Pharmacology Exam #3 - University of
Cincinnati
Describe the acetylcholinesterase inhibitor drugs. - ANS-Indication
• Management of mild - moderate Alzheimer's dementia
• Often initiated by PCPs or after consultation
MOA
• Block enzyme that degrades acetylcholine → results in more acetylcholine at the synaptic
cleft → enhances cholinergic transmission
Effects
• Diminishes signs and symptoms of dementia
• Improves function and mildly slows progression of symptoms (not progression of disease)
Cholinesterase inhibitor therapy:
• based on concept that inhibition of acetylcholinesterase in CNS improves cholinergic
transmission (at least at the still functioning neurons)
Typical response
• 1/3 of patients treated display modest improvement in cognitive testing scores, function and
behavior
• 1/3 show no change
• 1/3 not able to tolerate medication d/t adverse effects
ADE
• Most frequent- GI symptoms (N/V/D), insomnia, fatigue, muscle cramping, anorexia
\How do you choose choice of therapy for epileptic patients? - ANS-• Classification of
seizures being treated
• Patient specific variables
(age, comorbid conditions, lifestyle, other preferences)
• Characteristics of the drug: cost, drug interactions w/ other pharmacological therapy
Several drugs may be equally effective, making toxicities and characteristics of the patient
major considerations in drug selection
• Initiated by neurology
Choose agent appropriate to type of seizure
Choose least toxic option
Initiate monotherapy if possible
• Titrate dose upward until control is achieved or ADE occur Phenobarbital effective for
prevention of febrile seizures in children
,• Long-term prophylactic treatment of febrile seizures is not recommended by the AAP
• Patients receiving monotherapy usually w/ better adherence and fewer ADEs
• Nonadherence common
most common reason for treatment failure
\How do you evaluate the therapeutic response to antimicrobial agents? - ANS-• Review
patient status
• C&S result → always narrow spectrum if possible!
• Physical S/S
• Diagnostics
• Consider route
• Lack of response...
• Wrong drug? Dose? Tissue concentration?
• Wrong bug? MDR organism?
• Host factors
\How do you identify bacteria through Aerobic vs Anaerobic Organisms? - ANS-Aerobes-
require oxygen
• Most common cause of infection
• Obligate aerobes & others
• Common Gm + aerobes
• Staphylococci → resistance → Methicillin resistant staphylococcus aureus (MRSA)
• Streptococci
• Enterococcus → resistance → Vancomycin resistant enterococcus (VRE)
• Common Gm - aerobes
• Moraxella catarrhalis,
• neisseria gonorrhoeae,
• Haemophilius influenzae
• SPACE bugs- serratia, pseudomonas aeruginosa, acinetobacter helicobacter, citrobacter,
enterobacter (Hard to treat )
Anaerobes- thrive w/o oxygen
• Local microbiota enter previously sterile tissue
• Virulence factors
• Exotoxins
• Common anaerobes
• Clostridium perringes, difficile
• Fusobacterium
• Actinomyces
• Bacteroides fragilis ‐ anaerobe most commonly isolated from intraabdominal infections and
bacteremia
\How do you identify bacteria through gram stains? - ANS-• Enhances visualization of
bacteria
• Reveals morphology
• First discovered by Hans Christian Gram in 1884
• Used to distinguish Gram positive from Gram negative bacteria prior to culturing the
bacteria
• Utilizes Crystal Violet, iodine, & Safranin to stain bacteria
, • Gram positive bacteria stain violet/purple
• Gram negative bacteria stain pink
\How do you treat geriatric populations with Neuroleptic/antipsychotic drugs? -
ANS-Symptom management in geriatric patients
(APA)American Psychiatric Association guidelines
• Nonpharmacologic management is initial approach
• Use of psychotropics in geriatric dementia is common practice, but they do not have FDA
approval for this use
• Antipsychotics are useful for long-term management of behavioral/psychologic symptoms
of dementia and delirium resistant to behavioral therapy
• Psychotropics useful in tx symptoms of dementia - Agitation, Hyperactivity, Hallucination,
Suspiciousness, Hostility, Uncooperativeness
\How do you treat migraines? - ANS-• Mild-to-moderate migraine attack
• NSAIDs
Aspirin, ibuprofen, naproxen, diclofenac,
• Combination acetaminophen/ aspirin/ caffeine demonstrated the most consistent efficacy
Acetaminophen alone not typically recommended
• Rectal suppository & intramuscular (IM) ketorolac in severe N/V
\What agents are used to treat HSV and varicella - zoster? - ANS-• Acyclovir- oral, IV &
topical
• Valacyclovir- oral • (prodrug- converted to acyclovir)
• Penciclovir- topical
• Famciclovir- oral • (prodrug -converted to penciclovir)
• Foscarnet, Cidofovir & Ganciclovir- IV
MOA- inhibit viral DNA synthesis
\What antimicrobials are bacteriostatic vs bactericidal? - ANS-**See power point for more
\What are abortive agents? - ANS-Serotonin receptor agonists (triptans)
First-line for moderate to severe migraine or rescue therapy when nonspecific medications
are ineffective
MOA:
- All serotonin receptor agonists have comparable mechanism of action
- results in cranial vessel constriction,
- rapidly and effectively aborts / markedly reduces the severity of migraine headaches in
about 70% of pts
ADE
Paresthesias
Fatigue
Dizziness
Flushing
Nausea/dry mouth
Somnolence
Chest tightness or pressure
Serious ADE
Cincinnati
Describe the acetylcholinesterase inhibitor drugs. - ANS-Indication
• Management of mild - moderate Alzheimer's dementia
• Often initiated by PCPs or after consultation
MOA
• Block enzyme that degrades acetylcholine → results in more acetylcholine at the synaptic
cleft → enhances cholinergic transmission
Effects
• Diminishes signs and symptoms of dementia
• Improves function and mildly slows progression of symptoms (not progression of disease)
Cholinesterase inhibitor therapy:
• based on concept that inhibition of acetylcholinesterase in CNS improves cholinergic
transmission (at least at the still functioning neurons)
Typical response
• 1/3 of patients treated display modest improvement in cognitive testing scores, function and
behavior
• 1/3 show no change
• 1/3 not able to tolerate medication d/t adverse effects
ADE
• Most frequent- GI symptoms (N/V/D), insomnia, fatigue, muscle cramping, anorexia
\How do you choose choice of therapy for epileptic patients? - ANS-• Classification of
seizures being treated
• Patient specific variables
(age, comorbid conditions, lifestyle, other preferences)
• Characteristics of the drug: cost, drug interactions w/ other pharmacological therapy
Several drugs may be equally effective, making toxicities and characteristics of the patient
major considerations in drug selection
• Initiated by neurology
Choose agent appropriate to type of seizure
Choose least toxic option
Initiate monotherapy if possible
• Titrate dose upward until control is achieved or ADE occur Phenobarbital effective for
prevention of febrile seizures in children
,• Long-term prophylactic treatment of febrile seizures is not recommended by the AAP
• Patients receiving monotherapy usually w/ better adherence and fewer ADEs
• Nonadherence common
most common reason for treatment failure
\How do you evaluate the therapeutic response to antimicrobial agents? - ANS-• Review
patient status
• C&S result → always narrow spectrum if possible!
• Physical S/S
• Diagnostics
• Consider route
• Lack of response...
• Wrong drug? Dose? Tissue concentration?
• Wrong bug? MDR organism?
• Host factors
\How do you identify bacteria through Aerobic vs Anaerobic Organisms? - ANS-Aerobes-
require oxygen
• Most common cause of infection
• Obligate aerobes & others
• Common Gm + aerobes
• Staphylococci → resistance → Methicillin resistant staphylococcus aureus (MRSA)
• Streptococci
• Enterococcus → resistance → Vancomycin resistant enterococcus (VRE)
• Common Gm - aerobes
• Moraxella catarrhalis,
• neisseria gonorrhoeae,
• Haemophilius influenzae
• SPACE bugs- serratia, pseudomonas aeruginosa, acinetobacter helicobacter, citrobacter,
enterobacter (Hard to treat )
Anaerobes- thrive w/o oxygen
• Local microbiota enter previously sterile tissue
• Virulence factors
• Exotoxins
• Common anaerobes
• Clostridium perringes, difficile
• Fusobacterium
• Actinomyces
• Bacteroides fragilis ‐ anaerobe most commonly isolated from intraabdominal infections and
bacteremia
\How do you identify bacteria through gram stains? - ANS-• Enhances visualization of
bacteria
• Reveals morphology
• First discovered by Hans Christian Gram in 1884
• Used to distinguish Gram positive from Gram negative bacteria prior to culturing the
bacteria
• Utilizes Crystal Violet, iodine, & Safranin to stain bacteria
, • Gram positive bacteria stain violet/purple
• Gram negative bacteria stain pink
\How do you treat geriatric populations with Neuroleptic/antipsychotic drugs? -
ANS-Symptom management in geriatric patients
(APA)American Psychiatric Association guidelines
• Nonpharmacologic management is initial approach
• Use of psychotropics in geriatric dementia is common practice, but they do not have FDA
approval for this use
• Antipsychotics are useful for long-term management of behavioral/psychologic symptoms
of dementia and delirium resistant to behavioral therapy
• Psychotropics useful in tx symptoms of dementia - Agitation, Hyperactivity, Hallucination,
Suspiciousness, Hostility, Uncooperativeness
\How do you treat migraines? - ANS-• Mild-to-moderate migraine attack
• NSAIDs
Aspirin, ibuprofen, naproxen, diclofenac,
• Combination acetaminophen/ aspirin/ caffeine demonstrated the most consistent efficacy
Acetaminophen alone not typically recommended
• Rectal suppository & intramuscular (IM) ketorolac in severe N/V
\What agents are used to treat HSV and varicella - zoster? - ANS-• Acyclovir- oral, IV &
topical
• Valacyclovir- oral • (prodrug- converted to acyclovir)
• Penciclovir- topical
• Famciclovir- oral • (prodrug -converted to penciclovir)
• Foscarnet, Cidofovir & Ganciclovir- IV
MOA- inhibit viral DNA synthesis
\What antimicrobials are bacteriostatic vs bactericidal? - ANS-**See power point for more
\What are abortive agents? - ANS-Serotonin receptor agonists (triptans)
First-line for moderate to severe migraine or rescue therapy when nonspecific medications
are ineffective
MOA:
- All serotonin receptor agonists have comparable mechanism of action
- results in cranial vessel constriction,
- rapidly and effectively aborts / markedly reduces the severity of migraine headaches in
about 70% of pts
ADE
Paresthesias
Fatigue
Dizziness
Flushing
Nausea/dry mouth
Somnolence
Chest tightness or pressure
Serious ADE
