https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\nBacterostatic
kills the bacteria<\/p>\n\n\n\n
bacteriocidal
kills the bacteria and stops the growth or spread of the infection<\/p>\n\n\n\n
Bacteriostatic drugs
clindamycin
macrolides
sulfonamides
tetracyclines<\/p>\n\n\n\n
Bactericidal drugs
ahminoglycosides
beta-lactums
fluroquinolones
Metronidazole
Streptogramins
vancomycin<\/p>\n\n\n\n
anti-microbial resistance
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<\/p>\n\n\n\n
subclasses of Beta-lactams PCNS
natural PCNS
aminopenicillins
anti-staphylococcal PCNs
extended Spectrum PCNs<\/p>\n\n\n\n
Pharmacodynamics of Beta-lactam PCNs
inhibit biosynthesis of bacterial wall (beta-lactam ring)<\/p>\n\n\n\n
1st line therapy for Strep pharyngitis.
penicillin V<\/p>\n\n\n\n
1st line therapy for all bites
Amoxicillin\/Clavulanate (Augmentin)<\/p>\n\n\n\n
Natural PCN’s, Drugs
Penicillin V potassium (ledercillin) Penicillin G sodium (PCN G-Na)
Penicillin G procaine (Duracillin)
Penicillin G benzathine (Permapen)
Penicillin G potassium (Pfizerpen)<\/p>\n\n\n\n
Natural PCNs active against
aerobic gram (+) organisms<\/p>\n\n\n\n
Aminopenicillins active against
Gram (-) organisms<\/p>\n\n\n\n
Aminopenicillins Drugs
Amoxicillin
Ampicillin
Combinations:
Amoxicillin-clavulanate (Augmentin)<\/p>\n\n\n\n
1st lines therapy for acute otitis media (AOM) & sinusitis
Amoxicillin<\/p>\n\n\n\n
When aminopenicillins are combined with beta-lactamase inhibitors
their spectrum in broadened<\/p>\n\n\n\n
beta-lactamase inhibitors that can be combined with aminopenicillins
clavulanate, sulbactam, & tazobactam<\/p>\n\n\n\n
Penicillinase-resistant penicillins drugs
Nafcillin
Oxacillin
Cloxacillin
Dicloxacillin
Methicillin<\/p>\n\n\n\n
Penicillinase-resistant penicillins active against
Streptococcus, MSSA, some coagulase-negative staphylococci, peptostreptococcus<\/p>\n\n\n\n
Anti-pseudomonal penicillin drugs
piperacillin
ticarcillin<\/p>\n\n\n\n
combination:
piperacillin\/taxobactam<\/p>\n\n\n\n
ticarcillin\/clavulanate<\/p>\n\n\n\n
Anti-pseudomonal penicillins active against
gram (-) organisms<\/p>\n\n\n\n
1st generation cephalosporins drugs
Cephradine (Anspor)
Cefazolin (ancef)
Cefadroxil (Duricef)
Cephalexin (keflex)<\/p>\n\n\n\n
2nd generation cephalosporins drugs
Cefuroxime sodium (Zinacef)
Cefuroxime (Ceftin)
Cefaclor
Cefprozil
Cefotetan (Cefotetan)
Cefoxitin (Mefoxin)<\/p>\n\n\n\n
3rd generation cephalosporins drugs
Cefdinir (Omincef)
Cefpodoxime (Vantin)
Cefotaxime (Celizox)
Ceftazidime Fortax)
Ceftriaxone (Rocephin)
Cedax
Cefixime (Suprax)<\/p>\n\n\n\n
4th generation cephalosporins drugs
Cefepime (Maxipime)<\/p>\n\n\n\n
1st generation cephalosporins active against
gram (+) cocci<\/p>\n\n\n\n
2nd generation cephalosporins active against
gram (+)
increased activity for H. influenzae
bateroides fragilis<\/p>\n\n\n\n
3rd generation cephalosporins active against
uncommon gram (-) organisms<\/p>\n\n\n\n
4th generation cephalosporins active against
primarily Gram (+) and but also Gram (-)<\/p>\n\n\n\n
which cephalosporins are best against gram (+) organisms
cefdinir & cefpodoxime<\/p>\n\n\n\n
ADR for cephalosporins
serum sickness
seizure
coagulation abnormalities<\/p>\n\n\n\n
indications for cephalosporins
exacerbation of chronic bronchitis
AOM (when amoxicillin fails)
Sinusitis<\/p>\n\n\n\n
Pharmacodynamics of cephalosporins
inhibit synthesis of bacterial cell wall<\/p>\n\n\n\n
Fluoroquinolone older drugs
cipofloxacin (cipro)
norfloxacin (noroxin)
ofloacin (flovin)<\/p>\n\n\n\n
Fluoroquinolones new drugs
gemifloxacin (factive)
levofloxacin (levaquin)
moxifloxacin (avelox)<\/p>\n\n\n\n
fluoroquinolones active against
Gram (-) organisms<\/p>\n\n\n\n
Pharmacodynamics of fluoroquinolines
Interferes with DNA synthesis leading to inability to divide and ultimately, cell death<\/p>\n\n\n\n
Fluoroquinolones indications
PNA
sinusitis
UTI
proctitis
bronchitis
skin, joint infections
Travelers diarrhea (!st line therapy)<\/p>\n\n\n\n
black box warning for fluoroquinolones
tendon rupture<\/p>\n\n\n\n
macrolide drugs
erythromycin
clarithromycin
dirithromycin
azithromycin
telithromycin<\/p>\n\n\n\n
Pharmacodynamics of macrolides
Interferes with steps involves in protein synthesis thereby rendering cell division non-functional<\/p>\n\n\n\n
macrolides are active against
gram (+) organisms & gram (-) organisms<\/p>\n\n\n\n
Macrolide indications
CAP (DOC)
legionella PNA (DOC)
pertussis
chronic bronchitis
chlamydia
H. pylori
Group A Strep
mycobacterium avium complex
endocarditis prophylaxis<\/p>\n\n\n\n
Macrolide drug interactions
CYP450 & 3A4 inhibitors
statins
theophylline
colchicine
carbamazepine<\/p>\n\n\n\n
sulfonamide drugs
sulfasalazine
mafenide
silver sulfasalazine<\/p>\n\n\n\n
combinations:
trimethoprim\/sulamethoxazole (Bactrim)<\/p>\n\n\n\n
sulfonamide drugs active against
Grams (+) & Gram (-)<\/p>\n\n\n\n
sulfonamide indications
Ulcerative colitis
ocular infections
burn infections
toxoplasmosis
chronic bacterial proctitis
prevention of UTIs in women<\/p>\n\n\n\n
Pharmacodynamics of sulfonamides
Inhibits invading organisms from using substances essential to their growth and development; block folic acid synthesis<\/p>\n\n\n\n
Trimethoprim mechanism of action
inhibits DNA synthesis<\/p>\n\n\n\n
Trimethoprim active against
gram (-) & gram (+) organisms<\/p>\n\n\n\n
Nitrofurantoin mechanism of action
inhibits acetyl co-enzymes<\/p>\n\n\n\n
Nitrofurantoin active against
gram (-) & gram (+) organisms<\/p>\n\n\n\n
sulfonamide drug interactions
sulfonylureas
methotrexate
cyclosporine
hydantoins
probenecid
thiazide diuretics
warfarin<\/p>\n\n\n\n
nitrofurantoin drug interactions
probenecid
anticholinergics
magnesium salts<\/p>\n\n\n\n
sulfonamide ADR
N\/V\/D
hypersensitivity reactions
photosensitivity
G6PD deficiency
Steven-Johnson syndrome
crystals in urine<\/p>\n\n\n\n
AIDS and sulfonamides
AIDs patients are at increased risk for ADRs<\/p>\n\n\n\n
Nitrofurantoin ADR
cough<\/p>\n\n\n\n
ADR with G6PD and sulfonamides
results in acute hemolytic anemia<\/p>\n\n\n\n
blood dyscrasias and sulfonamides
toxic effects and death<\/p>\n\n\n\n
Bactrim indications
uncomplicated UTI
exacerbations of chronic bronchitis
MRSA<\/p>\n\n\n\n
Bactrim drug interactions
ACEI
ARBs
phenytoin
warfarin
cyclosporine<\/p>\n\n\n\n
Macrobid indication
UTI<\/p>\n\n\n\n
Clindamycin indications
MRSA (1st line therapy in areas where resistance is low)
gram (+) cocci (2nd line therapy)
endocarditis prophylaxis
pneumococcal PNA
skin\/tissue infections
URI\/LRI (2nd or 3rd line)
Malaria
dental infections
bacterial vaginosis (off-label)<\/p>\n\n\n\n
clindamycin ADRs
C-diff infection
N\/V
bitter or metallic taste<\/p>\n\n\n\n
Clindamycin mechanism of action
suppress protein synthesis<\/p>\n\n\n\n
prophylaxis treatment for ophthalmia neonatorum
erythromycin ointment within one hour of delivery<\/p>\n\n\n\n
what causes ophthalmia neonatorum
chlamydia<\/p>\n\n\n\n
1st line therapy for uncomplicated UTI
trimethoprim\/sulfamethoxazole (Bactrim)<\/p>\n\n\n\n
most common UTI orgamisms
E.coli
Klebsiella
Proteus (men)
Pseudomonas
Enterobacter
Staphylococcus saprophyticus<\/p>\n\n\n\n
1st line therapy for uncomplicated UTI in adult
women
nitrofurantoin<\/p>\n\n\n\n
Characteristics of Complicated UTI
symptoms > 7 days
Rigors
flank pain
DM, pregnancy, immunocompromised, renal calculi
recent d\/c from hospital for nursing home
3 or > UTI in past year
failed antibiotics within past 4 months
resident at ECF<\/p>\n\n\n\n
Recurrent UTI prevention
Bactrim single strength daily at bedtime x 6 months<\/p>\n\n\n\n
indications for referral to Urologist
neonates, children <5
gross hematuria
persistent microscopic hematuria
symptoms of obstruction
persistent UTIs
infection with urea-splitting bacteria
symptomatic pregnant patients
high fever
dehydrated
septic<\/p>\n\n\n\n
Antimycobacterial drugs
isoniazid (INH)
Rifampin
Ethambutol
Pyrazinamide
Streptomycin<\/p>\n\n\n\n
antimycobacterial mechanism of action
interferes with lipid &Nucleic acid
biosynthesis in growing organisms<\/p>\n\n\n\n
active TB first phase (initiation phase) drugs
2 Months:
INH, Rifampin (RIF), pyrazinamide (PZA) and ethambutol (EMB)<\/p>\n\n\n\n
active TB 2nd phase (continuation) drugs
4-7 months:
INH & RIF<\/p>\n\n\n\n
antiviral drugs: nucleoside analogues
Acyclovir (Zovirax), valacyclovir
Famciclovir
Ganciclovir
cidofovir
valgancidovir
ribavirin<\/p>\n\n\n\n
Acyclovir (Zovirax) indications
HSV-1 & 2, varicella-zoster virus, EBV, herpes virus 6, CMV,<\/p>\n\n\n\n
Valacyclovir (Valtrex) indications
HSV-1 & 2, varicella-zoster virus, EBV, herpes virus 6, CMV,<\/p>\n\n\n\n
famciclovir indications
HSV-1 & 2, EBV, Hep B<\/p>\n\n\n\n
Ganciclovir indications
CMV<\/p>\n\n\n\n
Ribavirn indications
Chronic Hep C, RSV<\/p>\n\n\n\n
antiviral (nucleoside analogues) mechanism of action
interferes with DNA synthesis & inhibiting viral replication<\/p>\n\n\n\n
Antivirals for Influenza (neuraminidase inhibitors)
oseltamivir (Tamiflu), (PO) zanamivir (inhaled)
Peramivir (IV)<\/p>\n\n\n\n
Antiviral Neuraminidase inhibitor mechanism of action
cleaving viral attachment to the host cell surface allow for viral circulation<\/p>\n\n\n\n
Monitoring after given antiviral for flu
no flu vaccine for 2 weeks before or 48 hours after antiviral is given<\/p>\n\n\n\n
Antifungal (Antimycotics) classes
azoles
polyene macrolides
Allylamines
Nuclear Acid Synthesis inhibitors
Griseofulvin<\/p>\n\n\n\n
Azoles – Triazoles drugs
fluconazole (Diflucan)
itraconazole (Onmel)
voriconazole (Vfend)
Clotrimazole
Ketoconazole
minonazole
terconazole
tioconazole<\/p>\n\n\n\n
Polyene Macrolides drugs
amphotericin B
nystatin<\/p>\n\n\n\n
Allylamines Drugs
Terbinafine (Lamasil)
Naftifine<\/p>\n\n\n\n
Nuclear acid synthesis inhibitor drugs
Flucytosine<\/p>\n\n\n\n
Azoles mechanism of action
reduce erogsterol production by inhibition of the fungal CYP450 enzyme 14 alpha-demethylase<\/p>\n\n\n\n
Polyene Macrolides MOA
binds to sterol in the fungal cell membrane, altering cell permeability and allowing intracellular components to leak out<\/p>\n\n\n\n
Flucytosine mechanism of action
Inhibits DNA synthesis by conversion to 5-fluorouracil; inhibits thymidylate synthase.<\/p>\n\n\n\n
Ketoconazole mechanism of action
Inhibits steroid synthesis (inhibits desmolase).<\/p>\n\n\n\n
fluconazole & posaconazole mechanism of action
inhibit fungal CYP450=fungal cell walls weaken<\/p>\n\n\n\n
itraconazole & voriconazole mechanism of action
inhibit formation of ergosterol= increases cell wall permeability=osmotic instability<\/p>\n\n\n\n
Clotrimazole indications
dermatophyte
candida albicans
oral and vaginal canidasis<\/p>\n\n\n\n
Ketoconazole indications
vulvovaginal candidasis
paronychia
fungal PNA
esophageal candidasis<\/p>\n\n\n\n
Fluconazole indications
candidiasis, cryptococcal meningitis
severe systemic infections, vaginal candidasis
oropharyngeal candidasis
esophageal candidasis<\/p>\n\n\n\n
Itraconazole (Sporanox) indications
blastomycosis,
nonmeningeal histoplasmosis,<\/p>\n\n\n\n
Posaconazole (Noxafil) indications
oropharyngeal candidiasis<\/p>\n\n\n\n
Voriconazole (Vfend) indications
invasive aspergillosis<\/p>\n\n\n\n
Terbinafine (Lamisil) indications
onychomycosis of fingernails and toenails<\/p>\n\n\n\n
Amphotericin B
severe systemic fungal infections: HIGHLY TOXIC<\/p>\n\n\n\n
Griseofulvin indications
Oral treatment of superficial infections- dermatophytes (tinea, ringworm)
tinea capitis (1st line drug)<\/p>\n\n\n\n
Miconazole (Monistat) indications
Primarily used for vaginal candidiasis.<\/p>\n\n\n\n
Antifungal monitoring
monitor for liver toxicity<\/p>\n\n\n\n
Anthelmintic (antiparasitic) drugs
mebendazole
thiabendazole
albendazole
pyrantel
ivermectin<\/p>\n\n\n\n
Benzimidazoles MOA
Interfere with elongation of the microtubules that are responsible for parasitic cellular structure, leading to a disruption of growth and division<\/p>\n\n\n\n
Pyrantel MOA
paralyzes worms to allow expulsion by peristalsis<\/p>\n\n\n\n
Ivermectin MOA
intensifying GABA-mediated signal transduction in peripheral nerves (causing worm paralysis)<\/p>\n\n\n\n
Mebendazole (Vermox) indications
DOC for intestinal & tissue nematodes (roundworm)<\/p>\n\n\n\n
Nematodes
Intestinal and tissue roundworms<\/p>\n\n\n\n
Cestodes
flatworms and tapeworms<\/p>\n\n\n\n
Trematodes
flukes<\/p>\n\n\n\n
Albendazole (Albenza) indication
tissue nematodes:
hookworm, trichiasis
giardiasis<\/p>\n\n\n\n
Pyrantel indications
pinworm, trichiasis, hookworms<\/p>\n\n\n\n
Ivermectin (Stromectol) indications
tissue nematodes<\/p>\n\n\n\n
patient education for albendazole & mebendazole
take with a high fat meal<\/p>\n\n\n\n
patient education for ivermectin
take on empty stomach<\/p>\n\n\n\n
patient education for ibendazole
don’t use if pregnant; use back of contraceptive<\/p>\n\n\n\n
Metronidazole (Flagyl), nitazoxanide, & tinidazole
used to treat protozoal infections:
t. vaginalis
G. lambila
E. histolytica<\/p>\n\n\n\n
Metronidazole indications
protozoal & bacterial infections<\/p>\n\n\n\n
Nitazoxanide (Alinia) indications
diarrhea caused by G. Lambila & C. parvum<\/p>\n\n\n\n
Tinidazole (Tindamax) indications
amebiasis bacterial vaginosis, giardiasis, & trichomoniasis<\/p>\n\n\n\n
Metronidazole MOA
inhibits DNA synthesis<\/p>\n\n\n\n
Nitazoxanide (Alinia) MOA
interferes with the pyruvate ferredoxin oxidoreductase-dependent electron transfer reaction<\/p>\n\n\n\n
tinidazole (Tindamax): MOA
deactivates DNA and other proteins<\/p>\n\n\n\n
Metronidazole drug interactions
-Warfarin (increases anticoagulation)
-Alcohol (Disulfiram reaction)
-lithium (increases level)
-CYP450 inhibitors & inducers (affect drug concentration)<\/p>\n\n\n\n
bacterial vaginosis treatment
Metronidazole (Flagyl)-1st line therapy<\/p>\n\n\n\n
Diagnosis of bacterial vaginosis
Three or four criteria:<\/p>\n\n\n\n
\n- Thin, white vaginal discharge<\/li>\n\n\n\n
- Vaginal discharge with pH of >4.5<\/li>\n\n\n\n
- Clue cells<\/li>\n\n\n\n
- Positive KOH whiff test (fishy odor secondary to release of amines)<\/li>\n<\/ol>\n\n\n\n
cardinal symptoms of chronic bronchitis which indicate need for antibiotic
1.) increased sputum volume
2.) increased sputum purulence
3.) increase dyspnea<\/p>\n\n\n\n
Tinea corporis (ringworm) treatment
terbinafine
naftifine
butenafine
ciclopirox olamine<\/p>\n\n\n\n
Tinea pedis (athletes foot) treatment
terbinafine
naftifine
butenafine
ciclopirox olamine<\/p>\n\n\n\n
Tinea Capitis (Scalp Ringworm) treatment
terbinafine
Griseofulvin (1st line therapy)<\/p>\n\n\n\n
Tinea Cruris (Jock Itch) Treatment
naftifine
butenafine
ciclopirox olamine<\/p>\n\n\n\n
onychomycosis
ciclopirox<\/p>\n\n\n\n
1st line treatment for primary and secondary skin infections
1st generation Cephalosporins:
cephalexin
dicoxacillin
amoxilcillin\/claulanate
clindamycin<\/p>\n\n\n\n
medications and dose to eradicate nasal MRSA
intranasal mupirocin: 1\/2 tube in each nostril BID x 5 days<\/p>\n\n\n\n
symptomatic treatment for viral URIs
decongestant
Tylenol
ASA
Motrin
increase fluid intake
cough drops
nasal saline spray
rest<\/p>\n\n\n\n
treatment for acute sinusitis
amoxicillin with or without clavulanate<\/p>\n\n\n\n
Antacids MOA
Neutralize gastric acid to bring the pH above 3 and inactivate pepsin<\/p>\n\n\n\n
which antacids have the highest absolute neutrophil count (ANC)?
sodium bicarbonate and calcium carbonate<\/p>\n\n\n\n
What do calcium containing antacids needs for absorption?
vitamin D<\/p>\n\n\n\n
Antacid Indications
hyperacidity,
PUD, GERD, Calcium deficiency, Chronic Renal failure, osteoporosis prevention<\/p>\n\n\n\n
What is the 1st line therapy for GERD?
H2 blockers and PPIs<\/p>\n\n\n\n
Antacid ADRs
Mg-diarrhea
aluminum & Ca=constipation<\/p>\n\n\n\n
Antacids: Drug Interactions
-Adsorption of other drugs to antacids:
Reduces the ability of the other drug to be absorbed into the body=separate administration by 2 hours<\/p>\n\n\n\n
antacid patient education
symptoms > than 2 weeks,
extreme pain, cramping, or blood in stool=call provider<\/p>\n\n\n\n
lifestyle changed to prevent GERD symptoms
stop smoking
increase HOB while sleeping
no spicy food, no alcohol, no fatty foods, no chocolate, no caffine<\/p>\n\n\n\n
Antidiarrheal classes
opiates
absorbents
anticholinergics
Crofelemer<\/p>\n\n\n\n
Absorbent antidiarrheals drugs
Kaolin
pectin
Bismuth subsalicylate (Pepto-Bismol) ; use with each loose stool<\/p>\n\n\n\n
opiate antidiarrheals drugs
Diphenoxylate with atropine (Lomotil)
Diphenoxin with atropine (Motofen)
Loperamide (immodium)<\/p>\n\n\n\n
anticholinergic antidiarrheals drugs
atropine
propantheline<\/p>\n\n\n\n
what causes most diarrhea?
infection, food or drug ingestions, or inflammatory bowel disease<\/p>\n\n\n\n
Kaolin MOA
attracts and holds on to bacteria<\/p>\n\n\n\n
pectin MOA
thickens stool<\/p>\n\n\n\n
Bismuth Subsalicylate MOA
antisecrectory & antimicrobial effects<\/p>\n\n\n\n
Lomotil (diphenoxylate\/atropine) MOA
decreases bowel secretions and peristalsis<\/p>\n\n\n\n
motofen (difenoxin\/atropine) MOA
decreases bowel secretions and peristalsis<\/p>\n\n\n\n
Loperamide (Imodium) MOA
Decreases GI motility; binds to opioid receptors<\/p>\n\n\n\n
Crofelemer (Fulyzaq) indication
diarrhea in patient with HIV\/AIDS who are taking antivirals<\/p>\n\n\n\n
antidiarrheal precautions\/contraindications
opiods: toxic megacolon
pepto: do not use in children with flu-like illness
contraindicated in most children
caution in pts with hepatorenal disease<\/p>\n\n\n\n
antidiarrheal ADRs
constipation
bismuth=black tongue, gray\/black stool
anticholinergic effects
CNS effects<\/p>\n\n\n\n
antidiarrheal drug interactions
ASA: increased risk for salicylate toxicity
insulin or oral DM meds: increased risk for hypoglycemia
thrombolytics: increased risk for bleeding
lomotil & immodium: increased CNS depression with alcohol and anticholinergic effects with other anticholinergics drugs<\/p>\n\n\n\n
Laxative classes
stimulants
osmotics
bulk-producing laxatives
lubricants
surfactants
hyperosmolar laxatives
chloride channel activators
opioid receptor antagonists<\/p>\n\n\n\n
laxative stimulant
cascara
senna
bisacodyl
castor oil; stimulate myenteric plexus; rapid acting, short term<\/p>\n\n\n\n
Osmotic laxatives
Mg hydroxide
Mg citrate
Na phosphate
polyethlyene glycol electrolyte solution
polyethlyene glycol (PEG) 3350; draw water into intestinal lumen<\/p>\n\n\n\n
Bulk producing laxative
Psyllium
methyl cellulose
polycarbophil; mixes with water in intestine; slow response, long-term; older adults<\/p>\n\n\n\n
Lubricant laxatives
mineral oil; soften stool, lubricates intestine<\/p>\n\n\n\n
surfactant laxative
docusate compounds (Colace); reduce surface tension on the oil water interface on the stool & facilitate a mixture of fat & water into the stool<\/p>\n\n\n\n
hyperosmolar laxative
glycerine
laculose; draws water into intestines<\/p>\n\n\n\n
Chloride channel activators drugs
lubiprostone (Amitiza); soften stools and increases GI motility; choric idiopathic constipation, IBS, opioid induced constipation<\/p>\n\n\n\n
Opioid receptor antagonists drugs
methylnaltrexone; antagonist in the mu-receptor in the GI track; opioid induced constipation<\/p>\n\n\n\n
laxative 1st line therapy
stimulants<\/p>\n\n\n\n
Laxatives are contraindicated in
N\/v
undiagnosed abd pain
bowel obstruction
Renal dysfunction (Mg hydroxide)<\/p>\n\n\n\n
laxative precautions
abuse and dependency
cathartic colon=ulcerative colitis
tartrazine sensitivity=allergic reactions=asthma<\/p>\n\n\n\n
Cytoprotective agents
sucralfate (Carafate)
misprostol (Cytotec); tx Peptic ulcers caused by NSAID use<\/p>\n\n\n\n
Clinical Pearl for polyethylene glycol electrolyte solution
salty taste; place on ice in Basin; drink 240 ml\/10 mins; tic tac or hard candy reduces salty taste<\/p>\n\n\n\n
Sucralfate (Carafate)
Adheres to injured gastric ulcers upon contact with gastric acids; . Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and at HS and do not administer within 30 minutes of antacids.; use for 8 weeks<\/p>\n\n\n\n
Misprostol (Cytotec)
inhibits gastric secretion, mucosal protection; analog of prostaglandin E1; prophylaxis for duodenal ulcers due to NSAIDS or for those that must use NSAIDS; only take during NSAID therapy!; take with food<\/p>\n\n\n\n
Cytoprotective Agents Side Effects
Carafate=constipation
misoprostol=diarrhea, menstrual problems<\/p>\n\n\n\n
Misoprostol precautions
pregnancy category X;
Caution with renal impairment;<\/p>\n\n\n\n
antiemetic classes
Phenothaizine,
Anticholinergics,
Antihistamines,
-5-HT3 Receptor Blockers,
Cannaboids,
P\/neurokinin 1 (NK1) receptor antagonists,
trimethobenzamide<\/p>\n\n\n\n
Antihistamines antiemetics
anticholinergic, histamine-blocking;
Dramamine, Benadryl, Vistaril, Antivert<\/p>\n\n\n\n
Phenothiazines antiemetics
block dopamine receptors in chemoreceptor trigger zone; not for children; Compazine, perphenazine, Phenergan<\/p>\n\n\n\n
Cannaboids antiemetics
for N\/V associated with cancer & appetite stimulant: dronabinol (Marinol)<\/p>\n\n\n\n
5-HT3 receptor antagonist antiemetics
ondansetron (Zofran)
palonosteron (Aloxi)
dolaseton mesylate (Anzmet)
granisetron (Kytril, Sancuso)<\/p>\n\n\n\n
Anticholinergic antiemetics
Scopolamine (Transderm Scop)<\/p>\n\n\n\n
P\/neurokinin 1 receptor antagonist antiemetic
Aprepitant (emend)<\/p>\n\n\n\n
Mics antiemetic
trimethobenamide (Tigan)<\/p>\n\n\n\n
monitoring of long term use of promethazine
CBC=monitor for bone marrow depression & blood dyscrasias<\/p>\n\n\n\n
antihistamine antiemetic precautions\/ contraindications
anticholinergic effects, narrow angle glaucoma, seizure, pyloric obstruction, hyperthyroidism, CV disease, BPH, contraindicated in severe liver disease<\/p>\n\n\n\n
phenothiazine precautions\/contraindications
contraindicated in parkinsons, narrow angle glaucoma, bone marrow depression, severe CV disease; precaution in respiratory impairment=”silent PNA”, and aspiration risk<\/p>\n\n\n\n
dronabinol precautions\/contraindications
lowers seizure threshold
allergy to sesame oil
potential for abuse
CV disorders<\/p>\n\n\n\n
5-HT3 antagonists antiemetic precuations\/contraindications
mask progressive illeus
zofran contains aspartame=caution in patients with phenylketonuria<\/p>\n\n\n\n
Scopalamine (Transderm Scop) precuations\/contraindications
caution: open-angle glaucoma, eldery-increases CNS effects, GI or bladder neck obstruction
contraindicated: narrow-angle glaucoma<\/p>\n\n\n\n
Aprepitant (Emend) precautions\/contraindications
contraindicated to use other drugs metabolized by CYP 34A<\/p>\n\n\n\n
Phenothiazines ADR
extrapyramidal reactions<\/p>\n\n\n\n
Promethazine (Phenergan) ADR
fatal respiratory depression in children < 2<\/p>\n\n\n\n
H2 receptor antagonists MOA
inhibit acid secretion by parietal cells. reduced gastric acid secretion by 35%-50%;
zantac is 5-12 times more potent; pepcid 30-60 times for potent that Tagamet<\/p>\n\n\n\n
H2 receptor antagonists drugs
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
nizatidine (Axid)<\/p>\n\n\n\n
H2 receptor antagonists precuations\/contraindications
caution in: renal impairment-reduce dose for renal dysfunction; no Zantac or Pepcid for children;
axid can causes hepatocellular injury<\/p>\n\n\n\n
H2 receptor antagonists ADR
gynecomastia, impotence, (cimetadine=worst effects), confusion, agitation, depression, disorientation, blood dyscrasias<\/p>\n\n\n\n
H2 receptor antagonists drug inteactions
cimetidine and CYP 1A2, 2C9, & 2D6<\/p>\n\n\n\n
H2 receptor antagonists monitoring
liver function with high doses or long term use<\/p>\n\n\n\n
H2 receptor antagonists patient education
take with meals, separate antacids by 30 min-1hr, smoking decreases absorption, alcohol increases gastric irritation, don’t double the dose, no carafate within 2 hours<\/p>\n\n\n\n
Prokinetic drugs
Metoclopramide (Reglan)<\/p>\n\n\n\n
prokinetic MOA
stimulate motility of GI tract without stimulating gastric, biliary or pancreatic secretions<\/p>\n\n\n\n
black box warning for metoclopramide (Reglan)
increased risk for tardive dyskinesia<\/p>\n\n\n\n
Metoclopramide (Reglan) pecaution\/contraindications
contraindicated: GI bleed, mechanical obstruction, new GI sx, perforation
Caution: in patient with depression=increases SI<\/p>\n\n\n\n
Metoclopramide (Reglan) ADR
tardive dyskinesia, depression, dizziness, diarrhea, hypoglycemia (diabetics)<\/p>\n\n\n\n
Metoclopramide (Reglan) drug interactions
increase CNS depression with other CNS depressant drugs,
increased risk for EPs with other drugs that cause EPs, anticholinergics reverse action of Reglan<\/p>\n\n\n\n
Proton Pump Inhibitors (PPIs) MOA
antisecretory; inhibit H+\/K+\/ATpase enzyme system secretory surface or parietal cell; suppress gastric acid secretion up to 72 hours<\/p>\n\n\n\n
Proton Pump Inhibitors (PPIs) indications
hyperacidity, duodenal & gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, part of regimen for PUD, GERD<\/p>\n\n\n\n
Proton Pump Inhibitors (PPIs)
omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), dexlansoprazole (Dexilant), rabeprazole (Aciphex)<\/p>\n\n\n\n
PPI Precautions\/Contraindications
caution in: hepatic dysfunction, & elderly
contraindicated:
protonix & rabeprazole in children <12<\/p>\n\n\n\n
PPI ADRs
nutrient deficiencies: decreased iron, B12, & Ca+ (long-term use, increases risk for osteoporosis and fractures, increased risk for c-diff, samonella, and campy,
increases risk for PNA (short-term), ? causes gastric cancer<\/p>\n\n\n\n
PPI drug interactions
CYP 450 enzymes, decreased effects of certain antivirals, decreases absorption of ketoconazole, ampicillin, digoxin, and iron salts,
monitor INR with coumadin and PPIs<\/p>\n\n\n\n
PPI black box warning
Plavix and omeprazole: decreases the active metabolite of Plavix by 46%= decreased effectiveness<\/p>\n\n\n\n
PPI monitoring
patients on PPI for ulcer= test for H. pylori, stop PPI therapy x 2 weeks for H. pylori breath test or stool test.<\/p>\n\n\n\n
GERD management<\/p>\n\n\n\n
\n- Non-pharm measures<\/li>\n<\/ol>\n\n\n\n
\n- Elevate head of bed<\/li>\n\n\n\n
- Avoid alcohol, caffeine, spices, peppermint, etc<\/li>\n\n\n\n
- Stop smoking<\/li>\n\n\n\n
- Weight reduction if obese<\/li>\n<\/ul>\n\n\n\n
\n- Antacids PRN<\/li>\n\n\n\n
- H2 blockers (“-tidines”) in high doses at night or divided BID dosing<\/li>\n\n\n\n
- PPIs (“-zoles”) if H2 blockers are ineffective<\/li>\n\n\n\n
- GI\/surgical consult PRN<\/li>\n<\/ol>\n\n\n\n
PPI therapy for mod to severe GERD
PPI daily x 8 weeks, 30-60 mins before breakfast; tailored to symptom relief; if no relief after 3 months=refer to GI specialist;<\/p>\n\n\n\n
PPI step up or step down approach
if no symptom relief in 8 weeks, increase PPI to BID for 4-8 weeks; if symptom free for 4 weeks step down to daily PPI & reassess in 6-12 months; no symptom relief in 8 weeks=refer<\/p>\n\n\n\n
PUD stepped-approach algorithm
Step 1: lifestyle modification\/antacids
Step 2: H. pylori testing\/PPI
Step 3 (uncomplicated): tx for H.pylori
Step 4 (uncomplicated): PPI continues for 8-12 weeks until healed
Step 5 (uncomplicated, low risk): no on-going therapy
Step 5 (uncomplicated, high risk): PPI or H2RA (smokers, >60, CPOD, CAD, hx of bleeding, ulcers or NSAIDs)
Step 3 (complicated, bleeding): refer to GI for endoscopy
Step 4 (complicated): tx for H. pylori
Step 5 (complicated): repeat endoscopy in 12 weeks to determine healing<\/p>\n\n\n\n
1st line triple therapy for H. Pylori
1.) PPI BID
2.) clarithromycin 500 mg BID or metronidazole 500 mg BID
3.) amoxicillin 1G BID
x 10-14 days<\/p>\n\n\n\n
2nd line therapy for H. Pylori with PCN allergy
1.) PPI BID
2.) clarithromycin 500 mg BID
3.) metronidazole 500 mg BID
x 7-14 days<\/p>\n\n\n\n
2nd line therapy or rescue therapy for H. Pylori
1.) PPI BID
2.) levofloxacin 250-500 mg BID
3.) amoxicillin 1G BID
x 10-14 days<\/p>\n\n\n\n
IBS with constipation treatment
lupiprastone (Amitiza)<\/p>\n\n\n\n
Traveler’s Diarrhea Treatment
bismuth subsalicylate (pepto-bismol) 2 tablets or 2 oz before each meal and at HS;<\/p>\n\n\n\n
High risk destinations for traveler’s diarrhea
Central & South American, Africa, Middle East, Mexico, Asia,<\/p>\n\n\n\n
Intermediate risk destinations for traveler’s diarrhea
eastern Europe, South Africa, and Caribbean Islands<\/p>\n\n\n\n
the most common cause of Traveler’s diarrhea
E. coli<\/p>\n\n\n\n
other causes of traveler’s diarrhea
2) campy
3) shigella
4) salmonella<\/p>\n","protected":false},"excerpt":{"rendered":"
NR565 \/ NR 565 Final Exam Guide (Latest 2024 \/ 2025): Advanced Pharmacology Fundamentals – Chamberlain NR-565 Advanced Pharmacology FundamentalsFinal Exam GuideBacteriostaticCorrect Answer:kills the bacteriaBactericidalCorrect Answer:kills the bacteria and stops the growth or spread of the infectionBacteriostatic drugsCorrect Answer:clindamycinmacrolidessulfonamidestetracyclines Bactericidal drugsCorrect Answer:ahminoglycosidesbeta-lactumsfluroquinolonesMetronidazoleStreptograminsvancomycinanti-microbial resistanceCorrect Answer:1.) not knowing if the pt had recent use of antibiotics2.) provider […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-131002","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131002","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=131002"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131002\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=131002"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=131002"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=131002"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}