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Ocular Pharm > Anti Infectives part 2 > Flashcards

Anti Infectives part 2 Flashcards

1
Q

Sulfanomides compete with _____

A

PABA

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2
Q

Sulftanomides are combined with _____ in a 5:1 ratio.

A

Trimethoprim

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3
Q

What is involved in the inhibition of dihydropteroate synthase

A

PABA doesn’t convert to DHF

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4
Q

What is involved in the inhibition of dihydrofolate reductase

A

DHF doesn’t covert to THF

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5
Q

Polytrim solution (polymyxin B + trimethoprim) as well as sulfadiazine and ______ are drugs used together to treat taxoplasmosis and are folic acid inhibitor combos

A

pyrimethamine

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6
Q

____ is first line treatment for MRSA with 95% efficacy

A

Trimethoprim

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7
Q

What are folic acid inhibitor adverse reactions

A
  1. Hypersensitivity

2. Blood dycrasias

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8
Q

What are folic acid inhibitor adverse reactions for sulfonamides

A
  1. Stevens Johnson syndrome
  2. Nephrotoxicity
  3. Coumadin potentiation
  4. Myopia +/- astigmatism (reverible)
    * Contraindicated in pregnancy!
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9
Q

What are folic acid inhibitor adverse reactions for trimethoprim

A

bone marrow suppression

*contraindicated in pregnancy!

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10
Q

______ are DNA synthesis inhibitors

A

Fluoroquinolones

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11
Q

Fluoroquinolone’s are bactericidal and inhibit DNA gyrase and _____

A

topoisomerase IV

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12
Q

____ is the only fluoroquinolone that is a topical suspension and is a 5th generation flouroquinolone

A

Besifloxacin

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13
Q

____ and ____ are 2nd generation fluoroquinolones.

A

Ciprofloxacin and ofloxacin

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14
Q

____ is a 3rd generation fluoroquinolone

A

Levofloxacin

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15
Q

_____ and ___ are fourth generation fluoroquinolones

A

moxifloxacin and gatifloxacin

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16
Q

What are fluoriquinolone adverse reactions

A
  1. phototoxicity
  2. tendinitis
  3. reduced levels in combinations w antacids, Fe, and Zn
  4. convulsions (pO)
  5. ciprofloxacin –> white corneal precipitates, reduced metabolism of theophylline
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17
Q

what are contraindications of fluoroquinolone

A
  1. less than 18 yoa (pO) due to inhibition of bone growth and damage to cartilage.
  2. pregnancy
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18
Q

The best topicals for treating psudomanas infections are fluoroquinolones, aminoglycosides and ______

A

polymyxin B

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19
Q

What are the best ocular ab’s for children

A
  1. trimethorpim/polymyxin B

2. AzaSite

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20
Q

What are the best ocular Ab’s for adults

A
  1. Mild: Bacitracin/polymyxin B
  2. Moderate: Neomycin
  3. Tobramycin
  4. Severe: Besifloxacin or Levofloxacin
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21
Q

The dilemma to combine an antimicrobial agent and steroid depends on all of the following:

A
  1. oval shaped processes at/near the limbus are inflammatory
  2. severity of infection relative to conjunctival injection
  3. Is the corneal epithelium intact?
  4. Does pt test positive for lymphadenopathy
22
Q

When choosing Antibiotics select drugs with the _____ spectrum and use ____ agents whenever possible so we don’t make them susceptible to resistance

A

narrowest; older

23
Q

Viruses only replicate upon entering cells. They need a _____.Cells that host viral particles may experience collateral damage when antiviral agents are used. Viral ____ affects antiviral drug therapy efficacy

A

host; mutation

24
Q

_____ is a cold virus that is the most common cause of an eye infection. There is currently no FDA approved treatment for this type of infection and it is self resolving.

A

adenovirus

25
Q

If patient comes in your office and they have AIDs ask about:

A
  1. viral load

2. T cell count

26
Q

Pyrimidines inhibit thymidine synthesis. _____ is a pyrimidine analog and is used for HSV keratitis. There is risk of keratopathy, elevated IOP, lid and stromal edema and it is Pregnancy Category ______

A

Trifluridine; C

27
Q

What are the purine analogs that are used

A
  1. Acyclovir (Preg category B)
  2. Ganciclovir (Preg category C
  3. Famciclovir
  4. Valcyclovir
28
Q

Both acyclovir and ganciclovir have oral risk of ____ ____

A

blood dycrasias

29
Q

Famciclovir has an extended plasma life and Valcyclovir has an long plasma _____ life and is better suited for deeper infections such as stromal keratitis. Cross sensitivity seen with _______

A

half; Acyclovir

30
Q

_____ is drug of choice for HS keratitis therapy due to lower dosing frequency

A

Famciclovir

31
Q

What is the ocular involvement with fungal infections

A
  1. cornea
  2. conjunctiva
  3. lens
  4. ciliary body
  5. vitreous body
  6. uvea
32
Q

Which yeasts are involved ocularly

A
  1. Candida

2. Cryptococcus

33
Q

Which molds are involved ocularly

A
  1. aspergillus
  2. fusarium
  3. curvularia
34
Q

What causes enhanced risk of fungal infection

A
  1. contact lens wear
  2. steroids
  3. trauma
  4. immunocompromise
35
Q

What are therapeutic concerns of fungal infections

A
  1. drug adverse effects
  2. narrow spectrum of drug activity
  3. poor tissue penetration
  4. drug resistance
36
Q

_____ is a polyene anti fungal which acts by creating pores in fungal ergosterol walls. It is the only FDA approved topical and is pregnancy category c. Polyenes have negligible resistance

A

Natamycin

37
Q

____ act by inhibiting ergosterol synthesis. They inhibit some cytochrome P450 enzymes which reduces metabolism of other drugs. They can develop resistance.

A

Azoles

38
Q

______ refers to branching out and expanding infection

A

Fungistatic

39
Q

______ inhibit glucan synthesis which weakens cell wall. It has poor oral availability which renders them to be used in hospital settings.

A

Echinocandins

40
Q

What are anti fungal adverse reactions of amphotericin B

A

renal toxicity

41
Q

What are anti fungal adverse reactions of flucytosine

A

bone marrow toxicity, hepatotoxicity

42
Q

What are anti fungal adverse reactions of azoles

A

Ketoconazole: supplanted by other members of this group due to pronounced hepatotoxicity
Fluconazole: hepatoxicity and GI disturbances

43
Q

What are anti fungal adverse reactions of echinocandins

A

notable less risk of hepatotoxicity since they are not metabolized by major liver enzymes.

44
Q

what is the most common toxicity associated with anti fungal agents

A

hepatoxicity

45
Q

what is responsible for the most virulent form of infectious keratitis having the worst prognosis

A

acanthamoeba; mostly associated with contact lens wear. can go into dormant phase. Found in fresh water, soil, and airborne cysts

46
Q

Although medical therapy for acanthameoba is not well established, corneal epithelial debridement and topical ______ are options

A

biguanides

47
Q

What do the macrolides consist of

A
  1. Azythromycin
  2. Erythromycin
  3. Clarithromycin
48
Q

What are macrolide adverse reactions?

A
  1. Augment plasma levels of theophylline

2. Breast cancer

49
Q

What are contraindications of macrolides

A

Pregnancy! Avoid Clarithromycin (Preg Category C)

50
Q

What is highly toxic orally thus now limited to topical use only

A

chloramphenicol; stand alone drug

51
Q

What results in grey baby syndrome and optic neuritis with prolonged therapy

A

chloramphenicol

52
Q

Bacteria utilize ____ for folate synthesis. Sulfonamides act as competitive agonists

A

PABA

Ocular Pharm (12 decks)

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