Prototype Drug

Question 1

Amoxicillin

Answer 1

Broad spec; +/-, some anaerobic
oral, excreted renally
CWI

Question 2

Beta-Lactamase Inhibitors

Answer 2

Agumentin (Clauvulanic acid + amoxicillin)
Unasyn (Sulbactam)
Zosyn (Tazobactam)
CWI

Question 3

Agumentin: (Clauvulanic acid + amoxicillin)

Answer 3

covers gram +/- and some anaerobic organisms, beta-lactamase produced
AE: hypersensitivity, diarrhea
CWI

Question 4

Cephalosporins

Answer 4

similar to penicillin so allergies

CWI

Question 5

Cephalexin (Keflex)

Answer 5

Mainly active against gram + (skin flora)
AE: nausea, vomiting, diarrhea
CWI
1st gen

Question 6

Ceftriaxone

Answer 6

IV or IM, some +/- coverage
great CNS penetration
AE: hypersensitivity, may increase bleeding tendencies 
Contra: avoid in neonates for billi
CWI
3rd gen

Question 7

Doxycycline

Answer 7

gram +/-, mycoplasma pneumniae, chlamydia, tick borne
AE: photo-toxicity, tooth discoloration, C. diff
DI: binds to cations (avoid milk), oral contraceptives
bacteriostatic broad
PSI

Question 8

Azithromycin

Answer 8

reversibly binds to 50s ribosomonal subunits inhibiting protein synthesis
can cover atypical organisms: mycoplasma, legionella, chlamydia
AE: N/V, abdominal pain, from risk of QT prolongation of EKG

Question 9

Metronidazole

Answer 9

Protozoa, anaerobic bacteria
MOA: inhibits nucleic acid synthesis= cell death
DI: Ethanol: facial flushing, vomiting, tachycardia
AE: nausea, headache, metallic taste, hypersensitivity reactions
Bacteriocidal but fairly narrow spectrum

Question 10

Fluconazole

Answer 10

MOA: inhibition of CYP450
used for candida
AE: N, headache, rash, abdominal pain, 
DI: inhibition of CYP3A4
Fungistatic

Question 11

unfractionated heparin

Answer 11

anticoagulant
binds to/enhance the effects of anti-thrombin>inactivation of thrombin & factor Xa
IV, SQ
AE: bleeding, heparin-induced thrombocytopenia

Question 12

Enoxaprin (lovenox)

Answer 12

anticoagulant: lower molecular weight heparin
enhance the effects of anti-thrombin>inactivation of factor Xa
SQ
AE: bleeding, heparin-induced thrombocytopenia
no protein binding, more predictable bioavailability

Question 13

Warfarin (coumadin)

Answer 13

anticoagulant: Vitamin K antagonist
inhibits synthesis of Vit K dependent clotting factors (VII, IX, X & thrombin)
AE: bleeding
Antidote: (Vitamin K), be careful of veg consumption

Question 14

Dabigatran (pradaxa)

Answer 14

anticoagulant: direct thrombin inhibitor
AE: bleeding, GI effects (pain, nausea, dyspepsia)

Question 15

Rivaroxaban (Xarelto)

Answer 15

anticoagulant: direct factor Xa inhibitor
AE: bleeding

Question 16

Ferrous Sulfate

Answer 16

nutritional sup for iron deficiency anemia
AE: GI effects: nausea, heartburn, CONSTIPATION, and diarrhea, can turn stools dark green or black
Can be toxic in large doses: treat with deferoxamine
DI: reduced absorption if taken with antacids; increased absorption if given with vita C but also increases AE

Question 17

Iron Dextran

Answer 17

parenteral iron preparation for iron deficiency anemia

AE: anaphylactic reactions, hypotension, circulatory failure, cardiac arrest

Question 18

cyanocobalamin

Answer 18

Vitamin B12 product
helps activate folic acid?
AE: generally safe, may see hypokalemia due to erythrocyte production
PO, IM, SC, intransally (NEVER IV), must be deep IM/SC

Question 19

Folic Acid

Answer 19

Nutritional sup, essential for DNA synthesis
important for early pregnancy: neural tube defects
PO or IV

Question 20

Erythropoietin (Procrit)

Answer 20

Erthropoietic growth factor
SC or IV
stimulate RBC formation (renal disease, oncologic/hematologic)

Question 21

Lisinpril (Zestril)

Answer 21

ACE inhibitor
shown to slow progression of kidney injury in diabetes pt
AE: persistant cough, hyperkalemia, teratogenic, angioedema

Question 22

Losartan (Cozaar)

Answer 22

Angiotensin Receptor Blocker
does not cause ACE cough
AE: teratogenic, angioedema, hyperkalemia,

Question 23

Amlodipine

Answer 23

Calcium Channel Blocker
dilates blood vessels
can cause a reflexive tachycardia
AE: peripheral edema (problem if already HF edema)

Question 24

Hydralazine

Answer 24

Vasodilator
PO/ IV
AE: tachycardia, can cause SLE

Question 25

Metroprolol (Lopressor)

Answer 25

Beta Adrenergic Blocker (sympatholytics)
decreased cardiac output, suppress reflex tachycardia, reduces release of renin
AE: bradycardia, heart block, bronchoconstriction (be careful with asthma)

Question 26

Labetalol (Trandate)

Answer 26

Combination Beta & Alpha Blocker
decreased cardiac output, suppress reflex tachycardia, reduces release of renin
AE: bradycardia, heart block, bronchoconstriction (be careful with asthma)

Question 27

Nitrofuratoin (Macrobid, Macrodantin)

Answer 27

Nitrofuran Antibiotic
some gram +/-
bacteriostatic but can be bactericidal at high does
Good for UTI (only therapeutic in the urine)
Metabolism inhibitor (folate antagonist); damages DNA
avoid in patients with decreased kidney function; good for pregnancy
AE: brown urine, GI disturbances (N/V/D), pulmonary reactions, peripheral neuropathy, hepatotoxicity

Question 28

Trimethoprim/Sulfanethoxazole (Bactrium, Septra)

Answer 28

Sulfonamide Antibiotic (SS or DS)
Good for UTI; broad spectrum
Inhibitors of folate synthesis and reduction; bacteriostatic
DI: warfarin (increased bleeding)
AE: Hyperkalemia, thrombocytopenia, neutropenia, megaloblastic anemia, Kernicterus, renal dysfunction, hypersensitivity reactions (Stevens-Johnson)

Question 29

sodium bicarbonate

Answer 29

electrolyte
uses: metabolic acidosis, hyperkalemia (doesn’t fix it/bandaid)
AE: can be caustic to the vasculature; can cause hypokalemia, Metabolic alkalosis

Question 30

potassium chloride

Answer 30

common choice
IV and PO
for hypokalemia but don’t make them hyper
AE: GI: N/V/D, abdominal discomfort, esophagitis. give with food!
IV can cause local irritation and pain

Monitor serum K levels, signs of hyperkale, IV site
Contraindications: monitor in renal dysfunction, and other meds that increase K

Question 31

magnesium sulfate

Answer 31

IV
replacement
Uses: hypomagnesemia, preeclampsia and eclampsia, migraines, status asthmaticus
Mag: activates IC enzymes
binds mRNA to the ribosomes
helps skeletal muscle contractility and blood coag.

Question 32

calcium chloride

Answer 32

1g=3g of gluconate (more potent/ elemental Ca)
more caustic to the vasculature, admin centrally
if give too fast, kidneys will dump it

Question 33

dextrose 50% injection

Answer 33

treatment for hyperkalemia with IR: shifts K back into cells (doesn’t get rid of it)

Question 34

albuterol

Answer 34

Short acting B2 agonist
binds to B2 in lungs: bronchodilation
Binds to B2: activates adenylate cyclase which then stimulates production of cAMP
cAMP is used by the Na-K ATPase pump to move intracellularly

AE: tachycardia, only temp decrease in K

Question 35

dextrose 50% injection

Answer 35

treatment for hyperkalemia with IR: shifts K back into cells (doesn’t get rid of it)
used for hypoglycemia and hyperkalemia

Question 36

insulin, regular

Answer 36

treatment for hyperkalemia with D50%: shifts k back into cells (doesn’t get rid of it)
via NA-K ATPase pump in cell membrane

IV or SC, diabetes and hyperkalemia; essential for cellular uptake of glucose
monitor blood sugar

Question 37

kayexalate

Answer 37

sodium polystyrene
Resin that exchanges Na for K in the gut then you poop it out. 
PO or rectally
takes a few hours- not for emergencies
AE: intestinal necrosis and GI effects