Anti-Microbials Part 2 Flashcards
1
Q
what is the prophylaxis if patient is at high risk for endocarditis and undergoing surgical or dental procedures?
A
- amoxicillin
2
Q
what is the prophylaxis for exposure to gonorrhea?
A
- ceftriaxone
3
Q
what is the prophylaxis for history of recurrent UTIs?
A
- TMP-SMX
4
Q
what is the prophylaxis to exposure to meningococcal infections?
A
- ceftriaxone
- ciprofloxacin
- rifampin
5
Q
what is the prophylaxis for a pregnant woman carrying gruop B strep?
A
- intrapartum penicillin G
- ampicillin
6
Q
what is the prophylaxis for prevention of gonococcal conjunctivitis in newborns?
A
- erythromycin ointment on eyes
7
Q
what is the prophylaxis for prevention of postsurgical infection due to S. aureus?
A
- Cefazolin
8
Q
what is the prophylaxis for strep pharyngitis in child with prior rheumatic fever?
A
- benzathine penicillin G
- oral penicillin V
9
Q
what is the prophylaxis for exposure to syphilis?
A
- benzathine penicillin G
10
Q
HIV infection for cell count of CD4 < 200 cells/mm3
A
Pneumocystis pneumonia
11
Q
prophylaxis for HIV patients with cell count CD4 < 200 cells/mm3
A
TMP-SMX
12
Q
HIV infection for cell count of CD4 < 100 cells/mm3
A
Pneumocystis pneumonia and toxoplasmosis
13
Q
prophylaxis for HIV patients with cell count CD4 < 100 cells/mm3
A
TMP-SMX
14
Q
HIV infection for cell count of CD4 < 50 cells/mm3
A
Mycobacterium avium complex
15
Q
prophylaxis for HIV patients with cell count CD4 < 50 cells/mm3
A
azithromycin or clarithromycin
16
Q
what are the treatments for MRSA?
A
- vancomycin
- daptomycin
- linezolid
- tigecycline
- ceftaroline
17
Q
what are the treatments for VRE?
A
- linezolid and streptogramins (quinupristin, dalfopristin)
18
Q
what are the treatments for multidrug resistant P. aeruginosa, multidrug resistant Acinebacter baumannii?
A
- polymyxins B and E (colistin)
19
Q
antifungal drugs that disrupt cell membrane integrity
A
- amphotericin B
- nystatin
20
Q
antifungal drugs that inhibit nucleic acid synthesis
A
- flucytosine
21
Q
antifungal drugs that inhibit cell wall synthesis
A
- echinocandins
- anidulafungin
- caspofungin
- micafungin
22
Q
antifungal drugs that inhibit lanosterol synthesis
A
- terbinafine
23
Q
antifungal drugs that inhibit ergosterol synthesis
A
- azoles
- clotrimazole
- fluconazole
- itraconazole
- ketoconazole
- miconazole
- voriconazole
24
Q
amphotericin B–mechanism
A
- binds ergosterol (unique to fungi)
- forms membrane pores that allow leakage of electrolytes
- “amphotericin “tears” holes in the fungal membrane by forming pores”
25
amphotericin B--use
* serious, systemic mycoses
* *Cryptococcus*
* amphotericin B with or without flucytosine for cryptococcal meningitis
* *Blastomyces*
* *Coccidioides*
* *Histoplasma*
* *Candida*
* *Mucor*
* intrathecally for fungal meningitis
26
what should you supplement amphotericin B use with and why?
* K+ and Mg+ b/c of altered renal tubule permeability
27
amphotericin B--toxicity
* fever/chills--"shake and bake"
* hypotension
* nephrotoxicity
* arrhythmias
* anemia
* IV phlebitis--"**amphloterri**ble"
28
what decreases the risk of nephrotoxicity from taking amphotericin B?
* hydration
29
what decreases toxicity from taking amphotericin B?
* liposomal amphotericin
30
nystatin--mechanism
* same as amphotericin B
* binds ergosterol (unique to fungi)
* forms membrane pores that allow leakage of electrolytes
* topical use only as too toxic for systemic use
31
nystatin--use
* "swish and swallow" for oral candidiasis (thrush)
* topical for diaper rash or vaginal candidiasis
32
flucytosine--mechanism
* inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase
33
flucytosine--use
* systemic fungal infections (especially meningitis caused by *Cryptococcus*) in combination with amphotericin B
34
flucytosine--toxicity
* bone marrow suppression
35
name the azoles
* clotrimazole
* fluconazole
* itraconazole
* ketoconazole
* miconazole
* voriconazole
36
azoles--mechanism
* inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P-450 enzyme that converts lanosterol to ergosterol
37
azoles--use
* local and less serious systemic mycoses
38
fluconazole--use
* (azole)
* chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types
39
itraconazole--use
* (azole)
* *Blastomyces*
* *Coccidioides*
* *Histoplasma*
40
clotrimazole and miconazole--use
* (azole)
* for topical fungal infections
41
azoles--toxicity
* testosterone synthesis inhibition
* gynecomastia, especially with ketoconazole
* liver dysfunction
* inhibits cytochrome P-450
42
terbinafine--mechanism
* inhibits the fungal enzyme squalene epoxidase
43
terbinafine--use
* dermatophytoses
* especially onychomycosis--fungal infection of finger or toe nails
44
terbinafine--toxicity
* GI upset
* headaches
* hepatotoxicity
* taste disturbance
45
name the echinocandins
* anidulafungin
* caspofungin
* micafungin
46
echinocandins--mechanism
* inhibit cell wall synthesis by inhibiting synthesis of beta glucan
47
echinocandins--use
* invasive aspergillosis
* *Candida*
48
echinocandins--toxicity
* GI upset
* flushing (by histamine release)
49
griseofulvin--mechanism
* interferes with microtubule function
* disrupts mitosis
* deposits in keratin containing tissues
* ie. nails
50
griseofulvin--use
* oral treatment of superficial infections
* inhibits growth of dermatophytes (tinea, ringworm)
51
griseofulvin--toxicity
* teratogenic
* carcinogenic
* confusion
* headaches
* inc cytochrome P-450
* inc warfarin metabolism
52
antiprotozoan therapy
* pyrimethamine--toxoplasmosis
* suramin and melarsoprol--*Trypanosoma brucei*
* nifurtimox--*T. cruzi*
* sodium stibogluconate--leishmaniasis
53
anti mite/louse therapy
* permethrin
* malathion
* lindane
* used to treat scabies (*Sarcoptes scabei*) and lice *(Pediculus* and *Pthirus*)
* "treat **PML (P**esty **M**ites and **L**ice) with **PML (P**ermethrin, **M**alathion, **L**indane), b/c they **NAG** you (**N**a, **A**ChE, **G**ABA blockade)"
54
permethrin--mechanism
* (anti-mite/louse therapy)
* blocks Na+ channels --\> neurotoxicity
* "treat **PML** (**P**esty **M**ites and **L**ice) with **PML** (**P**ermethrin, **M**alathion, **L**indane), b/c they **NAG** you (**N**a, **A**ChE, **G**ABA blockade)"
55
malathion--mechanism
* (anti mite/louse therapy)
* acetylcholinesterase inhibitor
* "treat **PML** (**P**esty **M**ites and **L**ice) with **PML** (**P**ermethrin, **M**alathion, **L**indane), b/c they **NAG** you (**N**a, **A**ChE, **G**ABA blockade)"
56
lindane--mechanism
* (anti mite/louse therapy)
* blocks GABA channels --\> neurotoxicity
* "treat **PML** (**P**esty **M**ites and **L**ice) with **PML** (**P**ermethrin, **M**alathion, **L**indane), b/c they **NAG** you (**N**a, **A**ChE, **G**ABA blockade)"
57
chloroquine--mechanism
* blocks detoxification of heme into hemozoin
* heme accumulates and is toxic to plasmodia
58
chloroquine--use
* treatment of plasmodial species other than *P. falciparum*
* frequency of resistance in *P falciparum* is too high
59
why does *P. falciparum* have high resistance to chloroquine and how should you treat it?
* resistance due to membrane pump that dec intracellular concentration of drug
* treat with artemether/lumefantrine or atovaquone/proguanil
60
how should you treat malaria?
* quinidine in US (quinine elsewhere)
* artesunate
61
chloroquine--toxicity
* retinopathy
* pruritis--especially in dark skinned individuals
62
antihelminthic therapy
* Mebendazole--microtubule inhibitor
* pyrantel pamoate
* ivermectin
* diethylcarbamazine
* praziquantel
63
oseltamivir, zanamivir--mechanism
* inhibit influenze neuroaminidase --\> dec release of progeny virus
64
oseltamivir, zanamivir--use
* treatment and prevention of both influenza A and B
65
acyclovir, famciclovir, valacyclovir--mechanism
* guanosine analogs
* monophosphorylated by HSV/VZV thymidine kinase and not phosphorylated in uninfected cells --\> few adverse effects
* triphosphate formed by cellular enzymes
* preferentially inhibit viral DNA Polymerase by chain termination
66
acyclovir, famciclovir, valacyclovir--use
* HSZ and VZV
* weak activity against EBV
* no activity against CMV
* used for HSV-induced mucocutaneous and genital lesions as well as for encephalitis
* prophylaxis in immunocompromised patients
* no effect on latent forms of HSV and VZV
67
valacyclovir vs. acyclovir
* valacyclovir is a prodrug of acyclovir
* valacyclovir has better oral availability
68
acyclovir, famciclovir, valacyclovir--toxicity
* obstructive crystalline nephropathy
* acute renal failure
* both may occur if not adequately hydrated
69
acyclovir, famciclovir, valacyclovir--mechanism of resistance
* mutated viral thymidine kinase
70
ganciclovir--mechanism
* 5' monophosphate formed by a CMV viral kinase
* guanosine analog
* triphosphate formed by cellular kinases
* preferentially inhibits viral DNA polymerase
71
ganciclovir--use
* CMV--especially in immunocompromised patients
72
vanganciclovir vs. ganciclovir
* vanganciclovir is a prodrug of ganciclovir
* vanganciclovir has better oral availability
73
ganciclovir--toxicity
* bone marrow suppression--leukopenia, neutropenia, thrombocytopenia
* renal toxicity
* more toxic to host enzymes than acyclovir
74
ganciclovir--mechanism of resistance
* mutated viral kinase
75
foscarnet--mechanism
* viral DNA/RNA polymerase inhibitor
* HIV reverse transcriptase inhibitor
* binds to pyrophosphate binding site of enzyme
* does not require any kinase activity
* "**fos**carnet = pyro**fos**phate analog"
76
foscarnet--use
* CMV retinitis in immunosompromised patients when ganciclovir fails
* acyclovir resistant HSV
77
foscarnet--toxicity
* nephrotoxicity
* electrolyte abnormalities can lead to seizures
* hypo/hypercalcemia
* hypo/hyperphosphatemia
* hypokalemia
* hypomagnesemia
78
foscarnet--mechanism of resistance
* mutated DNA polymerase
79
cidofovir--mechanism
* preferentially inhibits viral DNA polymerase
* does not require phosphorylation by virla kinase
80
cidofovir--use
* CMV retinitis in immunocompromised patients
* acyclovir resistant HSV
* long half life
81
cidofovir--toxicity
* nephrotoxicity
82
how to decrease possible toxicity of cidofovir?
* coadminister with probenecid and IV saline
83
HIV therapy
* highly active antiretroviral therapy (HAART)
* often initiated at the time of HIV diagnosis
84
what does the highly active antiretroviral therapy for HIV consist of?
* 3 drugs to prevent resistance
* 2 NRTIS
* 2 integrase inhibitor
85
what are the strongest indications for patients to receive HAART?
* AIDS defining illness
* low CD4+ cell counts (\<500 cells/mm3)
* high viral load
86
what are the 5 classes of HIV therapy drugs?
* NRTIs
* NNRTIs
* protease inhibitors
* integrase inhibitors
* fusion inhibitors
87
name the NRTIs
* Abacavir (ABC)
* DIdanosine (ddl)
* Emtricitabine (FTC)
* Lamivudine (3TC)
* Stavudine (d4T)
* Tenofovir (TDF)
* Zidovudine (ZDV, formerly AZT)
88
NRTIs--mechanism
* competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (lack a 3' OH group)
89
which of the NRTIs are nucleotides? which are nucleosides?
* **T**enofovir is a nucleo**T**ide
* the others are nucleosides and nee to be phosphorylated to be active
* "Ha**ve you dined (vudine)** with my **nuclear** (**nucleo**sides) family?"
90
what is special about Zidovudine (ZDV)?
* can be used as a general prophylaxis
* can be used during pregnancy to dec risk of fetal transmission
91
when is Abacavir (ABC) contraindicated?
* when the patient has an HLA-B\*5701 mutation
92
NRTIs--toxicity
* bone marrow suppression--can be reversed with granulocyte colony stimulating factor (G-CSF) and erythropoietin
* peripheral neuropathy
* lactic acidosis--nucleosides
* anemia--ZDV
* pancreatitis--didanosine
93
name the 3 NNRTIS
* delavirdine
* efavirenz
* nevirapine
94
NNRTIs--mechanism
* bind to reverse transcriptase at site different from NRTIs
* do not require phosphorylation to be active or compete with nucleotides
95
what are common toxicity signs for all NNRTIs?
* rash
* hepatotoxicity
96
efavirenz--toxicity
* (NNRTI)
* vivid dreams
* CNS symptoms
97
what is a contraindication for delavirdine and efavirenz?
* (NNRTI)
* pregnancy
98
name the **protease** inhibitors
* ataza**navir**
* daru**navir**
* fosampre**navir**
* indi**navir**
* lopi**navir**
* rito**navir**
* saqui**navir**
* ****"**Navir** (never) **tease** a **protease**"
99
protease inhibitors--mechanism
* assembly of virions depends on HIV-1 protease (pol gene) which cleaves the polypeptide products of HIV mRNA into their functional parts
* so, pretease inhibitors prevent maturation of new viruses
100
what is important about ritonavir?
* (protease inhibitor)
* can "boost" other drug concentrations by inhibiting cytochrome P-450
101
protease inhibitors--toxicity
* hyperglycemia
* GI intolerance--nausea, diarrhea
* lipodystrophy--Cushing like syndrome
102
indinavir--toxicity
* (protease inhibitor)
* nephropathy
* hematuria
103
why is rifampin contraindicated with protease inhibitors?
* rifampin is a potent CYP/UGT inducer
* contraindicated with protease inhibitors b/c it can decrease protease inhibitor concentration
104
name the in**tegr**ase inhibitors
* ral**tegr**avir
* elvi**tegr**avir
* dolu**tegr**avir
105
integrase inhibitors--mechanism
* inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase
106
integrease inhibitors--toxicity
* inc creatine kinase
107
name the fusion inhibitors
* enfuvirtide
* maraviroc
108
enfurvirtide--mechanism
* (fusion inhibitor)
* binds gp41 to inhibit viral entry
109
enfurvirtide--toxicity
* skin rxn at injection site
110
maraviroc--mechanism
* (fusion inhibitor)
* binds CCR-5 on surface of T cells/monocytes which inhibit interaction with gp120
111
interferons--mechanism
* glycoproteins normally synthesized by virus-infected cells
* exhibit a wide range of antiviral and antitumoral properties
112
INF alpha--use
* chronic hepatitis B and C
* Kaposi sarcoma
* hairy cell leukemia
* condyloma acuminatum
* renal cell carcinoma
* malignant melanoma
113
IFN beta--use
* multiple sclerosis
114
IFN gamma--use
* chronic granulomatous dz
115
interferon--toxicity
* flu like symptoms
* depression
* neutropenia
* myopathy
116
name the hepatitis C therapy drugs
* ribavirin
* sofosbuvir
* simeprevir
117
ribavirin--mechanism
* inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
118
ribavirin--use
* chronic HCV
* also used in RSV
* palivizumab preffered in children
119
ribavirin--toxicity
* hemolytic anemia
* severe teratogen
120
sofosbuvir--mechanism
* inhibits HCV RNA dependent RNA polymerase acting as a chain terminator
121
sofosbuvir--use
* chronic HCV in combination with ribavirin
* +/- peginterferon alfa
* do not use as monotherapy
122
sofosbuvir--toxicity
* fatigue
* headache
* nausea
123
simeprevir--mechanism
* HCV protease inhibitor
* prevent viral replication
124
simeprevir--use
* chronic HCV in combination with ledipasvir (NS5A inhibitor)
* do not use as monotherapy
125
simeprevir--toxicity
* photosensitivity rxns
* rash
126
what is the goal of infection control techniques?
* reduction of pathogenic organism counts to safe levels--disinfection
* inactivation of self propagating biological entities--sterilization
127
list 5 infection control techniques
* autoclave
* alcohols
* chlorhexidine
* hydrogen peroxide
* iodine and iodophors
128
explain autoclave
* pressurized steam at \> 120 deg C
* may be sporicidal
129
explain alcohols (as an infection control technique)
* denature proteins and disrupt cell membranes
* not sporicidal
130
explain chlorhexidine
* denatures proteins and disrupts cell membranes
* not sporicidal
131
explain hydrogen peroxide as an infection control technique
* free radical oxidation
* sporicidal
132
explain iodine and iodophors as an infection control technique
* halogenation of DNA, RNA, and proteins
* may be sporicidal
133
name tha antimicrobials to avoid during pregnancy
* **S**ulfonamides
* **A**minoglycosides
* **F**luoroquinolones
* **C**larithromycin
* **T**etracyclines
* **R**ibavirin
* **G**riseofluvin
* **C**hloramphenicol
* "**SAF**e **C**hildren **T**ake **R**eally **G**ood **C**are"
134
what is the adverse effec tof sulfonamides during pregnancy?
kernicterus
135
what is the adverse effect of aminoglycosides during pregnancy?
ototoxicity
136
what is the adverse effect of fluoroquinolones during pregnancy?
cartilage damage
137
what is the adverse effect of clarithromycin during pregnancy?
embryotoxic
138
what is the adverse effect of tetracyclines during pregnancy?
* discolored teeth
* inhibition of bone growth
139
what is the adverse effect of ribavirin during pregnancy?
teratogenic
140
what is the adverse effect of griseofulvin during pregnancy?
teratogenic
141
what is the adverse effect of chloramphenicol during pregnancy?
Gray baby syndrome
