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Pharmacology > Exam 5: Antimicrobials > Flashcards

Exam 5: Antimicrobials Flashcards

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1
Q

mechanisms of drug resistance

A

not enough drug, structure change in drug target, drug antagonist, drug inactivation (enzyme produced from microbe)

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2
Q

superinfection

A

new infection that appears during the course of tx of primary infection

difficult to treat - typically resistant
yeast infection example

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3
Q

selection of abx

A

identify organism
drug sensitivity
host factors - functioning immune sys? allergies? site of infection? foreign body (cath)?

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4
Q

empiric therapy

A

abx selection based on initial presentation and common microbes found with the problem

ex. guy comes in immediately after getting a cut

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5
Q

acute therapy

A

lab -> cult/sent, abx started immediately with broad-spectrum abx

ex. guy comes in days later and with swollen, red leg (worry for sepsis)

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6
Q

tx principles

A

monitor first dose
patient ed - no sharing and complete course

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7
Q

major ADRs

A

hypersensitivity, superinfections, organ toxicities (ear, liver, kidney)

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8
Q

situations for prophylactic abx tx

A

UTI, COPD, pre-op, dental procedures, bacterial endocarditis, bites/wounds/STD exposures, neutropenic, labor and delivery

not abx but vaccines also

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9
Q

gram positive examples

A

cocci - staph, strep
bacilli - mycobacterium, antracis

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10
Q

gram negative examples

A

pseudomonas - gonorrhea, h. pylori, salmonella

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11
Q

drug therapy for UTIs

A

*Trimethoprim/sulfamethoxazole (first line)Bactrim
*Nitrofurantoin(first line)
* Fosfomycin (first line)

*Phenazopyridine (Pyridium) –> AZO, not abx

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12
Q

enzymes needed for HIV replication

A

reverse transcriptase, protease, integrase

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13
Q

HAART

A

highly active antiretroviral therapy for HIV/AIDs CD4 count <500

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14
Q

penicillin

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

narrow (PCN G) to broad spectrum (amoxicillin) to extended spectrum (piperacillin)

ADRs: common hypersensitivity (anaphylaxis), GI, interfere w/ contraceptives

no PO - stomach acid, can’t penetrate gram neg walls, inactivated by penicillinase

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15
Q

ampicillin/amoxicillin

A

broad spectrum (worry about super infections)

use: gram + or - (e. coli)

ADRs: rash, GI upset

commonly used with other abx to inhibit beta-lactamase (augmentin ex)

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16
Q

beta-lactamases

A

bacteria that resist penicillin through enzymes that inactivate the beta-lactam ring of the drug

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17
Q

cephalosporins

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

broad spectrum and more effective with higher gen (against gram -)

minimal ADRs - cross allergy to PCN, superinfections, poor GI absorption (IV/IM)

implications: no alcohol (Disulfiram-like), promotes bleeding (warfarin), C.diff concerns

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18
Q

different generations of cephalosporins

A

1st Generation; Cefazolin (Ancef) ; Cephalexin (Keflex)

2nd Gen: Cefuroxime (Ceftin); Cefaclor (Ceclor)

3rd Gen: Ceftriaxone (Rocephin); Ceftazidine (Fortaz)

4th Gen: Cefipime (Maxipime)-

5th Gen: Ceftaroline (Teflaro)- Effective: MRSA and VRSA

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19
Q

imipenem

A

“beta-lactam” abx - weaken cell wall membranes and bacteria lysis

broad spectrum - gram + and -; only IV

resists beta-lactamases

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20
Q

vancomycin

A

MOA: inhibitor of cell wall synthesis (binds to precursors of cell wall)

use: severe C. diff or MRSA

ADRs: nephrotoxic (peak/trough/creatinine), ototoxic, rapid infusion -> “red man syndrome”

widely used in hospital, only IV infusion (thrombophlebitis), SLOW IV push

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21
Q

tetracylclines

A

broad spectrum, bacteriostatic, gram +/-, mostly 2nd line r/t resistance
-cycline (doxy)

MOA: inhibits protein synthesis -> blocks mRNA translation

use: anthrax, chlamydia, cholera, acne, h. pylori, periodontal disease

ADRs: GI irritation, binds to calcium -> teeth trouble, superinfections, hepatotoxic, nephrotoxic, photosensitive, **teratogenic

interactions: chelates w/ metal ions (avoid calcium, iron, magn, alumin, zinc) -> 2 hours apart

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22
Q

erythromycin

A

macrolide - broad spectrum, bacteriostatic (inhibits protein synthesis)

use: bordetella pertussis, w/other abx for pna and chlamydia, resp & skin infx

ADRs: very safe, GI effects, **QT prolongation

Interactions: antidysrythmics, hepatic enzyme inhibitor (incr. levels of other drugs)

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23
Q

azithromycin/clarithromycin

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A

easier dosing than erythro (Qday or BID) and help with resistance to erythro

24
Q

clindamycin

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A

broad spectrum, bacteriostatic (inhibits protein synthesis)

limited to anerobic infx (does not cross BBB) -> severe strep A and gangrene (c. perfrigens)
abdominal and pelvic infx

**big risk for C. diff

25
C. diff tx
IV replacement, electrolyte management, vancomycin drugs to slow GI motility should not be used
26
linezolid
**MDROs - reserved for VRE and MRSA ADRs: diarrhea, N/V, HA, **myelosuppression (monitor CBC)
27
aminoglycosides
narrow spectrum, bactericidal Gentamicin, amikacin, tobramycin, neomycin use: aerobic gram- bacilli - used in GI for rapid affect only IM/IV - highly polar (not absorbed in GI and doesn't cross BBB) ADRs: ototoxicity and nephrotoxicity **need trough levels, skeletal muscle relaxation and neuromyo blockade (paralysis + resp depress)
28
sulfonamides & trimethoprim
Tri-metho-prim / Sulfa-methoxazole (Bactrim; Septra) -> **UTIs MOA: Disrupt synthesis tetrahydrofolate -> derivative of folic acid ADRs: hypersensitivity (mild to severe Stevens-Johnson syndrome-flu-like & blisters), hemolytic anemia, kernicterus, renal injury w/ crystalluria
29
fluoroquinolones
-floxacin (cipro, levo) broad spectrum, uses: resp, UTI, GI, skin/bone, prevent anthrax exposure MOA: disrupt DNA replication & cell division ADRs: GI, CNS, superinfection, photosens, tendons, QT prolong, hypoglycemia decreased levels by dairy, antacids increases levels of warfarin and theophylline *monitor for tox
30
metronidazole
(Flagyl) abx and antiprotozoal - only anaerobic orgs, broad spectrum GI, GU, CNS, bone, joint infx - prophylactic for surgeries IV = slow, PO = metallic taste/GI upset ADR: CNS (HA/dizzy/seiz), rash, Stevens johnson, GI upset no alcohol (Disulfiram-like)
31
bacitracin
MOA: Inhibits cell wall synthesis > cell lysis and > cell death only topical, gram +, skin infx - lots of combo meds
32
nitrofurantoin
(Macrobid) broad spectrum uncomplicated, lower UTIs -> prophylactic ADRs: GI upset, pulm (hypersensitivity), heme (CBC), hepatotoxic, peripheral neuropathy, birth defects, CNS Implications: Monitor renal function, UOP, BMs, respiratory status, CBCs, liver function take w/ food, no driving, dizzy/drowsy, increase fluids
33
phenazopyridine
urinary analgesic (Azo) MOA: acts locally in urinary tract mucosa to produce analgesic and relief from S/S bright orange urine -> invalidates UA results, need culture
34
Amphotericin B
broad spectrum antifungal, highly toxic (IV, no PO), used for systemic fungal infx increases permeability of cell membrane (fungistatic and cidal) **safety alert ADRs: infusion reactions, nephrotoxic, hypokalemia, bone marrow suppress., liver failure, arrythmias, phlebitis monitor creatinine and electrolytes
35
fluconazole
broad spectrum antifungal w/ lower tox, PO or IV inhibits liver enzymes (inc other meds) systemic mycoses and candidiasis ADRs: N/V/D, abd pain, HA, stevens johnson synd
36
other -azoles
itraconazole = liver inj and card suppress ketaconazole = hepatotoxic
37
Caspofungin
echinocandins MOA: disrupts biosynthesis of cell wall IV only Use: systemic infx that are intolerant/unresponsive to other meds
38
Nystatin
polyene abx MOA: alters cell membrane permeability topical or PO - mild GI upset and rare rash
39
acyclovir
antiviral - PO, topical, IV MOA: Inhibits viral replication by suppressing synthesis of viral DNA herpes simplex & varicella ADRs: n/v, HA, dizzy, skin irritant, phlebitis, reversible nephrotoxicity implications: lower dose for renal impairment
40
ganciclovir
synthetic antiviral - IV, PO, topical only approved for cytomegalovirus in immunocompromised ADRs: **black box warning - granulo and thrombocytopenia, teratogenic, carcinogenic implications: lower dose for renal, monitor CBC
41
interferon alfa
MOA: block viral entry into cells by binding to receptor cells use: hepatitis - SQ or IM ADRs: flu-like sumptoms, depression, SI, GI, alopecia
42
ribavirin
unclear MOA - use HEP C broad spectrum antiviral, PO ADRs: hemolytic anemia, teratogenic, flu-like, autoimmune disorders w/interferon
43
simeprevir/grazoprevir
protease inhibitors MOA: protease=enzyme required for replication HEP C ADRs: hepatic inj, photosen, rash take w/ food
44
daclatasvir & sofosbuvir
NS5A & NS5B inhibitors used w/ other hep C drugs ADR: HA, fatigue, lots of drug inter.
45
lamivudine
MOA: inhibits viral DNA synthesis for Hep B and HIV ADR: lactic acidosis, hepatomegaly, pancreatitis
46
oseltamivir
Tamiflu grab more from book *
47
remdesivir
EUA for covid shorter recovery time, not sufficient to help mortality
48
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NNRTI)
MOA: suppress synthesis of viral DNA by reverse transcriptase **black box: fatal lactic acidosis w/ hepatic steatosis
49
zidovudine
NRTI no longer used other than perinatal transmission (Retrovir or AZT) ADR: **black box - severe anemia, neutropenia, lactic acidosis w/ hepatomegaly, myopathy
50
abacavir
NRTI (Aizgen or ABC) ADRs: **same black box as other NRTIs, hypersensitivity, MI no alcohol
51
lopinavir/ritonavir
Protease inhibitor most effective antiretroviral - reduces HIV viral count to undetectable ADRs: ^BGL, lipodystrophy, hyperlipid, dec. card contract, hepatotoxicity lots of drug interactions
52
raltegravir
Integrase stand transfer inhibitors (INSTIs) MOA: stops action of integrase so HIV DNA is NOT integrated into the T cell’s DNA. HIV daughter cells are not made ADRs: relatively well tolerated, watch liver enzymes, insomnia
53
enfuvirtide
Fusion inhibitors - block entry into CD4 T cells used for infx resistant to other drugs
54
maraviroc
CCR5 antagonists - 50-60% of HIV strains must bind with CCR5 to enter cell also used when resistant
55
common OIs w/ HIV/AIDs
** greatest risk <200 CD4 Pneumocystis carinii (jiroveci) pneumonia – Bactrim (TMP/SMZ) Cytomegalovirus retinitis (CMV) – Ganciclovir M. tuberculosis – 4-Drug for TB; Cryptococcal meningitis – Amphotericin B HSV or VZV - Acyclovir Candidiasis – “azole”
56
abx for common infx
Staph - C. diff - clindamycin

Pharmacology (12 decks)

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