NYU pharmacology exam 2

Narrow spectrum penicillin

amoxicillin, used for staphylococcus infections

Broad spectrum penicillin

ampicillin, used for gram + and gram -

Extended spectrum penicillin

Piperacillin, used for more gram -

bone, joint, skin, soft tissue, respiratory tract, urinary tract infections

Penicillin MOA

interferes with cell wall synthesis, bactericidal

Penicillin Adverse reactions

GI distress, superinfection, 5%-10% of pts have allergy

Penicillin contrainciations

hx of allergy/anaphylaxis; renal insufficiency

Bactericidal

kills bacteria

Bacteriostatic

inhibits bacterial growth

Beta lactamase inhibitor

Tazobactam

tazobactam use

treat bite wound infections, bloodstream infections, DM foot infections, intra-abdominal infections, pneumonia, sepsis

Tazobactam Adverse reactions

GI distress, superinfection, headache, insomina

Cephalosporins MOA

inhibit cell wall synthesis; bactericidal

Cephalosporins adverse effects

GI distress, nephrotoxicity, decresed seizure threshold, 5%-10% allergic

1st generation cephalosporins

Cephalexin; only gram +

2nd generation cephalosporins

Cefaclor; gram - but not psudomonas

3rd generation cephalosporins

ceftrixane; more gram - and crosses the blood brain barrier

4th generation cephalosporins

Cefepime; gram - and gram + includes pseudomonas

5th generation cephalosporins

Ceftaroline; treatment for MRSA

Macrolides

Erythromycin

Erythromycin MOA

inhibits protein synthesis; bacteriostatic and can be bactericidal in large doses

Erythromycin uses

Respiratory (upper), GI tract, mycoplasma, chlamydia, legionella

Erythromycin adverse reactions

GI distress, superinfection, hepatotoxicity (excreted by the liver)/ototoxicity, prolonged QT interval

Erythromycin considerations

-Contraindicated with Statins

-Decreases effectiveness of oral contraceptives

Lincosamides

Clindamycin

Clindamycin MOA

inhibits protein synthesis; bacteriostatic and bactericidal

Clindamycin uses

Osteomyelitis and Toxic shock syndrome

-also severe PID, post-partum endometriosis, septic arthritis, skin and soft tissue infection

Clindamycin side effects

C. diff because its so broad spectrum

Glycopeptides

Vancomycin

Vancomycin MOA

inhibits cell wall synthesis; primarily active against gram + MRSA and C.diff

Vancomycin Uses

Oral: C.diff; IV: MRSA

Vancomycin considerations

-75% excreted by the kidneys (very nephrotoxic)

-very caustic to the veins (rotate access/IV sites and monitor for infiltration/phlebitis)

red man syndrome

Due to rapid infusion of vancomycin (go slow to prevent

-causes flush and rash

-let the provider know

-differentiate between this and hypersensitivity

Tetracycline MOA

inhibits protein synthesis; bacteriostatic

tetracycline Uses

Broad spectrum antibiotic for gram + and gram -; used for atypical bacteria; H.Pylori, acne vulgaris, anthrax

Tetracycline adverse reactions

-photosensitivity (avoid sun and use sunscreen)

-teratogenic

-GI distress

-causes tooth discoloration and impacts long bones in children under 8

Aminoglycosides

Gentamicin

Gentamicin MOA

inhibits protein synthesis; broad spectrum bactericidal

Gentamicin uses

Severe gram - infections

gentamicin adverse reactions

-superinfection

-nephrotoxicity/ototoxicity (pt will need dialysis)

-thrombocytopenia

Gentamicin considerations

-doesnt cross blood brain barrier

-check kidney levels daily

-primarily given IV (IM in children)

Fluoriquinolones

Ciprofloxacin

Ciprofloxacin MOA

Interrupts DNA synthesis; bactericidal

Ciprofloxacin uses

UTS (highly concentrated in urine)

-also bone and joint infections, bronchitism pneumonia, gonorrhea

Ciprofloxacin adverse reactions

-ruptured achilles tendon

-photosensitivity

-suicidal ideation

-seizures

Ciprofloxacin cautions

-patients with myasthenia gravis, seizure disorder or depression

-patients taking warfarin

Lipopeptides

Daptomycin

Daptomycin MOA

inhibits protein, DNA and RNA synthesis; bactericidal

Daptomycin uses

Vancomycin resistant enterococcus and MRSA

-also used for endocarditis, DM foot infections, meningitis, osteomyelitis, complicated skin infections

Daptomycin Adverse reactions

Rhabodomyolysis, myopathy, peripheral neuropathy

-also chest pain, edema, insomina

Sulfonamides

Sulfamethoxazole-trimethoprim

Sulfonamides MOA

Inhibits formation of folic acid in cell wall; bacteriostatic

Sulfonamides Uses

UTI, prostatitis, respiratory infection, traveler's diarrhea

Sulfonamides Adverse reactions

-Hyperkalemia

-Can cause sensitivity with sulfa allergies/allergies to furosemide

-Steven johnson syndrome

-blood dycrasias

Sulfonamides Considerations

-high resistance rate

-interferes with oral contraceptives

-teratogenic

Polyenes

Amphotericin B

Amphotericin B MOA

bindis to a component of the cell wall causing it to leak, fungistatic or fungicidal

Amphotericin B Uses

severe or systemic fungal infections

Amphotericin B Adverse reactions

Bone marrow suppression (anemia)

-also more commonly: fever, flushing, chills, dyspnea, tachycardia, nausea, hypotension, headache

-can cause nephrotoxicity in high doses and electrolyte imbalances

Amphotericin B considerations

-push slowly over 4 hourse

-pre medicate with antipyretics, antihistamines, corticosteriods

-Azoles

Ketoconazole

Ketoconazole MOA

interrupts integrity of cell wall, leading to cell death

Ketoconazole Uses

cutaneous infections (candida, yeast infection, tinea infection), histoplasmosis (from bird or bat droppings), Disseminated coccydioidomycosis (fungus from desert soil) BE CAREFUL WHERE YOU GARDEN

Keoconazole adverse reactions

-topicals: burning, itching, redness, local hypersensitivity

-IV: GI distress, liver toxicity

*Less toxic than amphotericin B

Antiprotozoal

Metronidazole

Metronidazole MOA

Damages DNA

Metronidazole uses

condidiasis, histoplasmosis, cryptococcal meningitis

Metronidazole Adverse reactions

CNS symptoms, seizures, peripheral neuropathy, dark urine, disulfiram reaction (prolonged hangover effect)

Metronidazole contraindications and cautions

-Pt's with hx of blood dyscrasias, HF, liver or renal failure

-Active CNS disease

-Severe blood disorder

-1st trimester of pregnancy

Antiviral Herpes drugs

Acyclovir

Acyclovir MOA

Interferes with viral nucleic acid synthesis; bacteriostatic

Acyclovir Uses

-Herpes simplex [1]

-Genital herpes [2]

-Varicella-zoster (chickenpox)

-Herpes zoster (shingles) [3]

Acyclovir Adverse reactions

-topical: burning/itching at application site

-oral: GI distress, headache, vertigo

-IV: renal toxicity, thrombophlebitis (may lead to tissue damage)

Acyclovir teaching

-NOT a cure for herpes

-Teach safer sex practices

-pt needs cervical cancer screenings

Tuberculosis treatment: Antimycobacterial drugs

-Isoniazid (INH)

-Rifampin

Isoniazid MOA

Inhibits cell wall synthesis and blocks vitamin B16; bactericidal or bacteriostatic

Isoniazid uses

Antitubercular, active and latent TB

Isoniazid Adverse reactions

Psychotic behavior, hepatotoxicity, seizures, peripheral neuropathy

-also GI distress, electrolyte imbalances, blood dyscrasias

Isoniazid Cautions and Considerations

-Pts over 50, alcoholics, liver disease, HIV, seizures disorders

-observe for liver damage and monitor liver enzymes

-administer B6 to prevent peripheral neuropathy

Rifampin MOA

inhibits RNA synthesis

Rifampin Uses

TB, leprosy, meningitis, legionella

Rifampin adverse reactions

-turns urine, sweat, tears, and saliva orange-red (harmless and expected)

-liver toxicity

-GI distress, flushing, rash, itch

Rifampin considerations

-interferes with oral contraceptives

-monitor liver enzymes

-monitor for signs of DRESS

Drugs that interfere with oral contraceptives

-Erythromycin

-Sulfonamides

-Rifampin

Urinary Antiseptics

Nitrofurantoin

Nitrofurantion MOA

Interferes with RNA and DNA producing enzymes, bacteriostatic or bactericidal

Nitrofurantoin uses

treat and prevent UTI; gram + and gram - bacerial, especially E.coli

Nitrofurantoin Adverse reactions

-Permanent peripheral neuropathy: muscle weakness, numbness, tingling

-rust/brown urine

-GI distress and hypersensitivity

-Blood cell deficiencies

Nitrofurantoin considerations

Not for patients with kidney function impairment, pregnant, nursing or laboring patients, or patients with liver disorders

Urinary Analgesics

Phenazopyridine

Phenazopyridine MOA

Azo dye excretes local anesthetic on urinary tract

Phenazopyridine Uses

dysuria, UTI symptomatic relief

phenazopyridine considreations

-high doses lead to renal failure in pts with pre existing renal diseases

-turns urine red/orange (expected and harmless)

Transgender male transitioning agents

-testosterone

-progestin

-finasteride

Testosterone in FtM

-steroid hormone (androgen)

-stimulates male secondary sexual characteristics

-goal is to reach physiological male range

-too much leads to aromatization (increased release of estrogen)

Testosterone routes FtM

-Injectable $:

-testosterone cypionate/enanthate(dervived from sesame): every 2 weeks

-long acting injectable undecanoate (Aveed): every 10 weeks

-Topical (Gel/Patch): daily

-Pellet (implantable)$: every 3-6 months

-Topical: clitoral enlargement

Testosterone considerations FtM

-effects are vigorous and remarkable

-adjust dosages according to: cessation if menses, progression of masculinizing effect, and side effects

- younger pts: lower body mass, smaller doses

Progestion FtM

Depo-provera

-cessation of menses

Finasteride FtM

Propecia, Proscar

-treat male pattern baldness

-may cause thinning of other body hair

-may interfere with clitoral enlargement

Transgender Female transitioning agents

-Estrogen

-Androgen blockers

-progestin

Estrogen MtF

-steroid hormone that promotes development and maintenance of female characteristics of the body

-anti-androgen effect (blocks testosterone)