antibiotics, antivirals, antihelminthics, antifungals, antiparasitics Flashcards
categories, idications, drug interactions, adverse reactions activity (166 cards)
1
Q
Categories of antibiotics
A
PCNs, cephalosporins, macrolids, fluoroquinolones, lincoside, azalides, ketolides, oxalodinones, sulfonamides, trimethaprim, nitrofurantoin, tetracycline, vancomycin, antimycobacterials
2
Q
What are the main causes of antimicrobial resistance?
A
Overuse of broad spectrums, use in children under 2 and older than 65, day care centers, exposure to young children, multiple medical comorbidities, immunosuppression
3
Q
What is an antibiogram?
A
Chart that shows antibiotic resistance in your area
4
Q
What vaccination has decreased antibiotic resistance?
A
Pneumococcal vaccine
5
Q
What are PCNs and cephalosporins known as?
A
Beta-lactmas
6
Q
How do beta lactams kill bacteria?
A
Inhibits peptidogylcan in cell walls; leads to cell lysis
7
Q
What bacteria are the natural PCNs good against?
A
Streptococcus, some Enterococcus, some non-penicillinase producing staphylococcus
8
Q
Which PCN is more able to attack gram negative?
A
Ampicilllin, because it can more easily penetrate outer membrance
9
Q
What strains is ampicillin effective against?
A
gram negative UTI and GI, like E coli, P. mirabilis, salmonella, some shigella and some enterrococcus
10
Q
What respiratory pathogens is ampicillin effective against?
A
moraxella catarrhalis and H influenzae type by
11
Q
What are often combined with beta lactams to broaden their spectrum of activity?
A
clavulanate, tazobactam, slbactam
12
Q
How are PCNs absorbed?
A
Well absorbed in GI, some affected by acid
13
Q
Which PCNs are absorbed the best?
A
Doxacillian and amoxicillin better than ampicillin
14
Q
What is the distribution, metabolism and excretion of PCNs?
A
Most bound to plasma proteins, well distributed, small amount metabolized, largely in urine
15
Q
What drug prolongs the half-life of PCNs and increases its risk for toxicity?
A
Probenecid
16
Q
What are the most common adverse reactions of PCNs?
A
- allergic reactions within 2 to 30 minutes; can be relieved by desensitization therapy
- rash that is not allergic within 7 to 10 days
- GI stuff made worse by clavulanate
- Fungal overgrowth and C diff
17
Q
What pregnancy category are PCNs?
A
Category b
18
Q
What are PCNs primarily used for, and dosing?
A
- infections seen in primary care
- first line for AOM and sinusitis
- Streptococcal pharyngitis (strep A)
- UTI in pregnant women
19
Q
What is the first line of treatment for bites?
A
Amoxicillin-clavulanate
20
Q
What are key considerations in rational drug selection?
A
rapid strep test vs. empirical, and cost
21
Q
What should be monitored in PCNs?
A
symptom relief , possible resistance, possible viral
22
Q
What should patient education of PCNs be?
A
course completion, resistance, adverse reactions
23
Q
How do cephalosporins work?
A
inhibit mucopeptide synthesis in cell wall, leads to lysis
24
Q
How many generations of cephalosporins are there?
A
4 primary
25
What are the first generation cephalosporins active against?
skin and soft tissue infections caused by gram positive bacteria like s. aureus and s. epidermis
26
What are second generation cephalosporins active against?
same as first generation plu kiebsiella, proteus, and E coli
27
What are third generation cephalospoins goos against?
broader spectrum and better against gram negative
28
What are fourth generation cephalosporins good for?
They are resistant to beta lactamase and are active against both gram positive and gram negative bacteria.
29
What is a hospital associated pathogen that fourth generation cephalosporins are active against?
Pseudenomas
30
How are cephalosporins absorbed, metabolized, and excreted?
absorbed in GI, widely distributed to tissues, mostly bound to proteins; some metabolites formed, most excreted through kidneys, varying degrees of unchanged drug in urine
31
What are adverse drug reactions assoicated with cephalosporins?
allergies, skin rashes, arthalgia, coagulation abnormalities, anemai, neutropenia, leukopenia, thrombocytosis, fever, seizures, renal/hepatic failure
32
What are cephalosporins used for, and dosing?
Used in acute otitis media when PCNs have failled;
The first generations are used for strep pharyngitis and skin infections;
They can be used as second line drugs for UTIs
Several can be used for comunity acquired pneumonia
33
What should be monitored with cephalosporins
C diff and renal function
34
What is patient education for cephalosproins?
Use as prescribed
35
How do fluoroquinolones work?
Interfere with enzyme needed for DNA synthesis
36
What bacteria are fluoroquinolones really good against?
gram negative
37
Which population should not receive fluoroquinolones?
Children under age of 18
38
What can fluoroquinolones no longer be used for because of resistance?
Gonorrhea and resistance TB
39
How should fluoroquinolones be taken?
On empty stomach for good absorption
40
What is the black box warning for fluoroquinolones?
tendon rupture
41
What are other adverse reactions of fluoroquinolones?
C diff, CNS symptoms, renal/hepatic failure, cardiovascular issues and arrythmias, pregnancy issues
42
What are the clinical uses for fluoroquinolones?
complicated UTIs, kidney infections, complicated bacterial prostatitis
pneumonia and chornic bonchitis exacerbation
PCN-resistant S. pneumonia, skin infections, bone/joint infections, serious intraabdominal diarrhea
43
What should be monitored for when using fluoroquinolones?
watch for prolonged use, in high risk patients get EKG before using moxifloxacin, alcohol use, tendonitis rupture
44
What should patient education for fluoroquinolones be?
food delays absorption, lots of drug interactions, take with a glass of water, watch out for dizziness, if tendon tenderness stop and notify doctor
45
What is the only used drug of the lincosides?
Clindamycin (Cleocin)
46
What is Clindamycin used for?
only gram positive: corynbacterium acnes, garnarella vaginallis, some MRSA
47
What does Clindamycin not work against?
gram negative
48
How is clindamycin absorbed?
Oral completely absorbed, not affected by gastric acid
49
What are adverse drug reactions associated with clindamycin?
severe colitis, dermatological stuff, thrombocytopenia, neutropenia, eosinophilia
50
What is clindamycin used for, and dosing?
First line for MRSA in some areas, used in PCN resistnat patients, resistant strep pneumonia, dental infections
51
What is the rational drug selection for clindamycin?
It's considered 2nd line, and only has narrow spectrum aerobic activity; it can be first line in children and pregnancy
52
What should be monitored for with clindamycin?
diarrhea, especially C diff potential
53
What should patients be educated about with clindamycin?
diarrhea and C diff, finish therapy
54
What is a well known drug from the macrolides, azalides, and ketolides?
Erythromycin
55
How do macrolides work?
inhibits ribosome protein synthesis
56
What makes macrolides increase in activity
alkaline environments/media
57
What kinds of bacteria are susceptible to macrolides?
atypicals and intracellular organisms that are resistant to beta lactams
58
What is the resistance in macrolides like?
Cross resistance to all in the class
59
Describe absorption and metabolism for macrolides?
Well absorbed in duodenum; inhibitors of CYP 450 enzyme
60
What happens when macrolides are combined with statins?
Increases risk of myopathy
61
What unusual thing does macrolides do after absorption?
Enterohepatic recycling, which leads to build up in system; causes N/V; levels higher in tissues than in serum
62
What are precautions for macrolides?
Statins; safe in pregnancy and children
63
What are adverse drug reactions in macrolides?
dose related GI issues, N/V/D, abdominal cramping
| skin issues, Steven-Johnson
64
What are drug interactions of macrolides?
statins, CYP 450 enzyme
65
What are clinical dosing and use of macrolides?
primary use for mycoplasm community acquired pneumonia (zithromax); chlamydia, pertussis, H. pylori (clarithromycin), chronic bronchitis
66
What is the rational drug selection for macrolides?
alternative to PCn allergy, inreasing resistance, don't use for AOM or sinusitis
67
What should be montiored for with macrolides?
altered metabolism responses to other drugs by CYP450 and 2C9; hepatic/renal problems, hearing loss
68
What should patients be educated about with macrolides?
ADR and drug interactions
69
How do sulfonamides work?
inhibit folic acid synthesis
70
How does trimethaprim work?
inhibits DNA synthesis
71
How does nitrofurantoin work?
inhibits acetyl coenzymes
72
What kind of bacteria are sulfonamides, trimethaprim, and nitrofurantoin effective against?
Gram positive and gram negative
73
What specific bacteria can s, t, and n be used with?
E coli, s. pyogenes, s. pneumonia, h. influenze, and some protozoa
74
What are adverse drug reactions of s, t, and n?
GI issues, stomatitis, rashes, hypersensitivity, photosensitivity, CNS, dizziness, drug interactions
75
When should s, t, and/or n be avoided?
G6PD defiency
76
What is the clinical use and dosing of s, t, and n?
Mostly UTI, sometimes MRSA
77
What is the rational drug selection for s, t, and n?
lost cost alternative in children when they have PCN allergies
78
What should be monitored with s, t, and n?
control in UTI, CBC if using long term, chest xray if cough with nitrofurantoin
79
What is the patient education for s, t, and n?
Finish course, ADRs, reactions
80
What is the primary drug in oxazolidinones?
Linezolid
81
How does linezolid work?
inhibits ribosomal protein synthesis
82
What is linezolid most helpful against?
aerobic gram positive
83
What is the absorption for linezolid?
well absorbed orally, doesn't interfere with CYP450 enzymes
84
What are ADRs with linezolid?
D/HA/N, myelosuppression that resolves after quitting drug
85
When should linezolid be used?
pneumonia and complicated skin infections, but try less expensive drugs first
86
What is the rational drug selection for linezolid?
high cost, use if resistance to vanc is a problem
87
What is the patient education for linezolid?
ADRs and patient administration
88
What are the two main drugs in the tetracyclines?
Tetracycline and doxycycline
89
How do tetracyclines work?
they bind to the 30S unit of the ribosome
90
How is absorption of tetracylcines affected?
Food, milk and calcium decrease absorption
91
What are precautions and contraindications with tetracyclines?
don't give to pregnant or lactating women, children less than 8 because of dental issues
92
What are the drug interactions with tetrayclines?
many
93
What is the clinical use and dosing for tetracylcines
doxycycline is first line for trachomatis and U.urealyticum, p. acnes, and some h. pylori regimens
94
What is the rational drug selection for doxycycline?
doxycycline and minocycline can be taken with food; tetracycline not so great anymore b/c of resistance
95
What is patient education for tetracyclines
administration, AdRs, avoid during pregnancy
96
What is an example of a lipoglycopeptide?
Vancomycin, telavancin, and dalbavancin
97
What are lipoglycopeptides used for?
severe gram positive infections that are resistant to first line
98
How do lipoglycopeptides work?
Inhibit cell wall synthesis
99
How are lipoglycopeptides abosrbed?
Not well orally, given IV
100
What are ADRs for lipoglycopeptides?
ototoxicity, nephrotoxicity, Red Man syndrome if given too fast
101
What is the clinical use and dosing for lipoglycopeptides?
serious gram positive when MRSA coverage is necessary or there are PCN issues
102
What should be monitored for with lipoglycopeptides?
Hearing and renal function
103
What should patient education for lipoglycopeptides be?
Administration and ADRs
104
What are mycobacteria?
Slow growing bacteria that are resistant to drugs that depend on how rapidly cells divide
105
What makes mycobacteria resistant to drugs?
Lipid rich cell wall
106
What is unique about mycobacteria?
They can go dormant and easily become resistant to single drugs
107
What are the main mycobacterials?
isoniazid, ethambutol, and rifampin
108
How do isonizaid, ethambutol, and rifampin work?
INH and ethambutol inhibit synthesis of mycolic acides, ehtambutol inhibits arabinogalactan needed for cell walls, rifampin binds to subunit of RNA polymerase and inhibits RNA synthesis
109
What are the resistant issues with mycobacteria drugs?
Quickly develop resistance, cross resistance with INH and ethionamide
110
How are mycobacteria drugs absorbed?
Well absorbed orally, metabolism of INH varies widely, dependent on acetylator status
111
What are the ADRs of antimycobacterials?
INH: peripheral neuropathy,
INH, rimfapin, and pyrazinamide: hepatotoxicity
ethambutol: optic neuritis
streptomycin and capreomycin are ototoxic
Rifabutin: thrombocytopenia and neutropenia
112
What are the drug interactions of antimycobacterials?
many drug interactions; rifampin is CYP450 inducer
113
What is the clinical use and dosing for antimycobacterials?
Follow CDC guidelines, TB requires 4 drug therapy, Preventive therapy with INH
114
What is rational drug selection for antimycobacterials?
Follow CDC guidelines
115
How should antimycobacterials be montiored?
Directly observed
116
What is the patient education for antimycobacterials?
Take medications daily, report ADRs
117
What are nucleoside analogues for?
antirvirals
118
How do nucleoside analogues work?
block entry to cells or be active inside cells to be effective
119
What is acyclovir active against?
herplex simplex 1 and 2, varicella-zoster, epstein-barr, cytomegalovirus and herpes virus 6
120
What is valacyclovir good against?
converts to acyclovir and then active against same things
121
What is famciclovir good against?
HS1-2, VZ, EB, and Hep B
122
What is ganciclovir good for?
CMV
123
What are ADRs of the nucleoside analogues?
acyclovir: few when given orally
valacyclovir can causes thrombocytopenia pupura and hemolytic uremia in immunosuppressed
famciclovir causes headeache
Ganciclovir can cause blood cell issues, carcinogenic
124
What are the drug interactions of nucleoside analogues?
Few
125
What are the clinical uses and dosing for nucleoside analogues?
herpes simplex genital herpes intial outbreak and suppression;
Herpes zoster (shingles) start within 3 days;
Varicella (chickenpox) start within 24 hours;
gingivostomatitis in children
Bell's palsy
126
What are the rational drug choices regarding nucleoside analogs?
Choice based on cost and convience
127
What is the monitoring for nucleoside analogs?
monitoring rash, temperature, BUN and creatinine in high risk patients
128
What is the patient education for nucleoside analogs?
Start drug at earliest sign of infection, stay hydrated, and teach signs of renal failrue, encephalopathy, and blood dyscrasias
129
What are the main antivirals for influenza?
oseltamivir (tamiful), peramivir (rapivab), and zanamivir (Relenza)
130
Which flus do the influenza antivirals treat?
A and B
131
What are the pharmacodynamics of the flu antivirals?
Sensitivity varies each year; rimartidine and amratidine have resistance - no longer recommended for the flu
132
Describe absorption for flu antivirals?
oseltamiviir is well absorbed orally; Zanamivir is inhaled with less than 17% absorption; peramivir is givene IV
133
What are the adverse drug reactions for flu antivirals?
Zanamivir: bronchitis and SOB
134
What is the clinical use and dosing for flu antivirals?
oseltamivir and zanamivir good for prophylaxis and treatment of A and B; peramivir is only for acute flu in those 18 or older; CDC guidelines need to be evaluted annually
135
What should be montiored for with the flu antivirals?
renal function in older people, hallucinations, confusion and cognitive impairment in elderly
136
What is the patient education for flu antivirals?
complete full course of therapy, ADRs, get flu vaccination every year
137
What type of drug are system azoles?
Anti-fungals
138
What are the polyene macrolides?
Anti-fungals amphotericin B and nystatin
139
What azoles have broad spectrum activity?
butoconazole, clotrimazole, ketoconazole, minonazole, terconazole, etc.
140
What kind of anti-fungals are good against yeast and dermatophytes?
alklyamines
141
What are examples of the alklyamine anti-fungals?
naftifine, terbinafine
142
What are nuclear acid synthesis inhibitors for?
anti-fungal
143
What is an example of a nuclear acid synthesis inhibitor?
flucytosine
144
What is griseofulvin?
An anti-fungal
145
What are the pharmokinetics of antifungals?
absorption of itraconazole is enhanced by food;
absorption of griseofulvin is enhanced by fat;
fluconazole inhibits CYP450 and 2C9
itraconazole and ketoconazole inhibit CYP450
146
What are the adverse drug reactions of the antifunglas?
hepatotoxicity
147
What are the drug interactions of anti fungals?
Many mess with CYP 450
148
What is the clinical use and dosing for antifungals?
oral fungals treat yeast and dermatophytes, and invasive systemic mycoses; fluconazole requries a loading dose
149
What is the rational drug selection for anti-fungals?
Fluconazole has the fewest drug interactions
150
What should be monitored with the anti fungals?
ketoconazole needs liver enzyames and bilirubin every 3-4 months
151
What is patient education for antifungals?
take with food, don't use alcohol, watch for signs fo liver damage
152
How do antihelminthics work?
intestintal nematodes treated with mebendazole, pryantel, and thiabendazole;
tissue nematodes treated with mebendazole, thiabendazole, ivermectin, and albendazole
153
How many cases of pinworm are treated yearly in the US?
50 million
154
What are the adverse drug reactions for antihelminthics?
N/V/D, abdominal pain, mebendazole can cause neutropenia, Ivermectin can cause Mazzotti reaction.
155
What is the clinical use and dosing for antihelminthics?
pinworms: single dose of mebendazole or pyrantel, or albendazole;
whipworms: mebendazole, albendazole, or pyrantel;
round worms: mebendazole;
hookworms: mebendazole, albendazole, pyrantel
threadworm: ivermectin or thiabendazole
scabies: off label ivermectin in immunocomprimised people
156
What is the rational drug selection for antihelminthics?
See CDC guidelines
157
What should be monitored for with antihelminthics?
albendazole and mebendazole need to be given with high fat meal;
Ivermectin should be taken without food;
Albendazole should not be taken during pregnancy and there should be back up contraceptive
158
What is metronidazole?
Treats both bacterial and parasitic infections;
| Good against trichonomas, amoebas, h. pylori, and C fdiff
159
What is nitazoxanide for?
Treats giardia and cryptosporidium
160
What is tinidazole for?
amoebas, giardia, and trichonomas
161
What are the pharmakinetics of metrinodazole?
Well absorbed orally
162
What are the ADRs with the antiparasitic drugs?
mitronidazole can cause anorexia, N/V, metallic taste, abdominal pain
163
What is the clinical use and dosing for the antiparasitics?
metronidazole and tinidazole are for protozoan infections;
| metronidazole can help with anaerobic bacterial infections, vaginosis, and is used in H. pylori treatment
164
What is the rational drug selection for the antiparasitics?
metronidazole is cheap, don't use during first trimester of pregnancy
165
What should be monitored with the anti parasitics?
resolution and signs of neutropenia
166
What is the patient education for antiparasitics?
administration, metallic taste, avoid alcohol, partner might also need treatment
