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160 Cards in this Set
- Front
- Back
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Voriconazole
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DOC for aspergillosis and other agressive fungals, it is hepatotoxic like other -azoles, and it also causes visual changes
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Amphotericin B side effects and use
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nephrotoxic, crosses placenta, renal failure, and hypokalemia. It is the alrenative drug for aspergillus, mucormycoses, and fusarioses
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Butenafine
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Used topically and therefore the DOC for all tinea except tinea capitis and since it is topical the side effect of hepatoxicity is decreased
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Grieseofulvin side effects
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hepatotoxic, teratogenic, induces human P450, causes a disulfiram-like reaction, photosensitivity rash when exposed to sunlight
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P. vivax or P. ovale species of malria
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have hypnozoites (latent form) and thus need an anti-malarial plus primaqune
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Treatment if chloroquine sensitive
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chloroquine
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Treatment if chloroquine resistant P. falciparum
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quinine plus one of the following: doxycycline, tetracycline, or clindamycin (if pregnant use clindamycin)
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Side effect of quinine
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cinchonism (tinnitus, photophobia, mental dullness, depression, confusion, headache, and nausea)
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Metronidazole DOC for
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trichomoniasis and amoebiasis, it can cause disulfiram-like reaction, darken urine, and occasionally paresthesias, peripheral neuropathy, or seizures
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Nifurtimox treatment for
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Chagas disease by creating ROS and is thus contraindicated in G6PD deficiency
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Amphotericin B
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only drug effective against Naegleria fowleri which is extremely aggressive and 95% of treated patients die
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Albendazole or mebendazole DOC for
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most roundworm infections and albendazole is also DOC for trichinosis
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Roundworms that albendazole or mebendazole are not first-line treatment
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Anisakis simplex, Dranunculus medinensis, Onchocerca volvulus, and Wuchereria bancrofti
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Interferon clinical use
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Chronic HBV and Chronic HCV
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Acyclovir clinical use
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DOC for HSV-1 and HSV-2, EBV, NOT for CMV that is ganciclovir
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Zanamivir, Oseltamivir
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Influenza A and B, Zanamivir is not recommended in lung disease because it causes bronchospasms
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Tirifluridine use
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HSV resistant to acyclovir and DOC for herpes keratitis
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T1-T3 & T12 rule of 3's
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the transvere process is located on the same horizontal plane as the spinous process of that given vertebrae
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5 parts of typical ribs
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includes ribs 3-10, head, neck, tubercle, shaft, and angle
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The action/motion of ribs
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1-5--pump, 6-10--bucket, 11-12--caliper
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Secondary muscles of respiration
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pectoralis minor, quadratus lumborum, serratus anterior and posterior, scalenes, and latissimus dorsi
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Key ribs
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Inhalation SD--infeiror or lowest rib in group Exhalation SD--superior or first rib in group
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MOA of penicillins and cephalosporins
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inhibt peptide cell wall synthsis
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Type I
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More than 1 segment, S and R opposite, Neutral and S is written first, e.g. T5NSrRl
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What indicates acute SD?
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erythematus, boggy spongy, hot, moist, with hypertonic musles, pain with movement, sharp, intense, severe stabbing, and throbbing
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What is Levodopa?
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stimulates dopamine and is used for Parkinson's and induces P450
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What is not a pharmaceutical and compete for renal transporters?
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Uric acid, if it increases get gout
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Sequence of treatment
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start centrally and then move to periphary unless acute then can start peripherally to gain access to central
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What is an eccentric contraction?
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A muscle contraction that results with that muscle's lengthening due to external force
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What would increase the pharm affect of a drug
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1. It is hydrophilic so it does not bind to albumin and is active. 2. It inhibits P450 3. 2 drugs compete for the same renal transporter so the concentration of the drug increases
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What is the use of Niacin and its side effects?
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AKA vitamin B3, used to treat and prevent pellagra (which is due to a niacin deficiecny) and it causes cutaneous flushing
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Uses of EDTA?
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Antidote for lead poisoning and also as an anticoagulatant in the lab
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DOC for UTI in the preganant pt.?
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Nitrofuration (inhibits bacterial enzyme synthesis0
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MOA of tetracyclines
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They inhibit tRNA binding and therefore inhibit protein synthesis
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One Pharmaceutical Brings About Rapid Liver Metabolism
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inducers of P450, OCP, Phyenytoin, Barbiturates, Alcohol, Rifampin, Levodopa, and Methadone
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Minigitis prophylaxis of close contacts
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Rifampin for H. influenza, Rifampin or cefriaxone or ciprofloxacin for Neisseria meningitis
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Some Pharmeceutical Classes Inhibit Drug Catabolism
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P450 inhibitors: Sulfonamides, Phenylbutazone, Chloramphenicol, Isoniazid, Dicumarol, Cimetidine
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Emperic treatment for viral conjuctivitis (pink eye)
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None or chilled artificial tears
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Emperic treatment for bacterial conjuctivitis (non-gonoccal, non-chlamydia)
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Fluoroquinolones by drops
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DOC for Strep. pyogenes
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Penicillin G or V
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Emperic treatment for osteomylitis
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<4 months old--Naficillin or oxacillin + ceftarvidine or cefepime >4 months old--Naficillin or oxacillin
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Emperic treatment for otitis media
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<2--amoxicillin >2 and no fever or pain--analgesics
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Emperic treatment for otisis externa
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ofloxacin drops or polymyxin + neomycin + hydrocortisone drops or ciproflaxin + hydrocortisone drops
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DOC for Bacillus cereus
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Vancomycin or Clindamycin
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When do you not give antidiarrheals
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If the patient is febrile do not give loperamide and bismuth subsalicylate
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Emperic treatment for minigitis
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Neonate--ampicillin + cefotaxime Child or adult--ceftriaxone or cefotaxime + dexamethasone + vancomycin >50 or alcoholic or decreased immune system--dexamethasone + vancomycin + ampicillin
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Some Pharmaceutical Plus Urate Stop Transporters
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Drugs that compete for renal transporter: Sulfonamides, Probenecid, Penicillin, Urate, Salicylates, Thiazides
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Emperic treatment for any encephalitits
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Acyclovir (if HSV+ continue acyclovir)
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What is the DOC for MRSA?
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Vancomycin (which inhibits cell wall synthesis)
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Serum Proteins Can Spew
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Drugs that are easily displaced from albumin: Sulfonamides, Phenylbutazone, Coumadin, Sulfonylureas
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Opiate overdose symptoms
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MORPHINE: Miosis, Out of it (sedated), Respiratory depression, Pneumonia, Hypotension, Inconsistency (constipation, urinary rentention), Nause, and Emesis
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Neutral, Flexed, or Extended?
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If it gets worse in flexion and better with extension then it is extended
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Type II
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1 segment, flexed or extended, S and R in samd direction and rotation is listed first e.g. T5FRSr
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What is the use for Zidovudine (AZT) and what are its side effects?
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Antiviral for HIV, SE--bone marrow toxic
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What drugs have neural tube defects as a major side effect?
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Carbamazepine, Valproic acid both when taken by mother during pregnancy
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HVLA
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high velocity (very fast) is applied with low amplititude (minimal force) and always during exhalation (relaxation phase)
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What is facilitated postional release?
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Body part is put in neutral in all 3 plans then add an activating force (compression or traction), then move away from barrier and hold for 3-4seconds. For superficial muscles and deep intervetrebral muscles
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What drugs have nephrotoxicity as a major side effect?
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Aminoglycosides, Foscarnet, Cidofovir, NSAIDS, Cyclosporine, and Amphotericin
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What drug class do you NOT combine with aminoglycosides and why not?
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Loops to avoid nephrotoxicity and ototoxicity of aminoglycosides
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Where is the transverse ligament?
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Posterior to the dens; extends between the two C1lateral masses and holds the dens in place to protect the spinal cord
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Where do C1-C7 nerve roots emerge from?
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Above their vertebra and they sit on their own disc
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OA, AA
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OA--flextion and extension
AA--Rotation S and R are opposite for both |
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To evalutes AA what do you do?
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Flex 45 degrees to lock out C1-C7 and check for a rotation restriction
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Borrellia burgdorteri DOC
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doxycycline (or erythromycin)
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Campylobacter jejuni DOC
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1st line--azithromycin (erythromycin)
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Candida spp. DOC
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Skin/vagina--miconazole systemic infection--fluconazole
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Chlamydia trachimontis DOC
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Doxycyline or azithromycin if can't take doxy or <8yrs old
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Corynebacterium diptheriae DOC
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erythromycin
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Gardnerella vaginalis DOC
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metronidazole (alternitive is tinidazole)
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Hemophilus ducreyi DOC
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azithromycin or ceftriaxone
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Side effect of beta-blockers
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fatigue, insomnia, impotence, decreased HDL, increased TGs (non-selectives are contraindicated in COPD and asthma pts)
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MOA of CCBs
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Blocking Ca results in vasodilation of the vasculature leading to decreased cardiac out put and decreased BP
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Target BP for those at risk for CAD
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<130/80
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Target BP for all other pts
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<140/90
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Stage 2 Hypertension
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>160 and/or >100
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First line treatment of HTN
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Thiazide
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Tx if have stage 2 HTN
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2 drugs 1 is a thiazide
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DOC for HTN in a diabetic
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ACE inhibitor is preferred ARBs if can't take an ACE
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Hypertensive Emergenvy
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>210 and/or >150
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Common side effects of ACE inhibitors
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dry couch, angioedema
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ARBs and bradykinin levels
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They do not suppress bradykinin
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Spironolactone
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K+ sparing diurectic
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Ergot alkaloids MOA
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Block 5-HT2 and thus causes vasoconstriction
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Bromocriptine MOA and use
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agonist of dompamine receptors used for Parkinson's and hyperprolactinemia
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Carbonic Anhydrase Inhibitiors side effects
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hypokalemia, renal stone formation, drowsiness, and metabolic acidosis
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Loop diurectics side effects
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hypocalcemia, hypokalemia, hyperuricemia, alkalosis
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Thiazides side effects
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Hypercalcemia
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Spironolactone MOA
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inhibits aldosterone which leads to the inhibition of Na reabsorption
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Antianginal drugs
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nitrates, beta-blockers, CCB
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How nitrates help angina
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they decrease PVR, Preload, and O2 demand
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Aspirin uses
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decreases reourrence of MI, decreases mortality in post-MI pts, and can inhibit clotting in high risk situations
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Low Molecular weight heparin (LMWH)
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inhibits primarliy factor X, needs at least 12 hrs to take affect, no antidote, but do not have to monitor it like with heparin
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Heparin MOA
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Enhances antithrombin III which inhibits factors, 9, 10, 11, and 12
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Warfarin MOA
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blocks vitamin K which decreases factors 2, 7, 9, and 10
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Streptokinase MOA
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activastes plasminogen and catalyzes degradation of firbrinogen and factors 5 and 7
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Classes of antiarrhythmic drugs
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Sodium blockers, Beta blockers, Potassium blockers, and CCB
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Metoprolol use
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Used post MI because number one cause of death post MI is arrhythmia
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Amiodarone
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first line drug for many ventricular and SVTs, potassium channel blocker
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CCBs use
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A-fib
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Glycosides use
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CHF but not with loops or thiazides because they cause hypokalemia
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All iotropic drugs cause
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increased contractibiltiy of the heart by increasing Ca
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Asthma
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bronchoconstriction of bonchial smooth muscle, inflammation of cronchial walls, and increased mucus secretion
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Albuterol
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DOC for all categories of asthma, shor-acting beta2 agonist
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Long acting beta 2 agonists never...
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use as monotherapy!
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Steroids used in status asthmaticus
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IV Methylprednisolone
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What is used in all forms of persistant asthma?
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Corticosteroid
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Ultralente
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long-acting insulin
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What is the first line medication for Type 2 DM?
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Metformin
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Fasting serum glucose for DM
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>126
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Random serum glucose for DM
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> or equal to 200
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HbA1C for DM
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> or equal to 6.5%
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Serum glucose 2hr after 75g oral glucose load
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> or equal to 200
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Sulfonylureas MOA
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inhibit insulin release from beta-islet cells
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Exenatide serious side effect
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increases risk of pancreatitis and even fatal pancreatitis
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Familial hypercholesterolemia type IIB
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40% of all inherited hyperlidemias, it is due to a mutant B100 which leads to increased LDL and VLDL, it is very athrogenic
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Familial hypertriglycerdemia Type IV
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the most common of all inherited hyperlidemias, due to overproduction of VLDL and also glucose intolerance and hyperinsulinemia, low HDL
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Indications for estrogens
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contraception, HRT, replacement therapy in deficient individuals
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MOA of LSD
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seritonin agonist
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Phencyclidine (PCP) MOA
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inhibits the reuptake of dopamine, serotonin, and NE
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Affects of stimulating Mu receptors
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repiratory depression, euphoria/sedation, physical dependence, decreased GI motility, pupil constriction, ANALGESIA (strong effect here)
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Naloxone use
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opiod overdose, IV works in 30 seconds
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TCAs MOA
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block the reuptake of NE and serotonin
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MOA OF MAOIs
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they bock MOA which normally prevents NT from getting into the synaptic cleft thus they increase Ne and serotonin
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Patients on MAOI must avoid what in their diet and why?
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Tyramine because it can cause a hypertensive crisis
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Bupropion
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antidepressant that blocks the reuptake of NE and DOPAMINE (this more than the NE), can be used as monotherapy, and does not cause weight gain and sexual dysfunction like other antidepressants
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DOC for bipolar disorder
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Lithium
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Carbamazepine ADRs
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Stevens-Johnson syndrome, bone morrow suppression (which can be severe and lead to agranulocytosis)
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What are the birth defects caused by Valproi acid, Carbamazepine, and Lithium
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Spina bifida, anencephalus, and rachischisis for V and C and for lithium its Ebstein's anomaly of the heart
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MOA of CNS stimulants
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block phosphodiestrase and adenosine which leads to increased cAMP which leads to increased Ca release
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What is the only anesthetic to cause vasoconstriction?
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Cocaine
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MOA of Amphetamines
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block MOA and releases intracellular stores of catecholamines especially dopamine
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Hypertriglyceridemia definition
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TG >150mg/dL
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MOA of Niacin
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decreases hepatic uptake of released free fatty acids
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What is the go to drug for hyperlipidemia?
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statins
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MOA of statins
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inhibits HMG-CoA reductase
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DOC for status epilepticus
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Diazepam
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Phenobarbital use
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long term seizure control, status epilepticus, and eclampsia. Also DOC for recurrent febrile seizures in kids
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Diphenhydramine
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an H1 blocker used for allergy and motion sickness
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What is different about second generation antihistamines?
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they cross the BBB less so they are non-sedating
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Four major types of anesthia
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General, Regional, Local, Monitored Anethseia Care (M.A.C.)
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What indicates high potency of inhaled anestheic agents?
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Low MAC and high lipid solubility
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Nitrous oxide
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inhaled anestheic that is the least hepatotoxic and has the least cardiovascular effects
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Three types of regional anesthesia
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spinal, epidural, nerve block
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MOA of all local anesthetic agents
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work to block sodium channels on the cell membranes of small, unmyelinated nerve fibers
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Drug classes for Parkinson's Disease
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Anticholinergics, COMT inhibitors, Dopaminergic agents, and MAOIs
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Pramipexole MOA
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dopamine receptor agonist, binds to D2 and D3 (prefers this one), also used for restless leg syndrome
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Can you take the antipsychotics phenothiazine and haloperidol if you have parkinson's?
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No because they block DA receptors, they are contraindicated
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MOA of all neuroleptics
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block DA receptors, D1-5, especially D2
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Thioridazine use
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contraindicated as first line therapy, can cause prolonged QT, torsades, and sudden death
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DOC for neuroleptic malignant syndrome
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Dantrolene, it is marked by muscle regidity, high fever, and autonomic instability
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Antipsychotics block what receptors?
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DA, cholinergic, alpha-adrenergic, and H1
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Carbamazepine
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DOC for either type of partial focal seizures
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DOC for absence seizures
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Ethosuximide
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Tiagabine use
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only as adjunctive with other anti-seizure meds
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Dronabinol use
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derivative of THC, used to alleviate nausea associated with chemotherapy
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Meclinizine use
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vertigo, via blocking H1 receptors
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MOA of stool softeners
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attract water in the lumen which softens the stool and distends the intestine which increases peristalsis
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DOC for osteoporosis
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Bisphophantes
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What can you not combine with Bisphosphonates and why?
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Calcium or calcium containing foods because they will bind to the Ca in the gut and pass out with the stool
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What pts are contraindicated for bisphosphate use?
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those with poor renal function, history of esphogeal or gastric disorders, inability to be upright for at least 30 minutes, those with inflammatory problems of the jaw or gums
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