Drugs Flashcards
1
Q
5 major classes of antifungals
A
Polyenes, Azoles, Pyrimidines, Echinocandins, Allylamines
2
Q
Which classes of antifungals act on cell membrane?
A
Polyenes, Azoles, Allylamines
3
Q
Which class of antifungal act on cell wall?
A
Echinocandins
4
Q
Which class of antifungal act on DNA?
A
Pyrimidines
5
Q
Mechanism of polyenes
A
bind to ergosterol –> cell lysis
6
Q
Polyenes (2)
A
Amphotericin B, Nystatin
7
Q
Way of administration of Amphotericin B
A
IV
8
Q
Empirical IV antifungal
A
Amphotericin B
9
Q
Coverage of Amphotericin B (6)
A
Candida, Cryptococcus, Aspergillus, Mucoromycetes, Coccidiodes, Histoplasma
10
Q
Side effects of Amphotericin B (4)
A
Renal toxicity, fever, n/v, phlebitis
11
Q
Which antifungal requires close RFT monitoring?
A
Amphotericin B
12
Q
Describe the renal toxicity of Amphotericin B (3)
A
- dose-dependent
- renal wasting of K, Mg, HCO3-
- renal tubular acidosis
13
Q
Salt of original Amphotericin B
A
Amphotericin B deoxycholate
14
Q
What is the formulation to reduce side effects of Amphotericin B?
A
Liposomal formulation
15
Q
Nystain usage (way of administration) (3)
A
- Oral & oesophageal candidiasis (oral swish and swallow)
- Vaginal candidiasis (topical)
- Sclerosing agent (IV)
16
Q
2 Types of Azoles
A
Imidazoles, Triazoles
17
Q
Mechanism of Azoles
A
inhibit cytochrome-P450 dependent 14-demethylase –> stop conversion from lanosterol to ergosterol
18
Q
Side effects of Azoles (2)
A
CYP450 inhibitor, Hepatotoxicity
19
Q
Which classes of antifungal requires LFT monitoring? (2)
A
Azoles, Pyrimidines
20
Q
Which 2 pathogens are intrinsically resistant to Azoles?
A
Candida glabrata, Candida krusei
21
Q
Triazole with good CNS penetration and is used for long term treatment of Cryptococcal meningitis
A
Fluconazole
22
Q
Antifungal with transient visual change as a common side effect
A
Voriconazole
23
Q
Triazole that cover zygomycetes
A
Posaconazole
24
Q
Antifungal with haematological suppression as side effect
A
5-flurocytosine
25
Antifungal that induces resistance rapidly if given as monotherapy (synergism with?)
5-flurocytosine, synergistic with amphotericin B
26
Way of administration of 5-Flurocytosine
oral
27
Echinocandins (3)
Caspofungin, Micafungin, Anidulafungin
卡士普 米卡 安妮杜拉
28
Way of administration of Echinocandins
IV (daily dose)
29
Mechanism and coverage (2, effect) of Echinocandins
inhibit 1,3 D-glucan synthase --> inhibit cell wall synthesis
Coverage: Candida (fungicidal), Asperigillus (fungistatic)
30
Antifungal class that is ineffective in UTI and CNS infections due to questionable penetration
Echinocandins
31
Allylamines (2)
Terbinafine, Naftifine
32
Mechanism of Allylamines
inhibit squalene monoxygenase --> inhibit ergosterol synthesis
33
Antifungals available as OTC nail lacquer
Amorolfine 阿莫羅芬, Ciclopirox
34
Why liposomal formulations of amphotercin B cannot be made manually?
risk of precipitation, instability
35
Which 2 non β lactams commonly cause C. difficile colitis?
Quinolones, Clindamycin
36
Which 3 non β lactams cause renal toxicity?
Glycopeptides, Aminoglycosides, Polymyxins
37
Which 2 non β lactams cause ototoxicity?
Aminoglycosides, Glycopeptides (rare)
38
Which non β lactam causes neuromuscular block as a rare side effect?
Aminoglycosides
39
Which non β lactam cause peripheral neuropathy and optic neuropathy?
Oxazolidinones
40
Which 2 non β lactams cause CNS toxicity?
Polymyxins, Quinolones (rare)
41
Which non β lactam causes teeth discoloration, depresses bone growth and thus is contraindicated in children <8y?
Tetracyclines
42
Which non β lactam causes cartilage injury and is thus contraindicated in children <16y?
Quinolones
43
Which 2 non β lactams cause thrombocytopenia?
Glycopeptides, Oxazolidinones (prolonged use)
44
Which non β lactam causes acute haemolytic anaemia?
Co-trimoxazoles
45
Which non β lactam causes aplastic anaemia, which could be fatal?
Chloramphenicols
46
Which 3 non β lactams can cross placenta and is thus terotogenic?
Aminoglycosides, Metronidazoles, Chloramphenicols
47
Which non β lactam causes red man syndrome?
Vancomycin
48
Which non β lactam cause photosensitivity and SJS?
Co-trimoxazoles
49
Which 2 non β lactams potentiate effects of Warfarin?
Ofloxacin, Metronidazoles
50
Side effects of Aminoglycosides (4)
nephrotoxicity, ototoxicity, neuromuscular block, terotogenic
51
Side effects of Linezolid (3)
thrombocytopenia, peripheral neuropathy, optic neuropathy
52
Side effects of Tetracyclines (2)
Teeth discoloration, depress bone growth
53
Side effects of Septrin (3)
Acute haemolytic anaemia, photosensitivity, SJS
54
Side effects of Vancomycin (4)
nephrotoxicity, ototoxicity (rare), neutropenia & thrombocytopenia, red man syndrome
55
Which non β lactam causes tendinopathy?
Quinolones
56
Side effects of Quinolones (6)
GI distress, C. difficile colitis, cartilage injury, tendinopathy, CNS toxicity, arrhythmia
57
Side effects of Polymyxins (2)
nephrotoxicity, CNS toxicity
58
Side effects of Chloramphenicals (2)
aplastic anaemia, terotogenic
59
Side effect of Spectinomycin
discomfort at injection site
60
Mechanism of Glycopeptide
bind D-ala-D-ala tail --> stop elongation fo peptidoglycan
61
Usage of vancomycin
[IV] MRSA systemic infection
[oral] C. difficile colitis
62
Which 2 non β lactam have post-antibiotic effect?
Aminoglycosides, Quinolones
63
Mechanism of Aminoglycosides
cause misreading of mRNA --> - protein synthesis
64
Glycopeptides (2)
Vancomycin, Teicoplanin
65
Aminoglycosides (5)
Streptomycin, Gentamicin, Amikacin, Netilmicin, Neomycin
66
Which Aminoglycoside is available in topical, eye drops, and oral form?
Neomycin
67
Which Aminoglycoside has the least ototoxicity?
Netilmicin
68
Mechanism of Linezolid
inhibit protein sythesis initiation
69
Usage of Linezolid
MRSA infection in vancomycin failure / allergy
70
Mechanism of Macrolides
block 50s formation --> block a.a. elongation --> inhibit protein sythesis
71
Prescription precaution of oral Macrolide
1h before meal or 2h after meal
72
Macrolides (3)
Erithromycin, Clarithromycin, Azithromycin
73
Mechanism of Tetracyclines
reversibly binding to 30s --> inhibit protein synthesis
74
Tetracyclines (2)
Doxycycline, Tigecycline
75
Septrin full form
Trimethoprim-Sulfamethoxazole
76
Mechanism of Septrin
inhibit folic acid synthesis
77
Quinolones (5) (in ascending order of GPB activity)
Ofloxacin < Ciprofloxacin < Levofloxacin < Moxifloxacin < Gemifloxacin
78
Mechanism of Quinolones
inhibit bacterial DNA synthesis (DNA gyrases, DNA topoisomerases IV)
79
DDI of Ofloxacin
enhance effect of Warfarin
Mg or Al containing antacids, Fe containing drugs interfere with absorption
80
Mechanism of Metronidazole
intermediate reacts with DNA
81
Mechanism of Polymyxins
penetrate into outer cell membrane -->
competitively replace cations —> combine with negatively charged phospholipids —> disrupt cell membrane integrity
82
Lincosamide (2)
Lincomycin, Clindamycin
83
Which 5 non β lactams are bacteriostatic instead of bacteriocidal?
Oxazolidinones, Macrolides, Tetracyclines
Spectinomycin, Fusidic acid
84
Which non β lactam acts on cell wall?
Glycopeptides
85
Which non β lactam acts on cell membrane?
Polymyxins
86
Which 3 non β lactams act on DNA?
Co-trimoxazoles, Quinolones, Metronidazoles
87
Which non β lactams mainly target on GPB? (3)
Glycopeptides, Oxazolidinones, Lincosamides
88
Which non β lactams mainly target on GNB? (2)
Aminoglycosides, Quinolones
89
Which non β lactams mainly target on anaerobes?
Metronidazoles
90
Which non β lactams cover atypical bacteria? (3)
Tetracyclines, Chloramphenicals, Macrolides
91
Which non β lactam cover intracellular organisms?
Tetracyclines
92
Usage of Spectinomycin
Nesseria gonorrhoeae infection
93
Usage of Co-trimoxazoles (2)
Toxoplasma gondii, Pneumocystis jirovecii
94
Which 2 non β lactams are contraindicated in children?
Tetracyclines, Quinolones
95
Traditional anti-TB drugs (4)
Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E)
96
Which anti-TB drug causes peripheral neuropathy and vitamin B6 may be co-administered?
Isoniazid
97
Which ABx causes orange discoloration of urine?
Rifampicin
98
Which anti-TB drug is a P-450 inducer?
Rifampicin
99
Mechanism of Rifampicin
inhibit DNA-dependent RNA polymerase
100
Which anti-TB drug develops resistance rapidly when given as monotherapy?
Rifampicin
101
Which anti-TB drug causes polyarthralgia?
Pyrazinamide
102
Which anti-TB drug causes ocular toxicity? Describe
Ethambutol
↓ visual acuity and loss of colour vision
103
Treatment regimen of active TB
2 month HRZE + 4 month HR
104
What ABx is used for TB treatment when isoniazid is contraindicated?
Replace isoniazid with levofloxacin
105
Which ABx are bacteria with VanA gene resistant to?
Glycopeptides
106
Which ABx are bacteria with mcr-1 gene resistant to?
Polymyxins
(mobilised colistin resistance)
107
Which ABx are bacteria with gyrA, parC genes resistant to?
Quinolones
108
Which ABx are bacteria with erm gene resistant to?
Macrolides
109
Which ABx commonly require TDM? (3)
vancomycin, gentamicin, amikacin...
110
Which Co-trimoxazole inhibit dihydrofolate reductase?
Trimethoprim
111
Which Co-trimoxazole inhibit dihydropteroate synthetase?
Sulfamethoxazole
112
Which ABx are bacteria with rpoB gene resistant to?
Rifampicin
113
Mechanism of beta-lactams
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
Augmentin full form
Amoxicillin + Clavulanic acid
115
Tazocin full form
Piperacillin + Tazobactam
116
Oral form of penicillin
Penicillin V
117
Oral form of Aminopenicillins
Amoxicillin
118
Which beta lactam requires co-administration of weekly vitamin K?
Cefoperazone + Sulbactam
119
Which type of adverse drug reaction does allergy belong to?
Type B
120
Risk factors for penicillin allergy (4)
- frequent, repeated course of penicillin
- parenteral administration
- hereditary factors
- Hx of SJS, toxic epidermal necrolysis, drug hypersensitivity syndrome
121
Test to determine whether the patient has antibiotic allergy and procedure
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
Indication for desensitization test (2)
definite / suspected history of Type I allergy, and alternative ABx not available
123
Which beta lactam does not need renal adjustment as most of it is not excreted via urine? (Via what?)
Ceftriaxone (bile)
124
Example of synergism & antagonism of antiotics with penicillin
Synergism: Aminoglycosides (enable entry of drugs)
Antagonism: Bacteriostatic agents (inhibit bacteriocidal effect of beta-lactams)
125
Time-dependent killing v.s. Concentration-dependent killing
Time-dependent: ↑ frequency of dose --> ↑ killing (e.g. β-lactams)
Concentration-dependent: ↑ dosage --> ↑ killing (e.g. Aminoglycosides)
126
What is post-antibiotic effect?
persistent suppression after ABx exposure, even when concentration < min inhibitory concentration (MIC)
127
Calculation of post-antibiotic effect
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
Trough level v.s. Peak level in ABx TDM
Trough level: correspond to toxicity (adjusted by frequency)
Peak level: correspond to clinical outcomes (adjusted by dosage)
129
Which gene does MRSA belong making it resistant to penicillin? (Effect)
mecA (modification of penicillin-binding protein)
130
4 resistance mechanisms against beta-lactams
1. Permeability barrier
2. Efflux pump
3. Modification of penicillin-binding protein
4. β-lactamase
131
3 types of β-lactamases & Treatment
1. ESBL (Carbapenem)
2. AmpC β-lactamase (4th GC)
3. Carbapenemase (?)
132
Which type of β-lactamase does New Delhi Metallo-beta-lactamase belong to?
Carbapenemase
133
How do bacteria acquire resistance gene? (3)
Transformation (from environment)
Conjugation (via pilus)
Transduction (via bacteriophage)
134
Types of vaccines (4+2)
Live attenuated, Inactivated, Subunit, Toxoid
mRNA, vector
135
Toxoid vaccines (2)
Tetanus, Diphtheria
136
Subunit vaccines (3)
HBV, HPV, acellular Pertussis
137
Inactivated vaccines (3+4)
Pneumoccocus, Hib, Meningococcus ACYW
HAV, Polio (IM), Rabies, Influenza (injected)
138
Order the immunogenicity of the 3 MC vaccine types by descending order
Live attenuated > Inactivated > Subunit
139
Example of vector used for vector vaccines
Adenovirus
140
Vaccine adverse reactions: common (3+1) & rare (2)
Common:
- discomfort at injection site, fever, malaise
- anaphylaxis
Rare:
- GBS
- reversion to virulence
141
Can pregnency get vaccination? (live attenuated, inactivated)
Live attenuated: ⨉
Inactivated: ok
142
3 types of aims of vaccination programme
eradication, elimination, containment
143
HK Childhood immunization programme: details
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
What is DTaP-IPV?
Diphtheria, Tetanus, acellular Pertussis & Inactivated Poliovirus vaccine
145
Which vaccine is patients with renal failure on dialysis suggested to take?
HBV
146
What vaccines should patients with BM transplant take?
all childhood vaccination
147
What type of vaccine is Sinovac?
Inactivated
148
What type of vaccine is BioNtech? What is its mechanism?
mRNA
mRNA encoding spike protein --> induce human cells to make spike protein
149
Side effects of Amantadine, Rimantadine
insomnia, drowsiness
150
Which influenza drug is intranasal?
Zanamivir
151
Which influenza drug is available for patients >12y only?
Baloxavir
152
Mechanism of anti-herpesviridae drugs
DNA polymerase inhibitor --> chain termination of DNA synthesis
153
Why acyclovir has a good safety profile?
require 3-time phosphorylation to be activated, with first step being viral thymidine kinase
154
Number of dosage of acyclovir per day
5
155
Antiviral for CMV
Ganciclovir
156
Side effects for virus-specific immunoglobulin (3)
HSR, blood-borne pathogens, IC formation
157
Antiviral for genital warts / genital herpes resistant to acyclovir
Imiquimod (Aldara)
158
Antibiotics prophylaxis for different surgical wounds
Clean: not required except
- Neurosurgery: Ceftrixone
- Knee implant: Cefazolin
Clean-contaminated: Cefazolin
Contaminated: Cefuroxine + Metronidazole
Dirty: case-by-case
159
When should surgical prophylaxis be given? After how much time should dosing be repeated? What surgery requires addition (for how long)?
30~60mins before incision, single dose IV
2x half life of the drug
Cardiothoracic surgery (72 hours after surgery)
160
Post-exposure prophylaxis for influenza A
Oseltamivir
161
Post-exposure prophylaxis to HIV
(Tenofovir + Emtricitabine) + Raltegravir
162
Example of dual NRTI drugs for HIV
Tenofovir + Emtricitabine
163
Example of integrase strand-transfer inhibitor for HIV
Raltegravir
164
2 anti-herpesviridae drugs with higher oral availability
Valaciclovir, Famiciclovir
165
How to prevent red man syndrome caused by vancomycin?
slow infusion
166
Which antibiotic is used in the susceptibility test for MRSA?
cefoxitin
167
What is the D test for antibiotic susceptibility? (which ABx used and what does it test for?)
erythromycin + clindamycin
clindamycin-resistant Staphylococci
168
Special susceptibility tests for ESBL (2)
keyhole effect + double disk synergy test
169
Resistance mechanism towards quinolone
Single point mutation
At quinolone resistant determining region (QRDR) (e.g. gyrA, parC)
170
Resistance mechanism to polymyxin
mcr1 gene mutation —> modify lipid A of LPS with pEtN (phospho-ethanolamine) —> neutralise overall negative charges —> positively charged polymyxin cannot bind to LPS
171
Resistance metabolism to septrin
Mutation in synthase gene —> decrease permeability and increase efflux
172
Advantages and disadvantages of live attenuated vaccine (2+2)
Highly immunogenic, long lasting
Risk of reversion to virulence, require cold temperature to maintain viability
173
Which penicillin gives rash as side effects?
Amoxicllin / Ampicillin
