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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
What is an ABS used as a first-line agent for the prevention and treatment of both latent and active TB?
Isoniazid (INH) - isonicotinylhydrazide
26
_________ 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 ```
Isoniazid (INH) - isonicotinylhydrazide
27
Side effects of Isoniazid (INH) - isonicotinylhydrazide?
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.
28
Black Bow warning of Isoniazid (INH) - isonicotinylhydrazide?
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
29
Rifampicin (Rifampin) Class?
ABS antitubercular agent
30
Rifampicin (Rifampin) MOA?
inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription
31
What is Rifampicin (Rifampin) used to treat?
bacterial infection like TB, leprosy and legionnaire's disease
32
what is almost always used along with other antibiotics, except when given to prevent H. Flu type B and meningococcal disease
Rifampicin (Rifampin)
33
what is the most serious adverse effect of Rifampicin (Rifampin) ?
Hepatotoxicity GI effects Flu-like symptoms Decrease effects of birth control meds
34
what causes urine, sweat, tears to become orange-red color?
Rifampicin (Rifampin)
35
Can you breat feed on Rifampicin (Rifampin) ?
NO
36
Seeing the orange drug color in the urine or other bodily fluids may also be useful to what?
monitor effective absorption of the drug
37
Pyrazinamide (Tebrazid) class?
Antitubercular Agents
38
Pyrazinamide (Tebrazid) MOA?
converted to pyrazinoic acid in susceptible strains of Mycobacterium which lowers the pH of the environment exact mechanism has not been elucidated
39
Clinical uses of Pyrazinamide (Tebrazid) ?
TB treatment, initial and continuous phase
40
Side effects of Pyrazinamide (Tebrazid) ?
CNS - malaise GI - anorexia, N and V Neuromuscular and skeletal - myalgia and arthralgia
41
Pregnancy implications of Pyrazinamide (Tebrazid) ?
no teratogenic effects but found in low conc. in breat milk
42
Ethambutol (Myambutol) class?
Antitubercular agent
43
Ethambutol (Myambutol) MOA?
inhibits arabinose transferase resulting in impaired mycobacterial cell wall synthesis
44
Ethambutol (Myambutol) uses?
active TB
45
Adverse reactions of Ethambutol (Myambutol) ?
Cardiovascular - Myocarditis, pericarditis CNS - confusion, disorientation, hallucination, dizziness, peripheral neuritis Derm - erythema multiforme Endocrine - hyperuricemia GI - abdominal pain
46
Adverse reactions of Ethambutol (Myambutol) CNS?
confusion and disorientation
47
Adverse reactions of Ethambutol (Myambutol) derm ?
erythema multiforme
48
Adverse reactions of Ethambutol (Myambutol) hepatic ?
elevated LFT's
49
Adverse reactions of Ethambutol (Myambutol) ophthalmic ?
optic neuritis
50
Pregnancy Implications of Ethambutol (Myambutol) and breat feeding considerations ?
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
Amphotericin B (AmBisome) Class?
Antifungal agent, polyene
52
Amphotericin B (AmBisome) MOA?
disruption of fungal cell wall synthesis bind to sterols, primarily ergosterol, which leads to the formation pores that allows leakage of cellular components
53
Clinical uses of Amphotericin B (AmBisome) ?
treating wide range of systemic fungal infections
54
Reserved for severe infections in critically ill, or immunocompromised patients
Amphotericin B (AmBisome)
55
what is considered first line therapy for invasive mucormycotic infections, cryptococcal meningitis and certain aspergillum and candida infection
Amphotericin B (AmBisome)
56
Treatment of candiduria?
irrigation of the bladder w/ Amphotericin B (AmBisome)
57
treatment of coccidioidal meningitis
intrathecal administration of Amphotericin B (AmBisome) in the lumbar subarachnoid space
58
Treatment of fungal endophthalmitis ?
intravitreal and intracameral injection of Amphotericin B (AmBisome)
59
Prevention of invasive fungal infections such as patients with hematologic malignancies and lung transplant recipients ?
aerosolized (nebulized) Amphotericin B notably Amphotericin B deoxycholate
60
Side effects of Amphotericin B (AmBisome) ?
shake and bake (high fever and shaking chills) Nephrotoxicity Electrolyte imbalances hypotension, anorexia, N, V, HA, SOB, malaise
61
what is a complication that primarily occurs in patients receiving infusions?
Phlebitis
62
How do you minimize Amphotericin B - induced thrombophlebitis ?
Hydrocortisone (Decadron) alternating infusion sites and using a central line less than 4 hr infusion time
63
Fluconazole (Diflucan) class?
antifungal
64
Fluconazole (Diflucan) MOA?
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
Clinical uses of Fluconazole (Diflucan)?
Candidiasis - esophageal, oropharyngeal, candidemia, vaginal IV / Oral
66
Adverse reactions of Fluconazole (Diflucan)?
CNS - HA, dizziness Derm - rash GI - N, V, pain diarrhea Hepatic - hepatitis increased LFTs ( always watch liver)
67
Oral fluconazole is ________ for the treatment of _______ candidiasis; however, use for this indication in pregnant woman is not ____________.
approved vaginal recommended use caution with lactation
68
What is pulmonary HTN?
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
Pulmonary HTN, Calcum channel blocker?
Amlodipine (Norvasc)
70
Pulmonary HTN, Endothelin receptor antagonists?
Bosentan (Tracleer)
71
Pulmonary HTN, Phosphodiesterase Type 5 inhibitors? (PT5)
Sildenafil (Revatio)
72
Pulmonary HTN, Prostaglandins (Prostacyclins)
Iloprost (Ventavis)
73
Amlodipine (Norvasc) class?
CCB
74
Amlodipine (Norvasc) MOA?
inhibits calcium ion from entering the "slow channels", producing a relaxation of coronary vascular smooth muscle and coronary vasodilation
75
Clinical uses of Amlodipine (Norvasc)?
Pulm. HTN HTN CAD
76
Disease-related concerns with Amlodipine (Norvasc)?
Aortic stenosis (calcified aortic valve) - may reduce coronary perfusion resulting in ischemia Hepatic Impairment
77
Bosentan (Tracleer) class?
endothelium receptor antagonist
78
Bosentan (Tracleer) MOA?
endothelial receptor ANTAGONIST that blocked endothelia receptors on endothelium and vascular smooth muscle
79
Because of the risks of _________________________________, bosentan is available only through a restricted program called the Tracleer REMs Program
hepatotoxicity and birth defects
80
Sildenafil (Revatio, Viagra) class?
Phosphodiesterase type 5 inhibitor (PD5 inhibitor)
81
Sildenafil (Revatio, Viagra) MOA?
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
Sildenafil (Revatio, Viagra) what is the Revatio part for?
Pulmonary arterial hypertension (PAH) and has different labeling for the US and Canada
83
Sildenafil (Revatio, Viagra) has a different dosing then its use for Pulmonary HTN and Viagra. T or F
True
84
Iloprost (Ventavis) class?
Prostacyclin, Prostaglandin; vasodilator
85
Iloprost (Ventavis) MOA?
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
Iloprost (Ventavis) Inhaled or IV dosing?
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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