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NR 566 Advanced Pharmacology Final Exam Review Latest, Exams of Pharmacology

South University - SavannahPharmacology

NR 566 Advanced Pharmacology Final Exam Review NR 566 Advanced Pharmacology Final Exam Review NR 566 Advanced Pharmacology Final Exam Review NR 566 Advanced Pharmacology Final Exam Review NR 566 Advanced Pharmacology Final Exam Review

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NR566 Advanced Pharmacology Final
Exam Review|
1. Antacids MOA
- Neutralize gastric acid to bring the pH above 3 and inactivate pepsin
2. which antacids have the highest absolute neutrophil count (ANC)?
- sodium bicarbonate and calcium carbonate
3. What do calcium containing antacids needs for absorption?
- vitamin D
4. Antacid Indications
- hyperacidity,
- PUD, GERD, Calcium deficiency, Chronic Renal failure, osteoporosis prevention
5. Monitoring after given antiviral for flu
- no flu vaccine for 2 weeks before or 48 hours after antiviral is given
6. 1st line therapy for uncomplicated UTI
- trimethoprim/sulfamethoxazole (Bactrim)
7. what causes ophthalmia neonatorum
- chlamydia
8. patient education for albendazole & mebendazole
- take with a high fat meal
9. patient education for ivermectin
- take on empty stomach
10. patient education for ibendazole
- don't use if pregnant; use back of contraceptive
11. Aminopenicillins Drugs
- Amoxicillin
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NR566 Advanced Pharmacology Final

Exam Review|

  1. Antacids MOA
  • Neutralize gastric acid to bring the pH above 3 and inactivate pepsin
  1. which antacids have the highest absolute neutrophil count (ANC)?
  • sodium bicarbonate and calcium carbonate
  1. What do calcium containing antacids needs for absorption?
  • vitamin D
  1. Antacid Indications
  • hyperacidity,
  • PUD, GERD, Calcium deficiency, Chronic Renal failure, osteoporosis prevention
  1. Monitoring after given antiviral for flu
    • no flu vaccine for 2 weeks before or 48 hours after antiviral is given
  2. 1st line therapy for uncomplicated UTI
    • trimethoprim/sulfamethoxazole (Bactrim)
  3. what causes ophthalmia neonatorum
    • chlamydia
  4. patient education for albendazole & mebendazole
    • take with a high fat meal
  5. patient education for ivermectin
    • take on empty stomach
  6. patient education for ibendazole
    • don't use if pregnant; use back of contraceptive
  7. Aminopenicillins Drugs
    • Amoxicillin
  • Ampicillin
  • Combinations:
  • Amoxicillin-clavulanate (Augmentin)
  1. Fluoroquinolone older drugs
  • cipofloxacin (cipro)
  • norfloxacin (noroxin)
  • ofloacin (flovin)
  1. Fluoroquinolones new drugs
  • gemifloxacin (factive)
  • levofloxacin (levaquin)
  • moxifloxacin (avelox)
  1. Macrobid indication
  • UTI
  1. the most common cause of Traveler's diarrhea
  • E. coli
  1. PUD stepped-approach algorithm
  • Step 1: lifestyle modification/antacids
  • Step 2: H. pylori testing/PPI
  • Step 3 (uncomplicated): tx for H.pylori
  • Step 4 (uncomplicated): PPI continues for 8-12 weeks until healed
  • Step 5 (uncomplicated, low risk): no on-going therapy
  • Step 5 (uncomplicated, high risk): PPI or H2RA (smokers, >60, CPOD, CAD, hx of bleeding, ulcers or NSAIDs)
  • Step 3 (complicated, bleeding): refer to GI for endoscopy
  • Step 4 (complicated): tx for H. pylori
  • Step 5 (complicated): repeat endoscopy in 12 weeks to determine healing
  1. what causes most diarrhea?
  • infection, food or drug ingestions, or inflammatory bowel disease
  1. symptomatic treatment for viral URIs
  • decongestant
  • Tylenol
  • ASA
  • Motrin
  • increase fluid intake
  • cough drops
  • nasal saline spray
  • rest
  1. 1st lines therapy for acute otitis media (AOM) & sinusitis
  1. 3rd generation cephalosporins drugs
    • Cefdinir (Omincef)
    • Cefpodoxime (Vantin)
    • Cefotaxime (Celizox)
    • Ceftazidime Fortax)
    • Ceftriaxone (Rocephin)
    • Cedax
    • Cefixime (Suprax)
  2. 4th generation cephalosporins drugs
    • Cefepime (Maxipime)
  3. 2nd generation cephalosporins active against
    • gram (+)
    • increased activity for H. influenzae
    • bateroides fragilis
  4. 3rd generation cephalosporins active against
    • uncommon gram (-) organisms
  5. 4th generation cephalosporins active against primarily
    • Gram (+) and but also Gram (-)
  6. which cephalosporins are best against gram (+) organisms
    • cefdinir & cefpodoxime
  7. ADR for cephalosporins
    • serum sickness
    • seizure
    • coagulation abnormalities
  8. indications for cephalosporins
    • exacerbation of chronic bronchitis
    • AOM (when amoxicillin fails)
    • Sinusitis
  9. Pharmacodynamics of cephalosporins
    • inhibit synthesis of bacterial cell wall
  10. fluoroquinolones active against
    • Gram (-) organisms
  11. Pharmacodynamics of fluoroquinolines
    • Interferes with DNA synthesis leading to inability to divide and ultimately, cell death
  1. Fluoroquinolones indications
    • PNA
    • sinusitis
    • UTI
    • proctitis
    • bronchitis
    • skin, joint infections
    • Travelers diarrhea (!st line therapy)
  2. black box warning for fluoroquinolones
    • tendon rupture
  3. macrolide drugs
    • erythromycin
    • clarithromycin
    • dirithromycin
    • azithromycin
    • telithromycin
  4. Pharmacodynamics of macrolides
    • Interferes with steps involves in protein synthesis thereby rendering cell division non-functional
  5. macrolides are active against
    • gram (+) organisms & gram (-) organisms
  6. Macrolide indications
    • CAP (DOC)
    • legionella PNA (DOC)
    • pertussis
    • chronic bronchitis
    • chlamydia
    • H. pylori
    • Group A Strep
    • mycobacterium avium complex
    • endocarditis prophylaxis
  7. Macrolide drug interactions
    • CYP450 & 3A4 inhibitors
    • statins
    • theophylline
    • colchicine
    • carbamazepine
  8. sulfonamide drugs
  1. sulfonamide ADR
    • N/V/D
    • hypersensitivity reactions
    • photosensitivity
    • G6PD deficiency
    • Steven-Johnson syndrome
    • crystals in urine
  2. AIDS and sulfonamides
    • AIDs patients are at increased risk for ADRs
  3. Nitrofurantoin ADR
    • Cough
  4. ADR with G6PD and sulfonamides
    • results in acute hemolytic anemia
  5. blood dyscrasias and sulfonamides
    • toxic effects and death
  6. Bactrim indications
    • uncomplicated UTI
    • exacerbations of chronic bronchitis
    • MRSA
  7. Bactrim drug interactions
    • ACEI
    • ARBs
    • phenytoin
    • warfarin
    • cyclosporine
  8. Clindamycin indications
    • MRSA (1st line therapy in areas where resistance is low)
    • gram (+) cocci (2nd line therapy)
    • endocarditis prophylaxis
    • pneumococcal PNA
    • skin/tissue infections
    • URI/LRI (2nd or 3rd line)
    • Malaria
    • dental infections
    • bacterial vaginosis (off-label)
  9. clindamycin ADRs
  • C-diff infection
  • N/V
  • bitter or metallic taste
  1. Clindamycin mechanism of action
  • suppress protein synthesis
  1. prophylaxis treatment for ophthalmia neonatorum
  • erythromycin ointment within one hour of delivery
  1. most common UTI orgamisms
  • E.coli
  • Klebsiella
  • Proteus (men)
  • Pseudomonas
  • Enterobacter
  • Staphylococcus saprophyticus
  1. 1st line therapy for uncomplicated UTI in adult woman
  • nitrofurantoin
  1. Characteristics of Complicated UTI
  • symptoms > 7 days
  • Rigors
  • flank pain
  • DM, pregnancy, immunocompromised, renal calculi
  • recent d/c from hospital for nursing home
  • 3 or > UTI in past year
  • failed antibiotics within past 4 months
  • resident at ECF
  1. Recurrent UTI prevention
  • Bactrim single strength daily at bedtime x 6 months
  1. indications for referral to Urologist
  • neonates, children <
  • gross hematuria
  • persistent microscopic hematuria
  • symptoms of obstruction
  • persistent UTIs
  • infection with urea-splitting bacteria
  • symptomatic pregnant patients
  • high fever
  • dehydrated
  • septic
  1. Antivirals for Influenza (neuraminidase inhibitors)
    • oseltamivir (Tamiflu), (PO) zanamivir (inhaled)
    • Peramivir (IV)
  2. Antiviral Neuraminidase inhibitor mechanism of action
    • cleaving viral attachment to the host cell surface allow for viral circulation
  3. Antifungal (Antimycotics) classes
    • azoles
    • polyene macrolides
    • Allylamines
    • Nuclear Acid Synthesis inhibitors
    • Griseofulvin
  4. Azoles - Triazoles drugs
    • fluconazole (Diflucan)
    • itraconazole (Onmel)
    • voriconazole (Vfend)
    • Clotrimazole
    • Ketoconazole
    • minonazole
    • terconazole
    • tioconazole
  5. Polyene Macrolides drugs
    • amphotericin B
    • nystatin
  6. Allylamines Drugs
    • Terbinafine (Lamasil)
    • Naftifine
  7. Nuclear acid synthesis inhibitor drugs
    • Flucytosine
  8. Azoles mechanism of action
    • reduce erogsterol production by inhibition of the fungal CYP450 enzyme 14 alpha-demethylase
  9. Polyene Macrolides MOA
    • binds to sterol in the fungal cell membrane, altering cell permeability and allowing intracellular components to leak out
  10. Flucytosine mechanism of action
    • Inhibits DNA synthesis by conversion to 5-fluorouracil; inhibits thymidylate synthase.
  1. Ketoconazole mechanism of action
    • Inhibits steroid synthesis (inhibits desmolase).
  2. fluconazole & posaconazole mechanism of action
    • inhibit fungal CYP450=fungal cell walls weaken
  3. itraconazole & voriconazole mechanism of action
    • inhibit formation of ergosterol= increases cell wall permeability=osmotic instability
  4. Clotrimazole indications
    • Dermatophyte
    • candida albicans
    • oral and vaginal canidasis
  5. Ketoconazole indications
    • vulvovaginal candidasis
    • paronychia
    • fungal PNA
    • esophageal candidasis
  6. Fluconazole indications
    • candidiasis, cryptococcal meningitis
    • severe systemic infections, vaginal candidasis
    • oropharyngeal candidasis
    • esophageal candidasis
  7. Itraconazole (Sporanox) indications
- blastomycosis, - nonmeningeal histoplasmosis,
  1. Posaconazole (Noxafil) indications
- oropharyngeal candidiasis
  1. Voriconazole (Vfend) indications
- invasive aspergillosis
  1. Terbinafine (Lamisil) indications
- onychomycosis of fingernails and toenails
  1. Amphotericin B
- severe systemic fungal infections: HIGHLY TOXIC
  1. Griseofulvin indications
- Oral treatment of superficial infections- dermatophytes (tinea, ringworm)
  1. Ivermectin (Stromectol) indications
- tissue nematodes
  1. Metronidazole (Flagyl), nitazoxanide, & tinidazole
- used to treat protozoal infections: - t. vaginalis - G. lambila - E. histolytica
  1. Metronidazole indications
- protozoal & bacterial infections
  1. Nitazoxanide (Alinia) indications
- diarrhea caused by G. Lambila & C. parvum
  1. Tinidazole (Tindamax) indications
- amebiasis bacterial vaginosis, giardiasis, & trichomoniasis
  1. Metronidazole MOA
  • inhibits DNA synthesis
  1. Nitazoxanide (Alinia) MOA
- interferes with the pyruvate ferredoxin oxidoreductase-dependent electron transfer reaction
  1. tinidazole (Tindamax): MOA
- deactivates DNA and other proteins
  1. Metronidazole drug interactions
- Warfarin (increases anticoagulation) - -Alcohol (Disulfiram reaction) - -lithium (increases level) - -CYP450 inhibitors & inducers (affect drug concentration)
  1. bacterial vaginosis treatment
- Metronidazole (Flagyl)-1st line therapy
  1. Diagnosis of bacterial vaginosis
- Three or four criteria: - Thin, white vaginal discharge - Vaginal discharge with pH of >4. - Clue cells - Positive KOH whiff test (fishy odor secondary to release of amines)
  1. cardinal symptoms of chronic bronchitis which indicate need for antibiotic
  • increased sputum volume
  • increased sputum purulence
  • increase dyspnea
  1. Tinea corporis (ringworm) treatment
  • terbinafine
  • naftifine
  • butenafine
  • ciclopirox olamine
  1. Tinea pedis (athletes foot) treatment
  • terbinafine
  • naftifine
  • butenafine
  • ciclopirox olamine
  1. Tinea Capitis (Scalp Ringworm) treatment
  • Terbinafine
  • Griseofulvin (1st line therapy)
  1. Tinea Cruris (Jock Itch) Treatment
  • naftifine
  • butenafine
  • ciclopirox olamine
  1. onychomycosis
  • ciclopirox
  1. 1st line treatment for primary and secondary skin infections
  • 1st generation Cephalosporins:
  • cephalexin
  • dicoxacillin
  • amoxilcillin/claulanate
  • clindamycin
  1. medications and dose to eradicate nasal MRSA
  • intranasal mupirocin: 1/2 tube in each nostril BID x 5 days
  1. treatment for acute sinusitis
  • amoxicillin with or without clavulanate
  1. What is the 1st line therapy for GERD?
  • H2 blockers and PPIs
  1. Antacid ADRs
  1. Lomotil (diphenoxylate/atropine) MOA
  • decreases bowel secretions and peristalsis
  1. motofen (difenoxin/atropine) MOA
  • decreases bowel secretions and peristalsis
  1. Loperamide (Imodium) MOA
  • Decreases GI motility; binds to opioid receptors
  1. Crofelemer (Fulyzaq) indication
  • diarrhea in patient with HIV/AIDS who are taking antivirals
  1. antidiarrheal precautions/contraindications
  • opiods: toxic megacolon
  • pepto: do not use in children with flu-like illness
  • contraindicated in most children
  • caution in pts with hepatorenal disease
  1. antidiarrheal ADRs
  • constipation
  • bismuth=black tongue, gray/black stool
  • anticholinergic effects
  • CNS effects
  1. antidiarrheal drug interactions
  • ASA: increased risk for salicylate toxicity
  • insulin or oral DM meds: increased risk for hypoglycemia
  • thrombolytics: increased risk for bleeding
  • lomotil & immodium: increased CNS depression with alcohol and anticholinergic effects with other anticholinergics drugs
  1. Laxative classes
  • stimulants
  • osmotics
  • bulk-producing laxatives
  • lubricants
  • surfactants
  • hyperosmolar laxatives
  • chloride channel activators
  • opioid receptor antagonists
  1. laxative stimulant
  • cascara
  • senna
  • bisacodyl
  • castor oil; stimulate myenteric plexus; rapid acting, short term
  1. Osmotic laxatives
  • Mg hydroxide
  • Mg citrate
  • Na phosphate
  • polyethlyene glycol electrolyte solution
  • polyethlyene glycol (PEG) 3350; draw water into intestinal lumen
  1. Bulk producing laxative
  • Psyllium
  • methyl cellulose
  • polycarbophil; mixes with water in intestine; slow response, long-term; older adults
  1. Lubricant laxatives
  • mineral oil; soften stool, lubricates intestine
  1. surfactant laxative
  • docusate compounds (Colace); reduce surface tension on the oil water interface on the stool & facilitate a mixture of fat & water into the stool
  1. hyperosmolar laxative
  • glycerine
  • laculose; draws water into intestines
  1. Chloride channel activators drugs
  • lubiprostone (Amitiza); soften stools and increases GI motility; choric idiopathic constipation, IBS, opioid induced constipation
  1. Opioid receptor antagonists drugs
  • methylnaltrexone; antagonist in the mu-receptor in the GI track; opioid induced constipation
  1. laxative 1st line therapy
  • stimulants
  1. Laxatives are contraindicated in
  • N/v
  • undiagnosed abd pain
  • bowel obstruction
  • Renal dysfunction (Mg hydroxide)
  1. laxative precautions
  • abuse and dependency
  • cathartic colon=ulcerative colitis
  • tartrazine sensitivity=allergic reactions=asthma
  • for N/V associated with cancer & appetite stimulant: dronabinol (Marinol)
  1. 5-HT3 receptor antagonist antiemetics
  • ondansetron (Zofran)
  • palonosteron (Aloxi)
  • dolaseton mesylate (Anzmet)
  • granisetron (Kytril, Sancuso)
  1. Anticholinergic antiemetics
  • Scopolamine (Transderm Scop)
  1. P/neurokinin 1 receptor antagonist antiemetic
  • Aprepitant (emend)
  1. Mics antiemetic
  • trimethobenamide (Tigan)
  1. monitoring of long term use of promethazine
  • CBC=monitor for bone marrow depression & blood dyscrasias
  1. antihistamine antiemetic precautions/ contraindications
  • anticholinergic effects, narrow angle glaucoma, seizure, pyloric obstruction, hyperthyroidism, CV disease, BPH, contraindicated in severe liver disease
  1. phenothiazine precautions/contraindications
  • contraindicated in parkinsons, narrow angle glaucoma, bone marrow depression, severe CV disease; precaution in respiratory impairment="silent PNA", and aspiration risk
  1. dronabinol precautions/contraindications
  • lowers seizure threshold
  • allergy to sesame oil
  • potential for abuse
  • CV disorders
  1. 5-HT3 antagonists antiemetic precuations/contraindications
  • mask progressive ileus
  • zofran contains aspartame=caution in patients with phenylketonuria
  1. Scopalamine (Transderm Scop) precuations/contraindications
  • caution: open-angle glaucoma, eldery-increases CNS effects, GI or bladder neck obstruction
  • contraindicated: narrow-angle glaucoma
  1. Aprepitant (Emend) precautions/contraindications
  • contraindicated to use other drugs metabolized by CYP 34A
  1. Phenothiazines ADR
  • extrapyramidal reactions
  1. Promethazine (Phenergan) ADR
  • fatal respiratory depression in children < 2
  1. H2 receptor antagonists MOA
  • inhibit acid secretion by parietal cells. reduced gastric acid secretion by 35%-50%;
  • zantac is 5-12 times more potent; pepcid 30-60 times for potent that Tagamet
  1. H2 receptor antagonists drugsCimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • nizatidine (Axid)
  1. H2 receptor antagonists precuations/contraindications
  • caution in: renal impairment-reduce dose for renal dysfunction; no Zantac or Pepcid for children;
  • axid can causes hepatocellular injury
  1. H2 receptor antagonists ADR
  • gynecomastia, impotence, (cimetadine=worst effects), confusion, agitation, depression, disorientation, blood dyscrasias
  1. H2 receptor antagonists drug inteactions
  • cimetidine and CYP 1A2, 2C9, & 2D
  1. H2 receptor antagonists monitoring
  • liver function with high doses or long term use
  1. H2 receptor antagonists patient education
  • take with meals, separate antacids by 30 min-1hr, smoking decreases absorption, alcohol increases gastric irritation, don't double the dose, no carafate within 2 hours
  1. Prokinetic drugs
  • Metoclopramide (Reglan)
  1. prokinetic MOA
  • stimulate motility of GI tract without stimulating gastric, biliary or pancreatic secretions
  1. black box warning for metoclopramide (Reglan)
  • increased risk for tardive dyskinesia
  1. Metoclopramide (Reglan) pecaution/contraindications