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PHRM 5001 > 6. Antimicrobial Drugs > Flashcards

6. Antimicrobial Drugs Flashcards

1
Q

What are the characteristics of an ideal drug? (hint: 9 things)

A

Selective toxicity, microbicidal, relatively soluble, can maintain potency, does not contribute to antimicrobial resistance, compliments/assists host’s defences, can be quickly delivered to the site of action, reasonable price and readily available, does not negatively affect host’s health

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2
Q
  1. What is the structural complexity of fungal cells similar to? Why is this a problem?
  2. What do antifungal drugs interfere with, and what does this disrupt?
A
  1. Similar to humans, poses serious therapeutic risk, difficult to achieve selective toxicity
  2. Cell membrane, disrupts selective permeability
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3
Q
  1. What do antiviral drugs target? (hint: can target 3 things)
  2. What complications can arise when treating viral infections?
A
  1. Nucleic acid synthesis, viral assembly or release
  2. Attacking the intracellular virus may harm the host, maximal viral replication before symptoms appear, viruses exhibit antigenic mutability
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4
Q
  1. How do antibacterial drugs function?

2. The mechanism of action involves the inhibition of…? (Hint: 5 things)

A
  1. Increase therapeutic index by targeting structures/processes unique to prokaryotic cells
  2. Cell wall synthesis, cell membrane, protein synthesis, nucleic acid synthesis, essential metabolic pathways
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5
Q
  1. How are inhaled antimicrobials often given?
  2. What are the advantages of inhalational therapy? What are the disadvantages?
  3. Special considerations? (hint: 5)
A
  1. Prophylactically
  2. Advantages: Directly targets lungs, increased concentrations delivered to site of infection, fewer/less severe side effects
    Disadvantages: Airway irritation, environmental contamination, occupational exposure
  3. Drug dosages, exposure levels, safeguards for pts and HCPs, aerosol generators, toxic effects
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6
Q
  1. What is Aerosolized Pentamidine a second-line treatment (aka prophylaxis) in the prevention of?
  2. What patients is this commonly seen in?
  3. What is Pentamidine thought to interfere with?
  4. What is the standard dose, and how often is it administered?
A
  1. Prevention of Pneumocystis jirovecii/carinii pneumonia (PCP)
  2. HIV/AIDS pts, oncology pts
  3. Nuclear metabolism, synthesis of DNA, RNA, phospholipids and proteins
  4. 300 mg reconstituted in 6 ml sterile water, given once every 4 wks
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7
Q
  1. Airway side effects of Pentamidine? (hint: 5 things)
  2. What can you do prior to administration to decrease the side effects?
  3. Systemic side effects? (hint: 8 things)
A
  1. Cough, SOB, bad/bitter taste, bronchospasm & wheezing, spontaneous pneumothoraces
  2. Pre-treat with bronchodilators
  3. Conjunctivitis, rash, neutropenia, pancreatitis, renal insufficiency, dysglycemia, digital necrosis, extra pulmonary PCP infections
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8
Q

Because of the environmental precautions with aerosolized pentamidine, what does the nebulizer system have to incorporate? (hint: 5 things)

A

One-way valves, expiratory filter, nose plug, MMD of 1-2 um to target alveoli, turn neb off when talking/coughing

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9
Q

What are the environmental precautions that should be taken with aerosolized Pentamidine? (hint: 4 things)

A

Administer in a negative pressure room, barrier protection including N95, screen pts for TB, pregnant/nursing mothers should avoid

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10
Q
  1. What is Ribavirin used to treat? What can this infection cause?
  2. How does Ribavirin function? (what does it interfere with, and what does this cause)
    Virocidal or virostatic?
A
  1. Treats complicated respiratory syncytial virus (RSV) infections, can cause bronchiolitis and/or pneumonia
  2. Interferes with viral assembly → nucleoside analogue resembling guanosine taken up by DNA chain, inhibiting assembly process
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11
Q
  1. What device is used to administer Ribavirin?
  2. What is this used in conjunction with?
  3. How big are the particles created?
  4. What is this not intended for use with, and why?
A
  1. SPAG-2 nebulizer
  2. Hood
  3. 1.3 um
  4. Ventilators, can occlude/impair exp. valves, impair sensors, ETT blockage
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12
Q
  1. What is the dosing schedule for Ribavirin? (Dose, what is it administered in, for how long each day, for how many days)
  2. Is it reconstituted in sterile water, and if so how much total volume?
  3. What effects can this drug cause, making environmental control essential?
A
  1. 20 mg/ml solution via LVN system for 12-18 hrs/day, 3-7 day treatment
  2. Reconstituted w/ sterile water for total vol. of 300 ml (6g/300 ml)
  3. Carcinogenic effects, teratogenic effects
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13
Q

Serious systemic side effects with Ribavirin… what are the pulmonary effects? cardiovascular? hematologic? dermatologic?

A

Pulmonary: bronchospasm, pneumo, apnea, bacterial pneumonia
CV: Hypotension, cardiac arrest, digitalis toxicity
Hematologic: Reticulocytosis
Dermatologic: Rash, eyelid erythema, conjunctivitis

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14
Q

What type of drug is Palivizumab? What is this used to prevent?
How is it administered, and how often?
Which patients are at high risk, so the drug is often given prophylactically?

A
  1. Therapeutic monoclonal antibody, used to prevent serious LRTI caused by RSV
  2. via IM injection, given monthly t/o RSV season
  3. Congenital heart disease, BPD, prematurity
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15
Q
  1. What is Zanamivir (Relenza) used to treat? What does it inhibit to achieve this?
  2. When does this have to be taken?
  3. What is the name of the oral version?
A
  1. Influenza A (H1N1) and B infections, inhibits neuraminidase
  2. Within the first 2 days of infection
  3. Oseltamivir (Tamiflu)
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16
Q
  1. How is Zanamivir (Relenza) administered?
  2. How often is it administered and for how long?
  3. What are the adverse effects? (Hint: 4 things)
A
  1. DPI diskhaler
  2. Taken BID for 5 days
  3. Bronchospasm, decreased lung function, dizziness/headache, GI rxns
17
Q

What kind of drug is nebulized TOBI (aerosolized tobramycin)? What is this used to treat?
What other form of administration exists?
Why is this not given orally? What route(s) does tobramycin require?

A
  1. Aminoglycoside abx, used to manage Pseudomonas aeruginosa infections in CF pts
  2. DPI
  3. Do not give sufficient lung levels to inhibit P. aeruginosa, has poor oral bioavailability, requires either IV or inhaled route
18
Q
  1. What is the MOA of tobramycin?

2. What are the advantages with inhalational administration?

A
  1. Blocks protein synthesis

2. Decreased systemic toxicity, reduced cost vs. IV, ease of use at home, decreased risk of drug-resistant strains

19
Q
  1. What is the maintenance dosing schedule of Tobramycin? (How many mg, how many times a day, for how many days, how far apart are doses taken, how many days off medication)
  2. What needs to be done before this therapy can be taken?
  3. What nebulizer device does this drug this need to be given through? Can it be mixed with other drugs?
A
  1. 300 mg inhaled BID x 28 days, doses taken 6-12 hrs apart, followed by 28 days off
  2. Take other therapies first!! (bronchodilators, dornase alfa, CPT)
  3. Pari LC Plus, NO DO NOT MIX!
20
Q
  1. Possible side effects of aerosolized tobramycin? (hint: 3)
  2. Serious side effects? (hint: 4)
A
    • Tinnitus, hearing loss
      - Voice changes
      - Cough and bronchospasm
    • Impaired renal fxn
      - Neuromuscular blockade
      - Fetal harm
      - Cross-allergenicity
21
Q
  1. How is aerosolized colistin created? Is it typically inhaled?
  2. What is this used to treat?
  3. What use is currently under investigation for this drug?
A
  1. Inactive prodrug colistimethate hydrolyzed into bioactive colistin, no inhalation is an off-label use
  2. P. aeruginosa in CF pts
  3. treating VAP
22
Q

What are the significant side effects of aerosolized colistin? (CNS, resp, GI, skin, urinary, MS)

A

CNS: headache, dizziness, slurred speech, vertigo
Resp: distress, apnea
GI: gastric distress
SKin: Urticaria, rash
Urinary: decreased urine output, nephrotoxicity
MS: lower extremity weakness

23
Q
  1. What is the trade name of aerosolized Astreonam?
  2. What is this used to treat? What age range? What other specifics must the pt have?
  3. Course of treatment? How often is it taken each day?
  4. Dosage? What is it diluted with?
  5. What nebulizer system is this administered with? Can it be mixed with other drugs?
A
  1. Cayston
  2. P. auruginosa in CF pts > 7 yrs old with FEV1 25-75%
  3. 28 day treatment, taken TID
  4. 75 mg/syringe, must be diluted with sterile diluent (0.17% NaCl)
  5. Altera nebulizer system, NO DO NOT MIX!
24
Q

What are the precautions with aerosolized Astreonam? (hint: 2 of them)

A

Drug resistance may develop when used in absence of infection with P. aeruginosa
Severe allergic rxns noted with aztreonam injections, observe pts on inhaled treatment carefully

25
Q

Adverse effects of aerosolized aztreonam? (8 things)

A

Bronchospasm, cough, nasal congestion, sore throat, fever, chest pain, abdominal pain, vomiting

26
Q

How do you assess for efficacy of inhaled Abx? (hint: 5 things)

A

Monitor PFTs, monitor for adverse side effects, assess rate of hospitalization before and after Abx, teach pts peak flow meters, minimize drug resistance by alternating therapies

PHRM 5001 (12 decks)

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