Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
109 Cards in this Set
- Front
- Back
|
What is the difference between an antiseptic and a disinfectant?
|
antiseptic kills and inhibits organisms on body. disinfectant kills and inhibits organisms on inanimate objects
|
|
|
What is the difference in coverage for iodophors like Betadine and Clorhexidine?
|
Both cover GPCs, GNRs but Chlorhexidine is better for fungi
|
|
|
What is the mechanism of action for penicillins, cephalosporins, carbapenems, monobactams and vancomycin?
|
inhbition of cell wall synthesis
|
|
|
What is the mechanism of action of tetracycline, aminoglycosides and linezolid?
|
inhibitors of the 30s ribosome and protein synthesis
|
|
|
What is the mechanism of action of erythromycin, clindamycin, chloramphenicol, Synercid?
|
inhibitors of the 50s ribosome and protein synthesis
|
|
|
What is the mechanism of quinolones?
|
inhibitor of DNA helicase (DNA gyrase)
|
|
|
What is the mechanism of rifampin?
|
inhibitor of RNA polymerase
|
|
|
What is the mechanism of metronidazole?
|
Produces oxygen radicals that breakup DNA
|
|
|
Whast is the mechanism of sulfonamides?
|
PABA analogue, inhibit purine synthesis
|
|
|
What is the mechanism of trimethoprim?
|
inhibits dihydrofolate reductase, inhibits purine synthesis
|
|
|
____ have irreversible binding to ribosome and are considered bactericidal
|
aminoglycosides
|
|
|
What is the most common method of antibiotic resistance?
|
transfer of plasmids
|
|
|
How is the mechanism of resistance to methiclllin or vancomycin developed?
|
mutation in cell wall binding protein
|
|
|
How is the mechanism of resistance to gentamicin developed?
|
resistance due to modifying enzymes leading to decrease in active transport
|
|
|
What do you do if abx peak is too high?
trough too high? |
decrease amount of each dose
decrease frequency |
|
|
Which antibiotic's coverage can be described as: Not effective against Staphylococcus or Enterococcus. But effective against GPCs, streptococci, syphilis, Neisseria meningitides (GPR), Clostridium perfringens (GPR), beta-hemolytic Streptococcus, anthrax
|
Penicillin
|
|
|
Anti-staph penicillins
|
Oxacillin/nafcillin
|
|
|
Same coverage as penicillin but also picks up enterococci
|
Ampicillin/amoxicillin
|
|
|
Name the two abx that are broad-spectrum - pick up GPCs (staph and strep), GNRs, +/- anaerobic coverage. Effective for enterococci but not effective for pseudomonas, acinetobacter or serratia.
|
Unasyn (ampicillin/sulbactam) and Augmentin (amoxicillin/clavulanic acid)
|
|
|
Name the two antipseudomonal abx that are broad spectrum – pick up GPCs (staph and strep), GNRs, anaerobes. Effective for enterococci; effective for Pseudomonas, Acinetobacter, and Serratia.
|
Timentin (ticarcillin/clavulanic acid) and Zosyn (piperacillin/sulbactam)
|
|
|
What are the side effects of ticarcillin/piperacillin?
|
inhibit platelets; high salt load
|
|
|
Name two first generation cephalosporins
|
Ancef (cefazolin), Keflex (cephalexin)
|
|
|
What does the first generation cephalosporins cover?
|
GPCs staph and strep
Not effective for enterococcus; does not penetrate CNS |
|
|
Which first generation cephalosporin is best for phrophylaxis?
|
cefazolin (Ancef) has the longest half-life
|
|
|
What are the side effects of the first generation cephalosporins?
|
can produce positive coombs test
|
|
|
Name three 2nd-generation cephalosporins
|
cefoxitin, cefotetan, cefuroxime
|
|
|
Main side effect of 2nd-generation cephalosporins.
|
Prolonged PT
|
|
|
Third generation cephalosporins cover ___ mostly, +/- anaerobic coverage.
|
GNRs
|
|
|
What major side effect of ceftriaxone?
|
cholestatic jaundice, sludging in the gallbladder
|
|
|
Monobactam (aztreonam) covers GNRs and picks up what 3 others?
|
Pseudomonas, Acinetobacter, Serratia
|
|
|
Carbapenems (meropenem/imipenem) are broad spectrum covering GPCs, GNRs and anaerobes. Not effective for what 3 (with mnemonic)?
|
MEPP: MRSA, Enterococcus, Proteus, Pseudomonas
|
|
|
What can be added to carbapenems to prevent renal hydrolysis of the drug and increase half-life.
|
cilastin
|
|
|
What is the major side effect of carbapenems?
|
can cause seizures
|
|
|
What is the coverage of Bactrim?
|
GNRs, +/- GPCs. Not effective Enteroccoccus, Pseudomonas, Acinetobacter, and Serratia
|
|
|
Bactrim side effects?
|
teratogenic, allergic reactions, renal damage, Steven-Johnson syndrome (erythema multiforme, hemolysis in G6PD-deficient patients
|
|
|
What is the coverage of quinolones?
|
GPCs, mostly GNRs. Not effective for Enterococcus; picks up Pseudomonas, Acinetobacter and Serratia. 40% of MRSA sensitive
|
|
|
What is the coverage of aminoglycosides?
|
GNRs. Good for pseudomonas, Acinetobacter and Serratia. Not effective for anerobes (need O2).
|
|
|
Aminoglycosides are synergistic with ___ for Enterococcus
|
ampicillin
|
|
|
What is the coverage for macrolides?
|
GPCs; best for CAP and atypical pneumonias
|
|
|
The main side effects of macrolides are ___ (PO) and ___ (IV). Also binds ___ receptor.
|
nausea, cholestasis, motilin receptor (prokinetic for bowel)
|
|
|
Name side effects of vancomycin
|
HTN, redman syndrome (histamine release), nephrotoxicity, ototoxicity
|
|
|
Main side effect of tetracycline?
|
tooth discoloration in children
|
|
|
Coverage of clindamycin
|
anaerobes, some GPCs, good for aspiration pneumonia. Can be used to treat C. perfringens
|
|
|
Main side effect of clindamycin?
|
pseudomembranous colitis
|
|
|
Metronidazole covers ____
|
anaerobes
|
|
|
2 main side effects of metronidazole
|
disulfiram-like reaction, peripheral neuropathy
|
|
|
Prolonged broad-spectrum antibiotics +/- fever -> add ____
Possible fungal sepsis -> add ___ |
fluconazole, amphotericin
|
|
|
2 side effects of Isoniazid?
|
hepatotoxicity, B6 deficiency
|
|
|
2 side effects of Rifampin?
|
hepatotoxicity, GI sx
|
|
|
Side effect of Pyrazinamide?
|
hepatotoxicity
|
|
|
Side effect of Ethambutol?
|
retrobulbar neuritis
|
|
|
Name 4 TB drugs?
|
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
|
|
|
Inhibits DNA polymerase, usually used for HV infections; can be used for EBV.
|
Acyclovir
|
|
|
Used for CMV infections. Side effects decreased bone marrow, CNS toxicity.
|
Ganciclovir
|
|
|
Name 4 drugs effective for enterococcus.
|
vancomycin, Timentin/Zosyn, ampicillin/amoxicillin, or gentamicin with ampicillin.
|
|
|
Name drugs effective for Pseudomonas, Acinetobacter and Serratia
|
ticarcillin/piperacillin, Timentin/Zosyn, third-generation cephalosporins, aminoglycosides, meropenam/imipenam (resistance can develope in Pseudomonas), or fluoroquinolones
|
|
|
Significance of sublingual and rectal drugs?
|
do not pass through liver first
|
|
|
skin absorption based on ____ through the epidermis
|
lipid-solubility
|
|
|
CSF absorption is restricted to ____, ____ drugs
|
nonionized, lipid-soluble
|
|
|
Albumin - largely responsible for binding drugs (____ and ____ 90% bound)
|
PCN, warfarin
|
|
|
____ will displace unconjugated bilirubin in newborns
|
sulfonamides
|
|
|
___ and heavy metals stored in bone
|
tetracycline
|
|
|
In what type of kinetics constant amount of drug is eliminated regardless of dose?
|
0 order kinetics
|
|
|
In what type of kinetics is drug eliminated proportional to dose?
|
1st order kinetics
|
|
|
How many half-lives for a drug to reach steady state?
|
5
|
|
|
Amount of drug in the body divided by amount of drug in plasma or blood
|
Volume of distrobution
|
|
|
Drugs with a high volume of distrobution have higher concentrations in the ___ compartment compared with the ___ compartment.
|
extravascular (ie fat tissue), intravascular
|
|
|
Fraction of unchanged drugs reaching the systemic circulation. Assumed to be 100% for IV drugs, less for other routes.
|
bioavailability
|
|
|
Drug level at which desired effect occurs in 50% of pts.
|
ED50
|
|
|
Drug level at which death occurs in 50% of pts.
|
LD50
|
|
|
Tachyphylaxis
|
tolerance after only a few doses
|
|
|
Dose required for effect.
|
Potency
|
|
|
Ability to achieve result without untoward effect
|
efficacy
|
|
|
Microsomal drug metabolism takes place in ____
|
hepatic cell endoplasmic reticulum, P-450 system
|
|
|
Which phase of microsomal drug metabolism has demethylation, oxidation, reduction, hydrolysis reactions (mixed function oxidases, requires NADPH/oxygen)
|
Phase I
|
|
|
Which phase of microsomal drug metabolism has glucuronic acid and sulfates attache (forms water-soluble metabolite); often inactive and ready for excretion.
|
Phase II
|
|
|
P-450 Inducers with mnemonic
|
Queen Barb Steals Phen-phen and Refuses Greasy Carbs Chronically
Qunidine, Barbituates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic etoh |
|
|
P-450 inhibitors with mnemonic
|
SIC KEG A
Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erthyromycin, Grapefruit juice, Acute etoh |
|
|
P-450 system transforms aromatic hydrocarbons into ___
|
carcinogens
|
|
|
What is the most important organ for eliminating most drugs?
|
kidney (glomerular filtration and tubular secretion)
|
|
|
What type of druges are more water soluble and more likely to be eliminated in unaltered form.
|
Polar drugs (ionized)
|
|
|
What type of drugs are more fat soluble and more likely to metabolized before excretion?
|
Nonpolar drugs (nonionized)
|
|
|
Gout is caused by uric acid buildup; end product of ___ metabolism
|
purine
|
|
|
Used in the tx of gout, anti-inflammatory; binds tubulin and inhibits migration.
|
Colchicine
|
|
|
Used in the tx of gout, anti-inflammatory.
|
Inomethacin
|
|
|
Used in the tx of gout, xanthine oxidase inhibitor, blocks uric acid formation from xanthine.
|
Allopruinol
|
|
|
Used in the tx of gout, increases renal secretion of uric acid.
|
Probenecid
|
|
|
Lipid lowering agent that can bind vitamin K and cause bleeding tendancy.
|
cholestyramine (Questran)
|
|
|
What antiemetic causes tardive dyskinesia (inhibits dopamine receptors)? what is the tx?
|
Promethazine (Phenergan), diphenhydramine (Benadryl)
|
|
|
Prokinetic drug that is a dopamine receptor blocker that can be used to increase gastric motility and gut motility in general.
|
Metoclopramide (Reglan)
|
|
|
Antiemetic; serotonin receptor inhibitor.
|
Ondansetron (Zofran)
|
|
|
Somatostatin analog used to treat acromegaly and diarrhea associated with carcinoid syndrome and VIPomas.
|
Octreotide
|
|
|
Digoxin MOA?
|
inhibits Na/K ATPas and increases myocardial calcium
|
|
|
Digoxin major side effect
|
decreased blood flow to intestine has been implicated in mesenteric ischemia
|
|
|
What does hypokalemia do to Digoxin?
|
increased sensitivity of heart, can precipitate arrhythmia or AV block
|
|
|
Is digoxin cleared with dialysis?
|
no
|
|
|
3 major side effects of Procainamide
|
lupus-like syndrome, pulmonary fibrosis, torsades
|
|
|
treatment for Torsades?
|
Magnesium
|
|
|
QT interval that is concerning with Procainamide
|
>400
|
|
|
Medication that causes transient interruption of the AV node?
|
adenosine
|
|
|
Best single agent shown to reduce mortality in pts with CHF. Can also prevent CHF post-MI.
|
ACEi (captopril)
|
|
|
MOA of atropine
|
acetylcholine antagonist
|
|
|
Name 2 drugs used to inhibit adrenal steroid synthesis. Used in patients with adrenocortical CA.
|
Metyrapone and aminoglutethimide
|
|
|
Analogue of GnRH and LHRH. Inhibits release of LH and FSH from pituitary when given continuously (paradoxic effect)
|
Leuprolide
|
|
|
Can be used in pts with GI bleeding by reducing intestinal blood flow.
|
Vasopressin (ADH)
|
|
|
Used in gout and to close PDA
|
indomethacin (inhibits prostaglandin production)
|
|
|
PGE1 derivative; a protective prostaglandin used to prevent peptic ulcer disease. Consider use in pts on chronic NSAIDs
|
Misoprostol
|
|
|
What is the 1st and 2nd acid/base disturbances seen in ASA poisoning.
|
1st respiratory alkalosis; 2nd metabolic acidosis
|
|
|
Side effect of Gadolinium?
|
nausea
|
