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antimicrobials II Flashcards

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1
Q

TB prophylaxis

A

Isonizaid

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2
Q

TB Tx

A 
RIPE
Rifampin
Isoniazid
Pyranxinamdie
Ethambutal
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3
Q

MAI prophylaxis

A

azithromycin

rifabutin

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4
Q

MAI Tx

A

more drug resistent then TB
azithromycin or clartithromycin + ethambutol
add rifabutin or ciprofloxacin

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5
Q

M. leprae Tx

A

long-term w/dapsone and rifampin for tuberculoid form

add clofazimine for lepromatous form

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6
Q

what blocks mycolic acid synthesis

A

Isoniazid

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7
Q

what blocks arabinoglycan synthesis

A

ethmbutol

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8
Q

what blocks DNA-dependent RNA polymerase?

A

ribambutin

rifampin

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9
Q

what works intracellularly via unclear MOA

A

pyrazinamide

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10
Q

rifamycins

A

rifampin

rifabutin

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11
Q

rifamycins MOA

A

inhibit DNA-dependent RNA polymerase

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12
Q

rifamycins uses

A

TB
delay resistance to dapsone in leprosy
meningococcal prophylaxis and H. influenza prophylaxis in exposed kids

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13
Q

rifamycins ADRs

A

minor hepatotoxicity and DDIs (increase P-450)
orange body fluids
rifabutin > rifampin in HIV pts

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14
Q

rifamycins resistance

A

mutations reduce drug binding to RNA

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15
Q

rifampins acronym

A 
4Rs:
RNA polymerase inhibitor
Ramps up P-450
Red/orange body fluids
Rapid resistance if used alone
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16
Q

isoniazid MOA

A

decrease synthesis or mycolic acids

bacterial catalase peroxidase (KatG) needed to convert INH to active metabolite

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17
Q

isoniazid uses

A

TB
only agent that can be used solo
strongly affected by acetylation rates

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18
Q

isoniazid ADRs

A

INH: Injures Neurons and Hepatocytes
neurotoxic
hepatotoxic
pyridoxine (B6) can prevent neurotoxicity

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19
Q

isoniazid resistance

A

mutations leading to underexpression of KatG

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20
Q

pyrazinamide MOA

A

unknown, prpdrug

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21
Q

pyrazinamide uses

A

TB

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22
Q

pyrazinamide ADRs

A

hyperuricemia

hepatotoxic

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23
Q

ethambutol MOA

A

decreaes carbohydrate polymerization of mycobacterium cell wall by blocking arabinoxyltransferase

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24
Q

ethambutol uses

A

TB

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25
ethambutal ADRs
``` optic neuropathy (red-green color blindness) pronounce eye-thambutal ```
26
high risk for endocarditis and undergoing surgical or dental procedures prophylaxis
amoxicillin
27
exposure to gonorrhea prophylaxis
ceftriaxone
28
recurrent UTIs prophylaxis
TMP-SMX
29
exposure to meningococcal prophylaxis
ceftriaxone cipro rifampin
30
prego w/grp B strep
Penicillin G
31
prevention of gonococcal conjunctivitis in newborn
erthyromycin ointment
32
prevention of postsurgical S. aureus
Cefazolin
33
prevention of strep pharyngitis in kid w/prior rheumatic fever
bezathine penicillin G | PO penicillin V
34
exposure to syphilis
bezathine penicillin G
35
prophylaxis when CD4
TMP-SMX for pneumocystis pneumonia
36
prophylaxis when CD4
TMP-SMX for pneumocystis pneumonia and toxo
37
prophylaxis wheN CD4
azithromycin or clarithromycin for MAI
38
Tx MRSA
``` Vanco daptomycin linezolid tigecycline ceftaroline ```
39
Tx VRE
linexolid | streptogramins
40
Tx multi drug resistant P. aeruginosa
Polymyxins B and E (colistin)
41
Tx multi drug resistant acinetobacter baumannii
polymyxins B and E (colistin)
42
lanosterol synthesis inhibitor
terbineafine
43
ergosterol synthesis inhibitors
-azole
44
cell wall synthesis inhibitors
echinocandins | -fungin
45
forms membrane pores
polyens: - amphotercin B - Nystatin
46
nucleic acid synthesis inhibitors
flucystosine
47
amphotericin B MOA
binds ergosterol and forms pores | amphoTERicin -> tears holes
48
amphotericin B uses
``` serious systemic mycoses cryptococcus blastomyces histoplasma candida mucor intrathecally for fungal menigitis must supplement K and Mg d/t altered renal tubule permeability ```
49
amphotericin B ADRs
``` aka amphoterrible fever/chills (shake and bake) hypotension nephrotoxic (overhydrate to prevent) arrrhythmias anemia IV phlebitis ```
50
Nystatin MOA
same as amphotericin B
51
nystatin uses
too toxic for systemic use swish and swallow for oral candidasis topical for diaper rash or vaginal candisasis
52
flucytosine MOA
inhibits DNA and RNA biosythesis by conversion to 5-FU by cytosine deaminase
53
flucytosine use
systemic fungal infections | combo w/amphotercin B
54
flucytosine ADRs
bone marrow suppression
55
azoles MOA
inhibit ergosterol
56
azoles uses
local and less serious systemic mycoses fluconazole- chronic suppression of crypto and candidasis in AIDs and candidasis in anyone itraconazole- blasto, coccidioides, histo clotrimazole and micronazole for topical fungal infections
57
azole ADRs
testesterone synthesis inhibitons | liver dysfnx
58
terbinafine MOA
inhibits fungal squalen epoxidase
59
terbinafine uses
dermatophytoses (especially onychomycosis)
60
terbinafine ADRs
GI HA hepatotoxic tast disturbance
61
echinocandins MOA
inhibit cell wall synthesis by blocking beta-glucan
62
echinocandins use
invasive aspergillosis, Candida
63
echinocandins ADRs
GI | flushing d/t histamine release
64
griseofulvin MOA
interferes w/microtubule fnx | deposits in keratin tissues
65
griseofulvin uses
oral Tx of superficial infections | inhibits growth of dermatophytes
66
griseofulvin ADRs
``` teratogenic carcinogenic confusion HA increase P-450 and warfarin meta ```
67
antiprotoxoan therapy
``` pyrimethamine sramin melarsoprol nifurtimox sodium stibogluconate ```
68
Tx toxo
pyrimethamine
69
Tx trypanosoma brucei
suramin and melarsoprol
70
Tx T cruzi
nifurtimox
71
Tx leishmaniasis
sodium stibugluconate
72
anti-mite/louse Tx
permethrin malathion lindane
73
chloroquine MOA
blocks detox of heme -> hemozoin -> heme accumlates toxic to plasmodia
74
chloroquine uses
Tx of plasmodial species other then p. falciparum (too resistant)
75
chloroquine ADRs
retinopathy | pruitis
76
Tx of falciparum
artemther/lumefantrine or atovaquone/proguanil
77
Tx of life threatening malaria
US- quinidine | elsewhere- quinine
78
viral attachment inhibitors
maraviroc
79
viral penetration inhibitors
enfuvirtide
80
integrase inhibitors
raltegravir
81
protease inhibitors
-navir | navir (never) tease a protease
82
reverse transcriptase inhibitors
NRTIs | NNRTIS
83
NRTIs
``` abacavir (ABC) didanosine (ddl) emtrictabine (FTC) lamivudine (3TC) stavudine (d4T) tenofovir (TDF) zidovudine (ZDV/AZT) ```
84
NNRTIs
delavirdine efacirenx nevirapine
85
protein synthesis inhibitors
interferon alpha (HBV, HCV)
86
uncoating antivirals
amantadine rimantadine no longer used for influenza d/t resistance
87
nucleic acid synthesis inhibitors
guanosine analogs viral DNA polymerase inhibitors guanine nucleotide synthesis
88
guanosine analogs
acylcovir (HSV, VZV) | ganciclovir (CMV)
89
viral DNA polymerase inhibitors
cidofovir (HSV) | foscarnet (CMV)
90
guanine nucleotide synthesis
ribavirin (RSV, HCV)
91
block release of viral progeny
neuroamindase inhibitors -osteromivir -zanamivir influenza A and B
92
osteomivir, zanamivir MOA
inhibit neuroamidase decrease progeny release
93
osteomivir, zanamivir uses
Tx and prevent influenza A and B
94
acyclovir, famciclovir, valacyclovir MOA
guanosine anaglogs | preferentially inhibit DNA polymerase by chain termination
95
acyclovir, famciclovir, valacyclovir uses
active HSV, VZV (no effect on latent) | weak against EBV, nothing against CMV
96
acyclovir, famciclovir, valacyclovir ADRs
obstructive crystaline nephropathy and acute renal failure if not hydrated
97
acyclovir, famciclovir, valacyclovir resistance
viral mutated thymidine kinase
98
ganciclovir MOA
guanosine analog | inhibits viral DNA polymerase by chain termination
99
ganciclovir uses
CMV
100
ganciclovir ADRs
pancytopenia | renal toxicity
101
gancicilovir resistance
mutated viral kinase
102
foscarnet MOA
viral DNA/RNA pilymerase inhibitor and HIV reverse transcriptase inhibitor
103
foscarnet uses
CMV retinitis when ganciclovir fails | acyclovir resistance HSV
104
foscarnet ADRs
nephrotoxic, electrolyte abnormalities -> seizures
105
foscarnet resistance
mutated DNA polymerase
106
cidofovir MOA
preferentially inhibits viral DNA polymerase does NOT require phosphorylation by viral kinase long half-life
107
cidofovir use
CMV retinitis | acyclovir resistance HSV
108
cidofovir ADRs
nephrotoxic | coadminister probenecid and IV saline
109
HIV Tx
``` 3 drugs: 2 NRTIS and 1 of: NNRTI or Protease inhibitor or integrase inhibitor ```
110
protease inhibitors MOA
prevent HIV-protease (pol gene) virus cannot mature | ritonavir boosts other drugs by inhibiting P-450
111
protease inhibitor ADRs
``` hyperglycemia GI lipodystrophy nephropathy hematuria ```
112
protease inhibitors DDI
cannot combo w/rifampin
113
NRTIs MOA
competitively inhibit nucleotide binding reverse transcriptase and terminate DNA chian Tenovir is a nuceloTide, the others are nucleosides
114
NRTI uses
use 2 for HIV therapy | ZVD (old AZT) used during prego to prevent transmission
115
NRTIs ADRs
``` bone marrow supression (give G-CSF and EPO) peripheral neuropathy lactic acidosis anemia pancreatitis ```
116
NNRTIs MOA
bind reverse transcriptase at different site then NRTIs | DO NOT require phosphorylation
117
NNRTI ADRs
rash hepatotoxic vivid dreams and CNS symptoms are common w/efavirenz CI in prego
118
raltegravir MOA
inhibits HIV genome integration
119
raltegravir ADRs
increased creatine kinase
120
fusion inhibitors
enfuvirtide- binds gp41 inhibiting viral entry | marviroc- binds CCR-5
121
fusion inhibitors ADRs
skin rxn at injection site
122
interferon alpha use
``` chronic HBV, HCV kaposi sarcoma hairy cell leukemia condyloma acuminatum RCC malignant melanoma ```
123
interferon beta use
MS
124
interferon gamma use
chronic granulomatous disease
125
interferon ADRs
neutropenia and myopathy
126
Hep C therapy
ribavirin simeprevir sofobuvir
127
ribavirin MOA
inhibits synthesis of guanine nucleotides by competitvely inhibiting inosine monophosphate dehydrogenase
128
ribavirin use
chronic HCV | RSV (palivizumab preferred in kids)
129
ribavirin ADRs
hemolytic anemia | severe teratogen
130
simeprevir MOA
HCV protease inhibitor | prevents viral replication
131
simeprevir use
chronic HCV in combo w/ribavirin and peginterferon alpha | do not use as monotherapy
132
simeprevir ADRs
photosensitivity | rash
133
sofobuvir MOA
inhibits HCV RNA dependent RNA polymerase, chain terminator
134
sofobuvir uses
chronic HCV in combo with ribavirin +/- perinterferon | do not use as monotherpay
135
sofobuvir ADRs
fatigue HA nausea
136
what cleansing processes destroy spores?
autoclave hydrogen peroxide iodine and idophors (maybe)
137
Abx CI in prego
``` SAFe Children Take Really Good Care sulfonamides aminoglycosides fluoroquinolones clarithromycin tetracyclines ribavirin griseofulvin chloroamphenicol ```
138
sulfonamides in prego
kernicterus
139
aminoglycosides in prego
ototoxic
140
fluoroquinolones in prego
cartilage damage
141
clarithromycin in prego
embyrotoxic
142
tetracyclines in prego
discolored teeth | inhibition of bone growth
143
ribavirin in prego
teratogenic
144
grisesfulcin in prego
teratogenic
145
chloramphenicol in prego
gray baby syndrome

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