Term
|
Definition
1st gen. cephalosporin
DOC for impetigo |
|
|
Term
|
Definition
1st gen. cephalosporin
Kefzol |
|
|
Term
|
Definition
1st gen. cephalosporin
Keflex |
|
|
Term
|
Definition
1st gen. cephalosporin
Velosef |
|
|
Term
|
Definition
2nd gen. cephalosporin
oral
Cefazil |
|
|
Term
|
Definition
2nd gen. cephalosporin
oral
Used for sinusitis
Ceftin, Zinacef |
|
|
Term
|
Definition
2nd gen. cephalosporin
oral
Ceclor, Raniclor |
|
|
Term
|
Definition
2nd gen. cephalosporin
parenteral |
|
|
Term
|
Definition
2nd gen. cephalosporin
parenteral
need Vit. K prophylaxis |
|
|
Term
|
Definition
2nd gen. cephalosporin
parenteral
Zefazone |
|
|
Term
|
Definition
carbacephem (2nd gen. cephalosporin)
parenteral
Lorabid |
|
|
Term
|
Definition
3rd gen. cephalosporin
oral
Omnicef |
|
|
Term
|
Definition
3rd gen. cephalosporin
oral
Spectracef |
|
|
Term
|
Definition
3rd gen. cephalosporin
oral
Suprax |
|
|
Term
|
Definition
3rd gen. cephalosporin
oral
Vantin |
|
|
Term
|
Definition
3rd gen. cephalosporin
oral
Cedax |
|
|
Term
|
Definition
3rd gen. cephalosporin
parenteral
Cefizox |
|
|
Term
|
Definition
3rd gen. cephalosporin
DOC for N. gonorrhea
parenteral
Rocephin |
|
|
Term
|
Definition
3rd gen. cephalosporin
anti-pseudomonal agent
Fortaz |
|
|
Term
|
Definition
4th gen. cephalosporin
IV abx
Maxipime |
|
|
Term
|
Definition
Penicillins
Cephalosporins |
|
|
Term
|
Definition
1. Bind to penicillin binding protein (PBP) under chromosomal control (3 to 6 receptors)
2. Inhibition of cell wall synthesis
3. Activation of autolytic enzymes in the cell wall |
|
|
Term
|
Definition
Binds to peptide substrate via 5 H-bonds.
By binding to these residues with high affinity the antibiotic prevents them from being accessible to the active site of the transpeptidases.
Peptide cross-linking therefore cannot occur and the structural integrity of the peptidoglycan is compromised causing the cell to lyse. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Binds 2 sites on the 50S ribosomal subunit. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Binds the 23S rRNA receptor on the 50S ribosomal subunit preventing translocation of the peptide chain and interrupting RNA dependent protein synthesis |
|
|
Term
|
Definition
aminoglycoside
most ototoxic of aminoglycosides |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
aminoglycoside
least ototoxic of aminoglycosides |
|
|
Term
| List the 5 aminoglycosides in decreasing order of ototoxicity. |
|
Definition
1. Neomycin
2. Gentamycin
3. Tobramycin
4. Amikacin
5. Netilmicin |
|
|
Term
|
Definition
1. Bind electrostatically to the outer membrane
2. Replace Mg and Ca ions
3. Weaken the outer membrane and migrate into the cell
4. Precipitate DNA molecules in the cytoplasm
5. Bind 30S subunit of 16S ribosomal RNA and interfere with translation |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Cipro XR |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Levaquin |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Avelox |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Factive |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Noroxin |
|
|
Term
|
Definition
quinolone/fluoroquinolone
Floxin |
|
|
Term
| quinolone/fluoroquinolone M of A |
|
Definition
Block DNA synthesis
1. inhibits DNA gyrase - regulates the superhelical twists
2. inhibit DNA topoisomerase IV - segregating newly formed DNA into daughter cells |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Bind the 30S ribosomal subunit and prevent docking of the aminoacyl-tRNA complex to inhibit protein synthesis |
|
|
Term
|
Definition
1. griseofulvin
2. terbinafine (Lamisil)
3. itraconazole (Sporanox)
4. fluconazole (Diflucan)
5. nystatin |
|
|
Term
|
Definition
1. butoconazole (Gynazole)
2. miconazole (monistat)
3. clotrimazole (Gyne-Lotrimin)
4. terconazole (Terazol) |
|
|
Term
|
Definition
griseofulvin - DOC for peds
terbinafine
itraconazole
adjunct therapy:
2% ketoconazole shampoo
1% selenium sulfide shampoo |
|
|
Term
|
Definition
same as tinea capitis
griseofulvin
terbinafine
itraconazole
longer treatment periods
add systemic corticosteroid therapy if no response after 2 weeks of treatment |
|
|
Term
|
Definition
oral antifungal therapy
griseofulvin
terbinafine
itraconazole
fluconazole
nystatin |
|
|
Term
Tinea unguium treatment
(onychomycosis) |
|
Definition
pulse therapy; oral antifungals
terbinafine
itraconazole
fingernails (3-4 months)
toenails (6-8 months) |
|
|
Term
|
Definition
Topical antifungal therapy first!
butoconazole
miconazole
clotrimazole
terconazole
Oral antifungal therapy 2nd |
|
|
Term
|
Definition
Topical antifungal therapy 1st!
butoconazole
miconazole
clotrimazole
terconazole
Oral antifungal therapy 2nd |
|
|
Term
Tinea corporis treatment
(ring worm) |
|
Definition
Topical antifungal therapy
butoconazole
miconazole
clotrimazole
terconazole |
|
|
Term
|
Definition
Topical antifungal therapy
butoconazole
miconazole
clotrimazole
terconazole
Emollients (skin moisturizer)
Lactic acid/Lac-Hydrin cream |
|
|
Term
|
Definition
Topical antifungal therpay
clotrimazole and betamethasone cream (Lotrisone) |
|
|
Term
Amphotericin B indications
form |
|
Definition
systemic fungal infections
zygomycosis
only IV |
|
|
Term
voriconazole indications
form |
|
Definition
DOC for Aspergillus
IV and PO |
|
|
Term
|
Definition
cryptococcus, some species of Candida
only used in combination with other antifungals |
|
|
Term
| echinocandins indications |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
oropharyngeal candidiasis that was not cured using other azole medications
zygomycosis
prophylaxis against: aspergillus, candida |
|
|
Term
| itraconazole prophylaxis indications |
|
Definition
| used for allograft recipients, but switch to voriconazole when patients receive corticosteroids or have had a mold infection in the past |
|
|
Term
| fluconazole prophylaxis indications |
|
Definition
DOC for yeast infection
recommended therapy for patients with persistent immune dysfunction
Coccidoiodomycosis - "Vally fever" |
|
|
Term
| Pharmacokinetic changes with pregnancy |
|
Definition
1. GI - decreased motility and increased pH
2. increased Volume of distribution (increase in plasma volume)
3. decreased serum albumin levels
4. net impact is no change in dosing
5. hepatic drug metabolism may increase or decrease
6. renal elimination - increased blood flow and increased glomerular filtration rate but usually no sig. change on drug dosing |
|
|
Term
| What drug characteristics increase the rate of transfer across the placenta? |
|
Definition
1. lipophilic
2. low ionization
3. low molecular weight
4. increased maternal free drug |
|
|
Term
| How do most drugs move across the placenta? |
|
Definition
|
|
Term
| When is the greatest potential to influence organ development by exposure to drugs in utero? |
|
Definition
| during the embryonic period (first 8 weeks) |
|
|
Term
|
Definition
| studies in pregnant women without risk |
|
|
Term
|
Definition
animal studies without risk - no human studies
no animal or human studies with risk - studies in pregnant women without risk |
|
|
Term
|
Definition
Animal studies with risk - no human studies
No animal or human studies |
|
|
Term
|
Definition
| Studies in pregnant women show increase in risk - benefits may outweigh the potential risks |
|
|
Term
|
Definition
teratogenic - includes about 30 medications
1. ACE-I
2. Anticonvulsants - carbamazepine and phenytoin
3. Anti-thyroid drugs
4. Oral Hypoglycemic drugs
5. Tetracycline |
|
|
Term
Self medication during pregnancy:
pain?
nausea?
constipation?
hemorrhoids?
vitamins?
herbals? |
|
Definition
pain - tylenol
nausea - ginger or gingerale
constipation - drink more fluids, eat more fiber
hemorrhoids - topicals, sitz bath
vitamins - prenatal vitamin w/ Fe and folic acid supplements
herbals - stop during pregnancy |
|
|
Term
| When should necessary drugs be taken during lactation? |
|
Definition
60 minutes after nursing and 3-4 hours before next feeding because milk is produced during and immediately after nursing so this is the time of highest drug uptake
Also terminate nursing prior to ingestion of hind milk because it has the highest concentration of drug |
|
|
Term
T/F
Nicotine and caffeine do NOT pose health risk through milk. |
|
Definition
|
|
Term
| Pharmacokinetic differences in pediatrics |
|
Definition
1. GI - pH affects passive diffusion across gastric mucosa [premature infants have higher gastric pH (less acid) and neonates have rapid changes in the first 24 hours] gastric emptying time [slower in premature infants - may lead to higher drug concentration]
2. IM sites - neonates have less muscle mass, insufficient muscular contraction to move drug out of muscles, and poor diffusion to peripheral areas [IV is preferred]
3. Skin - neonates have increased percutaneous absorption. Toxic effects: hexachlorophene soaps, rubbing alcohol, and salicylic acid ointment. Therapeutic: theophylline in premature infants |
|
|
Term
| Extracellular fluid volume: premature infants to adults |
|
Definition
| preemies > neonates > infants > adults |
|
|
Term
| Why is there an increase in free drug in neonates? |
|
Definition
1. decreased plasma protein - so drug not binding to anything
2. competition with natural compounds for elimination - bilirubin interferes with liver metabolism
3. increased volume of distribution
4. increase in loading dose
5. increased renal clearance - bound is not eliminated |
|
|
Term
| Rate of metabolism and elimination of drug |
|
Definition
| Infants < children < adults |
|
|
Term
T/F
Premature infants need higher doses of morphine. |
|
Definition
| True - because the drug is converted much more slowly and the converted form in 20x more active |
|
|
Term
| Theophylline in pediatrics |
|
Definition
in premies theophylline does not clear as quickly, so give lower doses
in children 1-9 years theophylline is elimated faster compared to premies or adults so give higher doses |
|
|
Term
| What factors affect drug selection in pediatrics? |
|
Definition
1. Carriers - propylene glycol in injectable drugs causes hyperosmolality in infants
2. preservatives - benzyl alcohol causes seizures, cardiovascular collapse, and death in premature infants
3. unique side effects in peds - tetracyclines cause dental staining and quinolones cause joint disease
4. Decrease in nephrotoxicity in infants - can use gentamycin in peds but not adults |
|
|
Term
| How does cystic fibrosis affect pharmacokinetics? |
|
Definition
1. increased elimination of certain drugs
2. increased volume of distribution |
|
|
Term
| What 4 features of IV drug administration change the effectiveness of the drug? |
|
Definition
1. Flow rate
2. injection site
3. volume of drug
4. fluid volume of the tubing |
|
|
Term
T/F
Small volumes = larger errors. |
|
Definition
| True - if you give 9.9 mL when you should have given 10, you have made a bigger error than if you gave 99.9 when you should have given 100. |
|
|
Term
| premature infant definition |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the steady-state concentration? |
|
Definition
| when the amount of drug coming in = the amount going out; drug level in body is not changing (climbing or decreasing) |
|
|
Term
| What is the most important pharmacokietic parameter and why? |
|
Definition
| clearance - because it determines the steady-state concentration for a given dosage rate |
|
|
Term
|
Definition
the average steady-state concentration
the steady state concentration that would have occurred if the medication had been delivered by continuous infusion |
|
|
Term
| How many half-lives does it take to reach Css using continuous dosing? |
|
Definition
|
|
Term
| What drugs prolong the QT interval? |
|
Definition
Ketolides - telithromycin
Macrolides - erythromycin, clarithromycin, azithromycin
Quinolones - ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, norfloxacin, orfloxacin |
|
|
Term
| When should telithromycin be avoided? |
|
Definition
In patients:
1. with congenital prolongation of the QT interval
2. with ongoing pro-arrhythmic condition such as uncorrected hypokalemia or hypomagnesemia
3. with clinically significant bradycardia
4. recieving Class IA or Class III antiarrhythmic agents |
|
|
Term
| Treatment for meningitis caused by Bacillus anthracis (terrorist activity) |
|
Definition
| Ciprofloxacin + vancomycin |
|
|
Term
Empirical therapy for bacterial meningitis
Newborn to 1 month
1 month to 60 years
> 60 years |
|
Definition
Newborn to 1 month - ampicillin + ceftriaxone
1 month to 60 years - ceftriaxone + vancomycin
> 60 years - ampicillin + ceftriaxone + vancomycin |
|
|
Term
| What adjunct meningitis treatment is used for patients with inflammation within the subarachnoid space? |
|
Definition
|
|
Term
| What are 4 characterizations of inflammation within the subarachnoid space? |
|
Definition
1. cerebral edema
2. altered cerebral blood flow
3. neuronal injury
4. increased intracranial pressure |
|
|
Term
T/F
The more impaired the meningitis patient is at presentation, the more likely Dexamethasone will be beneficial. |
|
Definition
|
|
Term
| Treatment for CAP in adults and peds |
|
Definition
adults: levofloxacin, gemifloxacin, clarithromycin
Peds: clarithromycin, amoxicillin/clavulanate, ceftriaxone |
|
|
Term
| Treatment for atypical pneumonia |
|
Definition
| levofloxacin, clarithromycin, and doxycycline |
|
|
Term
| Treatment for nursing home acquired pneumonia |
|
Definition
levofloxacin or moxifloxicin
OR
amoxicillin/clavulanate or cefuroxime or cefpodoxime AND azythromycin |
|
|
Term
| What is Palvizumab (Synagis)? |
|
Definition
| RSV vaccine - humanized monoclonal antibody (95% human, 5% murine) |
|
|
Term
| Who should receive Palvizumab vaccine? |
|
Definition
premature infants
infants with chronic lung disease
infants with congenital heart disease |
|
|
Term
| How is Palivizumab injected? |
|
Definition
| injected into a large muscle once a month for several months |
|
|
Term
| How does Palivizumab work? |
|
Definition
| It is directed to an epitope in the A antigenic site of the F protein of RSV, which is required for fusion of the virus to a host cell |
|
|
Term
T/F
There are resistant RSV strains identified in clinical settings. |
|
Definition
|
|
Term
|
Definition
1st gen oral antihistamine
Benadryl |
|
|
Term
|
Definition
1st gen oral antihistamine
Chlor-trimeton |
|
|
Term
|
Definition
1st gen oral antihistamine
Dimetapp |
|
|
Term
|
Definition
1st gen oral antihistamine
Tavist |
|
|
Term
|
Definition
1st gen oral antihistamine
Rx only
Atarax |
|
|
Term
|
Definition
2nd gen oral antihistamine
Alavert, Claritin |
|
|
Term
|
Definition
2nd gen oral antihistamine
Zyrtec |
|
|
Term
|
Definition
2nd gen oral antihistamine
DOC for glaucoma pt. |
|
|
Term
|
Definition
2nd gen oral antihistamine
Clarinex
only 1 of optical isomers of loratadine |
|
|
Term
|
Definition
2nd gen oral antihistamine
Xyzal
only 1 of optical isomers of cetirizine |
|
|
Term
|
Definition
2nd gen nasal antihistamine
AR/VMR
Astelin |
|
|
Term
|
Definition
2nd gen nasal antihistamine
AR
Patadin nasal |
|
|
Term
|
Definition
nasal steroid - alcohol based
Flonase |
|
|
Term
|
Definition
nasal steroid - alcohol based
Nasalide |
|
|
Term
|
Definition
nasal steroid - H2O based
Nasonex |
|
|
Term
|
Definition
nasal steroid - H2O based
Rhinocort aqua |
|
|
Term
| beclomethasone diproponate |
|
Definition
nasal steroid - H2O based
Beconase AQ |
|
|
Term
|
Definition
nasal steroid - H2O based
Nasacort AQ |
|
|
Term
|
Definition
mast cell stabilizer
Nasalcrom |
|
|
Term
|
Definition
anticholinergic agent
Atrovent nasal |
|
|
Term
|
Definition
nasal decongestant
Neo-Synephrine |
|
|
Term
|
Definition
nasal decongestant
Naphcon Forte |
|
|
Term
|
Definition
nasal decongestant
Tyzine pediatric |
|
|
Term
|
Definition
|
|
Term
|
Definition
nasal decongestant
Inspire |
|
|
Term
|
Definition
leukotriene receptor antagonist
Singulair |
|
|
Term
|
Definition
leukotriene receptor antagonist
Accolate |
|
|
Term
|
Definition
leukotriene receptor antagonist
Zyfloc CR |
|
|
Term
|
Definition
mast cell stabilizer
Alamast |
|
|
Term
|
Definition
mast cell stabilizer
Alocril |
|
|
Term
|
Definition
mast cell stabilizer
Alomide |
|
|
Term
|
Definition
nasal steroid - H2O based
Omnaris |
|
|
Term
|
Definition
nasal steroid - alcohol based
Veramyst |
|
|
Term
| Treatment for resistant TB |
|
Definition
INH
Rifampin
Pyrazinamide
Plus 2 or 3 additional agents that have not been used before (Rifabutin, Ethambutol) |
|
|
Term
|
Definition
Streptococcus pneumoniae 40-50%
Haemophilus influenzae 30-40%
Moraxell catarrhalis 10-15% |
|
|
Term
| Treatment for bacterial otitis externa (include dosing) |
|
Definition
colistin/neomycin/hydrocortisone - 4ggts AD/AS/AU tid x 10 days (CI if TM perforated)
ofloxacin - 10 ggts AD/AS/AU bid x 10 days (can be used with perforated TM)
ciprofloxacin/dexamethasone - 4 ggts AD/AS/AU bid x 7 days (CI in viral or fungal infetions) |
|
|
Term
| Treatment for fungal otitis externa (include dosing) |
|
Definition
2% acetic acid solution
1% clotrimazole or tolnaftate - 4 ggts AD/AS/AU tid x 10 days |
|
|
Term
| Non-antibiotic therapy for acute bacterial rhinosinusitis |
|
Definition
Nasal decongestant sprays
anticholinergic decongestants
saline solutions
mucolytics
DO NOT USE nasal steroids! |
|
|
Term
| Antibiotic therapy for acute bacterial rhinosinusitis |
|
Definition
1st line: amoxicillin
penicillin allergy: trimethoprim/sulfamethoxazole or macrolide
recent abx use: fluoroquinolone or high dose amoxicillin/clavulanate |
|
|
Term
| Specific abx therapy for ABRS in adults |
|
Definition
high dose amoxicillin or high dose amoxicillin/clavulanate
cefpodoxine
moxifloxacin
clarithromycin |
|
|
Term
| Specific abx therapy for ABRS in pediatrics |
|
Definition
high dose amoxicillin
high dose amoxicillin/clavulanate
cefdinir
clindamycin |
|
|
Term
| Treatment of UTI in post-menopausal female with complicating factors (sulfa allergy, TMP-SMX failure, etc) |
|
Definition
ciprofloxacin x 7 days (longer than younger women)
nitrofurantoin (same dosing regardless of age) |
|
|
Term
| Treatment of UTI in post-menopausal female without complicating factors |
|
Definition
| TMP-SMX x 7 days (longer than younger women) |
|
|
Term
| Treatment of UTI in pregnant women |
|
Definition
nitrofurantoin x 7 days
fosfomycin
cephalexin |
|
|
Term
| Treatment of nonpregnant female with complicating factors |
|
Definition
ciprofloxacin x 3 days
nitrofurantoin |
|
|
Term
| Treatment of nonpregnant female without compicating factors |
|
Definition
|
|
Term
| Treatment of gonorrhea - neonate |
|
Definition
|
|
Term
| Treatment of gonorrhea - uncomplicated in adults |
|
Definition
|
|
Term
| Treatment of gonorrhea - disseminated in adults |
|
Definition
initial hospitalization
ceftriaxone |
|
|
Term
| Treatment of concomitant chlamydia and gonorrhea |
|
Definition
ceftriaxone or cefixime + doxycycline
OR
azythromycin |
|
|
Term
| What medication should be avoided during tx of gonorrhea during pregnancy? |
|
Definition
|
|
Term
| Parenteral treatment of gonorrhea during pregnancy |
|
Definition
ceftriaxone
spectinomycin
cefixime |
|
|
Term
| What medication should be avoided during treatment of concomitant gonorrhea and chlamydia during pregnancy? |
|
Definition
|
|
Term
| Treatment of cocomitant gonorrhea and chlamydia infections during pregnancy |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Treatment of latent syphilis |
|
Definition
| 3 doses of benzathine penicillin G over 2 weeks (versus 1 dose for active syphilis) |
|
|
Term
| Treatment of syphilis if penicillin allergic |
|
Definition
doxycycline
azythromycin
tetracycline
ceftriaxone |
|
|
Term
| Treatment of neurosyphilis |
|
Definition
hospitalization
benzathine penicillin G
oral doxycycline is NOT approved!! |
|
|
Term
| Treatment of syphilis during pregnancy |
|
Definition
benzathine penicillin
if allergic - desensitize with immunotherapy and continue
treatment is associated with Jarisch-Herheimer reaction in 45% which causes uterine contractions and may precipitate labor
If less than 4 weeks between treatment and delivery, neonate will be infected even with adequate treatment |
|
|
Term
|
Definition
|
|
Term
| Treatment of chlamydia in pregnancy |
|
Definition
azythromycin
amoxicillin
alternative: erythromycin |
|
|
Term
| Treatment of lymphogranuloma venerueum |
|
Definition
increase length of therapy
doxycycline
alternative: erythromycin |
|
|
Term
| Treatment of persistant urethritis due to chlamydia |
|
Definition
metronidazole +
erythromycin |
|
|
Term
| Treatment of first episode of genital herpes; episodic and suppressive |
|
Definition
acyclovir
famciclovir
valacyclovir |
|
|
Term
| Treatment of trichomoniasis |
|
Definition
metronidazole (pregnancy catagory B)
tinidazole (C) |
|
|
Term
|
Definition
may regress spontaneously
podophyllotoxin
imiquimod
sinecatechins |
|
|
Term
| What strains of HPV are covered by the vaccine? |
|
Definition
|
|
Term
|
Definition
azythromycin
ceftriaxone
alternatively: ciprofloxacin or erythromycin |
|
|
Term
| Treatment for diabetic foot infection (or puncture wounds of the feet) |
|
Definition
mupirocin
silver sulfadiazine (Gram -/+ and yeast)
more intense:
becaplermin (12 hour treatment, apply and remove)
broad spectrum abx - fluoroquinolone or amoxicillin/clavulanate |
|
|
Term
|
Definition
Regranex
PDGF - send signals to cells around ulcer and recruit them to the site of the ulcer where they initiate proliferation
12 hour topical tx - apply in AM, remove in PM |
|
|
Term
| What is the target serum level for digoxin in heart failure treatment? |
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Definition
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Term
| What is the toxic level of digoxin? |
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Definition
| 2.2 ng/mL - causes arrhythmias |
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Term
| Site of action of thiazides |
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Definition
| cortex: straight proximal tubule and DCT (most is DCT) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
acts primarily on DCT by blocking the co-transport of Na+ and Cl- across the membrane of the DCT from urine to blood
also enhances the action of the Na+/Ca2+ exchanger - Na+ into urine and Ca2+ into blood |
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Term
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Definition
furosemide
torsemide
bumetanide |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Site of action of loop diuretics |
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Definition
Cortex: proximal straight tubule and DCT
Outer medulla: thick ascending limb |
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Term
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Definition
| inhibit the Na+/K+/2Cl- transport of the thick ascending limb of Henle |
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Term
| Potassium sparing diuretics |
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Definition
spironolactone
eplerenone
triamterene |
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Term
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Definition
| potassium sparing diuretic |
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Term
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Definition
| potassium sparing diuretic |
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Term
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Definition
| potassium sparing diuretic |
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Term
| K-sparing diuretic site of action |
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Definition
| collecting tubules and ducts |
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Term
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Definition
spironolactone and eplerenone:
reduce Na absorption in collecting tubules and ducts
antagonism of aldosterone
Triamterene:
only reduces Na absorption in the collecting tubules and ducts - it does not antagonize aldosterone |
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Term
| acelazolamide site of action |
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Definition
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Term
| osmotic agents (mannitol) site of action |
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Definition
Cortex: PCT
Inner medulla: thin descending limb and collecting duct |
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Term
| ADH antagonists site of action |
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Definition
| Outer/Inner medulla: collecting duct |
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Term
| BP meds for female adolescents |
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Definition
| No ACE-I or ARB because of possibility of pregnancy |
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Term
| BP meds for postmenopausal women |
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Definition
| thiazide diuretic - Ca retention and positive bone mineral density |
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Term
| BP meds for African-Americans |
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Definition
Combo therapy
Low renin pattern of HTN |
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Term
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Definition
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Term
T/F
In very old patients, lowering BP to target levels decreases survivability compared to keeping patients at 10 mm Hg over goal. |
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Definition
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Term
| BP meds in patients with LVH too |
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Definition
ACE-I or ARB
regression of LVH |
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Term
| BP meds in patients with COPD too |
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Definition
Avoid non-selective beta blockers
Beta blockers in high doses are all non-selective
Can use beta blockers where B1 >>> B2 in low doses |
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Term
BP treatment goal for patient with:
HTN |
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Definition
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Term
BP treatment goal for patient with:
diabetes |
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Definition
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Term
BP treatment goal for patient with:
chronic renal disease |
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Definition
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Term
| When is thrombolytic therapy used to treat VTE? |
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Definition
DVT:
only to treat or prevent gangrene
PE:
1. massive PE
2. shock
3. severe hypoxemia
4. right HF
5. hypotension
Only in severe cases will these drugs improve patient outcomes |
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Term
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Definition
proteolytic enzymes convert plasminogen to plasmin which degrades the fibrin mechanism
enhances the natural process of clot removal
one week following acute treatment, clot lysis and vessel patency are similar with or without thrombolytic therapy |
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Term
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Definition
conventional agents (nonselective plasmin production):
streptokinase
urokinase
Clot (fibrin) selective agent:
Recombinant tissue plasminogen activator (t-PA) |
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Term
| CI for thrombolytic agents |
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Definition
1. recent thoracic, abdominal, or CNS surgery
2. recent CVA, trauma, or neoplasm
3. bleeding ulcer
4. malignant HTN
5. anticipated invasive procedures (arterial punctures, biopsies, central lines)
6. concurrent hemostatic dysfunction |
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Term
| What drug class used to treat hyperlipidemia causes myopathy? |
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Definition
| statins - rosuvastatin, atorvastatin, simvastatin, lovastatin, fluvastatin, pravastatin |
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Term
| Myopathy caused by statins |
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Definition
1. see bilateral muscle pain in major muscles
2. measure with creatinine kinase
3. overall risk of myopathy is low and rhabdomyolysis is rare
4. If myopathy occurs, stop for 1 month, then use a different statin
5. adding ezetimibe to statin therapy does not increase myopathy
6. adding fibrates to statin therapy increases myopathy/rhabdomyolysis |
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Term
T/F
dyslipidemia is one of the treatable risk factors for coronary heart disease |
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Definition
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Term
T/F
When using statins, see a decrease in adverse cardiac events even when not at treatment goal. |
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Definition
| True - helps with plaque stability and decreases CRP |
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Term
| __ % reduction in CHD event rates for every __ % reduction in HDL OR LDL |
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Definition
1% for every 1% in LDL
1% for every 2% in HDL |
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Term
| LMWH vs. unfractionated heparin |
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Definition
LMWH
1. more reliable pharmacokinetic response (predictable anticoag response)
2. great sub-cu bioavailability
3. lower incidence of thrombocytopenia
4. reduced need for lab monitoring
5. longer half-life (once a day dosing)
6. dose independent clearing |
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Term
| Side effects of amiodorone |
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Definition
number and severity of toxic effects increases with dosage (doses less than 200 mg/dL or less have low incidence of lung or thyroid effects)
cardiac - bradycardia, heart block, heart failure
extra-cardiac - pulmonary fibrosis, skin deposits (photodermatitis, bluish gray discoloration)
CNS (common) - paresthesia, tremor, ataxia, HA
thyroid dysfunction - Hyper or hypothyroidism (labs should be done at least every 6 months)
liver necrosis - assess at least every 6 months |
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Term
| Describe premature ventricular contractions on EKG |
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Definition
broad QRS complexes (> .12 sec)
occur earlier than normal
followed by compensatory pause |
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Term
| Management of PVCs in absence of heart disease |
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Definition
little risk of developing arrhythmia
antiarrhythmic therapy increases the risk of dying
DOC initially if symptomatic: beta blocker - sotalol (nonselective beta blocker)
Do not use sotalol in asymptomatic pt because of proarrhythmia effects |
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Term
| Management of PVCs in presence of structural heart disease |
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Definition
radiofrequency ablation
Refer for Class I antiarrhythmic drugs or amiodarone |
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Term
| What drug is used to reverse the anticoagulation effects of heparin (UFH and LMWH)? |
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Definition
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Term
| What drug is used to reverse the anticoagulation effects of warfarin? |
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Definition
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Term
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Definition
1. Hypotension - pts are hypovolemic
2. Hyperkalemia - esp. if used in combo with K-sparing diuretics, KCl tablets, or an ARB
3. angioedema
4. dry cough - increased bradykinin levels
5. teratogenic - CI in pregnancy and not good choice in fertile females |
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Term
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Definition
1. Hypotension - orthostatic or hypovolemia
2. Hyperkalemia - if used in combo with K-sparing diuretics, KCl tablets, ACE-I
3. angioedema - less common than ACE-I
4. CI in pregnancy |
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Term
| What are the 3 parts of Virchow's triad for PE? |
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Definition
1. hemodynamic imbalance
2. hypercoagulability
3. vessel wall damage |
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Term
| Causes of hemodynamic imbalance |
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Definition
burns
cancer
pregnancy
HF
major surgery
fracture
MI
stroke |
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Term
| Causes of hypercoaguability |
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Definition
estrogen therapy
thrombophilias
previous VTE
pregnancy
cancer |
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Term
| Causes of vessel wall damage |
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Definition
trauma
major surgery
fracture (hip or leg) |
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