Lungs Flashcards

Question

Spectrum voriconazole

Answer 1

Similar to itraconazole Candida spp( including fluconazole-resistant species such as candida krusei) and the dimorphic fungi Treatment of choice for invasive aspergillosis and some environmental molds Enhanced activity against aspergillus spp. Versus other azoles.

Answer 2

Available only as a liquid oral preparation

Answer 3

Broadest spectrum member of azoles Activity against most species of candida and aspergillus Only azole with significant activity against the agents of mucormycosis

Answer 4

Salvage therapy in invasive aspergillosis Prophylaxis of fungal infections during induction chemotherapy for leukemia Allogeneic bone marrow transplant patients with graft versus host disease

Answer 5

These are large cyclic peptides linked to a long chain FA

Answer 6

Inhibit glucan synthase

Answer 7

Candida Aspergillus Not C neoformans or the agents of zygoma oasis and mucormycosis

Answer 8

Disseminated and mucocutaneous candida infections Empiric antifungal therapy during febrile neutropenia -replaced amphotericin B for this indication

Answer 9

Point mutations in glucan synthase

Answer 10

Well tolerated!

Answer 11

Invasive aspergillosis Only as a salvage therapy in patients that don’t respond to amphotericin B Not primary treatment

Answer 12

9-11 hours

Answer 13

Mucocutaneous candidiasis Candidemia Prophylaxis of candida infections in bone marrow transplant patients

Answer 14

11-15 hours

Answer 15

Esophageal candidiasis and invasive candidiasis , including candidemia

Answer 16

24-48 horus

Answer 17

Amphotericin B Flucytosine Azoles -ketoconazole, itraconazole, voriconazole, posaconazole Echinocandins -caspofungin, micafungin, anidulafungin

Answer 18

Virus binds to host cell and integrates into host genome Gene transcription of viral proteins, cleavage, and maturation produces new visions

Answer 19

Resistance quickly develops, espicially with monotherapy HAART-highly active antiretroviral therapy CD4 T celll counts, viral load assays, and the patients clinical status must be monitored to assess effectiveness of chosen antiretroviral regimen

Answer 20

To decrease the circulating viral load

Answer 21

HIV-1 (focus on these notes) Effectiveness to HIV2 varies

Answer 22

Used in combination with other agents NNRTIs, PIs, or integrate inhibitos

Answer 23

Competitive inhibition of HIV1 reverse transcriptase

Answer 24

Point mutations in HIV1 reverse transcriptase

Answer 25

Mitochondrial toxicity

Answer 26

Guanosine analog

Answer 27

Hypersensitivity (8%) first 6 weeks therapy - fever, fatigue, nausea, vomiting, diarrhea, and abdominal pain - respiratory symptoms-dyspnea, pharyngitis, cough - skin rash - do not reintroduce abacavir if hypersensitivity is observed. Reintroduce could result in severe outcomes including death

Answer 28

Synthetic analog of deoxyadenosine

Answer 29

Dose dependent pancreatitis - conditions or drugs that may cause pancreatitis are contraindicated - alcohol abuse, hyperTG Retinal changes and optic neutiris - adults with high doses and children - mandate periodic retinal examinations

Answer 30

Fluoridated analog of lamivudine

Answer 31

HA, diarrhea, nausea, and rash | -hyperpigmentation of the palms or soles may be observed particularly in african Americans (13%

Answer 32

HBV, s discontinuation could exacerbate HBV

Answer 33

Cytosine analog

Answer 34

Uncommon, hypersensitivity rate

Answer 35

HBV so discontinuation could exacerbate HBV symptoms in a patient infected with both

Answer 36

Thymidine analog

Answer 37

MAJOR-dose related peripheral sensory neuropathy | -increased by concomitant neurotoxic drug use or in patients with advanced immunosuppression

Answer 38

An acyclic nucleoside phosphonate (nucleotide) analog of adenosine

Answer 39

Water soluble prodrug of active tenofovir | Recommended for use during preg

Answer 40

GI complaints | -nausea, diarrhea, vomiting, flatulence

Answer 41

A phosphonoamidate prodrug of tenofovir Less renal toxicity than tenofovir dinoprostone fumurate

Answer 42

Uncommon | May include GI symptoms or HA

Answer 43

HBX, discontinuation may exacerbated

Answer 44

Deoxythymidine analog | Safe in preg

Answer 45

Microcytic anemia 1-4% Neutropenia (2-8%) GI intolerance, HA, insomnia may occur -tend to resolve during therapy

Answer 46

Bind directly to HIV1 reverse transcriptase resulting in allosteric inhibiton of RNA and DNA dependent DNA polymerase activity

Answer 47

Delaviridine, efacirenz, nevirapine

Answer 48

Etravirine, rilpivirine

Answer 49

Baseline genotypes testing is recommended to screen for resistant HIV1 reverse transcriptase mutants (point mutations that alert NNRTI binding )

Answer 50

GI intolerance Skin rash

Answer 51

Cyp450—many drug drug interaction

Answer 52

Skin rash in 38% Avoid in preg CYP3A4 and 2D6

Answer 53

Combined with tenofovir and emtricitabine in the conformation atrial as a once a day combination pill

Answer 54

3a4 and 2B6

Answer 55

Main involve CNS 5-% -dizzy, drowsy, insomnia, nightmares, HA These dimish with continued therapy Increase with alcohol and psychoactice drug use Psychiatric symptoms may necessitate discontinuation -depression, mania, psychosis Skin rash 28% Nauseas, vomiting, diarrhea, crystalluria, elevated liver enzymes, increases in total serum cholesterol by 10-20%

Answer 56

Can be used in pregnancy but only after the first 8 weeks due to birth defects observed ina. Primate study

Answer 57

A diarylpyrimidine

Answer 58

Most common-rash, nausea, diarrhea Substrate as well as an inducer of CYP3a4 and an inhibitor of 2C9 and 2C19

Answer 59

A single dose administered at the onset of labor followed by another dose to the neonate within 3 days of delivery is effective at preventing transmission of HIV from mother to newborn

Answer 60

Rash 2-% - maculopapular eruption that spares palms and soles - occurs in the first 4-6 weeks of therapy - can be a dose limiting toxicity Liver toxicity 4% -more frequent with higher CD4 cell count, in women, and in those with HBV and HCV co infection

Answer 61

Co formulated with emtricitabine and tenofovir into a singe once daily tablet to increase compliance A diarylpyramidine (like etravirine) Can use in preg

Answer 62

Most common-rash, depression, HA, insomnia, increased serum aminotransferase

Answer 63

Block the HIV protease and prevent the maturation of the final structural proteins that make up the mature vision core

Answer 64

IG intolerance (may be dos limiting) Lipodystrophy -metabolism-hyperglycemia, hyperlipidemia Morphological-lipoatrophy, fat depression Redistribution and accumulation of body fat -central obesity, dorsocervical fat enlargement (buffalo hump), peripheral and facial wasting, breast enlargement , a cushingoid appearance

Answer 65

CYP3A4 | -ritonavir has the most pronounced inhibitory effect and saquinavir the least

Answer 66

``` Atazanavir Darunavir Fosamprenavir Indinavir Lopinavir Nelfinavir Ritonavir Saquinavir Tipranavir ```

Answer 67

Boosted atazanavir is a recommended PI agent for use in pregnant women

Answer 68

Most common-diarrhea, nausea Skin rash in 20% Indirect hyperbilirubinemia with overt jaundice (10%)

Answer 69

Must be co administered with ritonavir or cobicistat Boosted darunavir is a recommended PI agent for use in pregnant women

Answer 70

Rash 2-7% -occasionally severe Darunavir contains a ulfonamide moiety -may cause a hypersensitivity reaction in a patient with a sulfa allergy

Answer 71

Prodrug of amprenavir, rapidly hydrolyzed by enxymes in the intestinal epithelium

Answer 72

Most common-HA, nausea, diarrhea, perior Ali paresthesia, depression Contains a sulfonamide moiety -may cause a hypersensitivity reaction in a patient with a sulfa allergy Rash in 19%

Answer 73

Most common-unconjugated hyperbilirubinemia and nephrolithiasis due to urinary crystallization of the drug - nephrolithiasis can occur days after initiating therapy - incidence 10% Consumption of 48 ounces of water a day is important to prevent kidney stones

Answer 74

Allows for twice daily dosing (as opposed to 3 times a day) but this increases the chance for kidney stones so a higher fluid intake is required (1.5-2L)

Answer 75

Available only in combination with low dose as a booster Preferred treatment for pregnant women

Answer 76

Generally well tolerated

Answer 77

Diarrhea and flatulence | -diarrhea may be dose limiting

Answer 78

No longer used as a sole PI agent due to its high rate of GU side effects at standard dose -a lower dose used for inhibiton of CYP3A4 Very potent inhibitor of P450 system -used primarily as a booster

Answer 79

Used primarily as a booster Prodrug

Answer 80

Minimal amount of the drug absorbed when taken orally

Answer 81

GI discomfort -nausea, diarrhea, abdominal discomfort, dyspepsia When boosted with ritonavir, less dyslipidemia, of GI toxicity than with other boosted regimens Hypersensitivity (rare)

Answer 82

Indicated for use in treatment -experienced patients who harbor strains resistant to other PI agents Used in combination with ritonavir Contains sulfonamide moiety and should not be Syed in a patient with a sulfa allergy

Answer 83

Most common-diarrhea, nausea, vomiting, ab pain Urticaria or maculopapular rash 10-14% Hypersensitivity rate

Answer 84

Viral attachment to host cell Viral envelope glycoproteins complex gp160 (gp120+gp41) binds to its cellular receptor CD4 This binding changes the structure of gp120 which enables access to the chemokine receptors CCr5 or CxR4 Biding to chemokine receptors again leads to structural changes and exposes gp41 Gp41 leads to the fusion of the viral envelope with the host cell membrane and entry of the viral core into the host cell

Answer 85

Enfuvitride

Answer 86

Synthetic 36 aa peptide

Answer 87

Binds to gp41 preventing the conformational and structural changes needed to allow fusion of the viral envelope with the host cell membrane

Answer 88

Must be administered with subcutaneous injection (2 x a day)

Answer 89

Mutations in gp41

Answer 90

Local injection site reactions

Answer 91

Not really

Answer 92

Viral attachment to host cell Viral envelope glycoproteins complex gp160 (gp120+gp41) binds to its cellular receptor CD4 This binding changes the structure of gp120 which enables access to the chemokine receptors CCR5 or CXCR4 Binding to chemokine receptors again leads to structural changes and exposes gp41 Gp41 leads to fusion of the viral envelope with the host cell membrane and entry of the viral core into the host cell

Answer 93

Binds specifically and selectively to CCR5 to prevent viral entry into the host cell

Answer 94

Oral administration

Answer 95

Mutations in V3 loop of gp120

Answer 96

Generally well tolerated Systemic allergic reaction followed by hepatotoxicity has been reported -discontinue maraviroc if this occurs

Answer 97

Inhibit strand transfer and prevent integration of reverse transcribed HIV DNA into the chromosomes of the host cell

Answer 98

Well tolerated HA and GI effects most common

Answer 99

Preferred agent for treatment of treatment naive patients when combined: Tenofovir/emtricitabine Abacavir/lamivudine

Answer 100

Infrequent Hypersensitivity (rash and systemic symptoms have been reported -dolutegravir should be discontinued

Answer 101

Approved in 2012 only available as part of a combination pill -s tri il4 (elvitegravir, cobicistat, emtricitabine, and tenofovir) Requires boosting to be efficacious -combined with cobicistat -inhibits CYP3A4 AE few

Answer 102

Pyrimidinone analog A preferred option for treatment naive persons beginning HAART Recommended for use during pregnancy

Answer 103

Neuramindiase inhibitor Interferes with release of progeny influenza A and B virus from infected host cells, thus halting the spread of infection within the respiratory tract. They competitively and reversible interact with the active enzyme site to inhibit viral neuraminidase activity at low nanomolar concentrations, resulting in clumping of newly released influenza virions to each other and to the membrane of the infected cell. Early administration is crucial bc replication of influenza peaks 24-72 hours after the onset of illness. Initiation of a 5 day course within 48 hours after the onset of illness modestly decreaseses the duration of TMP TOMS, as well as duration of viral shedding and viral titer. Once day prophylaxis is effective in preventing disease exposure Oral prodrug that is activated by hepatic esterases and widely distributed through body. Oral available 80%, plasma protein binding is low and concentrations in the middle ear and sinus fluid are similar to plasma. HL 6-10 hours Excretion by kidney Oseltamivir is active metabolite snow serum concentrations increase with declining renal function

Answer 104

H1N1, H3N2, influenzae B Influenza a and b

Answer 105

May embrace and be transmissible >98% of H1N1 and H3N2 strains as well as 100% flu B retained susceptibility to both

Answer 106

N/V, HA (take with food) Fatigue, diarrhea (more common prophylactic use) Rash rare Neuropsychiatric events (self injury and delirium), particularly in Japanese adolescent

Answer 107

Analog of sailing acid, interfere with release of progeny of influenza A and B virus from infected host cells, thus halting the spread of infection within the respiratory tract. These agents competitively and reversible interact with the active enzyme site to inhibit viral neuraminidase activity at low nanomolar concentrations, resulting in clumping of newly released influenza virions to each other and to the membrane of the infected cell. Early administration is crucial bc replication of influenza virus peaks at 24 -72 hours after the onset of illness. Initiation of a 5 day course of therapy within 48 hours after the onset of illness modestly decreases the duration of symptoms, as well as duration of viral shedding and viral titer; some studies have also shown a decrease in the incidence of complications. Once daily prophylaxis is 70-90% effective in preventing disease after exposure

Answer 108

Influenza a and b

Answer 109

May emerge and be transmissible >98% of H1N1 and H3N2 strains as well as 100% if influenza B virus tested in 2015 retained susceptibility

Answer 110

Administered directly to the respiratory tract via inhalation. Of the active compound 10-20% reaches the lungs; the remainer is deposited in the oropharyngeal. The concentration of the drug in the respiratory tract is estimated to be more than 1000 times the 50% inhibitory concentration for neuraminidase, and the pulmonary half life is 2.8 hours. Of the total dose, 5015% is absorbed and excreted int he urine with minimal metabolis,.

Answer 111

Cough, bronchospasm (occasionally severe), reversible decrease in pulmonary function, and transient nasal and throat discomfort. NOT recommended if have underlying airway disease

Answer 112

Neuraminidase inhibitor, a cyclopentane analog,

Answer 113

Influenza. A and b

Answer 114

Treat within 48 hours Less than 30% is protein bound. Is not significantly metabolized and major route of elimination is kidney. Dose adjustment is required for renal insuffiency. The elimination HL following IV is 20 hours

Answer 115

Serious skin or kypersensitivity reaction (Stevens johnson , erythema multiforme) have been rarely reported Hallucinations, delirium, abnormal behavior in patients with influenza receiving it

Answer 116

Tricyclic amines of the adamantane family that block the M2 proton ion channel of the virus particle and inhibit uncoating of the viral RNA within infected host cells, thus preventing its replication. 4-10 times less active than rimantadine. Well absorbed and 67% bound to protein, HL 12-18 hours. Excreted unchanged in urine Dose reductions are required in elderly and in patients with renal insuffiency

Answer 117

Influenza a 70-90% protective in prevention when initiated before exposure and limit duration of clinical illness by 1-2 days

Answer 118

Amantadine AE

Answer 119

High to H1N1 and H3N2, not recommended anymore for prevention

Answer 120

Teratogenic and embryotoxic GI -nausea, anorexia CNS-nervousness, difficulty in concentrations,, insomnia, light headed Serious-behavioral changes, delirium, hallucinations, agitation, seizuresmay be due to alteration of dopamine neurotransmisssion )less frequent with R than A and associated with renal insuffiency, seizure disorders, LOF age and may increase with concomitant antihistamines, anticholinergics, hydrochlorothiazide and TMPSMX

Answer 121

Tricyclic amines of the adamantane family that block the M2 proton ion channel of the virus particle and inhibit uncoating of the viral RNA within infected host cells, thus preventing its replication 4-10 times more active than amantadine. 40% bound to protein HL 24-4 hours Nasal mucus concentrations average 50% higher than those in plasma, and CSF levels are 52-96% of those in serum. Extensive metabolism by hydroxylation, conjugation, and glucuronidation before urinary excretion Dose reduction in elderly or renal insuffiency of with severe hepatic insuffiency

Answer 122

Influenza a 70-90% protective in prevention when initiated before exposure and limit duration of clinical illness by 1-2

Answer 123

High to H1N1 and H3N2, not recommended anymore for prevention

Answer 124

Teratogenic and embryogenic GI -nausea, anorexia CNS-nervousness, difficulty in concentrations,, insomnia, light headed Serious-behavioral changes, delirium, hallucinations, agitation, seizuresmay be due to alteration of dopamine neurotransmisssion )less frequent with R than A and associated with renal insuffiency, seizure disorders, LOF age and may increase with concomitant antihistamines, anticholinergics, hydrochlorothiazide and TMPSMX.

Answer 125

First line-isoniazid, rifampin, pyrazinamide, and ethambutol Isoniazid and rifampin most active Isoniazid-rifampin combo given for 9 months will cure 95-98% of Tb but a intensive phase of treatment is needed for first two months due to prevelance of resistance. Do this by adding pyrazinamide during intensive phase and puts treatment at 6 months will no less efficacy. Usually use four drug regimen in practice-isoniazid, rifampin, pyrazinamide, and ethambutol until susceptibility is determined. If susceptible continue isoniazid and rifampin for four moths. Neighbor ethambuto nor other streptomycin add substantially to overall activity of the regimen but the fourth drug provides additional coverage if the isolate proves to be resistant to isoniazid, rifampin or both. If therapy starts after it is known that strain is susceptible to isoniazid and rifampin, ethambutolol does not need to be added. 10% isoniazid resistance. Resistance to both isoniazid and rifampin 1% Multi drug resistance is more preventlant in other parts of the world. Resistance to rifampin alone is rare

Answer 126

Most active drug for treatment of Tb caused by susceptible strains. Small molecule that is freely soluble in water. Penetrates into macrophages and is active against extracellular and intracellular organisms Inhibits synthesis of mycotic acids, which are essential components of mycobacteria cel walls. Prodrug that is activated by KatG, the mycobacteria catalase peroxidase. The activated form forms a covalent complex with an axel carrier protein (AcpM) and KasA, a beta ketoacidosis carrier protein synthetase, which blocks mycotic acid synthesis.

Answer 127

Associated with mutations resulting in overexpression on inhA, which encodes an NADH dependent acyl carrier protein reductase, mutation or deletion of the KatG gene; promoter mutations resulting in overexpression of ahpC, a gene involved in protection fo the cell from oxidative stress and mutations in kasA. Overproducers of inhA express low level isoniazid resistance and cross resistance to ethionamide. KatG mutatnsts express high level isoniazid resistance and often are not cross reasistnt to ethionamide Rare will be resistant to both so give both . At least two active agents should always be used to treat active Tb to prevent emergence of resistance during therapy

Answer 128

Readil absorbed from the GI tract, optimally on an empty stomach; peak concentrations may be decreased by up to 50% when taken with a fat meal. Diffuses readily into all body fluids and tissues. The concentration int he CNS and CSF ranges from 20 to 100% to serum Metab-acetylation by liver N acetyltransferase, is genetically determined. Tumors rapid excretion by rapid acetylators Metabolites Excreted in urine. Not need to adjust for renal failure or hepatic insuffiency . Inhibits several P450 enzymes, leading to increased concentrations of such medications as phenytoin, carbamazepine, and benzodiazepines. However when used in combination with rifampin, a potent CYP enzyme inducer, the concentrations of these meds is decreased

Answer 129

Immunologic -fever, skin rash, drug induced SLE Direct -hepatitis, increase Aminotransferases (seen in 10-20% but don’t need to stop-stop if hepatitis, not increase in ALT AST)., Clincial hepatitis with loss of appetite, nausea, vomiting, jaundice, RUQ pain , DEATH, hepatocellular damage and necrosis Risk of hepatitis depends on age usually over 50. Also alcohol dependence and possible during pregnancy and postpartum...stop use Peripheral neuropathy -more likely in slow acetylators , malnutrition, alcohol, diabetes, AIDS< uremia, due to pyridoxine defiency. Isoniazid promotes excretion of pyridozine and this toxicity is readily reversed by administration of pyridoxine in a dosage as low as 01. CNS_memory loss, psychosis, ataxia, seizures. May respond to pyridoxine Tinnitus, GI discomfort, Hematologic issues

Answer 130

Semisynthetic derivative of rifamycin Binds to the B subunit of bacterial DNA dependent RNA polymerase and thereby inhibits I RNA synthesis . Resistanceresults from any one of several possible point mutations in rpoB, the gene for the B subunit of RNA polymerase. These mutations result in reduced binding of rifampin to RNA polymerase. Human RNA polymerase does not bind rifampin and is not inhibited by it. Rifampin is bactericidal for mycobacteria . It readily penetrates most tissues and penetrates into phagocytic cells. It can kill organisms that are poorly accessible to many other drugs, such as intracellular organisms and those sequestered in abscesses and lung cavities.

Answer 131

Gram + organisms, some gram negative such as Neisseria and haemophilus species, mycobacteria and chlamydia. mycobacteria. With isoniazid or other antitb drugs to patients with active Tb Meningococcal carriage. Staph carriage. Osteomyelitis (staph) prosthetic joint infections, prosthetic valve endocarditis

Answer 132

Resistant mutants present in all microbial populations and readily selected out if rifampin is used as a single drug, No cross resistance to other drug classes of antimicrobial drugs, but there is cross resistsance to other rifamycin derivatives rifabutin and rifapentine

Answer 133

Well absorbed after oral administration and excreted mainly through the liver into bile. It then undergoes enterohepatic recirculating, with the bulk excreted as a deacylated metabolite in feces and a small amount excreted int he urine. Dosage adjustment for renal or hepatic insuffiency is not necessary. Usual doses result in serum levels 5-7 mcg/mL. Rifampin is distributed widely in body fluids and tissues . The drug is relatively highly protein bound, and adequate CSF concentrations are acheived onyl in presence of meningeal inflammation

Answer 134

Strong inducer P450, which increases the elimination of numerous other drugs Co administration results in significantly lower serum levels of drugs Harmless ORANGE URINE, SWEAT AND TEARS. Rash, thrombocytopenia, nephritis Cholestatic jaundice and hepatitis, light chain proteinuria, Flu like syndrome

Answer 135

Synthetic water soluble , heat stable compound , Inhibits mycobacteria arabinosyl transferase, which are encoded by the embCAB Operon. Arabinosyl transferase are involved in the polymerization reaction of arabinosyl an, an essential component of the mycobacteria cell wall.

Answer 136

Tb and other mycobacteria Mycobacterium avium complex -given with other agents

Answer 137

Mutations resulting in overexpression of emb gene products or within the embB structural gene. Rapid when drug used alone. Always given with another antiTb drug. (Isnoazis, rifampin, pyrazinamide during intima treatment),

Answer 138

Well absorbed from gut. HL 2-4 horus 20% excreted in feces 50% urine unchanged. Accumulated INR enal failure, and does reduced 3x if creatine clearance less than 30 ml/min. Crosses BBB only when meninges inflamed Concentrations in CSF range depending on meningeal infallmmamtion

Answer 139

Hypersensitivity rare Common-retrobulbar neuritis, resulting in loss of visual acuity and red green color blindness. (Usually when used for several months) Visual disturbances occur in 3% after at least 1 month. Get baseline monthly visual acuity and color discrimination testing with attention if high doses or renal issues CONTAINDCATED IN YOUNG BC OF VISION AND RED GREEN COLOR DISCRMINIAOTN

Answer 140

Relative nicotinamide, and it is used only for treatment of Tb. Stable and slightly water soluble. Inactive at neutral pH, but at 5.5 it inhibits Tb. Taken up by macrophages and exerts its activity against mycobacteria residing within the acidic environment Converted to pyrazinamide acid-the active form of the drug-by mycobacteria pyrazinamide seems, which is encoded by pncA. Pyrazinamide acid disrupts mycobacteria cell membrane metabolism and transport function

Answer 141

May be due to impaired uptake of pyrazinamide or mutations in pncA that impair conversion of PZa to its active form

Answer 142

well absorbed from the GI tract and widely distributed in body tissues, including inflamed meninges. HL 8-11 hours. The parent compound is metabolized by the liver, but metabolites are really cleared; therefore, PZA should be administered at 25-35 mg/kg is unused for thrice weekly or twice weekly treatment regimens.

Answer 143

Major adverse effects of PZA include hepatoxocity , nausea, vomiting, drug fever, photosensitivity, and hyperuricemia. The latter occurs uniformly and is not a reason to halt therapy if patients are asymptomatic.

Answer 144

Tubercle bacilli develop resistance to pyrazinamide fairly readily, But there is no cross resistance with isoniazid or other anti mycobacteria drugs

Answer 145

Isoniazid, rifampin, ethambutol, pyrazinamide

Answer 146

Streptomycin, ethionamide, capreomycin, cyclosporine, aminosalicylic acis, kanamycin and amikacin, fluoroquinolones, linezolid, rifabutin, rifapentine, bedauiline

Answer 147

Aminoglycosides. Lessen dose if on dialysis of creatinine clearance less than 30ml/min

Answer 148

TB, MAC, mycobacterium kansassi | Others are resistant

Answer 149

All large populations of Tb contain some streptomycin resistant mutants. 1 in 10^9 are resistant . Due to point mutation in either rpsL gene encoding the S12 ribosomal protein or the respiratory gene encoding 16S ribosomal RNA, which alters the ribosomal binding sit.

Answer 150

Penetrates into cells poorly and is active mainly against extracellular tubercle bacilli. The drug crosses the bbb and achieves therapeutic concentrations with inflamed meninges

Answer 151

Streptomycin sulfate is used when an injectable drug is needed or desirable and in the treatment of infections resistant to other drugs.

Answer 152

Ototoxicity and nephrotoxicity. Vertigo and hearing loss are the most common AE and may be permanent. Dose related. And increased in elderly. Adjust with renal prob. Reduce to no more than 6 months

Answer 153

Chemically related to isoniazid and similarly blocks the synthesis of mycotic acids. It is poorly water soluble and available only for oral use. Metabolized by liver

Answer 154

Tubercle bacilli | -CSF equal to serum

Answer 155

CSF same as serum Administered at an intima dose which is increased Hepatotoxicity. Neurologic symptoms may be alleviated by pyridoxine

Answer 156

Rapidly in vitro in Vito. There can be low level cross resistance between isoniazid and ethionamide

Answer 157

Peptide protein synthesis inhibitor antibiotic obtained from strep capreomycin.

Answer 158

Mycobacteria, including multidrug resistant strains of M tuberculosis (when resistant to streptomycin)

Answer 159

Some cross resistance with amikacin and kanamycin. Associated with rss , EUS, or tlyA gene mutations

Answer 160

Nephrotoxicity and ototoxicity Tinnitus, deafness, vestibular disturbances Injection pain and sterile abscess

Answer 161

Intermittent dissing

Answer 162

Structural analog of D alanine-inhibits cell wall synthesis Two oral doses,

Answer 163

Two oral doses Cleared renally, and the dose should be reduced by half if creatinine clearances is less than Widely distributed to tissues, including the CNS

Answer 164

Peripheral neuropathy and CNS dysfunction, including depression and psychoses. Pyridoxine should be given with cycloserine bc this ameliorates neurologic toxicity. Most common first 2 weeks of therapy,

Answer 165

Folate synthesis antagonist that is active almost exclusively against M tuberculosis. Structurally similar to PABA and is thought to have a similar MOA to the sulfonamides. must be administered sprinkled over applesauce or yogurts or fruit

Answer 166

Tubercle bacilli

Answer 167

Granule formulation results in improved absorption from GI Widely distributed in tissues and body fluids except the CSF Rapidly excreted in urine, in part as active PAs and in part as the acetylated compound and other metabolic products. To avoid accumulation in renal impairment lessen with creatine clearance less than 30 Very high in urine can give crystsalluria

Answer 168

Other oral drugs are better tolerated . GI symptoms are common but occur less frequently with the delayed release granules; they ma be dimished by giving the drug with meals and with antacids. Peptic ulceration hemorrhage may occur. Hypersensitivity reactions manifested by fever, joint pains, skin rashes, hepatosplenomegaly, hepatitis, adenopathy, and granulocytes Elia often occur after 3-8 weeks of PAS therapy. Making it necessary to stop administration temporarily or permanently

Answer 169

Aminoglycoside antibiotics . Kanamycin has been used for treatment of Tb caused by streptomycin resistant strains but is no longer available in USA and less toxic alternatives taken its place (capreomycina nd amikacin)

Answer 170

Treat Tb due to prevelance of multidrug resistant strains. Prevelance of amikacin resistant strains is low and most multidrug resistant strains remain amikacin susceptible. M Tb is inhibited at concentrations 1mcg or less Active against atypical mycobacteria.

Answer 171

No cross resistance between streptomycin and mikacin, but kanamycin resistance often indicated resistance o amikacin as well.

Answer 172

Tb suspected or known to be caused by streptomycin resistant or multidrug resistant strains. This drug must be used in combination with at least one a preferably two or three other drugs to which the isolate is susceptible for treatment of drug resistant cases.

Answer 173

In addition to their activity against many gram positive and gram negative bacteria, ciprofloxacin, levofloxacin, gatofloxacin and moxifloxacin inhibit strains of M Tb . Alsoactive against atypical mycobacteri

Answer 174

Most active against M Tb

Answer 175

Slightly more active than ciprofloxacin against M Tb, whereas ciprofloxacin is slightly more active against atypical mycobacteria

Answer 176

When strains are resistant to first line. Use moxifloxacin or levofloxacin

Answer 177

Point mutations in grade A subunit, develops rapidly if a fluoroquinolones is used as a single agent; thus the drug must be used in combination with two or more additional active agents Resistance to one indicates resistant to all However moxifloxacin may retain some activity in strains resistant to ofloxacin

Answer 178

Inhibits strains of Mtb Good intracellular concentrations and is active in murine models of Tb In combo with other second and third line drugs to treat multidrug resistant Tb . Conversion of sputum cultures to negative was associated with it

Answer 179

Bone marrow suppression and irreversible peripheral and optic neuropathy, have been reported with the prolonged courses of therapy that are necessary for treatment of Tb. Low -prevent AE and supplement pyridoxine

Answer 180

Only multidrug resistant

Answer 181

Patients on concomitant serotonergic agents due to concern for serotonin syndrome

Answer 182

Derived from rifamycin and is related to rifampin.

Answer 183

M tuberculosis, MAC, and mycobacterium fortuitous.

Answer 184

Cross resistance with rifampin is virtually complete Some resistant strains may appear susceptible to rifabutin in vitro but a clincal response is unlikely bc the molecular basis of resistance, rpoB mutation, is the same

Answer 185

Both subrate and inducer of cytochrome p450 enzymes. Because it is a less potent inducer, rifabutin is often used in place of rifampin for treatment of Tb in patients with HIV infection who are receiving antiretroviral therapy with a protease inhibition, a nonnucleoside reverse transcriptase inhibitor or an integrate strand transfer inhibit, drugs that also cytochrome p450 or UDP glucuronosyltransferases substrates

Answer 186

May accumulate in severe renal impairment, and the dose should be reduced by half if creatinine clearance is less than 30ml.min. Rifabutin is associated with similar rates of hepatotoxicity or rash compared to rifampin; it can also cause leukopenia, thrombocytopenia, andoptic neuritis

Answer 187

Another analog of rifampin. As with all rifamycin, it is a bacterial RNA polymerase inhibitor, and cross resistance between rifampin and rifapentine is complete.

Answer 188

M Tb and MAC

Answer 189

Potent inducer of P450 enzymes, and it has the same drug interaction profile; however when is given intermittently, induction of metabolism of other medications is less pronounced compared to rifampin. HL 13 hours Not given at high risk of failure patients or positive cultures at the end of the intensive treatment phase and those with evidence of cavitation on chest radiographs. DONT use to treat active Tb in patients with HIV bc unacceptable high relapse rate with rifampin resistant organisms. Combined with isoniazid Effective for latent Tb

Answer 190

Similar to rifampin.

Answer 191

Diarylquioline-first drug with a novel mechanism of action against M Tb to be approved since 1971. Inhibits adenosine 5-triphosphate synthase in mycobacteria, has in vitro activity against both replicating and nonreplicating bacilli, and has bactericidal and sterilizing activity in the murkiness model of Tb .

Answer 192

Cross resistance has been reported between bedaquiline and clofazimine, likely via upregulation of the multisubstrate efflux pump, mmpL5

Answer 193

Peak plasma concentration and plasma exposure increase twofold when given with high fat foot. Highly protein bound>99%, is metabolized chiefly through the cytochrome p450 system, and is excreted primarily via the feces. HL bedaquiline -5.5 months Long elimination phase probably reflects slow release of bedaquiline and M2 (major metabolite) from peripheral tissues 3a4 is major isoenzymes involved int he metabolism and potent inhibitors or inducers of this enzyme cause CLINCIALLY significant drug interactions

Answer 194

In combination with at least three other active medications, may be used for 24 weeks of treatment in adults with laboratory confirmed pulmonary Tb if the isolate is resistant to both isoniazid and rifampin .

Answer 195

25% or more Nausea, arthralgias, and headache. Hepatotoxicity and cardiac toxicity. Black box warning related to QT prolongation and mortality . Reversed for patients who do no have other treatment options and used with caution in patients with other risk factors for cardiac conduction abnormalities

Answer 196

Routine monitoring of symptoms and lung function Patient education to create a partnership between clinical and patient Controlling environmental factors (trigger factors) and comorbid conditions that contribute to asthma severity Pharmacological therapy

Answer 197

Reduction in impairment and reduction of risk

Answer 198

Can usually be managed with rescue inhalers to treat symptoms and controller inhalers that prevent symptoms. Severe cases may require longer acting inhalers that keep the airways open, as well as oral steroids.

Answer 199

Minimal chronic symptoms, including nocturnal Minimal exacerbations No emergency visits Minimal use of a required B2 agonist No limitations on activities, including exercise Peak expirations flow circadian variation<20% Near normal peak expirations flow Minimal AR from medicine

Answer 200

ICS low dose SABA

Answer 201

SABA | LABA ICS low dose

Answer 202

LABA ICS high dose SABA

Answer 203

OCS, LABA, ICS high dose, SABA

Answer 204

Rescue inhaler

Answer 205

Low dose inhaled corticosteroid plus LABA Rescue inhaler

Answer 206

Low dose inhaled corticosteroid plus a LABA Rescue inhaler as needed Consider seeing an asthma specialist

Answer 207

Medium dose inhaled corticosteroid plas a LABA Rescue inhaler as needed See an asthma specialist

Answer 208

High dose inhaled corticosteroid plus a LABA Consider amalizumab Rescue inhaler as needed See an asthma specialist

Answer 209

High dose inhaled corticosteroid plus a LABA plus oral corticosteroid and consider amalizumab Rescue inhaler as needed See an asthma specialist

Answer 210

Bronchodilators Anti inflammatory drugs Leukotriene antagonist Monoclonal antibody

Answer 211

B2 agonists Anticholinergic drugs Methylxanthines

Answer 212

Inhaled corticosteroids

Answer 213

Bronchodilators act primarily on airway smooth muscle to reverse the bronchoconstriction of asthma. This gives rapid relief of symptoms but has little or no effect on the underlying inflammatory process. Thus, bronchodilators are not sufficient to control asthma in patients with persistent symptoms. There are three classes of bronchodilator in currentt use: B2 adrenergic agonists, anticholinergics, and theophylline of these, B2 agonists are by far the most effective.

Answer 214

B2 agonsits activate B2 adrenergic receptors, which are Woden expressed int he airways. B2 receptors are coupled through a stimulators G protein to adenylyl cyclase, resulting in increased intracellular cyclic adenosine monophosphate (AMP), which relaxes smooth muscle cells and inhibits certain inflammatory cells, particularly mast cells. The primary action of b2 agonists is to relax airway smooth muscle cells of all airways, where they act as functional antagonsits, reversing and preventing contraction of airway smooth muscle cells by all known bronchoconstrictors. This generalized action is likely to account for their great efficacy as bronchodilators in asthma. There are also additional non bronchodilator effects that may be CLINCIALLY useful , including inhibition of mast cell mediator release, reduction in plasma exudation, and inhibition of sensory nerve activation. Inflammatory cells express small numbers of B2 receptors but these are rapidly down regulated with B2 agonist activation so that, in contrast to corticosteroids, there are no effects on inflammatory cells in the airways and there is no reduction in airway hyper responsiveness.

Answer 215

Usually associated with b agonists are not problematic when given by inhalation. The most common-muscle tremor and palpitations, which are seen more commonly in elderly patients. There is a small fall in plasma K due to increased uptake by skeletal muscle cells, but this effect does not usually cause any clincial proble,. Tolerance is a potential problem with any agonist given chronically, but while there is down regulation of b2 receptors, this does not reduce the bronchodilator response as there is a large receptor reserve in airway smooth msucle cells. By contrast mast cells become rapidly tolerant, but their tolerance may be prevented by concomitant administration of inhaled corticosteroids

Answer 216

Asthma, acute bronchitis, COPD, bronchiolitis

Answer 217

HA, dizziness, insomnia, dry mouth, cough

Answer 218

BB, digoxin, diuretics, monoamine oxidase inhibtiors, tricyclic antidepressants

Answer 219

Paradoxical bronchospasm, deterioration of asthma, use of anti inflammatory agents, cardiovascular effects, do not exceed recommended dose, immediate hypersensitivity reactions

Answer 220

Beta adrenergic agonist with preferential effects on the beta 2 receptos resulting in smooth muscle relaxation. Only b2 drug available by subcutaneous injection (terbutaline sulfate inj>> patients with sulfur allergy, not recommended)

Answer 221

FDA approved for the treatment or prophylaxis of bronchospasm associated with asthma, bronchitis and emphysema in patients 12 years old and older

Answer 222

HA, nausea, tachycardia and palpitations. However, more serious maternal AE that can occur include cardiac ischemia, hypotension and tachycardia

Answer 223

BBW (black box warning) not recommended as a medication for tocolysis

Answer 224

Used as a bronchodilator for bronchial asthma and for reversible bronchospasm which may occur in association with bronchitis and copd

Answer 225

Nervousness, HA, dizziness, palpitations, GI distress, tremor, throat irritation, nausea, vomiting, cough and asthma exacerbation

Answer 226

Beta adrenergic aerosol bronchodilators should not be used concomitantly with metaproterenol bc they may have additive effects. Beta adrenergic agonists should be administered with caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, since the action of beta adrenergic agonists on the vascular system may be potentiated

Answer 227

Can produce a significant cardiovascular effect in some patients , as measured by pulse rate, bp, symptoms, and/or ECG changes. As with other beta adrenergic aerosols, metaproterenol can produce paradoxical bronchospasm (which can be life threatening0

Answer 228

Used int he prevention and reversal of bronchospasm in patients 12 years of age and older with reversible bronchospasm including asthma. It may be used with or without concurrent theophylline and/or corticosteroids

Answer 229

CNS: nervousness, tremor, HA, dizzy, Cardio: palpitations, tachycardia Respiratory: cough GI: nausea

Answer 230

Other short acting beta adrenergic aerosol bronchodilators should not be used concomitantly with pirbuterol bc they may have additive effects

Answer 231

Cardiovascular: like other inhaled beta adrenergic agonists, can produce a CLINCIALLY significant cardiovascular effect in some patients, as measured by pulse rate, bp and/or symptoms

Answer 232

Used in treatment or prevention of bronchospasm in patients 4 years of age and older with reversible obstructive airwaydisease

Answer 233

Accidental injury, bronchitis, dizzy, pain, pharyngitis, rhinitis, vomiting

Answer 234

Potentiation the effect of other SABA drugs

Answer 235

Life threatening paradoxical bronchospasm may occur

Answer 236

Treatment of asthma in patients>5 years as an add on to long term asthma control medication such as an inhaled corticosteroid. Prevention of exercise induced bronchospasm (EIB) in patients > 5 years. Maintence treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease

Answer 237

Asthma: viral infection, bronchitis, chest infection, dyspnea, chest pain, tremor, dizzy, insomnia, tonsillitis, rash, dysphagia, and serious asthma exacerbation COPD: upper respiratory tract infection, back pain, pharyngitis, chest pain, sinusitis, fever, leg cramps, muscle cramps, anxiety, pruritis, increased sputum and dry mouth

Answer 238

Adrenergic agents: use with caution. Additional adrenergic drugs may potentiation sympathetic effects Canthine derivatives, systemic, corticosteroids, and non K sparing diuretics: use with caution. May potentiation hypoK or ECG changes mAO inhibits, tricyclic antidepressants, macrolides, and drugs that prolong QT: use with extreme caution. May potentiation effect on CVD BB: use with caution and only when medically necessary. May decrease effectiveness and produce severe bronchospasm.

Answer 239

CVD: like other inhaled beta adrenergic agonsits, can produce a CLINCIALLY significant cardiovascular effect in some patients, as measured by pulse rate, bp and/or symptoms

Answer 240

Used in treatment or prevention of bronchospasm in patients 4 years of age and older with reversible obstruction=Clive airway disease

Answer 241

Accidental injury, bronchitis, dizzy, pain pharyngitis, rhinitis, and vomiting

Answer 242

May potentiation and effect of other Saba drugs

Answer 243

Life threatening paradoxical bronchospasm may occur

Answer 244

Treatment of asthma in patients aged 4 years and older. Prevention of exercise induced bronchospasm in patients aged 4 years and older. Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease

Answer 245

Asthma: HA, influenza, nasal/sinus congestion, pharyngitis, rhinitis, trachietis/bronchitis. COPD: cough, HA, musculoskeletal pain, throat irritation, viralrespiratory infection

Answer 246

Strong cytochrome P450 3a4 inhibtors : use not recommended. May increase risk of cardiovascular effects Monoamine oxidase inhibitors and tricyclic antidepressants: use with extreme caution. May potentiation effect of salmeterol on vascular system BB: use with caution. May block bronchodilators effects of beta agonists and produce severe bronchospasm. Diuretics: use with caution. ECG changes and/or hypokalemia associated with non K sparing diuretics may worsen with concomitant beta agonists

Answer 247

Asthma: without concomitant use of a long term asthma control medication such as an inhaled corticosteroid. Primary treatment of status asthmaticus or acute episodes of asthma or COPD requiring intensive measures Severe hypersensitivity to milk proteins *LABA increase the risk of asthma related death and asthma related hospitalizations. Prescribe for asthma only as concomitant therapy with an inhaled corticosteroid. Do not initiate in acutely deteriorating asthma or COPD Do not use to treat acute symptoms. Not a substitute for corticosteroids Patients with asthma must take a concomitant inhaled corticosteroid. Do not use in combination with an additional medicine containing a LABA bc of risk of overdose. If paradoxical bronchospasm occurs, discontinue and institute alternative therapy

Answer 248

LABA used to treat breathing problems caused by COPD including chronic bronchitis and emphysema

Answer 249

Most common adverse reactions are cough, oropharyngeal pain, nasopharyngitis, HA, nausea

Answer 250

Other adrenergic drugs may potentiation effect. Xanthing derivatives, steroids, diuretics or non K sparing diuretics may potentiation hypoK or ecg changes

Answer 251

BBW long acting beta 2 adrenergic agonists (LABA) increase the risk of asthma related death

Answer 252

Used in the long term once daily maintenance bronchodilator treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema

Answer 253

Most common AE reactions are nasopharyngitis, Upper respiratory tract infection, bronchitis, urinary tract infection, cough, dizzy, rash, diarrhea, back pain and arthralgias

Answer 254

Other adrenergic drugs may potentiation effect. Xanthine derivatives , steroids, diuretics or non K sparing diuretics may potentiate effect on cardiovascular system. Use with extreme caution. Bb may decrease effectiveness

Answer 255

BBW, long acting beta 2 adrenergic agonists increase the risk of asthma related death

Answer 256

Anticholinergics block acetylcholine from binding to it receptors on certain nerve cells. They inhibit parasympathetic nerve impulses. These nerve impulses are responsible for involuntary msucle movements in the GI tract, lungs, urinary tract, and other parts of your body

Answer 257

Atropine Ipratropium Tiotropium Aclidinium

Answer 258

ATROPINE IS A MUSCARINIC ANTAGONIST INDICATED FOR TEMPORARY BLOCKADE OF SEVERE OR LIFE THREATENING MUSCARINIC EFFECTS

Answer 259

MOST ADVERSE REACTIONS ARE DIRECTLY RELATED ATROPINES ANTIMUSCARINIC ACTION. DRYNESS OF THE MOUTH, BLURRED VISION, PHOTOPHOBIA AND TACHYCARDIA COMMONLY OCCUR WITH CHRONIC ADMINISTRATION OF THERAPEUTIC DOSES

Answer 260

ATROPINE DECREASES THE RATE OF MEXILETINE ABSORPTION WITHOUT ALTERING THE RELATIVE ORAL BIOAVAILABILITY; THIS EDLAY IN MEXILETINE ABSORPTION WAS REVERSED BY THE COMBINATION OF ATROPINE AND IV METOCLOPRAMIDE DURING PRETREATMENT FOR ANESTHESIA

Answer 261

When the recurrent use of atropine is essential in patients with CAD. The total dose should be restricted to 2-3 mg to avoid the detrimental effects of atropine induced tachycardia on myocardial oxygen demand

Answer 262

Used as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema

Answer 263

As an anticholinergic drug, cases of precipitation or worsening of narrow angle glaucoma, mydriasis, acute eye pain, hypotension, urinary retention, tachycardia, constipation, bronchospasm, including paradoxical bronchospasm have been reported

Answer 264

Caution is advised in the co administration of ipratropium with other anticholinergic containing drugs

Answer 265

Is an anticholinergic indicated for long term, once daily, maintenance treatment of bronchospasm associated with COPD, and for reducing COPD exacerbations

Answer 266

The most common adverse reactions were upper respiratory tract infection, dry mouth, sinusitis, pharyngitis, and rhinitis.

Answer 267

May interact additively with concomitantly used anticholinergic medications. Avoid administration fo tiotropium with other anticholinergic containing drugs

Answer 268

Not for acute use. Not a rescue medication. Immediate hypersensitivity reactions may include; angioedema, urticaria, rash, bronchospasm, or anaphylaxis can occur. Use with caution in patients with severe hypersensitivity to milk proteins

Answer 269

Indicated for the long term maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema

Answer 270

Include but are not limited to paradoxical bronchospasm, worsening of narrow angle glaucoma, worsening of urinary retention

Answer 271

In vitro studies suggest limited potential for CYP450 related metabolic drug interactions, thus no formal interaction studies have been performed. Drug performance is still highly monitored since the drug was approved in 2012.

Answer 272

Not for acute use. This drug is intended as a twice daily maintenance treatment for COPD and is not indicated for the initial treatment of bronchospasm

Answer 273

Methylxanthines are a unique class of drug that are derived from the purine base xanthine. Xanthine is produced naturally by both plants and animals. The methylxanthines, theophylline, and dyphylline are used int he treatment of airways obstruction caused by conditions such as asthma, chronic bronchitis, or emphysema. Caffeine and theobromine (in chocolate) are also methylxanthines

Answer 274

Has two distinct actions in the airways of patients with reversible obstruction; smooth muscle relaxation (bronchodilator) and suppression of the response of airways to stimuli (non bronchodilator prophylactic effects)

Answer 275

Used in the treatment of asthma and other lung problems, such as emphysema and chronic bronchitis

Answer 276

cNS excitement, hAA, insomnia, irritability, restlessness, seizure, diarrhea, nausea, vomiting, urinary retention

Answer 277

Theophylline interacts with a wide variety of drugs. The interaction is increased or decreased based on serum theophylline concentrations. Theophylline only rarely alters the pharmacokinetics of other drugs

Answer 278

Theophylline should be used with extreme caution in patients with the following clinical conditions due to the increased risk of exacerbation of the concurrent condition: active PUD, seizure disorder cardiac arrhythmias (not including Brady arrhythmia)

Answer 279

By far most effective controllers for asthma, and their early use has revolutionized asthma therapy. Most effective anti inflammatory agents used in asthma therapy, reducing inflammatory cell numbers and their activation in the airways.

Answer 280

Reduce eosinophils int he airways and sputum, and numbers of activated T lymphocytes and surface mast cells in the airway mucosa. These effects may account for the reduction in AHR that is seen with chronic ICS therapy.

Answer 281

Several effects both einflammatory process The major effect-corticosteroids is to switch off the transcription of multiple activated genes that encode inflammatory proteins such as cytokines, chemokines, adhesion molecules, and inflammatory enzymes. This effect involves several mechanisms, including inhibiton of the transcription factors NF KB but an important mechanism is recruitment of histone deacetyation 2 inhibitor to the inflammatory gene complex, which reverses the histone acetylation associated with increased gene complex, which reverses the histone acetylation associated with increased gene transcription. Also activated anti inflammatory genes such as nitrogen-activated protein kinase phosphatase 1, and increase the expression of B2 receptors.

Answer 282

Most metabolic and endocrine side effects of corticosteroids are also mediated through transcriptional activation.

Answer 283

ICS Beneficial in treating asthma of any severity and age. Usually given twice daily but some may be effective once daily in mildly symptomatic patients. ICS rapidly improve symptoms of asthma, and lung function improves over several days. They are effective in preventing asthma symptoms, such as exercise induced asthma and nocturnal exacerbations, but also prevent severe exacerbations

Answer 284

Early treatment with ICS appears to prevent irreversible changes in airway function that occur with chronic asthma.

Answer 285

Results in slow deterioration of asthma control, indicating that they suppress inflammation and symptoms, but do not cure the underlying condition.

Answer 286

First line for patients with persistent asthma, but if they do not control symptoms at low doses, it si usual to add a LAB as the next step

Answer 287

Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone Triamcinolone

Answer 288

Prescribed as a maintenance treatment for asthma and as prophylactic therapy in patients 5 years of age and older. Also used in the treatment of asthma in patients who require oral corticosteroid therapy to reduce or eliminate the need for the systemic corticosteroids

Answer 289

Most common AE include HA, pharyngitis, oral symptoms (inhalation route) and sinusitis

Answer 290

Most common AE include HA, pharyngitis, oral symptoms(inhalation route) and sinutisit

Answer 291

Other drugs may interact with beclomethasone inhalation, including prescription and OTC medicines, vitamins and herbal products

Answer 292

Particular care is needed in patients who are transferred from systemically active corticosteroids to beclomethasone bc deaths due to adrenal insuffiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available inhaled corticosteroids. After withdrawal from systemic corticosteroids, a number of months are required for recovery of hypothalamic pituitary function

Answer 293

Maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients six years of age or older

Answer 294

Most common AE are nasopharyngitis, nasal congestion, pharyngitis, rhinitis allergic, viral URI, nausea, viral gastroenteritis, otitis media, oral candidiasis

Answer 295

The main route of metabolism of corticosteroids ,including budesonide, is via 3a4

Answer 296

This drug should not be used where primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required. Severe hypersensitivity to milk proteins and any of the ingredients in budesonide is contraindicated

Answer 297

Prescribed as an inhaled corticosteroid indicated for maintenance treatment of asthma as prophylactic therapy in adult and adolescent patients 12 years of age and older

Answer 298

Most common are HA< nasopharyngitis, sinusitis, pharyngolaryngeal pain, upper respiratory infection, arthralgia, nasal congestion, pain in extremity and back pain

Answer 299

In clincial studies, concurrent administration of ciclesonide and other drugs commonly used in the treatment of asthma (albuterol, formoterol) had no effect on pharmacokinetics of desciclesonide

Answer 300

Ciclesonide is not indicated for the relief of acute bronchospasm. Use is not recommended in presence of Candida albicans infection of the mouth and pharynx, tb, fungal , bacterial , viral, or parasitic infection

Answer 301

Indicated for the maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 6 years of age and older. Also indicated for asthma patients requiring oral corticosteroid therapy where adding flunisolide therapy may reduce or eliminate the need for oral corticosteroids

Answer 302

The most common are pharyngitis, rhinitis, HA, sinusitis, and increased cough

Answer 303

No significant drug interactions with other drugs used in asthma therapy. However the effects of some other drugs can change if you take other drugs or herbal products at the same time

Answer 304

Contraindications in patients for primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required

Answer 305

Maintenance treatment of asthma as prophylactic therapy in patients aged 4 and older. Not indicated for relief of acute bronchospasm

Answer 306

Most common adverse reactions are upper respiratory tract infections or inflammation , throat irritation, sinusitis, dysphagia, candidiasis, cough, bronchitis, and HA

Answer 307

Strong p450 3a4 inhibtiors use not recommended. May increase risk of systemic corticosteroid effects

Answer 308

Candida albicans infection of the mouth and pharynx may occur monitor patients periodically. Advise the patient to rinse his/her mouth with water without swallowing after inhalation to help reduce the risk

Answer 309

Maintenance treatment of asthma as prophylactic therapy in patients 4 years of age and older

Answer 310

The most common adverse reactions are HA< allergic rhinitis, pharyngitis, URI, sinusitis, oral candidiasis, dysmenorrhea, musculoskeletal pain, back pain, and dyspepsia

Answer 311

In clincial studies, the concurrent administration of mometasone and other drugs commonly used int he treatment of asthma was not associated with any unusual adverse reactions

Answer 312

Use of this drug is contraindicated in patients with status asthmaticus or other acute episodes of asthma where intensive measures are required. Also contraindicated in patients with a known hypersensitivity to milk proteins or any ingredients of mometasone

Answer 313

Indicated in the maintenance treatment of asthma patients who require systemic corticosteroids administration , where adding this agent may reduce or eliminate the need for the systemic corticosteroids. Not indicated for the relief of acute bronchospasm

Answer 314

Diarrhea, oral minilia, toothache, vomiting , weight gain, bursitis, myalgia, dry mouth, rash, chest congestion, voice alteration

Answer 315

The concurrent administration of triamcinolone and other drugs commonly used in the treatment of asthma was not associated with any unusual adverse reactions

Answer 316

Contraindications in the primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required. Particular care is needed in patients who are transferred from systemically active corticosteroids to triamcinolone bc deaths due to adrenal insuffiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to aesolized steroids in recommended doses

Answer 317

Fluticasone+salmeterol Budesonide+fomoterol

Answer 318

Oral corticosteroids are used in combination with SABA to treat moderate to severe asthma flare ups. Oral corticosteroids are more likely to cause side effects than inhaled corticosteroids

Answer 319

Used as an antiinflammatory or immunosuppressive agent for certain allergic, Dermatologic, GI, hematologic, ophthalmologist, nervous system, renal respiratory, rheumatologist, specific infectious diseases or conditions and organ transplatation. Also used for the treatment of certain endocrine conditions and for palliation of certain neoplastic conditions

Answer 320

Common include fluid retention, alteration in glucose tolerance, elevation in bp, behavioral and mood changes, increased appetite and weight gain

Answer 321

Anticoagulant agents may enhance or dimish anticoagulant effects. May increase blood glucose concentrations. Use of NSAIDS including aspirin and salicylate increased the risk of GI side effects

Answer 322

May lead to hypothalamic pituitary adrenal axis suppression. Monitor patients for Cushing syndrome and hyperglycemia with chronic use and taper doses gradually for withdrawal after chronic use

Answer 323

Among most prescribed drugs for the management of asthma, used both for treatment and prevention of acute asthmatic attacks. This class of drugs acts by binding to cysteine leukotriene (CysL T) receptors and blocking their activation and the subsequent inflammatory cascade which cause the symptoms commonly associated with asthma and allergic rhinitis. This cysteinyl leukotrienes (LTC4, LTD4, LTE4) are products of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils. These eicosanoids bind to cysteinyl leukotriene (CysL T) receptors. THe CysL T type 1 receptor is found in the human airway (including airway SM cells and macrophages) and on other pro inflammatory cells (including eosinophils and certain myeloid stem cells). CysLts have been correlated with the pathophysiology of asthma and allergic rhinitis. In asthma, leukotriene mediated effects include airway edema, smooth msucles contraction, and altered cellular activity associated with the inflammatory process)

Answer 324

Orally active compound that binds with high affinity and selectivity to the CysLT1 receptor (in preference to other pharmacologically important airway receptors, such as the prostatis, cholinergic, or B adrenergic receptor). Montelukast inhibits physiologic actions of LTD4 at the cysLT1 receptor without any agonist activity. More specifically, montelukast causes inhibition of airway cysteinyl leukotriene receptors as demonstrated by the ability to inhibit bronchoconstriction due to inhaled LTD4 in asthmatics

Answer 325

Primaryily prescribed to treat allergies and prevent asthma attacks

Answer 326

URI, fever, HA, sore throat, cough, stomach pain, diarrhea, earache, ear infection, flu, runny nose, sinus infection

Answer 327

The concurrent administration of montelukast and other drugs commonly used int he treatment of asthma was not associated with any unusual adverse reactions

Answer 328

Not indicated for use in the reversal of bronchospasm in acute asthma attacks, including status asthmaticus. Therapy with montelukast can be continued during acute exacerbations of asthma. Patients who have exacerbations of asthma after exercise should have available for rescue a short acting inhaled B agonist

Answer 329

Selective and competitive receptor antagonist of leukotriene D4 and E4 (LTD4 and LTE4) components of slow reacting substance of anaphylaxis (srsa0 cysteinyl leukotriene production and receptor occupation have been correlated with the pathophysiology of asthma, including airway edema, smooth msucle constriction and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma

Answer 330

Prophylaxis and chronic treatment of asthma in adults and children 5 years of age and older.

Answer 331

Coadminstration with warfarin results in a CLINCIALLY significant increase in prothrombin time. Patients on oral warfarin anticoagulant therapy and zafirlukast should have their prothrombin times monitored closely and anticoagulant dose adjusted accordingly

Answer 332

Hepatotoxicity: cases of life threatening hepatic failure have been reported in patients treated with safirlukast. Cases of liver. Injury without other attributable cause have bee reported from ost marketing adverse event surveillance zafirlukast

Answer 333

Immediate relase tablts were withdrawn from US market in 2008 Controlled release still avail early a Inhibitor of 5 lipoxygenase and thus inhibits leukotriene (LTB4, LTC4, LTD4, and LTE4) formation

Answer 334

Leukotriene synthesis inhibitor indicated for the prophylaxis and chronic treatment of asthma in adults and children 12 years of age and older and not used to treat an acute asthma

Answer 335

Most common AE include sinusitis, nausea, and pharyngolaryngeal pain

Answer 336

Increases theophylline evils and increases warfarin levels. Monitor prothrombin time and adjust warfarin dose accordingly. Zileuton increases propranolol levels and bb activity

Answer 337

Not recommended in cases where active liver disease or persistent hepatic function enzyme elevations are over 3 times the upper limit of normal

Answer 338

Omalizumab

Answer 339

Anti IgE antibody indicated for moderate to severe persistent asthma in patients 6 yers of age and older with a positive stint est or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids. Also, indicated in the treatment for chronic idiopathic urticaria in adults and adolescents 12 years of age and older who remain symptomatic despite H1 antihistamine treatment

Answer 340

The most common adverse reactions in clincial studies with adult and adolescent patients>12 with arthralgia, pain, leg pain, fatigue, dizzy, fracture, arm pain, pruritis, dermatitis, and earache

Answer 341

No formal drug interaction studies have been performed with omalizumab. In patients with asthma the concomitant use of this agent and allergen immunotherapy has not been evaluated

Answer 342

BBQ anaphylaxis: administer only in a healthcare setting prepared to manage anaphylaxis that can be life threatening and observe patients for an appropriate period of time after administration

Answer 343

Although distinct syndromes , some patients with asthm have features of COPD and some patients with COPD have features of asthma with more reversibility and increased airway and blood eosinophils. This may represent to coincidence of two common diseases, or these may be distinct phenotypes. ACO patients tend to have more symptoms and exacerbations. They may benefit from triple therapy with ICS, LABA and LAMA

Answer 344

Reduction in impairment Reduction risk

Answer 345

Viral respiratory infections Exercise Endocrine factors Drugs: asprin, bb Weather changes: cold air Allergens Emotional expression: anger, laughing Food additives: sulfite Environmental changes Exposure to irritant and occupational chemicals

Answer 346

Hormonal changes COPD Upper airway Rhinitis GERD Fat Sleep apnea

Answer 347

Anti inflammatory drugs Bronchodilators

Answer 348

Decrease acetylcholine (muscarinic) and adenosine (theophylline) which increase bronchial tone

Answer 349

Increase AC and cAMP for bronchodilator

Answer 350

Decrease PDE which increase cAMP and increase bronchodilation

Answer 351

Selective reversible antagonsits of CysLT1 receptors) Taken orally Are bronchodilators Have antiinflammatory action Less effective than ICS Have glucocorticoids sparing effect(potentiate corticosteroids)

Lungs Flashcards

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