Exam 1 (1-4 IND MOD)

  1. Define the following terms: Pharmacokinetics
    • Focuses on the processes of absorption, distribution, biotransformation (metabolism), and excretion (elimination).
    • ACTION OF THE BODY ON THE DRUG
  2. Define the following term Pharmacodynamics
    • Study of biochemical and physiological effects of drugs and the function of living organisms and of their component parts.
    • EFFECTS OF DRUG ON THE BODY
    • MECHANISM OF ACTION, INTENDED EFFECTS, SIDE EFFECTS, AND INTERACTIONS
  3. List the 4 components of pharmacokinetics
    • Absorption
    • Distribution
    • Biotransformation
    • Excretion
  4. How the drug leaves its site of administration (GUT > PLASMA)
    HOW MUCH OF THE DRUG THERE IS AND HOW FAST THE DRUG LEAVES ITS SITE OF ADMINISTRATION
    Absorption
  5. how much of the drug reaches the site of action in the body
    Bioavailability
  6. Factors affecting absorption:
    • Drug characteristics
    • Routes
    • Blood Flow
    • Cell Membrane Characteristics
  7. What are drug characteristics that affect absorption
    • Formulation of drug
    • Concentration of drug
    • Lipophilic drug formations
    • Acidic drugs
  8. What are routes of administration that affect absorption
    • Oral
    • Sublingual
    • Inhalation
    • Ophthalmic
    • Topical
    • Rectal
  9. Transport of a drug in bodily fluids from the bloodstream (at site of absorption) to various tissues in the body
    TRANSPORT OF DRUG TO BODY TISSUES
    Distribution
  10. Factors affecting distribution:
    • Plasma protein binding
    • Amount of adipose tissue (body fat)
    • Edema
    • Tissue binding
  11. 2 phases of distribution
    • First: Movement from the site of administration to bloodstream
    • Second: Delivery of drug into the tissue at site of action
  12. CHEMICAL INACTIVATION OF A DRUG
    CONVERSION TO MORE WATER-SOLUBLE COMPOUND THAT CAN BE EXCRETED FROM BODY
    Biotransformation
  13. PRIMARY site of biotransformation
    liver
  14. Two Phases of Biotransformation
    Lipophilic > Phase 1 (P450) drug inhibits or induces reaction > Hydrophilic less active compound > Phase II glucuronidation/conjugation > Highly water-soluble inactive substrate
  15. Phase of biotransformation that
    makes the drug more hydrophilic through oxidation, reduction, or hydrolysis
    Phase I
  16. where is Cytochrome P450 concentrated
    liver, intestine, lungs
  17. Which CYP 450 enzyme MOST ABUNDANT, 50% clinical significance: antihistamines, antibiotics, lipid-lowering agents, antihypertensives, protease inhibitors, azole antifungals
    CYP 3A4
  18. Which CYP 450 enzyme is SECOND MOST ABUNDANT, 30% clinical significance: SSRIs, Pain relievers, B-blockers, conversion of codeine to morphine
    CYP 2D6
  19. A drug that is affected by a change in its enzyme metabolism
    Substrate
  20. A drug that causes acceleration in the enzyme metabolization of another drug
    Inducer
  21. First-Pass effect
    When a drug is taken orally, it passes from intestine directly to liver by way of hepatic portal blood flow (via portal vein).
  22. PRODRUG:
    COMPOUND THAT IS INITIALLY PHARMACOLOGICALLY INACTIVE
  23. What is it called when ORAL MEDS are EXTENSIVELY METABOLIZED TO INERT COMPOUNDS WHEN THEY FIRST PASS THROUGH THE LIVER (WHICH IS WHY LARGE AMOUNTS OF DRUG MUST BE GIVEN FOR SUFFICIENT DRUG TO REMAIN AFTER, OR ALTERNATIVE ROUTE IS CHOSEN).
    First pass effect
  24. 2 steps of Phase two biotransformation
    • First pass effect
    • Glucuronidation
  25. Involves conjugation, or attachment of particles to the molecule, making it a highly water-soluble substance with little or no pharmacologic activity
    Glucuronidation
  26. Process by which drugs and their metabolites are removed from the body
    Excretion
  27. Where does excretion occur? Primarily?
    • LIVER  & KIDNEY
    • KIDNEY
  28. 3 steps of excretion
    • Glomerular Filtration
    • Tubular Secretion
    • Partial Reabsorption
  29. Drug enters renal tubule by filtration
    Depends on: amount of protein binding because a drug does not filter in tubule if bound to protein; rate of glomerular filtration which depends on kidney function and cardiovascular status
    Glomerular Filtration
  30. Adds anion and cations to proximal renal tubule. Two drugs may compete for the same active transport carriers which causes excretion to slow
    Tubular Secretion
  31. Depends on pH of urine
    Alkalinization of urine: increases excretion of acidic molecules
    Acidification of urine: increase excretion of basic molecules
    Partial Reabsorption
  32. Considerations of RENAL INSUFFICIENCY/DAMAGE when prescribing meds
    CREATININE CLEARANCE MUST BE OBTAINED BEFORE MODIFYING DOSAGE OF MEDICATION
  33. VOLUME OF PLASMA FROM WHICH ALL DRUGS ARE REMOVED WITHIN A GIVEN TIME
    CLEARANCE
  34. IF DRUG STORED IN ADIPOSE TISSUE:
    NOT CLEARED FROM BODY (LIPOPHILIC)
  35. VOLUME OF DISTIRUBITION AFFECTS
    THE CLEARANCE OF DRUG AND HALF-LIFE
  36. Routes of elimination aside from urine:
    • Fecal: significant for patients with hepatic insufficiency/failure
    • Respiratory: important in elimination of anesthetic gases
    • Breast milk: effect on nursing infant
  37. When a drug has a stable concentration or when administered at the rate at which it is eliminated
    Steady State
  38. Length of time required for the amount of drug in the body to decrease by half
    Depends on concentration of drug
    When a patient is given a drug on a regular schedule, the drug will continue to accumulate until steady state is achieved
    Half-life
  39. After how many half-lives is 94-97% of drug eliminated
    After four or five half-lives
  40. When the amount of drug concentration exceeds the ability of the liver to metabolize the drug
    Amount of drug eliminated is constant
    Toxicity a frequent problem
    Non-linear kinetics
  41. How does drug formulation affect absorption
    Influences dissolution rate of solid form of drug
  42. How does drug concentration affect absorption
    Higher the concentration, more quickly drug is absorbed
  43. How do lipophilic drug formulations affects absorption? Non-Ionized drugs? Ionized drugs?
    • Lipophilic drug formulations are more readily absorbable
    • nonionized drugs are more lipid soluble and may readily diffuse across cell membranes.
    • Ionized drugs are lipid insoluble and nondiffusible
  44. How are acidic drugs absorbed? Alkaloid?
    • Acidic Drugs become nonionized in acidity of the stomach and then diffuse across membranes
    • Basic drugs (alkaloids) tend to ionize and are not well absorbed in stomach but may be better absorbed in small intestine.
  45. Most common, convenient, cheapest, and safest route of drug administration
    Oral
  46. Disadvantages of oral meds
    • Poor GI absorption due to physical drug characteristics
    • Irritation of GI mucosa may cause ulceration/emesis
    • Low GI pH and digestive enzymes destroy drugs
    • Interactions of drug and food/other substances in GI tract
  47. Sublingual administration benefits
    • Avoid 1st pass effect
    • Reaches site of action quickly
  48. Topical administration benefits
    • Avoids first pass
    • Skin not intact absorbs meds more readily
    • Apply to intact, healthy skin
  49. Rectal med administration benefit? Disadvantage?
    • Avoids first pass
    • Skin not intact absorbs meds more readily
  50. Inhalation administration benefit
    Pulmonary: large surface area making absorption more rapid
  51. How does blood flow affect absorption
    Decreased circulation (CHF) results in decreased drug absorption
  52. How does Cell Membrane Characteristics affect absorption
    • Cell membrane proteins can be integral (pass through membrane) or peripheral (attach to surface of membrane)
    • Lipophilic passes through membranes better than hydrophilic
    • Nonionized drugs are more lipid soluble and readily diffuse across cell membranes
    • Acidic drugs become nonionized in acidic environment of stomach
    • Basic drugs such as alkaloids ionize in stomach and are not well absorbed
  53. drug company wishes to manufacturer a drug that is a generic of the brand name. In order to be considered bioequivalent by the FDA, the generic drug should have a bioavailability within what range of the brand name drug?
    80-125%
  54. Explain the concept of Volume of Distribution.
    • Vd is a description of the amount of space into which a drug may spread or be distributed.
    • Useful when one is determining where drug goes after absorption, predicting drug concentrations, understanding how well a drug is absorbed into tissues, and whether it will accumulate in tissues.
    • Small volume of distribution: not widely distributed
    • The large the Vd, the more drug there is in the tissues
    • Factors affecting: plasma protein binding, obesity, edema, and tissue binding
  55. The HIV protease inhibitors are potent inhibitors of the CYP3A4 enzymes. Some of the “statins” (i.e. simvastatin, lovastatin, atorvastatin) are substrates of the CYP3A4 enzymes. What would you expect if you combined a protease inhibitor with one of these statins?
    I would expect to see an accumulation of statins since the HIV protease inhibitors cause CYP3A4 to metabolize the drug more slowly.
  56. A patient is started on a drug that has a half-life of 14 hours, when would you expect steady-state to be reached?
    56 hours or 2.3 days
  57. BK is a 48 y.o. male with diabetes and end stage renal disease. He has a low serum albumin and is receiving phenytoin for a seizure disorder. Phenytoin is highly bound to serum albumin. Would you expect him to require or lower or higher dose of phenytoin compared to a patient with normal albumin levels?
    I would expect him to require a lower amount because there would be an accumulation of Phenytoin in the blood since there is not enough albumin for drug-protein binding. Also lower because his end stage renal disease means he has is not able to clear drugs as readily and will also have an accumulation of Phenytoin from that specific disease process.
  58. Rifampin is a potent inducer of the CYP3A enzyme, cyclosporine is a substrate of CYP3A. What would you expect if you combined rifampin with cyclosporine?
    I would expect to see a rapid decrease in cyclosporine concentration as rifampin would cause CYP3A to rapidly metabolize cyclosporine
  59. Which routes of administration have less of a first-pass effect?
    • Sublingual
    • Topical
    • Rectal (less than oral)
    • Inhalation
    • Ophthalmic
  60. Describe some pharmacokinetic  absorption differences in pediatric patients compared to adult patients.
    • Fluctuating GI function from neonate to 8 months affects enteral administration
    • Transdermal permeability is enhanced in premature infants and newborns
  61. Describe some pharmacokinetic metabolism differences in pediatric patients compared to adult patients.
    • Slower in infants than older children and adults
    • Slow clearance rates and prolonged half-lives
    • Neonate: higher proportion of body weight is in the form of water than adult
    • Reduced % of fat in premature infants
    • Plasma protein binding in neonates comparatively low
    • Premature infants: incomplete glial development enhances permeability of blood brain barrier and permits drugs and bilirubin to enter CNS more readily
  62. Describe some pharmacokinetic excretion differences in pediatric patients compared to adult patients.
    • GFR is at 50% of adult value by 3rd week of life, reaches adult value by 6 months
    • Changes in urinary pH affect excretion
  63. Describe pharmacokinetic distribution differences in geriatric patients compared to younger adult patients.
    • Decline in total body water
    • Body mass lean vs. fat (less muscle, more fat)
    • Decrease in serum albumin
  64. Describe pharmacokinetic biotransformation differences in geriatric patients compared to younger adult patients
    • Phase 1
    • Drugs compete with CYP450 pathway
    • Drugs to be excreted by liver should be started at 30-40% less than average dose
    • Loss of hepatic reserve
    • Declining mass
    • Decreased hepatic blood flow
    • Altered nutrition status
  65. Describe pharmacokinetic elimination differences in geriatric patients compared to younger adult patients.
    • Decreased number of nephrons
    • Decreased renal blood flow, GFR, and tubular secretion rate
    • Increased number of sclerosed glomeruli
    • Decreased creatinine clearance
  66. When is the most critical period to avoid drug exposure in pregnancy and why?
    3-8 weeks because major organogenesis occurs and there is a risk of inducing major malformations
  67. Name 5 common conditions requiring treatment during pregnancy.
    • UTI
    • N/V
    • Infection
    • HTN
    • DM
    • Depression
  68. What are the 2 top selling OTC medications?
    • Cough/Cold
    • Headaches
  69. Specify patient education about OTC medication warnings.
    • Read labels
    • Do not take higher dosages or for a longer time than indicated on the label
    • If symptoms persist, stop self-treatment and talk with health care professional
    • Know potential side effects
    • Discard medicine after expiration date
    • If you don’t understand directions, ask pharmacist
    • All meds have potential to interact with other meds
    • NEVER GUESS DOSE FOR CHILD, AVOID CONVERSIONS, FOLLOW AGE LIMIT RECOMMENDATIONSUSE CHILD-RESISTANT CAP
    • THROW AWAY OLD, DISCOLORED, OR EXPIRED MEDS
  70. If patients are considering complimentary or alternative medicines, as their provider name 3 variables that you must be aware of and educate them.
    • Geriatrics: polypharmacy
    • Pediatrics: weight, age
    • Pregnancy and lactation: teratogenicity, fetotoxicity
  71. List the important components of a traditional prescription and name 3 ways to avoid mistakes
    • Name and address of patient
    • Date prescription is written
    • Age and weight of patient
    • Superscription (Rx meaning take)
    • Inscription (drug ingredients and quantities, strength, or concentration)
    • Drug: no abbreviations, full medication name
    • Strength or concentration (dose to be dispensed)
    • Signature (S, Sig) meaning directions for use (not provider signature)
    • Signature of physician at bottom
  72. When treating a patient with an acute asthma exacerbation, which medications would you consider selecting? What are the most common doses?
    • Short Acting B2-agonist
    • Albuterol – 2 inh (90mcg each) q 4-6 hours prn, nebulizer: 2.5mg (unit dose or dilute 0.5 ml of 0.5% soln with 2.5mL of sterile saline)
    • Anticholinergics
    • Ipratropium – 2-3 inh (17mcg each) q 6-8 hours (or 12 inh in 24 hrs)
    • Systemic Corticosteroids
    • Oral Prednisone/Prednisolone – 40-60mg/day PO qd-bid x 3-10days (ADULT) or 1-2 mg/kg/day PO qd-bid x 3-10 days (max 60 mg/day)
  73. According to the NHLBI or GINA guidelines, which medications are appropriate for the preventive treatment of moderate persistent asthma?
    Low-moderate doses of beclomethasone, budesonide, fluticasone, salmeterol
  74. Where are the beta 1 receptors located? What adverse effects does stimulation of the beta 1 receptors cause?
    Beta 1 receptors are located in the heart leading to tachycardia, palpitations, increased blood pressure, chest tightness, arrhythmias
  75. According to the clinical guidelines, where do the leukotriene modifiers fit in to the treatment plan of asthma?
    Step 2, LTRA can be an alternative to low-dose ICS for patients requiring long-term anti-inflammatory medications in addition to a quick relief bronchodilator or in patients with aspirin sensitive asthma. Because they are weaker than ICS, usually are an add on therapy.
  76. List the potential drug interactions that can occur with the leukotriene modifiers.
    May decrease effectiveness when cytochrome P450 inducers such as phenobarbital or rifampin are co-administered.
  77. Theophylline is metabolized by CYP1A2 enzyme system. What would you expect to see regarding the drug levels if theophylline is given with an
    inducer? Inhibitor?
    • Inducer: Decreased levels of Theophylline due to rapid metabolism from inducer.
    • Inhibitor: Increased levels of Theophylline due to the inhibitor slowing down metabolism of the drug.
  78. What adverse effects would you expect to see with theophylline?
    • Fever, flushing, rash, tachypnea, hyperglycemia
    • N/V, tachycardia, HA, insomnia
    • BAD: seizures, hypokalemia, ventricular arrhythmias, death
  79. When would you consider the Anti-IgE Monoclonal Antibody Omalizumab
    (Xolair®) in treating asthma?
    Step 5 due to possibility of allergies
  80. What is the mechanism of action of the inhaled and intranasal steroids?
    Locally reduce airflow obstruction by reducing airway inflammation in the bronchioles. They suppress cytokine production, airway eosinophil recruitment, and release of inflammatory mediators.
  81. When treating allergic rhinitis with intranasal steroids, what would you need to tell your patient regarding the effects of the medication?
    They must be used consistently on a daily basis for effectiveness and maximum effects may not be noticed for several days to weeks.
  82. What are the advantages and disadvantages of the mast cell stabilizers? Where in the treatment of asthma would you consider this class of medications?
    • Advantages
    • No significant drug interactions
    • Effective in reducing rhinorrhea, sneezing, and nasal itching
    • Excellent safety profile
    • Disadvantages
    • Very slow onset with therapeutic effects occurring in about a week, 2-4 weeks for maximum therapeutic effect
    • SE: can cause eosinophilic pneumonia Minimal effect on nasal congestion
    • Many inhalers contain chlorofluorocarbons (CFCs) and are being rotated off market
    • Not for acute
    • Asthma Treatment
    • Step 2
  83. For which condition are the anticholinergics considered a first line agent? What are all of the medication options for this condition?
    • COPD
    • B2-adrenergic agonists (albuterol/salmeterol), Methylxanthines (theophylline), Corticosteroids (prednisone, fluticasone), Expectorants (guaifenesin)
  84. Decongestants are sympathomimetics. What is their mechanism of action? What adverse reactions may occur because of this mechanism of action? What medical conditions are contraindications for the use of these medications?
    • MOA: Act on a-adrenergic receptors of vascular smooth muscle and cause vasoconstriction of arterioles leading to increased blood pressure, dilation of pupils, intestinal relaxation, and bladder sphincter contraction.
    • SA: Insomnia, tachycardia, palpitations, HAs, dizziness, nausea, nervousness, agitation, weakness, tremors, elevated blood pressure.
    • Contraindicated: Hyperthyroidism, Hypertension, CAD
  85. What precautions will you tell patients about regarding use of decongestants and antihistamines?  Summarize prescribing recommendations for children and those patients with HTN.
    • Decongestants:
    • Reduce consumption of caffeine-containing beverages (coffee, tea, cola) because it can increase restlessness and insomnia
    • Use nasal medication for only 2-3 days and then stop to prevent rebound symptoms.
    • Children: Oral
    • <2 – 4mg/kg/day q 6 hrs
    • 2-5 – 15mg q 4-6 hrs, max 60 mg/24 hrs
    • 6-12 – 30 mg q 4-6 hrs, max 120 mg/24 hrs
    • ER preparations containing 120-240 mg not to be used for children under 12 years.
    • HTN: only if controlled and then extreme caution (sustained-release less effect on cardiovascular system), alternative: topical decongestants
    • Antihistamines:
    • Used to treat allergies and not URIs including colds and sinuses
    • Do not use alcohol, sleeping pills, sedatives, or tranquilizers while taking
    • May have sedative effect causing dizziness. Avoid driving or performing hazardous tasks until effects wear off.
    • Store in tightly closed container in a cool, dry place away from heat and sunlight and out of children’s reach
    • May cause upset stomach, take with food
    • May cause photosensitivity, avoid prolonged sun exposure
    • Do not crush or chew sustained released preparations.
  86. In the following patients, decide which would be the best medication for that patient:

     A 55-year-old female with history of asthma having an asthma exacerbation.
    albuterol
  87. In the following patients, decide which would be the best medication for that patient:

    A 13 year old boy with recurrent asthma exacerbations (currently stable), needs maintenance therapy.
    beclomethasone, budesonide, fluticasone, salmeterol
  88. In the following patients, decide which would be the best medication for that patient:

    A 67 year old smoker with Stage II COPD not responding to use of short acting beta 2 agonist and ipratropium (Combivent) use 4 times per day.
    ICS added to regimen (Fluticasone)
  89. In the following patients, decide which would be the best medication for that patient:

    A 26-year-old female with allergic rhinitis with symptoms of nasal congestion and clear nasal discharge.
    Pseudoephedrine and Montelukast
  90. The penicillinase resistant penicillins were developed to overcome resistance to which organism?
    Staphylococcal bacteria that produce penicillinase
  91. The beta-lactamase inhibitor/penicillin combination productions provide enhanced coverage against which organisms?
    • Staph aureus
    • Moraxwll Catarrhalis
    • influenza
    • Salmonella
    • Shigella
  92. What antibiotics would you consider to treat an infection due to penicillin-resistant Streptococcus pneumoniae?
    Azithromycin or Clarithromycin
  93. A patient presents with an uncomplicated skin and soft tissue infection, which class of cephalosporin would you use to treat this infection?
    2nd Generation: Cefprozil
  94. The 2nd generation cephalosporin cefuroxime has enhanced activity compared to the 1st generation cephalosporin cephalexin versus which organism?
    ECOLI
  95. Which antibiotics have appreciable activity versus CA-MRSA (community-acquired methicillin-resistant Staphylococcus aureus)?
    VANCOMYCIN if MRSA ISOLATE >15% (STANDARD)
  96. Which classes of antibiotics have appreciable activity versus atypical pathogens (i.e. Mycoplasma, Chlamydia, Legionella) and why?
    • AZITHROMYCIN (MACROLIDE), CLARITHROMYCIN (MACROLIDE), DOXYCYCLINE (TETRACYCLINE)
    • THEY ARE EFFECTIVE BECAUSE THEY ARE BROAD SPECTRUM AND HAVE SIGNIFICANTLY INCREASED POTENCY AGAINST GRAM-NEGATIVE BACTERIA AND ANAEROBES. MOST ANTIBIOTICS TARGET THE CELL WALL AND MYCOPLASMA DOES NOT HAVE A CELL WALL, MACROLIDES TARGET PROTEIN SYNTHESIS.
  97. Which macrolide has the best activity versus Haemophilus influenzae?
    AZITHROMYCIN AND CLARITHROMYCIN HAVE SAME EFFICACY BUT AZITHROMYCIN WOULD HAVE BETTER EFFICACY DUE TO COMPLIANCE SINCE IT IS ONCE DAILY DOSING
  98. What are the most common adverse effects of the macrolides?
    • RASH
    • PHOTOSENSATIVITY
    • GI DISTRESS (NVD, DYSPEPSIA)
    • ERYTHROMYCIN: INSOMNIA, HA, DIZZINESS, ASTHENIA
  99. Which fluoroquinolones have enhanced gram-positive activity?
    • NEWER FLUOROQUINOLONES:
    • LEVOFLOXACIN
    • MOXIFLOXACIN
    • GEMIFLOXACIN
  100. A patient is prescribed doxycycline for an infection. What adverse effects may occur with this med and how would you counsel your pt to take this medication?
    • DIARRHEA
    • SIT UPRIGHT WITH A FULL GLASS OF WATER AND DO NOT LIE DOWN FOR ½ A HOUR AFTERDUE TO RISK OF ESOPHAGEAL ULCERATION. AVOID UNECESSARY SUNLIGHT, REPORT SIGNS OF HEPATOTOXICITY
  101. What is the spectrum of activity of clindamycin? In which conditions is this agent warranted? When is it a first line drug? A second line drug?  (see table p. 659)
    • 1ST LINE: ORAL MICROFLORA INFECTION, POLYMICROBIAL
    • 2ND LINE: CELLULITIS, DOG BITES, PHARYNGITIS, DENTAL, ESOPHAGEAL, URI PROCEDURES, BACTERIAL VAGINOSIS, MASTITIS
    • SPECTRUM: USE WITH SERIOUS INFECTIONS ONLY (STREP, PNEUMO, STAPH, ANAEROBIC) NARROW: BINDS EXCLUSIVELY TO 50S SUBUNIT OF BACTERIAL RIBOSOMES AND SUPPRESSES PROTEIN SYNTHESIS
  102. A 74 year old female is receiving ciprofloxacin for an upper urinary tract infection. One week after starting therapy she develops severe diarrhea (10 malodorous watery loose stools per day).  What do you think is the cause of the diarrhea and what do you recommend?
    THE CAUSE WOULD BE A DISRUPTION OF THE COLON’S NORMAL FLORA LEADING TO OVERGROWTH OF C DIFFICILE. I WOULD RECOMMEND DISCONTINUING THE MEDICATION, ENCOURAGING AND EDUCATING ON APPROPRIATE FLUID AND ELECTROLYTE MANAGEMENT, PROTEIN SUPPLEMENTATION, AND ANTIBIOTIC THERAPY FOR C DIFF. POSSIBLE EVALUATION OF SURGICAL INTERVENTION.
  103. Which class of antibiotics is contraindicated in pregnancy, lactation, and children < 8 years old?
    TETRACYLINES
  104. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Acute otitis media in a 2 year old boy allergic to PCN:
    S. PNEUMONIA, H, INFLUENZA. TREAT WITH AMOXICILLIN, 2ND CHOICE: AZITHROMYCIN
  105. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Sinusitis in a 25 year old male:
    S PNEUMONIA, H INFLUENZA. TREAT WITH AMOXCILLIN, 2ND CHOICE: AZITHROMYCIN
  106. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Exudative pharyngitis (bacterial):
    GROUP A, C, G STREP. TREAT WITH PENICILLIN, 2ND CHOICE: AZITHROMYCIN
  107. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Acute exacerbation of chronic bronchitis in a 68 year old male with COPD:
    STREP PNEUMONIA, H INFLUENZA. IF MODERATE: AMOXICILLIN, 2ND CHOICE: SEVERE: AZITHROMYCIN
  108. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Community Acquired Pneumonia (CAP) in a 56 year old female:
    MYCOPLASMA, S PNEUMONIA, H INFLUENZA. TREAT WITH AZITHROMYCIN. 2ND CHOICE: FLUOROQUINOLONE (CIPROFLOXACIN)
  109. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    UTI caused by E. coli in an 18 year old female (not pregnant):
    MYCOPLASMA, S PNEUMONIA, H INFLUENZA. TREAT WITH AZITHROMYCIN. 2ND CHOICE: FLUOROQUINOLONE (CIPROFLOXACIN)
  110. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Chlamydia in a 16 year old female (pregnancy unknown
    C TRACHOMATIS: AZITHROMYCIN. 2ND CHOICE: ERYTHROMYCIN
  111. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    CA MRSA in a 3 year old girl:
    STREP AUREUS. TREAT WITH TMP/SMX (<15%). 2ND CHOICE: AZITHROMYCIN
  112. Of the infections in the scenario listed below, list the most common bacteria causing the infection and the drug of choice and one alternative to treating the infection.

    Diabetic foot infection in a 66 year old female:
    GROUP A STREP, S AUREUS. TREAT WITH TMP/SMX. 2ND CHOICE: ERYTHROMYCIN
  113. Your patient presents with a skin rash that you diagnose as eczema. What are your treatment options?
    Topical Corticosteroids: Group 3-4
  114. What are the most common side effects with steroid creams?
    • Local: Itching, Burning, erythema, folliculitis, perioral dermatitis, acneiform eruption, dry skin, allergic contact dermatitis, maceration, secondary infection, skin atrophy striae, telangiectasia
    • When reducing or discontinuing rebound can occur: chronic plaque psoriasis may develop to pustular psoriasis
  115. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? CREAMS?
    • Useful in groin, genitals, axilla
    • Cosmetically more acceptable
    • Best used for exfoliative dermatitis
    • CONS: can be drying with prolonged use
  116. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? OINTMENTS?
    • Greater penetration
    • Useful for drier lesions
    • Enhanced potency
    • CONS: greasy feeling on skin, too occlusive
  117. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? GELS
    • Useful in acute exudative inflammation (poison ivy)
    • Nonalcoholic gels are more lubricating and can useful in drying scalp lesions
    • Alcohol feels cool and are drying
    • CONS: unpleasant sticky feeling
  118. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? SOLUTIONS/LOTIONS?
    • Most USEFUL FOR SCALP because it penetrates hair shaft
    • CONS: can be drying and irritating
  119. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? AEROSOLS
    • Convenient for patients who lack mobility and have difficulty reaching lower legs
    • Useful in moist lesions (poison ivy)
  120. What are you first and second line treatment choices for psoriasis?
    1st line: Group I Corticosteroids, Corticosteroids + Vit D, 2nd: Cyclosporine
  121. Your patient, a 6-month-old child, presents with scabies. Which agent would be contraindicated and why?
    Lindane because it is absorbed through skin and children have more skin surface area relative to body weight
  122. Your infant patient presents with tinea capitus. Are any topical antifungals considered effective for this condition?
    None considered effective for infant patients with this condition
  123. Your 8 y/o patient presents with tinea corporis. What are your treatment options?   See table 13-4.
    • Econazole
    • Miconazole
    • Tolnaftate
  124. What is the primary use for mupirocin (Bactrobanâ)?
    • Topical infections
    • Impetigo
    • S Aureus infections like MRSA
  125. Your adult patient is diagnosed with acne rosacea. What agent is the treatment of choice for this?  Note: see web link on rosacea treatment in your supplemental materials.
    Metronidazole
  126. Your 18-year-old female patient presents for treatment of moderate acne. What are your first and second line treatment choices and considerations for this patient?  Which agent would be most appropriate for use in this patient?
    • 1st Topical sulfacetamide + sulfur or other topical antibiotic with Benzoyl peroxide w/ or w/out oral antibiotics
    • 2nd: Topical Retinoid
  127. What is the indication for topical agents in the treatment of herpes simplex? Herpes zoster?
    • Indication for topical treatment helps to shorten healing time and the duration of viral shedding and pain in patients with initial herpes outbreak
    • Topical Acyclovir
  128. Is it your task as a primary care provider to provide ongoing management of glaucoma? What are some common medications that can interfere with glaucoma treatment?  You will need to look this up.
    • Brimonidine: none
    • Timolol: CYP2D6 substrate, antihypertensive agents
    • Pilocarine: cholinergics
    • MAOIs
  129. What is the least expensive agent to treat bacterial conjunctivitis?
    Sulfacetamide sodium
  130. What should you order to prevent swimmer’s ear in a high school swimmer?
    2% acetic acid, boric acid, isopropyl alcohol, or Burow’s solution after exposure
Author
LaurenHH
ID
337791
Card Set
Exam 1 (1-4 IND MOD)
Description
HELP
Updated