Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PAM Semester 2 > Pharmacotherapeutics Exam 3 > Flashcards

Pharmacotherapeutics Exam 3 Flashcards

1
Q

Opportunistic vs. Local

A

Opportunistic infections are those that develop mainly in immunocompromised hosts; primary infections can develop in immunocompetent hosts.

Local fungal infections typically involve the mouth (causingstomatitis), and/or vagina (causingcandidal vaginitis) and may occur in normal or immunocompromised hosts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fungistatic

A

Fungistatic:Anti-fungal agents that inhibit the growth offungus(without killing the fungus)
ex. Fluconazole, Itraconazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fungicide

A

Fungicide: Agents that kill the fungus.

Ex. amphotericin B or echinocandin compound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Triazole family of zoles

A

fluconazole (Diflucan)
itraconazole(Sporanox)
voriconazole(Vfend)

posaconazole (Noxafil)
isavuconazole (Cresemba)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Imidazoles family of zoles

A

ketoconazole (Nizoral) (systemic)
clotrimazole (Lotrimin)(Topical)
miconazole (Monistat)(Topical)
econazole(Topical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diflucan

A

fluconazole (Diflucan)
Vaginal candidiasis 150mg orally once

Potentiates warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TB Drug side effects

INH

A

INH
Iron accumulates (sideroblastic anemia)
Neuritis (give B6)
Hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TB Drug side effects``

Ethambutol

A

Eyes
Red/green discrimination,
visual acuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TB Drug side effects

Pyrazinamide / Puricinamide

A

Hyperuricemia (gout)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TB Drug side effects

Rifampin

A

Red/orange metabolites (orange urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

nontuberculous mycobacteria

A

Mycobacterium aviumcomplex (MAC),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Atypical mycobacterial disease

A

For patients with macrolide-susceptible disease, a multidrug regimen similar to that used for pulmonary MAC disease

(ie, a macrolide plusethambutolplus a rifamycin)

is generally used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ivermectin

A

Ivermectinis the drug of choice for the treatment of onchocerciasis and for strongyloidiasis. Ivermectin is effective against several intestinal nematodes including ascariasis, trichuriasis, and enterobiasis.

Ivermectin is also effective for treatment of ectoparasitic infestations including scabies and head lice.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Albendazole

A

Albendazolehas a broad range of activity against helminthic infections,

including neurocysticercosis, echinococcosis, ascariasis, hookworm, and trichuriasis.

Albendazole also has activity against a number of less common tissue nematode infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ivermectin

A

Indications for STROMECTOL:

Intestinal strongyloidiasis due toStrongyloides stercoralis.

Onchocerciasis due to immatureOnchocerca volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The triazole family benfits

A

The triazole family includesfluconazole,itraconazole,voriconazole,posaconazole, andisavuconazole, which have activity against many fungal pathogens without the serious nephrotoxic effects observed with amphotericin B.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Issues with Ampho B

A

Nephro toxic

contra for preg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ketoconazole side effects

A

GI upset / intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Azoles and candida

A

Despite this mechanism of action, the azoles are generally considered fungistatic againstCandidaspecies

Azole use should be avoided during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Indications for Ketoconazole Tablets:

A

Susceptible systemic fungal infections (blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, paracoccidioidomycosis

Avoid in Acute or chronic liver disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ketoconazole contraindications

A

Acute or chronic liver disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Amphotericin B is considered?

A

Amphotericin B is generally considered cidal against susceptible fungi at clinically relevant concentrations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When to use and not use ampho B

A

Because of the toxicities associated with its intravenous use along with the expanded availability of safer treatment options, amphotericin B is frequently reserved for patients who have severe, life-threatening invasive fungal infections or who are unable to tolerate alternative antifungal agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Echinocandins

A

The first class of antifungals to target the fungal cell wall, was a milestone achievement in antifungal chemotherapy

3 types
caspofungin (Cancidas),
micafungin (Mycamine),
anidulafungin (Eraxis).

Echinocandins are widely used for the treatment of invasive candidiasis,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Echinocandins are widely used for the treatment of

A

invasive candidiasis,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cancidas

A

an echinocandin (Glucan synthesis inhibitor)

Antifungal

warning: Severe hepatic impairment
check LFT’s

Adverse: increased alkaline phosphatase and ALT/AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

albendazole (Albenza)

A

Indications for ALBENZA:

Tapeworms!!!

Parenchymal neurocysticercosis from active lesions due toTaenia solium(pork tapeworm).

Cystic hydatid disease of the liver, lung, and peritoneum due toEchinococcus granulosus(dog tapeworm).

Adverse: Abnormal liver function test, abdominal pain, GI upset,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

permethrin (Nix)

A

Scabies.

Scabicide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anti-protozoal therapy

activity against giardiasis

A

metronidazole (flagyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Anti-protozoal therapy

Activity against pneumocystis

A

trimethoprim-sulfamethoxazole (bactrim)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Anti-protozoal therapy

Activity against amebiasis

A

metronidazole (flagyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

protozoa

A

Giardiasis
Pneumocystis
Amebias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Plaquenil

A

hydorxychloroquine

Adverse:           irreversible retinopathy
Headache, 
dizziness, 
nausea, vomiting, diarrhea, 
abdominal pain, 
visual disturbances, 
rash;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

MOA of -bendazole’s

A

Inhibits microtubule formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pyrantel pamoate MOA

A

Depolarizes neuromuscular junctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

praziquantel MOA

A

Anti Parasitic (flukes)

Increases calcium permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ivermectin MOA

A

GABA agonist
kills microfilaiae
Alters chloride ion permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Diethylcarbamazine MOA

A

Increases phagocytosis of microfilariae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Niclosamide MOA

A

Blocks oxidative phosphorylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Toxoplasmosis treatment

A

If treatment is indicated for acute systemic infection

a pyrimethamine-containing regimen (with eithersulfadiazineorclindamycin) is typically preferred.

However, ifpyrimethamineis not available,

trimethoprim-sulfamethoxazolecan be administered.

The duration of treatment is usually two to four weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Trichomoniasis treatment

A

For nonpregnant females and their sex partners,

7 days ofmetronidazole, 500 mg twice daily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Congenital varicella treatment

Herpes simplex virus Treatment

Human papillomavirus Treatment

All the same

A

Acyclovir

—Newborns with severe disseminated VZV infection (eg, pneumonia, encephalitis, thrombocytopenia, severe hepatitis)

IVacyclovir(30 mg/kg per day in 3 divided doses) for 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Zika virus

A

There is no specific treatment for Zika virus infection

Management consists of :

rest and symptomatic treatment,

including drinking fluids to prevent dehydration

acetaminophento relieve fever and pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Herpes simplex virus

A

Acyclovir

—Newborns with severe disseminated VZV infection (eg, pneumonia, encephalitis, thrombocytopenia, severe hepatitis)

IVacyclovir(30 mg/kg per day in 3 divided doses) for 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Human papillomavirus

A

Acyclovir

—Newborns with severe disseminated VZV infection (eg, pneumonia, encephalitis, thrombocytopenia, severe hepatitis)

IVacyclovir(30 mg/kg per day in 3 divided doses) for 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Lyme disease cause

A

It is a spirochetal infection caused byBorreliaspecies

(Borrelia burgdorferiin the United States)

Lyme disease can involve the skin, joints, nervous system, and heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Lyme disease can involve

A

skin, joints, nervous system, and heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Early stage-erythema migrans treatment

target rash

A

treatment withdoxycyclinefor most patients with early localized Lyme disease for 10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Syphilis cause

A

Treponema pallidum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Syphilis Treatment (all stages)

A

Penicillin is the treatment of choice for all stages of syphilis.

For patients who are allergic to penicillin, alternative agents include tetracyclines,ceftriaxone, andazithromycin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q 
Syphilis Treatment (all stages)
if allergic to penicillin
A

penicillin, alternative agents include

tetracyclines
ceftriaxone
azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Systemic inflammatory response syndrome (Sepsis)

cause

A

Gram positive bacteria are the pathogens that are most commonly isolated from patients with sepsis.

Blood cultures are key!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Pregnancy Ratings

A

ABCD & X

A- Okay for pregnancy

B - okay in pregnant rats (should be ok)

C - adverse effects in animals, no human data

D- Possible fetal risk (weigh benefits vs risks)

X - Fetal abnormalities (not for pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Pregnancy Rating A

A

A- Okay for pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Pregnancy Rating B

A

B - okay in pregnant rats (should be ok)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Pregnancy Rating C

A

C - adverse effects in animals, no human data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Pregnancy Rating D

A

D- Possible fetal risk (weigh benefits vs risks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Pregnancy Rating X

A

X - Fetal abnormalities (not for pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

women with acute cystitis (non pregnant)

A 
Macrobid (100mg BID x 5d)
or
Bactirm (1 DS tab BID x 3d
or
Fosfomycin (3 gms once)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Men with acute cystitis

A 
Macrobid (100mg BID x 5d)
or
Bactirm (1 DS tab BID x 3d
or
Fosfomycin (3 gms once)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Men with acute cystitis & women with acute cystitis (non pregnant)

A 
Macrobid (100mg BID x 5d)
or
Bactirm (1 DS tab BID x 3d
or
Fosfomycin (3 gms once)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Macrobid name

A

Nitrofurantoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

For men with acute cystitis

and prostate involvement

A

ciprofloxacin500 mg BID or 1000 mg ER QD, x 10d

levofloxacin750 mg QD x 5d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Acute UTI pathogen

A

E.Coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

women with acute complicated UTI

outpatient) (nonpregnant

A

fluoroquinolones (eg,levofloxacinorciprofloxacin, given for 5 to 7 days)

or

Bactrim(given for 7 to 10 days).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Pyelonephritis in pregnancy

A 
Mild:
Ceftriaxone
Cefepime
aztreonam
Ampicillin plus gentamicin
Severe:
Piperacillin
Meropenem
Ertapenem
doripenem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Mild Pyelonephritis in pregnancy

A

Ceftriaxone
Cefepime
aztreonam
Ampicillin plus gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Severe Pyelonephritis in pregnancy

A

Piperacillin
Meropenem
Ertapenem
doripenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Keflex

A

1st gen cephalosporin

Potentiates metformin (monitor and adjust metformin dose).

Reactions:
GI upset
abdominal pain
C. difficile-associated diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

ertapenem (Invanz)

A

Carbapenem.
(Bactericidal and inhibits cell wall synthesis)

for complicated UTIs

Contra:
Penicillin, cephalosporin, or other β-lactam allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

nitrofurantoin (Macrobid)

A

For Susceptible acute uncomplicated UTIs.

100mg Q12 x 7d. (with food)

Contras:
Anuria, oliguria, 
CrCl <60mL/min. 
Neonates <1 month of age. 
First trimester
Labor & delivery. Pregnancy at term. 
History of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin.

Preg class B

Antibiotic. Bacteriostatic-Mostly. Inhibits DNA, RNA, protein, and cell wall synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is nitrofurantoin (Macrobid) not used for?

A

Not for treating pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

fosfomycin

A

Uncomplicated susceptible UTIs in women.

Preg Class B

MOA: Bactericidal and inhibits cell wall synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Zosyn (piperacillin)

A

Contraindications:
Penicillin, cephalosporin, or β-lactamase inhibitor allergy.

ZOSYN 3.375g Classification:
Broad-spectrum penicillin + β-lactamase inhibitor.

Adverse: difficile-associated diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Pediatric UTI Treatment

A

empiric therapy for coverage forEscherichiacoli

second- or third-generation cephalosporin
rather than
amoxicillin-clavulanate,trimethoprim-sulfamethoxazole(TMP-SMX), or a first-generation cephalosporin as the first-line agent for these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

phenazopyridine (Azo and others)

A

Discolors urine and fabric (red-orange).

Urinary tract analgesic.

Interferes with colorimetric urine tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Urethritis (STD / Men)

A

Urethritis (STD / Men)
pain, burning, or stinging, discharge, fluid leak

Chlamydia, Gonorrhea, Mycoplasma genitalium, and Trichomoniasis

gonococcal urethritis, intracellular diplococci

IM CEF 500mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Urethritis in women

A

chlamydia, gonorrhea, trichomoniasis,Candidaspecies, herpes simplex virus, and noninfectious irritants, such as a contraceptive gel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Most common pathogens of urethritis

A

Neisseria gonorrhoeae, Chlamydia trachomatis,andMycoplasma genitaliumare the most common organisms associated with urethritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

nongonococcal urethritis

A

azithromycin(1 g).single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Urethritis gonococcal

A

IM CEF 500mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

The most common causes of acute scrotal pain in adults are?

A

acute epididymitis and testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

acute epididymitis tests

A

urinalysis and urine culture

diagnostic studies forNeisseria gonorrhoeaeandChlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Causes of acute epididymitis in men under the age of 35.

A

N. gonorrhoeaeandC. trachomatisare the most common organisms responsible for acute epididymitis in men under the age of 35.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Causes of acute epididymitis in men over the age of 35.

A

usually Escherichia coli,

often in association with obstructive uropathy from benign prostatic hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Treatment of epididymitis (under 35)

A

Cef 500mg IM

plusdoxycycline100 mg Bid for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Treatment of epididymitis (over 35) who are at low risk for sexually transmitted infections:

A

levofloxacin500 mg QD for 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Treatment of epididymitis Males of any age who practice insertive anal intercourse

A

Cef 500mg IM
plus
levofloxacin500 mg QD for 10 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Orchitis

A

Orchitis causes pain and can affect fertility.

Bacterial or viral infections can cause orchitis, or the cause can be unknown.

Orchitis is most often the result of a bacterial infection, such as a sexually transmitted infection (STI).

In some cases, the mumps virus can cause orchitis.

If viral, look for Mumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

If Orchitis is viral look for?

A

Mumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Acute Bacterial Prostatitis (ABP)

A

Patients are typically acutely ill, with spiking fever, chills, malaise, myalgia, dysuria, irritative urinary symptoms (frequency, urgency, urge incontinence), pelvic or perineal pain, and cloudy urine.

The prostate is often firm, edematous, and exquisitely tender. Common laboratory findings include peripheral leukocytosis, pyuria, bacteriuria, and, occasionally, positive blood cultures. Inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) are elevated in most cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Acute Bacterial Prostatitis (ABP)

Treatment

A

Empiric treatment withtrimethoprim-sulfamethoxazoleor a fluoroquinolone, unless drug resistance is suspected

Bactrim DS: (off-label use): BID x 6wks

Cipro: 500 mg Q12 x 4 to 6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Chronic Bacterial Prostatitis (CBP)

A

very common, with E.colibeing most common

On rectal examination, there may be prostatic hypertrophy, tenderness, edema, and nodularity. However, the prostate exam is frequently normal.

Presentation may be subtle or have little or no symptoms

94
Q

Chronic Bacterial Prostatitis (CBP)

Treatment

A

Fluoroquinolones and sulfonamides

Bactrim DS: (off-label use): BID x 6wks

Cipro: 500 mg Q12 x 4 to 6 wks

95
Q

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

A

In most patients, we suggest combination therapy with an alpha blocker and an antiinflammatory agent.

A reasonable option is(flomax) tamsulosin0.4 mg daily for six weeks andibuprofen400 mg three times daily for one week.

96
Q

Types of incontinence

A

Stress (weak pelvic muscles)
Urge (involuntary contraction of bladder)
Overflow (blockage of urethra)
Neurogenic (Nervous system issues)

97
Q

Stress incontinence Causes

A

due to increased abdominal pressure under stress

Weak pelvic floor muscles

98
Q

Urge incontinence Causes

A

due to involuntary contraction of the bladder muscles

99
Q

overflow incontinence Causes

A

due to blockage of the urethra

100
Q

Neurogenic incontinence Causes

A

due to disturbed function of the nervous system

101
Q

Overactive bladder

A

Detrusor muscle contracts before bladder is full

102
Q

General antimuscarinic (anticholinergic) issues:

A

All antimuscarinics are contraindicated in
gastric retention,
untreated narrow angle closure glaucoma,
and supraventricular tachycardia

they all cause dry mouth, constipation, tachycardia, palpitations

All have additive effects with first-generation H1 antihistamines

Red, dry, blind, hot, mad,

103
Q

Generic and Trade names-Antimuscarinic

For UUI/OAB

A 
darifenacin (Enablex)
fesoterodine (Toviaz)
oxybutynin (Ditropan)
solifenacin (Vesicare)
tolterodine (Detrol)
trospium(Sanctura)
104
Q

For women who cannot tolerate antimuscarinic therapy?

A

Mirabegron

105
Q

Treatment of mixed urinary incontinence should begin with?

A

lifestyle modification and pelvic floor muscle training.

(also pessary)

May be exacerbated by pregnancy (consult ob/gyn)

106
Q

oxybutynin (Ditropan)

A

bladder instability (preg cat B)

Antispasmodic/anticholinergic.

uninhibited neurogenic or reflex neurogenic bladder

(eg, urinary urgency, frequency, leakage, urge incontinence, dysuria).

adverse:
Dry mouth, constipation, somnolence, headache, diarrhea, nausea, tachycardia, blurred vision, dry eyes, other anticholinergic effects.

107
Q

oxybutynin (Ditropan)

contraindications

A

Contra:
Uncontrolled glaucoma.
GI obstruction. Paralytic ileus. Intestinal atony in elderly or debilitated. Severe colitis. Myasthenia gravis. Megacolon. Toxic megacolon in ulcerative colitis
SVT

108
Q

mirabegron (Myrbetriq)

A

(Beta-3 adrenergic agonist)

overactive bladder

Adverse rx = hypertension

Warnings:
Severe uncontrolled hypertension: not recommended.

Monitor blood pressure periodically.

Significant bladder outlet obstruction,

patients taking antimuscarinic drugs for OAB: risk of urinary retention

109
Q

Benign prostatic hyperplasia (BPH)

A

increased frequency of urination, nocturia, hesitancy, urgency, and weak urinary stream

110
Q

tamsulosin (Flomax)

A

BPH (alpha blocker)

Warnings:
Rule out prostate cancer.
Sulfa allergy. Syncope. End-stage renal disease. Severe hepatic impairment. Cataract or glaucoma surgery

Adverse Reactions:
Headache, abnormal ejaculation, dizziness, rhinitis, infection, asthenia, back pain, diarrhea,

111
Q

finasteride (Proscar)

A

Not for use in children or women. Pregnant women (Cat.X)

Type II 5 alpha-reductase inhibitor.

used for BPH, urinary retention

Impotence, decreased libido or ejaculate volume, breast enlargement or tenderness

Increased risk of high-grade prostate cancer. Monitor prostate specific antigen (PSA) values; double PSA levels for comparison with normal ranges.

112
Q

PDE-5 inhibitors

A

tadalafil is approved for BPH

can potentiate the hypotensive effects of alpha-1-adrenergic antagonists.

113
Q

Tadalafil (cialis)

A

PDE-5 inhibitors
Phosphodiesterase type 5 inhibitor (cGMP-specific).

Contra
NItrates
Hypotension with nitrates
other antihypertensives, alcohol (≥5 units).

Benign prostatic hyperplasia (BPH). Limitations of use: if concomitant with finasteride to initiate BPH treatment, such use is recommended for up to 26 weeks

114
Q

BPH instructions

A

avoiding fluids prior to bedtime or before going out, reducing consumption of mild diuretics such as caffeine and alcohol, and double voiding to empty the bladder more completely

115
Q

BPH with ED

A

(PDE)-5 inhibitors are a reasonable alternative to alpha-1-adrenergic antagonists

116
Q

Mild to mod BPH

A

For most patients with mild to moderate symptoms of BPH
(ie, International Prostate Symptom Score [IPSS] <8 or 8-19, respectively,

we suggest monotherapy with an alpha-1-adrenergic antagonist for initial treatment.

if cant tolerate alpha 1 give finasteride

117
Q

Severe BPH (over 40ml)

A

Alpha 1 and alpha 5

Tamsulosin and finasteride

118
Q

Urethral disorders

A

Prolapse

119
Q

Testicular disorders

A

Torsion
Hydrocele
Varicocele

120
Q

Penile disorders

A

ED

121
Q

4 types of stones

A

Uric acid
Calcium
struvite
Cystine

122
Q

Uric acid Stones

A

people who don’t drink enough water
high protein diets
gout

123
Q

Calcium Stones

A

Most common
high calcium
high vit D
intestinal bypass surgery

124
Q

struvite Stones

A

form from UTI
Grow quickly
become large

125
Q

Cystine Stones

A

hereditary disorder of kidney

kidney secrets too much AA cystine

126
Q

Stones < 5 mm

A

Patients should be instructed to strain their urine for several days and bring in any stone that passes for analysis.

Bothtamsulosin (alpha-1 blocker) andnifedipine (calcium channel blocker)have been shown to increase the likelihood of stone passage
Tamulosin is better

127
Q

Stones 5-10 mm

A

If signs of infection, then immediate need of IV antibiotics before anything else!

If complicating factors (Infection) such as fever, gross hematuria, massive intractable pain then hospitalization is a must!

Hydration then pain control then surgery

128
Q

Stones > 10 mm

A

If signs of infection, then immediate need of IV antibiotics before anything else!

If complicating factors (Infection) such as fever, gross hematuria, massive intractable pain then hospitalization is a must!

IV Hydration with IV pain control then surgery. Analgesics including morphine, meperidine, or ketorolac.

Hydronephrosis can happen

129
Q

5 classes of antibiotics that can cause kidney stones

A 
Sulfa
Ceph
Fluoroquin
Nitrofurantoin
Broad spectrum penicilins
130
Q

Antibiotic for Stones

A

If signs of infection usually for pre-op!

Most common Zosyn!

131
Q

Drugs used for helping stone passage

A

tamulosin & nifepedine for 4 weeks

then reimage

Alpha-1 blockers are the best med for passage of 5-10 mm stones (tamulosin)

132
Q

alprostadil (Muse)

A

Urethral suppository or injection

Prostaglandin.

Smooth muscle relaxant

Side effects:
lightheadedness, burning sensation, priapism

Contraindications:
Urethral stricture. Balanitis. Severe hypospadias and curvature. Acute or chronic urethritis. Predisposition to venous thrombosis (eg, sickle cell anemia or trait).

133
Q

Prepubertal girls with symptomatic urethral prolapse can be treated with

A

topical estrogen therapy (eg, Premarin cream or Estrace cream 0.01%) similar to postmenopausal women with this problem.

134
Q

Metabolic acidosis

A

characterized by a low serum HCO3 and a low arterial pH; the serum anion gap may be increased or normal

135
Q

Metabolic alkalosis

A

is characterized by an elevated serum HCO3 and an elevated arterial pH.

136
Q

Respiratory acidosis

A

characterized by an elevated arterial PCO2 and a low arterial pH.

137
Q

Respiratory alkalosis

A

characterized by low arterial PCO2 and an elevated arterial pH.

138
Q

MUDPILES

Metabolic Acidosis –anion Gap

A 
M= Methanol, metformin
U= Uremia
D= Diabetic ketoacidosis (also consider alcoholic, starvation ketoses)
P= Paracetamol (APAP), Paraldehyde (anticonvulsant), propylene glycol (hand sanitizer, medication solvent, artificial tears, antifreeze)
I= Iron, isoniazid (TB medication), inborn errors of metabolism
L= Lactic acidosis
E= Ethanol, ethylene glycol (antifreeze, coolants, TASTES GOOD!)
S= Salicylates
139
Q

Acid Base

ROME

A 
Respiratory Opposite
(pH up, CO2 down)(alk)
(pH down, CO2 up)(Acid)

Metabolic Equal
pH up, HCO3 up (alk)
pH down, HCO3 down (Acid)

140
Q

Metabolic Acidosis Treatment

A

sodium bicarbonate

141
Q

Metabolic alkalosis Treatment

A

Fix Cause of too much bicarb

i.e. Stop vomiting, stop loop/thiazide diuretics etc

142
Q

Metabolic alkalosis

What is also often present and needs correcting

A

Hypokalemia

treat with potassium, potassium sparing diuretic

143
Q

Respiratory Alkalosis Treatment

A

treat the underlying cause (hyperventilation)

(eg, reassurance, anxiolytic, pain control)

(sedation, reduce respiratory rate and/or tidal volume when on mechanical ventilation

144
Q

Hypokalemia most common cause

A

The most common causes of hypokalemia are gastrointestinal or urinary losses due to vomiting, diarrhea, or diuretic therapy.

145
Q

6 L’s of Hypokalemia

A 
Lethargy
Lethal cardiac arrhythmias
Leg cramps
Limp muscles
Low breathing (shallow respirations)
less stool (constipation)
146
Q

Hypokalemia Treatment

A

Oralpotassium chloride

mild to moderate hypokalemia (serum potassium 3.0 to 3.4 mEq/L

147
Q

Potassium chloride (Klor-Con, K-dur)

A

8mEq, 10mEq
Hypokalemia, including that caused by diuretics.

Contra: Hyperkalemia.
Adverse: Hyperkalemia.

Interactions:
Hyperkalemia with ACE inhibitors, spironolactone, triamterene, amiloride, and potassium-containing salt substitutes.

148
Q

Hyperkalemia Treatment

A

(potassium antagonist)
Calcium

(push extra-cell potassium into cells)
Insulin / glucose
sodium bicarb (meta acid)
Beta 2 agonist (albuterol)

(get rid of potassium)
loop/thiazide diuretics
dialysis
kayexalate

149
Q

Hyperkalemia Treatment

3 approaches

A
  1. protect the heart
    (calcium)
  2. redistribute potassium
    (insulin, dextrose, bicarb, beta 2)
  3. increase potassium excretion
    (kayexalate, dialysis)
150
Q

Sodium polystyrene sulfonate; (KAYEXALATE)

A

Not for treating life-threatening hyperkalemia due to its delayed onset of action.

Cation exchange resin.

151
Q

hyponatremia acute vs chronic

A

Acute – If the hyponatremia has developed over a period of less than 48 hours, it is called “acute.”

Chronic – If it is known that hyponatremia has been present for more than 48 hours

152
Q

hyponatremia

Mild, moderate, severe

A

Mild = 130-134

Moderate = 120-129

Severe = below 120

153
Q

hyponatremia treatment goal timeframes

A

raise sodium 4-6 per 24 hours

in severe max is 8 in 24 hours

154
Q

Acute hyponatremia

A

less than 130

Asymptomatic = 50 ml 3% Saline (hypertonic)

155
Q

SIADH Tx

A

fluid restriction, hypertonic saline

156
Q

Hyponatremia

Hypovolemic, Hypervolemic, Euvolemic

A

Hypovolemic
Normal saline 500-1000mL/hr until BP stable, then 200mL/hr while checking sodium frequently to ensure only rising about 0.5meq/hr

Hypervolemic- Fluid restriction, loop diuretics if severe. In special cases: hemodialysis, albumin, paracentesis

Euvolemic- Free water restriction. Caution: in SIADH, saline may worsen due to retaining the free water.

157
Q

Hyponatremia

Hypovolemic,

A

Normal saline 500-1000mL/hr until BP stable, then 200mL/hr while checking sodium frequently to ensure only rising about 0.5meq/hr

158
Q

Hyponatremia

Hypervolemic,

A

Fluid restriction, loop diuretics if severe. In special cases: hemodialysis, albumin, paracentesis

159
Q

Hyponatremia

Euvolemic,

A

Free water restriction. Caution: in SIADH, saline may worsen due to retaining the free water

160
Q

Hypernatremia Tx

A

hypotonic fluids: H2O, D5W, 0.45 NS, 0.2 NS,

use isotonic fluids if hypovolemic – NS or Lactated ringers.

3 steps:
Correct shock (Normal saline!)

Treat underlying cause (fever, vomiting, diabetes insipidus, etc)

Replace water deficit

161
Q

Hypernatremia 3 steps of Tx

A

Correct shock (Normal saline!)

Treat underlying cause (fever, vomiting, diabetes insipidus, etc)

Replace water deficit

162
Q

Hypocalcemia causes

A

LOW CALCIUM

Low pth
Oral intake inadequate (alcohol, bulimia)
Wound drainage (GI)
Celiacs, chrohns
Acute pancreatitis
Low vit D (calcium reabsorb)
CKD
Increased Phosphorus (CA and phos are opposites)
Using meds (mag, laxatives, loop, calcium binders)
Mobility Issues

163
Q

Hypocalcemia Signs and symptoms

A

CRAMP

Confusion
Refelexes hyperactive
Arrhythmias (prolong QT/ST)
Muscle spasms
Positives Trousseaus
164
Q

Hypocalcemia Tx

A

IV calcium therapy in asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL

for milder - use oral calcium supplements

also use vitamin D supplements

165
Q

Hypercalcemia Tx

A

lowering the serum calcium concentration and, if possible, treating the underlying disease.

166
Q

zoledronic acid(Reclast)

A

Bisphosphonate

Contraindications:
Hypocalcemia

Preg Cat D

167
Q

denosumab (Prolia)

A

Osteoclast inhibitor (RANKL inhibitor).

Should be administered by a healthcare professional. 60mg SC once every 6mos

Contraindications:
Hypocalcemia. Pregnancy.

168
Q

Hyperphosphatemia Signs & Symptoms

A

Same as hypocalcemia (CA and phos are opposites)

CRAMP

Confusion
Refelexes hyperactive
Arrhythmias (prolong QT/ST)
Muscle spasms
Positives Trousseaus
169
Q

Hyperphosphatemia Causes

A

Same as hypocalcemia (CA and phos are opposites)

LOW CALCIUM

Low pth
Oral intake inadequate (alcohol, bulimia)
Wound drainage (GI)
Celiacs, chrohns
Acute pancreatitis
Low vit D (calcium reabsorb)
CKD
Increased Phosphorus (CA and phos are opposites)
Using meds (mag, laxatives, loop, calcium binders)
Mobility Issues

170
Q

Kidneys

Physiology, Pharmacodynamics and Pharmacokinetics

A

Major function is to eliminate excess ions and wastes from the blood.

Renal clearance = ability of the kidneys to remove molecules from blood plasma by excreting them into urine.

Secretion = Molecules/ions move out of the peritubular capillaries and into the interstitial fluid

Reabsorption decreased renal clearance; Secretion increases renal clearance

Rate of excretion= Filtration rate + secretion rate - Reabsorption rate

171
Q

GFR normal values

A

approx 130 for men
approx 120 for women

Depends on age, sex, body, etc.
tends to decrease with age

172
Q

GFR filtration marker

gold standard

A

Inulin

173
Q

Creatinine clearance equation

A

CKD-EPI equation

Most accurate

174
Q

Drugs associated with Acute renal failure

Pre renal

A

Diuretics

NSAIDS

175
Q

Drugs associated with Acute renal failure

Intrinsic

A

Antibiotics

Aminoglycosides
Penicillin
Tetracyclines
fluoroquinolones
cephalosporins
Pentamitidine
176
Q

Drugs associated with Acute renal failure

Post renal

A

Sulfonamides

Acyclovir

177
Q

Antibiotic renal dosing

A

Most antibiotics are subject to renal dosing for kidney issue patients

178
Q

AKI / AKF

RIFLE criteria

A

Risk (increased creatinine 1.5x / low urine output 6-12hr)

Injury (increased creatinine 2x / low urine output 12-24hr)

Failure (increased creatinine 3x / low urine output over 24hr or renal replacement therapy)

Loss (renal replacement therapy greater than 4 weeks)

End stage (renal replacement therapy greater than 3 months)

179
Q

Acute Interstitial Nephritis

A

Drug causes:
PCN, Sulfa, Cipro, Cephalosporins, Rifampin, Allopurinol

SCCRAP

Urinalysis will show WBC Casts

TX – remove offending agent

180
Q

Acute Tubular Necrosis (ATN)

A

Acute destruction and necrosis of the renal tubules of the nephron

Exogenous toxic Causes:
dye, Vanco, aminoglycosides, NSAIDS

Urinalysis - ”Muddy Brown Casts”,

TX – first – IV fluids and remove offending agent(s)

181
Q

Urinalysis with muddy brown casts

A

Acute Tubular Necrosis (ATN)

182
Q

Urinalysis with WBC Casts

A

Acute Interstitial Nephritis

183
Q

Acute Glomerulonephritis

A

Several etiologies – post-infection (think strep)

Tx: All forms except the rapidly progressive forms are typically self-limiting

Edema, HTN, hypervolemia – Loop diuretics, beta-blockers, CCBs

Post strep AGN- maybe antibiotics

184
Q

Renal Vascular Hypertension (Intrinsic)

A

most common cause of secondary HTN

Tx Gold standard – revascularization via renal catheter arteriography both diagnoses and treats

Medical management – ACE-I or ARBs.
BUT
– both are contraindicated if bilateral stenosis present or if the patient has only 1 kidney!

185
Q

most common cause of secondary HTN

A

Renal Vascular Hypertension (Intrinsic)

186
Q

-pril

A

ACE

187
Q

-Sartan

A

ARB

188
Q

lisinopril (Zestril)

A

ACE

Contra: History of ACEI-associated or other angioedema

Adverse Rx: Cough, Hyperkalemia, angioedema

Fetal Toxicity (preg cat X)

189
Q

ACE side effects

A

Cough!!
prevents the breakdown of bradykinin and substance P, resulting in an accumulation of these protussive mediators in the respiratory tract.

Angioedema
ACE inhibitor-inducedangioedemaare related to elevated levels of bradykinin, an inflammatory vasoactive peptide, which leads to vasodilation of blood vessels

190
Q

valsartan (Diovan)

A

Angiotensin II receptor blocker (ARB).

Fetal Toxicity (preg cat X)

191
Q

Natriuretic Diuretics

A

Natriuretic diuretics are among the most commonly used drugs

They act by diminishing sodium reabsorption at different sites in the nephron, thereby increasing urinary sodium and water losses

192
Q

Diuretic types Drugs

A 
Thiazide
Loop
Potassium sparing
Carbonic Anhydrase inhibitors
Osmotic
193
Q

Thiazide diuretics Drugs

A

HCTZ
Metolazone
Chlorothiazide
Chlorthalidone

194
Q

Loop Diuretics Drugs

A

Bumetanide
Furosemide
Torsemide

195
Q

Potassium sparing Diuretics Drugs

A

Amiloride
Eplerenone
Spiralactone
Triamterene

196
Q

Carbonic Anhydrase inhibitors Drugs

A

Acetazolamide

197
Q

Osmotic Diuretics Drugs

A

Mannitol

Urea

198
Q

Thiazide diuretics Drugs MOA

A

Early distal tubule

Inhibition of sodium, chloride, cotransport

199
Q

Loop Diuretics Drugs MOA

A

Loop of Henle (thick ascending limb)

Inhibition of sodium, chloride, potassium cotransport

200
Q

Potassium sparing Diuretics Drugs MOA

A

Late distal tubule
Collecting duct

Inhibition of sodium reabsorption and potassium secretion

201
Q

Carbonic Anhydrase inhibitors Drugs MOA

A

Proximal tubule

Inhibition of bicarbonate reabsorption

202
Q

Osmotic Diuretics Drugs MOA

A

Proximal tubules
loop of Henle
collecting duct

inhibition of water and sodium reabsorption

203
Q

furosemide (Lasix)

A

Diuretic (loop). used for edema

Initially 20–80mg daily

Contraindications:
Anuria.

Adverse Reactions:
Excessive diuresis, fluid or electrolyte imbalance

204
Q

hydrochlorothiazide (HCTZ)

A

Diuretic (thiazide).

Contraindications:
Anuria. Sulfonamide allergy.

Warnings
Renal or hepatic impairment. Arrhythmia. Diabetes. Gout. Asthma. SLE.

Preg Cat B

Adverse Reactions:
Electrolyte disorders (esp. hypokalemia), hyperglycemia, hyperuricemia,
205
Q

acetazolamide (Diamox)

A

Carbonic anhydrase inhibitor.

used for Acute high altitude sickness

INJECTION Contraindications:
Hypokalemia. Hyponatremia, Sulfonamide allergy.

206
Q

spironolactone (Aldactone)

A

Diuretic (K+sparing).

Contraindications:
Hyperkalemia. Addison’s disease. Concomitant eplerenone.

Boxed Warning:
In toxicity studies, shown to be tumorigenic in rats

Warnings:
Increased risk of hyperkalemia in renal impairment

Adverse Reactions:
Gynecomastia

Increased risk of severe hyperkalemia with concomitant K+supplements, K+containing salt substitutes, or drugs that increase potassium (eg, ACEIs, ARBs, NSAIDs, heparin, LMWH, trimethoprim);

207
Q

CKD

A

Kidney Damage for 3 or more months
(regardless of cause)

GFR less than 60
or
albumin excretion 30 or greater

208
Q

Causes of CKD

A 
#1 Diabetes 
#2 Hypertension
#3 other
also barely PKD and Glomerular disease
209
Q

CKD risks

A 
Smoking
diabetes
over 60
family history
obesity
heart disease
hypertension
210
Q

GFR number by stages

A

Normal = or > than 90

Mild = 60-89

Moderate = 30-59

Severe = 15-29

Failure = less than 15 or on dialysis

211
Q

CKD is associated with higher risks for?

A 
cardiovascular disease
end-stage renal disease (ESRD)
infection
malignancy
mortality
212
Q

CKD Management

A

treatment of reversible causes of renal dysfunction and preventing or slowing the progression of renal disease

213
Q

When should CKD patient be referred to Nephrologist?

A

When eGFR is <30

in order to discuss and potentially plan for renal replacement therapy

214
Q

CKD Tx

A

Treat the HTN – ACE-I or ARBs – do this early in disease!

Renal transplantation is the treatment of choice for patients with end-stage renal disease

215
Q

Treatment of choice for patients with end-stage renal disease

A

Renal transplantation

216
Q

What is the major cause of death and graft loss in diabetic renal transplant recipients.

A

CVD

217
Q

Diabetes in Kidney transplant

A

Diabetes mellitus commonly develops within the first few months posttransplant,

but there is continued risk for the life of the patient and transplant.

Patients should be screened with a fasting blood glucose weekly for the first four months after transplantation,

and then at three and six months and annually thereafter

218
Q

Common diseases in kidney transplant

A 
CVD
HTN
Diabetes
Bone disease
Cancer
219
Q

Pregnancy in kidney transplant

A

Pregnancy in a transplant recipient is considered high risk

220
Q

What vaccine should kidney transplant patients have?

A

PneumococcalVaccine

221
Q

PKD Tx

A

Prevent complications and preserve renal function = control BP and treat UTIs aggressively

No cure

Treatment is supportive

Pain management,
HTN with ACE & ARB
Infections with antibiotics
dialysis or transplantation

222
Q

Horseshoe Kidney Tx

A

TX – most do not require treatment unless infection/obstruction present

223
Q

Hydronephrosis Tx

A

Remove obstruction

224
Q

Renal Cell Carcinoma Tx

A

partial or radical nephrectomy

225
Q

Wilms Tumor/Nephroblastoma Tx

A

total nephrectomy plus chemotherapy

226
Q

Nephrotic Syndrome

A

Proteinuria > 3.5g/DAY

Most common in children

Focal segment glomerulosclerosis” – HIV, heroin, HTN

African American patients

227
Q

Nephrotic Hallmark Features

A

HYPOalbuminemia

HypErcholesterinemia

EDEMA

228
Q

Nephrotic Syndrome Tx

A

glucocorticoids (SLE or MCD), loop or thiazide diuretics, ACE or ARB, statin

229
Q

Nephritic Syndrome

A

proteinuria, HTN (always),

230
Q

Nephritic Syndrome Tx

A

Steroids (SLE, Wegner’s, Goodpasture’s)

Treat underlying cause
General Measures
Control HTN
Aggressive treatment of infection

Avoid nephrotoxins
NSAIDs, radiocontrast, aminoglycosides

231
Q

Primaquine

A

Stops the latent reactivity of malaria

232
Q

Pregnant uncomplicated

A

macrobid
augmentin/amox
keflex

PAM Semester 2 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions