Pharm quiz 2 Flashcards
1
Q
Decongestants
A
Sympathomimetics
2
Q
Sympathomimetics
A
Mimic sympathetic system
- Pseudoephedrine
- Phenylephrine
Ocular-
- Oxymetazoline
- Naphazoline
- Xylometazoline
3
Q
SYMPATHOMIMETICS info
A
Cardiac excitatory action
Increased heart rate and contractility
Positive chronotropic and inotropic effects
Metabolic actions Increased glycogenolysis Free fatty acid liberation from tissues Hormone modulation Insulin Renin pituitary
4
Q
Sympathomimetics CNS actions:
A
- Respiratory stimulation
- Wakefulness
- Psychomotor activity
- Appetite reduction
- Neurotransmitter release
5
Q
Sympathomimetics Alpha Agonists
A
- Phenylephrine (Sudafed PE)
- Pseudoephedrine (real Sudafed)
- Oxymetazoline (Afrin)
- Naphazoline (Clear Eyes)
6
Q
Phenylephrine uses
A
Uses:
Nasal decongestant
Mydriatic
Hemorrhoid treatment
7
Q
PHENYLEPHRINE ADRs
A
Dose-dependent increase in blood pressure
-Compensatory decrease in heart rate
Arrhythmia, tachycardia
Dizziness
Insomnia, nervousness
Headache
Excess sweating
Shaking
AVOID in patients with htn, heart disease, hyperthyroid, BPH
8
Q
Pseudoephedrine uses:
A
congestion due to allergic rhinitis or URI
Eustachian tube congestion
9
Q
pseudoephedrine actions
A
Vasoconstriction
Increased B/P, arrhythmia
10
Q
Pseudoephedrine drug interactions
A
MAO inhibitors
Beta blockers
Can lead to unopposed alpha agonist activity
Digoxin
AVOID: Htn, cardiac disease, hyperthyroid
11
Q
Oxymetazoline uses
A
- URI
- Allergies
12
Q
Intranasal Steriods
A
- Fluticasone
- Mometasone
- Beclomethasone
13
Q
Intranasal Steroids ADRs
A
Epistaxis Nasal septal perforation Candida infection Impaired wound healing Glaucoma, cataracts Adrenal suppression Peds growth suppression Headache Cough, URI, pharyngitis
14
Q
Mast Cell Stabilizer
A
Epistaxis Nasal septal perforation Candida infection Impaired wound healing Glaucoma, cataracts Adrenal suppression Peds growth suppression Headache Cough, URI, pharyngitis
15
Q
Comely Sodium MOA:
A
MOA: Prevents mast cell degranulation and histamine release
16
Q
Comely Sodium ADRs
A
Sneezing, Stinging
17
Q
Leukotriene Inhibitors
A
- Montelukast
- Zafirlukast
- Zileuton
18
Q
Leukotriene Receptor Antagonists uses
A
Effective for nasal congestion, rhinorrhea, conjunctivitis, bronchial symptoms
More effective when used along with an antihistamine
Can be used for chronic asthma
19
Q
Montelukast MOA
A
- Selective antagonist for CysLT1 receptor
- Found in airway and inflammatory cells
20
Q
Montelukast Indications
A
- Asthma in ages one year and up
- Exercise-induced bronchoconstriction age 15 and up
- Allergic rhinitis in ages 6 months and up
21
Q
Montelukast ADME
A
- Absorbed rapidly
- Peak dose-dependent 2 – 4 hrs
- Minimal absorption across BBB
- Substrate CYP3A4 and 2C9
- Half-life 2.7 – 5.5 hrs in adults
- Excreted in feces and bile
22
Q
Montelukast ADRs
A
- Well-tolerated
- Some GI discomfort
- Headache, fever
- Dental pain
- Dizziness
23
Q
Montelukast warning for neuropsych:
A
Anxiety, agitation, depression, abnormal dreams, hallucinations
Primarily peds but all ages possible
24
Q
Zafirlukast MOA:
A
- Competitive antagonist of LTD4 and LTE4 receptors
- Prevents increased vascular permeability and eosinophil influx into lung tissues
25
Zafirlukast Indications
Prevention and treatment of chronic asthma in ages 5 and up
26
Zafirlukast Contraindication
Hepatic impairment including cirrhosis
27
Zafirlukast ADRs
```
Neuropsychiatric issues
-Insomnia, depression
Liver damage
-Limits use of zafirlukast
-Jaundice, n/v, abdominal pain, fatigue, pruritus
Churg-Strauss syndrome
-Systemic vasculitis
-Starts with asthma symptoms
-May have rash, GI bleed, extremity pain
```
28
Zileuton MOA
Prevents leukotriene synthesis by inhibiting 5-lipoxygenase
29
Zileuton indication
prophylaxis and treatment of asthma in ages 12 & up
30
Nasal Saline Irrigation uses
Chronic Rhinosinusitis
31
Nasal Saline Irrigation AE
Nasal burning, irritation, nausea. death from amoebic tap water
32
Tx for cough due to URI:
- First generation antihistamine with decongestant
- Limited efficacy of central and peripherally-acting antitussives
- Benzonatate (Tessalon), codeine, dextromethorphan not recommended
- Zinc not recommended
- Albuterol not recommended unless asthma present
- Cochrane 2012
- No good evidence for the use of any OTCs
- Review of 26 trials involving 4037 pts
33
Chronic Bronchitis / COPD Tx
- Ipratropium bromide recommended
- Codeine and dextromethorphan recommended
- No relief with mucolytics
34
Antitussives (cough suppressants)
```
Anesthetics
-Menthol, phenol
Demulcents
-Gelatin, pectin
Expectorants
-guaifenesin
Anesthetics
Honey
```
35
OTC Antitussives
Dextromethorphan
36
Rx Antitussives
Benzonatate (Tessalon, Tessalon Perles)
Codeine
Lidocaine
37
Dextromethorphan hydrobromide
| MOA
NMDA receptor antagonist
| Avoid with MAOI
38
Dextromethorphan hydrobromide
CYP 2D6
39
Dextromethorphan hydrobromide
| Dissociative properties
Hallucinogenic
| Similar to PCP, ketamine
40
Codeine uses
Cough suppressant, Pain reliever
41
What receptor does codeine bind to and what is it converted to?
Opioid receptors
| Morphine
42
Codeine ADRs
```
Respiratory depression
Dizziness
Drowsiness
Headache
Tachycardia, palpitations
Nausea/vomiting
Rash
Itching
```
43
BENZONATATE (TESSALON PERLES) MOA
reduces cough reflex
44
BENZONATATE (TESSALON PERLES) ADRs
Sedation, dizziness
Headache, hallucinations
GI upset
Pruritus
45
```
Sedation, dizziness
Headache, hallucinations
GI upset
Pruritus
can you crush or chew?
```
no, can compromise airway
46
GUAIFENESIN (MUCINEX)
Mucolytic and expectorant
47
GUAIFENESIN (MUCINEX) MOA
Increases respiratory fluid, thinning secretions for easier removal
May impair normal inflammatory response to URI
48
GUAIFENESIN (MUCINEX) ADRs
Generally well-tolerated
| Nausea, drowsiness, vomiting
49
Bacteriostatic drugs
```
Chloramphenicol
Erythromycin
Clindamycin
Sulfonamides
Trimethoprim
Tetracyclines
```
50
Bactericidal drugs
```
Aminoglycosides
Beta-lactams
Vancomycin
Quinolones
Rifampin
Metronidazole
```
51
Are bacteriostatic or bactericidal drugs better with immunocompromised patients
bactericidal
52
MIC=
= minimal inhibitory concentration
Drug concentration needed to inhibit bacterial growth
*Need 5x MIC at site of infection for antibacterial activity
53
MBC=
minimal bactericidal concentration
| Drug concentration needed to kill pathogen
54
Postantibiotic effect (PAE)
Continued bacterial growth suppression after antibiotic exposure
55
Combining ABX (2 types)
Synergism
-Effects of two or more ABX used together decrease MIC or MBC vs when used alone
-Important in endocarditis
Antagonism
-Combined effects less than when two or more drugs are used individually
56
How do penicillins work?
they effect cross-linking
57
Penicillin MOA
Bactericidal
* Interfere with bacterial cell wall synthesis
- only effects bacteria that are actively growing
58
Penicillin Resistance
- Inactivation by β-lactamase
- Modification of penicillin binding proteins (PBPs)
- Porin changes
- Impaired penetration of drugs to PBPs
- Efflux (bacteria ingests antibiotic and spits it back out)
59
Penicillin Resistance
- Inactivation by β-lactamase (most common)
- Modification of penicillin binding proteins (PBPs)
- Porin changes
- Impaired penetration of drugs to PBPs
- Efflux (bacteria ingests antibiotic and spits it back out)
60
what is Clavulanic acid?
not an antibiotic itself, helps other antibiotics (counters resistance)
61
MRSA
Altered PBPs
| -resistant to all penicillin
62
Gram - penicillin resistance
- impermeable cell wall
| - or efflux
63
Oral PCNs
- Pen VK
- Amoxicillin (+/- clavulanate)
- Cloxacillin
64
Injectable PCNs (big gun hospital drugs)
- Pen G
- Ampicillin
- Nafcillin
- Oxacillin
65
when to take meds on empty stomach?
1 hour before a meal
| 2 hours after
66
PCN is poorly absorbed where?
eye, prostate, CNS
67
is PCN protein bound?
yes, clinically relevant in >95%
68
how is PCN eliminated?
Renally
| -also saliva and breast milk
69
PCN ADRs
```
Hypersensitivity
-Rash
-Anaphylaxis
GI upset
-N/V/D
Pseudomembranous colitis
-C.diff
Rare
-Drug-induced lupus
-Autoimmune hemolytic anemia
Toxicity
-Seizures
```
70
Natural PCNS
- Penicillin G (injectable)
| - Penicillin VK (oral)
71
Natural penicillins spectrum
- Gram +
- Strep MSSA
- Treponema pallidum
- Enterococcus
72
Pen G treatment info
Syphilis
- no known pregnancy
- delayed absorption allows for longer time in tissues and blood
- lower peak concentration
73
Pen G uses:
- Syphilis (DOC)
- Strep pharyngitis (first-line)
- Rheumatic fever prophylaxis
- Endocarditis treatment
- Second-line for Lyme Disease treatment
74
Pen VK
-Strep pharyngitis
(first-line)
-Rheumatic fever prophylaxis
-Mild SSTIs
75
Pen G Benzathine administration and ADRs
IM only!
- ADRs:
- Rash
- Allergic rxn
- C.diff
- Candidiasis
- Toxicity: seizures
76
Pen VK AEs
```
Nausea/vomiting/diarrhea
GI upset
Black hairy tongue
Anaphylaxis
*CDAD
```
77
Aminopenicillins:
- Ampicillin (IV)
| - Amoxicillin (oral)
78
Aminopenicillins spectrum
-sopme gram - , but not good
-enterococcus
-some anaerobes
Amoxicillin:
MSSA
Neisseria meningitidis
M. cat, H. flu
gram –
Unasyn has activity against Pseudomonas, Neisseria gonorrhea
79
Amoxicillin/ampicillin uses:
```
ENT
First-line for group A Strep pharyngitis, otitis media
Endocarditis prophylaxis (PCN alternative)
Chlamydia during pregnancy
Lyme disease (first-line)
H.pylori (PrevPAC)
Anthrax PEP
UTI
```
80
Extended (broad) spectrum PCNs
-better gram -
Piperacillin (Pipracil)
Piperacillin/tazobactam (Zosyn)
Ticarcillin/clavulanate (Timentin)
81
Extended (broad) spectrum PCNs uses:
```
Septicemia
Lower respiratory infections
Bone/joint infections
Skin infections
UTI
Endometritis
peritonitis
```
82
Narrow Spectrum PCNs
```
Antistaphylococcal PCNs
Resistant to staph β-lactamase
*Activity against staph, strep and pneumococci
Relatively hydrophobic
No activity against gram -
Nafcillin
Oxacillin (IV)
Cloxacillin, dicloxacillin (oral)
Effective against MSSA, but not MRSA
*** doesn't cover mrsa
```
83
Narrow Spectrum PCNs side effects:
```
N/v
CDAD
*Nafcillin
-Phlebitis
-Agranulocytosis
-Acute interstitial nephritis
*Oxacillin
-Reversible hepatotoxicity
```
84
PCN allergy
- allergic to one, allergic to all
- uses different ABX
- syphilis requires PCN
- Desensitization
85
Cephalosporins MOA
Inhibit bacterial cell wall synthesis via binding of PBPs
| -No activity against enterococci and Listeria
86
Can you give a cephalosporin to a patient with a penicillin allergy?
It depends. You can not give them first generation cephalosporin, but can give them second generation some times, and can always give 3 or 4 gen. if anaphylaxis, don’t give them any just incase
87
1st gen Cephalosporins
Oral: Cephalexin, cefadroxil
Parenteral: Cefazolin (pre-op)
88
1st gen Cephalosporins work against what gram + and gram - bacteria
Gram +:Pneumococcus, strep, MSSA
| Gram -:E. coli, K. pneumo, P. mirabilis
89
1st gen Cephalosporins uses:
GAS pharyngitis in PCN allergic patients
| Skin/soft tissue infections due to MSSA or strep
90
1st gen Cephalosporins PK:
-high urine excretion
91
1st gen Cephalosporins Contra:
PCN or cephalosporin allergic rxn
92
1st gen Cephalosporins ADRs:
```
Diarrhea, N/V, stomach cramps
Drug-induced hepatitis
Pancytopenia
candidiasis
CDAD
```
93
2nd gen Cephalosporins Oral and IV drugs
Oral: Cefprozil, Cefuroxime
IV: Cefotetan, Cefoxitin, Cefuroxime
94
2nd gen Cephalosporins spectra and ADRS
spectra: similar to 1st gen + extended gram - coverage
ADRs: similar to 1st gen
95
2nd gen Cephalosporins oral uses:
```
GAS pharyngitis
AOM
Acute sinusitis
Bronchitis
SSTI due to Strep or MSSA
UTI
Early Lyme disease
```
96
2nd gen cephalosprins IV uses
```
Pre-op prophylaxis
SSTI
Lower RTI
Gyn
No Chlamydia activity
Peritonitis
Bone/joint
```
97
3rd gen cephalosporins Oral
* Cefixime (Suprax)
| * Cefdinir (Omnicef)
98
3rd gen cephalosporin ***IV/IM:
Ceftazidime (Fortaz, Tazicef)
Ceftriaxone (Rocephin)
Cefotaxime (Claforan
(IM mixed with lidocaine for pain)
99
***Ceftazidime is active against __________, but not Staph
Pseudomonas
100
3rd gen cephalo spectra
- better gram - coverage than 2nd gen
| - cross BBB
101
3rd gen cephalo indications
```
UTI
Pyelonephritis
Nosocomial infections (ceftazidime)
Gonorrhea, Lyme disease (ceftriaxone)
Meningitis
SSTIs
Febrile neutropenia
```
102
Ceftazidime-avibactam (Avycaz)
***Indications: complicated intra-abdominal and urinary tract infections
ADRs: N/V, hypersensitivity, CDAD, seizures
Decreased response in pts with renal insuff
Renally eliminated (dose adjust)
103
4th Gen cephalo
Cefepime (Maxipime)
104
Cefepime (Maxipime)
```
IV
Broad-spectrum
Active against Pseudomonas, strep, enterobacter
*Penetrates CSF (menegitis)
Renally eliminated
Pneumonia
Febrile neutropenia
UTI, SSTI
Peritonitis
Assoc with neurotoxicity
Seizures
Renal dose adjustments
```
105
cephalosporins 5.0
Ceftaroline (IV)
106
Ceftaroline
```
Better Staph coverage
***Including MRSA
Neisseria
Similar gram – activity to ceftriaxone
No activity against anaerobes
CAP and SSTI
ADRs
Hypersensitivity
CDAD
Drug-induced hemolytic anemia
```
107
Monobactam
Aztreonam
108
Aztreonam info
```
IM or IV
Resistant to hydrolysis by β-lactamases
Spectrum
*Gram – including Ps. Aeruginosa
*No gram + or anaerobic activity
*Uses
UTI
Lower RTI
Septicemia
SSTI
Peritonitis
Endometritis, pelvic cellulitis
```
109
Aztreonam ADRs
```
Rarely cross-reactive with PCN allergy
*ADRs
Hypersensitivity
CDAD
Toxic epidermal necrolysis (severe skin sluffing)
Diarrhea
Nausea
Pancytopenia
Hypotension
Weakness, myalgia
Dose adjust in renal failure
```
110
Carbapenems
Imipenem and cilastatin (Primaxin)
Ertapenem (Invanz)
Doripenem (Doribax)
Meropenem (Merrem)
111
Carbapenems
```
Broadest spectrum of β-lactams
Gram +, Gram – bacilli, anaerobes
Best to reserve for critically ill
Some cross-reactivity with PCN allergy
Increased risk of seizure
Greatest risk with imipenem (1.5% of patients)
```
112
Carbapenems uses
```
Intra-abdominal infections
Neutropenic fever
Sepsis
UTI
osteomyelitis
```
113
*Meropenem
| uses
pneumonia, SSTI, meningitis
114
*Ertapenem
| uses
Pelvic infections, colorectal surgery prophylaxis
115
Carbapenems ADRs + drug interactions
```
*ADRs
Hypersensitivity
Seizure
CDAD
Transient LFT elevations
```
*Drug interactions
Reduce concentration of valproic acid
Probenecid
