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Pharamacology, theraputics and prescribing > Anti virals, microbials and fungals > Flashcards

Anti virals, microbials and fungals Flashcards

1
Q

Give 4 types of anti herpes drugs

A

aciclovir, gangciclovir, foscarnet, cidofovir

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2
Q

How do aciclovir, gangciclovir, foscarnet and cidofovir work?

A

All inhibit viral DNA polymerase, most by acting as guanosine analogue, except forscarnet which acts as a pyrophosphate analogue

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3
Q

Which virus is aciclovir used to treat?

A

HSV1 and 2 and VZV

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4
Q

How can you get resistance to aciclovir?

A

reduction/ removal of the TK enzyme which activates aciclovir

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5
Q

Give 3 ADRs of aciclovir and gangciclovir?

A
  • nephrotoxic

- headache, confusion, behaviour change, psychosis, seizures, coma

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6
Q

Describe the order of drugs used to treat CMV

A

gangciclovir, then foscarnet, then cidofovir

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7
Q

Describe how resistance can arise to gangciclovir, foscarnet and cidofovir

A

foscarnet= resistance can arise from RT or polymerase mutations but are rare
Cidofovir and gangciclovir= DNA polymerase mutations (esp UL54)

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8
Q

What can cidofovir be used to treat?

A

CMV, adenovirus, EBV, polymavirus etc

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9
Q

Give 3 ADRs of cidofovir and foscarnet

A
  • nephrotoxic
  • myelosurpression
  • CNS effects (headache, n+v, coma, seizures etc)
  • diarrhoea
  • fever
  • anxiety
  • fatigue
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10
Q

How is hepatitis B treated?

A

Lamivudine, adefovir, entacavir

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11
Q

How does lamivudine work?

A

Cystidine analogue- false substrate and chain terminator of reverse transcriptase enzyme.

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12
Q

Give an ADR of lamivudine

A

raised LFTs, otherwise well tolerated

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13
Q

Give one drug which may be used for treatment of hep C?

A

Ribavirin, also interferons. Sofosburvir is new drug with good data.

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14
Q

How does sofosbuvir work?

A

Inhibits HCV polymerase to inhibit replication of virus

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15
Q

How does ribavirin work?

A

Guanosine analongue, so inhibits RNA/mRNA synthesis and nucleoside stores

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16
Q

Name 2 antivirals to treat influenza

A

oseltamivir, zanamivir. Note: these can be used a prophylaxis, are not that effective and yearly vaccines are the preffered approach

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17
Q

How do oseltamivir (tamiflu) and zanamivir work?

A

inhibit neuraminidase, which prevents newly made virus leaving the host cell

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18
Q

How does resistance to anti- influenza drugs occur?

A

neuraminidase enzyme mutations,

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19
Q

Give 4 classes of drugs to treat HIV

A
  • NRTIs (nucleoside RT inhibitors causing chain termination- lamivudine)
  • NNRTIs (direct (non- nucleoside) RT inhibitors - neviapine)
  • protease inhibitors (neviapine)
  • fusion inhibitors (enfurvirtide)
  • Integrase inhibitors
  • CD4 receptor inhibitors
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20
Q

Give 2 ADRs of NRTIs such as zidovudine (AZT)

A
  • hyperlactataemia
  • lactic acidosis
  • hepatomegaly
  • steatosis
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21
Q

Why is anti- viral resistance monitoring important?

A
  • optimises clinical outcomes and care of the pt
  • reduce costs and ADRs of using ineffective therapy
  • reducing spread of resistant viruses
22
Q

When is viral resistance testing done?

A

when the treatment is not working, need to see if due to resistance, poor compliance or high baseline of viral load

23
Q

how is viral resistance testing done?

A

By phenotype- intubate virus with varying concentrations of the drug and culture to see if virus can grow
By genotype- gene sequencing, PCR etc

24
Q

What is an unfit virus? When do they often occur

A

A virus which has mutated to become resistant to an antiviral, but as a result has become less effective at replicating. The drug which the virus is resistant to is still given as it keeps replicating power of the virus low. This is common in lamivudine

25
Q

When may anti- biotics be given for prophylaxis?

A

before surgery, meningitis contact, asplenia, immuno deficiency

26
Q

What factors are taken into consideration when giving empirical antibiotics?

A
  • likely organism (age, date, PMH, occupation, travel, duration and site of infection)
  • likely susceptibility and consequences of wrong choice
  • safety (age, allergies, interactions, toxcicity, cost, administration, pregnancy)
27
Q

Give 3 general ADRs of anti- biotics?

A
  • N+ V
  • Most are neuro, nephro and hepatotoxic
  • many may cause idiosyncratic reactions (dunno cause/ how it happens)
  • ecological effects on microbiota (C. diff)
  • drug interactions
28
Q

How does vancomycin work? When is it used?

A

inhibits cell wall synthesis via phospholipids and peptidoglycan inhibition at a site earlier than penicillins . it is generally reserved for mutli drug resistant organisms (mainly gram+)

29
Q

Which anti- microbials are most likely to cause C. diff?

A
  • cephalosporins
  • co- amoxiclav
  • clindamycin
  • fluoroquinolones
30
Q

Give one ADR specific to tetracyline?

A

turns teeth yellow if given to children

31
Q

Which drug would be given to treat cellulitis?

A

Flucoxacillin

32
Q

What drug should be used to treat c. diff?

A

Metronidazole

33
Q

What drug should be used to treat UTIs?

A

Trimethoprim or nitrofurantion

34
Q

What drug should be used to treat neisseria meningitisis?

A

ceftriaxone

35
Q

What drug should be used to treat gram + sepsis?

A

vancomycin

36
Q

What drug should be used to treat uncomplicated community acquired pneumonia?

A

amoxicillin or doxycylin

37
Q

What drug should be used to treat complicated community acquired pneumonia?

A

macrolides or tetracyline

38
Q

What drug should be used to treat hospital acquired pneumonia?

A

co- amoxiclav

39
Q

What drug should be used to treat severe, bacterial gastroenteritis (campylobacter, enterotoxic E. coli, shigella dysenteriae)

A

ciprofloxacin (if used in salmonella, may make you worse)

40
Q

What drugs should be used severe giardia, entamoeba, cyclospora and cyptosporidium infections?

A

Giardia and entamoeba= metronidazole
Cyclospora= trimethoprim
cyptosporisium= nitazoxanide

41
Q

How are trachomatis vaginalis, thrush and bacterial vaginosis treated?

A

TV and BV= metronidazole

thrush= fluconazole

42
Q

How is syphilis treated?

A

IM benzathine penicillin G

43
Q

How is gonorrhoea treated?

A

IM ceftriaxone and oral azithromycin

44
Q

How is chlamydia trachomatis treated?

A

doxycycline

45
Q

How is pyelonephritis treated?

A

trimethoprim, not nitrofurantoin as not systemic

46
Q

What is the minimum inhibitory concentration?

A

The minimum concentration of antibiotics needed to inhibit growth of a bacteria in vitro to a specific single isolate and antibiotic

47
Q

What is the difference between time and concentration dependant killing?

A

One theory is that successful treatment needs prolonged antibiotic prescence at a infection, but concentration doesnt matter as long as >MIC
Conc dependant killing is that time doesnt matter as much as concentration

48
Q

How does carbapenem resistance occur?

A
  • decreased permeability
  • increased efflux
  • carbepenemase production
49
Q

State the 3 categories of antimicrobial stewardship and for each give an example

A
  • persuasive: education, consensus, opinion leaders, reminders, audit, feedback
  • restrictive: formulary restriction, automatic stop orders
  • structural: computerised records, rapid lab tests, expert systems, quality monitoring
50
Q

What 4 drugs are needed to treat TB?

A
  • rifampicin (6 months)
  • isoniazid (6 months)
  • pyrazinamide (2 months)
  • ethambutol (2 months)
51
Q

Give 4 ADRs for drugs to treat TB?

A
  • all hepatotoxic
  • many nephrotoxic
  • GI upset
  • psychosis
  • epilepsy
  • anaphylaxis
  • optic neuritis, colourblindness (ethambutol)

Pharamacology, theraputics and prescribing (15 decks)

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