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70 Cards in this Set
- Front
- Back
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Adverse Drug Reactions/Adverse Drug Events, causes |
a response to a drug that is noxious and unintended and occurs at doses normally used for man for prophylaxis, diagnosis, or therapy of disease, or for the modification of physiologic function any undesirable experiences associated with the use of a drug or medical product in a patient |
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Alexander Fleming
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Cultures fungus Penicillum in 1928; nobel prize in Medicine 1945 |
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Antimicrobial resistance
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Patterns of resistance differ from one community to the next and they change rapidly, know the patterns in your patient population. Culture and ID organisms, monitor all culture results, and share your findings with other clinicians. |
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Bioequivalence
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Generic drugs will be 20+- bioavailability as brand/trade name drugs.
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Blood-borne route of spread
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Pathogens spread via this route include HIV, hepatitis C & B, west nile, T. pallidum (syphilis), and T. cruzi (Chagas disease). |
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Cellulitis, risk factors
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Known injury, weakened immune system, skin conditions, chronic swelling of extremities, hx of cellulitis, intravenous drug use, and obesity. |
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Contraindications to live virus vaccination
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Immunocompromised patients (may have a reduced antibody response to active immunization procedures)
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CYP450 enzyme families
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responsible for metabolizing most of the drugs in current use within the liver and small intestine |
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CYP450 polymorphism
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1% of population must have a variant of one of the CYP450 enzymes to be considered.
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Cystitis, treatment
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Nitrofurantoin, TMP-SMX, or fosfomycin. Beta-lactam antibiotics may be used when other recommended agents cannot be used. Fluoroquinolones are typically reserved for complicated cystitis.
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Drug-drug interactions |
Interactions occur during the absorption phase which can in turn affect the bioavailability of the drug. |
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DTaP vaccination |
Diphtheria, tetanus toxoid, and acellular pertussis vaccine |
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Fever, treatment
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Depends on cause. Usually drink fluids and get plenty of rest. A slight fever can make it hard virus/bacteria to survive. |
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First pass metabolism
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All drugs given orally will first pass through the liver an be metabolized to inert compounds (this is part of phase 2 of drug metabolism). In order to avoid first pass effect (liver metabolism), other routes such as transdermal or sublingual may be used |
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Fluoroquinolones
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Ciprofloxacin & levaquin or "Floxacin" drugs, broad spectrum of action againsts gram positive and gram negative organisms; not active against C.Difficile but may cause; inhibits DNA gyrase. Effects developing bones and cartilage in children, risk of tendon rupture risk especially after age 60. Used for lower respiratory tract infections, complicated UTI's |
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Furuncle/carbuncle, treatments |
If the patient does not have recurrent furuncles, which are usually associated with S. aureus, and shows no systemic symptoms of fever, chills or malaise then incision and drainage will be the best line of treatment. Antibiotics may be unnecessary unless a systemic infection is suspected and should be used. Antibiotics’ of choice will depend on individual patient and their health history. Preventing Cellulitis is key to avoiding further damage to surrounding tissues. |
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Gerhard Domagk
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Discovered the value of sulfa-portion of the wool dye, Prontosil, had antibacterial activity that helped treat streptococcal infections. Treated President F. D. Roosevelt's son. Nobel prize in Medicine in 1939 (received award in 1947) |
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Group A, beta hemolytic streptococcal pharyngitis treatment options
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Penicillin V PO for 10 days or if there is any allergy or an area of high resistance then a first generation cephalosporin like Keflex |
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Haemophilus influenza |
Gm (-), aerobic but can be anaerobic. Was mistakenly thought to cause influenza but later found not to. Causes URIs with some fever, then moves to lower resp tract |
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Haemophilus influenzae (Hib) vaccine |
Prevents Hib type B but not other types. Prevents meningitis and pneumonia. Children (under 5) are giving 3-4 doses. Can be given at same time as other vaccines. |
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Hepatitis A |
Highly contagious, mode of transmission is fecal-oral route (contaminated water or food, poor hygene). VACCINE is inactivated, 2 doses: one at 12+ months, second at 6-12 months after first |
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Hepatitis B |
Intracellular parasite (causes cellular damage to liver) Liver CA and cirrhosis can occur. VACCINE is recommended for all infants ASAP, need 3 doses total. OK to administer to pregnant and nursing mothers |
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Herd immunity
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Vaccination of a significant portion of a population provides a measure of protection for individuals who have not developed immunity. Herd immunity theory proposes that, in contagious diseases that are transmitted from individual to individual, chains of infection are likely to be disrupted when large numbers of a population are immune or less susceptible to the disease.
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HIV
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CD4 & CD8 undergo changes that render them useless. Late stage shows continued falling CD4 counts w drops to 50 cells/mm3. Neurologic changes similar to dementia. TREATMENT: HAART drug combinations or cocktails. Nucleoside Analog Reverse Transcriptase Inhibitors (NRTIs), Protease Inhibitors (PIs), Fusion Inhibitors prevent HIV from entering target cell. Intefrase inhibitors interfere w DNA strand transfer... |
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HPV types in current vaccine preparations
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Type 6, 11, 16 & 18 are in the quadrivalent vaccine
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HPV vaccines |
Gardasil & Cervarix. Females 9-26 yoa: 3 doses; Males only one vaccine (13-21 yoa) |
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HPV-related illness causation
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Genital warts, recurrent respiratory papillomatosi (warts in respiratory tract), cervical CA, CA of vulva, vagina, penis, anus, throat, tongue, and tonsils.
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Influenza vaccination |
3 types: inactivated (IM), live attenuated (intranasal - ages 2-49) and recombinant (allx to eggs). Do not give to chemo pts or ppl allx to egg, chickens, or gentamicin. |
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Lice, treatment
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Wash sheets, towels, bedding in hottest water and dryer settings. Permethrin 1% to 5% is first line treatment, malathion is second line treatment. Also Spinosad is approved pesticide.
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Lindane
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Antiparasitic topical agent for scabies, head lice, or crab lice. Trade, class names: Kwell, scabicide/ pediculicide; 3rd line of treatment for lice due to resistance
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Mechanism of action, cephalosporins |
BACTERICIDAL- similar to penicillin they interfere with cell wall synthesis through inhibition of synthesis of bacterial peptidoglycan in cell wall. |
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Mechanism of action, fluoroquinolones
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Inhibition of DNA gyrase, enzyme needed for transcription, replication, and repair of bacterial DNA. This blocking that occurs at concentrations of 0.1- 10g/ml promotes superhelical formation of bacterial DNA, result- destruction |
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Mechanism of action, macrolides
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BACTERIOSTATIC OR BACTERICIDAL- inhibition of step in protein synthesis from binding to 50S ribosomal subunit causing RNA to dissociate from ribosome. In GI modulate inflammation by inhibiting production of cytokine interleukin 8 |
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Mechanism of action, penicillins
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BACTERICIDAL- disrupt synthesis of the bacterial cell wall, weaken structure, and compete for enzyme proteins that catalyze transpeptidation and cross linking. Formation might catalyze the activation of autolytic enzymes in cell wall that cause progressive bacterial lysis. |
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Mechanism of action, sulfonamides
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BACTERIOSTATIC- competitive antagonists that inhibit enzyme responsible for use of PABA in synthesis of folic acid. Prevents reproduction of bacteria that synthesisezes folic acid |
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Medicare Part D phases
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- Deductible phase: patient pays 100% of drug cost up to $320 |
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MRSA
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MRSA resistant to beta-lactam agents (penicillins & cephalosporins). TREATMENT: clindamycin(may cause cdiff), TMP/SMX and tetracyclines(not in pregnancy) both FDA approved. Do NOT use floroquinolones due to increasing resistance. |
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Neisseria gonorrheae
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Patients who are infected with gonorrhea are often co-infected with chlamydia (so both are covered with this treatment). CDC recommendations: rocephin 250 mg IM x 1 plus either azithromycin 1 gm orally or doxycycline 100mg twice daily for 7 days. For patients allergic to cephalosporins, give azithromycin 2gm orally; offer partner treatment |
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Neisseria meningitidis
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Causes meningococcal disease. Spread through the exchange of respiratory and throat secretions (kissing/spitting). LP confirms presence of meningitis. Third generation cephalosporin (rocephin) first line of defense. |
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Oropharyngeal candidiasis, risk factors |
Change in diet, Poor nutrition, Sleep deprivation, Diabetes. Use of antibiotics, Pregnancy, Corticosteroids, immunosuppressed. |
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Oropharyngeal candidiasis, treatment
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Nystatin, 400,000-600,000 for adults and child and 200,000 for infants. 4-5 times/day
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Otitis media (bacterial), treatment |
Infective agents: Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis. Amoxicillin (1st line for uncomplicated cases with no previous treatment in past 30 days), amoxicillin-clavulanate (AM/CL) for 1st line in pts who have had treatment in last 30 days; macrolides (azithromycin, clarithromycin, erythromycin) and lincosamides (clindamycin) are alternatives |
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P-glycoprotein (P-gp) |
Efflux transporter expressed by mdr-1 that protects cells against toxic chemicals; can aggressively pump some drugs back across the intestinal mucosa from the circulation where the drug is eliminated, or from the liver into the bile for hepatic elimination |
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Penicillins |
Beta-lactam antibiotics. Gram + bacteria only. |
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Permethrin
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First line defense for treatment of head lice
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Pertussis, transmission
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Found only in humans. Spread by coughing, who then breathe in the pertussis bacteria. Many infants get it from someone who does not know that have it. Symptoms usually develop within 5-10 days.
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Pharmacodynamics
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Effects of the DRUG on the body
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Pharmacogenomics
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The study how genes affect a person's response to drugs.
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Pharmacokinetics
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1. Absorption: how drug leaves site of administration
2. Distribution: transport/movement of drug in body from blood stream to tissue 3. Biotransformation (metabolism): chemical inactivation/breakdown by converting for excretion, with liver as main site. 4. Excretion (elimination): drugs and metabolites are removed from body, with kidney and liver as main sites |
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Pharyngitis, bacterial, treatment
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Penicillin V PO x 10 days; oral first generation cephalosporin (keflex) in areas of high resistance. |
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Polyvalent pneumococcal polysaccharide vaccine, indications
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Give to all adults age 65+, anyone 2-65 with long term health problems (heart/lung disease, DM, sickle cell, alcoholism, cirrhosis, CSF leaks, cochlear implants, Hodgkin's disease, lymphoma or leukemia, kidney failure, HIV; receiving chemotherapy, long-term steroids, or radiation; anyone 19-64 who smokes or has asthma) |
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Polyvalent pneumococcal polysaccharide vaccine, schedule
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PPSV13 is given to children under 2 yoa : 4 doses at 2, 4, 6, and 12-15 months |
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Pneumonia, microbial causes
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Gram + Streptococcus pneumoniae (most common), staph aureus and bacillus anthracis. Gram - (less frequent) h. Influenzae, klebsiella pneumoniae, e. Coli, bordetella pertussis and morexella catarrhalis. |
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Polio vaccine
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Inactivated poliovirus (IPV). IPV given as injection. May be given at same time with other vaccines. Children are vaccinated with 4 doses. |
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Pregnancy drug risk categories
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Category A - adequate and well-controlled studies have failed to demonstrate a risk to the fetus
Category B - animal reproduction studies have failed to demonstrate a risk to fetus (no studies on woman) Category C - animal studies have shown adverse effects (no studies on woman) potential benefits outweigh risks Category D - positive evidence of human fetal risk but potential benefits may outweigh risks Category X - studies have shown fetal risks but risks outweigh benefits Category N - FDA has not classified drug |
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Prescriptions: The parts of a valid prescription
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Must be dated and signed (controlled), include patients full name and address, providers full name, address and DEA registration number.
Must include drug name, strength, dosage form, quantity prescribed, directions for use and number of refills. |
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Prodrugs
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A prodrug requires biotransformation to become pharmacologically active. Until this occurs, it's essentially an inactive chemical. Phase 1 enzymes change to active drug. Inhibition of the enzyme could render it useless.
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Rotavirus vaccination and complication
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Two brands: RotaTeq(RV5) - requires 3 doses and Rotarix(RV1) - requires 2 doses. Both are given orally.
Complications: Rotashield(dc'd) caused intussusception, which causes the small bowels to back up into another part of the intestine. |
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Shingles
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Latent infection caused by the chickenpox virus. The elderly have decreased cellular immunity to the varicella zoster vaccine creating an opportunity for the latent infection to awaken and reactivate the virus in the form of shingles. Adults 60 years and older are recommended to receive the shingles vaccine (Zostavax) |
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Stevens-Johnson Syndrome |
Rare, severe, immune drug (sulfonamide) reaction that typically involves skin and mucous membranes. Typical onset is 48-72 hrs after exposure to reactive agent. Medical emergency- treat with fluids, wound care, pain meds |
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Streptococcus pneumonia
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Gm (+) cocci that causes otitis media (OM), other URIs, rheumatic fever, impetigo, endocarditis. First choice treatment for OM is amoxicillin, alternatives include azithromycin or clarithromycin for infx not treated in last 30 days. For resistant infx, AM/CL, cefdinir, cefpodoxime, cefprozil or cefurozime |
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Tetracyclines
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Wide-spectrum antibiotic useful for empirical therapy. First choice drug for: acute bacterial exacerbation of COPD, Chlamydia, Lyme disease, gonorrhea and rickettsial infections; also for S. pneumonia, H. influenza, Legionella, Mycoplasma, Brucella, M. catarrhalis. Should not be given to pedi (<8) or pregnant pts due to permanent damage to teeth and bone. Cause photosensitivity, elevated BUN/Creat. DO NOT take with antacids, mild, foods containing magnesium, aluminum, Ca+, or zinc (decreases absorption). DDI: bismuth subsalicylate, kaolin, pectin (reduce absorption) |
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Trimethoprim-sulfamethoxazole (Bactrim)
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Sulfonamide with wide antibacterial spectrum including gm(+) & (-) organisms. Used to treat UTI, OM, shigellosis, sinusitis. Do not use to treat streptococcal pharyngitis due to greater incidence of resistance than w pcn. Frequent allergic reactions occur in 6% of population. The use of TMP/SMX in elderly results in increased risk of severe reactions, esp. with impaired renal or liver functions. |
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Treatment of the "common cold"
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Also known as nasopharyngitis, rhinopharyngitis, acute coryza, head cold, or simply a cold - is a viral infectious disease of the upper respiratory tract which primarily affects the nose. |
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Vaccines containing live viruses
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Adenovirus, Herpes zoster (Zostavax), Influenza, MMR, Rotovirus, Varicella, Smallpox, Yellow Fever |
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Variation in drug responses, reason for
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Genetic factors play an important role in variations of drug response. Genetic polymorphism of proteins involved in targeting (pharmacodynamics) and drug metabolism and transport (pharmacokinetics).
Also, environmental chemicals, co administered drugs, food, smoking and alcohol. |
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Varicella-zoster vaccine
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Live attenuated virus administered to protect against the viral disease commonly known as chickenpox caused by varicella zoster virus. Marketed as Varivax
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Viral transmission routes
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Person to person: touch, contaminated blood or bodily fluids, saliva and air.
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William Withering
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Provided initial quantifiable data regarding heart failure treatment. Recognized the active ingredient from the foxglove plant, digitalis. |
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Cephalosporins
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Most widely used by primary care provider is First generation: cephalexin (Keflex); Second Generation: cefprozil (Cefzil), cefuroxime (Ceftin); Third generation: ceftriaxone (Rocephin). First Generations: Skin and soft tissue, Urinary Tract Infections (UTI). Second Generations: Otitis Media, Gonorrhea, Acute bronchitis or pneumonia in patients with COPD, Pneumonia, community -acquired; Sinusitis, Lime diseas, bactericidal. Are B-lactam antibiotic that have the ability to resist bacterial enzymes, especially B-lactamase. They interfere with cell wall synthesis through inhibition of the synthesis of the bacterial peptidoglycan in the cell wall. The antibiotic binds to the enzymes that build and maintain the cell wall. |
