Pharmacology Flashcards
Pharmacology is the
study of the interactions between the body and drugs
Pharmacokinetics is the
movement of drugs through the body (absorption, bioavailability, distribution, metabolism and excretion)
Pharmacodynamics is the
study of the physiologic and biochemical effects of drugs
Pharmacogenomics is the
study of how a person’s genes affect responses to medications
What drug classes are affected by kidney disease?/
- NSAIDs: Reduction in blood flow will damage kidneys
- ACEIs: Higher risk of hyperkalemia
- Warfarin: Higher incidence of overcoagulation
- Lithium: Increases risk of kidney injury
- Contrast dyes: can injure kidneys
- K+ sparring diuretics: Increased risk of hyperkalemia
- Bowel prep (oral sodium phosphate) may result in sudden loss of kidney function
What drug classes are potent inhibitors of the CYP450 system
- Macrolides (erythromycin, clarithromycin)
- Antifungals (ketoconazole, fluconazole, phenytoin)
- Cimetidine (Tagamet)
- Citalopram (Celexa)
- Protease inhibitors (saquinavir, indinavir, nelfinavir)
- Grapefruit juice
What drugs are affected by grapefruit juice
- statins
- erythromycin
- CCB
- Antivirals
- Amiodarone
- Benzodiaepines
- Cisapride
- Carbamazepine
- buspirone
What drugs have a narrow therapeutic index and require monitoring of levels
- warfarin: monitor INR
- digoxin: monitor dig levels, EKG, lytes
- Theophylline: Monitor blood levels
- Carbamazepine (tegretol) and phenytoin (dilantin): Monitor blood levels
- Levothyroxine: Monitor TSH
- Lithium: Monitor blood levels and TSH
What is a safety consideration with H2 antagonists
-mental status changes with kidney disease avoid if creatinine clearance is <50mL/min
What is a safety issue with proton pump inhibitors
increased risk of
- fractures
- pneumonia
- c diff
- hypomagnesium
- B12
- iron malabsorption
- atrophic gastritis
- kidney disease
What herbs does warfarin interact with
G herbs
- garlic
- ginger
- gingko
- ginseng
also feverfew, green tea, fish oil
What is the black box warning for Pioglitazone (Actos)
Can exacerbate CHF so do not use if NYHA Class III or IV
Aside from HF what other contraindications do you need to consider with Pioglitazone
- hx of MI
- hx of stroke
- hx of bladder CA
- T1DM
- Eye or liver problems
What are examples of atypical antipsychotics
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
What are AE and drug safety considerations for atypical antipsychotics
- weight gain
- metabolic syndrome
- T2DM
- monitor weight q3 months
- higher mortality on elderly patients
What labs should you consider in patients taking atypical antipsychotics
- TSH
- lipids
- blood glucose
- A1C
- Weight
- BMI
What is a consideration with bisphosphonates
- erosive esophagitis (chest pain with eating, odonophagia, dysphagia; take with 8oz glass of water before breakfast and do not lie down for 30 minutes afterwards
- CI: Active GI disease, esophageal strictures/varices
What are safety concerns of stains
-don’t mix with grapefruit juice will result in drug induced hepatitis, or rhabdomyolysis
What statin has the highest risk for rhabdo
-high dose zocor
What medication increases risk for c diff diarrhea
clindamycin
What is an AE with inhaled corticosteroids
-adrenal insufficiency (check if sx like hypoglycemia, hypotension, altered mental status, weakness)
What is an AE of systemic glucocorticoids
- cataracts
- osteoporosis
- skin changes
- emotional lability
- weight gain
- high BP
What medications should be avoid in older adults according to the beers criteria
Anti-psychotics Rivaroxaban and dabigatra Tramadol Antihistamines Anticholinergics
What are life threatening effects of digoxin
- severe bradycardia
- heart block
- ventricular tachycardia
- ventricular fibrillation
What is a normal potassium level
3.5-5
In valvular disease or prosthetic heart valves the only anticoagulant you can use is
aWarfarin
In warfarin use the INR will increase __ to ___ days after first dose but full anticoagulation effect takes __ to ___ days
2-3
5-7
If a patient has a stable INR and has a single out of range INR 0.5 or less below or above therapeutic, advise
to continue current dose and recheck in 1-2 weeks
If INR is <5 with no signifcant bleeding you should
-omit 1 dose and or reduce the maintenance dose slightly
Beta blockers are contraindicated in
chronic lung disease (COPD, asthma)
-Do not discontinue because of severe rebound
_____ is the SSRI most likely to prolong QT interval
Celexa
What are adverse effects of thiazide diuretics
- Hyperglycemia
- Hyperuricemia
- Hyperlipidemia
- Hypokalemia
AE of spironolactone include
- gynecomastia
- hyperkalemia
People with both hypertension and osteoporosis receive extra benefit from this class of medication
Thiazides
Patients with sulfa allergies should avoid what diuretics
thiazide and loop
Adverse effects of ACEi and ARBS
- Hypotension
- Hyperkalemia
- Angioedema
- AKI
in ACEi only ACEi cough
What are adverse effects of CCBs
- hypotension
- bradycardia
- heartblock
- headache
- Reflex tachycardia
What medication is 1st line for raynauds
CCBs
What are adverse effects of beta blockers
- bronchospams
- bradycardia
- depression
- fatigue
- erectile dysfunction
- blunts the hypoglycemic response
What are adverse effects of alpha blockers
- Orthostatic hypotension
- dizziness, syncope
- priapism
Tetracycline antibiotics are affective again gram ____ as well as
positive and negative and atypical bacteria/pathogens
What are examples of Tetracyclines
- Doxycycline
- Minocycline
- Tetracycline
What are the adverse effects of tetracyclines
- CI: in pregnancy or lactation, risk of neural tube defects, cleft palate, skeletal defects
- teeth discoloration (can use after 8 years old)
Doxycycline is indicated in the treatement of
- STIs
- Resp tract infect
- anthrax
- RMSF
- ophthalmic infections
- skin
- malaria prophylaxis
- specific bacterial infection
Minocycline is indicated in
- Acne
- STIs
- infective endocarditis
What are the adverse effects of tetracyclines
- photosensitivity reactions
- esophageal irritation
- Pseudotumor cerebri
Macrolides cover what pathogens
gram positive
atypical bacteria
What are examples of macrolides and are the CYP34A inhibitors?
- erythromycin
- Clarithromycin
- Azithromycin
*Only erythromycin and Clarithromycin are CYP34A inhibitors
What are adverse effects of macrolides
- GI distress
- Hepatotoxicity
- QT prolongation
- May exacerbate myasthemia Gravis
Rocephin (Ceftriaxone) 250mg IM is 1st line for
gonorrheal infections
First generation cephalosporins work agains
-gram +
What are adverse effects of cephalosporins
- hypersensitivity reactions
- C Diff
- Leukopenia
- Thrombocytopenia
3rd generation cephalosporins are indicated in
- meningitis
- genitourinary tract infections
- CAP
- Bone and joint infections
- skin and soft tissue infections
Example of a 1st generation cephalosporin
Keflex or Cephalexin
What are adverse effects of penicillins
- diarrhea
- C diff
- vaginitis
- Steven Johnson syndrome
You should avoid ____ in patients with concurrent mono because
amoxicillin; produces a morbilliform rash
macular or maculopapular lesion
Gram-Positive Bugs
- Staph
- Strep
- Enterococcus
Plus listeria, diptheria, clostridium, bacillus anthracis. p. acne,
Everything else is gram negative
What medications are beta-lactams
- penicillins
- cephalosporins
Never give a cephalosporin if the pt had the following reactions to penicillins
- PCN reaction was anaphylaxis
- if PCN reaction was Hives
You can give a cephalosporin if the patient had penicillin and had a
morbiliform rash
Morbiliform rashes occur with
- Sulfa drugs and HIV
- Pencillins and Mono
Penicillins are used to treat
- Gram + (not staph)
- Strep A, B, C, G
- Enterococcus
- Strep pneuo
- SRSP
- Botulism (wound)
Amoxicllin/Clavulanic acid is used to treat
- gram positive
- Gram negatives
- Beta lactamase (not MRSA)
- strep
- enterococcus
- strep pneumo
- DRSP
- H influenza
- M catarrhalis
- E coli
- Neisseria
- Diptheria
You assume a bug produces beta-lactamase if the patient has had
antibiotics in last 3 months
Sulfonamides are used for
Gram negatives and MRSA
*now have high resistance for E. Coli
Tetracyclines are used for
Gram negatives, atypicals, MRSA
- Minocycline is a good choice for MSSA and CA-MRSA
- Doxycycline good for atypical pathogens and lower resp tract pathogens
1st generation cephalosporins are used to treat
Staph: MSSA
Strep
2nd generation cephalosporins are used to treat
- gram + (staph, strep)
- gram negatives
H.Flu
E.coli
Proteus mirabillis
*Not beta lactamase
3rd generation cephalosporin are used to treat
Strep groups, gram negatives, Beta-lactamase, H. flu, M. cat, E. coli, Klebsiella, shigella
Extended spectrum 3rd generation are used to treat
-gram +, gram -, beta lactamase
What do macrolide treat
-atypical pathogens
Ciprofloxacin is used to kill
Gram negatives and atypical pathogen (3rd choice)
Respiratory quinolones is used to treat
-gram positive, negative (above the belt), atypical pathogens, DRSP, aerobes, anaerobes
Nitrofurantoin treats
urinary pathogens
Flagyl is used to treat
- anaerobes
- clostridium
Clindamycin is used to treat
-gram +, aerobes, anaerobes
Vancomycin is used to treat
-gram +, anaerobes
Fluoroquinolones are effective agains
Gram negative and atypical bacteria
4th gen (levo, moxi) have great gram + coverage
What is the black box warning for quinolones
Achilles tendon ruputre
What are CI of quinolones
- Children (<18)
- Myasthenia gravis
- Pregnancy
- Breastfeeding
- Hx of CVD, aneurysms and hypertension
What are adverse effects of quinolones
- hypoglycemia
- CNS effects
- QT prolongation
- Peripheral neuropathy
- Phototoxicity
- Double vision
- Tendinopathy
- Hepatotoxicity
