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Drugs- Basic High Yield Stuff for Boards > AntiMyco/ AntiFungal/ Antiparasites > Flashcards

AntiMyco/ AntiFungal/ Antiparasites Flashcards

1
Q

M. TB prophylaxis (1)

A

isoniazid

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2
Q

M. avium prophylaxis (2)

A

Azithromycin

Rifabutin

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3
Q

M. Leprae prophylaxis

What cells become infected?

A

N/A

Schwann cells

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4
Q

M. TB treatment

A 
"RIPE"
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
(RIPS for kids-->streptomycin)
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5
Q

M. avium treatment

A
  • more drug resistant than M. TB
    Ethambutol + Azithromycin/Clarithromycin
    –> can add Rifabutin or Ciprofloxacin
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6
Q

M. leprea treatment:
Tuberculoid
Lepromatous

A

“Dr. C for Leprosy”
Tuberculoid: DR
Lepromatous: DR.C

Long-term treatment:
Dapsone
Rifampin
+Clofazimine (lepromatous)

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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

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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)

  1. F
  2. Night sweats
  3. Chronic cough
  4. Wt loss
  5. Fatigue
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9
Q

Rifamycins:

Name (2)

A
  1. Rifampin

2. Rifabutin

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10
Q

Rifamycins:
MOA
MOResistance
Monotherapy?

A
  • Inhib DNA-dep RNA polymerase
  • Mutations reduce drug binding to RNA polymerase
  • Monotherapy rapidly leads to resistance
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11
Q 
Rifamycins:
Clinical Use(4)
A
  1. M. TB
  2. Leprosy (delays dapsone resistance dev)
  3. Meningococcal prophylaxis
  4. Chemoprophylaxis in contacts of children w/ H. flu(B)
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12
Q

Rifamycins:
Adverse(3)
which Rifamycin is preferred in HIV pts?

A
  1. hepatotox
  2. induce P450s
  3. Orange body fluids (nonhazardous)

Rifabutin > rifampin in pts w/ HIV infection b/c less P450 stimulation

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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

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14
Q

Drugs which induce P450 (8)

A

“Chronic Alcoholics STeal PHEN-PHEN and NEver Refuse GReasy CARBs”

  1. Chronic Alcohol use
  2. St. John’s wort
  3. Phenytoin
  4. Phenobarbital
  5. Nevirapine
  6. Rifampin
  7. Griseofulvin
  8. Carbamazepine
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15
Q

What must always be given when admin Isoniazid?

A

B6 (pyridoxine)

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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

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17
Q

Isoniazid:
Clinical Use (3)
Variations among patients?

A
  1. treat M.TB (RIPE)
  2. solo prophylaxis of TB
  3. Monotherapy for latent TB

different INH half-lives in fast vs. slow acetylators

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18
Q

Isoniazid:

Adverse(7)

A

“INH Injures Neurons and Hepatocytes”

  1. Hepatotox
  2. P450 inhib
  3. Drug-induced Lupus
  4. Vit B6 def (peripheral neuropathy/ sideroblastic anemia
  5. Hemolysis in G6PD def
  6. Seizures
  7. Increase anion Gap Met Acidosis
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19
Q

Hepatitis causing drugs (5)

A
  1. Rifampin
  2. Isoniazid
  3. Pyrazinamide
  4. Statins
  5. Fibrates

(first 3 treat mycobacteria, last 2 treat dyslipidemia)

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20
Q

Hemolysis in G6PD def (7)

A

“Hemolysis is D Pain”

  1. Isoniazid
  2. Sulfonamides
  3. Dapson
  4. Primaquine
  5. Aspirin
  6. Ibuprofen
  7. Nitrofurantoin
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21
Q

drug induced SLE-like syndrome (6)

A

“Having Lupus is SHIPP-E”

  1. Sulfa drugs
  2. Hydralazine
  3. Isoniazid
  4. Procainamide
  5. Phenytoin
  6. Etenercept
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22
Q

Seizure induced by Meds (4)

A

“With seizures, I BItE my tongue”

  1. Isoniazid (B6 def)
  2. Bupropion
  3. Imipenem/ Cilastatin
  4. Enflurane
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23
Q

P450 inhibiting drugs (10)

A

“AAA RACKS In GQ Magazine”

  1. Acute alcohol abuse (AAA)
  2. Ritonavir
  3. Amiodarone
  4. Cimetidien
  5. Ketoconazole
  6. Sulfonamides
  7. Isoniazid (INH)
  8. Grapefruit juice
  9. Quinidine
  10. Macrolides (Not Azithromycin)
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24
Q

Causes for increased anion Gap Met acidosis

A

“MUDPILES”

  1. Methanol
  2. Uremia
  3. DKA
  4. Propylene glycol
  5. Iron Tablet/ INH
  6. Lactic Acidosis
  7. Ethylene glycol
  8. Salycilates (late)
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25
Q

Causes of Sideroblastic Anemia

A
  1. genetic
  2. Acquired- myelodysplastic syndrome
  3. Reversible (4)
    - Alcohol (#1), -Vit B6 def, -Copper def, -Isoniazid
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26
Q

Pyrazinamide:
MOA->what improves effectiveness
Clinical Use(1)
Adverse(2)

A

‘P’rodrug w/ Unknown MOA
Works best at acidic pH (like in host phagolysosome)
1. M.TB(RIPE)

  1. Hyperuricemia
  2. Hepatotoxicity
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27
Q

Drug Induced Hyperuricemia(5)

A

“Painful Tophi & Feet Need Care”

  1. Pyrazinamide
  2. Thiazides
  3. Furosamide
  4. Niacin
  5. Cyclosporine
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28
Q

Ethambutol:
MOA
Clinical Use(1)
Adverse

A
  • blocks arabinosyltransferase to decrease carb polymerization of Mycobacterium cell wall
  • M.TB(RIPE)
  • Optic neuropathy (RED-GREEN color blindness)

“EYEthambutol”

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29
Q 
Streptomycin:
Drug Class
MOA
Clinical Use(1)
Adverse (2)
A
  • 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
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30
Q

Antibiotics which inhib 30S?

Antibiotics which inhib 50S?

A

“Buy AT 30, CCEL at 50”

30S

  1. Aminoglycosides
  2. Tetracyclines

50S

  1. Chloramphenicol
  2. Clindamycin
  3. Erythromycin (macrolides)
  4. Linezolid
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31
Q

Prophylaxis for high risk endocarditis and undergoing surgical or dental procedures

A

Amoxicillin

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32
Q

Prophylaxis for exposure to gonorrhea

A

Ceftriaxone

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33
Q

Prophylaxis for history of recurrent UTIs

A

TMP-SMX (bactrim)

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34
Q

Prophylaxis for exposure to meningococcal infection(3)

A
  1. Cetriaxone
  2. Ciprofloxacin
  3. Rifampin
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35
Q

Prophylaxis for pregnant woman carrying GBS(2)

A

intrapartum PenG or Ampicillin

36
Q

Prophylaxis for gonococcal conjunctivitis in newborn

A

Erythromycin ointment on eyes

37
Q

Prophylaxis for post surgical infection due to S. aureus

A

Cefazolin (first gen)

38
Q

Prophylaxis for strep pharyngitis in child with prior Rheumatic Fever (2)

A
  1. Benzathine PenG

2. Oral PenV

39
Q

Prophylaxis for exposure to syphilis

A

Benzathine PenG

40
Q 
Endocarditis causing agents:
acute
subacute
associated with colon cancer
prosthetic valves
A
  • 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
Q

threatening microbes if CD4

A
  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
Q

threatening microbes if CD4

A
  1. HIV dementia
  2. JC virus (PML)
  3. P.jirovecii (PCP)
  4. Toxo- brain abscess
43
Q

threatening microbes if CD4

A
  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
Q

CD4

45
Q

CD4

46
Q

CD4

A

Azithromycin/Clarithromycin

47
Q

Highly resistant MRSA treatment (5)

A

“Very Dangerous Cocci Loathe Treatment”

  1. Vancomycin (not in renal disease)
  2. Daptomycin
  3. Ceftaroline (5th gen)
  4. Linezolid
  5. Tigecycline
48
Q

Highly resistant VRE Treatment(4):

A

“Enterococcus Don’t Quite Like Vancomycin”

  1. Dalfopristin
  2. Quinupristin
  3. Linezolid
  4. Streptogramins
49
Q

Multidrug-resistant P. aeruginosa &
Multidrug-resistant Acinetobacter baumannii
(2)

A

Polymyxins B and E(colistin)

50
Q 
Compare Bacteria to Fungi:
Prokaryote vs eukaryote
size
nuclear membrane
ribosome
cell wall
A

Bacteria: prokaryote, small, 70s, pepidoglycan cell wall

Fungi: Eukaryote, larger, nuclear membrane, organelles, 80s, Chitins/glycans/mannons in cell wall

51
Q 
compare human vs fungi:
prokaryote vs eukaryote
organelles
ribosome
haploid vs diploid
cell membrane
A

Human: Eukaryote, organelles, 80s, diploid, cholesterol membrane

Fungi: Eukaryote, organelles, 80s, haploid, ergosterol membrane, squalene epoxide, griseofulvin microtubules

52
Q

Amphotericin B:

MOA

A

“AmphoTERicin ‘TEARS’ holes in the fungal membrane”

Binds Ergosterol–>forms membrane pores–>leak electrolytes

53
Q

Amphotericin B:
Clinical (6)
Special administration

A

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
Q

Amphotericin B:
Adverse(6)
How to decrease Adverse(2)

A
  1. Shake & bake (F/C)
  2. Hypotension
  3. Nephrotox
  4. arrhythmias
  5. anemia
  6. IV phlebitis

decrease with hydration and liposomal amphotericin

55
Q

Nystatin:
MOA
Administration
Clinical use (3)

A
  • 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
Q

Flucytosine:

MOA(2 steps)

A
  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
Q

Flucytosine:
Clinical use (1)
Adverse (1)

A

Use: systemic fungal infections; esp Crypto meningitis in combo w/ AmpB

Adverse: BM suppression like all chemotherapy agents

58
Q

Describe 5-FU chemo drug

A
  • blocks thymidylate synthase to decrease dTMP/DNA synthesis
  • Treat: Colon ca., Pancreatic ca., Basal cell ca (topical)
  • Adverse: Myelosuppresion Irreversible
59
Q 
Azoles: 
Name(6)
which is topic?
Which cross BBB
Which is strongest?
Which causes gynecomastia?
A
  1. Clotrimazole-topical
  2. Miconazole-topical
  3. Fluconazole- crosses BBB
  4. Itraconazole
  5. Voriconazole
  6. Ketoconazole-strongest, causes gynecomastia
60
Q

Azoles:

MOA

A

Inhib ergosterol synthesis by inhib P450 enzyme(14a demthylase) that converts lanosterol to ergosterol

61
Q

Azoles:

Clincial Use

A

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
Q

Azoles:

Adverse(2)

A
  1. Testosterone synthesis inhib (gynecomastia w/ Ketoconazole)
  2. Liver dysfunction via P450 inhib ( “AAA RACKS In GQ Magazine”)
63
Q

Gynecomastia Causes:

  1. increased estrogen(4)
  2. congenital(1)
  3. Drugs (5)
A 
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
Q

Terbinafine:

MOA

A

inhib squalene epoxidase (fungal only)

65
Q

Describe how terbinafine and azoles inhibit the formation of ergosterol

A
  1. squalene –>squalene epoxide via squalene epoxidase (inhib by terbinafine)
  2. Squalene epoxide–>lanosterol–>ergosterol via 14a-demethylase(P450) (inhib by azoles)
66
Q

Terbinafine:
Clinical use(1)
Adverse(4)

A
  1. Dermatophytoses (esp. onychomycosis-fungal infections of finger/toe nail)
  2. GI upset
  3. HA
  4. Hepatotox
  5. Taste disturbance
67
Q

Systemic Fungi and their geographic location (4)

A
  1. Histo- Mississippi/Ohio
  2. Blasto- Central America
  3. Cocci- California/Arizona/SW USA
  4. Paracocci- Latin America
68
Q

Opportunistic fungi (6)

A
  1. Candida
  2. Aspergillus
  3. Cryptococcus
  4. Mucor/Rhizopus
  5. Pneumocystis
  6. Sporothrix
69
Q

Cutaneous Fungal infections (6)

named after areas of the body

A

Tinea…

  1. capitis
  2. corporis
  3. cruris
  4. pedis
  5. unguium
  6. versicolor
70
Q

Echinocandins:

Names (3)

A

“-fungin”

  1. Anidulafungin
  2. Caspofungin
  3. Micafungin
71
Q

Echinocandins:
MOA
Clinical Use(2)
Adverse(2)

A
  • 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
  3. GI upset
  4. Flushing (by histamine release)
72
Q

Griseofulvin:
MOA
Where does it deposit?

A
  • interferes w/ microtubule formation–>disrupts anaphase(mitosis)
  • deposits in keratin-containing tissues (like nails)
73
Q

Griseofulvin:
Admin
Clinical Use(1)
Adverse (4)

A
  • 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
Q

Treatment for:

Giardia/ Entamoeba

A

Metronidazole

Giardia- fatty foul-smelling diarrhea
Entamoeba- bloody diarrhea

75
Q

Treatment for:

Toxoplasmosis

A

Pyrimethamine

76
Q

Treatment for:

Trypanosoma brucei

A
  1. Melarsoprol
  2. Suramin
    “MELatonin SURe helps me sleep (T.brucei=Af. Sleeping Sickness)”
77
Q 
Treatment for: 
Trypanosoma cruzi (2)
A

Nifurtimox, Benznidazole

“MOXie people Take CRUZes to South America”

78
Q

Treatment for:

Leishmaniasis

A

Sodium Stibogluconate

“treat leishmania’S’i’S’ with ‘S’odium ‘S’tibogluconate”

79
Q

Treatment for:

Mites/ Louse

A

“treat PML(Pesty Mites and Lice) with PML because they NAG you”
PML= Permethrin, malathion, lindane
NAG=Na, AchE, GABA blockade

80
Q

Chloroquine:
MOA
MOResistance

A

-Blocks detoxification of heme into hemozoin–>Heme accumulates which is toxic to plasmodia
(Hb–>Globin + Heme–>Hemozoin)

-Membrane pump decreases intracellular drug concentration.

81
Q

Chloroquine:
Clinical Use
Adverse (2)

A

plasmodial species EXCEPT P.FALCIPARUM!

  1. Retinopathy
  2. Pruritus (especially in dark-skinned people)
82
Q

Treatment for:
P. Falciparum (2)

For life-threatening P. falciparum in USA vs. elsewhere

A
  1. artemether/lumefartrine
  2. atovaquone/proguanil

USA= quinidine or artesunate
Elsewhere=Quinine or artesunate

83
Q

4 malaria species:

A
  1. P. falcifarum
  2. P.malarie
  3. P. Ovale
  4. P.vivax
84
Q

Triad of Toxoplasmosis:

A
  1. Chorioretinitis
  2. Hydrocephalus
  3. Intracranial Ca+2
85
Q

MOA for Mebendazole/Albendazole

A

microtubule inhibitor in helminths

86
Q

Antihelminthic agents(5)

A
  1. Mebendazole/Albendazole
  2. Pyrantel pamoate
  3. Ivermectin
  4. Diethylcarbamazine
  5. Praziquantel

Drugs- Basic High Yield Stuff for Boards (20 decks)

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