pharm test one Flashcards by Chelsea Kaye-Bidinger

principals of antibiotic prescribing

confirm presence of infection
identify pathogen (when possible)
consider host factors - allergies and cost
select the narrowest spectrum* w/shortest effective duration
consider pharmacokinetics and dynamics
monitoring of therapeutic response

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Pharmacokinetics

What the body does to the drug

- considers absorption, distribution, metabolism and elimination of drugs (also bio-avalibility, half-life, toxicity

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Pharmacodynamics

the effects of drugs on the body

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5 categories of anti-microbial drugs

cell wall inhibition
protein synthesis inhibition
nucleic acid synthesis inhibition
folic acid synthesis inhibition
Disruption of cell membrane function

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cell wall inhibitors

Beta-lactams

penicillins and cephalosporins

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1st pass effect

is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation. Not an issue with IV medications

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Agonist

stimulates or increases effect

Combines with a receptor and stimulates target organ. Must fit as lock and key (very specific)

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Antagonist

inhibits/blocks - can block off-switch or block re-uptake
A drug that combines with a receptor interferes with a naturally occurring agonist to inhibit a response. (cannot produce a biological effect)

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half-life

The time it takes to eliminate one half of the drug from the body
not dose dependent

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always consider…

the therapeutic objective

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6th vital sign

LMP

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worst drug ever?

warfarin

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an enzyme that participates in metabolism of more than 50 medications

CYP (2D6)
genetic variations should be considered when prescribing - large number of east Asians have a variant of cyp2d6 which slows metabolism

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considerations for prescribing in pregnancy

titrate anti-hypertensives, Ho-thyroid meds*** can cause birth defects, always consult OB, monitor creatinine

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first line NSAID in pediatrics

advil

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first line NSAID in elderly

naproxen

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aspirin affects platelet aggregation for how long?

8 to 11 days - lifetime of a platelet

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who should not take aspirin?

peds and gout patients

what are we concerned with suppressing when giving corticosteroids?

Hypothalamic-Pituitary-Adrenal (HPA) Axis Feedback

just two weeks Rx can affect feedback for up to one year to equalize

side effects of prolonged corticosteroid use?

humpy moon face - decrease in Ca absorption in GI - removes it from bones! muscle wasting, redistributes fat from extremities to trunk, immune response affected, mood swings, Osteoporosis of Bone, Skin Thinning and Wasting, Connective Tissue Breakdown, Changes in plasma cells, Increased Neutrophils, Thrombocytes & RBC’s, Decreased Lymphocytes, Eosinophils & Basophils, Edema, increased BP

Inhibition of protein synthesis drugs

Macrolides: erythromycin, azithromycin, clarithromycin
Tetracyclines: tetracycline, doxycycline, minocycline
Aminoglycosides: gentamicin, tobramycin, amikacin

Inhibition of Nucleic Acids drugs

-flox, flu, flagyl
Fluoroquinolones: -flox
Ciprofloxacin, Levofloxacin, moxifloxacin
Anti viral agents: Oseltamivir (Tamiflu), Amantidine
Anti anaerobes, antiprotozoal: Metronidazole (Flagyl)

Inhibition of folic acid synthesis drugs

Sulfonamides: Trimethoprim/sulfamethoxazole (Bactrim

Disruption of cell membrane drugs

Antifungals: Oral & topical: Clotrimazole, fluconazole, ketoconazole (hepatotoxic), nystatin, griseofulvin

guidelines for steroid rx?

Use lowest effective dose, Taper off, and use non-systemic when possible - always be careful with possible hypothalamic-pituitary-adrenal suppression

How do glucocorticoids alter inflammation?

Decrease production of prostaglandins, thromboxanes and leukotrienes, blocked cytokines

How do NSAIDS and steroids affect inflammation?

Inhibition of Cox 1 and 2 and the release of inflammatory prostaglandins and sensitization to pain. (Inflammation = vasodilation, increased vascular permeability)

What are the additional effects of NSAIDS on the body?

Decreased protective effects of normal physiologic prostaglandins - cardiovascular risk, Gastric ulcers, GI bleeding, Platelet dysfunction (inhibited TxA2) and prolonged bleeding time, Anemia, Impaired renal function, esp. elderly and with renal impaired, Edema and Na+ retention -> HTN, uterine contractions and spontaneous abortion NSAIDS may antagonize most anti-hypertensives except for calcium channel blockers, Tylenol = 1st reason for spontaneous hepatic failure

how do anti-histamines work?

H1 receptor antagonists reducing histamine effects decreased mucus, decreased vascular permeability = less edema

Aspirin ADR (adverse drug reaction)

reye's in peds

fluoroquinolone (cipro) ADR

tendon rupture (no for pregnancy too)

tetracycline contraindications

teeth staining Not recommended for pregnant women, infants and children 8 years or younger.

pt edu for flagyl

no drinking! | metallic taste

Contraindications of bactrim

Contraindicated in newborns and during last two months of pregnancy because it is a folic acid inhibitor

atypicals and ticks (lyme prevention*) what will you use?

tetracycline! | Doxycycline

Streptococcus pyogens treatment?

pen V | in lungs

Haemophilus influenzae H flu/HIB treatment?

Augmentin (amoxicillin/clavulanate) | sinuses, URI, ears

Mycoplasma treatment?

macrolide (z-pack) | lungs - walking PNA

Escherichia coli treatment?

Bactrim - trimethoprim and sulfamethoxazole UTI Nitrofurantoin - only good for uncomplicated e coli UTIs

Tinea capitis treatment?

Griseofulvin - - head - fungal long duration d/t skin and hair - eat w/ high fat food

Staphylococcus aureus treatment?

Augmentin or 1st generation cephalosporin (cefazolin) staph = skin strep and staph = penicilin

Adenovirus treatment?

- common cold, sore throat, bronchitis - no ABX!

Streptococcus pneumoniae treatment?

Augmentin (respiratory tract)

Chlamydia trachomatis treatment?

macrolide (azithromycin) and ceftriaxone | - always treat for gonorrhea too