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Pharmacology I > 2 - Antimicrobials III > Flashcards

2 - Antimicrobials III Flashcards

1
Q

Intensive TB therapy is always initiated with:

A

FOUR DRUGS for at least 8 weeks

Isoniazid and Rifampin are ALWAYS included

  1. Isoniazid
  2. Rifampin
  3. Pyrazinamide
  4. Ethambutol
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2
Q

TB continuation therapy consists of:

A

Isoniazid and Rifampin for at least 18 weeks

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3
Q

Why is TB so hard to treat in patients with HIV

A

Obviously their host immune system is weaker

BUT ALSO Rifampin accelerate the metabolism of reverse transcriptase inhibitors, so the most beneficial drug is unavailable to them

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4
Q

What causes TB to transition from latent to active?

A

Anything that severely taxes the immune system

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5
Q

What percentage of people with latent TB will develop active TB?

A

5-10%

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6
Q

When is isoniazid bactericidal? When is it bacteriostatic?

A

Bactericidal to mycobacteria that are actively dividing

bacteriostatic to dormant organisms

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7
Q

Isoniazid carries a black box warning for:

A

hepatotoxicity

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8
Q

What is the most common adverse effect of isoniazid?

A

Peripheral neuropathy

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9
Q

Does Isoniazid cross the BBB?

A

Yes

It causes several CNS effects

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10
Q

What is the MOA of Rifampin?

A

Inhibits bacterial protein synthesis by inhibiting RNA polymerase

Mammalian RNA polymerases are not effected

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11
Q

What are two main adverse effects of Rifampin?

A

Hepatotoxicity

Discoloration of body fluids

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12
Q

What is the MOA of pyrazinamide?

A

Inhibits growth by lowering pH and inhibiting fatty acid synthesis

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13
Q

What is the main adverse effect of pyrazinimide?

A

It is THE MOST Hepatotoxic of all the first line drugs!!!

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14
Q

What is the MOA of ethambutol?

A

Bactericidal

Inhibits mycobacterial cell wall synthesis

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15
Q

What should you say to a woman taking pyrazinamide who is having joint pain?

A

May be causing gouty arthritis

recommend NSAIDs for pain and reassure it will resolve after therapy ends

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16
Q

When you prescribe fluroquinolones, what is the one adverse effect that should be first in your mind?

A

The possibility of tendon rupture

Especially in patients over 60

17
Q

Name four fluoroquinolones

A
  1. Ciprofloxacin
  2. Levaquin
  3. Ofloxacin
  4. Metronidazole
18
Q

What is the MOA of ciprofloxacin?

A

Inhibits two bacterial enzymes required for DNA replication and cell division

RAPIDLY bactericidal

19
Q

Which ABX is used to treat anthrax?

A

Cipro

20
Q

Why do fluoroquinolones damage tendons?

A

They disrupt the extracellular matrix of cartilage in immature animals

It’s reversible if diagnosed early

21
Q

What are the first signs of tendon rupture?

A

tendon pain, swelling, or inflammation

22
Q

How should patients on fluoroquinolones be advised?

A

Don’t exercise if you’re having an tendon pain whatsoever until a rupture has been ruled out

23
Q

Cipro carries a black box warning for two AEs:

A

Tendon Rupture

Myasthenia Gravis (exacerbates muscle weakness)

24
Q

What is the MOA of metronidazole?

A

prodrug that’s converted in the cell and causes DNA destruction

ONLY WORKS IN ANAEROBES, because aerobes don’t have the enzyme to convert it

25
Q

When you think Metronidazole, think:

A

GI:

H Pylori and C. Diff

26
Q

Which mycoses are opportunistic?

A

Candidiasis

Aspergillosis

Cryptococcosis

mucormycosis

27
Q

Which mycoses are non-opportunistic?

A

Histoplasmosis

Coccidioidomycosis

Sporotrichosis

Blastomycosis

28
Q

Amphotericin B belongs to which drug class?

A

Polyene antibiotics

29
Q

What is the MOA of Amphotericin B?

A

Binds to sterol components of the fungal cell membrane and causes leakage of cations (K)

30
Q

Why are bacteria not effected by Amphotericin B?

A

They don’t have any sterols in their cytoplasmic membrane

31
Q

Why is Amphotericin B so toxic to humans?

A

Because mammalian cell membranes have sterol

Ampho binds more strongly to ergosterol in fungi than it does to cholesterol in mammals, so fungi are more effected, but it’s not totally selective

32
Q

Why does Amphotericin B cause infusion reactions?

A

causes monocytes and macrophages to release TNF, IL-1 and IL-6

Begins 11-3 hours after administration

Pretreat with benadryl and tylenol

33
Q

Which organ is most effected by Amphotericin B?

A

Kidneys

Renal impairment occurs in practically all patients

May be reversible, but if the total dose is greater than 4g, residual impairment will probably be present

34
Q

How can you minimize kidney impairment in patients receiving Amphotericin B IV?

A

Infuse 1L saline on days ampho will be given

35
Q

Which drug formulation of Amphotericin B is least likely to cause nephrotoxicity?

A

The lipid based formulas are less toxic, but much more expensive

36
Q

Which class of drugs is used to get rid of parasitic worms?

A

Anthelmintics

Pharmacology I (29 decks)

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