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Clin Pharm > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Griseofulvin; MOA, Use, Toxicity

A

MOA
 Fungistatic
 disrupts mitotic spindle

Use
 Dermatophytes
 1-4 month therapy
 Used in SA, equine, & food animal ELDU

Toxicity
 Ds
 Depression, anorexia
 Hepatotoxicity
 Bone marrow suppression
 Ataxia especially in cats
 Maybe teratogenic & carcinogenic
 Absorption enhanced by high fat meal

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2
Q

Flucytosine; MOA, Use, Toxicity

A

MOA
 Fungistatic
 Prodrug converted to antimetabolite
 Disrupts protein synthesis

Use
 Cryptococcus
 Some candida
 In combo w/ amphotericin B due to resistance

Toxicity
 Contraindicated in cats
 Mammal cells do not convert to active form BUT some GI flora may -> toxic to mammal
 Bone marrow suppression
 Mucus membrane ulcers

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3
Q

Amphotericin B; MOA, Use, Toxicity

A

MOA
 Fungicidal
 Binds ergosterol & Disrupts membrane function
 Long ½ life
 Mostly eliminated by urine

Use
 Severe systemic infections
 Histoplasma
 Blastomyces
 Cryptococcus
 Coccidioides
 NO DERMATOPHYTES

Toxicity
 Nephrotoxicity
 Anaphylaxis – vomiting & fever
 DO NOT combine w/ Azoles

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4
Q

Ketoconazole; MOA, Use, Toxicity

A

MOA
 Fungistatic
 Requires acidic environment for oral absorption
 Inhibits CYP450 & ergosterol synthesis

Use
 Candida
 Malassezia dermatitis in dogs
 Dermatophytes in dogs & cats
 Add on treatment for systemic infection
 Maybe adrenal hyperplasia

Toxicity
 Safer than amphotericin B
 GI upset
 Hepatotoxicity in cats
 interference w/ progesterone & tostesterone
 EXTREME drug interactions

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5
Q

Itraconazole

A

o Better efficacy against Candida, Aspergillus, Dermatophytes & systemic fungi than Ketoconazole
o Fewer adverse effects
o More expensive

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6
Q

Fluconazole

A

o No metabolism
o Excreted in urine
o Penetrates CNS & urinary tract
o Better oral bioavailability than Ketp or Itra

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7
Q

Clotrimazole

A

o Topical
o Nasal aspergillosis in dogs
o Infused into bladder for fungal candiduria in SA
o Otitis externa due to Malassezia

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8
Q

Miconazole

A

o Topical for dermatophytosis in SA
o Could use frequent IV for systemic

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9
Q

Terbinafine; MOA, Use

A

MOA
 Inhibit enzyme squalene epoxidase ->
 Decreased ergosterol synthesis

Use
 Long term treatment for onychomycosis
 Topically & systemically for dermatophytosis in SA

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10
Q

Idoxuridine

A

o Antiviral for the eye

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11
Q

Oseltamivir

A

o Used to reduce severity of parvovirus
o Poor efficacy

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12
Q

Oral Famiclovir

A

o Used for feline herpes virus

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13
Q

Zidovudine

A

o FIV
o FLV
o Banned in birds

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14
Q

Classes of Penicillins & Drugs

A

Natural
 Penicillin G

Aminopenicillins
 Amoxicillin
 Ampicillin

Beta Lactamase Inhibitors
 Amoxicillin clavulanate (Clavimox)

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15
Q

Classes of Cephalosporins & Drugs

A

1st Gen
 Cephalothin
 Cephalexin
 Cefazolin

3rd Gen
 Ceftiofur
 Cefpodoxime
 Cefovecin
 Ceftriaxone

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16
Q

Tetracycline; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
o Tetracycline
o Oxytetracycline
o Doxycycline

MOA
* Bacteriostatic 30s proteins

Spectrum
* All accept Staph. Pseudomonas & E. coli
* Not good for UTIs

Tox
* GI
* Death in horses
* Fever
* Renal & hepatic toxicity
* Esophageal lesions in cats

Use
* Respiratory dz & anaplasmosis in cows
* Intrauterine infusion in cows
* Neorikettsia Ristcii in horses
* Doxy is drug of choice for intracellular pathogens

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17
Q

Aminoglycoside; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
o Gentamicin
o Amikacin

MOA
* Bacteriocidal 30s proteins

Spectrum
* ALL aerobes

Tox
* Nephrotoxicity
* Ototoxicity (irreversible)
* Neuromuscular blockade (reversable)
* Bone marrow suppresion
* Amikacin least toxic
* Do not use in hypovolemia

Use
* Gentamicin systemically in horses
* Amikacin in foals, dogs, cats
* Amikacin as intrauterine infusion in horses
* Gentamicin for regional limb perfusion

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18
Q

Macrolides; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
o Erythromycin
o Tilmicosin
o Azithromycin
o Tylosin
o Tulathromycin

MOA
Bacteriostatic

Spectrum
* Newer all
* Older gram (+) aerobes

Toxicity
* GI
* Colitis in horses
* Hyperthermia in foals
* Tilmicosin cause severe cardio tox

Use
* Gamithromycin, Tulathromycin, Tilmicosin resp dz & foot rot in cows
* Tylosin for IBD in dogs

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19
Q

Amphenicol Drugs; Drugs, MOA, Spectrum, Use

A

Drugs
o Chloramphenicol
o Florfenicol

MOA
* Bacteriostatic 50s

Spectrum
* All accept Staph. Pseudomonas & E. coli
* Not good for UTIs

Use
* CNS infection
* Some rickettsiae
* Mycoplasma
* Florfenicol for respiratory dz & foot rot in cows

20
Q

Lincosamide; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
Clindamycin

MOA
* Bacteriostatic 50s

Spectrum
* All Gram (+)

Tox
* Do not use in horses

Use
* Wounds
* Abscesses
* periodontal dz
* osteomyelitis

21
Q

Antimetabolite; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
o Sulfadiazine
o Trimethoprim-sulfa
o Ormetoprim-sulfadimethoxine

MOA
 Sulfas – bacteriostatic
 Sulfas + folate = bacteriocidal
 Disrupt dihydrofolic acid becoming tetrahydrofolic acid ->
 Bacteria cannot complete protein synthesis

Spectrum
 Aerobic gram (+) & (-)
 NOT Staph, E Coli, Proteus, Klebsiella, Pseudomonas

Toxicity
 Hypersensitivity
 Keratoconjunctivitis sicca (do tear test before & monitor)
 Nephrotoxicity (rare)

Clinical Use
 GI infections
 CNS & joint coccidisosis
 Bacterial enteritis
 Bacteria pneumonia
 Skin & soft tissue infections
 Cystitis & prostatitis in dogs
 Trying to get away from use due to tissue residue issues

22
Q

Fluroquinolone; Drugs, MOA, Spectrum, Tox, Use

A

Drugs
o Enrofloxacin
o All the -oxacin

MOA
* Bacteriocidal

Spectrum
* Aerobic gram (+) & (-)
* Pradofloxacin gram (+) anaerobic (cats only)

Tox
* Irreversible cartilage damage in growing animals
* Retinopathy & irreversible blindness in cats
* Seizures at high doses
* Inhibit cytochrome P450 metabolism
* Pradofloxacin cause bone marrow suppression in dogs – use in cats ONLY

Use
* Penetrate prostate, respiratory tract and CNS
* Achieve high conc. in urine
* Enrofloxacin & danofloxacin used for bovine resp. dz
* NO ELDU in food animals

23
Q

Beta Lactams; Drug Classes, MOA, Toxicity

A

Drug Classes
 Penicillins
 Cephalosporins
 Vancomycin

MOA
 Bactericidal
 Bind bacterial transpeptidase enzymes ->
 Inhibit cell wall synthesis

Toxicity
 Very safe
 Most commonly hypersensitivity
 GI flora change
 Cepahlosporins - renal toxicity
 Vancomycin – hypersensitivity skin reaction & renal tox
 Prohibited in food animals

24
Q

Spectrum of Activity for Penicillins

A

 Aerobic or Anaerobic
 Gram (+) or (-)
 Natural penicillin & aminopenicillins not effective on Pseudomonas & Staph

25
Q

Spectrum of Activity for Cephalosporins

A

 Aerobes
 Cefoxitin & Cefotetan can also do anaerobes

26
Q

Spectrum of Activity for Imipenem & Vancomycin

A

 Both drugs usually reserved for humans

Imipenem
* Aerobic or Anaerobic
* Gram (+) or (-)

Vancomycin
* Aerobes
* Gram (+) or (-)

27
Q

Uses of Cefadroxil/Cephalexin, Cefazolin, Cephapirin, Cefoxitin, Ceftiofur, Cefovecin, Cefpodoxime, Carbapenems

A

Cefadroxil & Cephalexin
* Most common ceph used
* Poor PO in horses

Cefazolin
* Dogs, cats, horses
* Penetrates bone

Cephapirin
* For cows

Cefoxitin
* Abdominal sx prophylaxis in SA

Ceftiofur
* UTIs in SA
* Resp. infections in horse, cow, pig

Cefovecin
* One time injectable for skin infections in SA

Cefpodoxime
* Skin infections in dogs

Carbapenems
* Not labeled for vet med
* Severe resistant infections in SA & foals

28
Q

Rifampin; MOA, Spectrum, Tox, Use

A

MOA
* Bacteriocidal at high conc.
* Interferes w/ RNA synthesis

Spectrum
* Gram (+) aerobes

Tox
* Liver toxicity

Use
* Rhodococcus equi

29
Q

Metronidazole; MOA, Spectrum, Tox, Use

A

MOA
* Bacteriocidal
* Undefined

Spectrum
* Anaerobic gram (+) & (-)

Tox
* Vestibular toxicity
* Maybe neurotoxicity in cats

Use
* Anaerobic infections
* Dogs & horses ONLY

30
Q

Methanamine

A

 Acidic environment -> formeldahyde ->
 Urinary antiseptic ->
 Used for uncontrolled UTIs

31
Q

Polymyxin B; MOA, Use, Spectrum of Action, Adverse Effects

A

MOA
 Disrupts wall of gram (-)

Use
 Eye infections
 Low controlled dose for endotoxin in equine colic

Spectrum of Action
 Pseudomonas
 Salmonella
 E. coli

Adverse Effects
 Dose dependent nephrotoxicity, neuromuscular blockade, CNS tox
 Make sure pt is hydrated

32
Q

Drugs to Consider for Treatment of MRSA

A

o Chloramphenicol
o Tetracycline
o Aminoglycosides (best because bacteriocidal)
o Rifampin

33
Q

Drugs to Consider for Treatment of Pseudomonas

A

o Amikacin & gentamycin
o ceftazidime, cefotaxime
o ticarcillin, piperacillin, carbenicillin
o Fluroquinolone w/ beta-lactam
o Imipenem (last resource)

34
Q

Drugs to Consider for Treatment of Nocardia, Mycoplasma, & Rickettsiaceae/Anaplamataceae

A

Nocardia
 Sulfonamides

Mycoplasma
 Tetracyclines
 Macrolides
 Amphenicols

Rickettsiaceae/ Anaplamataceae
 Tetracyclines
 amphenicols

35
Q

Antibiotics that target both aerobe, anaerobe, gram (+) & (-)

A

o Ampicillin w/ enrofloxacin (NOT in young animals)
o Amoxicillin/clindamycin/metronidazole + fluoroquinolones (dogs; avoid in young)
o Amoxicillin/clavulanic (cat; limited effect against anaerobes)
o Imipenem (not an option for empirical and ambulatory treatment)
o Penicillin and gentamycin or amikacin (no for ambulatory treatment)
o Ticarcillin‐sulbactam
o Ceftazidime
o Cefotaxime

36
Q

Which Drugs are Bacteriocidal and which are Bacteriostatic

A

Bacteriocidal Drugs
o Beta‐lactams
o Vancomycin
o Aminoglycosides
o Metronidazole
o Fluoroquinolones
o TMS
o Rifampin

Bacteriostatic Drugs
o Macrolides
o Tetracyclines
o Chloramphenicol
o Clindamycin

37
Q

Which Drugs are Hydrophilic and which are Lipophilic

A

Hydrophilic Antibiotics
o Beta‐lactams
o Vancomycin
o Aminoglycosides

Lipophilic Antibacterials
o Macrolides
o Fluoroquinolones
o Tetracyclines
o Chloramphenicol
o Clindamycin

38
Q

Time Dependent Antibiotics and how to enhance dosage regimen

A

o Beta‐lactams
o Macrolides
o Lincosamides
o Sulfonamides

o Antibiotics effective when plasma conc. Exceeds 4 x MIC for MOST of dosing interval
o Can enhance dosage regimen by reducing interval or using CRI

39
Q

Concentration Dependent Antibiotics and how to enhance dosage regimen

A

o Aminoglycosides
o Fluoroquinolones

o Most effective when exceeds 8 x MIC for at least a short time
o Can enhance dosage regimen increase dose or reduce interval

40
Q

Complicated Infections

A

o Prior antibiotic therapy was unsuccessful
o Immune compromise
o Infection likely involves more than 1 bacteria
o Environment where resistant bacteria may be present such as hospital
o Bacteria is likely resistant

41
Q

Culture & Sensitivity Rules

A

o 90% that test susceptible will be
o 60% that test resistant will be susceptible
o Intermediate discourages standard dose because it may be resistant to standard
o C/S based on plasma/serum conc. not tissue

42
Q

Microbiological/ Epidemiological Vs PK/PD Vs Clinical Breakpoints

A

o MIC decided by CLSI

Microbiological/Epidemiologcial
 Population MIC /zone diameter

PK/PD
 AUC/MIC
 Cmax/MIC
 %dose interval / MIC

Clinical
 Outcome data from field trials at standard doses

43
Q

Host Factors that Decrease Antibiotic Efficacy & Drugs Effected

A

Hypertonic environment
 Affect beta lactams accept cefovecin & cefpodoxime

Acidic Environment
 Macrolides
 Fluoroquinolones
 Aminoglycosides
 Penicillin (inactivates at pH 6)

Purulent debris
 Aminoglycosides
 Vancomysin

Low O2
 Aminoglycosdies

High O2
 Metronidazole

44
Q

Which Antibiotic is commonly used CRI

A

Beta Lactams

45
Q

Length of Treatment for Acute Vs Chronic Bacterial Infections

A

Acute
 5 days
 7-10d
 reassess in 2 days

Chronic
 >21d
 re-culture & assess 7 days prior to discontinuation
 re-culture & assess 1-2wks after discontinuation

Clin Pharm (8 decks)

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