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25 Cards in this Set
- Front
- Back
Aminoglycoside absorption
a)orally b)IV intermittent infusion |
a)minimal
b)preferred method over 30-60 minutes |
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Aminoglycoside absorption
a)continuous IV infusion b)IM |
a)unsafe due to toxicity
b)good in ppl under 40, not good in ppl over 40 |
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Broad categories of AG's ADR's (3)
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1)ototoxicity
2)nephrotoxicity 3)neuromuscular paralysis |
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AG's ear adverse effects (4)
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1)ototoxicity (2-10%) w/ trough levels great than 2
2)vestibular toxicity (dizziness) 3)tinnitus, high freq. hearing loss 4)hearing unlikely to improve if drug is dc'd |
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AG's kidney adverse effects (4)
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1)nephrotoxicity
2)occurs in all pts who take it longer than 3 days 3)associated w/ trough's greater than 2 4)usually reversible |
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Neuromuscular paralysis will occur w/ AG's when... (4)
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use of:
a)Mg b)curare c)botulism d)myasthenia gravis IS ALSO INVOLVED |
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AG's spectrum (2)
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1)G(-)
2)if used w/ B-lactams they can kill staph/enterococcus |
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AG's bactericidal mechanism (2)
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1)inhibit protein synthesis by binding ribosomal mRNA
2)uptake INTO bacteria is energy and O2 dependent via active transport |
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Normal dosing of AG's
a)peaks b)trough's |
a)5-10
b)less than 2 |
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Once daily dosing
a)peaks b)troughs |
a)15-20+
b)0-1 |
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Why use ONCE-daily dosing for AG's (5)
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1)normal may result in suboptimal []s
2)timing of doses and serum []s have significant error=delayed interpretation and longer periods suboptimal 3)[] dependent killing, so higher peaks = more bacteria killed 4)post antibiotic effect allows for the really low peaks of once daily dosing 5)resistance of bacteria after first dose |
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How is once-daily dosing good for the toxicities of AG's
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1)allows for rest of the organs suffering the toxicities b/c of uptake saturation @ the organs
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Hepatic cells where drugs are metabolized and is ____ dependent
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Parenchymal Cells
oxygen dependent |
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Hepatic drug transporter he wanted us to know
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p-glycoprotein (MDL1, MDR3)
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CYP2C19, CYP2C9/10, CYP2D6, CYP3A4 all have the same 3 inducers
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1)phenobarbital
2)phenytoin 3)rifampin |
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Phase II metabolic drug rxns (6)
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1)conjugation systems
2)glucuronic acid 3)sulfate 4)acetylation 5)methylation 6)glutathione ALL END IN TRANSFERASE |
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Measurement of hepatic impairment (4 of many)
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1)ALT,AST predict liver damage NOT fxnal impairment
2)serum albumin/PT 3)serum bilirubin 4)C14 breath test, caffeine (as marker compounds) |
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Ultrafiltration
a)adv b)factros affecting protein binding results (4) |
a)less expensive but reliable
1)drug binding to membrane 2)sieve effect 3)protein leakage 4)[] dependence |
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Albumin properties (6)
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1)binds to acidic drugs
2)60% of ttl protein in most pts 3)60-70% intravascular, 30-40% extravascular 4)low and high capacity (saturable) 5)high and low affinity binding depending upon binding site 6)normal [] = 35-50g/L |
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Alpha-acid glycoprotein (AAG) properties (2)
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1)binds basic drugs
2)acute phase reactant |
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Common way to describe protein binding
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scratchard plot
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IM admin of theophylline
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precipitation in muscle and painful DO NOT DO THIS
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Drugs incr CL of theophylline (4 of many)
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1)phenytoin
2)tegretol 3)rifampin 4)corticosteroids |
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Drugs decr CL of theophylline*** (3 of many)
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1)erythromycin
2)ciprofloxacin 3)OC's |
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Theophylline mechanism of axn (3)
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1)inhibits cyclic nucleotide PDE enzymes that catalyze the breakdown of cAMP and GMP
2)this enhances activites of autocoids, hormones and NTs that signal via cyclic nucleotides 3)adenosine antagonist |