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CMT > Antimicrobial Review > Flashcards

Antimicrobial Review Flashcards

1
Q

Penicillin

MOA

A

Inhibits cell wall synthesis

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2
Q

Penicillin

Mechanisms of Resistance

A
  • B-lactamase production
  • Altered PBP
  • Decreased drug permability
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3
Q

Penicillin

Gram Pos Coverage

List specific bacteria

A

Streptococcus spp
Listeria spp
Clostridium spp

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4
Q

Penicillin

Gram Neg Coverage

List specific bacteria

A

Neisseria spp
Pasteurella

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5
Q

Penicillin

Overall Coverage

A

Gram Positives
Gram Negatives (more limited)
Spirochete (Treponema pallidum)

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6
Q

Penicillin

Side Effects

A
  • IgE-mediated anaphylaxis
  • Integumentary (Maculopapular rash)
  • GI upset- Nausea, vomiting, diarrhea
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7
Q

Antistaphylococcal Penicillins

List the Meds

A

Nafcillin
Oxacillin
Dicloxacillin

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8
Q

Antistaphylococcal Penicillins

Gram Positive Bacterial Coverage

list specific species

A

Gram Positives
* streptococcus spp
* Clostridium spp
* Methicillin-susceptible Staphylococcus Aureus

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9
Q

Antistaphylococcal Penicillins

Side Effects

A

Hematologic/Oncologic: agranulocytosis
GI: cholestasis, n/v/d

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10
Q

Aminopenicillins

Overall Coverage

A

Gram Positives
Gram Negatives
Improved gram neg coverage compared to penicillins

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11
Q

Aminopenicillins

A

Amoxicillin

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12
Q

Aminopenicillins

Gram Positive Coverage

A

Streptococcus spp
Enterococcus spp

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13
Q

Aminopenicillins

Gram Neg Coverage

A

E. Coli
Proteus mirabilis
H. Influenzae
Salmonella spp
Shigella spp
Neisseria meningitidis

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14
Q

Aminopenicillins

Side Effects

A

GI: n/d
Renal: nephrotoxicity

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15
Q

What can aminopenicillins be combined with?

A

beta-lactamase inhibitors

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16
Q

Which is better absorbed, amoxicillin or ampicillin?

A

Oral amoxicillin

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17
Q

Piperacillin/Tazobactam

Side Effects

A

Hypersensitivity (anaphylaxis)
Integumentary: Stevens-Johnson Syndrome, Toxic epidermal necrosis
Renal: nephrotoxicity
GI: n/v/d

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18
Q

Piperacillin/Tazobactam

Overall Bacterial Coverage

A

BROAD SPECTRUM (positives, negatives, anaerobes)

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19
Q

How are piperacillin/tazobactams administered?

A

Infusion (over 4 hrs)

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20
Q

Cephalosporins

MOA

A

binds to penicillin binding proteins to prevent cell wall synthesis

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21
Q

Cephalosporins

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time dependent
Bactericidal

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22
Q

Penicillins

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time dependent
Bactericidal

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23
Q

Cephalosporins

Class

A

Beta-Lactams

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24
Q

Cephalosporin

Coverage

A

1st Gen: great w/ gram positives, poor gram neg coverage
3rd Gen: equalish gram neg/pos coverage
5th Gen: great gram neg coverage, poor gram pos coverage

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25
Q

Cephalosporins

1st Gen Meds & Admin Route

List med names & PO/IV/IM

A

Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)

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26
Q

Cephalosporins

1st Gen Coverage

A

MSSA
Beta-hemolytic Streptococcus
PEcK

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27
Q

Define

PEcK

A

Proteus
E. coli
Klebsiella

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28
Q

Cephalosporins

2nd Gen Meds & Admin Route

List med names & PO/IV/IM

A

Cefaclor (PO)
Cefprozil (PO)
Cefuroxime (IV/IM/PO)
Cefoxitin (IV/IM)
Cefotetan (IV/IM)

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29
Q

Cephalosporins

2nd Gen Coverage

A

MSSA
Beta-hemolytic Streptococcus
HEN PEcKS
Oral Anaerobes

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30
Q

Define

HEN PEcKS

A

H. Influenzae
Enterobacter aerogenes
Neisseria
Proteus
E. coli
Klebsiella
Serratia marcescens

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31
Q

Cephalosporins

3rd Gen Meds & Admin Route

List med names & PO/IV/IM

A

Cefotaxime (IV/IM)
Ceftazidime (IV/IM/Neb/Intravitreal)
Ceftriaxone (IV/IM)
Cefixime (PO)
Cefpodoxime (PO)
Cefdinir (PO)

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32
Q

Cephalosporins

3rd Gen Coverage

A

MSSA & Streptococcus
Neisseria meningitidis & gonnorhea
Oral anaerobes
Pseudomonas
Moraxella
H. Influenzae

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33
Q

Cephalosporins

Pearls

A
  • Cross BBB, so can be utilized for meningitis
  • Ceftazidime has pseudomona coverage
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34
Q

Cephalosporins

3rd Gen Contraindications

A
  • Infants < 28 days when also using calcium containing products
  • Neonates w/ hyperbilirubinemia
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35
Q

Cephalosporins

4th Gen Meds & Admin Route

A

Cefepime (IV/IM)

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36
Q

Cephalosporins

4th Gen Coverage

A

MSSA & Streptococcus
Neisseria meningitidis & gonnorhea
Oral anaerobes
Pseudomonas

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37
Q

Cephalosporins

Which generations can be used to treat meningitis because they cross the BBB?

A
  • 3rd Gens
  • 4th Gen
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38
Q

Cephalosporins

4th Gen Contraindications

A
  • use with caution in patients w/ seizures (neurotoxicity)
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39
Q

Cephalosporins

5th Gen Meds & Admin Routes

A

Ceftaroline (IV)
Ceftolozone/Tazobactam (IV)

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40
Q

Cephalosporins

Ceftaroline Coverage

A

MSSA, MRSA, & Streptococcus
Neisseria meningitidis & gonnorhea
Pseudomonas
Moraxella
H. Influenzae

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41
Q

Cephalosporins

Ceftolozone/Tazobactam Coverage

A

pseudomonas
No MRSA coverage

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42
Q

Cephalosporins

Side Effects

A

n/v, loss of appetite, abd pain, nephrotoxicity, hemolytic anemia, super infection (C. diff)

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43
Q

Do cephalosporins have cross reactivity with pencillin allergy?

A

Yes- greatest in Gen 1 and decreases throughout rest of gens.
3rd Gen and beyond show minimal cross reactivity, but we still avoid in allergy

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44
Q

Do cephalosporins cover Enterococcus spp?

A

NO

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45
Q

Which cephalosporin does not require renal dose adjustment?

A

Ceftriaxone

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46
Q

Carbapenem Meds

A

Doripenem
ertapenem
Imipenem
Meropenem

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47
Q

Carbapenems

MOA

A

inhibit cell wall synthesis by binding to PBPs, thus, causing bacterial cell wall defect

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48
Q

Carbapenems

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

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49
Q

Carbapenem

Bacterial Coverage

A

Gram neg cocci and bacilli
MSSA and Streptococcus
Anaerobes

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50
Q

Carbapenems

Side Effects

A

n/v, abd pain, seizures, nephrotoxicity, injection site rxn

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51
Q

Carbapenems

Does ertapenem cover pseudomonas?

A

NO

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52
Q

Monobactam Med

A

Aztreonam

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53
Q

Monobactam

MOA

A

inhibits synthesis of bacterial cell wall by blocking peptidoglycan crosslinking

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54
Q

Monobactams

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time Dependent
Bactericidal

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55
Q

Monobactam

Coverage

A

Citrobacter spp
Enterobacter spp
E. coli
Haemophilus spp
Klebsiella spp
Proteus spp
Serratia spp

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56
Q

Monobactams

Side Effects

A

n/v/d, pain at injection site, increase in serum transaminases, neutropenia

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57
Q

Macrolide Meds

A

Azithromycin
Clarithromycin
Erythromycin
Fidaxomicin

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58
Q

Macrolides

MOA

EXCLUDES FIDAXOMICIN

A

inhibits RNA-dependent protein synthesis by binds to the 50S ribosomal subunit

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59
Q

Macrolides

MOA

Fidaxomicin

A

Inhibits RNA polymerase by binding to the DNA template RNA polymerase complex

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60
Q

Macrolides

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time Dependent
Bacteriostatic

At high concentrations can be bactericidal

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61
Q

Macrolides

Side Effects

A

GI: n/v/d, abd pain
Hepatic: cholestatic jaundice
Cardiac: QT prolongation

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62
Q

Macrolides

What is the only bacteria Fidaxomicin is used for?

PPP

A

C. diff

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63
Q

Macrolides

Which macrolide has the largest risk of GI disturbance?

PPP

A

Erythromycin

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64
Q

Macrolides

Overall Bacterial Coverage

Excludes fidaxomicin

A

Gram Positives
Atypical Bacteria
Spirochete
Limited Gram Negatives

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65
Q

Macrolides

Gram Positive Coverage

Excludes Fidaxomicin

A

Group A Streptococci
Corynebacterium diphtheriae
Cutibacterium acnes

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66
Q

Macrolides

Atypical Bacterial Coverage

Excludes Fidaxomicin

A

Mycoplasma pneumoniae
Chlamydia trachomatis
Chlamydophila pneumoniae
Legionella spp

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67
Q

Macrolides

Spirochete Coverage

Excludes Fidaxomicin

A

Treponema pallidum
Borrelia burgdorferi

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68
Q

Macrolides

Gram Negative Coverage

Excludes Fidaxomicin

A

Campy

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69
Q

Lincosamide

MOA

A

inhibits protein synthesis by binding to the 50S ribosomal subunit

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70
Q

Lincosamide Med

A

Clindamycin

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71
Q

Lincosamide

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time Dependent
Bacteriostatic

at high concentrations it can be bactericidal

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72
Q

Lincosamides

Side Effects

A

GI: n/v/d, C. diff infection
Integum: Stevens-Johnson Syndrome
Cardiac: QT prolongation

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73
Q

Lincosamides

Overall Coverage

A

Gram Positives
Anaerobes

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74
Q

Can Clindamycin be used for community acquired MRSA?

A

Yes

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75
Q

Tetracycline Meds

A

Doxycycline
Minocycline
Tetracycline

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76
Q

Tetracyclines

MOA

A

Binds to the 30S ribosomal unit, inhibiting protein synthesis

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77
Q

Tetracyclines

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Combination of concentration and time dependent
Bacteriostatic

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78
Q

Tetracyclines

Risk of what injury if patient doesn’t take with water & remain upright?

PPP

A

Esophageal injury

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79
Q

Tetracyclines

Contraindications

PPP

A

Avoid in children < 8 and pregnant women due to concern of dental discoloration & bone development delay

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80
Q

Tetracyclines

Overall Coverage

A

Broad Spectrum AF

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81
Q

Tetracyclines

Gram Positive Coverage

A

MRSA
Streptococcus (watch for increasing resistance)
Bacillus anthracis

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82
Q

Tetracyclines

Gram Negative Coverage

A

Rickettsiae
H. Influenzae
Helicobacter pylori
Vibrio cholerae

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83
Q

Tetracyclines

Anaerobe/Spirochete/Atypical Bacteria Coverage

A

Anaerobe: bacteriodes fragilis
Spirochetes: treponema pallidum, berelia burgodrferi
Atypicals: mycoplasma pneumoniae, chlamydia trachomatis, chlamydophila pneumoniae, Legionella spp

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84
Q

Tetracyclines

Side Effects

A
  • Teeth & Bone Effects
  • Integum: photosensitivity
  • GI: n/d/v, C. diff infection
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85
Q

Aminoglycosides

MOA

A

interferes with bacterial protein synthesis by irreversibly binding to the 30S ribosomal subunit

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86
Q

Aminoglycoside Meds

A

Gentamicin
Tobramycin
Amikacin

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87
Q

Aminoglycosides

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

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88
Q

Aminoglycosides

Gram Negative Coverage

A

PEcK
Pseudomonas
Enterobacter
Shigella

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89
Q

Aminoglycosides

Side Effects

A

Renal Toxicity
Vestibular/Auditory Toxicity
Neuromuscular Blockades

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90
Q

Are aminoglycosides uses as a mono treatment?

PPP

A

NO- paired with broad spectrum beta-lactams

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91
Q

Sulfonamide Meds

A

Sulfamethoxazole
Trimethoprim

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92
Q

Sulfonamides

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time Dependent
Bacteriostatic

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93
Q

Sulfonamides

Sulfamethoxazole MOA

A

Inhibits bacterial folic acid synthesis via competing with para-aminobenzoic acid inhibiting formation of dihydrofolic acid formation

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94
Q

Sulfonamides

Bacteria Coverage

A

Broad Spectrum
Gram Positives (including MRSA)
Gram Negatives
Protozoa (cyclo)
Fungi

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95
Q

Sulfonamides

Trimethoprim MOA

A

competitively inhibits folic acid production by inhibiting dihydrofolic acid reduction to tetrahydrofolate, leading to inhibition of the enzymes in folic acid production

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96
Q

Sulfonamides

Side Effects

A

GI: n/v/d
Heme: thrombocytopenia, hemolytic anemia, severe hyperkalemia
Integum: photosensitivity

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97
Q

Sulfonamides

Contraindications

PPP

A
  • hypersensitivity to sulfa
  • hx of drug induced thrombocytopenia
  • infants < 2 mo
  • pregnancy
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98
Q

Fluoroquinolones

MOA

A

Inhibiting the activity of DNA gyrase and topoisomerase which are enzymes essential for bacterial DNA replication

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99
Q

Fluoroquinolones Meds

A

Ciprofloxacin
Levofloxcain
Moxifloxacin
Ofloxacin
Gemifloxacin
Delafloxacin

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100
Q

Fluoroquinolones

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

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101
Q

Fluoroquinolones

Gram Pos Coverage

A

Staphylococcus spp
Streptococcus spp (minus cipro)
Enterococcus faecalis
Listeria monocytogenes

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102
Q

Fluoroquinolones

Gram Neg Coverage

A

PEcK
H. influenzae
pseudomonas (only cipro)

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103
Q

Fluoroquinolones

Which meds have coverage against addition atypical bacteria?

2

A

levo
moxi

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104
Q

Fluoroquinolones

Side Effects

A

GI: n/v
Cardio: QT prolongation
Neuro: CNS adverse effects (insomnia, hallucinations, seizures)
Integum: photosensitivity
Musculo: TENDON RUPTURE

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105
Q

Nitroimidazole Meds

A

Metronidazole

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106
Q

Nitroimidazoles

MOA

A

diffuses into the organism and inhibits protein synthesis by interacting with DNA which leads to the loss of DNA helical structure and strand breakage

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107
Q

Nitroimidazoles

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

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108
Q

Nitroimidazoles

Bacterial Coverage

A

Anaerobic bacteria
Protozoan parasites

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109
Q

Nitroimidazoles

Side Effects

A

GI: n/v/d
Neuro: seizures, peripheral neuropathy

110
Q

Nitroimidazoles

Describe restrictions on alcohol use

PPP

A

Avoid alcohol during therapy and 3 days after completion of series.

Disulfiram-like reaction occurs which will induce severe nausea and vomiting if alcohol is used with this med.

111
Q

Glycopeptide/Lipoglycopeptide Meds

A

Vancomycin
Dalbavancin
Telavancin
Oitavancin

112
Q

Glycopeptides/Lipoglycopeptides

MOA

A

inhibits transpeptidation by binding to the D-alanyl-D-alanine residues of the bacterial cell wall.

113
Q

Glycopeptide

Time or concentration dependent?
Bactericidial or bacteriostatic?

Vancomycin

A

Time Dependent
Bactericidal

114
Q

Lipoglycopeptides

Time or concentration dependent?
Bactericidial or bacteriostatic?

Dalbavancin, telavancin, oritavancin

A

Concentration Dependent
Bactericidal

115
Q

Glycopeptide

Bacterial Coverage

Vancomycin

A
  • most gram positive cocci & bacilli (good for resistant strains)
  • Enterococcus
  • C. diff (PO ONLY)
116
Q

Lipoglycopeptides

Bacterial Coverage

Dalba/Tela/Orita

A

Streptococcus
Enterococcus spp- including VRE
Staphylococcus aureus- Orita active against VRSA

117
Q

Glycopeptides/Lipoglycopeptides

Side Effects

A

GI: n/v, taste disturbance
GU: nephrotoxicity (vanco, tela), foamy urine

118
Q

Vancomycin infusion related rxn

PPP

A

Red Man Syndrome
- flushing, redness, hypotension, chest pain
- Directly related to infusion rate, should not be administered faster than 1 gram/hr

119
Q

Polypeptides Meds

A

Colistin
Bacitracin
Polymyxin B

120
Q

Bacitracin

MOA

A

Polypeptide antibiotic that inhibits cell wall synthesis

121
Q

Colstin & Polymyxin B

MOA

A

Binds to the anionic outer membrane and thereby neutralizes the bacteria’s toxicity and causes cell death

122
Q

Colstin & Polymyxin B

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

123
Q

Polypeptide

Bacterial Coverage

for Colistin & Polymyxin B

A

E. coli
Enterobacter spp
Klebsiella spp
Citrobacter spp
Salmonella spp
Shigella spp

124
Q

Polypeptides

Bacterial Coverage

Bacitracin

A

most superficial skin infections caused by Staph aureus

125
Q

Polypeptides

Side Effects

A

Nephrotoxicity, paresthesia, vertigo, slurred speech, muscle weakness

126
Q

What type of infections is Bacitracin used for?

PPP

A

topical infections

127
Q

Streptogramins

A

Quinupristin
Dalfopristin

128
Q

Streptogramin

Quinupristin MOA

A

inhibits the early phase of protein synthesis

129
Q

Streptogramin

Quinupristin MOA

A

inhibits the late phase of protein synthesis

130
Q

Streptogramin

Bacterial Coverage

A
  • Streptococcus
  • Staphylococcus
  • C. perf
  • Peptostreptococcus spp
  • Enterococcus faecium including VRE
  • some gram negative anaerobic bacilli
  • Atypical respiratory pathogens
131
Q

Streptogramin

Side Effects

A

muscle/joint pain, n/v/d, rash, headache

132
Q

How should streptogramins be administered?

PPP

A

via central line due to phlebitis when given peipherally

133
Q

When do we adjust the dose of streptogramins?

PPP

A

in hepatic insufficiency

134
Q

Oxazolidanones Meds

A

Linezolid
Tidezolid

135
Q

Oxazolidanones

MOA

A

binds 50S subunit and blocks bacteria’s ability to assemble transfer RNA-ribosomal complex which ultimately inhibits protein synthesis

136
Q

Oxazolidanones

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Time Dependent
Bacteriostatic: Enterococcus and Staphylococcus
Bactericidal: Streptococcus

137
Q

Oxazolidanones

Bacterial Coverage

A

Streptococcus
Enterococcus includes VRE
Staphylococcus includes MRSA
Mycobacteria spp
Anaerobes

138
Q

Oxazolidanones

Side Effects

A

Reversible myelosuppression, irreversible peripheral neuropathy, reversible optic neuropathy, serotonin syndrome

139
Q

What drug use is contraindicated with oxazolidanones?

PPP

Hint: think of the side effects

A

MAOIs
Do not use oxazolidanones within 2 wks of MAOI use

140
Q

Nitrofurantoin

MOA

A

inhibits bacterial enzymes responsible for cell wall synthesis

141
Q

Nitrofurantoin

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration dependent
Bactericidal

142
Q

Nitrofurantoin

Bacterial Coverage

A

E. coli
Citrobacter spp
S. saprophyticus
E. faecalis

143
Q

Nitrofurantoin

Side Effects

A

GI disturbance, headache, dizziness, confusion, pancreatitis

144
Q

Which E. coli does nitrofurantoin specifically cover due to resistance?

PPP

A

ESBL E. coli

145
Q

Rifampin

MOA

A

binds to and inhibits DNA dependent RNA polymerase

146
Q

Rifampin

Time or concentration dependent?
Bactericidial or bacteriostatic?

A

Concentration Dependent
Bactericidal

147
Q

Rifampin

Bacterial Coverage

A

Staphylococcus spp
Streptococcus spp
Legionella spp
B. fragilis
Y. pestis
C. burnetti
Neisseria meningitides

148
Q

Rifampin

Side Effects

A

hepatotoxicity, thrombocytopenia, AKI, flu-like syndrome

149
Q

What is Rifampin a strong inducer of?

PPP

A

CYP enzymes, many drug-drug interactions

150
Q

Acyclic Analogues of 2’ deoxyguanosine

A

Acyclovir
Valacyclovir
Penciclovir
Famciclovir

151
Q

Nucleoside Analogues of Guanosine

A

Ganciclovir
Valganciclovir

152
Q

Neuraminidase Inhibitors

A

Oseltamivir
Zanamivir

153
Q

Acyclic Phosphonate Nucleotide Analog

A

Cidofovir
Brincidofovir

154
Q

Acyclovir & Valacyclovir

MOA

A

competitively inhibits viral DNA polymerase, incorporates into and terminates the growing viral DNA chain, and inactivates the viral DNA polymerase

155
Q

Acyclovir & Valacyclovir

Coverage

A

Herpes virus

156
Q

Acyclovir & Valacyclovir

Side Effects

A

n/v, abd pain, dizziness
nephrotoxicity (more w/ acyclovir)

157
Q

Acyclovir & Valacyclovir

____ is a prodrug of ____

PPP

A
  1. Valacyclovir
  2. Acyclovir
158
Q

What do you give the pt to prevent nephrotoxicity with IV formulations?

PPP

A

hydrate with 1mL/kg/hr

159
Q

Penciclovir & Famciclovir

MOA

A

selectively inhibits viral DNA polymerase by competing with deoxyguanosine triphosphate

160
Q

Penciclovir & Famciclovir

Coverage

A

Herpes virus & hepatits B virus

161
Q

Penciclovir & Famciclovir

Side Effects

A

Mild erythema, headache, fatigue, GI disturbances

162
Q

Penciclovir & Famciclovir

____ is a prodrug of ___

A
  1. Famciclovir
  2. Penciclovir
163
Q

Penciclovir is formulated as:
Famciclovir is available as:

A
  1. cream only
  2. tablet
164
Q

Ganciclovir & Valganciclovir

MOA

A

competitively inhibits incorporation of deoxyguanosine triphosphate into elongating DNA resulting in short subgenomic CMV DNA fragments that are not considered infectious

165
Q

Ganciclovir & Valganciclovir

Coverage

primary & secondary coverages

A

herpes virus
some coverage for vaccina virus, HPV, and influenza A

166
Q

Ganciclovir & Valganciclovir

____ is a prodrug of ____

PPP

A
  1. valganciclovir
  2. ganciclovir
167
Q

What is ganciclovir’s main use?

PPP

A

treatment or prevention of CMV infection in immunocompromised pts

168
Q

Oseltamivir & Zanamivir

MOA

A

reversible inhibitor of influenza neuraminidase which inhibits the release and spread of the infectious form of the virus

169
Q

Oseltamivir & Zanamivir

Coverage

A

Influenza A
some Influenza B activity

170
Q

Oseltamivir & Zanamivir

Side Effects

A

n/v/d, headache, rash
Bronchospasm (zanamivir)

171
Q

When must oseltamivir & zanamivir therapy begin following sx onset?

A

48 hrs

172
Q

How is zanamivir formulated?

A

powder for inhalation

173
Q

CMV

A

cytomegalovirus

174
Q

Cidofovir & Brincidofovir

MOA for CMV

A

competitive inhibitor and an alternate substrate for CMV DNA poly. Incorporates into the CMV DNA strand and blocks further viral DNA synthesis leading to non-productive infection.

175
Q

Cidofovir & Brincidofovir

MOA for HPV

A

infected cells are trapper in the S phase which stops DNA synthesis.
Also causes induction of DNA fragment and caspase-3-protease activity leading to apoptosis

176
Q

Cidofovir & Brincidofovir

Coverage

A

Herpes virus, adenoviruses, papillomavirus

177
Q

Cidofovir & Brincidofovir

Side Effects

A

nephrotoxicity, neutropenia, alopecia, application site rxn

178
Q

____ is a prodrug of ____

Cidofovir & Brincidofovir

A
  1. brincidofovir
  2. cidofovir
179
Q

Foscarnet

MOA

A

binds reversibly near the pyrophosphate-binding site of DNA polymerase and then blocks the cleavage of the pyrophosphate moeity from deoxynucleotide triphophate which halts DNA chain elongation

180
Q

Foscarnet

Coverage

A

Herpes virus
Hep B
HIV

181
Q

Foscarnet

Side Effects

A

GI Disturbances, injection site rxn, vision changes

182
Q

What is foscarnet almost exclusively used for?

PPP

A

CMV- esp if ganciclovir cannot be used
Acyclovir resistant HSV and VZV

183
Q

Docosanol

MOA

A

inhibits the fusion between human cell plasma membrane and HSV envelope preventing viral entry into the cell and subsequent viral replication

184
Q

Docosanol

Coverage

A

herpes labialis

185
Q

Docosanol

Side Effects

A

application site rxn (redness, burning, dryness, swelling)

186
Q

When is the best time to use Docosanol? At what point is efficacy reduced?

PPP

A
  1. Best time is at the first sign of a cold sore
  2. Efficacy is reduced if blisters have already formed.
187
Q

Polyene Meds

A

Amphotericin B
Nystatin

188
Q

-azole derivatives

A

Clotrimazole
Ketoconazole
Fluconazole
Itraconazole
Voriconazole
Posaconazole

189
Q

Echinocandins

A

Anidulafungin
Caspofungin
Micafungin

190
Q

Nystatin

MOA

A

binds to ergosterol

191
Q

Nystatin

Time or concentration dependent?
Fungicidal or Fungiostatic?

A

Concentration Dependent
Fungicidal

192
Q

Nystatin

Fungal Coverage

A

Aspergillus fumigatus
Candida albicans
Coccidoides immitis
Cryptococcus neoformans
Histoplasma capsulatum

193
Q

Nystatin

Side Effects

A

Mouth irritation, n/v/d

194
Q

How is Nystatin most commonly used?

PPP

A

Mouth rinse for thrush

195
Q

Amphotericin B

MOA

A

binds to ergosterol in the fungal cell membrane, which leads to the formation of pores, ion leakage, and ultimately fungal cell death

196
Q

Amphotericin B

Time or concentration dependent?
Fungicidal or Fungiostatic?

A

Concentration Dependent
Fungicidal

197
Q

Amphotericin B

Overall Fungal Coverage

A

Broad Spectrum

198
Q

Amphotericin B

What does it not cover fungally?

A

Candida lusitaniee, Aspergillus terreus, Scedosporium spp, Trichosporon spp

199
Q

Amphotericin B

Side Effets

A
  • infusion rxn (chills, fever, anorexia, headache, hypotension, n/v)
  • Nephrotoxicity
  • Electrolyte abnormalities
200
Q

What must Amphotericin B standard formulation be given with? Why?

PPP

A
  1. 5% dextrose in water
  2. Precipitation
201
Q

Why is the lipid formulation of Amphotericin B preferred?

PPP

A

Less nephrotoxicity, fewer infusion related rxns

202
Q

-azole derivatives

MOA

A

inhibits the C14-alpha demethylation of lanosterol in fungi, which intereferes with the synthesis of ergosterol in the fungal cell membrane

203
Q

-azole derivitaves

Time or concentration dependent?
Fungicidal or Fungistatic?

A

Time Dependent
Fungistatic

204
Q

-azole derivatives

Clotrimazole Coverage

A

Candida spp
Malassezia furfur
Dermatophytes

205
Q

-azole derivatives

Ketoconazole Coverage

A

Candida spp
Malassezia furfur
Dermatophytes
some dimorphic fungi

206
Q

-azole derivatives

Fluconazole Coverage

A

Candida spp (not glabrata or krusei)
Malassezia furfur
Dermatophytes
Cryptococcus neoformans
Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum
Prototheca spp
Demitiaceous molds

207
Q

-azole derivatives

Itraconazole Coverage

A

Fluconazole coverage +
Aspergillus spp
Sporothrix schenckii

208
Q

-azole derivatives

Voriconazole Coverage

A

Candida spp (resistant strands)
Aspergillus spp (Ampho B resistant A. terreus)
Fusarium spp
Scedosporium apiospermum
Trichosporon spp
molds

209
Q

-azole derivatives

Posaconazole

A

Fluconzole Coverage plus
Zygomycetes

210
Q

-azole derivatives

Shared Side Effects

A

GI discomfort

211
Q

-azole derivatives

Clotrimazole Side Effects

A

skin irritation, elevated LFTs

212
Q

-azole derivatives

Ketonconazole Side Effects

A

acne, cracked/dry skin

BB: hepatotoxicity

213
Q

-azole derivatives

Fluconazole Side Effects

A

rash

214
Q

-azole derivatives

Itraconazole Side Effects

A

Hypertension, hypokalemia

BB: heart failure

215
Q

-azole derivatives

Voriconazole Side Effects

A

hepatotoxicity, visual disturbances, QT interval prolongation

216
Q

-azole derivatives

Posaconazole Side Effects

A

QT interval prolongation, hepatitis

217
Q

Which -azole derivative has the fewest drug-drug interactions via CYP enzymes?

PPP

A

Fluconazole

218
Q

In what environment should itraconazole/ketoconazole capsules be taken for optimal absorption?

PPP

A

I: Acidic- empty stomach
K: acidic- with an acidic beverage

219
Q

What increases the bioavailability of posaconazole?

PPP

A

high fat meal- increases by 400%

220
Q

Echinocandins

MOA

A

inhibits beta-1,3,-D-glucan synthase which is an ezyme neccesary for the synthesis of an essential component of the fungal cell wall

221
Q

Echinocandins

Time or concentration dependent?
Fungicidal or Fungistatic?

A

Concentration Dependent
Fungicidal (Candida)
Fungistatic (Aspergillus)

222
Q

Echinocandins

Fungal Coverage

A

Candida spp
Aspergillus spp

223
Q

Echinocandins

Side Effects

A

All: infusion site rxn
C/M: GI disturbances, electrolyte disturbances

224
Q

Why do echocandins have fewer drug-drug interactions than -azole derivatives?

PPP

A

Echocandins are not hepatically metabolized

225
Q

Flucytosine

MOA

A

penetrates the fungal cell wall which is converted to 5-fluorouracil which competes with uracil, this interfering with fungal RNA

226
Q

Flucytosine

Time or concentration dependent?
Fungicidal or Fungistatic?

A

Concentration Dependent
Fungistatic

227
Q

Flucytosine

Fungal Coverage

A

Candida spp
Crypto spp

228
Q

Flucytosine

Side Effects

A

Bone marrow suppression, hepatotoxicity, enterocolitis, GI disturbances

229
Q

Why can Flucytosine not be used as a mono treatment?

A

Rapid development of resistance if used as mono treatment

230
Q

3 types of parasites

A
  1. single cell organisms
  2. multicellular helminths
  3. ectoparasites
231
Q

Which areas are most impacted by parasitic infetions?

A

Tropical areas with poor sanitation

232
Q

Antimalarial Meds

A

Pyrimethamine
Chloroquine/Hydroxycholorquine
Artemether
Artesunate
Malarone
Mefloquine
Primaquine
Tafenoquine

233
Q

Pyrimethamine

MOA

A

inhibits the dihydrofolate reductase of plasmodia and thereby blocks the biosynthesis of purines and pyrimidines

234
Q

Pyrimethamine

Parasitic Coverage

A

Plasmodia
Toxoplasma

235
Q

Pyrimethamine

Side Effects

A

n/v, insomnia, anorexia

236
Q

(Hydroxy)Cholorquine

MOA

A

inhibits the formation of hemozoin (Hz) from the heme released by the digestion of hemoglobin (Hb). The free heme lyses membranes leading to parasitic death.

237
Q

(Hydroxy)Chloroquine

Parasitic Coverage

A

asexual erythrocytic stages of:
* Plasmodium falciparum (not active against mature gametocytes)
* Plasmoidum vivax
* Plasmodium malariae
* Plasmodium ovale

238
Q

(Hydroxy)Chloroquine

Side Effects

A

n/v, tremors, convulsions, coma

239
Q

Artesunate and Artemether

MOA

A

reacts with heme, generating free radicals which inhibit protein and nucleic acid synthesis of the Plasmodium parasites during all erythrocytic stages

240
Q

Artesunate and Artemether

Parasitic Coverage

A

All human malarial parasites including multi-drug resistant Plasmodium falciparum strains

241
Q

Artesunate and Artemether

Side Effects

A

QT prolongation, bradycardia, n/v/d

242
Q

What 2 drugs constitute Malarone?

A

atovaquone + proguanil

243
Q

Malarone

MOA of atovaquone

A

causes collapse of the parasitic mitochondrial membrane potential

244
Q

Malarone

MOA of proguanil

A

inhibits dihydrofolate reductase after CYP catalyzed cyclization

245
Q

Malarone

Parasitic Coverage of Atovaquone

A

asexual stages of many parasites

246
Q

Malarone

Parasitic Coverage of Proguanil

A

only used for the prevention of falciparum malaria

247
Q

Malarone

Side Effects

A

n/v, anorexia, insomnia, weakness

248
Q

Mefloquine

MOA

A

inhibit merozoite invasion and interact with proteins involved with lipid trafficking and nutrient uptake

249
Q

Mefloquine

Coverage

A

sexual forms of Plasmodium spp
some activity against sexual forms of P. vivax, malariae and ovale

250
Q

Mefloquine

Side Effects

A

dizziness, anxiety, insomnia, vivid dreams, visual disturbances, depression, psychosis

251
Q

Primaquine & Tafenoquine

MOA

A

not well understood
possibly generates reactive O2 species or interferes with ETC

252
Q

Primaquine & Tafenoquine

Parasitic Coverage

A

all stages of the plasmodium development in humans & Pneumocystis jiroveci

253
Q

Primaquine & Tafenoquine

What is radicle cure?

A

anti-relapse therapy

254
Q

Primaquine & Tafenoquine

Against what parasites do Primaquine & Tafenoquine induce radical cure?

PPP

A

P. vivax
P ovale

255
Q

Primaquine & Tafenoquine

Side Effects

A

n/v/, tarry stools, dizziness, anorexia, hemolytic anemia

256
Q

Antihelmentics

A

Albenazole
Mebendazole
Ivermectin
Praziquantel
Pyrantel pamoate

257
Q

Albendazole & Mebendazole

MOA

A

Selectively bind to nematode beta-tubulin, inhibiting polymerization, thus preventing the formation of microtubules and so stopping cell division

258
Q

Albendazole & Mebendazole

Coverage

A

helminths and protozoa

259
Q

Albendazole & Mebendazole

Side Effects

A

prolonged courses can cause liver function abnormalities, bone marrow toxicity

260
Q

Ivermectin

MOA

A

influx of chloride ions through the cell membrane of invertebrates by activation of specifc ivermectin-sensitive ion channels. The hyperpolarization leads to muscle paralysis

261
Q

Ivermectin

Coverage

A

most nematode parasites, ectoparasites infeestations, helminth parasites

262
Q

Ivermectin

Side Effects

A

fever, myalgia, malaise, lightheadedness

263
Q

Praziquantel

MOA

A

causes a rapid calcium influx leading to severe spasms and paralysis of the worm

264
Q

Praziquantel

Coverage

A

trematodes except Fasciola spp

265
Q

Praziquantel

Side Effects

A

headache, dizziness, abd pain, nausea, ithcing

266
Q

Parasiticides

A

Permethrin
Spinosad

267
Q

Permethrin

MOA

A

acts on the nerve cell membrane to disrupt the sodium channel current by which the polarization of the membrane is regulared leading to paralysis of the scabies/lice

268
Q

Permethrin

Coverage

A

lice, ticks, fleas, mites, other arthropods

269
Q

Permetrin

Side Effects

A

irritation, burning, itching

270
Q

Spinosad

MOA

A

alters the function of nicotinic and GABA-gated ion channels leading to rapid excitation of the parasites nervous system. Leads to involuntary muscle contractions, tremors, paralysis, and death.

271
Q

Spinosad

Coverage

A

lice, scabies

272
Q

Spinosad

Side Effects

A

application site rxns (redness, swelling, itching, burning)

CMT (78 decks)

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