PHARM FINAL Flashcards
ANTIBIOTIC TREATMENT FOR DACRYOCYSTITIS
- augmentin
- clindamycin
- vancomycin + ceftriaxone
ANTIBIOTICS TREATMENT FOR BLEPHARITIS
- anterior blepharitis = can use azithromycin solution or erythromycin ointment (on top of eyelid hygiene / warm compresses)
- posterior blepharitis = more systemic antibiotics if eyelid hygiene / Meibomian gland massage doesn’t work = Tetracyclines or Azithromycin
ANTIBIOTICS TREATMENT FOR BLEPHARITIS
- anterior blepharitis = can use azithromycin solution or erythromycin ointment (on top of eyelid hygiene / warm compresses)
- posterior blepharitis = more systemic antibiotics if eyelid hygiene / Meibomian gland massage doesn’t work = Tetracyclines or Azithromycin
ANTIBIOTICS TO TREAT HORDEOLUM
- MC caused by staph aureus
- mainstay of treatment = warm compresses
- ABX = azithromycin or Bactroban ointment
UNASYN
ampicillin + sulbactam (beta lactamase inhibitor)
beta lactamase inhibitors
clavulanate (augmentin)
sulbactam (unasyn)
tazobactam (Zosyn)
antibiotics used to treat blowout fracture if infection develops/needed
Unasyn (ampicillin + sulbactam)
or clindamycin
treatment for lyme disease
doxycycline = adults
amoxicillin in children < 8 & pregnancy
if doxy is CI or if allergic to PCN = give azithro or erythro
treatment for RSMF
doxycycline, even in kids < 8
2nd line = Chloramphenicol - if pregnant….however chloramphenicol in 3rd trimester = associated with Grey Baby Syndrome
AUGMENTIN
amoxicillin + clavulanate
Treatment for WILSON’S DISEASE
D-Penicillinase = chelates copper
Zinc = increases fecal excretion of copper, and decreases intestinal absorption of copper
TREATMENT FOR H.PYLORI
CAP
Clarithromycin + Amoxicillin + PPI (omeprazole)
if allergic to PCN = give metronidazole instead (with clarithromycin + PPI)
TREATMENT FOR WET MACULAR DEGENERATION
dry = drusen; gradual vision loss, more common wet = neovascularization; less common, more rapid loss
BEVACIZUMAB = intra-vitreal anti-angiogenic = inhibits VEGF (vascular endothelial growth factor) to reduce neovascularization
TREATMENT FOR PROLIFERATIVE DIABETIC RETINOPATHY
VEGF INHIBITOR = BEVACIZUMAB
ACETAZOLAMIDE (diuretic) IS USED FOR
- altitude sickness
- papilledema
- glaucoma (1st line for acute angle closure glaucoma, but not 1st line for chronic (open angle) glaucoma - latanoprost/prostaglandin analogs = 1st line)
- epilepsy
eye drops for contact lens wearers
CIPROFLOXACIN (protects against pseudomonas)
antibiotics to avoid with corneal abrasions
AMINOGLYCOSIDES = toxic to corneal epithelium
STEROIDS = slows epithelial healing & predisposed to further infection
never prescribe topical anesthetics for the eyes
- can prescribe cycloplegics though
GONORRHEA
CEFTRIAXONE (ROCEPHIN)
CHLAMYDIA
AZITHROMYCIN OR DOXYCYCLINE
AMINOGLYCOSIDE DRUGS
streptomycin gentamycin tobramycin amikacin neomycin
medication for bacterial conjunctivitis
erythromycin
can also use azithromycin, fluoroquinolones (moxifloxacin), sulfonamides, aminoglycosides (can be toxic to cornea).
if contact lens wearer = fluoroquinolones (cipro)
medication for viral conjunctivitis
supportive therapy - cool compresses, artificial tears
can give topical antihistamines for itching / redness
- H1 blocker topical antihistamine = Olopatadine (Patanol = antihistamine / mast cell stabilizer)
medication for allergic conjunctivitis
- topical antihistamines: H1 blockers = Olopatadine (Patanol), Pheniramine/Naphazoline (Naphcon A)
- can give topical NSAID - ketorolac
- topical steroids
- (se of long term steroid use on eyes = glaucoma, cataracts, and HSV keratitis)
medication that can cause optic neuritis
ETHAMBUTOL
also chloramphenicol
treatment for orbital cellulitis
- IV abx: Vancomycin, Clindamycin, Cefotaxime, Ampicillin/sulbactam (unasyn)
HSV keratitis treatment
- treat with topical antivirals = trifluridine, vidarabine, ganciclovir ointment, PO acyclovir
Bacterial keratitis treatment
Treat with fluoroquinolone drops (moxifloxacin) - do NOT patch!
cataracts are a SE of
steroids
TREATMENT FOR ACUTE ANGLE CLOSURE GLAUCOMA
- 1st line = ACETAZOLAMIDE - decreases aqueous humor production –> decreases IOP
- BB - Timolol - reduces IOP pressure without affecting visual acuity
- Miotics (constricts) / cholinergics = Pilocarpine, Carbachol = acetylcholine induced papillary constriction –> reduces IOP by increasing aqueous humor drainage through pupil constriction
- Alpha 2 agonists - apraclonidine , brimonidine - suppresses aqueous humor production, and increases outflow
TREATMENT FOR CHRONIC OPEN ANGLE GLAUCOMA
1st line = prostaglandin analogs = Latanoprost –> reduces IOP
- Timolol (BB)
- Brimonidine (alpha-2 agonist) - decreases production and increases outflow
- acetazolamide (carbonic anhydrase inhibitor - reduces IOP by decreases production of aqueous humor)
TREATMENT FOR PAPILLEDEMA
ACETAZOLAMIDE = decreases production of aqueous humor
optic neuritis treatment
- IV methylprednisolone followed by oral steroids
- vision usually returns with treatment
EPIDIDYMITIS TREATMENT
- in younger men < 35 = consider GC & Chlamydia = give Ceftriaxone 250mg IM + Doxy 100mg BID x 10 days (if septic = hospitalize for IV hydration & IV antibiotics)
- in older men or hx of BPH, urethral stricture, or chronic UTI = consider enteric gram negative bacteria = fluoroquinolones!
- Levaquin 500mg qday x 10 days: outpatient management
SYMPTOMATIC TREATMENT
⦁ NSAIDS
⦁ Scrotal elevation
⦁ Ice
lot of symptomatic relief while waiting for ABX to work
MEDS THAT CAN CAUSE PRIAPISM
PDE-5 inhibitors
antidepressants (especially Trazodone)
antipsychotics
anticonvulsants
alpha blockers
PHENYLEPHRINE
alpha agonist used for PRIAPISM (1st line!)
causes vasoconstriction - will increase venous outflow of blood / contract smooth muscle
CONTRAINDICATIONS = cardiac or CV history
TREATMENT FOR PRIAPISM
TREATMENT FOR LOW FLOW (ISCHEMIC PRIAPISM)
1st line = PHENYLEPHRINE = alpha agonist intracavernous injection - causes contraction of smooth muscle - will increase venous outflow
TERBUTALINE = PO or SQ - constricts cavernosal artery - decreases arterial inflow; may be used if < 4 hrs
Needle Aspiration of corpora to remove blood; especially if > 4 hours duration - can also give phenylephrine in addition to aspiration
surgery if not responsive to medication / aspiration
TREATMENT FOR HIGH FLOW (NON-ISCHEMIC)
- observation
- can do arterial embolization or surgical ligation if refractory
reversal of methotrexate
Leucovorin
medication to treat EPS (extrapyramidal symptoms)
Cogentin (Benztropine)
BBW of anti-depressants
suicidal thinking / behavior
SNRI indicated for DPN & Fibromyalgia
Duloxetine (Cymbalta)
SNRI DRUGS
VENLAFAXINNE (EFFEXOR)
DESVENLAFAXINE (PRISTIQ)
DULOXETINE (CYMBALTA)
LEOMILNACIPRAN (FETZIMA)
URINARY RETENTION MEDICATION
ALPHA-1 BLOCKERS
- Prazosin (Minipress)
- Tamsulosin (Flomax)
- Doxazosin (Cardura)
PYELONEPHRITIS MEDICATION
FLUOROQUINOLONES** if resistance is low
cipro or Levaquin
if resistance is high = give Bactrim or augmentin
if in hospital = give IV ceftriaxone, then discharge on fluoroquinolones
TREATMENT FOR GOUT
ALLOPURINOL
PHENOZOPYRIDINE
anesthetic agent (pill) in urogenital tract - can give for symptoms of dysuria. Turns urine dark orange. Will stain clothes permanently
CYSTITIS TREATMENT
WOMEN nitrofurantoin (Macrobid) Bactrim can give phenozopyridine (pyridium) reserve fluoroquinolones (for pyelonephritis and more severe cases due to resistance)
MEN
Bactrim
fluoroquinolone
PDE-5 INHIBITORS
SILDENAFIL (VIAGRA)
TADALAFIL (CIALIS)
VARDENAFIL (LEVITRA)
MOA = increases nitric oxide levels and increases cGMP –>
BPH TREATMENT
⦁ Alpha-1 blockers
⦁ 5 alpha-reductase inhibitors
⦁ Combo = Dutasteride-Tamsulosin (Jalyn)
⦁ Tadalafil (Cialis) = 5PDE-inhibitor
ALPHA-1 BLOCKERS
⦁ Tamsulosin (Flomax) ⦁ Terazosin (Hytrin) ⦁ Doxazosin (Cardura) ⦁ Alfuzosin (Uroxatrol) ⦁ Silodosin (Rapaflo)
Alpha-1 blockers = more effective than 5-alpha reductase inhibitors for short & long term symptom management
MOA = relaxes smooth muscle in bladder neck, prostatic capsule, and prostatic urethra
Alpha-1 receptors = located in the base of the bladder and in the prostate
SE OF ALPHA-1 BLOCKERS
***MOST COMMON SE = DIZZINESS & ORTHOSTATIC HYPOTENSION
OTHER SE
⦁ problems with ejaculation - found primarily with Tamsulosin (flomax) - this is a problem with all alpha blockers, but more so with Tamsulosin
- retrograde ejaculation in Silodosin (Rapaflo)
⦁ Doxazosin (Cardura) & Terazosin (Hytrin) = cause more BP lowering than others
⦁ Tamsulosin (Flomax), Alfuzosin (Uroxatrol) & Silodosin (Rapaflo) = less BP effects
⦁ ***Alpha-1 blockers = can cause severe hypotension if used with PDE-5 inhibitors
5 ALPHA REDUCTASE INHIBITORS
⦁ Finasteride (Proscar)
⦁ Dutasteride (Avodart)
Combo: 5-ARI + alpha-1 blocker
⦁ Dutasteride (Avodart) + Tamsulosin (Flomax) = Jalyn
The only agents that provide LONG TERM DECREASE IN PROSTATE SIZE and decreased need for prostatic surgery
MOA
- 5- alpha reductase converts testosterone to dihydrotestosterone
- by inhibiting 5-alpha-reductase = blocks conversion of testosterone to dihydrotestosterone = suppresses serum dihydrotestosterone levels
- This decreases prostate size
- may take up to a year to notice reduction in symptoms
- decreased need for surgery
- decreased development of acute urinary retention
- the larger the prostate volume, the more effective the medication**
- Dutasteride (Avodart) may be more potent than Finasteride (Proscar)
SE
⦁ decreased libido
⦁ ejaculatory or erectile problems (ED)
- may only have these SE for the first year of therapy
⦁ **decreases serum PSA by 50%****
- in the first 24 months of therapy = multiply PSA by 2 when interpreting results - after 24 months of therapy = multiply PSA by 2.5 when interpreting results - There is decreased development of prostate cancer, but concern of possible increased incidence of high grade lesions
5-PDE INHIBITORS
⦁ Tadalafil (Cialis)
⦁ Vardenafil (Levitra)
⦁ Sildenafil (Viagra)
⦁ Avanafil (Stendra)
MOA
- For an erection to occur, nitric oxide (NO) is released in the corpus cavernosum during sexual stimulation
- Nitric Oxide (NO) then activates the enzyme guanylate cyclase –> results in increased levels of cGMP (cyclic guanosine monophosphate) –> produces smooth muscle relaxation and inflow of blood to the corpus cavernosum
- PDE-5 degrades cGMP (erection goes away) in the corpus cavernosum, so PDE-5 inhibitors enhance the effect of NO by inhibiting PDE-5 from degrading cGMP = leads to maintained erection
- PDE-5 inhibitors do not directly cause penile erections…they enhance erections (still need arousal)
CONTRAINDICATIONS TO PDE-5 INHIBITORS
⦁ men taking nitrates
⦁ caution with alpha-1 blockers due to risk for severe hypotension
ADVERSE REACTIONS
⦁ severe hypotension (with nitrates or alpha-1 blockers)
⦁ common = flushing, headaches, dyspepsia
⦁ visual effects = transient blue vision with sildenafil (viagra), may increase risk for nonarteritic ischemic optic neuropathy
⦁ Hearing loss
⦁ Priapism
FLUOROQUINOLONES
MOA = inhibits DNA topoisomerase
Pregnancy category = C
Black box warnings (2) = tendon rupture; may exacerbate myasthenia gravis
Adjust dose based on renal function
Urologic indications
⦁ Cystitis
⦁ UTI (pyelonephritis)*
⦁ Prostatitis
BACTRIM
Class = Sulfonamides
MOA = inhibits folic acid synthesis - avoid in pregnancy!
- effective against gram negative and staph; not active against group A strep
Pregnancy category = X
- 2nd best coverage for MRSA after Vanco
- oral tx for MRSA
can be used for UTIs - cystitis / pyelonephritis
drug given to terminate ectopic pregnancy fetus prior to rupture
METHOTREXATE
drug given to allow quick passage of spontaneous abortion/miscarriage rather than expectant and surgery
MISOPROSTOL (CYTOTEC)
drug given to stop contractions with pre-term labor
magnesium sulfate
drug given in preterm labor to help fetal baby’s lungs mature
betamethasone or dexamethasone
drug given for hypercalcemia oncologic emergency
IV PAMIDRONATE
drug given for spinal cord compression due to malignancy
decadron (dexamethasone)
