Classes 1-4
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Common Errors in Prescribing Medications for Children | Fatigue, Hunger, Concentration, Stress, Distraction, Lack of Training, Lack of access to info
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| List the Steps you can take to prevent medication errors when prescribing | I Can PresCribE A Drug
indication, contraindication, precautions, cost/compliance, efficacy, adverse effects, dose/duration/direction
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| Describe what ENANTIONER DRUGS are | drugs that exist in pairs
usu one side is more effective
the less active side is usu the cause of ADE
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| How do drug interactions affect ABSORPTION? | absorbed best in neutral environment (unionized)
Passive (high conc-> low conc)
Facilitated (low conc-> high conc)*carrier
Active (low conc-> high conc)*energy
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| How do drug interactions affect DISTRIBUTION? | competition for plasma protein binding, displaces one drug from a binding site by another, increasing free concentration
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| How do drug interactions affect METABOLISM | mainly involves CYP 450 system in the liver
Phase 1 (small intestine major site of metabolism,contains enterocytes in bowel mucosa and CYP450 enzymes)
phase2 (responsible for synthesis of water soluble compounds like morphine, propofol and caffeine)
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| How do drug interactions affect ELIMINATION? | requires drug to be polarized, un-polarized drugs diffuse back into circulation
*kidneys (major route)*liver (bile)
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| Explain principles of Therapeutic Monitoring | use to monitor concentrations to adjust regimen to avoid ADR.
to determine dosage, TR for patient and compliance
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| Why would you INCREASE/DECREASE a dose? | changes the steady state peak concentration
(inc the dose = inc SS = drug concentration)
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| Why would you INCREASE/DECREASE the dosing interval? | Dosing interval influences peaks/troughs
(inc interval = dec trough = allows time for M&E)
ex if you check a trough and it is incr, then change the interval from Q12 to Q 24 = decrease trough
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| What is the difference between time vs. concentration-dependent killing of bacteria? | time dependent (time the drug id above the MIC, so more freguent dosing or cont infusion)ex.PCN
concentration dependent (increased effect (peak) when doses are above MIC, so larger less frequent doses)ex. aminoglycosides
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| What is the difference between ON vs. OFF label use of drugs | OFF label (not illegal)
NO peds dosing, NO warning of ADE, NO drug interaction info, NO liability sponsor, NO long term surveillance, NO peds formulations
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| What are LEGEND, OTC, and CONTROLLED drugs? | Legend are prescription drugs
Controlled drugs can be abused. NP can prescribe schedule II-V
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| Proprietary vs. Nonproprietary | NON-Proprietary (generic/common name)
ex. acetaminophen, ibuprofen, aspirin
Proprietary (trade name by company)
ex. Tylenol, Motrin, Vicodin
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| Pharmacokinetics and Pharmacodynamics | Kinetics: what the body does to a drug
Dynamics: what the drug does to the body
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| Hydrophilic vs. Lipophilic Drugs | Hydrophilic (water soluble)drugs have a smaller Vd than lipophilic (lipid soluble)
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| P-glycoprotein | reverse transporter protein
is a membrane -bound transport sys responsible for drug transport across cell membranes
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| Bioavailability, including first pass hepatic metabolism | the fraction of admin drug that reaches the circulation
Affected by 1st pass (drug metabolized by gut wall or liver before entering into bloodstream) decrease concentration
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| CYP 450 enzyme system | super family of over 100 different enzymes
(phase 1 reaction)
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| Inducers vs. inhibitors | Inducers (Increase rates of CYP enzymes & metabolism,decreases plasma conc, drug activity, and TE.Increases prodrug activity)
Inhibitors (do the opposite)*grapefruit juice
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| Genetic variation in CYP metabolism | can alter drugs efficacy and risk AE
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| Poor vs. Rapid Metabolizers | Poor->Caucasians, Chinese/Japanese, Asians
*cough syrup
Rapid->Smoking can metabolize drugs faster
Thyroid function, Age extremes, Pesticides
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| Vd | distribution of drug in the body compared to unbound plasma conc
*the more body the drug can be distributed to the more drug concentration is dec
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| Non-genetic vs. Non-drug considerations for metabolism | Can inhibit (grapefruit juice, charbroiled food, cruciferous veggies (broccoli, cauliflower,cabbage)
Smoking can metabolize drugs faster
Thyroid function, Age extremes, Pesticides
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| Slow vs. Fast acetylators (How fast does this affect drug availability) | Slow->more drug in plasma, risk of toxicity
* children= increase with age
Fast-> too little drug in plasma, decreased Therapeutic effect
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| Properties of drugs that increase their renal clearance | Incr renal flow=incr excretion
incr protein binding=decr excretion
mainly by acid/base transport (pcn, histamine)
incr secretion in drug poisoning
alkaline urine= prevent reabsorption of acid
acidic urine=prevents reabsorption of bases
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| T 1/2 | Time to 50% reduction of drug in the body
*time required to meet steady state
*it takes 3-5 1/2 lives to get up to the steady state, reached faster with loading dose
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| steady state | steady state achieved when rate of elimination=rate of administration(amt taken)
*represewnts equilibrium in drug concentration
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| Drug-receptor binding | Most drugs exert their effect by binding to a receptor a protein on or w/I a cell
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| Agonists vs. Antagonist | Agonist->drug that binds to a receptor to stimulate the target organ
Antagonist-> drug that decreases or opposes responses caused by drug agonists *if stopped can have rebound effect
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| Tachyphylaxis | Repeated/continuous stimulation of a receptor by a drug can desensitize the drug
*protects the cell from excessive stimulation, lowers the response of the drug
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| Therapeutic index (TI) and drug safety | measure of safety of drugs
large value indicates wide margin b/t effective and toxic
bioavailability is critical in drugs with narrow TI
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| Difference in pharmacokinetics in adults vs. infants/children |
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| Prodrug and how metabolism effects drug effectiveness |
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| Factors contributing to ABX resistance and measures to minimize | inapprop use, inadequate coverage, excessive broad spectrum use, poor adherence, retained abx for later use, prolonged hosp saty immunosuppressed population, invasive device
reducing resistance->education, abx stewardship, infection control, vaccinations
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| STAPH | gram + cocci aerobic catalase +
aureus(coagulase +) epidermis (coagulase -)
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| STREP | gram + cocci aerobic catalase -
pneumoniae (a-hemolysis) GAS (B-hemolysis)
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| Pseudomonas | gram - rods aerobic
(e.coli, salmonella, shigella) cocci->nisseria
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| Distinguish normal flora vs. disease causing | see chart
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| Drug Classes | Beta lactams(pcn, cephalosporins,carbapenems)
fluoroquinolones
aminoglycosides
macrolides
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| Bactericidal vs. Bacteriostatic | Bactericidal-> kills bacteria
Bacteriostatic-> suppress growth allowing the immune sys to fight infection
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| Different approaches to antimicrobial therapy (prophylaxis, empirical tx, definitive) | P=prevent infection
E=treatment of infection prior to knowing known organisms
D=culture & sensitivities narrow the treatment specturm
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| beta lactamase- producing microbes (their consequences and treatment) | M.catarrhalis, H. influenzae
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| Common bacterial organisms for HEENT infections | RSV, Parainfluenza, FLU, Coronavirus, M.catarrhalis,Recurrent OM: Parechovirus Chlamydia, Mycoplasma
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| Drugs used to treat HEENT infections (indication, primary and alternate, instru) | Amoxicillin, Azithromycin, Ceftriaxone, Augmentin, Levofloxacin
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| Amoxicillin | 25-45mg/kg/dose BID 80-90mg/kg/dose BID
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| Amoxicillin-clavulante | <3mo (20-40mg/kg/d)BID 4:1ratio 3mo and older (25-45mg/kg/dose)BID 7:1ratio 3mo to <40kg (90mg/kg/d)BID 14:1ratio >16 yo (1000mgamox/62.5mgclav) 16:1ratio
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| Azithromycin | 10mg/kg/24hr QDx3days
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| Guideline for non-treatment of AOM | Observation is approp, if follow-up can be ensured nonsevere illness in mild otalgia and temp<39. severe illness w/ otalgia temp>39.0 A cetain dx meets 3 criteria 1. rapid onset 2. signs of middle ear effusion 3. s/s of middle ear inflammation
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| 3 first-line ophthalmic abx pathogens treated and age guidelines | Ciprofloxacin, polymyxin B-bacitracin, Polymyxin B-trimethoprim
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| How do Drug transfer increase throughout pregnancy | Placental Anatomy, Placental and Maternal Factors
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| What influences Placenta development and gestational changes in fetal drug delivery | Surface Area (stretches and accommodates the fetus)
Membrane thickness decreases overtime->term
Increased bd flow to membrane (500ml to 600ml/min)
pH differences b/w mom and fetus
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| What are the contributing factors to drug trapping in the fetus | Ion trapping occurs when ionized drugs are trapped in the fetal circulation
fetus(7.3) mom(7.4)
so when weak bases are more ionized, they will also be more ionized in the fetal circulation->net circulation
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| Describe the mechanism of drug transfer across the placenta | Simple diffusion(passive), facilitated(carrier mediated), active transport(carrier medicated/ATP)P-glycoprotein(pumps drugs back into the maternal circulation=decr fetal transfer)
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| Which drugs have rapid placental transfer | ABX, Benzo, Phenytoins, Barbi, etoh, meperidine, salic, lido, propranolol, cocaine, heroin
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| Which drugs/chemicals can pass into the breast milk | Diffusion is most common mechanism
*milk is very acidic and can also cause ion trapping
radio active chemicals cross over easily
*DDT
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| What are the FDA teratogenic risk categories | Category A(no risk to fetus)
Category B(animal studies have not shown risk)
Category C(animal studies have shown risk, but benefit to mom may out way harm to fetus)
Category D(studies show harm, but may warrant use anyway)
Category X(risk outweigh ben
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| What are the significant developmental changes of the skin | 13% of infant total body is skin vs. 3% adult
infants have greater total surface area
preemie have thinner epidermis and dcer fat, which icre perfusion/hydration of the skin
infants have incre risk of toxicity from topical drugs
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| Identify common age related areas of atopic dermatitis | less than 2->face, scalp, hands, feet
older ->adolescent->inside knees/elbows, neck, hands, feet
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| What is the stepwise treatment of atopic dermatitis | 1st line tx->topical corticosteroids (non-specific anti-inflam)immunosupre, vasoconstr
Oint->Gels->Creams->Lotion
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| How do you treat itching and super infections in AD | itching->Benadryl, hydroxyzine, cetirizine, montelukast, emollients
Super infections-> topical (mupirocin)
po-cepalexin(keflex), augmentin, cefprozil
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| What important educational points to remember with AD | apply thinly BID, start at 1st sign of flair, then taper to moisturizer
don't use steroids in infected areas
don't apply to wet skin and wash hands after application
chill before use to decr sting
apply moisturizer on top after
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| Contact dermatitis and treatment | irritant, rash usu at the point of contact
Tx: low->interm steroids (1%, 2.5%)
high potency if plant dermatitis
oral steroid if sever x2-3wks to prevent rebound prednisone1mk/kg/d, max40mg/d
methylprednisone(Medrol pack)6day,
24mg d1 taper to 4mg->d
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| Diaper rash and treatment | irritant due to urine, feces under occlusion
infectious: candida
Tx:frequent diaper changes, open to air, keep dry,no chemicals/powder
OTC barrier: A&D, zinc ox (desitin)balsam of peru(balmex)
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| Tinea Corporis | 1st line tx:(allyamines,fungicidal):terbinafine(lamisil), naftifiine 1%(naftin)
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| What are the causes of acne and common bacterial flora | incr sebum production, occlusion of hair follicle
colonization by propionibacterium acnes
control inflammation by altering bacterial flora
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| What is the algorithm for treatment of each level of acne | see chart
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| Topical retinoid and retinoid like compounds | 1st line Tretinoin (Retin-A)(0.025%, 0.1%)
start w/lowest concentration then incr ifneed
Adapalene (Differin)a retinoid like comp
gel(0.1%) >than 12 y.o
*increase photosensitivity
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| Topical abx | Clinda (Clinda-Derm)use in >12yrs
Erythro (Akne-Mycin)solu->1,2% oint/gel 2%
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| Tetracycline | inhibits growth of P acnes
use for 4-6 months, then go back to topical
1st line po
take on empty stomach
photsensivity, staining teeth<12yrs
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| Isotretinoin | Accutane
*most potent agent for acne tx
decr sebum production
tx for 20weeks
ADE: IBS and teratogenicity
iPledge
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| What are the common causative organisms for bacterial skin infections | s. arues, s.pyogenes, GAS
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| Impetigo | Extensive lesions
Cephalexin (50-75mg/kg/d TID)
Amoxicllin-calvulante (45mg/kg/d)
if CA-MRSA
Clinda(30mg/kg/d TID)
Bactrim (8mgTMP/kg/d BID)
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| Cellulitis | s. aureus, s.pyogenes
human bite(bacteroides)anmi bite(pasteurella)
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| What organisms causes lice and scabies | Pediculus humanus and Sacroptes scabiei
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| Scabies treatment | 5% cream (Elimite Rx)>2yr
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| Lice treatment | 1% cream rinse >2mos (NIX, OTC)
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| What are the 3 factors affected by absorption | 1. Blood flow at the site (poor blood flow delays absorption)
2.GI function (varies until 20-30 mths)
3.Thin stratum corneum
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| Beta Lactams | 1/2 abx
can have hypersensitivity reactions (rash, interstitial nephritis, anaphylaxis)
adjust for renal function *seizures
safe to give in pregnancy *decr contraception
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| Bactericidal Agents | PCN, Cephalosporins, Carbapenems, Fluoroquinolones (Quinolones),Aminoglycosides*,Glycopeptides,
Folate Antagonist, Nitroimidazoles
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| Natural Penicillin | PCN G*does not survive in stomach (parental) PCN V (oral) *gram +
use:syphilis, step pharynx, endocarditis
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| Anti-staphylococcal PCN | nafcillin, oxacillin, dicloxacillin *gram +
metabolized by the liver
crosses blood-brain barrier
AE: acute interstitial nephritis
Use:MSSA (endocarditis, skin/soft tissue inf)
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| Aminopenicllins | amoxicillin (oral), ampicillin (IV) *gram +
good gram - cocci coverage
use: URI (pharyngitis, otits media)
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| Beta-lactam/beta-lactamase inhibitor combinations | amoxicillin/clavulante,ampicillin/sulbactam
piperacillin/tazobactam,ticarcillin/clavulana
*use:empiric tx for nosocomial inf, per appy, diabetic ulcers, aspir pna
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| Anti-pseudomonal PCN | extended spectrum PCN
piperacillin, ticarcillin *gram +/incr gram-
use:infections caused by pseudomonas or GNR
*often use with beta-lactamase inhibitor
interacts with Warfarin
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| Cephalosporins | grouped by generations
cross allergenicity with pcn (mostly 1st gen)
most excreted by kidneys
in general are safe
*phlebitis at IV site, false + glucose test
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| 1st generation Cephalosporins | cefazolin, cephalexin (Kelfex)
less frequent dosing
use: Skin/soft tissue (s.aurues, strep), surgical prophylaxis, MSSA endocarditis
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| 2nd generation Cephalosporins | cefotetan (po) cefuroxime (po,IV) cefoxitin cefprozil
*gram -
AE: inhibit Vit K production and prolong bleeding, disulfiram-like rx w/ etoh (cefotetan)
use:URI & community acquired pna
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| 3rd generation Cephalosporins | ceftriaxone, cefotaxime, cefdinir, ceftazidime
*Broad Spectrum Agents*
AE:C-diff assoc, vit k inhibition, iron antacids, H2 blockers reduce absorption
ceftriaxone-> calcium forming crystals
*Avoid use in neonates with hyperbili
use:lowerURI,pyelo,men
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| 4th generation Cephalosporins | cefipime (IV only)
*Broadest Spectrum gram+ and - (pseudomonas)
use:febrile neutropenia, nosocomial pna, UTI
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| 5th generation Cephalosporins | ceftaroline *newly approve, not for kids
use: MRSA, community acquired pna
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| Carbapenems (IV or IM) | imipenem/cilastatin, meropenem, ertapenem
*Broadest spectrum agents
gram+ and -
use: MSSA, Pseudomonas, Superbugs(complicated peds UTIs)
AE:sz, avoid in meningitis and PCN allergy
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| Fluoroquinolones (Quinolones) | ciprofloxacin, levofloxacin, moxfloxacin, gemifloxacin
Broad spectrum
AE: photosensitivity, nephritis, prolong QT
Black box->worsening MG and Achilles tendon
bioavil->decr w/Ca, Fe, antacids, milk, mvit
use:pna, sinusitis, gonorrhea, pseudo(cipro)
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| (Quinolones) | increase levels of theophylline, phenytoin, warfarin
concurrent use of Nsaids incr risk of sz
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| Aminoglycosides | gentamycin, tobramycin, amikacin
gram- bacilli
AE:ototoxicity, nephrotoxicity, renal failure
avoid in preg(8th cranial nerve fetal toxic)
narrow TI
*dose based on ideal body wt
use:febrile neutropenia, sepsis, VApna
endocarditis, osteomyelitis
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| Macrolides | clarithromycin, azithromycin
*not used for serious infections
AE:sign GI, prolong QT interval, extensive drug interaction (CYP450)*azithro
use:travelers diarrhea(azithro)h.pylori(clar)
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| Glycopeptides | vancomycin
*broad gram +
AE:red man syn,ototoxicity, nephrotoxicity
use:drug of choice MRSA, po tx for Cdiff
*troughs are important->gives an idea if drug is being excreted properly. incr torugh=incr nephrotoxicity
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| Tetracyclines | doxycycline,tigecycline (most used) minocycline, tetracycline, gram - bacilli
AE: discoloration of teeth child<8yo, affect bone deve in fetus
use:URI, CAP, malaria prophylaxis, complicated skin/soft tissue inf
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| Folate Antagonist | trimethoprim/sulfamethoxazole (TMP/SMX)
*dose based on TMP* (ex)broad spectrum
*bacterial resistance common
AE: photosensitivity, multi drug interactions (warfarin, phenytoin)*avoid w/ sulfa allergy
*avoid in term infants/pregn (neonatal kernicterus)
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| Lincosamides | clindamycin *gram +
AE: high risk Cdiff
use:skin/soft tissue (oral cavity)
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| Nitroimidazoles | metronidazole *gram+and-(wipes out anaerobes)
AE: metallic taste, reversible peripheral neuropathy, disufiram-like rx
use:vaginal tric h.pylori gi ulcers, drug of cjoice for cdiff
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| Ciprofloxacin 3.3mg/g | Staph, s.pneum, s.pyogens drops >1yr (1-2 Q2hx 2d, then Q4hx 5d) oint >2yr (1/2in TIDx2d, then BIDx 5d)
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| Polymyxin B-bacitracin 10000U:500U | staph, strep, clostridia, gm- gonococci, meningococci, p.aeruginosa, H.influ all ages oint: 1/2in BID Q3hx7-10d
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| Polymyxin B-trimethoprim 10000U: 1mg/ml | s.aureus, s. pneumon, s. pyogen, p. aerugin. H.influ drops >2mo-> 1 drop Q3h (max 6dr/day)x7-10d
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| Acute Otits Media | middle ear infection ear pain, fever, otorrhea, bulging TM causes: gm+ strep, gm- h.influ & m.cata 1st line tx: high dose amox 80-90mg/kg 5-7d if>6yo,intact TM, no AOM w/i 1mo 10d if<6yo,severe ds, recent AOM pcn allergic:azithro 10/kg, 5mg/kg 2-5d
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| Otitis media with Effusion (OME) | presence o fluid in middle ear w/o ss in infec tx: observation for 3mo w/observation chronic OME ->persisent for >3mo cause:s.pneum, h.influ,m.catarr 1st line treatment tympanostomy tubes
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| Chronic Suppurative Otitis Media (CSOM) | Purulent otorrhea associated w/ chronic TM perforation >6mo causes: p. aeroginosa, CA-MRSA, s aureus tx: topical fluroquinolones w/ or w/o steriod ciprofloxacin drops BIDx7d or Ofloxacin
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| Pharyngitis | viral:sugessted by rhinorrhea, pink eye, cough bacterial:GAS, if untx causes rheumatic fever endocarditis or poststrep glomer 1st line:amox 50-75mg/kg, pcn 50-75, azith 12mg/kg 2nd line: Augmentin or clinda
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| Acute Bacterial Sinusitis | paranasal sinuses lasting<30d symp:nasal/postnasal discharge, cough, fevers tx:high dose amox for 14d or until symp free
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| Conjunctivitis "pink eye" | infectious often bilateral common in winter rx:polmyxin Bsulfate and trimethoprin sulfate (Polytrim) or ciproflozacin if no improvement in48-72hrs, send cx pink eye & OM-> Augmentin x10days
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| Chronic conjunctivitis | R/O tear duct obstruction (dacryocystitis) -no abx needed, only if infected Treatment should be based in cx -Gent drops (staph, pseudo) -erythro oint 0.5% (staph, strep) if no improvement in 3 days, refer to ophal
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| Common causes of ophthalmia neonatorum (neonatal conjunctivitis) | any infant<1mo *send cx to r/o gonococcal, chlamydial or hsv gonococcal prophylaxis->erthro oint w/i 1hr
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| Blepharitis | acute/chronhic inflam of eyelash follicules cause:s.aureus,poor hygiene,eczema,lice,makeu cleanse w/no tear shampoo, erythro oint BID tx for extra week after symptoms resolve
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| Hordeolum (stye) | infection of the sebaceous gland of eyelash/lid not usu tx w/ abx if needed eryth oint
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| Periorbital cellulitis | infection/inflammation of tissue surrounding eye-> orbit not involved acute onset, pain, swelling/redness, fever kids<2 unilateral infection cases:bacteremia,sinusitis,trauma,insect bite makeup-> adolescent females Ceftriaxone50-75mg/kg(IV) Augmentin
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| What is significant about Placental Anatomy | Uteroplacental circulation is established in the 2nd week after fertilization, but not well established until 4th week
->fetus is somewhat protected for a short time
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| What is the function of the placenta | delivers o2, water & electrolytes
also filters waste
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| When is fetus most at risk | Fetus is at risk early on during pregnancy
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| How does GI and Cardio changes in pregnancy effect drug delivery to the fetus | Gi-> gastric emptying time is incr and intestinal motility is decr =incr extracelluar fluid/plasma vol= incr free drug
Cardio->bd vol incre, CO incr 40-50%
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| What are the characteristics of Atopic Dermatitis (Eczema) | chronic skin disorder, hypersensitivity rx(incr IgE) asso w/ asthma, allergies (triad)
itchy,dry,raw red, inflam, oozing, crusted
lichenification->thickening of skin
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| Tinea Vesicolor | organism:pityrosporum orbiculare
tx: selenium sulfaide or ketoconazole shampoo
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| Where is the major site of drug metabolism and why? | small intestine, b/c it contains enterocytes in the bowel mucosa (CYP contining enzymes)
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| Large therapeutic window allows for? | less frequent dosing
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| Narrow therapeutic window requires? | more frequent dosing to avoid toxicity
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| Which Enantiomer is usu responsible for ADEs? | the less active enantiomer is often responsible
(eg. tachcardia with albuterol)
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| What is Passive Diffusion | diffusion from low concentration->high concen
vast majority of drugs use this process
hydrophilic drugs->aqueous pores
lipophylic->dissolve through lipid layer
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| What is Facilitated Diffusion | low concentration->high concentration
carrier proteins factiliate diffusion of drugs acros membrane
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| What is Active Transport Diffusion | low concentration->high concentration
carrier proteins actively carry drugs acros membrane
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| How are drugs affected by pH | most drugs are weak acids or bases
drugs pass through membranes more easily if UNIONIZED
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| Which drugs have a greater 1st pass effect | Lidocain, Morphine, Nitroglycerine, Warfarin
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| What happens to a drug with a greater 1st pass effect? | Drug concentration is decreased in the blood stream
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| What factors influence Bioavailability | Enterohepatic recycling, drug solubility, and chemical insability
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| Why do hydrophilic drugs have higher Vd in newborns | because the water content is higher than adults
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| Why do lipophilic drugs have reduced Vd in preterm newborns | because pretern newborns have reduced percent of body fat
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| What happens during Biotransformation | it is the process of chemically changing drugs
mainly occurs in the liver
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| What is the result of biotransformation | Increases water solubility, decreases lipid sol
increase polarity
resulting compounds readily excreted in urine
can result in metabolites with potent toxicity (prodrugs)
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| Describe Phase I of biotransformation | Most common
drugs are oxidized and reduced to a more polar form
Most frequently catalyzed by CYP450
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| What is the mechanism of CYP inducers | Increases rate of CYP enzyme synthesis
Decreases rates of enzyme degradation
Increases drug meatbolism
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| What is the consequence of CYP inducers | Decreases plasma concent, drug activity, and Thera effect
Increases prodrug activity
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| What is the mechanism of CYP inhibitors | decreases drug metabolism
increases plasma concent, and thera effect
decreases prodrug effect
increases toxic effects
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| What happens in Phase II Biotransformation | Conjugation or linking drugs with a polar chemical
Increase water solubility and renal excretion by further increasing polarity
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| What is Acetylation | Detoxification pathway in the liver
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| Why does acetyl radical congugation to a drug do? | increases excretion
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| What happens with slow acetylators | risk of toxiciity
more drug in the plasma
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| What happens with fast acetylators | Decreased therapeutic effect
too little drug in plasma
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| Name types of clearance | First order
Zero Order
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| What is First Order | flow limited clearance
amt eliminated (per time)portional to amy in body
t1/2 constant, not dependent on concentraton
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| What is Zero Order | capacity limited clearance
amt eliminated (per time)is constant
t1/2 increases as concentration increases
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| What is EC50 | concentration of drug producing more potent drug
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| What does a low EC50 indicate | it diciates a more potent drug, where less of the drug is needed to produce the same effect
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| Name the antibacterial drug classes | Beta lactams, Fluoroquinolones, Aminoglycosides, Macrolides, Tetracyclines, Gycopeptides, Nitroimidazoles, Folate antagonists, Lincosamides
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