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Test > Anaerobic Agents, Influenza, And Antifungals > Flashcards

Anaerobic Agents, Influenza, And Antifungals Flashcards

1
Q

Clindamycin provides coverage for what type of bugs?

A

Gram + anaerobes
-Gr + S. Aureus, GABHS, CA MRSA
- abscesses, bacterial vaginosis

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2
Q

What is the MOA for Clindamycin?

A

Inhibits protein synth by binding to 50s ribosome; can compete with Macrolides
Both bacteriostatic and bactericidal

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3
Q

What is a good alternative drug if allergic to PCNs?

A

Clindamycin

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4
Q

What are the SE of Clindamycin?

A

C. Diff and diarrhea, fever/rash, minor risk of hepatotoxicity, neutropenia, and preterm birth with cream for bacterial vaginosis

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5
Q

What is the MOA of metronidazole (flagyl)?

A

Prodrug
With anaerobic bugs, can create free radicals toxic to cell, bind to DNA and cause cell death
- bactericidal

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6
Q

What is metronidazole (Flagyl) prescribed for?

A
  • Gram - anaerobes
    -* first line for c diff
  • *protozoal infections: trichomonas vaginalis, giardia, entamoeba histolytica
  • soft tissue infections including acne, intraabdominal infections, colitis, bacterial vaginosis dt gardnerella vaginalis
  • H pylori if you need an alternative to amoxicillin
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7
Q

What are the SE of metronidazole (flagyl)?

A

Metallic taste, neuropathies, seizures, disulfiram like reactions (avoid anything containing ETOH), inhibitor of CVY2C9 (DDI with s-warfarin)

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8
Q

What type of vaccine is Flumist and who should NOT get it?

A

-live attenuated
- avoid if egg allergy, GBS, immunocompromised, steroids, HIV, CA, asthma, 2nd and 3rd tri pregnancy, peds if taking aspirin

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9
Q

What should pts do if they get FluMist?

A

Avoid immunocompromised for 7d (book says 7, lecture says 21)

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10
Q

Which Influenza drugs are NOT recommended anymore?

A

Amantadine and Rimantadine
- dt resistance, no longer recommended, limited to flu A coverage

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11
Q

Which drugs are recommended for flu A and B?

A

Baloxavir, Oseltamivir (tamiflu), Peramivir, Zanamivir

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12
Q

Essentially, what do Baloxavir, Oseltamivir, Peramivir, and Zanamivir do?

A

Block viral budding and release via neuraminidase inhibition

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13
Q

Who can get Oseltamivir and what are it’s SE?

A

Any age group, oral or suspension, ok for NGT
- GI upset, HA

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14
Q

Which flu drug is given as an inhalation?

A

Zanamivir
- SE broncos pass, avoid with respiratory disease or milk protein allergy

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15
Q

Who should get a neuramidase inhibitor?

A

Severely ill, + comorbidities, in hospital and around other immunocompromised, even if its post 48h infection
- under 2y and over 65y, women pregnant or postpartum, adults taking long term aspirin, American Indian or AK Native, morbidly obese

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16
Q

Amphotericin is what type of antifungal?

A

Ergosterol Inhibitor
-fungicidal
- lipophilic drug, binds to ergosterol in cell wall causing lysis

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17
Q

Why can ergosterol inhibitors, like amphotericin, cause nephrotoxicity and electrolyte abnormalities?

A

Amphotericin creates a pore in cell membranes, but can also affect human cells, particularly in nephrons.

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18
Q

What are the SE of amphotericin?

A

-infusion reactions (chills, fever, rigors); give with NSAIDs, Benadryl, etc.
- with decreased CrCl if given too fast can cause cardiac dysrythmias dt electrolyte changes
- can increase toxicities of dig and neuromuscular blockers

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19
Q

What do the liposomal products do for amphotericin?

A

They provide lipid binding to protect against nephrotoxicity

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20
Q

Does amphotericin cross BBB?

A

No

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21
Q

What is flucytosine used for?

A

Typically with another drug like amphotericin B or fluconazole for cryptococcal/candidal meningitis, candida peritonitis, candiduria

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22
Q

What is Flucytosine’s MOA?

A

Related to chemo agent 5-FU, stops fungal cell replication by inhibiting DNA/RNA synthesis

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23
Q

How does flycytosine affect bone marrow?

A

If the trough is too high it can cause bone marrow suppression

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24
Q

What are flucytosine’s ADEs?

A

-bone marrow suppression, GI
- caution with other myelosuppressive drugs like clozapine, carbamazepine, AZT
- renal dosing
- fungus can down regulate cytosine deaminase for resistance

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25
Q

What is nystatin’s MOA?

A

Ergosterol inhibitor, binds to ergosterol in cell wall causing lysis
- no absorption from GI tract or topically, too toxic for IV, only given topical or vaginal tablet

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26
Q

What is nystatin given for?

A

Cutaneous, mucocutaneous and oral candida infections

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27
Q

What type of drug is Terbinafine?

A

Antifungal, ergosterol inhibitor, synthetic allylamine
-causes cell lysis
-large Vd
-t1/2 8-16d

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28
Q

What does Terbinafine cover?

A

Trichophyton, microsporum, candida, epidermiphyton, scopulariosis, dermatophytes (toe nail fungus)

29
Q

How long is the dosing for Terbinafine for toe nail fungus?

A

12w

30
Q

What are the clinical issues for Terbinafine?

A

SE: GI, malaise, dysgeusia, hepatotoxicity (check LFTs)
- can Rifampin can cause a 100% increase in clearance
- Cimetidine can cause a 33% reduction in clearance

31
Q

What drugs are included in the ergosterol inhibitors class of Azoles?

A

[Triangles: Fluconazole, Itraconazole, Voriconazole]
[Imidazoles: Clotrimazole, Ketoconazole, Miconazole]

32
Q

What is the MOA for Azoles?

A

Inhibit ergosterol synthesis by inhibiting an enzyme dependent on CYP450, inhibiting creation of ergosterol, inhibiting cell synthesis
- can also cross over and effect human cells (adrenal and gonadal steroid hormone formation)

33
Q

Fluconazole is used for what?

A

Oral, esophageal, UTI, vaginal candida, cryptococcal meningitis dt good CNS penetration

34
Q

Is fluconazole affected by food or gastric acidity?

A

No

35
Q

Is fluconazole subject to renal dosing?

A

Yes, dt long half life

36
Q

What drug to drug interactions should you watch out for with fluconazole?

A

Warfarin, as fluconazole is a CYP2C8/9 inhibitor

37
Q

What is Itraconazole used for?

A

Aspergillosis, Blastomycosis, and Histoplasmosis mainly
- also onychomycosis, oral and esophageal candida

38
Q

Does Itraconazole require food or gastric acidity to be absorbed?

A

Yes, but only with capsule. Caution with H2RA, PPI agents. Can take with a coke

39
Q

What should you watch out for with Itraconazole?

A

Rising LFTs with long term use, and drug to drug interaction (strong CYP450 3A4 inhibitor

40
Q

What is Isavuconazonium used for?

A

Invasive Aspergillosis and Mucormycosis

41
Q

What should you watch out for with Isavuconazonium?

A
  • drug:drug - major CYP450 3A4, OCT2, P-gp inhibitor
  • monitor LFTs, renal dose
  • can cause hypokalemia, edema, HA, N/V
42
Q

What is Voriconazole given for?

A

Mostly Invasive aspergillosis and candidemia
- also esophageal candidiasis, scedosporiosis, fusariosis

43
Q

What are the major drug:drug interactions with Voriconazole?

A
  • need to increase maintenance dose of Voriconazole if on Dilantin
  • will need to increase dose of efavirenz if on it
    -2C19, 2C9 and 3A4 inhibitor
44
Q

What are the SE of Voriconazole?

A

QT prolongation, melanoma, hallucinations, vision changes, liver tox, anaphylaxis w CKD
- absorption not dependent on gastric acidity, but take one hour before or after meal
- renal dosing recommended
-Preg D

45
Q

What is Posaconazole used for?

A

Invasive Aspergillosis, candida infections, cryptococcal infections, mucormycosis

46
Q

What are the SE of Posaconazole?

A

-fever, HA, fatigue, most at risk for QT prolong, electrolyte changes, n/v/d
- only renal dose when CrCl below 20
- strong 3A4 inhibitor
- take with meals, avoid PPI, H2RA

47
Q

What antifungal is a pregnancy category D?

A

Voriconazole

48
Q

Ketoconazole is given for what?

A

Fungal infections (candida, blastomycosis, histoplasmosis, paracoccidiomycosis)
*Seborrheic dermatitis
Tinea Versicolor

49
Q

What forms do Ketoconazole come in?

A

Tablet, topical, shampoo

50
Q

What other use is Ketoconazole used for besides fungal infections?

A

Prostate CA, dt inhibition of androgen synthesis via CYP450 inhibition of testosterone production

51
Q

Does Ketoconazole penetrate into CNS?

A

No

52
Q

Does Ketoconazole require gastric acidity?

A

Yes, avoid antacids, drink a coke

53
Q

What is clotrimazole (Lotrimin) used for?

A

Cutaneous candidiasis and vulvovaginal candidiasis

54
Q

What is Miconazole (Monistat) used for?

A

Tinea corporis (ring worm) or pedis (athlete’s foot) or cruris (jock itch)
Vulvovaginal candidiasis

55
Q

What is Terconazole used for?

A

Vulvovaginal candidiasis

56
Q

What is Luliconazole used for?

A

Tenia pedis, Tinea cruris or corporis

57
Q

What is oxiconazole (oxistat) used for?

A

Tinea corporis, cruris, pedis, and versicolor

58
Q

What is Sulconazole used for?

A

Tinea infection

59
Q

What is Efinaconazole used for and why is it a pain in the ass?

A

Onychomycosis (toe nail infection), requires you to paint your toes with it qd x 48 weeks

60
Q

Echinocandins are which drugs?

A

Anidulafungin, caspofungin, micafungin

61
Q

What is the MOA for echinocandins?

A

Inhibits formation of 1,3 beta D glucan, a component of candida cell walls, resulting in lysis

62
Q

What form are echinocandins given?

A

IV

63
Q

What are echinocandins given for?

A

Candidemia, aspergillosis (caspofungin), and prophylaxis for stem cell transplants (micafungin)

64
Q

What are the SE for anidulafungin?

A

Itching. no renal dosing. No known drug interactions

65
Q

What are the SE for caspofungin?

A

Hypotension, edema, tachycardia, fever/chills, HA, hypokalemia, N/V/D, increased LFTs, phlebitis
- no renal dosing but decrease with hepatic impairment
- up dose for CYP450 inducers (rifampin, carbamazepine, phenytoin, efavirenz, nevirapine)
- avoid with cyclosporine dt hepatic tox

66
Q

What are the SE for Micafungin?

A

hypokalemia, hypomag, fever, HA, N/V/D, thrombocytopenia, insomnia, phlebitis, BP changes
- no renal or hepatic dosing

67
Q

What is Griseofulvin used for?

A

Ringworm of scalp, body, or foot caused by trichophyton, microsporum, epidermophyton

68
Q

What is Griseofulvin’s MOA?

A

Fungistatic. Targets new skin where it binds to keratin, preventing new fungal infections. Treatment takes a long time

69
Q

What is the pregnancy category for Griseofulvin?

A

Category D/X

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