-
Which 1st generation Cephalosporin is used as single dose prophylaxis for surgical coverage?
Cefazolin (Ancef)
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Which Cephalosporins are resistant to PCNase and are a good PCN G substitute?
1st generation: Cefazolin (Ancef) and Cephalexin Keflex
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Which Cephalosporin is used as tx for N. gonorrhea and CAN be used with renal impairment?
Ceftriaxone (Rocephin)
-
What is the BROADEST sprectrum Beta-Lactam, which is used when there is resistance to 3rd/4th generation Cephs?
Carbapenems (Imipenem, Meropenem)
-
What combination of drugs allows for better function of a Beta-Lactam by inhibiting Beta-lactamase?
Amoxicillin/Clavulanic Acid (Augmentin)
-
What is the MoA of Vancomycin?
Cell wall inhibitor
-
What is the coverage of Vancomycin?
Gram+, MRSA! (C. Difficile, Enterococcal endocarditis)
-
If giving an antibx via IV infusion and the pt. develops Red Man Syndrome, what drug is being infused?
Vancomycin (MUST go slow! Give antihistamine!)
-
What cell wall inhibiting antibx is used mostly topically due to systemic nephrotoxicity?
Bacitracin
-
What antibx is used with resistant Gram+ infections (MSSA, MRSA, VRE)?
Daptomycin (Cubicin*)
-
What is the MoA of FQ’s?
Nucleic Acid Inhibitor – interfere with gyrase and topoisomerase
-
What is a major adverse effect of FQ’s?
Tendon Rupture (conn. tissue problems, AVOID with pregrancy)
-
Which FQ is active against BOTH pseudomonas and Anthrax (as well as aerobic Gram-)?
Ciprofloxacin (Cipro)
-
Which FQ is considered a “respiratory FQ” that is active against S. pneumniae?
Levofloxacin (Levaquin)
-
What is the MoA of Sulfamethoxazole?
Folate Antagonist
-
Tetracyclines, Aminoglycosides, and Macrolides all have what in common?
Protein Synthesis Inhibitors: action on the ribosomes
-
Bind to the 30s subunit of the ribosome?
Tetracyclines, Aminoglycosides
-
Bind to the 50s subunit of the ribosome?
Macrolides (Erythromycin), Chloramphenicol
-
Why is the use of Tetracycline contraindicated in pediatric pts.?
Binds to tissues undergoing calcification: bone deposition, dental discoloration, hypoplasia
-
A pt. comes in with a tick borne illness (RMSF, Lyme) what antibx is used as 1st line tx?
Tetracyclines (Doxycycline – can be used w/ RENAL IMPAIRMENT)
-
Which antibx has the same coverage as PCN and is used as a substitute w/ PCN allergy?
Erythromycin
-
Due to the adverse effects of anemia, Gray Baby syndrome, GI upset, and superinfections which drug is LIMITED to life threatening infections?
Chloramphenicol
-
Which antibiotic MUST be monitored due to ototoxicity/nephrotoxicity?
Aminoglycosides
-
Used to tx Upper Resp Inf?
Amoxicillin/Augmentin
-
Used to tx Strep. pharyngitis?
PCN
-
Used to tx bacterial UTIs?
FQ’s or Folate Antagonists (Trimethoprim)
-
Neisseria, E. coli, Klebsiella, Pseudomonas, Salmonella, Shigella, H. flu, M. Cat all = ?
Gram -
-
Staph, Strep, Clostridium all = ?
Gram +
-
PCN, Cephalosporins, Monobactams, Carbapenems all =?
Cell wall inhibiting Beta Lactams
-
What is the antibx of choice for Group A Strep/Syphilis?
PCNs
-
Which PCN is active against P. aeruginosa, Kelbsiella, and Bacteroides?
Piperacillin
-
What type of HA is classified by severe, sharp, stabbing, unilateral pain of short duration?
Cluster HA
-
What is the acute abortive tx for Cluster HA’s?
Oxygen
-
What is the prophylactic tx for Cluster HA’s?
CCB’s, Lithium, Ergotamine(QHS)
-
Dosing for Acetaminophen (Tylenol)?
1000mg Q4-6hrs (max 4000mg in 24 hours)
-
Dosing for Ibuprofen (Advil, Motrin)?
200-800mg Q6hrs
-
Dosing for Sumatriptan (Imitrex)?
6mg SQ, repeat in 1hr if needed
-
Dosing for Butorphanol Nasal Spray (Stadol)?
1 spray (1mg) in 1 nostril! Repeat in 1hr if needed, LIMIT 4sprays/day!
-
Which HA is characterized by pain shooting form mouth to ipsilateral eye/ear/nose?
Trigeminal Neuralgia
-
1st line tx for Trigeminal Neuralgia?
Carbamazepine (Tegretol*), Gabapentin (Neurontin*)
-
Tx for TMJ disorders?
NSAID, Relaxation Tech, Muscle Relaxant (Flexeril*, Skelaxin*), Dental appliances
-
Used for a severe HA with N/V?
Ketorolac (Toradol*)
-
Contains acetaminophen/aspirin/caffeine?
Excedrin, Goody’s powder
-
Provides sedation and muscle relaxation for tension HA?
Butalbital (Barbiturate)
-
Non-selective 5HT1 receptor agonist that constricts intracranial blood vessels and is tx for moderatesevere MHA and Cluster HA?
Ergot Derivatives: Ergomar*, DHE*, Migranal*, Cafergot*
-
#1 side effect of ergot derivatives?
N/V (give antiemetic)
-
NEVER give ergots within 24 hours of what?
Triptans
-
5HT2 antagonist used for refractory HA?
Methsergide
-
1st line tx for moderate to severe migraines/rescue therapy?
Triptans: Imitrex*, Treximet*
-
How frequently can Triptans be taken?
2 doses in 24 hours, no more than 2x per week
-
When are opiods indicated as tx for HA?
Intractable migraines (severe) w/ pt. contraindicated for other tx
-
Na+ channel/Ca+ channel blockade, GABA actions (increase Cl- channel opening), and inhibition of glutamate areall tx for what?
Seizures
-
Works by blocking Na+ channels and is used for partial or tonic-clonic seizures?
Carbamazepine (Tegretol*)
-
Work by augmenting GABA which increases Cl- channel openings and decreasing neuronal firing?
Benzodiazepines: Lorazepam (Ativan), Diazepam (Valium)
-
Used to tx status epilepticus and as adjunctive tx?
Benzodiazepines
-
This GABA augmenting drug has a Black Box warning of Hepatic Failure, Pancreatitis, and Teratogenicity?
Valproic Acid
-
This drug inhibits Ca+ channels and is used with Absence Seizures?
Ethosuximide (Zarontin*)
-
Used for neuropathic pain?
Pregabalin (Lyrica*)
-
Has multiple mechanisms and is given as a loading dose for Status Epilepticus?
Phenytoin (Dilantin*)
-
Used for tonic-clonic partial seizures?
Carbamazepine, Phenytoin, Valproic acid
-
Used for absence seizures?
Ethosuximide, Valproic acid, Clonazepam
-
Used for Myoclonic seizures?
Valproic acid, Clonazepam
-
Combination of lidocaine and prilocaine used prior to minor procedures (Derm, genital lesions)?
EMLA cream
-
Inhibits Substance P, from peppers, and requires regular use for benefit?
Capsaicin
-
Muscle relaxant used for tx of spasticity associated with MS or spinal cord lesions?
Baclofen
-
Medications to improve cognition?
Vit. E, Selegiline, Estrogen, NSAIDs
-
A NMDA receptor antagonist used for moderate to severe Alzheimer’s by blocking toxic effect of excess glutamate?
Memantine (Namenda)
-
A cholinesterase inhibitor used in mild to moderate Alzheimer’s?
Donepezil (Aricept) – specific, less SE’s
-
Initial treatment for Parkinson’s, delays the need to start Levodopa and decreases motor fluctuations for first 5 years?
Dopamine agonists (ex. Pramipexole – no liver metabolism, antidepressant effects)
-
A COMT inhibitor that prevents the degradation of levodopa and decreases the “off time” significantly?
Entacapone (Comtan)
-
Used for the tx of Parkinson’s when the symptoms begin interfering with life?
Levodopa
-
Added to Levodopa to block the conversion to dopamine in the periphery?
Carbidopa (levodopa/carbidopa = Sinemet*)
-
Why must the Sinemet dose/frequency be increased over time?
End-of-Dose deterioration “wearing off” and drug resistant “off” periods
-
Why would you use MAO-B inhibitors as a tx of Parkinson’s?
- Symptomatic benefit for pt wanting to delay tx with Dopamine agonists
- Anticholinergics (Cogentin*, Symmetrel*) work by blocking Ach in the substantia nigra, which increases dopamine effects. What Parkinson’s symptoms are improved by these actions?
- Resting tremor, drooling (avoid if pt. >70yoa)
-
Anticoagulant that interferes with Vit. K synthesis (coagulation factors II, VII, IX, X)?
Warfarin (Coumadin*)
-
Injectable anticoagulant which increases the action of antithrombin III (coag. factors IX, I, XI, XII)?
Heparin
-
Antiplatelet vasodilator that inhibits activity of adenosine deaminase and phosphodiesterase (decreases platelet aggregation)?
Dipyridamole (+Warfarin decreases thrombosis post heart valve replacement, +Aspirin (Aggrenox) decreased risk of stroke)
-
Used for stroke prevention when patient is intolerant to Aspirin?
Ticlopidine (Ticlid)
-
Antiplatelet that blocks ADP receptors and prevents fibrinogen binding and is used in pts. with established PAD for prevention of MI/Stroke?
Clopidogrel (Plavix)
-
Antiplatelet that blocks PG synthetase which prevents formation of thromboxane A2 (actions on hypothalamus decrease fever!)?
Aspirin
-
Three important things used for STROKE prevention?
Aspirin, Statins, BP management
-
IV thrombolytic that is the tx of CHOICE for acute stroke or AMI?
Alteplase (Activase, tPA)
-
Used for ADD/ADHD and narcolepsy by increasing catecholamines in the CNS?
Amphetamines (Ritalin, Concerta, Adderall)
-
Withdrawal effects of Nicotine?
Irritability, anxiety, restlessness, difficulty concentrating, HA
-
Caffeine is what kind of drug?
Methylxanthine
-
What is the tx for mycobacteria meningitis?
Isoniazide, Pyridoxine (B6), Rifampin, Pyrazinamide, and Ethambutol ~9mo!!!
-
Most common cause of aseptic meningitis?
VIRAL – Enterovirus, Cocksackie, Echovirus
-
Tx for aseptic meningitis?
1. symptomatic (rest, fluids, analgesics) 2. AVOID STEROIDS 3. Antivirals
-
What is the appropriate age for Hib vaccine?
2-18mo.
-
Peds. 11-12, high school age (if not at 12oya), college freshmen in dorms, microbiologists, military, people living in Africa, pt. with splenectomy/immune disorder, and exposed pts. are all eligible for what vaccine?
Menactra
-
What class of antibiotics has a black box warning for neurotoxicity, nephrotoxicity, and ototoxicity?
aminoglycosides
-
What antibx is used in the case of a CSF leak, and basilar skull fracture (S. pneumo, H. flu)?
Vancomycin with a 3rd generation Cephalosprin
-
What steriod is used with adults with pneumococcal meningitis 10-20 minutes to 1st antibx dose?
dexamethasone
-
For the treatment of osteomyelitis what are the 3 steps of treatment?
- Surgery/Debridement
- Antibx
- ( Gram - = Ciprofloxacin, cefipime)(MSSA = Naficillin)(MRSA = Vancomycin)
- Hyperbaric O2, Vacuum closure (NPWT)
-
What drug is used as a nasal spray for the treatment of osteoporosis, hypercalcemia, and Padget’s disease? What is it’s MoA?
Calcitonin (Miacalcin*), inhibits osteoclasts, inhibits tubular resorption of Ca+
-
What is a treatment option for post-menopausal women with osteoporosis who cannot take estrogen?
Raloxifene (Evista*)
-
In the case of a woman with osteoporosis, what is HRT tx option if she has had a hysterectomy? if she has an intact uterus?
- Hysterectomy=ERT alone
- Intact=ERT with progestin
- ERT is a good combo with bisphosphonates*
-
What is the dosage of Fosamax in the tx of osteoporosis?
10mg/day or 70mg/week
-
What is the dosage of Boniva in the tx of osteoporosis?
2.5 mg/day or 150mg/MONTH (must remain upright for 60mins)
-
What is the proper administration of bisphosphonates (Boniva, Fosamax) in the treatment of osteoporosis?
- Take in the AM, 30-120 mins B4 food/other meds
- Take with a full glass of water
- Pt must remain upright for at least 30 minutes
-
What is the FIRST LINE tx for osteoporosis?
Bisphosphonates (Fosamax, Boniva, Zometa)
-
What is the proper doasage for daily supplementation of Vit. D?
400-800 IU (<2000 IU/day)
-
What is the best supplement for osteoporosis prevention? Dose?
Calcium Salts (Tums, Oscal+D), 1200-1500mg per day divided (NO more than 2500mg per daytoxic!)
-
What is the most common cause of drug induced osteoporosis?
Glucocorticoids (Prednisone), >5mg/day for >3mo.
-
What is an opiate antagonist that is effective QUICKLY (~30seconds) and is useful for emergent OD tx?
Naloxone (Narcan*)
-
What drugs are used for controlled detox from opiates?
Buprenorphine, Methadone
-
What synthetic opiod is used for analgesic purposes as injection in post-op and labor/delivery?
Fentanyl (Duragesic*)
-
What synthetic opiod is best for women in labor as it is less likely to prolong labor?
Meperidine (Demerol*)
-
What drug works by hyperpolarizing cells, decreasing neuronal firing, presynaptic inhibition, and decreasing the release of substance P?
Morphine
-
Which opiate receptor involves PAIN relief and respiratory depression?
Mu
-
Which opiate receptor has sedative actions?
Kappa
-
What is the initial therapy of choice for RA? Dosage?
Methotrexate (MTX), 7.5mg once weekly
-
What drugs are used in the treatment of RA for pts who have not responded adequately to MTX?
Biologics (TNF alpha inhibitors= Enbrel*, Remicade*)
-
What is the drug of choice for the tx of RA in the case of potential pregnancy?
Sulfusalazine
-
What are the most common causes of drug-induced Lupus?
Hydralazine, procainamide, chlorpromazine
-
What is an immunosuppressant drug use for the treatment of both SLE and RA?
Cyclophosphamide (Cytoxan*)
-
What are the major side effects of Sulfasalazine (Azulfidine*)?
- GI: anorexia, N/V/D
- Hematologic: leukopenia
-
What is the NSAID drug of choice for acute Gout? Dose?
- Indomethacin (Indocin*)
- 25-50mg PO every 8hrs
-
What is the MoA of uricosuric medications?
Renal clearance of uric acid by inhibiting renal tubular reabsorption
-
What is an adverse effect common to uricosurics (Probenecid, Benemid*)?
Precipitation of acute gouty arthritis and stone formation (even though that is what it is used to tx!)
-
What is the drug of choice in patients with a hx of urinary stones or impaired renal function as prevention for acute gout?
Allopurinol (Zyloprim*)
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