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Pharmacology > Antifungals, Antimalarials, Antivirals > Flashcards

Antifungals, Antimalarials, Antivirals Flashcards

1
Q

what is the drug used for latent and active TB, inhibits mycolic acid in bacteria, disrupting the cell wall

A

Isoniazid

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2
Q

Coverage isoniazid

A

m. tuberculosis

m. kansasii (at high conc)

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3
Q

cross-resistance possible between isoniazid and ______ (drug)

A

ethionamide

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4
Q

isoniazid Adverse effects?

A

hepatitis, peripheral neuropathy, CNS effects, hypersensitivity

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5
Q

in treating ACTIVE TB, drug-susceptible drugs require ___ months of treatment, while multi-drug resistance requires _____

A

6 months

2 + years

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6
Q

WHAT TWO factors do you look at when assessing HIV?

A

CD4 and viral load

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7
Q

does isoniazid enter the CSF?

A

yes

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8
Q

where does metabolism occur for isoniazid?

A

liver

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9
Q

What is Rifampin, Rifabutin, Rifapentine used for?

A

TB and HIV

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10
Q

Which Rifamycin is has greater activity, and longer 1/2 life, used to treat Latent TB

A

Rifapentine

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11
Q

Which drug to NEVER USE FOR MONOTHERAPY for treating TB?

A

Rifampin

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12
Q

Which Antifungal has a LOW therapeutic index, but is best drug of choice for treating several life-threatening mycoses?

A

Ampho B

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13
Q

Does the administration (IV) for ampho B need to be slow or fast?

A

SLOW - insoluble in water

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14
Q

Ampho B is insoluble in water - what are the 2 preparations of it?

A
  • Mixed with sodium deoxycholate

- Lipid preparation - only for salvage therapy if can’t tolerate other kind

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15
Q

Does Ampho B cross the CSF?

A

no

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16
Q

Azotemia can occur in which anifungal?

A

Ampho B - infuse with normal saline and lipid-based ampho B to avoid this.

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17
Q

Flucytosine is combined with which other antifungal?

A

Ampho B

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18
Q

Which antifungal is converted to 5-FU in the fungal cell?

A

Flucytosine

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19
Q

What is flucytosine’s coverage?

A

systemic mycoses, meningitis caused by c. albicans, c. neoformans, cryptococcosis

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20
Q

Resistance is increasing, especially for immunocompromised with this type of antifungal

A

Triazoles (fluconazole, itraconazole, posaconazole…)

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21
Q

Fluconazole is limited to yeasts and fungi. It has no coverage against ______

A

aspergillosis or zygomycosis

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22
Q

Fluconazole is the drug of choice for treatment of what?

A

induction therapy of treating Cryptococcus neoformans, candida, coccidioidomycosis

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23
Q

Which antifungal is used for prophylaxis in bone marrow transplant?

A

Fluconazole

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24
Q

Which is the LEAST active (worst coverage) of the Triazoles

A

Fluconazole

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25
Q

Does Itraconazole reach the CSF?

A

no

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26
Q

Which triazole has the BROADEST coverage?

A

Posaconazole

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27
Q

Which triazole has the longest 1/2 life?

A

Posaconazole

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28
Q

Which types of drugs interact with posaconazole, and decreases its absorption?

A

Drugs that affect gastric pH - PPI/H2 blockers

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29
Q

This triazole has a TON of interactions and contraindicated medications

A

Voriconazole

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30
Q

What are the Echinocandins?

A

Capsofungin
Micafungin
Anidulafungin

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31
Q

What is Capsofungin used FIRST LINE for treating?

A 
invasive candidiasis 
(2nd line for aspergillus when ampho B or azoles don't work)
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32
Q

True or False: you need to adjust capsofungin for RENAL dysfunction but not for HEPATIC dysfunction

A

FALSE - adjust only for hepatic dysfunction

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33
Q

Anidulafungin is First line treatment for which type of infection?

A

invasive fandidasis

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34
Q

Micafungin is prophylaxis of invasive candida for those undergoing which procedure?

A

hematopoietic stem cell transplantation

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35
Q

Which Echinocandin can be used in severe hepatic (liver) disfunction?

A

Anidulafungin

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36
Q

Terbinafine, Naftifine, and Butenafine are what type of CUTANEOUS antifungals?

A

Squalene epoxidase inhibitors

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37
Q

Which type of antifungal is drug of choice for fungal infection of the NAILS?

A

PO Terbinafine (also used for the scalp - tinea capitis)

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38
Q

Does topical terbinafine have a slow or fast 1/2 life?

A

SLOW - 200-400 hours

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39
Q

This cutaneous antifungal requires MONTHS duration of use in order to see results?

A

Griseofulvin

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40
Q

Griseofulvin concentrates/distributes where?

A

skin, hair, nails, adipose

41
Q

Griseofulvin CONTRAINDICATIONS?

A

Pregnancy

Porphyria

42
Q

Nystatin is commonly used as powder and cream. what administration is NOT OK and why?

A

IV - toxic when absorbed systemically

43
Q

Oseltamivir

Zanamavir

A

Neuraminidase inhibitors

44
Q

when do you administer neuraminidase inhibitors?

A

PRIOR to flu exposure (48 hours)

45
Q

which neuraminidase inhibitor is safe for pregnancy

A

Oseltamivir

46
Q

What is ribavirin used for?

A

severe RSV and chronic HepC (when in combo with interferon alpha)

47
Q

is Ribavirin ok to use in pregnancy?

A

NO

caution in infants too

48
Q

Of the hepatitis infections A, B, C, D, E, the most common are A,B,C. Which 2 are there treatments available for?

A

hepatitis B and C

49
Q

This antiviral class comes in alpha, beta, and gamma forms

A

Interferons

50
Q

Interferons are used to treat which viral infection?

51
Q

Treatment of Chronic hepatitis C USED TO BE interferon + ribavirin, but NOW it is _____

A

direct-acting antivirals

52
Q 
Simeprevir
Sofosbuvir
Simeprivir + sofosbuvir
Sofosbuvir + Ledipasvir
Ombitasvir + paritaprevir + ritonavir + dasabuvir
A

Direct-acting antiviral agents (2nd generation)

used in treating hep c

53
Q

what is Acyclovir and Valacyclovir used to treat?

A

Herpes simplex 1/2, Varicella-zoster, EBV

54
Q

Cidofovir used to treat _____?

A

Cytomegalovirus in patients with AIDS

55
Q

CONTRAINDICATION of using Cidofovir

A

Renal impairment, and caution with renal dysfunction

56
Q

Foscarnet treats what?

A

it is an antiviral, treats CMV retinitis in immunocompromised

57
Q

Which 5 classes of drugs treats HIV?

A

NRTIs, NNRTIs, Protease inhibitors, Entry inhibitors, Integrase inhibitors

58
Q

Which NRTI is best to use if renal impairment, because it is metabolized in the liver?

59
Q 
Zidovudine
Stavudine
Lamivudine
Didanosine
Tenofovir
Emtricitavine
Abacavir
A

NRTIs (HIV treatment)

60
Q

Nevirapine
Efavirenz
Etavirine
Rilpivirine

A

NNRTIs (HIV treatment)

61
Q 
Ritonavir
Saquinavir
Indinavir
Nelfinavir
Fosamprenavir
Lopinavir
Atazanavir
Tipranavir
Darunavir
A

Protease inhibitors (HIV treatment)

62
Q

Which severe AE do you need to be aware of when using Tenofovir to treat HBV?

A

fanconi’s syndrome, decreased bone density

63
Q

during which phase of herpes (cold sore) must you treat with acyclovir or valaciclovir?

A

Acute phase

NO EFFECT DURING LATENT stage

64
Q

Trifluridine Coverage?

A

antiviral - treats HSV1, HSV2, vaccinia virus (eye infections)

65
Q

Why is trifluridine only available topically?

A

TOXIC SYSTEMICALLY! use topically in eye

66
Q

which protease inhibitor can you NOT use PPI/H2 blockers, as they cause in increase in bilirubin/jaundice?

A

Atazinavir

67
Q

Using this class of of HIV meds chronically can lead to fat redistribution around abdomen and neck

A

Protease inhibitors

68
Q

Ampho B does not cross CSF, vitreous humor, or amniotic fluid, but IT DOES CROSS what?

69
Q

What is the drug of choice for aspergillus (Triazole)

A

Voriconazole

70
Q

This antifungal replaces Ampho B for drug of choice for treating invasive aspergillus

A

Voriconazole

71
Q

Which Cutaneous antifungal treatment DOES NOT COVER candidiasis

A

tolnaftate

72
Q

Tolnaftate MOA

A

stunts fungal growth

73
Q

Griseofulvin MOA

A

disruption of fungal mitosis

74
Q

most common causes of cutaneous fungals

A

trichophyton
microsporum
epidermophytin

75
Q

Which antigungal is used in prophylaxis for stem cell transplantation

A

micafungin

76
Q

which “male” medications do you need to MAKE SURE TO wash your hands after use for risk of harming children/pregnancy women

A

Testosterone supplements & 5-alpha reductase

77
Q

Which 2nd line TB medication has Adverse effects that are mainly CNS related - lethargy, suicidal thoughts, anxiety!

A

Cycloserine

78
Q

Newest TB drug, used for treating MDR-TB

A

Bedaquiline

79
Q

Bedaquiline AE

A

QT prolongation

80
Q

which antimacrolide therapy’s MOA is inhibition of folate synthesis

81
Q

primaquine only works in the erythrocytic or exoerythrocytic form?

A

exoerythrocytic

82
Q

first line treatment for invasive candidiasis?

A

echinocandins

83
Q

first line treatment for invasive aspergillosis

A

voriconazole

84
Q

which 2 medications used to treat nematodes are CONTRAINDICATED in pregnancy?

A

ivermectin

Mebendazole

85
Q

which antihelmetic drug is used for lung/blood/intestinal/liver worms?

A

praziquantel

86
Q

coverage of choice for c. neoformans AFTER induction therapy with ampho B and flucytosine?

A

fluconazole

87
Q

of the Triazoles, which DOES NOT cross into the CSF?

A

Itraconazole

88
Q

which triazole has AEs that include visual and auditory hallucinations?

A

voriconazole

89
Q

why is Voriconazole tough to administer?

A

SO MANY CONTRAINDICATIONS AND INTERACTIONS

90
Q

TOP 3 TREATMENT options for invasive aspergillosis

A

Ampho B + flucytosine –> Voriconazole –> Capsofungin

91
Q

first line treatment for invasive candidiasis?

A

echinocandins: capsofungin, Anidulafungin, micafungin

92
Q

which echinocandin DOES NOT require a loading dose when initiating?

A

micafungin

also used as prophylaxis in stem cell transplants

93
Q

nystatin coverage?

A

cutaneous/oral candida
oropharyngeal/cutaneous candidiasis
NO TINEAs

94
Q

Treatment for Latent TB

A

isoniazid + Rifapentine for 9 months

95
Q

Due to rifampin’s risk of liver failure, which patients to BE CAREFUL in?

A

alcoholics
elderly
liver failure

96
Q

which of the 4 first-line treatments for active TB can be discontinued after 2 months of a 6 month regimen?

A

pyrazinamide

97
Q

what 2 meds are used to treat leprosy?

A

Dapsone

Clofazimine

98
Q

Clofazimine MOA (leprosy)

A

phenazine dye generates toxins

can cause brown/pink discoloration of skin

Pharmacology (12 decks)

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