pharm-jaime

beta-lactam drugs

- penicillin (amoxicillin)

- cephalosporins

- carbapenems

penicillin and cephalosporin MOA

stops synthesis of bacterial cell wall by binding proteins to produce a defective wall

carbapenem MOA

stops synthesis of bacterial cell walls by binding with PCN-binding proteins

aminoglycoside prototype

gentamicin

gentamicin MOA

penetrate bacterial cell walls, preventing bacterial synthesis of proteins necessary for function/replication

what is unique about aminoglycoside (gentamicin)?

"-NO-" = nephrotoxicity & ototoxicity, narrow spectrum, peak & trough = access effectiveness

fluoroquinolone prototype

ciprofloxacin

fluoroquinolone (ciprofloxacin) MOA

interfere w/ bacterial DNA enzyme synthesis required for bacterial growth and development

what is unique about fluoroquinolone (ciprofloxacin)?

achilles tendon rupture, metabolized mainly in the kidneys

tetracycline MOA

penetrate microbial cells, stopping protein synthesis

what is unique about tetracycline?

you cannot give to pregnant women or <8 y/o because it can cause discoloration of teeth enamel & depress bone growth

sulfonamides prototype

trimethoprim (sulfamethoxazole [Bactrim])

sulfonamides (trimethoprim/sulfamethozole) MOA

stops dihydropteroate synthase, key enzyme in the bacterial folic acid synthesis pathway (stops multiplication of new bacteria)

UTI medications

tripmethoprim (sulfamethoxazole) & nitrofurantoin (furadantin, macrodantin)

urinary antiseptics prototype

nitrofurantoin (furadantin, macrodantin)

urinary antiseptics MOA

inhibit bacterial DNA/RNA synthesis

macrolides prototypes

erythromycin & azithromycin (Z-pack)

macrolides (erythromycin & azithromycin) MOA

bind the bacterial 50S ribosomal subunit, causing the cessation of bacterial protein synthesis

what is a big concern with macrolides?

liver disease, we take AST & ALT labs

anti-infective agents prototypes

vancomycin & metronidazole

anti-infective agent: vancomycin MOA

inhibits the second stage of cell wall synthesis, alerting the permeability of cell membrane and selectively inhibit ribonucleic acid synthesis -- glycopeptide antibiotic

what is the main concern with anti-infective agent: vancomycin?

red man syndrome, decrease in WBCs, can cause c. diff, & careful w/ intestinal disorders

anti-infective agent: metronidazole MOA

inhibits protein synthesis by interacting with DNA and causes a helical DNA structure & strand breakage

what is the main concern with anti-infective agent: metronidazole?

increase in BP, want to avoid alc bevs or propylene glycol & can increase sodium, careful w/ pts w/ GI disorders, used to treat c. diff

first line agents prototype

isoniazid & rifampin

first line agent: isoniazid MOA

inhibits mycolic acid synthesis, interferes w/ cell wall synthesis & bactericidal effects

what is main concern for first line agent: isoniazid

renal impairment, hepatotoxic, we WANT to take on an empty stomach/no alc (ETOH)

first line agent: rifampin MOA

inhibit bacterial DNA-dependent RNA polymerase

what is main concern for first line agent: rifampin?

orange discoloration of body secretions

acyclovir treats ___.

herpes simplex virus (HSV) & varicella-zoster virus (VZV)

acyclovir MOA

inhibit viral reproduction, does not eliminate viruses from tissues

acyclovir main concerns

want to be careful with pts w/ renal failure -- check BUN and creatinine labs

what do we use to treat influenza?

amantadine & oseltamivir

amatadine & oseltamivir MOA

inhibit viral reproduction, does not eliminate viruses from tissues

tuberculosis drugs

isoniazid & rifampin

fungal infection drugs

polyene: amphotericin B, nystatin & azoles: fluconazole

polyene prototypes

amphotericin b & nystatin

polyene (amphotericin b) MOA

binds with ergosterol and disrupts cell membrane

what is the main concern with polyene (amphotericin b)?

we want to pretreat with diphenhydramine & acetaminophen/aspirin and/or antiemetic

want to watch out for thrombophlebitis, transfusion rxn

take blood cultures

polyene (nystatin) MOA

binds with ergosterol and disrupts cell membrane

azole prototype

fluconazole

azole (fluconazole) MOA

inhibits synthesis of ergosterol and disrupts cell membrane

what do we want to get for all fungal infections before diagnosing?

blood cultures

what parasite is permethrin used for?

scabicides (skin)

permethrin MOA

quickly paralyzing the nervous system of insects (contact or ate by insects)

what parasite is ivermectin used for?

pediculicides (scalp/hair)

what are the traditional antiepileptic drugs (AED)?

- hydantonins (phenytonin)

- carbamazepine (tegretol)

- barbiturates (phenobarbital)

- benzodiazepines (lorazepam & diazepam)

antiepileptic (AEDs): hydantonins (phenytonin) MOA

stabilizes the neuronal membrane by delaying the influx of sodium ions into the neurons and preventing the excitability caused by excessive simulation (impacts Na & neuron)

what makes hydatonins (phenytonin) unique?

- gingival hyperplasia (red overgrowth in gums)

- half-life: 8-40 hours

- SDL: 10-20 mcg/mL

what is the serum drug level of hydantonins (phenytoin)?

10-20 mcg/mL

antiepileptic (AEDs): carbamazepine (tegretol) MOA

works on sodium channels

what are the SE/AE of carbamazepine?

- neuro: nystagmus (eye wiggle), ataxia (poor muscle control)

- hemato: affect WBC, plt count

- derm/skin: rash, photosensitivity rxns

what is the serum drug level of carbamazepine?

5-12 mcg/dL

antiepileptic (AEDs): barbiturates (phenobarbital) MOA

depresses the CNS by inhibiting the conduction of impulses in the reticular activating system, depressing the cerebral cortex & cerebellar function

what is unique about barbiturates (phenobarbital)?

Stevens-Johnson syndrome, when first administering we HAVE to watch for pts ability to breathe

antiepileptic (AEDs): benzodiazepines (lorazepam & diazepam) MOA

depresses the CNS

what is the antidote for benzodiazepines (lorazepam & diazepam)?

flumazenil

rapid acting insulin prototypes

lispro, aspart, glulisine (LAG)

rapid acting insulin (LAG) MOA

RAPIDLY opens up the cells and lets sugar into the cells for energy

course/rate of the rapid acting insulin (LAG)

starts to work in 15 mins, peaks in 2.5 hours, lasts 5 hours

you give rapid acting insulin ___ a meal and is known as ___

before; bolus

rapid acting insulin can be given as a ___ and in a ___

injection; pump

long acting insulin prototype

glargine

long acting insulin (glargine) MOA

SLOWLY opens up the cells and lets sugar into the cells for energy

course/rate of the long acting insulin (glargine)

starts to work in 1 hour, no peak, lasts 24 hours

long acting insulin is known as ___

basal

long acting insulin is only given as an ___

injectable

oral hypoglycemics medications

- biguanide (metformin)

- sulfonylureas ("gly")

- SGLT2 inhibitors (canagliflozin)

oral hypoglycemics -- biguanide (metformin) MOA

telling fat to to open, "slapping the liver" (don't produce any more glucose), sugar goes to GI

we want to monitor for ___ when giving a patient metformin

fatal lactic acidosis

what is a main concern about metformin/biguanide?

AE of lactic acidosis

oral hypoglycemics -- sulfonylureas ("gly") MOA

tells pancreas to ↑ insulin release

what is the main concern with sulfonylureas (AE)?

hypoglycemia

subgroups of sulfonylureas

- glyburide

- glipizide

- glimepiride

sodium glucose cotransporter 2 (SGLT2) inhibitor prototype

canagliflozin

SGLT2 inhibitor (canagliflozin) MOA

blocks reabsorption of glucose in kidney; promotes excretion of excess glucose in the urine; renal protective decreasing protein loss (LIKE A DIURETIC - FUROSEMIDE)

SGLT2 inhibitor (canagliflozin) AE

may cause UTI because glucose stores in the bladder

what do we want to monitor for when giving SGLT2 inhibitor (canagliflozin)?

dehydration, hypotension, UTI, vulvovaginal candidiasis

local anesthesia prototypes

admides (lidocaine [xylocaine]) and esters (chloroprocaine [nescaine])

local anesthesia (amides & esters) MOA

stops sensory & motor w/ localization on nerve conduction but NOT consciousness (no CNS depressing)

amides causes ___ allergic reactions

less

esters causes ___ allergic reactions

more

general anesthesia prototype

inhaled agents

general anesthesia (inhaled agents) MOA

CNS depressing, inhibits neurotransmitters that activate the RAS - easily cross the blood brain barrier

what are severe SE/AE of inhaled agents

low BP (hypotension), respiratory depression, larynospasm, shivering

we want to do the following when giving inhaled agents

assess V.S. & LOC, administer oxygen, keep pt warm, monitor N/V

cytoprotective agents prototypes

- epoetin (procrit)

- fligrastim (neupogen)

- pegfilgrastim (neulasta)

- oprelvekin (neumega)

- sargramostin (leukine)

epoetin (procrit) MOA

trick bone marrow that RBC is low & to push more

filgrastim (neuopogen) MOA

stimulates production, maturation & activation of neutrophils

pegfilgrastim (neulasta) MOA

stimulates production, maturation and activation of neutrophils (long acting version of Filgrastim)

__ is the old cousin of __

peg; fil

oprelvekin (neumega) MOA

prevent thrombocytopenia

sargramostin (leukine) MOA

decrease neutropenia and risk of infection (WBCs and neutrophils) and stimulate stem cells after stem cell transplant and bone marrow transplantation

we use sargramostin (leukine) for ___ and ___.

stem cell transplant; bone marrow transplant

leukopenia

WBC < 3,500 cells/mcL

neutropenia

neutrophils < 1500/mcL

anemia for men

hemoglobin < 13.5g/dL

anemia for women

hemoglobin < 12.0g/dL

low hematocrit for men

< 38.8%

low hematocrit for women

< 34.9%