Term
| Cyclooxygenase Inhibitors |
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Definition
Anti-Inflammatorhy Drugs and Acetaminophen
Uses(block Cox-2): suppress inflammation, relieve pain, reduce fever
adverse(also blocks Cox-1, bad): gastric ulcer, bleeding, renal impairment |
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Term
| Classification of COX Inhibitors |
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Definition
*Drugs with anti-inflammatory properties: NSAIDS
*Drugs without anti-inflammatory properties: acetaminophen |
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Term
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Definition
| First generation NSAID, bark of willow tree, arthritis pain |
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Term
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Definition
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Term
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Definition
| NOT and NSAID: good for fever and pain, NOT inflammation |
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Term
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Definition
-Nonselective COX inhibitor
-analgesic, antipyretic, anti-inflamm.
-suppression of platelet aggregation
-dysmenorrhea
-AD and cancer prevention (colorectal)
- |
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Term
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Definition
| GI, bleeding, renal impairment, salicylism, Reye's syndrome (encephalopathy), anaphylaxis |
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Term
| Ibuprofen (Advil, Motrin) |
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Definition
| 1st Gen, NSAID. Propionic Acid derivative. Less effective against fever, less GI bleeding, inhibit platelets vs. aspirin |
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Term
Naproxen (Naprosyn)
Naproxen Sodium (Alleve) |
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Definition
| 1st gen. NSAID: very well tolerated, multiple indications |
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Term
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Definition
NSAID: 2nd gen. Fewer adverse effects than 1st gen.
uses: osteoarthritis, RA, acute pain, dysmenorrhea, familial adenomatous polyposis (no benefit in preventing colorectal cancer) |
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Term
| Celecoxib (Celebrex) adverse effects |
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Definition
| GI ulceration, CV events, renal tox: sulfonamide allergy, contra-indicated in 3rd trimester, Warfarin, increase risk of bleeding (recent 2 minute commercials re: safety concerns, only 2nd gen NSAID left standing) |
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Term
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Definition
| 2nd Gen NSAID: withdrawn in US following CABG. Hypersensitivity rxn: Steven-Johnson syndrome (fatality risk, black skin), Toxic Epidermal Necrolysis (fatality risk); no demonstrated advantage over other NSAIDS: Pfizer asked to suspend sales |
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Term
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Definition
| NSAID: 2nd gen NSAID. Compare to Celebrex COX-2 inhib. VIGOR: Vioxx GI Outcomes Research. More CV w/ high dosage. Compared to Naproxen. Pulled in 2004. |
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Term
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Definition
Uses: analgesic, antipyretic, NOT ANTI-INFLAMMATORY.
Action: inhibits prostaglandin synthesis in CNS |
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Term
| Acetaminophen (Tylenol): adverse effects |
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Definition
-Hepatotoxicity: 4gm/day=max adult dose
-OD: hepatic necrosis
-Acetylcysteine (Mucomyst, Acetadote) = antidote. Substitutes for glutathione. Mucomyst=oral, unpleasant-vomiting!!! |
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Term
| Metabolism of acetaminophen |
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Definition
| toxic metabolite build-up in liver due to glutathione depletion by ETOH and Acetaminophen OD. CHRONIC (alcoholic + >4g/day) |
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Term
| Glucocorticoid Physiology |
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Definition
-metabolic effects: inc. glucose
-CV effects: need glu. to maintain BP
-stress effects: fight or flight
-maintain H2O and Na
-Lungs in neonates |
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Term
| Glucocorticoids: therapeutic uses in non-endocrine disorders |
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Definition
-allergic rxn: inhaled
-asthma: inhaled
-dematologic disorder: cream
-neoplasms: paired w/ something else
-suppression of allograft rejection
-prevention of respiratory distress synd. in neonates |
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Term
| Feedback regulation of glucocorticoid synthesis and secretion |
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Definition
(can shut down after medicated)
**see p. 3 diagram** |
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Term
| Glucocorticoids: adverse effects |
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Definition
**adrenal insufficiency: life threatening
*osteoporosis
*cataracts and glaucoma (excess glu)
*PID
***adrenal suppression after weeks of oral glucocorticoids
*infection
*glucose intolerance
*myopathy
*fluid and electrolyte disturbance
*growth retardation
*psychologic disturbances |
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Term
| Glucocorticoid drug interactions |
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Definition
| interactions related to potassium loss, NSAIDs inc. PID, insulin and oral hypoglycemics (T2DM), vaccines(can get disease)************ |
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Term
| Glucocorticoid withdrawal |
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Definition
| taper dosage over 7 days, switch from multiple to single doses, taper to 50% physiologic values, monitor for signs of insufficientcy |
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Term
| Rheumatoid Arthritis (RA) treatment |
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Definition
Autoimmune inflammatory disorder: pannus (loss of cartilage that leads to bone fusion)
Tx: relieve symptoms, maintain joint fx, minimize systemic involvement, delay (not cure) progression of disease |
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Term
| Classes of Antiarthritic Drugs |
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Definition
NSAIDs: Nonsteroidal anti-inflammatory drugs
DMARDs: Disease-Modifying Antirheumatic Drugs (immune system)
Glucocorticoids: adrenal corticosteroids (don't like to use long term) |
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Term
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Definition
1) NSAIDs (Celebrex)
2)DMARDs (Methotrexate)
3) Glucocorticoids may be added until DMARDs take effect |
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Term
| Methotrexate (Rheumatrex) |
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Definition
Antiarthritic drug: inhibits folic acid synthesis
-most rapid-acting DMARD (80% improve)
-adverse: hepatic fibrosis, bone marrow suppression, GI ulcers, fetal death or abnormalities
-anticancer drug |
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Term
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Definition
Antiarthritic and spine and skin disorders: $$$, new DMARD, TNF blocker
adverse: inc. risk of infection, injection site rxn., heart failure |
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Term
| Disease-Modifying Antirheumatic Drugs |
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Definition
*Methotrexate: folic acid inhibition
*Entanercept (Enbrel): TNF blocker
*Infliximab (Remicade): TNF antibody
*Adalimumab (Humira): monoclon. to TNF
*Anakinra (Kineret): IL-1 receptor antag. |
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Term
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Definition
-recurrent inflammatory disorder
-hyperuricemia
-severe joint pain, large toe
-Tophi=gritty deposits in joints
Causes: excessive prod. of uric acid, impaired renal excretion of uric acid |
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Term
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Definition
-NSAIDs (Indomethacin, Indocin)
-Glucocorticoids (prednisone)
-Colchicine |
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Term
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Definition
| NSAID for gout, 1st choice, minimal GI effects, headache |
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Term
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Definition
GOUT-specific drug: Anti-inflammatory
-leukocyte migration and infiltration inhibited by microtubule disruption
-GI side effects
-preferred oral not IV |
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Term
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Definition
-Allopurinol (Zyloprim)
-Fevuxostat (Uloric)
-Probenecid
**Sufinpyrazone (Anturane): inc. renal secretion of uric acid, oral, used in chronic gout |
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Term
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Definition
-GOUT: reduces blood levels of uric acid
-uses: chronic tophaceous gout, hyperuricemia due to chemo
-adverse: well tolerated, rash, fever, GI, drowsiness |
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Term
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Definition
GOUT: NEW
-first new in 40 yrs.
-MOA: inhibit XO, same as allopurinol
-adverse effects uncommon
-GOOD DRUG |
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Term
| Basic Priciples of Antimicrobial Therapy |
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Definition
-Chemo=use of chem to destroy invading org
-Antibiotic=one microbe destroys another
-Antimicrobial=natural or synthetic
-selective tox=no injury to host (cell wall)
-Narrow vs. broad spectrum |
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Term
| Drugable targets of antibiotics |
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Definition
-cell wall synthesis
-cell membrane permeability
-protein synthesis (prefer non-lethal so memory cells form)
-nucleic acid synthesis
-antimetabolites (sulfa drugs)
-viral enzyme inhibitors (reverse transcriptase inhibitors) |
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Term
| Mechanisms of microbial drug resistance |
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Definition
***Staphylococcus aureus
-spontaneous mutation
-conjugation (gram- bacteria, resistance factor, multiple drug resistance) |
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Term
| Delaying Emergence of Drug Resistance |
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Definition
-vaccinate
-get the catheters out
-target the pathogen
-access the experts
-practice antimicrobial control
-use local data
-use Vanco as last resort |
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Term
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Definition
-match bug to drug
-ID organism
-drug sensitivity of org: gram + or -
-host factors: age
-allergy: penicillin
-patient variables: pathology
-penetration to site of infection (BBB) |
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Term
| Misuses of Antimicrobial Drugs |
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Definition
-untreatable infection; common cold
-fever of unknown origin
-improper dosage: TB, dosage + length of time
-unidentified organism
-omission of surgical drainage: catheters |
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Term
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Definition
Antibiotics that weaken the cell wall, causing bacteria to take up H2O and burst
-bactericidal
-bacterial resistance: drug can't reach target, or inactivation by bacterial penicillinase (enz. that breaks down penicillin) |
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Term
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Definition
| Inhibition of transpeptidase, which makes strong cell walls in bacteria |
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Term
| Gram + vs. Gram - bacteria: the bacterial cell envelope |
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Definition
*Gram + = thick peptidoglycan in cell wall
*Gram - = thin peptidoglycan in cell wall + outer membrane
(both have inner cytoplasmic membrane) |
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Term
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Definition
| Penicillins are comprised of a Beta-lactam ring. Many bacteria make beta-lactamase that inactivates the drug by breaking a N-C bond |
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Term
Classifications of Penicillins
(-cillin=beta-lactam ring) |
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Definition
*narrow spectrum: penicillinase sensitive
*narrow spectrum: penicillinase resistant
*broad spectrum
*extended spectrum |
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Term
| Penicillin G (Benzylpenicillin) |
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Definition
4 forms of penicillin salts:
-Sodium penicillin
-Potassium penicillin
-Procaine penicillin
-Benzathine penicillin |
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Term
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Definition
Types:
-Immediate (2-30 minutes)
-Accelerated (1-72 hours)
-Late (days to weeks)
Anaphylaxis: laryngeal edema, bronchoconstriction, severe hypotension
Tx: epinephrine, resp support
Prevention: skin test, have resp support ready |
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Term
| Penicillinase-resistant penicillins, anti-staph |
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Definition
*Nafcillin
*Oxacillin
***Dicloxacillin-oral |
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Term
| Amoxicillin (Amoxil, oral) |
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Definition
Broad spectrum penicillin (aminopenicillin)
also in this class: Ampicillin (Principen)
adverse: rash, diarrhea |
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Term
Ticarcillin (Ticar, IV)
Carbenicillin indanyl (Geocillin, oral) |
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Definition
Extended spectrum penicillins (antipseudomonal penicillins)
also in this class: Piperacillin |
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Term
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Definition
Penicillin/Beta-Lactamase Inhibitor Combinations, only available in fixed-dose combos:
-Augmentin=Amoxicillin/Clavulanic acid |
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Term
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Definition
*most widely used group of antibiotics
-"ceph"=beta-lactam
-similar to penicillin structure
-bactericidal
-given parenterally
adverse: less than cillins, bleeding, thrombophlebitis |
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Term
| Classification of cephalosporins |
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Definition
Get better @ act. against gram-, resistance to B-lactase, into cerebrospinal fluid:
1st: Cephalexiin (Keflex): oral
2nd: Cefaclor (Ceclor): oral
3rd: Cefpodoxime (Vantin): oral
4th: Cefepime (Maxipime): IM/IV |
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