Pharm 2 Week 1

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MarieElise
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257077
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Pharm 2 Week 1
Updated:
2014-01-20 15:33:03
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pharm
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Drugs for Tuberculosis Antivirals Drugs for HIV
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  1. 4 drugs used to treat tuberculosis
    • Isoniazid
    • Rifampin
    • Pyrizinamide (P, PZA)
    • Ethambutol
  2. Treatment for TB begins with ________ treatment and then shifts to _________ treatment as _________ is established
    • empiric treatment
    • focal treatment
    • drug sensitivity
  3. Why would being immunocompromised make TB treatment with Ethambutol less effective?
    It relies on intact host immunity (is bacteriostatic)
  4. Which TB drug is the standard treatment, especially for latent, and why?
    • Isoniazid
    • effective
    • relatively safe
    • inexpensive
  5. Why is patient adherence difficult when treating TB?  What treatment option promotes adherence?
    • long term
    • drugs are hard on system 
    • Direct Observation Therapy
  6. Rifampin, Isoniazid and Pyrinamide are all bacterio_______; Ethambutol is bacterio______
    • -cidal
    • -static
  7. Where are Rifampin, Isoniazid and Pyrinamide metabolized?  What is the main adverse effect to worry about?
    • Liver
    • Hepatoxicity
  8. S/S of hepatoxicity to teach patients about for R, I, PZA
    • Jaundice
    • Malaise
    • Anorexia
    • Fatigue
    • Nausea
    • Darkened urine
    • Pale stools
  9. What effect does Rifampin have on P450?  What does this do to HIV treatment?
    Induces it; makes HIV drugs less effective
  10. Multi-drug resistant TB is resistant to which drugs?  Extensively drug resistant TB?
    • MDR-TB: I & R
    • XDR-TB: I, R & others
  11. AE's of Isoniazid and associated teachings
    • hepatoxicity: assess baseline liver functions
    • -older people at greatest risk

    peripheral neuropathy: pins and needles
  12. AE's of Rifampin and associated teachings
    Hepatoxicity

    -induces P450

    makes oral contraceptives ineffective: use alternate form

    decreases levels of other drugs due to increased drug metabolism

    flu-like symptoms

    discoloration of bodily fluids: may stain contacts
  13. AE's of PZA
    Hepatoxicity

    Rapid resistance: always question if prescribed alone

    • Hyperurecemia with gouty arthritis
    • (uric crystals)
  14. AE's of Ethambutol
    • optic neuritis 
    • -loss of central vision
    • -impaired color differentiation 

    report changes in vision; assess vision before treatment starts and monthly

    not given to children under 8
  15. What drug treats herpes simplex, varicella-zoster virus and cytomegalovirus?
    • Acyclovir (Zovirax)
    • Ganciclovir
  16. when acyclovir is administered via IV, it may cause ______.  How can this be avoided?
    • nephrotoxicity
    • adequate hydration during treatment and for two hours after
  17. drugs used to treat Hepatitis (HCV and HBV)
    Interferon Alpha (2a/2b)
  18. when do you treat Hep C?
    only when certain S/S are present:

    • HCV viremia (virus enters bloodstream and accesses body)
    • persistant elevated ALT
  19. how does interferon alpha work?
    affects viral replication
  20. AE's of interferon alpha?
    • N/V/D
    • Flulike symptoms
    • hemolytic anemia
    • depression
    • thyroid disfunction
    • bone marrow suppression
  21. Why do anti-virals have such adverse effects?
    virus replicates inside host cells so can't damage virus without damaging host
  22. Primary management of influenza is _____
    Secondary is _____
    • vaccination
    • drugs
  23. Drugs to treat influenza
    • vaccines
    • Tamiflu
    • Amantadine
  24. two kinds of flu vaccine
    • inactivated
    • live, attenuated influenza vaccine (LAIV)
  25. AE's of influenza vaccine
    • pain at site of injection
    • flu-like symptoms
  26. protection from influenza begins when?
    1-2 weeks after vaccination
  27. nasal spray influenza vaccine (FluMist) lasts how long?  who can get it?
    • 6+ months
    • ages 2-49
  28. what is the general overview of HIV diagnosis and treatment?
    • it's very complicated to diagnose
    • lots of drugs exist to treat it
    • there are a lot of complications and interactions
  29. What are NRTIs?
    prototype?
    • Nucleoside Reverse Transcriptase Inhibitors
    • Retrovir
  30. What are NNRTIs?  Prototype?
    • Non-Nucleoside Reverse Transcriptase Inhibitors
    • Sustiva
  31. 4 classes of drugs for treating HIV
    • NRTIs
    • NNRTIs
    • Protease Inhibitors
    • Integrase Inhibitors
  32. which class of HIV drugs are the most effective?
    Protease Inhibitors
  33. What's ART and HAART?
    • Antiretroviral therapy
    • Highly Active Antiretroviral Therapy
  34. what's a retrovirus?  how can it be stopped?
    • uses RNA as genetic material
    • transcribes RNA to DNA

    stop replication by blocking enzymes
  35. testing for efficacy of HIV treatment involves counts of what cell?
    CD4 T-cells
  36. how do you treat HIV in pregnant women?  which drug is preferred?
    • Same principles
    • "If you can save the mother, you can save the baby"

    Retrovir
  37. Retrovir is a ________ (drug class)
    how does it work?
    • NRTI
    • suppresses synthesis of viral DNA
  38. AE's of Retrovir
    • N/V/D --very common
    • Anemia/neutropenia
    • abdominal pain
    • headache
    • insomnia myopathy
  39. patient teachings for Retrovir
    • adherence is important
    • assess muscle changes
    • -weakness, spasm, stiffness, cramps
  40. Sustiva is a _______ (drug class)
    How does it work?
    • NNRTI
    • inhibits synthesis of viral DNA

    Induces P450: accelerates drug metabolism
  41. AE's of Sustiva and associated patient teachings
    • CNS effects (in 50%) of patients: take at bedtime
    • -avoid in patients with history of mental illness or substance abuse

    Rash/Steven Johnson Syndrome:  Stop treatment immediately

    Oral contraceptives don't work
  42. What's Steven Johnson Syndrome?
    what drug is it associated with?
    • skin sloughs off and changes color
    • Sustiva (for HIV)
  43. What is the prototype for Protease Inhibitors?
    how does it work?
    • Kaletra
    • stops protease from contributing to HIV maturing
  44. AE's of Kaletra
    causes other chronic conditions

    cardiovascular: Prolongs PR & QT intervals

    Fat redistribution (hyperlipidemia)

    Diabetes/hyperglycemia

    reduces bone density

    increased bleeding in hemophilia
  45. Teachings for Kaletra
    beware of falls (hemophilia)

    monitor glucose levels and for S/S of diabetes (i.e. polydipsia, polyurea)

    monitor cholesterol
  46. Which two classes of HIV drugs can be most successfully combined to reduce viral load to undetectable levels?
    Protease Inhibitors and NRTIs
  47. HIV fusion inhibitor works how?
    how is it given?
    • blocks entry of HIV into cells
    • SubQ

    • Enfuvirtide
    • (Fuzeon)
    • (T-20)
  48. AE's of fusion inhibitors?
    pneumonia
  49. HIV Integrase Strand Inhibitors works how?
    inhibit insertion of HIV DNA into cells

    Raltegravir (Isentress)
  50. AE's for Isentress (Integrase Strand Inhibitor) and patient teachings/monitor
    • SJS
    • Organ disfunction: monitor kidneys and liver

    -rare but fatal
  51. CCR5 Antagonists work how?
    Maraviroc (Selzentry)

    • only for certain strain of HIV
    • blocks viral entry to cell

    used with other HIV drugs
  52. who can't take CCR5 antagonists?
    patients under 16
  53. AE/s of CCR5 antagonists and associated patient teachings/monitor?
    myocardial ischemia, infarction: teach S/S to report

    Hepatoxicity: monitor liver function

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