Advanced Pharmacology Study Material for Test 1, Exams of Nursing

Download Advanced Pharmacology Study Material for Test 1 and more Exams Nursing in PDF only on Docsity! Advanced Pharmacology test 1 Study Material Beta lactamase inhibitors - Correct answer Clavulanic acid, sublactam, taxobactam Unasyn - Correct answer Ampicillin and sulbactam Augmentin - Correct answer Amoxicillin clavulanic acid Hapten - Correct answer Drug +plasma protein severe allergic reaction Mechanisms resistance to beta lactamase - Correct answer Inactivation by beta lactamase, mutation trans peptidase target, impaired penetration of drug into organism, drug effluent pumps MRSA - Correct answer Resistant organisms produce PBPs with decreased affinity for binding beta lactam antibiotics Impaired penetration of drug into organosm - Correct answer Absence of porins or down regulation of porins or porins smaller Drug efflux pumps - Correct answer Nonspecific, spit out whatever bacteria doesn't need, major mechanism MDR Prevention of resistance steains - Correct answer Testing, choose right antibiotic, complete course therapy, don't use antibiotic when not indicated Mutidrug resistant organisms - Correct answer Organisms that are resistant to 1 or more class of organisms. Drug efflux pumps Penicillin - Correct answer Bactericidal Penicillin adverse effects - Correct answer GI distress, oral/vaginal candidiasis, rash, anaphylaxis Cephalosporins - Correct answer More stable against beta lactamases, increased range activity 1st generation cephalosporin - Correct answer Cefazolin, cephalexin G+, susceptible beta lactamase 2,3 generations cephalosporins - Correct answer Broader spectrum, Increase resistance beta lactamase, increase half life, some cross BBB 4,5 generations cephalosporins - Correct answer Cefepine, excellent resistance most beta lactamase, excellent CNS penetration, ceftaroline against MRSA Adverse reactions cephalosporins - Correct answer Hypersensitivity, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia, anorexia Cefotetan - Correct answer Avoid ETOH! Disulfiram like reaction with this cephalosporins Treatment for C diff from broad spectrum cephalosporin - Correct answer Vancomycin, metrondiszole Example monobactam - Correct answer Aztreonam IV or IM Active against G neg only Tolerated by PCN allergic patiemts Example carbapenem - Correct answer Imipenem, IV or IM only Widest spectrum of any beta lactam, must prescribe with cilastin to inhibit first pass elimination by renal enzyme dehydropeptidase, low crossreactivity for PCNs. Good for meningitis, peritonitis in really sick patients Vancomycin - Correct answer Cell wall inhibitor but not beta lactam, glycopeptide structure, best treatment for MRSA and G+. Only use Italy to treat antibiotic induced colitis, C. difficile and staph entericolitis Must monitor peak and trough, poorly absorbed po Vancomyicin - Correct answer Bacterocidal for G + Examples aminoglycosides - Correct answer Streptomycin, gentsmicin, tobramycin, amikacin Aminoglycosides - Correct answer Bactericidal inhibitors of protein synthesis. Useful against gram neg, acts at 30s ribosome subunit. Used in combo with other abx for synergistic. Used for gram + infections that are resistant to other abx Side effects aminoglycosides - Correct answer Ototoxicity: auditory/vestibular. And Nephrotoxicity. More toxicity in elderly, renal jnsufficency and dosing >5 days. Avoid use with loop diuretics or vancomycin or amphotericin. Inhibitors bacterial DNA synthesis - Correct answer Antifolate drugs, DNA gyrase inhibitors, sulfonamides Sulfonamides - Correct answer SMX-TMP, Bactrim, bacteriostatic action: prevents synthesis of folic acid required for purines and núcleos acid to make DNA. Concentrated in kidneys, mainstay for UTIs Sulfonamides - Correct answer Effective against gram +\- bacteria. UTIs, PJP, shigella. Very water soluble. High concentration in urine Sulfonamides Adverse effects - Correct answer Crystalluria, hypersensitivity SO groups sulfur allergies, N/V, rare: bone marrow fxn, aplastic anemia, agranulocytosis Supplement folic acid Fluoroquinolone Examples - Correct answer Ciprofloxacin, levofloxacin Fluoroquinolones - Correct answer Bactericidal, alter DNA, block bacterial DNA synthesis by inhibiting DNA gyrase, prevents opening of DNA supercoil for transcription and replication Fluoroquinolones Absorption elimination - Correct answer Excellent po absorption, really good bioavailability. Renal elimination. Absorption decreased by antacids, MVI, ca, MG, Iron Adverse effects fluoroquinolones - Correct answer Generally well tolerated, NVD, HA Potential QT elongation, worse with uncorrected hypokalemia, may damage growing cartilage. No for kids Black box fluoroquinolones - Correct answer Increased risk of tendinitis and tendon rupture. Risk increased by older, renal insufficiency and steroid use Nursing implications Sulfonamides - Correct answer Hydration! Assess RBC prior to therapy, oral dose with food Nursing implications Penicillin - Correct answer Oral dose with water not acid juice(nullifies), empty stomach, monitor allergic reaction Nursing implications Cephalosporin - Correct answer Assess PCN allergy. Give with good to decrease GI upset even though delay absorption. Watch Antabuse with ETOH Nursing implications Macrolides - Correct answer Better empty stomach but may take after food. Azithromycin does not inhibit CYP450 Nursing implications Tetracycline - Correct answer Photosensitive, avoid milk products Antitubercular drugs - Correct answer Rifampin, isoniazid, pyrazinamide, ethambutol RIPE Isoniazid - Correct answer IM, PO. Drug of choice Isoniaizid - Correct answer Metabolized in liver via acetylation. Watch for accumulation.check LFTs. Get side effects in patients who are slow acetylators. Hepatotoxic for those with liver disease Adverse effects isonazid - Correct answer Peripheral neuropathy. Black box hepatotoxic Ethambutol adverse effects - Correct answer Blindness, optic neuritis Rifampin adverse effects - Correct answer Hepatitis, colitis, discolor urine/sweat/tears normal Antifungals examples - Correct answer Amphotericin B, fluconazol/diflucan Amphotericin - Correct answer Systemic and topical disrupts cell membrane. Very toxic, very effective. Phlebitis, nephrotoxic,?electrolye imbalance, cardiac dysrhthmua and arrest Fluconazole/Diflucan - Correct answer Interferes with synthesis of ergosterol which is essential for fungal cell membranes Fluconazole - Correct answer Fungal infections CNS, bones, eyes, UTI, respiratory tract. Only works with Candida albicans Less toxic than amphotericin. Potent inhibitor CYPS 450!!! Vancomycin MOA - Correct answer Bi FS to peptidoglycan and prevents incorporation, no peptide cross bridge, cell wall not well built, lysis Attachment and entry inhibitors HIV - Correct answer Maraviroc enfuviritide Ion channel blocker influenza - Correct answer Amantidine, rimantidine Herpes and HIV Polymerase inhibitors - Correct answer Acyclovir, zidovudine, efavirenz, vidarabine, ganciclovir Acyclovir - Correct answer Prodrug, requires 3 phosphorylation to become activated. HIV and HCV protease inhibitor - Correct answer Prodrug, requires 3 phosphorylation to become activated. First phosphorylation occurs Interferons Hepatitis - Correct answer Endogenous antiviral immunomodulatory proteins. Binding of interferons to cells initiated production of antiviral proteins Interferon alpha - Correct answer SC or IM HBV and HCV Pegylated Interferon - Correct answer Polyethylene glycol chains, increase half life, reduction dosing to 1/week, better tolerated Interferon side effects - Correct answer Problematic! Flu like, thrombocytopenia, granulocytopenia, elevated ALT, nausea, fatigue, rash, athralgia, severe psych depression, psychoses Contraindications for interferons - Correct answer Psychosis, severe depression, neutropenia, seizures, severe cirrhosis, pregnancy-SAB Treatment HBV - Correct answer Tenofovir, entecavir Both inhibit HBV DNA polymerase also used treat HIV Side effects tenofovir and entecavir for HIV and HBV - Correct answer Rash, nausea, fatigue Hepatitis c - Correct answer RNA virus, goal is eradication of virus, don't need interferons to treat Hep C, curative, viekira pack Viekira pack - Correct answer Ombitsavir, paritaptrevir Ritonavir Dasabuvir HIV structure - Correct answer Blood borne pathogen, obligate parasite, RNA virus double strand identical RNA, retrovirus. Needs reverse transcriptase to get RNA back to DNA and then mRNA to protein. HIV structure - Correct answer HIV enzymes - Correct answer Reverse transcriptase, HIV integrase, HIV protease Reverse transcriptase - Correct answer Takes viral RNA and makes mirror image DNA HIV integrase - Correct answer New DNA enters nucleus of CD 4 cell and integrase inserts it into host cell DNA HIV Protease - Correct answer Cuts up poly protein chain into individual proteins make up new viruses Antiretroviral agents 4 classes - Correct answer NRTI/NNRTI, protease inhibitor, Fusion inhibitors Integrase inhibitors NRTI/NNRTI - Correct answer Mimic endogenous nucleosides, competitive inhibitors HIV Reverse Transcriptase, Incorporate into viral DNA and cause chain termination of HIV synthesis Examples of NRTI/NNRTI - Correct answer Zidovudine, Stauvidine Lamivudine Major Side effects NRTI - Correct answer N/v, rash, neuropathy Black Box NRTI Abacavir - Correct answer Fatal hypersensitivity reactions, Stevens johsons Black Box zidovudine - Correct answer Aplastic anemia NNRTIs - Correct answer Bind directly to HIV reverse transcriptase to inhibit it. Allosteric Inhibition. Non competitive inhibitors of HIV RT Examples of NNRTIs - Correct answer END Nevirapine, delavirdine, efavirenz NNRTIS side effects - Correct answer Rash, interactions with cyps especially cyp3A4 NNRTIs resistance - Correct answer Can develop rapidly Cross resistance rapidly b/c all bind at same place so if gene mutation affects all NNRTIS Never use alone Protease inhibitor - Correct answer Inhibits HIV enzymes viral for maturation of HIV to fully functional virus Protease inhibitors Examples - Correct answer SIR Saquinavir Indiana ir Ritonavir Protease inhibitors cross resistance - Correct answer All bind to same site in protease if one stops working b/c mutation at binding site then all are affected, Protease inhibitor Metabolism - Correct answer CYP3A4, may also inhibit CYP3A4 HIV drug boosting - Correct answer Ritonavir boosting effect on protease inhibitors, inhibits CYPS 3A4, whichever keeps other drug in circulation longer Protease inhibitors Adverse effects - Correct answer N/v, hyperglycemia, lipodystrophy, pancreatitis GI side effects usually resolve after 4 weeks Protease inhibitors Interactions - Correct answer Other CYP 3A4 substrates, Severe hepatic impairment Never use alone- quick resistance! Fusion inhibitors Examples - Correct answer Enfurvitide Maraviroc Promotes platelet aggregation, Cox 2 - Correct answer Only active in cells during inflammation/injury, inflammatory prostaglandins Aspirin - Correct answer Irreversible inhibitor of Cox 1&2, used in CV disease to inhibit platelet aggregation and blood clots, greater risk of GI bleeding than ibuprofen Adverse effects aspirin - Correct answer GI upset, gastric and duodenal ulcers, potential nephrotoxicity Rare hypersensitivity Black Box Aspirin Reyes Syndrome - Correct answer Hepatic encephalopathy Liver steatosis Kids and teens taking aspirin after viral infection Non selective COX inhibitors Examples - Correct answer Propionic acid derivatives Ibuprofen, naproxen, ketoprofen Naproxen - Correct answer 20x more potent than aspirin, longer half life Ibuprofen + aspirin - Correct answer Ibuprofen antagonizes irreversible platelet inhibition of aspirin. Ibuprofen displaces aspirin Examples acetic acid derivatives - Correct answer Indomethacin, diclofenac, keterolac Indomethacin - Correct answer Poorly tolerated Many GI effects Use for rheumatic and gout Acetaminophen - Correct answer Technically not a NSAID Acts directly on CNS Analgesia Antipyretic No antiinflamatorios effect No platelet effects No GI ulceration Black Box tylenol - Correct answer Overdose causes irreversible oxidative damage Acetaminophen overdose - Correct answer Gluthatione depletion, byproducts metabolism cause iirversible oxidative damage Rescue for acetaminophen overdose - Correct answer Stomach la age, activated charcoal Acetylcysteine directly binds to free radicals, star within 10 hrs Selective COX 2 inhibitors - Correct answer Celecoxib Analgesic Antiinflamm Antipyretic No platelet effect Uses selective Cox 2 inhibitors - Correct answer Osteoarthritis Rheumatoid arthritis Gouty arthritis Musculoskeletal pain Selective Cox 2 inhibitors problem - Correct answer Higher rate cardiovascular thrombotic events Prostacyclin synthesis inhibited and platelets now sticking where they shouldn't Also Renal toxicity b/c Cox 2 protective kidneys, rash from sulfur/sulfonamides Systemic corticosteroid - Correct answer Effective severe inflammation Naturally released from adrenal cortex Suppress histamine and prostaglandins Can inhibit immune system to reduce inflammation Treatment with corticosteroids - Correct answer Short term for acute inflammation Long term therapy Minimize dose Use alternate day Cushing syndrome D/c gradually Clinical uses corticosteroids - Correct answer Arthritis, GI disorder Adverse effects corticosteroids - Correct answer Rare if used less than 2 weeks Long term Hyperglycemia Edema HTN Hypokalemia Mineralcorticoid effect Redistribution fat Osteoporosis Increased risk infection Impaired wound healing Insomnia Behavior changes Iatrogenic Cushing Consequences abrupt discontinuation corticosteroids - Correct answer Adrenal insufficiency Hypotension Lethargy Renal failure N/v Addisons disease DMARDs - Correct answer Disease modifying anti rheumatic drugs Pharmacology Rheumatoid arthritis - Correct answer Initial NSAIDs Corticosteroid for severe inflammation DMARDS Rheumatoid arthritis - Correct answer Synovial membrane fist effected Spreads to articular cartilage, fibrous joint capsule Autoimmune disease