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81 Cards in this Set
- Front
- Back
gp 2b/3a receptor inhibitors (3)
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abciximab, eptifibatide, tirofiban
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Heparin
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do NOT cross placenta, reversed by protamine.
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heparin side effects
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HIT/HAT, hypersensitivity, thrombocytopenia, osteoporosis
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HIT
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BAD. IgG complex w/ heparin + PF4. onset: 7--14 days
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LMWH (3)
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enoxaparin, tinzaparin, dalteparin
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LMWH when Renal dx
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adjust dosage if Renal dx
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warfarin MOA
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inhibit factor 7, 9, 10, 2 (vit K dependent)
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warfarin reversed by
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reversed by oral phytonadione.
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warfarin protein binding
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displaced by ASA, Sulfonamides, phenytoin, increase warfarin activity
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warfarin inducers
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carbamepzine, barbiturates, rifampin, decrease activities
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warfarin inhibitiors
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cimentidine, macrolides, antifungal (azoles), metronidazole. increase warfarin activities
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direct thrombin inhibitors (3)
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argatroban, lepirudin, bivalrudin
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argatroban
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for HIT
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4 newer anti-coag drugs
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ximelagatran, dabigatran, rivaxaban, apixaban
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thromolytics (4)
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streptokinase, alteplase, tenecteplase, reteplase
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thrombolytics reversed by
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aminocaproic acid, or cryoprecipiatate
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thrombolytics/anti-fibrinolytic (3)
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anistreplase, dutelplase, transexamic acid
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asa
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anti-platelet. irreversibly inhibits COX in platelet. Low dose: selectively block TXA2.
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salicylism
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vomit, tinititus, dizzy
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ADP inhibitors (3)
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clopidogrel, ticlopidine, prasugrel
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if chemo/ neutropenic/ bacteremia, then pick
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bacterialcidal
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if ascites/ abcess/ endocarditis/ meningitis, then pick
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pick bacertialcidal
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inhibit wall synthesis
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beta-lactam agents, vancomycin
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affect permeability of cell membrane
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amphotericin B
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inhibit protein synthesis
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macrolides, tetracycline, aminoglycosides, clindamycin, chloramphenicol
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affect nucleic synthesis
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quinolones, trimethoprim, sulfonamides
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plasmid-mediated resistance
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transferrable, usually >1 class of antibiotics
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chromosomal-mediated resistance
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generally not transferrable
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procain penicilin G
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gonorrhea
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benzathine penicilin G
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syphilis
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beta-lactam
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bacterialcidal, only work on active bacteria
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cycloserine
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for TB
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Transpeptidase
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for cross-linking, (penicilin-binding proteins), target of beta-lactam
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resistance to beta-lactams (3)
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altered target, decreased penetration, enzyme inactivation
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altered target site eg:
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MRSA, penicilin-resistant pneumococci, enterococcus resistant to penicilin
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decreased penetration eg:
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G (-) outer membrane impermeable, no porin / altered porin protein
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enzymatic inactivation eg:
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beta-lactamases. Staph aureus has plasmid encode extracellular penicillinase; beta-lactamases in G(-)'s periplasmid space (plasmid or chromosome)
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penicilin side effect
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leukopenia. IV: irritation to vein
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penicilin G side effect
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CNS more irritable --> seizure
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penicilin allergy
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IgE mediated, mast cell degranulation, anaphylaxis
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penicilin family
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penicilin G (benzylpenicilin), oxacillin, cloxacillin, dicloxacillin, fluocloxacillin, nafcillin, ampicillin, ticarcillin, amoxicillin
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penicillin G, V
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NOT effecitive against staph
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penicillinase-resistant penicillins (kill staph)
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oxacillin, methicillin, dicloxacillin, nafcillin
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ampicillin, amoxicillin
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kill G(-), eg: H. flu, E. Coli, proteus mirabilis. But NOT staph or anything has broad-spec beta-lactamase
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piperacillin
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kill G(-)
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oral penicillin: protein bound
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Poor penetration in: CSF, Brain, Ocular fluid, prostate, phagocytic cells
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oxacillin (metabolized by)
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liver. Other penicillins are NOT
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penicillin excreted in
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Urine (Glomerular filtration, tublular secretion). Urine level > serum level
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penicillin side effects
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hypersensitivity, serum sickness, allergic vasculitis, fever, eosinophilia, bone marrow suppress, thrombophlebitis, seizure (inhibit GABA receptors), hyperKalemia
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suicide inhibitors
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ciavulanic acid+amoxicilin, sulbactam + ampicillin, tazobactam + piperacillin
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cephalosporin 1st gen
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kill G(+) even penicillin-resistant staph, G(-) like E. Coli, K. pneumoniae
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cephalosporin 2nd gen
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better kill G(+) than 1st gen, but less than 3rd gen
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cephalosporin 3rd gen
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resistant to broad beta-penicilinase, but kill most G(-) like P. aeruginosa. best kill G(+)
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cephalosporin 3rd gen
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good penetration into CSF, DOC for meningitis
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cephalosporin 1st gen drugs
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cefazolin, cephalexin
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cepha 2nd gen drugs
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cefuroxime, cefaclor, ceftoxitin ( mefoxin), cefotetan
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cepha 3rd gen drugs
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cefotaxime, ceftriaxone, ceftazidime
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cepha 4th gen drugs
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cefepime, more resistant to B-lactamases than 3rd gen
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1st gen cepha drugs treat
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non-penicillin resistant strep, non-MRSA staph. NOT enterococci, listeria
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2nd gen cepha drugs treat
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E coli, klebsiella, proteus, H flu, Moraxella catarrhalis. less active against G + than 1st gen
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3rd gen cepha drugs treat
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serratia, N. Gonorrhea,
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cefotaxime
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3rd gen, treat staph aureus, strep pyogens
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ceftazidime
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3rd gen, treat pseudomonas aeruginosa
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cefepime
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4th gen, more resistant to some beta-lactamase
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methicillin-resistant staph, and enterococci are resistant to
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cepha
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cepha drugs metabolized by
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liver
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cepha drugs excreted by
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kidneys, concentrated in urine like penicillins
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side effects of cepha
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hypersensitivity/cross react w/ penicillin. bone marrow suppression. disulfiram-like rxn. sodium load (avoid using in CHF pts)
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aztreonam
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mono-bactam. NO cross-rxn w/ penicillin/cepha. ONLY aerobic G(-) rods (e coli, kleb, enterobacter, pseudomonas)
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imipenem
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has a specific porin in G(-) bacilli, penetrate CSF. broad spec, G(+), G(-), anaerobes, stuff resistant to cepha
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imipenem metabolized in
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Urine by brush border dipeptidase. To treat UTI: must use cilastin to inhibit dipeptidase in brush border.
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imipenem tox
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hypersensitivity
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vacomycin
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NOT beta-lactam. inhibit end-stage cell wall synthesis (inhibit transglycosylation)
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vancomycin delivery & excretion
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No oral, must be IV. Excretion is by glomerular filtration
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vancomycin tox
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ototoxicity, nephrotoxicity when combined w/ aminoglycosides
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vancomycin resistance problem
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all G(+) except vancomycin resistant enterococci (VRE)
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vancomycin use
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G(+) like MRSA, c. diff enterocolitis (use Oral vanco as 2nd line, 1st line is metronedizole to avoid VRE)
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polymyxins
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polymyxin B, colistin. "detergent", disrupt cell membrane. No oral absorbtion, renal excretion, nephrotox/neurotox. Use for MDR G(-) bacilli (eg acinetobacter)
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daptomycin
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not beta-lactam. target cell membrane. renal excretion. tox: myositis (mm enzymes leak). cannot use in pneumonia, use as alternative to vanco for MRSA/enterococci
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daptomycin resistance:
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thru change of cytoplasmic membrane voltage
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bacitracin
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topical use only. for staph. Rarely causes hypersensitivity
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