Copy of Micro ID - Sheet1

Question 1

Penicillin G

Answer 1

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant 2) IV Penicillin (Prototype Beta-lactam abx;Non-penicillinase resistant); Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes 3) Hypersensitivity rxns; Hemolytic anemia 4) Resistance: Beta-lactamases cleave Beta-lactam ring

Question 2

Penicillin V

Answer 2

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant 2) PO Penicillin (Prototype Beta-lactam abx;Non-penicillinase resistant); Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes 3) Hypersensitivity rxns; Hemolytic anemia 4) Resistance: Beta-lactamases cleave Beta-lactam ring

Question 3

Methicillin

Answer 3

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site) 2) PNC-Resistant PNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group 3) Hypersensitivity rxns; Interstitial nephritis (Methicillin specific)

Question 4

Nafcillin

Answer 4

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site) 2) PNC-Resistant PNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group 3) Hypersensitivity rxns 4) Use naf for staph!

Question 5

Dicloxacillin

Answer 5

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site) 2) PNC-Resistant; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group 3) Hypersensitivity rxns

Question 6

Ampicillin

Answer 6

1) Extended-spectrum PNC–Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci) 2) AminoPNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Wider spectrum; Penicillinase sensitive. Also combine w/ clavulonic acid to protect against Beta-lactamase. 3) Hypersensitivity rxs; Ampicillin rash; Pseudomemranous colitis 4) Resistance: Beta-lactamases cleave Beta-lactam ring

Question 7

Amoxicillin

Answer 7

1) Extended-spectrum PNC–Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci) 2) AminoPNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Wider spectrum; Penicillinase sensitive. Also combine w/ clavulonic acid to protect against Beta-lactamase. 3) Hypersensitivity rxs; Ampicillin rash; Pseudomemranous colitis 4) Resistance: Beta-lactamases cleave Beta-lactam ring; AmOxicillin has greater Oral bioavailability vs Ampicillin

Question 8

Ticarcillin

Answer 8

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum 3) Hypersensitivity rxns 4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

Question 9

Carbenicillin

Answer 9

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum 3) Hypersensitivity rxns 4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

Question 10

Piperacillin

Answer 10

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum 3) Hypersensitivity rxns 4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

Question 11

Clavulonic Acid

Answer 11

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase) 2) Beta-lactamase inhibitor 3) – 4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

Question 12

Sulbactam

Answer 12

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase) 2) Beta-lactamase inhibitor 3) – 4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

Question 13

Tazobactam

Answer 13

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase) 2) Beta-lactamase inhibitor 3) – 4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

Question 14

Cefazolin

Answer 14

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae. **Cefazolin–used prior to surgery to prevent S. aureus wound infections. 2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Orgs covered by 1st Generation=PEcK–Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Orgs typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 15

Cephalexin

Answer 15

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae 2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Orgs covered by 1st Generation=PEcK–Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 16

Cefoxitin

Answer 16

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens 2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 17

Cefaclor

Answer 17

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens 2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 18

Cefuroxime

Answer 18

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens 2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 19

Ceftriaxone

Answer 19

1) Serious gram-negative infections resistant to other Beta-lactams; **Ceftriaxone–meningitis & gonorrhea 2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 20

Cefotaxime

Answer 20

1) Serious gram-negative infections resistant to other Beta-lactams 2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 21

Ceftazidime

Answer 21

1) Serious gram-negative infections resistant to other Beta-lactams; **Ceftazidime–Pseudomonas. 2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 22

Cefepime

Answer 22

1) Increase activity against Pseudomonas & gram-positive orgs 2) Beta-lactam, 4th Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 23

Ceftaroline

Answer 23

1) **Only Cephalosporin that covers MRSA 2) Beta-lactam, **Newest Generation Cephalosporin; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal 3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides. 4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

Question 24

Aztreonam

Answer 24

1) Gram-negative rods only–No activity against gram-positives or anaerobes. For penicllin-allergic pts & those w/ renal insufficiency who cannot tolerate aminoglycosides 2) Beta-lactam, Monobactam; Resistant to Beta-lactamases. Prevents peptidoglycan cross-linking by binding to PBP3. Synergistic w/ Aminoglycosides. No cross-allergenicity w/ Penicillins. 3) Usually nontoxic; Occasional GI upset

Question 25

Meropenem

Answer 25

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to life-threatening infections, or after other drugs have failed. **Meropenem, however, has a reduced risk of seizures & is stable to dehydropeptidase I. 2) Beta-lactam, Carbapenem; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC) 3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma levels

Question 26

Imipenem (w/ Cilastatin)

Answer 26

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to life-threatening infections, or after other drugs have failed. *Meropenem, however, has a reduced risk of seizures & is stable to dehydropeptidase I. 2) Beta-lactam, Carbapenem; *Imipenem–broad-spectrum, Beta-lactamase-resistant carbapenem. Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). **Always administered w/ Cilastatin (inhib of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules. 3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma level

Question 27

Vancomycin

Answer 27

1) Gram-positive only–serious, amultidrug-resistant orgs, including MRSA, enterococci, & C. difficile (oral dose for pseudomembranous colitis) 2) Antimicrobial; Inhib cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal. 3) Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing–red man syndrome (can largely prevent by pretreatment w/ antihistamines & slow infusion rate). Well tolerated in general (–does NOT have many problems) 4) Resistance: Occurs w/ amino acid change of D-ala D-ala to D-ala D-lac. [“Pay back 2 D-alas (dollars) for VANdalizing (VANcomycin)]

Question 28

Streptomycin

Answer 28

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. 2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet) 3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen. 4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation. 4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

Question 29

Tobramycin

Answer 29

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. 2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet) 3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen. 4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation. 4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

Question 30

Amikacin

Answer 30

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. 2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet) 3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen. 4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation. 4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

Question 31

Neomycin

Answer 31

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.; *Neomycin–for bowel surgery 2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet) 3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen. 4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation. 4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

Question 32

Gentamicin

Answer 32

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs. 2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet) 3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen. 4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation. 4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

Question 33

Minocycline

Answer 33

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia. 2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut 3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy. 4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

Question 34

Demeclocycline

Answer 34

1) Acts as diuretic in SIADH; *Rarely used as antibiotic (Role of abx= Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia.) 2) Tetracycline; MOA in SIADH tx=ADH antagonist; MOA as abx=Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut 3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy. 4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

Question 35

Doxycycline

Answer 35

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia. 2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. *Doxycycline is fecally eliminated & can be used in pts w/ renal failure. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut 3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy. 4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

Question 36

Tetracycline

Answer 36

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia. 2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut 3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy. 4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

Question 37

Erythromycin

Answer 37

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins) 2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic. 3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants. 4) Resistance: Methylation of 23S rRNA binding site.

Question 38

Clarithromycin

Answer 38

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins) 2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic. 3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants. 4) Resistance: Methylation of 23S rRNA binding site.

Question 39

Azithromycin

Answer 39

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins) 2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic. 3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants. 4) Resistance: Methylation of 23S rRNA binding site.

Question 40

Chloramphenicol

Answer 40

1) Meningitis (Haemophius influenzae, Neisseria meningitidis, Streptococcus pneumoniae). Conservative use d/t toxicities but often still used in developing countries b/c of low cost 2) Protein Synthesis Inhib; Blocks peptidyltransfease at 50s ribosomal subunit. Bacteriostatic 3) Anemia (dose dep), Aplastic aneima (dose dep), Gray baby syndrome (in premature infants b/c lack liver UDP-glucuronyl transferase) 4) Resistance: Plasmid-encoded acetyltransferase that inactivates drug

Question 41

Clindamycin

Answer 41

1) Anaerobic infections (e.g., Bacteroides fragilis, Clostridium perfringens) in aspiration pneumonia or lung abscesses. Also oroal infections w/ mouth anaerobes. 2) Protein Synthesis Inhib; Block peptide transfer (transpeptidation at 50s ribosomal subunit. Bacteriostatic. 3) Pseudomembranous colitis (C. dificile overgrowth), fever, diarrhea. 4) Clindamycin tx anaerobes ABOVE the diaphragm vs Metronidazole (which tx anaerobes BELOW the diaphragm)

Question 42

Sulfadiazine

Answer 42

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI. 2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic. 3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin) 4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

Question 43

Sulfisoxazole

Answer 43

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI. 2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic. 3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin) 4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

Question 44

Sulfamethoxazole (SMX)

Answer 44

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI. 2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic. 3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin) 4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

Question 45

Trimethoprim (TMP)

Answer 45

1) Used in combo w/ sulfonamides [trimethoprim-sulfamethoxazole (TMP-SMX)], causing sequential block of folate synth. This combination is used to tx: UTIs, Shigella, Salmonella, Pneumocystic jirovecii pneumonia (tx & prophylaxis) 2) Inhib bacterial dihydrofolate reductase. Bacteriostatic 3) Megaloblastic anemia, leukopenia, granulocytopenia. [May alleviate w/ supplemental folinic acid (=Leucovorin rescue)] 4) TMP–Treats Marrow Poorly

Question 46

Ciprofloxacin

Answer 46

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 47

Norfloxacin

Answer 47

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 48

Levofloxacin

Answer 48

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 49

Ofloxacin

Answer 49

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 50

Sparfloxacin

Answer 50

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 51

Moxifloxacin

Answer 51

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 52

Gatifloxacin

Answer 52

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 53

Enoxacin

Answer 53

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 54

Nalidixic acid

Answer 54

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs 2) Quinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids. 3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone. 4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

Question 55

Metronidazole

Answer 55

1) Txs Giardia**, Entamoeba, Trichomonas*, Gardnerella vaginalis, Anaerobes (Bacteroides, C. dificile). Used w/ proton pump inhib & Clarithromycin for “triple therapy” against H. Pylori* (GET GAP on the Metro w/ metronidazole!) 2) Forms free radical toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal 3) Disulfuram-like rxn w/ alcohol; HA, Metallic taste

Question 56

Antimicrobial Drugs: Prophylaxis & Tx -M. tuberculosis -M. avium-intracelluare -M. leprae

Answer 56

Antimicrobial Drugs: Prophylaxis & Tx -M. tuberculosis–Prophylaxis=Isoniazid & Tx=Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE for tx) -M. avium-intracelluare–Prophylaxis=Azithromycin & Tx=Azithromycin, Rifampin, Ethanobutol, Streptomycin -M. leprae–Prophylaxis=N/A & Tx=Long-term tx w/ Dapsone & Rifampin for tuberculoid form. Add Clofazimine for lepromatous form.

Question 57

Isoniazid (INH)

Answer 57

1) Mycobacteriium tuberculosis; Only drug used as solo prophylaxis against TB 2) Antimicrobial; Decreases synth of mycolic acids. Bacterial catalase-peroxidases (KatG) needed to convert INH to active metabolite 3) Neurotoxicity, Hepatotoxicity. Pyridoxine (vit B6) can prevent neurotoxicity, lupus (INH–Injures Neurons & Hepatocytes) 4) Different INH half-lives in fast vs slow acetylator

Question 58

Rifampin

Answer 58

1) Mycobacterium tuburculosis; Delays resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ Haemophilus influenzae type B 2) Antimicrobial; Inhib DNA-dep RNA polymerase 3) Minor hepatotoxicity & drug rxns (increased P-450); Orange body fluids (nonhazardous side effect) 4) 4 Rs–RNA polymerase inhib, Revs up microsomal P-450, Red/orange body fluids, Rapid resistance if used alone

Question 59

Pyrazinamide

Answer 59

1) Mycobacterium tuberculosis 2) Antimicrobial; Mech unknown–thought to acidify intracellular env via conversion to pyrazinoic acid. Effective in acidid pH of phagolysosomes, where TB engulfed by macs is found 3) Hyperuricemia, Hepatotoxicity

Question 60

Ethambutol

Answer 60

1) Mycobacterium tuberculosis 2) Antimicrobial; Decreases carbohydrate polymerization of mycobacterum cell wall by blocking arabinosyltransferase 3) optic neuropathy (red-green color blindness)

Question 61

Antimicrobial Prophylaxis: -Meningococcal infection

Answer 61

-Ciprofloxacin (Rx of choice) -Rifampin for children

Question 62

Antimicrobial Prophylaxis: -Gonorrhea

Answer 62

-Ceftriaxone

Question 63

Antimicrobial Prophylaxis: -Syphilis

Answer 63

-Benzathine penicllin G

Question 64

Antimicrobial Prophylaxis: -History of recurrent UTIs

Answer 64

-TMP-SMX

Question 65

Antimicrobial Prophylaxis: -Endocarditis w/ surgical or dental procedures

Answer 65

-Penicillins

Question 66

Antimicrobial Prophylaxis: -Pregnant woman carrying group B strep

Answer 66

-Ampicillin

Question 67

Antimicrobial Prophylaxis: -Strep pharyngitis in child w/ prior rheumatic fever

Answer 67

-Oral penicllin

Question 68

Antimicrobial Prophylaxis: -Prevention of postsurgical infection due to S. aureus

Answer 68

-Cefazolin

Question 69

Antimicrobial Prophylaxis: -Prevention of gonococcal or chlamydial conjunctivitis in newborn

Answer 69

-Erythromycin ointment

Question 70

HIV: Prophylaxis Tx & Infection -CD4 < 200 cells/mm3 -CD4 < 100 cells/mm3 -CD4 < 50 cells/mm3

Answer 70

HIV Prophylaxis Tx & Infection: -CD4 < 200 cells/mm3=*TMP-SMX; Pneumocytis pneumonia -CD4 < 100 cells/mm3=*TMP-SMX=Pneumocytis pneumona & Toxoplasmosis -CD4 < 50 cells/mm3=Azithromycin; Mycobacterium avium complex *Aerosolized Pentamidine–can be used if pt is unable to tolerate TMP-SMX, butt this may not prevent toxoplasmosis

Question 71

Tx for highly resistant bacteria: -MRSA -VRE

Answer 71

-MRSA tx = Vancomycin -VRE tx =Linezolid & Streptogramins (quinupristin/dalfopristin)

Question 72

Amphotericin B

Answer 72

1) Serious systemic mycoses, Cryptococcus (w or w/o Flucytosine for cryptococcal meningitis), Blastomyces, Coccidioides, Histoplasma, Candida, Mucor. Intrathecally for fungal meningitis. 2) Antifungal; Alters membrane fnx–Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes (AmphoTERicin “TEARs” holes in fungal membrane) 3) Fever/chills (“shake & bake”), Hypotension, Nephrotoxicity, Arrhythmias, Anemia, IV phlebitis (“AMPHOTERRIble); Hydration reduces nephrotoxicity (see line #4); Liposomal Amphotericin reduced toxicity 4) Supplement K & Mg b/c of altered renal tubule permeability

Question 73

Nystatin

Answer 73

1) “Swish & swallow” for oral candidiasis (thrush); Topical for diaper rash or vaginal candidiasis 2) Antifungal; Same MOA as Amphotericin B [=Alters membrane fnx–Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes (AmphoTERicin “TEARs” holes in fungal membrane)]. Topical form b/c too toxic for systemic use

Question 74

Fluconazole

Answer 74

1) Local & Less serious systemic mycoses; Floconazole specific=Chronic suppression of cryptoccal meningitis in AIDs pts & candida infection of all types 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

Question 75

Ketoconazole

Answer 75

1) Local & Less serious systemic mycoses 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia, esp Ketoconazole) Liver dysfnx (inhib cytochrome P-450)

Question 76

Clotrimazole

Answer 76

1) Local & Less serious systemic mycoses; Clotrimazole (& Miconazole) specific=Topical fungal infections 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

Question 77

Miconazole

Answer 77

1) Local & Less serious systemic mycoses; Miconazole (& Clotrimazole) specific=Topical fungal infections 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

Question 78

Itraconazole

Answer 78

1) Local & Less serious systemic mycoses; Itraconazole specific=Tx for Bastomyces, Coccidiodes, & Histoplasma 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

Question 79

Voriconazole

Answer 79

1) Local & Less serious systemic mycoses 2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol 3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

Question 80

Flucytosine

Answer 80

1) Tx of systemic fungal infections (esp. meningitis caused by Cryptococcus) in combo w/ Amphotericin B 2) Antifungal; Inhib DNA & RNA biosynth by conversion to 5-fluorouracil by cytosine deaminase 3) BM suppression

Question 81

Caspofungin

Answer 81

1) Invasive aspergilliosis, Candida 2) Antifungal; Inhib cell wall synth by inhibiting synth of Beta-glucan 3) GI upset, flushing (by histasmine release)

Question 82

Micafungin

Answer 82

1) Invasive aspergilliosis, Candida 2) Antifungal; Inhib cell wall synth by inhibiting synth of Beta-glucan 3) GI upset, flushing (by histasmine release)

Question 83

Terbinafine

Answer 83

1) Tx dermatophytoses (esp onchomycosis=fungal infection of finger or toe nails) 2) Antifungal; Inhib fungal enzyme squalene epoxidase 3) Abn LFTs, Visual disturbances

Question 84

Griseofulvin

Answer 84

1) PO tx of superficial infections; Inhib growth of dermatophytes (tinea, ringworm) 2) Antifungal; Interferes w/ microtubule fnx; Disrupts mitosis. Deposits in keratin-containing tissues (e.g. nails) 3) Teratogenic, Carinogenic, Confusion, HAs, Increase P-450 & warfarin metabolism

Question 85

Pyrimethamine

Answer 85

1) Tx Toxoplasmosis 2) Antiprotozoan

Question 86

Suramin

Answer 86

1) Tx Trypanosoma brucei 2) Antiprotozoan

Question 87

Melarsoprol

Answer 87

1) Tx Trypanosoma brucei 2) Antiprotozoan

Question 88

Nifurtimox

Answer 88

1) Tx Trypansoma cruzi 2) Antiprotozoan

Question 89

Sodium stibogluconate

Answer 89

1) Tx Leishmaniasis 2) Antiprotozoan

Question 90

Chloroquine

Answer 90

1) Tx of plasmodial species other than P. falciparium ( d/t high resistance; see line #4) 2) Blocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodia 3) Retinopathy 4) P. falciparum mechanism of resistance: Membrane pump that decreases intracellular concentration of Chloroquine; Tx P. falciparum w/ Artemether/Lumifantrine OR Atovaquone/Proguanil; Tx life-threatening malaria w/ Quinidine in US (quinine elsewere) or Artisunate

Question 91

Txs for P. falciparum

Answer 91

-Artemether/Lumifantrine OR Atovaquone/Proguanil -NOT Chloroquine (d/t resistance)

Question 92

Txs for life-threatening malaria

Answer 92

-Quinidine in US (quinine elsewere) or Artisunate

Question 93

Mebendazole

Answer 93

2) Antihelminthic therapy; Immobilize helminths

Question 94

Pyrantel pamoate

Answer 94

2) Antihelminthic therapy; Immobilize helminths

Question 95

Ivermectin

Answer 95

2) Antihelminthic therapy; Immobilize helminths

Question 96

Diethylcarbamazine

Answer 96

2) Antihelminthic therapy; Immobilize helminths

Question 97

Praziquantel

Answer 97

1) Tx for flukes (trematodes, e.g. Schistosoma) 2) Antihelminthic therapy; Immobilize helminths

Question 98

Zanamivir

Answer 98

1) Tx and prevention of: Influenza A & B 2) Antiviral therapy; Inhib influenza neuraminidase, Decreasing the release of pogeny virus

Question 99

Oseltmavir

Answer 99

1) Tx and prevention of: Influenza A & B 2) Antiviral therapy; Inhib influenza neuraminidase, Decreasing the release of pogeny virus

Question 100

Ribavirin

Answer 100

1) RSV, Chronic hepatitis C 2) Antiviral therapy; Inhib synth of guanine nucleotides by competitively inhibiting IMP dehydrogenase 3) Hemolytic anemia, Severe teratogen

Question 101

Acyclovir

Answer 101

1) HSV & ZVZ; Weak activity against EBV. No activity against CMV. Used for HSZ-induced mucocutaneous & genital lesions as well as encephalitis. Prophylaxis in immunocompromised pts. No effect on latent forms of HSZ & ZVZ. 2) Antiviral therapy; Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inihib viral DNA polymerase by chain termination 4) Mechanism of resistance: Mutated viral thymidine kinase

Question 102

Valacyclovir

Answer 102

1) HSV & ZVZ; Weak activity against EBV. No activity against CMV. Used for HSZ-induced mucocutaneous & genital lesions as well as encephalitis. Prophylaxis in immunocompromised pts. No effect on latent forms of HSZ & ZVZ. 2) Antiviral therapy; **= a prodrug of Acyclovir, so has better oral bioavailability vs Acyclovir** Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inihib viral DNA polymerase by chain termination 4) Mechanism of resistance: Mutated viral thymidine kinase

Question 103

Famciclovir

Answer 103

1) Herpes Zoster 2) Antiviral therapy; **Related to Acyclovir**

Question 104

Ganciclovir

Answer 104

1) CMV, esp in immunocompromised pts. 2) Antiviral therapy; 5’-monophosphate formed CMV viral kinase Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhib viral DNA polymerase 3) Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity; More toxic to host enzymes vs Acyclovir 4) Mechanism of resistance: Mutated CMV DNA polymerase or lack of viral kinase

Question 105

Valganciclovir

Answer 105

1) CMV, esp in immunocompromised pts. 2) Antiviral therapy; **a prodrug of Ganciclovir, so has better ora bioavailability vs Ganciclovir** 5’-monophosphate formed CMV viral kinase Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhib viral DNA polymerase 3) Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity; More toxic to host enzymes vs Acyclovir 4) Mechanism of resistance: Mutated CMV DNA polymerase or lack of viral kinase

Question 106

Foscarnet

Answer 106

1) CMV retinitis in immunocompromised pts when Ganciclovir fails; Acyclovir-resistant HSV 2) Antiviral therapy; A pyrophosphate analog (Foscarnet=pyroFOSphate analog). Viral DNA polymerase inhib that binds to pyrophosphate-binding site of the enzyme. Does not req activation by viral kinase 3) Nephrotoxicity 4) Mechanism of resistance: Mutated DNA polymerase

Question 107

Cidofovir

Answer 107

1) CMV retinitis in immunocompromised pts; Acyclovir-resistant HSV 2) Antiviral therapy; Preferentially inhib viral DNA polymerase. Does not req phosphorylation by viral kinase. Long t-1/2. 3) Nephrotoxicity (co-admin w/ Probenecid & IV saline to reduce toxicity)

Question 108

HIV Therapy: -Name -When to initiate -Drug regimen

Answer 108

-Highly active antiretroviral therapy (HAART) -Initiate when pts present w/ AIDS-defining illness, low CD4+ cts (<500 cells/mm3), or high viral load -Regimen consists of (3) drugs to prevent resistance: –2 nucleoside reverse transcriptase inhib (NRTIs) + –1 non-nucleoside reverse transcriptase inhib (NNRTI) OR 1 protease inhib OR 1 integrase inhib

Question 109

Lopinavir

Answer 109

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 110

Atazanavir

Answer 110

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 111

Darunavir

Answer 111

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 112

Fosaprenavir

Answer 112

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 113

Saquinavir

Answer 113

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 114

Ritonavir

Answer 114

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy 4) All protease inhibitors end in -navir [Navir (never) tease a protease]; Ritonavir specific=CYP450 inhib

Question 115

Indinavir

Answer 115

1) HIV therapy 2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts) 3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy; Indinavir specific ADE=Hematuria 4) All protease inhibitors end in -navir [Navir (never) tease a protease]

Question 116

Tenofovir (TDF)

Answer 116

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy, Lactic Acidosis 4) Is a nucleotide analog, so does not have to be activated (vs other NRTIs, which are nucleoside analogs & therefore, req activation)

Question 117

Emtricitabine (FTC)

Answer 117

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis 4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 118

Abacavir (ABC)

Answer 118

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis 4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 119

Lamivudine (3TC)

Answer 119

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis 4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 120

Zidovudine (ZDV, formerly AZT)

Answer 120

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis; ZDZ specific ADE=Anemia 4) Used for general prophylaxis & during pregnancy to reduce risk of fetal transmission; Must be phosphorylated to be activated (the second statement is true of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 121

Didanosine (ddl)

Answer 121

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis 4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 122

Stavudine (d4T)

Answer 122

1) HIV therapy 2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group) 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis 4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

Question 123

Nevirapine

Answer 123

1) HIV therapy 2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

Question 124

Efazirenz

Answer 124

1) HIV therapy 2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

Question 125

Delavirdine

Answer 125

1) HIV therapy 2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides 3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

Question 126

Raltegravir

Answer 126

1) HIV therapy 2) Integrase inhib; Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase 3) Hypercholesterolemia

Question 127

IFN-Alpha

Answer 127

1) Chronic hepatitis B & C; Kaposi’s sarcoma 2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses 3) Neutropenia, Myopathy

Question 128

IFN-Beta

Answer 128

1) MS 2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses 3) Neutropenia, Myopathy

Question 129

IFN-Gamma

Answer 129

1) NADPH oxidase deficiency 2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses 3) Neutropenia, Myopathy

Question 130

Abx to avoid in pregnancy

Answer 130

Contraindicated in Pregnancy –> Adverse Effect: -Sulfonamides –> Kernicterus -Aminoglycosides –> Ototoxicity -Fluoroquinolones –> Cartolage damage -Clarithromycin –> Embryotoxic -Tetracyclines –> Discolored teeth, Inhib of bone growth -Ribavirin (antiviral) –> Teratogenic -Griseofulvin (antifungal) –> Teratogenic -Chloramphenicol –> “Gray baby” (SAFe Children Take Really Good Care)

Question 131

Sulfadiazine

Answer 131

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI. 2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic. 3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin) 4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis