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Therapeutics III > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

INH MOA

A

Bactericidal

May inhibit mycolic acid synthesis and disrupt cell wall

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2
Q

Rifampin MOA

A

Bactericidal

Inhibits bacterial DNA- dependent RNA polymerase RNA synthesis by blocking the initiation of RNA transcription

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3
Q

Rifabutin MOA

A

Bactericidal. Inhibits DNA dependent RNA polymerase

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4
Q

Ethambutanol MOA

A

Bacteriostatic

Appears to suppress multiplication by interfering with RNA synthesis, effective only against actively dividing.

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5
Q

Pyrazinamide MOA

A

Unknown

Static or cidal depending on concentration and susceptibility of organism

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6
Q

Streptomycin MOA

A

Bactericidal
Interferes with initiation complex between mRNA and 30S ribosomal subunit causing DNA to be misread and thus nonfunctional proteins are produced leading to cell death

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7
Q

PD of antimycobacterials

A

Streptomycin- concentration dependent killing
The rest- time-dependent killing
Streptomycin and rifampin have prolonged PAE thus protecting against re-growth when levels fall below MIC

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8
Q

Spectrum of activity for antimycomacterials

A

Resistance may occur if any of these drugs are used alone for active treatment
All have activity for Mycobacterium tuberculosis
Some have activity for non-tuberculosis mycobacteria

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9
Q

Rifampin spectrum of activity

A

M. tuberculosis, M. leprae, H. influenzae, S. aureus, S. epidermidis, staphylococci, most streptococci, some Enterobacterales

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10
Q

Antimycobacterials renal dosing

A

Renal dose adjustments for pyrazinamide, ethambutol, levofloxacin, aminoglycosides if CrCl <30mL/min

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11
Q

Antimycobacterials hepatotoxicity

A

Isoniazid, rifampin, pyrazinamide

Pyrazinamide most likely to cause hepatotoxicity

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12
Q

Peripheral neuropathy of antimycobacterials

A

INH, PZA, and quinolones

Pregnant women, alcoholics, and patients with poor diets shuold recieve pyridozine daily

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13
Q

INH drug interaction

A

alcohol
rifampin and other hepatotoxic drugs
Ketoconazole

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14
Q

Rifampin drug interactions

A 
alcohol
INH and hepatotoxic drugs
Aminophylline and theophylline
Coumadin
Oral diabetic agents
Azoles
Chloramphenicol
Oral contraceptives
Corticosteroids
Digoxin
Propafenone
Quinidine
Estrogen 
PHT
Verapamil
ALL increased metabolism by rifampin
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15
Q

Ethambutol DDI

A

antacids my delay and reduce abs

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16
Q

Pyrazinamide DDI

A

cyclosporine

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17
Q

Streptomycin DDI

A

aminoglycosides, capreomyxin, polymyxins

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18
Q

Antimycobacterials patient monitoring

A 
LFTs and monitor for symptoms of liver disease
CBC
Visual exam
Hearing exam and renal function 
Serum conc. monitoring with streptomycin
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19
Q

Prophylaxis of TB drugs

A

INH + Rifapentine

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20
Q

Tx of TB drugs

A

INH, rifampin, ethambutol, pyrazinamide, streptomycin

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21
Q

Mycobacterium tuberculosis

A 
Acid fast bacteria
Slow-growing
Difficult to culture (2-3 weeks for susceptibilities)
Most prevalent and deadly ID globally
Drug resistance is major concern
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22
Q

How is TB spread?

A

aerolized droplet nuceli

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23
Q

TB airborne precautions

A

Negative-pressure room
Personal protective equipment, N95 respirator
May be D/Cd after 3 consecutive days of negative AFB sputum smears

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24
Q

TB presentation

A

Weight loss, fatigue, productive cough often with hemoptysis
Sputum smear with acid-fast bacilli (AFB)
Upper lobes of lung with patchy or nodular infiltrates
Positive skin test

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25
Q

Extrapulmonary TB

A

Lymphatic and pleural space most common sites
More common in patients with HIV
Typically treated with conventional TB regimens
TB meningitis- 9-12 months therapy

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26
Q

Directly observed therapy (DOT)

A

the standard of care for tx of active Tb

Long duration of therapy after improvement of symptoms

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27
Q

Tx of active tb

A 
Initial phase (months 1-2)- isoniazid, rifampin, pyrazinamide, ethambutol
Continuation phase (months 3-6)- isoniazid, rifampin. Extended to 7 months if positive cultures show after 2 months

Ethambutol can be D/Cd once susceptibility to other agents is shown.

5 days/week DOT therapy most effective

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28
Q

Tx of latent TB (LTBI)

A

Once weekly INH + Rifapentine for 12 weeks

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29
Q

Bulbar neuritis

A

Ethambutol

Monitor for vision changes and loss of red-green differentiation

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30
Q

Resistance in TB

A

Resistance to first-line therapy is common
Multidrug resistant TB- use Bedaquiline- based regimen
If resistance is discovered add at least 2 drugs to which the organism is susceptible

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31
Q

Antifungal therapy cell membrane

A

Nystatin
Amphotericin B
Azole antifungals

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32
Q

Antifungal therapy DNA/RNA synthesis target

A

5-Flucytosine

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33
Q

Antifungal therapy cell wall target

A

Echinocandins

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34
Q

Nystatin MOA

A

Binds to sterols in the fungus cell membrane, affecting cell wall permeability and allowing for leakage of intracellular contents out of the cell leading to cell death.

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35
Q

Nystatin spectrum

A

Candida Spp

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36
Q

Nystatin clinical use

A

Oral candidiasis, decontamination prior to surgery

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37
Q

Amphotericin B MOA

A

Binds to ergosterol on fungal cell membranes causing destabilization which affects cell wall permeability and allows for vital substances to leak out of the cell, leading to death

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38
Q

Amphotericin B spectrum

A 
Candida Spp. (C. lustaniae resistant)
Histoplasma
crytptococcus
aspergillus
blastomycosis
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39
Q

Amphotericin B clinical use

A

Crytococcal meningitis, mucormycosis, invasive fungal infections not responsive to other therapies.

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40
Q

Amphotericin B PK considerations

A

Comes in lipid based formulations and rapidly distributes into tissues

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41
Q

Amphotericin B DDI

A

Nephrotoxic drugs, azole antifungals

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42
Q

Amphotericin B acute toxicities

A

fevers, chills, hypotension, arrythmias, thrombophplebitis, HA

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43
Q

Amphotericin B premedicate

A

Need to premedicate with APAP, meperidine, and diphenhydramine 30 minutes before infusion to prevent acute toxicities.
Use meperidine only if a reaction was previously reported

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44
Q

Amphotericin B chronic toxicities

A

Nephrotoxicity, electrolyte depletion, anemia, LFT elevation

Pre and post hydrate to prevent nephrotoxicity

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45
Q

Ketoconazole

A 
Spectrum- candida spp.
Uses- limited
PK considerations- potent CYP3A4 inhibitor
AE- hepatic impairment BBW
DDI- drugs that increase gastric pH
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46
Q

Ketoconazole BBW

A

Hepatic impairment

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47
Q

Intraconazole

A

Spectrum- Candida Spp., histoplasmosis, aspergillus
Uses- DOC for endemic fungi (histoplasmosis, blastomycosis, coccoidomycosis)
PK- monitor plasma conc.
AE- taste disturbance, GI

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48
Q

Fluconazole

A

Spectrum- Candida Spp.
Uses- candida infections
PK -renal dose
AE- dose-related alopecia, bone marrow suppression, Additive QTc prolongation

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49
Q

Voriconazole

A

Spectrum- Candida Spp., Aspergillus spp.
PK- cannot dialyze
AE- Dose related visual disturbances

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50
Q

Posaconazole

A

Spectrum- Candida Spp., Aspergillus Spp.

AE- Elevated LFTs, GI, intolerance, hypokalemia

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51
Q

Isavuconazole

A

Spectrum- Candida spp., aspergillus, mucormycosis
Uses- invasive aspergillus and mucormycosis
AE- N/V/D, infusion reactions

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52
Q

5-Flucytosine (5-fc)

A

Spectrum- Candida spp., crytococcus, aspergillus
Uses- cryptococcal meningitis in combo with amphotericin B
AE- Renal toxicity, dose-dependent myelosuppression, increased AST/ALT
Never use as monotherapy!

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53
Q

Echinocandins

A

Spectrum- Candida Spp.
Uses- Infections of candida Spp. resistant to azoles
PK- not dialyzable, minimal CNS
AE- fever, rash, increased LFTs

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54
Q

Hookworms S/Sx

A

Abdominal pain, iron deficiency anemia, malnutrition, loss of appetite, desire to eat soil

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55
Q

Hookworms tx

A

Mebendazole 100mg BID for 3 days or 500mg once

Albendazole 400mg once

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56
Q

Roundworms Tx

A

Mebendazole 100mg BID for 3 days ot 500mg once

Albendazole 400mg once

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57
Q

Pinworms Dx

A

Scotch tape test to look for eggs

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58
Q

Pinworms tx

A

Pyrantel pamoate 11mg/kg/day (max 1 g) for 3 days; repeat in 10-14 days
Mebendazole 100mg once; repeat in 10-14 days
Albendazole- 400mg once; repeat in 10-14 days

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59
Q

Tapeworms Tx

A

Praziquantel 5-10mg/kg once

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60
Q

Liver flukes where?

A

Ingestion (drinking water, swimming, eating infected aquatic vegetation, eating infected raw meat)
Most common in Asia, Africa, S. America, or middle east but can be found anywhere where human waste is used as a fertilizer

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61
Q

Liver flukes S/Sx

A

Chronic diarrhea, abdominal pain, ulcers, hemorrhage, abscess, liver damage

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62
Q

Liver flukes Tx

A

Thorough cooking of meats kills flukes.

Praziquantel 20mg/kg BID for 1 day

63
Q

Trichomoniasis transmission

A

STD- feeds on bacteria and WBC.

Can survive outside of the body for several hours (uncommon mode of transmission)

64
Q

Trichomoniasis S/Sx

A

50% asymptomatic

Women- vaginal discharge (malodorous, grayish), vulvar pruritus, erythematous vagina, dyspareunia, dysuria

65
Q

Trichomoniasis Tx

A

Metronidazole 2g PO once or 500mg BID for 7 days

Must treat asymptomatic partners

66
Q

Amebiasis Transmission

A

Fecal cysts in contaminated food, water

Can migrate to lung, liver, brain

67
Q

Amebiasis S/Sx

A

Usually develops gradually; high fever, intermittent bloody diarrhea with mucus, cramps, RUQ pain, hepatomegaly, liver tenderness, vomiting, dehydration, anemia
Can be life threatening!

68
Q

Amebiasis Tx

A

Metronidazole 500-750mg TID for 10 days (works in tissues) followed by iodoquinol or paromomycin as a luminal amebicide

69
Q

Giardiasis transmission

A

Found in GIT, highly contagious.

Transmitted via ingestion of contaminated water

70
Q

Giardiasis S/Sx

A

Appear after 2 weeks of exposure- diarrhea, dehydration, stomach cramps, gas, weight loss

71
Q

Giardiasis diagnosis

A

Cysts found on fecal smear

72
Q

Giardiasis Tx

A

Metronidazole 250mg TID for 5 days

73
Q

Toxoplasmosis tranmission

A

Ingestion of cysts, affect intestine first, then lymph nodes then CNS
Raw undercooked meat, kittens (in feces)

74
Q

Toxoplasmosis S/Sx

A

Fever, HA, photophobia, muscle pain, anemia

Opportunistic infection in AIDS

75
Q

Toxoplasmosis Dx

A

Presence of two toxo antibody, CT scan

76
Q

Toxoplasmosis Tx

A

Pyrimethamine plus sulfadiazine

77
Q

Malaria transmission

A

Plasmodium transmitted due to infected mosquito.
Exoerythroctic stage- sprozoites injected into bloodstream invade hepatocytes.
Erythrocytic stage- schizonts rupture and infect erythrocytes

78
Q

Malaria S/Sx

A

Erythrocytic phase preceded by prodrome of malaise, fatigue, arthralgias, myalgias, abdominal pain, vomiting, anemia, splenomegaly.
Prodrome followed by high fevers, chills, alternating cold and hot
Occasionally seizures, hypoglycemia, coma, etc.

79
Q

Malaria prophylaxis

A

Chloroquine once/week beginning 1 week before leaving and continuing for 4 weeks after leaving endemic area.
If chloroquine resistant area- mefloquine

80
Q

Malaria Tx

A

Chloroquine x 3 days
Chloroquine resistant areas- oral quinine sulfate plus either mefloquine, doxycycline, or pyrimethamine/sulfadozine for 7 days
Artemether-Lumefantrine

81
Q

Albendazole indications

A

Ascariasis, Giardiasis, Neurocystecosis

82
Q

Albendazole AE

A

Abdominal pain, increase in LFTs, N/D

83
Q

Albendazole comments

A

Not for <2 yo
Take with fatty meals
Monitor LFTs and CBC
Do not use in pregnancy

84
Q

Nitazoxanide indications

A

Giardiasis, Cryptosporidium

85
Q

Nitazoxamide AE

A

GI, abd pain, D/V, HA

86
Q

Nitazoxamide comments

A

Age >1

Take WF

87
Q

Mebendazole indications

A

Ascariasis, trichuriasis, hookworm, pinworm

88
Q

Mebendazole AE

A

GI, abd pain, D, CNA, HA, dizziness

Myelosuppression in high doses

89
Q

Mebendazole comments

A

Tk WF

Contraindicated in pregnancy

90
Q

Pyrantel pamoate indications

A

Pinworm, hookworm

91
Q

Pyrantel pamoate AE

A

N/D, anorexia, cramps, HA, dizziness

92
Q

Pyrantel pamoate comments

A

Repeat dosing for pinworms after 10-14 days

93
Q

Metronidazole indications

A

Amebiasis, giardiasis, trichomonas, anaerobes

94
Q

Metronidazole AE

A

N/V, epigastric distress, HA, metallic taste

95
Q

Metronidazole comments

A

Tk WF

Avoid alcohol

96
Q

Chloroquine indications

A

Malaria (blood stage)

97
Q

Chloroquine AE

A

N/V/D, dizziness, HA< blurred vision, fatigue, dermatitis

98
Q

Chloroquine comments

A

Take after meals
Contraindicated in psoriasis and G6PD deficiency
Use cautiously in liver disease

99
Q

Primaquine indications

A

Malaria

100
Q

Primaquine AE

A

N/V/D, abdominal pain, mental depression, bone marrow suppression

101
Q

Primaquine comments

A

Not for use in severe G6PD deficiency or pregnancy

102
Q

Mefloquine indications

A

P. facuparum malaria

103
Q

Mefloquine AE

A

N/V/D, abdominal pain, bradycardia, vertigo, dizziness, confusion, hallucinations, psychosis, rash, itching, convulsions

104
Q

Mefloquine comments

A

Dose related AE

Pregnancy category C

105
Q

Quinine sulfate indications

A

Malaria

106
Q

Quinine sulfate AE

A

N/V/D, flushing, dizziness, hypotension, QTc prolongation, hematologic

107
Q

Quinine sulfate comments

A

Rarely used alone
Monitor EKG if IV
Safe in pregnancy

108
Q

Pyrimethamine plus sulfadoxazine indications

A

Malaria prophylaxis

109
Q

Pyrimethamine plus sulfadoxazine AE

A

N/V/D, abd pain, glossitis, stomatitis, hemolytic anemia, megabastric anemia, neutropenia, rash

110
Q

Pyrimethamine plus sulfadoxazine comments

A

Steven Johnsons syndrome possible
Monitor G6PD deficiency
Monitor CBC

111
Q

M2 inhibtor

A

Amantadine, Rimantadine

112
Q

Amantadine

A 
M2 inhibitor
Activity- influenza Type A
AE- CNS/GI
DDI: antihistamines, anticholinergics
Contraindications- Acute angle glaucoma
Indications: Treatment >1, prophylaxis
113
Q

Which anti influenza agents can be used for treatments >1?

A

Oseltamivir, Amantadine

114
Q

Which anti influenza agents can be used for treatment >7?

A

Zanamivir

115
Q

Which anti influenza agent can be used only for adults only treatment?

A

Peramivir

116
Q

Which anti influenza can be used for treatment >12 years old?

A

Baloxavir

117
Q

Which anti influenza agents can be used for prophylaxis?

A

Amantadine
Rimantadine (adults only)
Oseltamivir (>13)
Baloxavir

118
Q

Rimantadine

A 
M2 inhibitor
Only for type A
AE- GI
Contraindications- severe liver dysfunction
Adults only prophylaxis
119
Q

Neuraminidase

A

Zanamivir
Oseltamivir
Peramivir

120
Q

Polymerase acidic endonuclease inhibitor

A

Baloxavir marboxil

121
Q

Zanamivir

A 
Neuraminidase
Types A and B
AE- Bronchospasm
Contraindications- underlying airway disease
Therapy >7
122
Q

Oseltamivir

A 
Neuraminidase
Types A and B
AE- GI
DDI_ Probenecid
Therapy >1 and prophylaxis >13
123
Q

Peramivir

A

Neuraminidase
Types A and B
AE- GI
Adults only tx

124
Q

Baloxavir

A

Polymerase acidic endonuclease inhibitor
Types A and B
AE- mild diarrhea and bronchitis
Treatment >12, prophylaxis

125
Q

HSV-1 vs HSV-2

A 
HSV-1= non genital transmission, common cause of meningoencephalitis
HSV-2= sexually transmitted
126
Q

Treatment of CMV

A

CMV rhinitis- IV ganciclovir + valganciclovir or foscarnet or cidofovir
CMV esophagitis- ganciclovir, valganciclovir, foscarnet

127
Q

Acyclovir and valacyclovir MOA

A

Guanosing analog, inhibits DNA polymerase

128
Q

Acyclovir and Valacyclovir uses

A

HSV, VZV

129
Q

Acyclovir, valacyclovir AE

A

Local irritation with topical use

Nephrotoxicity, neurotoxicity, hemopoietic toxicity

130
Q

Ganciclovir and valganciclovir uses

A

CMV

131
Q

Ganciclovir and valganciclovir AE

A

BBW: Bone marrow suppression
Renal dysfunction
N/V/D

132
Q

Famciclovir uses

A

Recurrent genital herpes, localized herpes zoster

133
Q

Cidofovir moa

A

Monophosphate nucleotide analog

134
Q

Cidofovir uses

A

CMV, HSV, VSV, EBV, and other

Not first line

135
Q

Cidofovir AE

A

Nephrotoxicity, hematologic toxicity

Requires prehydration and oral probenecid before admin

136
Q

Letermovir MOA

A

A novel CMV DNA terminase complex inhibitor

137
Q

Letermovir uses

A

Prophylaxis and treatment of CMV

138
Q

Letermovir AE

A

Tachycardia with Afib

Contraindicated- pts on pimozide or ergot alkaloids

139
Q

Foscarnet uses and AE

A

Not first line- CMV, HSV, VZV

AE- nephrotoxicity, hematologic toxicity, electrolyte imbalance, neurotoxicity

140
Q

Anti-HBV agents

A

NRTIs

Entecavir, TdF, Taf

141
Q

Sustained virologic response (SVR)

A

Surrogate marker most often used to evaluate efficacy of therapy. Check for 12 weeks.

142
Q

DAA classes

A

NS3/4A, NS5A, NS5B

143
Q

NS3/4A

A

Agents that end in -previr

144
Q

NS5A

A

Agents that end in -sivir

145
Q

NS5B

A

Agents that end in -buvir

146
Q

Harvoni

A

Not for genotype 3
Do not use in CrCl <30mL/min
Bradycardia with amiodarone

147
Q

Epclusa

A

All genotypes
Do not use in CrCl <30mL/min
Bradycardia with amiodarone

148
Q

Zepatier

A

Not for genotypes 5,6
Do not use in hepatic impairment!
Avoid statins

149
Q

Mavyret

A 
All genotypes
Take WF
Do not use in hepatic impairment 
Avoid atorvastatin and simvastatin
Increased bilirubin
150
Q

Which HCV medications can you not use in hepatic impairment?

A

Zepatier

Mavyret

151
Q

Which HCV medications can you not use in CrCl <30?

A

Harvoni

Epclusa

152
Q

Which HCV medications cover all genotypes?

A

Epclusa
Mavyret
Vosevi

153
Q

How long to treat HCV?

A

8-12 weeks

Therapeutics III (7 decks)

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