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Advanced Pharmacology > antibiotics, antivirals, antihelminthics, antifungals, antiparasitics > Flashcards

antibiotics, antivirals, antihelminthics, antifungals, antiparasitics Flashcards

categories, idications, drug interactions, adverse reactions activity

1
Q

Categories of antibiotics

A

PCNs, cephalosporins, macrolids, fluoroquinolones, lincoside, azalides, ketolides, oxalodinones, sulfonamides, trimethaprim, nitrofurantoin, tetracycline, vancomycin, antimycobacterials

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2
Q

What are the main causes of antimicrobial resistance?

A

Overuse of broad spectrums, use in children under 2 and older than 65, day care centers, exposure to young children, multiple medical comorbidities, immunosuppression

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3
Q

What is an antibiogram?

A

Chart that shows antibiotic resistance in your area

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4
Q

What vaccination has decreased antibiotic resistance?

A

Pneumococcal vaccine

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5
Q

What are PCNs and cephalosporins known as?

A

Beta-lactmas

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6
Q

How do beta lactams kill bacteria?

A

Inhibits peptidogylcan in cell walls; leads to cell lysis

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7
Q

What bacteria are the natural PCNs good against?

A

Streptococcus, some Enterococcus, some non-penicillinase producing staphylococcus

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8
Q

Which PCN is more able to attack gram negative?

A

Ampicilllin, because it can more easily penetrate outer membrance

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9
Q

What strains is ampicillin effective against?

A

gram negative UTI and GI, like E coli, P. mirabilis, salmonella, some shigella and some enterrococcus

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10
Q

What respiratory pathogens is ampicillin effective against?

A

moraxella catarrhalis and H influenzae type by

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11
Q

What are often combined with beta lactams to broaden their spectrum of activity?

A

clavulanate, tazobactam, slbactam

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12
Q

How are PCNs absorbed?

A

Well absorbed in GI, some affected by acid

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13
Q

Which PCNs are absorbed the best?

A

Doxacillian and amoxicillin better than ampicillin

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14
Q

What is the distribution, metabolism and excretion of PCNs?

A

Most bound to plasma proteins, well distributed, small amount metabolized, largely in urine

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15
Q

What drug prolongs the half-life of PCNs and increases its risk for toxicity?

A

Probenecid

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16
Q

What are the most common adverse reactions of PCNs?

A
  1. allergic reactions within 2 to 30 minutes; can be relieved by desensitization therapy
  2. rash that is not allergic within 7 to 10 days
  3. GI stuff made worse by clavulanate
  4. Fungal overgrowth and C diff
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17
Q

What pregnancy category are PCNs?

A

Category b

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18
Q

What are PCNs primarily used for, and dosing?

A
  1. infections seen in primary care
  2. first line for AOM and sinusitis
  3. Streptococcal pharyngitis (strep A)
  4. UTI in pregnant women
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19
Q

What is the first line of treatment for bites?

A

Amoxicillin-clavulanate

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20
Q

What are key considerations in rational drug selection?

A

rapid strep test vs. empirical, and cost

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21
Q

What should be monitored in PCNs?

A

symptom relief , possible resistance, possible viral

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22
Q

What should patient education of PCNs be?

A

course completion, resistance, adverse reactions

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23
Q

How do cephalosporins work?

A

inhibit mucopeptide synthesis in cell wall, leads to lysis

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24
Q

How many generations of cephalosporins are there?

A

4 primary

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25
Q

What are the first generation cephalosporins active against?

A

skin and soft tissue infections caused by gram positive bacteria like s. aureus and s. epidermis

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26
Q

What are second generation cephalosporins active against?

A

same as first generation plu kiebsiella, proteus, and E coli

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27
Q

What are third generation cephalospoins goos against?

A

broader spectrum and better against gram negative

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28
Q

What are fourth generation cephalosporins good for?

A

They are resistant to beta lactamase and are active against both gram positive and gram negative bacteria.

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29
Q

What is a hospital associated pathogen that fourth generation cephalosporins are active against?

A

Pseudenomas

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30
Q

How are cephalosporins absorbed, metabolized, and excreted?

A

absorbed in GI, widely distributed to tissues, mostly bound to proteins; some metabolites formed, most excreted through kidneys, varying degrees of unchanged drug in urine

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31
Q

What are adverse drug reactions assoicated with cephalosporins?

A

allergies, skin rashes, arthalgia, coagulation abnormalities, anemai, neutropenia, leukopenia, thrombocytosis, fever, seizures, renal/hepatic failure

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32
Q

What are cephalosporins used for, and dosing?

A

Used in acute otitis media when PCNs have failled;
The first generations are used for strep pharyngitis and skin infections;
They can be used as second line drugs for UTIs
Several can be used for comunity acquired pneumonia

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33
Q

What should be monitored with cephalosporins

A

C diff and renal function

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34
Q

What is patient education for cephalosproins?

A

Use as prescribed

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35
Q

How do fluoroquinolones work?

A

Interfere with enzyme needed for DNA synthesis

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36
Q

What bacteria are fluoroquinolones really good against?

A

gram negative

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37
Q

Which population should not receive fluoroquinolones?

A

Children under age of 18

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38
Q

What can fluoroquinolones no longer be used for because of resistance?

A

Gonorrhea and resistance TB

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39
Q

How should fluoroquinolones be taken?

A

On empty stomach for good absorption

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40
Q

What is the black box warning for fluoroquinolones?

A

tendon rupture

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41
Q

What are other adverse reactions of fluoroquinolones?

A

C diff, CNS symptoms, renal/hepatic failure, cardiovascular issues and arrythmias, pregnancy issues

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42
Q

What are the clinical uses for fluoroquinolones?

A

complicated UTIs, kidney infections, complicated bacterial prostatitis
pneumonia and chornic bonchitis exacerbation
PCN-resistant S. pneumonia, skin infections, bone/joint infections, serious intraabdominal diarrhea

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43
Q

What should be monitored for when using fluoroquinolones?

A

watch for prolonged use, in high risk patients get EKG before using moxifloxacin, alcohol use, tendonitis rupture

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44
Q

What should patient education for fluoroquinolones be?

A

food delays absorption, lots of drug interactions, take with a glass of water, watch out for dizziness, if tendon tenderness stop and notify doctor

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45
Q

What is the only used drug of the lincosides?

A

Clindamycin (Cleocin)

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46
Q

What is Clindamycin used for?

A

only gram positive: corynbacterium acnes, garnarella vaginallis, some MRSA

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47
Q

What does Clindamycin not work against?

A

gram negative

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48
Q

How is clindamycin absorbed?

A

Oral completely absorbed, not affected by gastric acid

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49
Q

What are adverse drug reactions associated with clindamycin?

A

severe colitis, dermatological stuff, thrombocytopenia, neutropenia, eosinophilia

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50
Q

What is clindamycin used for, and dosing?

A

First line for MRSA in some areas, used in PCN resistnat patients, resistant strep pneumonia, dental infections

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51
Q

What is the rational drug selection for clindamycin?

A

It’s considered 2nd line, and only has narrow spectrum aerobic activity; it can be first line in children and pregnancy

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52
Q

What should be monitored for with clindamycin?

A

diarrhea, especially C diff potential

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53
Q

What should patients be educated about with clindamycin?

A

diarrhea and C diff, finish therapy

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54
Q

What is a well known drug from the macrolides, azalides, and ketolides?

A

Erythromycin

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55
Q

How do macrolides work?

A

inhibits ribosome protein synthesis

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56
Q

What makes macrolides increase in activity

A

alkaline environments/media

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57
Q

What kinds of bacteria are susceptible to macrolides?

A

atypicals and intracellular organisms that are resistant to beta lactams

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58
Q

What is the resistance in macrolides like?

A

Cross resistance to all in the class

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59
Q

Describe absorption and metabolism for macrolides?

A

Well absorbed in duodenum; inhibitors of CYP 450 enzyme

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60
Q

What happens when macrolides are combined with statins?

A

Increases risk of myopathy

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61
Q

What unusual thing does macrolides do after absorption?

A

Enterohepatic recycling, which leads to build up in system; causes N/V; levels higher in tissues than in serum

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62
Q

What are precautions for macrolides?

A

Statins; safe in pregnancy and children

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63
Q

What are adverse drug reactions in macrolides?

A

dose related GI issues, N/V/D, abdominal cramping

skin issues, Steven-Johnson

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64
Q

What are drug interactions of macrolides?

A

statins, CYP 450 enzyme

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65
Q

What are clinical dosing and use of macrolides?

A

primary use for mycoplasm community acquired pneumonia (zithromax); chlamydia, pertussis, H. pylori (clarithromycin), chronic bronchitis

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66
Q

What is the rational drug selection for macrolides?

A

alternative to PCn allergy, inreasing resistance, don’t use for AOM or sinusitis

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67
Q

What should be montiored for with macrolides?

A

altered metabolism responses to other drugs by CYP450 and 2C9; hepatic/renal problems, hearing loss

68
Q

What should patients be educated about with macrolides?

A

ADR and drug interactions

69
Q

How do sulfonamides work?

A

inhibit folic acid synthesis

70
Q

How does trimethaprim work?

A

inhibits DNA synthesis

71
Q

How does nitrofurantoin work?

A

inhibits acetyl coenzymes

72
Q

What kind of bacteria are sulfonamides, trimethaprim, and nitrofurantoin effective against?

A

Gram positive and gram negative

73
Q

What specific bacteria can s, t, and n be used with?

A

E coli, s. pyogenes, s. pneumonia, h. influenze, and some protozoa

74
Q

What are adverse drug reactions of s, t, and n?

A

GI issues, stomatitis, rashes, hypersensitivity, photosensitivity, CNS, dizziness, drug interactions

75
Q

When should s, t, and/or n be avoided?

A

G6PD defiency

76
Q

What is the clinical use and dosing of s, t, and n?

A

Mostly UTI, sometimes MRSA

77
Q

What is the rational drug selection for s, t, and n?

A

lost cost alternative in children when they have PCN allergies

78
Q

What should be monitored with s, t, and n?

A

control in UTI, CBC if using long term, chest xray if cough with nitrofurantoin

79
Q

What is the patient education for s, t, and n?

A

Finish course, ADRs, reactions

80
Q

What is the primary drug in oxazolidinones?

A

Linezolid

81
Q

How does linezolid work?

A

inhibits ribosomal protein synthesis

82
Q

What is linezolid most helpful against?

A

aerobic gram positive

83
Q

What is the absorption for linezolid?

A

well absorbed orally, doesn’t interfere with CYP450 enzymes

84
Q

What are ADRs with linezolid?

A

D/HA/N, myelosuppression that resolves after quitting drug

85
Q

When should linezolid be used?

A

pneumonia and complicated skin infections, but try less expensive drugs first

86
Q

What is the rational drug selection for linezolid?

A

high cost, use if resistance to vanc is a problem

87
Q

What is the patient education for linezolid?

A

ADRs and patient administration

88
Q

What are the two main drugs in the tetracyclines?

A

Tetracycline and doxycycline

89
Q

How do tetracyclines work?

A

they bind to the 30S unit of the ribosome

90
Q

How is absorption of tetracylcines affected?

A

Food, milk and calcium decrease absorption

91
Q

What are precautions and contraindications with tetracyclines?

A

don’t give to pregnant or lactating women, children less than 8 because of dental issues

92
Q

What are the drug interactions with tetrayclines?

A

many

93
Q

What is the clinical use and dosing for tetracylcines

A

doxycycline is first line for trachomatis and U.urealyticum, p. acnes, and some h. pylori regimens

94
Q

What is the rational drug selection for doxycycline?

A

doxycycline and minocycline can be taken with food; tetracycline not so great anymore b/c of resistance

95
Q

What is patient education for tetracyclines

A

administration, AdRs, avoid during pregnancy

96
Q

What is an example of a lipoglycopeptide?

A

Vancomycin, telavancin, and dalbavancin

97
Q

What are lipoglycopeptides used for?

A

severe gram positive infections that are resistant to first line

98
Q

How do lipoglycopeptides work?

A

Inhibit cell wall synthesis

99
Q

How are lipoglycopeptides abosrbed?

A

Not well orally, given IV

100
Q

What are ADRs for lipoglycopeptides?

A

ototoxicity, nephrotoxicity, Red Man syndrome if given too fast

101
Q

What is the clinical use and dosing for lipoglycopeptides?

A

serious gram positive when MRSA coverage is necessary or there are PCN issues

102
Q

What should be monitored for with lipoglycopeptides?

A

Hearing and renal function

103
Q

What should patient education for lipoglycopeptides be?

A

Administration and ADRs

104
Q

What are mycobacteria?

A

Slow growing bacteria that are resistant to drugs that depend on how rapidly cells divide

105
Q

What makes mycobacteria resistant to drugs?

A

Lipid rich cell wall

106
Q

What is unique about mycobacteria?

A

They can go dormant and easily become resistant to single drugs

107
Q

What are the main mycobacterials?

A

isoniazid, ethambutol, and rifampin

108
Q

How do isonizaid, ethambutol, and rifampin work?

A

INH and ethambutol inhibit synthesis of mycolic acides, ehtambutol inhibits arabinogalactan needed for cell walls, rifampin binds to subunit of RNA polymerase and inhibits RNA synthesis

109
Q

What are the resistant issues with mycobacteria drugs?

A

Quickly develop resistance, cross resistance with INH and ethionamide

110
Q

How are mycobacteria drugs absorbed?

A

Well absorbed orally, metabolism of INH varies widely, dependent on acetylator status

111
Q

What are the ADRs of antimycobacterials?

A

INH: peripheral neuropathy,
INH, rimfapin, and pyrazinamide: hepatotoxicity
ethambutol: optic neuritis
streptomycin and capreomycin are ototoxic
Rifabutin: thrombocytopenia and neutropenia

112
Q

What are the drug interactions of antimycobacterials?

A

many drug interactions; rifampin is CYP450 inducer

113
Q

What is the clinical use and dosing for antimycobacterials?

A

Follow CDC guidelines, TB requires 4 drug therapy, Preventive therapy with INH

114
Q

What is rational drug selection for antimycobacterials?

A

Follow CDC guidelines

115
Q

How should antimycobacterials be montiored?

A

Directly observed

116
Q

What is the patient education for antimycobacterials?

A

Take medications daily, report ADRs

117
Q

What are nucleoside analogues for?

A

antirvirals

118
Q

How do nucleoside analogues work?

A

block entry to cells or be active inside cells to be effective

119
Q

What is acyclovir active against?

A

herplex simplex 1 and 2, varicella-zoster, epstein-barr, cytomegalovirus and herpes virus 6

120
Q

What is valacyclovir good against?

A

converts to acyclovir and then active against same things

121
Q

What is famciclovir good against?

A

HS1-2, VZ, EB, and Hep B

122
Q

What is ganciclovir good for?

A

CMV

123
Q

What are ADRs of the nucleoside analogues?

A

acyclovir: few when given orally
valacyclovir can causes thrombocytopenia pupura and hemolytic uremia in immunosuppressed
famciclovir causes headeache
Ganciclovir can cause blood cell issues, carcinogenic

124
Q

What are the drug interactions of nucleoside analogues?

A

Few

125
Q

What are the clinical uses and dosing for nucleoside analogues?

A

herpes simplex genital herpes intial outbreak and suppression;
Herpes zoster (shingles) start within 3 days;
Varicella (chickenpox) start within 24 hours;
gingivostomatitis in children
Bell’s palsy

126
Q

What are the rational drug choices regarding nucleoside analogs?

A

Choice based on cost and convience

127
Q

What is the monitoring for nucleoside analogs?

A

monitoring rash, temperature, BUN and creatinine in high risk patients

128
Q

What is the patient education for nucleoside analogs?

A

Start drug at earliest sign of infection, stay hydrated, and teach signs of renal failrue, encephalopathy, and blood dyscrasias

129
Q

What are the main antivirals for influenza?

A

oseltamivir (tamiful), peramivir (rapivab), and zanamivir (Relenza)

130
Q

Which flus do the influenza antivirals treat?

A

A and B

131
Q

What are the pharmacodynamics of the flu antivirals?

A

Sensitivity varies each year; rimartidine and amratidine have resistance - no longer recommended for the flu

132
Q

Describe absorption for flu antivirals?

A

oseltamiviir is well absorbed orally; Zanamivir is inhaled with less than 17% absorption; peramivir is givene IV

133
Q

What are the adverse drug reactions for flu antivirals?

A

Zanamivir: bronchitis and SOB

134
Q

What is the clinical use and dosing for flu antivirals?

A

oseltamivir and zanamivir good for prophylaxis and treatment of A and B; peramivir is only for acute flu in those 18 or older; CDC guidelines need to be evaluted annually

135
Q

What should be montiored for with the flu antivirals?

A

renal function in older people, hallucinations, confusion and cognitive impairment in elderly

136
Q

What is the patient education for flu antivirals?

A

complete full course of therapy, ADRs, get flu vaccination every year

137
Q

What type of drug are system azoles?

A

Anti-fungals

138
Q

What are the polyene macrolides?

A

Anti-fungals amphotericin B and nystatin

139
Q

What azoles have broad spectrum activity?

A

butoconazole, clotrimazole, ketoconazole, minonazole, terconazole, etc.

140
Q

What kind of anti-fungals are good against yeast and dermatophytes?

A

alklyamines

141
Q

What are examples of the alklyamine anti-fungals?

A

naftifine, terbinafine

142
Q

What are nuclear acid synthesis inhibitors for?

A

anti-fungal

143
Q

What is an example of a nuclear acid synthesis inhibitor?

A

flucytosine

144
Q

What is griseofulvin?

A

An anti-fungal

145
Q

What are the pharmokinetics of antifungals?

A

absorption of itraconazole is enhanced by food;
absorption of griseofulvin is enhanced by fat;
fluconazole inhibits CYP450 and 2C9
itraconazole and ketoconazole inhibit CYP450

146
Q

What are the adverse drug reactions of the antifunglas?

A

hepatotoxicity

147
Q

What are the drug interactions of anti fungals?

A

Many mess with CYP 450

148
Q

What is the clinical use and dosing for antifungals?

A

oral fungals treat yeast and dermatophytes, and invasive systemic mycoses; fluconazole requries a loading dose

149
Q

What is the rational drug selection for anti-fungals?

A

Fluconazole has the fewest drug interactions

150
Q

What should be monitored with the anti fungals?

A

ketoconazole needs liver enzyames and bilirubin every 3-4 months

151
Q

What is patient education for antifungals?

A

take with food, don’t use alcohol, watch for signs fo liver damage

152
Q

How do antihelminthics work?

A

intestintal nematodes treated with mebendazole, pryantel, and thiabendazole;
tissue nematodes treated with mebendazole, thiabendazole, ivermectin, and albendazole

153
Q

How many cases of pinworm are treated yearly in the US?

A

50 million

154
Q

What are the adverse drug reactions for antihelminthics?

A

N/V/D, abdominal pain, mebendazole can cause neutropenia, Ivermectin can cause Mazzotti reaction.

155
Q

What is the clinical use and dosing for antihelminthics?

A

pinworms: single dose of mebendazole or pyrantel, or albendazole;
whipworms: mebendazole, albendazole, or pyrantel;
round worms: mebendazole;
hookworms: mebendazole, albendazole, pyrantel
threadworm: ivermectin or thiabendazole
scabies: off label ivermectin in immunocomprimised people

156
Q

What is the rational drug selection for antihelminthics?

A

See CDC guidelines

157
Q

What should be monitored for with antihelminthics?

A

albendazole and mebendazole need to be given with high fat meal;
Ivermectin should be taken without food;
Albendazole should not be taken during pregnancy and there should be back up contraceptive

158
Q

What is metronidazole?

A

Treats both bacterial and parasitic infections;

Good against trichonomas, amoebas, h. pylori, and C fdiff

159
Q

What is nitazoxanide for?

A

Treats giardia and cryptosporidium

160
Q

What is tinidazole for?

A

amoebas, giardia, and trichonomas

161
Q

What are the pharmakinetics of metrinodazole?

A

Well absorbed orally

162
Q

What are the ADRs with the antiparasitic drugs?

A

mitronidazole can cause anorexia, N/V, metallic taste, abdominal pain

163
Q

What is the clinical use and dosing for the antiparasitics?

A

metronidazole and tinidazole are for protozoan infections;

metronidazole can help with anaerobic bacterial infections, vaginosis, and is used in H. pylori treatment

164
Q

What is the rational drug selection for the antiparasitics?

A

metronidazole is cheap, don’t use during first trimester of pregnancy

165
Q

What should be monitored with the anti parasitics?

A

resolution and signs of neutropenia

166
Q

What is the patient education for antiparasitics?

A

administration, metallic taste, avoid alcohol, partner might also need treatment

Advanced Pharmacology (4 decks)

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