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Pharamcology > Week 9 > Flashcards

Week 9 Flashcards

1
Q

_____ is used to suppress withdraw symptoms in opioid dependent individuals. (treats opiates addiction) It still promotes euphoria and psychological dependence. It is an adjunct to promote withdrawal from opioid and it is much ______ than needles since it is taken orally. It has been mor commonly abused lately as an analgesia to replace _______. High doses can result in severe ______ depression and death.

A

Methadone
Cleaner
oxycodone
respiratory

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2
Q

_______ is used to treat opiate overdose and is a pure antagonist used to decrease adverse effects of narcotic overdose, respiratory depression in particular. Available IV, SC or IM

A

Naloxone

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3
Q

______ is an OTC anti-diarrheal. It also is not significantly absorbed through GI tract and as a result its effects are limited to GI tract.

A

Loperamide

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4
Q

Local anesthetics act as ___ ion channel blockers and block all nerve conduction in nerves into which they dissolve. They work by dissolving through the nerve membrane and then blocking the channel of the sodium channel protein from the ______

A

Na

inside

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5
Q

What are the two class of local anesthetics?

A

Esters and Amides

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6
Q

____ is a ester and is strictly topical anesthetic Sold over OTC and can be used before a shot. Found in sunburn (Solarcaine) and vaginal itching (Vagisil)

A

Benzocaine

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7
Q

_____ is a ester and is also C II drug. Both anesthetic and vasoconstrictor make it useful for oral surgery.. May inhibit dopamine repute in brain increasing dopamine levels to act as an stimulant.

A

Cocaine

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8
Q

_____ is an ester and is a name many people have heard of when local anesthetics are mentioned but it hasn’t been used or manufactured in years.

A

Novocaine

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9
Q

______ is an Amide and is the local anesthetic of choice by dental offices but articaine is a big completion. It is combined with Epi and ____ ____ to act as a preservative.

A

Lidocaine

Sodium bisulfate

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10
Q

_____ is an ester/amide combination and is becoming an increasingly important dental local anesthetic.

A

Articaine

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11
Q

____ indians chewed coca leaves to get a mild stimulate and to reduce fatigue. IN late 1800’s it was discovered by western society and marketed in a wine, and Coca-cola until 1902.

A

Andean

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12
Q

Treat names for cocaine hydrochloride include ____, _____, ____. Free base form can be snorted or smokes. It can be converted to this form by a solution of ___ ____ and evaporating off the water. When the solid residue is smoke the heat causes decomposition of the carbonate to CO2 in small explosive pops which gave the name crack. High levels can result in FORMICATION

A

coke, snow, blow

baking soda

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13
Q

Diabetes mellitus is characterized by _____ which can occur after a meal (______) during fasting, or both.

A

hyperglycemia

postprandial

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14
Q

Type 1 diabetes also called _____ _____ _____ _____ (IDDM) or juvenile onset diabetes. It is due to a complete ____ of insulin production by the ____ cells on the pancreas. The cause appears to be an autoimmune response against the beta cells of the pancreas.

A

Insulin dependent diabetes mellitus
lack
beta

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15
Q

Type 2 diabetes (insulin resistant) is a complex and progressive disease that typically does not manifest itself until middle age or later. In the early stages of type 2 insulin production is probably normal or even elevated; hyperglycemia is probably due to insufficient functional insulin _____. As type 2 progresses the pancreas may fail in its ability to synthesize insulin and insulin production may also fail.

A

receptors

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16
Q

Primary treatment of type 1 diabetes is SC injection of insulin. Before 1984 the insulin injection was obtained from ____ or _____ pancrei. Their insulin is very similar to humans but slight differences. Since 1984 ______ & ______ known as human insulin has taken over the market.

A

pork or beef

Humulin and Novolin

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17
Q

Insulin can’t be taken orally because it is ____ and enzymes of the stomach and intestine denature and hydrolyze it to amino acids. Injection sites could be thigh abdomen or upper arm and must be moved since insulin stimulates conversion of glucose into fat and one injection site can lead to _______ in that area.

A

protein

lipohypertrophy

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18
Q

Short acting insulin such as _____ and _____ is a clear solution of soluble insulin normally taken before a meal. onset action occur in 0.5 hrs underrates a peak in 2-5hours. These two insulin will polymerize (aggregate) in concentrated solutions into ____ and ____ which are inactive. after injection the insulin will slowly depolymerize back into the active monomer but takes times. Therefore eli Lilly has synthesized a new insulin ____ in which the order of two amino acids are reversed from human insulin resulting in no polarization and gives a faster onset.

A

Humulin R
Novolin R

dimers and hexamers

Humalog

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19
Q

Intermediate acting insulin exists as cloudy suspension of tiny crystals which must dissolve in tissue before they can be active. The intermediate form of insulin exists as an insoluble suspension of insulin crystals which have been made by precipitating insulin with the protein _____. These insulins are ____ ____ ____(NPH), _____ and _____.

A

protamine
Neutral protamine Hagedorn
Humulin N
Novolin N

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20
Q

_____ and ______ is a combination of the intermediate acting insulin and regular insulin in a stable 70:30 mix. 70% NPH and 30% regular.

A

Humulin 70/30

Novolin 70/3

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21
Q

______ is a semisynthetic form of long acting (24hr) insulin which has become quite popular for controlling fasting glucose levels. It can be used with ______ which provides postprandial blood glucose control. Advertised QD but people are taking it BID like NPH.

A

Lantus

Humalog

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22
Q

To much insulin could result in hypoglycemia and may produce headaches, drowsiness and fatigue. Severe cases include tachycardia, sweating, nervousness. To little insulin can result in hyperglycemia and better control of insulin can lead to fewer long-term health problems.

A
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23
Q

The DCCT study diabetics taking 4 insulin injection per day had a 60% reduction in clinical ______, a 56% reduction in _______ and a 27% reduction in retinopathy compared to those who only took 1 0r 2 injection per day.

A

neuropathy

macroalbuminuria

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24
Q

Old paradigm ______+_______

New paradigm______+_____

A

Regular insulin + Humulin N

Humalog + Lantus

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25
Q

Long term blood sugar control is monitored by measuring the amount of ______ ______, commonly abbreviated ______. Glycated protein is from glucose reacting with blood proteins. In non-diabetics __-__% of hemoglobin exists as glycated hemoglobin. The % of glycated hemoglobin in diabetics is higher thus 6.3% would be regarded as maintaining excellent blood glucose control while a diabetic with 8.5% need to put more effort in. Some recent studies indicate the increased risk go hypoglycemic episodes in patients trying to achieve really tight control less than 7% and there is some data suggesting that overall mortality may increase.

A

glycated hemoglobin

HbA1c

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26
Q

Other alternative methods of insulin administration are ____ ____ allow for a continuous infusion of insulin but are expensive and require a great deal of patient motivation to be used properly. They usually use a fast acting insulin _____

A

insulin pumps

Humira

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27
Q

An inhalation form of inulin ______ made it to phase __ in clinical trials but absorption in the lungs was not enough and to many adverse effects.

A

Exubera

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28
Q

transplants of the pancrei are expensive and require the use of ____ to suppress the immune system but these are expensive. Also the use of immunosuppressive drugs for a developing type 1 diabetic can ____ destruction of beta cells

A

cyclosporine

halt

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29
Q

Some early type 2 diabetics may be able to control diabetes by _____ accompanied by _____. Not usually successful . Type 2 diabetes has been linked to lack of exercise and high carbohydrate/low fiber diets.

A

diet

exercise

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30
Q

Type 2 diabetics can use oral diabetic drugs such as _____ an option not available to type 1. These drugs stimulate release of insulin from the beta cells of the pancreas. Thes drugs can also cause increased _____ and _____

A

Sulfonylureas

appetite and weight gain

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31
Q

The most commonly used sulfonylurea drugs include, ____, _____, and _____. Although these drugs work they may lose efficacy as the disease progresses and so insulin injection may be used.

A

glyburide, glipizide, and glimepiride

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32
Q

the ___ tribe that has adopted the western diet in arizona, at least 50% of the population over 35 is diagnosed with type 2 diabetes

A

Pima

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33
Q

______ is currently the most commonly prescribed oral diabetic drug for type 2 diabetics. It works entirely differently from the sulfonylurea drugs and appears to address the type 2 diabetes problem more directly. It decrease _____ production of glucose, increases the sensitivity of the liver insulin receptors to insulin and elevates _____ utilization of glucose. Does not cause____ like sulfonylurea drugs

A

Metformin
Liver
Muscle
hypoglycemia

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34
Q

Metformin is also used for PCOS ____ ___ ____ ____

A

polycystic ovary syndrome

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35
Q

_____ and ____ increase sensitivity of insulin receptors primarily in the muscle and adipocytes. These drugs together with metformin have become drugs of choice for early type 2. However the glitazone drugs have recently gotten ___ ___ warnings due to increased risk of CHF and mortality in patients on ______. Although both glitazone drugs are effective at lowering blood sugar, it is not clear whether they lower mortality, another case of surrogate outcomes

A

Rosiglitazone and pioglitazone
black box
roiglitazone

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36
Q

____ was the original glitazone drug but taken off the market in 2000 due to rare but often fatal liver failure.

A

Troglitazone

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37
Q

______ are naturally occurring peptide hormones that stimulated the release of insulin from beta cells as well as slowing the emptying of the stomach contents into the duodenum. A drugs of this family is ______ and has to be taken Sq and ____ can be taken orally.

A

Incretins
byetta
januvia

38
Q

_____ inbits absorption of glucose from the kidneys and increase glucose in the urine

A

Invokana

39
Q

peptic ulcers are due to a gap in the protective ______ layer of the 25% stomach (gastric ulcers) or the 75% duodenum (duodenal ulcers).

A

mucosal

40
Q

The vast majority of ulcers are due to an infection with _____ _____ or the use of NSAID’s. It used to be thought that ____-____ syndrome was the main cause.

A

helicobacter pylori

Zollinger-Ellison

41
Q

___ antagonists cause the secretion of acid to decrease which in return causes the pH to increase. Increase in pH reduces the activity of ____

A

H2

pepsin

42
Q

_____ was the first H2 antagonist marketed in 1977 and was once the most commonly prescribed drug in the US. This drug inhibits cytochrome p450 and can cause g____,a nd ______ dysfunction.

A

cimetidine
gynecomastia
erectile

43
Q

______, _____ and ______ are newer H2 antagonist have longer half life than cimetidine and they do not inhibit cytochrome P-450 and they do not act as antagonists of androgenic receptors. a course if typically 4-8 weeks.

A

Ranitidine, Famotidine, Nizatidine

44
Q

_______ is a direct inhibitor of the proton pump in stomach ____ cells. Can work in two hours and is taken QID.

A

Omeprazole

parietal

45
Q

_____ is the s mirror image of omeprazole. Claims to have fewer side effects and is the 7th most commonly prescribed drug in the US in 2008.

A

Esomperazole

46
Q

_____ and ____ and ____ are all PPI’s

A

Pantoprazole
Lansoprazole
Rebeprazole

47
Q

Long term use of PPI’s could reduce nutrient absorption efficiency due to less denaturation of nutritional proteins, poorer absorption of B-12. There has been positive correlation between patients on term PPI’s and increased risk of ____ fracture

A

bone

48
Q

Treatment of Helicobacter pylori requires the use of an antibiotic which can be _______, ____ or _______. Also with the use of a PPI

A

metronidazole, amoxicillin, or tetracycline.

49
Q

_____ _____ _____ _____(GERD) occurs when gastric HCL passes into he esophagus due to _____ ______ _____ (LES) relaxation. Commonly occurs in bed ridden people and older people. Treatment includes H2 antagonists or PPI’s but does not corrects LES relaxation.

A

Castro-Esophageal Reflux Disease

lower esophageal sphincter

50
Q

Gram positive bacteria have a thick _______ cell wall. The bacteria included in this staphylococcus (most common cause of hospital infection), streptococcus, clostridium, bacillus, and helicobacter

A

peptidoglycan

51
Q

Gram negative bacteria have a thin peptidoglycan wall surrounded by a second lipid bilayer membrane. Common gram negative bacteria are Enterobacter, Neisseria (STD) Pseudomonas.

A

dd

52
Q

Antibiotics which inhibit bacterial growth are called ____, while those which kill bacteria are _______. An antibiotic can either inhibit growth or kill the bacteria depending on the doses.

A

bacteriocidal

bacteriostatic.

53
Q

The MIC is ___ ______ ____ while the MBC is _____ _____ ______. Broad spectrum vs narrow spectrum.

A

Minimum inhibitory concentration

minimum bacteriocidal concentration

54
Q

3 ways that a bacteria can become resistance to an antibiotic are modifying their cell wall so they are longer preamble to the antibiotic, modified and enzyme so it is no longer affected by the antibiotic and have acquired enzyme that destroys the antibiotic.

A

____

55
Q

Penicillin works by inhibiting an enzyme called _______ which is involved in synthesizing the bacterial cell wall. Many strains of bacteria now are impermeable to penicillin. Other bacterial strains have changed the structure of the transpeptidase enzymes that penicillin binds to. Bacteria that have done this are referred to as ____ resistant and generally resistant to all of the penicillin family. Example is ____ bacteria. Third form is when the bacteria acquires an enzyme called ___ _____ which can destroy 4-membered beta lactic ring of the penicillin family. Bacteria contain this are called _____ _____ ___-____ _____ (ESBR)

A 
transpeptidase
methicillin
MRSA
beta lactamse
extended spectrum beta-lactamase resistant
56
Q

_____ refers to hospital acquired infection nd ______ _____ are inquired anywhere else but a hospital.

A

nosocomial

community acquired

57
Q

The most common side effect of penicillin is ____ reaction. this can vary from a mild rash to life treating _____ shock. There have also been reports of amoxicillin inhibiting pal contraceptive action and causing unplanned pregnancies.

A

allergic

anaphylactic

58
Q

______ is the earliest penicillin still in use.Not table in acid and has to be given IV. Narrow spectrum and rarely used.

A

Penicillin G

59
Q

_______ is stable to stomach acid and available in oral form. Narrow spectrum which works primarily against gram positive bacteria such as staphylococcus and stretches species although some gram negative bacteria also susceptible.

A

Penicillin V

60
Q

_______ fifth most commonly prescribed drug in US in 2008. Broad spectrum penicillin which works on some additional gram negative bacteria.

A

Amoxicillin

61
Q

amoxicillin is the most commonly prescribed antibiotic in this country and has developed resistance to bacteria that have acquired the beta lactase enzyme. Chemist now combine it with ____ _____ and is marketed under the trade name ______.

A

Potassium clavulanate

Augmentin

62
Q

The _______ family of drugs is closely related to the penicillin family. They are made by bacteria first isolated from the ______ in Naples Italy. They are divided into three generations based on development of newer drugs. Broader spectrum. they are expensive and still under patent.

A

Cephalosporins

sewers

63
Q

_______ first generation of cephalosporins and frequently used to treat UTI respiratory infections and soft tissue infection from trauma. MOST commonly prescribed cephalosporin

A

Cephalexin

64
Q

Second gen cephalosporins include ____, ___ and ____ and all can be given orally.

A

cefzil, ceclor, ceftin

65
Q

______ is the drug if choice fro gonorrhea; also preferred drugs for meningitis and pneumonia. Must be given IV or IM and is a third gen cephalosporin.

A

Ceftriaxone

66
Q

______ is used for treating otis media and is a thin gen cephalosporin.

A

Cefdinir

67
Q

_____ (third gen cephalosporin) a broad spectrum drug effective against PSEUDOMONAS AERUGINOSA a common and particularly difficult infection to treat. Found in soil, and ponds. It pumps many of the common antibiotics out of the lungs and in general is resistant to most common antibiotics. It must be given by injection.

A

Ceftazidime

68
Q

______ is normally reserved for life treating gram positive infection push as MRSA (____ _____ _____ ______). It is the second choice dragster metronidazole. Not absorbed through he GI tract and must be given IV for systemic infection. resistant bacteria to this drug are known as ___ ____ ___(VRE). Common side effects include ototoxicity and nephrotoxcitiy. Also inhibits cell wall synthesis

A

Vancomycin
Methicillin resistant staphylococcus aureus
Vancomycin resistant enterococci

69
Q

____ works by inhibiting protein synthesis in bacteria. Its spectrum is similar to that of the penicillins. Taken ti or QID for 10 days. Frequently cases _____. Available in EC form to reduce GI disturbance. Used for patients who are allergic to penicillin and used to treat acne. Most commonly prescribed for UTI.

A

Erythromycin

Nausea

70
Q

_____ has replaced erythromycin and can be taken QD for 5 days. It is concentrated by the white blood cells thus heads to infection. Lower incidence of nausea. most commonly prescribed macrolide antibiotic.

A

azithromycin

71
Q

Tetracyclines work by inhibiting bacterial ________. They are broad spectrum drugs which are also used as an alternative in patients allergic to penicillin. Widely used in feed in _____ and _______ to increase weight. usually taken PO and topical formulation are used for acne.

A

ribosomes

chicken and cow

72
Q

_____ itself has a short half life and must be taken ti or aid and should be taken on an empty stomach to maximize absorption. However it causes gastric distress

A

tetracycline

73
Q

_________ has a QD formulation and is well absorbed in presence of food.Must be taken with food to reduce GI disturbance. Low dose of this drug inhibits breakdown of ______ in gums and may promote regrowth of receding gingival in _____ disease

A

doxycycline
collagen
periodontal

74
Q

________ it is most widely used as a topical agent in treatment of acne. It is the second choice drug after metronidazole in the treatment of abdominal and pelvic infection by bactericides fragilis, a pathogen resistant to most other antibiotics. Not used internally because of the risk of superinfection.

A

clindamycin

75
Q

_______ are large ionic polysaccharide molecule and are not absorbed through he GI wall. Must be given IV. CAN be given orally to reduce bacterial population in the GI tract before colorectal surgery. Effective against gram negative. _____ and ____ are two of the primary drugs in this class. _____ was the first in this drug class and requires a special order form the manufacturer.

A

Aminoglycosides
Gentamicin and tobramycin
streptomycin

76
Q

_______ works by inhibiting protein synthesis on bacterial chromosomes. It is highly lipophilic and passes through the BBB easily making it effective for treating meningitis, brain abscesses. Replaced by other drugs but still used in developing countries.

A

Chloramphenicol

77
Q

Sulfonamide drugs are the oldest antibiotic still in used (first used in 1936). They inhibit the synthesis of of _____ ___ which is essential in the synthesis of DNA. They have a structure similar to PABA a molecule used in the synthesis of ____ ____. Used primality in treatment of UTI’s, ear infection and branchial infections. Resistance occurs so they are combined with ______ another competitive inhibitor of folic acid

A

folic acid
folic acid
trimethoprim

78
Q

________ is the most commonly prescribed sulfonamide antibiotic. A combination of this drug and ______ is sold under the names septa and bactrim.

A

Sulfamethoxazole

Trimethoprim

79
Q

________ is a suldonamide but used primarily as an NSAID for reducing the inflammatory response of ulcerative colitis, rheumatoid arthritis and several other.

A

Sulfasalazine

80
Q

______ is used primarily to treat UTI’s especially cystitis infection and for prophylactic use. Adverse effects include ANOREXIA, NAUSEA, pulmonary reactions and BROWN COLORING OF THE URINE

A

Nitrofurantoin

81
Q

______ is part of the Fluoroquinolone family and is a very broad spectrum drug that is active against both gram positive and gram neagtive bacteria. Absorption is decreased with +2 and +3 ions. should not be taken with milk, antacids or mineral supplements. Used in animal feed. can cause headaches and nausea, rash.

A

Ciprofloxacin

82
Q

_______ is part of the Fluoroquinolone family and has an even broader spectrum and have been widely used for treating pneumonia.

A

Levofloxacin

83
Q

_________ is part of the Fluoroquinolone family and also inhibits DNA synthesis and is most effective for protozoal and obligate anaerobic bacteria. It is the drug of choice for treating infection with Giardia helicobacter pylori. It causes gastric distress and _____ be taken with food to reduce this effect. It inhibits the detoxification of ______. Inhibits the conversion of toxic acetaldehyde into non-toxic acetic acid. Drinking alcohol can produce flushing, tachycardia and headache.

A

Metronidazole
should
ethanol

84
Q

____ is only used in treatment of TB in combination with ISONIAZID and other drugs. It inhibits bacterial DNA dependent RNA polymerase. It’s combined with isoniazid and other drugs to reduce likely hood of resistance. Treatment last for 6 months to a year.

A

Rifampin

85
Q

____ _, ____ and _______ increase permeability of cell wall, resulting in osmotic pressure imbalance and cell lysis. Very ototoxic and nephrotoxic and as a result are only topical. Sold together as triple antibiotic cream.

A

Polymyxin B, neomycin and bacitracin

86
Q

Yeast infection can be oral aka _____ also vaginal and epidermal. They are eukaryotic thus antibiotics don’t work. The -azole drugs work by inhibiting the synthesis of _____ a molecule essential for the synthesis of fungal and yeast cell membranes.

A

thrush

ergosterol

87
Q

________ inhibits the synthesis of ergosterol. It is used topically, as lozenges for thrush and as tablets primarily in the treatment of vaginitis and oropharyngeal infections due to candida albicans and some fungal infections such as ______ _____ (athletes foot). requires 1-4 weeks

A

Clotrimazole

Tinea pedis

88
Q

_____ is available OTC in PO form and in cream and shampoo for topical use. Taken orally, it is concentrated in the skin while systemic concentrations remain low. It is used primarily in treatment of superficial mycoses. Side effects include rash, fever, rare hepatotoxicity. Takes one or more weeks.

A

Ketoconazole

89
Q

_____ is available as a cream or vaginal sup. used for Candida infections and some mycoses. OTC and take 1 or more weeks for cure.

A

Miconazole

90
Q

______ requires prescription but 1-2 doses is usually effective intreating vaginal candidiasis in 1-2 days instead 1-2 weeks of OTC meds. Also used for systemic infection such as s__ J___ V____ ____ or meningitis caused by fungal infections of cryptococcus and coccidioides.

A

Fluconazole

San Joaquin Valley Fever

Pharamcology (12 decks)

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