Week 4 Flashcards
(149 cards)
1
Q
Types of Natural Pencillin
A
- Penicillin G aqueous
- Penicillin G procaine and benathine
- Penicillin V (PenVeek, Vi-CillinK
2
Q
Types of Amino Penicillin
A
- amoxixillin (Amoxil)
- ampicillin (Omipen)
3
Q
Antistaphylococcal Penicillin
A
dicloxacillin (Dynapen)
nafcillin (Nafcil, Unipen)
oxacillin (Prostaphlin)
4
Q
Antipseudomonal Penicillin
A
pipercillin (Piperacil)
ticarcillin (Ticar)
5
Q
B-Lacatamase inhibtors
A
Ampicillin/sulbactam (unasyn)
amoxicillin/clavulanate (Augmentin)
piperacillin/tazobactam (Zosyn)
ticarcillin/clavulante (Timentin)
6
Q
1st Generation Cephalosporins
A
Cefadroxil (druicef) PO
Cefazolin (Ancef, Kefzol) INJ
Cephalexin (Keflex) PO
7
Q
2nd Generation Cephalosporins
A
Cefaclor (Ceclor) cefotetan (Cefotan) cefoxitin (Mefoxin) cefprozil (Cefzil) cefuroxime (Zinacef) cefuroxime axetil (Ceftin)
8
Q
3rd Generation Cephalosporins
A
cefdinir (Omnicef) cefditoren (Spectracef) cefixime (Suprax) cefotaxime (Clarforan) cefpodoxime (Vantin) ceftazidime (Fortaz) cefibuten (Cedax) ceftriaxone (Rocephine)
9
Q
Penicillin: Mechanism of action
A
Interfere with bacterial cell wall synthesis
bind to peptidoglycan layer causing bacterial cell lysis and death
10
Q
Penicillin: Mechanism of Resistance
A
1) B-Lactamase/Penicillinase
2) Modified PBP’s (decreased affinity for PCN)
3) Decreased permeability (Gram negative external surfaces that reduce drug permeability)
11
Q
Types of Macrolides
A
azithromycin (Z-Pak, Zithromax)
clarithromycin (Biaxin)
erythromycin (multiple brands)
12
Q
Macrolides: Mechanism of action
A
inhibits bacterial ribosomal protein synthesis
13
Q
Macrolides: Antibacterial Spectrum
A
Respiratory/genital infections (if pt. allerigic to PCN)
Otitis media
Community acquired pneumonia
Pelvic infections caused by Chlamydia trachomatis
Topical for acne
Whooping Cough
14
Q
Macrolides: ADR
A
GI intolerance (most common) Cholestatic jaundice Abnormal taste sensations Prolonged QT interval
15
Q
Drug responsible for metal taste in mouth
A
Clarithromycin
16
Q
Antipseudomonal Penicillins: Spectrum Diseases
A
Nosocomial pneumonia, nosocomial UTI, complicated cellulitis, abdominal infections
17
Q
Drug interactions with erythromycin and clarithromycin
A
theophylline warfarin antifungals statins seizure drugs detrol digoxin
18
Q
Caution with macrolides in patients with what?
A
Severe hepatic dysfunction
19
Q
Macrolides: off label uses
A
erythromycin used to treat diabetic gastroparesis by increasing GI motility and gastric emptying
20
Q
List of tetracyclines
A
demeclocycline (Declomycin)
doxycycline (Vibramycin)
minocycline (Minocin)
tetracycline (Sumycin)
21
Q
Natural Penicillin: Spectrum of Bacteria/Pathogens
A
Bacteria-Gram Positive Cocci
Pathogens- Strep Viridans, Strep pyogenes, strep pneumonia
22
Q
Natural Penicillin: Spectrum Diseases
A
Syphilis, endocarditis, pneumonia, strep throat, group B strep infections
23
Q
Amino Penicillins: Spectrum of Bacteria/Pathogens
A
Bacteria- Both gram positive and gram negative
Pathogens- haemophilus influenzae, strep pneumonia, E. coli, proteus mirabilis, enterococcus
24
Q
Amnio Penicillins: Spectrum Diseases
A
Sinusitis, throat infections, otitis media, UTI’s
25
Antipseudomonal Penicillins: Spectrum of Bacteria/Pathogens
Bacteria- gram negative bacilli/rods
| Pathogens- pseudomonas aeruginosa, serratia, klebsiella
26
Antipseudomonal Penicillins: Diseases
Nosocomial pneumonia, nosocomial UTI, complicated cellulitis, abdominal infections
27
Tetracyclines: Mechanism of Action
inhibits bacterial ribosomal protein synthesis
28
Tetracyclines: Spectrum
```
Community acquired pneumonia
lyme's disease, rocky mountain spotted fever, tularemia, anthrax treatement
pelvic infections
acne
MRSA
```
29
Best drug to treat CAP
Docycycline
30
Pelvic infection caused by
Chlamydia trachomatis
31
Tetracyclines :pharmacokinetics
high concentrations achieved in body organs, skin, bone and teeth
32
Tetracyclines: pharmacokinetics
Metabolized in liver first, then excreted by kidneys
| Crosses placenta and excretes into breast milk
33
Tetracyclines: drug interactions
Chelate with 2+ and 3+ cations (Ca2+, Fe3+)
antacids, multivitamins
milk, cheese
34
Tetracyclines: ADR
GI intolerance
Photosensitivity
Teeth discoloration
Hypersensitivity reactions
Fatal hepatic toxicity at high doses (rare)
inhibit skeletal growth in developing fetus during pregnancy
35
Clindamycin: Mechanism of Action
inhibits bacterial ribosomal protein synthesis
36
Clindamycin: ADR:
hypersensitivity reactions
high incidence of causing Clostridium difficile
Cause non-Clostridium difficile diarrhea, N/V
37
Clindamycins: Spectrum
excellent anaerobic and gram+ coverage
almost no gram - coverage
alternative to PCN and cephalosporins where gram+ coverage is needed
38
Clindamycins: commonly used
Diabetic foot cellulitis where gram- not suspected
skin and soft tissue infections w/ PCN allergy
Mild aspiration pneumonias where anaerobe may be present
acne
Staphylococcus aureus (CA-MRSA)
39
B-Lactamase Inhibitor Combinations: Spectrum of Bacteria/Pathogens
Bacteria- gram positive, enhanced gram negative and anaerobic coverage
Pathogens- "anything that's stinky"
40
B-Lactamase Inhibitor Combinations: Spectrum Diseases
diabetic foot ulcers, abscesses, animal bites, abdominal infections, anaerobic infections, polymicrobial infections
41
Antistaphylococcal Penicillins: Spectrum of Bacteria/Pathogens
Bacteria- gram positive
| Pathogens- staph aureus, other staph strains
42
Antistaphylococcal Penicillins: Spectrum Diseases
Soft tissue and bone infections, endocarditis
43
Antifolate Drugs: Sulfa Drugs/Sulfonamides
```
Mafenide
Silver sulfadiazine (Silvadene)
Sulfacetamide (Cetamide)
Sulfadiazine (Microsulfon)
Sulfamethoxazole (Bactrim component)
Sulfisoxazole (Gantrisin)
Triple sulfa vaginal cream (Sultrin)
```
44
Antifolate Drugs: Sulfa Drugs: Mechanism of Action
Sulfonamides use up much of the enzyme needed to convert PABA to folic acid, thus decreasing folic acid production.
45
Antifolate Drugs: Sulfa Drugs: Pharmacokinetics
```
Well absorbed orally.
Distributes throughout body water.
Highly protein bound.
Metabolized in the liver.
Excreted renally.
```
46
Antifolate Drugs: Sulfa Drugs: Drug Interactions
With other highly protein bound drugs e.g. warfarin and phenytoin (Dilantin)
47
Antifolate Drugs: Sulfa Drugs: ADR
Hypersensitivity Reactions
Nephrotoxicity
GI upset, diarrhea
Kernicterus: sulfonamides displace bilirubin from protein binding sites
Rare: aplastic anemia, pancreatitis, thrombocytopenia
48
Persons allergic to sulfonamides may have cross sensitivity with these medications
```
Celecoxib (Celebrex)
Furosemide (Lasix)
Hydrochlorothiazide
sulfasalazine (Azulfidine)
Zonisamide (Zonegram)
Glyburide & Glipizide sulfonylureas
```
49
If you are allergic to sulfonamide Rx, then which 3 drugs will the pharmacist call you on (to tell you, you cannot administer these drugs)?
Celecoxib (Celebrex)
Sulfasalazine (Azulfidine)
Zonisamide (Zonegram)
50
Antifolate Drug: Trimethoprim: Mechanism of Action
Dihydrofolate reductase inhibitor. Dihydrofolate reductase converts folic acid to its active form, tetrahydrofolic acid
51
Antifolate Drug: Trimethoprim: Pharmacokinetics
```
Similar to sulfonamides:
Well absorbed orally.
Distributes throughout body water.
Highly protein bound.
Metabolized in the liver.
Excreted renally.
```
52
Antifolate Drug: Trimethoprim: ADR
can produce effects of folate deficiency if given in very high doses
53
Co-Trimoxazole (Bactrim, Septra): Mechanism of Action
Synergy: shows greater antimicrobial activity than equivalent quantities of either drug used alone
Inhibits 2 sequential steps in the synthesis of active folic acid
54
Co-Trimoxazole (Bactrim, Septra): ADR
Hypersensitivity Reactions
Nephrotoxicity
GI upset, diarrhea
Kernicterus: sulfonamides displace bilirubin from protein binding sites
Rare: aplastic anemia, pancreatitis, thrombocytopenia
Can produce effects of folate deficiency if given in very high doses
55
Co-Trimoxazole (Bactrim, Septra): Drug Interactions
With other highly protein bound drugs e.g. warfarin & phenytoin (Dilantin)
56
Co-Trimoxazole (Bactrim, Septra): Therapeutic Indications
UTI
Prostate Infections
Otitis media, sinusitis, & other resp. infections
Tx & prophylaxis Pneumocystis jiroveci pneumonia
CA-MRSA
57
What are the main pathogens that Bactrim & Septra target?
```
Serratia
M. catarrhalis
H. influenza
L. monocytogenes
P. mirabilis
E. coli
```
58
What pathogen is most common in a UTI?
E. coli
59
ketoconazole: Mechanism of action
alters permeability of fungal cell wall & inhibits several fungal enzymes that causes toxin build up in fungal cell
60
ketoconazole: Therapeutic uses
OTC dandruff shampoo
| orally for systemic fungal infections of lung, bone, skin, ect.
61
ketoconazole: systemic fungal infections are caused by what?
Blastomyces dermatitidis, Candida albicans, Coccidioides immitis, Histoplasma capsulatum
62
ketoconazole: pharmacokinetics
1) requires an acidic environment for adequate absorption 2) food, antacids, H2-blockers and proton pump inhibitors impair oral absorption
63
ketoconazole: drug interactions
significant cytochrome p450 interactions
64
Ketoconazole: adverse drug reactions
GI upset, N/V, diarrhea, rash
endocrine effects - can inhibit sex steroid synthesis
black box warning: fatal hepatic toxicity can occur
65
fluconazole: mechanism of action
same as itraconazole: decreases ergosterol synthesis and inhibits cell membrane formation
66
fluconazole: therapeutic uses
IV & oral: oral and esophageal candidiasis (thrush)
oral: single oral dose effectively treats vulvovaginal candidiasis (yeast infection)
IV & oral: systemic fungal infections of lung, bone, skin
67
fluconazole: drug interactions
Significant cytochrome p450 interactions
68
fluconazole: adverse drug reactions
GI upset, N/V, headache, diarrhea, rash
| fatal hepatic toxicity can occur
69
itraconazole: mechanism of action
same as fluconazole: decreases ergosterol synthesis and inhibits cell membrane formation
70
itraconazole: oral therapeutic use
onychomycosis of the fingernail and toenails
71
itraconazole: pharmacokinetics
1) capsules and oral solution are not bioequivalent
2) requires acidic environment for absorption
3) food, antacids, H2-blockers and proton pump inhibitors impair oral absorption
72
itraconazole: drug interactions
significant cytochrome p450 interactions
73
itraconazole: adverse drug reactions
GI upset, N/V, diarrhea, rash
fatal hepatic toxicity can occur
black box warning: rase cases of serious CV adverse events have occurred. Cation with pts with left ventricular dysfunction or CHF
74
posaconazole: therapeutic uses
oral: treats thrush in patients refractory to other "azoles"
| Prophylaxis of invasive Candida and Aspergillus infections in immunocompromised patients
75
List the quinolones
ciprofloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, sparfloxacin
76
Quinolone mechanism of action
inhibit the replication of the bacteria by interfering with 2 bacterial enzymes, DNA gyrase and topoisomerase
77
First line quinolones for community-acquired pneumonias
Levofloxacin and moxifloxicin
78
most common pathogens for community-acquired pneumonia
```
Streptococcus pneumonia
Haemophilus influenzae
Chlamydia pneumoniae
Mycopolasma pneumoniae
Legionella pneumoniae
```
79
Quinolone coverage of bacteria (in general)
excellent gram negative coverage
some gram positive coverage
almost no anaerobic coverage
80
Quinolone of choice for pseudomonas coverage
Ciprofloxacin
81
Quinolone spectrum
UTI, prostate infections, CAP, pseudomonas infections, pelvic infections caused by chlamydia trachomatis, anthrax, some skin and soft tissue infections
82
Quinolone pharmacokinetics
excellent oral absorption, distributes into bone and prostate, high levels in lungs and urine
83
Quinolone ADRs
GI upset, diarrhea, nausea, hypersensitivity reactions, CNS side effects, prolonged QT interval (torsades), tendon ruptures, bone development abnormalities,
84
Quinolones are contraindicated in which patients?
pregnancy, breast-feeding, and children under age 18 b/c of bone development abnormalities
85
griseofulvin: mechanism of action
inhibits fungal cell mitosis at metaphase
86
griseofulvin: therapeutic uses
treatment of susceptible tinea infections of skin, hair and nails
87
Vulvovaginal Candidiasis (uncomplicated): choosing which pharmacologic treatment
Therapy is personal preference - cure rates are similar among products. Immediate relief is better achieved with topical products rather than oral.
88
Metronidazole therapeutic uses
DOC for clostridium difficile, good anerobic coverage (abdominal infections, aspiration pnneumonia), protozoal infections
89
Metronidazole ADR
N/V, headache, metallic taste, anorexia, vertigo, insomnia, seizure
90
Metronidazole Drug Interactions
Disulfuram reaction with alcohol--severe N/V and abdominal cramps, avoid alcohol during therapy and up to 24 hours after last dose
91
Nitrofurantoin mechanism of action
inhibits various bacterial enzymes
92
Oropharyngeal Candidiasis (OPC): treatment for low risk patients
topical antifungals are first-line therapy for OPC
93
Nitrofurantoin ADR
Discoloration of urine, GI disturbances, hypersensitivity reactions, pulmonary toxicity
94
Which "big-gun" antifungal is a member of the azole family and often reserved for azole-resistant infections?
voriconazole
95
Which "big-gun" antifungal is almost always used with other antifungals?
flucytosine
96
Tinea infections: pathophysiology
1) Infection does not involve living tissue but the superficial layers of skin only
97
What is Butenafine cream (Lotrimin Ultra) used for?
superficial dermatological fungal infections
98
What are the OTC antifungals for superficial mycoses?
Butenafine, Butoconazole, Clotrimazole, Miconazole, Nystatin, Terbinafine, Terconazole, Ticonazole, Tolnaftate
99
Vulvovaginal Candidiasis: pathogens
primarily Candida albicans (90%)
100
Recurrent Vulvovaginal Candidiasis is more common in what groups of people? (3)
immunocompromised
uncontrolled diabetes
pregnancy
101
What kinds of alterations in the vaginal environment can increase risk of Vulvovaginal Candidiasis?
pH changes, stress, hormone changes, sexual activity, pregnancy, contraceptive use, douches, antibiotics
102
Vulvovaginal Candidiasis: non-pharmacologial treatment
1) keep genital area clean and dry, avoid hot tubs
2) avoid constrictive clothing, wear cotton
3) avoid soaps and perfumes in genital area
103
Community-Acquired Pneumonia (CAP): treatment of adult outpatient co-morbidities
levofloxacin alone, moxifloxacin alone, or a combination of azithromycin, clarithromycin, or doxycycline PLUS either high dose amoxicillin or high dose amox/clavulanate
104
Pharmacologic Treatment of Recurrent VVC
14 days of an intravaginal product or 2 doses of fluconazole 3 days apart may be used followed by 6 months long-term suppressive therapy
105
Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: pathogens
Candida albicans causes 80% of OPC and esophageal candidiasis
106
Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: epidemiology
1) often occurs in infants, elderly, & immunocompromised
| 2) 1/3 to 1/2 of older adults develop OPC
107
Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: etiology
1) Most commonly reported ADR of inhaled corticosteroids (37% occurrence)
2) Most common opportunistic infection of HIV patients (80-90% will develop at some time) and is
an extremely common initial manifestation of the disease
108
Oropharyngeal Candidiasis (OPC) and Esophageal Candidiasis: treatment for low risk patients
topical antifungals are first-line therapy for OPC
109
Oropharyngeal Candidiasis (OPC): treatment for severe or unresponsive cases
systemic antifungals
110
Esophageal Candidiasis: treatment
aggressive systemic antifungal therapy
111
Tinea infections: epidemiology & etiology
1) Tinea infections are second only to acne in frequency of reported skin disease
2) Of all the forms of tinea, tinea pedis is the most common
112
Tinea infections: pathophysiology
1) Infection does not involve living tissue but the superficial layers of skin only
113
What are the specific non-pharmacological treatment for Tinea pedis
Change socks two to three times daily and wear protective footwear in public showers & pool areas
114
Tinea infections: What do you tell pts about topical antifungal treatment?
Apply topically at least 1 inch beyond affected area. Continue tx at least 1 to 2 weeks after clearing
115
Onychomycosis: treatment
Oral antifungals are required x at least 3 months for toenails and at least 2 months for fingernails.
116
five classifications of pneumonia
1) Community-acquired pneumonia, 2) Aspiration
| pneumonia, 3) Hospital-acquired pneumonia, 4) Ventilator-associated pneumonia, and 5) Healthcare-associated pneumonia
117
Community-Acquired Pneumonia (CAP): most common pathogen (25-70%)
steptococcus pneumoniae
118
Community-Acquired Pneumonia (CAP): treatment of adult outpatient otherwise healthy
azithromycin, clarithromycin, erythromycin, or
| doxycycline; alternatives include levofloxacin or moxifloxacin
119
Community-Acquired Pneumonia (CAP): treatment of adult outpatient co-morbidities
levofloxacin alone, moxifloxacin alone, or a combination of azithromycin, clarithromycin, or doxycycline PLUS either high dose amoxicillin or high dose amox/clavulanate
120
Community-Acquired Pneumonia (CAP): treatment of Pediatric outpatient:
azithromycin or clarithromycin; alternatives include high dose amoxicillin, high dose amoxicillin/clavulanate, or IM ceftriaxone
121
Community-Acquired Pneumonia (CAP): duration of treatment
Azithromycin - 5 days
Levofloxacin when dosed at 750mg daily - 5 days
all other antibiotics - 7 to 10 days
122
Gonorrhea: pathogen
Neisseria gonorrhoeae (gram-negative diplococci)
123
A pt who tests positive for gonorrhea should also be tested for which other STIs?
Chlamydia trachomatis, syphillis, and HIV
124
Antibiotic tx for gonorrhea should also include coverage against what? With which 2 drugs?
Coverage against Chlamydia trachomatis with Azithromycin or Doxycycline
125
Gonorrhea: Which class of drugs should you not use in individuals w/ a hx of recent travel to foreign countries w/ known resistance or in men who have sex w/ men?
Fluoroquinolones
126
Gonorrhea: uncomplicated tx of infx of the cervix, urethra, rectum, or pharynx
ceftriaxone IM plus azithromycin or doxycycline (dual gonococcal coverage + chlamydial coverage)
127
Gonorrhea: tx in pregnant women
ceftriaxone IM plus azithromycin
128
Gonorrhea: tx ophthalmic neonatorum prophylaxis
either erythromycin or tetracycline ophthalmic ointment single application
129
Gonorrhea: tx for cases of severe cephalosporin allergy
azithromycin orally
130
Chlamydia: pathogen
Chlamydia trachomatis
131
Chlamydia: best tx options
azithromycin 1g single dose
| doxycycline 100mg q12h x 7 days
132
Chlamydia: other tx alternatives
erythromycin x 7 days
| levofloxacin x 7 days
133
Chlamydia: tx in pregnancy
AVOID fluoroquinolones and tetracyclines!
| Macrolides are preferred and Amoxicillin can be an alternative.
134
Chlamydia: tx of ophthalmic or lung infx in neonates
erythromycin oral x 14 days
135
Syphillis: pathogen
Treponema pallidum (a spirochete/gram-negative bacteria)
136
Syphillis: prominence
black men and men who have sex w/ men
137
Syphillis: primary symptoms
solitary, painless cancre at the site of the infx about 3 wks after exposure
138
Syphillis: secondary symptoms
systemic symptoms: fatigue, diffuse rash, fever, lymphadenopathy, and genital condyloma latum (flat, wart-like growths)
139
Syphillis: infx rates in infants to infected mothers
nearly 100%
140
Syphillis: preferred tx
Benzathine penicillin G IM. Dose & duration vary depending upon stage and HIV status.
141
Syphillis: alternatives in PCN allergy
ceftriaxone IM, doxycycline, minocycline, tetracycline, erythromycin, or azithromycin
142
Trichomoniasis: pathogen
Trichomonas vaginalis
143
Trichomoniasis: tx
Metronidazole or tinidazole
144
Bacterial Vaginosis: pathogen
Gardenella vaginalis, Prevotella sp., Mycoplasma hominis, and Mobiluncus sp.
145
Bacterial Vaginosis: tx
oral or intravaginal metronidazole or clindamycin
146
Pelvic Inflammatory Disease (PID): pathogens
Chlamydia trachomatis
Neisseria gonorrheoeae
Possible anaerobes (Bacteroides, Peptostreptococci)
Possible gran-negative rods (Haemophilus, E. coli)
147
PID: outpatient tx
ceftriaxone IMx1 + doxycycline x 14 days +or- metronidazole x 14 days
148
PID: alternative outpatient tx
ceftriaxone can be replaced w/ cefotetan IMx1 + probenecid x 1
149
PID: inpatient tx
cefotetan IV or cefoxitin IV + doxycycline po or IV
| clindamycin IV + gentamicin IV + doxy +or- metronidzole
