Pharmacology: Exam 2

Which Ketolide exacerbates (worsens) myasthenia gravis? - correct answer Telithromycin Myasthenia gravis (MG) - correct answer a lack of nerve impulses and muscle responses at the myoneural junctions; causes fatigue and muscular weakness of the respiratory system, facial muscles, and extremities Characteristics of MG include: - correct answer ⚫ Muscular weakness and fatigue Respiratory muscle paralysis, ptosis (drooping of upper eyelid), difficulty chewing and swallowing Myasthenia gravis (MG) is - correct answer an autoimmune disease resulting from a loss of acetylcholine Myasthenia gravis (MG) does not directly affect which body systems? - correct answer Cardiovascular, GI, and CNS Treatment for MG involves.... - correct answer Cholinesterase inhibitors inhibit the action of the enzyme (AcHE), resulting in more acetylcholine being available to activate the receptors and promote muscle contraction. Which two drugs help with myasthenia / cholinergic crisis? - correct answer 1. Neostigmine 2. Pyridostigmine bromide Neostigmine - correct answer ⚫ AChE/ Cholinesterase inhibitor Short acting drug Treats myasthenia crisis Pyridostigmine bromide - correct answer ⚫ AChE/ Cholinesterase inhibitor Intermediate acting drug *Prevents* myasthenia crisis -(tip to remember prevents versus treats *P*yridostigmine *p*revents) Multiple sclerosis (MS) - correct answer An autoimmune disorder which attacks myelin sheath of nerve fibers in brain and spinal cord; Causes lesions or plaques Characteristics of MS include - correct answer ⚫ Remissions and exacerbations Weakness Spasticity in extremities Diplopia (double vision) Multiple sclerosis treatment: - correct answer ⚫ tapering course of glucocorticoids (prednisone), adrenocorticotropic hormone (ACTH) biologic (immune) response modifiers (BRMs) immunosuppressant therapy Signs of inflammation - correct answer ⚫ pain swelling heat redness loss of function How do anti-inflammatory drugs (NSAIDs) work? - correct answer ⚫ Inhibit COX enzyme Inhibit prostaglandin synthesis Characteristics of aspirin - correct answer ⚫ Antiinflammatory antiplatelet antipyretic effects (fights fever) Increased risk of bleeding (avoid in elderly because of increased risk of falls) Aspirin should be avoided during which trimester of pregnancy? - correct answer 3rd trimester Aspirin is contraindicated in children because of - correct answer the possibility of getting Reye's syndrome Infliximab is - correct answer an immunomodulator that disrupts the inflammatory process and delays disease progression Infliximab is commonly given for which 2 conditions? - correct answer 1. Rheumatoid arthritis (RA) 2. Crohn's disease Infliximab is administered via which route? - correct answer Intravenous (IV) Indomethacin is - correct answer a para-chlorobenzoic acid NSAID that causes: - Water and sodium retention - Increased BP Indomethacin is commonly given for which 3 conditions? - correct answer 1. Rheumatoid arthritis (RA) 2. Gout arthritis 3. Osteoarthritis - it is also a potent prostaglandin inhibitor Indomethacin characteristics: - correct answer ⚫ Highly protein bound Moderate half life (4.5 hrs) very irritating to the stomach; should be taken with food For drugs with a narrow therapeutic index ____ and ____ of serum antibiotic levels are monitored to determine if the drug is within the therapeutic range to reach the desired effect - correct answer peak and troughs Serum peak levels are drawn - correct answer 45 to 60 minutes after drug has been administered Serum trough levels are drawn - correct answer minutes before the next drug dosing If the serum peak level is too high.... - correct answer drug toxicity can occur If the serum trough level is below the therapeutic range... - correct answer the patient is *not* receiving an adequate antibiotic dose to kill the targeted microorganism Acquired bacterial resistance is caused by - correct answer prior exposure to antibacterial medication Continuous use of tetracyclines has resulted in bacterial resistance to the drugs used for treatment. Tetracycline resistance has increased in the treatment of ______ and ______. - correct answer pneumococcal and gonococcal infections Culture and sensitivity tests - correct answer Used to detect the infective microorganism present in a sample (e.g., blood, sputum, swab) and what drug can kill it Culture and sensitivity tests: it is important to... - correct answer Wait until culture results are received before initiating antibiotic treatment What is determined by the culture test? - correct answer The organism causing the infection What is determined by the sensitivity test? - correct answer Which antibiotics the organism is sensitive to (higher percentages= increased effectiveness of the antibiotic) Narrow- spectrum antibiotics - correct answer are primarily effective against only one type of organism caused by *gram positive* bacteria Ex: 1. Penicillin 2. Erythromycin Broad- spectrum antibiotics - correct answer can be effective against both gram positive and gram negative organisms (multiple) Ex: 1. Tetracycline 2. Cephalosporins 3. Amoxicillin Broad- spectrum antibiotics are frequently used to - correct answer treat infections when the microorganism has not yet been identified (by C&S test) because they can have an effect on a wider range of infections Amoxicillin is the most commonly prescribed _____ derivative for ____ and _____. - correct answer penicillin, children and adults (amoxicillin is 20% protein bound) Amoxicillin can be used to treat which 4 conditions? - correct answer 1. respiratory infection 2. urinary tract infection (UTI) 3. otitis media (inflammation of middle ear) 4. sinusitis Amoxicillin is well absorbed in the GI tract therefore.... (hint: drug interaction) - correct answer the effectiveness of oral contraceptives is decreased (if taken with amoxicillin) *tetracyclines also decrease birth control effectiveness* Which two medications can decrease the effectiveness of oral contraceptives? - correct answer 1. Amoxicillin 2. Tetracyclines Erythromycin - correct answer ⚫ Macrolide Binds to 50S ribosomal subunits and inhibits protein synthesis narrow spectrum drug Most gram-positive, some gram-negative bacteria bacteriostatic - correct answer low to moderate doses of Erythromycin bactericidal - correct answer high doses of Erythromycin Erythromycin can treat - correct answer ⚫Moderate-to-severe infections Respiratory, GI tract Skin, soft tissue Sexually transmitted infections mycoplasmal pneumonia Legionnaire's disease Side effects/adverse reactions of erythromycin - correct answer Tinnitus (ringing of ears), ototoxicity (hearing loss) GI distress Superinfection