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PHARM > Exam 3 Drugs > Flashcards

Exam 3 Drugs Flashcards

1
Q

Accumulates in renal dysfxn

A

Isoniazid, Cycloserine

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2
Q

Broader/more potent that first azole.

Blastomycosis, sporotrichosis, paracoccidomycosis, histoplasmosis

capsule: acidic bev
soln: on empty stomach

Liver metab
BOX WARN: HF, Vent dysfxn

A

Itraconazole

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3
Q

This drug may cause optic neuritis due to higher doses of the medication or due to renal dysfxn.

A

Ethambutol

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4
Q

Enterohepatic cycling

A

Rifampin

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5
Q

First member azole but least active. Hepatotoxic, skin rash.

Good to tx mucocutaneous or vulvovaginal candida.

prophylaxis for bone marrow recipients/transplants with fungal infections

C. neoformans post-ampho/flu tx

A

Fluconazole

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6
Q

4 R’s

RNA poly. inh.
Revs P450
Red, orange
Rapid resistance used alone

A

Rifampin (a macrocyclic abx)

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7
Q

Do not take antacids with these

A

Quinolones, Methenamine, Isoniazid

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8
Q

First of the echinocandin class, and first line option for Candidiasis.

Second line option for invasive aspergillus. (For those pts who failed or couldn’t do an azole).

Increase dose w/P450 inducers like Rifampin

A

Caspofungin

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9
Q

Little difference between what is toxic and what is therapeutic

Corticosteroid/antipyeretic can be given before administration to prevent fever and chills.

K+/Magnesium supplements can help if cellular electrolyte leakage occurs causing hypokalemia, etc.

30-60 mins prior can also give Ibuprofen for associated pain with infusion

Heparin for possible thrombophlebitis preventing coagulation

Loading pt with sodium can minimize nephrotoxicity

Class of Abx need to monitor for with Amphotericin due to increased nephrotoxicity (aminoglycosides, vancomycin)

A

Things to remember for Ampho B

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10
Q

Used to treat tinea pedis (athlete’s foot), corporis(ring worm)

Tinea cruris (groin) x 1 week duration

Avoid: severe renal dysfxn, hepatic dysfxn, nursing mothers

Causes taste/visual disturbances, dyspepsia

A

Terbinafine

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11
Q

IV or PO (Same daily dose for IV or Oral because oral absorption is rapid and complete)

IV spared for pts unable to tolerate oral admin, amphotericin, etc
Use cautiously for liver dyfxn

A

Fluconazole

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12
Q

These are used first line for the tx of invasive candidiasis/candidemia.

These have an advantage because they hae no P450 interactions. Good for pts who had no other alternatives. Good for polypharmacy pts.

A

Anidulafungin and Micafungin

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13
Q

Used for dermatophytosis of scalp and hair; Fungistatic

1/per day dosing

Requires long duration of treatment, 6 to 12 months for onychomycosis. Pts need to be aware of the extent of tx.

Absorption is enhanced by high-fat meals

Contraindicated in pregnancy and porphyria (causes CNS effects - no sunbathing/tanning).

A

Griseolfulvin

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14
Q

When this is added to the TB tx regimen, it can cause 1-5% liver damage. Make sure to monitor liver fxn.

A

Pyrazinamide

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15
Q

Azoles inhibit CYP450 and are fungistatic agents. Explain how azoles interact with an inducer vs a substrate.

A

Inducers lower azole concentrations; azole inhibition of P450 will cause substrate retention

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16
Q

Prophylaxis for TB skin converters.

Bimodal distribution

Take on empty stomach if possible.

A

Isoniazid

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17
Q

This echinocandin is great especially for a pt who has severe hepatic dysfxn

A

Anidulafungin

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18
Q

Squalene epoxidase inhibitors like Terbinafine, naftifine, and butenafine are for cutaneous mycotic infections and are considered ____.

A

fungistatic

used as topicals for the most part

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19
Q

Like Terbinafine, these are used for topical treatment of tinea infections (corporis, cruris, pedis)

A

Naftifine and Butenafine

20
Q

This drug inhibits fungal DNA synthesis/protein synthesis.

Available in various forms: shampoo, gel, cream, soln. Can be applied like a nail polish too.

1% shampoo tx for seborrheic dermatitis.

Cream, gel, suspension: Tinea pedis, cruris, corporis, versicolor; Cutaneous Candida

A

Cicloporox

21
Q

This causes red-bron skin discoloration

A

Clofazimine

22
Q

In RIPE therapy, if you suspect resistance is an issue what do you do?

A

Add Streptomycin to RIPE regimen.

23
Q

Synthetic broad agent

Invasive aspergillosis, candidiasis, other serious infections

oral, IV

CYP450 (elimination)
inhibitor and substrate of P450

Visual/auditory hallucinations (concentration dependent)

Cyclosporine, phenytoin, triazolam, warfarin (toxicity caused)

A

Voriconazole

“Vori said she sees and hears things! spooky!”

24
Q

For antimycobacterial tx of MAC in an HIV pt, what options are there?

A

Respiratory quinolones can be helpful. Azithromycin is preferred in combination with ethambutol + rifabutin for MAC (azithromycin doesn’t interfere with antiretrovirals).

25
Q

Eye issues with TB tx

Optic neuritis (2 drugs)
Uveitis (1 drug)
Red/green color blindness (1 drug)

Make sure to get a baseline for ocular fxn before starting tx.

A

Optic neuritis (Isoniazid, ethambutol)
Uveitis (rifabutin)
Red/Green (ethambutol)

26
Q

DOC for treating dermatophyte onychomycoses and tinea capitis

PO oral route needed for these two cases

A

Terbinafine

27
Q

Commonly used to tx Candida and aspergillus (esp. in immunocompromised pts)

Oral susp tab, IV (take w food)

Glucoronidation (elimination)

Statin, citalopram, risperidone contraindications

Hepatotoxic

A

Posaconazole

28
Q

Peripheral neuropathy, hepatitis

Injures neurons, hepatocytes

A

Isoniazid

29
Q

An advantage of Rifapentine?

A

It has a longer half-life than rifampin and can be administered once a week. (Given 2x a week during the intensive phase).

30
Q

Hypae distorter; fungistatic

NOT good for candida

Tx for Tinea pedis, cruris, corporis

1% soln, cream, powder

OTC and easy to p/u (be careful to counsel pts about these products that they are treating the right things appropriately).

A

Tolnaftate

31
Q

For aspergilosis

Prodrug, IV, Oral (capsules)

Long half-life (130hrs), given in cycles

inhibitor and substrate of P450

A

Isavuconazole

32
Q

Bone-marrow depression (chemo/radiation pts – be careful these meds also depress the bone marrow).
Lot of monitoring with these medications, this and amphotericin, to avoid adverse effects.

A

Amphotericin B and Flucytosine

33
Q

“LIFTNAHHR” for the side effects of Ampho B

A

Low therapeutic index, injection site pain, fever/chills, NV/D/malaise, Anemia/arthralgia/myalgia, HA, Hypotension, Thromboplebitis, Renal Impairment

34
Q

Topical azoles

A

Imidazoles

35
Q

“ICE” for drugs that you need to have B6 supplementation

A

Isoniazid, Cycloserine, Ethionamide

36
Q

Treats a variety of topical conditions: Tinea corporis, Tinea cruris, Tinea pedis, Oropharyngeal and vulvovaginal candidiasis.

Topical use associated with contact dermatitis, vulvar irritation and edema.

Thrush: Cotrimazole (lozenge); Miconazole (buccal)

Oral ketoconazole is rarely used anymore due to severe liver injury; adrenal insufficiency

A

Imidazoles

37
Q

Azoles for cutaneous and/or systemic infections

A

Triazoles

38
Q

Used in combination with Amphotericin B for the treatment of systemic mycosis and meningitis caused by C. neoformans and C. albicans. Almost never used alone due to resistance.

A

Flucytosine

39
Q

Drug of choice for several life threatening mycoses (Candida albicans, histoplasma capsulatum, cryptococcus neoformans, protozoal infections).

Slow, IV infusion

Liposomal preps have decreased renal infusion toxicity

A

Amphotericin B

40
Q

Polyene antifungal used for cutaneous and oral Candida.

Fungistatic/cidal

Not absorbed from the GI tract. Not used parenterally due to systemic toxicity.

Oral swish and swallow/spit agent for thrush.

Intravaginal for vulvovaginal candida. Topical for cutaneous.

A

Nystatin

41
Q

Which drug can be considered to tx pneumonia caused by Jiroveci in HIV pts?

A

Dapsone

42
Q

These are teratogenic and should be avoided in pregnancy unless the benefit outweighs the risk to fetus.

A

Azoles

43
Q

Can be used solely for Candida urinary tract infections when fluconazole is not appropriate. Resistance still an issue

A

Flucytosine

44
Q

“Right Now The Heat Burns” to remember the side effects of Flucytosine

A

Reversible Neutropenia, Thrombocytopenia, Hepatic Dys Fxn, Blood marrow depression

Other: serious enterocolitis

45
Q

These drugs are antifungal cell wall inhibitors used to treat azole resistant apergillus, and candida (most species).

Given IV once daily. Has histamine/flush rxn when too rapid.

A

Echinocandins (end in ~fungin)

46
Q

These two TB drugs can cause urate retention causing problems in gout patients.

A

Pyrazinamide and Ethambutol

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