Test 4 Flashcards

Question

Tetracyclines (end in cycline)

Answer 1

- Inhibit protein synthesis (as opposed to damaging layers of the cell wall) - Indications: - Rickettsial disease (rocky mountain fever, typhus) - Chlamydial disease - Cholera - Lyme disease - Anthrax - H. pylori - MOA: Bind to 30S ribosomal subunit to penetrate microbial cells and inhibit bacterial protein synthesis - Adverse effects: - Permanent discoloration of teeth - Inhibition of C++ absorption in long term use - Suppression of bone growth - Photosensitivity - C.diff - Renal impairment - Interactions - Decreased absorption when given with milk products, calcium supplements, iron supplements, magnesium containing laxatives, antacids, digoxin - Chelate formation - Nursing considerations: Do not give to pregnant or lactating women, or kids (decreased growth)

Answer 2

- Macrolide - Bacteriostatic inhibitor of protein synthesis - MOA: Binds to 50S ribosomal subunit (vs 30S like in tetracyclines) and inhibits protein synthesis - Typically bacteriostatic - Indications - B. pertussis (whooping cough) - Acute diphtheria (corynebacterium) - Chlamydial infections (like tetracyclines) - M. pneumonia - Adverse effects - GI - Superinfection of the bowel - Thrombophlebitis - **QT prolongation/sudden cardiac death** - Interactions - Food (decreases absorption) - Warfarin - Antiarrhythmics

Answer 3

- Inhibits protein synthesis - Indications: Active against most anaerobic bacteria (both gram negative and positive) - Only used for certain anareobic infections located outside the CNS - **Can induce severe antibiotic-associated Clostridium difficile associated diarrhea** - Superinfection of the bowel - Probably why it's only indicated for certain anaerobic infections outside the CNS - Can be fatal

Answer 4

- Aminoglycoside - Bactericidal inhibitor of protein synthesis - Indications: Treatment of ***serious*** infections caused by ***_aerobic gram-negative bacilli_*** - Narrow spectrum - Types of bacteria - Pseudomonas aeruginosa - E coli - Klebsiella - Serratia - Proteus mirabilis - MOA: Inhibits protein synthesis by binding to 30S ribosomal subunit (just like tetracyclines) - Dosing: - Single large dose each day or - 2-3 smaller doses - Adverse effects: Ototoxicity, nephrotoxicity - Nursing considerations: Monitor serum levels - The same aminoglycoside dose can produce different effects in different patients - Peak levels must be high enough to be effective but low enough to reduce toxicity

Answer 5

- Info about both drugs - Broad spectrum antibiotics - MOA: Inhibit folic acid and DNA synthesis - Indications: Treatment of choice for UTI - Bacteriostatic - TMP-SMZ combo - Inhibits sequential steps in bacterial folic acid synthesis (same as individual drugs) - Much more potent - Indications: - Uncomplicated urinary tract infections - Pneummocystis carinii (a fungus. Think carinii-carnivorous because fungii eat shit or something) - GI infections - Administration: IV, IM, PO - Excreted via pee - Adverse effects: - GI upset - Hypersensitivity (rash, photosensitivity, Stevens-Johnson syndrom but that's rare af) - Hemolytic anemia on G6PD deficiency - An enzyme that promotes the function of red blood cells - Kernicterus in newborns - Kernicterus = brain damage from high levels of bilirubin in the blood - Crystalluria - Cloudy pee from crystals - Rare

Answer 6

- Broad spectrum antibiotic - Effective against - Aerobic gram - - Some gram + - Bacteriocidal - MOA: Inhibits bacterial DNA replication - Side effects: Mild - Contraindications: Avoid use in children due to rare risk of tendon damage - Drug interactions: Absorption reduced by aluminum and magnesium antacids, iron and zinc salts, and dairy products

Answer 7

- 2nd gen fluoroquinolone - Broad spectrum antibiotic - Bacteriocidal - MOA: INhibits two bacterial enzymes needed for DNA replication and cell division - Indications: Most gram -, some gram + - UTI - GI - Respiratory - Bone - Skin - Antrhax prevention - Some serious infections - Complicated UTI (gram - E. coli) - High risk of resistance, so not used for staph infx - Routes: IV, PO - Adverse effects: - Mild GI - CNS effects (dizziness and confusion, especially in the elderly) - Phototoxicity (risk of sunburn) - Blackbox warning: Tendon rupture - Avoid in children and elderly - Increased risk of clostridium difficile - Increased risk for candida infections - Contraindications: Avoid in children \<18 y/o except in cases of complicated UTI or post anthrax inhalation

Answer 8

- UTI treatment - Bacteriocidal - MOA: Inhibits bacterial cell wall synthesism, resulting in bacterial lysis and death - Dosing: Single 3 gm dose in uncomplicated UTIs - Symptoms resolve in 2-3 days - If symptoms don't improve, giving another dose does not help and only increases risk of side effects - Side effects: Diarrhea, headache, vaginitis

Answer 9

- Antimycobacterial agents - Prodrug (metabolized into active drug after administering) - Indications: Active and latent TB - 1st line aginst TB due to superior efficacy, low toxicity, ease of use, patient acceptance, and affordability - MOA: Inhibits synthesis of mycolic acid, a fatty acid in the mycobacterial cell wall - Adverse effects: Hepatotoxicity, peripheral neuropathy, seizures, dizziness - Drug interactions: Inhibits P450 isozymes (enzymes essential for drug metabolism)

Answer 10

- Broad spectrum antibiotic - Indications: TB and leprosy - 1st line drug for TB - MOA: Inhibits protein synthesis by suppressing RNA synthesis - Adverse effects: Hepatitis, discoloration of body fluids

Answer 11

- Antiprotozoal and antibacterial drug - Indications: - Drug of choice for symptomatic intestinal amebiasis (an infection of the intestines with a parasite called Entamoeba histolytica) and systemic amebiasis, giardiasis (a diarrheal disease caused by the microscopic parasite Giardia duodenalis), and trichomoniasis (a very common STD) - Anaerobic infections - MOA: Interacts with DNA causing strand breakage that results in impairment of DNA function - Adverse effects: Metallic taste in mouth, darkened urine, nausea, headache, neurologic injury, SJS, dry mouth - Drug interactions: Alcohol (increased sensitivity)

Answer 12

- Nucleoside reverse transcriptase inhibitor (NRTI) - Antiretroviral drug - MOA: Suppresses synthesis of viral DNA - Prodrug: Must be converted to active form - Competitively binds to viral reverse transcriptase (RT) - Once incorporated into growing DNA strand, it prevents RT from adding more bases, thus blocking further growth - Adverse effects: - Impairment of mitochondrial function resulting in - Lactic acidosis: Hyperventilation resulting from increased CO2, nausea, makaise, fatigue - Fatty/enlarged liver - Pancreatitis - Hypersensitivity: 1-6 weeks, 5-8% of patients - Contraindications: - People who test positive for HLA-B 5701 (an antigen that increases the risk for hypersensitivity reactions to abacavir) - CAD - Interactions: Alcohol increases ABC levels

Answer 13

- Non-nucleoside reverse trasncriptase inhibitor - Only NNRTI recommended for first line HIV therapy - Dosing: PO once daily - Adverse effects: - Teratogenicity: Fetal defects. Avoid use in pregnancy - CNS effects in 50% of patients: They feel drunk - Maculopapular rash

Answer 14

- Protease inhibitor - MOA: Prevent maturation of HIV by blocking protease - High HIV resistance - Should never be the sole medication - Adverse effects - Hyperglycemia/ diabetes - Lipodystrophy - Hyperlipidemia - Elevated liver enzymes - Prolongation of P-R interval - Elevated blood lipid (25% of patients) - Rash (1-% of patients) - CYP (cytochrome P450) system interactions - Decreased serum levels of ARTs, b blockers, CCBs, amiodarone, lidocaine - Increased serum levels of ABC

Answer 15

- Protease inhibitor booster - MOA: Induces CYP 450 - Increased serum concentration of other protease inhibitos - Allows lower dosing of boosted drug and decreases pill burden - Side effects: GI intolerance, hyperlipidemia - Dose related

Answer 16

- HIV Integrase Strand Transfer Inhibitor (INSTIs) - MOA: Inhibits integrase so that HIV cannot insert DNA into hist cells - Better viral suppression than NNRTI or PI - High risk for HIV resistance - Dolutegravir (another drug) has a lower risk for HIV resistnace - Adverse effects: Generally very well tolerated - Insomnia, fatigue, dizziness, headache - Diarrhea, nausea - FDA pregnancy risk

Answer 17

- Fusion inhibitor - Prevents fusion between viral and target cell (no entrance of HIV into cell) - Never used alone - Seldom used at that - EXPENSIVE (BID subQ dosing costs $20,000 a year) - Adverse effects - Injection site reactions - Pneumonia - Hypersensitivity reactions