Pharm - Teratogens, STDs, Bladder issues, Ovarian Chemo Flashcards
1
Q
HSV drugs
A
Acyclovir or Famciclovir or Valacyclovir for 7-10 days
2
Q
Acyclovir and Valacyclovir MOA
A
competitively inhibits viral DNA polymerase; competes with deoxyguanosine triphosphate for incorporation into viral DNA; requires activation intracellularly in thymidine kinase
3
Q
Famciclovir MOA
A
metabolized (de-acetylated) to penciclovir, does not cause chain termination
4
Q
Acyclovir, Valacyclovir AE
A
crystalline neurotoxicity including seizures, and nephrotoxicity; make sure patient is well hydrated to avoid; adjust dose in renal dysfunction
5
Q
Syphilis treatment
A
Benzathine Penicillin G intramuscularly
6
Q
Benzathine Penicillin MOA
A
binds PBP causing cell lysis; IM allows 2 week depot of the drug; poor CSF penetration (not effective in CNS infection)
7
Q
Jarisch-Herxheimer Reaction
A
observed in patients with syphilis after initial penicillin injection; chills, fever, HA, myalgias, arthralgias, increased edema/color at cutaneous lesion; fades within 48hrs
8
Q
Chlamydia treatment
A
Azithromycin or Doxycycline or Erythromycin or Levofloxacin or Ofloxacin; in pregnancy use Amoxicillin
9
Q
Azithromycin, Erythromycin MOA
A
binds 50s ribosomal subunit, bacteriostatic
10
Q
Doxycycline MOA
A
binds 30s ribosomal subunit, bacteriostatic
11
Q
Levofloxacin MOA
A
inhibits DNA gyrase (topo II) in gram negative, bactericidal; inhibits topo IV in gram-positive, bactericidal
12
Q
Ofloxacin MOA
A
inhibits topo IV in gram-positive, bactericidal; inhibits DNA gyrase (topo II) in gram negative, bactericidal
13
Q
Amoxicillin MOA
A
bactericidal beta-lactam; binds PBPs causing cell lysis
14
Q
Erythromycin PKPD
A
short half life, P-gp and CYP3A4 substrate and inhibitor; minimal elim in urine most in stool
15
Q
Azithromycin AE
A
GI upset; vaginitis
16
Q
Doxycycline AE
A
GI upset, hepatic damage in high dose esp in pregnancy (cat D); photosensitivity with sunlight
17
Q
Erythromycin AE
A
GI upset; increases toxicity of CYP3A4 substrates; estolate preparations may cause cholestatic jaundice; risk of cardiac death with 3A4 inhibitors; may cause hypertrophic pyloric stenosis in neonates
18
Q
Levofloxacin and Ofloxacin AE
A
taste disturbance, GI upset, BBW of tendonitis and rupture and exacerbation of muscle weakness; Cat C for pregnancy
19
Q
Drugs for Chancroid
A
Azithromycin, Ceftriazone, Ciprofloxacin, or Erythromycin
20
Q
Ceftriaxone MOA
A
bactericidal beta lactam: binds PBPs causing cell lysis
21
Q
Ciprofloxacin MOA
A
inhibits DNA gyrase (topo II) in gram negative: bactericidal; inhibits topo IV in gram-positive: bactericidal
22
Q
Ciprofloxacin and pregnancy
A
Contraindicated; distributes into breast milk and crosses placenta
23
Q
Treatment of gonococcal infections of cervix, urethra, rectum
A
Ceftriaxone or Cefixime, plus Azithromycin or Doxycycline
24
Q
Treatment of gonococcal infections of pharynx
A
Cetriaxone plus Azithromycin or Doxycycline
25
Cefixime MOA
bactericidal beta-lactam: binds PBPs causing cell lysis
26
Cefixime AE
diarrhea, GI upset; rarely may increase clotting time; false positive for urinary glucose in diabetic patients
27
Urethritis/Cervicitis treatment choices
Azithromycin or Doxycycline or Erythromycin or Levofloxacin or Ofloxacin
28
Recurrent Urethritis/Cervicitis treatment choices
Metronidazole or Tinidazole plus Azithromycin
29
Trichomoniasis treatment choices
Metronidazole or Tinidazole
30
Metronidazole, Tinidazole MOA
amebicidal, bactericidal, and trichomonacidal; unionized drug taken up by organisms which disrupts DNA's helical structure, thereby inhibiting bacterial nucleic acid synthesis
31
CYP interactions and elimination with Metronidazole and Tinidazole
M inhibits CYP2C9; T metabolized by 3A4; both cause urine discoloration
32
Metronidazole, Tinidazole AE
avoid in pregnancy and breastfeeding; GI upset, candidiasis, disulfiram-like effect (avoid alcohol), potentially 2ndary malignancies
33
Bacterial Vaginosis treatment options
Metronidazole, Clindamycin, or Tinidazole
34
Clindamycin MOA
binds 50S ribosomal subunit to inhibit protein synthesis; bacteriostatic
35
Clindamycin AE
use intravaginally during 1st trimester to avoid low birthweight, pre-term delivery, premature rupture of the membrane, and neonatal infections; excreted in breast milk; vaginal inflammation and itching
36
Candidiasis treatment options
OTC - butoconazole, clotrimazole, miconazole, tioconazole; Rx - Butoconazole, Terconazole, Fluconazole(only oral)
37
Azole MOA
block ergosterol synthesis through interaction with 14-alpha demethylase, a CYP necessary conversion of lanosterol to ergosterol
38
Azole AE
Flu inhibits 2C9 and is widely distributed; high doses can cause abdominal wall defects and cleft palate in a fetus; can weaken condoms and diaphragms
39
Genital wart drugs
Podofilox, Imiquimod, Sinecatechins
40
Podofilox MOA
plant derived mitotic spindle inhibitor blocking microtubular activity in keratinocytes
41
Imiquimod MOA
an immune response modifier
42
Sinecatechins MOA
green tea extract antioxidant; can cause pain and discomfort at application site
43
Fetal therapeutics
corticosteroids for lung maturaiton; digoxin or flecainide for fetal arrhythmias, NSAIDs for ductus arteriosus, anti HIV drugs to prevent infection from mother
44
Signs of withdrawal in newborns
autonomic hyperactivity, with irritability, excessive crying, poor feeding and abnormal reflexes featuring prominently
45
Issues with withdrawal signs in a newborn
it may mimic other conditions such as infection, hypoglycemia, hyperthyroidism, intracranial hemorrhage, hypoxic-ischemic encephalopathy, and hyperviscosity
46
Determinants of trans-placental drug passage
lipid solubility, degree of ionization, Mol. wt < 600 (can cross), duration and timing of exposure, maternal plasma concentration, placental development and blood flow, energy dependent drug transporter proteins
47
Placental drug metabolism
aromatic oxidation (hydroxylation, N-dealkylation, demethylation) may decrease fetal exposure and toxicity, can increase exposure to carcinogens; hepatic metabolism affects toxicity
48
Timing for major morphologic abnormalities
3-9 weeks
49
Pharmacokinetic properties of newborns
slower GI but fast IM absorption, more body water than lipid, limited protein binding, larger liver/body wt, immature enzymes, larger brain/body wt ration, higher BBB permeability, immature renal function
50
Types of drugs to avoid in breast feeding
CNS drugs that cause sedation or dependence in the infant, thyroid suppressants, bone marrow suppression (chloramphenicol)
51
Mechanism of paternal teratogenicity
mutation in the DNA or altered gene expression, direct contact with fetus via seminal fluid
52
Classes of drugs with known male teratogenicity
antivirals (contra), retinoids, adnrogen receptor antagonist, DMARD, AED, MABs, Anticancer drugs
53
Anticholinergics
Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine, Trospium Botulinum toxin
54
Sympathomimetics
Mirabegron, Pseudoephedrine, Ephedra, Ma Huang
55
Drugs for Urinary Retention
Bethanechol, Neostigmine
56
Drugs for opiate induced urinary retention
Methylnaltrexone and Naloxone
57
Most common drugs for urinary incontinence
tolterodine and oxybutynin
58
Treatment for incontinence due to urge (detrusor overactivity)
Anticholinergics - Oxybutynin and Tolterodine
59
Treatment for incontinence due to stress (outlet incompetence)
Topical estrogen, alpha agonists, non-drug method
60
Treatment for incontinence due to mixed etiologies
focus treatment on predominant symptoms
61
Treatment for incontinence due to atonic bladder
catheterization
62
Treatment for functional incontinence
therapy choice to eliminate cause
63
Effects of muscarinic blockage on salivary glands
dry mouth
64
Effects of muscarinic blockage on cardiac tissue
tachycardia, palpitations, prolonged QTc interval
65
Effects of muscarinic blockage on GI tract
slowing of transit time (constipation), effects on sphincter tone and gastric acid secretion
66
Effects of muscarinic blockage on CNS, brain (cortex and hippo-campus)
effects on memory, cognition and psychomotor speed, confusion, delirium, hallucinations, sleep disruption
67
Effects of muscarinic blockage on bladder (detrusor muscle)
decreased contraction, urinary retention
68
Type of muscarinic receptors in bladder
M2 (opposes beta receptor) and M3 (acts by direct effect)
69
Organ systems with same receptors as bladder
M2 - Cardiac, GI, CNS
| M3 - Salivary glands, Eye, GI, CNS
70
Effects of muscarinic blockage on eye
dry eyes, blurred vision
71
Peripheral adverse effects of anticholinergic drugs
dry mouth, mydriasis, constipation, urinary retention, tachycardia
72
Central adverse effects of anticholinergic drugs
sedation, confusion/delirium, hallucinations, slowed cognitive function, sleep disruption
73
Anticholinergic that does not cross BBB
Trospium due to quaternary amine structure
74
Selective receptor binding anticholinergic
Darifenacin
75
Anticholinergic without CYP metabolism
Trospium
76
CYPs used by most anticholinergics
3A4+/-2D6
77
Trospium absorption and excretion
Poor oral bioavailability - take on empty stomach; Renal tubular secretion; 80% urinary excretion as parent drug
78
Anticholinergics with best oral absorption
Solifenacin (90%), Tolterodine (75%), Fesoterodine ER (52%)
79
Anticholinergic with longest half life
Solifenacin (45-68 hours)
80
Anticholinergics contraindications
angle closure or narrow-angle glaucoma, urinary and gastric onstruction, need for mental alertness, Alzheimer's type dementia
81
Benefits of extended release anticholingergics
more convenient dosing; reduces risk of dry mouth without loss of efficacy
82
Botox effects of bladder
peripheral afferent desensitization, inhibition of expression of purinergic and proposed SP receptors, blocks excitarory effect on suburothelial afferent and detrusor parasympathetic nerve endings during urine storage
83
Mirabegron MOA
beta 3 agonist; increases bladder capacity by relaxing detrusor smooth muscle
84
Mirabegron PKPD
low oral absorption (decreased more by food), CYP3A4>>2D6 metabolism and butylcholinesterase, UGT, and alcohol dehydrogenase metabolism; 50hr half life
85
Pseudoephedrine MOA
direct and indirect alpha and beta agonist (alpha>beta effects)
86
Pseudoephedrine half life
9-16hrs depending on urinary pH (increased urinary excretion with acidic urine)
87
Ephedra, Ma-Huang MOA
indirect non-selective alpha and beta agonist
88
Ephedra, Ma-Huang half life
5hrs
89
Mirabegron AE
increased BP, tachycardia
90
Pseudoephedrine AE
HTN, tachyarrhythmia, A-fib, insomnia, anxiety, restlessness, MAOI interactions
91
Ephedra AE
HTN, tachyarrhythmia, A-fib, insomnia, anxiety, restlessness, MAOI interactions
92
Methionine MOA and uses
ancillary drug that creates ammonia free urine by acidifying urine pH; used to control odor, dermatitis, and ulceration in incontinent adults
93
Methionine dosing and AE
take with food or milk or other liquid; can cause drowsiness, n/v
94
Bovine Collagen uses
sterile, highly purified dermal collaged that is injected into urethra/bladder neck for incontinence due to intrinsic sphincter deficiency. Used for patients failing other therapies for >12mo
95
Bovine Collagen MOA
forms a soft cohesive network of fibers increasing tissue bulk around the urethral lumen
96
Bovine Collagen AE
urinary retention, hematuria, injection site reaction, worsening incontinence, erythema, urticaria, abscess formation
97
Bethanechol MOA
muscarinic agonist in urinary bladder and GI tract; ionized and does not cross BBB
98
Neostigmine MOA
inhibits acetylcholinesterase, augments action of Ach at both muscarinic and nicotinic receptors
99
Neostigmine metabolism and excretion
inactivated by cholinesterases and hepatic microsomal enxymes; primarily urinary excretion as parental drug
100
Bethanechol AE
lightheadedness, syncope, diarrhea, stomach cramps, dizziness, excessive tear production, miosis, urgent desire to urinate
101
Neostigmine AE
AV block, bradyarrhythmia, cardiac arrest, cardiac dysrhythmia, hypotension, syncope, tachycardia
102
Mechanism of opiate urinary incontinence
mediated by mu and delta receptors in sacral cord inhibiting parasympathetic outflow and thus detrusor activation
103
Chemotherapeutics for Ovarian Cancer
Carboplatin, Cisplatin, Cyclophosphamide, Doxorubicin, Paclitaxel
104
Chemotherapeutics for Bladder Cancer
Bacillus Calmette-Guerin (BCG), Cisplatin, Doxorubicin, Mitomycin C, Thiotepa
105
Treatment for stage 1 &2 ovarian cancer
Carboplatin or Cisplatin (intraperitoneal) with cyclophosphamide and/or doxorubucin
106
Treatment for stage 3&4 ovarian cancer
Carboplatin or cisplatin with paclitaxel
107
BCG MOA
binds to urothelial cells, activating APCs, which induces production of effector cells; increased response with successive cycles
108
Carboplatin/Cisplatin MOA
forms DNA intrastrand crosslinks and adducts
109
Cyclophosphamide MOA
pro-drug of active alkylating moiety
110
Doxorubucin MOA
intercalator, free radical generator, topo II inhibitor
111
Mitomycin C MOA
mono and bi functional alkylating agent
112
Paclitaxel MOA
microtubule stabilized inhibiting depolymerization
113
Thiotepa MOA
polyfunctional alkylator with loss of azindine (alylator) moiety
114
Doxorubicin AE
myelosuppression, CHF, Hepatic disease, secondary malignancies, extravasational necrosis, n/v
115
Cyclophosphamide AE
blood dyscrasias, hemorrhagic cystitis, amenorrhea/infertility, secondary malignanies, pulmonary fibrosis
116
Mitomycin C AE
pancytopenia, chemical cystitis, contact dermatitis, palmar/plantar erythemas
117
Paclitaxel AE
taxane hypersensitivity, myelosuppression, myalgia, arthralgia
118
Thiotepa AE
pancytopenia, dysuria, urinary retention, chemical/hemorrhagic cystitis, renal dysfunction
