Explain how you would use a metered-dose inhaler (MDI). - ANSWER-1.) Remove the cap and shake the inhaler.
2.) Breathe out all the way.
3.) Breathe in
... [Show More] and press down on the inhaler.
4.) Hold your breath for a count of 10.
5.) Slowly breathe out.
How long should you hold your breathe after breathing in from an inhaler? - ANSWER-10 seconds
What are spacers used for with inhalers? - ANSWER-patients who have difficulty using an inhaler and are at risk for adverse side effects; ensures that they are getting enough of the medication (especially in children)
Explain how to use a spacer. - ANSWER-1.) Remove cap and shake the puffer, then insert puffer into the spacer.
2.) Place lips around mouthpiece and press the puffer once.
3.) Breathe in and out normally though the mouth 4-6 times.
How many times should you breathe in through the spacer after a puff from the inhaler? - ANSWER-4-6 times
What age groups require nebulizers? - ANSWER-small children or for severe asthma episodes
What is the MOA of isoniazid? - ANSWER-inhibits mycolic acid synthesis
What is Isoniazid used to treat? - ANSWER-TB
How long should Isoniazid be used for when used alone in the treatment of TB? - ANSWER-daily x9 months
What adverse effects are associated with Isoniazid? - ANSWER-- hepatitis***
- peripheral neuropathy***
- lupus***
- rash
- metabolic acidosis***
What drug can cause metabolic acidosis? - ANSWER-Isoniazid
What medication can be administered with Isoniazid in order to prevent peripheral neuropathy? - ANSWER-Pyridoxine (vitamin B6)
What labs should you perform to monitor adverse effects from Isoniazid? - ANSWER-LFT, CBC
What drugs does Isoniazid interact with? - ANSWER-- alcohol
- phenytoin (anticonvulsant)
- disulfiram (alcohol, antabuse)
- carbamazepine
- anticoagulants
- ketoconazole
What is the MOA of Ethambutol? - ANSWER-Inhibits arabinosyl transferase
What TB drug is always given in combination with other antituberculosis drugs to reduce drug resistance? - ANSWER-Ethambutol
What adverse effects are associated with Ethambutol? - ANSWER-- gout***
- rash
- peripheral neuropathy***
- optic neuritis***
- scotoma (peripheral vision loss, green/red vision loss)
What drugs can cause gout? - ANSWER-Ethambutol & Pyrazinamide
What drug can cause optic neuritis and vision loss? - ANSWER-Ethambutol
What is scotoma? - ANSWER-a partial loss of vision or a blind spot in an otherwise normal visual field (peripheral vision loss)
Why do you need to adjust the dosing for Ethambutol? - ANSWER-can cause renal damage
What is the MOA of Pyrazinamide? - ANSWER-inhibits mycolic acid synthesis
What drug is used in combination with Isoniazid and Rifampin in the short-course (6 months) treatment of TB? - ANSWER-Pyrazinamide
What adverse effects are associated with Pyrazinamide? - ANSWER-- hepatitis***
- hyperuricemia ***
- gout***
- arthritis
- photosensitive dermatologic rash***
- N/V
- drug fever
- photosensitivity
What drug can cause a photosensitive dermatologic rash? - ANSWER-Pyrazinamide
What drug can cause hyperuricemia? - ANSWER-Pyrazinamide
What labs should you monitor with Pyrazinamide? - ANSWER-LFT, uric acid levels
Why does the dose of Pyrazinamide need to be adjusted? - ANSWER-can cause renal damage
Can you give Pyrazinamide with pregnancy? - ANSWER-Yes, after the 1st trimester
What is the MOA of Rifampin (Rifadin)? - ANSWER-inhibits RNA synthesis
What is Rifampin (Rifadin) used to treat? - ANSWER-TB
How long is Rifampin (Rifadin) typically used in the treatment of TB? - ANSWER-daily x4 months
What adverse effects are associated with Rifampin (Rifadin)? - ANSWER-- hepatitis***
- orange discoloration of secretions (tears, urine)***
- immunologic-mediated illness
- thrombocytopenia***
- GI upset
- hypersensitivity
- fever
What drug can cause thrombocytopenia? - ANSWER-Rifampin (Rifadin)
What drug can cause orange discoloration of secretions (tears, urine)? - ANSWER-Rifampin (Rifadin)
What DDI occur with Rifampin (Rifadin)? - ANSWER-Strong CYP450 inducer***
- increases clearance of methadone***, warfarin***, digoxin, ketoconazole, verapamil, phenytoin, OCPs, protease inhibitors***
What are the contraindications to using Rifampin (Rifadin) to treat TB? - ANSWER-Patients taking protease inhibitors, NNRTIs
What is the MOA of Streptomycin? - ANSWER-inhibits protein synthesis by binding to ribosome
What aminoglycoside can be used to treat TB? - ANSWER-Streptomycin
What adverse effects are associated with Streptomycin? - ANSWER-- nephrotoxicity***
- ototoxicity (CN8)***
- hypersensitivity
What TB drug is associated with nephrotoxicity and ototoxicity? - ANSWER-Streptomycin
What drugs does Streptomycin interact with? - ANSWER-- loop diuretics
- neuromuscular blockers (cisatracurium -- can prolong paralysis)
Why do you need to adjust the dose for Streptomycin? - ANSWER-can cause renal damage
What TB drugs do you need to adjust the dose to prevent renal damage? - ANSWER-Ethambutol
Pyrazinamide
Streptomycin
What TB drug can cause red-green blindness? - ANSWER-Ethambutol
What is the treatment for active TB? - ANSWER-RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) x 8 weeks + 2 drugs x 16 weeks
What baseline lab do you have to draw prior to starting TB treatment? - ANSWER-LFTs (hepatotoxicity)
What is the MOA of Respiratory fluoroquinolones? - ANSWER-inhibits cell wall synthesis
What are Respiratory fluoroquinolones active against? - ANSWER-atypical mycobacteria TB
What is the 2nd line treatment for TB? - ANSWER-Respiratory fluoroquinolones (Amikacin, Moxifloxacin, Ciprofloxacin)
What are some types of Respiratory fluoroquinolones? - ANSWER-Amikacin, Moxifloxacin***, Ciprofloxacin, Levofloxacin***
What adverse effects are associated with Respiratory fluoroquinolones? - ANSWER-- photosensitivity
- QT prolongation
What are some types of Beta-lactams? - ANSWER-Cephalosporins
PCNs
Monobactams
What is the MOA of beta lactams? - ANSWER-inhibit cell wall synthesis
What are Cephalosporins used to treat? - ANSWER-PNA, AOM, acute epiglottitis
What are contraindications to Cephalosporins? - ANSWER-Renal disease, hepatic impairment, bleeding disorder, pregnancy, PCN allergy
What adverse effects are associated with Cephalosporins? - ANSWER-- diarrhea***
- disulfiram reaction***
What are Penicillins used to treat? - ANSWER-- Sinusitis
- bacterial exacerbation of chronic bronchitis
What adverse effects are associated with Penicillins? - ANSWER-- diarrhea
- hematologic***
- nephrotoxicity***
- hypersensitivity
What Penicillin is associated with maculopapular rash in patients with infectious mononucleosis? - ANSWER-Ampicillin
What Penicillin has the highest occurrence of diarrhea? - ANSWER-Augmentin
What are Monobactams used to treat? - ANSWER-- CF complications
- bronchiectasis
What are contraindications to using Monobactams? - ANSWER-- renal dysfunction
- pregnancy
What adverse effects are associated with Monobactams? - ANSWER-- GI upset
- vertigo
- allergy
What is the MOA of Macrolides? - ANSWER-bind to the 50s ribosomal subunit, resulting in inhibition of RNA dependent protein synthesis
What is the 1st line treatment for outpatient/inpatient ICU CAP? - ANSWER-Macrolides
What is the DOC for pertussis? - ANSWER-Macrolides
What are some types of Macrolides? - ANSWER-erythromycin, azithromycin, clarithromycin
What are some contraindications to using Macrolides? - ANSWER-CYP450, pts. on Warfarin
What adverse effects are associated Macrolides? - ANSWER-- QT prolongation
- hepatotoxicity
- GI
What medications cause an increased incidence of muscle toxicity when used with Macrolides? - ANSWER-niacin or statins
What is the MOA of Tetracyclines? - ANSWER-bind to 30S and inhibit protein synthesis
What is the 1st line treatment for outpatient ATYPICAL CAP? - ANSWER-Doxycycline
What are Tetracyclines used to treat? - ANSWER-Atypical CAP, pleural effusion
What should you avoid using with Tetracyclines? - ANSWER-dairy
What adverse effects are associated with Tetracyclines? - ANSWER-- GI
- photosensitivity***
- dental stains***
What group of people con you NOT use Tetracyclines with? - ANSWER-children <8 y/o + pregnancy
What is the MOA of sulfa drugs? - ANSWER-inhibits synthesis of folic acid
What are sulfa drugs used to treat? - ANSWER-acute bacterial exacerbation of chronic bronchitis
What can happen if you use sulfa drugs in pregnancy patients or infants? - ANSWER-kernicterus (brain damage that can happen in newborns with jaundice)
What adverse effects are associated with sulfa drugs? - ANSWER-- GI upset
- hepatitis
- leukopenia
- thrombocytopenia
- SJS
- photosensitivity***
- hemolysis for G6PD deficiency***
What drug should you not give after the 2nd trimester due to risk of kernicterus and photosensitivity? - ANSWER-sulfa drugs
What drug is associated with hemolysis in patients with G6PD deficiency? - ANSWER-sulfa drugs
What is the MOA of Glycopeptides? - ANSWER-inhibits cell wall synthesis
What are Glycopeptides used to treat? - ANSWER-MRSA, Enterococcus/strep infections
What class of medication can you prescribe if a patient is allergic to B-lactams? - ANSWER-Glycopeptides
What is a contraindication to using Glycopeptides? - ANSWER-Administration w/ another ototoxic/nephrotoxic drug
What adverse effects are associated with Glycopeptides? - ANSWER-- Phlebosclerosis
- nephrotoxicity
- ototoxicity
What class of medications is associated with Phlebosclerosis, nephrotoxicity, and ototoxicity? - ANSWER-Glycopeptides
What do Aminoglycosides cover? - ANSWER-gram (-) anaerobes ONLY
What is the MOA of Aminoglycosides? - ANSWER-inhibit protein synthesis by binding to the 30S subunit
What are Aminoglycosides used to treat? - ANSWER-- nosocomial PNA
- TB
What is a contraindication it using Aminoglycosides? - ANSWER-impaired renal function
What adverse effects are associated with Aminoglycosides? - ANSWER-- ototoxicity***
- nephrotoxicity***
- hearing loss tinnitus
- vertigo
- ataxia
What is the MOA of Nitroimidazole? - ANSWER-Bio-reduction of nitro group which influences the rate of entry of drug into susceptible cell
What is Nitroimidazole used to treat? - ANSWER-Bacterial and parasitic infections
When can you NOT use Nitroimidazole to treat bacterial and parasitic infections? - ANSWER-1st trimester of pregnancy
What adverse effects are associated with Nitroimidazole? - ANSWER-- HA
- loss of appetite
- vomiting
- diarrhea
- heartburn
- cramps
- constipation
What drug interaction occurs with Nitroimidazole that accelerates drug elimination? - ANSWER-phenytoin and phenobarbital
What drug interaction occurs with Nitroimidazole that decreases drug elimination? - ANSWER-cimetidine
What adverse reaction can occur when you combine Nitroimidazole with Metronidazole? - ANSWER-lithium toxicity
What is the MOA of Oxazolidinone (Linezolid, Tedizolid)? - ANSWER-Binds to 50S subunit to inhibit protein synthesis, bacteriostatic
What bacteria does Oxazolidinone (Linezolid, Tedizolid) cover? - ANSWER-gram (+), TB, vancomycin-resistant infections
What adverse effects are associated with Oxazolidinone (Linezolid, Tedizolid)? - ANSWER-- GI
- N/V/D
- HA
- thrombocytopenia (most common)
- neutropenia
What is the off-label use for Oxazolidinone (Linezolid, Tedizolid)? - ANSWER-TB
What drug causes thrombocytopenia AND neutropenia as an adverse effect? - ANSWER-Oxazolidinone (Linezolid, Tedizolid)
What is the MOST COMMON adverse effect of Oxazolidinone (Linezolid, Tedizolid)? - ANSWER-thrombocytopenia
What is the MOA for Amantadine (Symmetrel) AND Rimantadine (Flumadine)? - ANSWER-Inhibits viral uncoating and release of viral nucleic acid by inhibiting M2 protein
What is Amantadine (Symmetrel) used to treat AND Rimantadine (Flumadine)? - ANSWER-Influenza A ONLY
How many days should you prescribe Amantadine (Symmetrel) AND Rimantadine (Flumadine)? - ANSWER-100 mg PO BID x3-7 days
What adverse effects are associated with Amantadine (Symmetrel) AND Rimantadine (Flumadine)? - ANSWER-- CNS effects
- N/V/D
- peripheral edema
- orthostatic hypotension
What influenza drug is associated with orthostatic hypotension? - ANSWER-Amantadine (Symmetrel) AND Rimantadine (Flumadine
What is the MOA of Zanamivir (Relenza)? - ANSWER-inhibits neuraminidase
What are the TOC for influenza A&B? - ANSWER-Zanamivir (Relenza) & Oseltamivir (Tamiflu)
What is Zanamivir (Relenza) used to treat? - ANSWER-influenza A&B
What is the MOA of Oseltamivir (Tamiflu)? - ANSWER-inhibits neuraminidase
What is Oseltamivir (Tamiflu) used to treat? - ANSWER-influenza A&B
When do you need to administer Zanamivir (Relenza) & Oseltamivir (Tamiflu) to have the greatest efficacy? - ANSWER-within 48 hours of symptom onset
What adverse effect is associated with Zanamivir (Relenza)? - ANSWER-bronchospasm cough
What influenza medication is NOT recommended for patients with asthma or COPD? - ANSWER-Zanamivir (Relenza)
What adverse effects are associated with Oseltamivir (Tamiflu)? - ANSWER-- CNS effects (anxiety, HA, insomnia***)
- GI (N/V)
What influenza medication is insomnia associated with? - ANSWER-Oseltamivir (Tamiflu)
What is the MOA of Peramivir (Rapivab)? - ANSWER-inhibits neuraminidase
What is Peramivir (Rapivab) used to treat? - ANSWER-influenza A&B
What influenza medication is the only one that is commercially available for IV use? - ANSWER-Peramivir (Rapivab)
When do you need to start treatment for Peramivir (Rapivab) to be most effective? - ANSWER-within 48 hours of symptom onset
What is the MOST COMMON adverse effect associated with Peramivir (Rapivab)? - ANSWER-diarrhea
What causes influenza epidemics? - ANSWER-viral antigenic drift
What cause influenza pandemics? - ANSWER-viral antigenic shift
What do fungal cells contain in their plasma membrane? - ANSWER-ergosterol
What is the MOA of Amphotericin B
(Fungizone)? - ANSWER-binds to ergosterol and acts on ionophores to cause leakage of potassium ions causing cell lysis
What is the gold standard for respiratory fungal infections? - ANSWER-Amphotericin B (Fungizone)
How is Amphotericin B (Fungizone) typically administered for fungal respiratory infections? - ANSWER-IV
What is Amphotericin B (Fungizone) effective against? - ANSWER-candidiasis, aspergillosis, cryptococcal meningitis
What antifungal medication is often used with systemic infections? - ANSWER-Amphotericin B
(Fungizone)
What adverse effects are associated with Amphotericin B
(Fungizone)***? - ANSWER-- nephrotoxicity
- hyperkalemia
- hypomagnesemia
- infusion rxns (fever, chills)
- thrombophlebitis
What should you do prior to giving Amphotericin B (Fungizone)? - ANSWER-pre-medicate due to the release of cytokines
What would you use premedicate with for the treatment of Amphotericin B (Fungizone)? - ANSWER-acetaminophen, diphenhydramine, hydrocortisone
How would you treat rigors associated with Amphotericin B (Fungizone) use? - ANSWER-meperidine
What labs should you monitor with Amphotericin B (Fungizone)? - ANSWER-renal function, potassium, magnesium
What is the MOA of Nystatin? - ANSWER-binds to ergosterol and acts on ionophores to cause leakage of potassium ions causing cell lysis
What is Nystatin used to treat? - ANSWER-candidal vulvovaginitis, oropharyngeal candidiasis
How is Nystatin administered? - ANSWER-topically
What antifungal medication is too toxic for systemic administration but is ok to use when administered orally? - ANSWER-Nystatin
What is the MOA of Ketoconazole? - ANSWER-Inhibits ergosterol synthesis
What is Ketoconazole used to treat? - ANSWER-candidiasis of skin, dandruff, Cushing's disease [Show Less]