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201 Cards in this Set
- Front
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What is the first line treatment for essential HTN in general population?
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diuretics
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First line tx for CHF?
what is contraindicated in decompensated CHF? |
ACE inhibitors/ARBs
beta blockers |
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antihypertensive therapy for diabetic pts? why?
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ACE inhibitors b/c they are protective against diabetic nephropathy
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first line tx for isolated systolic HTN in general population?
how about in diabetics? |
general population: thiazide or dihydropydridine (Amlodipine, Nifedipine)
diabetics: ARBs/ ACE inhibitors |
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first line tx for HTN in pregnancy?
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Hydralazine with methyldopa
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Hydralazine
MOA? toxicity? |
cGMP increases --> smooth muscle relaxation
vasodilates arteries > veins compensatory tachycardia (contraindicated in angina/CAD), headache, lupus-like syndrome |
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List 2 classes of Ca channel blockers.
How are their actions different? |
dihydropyridine (Amlodipine, Nifedipine); more action on smooth muscle (arteriole > veins)
non-dihydropyridine (verapamil, diltiazem): more action on heart, better for arrhthmias |
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which calcium channel blocker is most specific to heart tissues?
toxicity? |
verapamil (non-dihydropyridine)
AV block |
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Nitroglycerin, isosorbide dinitrate
MOA? toxicity? |
dilate VEINS >> arteries -> decrease preload by releasing NO to smooth muscle
reflex tachycardia, hypotension, headache |
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What is Monday disease?
what substance is it associated with? |
nitrate exposed in industrial environemnt
development of tolerance for vasodilatng action during the work week and loss of tolerance over the weekend, resulting in tachycardia, dizziness, and headache on reexposure |
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list 3 drug used in malignant hypertension and their MOA
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Nitroprusside: increase cGMP via direct release of NO
Fenoldopam: D1 agonist; relaxes renal vascular smooth muscle Diazoxide: K+ channel opener |
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Nitroprusside
indication toxicity |
malignant htn
can cause cyanide toxicity |
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diazoxide
indication toxicity |
malignant HTN
can cause hyperglycemia (reduces insulin release) |
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list 2 beta antagonists contraindicated for angina. why?
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pindolol and acebutolol
partial beta agonists |
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HMG-CoA reductase inhibitors
side effects (4) |
hepaptotoxicity (increase LFTs)
rhabdomyolysis myopathy teratogenic |
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Niacin
MOA toxicities |
MOA:
inhibits lipolysis in adipose tissue reduces hepatic VLDL secretion into circulation toxicities: red, flushed face, which is decreased by aspirin or long-term use Hyperglycemia (acanthosis nigricans) Hyperuricemia (exacerbate gout) hepatitis |
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2 lipid lowering agents that can form cholesterol gallstones.
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bile acid resins (cholestyramine, colestipol, colesevelam)
fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate) |
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fibrates
MOA toxicities |
upregulate LPL -> increase TG clearance
myositis, hepatotoxicity, cholesterol gallstones |
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Digoxin
MOA clinical use |
direct inhibition of Na/K pump -> inhibition of Ca/Na exchange -> increased intracellular Ca -> positive ionotropy
also stimulates VAGUS nerve used in CHF and atrial fib |
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How do you treat Atrial Flutter?
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Class IA, IC, or III antiarrhythmics
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Digoxin
toxicities |
cholinergic: nausea, vomiting, diarrhea, blurry yellow vision (think Van Gogh)
arrhthymia, hyperkalemia |
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Digoxin
antidote |
slowly normalize K+, lidocaine, cardiac pacer, anti-dig Fab framgments, Mg+
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General MOA of class I Antiarrhytmics?
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Na channel blockers
slow or block conduction decrease slope of phase 0 depolarization increase threshold for firing in abnormal pacemaker cells are state dependent (selectively depress tissue that is frequently depolarzied, e.g. fast tachycardia) |
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list 3 Class IA antiarrhtymics
MOA? |
"the Queen Proclaims Diso's pyramid"
Quinidine, Procainamide, Disopyramide increase AP duration, increased effective refractory period, increase QT interval |
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Quinidine
what class antiarrhythmics? toxicities? |
class IA
Cinchonism: headache, tinnitus, thrombocytopenia torsades de pointes due to increased QT interval |
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procainamide
what class antiarrhytmics? toxicity? |
class IA
reversible SLE-like syndrome and torsade de pointe |
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Indication for class IA antiarrhythmics.
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Quinidine, procainamide, Disopyramide
indicated for atrial and ventricular arrhythmias, esp reentrant and ectopic supraventricular and ventricular tachycardia |
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Class IB antiarrhythmics
List 3. indication? |
"I'd Buy Lidy's Mexican Tacos"
Lidocaine, Mexiletine, Tocainide useful in acute ventricular arrhythmias (esp post-MI) and in digitalis-induced arrhythmias |
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Class IC antiarrhythmics
List 3. Indications? |
"Chipotle's Food has Excellent Produce"
Flecainide, Encainide, Propafenone Useful for V-tachs that progress to VF and in intractable SVT. Usually used only as last resort in refractory tachyarrhthmias. For pts w/o structural abnormalities |
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Class IC antiarrhythmics
contraindications? toxicities? |
contraindicated in post-MI
proarrhythmic significantly prolongs refractory period in AV node |
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List class II antiarrhythmics. (5)
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beta blockers
Propranolol timolol Esmolol metoprolol atenolol |
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What is a short acting class II antiarrhythmic?
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esmolol
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Class II antiarrhythmics
MOA |
beta blockers
decrease cAMP, Ca current suppress abnormal pacemakers by decreasing slope of phase 4. |
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Clinical use for class II antiarrythmics?
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V-tach, SVT, slowing ventricular rate during a-fib and a flutter
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What metabolic toxicity do class II antiarrhythmics have?
tx? |
may mask the signs of hypoglycemia (beta 1: adrenergic signs; beta 2: metabolic changes)
Metoprolol can cause dyslipidemia tx overdose with glucagon |
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List 5 Class III antiarrhythmics
MOA? |
K+ channel blockers:
Sotalol, ibutilide, bretylium, dofetilide, amiodarone increase AP duration, ERP, QT interval (like Ia). used when other antiarrhythmics fail |
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Sotalol, ibutilide
class? toxicities? |
class III antiarrhythmic
both: torsades de pointes Sotalol: excessive beta block |
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amiodarone
class? toxicities? |
Class III antiarrhythmic
pumonary fibrosis, hepatotoxicity, hypothyroidism/hyperthyroidism Remember to check PFTs, LFTs, TFTs when using amiodarone |
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What Ca channel blocker is used in isolated systolic HTN?
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amlodipine
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list 2 class IV antiarrhythmics.
target tissue? MOA? |
Verapamil, diltiazem
primarily affect AV nodal cells. Decrease conduction velocity, increase ERP, PR interval |
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Drug of choice in diagnosing/abolishing supraventricular tachycardia?
how do you block this drug? |
Adenosine
very short acting effects blocked by theophylline |
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What ion is used to stop torsades pointes and digoxin toxicity?
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Mg++
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What drugs are K+-channel openers (for cardio)
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Minoxidil (for severe HTN) and diazoxide (for malignant HTN)
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What is a side effect of diazoxide that is clinically significant
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hyperglycemia (reduces insulin release by opening the K+ channels)
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What are nitroglycerin, isosorbide dinitrate used for
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angina, pulmonary edema
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What is the main effects of these drugs:
statins Niacin Fibrates |
Statins: decrease LDL
Niacin: increase HDL Fibrates: decrease triglycerides |
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What lipid-lowering agent causes decrease absorption of fat-soluble vitamins
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bile acid resins (cholestyramine)
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What drug increases digoxin toxicity
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quinidine
displaces digoxin from tissue-binding sites |
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What drug has a reversible SLE-like syndrome
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"HIPP"
Hydralazine has a lupus-like syndrome INH Procainamide (Class IA antiarrhythmic) Phenytoin |
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What class of antiarrhythmics are useful in digitalis-induced arrhythmias
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Class IB
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What is a toxicity of all Class 1 antiarrthythmic drugs
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hyperkalemia
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drugs used to prevent nodal arrhythmias
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Ca channel blockers
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What is the drug of choice in stopping/diagnosing SVT
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Adenosine
(effects blocked by theophylline) |
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How does K+ act as an antiarrhythmic
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depresses ectopic pacemakers in hypokalemia (like in digoxin toxicity)
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List 5 classes of drugs used in glaucoma
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1. alpha agonists (epi and brimonidine)
2. beta blockers 3. Acetazolamide 4. Cholinomimetics 5. Prostaglandin: Latanoprost |
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Brimonidine
MOA? Indication? |
alpha2 agonist
decrease aqueous humor synthesis |
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what drug is indicated in Emergency glaucoma?
MOA? |
Pilocarpine (direct cholinomimetic)
contract ciliary muscle and open trabecular meshwork |
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Methadone
MOA? Indication? why? |
agonist at opioid mu receptor and opens K+ channels and close Cl- channels -> decrease synaptic tranmission
indicated for maintenance programs for addicts b/c it has a long half-life, which suppresses the withdrawal sxs and reduces risks of addiction |
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Morphine
toxicity? what sxs do not develop tolerance? |
addiction, respiratory depression, additive CNS depression wither other drugs, miosis, constipation
Miosis and constipation do not develop tolerance |
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Tramadol
class/MOA? toxicity? |
very weak opioid agonist; SNRI
decreases seizure threshold |
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Phenytoin
MOA? indication? toxicity? |
increases Na channel inactivation
indicated for seizures; first line for tonic-clonic and status epilepticus prophylaxis Gingival hyperplasia, megaloblastic anemia, fetal hydantoin syndorme, SLE-like syndrome, induction of cytochrome P450 |
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1st line tx for status elipticus prophylaxis
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phenytoin
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1st line tx for acute sxs of status epilepticus
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Diazepam and lorazepam
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1st line tx for absence seizure
MOA? |
Ethosuximide
blocks thalamic T type Ca channels |
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1st line tx for tonic-clonic generalized seizure (3)
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Phenytoin
Valproic acid Carbamazepine |
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First line tx for trigeminal neuralgia.
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carbamazepine
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first line tx for seizures in pregnant women and children
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phenobarbital
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first line tx to prevent seizures of eclampsia
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MgSO4
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Carbamazepine
class/MOA? toxicity? |
anti-seizure medication; increases inactivation of Na channels
agranulocytosis, aplastic anemia, teratogenesis, induction of P450, SIADH, Stevens-Johnson syndrome |
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List anti-seizure medications associated with Stevens-Johnson syndrome.
What is Stevens-Johnson syndrome? |
Carbamazepine, Ethosuximide, lamotrigine
SJ syndrome: allergic rxn to the drugs; prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal necrosis and sloughing |
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Valproic acid
toxicity? |
rare but fetal hepatotoxicity, spina bifida in fetus (by inhibiting intestinal absorption of folate)
contraindicated in pregnancy |
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Barbiturates
MOA? toxicity? contraindication? |
facilitate GABAa axn by increasing the DURATION of Cl- channel opening, thus decreasing the neuron firing
additive CNS depression with EtOH, respiratory or CV depression, P450 induction contraindicated in porphyria |
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Benzodiazepines
MOA? Advantage over barbiturates? |
facilitate GABAa axn by increasing frequency of Cl channel opening. Decreased REM sleep
less risk of respiratory depression and coma than with barbiturates |
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what drug is used for detoxification, esp EtOH withdrawal?
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long acting benzo: diazepam and chlordiazepoxide
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list 3 short-acting benzodiazepines.
side effect? |
TOM Thumb
Tirazolam Oxazepam Midazolam highly addictive |
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how do you tx overdose of benzodiazepine?
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flumazenil: competitive antagonist at GABA receptor
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N2O as inhaled anesthetic
induction rate? potency? toxicity? |
low blood solubility -> fast induction
low lipid solublity -> low potency expansion of trapped gas |
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Halothane as inhaled anesthetic
induction rate? potency? toxicity? |
high blood solubility -> slow induction
high lipid solubility -> high potency hepatotoxicity |
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how is potency measures?
how does AV concentration gradient related to onset of action? |
potency = 1/ MAC
MAC: minimum alveolar conc at which 50% of population of anesthesized high AV conc gradient = high solubility = more gas required to saturate tissue = SLOWER onset of action |
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Thiopental
class? indication? why? |
barbiturate
used for induction of anesthesia b/c it has high potency, high lipid solubility, rapid entry into brain |
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what is the most common anesthetic used for endoscopy?
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Midazolam (benzodiazepine)
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What anesthetic acts as dissociative anesthetics and causes disorientation, hallucination and bad dreams?
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Ketamine (arycyclohexylamines)
A PCP analog; blocks NMDA receptors, CV stimulant |
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Propofol
MOA? indication? |
potentiate GABAa
for rapid anesthesia induction and short procedures |
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List 2 classes of local anesthetics.
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Esters: procaine, cocaine, tetracaine
Amides (2 I's in the name): Lidocaine, mepivacaine, bupivavaine |
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tx for anorexia/bulimia
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SSRIs
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In what situation do you need to apply more local anesthetics to achieve the same result?
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in infected (acidic) wound b/c alkaline anesthetics are charged and cannot penetrate membrane effectively
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What drug intoxication is associated with pinpoint pupils? (1)
What drug intoxication is associated with dilated pupils? (4) |
pinpoint pupils (constricted): opioids
dilated pupils: amphetamines, cocaine, LSD, Opioid withdrawal |
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What drug is co-administered to increase the effect of local anesthetics?
exception? |
epinephrine to enhance local vasoconstriction
except for cocaine |
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List sxs of opioid intoxication.
tx? |
CNS depression, nausea, and vomiting, constipation, pupil constriction, seizures (life-threatening)
tx: naloxone, naltrexone |
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Which sensation is blocked first with local anesthetics? last?
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Pain (first) > temperature > touch > pressure (last)
small-diameter, and myelinated fibers are affected first. Size predominates over myelination |
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List sxs of alcohol withdrawal.
tx? |
tremor, tachycardia, HTN, malaise, nausea, seizures, delirum tremens, tremulousness, agitation, hallucinations (including tactile)
tx: chlordiazepoxide, diazepam |
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succinycholine
class/MOA? indications? toxicity? |
depolarizng neuromuscular (nicotinic) blocker
indicated for muscle paralysis in surgery or mechanical ventilation complications: hypercalcemia and hyperkalemia irreversible during depolarizing phase |
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List sxs of PCP intoxication.
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BELLIGERENCE, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycadia, ataxia, homicidality, psychosis, delirium
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Tubocurarine, pancuronium
class/MOA? indication? reversal of action? |
nondepolarzing neuromuscular blocker (nicotinic receptor)
indicated for muscle paralysis in surgery or mechanical ventilation reversal by cholinesterase inhibitors (neostigmine, edrophonium) |
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List sxs of LSD intoxication
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marked anxiety or depression, delusions, visual hallucinations, FLASHBACKS, pupillary dilation
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Malignant hyperthermia
cause? tx? |
caused by inhalation of anesthetics (except N2O) and succinycholine
treat with dantrolene |
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What are 2 most immediate sxs of smoking marijuana?
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conjunctival injection (red eye), tachycardia
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List drugs used in Parkinson's. (5)
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BALSA
1. Bromocriptine: agonize DA receptors 2. Amatadine: increase DA 3. Levodopa (with carbidopa): act as DA 4. Selegiline: MAO B inhibitor; prevent breakdown of DA 5. Antimuscarinic (Benztropine): curb excess cholinergic activity |
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Suboxone
indication? MOA? advantage over the alternative? |
for tx of heroin addiction
naloxone + buprenorphine (partial agonist); long acting with fewer withdrawal sxs than methadone. Naloxone is not active when taken orally, so withdrwal sxs can occur only if injected (lower abuse potential) |
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List 2 phenomenon observed with long-term Parkinson's therapy.
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On-off phenomenon
wearing off phenomenon |
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Delirum tremens (DT)
what is it? sxs? tx? |
life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink.
sxs in order of appearance: autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic sxs (hallucinations, delusions), confusion tx: benzodiazepines |
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Benztropine
MOA indication |
muscarinic antagonist
Used in Parkinson's: improves tremor and rigidity but has little effect on bradykinesia |
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Antipsychotics
List high potent neuroleptics. List low potent neuroleptics |
typical antipsychotics; haloperidol + -azines
high potent (neurologic side effects): haloperidol, trifluoperazine, fluphenazine low potent (non-neurologic side effects): thioridazine, chlorpromazine |
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What is co-administered with L-dopa? why?
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carbidopa to prevent peripheral conversion of L-dopa to DA, which can cause arrhythmia and decreased the bioavailability in the brain
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toxicities of antipsychotics (6)
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1. lipid soluble -> stored in fat -> slow metabolism
2. EPS side effects 3. hyperprolactinemia -> galactorrhea 4. block muscarinic (dry mouth, constipation) 5. block alpha (hypotension) 6. block histamine (sedation) |
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Selegiline
MOA? indication? |
MAO-B inhibitor (MAO-B selective degrades DA over NE and 5HT)
adjunctive to L-dopa in tx of Parkinson's |
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special toxicity of Chlorpromazine and thioridazine
their class? common side effects? |
both are short-acting typical antipsychotics
greater anti-cholinergic (dry mouth, constipation), anti-histamine (sedation), and anti-alpha (hypotension) but NO NEUROLOGICAL SIDE EFFECTS (e.g. EPS sxs) Chlorpromazine: Corneal deposits Thioridazine: reTinal deposits |
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Tx strategy for Huntington's
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Huntington's is characterized by increased DA and decreased GABA + Ach
Reserpine + tetrabenazine: amine depleting (decrease DA) Haloperidol: DA receptor antagonist |
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Evolution of EPS side effects with antipsychotics.
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4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day akinesia (parksonian sxs) 4 wk akathisia (restlessness) 4 mo tardive dyskinesia (steretypic oral-facial mvmt); irreversible |
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Sumatriptan
MOA? indication? toxicity? |
5-HT1b/1d agonist
causes vasoconstriction, inhibition of CN V activation and vasoactive peptide release used in acute migraine and cluster headache toxicity: coronary vasospasm and mild tingling |
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Neuroleptic malignant syndrome (NMS)
cause? sxs? tx? |
caused by antipsychotics
sxs: think FEVER Fever Encephalopathy Vitals unstable (autonomic instability) Elevated enzymes Rigidity for muscles (myoglobinuria) tx: dantrolene, DA agonists (e.g. bromocriptine) |
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memantine
MOA? indication? |
NMDA receptor antagonist; helps prevent excitotoxicity
used in Alzheimer's drugs |
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List atypical antipsychotics.
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it's atypical for Old CLOsets to QUIETly RISPER from A to Z
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone |
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Olazapine
class/MOA? indication? adverse effect? |
atypical antipsychotics
blocks 5HT2, alpha, H1, and DA receptors used for schizophrenia (+ and - sxs), OCD weight gain |
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Clozapine
class? toxicity? |
atypical antipsychotic
weight gain agranulocytosis (requires weekly WBC monitoring) |
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Lithium
indication? |
mood stabilizer for bipolar disorder, also SIADH
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Lithium toxicity
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LMNOP
Lithium side effects: Movement (tremor) Nephrogenic DI hypOthyroidism Pregnancy problems: Ebstein anomaly |
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List drugs that increase serum Lithium level and increase proximal tubular Na absorption.
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NSAIDs, thiazide, ACE inhibitors
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Buspirone
MOA? indication? advantage over alternatives? |
5HT1a agonist
used in generalized anxiety disorder. Minimal hypnotic effects, addiction, or tolerance. Does not interact with alcohol (vs barbiturates, Benzodiazepine) |
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imiprimine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
class? indication? |
TCA
major depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia |
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List 3 major toxicities of TCA.
how do you treat one of the toxicities? |
tri-C's
Convulsion, Coma, Cardiotoxicity NaHCO3 for CV toxicity |
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what TCA is preferred in the elderly? why?
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Nortriptyline (secondary TCA)
less anticholinergic effect -> decrease in confusion and hallucinations (anticholinergic side effects) |
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Fluxetine, paroxetine, sertraline, citalopram
class? indications? |
SSRIs
depression, OCD, bulimia, social phobia |
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List main toxicities of SSRIs.
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GI distress, sexual dysfxn (anorgasmia), serotonin syndrome
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What is serotonin syndrome? what drugs are associated?
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associated with any drug that increase 5HT: SSRIs, SNRIs, MAO inhibitors
sxs: hyperthermia, muscle rigidity, CV collapse, flushing diarrhea, seizures. |
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tx for serotonin syndrome?
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cyproheptadine (5HT2 receptor antagonists)
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Venlafaxine, duloxetine
class? indications? |
SNRIs
depression Venlafaxine: also used for generalized anxiety disorder duloxetine: also used for DM peripheral neuropathy |
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Phenelzine, tranylcypromine, isocarboxazid
class? indications? |
nonselective MAO inhibitors: increase amine NTs (NE, 5HT, DA)
atypical depression, anxiety, hypochodriasis |
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Selegiline
class? indication? |
selective MAO-B inhibitor
used in Parkinson's disease in conjunction to L-dopa |
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Phenelzine, tranylcypromine, isocarboxazid
toxicity? |
hypertensive crisis with tyramine ingestion (in foods such as wine and cheese) and beta agonists.
CNS stimulation can cause serotonin syndrome with SSRIs or meperidine |
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hypertensive crisis
causative drug? |
MAO inhibitors with tyramine or Beta agonists
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What 2 drugs are contraindicated with MAO inhibitor administration. why?
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SSRI and meperidine
can cause serotonin syndrome |
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what drug is indicated in pts with depression that do not want sexual dysfunction?
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Bupropion (Wellbutrin)
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Mirtazapine
MOA? indication? |
alpha2 antagonist (relealse NE and 5HT), 5HT2 and 5HT3 antagonists.
for depression with insomnia |
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Trazodone
MOA? indication? toxicity? |
inhibits 5HT reuptake
used for insomnia, as high doses are needed for antidepressant effects. TrazoBONE; causes priapism |
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List tx options for following psychiatric conditions.
Alcohol withdrawal |
long acting benzodiazepine: Diazepam, Chlordiazepoxide
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List tx options for following psychiatric conditions.
anorexia/bulimia |
SSRIs
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List tx options for following psychiatric conditions.
Anxiety |
Benzodiazepines
Buspirone SSRIs |
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List tx options for following psychiatric conditions.
ADHD |
Methylphenidate (ritaline)
Amphetamines (dexedrine) |
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List tx options for following psychiatric conditions.
Atypical depression |
MAO inhibitors
SSRIs |
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List tx options for following psychiatric conditions.
Bipolar disorder |
"mood stabilizers": Lithium, Valproic acid, Carbamazepine
Atypical antipsychotics |
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List tx options for following psychiatric conditions.
Depression |
SSRIs
SNRIs TCAs |
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List tx options for following psychiatric conditions.
Depression with insomnia |
Mirtazapine
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List tx options for following psychiatric conditions.
Obsessive-compulsive disorder |
SSRIs
Clomipramine |
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List tx options for following psychiatric conditions.
Panic disorder |
SSRIs
TCAs Benzodiazepines |
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List tx options for following psychiatric conditions.
PTSD |
SSRIs
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List tx options for following psychiatric conditions.
Schizophrenia |
Antipsychotics
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List tx options for following psychiatric conditions.
Tourette's syndrome |
Antipsychotics (haloperidol)
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List tx options for following psychiatric conditions.
Social phobias |
SSRIs
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List beta lactams.
MOA? |
Penicillin
Methicillin Ampicillin Ticarcilln, pipercillin Cephalosporins Aztreonam Imipenem blocks peptidoglycan cross-linking |
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List 30S inhibitors
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AT
Aminoglcosides: Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin ("GNATS") Tetracycline (all the"-cyclines") |
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List 50S inhibitors.
What is the common feature? |
Macrolides: Erythromycin, azithromycin, clarithrymycin
Chloramphenicol Clindamycin all are bacteriostatic |
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What antibiotic blocks DNA topoisomerases?
blocks mRNA synthesis? |
Flouroquinolones: blocks topoisomerase II
Rifampin: blocks mRNA synthesis |
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Methicillin, nafcilin
spectrum? toxicity? |
a beta lactamase resistant
Staph aureus except MRSA toxicity: interstitial nephritis |
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Ampicillin
adjunctive therapy? indication? |
combine with clavulanic acid (penicillinase inhibitor) to enhance spectrum
Gram positives + gram negative rods (HELPS) Haemophilus influezae E coli Listeria Proteus Salmonella Enterococci |
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list 3 antipseudomonals
adjunctive therapy? |
Take Care of Pseudomonas
Ticarcillin Carbenicillin Piperacillin adjunct with clavulanic acid (penicillinase inhibitor) |
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1st generation cephalosporin
2 prototypes? specturm? |
Cefazolin, cephalexin
gram+ and "PEcK" Proteus E coli Klebsiella |
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2nd generation cephalosporin
3 prototypes? spectrum? |
cefoxitin, cefaclor, cefuroxime
gram + and "HEN PEcKS" Haemophilus Enterobacter aerogenes Neisseria spp. Proteus E coli Klebsiella Serratia marcescens |
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3rd generation cephalosporin
3 prototypes? spectrum? |
ceftriaxone, cefotaxime, ceftazidime
serious gram-negative infections resistant to other beta-lactams; meningitis (most penetrate BBB) |
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Aztreonam
spectrum? indication? |
gram negative rods: Klebsiella, Pseudomonas, Serratia
NO activity against gram positives or anaerobes for penicillin-allergic pts and those with renal insufficiency who cannot tolerate aminoglycosides |
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Imipenem
MOA? adjunctive therapy? |
B-lactamse resistant carbapenem
always administered with cilastatin (inhibitor of renal dihydropeptidase I) to decrease inactivation in renal tubules |
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Imipenem
indication? side effects? better alternative? |
drug of choice for Enterobacter
causes seizures, GI stress, skin rash Meropenum has a reduced risk of seizures and is stable for dihydropeptidase I |
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Vancomycin
MOA? toxicity? resistance? |
blocks D-ala D-ala cell wall mucopeptide formation
NOT Nephrotoxicity Ototoxicity Thrombophlebitis diffusing flushing (red man syndrome; due to non-specific mast cell degranulation; NOT IgE-mediated) resistance develops when mucopeptide changes to D-ala D-lac |
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Aminoglycosides
requirement? indication? toxicity? |
require O2 uptake (ineffective against anaerobes)
severe gram negative rod infections NOT Nephrotoxicity Ototoxicity Teratogen (CN VIII toxicity) |
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Tetracycline
special direction for administration? toxicity? |
must NOT take with milk, antacids, or Fe-containing preps b/c divalent cations inhibit its absorption in the gut
discoloration of teeth and inhibition of bone growth in children photosensitivity contraindicated in pregnancy |
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Doxycycline
class? indicaiton? |
a tetracycline (30s inhibitor)
fecally eliminated so indicated for pts with renal failure |
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Erythromycin
MOA? toxicity? |
blocking translocation by binding to 23S rRNA of the 50S ribosomal subunit.
prolonged QT interval |
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Chloramphenicol
indication? toxicities? |
menigitis (H. influenzae, Neisseria m. strep pneumoniae)
Anemia, aplastic anemia Gray baby syndrome (in premature infants b/c lack live UDP-glucoronyl transferase) |
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Clindamycin
indication? toxicity? |
treat anaerobic infections
pseudomembranous colitis (C. difficile overgorwth) |
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Sulfamethoxazole
MOA? toxicity? |
PABA antimetabolites inhibit dihydropterate synthase --> decreased THF
hemolysis in G6PD deficient kernicterus in infants displace other drugs from albumin |
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Trimethoprim
MOA? toxicity? |
inhibit bacterial dihydrofolate reductase
megaloblastic anemia, leukopenia, granulocytopenia |
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Ciprofloxacin
class and MOA? toxicity? |
a flouroquinolone
inhibit DNA gyrase (topoisomerase II) damage cartilage (contraindicated in pregnant women and children) tendonitis and tendon rupture in adults |
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Metronidazole
MOA? indication? toxicity? |
toxic metabolites in bacterial cell that damage DNA
GET CAP on the Metro Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobes (bacteroides, Clostridium) H. Pylori disulfiram-like rxn with alcohol; headache, metallic taste |
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polymyxins
MOA? clinical use? |
disrupts cell membrnae
for resistant gram-negative infections |
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List 5 anti-TB drugs and their toxicity.
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INH-SPiRE
INH (Isoniazid) Streptomycin Pyrazinamide Rifampin Ethambutol: red-green color blindness all others cause hepatotoxicity |
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prophylactic tx for M. tuberculosis
prophylactic tx for M avium-intracellulare? |
MTb: Isoniazid
M. Avium-intracellulare: Azithromycin |
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INH (Isoniazid)
MOA? toxicity? metabolism? |
decreased synthesis of mycolic acid
neurotoxicity (prevent with vit B6) and hepatotoxicty Bimodal distribution of metabolism due to different INH half-lives in fast vs slow acetylators |
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Rifampin
MOA? Toxicity? |
4 R's
RNA polymerase inhibitor Revs up microsomal p450 Red/orange body fluids Rapid resistance if used alone |
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prophylactic tx for menigococcal infection?
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Rifampin
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Prophylactic tx for Pneumocystis jiroveci pneumonia?
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TMP-SMX
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Treament for MRSA?
Treament for VRE? |
MRSA: vancomycin
VRE: linezolid and streptogramins |
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Amphotericin B
MOA? toxicity? |
binds ergosterol --> pore formation
Nephrotoxicity (reduced with hydration) arrhythmias due to hypokalemia and hypomagnesia |
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Nystatin
MOA? clinical use? |
binds to ergosterol
for oral candidiasis (thrush) topical for diaper rash or vaginal candidiasis |
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Azoles
MOA? toxicity? |
inhibit fungal ergosterol synthesis
hormone synthesis inhibition (gynecomastia), liver dysfxn |
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what drug is used to tx cryptococcal meningitis in AIDS pts?
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Fluconazole
can cross BBB |
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Caspofungin
MOA? clinical use? |
inhibit beta-glucan --> inhibit cell wall synthesis of fungus
invasive aspergillosis |
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Terbinafine
MOA? clinical use? |
inhibit fungal enzyme squalene epoxidase
used to tx dermatophytoses (especially onychomycosis) |
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Amantadine
MOA? clincal use? |
blocks viral penetration/uncoating (M2 protein)
also causes the release of DA from intact nerve terminals prophylactic tx for influenza A Parkinson's disease |
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Amantadine vs Rimantidine
compare |
both block viral uncoating (M2 protein)
Rimantidine does not cross BBB, so fewer CNS side effects Amantadine causes cerebellar problems (ataxia, dizziness, slurred speech) |
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what 2 drugs inhibit influenza neuraminidase?
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Zanamivir, oseltamivir
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Acyclovir
clinical use? MOA? Requirement? |
for HSV, VZV, EBV
monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog --> inhibit viral DNA polymerase |
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Ganciclovir
clinical use? MOA? Requirement? |
for CMV, esp. immunocompromised pts
Guianosine analog --> inhibit viral DNA polymerase activated by CMV kinase or HSV/VZV thymidine kinase |
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Which one is more toxic: Acyclovir or Ganciclovir?
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Ganciclovir (leukopenia, neutropenia, thrombocytopenia,and renal toxicity)
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Foscarnet
MOA? Clinical use? |
viral DNA polymerase inhibitor; does not require activation by viral kinase
CMV retinitis in immunocompromised pts when ganciclovir fails in acyclovir-resistant HSV |
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Protease inhibitor
common postfix? toxicity? |
all end in -navir; e.g. Squinavir, indinavir
hyperglycemia, lipodystrophy (sunken cheeks and buffalo humps) thrombocytopenia (indinavir) |
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Enfuvirtide
MOA? |
fusion inhibitor by binding to viral gp41 subunit
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Zidovudine
MOA? toxicity? |
nucleosides reverse transcriptase inhibitors
lactic acidosis megalobalstic anemia |
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HAART
indication? |
highly active antiretroviral therapy
initiated when pts have low CD4 counts (< 500) or high viral load. also used as prophylactic tx in general population and during pregnancy |
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Nevirapine, Efavirenz, Delavirdine
class? |
non-nucleoside reverse transcriptase inhibitor used in HIV therapy
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List antibiotics to avoid in pregnancy (9).
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SAFE Moms Take Really Good Care
Sulfonamides: kernicterus Aminoglycosides: ototoxicity Fluoroquinolone: cartilage damage Erythromycin: acute cholestatic hepatitis in mom (and clarithromycin is embryotoxic) Metronidazole: mutagenesis Tetracycline: discolored teeth, inhibition of bone growth Ribavirin: teratogenic Griseofulvin: teratogenic Chloramphenicol: gray baby syndrome |
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Rifampin
clinical use? |
1. Mtb (must use with other agents such as INH, Pyrazinamide Ethambutol)
2. delays resistance to dapsone when used for leprosy 3. prophylaxis for meningococcal infection 4. chemoprophylaxis for contacts with children with Haemophilus influenzae type B |
