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Pharmacology (SPRING 2024) > UNIT 3 EXAM > Flashcards

UNIT 3 EXAM Flashcards

1
Q

Microbiology

A

Study of microscopic organisms

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2
Q

Bacteria

A

Single-celled, prokaryotic organisms

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3
Q

Normal Flora

A

Good bacteria that is found in the GI tract, nose, mouth, and on skin that keeps us healthy

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4
Q

Pathogen

A

An organism that produces an infection or disease

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5
Q

Defense Mechanisms

A

Our body’s response to something foreign (white blood cells, skin, immune response) that prevents/protects from infection

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6
Q

Antibiotics

A

drugs (or chemicals) that interfere with the life-process of a pathogen, making them incapable of reproducing and, in some cases, killing.

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7
Q

Staphylococcus aureus

A

often cause skin infections

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8
Q

Streptococcus pyogenes

A

causes strep (a disease that results in a sore throat (pharyngitis)

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9
Q

Streptococcus pneumoniae

A

bacterium that causes infections: otitis media, sepsis, and community-acquired pneumonia, and meningitis

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10
Q

Cocci

A

spherical bacteria

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11
Q

Bacilli

A

rod-shaped bacteria

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12
Q

Spirilla

A

Curved-rods

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13
Q

Strepto

A

Chains

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14
Q

Staphylo

A

clusters

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15
Q

Diplo

A

Pairs

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16
Q

Gram positive

A

retain blue stain from crystal violet (purple)

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17
Q

Gram negative

A

retain red stain from safranin (red)

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18
Q

Antibiotic Sensitivity

A

ID the bacteria to identify which antibiotics will be effective;
response to antibiotic therapy varies with different types of bacteria

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19
Q

Culture and Sensitivity

A

test performed to ID bacteria and determine antibiotic susceptibility;
take a specimen/sample;
add antibiotics to medium to determine what antibiotics are effective;
newer technologies give faster results for some organisms

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20
Q

Empiric Therapy

A

initiate drug therapy before ID;
use a broad spectrum antibiotic;
may change drug choice after ID and sensitivity are detrmined

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21
Q

Antibacterial Agents

A

Bacteriostatic;
Bactericidal

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22
Q

Bacteriostatic Agents

A

inhibit reproduction and growth of bacteria;
elimination of bacteria is more dependent on the immune system (leukocytes, macrophages)

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23
Q

Bactericidal Agents

A

drugs that kill bacteria

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24
Q

Antibiotics NOT EFFECTIVE

A

fungal infection,
virus,
parasites

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25
Q

Antibiotics EFFECTIVE

A

bacteria;
cancer

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26
Q

Bacterial Resistance

A

antibiotic becomes ineffective as bacteria resist its actions;
may occur:
1) bacteria produce enzymes that inactivate the antibiotic
ex: penicillinase, cephalosporinase
2) antibiotic cannot penetrate cell wall of bacterium; bacterium alters cell wall

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27
Q

Penicillinase

A

destroy penicillins

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28
Q

Cephalosporinase

A

destroys cephalosporins

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29
Q

Chemoprophylaxis

A

use of antibiotics before a bacterial infection has developed;
i.e. prior to abdominal surgery, gunshot wound, knee/hip replacement, history of heart valve replacement, exposure to TB or other contagious disease

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30
Q

Superinfection

A

Overgrowth of bacteria over a earlier one not treated by the medication administered initially;
could be caused by the elimination of normal flora;
ex: diarrhea, oral thrush, vaginal yeast

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31
Q

Common Antibiotic Side Effects

A

N/V/D and photosensitivity

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32
Q

Serious Antibiotic Side Effects

A

ototoxicity (temporary or permanent);
nephrotoxicity;
hepatotoxicity

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33
Q

Allergic Reactions

A

skin rash/hives;
pruritis (itching);
pyrexia (fever);
shortness of breath;
edema;
anaphylaxis (airway swells, multi-organ failure; give EPI)

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34
Q

Four Basic MOA (Antibiotics)

A

Cell Wall Synthesis Inhibitors
Protein Synthesis Inhibitors
Folate Biosynthesis Inhibitors
Nucleic Acid Synthesis Inhibitors

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35
Q

Antibiotics: Cell Wall Synthesis Inhibitors

A

Penicillins
Beta Lactamase Inhibitors
Penicillin Combo Drugs
Cephalosporins

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36
Q

Penicillin

A

bactericidal;
mold;

MOA: beta lactam ring binds to and inhibits bacterial enzymes to work in cell wall synthesis;
loss of osmotic pressure, cell lysis, loss of nutrients, and cell death

USES: strep, staph, UTI, upper and lower respiratory infections, otitis media

PATIENT TEACHING/SIDE EFFECTS: N, D, rash, inflammation at injection site of given parenterally

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37
Q

Parenteral Drug Administration

A

IV, IM, Sub q

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38
Q

PENICILLINS

A

1) penicillin (Veetids)
2) amoxicillin (Amoxil)
3) ampicillin (Principen)
4) didoxacillin (Dynapen)

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39
Q

Four Generation of Penicillin

A

Generation 1: narrow spectrum; effective against gram positive bacteria; given orally and parenterally
Generation 2: spectrum is broader, covering more of the gram negative bacteria; given orally or parenterally
Generation 3: broader spectrum of activity than Generation 2; drugs given orally or parenterally
Generation 4: the widest spectrum of activity with the most potent effects; these are given parenterally; good for patients who are on Na+ restricted diets

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40
Q

Antibiotics: Beta-Lactamase Inhibitors

A

Bactericidal;

MOA: inhibit enzymes produced by bacteria called penicillinases that deactivate PCN and make it ineffective; also inhibit cell wall synthesis

USES: when bacteria are resistant to PCN; upper/lower respiratory infections, UTI, otitis media, strep, staph

PATIENT TEACHING/SIDE EFFECTS: N, D, rash, inflammation at the injection site, cannot take if allergic to PCN

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41
Q

Antibiotics: Beta-Lactamase Inhibitors

A

bactericidal;

clavulante + amoxicillin = Augmentin
sulbactam + ampicillin = Unasyn
tazobactam + piperacillin = Zosyn

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42
Q

Antibiotics: Caphalosporins

A

bactericidal;

MOA: inhibits cell wall synthesis of bacteria;
loss of osmotic pressure, cell lysis, loss of nutrients, and cell death

USES: strep, staph, upper/lower respiratory infections, otitis media, pneumonia, UTI, when a patient is allergic to penicillin, pre-op prophylaxis

PATIENT TEACHING/SIDE EFFECTS: 20% cross-sensitivity for allergy to penicillin and cephalosporins, GI upset, diarrhea, rash, some cause disulfiram reaction when alcohol is used, cefdinir (Omnicef) might cause bright red stools

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43
Q

CEPHALOSPORINS

A

1) cephalexin (Keflex)
2) cefotetan (Cefotan)
3) ceftriaxone (Rocephin)
4) cefador (Cedor)
5) cefixime (Suprax)
6) cefadroxil (Duricef)
7) cefdinir (Omnicef)

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44
Q

Four Generations of Cephalosporins

A

First Generation: active against some gram positive and negative bacteria.
Second Generation: broader than first generation; more potent.
Third Generation: broader than second generation.
Fourth Generation: greater resistance to beta-lactamase inactivating enzymes

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45
Q

Antibiotics: Protein Synthesis Inhibitors

A

1) Tetracyclines
2) Macrolides
3) Aminoglycosides
4) Lincosamides

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46
Q

Antibiotics: Tetracyclines

A

Bacteriostatic;

MOA: bind to ribosomes and interfere with protein synthesis of bacteria

USES: acne, lower respiratory tract infection, chlamydia, skin infections

PATIENT TEACHING/SIDE EFFECTS: N/V/D, photosensitivity, yellowing of teeth and deposits into growing bones - not recommended for children or women who are pregnant (Category D); do not take with dairy products , antacids and Fe+ tabs (decrease effectiveness), nephrotoxicity, hepatoxicity, superinfection, take 1 hour before meals and few hours after meals, do not take outdated drugs - Fanconi syndrome involving kidneys

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47
Q

ANTIBIOTICS: TERACYCLINES

A

bacteriostatic;

tetracycline (Achromycin)
doxycycline (Vibromycin)
minocycline (Minocin)

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48
Q

Antibiotic: Macrolides

A

mostly bacteriostatic;

MOA: inhibits protein synthesis;

USES: ear, nose, throat infections;
chlamydia;
pneumonia

PATIENT TEACHING/SIDE EFFECTS: GI disturbances, arithromycin (Z-Pak) has shown an elevation in LFTs and arrythmias, should have a gap between time of taking antacids and meds, clarithromycin (Biaxin) - metallic taste in the mouth, arithromycin (Z-Pak) loads on day 1 with 2 tabs

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49
Q

ANTIBIOTICS: MACROLIDES

A

erythromycin;
clarythromycin (Biaxin);
azithromycin (Zithromax, Z-Pak)

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50
Q

Antibiotics: Aminoglycosides

A

bactericidal;

MOA: diffuse through bacteria’s cell membrane into cytoplasm, bind to bacterial ribosomes and inhibit protein synthesis;

USES: before/after abdominal/intestinal surgery;
conjunctivitis;
otitis media;
bronchitis;
Staph infections ;
serious gram negative bacilli

PATIENT TEACHING/SIDE EFFECTS: when administered parenterally: ototoxicity and nephrotoxicity, tinnitus is a sign of ototoxicity, hearing loss may be permanent or temporary, N/V/D, may interfere with renal - oliguria

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51
Q

ANTIBIOTICS: AMINOGLYCOSIDES

A

bactericidal;

streptomycin;
gentamicin (Garamycin);
tobramycin (Tobrex)

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52
Q

Antibiotics: Lincosamides

A

bacteriostatic;

MOA: inhibit protein synthesis;

USES: deep tissue infections, acne;

DRUGS: clindamycin (Cleocin);

PATIENT TEACHING/SIDE EFFECTS: diarrhea, allows overgrowth of C. diff (that causes diarrhea and colitis), pseudomembranous colitis (a severe inflammation of inner lining of large intestine)

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53
Q

Antibiotics: Sulfonamides

A

bacteriostatic;

MOA: inhibit the synthesis of folic acid -> inhibit growth

USES: burns, skin infections, acne

PATIENT TEACHING/SIDE EFFECTS: N/V/D, photosensitivity, crystalluria - crystals in urine causing cell damage, must have adequate fluid intake to prevent crystalluria , blood in the urine, reduced urine output;
blood disorders: anemia, leukopenia, thrombocytopenia, meds commonly have an odor, monitor for rash/Stevens-Johnsons syndrome, increases effects of coumadin (Warfarin) and hypoglycemia drugs

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54
Q

ANTIBIOTICS: SULFONAMIDES

A

bacteriostatic;

sulfamethoxazole/trimethoprin (Azulfidine);
sulfasalazine (Ganstrin);
sulfisoxazole (Silvadene);
silver sulfadiazine (Sulamyd)

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55
Q

Antibiotics: Nucleic Acid Synthesis Inhibitors

A

Fluoroquinolones (bactericidal)

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56
Q

Antibiotics: Fluoroquinolones

A

bactericidal;

MOA: inhibits an enzyme needed for synthesis of bacterial DNA and bacterial replication;

USES: UTI, GI, respiratory, soft tissue, bone and joint infections, anthrax, conjunctivitis

PATIENT TEACHING/SIDE EFFECTS: dizziness, HA, photosensitivity, crystalluria, drowsiness or anxiety, GI disturbances, rash, tendon rupture/tendinitis, if patient is over 60 and on steroids/increases the risk of tendon rupture, avoid iron, zinc, antacids several hours before and after dozing

NEW WARNINGS: black box warning - in a black box,
mental health effects - disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium,
hypoglycemic effects, severe joint pain, and debilitating musculoskeletal effects, peripheral neuropathy, and rupture of aneurysms, do not use in patients with history of blockages or aneurysms

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57
Q

ANTIBIOTOCS: FLUROQUINOLONES

A

ciprofloxacin (Cipro);
levofloxacin (Levaquin);
moxifloxacin (Avelox)

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58
Q

Antibiotic: vancomycin (Vancocin)

A

bactericidal;

MOA: inhibits cell wall synthesis;

USES: last resort - superbugs, Methicillin Resistant Staph Aureus (MRSA), enterococcal infections, pseudomembranous colitis

PATIENT TEACHING/SIDE EFFECTS: vancomysin-flushing syndrome - flushing of neck and upper body due to histamine release, ototoxicity, nephrotoxicity, fever, chills, phlebtis (inflammation of a vein) at injection site

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59
Q

Antibiotic: metronidazole (Flagyl)

A

bactericidal;

MOA: binds to bacterial DNA and breaks it apart

USES: bacterial and protozoa infections (intestinal and vaginal), Clostridium difficile, skin infections

PATIENT TEACHING/SIDE EFFECTS: GI upset, metallic taste, dizziness, ataxia, disulfiram type reaction with alcohol (N/V and severe HA)

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60
Q

Antibiotics: Urinary Tract Agents

A

Urinary Tract Antiseptic;
Urinary Tract Analgesic

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61
Q

Antibiotic: Urinary Tract Antiseptic

A

nitrofurantoin (Macrodantin);
bactericidal;

MOA: damages bacterial DNA;

PATIENT TEACHING/SIDE EFFECTS: adequate hydration

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62
Q

Urinary Tract Analgesic

A

phenazopyridine (Pyridium);

USE: combo drug therapy with antibiotic for UTIs, provides pain relief;

PATIENT TEACHING/SIDE EFFECTS: changes color of urine to orange, hydrate

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63
Q

Preventing Infections

A

Antiseptics;
Disinfectants

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64
Q

Antiseptics

A

chemicals applied to only living tissue, without killing or harming tissue
i.e. alcohol (rubbing), Hibiclens, Betadine

65
Q

Disinfectants

A

chemicals used on non-living objects (equipment and countertops)
i.e. Formaldehyde
helps prevent nosocomial infections: hospital acquired

66
Q

Preventing Infections and Resistance

A

use good handwashing;
cover your mouth when coughing (using the bend of the arm; keep your hands clean);
take antibiotics as prescribed;
don’t share medications;
take the entire regimen; don’t save half for next time you get sick

67
Q

Fungus

A

yeast or mold;
plant-like;
found in soil, air, contaminated foods

68
Q

Mycotic infection

A

fungal infection;
symptoms: itching, redness, blisters, broken skin, inflammation of scalp, burning/discomfort

69
Q

Fungal Infections

A

System Infections;
Dermatophytic Infections;
Candidiasis

70
Q

System Infections

A

may involve multiple organs; invasive;
may involve blood, heart, lungs, GI tract, urinary tract, common in immunocompromised patients (HIV, chemo, neutropenic patients, etc) and patients in ICU

71
Q

Dermatophytic Infections

A

skin, hair, nails (athlete’s foot, ringworm); immune system blocks penetration to other tissue layers

72
Q

Candidiasis

A

superficial infections of skin and mucous membranes (vaginal yeast, thrush - oral yeast); may be a result from elimination of normal flora from antibiotic use or inhaled corticosteroids (must always rinse after)

73
Q

Antifungals

A

treat mycotic infection;
selective spectrum of activity: fungicidal and fungistatic

74
Q

Antifungal: amphotericin B (Fungizone)

A

systemic agent;
usually fungicidal;

MOA: binds to ergosterol which is needed for fungal cell membrane integrity; electrolytes leak out due to the formation of pores

PATIENT TEACHING/SIDE EFFECTS: chills, fever, muscle spasms, HA, V, hypotension;
may be given pretreatment meds t help with side effects (NSAID, steroids or diphenhydramine);
given IV-invasive for administration; monitor blood, liver, kidney functions (hypokalemia, hypomagnesemia)

75
Q

Antifungal: griseofulvin (Grisactin)

A

used for dermatophytic infections;
fungicidal

MOA: binds to keratin so fungi cannot utilize or infect it, bind to lipids of actively growing fungi and inhibits cell reproduction

PATIENT TEACHING/SIDE EFFECTS: treatment is 4-6 weeks for hair/scalp infections, 3-4 months for fingernail treatments, 6 months for toenail infections; NVD, photosensitivity, HA, rash

76
Q

azoles

A

fungistatic or fungicidal depending on dosage, treats candidiasis ad dermatophytic infections, can be alternative to amphotericin B;

MOA: prevent formation of ergosterol which is needed for fungal cell membrane integrity, nutrients leak out to fungal cell destruction

PATIENT TEACHING/SIDE EFFECTS: GI upset, fever, rash, skin peeling, hepatoxicity, photosensitivity, arrhythmias

77
Q

Strep throat/streptococcal pharyngitis

A

a bacterial infection that may cause a sore, scratchy throat, swollen glands and fever;
generally transmitted by direct contact with the mucus or sores of someone else with strep

78
Q

Antifungals: Azoles

A

ketoconazole (Nizoral);
miconazole (Monistat);
fluconazole (Diflucan);
clotrimazole (Lotrimin)

79
Q

Antifungal: nystatin (Mycostatin)

A

USES: candidiasis of skin and mucous membranes (vaginal, intestinal, oral yeast - especially in peds), safe for use during pregnancy

MOA: binds to ergosterol which is needed for fungal cell membrane integrity, changes the fungal cell permeability, electrolytes leak out due to formation of pores

PATIENT TEACHING/SIDE EFFECTS: N/V/D

80
Q

DRUG OF CHOICE (Systemic Infection)

A

amphotericin B (Fungizone IV)

81
Q

DRUG OF CHOICE (Dermatophytic Infection)

A

griseofulvin (Grisactin)

82
Q

DRUG OF CHOICE (Candidiasis Infection)

A

fluconazole (Diflucan)

83
Q

DRUG OF CHOICE (Oral Thrush in Peds)

A

nystatin (Mycostatin)

84
Q

Malaria

A

infectious disease of the circulatory system and liver;
widespread in Africa, Asia, and South America;
protozoan parasite Plasmodium: carried by the Anopheles mosquito and injected directly into human bloodstream when bitten;
invade liver and RBCs (causing RBCs to rupture)

85
Q

Symptoms of Malaria

A

shivering/chills
fever
sweating
a decrease in RBCs (anemia and weakness)
Jaundice

86
Q

Antimalarials

A

drugs used for prophylaxis, for an acute attack, and to cure by eradicating all parasites from the body;
no vaccine

87
Q

Antimalarials

A

protozoa-cidal;
prophylaxis and treatment of malaria

DRUGS: hydroxychloroquine (Plaquenil)
mefloquine (Lariam)
chloroquine (Aralen)

88
Q

Antimalarial: hydroxychloroquine (Plaquenil)

A

protozoa-cidal;

MOA: acts on DNA inhibiting enzyme-activity;
anti-inflammatory tx for lupus and RA

PATIENT TEACHING/SIDE EFFECTS: stomach pains, HA, N, retinopathy, take one week before travel, weekly during travel, and 4 weeks after leaving the endemic area

89
Q

Antimalarial: mefloquine (Lariam)

A

protozoa-cidal;

MOA: acts on erythropatic stages of Plasmodium (not hepatic stages)

PATIENT TEACHING/SIDE EFFECTS: dizziness, difficulty sleeping, anxiety, vision disturbances, not be taken with other cardiac drugs - cardiotoxicity, Stevens-Johnson syndrome, taken once a week starting two weeks before travel/during travel/and take 4 weeks after leaving the endemic area

90
Q

Antimalarial: chloroquine (Aravel)

A

protozoa-cidal;

MOA: accumulates in parasites, binds to critical metabolic substances, breaks down Plasmodia membranes and kills the organisms;
also treats amoebic dysentery, leg cramps, lungs, and RA

PATIENT TEACHING/SIDE EFFECTS: N, D, blurred vision, HA, vertigo, can cause anemia and leukopenia, take one week before travel/during travel/and 4 weeks after leaving the endemic area

91
Q

Anthelmintics

A

work on parasitic worms in intestines; usually contracted by contaminated food or soil ingested;

Symptoms: D,V, loss of appetite, itching - anal, abdominal cramps, weight loss

92
Q

Anthelmintics

A

facilitate elimination of parasitic worms;

DRUGS: mebendazole (Vermox)
thiabendazole (Mintezol)

MOA: paralytic; combo with laxative

PATIENT TEACHING/SIDE EFFECTS: N, D, fever, HA, cramps

93
Q

Tuberculosis (TB)

A

leading infectious killer on earth (about 2 million people die from TB yearly);
caused by mycobacterium tuberculosis;
affects the lungs, but can also affect the brain, spinal cord and kidneys;
can lie dormant for years;
increase in bacterial resistance to ANTI-TB drugs;
contacted by contaminated droplets from an infected individual who has sneezed or coughed

94
Q

Tuberculosis (TB) Symptoms

A

weight loss, fever/chills, malaise, night sweats, persistent cough (sometimes produces blood); loss of apetite

95
Q

Tuberculosis Diagnosis

A

Mantoux Test and Blood Tests (Quantiferon or T-SPOT)
Chest X-Ray
Sputum Test

96
Q

Mantoux Test

A

used to diagnose tuberculosis;
purified protein derivative,
skin test;
measures induration (soft tissue becomes harder and thicker due to inflammation);
return in 48-72 hours for reading;
two-step test - return for a second test in 1-3 weeks

97
Q

BCG vaccine

A

for TB;
not widely used in the US, given to high-risk individuals;
can cause a false positive skin test

98
Q

Treatment for TB (4-drug regimen)

A

isoniazid (INH, Nydrazid)
rifampin (Rifadin)
pyrazinamide (Tetrazide)
ethambutol (Myambutol)

USE: TB tx and prophylaxis

PATIENT TEACHING/SIDE EFFECTS: can cause flu-like symptoms, GI upset, take the full regimen

99
Q

isoniazid (INH, Nydrazid)

A

inhibits bacterial cell wall synthesis;
can cause hepatitis and peripheral neuritis (numbness in hands - vitamin B6 helps prevent neuritis), avoid alcohol

1 of the 4 drugs (TB regimen)

100
Q

rifampin (Rifadin)

A

inhibits RNA synthesis of bacteria;
stains urine, tears and body fluids orange (avoid wearing contacts)

1 of 4 TB drugs (regimen)

101
Q

pyrazinamide (Tebrazide)

A

inhibits bacterial replication;
can cause hyperuricemia and symptoms of gout

1 of 4 TB drugs (regimen)

102
Q

ethambutol (Myambutol)

A

inhibits bacterial cell wall synthesis;
can cause optic neuritis;
eye exams before and after treatment

103
Q

Drug Resistance with TB

A

if shown, do not complete the full course of treatment;
occurs if healthcare providers prescribe the wrong tx (wrong dose or length of time);
drugs are not available;
drugs are of poor quality;
patients do no take all of their drugs;
develop TB after previously treated;
patients come from areas in the world where drug-resistant TB is common;
have spent time with someone who is TB resistant

104
Q

Virus

A

small infectious agent;
invades a living cell to survive;
cannot reproduce without a host;
contain genetic material (DNA or RNA) and an outside lipid layer;
use cell host to replicate itself;
can cause influenza A & B, chicken pox, mononucleosis, cold sores, common cold, pneumonia, GI illness, HIV-AIDS

105
Q

HIV

A

Human Immunodeficiency Virus;
RNA virus/retrovirus;
contains reverse transcriptase (reverses normal cell processes and reproduces by transcribing in DNA);
infects the T-helper cells (CD4) and the macrophages of the immune system; immunosuppression;
no vaccine (research continues), rapidly replicates and mutates so frequently that it becomes unrecognizable to host immune cells;
contains single strand RNA to double strand DNA to make more retroviruses;
contains integrase;
allows viral DNA t enter host nuclei and chromosomes

106
Q

HIV Transmission

A

person to person by sexual contact (vaginal or anal intercourse), contaminated blood via transfusion, fetal infection in utero, sharing contaminated needles (IV drug use) or accidental needle stick

107
Q

HIV Per CDC

A

40,000 new cases per year in the US

108
Q

HIV Diagnosis

A

antigen, antibody, and/or virus in blood or oral fluid;
no cure;
after infection, usually acute illness followed by clinical latency (may last 3 to 10 years)

109
Q

Signs and Symptoms of HIV

A

altered mental status, adenopathy/lymphadenopathy, cough, D, difficulty swallowing, fatigue, fever, HA, numbness, oral, retinal, skin lesions, shortness of breath, sweating, vision changes, weakness, weight loss

110
Q

AIDS Diagnosis

A

caused by HIV;
when CD4 helper cell count (T-lymphocytes) drops to less than 200;
presence of opportunistic disease

111
Q

Opportunistic Disease

A

diseases that would not affect a healthy individual (severe immunosuppression);
include herpes, candida, Cytomegalovirus (CMV) - herpes virus causing hepatitis and encephalitis;
Pneumocystis jirovecii pneumonia (PCP) - fungal;
Toxoplasmosis - parasitic infection, infected meat or in cat litter;
TB

112
Q

Treatment of HIV/AIDS

A

no definitive cure, but have seen cure in some patients undergoing chemotherapy followed by stem cell transplants and patients with undetected viral loads on antiretrovirals;
improve quality of life and immune function

113
Q

ART (Antiretroviral therapy)

A

polypharmacy;
attack different stages of viral life cycle

114
Q

6 Antiretroviral Agents (Anti-HIV)

A

Nucleotide Reverse Transcriptase Inhibitors;
Non-Nucleotide Reverse Transcriptase Inhibitors;
Protease Inhibitors;
Fusion Inhibitors;
Entry Inhibitors;
HIV Integrase Strand Transfer Inhibitors

115
Q

The HIV life cycle

A

Binding (attachment)
Fusion
Reverse Transcription
Integration
Replication
Assembly
Budding

116
Q

Antiretroviral Agents: Nucleotide Reverse Transcriptase Inhibitors (NRTI)

A

MOA: compete for a spot in DNA chain; inhibits reverse transcriptase and viral synthesis

PATIENT TEACHING/SIDE EFFECTS: peripheral neuropathy, bone marrow suppression, GI upset, monitor kidney and liver function

117
Q

Antiretroviral Agents: Nucleotide Reverse Transcriptase Inhibitors (NRTI) drugs

A

zidovudine (AZT; Retrovir)
didanosine (ddl) (Videx)
starudine (d4T) (Zerit)
lamivudine (3TC) (Epivir)
emtricitabine (FTC) (Emtrivia)
tenofovir disoproxil fumarate (TDF) (Viread)

118
Q

Antiretroviral Agents: Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI)

A

MOA: bind to enzyme reverse transcriptase, inhibiting protein synthesis without harming human DNA activity

PATIENT TEACHING SIDE EFFECTS: monitor kidney and liver function

119
Q

Antiretroviral Agents: Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) drugs

A

clelavirdine (Rescriptor)
nevirapine (Viramune)
efavirenz (Sustiva)

120
Q

Antiretroviral Agents: Protease Inhibitors

A

MOA: inhibit HIV protease (enzyme needed for protein synthesis)

PATIENT TEACHING/SIDE EFFECTS: GI upset, weakness, HA

121
Q

Antiretroviral Agents: Protease Inhibitors drugs

A

saquinavir (Fortovase)
ritonavir (Norvir)
indinavir (Crixivan)
nelfinavir (Viracept)

122
Q

Antiretroviral Agents: Fusion Inhibitors

A

MOA: interferes with entry of virus into the host cell by preventing the HIV fusion sequence

DRUG: enfuvirtide (T-20; Fuzeon)

PATIENT TEACHING/SIDE EFFECT: GI upset, HA, muscle/joint pain, monitor liver function

123
Q

Antiretroviral Agents: Entry Inhibitors

A

MOA: blocks HIV attachment to host cell and prevents it from penetrating host cell

DRUG: maraviroc (Selzentry)

PATIENT TEACHING/SIDE EFFECTS: cough, GI upset, muscle/joint discomfort, respiratory infections

124
Q

Antiretroviral Agents: HIV Integrase Strand Transfer Inhibitors

A

MOA: blocks enzyme produced by the retrovirus that enables its genetic material to be integrated into host DNA

DRUG: raltegravir (Isentress)

PATIENT TEACHING/SIDE EFFECTS: GI upset, fatigue, HA, dizziness, insomnia

125
Q

Monitoring of HIV

A

Viral Load (plasma HIV RNA)
-the lower, the better

CD4 count
-the higher, the better

126
Q

Virus: Influenza

A

Flu virus;
A&B;
head and chest congestion, fever, muscle/body aches, cough, rhinorrhea, sneezing;
spread by contact to mouth or inhaling contaminated droplets into respiratory tract;

secondary infections: bacterial, otitis media, pneumonia, bronchitis

127
Q

Herpes Simplex Virus

A

painful, viruses are found in fluid-filled blisters

HSV-1 mostly oral, fever blisters, cold sores (can cause genital blisters - less common)

HSV-2 genital blisters
avoid kissing/sharing utensils if oral; avoid intercourse if genital (can affect method of childbirth)

128
Q

Antivirals

A

acyclovir (Zovirax)
valacyclovir (Valtrex)
amantadine (Symmetrel)
oseltamivir (Tamiflu)
zanamivir (Relenza)

PATIENT TEACHING/SIDE EFFECTS: GI upset, HA, joint/muscle pain, monitor kidney and liver function (acyclovir and valacyclovir)

129
Q

Antiviral: acyclovir (Zovirax)

A

tx of HSV1 (usually oral) and HSV 2 (genital)

MOA: inhibits herpes replication, blocks nucleic acid synthesis

130
Q

Antiviral: valacyclovir (Valtrex)

A

tx of HSV1 and HSV2

MOA: inhibits herpes replication

131
Q

Antiviral: amantadine (Symmetrel)

A

treats influenza A

MOA: prevents virus from releasing DNA into host cell

132
Q

Antiviral: oseltamivir (Tamiflu)

A

oral, influenza B, swine flu

MOA: causes viruses to aggregate/clump together, unable to connect with host cell to invade and replicate

133
Q

Antiviral: zanamivir (Relenza)

A

inhaled, influenza B, swine flu

MOA: causes viruses to aggregate/clump together, preventing replication and spread

134
Q

Cancer

A

development and reproduction of abnormal cells;
cell reproduction is rapid (uncontrolled);
structural alteration of cells and loss of function;
cells rob normal cells of vital nutrients

135
Q

Tumor or Neoplasm

A

groups of cells without function
1) Malignant: bad, cancerous
2) Benign: noncancerous, bur can still cause complications

136
Q

Primary Site

A

origination/ original location of tumor

137
Q

Metastasis

A

cancer spreads to other locations in the body (circulatory or lymphatic)

138
Q

Tumors

A

solid (breast, lungs)
diffuse (leukemia, Hodgkin’s disease)

139
Q

Antineoplastics

A

drugs used to inhibit tumor growth or cell reproduction;
cannot differentiate healthy cells from cancer cells; healthy cells get destroyed as well;
can be very toxic to the body

140
Q

Chemotherapy

A

drugs used to kill cancer (also used for autoimmune conditions);
commonly given in cycles to allow a resting period for normal cells to recover

141
Q

Hematologists

A

specialized doctors who research, diagnose, treat, and help prevent blood-related conditions and disease

142
Q

Oncologist

A

doctor who has special training in diagnosing and treating cancer

143
Q

Types of cancer

A

carcinomas, sarcomas, leukocytes, and lymphocytes

144
Q

Carcinomas

A

stomach: gastric adenocarcinoma
liver: hepatocellular carcinoma
breast: carcinoma of the breast
kidney: renal cell carcinoma
skin: basal or squamous cell carcinoma

145
Q

Sarcomas

A

bone: osteosarcoma; Ewing’s sarcoma
fat: liposarcoma
lymph and blood vessels : angiosarcoma

146
Q

Cancer Statistics

A

2nd leading death in the US
1 in 3 people develop some type of cancer in their lives

147
Q

Two Types of Cancer Drugs

A

Cell Cycle Nonspecific Agents
Cell Cycle Specific Agents

148
Q

Cell Cycle Nonspecific Agents (CCNS)

A

cytotoxic at any phase of cell cycle;
alkylating

149
Q

Cell Cycle Specific Agents (CCS)

A

cytotoxic during a specific phase of cell cycle;
Antimetabolites, Plant Extracts/Mitotic Inhibitors, Cytotoxic Antibiotics

150
Q

Antineoplastics: Alkylating Drugs

A

MOA: bind irreversibly to RNA, DNA and proteins; cell dies from inability to maintain metabolic and reproductive functions, CCNS

151
Q

Antineoplastics: Alkylating Drugs

A

busulfan (Myleran) - leukemia
PATIENT TEACHING/SIDE EFFECTS: pulmonary fibrosis

cisplatin (Plantinol) - testicular, breast, ovarian, lung cancer
PATIENT TEACHING/SIDE EFFECTS: nephrotoxicity, ototoxicity

cyclophosphamide (Cytoxan) - breast, ovarian, leukemia
PATIENT TEACHING/SIDE EFFECT: cystitis, pre-drug hydration for prevention

mechlorethaminel (Mustargen) - lymphomas, leukemia

carboplatin (Paraplatin) - breast, lung, ovarian, bladder cancer

PATIENT TEACHING/SIDE EFFECTS (4,5): N, V, ulcers of skin/GI tract, alopecia

152
Q

Antineoplastics: Antimetabolites

A

MOA: taken up by normal and cancerous cells and incorporated into the metabolic pathway for DNA synthesis;
functions antimetabolite that inhibits enzymes essential for RNA and DNA synthesis; most effective in the S phase of CCS

DRUGS: mercaptopurine (Purinethol) - leukemia
PATIENT TEACHING/SIDE EFFECTS: hyperuricemia

methotrexate (Folex) - leukemia
PATIENT TEACHING/SIDE EFFECT: mucositis, administer folic acid/leucovorin for overdose

153
Q

CCS: Cytotoxic Antibiotics

A

MOA: kills cells by inhibiting nucleic acid and proteins synthesis, mostly active during G 2 phase, CCS

DRUGS: bleomycin (Bleoxane) - head/neck, testicular, ovarian
doxorubicin (Adriamycin) - lymphoma, breast cancer

PATIENT TEACHING/SIDE EFFECTS: cardiac toxicity, hepatotoxicity

154
Q

CCS: Plant Extracts/Mitotic Inhibitors

A

MOA: inhibits mitosis during metaphase by binding to microtubules, most effective during M phase;

DRUGS: vincristin (Onvocin) - leukemia; lymphoma
PATIENT TEACHING/SIDE EFFECTS: neurotoxicity

vinblastine (Velban) - lymphoma

etoposide (Toposar) - testicular, lung cancers

paclitaxel (Taxol) - ovarian, breast, lung cancer

docetaxel (Taxotere) - breast, lung, prostate cancer

PATIENT TEACHING/SIDE EFFECTS: myelosuppression, peripheral neuropathy

155
Q

Hormonal Antagonists

A

MOA: block hormones from binding to receptors on cancer cells, prevent cancer cell growth, do not kill cells directly

USES: adjunct therapy following surgery, radiation, chemotherapy (usually given for several years following cancer treatment)

DRUGS: anti-estrogens
anti-androgens

156
Q

Hormonal Antagonists; Anti-estrogens

A

tamoxifen (Nolvadex) - breast cancer
raloxifene (Evista) - breast cancer, prevents osteoporosis

PATIENT TEACHING: similar to menopause , increases risk for thromboembolismH

157
Q

Hormonal Antagonists: Anti-Androgens

A

bicalutamide (Casodex) - prostate cancer;
flutamide (Eulexin) - prostate cancer

PATIENT TEACHING: gynecomastia, impotency, hot flashes, liver complications

158
Q
A

Pharmacology (SPRING 2024) (7 decks)

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