NR 565 Advanced Pharmacology Fundamentals Final Exam Guide
Bacteriostatic
Correct Answer:
kills the bacteria
Bactericidal
Correct Answer:
kills the bacteria and stops the growth or spread of the infection
Bacteriostatic drugs
Correct Answer:
clindamycin
macrolides
sulfonamides
tetracyclines
Bactericidal drugs
Correct Answer:
ahminoglycosides
beta-lactums
fluroquinolones
Metronidazole
Streptogramins
vancomycin
anti-microbial resistance
Correct Answer:
1.) not knowing if the pt had recent use of antibiotics
2.) provider overuse of broad=spectrum antibiotics
3.) not performing susceptibility testing
4.) Age younger than 2 years or older than 65 years
5.) Daycare center attendance
6.) Exposure to young children
7.) Multiple medical co-morbidities
8.) Immunosuppression
Pharmacodynamics of Beta-lactam PCNs
Correct Answer:
inhibit biosynthesis of bacterial wall (beta-lactam ring)
subclasses of Beta-lactams PCNS
Correct Answer:
natural PCNS
aminopenicillins
anti-staphylococcal PCNs
extended Spectrum PCNs
1st line therapy for Strep pharyngitis.
Correct Answer:
penicillin V
1st line therapy for all bites
Correct Answer:
Amoxicillin/Clavulanate (Augmentin)
Natural PCN’s, Drugs
Correct Answer:
Penicillin V potassium (ledercillin) Penicillin G sodium (PCN G-Na)
Penicillin G procaine (Duracillin)
Penicillin G benzathine (Permapen)
Penicillin G potassium (Pfizerpen)
Natural PCNs active against
Correct Answer:
aerobic gram (+) organisms
Aminopenicillins active against
Correct Answer:
Gram (-) organisms
Aminopenicillins Drugs
Correct Answer:
Amoxicillin
Ampicillin
Combinations:
Amoxicillin-clavulanate (Augmentin)
1st lines therapy for acute otitis media (AOM) & sinusitis
Correct Answer:
Amoxicillin
When aminopenicillins are combined with beta-lactamase inhibitors
Correct Answer:
their spectrum in broadened
lab levels that indicate a pituitary tumor
normal/elevated TSH
increased FT4 and T3
lab levels that indicate primary hypothyroidism
low TSH
normal FT4
elevated T3
lab levels that indicate exogenous T4 ingestion
low TSH
high FT4
normal T3
normal T4 levels
4.5-12.5
normal FT4
0.9-2
normal T3
80-220
normal FT3
230-620
normal TSH
0.3-6
timeframe for re-check of labs after starting levothyroxine
6-8 weeks
s/s of hypothyroidism
Hyporeflexia, slow thought process, weight gain, constipation, cold intolerance
S/S of hyperthyroidism
Hyperreflexia, mind racing, weight loss, diarrhea, heat intolerance
Tx of thyroid storm
Methimazole and propylthiouracil
Result of not treating hypothyroidism during pregnancy
Can decrease IQ and other aspects of neurophysical function in the child
Meds that can decrease absorption of levothyroxine
H2 receptor blockers (cimetidine), PPI, carafate, cholestyramine (Questran), colestipol (Colestid), aluminum-containing antacids (Maalox), calcium supplements, iron supplements, mag salts, Xenical
Meds that accelerate levothyroxine metabolism
Phenytoin, carbamazepine (Tegretol), rifampin, zoloft, phenobarbital
Interaction between warfarin and levothyroxine
Accelerates degradation of vitamin K dependent clotting factors (enhances warfarin effect)
Interaction between catecholamines and levothyroxine
Increases cardiac responsiveness
How to confirm a DM dx
FBG >/= 126
Random BG >/= 200 plus s/s of DM
OGTT >/= 200
A1C 6.5% or >
A1C goal for DM pts
< 7%
Pre-meal BG goal
70-130
Peak post-meal BG goal
< 180
What time interval should A1C be rechecked?
Every 3 months until under 7%, then every 6 months
Action of insulin
Promotes conservation of energy and buildup of energy stores, such as glycogen. Promotes cell growth and division
What insulin can be mixed?
NPH w/ short-acting
Baseline data prior to insulin
Random BG
FBG
A1C
Electrolytes
Urinary glucose and ketones
What meds can raise BG
Sympathomimetics
Glucocorticoids
What meds can lower BG
Sulfonyleureas
Rapid-acting insulins
Humalog (Lispro)
Novalog (Aspart)
Apidra (Glulisine)
Short-acting insulins
Regular (Humulin R, Novolin R)
Intermediate acting insulins
Isophane (NPH)
Long acting insulins
Lantaus (Glargine)
Levimir (Detemir)
Pioglitazone considerations
Severe HF
Bladder CA or a hx of
GLP1
glucagon-like peptide 1 receptor agonists
TZD
Thiazolidinediones
DPP4-i
Dipeptidyl peptidase-4 inhibitors
SGL T2i
Sodium-glucose cotransporter 2 inhibitors
What drug class should be considered for DM prior to insulin?
Biguanide
Insulin correction dose calculation
Actual blood sugar – target blood sugar / correlation factor
Correlation factor equation
Insulin sensitivity factor constant / TDD
Insulin sensitivity factor
1500 for regular
1800 for rapid acting
TDD equation
Pt’s kg x 0.6 units
Examples of GLP-1
Exenatide (Byetta, Bydureon), liraglutide (Victoza), dulaglutide (Trulicity), Lixisenatide (Adlyxin), semaglutide (Ozempic)
MOA of GLP-1
Lowers BG by slowing gastric emptying, stimulating glucose-dependent insulin release, suppressing postprandial glucagon release, and reducing appetite
Adverse effects of GLP-1
Hypoglycemia
N/v/d
Pancreatitis
Renal insufficiency
Thyroid CA
Examples of amylin mimetics
Pramlintide (Symlin)
MOA of amylin mimetics
Delays gastric emptying and suppresses glucagon secretion, decreasing the postprandial rise in glucose
Adverse effects of amylin mimetics
hypoglycemia, nausea, injection site reactions
Examples of thiazolidinediones (Glitazones)
Pioglitazone (Actos)
Rosiglitazone (Avandia)
MOA of thiazolidinediones
Decrease insulin resistance and thereby increase glucose uptake by muscle and adipose tissue and decrease glucose production by the liver
Adverse effects of thiazolidinediones
Hypoglycemia, HF, bladder CA, fractures (women), ovulation
Examples of glucosidase inhibitors
Acarbose (Precose)
Miglitol (Glyset)
MOA of glucosidase inhibitors
Delay carb digestion and absorption, thereby decreasing the postprandial rise in BG
Adverse effects of glucosidase inhibitors
flatulence, diarrhea, abdominal pain
DPP-4i examples
Alogliptin (Nesina)
Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
Sitagliptin (Januvia)
MOA of DPP-4i
Enhance the activity of incretins by inhibiting their breakdown and therefore increase insulin release, reduce glucagon release, and decrease hepatic glucose production
Adverse effects of DPP-4i
Pancreatitis, hypersensitivity reactions
Examples of sulfonylureas
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Glynase)
Adverse effects of sulfonylureas
hypoglycemia, weight gain
MOA of sulfonylureas
Promote insulin secretion by the pancreas; may also increase tissue response to insulin
Examples of meglitinides (Glinides)
Nateglinide
Repaglinide
MOA of meglitinides
Promote insulin secretion by the pancreas
Adverse effects of meglitinides
hypoglycemia, weight gain
examples of SGLT2
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
MOA of SGLT2
Increase glucose excretion via the urine by inhibiting proteins in the kidney tubules, decreasing glucose levels and inducing weight loss by caloric loss through the urine
Adverse effects of SGLT2
Genital mycoctic infections, orthostasis
Examples of dopamine agonists
Bromocriptine (Cycloset)
MOA of dopamine agonists
Activates dopamine receptors in the CNS
Adverse effects of dopamine agonists
Orthostatic hypotension, exacerbation of psychosis
Examples of biguanides
Metformin (Glucophage, Glucophage XR)
MOA of biguanides
Decreases glucose production by the liver, increases tissue response to insulin
Adverse effects of biguanides
Decreased appetite
N/v/d
Lactic acidosis
Black box warning for metformin
Severe metabolic acidosis can occur w/ accumulation of metformin
What patients are at the greatest risk of metabolic acidosis
DM pts with significant renal impairment who take metformin
Step 1 of DM tx
Lifestyle changes plus metformin
Step 2 of DM tx
Add drug such as thiazolidinediones, SGLT2 inhibitor, DPP-4i, GLP-1 receptor agonist
Step 3 of DM tx
Three drug combo
Step 4 of DM tx
Combo injectable regimen inclusive of insulin
What tx should a pt have if their A1C is 9% at dx?
Dual therapy
What tx should a pt have if their A1C is 10% or FBG is 300 or more at dx?
Injectable therapy
Who is at risk for toxicity from methylxanthines
Pts w/ liver dysfunction
Tx for methylxanthine toxicity
Activated charcoal and a cathartic
Examples of methylxanthines
Theophylline
Aminophylline
Therapeutic goal of methylxanthines
Bronchodilation to decrease the intensity and frequency of moderate to severe asthma attacks and to control COPD exacerbations
Baseline data for methylxanthines
FEV1
Contraindications for methylxanthines
Untreated seizure disorder or PUD
Precautions for methylxanthines
Heart disease, liver dysfunction, seizure disorders, PUD
Monitoring requirements for methylxathines
FEV1, frequency/severity of attacks, HR and rhythm, EKG, levels to ensure they are in a therapeutic range
Drug interactions that increase the effects of methylxanthines
Cimetidine
Fluoroquinolone ABX
Drug interactions that decrease the effects of methylxanthines
Phenobarbital
Phenytoin
Rifampin
Step 1 therapy for asthma and COPD
SABA PRN
Step 2 therapy for asthma and COPD
SABA PRN + low dose ICS or comolyn/montelukast/theophylline
Step 3 therapy for asthma and COPD
SABA PRN + low dose ICS + LABA/medium dose ICS
Step 4 therapy for asthma and COPD
SABA PRN + medium dose ICS + LABA
Step 5 therapy for asthma and COPD
SABA PRN + high dose ICS + LABA and possibly omalizumab
Step 6 therapy for asthma and COPD
SABA PRN + high dose ICS + LABA + oral glucocorticoids and possibly omalizumab
Recommended step for initial tx of intermittent asthma
Step 1
Recommended step for initial tx of mild persistent asthma
Step 2
Recommended step for initial tx of moderate persistent asthma
Step 3
Recommended step for initial tx of severe persistent asthma
Step 4
Contraindications for beta agonists
Tachydysrhythmias or tachycardia associated w/ digitalis toxicity
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