Term
Hx of antimicrobials:
1840's: ____ discovers micro-organisms to be the cause of fermentation
1860's: ___ implements antisepsis
1877: ___ & ____ report common aerobic microorganisms that inhibit anthrax
188's: ___'s search for the "magic bullet" yields arsenic for syphillis
1927: ___ discovers penicillin
1932: ___ begins clinical trials with sulfa drugs
1941: ___ & ___ launch clinical trial w/ penicillin in UK |
|
Definition
1840's: Louis pasteur
1860's: Joseph Lister
1877: Pasteur and Joubert1
1880's: Robert Koch
1927: Alexander Fleming
1932: Gerhard Domagk
1941: Florey and Chain |
|
|
Term
Koch's Postulates:
1. ____ must be isolated from every disease it is believed to cause
2. Bacterial isolated from host w/ disease in question must be grown in _____
3. Susceptible host infected w/ bacteria must develop ____
4. Bacteria must be isolated from the experimentally infected host |
|
Definition
1. suspect bacteria
2. pure culture
3. disease
|
|
|
Term
| How do you avoid development of bacterial resistance to abx? |
|
Definition
continue tx long enough
use abx only when necessary
use combo abx when needed |
|
|
Term
|
Definition
how bacteria spread abx resistance to other bacteria
they contain genes that can alter fxn of abx, assist in pumping abx out, or assist bacteria in degrading abx |
|
|
Term
Which are bacteriostatic and which are bactericidal?
Chloramphenicol
Aminoglycosides
Beta lactam agents
Isoniazid
Clindamycin
Macrolides
Nitrofurantoin
Metronidazole
Sulfas
Tetracyclines
Quinolones
Trimethoprin
Rifampin
Vanc |
|
Definition
Static: chloramphenicol, clindamycin, macrolides, nitrofurantoid, sulfas, tetracyclines, trimethoprin
Cidal: aminoglycosides, beta-lactams, isoniazid, metronidazole, quinolones, rifampin, vanc
In general, cell wall active drugs are bactericidal and protein synthesis inhibitors are bacteriostatic |
|
|
Term
| Stimuli and suppressors for gastric acid secretion |
|
Definition
stimuli: gastrin, H2, ACh
Suppressors: prostaglandin, E2, I2 |
|
|
Term
| Gastrinoma (gastrin-secreting tumor). presents w/ multiple, frequent ulcerations throughout GI tract |
|
Definition
| Zollinger-Ellison syndrome |
|
|
Term
gram neg bacillus (spiral flagellate) that causes non-invasive chronic gastritis
70-75% prevalence rate in duodenal ulcers |
|
Definition
|
|
Term
|
Definition
chemoreceptor trigger zones in brain
vomiting center in medulla
vestibular/cerebellar afferents
cortex inputs
peripheral inputs |
|
|
Term
| pt experiences fullness, bloating, pain, and nausea after abd surgery. what do you treat with? |
|
Definition
paralytic ileus --
if it's just been a day or two - wait
if longer: carbachol, bethanechol, neostigmine, metoclopramide (reglan), cisapride (propulsid) |
|
|
Term
pathophysiologic hallmark of asthma is ____ brought about by the contraction of smooth muscle, vascular congestion, edema of bronchial wall and thick, tenacious sputum
Airway ___ is the key underlying process
All this leads to ____
Airway remodeling due to chronic inflammation eventually leads to _____
___ cells dominate in acute phase, ____ dominate in chronic phase |
|
Definition
reduction in airway diameter
Airway inflammation
bronchospasm
decreased pulmonary fxn
mast cells - acute
basophils (release leukotrienes) - chronic |
|
|
Term
| pt has SOB. bronchial washings: increased inflammatory cells (eosinophils, basophils, macrophages, lymphocytes) |
|
Definition
|
|
Term
___ is a common complication of inhaled glucocorticoids
tx? |
|
Definition
|
|
Term
| allergic rhinitis tx strategies |
|
Definition
avoid allergens
immunotherapy - shots
prevent IgE binding to inflammatory cells
block histamine
reduce nasopharyngeal hyperemia
block/reduce inflammatory reaction |
|
|
Term
chronic, gradually progressive pulmonary disorder
hallmarks: airflow obstruction, gradual alveolar dilation and fibrosis |
|
Definition
|
|
Term
Airway obstruction predominates
Underlying cause is bronchial damage and inflammation
Asthma-like “reactive airway” contributes
Productive cough
Chronic or recurrent infections also contribute |
|
Definition
|
|
Term
Dilation and destruction of terminal airways and alveoli predominate
Reduction of surface area for interaction with air
SOB is main sx |
|
Definition
|
|
Term
|
Definition
Prevent: stop smoking (Clonidine, Buproprion)
Abx
Improve airways: beta2 agonists, glucocorticoids, leukotriene inhibitors, atrovent, spiriva
|
|
|
Term
| 2 main bone mass determinants |
|
Definition
ca availability
osteoclas/blast balance |
|
|
Term
3 natural bone modulators
1. increases Ca absorption from gut, enhances ca renal reabsorption
2. stimulates osteoclasts, dose-dependent bone loss or gain. hypercalcemia
3. inhibits osteoclasts |
|
Definition
1. vit D
2. PTH
3. calcitonin |
|
|
Term
| 2 drugs that can cause osteoporosis |
|
Definition
|
|
Term
what dz?
women > men and earlier than men
due to falling estrogen levels
estrogen receptors in bone reduce PTH effects |
|
Definition
|
|
Term
| indications for hormone replacement therapy |
|
Definition
absent uterus
significant vasomotor flushes
low risk for CV disease
significant risk of osteoporosis |
|
|
Term
| When are combo abx indicated? |
|
Definition
- broad spectrum for seriously ill
- treat polymicrobial infections
- reduce risk of infection (TB)
- lower toxicity of one agent
- synergistic - more potent
|
|
|
Term
ex of abx synergism:
1. agents that clock sequential steps in metabolic process, such as ______
2. agents that inhibit bacterial abx defenses, such as ____.
3. Agents that enhance uptake of another agent, such as ____ for ____. |
|
Definition
1. Trimethoprin-sulfamethoxazole (bactrim)
2. Beta-lactamase inhibitors
2. Cell wall agents for aminoglycosides |
|
|
Term
Ex of abx antagonism:
1. reduction of cidal activity by a static agent: ____ antagonizes ____
2. INduction of enzymatic inhibition: some agents induce enteric bacteria to produce ____ |
|
Definition
1. tetracycline antagonizes penicillin
2. beta lactamase |
|
|
Term
| When to use abx prophylaxis |
|
Definition
surgery: cefazolin for c-sections, hysterectomy, and ortho surgery (staph)
high risk of transmission of infection: penicillin or clindamycin before dental procedures for pts w/ valves, etc, close contacts of pts w/ cholera, anthrax, palgue, meningitis |
|
|
Term
3 main classifications of bacteria:
1. protists & fungi
2. "regular" bacteria - staph, strep, e.coli + atypical bacteria - mycoplasma, chlamydia, rickettsia, spirochetes, mycobacteria
3. viruses & prions |
|
Definition
1. eukaryotes
2. prokaryotes
3. non-living pathogens |
|
|
Term
What are some eubacteria?? NOT eukaryotes
2 obligate intracellular bacteria? |
|
Definition
eubacteria: staph, strep, e. coli
obligate intracellular: chlamydia + rickettsia |
|
|
Term
What gram classification?
1. staph, strep, enterococcus
2. bacillus anthracis, c. diphteriae, clostridium
3. N. gonorrhea, N. meningitidis
4. E. Coli, proteus, enterobacter, salmonella
5. treponema pallidum (syphilis)
6. mycobacteria |
|
Definition
1. gram pos cocci
2. gram pos bacilli
3. gram neg cocci
4. gram neg bacilli
5. spirochetes
6. acid-fast bacili
|
|
|
Term
| 4 classes of abx based on what they inhibit: |
|
Definition
1. cell wall synthesis inhibitors
2. protein synthesis inhibitors
3. Nucleic acid inhibitors
4. Folate synthesis (metabolism) inhibitors |
|
|
Term
|
Definition
1. penicillins
2. Cephalosporins
3. Carbapenems
3. Monubactams |
|
|
Term
| 2 classes of cell wall abx |
|
Definition
beta-lactams
1. penicillins
2. Cephalosporins
3. Carbapenems
3. Monubactams
others
1. vanc
2. daptomycin
3. bacitracin |
|
|
Term
| penicillins are synergistic w/ ____ |
|
Definition
|
|
Term
| what 3 drugs are a penicillin combined with another drug that are beta-lactamase inhibitors |
|
Definition
1. Augmentin - pencillin + clavulanic acid
2. Unasyn - ampicillin + sulbactam
3. Zosyn - piperacillin + tazobactam |
|
|
Term
| toxicities of penicillins |
|
Definition
hypersensitivity: 5% - itchy rash --> angioedema,
anaphylaxis
Rash (not hypersensitivity)
Diarrhea
Nephritis |
|
|
Term
Classes of penicillins
1. Pen G & V
2. methacillin, cloxacillin, nafcillin, oxacillin
3. ampicillin, amoxicillin
4. carbencillin, mezocillin, piperacillin, ticarcillin |
|
Definition
1. natural penicillins
2. anti-staph cillins
3. extended spectrum
4. Anti-pseudomonal
|
|
|
Term
| What abx is most commonly used for otitis media, UTI, and for dental prophylaxis? |
|
Definition
|
|
Term
| Which abx is most potent and useful in intra-abdominal infections and in burn pts? What is a down side? |
|
Definition
piperacillin (anti-pseudomonas)
susceptible to b-lactamase |
|
|
Term
| 4 generations of cephalosporins - drugs and effectiveness |
|
Definition
1. cefazolin (ancef, kefzol) - gram pos
2. more gram neg coverage
3. ceftriaxone (Rocephin) - more gram neg + ability to cross BBB
4. Cefepime - better b-lactamase resistance, better for staph
|
|
|
Term
| ___ have a 5-15% cross-reactivity with penicillins (if you're allergic to pens, the chance you'll be allergic to these too) |
|
Definition
|
|
Term
| 2 side effects of cephalosporins |
|
Definition
1. disulfiram-like effect: if you drink alcohol w/ it, you'll get sick
2. Bleeding due to vit K action |
|
|
Term
what class of drugs?
- pen/ceph allergy cross reaction
- braod spectrum coverage
- parenteral only
- expensive
- may cause: seizures, nausea, diarrhea
ex? |
|
Definition
| carbapenems - imipenem, meropenem |
|
|
Term
what class of drugs?
- low allergy reaction - safe to use in ceph/pen allergy
- ineffective against gram pos
- mostly used against enterobacter
ex? |
|
Definition
|
|
Term
What drug?
- "Ace in the hole"
- IV or oral
- synergistic w/ aminoglycosides
- effective against enterococcus, resistant staph/strep, c. diff
- nephro and ototoxic
- Side effect: Red man syndrome - flushing due to histamine release |
|
Definition
|
|
Term
What drug?
- gram pos coverage only
- works on resistant staph/strep, enterococcus
- Not useful for pneumonia - inactivated by surfactant
- Cannot be used wtih statins -- Rhabdomyolysis |
|
Definition
|
|
Term
explosive bloody diarrhea that can be life threatening
- occurs after use of broad spectrum abx
- therapy: supportive, vanc or metronidazole |
|
Definition
| Pseudomembranous colitis (C. Diff) |
|
|
Term
| 3 protein synthesis inhbitors |
|
Definition
tetracyclines
aminoglycosides
macrolides |
|
|
Term
Protein synthesis inhibitor that is a broad spectrum static agent, limited to gram neg organisms (chlamydia, mycoplasma, acne, protozoa)
anti-inflammatory action
oral absorption reduced w/ food
side effects?
contraindications? |
|
Definition
tetracyclines
photosynsitivity
Contraindicated: pregnancy and kids
|
|
|
Term
| IV only glycylcycline (type of TCN) that is used for resistant staph/strep |
|
Definition
|
|
Term
bacteriocidal agents that are protein synthesis inhibitors
- widely used in serious gram neg infections.. some gram pos coverage
- all parenteral
- synergistic with loop diuretics
side effects?
drugs? |
|
Definition
aminoglycosides
ototoxic, nephrotoxic
amikacin, gentamycin, tobramycin
|
|
|
Term
Protein synthesis inhibitor w/ good gram pos coverage
gram neg: chlamydia, legionella, mycoplasma, treponema, helicobacter, diphtheria
SAFE IN PREGNANCY AND PEDS
lots of drug interactions (CYP450)
side effects?
drugs? |
|
Definition
macrolides
GI upset, ototoxic
erythromycin
azithromycin
clarithromycin
telithromycin
clindamycin |
|
|
Term
broad spectrum protein synthesis inhibitor (a TCN). especially good against anaerobes.
- known to cause C. diff |
|
Definition
|
|
Term
| broad spectrum tetracycline that's only used as a backup. can cause bone marrow suppression and gray baby syndrome |
|
Definition
|
|
Term
| tetracycline used for vancomycin resistance |
|
Definition
|
|
Term
IV only drugs used for vanc resistance
can cause arthralgia, myalgia, and hyperbilirubinemia |
|
Definition
| quinupristin & dalfopristin |
|
|
Term
4 generations of nucleic acid inhibitors:
1. for E. coli UTI only
2. expanded gram neg coverage. better tolerated but can damage growing cartilage, ligaments, and connective tissue -- tendon damage/rupture. therefore contraindicated in kids and pregnancy. exs?
3. better gram + coverage than 2nd gen. ex?
4. not good against atypical organisms but better gram + and anaerobic coverage. ex? |
|
Definition
1. quinolones
2. fluoroquinolones - norfloxicin, ciprofloxacin
3. lomefloxacin, levofloxacin
4. moxifloxacin |
|
|
Term
2nd gen nucleic acid inhibitors:
1. good for UTI and prostatitis
2. good for gonorrhea & anthrax |
|
Definition
|
|
Term
| 4th generation nucleic acid inhibitor reserved for multiple drug resistance organisms |
|
Definition
|
|
Term
folate synthesis inhibitors that are contraindicated in pregnancy and newborns due to risk of kernicterus.
- cannot be combined w/ other abx
1. p-aminobenzoic acid (PABA)
2. systemic agents: ____
3. used for IBD
4. topical agents
5. uti agents |
|
Definition
sulfonamides
2. sulfa's (sulfamethoxazole)
3. sulfasalazine
4. silver sulfadiazine, mafenide
5. trimethoprim, sulfisoxazole |
|
|
Term
sulfonamide most commonly used for UTI or penumocystis
- urticaria in allergic reactions
- hemolytic anemia w/ G6PD deficiency
- can cause aplastic anemia |
|
Definition
| co-trimoxazole (trimethoprim + sulfamethoxazole) AKA Bactrim |
|
|
Term
| triple drug treatment for leprosy |
|
Definition
| dapson, clofazimine, rifampin |
|
|
Term
1st Line TB Tx
1. use caution in liver/renal failure
- peripheral neuritis (B6 deficiency), hepatitis, drug interactions
2. CYP 450 induction w/ oral contraceptives. cannot be combined w/ pyrazinamide due to liver toxicity |
|
Definition
|
|
Term
|
Definition
aminoglycosides
fluoroquinolones
macrolides |
|
|
Term
special precautions for ____:
contraindicated in pregnancy and kids
dental enamel dysplasia and discoloration
growth inhibition & bone deformity
photosensitivity |
|
Definition
|
|
Term
| miscellaneous abx that converts to formaldehyde in urine to kill bacteria. used in uncomplicated cystitis. contraindications? |
|
Definition
methenamine
contraindications: hepatic & renal insufficiency. w/ sulfa drugs, upper UTI |
|
|
Term
| miscellaneous abx w/ limited spectrum of action that turns urine brown and can occasionally cause penumonitis, pulm fibrosis, and peripheral neuritis |
|
Definition
|
|
Term
analgesic for uti
can turn urine orange/red
methemoglobinemia in high doses |
|
Definition
| phenazopyridine (pyridium) |
|
|
Term
drug useful against leprosy and pneumocystis
adverse effects: hemolysis (esp G6PD def) and peripheral neuropathy |
|
Definition
|
|
Term
what class of drugs?
clotrimazole (lotrimin)
miconazole (monistat)
econazole (spectazole)
nystatin (mycostatin)
griseofulvin (grifulvin)
butoconazole
terbeinfine (lamisil)
terconazole (terazol) |
|
Definition
|
|
Term
| 3 most common systemic/subcu antifungals |
|
Definition
amphotericin B
fluconazole (diflucan)
ketoconazole |
|
|
Term
| fungal cell wall inhibitor w/ IV route administration only |
|
Definition
|
|
Term
potent, broad spectrum fungicide. IV administration
low therapeutic index: fever, chills, hypotensive crisis, anemia, thrombophlebitis |
|
Definition
|
|
Term
systemic antifungal w/ no endocrine side effects and least CYP450 impact
- good CNS penetration - 1st choice for meningitis
- oral or IV
- GYN use: single dose for vaginitis if cream doesn't work
- rare hepatic tox |
|
Definition
|
|
Term
| 1st choice for cryptococcal meningitis |
|
Definition
|
|
Term
antifungal that is synergistic with amphotericin B -- therefore don't have to give as much amphotericin and can limit toxicity
only effective against cryptococcus and candida |
|
Definition
|
|
Term
broad spectrum antifungal best used for histoplasmosis
coca-cola improves absoprtion
- anti-steroidal properties: ED, libido drop, period problems
- strong CYP450 inhibitor
- gonadal and adrenal steroid inhibitor
- can NOT be given w/ amphotericin B |
|
Definition
|
|
Term
new azole used in candida septicemia & invasive aspergillosis
side effects: visual changes |
|
Definition
|
|
Term
oral antifungal used for superficial infections when topical agents fail
potentiates ethanol |
|
Definition
|
|
Term
| used as "swish and swallow" for oral candida infections |
|
Definition
|
|
Term
| dopamine balance: too much = ____, too little = ____ |
|
Definition
too much: psychosis
too little: parkinson's |
|
|
Term
| strong inhibitory neurotransmitter |
|
Definition
|
|
Term
what neurotransmitter?
controls visceral functions like sleep, temp, appetite, and neuroendocrine. thus when used as a drug, it has those side effects. |
|
Definition
|
|
Term
1. suppression of responsiveness to a constant level of stimulation or reduction of anxiety
2. increase in drowsiness leading to initiation of natural sleep. a sedative w/ a short sleep latency interval |
|
Definition
|
|
Term
| properties of the ideal hypnotic? |
|
Definition
induces normal sleep pattern
minimal interference w/ sleep levels
minimal rebound, tolerance, & dependence |
|
|
Term
| adverse effects of sedatives |
|
Definition
- raise convulsion threshold
- muscle relaxant
- sedation
- tolerance
- physical & psych dependence --> VERY common
- overdose potential
- reduced cognition, control of impulses
- euphoria
- confusion
- ataxia |
|
|
Term
| why is tolerance common in sedatives? |
|
Definition
main reason: reduction in gaba receptor concentration
also enzyme induction |
|
|
Term
which sedatives have highest risk of dependence?
what can greatly increase risk of overdose |
|
Definition
|
|
Term
| 4 classes of sedatives & hypnotics |
|
Definition
benzos
barbiturates
antihistamines
ehtanol |
|
|
Term
what classes of barbiturates?
1. phenobarbital (luminal)
2. thipental
3. pentobarbital, amobarbital, secobarbital |
|
Definition
1. long acting (1-3 days)
2. ultra-short acting (3-8 hours)
3. short acting (10-20 hours) |
|
|
Term
3 types of GABA receptors:
1. mediates anti-anxiety
2. mediates myorelaxant
3. mediates anticonvulsion |
|
Definition
1. gamma-2
2. alpha-2
3. alpha-1 |
|
|
Term
benzodiazapines act on ___ receptors.
1. _____:
flurazepam, temazepam, triazolma
2. ____:
alprazolam (xanax), lorazepam (ativan), diazepam (valium), clonazepam (klonopin) |
|
Definition
GABA
1. hypnotics
2. sedatives |
|
|
Term
benzo antagonist that is parenteral only
- rapid but short action
- dizziness and nausea can occur |
|
Definition
|
|
Term
|
Definition
anxiolytic anti-histamines
these are the safest sedatives |
|
|
Term
|
Definition
non-benzos:
eszopiclose (lunesta)
zaleplon (sonata)
zolpidem (ambien) |
|
|
Term
|
Definition
methylxanthines
nicotine
cocaine
amphetamine
modafinil |
|
|
Term
|
Definition
caffeine
theophylline
theobromine - in chocolate |
|
|
Term
stimulant that improves alertness, attention, and reflexes at low dose but creates hypotension & resp paralysis at high dose
addiction potential > heroin |
|
Definition
|
|
Term
stimulant with local anesthetic properties, increases arousal and sense of well being
accentuates NE
depletes dopamine
highly addicting
fatal arrhythmias
MI, coronary vasospasm
lowered seizure threshold |
|
Definition
|
|
Term
stimulant that produces catecholamine effects & inhibits MAO
- increases alertness, concentration, and sense of well-being but does not enhance performance
- used for add and narcolepsy
highly addictive, may produce paranoid psychosis
- insomnia, dizziness, anorexia
- increased HR and contractility
ex? |
|
Definition
amphetamines
- dextroamphetamine - adderall
- methamphetamine - speed
- methylphenidate - ritalin |
|
|
Term
non-amphetamine stimulant/analeptic
- less euphoria
- less potential for abuse (class IV)
- indications: narcolepsy, somnolence due to sleep apnea, work shift related somnolence |
|
Definition
|
|
Term
| 3 commonalities of all stimulants |
|
Definition
1. all are addictive
2. all have withdrawal sx
3. all are commonly used/abused |
|
|
Term
types of depression:
1. normal reaction to tragedy/loss
- becomes abnormal >6 weeks
2. genetic component
- probable neurotransmitter imbalance - serotonin/NE
3. alternating periods of mania and depression |
|
Definition
1. reactive (secondary)
2. endogenous
3. bipolar |
|
|
Term
drug to stop and then prevent the manic phase of bipolar disorder
- uses IP3 as 2nd messenger
- nonsedating and noneuphoric
- narrow therapeutic index
adverse effects:
tremor, ataxia, confusion, convulsion
CYP450 - check other drugs before adding this
other options? |
|
Definition
lithium carbonate/lithium salts
alternatives: carbamazepine, valproic acid |
|
|
Term
enzyme present in nerves, gut, and liver that inactivates adrenergic drugs, NE, dopamine, and tyramine
has 2 isoforms:
A - degrades NE and tyramine
B - degrades dopamine |
|
Definition
|
|
Term
naturally occurring adrenergic agonist present in many foods
normally metabolized by MAO
what can happen if not degraded? |
|
Definition
tyramine
tyrmaine crisis: HTN, tachy, arrhythmia, CVA |
|
|
Term
Antidepressant group including Isocarboxizid (marplan), phenelizine (Nardil), tranylcypromine (parnate)
initial phase: stimulant
2-6 weeks: antidepressant
adverse effects: tyramine crisis (with certain foods), anticholinergic (blurred vision, dry mouth, urinary retention, constipation, overdose potential |
|
Definition
|
|
Term
side effects of what class of antidepressant?
anticholinergic, antialpha adrenergic (orthostatic hypotension, reflex tachy)
all are capable of lethal overdose |
|
Definition
|
|
Term
|
Definition
1st: imipramine (tofranil)
amitriptyline (elavil) |
|
|
Term
|
Definition
depression
eating disorders (bulimia/anorexia)
OCD
panic attacks
PMS |
|
|
Term
popular SSRIs
much safer than MAOIs and TCAs |
|
Definition
fluoxitine (prozac)
Paroxetine (paxil)
Sertraline (zoloft)
Escitalopram (lexapro)
Citalopram (Celexa) |
|
|
Term
|
Definition
sexual dysfunction
changes in appetite/weight gain
suicide risk iin teens
|
|
|
Term
what group of antidepressants?
- may be effective when ssri's aren't
- effective against neuropathic pain
- hard to overdose
include venlafaxine (effexor) and duloxetine (cymbalta) |
|
Definition
|
|
Term
| 2 special niches for atypical antidepressants |
|
Definition
nicotine withdrawal
neuropathy |
|
|
Term
| what psychotropic drugs are approved for use in pregnancy? |
|
Definition
|
|
Term
disorder characterized by delusions, hallucinations, and abnormal cognition
most commonly, schizophrenia
most common tx: blocking dopamine receptors |
|
Definition
|
|
Term
| high potency dopamine blockers create ___ side effects, low potency create ___ side effects |
|
Definition
high: extrapyramidal
low: anticholinergic (hypotension, autonomic, sedation) |
|
|
Term
Antipsychotic drug that has some dopamine blocking effects and some serotonin inhibiton
creates less extrapyramidal and anticholinergic side effects
major problems: metabolic - weight gain, T2DM, hypercholesterolemia, CV disease |
|
Definition
|
|
Term
ex of what drug class?
phenothiazines:
aliphatic: chlorpromazine (thorazine)
butyronphenones: Haloperidol (HALDOL)
thioxanthenes (Navane) |
|
Definition
|
|
Term
what drug class?
olanzepine (zyprexa)
risperidone (risperdal)
clozapine (clozaril) |
|
Definition
|
|
Term
| antipsychotic drug side effects |
|
Definition
extrapyramidal: parkinsonian, tardive dyskinesia
antimuscarinic: dry mouth, blurred vision, constipation, urinary retention
Alpha adrenergic: orthostatic hypotension, ejaculatory dysfunction
dopamine inhibition: hyperprolactinemia, galactorrhea, gynecomastia |
|
|
Term
| life threatening muscle rigidity eading to hyperthermia due to increased sensitivity to extrapyramidal effects of antipsychotics |
|
Definition
| neuroleptic malignant syndrome |
|
|
Term
| status epilepticus is a seizure lasting > __ min |
|
Definition
|
|
Term
anti-seziure drug that is common initial choice for adults
- stabilizes neuronal membranes to restrict ion flow
- oral and IV preps
- 24 hr half life = once a day dosing
side effects: nausea, gingival hyperplasia, coarsening of facial features, megaloblastic anemia, nystagmus, ataxia, diplopia, agranulocytosis |
|
Definition
|
|
Term
cleft lip and palate
facial abnormalities
heart anomalies
mental retardation/microcephaly
after pregnant woman takes dilantin |
|
Definition
|
|
Term
anti-seizure drug thtat stabilizes neuronal membranes
-tricyclic derivative
- most efficacious for partial seizures
- hepatic toxicity - must monitor enzymes
- drug interactions (erythromycin, cimetidine, diltiazem, INH, sulfa) |
|
Definition
|
|
Term
| carbamazepine derivative that has less side effects |
|
Definition
| oxcarbazepine (trileptal) |
|
|
Term
barbituate anti-seizure med used in peds
causes kernicterus if used in pregnancy
side effects: sedation, anticholinergic |
|
Definition
|
|
Term
what seizures are each used for?
1. topiramate (topamax)
2. tiagabine (gabitril)
3. gabapentin (neurontin)
4. ethosuximide (zarontin)
5. Lamotrigine (Lamictal)
6. valproic acid
7. clonazepam (Klonopin) |
|
Definition
1. general & partial -- reduces BCP effectiveness
2. partial
3. partial
4. absence
5. adjunct - severe dermatitis
6. absence & myoclonic
7. absence |
|
|
Term
anti-seizure GABA analog similar to gabapentin
- also used for neuropathy and fibromyalgia
- schedule V drug due to potential for abuse |
|
Definition
|
|
Term
| 2 seizures meds to avoid in 1st trimester |
|
Definition
trimethadione
valproic acid |
|
|
Term
| indications for opiate use |
|
Definition
analgesia - acute severe pain, NOT chronic
acute pulmonary edema
cough suppression
diarrhea |
|
|
Term
DEA drug schedule:
I. high abuse potential. no medical use.
II. high abuse potential. medical indications
III. less abuse potential. medical indications
IV. low abuse potential. medical indications
V. low abuse potential. medical indications |
|
Definition
I. heroin, LSD, marijuana
II. morphine, cocaine, oxycodone, opium, amphetamines
III. hydrocodone, codeine, anabolic steroids, marinol
IV. benzos, phenobarb, modafinil
V. small amts of opium/codeine, pregabalin |
|
|
Term
|
Definition
morphine
meperidine (demerol)
Hydromorphone (Dilaudid)
Oxymorphone
Methadone
Diacetylmorphine (heroin)
fentanyl |
|
|
Term
|
Definition
| morphine capsule w/ inner core of naltrexone (an antagonist) --> made so it can only be swallowed, not snorted or shot |
|
|
Term
strong opioid agonist w/ antimuscarinic effects (tachy)
- lowered seizure threshold
- neg inotropic effects
- < nausea than morphine
- less neonatal depression |
|
Definition
|
|
Term
potent opioid agonist that is better for chronic, difficult to treat pain
- slower tolerance and dependence
- good for treating opioid addiction --> heroin addicts |
|
Definition
|
|
Term
|
Definition
| partial opioid agonist known as the "professional man's methadone" |
|
|
Term
oxycodone + ASA
Hydrocodone + acetaminophine or ibuprofen
codeine |
|
Definition
|
|
Term
| which tylenol + codeine preparation is most common? |
|
Definition
| tylenol 3 - 30 mg codeine |
|
|
Term
how do mixed partial opioid agonists work?
Pentazocine (Talwin), nalbuphine (Nubain), buprenorphine (Buprenex), butorphanol (Stadol), dezocine (Dalgan |
|
Definition
agonists when used along
antagonists when used w/ other opioids |
|
|
Term
|
Definition
sedation & resp depression
increased ICP - r/o head trauma before use
dysphoria
hallucinations
n/v
constipation
urinary retention
itching
urticaria |
|
|
Term
| important opioid drug interaction? |
|
Definition
|
|
Term
| **what happens when you give an opioid to a pt w/ biliary colic? |
|
Definition
worsens pain initially
transient elevation in amylase and lipase --> mimics pancreatitis |
|
|
Term
| you find a pt comatose due to opiate overdose... what do you treat them with? |
|
Definition
naloxone (narcan)
nalmefen (revex)
naltrexone (revia) |
|
|
Term
non-narcotic analgesic that is a synthetic opioid agonist due to it's weak mu receptor agonism
also a weak NE and serotonin reuptake inhibitor so its useful in neuropathic pain
lowers seizure threshold |
|
Definition
|
|
Term
| an opiate that is used as anti-diarrheal agent |
|
Definition
|
|
Term
| ** summary of opiate cautions (6) ** |
|
Definition
1. increased ICP
2. increased biliary pressure
3. tolerance
4. dependance & withdrawal
5. nausea & constipation
6. avoid mixing agonists w/ partial agonists |
|
|
Term
| loss of dopaminergic neurons in substantia nigra, reduced dopamine/ACh ratio in neostriatum |
|
Definition
|
|
Term
| 2 drugs that can induce parkinsonism |
|
Definition
| phenathiazines, haloperidol |
|
|
Term
1st choice in parkinson's tx
- increaes dopamine in substantia nigra
- works best in early disase
adverse effects: anorexia, nausea, tachy, arrhythmias, browl saliva/urine, hallucinations, dyskinesia |
|
Definition
|
|
Term
| what happens if you give levodopa w/o carbidopa? |
|
Definition
| levodopa won't be effective bc it will be broken down before it can be converted to dopamine in the brain |
|
|
Term
Pramipexole (mirapex)
Ropinrole (Requip) |
|
Definition
| 2 non-ergot dopamine agonists for parkinson's tx |
|
|
Term
| dopaminergic side effects |
|
Definition
orthostatic hypotension
nausea
hallucinations/confusion
vasospasm
peptic ulcer |
|
|
Term
2 anticholinergic parkinson's drug that change the dopamine/ach ratio
- adverse effects: blurred vision, urinary retention, mydriasis
contraindications: glaucoma, BPH |
|
Definition
benztropine (cogentin)
Trihexyphenidyl (artane) |
|
|
Term
selective MAO-B inhibitor that results in elevated doapamine levels to tx parkinsons
enhances effects of levodopa/carbidopa
low risk of HTN crisis |
|
Definition
|
|
Term
| antiviral agent used in parkinson's tx to reduce bradykinesia by increasing dopamine production from surviving neurons |
|
Definition
|
|
Term
COMT inhibitor used for "on-off" parkinson's to reduce levodopa degredation
danger: fulminating hepatic necrosis |
|
Definition
|
|
Term
Common neurologic disorder
About 350,000 Americans
Women outnumber men by 2:1
Most commonly begins in the 20-40 y/o age range
Characterized by areas of demyelination in the CNS
Inflammatory damage (probably autoimmune)
Followed by gliosis (scarring)
These lesion vary in time and location |
|
Definition
|
|
Term
sx of what disease?
Limb weakness, numbness or tingling
Spastic paraparesis of various muscle groups
Optic neuritis (vision loss)
Diplopia (double vision)
Loss of control of bladder or rectal sphincters
Vertigo |
|
Definition
|
|
Term
Gold standard MS tx?
other tx? |
|
Definition
gold standard: Interferon
other:
corticosteroids
IVIG
methotrexate, alemtuzumab
|
|
|
Term
Avonex and Betaseron
toxicity |
|
Definition
Interferon B-1a and B-1b tx used to tx MS
tox: neuropsychiatric |
|
|
Term
| ** most common cause of dementia in elderly |
|
Definition
|
|
Term
drug class with some evidence for diminished CNS cholinergic activity in AD
includes donepazil (aricept), galantamine (razadyne), rivastigmine (exelon) |
|
Definition
|
|
Term
what drug class?
Activated by glutamate (neurotransmitter) action
Excess glutamate activity may be part of Alzheimer pathophysiology
Memantine (Namenda, Auxera, Ebixa)
Effectiveness:
Moderate reduction of rate of progression
Small + effects on cognition
Side effects:
Confusion, dizziness, insomnia, agitation
Some of these side effects are actually sx of alzheimer’s itself |
|
Definition
|
|
Term
___ actions:
Inhibits Catabolic Actions
- Inhibits glycogen breakdown
- Inhibits amino acids & fatty acid breakdown into ketones
Anabolic Actions
- Promotes glycogen production & storage
- Promotes triglyceride synthesis
Effect on Muscle
- Promotes protein synthesis, glucose transport, glycogen storage
Effect on Adipose Tissue
- Increased triglyceride storage
- Most efficient energy storage form |
|
Definition
|
|
Term
Accumulation of (acetoacetate, B-hydroxybutyrate)
Significant Hyperglycemia (300-600 mg/dl)
Falling Arterial ph: (6.8 – 7.3)
Tachycardia, dehydration, shortness of breath, lethargy to coma
Fatal if not corrected |
|
Definition
|
|
Term
Humulin, Lente Humulin, NPH Humulin
Novolin, Novolog, Velosulin |
|
Definition
|
|
Term
Analog of amylin (islet amyloid pancreatic peptide)
Adjunct to increase satiety, reduce post meal glucagon secretion |
|
Definition
|
|
Term
Mode of Action
- Bind to islet receptor
- Causes stored insulin to be released
Duration of Action: 6-60 hours
Hepatic & Renal Excretion
- Avoid use in hepatic or renal failaure
Increase Deaths from CV Disease?
CONTRAINDICATED IN PREGNANCY |
|
Definition
| First Generation Sulfonylurias |
|
|
Term
Fewer Side Effects than 1st Generation
May Work in Patients Where 1st Generation Drugs Have Failed
Avoid Use in Elderly and Those with CVD
Still had some issues with hypoglycemia
3 Preparations:
Glipizide (Glucotrol)
Glyburide (Micronase, DiaBeta)
Glimepiride (Amaryl) |
|
Definition
|
|
Term
| caution for all sulfonylurias in DM? |
|
Definition
| hepatic or renal insufficiency |
|
|
Term
Some Overlap with Sulfonylurea Receptor
Fast Onset, Short Duration = Low hypoglycemic concerns
Hepatic Excretion
Preparations:
Repaglinide (Prandin)
Nateglinide (Starlix)
Tid Before Meals
caution? |
|
Definition
meglitinides
beware of CYP3A4 inhibitors - macrolides and fluconazole |
|
|
Term
| 3 ways to reduce insulin resistance |
|
Definition
weight loss and exercise
Biguanides (metformin)
Thiazolidinediones "glitazones" |
|
|
Term
Drug of choice for T2DM that reduces gluconeogenesis to reduce insulin resistance
side effects?
contraindications |
|
Definition
biguanides - metformin
GI side effects: n/d, bloating
lactic acidosis possible
contraindications: liver, heart, renal dz |
|
|
Term
Enhanced Tissue Sensitivity to Insulin
Mode of action includes gene regulation
-Slow onset of action
Improves Lipid Profiles
May help with weight loss
Can Be Hepatotoxic
Monotherapy or in combination with:
-Sulfonylureas
-Metformin |
|
Definition
| glitazones (thiazolidinediones) |
|
|
Term
substances secreted by L cell in intestine
decreases glucagon secretion
increases insulin secretion
may help preserve beta cells
how is this action potentiated in DM tx? |
|
Definition
GLP-1 (glucagon-like peptide 1)
give GLP-1 analogs
give DPP-4 (breaks down GLP-1) inhibitors |
|
|
Term
1. exenatide (byetta)
2. liraglutide (victoza)
3. sitagliptin (januvia) |
|
Definition
1 & 2 - glp-1 analogs
3 - DPP4 inhibitor |
|
|
Term
Reduce Starch and Disaccharide Absortion
By Competitive Inhibition
Take Before Meals
Main Side Effects: Flatulence, Diarrhea, Bloating/Abdominal Pain
Due to higher glucose concentrations in lower intestine which may facilitate bacterial colonization, which produce gas
Monotherapy Rarely, Adjunct Commonly |
|
Definition
alpha-glucosidase inhibitors
--> reduce glucose absorption frm GI tract
acarbose (precose)
miglitol (glyset) |
|
|
Term
| 4 sites in parietal cells that can be blocked/stimulated to prevent gastric acid secretion |
|
Definition
1. cholinergic receptors - blocked
2. H2 receptors - blocked
3. prostaglandin receptors - stimulated
4. proton pump - inhibited |
|
|
Term
| eradicating ____ to reduce peptic ulcers requires 2 weeks of multi-drug tx with at least PPI and abx |
|
Definition
|
|
Term
What class?
how long to action?
side effects?
rate potency
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nazatidine (Axid) |
|
Definition
H2 antagonists
famotidine > nizatidine > ranitidine > cimetidine
45 min
anti-adrogen effects
ihibits CYP450 (just zantac & cimetidine)
HA
dizziness
myalgia
diarrhea |
|
|
Term
Most powerful HCl secretion suppressors
>60% reduction of acid secretion
90% of nocturnal secretion
30-40% of stimulated secretion
Short term indications:
Erosive esophagitis
Acute peptic ulcer
Long term indications:
Z-E Syndrome
Refractory GERD
onset?
side effects? |
|
Definition
PPI
1-2 hours onset
SE: omeprazole decreases effectiveness of clopidogrel |
|
|
Term
Prostaglandin agonist
FDA indication: preventing mucosal injury due to NSAIDs
CONTRAINDICATED IN PREGNANCY
Can trigger first trimester abortion
Side effects:
Diarrhea (dose related)
Nausea
Abdominal pain (cramps) |
|
Definition
|
|
Term
| what happens when you give calcium carbonate tabs for PUD? |
|
Definition
| bloating, flatulence, cramping |
|
|
Term
Magnesium tablets cause diarrhea
Aluminum tablets cuase constipation
how do you solve this to tx PUD? |
|
Definition
| combine them -- maalox, mylanta |
|
|
Term
| contraindications for antacid use |
|
Definition
|
|
Term
|
Definition
|
|
Term
Effectiveness:
Forms protective gel with gastric mucin
Barrier protection
Enhances prostaglandin production
Take on empty stomach 1 hour before meal
Side effects:
Consitipation
Reduced absorption of other drugs
Avoid use in renal failure (aluminum) |
|
Definition
|
|
Term
Effectiveness:
Anti-microbial action
Used as part of helicobacter regimen
Decreased Pepsin activity
Increase mucosal secretion (mucin)
Promotes ulcer healing
Clays in Pepto-Bismol may also contribute
Side effects:
Constipation
Black stools |
|
Definition
|
|
Term
what laxative?
Castor oil, emodin (senna, aloe,cascara), bisacodyl, phenolphthalein
Action in 6-8 hours
Take at bedtime
concern? |
|
Definition
irritants/stimulants
atonic colon w/ prolonged use |
|
|
Term
what laxative?
what use?
Colloids
Agar, methylcellulose, bran, psyllium
Water retention, intestinal distention
Saline cathartics
Magnesium (sulfate,citrate,hydroxide), polyethylene glycol (Golytely, Colyte), Lactulose, glycerin, Mannitol
Same mechanism of action |
|
Definition
bulking agents
most commonly used as bowel prep |
|
|
Term
Diphenoxylate (Lomotil)
LOPERAMIDE (IMODIUM)
Both are opiate analogs (meperidine)
Anti-acetylcholine effects
Dry mouth, sedation
Side effects:
Drowsiness, cramps, dizziness
Avoid use in adults with severe colitis
UC, Crohn’s disease
TOXIC MEGACOLON IN KIDS |
|
Definition
|
|
Term
what kind of drugs?
Phenothiazines:
Prochlorperazine (Compazine)
Substituted Benzamides:
Metoclopramide (Reglan)
Butyrophenones:
-Domperidone
-Droperidol (Inapsine)
-Haloperidol (Haldol)
Benzodiazepines:
- Alprazolam (Xanax)
- Lorazepam (Ativan)
Corticosteroids:
- Dexamethasone (Decadron)
- Methylprenisolone (Medrol)
Cannabinoid Receptor Agonist (marijuana):
- Dronabinol (Marinol)
Serotonin Receptor Blockers:
- Granisetron (Kytril)
- Ondansetron (Zofran) |
|
Definition
|
|
Term
most anti-emetics block waht neurotransmittera?
thus, they'll have what side effects? |
|
Definition
dopamine or serotonin
Dopamine:
•Sedation
•Diarrhea
•Extrapyramidal symptoms
•Hypotension
•Hyperprolactinemia (galactorrhea, gonadal suppression)
•Only with prolonged use
Serotonin:
•Expensive
•Diarrhea/constipation
•Headache
•Dizziness
•Mild EKG changes
•Prolonged QT interval = increased risk of ventricular arrhythmias
•Esp. with dolasetron
|
|
|
Term
What drug class?
Ondanestron (Zofran)
Dolasetron (Anzemet)
Granisetron (Kytril)
Palonosetron (Aloxi) |
|
Definition
| serotonin receptor blockers for anti-emetic |
|
|
Term
| most potent and least potent anti-emetics |
|
Definition
most: serotonin antagonist, sub benzamide, phenothiazine
least: antihistamine, anticholinergic, benzos |
|
|
Term
| what are two conditions that may require a prokinetic agent? |
|
Definition
paralytic ileus
diabetic gastroparesis |
|
|
Term
Carbachol
Bethanechol
Neostigmine
Metoclopramide (Reglan) (dopamine antagonist)
cisapride (propulsid)
ondansetron (zofran)
tagaserod (zelnorm, zelmac)
motilin-like agents (macrolides abx) |
|
Definition
| prokinetics -- for paralytic ileus or diabetic gastroparesis |
|
|
Term
| utility and adverse effects of Beta-2 agonists |
|
Definition
utility: bronchodilation
adverse effects: hyperglycemia, hypotension, dizziness, tachy (beta-1) |
|
|
Term
what kind of drug?
albuterol (proventil, ventolin)
metaproterenol (alupent)
terbutaline (Brethin, bricanyl)
Pirbuterol (maxair)
Levalbuterol (xopenex) |
|
Definition
| short acting beta-2 agonists |
|
|
Term
what kind of drug? duration? utility?
salmeterol (servent)
Bitoleterol (tornalate) |
|
Definition
long acting beta-2 agonists
12+ hr
prevent recurrent attacks |
|
|
Term
what kidn of drug?
beclomethasone (beconase)
tramcinolone (Azmacort)
Budesonide (Pulmicort)
Fluticasone (Flovent) |
|
Definition
|
|
Term
potential glucocorticoid risks:
1. at >1,600 ug/day
2. at >500 mcg/day
3. at >1,000 mcg/day |
|
Definition
1. adrenal-pituitary suppression
2. bone loss
3. hyperglycemia |
|
|
Term
What is fluticasone + selmeterol?
Mometasone + formoterol?
Budesonide + formoterol? |
|
Definition
Fluticasone + selmeterol = advair diskus
mometasone + formoterol = Dulera
Budesonide + formoterol = Symbicort
- combined long acting B-2 and glucocorticoid
good for prevention |
|
|
Term
Leukotrienes and asthma
montelukast? |
|
Definition
elevated leukotrienes are counterproductive to asthma
montelukast = singular
- leukotriene receptor antagonist
- liver toxicity |
|
|
Term
first line tx in mild-moderate asthma
anti-inflammatory tthat inhibits allergic bronchospasm
no intrinsic bronchodilating properties
Useful only in prophylaxis - takes 2-3 mos to work
1/10K allergic rxn
Also used in allergic rhinitis to prevent IgE activation - must be given a few months before expected allergen exposure |
|
Definition
| Cromolyn (intal) & Nedocromil (Tilade) |
|
|
Term
Bronchodilator that is a phosphodiesterase (second messenger) inhbitor
- formerly first line, now third line
- used in peds in place of glucocorticoids to avoid growth impairment
- used in adults for nocturnal asthma |
|
Definition
|
|
Term
1. Anticholinergic to decrease airway secretions
2. MAB anti-IgE to prevent allergen-IgE binding |
|
Definition
1. ipratroprium bromide (Atrovent)
2. Omalizumab (Xolair) |
|
|
Term
|
Definition
1. short acting beta-2
2. Epi subcu
3. Oral glucocorticoids 5-10 days
|
|
|
Term
|
Definition
No drugs are contraindicated
make sure asthma is well controlled
non-selective beta agonists like epinephrine may cause uterine vasoconstriction |
|
|
Term
| 1st vs. 2nd generation H1 blockers |
|
Definition
1st gen: Benadryl - effective but short half life and drowsiness
2nd gen: preferred - Loratadine (Claritin) and Cetirizine (Zertec) - don't cross BBB |
|
|
Term
Drug used to treat allergic rhinitis by causing nasopharyngeal vasoconstriction (alpha blocker)
- has reactive hyperemia after 2-3 days of use |
|
Definition
|
|
Term
Fluticasone (flonase)
Triamcnolone (nasocort)
Mometasone (Nasonex) |
|
Definition
nasal glucocorticoids
used to reduce inflammation in allergic rhinitis |
|
|
Term
| combo tx of choice for allergic rhinitis |
|
Definition
1. inhaled glucocorticoid - preventative
2. Cromolyn/nedocromil to keep glucocorticoid use low
3. 2nd gen antihistamine |
|
|
Term
Airway obstruction predominates
Underlying cause is bronchial damage and inflammation
Asthma-like “reactive airway” contributes
Productive cough
Chronic or recurrent infections also contribute |
|
Definition
|
|
Term
|
Definition
1. PREVENT - stop smoking
2. IMPROVE - abx to control infection, bronchodilators/glucocorticoids/leukotriene inhibitors to improve airways
3. SUPPORT - O2 |
|
|
Term
| osteoclasts v osteoblasts |
|
Definition
clasts: break down bone
blasts: calcify bone |
|
|
Term
SERM used to treat osteoporosis
increases vasomotor flushes
may reduce risk of breast cancer |
|
Definition
|
|
Term
drug group that blocks bone reabsorption (osteoclast inhibition)
increases bone mass
reduces plasma ca levels
indicated for osteoporosis, paget's, metastatic bone dz
side effects; GI upset, nausea, esophageal irritation (take w/ full glass of water, remain upright), OSTEONECROSIS OF JAW
include: alendronate (fosamax) and Risedronate (actonel) -- all end in "nate" |
|
Definition
|
|
Term
| fluoride and osteoporosis |
|
Definition
| not approved - does not help, only hurts |
|
|
Term
drug used in "difficult to treat" osteoporosis
useful adjunct for tx of hypercalcemia
increases bone density
reduces spine fx rate but NOT hip |
|
Definition
|
|
Term
| Vit D analogs all end in -ol |
|
Definition
|
|
Term
which has the greatest potnetial for physical dependence?
nicotine, cocaine, cannabis, amphetamines |
|
Definition
|
|
Term
which benzo is useful in terminating frequent or prolonged seizures (status)?
alprazalam
temazepam
triazolam
diazepam |
|
Definition
|
|
Term
which of the following is an anget of choice in treating panic disorder?
ramelteon
hydroxyzine
lorazepam
alprazolam |
|
Definition
|
|
Term
which antidepressant can result in seizures when taken at high doses?
amitriptyline
buproprion
trazadone
all |
|
Definition
|
|
Term
which drug can reverse DI that can result from lithium tx?
insulin
phenelzine
amiloride
alprazolam |
|
Definition
|
|
Term
which is a typical neuroleptic drug w/ high potency?
thiothixene
clozapine
chlorpromazine
ziprasidone |
|
Definition
|
|
Term
which has significant serotonin receptor blocking activity?
risperidone
chlorpromazine
haloperidol |
|
Definition
|
|
Term
which antiepileptic has 100% renal elimination?
oxcarbazepine
pregabalin
tiagabine
topiramate |
|
Definition
|
|
Term
| what parkinson drug has the potential to cause pulm/retroperitoneal fibrosis |
|
Definition
|
|
Term
which is an ultra short acting insulin?
glulisine
lente
ultralente
glargine |
|
Definition
|
|
Term
% HbA1C can be achieved w/ intensive insulin regimens?
6
7
8
9 |
|
Definition
|
|
Term
Whihc requries 20 min to achieve peak effect?
meperidine
morphine
fentanyl |
|
Definition
|
|
Term
| A comatose patient is given naloxone by a paramedic. What toxicity can be expected if it turns out the coma is NOT due to an opiate drug overdose? |
|
Definition
|
|
Term
Seizures can occur in patients using tramadol, especially if they are also taking which of the following drugs?
clozapine
propanolol
losartan
fluoxetine |
|
Definition
|
|
Term
Which of the following drug groups should be avoided in patients with inflammatory bowel disease?
biguanides
sulfonylureas
glycosidase inhbitors
meglitininds |
|
Definition
|
|
Term
1. Which of which of the following works to inhibit pepsin and increase the amount of protective gastric mucus?
famotidine
bismuth salts
dicyclomine
omeprazole |
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Definition
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Term
Long term use of which of the following may be associated with an increased risk of colitis caused by Clostridium difficile?
lansoprazole
nizatidine
ondansetron
diphenoxylate |
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Definition
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|
Term
which is an H2 antagonist?
omeprazole
nizantidine
metoclopramide
misoprostol |
|
Definition
|
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Term
which can cause insomnia?
mineral oil
dexamethosone
metocloparmide
aprepitant |
|
Definition
|
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Term
which can cause extrapyramidal side effects?
alprazolam
ondansetron
prochlorperazine |
|
Definition
|
|
Term
which can cause dyspohria/hallucinations?
nabilone
misoprostol
loperamide
lansoprazole |
|
Definition
|
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Term
which can stimulate uterine contraction in pregnant pts?
nabilone
dexamethasone
loperamide
castor oil |
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Definition
|
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Term
Which of the following should not be used by young children due to a risk of toxic megacolon?
nabilone
dexamethazone
loperamide
castor oil |
|
Definition
|
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Term
| Receptor polymorphisms explain why some asthma patients experience a worsening of their symptoms with the use of which drug type |
|
Definition
| long acting beta 2 agonists |
|
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Term
| Which asthma medication is considered “pediatric friendly” because it is available as chewable tablets?___________ |
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Definition
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Term
The use of broad spectrum antibiotics can result in a superinfection of which of the following organisms?
e coli
candida
staph epidermidis
clamydia |
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Definition
|
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Term
4. Which of the following is the broadest spectrum β-lactam antibiotic currently available?
meropenem
amoxicillin
aztrenam
cefepime |
|
Definition
|
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Term
Which of the following characteristics would be most likely to improve an antibacterial drug’s ability to penetrate the blood brain barrier?
high molecular weight
strong protein binding
increased lipid solubility
all |
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Definition
| increased lipid solubility |
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Term
What is the term used for the lowest concentration of an antibiotic that kills 99% of the target bacteria?
MIC
MBC
Bactericidal limit
lethality threshold |
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Definition
|
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Term
| 7. Which antibiotic has become the agent of choice in the treatment of meningitis? |
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Definition
|
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Term
| 8. Which cyclic lipopeptide antibiotic is useful in treating infections caused by MRSA and VRE? |
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Definition
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Term
1. Which antibiotic below is most likely to cause vestibular side effects such as dizziness with nausea?
clindamycin
aztreonam
chloramphenicol
minocycline |
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Definition
|
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Term
| 2. Which of the following drugs would be the treatment of choice for an infection caused by Borrelia burgdorferi? |
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Definition
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Term
3. Which drug below is most likely to cause venous irritation during treatment?
tigecycline
quinupristin/dalforpristin
levofloxacine
amphotericin B |
|
Definition
| quinipristin/dalforpristin |
|
|
Term
4. Which of the following is most effective in treating pneumonia caused by Pneumocystis jiroveci?
nitrofuratoin
chloramphenicol
moxifloxacin
cotrimoxazole |
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Definition
|
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Term
5. Which of the following is highly effective in treating acute diarrheal diseases?
suulfadiazine
tygecycline
methanamine
cipro |
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Definition
|
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Term
6. Which of the following has a long enough half life to permit once a day dosing?
levofloxacin
ciprofloxacin
nifurantoin
norfloxacin |
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Definition
|
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Term
7. Which antifungal drug is synergistic with amphotericin B
ketoconazole
terbinafine
capsofungin
flucytosine |
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Definition
|
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Term
| 8. Which antimycobacterial drug can precipitate attacks of gouty arthritis? |
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Definition
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