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Phirst Grade Pharm I
NSG 215 Pharmacology
| Question | Answer |
|---|---|
| Chemotherapeutic Drugs are agents that affect cells by: | 1. Altering cellular function or disruption of cellular activity. 2. Preventing cellular reproduction, leading to cell death |
| Histocompatability antigen | Proteins located on the membrane that serve as genetic markers, id's the cell as self. |
| Chemotherapeutic Agents- Bacteriostatic or Bacteriocidal? | Bacteriocidal. Alters cell membrane structure; causing rupture. |
| Anti infectives are used to: 1. 2. 3. | 1 Treats systemic infections (sepsis) 2. TX local infections (strep throat) 3. Prophylaxis (Malaria) |
| Anti-Infectives include: | Antibiotics Antivirals Antifungals Antiprotozoals |
| Frequently associated with infections of Respiratory Tract and soft tissues | Gram Positive |
| Associated with infections of the GU and GI tract | Gram Negative |
| Penicillin's Bacteriocidal or Bacteriostatic? | Bacteriocidal. Causes bacterium to take up excess water = cell membrane rupture ONLY LETHAL to bacteria undergoing active growth and division |
| A bacterial enzyme that inactivates most but not all penicillins | Penicillinase |
| Enzymes that are produced by bacteria that are specific for the chemical structure of the penicillins and render them ineffective | Beta Lactimase |
| What are penicillins prescribed to treat? | TX streptococcal infections: Strep throat, tonsillitis, scarlet fever, syphilis |
| What is a common side effect of penicillin? | GI disturbances, ALLERGIES; ANAPHYLAXIS |
| Patients who are allergic to any of the _____________ may also be allergic to Penicillin | Cephalosporins |
| Naming convention for penicillins? | "Cillin" : Penicillin G, Amoxicillin, Pipercillin, Ampicillin, benzathine penicillin |
| Beta-lactamase inhibitors bind and inactivate beta-lactamase enzymes produced by what bacteria? | E. Coli, Klebsiella, Enterobacter, Staph aureus |
| Beta lactamase inhibitors are used in conjunction with ____________ to protect this drug from destruction. | Penicillins |
| Clavulanate, sulbactam, and tazobactum are all drugs that are available in combination with the penicillins | beta lactamase inhibitors |
| Unasyn belongs to what category of drugs? | combo PNC and betalactamase inhibitors ampicillin and sulbactam |
| Augmentin is the combination of penicillin and what other drug? | clavulanate |
| Zosyn is the combo of penicillin and what? | tazobactam |
| Group is similar to PNC in stucture and activity, they have a beta-lactum ring | Cephalosporins |
| Cephalosporins, bacteriocidal or bacteriostatic? | Bacteriocidal Low toxicity, most widely used antibiotic |
| Effective against gram positive, modest against gram negative. NOT EFFECTIVE FOR MRSA | 1st generation cephalosporins |
| First gen cephalosporins are effective against which organisms? | Streptococci, Staphylococci (except MRSA), Neisseria, Salmonella, Shigella, E-Coli, Klebsiella, Bacillus |
| Which generation Cephalosporin? Effective against Gram negative, limited category, mostly used for prophylaxis. | Second Generation useful for: Hemophilus influenza, Klebsiella, E. Coli, Proteus |
| 3Rd generation Cephalosporins Gram positive or negative? | weak gram positive, strong gram negative. |
| 3rd Generation Cephalosporins what are they used for? | Penetrates to the CSP, given for menigitis caused by gram-negative bacilli. E. Coli, Proteus, Citrobacter, Serratia, Meningeal infections caused by H. Influenzae, Neisseria meningitides, Streptococcus pneumoniae |
| 4Th Generation Cephalosporins why are they better than 3rd Generation? | Greater spectrum of antimicrobial activity and greater stability against beta-lactamase enzymes |
| Which Cephalosporin is given for surgical prophylaxis and tx of infections of the respiratory tract, skin and soft tissues, bones, joints, urinary tract, brain, spinal cord, and bloodstream | Cefipime (Maxipime) *Reserved for difficult infections* |
| Cephalosporins are used as treatment of..... | Surgical prophylaxis, TX Respiratory tract infections, skin and soft tissues, bones, joints, urinary tract, brain/spinal cord, bloodstream |
| Contraindications for cephalosporins? | Previous allergic reaction to PNC |
| How do Cephalosporins work? How are they named? | Disrupts cell wall synthesis "CEPH, CEF" Cephalexin (keflex) Cefotetan (cefotan) Cefriaxone (rocephin) Cefepime (maxipime) |
| Bacteriostatic; gram positive and gram negative bacteria Tx UTI | Sulfonamides "Sulfa"diazine "Sulfa"salazine "Sulfa"methoxazole |
| what is the action of sulfonamides? | Disrupts the synthesis of tetrahydrofolic and folic acid production, necessary for synthesis of DNA/RNA and some proteins |
| What drug is similar to and often used with sulfonamides? | Trimethoprim |
| Combination Sulfamethoxazole and trimethoprim are known as what more common names? | Bactrim/Septra |
| Work by interfering with protein synthesis. Enters microbial cells and attach to 50S ribosomes. Inhibits protein synthesis. | Macrolides |
| Macrolides, effective against gram positive or negative? Bacteriostatic or Bacteriocidal? | Gram positive and broad spectrum - steptococci, pneumococci, most staphylococci Bacteriostatic but can also be Bacteriocidal |
| Macrolide prototype? Tx? | Erythromycin - tx. Legionnaires, used as sub for PNC G, chylamidial infections, mycoplasmal pneumonia, FIRST choice for whooping cough (Pertussis) |
| Macrolides? | "THROMYCIN" Erythromycin Azithromycin (zithromax) Clarithromycin (biaxin) |
| Nursing considerations for administering Macrolides? | Give on empty stomach 1 hour before or at least 2-3 hours after a meal CAUSES severe nausea/vomiting |
| What are Macrolides (THROMYCIN) used to treat? | Respiratory, skin/soft tissue infections caused by strep and staph infections |
| "FLOXACIN" | Fluoroquinolones, before addition of fluoride molecule were "quinolones." developed to treat UTI. |
| Synthesized by adding a fluorine molecule to the quinolone structure | Fluoroquinolones addition of molecule increases activity against gram negative organisms/ broadens antimicrobial spectrum |
| Fluoroquinolones bacterialcidal or static? | Bacteriocidal, active against gram negative and positive. Interferes with DNA enzyme action necessary for growth and repro. |
| What drug category treats gonorrhea and multi-drug resistant TB? | Fluoroquinolones |
| What drugs are in the Fluoroquinolones category? | "Floxacin" Ciprofloxacin (cipro) Levofloxacin (levaquin) Gatafloxacin (tequin) Ofloxacin (Avelox) Sparfloxacin (zagam) |
| Narrow spectrum antibiotics used primarily against aerobic gram negative bacteria; Pseudomonas, Proteus, E. Coli, Klebsiella, Enterobacter, Serratia species | Aminoglycosides "CIN" Gentamicin (garamycin) Amikacin (Amikin) Tobramycin (Nebcin) |
| How would Gentamicin (Cephalosporin) be administered? | Must be given parenterally IM/IV Poorly absorbed by GI tract |
| Side effects/contraindications of Aminoglycosides? | Serious adverse effects, hepato and nephro toxic! DO NOT give concurrent with potent diuretics! PEAK AND TROUGH must be drawn! |
| How do Aminoglycosides work? | Inhibits protein synthesis |
| Inhibition of protein synthesis, suppresses bacterial growth by bind to 30S ribosomal subunit, inhibits bind of tRNA to MRNA. | Tetracyclines "CYCLINE" Broad spectrum Doxycycline (vibramycin) Tetracycline (panmycin) Minocycline (minocin) Demeclocycline (Declomycin) |
| Tetracyclines are used for what disorders? | Rocky mountain spotted fever Chlamydial infect Brucellosis Cholera Mycoplasma pneumoniae Lyme disease Anthrax Gastric infection caused by H. Pylori Treats ACNE (low dose) |
| contraindications of tetracycloines? | Not for use during pregnancy or children under the age of 8. May cause permanent teeth discoloration **Do not take with Milk products/most antacids** (binder) Photosensitivity |
| Slow growing microbes, thick lipid rich membranes- holds acid when stained (acid fast bacillus) | Mycobacteria |
| Drugs used to treat TB (mycobacterium tb) | Antimycobacterial antibiotic Isoniazide (INH) Rifampin (Rifadin) Ethabutol (myambutol) TX for active TB, always 3 drug combo Inactive, single drug prophylaxis |
| Drugs to TX Leprosy (Mycobacterium leprae) | Leprostatic antibiotics Dapsone- similar to sulfonamides, inhibits folic acid production |
| Aztreonam (Azactam) what category use? | Monobactam antibiotic Used for gram - enterobacteria and/or when PT allergic to PNC or cephalosporins Disrupts cell wall synthesis (bacteriocidal) |
| "MYCIN" Similar to macrolides but more toxic TX severe infection when less toxic antibio can't be used Inhibits protein synth | Lincosamides "mycin" Clindiamycin (cleocin) (prototype) bacteriostatic Lincomycin (lincocin) |
| Lincosamides Effective against? | Gram positive cocci including group A, streptococci, pneumococci, most staph, some anaerobes, clostridia and bactericides fragile |
| Side effects of Lincosamides? | GI related, possible fatal pseudomembranous collitis |
| New category with only one med Telithromycin (KETEK) Related to what group? | Ketolides Related to Macrolides blocks protein synthesis |
| Ketek is used to treat what disorder? Side effects? | Mild to Moderate community acquired pneumonia SE: GI |
| New class of broad spectrum antibio effective against gram+ and Gram - TX serious infections caused by strains of various bacteria (NOT MRSA) Not recommended for use under 18 | Carbapenems "penem" Imipenem (primaxin) most common Meropenem (merrem) Ertapenem Doripenem (Doribax) |
| How would the nurse administer Primaxin (Imipenem)? | Carbapenems must be given parenterally |
| Common adverse effects of Carbapenems? | GI |
| "MISC drugs" | Metronidizole (Flagyl) Vancomycin |
| Used for prevention and treatment of anaerobic bacterial infections (often used prior to or concurrent with surgery of the abdomen, colorectal) | Flagyl (metronidizole) |
| Can be used for C. Diff associated with Pseudomembranous colitis, protozoa that causes amebiasis, giardiasis, and trichomoniasis | Flagyl |
| Effective against anaerobic bacteria including gram negative bacilli such as Bacteroides, gram positive Clostridia | Flagyl |
| Only active against Gram Positive organism. Inhibits cell wall synthesis. ONLY for severe infections such as MRSA | Vancomycin |
| Particles composed of either DNA or RNA encapsulated with a protein coat can only live and replicate inside a living cell | Virus |
| When using Oseltamivir (Tamiflu) dosing must begin within __hours of symptoms | 48 |
| First flu drug available | Amantadine (symmetrel) Believed to inhibit viral coating |
| Uses for Amantadine (Symmetrel) are...... | Prevention/TX of flu, Respiratory tract infection, Parkinsons disease symptoms |
| First choice drug for treatment of infections cause by herpes simplex or varicella zoster viruses | Acyclovir (zovirax) Inhibits viral replication by suppressing synthesis of viral DNA |
| Use for Foscarnet (fosavir)? | Treats cytomegalovirus and herpes simplex Good hydration should be implemented to decrease toxic effects |
| Reverse transcriptase inhibitors action and what do they treat? | HIV Binds to DNA/RNA to prevent transfer of information |
| Protease inhibitors are used to treat? | HIV Blocks manufacture of protease necessary for viral replication |
| Nucleosides | TX HIV Interferes with replication by inhibiting protein synthesis |
| Non-nucleosides | TX HIV Interferes with synthesis of HIV DNA by causing premature termination of the growing DNA strand |
| HIV meds- what implications for nursing? | Must be admin around the clock to be effective Monitor Renal and hepatic function prior to and during tx. Instruct that severe rashes may occur, med must be d/c'd if this occurs. |
| Two categories of antifungal agents | 1. Drugs that tx superficial mycoses 2 drugs that tx systemic mycoses |
| This drug is active against a broad spectrum of pathogenic fungi, it is highly toxic TX histoplasmosis, leismaniasis | amphotericin B |
| Amphotericin B | Binds to components of fungal cell membrane, increases permeability, leakage of cell contents Not used frequently, toxic |
| Patient has been prescribed amphotericin B, what precautions should the nurse take prior to administering med? | Can cause renal failure, must be closely monitored. Should not be on any other nephrotoxic drugs OR corticosteroids- increase renal failure risk! |
| Largest group of commonly used antifungals | Azoles Ketoconazole (first on market) Fluconazole (Diflucan) #1 given |
| Oral alternative to Amphotericin B, treats less severe mycoses. Can be taken orally, topically or as a shampoo | Ketoconazole |
| Ketoconazole mechanism of action | Inhibits the synthesis of ergosterol- an essential component of the fungal membrane SE: N |
| Fluconazole (Diflucan) Action? USE? | Same action as ketoconazole (But safer) Used to tx candidiasis, cryptococcal meningitis, other systemic fungal infections |
| Topical antifungals? | AZOLES Clotrimazole (lotrimin) Butoconazole (Femstat) LOCAL USE ONLY |
| Dermatophytes | Fungi that cause infections such as the tinea infections, candida infections |
| Malaria treatments? | Antiprotozoals, Mefloquine TX and prophylaxis of Malarial infection Chloroquine acute tx and prophylaxis |
| Mefloquine USE? Implications? | Tx/prophylaxis of malarial infection Bacteriocidal, causes acidity and rupture of plasmodium cells Tx must be started 1 week before travel, once a week while in area, 4 weeks after return |
| Chloroquine used for..... can also be used for..... | Acute tx/prophylaxis of malaria Inhibits protozoal repro and protein synthesis TX begins 2 wk prior to travel, while in region, 6-8 weeks after. CAN ALSO BE USED FOR RHEUMATOID ARTHRITIS |
| Malarial drugs--- Cautions? | Caution in patients who are taking drugs that affect the retina Assess frequently for vision and hearing changes |
| Giardiasis | Inection of sm. Intestine caused by protozoa, Giardia Lamblia From cysts in contaminated water. |
| Giardiasis S/S, tx? | Severe diarrhea, mucous filled stools, fever, cramps, nausea, weakness, weight loss TX with metronidazole (Flagyl) |
| Metrocondazole (Flagyl) | Inhibits DNA synthesis Tx intestinal infections, For GIARDIASIS, 250MG PO TID for 7 days! |
| Infection caused by a fluke (worm) carried by a snail. S/S? TX? | Schistosomiasis Pruiritic rash, fever, chills, headache, Chronic: abd pain, diarrhea, splenomegaly, hepatomegaly, cardiac ischemia Mebendazole (Vermox) |
| Mebendazole (Vermox) give to treat? | Worm infestations Blocks glucose uptake by susceptible helminthes |
| Antineoplastics are used to treat? | Cancers Affects cell survival or boosts immune system |
| antineoplasic agents? | Alkkylating agents, antimetabolites, antineoplastic antibiotics, mitotic inhibitors, hormones, hormone modulators. |
| Adverse reaction of antineoplastics? | N&V, Diarrhea, alopecia, mouth sores, bone marrow suppression |
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