Antiinfectives part 2 Flashcards
Which medication can be used to treat influenza A and B?
Oseltamivir (Tamiflu)
INH is available in what forms?
PO and IM
Sx of lactic acidosis and hepatomegaly?
nausea, vomiting, abdominal pain, malaise, fatigue, anorexia, and hyperventilation
How often should we monitor serum creatine with Amp B tx?
Q2-4 days
Adverse effects of Amphotericin B?
infusion rxns*, elevated liver enzymes, nephrotoxicity, delirium, hypotension, HTN, wheezing, hypoxia, hypokalemia, and hematologic effects.
Therapeutic use of INH?
- Single use for latent TB.
2. Must be used in combination for active TB.
What 2 main labs need to evaluated prior to administration of all HIV meds?
CD4 T cell counts and plasma HIV RNA (viral load) assays
MOA of Enfuvirtide?
Keep virus from entering the cell
How should Itraconazole be taken?
with food or cola beverage to enhance absorption
What is a disadvantage of Azoles?
Inhibit cytochrome P450
Common adverse effects of Darunavir?
Hyperglycemia/ diabetes, fat redistribution, HLD, reduced bone density, elevation of serum transaminase.
Pre-tx options for mild infusion rxns assoc with Amp B?
Diphenhydramine + acetaminophen. ASA (not best option d/t kidney damage)
Precautions with Enfuvirtide?
PNA risk factors, low initial CD4 counts, high initial viral load, IV drug use, smoking, hx of lung disease.
How to prevent phlebitis if using peripheral line?
change PIV sites often
What is used to treat when a patient has issues with peripheral neuropathy?
Pyridoxine (vitamin B6)
T/F. Take drugs that raise gastric pH at least 1hr before Itraconazole or 2 hours after.
True
What are the 4 classes of antifungal drugs?
Polyene abx, Azoles, Echinocandins, and Pyrimidine analogs.
When does Oseltamivir need to be taken to be effective?
Within 48 hours
Precautions with Raltegravir?
Pregnancy risk, category C
Adverse effects of Itraconazole?
Cardiosuppression, Liver damage, inhibit drug-metabolizing enzymes, *nausea, *vomiting, *diarrhea
How should Darunavir be taken?
PO w/ food. Must be boosted w/ Ritonavir.
How can we minimize renal damage during Amp B therapy?
infuse 1L of saline on tx days
Common adverse effects for NRTIs?
Lactic acidosis with hepatomegaly
Ethambutol is available in what forms?
PO (QD, w/ food if GI upset)
What are the 1st line drugs for TB tx?
Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), and Ethambutol (EMB)
Common adverse effects of Raltegravir (Isentress)?
insomnia and HA
MOA of Acyclovir?
Interferes with viral DNA synthesis.
Therapeutic use of Rifampin?
- Active TB.
- Elimination of meningococcal carriers.
- Prevention of disease caused by Haemophilus influenzae type B in close contacts.
- Synergy with other antimicrobial agents for S. aureus infections.
Rifampin contraindications?
patient’s taking protease inhibitors and delavirdine.
Which azole is an alternative to Amp B?
Itraconazole (Sporanox)
Therapeutic use of Acyclovir?
Recurrent genital herpes infections, mucocutaneous herpes, varicella-zoster.
Therapeutic use of Metronidazole?
o Intestinal amebiasis o Amebic liver abscess o Trichomoniasis o Bacterial vaginosis o IV anaerobic infections.
What class drug is Efavirenz (Sustiva)?
NNRTI
What are sx of hepatitis?
jaundice, anorexia, malaise, fatigue, nausea
MOA of Itraconazole
- Inhibits synthesis of ergosterol.
2. Inhibits fungal cytochrome P450.
MOA of Efavirenz?
acts within the CD4 cell
Adverse effects of Maraviroc?
Cough, dizziness, pyrexia, rash, abdominal pain, MSK symptoms, URI, hepatotoxicity
Abacavir falls under which class of antivirals?
NRTIs
Available forms of PZA?
PO (QD, empty stomach)
Serious adverse effects of Flagyl?
superinfection, seizures, Steven-johnson’s syndrome
Acyclovir precautions?
dehydration , renal impairment, taking nephrotoxic drugs
Common adverse effects of Flagyl?
dizziness, HA, abd pain, nausea, anorexia, metallic taste
What antiviral class is Enfuvirtide (Fuzeon)?
Fusion inhibitor
MOA of Oseltamivir?
inhibits viral enzyme neuraminidase
MOA of Abacavir?
Will work within the CD4 cell
What are signs of liver dysfunction?
anorexia, darkened urine, pale stools, yellow discoloration of eyes or skin.
MOA of Ethambutol?
Bacteriostatic: weakens but does not fully kill the bacilli. Active against strains that are resistant to isoniazid and rifampin.
Therapeutic use of Ethambutol (Myambutol)?
- Initial treatment of TB and treatment of patients who have received therapy previously.
- Tuberculosis
Extent of renal damage assoc w/ Amp B is r/t?
TOTAL dose administered over full course of tx.
Interactions with INH?
phenytoin, rifampin, rifabutin, rifapentine or pyrazinamide
Metronidazole is available in what?
Topical, PO, IV
What meds should be avoided while takin Amp B?
nephrotoxic drugs and NSAIDs
Infusion consideration with Amp B?
test dose, check for precipitate, assess for phlebitis, individualized dosing.
Caution use of INH with?
ETOH abuse, DM, vitamin B6 deficiency, >50
Rifampin can reduce effectiveness of what drugs?
warfarin, delavirdine (NNRTI), oral contraceptives, most protease inhibitors.
Adverse effects of Rifampin?
Red discoloration of tears, sweat, saliva, & urine, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, hepatotoxicity, CNS symptoms, rash, blood dyscrasias, acute renal failure
Pre-tx options for rigors assoc with Amp B?
Meperidine (Demerol), dantrolene (Revonto), hydrocortisone (if needed give slowly)
Adverse effects of Enfuvirtide?
injection site rxns, PNA, hypersensitivity rxns
Drug class of Metronidazole (Flagyl)?
Abx, Antiprotozoal
Adverse effects of INH?
Peripheral neuropathy*, hepatotoxicity, optic neuritis, anemia, psychological disturbances.
Contraindications for Oseltamivir?
HTN, children <1
Rifampin is available in what forms?
PO and IV (slow infusion)
How is PO Flagyl taken?
QD with food if GI upset
Darunavir drug interactions?
Inhibits cytochrome P450
How should Acyclovir be applied topically?
with rubber glove
How should Efavirenz be taken?
PO, empty stomach, same time QD
Therapeutic use of Pyrazinamide (PZA)?
TB
What other baseline labs should be taken for Darunavir?
serum transaminase and blood glucose
Contraindications for Itraconazole?
contraindicated for patients taking pimozide, quinidine, dofetilide, or cisapride
MOA of Raltegravir?
works outside of the CD4 cell to stop HIV from replicating
PZA contraindications?
severe liver disease or acute gout
What are the injectable drugs used as second line TB drugs?
Streptomyces: Capreomycin [Capastat Sulfate]
Aminoglycoside antibiotics: Amikacin [Amikin], kanamycin
Name 2 fluoroquinolones used as second line TB drugs?
Levofloxacin [Levaquin] and moxifloxacin [Avelox]
Residual kidney damage assoc with Amp B is likely to occur at what level?
total dose >4g
T/F. Heparin can be used in the infusion site to prevent phlebitis associated with Amp B therapy.
True
Amphotericin B is available in what forms?
IV- slow infusion 2-4hrs
Intrathecal??
How does PZA cause hyperurecemia?
inhibits the excretion of uric acid
What are rare side effects of Amp B?
rash, seizures, anaphylaxis, dysrhythmias, acute liver failure, nephrogenic diabetes insipidus.
What class drug is Raltegravir (Isentress)?
INSTIs
INH contraindications?
acute liver disease or hx of INH hepatotoxicity
MOA of Amphotericin B?
Binds to ergosterols to make fungal cell more permeable.
Precautions with Ethambutol?
ETOH abuse
When are second line TB drugs used?
- Resistance to 1st line drugs.
- severe pulmonary TB
- disseminated (extrapulmonary) infection.
PZA precautions?
ETOH abuse
Precautions with Tamiflu?
Lactation
What baseline information do we need for Itraconazole?
hx of heart disease, liver function test
How can nephrotoxicity be reduced with Acyclovir tx?
ensure adequate hydration during the infusion and for 2 hours after.
How is IV Flagyl administered?
Infuse over 60min
Precautions with Maraviroc?
elevated liver function and cardiovascular disease.
Precautions with Metronidazole?
hepatic and renal impairment and seizure disorder
What additional baseline lab should be assessed before giving Maraviroc?
proof that HIV strain is CCR5 tropic
Itraconazole is available in what forms?
PO, QD
Adverse effects of Ethambutol?
Hyperuricemia, optic neuritis; allergic rxn, GI upset, confusion.
Ethambutol contraindications?
optic neuritis (take baseline eye test)
What class is Darunavir?
Protease inhibitor
Rifampin precautions?
ETOH abuse, liver disease.
Precautions for Itraconazole?
Cardiac disease, significant pulmonary disease, liver disease.
MOA of Pyrazinamide?
Bactericidal to M. tuberculosis
What 2 drugs can produce the shortest TB therapy?
Isoniazid and Rifapentine
MOA of Rifampin?
Inhibits synthesis of RNA; bactericidal effect.
What antiviral class is Maraviroc (Selzentry)?
CCR5 antagonist
What are the advantages of Azoles?
lower toxicity and can be given orally
What are sx of infusion rxns with Amp B?
flu like: fever, chills, N, HA
Which polyene abx is reserved for life threatening infections?
Amphotericin B
Adverse effects of Tamiflu?
Nausea, vomiting, abdominal pain, CNS symptoms
What is cardiosuppression?
transient decrease in ventricular ejection fraction
Adverse effects of PZA?
Hepatotoxicity,
Nongouty polyarthralgias **,
Hyperuricemia, N/V/D, Photosensitivity.
Available forms of Acyclovir?
PO, buccal, IV, topical
Best line to infuse Amp B?
using a central vein
Adverse effects of Efavirenz?
CNS rash and other hypersensitivity rxns, Steven Johnson’s, teratogenicity
Adverse effects of Acyclovir?
Dizziness, headache, diarrhea, nausea, IV form: phlebitis*, reversible nephrotoxicity also vertigo.
Interactions with Metronidazole?
alcohol, Cimetidine, phenobarbital, rifampin, phenytoin, lithium, and warfarin
How should Enfuvirtide be given?
Subcut BID
