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NYU Pharm Exam 2 Review Notes
1. Bactericidal: kills microorganisms
2. Bacteriostatic: inhibits growth of microorganisms
3. Antibiotics Adv Reactions: Allergic or hypersensitivity
- Mild: rash, pruritus, hives
- Severe: anaphylactic shockTreatment: antihistamine, epinephrine, bronchodilator Superinfection
- Secondary infection (e.g., mouth, respiratory tract, intestine, GU tract, skin) Organ toxicity
- Damage to organs, usually liver & kidneys, ears
4. Natural/Inherent Resistance: occurs without previous exposure to antibacterial drug
5. Aquired resistance: Caused by prior exposure to the antibacterial
Causes many nosocomial infections
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6. Preventing Resistance: Take antibiotics exactly as prescribed
Safely discard any leftover meds Never take antibiotic for viral infections Never skip doses or stop taking them early Antibiotic stewardship
7. Antibiotics MOA: •Inhibition of cell wall synthesis
- Alteration in membrane permeability
- Inhibition of protein synthesis
- Inhibition of RNA & DNA synthesis Interference with cellular metabolism
8. Antibiotic spectrums: Narrow-spectrum : primarily ettective against one group go organism
Broad-spectrum: can be ettective against multiple groups, used when culture can't be identified
9. Penicillins(narrow-spectrum): prototype: Amoxicillin
MOA: interferes w cell wall synthesis; cell lysis & death use: staph infections Ad/Re: anaphylaxis, nausea, vomitting, diarrhea, superinfection
10. Penicillins (Broad-spectrum): Prototype:
Ampicillin MOA: interferes w cell wall synthesis; cell lysis & death Use: treat both gram +/-
4 / 19 MOA: ettective against gram +, bacteriostatic, bactericidal Use: osteomyelitis, toxic shock syndrome, severe PID, postpartum endometritis, septic arthritis, skin n soft tissue infection s/e: c diflcile colitis
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17. Glycopeptides: Prototype:
vancomycin MOA: primarily against a gram plus, MRSA, and C ditt Use: sepsis, CDF, endocarditis, osteomyelitis, pneumonia, skin and soft tissue infection Indications: Iv (drug resistant s aureus[mrsa]), oral (c. ditt) red man syndrome due to rapid infusion
18. Tetracyclines: prototype: tetracycline
MOA: bacteriostatic, inhibits bacterial proteins synthesis use: broad-spectrum against gram + and -, used for atypical bacteria, H pylori, acne vulgaris, anthrax
19. Tetracycline a/r: ad/re: photosensitivity, teratogenetic, irritating to gastric mucosal, avoiding children in
less than eight (teeth discoloration and impact on long bones) * continue to use results in bacterial resistance*
20. Aminoglycosides: Prototype:
gentamicin Moa: inhibits bacterial proteins synthesis uses: severe gram-negative infection A/R: super infection, nephrotoxicity, thrombocytopenia, bactericidal * cannot be absorbed from G.I. tract, does not cross the blood brain barrier in adults, primarily Im an IV*
21. Fluoroquinolones: Prototype Ciprofloxacin
MOA: interrupts DNA synthesis uses broad-spectrum gram +/-, bactericidal, UTI, bone and joint infection, bronchitis, pneumonia, gonorrhea
22. Lipopeptides: Prototype: daptomycin
MOA: inhibits protein, DNA, RNA synthesis; bactericidal
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30. Ketoconazole a/r: burning, itching, redness, localized hypersensitivity, liver toxicity, gi symptoms
less toxic than amphotericin b
31. Antiprotozoal/Antibiotic: Prototype:
metronidazole MOA: damages DNA in anaerobic organisms interferring w synthesis Use: candidiasis, histoplasmosis, cryptococcocal meningitis
32. Metronidazole a/r: gi ettect, cns symptoms, seizures, peripheral neuropathy, darkening of urine
disulfiram reaction caution/contra: hx of blood dycrasias, hf, liver/renal failure, seizure, 1st semester pregnancy
33. Herpes Antiviral Drug: Prototype:
Acyclovir MOA: bacteriostatic; interferes w viral nucleic acid synthesis Use: herpes simplex, genital herpes, varicella-zoster[chickenpox], herpes zoster[shingles]
34. Acyclovir a/r: burning, itching, vertigo, gi symptoms , renal toxicity, thrombophlebitis
treat asap diagnosis of herpes zoster, not cure for genital herpes contra: milk protein hypersensitivity
35. Tuberculosis treatment: intensive: 2months [4drugs daily]
continuation[2 drugs daily] Sputum should be obtained for acid fast bacilli smear and culture at monthly intervals until two consecutive cultures are negative hepatotoxicity, ocular toxicity
36. Antimycobacterial: Prototype: isoniazid [INH]
8 / 19 MOA: inhibits cell wall synthesis and blocks pyridoxine (via b6); bacteriostatic/cidal based on concentration Use: Antitubercular; active and latent tb
37. Isoniazid (INH) a/r: •Adverse reactions: GI distress, peripheral neuropathy, psychotic behavior, seizures,
blood dyscrasias, hepatotoxicity, electrolyte imbalances
- Caution: >50 y/o, alcoholism, liver disease, HIV, seizure disorder
- Considerations:
- Observe for liver damage (jaundice, abdominal pain, unusual fatigue)
- Monitor liver enzymes
- Administer B6 to prevent peripheral neuropathy
- Contraindications: allergy to INH, history of liver damage from INH
38. Prototype: rifampin: antimycobacterial
drug MOA: inhibit ran synthesis, blocking transcription Use: tb, leprosy, meningitis, legionella
39. Rifampin a/r: •Liver toxicity
- Urine, saliva, tears, and sweat turns red-orange
- GI symptoms
- Flushing, rash, itch Considerations:
- Monitor liver enzymes
10 / 19 ettects: •Sexual processes
- Accessory sexual organs
- ‘RBC and platelet production
- Bone and muscle growth
44. Testosterone a/r: •Altered libido
- Aggressive behavior
- Hyperglycemia
- Priapism
- Venous thromboembolism
- Hepatotoxicity
- Na+ & H2O retention
- Polycythemia
- Hypertension
- BPH
- Hyperlipidemia Hepatic necrosis, Hepatitis, Hepatic tumors (risk for liver cancer), Respiratory distress
45. Anabolic steroids: Synthetic testosterone: Ettects: anabolic
- bone & muscle development
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- strength and power
- androgenic
- sexual characteristics
- euphoria & enhanced sexual performance
- changes in mood and behavior Indications:
- delayed puberty
- hypogonadism
- muscle loss in cancer and AIDS
- osteoporos is breast cancer
46. Anabolic steroids risks and lt effects: Risks:
- Addiction
- HIV, hepatitis transmission Long-term ettects:
- Renal impairment or failure
13 / 19 MOA: relaxes muscle around prostate, decr pressure on urethra, incr urinary flow Use: BPH
51. Tamulosin a/r: orthostatic hypotension, priapism, stutty nose, headache, dizziness, vision changes
Considerations: taken indefinitely
52. 5-alpha reductase inhibitors: Prototype:
finasteride MOA: "shrinks prostate" Use: BPH, male pattern baldness
53. finasteride a/r: “libido, impotence, hirsutism,
ED Caution:
- No blood donation for 1 month after last dose
- Months before any improvement in urine flow Pregnant patients should avoid touching finasteride
54. Crystalloids: Short term maintenance therapy
treat dehydration and electrolyte in balance examples: dextrose in water, 0.9 saline, lactated ringer's, .45 saline
55. colloids: albumin, dextran solutions
56. sodium: major extracellular
cation 135-145 mEq/L
57. Hyponatremia: causes: polydipsia d/t psychosis, diuretics, SIADH, surgery, hypothyroidism, HIV, exercise
induced signs/symp: neurological symptoms
14 / 19 treatment: repletion; too fast is dangerous
58. Hypernatremia: Causes: free water loss, skin loss, gi loss, urinary loss
signs/symo: neurological manifestations treatment: oral water replacement , IVF (D5W or half NS)
59. potassium: major intracellular cation
3.5 - 5.5 mEq/L
- Transmission and conduction of nerve impulses
- Contraction of cardiac, skeletal, and smooth muscles
- Normal kidney function
- Change carbohydrates to energy
- Change amino acids to protein
- Promotes glycogen storage in hepatic cells
60. Hypokalemia: causes: •Decreased intake
- Increased availability of insulin
- Hypothermia
- Upper/lower GI loss
- Diuretics
- Urinary/sweat loss
- Dialysis
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- Tomatoes, cucumbers, tuna, spinach
- Drug ettect on potassium balance
63. chloride: 96 -106 mEq/L
- Maintain acid-base balance
- Regulate fluids
- Transmit nerve impulses
64. Hypochloremia:
Causes Excess use of
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- Laxatives
- Corticosteroids
- Chemotherapy
- NG suction
- Prolonged diarrhea or vomiting
- HF
- Renal dysfunction
- Endocrine disorder
- Chronic lung disease (emphysema) treatment: diet, ivf, address underlying cause
65. Hyperchloremia: Causes
- DM
- Severe dehydration
- Renal dysfunction
- Severe diarrhea
- Intake of too much saline solution (surgery)
- Extremely high ingestion of dietary sodium
- Respiratory alkalosis
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- Mg use in eclamptic patients treatment: restrict mg, treat cause, dialysis
69. Morphine Sulfate: MOA: CNS depression; suppression of pain impulses by bing w/ opiate receptors
Use: severe pain, anxiety in mi, dyspnea ad/re: hypotension, itching
