Pharmacology Flashcards
Drugs easily displaced from albumins –> ____ plasma drug level
INCREASE
- Sulfonamides
- Phenylbutazone
- Tolbutamide
- Coumarin
Drugs that induce P450 –> _____ plasma drug levels
DECREASE
- Alcohol
- Barbiturates
- Phenytoin
- Rifampicin
Drugs that inhibit P450 –> ______ plasma drug levels
INCREASE
- Chloramphenicol
- Sulfonamides
- Phenylbutazone
Drugs that compete for renal transporters –> ______ plasma drug levels
INCREASE
- Uric acid
- Probenecid
- Penicillins
- Sulfonamides
- Salicylates
- Thiazides
Risk of severe hemorrhage if coumarins are combined with
any other drug that competes for albumin
_______ displace sulfonureas from albumin leading –> hypoglycemia
Sulfonamides
What is the effect of Barbiturates on MAO-I?
induce P450 enzymes –> enhanced metabolism of MAO inhibitors –> ineffective tx of depression
What effect does P450 induction have on estrogen?
It enhances estrogen metabolism, which reduces oral contraceptive effects
What effect do steroids have on MAO-I?
they compete with MAO-I for P450 enzymes –> reduced metabolism of MAO-I –> risk of OD
NEVER combine aminoglycosides with:
- Neuromuscular blockers (enhanced block)
- Loop diuretics (compounds ototoxicity)
NEVER combine MAO-I with:
- Levadopa (HTN crisis)
- Amphetamine (HTN crisis)
- Tricyclic antidepressants
Famous SE of Penicillin
Anaphylactic shock
Famous SE of Isoniazid
Hepatotoxicity
Famous SE of Cyclosporin
Renal toxicity
Famous SE of Aminoglycosides (Neomycin)
Ototoxicity
Famous SE of Hydralazine
Drug-induced Lupus
Famous SE of Tetracyclines (Doxycycline, Minocycline)
Photosensitivity (skin)
Cutaneous flushing is a famous SE cz’d by
Niacin
Niacins is also HEPATOTOXIC
Famous SE of Zidovudine aka Azidothymidine (AZT)
Bone marrow suppression
Antidote to Acetominophen intoxication
NAC
Antidote to Opiate intoxication
Naloxone
Antidote to Benzo intoxication
Flumazenil
Antidote to Methanol or Ethylene Glycol intoxication
Ethanol
Antidote to CO intoxication
100% O2
Antidote to Cyanide intoxication
Amyl nitrate
Antidote to Organophosphate intoxication
- Atropine
- Pralidoxime
Antidote to iron intoxication
deferoxamine
Antidote to lead intoxication
EDTA
Antidote to coumarin intoxication
Vitamin K
Antidote to Heparin intoxication
Protamine
What does alpha-1 do?
- Tubules
- Tightening/contraction of b.v.
- Paralysis/relaxation of GI tube
What does alpha-2 do?
- Affects CNS
- Emergency break on SNS
What does Beta-1 do?
- Pro-sympathetic
- Affects heart
What does Beta-2 do?
- Pro-sympathetic
- Affects lungs
What ADR can B6 cause?
peripheral neuropathy
MOA of statins
HMG-CoA reductase inhibitors
Simvastatin and Atorvastatin
- Class: Statins (lipid-lowering agent)
- MOA: HMG-CoA reductase inhibitors
- give CoQ10!
- ADR: rhabdomyolysis
What labs should you check with statins rx?
Check AST and ALT prior to Rx and 6 weeks post-Rx
Common and serious ADR of statins
Rhabdomyolysis
*d/c statins if pt. has mm. pain, even if LFTs are normal
Colesevelam
- Class: Bile sequesterant (lipid-lowering agent)
- MOA: combines w/ bile to form insoluble compound that is then excreted
- ADR: constipation, fecal impaction, abdominal pain, nausea
Gemfibrozil
- Class: Fibrates (lipid-lowering agent)
- MOA: inhibits peripheral lypolysis, decr. hepatic FFA extraction, inhibits synthesis and incr. clearance of VLDL carrier Apo B
- ADR: often hepatotoxic (so falling out of favor)
When would you use carbonic anhydrase inhibitors?
MOA?
Emergency situations
This diuretic works by blocking HCO3 reabsorption in the proximal convoluted tubule –> resorbs 67% Na and H20 (A LOT!)
Furosemide
- Class: Loop Diuretic
- MOA: works at ascending loop of Henle and resorbs 25% Na
- ADR: hypokalemia (K+ wasting) and hyperglycemia
Hydrochlorothiazide
- Class: Thiazide diuretic
- MOA: works at the distal tubule/collecting duct via Na-Cl transporter and resorbs 8% Na
- ADR: hypokalemia (K+ wasting) and hyperglycemia
Hydrochlorothiazide is C/I in pt with a hypersensitivity to _____
sulfonamide drugs
1st line drugs for HTN
HCTZ (thiazide diuretics)
How to loop diuretics and thiazide diuretics affect blood sugar?
cause hyperglycemia
Triamterene
- Class: Potassium sparing diuretic
- MOA: acts on distal tubules
- ADR: HYPERkalemia
Why do you commonly use HCTZ and Triamterene together?
HCTZ is a potassium wasting diuretic and Triamterene is a potassium sparing diuretic so they can balance each other out
Spironolactone
- Class: Potassium sparing diuretic
- MOA: Acts on distal tubule; aldosterone receptor antagonist
- ADR: HYPERkalemia
Note: also used for PCOS
Atenolol
- Class: Beta blocker (selective)
- MOA: acts on B1 adrenergic receptor
- ADR: fatigue, bronchospasm, hypotension, bradycardia
**Abrupt discontinuation is dangerous
Carvedilol
- Class: Beta blocker (non-selective)
- MOA: acts on B1 and B2 adrenergic receptors
- ADR: fatigue, hypotension, bradycardia
**Abrupt discontinuation is dangerous
Propanolol
- Class: Beta blocker (non-selective)
- MOA: acts on B1 and B2 adrenergic receptors
- ADR: fatigue, hypotension, bradycardia
**Abrupt discontinuation is dangerous
Carvedilol
- Class: Beta blocker (non-selective)
- MOA: acts on B1 and B2 adrenergic receptors
- ADR: fatigue, hypotension, bradycardia
**Abrupt discontinuation is dangerous
Propanolol
- Class: Beta blocker (non-selective)
- MOA: acts on B1 and B2 adrenergic receptors
- ADR: fatigue, hypotension, bradycardia
**Abrupt discontinuation is dangerous
Timolol
- Class: Beta blocker (non-selective)
- MOA: acts on B1 and B2 adrenergic receptors
- ADR: fatigue, hypotension, bradycardia
**Abrupt discontinuation is dangerous
What is a common off-label use for B1 and B2 adrenergic receptor blockers?
migraines
Diltiazem
- Class: CCB
- MOA: makes Ca++ plateau shorter –> weakening the pump
- ADR: CHF
Verapamil
- Class: CCB
- MOA: makes Ca++ plateau shorter –> weakening the pump
- ADR: CHF
Amlodipine
- Class: CCB
- MOA: makes Ca++ plateau shorter –> weakening the pump
- ADR: CHF
If a pt with CHF needs to be put on an antihypertensive drug, which drug class should be avoided?
CCB
What drug interaction do the CCBs have?
increase levels of cimetidine (H2 receptor antagonist)
What affect to all of the angiotensin agents (ACE-I and ARBs) have on potassium?
the sequester potassium
K+ sparing
Lisinopril
- Class: ACE-I
- MOA: inhibit angiotensin converting enzyme in the lungs
- ADR: dry, persistent cough; hyperkalemia
What is a big C/I for ACE-I?
Pregnancy (b/c it can affect fetal lung development)
Ramipril
- Class: ACE-I
- MOA: inhibit angiotensin converting enzyme in the lungs
- ADR: dry, persistent cough; hyperkalemia
Irbesartan
- Class: ARB
- MOA: inhibit ANG-2 receptors
- ADR: hyperkalemia
**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I
Losartan
- Class: ARB
- MOA: inhibit ANG-2 receptors
- ADR: hyperkalemia
**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I
Clonidine
- Class: Alpha-2 Agonist Anti-hypertensive
- MOA: alpha-2 is an emergency break SNS
**this drug is used in emergency HTN crisis situations!
What is the typical dose of Reserpine?
- 1 - 0.25 mg BID
* impt to know this because they may asl question about how to dose Rauwolfia serpentina tincture (the extract will be standardized to mg reserpine)
Famous SE of NSAIDs
*Renal toxicity
Hepatotoxicity
Famous SE of Sulfonamides (Sulfamethoxazole, Sulfacetamide)
Photosensitivity (skin)
Hemolysis in pt. with G6PD-deficiency
Famous SE of Sulfonylureas (Glyburide)
Photosensitivity (skin)
Valsartan
- Class: ARB
- MOA: inhibit ANG-2 receptors
- ADR: hyperkalemia
**exist to give to pt w/ dry cough that are otherwise responsive to ACE-I
Do not give ________ to pt with G6PD-deficiency because it may cause hemolysis
Sulfonamides (Sulfamethoxazole, Sulfacetamide)
Warfarin
- Class: Anti-thrombotic, Anti-coagulation
- MOA: Vit K antagonist; acts on EXTRINSIC factors 2, 7, 9, 10
- ADR: Prolonged bleeding, hemorrhage
What do you need to monitor when pt is on warfarin?
prothrombin time (PT)
*from PT you can derive prothrombin ratio (PR) and international normalized ratio (INR)
Heparin
- Class: Anti-thrombotic, Anti-coagulation
- MOA: inhibits clotting factors by binding to antithrombin III (AT3); affects thrombin and fibrin; works downstream and doesn’t affect Vit K
- ADR: Hemorrhage
- MC injection (SC)
- IV is given to tx thromboembolism
Clopidogrel
- Class: Anti-thrombotic, Anti-coagulation
- MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2)
- ADR: Bleeding, Neutropenia, TTP
Aspirin
- Class: Anti-thrombotic, Anti-coagulation, NSAID
- MOA: inhibit platelets sticking together by preventing formation of thromboxane A2 (TXA2)
- ADR: Bleeding and salicylism (OD)
What is salicylism and how does it present?
OD of aspirin
characterized by acid-base disturbances, electrolyte imbalance and CNS effects
s/sx: tinnitus, deafness, N/V; early CNS stimulation (hyperkinetic agitation, excitement, mania, delirium, convulsions); later CNS depression (stupor and coma)
Digoxin
- Class: Class I Antiarrhythmic
- MOA: cardiac glycoside that inhibits Na-K pump and increases intracellular Ca++ –> contraction is stronger; also increase PNS flow and SA and AV nodes –> decreased HR
- ADR: death (problem is digoxin works everywhere in body so if dose is too high or brain is affected it can result in death)
Sx of Digoxin toxicity
fatigue, mm. weakness, agitation, anorexia, nausea, *yellow halos around vision
If a pt presents on digitalis/digoxin what should you always choose as an answer if available?
monitor their blood levels of digitalis/digoxin
this should be done first!
Quinine/Quinidine toxicity
Cinchonism
S/Sx: tinnitus, hearing loss, HA, nausea, dizziness, vertigo, visual changes
What are the 3 primary indications for Beta blockers in cardiology?
Antihypertensive, Antiarrhythmic, Antianginal
What are the 3 primary indications for CCB in cardiology?
Antihypertensive, Antiarrhythmic, Antianginal
Class I antiarrhythmics
Digoxin
Class II antiarrhythmics
BB
Class III antiarrhythmics
Amiodarone
Class IV antiarrhythmics
CCB
Amiodarone
Class: Class III Antiarrhythmic
MOA: delays repolarization and prolongs AP
ADR: VERY toxic w/ many ADR; most severe is lung toxicity (often leads to death); rare, fatal liver toxicity
If NTG relieves chest pain, what does that indicate?
Anginal pain is the only thing relieved by NTG and will be relieved w/in 2-3 min of taking SL NTG
Nitroglycerin (NTG)
Class: Anti-anginal
MOA: increases blood supply to heart
ADR: MAJOR headache
Pt. went to ER for angina and was prescribed a bunch of new meds. A week later the start having new-onset, severe HA. What is the most likely cause?
NTG
Anti-anginal drugs
- NTG
- BB: Atenolol, Metoprolol, Carvedilol, Propranolol, Timolol
- CCB: Diltiazem, Verapamil, Amlodipine
Fexofenadine
- Class: OTC antihistamine
- MOA: H1C receptor antagonist
- Non-sedating (doesn’t cross BBB)
Loratadine
- Class: OTC antihistamine
- MOA: H1 receptor antagonist
- Non-sedating (doesn’t cross BBB)
Cetirizine
- Class: OTC antihistamine
- MOA: H1 receptor antagonist
- Non-sedating (doesn’t cross BBB)
Diphenhydramine
- Class: OTC antihistamine
- MOA: H1 receptor antagonist
- ADR: SEDATION (b/c crosses BBB), seizures, thrombocytopenia, agranulocytosis
*can also use for insomnia
Promethazine
- Class: OTC antihistamine
- MOA: H1 receptor antagonist
- ADR: SEDATION (b/c crosses BBB)
- *BB warning = respiratory distress and gangrene (if injected)
*also used for motion sickness and N/V
It is C/I to combine Fexofenadine with
erythromycin, ketoconazole, or itraconazole d/t potential of FATAL arrhythmias
It is C/I to combine Diphenhydramine with
CNS depressants or MAO-I
Hydroxyzine
- Class: Antihistamine; Anxiolytic; Sedative/Hypnotic
- MOA: H1 Receptor Antagonist
- ADR: Drowsiness, xerostomia, blurred vision
- also used for preoperative sedation
It is C/I to combine Hydroxyzine with
CNS depressants
*also C/I in pregnancy and lactation
Epinephrine
- Class: Sympathomimetic (bronchodilator)
- MOA: vasoconstriction via alpha-1 receptor and vasodilation via beta-2 receptor
- ADR: cerebral hemorrhage, CVA, Vfib
*although it can be used for acute asthma, it is less preferred b/c it has such global action on ANS
Epinephrine is C/I with
Acute-closure glaucoma
What are the only two drugs that can be used acute asthma attack?
Albuterol (preferred)
Epinephrine
Dextroamphetamine
- Class: Sympathomimetic
- MOA: Release NE and Dopa
For ADD, PD, Narcolepsy. Used to be used for respiratory stuff but isn’t best option anymore.
Pseudoephedrine
- Class: Sympathomimetic (Decongestant)
- MOA: Stimulates alpha-1 receptor –> vasoconstriction
- ADR: HTN, anxiety, palpitations, HA, insomnia (not as bad as amphetamines)
Pseudoephedrine is C/I with
MAO-I
Oxymetazoline
- Class: Sympathomimetic (Decongestant)
- MOA: Stimulates alpha-1 receptor –> vasoconstriction
- ADR: anaphylaxis, arrhythmia, asthmatic episode; REBOUND CONGESTION
**Primarily used at OTC nasal spray or eye drop
Phenylephrine
- Class: Sympathomimetic (Decongestant and Hypotension)
- MOA: Stimulates alpha-1 receptor –> vasoconstriction
- ADR: arrhythmia, anaphylaxis, asthmatic episodes, HA
The decongestant Phenylephrine is C/I with
MAO-I and also in severe HTN
FYI: in addition to being a decongestant it is used to tx HYPOtension
Albuterol
Class: Bronchodilator (SABA)
MOA: B2 adrenergic agonist –> bronchodilation
ADR: nervousness, tremor, tachycardia, HA, palpitations, N/V, BRONCHOSPASM
Albuterol should not be used with
CNS stimulants
Onset of albuterol is _______ and it lasts ______
Onset: 15 min
Lasts: 3-4 hr
Atropine
Class: Bronchodilator (parasympatholytic)
MOA: Muscarinic antagonist
ADR: dry mouth, tachycardia, some CNS effects
**used for EMERGENCY bronchodilation as an injectable
When do you use atropine as a bronchodilator?
in an EMERGENCY to back up epinephrine…
Epi is a sympathomimetic and Atropine is a parasympatholytic
Guaifenesin
Class: Mucolytic
MOA: decreases viscosity of secretions
(OTC)
Fluticasone
- Class: Corticosteroid (Respiratory inhalent)
- MOA: potent vasoconstrictive and anti-inflammatory
- ADR: oropharyngeal candidiasis
- nasal tx and prophylaxis of allergic rhinitis, nasal polyps
MC inhaled steroid
Fluticasone
Fluticasone C/I
- Hypersensitivity to milk proteins (may result in anaphylaxis, angioedema, rash, urticaria)
- Status asthmaticus, acute bronchospasms
Mantoux test/PPD skin test
inject 0.1 mL intradermally and result is read 48-72 hr after administration; positive in 10 mm induration
MOA: antigenic purified protein derivative (PPD) of Mycobacterium tuberculosis
Isoniazid (INH)
- Class: Isonicotinic acid; Antitubucular Agents
- MOA: mycolic acid synthesis inhibition
- ADR: hepatotoxicity (10-20%)
Isoniazid inhibits _______ and decreases metabolism of _______.
P450
Phenytoin
Cromolyn Sodium
- Class: Mast cell stabilizers, Inhaled
- MOA: prevents degranulation of mast cells
- ADR: throat irritation
**ONLY used for prophylaxis, NOT in an acute situation
Ipatropium Bromide
- Class: Anticholinergic Bronchodilator (parasympatholytic), Inhaled
- MOA: Muscarinic antagonist
- ADR: arrhythmia (not used much anymore d/t high risk of this SE)
- Primarily for maintenance in COPD and asthma; NOT for acute attack
Tiotropium Bromide
- Class: Anticholinergic Bronchodilator (parasympatholytic), Inhaled
- MOA: Muscarinic antagonist
- ADR: arrhythmia
- Primarily for maintenance in COPD and asthma; NOT for acute attack
Salmeterol
- Class: Bronchodilator, Inhaled
- MOA: LABA(agonist)
- ADR: asthma-related DEATH (huge issue w/ LABA if pt misses a dose - SUDDEN REBOUND ASTHMA ATTACK)
Montelukast Sodium
- Class: Antiasthmatic
- MOA: Leukotriene receptor antagonist
- maintenance of asthma and prophylaxis of exercise-induced asthma; allergic rhinitis (2nd line)
Metabolism of Montelukast Sodium is increased with
Phenytoin
Peripheral edema may occur if Montelukast Sodium is mixed with _______
Prednisone
Name two opiate cough suppressants and what their primary ADR is
Codeine and Hydrocodone (in cough syrup)
ADR: respiratory distress
Dextromethorphan
Class: non-narcotic central antitussive
MOA: suppresses medullary cough center
ADR: robo-trippin’ if OD
If Dextromethorphan is mixed with Fluoxetine it can cause
serotoninergic syndrome
If Dextromethorphan is mixed with Trazadone it may cause
serotonin syndrome
If Dextromethorphan is mixed with Phenelzine it may cause
Hypertensive crisis
Drugs that can cause Hemolytic Uremic Syndrome
Chemo, Tacrolimus, Oral contraceptives
Pentoxifylline
- Class: Hematologic agent
- MOA: reduces blood viscosity by increasing deformability of leukocytes and erythrocytes; improves microcirculation
- ADR: angina, arrhythmias, hepatitis, blood dyscrasias, hypotension
Combining Pentoxifylline with ________ can increase the risk of ADRs
Ciprofloxacin
ADR: N/V, dizziness, HA, flushing, angina, palpitations, arrhythmias, hepatitis, jaundice, blood dycrasias, sleep disturbance, hypotension, thrombocytopenia, intrahepatic cholestasis
Deferoxamine
- Class: Iron Chelating Agent
- MOA: forms a complex with iron and is excreted through kidneys
- ADR: blue fingernails, lips, skin
ADRs of Deferoxamine are more likely when combine with _______ or ________
Prochlorperazine or Vitamin C
ADR: blue nails/lips/skin, blurred vision, seizures, dyspnea, tachypnea, tachycardia, hearing problems, flushing of skin
Nystatin
- Class: Antifungal
- MOA: disrupts fungal cell wall
- ADR: contact derm
- Candida
**Good topical/GI agent but not absorbed well into systemic circulation
Fluconazole
- Class: Systemic antifungal
- MOA: decreases ergosterol synth by inhibiting fungal P450, degrading fungal cell wall
- ADR: liver damage (b/c we also have P450)
**do not take this with any other hepatotoxic drugs
Ketoconazole
- Class: Systemic antifungal
- MOA: decreases ergosterol synth by inhibiting fungal P450, degrading fungal cell wall
- ADR: liver damage (b/c we also have P450)
**do not take this with any other hepatotoxic drugs
Terbinafine
- Class: Antifungal
- MOA: inhibits squalene epoxidase, reducing fungal cell membrane ergosterol synthesis
- For toenail fungus
- Oral or topical
Permethrin
- Class: Antiparasitic
- MOA: disrupts Na++ current in parasite –> paralysis
- ADR: seizures*, irritation, CNS toxicity
- Lice and scabies
*not a typical SE but if kiddo drinks this topical medication they can die
Mebendazole
- Class: Antihelminthic
- MOA: starves worms of nutrients
- ADR: abdominal pain, diarrhea, fever (dead worms are antigenic, which is actual cz of SE- fiber helps move worms along)
- pinworms, roundworms, hook works
*Need to repeat drug a second round to also get cyst forms
Metronidazole
- Class: Antiprotazoal
- MOA: inhibits DNA synthesis of microorganisms
- ADR: GI distress, seizures, ataxia, jt pn
- Amoebas, Trichomoniasis, Giardia, Bacterial vaginosis
You should NEVER take Metronidazole with _______
EtOH
Will make pt VERY ill, vomiting, can lead to liver failure
**This is a COMMON board question
Hydroxychloroquine
- Class: Antiprotazoal, DMARD
- MOA: impairs complement-dependent antigen-antibody rxn
- ADR: Cinchonism (vertigo, tinnitus, vision change, dizziness)
- tx malaria, SLE, RA
What antibiotics are safe during lactation/in kiddos?
- Penicillin: penicillin, ampicillin, amoxicillin, amoxicillin + clavulanate
- Macrolides: erythromycin, clarithromycin, azithromycin
- Cephalosporins: cephalexin, cefuroxime, cefdinir, ceftriaxone
What antibiotics should you avoid during lactation/in kiddos?
- Tetracyclines: doxycycline, minocycline
- Fluoroquinolones: ciprofloxacin, levofloxacin
Which antibiotics should be avoided in infants with G6PD deficiency?
- Sulfonamides: Sulfamethoxazole/Trimethoprine
- Nitrofurantoin
Gentamicin
- Class: Aminoglycosides (antibiotic)
- MOA: Bactericidal; binds 30S subunit inhibiting protein synthesis
- ADR: Severe ototoxicity
- internal or eye drops
- Used in ‘hospital-severe’ infx cz’d by gram negative, Pseudomonas auerginosa
Cephalexin
- Class: 1st Gen Cephalosporin (B-lactam antibiotic)
- MOA: Bactericidal, inhibits cell wall synthesis
- Broad spectrum. Work esp. well against Staph aur. and Strep. infx
*1st Gen are active against most Gm+ and some Gm- bacteria
Cephalexin interacts with ________ results in _________
Metformin
Sx of low blood sugar
Pt should not take Cephalosporins if they are allergic to _______
Penicillins
esp. if they have had an anaphylactic rxn to Penicillin
Cefuroxine
- Class: 2nd Gen Cephalosporin (B-lactam antibiotic)
- MOA: Bactericidal, inhibits cell wall synthesis
- Drug of choice to tx H. influenza and lower respiratory tx infx
*2nd Gen are active against are less active against Gm+ than 1st Gen but have broader Gm- action
Cefdinir
- Class: 3rd Gen Cephalosporin (B-lactam antibiotic)
- MOA: Bactericidal, inhibits cell wall synthesis
*3rd Gen have widest Gm- activity of cephalosporins
Ceftriaxone
- Class: 3rd Gen Cephalosporin (B-lactam antibiotic)
- MOA: Bactericidal, inhibits cell wall synthesis
- commonly used to tx serious infx at home
*3rd Gen have widest Gm- activity of cephalosporins
Penicillin VK
- Class: Penicillins (B-lactam antibiotic)
- MOA: Inhibit cell wall synthesis
- ADR: diarrhea, oral candidiasis, black hairy tongue
- 1’ works on Gm+: Strep., Pneumococcal, Staph.
Amoxicillin
- Class: Penicillins (B-lactam antibiotic)
- MOA: Inhibit cell wall synthesis
- ADR: hyperactivity, insomnia, rash, exfoliative dermatitis, hypersensitivity vasculitis
- Listeria meningitis, otitis media, peptic ulcers (H. pylori), UTI’s, Salmonella
Ampicillin
- Class: Penicillins (B-lactam antibiotic)
- MOA: Inhibit cell wall synthesis
- ADR: hypersensitivity, SJS, hemolytic anemia, thrombocytopenia purpura
- Bacterial infx, meningitis, endocarditis (tx and prophylaxis), typhoid fever, anthrax
Amoxicillin + Clavulanate
- Class: Penicillin (B-lactam antibiotic)
- MOA: inhibits cell wall synthesis and Clav. is effective against B-lactamase producing organisms
- bacterial infx, community acquired pneumonia, bacterial sinusitis
Erythromycin
- Class: Macrolide antibiotic
- MOA: interferes with bacterial DNA synthesis
- ADR: abdominal pn, N/V, diarrhea
- M. pneumo, pertussis, neonatal C. pneumo, Strep throat, URI
Are macrolides safe in pregnancy?
- Erythromycin is C/I
- Clarithromycin is Class C
- Azithromycin is Class B
Clarithromycin
- Class: Macrolide antibiotic
- MOA: interferes with bacterial DNA synthesis
- Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid
Azithromycin
- Class: Macrolide antibiotic
- MOA: interferes with bacterial DNA synthesis
- Bronchitis, Non-gonococcal urethritis, cervicitis, chancroid (
Doxycycline
- Class: Tetracycline antibiotic
- MOA: interferes with bacteria protein synthesis
- ADR: intracranial HTN, photosensitivity, dental staining, affects bone development
- Chlamydia, Lyme dz, Sebulytic (acne)…and everything covered by macrolides, penicillins, B-lactams
Minocycline
- Class: Tetracycline antibiotic
- MOA: interferes with bacteria protein synthesis
- ADR: intracranial HTN, photosensitivity, dental staining, affects bone development
- Chlamydia, Lyme dz, Sebulytic (acne)…and everything covered by macrolides, penicillins, B-lactams
Are tetracyclines C/I in pregnancy?
Use during 1st trimester is controversial
Are tetracyclines C/I in children?
Try to avoid using them in lactation and kids d/t risks of dental staining and adverse effects on bone development
Sulfamethoxazole/Trimethoprine
- Class: Sulfonamide Antibiotic
- MOA: Bacteriostatic (not -cidal); interfere with bacterial folic acid synthesis
- oldest antibiotic and lots of people are sensitive to it, MANY ADR (SJS, toxic epidermal necrolysis)
- UTI, OM, URI, Pneumocystis carinii, Traveler’s diarrhea
Nitrofurantoin
- Class: Nitrofurantoin Antibiotic
* only used for UTI (kills E. coli very well)
Is Nitrofurantoin safe in pregnancy?
Absolute C/I in 3rd trimester b/c if baby is born with Nitro in system it can cz hemolysis of the newborn
However, it’s used all the time in the 1st trimester
Clindamycin
- Class: Lincosamide Antibiotic
- MOA: interferes w/ process of peptide elongation in bacterial protein synthesis
- Alternative to penicillin
Ciprofloxacin
- Class: Fluoroquinolones
- MOA: Bactericidal; interferes w/ DNA synthesis
- ADR: tendon pathology, Achilles tendon rupture
- Wide spectrum
Levofloxacin
- Class: Fluoroquinolones
- MOA: Bactericidal; interferes w/ DNA synthesis
- ADR: tendon pathology, Achilles tendon rupture
- Wide spectrum
Is it safe to use fluoroquinolones in kids?
do NOT use in kids < 18 y/o d/t risk of arresting growth plates
Isoniazid
- Class: Antituberculosis (antibiotic)
- MOA: inhibit cell wall synthesis of Mycobacterium tuberculosis
- ADR: Hepatotoxic; **Many serious SE but better than dying from TB
- 1st line
- take drug for 6-18 mo.
Rifampin
- Class: Antituberculosis (antibiotic)
- MOA: impaires RNA synthesis
- ADR: Hepatotoxic; **Many serious SE but better than dying from TB
- 2nd line
- take drug for 6-18 mo.
1st line tx for TB
Isoniazid
2nd line tx for TB
Rifampin
What nutrient should you give when txing TB with Isoniazid or Rifampin?
B6 (Pyridoxine)
both drugs deplete it
Mupirocin
- Class: Topical antibiotic
- MOA: bacterial RNA inhibition
- Impetigo, MRSA
What is a common risk with neomycin?
Contact dermatitis
Triple antibiotic (Neomycin, Polymyxin B, Bacitracin)
- Class: Topical antibiotic
- ADR: allergic contact dermatitis and hypersensitivity (do not use in eyes or on large areas of body)
Amantadine
- Class: Antiviral, Antiparkinsonian (anticholinergic)
- MOA: weak dopamine agonist; non-competitive inhibition of NMDA; prevents release of infectious viral nucleic acid
- ADR: Anti-SLUDE; seizures, psychosis, hallucination
- Herpes zoster in immunocompromised; Parkinson’s dz
Amantadine is C/I with
CNS stimulants, narrow-angle glaucoma, seizure d/o, lactation, Pregnancy C
Acyclovir
- Class: Antiviral, Nucleoside analogue
- MOA: Inhibits viral multiplication by interfering w/ DNA synthesis
- only enters cells with surface markers for HHV family
Which antivirals are safe in lactating women?
Acyclovir and Valacyclovir
Which antivirals are not safe in lactating women?
Amantadine
Valacyclovir
- Class: Antiviral, Nucleoside analogue
- MOA: Inhibits viral multiplication by interfering w/ DNA synthesis
- only enters cells with surface markers for HHV family
- metabolizes into acyclovir but requires lower doses b/c of the reverse 1st pass effect
Interferon, Alpha
- Class: Antiviral, Antineoplastic
- MOA: bind to cell surface receptors and block viral protein synthesis
- ADR: “INF ALPHA” (Inhibit bone marrow, Neurotoxicity, Flu-like sx, Autoimmune d/o, Liver enzyme elevations, Proteinuria, Hypotn, Alopecia).
**Tx Hep B and C, genital warts (HPV), CA (leukemia, AID-related Kaposi’s sarcoma, Malignant melanoma)
Interferon, Beta
- Class: Antiviral, Antineoplastic
* Pretty much just used to tx multiple sclerosis
Although Interferon-Alpha is indicated in chronic Hep B and C tx, it is C/I in ________
AI hepatitis and hepatic decompensation
Oseltamivir
- Class: Antiviral
- MOA: selective competitive inhibitor of neuraminidase (enzyme needed for viral replication) of Influenza A and B
- prevention and tx of Influ A and B; although resistant to H1N1 strain
Zidovudine
- Class: Antiretroviral
- MOA: Nucleotide Reverse Transcriptase Inhibitor; inhibits DNA replication
- HIV infx and prophylaxis of HIV infx
Azidothymidine (AZT)
other name for the HIV drug Zidovudine
Adalimumab
- Class: TNF blocker, Immunosuppressive, DMARD
- MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha
- ADR: increases chance of getting other infx and of getting CA
- Inflammatory dz (RA, AS, Psoriatic Arth, Crohn’s, UC, Plaque psoriasis, Juvenile Arth)
When is Adalimumab C/I?
Active TB
Severe infx
Concomitant use w/ live vaccines
Infliximab
- Class: TNF blocker, Immunosuppressive, DMARD
- MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha
- ADR: increases chance of getting other infx and of getting CA
- Inflammatory dz (RA, AS, Psoriatic Arth, Crohn’s, UC, Plaque psoriasis, Juvenile Arth)
Enteracept
- Class: TNF blocker, Immunosuppressive, DMARD
- MOA: Human IgG monoclonal Ab that binds to and inhibits TNF-alpha
- ADR: increases chance of getting other infx and of getting CA
- Inflammatory dz (RA, AS, Psoriatic Arth, Crohn’s, UC, Plaque psoriasis, Juvenile Arth)
Tofacitinib
- Class: Immunosuppressive, Janus kinase (JAK) inhibitor
- MOA: inhibits JAK which prevents the body from responding to cytokine signals
- ADR: increases chance of getting other infx and of getting CA
- RA
When is Tofacitinib C/I?
Acute TB
Severe infx
Tacrolimus
- Class: Cell-Mediated Immunity Suppressor
- MOA: suppresses CMI rxn and some humoral immunity
- Developed to prevent organ rejection
Cyclosporine
- Class: Cell-Mediated Immunity Suppressor
- *Not commonly used as a CMI inhibitor but is VERY commonly used as eye drops for dry eyes (doesn’t seem to have systemic effects when used in eye, but cautions around use if there is viral infx in eye)
Triamcinolone
- Class: Corticosteroid (anti-inflammatory)
- MOA: potent glucocorticoid with minimal mineral corticoid activity
- ADR: joint swelling, contusions, sinusitis, cough
- RA, dermatoses, MS, inflammatory and allergic conditions
When is Triamcinolone C/I?
systemic fungal infx
idiopathic thrombocytopenic purpura
live or live, attenuated vaccine
Anastrozole
- Class: Oncologic; Biologic type drug
- MOA: aromatase inhibitor (decreases estrogen formation)
- ADR: menopausal sx
- Tx estrogen positive cancers
Doxorubicin
- Class: Chemotherapeutic agent; Anthracycline antibiotic
- MOA: DNA blocker (intercalates DNA)
- ADR: LIFE-THREATENING heart damage, bone marrow suppression
- IV drug
If you have pt on Doxorubicin, what should be your first goal?
Protect the heart!
this chemo agent can cz life-threatening heart damage
Paclitaxel
- Class: Taxane, Chemotherapeutic agent
- MOA: Mitotic inhibitor
- ADR: purplish, painless vesicular lesions onf tongue; also think of rapidly dividing cells of the body
What is Paclitaxel derived from?
Pacific Yew tree (Taxus brevifolia)
Vinblastine
- Class: Chemotherapeutic agent
- MOA: Binds tubilin inhibiting assembly of microtubules
- ADR: bone marrow suppression; also think of rapidly dividing cells of the body
What is Vinblastine derived from?
vinca alkaloid from Madagascar periwinkle (Catharanthus roseus)
Methotrexate
- Class: Chemotherapeutic Agent; Abortifacient
- MOA: inhibits dihydrofolate reductase
- ADR: ulcerative stomatitis, low WBC count
- used for chemo, pregnancy termination, and AI d/o (psoriasis, psoriatic arth, Crohn’s, RA, etc.)
5-Fluorouracil
- Class: Chemotherapeutic agent, Pyrimidine Analog
- MOA: inhibits DNA and RNA synthesis
- ADR: darkening of the tongue and purplish, painless vesicular lesions on tongue
Penicillamine
- Class: Chelator (oral)
- MOA: chelates copper
- ADR: very hard on GI tract (many ppl can’t tolerate)
- tx Wilson’s dz
EDTA
- Class: Chelator (1’ IV)
- MOA: chelate metals, lead, Ca++, aluminum
- ADR: hypocalcemia if using Na-EDTA (doesn’t happen with Ca-EDTA)
- Tx lead poisoning
Deferoxamine
- Class: Chelator (IV/IM/SQ)
- MOA: Primarily chelates iron; also chelates some aluminum
- Tx iron overload and s/t aluminum toxicity
DMPS
- Class: Chelator (1’ IV)
- MOA: chelates mercury
- ADR: hypomagnesemia, hypotn (–>LOC)
DMSA
- Class: Chelator (oral)
- MOA: chelates mercury, lead, and other heavy metals
- ADR: hypomagnesemia, hypotn/LOC (same as DMPS but less acute and severe d/t oral dosing)
Which OTC drug can precipitate an acute gout attack?
Aspirin (salicylates)
Drugs that interfere with renal excretion of uric acid and can precipitate acute gout attack?
*EtOH, *diurectics, salicylates, nicotinic acid, cyclosporine, levodopa, cytotoxic agents
Rapid lowering of uric acid via _____ can lead to ‘drug-induced gout’
Allopurinol