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PHARMACOLOGY > ANTIBACTERIAL AND ANTI-INFECTIVES (PART 2) > Flashcards

ANTIBACTERIAL AND ANTI-INFECTIVES (PART 2) Flashcards

1
Q

etiologic agent of pulmonary TB

A

mycobacterium tuberculosis

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2
Q

most common site for the development of TB is the ___ (85% of patients)

A

lungs

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3
Q

most infectious TB patients

A

those with:
- cavitary pulmonary disease
- laryngeal TB

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4
Q

typical TB lesion

A

epithelioid granuloma with central caseastion necrosis

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5
Q

a cough of ___ weeks or more is already suspicious for PTB

A

2 weeks

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6
Q

symptoms of TB (along with cough)

A
  • night sweats
  • weight loss
  • anorexia
  • unexplained fever and chills
  • chest pain
  • fatigue
  • body malaise
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7
Q

true or false: absence of fever excludes TB

A

false

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8
Q

true or false: physical findings are of little utility of PTB

A

true

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9
Q

what are the drugs used for TB?

A

RIPES

Rifampicin (R)
Isoniazid (H/INH)
Pyrazinamide (Z)
Ethambutol (E)
Streptomycin (S)

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10
Q

usual dose of isoniazid (H/INH)

A

5 mg/kg max 300 mg

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11
Q

usual dose of rifampicin (R)

A

10 mg/kg max 600 mg

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12
Q

usual dose of of pyrazinamide (Z)

A

25 mg/kg max 2 g (2000 mg)

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13
Q

usual dose of ethambutol (E)

A

15 mg/kg

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14
Q

usual dose of streptomycin (S)

A

15 mg/kg max 1 g (1000 mg)

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15
Q
  • inhibits FATTY acid synthase and MYCOLIC acid synthesis
  • excellent BACTERICIDAL activity against both intracellular and extracellular actively dividing MTB
  • BACTERIOSTATIC against slowly dividing organisms
A

isoniazid (H/INH)

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16
Q
  • binds to and inhibits mycobacterial DNA-dependent RNA polymerase = blocking RNA synthesis
  • both intracellular and extracellular BACTERICIDAL activity, both in dividing and non-dividing MTB
A

rifampicin (R)

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17
Q
  • has sterilizing activity
  • most active antimycobacterial agents available and therefore cornerstone of FIRST-LINE TB treatment
A

rifampicin (R)

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18
Q
  • exact mechanism is unclear but FATTY acid synthetase-I may be the primary target
  • more active against SLOWLY replicating organisms than against actively replicating organisms
A

pyrazinamide (Z)

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19
Q
  • active only in ACIDIC environment (pH < 6)
  • found within phagocytes or granulomas
A

pyrazinamide (Z)

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20
Q
  • inhibits ARABINOSYLTRANSFERASES involved in cell wall synthesis
  • inhibits the formation of ARABINOGALACTAN and LIPOARABINOMANNAN
A

ethambutol (E)

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21
Q
  • BACTERIOSTATIC antimycobacterial agents which provides synergy with other drugs
  • LEAST potent against MTB
A

ethambutol (E)

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22
Q
  • inhibits protein synthesis by binding at 30s mycobacterial ribosome
  • BACTERICIDAL against dividing MTB but has only low-level early bactericidal activity
A

streptomycin (S)

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23
Q

what category?

  • new PTB (bacteriologically or clinically diagnosed)
  • new extra-PTB (bacteriologically or clinically diagnosed), except CNS/bones or joints
A

category I

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24
Q

what category?

  • new extra-PTB (CNS/bones or joints)
A

category Ia

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25
Q

what category?

  • pulmonary or E-PTB, previously treated drug-susceptible TB (bacteriologically or clinically diagnosed), except CNS/bones or joints
A

category II

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26
Q

what category?

  • relapse
  • treatment after failure
  • treatment after lost to follow-up (TALF)
  • previous treatment outcome unknown (PTOU)
A

category II

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27
Q

what category?

  • E-PTB (CNS/bones or joints), previously treated, drug susceptible TB (bacteriologically or clinically diagnosed)
A

category IIa

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28
Q

what category?

  • standard regimen drug-resistant (SRDR): rifampicin resistant TB or multi-drug resistant TB
  • XDR TB regimen: extensively drug-resistant TB
A

drug resistant TB

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29
Q

alternative TB treatment regimen (initial and continuation) for:
category I

A

initial: 2 HRZE
cont: 4 HR / 4 HZE

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30
Q

alternative TB treatment regimen (initial and continuation) for:
category Ia

A

initial: 2 HRZE
cont: 10 HR

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31
Q

alternative TB treatment regimen (initial and continuation) for:
category II

A

initial: 2 HRZES and 1 HRZE
cont: 5 HRE

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32
Q

alternative TB treatment regimen (initial and continuation) for:
category IIa

A

initial: 2 HRZES and 1 HRZE
cont: 9 HRE

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33
Q

alternative TB treatment regimen (initial and continuation) for:
drug resistant TB

A

individualized based on prev. treatment and drug sensitivity

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34
Q

management for RIFAMPICIN caused GI intolerance

A

give medication at bed time

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35
Q

management for RIFAMPICIN caused orange-red urine

A

reassure patient

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36
Q

management for RIFAMPICIN caused flu-like symptoms

A

give anti-pyretics

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37
Q

management for PYRAZINAMIDE caused arthralgia due to hyperuricemia

A

give aspirin or NSAID

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38
Q

management for IZONIAZID caused burning sensation in feet (peripheral neuropathy)

A

give pyridoxine (vit b6) 100-200 mg daily; 10 mg daily for prevention

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39
Q

management for STREPTOMYCIN caused pain at injection site

A

warm compress

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40
Q

management for ANY DRUG caused mild skin reactions

A

give anti-histamines

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41
Q

which drug causes this MAJOR side effect?

  • severe skin rash (hypersensitivity)
  • jaundice due to hepatitis
A

any drug

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42
Q

which drug causes this MAJOR side effect?

  • impairment for visual acuity and color vision due to optic neuritis
A

ethambutol (E)

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43
Q

which drug causes this MAJOR side effect?

  • hearing impairment, tinnitus, and dizziness due to damage of CN VIII
A

streptomycin (S)

44
Q

which drug causes this MAJOR side effect?

  • oliguria or albuminuria due to renal disorder
A

streptomycin (S) and rifampicin (R)

45
Q

which drug causes this MAJOR side effect?

  • psychosis and convulsion
A

isoniazid (H/INH)

46
Q

which drug causes this MAJOR side effect?

  • thrombocytopenia, anemia, and shock
A

rifampicin (R)

47
Q

what are the drugs that affect fungal membranes?

A
  • amphotericin B
  • azoles
48
Q

what drugs are under azoles?

A
  • itraconazole
  • ketoconazole
  • miconazole
  • fluconazole
  • clotrimazole
  • voriconazole
49
Q
  • binds to ERGOSTEROL, a major components of fungal cell membranes
  • forms amphotericin pores that alter membrane stability and allow LEAKAGE of cellular contents
A

amphotericin B

50
Q
  • indications: topical infections, initial treatment for severe fungal infections (ex: candida albicans, histoplasma capsulatum, cryptococcus neoformans)
  • AE: chills, fever, impaired renal functions
A

amphotericin B

51
Q
  • inhibit the cytochrome p450 mediated sterol demethylation of lanosterols to ergosterol in fungal membranes
  • broad spectrum antifungals
A

azoles

52
Q
  • replaced ketoconazole for the treatment of all mycoses
  • used topically for DERMATOPHYTE INFECTIONS and mucotaneous candidiasis or as shampoo for SEBORRHEIC dermatitis
A

itraconazole

53
Q
  • drug of choice for DISSEMINATED BLASTOMYCOSIS
  • inhibition of cytochrome p450 metabolism (CYP3A4), increases or decreases metabolism of many drugs leading to toxicity
  • SE: gastric upset, itching, rashes, headache
A

itraconazole

54
Q
  • used of topical application
  • used in DERMATOPHYTE infections (tinea pedis, ringworm, and cutaneous and vulvovaginal cadidiasis)
A

miconazole and clotrimazole

55
Q

used topically for CANDIDA infections of the skin, mucous membranes and intestinal tract

A

nystatin

56
Q
  • useful for OROPHARYNGEAL and SYSTEMIC CANDIDIASIS
  • penetrates CSF
A

fluconazole

57
Q
  • DOC for crytptococcal meningitis and disseminated histoplamosis
  • inhibits CYP3A4 and CYP2C9
  • AE: nausea, vomiting, diarrhea, and reversible alopecia
A

fluconazole

58
Q
  • actively transported into fungal cells and is converted to 5-fluorouracil and subsequently to 5-fluorodeoxyuridylic acid
  • inhibits THYMIDYLATE synthetase and thus pyrimidine and nucleic acid synthesis
A

flucytosine

59
Q
  • resistance develops rapidly, rarely used as a single drug but often used in COMBINATION with other antifungals
  • relatively non toxic
  • AE: depression of bone marrow function
A

flucytosine

60
Q
  • infecting organism of amebiasis
  • ingested in cyst form
  • divides in the colon
  • can invade the intestinal wall to cause severe dysentery
A

entamoeba histolytica

61
Q
  • used for INTESTINAL AMEBIASIS as for AMEBIC LIVER ABSCESSES
  • active agents for giardia intestinalis and t. vaginalis
A

metronidazole and tindazole

62
Q
  • show activity against many anaerobic bacteria
  • AE: disulfram-like reactions, teratogenic effects
A

metronidazole and tindazole

63
Q

most important parasitic disease in humans

A

malaria

64
Q

in humans the ___ cycle is responsible for malaria

A

erythrocytic cycle

65
Q

malaria is a protozoan disease caused by 4 species of ___

A

plasmodium

66
Q

malaria is transmitted by the bite of infected ___

A

anopheles flavirostris

67
Q

what malaria drug regimen?

  • first line treatment in probable and confirmed falciparum malaria that is not severe
A

CQ + SP

chloroquine + sulfadoxine/pyrimethamine

68
Q

what malaria drug regimen?

  • second line drug for cases which did not respond to adequate CP + SP
  • not reco for pregnant and children < 8
A

A-L

artemether-lumefantine

69
Q

what malaria drug regimen?

  • third line drug for those who did not respond to second line
  • DOC for severe malaria
A

Q+TD

quinine + tetracycline/doxycycline
(Q + clindamycin for pregnant and children)

70
Q

what malaria drug regimen?

  • given as single dose to confirmed p. falciparum to prevent transmission
  • given for 14 days to confirmed p. vivax to prevent relapse
  • only drug that can eradicate extrahepatic stages of parasite
A

primaquine

71
Q

DOC for p. vivax cases

A

chloroquine

72
Q

malarial drug side effects:

  • megaloblastic anemia
  • pancytopenia
  • pulmonary infiltration
A

pyrimethamine

73
Q

malarial drug side effects:

  • anaphylaxis
  • urticaria
  • fever
A

artemether

74
Q

malarial drug side effects:

  • cinchonism
  • tinnitus
  • high-tone hearing loss
  • hypoglycemia
  • bitter taste
A

quinine

75
Q

malarial drug side effects:

  • massive hemolysis in G6PD deficiency
A

primaquine

76
Q

malarial drug side effects:

  • nausea
  • dysphoria
  • pruritus
  • retinopathy (>100 g)
A

chloroquine

77
Q

drugs used for severe falciparum malaria

A

AAQQ

  • artesunate
  • artemether
  • quinine dihydrochloride
  • quinidine
78
Q

drugs for malaria prophylaxis

A
  • doxycycline
  • primaquine
  • atovaquine/proguanil
  • chloroquine
  • mefloquine (pregnant)
79
Q

when using malaria prophylaxis, it should be started ___ before potential exposure and for ___ after leaving the area

A

2 weeks,
8 weeks

80
Q
  • active against NEMATODE (ROUNDWORM) infections
  • bind with high affinity to parasite free B-TUBULIN to inhibit polymerization and microtubule assembly
A

albendazole and mebendazole

81
Q
  • irreversibly inhibit glucose uptake by nematodes = glycogen depletion and decreased ATP production
  • immobilizes the intestinal parasite, then cleared from GI tract
A

albendazole and mebendazole

82
Q
  • DOC for cysticercosis and cystic hydatid disease
  • AE: GI distress during short term therapy
  • potentially teratogenic
A

albendazole

83
Q
  • active against cestode (tapeworm) and trematode (fluke) infections
  • causes PARALYSIS of the worm due to increased cell membrane permeability of calcium
A

praziquantel

84
Q
  • most effective drug against all types of fluke infections (schisto, parago)
  • AE: fever and rashes, contraindicated in ocular cystercosis
A

praziquantel

85
Q
  • active againts cestode (tapeworm) and trematode (fluke) infections
  • inhibits parasite RESPIRATION
  • alternative for fasciola hepatica and as an alternative to praziquantel for acute pulmonary paragonimiasis
A

bithionol

86
Q

what are the antiherpes virus drugs

A
  • acyclovir
  • penciclovir and docosanol
  • ganciclovir
  • foscarnet
87
Q
  • PURINE analog, required viral THYMIDINE KINASE to inhibit the activity of viral DNA polymerase
  • does not eradicate latent virus
A

acyclovir

88
Q
  • used as TOPICAL cream to treat herpes
  • D___ prevents fusion with the HSV envelope with cell membranes, thereby inhibiting viral penetration
A

penciclovir and docosanol

89
Q

DEOXYGUANOSINE analog that inhibits replication of CMV

A

ganciclovir

90
Q

inhibits viral DNA and RNA polymerase and HIV reverse transcriptase

A

foscarnet

91
Q

what are the anti-influenza agents?

A
  • amantadine and rimantadine
  • zanamivir and oseltamivir
92
Q

interact with the M2 protein of the proton channel of the virus to inhibit the uncoating and replication of the viral RNA in infected cells

A

amantadine and rimantadine

93
Q
  • used to treat ORTEHOMYXOVIRUS (influenza A), administered within the first 48 hours of symptoms and as prophylaxis
  • AE: mild CNA effects, GI dysfunctions, teratogenic effects
A

amantadine and rimantadine

94
Q
  • NEURAMINIDASE inhibitors
  • treatment and prophylaxis of acute uncomplicated influenza infection (influenza A and B)
  • AE: abd pain, GI dysfunctions (O), bronchospasm (Z)
A

zanamivir and oseltamivir

95
Q
  • acts by inhibiting HIV encoded RNA dependent DNA polymerase (reverse transcriptase)
  • combination therapy with NRTI with drugs from the other classes of antiretroviral agents is most effective (reduced likelihood of resistance)
    AE: metabolic acidosis, hepatic toxicity
A

antiretroviral drugs

96
Q

examples of antiretroviral drugs

A
  • zidovudine
  • didanosine
  • stavudine
  • lamivudine
97
Q

a medicine that reduces your chances of getting HIV from sex or injection drug use

A

PrEP (pre-exposure prophylaxis)

98
Q

2 pills approved for use as PrEP

A

truvada and descovy

99
Q

PrEP for people at risk through sex or injection drug use

A

truvada

100
Q

PrEP for people at risk through sex, not for people assigned female at birth who are at risk through receptive vaginal sex

A

descovy

101
Q

the only shot approved for use as PrEP, for people at risk through sex who weight at least 77 pounds (35 kg)

A

apretude

102
Q

use of antiretroviral drugs after a single high risk event to stop HIV seroconversion

A

PEP (post exposure prophylaxis)

103
Q

PEP must be started as soon as ___ hours within a possible exposure

A

72 hours

104
Q

covid 19 medication:

  • adults, children > 12
  • start ASAP, must begin wihtin 5 days of when symptoms start
  • taken at home, PO
A

nirmatrelvir and ritonavir (paxlovid)

105
Q

covid 19 medication:

  • adults and children
  • start ASP, must begin within 7 days of when symptoms start
  • IV infusions at a facility for 3 days
A

remdesivir (veklury)

106
Q

covid 19 medication:

  • adults
  • start ASAP, must begin within 5 days of when symptoms start
  • taken at home, PO
A

molnupiravir (lagevrio)

PHARMACOLOGY (9 decks)

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