Exam 2 Flashcards
1
Q
INH MOA
A
Bactericidal
May inhibit mycolic acid synthesis and disrupt cell wall
2
Q
Rifampin MOA
A
Bactericidal
Inhibits bacterial DNA- dependent RNA polymerase RNA synthesis by blocking the initiation of RNA transcription
3
Q
Rifabutin MOA
A
Bactericidal. Inhibits DNA dependent RNA polymerase
4
Q
Ethambutanol MOA
A
Bacteriostatic
Appears to suppress multiplication by interfering with RNA synthesis, effective only against actively dividing.
5
Q
Pyrazinamide MOA
A
Unknown
Static or cidal depending on concentration and susceptibility of organism
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
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
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
9
Q
Rifampin spectrum of activity
A
M. tuberculosis, M. leprae, H. influenzae, S. aureus, S. epidermidis, staphylococci, most streptococci, some Enterobacterales
10
Q
Antimycobacterials renal dosing
A
Renal dose adjustments for pyrazinamide, ethambutol, levofloxacin, aminoglycosides if CrCl <30mL/min
11
Q
Antimycobacterials hepatotoxicity
A
Isoniazid, rifampin, pyrazinamide
Pyrazinamide most likely to cause hepatotoxicity
12
Q
Peripheral neuropathy of antimycobacterials
A
INH, PZA, and quinolones
Pregnant women, alcoholics, and patients with poor diets shuold recieve pyridozine daily
13
Q
INH drug interaction
A
alcohol
rifampin and other hepatotoxic drugs
Ketoconazole
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
15
Q
Ethambutol DDI
A
antacids my delay and reduce abs
16
Q
Pyrazinamide DDI
A
cyclosporine
17
Q
Streptomycin DDI
A
aminoglycosides, capreomyxin, polymyxins
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
19
Q
Prophylaxis of TB drugs
A
INH + Rifapentine
20
Q
Tx of TB drugs
A
INH, rifampin, ethambutol, pyrazinamide, streptomycin
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
22
Q
How is TB spread?
A
aerolized droplet nuceli
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
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
25
Extrapulmonary TB
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
26
Directly observed therapy (DOT)
the standard of care for tx of active Tb
| Long duration of therapy after improvement of symptoms
27
Tx of active tb
```
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
28
Tx of latent TB (LTBI)
Once weekly INH + Rifapentine for 12 weeks
29
Bulbar neuritis
Ethambutol
| Monitor for vision changes and loss of red-green differentiation
30
Resistance in TB
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
31
Antifungal therapy cell membrane
Nystatin
Amphotericin B
Azole antifungals
32
Antifungal therapy DNA/RNA synthesis target
5-Flucytosine
33
Antifungal therapy cell wall target
Echinocandins
34
Nystatin MOA
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.
35
Nystatin spectrum
Candida Spp
36
Nystatin clinical use
Oral candidiasis, decontamination prior to surgery
37
Amphotericin B MOA
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
38
Amphotericin B spectrum
```
Candida Spp. (C. lustaniae resistant)
Histoplasma
crytptococcus
aspergillus
blastomycosis
```
39
Amphotericin B clinical use
Crytococcal meningitis, mucormycosis, invasive fungal infections not responsive to other therapies.
40
Amphotericin B PK considerations
Comes in lipid based formulations and rapidly distributes into tissues
41
Amphotericin B DDI
Nephrotoxic drugs, azole antifungals
42
Amphotericin B acute toxicities
fevers, chills, hypotension, arrythmias, thrombophplebitis, HA
43
Amphotericin B premedicate
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
44
Amphotericin B chronic toxicities
Nephrotoxicity, electrolyte depletion, anemia, LFT elevation
| Pre and post hydrate to prevent nephrotoxicity
45
Ketoconazole
```
Spectrum- candida spp.
Uses- limited
PK considerations- potent CYP3A4 inhibitor
AE- hepatic impairment BBW
DDI- drugs that increase gastric pH
```
46
Ketoconazole BBW
Hepatic impairment
47
Intraconazole
Spectrum- Candida Spp., histoplasmosis, aspergillus
Uses- DOC for endemic fungi (histoplasmosis, blastomycosis, coccoidomycosis)
PK- monitor plasma conc.
AE- taste disturbance, GI
48
Fluconazole
Spectrum- Candida Spp.
Uses- candida infections
PK -renal dose
AE- dose-related alopecia, bone marrow suppression, Additive QTc prolongation
49
Voriconazole
Spectrum- Candida Spp., Aspergillus spp.
PK- cannot dialyze
AE- Dose related visual disturbances
50
Posaconazole
Spectrum- Candida Spp., Aspergillus Spp.
| AE- Elevated LFTs, GI, intolerance, hypokalemia
51
Isavuconazole
Spectrum- Candida spp., aspergillus, mucormycosis
Uses- invasive aspergillus and mucormycosis
AE- N/V/D, infusion reactions
52
5-Flucytosine (5-fc)
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!
53
Echinocandins
Spectrum- Candida Spp.
Uses- Infections of candida Spp. resistant to azoles
PK- not dialyzable, minimal CNS
AE- fever, rash, increased LFTs
54
Hookworms S/Sx
Abdominal pain, iron deficiency anemia, malnutrition, loss of appetite, desire to eat soil
55
Hookworms tx
Mebendazole 100mg BID for 3 days or 500mg once
| Albendazole 400mg once
56
Roundworms Tx
Mebendazole 100mg BID for 3 days ot 500mg once
| Albendazole 400mg once
57
Pinworms Dx
Scotch tape test to look for eggs
58
Pinworms tx
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
59
Tapeworms Tx
Praziquantel 5-10mg/kg once
60
Liver flukes where?
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
61
Liver flukes S/Sx
Chronic diarrhea, abdominal pain, ulcers, hemorrhage, abscess, liver damage
62
Liver flukes Tx
Thorough cooking of meats kills flukes.
| Praziquantel 20mg/kg BID for 1 day
63
Trichomoniasis transmission
STD- feeds on bacteria and WBC.
| Can survive outside of the body for several hours (uncommon mode of transmission)
64
Trichomoniasis S/Sx
50% asymptomatic
| Women- vaginal discharge (malodorous, grayish), vulvar pruritus, erythematous vagina, dyspareunia, dysuria
65
Trichomoniasis Tx
Metronidazole 2g PO once or 500mg BID for 7 days
| Must treat asymptomatic partners
66
Amebiasis Transmission
Fecal cysts in contaminated food, water
| Can migrate to lung, liver, brain
67
Amebiasis S/Sx
Usually develops gradually; high fever, intermittent bloody diarrhea with mucus, cramps, RUQ pain, hepatomegaly, liver tenderness, vomiting, dehydration, anemia
Can be life threatening!
68
Amebiasis Tx
Metronidazole 500-750mg TID for 10 days (works in tissues) followed by iodoquinol or paromomycin as a luminal amebicide
69
Giardiasis transmission
Found in GIT, highly contagious.
| Transmitted via ingestion of contaminated water
70
Giardiasis S/Sx
Appear after 2 weeks of exposure- diarrhea, dehydration, stomach cramps, gas, weight loss
71
Giardiasis diagnosis
Cysts found on fecal smear
72
Giardiasis Tx
Metronidazole 250mg TID for 5 days
73
Toxoplasmosis tranmission
Ingestion of cysts, affect intestine first, then lymph nodes then CNS
Raw undercooked meat, kittens (in feces)
74
Toxoplasmosis S/Sx
Fever, HA, photophobia, muscle pain, anemia
| Opportunistic infection in AIDS
75
Toxoplasmosis Dx
Presence of two toxo antibody, CT scan
76
Toxoplasmosis Tx
Pyrimethamine plus sulfadiazine
77
Malaria transmission
Plasmodium transmitted due to infected mosquito.
Exoerythroctic stage- sprozoites injected into bloodstream invade hepatocytes.
Erythrocytic stage- schizonts rupture and infect erythrocytes
78
Malaria S/Sx
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
Malaria prophylaxis
Chloroquine once/week beginning 1 week before leaving and continuing for 4 weeks after leaving endemic area.
If chloroquine resistant area- mefloquine
80
Malaria Tx
Chloroquine x 3 days
Chloroquine resistant areas- oral quinine sulfate plus either mefloquine, doxycycline, or pyrimethamine/sulfadozine for 7 days
Artemether-Lumefantrine
81
Albendazole indications
Ascariasis, Giardiasis, Neurocystecosis
82
Albendazole AE
Abdominal pain, increase in LFTs, N/D
83
Albendazole comments
Not for <2 yo
Take with fatty meals
Monitor LFTs and CBC
Do not use in pregnancy
84
Nitazoxanide indications
Giardiasis, Cryptosporidium
85
Nitazoxamide AE
GI, abd pain, D/V, HA
86
Nitazoxamide comments
Age >1
| Take WF
87
Mebendazole indications
Ascariasis, trichuriasis, hookworm, pinworm
88
Mebendazole AE
GI, abd pain, D, CNA, HA, dizziness
| Myelosuppression in high doses
89
Mebendazole comments
Tk WF
| Contraindicated in pregnancy
90
Pyrantel pamoate indications
Pinworm, hookworm
91
Pyrantel pamoate AE
N/D, anorexia, cramps, HA, dizziness
92
Pyrantel pamoate comments
Repeat dosing for pinworms after 10-14 days
93
Metronidazole indications
Amebiasis, giardiasis, trichomonas, anaerobes
94
Metronidazole AE
N/V, epigastric distress, HA, metallic taste
95
Metronidazole comments
Tk WF
| Avoid alcohol
96
Chloroquine indications
Malaria (blood stage)
97
Chloroquine AE
N/V/D, dizziness, HA< blurred vision, fatigue, dermatitis
98
Chloroquine comments
Take after meals
Contraindicated in psoriasis and G6PD deficiency
Use cautiously in liver disease
99
Primaquine indications
Malaria
100
Primaquine AE
N/V/D, abdominal pain, mental depression, bone marrow suppression
101
Primaquine comments
Not for use in severe G6PD deficiency or pregnancy
102
Mefloquine indications
P. facuparum malaria
103
Mefloquine AE
N/V/D, abdominal pain, bradycardia, vertigo, dizziness, confusion, hallucinations, psychosis, rash, itching, convulsions
104
Mefloquine comments
Dose related AE
| Pregnancy category C
105
Quinine sulfate indications
Malaria
106
Quinine sulfate AE
N/V/D, flushing, dizziness, hypotension, QTc prolongation, hematologic
107
Quinine sulfate comments
Rarely used alone
Monitor EKG if IV
Safe in pregnancy
108
Pyrimethamine plus sulfadoxazine indications
Malaria prophylaxis
109
Pyrimethamine plus sulfadoxazine AE
N/V/D, abd pain, glossitis, stomatitis, hemolytic anemia, megabastric anemia, neutropenia, rash
110
Pyrimethamine plus sulfadoxazine comments
Steven Johnsons syndrome possible
Monitor G6PD deficiency
Monitor CBC
111
M2 inhibtor
Amantadine, Rimantadine
112
Amantadine
```
M2 inhibitor
Activity- influenza Type A
AE- CNS/GI
DDI: antihistamines, anticholinergics
Contraindications- Acute angle glaucoma
Indications: Treatment >1, prophylaxis
```
113
Which anti influenza agents can be used for treatments >1?
Oseltamivir, Amantadine
114
Which anti influenza agents can be used for treatment >7?
Zanamivir
115
Which anti influenza agent can be used only for adults only treatment?
Peramivir
116
Which anti influenza can be used for treatment >12 years old?
Baloxavir
117
Which anti influenza agents can be used for prophylaxis?
Amantadine
Rimantadine (adults only)
Oseltamivir (>13)
Baloxavir
118
Rimantadine
```
M2 inhibitor
Only for type A
AE- GI
Contraindications- severe liver dysfunction
Adults only prophylaxis
```
119
Neuraminidase
Zanamivir
Oseltamivir
Peramivir
120
Polymerase acidic endonuclease inhibitor
Baloxavir marboxil
121
Zanamivir
```
Neuraminidase
Types A and B
AE- Bronchospasm
Contraindications- underlying airway disease
Therapy >7
```
122
Oseltamivir
```
Neuraminidase
Types A and B
AE- GI
DDI_ Probenecid
Therapy >1 and prophylaxis >13
```
123
Peramivir
Neuraminidase
Types A and B
AE- GI
Adults only tx
124
Baloxavir
Polymerase acidic endonuclease inhibitor
Types A and B
AE- mild diarrhea and bronchitis
Treatment >12, prophylaxis
125
HSV-1 vs HSV-2
```
HSV-1= non genital transmission, common cause of meningoencephalitis
HSV-2= sexually transmitted
```
126
Treatment of CMV
CMV rhinitis- IV ganciclovir + valganciclovir or foscarnet or cidofovir
CMV esophagitis- ganciclovir, valganciclovir, foscarnet
127
Acyclovir and valacyclovir MOA
Guanosing analog, inhibits DNA polymerase
128
Acyclovir and Valacyclovir uses
HSV, VZV
129
Acyclovir, valacyclovir AE
Local irritation with topical use
| Nephrotoxicity, neurotoxicity, hemopoietic toxicity
130
Ganciclovir and valganciclovir uses
CMV
131
Ganciclovir and valganciclovir AE
BBW: Bone marrow suppression
Renal dysfunction
N/V/D
132
Famciclovir uses
Recurrent genital herpes, localized herpes zoster
133
Cidofovir moa
Monophosphate nucleotide analog
134
Cidofovir uses
CMV, HSV, VSV, EBV, and other
| Not first line
135
Cidofovir AE
Nephrotoxicity, hematologic toxicity
| Requires prehydration and oral probenecid before admin
136
Letermovir MOA
A novel CMV DNA terminase complex inhibitor
137
Letermovir uses
Prophylaxis and treatment of CMV
138
Letermovir AE
Tachycardia with Afib
| Contraindicated- pts on pimozide or ergot alkaloids
139
Foscarnet uses and AE
Not first line- CMV, HSV, VZV
| AE- nephrotoxicity, hematologic toxicity, electrolyte imbalance, neurotoxicity
140
Anti-HBV agents
NRTIs
| Entecavir, TdF, Taf
141
Sustained virologic response (SVR)
Surrogate marker most often used to evaluate efficacy of therapy. Check for 12 weeks.
142
DAA classes
NS3/4A, NS5A, NS5B
143
NS3/4A
Agents that end in -previr
144
NS5A
Agents that end in -sivir
145
NS5B
Agents that end in -buvir
146
Harvoni
Not for genotype 3
Do not use in CrCl <30mL/min
Bradycardia with amiodarone
147
Epclusa
All genotypes
Do not use in CrCl <30mL/min
Bradycardia with amiodarone
148
Zepatier
Not for genotypes 5,6
Do not use in hepatic impairment!
Avoid statins
149
Mavyret
```
All genotypes
Take WF
Do not use in hepatic impairment
Avoid atorvastatin and simvastatin
Increased bilirubin
```
150
Which HCV medications can you not use in hepatic impairment?
Zepatier
| Mavyret
151
Which HCV medications can you not use in CrCl <30?
Harvoni
| Epclusa
152
Which HCV medications cover all genotypes?
Epclusa
Mavyret
Vosevi
153
How long to treat HCV?
8-12 weeks
