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Pharmacolgy 2 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Anti microbial definition

A

natural and synthetic compounds that either inhibit or kill micro organisms

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2
Q

Chemotherapy definition

A

application of a chemical agent that has a specific toxic effects on a disease producing organism

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3
Q

Antibiotic definition

A

an agent derived from a microorganism that inhibits or kills other microorganisms

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4
Q

Anti infectives include what?

A

antibiotics, antivirals, antifungals

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5
Q

What is the empiric therapy?

A

treatment based on best guesses from available data as to causative agents

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6
Q

Bacteria that need oxygen are called what?

A

aerobic

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7
Q

Bacteria that dont need oxygen are called what?

A

anerobic

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8
Q

What type of bacteria are harder to treat?

A

anerobic

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9
Q

Gram positive organisms stain what color?

A

purple

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10
Q

Gram negative organisms stain what color?

A

pink

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11
Q

Are gram negative or gram positive harder to treat?

A

gram -

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12
Q

What is the Kirby Bauer disk diffusion?

A

classic test in which bacteria are cultured and grown on solid media in an agar dish. Antibiotic containing paper disks are then placed on the lawn of bacteria

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13
Q

What is the E test or elliptical test?

A

the E test strip is placed on an agar plate and heavily inoculated with the organism, the strip creates an antimicrobial gradient which results in the zone of inhibition

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14
Q

The E test allows to determine what?

A

minimal inhibitory concentration

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15
Q

If the MIC is at levels that cannot be safely achieved in the patient the organism is termed what?

A

resistant

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16
Q

The minimal drug concentration that kills the organism after a 24 hour incubation is termed what?

A

minimal bactericidal concentration

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17
Q

MRSA is resistant to what drug?

A

methicillin resistant (gram +)

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18
Q

VRSA is resistant to what drug?

A

vancomycin resistant (gram +)

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19
Q

Clindamycin have excellent levels in what part of the body?

A

the bone

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20
Q

Aminoglycosides, quinolones achieve high levels in what part of the body?

A

urine

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21
Q

Time dependent definition

A

if microbial kill rate is influenced by the time of drug concentration meets or exceeds the MIC

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22
Q

Concentration dependent definition

A

if microbial kill rate is influenced by a high enough concentration of the drug (synergist effects)

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23
Q

What does post antibiotic effect mean?

A

refers to the sustained suppression of bacterial growth even after the concentration of antibiotic declines below detectable levels

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24
Q

Bacteriostatic

A

inhibit growth kill the bacteria

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25
Q

Bactericidal

A

kill the bacteria

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26
Q

Beta lactams include what following classes of drugs

A

penicillians, cephalosporins, monobactams, carbapenems

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27
Q

Beta lactams are all what?

A

time dependent organism killers

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28
Q

most penicillins are destroyed if taken orally due to gastic pH except for what two drugs?

A

ampicillin and amoxicillin

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29
Q

Mechanism of action of penicillin

A

inhibit bacterial cell wall synthesis, activate autolytic system within bacteria resulting in self destruction

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30
Q

Cephalosporins are what?

A

similar to penicillin in mechanisms of action but they have longer half lives

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31
Q

Are cephalosporins bactericidal or bacteriostatic

A

bactericidal

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32
Q

Mechanism of action for cephalosporins

A

inhibit cell wall synthesis resulting in cell lysis

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33
Q

2nd and 4th generations are used for what?

A

respiratory and urinary tract infections

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34
Q

What is the only drug available in the monobactam category?

A

Aztreonam (Azactam)

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35
Q

Are monobactams bactericidal or bacteriostatic

A

bactericidal

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36
Q

Carbapenems are what?

A

broad spectrum and active against many organisms that are penicillin and cephalosporin resistant

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37
Q

Quinolones are what?

A

block the enzyme responsible for DNA growth and are bactericidal

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38
Q

What is a potential side effect of quinolones

A

tendon rupture, need to wear sunscreen

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39
Q

What are some common quinolones

A

ciprofloxacin (Cipro), Levofloxacin (Levoquin), Moxifloxacin (Avelox), Gemifloxacin (Factive)

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40
Q

Aminoglycosides are bactericidal or bacteriostatic

A

bactericidal

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41
Q

Aminoglycosides are used a lot for what patients?

A

CF patients

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42
Q

Aminoglycosides are synergistic when used with what?

A

Beta lactams

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43
Q

Aminoglycosides that are useful in treating VAP are what?

A

Tobramycin, Gentamicin, Amikacin

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44
Q

Protein synthesis inhibitors classifications

A

Macrolides, Tetracyclines, Tigecycline (tiger)

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45
Q

Macrolides

A

active agent used to treat gram positive, gram negative, and atypical bacteria

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46
Q

Macrolides are the preferred treatment choice for what?

A

atypical pneumonias

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47
Q

Examples of macrolides are what?

A

Erythromycin, Clarithromycin, Azithromycin, Telithromycin

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48
Q

Are macrolides bacteriostatic or bactericidal

A

bacteriostatic

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49
Q

Macrolides should not be used with what kind of drugs?

A

narrow therapeutic windows due to complications like inhibiting the cytochrome P450 system (warfarin, theophylline)

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50
Q

Tetracyclines are what?

A

broad spectrum bacteriostatic drug class

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51
Q

Tetracyclines should not be taken with what?

A

antacids, iron, or dairy

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52
Q

Examples of tetracyclines?

A

Doxycycline, and Minocycline

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53
Q

Tigecycline

A

newer, indicated for gram + (VRE, VRSA, MRSA, and S.pneumonie

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54
Q

Clinical use of tigecycline

A

skin infections, complicated inta abdominal infections, CAP

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55
Q

Folate inhibitors are what?

A

sulfonamide drugs that primarily treat uncomplicated urinary tract infections

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56
Q

Examples of folate inhibitors are what?

A

sulfamethoxazole/trimethoprin (Bactrim, Spetra), and sulfisoxazole

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57
Q

Folate inhibitors are used for what type of patients?

A

immunocompromised

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58
Q

Vancomycin

A

bactericidal glycoprotein antibiotic that lysis cell wall

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59
Q

Vancomycin is the primary medication to treat what?

A

MRSA

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60
Q

Streptogramins examples

A

Dalfopristin, Quinupristine

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61
Q

Is streptogramins bactericidal or bacteriostatic

A

bacteriostatic

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62
Q

Oxazolidinoes example

A

Linezolid, only drug available in this class

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63
Q

Lipopetides example

A

Daptomycin (Cubicin)

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64
Q

Lipopetides

A

bactericidal antibiotic that works by depolarizing the cell membrane

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65
Q

Lipopetides cannot be used to treat pneumonias because of what?

A

activity is inhibited by pulmonary surfactant

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66
Q

Metronidazole

A

synthetic drug that can treat anerobic infections (GI tract), bactericidal

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67
Q

What is the most common places to get TB

A

prison, college dorms

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68
Q

TB requires multiple drugs for how long?

A

6-12 months

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69
Q

What is the initial treatment of TB

A

Isoniazid, Pyrazinamide, Rafampin, Ethambutol

70
Q

Isoniazid is distributed well in the body especially where?

A

Cerebral spinal fluid

71
Q

Isoniazid is metabolized by what?

A

liver

72
Q

Isoniazid is eliminated by what?

A

kidneys

73
Q

Isoniazid is bacterialcidal against what?

A

replicating tuberculosis bacilli

74
Q

Isoniazid is bacteriostatic against what?

A

non replicating organisms

75
Q

Rifampin and Rifabutin

A

do not penetrate CNS, absorbed orally, bactericidal

76
Q

Rifampin

A

metabolized through the liver and induces the CYP system

77
Q

What is CYP induction

A

known to decrease plasma concentrations of drugs hepatically metabolized

78
Q

Rifabutin

A

metabolized in liver, weaker enzyme inducer than rifampin

79
Q

Pyrazinamide

A

nicotinic acid derivative that is well distributed into most tissues including the CSF

80
Q

What is the MOA of pyrazinamide

A

unknown, speculated against mycobacteria when tested in an acidic enviroment

81
Q

Ethambutol

A

synthetic, orally administered, bacteriostatic

82
Q

MOA of ethambutol

A

dec the synthesis of cell wall polysacchrides such as arabinogalactan to inhibit mycobacterial cell growth

83
Q

Streptomycin

A

aminoglycoside used in 1940 for treatment of TB

84
Q

Anti virals have common name ending of what?

A

cyclovir, ciclovir, mantadine, mivir

85
Q

What are the most common infectious agents in humans

A

viruses

86
Q

Acyclovir and Valacyclovir

A

V was developed as a prodrug in order to improve GI absorption of acyclovir

87
Q

MOA of Valacyclovir and Acyclovir

A

disrupt viral DNA replication

88
Q

Clinical use of Valacyclovir and Acyclovir

A

both effective against HSV 1 and HSV 2 (herpes), varicella zoster virus, genital infections

89
Q

Penciclovir and Famciclovir (prodrug) MOA

A

disrupt growing DNA chains, interfering with viral DNA syntheis and replication

90
Q

Canciclovir and Valganciclovir (prodrug) MOA

A

both incorporate into growing DNA chains and terminate viral DNA synthesis and replication

91
Q

Amantadine and Rimantadine MOA

A

inhibit viral replication and viral assembly

92
Q

Clinical use of Amantadine and Rimantadine

A

active against influenza A only. can be used prophylactically

93
Q

Oseltamivir MOA

A

inhibits flu A and B

94
Q

Anti fungals end with what?

A

conazole, fungin

95
Q

Fungal infections are now on the rise due to the inc. number of immunocompromised patients like what?

A

AIDS, cancer chemo, and organ transplant

96
Q

Polyene group MOA

A

bind to ergosterol which is the building block for the cell wall, this binding creates pores allowing for essential components to escape through resulting in cell death

97
Q

Amphotericin B is what?

A

polyene, treatment of choice for fungal infections, lipid based

98
Q

Amphotericin B is the first line agent for several pulmonary fungal infections like what?

A

aspergillosis, blastomycosis, histoplasmosis, cocidioidomycosis

99
Q

Nystatin

A

polyene, oral and topical cream, used to treat candidiasis

100
Q

Azoles group includes what?

A

Ketoconazole, Fluconazole, Itraconazole, Vorionazole, and Posaconazole

101
Q

MOA for Azoles

A

prevent the production of ergosterol causing a fungistatic effect

102
Q

What was the first drug in the Echinocandin group

A

caspofungin and then Micafungin and Anidulafungin

103
Q

MOA for the Echinocandin group

A

inhibit cell wall synthesis by inhibiting (1,3)- B-D-glucan synthesis, may be either fungicidal or fungistatic

104
Q

Flucytosine MOA

A

inhibits RNA formation, which decreases protein synthesis and prevents cell growth, fungistatic

105
Q

general considerations in anerosolizing antibiotics

A

more viscous and may affect neb performance, environmental contamination, physical incompatibilty b/w some antibiotics

106
Q

What was the first commerically available drug for nebulization

A

TOBI

107
Q

MOA of TOBI

A

aminoglycoside antibiotic for treatment of gram 1 infections, binds to bacterial ribosomes=block protein synthesis=cell death

108
Q

Dosage of TOBI

A

300 mg BID X 28 days then 28 days off, vial 300mg/5mL

109
Q

What organism does TOBI help with

A

P. aeruginosa in CF

110
Q

Storage of TOBI

A

refrigerated, avoid intense light

111
Q

TOBI administration

A

6 years and older, do not mix with other meds in neb, administer over 15 minutes with PARI LC neb

112
Q

Administration order of TOBI

A

Bronchodilator, CPT, other nebulized meds, and TOBI

113
Q

Adverse effects of TOBI

A

voice alteration rinse and expectorate post therapy, tinnitus (ear rinning), mucosal/airway edema, possible inc in bacterial resistance

114
Q

Precautions with TOBI

A

potential to cause fetal harm, local airway irritation causing cough and bronchospasm

115
Q

TOBI clinical use

A

Treat and prevent early colonization with Pseudomonas, maintain lung function, reduce rate deterioration, treatment of pneumonia due to MDR organisms

116
Q

TOBI clinical pearls

A

<10% systemic absorption, preservative free, localized effect

117
Q

MOA of Amikacin

A

aminoglycoside which inhibits protein synthesis in susceptible bacteria by finding to 30S ribosomal subunits in gram (-) bacterial infections, bactericidal, concentration dependent

118
Q

Dosage of Amikacin

A

2 mL vial of 500 mg inhalation pre mixed Q8H

119
Q

Storage of Amikacin

A

stored at controlled room temp, stable for 24 hours at room temp, 2 days at refrigeration when mixed in D5W, NS, and LR

120
Q

Admin of Amikacin

A

must use with Respigard 2 neb

121
Q

Adverse rxns of Amikacin

A

nephrotoxicity, ototoxicity, neurotoxicity

122
Q

Clinical use of Amikacin

A

treatment of serious infections respiratory tract infections due to organisms to gentamicin and tobi including pseudomonas, proteus, serratia

123
Q

Contraindications to Amikacin

A

hypersensitivity to amikacin sulfate or any component of the formulation

124
Q

Colistamethate sodium (Colistin) MOA

A

inc. cell permeability, leak contents of cell, cell lysis/death, concentration dependent, bactericidal

125
Q

Colistin dosage

A

75-150 mg every 8-12 hours, made of 2 components (E1 is associated with airway inflammation)

126
Q

Colistin admin

A

dilute powder with 2 mL sterile water, swirl gently, administer immediately, use seperate neb

127
Q

Storage of Colistin

A

room temp

128
Q

Adverse effects of Colistin

A

bronchoconstriction, cough

129
Q

Clinical use of Colistin

A

prevention and treatment of P. aeruginosa infections in CF pts, rapid bactericidal activity vs. gram (-) organisms

130
Q

Colistin clinical pearls

A

<1% systemic absorption, localized effect, very potent vs. many resistant organisms

131
Q

Cayston (aztreonam)

A

inhaled monobactam antibiotic, not indicated for patients below 7. bactericidal

132
Q

Dosage of Cayston

A

75 mg/vial powder, reconstitute with 1 mL of saline, use immediately

133
Q

Storage of Cayston

A

comes in 2 cartons for a 28 day supply, may store at room temp, should be protected from light

134
Q

Admin of Cayston

A

Altera neb

135
Q

Recommended order of admin for Cayston

A

Bronchodilator, mucolytic, and then Cayston. LABA can be taken 30 min-12 hours prior of admin

136
Q

Procedure for Cayston

A

pour the reconstituted solution into the handset of the neb, turn the unit on, place mouthpiece in mouth, breath normally, admin takes b/w 2-3 mins

137
Q

Precautions for Cayston

A

do not use on patients with known allergy to aztreonam or beta lactams, bronchoconstriction

138
Q

Aztreonam and pregnancy

A

crosses placenta, no known fetal toxicity, excreted in breast milk

139
Q

Nebupent (pentamidine) MOA

A

anti protozoal agent, not fully understood, block RNA and DNA synthesis, bind lung tissue and then slowly absorbed into circulation

140
Q

Nebupent dosage

A

300 mg inhaled once every 4 weeks, add 3-6 mL sterile water

141
Q

Storage of nebupent

A

room temp for 48 hours once mixed, protect from light

142
Q

Nebupent admin

A

Respirgard 2, rate 5-7 mL/min, do not mix with other meds, may induce bronchospasm

143
Q

Nebupent admin enviromental risk

A

HCW: minimize exposure to drug, conjunctivitis and bronchospasm

144
Q

Nebupent adverse effects

A

systemic: rash, dec WBC, hypoglycemia/DM, renal insufficiency. Local airway: cough and bronchial irriation, SOB, bitter/burning taste

145
Q

Nebupent clinical use

A

2nd line for prevention of PCP, HIV w/CD4 <200 cells/mm3, prophylaxis in pregnancy during 1st trimester

146
Q

Nebupent clinical pearls

A

PCP typically only in immunocompromised, higher lung concentrations than IV

147
Q

dosage of Vancomycin

A

250 mg/5 mL solution nebulized BID

148
Q

Admin of Vancomycin

A

PARI neb

149
Q

Storage of Vancomycin

A

kept at room temp, the reconstituted drug is good for up to 14 days

150
Q

Clinical use of Vancomycin

A

treatment of pneumonia caused by highly penicillin resistant S pneumoniae (MRSA), especially when cephalosporins cannot be used

151
Q

Contraindications to Vancomycin

A

known hypersensitivity, known allergy to corn or corn products

152
Q

Adverse rxns to Vancomycin

A

ototoxicity, nephrotoxicity, urticaria (hives), flaky skin, macular rashes, eosinophilia, shock like state, transient anaphylaxis, vasculitis, neutropenia, eosinophilia, diarrhea

153
Q

Relenza (zanamavir) MOA

A

anti viral, neuroaminidase inhibitor, prevent viral replication, bind enzyme required for virus to be released after RNA replication and blocking the action

154
Q

Relenza dosage

A

diskhaler- 4 blisters/rotadisk (one 5 mg blister per inhalation). Treatment: 2 inhalations (10mg) Q12 hoursX5 days

155
Q

Relenza admin

A

must take within 48 hours to be effective for treatment. Not to be used with nebs, do not admin 2 weeks before or 48 hours after live flu vaccine

156
Q

Relenza adverse effects

A

serious bronchospasm, nausea, dizziness, cough, ENT infections

157
Q

Relenza clinical use

A

prophylaxis in unvaccinated, useful anti viral flu med, limited system absorption, > 5 years old

158
Q

Clinical pearls of Relenza

A

active against flu A and B, dec duration of illness by 1 day, may dec. viral shedding

159
Q

Virazole (ribavirin)

A

anti viral, used to treat pneumonia brought on by respiratory synctial virus (RSV), used to treat immuno suppressed pts with viral infections

160
Q

Dosage of Virazole

A

6 grams/viral reconstituted to a 2 % solution, very expensive

161
Q

Frequency of Virazole

A

3 vials/day for 3-7 days

162
Q

Admin of Virazole

A

SPAG 2 neb, meds is to be given continuously over 12-18 hours per day

163
Q

Complications of Virazole

A

attacking the intracellular virus may harm the host cell, viral replication is maximal before the appearance of symptoms

164
Q

Adverse effects of Virazole

A

fatigue, headache, insomnia, nausea, anemia, bronchospasm

165
Q

Amphotericin B MOA

A

anti fungals used to treat and prevent bronchopulmonary fungal infections in patients with neutropenia

166
Q

Dose of Amphotericin

A

5-30 mg/day to a max of 50 mg/day

167
Q

Supplied of Amphotericin

A

injection, powder for reconstitution

168
Q

Storage of Amphotericin

A

prior to reconstitution store in refrigerator and protect against exposure to light, after that store at room temp for 24 hours protect from light or refrigerate for 1 week

169
Q

Preparation of Amphotericin

A

reconstitute the powder with 10 mL sterile water, shake gently, do not reconstitute with saline solution. After each reconstitution each vial contains 50mg/10mL

170
Q

Admin of Amphotericin

A

treatments must be given with Respigard 2, small volume neb should only be used for vented patients, may be pretreated with 4 inhalations albuterol

171
Q

Clinical use of Amphotericin

A

potentially life threatening fungal infections like aspergillosis, mucomycosis, histoplasmosis (common)

172
Q

Adverse effects of amphotericin

A

bronchospasm, anorexia, chills, nausea, shaking fever, hypotension, headache, coughing, vomiting, bad taste

Pharmacolgy 2 (1 decks)

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