriocidal drug
to allow the immune system to catch up
common uses for tyrosine kinase inhibitors
ADRs
leukemia, lung cancer, renal cell carcinoma
drug interactions, bone marrow suppression
in drugs with first order elimination time required to reach concentration at steady state is dependent on what
half life
three types of nasal corticosteroids
¨Beclomethasone (Beconase, Vancenase)
¨Fluticasone (Flonase)
¨Flunisolide (Nasalide)
multistep theory of oncogensis
there must be an activated oncogene and a deactivated or overwhelmed tumor suppressor gene
symptoms of acute prostatitis
Fever is common
Perineal, sacral, suprapubic pain/discomfort
Irritative voiding symptoms
what is the most powerful antipseudomonal penicillin
piperacillin
used in intrabdominal infections but is susceptible to beta lactamase
toxicity related to aldosterone antagonsists
hyperkalemia
antiandrogenic effects (gynecomastia, ↓hirsuitism)
how do you decide to use bacteriostatic vs cidal
healthy patients can use either, but immunocompromised patients bacteriocidal agents should be used
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
four types of fungal pathology
superifical infection
pulmonary infections
CNS infections
systemic
pharmacodynamics
the study of what the drug does to the body
driver mutations
oncogenic mutations that drive the cancer process, tend to be the same in the same types of cancer
why is vancomysin important
because it works for most bacteria and is controlled to prevent resistance
asthma
chronic pulmonary disorder characterized by episodic reversible airflow obstruction
what will a superfincetion of C diff cause
pseudomembranous colitis
nonbeta lactams
´Vancomycin (Vancocin)
´Bacitracin (ointment, Neosporin, Polysporin)
´Fosfomycin (Monurol): UTI treatment
´Cycloserine (Seromycin)
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
systemic antifungals new to market, only IV use, inhibits fungal cell walls
echinocandins
three types of non-cyclic OCs
seasonale (7 placebos that give 3 periods)
seasonique (only one period at the end)
Lybrel (no periods, continuous
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%
side effects related to estrogen oral contraceptives
progestin
breast tenderness, nausea, fluid retention
dysphoria, breast tenderness, oily skin, fat gain
describe VEGF therayo for cancer therapy
inhibits the BRAF gene, improves outcomes in melanoma, colon, lung cancer
most common genetic cause of hypercoagulability
what does it do
abnormal factor V (Leiden)
factor V Leiden cannot be inactivated by protein C
T/F many drugs have pH dependant absorption
false, many are altered by pH but not many are absorbed into the blood stream
T/F abx are always needed for cystitis and pyelonephritis
false, they are usually necessary for cystitis but always for pyelonephritis
two main types of asthma
which is more prevalent
allergic and idosyncratic
allergic
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
how do phase II enzymes create polor compounds
add a functional group
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
outpatient devices for inhalation treatment of asthma
metered dose inhalers
dry powder inhaler
methods for reducing bronchospasm assocaited with asthma
relax bronchial smooth muscle by stimulating Beta2 sympathetic receptors
block parasympathetic muscarinic receptors
concerns related to injectable progestins
CV/lipid concerns
probably bone loss (Low E2)
female sexual dysfunction from low androgens and dysphoria
common respiratory viruses
FLu A and B
RSV
DEA drug schedule class III
less abuse potential than I and II, all have accepted medical uses (codeine, steroids, marinol)
parasite drug to know
metronidazole
causes of metabolic acidosis
renal failure
ketoacidosis
ingestion of acid (aspirin overdose)
ADRs with tazarotene
<20% of body surface is treated
can be teratogenic
also photosensitizing
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
how is lupron used in chemo
down regulation of FSH receptors produces low androgen levesl
Anti-IgE Monoclonal Antibody treatment for asthma
why is it saved for difficult cases
¨Omalizumab (Xolair)
it is costly
factors affecting prognosis of cancer
cancer type
differentiation
staging at Dx
age
quality of medical care
G+ bacilli
bacilus anthracis, clostridium diptheria
LMW heparin preparations
enoxaprin (lovenox)
significant differences between chronic and acute prostatitis
chronic prostatitis is more common in ment between 40-60
no fever with chronic
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
excretion
the process by which a body ultimately eliminates a partent drug
treatment strategies for BPH
Observation
Herbs, dietary
Medical treatment
Surgical treatment
anti hep interereon toxicity
- Neuropsychiatric: Contraindicated in psychosis, depression
- Flu-like syndromes
- Marrow suppression
- Hepatic toxicity
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
indications for heparin use
prophylaxis (surgery, ICU)
theraputic (DVT, PE)
what is the most common use of sulfonamidea
UTIs (co-trimoxazole)
pathophysiological hallmarts of COPD
¤Airflow obstruction
¤Alveolar dilation and destruction
¤Airway infection (chronic and acute)
typical UA results with UTI
cloudy or bloody
increased WBCs, bacturia, RBCs
casts = pyelonephtitis)
four penicillin types
natural
anti staphyolococcal
extended spectrum
anti pseudomona;
isoniazid toxicity
peripheral neuritis
heptatis (linked to age and ETOH)
drug interactions
treatment of allergic conjunctivitis
systemic antihistamines work
topical is better
anti flu drugs
amantidine and rimantidine prophylaxis against flu A
neuraminase inhibitors (Inhaled Zanamivir, oral.parenteral oseltamivir)
ribavirin
what is the effect of blood flow on instestinal absorption
more absorption happens because there is more blood flow, specifically in lipoholic drugs
facts about herpes simplex
teratogenic in early pregnancy
potentially fatal in new borns
severe infection possible with immunocompromised patients
T/F erythromycin are safe for kids and pregnancy
true
when would an abnormal bacteria or fungus be suspected for a UTI
indwelling catheter
bed ridden
immunosuppresedd
anti pseudomonal penicllin
´Carbenicillin (Geocillin)
´Mezocillin (Mezlin)
´Piperacillin (Pipracil)
´Ticarcillin (Ticar)
most common tetracycline complaint
gastric distress, but that can be combated by taking it with food
what are 2nd generation quinolines used for
examples
- Expanded gram negative coverage
- Atypical coverage (chlamydia, mycoplasma)
- Some gram + coverage
norfloxicin, ciprofloxicin
clincal causes of decreased half life (reasons to increase dose)
increased hepatic blood flow
decreased protein binding
increased metabolism
less common ADRs with alpha receptor blockers
CYP interaction
ejaculatory dysfunction
function of loop diuretics
blocks tubule reabsorption of Na
significantly increases Na+ and Cl-
venous dilation
anti CMV agents
- Ganciclovir (Cytovene)
- Cidofovir (Vistide)
- Foscarnet (Foscavir)
Nonnucleoside RT Inhibitors
- Nevirapine (Viramune)
- Delavirdine (Rescriptor)
- Efavirenz (Sustiva)
when is cromolyn the first line treatment of asthma
mild to moderate cases
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
treatments safe for asthma and pregnancy
¤Beta 2 agonists
¤Glucocorticoids
¤Cromolyn
¤Ipratropium, tiotropium
diruetic drug classes
carbonic anhydrase inhibitors
osmotic agents
thiaizide and thiazide-like agents
loop agents
potassium sparing
ADH antagonists
what is the risk of introducing substances that act against non-mammalian metabolism
there will be an allergic event
types of inhaled antihistamines
benefit of use
¨Azelastine nasal spray (Astelin)
¨With fluticasone: Dymista
¨Risks of sedation seem very low
what inhibits absorption of tetracylcline
dairy
rules for thrombolytic therapy
sooner is better
its not always effective
can cause hemorrhage
when might fluoroquinolones be contraindicated due to risk factors
when a person is at risk for tendon rupture due to age >60 or steroids
notable 1st generation quniolines
nalidixic acid, used for UTIs
Emin
the minimum concentration below which no effect is observed
health risks associated with menopause HRT
cardiovascular risk
breast cancer risk increase
probably no help in cognition
main mycobacterium pathogens
tuberculosis, mycobacterium bovis, mycobacterium leprae
indications for thrombolytics
DVT, PE, ischemic stroke, clotted shunts/catheters
how can penicillins be used to fight beta lactam producing bacteria
add a beta lactamase inhibitor (clavulanic acid)
T/F most patients will benefit from some level of corticosteroid therapy for asthma
true
integrase inhibitors
- Raltegravir (Isentress)
- No interference by CYP450 inhibitors or inducers
- Generally well tolerated
- Headache, nausea, diarrhea
three inhaled glucocorticoids
¨Flunisolide (Aerobid)
¨Budesonide (Plumicort)
¨Fluticasone (Flovent)
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
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
types of inhaled antihistamines
benefit of use
¨Azelastine nasal spray (Astelin)
¨With fluticasone: Dymista
¨Risks of sedation seem very low
causes of ED
medical disorders (vascular compromise, DM, androgen insufficiency)
iatrogenic (ADRs from HTNdrugs, sequela from surgery)
pysch
ingeneral how much of an aersol asthma medication is inhaled vs swallowed
2-10%
derivatives of atropine used as anticholinergic/muscarinic drugs in management of secretions in asthma
side effects
¨Ipratropium (Atrovent), ¨Tioptropium (Spiriva)
urinary retention, constipation, glaucoma
two types of vaginal estrogen creams
what are they used for
estradiol and conjugated estrogens
treatment of vaginal atrophy (dysparenunia, urinary incontinence/urgency)
T/F most patients will benefit from some level of corticosteroid therapy for asthma
true
how is EPO used in cancer treatment
helps prevent anemia in the presence of bone marrow suppression
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
Protease Inhibitors
- Saquinavir (Invirase)
- Ritonavir (Norvir)
- Ritonavir/lopinavir (Kaletra)
G- cocci
neiseria gonnorhoeoa, meningitides
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
five possible treatments of hot flashes
estrogen (high efficacy)
SSRI (moderate to good)
gabapentin (moderate)
progestin (moderate)
clonidine (some help)
PDE-5 inhibitor examples
sildenafil (PRN)
tadalafil (daily)
which method of treating bronchospams is associated with asthma is more effective
beta2 agonists
limitation of nitrofurantoin
common issue
rare complications
only useful against UTI caused by non-resistant E Coli
brown urine
pneumonitis/fibrosis, peripheral nephtitis
monobactum to know
azetronam
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
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
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
short acting beta2 onset
duration
benefits
1-5 minutes
2-6 hours
bronchodilation with minimal anti-inflammatory effects
three types of urinary antiseptics
methenamine
nitrofuratoin
nitrofurantoin monohydrate
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
toxicicty to penicilin
hypersensitivity (rash, angioedema, anaphylaxsis)
diarrhea
nephritis (exp mthicillin)
two examples of muscarinic receptor blockers used in asthma treatment
action
ipratropium, tiotrpoium
helps relieve bronchospasm, reduces airway secretion
treatment of an acute thrombic event
thrombolysis
anticoagulation
thrombectomy
psoriasis defined
females <>=males?
symptoms
chronic relapsing skin disorder
no bias
itching, joint inflammation, depression
antiprostaglandin approach to anticoagulation
asipirin to prevent CVD
can cause GI bleeds
what is the function of cromolyn
stabilizes mast cells to prevent antigen induced broncospasm but has no bronchdilating properties
Tmax
time to max concentration, the time after adminstration when the maximum plasma concentration is reached
what types of cells are most susceptible to cytotoxic chemo
rapidly dividing cells
three ingredients of triple abx ointment
neomycin, bacitracin, polymyxin
adverse drug reactions related to corticosteroid treatment of asthma
pituitary-adrenal suppression >1600 micrograms/day
bone loss
hyperglycemia significant >1000mcg/day
duration and utility of long acting beta2’s
duration: 12 hours
utility: preventing recurrent acute attacks
what causes airflow obstruction in asthma
smooth muscle contraction, vascular congestion, edema, thick sputum
brought on by airway inflammation
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
fluoroquinoline toxicity
GI distress
CNS symptoms
liver toxicity
photosensitivity
generally well tolerated
T/F luminal membrane postassium sparing diuretics are very effective
false, they are not very effective and are usually combined with thiazides or loops
how is the FDA safe in pregnancy list changing as of 2015
toxicity with oxazolindnones
hematologic toxicity from thrombocytopenia
inhibit monoamine oxidase (parkinsons treatment)
drug interactions with AZT
•Cimetidine, indomethacin, lorazepam, acetoaminophen
what is the action of alpha adrenergic agonists in treatment of allergic rhinitis
vasoconstriction to reduce hyperemia
distribution
how a drug is disseminated through out the body
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
DEA drug schedule class V
lowest abuse potential (low dose codeine, opium, pregabalin
natural penicillin is used against what
Gram + except staph
syphilis
what constitutes a narrow theraputic window
if the difference between ED50 and TD50 is 2x or less
irritative symptoms of BPH
Urgency
Frequency
Nocturnal voiding
All due to bladder pressure changes from partial outflow tract obstruction
what is the advantage of ketolides over macrolides
one example of a ketolide
broader spectrum of action with less antibacterial resistance
telithromycin
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
beta-1 agonist effects from Beta-2 crossover
HTN, tachycardia
absorption
how fast a drug is absorbed into the blood
enzymes that peform metabolic elimination
blood esterases
phase I enzymes (oxidative, reduction, hydrolysis)
phase II (conjugative enzymes)
how can the autonomic influences of the destrusor muscle be modified
cholinergic drugs can cause urgency and frequency
anitcholinergics will cause urinary retention
two factor X inhibitors
rivaroxaban (xarelto) and apixaban(eliquis)
rhinitis treatment strategies
avoid allegerns
desensitize the immune system
prevent mast cell degranulation
block histamine
reduce nasopharyngeal hyperemia
block/reduce inflammtion
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
what is oral terbinifine used for
how long is the treatment
what must be monitored
onychomycosis
3-6mo
can be liver toxic
treatment strategies for asthma
reduce inflammation
increase airway diameter
improve airway secretions
inhibition of carbonic anhydrase causes what
alkaline urine
metabolic acidosis
minimal sodium loss
non linear kinetics
drug elimination is disproportionate to dose (2x concentration leads +/- 2x change in concentration)
asthma treatment principles
preventing inflammation is key
use Beta-2 agoninsts for acute episodes
prevent recurrence with anti-inflammatories and long actings Beta-2
clearnace (CL, Cl, Cl/f)
a measure of the volume of plasma from which drug is removed per time
theraputic range
the concentration of a drug, typically in plasma, where efficacy is maximized and the risk of toxicity is low
T/F use of diuretics can completely eliminate Na from the body
false, the body will eventually reach a new equilibrium
typical ADR of methotrexate
bone marrow suppression, mucosal ulcers, hepatotoxic
what is one method to reach steady state concentration faster
adminster a loading dose
types of implantable progestins
side effects
implanon, nexplanon
risks and side effects similar to progestins
diuretic combinations
loop+thiazide (useful in pts who are refractory to loop diuretics)
loop/thiazide + potassium sparing
why do 1st generation anti-histamines cause drowsiness
they can cross the blood brain barrier
what should be done when prescribing warfarin or with a patient who is on warfarin
check for drug interactions
what is the function of leukotriene inhibitors
decrease action to prevent bronchoconstriction
ingeneral how much of an aersol asthma medication is inhaled vs swallowed
2-10%
three types of nasal corticosteroids
¨Beclomethasone (Beconase, Vancenase)
¨Fluticasone (Flonase)
¨Flunisolide (Nasalide)
possible use of aromatase inhibiors in BPH treatment
might able to improve the estrogen/test ratio in overweight men
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
2nd generation antihisamines
are 1sts or 2nd gen better
Loratadine (Claritin), cetirizine (Zirtek), Fexofenadine (Allegra)
2nd gens
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
rifampin + pyrazinamide will result in what adverse effect
liver toxicity
cystitis symptoms
irritative voiding symptoms (frequency, urgency, pain)
hematura
fever (commonly in kids)
disadvantages of oral administration
lag time to reach plasma
plasma concentration is influenced by absorption and elimination
tetracyclines are most often used in what setting
outpatient
what are retinoids made of
what are they used for
vitamin A derivatives
acne and psoriasis
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
what is the function of clinically useful diuretics
why do they work
causes an increased secretion of Na
water follows Na
what is the major complication of CMV
can infect fetus
causes retinitis and encephalitis in immunocompromised pateints
what is the important clinical challenge for HIV
how do we lengthen the HIV latent phase
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
what is the issue with in vitro lymphcyte training
it doesn’t add much to life span an costs a lot
what is the action of theophylline
inhibits phosphodiesterase to decrease muscarinic receptor function
some anti-inflammatory effect
proteinuria is usually = what
renal disease
T/F mineralocorticoid rececptor agonists can prevent cardiac remodeling
T/F they are typically not used as a sole medication
true, maybe
true
sterptogramin use
two types, with use
bacteriocideal against most organsisms
quinupristin and dalfopristin (synercid), vancomycin resistance
