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Pharmacology > Chap 13 and 14 > Flashcards

Chap 13 and 14 Flashcards

1
Q

Antiinfective agents currently approved for administration as inhaled aerosols

A

Pentamidine isethonate (NebuPent), Ribavirin (Virazole), Tobramycin (TOBI), Aztreonam (Cayston), and zanamivir (Relenza)

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2
Q

Pentamidine is used to

A

prevent and treat Pneumocystic pneumonia (PCP) in patients with acquired immunodeficiency syndrom (AIDS),

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3
Q

Ribavirin is used to

A

treat respiratory synctial virus (RSV). A single or monoclonal antibody preparation, Palivizumab (Synagis) offers prophylaxis and treatment for RSV infection

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4
Q

Inhaled tobramycin and aztreonam are available for the management of

A

Pseudomonas aeruginosa infection in pts with CF

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5
Q

Zanamivir is an inhaled antiviral agent used to treat

A

influenza

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6
Q

Pentamidine by inhalation is indicated for the prevention of

A

PCP in high risk immunodeficiency virus (HIV)- infected pts who have a history of one or more episodes of PCP or a peripheral CD4 (T4 helper cell), lymphocyte count of 200/mm or less

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7
Q

Aerosolized ribavirin is indicated for the

A

treatment of hospitalized infants with RSV

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8
Q

Aerosolized tobramycin is indicated for the

A

management(control) of chronic P. aeruginosa infection in CF

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9
Q

Aerosolized Aztreonam is indicated to improve

A

pulmonary symptoms in CF pts with P. aeruginosa infection

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10
Q

Inhaled zanamivir is indicated for the

A

Treatment of uncomplicated acute illness caused by the influenza in adults and children age 7 years and older who have been symptomatic for no more than 2 days. It may also be used prophylactically in children 5 years and older against the influenza virus

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11
Q

Pentamidine (NebuPent) is a what agent

A

antiprotozoal agent that is active agains Pneumocystis carinii that causative organism for Pneumocystic jiroveci pneumonia (PJP)

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12
Q

Pentamidine (NebuPent) can be given either

A

parenterally (IV/IM-distributes quickly to major organs) or as an inhaled aerosol, but it is not absorbed with oral administration

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13
Q

Aerosolized Pentamidine isethionate is approved for use as ___ prophylactic therapy in pts with AIDS to prevent PCP

A

Second line prophylactic therapy… With significant side effects and less efficacy than with the oral agent trimethoprimsulfamethoxazole (TMP-SMX).

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14
Q

Pentamidine side effects

A

local airway effects, such as cough, bronchospasm, and dyspnea, and a bad taste and systemic effects

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15
Q

Aerosolized pentamidine should be administered

A

with a neb capable of producing small particle sizes (MMD 1-2um) in Respirgard II neb flow rate of 5-7 L/min

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16
Q

Approved dose of aerosolized Pentamidine (NebuPent)

A

300mg given by inhalation once every 4 weeks, Supplied as a dry powder with 300mg in single vial, reconstituted with 6 ml of sterile water for injection. 6ml placed into nebulizer

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17
Q

Sterile water not saline

A

saline can cause precipitation

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18
Q

Where is Pentamidine excreted

A

75% in urine and 25% in feces over the months after administration

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19
Q

Pentamidine is not

A

Teratogenic, mutagenic, and carcinogenic potential is minimal

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20
Q

Pentamidine Environment precautions

A

One way valves and an expiratory filter
stop neb if pt takes mouthpiece out of mouth
MMD of 1-2 um to increase alveolar targeting
Screen pt for cough history
use of Bagonist
Administer aerosol in a negative pressure room with 6 air changes per hour
or consider using isolation booth/hood
Use barrier protection
Screen pts with HIV infection for TB

THESE TESTS ARE EXPENSIVE AND MEASURES ARE DIFFICULT

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21
Q

Ribavirin (virazole) is classified as a what drug

A

antiviral drug, it is active against RSV, influenza viruses (type A and B), and the herpes simplex virus. (possibly inefective)

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22
Q

Ribavirin (virazole) virostatic or virucidal?

A

Virostatic and inhibits DNA and RNA (viruses). synthetic nucleoside analag

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23
Q

Infection with RSV in children results in either

A

bronchiolitis or pneumonia (november to march, winter months)

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24
Q

Virus

A

can be defined as an obligated intracellular parasite, containing either DNA or RNA, that reproduces by synthesis of subunits within the host cell and causes disease as a consequence of this replication

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25
Q

Ribavirin dosage

A

given as a 20mg/ml solution, SPAG-2 Neb for 12 to 18 hours per day, for a minimum of 3 days and not more than 7. The drug is supplied as a 6g of powder in 100ml vial, reconstitued in sterile water for injection or inhalation

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26
Q

SPAG-2

A

Large volume, pneumatically powered nebulizer operating on a jet shearing principle, with baffling of aerosol particales and a drying chamber to reduce particle size further to a level of approx 1.3 um MMD
Residual solution in reservoir should be discarded before adding new and solution should be visually inspected

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27
Q

Mechanism of action by which ribavirin exerts its virostatic effect

A

is not completely understood

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28
Q

Ribavirin side effects (Pulmonary, cardio, Hema, Derma)

A

Pulmonary- Deterioration of pulmonary function and worsening of asthma or COPD, pneumothorax, apnea, and bacterial pneumonia
Cardiovascular- Cardiovascular instability= hypotension, cardiac arrest, and digitalis toxicity
Hematologic- Effects on blood cells
Dermatologic/topical- rash, eyelid erythema, and conjunctivitis

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29
Q

Ribavirin has potential for

A

mutagenic and carcinogenic effects based on in vitro and animal studies, drug has caused testicular lesions in rats, it is teratogenic or embryocidal in animal species

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30
Q

Palivisumab ( Synagis)

A 
New drug class of therapeutic monoclonal antibodies
-approved for the prevention and treatment of RSV in premature infants and infants with bronchopulmonary dysplasia (BPD)
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31
Q

Palivisumab (Synagis) Dosage and administration

A

Powder for injection is lyophilized or freeze-dried and is available at 50mg/ml or 100mg/ml. Recommended dose is 15mg/ml given IM once a month before the start of and throughout the RSV season

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32
Q

Palivisumab (synagis) mechanism of action

A

is a humanized monoclonal antibody produced by recombinant DNA techniques, directed against the F protein of RSV.

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33
Q

Most serious adverse reaction of Palivisumab (Synagis)

A

anaphylaxis (1 per 100,000 cases).. other less are fever, upper resp infection, otitis media, rhinitis, rash , pain, hernia, and coughing/wheezing

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34
Q

Nebulized tobramycin is used to manage

A

chronic Pseudomonas aeruginosa infection in pts with CF as an alternative to IV therapy

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35
Q

Side effects of tobramycin are

A

tinnitus and voice changes

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36
Q

Tobramycin dosage and administration

A

recommended for children 6 years of age or older.
300mg twice daily approx 12 hours apart and not less than 6 hours apart for 28 days consecutively, with the next 28 days off the drug. Cycle repeated. Keep in fridge temps 2-8C (36-46F)

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37
Q

Dont mix what with tobramycin

A

Dornase alfa or any other drug with tobramycin in the neb because of incompatibility with other drugs.. should be inhaled after other therapies

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38
Q

Tobi is a member of the

A

aminoglycoside family of antibiotics. Effective in treating gram negative infections and have a bactericidal effect, blocking protein synthesis in the bacteria and causing cellular death.

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39
Q

Aerosolized Aztreonam (Cayston) is used to improve

A

pseudomonas aeruginosa infection in pts with CF. Should be pretreated with a bronchodilator before.

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40
Q

Administration of Aztreonam (cayston)

A

given as IV solution, also inhaled, not indicated for pts younger than 7 years of age or those with B. cepacia. FEV1 greater than 25% or less than 75% predicted.
-Supplied in 28 day kit, each 2 ml single use flass vial contains 75 mg and mixed with 1ml sterile water

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41
Q

Aztreonam (cayston) nebulizer

A

Altera Neb system. 3 times a day for 28 days and 28 days off. Fridge, once open room temp 28 days

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42
Q

Mechanism of action of Aztreonam

A

displays in vitro activity agains gram negative erobic bacteria.

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43
Q

Cayston can cause

A

bronchospasm and decreased pts FEV1, pts should be screened for baseline pulmonary function

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44
Q

Zanamivir is available for administrationwith

A

a DPI to treat acute symptoms of influenza. inhibits viral neuraminidase (NA) -Diskhaler device. each blister contains 5mg of drug. Two inhalations, taken twice daily approx 12 hours apart for 5 days (5 day course of drug)

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45
Q

Zanamivir side effects

A

bronchospasm of lung deterioration, especially in preexisting airways disease and undertreatment of inapproprate treatment of nonviral bacterial resp infections

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46
Q

Zanamivir (Relenza) is an

A

antiviral agent approved for use in the treatment of uncomplicated influenza illness in adults and children older than 7 years of age during early onset (within the first 2 days) of infection.

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47
Q

Agent that stops a virus from replicating is called

A

virostatic

48
Q

Virus that causes formation of syncytial masses in infected cell structures is

A

Resp. Syncytial Virus (RSV)

49
Q

Inherited disease of the exocrine galnds, affecting the pancrease, resp system, and apocrine galnds, is called

A

CF

50
Q

The pneumonia common among pts with lowered immune system response is

A

Pneumocystis Pneumonia (PCP)

51
Q

An agent that kills a virus is described as

A

Virucidal

52
Q

Why is TOBI specified to one neb

A

because it is a thick medication

53
Q

A treatment dose of what mg of zanamivir is recommended for influenza infection

A

10mg

54
Q

Oseltamivir phosphate (tamiflu) has an off label use for

A

H1N1 -swine flu

55
Q

Antimicrobials

A

natural and synthetic compounds that either inhibit or kill microorganisms

56
Q

MIC, mind inhibitory concentratiin

A

Lowest concentration of antimicrobial that prevents visible growth

57
Q

MBC, min bactericidal concentration

A

Lowest concentration of antimicrobial agent that prevents growth of an organism after 24 hours

58
Q

Bacteriostatic

A

Drug that inhibits grow but dont kill bacteria

59
Q

Bacteriocidal

A

Drug that kills bacteria

60
Q

Time dependent response

A

Kill rate influence by the time of drug concentration above MIC

61
Q

Concentration dependent response

A

Kill rate increases proportional with drug concentration

62
Q

Antimicrobial combinations

A

Synerguc effect is demonstrated when combined effect of two antimicrobials is greater than their added effect (1+1>2)

63
Q

Pencillins (bread mold)

A

Several different classes, natural and synthetic
- bactericidal , demonstrate time dependent killing and can act synergistically with aminoglycosides against some bacteria

64
Q

Most common side effects of pencillins are

A

Hypersensitivity

65
Q

Pencilin names

A

Usually end in “lin”

66
Q

Pencillinase

A

Resistant pencillins

  1. Active against gram positive cocci (staph and strep)
  2. Routinely used in skin and soft tissue infections
67
Q

Cephalosprins

A

Presently, 4 generations of Cephalosporins

  • structurally similar to penicillin
  • names usually start with Cef or Ceph
  • treatment for gram positive organisms
  • moderate coverage of gram negative organisms(2nd gen)
  • 4th gen have extended gram positive and negative coverage
  • one of the most popular broad spectrum antibiotics
  • excellent broad spectrum antibiotics
68
Q

Broad spectrum antibiotic

A

Covers most bacteria

69
Q

Carbapenems

A

Newest class of Beta-lactams

  • carapenems are bactericidal
  • excellent coverage for both gram positive and negative bacteria and most anaerobes
  • excellent broad spectrum antibiotic
  • these antibiotics are usually reserved for infections that are resistant to most other agents
70
Q

Aminoglycosides

A

Bactericidal and concentration dependent killing

  • generally used to treat gram negative organisms
  • used for treating VAP
  • synergistic with B-lactams
  • TOBI is a aminoglycoside ..Treat CF
  • Streptimycin a major agent in treating TB
  • beware of nephrotoxicity(kidney) and ototoxicity (ear)
71
Q

Quinolones

A

Bactericidal agents and concentration dependent killing

-quinolones effective in treating upper and lower resp tract infections

72
Q

Tetracyclines

A
  • bacteriostatic
  • great broad spectrum antibiotic
  • treats resp tract infections, sexual transmitted infections, and infections
  • good for acne
  • side effect is bone growth and not used with children
73
Q

Macrolides

A
  • used in treatment of both gram positive and negative organisms
  • bacteriostatic
  • drug of choice in treating atypical pneumonia
  • used as a prophylactic treatment of Myobactrium Avium infection in HIV
74
Q

Trimethoprim- sulfamethoxole (TMP-SMX)

A

Acts synergistically and is bacteriostatic
-treatment of PCP in FC
- first line treatment
(Next: Pentamine)

75
Q

Antimycobacterials (anti TB agents)

A

Isoniazid, Rifamycins, Pyrazinamide, Ethambutol, Streptomycin

76
Q

Isoniazid

A

-Antimycobacterials: anti TB agents

Bactericidal against TB and bacteriostatic against nonreplicating organisms

77
Q

Rifamycins

A

-antimycobacterials: anti TB agents

Bactericidal against actively dividing bacteria

78
Q

Pyrazinamide

A

-Antimycobacterials: anti TB agents

Bactericidal

79
Q

Ethambutol

A

-antimycobacterials: anti TB agents

Bacteriostatic

80
Q

Streptomycin

A

-antimycobacterials: anti TB agents
Aminoglycoside
One of the first antibiotic found effective against TB

81
Q

Antifungals

A

Polyenes: fungicidal- kill fungus
-amphotericin B and Nystatin

Azoles: fungistatic- reduce production

82
Q

What agents are considered first line therapy for treatment of pulmonary tuberclosis

A

Isoniazid, rifamycin, pyrazinamide, and ethambutol

83
Q

What is the antimicrobial agent of choice for treatment of PCP

A

Trimethoprim- sulfamethoxazole

84
Q

Which b lactam antibiotic is least likely to cause an allergic reaction in a pt with a penicillin allergy

A

Aztreonam

85
Q

Describe at least 3 parameters that may indicate antibiotic failure in a patient

A

Continued fever spikes, elevated WBC count, repeated positive cultures, and nonresolution or worsening of symptoms (hypotension or mental status change) may indicate antibiotic failure

86
Q

Both natural and synthetic compounds that either inhibit or kill microorganisms are called

A

synergism

87
Q

natural compounds that produced by microorganisms that either inhibit or kill other microorganisms are called

A

antibiotics

88
Q

Antagonism

A

describes when the effect of a combination of two antimicrobials is lower than the effect expected from either agent alone

89
Q

Four factors that must be considered before choosing an antimicrobial agent

A
  1. ID pathogen
  2. Determine susceptibility
  3. Consider host factors
  4. Consider drug factors
90
Q

what is responsible for the difference in gram stain

A

structural compounds of their cell wall

91
Q

Mycobacterium tuberculosis requires an __ ___ stain to penetrate its waxlike cell wall

A

acid-fast

92
Q

Zone inhibition

A

published breakpoints for the diameter of the clear zones used to determine whether its susceptible or resistant

93
Q

Clinical situation where a pt may fail to respond to antimicrobial therapy

A

bone marrow transplant recipient with an active infection may not improve bc of their impaired immune functions

94
Q

The phenomenon in which bacterial growth is inhibited even after the drug level drops below detectable levels

A

PAE= post antibiotic effect

95
Q

Response to therapy is best measured by

A

clinical assessment

96
Q

Penicillins and cephalosporins exert their pharmacologic activity by inhibiting

A

cell wall synthesis

97
Q

Cephalosporins inhibit

A

bacterial cell wall synthesis in a manner similar to penicillin

98
Q

T/F The monobactam aztreonam is active only against gram negative aerobic bacilli such as pseudomonas aeruginosa

A

T

99
Q

Aminoglycosides that are used in treatment of CF

A

Tobramycin and Amikacin

100
Q

Aminoglycosides that are used in the tx of VAP

A

Gentamicin, Tobramycin, and amikacin

101
Q

Broad spectrum antibiotics that are used in both pulmonary and systemic infections and are effective for treatment of diseases such as Rocky Mountain spotted fever, lyme disease, and others

A

Tetracylines

102
Q

Tetracylines inhibit

A

blocks protein synthesis , resulting in bacteriostatic effect

103
Q

Vancomycin is useful for the tx of infections caused by

A

MRSA

104
Q

Pts with suspected TB should remain in hospital room until one of the following met

A
  1. Determined not to have TB
  2. Discharged
  3. Confirmed to be noninfectious
105
Q

Drug tx for TB consists of multiple antibiotics for

A

6-12 months

106
Q

Acid fast stain is used to identify

A

M. Tuberculosis

107
Q

Which of the following common pathogens cause CAP

A

H. influenzae

108
Q

The incidence of fungal infections has increased dramatically, with ____species now the fourth most commonly isolated bloodstream pathogen

A

candida

109
Q

Pt with IV Diagnosed with PCP you give?

A

TMP-SMX

110
Q

Which of the following drugs is used in the treatment of VAP

A

notes- aminoglycosides

Quiz- Gentamicin (and tobi)

111
Q

For gram negative infection and has poor GI absorption and is parenteral :

A

Aminoglycosides

112
Q

Test involves placing discs, saturated with antibiotics, on an agar plate inoculated with the microbe :

A

Zone of inhibition

113
Q 
Aminoglycosides are used primarily for :
A) mycoplasma infections.
B) gram-negative infections.
C) viral infections.
D) gram-positive infections.
A

gram-negative infections

114
Q

The natural penicillins are primarily effective against:

I. gram-negative bacteria.
II. gram-positive bacteria.
III. viruses.
IV. anaerobes.
V. mycoplasmas.
A

Gram-positive bacteria and anaerobes

115
Q

The drug of choice for legionella bacteria is

A

Erythromycin

116
Q 
Which of the following pathogens are responsible for CAP?
A. S-pneumoniae
B. H-Influenza
C. M-pneumoniae
D. Legionella
A

ALL

Pharmacology (10 decks)

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