The Effects of Climate Change on Biodiversity, Exams of Health sciences

Download The Effects of Climate Change on Biodiversity and more Exams Health sciences in PDF only on Docsity! NURS 5344 PHARM STUDY GUIDE QUIZ 1. MODULE 1 1. What are the BON rules and regulations for prescriptive authority for the advance practice nurse? 1. Texas is very restricted 2. Describe the pharmacokinetic processes of absorption, distribution, metabolism and elimination and how differences in these areas affect drug action. 1. Absorption 1. Drug’s movement from the site of administration into the blood. 2. Distribution 1. Drug’s movement from the blood into the interstitial space of tissues and from there into cells. 3. Metabolism 1. Biotransformation is the enzymatically mediated alteration of drug structure. 4. Elimination 1. Combination of metabolism and excretion 3. Compare and contrast pharmacokinetics and pharmacodynamics of special populations—pediatrics, older adults and those that are pregnant. 1. Pediatrics—they have organ immaturity, elderly—they have organ degeneration, loss of nephrons, excretion of drug is decreased and you have to give this population a lower dose of medication. Medication can pass through milk of lactating females. 4. Analyze a drug interaction to determine an appropriate course of action. 1. Basic mechanism of drug-drug interactions through pharmacokinetic interactions are altered absorption, altered distribution, altered metabolism, and altered renal excretion. 5. Identify medications with a narrow therapeutic index requiring drug level monitoring. 1. 6. Discuss the effect of ionization and pH on absorption. 1. Drugs that are weak acids are best absorbed in acidic environments. Acidic drugs accumulate on the alkaline side, basic drugs accumulate on the acidic side known as ion trapping. Ionization of the drugs is pH dependent, when the pH and the fluid on one side of the membrane differs from the pH on the other side, drug molecules tend to accumulate on the side where the pH most favors ionization. 7. Discuss factors affecting drug distribution. 1. Competition for protein binding and alteration of extracellular pH 8. Discuss barriers affecting drug distribution—such as placental membrane, blood brain barrier and volume of distribution. 1. Placental membrane: drugs are easily passed through the placental membrance 2. Blood brain barrier: the PGP pumps drugs back into the blood and thereby limits their access to the brain. 3. Volume of distribution: 9. Discuss the “first-pass effect”—what effect can this have on distribution of a drug? 1. Rapid hepatic inactivation of certain oral drugs. When drugs are absorbed by the GI tract, they are carried directly to the liver through the hepatic portal vein NURS 5344 PHARM STUDY GUIDE QUIZ 1. before entering the systemic circulation. If the capacity of the liver to metabolize the drug is extremely high, this drug can be completely inactivated on its first pass through the liver. 10. Discuss the significance of the Cytochrome P450 system on metabolism of drugs. 1. It is a group of 12 closely related enzyme families. CYP1, CYP2, CYP3 metabolize drugs. The other 9 families metabolize endogenous compounds (ex. Fatty acids, steroids). 11. Discuss the major hepatotoxic drugs and possible effects on drug metabolism. 1. 12. List various routes of drug elimination—review normal renal function including glomerular filtration, passive tubular reabsorption and active tubular secretion; describe the implications on drug clearance and how elimination affects prescribing. 1. 13. Discuss terms used to describe drug actions-agonist, partial agonist, antagonist. 1. Agonist: molecules that activate receptors 2. Partial agonist: Only has moderate intrinsic activity. Maximal effect that a partial agonist can produce is lower than that of a full agonist. 3. Antagonist: Produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs. 14. Discuss the impact of food on drug absorption, drug metabolism and on drug toxicity and action—as well as the timing of drug administration. LIFESPAN 1. Hepatic metabolism and GFR increase during pregnancy, dosages of some drugs may need to be increased. 2. Rate of albumin to water decreases 1. Third trimester: Renal blood flow is doubled and renal excretion is accelerated (drugs excreted rapidly) 2. Tone and mobility of bowel decrease 3. Prolongation of drug effects Total (½ life increases) 3. Understand stages of development in pregnancy 1. Conception: through week 2 2. Embryonic period: week 3-week 8 a) Gross malformations can be produced by teratogens 3. Fetal period: week 9-delivery 4. Understand pregnancy labeling 1. 3 categories now a) Pregnancy, lactation, male & female reproductive potential 5. How do you decrease risk in the infant during breastfeeding? 1. Take meds immediately after breastfeeding, avoid drugs that have long half-lives, choose drugs that tend to be excluded from milk, avoid drugs that are known to be hazardous. 6. How do pediatric patients differ in their response to medications? 1. Absorption a) Oral? NURS 5344 PHARM STUDY GUIDE QUIZ 1. 7. Beta Lactam? 1. Penicillins (penicillin G, Ampicillin, amoxicillin, pipercillin) 2. Carbapenems (ztreonam, Imipenem, Meropenem, Ertapenem) 3. Cephalosporins (Cefazolin, ceftriaxone, cefotetan) 4. Vancomycin 5. Lypoglycoproteins (telavancin) 6. Monobactrams (aztreonam) 7. Fosfomycin 8. What are the medications that react with PCN? 1. Aminoglycosides, bacteriostatic agents, and probenecid 9. What organisms are susceptible to PCN? 1. Gram-positive bacteria and gram-negative 10. Beta lactams 1. Penicillins, cephalosporins and carbapenems (drugs that end in -nem and -nam) b) Mechanism of action: weaken cell wall and promote bacterial lysis and death. Active only against bacteria that is undergoing growth and cell division. c) allergy potential between penicillin and cephalosporins* d) Allergic Reaction 1. Immediate: 2-30 minutes after dose 2. Accelerated: 1-72 hours after dose 3. Delayed: days to weeks 4. Treatment: epinephrine (IM or SubQ or IV), respiratory support. e) Drug-drug interactions: aminoglycosides, bacteriostatic agents, probenecid f) Penicillin G AKA Penicillin 1. Bactericidal to gram-positive and gram-negative bacteria. 2. Drug of choice g) Ampicillin and Amoxicillin 1. Broad spectrum 2. Gram-negative bacilli i. Haemophilus influenza ii. E. Coli iii. Salmonella iv. Shigella 3. Adverse reaction i. Rash ii. Diarrhea h) Piperacillin 1. Extended-spectrum penicillin 2. Fights against: pseudomonas, enterbacter, proteus, bacteroides fragilis, klebsiella 3. Administered: parenterally via IV Mediated by IgE antibodies NURS 5344 PHARM STUDY GUIDE QUIZ 1. 4. Adverse reaction: bleeding secondary to disrupting platelet aggregation. i) Penicillin combination (beta-lactamase inhibitors) 1. Ampicillin/sulbactam 2. Amoxicillin/clavulanate 3. Piperacillin/tazobactam j) Resistance issues with penicillin 1. Primarily against Staphylococcus aureus i. MRSA (sensitive) 2. Developed to resist penicillinase 3. Hepatotoxicity 4. Dose reduction in renal insufficiency k) Nephrotoxicity* 1. Kidney toxicity 2. Monitor renal function 2. Generations of cephalosporins a) Mechanism of action: bind to penicillin-binding proteins and disrupt cell wall synthesis, activate autolysis, damage cell wall. b) Most affective in cells undergoing active growth and division. c) Drug-drug interaction: probenecid d) Cefazolin & Ceftriaxone-do not give with alcohol e) Cefotetan & Ceftriaxone (decreases vitamin K metabolism)-do not give with warfarin f) Ceftriaxone-do not give with calcium g) Adverse effects: allergic reaction, bleeding, thrombophlebitis 1. 1st: 2. 2nd 3. 3rd i. Destroyed by beta-lactamases ii. No CSF iii. Gram + iv. Narrow spectrum v. Used for prophylaxis, surgical prophylaxis vi. Rarely used for active infections i. Less sensitive to destruction ii. No CSF iii. Less gram + more gram – iv. Rarely used for active infections v. Effective against H. Influenza, klebsiella, pneumococci, and staphylococci vi. Good for upper respiratory infections, otitis media, bacterial sinusitis i. Highly resistant ii. Enters CSF* (good treatment for meningitis) iii. Highly active against gram - iv. Preferred for severe infections NURS 5344 PHARM STUDY GUIDE QUIZ 1. 4. 4th 5. 5th i. Highly resistant ii. Enters CSF iii. Excellent gram – coverage iv. Commonly used to treat healthcare & hospital associated pneumonia (especially caused from pseudomonas) i. Used for infections associated with MRSA h) Thrombophlebitis with cephalosporins 1. Give by slow IV piggyback 2. Dilute drug (50-100 mL IV solution) 3. Carbapenems (Imipenem, meropenem, ertapenem, doripenem) a) Very broad antimicrobial spectrum b) Not effective against MRSA c) Imipenem 1. Good for treating mixed infections ii. staph aureus iii. gram – bacilli 2. binds to PBP1 and PBP2 d) Adverse effects 1. GI: nausea and vomiting 2. Skin rash and pruritus 3. Fever e) Drug-drug interaction: valproate (break through seizures can occur) f) Administered only parenterally 4. Vancomycin g) No beta-lactam ring h) Uses and coverage 1. MRSA and C diff infections (IV)* 2. Oral is only used for c. diff (PO)* 3. Penicillin allergic patients for streptococcal endocarditis (rotten teeth that give a patient heart problems) i) Adverse Effects** 1. Thrombophlebitis 2. Thrombocytopenia 3. Red man syndrome* i. Hypotension ii. Histamine flush iii. Not an allergic reaction* j) Nephrotoxicity and ototoxicity* 1. Monitor renal function 5. Lypoglycoproteins k) Telavancin 1. Uses NURS 5344 PHARM STUDY GUIDE QUIZ 1. f) Symptoms improve within 2-3 days after taking BACTERIOSTATIC INHIBITORS (suppress growth, do not kill) 1. Tetracyclines (tetracycline, demeclocycline, doxycycline, minocycline) a) Broad spectrum b) Work against gram + and – c) Mostly used outpatient d) Extensive use = increased in bacterial resistance e) Uses 1. Chylamydial infections and other STDs 2. Helicobacter pylori (causes ulcers in the duodenal and gastric) 3. Acne 4. Skin infections 5. Anthrax (doxycycline) 6. Infectious disease 7. PUD 8. Periodontal disease 9. RA 10. RMSF 11. Pneumonia 12. Lyme disease f) Why can’t we give to children under 8 and pregnant women?* 1. Can irreversibly stain teeth (4 months-8 years old)* 2. Impact skeletal development in babies* g) Photosensitivity* 3. Wear sunscreen h) Adverse effects 1. Nausea, cramps, epigastric burning 2. Create superinfections—c. diff 3. Hepatotoxicity—IV form i) tetracycline with iron, vitamins, or calcium – bioavailability* 1. Impaired absorption of antibiotic 2. If you want to take iron, vitamins, or calcium leave 2 hours in between tetracyclines 2. Macrolides a) Broad spectrum b) Erythromycin 1. High dose IV is cidal 2. Low dose PO is static 3. Food increases absorption 4. Metabolized by CYP3A4 system 5. Drug-drug interactions: theophylline, carbamazepine, warfarin, verapamil, diltiazem, HIV protease inhibitors, simvastatin cipro NURS 5344 PHARM STUDY GUIDE QUIZ 1. 6. Uses i. Alternative to PCN in allergic patients ii. Atypical infections 1. Group A strep 2. Corynebacterium diphtheriae 3. Whooping cough 4. Chlamydia and Mycoplasma (walking pneumonia) 7. Side effects i. GI difficulties most common with oral erythromycin 1. N/V/D, abdominal cramping, hepatotoxicity ii. Less side effects with newer macrolides c) Azithromycin 1. Cause QT prolongations** d) Clindamycin (Cleocin) 1. Bacteriostatic 2. BLACK BOX WARNING: Promote severe c. diff in elderly patients 3. Uses i. Anaerobic bacteria, gram – and + 4. Used as alternate to penicillin 5. Adverse effects i. Hepatic toxicity ii. Blood dyscrasias iii. Diarrhea iv. Hypersensitivity reactions 3. Oxazolidiones (Zyvox or Linezolid) a) Used to treat VRE and MRSA b) Very expensive c) Limited use due to resistance d) Gram + bacteria, NO gram - bacteria 1. Enterococcus 2. MRSA 3. Staphylococcus epidermidis 4. Strep pneumonia e) Adverse effects 1. Diarrhea 2. Nausea 3. Vomiting 4. Headache 5. Myelosuppression f) Drug-drug interactions 1. MAOIs and Tedizolid 4. Ketolides NURS 5344 PHARM STUDY GUIDE QUIZ 1. a) Telithromycin 1. Uses i. Strep pneumonia 2. Adverse effects i. Severe liver damage ii. GI effects iii. Visual disturbances iv. Prolonged QT interval v. BLACK BOX WARNING: muscle weakness and shouldn’t be used in myasthenia gravis due to respiratory failure. 5. Streptogramins a) Dalfopristin 1. Uses i. Vancomycin-resistant enterococcus 2. Adverse effects i. Hepatic toxicity 3. Drug-drug interactions: CYP3A4 system b) Chloramphenicol 1. Uses i. Life threatening infections 2. Adverse effects i. Reversible bone marrow depression ii. Fatal aplastic anemia (BLACK BOX WARNING) iii. Gray syndrome iv. GI effects v. Peripheral neuropathy 6. Tigecycline a) Broad spectrum bacteria b) Causes increased mortality (not used unless other infection isn’t responding to other agents) 7. Retapamulin and mupirocin a) Topical used for impetigo 8. Mupirocin a) Used in nostrils for MRSA for people who are carriers 9. Aminoglycosides (gentamycin, tobramycin, amikacin) a) Uses and coverage 1. Gram negative only i. Serious or life-threatening infections* 1. Alone or with other antibiotics ii. Local treatment (ear/eye infection) 2. Bactericidal 3. Narrow spectrum b) Sensitive organisms** NURS 5344 PHARM STUDY GUIDE QUIZ 1. d) Adverse effects 1. GI—nausea and vomiting 2. Rash 3. Hyperkalemia 4. Steven-Johnson syndrome 5. Blood dyscrasias 6. Kernicterus 7. Renal damage or crystal urea 8. Birth defects in 1st trimester DRUGS TO TREAT UTIs** 1. Uncomplicated UTIs a) Single dose therapy 1. For uncomplicated, non pregnant females b) Conventional therapy 1. For pregnant females c) Nitrofurantoin and Bactrim DS** d) If there’s resistance: fluoroquinolones are used** e) Fosomycin= single dose therapy f) Nitrofurantoin rapidly metabolized and concentrates in the bladder** 1. Used for acute cystitis, NOT pyleo 2. Acute and uncomplicate Pyleo a) Mild and moderate infection treat at home 1. First line: TMP, SMZ, Cipro and levofloxacin for 10- 14 days 2. Second line: augmentin (amoxicillin clavulanate AKA cephalexin) b) Severe infection requires hospitalization and IV antibiotics then once controlled you start oral antibiotics 3. Cipro, ceftrizxone, ceftazidime, ampicillin plus gentamicin, ampicillin/culbactam 3. Complicated UTIs a) Need to do a C&S and treat with broad spectrum until it comes back** 4. UTI relapse a) Long-term therapy: prophylactically low dose of TMP/SMZ 3x weekly for 6 months or TMP at bedtime for 6 months or nitrofurantoin for 6 months** 5. Postcoital cystitis a) Take nitrofurantoin and void after intercourse 6. Prostatitis** a) Signs & Symptoms 1. High fever, chills, malaise, myalgia, localized pain, dysuria, nocturia, urinary urgency, urinary frequency b) Causes NURS 5344 PHARM STUDY GUIDE QUIZ 1. 1. E. coli, indwelling urethral catheters, urethral instrumentation, or transurethral prosthetic resection c) Treatment 1. 2-4 weeks of fluroquinolone or doxycycline 7. UTI antiseptics a) Nitrofurantoin and methenamine** 1. Bacteriostatic 2. High concentrations=bactericidal 3. Uses i. Lower UTI ii. Prophylaxis iii. Recurrent infections 4. Not absorbed systemically (doesn’t work for kidney infections) 5. Adverse effects i. GI ii. Pulmonary iii. Hematologic (agranulocytosis, leukopenia, thrombocytopenia, megaloblastic anemia) iv. Peripheral neuropathy (irreversible) v. Hepatotoxicity vi. Birth defects (DO NOT GIVE TO PREGNANT FEMALES) 6. Methenamine i. Uses 1. Chronic lower UTIs ii. Adverse effects 1. Contraindicated in pt with renal and liver failure iii. Drug-drug interactions 1. Urinary alkalinizers 2. Sulfonamides 8. Floroquinolones (cipro) a) Broad spectrum b) PO and IV c) Resistance in N. Gonorrhoeae** 1. Excellent oral absorption (PO) d) Cipro 1. Uses (gram -) i. Anthrax* ii. Respiratory infections iii. UTIs iv. GI infections v. Bones, joints, soft tissue infecitons 2. Adverse Effects** i. Cartilage damage** NURS 5344 PHARM STUDY GUIDE QUIZ 1. 1. FDA black box warning: increase risk of tendonitis and tendon rupture—not dose dependent* ii. Photosensitivity 1. Wear sunscreen iii. Confusion in elderly iv. N/V/D v. Dizziness vi. Headaches vii. Restlessness viii. Occasionally seizures ix. Candida infections of pharynx & vagina x. C. diff xi. Increased risk for aortic dissection or ruptured abdominal aortic aneurysm. 3. Drug-drug interactions** i. Glucocorticoids ii. Antacids, magnesium, arm salts, zinc salts, sucralfate, milk, dairy products (absorption is reduced) iii. Theophylline, warfarin, tinidazole (causes elevations of these meds) 4. Contraindications i. Don’t give to pregnant or lactating women and children <18* ii. Myasthenia gravis (causes muscle weakness) e) Ofloxacin, Moxifloxacin, Levofloxacin 1. Uses i. Respiratory tract ii. UTI iii. GI tract iv. Skin and soft tissues f) Gemifloxacin 1. Uses i. CAP and bacterial bronchitis g) Delafloxacin 1. Uses i. Skin and skin structure infections h) Flagyl (metronidazole) 1. Uses** i. Bacteroides fragilis ii. Fusobacterium iii. Gardnerella vaginalis iv. Peptococcus v. peptostreptococcus 2. Adverse effects** Quinolones interfere with warfarin so you must watch the PT/INR because it would be high NURS 5344 PHARM STUDY GUIDE QUIZ 1. 3. Azithromycin, ceftriaxone, cipro, erythromycin base j) Herpes simplex virus** 1. Acyclovir, famciclovir, valacyclovir i. Can be taken every day for suppressive therapy or can preserve it and take them when there’s an active outbreak ii. Vancyclovir 500mg taken daily can decrease transmission by 50% iii. Infants exposed at birth should be treated with acyclovir ANTIFUNGALS 5. Amphotericin B (broad spectrum, given IV) a) Uses 1. Some protozoa 2. Systemic mycoses b) Mechanism of action 1. Binds to ergosterol in the fungal cell membrane and increases permeability and the cell leaks intracellular cations reduces viability. Bacteria not affected. 2. Fungicidal or fungistatic c) Adverse effects 1. Infusion reactions i. Phlebitis 2. Renal damage causes hypokalemia (may need potassium and monitor creatinine) 3. Fever, chills, rigors, nausea, headache. 4. Hematologic effects: bone marrow suppression and normochromic normocytic anemia (monitor h&h) d) Drug-drug reactions 1. Hydrocortisone-high incidence of phlebitis 2. Aminogylcosides-nephrotoxic 3. Cyclosporins-nephrotoxic 4. NSAIDS-nephrotoxic e) BLACK BOX WARNING 1. Highly toxic, only used in the setting of life threatening infections. 6. Azoles (Itraconazole, fluconazole, voriconazole, ketoconazole, Posaconazole, isavuconazonium) a) Uses (orally) 1. Systemic mycoses b) Mechanism of Action 1. Inhibits the synthesis of the ergosterol and disrupts the fungal cell membrane . Inhibits fungal cytochrome p450 c) Adverse effects 1. Liver damage (monitor liver enzymes) NURS 5344 PHARM STUDY GUIDE QUIZ 1. 2. GI effects (N/V/D) d) Drug-Drug interactions (inhibit p450 drug metabolism) 1. Dofetilide (antiarrhythmic) 2. Warfarin 3. Cyclosporin 4. Lovastatin 5. Simvastatin 6. PPIs (inhibit absorption) 7. Cola (enhances absorption) e) BLACK BOX WARNING 1. Decrease in ventricular ejection fraction—should not be used in patients with heart failure or ventricular dysfunction 7. Echinocandins a) Caspofungin, Micafungin, Anidulafungin 1. Uses i. IV therapy of invasive aspergillus not responsive to amphotericin B, itraconazole, and candida infections 2. Adverse effects i. Fever ii. Phlebitis 3. Drug-drug interactions i. Drugs that induce cytochrome P450 may decrease levels ii. Decreases levels of tacrolimus iii. Combining with cyclosporine can increase risk for liver injury 8. Pyrimidine Analog b) Flucytosine 1. Uses i. Serious infections from candida and cryptococcus neoformans 2. Adverse effects i. Half life prolonged in patients in renal impairment (BLACK BOX WARNING) ii. Bone marrow suppression iii. Neutropenia or thrombocytopenia iv. Rarely fatal agranulocytosis v. Hepatotoxicity 3. Drug-drug interactions i. ?? 9. Which drugs treat? a) Tinea pedis 1. Terbinafine (topical) 2. Butenafine (topical) 3. Ciclopirox (topical) NURS 5344 PHARM STUDY GUIDE QUIZ 1. b) Tinea corporis 1. Terbinafine (topical) 2. Butenafine (topical) 3. Ciclopirox (topical) c) Tinea cruris 1. Terbinafine (topical) 2. Butenafine (topical) 3. Ciclopirox (topical) d) Tinea capitis 1. Fluconazole 2. Terbinafine 3. Itraconazole 4. Butenafine e) Vulvovaginal candidiasis 1. Topical antifungals 2. 1 dose of fluconazole 150mg f) Onychomycosis 1. Terbinafine (topical) and itraconazole TUBERCULOSIS DRUGS 1. Two species of bacteria a) Tubercular bacilli b) 2. When is treatment considered effective? a) 3. How are drugs chosen for treatment? a) Initial drug selection is empiric based on patterns of drug resistance in the community and immunocompetence of the patient. Once culture sputum results come back, regimen should be adjusted accordingly. 4. What are first line drugs? Second line? a) 1st line: Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Rifapentine, and Rifabutin b) 2nd line: Cycloserine, Ethionamide, Capreomycin, Para- aminosalicylic acid, aminoglycosides, quinolones. 5. What is the induction phase of treatment? Continuation Phase? a) Induction phase: eliminate actively dividing extracellular tubercle bacilli b) Continuation phase: eliminate persistent intracellular organisms 6. Define multidrug resistant TB. Define extensively resistant TB. a) Multidrug resistant: TB resistant to both isoniazid and rifampin, the two most effective drugs for TB b) Extensively resistant: TB that is resistant to not only isoniazid and rifampin but to all fluoroquinolones and at least one of the injectable second-line anti-TB drugs. 7. Isoniazid NURS 5344 PHARM STUDY GUIDE QUIZ 1. b) Multi drug resistant? 1. Isoniazid resistant i. Treated for 6 months with 3 drugs 1. Rifampin, ethambutol, pyrazinamide 2. Rifampin resistant i. Treated for 18-24 months with 3 drugs 1. Isoniazid, ethambutol, pyrazinamide c) Extensively drug resistant? 1. Treatment is prolonged to at least 24 months 2. Use 2nd and 3rd line drug—less effective 3. Initial therapy can consist of 5,6,7 drugs i. Isoniazid, rifampin, pyrazinamide, ethambutol, amikacin or capreomycin, levofloxacin, cycloserine, ethionamide or PAS. 4. Last resort i. Infected tissue removed by surgery d) Patients with TB and HIV? 1. Rifabutin can be used but it can accelerate the metabolism of protease inhibitors and NNRTIs but not as much as rifampin. e) Latent TB? 1. Treated with one or two drugs 2. TB must be ruled out 3. Isoniazid alone daily or twice weekly for nine months or isoniazid daily or twice weekly for 6 months 4. Rifampin alone daily for 4 months, isoniazid plus rifapentines taken weekly for three months f) How do you promote treatment adherence? 1. Directly observed therapy i. Administration of each dose is done in front of representative of the health department 2. Intermittent dosing (2-3 times a week) g) How do you evaluate? 1. Three primary modes i. Bacteriologic evaluation of sputum 1. Evaluated monthly until 2 consecutives are negative ii. Chest radiographs 1. Done in pt with negative pretreatment sputum test 2. Repeat every 2 months after initial tx iii. Clinical evaluation 1. Fever, malaise, anorexia, cough must be evaluated at every clinic visit 2. Should be markedly decreased within 2 weeks NURS 5344 PHARM STUDY GUIDE QUIZ 1. ANTHELMINTICS 1. What are the antihemintics drugs? a) Drugs of choice 1. Mebendazole, albendazole, pyrantel pamoate, praziquantel, diethylcarbamazine, ivermectin. 2. Anthelmintic drugs are generally devoid of serious adverse effects 3. Important to match drug with infesting worm 4. Many worm infestations are both asymptomatic and self-limited, hence drug therapy can be optional ANTIVIRALS FOR NON HIV 1. Acyclovir a) Uses 1. 1st choice for herpes simplex virus or varicella zoster virus b) Adverse effects 1. IV i. Phlebitis ii. Nephrotoxicity iii. Neurotoxicity 2. Oral i. GI effects ii. Vertigo 2. Valacyclovir a) Uses 1. Herpes zoster, genital herpes, herpes labialis, cold sores, varicella, chicken pox b) Adverse effects 1. Hematologic affects: thrombocytopenia, aplastic anemia 2. Neurologic: psychosis, encephalopathy, seizures 3. GI affects 3. Famciclovir a) Uses 1. Genital HSV, herpes zoster, orolabial HSV b) Adverse effects 1. Blood dyscrasias i. Neutropenia ii. Thrombocytopenia 2. Stevens Johnson Syndrome 3. CNS—hallucinations, delirium c) Drug-drug interactions 1. Live varicella & zoster vaccine 4. Ganciclovir a) Uses NURS 5344 PHARM STUDY GUIDE QUIZ 1. 1. Herpes simplex viruses, CMV virus (prevention and tx in immunocompromised pt—transplant pt, HIV, and those receiving immunosuppressing drugs) b) Adverse effects 1. Granulocytopenia 2. Thrombocytopenia 3. Reproductive toxicity 4. Teratogenic and carcinogenic effects 5. Nausea, fever, rash, anemia, liver dysfunction, confusion, other CNS symptoms 5. Valganciclovir a) Uses 1. CMV, retinitis, prevention of CMV disease in high- risk organ transplant recipients b) Adverse effects 1. Blood dyscrasias i. Bone marrow suppression ii. Granulocytopenia iii. Anemia iv. Thrombocytopenia 2. N/V/D 3. Potential mutagenesis and carcinogenesis 6. Cidofovir a) Uses 1. CMV retinitis in patients with AIDS b) Adverse effects 1. Nephrotoxicity 2. Neutropenia 3. Ocular disorders VIRAL HEPATITIS DRUGS & FLU a. What are the medications used in the treatment of hepatitis? i. Hep C 1. Pegylated interferon alfa combined with ribavirin a. Interferon alfa: only given subQ i. Conventional vs. long acting ii. Adverse effects: flu-like, neuropsychiatric effects, depression, fatigue, thyroid dysfunction, heart damage, bone marrow suppression, neutropenia, thrombocytopenia b. Ribavirin i. Used in combo with interferon alfa ii. Aerosol form to treat children with RSV iii. Adverse effects: flu-like, severe depression, hemolytic anemia, birth defects (do not give to pregnant women) NURS 5344 PHARM STUDY GUIDE QUIZ 1. LOCAL ANESTHESIA 1. What is MOA of local anesthetics? a. Suppress pain by blocking sodium channels and impulses, conduction along the axons and the selectivity of the anesthetic effects, only neurons located near the side of administration are affected and they suppress pain without generalized depression of the CNS 2. What 3 properties determines the ability of anesthetic to penetrate axon membrane? a. Molecular size, lipid solubility, degree of ionization at the tissue pH 3. Why are vasoconstrictors used in conjunction with local anesthetics? a. Delays the systemic absorption and prolongs anesthesia and reduces the risk of toxicity 4. What blood dyscrasia can occur from benzocaine? a. Methemoglobinemia-hgb is modified so it cant release O2 into the tissues and if enough hgb is converted to methemoglobin, death can result. 5. What are application guidelines for topical anesthetics to prevent systemic reactions? a. Apply the smallest amount needed, avoid application to large areas, avoid broken or irritated skin, avoid strenuous exercise, wrapping the site and heating the site. DRUGS FOR HEADACHES 1. What is pathophysiology of migraine? a. Neurovascular disorder that involves the dilation and inflammation of intracranial blood vessels. Vasodilation causes the pain. 2. What foods can trigger migraines? a. Aged cheeses, wine, cured meats, hot dogs, lunch meat, chocolate, Chinese food, canned soups, diet sodas, artificial sweeteners, yellow food coloring. 3. What drug classes are abortive medications? a. NSAIDs/aspirin b. Opioid analgesics: butorphanol and meperidine c. Serotonin 1B/1D receptor agonists: triptan d. Ergot alkaloids 4. What drug classes are preventive? What can happen with all preventive medications have if taken too frequently? a. Beta blockers, antiepileptic drug, tricyclic antidepressants, calcium channel blockers, botulism toxin, ACE inhibitors, Angiotensin 2 receptor blockers. b. Chronic headache 5. What are some herbal meds effective with migraines? What are their side effects? a. riboflavin B2 and coenzyme Q-10 b. Side effects: GI, liver damage and cancer 6. What is treatment for menstrual migraine? a. Tricyclic antidepressants, estrogen gel and patches HEADACHES 1. NSAIDs: First line 2. Seratonin 1B1D Receptor Agonists/Triptans a. What is MOA? NURS 5344 PHARM STUDY GUIDE QUIZ 1. i. Binds to receptors on the intracranial blood vessels and causes vasoconstriction, diminishes perivascular inflammation b. Side effects? i. Chest symptoms: heavy arms or chest pressure ii. Teratogenic iii. Vertigo, malaise, fatigue, tingling sensation, bad taste with intranasal form c. Drug/drug interactions? i. Ergot alkaloids, sumatriptan and all other triptans d. What is Treximet? i. Combination of Sumatriptan & Naproxen 3. Ergot Alkaloids a. What is MOA? i. Works by agonist activity at subtypes of serotonin receptors and specifically the 5HT1B and 5HT1D receptors. Suppresses the release of CGRP, to block inflammation associated with the trigeminal vascular system. b. Side effects? i. N/V ii. Overdose: causes ischemia secondary to constriction of the peripheral arteries. Extremities become cold, pale and numb. Muscle pain and then gangrene sets in. iii. Teratogenic c. Drug/drug interactions? i. Drugs that are CYP3A4 inhibitors ii. Triptans iii. SSRIs 4. What are primary treatments for cluster HA? a. Prophylaxis b. Glucocorticoids, verapamil, lithium 5. What are primary treatments for tension HA? a. Acetaminophen, NSAIDs (aspirin, ibuprofen, naproxen), butalbital OPIOIDS 1. What are 3 main classes of opioid receptors? a. Mu receptors b. Kappa receptors c. Delta receptors 2. What are 3 classifications of drugs that act as opioid receptors? a. Agonist b. Partial agonist c. Antagonist NURS 5344 PHARM STUDY GUIDE QUIZ 1. 3. 4. Strong opioid agonist a. Morphine i. What are therapeutic uses? 1. Relieve pain without affecting any other senses, no loss of consciousness ii. Side effects? BB warning? 1. Respiratory depression (BLACK BOX WARNING) 2. Constipation, orthostatic hypotension, urinary retention and hesitancy, N/V, euphoria, sedation, drowsiness, neurotoxic, delirium, agitation, myoclonus, hyperalgesia, renal impairment, pre-existing cognitive impairment. iii. What is tolerance? Cross tolerance? Dependence? 1. Tolerance: increased doses are needed to obtain the same response. 2. Cross tolerance: tolerance to another opioid agonists will develop, but there’s no tolerance to the miosis or constipation. 3. Dependence: abstinence syndrome with abrupt discontinuation, occurs about 10 hours after the last dose. a. Initial: yawning, rhinorrhea, sweating b. Progess: violent sneezing, weakness, n/v/d, bone & muscle pain, muscle spasms and kicking movement. iv. What are the medications available to treat opioid induced constipation (OIC)? 1. Naloxegol, methylnaltrexone, lubiprostone v. What is the reversal drug? Naloxene vi. Drug designed to discourage abuse? Naltrexone b. Others: fentanyl 5. Mod-strong opioid agonist a. Codeine: Class II alone, III with acetaminophen, V as cough suppressant b. Oxycodone c. Hydrocodone d. Tapentadol 6. Opioid agonist antagonist a. Pentazocine b. Nalbuphine c. Butorphanol d. Buprenorphine Prolongs QT 7. Dosing guidelines NURS 5344 PHARM STUDY GUIDE QUIZ 1. b. Cox 2: mediates inflammation and sensitizes receptors to painful stimuli, mediates fever, contributes to perception of pain, promotes vasodilation, contributes to colon cancer. i. Risk for MI and stroke 3. ASA a. Drug interactions? i. Anticoagulants (warfarin and heparin) ii. Glucocorticoids iii. Alcohol iv. Ibuprofen v. ACE inhibitors and ARBs b. Side effects? i. Ulceration and bleeding of GI ii. Reversible impairment of kidneys iii. Edema iv. Toxic levels—tinnitus, sweating, headache, dizziness v. Children <18 years old—Reye syndrome 4. Non ASA first generation NSAIDs –indications RA, OA a. Ibuprofen, Naproxen b. SAFETY ALERT: All first-generation NSAIDs are associated with an increased risk of GI bleeding that can lead to hospitalization or death 5. 2nd Generation NSAIDs-indications RA, OA a. Celecoxib, Meloxican i. What are drug/drug interactions 1. Warfarin (increases anticoagulant effect) 2. ACE inhibitors (decrease antihypertensive effects) 3. Lithium (increase levels) 4. Fluconazole (increases celecoxib levels) Both first and second generation pose the risk for heart disease, renal function, and GI bleed though Cox 2 pose less risk for GI 6. Acetaminophen a. No anti-inflammatory action b. What are side effects? i. Steven Johnson syndrome ii. Acute generalized pustulosis iii. Toxic epidermal necrolysis iv. Hepatic toxicity v. Hepatic necrosis vi. N/V/D, sweating c. Drug/drug? i. Alcohol (increase risk to liver) ii. Warfarin (increase risk of bleeding) d. Vaccines? i. Tylenol can blunt the immune response e. What is treatment for overdose? i. Acetylcysteine or Mucomyst NURS 5344 PHARM STUDY GUIDE QUIZ 1. GLUCOCORTICOIDS 1. What are therapeutic uses? a. Help mature lungs in a fetus b. Suppress immune response in inflammation c. Rheumatoid arthritis, systemic lupus, erythematosus, synovitis, osteoarthritis, gouty arthritis, allergic conditions, asthma, skin diseases (stigmas, psoriasis, mycosis, fungoides, seborrheic dermatitis, contact dermatitis, exfoliative dermatitis), neoplasms, suppression of allograft rejections. 2. What are metabolic effects? a. Protein synthesis is suppressed and fat deposits are mobilized and sodium retention and potassium excretion, inhibits the intestinal absorption of calcium and anti-inflammatory and immunosuppressant effects. 3. What are adverse effects? a. Adrenal insufficiency, osteoporosis, pneumocystis pneumonia, hyperglycemia, glycosuria, proximal myopathies in the proximal muscles of the arms and legs. 4. Drug/drug interactions? a. Diuretics (loss of potassium) b. NSAIDs (risk of GI bleed) c. Insulin and oral hypoglycemics d. Vaccines 5. How should these drugs be tapered? a. Taper the dosage to 50% of the physiologic value, monitor for signs of insufficiency RA 1. Chronic systemic inflammation including the synovial membranes of multiple joints 2. Shortens lifespan and increases risk of CV and stroke 3. Goal of treatment a. Reduce inflammation and pain while preserving function and preventing deformity 4. First line treatment: a. NSAIDs with DMARD 5. DMARDs a. Traditional i. Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, minocycline, Penicillamine, Azathioprine, Cyclosporine 6. Biological response modifiers a. Non-TNF i. Abatacept, rituximab, anakinra, tocilizumab b. Anti-TNF i. Infliximab, adalimumab, etanercept, certolizumab, golimumab 7. Oral JAK inhibitors a. Tofacitinib, Ruxolitinib All of these drugs suppress immune system NURS 5344 PHARM STUDY GUIDE QUIZ 1. COMMONLY USED NSAIDs DMARDS/TRADITIONAL 1. Methotrexate a. Adverse reactions? i. Hepatic fibrosis, bone marrow suppression, GI ulceration, pneumonitis (BLACK BOX) b. Bone Marrow? i. Suppression 2. Sulfasalazine a. GI side effects 3. GOUT 1. Cause a. Excessive production of uric acid b. Impaired renal excretion of uric acid 2. Flare up < 3 times per year