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Pharm 1 > Pharm test 3 (Vaccines, GI, UTI, Ophthalmic) > Flashcards

Pharm test 3 (Vaccines, GI, UTI, Ophthalmic) Flashcards

1
Q

Adjuvant

A

Added to a vaccine to improve immune response. Tetanus is added to alum.

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2
Q

Conjugate Vaccine

A

Linking weak antigens to stronger ones. MC a bacterial polysacharride (H.flu).

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3
Q

Examples of live, attenuated vaccines

A

Adenovirus

Measles

Mumps

Rubella

Smallpox

Varicella-Zoster

Yellow fever

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4
Q

Examples of killed vaccines

A

Polio

Rabies

Hepatitis A

Influenza (killed or attenuated)

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5
Q

What kind of vaccine is LAIV/FluMist?

Who is it approved for?

A

It is a live attenuated influenza vaccine.

Delivered as a nasal spray.

Approved for healthy people 2-49 years old.

Not for PG or sick people.

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6
Q

What are the two forms of the HPV vaccine?

A

Gardasil is quadravalent (16, 18, 6, and 11)

Cervarix is bivalent (16 and 18)

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7
Q

Hib Vaccine

A

Effective against all Hib type B but not against non-tybe B Haemophilus influenza.

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8
Q

Meningococal vacine

A

Recommended for people living in close proximity to one another, dorms or barracks.

It is one example of a conjugate vaccine.

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9
Q

Pneumococcal Vaccine

(MC pneumovax)

A

Fights Strep. Pneumoniae.

**Use for people who are: asplenic, diabetic, have chronic renal disease. **

23-valent vaccine

Ineffective for children under 2.

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10
Q

What are five drug categories used to treat IBD?

A

Aminosalicylates

Antibiotics

Corticosteroids

Immunomodulatory agents

Probiotics

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11
Q

5-ASA / Mesalamine

A

Class: Aminosalicylates

Indications: IBD

MOA: Inhibition of leukotriene production, anti-PG, anti-oxidant.

Char: PO, IM, IV, PR.

SE: N/V, diarrhea, Abd pain.

**Contains aspirin. **

Pro-drug forms are also available.

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12
Q

Which type of IBD benefits more from ABX

A

Crohn’s patients do bedder with ABX than UC patients.

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13
Q

Which two ABX are common for IBD?

A

Metronidazole (don’t drink alcohol)

Ciprofloxin (tendun rupture)

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14
Q

Rifaximin / Ixifaxin

A

Based on the structure of Rifampin

Mostly used for Traveler’s diarrhea or hepatic encephalopathy.

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15
Q

Prednisone / Deltasone

A

Class: Glucorticoid/corticosteroid

Indications: Preferred for reactive airway Dz or moderate/severe allergic RXN.

MOA: Affects gene transcription to either stimulate or repress protein production.

Char; PO, IM, IV, PR.

SE: INFX, HTN, hyperglycemia, bone loss, etc.

Only effective in 35-50% of IBD patients.

Take the drug all at once in the morning.

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16
Q

Budenoside / Entocort

A

Synthetic glucocorticoid for mild-moderate Crohn’s.

Delayed release until it reaches the ileum and ascending colon.

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17
Q

Azthioprine / Immuran

A

Class: Immunomodulator

Indication: IBD, RA, other AI conditions, transplant rejection, CA chemo

MOA: Inhibits purine synthesis, apoptosis of T-cells.

Char: PO, IM, IV. This is a pro-drug that is converted to mercaptopurine.

SE: Nausea, fative, hair loss, and rash. More susceptible to INFX.

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18
Q

You can’t donate blood when taking this drug

A

Azthioprine / Immuran

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19
Q

Infliximib / Remicade

A

Class: Immunomodulator - TNF inhibitor

Ind: IBD, RA, psoriasis, AI

MOA: Inhibits the pro-inflammatory cytokine, TNF-Alpha

Char: human-murine monoclonel antibody, IM or SQ

SE: Marked susceptibility to infection and sepsis.

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20
Q

What should you never do in a patient with a suspected bowel obstruction?

A

**Never give an oral laxative, only give it PR. **

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21
Q

What is the difference between soluble and insoluble fiber?

A

Insoluble fiber posseses passive water attracting properties that increase bulk and decrease transit time.

Soluble fiber is metabolized via fermentation and yeilds products that improve bowel health.

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22
Q

Psyllium / Metamucil

A

Class: Fiber Laxative

Ind: Constipation, irritable bowel, reduces colon CA risk, lowers cholesterol.

MOA: Made from groudn psyllium husks that contain both soluble an insoluble fiber.

Char: PO (powder, capsule, wafer)

SE: May cause diarrhea, avoid in suspected obstruction

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23
Q

Docusate / Colace

A

Category: Stool softner

Ind: Constipation, hemorrhoids, reduce straining

MOA: Anionic surfactant

Char: Capsule, liquid, suppository.

SE: Flatulence, bloating, cramping, diarrhea.

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24
Q

Magnesium Hydroxide / Mild of magnesia

A

Class: Osmotic laxative, antacid

Ind: Constipation, indigestion

MOA: Mg salts are poorly absorbed and act as osmotic agents to draw water into the GI tract.

Char: PO, chewable tablets, capsules, liquids.

SE: Diarrhea, cramping, electrolyte imbalance

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25
Q

Bisacodyl / Dulcolax

A

Class: Stimulant laxative

Ind: Constipation

MOA: Increases intestinal motility

Char: PO, 2-6 hours to effect.

SE: Diarrhea, cramping, sweating, laxative dependence.

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26
Q

Loperamide / Imodium

A

Class: Antidiarrheal **analog of meperidine**

Ind: Acute or chronic diarrhea

MOA: Diminished peristalsis due to activation of opiate receptors in GI tract. Opiate receptor agonist. Acts only on the meyenteric plexi of the intestine and does not stimulate opiate receptors in the brain.

Char: PO

SE: Dizziness, H/A.

CI in bacterial infections with fever or in severe colitis because there is a risk of toxic mega-colon.

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27
Q

Which drug is an analog of meperidine?

A

Loperamide / Imodium

28
Q

Diphenoxylate with atropine / Lomotil

A

Class: Antidiarrheal

Ind: Acute diarrhea

MOA: Combo of morphine analog and acetylcholine inhibitor results in diminished peristalsis.

Char: PO, generally not used beyond 48 hours

SE: Dry mouth is common, urinary retention, abd pain.

Generally, avoid when diarrhea is with fever.

CI with bacterial or parasitic infetions.

CI in severe colitis (toxic megacolon).

29
Q

What class of drug would you use to treat mild nausea?

What about moderate to severe?

A

Mild = Antihistamines

Moderate-severe = 5-HT3 receptor site blockers

30
Q

Meclizine / Antivert

A

Class: Antiemetic

Ind: Mild to moderate nausea

MOA: H1 histamine blocker

Char: PO, Sedating antihistamine

SE: Drowsiness, dizziness, dry mouth, urinary retention

31
Q

Metoclopramide / Reglan

A

Class: Antiemetic/pro-kinetic

Ind: Mild/moderate nausea, gastric stasis, GERD

MOA: DA 2 blocker and mixed 5HT3 antagonist 5HT4 agonist

Char: Increases peristalsis

SE: Drowsiness, dizziness, H/A

Use with caution in Parkonsin’s Dz

32
Q

Ondansetron / Zofran

A

Class: Antiemetic

Ind: Severe nausea

MOA: Blockade of 5HT3 receptor sites

Char: PO, IV, good for chemo

SE: Dizziness, H/A

33
Q

Emetic / Ipecac

A

Class: Emetic

Ind: Induction of vomiting for drug OD or poisoning

MOA: Stimulation of medullary chemoreceptor trigger zones and local GI irritation

Char: PO works in 10-30 minutes. Give with H2O

SE: Abdominal muscle spasm, dizziness, dehydration

CI if pt is not fully conscious or for caustic poisoning

Not given with charcol (absorbs the drug)

34
Q

Calcium carbonate / Tums

A

Class: Antacid

Ind: GERD

MOA: Neutralize stomach acid

Char: PO,

SE: Constipation, altered absorption

35
Q

Ranitidine / Zantac

A

Class: H2 histamine receptor antagonist

Ind: Gastritis, PUD, GERD

MOA: Blocks action of histamine on parietal cellsin the stomach, decreasing acid production

Char: PO, IV

SE: Well tolerated, H/A, confusion, dizziness, rash.

36
Q

Omeprazole / Prilosec

A

Class: Proton Pump Inhibitor

Ind: Gastritis, PUD, GERD

MOA: In hibits H/K ATPase pump of parietal cells, reducing acid secretion

Char: PO, generally used 2-8 weeks for GERD and 1-2 weeks for PUD.

SE: H/A, dizziness, diarrhea.

37
Q

Esomeprazole / Nexium

A

A single enantiomer of omeprazole / prilosec

38
Q

Triple therapy for PUD

A

PPI Based = PPI and 2 ABX for 1-2 weeks

Bismuth based = Bismuth subsalicylate and 2 ABX for 1-2 weeks

39
Q

How does bismuth affect H. pylori?

A

Damages the H. pylori cell wall and reduces bacterial adherence to mucosal cells.

40
Q

What are the ABX options for PUD triple therapy?

A

Amoxicillin

Erythromycin

Clarithromycin

Tetracycline

Metronidazole

41
Q

What is a sample prescription for PUD triple therapy?

A

Omeprazole / Prilosec 20mg BID

Amoxicillin / Amoxil 1gm BID

Clarithromycin / Biazin 500mg QD

Taken for 7-14 days with H. Pylori lab tests as a follow up

42
Q

Oxybutynin / Ditropan

A

Class: Anticholinergic medication

Ind: Urge incontinence or hyperhidrosis

MOA: Competitive antagonism of M3 subtype muscarinic acetylcholine receptors

Char: PO, 2-4x a day.

**SE: Dry mouth, dry eyes, constipation, blurred vision, drowsiness, dizziness, and diminished sweating. **

**Risk of heat stroke when exercising on this med. **

43
Q

What is the main approach mechanism for treating urge incontinance?

A

Medications block acetylcholine action on the bladder and diminish the detrusor muscle contraction.

44
Q

Tolterodine / Detrol

A

Class: Anticholinergic medication

Ind: Urge incontinence

MOA: Competitive antagonism of M2 and M3 miscarinic receptors.

SE: Few side effects, seems to target the bladder more than other tissues.

Potential interaction with drugs metabolized by P450 enzymes.

45
Q

Imipramine / Tofranil

A

Class: Trycyclic antidepressant, can also treat urge incontinance and enuresis.

MOA: Serotonin and norepinephrine reuptake inhibitor. Appears to diminish acetylcholine uptake in smooth muscle.

Char: Given at bed time for enuresis.

SE: Dry mouth, blurred vision, constipation, insomnia, flushing, tremulousness, and weight gain.

*Increased risk for suicidal ideation and suicide

*Overdose can be fatal due to heart block

46
Q

What should you always check in kids with enuresis?

A

Draw blood sugar, enuresis may be a sign of diabetes.

47
Q

What are the two main medications for management of BPH?

A

Alpha blockers (relax smooth muscle in the prostate and the bladder neck)

5-alpha-reductase inhibitors (decrease production of DHT, the hormone responsible for prostatic enlargement)

48
Q

Tamusolin / Flomax

A

Class: Alpha 1 receptor antagonist

Ind: BPH

MOA: Smooth muscle relaxation via alpha adrenergic antagonism

Char: Preferential selectivity for the alpha 1A receptors found in the prostate versus the alpha 1B receptors found in blood vessels.

SE: Possible retrograd ejaculation.

49
Q

What works faster, alpha blockers or 5-alpha reductase inhibitors?

A

Alpha blockers work faster but have a shorter duration.

50
Q

Finasteride / Proscar

A

Class: 5-ARI

Ind: BPH

MOA: Blocks conversion of testosterone to dihydrotestosterone

**Char: Propecia is a lower dose of the same drug, used to treat male pattern baldness. **

SE: Impotency, Category X in PG.

51
Q

Phenazopyridine / Pyridium

A

Class: Made from a dye, not an ABX

Ind: Relieve pain, burning, and urge to urinate due to cystitis. Does not treat the cause.

MOA: Unknown, acts as a bladder analgesic.

Char: PO 100-200mg, 2-3x/day PRN. Takne for only 2 days.

SE: Turns urine orange or red, this indicats a therapeutic dose has been reached. H/A, nausea, yellowish discoloration in skin/eyes.

Do not wear contact lenses, the drug can permanently discolor the contacts. (DT decreased kidney excretion and is reversable).

52
Q

How do estrogen meds affect bladder infections?

A

Oral estrogen use can increase bladder infections, topical estrogen use doesn’t carry the same risk.

53
Q

What do mydriatics do?

A

They dilate the pupil

54
Q

What do Cycloplegics do?

A

The cause paralysis of accommodation

Ex. Homatropine

55
Q

What do miotics do?

A

They cause pupillary constriction

Ex. Pilocarpine

56
Q

What test should you always do on patients presenting with pink eye? What should the results be?

A

Always do a visual acuity exam, vision should be normal and painless.

57
Q

Tetrahydrozoline / Visine

A

Class: Ocular astringent, redness reliever

Ind: “Gets the red out”, allergies

MOA: Vasoconstriction

Char: Solution contains tetrahydrozoline (vasoconstriction) and Zinc sulfate (astringent)

SE: Local irritation, rebound vasodilation

ALSO AN ALPHA -AGONIST –> VASOCONSTRICTION

58
Q

Azelastine / Optivar

A

Class: Ocular Antihistamine

Ind: Allergic conjunctivitis

Char: Solution

SE: Local irritation, very limited systemic absorbtion

59
Q

Ketorolac / Acular

A

Class: Ocular NSAID

Ind: Ocular discomfort from swelling

MOA: Cyclooxygenase inhibitor

Char: Solution

SE: Local irritation, limited systemic absorption, no increased risk of cataracts or glaucoma.

60
Q

Bacitracin-Polymyxin B / Polysporin Ophthalmic

A

Class: ABX

Ind: Bacterial conjunctivitis, blepharitis, corneal ulcers, styes, infected tear ducts. Prophylactic after corneal abrasion.

MOA: Inhibits bacterial protein synthesis, bactericidal

Char: solutions, ointments, applied in different time schedules.

Se: Local irritation, low systemic absorption.

61
Q

Vidarabine / Ara-A

A

Class: Antiviral, specific for HSV

Ind: Herpes simplex keratoconjunctivitis

MOA: Inhibits viral DNA synthesis

Char: Ointment, solution for ophthalmic use, IV

Ineffective for optical herpes zoster.

SE: Local irritation, low systemic absorption.

62
Q

What are the four key signs for acute angle-closure glaucoma?

A

Red eye

Discomfort

Descreased peripheral vision

Pupil that doesn’t move much

63
Q

Timolol / Timoptic

A

Class: Ocular Beta-adrenergic antagonist

Ind: glaucoma

MOA: Blocks the ocular effects of epinephrine which serves to reduce the production of the aqueous humor.

Char: Solution and gels

SE: Systemic absorption –> Worsening of asthma or pmphysema, low BP, fatigue, impotence.

64
Q

Latanoprost / Xalatan

A

Selective prostaglandin receptor agonist that increases uveoscleral outflow. Improves outflow of aqueous humor and reduces IOP.

Few SE, local irritaiton, may cause lengthening and thickening of the eyelashes.

65
Q

What are the two main treatment options for glaucoma?

A

Use either a prostaglandin analog or a beta-blocker

Pharm 1 (2 decks)

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