Exam #2 respiratory, antibacterials, antifungals, and antivirals

How long before surgery should you take cephalosporins?

60 mins before skin incision

What three medication classes have similar mechanism of action: block cell wall synthesis?

cephalosporins, glycopeptide (vancomycin), beta-lactams (amoxicillin)

What are 3 side effects of cephalosporins?

GI disturbances (C. diff diarrhea), hypersensitivity, and nephrotoxicity

Other than to treat bacterial infections, what are cephalosporins used for?

prophylactically before certain surgeries

Cephalexin and cefuroxime are examples of which medication class?

cephalosporins (antibacterial)

What three medication classes all have the mechanism of action: block protein synthesis?

tetracyclines, aminoglycosides (gentamicin) , and macrolides (thro)

What are two considerations while taking tetracyclines?

sit up for 30 minutes after taking and avoid dairy

What are 5 side effects while taking tetracyclines?

photosensitivity, hypersensitivity, teeth discoloration, hepatic/renal toxicity, and esophagitis

What are 4 side effects of macrolides?

QT prolongation, torsades de pointes, hepatotoxicity, and ototoxicity

What is one example of a macrolide?

erythromycin

What are 2 side effects of aminoglycosides?

ototoxicity and nephrotoxicity

What should you monitor for while your pt is on aminoglycosides?

Renal function (BUN) and serum concentration (creatinine)

What drug classes block DNA synthesis/targeted (antibacterial, antiviral)

Fluoroquinolones, metronidazole (nucleic acid blocked, anaerobic organisms), acyclovir sodium

What are 5 side effects of fluoroquinolones?

longer QT interval, tendonitis, peripheral neuropathy, crystalluria, and photosensitivity

What are two black box warnings for fluoroquinolones?

tendon rupture and aortic aneurysm

What are two examples of fluoroquinolones?

ciprofloxacin and levofloxacin

What are 3 side effects of vancomycin?

nephrotoxicity, ototoxicity, and red man syndrome

What antibacterial is used for serious gram (+) infections?

vancomycin

What is the mechanism of action for nitrofurans? (nitrofurantoin: macrobid, macrodantin)

convert to reactive intermediates in bacterial cells, interferes with cellular processes

What are two main side effects of nitrofurantoins?

pulmonary toxicity and hepatotoxicity

Nitrofurantoins interact with which other antibacterial drug class?

fluroquinolones

What infections are nitrofurantoins usually used for?

uncomplicated lower UTIs

Metronidazole is which antibacterial medication class?

nitroimidazole

What are 4 side effects of metronidazole?

metallic taste, peripheral neuropathy, seizures, and confusion

What are two drug interactions with metronidazole?

disulfiram and warfarin

What is the black box warning for penicillin G?

cardiopulmonary arrest

What are 3 side effects of amoxicillin?

nephrotoxicity, hepatotoxicity, and hypersensitivity

True or False: oral contraceptives are enough while taking amoxicillin

false

What is the mechanism of action for sulfonamides? (bactrim)

block bacterial folate synthesis by inhibiting enzymes

What are 3 side effects of sulfonamides?

photosensitivity, hypoglycemia, and renal failure

What is a good acronym to remember about sulfonamides?

SULF: Sunburn, Urine crystals, Love water (2-3L), Folic acid daily

What is something you should monitor for while a patient is on sulfonamides?

hyperkalemia

Ketoconazole (nizoral) is which medication class?

antifungal

What is the mechanism of action for ketoconazole?

inhibit synthesis of lanosterol

What are side effects of ketoconazole?

dry mouth, tongue discoloration, hepatotoxicity, adrenal insufficiency, and liver injury

What should be monitored while a pt is on ketoconazole?

liver enzyme levels

Amphotericin B is in which medication class?

antifungal

Amphotericin B is used to treat what?

severe systemic fungal infections

What are 5 side effects of amphotericin B?

hypokalemia, hypomagnesemia, nephrotoxicity, tachypnea, and encephalopathy

What is the mechanism of action for amphotericin B?b

binds to ergosterol in the cell membrane causing fungal death

Terbinafine is in which medication class?

antifungal

What is the mechanism of action for terbinafine?

act as a noncompetitive inhibitor of the enzyme squalene epoxidase, inhibit fungal cell membrane production

What are 5 side effects of terbinafine?

dysgeusia, weight loss, visual disturbances, stevens johnson syndrome, and hepatotoxicity

What food/drink should you avoid while taking terbinafine?

caffeine

Oseltamivir phosphate is in which medication class?

influenza neuraminidase inhibitor, antiviral

What is the mechanism of action for oseltamivir phosphate?

prevent viral replication

What are 2 side effects of oseltamivir phosphate?

behavioral changes and stevens johnson syndrome

How long after getting the influenza vaccine should you wait to take oseltamivir phosphate?

2 weeks or 2 days before getting the vaccine

What is the medication class of nirmatrelvir and ritonavir?

protease inhibitor, antiviral 

What is the mechanism of action for nirmatrelvir and ritonavir?

target SARS-CoV-2 enzyme Mpro preventing replication

What are 4 side effects of nirmatrelvir and ritonavir?

hypersensitivity (toxic epidermal necrolysis), affected taste, stevens johnson syndrome, and elevated liver enzymes

What is the therapeutic use for nirmatrelvir and ritonavir?

covid-19 (mild to moderate)

What is the medication class for acyclovir sodium (zovirax)?

nucleoside analogue

What is acyclovir sodium usually used to treat?

HSV-2

What are 4 side effects of acyclovir sodium?

inflammation/phlebitis, angioedema, hypotension, and elevated liver enzymes

What medication class is dextromethorphan?

antitussive

What is the use for dextromethorphan? (antitussive)

dry, hacking, nonproductive cough that interferes with sleep

What are 3 side effects of dextromethorphan (antitussive)?

nausea, drowsiness, rash

What medication class is pseudoephedrine?

nasal decongestant

How do nasal decongestants work? (pseudoephedrine)

constrict arterioles and reduce blood flow to the nasal mucosa

Why is pseudoephedrine a restricted drug?

Can be used to make methamphetamine drugs

What are 3 side effects of pseudoephedrine?

cardiac dysrhythmias, hypertension, nervousness

What are 2 other decongestants like pseudoephedrine?

phenylephrine or oxymetazoline

What medication class is guaifenesin?

expectorant

Why would you use guaifenesin?

productive coughs, loosens mucus

What are 4 side effects of guaifenesin?

skin rash, headache, nausea, vomiting

What medication class is acetylcysteine? 

mucolytics

What are mucolytics used for?

liquify viscous mucous secretions

What are 2 rare side effects of mucolytics? (acetylcysteine)

airway inflammation and bronchospasm (inhibit ciliary function)

How long after/before taking a mucolytic should you have a bronchodilator?

10-15 minutes

What medication class is diphenhydramine?

antihistamine, first generation H1 receptor antagonists

What is one side effect of diphenhydramine (benadryl)?

CNS depression (drowsiness, sedation)

What medication class is cetirizine and loratadine?

antihistamine: second generation H1 receptor blockers

What medication class are albuterol and levalbuterol?

short acting beta agonists (SABA)

Why would you use a SABA? (albuterol)

immediate bronchodilator that acts on B2 receptors in the lungs to allow for bronchodilation

What is the onset, peak, and duration for SABAs?

O: 5-15 min P:1-1.5 hrs D: 6 hrs

Which SABA has less cardiac effects levalbuterol or albuterol?

levalbuterol

What medication class are salmeterol and formoterol?

long acting beta agonists (LABAs)

What are 2 side effects of LABAs?

tachycardia and sore throat

What medication class ipratropium and tiotropium?

anticholinergic (LAMA and SAMA)

What is the use of SAMAs?

manage conditions causing bronchoconstriction (asthma, emphysema)

What is the duration of SAMAs?

4-6 hrs

What is the duration of LAMAs?

12-24 hrs

What are some medications that are LAMAs?

Umeclidinium, tiotropium (spiriva), glycopyrrolate, aclidinium, revefenacin

What is the medication class of fluticasone and budesonide?

corticosteroid

What are inhaled corticosteroids used for and why? (fluticasone, budesonide)

used in the treatment of inflammatory conditions because they suppress airway inflammation

What are 4 side effects of corticosteroids?

cough, dry mouth, thrush, sore throat

When should you take a bronchodilator while on a corticosteroid?

prior to taking inhaled steroid

What medication class is omalizumab?

immunosuppressant monoclonal antibodies, anti IgE

What is omalizumab used for?

treat allergic asthma that is not well controlled

After taking omalizumab how long can it take for anaphylaxis to occur?

4 days

What medication class is montelukast?

leukotriene receptor antagonist

What is montelukast used for?

long term treatment of asthma

What is one side effect of montelukast?

neuropsychiatric events

Fexofenadine belongs to which medication class?

third generation H1 receptor antagonist, antihistamine

What antimicrobials cause photosensitivity?

tetracyclines, sulfonamides, fluoroquinolones

What antimicrobials cause nephrotoxicity and ototoxicity?

MYCINs: vancomycin, gentamicin