PHARM- URI & sinusitis Flashcards
when is intranasal steroids not recommended?
in common colds! (viral rhinosinusitis)
3 classes used in tx of common cold
decongestants
expectorants
antitussives
3 decongestants learned (POP)
pseudoephedrine (sudafed)
oxymetazoline (afrin)
phenylephrine
which 2 meds are intranasal?
oxymetazoline
phenylephrine (also PO, IV)
4 shared ADR of the 3 decongestants
tachycardia
decreased appetite
elevated BP & HR
insomnia
which of the three decongestants have rhinitis medicamentosa as a possible ADF?
oxymetazoline
4 shared Contra of pseudoephedrine & oxymetazoline
cardiac dz
HTN
glaucoma
MAOI use
which decongestant causes NE release which decreases swelling & discharge
pseudoephedrine
which decongestant decreases mucosal edema by direct activity & has 10 min onset
oxymetazoline
name the single expectorant we learned
Guaifenesin (Mucinex)
MOA of Guaifenesin
increases effective hydration of respiratory tract & reduces mucus viscosity to facilitate removal
5 ADR of guaifenesin
N/V
dizziness & drowsiness
HA
rash
nephrolithiasis
3 scenarios to be cautious of prescribing guaifenesin
hypersensitivity
nephrolithiasis
<6 yo
name the antitussives (DCH)
dextromethorphan
codeine
hydrocodone combo
dextromethorphan MOA (3)
central depression of cough center (medulla oblongata)
uncompetitive NMDA receptor antagonist
sigma-1 receptor agonist
ADR of antitussives
all: n/v/d, dizziness, drowsiness/sedation
dext: nervousness & restless
codeine & hydro combo: constipation, itching, resp. suppression
which antitussive is commonly combined w/ promethazine (antihistamine) in cough syrups?
codeine
which 2 antitussives is commonly prescribed but not effective at reducing cough in acute URI
codeine & hydrocodone combo
2 contra for dextromethorphan
<4yo
MAOI
3 contra for codeine & hydrocodone combo
<12yo
asthma
respiratory d/o
diphenhydramine may relieve rhinorrhea & sneezing so why is it also impractical?
because of the sedating side effects
coverage of amoxicillin vs augmentin
augmentin covers same as amoxicillin + most anaerobes, M. catarrhalis, Klebsiella
how do the PCNs work?
arrest cell wall synthesis via PBP
augmentin helps expand its coverage for beta-lactamase resistance
3 ADR of PCNS
hypersensitivity rxns
n/v/d
non-allergic rash w/ EBV
formulations of the macrolides
PO & IV
how do macrolides work?
stop protein synthesis via 50s
4 bacteria covered by macrolides but not by PCN
M. catarrhalis
chlamydia spp
legionella
mycoplasma
2 ADR of macrolides
anorexia
vomiting & diarrhea
which medication(s) should you not prescribe is someone is taking cisapride or pimozide?
macrolides– azithromycin, eythromycin
formulation of levofloxacin & how it works
PO & IV
inhibits DNA gyrase
3 coverage of levofloxacin
pseudomonas, S. pneumonia
atypical resp. (legionella, mycoplasma)
most gram negative
doesn’t cover anaerobes reliably
which abx has arthropathy & tendiopathy, CNS toxicity, photosensitivity and QT prolongation as ADRs?
levofloxacin
3 contra of levofloxacin
pregnancy
<18 or elderly
using class IA or III antiarrhythmics
TMP & sulfa MOA
tmp: blocks enzymes used in folic acid pathway
sulfa: blocking PABA from making dihydrofolic acid
which medication should you be watchful of if a patient is already taking warfarin
TMP-Sulfa
TMP-sulfa coverage
S. pneumoniae, H. influenzae, M. catarrhalis, Pneumocystis jiroveci, Pasteurella multocida, Stenotrophomonas maltophilia; Most E. coli, Klebsiella, Proteus, MRSA
which abx has SJS/toxic epidermal necrolysis, hemolytic anemia & reversible myelosuppression as ADR?
TMP-sulfa
which med has Contra of drug-induced thrombocytopenia hx, folate deficiency anemia, <2 months old or marked hepatic/renal dz?
TMP-Sulfa
how does doxycycline work?
inhibits 30s bacterial ribosome
ADR of nausea, photosensitivity, intracranial HTN
doxycycline
contraindicated in pregnancy and kids under 8 yrs old
doxycycline
clindamycin MOA
inhibits 50s bacterial ribosome
its only ADR is diarrhea/c.diff
clindamycin
contraindicated for meningitis or c. diff hx
clindamycin
