What are the factors that can influence drug response?
Route, dosage, timing, presence of food, gender, race, weight, and diet
What is the primary site of drug metabolism?
Liver
When 2 drugs produce a greater effect than one alone it is called ?
An Additive interaction
When one drug increases the action of another drug it is called?
Synergistic interaction
What age group is more prone to toxocity due to poor nutrition and chronic illness?
The elderly
Cholinergic drugs replace acetylcholine in?
Skeletal muscle and smooth muscle
By replacing acetylcholine with Cholinergic drugs you increase what?
muscle tone and movement and or production of body fluids.
Anticholinergic do what to the body?
DRY it up!
Anticholinergic do the opposite of cholinergics drugs with similiar side effects?
Dry mouth, confusion, drug handover, and constipation
When benozdiazepines like ativan and klonapin, are given, monitor for what?
Sedation because they are given for anxiety, tremors, muscle spasms, tension, insomnia
Carbon monoxide poisoning
Respiration is deep and difficult, pinkness of skin in high doses, increased pulse, dizziness,muscle weakness, ringing in the ears, throbbing in the temples, headache, faintness, nausea, and dilated pupils.
Vancomycin is what kind of antibiotic?
aminoglycoside in which Peaks and Troughs are done for it.
Pavulon, Norcuron, Anectine, all require what?
Mwchanical ventilation
Tetracyclines are not given with what?
milk
Tetracyclines are not given to whom?
Cildren under 8 or pregnant women
Tetracyclines are
broad spectrum drugs and bacteriostatic antibiotics for gram Negative ANd gram Positive organisms!
Tetracyclines END in what?
CYCLINE!!!!
Cephalosporins have
Limited Anaerobic activity
1st Generation-G+
4th Generation G- Later the generation, more G- coverage
More resistant to beta lactamases than pcns
Cephalosporinss are
?lactam antibiotics, bactericidal, same mode of action as other beta-lactam antibiotics disrupting synthesis of the peptidoglycan layer of bacterial cell walls. First-generation active against Gram-positive , and successive generations have increased acti
Cephalosporins can be ?
Given to people with PCN allergy
Pregnancy Cat B
less affected by stomach acid
3-7% cross-sensitivity in pt. with PCN allergy
Cephalosporins generations?
- 1st gen: cephalexin
- 2nd gen: cefuroxime
- 3rd gen: ceftazdime
- 4th gen: cefepime
Later gen have increased resistance to B-lactamase, CNS penetration, more activity against G-, antipseudomonal
Early gen have better activity against G+
MECH: inhibit ce
Cephalosporin is an?
Antibiotic similar to penicillin and used o treat infections of the respiratory tract, ear, urinary tract, bones, and blood. Store in frig and take With FOOD!
Cephalosporin
Prototype drug: cefotaxime (Claforan)
Mechanism of action: to act with broad-spectrum activity against gram-negative organisms
Primary use: for serious infections of lower respiratory tract, central nervous system, genitourinary system, bones, blood, and
Cephalosporins SOME BeGiN with?
-cef; -cefp; -ceph
Cephalosporin has a
hypersensitivity, disulfiram-like reaction with ethanol, increased nephrotoxicity of aminoglycosides
Some Cephalosporins
Duracef, ancef, keflex, Made from fungi
Common side effects:
Diarrhea
N/V
Rash
Pain at site of IM
Phlebitis at IV site
Anaphylaxis
Hard on veins
Vancomycin can be?
Given IV for severe Staph infections
Monitor blood levels due to ototoxicity and nephrotoxicity
Antibiotic
Vancomycin used for
Gram Positive, MSRA, C- diff
Vancomycin's risk of ototox and nephrotox is increased by which drugs?
Aminoglycosides, amphotericin B, cisplatin and pentamidine. Monitor renal and hearing function tests.
Tylenol
Tx OA, up to 4 g taken regularly. (not-anti-inflammatory) S/e: hepatotoxicity monitor liver enzymes
myasthenia gravis causes
abnormal and rapid fatigue of the muscles, particularly in the face, because the body produces antibodies against its own ACh receptors located on muscle fibers
myasthenia gravis is a
My- muscle, asthenia - weakness, gravis - grave or serious. A neurological disease characterized by severe muscle weakness.
myasthenia gravis treatment
Cholinesterase inhibitors (prostigmine, pyridostigmine (Mestinon)), Thymectomy in severe cases, immunosuppressive drugs: Prednison, Cyclosporine, Azathioprine; Plasmapheresis (removes abnormal antibodies), high dose intravenous immune globulin
myasthenia gravis treatment
- 50% a/w thymic hyperplasia, 20% a/w thymic atrophy, 15% a/w thymoma
- Myasthenia crisis is rapidly progressing weakness esp. in respiratory muscles
- Treatment: acetyl cholinesterase inhibitors, corticosteroids, thymectomy, plasmapheresis
Macrolides that end in
Erythromycin, tylosin, Tilmicosin, Azithromycin, Clarithromycin
Macrolides side effects
Take on an empty stomach, Take with plenty of water, PROTOTYPE: erythromycin (Ery-Tab, Eryc) a class of older antibiotics that can be bactericidal or bacteriostatic USES: tx of URIs and urinary tract infections (UTIs), and are often used when pts are alle
Macrolides side effects
-Anorexia, N/V, diarrhea, tinnitis, abdominal cramps, rash, pruritis and photosensitivity
Oxazolidinones is a
NEW CLASS of antibacterial drugs that inhibit initiation of protein synthesis. Ex: LINEZOLID which is effective against MRSA, VRE.
Oxazolidinoness SE
severe diarrhea, bone marrow suppression, secondary infections, lactic acidosis, seizures, visual neuropathy
With Oxazolidinones avoid ?
Tyramine which is found in most cheeses, beer, yeast, wine, and chicken liver. Sometimes called the "cheese reaction
Linezolid side effects
GI-nausea, diarrhea, headache, Myelosuppression-anemia, leukopenia, thrombocytopenia
Linezolid side effects
- diarrhea, nausea, headache
- tongue discoloration, skin rash
- **** bone marrow toxicity with prolonged use
Fluoroquinolones
- ciprofloxacin
- levofloxacin
- moxifloxacin
Most modern quinolones have fluorine substitution (fluroquinolones) that gives them greater potency and expanded spectrum (better G+ coverage)
USE: majority of use is inappropriate; excellent against nosocomia
Fluoroquinolones end in ?
floxacin
Fluoroquinolones side effects floxacin
Headache, Nausea, Diarrhea, Elevated Bun, AST(SGOT), ALT (SGPT), Creatinine, Alkaline phosphatase, Descreased WBC and hematocrit, Rash, Photosensivity, Achille tendon rupture
Fluoroquinolones side effects floxacin
CNS: SEIZURES, dizziness, headache, insomnia, CV: ARRHYTHMIAS, GI: HEPATOTOXICITY (NORFLOXACIN), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.
With Fluoroquinolones you should increase what? floxacin
FLUIDs due to Crystaluria risk
Sulfonamides may cause
A/R: Stevens-Johnson Syndrome, crystalluria (crystals in urine). Thrombocytopenia, Aplastic Anemia, Leukopenia. Photosensitivity
MED: timethoprim (Bactrim, Septra), silver sulfadiazine (Silvadene - also used to treat burns)
Sulfonamides are given
S/I: must be given on empty stomach (1 hr before or 2 hrs after meals).
MED: timethoprim (Bactrim, Septra), silver sulfadiazine (Silvadene - also used to treat burns)
With Sulfonamides
These drugs are a bacteriostatic: inhibits growth of bacteria. But does not kill them
USE: Treat UTI's. INCREASE FLUIDS, MRSA, and skin infections
MEDS: timethoprim (Bactrim, Septra), silver sulfadiazine (Silvadene - also used to treat burns)
Some Lincosamides are
Lincomycin, clindamycin, pirlimycin
Lincosamides end in
mycin
Take Lincosamides
Food impairs the absorption of lincomycin. The patient should take nothing by mouth (except water) for 1 to 2 hours before and after taking lincomycin.
Lincosamides end in
MYCIN, Lincomycin
clindamycin
pirlimycin
Lincosamides are for the
inhibition of bacterial protein synthesis, gram + anaerobic, used for oral dental problems, deep wounds or skin infections EG: clindamycin, Lincomycin
Lincosamides are Very strong
Mechanisms of Action of Antibacterial Drugs:
Useful in treating infections from intestinal perforation, DM foot, gang green, gram positive
Azithromycin treats
Infection of the lower and Upper respiratory tract and skin
Azithromycin and Erythromycin are
Macrolide (50S). Inhibits protein synthesis by blocking translocation by peptidyltransferase (50s). Bacteriostatic.
Use: URI, pneumonia, STDs (clamydia/gon), gram(+) cocci, mycoplasma, Legionella
Tox: GI distress, rash
Azithromycin is the
second generation macrolide has an extended spectrum of activity and a long half-life
Azithromycin is a
MOA: Macrolide -> reversibly bind to 50S -> inhibits translocation -> bacteriostatic
ROA: oral -> decreased with food, excreted in urine, t1/2 = 2-4 days -> has increased tissue penetration
USE: good for G+ (respiratory and soft-tissue), alternative to pe
Acyclovir is a
Zovirax Antivirals Genital herpes, herpes zoster, chicken pox, Increase fluids due to Risk of crystalluria