PART 2 of Pharm M2

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optos
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PART 2 of Pharm M2
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2012-01-18 00:12:22
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pp 55-69
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  1. Pioglitazone**
    Medication for diabetes

    • Pioglizazone
    • insulin

    Use:
    type 2 diabetes

    Mechanism of action:
    decreases insulin resistance at peripheral sites and in liver (incrreases effects of insulin)

    • Adverse effects: caution in patients with edema or heart failure due to fluid retention
    • - avoid in hepatic impairment (monitor fxn)
    • - can cause edema, weight gain, induce CHF, tooth disorders, headaches, myalgia (muscle sore) sinusitis, anemmia

    Admin/PK:
    can contribute to hypoglycemia when combined with other agents that lower blood glucose

    • D-D interaction:
    • - increased effect: thioridazine (leads to arrhythmias), atazanvir, gembibrozil, ritonavir, trimethoprim
    • - Cytochrome P450 effect
    • - May enhance amiodarone, amphetamines, beta blockers, etc.
    • - Decrased effect: CYP2C8 inducers, bile acid sequestrants, carbamazepine, phenytoin, rifampin
    • Comments: rare reports of decreased VA, macular edema (new onset or worsening)
    • - best effect is approx. 0.5-1.4%
    • - reduction in alc. (caution with ethanol) -> hypoglycemia
    • - 1-1.5% reduction in HbA1C
    • - Shouldn’t be admin with food because peak
    • concentrations delayed
    • - Caution with: alfafa, aloe, bilberry, bitter melon, celery garlic, ginger, ginseng, marshmallow -> hypoglycemia
  2. Nateglinide
    Repaglinide*
    glinide - insulin

    Use: Type 2 Diabetes

    Mechanism of action: Stimulates release of insulin from functioning beta cells (only works with fxning beta cells!)

    • Adverse effects: Hepatic function impairment;
    • Can cause hypoglycemia and other adverse effects
    • (blood dyscrasias, bp changes, cardiac)

    Admin/PK: Not used as monotherapy in pts inadequately controlled with other diabetic meds

    • Comments: Meds which increase blood glucose levels may lessen effects of nateglinide/repaglinide
    • Nateglinide - reduce 0.5% HbA1C, not common
    • Repaglinide - best effect is approx. 0.5-1.5%, decrease in alc, used in combo w/other drugs
  3. Exenatide
    Diabetes med

    Use:
    type 2 diabetes

    Mechanism of action: glucagon-like peptide to improve pancreatic beta cell response, secretion and slow gastric empying.

    • Adverse effects:
    • - avoided in patients with renal insufficiency
    • - severe GI dz
    • - gastroparesis (contraindication)
    • - reports of pancreatitis
    • - can cause dizziness, diarrhea, GI upset, headache, GERD, hypoglycemia

    Admin/PK: adjunct in the treatment of patients who take metformin, a sultonylurea, or combination of these meds but who have not achieved adequate control; not an insulin substitute

    • Comments: not an insulin substitute
    • - best effect approx. 1%
    • - given subcutaneously
  4. Pramlintide
    Diabetic Medication

    Use: Adjunct (A thing added to something else as a supplementary rather than an essential part.) in treatment of type-1and type-2 diabetes

    • Mechanism of action:
    • - slow rates of food absorption
    • - modulates gastric emptying
    • - helps prevent post-meal rise in bld glu and inc. satiety

    • Adverse effects:
    • - N/V, abdominal pain, arthralgia, cough, headache, hypoglycemia, fatigue, dizziness, etc

    Admin/PK: contraindicated in patients with gastroparesis (condition that reduces the ability of the stomach to empty its contents, but there is no blockage (obstruction))

    • Comments: doses of other drugs must be adjusted
    • - BE (best effect) is approx 0.5%
    • - dec in alc
    • - given simutaneously
  5. Sitagliptin
    Diabetes med

    Use: Adjunct in treatment of type-1and type-2 diabetes

    Mechanism of action: blocks effects of dipeptidyl pepti-dase (DPP-4), enzyme that breaks down incretin hormones.. WANT more INCRETIN :) (increases in incretins leads to a rise in insulin levels and a corresponding decrease in blood glucose levels)

    Adverse effects: upper respiratory tract infections, sore throat, diarrhea, N/V, pancreatitis, hypoglycemia, weight gain, heachache, rash

    • Admin/PK:
    • - Can contribute to hypoglycemia when used with other agents that lower blood glucose but is used as an adjunct with other medications
    • - Important to monitor blood glucose levels and A1C levels

    • Comments:
    • Other DPP-4 inhibitor drugs similar to sitagliptin now available but recent reports of pancreatitis associated with CLASS may affect new entrants and use
    • - 0.5-0.8%
    • - dec. in alc.
  6. Saxagliptin
    Use: adjunct in Tx of type-1 and type 2 diabetes

    Mechanism of action: a DPP-4 inhibitor that is more commonly used. same as sitagliptin

    Adverse effects: headaches, sinusitis, abdominal pains, diarrhea, N/V. hypoglycemia, weight, peripheral edema, rash

    Admin/PK: dose adjustment needed for renal impairement, need to monitor bld glu and A1C levels

    • Comments: taken orraly, once daily
    • - decrease HbA1C to 1%
  7. Albuterol**
    Levalbuterol
    Pirbuterol
    Bitolterol
    • respiratory med
    • Albuterol -> drug of CHOICE, top 10!

    • Use: Asthma, COPD, emphysema
    • - As tocolytic agent (anti-contraction) but can lead to myocardial ischemia

    • Mechanism of action: beta 2 adrenergic receptor agonist causes brachodilation
    • Adverse effects: vasodilation, tachycardia, pallitations, tremor, CNS stimulation.
    • - caution with angina
    • - can cause atrial fibrillation if used too often in elderly
    • OTHER: rash, hyperglycemia, lactic acidosis, D/N/V, muscle cramps otitis media, vertigo, asthma issues, allergic reaction

    • Admin/PK:
    • Albuterol:
    • Onset of action after inh = <15 min
    • Duration: 4 hours
    • PO and INH available.
    • Should do it 1 hr before exercise.
    • Cross placenta but safe if inhaled
    • Levalbuterol: INH form only. longer duration of action, best for maintenance.
    • Piruterol and Bitolterol: INH only. duration is 4-6 hours
    • Comments:
    • Albuterol -> Drug of choice for acute asthma symptoms and to prevent effort-associated asthma.
    • Not used for those tachyarrhythmias
    • Levalbuterol -> should only be used every 6-8 hours (otherwise can stimulate atrial fibrillation
  8. Salmeterol
    top 10

    Use: maintenance in chronic asthma, COPD

    Mechanism of action: long lasting B2 adrenergic receptor agonist

    Adverse effects: Vasodilation, tachycardia, palpitations, tremor, CNS stimulation, nasopharyngitis, HA, cough, etc.

    • Admin/PK: INH form only.
    • duration: 12 hours (so drug is used only 2x a day... used to maintain, not acute)

    Comments: NOT for ACUTE attacks, Advair Diskus® is a combo of salmeterol and fluticasone
  9. Ipratropium
    Tiotropium**
    • Respiratory Med
    • Tiotropium** -> top 30

    • Use: bronchospasm associated with COPD in adults
    • Tiotropium** -> maintenance use (not acute exacerbation)

    Mechanism of action: Muscarinic antagonist, reverses ACH induced bronchospasm

    • Adverse effects: cough, dry mouth, and blurred vision can occur
    • Titoropium**: Xerostomia, UR tract infection, sinusitis,
    • angina, edema, CNS, rash, hypercholesterolemia, hyperglycemia, GI, UTI, myalgia, cataract, respiratory issues, allergic reaction, herpes zoster

    • Admin/PK: INH form only.
    • Ipratropium - use every 6 hours
    • Tiotropium** - use once a day (maintenance, not acute)

    Comments: caution in narrow angle glaucoma
  10. Cromolyn
    Nedocromil
    Respiratory Med

    Use: to prevent prophylaxis of asthma attacks; maintenance therapy only

    Mechanism of action: mast cell stabilizers prevent release of histamine

    • Adverse effects: Minimal ADEs, throat irritation and
    • unpleasant taste reported.

    • Admin/PK: Inhalant form.
    • May take several weeks for full effect to occur (not acute)

    • Comments: not effective in Txing acute attacks
    • used in eyedrops to prevent allergies
  11. Systemic Corticosteroids**
    (Prednisone and methylprednisolone)
    Respiratory Med

    Use: Acute asthma and COPD exacerbation (autoimmune disorder)

    Mechanism of action: Decrease inflammation and edema in respiratory tract, enhance sympathomimetic bronchodilator activity.

    • Adverse effects: Na+/Water retention,
    • elevate blood glucose (watch diabetics), can alter e-lytes, GI irritation, CNS effects.
    • Several LT use consequences (suppress bone marrow,
    • leading to leucokemia =lower WBC count)
    • Blurred vision, change in IOP

    • Admin/PK: PO/IV/IM administration
    • Standard tx: admin with albuterol in acute
    • situations.
    • Taper off ASAP to avoid adrenal reliance (short course taper of 3-4 dys)

    • Comments: Adjuncts in acute situations not able to be controlled with bronchodilators alone.
    • 3 complaints:
    • 1) COPD and emphysema will become dependent: will be put on prednisone
    • 2) Can induce Type 2 Diabetes
    • 3) Lead to osteoporosis.

    Uses can increase IOP, caution in glaucoma, ocular HT, cataracts
  12. Flunisolide
    Fluticasone** (top 25)
    Respiratory Medication

    Use: Chronic asthma (maintenance)

    Mechanism of action: Decrease inflammation and edema in respiratory tract, enhance sympathomimetic brochodilatior activity

    • Adverse effects:
    • - usually does not cause systemic corticosteroid effects
    • - incr. risk of oral candidiasis
    • - potential for drug interactions
    • Fluticasone** only:
    • Oral: Affects, Upper Respiratory tract, CS, GI, neuromuscular, respiratory, oral candididasis, CV, dermatologic, endocrine metabolic, hepatic, hematologic, otitis
    • Nasally inhaled: CNS,
    • GI, neuromuscular, respitary, flu-like symptoms, skin, heart problems, loss of taste/smell
    • Admin/PK: inhaled form only (increases risk of oral trush, so rinse mouth after to keep oral flora intact)
    • Flunisolide: if using INH and beta agonist (albuterol) use the beta agonist 1st bc it works faster and quicker to open up passages to allow corticosteroid to penetrate more.
    • beta agonist -> then corticosteroid --> then rinse mouth

    • Comments for both Flunisolide & Fluticasone** :
    • Other similar products: beclomethasone/QVAR®, mometasone/Asmanex ®, triamcinolone/Asmacort®
    • Blurred vision, change in IOP; caution in glaucoma, catracts
    • Fluticasone ONLY**:
    • Oral: blepharoconjuncitvitis, conjunctivitis, keratititis
    • Nasally inhaled: glaucoma, blurred vision,
      bronchospasm, cataracts, conjunctivitis, dry/irritated eyes
  13. Montelukast
    Zafirlukast
    Zileuton
    Respiratory Med

    Use: Chronic asthma, prevention/maintenance

    Mechanism of action: leukotriene R antagonist

    • Adverse effects:
    • - Hairband HA
    • - GI upset.
    • - May cause hepatic ADEs (check liver fxn with AST/ALT/AlKPHOS)
    • - Some drug/drug interactions in older.
    • - New CNS/psychiatric warnings(esp Montelukast in kids)

    • Admin/PK: PO forms.
    • Montelukast: qday (once a day)
    • Zafirlukast & zileuton: BID

    Comments: watch for increased respiratory infections in elderly pts
  14. What are microorganisms?
    microorganisms are living forms of microscopic or submicroscopic size
  15. What are the 4 general groups of microorganisms?
    • 1) bacteria (includes Chlamydiae, Rickettsiae, Mycoplasma)
    • 2) Viruses
    • 3) Fungi
    • 4) Protozoa (from CTL -> protoza infection)
  16. Bacteria are ____-celled microorganisms occuring in many forms, existing either as free-living organisms, or as parasites (as in the case of obligate intracellular parasite Chlamydiae)
    single-celled
  17. Properties of Bacteria
    • single-celled microorganisms
    • forms: free-living or parasites
    • range of biochemical and often pathogenic properties
    • small (size ranges 0.2-2 microns)
    • gram +
    • gram -
  18. Choose the best answer:

    Gram Positive
    After the cell sample is fixed, stained, and washed, the bacterial cell walls:
    A) Retain the crystal violet dye and have a purple cell wall under a microscope
    B) Retain the crystal violet dye and have a light reddish cell wall under a microscope
    C) Do not retain the cyrstal violet dye and have a purple cell wall under a microscope
    D) Do not retain the cyrstal violet dye and have a light reddish cell wall under a microscope
    • A) Retain the crystal violet dye and have a purple cell wall under a microscope
    • adheres to peptidoglycan and remains stained
  19. Choose the best answer:

    Gram Negative
    After the cell sample is fixed, stained, and washed, the bacterial cell walls:
    A) Retain the crystal violet dye and have a purple cell wall under a microscope
    B) Retain the crystal violet dye and have a light reddish cell wall under a microscope
    C) Do not retain the cyrstal violet dye and have a purple cell wall under a microscope
    D) Do not retain the cyrstal violet dye and have a light reddish cell wall under a microscope
    D) Do not retain the cyrstal violet dye and have a light reddish cell wall under a microscope. They retain the reddish safarinin dye. These bacteria are decolorized and do not retain the crystal violet dye
    (this multiple choice question has been scrambled)
  20. Bacteria are not always able to be fully ID'd by Gram's stain alone, what other special methods can help give a preliminary or final ID of the bacteria? (3)
    • special stain and dye: Acid fast staining (ex: used for Mycobacteria)
    • basis of rising antibody titers, special immunofluorescence assays
    • morphological shape
  21. What are some bacteria that do NOT possess a rigid cell wall so they must be ID'd on the basis of rising antibody titers, special immunofluorescence assays, etc ?
    • Legionella (in soil and dirty water)
    • Rickettsiae (extremely small, does possess a cell wal lbut no eptidoglycan)
    • Chlamydia (smaller than Rickettsiae, obligate intracellular parasite, possess cell wall but no peptidoglycan and robosomes)
    • Mycoplasma (lacks rigid cell wall, community acquired pneumonia - affects humans)
  22. What are the 5 commonly causes of community acquired pneumonia (in order)?
    • 1. Strep Pneumoniae
    • 2. Hemophlius influenza
    • 3. Mycoplasma pneumoniae
    • 4. Chlamydia pneumoniae
    • 5. Legionella pneumoniae
  23. What are the prinicpal groups of true bacteria are distinguished by their morphological shapes when viewed under the microscope?
    • Cocci
    • Bacilli
    • Spirillum
    • Spirochetes
    • Fungus-like
  24. Decribe the characteristics of the bacteria: Cocci
    • spherical
    • ex: Streptococci, Staphylococci, and Neisseria
  25. Decribe the characteristics of the bacteria: Bacilli
    • rod-shaped
    • Ex: E.coli, Bacillus, and Clostridia
  26. Decribe the characteristics of the bacteria: Spirillum
    • short, rigid spirals
    • ex: Vibrio (present in raw crab eggs and roe and other seafood and shellfish), Cholera
  27. Decribe the characteristics of the bacteria: Spirochetes
    • protozoa-like bacteria that are thin, flexible, motile, and spiral-shaped
    • ex: Borrelia (lyme dz) and Treponema (syphilis)
  28. Decribe the characteristics of the bacteria: Fungus-like
    • bacteria that possess branching filamentous elements resembling fungal hyphae.
    • ex: Mycobacteria, Nocardia, and Actinomyces
  29. Pick the best answer:
    Rickettsiae is:
    A) Obligate intracellular parasites which possesses cell walls and robosomes but must rely on host cell for metabolic E
    B) Extremely small bacteria thought to be viruses because their growth takes place within a host cell and has cell wall
    C) Lacks cell wall
    D) Lack cell wall and bound by membranes, IDd with antibody titers
    B) Extremely small bacteria thought to be viruses because their growth takes place within a host cell and has cell wall. Ex: Coxiella, Typhus, Rickettsiae. Not seen on gram stain
    (this multiple choice question has been scrambled)
  30. Pick the best answer:
    Mycoplasma is:

    A) Very large bacteria that has a rigid cell wall
    B) Very small, lacks cell wall and bound by membranes, IDd with antibody titers
    C) Extremely small bacteria thought to be viruses because their growth takes place within a host cell and has cell wall
    D) Obligate intracellular parasites which possesses cell walls and robosomes but must rely on host cell for metabolic E
    B) Very small, lacks cell wall and bound by membranes, IDd with antibody titers. Ex: Mycoplasma pneumnoiae
    (this multiple choice question has been scrambled)
  31. Pick the best answer:
    Chlamydia is:

    A) Extremely small bacteria thought to be viruses because their growth takes place within a host cell and has cell wall
    B) Very large bacteria that has a rigid cell wall
    C) Very small, lacks cell wall and bound by membranes, IDd with antibody titers
    D) Obligate intracellular parasites which possesses cell walls and ribosomes but must rely on host cell for metabolic E
    D) Obligate intracellular parasites which possesses cell walls and ribosomes but must rely on host cell for metabolic E. Smaller than Rickettsiae and also thought to be a virus at one point. Dx: using titers. Ex: Chlamydia pneumoniae, C. trachomatis, and C. psittaci
    (this multiple choice question has been scrambled)
  32. Viruses are the _____ microorganisms known to have non-pathogenic/pathogenic (circle one) properties in humans.
    • smallest
    • pathogenic
  33. Viruses size:
    A) Millimicrons
    B) Nanomicrons
    C) Micrometers
    D) Nanometers
    B) Nanomicrons. SUPER small
    (this multiple choice question has been scrambled)
  34. What are the properties of a VIRUS?
    • smallest microorganism
    • pathogenic properties in humans
    • size: nanomicrons
    • contains nucleic acid fragments (DNA or RNA), a capsid, and lipoprotein coat
    • uses structures and systems in host cells to recplicate themselves
    • most often causes eye infections: Herpes virus and adenovirus
  35. List the properties of: Specimen colletion
    • colleted with care to prevent inadvertent contamination
    • collection sites should represent suspected location of infection
    • specimen amt shld be sufficient size and numbers
    • need to be placed in appropriate containers and labelled
    • delivery should occur promptly
  36. Culture and Sensitivity is a test in which patient specimens are cultured on approp. media and incubated. Bacteria grown on the media must be directly ______, _______, and ______ for susceptibility to different Ab.
    isolated, identified, and tested
  37. Sensitivity testing may be done by using 3 types of methods which are:
    • disc method
    • automated disc method
    • serial dilution method
  38. Cultures:
    Colonies surrounded by greenish zones means:
    A) partially hemolytic bacteria
    B) non-hemolytic bacteria
    C) fully hemolytic bacteria
    • A) partially hemolytic bacteria.
    • = Alpha hemolytic Streptocci such as S. viridans or S. pneumoniae.
    • in chains and pairs
  39. Cultures:
    Colonies surrounded by clear zones means:
    A) partially hemolytic bacteria
    B) non-hemolytic bacteria
    C) fully hemolytic bacteria
    • C) fully hemolytic bacteria
    • = beta hemolytic Streptococci such as Group A Streptococci
    • S.pyogen in eye
  40. Cultures:
    Colonies NOT surrounded by zones means:
    A) partially hemolytic bacteria
    B) non-hemolytic bacteria
    C) fully hemolytic bacteria
    • B) non-hemolytic bacteria
    • = Gamma hemolytic such as Streptococci like Enterococci
  41. Sensitivity:
    Wide zones of inhibited (no) growth indicate antibiotic ____.
    A) minimal sensitivity
    B) sensitivity
    C) antibiotic resistance
    B) sensitivity
    (this multiple choice question has been scrambled)
  42. Sensitivity:
    Areas with minimal growth inhibition indicate antibiotic ____.
    A) antibiotic resistance
    B) sensitivity
    C) minimal sensitivity
    C) minimal sensitivity
    (this multiple choice question has been scrambled)
  43. Sensitivity:
    Areas with no growth inhibition indicate antibiotic ____.
    A) sensitivity
    B) antibiotic resistance
    C) minimal sensitivity
    B) antibiotic resistance
    (this multiple choice question has been scrambled)
  44. Define: Minimum inhibitory concetration (MIC)
    • The LOWEST in-vitro concentration of antibiotic in solution with a bacterial suspension that prevents/inhibits growth of the bacteria after an incubation period.
    • Note: look at minimum MIC breakpoint
    • if >8 not acceptable
    • if <4 good!
  45. MIC:
    If the concentration of the Ab represented by the MIC can be achieved in the patient's serum by normal routes of delivery, the bacteria is said to be ________ to the Ab
    sensitive
  46. MIC:
    If the MIC is above the achievable level, or is within range that would be toxic to a patient, then the bacteria is said to be ______ to the Ab.
    resistant
  47. Define: Broad Spectrum
    Ab which halt the growth of, or eradicate many differnt bacteria
  48. Define: Narrow Spectrum
    Ab whcih are effective for a specific bacteria only
  49. Define: Bacteriocidal
    Ab whose mechanisms of action (MOA) usually result in bacterial cell death
  50. Define: Bacteriostatic
    Ab whose MOA results in inhibiting or arresting growth, development, or multiplication of the infecting bacteria

    static = still, lack of movement
  51. List the 6 anti-infective MOA:
    • 1. inhibition of cell wall synthesis, cause cell wall lysis. ex: Penicillins, cephalosporin, vancomycin
    • 2. alteration of cell mb permeability, inhibition of active transport across the cell mb (most antifungal)
    • 3. inhibition of protein synthesis via inhibition of ribosomal subunit transcription/translation (macrolides/ketolides, tetracyclines, glycylcycline, quinu/dalfo, aminoglycosides, clindamycin, linezolid)
    • 4. inhibition of nucleic acid synthesis/replication, stimulating reduction products (sulfonamides, ketronidazole, possibly tinidazole)
    • 5. inhibition of DNA gyrase or DNA-polymerase (fluoroquinolones)
    • 6. Binding to DNA, interfereing with/preventing replication (most antiviral drugs)
  52. List the 5 considerations when selecting appropriate antimicrobial agents
    • 1. the infecting microorganism and its susceptibilities
    • 2. Type of infection (abscess, UTI, sepsis, meningitis, cellulitis, etc)
    • 3. Host factors (age, current illness, immune status, renal fxn, WBC count etc)
    • 4. Anti-infectives and their properties (dose, routes of admin, metabolic properties, potential toxicities, drug interations, etc)
    • 5. Public health considerations (hospital and community resistance patterns)
  53. True or False:
    Ab are primarily effective against viruses. They do not have clinical effect against bacteria.
    FALSE: Ab are primarily effective against bacteria. They do not have clinical effect against viruses.
  54. True or False
    Ab are not effective at treating fungal infections.
    True: Antifungal meds treat these
  55. True or False

    Some Ab also have anti-protozoal properties and can be used to Tx infections caused by some protozoa
    True (like sulfa drugs)
  56. Final ID and susceptibilities of the bacteria to anti-infective agents come from ______ and ______ testing.
    culture and sensitivity testing
  57. What are the most common eye infections?
    • Blepharitis
    • Hordeolum
    • Conjunctivitis (bacterial and viral)
    • Dacryocystitis
    • Canaliculitis
    • Endophthalmitis
    • Retinitis
    • Orital cellulitis
  58. Name the OTHER 3 bacterial eye infection pathogens
    • Chlamydia trachomatis
    • actinomyces
    • Nocardia
  59. Name the OTHER 2 Fungal eye infection pathogens
    • Candida sp.
    • Aspergillus
  60. Name the 1 other parasitic eye infection pathogens
    Acanthamoeba
  61. Name the 4 herpes virus
    • herpes simplex type 1
    • herpes simplex type 2
    • Varicella-zoster
    • Cytomegalovirus
  62. Name the adenovirus eye infection pathogens
    • Types 3 and 7 in children
    • Types 8, 11, 19 in adults (think 8+11 = 19.. when we are more adult-like)

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