AntiMyco/ AntiFungal/ Antiparasites Flashcards
1
Q
M. TB prophylaxis (1)
A
isoniazid
2
Q
M. avium prophylaxis (2)
A
Azithromycin
Rifabutin
3
Q
M. Leprae prophylaxis
What cells become infected?
A
N/A
Schwann cells
4
Q
M. TB treatment
A
"RIPE" Rifampin Isoniazid Pyrazinamide Ethambutol (RIPS for kids-->streptomycin)
5
Q
M. avium treatment
A
- more drug resistant than M. TB
Ethambutol + Azithromycin/Clarithromycin
–> can add Rifabutin or Ciprofloxacin
6
Q
M. leprea treatment:
Tuberculoid
Lepromatous
A
“Dr. C for Leprosy”
Tuberculoid: DR
Lepromatous: DR.C
Long-term treatment:
Dapsone
Rifampin
+Clofazimine (lepromatous)
7
Q
What color are mycobacteria in Acid-fast stain?
Name 2 distinct mycobacterial cell wall characteristics.
Who gets severe mycobacterial infections
A
pink
Mycolic acid, arabinogalactan
immunocompromised
8
Q
What is the characteristic cell of a granuloma?
What are the symptoms of an active TB infection?
A
large epithelia histiocyte (derived from MQ)
- F
- Night sweats
- Chronic cough
- Wt loss
- Fatigue
9
Q
Rifamycins:
Name (2)
A
- Rifampin
2. Rifabutin
10
Q
Rifamycins:
MOA
MOResistance
Monotherapy?
A
- Inhib DNA-dep RNA polymerase
- Mutations reduce drug binding to RNA polymerase
- Monotherapy rapidly leads to resistance
11
Q
Rifamycins: Clinical Use(4)
A
- M. TB
- Leprosy (delays dapsone resistance dev)
- Meningococcal prophylaxis
- Chemoprophylaxis in contacts of children w/ H. flu(B)
12
Q
Rifamycins:
Adverse(3)
which Rifamycin is preferred in HIV pts?
A
- hepatotox
- induce P450s
- Orange body fluids (nonhazardous)
Rifabutin > rifampin in pts w/ HIV infection b/c less P450 stimulation
13
Q
Rifamycins:
Mnemonic
A
Rifampin's 4 R's: RNA polymerase inhib Revs up the liver (P450) Red/orange body fluids Rapid resistance if used alone
RifAMPin RAMPS up P450, BUT rifaBUTin does not
14
Q
Drugs which induce P450 (8)
A
“Chronic Alcoholics STeal PHEN-PHEN and NEver Refuse GReasy CARBs”
- Chronic Alcohol use
- St. John’s wort
- Phenytoin
- Phenobarbital
- Nevirapine
- Rifampin
- Griseofulvin
- Carbamazepine
15
Q
What must always be given when admin Isoniazid?
A
B6 (pyridoxine)
16
Q
Isoniazid:
MOA
How converted to active form
MOResistance
A
-decrease synthesis of Mycolic Acid
-INH–>KatG(bacterial catalase peroxidase)–>active form
NOT EFFECTIVE IN ORGANISMS LACKING KATG
-Mutations causing underexpression of KatG
17
Q
Isoniazid:
Clinical Use (3)
Variations among patients?
A
- treat M.TB (RIPE)
- solo prophylaxis of TB
- Monotherapy for latent TB
different INH half-lives in fast vs. slow acetylators
18
Q
Isoniazid:
Adverse(7)
A
“INH Injures Neurons and Hepatocytes”
- Hepatotox
- P450 inhib
- Drug-induced Lupus
- Vit B6 def (peripheral neuropathy/ sideroblastic anemia
- Hemolysis in G6PD def
- Seizures
- Increase anion Gap Met Acidosis
19
Q
Hepatitis causing drugs (5)
A
- Rifampin
- Isoniazid
- Pyrazinamide
- Statins
- Fibrates
(first 3 treat mycobacteria, last 2 treat dyslipidemia)
20
Q
Hemolysis in G6PD def (7)
A
“Hemolysis is D Pain”
- Isoniazid
- Sulfonamides
- Dapson
- Primaquine
- Aspirin
- Ibuprofen
- Nitrofurantoin
21
Q
drug induced SLE-like syndrome (6)
A
“Having Lupus is SHIPP-E”
- Sulfa drugs
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
- Etenercept
22
Q
Seizure induced by Meds (4)
A
“With seizures, I BItE my tongue”
- Isoniazid (B6 def)
- Bupropion
- Imipenem/ Cilastatin
- Enflurane
23
Q
P450 inhibiting drugs (10)
A
“AAA RACKS In GQ Magazine”
- Acute alcohol abuse (AAA)
- Ritonavir
- Amiodarone
- Cimetidien
- Ketoconazole
- Sulfonamides
- Isoniazid (INH)
- Grapefruit juice
- Quinidine
- Macrolides (Not Azithromycin)
24
Q
Causes for increased anion Gap Met acidosis
A
“MUDPILES”
- Methanol
- Uremia
- DKA
- Propylene glycol
- Iron Tablet/ INH
- Lactic Acidosis
- Ethylene glycol
- Salycilates (late)
25
Causes of Sideroblastic Anemia
1. genetic
2. Acquired- myelodysplastic syndrome
3. Reversible (4)
- Alcohol (#1), -Vit B6 def, -Copper def, -Isoniazid
26
Pyrazinamide:
MOA->what improves effectiveness
Clinical Use(1)
Adverse(2)
'P'rodrug w/ Unknown MOA
Works best at acidic pH (like in host phagolysosome)
1. M.TB(RIPE)
1. Hyperuricemia
2. Hepatotoxicity
27
Drug Induced Hyperuricemia(5)
"Painful Tophi & Feet Need Care"
1. Pyrazinamide
2. Thiazides
3. Furosamide
4. Niacin
5. Cyclosporine
28
Ethambutol:
MOA
Clinical Use(1)
Adverse
- blocks arabinosyltransferase to decrease carb polymerization of Mycobacterium cell wall
- M.TB(RIPE)
- Optic neuropathy (RED-GREEN color blindness)
"EYEthambutol"
29
```
Streptomycin:
Drug Class
MOA
Clinical Use(1)
Adverse (2)
```
- Aminoglycoside
- Interfers with 30S "'A' begins alphabet, and Aminoglycosides inhibit initiation"
* Aminoglycosides require O2 for uptake
1. M.TB(2nd line) (RIPS)
1. Ototox (tinnitus/ vertigo/ataxia)
2. Nephrotox
30
Antibiotics which inhib 30S?
| Antibiotics which inhib 50S?
"Buy AT 30, CCEL at 50"
30S
1. Aminoglycosides
2. Tetracyclines
50S
1. Chloramphenicol
2. Clindamycin
3. Erythromycin (macrolides)
4. Linezolid
31
Prophylaxis for high risk endocarditis and undergoing surgical or dental procedures
Amoxicillin
32
Prophylaxis for exposure to gonorrhea
Ceftriaxone
33
Prophylaxis for history of recurrent UTIs
TMP-SMX (bactrim)
34
Prophylaxis for exposure to meningococcal infection(3)
1. Cetriaxone
2. Ciprofloxacin
3. Rifampin
35
Prophylaxis for pregnant woman carrying GBS(2)
intrapartum PenG or Ampicillin
36
Prophylaxis for gonococcal conjunctivitis in newborn
Erythromycin ointment on eyes
37
Prophylaxis for post surgical infection due to S. aureus
Cefazolin (first gen)
38
Prophylaxis for strep pharyngitis in child with prior Rheumatic Fever (2)
1. Benzathine PenG
| 2. Oral PenV
39
Prophylaxis for exposure to syphilis
Benzathine PenG
40
```
Endocarditis causing agents:
acute
subacute
associated with colon cancer
prosthetic valves
```
- s. aureus
- s. virridens (found in mouth/causes cavities)
- s. bovis (pathoma says this has a new name but don't remember it now)
- s.epidermis
41
threatening microbes if CD4
1. Candida-oral thrush
2. EBV - oral hairy leukoplakia
3. Bartonella henselae- Bacillary angiomatosis
4. HHV-8- Kaposi
5. Cryptosporidium - watery diarrhea
6. HPV- SCC(anus/cervix)
42
threatening microbes if CD4
1. HIV dementia
2. JC virus (PML)
3. P.jirovecii (PCP)
4. Toxo- brain abscess
43
threatening microbes if CD4
1. Aspergillus - hemoptysis
2. Crypto meningitis
3. Candida- esophagitis
4. CMV- Retinitis/esophagitis/colits/pneumonitis/ encephalitis
5. EBV- non-Hodgkin lymphoma/CNS lymphoma
6. Histoplasma- F/Wt loss/ Cough/ N/V/D
7. M. avium- F/Night sweats/focal lymphadenitis
44
CD4
TMP-SMX
45
CD4
TMP-SMX
46
CD4
Azithromycin/Clarithromycin
47
Highly resistant MRSA treatment (5)
"Very Dangerous Cocci Loathe Treatment"
1. Vancomycin (not in renal disease)
2. Daptomycin
3. Ceftaroline (5th gen)
4. Linezolid
5. Tigecycline
48
Highly resistant VRE Treatment(4):
"Enterococcus Don't Quite Like Vancomycin"
1. Dalfopristin
2. Quinupristin
3. Linezolid
4. Streptogramins
49
Multidrug-resistant P. aeruginosa &
Multidrug-resistant Acinetobacter baumannii
(2)
Polymyxins B and E(colistin)
50
```
Compare Bacteria to Fungi:
Prokaryote vs eukaryote
size
nuclear membrane
ribosome
cell wall
```
Bacteria: prokaryote, small, 70s, pepidoglycan cell wall
Fungi: Eukaryote, larger, nuclear membrane, organelles, 80s, Chitins/glycans/mannons in cell wall
51
```
compare human vs fungi:
prokaryote vs eukaryote
organelles
ribosome
haploid vs diploid
cell membrane
```
Human: Eukaryote, organelles, 80s, diploid, cholesterol membrane
Fungi: Eukaryote, organelles, 80s, haploid, ergosterol membrane, squalene epoxide, griseofulvin microtubules
52
Amphotericin B:
| MOA
"AmphoTERicin 'TEARS' holes in the fungal membrane"
| Binds Ergosterol-->forms membrane pores-->leak electrolytes
53
Amphotericin B:
Clinical (6)
Special administration
Serious, systemic mycoses
1. Crypto meningitis +/- Flucytosine (intrathecal)
2. Blasto
3. Cocci
4. Histo
5. Candida
6. Mucor
* supplement with K+/Mg+ b/c altered renal tubule permeability
54
Amphotericin B:
Adverse(6)
How to decrease Adverse(2)
1. Shake & bake (F/C)
2. Hypotension
3. Nephrotox
4. arrhythmias
5. anemia
6. IV phlebitis
decrease with hydration and liposomal amphotericin
55
Nystatin:
MOA
Administration
Clinical use (3)
- forms pores like Amp B
- Topical/oral mouth wash (too toxic for systemic use)
1. oral candida/thrush (swish and swallow)
2. diaper rash
3. vaginal candidiasis
56
Flucytosine:
| MOA(2 steps)
1. Flu-->5-FU via Cytosine deaminase (unique to fungi)
2. 5-FU inhib Thymidylate synthase( prevents dUMP-->dTMP)
Overall: decrease dTMP, decrease DNA synthesis
57
Flucytosine:
Clinical use (1)
Adverse (1)
Use: systemic fungal infections; esp Crypto meningitis in combo w/ AmpB
Adverse: BM suppression like all chemotherapy agents
58
Describe 5-FU chemo drug
- blocks thymidylate synthase to decrease dTMP/DNA synthesis
- Treat: Colon ca., Pancreatic ca., Basal cell ca (topical)
- Adverse: Myelosuppresion Irreversible
59
```
Azoles:
Name(6)
which is topic?
Which cross BBB
Which is strongest?
Which causes gynecomastia?
```
1. Clotrimazole-topical
2. Miconazole-topical
3. Fluconazole- crosses BBB
4. Itraconazole
5. Voriconazole
6. Ketoconazole-strongest, causes gynecomastia
60
Azoles:
| MOA
Inhib ergosterol synthesis by inhib P450 enzyme(14a demthylase) that converts lanosterol to ergosterol
61
Azoles:
| Clincial Use
Local and serious systemic mycoses
Fluconazole: 1. chronic suppression of cryptococcal meningitis in AIDS 2. all candidal infections
Itraconazole: Blasto, Cocci, Histo
Clotrimazole/Miconazole: topical fungal infections
62
Azoles:
| Adverse(2)
1. Testosterone synthesis inhib (gynecomastia w/ Ketoconazole)
2. Liver dysfunction via P450 inhib ( "AAA RACKS In GQ Magazine")
63
Gynecomastia Causes:
1. increased estrogen(4)
2. congenital(1)
3. Drugs (5)
```
Estrogen: 1. Cirrhosis 2. testicular tumor 3. puberty 4. old age
Congenital: Klinefelter
Drugs: "Some Drugs Create Awesome Knockers"
1. Spironolactone
2. Digoxin
3. Cimetidine
4. Alcohol
5. Ketoconazole
```
64
Terbinafine:
| MOA
inhib squalene epoxidase (fungal only)
65
Describe how terbinafine and azoles inhibit the formation of ergosterol
1. squalene -->squalene epoxide via squalene epoxidase (inhib by terbinafine)
2. Squalene epoxide-->lanosterol-->ergosterol via 14a-demethylase(P450) (inhib by azoles)
66
Terbinafine:
Clinical use(1)
Adverse(4)
1. Dermatophytoses (esp. onychomycosis-fungal infections of finger/toe nail)
1. GI upset
2. HA
3. Hepatotox
4. Taste disturbance
67
Systemic Fungi and their geographic location (4)
1. Histo- Mississippi/Ohio
2. Blasto- Central America
3. Cocci- California/Arizona/SW USA
4. Paracocci- Latin America
68
Opportunistic fungi (6)
1. Candida
2. Aspergillus
3. Cryptococcus
4. Mucor/Rhizopus
5. Pneumocystis
6. Sporothrix
69
Cutaneous Fungal infections (6)
| named after areas of the body
Tinea...
1. capitis
2. corporis
3. cruris
4. pedis
5. unguium
6. versicolor
70
Echinocandins:
| Names (3)
"-fungin"
1. Anidulafungin
2. Caspofungin
3. Micafungin
71
Echinocandins:
MOA
Clinical Use(2)
Adverse(2)
- inhib synthesis of B-glucan --> inhib cell wall synthesis
"CANDy is 'A'lways FUNgin"
1. invasive Aspergillosis (acute angle branches w/ septate hyphae)
2. Candida
1. GI upset
2. Flushing (by histamine release)
72
Griseofulvin:
MOA
Where does it deposit?
- interferes w/ microtubule formation-->disrupts anaphase(mitosis)
- deposits in keratin-containing tissues (like nails)
73
Griseofulvin:
Admin
Clinical Use(1)
Adverse (4)
- oral
- superficial infections -->inhib growth of dermatophytes (tine/ringworm)
1. Teratogenic
2. Carcinogenic
3. Confusion/HA
4. P450 inducer/increase warfarin metabolism
"Chronic Alcoholics Steal Phen-Phen & Never Refuse Greasy CARBs"
74
Treatment for:
| Giardia/ Entamoeba
Metronidazole
Giardia- fatty foul-smelling diarrhea
Entamoeba- bloody diarrhea
75
Treatment for:
| Toxoplasmosis
Pyrimethamine
76
Treatment for:
| Trypanosoma brucei
1. Melarsoprol
2. Suramin
"MELatonin SURe helps me sleep (T.brucei=Af. Sleeping Sickness)"
77
```
Treatment for:
Trypanosoma cruzi (2)
```
Nifurtimox, Benznidazole
"MOXie people Take CRUZes to South America"
78
Treatment for:
| Leishmaniasis
Sodium Stibogluconate
"treat leishmania'S'i'S' with 'S'odium 'S'tibogluconate"
79
Treatment for:
| Mites/ Louse
"treat PML(Pesty Mites and Lice) with PML because they NAG you"
PML= Permethrin, malathion, lindane
NAG=Na, AchE, GABA blockade
80
Chloroquine:
MOA
MOResistance
-Blocks detoxification of heme into hemozoin-->Heme accumulates which is toxic to plasmodia
(Hb-->Globin + Heme-->Hemozoin)
-Membrane pump decreases intracellular drug concentration.
81
Chloroquine:
Clinical Use
Adverse (2)
plasmodial species EXCEPT P.FALCIPARUM!
1. Retinopathy
2. Pruritus (especially in dark-skinned people)
82
Treatment for:
P. Falciparum (2)
For life-threatening P. falciparum in USA vs. elsewhere
1. artemether/lumefartrine
2. atovaquone/proguanil
USA= quinidine or artesunate
Elsewhere=Quinine or artesunate
83
4 malaria species:
1. P. falcifarum
2. P.malarie
3. P. Ovale
4. P.vivax
84
Triad of Toxoplasmosis:
1. Chorioretinitis
2. Hydrocephalus
3. Intracranial Ca+2
85
MOA for Mebendazole/Albendazole
microtubule inhibitor in helminths
86
Antihelminthic agents(5)
1. Mebendazole/Albendazole
2. Pyrantel pamoate
3. Ivermectin
4. Diethylcarbamazine
5. Praziquantel
