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Pharmacology: Unit 3 > Antimycobacterials and Antifungals > Flashcards

Antimycobacterials and Antifungals Flashcards

1
Q

Antimycobacterials work by targeting what in Mycobacteria?

A

Enzymes used to build the cell wall

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2
Q

Why are antimycobacterials usually given in combination treatments?

A

Target different enzymes
Minimize bacterial resistance

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3
Q

Mycobacteria replicate slower than “typical” bacteria. What effect does this have?

A

Easier to control
Harder to treat

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4
Q

What is unique about mycobacteria that makes them resistant to nearly all antibiotics?

A

They can exist in a dormant state

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5
Q

What is found in the cell walls of mycobacteria that make them structurally different from Gram (+) and (-) bacteria?

A

Mycolic Acids
(resist penetration)

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6
Q

What is the four drug cocktail used to treat Mycobacterium tuberculosis when it is an active disease?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

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7
Q

Isoniazid is bactericidal or bacteriostatic?

A

Bactericidal

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8
Q

What is the mechanism of action of Isoniazid?

A

Mycolic Acid synthesis inhibitor

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9
Q

Isoniazid is effective against active or dormant (latent) TB?

A

Both

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10
Q

What are the two most important drugs for Tuberculosis?

A

Isoniazid
Rifampin

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11
Q

Isoniazid acts as weak Monoamine Oxidase Inhibitor (MAO-I), what drugs may cause an interaction because of this?

A

Selective Serotonin Reuptake Inhibitor (SSRI)
Serotonin & Norepinephrine Reuptake Inhibitor (SNRI)

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12
Q

What is typically given to all patients who are taking Isoniazid?

A

Pyridoxine (Vitamin B6)

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13
Q

What are the adverse drug reactions of Isoniazid?

A

Peripheral Neuropathy (use pyridoxine)
Hepatotoxicity
Hemolysis with G6PD deficiency

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14
Q

Name two common Rifamycins.

A

Rifampin
Rifabutin

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15
Q

Are Rifamycins bactericidal or bacteriostatic?

A

Bactericidal

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16
Q

What is the mechanism of action of Rifamycins?

A

Inhibit DNA-dependent RNA polymerase

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17
Q

Why should you always screen for drug interactions with Rifamycins?

A

Extremely potent CYP450 inducers

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18
Q

Rifamycins also cause what kind of effect on oral contraceptives?

A

Reduced effectiveness
(use back up)

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19
Q

Which Rifamycin is the drug of choice for TB?

A

Rifampin

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20
Q

Which Rifamycin is the drug of choice for mycobacterium avium complex?

A

Rifabutin

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21
Q

What is a benign adverse drug reaction of Rifamycins that may scare the shit out of your patient?

A

Orange-red colored secretions

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22
Q

Is Pyrazinamide bacteriostatic or bactericidal?

A

Bacteriostatic

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23
Q

Why is Pyrazinamide used in the TB cocktail?

A

Shorten duration of treatment
9 months to 6 months

24
Q

How long is Pyrazinamide used for?

A

2 months

25
Q

What type of patient should not use Pyrazinamide?

A

Pregnant

26
Q

What is a common adverse drug reaction caused by Pyrazinamide?

A

Polyarthralgia (40%)

27
Q

Is Ethambutol a bactericidal or bacteriostatic?

A

Bacteriostatic

28
Q

What is the mechanism of action of Ethambutol?

A

Inhibits formation of arabinoglycan
(component of cell wall)

29
Q

When is Ethambutol used?

A

First 2 months of TB treatment

30
Q

Who is Ethambutol not recommended for?

A

Children under 5

31
Q

What is an adverse drug reaction that may occur when using Ethambutol and is dose-dependent?

A

Visual Disturbances (reversible)
- patients can’t tell red from green

32
Q

Name two Polyenes (antifungals).

A

Amphotericin B
Nystatin

33
Q

What is the mechanism of action of Polyenes?

A

Ergosterol binding in fungal cell membranes
(forms leaky pores)

34
Q

List three adverse drug reactions caused by Polyenes.

A

Nephrotoxicity
Infusion Reactions
Electrolyte Abnormalities (hypokalemia)

35
Q

Polyenes have a moderate clinical activity against what?

A

Zygomycetes

36
Q

Polyenes are the drug of choice for what infection?

A

Cryptococcal Meningitis

37
Q

Name four popular Azoles.

A

Fluconazole
Itraconazole
Voriconazole
Ketoconazole

38
Q

What is the mechanism of action of Azoles?

A

Fungal CYP-450 dependent enzyme inhibitor
(blocks ergosterol synthesis)

39
Q

What antifungals are considered the “mainstay” of antifungal fungal therapy?

A

Azoles

40
Q

What are two adverse drug reactions caused by Azole antifungals?

A

Hepatotoxicity
QT prolongation

41
Q

Why do Azoles have a high amount of drug interactions?

A

CYP450 Inhibitors

42
Q

How is Fluconazole eliminated from the body and how is this beneficial for treatments?

A

Renal Elimination
- only Azole with utility for Candiduria

43
Q

Fluconazole is the drug of choice for what type of fungal infections?

A

Candidiasis
- except for Candida krusei

44
Q

Azole medication that is only available in oral formulations.

A

Itraconazole

45
Q

Itraconazoles absorption is decreased by decreased gastric acidity caused by things such as PPI, H2 antihistamines. What can you instruct a patient to do in order to help increase the absorption?

A

Drink Soda

46
Q

Itraconazole is the drug of choice for what two infections?

A

Histoplasmosis
Blastomycosis

47
Q

Voriconazole is more than 90% orally bioavailable, however food decreases its absorption. What should you recommend your patients do?

A

Administer 1 hour before or after a meal

48
Q

Voriconazole is the drug of choice for what type of infection?

A

Invasive Aspergillosis

49
Q

Posaconazole is an antifungal that is available in either oral suspension, tablet or IV. What should the PO forms be taken with?

A

Food or Soda

50
Q

What is an important thing to remember about the suspension and tab form of Posaconazole?

A

Suspension and Tablet have different dosing

51
Q

Posaconazole is the drug of choice for what infections?

A

Prophylaxis of Invasive Aspergillosis and Candidiasis

52
Q

Name an Echinocandin.

A

Micafungin (IV)

53
Q

What is the mechanism of action of Micafungin?

A

Glucan Synthase Inhibitor
(decreases fungal cell wall synthesis)

54
Q

What is unique about the adverse drug reactions of Echinocandins?

A

Excellent Safety Profile

55
Q

What are possible drug interactions with Echinocandins?

A

Capsofungin and Micafungin interact with organ transplant rejection drugs.

56
Q

Echinocandins are the drug of choice for what type of infection?

A

Invasive Candidiasis

57
Q

What anti-fungal works by inhibiting epoxidation of squalene

A

Terbinafine

Pharmacology: Unit 3 (5 decks)

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