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Flashcards in antimicrobials II Deck (145):
1

TB prophylaxis

Isonizaid

2

TB Tx

RIPE
Rifampin
Isoniazid
Pyranxinamdie
Ethambutal

3

MAI prophylaxis

azithromycin
rifabutin

4

MAI Tx

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

5

M. leprae Tx

long-term w/dapsone and rifampin for tuberculoid form
add clofazimine for lepromatous form

6

what blocks mycolic acid synthesis

Isoniazid

7

what blocks arabinoglycan synthesis

ethmbutol

8

what blocks DNA-dependent RNA polymerase?

ribambutin
rifampin

9

what works intracellularly via unclear MOA

pyrazinamide

10

rifamycins

rifampin
rifabutin

11

rifamycins MOA

inhibit DNA-dependent RNA polymerase

12

rifamycins uses

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

13

rifamycins ADRs

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

14

rifamycins resistance

mutations reduce drug binding to RNA

15

rifampins acronym

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

16

isoniazid MOA

decrease synthesis or mycolic acids
bacterial catalase peroxidase (KatG) needed to convert INH to active metabolite

17

isoniazid uses

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

18

isoniazid ADRs

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

19

isoniazid resistance

mutations leading to underexpression of KatG

20

pyrazinamide MOA

unknown, prpdrug

21

pyrazinamide uses

TB

22

pyrazinamide ADRs

hyperuricemia
hepatotoxic

23

ethambutol MOA

decreaes carbohydrate polymerization of mycobacterium cell wall by blocking arabinoxyltransferase

24

ethambutol uses

TB

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