statins

metabolism (2)?

side fx?

2 prodrugs?

CYP3A4

excreted

teratogenic in pregnancy

liver disease

myopathy

minor GO

lovastatin, simvastatin

fibrates

mechanism?

metabolism

contraindicated?

combination?

gemfibrozil, fenofibrate

PPARa agonists (+ lipoprotein lipase, - hepatic VLDL production)

excreted

hepatic, renal dysfunction, gallbladder disease

past problems w/statin

bile acid resin

mechanism?

combination?

side fx?

contraindicated

cholestyramine, colestipol

insoluble complexes w/bile acids

yes, combo platter

GI, bulky, dec ADEK and other med absorption

coleselevam in hypertriglyceridemia!

niacin

mech?

contraindicated?

nicotinic acid/vitamin B

- lipolysis in adipose, - hepatic uptake of ApoA1, thus inc HDL

DM (hyperglycermia)

zetia

mech?

statins LDL   HDL   TG

 fibrates LDL   HDL   TG  

bile acid LDL   HDL   TG

niacin LDL   HDL   TG   

side fx

statins?

niacin?

fibrates?

statins: myalgia, myositis, rhabdo

niacin: hypergly

fibrates: precip of toxicities + statins

ipratropium bromide

class?

fluticasone

budesonide

beclomethasone

flunisolide

prednisone

steps in asthma tx?

4

3

2

1

quick

high dose ICS + LA-BA / oral CS

low tomed ICS + LA-BA / LT modifier (theophylline) 

low ICS / LT modifier

no daily med / systemic SC 

SA-BA

clopidogrel and ticagrelor

mech?

rev?

thienopyridines, P2Y12 antag

clopidogrel: irrev

ticafrelor: rev

abciximab

specific mech?

alteplase

mech?

tranexamic acid

mech?

protamine sulfate

mech?

org nitrates

name them.

mech?

3 half lives, route, and metab?

side fx?

glyceryl trinitrate

isosorbide dinitrate

isorbbide mononitrate

GC > inc cGMP

glyceryl trinitrate 30 s, SL, 100% first pass

isorbide dinitrate 10 m. OK bioavail

isorbide mononitrate 300 m. oral/top 100% bioav

HA, postural hypotension, dizziness, syncope, flushing, reflex tachy

diltiazem

class?

where fx?

preferred?

contraindicated?

route?

VOCC blocker

cardiac and vasculature

 variant angina

beta blocker use

oral

atenolol beta?

propranolol beta?

preferred?

contraindicated?

route?

side fx

atenolol B1

propranolol B1 and B2

stable angina

variant angina

oral

bronchospam, heart failure, brady, AV block, PVD, Raynauds

B blocker LA nitrate VOCC antag

recent MI?

asthma

htn

DM

B blocker - recent MI

LA nitrate - recent MI, asthma, htn, DM

VOCC antag - asthma, htn, DM

beta lactams?

antimycobacterials?

daptomycin?

pcn: (G, pcn G, lactamase resistant, extended)

beta lactamase inhib

carbopenems

monobactams

cephalosporins

anti-myco: isoniazid, ethambutol, pyrazinamide

daptomycin: pores in mmbrn

pcn G for? 

pcn V?

G+ and G- cocci, lactamase sensitive (non-beta lactamase)

including N. meningititis, clostridium, treponema pallidum

same as pcn G, better oral absorption

staph and strep

(penicillinase producing staph)

MRSA and enterococci are resistant

G+ (non lact) and G- bacilli

e coli, h influenzae, salmon, shiga

clavulanic acid 

mech?

for?

B lactamase suicide inhibitor

w/amx to treat B lactamase producers

cephalosporin side fx?

MRSA?

GI, nephrotoxicity, superinfection

no MRSA

cephalexin

category?

for?

note?

1st generation ceph

G+ and CA G-, surp proph

DONT penetrate CNS 

 limited?

oral

3rd gen ceph

extended G-, CNS/menigitis: pneumococci, meningcocci, H. infleunzae, E coli, Klebsiella, pcn res N. gonorrhoeae 

2nd and 3rd less effective against G+ than 1st gen

parental

4th gen ceph

extended G- (enterobactericiae, pseudomonas), G+

impenem

class?

route, metab?

note?

CNS?

side fx?

carbapenems (~ pcn), G- rods, G+, and anaerobes...serous H.A./mixed (not MRSA/VRE)

parental

renal metab/excret

w/cilastatin (inhib renal dehydropep)

CNS well

seizures (not recommended for CNS), N/V, superinfection

aztreonam

class?

route?

metab?

CNS?

for?

monobactam

IM/IV

renal

yes CNS

G- rods, no G+ or anaerobes

vancomycin

route?

CNS?

metab?

side fx?

for?

poor oral, no IM

throughout body, and CNS if meninges are inflammed

renal

flushing, tachy, hypoten, phlebitis

ototoxicity/nephrotox

G+ coc and rod. No longer for C diff

daptomcyin

route?

elim?

side fx?

for?

IV

renal

myalgias, inc CPK

skin and soft tissue: G+ (MRSA, step) and vanco sen Enter faec

fosfomycin

for?

gentamycin

category?

for?

route/absorption?

excretion?

resistance?

side fx?

aminoglycoside

aerobic G- noscomial infections (E coli, Klebsiella, pseudomonas)

topical/poor absorption (can kill gut flora)

kidney, in renal failure in dose reduction

"oxygen dependent mutant uptake", "anaerobes are resistant"

ototoxicity, nephrotoxicity

tetracycline

For?

mech?

absorption?

BBB?

excr/metab?

interactions?

side fx?

30s

Lyme disease, Rocky Mountain Spotted Fever, Q fever, Mycoplasma pneumoniae, Chlamydiae

Community acquired respiratory infections

Broad spectrum, Gram negative, Gram positive, amoeba

dairy reduces absorp

yes, good X BBB

kidney excret, hepatic metab

pseudomembranous colitis, superinfection, yellow teeth

reduce oral contraception, reduce elimination of warfarin

chloramphenicol

for?

mech?

BBB/placenta?

side fx?

metab?

sever anaerobic, other abx not work

50S

X BBB and placenta

hematologic toxicity, include irrec aplastic anemia

gray baby 

P405 (warfarin)

erythromycin

for?

mech?

resistance?

metab?

G- and G+ aerobes, some anaerobes, Mycoplasma pneumoniae, Legionella, Bordetella   pertussis Corynebacteriadiptheriae

50S

high, 50% HA

p450, theophylline, warfarin, cyclosporine

telithromycin

for?

mech?

contraindicated?

S. pneumoniae(inc. penicillin-resistant strains), H. influnezae, Moraxella catarrhalis, Chlamydophilapneumoniae, Mycoplasma pneumoniae.

50s

myasthenia gravis

clindamycin

for?

side fx?

serous G+, bacteriodes fragilis, intra-abdominal, female: pelvis, genital

pseundomembranous colitis

streptogramins, other name?

what?

for?

synercid

dalfopristin, quinupristin

meth sen SA or S pyogenes

linezolid

for?

oral bioa?

VR enterococcus faecium, MRSA, MSSA, pcn-res S. pneum

high bioa

mupirocin

for?

sulfadiazine

for?

category?

mech?

excret?

side fx?

chancroid, trachoma, UTI

antifolates

analog of PABA

renal, reduced dose in renal fail

dehydration, acute hemolytic anemia due to G6PD def

trimethoprim

for?

mech?

UTI (E coli, P mirbilis, K pneum, Enterobacter)

inhib of dihydrofolate reductase

bactrim, septra

for?

ciprofloxacin

for?

mech?

resistance?

UTI, prostatitis, lower RTI, etc

inhib gyrase and topo IV

high resistance

prototypes?

ACEI?

ARB

vasodilators

sympatholytics

diuretics

ACEI: cartopril

ARB: losartan

vasodil: isosorbide dinitrate (ISDN), hydralazine

sym: metoprolol, carvedilol, bisoprolol

diuretics: spironolactone, eplerenone

ACEI

dil/constrc, where?

heart fx?

kidney?

other fx?

side fx?

arteriolardilation

no change in HR, contract...NO reflex tachy

diu/natriuresis

inhib LV remodeling

CAPTOPRIL

bilateral renal a. stenosis

hyperkalemia

renal insuff

pregs

a. hypotension

uses of nitrates?

cautions of nitrates?

pulm congest, orthopnea/PND, CHF w/ischemia, acute CHF/pulm edema, chronic HF w/hydralazine

mitral stenosis, inc. intracranial pressure, anemia

hydralazine

dil/constrt, where?

heart, reflex?

a. dilator

dec afterload, reflex tachy

nesiritide

what?

for?

dil/constt?

heart?

kidney?

recomb BNP

acute HF, class IV

dil

dec LVEDP, congestion

natriuretic, dec aldosterone

spironolactone

mech?

contraind?

aldosterone antag

hyperkal, caution w/ACEI & ARB

tolvaptan

mech?

for?

ADH antag

CHF w/hyponatremia

prototypes

cardiac glycosides?

beta adr agonist?

PDE (type 3) inhib?

digoxin

B ag: dobutamine

PDE inhib: inamrinone

digoxin use?

dig fx of arrhy?

types of arrhy?

dig tox increased by?

dig tox dec? 

CHF: AF w/RVR

higher dig, higher % of arrhy

PVC, SVT, SA/AV block

dig tox increased: hypokalemia, hypothyroidism, renal fail, drugs (amiodarone, quinidine)

dig tox decreased: hyperthyroid

positive inotropes:

sympathomimetics (2)?

cAMP PDEI?

calcium sensitizing agents?

change mortality?

chronic therapy?

dopamine (CC), dobutamine (B ag)

cAMP PDEI: inamrinone

Ca sens: levosimendan

some increase mortality

only dig in chronic therapy