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ESUN MS2Unit6 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

As ppl age, gastric pH goes up or down? and what does it affect?

A

Goes up (achloridia)/drug absorption

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2
Q

As ppl age, total body water/lean body mass/fat storage go up or down? What do that affect?

A

Total body water/lean body mass go down
Fat storage goes up
Drug absorption

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3
Q

What are phase I and phase II drug metabolic pathways?

A

Phase I—>metabolize the drug into similar compound

Phase II —>metabolize the drug into inactive form

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4
Q

What should we consider if we see a elderly pt with normal serum creatinine level?

A

Maybe the normal level is masking a decreased GFR and a decreased lean body mass (lower creatinine production)

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5
Q

Why is adverse drug effects especially detrimental for elderlies?

A

Elderlies have lower physiological reserve to respond and recover from/they are on so many other drugs that might also have side effects

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6
Q

Why is anticholinergic drugs has potential harmful affect to elderly?

A

Potentiate the decline of cholinergic nerve—>increase risk of delirium and confusion

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7
Q

What is adverse side effect prescribing cascade?

A

Adverse side effect—>misinterpreted as new medical condition—>give additional drugs—>adverse side effect…

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8
Q

Why should elderly avoid NSAID?

A

Reduce renal blood flow/increase risk for stroke and MI/HoTN with increase risk of falling

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9
Q

What is the strategy when it comes to dosing elderly?

A

Start slow, go slow/avoid starting 2 drugs at the same time

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10
Q

How does iron supplement affect GI?

A

Constipation

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11
Q

Actue gastroenteritis/HoTN/rice water diarrhea/torsades, think what metal poisoning?

A

Arsenic

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12
Q

What symptoms do you see with Thallium poisoning?

A

Painful neuropathy/alopecia

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13
Q

What is the mechanism of chelating agents?

A

Form complex with heavy metal—>form chelate—>excrete

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14
Q

What is dimercaprol mixed with and how is it injected?

A

Peanut oil/IM

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15
Q

What is needed to be done to prevent metal induced renal toxicity when using dimercaprol?

A

Urine alkalization

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16
Q

What heavy metal poisoning do you use for Succimer?

A

Lead/cadmium/mercury

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17
Q

What poisoning is Prussian blue used for? and is it absorbed orally?

A

Cesium and thallium/no even though it is given orally

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18
Q

How to treat adult with high/mild/low (no symptoms) lead poisoning?

A

High—>dimercaprol/EDTA
Mild—>succimer
Low (no symptoms/lead level less than 70)—>remove from exposure

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19
Q

How to treat children with high/mild/low (no symptoms) lead poisoning?

A

High—>dimercaprol/EDTA
Mild (over 40)—>succimer
Low (under 40)—>remove from exposure

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20
Q

How is iron poisoning lethal?

A

It is a uncoupler of oxidative phosphorylation—>stop aerobic respiration
Ionic gap metabolic acidosis

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21
Q

Iron has positive or negative inotropic effect? vasoconstrictor or vasodilator?

A

Negative—>HoTN

Vasodilator—>HoTN

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22
Q

When is vomiting occur during iron poisoning?

A

Within 6 hours

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23
Q

Deferoxamine (IV) can only chelate what kind of iron and how long can you use it for and why?

A

Free iron/less than 24 hours, because it causes acute lung injury

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24
Q

What would stimulate the production of acid from parietal cells? and what are their second messengers?

A

Gastrin/histamine/ACh
ACh/gastrin—>Ca2+—>stimulate proton pump
Histamine—>Gs coupled—>stimulate proton pump

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25
Q

How does prostaglandin E2 analog affect acid production?

A

It binds to Gi—>inhibit proton pump

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26
Q

Are PPI competitive or noncompetitive?

A

Noncompetitive (unlike antiACh or antihistamine)

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27
Q

If a pt is getting refractory ulcers with H2 blockers, use what drug next?

A

PPl

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28
Q

What happens to the acid production if you suddenly stop H2 blockers? and what should you do instead?

A

Acid production increase more than normal (rebound hypersensitivity)/should taper

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29
Q

What are the 4 causes of GERD?

A

Reduced LES tone/increase acid production/not enough water intake to wash acid down/reduce the emptying of stomach into duodenum

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30
Q

What is topical phenylephrine used for?

A

Hemorrhoids—>vasoconstrictor

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31
Q

What side effect does prochlorperazine has and what drug should we use to counter that?

A

Torticollis/anticholinergic

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32
Q

Which 2 anti emetic drugs are used for anesthesia related vomiting?

A

Granesitron/dolasetron

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33
Q

What to use to treat gastroparesis?

A

Stomach pacemaker/promotility agent

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34
Q

What is the mechanism of toxin mediated diarrhea?

A

Toxin—>increase cAMP—>increase Cl- secretion into stomach/decrease Na, Cl-, glucose absorption from the stomach—>osmotic diarrhea

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35
Q

What is the mechanism of atropine for diarrhea?

A

Relax bowel smooth muscle/decrease secretion

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36
Q

Which pain killer can be use for diarrhea as well?

A

Codeine

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37
Q

What to give pt if loperamide doesn’t work?

A

Diphenoxylate (opioid agonist + atropine)

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38
Q

Pectin reduces ___ but not ___?

A

Water in the stool/but not the frequency of bowel movement

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39
Q

Why do we need to add additional drugs with stool softener?

A

Stool softener does not push stool, it just soften it

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40
Q

What do we use for chronic constipation pt?

A

Bulk forming colloid

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41
Q

How do lubiprostone/linaclotide/naloxegol work and what do they treat?

A

Lubiprostone—>stimulate Cl- channel
Linaclotide—>increase cGMP
Naloxegol—>mu receptor antagonist (for opioid induced constipation)
They all treat constipation

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42
Q

What drugs are used to manage constipation/diarrhea from irritable bowel syndrome?

A

Osmotic cathartics/loperamide or diphenoxylate

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43
Q

What does it mean when a bacteria has a high MIC (minimal inhibitory con.)?

A

I means it’s harder to kill it

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44
Q

Difference in structures of gram - and + bacteria?

A

Gram - : outer membrane with LPS

Gram + : thick cell wall

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45
Q

Beta lactam binds ___ and inhibit ___?

A

PBP/transpeptidation

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46
Q

What is a significant cause of resistance to beta lactam in gram negative bacteria?

A

Beta-lactamase

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47
Q

Can we use penicillin for staph?

A

No (resistance)

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48
Q

What are the 3 mechanism of resistance to antibiotics?

A

Enzyme destruction (beta lactamase)/reduce permeability(alteration in channel)/altered target site (low affinity binding to PBP)

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49
Q

Would beta lactam work on mycoplasma or chlamydia pneumoniae?

A

No, they don’t got no cell walls

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50
Q

What is the only beta lactam that works on MRSA?

A

Ceftaroline (5th gen cephalosporin)

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51
Q

How is ceftriaxone excreted?

A

Through bile

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52
Q

How long do you want to exceed the MIC when giving antibiotics?

A

At least half of the time during dosing interval (e.g. give drug for 8 hours, want at least 4 hours to exceed MIC)

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53
Q

What are some side effect of beta lactam?

A

Anaphylaxis (rare)/acute interstitial nephritis/rash/diarrhea

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54
Q

What bacteria does natural penicillin (G and V) treat?

A

Mostly gram + :

Strep/enterococcus/anaerobe/N. menigitidis/T. pallidum

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55
Q

What are the anti staph penicillins and what do they treat?

A

Oxacillin/nafcillin/dicloxacilllin

Gram + only (MSSA—>methicillin sensitive S. aureus)

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56
Q

What’s the mechanism of aminopencillin?

A

Ampicillin and amoxicillin—>improved penetration into gram - bacteria

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57
Q

What is the drug of choice for enterococcus and listeria?

A

Ampicillin

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58
Q

What is amoxicillin usually used for?

A

Otitis media

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59
Q

What are the side effects of ampicillin and amoxicillin?

A

Rash if given during viral infection (like EBV)

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60
Q

How is ampicillin usually given?

A

IV (bad oral absorption)

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61
Q

Does penicillin work on H. influenza?

A

No—>H. influenza produces beta lactamase

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62
Q

What are the extended spectrum penicillins?

A

Piperacillin/ticarcillin

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63
Q

Penicillin can combine with ___ to extend gram - coverage?

A

Beta lactamase inhibitor

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64
Q

What combination of penicillin are active against pseudomonas?

A

Piperacilloin + tazobactam

Ticarcillin + clacvulanate

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65
Q

What are the 2 cephalosporins that treat pseudomonas?

A

Ceftazidime/cefepime

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66
Q

Which has a lower risk of hypersensitivity reaction, penicillin or cephalosporin?

A

Cephalosporin

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67
Q

What is the side effect of ceftriaxone in neonate?

A

biliary sludging/kernicterus

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68
Q

What are the side effects of cephalosporin?

A

Coagulopathy/disulfiram like reaction with alcohol

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69
Q

What are first gen cephalosporin active against?

A

Gram + : strep and staph (MSSA)/PEK

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70
Q

Hypersensitivity reaction of penicillin or 1st gen cephalosporin is better tolerated?

A

1st gen cephalosporin

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71
Q

Which 2 cephalosporins are for prophylaxis colon surgery?

A

Cefoxitin and cefotetan

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72
Q

3rd gen cephalosporin has correlation with ___ infection?

A

C. diff

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73
Q

Side effect of cefepime?

A

Akinetic seizure (altered mental status)

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74
Q

Does ceftaroline cover pesudomonas?

A

No

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75
Q

What is ceftaroline used for?

A

Skin and soft tissues infection (cellulitis)

CAP

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76
Q

What drug does ceftaroline has a synergistic interaction with?

A

Daptomycin

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77
Q

Ceftazidime is combined with ___ to cover CRE and ESB: bacteria

A

Avibactam

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78
Q

Ceftolozane + ___ is another alternative for ESBL

A

Tazobactam

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79
Q

Carbapenems treats? and does it treat MRSA?

A

ESBL and pseudonomas

No

80
Q

Use meropenem specifically for?

A

Bacterial meningitis

81
Q

Carbapenems decresae which drug’s con.?

A

Valproic acid

82
Q

Which carbapenem has the longest half life and what bacteria can’t it treat?

A

Ertapenem—>no activity against pseudonomas

83
Q

Imipenems is avoided in ___ treatment?

A

Meningitis—>in case of seizure

84
Q

What group of bacteria does aztreonam treat?

A

Gram - ONLY

Pseudomonas

85
Q

Aztreonam has cross activity with __?

A

Ceftazidime

86
Q

Upper respiratory infection from S. peunomiae or H. influneza, start with ___, if not resolved, add ___?

A

Amoxicillin

Amoxicillin + clavulanate (augmentin)

87
Q

Vancomycin has activity against?

A

Gram + bacteria including MRSA and MSSA/S. epidermidis

88
Q

How is VRE resistant to vancomycin?

A

Change D-ala-Dala to D-ala-D-lac in its cell wall

89
Q

What are VISA and VRSA?

A

vanco intermediate resistance S. aureus

vanco resistance S. aureus (MIC >16)—>obtain resistance from VRE

90
Q

S. epidermidis has significant resistance to ___?

A

beta lactam

91
Q

Why do we treat S. aureus bacteremia for 6 weeks now?

A

To cover potential endocarditis

92
Q

80% of S. pneumoniae is resistant to ___ so use ___ instead

A

Cephalosporin/vanco

93
Q

Daptomycin is inactivated by ___?

A

Pul surfactant

94
Q

What are the 3 lipoglycopeptides (similar to vanco)? and what are their mechanism

A

Telavancin
Dalbavancin (super long half life 257hrs)
Ortiavancin (super long half life 195hrs)
Bind to cell wall precursors like vanco—>cell membrane depolarization

95
Q

What is the spectrum for telavancin?

A

Vanco’s spectrum + VISA and VRSA

96
Q

Which aminoglycosides is used for CF?

A

Aerosolized tobramycin

97
Q

Why do you have to take tetracycline upright? and what is other side effect of tetracycline?

A

It might cause erosive esophagitis/hyperpigmentation

98
Q

Which tetracycline cause vertigo?

A

Minocycline

99
Q

What is tigecycline? and what does it treat?

A

Derivative of minocycline/broad spectrum including MRSA and VRE
Not used for bacteremia

100
Q

What is macrolides usually treat?

A

Uncomplicated upper and lower respiratory infection

101
Q

Clindamycin is given with penicillin for ___?

A

Toxic shock syndrome

102
Q

Linezolid and tedizolid are alternative to what drug?

A

Daptomycin

103
Q

Linezolid and tedizolid inhibit ___ and cause serotonin syndrome?

A

MAO

104
Q

What is the only PO drug that treats pseudomonas?

A

Fluoroquinolones

105
Q

Which fluoroquinolones has activity against anaerobe?

A

Moxifloxacin

106
Q

Can you use cipro or levofloxacin alone for intraabdominal infection?

A

No. gotta pair them with metronidazole

107
Q

What kind of pt tend to have tendon rupture with fluoroquinolone?

A

Old pt who is on steroid

108
Q

Which fluoroquinolone most likely causes prolonged QT?

A

Moxifoxacin

109
Q

What is the mechanism of metronidazole?

A

Inhibit protein synthesis

110
Q

What are the 2 antibiotics used for anaerobic treatment?

A

Clindamycin above the diaphragm and metronidazole below

111
Q

What is the mechanism of rifamycin and ethambutol?

A

Rifampin—>bind bacterial DNA dependent RNA polymerase

Ethambutol—>blocks arabinosyl transferase—>inhibiting carbohydrate formation of the wall

112
Q

What is rifampin used for besides prophylaxis?

A

Prothetic valve endocarditis/prosthetic join infection (antibiofilm)

113
Q

What drug does isoniazid?

A

Potentialte phenytoin

114
Q

What else covers listeria besides ampixcillin? And does it cover anaerobe?

A

Bactrim/no

115
Q

What is trimethoprim’s affect on kidney?

A

It is a K sparing diuretics—>hyperkalemia

116
Q

What is the drug interaction with bactrim?

A

Warfarin—>increase INR

117
Q

Can antiretroviral kill the HIV virus?

A

No

118
Q

What is the HIV infection process?

A

Virus bind and enter the cell—>HIV RNA is converted to DNA via reverse transcriptase—>integrates into host genome via integrase—>transcription—>protein is cleaved via protease—>bud off

119
Q

What are the 5 major classes of antiretroviral drugs?

A

NRTI—>nucleoside reverse transcriptase inhibitor
NNRTI—>non nucleoside reverse transcriptase inhibitor
Protease inhibitor
Entry inhibitor
Integrase inhibitors

120
Q

What is the mechanism of NRTI? and its major side effect?

A 
DNA analogs (e.g. adenosine/guanine)--->termination of DNA chain
Lactic acidosis
121
Q

What are the side effects of tenofovir/abacavir/zidovudine?

A

Tenofovir—>nephrotoxicity
Abacavir—>hypersensitivity reaction
Zidovudine—>anemia

122
Q

What is the mechanism of NNRTIs? and their common side effects?

A

Bind directly to reverse transcriptase—>inhibit its action
Rash

123
Q

What are the side effects for efavirenz

A

Efavirenz—>CNS symptoms (vivid dream etc.)/teratogen

124
Q

What is the mechanism of protease inhibitors? and their side effects?

A

Bind to protease—>prevent it from cleaving proteins to function subunits
Metabolic toxicities—->dyslipidemia/hyperglycemia/lipodystrophy

125
Q

What is Ritonavir Boosting?

A

Ritonavir is a potent CYP450 inhibitor—>use in low dose with other drugs to increase their half life

126
Q

What is the only HIV drug that is not orally administered? side effect? and when is it used?

A

Enfuvirtide—>entry inhibitor
Increase rate of bacterial pneumonia
When you ran out of other options

127
Q

What is the only HIV drug that targets the host cell?

A

Maraviroc—>CCR5 antagonist

128
Q

Why integrase inhibitors have become the first line treatment?

A

Very effective and low side effects

129
Q

When and who should we start ART (antiretroviral therapy) to?

A

Everyone that has HIV

130
Q

What is HAART and what is its concept?

A

HAART—>high active antiretroviral therapy (combo therapy)

Combine at least 3 drugs with different mechanisms

131
Q

What is the combo of HAART?

A

2 NRTIs + something else like integrase inhibitor/PI/NNRTIs

Preferably with integrase inhibitor or PI

132
Q

What are the HAART goals?

A

Reach undetectable viral load

133
Q

If the resistance is developed against one of the NRTI, can you use another NRTI instead? and is the resistance permanent? and what is the best way to reduce resistance?

A

No because of cross resistance within class
It is permanent
Best way is to adhere to drug treatments—>resistance only develop during replication—>low viral load—>low rate of resistance development

134
Q

Most ppl who got Hep C clear it out or develop chronic Hep C? and is it curable?

A

Most people develop into chronic hep C

It is curable

135
Q

How is Hep C infect cells?

A

Gain entry—>translate RNA into protein—>protease cleave protein into function subunits

136
Q

What is the equivalent to viral cure for Hep C treatment? and what is the definition of SVR

A

SVR (sustained virologic response)—>Hep C remain undetectable 12 weeks after completion of the therapy

137
Q

Why is interferon and ribavirin are no longer used for Hep C treatments?

A

Lower efficacy and a lot of side effects

138
Q

What are the 3 new classes of drugs that treat Hep C? and how are they used?

A

NS (nucleoside) 5B polymerase inhibitors
NS5A inhibitors
NS3/4A protease inhibitors
Combo therapy like HIV

139
Q

What are the mechanisms of NS5B polymerase inhibitor and NS5A inhibitor?

A

NS5B—>compete with nucleotide and cause RNA chain termination like NRTI
NS5A—>inhibit viral phosphoprotein

140
Q

How does HSV replicate?

A

DNA virus enter cell—>use DNA polymerase to make mRNA

141
Q

How is foscarnet used?

A

IV use for acyclovir/ganciclovir resistance HSV/CMV

Lots of side effects

142
Q

What is the mechanism of acyclovir and penciclovir?

A

Need to be phosphorylated by viral thymidine kinase—>only effective in infected cells—>compete with DNA analogue—>terminate DNA chain

143
Q

Why do we use valacyclovir or famciclovir for oral therapy for HSV or VZV instead of acyclovir?

A

Valacyclovir and famciclovir are prodrug that are converted to acyclovir and penciclovir respectively—>higher bioavailability than just acyclovir

144
Q

Side effects of acyclovir?

A

CNS toxicity

Renal dysfunction with high dose

145
Q

What is the PO form of ganciclovir? and side effect of ganciclovir?

A

Valganciclovir

Myelosuppression

146
Q

What is the mechanism of foscarnet?

A

Directly inhibit HSV DNA polymerase/HIV reverse transcriptase

147
Q

What is the mechanism for neuraminidase inhibitors? and what is their greatest benefits of usage?

A

Inhibit neuraminidase—>prevent release of virus from host cell
To reduce rates of complications from influenza with severe disease

148
Q

When should you start neuraminidase inhibitors? and what is their major side effect?

A

Within 48 hours

Neuropsychiatric events—>agitation/anxiety

149
Q

What dose a fungal cell has that we dont?

A

Cell wall and ergosterol

150
Q

What are the MOA of triazoles?

A

Inhibit production of ergosterol by inhibiting 14-alpha-sterol-demethylase

151
Q

What is the spectrum of coverage from least to most of the triazoles?

A

Fluconazole—>voriconazole/itraconazole—>posaconazole

152
Q

What is the side effect of triazoles and which triazoles cause visual disturbance?

A

Liver toxicity

Voriconazole

153
Q

Which triazole has the lowest interaction potency?

A

Fluconazole

154
Q

What is intraconazole used for nowadays?

A

Treatment and prophylaxis for histoplasmosis

155
Q

What is posaconazole mainly used for?

A

Prophylaxis for immunocompromised pt

156
Q

Are triazoles CYP450 inducer or inhibitor?

A

Inhibitor

157
Q

What is the MOA of amphotericin B? side effect?

A

Bind to ergosterol and form pores in the cell wall

Kidney toxicity/acute infusion reaction (fever/rigor)/electrolyte abnormalities

158
Q

How to prevent acute infusion reaction with amphotericin B?

A

Pre treat with H1 blocker or meperidine

159
Q

How to limit amphotericin B side effect?

A

Mix it with lipid

160
Q

MOA of echinocandin? side effect and drug interaction?

A 
Inhibit beta(1.3)-D-glucan synthase--->decrease production of beta(1.3)-D-glucan--->inhibit cell wall formation 
Minimal side effect and drug interaction
161
Q

What is echinocandin most effective against?

A

Candida

162
Q

MOA of flucytosine? what route of administration is is used?

A

pyrimidine analog that inhibit RNA and DNA synthesis/oral only

163
Q

What happens with flucytosine monotherapy and what is the solution?

A

Resistance develops/combo with azole or ampho B

164
Q

Side effect of flucytosine?

A

Bone marrow toxicity

165
Q

Bile acid facilitate excretion of ?

A

Cholesterol/copper/bilirubin

166
Q

First line tx for MRSA?

A

Vanco/dapto/Linezolid

167
Q

What is the mechanism of fentanyl and what is it similar to?

A

Mu agonst—>heroin

168
Q

Pt comes in with altered mental status, the first thing you should think of is?

A

Hypoglycemia

169
Q

What are the 2 natural opioids?

A

Morphine and codeine

170
Q

What is withdraw of opioid caused by naloxone?

A

Flu like symptoms

171
Q

Benzo overdose produce what kind of vital signs? what about barb or alcohol?

A

Normal/respiratory depression

172
Q

What would happen if you give flumazenil to a pt with benzo overdose who takes benzo everyday?

A

Cause acute withdraw—>possible seizure

173
Q

How is overdose acetaminophen toxic?

A

Metabolized by CYP450—>produce NAPQI (toxic)—>glutathione neutralize it–>overwhelm the system—>central lobular necrosis of the liver

174
Q

When should N-acetylcysteine be given?

A

Within 8 hours

175
Q

What else does TCA block besides DA reuptake/M/alpha 1? and which one can kill the pt?

A

Block GABA and Na channel

Na channel blocker—>wide QRS—>ventricular arrhythmia—>death

176
Q

What is the antidote for ventricular arrhythmia caused by TCA overdose?

A

Sodium bicarb

177
Q

Physostigmine should not given to count anti M resulted from the over dose of ___?

A

TCA

178
Q

What else can you give to a pt with anti M besides physostigmine?

A

Benzo to sedate

179
Q

How do methanol and ethylene glycol kill the pt?

A

Metabolites cause acidosis

180
Q

What can you give for pt with non dihydropyridine?

A

Beta agonist/glucagon (like a beta agonist)/insulin/Ca

181
Q

What beta blocker overdose causes the most problems? and why?

A

Propranolol—>lipophilic (CNS effect)/cause wide QRS complex

182
Q

What predicts the severity of digoxin overdose?

A

Level of hyperkalemia

183
Q

What has a higher chance to cause seizure, cocaine or amphetamines?

A

Cocaine

184
Q

Do Cephalosporins has activity against MSSA?

A

Yes

185
Q

Is amoxicillin resistant to beta lactamase?

A

No

186
Q

Gram positive cocci in pairs, what kind of organism is it?

A

S peumoniae

187
Q

Trimethopram acts like what kind of diuretics and cause what?

A

K sparing/hyperkalemia

188
Q

Complicated UTI tx?

A

Gentamicin

189
Q

When do you test for drug resistance for HIV pt?

A

Before starting tx (transmitted resistance) and when tx fails

190
Q

Which class of HIV drugs has the least amount of cross resistance?

A

PI

191
Q

How long is HCV tx usually?

A

12-24wks

192
Q

Is seizure part of opioid overdose?

A

No

193
Q

How is naloxone given for opioid overdose?

A

Continous IV infusion

194
Q

Why don’t we use long acting paralytic agents?

A

Paralytic would stop the seizure in the body but not the brain—>masking brain seizure–>on going brain seizure—>ischemia—>cerebral edema—>death

195
Q

NE has predominately alpha or beta activity?

A

Alpha

ESUN MS2Unit6 (3 decks)

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