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Pharmacology (Dale Turley) > Respiratory Pt. 3 - Exam 4 > Flashcards

Respiratory Pt. 3 - Exam 4 Flashcards

1
Q

Two phases of Antituberculous regimens?

A 
intensive phase (2 months)
continuation phase (4-7 months)
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2
Q

How long to most patients receive Antituberculous tx?

A

6 months ( intensive for 2 months and continuation for 4 months )

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3
Q

What does R in RIPE stand for ?

A

Rifampin

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4
Q

What does I in RIPE stand for ?

A

Isoniazid

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5
Q

What does P in RIPE stand for ?

A

Pyrazinamide

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6
Q

What does E in RIPE stand for ?

A

Ethanbutol

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7
Q

Why are the RIPE drugs administered simultaneously?

A

to synchronize peak serum concentrations and optimize killing

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8
Q

What is the one drug that is excluded from RIPE intensive phase due to severe liver, gout, to pregnancy?

A

Pyrazinamide

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9
Q

What is the drug extracted from the initial acute phase?

A

Pyrazinamide

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10
Q

What should the intensive phase consist of if Pyrazinamide is excluded? and for how long?

A

Isoniazid, rifampin, ethambutol for 2 months

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11
Q

If Pyrazinamide is excluded that how long should the continuation phase be extended to?

A

7 months

total of 9 months now

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12
Q

What drugs are in the continuation phase?

A

Isoniazid and Rifampin

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13
Q

when should the continuation phase be extended to 7 months?

A

in patients with cavitary pulmonary TB on initial CXR and + sputum culture AFTER the 2 months intensive phase treatment

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14
Q

how long should patient education regarding symptoms of hepatitis and other possible drug toxicities be reinforced?

A

at least monthly

patients should watch for signs of toxicity and report them to the care provider and stop treatment immediately

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15
Q

Why is a sputum AFB smear and culture at the end of the intensive phase important?

A

it assesses the relapse risk and helps determine the duration of the continuation phase

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16
Q

Sputum and AFB cultures should be obtained at monthly intervals until?

A

until two consecutive sutures are negative

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17
Q

Positive sputum culture at __________ should prompt drug susceptibility testing of that isolate

A

2 months

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18
Q

what are the drugs associated with hepatoxicity and part of the first line treatment antituberculous drugs?

A

R, I, P

individually or in combination

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19
Q

what drug may be associated with a cholestatic elevation in serum bilirubin and alkaline phosphatase?

A

Rifampin

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20
Q

what antimyobacterial drugs associated with elevations in serum transaminase concentrations aka “ Transaminitis”

A

Isoniazid and Pyrazinamide

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21
Q

Patients receiving ________________ therapy should undergo baseline measurement of LFT

A

antituberculous

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22
Q

Isoniazid (INH) class?

A

Antitubercular agent

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23
Q

Isoniazid (INH) MOA?

A

Pro-drug, inhibits the synthesis of mycologic acids

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24
Q

Isoniazid (INH) is bactericidal to _______ dividing mycobacteria, but is bacteriostatic if the mycobacteria are ____ growing

A

rapidly

slow

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25
Q

What is an ABS used as a first-line agent for the prevention and treatment of both latent and active TB?

A

Isoniazid (INH) - isonicotinylhydrazide

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26
Q

_________ has been approved as prophylactic therapy for the following populations:

people wit hHIV
contact with TRB
people with a PPD going fro = to + within 2 yrs
people with pulmonary damage
injection drug users
PPD = to or > than 10 mm
pregnant with TB
preventative therapy
nursing moms
Preg mom and breastfeeding infant
A

Isoniazid (INH) - isonicotinylhydrazide

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27
Q

Side effects of Isoniazid (INH) - isonicotinylhydrazide?

A

peripheral neuropahty in 20%

GI reaction like nausea and vomitting

Bone marrow suppression (Aplastic anemia) - lack of production of RBC, platelets and WBCs

Maculopapular rash

increased serum liver enzymes conc.

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28
Q

Black Bow warning of Isoniazid (INH) - isonicotinylhydrazide?

A

Isoniazid-associated hepatitis usually occurs during the first 3 months of treatment and even after many months of tx

> 35 y.o. measure hepatic enzymes (AST, ALT) prior to starting therapy

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29
Q

Rifampicin (Rifampin) Class?

A

ABS antitubercular agent

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30
Q

Rifampicin (Rifampin) MOA?

A

inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription

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31
Q

What is Rifampicin (Rifampin) used to treat?

A

bacterial infection like TB, leprosy and legionnaire’s disease

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32
Q

what is almost always used along with other antibiotics, except when given to prevent H. Flu type B and meningococcal disease

A

Rifampicin (Rifampin)

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33
Q

what is the most serious adverse effect of Rifampicin (Rifampin) ?

A

Hepatotoxicity

GI effects
Flu-like symptoms
Decrease effects of birth control meds

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34
Q

what causes urine, sweat, tears to become orange-red color?

A

Rifampicin (Rifampin)

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35
Q

Can you breat feed on Rifampicin (Rifampin) ?

36
Q

Seeing the orange drug color in the urine or other bodily fluids may also be useful to what?

A

monitor effective absorption of the drug

37
Q

Pyrazinamide (Tebrazid) class?

A

Antitubercular Agents

38
Q

Pyrazinamide (Tebrazid) MOA?

A

converted to pyrazinoic acid in susceptible strains of Mycobacterium which lowers the pH of the environment

exact mechanism has not been elucidated

39
Q

Clinical uses of Pyrazinamide (Tebrazid) ?

A

TB treatment, initial and continuous phase

40
Q

Side effects of Pyrazinamide (Tebrazid) ?

A

CNS - malaise
GI - anorexia, N and V
Neuromuscular and skeletal - myalgia and arthralgia

41
Q

Pregnancy implications of Pyrazinamide (Tebrazid) ?

A

no teratogenic effects

but found in low conc. in breat milk

42
Q

Ethambutol (Myambutol) class?

A

Antitubercular agent

43
Q

Ethambutol (Myambutol) MOA?

A

inhibits arabinose transferase resulting in impaired mycobacterial cell wall synthesis

44
Q

Ethambutol (Myambutol) uses?

45
Q

Adverse reactions of Ethambutol (Myambutol) ?

A

Cardiovascular - Myocarditis, pericarditis

CNS - confusion, disorientation, hallucination, dizziness, peripheral neuritis

Derm - erythema multiforme

Endocrine - hyperuricemia

GI - abdominal pain

46
Q

Adverse reactions of Ethambutol (Myambutol) CNS?

A

confusion and disorientation

47
Q

Adverse reactions of Ethambutol (Myambutol) derm ?

A

erythema multiforme

48
Q

Adverse reactions of Ethambutol (Myambutol) hepatic ?

A

elevated LFT’s

49
Q

Adverse reactions of Ethambutol (Myambutol) ophthalmic ?

A

optic neuritis

50
Q

Pregnancy Implications of Ethambutol (Myambutol) and breat feeding considerations ?

A

Teratogenic effects

Ophthalmic abnormalities

The manufacturer suggests use during breast-feeding only if benefits to the mother outweigh the possible risk to the infant

51
Q

Amphotericin B (AmBisome) Class?

A

Antifungal agent, polyene

52
Q

Amphotericin B (AmBisome) MOA?

A

disruption of fungal cell wall synthesis

bind to sterols, primarily ergosterol, which leads to the formation pores that allows leakage of cellular components

53
Q

Clinical uses of Amphotericin B (AmBisome) ?

A

treating wide range of systemic fungal infections

54
Q

Reserved for severe infections in critically ill, or immunocompromised patients

A

Amphotericin B (AmBisome)

55
Q

what is considered first line therapy for invasive mucormycotic infections, cryptococcal meningitis and certain aspergillum and candida infection

A

Amphotericin B (AmBisome)

56
Q

Treatment of candiduria?

A

irrigation of the bladder w/ Amphotericin B (AmBisome)

57
Q

treatment of coccidioidal meningitis

A

intrathecal administration of Amphotericin B (AmBisome) in the lumbar subarachnoid space

58
Q

Treatment of fungal endophthalmitis ?

A

intravitreal and intracameral injection of Amphotericin B (AmBisome)

59
Q

Prevention of invasive fungal infections such as patients with hematologic malignancies and lung transplant recipients ?

A

aerosolized (nebulized) Amphotericin B notably Amphotericin B deoxycholate

60
Q

Side effects of Amphotericin B (AmBisome) ?

A

shake and bake (high fever and shaking chills)

Nephrotoxicity
Electrolyte imbalances

hypotension, anorexia, N, V, HA, SOB, malaise

61
Q

what is a complication that primarily occurs in patients receiving infusions?

62
Q

How do you minimize Amphotericin B - induced thrombophlebitis ?

A

Hydrocortisone (Decadron)

alternating infusion sites and using a central line

less than 4 hr infusion time

63
Q

Fluconazole (Diflucan) class?

A

antifungal

64
Q

Fluconazole (Diflucan) MOA?

A

interferes with fungal cytochrome P450 activity decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting cell membrane formation

Cytochromes of fungi are essentially similar to those of animals

65
Q

Clinical uses of Fluconazole (Diflucan)?

A

Candidiasis - esophageal, oropharyngeal, candidemia, vaginal

IV / Oral

66
Q

Adverse reactions of Fluconazole (Diflucan)?

A

CNS - HA, dizziness

Derm - rash

GI - N, V, pain diarrhea

Hepatic - hepatitis increased LFTs ( always watch liver)

67
Q

Oral fluconazole is ________ for the treatment of _______ candidiasis; however, use for this indication in pregnant woman is not ____________.

A

approved
vaginal
recommended

use caution with lactation

68
Q

What is pulmonary HTN?

A

Increase of blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries

Increase in lung vasculature, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms

enlarged right ventricle and fluid back up

69
Q

Pulmonary HTN, Calcum channel blocker?

A

Amlodipine (Norvasc)

70
Q

Pulmonary HTN, Endothelin receptor antagonists?

A

Bosentan (Tracleer)

71
Q

Pulmonary HTN, Phosphodiesterase Type 5 inhibitors? (PT5)

A

Sildenafil (Revatio)

72
Q

Pulmonary HTN, Prostaglandins (Prostacyclins)

A

Iloprost (Ventavis)

73
Q

Amlodipine (Norvasc) class?

74
Q

Amlodipine (Norvasc) MOA?

A

inhibits calcium ion from entering the “slow channels”, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation

75
Q

Clinical uses of Amlodipine (Norvasc)?

A

Pulm. HTN
HTN
CAD

76
Q

Disease-related concerns with Amlodipine (Norvasc)?

A

Aortic stenosis (calcified aortic valve) - may reduce coronary perfusion resulting in ischemia

Hepatic Impairment

77
Q

Bosentan (Tracleer) class?

A

endothelium receptor antagonist

78
Q

Bosentan (Tracleer) MOA?

A

endothelial receptor ANTAGONIST that blocked endothelia receptors on endothelium and vascular smooth muscle

79
Q

Because of the risks of _________________________________, bosentan is available only through a restricted program called the Tracleer REMs Program

A

hepatotoxicity and birth defects

80
Q

Sildenafil (Revatio, Viagra) class?

A

Phosphodiesterase type 5 inhibitor (PD5 inhibitor)

81
Q

Sildenafil (Revatio, Viagra) MOA?

A

PAH: inhibits phosphodiesterase type 5 (PDE-5) in smooth muscle of palm. vasculature which results in pulmonary vessel relaxation

Vasodilation in the pulmonary bed and the systemic circulation

82
Q

Sildenafil (Revatio, Viagra) what is the Revatio part for?

A

Pulmonary arterial hypertension (PAH) and has different labeling for the US and Canada

83
Q

Sildenafil (Revatio, Viagra) has a different dosing then its use for Pulmonary HTN and Viagra.

T or F

84
Q

Iloprost (Ventavis) class?

A

Prostacyclin, Prostaglandin; vasodilator

85
Q

Iloprost (Ventavis) MOA?

A

dilates systemic and pulmonary arterial vascular beds

with longer-term use, alters pulmonary vascular resistance and suppresses vascular smooth muscle proliferation

used for long term

86
Q

Iloprost (Ventavis) Inhaled or IV dosing?

A

6-9 times daily (no more than every 2 hrs) during waking hrs

each inhalation tx requires one entire single-use ampule - 1mL vile just more frequently

do not used if pregnant or lactation

LAST STEP FOR PULM. HTN

Pharmacology (Dale Turley) (31 decks)

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