Pharmacology Past Paper PDF (First Sem 2024-2025)

PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 “ANTIMICROBIALS” 3. Gram-negative - bacte...

PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 “ANTIMICROBIALS” 3. Gram-negative - bacteria not stained PRACTICE QUESTIONS - e.g., Neisseria meningitides, Escherichia coli, and Haemophilus influenzae) This microorganisms is also called mycosis, tinea, or candidiasis. a. Bacteria b. Virus c. Fungi d. Protozoan A patient is admitted to the health care facility with methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates administration of which drug? a. Nafcillin (Nallpen) GRAM-POSITIVE BACTERIA b. Aztreonam (Azactam) 1. Staphylococcus aureus c. Vancomycin (Vancocin) 2. Staphylococcus epidermidis d. Piperacillin-tazobactam (Zosynis) 3. Enterococcus avium 4. Staphylococcus simulans Patient is expected to receive antiviral drugs for 5. Streptococcus milleri 6. Staphylococcus aureus subspecies Influenza A and B? Which of the following drug is 7. Staphylococcus hominis sensitive to influenza A? 8. Enterococcus faecalis a. Oseltamivir b. Amantadine GRAM-NEGATIVE BACTERIA c. Acyclovir 1. Escherichia coli d. Daclatasvir 2. Enterobacter cloacae 3. Klebsiella pneumoniae 4. Pseudomonas aeruginosa DISEASE-PRODUCING ORGANISMS AND THEIR 5. Citrobacter koseri CHARACTERISTICS 6. Serratia marcescens 7. Morganella morganii 8. Baumann acinetobacter Bacteria- is composed of: 9. Klebsiella oxytoca 10. Bacillus 1. Prokaryotes ★ Bacilli: elongated, or rod-shaped ★ Cocci: spherical cocci appear in clusters, they are called VIRUSES “staphylococci”; when cocci are arranged in chains, they are called - a non-cellular, non-living infectious agent “streptococci”. consists of a nucleic acid (DNA or RNA) inside a protective coat (Capsid). - It reproduces within living cells and uses their DNA and RNA to generate more viruses. With the exception of HIV and some viral hepatitis, viruses are self-limiting that do not require antiviral. - Example of viruses are influenza A, B, & C, herpes viruses, hepatitis virus, and HIV. 2. Gram-positive - bacteria that retained a purple stain using a staining method - e.g., Staphylococcus aureus, Streptococcus pneumoniae, group B Streptococcus]) PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 Examples of parasitic worms are: ★ Cestodes (tapeworms) ★ Intestinal nematodes (roundworms) ★ Trematodes (flukes) ★ Tissue-invading nematodes (tissue roundworms and filarae ANTIBACTERIALS AND ANTIMICROBIALS “Antibiotic” - chemicals produced by one kind of microorganism that inhibit the growth of or kill another. FUNGI Antibacterial drugs do not act alone in destroying bacteria. - a multi-cellular eukaryotic organism that is heterotrophic that reproduces by both sexually Natural body defenses, surgical procedures to excise infected tissues, and dressing changes may be needed along and asexually & disperses by spores. with antibacterial drugs to eliminate the infecting bacteria.) Examples of fungi are: ★ Aspergillosis The Goal of anti-infective drugs is to reduce the ★ Moniliasis population of the invading organism until the body's ★ Histoplasmosis immune response can take over. ★ Mucormycosis If organism is too aggressive, it can be toxic to the host cell. If the immune system is weak, the body cannot deal PROTOZOAN effectively with the invading organism Mechanisms of antibacterial action - are free-living single-celled 1. Inhibition of bacterial cell-wall synthesis eukaryotes that could 2. Alteration of membrane permeability reproduce by both 3. Inhibition of protein synthesis sexually and asexually. It 4. Inhibition of the synthesis of bacterial could be aerobic or ribonucleic acid (RNA) and deoxyribonucleic anaerobic species that lives acid (DNA) mostly in moist areas. 5. Interference with metabolism within the cell Example of protozoan: PHARMACOKINETICS OF ANTIBACTERIAL DRUGS ★ Plasmodium falciparum ★ Plasmodium vivax ★ Plasmodium malariae Antibacterial drugs must not only penetrate the ★ Plasmodium ovale. bacterial cell wall in sufficient concentrations but also have an affinity for the binding sites on the bacterial cell. HELMINTHS The length of time the drug remains at the binding sites increases the effect of the antibacterial action. - are large parasitic worms that live and lay eggs in warm, moist soil where sanitation and hygiene are poor. PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 If the host's natural body defense mechanisms are inadequate, drug therapy might not be as effective. RESISTANCE TO ANTIBACTERIAL Sensitive to certain bacterial- bacteria are sensitive to a drug, the pathogen is inhibited or destroyed making the drug appropriate to the identified organisms. Antibacterial that has a longer half-life usually maintain a greater concentration at the binding site; therefore frequent dosing is not required. Most antibacterials are not highly protein bound, with a few exceptions (e.g., oxacillin, ceftriaxone, cefprozil, cloxacillin, nafcillin, clindamycin) Antibacterial drugs are used to achieve the minimum effective concentration (MEC) necessary to halt the growth of a microorganism Many antibacterials have a bactericidal effect (kill bacteria) against the pathogen when the drug concentration remains constantly above the MEC during the dosing interval. Others have a bacteriostatic effect (stop from reproducing). Bactericidal effect- kills bacteria Bacteriostatic effect- stop from reproducing Duration of use of the antibacterial varies according to the type of pathogen, site of infection, and immunocompetence of the host. Once-daily antibacterial dosing- such as with If bacteria are resistant, the pathogen continues to grow aminoglycosides, macrolides, and fluoroquinolones- despite administration of that antibacterial drug. has been effective in eradicating pathogens and has not caused severe adverse reactions (ototoxicity, nephrotoxicity) in most cases. “Natural resistance” - occurs without previous exposure to antibacterial drug. BODY DEFENSES “Acquired resistance” - caused by prior exposure to antibacterial. The effect that antibacterial drugs have on an infection depends not only on the drug but also on the host's defense mechanisms. Factors such as age, nutrition, immunoglobulins, white blood cells (WBCs), organ function, and circulation influence the body's ability to fight infection PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 PREVENTING RESISTANCE 1. Limit the use of antiinfectives 2. Take recommended dosage 3. Prescribers must avoid giving a more powerful drug first (5th generation drugs) APPROACHES TO TREATMENT OF SYSTEMIC INFECTIONS Identify the pathogen by “Culture and sensitivity (C&S) test” - this test will detect the infective microorganism “Healthcare-acquired infections” present in a sample (e.g., blood, wound, sputum, - infection acquired while patient is hospitalized. swab) and identify the best drug to kill it. - Many are due to drug-resistant bacteria. After Culture & Sensitivity test, If the identified bacteria are sensitive, the drug could be given. Healthcare-acquired infections- are also called “nosocomial infections”. It will either kill or stop the growth organisms. However, If resistant, the pathogen continues to grow “Cross-resistance” despite administration of that antibacterial drug. - can occur between antibacterial drugs that Thus the drug should be stop and prescribed the have similar actions. appropriate antibiotic where the pathogen is sensitive. Nursing Consideration: The nurse should ensure that a culture and sensitivity test was performed to the infected area before initiating antibiotics and may begin drug therapy before culture results are received. USE OF ANTIBIOTIC COMBINATIONS Antibiotic combinations should not be routinely prescribed or administered except for specific uncontrollable infections. “Antibiotic misuse” - increases antibiotic resistance resulting to Single antibiotic will successfully treat a bacterial antibiotic resistance. infection; however, when severe infection persists and is of an unknown origin or has been unsuccessfully treated with several single Highly resistant bacteria, so-called methicillin-resistant S. antibiotics, a combination of two or three antibiotics may be suggested. aureus (MRSA), became resistant not only to methicillin but to all penicillins and cephalosporins as well. The treatment of choice for MRSA is vancomycin. METHOD OF DEVELOPING AND PREVENTING RESISTANCE DEVELOPING RESISTANCE 1. Enzyme deactivates drug 2. Cellular permeability 3. Altering binding sites which do not accept the drug 4. Chemicals are produced acting as antagonis PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 - Superinfections can occur in the mouth, respiratory tract, intestine, genitourinary tract, and skin. ORGAN TOXICITY - the liver and kidneys are involved in drug metabolism and excretion, and antibacterials may result in damage to these organs. - Example, aminoglycosides can be nephrotoxic and ototoxic. CLASSIFICATIONS OF ANTIBIOTIC WITH EXAMPLE AND INDICATION EFFECTS OF ANTIBIOTIC COMBINATIONS Additictive- effect is doubled. Potentiative- one potentiates effect of other. Antagonistic- if one bactericidal and one bacteriostatic, desired effect is diminished. SPECTRUM 1. Narrow spectrum- acts only as a specific MO. 2. Broad spectrum- acts on many different MO. GENERAL ADVERSE REACTIONS OF ANTIBACTERIAL DRUGS ALLERGY OR HYPERSENSITIVITY - could be mild (rash, pruritus, and hives), treated with an antihistamine or severe (anaphylactic shock, which results in vascular collapse, laryngeal edema, bronchospasm, and cardiac arrest) which requires treatment with epinephrine, bronchodilators. - Shortness of breath is the first symptom which usually occurs within 20 minutes. SUPERINFECTION - is a secondary infection that occurs when the normal microbial flora of the body are disturbed during antibiotic therapy. PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 GENERATIONS OF CEPHALOSPORINS Common Side effects and adverse effects ANTIVIRAL Cephalosporins - Pruritus - GI distress “Antiviral Drugs” - are used to prevent or delay the spread of viral With high doses infections. - Increased bleeding, seizures - They inhibit viral replication by interfering with - Nephrotoxicity viral nucleic acid synthesis in the cell. - Some groups of antiviral drugs are effective against various viruses, such as influenzas A and B, herpesviruses, HBV and HCV, and HIV. DRUG INTERACTIONS With the exception of HIV and some viral hepatitis, viruses are self-limiting that do not Alcohol: may cause flushing, dizziness, headache, require antiviral. nausea, vomiting, and muscular cramps. Uricosurics: decrease cephalosporin excretion. PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 TYPE OF VIRUSES ANTI-VIRAL DRUGS PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 Other opportunistic infections are: ★ Aspergillosis SIDE EFFECTS AND ADVERSE REACTIONS ★ Mucormycosis ★ Pneumocystis pneumonia Dizziness, headache, insomnia, vertigo, fatigue, and GI ★ Fusariosis disturbances such as nausea, vomiting, and diarrhea. Primary Nurses must be aware of the FDA advisory that persons - occur in immunocompetent persons and receiving oral oseltamivir should be monitored closely result from inhaled spores. for abnormal behavior. Primary infections include: Incidence of self-injury and delirium has been reported ★ Coccidioidomycosis in post marketing surveillance. ★ Blastomycosis ★ Paracoccidioidomycosis ★ Cryptococcosis ★ Histoplasmosis ★ Including progressive disseminated ANTIFUNGAL histoplasmosis Antifungal drugs/Antimycotic drugs “Antimycotic drugs” 1. Polyenes (amphotericin B, nystatin) - are used to treat fungal infections. 2. Azoles (fluconazole) 3. Antimetabolites (flucytosine) Typically, antifungals are fungistatic or fungicidal 4. Echinocandins (caspofungin) depending upon the susceptibility of the fungus and 5. Miscellaneous antifungals (griseofulvin) the dosage. “Antifungal drugs” - are used to treat fungal infections (mycosis) such as the superficial infections (mucous membranes, hair, nails, and moist skin areas, oral candidiasis or thrush, and vaginal candidiasis); and systemic infections (lungs, CNS, abdomen). CLASSIFICATION OF FUNGAL INFECTIONS Local - Local fungal infections can be acquired by contact with an infected person. “Dermatophytes” - can cause local fungal infections involving the integumentary system, which includes mucous membranes, hair, nails, and moist skin areas. Fungal infections can be acquired by contact with an infected person “Candida albicans” - affects the mouth, it is called oral candidiasis or thrush. Opportunistic. - Opportunistic infections usually occur in the immunocompromised or debilitated population (e.g., patients who have cancer or AIDS) or in those taking antibiotics, corticosteroids, chemotherapy, or other immunosuppressives. PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 Adverse Effect 1. CNS Effects: headache, dizziness, fever, ANTIPROTOZOAL shaking, chills & malaise 2. GI effects: nausea, vomiting, dyspepsia, anorexia - used to treat Malaria. 3. Hepatic dysfunction 4. Derma effects: rash, pruritus “Malaria” 5. Renal dysfunctions - A life-threatening disease caused by multiple species of protozoan parasites of Genus NURSING CARE MANAGEMENT FOR PATIENT TAKING Plasmodium. ANTIFUNGAL - Malaria is caused by multiple species of protozoan parasites of the genus Plasmodium that are carried by infected Anopheles mosquitoes, and it remains one of the most prevalent protozoan diseases. PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 ANTIMALARIAL - Interrupts plasmodial reproduction of protein synthesis in RBC of the life cycle and in the hepatic and gametocyte stages ★ Amoebiasis ★ Leishmaniasis ★ Trypanosomiasis ★ Trichomoniasis ★ Giardasis ★ P.carinii pneumonia ★ Entamoeba histolytica PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 ANTI PROTOZOAL DRUGS Adverse Effect 1. CNS effects: headache, dizziness, ataxia, loss of coordination, peripheral neuropathy 2. GI effects: nausea, vomiting, diarrhea, unpleasant taste, cramps and changes in liver function 3. Superinfections (disrupted normal flora) PHARMACOLOGY NCM106 | Nunag H. | Lindo A. | Prof. Gutierrez P. FIRST SEM | S.Y 2024-2025 ANTHELMINTIC ANTHELMINTICS - Helminths are large parasitic worms that live and lay eggs in warm, moist soil where sanitation and hygiene are poor. - Transmission occurs from infected soil to the person, whereupon the helminth then feeds on host tissue. - It enter to the human hosts via contaminated food, bites of carrier insects, or direct penetration to skin. Most common site for helminthiasis (worm infection) is the intestine. 4 MAJOR GROUPS OF PARASITIC WORMS 1. Cestodes (tapeworms) - enter to the intestine via contaminated food (pork, beef, fish, and dwarf) - Taenia solium (pork tapeworm), T. saginata (beef tapeworm), Diphyllobothrium latum (fish tapeworm), and Hymenolepis nana (dwarf tapeworm). 2. Trematodes (flukes) - feed on the host. - Fasciola hepatica (liver fluke), Fasciolopsis buski (intestinal fluke), Paragonimus westermani (lung fluke), and Schistosoma species (blood flukes) 3. Intestinal nematodes (roundworms) - may feed on intestinal tissue - Ascaris lumbricoides (giant roundworm), Necator americanus (hookworm), Enterobius vermicularis (pinworm), Strongyloides stercoralis (threadworm), and Trichuris trichiura (whipworm). 4. Tissue-invading nematodes (tissue roundworms and filarae) - Trichinella spiralis (pork roundworm) and Wuchereria bancrofti (filariae)