Advanced Pharmacology for prescribers
-FINAL EXAM.
Ergotamine MOA - ANSWER-vascular effect prototype, causes prolonged
vasoconstriction, Used in migraine
Ergotamine - Monitor - ANSWER-impaired hepatic or renal function
Ergotamine ADRs - ANSWER-May cause severe N/V => pretreat with an antiemetic
Overuse can lead to medication-overuse HA
Vasospastic adverse effects can occur when recommended dose is exceeded
Ergotamine contraindications - ANSWER--due to increased ergot effects: within 24
hours of triptan, with strong CYP3A4 inhibitors, severe renal/hepatic impairment
-conditions affected by vasoconstriction: CHD, uncontrolled htn, preg category X,
sepsis, children
Sumatriptan - MOA - ANSWER-Act as 5-HT1 receptor agonists causing
vasoconstriction and blocking the release of vasoactive substances that can lead to
migraines.
Sumatriptan - Indication - ANSWER-Treatment of migraines. Successful in reducing the
severity of HA in 54-80% of patients
CI: CAD, uncontrolled HTN, pregnancy, ergotamine derivative use in past 24 hrs, MAOI
use in past 2 weeks
Caution: w/ SSRI use (serotonin syndrome), children
Sumatriptan - Monitor - ANSWER-Administer initial dose at clinic and monitor for
unknown coronary disease
Have pt keep HA diary
BP
Medication overuse
Sumatriptan (Imitrex) - type of drug - ANSWER-serotonin receptor agonist
Sumatriptan ADR - ANSWER-Common Adverse Effects
Injection: Tingling, dizziness, vertigo, flushed
PO: Cardiovascular: Hot and cold flashes, chest pain, chest pressure, chest tightness
Central nervous system: Pain, sensation of pressure, paresthesia, fatigue, feeling of
heaviness, malaise, sensation of tightness, heaviness of chest, vertigo
,GI: Sore throat
Respiratory: Pharyngeal edema
Zolmitriptan (Zomig) - type of drug - ANSWER-serotonin receptor agonist
Zolmitriptan MOA - ANSWER-Act as 5-HT1 receptor agonists causing vasoconstriction
and blocking the release of vasoactive substances that can lead to migraines.
Has higher PO bioavailability than sumatriptan
Zolmitriptan - Indication - ANSWER-Indication: Migraines
CI: CAD, uncontrolled HTN, pregnancy, ergotamine derivative use in past 24 hrs, MAOI
use in past 2 weeks
Caution: hepatic dysfunction, oral contraceptives, cimetidine
Zolmitriptan - Monitor - ANSWER-Have pt keep HA diary
BP
Medication overuse
Zolmitriptan - ADR - ANSWER-Unpleasant taste, nausea, dyspepsia, abdominal pain,
chest pain, chest pressure, dizziness, local alteration in temperature sensation
Amoxicillin - type of drug - ANSWER-PCN
Amoxicillin - MOA - ANSWER-A semi synthetic antibiotic, inhibits synthesis of cell wall
mucopeptide, broad spectrum bactericidal activity against strains of gram-positive and
gram-negative microorganisms.
Pregnancy Cat B
Amoxicillin - Indication - ANSWER-Top ABX prescribed to children, 2nd for adults
Upper Respiratory infections (pharyngitis, otitis media (1st line), sinusitis (not
recommended for thick green nasal d/c unless it persists for >10 days
STI (not for gonorrhea)
UTI (2nd line)
H. pylori
Endocarditis prophylaxis
Lyme disease
Exacerbation of Chronic Bronchitis (only w/ inc sputum volume, purulence, or dyspnea)
CI: severe rx to cephalosporins, carbapenems, beta-lactamase inhibitors
Amoxicillin - Monitor - ANSWER-Clinical response, C-diff
,Amoxicillin - ADR - ANSWER-Rash (pruritic, maculopapular), diarrhea, nausea,
vomiting, headache, vulvovaginitis
-Reduces efficacy of oral contraceptives. Backup recommended
Amoxicillin/Clavulanate (Augmentin) - type of drug - ANSWER-PCN
Amoxicillin/Clavulanate - MOA - ANSWER-Amoxicillin is susceptible to inactivation by
beta lactamases and ineffective against organisms that produce this enzyme.
Clavulanic acid inactivates beta-lactamase enzymes protecting amoxicillin against
degradation and extending its antibiotic spectrum
Amoxicillin/Clavulanate - Indication - ANSWER--Acute otitis media, Sinusitis
-pneumonia, serious or resistant
-Animal bites (excluding spider)
-Exacerbation of Chronic Bronchitis (only w/ inc sputum volume, purulence, or dyspnea)
CI: severe rx to cephalosporins, carbapenems, beta-lactamase inhibitors
Amoxicillin/Clavulanate - Monitor - ANSWER-clinical response, cx and susceptibility
tests
Amoxicillin/Clavulanate - ADR - ANSWER--rash, diarrhea (2x more likely than plain
amox), nausea, vomiting, mycosis, vaginitis, candidiasis
-Reduces efficacy of oral contraceptives. Backup recommended
Cephalexin (Keflex) - type of drug - ANSWER-Cephalosporin FIRST generation
Cephalexin - MOA - ANSWER-Inhibits mucopeptide synthesis in bacterial cell wall.
Inhibits PBP. Bactericidal.
Active against many gram-positive (S. aureus, S. epidermidis, most streptococci.
Active against limited gram-negative organisms: E. coli, Klebsiella pneumoniae, P.
mirabilis.
Not active against methicillin-resistant staphylococci or enterococci: Enterococcus. Not
active against anaerobes. Do not enter CSF.
Cephalexin - Indication - ANSWER-Mild to severe infection
Endocarditis prophylaxis
Strep pharyngitis, tonsillitis
Cystitis
Caution: markedly impaired renal function
, Cephalexin - Monitor - ANSWER--C. diff s/s (>3 watery, unformed stools/day or if blood
in stool.
prolonged therapy: BUN and CCr for renal function
PT if renal or hepatic impairment
Cephalexin - ADR - ANSWER-Seizures (high doses), diarrhea, abdominal pain, nausea,
vomiting, rashes, urticaria, hemolytic anemia, allergic reactions including anaphylaxis,
superinfection.
CDI
Cefuroxime (Ceftin) - type of drug - ANSWER-Cephalosporin SECOND generation
Cefuroxime - MOA - ANSWER-Same MOA as 1st gen. Active against same organisms
w/ increased activity against H. influenzae.
Take w/ food to enhance absorption
Cefuroxime - Indication - ANSWER-Same MOA as 1st gen. Active against same
organisms w/ increased activity against H. influenzae.
Cefuroxime - Monitor - ANSWER--C. diff s/s (>3 watery, unformed stools/day or if blood
in stool.
prolonged therapy: BUN and CCr for renal function
PT if renal or hepatic impairment
Cefuroxime - ADR - ANSWER-Seizures (high doses), diarrhea, abdominal pain,
nausea, vomiting, rashes, urticaria, hemolytic anemia, allergic reactions including
anaphylaxis, superinfection.
CDI
Ceftriaxone (Rocephin) - type of drug - ANSWER-Cephalosporin THIRD generation
Ceftriaxone - MOA - ANSWER-Same as 1st and 2nd. Activity against streptococcal
species: S. pneumoniae, MSSA, H. influenzae (including beta-lactamase strains), N.
gonorrhoeae, N. meningitidis, E. coli, Klebsiella, Proteus, Salmonella
Not good for anaerobes except Peptostreptococcus
Crosses blood brain barrier
Ceftriaxone - Indication - ANSWER--Good for infections w/ high resistance
-Gonorrhea
-FINAL EXAM.
Ergotamine MOA - ANSWER-vascular effect prototype, causes prolonged
vasoconstriction, Used in migraine
Ergotamine - Monitor - ANSWER-impaired hepatic or renal function
Ergotamine ADRs - ANSWER-May cause severe N/V => pretreat with an antiemetic
Overuse can lead to medication-overuse HA
Vasospastic adverse effects can occur when recommended dose is exceeded
Ergotamine contraindications - ANSWER--due to increased ergot effects: within 24
hours of triptan, with strong CYP3A4 inhibitors, severe renal/hepatic impairment
-conditions affected by vasoconstriction: CHD, uncontrolled htn, preg category X,
sepsis, children
Sumatriptan - MOA - ANSWER-Act as 5-HT1 receptor agonists causing
vasoconstriction and blocking the release of vasoactive substances that can lead to
migraines.
Sumatriptan - Indication - ANSWER-Treatment of migraines. Successful in reducing the
severity of HA in 54-80% of patients
CI: CAD, uncontrolled HTN, pregnancy, ergotamine derivative use in past 24 hrs, MAOI
use in past 2 weeks
Caution: w/ SSRI use (serotonin syndrome), children
Sumatriptan - Monitor - ANSWER-Administer initial dose at clinic and monitor for
unknown coronary disease
Have pt keep HA diary
BP
Medication overuse
Sumatriptan (Imitrex) - type of drug - ANSWER-serotonin receptor agonist
Sumatriptan ADR - ANSWER-Common Adverse Effects
Injection: Tingling, dizziness, vertigo, flushed
PO: Cardiovascular: Hot and cold flashes, chest pain, chest pressure, chest tightness
Central nervous system: Pain, sensation of pressure, paresthesia, fatigue, feeling of
heaviness, malaise, sensation of tightness, heaviness of chest, vertigo
,GI: Sore throat
Respiratory: Pharyngeal edema
Zolmitriptan (Zomig) - type of drug - ANSWER-serotonin receptor agonist
Zolmitriptan MOA - ANSWER-Act as 5-HT1 receptor agonists causing vasoconstriction
and blocking the release of vasoactive substances that can lead to migraines.
Has higher PO bioavailability than sumatriptan
Zolmitriptan - Indication - ANSWER-Indication: Migraines
CI: CAD, uncontrolled HTN, pregnancy, ergotamine derivative use in past 24 hrs, MAOI
use in past 2 weeks
Caution: hepatic dysfunction, oral contraceptives, cimetidine
Zolmitriptan - Monitor - ANSWER-Have pt keep HA diary
BP
Medication overuse
Zolmitriptan - ADR - ANSWER-Unpleasant taste, nausea, dyspepsia, abdominal pain,
chest pain, chest pressure, dizziness, local alteration in temperature sensation
Amoxicillin - type of drug - ANSWER-PCN
Amoxicillin - MOA - ANSWER-A semi synthetic antibiotic, inhibits synthesis of cell wall
mucopeptide, broad spectrum bactericidal activity against strains of gram-positive and
gram-negative microorganisms.
Pregnancy Cat B
Amoxicillin - Indication - ANSWER-Top ABX prescribed to children, 2nd for adults
Upper Respiratory infections (pharyngitis, otitis media (1st line), sinusitis (not
recommended for thick green nasal d/c unless it persists for >10 days
STI (not for gonorrhea)
UTI (2nd line)
H. pylori
Endocarditis prophylaxis
Lyme disease
Exacerbation of Chronic Bronchitis (only w/ inc sputum volume, purulence, or dyspnea)
CI: severe rx to cephalosporins, carbapenems, beta-lactamase inhibitors
Amoxicillin - Monitor - ANSWER-Clinical response, C-diff
,Amoxicillin - ADR - ANSWER-Rash (pruritic, maculopapular), diarrhea, nausea,
vomiting, headache, vulvovaginitis
-Reduces efficacy of oral contraceptives. Backup recommended
Amoxicillin/Clavulanate (Augmentin) - type of drug - ANSWER-PCN
Amoxicillin/Clavulanate - MOA - ANSWER-Amoxicillin is susceptible to inactivation by
beta lactamases and ineffective against organisms that produce this enzyme.
Clavulanic acid inactivates beta-lactamase enzymes protecting amoxicillin against
degradation and extending its antibiotic spectrum
Amoxicillin/Clavulanate - Indication - ANSWER--Acute otitis media, Sinusitis
-pneumonia, serious or resistant
-Animal bites (excluding spider)
-Exacerbation of Chronic Bronchitis (only w/ inc sputum volume, purulence, or dyspnea)
CI: severe rx to cephalosporins, carbapenems, beta-lactamase inhibitors
Amoxicillin/Clavulanate - Monitor - ANSWER-clinical response, cx and susceptibility
tests
Amoxicillin/Clavulanate - ADR - ANSWER--rash, diarrhea (2x more likely than plain
amox), nausea, vomiting, mycosis, vaginitis, candidiasis
-Reduces efficacy of oral contraceptives. Backup recommended
Cephalexin (Keflex) - type of drug - ANSWER-Cephalosporin FIRST generation
Cephalexin - MOA - ANSWER-Inhibits mucopeptide synthesis in bacterial cell wall.
Inhibits PBP. Bactericidal.
Active against many gram-positive (S. aureus, S. epidermidis, most streptococci.
Active against limited gram-negative organisms: E. coli, Klebsiella pneumoniae, P.
mirabilis.
Not active against methicillin-resistant staphylococci or enterococci: Enterococcus. Not
active against anaerobes. Do not enter CSF.
Cephalexin - Indication - ANSWER-Mild to severe infection
Endocarditis prophylaxis
Strep pharyngitis, tonsillitis
Cystitis
Caution: markedly impaired renal function
, Cephalexin - Monitor - ANSWER--C. diff s/s (>3 watery, unformed stools/day or if blood
in stool.
prolonged therapy: BUN and CCr for renal function
PT if renal or hepatic impairment
Cephalexin - ADR - ANSWER-Seizures (high doses), diarrhea, abdominal pain, nausea,
vomiting, rashes, urticaria, hemolytic anemia, allergic reactions including anaphylaxis,
superinfection.
CDI
Cefuroxime (Ceftin) - type of drug - ANSWER-Cephalosporin SECOND generation
Cefuroxime - MOA - ANSWER-Same MOA as 1st gen. Active against same organisms
w/ increased activity against H. influenzae.
Take w/ food to enhance absorption
Cefuroxime - Indication - ANSWER-Same MOA as 1st gen. Active against same
organisms w/ increased activity against H. influenzae.
Cefuroxime - Monitor - ANSWER--C. diff s/s (>3 watery, unformed stools/day or if blood
in stool.
prolonged therapy: BUN and CCr for renal function
PT if renal or hepatic impairment
Cefuroxime - ADR - ANSWER-Seizures (high doses), diarrhea, abdominal pain,
nausea, vomiting, rashes, urticaria, hemolytic anemia, allergic reactions including
anaphylaxis, superinfection.
CDI
Ceftriaxone (Rocephin) - type of drug - ANSWER-Cephalosporin THIRD generation
Ceftriaxone - MOA - ANSWER-Same as 1st and 2nd. Activity against streptococcal
species: S. pneumoniae, MSSA, H. influenzae (including beta-lactamase strains), N.
gonorrhoeae, N. meningitidis, E. coli, Klebsiella, Proteus, Salmonella
Not good for anaerobes except Peptostreptococcus
Crosses blood brain barrier
Ceftriaxone - Indication - ANSWER--Good for infections w/ high resistance
-Gonorrhea
