Exam 3 advanced respiratory pharmacology

What is the first step in identifying a potential pathogen? page. 221

Collection of specimens for culture

What are some examples of collections? page. 221

blood

urine

sputum

cerebrospinal fluid

pleural fluid

synovial fluid

peritoneal fluid

stool

What color does gram-positive bacteria stain? page. 221

Purple

what color does gram-negative bacteria stain? page. 221

Red

What are some common respiratory infections? page. 222

Rhinosinusitis

Bronchitis

Pneumonia

What do bactericidal medications do? page. 223

They kill bacteria

What do bacteriostatic medications do? 223

They stop the growth of bacteria

What are some bactericidal medications? page. 223

Vancomycin

penicillin

aminoglycosides

rifampin, rifabutin

What are some bacteriostatic medications? page. 223

Azoles

Chloramphenicol

Nitrofurantoin

tetracycline

What are some bacterial pathogens that you can get if you don't take the full course of the antibiotic (Gram positive)? page. 224

MRSA

VISA

VRSA

Penicillin-resistant Streptococcus Pneumonia

VRE

What are some bacterial pathogens that you can get if you don't take the full course of the antibiotic (Gram negative)? page. 224

MDR nonenteric bacilli

Third-generation cephalosporin-resistant

ESBL-producing Escherichia coli and klebsiella spp.

Ampicillin-resistant Haemophilus spp.

Carbapenemase-producing Enterobacteriaceae and acinetobacter spp.

The Beta-lactams are a large class of antibiotics that include which? page. 225

Penicillin

Cephalosporins

Carbapenems

Monobactams (aztreonam)

When was penicillin discovered? page. 225

In 1928 by Fleming

What is Penicillin's mechanism of action? page. 225

Penicillin binds to enzymes located within the cell wall and prevent cross-linking of the peptidoglycan structure necessary for cell wall development

What are clinical uses of penicillin? page. 225

Natural penicillin are effective primarily against gram-positive bacteria and anaerobes

What are two examples of aminopenicillins? page. 226

Ampicillin

Amoxicillin

What is the brand name of Ampicillin and how can it be given? page. 226

Brand name: Omnipen

Route: PO (by mouth), IM, IV

What is the brand name of Amoxicillin and how can it be given? page. 226

Brand name: Amoxil, Wymox

Route: PO (by mouth)

What is an example of Ureidopenicillins? page. 226

Piperacillin

What is the brand name of Piperacillin and how can it be given? page. 226

Brand name: Piperacil

Route: IM, IV

What is an adverse reaction to penicillin's? page. 227

The most common adverse reaction is hypersensitivity

What percentage of the population is allergic to penicillin? page. 227

3% to 10%

What are some symptoms/ signs of hypersensitivity to penicillin? page. 227

mild rash

life threatening anaphylaxis

thrombocytopenia (low platelet levels)

seizures

How many generations (classes) of cephalosporins are there? page. 227

Five

What is the mechanism of action for cephalosporins? page. 227

Cephalosporins bind to the penicillin-binding proteins within the cell wall and inhibit the cross-linking of peptidoglycan

What are the clinical uses of cephalosporins? page. 227

These agents are active against most gram-negative organisms

What are two examples of third generation cephalosporins? page. 228

Cefotaxime

Ceftriaxone

What are some common uses of third generation cephalosporins? page. 228

Respiratory infections

Ear infections

Strep throat

What is the brand name of Cefotaxime and how is it given? page. 228

Brand name: Claforan

Route: IM, IV

What is the brand name of ceftriaxone and how is it given? page. 228

Brand name: Rocephin

Route: IM, IV

What percent of hypersensitivity occurs in patients who are on cephalosporins? page. 229

1% to 3%

What problem can come from taking cefotetan and cefoperazone? page. 229

Hypoprothrombinemia

How are cephalosporins eliminated through the body? page. 229

Most cephalosporins are eliminated through the kidneys

What is done for patients who are on cephalosporins and have renal insufficiency? page. 229

These patients require dosage adjustments

What was the first antimicrobial and when was it discovered? page. 229

streptomycin; discovered in 1943

What are some examples of aminoglycosides? page. 229

Streptomycin

Gentamicin

Tobramycin

Netilmicin

Amikacin

What is the brand name of Gentamicin? page. 230

Garamycin

What is the brand name of Tobramycin? page. 230

Nebcin

What is the brand name of Amikacin? page. 230

Amikin

What is the mechanism of action of Aminoglycosides? page. 230

Aminoglycosides bind irreversibly to the 30S bacterial ribosome and inhibit the translation of RNA into proteins.

Is Tobramycin approved by the US FDA as an aerosol for the treatment of Pseudomonas aeruginosa infection in patients with CF? page. 230

YES

What are the primary toxicities associated with the use of aminoglycosides? page. 230

Nephrotoxicity and ototoxicity

What gram stain does aminoglycosides work against? page. 230

Gram-Negative they are bactericidal agents (kill bacteria)

Why has Tuberculosis (TB) received heightened attention? page. 236

Due to the increase in cases that are attributed to the HIV epidemic

What are the most commonly used antimycobacterial in the treatment of tuberculosis? page. 236

Isoniazid

Rifampin

Rifabutin

Pyrazinamide

Ethambutol

Streptomycin

What is the dosage and route of Isoniazid? page. 236

Dosage: 5 mg/kg/day; maximum 300 mg/day

Route: PO (by mouth), IM

What is the dosage and route of Rifampin? page. 236

Dosage:10 mg/kg/day; maximum 600 mg/day

Route: PO (by mouth), IV

What is the dosage and route of Rifabutin? page. 236

Dosage: 300 mg/day

Route: PO (by mouth)

What is the dosage and route of Pyrazinamide? page. 236

Dosage: 15-30 mg/kg/day; maximum 2000 mg/day

Route: PO (by mouth)

What is the dosage and route of Ethambutol? page. 236

Dosage: 15-25 mg/kg/day; maximum 2500 mg/day

Route: PO (by mouth)

What is the dosage and route of Streptomycin? page. 236

Dosage: 15 mg/kg/day; maximum 100 mg/day

Route: IM

What do antiviral agents mimic (excluding antiretrovirals)? page. 240

Nucleosides and inhibit DNA synthesis

What is the mechanism of action for Acyclovir and Valacyclovir? pages. 240-241

A nucleoside analog that is phosphorylated and inserted into the replicating viral DNA

What is Acyclovir and Valacyclovir most effective against? page. 241

They are most effective against herpes simplex virus HSV-1 and HSV-2

What is Acyclovir and Valacyclovir clinically used for? page. 241

The treatment of genital infections caused by HSV and VZV

How is Alpha 1 proteinase inhibitor given? page. 258

Alpha 1 proteinase inhibitor is given intravenously

What is Alpha 1 proteinase inhibitor intended for? page. 258

It is intended for the treatment of congenital alpha 1 AT deficiency, which leads to emphysema

What is Alpha 1 AT deficiency? page. 258

A genetic defect that can lead to the development of severe panacinar emphysema

How is Alpha 1 AT deficiency characterized by? page. 258

it is characterized by serum API levels less than 35% of normal

What percent of emphysema patients in the US does Alpha 1 antitrypsin deficiency account for? page. 258

2% estimated to be 60,000-100,000 Americans with severe Alpha 1 AT

What ethnicity does Alpha 1 AT deficiency primarily affect? page. 258

Caucasian

What part of the lungs does emphysema caused by API affect more? page. 258

The lower lung zones and is accelerated by cigarette smoking

What is the normal serum levels for API? page. 259

150 to 350 mg/dL

What is the recommended dosage and route of API? page. 259

Dosage: 60 mg/kg of body weight given once weekly

Route: IV at a rate of 0.08 mL/kg/min or greater depending on patient comfort and usually takes about 15 to 70 minutes for total infusion

What are some examples of Alpha 1 proteinase inhibitors? page. 259

Aralast NP

Glassia

Prolastin-C

Prolastin-C liquid

Zemaira

What is a general contraindication of API agents? page. 260

The agents are derived from human plasma, so disease transmission is possible

What are some signs of strong physical addiction or dependance on nicotine? page. 261

Smokes more than 15 cigarettes per day

Prefers brands with nicotine levels above 0.09 mg

Has habit of inhaling smoke frequently and deeply

Smokes within 30 minutes of rising

Finds it difficult to give up the first morning cigarette and smokes more frequently in the morning

Finds it difficult to refrain from smoking in smoke-free environments

Smokes even when ill enough to be bedridden

What are some examples of smoking cessation drug formulations? page. 261

Nicotine polacrilex

Nonnicotine antidepressant

Nonnicotine nicotinic receptor agonist

What is the brand name and dosage of Nicotine polacrilex? page. 261

Nicorette (gum) 2 mg

What is the brand name and dosage of Nonnicotine antidepressant? page. 261

Generic-Bupropion 150-mg sustained-release tablets

What is the brand name and dosage of nonnicotine nicotinic receptor agonist? page. 261

Chantix 1-wk titration of 0.5 mg once daily for first 3 days, twice daily for remainder of week

What is the target audience of e-cigarettes? page. 263

adolescents who are in middle school or high school

What is nitric oxide approved for? page. 264

It is approved for pulmonary vascular relaxation

What is nitric oxide used to treat? page. 264

It is used in the treatment of persistent pulmonary hypertension in newborns

Does nitric oxide vasodilate the pulmonary artery?

YES

What is the recommended dose of nitric oxide? page. 264

20 ppm (parts per million)

How long should nitric oxide treatment be maintained for? page. 264

it should be maintained for up to 14 days or until the underlying oxygenation problem has been resolved

Does the inhalation of nitric oxide produce an effect on pulmonary arterial pressure or gas exchange? page. 265

NO

What is a contraindication of nitric oxide? page. 266

Nitric oxide should not be used in neonates who are known to be dependent on right-to-left shunt

What are two FDA US synthetic analogs of prostacyclin? page. 266

iloprost (Ventavis) and treprostinil (Tyvaso)

Is epoprostenil sodium (Flolan) an inhalation agent that has been prescribed for off-label use in adults and children? page. 266

YES

What are Neuromuscular blocking agents (NMBAs) also termed as? page. 291

Paralytics or muscle relaxants

What do Neuromuscular blocking agents (NMBAs) do? page. 291

They are drugs that cause skeletal muscle weakness or paralysis, preventing movement

What are Neuromuscular blocking agents (NMBAs) used for in the clinical setting? page. 291

Intubation

Surgery

Facilitation of ventilation in certain critically ill patients

What are the two types of Neuromuscular blocking agents (NMBAs)? page. 291

Depolarizing agents and Nondepolarizing agents

What are some clinical uses of Neuromuscular blocking agents (NMBAs)? page. 291

To facilitate endotracheal intubation

To obtains muscle relaxation during surgery, particularly of the thorax and abdomen

To enhance patient-ventilatory synchrony

To reduce oxygen consumption

What are the most common examples of ventilated patients who require muscle relaxation? page. 291

Severe asthma patients

ARDS patients

uncomfortable ventilator modes such as pressure-controlled inverse ratio ventilation

What is an example of a Depolarizing Neuromuscular blocking agent (NMBA)? page. 292

Succinylcholine

What are some examples of Nondepolarizing Neuromuscular blocking agents (NMBA's)? page. 292

Rocuronium

Vecuronium

What is the chemical class of Succinylcholine? page. 292

Dicholine ester

What is the Pharmacologic properties of Succinylcholine? page. 292

Ultrashort duration

What is the time of onset, clinical duration, and mode of elimination of Succinylcholine? page. 292

Time of onset (min): 1-1.5

Clinical duration (min): 10-15

Mode of elimination: Hydrolysis by plasma cholinesterases

What is the chemical class of Rocuronium and Vecuronium? page. 292

Ammonio Steroid

What is the pharmacologic properties of Rocuronium and Vecuronium? page. 292

Intermediate duration; competitive

What is the time of onset, clinical duration, and mode of elimination of Rocuronium? page. 292

Time of onset (min): 1-2

Clinical duration (min): 30-60

Mode of elimination: Liver metabolism

What is the time of onset, clinical duration, and mode of elimination of Vecuronium? page. 292

Time of onset (min): 2-4

Clinical duration (min): 60-90

Mode of elimination: Liver metabolism and clearance; renal elimination

Nondepolarizing agents usually have a longer duration of action compared with the depolarizing agent Succinylcholine (Page. 293)

True

What are the dosages of rocuronium? page. 293

0.45

0.6

0.9

1.2

Does Vecuronium have minimal effects on heart rate and blood pressure? page. 294

YES

What are the Reversal agents used for reversal of nondepolarizing blocking agents? page. 295

Neostigmine

Pyridostigmine

Sugammadex