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Pharmacology > Pharmacology 2 - Exam 1 > Flashcards

Pharmacology 2 - Exam 1 Flashcards

1
Q

Valacyclovir (Valtrex)

A
  • Used for herpes zoster, simplexes (not varicella), may reduce transmission but does not eliminate
  • Prodrug of acyclovir
  • ADEs: TTP/HUS (fatal) - only occurs in immunocompromised (contraindication)
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2
Q

Interferon

A
  • Used for Hep B&C
  • SubQ injection or IM 3x/week
  • ADEs: flu-like symptoms, fatigue, depression & SI (can be given with antidepressant)
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3
Q

Amphotericin B : PT Teaching & Monitoring

A
  • ADEs: Nephrotoxicity (can reduce dose with concurrent flucytosine), infusion reaction like thrombophlebitis, fever/chills/rigor/headache (give a test dose), hypokalemia, bone marrow suppression
  • Monitor infusion site and rotate sites, baseline BUN/Creatinine and check weekly, I’s & O’s, saline flush, potassium levels + supplement if needed, CBC
  • Avoid other nephrotoxic drugs
  • Contraindicated with prior kidney disease
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4
Q

Aminoglycosides (Gentamycin)

A

MOA: inhibition of protein synthesis
- narrow spectrum, aerobic gram-negative bacilli, bactericidal
- Used most commonly as topical, IV, or IM (can be in ear or eye drops). Very safe in topical form (neomycin)
- not well absorbed in GI but can be used for tapeworm or amoebas - paromomycin)
- Does not cross BBB

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5
Q

Intradermal Injections

A

-TB and allergy testing
- 0.01 to 0.1mL, 3/8 to 5/8” needle, 25-27 gauge
- 5 to 15 degree angle, bevel up!

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6
Q

Bactrim : PT Teaching & Monitoring

A
  • ADEs: Hypersensitivities (Stevens-Johnson syndrome), blood dyscrasias, crystal formation in kidney, photosensitivity (severe), kernicterus (liver issues incl. bilirubin build up)
  • Contraindicated in pregnancy and newborns
  • Allergies: Sulfa
  • Monitor: CBC, signs of bleeding, infection signs, pallor, I’s & O’s, BUN/ Creatinine, lots of fluids given
  • Increases warfarin serum levels (reduce dosage of this)
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7
Q

Cephalosporins: pt teaching, monitoring

A
  • Coumadin can increase bleeding tendencies
  • Thrombophlebitis = rotate sites, administer slowly
  • Secondary colitis can cause dehydration
  • Disulfiram reaction = NO alcohol, including alcohol wipes, mouthwash, perfumes, and hand sanitizer
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8
Q

Rifampin

A
  • MOA: Bactericidal, inhibition of protein synthesis, broad-spectrum
  • Oral or IV admin, on an empty stomach preferred
  • ADEs: turns body excretions bright orange (tell your patient!), hepatotoxicity (monitor LFTs, avoid alcohol or tylenol), GI discomfort
  • Contraindicated with prior liver disease
  • Interacts with warfarin, HIV drugs, oral contraceptives (monitor PT/INR)
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9
Q

Penicillin

A

MOA: Weakens cellular wall (bactericidal)
- Can be broken down by beta-lactamase or penicillinase
- Used with combo drugs to inhibit beta-lactamase (ex: Augmentin - amoxicillin/clavulanate)
- Drug of choice for strep, gonorrhea, chlamydia
- Allergic reactions common and can be life threatening (depending on degree)

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10
Q

Nitrofurantoin (Furadantin, Macrodantin, Macrobid)

A
  • Uses: Acute UTI treatment, or prophylactic for recurrent
  • Broad-spectrum urinary antiseptic, bacteriostatic and bactericidal, damages bacterial DNA
  • 2nd line for acute cystitis
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11
Q

Nitrofurantoin : PT teaching & monitoring

A
  • ADEs: GI distress (can give with meals to minimize), hypersensitivity in pulmonary, blood dyscrasias, hepatotoxicity, peripheral neuropathy, headache/dizziness/drowsiness, urine and tooth discoloration
  • Monitor for dyspnea, cough, chest pain, fever/chills, CBC, bruises, pallor
  • Contraindicated with kidney disease (creatinine below 40 L/min), can turn urine brown
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12
Q

Cephalosporins (Prototype: cephalexin = Keflex 1st gen)

A

MOA: Bactericidal, weakens cellular wall
- Cross allergies with penicillin
- Multi-generational: more broad spectrum with each generation, earlier more effective with gram-positive, later with gram-negative, later gens less likely to be destroyed by beta-lactamase
- Poor GI absorption (new gens) usually IV only
- Best used for UTIs, PID, post-op infections, meningitis (crosses BBB), wound infections
- ADEs: causes secondary colitis, dehydration, diarrhea, bleeding tendencies, thrombophlebitis

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13
Q

Ectoparasiticides (permethrin - Nix) OTC

A
  • MOA: kills adult insects by attacking nervous system (does not work on eggs)
  • Uses: Lice infestation, drug of choice for scabies
  • ADEs: burning, itching, stinging, numbness, pain, rash, edema, erythema
  • Some resistance seen
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14
Q

Antifungal (Amphotericin B - Amphotec)

A
  • MOA: Broad-spectrum, can be fungistatic (low doses) or fungicidal (high doses), damages cell wall of mycoses
  • Uses: Systemic fungal infections (nystatin used for local)
  • Oral, topical (powder) for nystatin
  • Amph is IV only med (6-8 weeks everyday)
  • Amph is highly toxic, so we must be selective and cautious
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15
Q

Tetracyclines : Pt teaching & monitoring

A
  • ADEs: photosensitivity, esophageal ulcers, tooth discoloration in children or with chewing meds (children under 8), digoxin toxicity in some, not for use in pregnancy esp after 4th month, hepatotoxicity
  • Monitor I’s & O’s due to GI distress; monitor for jaundice and lethargy, no milk products!, take on empty stomach with large glass of water
  • Teaching : wear sunscreen, do not take at night and then lay down = ulcers
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16
Q

Antiseptic

A
  • applied to living tissue only for antimicrobial purpose
  • stop growth of organism
  • prophylaxis
  • ethanols, chlorine compounds, Chlorhexidine, phenols
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17
Q

IM injection Muscles

A
  • Vastus lateralis = 5/8 to 1”
  • Deltoid (2mL or less) = 1 to 1.5”
  • Ventrogluteal (3-5mL max) = 1.5”
    –> 90 degree entry
  • Aspiration once into muscle, check for blood
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18
Q

Fluoroquinolones PT Teaching & Monitoring

A
  • ADEs: GI discomfort, achilles tendon rupture, superinfections, phototoxicity
  • Monitor for n/v/d, I’s & O’s, sunscreen and protective clothing in the sun, PT/INR if on warfarin (can decrease dosage)
  • No children under age 18
  • Interactions: aluminum and magnesium can decrease absorption, milk and dairy products, can increase warfarin
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19
Q

Antihelmintics (mebendazole - Vermox)

A
  • MOA: broad-spectrum, inhibits uptake of glucose by parasite
  • Uses: drug of choice for roundworms, pinworms, hookworms
  • ADEs: transient abdominal pain and diarrhea
  • Education : Complete entire med course, all family members must be tested, evaluation needed 1 month after initial check, may need enema for cleansing, hand hygiene and perianal care is of upmost importance!
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20
Q

Aminoglycosides PT teaching & Monitoring

A
  • ADEs: ototoxic (constant high levels of the med), nephrotoxic, hypersensitivities (rash or hives), neuromuscular blockade (resp depression)
  • Monitor for ringing in ears, balance issues, headache, vertigo; urinalysis, dilute or cloudy, hematuria, I’s & O’s, BUN/ Creatinine
  • Very important to monitor drug levels especially troughs (need to know how much pt is being exposed to for ototoxicty risk), spacing of drug important
  • Use caution with Myasthenia gravis, general anesthetic, muscle relaxants
  • Y-site interactions with penicillin
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21
Q

Flu antivirals (oseltamivir - Tamiflu; zanamivir - Rolenza)

A
  • MOA: neuraminidase inhibitor (required for replication)
  • Used to treat influenza A&B
  • Must be given within 48 hours of beginning symptoms
  • ADEs: hypersensitivity reactions (rare- anaphylaxis or skin reaction)
  • Interacts with live-attenuated vaccine
22
Q

HIV Drugs

A
  • Fusion/Entry inhibitors
  • CCR5 antagonists
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Nonnucleoside/ nucleotide reverse transcriptase inhibitors (NNRTs)
  • Protease Inhibitors
  • Integrase strand transfer inhibitors (INSTI)
  • Pt’s usually on 3-4 of these to reduce toxicity + resistance and increase effectiveness
23
Q

Isoniazole : PT Teaching & Monitoring

A
  • ADEs: Hepatotoxicity, hypoglycemia (decrease in glucose control in diabetics)
  • Monitor for anorexia, malaise, fatigue, jaundice, LFTs, NO alcohol or tylenol, administer B6 alongside, monitor for ataxia with pt taking phenytoin
  • Contraindication with liver disease and alcoholism
  • Interacts with phenytoin (seizure drug) - increases toxicity, other hepatotoxic drugs
24
Q

Zidovudine (Retrovir/ AZT / ZDV)

A
  • First line HIV treatment
  • MOA: inhibition of DNA synthesis and viral replication
  • ADEs: bone marrow suppression (esp neutropenia), lactic acidosis (can be life threatening), n/v/d, hepatomegaly (fatty liver)
  • Use caution with pt’s with liver disease
  • Monitor CBC + platelets, look for bruising or bleeding, fatigue, sore throat, fluid/electrolytes, LFTs
25
Q

Sterilization

A
  • indicates destruction of all microbes
26
Q

Antiviral (acyclovir - Zovirax)

A
  • MOA: prevents reproduction of viral DNA
  • Used for Herpes infection (simplex and varicella-zoster)
  • Oral, topical, IV
  • ADEs: Mild discomfort (n/v, headaches, vertigo), reversible nephrotoxic in IV (esp if pt is dehydrated)
  • Interacts with probenecid (gout) = decreases elimination, toxicity risk
27
Q

Macrolides (erythromycin, azithromycin/ z-pak)

A

MOA: inhibit protein synthesis, bacteriostatic at low/normal dosage
- Oral or IV admin (IV can be irritating at the injection point, should dilute)
- Safest antibiotic from allergy standpoint, possible option (other than vanco) for those with penicillin allergy
- Used for sinus infections, Upper resp infections, bronchitis, STIs, skin infections

28
Q

SubQ Injections

A
  • Used for heparin and insulin
  • 2mL max in adults; 0.5mL in kids
  • 25 gauge, 5/8” at 45 degree angle
  • 25 gauge, 1/2” at 90 degree angle
  • 90 degree angle if obese
  • Children: 26-30 gauge, 1/2”, 90 degree angle
  • Inject while pinching skin
29
Q

Azoles (ketoconazole - Nizoral; fluconazole - Diflucan)

A
  • MOA: Broad-spectrum, acts on mycoses cell membrane
  • Uses: systemic or superficial fungal infections, drug of choice for non-fatal systemic infections, alternative to AmphB
  • Oral admin, topical for superficial
  • Inhibit C-450 pathway = interactions
30
Q

Quinine (Qualaquin)

A
  • Used for treatment of chloroquine-resistant malaria, 2nd line med, rarely used by itself
  • Contraindicated with optic neuritis
  • ADEs: Cinchonism = tinnitus, headache, visual disturbance, n/d; hemolysis with G6CD deficiency + hemolytic anemia; hypotension, dysrhythmias, profound hypoglycemia
  • Caution with AFib patients
31
Q

Disinfectant

A
  • Used on inanimate objects for antimicrobial purpose
  • stop growth of organism
  • prophylaxis
  • aldehydes, h2o2, iodine compounds
32
Q

Penicillin –> Allergies and pt teaching/monitoring

A
  • Anaphylactic rxns can occur = most serious
  • Renal impairment
  • Hyperkalemia leading to dysrhythmias
  • Y-site incompatibility with aminoglycosides (vanco)
  • MONITOR: pt for any signs of allergic reactions including itching - EKG and cardiac function - kidney fxn (BUN/ Creatinine, I’s & O’s)
  • Cross allergies with cephalosporins
33
Q

Sanitization

A
  • reduced contamination based on public health standards
34
Q

Carbapenems (Prototypical: imipenem-cilastatin - Primaxin)

A

MOA: weaken cellular wall
- Most broad spectrum and strongest we have
- Pregnancy risk C = very high risk
- IV or IM only
- Crosses BBB, used best for UTIs, pneumonia, peritonitis - good for mixed infections - good empirical guess

35
Q

Antimycobacterial (Isoniazid - INH)

A
  • MOA: prevents synthesis of mycolic acid in bacterium
  • Uses: TB, Leprosy, MAC (avium complex) - prolonged treatment (6-9mo or years for latent) = increases drug resistance
  • Other drugs used: Rifampin, fluoroquinolones (we use multiple drugs at once)
  • Typically oral admin, can be IM; without food preferably
36
Q

Glycopeptides (Prototype: vancomycin/ Vancocin)

A

MOA: weaken cellular wall
- Given IV usually, orally for GI infections due to poor GI absorption
- Used for serious infections like MRSA or C. Diff; drug of choice for gram-positive
- risk for resistance is increasing
- “Say no to vanco” = use only if others are ruled out

37
Q

Intramuscular Injections

A

Gauge:
- aqueous solution = 20-25; viscous = 18-21; children = 22-25
Needle length:
- thin adult: 5/8 to 1”; average = 1”; overweight = 1 to 1.5”; obese = 1.5”; infants = 1”; toddler = 1-1.75”; older children = 1.5”

38
Q

Sulfonamides and Trimethoprim (Sulfamethoxazole-trimethoprim = Bactrim)

A
  • MOA: Broad-spectrum that inhibits folic acid synthesis = inhibits replication, bacteriostatic, -cidal at high concentrations
  • Uses: cystitis (lower UTI), otitis media, bronchitis, pneumonia
  • IV or IM admin
  • Cannot mix with penicillin –> y-site incompatibility
39
Q

Antimalarial (Chloroquine - Aralen)

A
  • Uses: Drug of choice for mild to moderate malarial infection, used for prophylaxis
  • ADEs: (rare), visual disturbances, itching, headache, GI effects (n/d, abdominal discomfort) - take meds with food
  • use with caution with existing liver disease
  • Oral or IM, oral preferred
40
Q

Macrolides : Pt teaching & Monitoring

A
  • Monitor IV site if given that route (can cause thrombophlebitis), give with full glass of water preferably on empty stomach, monitor cardiac function, LFTs for long term doses, monitor digitoxin levels and PT/INR
  • ADEs: GI distress (n/v, epigastric pain), QT prolongation (sudden cardiac arrest risk), ototoxicity (at high doses)
  • Interacts with many drugs including antihistamines, warfarin, digoxin (can lead to toxicity), HIV drugs
41
Q

Glycopeptides (Vanco) : Pt teaching / monitoring

A
  • ADEs: Redman syndrome, ototoxicity, nephrotoxicity, infusion reaction, thrombophlebitis
  • Monitor for ringing in ears or changes in hearing (increase risk with other ototoxic meds)
  • Administer slowly if Redman or infusion rxn occurs (up to 4 hours)
  • Monitor I’s & O’s, BUN/Creatinine for kidney function, give plenty of fluids
  • Monitor drug levels, keep in therapeutic range - keep peaks and troughs in mind
42
Q

Pyrimidine Analog (Flucytosine)

A
  • MOA: disrupts fungal DNA/RNA synthesis, narrow spectrum (prone to resistance), used in combo with AmphB
  • ADEs: Bone marrow suppression, hepatotoxicity (mild and reversible liver dysfunction), interacts with 450 pathway drugs
  • Monitor CBC, LFTs weekly
43
Q

Fluoroquinolones (Ciprofloxacin - Cipro)

A
  • MOA: broad-spectrum bactericidal, inhibits enzyme needed for replication
  • Oral or IV admin route
  • Uses: respiratory, urinary (pyelonephritis), and GI infections, wound infections, med of choice for anthrax
44
Q

Tetracyclines (Prototype: Tetracycline - Sumycin)

A

MOA: inhibits protein synthesis, bacteriostatic
- Usually topical or oral admin, 2nd line antibiotics when infections are resistant to other antibiotics
- Used for chlamydia, peptic ulcer disease, malaria prophylaxis, H. Pylori

45
Q

Primaquine

A
  • Uses: drug of choice for preventing relapse of malaria
  • ADEs: hemolysis with G6PD deficiency leading to hemolytic anemia
46
Q

Bactericidal

A

Kills bacteria

47
Q

BUN + Creatinine normal values

A

BUN ( 10-20 mg/dL)
Creatinine ( 0.5 -1.1 mg/dL)

48
Q

Azoles : PT Teaching & Monitoring

A
  • ADEs: GI discomfort (n/v), hepatotoxicity
  • Monitor for n/v, jaundice, dark urine, clay colored stool, baseline LFTs (check monthly), sex hormone effects (gynecomastia, irregular menstruation)
  • Interacts with antacids, PP inhibitors, h2 inhibitors = decreases gastric acidity and reduces azole absorption (take 2 hours apart); drugs that use 450 pathway (digoxin, warfarin); can cause dysrhythmias or resp depression; rifampin enhances hepatic metabolism (might need higher dose)
49
Q

Bacteriostatic

A

Slows growth of bacterial cell, needs healthy immune function to knock out infection

50
Q

Carbapenems : pt teaching/monitoring

A
  • Hypersensitivity reaction, cross allergy with penicillins
  • GI upset (n/v, diarrhea) - monitor I’s & O’s
  • High risk of superinfection, secondary risk (watch for colitis, oral thrush, vaginal yeast)
  • Interacts with Depakote (seizure med)
51
Q

Antiprotozoal (Metronidazole - Flagyl)

A
  • MOA: broad-spectrum antimicrobial, bactericidal
  • Uses: effective against anaerobic bacteria, H. Pylori, C.Diff, prophylactically before surgery (vaginal, abdominal, and colorectal surgery)
  • ADEs: GI discomfort (also metallic taste), darkening of urine, CNS effects (numbness, ataxia)
  • Interactions: disulfiram rxn (NO alcohol, alcohol wipes, hand sanitizer), inhibits activation of warfarin (monitor PT/INR)

Pharmacology (6 decks)

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