pharm pneumonia and influenza
What is the Adverse effect of dextromethorphan?
Can increase risk of serotonin syndrome, GI distress, nausea, Dizziness, and drowsiness
BP is a 66-year-old woman who underwent a two-vessel coronary artery bypass graft 8 days ago and has been on a ventilator in the surgical intensive care unit since then. Her temperature is now rising and her chest radiograph reveals a new infiltrate in the right lower lobe. Her medical history includes coronary artery disease with a myocardial infarction 2 years ago, COPD, and hypertension. All antipseudomonal antibiotics in the institution are active against at least 90% of strains. BP has no known drug allergies. Which is the best empiric therapy for BP?
Cefepime 2 g IV every 8 hours plus tobramycin 7 mg/kg IV every 24 hours plus vancomycin 15 mg/kg IV every 24 hours
What is the adverse effect of Codeine?
Constipation, addiction, misuse, Respiratory depression
What is the influenza life cycle?
1.)Binding of flu virus to cell receptors (adsorption) 2.)Entry into the cell (endocytosis) 3.)Entry into the nucleus 4.)Transcription, translation, & replication of viral genome segments 5. Release of RNA virus into cytoplasm
What is the MOA of acetaminophen?
Activation of descending serotonergic inhibitory pathways in the CNS
What is the treatment dose of Oseltamivir?
Adult: 75 mg PO BID for 5 days Pediatric (weight-based): Infants: 3 mg/kg/dose BID Children/Adolescents: ≤15 kg: Oral: 30 mg twice daily. >15 to 23 kg: Oral: 45 mg twice daily. >23 to 40 kg: Oral: 60 mg twice daily. >40 kg: Oral: 75 mg twice daily. (Duration 5 days
What is the prophylactic dose of Oseltamivir?
Adult: 75 mg PO daily; usual duration 7 days Pediatric: Weight-based dose given once daily for 7 days
What are the Adamantanes inhibitors?
Amantadine and rimantadine which are both active against influenza A
What is the MOA of chlorpheniramine?
Antihistamine, blocks H1 receptor
What are the Endonuclease inhibitors?
Baloxavir
What is the MOA of Codeine?
Binds to the opiate receptors in the CNS
What is the MOA of Hydrocodone?
Binds to the opiate receptors in the CNS
What do you monitor in Aztreonam?
CBC and LFT
What is the MOA of dextromethorphan?
Decreases the sensitivity of cough receptors and interrupts cough impulse
Which drugs are centrally acting antitussives?
Dextromethorphan, Codeine, Hydrocodone, and Chlorpheniramine
What is the Adverse effects of guaifenesin?
Dizziness, drowsiness, and headache
PE is a 56-year-old man who comes to the clinic with a 3-day history of fever, chills, pleuritic chest pain, malaise, and productive cough. In the clinic, his temperature is 102.1°F (38.9°C) (all other vital signs are normal). His CXR reveals consolidation in the right lower lobe. His white blood cell count (WBC) is 14,400 cells/mm3 (high), but all other laboratory values are normal. He is given a diagnosis of community-acquired pneumonia (CAP). He has not received any antibiotics in 5 years and has no chronic disease states. He is allergic to sulfa drugs.
Doxycycline 100 mg orally twice daily for 5 days
What is the MOA of guaifenesin?
Expectorant, stimulates flow of respiratory tract
Which drugs are peripherally acting antisussives?
Guaifenesin, and Benzonatate
what is the black box warning of Acetaminophen?
Hepatotoxicity
What is the Adverse effects of Acetaminophen?
Hepatotoxicity, nausea, and vomiting
What is the adverse effects of Baloxavir>
Hypersensitivity, diarrhea, and reduces susceptibility to Influenza A
What is the CI in Zanamivir?
In patients with COPD or asthma
What is the black box warning of NSAIDs?
Increased risk of MI, stroke, hypertension, and HF
What is the MOA of Azetreonam?
Inhibits bacterial wall synthesis
What is the MOA of baloxavir?
Is a selective inhibitor of influenza cap dependent endonuclease
What is the Adverse effect of Chlorpheniramine?
Misuse, Constipation, depression, addiction
What is the Adverse effects of Hydrocodone?
Misuse, Constipation, depression, addiction
What adverse effect does Oseltamivir have?
Nausea Vomiting Neuropsychiatric effects (confusion, delirium, hallucination, and/or self-injury)
What is the Adverse effects for aztreonam?
Neutropenia, hepatotoxicity, dirrhea
What are the neuraminidase inhibitors?
Oseltamivir Zanamivir Peramivir
LC is a 6-year-old male who presents with his mom to the clinic with a 24h history of fever and fatigue and decreased oral intake. He weighs 20 kg and has a history of asthma. He tests positive on a rapid screen in the clinic for Influenza A Virus.
Oseltamivir (Tamiflu) 45 mg PO BID for 5 days
LC's mother is concerned about her other son who is 8 years old with a history of leukemia, and lives in the same home. He weighs 30 kg.
Oseltamivir 60 mg PO daily for 7 days
What is the Adverse effects of NSAIDs?
Prolonged bleeding, anemia, acute kidney injuries
What is the Adverse effects of Peramivir?
Serious skin reactions Hypersensitivity Neuropsychiatric events GI upset Neutropenia Hepatotoxicity
What is the adverse effects of Zanamivir?
Sore throat Cough Nasal symptoms Bronchospasm Neuropsychiatric events Allergic reactions
What is the Adverse effect of benzonatate?
Swallow whole, hallucination, sedation, confusion, chills
What is the MOA of amantadine and rimantadine?
Targets the M2 protein of Influenza A
What is the MOA of oseltamivir, Zanamivir, and Peramivir?
interfere with release of progeny influenza virus from infected cells, thereby preventing new rounds of infection
What is the MOA of NSAIDs?
reversibly inhibit the activity of cyclooxygenase- 1 and 2
What is the MOA of benzonatate?
suppresses cough by topical anesthetic action on the respiratory stretch receptors