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Pharm II > Pharm II exam > Flashcards

Pharm II exam Flashcards

1
Q

definitive therapy

A

Once microbiology results have helped to identify the etiologic pathogen and/or antimicrobial susceptibility data are available, every attempt should be made to narrow the antibiotic spectrum. This is a critically important component of antibiotic therapy because it can reduce cost and toxicity and prevent the emergence of antimicrobial resistance in the community.

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2
Q

empiric therapy

A

Because microbiological results do not become available for 24 to 72 hours, initial therapy for infection is often empiric and guided by the clinical presentation. A common approach is to use broad-spectrum antimicrobial agents as initial empiric therapy with the intent to cover multiple possible pathogens commonly associated with the specific clinical syndrome.

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3
Q

normal flora

A

The normal flora are bacteria which are found in or on our bodies on a semi- permanent basis without causing disease.

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4
Q

colonization

A

The presence of bacteria on a body surface (like on the skin, mouth, intestines or airway) without causing disease in the person.

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5
Q

infection

A

The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent. An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic (bodywide). Microorganisms that live naturally in the body are not considered infections. For example, bacteria that normally live within the mouth and intestine are not infections.

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6
Q

superinfection

A
  • – a new infection occurring in a patient having a preexisting infection, such as bacterial superinfection in viral respiratory disease or infection of a chronic hepatitis B carrier with hepatitis D virus.
  • –an infection following a previous infection, especially when caused by microorganisms that are resistant or have become resistant to the antibiotics used earlier
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7
Q

bactericidal

A

kill bacteria at drug serum levels achievable in the patient (more aggressive antimicrobial action)

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8
Q

bacteriostatic

A

bacteriostatic drugs arrest the growth and replication of bacteria at serum or urine levels achievable in the patient, thus limiting the spread of infection until the body’s immune system attacks, immobilizes, and eliminates the pathogen. If the drug is removed before the immune system has scavenged the organisms, enough viable organisms may remain to begin a second cycle of infection.

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9
Q

MIC

A

minimum inhibitory concentration - the lowest concentration of antibiotic that inhibits bacterial growth

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10
Q

MBC

A

minimum bactericidal concentration - the lowest concentration of antibiotic that kils 99.9% of bacteria

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11
Q

susceptible

A

The “susceptible” category implies that isolates are inhibited by the usually achievable concentrations of antimicrobial agent when the recommended dosage is used for the site of infection.

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12
Q

resistant

A

The “resistant” category implies that isolates are not inhibited by the usually achieveable concentrations of the agent with normal dosage schedules, and clinical efficacy of the agent against the isolate has not been reliably shown in treatment studies.

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13
Q

intermediate susceptibility

A

The “intermediate” category includes isolates with antimicrobial MICs that approach usually attainable blood and tissue levels and for which response rates may be lower than for susceptible isolates. The intermediate category implies clinical efficacy in body sites where the drugs are physiologically concentrated (e.g. quinolones and beta-lactams in urine) or when a higher than normal dosage of a drug can be used (e.g. betalactams).

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14
Q

sites with special accessibility factors to antibiotics (or lack of accessibility)

A

CNS: blood-brain barrier has tile-like endothelial cells with tight junctions; impede entry of all but small, lipophilic molecules. Note that when the brain becomes inflamed (e.g. meningitis), local permeability increases and some antibiotics can then enter the CSF in therapeutic amounts.

Prostate, vitreous body of eye: very difficult to get antibiotics here in therapeutic amounts

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15
Q

Which antibiotics are lipid-soluble and can penetrate into the CNS?

A

cloramphenicol

metronidazole

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16
Q

What are the patient factors that influence selection of antibiotic therapy? (6)

A

Immune system: antibiotics reduce the bacterial load but the host’s immune system must ultimately clear the infection - immunosuppressed individuals usually require higher-than-usual doses to eliminate infective organisms

Renal dysfunction: poor kidney function increases accumulation of antibiotics that would otherwise be eliminated

Hepatic dysfunction: erythromycin and tetracycline are concentrated or eliminated by the liver; use caution

Poor perfusion: decreased circulation to an area reduces the amount of antibiotic that reaches that area (e.g. diabetics/lower limbs)

Age: newborns have poorly developed renal/hepatic systems -> toxicity

Pregnancy: many antibiotics cross the placenta

Lactation: many antibiotics are present in breast milk

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17
Q

Name 3 anti-infectives that inhibit the CYP450 system.

A

Erythromycin
Sulfamethoxazole-Trimethoprim
indinavir/saquinavir

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18
Q

Cross-sensitivity/allergy risks between the beta-lactam antibiotics

A
  • –Up to 10% of people with reaction (rash, anaphylaxis) to penicillin will have reaction to cephalosporin
  • –Cross-reactivity is sometimes due to the beta-lactam ring, sometimes due to side chain moieties
  • –Ampicillin and amoxicillin share side chains with cephalosporins, but not penicillin
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19
Q

Reasons for antibiotic failure

A
  1. Drug resistance
  2. Hypersensitivity
  3. Direct toxicity
  4. Superinfections
  5. Premature stoppage of administration
  6. Not the right drug
  7. Failure to reach MIC/MBC
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20
Q

Name 2 synergistic drug combinations and explain why they are synergistic.

A

Penicillins + clavulanic acid: penicillins have a beta lactam ring, and bacteria have beta lactamases. Clavulanic acid binds and inactivates the beta lactamases, which enables the pencillin to be more effective.

Aminoglycoside + vancomycin or penicillin: Vanco & penicillin create a leaky cell wall, which makes it easier for the AGs to get in to where the protein is being synthesized and interrupt it.

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21
Q

How do nucleoside analogs work to treat viral infection?

A

Nucleoside analogs are incorporated into a growing nucleic acid strand, but since they lack a 3’ OH, no further elongation will be possible, because all nucleic acid synthesis requires a 3’ OH site for adding the NEXT nucleotide.

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22
Q

Name 3 nucleoside analogs and what they treat.

A

acyclovir - Herpes simplex, varicella zoster
valacyclovir - prodrug of acyclovir
ribavirin - children with RSV

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23
Q

How do protease inhibitors work to treat viral infection?

A

In the late stages of viral assembly, viral proteases cleave polyproteins into viral proteins. Protease inhibitors prevent this cleavage and therefore inhibit the production of new infectious virus particles.

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24
Q

Name 2 protease inhibitors and what they treat.

A

indinavir - HIV

saquinavir - HIV

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25
Q

amantadine:
What does it treat?
How does it work?
Mode of administration?

A

influenza A
prevents virus from entering host cells
well absorbed orally

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26
Q

interferon:
What does it treat?
How does it work?
Mode of administration?

A

interferons: mode of action not well understood; not active orally - interlesional, subq, IV
interferon a: hepatitis B, C
interferon b: relapsing-remitting MS
interferon g: chronic granulomatous disease

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27
Q

oseltamivir:
What does it treat?
How does it work?
Mode of administration?

A

influenza a, b
inhibits viral neuraminidase (prevents the release of new virions and their spread from cell to cell)
orally active prodrug

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28
Q 
What % of filtered Na+ is reabsorbed at:
proximal tubule
loop of Henle
distal tubule
cortical collecting duct
A

60% proximal tubule
20-25% loop of henle
3-5% distal tubule
1-2% collecting duct

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29
Q

What classes of diuretics work at each area of the tubule?

A

Proximal tubule: osmotics, carbonic anhydrase inhibitors
Loop of Henle: loop diuretics
Distal tubule: thiazides
Collecting duct: potassium-sparing diuretics

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30
Q 
What is the main CAI diuretic? 
What is its mechanism of action? 
What is its major side effect? 
How long is it prescribed for? 
What is it prescribed for?
A 
ACETAZOLAMIDE
blocks the enzyme that makes H+ ions available for exchange with sodium and water
Metabolic acidosis
2-4 days
Altitude sickness, glaucoma
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31
Q

Which loop diuretic is the most potent?

A

Ethacrynic acid

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32
Q

What is the mechanism of action of loop diuretics?

A

Act directly on the ascending limb of the loop of
Henle to inhibit sodium and chloride resorption (which also results in decreased potassium resorption, since it’s a Na+-K+-Cl- cotransporter - each molecule of sodium reabsorbed brings one molecule of potassium and two molecules of chloride).

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33
Q

What is another effect of loop diuretics?

A

Renal prostaglandins; vasodilation; bronchodilation

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34
Q

What is a major toxicity of loop diuretics?

A

Ototoxicity

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35
Q

What is the main reason furosemide is prescribed?

A

CHF

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36
Q

Which diuretics are used in normal kidney function?

A

CAI, thiazide, mannitol

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37
Q

Which diuretics are used in impaired kidney function?

A

loop diuretics

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38
Q

What are the four major side effects of loop diuretics?

A

hypokalemia
hyperglycemia
hyperuricemia (gout)
hypomagnesemia

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39
Q

What is the mechanism of action of thiazides?

A

Inhibit tubular resorption of sodium and chloride

ions

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40
Q

Main reason thiazides are prescribed

A

hypertension

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41
Q

Why are thiazides good antihypertensives?

A

Thiazides decrease MAP and TPR

42
Q

What is the mechanism of action of potassium-sparing diuretics?

A
  1. Inhibits sodium-potassium exchange in collecting ducts (less sodium reabsorbed = less potassium excreted)
  2. Competitively binds to aldosterone receptors thereby preventing effects of aldosterone (which are to reabsorb sodium and water)
43
Q

What is the major potassium-sparing diuretic?

A

Spironolactone

44
Q

What are the therapeutic uses of spironolactone?

A

hyperaldosteronism
hypertension
ascites

45
Q

What is a possible side effect of spironolactone?

A

HYPERKALEMIA

46
Q

What is another undesirable side effect of spironolactone?

A

gynecomastia

47
Q

Patient education about ribavirin and indinavir/saquinavir

A

ribavirin: absorption is increased if taken with fatty meals
indinavir/saquinavir: absorption is decreased if taken with meals; drink lots of water to reduce kidney stone risk; inhibit CYP enzymes so be careful with warfarin & phenytoin

48
Q

amantadine: mechanism of action, purpose, contraindication

A

prevents virus from entering host cells; influenza A; pregnant

49
Q

oseltamivir: mechanism of action, purpose, patient education

A

viral neuraminidase inhibitor (prevents the release of new virions and their spread from cell to cell); influenza A, B; GI side effects - take with food

50
Q

What are treatments for scabies and lice?

A

lindane, permethrin, pyrethrins

51
Q

What is treatment for hookworms, pinworms, roundworms, tapeworms, whipworms?

A

mebendazole

52
Q

What is treatment for giardia, trichomonas vaginalis, anaerobes?

A

metronidazole

53
Q

Name 5 broad-spectrum drugs/drug groups.

A 
amoxicillin
quinolones
streptomycin
tetracycline
chloramphenicol
54
Q

Name 3 macrolides

A

erythromycin, clarithromycin, azithromycin

55
Q

Name 3 aminoglycosides

A

neomycin
streptomycin
gentamycin

56
Q

Name 3 tetracyclines

A

tetracycline, doxycycline, minocycline

57
Q

Name 2 quinolones

A

ciprofloxacin, norfloxacin

58
Q

Name 2 drugs that can treat prostatitis

A

TMP-SMZ; quinolones

59
Q

What is the mechanism of action of TMP-SMZ?

A

blocks folate synthesis

60
Q

Drug that concentrates in bone

A

clindamycin

61
Q

short term side effects of corticosteroids (5)

A 
hyperglycemia
elevated white count
sodium retention
hypokalemia
jitteriness/euphoria/confusion (steroid psychosis)
62
Q

long term side effects of corticosteroids

A
  • -HPA axis suppression
  • -Cushingoid features (moon facies, redistribution of fat to trunk)
  • -cataracts, glaucoma
  • -decreased immune response - TB activation, poor wound healing
63
Q

Name 2 ACE inhibitors

A

lisinopril, captopril

64
Q

Name 2 angiotensin receptor blockers

A

valsartan, losartan

65
Q

Name 4 calcium channel blockers

A

nifedipine, amlodipine
verapamil
diltiazem

66
Q

Name 2 phosphodiesterase inhibitors

A

sildenafil, tadalafil

67
Q

What is a beta lactam class that works increasingly well against gram neg?

A

cephalosporins - each generation adds more gram negs

68
Q

What drug works against anaerobic or + cocci?

A

clindamycin

69
Q

What should you not take at the same time as cipro?

A

dairy, metals

70
Q

What is a major adverse effect from quinolones?

A

tendon rupture

71
Q

What is a major adverse effect of doxycycline?

A

photosensitivity

72
Q

What three antibiotics work against anaerobic organisms?

A

clindamycin, chloramphenicol, metronidazole

73
Q

What diuretic is given in crush injuries (rhabdomyolysis)?

A

mannitol - increases urine flow to prevent obstructive myoglobin casts

74
Q

Top 3 most prescribed antibiotics

A

Penicillin, erythromycin, cephalosporin

75
Q

A patient is allergic to penicillin; what is the chance they will have a reaction to cephalosporin?

A

10%

76
Q

name 4 anticoagulants

A

warfarin, heparin, dabigatran, LMW heparin

77
Q

What is used to treat glaucoma?

A

CAi

78
Q

What is used to to treat pulmonary hypertension?

A

phosphodiesterase inhibitors, dipyridamole

79
Q

warfarin: moa, indications, interactions, side effects

A 
inhibits recycling/reuse of vit. K
DVT, MI, artificial heart valves
foods with vit K; many drugs - macrolides, indinavir, erythromycin
bleeding, GI
narrow therapeutic index - must monitor
80
Q

heparin: moa, indications, interactions, side effects

A

inhibits activated clotting factors
DVT, open heart surgery; anticoag. in pregnancy
-
bleeding

81
Q

dabigatran: moa, indications, interactions, side effects

A

thrombin inhibitor
stroke prophylaxis, afib
-
bleeding

82
Q

LMW heparin

A

replaces heparin; more predictable effects; doesn’t require as much monitoring

83
Q

name 4 antiplatelet drugs

A

clopidogrel
ticlopidine
dipyridamole
aspirin

84
Q

what is one thing all antiplatelets do

A

prevent platelet aggregation

85
Q

which anti platelets reduce atherosclerotic events?

A

clopidogrel

ticlopidine

86
Q

what does dipyridamole do?

A

coronary vasodilator

87
Q

how does aspirin work?

A

inhibits COX-1 = reduced platelet aggregation

88
Q

With which diuretics do you need to monitor electrolytes?

A

thiazides, loop diuretics

89
Q

which diuretic type increases calcium reabsorption?

A

thiazides increase calcium reabsorption

90
Q

which diuretic type increases calcium secretion?

A

loop diuretics

91
Q

For patients with atrial fibrillation - what drug and for how long?

A

warfarin, indefinitely - prophylactic for blood clots in the atria

92
Q

What diuretic is used to treat altitude sickness?

A

acetazolamide (CAI)

93
Q

What drugs do you give to protect against repeat strokes in people who have had strokes?

A

anti-platelets: clopidogrel, ticlopidine, aspirin

94
Q

What agents can be used for neuropathic pain?

A

tricyclic antidepressants; SSRIs; anticonvulsants; neuropathic agents such as gabapentin

95
Q

Which diuretics can lead to hypomagnesemia?

A

Loop diuretics, thiazides

96
Q

What types of drugs are used for mild/moderate nociceptive pain?

A

NSAIDs

acetaminophen

97
Q

what types of drugs are used for neurogenic pain?

A

anticonvulsants
tricyclic antidepressants
SSRIs

98
Q

What types of drugs are used for severe, intense, or chronic malignant/nonmalignant pain?

A

opioids

99
Q

Which diuretics can lead to hypomagnesemia?

A

Loop diuretics, thiazides

100
Q

Most of the calcium channel blockers work on both cardiac muscle and vascular smooth muscle, but one of the CCBs has a much greater affinity for vascular calcium channels than for calcium channels in the heart and is therefore particularly useful for hypertension. What is this CCB?

A

dihydropyridines (nifedipine, amlodipine)

101
Q

What are CCBs prescribed for?

A

hypertension, angina

Pharm II (1 decks)

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