Alex's Pharm Exam 1 Study Guide PDF

PHARM EXAM 1 OTC drugs: indication, classification, MOAs, adverse effects, interactions all on pharm meds document Know different concentration for acids of acne/warts Salicylic acid 0.5-2% treat acne and has very low UV protection Salicylic acid 17-40% burns off warts ANYTHING ABOUT PREGNANT P...

PHARM EXAM 1 OTC drugs: indication, classification, MOAs, adverse effects, interactions all on pharm meds document Know different concentration for acids of acne/warts Salicylic acid 0.5-2% treat acne and has very low UV protection Salicylic acid 17-40% burns off warts ANYTHING ABOUT PREGNANT PTS KNOW -​ NSAIDS contraindicated in 3rd trimester due to premature closure of ductus arteriosus, prolonged labor, increased postpartum bleeding, and delayed parturition -​ Avoid aspirin during whole pregnancy -​ Azole topical therapy preferred 7 days while pregnant -​ Intranasal cromolyn is first line option while pregnant colds/allergic rhinitis/cough -​ Oxymetazoline is preferred 1st line nasal decongestant while pregnant if symptoms are severe (phenylephrine during 1st trimester cause minor malformations and pseudoephedrine cause abdominal wall defects) -​ Diphenhydramine and Chlorpheniramine are preferred antihistamines(2nd Gen can be used too) -​ Intranasal corticosteroids are compatible with pregnancy but may cause cleft lip/palate and low birth weight ANYTHING ABOUT LACTATION -​ Infant dose while lactating is 0.6-0.9% -​ Acetaminophen dose while lactating is 3.98% -​ Avoid aspirin while lactating -​ Pseudoephedrine compatible with lactation but may cause reduced milk production -​ Antihistamines are contraindicated during lactation -​ Dextromethorphan, guaifenesin, benzocaine, camphor(topical), and menthol all low risk and able to be used while breastfeeding Know GI treatment meds Antacids -​ Onset 5 min -​ MOA- buffering agent -​ Adverse effects- none huge concern unless renal issue -​ Drug interactions- Chelation with divalent cations Histamine type 2 receptor antagonist (Cimetidine,famotidine) “tidine” = “to dine” -​ onset- 30-45 min -​ MOA- block HCL production -​ Adverse effects- antiadrenergic  -​ Drug interactions- Cimetidine inhibits CYP450, 1A2, and 2C19 Proton pump inhibitors (omeprazole, esomeprazole,lansoprazole) 3 “prazole” = ppp = proton pump inhibitors -​ Onset- 60min-days for full effects -​ MOA- blocks gastric secretion -​ Adverse effects- increase risk of c. diff, bacterial peritonitis, and long term use is associated with osteoporosis -​ Drug interactions- Omeprazole inhibits CYP2C19 Name of vitamins: C= B3= B9= B12= Talked abt drug interaction/adverse effect will prob be tested on Refer to OTC list What drugs do do anticholinergic effects (dry eyes/mouth, blurry vision, urinary retention, constipation) First and second class antihistamines!! -​ First gen = diphenhydramine, chlorphenamine, doxylamine “mine” = 1st gen -​ Second Gen= loratadine,cetirizine,levocetirizine,fexofenadine “mine” w/out the m=2nd gen Know all Tylenol/NSAIDS Refer to OTCs MOA and adverse/side effects of glaucoma drugs Refer to glaucoma sheet Know the CYPs!!!! CYP3A4/5/7 most common CYP2D6 CYP2C19 CYP2C9 CYP1A1/2 PS PORCS (inducers) -​ phenytoin -​ Smoking -​ Phenobarbital -​ Oxycarbazepine -​ rifampin/rifabutin/rifapentine -​ Carbamazepine -​ St. johns wort G PAC-MAN(inhibitors) -​ Grapefruit -​ Protease inhibitors -​ Azoles -​ Cyclosporine and cimetidine -​ Macrolides -​ Amiodarone and dronedarone -​ Non-dhp ccb’s(diltiazem and verapamil) Know everything abt drug phase trials Phase 1: -​ Purpose: safety -​ Subjects:healthy volunteers -​ Scope:20-80 subjects -​ Time:6-12 months Phase 2: -​ Purpose:Safety and efficacy(dose response) -​ Subjects:intended pop. -​ Scope:100-300 -​ Time:1-2 yrs Phase 3: -​ Purpose:safety and efficacy at specified dose and determining labeling -​ Subjects:wide range of intended pop. -​ Scope:100s-1000s  -​ time:2-3yrs ALBUMIN = measure of protein Bioavailability of drugs: % of drug that reaches systemic circulation from site of administration what are the major ISMPs 1.​ No trailing 0 after decimal- risk of mistaking dose amount 2.​ No “naked” decimal point -” “ 3.​ No using q.d or QD abbreviation- mistaken as “q.i.d” use daily instead 4.​ Using T3 as drug abbreviation- use complete drug name to prevent mistaking drugs KNOW ALL PEDIATRIC PEARLS SLIDE!!! -​ All reconstituted meds will expire in 10-14 days -​ Some reconstituted meds may require refrigeration -​ Clindamycin reconstitution needs flavoring -​ Cefdinir reconstitution will turn stool red even though liquid is not red -​ Treatment for acute uncomplicated otitis media: amoxicillin: 90mg/kg/day orally in 2 divided doses for 10 days 2 DOSING QUESTIONS SEVERAL QUESTIONS ON THIS— BACTERIA: Be able to know what antibiotic to treat depending on basic characteristics of lab data!!! KNOW WHICH ANTIBIOTIC ARE IV/P.O. ADVERSE REACTIONS OF ANTIBIOTICS refer to written notes WHICH ANTIBIOTICS COVER MRSA CA-MRSA? P. AERUGINOSA Treat beta lactam resistant bacteria (staph aureus, strep pneumoniae, pseudomonas aeruginosa, e.coli) Penicillins -​ Penicillin V:PO  -​ Penicillin G:IV -​ Methicillin,Nafcillin, Oxacillin, and Dicloxacillin: PO -​ Piperacillin and ticarcillin: IV -​ piperacillin/tazobactam and ticarcillin/clavulanate:IV -​ Ampicillin: IV/PO -​ amoxicillin:PO -​ ampicillin/sulbactam: IV -​ amoxicillin/clavulanate: PO Cephalosporins -​ 1st gen: cephazolin IV and cephalexin PO -​ 2nd gen A: cefuroxime PO/IV , cefprozil and cefaclor PO -​ 2nd gen B: cefoxitin and cefotetan IV -​ 3rd gen: cefdinir PO and ceftazidime P. AERUGINOSA -​ 4th gen: cefepime IV P. AERUGINOSA -​ 5th gen: ceftaroline MRSA Carbapenems all IV Monobactams IV -​ Aztreonam P. AERUGINOSA Aminoglycosides IV -​ Gentimicin -​ Tobramucin -​ Amikacin P. AERUGINOSA -​ Streptomycin Macrolides -​ Azithromycin IV/PO -​ Clarithromycin PO -​ Erythromycin IV/PO Fluoroquinolones all IV/PO -​ Ciprofloxacin P. AERUGINOSA -​ Cevofloxacin P. AERUGINOSA -​ Moxifloxacin Glycopeptides -​ Vancomycin IV/PO MRSA -​ Felavancin and daptomycin IV MRSA Oxazolidinone -​ Linezolid IV/PO MRSA Glycycline -​ Tigecycline IV MRSA Tetracyclines -​ Doxycycline and minocycline CA-MRSA IV/PO -​ Tetracycline PO Sulfonamides -​ trimethoprim/sulfamethoxazole IV/PO CA-MRSA Lincosamides -​ Clindamycin IV/PO CA-MRSA Nitroimidazoles -​ Metronidazole IV/PO Bacteria that each antibiotic treats: MOA SLIDE 49 MOA -​ Beta Lactams(penicillins, cephalosporins,carbapenems,monobactams): inhibits cell wall synthesis -​ Vancymycin and Bacitracin: inhibits cell wall synthesis -​ Polymyxins: inhibit cell membrane -​ Sulfonamides and trimethoprim: inhibits folate synthesis (nucleic acid synthesis) -​ Quinolones: inhibit DNA gyrase (nucleic acid synthesis) -​ Rifampin: inhibit RNA polymerase (nucleic acid synthesis) -​ Macrolides, clindamycin,linezolid,tetracyclines,aminoglycosides: inhibit protein synthesis CR ADJUSTMENTS Refer to written notes ANY BLACK BOX WARNINGS -​ Codeine: respiratory depression/addictive -​ Acetaminophen: hepatotoxicity CODEINE AND DEXTROMETH DRUG INTERACTIONS KNOW WHICH ONE IS PRODRUG!! Refer to OTC notes MAX DOSES FOR PRESCRIPTION STRENGTH - Kids and adults Acetaminophen(Tylenol) -​ adults : 4000 mg -​ Kids: safe for all ages 160mg/5ml suspension —dose depends on weight IBUPROFEN -​ Approved after 6 months old -​ Adults: 3200 mg -​ Kids: 1200 mg Just adults: NAPROXEN : 660 mg Any resistance mechanism—what is alternative usage? 4 mechanisms of how bacteria become resistant: 1.​ Antibiotic inactivation/modification Ex: beta-lactamase = immune to beta lactams 2.​ Alteration of target/binding site Ex: Methicillin-resistant Staph. aureus(MRSA) = immune to all penicillins 3.​ Bypassing metabolic inhibitions Ex: some bacteria can scavenge folic acid from elsewhere making them resistant to sulfonamides because the way sulfonamides kill bacteria is by disrupting folic acid production 4.​ Preventing antibiotic accumulation -​ Efflux pumps -​ Decrease permeability of membrane Read an sig code —EAR VS EYE!!! -​ A=ear -​ O=eye -​ D=right -​ S=left -​ U=both