Week 6 (Exam 2) Flashcards
Black box warning for Isoniazid
Fatal Hepatitis
Anti-cholinergic drugs for bronchospasm
Atropine: temporary blockade
Ipratropium: Maintenance of asthma
Tiotropium: Long term maintenance
Aclidinium: Long term maintenance
Drug interactions of Peramivir
Live Flu Vaccine
Zafirlukast
Leukotriene Inhibitor
Selective and Competitive to D4 and E4 (slow reacting substance of anaphylaxis)
Prophylaxis and chronic treatment of asthma
Causes Hepatotoxicity
Tamiflu and the Flu Vaccine
Don’t give live flu vaccine (intranasal) within 2 weeks before or 48 hours after Tamiflu is given (it can interfere with the vaccines effectiveness)
Ciclesonide
ICS
Maintenance treatment for asthma prophylaxis over 12
Not indicated for acute bronchospasm, candida
Black Box Warnings associated with Micafungin
Altered hepatocytes and hepatocellular tumors after a treatment period of or above 3 months in rats
(this is in Europe, not US)
Beclomethason
Inhaled Corticosteroid (ICS) Deadly Adrenal insufficiency can happen when transferred onto it
Neuraminidase Inhibitor MOA
Completely inhibit viral neuraminidase enzymes
Prevents viral reproduction by budding from host cell
(the enzyme cleaves Sialic Acid on Glycoproteins on the surface of human cells that helps new visions to exit)
Flucytosine Combo
Usually with Liposomal Amphotericin B for Cryptococcal meningitis
Indications for methotrexate
Neoplastic Disease
Psoriasis
RA
Interstitial Lung Dz
Warnings and precautions of Amantadine
OD causes all kinds of toxicities
Cardiac Dysfunction
Don’t immediately discontinue if you have Parkinson’s
Suicide attempts, exacerbation of mental problems
History of Epilepsy, increased seizures
Neuroleptic Malignant Syndrome
Renal Disease (accumulates in plasma w/ decreased fxn)
Parkinsons have increased changes of Melanoma
Metabolism of Voriconazole
Interaction w/ CYP2C19 (and CYP2C9, CYP3A4)
Needs dose adaptation for cases of Renal Impairment
Peramivir MOA
IV Neuraminidase Inhibitor
Treats patients 18+ symptomatic no more than 2 days
Who should take Baloxavir?
People 12+ and symptomatic no more than 2 days
Fluconazole MOA
Interrupts conversion of lanosterol to ergosterol
Via binding to fungal CYP450, membrane disruption
Black Box warning associated with Azathioprine
Malignancy
Nintedanib
Kinase inhibitor for treating idiopathic pulmonary fibrosis
Co-Administration of P-gp and CYP3A4 may increase Nintedanib exposure
Adverse Effects of Amphotericin B
CNS (headache chills fever)
Nephrotoxic (esp. deoxycholate version)
Exercise Caution (OD causes cardiac arrest)
MOA of Baloxavir
Polymerase Acidic Endonuclease Inhibitor (inhibits virus mRNA replication, transcription)
Treats Acute Uncomplicated Influenza
Prednisone
OCS, anti-inflammatory
Also used for certain endocrine conditions
May lead to HPA suppression
Methylxanthines
Treats airway obstructions (asthma, emphysema, CB)
Theophylline, Theobromine (in chocolate), Caffeine
Dosing of Atropine and CAD
2 - 3mg total
Methylxanthine MOA
SM relaxation
Suppression of response of the airway to stimulus
Echinocandins
Cyclic Lipopeptides with N-Linked Acyl Lipid side chain
Capsofungin, Micafungin, Anidulafungin
Oseltamivir (Tamiflu)
Treats Influenza A and B if given within 48 Hours
Prophylaxis
Neuraminidase Inhibitor
When to take Zanamivir
Dont do vaccine within two weeks before or 48 hours after using this medicine
Does not prevent a bacterial infection that starts flu-like
Fluticasone
ICS
Maintenance treatment of asthma prophylaxis over 4
Budesonide
ICS
Maintenance treatment for asthma prophylaxis over 6
Milk protein and status asthmaticus is contraindicated
Adverse Effects of Voriconazole
Visual Disturbances, Fever, Etc Both adults and kids
Indacaterol and Vilanterol
LABA
Used to treat breathing problems from COPD
How does Amantadine work?
We don’t know, but it does increase DA
Interferes with function of transmembrane domain of viral M2 protein
Thats why it treats Parkinsons and the flu
Why avoid Peramivir during pregnancy?
Can cause fetal reduced renal papilla and dilated ureters
Who is Tamiflu not recommended for?
Patients with End Stage Renal Disease
Chronic Kidney Disease
Younger than 2 weeks old, or prevent in <1 year old
Montelukast
Leukotriene Inhibitor
Inhibits LTD4 at the CysLT1 receptor without agonist activity
Treats Allergies and prevents asthma attacks
ICS MOA
Reduces inflammation by switching off transcription of multiple genes
Reduces eosinophils and T lymphocytes and Mast Cells
Zileuton
Controlled release only
5-lipoxygenase inhibitor (B/C/D/E-4)
Prophylaxis and chronic asthma, NOT for acute attack
Not for active liver disease w/ enzymes 3x normal
Cysteinyl Leukotriene Receptors
Antagonized by Zafirlukast and Montelukast
Orally taken bronchodilators and anti-inflammatory
Potentiate Corticosteroid action
Warnings associated with Fluconazole
Liver Dysfunction
Potential Fetal Harm, Birth Defects
QT prolongation / torsade (inhibits Rectifier K Channel, esp bad in its with hypokalemia and other risks)
Geriatric Kidney Problems
Black box warnings with Flucytosine
Renal impairment caution
Pregnancy and Breastfeeding
Bone marrow depression
Indications for Amphotericin B
Cryptococcus Neoformans
Blastomyces Dermatitidis
Indications for Voriconazole
Invasive Aspergillosis
Deep tissue Candida Infections, Esophageal Candidiasis
Scedosporium Apiospermum and Fusarium
Indication for Streptomycin
Pulmonary Tb
Non-Tb limited infections
Half life of Amantadine
Range from 10 to 14 hours
Renal function impairment can make it 7-10 days
Zanamivir
Inhales, Reduces flu by 1.5 days if started within 48 hours
Amphoticerin B and Muscle Relaxants / Digitalis Glycosides
Hyperkalemia exaggeration
Warnings associated with Itraconazole
Sx of Liver Disease: N/V, anorexia, yellowing, dark urine
Black box for Heart Failure (inotropic effects)
Black box for CYP3A4 interactions
Contraindications of Voriconazole
Galactose Malabsorption Lapp Lactase Deficiencey Glucose Malabsorption Uncorrected Electrolyte Abnormalities Pregnancy
Most common adverse side effect of Peramivir
Diarrhea
Can also cause hallucinations, bacterial infection, hypersensitivity reactions
Black box warning for Mycophenolate
Embryofetal Toxicity, Malignancies, Serious Infection
Contra-Indications of Inhaled Zanamivir
Lung disease / breathing problems
History of Seizures
Allergy to lactose or milk proteins
Metabolism of Baloxavir
UGT1A3
CYP3A4
B2 Agonists and Asthma
Relax smooth muscle in airway Albuteral (SABA) Terbutaline (SABA, SubQ) Metaproterenol (SABA, Paradoxical bronchospasm) Pirbuterol (SABA, CV effects) Levalbuterol (SABA)
AmBisome
Amphotericin B intercalated into a liposomal membrane (macrocyclic-polyene-antifungal)
Olodaterol
LABA
Long-term, Once-daily maintenance bronchodilator
Black Box Warnings for Methotrexate
Death, Fetal Death, BM suppression, Hepatotoxicity, malignancy, skin reactions
Half Life of Amphotericin B
Up to 15 days
Who shouldn’t take Zanamivir?
Children younger than 12
Mycophenolate
Its an Immunosuppressive Drug for organ rejection but treats interstitial lung disease
Indications for Echinocandins
IV for Systemic Candida infection
Prophylaxis of Candida in Stem Cell Transplants
Black Box Warning for Streptomycin
Neurotoxic in patients with impaired renal function or pre renal azotemia
Indications of Fluconazole
Candida UTI / Peritonitis / Vaginal Candiasis / Thrush / Prophylaxis of candidiasis with BM transplant
Contraindications of Ethambutol
In patients who report visual side effects
May decrease visual acuity due to optic neuritis
Used to treat Pulmonary Tb
Hypersensitivity rxns of Baloxavir
Anaphylaxis, angioedema, urticaria, erythema multiforme
Amantadine Side Effects
Falling asleep, fatigue
Suicidality and depression
Hallucinations / Psychotic Behavior
Withdrawal
Why avoid giving Peramivir to kids?
Decreased Neutrophil Count, Diarrhea, Vomiting
Contraindications of Fluconazole
Coadministration of Terfenadine: QT prolongation
Both use CYP3A4
Tamiflu Activation
Activated by Carboxylesterase 1 Isoenzyme (CES1): converts it to Oseltamivir Carboxylate
Inhibited by Anti-Platelet agent Clopidogrel
Echinocandin MOA
Inhibit b(1,3)-D-Glucan Synthase: Enzyme for integrity of fungal cell wall
Black box warnings of Amphotericin B
Only used for life threatening cases
Omalizumab
Anti-IgE Antibody for moderate-severe asthma 6+
Also treats chronic idiopathic urticaria 12+
Can cause life-threatening anaphylaxis
Flucytosine MOA
Pyrimidine analogue that has activity against fungal species that interferes with purine and pyrimidine metabolism
Salmeterol
Laba for patients over 4
Maintenance for bronchospasm, Exercise-Induced
What does Croup Sound Like?
Stridor
Isoniazid MOA
Inhibits synthesis of Mycolic Acids / Bacterial cell wall
This is used to treat pulmonary Tb
Cystic Fibrosis
AR, CFTR, Cl- Channel, Chromosome 7, chronic lung infections, salty, pancreatic insufficiency, test for Immunoreactive Trypsinogen
Warnings of Rifampin
Liver Toxicity
CYP450 Inducer
Fomoterol
LABA for patients older than 5 as add-on
Maintenance treatment of bronchoconstriction in COPD
All LABAs increase risk of asthma related deaths
Indications for Azathioprine
Adjunct for prevention of rejection in renal transplant
Active RA
Interstitial Lung Dz
Mometasone
ICS
Maintenance treatment of asthma prophylaxis over 4
Dont take with milk protein hypersensitivity
Indications for Rifampin
Treats Pulmonary Tb and the Meningococcal carriers
Warnings and precautions of Baloxavir
Secondary Bacterial Infections
Pregnancy and the flu
Give antiviral Oseltamavir or Zanaivir stat!
What doses of Amphotericin B do you need to start verifying before giving?
Anything above 1.5 mg/kg
Flunisolide
ICS
Maintenance treatment of asthma prophylaxis over 6
May reduce or eliminate need for oral corticosteroids
MOA of Amphotericin B
Binds to the Sterol of a cell membrane leading to alterations in cell permeability and cell death
Also binds to cholesterol component of mammalian cell (Nephtotoxic)
Triamcinolone
ICS
Maintenance treatment of asthma prophylaxis over 4
Not for acute bronchospasm, or pt requringing systemic
Deaths due to adrenal insufficiency have occurred
Indications for Itraconazole
Aspergillus
Dematiaceous molds
Sporothrix Schenckii
Contraindications of Pyrazinamide
Severe Hepatic Damage
Acute Gout
This drug is used to treat pulmonary Tb
