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594 Cards in this Set
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|
This age represents 60% of all poisionings:
|
Kids 5 or younger (boys a little more than girls)
|
|
Drug that should be given in case of narcotic overdose:
|
Nalaxone
|
|
A pt in shock from a poisoning should be given:
|
Oxygen, ringer’s lactate, or IV saline
|
|
Most common “toxin” that is fatal:
|
Analgesics
|
|
Drugs for overdose:
|
Raly pack = D.O.N.T. (dextrose, oxygen, nalaxone, thaimine)
|
|
Kids that took grandparents medicine that says things that are yellow are purple has OD’d on:
|
Digoxin
|
|
Kid who is in ER who has a rapid pulse and tinnitus (ringing in his ears):
|
Aspirin (salicylate) poisoning
|
|
Kid who is dry as a bone, red as a beet, hot as a pistol, etc:
|
Anticholinergic symptoms (atropine, diphenhydramine)
|
|
Should be used for skin toxicants and most ingested toxicants:
|
Dilution using water (don’t use carbonated drinks)
|
|
Contraindications to using activated charcoal:
|
Coma, convulsions, age less than 9mo., nontoxic ingestion, ingestion of caustic substances, ingestion of petroleum distillate hydrocarbons
|
|
How long does it take syrup of ipecac to work?
|
Usually takes 30min to cause vomiting
|
|
Respiratory depressant that is a non-narcotic morphine derivative that induces vomiting in 1-3 minutes:
|
Apomorphine
|
|
When is it best to give activated charcoal?
|
30 – 60 min post ingestion of a toxin
|
|
Things that aren’t adsorbed by activated charcoal:
|
Acids, bases, EtOH, most organic solvents, and metals. PHAILS (pesticides, halocarbons, alcohols, Iron, Lithium, solvents)
|
|
If giving charcoal and ipecac how should you give these?
|
Charcoal adsorbs ipecac, so ipecac must be given 1st and emesis induced before charcoal can be given
|
|
When is whole bowel irrigation used?
|
For colonoscopies, whenever meds may form concretions, and for drug “packers”
|
|
Diuretic drugs most commonly used for diuresis:
|
Mannitol and furosemide
|
|
Symptoms of acute opioid overdose:
|
Miosis, CNS depression, respiratory depression, constipation
|
|
Best treatment for opioid overdose:
|
IV nalaxone
|
|
Reactive metabolite of acetaminophen:
|
NAPQI
|
|
Typical symptoms of tylenol overdose:
|
1st drowsy with upset stomach, then a couple days later there can be coma, jaundice, elevated ALT/AST and BUN
|
|
Specific antidote for acetaminophen overdose:
|
N-Acetylcysteine (provides cysteine needed for glutathione biosynthesis and directly conjugates NAPQI)
|
|
What do salicylates do?
|
Uncouple mitochondrial oxidative phosphorylation resulting in rapid depletion of GLYCOGEN and excessive heat
|
|
Symptoms of salicylate overdose:
|
Hyperthermia, initial hyperglycemia followed by hypoglycemia (as glycogen stores are depleted), TINNITUS, respiratory alkalosis followed by metabolic acidosis
|
|
How do you treat aspirin overdose?
|
Emesis and activated charcoal early, if high levels: hemodialysis
|
|
Pt with hyperkalemia, yellow-purple visual disturbance, fatigue, drowsiness, confusion has ingested:
|
Digoxin
|
|
How do you treat digoxin toxicity?
|
Digibind, Atropine for bradycardia, control hyperkalemia with insulin, dextrose, bicarb
|
|
Pt with hypotension, bradycardia, drowsiness, confusion, and respiratory distress/wheezing probably has:
|
Beta-blocker overdose
|
|
How do you treat beta-blocker overdose?
|
Glucagon IV, atropine for bradycardia, insulin/dextrose
|
|
Pt with severe hypotension, bradycardia, confusion, drowsiness, and AV-nodal block probably has ingested:
|
Ca-channel blockers
|
|
How do you treat Ca-channel blocker OD?
|
Calcium choloride IV, IV fluids, atropine for bradycardia, insulin/dextrose for hypotension
|
|
Pt with hypertension, hyperthermia, mydriasis (dilated pupil), arrythmias, and seizure/movement disorder has probably over-dosed on:
|
Meth or cocaine
|
|
How would you treat meth/coke overdose?
|
No specific antidote, so supportive care, treat the hyperthermia, benzo’s for agitation and seizure
|
|
The toxicity of overdose with this drug can be predicted by the widening of the QRS:
|
Tricyclic antidepressants
|
|
What are the symptoms of TCA overdose?
|
Anticholinergic symptoms (mydriasis, tachycardia, urinary retention, dry mouth, dry skin), respiratory depression, myoclonus/seizure, widened QRS (>100 = 1/3 have seizure, and > 160 = ½ have ventricular arrhythmias)
|
|
How do you treat TCA overdose?
|
Lavage or activated charcoal, sodium bicarb, benzo’s
|
|
A pt with N/V, lethargy, sedation, and seratonin syndrome (clonus, agitation, sweating, hyperthermia) has:
|
SSRI overdose
|
|
How would you treat someone who OD’d on SSRI’s?
|
Activated charcoal if early enough, benzo’s, Cyproheptadine (an anti-seratonin– only has modest effects though)
|
|
How do you treat acute ethanol intox?
|
Glucose, ventilation, and thiamine (to protect against Wernicke-Korasakoffs)
|
|
A person who has ingested an alcohol and smells of acetone has probably ingested:
|
Isopropanol
|
|
How do you treat isopropranol intox?
|
Ventilation and hemodialysis may be needed
|
|
What does a methanol intoxication do?
|
Metabolized to formix acid which can lead to severe metabolic acidosis and blindness
|
|
Ethylene glycol is metabolized to:
|
Glycolic acid, glyoxylic acid, and then oxalic acid
|
|
Best way to treat ethylene glycol or methanol intox:
|
Give them ethanol (get them drunk) to minimize metabolism. Give fomepizole (an alcohol dehydrogenase inhibitor)
|
|
The characteristic look of someone with CO poisoning:
|
Reddish skin d/t carboxyhemoglobin
|
|
How do you treat CO poisoning?
|
100% O2 (in a hyperbaric it decreases CO ½ life to 23min)
|
|
What does cyanide inhibit?
|
Cytochrome oxidase
|
|
What do cyanide victims look like and why?
|
They are bright red, d/t high O2 concentration in the blood
|
|
How do you treat cyanide poisoning?
|
Nitrites (amyl nitrite or sodium nitrite) and sodium thiosulfate
|
|
Sewage workers can be exposed to this that is like cyanide poisoning in that it inhibits cytochrome oxidase:
|
Hydrogen sulfide
|
|
These compounds can be toxic and work by inhibiting acetylcholinesterase:
|
Malathion and parathion (organophosphates)
|
|
Signs and symptoms of organophosphate toxicity:
|
Miosis, bradycardia, hypotension, excessive GI and resp secretions, uncontrolled urination, headache, anxiety, convulsions
|
|
How do you treat organophosphate toxicity?
|
Atropine and pralidoxime (2-Pam)
|
|
An example of a reversible acetylcholinesterase inhibitor is:
|
Carbamate (Sevin dust)– milder sx than organophosphates
|
|
Most common organochloride:
|
DDT
|
|
How do you treat heavy metal toxicity?
|
Chelation
|
|
Types of chelating agents:
|
Dimercaprol, Edetate, Penicillamine, Trientine, Succimer, Deferoxamine
|
|
Antidote to arsenical war gas Lewisite:
|
Dimercaprol (aka British anti-lewisite)
|
|
Used to treat Wilson’s disease (copper accumulation):
|
Penicillamine
|
|
It a pt with Wilson’s can’t take penicillamine then give:
|
Trientine
|
|
Indicated for lead, mercury, and aresenic poisoning:
|
Succimer
|
|
Specific iron chelating agent:
|
Deferoxamine
|
|
Most common heavy metal poisoning:
|
Iron (sx include shock, acidosis, cyanosis, liver injury)
|
|
Recommended chelation for lead poisoning:
|
Edetate, dimercaprol and penicillamine. Kids: give Succimer for lead poisoning
|
|
Recommended chelation therapy for mercury poisoning:
|
Dimercaprol and penicillamine
|
|
Underlying principle of antimicrobials is:
|
Selective toxicity
|
|
Used to remove microbes from objects:
|
Disinfectants
|
|
Used to remove microbes from the skin:
|
Antiseptics
|
|
A direct lethal effect on a bacteria:
|
Bacteriocidal
|
|
Reversible inhibition of bacterial growth:
|
Bacteriostatic (allows host defenses to work)
|
|
Only effective against either gram + or gram - :
|
Narrow spectrum antibiotic
|
|
Effective against gram + and - :
|
Broad spectrum antibiotic
|
|
An intermediate between broad and narrow spectrum:
|
Extended spectrum antibiotic
|
|
Bacteria with peptidoglycan and outer membrane:
|
Gram negative (stains pink)
|
|
Bacteria with big peptidoglycan layer:
|
Gram positive (stains purple)
|
|
Inhibits cell wall synthesis:
|
Penicillans
|
|
Inhibits protein synthesis:
|
Tetracyclines
|
|
Destroys cell membrane function:
|
-Azole antifungals
|
|
Alters nucleic acid synthesis:
|
Fluoroquinolones
|
|
What is minimum inhibitory concentration?
|
Lowest concentration of antimicrobial that will inhibit bacterial growth of an organism in overnight incubation
|
|
What is the treatment goal of the MIC?
|
Maintain circulating concentrations above the MIC
|
|
Types of microbial resistance:
|
Antibiotic metabolism by organism enzymes, Decreased entry into bacterial cells, Increased export from bacterial cells, Altered microbial target, Target pathway become unnecessary
|
|
Antibiotics that cause antibiotic associated colitis:
|
Clindamycin and Ampicillin
|
|
Poor distribution sites for antibiotics:
|
Bone, prostate, eye, alveoli, abscesses
|
|
Good antiseptics/germicides:
|
Anions, cations, phenols (lysole = cresol + soapy water), EtOH (70% solution), Iodine (very broad spectrum), Metals (mercury and silver are good– bacteriostatic)
|
|
Inhibitors of bacterial cell wall synthesis overview:
|
Bacitracin, Cephalosporins, Cycloserine, Carbapenems, Fosfomycin, Isoniazid, Penicillins, Vancomycin
|
|
Most important class of cell wall inhibitors:
|
Beta-lactams (Penicillins, cephalosporins, carbapenems, and monobactams)
|
|
Major toxicity of beta-lactams:
|
Allergic reactions to drugs
|
|
How do beta-lactams work?
|
The all bind covalently to penicillin binding protein
|
|
What happens when penicillin binding proteins are inhibited?
|
Influx of water into microbe and they burst
|
|
Beta-lactams are bacteriocidal and work best against:
|
Most active against growing bacteria with INTACT beta-lactam walls (beta wall must be intact for them to work)
|
|
How beta-lactams excreted?
|
Excreted in the unchanged in the urine (must have good renal function to take these drugs)
|
|
Non-allergic toxicity of note for beta-lactams:
|
CNS problems
|
|
Major form of resistance against beta-lactam drugs:
|
Beta-lactamase by the microbe that hydrolyzes the beta-lactam ring so the drugs can’t covalently bind and work
|
|
How is penicillins (a beta lactam) normally excreted?
|
Unchanged in the urine
|
|
Penicillins are mostly used against these bacteria:
|
Gram positive
|
|
4 groups of penicillins:
|
Pen G, beta lactamase resistant, extended spectrum, and extended spectrum with beta lactamase resistant pen’s
|
|
Is Pen G or Pen V given oral?
|
Pen G is given IM, while Penicillin V is given orally
|
|
The 2 pencillinase-sensitive narrow spectrum penicillins are:
|
Pencillin G and Penicillin V
|
|
Penicillinases-resistant (anti-staph) penicillins:
|
Methicillin, Oxacillin, and Cloxacillin
|
|
What is MRSA resistant to:
|
The penicillinase-resistant penicillins
|
|
This penicillin is extended spectrum (good for gram +/-):
|
Aminopenicillins (Ampicillin and Amoxicillin)
|
|
Clinical uses for amoxicillin:
|
Acute otitis media/sinusitis, Lower respiratory tract infections
|
|
Used for prophylaxis against endocarditis:
|
Ampicillin
|
|
Category of penicillins that has largely been replaced by 3rd gen cephalosporins, carbapenems, and fluoroquinolones:
|
Anti-pseudomonal penicillins (carboxypenicillins)
|
|
Why are the carboxypenicillins not used?
|
Their side-effects (sodium overload and increased bleed time)
|
|
Parenteral only, anti-pseudomonal penicillin (carboxypen):
|
Ticarcillin
|
|
Broader spectrum penicillin:
|
Piperacillin (parenteral only)
|
|
Only penicillin that’s absorption ISN’T decreased by food:
|
Amoxicillin
|
|
How should people be instructed to take penicillins (except for amoxicillin)?
|
Take 1hr before or 2hrs after a meal
|
|
How is penicillins excreted and what caution should be taken with them?
|
Excreted in urine, so if poor renal function they could build up and cause a seizure, etc..
|
|
Drug that blocks the tubular mechanism of penicillin excretion:
|
Probenacid (used for gout)
|
|
Most common type of allergy to penicillins:
|
Delayed reactions: skin rash, pruritis, and urticaria
|
|
Beta-lactamase inhibitors that are often mixed with antibiotics:
|
Clavulanic acid, sulbactam, Tazobactam
|
|
Properties of beta-lactamase inhibitors:
|
Poor antimicrobial effects, irreversibly inhibit bacterial beta-lactamase, used only in combo with penicillins
|
|
Most common used for beta-lactamase inhibitors:
|
Intra-abdominal infections with mixed an/aerobic infections
|
|
Broad spectrum antibiotics separated into generations:
|
Cephalosporins
|
|
Features of 1st generation Cephalosporins:
|
Extended spectrum, More effective against gram + than gram negative, Primarily excreted in the urine. Drugs to know: Cefazolin and Cefadroxil
|
|
Parenteral 1st gen cephalosporin used for surgery prophylaxis:
|
Cefazolin
|
|
2st gen cephalosporin, good against anaerobes, good for prophylaxis during ABDOMINAL surgery:
|
Cefoxatin
|
|
Biggest benefit of the 3rd and 4th gen cephalosporins:
|
Tend to cross the CSF better than other generations
|
|
Characteristics of 3rd/4th gen cephalosporins:
|
BROAD spectrum, Cross CSF better, preferred over penicillins and 1st and 2nd gen cephalosporins for gram negative bacteria
|
|
Best drug for treating meningitis from H. influenzae:
|
Ceftriaxone (Rocephin) crosses into meninges to treat
|
|
1st line treatment for N. gonorrhea:
|
Ceftriaxone and Cefixime
|
|
Important note on cephalosporin toxicity and penicillin allergy:
|
If a pt has had an anaphylactic shock reaction to a penicillin, DON’T give a cephalosporin
|
|
Some other toxicities from cephalosporins include:
|
CNS excitation, renal toxicity, hemolytic anemia, bleeding abnormalities
|
|
IMPORTANT: Ceftriaxone is chemically insoluble with what solutions (contraindicated for all ages!):
|
Calcium solutions (Don’t co-infuse in same or different lines/sites calcium and ceftriaxone within 48hrs of each other) – it caused fatalities in neonates, serious for all ages
|
|
Characteristics of carbapenems:
|
Broad spectrum, parenteral use only, resistant to most beta-lactamases, excreted in the urine
|
|
Imipenem is metabolized by a renal enzyme called:
|
Dehydropeptidase – (makes it nephrotoxic)
|
|
Imipenem is co-administered with:
|
Cillistatin (in fact they are sold as a combo)
|
|
Which is contraindicated in pregnancy: Imipenem, Meropenem, or Ertapenem?
|
Imipenem is the only one contraindicated in pregnancy the other 2 are okay (Meropenem and Ertapenem)
|
|
Drug of choice for enterobacter infections:
|
Carbapenems
|
|
Only monobactam (only has one beta-lactam ring) and only effective against gram-negative bacilli:
|
Aztreonam
|
|
Narrow spectrum drug only good for gram-neg bacilli:
|
Aztreonam (monobactam)
|
|
How does vancomycin work?
|
Prevent cross-linking of peptidoglycan layer (good for staph infections and flavobacterium– gram positive organisms)
|
|
How should vancomycin be given?
|
Slow IV infusion (causes tissues necrosis if given IM)
|
|
Main toxicity to vancomycin:
|
Nephrotoxicity (check kidney function)
|
|
Notable clinical uses of vancomycin:
|
MRSA, enteric infections, taken for ANTIBIOTIC associated COLITIS, in combo with gentamycin for enterococcus endocarditis in pt’s with penicillin allergy
|
|
Very nephrotoxic drug, narrow spectrum for gram positives, usually used topically:
|
Bacitracin
|
|
Another cell wall synthesis inhibitor that is good for urinary tract infections and is safe for pregnant women:
|
Fosfomycin
|
|
Protein synthesis inhibitors active at 30S:
|
Tetracyclines and Aminoglycosides
|
|
Protein synthesis inhibitors active at 50S:
|
Macrolides, Lincosamides, Chloramphenicol
|
|
Most protein synthesis inhibitors are considered bacteriostatic except for:
|
Aminoglycosides
|
|
How are the macrolides eliminated?
|
Hepatic metabolism (CYP)
|
|
Important treatment limitation of macrolides:
|
Don’t get into the CSF, even in meningitis
|
|
Prototypical macrolide, very similar to penicillin G, can be used in pt’s with an allergy to penicillin G:
|
Erythromycin
|
|
Best absorbed oral form of erythromycin:
|
Estolate salt
|
|
Most important side-effect to erythromycin:
|
Acute cholestatic hepatits
|
|
Drug of choice for Cornybacterium infections (diptheria):
|
Erythromycin
|
|
Advantages of using clarithromycin or erythromycin:
|
More potent, acid stable, better absorbed (less GI irritation), longer ½ life (BID dosing instead of QID dosing)
|
|
Azalide (macrolide) that is better for gram negative bacteria and has a long ½ life (~3days):
|
Azithromycin
|
|
Benefits of using azithromycin:
|
Not metabolized (doen’t affect other drugs in liver) and has very low plasma levels
|
|
“Pro-drug” macrolide (inactive on its own) that has to be taken with meals to increase bioavailability:
|
Dirithromycin
|
|
“ketolide” (macrolide) that binds ribosomal proteins and RNA, but also has serious hepatotoxicity/death as a result from using it:
|
Telithromycin
|
|
The 2 lincosamides:
|
Clindamycin and lincomycin
|
|
This age represents 60% of all poisionings:
|
Kids 5 or younger (boys a little more than girls)
|
|
Drug that should be given in case of narcotic overdose:
|
Nalaxone
|
|
A pt in shock from a poisoning should be given:
|
Oxygen, ringer’s lactate, or IV saline
|
|
Most common “toxin” that is fatal:
|
Analgesics
|
|
Drugs for overdose:
|
Raly pack = D.O.N.T. (dextrose, oxygen, nalaxone, thaimine)
|
|
Kids that took grandparents medicine that says things that are yellow are purple has OD’d on:
|
Digoxin
|
|
Kid who is in ER who has a rapid pulse and tinnitus (ringing in his ears):
|
Aspirin (salicylate) poisoning
|
|
Kid who is dry as a bone, red as a beet, hot as a pistol, etc:
|
Anticholinergic symptoms (atropine, diphenhydramine)
|
|
Should be used for skin toxicants and most ingested toxicants:
|
Dilution using water (don’t use carbonated drinks)
|
|
Contraindications to using activated charcoal:
|
Coma, convulsions, age less than 9mo., nontoxic ingestion, ingestion of caustic substances, ingestion of petroleum distillate hydrocarbons
|
|
How long does it take syrup of ipecac to work?
|
Usually takes 30min to cause vomiting
|
|
Respiratory depressant that is a non-narcotic morphine derivative that induces vomiting in 1-3 minutes:
|
Apomorphine
|
|
When is it best to give activated charcoal?
|
30 – 60 min post ingestion of a toxin
|
|
Things that aren’t adsorbed by activated charcoal:
|
Acids, bases, EtOH, most organic solvents, and metals. PHAILS (pesticides, halocarbons, alcohols, Iron, Lithium, solvents)
|
|
If giving charcoal and ipecac how should you give these?
|
Charcoal adsorbs ipecac, so ipecac must be given 1st and emesis induced before charcoal can be given
|
|
When is whole bowel irrigation used?
|
For colonoscopies, whenever meds may form concretions, and for drug “packers”
|
|
Diuretic drugs most commonly used for diuresis:
|
Mannitol and furosemide
|
|
Symptoms of acute opioid overdose:
|
Miosis, CNS depression, respiratory depression, constipation
|
|
Best treatment for opioid overdose:
|
IV nalaxone
|
|
Reactive metabolite of acetaminophen:
|
NAPQI
|
|
Typical symptoms of tylenol overdose:
|
1st drowsy with upset stomach, then a couple days later there can be coma, jaundice, elevated ALT/AST and BUN
|
|
Specific antidote for acetaminophen overdose:
|
N-Acetylcysteine (provides cysteine needed for glutathione biosynthesis and directly conjugates NAPQI)
|
|
This age represents 60% of all poisionings:
|
Kids 5 or younger (boys a little more than girls)
|
|
Drug that should be given in case of narcotic overdose:
|
Nalaxone
|
|
A pt in shock from a poisoning should be given:
|
Oxygen, ringer’s lactate, or IV saline
|
|
Most common “toxin” that is fatal:
|
Analgesics
|
|
Drugs for overdose:
|
Raly pack = D.O.N.T. (dextrose, oxygen, nalaxone, thaimine)
|
|
Kids that took grandparents medicine that says things that are yellow are purple has OD’d on:
|
Digoxin
|
|
Kid who is in ER who has a rapid pulse and tinnitus (ringing in his ears):
|
Aspirin (salicylate) poisoning
|
|
Kid who is dry as a bone, red as a beet, hot as a pistol, etc:
|
Anticholinergic symptoms (atropine, diphenhydramine)
|
|
Should be used for skin toxicants and most ingested toxicants:
|
Dilution using water (don’t use carbonated drinks)
|
|
Contraindications to using activated charcoal:
|
Coma, convulsions, age less than 9mo., nontoxic ingestion, ingestion of caustic substances, ingestion of petroleum distillate hydrocarbons
|
|
How long does it take syrup of ipecac to work?
|
Usually takes 30min to cause vomiting
|
|
Respiratory depressant that is a non-narcotic morphine derivative that induces vomiting in 1-3 minutes:
|
Apomorphine
|
|
When is it best to give activated charcoal?
|
30 – 60 min post ingestion of a toxin
|
|
Things that aren’t adsorbed by activated charcoal:
|
Acids, bases, EtOH, most organic solvents, and metals. PHAILS (pesticides, halocarbons, alcohols, Iron, Lithium, solvents)
|
|
If giving charcoal and ipecac how should you give these?
|
Charcoal adsorbs ipecac, so ipecac must be given 1st and emesis induced before charcoal can be given
|
|
When is whole bowel irrigation used?
|
For colonoscopies, whenever meds may form concretions, and for drug “packers”
|
|
Diuretic drugs most commonly used for diuresis:
|
Mannitol and furosemide
|
|
Symptoms of acute opioid overdose:
|
Miosis, CNS depression, respiratory depression, constipation
|
|
Best treatment for opioid overdose:
|
IV nalaxone
|
|
Reactive metabolite of acetaminophen:
|
NAPQI
|
|
Typical symptoms of tylenol overdose:
|
1st drowsy with upset stomach, then a couple days later there can be coma, jaundice, elevated ALT/AST and BUN
|
|
Specific antidote for acetaminophen overdose:
|
N-Acetylcysteine (provides cysteine needed for glutathione biosynthesis and directly conjugates NAPQI)
|
|
What do salicylates do?
|
Uncouple mitochondrial oxidative phosphorylation resulting in rapid depletion of GLYCOGEN and excessive heat
|
|
Symptoms of salicylate overdose:
|
Hyperthermia, initial hyperglycemia followed by hypoglycemia (as glycogen stores are depleted), TINNITUS, respiratory alkalosis followed by metabolic acidosis
|
|
How do you treat aspirin overdose?
|
Emesis and activated charcoal early, if high levels: hemodialysis
|
|
Pt with hyperkalemia, yellow-purple visual disturbance, fatigue, drowsiness, confusion has ingested:
|
Digoxin
|
|
How do you treat digoxin toxicity?
|
Digibind, Atropine for bradycardia, control hyperkalemia with insulin, dextrose, bicarb
|
|
Pt with hypotension, bradycardia, drowsiness, confusion, and respiratory distress/wheezing probably has:
|
Beta-blocker overdose
|
|
How do you treat beta-blocker overdose?
|
Glucagon IV, atropine for bradycardia, insulin/dextrose
|
|
Pt with severe hypotension, bradycardia, confusion, drowsiness, and AV-nodal block probably has ingested:
|
Ca-channel blockers
|
|
How do you treat Ca-channel blocker OD?
|
Calcium choloride IV, IV fluids, atropine for bradycardia, insulin/dextrose for hypotension
|
|
Pt with hypertension, hyperthermia, mydriasis (dilated pupil), arrythmias, and seizure/movement disorder has probably over-dosed on:
|
Meth or cocaine
|
|
How would you treat meth/coke overdose?
|
No specific antidote, so supportive care, treat the hyperthermia, benzo’s for agitation and seizure
|
|
The toxicity of overdose with this drug can be predicted by the widening of the QRS:
|
Tricyclic antidepressants
|
|
What are the symptoms of TCA overdose?
|
Anticholinergic symptoms (mydriasis, tachycardia, urinary retention, dry mouth, dry skin), respiratory depression, myoclonus/seizure, widened QRS (>100 = 1/3 have seizure, and > 160 = ½ have ventricular arrhythmias)
|
|
How do you treat TCA overdose?
|
Lavage or activated charcoal, sodium bicarb, benzo’s
|
|
A pt with N/V, lethargy, sedation, and seratonin syndrome (clonus, agitation, sweating, hyperthermia) has:
|
SSRI overdose
|
|
How would you treat someone who OD’d on SSRI’s?
|
Activated charcoal if early enough, benzo’s, Cyproheptadine (an anti-seratonin– only has modest effects though)
|
|
How do you treat acute ethanol intox?
|
Glucose, ventilation, and thiamine (to protect against Wernicke-Korasakoffs)
|
|
A person who has ingested an alcohol and smells of acetone has probably ingested:
|
Isopropanol
|
|
How do you treat isopropranol intox?
|
Ventilation and hemodialysis may be needed
|
|
What does a methanol intoxication do?
|
Metabolized to formix acid which can lead to severe metabolic acidosis and blindness
|
|
Ethylene glycol is metabolized to:
|
Glycolic acid, glyoxylic acid, and then oxalic acid
|
|
Best way to treat ethylene glycol or methanol intox:
|
Give them ethanol (get them drunk) to minimize metabolism. Give fomepizole (an alcohol dehydrogenase inhibitor)
|
|
The characteristic look of someone with CO poisoning:
|
Reddish skin d/t carboxyhemoglobin
|
|
How do you treat CO poisoning?
|
100% O2 (in a hyperbaric it decreases CO ½ life to 23min)
|
|
What does cyanide inhibit?
|
Cytochrome oxidase
|
|
What do cyanide victims look like and why?
|
They are bright red, d/t high O2 concentration in the blood
|
|
How do you treat cyanide poisoning?
|
Nitrites (amyl nitrite or sodium nitrite) and sodium thiosulfate
|
|
Sewage workers can be exposed to this that is like cyanide poisoning in that it inhibits cytochrome oxidase:
|
Hydrogen sulfide
|
|
These compounds can be toxic and work by inhibiting acetylcholinesterase:
|
Malathion and parathion (organophosphates)
|
|
Signs and symptoms of organophosphate toxicity:
|
Miosis, bradycardia, hypotension, excessive GI and resp secretions, uncontrolled urination, headache, anxiety, convulsions
|
|
How do you treat organophosphate toxicity?
|
Atropine and pralidoxime (2-Pam)
|
|
An example of a reversible acetylcholinesterase inhibitor is:
|
Carbamate (Sevin dust)– milder sx than organophosphates
|
|
Most common organochloride:
|
DDT
|
|
How do you treat heavy metal toxicity?
|
Chelation
|
|
Types of chelating agents:
|
Dimercaprol, Edetate, Penicillamine, Trientine, Succimer, Deferoxamine
|
|
Antidote to arsenical war gas Lewisite:
|
Dimercaprol (aka British anti-lewisite)
|
|
Used to treat Wilson’s disease (copper accumulation):
|
Penicillamine
|
|
It a pt with Wilson’s can’t take penicillamine then give:
|
Trientine
|
|
Indicated for lead, mercury, and aresenic poisoning:
|
Succimer
|
|
Specific iron chelating agent:
|
Deferoxamine
|
|
Most common heavy metal poisoning:
|
Iron (sx include shock, acidosis, cyanosis, liver injury)
|
|
Recommended chelation for lead poisoning:
|
Edetate, dimercaprol and penicillamine. Kids: give Succimer for lead poisoning
|
|
Recommended chelation therapy for mercury poisoning:
|
Dimercaprol and penicillamine
|
|
Underlying principle of antimicrobials is:
|
Selective toxicity
|
|
Used to remove microbes from objects:
|
Disinfectants
|
|
Used to remove microbes from the skin:
|
Antiseptics
|
|
A direct lethal effect on a bacteria:
|
Bacteriocidal
|
|
Reversible inhibition of bacterial growth:
|
Bacteriostatic (allows host defenses to work)
|
|
Only effective against either gram + or gram - :
|
Narrow spectrum antibiotic
|
|
Effective against gram + and - :
|
Broad spectrum antibiotic
|
|
An intermediate between broad and narrow spectrum:
|
Extended spectrum antibiotic
|
|
Bacteria with peptidoglycan and outer membrane:
|
Gram negative (stains pink)
|
|
Bacteria with big peptidoglycan layer:
|
Gram positive (stains purple)
|
|
Inhibits cell wall synthesis:
|
Penicillans
|
|
Inhibits protein synthesis:
|
Tetracyclines
|
|
Destroys cell membrane function:
|
-Azole antifungals
|
|
Alters nucleic acid synthesis:
|
Fluoroquinolones
|
|
What is minimum inhibitory concentration?
|
Lowest concentration of antimicrobial that will inhibit bacterial growth of an organism in overnight incubation
|
|
What is the treatment goal of the MIC?
|
Maintain circulating concentrations above the MIC
|
|
Types of microbial resistance:
|
Antibiotic metabolism by organism enzymes, Decreased entry into bacterial cells, Increased export from bacterial cells, Altered microbial target, Target pathway become unnecessary
|
|
Antibiotics that cause antibiotic associated colitis:
|
Clindamycin and Ampicillin
|
|
Poor distribution sites for antibiotics:
|
Bone, prostate, eye, alveoli, abscesses
|
|
Good antiseptics/germicides:
|
Anions, cations, phenols (lysole = cresol + soapy water), EtOH (70% solution), Iodine (very broad spectrum), Metals (mercury and silver are good– bacteriostatic)
|
|
Inhibitors of bacterial cell wall synthesis overview:
|
Bacitracin, Cephalosporins, Cycloserine, Carbapenems, Fosfomycin, Isoniazid, Penicillins, Vancomycin
|
|
Most important class of cell wall inhibitors:
|
Beta-lactams (Penicillins, cephalosporins, carbapenems, and monobactams)
|
|
Major toxicity of beta-lactams:
|
Allergic reactions to drugs
|
|
How do beta-lactams work?
|
The all bind covalently to penicillin binding protein
|
|
What happens when penicillin binding proteins are inhibited?
|
Influx of water into microbe and they burst
|
|
Beta-lactams are bacteriocidal and work best against:
|
Most active against growing bacteria with INTACT beta-lactam walls (beta wall must be intact for them to work)
|
|
How beta-lactams excreted?
|
Excreted in the unchanged in the urine (must have good renal function to take these drugs)
|
|
Non-allergic toxicity of note for beta-lactams:
|
CNS problems
|
|
Major form of resistance against beta-lactam drugs:
|
Beta-lactamase by the microbe that hydrolyzes the beta-lactam ring so the drugs can’t covalently bind and work
|
|
How is penicillins (a beta lactam) normally excreted?
|
Unchanged in the urine
|
|
Penicillins are mostly used against these bacteria:
|
Gram positive
|
|
4 groups of penicillins:
|
Pen G, beta lactamase resistant, extended spectrum, and extended spectrum with beta lactamase resistant pen’s
|
|
Is Pen G or Pen V given oral?
|
Pen G is given IM, while Penicillin V is given orally
|
|
The 2 pencillinase-sensitive narrow spectrum penicillins are:
|
Pencillin G and Penicillin V
|
|
Penicillinases-resistant (anti-staph) penicillins:
|
Methicillin, Oxacillin, and Cloxacillin
|
|
What is MRSA resistant to:
|
The penicillinase-resistant penicillins
|
|
This penicillin is extended spectrum (good for gram +/-):
|
Aminopenicillins (Ampicillin and Amoxicillin)
|
|
Clinical uses for amoxicillin:
|
Acute otitis media/sinusitis, Lower respiratory tract infections
|
|
Used for prophylaxis against endocarditis:
|
Ampicillin
|
|
Category of penicillins that has largely been replaced by 3rd gen cephalosporins, carbapenems, and fluoroquinolones:
|
Anti-pseudomonal penicillins (carboxypenicillins)
|
|
Why are the carboxypenicillins not used?
|
Their side-effects (sodium overload and increased bleed time)
|
|
Parenteral only, anti-pseudomonal penicillin (carboxypen):
|
Ticarcillin
|
|
Broader spectrum penicillin:
|
Piperacillin (parenteral only)
|
|
Only penicillin that’s absorption ISN’T decreased by food:
|
Amoxicillin
|
|
How should people be instructed to take penicillins (except for amoxicillin)?
|
Take 1hr before or 2hrs after a meal
|
|
How is penicillins excreted and what caution should be taken with them?
|
Excreted in urine, so if poor renal function they could build up and cause a seizure, etc..
|
|
Drug that blocks the tubular mechanism of penicillin excretion:
|
Probenacid (used for gout)
|
|
Most common type of allergy to penicillins:
|
Delayed reactions: skin rash, pruritis, and urticaria
|
|
Beta-lactamase inhibitors that are often mixed with antibiotics:
|
Clavulanic acid, sulbactam, Tazobactam
|
|
Properties of beta-lactamase inhibitors:
|
Poor antimicrobial effects, irreversibly inhibit bacterial beta-lactamase, used only in combo with penicillins
|
|
Most common used for beta-lactamase inhibitors:
|
Intra-abdominal infections with mixed an/aerobic infections
|
|
Broad spectrum antibiotics separated into generations:
|
Cephalosporins
|
|
Features of 1st generation Cephalosporins:
|
Extended spectrum, More effective against gram + than gram negative, Primarily excreted in the urine. Drugs to know: Cefazolin and Cefadroxil
|
|
Parenteral 1st gen cephalosporin used for surgery prophylaxis:
|
Cefazolin
|
|
2st gen cephalosporin, good against anaerobes, good for prophylaxis during ABDOMINAL surgery:
|
Cefoxatin
|
|
Biggest benefit of the 3rd and 4th gen cephalosporins:
|
Tend to cross the CSF better than other generations
|
|
Characteristics of 3rd/4th gen cephalosporins:
|
BROAD spectrum, Cross CSF better, preferred over penicillins and 1st and 2nd gen cephalosporins for gram negative bacteria
|
|
Best drug for treating meningitis from H. influenzae:
|
Ceftriaxone (Rocephin) crosses into meninges to treat
|
|
1st line treatment for N. gonorrhea:
|
Ceftriaxone and Cefixime
|
|
Important note on cephalosporin toxicity and penicillin allergy:
|
If a pt has had an anaphylactic shock reaction to a penicillin, DON’T give a cephalosporin
|
|
Some other toxicities from cephalosporins include:
|
CNS excitation, renal toxicity, hemolytic anemia, bleeding abnormalities
|
|
IMPORTANT: Ceftriaxone is chemically insoluble with what solutions (contraindicated for all ages!):
|
Calcium solutions (Don’t co-infuse in same or different lines/sites calcium and ceftriaxone within 48hrs of each other) – it caused fatalities in neonates, serious for all ages
|
|
Characteristics of carbapenems:
|
Broad spectrum, parenteral use only, resistant to most beta-lactamases, excreted in the urine
|
|
Imipenem is metabolized by a renal enzyme called:
|
Dehydropeptidase – (makes it nephrotoxic)
|
|
Imipenem is co-administered with:
|
Cillistatin (in fact they are sold as a combo)
|
|
Which is contraindicated in pregnancy: Imipenem, Meropenem, or Ertapenem?
|
Imipenem is the only one contraindicated in pregnancy the other 2 are okay (Meropenem and Ertapenem)
|
|
Drug of choice for enterobacter infections:
|
Carbapenems
|
|
Only monobactam (only has one beta-lactam ring) and only effective against gram-negative bacilli:
|
Aztreonam
|
|
Narrow spectrum drug only good for gram-neg bacilli:
|
Aztreonam (monobactam)
|
|
How does vancomycin work?
|
Prevent cross-linking of peptidoglycan layer (good for staph infections and flavobacterium– gram positive organisms)
|
|
How should vancomycin be given?
|
Slow IV infusion (causes tissues necrosis if given IM)
|
|
Main toxicity to vancomycin:
|
Nephrotoxicity (check kidney function)
|
|
Notable clinical uses of vancomycin:
|
MRSA, enteric infections, taken for ANTIBIOTIC associated COLITIS, in combo with gentamycin for enterococcus endocarditis in pt’s with penicillin allergy
|
|
Very nephrotoxic drug, narrow spectrum for gram positives, usually used topically:
|
Bacitracin
|
|
Another cell wall synthesis inhibitor that is good for urinary tract infections and is safe for pregnant women:
|
Fosfomycin
|
|
Protein synthesis inhibitors active at 30S:
|
Tetracyclines and Aminoglycosides
|
|
Protein synthesis inhibitors active at 50S:
|
Macrolides, Lincosamides, Chloramphenicol
|
|
Most protein synthesis inhibitors are considered bacteriostatic except for:
|
Aminoglycosides
|
|
How are the macrolides eliminated?
|
Hepatic metabolism (CYP)
|
|
Important treatment limitation of macrolides:
|
Don’t get into the CSF, even in meningitis
|
|
Prototypical macrolide, very similar to penicillin G, can be used in pt’s with an allergy to penicillin G:
|
Erythromycin
|
|
Best absorbed oral form of erythromycin:
|
Estolate salt
|
|
Most important side-effect to erythromycin:
|
Acute cholestatic hepatits
|
|
Drug of choice for Cornybacterium infections (diptheria):
|
Erythromycin
|
|
Advantages of using clarithromycin or erythromycin:
|
More potent, acid stable, better absorbed (less GI irritation), longer ½ life (BID dosing instead of QID dosing)
|
|
Azalide (macrolide) that is better for gram negative bacteria and has a long ½ life (~3days):
|
Azithromycin
|
|
Benefits of using azithromycin:
|
Not metabolized (doen’t affect other drugs in liver) and has very low plasma levels
|
|
“Pro-drug” macrolide (inactive on its own) that has to be taken with meals to increase bioavailability:
|
Dirithromycin
|
|
“ketolide” (macrolide) that binds ribosomal proteins and RNA, but also has serious hepatotoxicity/death as a result from using it:
|
Telithromycin
|
|
The 2 lincosamides:
|
Clindamycin and lincomycin
|
|
Lincosamide that is narrow spectrum against gram +’s, but highly effective against the anaerobe Bacteroides fragillis:
|
Clindamycin
|
|
Good benefit of clindamycin:
|
Good penetration to bone
|
|
Main concern with using clindamycin:
|
Can cause antibiotic associated colitis (treat with metronidazole or vancomycin)
|
|
Clindamycin is best for what infections?
|
Severe anearobic infections (bacteroides)
|
|
New class of antibiotic drug that binds 50S:
|
Retapamulin (new drug class is called Pleuromutilins)
|
|
Retapmulin is FDA approved for:
|
Impetigo d/t Strep pyogenes
|
|
1st broad spectrum antibiotic discovered, chloramphenicol, is one of a few antibiotics for:
|
Salmonella (typhoid fever) and effective against anaerobes
|
|
Chloramphenicol has excellent penetration into:
|
CSF, ocular, and joint fluids
|
|
Main drawback to using Chloramphenicol:
|
Its use is limited by serious toxicities: aplastic anemia d/t stem cell damage (caused “gray baby” syndrome)
|
|
Another good use of Chloramphenicol besides its use for salmonella:
|
Good for kids under 8 with Rickettsia (RMSF) – can’t use tetracycline for RMSF in kids less than 8
|
|
Streptogramins bind the 50S unit near the macrolide site and are comprised of these 2 drugs:
|
Quinupristin and dalfopristin (synergistic– sold as combo)
|
|
Main use of the streptogramins:
|
MRSA, vancomycin-resistant enterococcus, basically bacterial resistance to older drugs
|
|
Only oxazolidinone drug:
|
Linezolid (Zyvox)– binds between the 50S and 30S
|
|
Main use of oxazolinidones (Linezolid):
|
Reserved for multi-drug resistant Gram + organisms
|
|
The 50S ribosomal inhibitors:
|
Macrolides (Eryth, Clarith, Azith), Clindamycin, Streptogramins (Quin and Dalfopristin), Linezolid
|
|
Most all the 50S inhibitors have resistance d/t efflux pumps or another mutation except:
|
Linezolid
|
|
Bind the 30S ribosomal subunit (block translation):
|
Aminoglycosides, Spectinomycin, Tetracycline
|
|
Features of the tetracyclines:
|
Broad spectrum, bacteriostatic, absorption decreased by food, and main resistance is d/t drug export
|
|
Long acting tetracycline drug:
|
Doxycline
|
|
Don’t take tetracyclines with these because they form insoluble complexes:
|
Cations (so don’t take with dairy, antacids, multivitamins)
|
|
2 tetracycline drugs that you can take with food/dairy:
|
Doxycycline and Minocycline
|
|
Tetracycline don’t get into the CSF well, but they do go to:
|
Skin and saliva very well
|
|
Tetracycline of choice in renally impaired patients:
|
Doxycycline
|
|
Don’t give tetracycline to these patients:
|
Kids less than 8 and pregnant women
|
|
(from previous question) Why?
|
Crosses placenta to fetus, dental caries/teeth staining in kids
|
|
All tetracyclines cause photosensitivity, but especially:
|
Demococycline
|
|
What side-effect can be seen with outdated tetracycline:
|
Taking expired tetracycline can cause renal tubular dysfunction and possible kill them
|
|
New tetracycline drug that is good for complex skin and intra-abdominal infections:
|
Tigecycline
|
|
Indications for tetracyclines:
|
STD’s, Acne, rickettsial infection, LYME DISEASE, some parasites
|
|
The spectrum of the Aminoglycosides:
|
“Extended” spectrum – bacteriocidal (pokes holes in cell membrane)
|
|
Best use/indication for the aminoglycosides:
|
Good from GRAM NEGATIVE infection (esp. Pseudo aerogin)
|
|
Toxicity of aminoglycosides is:
|
Concentration AND time-dependent, Can damage the 8th cranial nerve (ototoxic), Nephrotoxic
|
|
Unique note about using aminoglycosides with other drugs:
|
Can’t be mixed in the same injection solution with other drugs– chemically inactivates one another
|
|
Most widely used aminoglycoside that is used for gram NEGATIVE infections:
|
Gentamicin
|
|
Semisynthetic aminoglycoside:
|
Amikacin
|
|
Given IM for penicillin resistant gonorrhea:
|
Spectinomycin
|
|
Types of nucleic acid inhibitors:
|
Fluorquinolones, Rifamycins, Metronidazole, Trimethoprim, Sulfonamides
|
|
How do the quinolones work?
|
Inhibit DNA gyrases and topoisomerase (Bacteriocidal)
|
|
Quinolones are most effective for:
|
Gram negative infections
|
|
2nd gen quinolone that is fluorinated and GREAT against gram negative infections (especially Pseudomonas aeroginosa):
|
Ciproflaxin
|
|
The 3rd gen fluorquinolone, Levofloxacin, is good for gram positive and gram negatives, but its best against this bug:
|
Streptococcus penumoniae
|
|
4th generation fluoroquinolone that is effective against anaerobes:
|
Moxifloxacin
|
|
Caution must be taken with the fluoroquinolones because:
|
They interact with di/trivalent cations (antacids, vitamins)
|
|
Fluoroquinolones have good distribution into this unique site:
|
Prostate
|
|
Three important AE’s for fluoroquinolones:
|
Might effect cartilage development, Contraindicated in pregnancy, Contraindicated in kids less than 18 yrs old
|
|
Fluoroquinolones most noted to cause prolonged QT:
|
Sparfloxacin
|
|
This fluoroquin is most noted to cause crystalluria (which you treat with copious amounts of water):
|
Norfloxacin
|
|
Most important clinical uses for fluorquinolones:
|
Pseudomonas infections in the immunocomprimised, Prostatitis, Soft tissue, joint, bone, Gram negative infections!intra-abd, and respiratory infections
|
|
How do the Rifamycins work?
|
Inhibits DNA-dependent RNA polymerase
|
|
Rifamycins are most commonly used to treat what infections:
|
Mycobacteria infections (use it for travelers diarrhea and TB)
|
|
Drug that works really well against anaerobic bacteria (especially bacteroides and clostridium):
|
Metronidazole
|
|
Metronidazole is the drug of choice for:
|
E. histolytica infections and antibiotic entrocolitis
|
|
This drug inhibits cell membrane function, isn’t absorbed from the gut, only effective against gram (-):
|
Polymyxin B (these are last resort drugs– pretty toxic)
|
|
Drugs that block folic acid synthesis:
|
Trimethoprim, Sulfonamides, Sulfones, Aminosalicylic acid
|
|
How do sulfa antibiotics work?
|
Compete with PABA for the enzyme dihydropteroate synthase (foods with PABA can affect metabolism)
|
|
Important note about sulfa pharmacokinetics:
|
Highly protein bound in serum, can displace other protein bound drugs, and prevent renal elimination
|
|
Most serious complication of sulfonamides:
|
Crystalluria
|
|
How would you try to prevent crystalluria?
|
Alkalize the urine, high fluid intake (bicarb, etc.)
|
|
Why are sulfonamides dangerous for neonates?
|
Can cause kernicterus (displaces bilirubin from albumin– don’t give to pregnant women in late pregnancy)
|
|
Rare skin/mucuous membrane disease caused by side effect of sulfa drugs:
|
Steven-Johnson syndrome
|
|
Most notable clinical use of sulfonamides:
|
Urinary tract infections
|
|
Antibiotic that inhibits dihydrofolate reductase:
|
Trimethoprim
|
|
This combo is used for UTI’s, but also good for Pneum carinii infections if people who DON’T have AIDS:
|
Trimethoprim/Sulfa combo
|
|
Most common cause of UTI’s:
|
E. coli (gram negative)
|
|
Urinary antiseptic that releases formaldehyde into an acidic environment (urine):
|
Methenamine
|
|
Important diseases caused by mycobacterium (acid fast, gram + bacilli, waxy):
|
TB, leprosy, and Myco avium complex (MAC)
|
|
Challenges to treating mycobacterium infections:
|
Slow growing, develop resistance quickly, lipid rich wall
|
|
Combo of these 2 primary drugs is often curable for most TB if taken for 9 months:
|
Isoniazid (INH) and Rifampin
|
|
THE drug of choice for prophylaxis and therapy for TB:
|
Isoniazid (INH)
|
|
How does isoniazid work?
|
Inhibits mycolic acid biosynthesis (cell wall of mycobacterium)
|
|
Biggest AE of Isoniazid in kids and adults, how to you try to prevent these AE’s?
|
Adults = polyneuritis (give B6– pyridoxine). Kids = convulsions (give B6– pyridoxine)
|
|
Although Isoniazid is excreted in the urine, renally impaired pt’s don’t need dosage adjustments, everyone takes this dose:
|
300mg QD
|
|
Most frequent MAJOR toxicity of Isoniazid is:
|
Hepatitis– if this occurs discontinue immediately!
|
|
How does Rifampin work?
|
Inhibits DNA-dependent RNA polymerase (inhibits bacterial transcription)
|
|
Most important clinical use of Rifampin?
|
Combo’d with Isoniazid (INH) for TB treatment
|
|
Important AE of Rifampin:
|
Inhibits P450’s and renders birth control ineffective (must use 2nd form of birth control while on this drug)
|
|
Unique side-effect to Rifampin:
|
Can cause red-orange tears/body fluids that can stain clothes
|
|
This rifamycin is good for AID’s pt’s taking protease inhibitors:
|
Rifabutin
|
|
Mycobacterial drug that works by blocking arabinosyl transferase:
|
Ethambutol
|
|
Unique side-effect to ethambutol:
|
Causes retrobulbar neurtis (red-green color blindness), need eye checks often to check for this
|
|
Good drug for shorter (6mo.) combo therapy:
|
Pyrazinamide (inhibits fatty acid synthase)
|
|
Main side-effect to pyrazinamide:
|
Liver toxicity– must check liver enzymes frequently
|
|
Initial 4 drug, standard regiment to treat tuberculosis (TB):
|
“RIPE”– Rifampin, Isoniazid, Pyrazinamide, Ethambutol
|
|
How long do you use the 4 drug treatment before switching to the TB continuation dosage of Rifampin and Isoniazid?
|
2 months for “RIPE” and then 4-7 months for Rifampin + INH
|
|
When 1st line drugs don’t work (i.e. RIPE drugs) use of the secondary drugs is used:
|
Capreomycin and Cycloserine
|
|
2nd line drug that is used when someone with TB can’t eat:
|
Streptomycin sulfate (given IV)
|
|
Main side-effects to Capreomycin:
|
Oto and nephrotoxic
|
|
This TB drug DOES NOT work against mycobacterium avium:
|
Isoniazid
|
|
This is the prototypical anti-leprosy drug:
|
Dapasone (similar to sulfonamides)
|
|
How is Dapasone taken?
|
Once a week dosing
|
|
Antibiotic prophylaxis is commonly used to prevent these two bugs:
|
Streptococcus (Gram + chains) and Staphylococcus (gram + clusters)
|
|
Most IMPORTANT use of antibacterial prophylaxis:
|
To prevent bacterial ENDOCARDITIS
|
|
New in 2007, prophylactic use of antibiotics in dentistry is ued only for:
|
Those at highest risk of developing bacterial endocarditis
|
|
2 primary classes of anti-fungals:
|
Azoles and polyenes (both target the cell membrane)
|
|
Most common muco-cutaneous fungus causing oral lesions:
|
Candida albicans
|
|
Most common opportunistic fungal pathogens:
|
Candida, Aspergillus, Cryptococcus, Phycomycetes
|
|
Nystatin and amphotericin B are in what class of anti-fungal?
|
Polyenes
|
|
How to the polyenes work (Nystatin and Ampho B)?
|
Act like detergents and remove ERGOSTEROL from membrane allowing cell contents to leak out
|
|
Anti fungal, never given IV, that is best for oral candida infections:
|
Nystatin
|
|
Very toxic (especially renal toxicity) anti-fungal that is reserved for progressive, potentially life threatening infections:
|
Amphotericin B
|
|
Considered the most toxic IV anti-infective on the market, sodium loading with normal saline helps reduce toxicity:
|
Amphotericin B
|
|
Chief sterol in fungal membranes:
|
Ergosterol
|
|
Class of anti-fungals that block synthesis of ergosterol:
|
~Azoles
|
|
What do the azoles inhibit?
|
Lanosterol 14-alpha-demethylase
|
|
Important to monitor when using azole anti-fungals:
|
Hepatic enzymes, they inhibit P450’s
|
|
Azole with the lowest potential for AE’s:
|
Fluconazole
|
|
Uses for fluconazole:
|
Cryptococcal meningitis in AID’s pts, Oro/esophogeal candidiasis, prophylaxis for oral candidiasis in AID’s pt’s
|
|
BROAD spectrum (than fluconazole) antifungal that is good for histoplasmosis in AID’s pts:
|
Itraconazole
|
|
Itraconazole can lead to serious hepatotoxicity, but its advantage of ketoconazole is:
|
Doesn’t affect testosterone/estradiol production as much
|
|
Itraconazole is contraindicated it pt’s taking what drugs:
|
Statins, cisapride, ergot alkyloids
|
|
Anti-fungal similar to itraconazole, but has activity against Fusarium:
|
Voriconazole
|
|
Notable AE of voriconazole:
|
Visual disturbances (blurred vision, altered color perception). DO NOT give to PREGNANT women!!!
|
|
Some of ketoconazoles unique side-effects:
|
Menstrual irregularities and gynecomastia
|
|
Azole lozenge for oral candidiasis in AID’s patients:
|
Clotrimazole
|
|
New azole that is used for prophylaxis of invasive Aspergillus and disseminated candidiasis in immunocompromised hosts:
|
Posaconazole
|
|
Posaconazole is active against this bug that other azoles aren’t active against:
|
Zygomycetes
|
|
Good for fungal nail infections:
|
Terbinafine
|
|
Orally effective antifungal that is very toxic to bone marrow and kidneys, fungi metabolize it to 5-fluoruracil:
|
Flucytosine
|
|
What is flucytosine used to treat?
|
Severe candida or cryptococcal infections when its combo’d with amphotericin B
|
|
How do the Echinocandins work?
|
Inhibit the fungal enzyme 1,3-Beta-D-glucan synthase (safe in renally impaired patients)
|
|
IV drug that is excellent for life threatening fungal infections in pt’s who can’t tolerate amphotericin B:
|
Capsofungin
|
|
Best drugs to treat jock itch, ringwork, etc.:
|
Topical azoles
|
|
Pregnant pt with a LIFE-threatening fungal infection, use:
|
Amphotericin B
|
|
What type of parasite is a virus?
|
Obligate intracellular
|
|
Types of DNA viruses:
|
Poxvirus, herpesvirus, adenovirus
|
|
Most common mechanism of action of antiviral drugs:
|
Inhibition of viral nucleic acid synthesis
|
|
Seven potential steps of to target in a virus life cycle:
|
Adsorption—entrance into host, uncoating of viral DNA/RNA, synthesis of early regulatory protein, production of viral RNA/DNA, capsid production, viral particle assembly, viral release from cell
|
|
A lot of drugs target this viral enzyme, which attaches to the nucleoside in our DNA:
|
Viral kinase
|
|
How do antiviral nucleoside analogs work?
|
The incorporations of these analogs terminates the replication of viral DNA and RNA chains
|
|
Most current analogs have modifications where on the molecule?
|
Modified on the ribose part of the molecule
|
|
How do antivirals get eliminated?
|
Not really metabolized, eliminated in the urine, not usually substrates for liver p450 enzymes
|
|
This class of anti-virals have more severe toxicities such as myopathy, neuropathy, and myelosuppression:
|
Anti-HIV agents
|
|
Why do the anti-HIV agents cause such severe toxicities?
|
Inhibition of cellular mitochondrial polymerase
|
|
What causes kaposi’s sarcoma?
|
Herpes virus 8
|
|
The prototypical herpes drug, acyclovir, works how?
|
Guanosine analog w/an “acyclic” group replacing the ribose. The drug terminates the viral chain from attaching to base
|
|
Alternatives to acyclovir if there is resistance:
|
Foscarnet or Cidofovir
|
|
Can acyclovir be used in pregnant women?
|
Yes (but not FDA approved), doesn’t cause birth defects, can be used for near term women with genital herpes
|
|
Used for acyclovir resistant herpes:
|
Foscarnet or Cidofovir
|
|
Acyclovir is used mainly to treat:
|
Herpes and Varicella zoster (shingles)
|
|
Acyclovir derivatives:
|
Famiciclovir, Penciclovir, valacyclovir
|
|
Drug/Treatment of choice for CMV infections or prophylactically in transplant patients:
|
Ganciclovir
|
|
Side effects of gangciclovir include:
|
Aspermatogenesis, granulocytopenia/thrombocytopenia, carcinogenic, * retinal detachment
|
|
People with persistent infection can develop resistance to gangcyclovir, what would you use in these instances?
|
Foscarnet or Cidofovir
|
|
Largely replaced gangciclovir for CMV retinitis that isn’t life/sight threatening:
|
Valganciclovir
|
|
Besides working for acyclovir resistant HSV or VSZ, what is Cidofovir’s other use?
|
Used to delay progression of CMV RETINITIS in AID’s pts
|
|
What type of vaccine is varivax, what is it used for?
|
Live attenuated virus against chicken pox (2 doses)
|
|
Vaccine for people older than 60 to prevent shingles:
|
Zostavax (live attenuated virus vax)
|
|
When is Zostavax contraindicated?
|
Immunocompromised, or or people with allergies to gelatin, neomycin, etc. (zostavax– prevents shingles)
|
|
What unique enzyme does HIV have?
|
Reverse transcriptase
|
|
How do you measure the effectiveness of HIV therapy?
|
Viral RNA load and CD4+ T-cell counts
|
|
How do the HIV reverse-transcriptase inhibitors work?
|
Inhibit RT, block transcription of viral RNA genome into DNA
|
|
1st RT-inhibitor HIV drug that reduces mother to child HIV transmission if taken for 14 wks after conception to birth:
|
AZT (Zidovudine)
|
|
Anti-HIV NRTI (RT-inhibitor) that is most highly associated with FATAL lactic acidosis:
|
Stavudine
|
|
How do the NON-nucleoside RT-inhibitors work?
|
Bind directly to RT enzyme and block its function
|
|
The 3 main NON-nucleoside RT-inhibitors:
|
Delaviridine, Nevirapine, Efavirenz
|
|
Which NNRT-inhibitor is contraindicated in preggos?
|
Efavirenz
|
|
How do the protease inhibitor HIV drugs work?
|
Block the virally encoded protease that is responsible for generating mature proteins to build new virus
|
|
How are the HIV protease inhibitor metabolized?
|
All are metabolized (and thus inhibit) CYP3A4– can interfere with metabolism of other drugs
|
|
Notable AE of protease inhibitors:
|
Fat redistribution (buffalo hump), hyperglycemia, GI issues
|
|
HIV protease inhibitor good for pediatric patients:
|
Indinavir (can cause kidney stones though)
|
|
HIV protease inhibitor that can cause bleeding in hemophiliacs:
|
Saquinovir
|
|
Protease inhibitor combo of choice for treatment naïve HIV patients:
|
Lopinavir + Ritonavir
|
|
Protease inhibitor good for those with drug resistance problems:
|
Tipranavir
|
|
HIV fusion inhibitor:
|
Enfuvirtide
|
|
Investigation HIV drugs that are integrase inhibitors work how?
|
Block integration of viral DNA into host genome
|
|
Maturation inhibitor drug for HIV:
|
Bevirimat (blocks processing of gag protein)
|
|
Name of the treatment regime for treating HIV pt’s:
|
HAART therapy (high active anti-retroviral therapy)
|
|
What is the current recommendation for initial therapy:
|
2 NRTI’s + Efavirenz (NNRTT) or 2 NRTI’s + PI combo (lopinavir/ritonavir)
|
|
What do you use for advanced HIV disease:
|
Darunavir or Tipranavir + Enfuviritide
|
|
If an HIV pt isn’t on anti-HIV therapy at onset of pregnancy, when should they begin treatment?
|
Wait until 10-12 wks gestation and then start tx
|
|
How long do newborns born to HIV moms’ need to take AZT?
|
6wks
|
|
HIV Agents contraindicated in pregnant women:
|
Stavudine and Didanosine (case fatal lactic acidosis) & Enfavirenz (teratogenic)
|
|
2 drugs used to prevent the flu:
|
Neuraminidase inhibitors (Oseltamivir, Zanamivir)
|
|
How do the neuraminidase inhibitors work?
|
Block neuraminidase which blocks release of new viral particles
|
|
Oseltamivir (ORAL) and Zanamivir (INHALED) are effective against the symptoms of:
|
Influenza A and B
|
|
Most effective method of PREVENTING the flu:
|
Influenza vaccine (inactive or live-attenuated vax)
|
|
Who is recommended to get the inactive flu vaccine?
|
Kids 6 – 59 months, pregnant women, people older than 50
|
|
What are the precautions with the live attenuated flu vaccine (FluMist)?
|
Not used in pregnant pt’s or immunocompromised, also pt’s who get FLUMIST should avoid contact with the immunocompromised for 7 days
|
|
Best drugs for prophylaxis against the asian flu (H5N1):
|
Oseltamivir and Zanamivir
|
|
How does Foscarnet work (used for acyclovir resistance)?
|
Block viral polymerases
|
|
Significant AE’s of Foscarnet?
|
Renal toxicity (must monitor Creat) and electrolyte disturbances
|
|
Characteristics of human interferon drugs for Hep B/C:
|
They are glycoproteins, and promote an antiviral state in uninfected cells
|
|
When is interferon contraindicated in Hep B/C?
|
Psychosis, severe depression, pregnancy, etc. . .
|
|
Drug approved for RSV and pneumonia in kids:
|
Ribavarin
|
|
Ribavarin is used in combo with ____ for chronic hepatitis C:
|
Interferon alpha
|
|
Contraindications of Ribavarin:
|
Pregnant women (teratogenic and embryotoxic), also preggos should avoid people taking it, don’t get preggo within 6 months of using it
|
|
Human papilloma vaccine:
|
Gardasil (give to women 9 to 26yrs old)
|
|
When is Gardasil contraindicated?
|
If your pregnant
|
|
What is rotavirus cause?
|
Gastroenteritis with fever, vomiting, diarrhea, dehydration
|
|
Deadliest type of malaria:
|
Plasmodium falciparum (intracellular parasite)
|
|
Malarial parasites associated with malarial relapse:
|
P. ovale and P. vivax
|
|
How is malaria transmitted?
|
Anopheles mosquito
|
|
Where does the malarial infection start?
|
Liver– Sporozoites in hepatocytes become schizonts
|
|
What part of the malarial infection consumes hemoglobin?
|
Trophozoites
|
|
What are the 3 classes of anti-malarials:
|
Blood schizontocides, tissue schizontocides, gametocides
|
|
How do the blood schizontocides work?
|
MAIN CLASS– targets erythrocytic form of parasite
|
|
How do the tissue schizontocides work?
|
Target developing or dormant liver forms
|
|
How do the gametocides work?
|
Kill sexual stage of the parasite
|
|
How do you treat P. falciparum or P. malaria infections?
|
Treat with blood schizonticides
|
|
How do you treat the P. ovale or P. vivax infections?
|
Treat with Primaquine (these persist in liver and relapse)
|
|
How do the blood schizontocides work?
|
Prevent the parasites degradation of heme
|
|
Drug of choice for prophylaxis and treatment of acute attacks of malaria:
|
Chloroquine– resistance is widespread (esp. for P. falciparum)
|
|
Unique side-effect of chloroquine:
|
Hyperpigmentation of macula (“bullseye”). Contraindicated in pt’s with: psoriasis, pophyria, retinal issues.
|
|
Drug of choice for P. falciparum that is resistant to other drugs:
|
Mefloquine (used for chemoprophylaxis and treatment)
|
|
Don’t co-administer mefloquine with:
|
Antiarrythmics, quinine, or halofantrine
|
|
Don’t give mefloquine to pt’s with what disorders:
|
Psych disorders: depression, psychosis, schizophrenia
|
|
Blood schizoticide derived from the bark of a cinchona tree:
|
Quinine
|
|
Quinine is co-administered with what drugs to treat chlorquine resistant P. falciparum infections:
|
Tetracycline or clindamycin
|
|
Side-effect disorder of quinine that is characterized by HA, nausea, blurred vision, and tinnuitis:
|
Cinchonism
|
|
What is the drug of choice for Trichomoniasis?
|
Metronidazole
|
|
Single-celled intracellular parasite spread by contact with cat feces or contaminated meat:
|
Toxoplasma gondii
|
|
Drugs of choice to treat toxoplasmosis infection:
|
Pyrimethamine + sulfadiazine (only used in extreme circumstances for pregnant women)
|
|
Most widely used to treat sand fly bite Leishmaniasis:
|
Sodium Stibogluconate
|
|
Drugs used to treat Trypanosoma:
|
Suramin (hemelymph), Melarsoprol (CNS), or Eflornithine
|
|
Chaga’s disease is caused by what organism?
|
Trypanosoma cruzi
|
|
Drugs of choice to treat Chaga’s (T. cruzi) disease:
|
Nifurtimax (for acute disease) and Benznidazole
|
|
Drug of choice to treat lice:
|
Permethrin
|
|
2nd drug of choice for lice:
|
Malathion
|
|
How do you treat scabies?
|
Topical 5% Permethrin (same drug as for lice)
|
|
|
|
|
High dose of insulin to suppress glucose levels, is used to reverse effects of what drug?
|
Beta-Blockers and Calcium Blockers
|
|
What law established the seperation of legand drugs from OTC?
|
Durham Humphrey Act
|
|
Tx GS(-) UTI w/ pt sulfa anaphylactic shock history
|
Methenamine
|
|
How should vanco be administered?
|
slowly IV to prevent thrombophlebitis and flushing seen w/ histamine release
|
|
Drug to tx C diff
|
Vancomycin
|
|
What are symptoms of acute cocaine overdose
|
HTN, Arrhythmias, Mydriasis, Seizures
|
|
Give NaHCO3 to counteract what drug OD?
|
Salicylates, stops m. acidosis
|
|
|
|
|
Acetaminophen: give antidote
|
Acetylcysteine
|
|
Anticholinergics: give antidote
|
Physostigmine
|
|
Anticholinesterases: give antidote
|
Pralidoxime (2-Pam)
|
|
Benzo’s: give antidote
|
Flumazenil
|
|
Cholinergics: give antidote
|
Atropine
|
|
Digoxin/Digitoxin: give antidote
|
Digoxin immune fab
|
|
Doxorubicin: give antidote
|
Dexrazoxane
|
|
Folate antagonists: give antidote
|
Leucovorin
|
|
Heparin: give antidote
|
Protamine sulfate
|
|
Ifosfamide: give antidote
|
Mesna
|
|
Insulin: give antidote
|
Glucagon
|
|
Opioids: give antidote
|
Naloxone
|
|
Oral anticoagulants: give antidote
|
Vitamin K
|
|
Non-depol muscle relaxers: give antidote
|
Pyrido/Neostimine and Endrophonium
|
|
|
|
|
|
|
|
Give class of drug: Amphetamine
|
CII
|
|
Give class of drug: analgesic combos w/ opioid and aspirin, acetaminophen, or ibuprofen
|
CIII
|
|
Give class of drug: barbsiturates
|
CIV
|
|
Give class of drug: benzodiazepines
|
CIV
|
|
Give class of drug: chloral hydrate
|
CIV
|
|
Give class of drug: Cocaine
|
CII
|
|
Give class of drug: Codeine
|
CII
|
|
Give class of drug: codeine cough syrups
|
CV
|
|
Give class of drug: Hydrocodone
|
CII
|
|
Give class of drug: Lomotil
|
CV
|
|
Give class of drug: methylphenidate
|
CII
|
|
Give class of drug: Morphine
|
CII
|
|
Give class of drug: Oxycodone
|
CII
|
|
Give class of drug: pentobarbital
|
CII
|
|
Give class of drug: pregabalin
|
CV
|
|
Give class of drug: propoxyphene alone or in combo
|
CIV
|
|
Give class of drug: Secobarbital
|
CII
|
|
Give class of drug: Testosterone salts
|
CIII
|
