PHARM- URI & sinusitis

Question 1

when is intranasal steroids not recommended?

Answer 1

in common colds! (viral rhinosinusitis)

Question 2

3 classes used in tx of common cold

Answer 2

decongestants
expectorants
antitussives

Question 3

3 decongestants learned (POP)

Answer 3

pseudoephedrine (sudafed)
oxymetazoline (afrin)
phenylephrine

Question 4

which 2 meds are intranasal?

Answer 4

oxymetazoline
phenylephrine (also PO, IV)

Question 5

4 shared ADR of the 3 decongestants

Answer 5

tachycardia
decreased appetite
elevated BP & HR
insomnia

Question 6

which of the three decongestants have rhinitis medicamentosa as a possible ADF?

Answer 6

oxymetazoline

Question 7

4 shared Contra of pseudoephedrine & oxymetazoline

Answer 7

cardiac dz
HTN
glaucoma
MAOI use

Question 8

which decongestant causes NE release which decreases swelling & discharge

Answer 8

pseudoephedrine

Question 9

which decongestant decreases mucosal edema by direct activity & has 10 min onset

Answer 9

oxymetazoline

Question 10

name the single expectorant we learned

Answer 10

Guaifenesin (Mucinex)

Question 11

MOA of Guaifenesin

Answer 11

increases effective hydration of respiratory tract & reduces mucus viscosity to facilitate removal

Question 12

5 ADR of guaifenesin

Answer 12

N/V
dizziness & drowsiness
HA
rash
nephrolithiasis

Question 13

3 scenarios to be cautious of prescribing guaifenesin

Answer 13

hypersensitivity
nephrolithiasis
<6 yo

Question 14

name the antitussives (DCH)

Answer 14

dextromethorphan
codeine
hydrocodone combo

Question 15

dextromethorphan MOA (3)

Answer 15

central depression of cough center (medulla oblongata)
uncompetitive NMDA receptor antagonist
sigma-1 receptor agonist

Question 16

ADR of antitussives

Answer 16

all: n/v/d, dizziness, drowsiness/sedation
dext: nervousness & restless
codeine & hydro combo: constipation, itching, resp. suppression

Question 17

which antitussive is commonly combined w/ promethazine (antihistamine) in cough syrups?

Answer 17

codeine

Question 18

which 2 antitussives is commonly prescribed but not effective at reducing cough in acute URI

Answer 18

codeine & hydrocodone combo

Question 19

2 contra for dextromethorphan

Answer 19

<4yo
MAOI

Question 20

3 contra for codeine & hydrocodone combo

Answer 20

<12yo
asthma
respiratory d/o

Question 21

diphenhydramine may relieve rhinorrhea & sneezing so why is it also impractical?

Answer 21

because of the sedating side effects

Question 22

coverage of amoxicillin vs augmentin

Answer 22

augmentin covers same as amoxicillin + most anaerobes, M. catarrhalis, Klebsiella

Question 23

how do the PCNs work?

Answer 23

arrest cell wall synthesis via PBP
augmentin helps expand its coverage for beta-lactamase resistance

Question 24

3 ADR of PCNS

Answer 24

hypersensitivity rxns
n/v/d
non-allergic rash w/ EBV

Question 25

formulations of the macrolides

Answer 25

PO & IV

Question 26

how do macrolides work?

Answer 26

stop protein synthesis via 50s

Question 27

4 bacteria covered by macrolides but not by PCN

Answer 27

M. catarrhalis chlamydia spp legionella mycoplasma

Question 28

2 ADR of macrolides

Answer 28

anorexia vomiting & diarrhea

Question 29

which medication(s) should you not prescribe is someone is taking cisapride or pimozide?

Answer 29

macrolides-- azithromycin, eythromycin

Question 30

formulation of levofloxacin & how it works

Answer 30

PO & IV inhibits DNA gyrase

Question 31

3 coverage of levofloxacin

Answer 31

pseudomonas, S. pneumonia atypical resp. (legionella, mycoplasma) most gram negative doesn't cover anaerobes reliably

Question 32

which abx has arthropathy & tendiopathy, CNS toxicity, photosensitivity and QT prolongation as ADRs?

Answer 32

levofloxacin

Question 33

3 contra of levofloxacin

Answer 33

pregnancy <18 or elderly using class IA or III antiarrhythmics

Question 34

TMP & sulfa MOA

Answer 34

tmp: blocks enzymes used in folic acid pathway sulfa: blocking PABA from making dihydrofolic acid

Question 35

which medication should you be watchful of if a patient is already taking warfarin

Answer 35

TMP-Sulfa

Question 36

TMP-sulfa coverage

Answer 36

S. pneumoniae, H. influenzae, M. catarrhalis, Pneumocystis jiroveci, Pasteurella multocida, Stenotrophomonas maltophilia; Most E. coli, Klebsiella, Proteus, MRSA

Question 37

which abx has SJS/toxic epidermal necrolysis, hemolytic anemia & reversible myelosuppression as ADR?

Answer 37

TMP-sulfa

Question 38

which med has Contra of drug-induced thrombocytopenia hx, folate deficiency anemia, <2 months old or marked hepatic/renal dz?

Answer 38

TMP-Sulfa

Question 39

how does doxycycline work?

Answer 39

inhibits 30s bacterial ribosome

Question 40

ADR of nausea, photosensitivity, intracranial HTN

Answer 40

doxycycline

Question 41

contraindicated in pregnancy and kids under 8 yrs old

Answer 41

doxycycline

Question 42

clindamycin MOA

Answer 42

inhibits 50s bacterial ribosome

Question 43

its only ADR is diarrhea/c.diff

Answer 43

clindamycin

Question 44

contraindicated for meningitis or c. diff hx

Answer 44

clindamycin