PDA Block 3 Week 2 Flashcards

Question

Cell- wall agents

Answer 1

``` Penicillin G and V Oxacillin Amipicillin, amoxicillin Ticarcillin Piperacillin Cefazolin Cephalexin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Imipenem Aztreonam Vancomycin Fosfomycin Bacitracin ```

Answer 2

Polymyxin & Daptomycin

Answer 3

Bind LPS in outer membrane of G- - G- spectrum (pseudomonas) - Topical use

Answer 4

Binds to bacterial cytoplasmic membrane - bactericidal - G+ ONLY - Staph aureus (MSSA, MRSA) - Strep pyogenes - Enterococcus - Staph bacteremia Adverse: - Nausea, diarrhea, GI flora alteration - muscle pain and weakness (monitor CK levels) - Used for complicated skin and skin structure infections - not for lung infections

Answer 5

``` Norfloxacin Ciprofloxacin Moxifloxacin Nitrofurantoin Rifampin Fidaxomicin Metronidazole ```

Answer 6

- Bactericidal - inhibits alpha subunit of DNA gyrase (interfers with control of DNA unwinding) Adverse effects - N/V/abdominal pain, enterocolitis - dizziness, headache, restlessness, depression - seizure - rash- photosensitivity - EKG irregularities, arrhythmia - peripheral neuropathy - arthorpathy/tendon rupture Precautioned: seizure disorder, pregnancy, children

Answer 7

Norfloxacin Ciprofloxacin Moxifloxacin

Answer 8

- used for Enterobacteriacea in urinary tract

Answer 9

urinary tract infections: Enterobacteriaceae

Answer 10

- UTI - infectious diarrhea (shigella, campylobacter), - bone and joint infection (enterobacter) - Skin infections - Chlamydia

Answer 11

G+ activity - respiratory infections (p. pneumonia, mycoplasma, legionella) - not for strep throat - Community acquired pneumonia - bacterial bronchitis

Answer 12

- Nitroreductase enzyme converts them to reactive compounds→ damage DNA - UTI Adverse effects: - nausea, vomiting, diarrhea - peripheral neuropathy - hypersensitivity, fever, chills - acute/ chronic pulmonary reactions, - acute and chronic liver damage - Granulocytopenia, leukopenia, megaloblastic anemia - acute hemolytic anemia

Answer 13

- inhibits bacterial RNA synthesis by binding RNA pol B - Bactericidal - used for treatment of pulmonary Tuberculosis - prophylaxis for meningococcal meningitis - prophylaxis of H. influenza type b meningitis Adverse: - serious hepatotoxicity - induces hepatic enzymes ( many CYPs), - orange color ( urine, saliva)—very lipophilic

Answer 14

- Non-competitive inhibitor of RNA polymerase (inhibits RNA synthesis) - Bactericidal - oral, poorly absorbed Use: C. Diff infection Adverse: GI upset, GI bleeding

Answer 15

Anaerobes reduce the nitro group of metraonidazole→ disrupts DNA - bactericidal Use: Anaerobes, C. Diff, combo therapy for H, pylori, gardenerella vaginalis Adverse: - n.v. anorexia, diarrhea, transient leukopenia, neutropenia, thrombophlebitis after IV infusion, bacterial and fungal superinfections (candida)

Answer 16

``` Gentamicin Tobramycin Amikacin Doxycycline Minocycline Tigecycline Chloramphenicol Erythromycin Clarithromycin Azithromycin Clindamycin Linezolid ```

Answer 17

Gentamicin Tobramycin Amikacin

Answer 18

- Only Bactericidal protein synthesis inhibitor - Not absorbed orally, given IV or IM - Glomerular filtration - concentration dependent killing Mechanism: - Penetrate pores of outer membrane - Bind to transport molecule on outer of surface of cytoplasmic membrane - Transported into cell - Bind to several ribosomal sites→ stops initiation→ causes pre-mature release of ribosome from mRNA and mRNA misreading -Primary for G- aerobic bacilli (Enterobacteriaceae, Pseudomonas) ``` Adverse: - Nephrotoxicity: usually reversible - Ototoxicity: both auditory and vestibular damage Related to dose of therapy - Neuromuscular blockage ```

Answer 19

Pseudomonas, Klebsiella, Enterobacter

Answer 20

Pseudomonas, Klebsiella, Enterobacter

Answer 21

For some gentamicin & tobramycin resistant strains

Answer 22

- transported into the cell by a protein carrier system - Bind to 30S ribosomal subunits, prevent attachment of aminoacyl-tRNA to the acceptor site on the MRNA-ribosomal complex→ amino acid cannot be added to the protein being synthesized - Bacteriostatic - Use: Rickettsia, Chlamydia, mycoplasma, Ureaplasma, Borrelia (Lyme) - calcium (bivalent cation) binds to tetracycline→ inhibits absorption (do not take with antacids and Ca2+ containing foods) Adverse: - Gastrointestinal disturbance: pseudomembranous enterocolitis - Candida superinfection in colon - Photosensitization with rash—sunlight makes rash worse - Teeth discoloration—avoid use in children (<8) - Contraindicated in pregnancy

Answer 23

- Tetracycline Use: Patients with impaired renal function Alternative for - PenG sensitive syphilis - Uncomplicated N. gonorrhoea -Least affinity for calcium

Answer 24

Use: Prophylaxis of Neiss. meningitidis Alternative for - PenG-sensitive syphilis; - uncomplicated gonorrhea - Calcium binding: moderate

Answer 25

- Bacteriostatic - Binds 30S ribosomal subunit and blocks aminoacyl-tRNA entry Use - Skin/Skin structure infections - Complicated intraabdominal infections - Community acquired pneumonia (CAP) 1. G- :E. coli, Citrobacter, Klebsiella, Enterobacter NOT pseudomonas 2. G+: Staphylococcus (MSSA and MRSA) 3. Anaerobes: Bacteroides & Clostridium perfingens 4. CAP: S. pneumonia, Haemophilius Adverse - N/V - increase risk of death

Answer 26

Interferes with binding of aminoacyl-tRNA to 50S subunit and inhibits peptide bond formation - Broad spectrum of activity - Alternate agent for treatment of meningitis in beta lactam allergic patients (cephalosporin) - Brain abscesses (anaerobes) Adverse reactions: - Bone marrow depression→ can progress to a fatal aplastic anemia (can be delayed) - Grey baby syndrome: vomiting, pallor, cyanosis, circulatory collapse - high levels of unmetabolized drug due to lack of phase II enzymes - Optic neuritis and blindness hypersensitivity- GI effects (enterocolitis)

Answer 27

- Bind to a 50S ribosomal subunit→ block protein synthesis by blocking translocation along ribosome - Bacteriostatic

Answer 28

- Macrolid - Primarily against G+ (strep in penicillin-allergic pts); Also good for atypical bugs: chlamydia, mycoplasma, Legionella, Bordetella - Very fast N/V (due to enhanced motility); inhibits CYP 3A4 metabolism/excretion of many drugs; increase risk of arrhythmia and cardiac arrest (esp with CYP3A4)

Answer 29

- Macrolid - Alternative to erythromycin for treatment of pharyngitis, respiratory infections. Also: like erythromycin: mycoplasma, legionella, Bordetella. Haemophilus, Moraxella, penicillin-resistant Strep pnemo. Helicobacter & atypical mycobacterial infections. 3 drugs combos: 2 ABX +acid blocker - Less GI effects than Erythromycin. Some CV risk (Prolonged QT) interval

Answer 30

- Macrolid - Respiratory infections (strep pneumo, Haemophilis, mycoplasma, Moraxella & chlamydia, Neisseria gonorrhoae (Ceftriaxone + azithromycin) - Less GI effects than Erythromycin. Some CV risk (Prolonged QT) interval Fewer GI disturbances than w/ erythromycin, fewer drug interactions, Cardiac (prolonged QT)

Answer 31

macrolide-like mechanism: binds to 50S ribosomal subunit - Inhibits most G+ cocci (Strep & MSSA) and many anaerobes including Bacteriodes fragilis - Not for hospital acquired MRSA, enterococcus, or G- aerobes Adverse Rxn - Antibiotic-associated enterocolitis—Associated with C. diff - GI irritation, diarrhea - Hepatotoxicity

Answer 32

- Macolid - interferes with protein synthesis, binds 50S subunit→ interferes with 70s initiation complex - Use: G+ spectrum - VRE: vancomycin resistant Enterococcus - s taphylococcus auerus (MRSA, MSSA- alterative to vancomycin) - Streptococcus, group A and B - Streptococcus pneumonia (including multi-drug resistant) Side effects - Non-selective inhibitor of MAO (avoid foods with tyramine)-Contraindicated in SSRI, tricyclics - Diarrhea, headache, n/v, bone marrow suppression

Answer 33

Sulfamethoxazole sulfadiazine Tripmethoprim

Answer 34

- Anti-folate - inhibit folate synthesis by competitive inhibition of dihydropteroate synthase - Sulfamethoxazole + Trimethoprim for UTI,

Answer 35

- Anti-folate ( dihydropteroate synthase) | - Silver sulfadiazine: topical for burn patients

Answer 36

- inhibits folate synthesis by competitively inhibiting dihydrofolate reductase - sulfamethoxazole (Bactrim)= synergistic effect is bactericidal-- Uncomplicated urinary infections—most common use Adverse effects of trimethoprim-sulfa combination 1. Sulfonamide side effects 2. N/V, diarrhea, rashes 3. Eosinophilia, neutropenia, bone marrow suppression 4. Especially pronounced in AIDS patients

Answer 37

``` IV Vancomycin linezolid daptomycin tigecycline ```

Answer 38

``` Oral Linezolid doxycyclin minocycline clindamycin TMP-SMX ```

Answer 39

- Caused by M. tuberculosis | - Rx: isoniazid, Rifampin, Ethambutol, Pyrazinamide, Streptomycin

Answer 40

Bactericidal for actively growing cells, -static for resting cells. - inhibits synthesis of mycolic acids. - pro-drug that is activated by catalase-peroxide (KatG protein) of tubercle bacillus. Activated drug targets enoyl-acyl carrier protein reductase InhA protein ( important for FA elongation and interferes with DNA synthesis. Resistance: results from mutations in KatG or InhA - Primary TB drug. Patients with INH-sensitive strain should receive INH if possible. - Give in combination with other agent - oral - antacids interfere with absorption - N- acetylation is under genetic control: Slow= half-life: 2-5 hours. Fast half life= 70 min -Neurotoxicity (peripheral neuritis)- impoved with B6 Adverse - hepatotoxicity: correlated with increased age. Possible caused by metabolite of IHN

Answer 41

- Inhibits bacterial DNA-dependent RNA polymerase (suppresses RNA synthesis). - Bactericidal for intra and extracellular organisms - Used with INH. Not used alone - limited penetration into CSF - metabolized in liver by deacetylation Adverse: - Hepatotoxicity: can be severe in alcoholics - inducer of CYPs (increase metabolism of other drugs—oral contraceptives, digoxin, warfarin) - orange/red color to urine, feces, saliva, tears, sweat, sputum

Answer 42

- interferes with arabinosyl transferase→ blocks cell wall synthesis - Tuberculostatic: spontaneous resistance occurs 1 in 106 -Use in conjunction with other drugs (INH) - well absorbed, adequate levels in CNS - half life: 3-4 hours - Adverse: well-tolerated -not hepatotoxic -optic neuritis→ decrease in visual acuity, loss ability to differentiate red from green

Answer 43

- Blocks mycolic acid synthesis by inhibiting fatty acid synthase I - Bactericidal -combo therapy - important part of short term multi-drug therapy -widely distributed including CSF Adverse: -Hepatic damage: may be fatal w/rifampin

Answer 44

-binds to several ribosomal sites: stops initiation and causes mRNA misreading -reserved for most serious forms of TB (disseminated disease) - IM administration - No CNS penetration - Adverse: - ototoxicity - nephrotoxicity

Answer 45

M. avium-intracellulare Ex: Rifabutin & Clarithromycin

Answer 46

- Rifampin analog for single agent prophylaxis of MAC in AIDs pts. (rec. for low CD4 counts) - multi-drug treatment of MAC Adverse: - similar to rifampin but less frequent ( Hepatotoxicity, inducer of CYPs, orange/red body fluids)

Answer 47

- part of multi-drug regimen for MAC - MAC prophylaxis - Bactericidal

Answer 48

Dapsone Clofazimine Rifampin

Answer 49

- structural analog of p-aminobenzoic acid (PABA)→ inhibits synthesis of folic acid - bacteriostatic - used in combination with other drugs (ie. Rifampin) - prophylaxis (&treatment) of Pneumocysitis jiroveci in AIDS pts. - oral - metabolized by same enzymes that acetylates INH: slow and fast acetylators Adverse: - Hemolytic anemia - methemoglobinemia

Answer 50

- binds to mycobacterial DNA interfering with reproduction and growth - used in combo chemotherapy (often for sulfone resistant leprosy -oral - highly lipophilic (long half life: ~2 mo) Adverse: - generally well tolerated - cause red/brown pigmentation of skin, sweat

Answer 51

``` Amphotericin B Flucytosine Caspofungin Fluconazole Itraconazole Voriconazole ```

Answer 52

``` Fluconazole Miconazole Clotrimazole Itraconazole Nystatin Amphotericin B ```

Answer 53

Terbinafine Griseofulvin Itraconazole

Answer 54

- Very lipophilic, binds ergosterol in fungal membranes producing membrane instability/leakage. - effective for most serious systemic mycoses - effective against candida, Histo, crypto, blasto, sporothrix, Coccidiodes - - IV for 6 to 12 weeks - NOT absorbed from GI - Total cumulative dose is impt for renal toxicity - limited CNS penetration - Adverse: Fever, nausea, vomiting, headache, chills, hypotension, hypokalemia, tachypnea, 90% will show non-permanent nephrotoxicity→ enhances toxicity of renally excreted drugs. – can cause permanent renal damage (total drug dose) –reversible hypochromic, normocytic anemia

Answer 55

-fungi contain a cytosine deaminase that converts 5FC→ 5FU. Metabolites of 5FU block nuclei acid synthesis - use: serious infection due to Candida, Cryptococcus - used with amphotericin -oral - when given with amphotericin→ allows reduction of amphotericin dose Adverse: - N/V, diarrhea, enterocolitis, leukopenia, thrombocytopenia - reversible elevated hepatic enzyme - use extreme caution in those with renal insufficiency or bone marrow depression

Answer 56

- inhibits cell wall synthesis by non-comptitively blocking synthesis of Beta (1,3) glucan→ cell lysis - uses: Invasive Aspergillus in pt intolerant of other drugs - Candida, esophageal and systemic - IV - does inhibit P450 - Adverse generally well tolerated -fever, n/v, rash -phlebitis at infection site

Answer 57

inhibit sterol 14-alpha sterol demthylase (fungal P450)→ blocks conversion of lanosterol to ergosterol (fungistatic) Fluconazole Itraconazole Voriconazole

Answer 58

- Cryptococcus meningitis - some Candida - oral - Excellent CNS penetration -excreted unchanged in urine Adverse -N/V/rash/Diarrhea/headache -hepatotoxicity: inhibits metabolism of several drugs

Answer 59

- Blastomyces - Histoplasma - Candida, esophageal and oropharyngeal - No CNS penetration - Metabolized in liver Adverse: - N/V/rash/Diarrhea/headache - hepatotoxicity: inhibits metabolism of several drugs - contraindicated w/drugs that inhibit CYP3A4

Answer 60

- invasive Aspergillus (-cidal), scedosporium - extended Candida spectrum - possibly some CNS entry - metabolized in liver - Adverse: N/V/rash/Diarrhea/headache -hepatotoxicity: inhibits metabolism of several drugs -visual disturbances, photosensitive rash -contraindicated with st. johns wort (p450 inducer)

Answer 61

- cream/suppository for vaginal candidiasis -topicals—burning, itching, irritation

Answer 62

- oral or vaginal candidiasis - Topical: oral torches, vaginal tablets, topical creams/solutions -oral form: may cause abnormal liver function test

Answer 63

oropharyngeal and esophageal candidiasis

Answer 64

- almost exclusively for Candida of skin, mucous membrane, GI, vaginal - Mechanism similar to amphotericin B -oral: GI distress

Answer 65

- binds ergosterol - topical for cutaneous or mucodal candida - not effective against dermatophytes - topical: hypersensitivity but no systemic toxicity

Answer 66

- Use: fungal eye infections eg. Conjunctivitis - Fusarium, Cephalosporium, Aspergillus Mechanism similar to amphotericin B - Might be used in conjunction with surgical measures Toxicity: conjunctival chemosis and hyperemia

Answer 67

- use: 12 week therapy for nail infections, shorter for other dermatophyte infection - Inhibits fungal squalene eposidase; non-competitively - Accumulation of squalene damages fungal cell membrane - Fungicidal - oral - remains in skin 12 weeks after therapy stopped - Adverse: diarrhea, dyspepsia, abdominal pain

Answer 68

- recalcitrant infections of skin, hair, nails, beyond scope of topical therapy - therapy for children w/ tinea capitis - Mechanism: slowly deposited into skin, hair, nails→ interferes with microtubule fuciton/mitotic spindle/mitosis (arrest cell cycle) - oral - use with topical Adverse: - contraindicated for pt with porphyria and advanced liver disease - increase metabolism of other drugs (oral contraceptives, warfarin) - Caution: penicillin allergies

Answer 69

- 3 mo therapy for toenail infections - oral - N/V/ rash/diarrhea, headache, edema - discontinue if signs of liver infections appear -inhibits metabolism of many drugs (digoxin, cyclosporine, warfarin)

Answer 70

- Miconazole - Clotrimazole - Tolnaftate: (tinactin)- cream/solution or foot spray or powder - Terbinafine: topical for dermatophytes - Ciclopirox: lacquer is only topical Rx for fungal nail infections

Answer 71

lacquer is only topical Rx for fungal nail infections

PDA Block 3 Week 2 Flashcards

(96 cards)