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Drugs Flashcards

1
Q

5 major classes of antifungals

A

Polyenes, Azoles, Pyrimidines, Echinocandins, Allylamines

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2
Q

Which classes of antifungals act on cell membrane?

A

Polyenes, Azoles, Allylamines

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3
Q

Which class of antifungal act on cell wall?

A

Echinocandins

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4
Q

Which class of antifungal act on DNA?

A

Pyrimidines

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5
Q

Mechanism of polyenes

A

bind to ergosterol –> cell lysis

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6
Q

Polyenes (2)

A

Amphotericin B, Nystatin

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7
Q

Way of administration of Amphotericin B

A

IV

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8
Q

Empirical IV antifungal

A

Amphotericin B

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9
Q

Coverage of Amphotericin B (6)

A

Candida, Cryptococcus, Aspergillus, Mucoromycetes, Coccidiodes, Histoplasma

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10
Q

Side effects of Amphotericin B (4)

A

Renal toxicity, fever, n/v, phlebitis

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11
Q

Which antifungal requires close RFT monitoring?

A

Amphotericin B

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12
Q

Describe the renal toxicity of Amphotericin B (3)

A
  • dose-dependent
  • renal wasting of K, Mg, HCO3-
  • renal tubular acidosis
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13
Q

Salt of original Amphotericin B

A

Amphotericin B deoxycholate

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14
Q

What is the formulation to reduce side effects of Amphotericin B?

A

Liposomal formulation

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15
Q

Nystain usage (way of administration) (3)

A
  • Oral & oesophageal candidiasis (oral swish and swallow)
  • Vaginal candidiasis (topical)
  • Sclerosing agent (IV)
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16
Q

2 Types of Azoles

A

Imidazoles, Triazoles

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17
Q

Mechanism of Azoles

A

inhibit cytochrome-P450 dependent 14-demethylase –> stop conversion from lanosterol to ergosterol

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18
Q

Side effects of Azoles (2)

A

CYP450 inhibitor, Hepatotoxicity

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19
Q

Which classes of antifungal requires LFT monitoring? (2)

A

Azoles, Pyrimidines

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20
Q

Which 2 pathogens are intrinsically resistant to Azoles?

A

Candida glabrata, Candida krusei

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21
Q

Triazole with good CNS penetration and is used for long term treatment of Cryptococcal meningitis

A

Fluconazole

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22
Q

Antifungal with transient visual change as a common side effect

A

Voriconazole

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23
Q

Triazole that cover zygomycetes

A

Posaconazole

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24
Q

Antifungal with haematological suppression as side effect

A

5-flurocytosine

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25
Q

Antifungal that induces resistance rapidly if given as monotherapy (synergism with?)

A

5-flurocytosine, synergistic with amphotericin B

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26
Q

Way of administration of 5-Flurocytosine

A

oral

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27
Q

Echinocandins (3)

A

Caspofungin, Micafungin, Anidulafungin
卡士普 米卡 安妮杜拉

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28
Q

Way of administration of Echinocandins

A

IV (daily dose)

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29
Q

Mechanism and coverage (2, effect) of Echinocandins

A

inhibit 1,3 D-glucan synthase –> inhibit cell wall synthesis
Coverage: Candida (fungicidal), Asperigillus (fungistatic)

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30
Q

Antifungal class that is ineffective in UTI and CNS infections due to questionable penetration

A

Echinocandins

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31
Q

Allylamines (2)

A

Terbinafine, Naftifine

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32
Q

Mechanism of Allylamines

A

inhibit squalene monoxygenase –> inhibit ergosterol synthesis

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33
Q

Antifungals available as OTC nail lacquer

A

Amorolfine 阿莫羅芬, Ciclopirox

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34
Q

Why liposomal formulations of amphotercin B cannot be made manually?

A

risk of precipitation, instability

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35
Q

Which 2 non β lactams commonly cause C. difficile colitis?

A

Quinolones, Clindamycin

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36
Q

Which 3 non β lactams cause renal toxicity?

A

Glycopeptides, Aminoglycosides, Polymyxins

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37
Q

Which 2 non β lactams cause ototoxicity?

A

Aminoglycosides, Glycopeptides (rare)

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38
Q

Which non β lactam causes neuromuscular block as a rare side effect?

A

Aminoglycosides

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39
Q

Which non β lactam cause peripheral neuropathy and optic neuropathy?

A

Oxazolidinones

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40
Q

Which 2 non β lactams cause CNS toxicity?

A

Polymyxins, Quinolones (rare)

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41
Q

Which non β lactam causes teeth discoloration, depresses bone growth and thus is contraindicated in children <8y?

A

Tetracyclines

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42
Q

Which non β lactam causes cartilage injury and is thus contraindicated in children <16y?

A

Quinolones

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43
Q

Which 2 non β lactams cause thrombocytopenia?

A

Glycopeptides, Oxazolidinones (prolonged use)

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44
Q

Which non β lactam causes acute haemolytic anaemia?

A

Co-trimoxazoles

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45
Q

Which non β lactam causes aplastic anaemia, which could be fatal?

A

Chloramphenicols

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46
Q

Which 3 non β lactams can cross placenta and is thus terotogenic?

A

Aminoglycosides, Metronidazoles, Chloramphenicols

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47
Q

Which non β lactam causes red man syndrome?

A

Vancomycin

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48
Q

Which non β lactam cause photosensitivity and SJS?

A

Co-trimoxazoles

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49
Q

Which 2 non β lactams potentiate effects of Warfarin?

A

Ofloxacin, Metronidazoles

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50
Q

Side effects of Aminoglycosides (4)

A

nephrotoxicity, ototoxicity, neuromuscular block, terotogenic

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51
Q

Side effects of Linezolid (3)

A

thrombocytopenia, peripheral neuropathy, optic neuropathy

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52
Q

Side effects of Tetracyclines (2)

A

Teeth discoloration, depress bone growth

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53
Q

Side effects of Septrin (3)

A

Acute haemolytic anaemia, photosensitivity, SJS

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54
Q

Side effects of Vancomycin (4)

A

nephrotoxicity, ototoxicity (rare), neutropenia & thrombocytopenia, red man syndrome

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55
Q

Which non β lactam causes tendinopathy?

A

Quinolones

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56
Q

Side effects of Quinolones (6)

A

GI distress, C. difficile colitis, cartilage injury, tendinopathy, CNS toxicity, arrhythmia

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57
Q

Side effects of Polymyxins (2)

A

nephrotoxicity, CNS toxicity

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58
Q

Side effects of Chloramphenicals (2)

A

aplastic anaemia, terotogenic

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59
Q

Side effect of Spectinomycin

A

discomfort at injection site

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60
Q

Mechanism of Glycopeptide

A

bind D-ala-D-ala tail –> stop elongation fo peptidoglycan

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61
Q

Usage of vancomycin

A

[IV] MRSA systemic infection
[oral] C. difficile colitis

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62
Q

Which 2 non β lactam have post-antibiotic effect?

A

Aminoglycosides, Quinolones

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63
Q

Mechanism of Aminoglycosides

A

cause misreading of mRNA –> - protein synthesis

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64
Q

Glycopeptides (2)

A

Vancomycin, Teicoplanin

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65
Q

Aminoglycosides (5)

A

Streptomycin, Gentamicin, Amikacin, Netilmicin, Neomycin

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66
Q

Which Aminoglycoside is available in topical, eye drops, and oral form?

A

Neomycin

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67
Q

Which Aminoglycoside has the least ototoxicity?

A

Netilmicin

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68
Q

Mechanism of Linezolid

A

inhibit protein sythesis initiation

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69
Q

Usage of Linezolid

A

MRSA infection in vancomycin failure / allergy

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70
Q

Mechanism of Macrolides

A

block 50s formation –> block a.a. elongation –> inhibit protein sythesis

71
Q

Prescription precaution of oral Macrolide

A

1h before meal or 2h after meal

72
Q

Macrolides (3)

A

Erithromycin, Clarithromycin, Azithromycin

73
Q

Mechanism of Tetracyclines

A

reversibly binding to 30s –> inhibit protein synthesis

74
Q

Tetracyclines (2)

A

Doxycycline, Tigecycline

75
Q

Septrin full form

A

Trimethoprim-Sulfamethoxazole

76
Q

Mechanism of Septrin

A

inhibit folic acid synthesis

77
Q

Quinolones (5) (in ascending order of GPB activity)

A

Ofloxacin < Ciprofloxacin < Levofloxacin < Moxifloxacin < Gemifloxacin

78
Q

Mechanism of Quinolones

A

inhibit bacterial DNA synthesis (DNA gyrases, DNA topoisomerases IV)

79
Q

DDI of Ofloxacin

A

enhance effect of Warfarin
Mg or Al containing antacids, Fe containing drugs interfere with absorption

80
Q

Mechanism of Metronidazole

A

intermediate reacts with DNA

81
Q

Mechanism of Polymyxins

A

penetrate into outer cell membrane –>
competitively replace cations —> combine with negatively charged phospholipids —> disrupt cell membrane integrity

82
Q

Lincosamide (2)

A

Lincomycin, Clindamycin

83
Q

Which 5 non β lactams are bacteriostatic instead of bacteriocidal?

A

Oxazolidinones, Macrolides, Tetracyclines
Spectinomycin, Fusidic acid

84
Q

Which non β lactam acts on cell wall?

A

Glycopeptides

85
Q

Which non β lactam acts on cell membrane?

A

Polymyxins

86
Q

Which 3 non β lactams act on DNA?

A

Co-trimoxazoles, Quinolones, Metronidazoles

87
Q

Which non β lactams mainly target on GPB? (3)

A

Glycopeptides, Oxazolidinones, Lincosamides

88
Q

Which non β lactams mainly target on GNB? (2)

A

Aminoglycosides, Quinolones

89
Q

Which non β lactams mainly target on anaerobes?

A

Metronidazoles

90
Q

Which non β lactams cover atypical bacteria? (3)

A

Tetracyclines, Chloramphenicals, Macrolides

91
Q

Which non β lactam cover intracellular organisms?

A

Tetracyclines

92
Q

Usage of Spectinomycin

A

Nesseria gonorrhoeae infection

93
Q

Usage of Co-trimoxazoles (2)

A

Toxoplasma gondii, Pneumocystis jirovecii

94
Q

Which 2 non β lactams are contraindicated in children?

A

Tetracyclines, Quinolones

95
Q

Traditional anti-TB drugs (4)

A

Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E)

96
Q

Which anti-TB drug causes peripheral neuropathy and vitamin B6 may be co-administered?

97
Q

Which ABx causes orange discoloration of urine?

A

Rifampicin

98
Q

Which anti-TB drug is a P-450 inducer?

A

Rifampicin

99
Q

Mechanism of Rifampicin

A

inhibit DNA-dependent RNA polymerase

100
Q

Which anti-TB drug develops resistance rapidly when given as monotherapy?

A

Rifampicin

101
Q

Which anti-TB drug causes polyarthralgia?

A

Pyrazinamide

102
Q

Which anti-TB drug causes ocular toxicity? Describe

A

Ethambutol
↓ visual acuity and loss of colour vision

103
Q

Treatment regimen of active TB

A

2 month HRZE + 4 month HR

104
Q

What ABx is used for TB treatment when isoniazid is contraindicated?

A

Replace isoniazid with levofloxacin

105
Q

Which ABx are bacteria with VanA gene resistant to?

A

Glycopeptides

106
Q

Which ABx are bacteria with mcr-1 gene resistant to?

A

Polymyxins
(mobilised colistin resistance)

107
Q

Which ABx are bacteria with gyrA, parC genes resistant to?

A

Quinolones

108
Q

Which ABx are bacteria with erm gene resistant to?

A

Macrolides

109
Q

Which ABx commonly require TDM? (3)

A

vancomycin, gentamicin, amikacin…

110
Q

Which Co-trimoxazole inhibit dihydrofolate reductase?

A

Trimethoprim

111
Q

Which Co-trimoxazole inhibit dihydropteroate synthetase?

A

Sulfamethoxazole

112
Q

Which ABx are bacteria with rpoB gene resistant to?

A

Rifampicin

113
Q

Mechanism of beta-lactams

A

mimic D-ala-D-ala residues –> transpeptidase binds to penicillin instead of D-ala-D-ala –> inhibit synthesis of peptidoglycan –> inhibit cell wall synthesis

114
Q

Augmentin full form

A

Amoxicillin + Clavulanic acid

115
Q

Tazocin full form

A

Piperacillin + Tazobactam

116
Q

Oral form of penicillin

A

Penicillin V

117
Q

Oral form of Aminopenicillins

A

Amoxicillin

118
Q

Which beta lactam requires co-administration of weekly vitamin K?

A

Cefoperazone + Sulbactam

119
Q

Which type of adverse drug reaction does allergy belong to?

120
Q

Risk factors for penicillin allergy (4)

A
  • frequent, repeated course of penicillin
  • parenteral administration
  • hereditary factors
  • Hx of SJS, toxic epidermal necrolysis, drug hypersensitivity syndrome
121
Q

Test to determine whether the patient has antibiotic allergy and procedure

A

Graded challenge:
- stop pre-treated with anti-histamines / glucocorticoids
- starting dose = 1/4 or 1/10 of full dose –> observe for 30~60 mins
- proceed to full dose –> observe for another 30~60 mins

122
Q

Indication for desensitization test (2)

A

definite / suspected history of Type I allergy, and alternative ABx not available

123
Q

Which beta lactam does not need renal adjustment as most of it is not excreted via urine? (Via what?)

A

Ceftriaxone (bile)

124
Q

Example of synergism & antagonism of antiotics with penicillin

A

Synergism: Aminoglycosides (enable entry of drugs)
Antagonism: Bacteriostatic agents (inhibit bacteriocidal effect of beta-lactams)

125
Q

Time-dependent killing v.s. Concentration-dependent killing

A

Time-dependent: ↑ frequency of dose –> ↑ killing (e.g. β-lactams)
Concentration-dependent: ↑ dosage –> ↑ killing (e.g. Aminoglycosides)

126
Q

What is post-antibiotic effect?

A

persistent suppression after ABx exposure, even when concentration < min inhibitory concentration (MIC)

127
Q

Calculation of post-antibiotic effect

A

PAE = T - C
(T = time of regrowth by 1 log of organisms after ABx removal)
(C = time for growth in control by 1 log)

128
Q

Trough level v.s. Peak level in ABx TDM

A

Trough level: correspond to toxicity (adjusted by frequency)
Peak level: correspond to clinical outcomes (adjusted by dosage)

129
Q

Which gene does MRSA belong making it resistant to penicillin? (Effect)

A

mecA (modification of penicillin-binding protein)

130
Q

4 resistance mechanisms against beta-lactams

A
  1. Permeability barrier
  2. Efflux pump
  3. Modification of penicillin-binding protein
  4. β-lactamase
131
Q

3 types of β-lactamases & Treatment

A
  1. ESBL (Carbapenem)
  2. AmpC β-lactamase (4th GC)
  3. Carbapenemase (?)
132
Q

Which type of β-lactamase does New Delhi Metallo-beta-lactamase belong to?

A

Carbapenemase

133
Q

How do bacteria acquire resistance gene? (3)

A

Transformation (from environment)
Conjugation (via pilus)
Transduction (via bacteriophage)

134
Q

Types of vaccines (4+2)

A

Live attenuated, Inactivated, Subunit, Toxoid
mRNA, vector

135
Q

Toxoid vaccines (2)

A

Tetanus, Diphtheria

136
Q

Subunit vaccines (3)

A

HBV, HPV, acellular Pertussis

137
Q

Inactivated vaccines (3+4)

A

Pneumoccocus, Hib, Meningococcus ACYW
HAV, Polio (IM), Rabies, Influenza (injected)

138
Q

Order the immunogenicity of the 3 MC vaccine types by descending order

A

Live attenuated > Inactivated > Subunit

139
Q

Example of vector used for vector vaccines

A

Adenovirus

140
Q

Vaccine adverse reactions: common (3+1) & rare (2)

A

Common:
- discomfort at injection site, fever, malaise
- anaphylaxis

Rare:
- GBS
- reversion to virulence

141
Q

Can pregnency get vaccination? (live attenuated, inactivated)

A

Live attenuated: ⨉
Inactivated: ok

142
Q

3 types of aims of vaccination programme

A

eradication, elimination, containment

143
Q

HK Childhood immunization programme: details

A

BCG: 0
HBV: 0,1,6
DTaP-IPV: 2,4,6,18,P1,P6
PCV13: 2,4,12
MMRV: 12,18
HPV [for girls only]: P5,P6

144
Q

What is DTaP-IPV?

A

Diphtheria, Tetanus, acellular Pertussis & Inactivated Poliovirus vaccine

145
Q

Which vaccine is patients with renal failure on dialysis suggested to take?

146
Q

What vaccines should patients with BM transplant take?

A

all childhood vaccination

147
Q

What type of vaccine is Sinovac?

A

Inactivated

148
Q

What type of vaccine is BioNtech? What is its mechanism?

A

mRNA
mRNA encoding spike protein –> induce human cells to make spike protein

149
Q

Side effects of Amantadine, Rimantadine

A

insomnia, drowsiness

150
Q

Which influenza drug is intranasal?

151
Q

Which influenza drug is available for patients >12y only?

152
Q

Mechanism of anti-herpesviridae drugs

A

DNA polymerase inhibitor –> chain termination of DNA synthesis

153
Q

Why acyclovir has a good safety profile?

A

require 3-time phosphorylation to be activated, with first step being viral thymidine kinase

154
Q

Number of dosage of acyclovir per day

155
Q

Antiviral for CMV

A

Ganciclovir

156
Q

Side effects for virus-specific immunoglobulin (3)

A

HSR, blood-borne pathogens, IC formation

157
Q

Antiviral for genital warts / genital herpes resistant to acyclovir

A

Imiquimod (Aldara)

158
Q

Antibiotics prophylaxis for different surgical wounds

A

Clean: not required except
- Neurosurgery: Ceftrixone
- Knee implant: Cefazolin
Clean-contaminated: Cefazolin
Contaminated: Cefuroxine + Metronidazole
Dirty: case-by-case

159
Q

When should surgical prophylaxis be given? After how much time should dosing be repeated? What surgery requires addition (for how long)?

A

30~60mins before incision, single dose IV
2x half life of the drug
Cardiothoracic surgery (72 hours after surgery)

160
Q

Post-exposure prophylaxis for influenza A

A

Oseltamivir

161
Q

Post-exposure prophylaxis to HIV

A

(Tenofovir + Emtricitabine) + Raltegravir

162
Q

Example of dual NRTI drugs for HIV

A

Tenofovir + Emtricitabine

163
Q

Example of integrase strand-transfer inhibitor for HIV

A

Raltegravir

164
Q

2 anti-herpesviridae drugs with higher oral availability

A

Valaciclovir, Famiciclovir

165
Q

How to prevent red man syndrome caused by vancomycin?

A

slow infusion

166
Q

Which antibiotic is used in the susceptibility test for MRSA?

167
Q

What is the D test for antibiotic susceptibility? (which ABx used and what does it test for?)

A

erythromycin + clindamycin
clindamycin-resistant Staphylococci

168
Q

Special susceptibility tests for ESBL (2)

A

keyhole effect + double disk synergy test

169
Q

Resistance mechanism towards quinolone

A

Single point mutation
At quinolone resistant determining region (QRDR) (e.g. gyrA, parC)

170
Q

Resistance mechanism to polymyxin

A

mcr1 gene mutation —> modify lipid A of LPS with pEtN (phospho-ethanolamine) —> neutralise overall negative charges —> positively charged polymyxin cannot bind to LPS

171
Q

Resistance metabolism to septrin

A

Mutation in synthase gene —> decrease permeability and increase efflux

172
Q

Advantages and disadvantages of live attenuated vaccine (2+2)

A

Highly immunogenic, long lasting

Risk of reversion to virulence, require cold temperature to maintain viability

173
Q

Which penicillin gives rash as side effects?

A

Amoxicllin / Ampicillin

MED4 MIC (8 decks)

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