Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Foundations of Disease and Therapy > Clinical Pharmacology of Antivirals, Antifungals, and Antibiotics > Flashcards

Clinical Pharmacology of Antivirals, Antifungals, and Antibiotics Flashcards

1
Q

Macrolides (Azithromycin)

ADME, Side Effects

A

Administered orally; food delays absorption

Diffuses into all fluids except CSF. Can cross placenta and enter fetal circulation; also enters breast milk

Excreted by kidney and liver

Large doeses cause epigastric distress. Inhibit CYPs and can have drug-drug interactions

Elevates QT interval and is associated with cardiovascular disease !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sulfonamides

Use, ADME, Side Effects

A

Highly concentrated in urine, good for treating UTI’s

May precipitate in acidic urine

Can cause acute hemolytic anemia in those with G6P Dehydrogenase Deficiency

Commonly cause rashes, ulceration on mucous membranes, and serum sickness

TOXIC EPIDERMAL NECROLYSIS - similar to Scarlet Skin Syndrome (Staph); skin loses glue that holds epidermis together and looks like second degree burn

CAN CAUSE ENCEPHALOPATHY AND BILIRUBIN DEPOSITS IN BRAIN OF FETUSES AND INFANTS - ABSOLUTE CONTRAINDICATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clindamycin

ADME, Side Effects

A

Can be given orally, parentally, or topically

Does not get into CSF, but crosses placenta

Accumulates in Neutrophils, Macrophages, and Pus - good for treating Staph and Strep

Excreted by liver and kidneys

Causes C. diff colitis and skin rash. Can lead to toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cidofovir

Use, Pharmacokinetics, Side effects, Interactions

A

Nucleotide analog that does not require phosphorylation - activity against Herpes, Papilloma, Polyoma, Pox, and Adenovirus

IV formulation treats CMV Retinitis and Acyclovir-resistant HSV infections

Does not penetrate CSF

HIGHLY NEPHROTOXIC - Co-Administer with Probenecid and Saline to limit toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Enfuvirtide:

Administration, Side Effects, Interactions

A

HIV Fusion inhibitor

only HIV drug given parenterally, route of elimination not known

Can cause cysts and reactions at site of injection

No interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which B-Lactam does not cross-react with Penicillin?

A

Aztreonam (a Monobactam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carbapenems: Imipenem

Use, ADME, Side Effects

A

Broad-Spectrum with activity against Pseudomonas

Imipenem must be co-administered with cilastatin to inhibit its secretion in urine

Excreted by kidneys

Cause Nausea and Vomiting

Can cross-react with penicillins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

(Anti-mitotic) Griseofulvin:

Distribution, Side Effects, Drug Interactions

A

Absorbed through GI

Deposited in keratin precursor cells where it persists and provides prolonged fungal resistance

Is Teratogenic (embryo deformation) and causes Confusion

Is a CYP 450 Inducer that Increases Warfarin metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Side Effects and Interactions of Polyenes

A
  • High Nephrotoxicity - drug accumulates in kidney since it’s excreted in urine
  • Restriction of renal blood flow and toxic to distal tubules
  • Due to drug attacking cholesterol renal membranes at high concentrations
  • Drug-Drug interactions with Cyclosporine and Aminoglycosides (concurrent nephrotoxicity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Toxicity of Penicillin (other than Hypersensitivity)

A
  • Pain at injection site (dose related)
  • large doses given to renal failure patients can cause confusion, twitching, and seizures
  • C. diff colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tetracyclines

ADME, Side Effects

A

Given orally or parenterally

Divalent cations interfere with absorption (milk and antacids)

Wide distribution, including CSF

Minocycline is completely absorbed by stomach and excreted through bile

Causes nausea and vomiting. Hepatic toxicity in large doses. Renal Toxicity and Fanconi Syndrome if taking expired drug

COMMONLY CAUSES PHOTOSENSITIVITY AND GETS DEPOSITED IN BONES AND TEETH - contraindicated in Pregnant and Children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Administration of Polyenes

A

Amphotericin B comes in:

  1. Oral suspension
  2. 4 IV Lipid formulations (Lipid formulations reduce toxicity and side effects)
  3. Topical - Nystatin
  4. Opthalmic - Natamycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cross-Reactivity of Cephalosporins and Penicillins

A

6-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ADME of Polyenes

A
  • Polyene = Amphotericin B
  • Poor oral absorption - must be given IV
  • Does not penetrate CSF, eye, or amniotic fluid
  • Half life of 15 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drug needs to be co-administered with Cilistatin?

A

Imipenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cefazolin (First Gen)

What it’s good for, ADME

A

Good for susceptible Staph and Strep (surgery prophylaxis)

Given parentally (other 1st gens are given orally)

largely circulates bound to plasma proteins

excreted by kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adverse effects of Azoles

A

In general, they are well-tolerated

INHIBIT TESTOSTERONE SYNTHESIS (ketoconazole)

“Associated w/ endocrine dysfunction”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CYP Inducer

A

Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HIV Integrase Inhibitors:

Side effects, Interactions

A

Raltegravir

May cause Rhabdomylosis and Hypercholesterolemia

No interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drugs to avoid during pregnancy and what they cause

A

“SAFe Children Take Really Good Care”

  • Sulfonamides - Kernicterus (bilirubin deposition in brain)
  • Aminoglycosides - Ototoxicity
  • Fluoroquinolones - Cartilage damage
  • Clarithromycin - Embryotoxic
  • Tetracyclines - Discolored Teeth, Inhibited Bone Growth
  • Ribavirin - Teratogenic
  • Griseofulvin - Teratogenic
  • Chloramphenicol - Gray Baby Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cefoxitin (second generation)

what it’s good for, ADME

A

Good for RTI’s, intra-abdominal infections, pelvic inflammatory disease, and diabetic foot ulcers

Given Parentally (others in gen given orally)

excreted by kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ganciclovir:

Pharmacokinetics, Use, Side Effects, Interactions

A

Monophosphorylated by Phosphotransferase in CMV

Commonly causes Neutropenia, Thrombocytopenia, Leukopenia, and is more toxic to host enzymes than Acyclovir

Do not give during pregnancy

Co-administration with nephrotoxic agents increases nephrotoxicity

23
Q

NNRTI’s

Side Effects and Interactions

A
  • Non-competitive inhibitors of HIV Reverse Transcriptase*
  • Efavirenz, Nevirapine, Delaviridine*

May cause Rash and Hepatotoxicity

May also cause CNS side effects such as depression, hallucination, and mania

Eliminated by CYPs, so may interact with other drugs metabolized by CYPs

24
Q

Acyclovir and Valacyclovir:

Pharmacokinetics, Activity, Absorption, Distribution, Excretion

A

Monophosphorylated by Thymidine Kinase in HSV/VZV

Used to treat HSV-1 and HSV-2 to reduce pain and improve recovery times

Can also treat VZV if used within 24 hours of rash onset

No activity in CMV, poor for EBV

Low oral bioavailability, Prodrug rapidly converted to ACV by liver

Widely distributed, including CSF

Excreted via kidney

25
Q

Aminoglycosides

Use, ADME, Side Effects

A

Parenteral Administration

Poor penetration - does not get inside cells, CSF, or Eye

No activity against anaerobes

Excreted by kidneys - Nephrotoxic

Accumulates in Perilymph and Endolymph of Inner ear - Causes Dizziness and Ototoxicity

Can cause Neuromuscular Blockade - Contraindicated in Myasthenia Gravis

26
Q

Which Penicillins are Oral vs IV?

A

Oral: Penicillin V, Amoxicillin

IV: Penicillin G, Ampicillin, Nafcillin, Piperacillin-Tazobactam

27
Q

Flucytosine:

Distribution, Side Effects, Interactions

A

Well absorbed through GI tract - Concentrates in CSF

May cause Bone Marrow Suppression

No drug interactions

28
Q

What determines what antibiotic to use?

A

Can the concentration of that antibiotic reach the minimum inhibitory concentration at the site of infection?

29
Q

Echinocandins:

Administration, Side Effects, Interactions

A

IV formulations only

May cause GI upset and flushing due to histamine

Cyclosporine increases levels of caspofungin by 35%

30
Q

Type II Penicilin Allergy

A

Penicillin acts as a Hapten and binds to Erythrocytes

This makes them antigenic, and it can result in lysis via complement or phagocytosis of RBC’s

31
Q

Metronidazole:

Side Effects

A

DO NOT MIX WITH ALCOHOL

Causes nausea, vomiting, skin flushing, tachycardia, and dyspnea

Can also cause metallic taste (dysgeusia) and black urine

32
Q

Rifamycin

Side effects

A

Colors urine, saliva, and tears orange-red

Flu-like illness

CYP Inducer; decreases half life of HIV drugs, contraceptives, and corticosteroids

33
Q

Allylamines: Side Effects and Interactions

(terbinafine)

A

Can lead to taste disturbances and hepatotoxicity

Metabolized by Liver

Rifampin decreases plasma concentrations (CYP inducer)

Cimetidine increases plasma concentratoins (increases stomach pH)

34
Q

Cefepime (4th gen)

Use, ADME

A

More resistant to Beta-Lactamases than Third Generation

Exellent CSF penetration

Given parentally

Cleared by kidneys

35
Q

Ethambutol

Side Effects

A

Dose dependent visual problems

Red-Green Color Blindness

36
Q

Pyrazinamide

Side Effects

A

Can cause hepatotoxicity, hyperuricemia, and gout

37
Q

Vancomycin:

Use, ADME, Side Effects

A

Use for MRSA, C. Diff, or for G+’s in Penicillin-allergic

Given IV over an hour

Secreted by kidneys

If infused too rapidly it can cause Red Man Syndrome - facial and neck flushing due to histamine release

38
Q

Isonazid

Side effects

A

Penetrates into granulomas

Causes Rash and fever

39
Q

Imidazoles vs Triazoles

A

Imidazoles are an older class of Azole

Triazoles are metabolized more slowly and have less effect on human sterol synthesis

40
Q

Ceftriaxone

What it’s good for, ADME

A

Broad-Spectrum; good for serious infections like Bacterial Meningitis, Lyme Disease, and G- Sepsis

Not active against Listeria and Strep Pneumo

Given Parentally

Good penetration in body tissues and fluids

Excreted through bile

41
Q

Acyclovir Resistance

How it happens, What to use instead

A

Lack of Thymidine Kinase (usually)

In this case, give drug that doesn’t require phosphorylation such as Cidofovir

42
Q

Fluoroquinolones (Ciprofloxacin)

ADME and Side Effects

A

Orally administered - divalent cations interfere with absorption (milk and antacids)

Gets inside cells

Cleared by kidneys and is excreted in breast milk

Causes nausea, vomiting, and abdominal discomfort

Can cause C. diff colitis

Causes headache and dizziness

Tendonopathy in adults and arthropy in children

43
Q

aDME of Penicillins

A

Widely distributed in tissues and secreations, EXCEPT: CNS, prostatic fluid, and eye

Does not kill intracellular pathogens

Rapid elimination through kidney (other compounds added to slow secretion)

secreted in breast milk

44
Q

Maraviroc:

Side Effects, Drug Interactions

A

HIV Entry Inhibitor by preventing gp120 from binding CCR5

Can cause allergic reactions and hepatotoxicity

INHIBITOR OF CYP 450

45
Q

NRTI’s

Pharmacokinetics, Side Effects, Interactions

A

The active triphosphates have 4x the half-lives of the parent compound - may accumulate in tissues to toxic levels

Cause skeletal muscle myopathy due to depletion of mitochondrial DNA

Also cause Bone Marrow Suppression, Hypersensitivity, Peripheral Neuropathy, Lactic Acidosis

Interacts with Stavudine and Zidovudine

46
Q

CYP Inhibitors

A

Erythromycin, Clarithromycin, and Ketoconazole

47
Q

Empiric Therapy vs Specific Therapy

A

Emperic Therapy - use of broad-spectrum drug

Specific Therapy - use of narrower drug to target organism

48
Q

Acyclovir and Valacyclovir:

Side Effects and Interactions

A

Dose-limiting renal toxicity

Interacts with Zidovudine (antiretroviral) and Cyclosporine (nephrotoxic)

49
Q

Foscarnet

Use, Mechanism, Side Effects, Interactions

A

Inhibits Viral DNA Polymerase but is not a nucleoside analog

Used to treat CMV Retinitis and Acyclovir resistant HSV

Causes Nephrotoxicity and Hypocalcemia

IV Pentamidine (anti-protozoal) increases hypocalcemia

50
Q

Aztreonam:

Use

A

Only works against G-, incuding Pseudomonas

Useful in patients with Penicillin allergy because it has no cross-reactivity

51
Q

Drug interactions of Azoles

A

INHIBITORS OF CYP 450 ENZYMES

Absorb better at low pH - don’t take with antacids

Can ketalate to metal cations in vitamins and slow absorption

Drugs that induce CYPs will significantly reduce serum concentratoins of Azoles

52
Q

Penciclovir

Mechanism of Action and Use

A

Phosphorylated by TK in HSV and VZV, similar to Acyclovir

The major difference is that Penciclovir is less potent but the half life is 4x greater

Used to treat Shingles (HZV)

53
Q

HIV Protease Inhibitors:

Side Effects and Interactions

A

Commonly cause nausea, diarrhea, and vomiting. Can cause fatal hepatotoxicity.

Can cause crystalluria from poor drug solubility, along with nephropathy and hematuria

Metabolized by CYP3A4 and may interact with other drugs metabolized by CYPs

54
Q

Toxic Epidermal Necrolysis

A

Rare side effect of Sulfa drugs

Looks like Scarlet Skin Syndrome caused by Staph

Layers of Epidermis become “unglued” and injury appears like a second degree burn

Foundations of Disease and Therapy (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions