Final Flashcards
Atripla
NRTI
Triplets! Emtricitabine + tenofovir + Efavirens NNRTI
HIV
Stribild
Great strides! SO LONG USE 4
Emtricitabine + tenofovir + ELVITEGRAVIR (INTEGRASE INHIBITORS) + Cobicistat
HIV
Tenofavir
NRTI
NucleoTide T for tenofavir
BACKBONE for HIV
Emtricitabine
NRTI
HIV
EEEK! HYPERpigmentation of palms + skin discoloration
Zidovudine
NRTI
HIV
Zido like vedo so wipe out cells causing anemia
Since it wipes everything out its good for Prophylaxis + Pregnancy
NRTIs moa
Competitively inhibit nucleotide binding to reverse transcriptase + terminate the DNA chain
Toxicity of NRTIs
bm suppression reverseed w/G-CSF
peripheral neuropathy
Lactic acidosis
the d didansonosine cause the p pancreatitis
MOA of NNRTIs
Bind to reverse transcriptase @ different site from NRTIs
Don’t require phosphorylation like nucleosides
Efaviranz
What the ef I have to take this on an empty stomach
And i get vivid dreams + CNS sx, a false positive cannabinoid test, + I’m teratogenic! FUCKKK
NNRTI
HIV
Rilpivirine
My pivots (rilPIVrine) not too high so I can’t use with high viral loads
Since those PPIs can pivot high can’t use w/rilpivarine b/c its a CYP450 Inducer!
NNRTI
HIV
What are common s/e of all NNRTIs
Rash + hepatotoxicity
Nevirapine
Never again I got hepatitis! Shits fatal w/necrosis
NNRTI
HIV
NRTI drugs
Emtricitabine FTC
Lamivudine 3TC
Tenofovir TDF
Zidovudine ZDV
Lamivudine 3TC
Lame!!!!
LamEpivir HBV
NTRI
HIV
NNRTI drugs
Efavirenz
Nevirapine
Rilpivirine
Protease inhibitor drugs
Atanzanavir
Darunavir
Ritanovir
Protease inhibitors MOA
Assembly of virions depends on HIV1 protease
PREVENT maturation of new viruses
Ritonavir
RIGHT ON! Boost other drugs by inhibiting CYP450
also with a c is CAPSULE which you must REFRIGERATE
protease inhibitor
HIV
All Protease inhibitors end in
navir! NEVER tease a PROTEASE
Truvada
NRTI
T is for two so emtricitabine + tenofovir
HIV
Kaletra
Lopnavir + Ritonavir
Kara wants to get prego so Drug of choice!
Protease inhibitor
HIV
Integrase inhibitor drugs
Raltegravir
Elvitegravir
Atanavir
att ooohh!!! need Acidic environment don’t use PPIs!
Indirect hyperbilirubinemia, lack of effect on lipids!!!
AAAA OKAYYYY w/the LIPIDSS
Protease inhibitors
HIV
Darunavir
DARN! i get a rash w/sulfa allergies
Protease inhibitor
HIV
Integrase inhibitor MOA
Inhibit HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase
Elvitegravir
COMBO Stribilid! An NRTI
Integrase inhibitor
HIV
Toxicity of integrase inhibitors
H/a, nausea, diarrhea, inc. cr kinase, + exacerbation of depression
Integrase inhibitor
HIV
Tenofavir s/e
renal insufficiency- do us a FAVIR + CHECK CREATANINE!
What can tenofovir be used w/Emtricitabine for?
Pre-exposure prophylaxis (PrEP) + post exposure prophylaxis (PEP)
S/E of zidovudine
Bone marrow suppression z is at the end of the alphabet and bum is at the end of the torso so bm suppression
Which two things that are used to clean things may become contaminates w/spores/bacteria + actually transmit infection
Disinfectants + antiseptics
Avoid use of what in neurosurgery
Chorhexidine gluconate hibiclens
Povidone-iodine betadine use
ointments, swabs, spray, SURGICAL SCRUB
What can be used on burn wounds
silver sulfadiazine SSD, silvadene
MOA of acyclovir, famciclovir, + valcyclovir
Phosphorylated into active triphosphate incorporated into viral DNA
PSYC! (cyclovir) viruses you can’t replicate!
HSV
The prodrug of acyclovir
Valacyclovir has better oral availability…like walah!!!! we made a prodrug for acyclovir so much better
When can you use acyclovir, famciclovir, + valacyclovir for VZV + HSV?
48-72 hrs of rash onset
(2-3 days b/c 3 drugs and 3 letters in HSV + HSV)
Prophylaxis in immunocompromised
Drugs used to treat CMV
Ganciclovir
Foscarnet
Cidofivir
Special considerations for Gancyclovir
IV ONLY
Black box warning for bone marrow toxicity gan is part of the gang which is bad so black box warning
Hydration, renal fxn, avoid direct contact w/skin
CMV
Valganciclovir
PO only valgan sounds like vegan which has to do with eating so only oral DRUG OF CHOICE for TX + PROPHYLAXIS vegan is healthy so drug of choice CMV
Foscarnet
HIGHLY NEPHROTOXIC
N + T in foscarNeT so nephro-toxic
CMV
HBV antivirals
PO HBV is bad so definitely need oral
Adefovir, lamivudine, entecavir, telbivudine, tenofovir
subcutaneously
Interferon alfa! Alpha is a so beginning of alphabet so start on skin
First line for HBV?
TENOFAVIR!
yess the same as HIV b/c its a 10.0
Lamivudine
HBV use lower dose than for HIV….lammmmmeee
resistance is common
Adverse effects of entecavir
Dizziness + fatigue
looks like entering the cave + the cave is dark so causes fatigue + the cave could be the brain so cause dizziness
GREAT FOR LAMIVUDINE RESISTANT HBV
Side effects of interferon
FLU! interferes w/your life b/c interferon but improves as tx continues
HBV
Interferon CI
Hepatic decompensation, autoimmune, arrythmia, + pregnancy
like i said interferes w/a ton of shit
HBV
Tx for HCV
Ribavirin
Sofosbuvir
simeprevir
Ribavirin
Active against HCV, RSV, influenza A + B, + HSV
CATEGORY X!!! teratogenic, hemolytic anemia, gi upset, + depression
Sofosbuvir
pangenotypic activity
HCV
1000 dollars a tablet!!!!
Simeprevir
Directly acting antiviral b/c its SIMPLE (SIMEprevir)
HCV
DIs
TAKE W/FOOD need some (SIMeprevir) food
Best method for routine prevention of influenza
Inactivated influenza vaccine!
Drugs for influenza virus
Amantadine
Rimantadine
Oseltamivir tamiflu
zanamivir
Amantadine
MEN are toxic so aMANtadine risk for CNS toxicity + used for parkinsons + drug induced EPS
NO LONGER RECOMMENDED FOR PROPHYLAXIS AMENNNNNN
Influenza
What has less CNS effects than amantadine
rimantadine…..righhhhttt choice!
influenza ONLY A
First line for Influenza
Oseltamivir alllll set (Oselt) to kick influenzas ass
Must be used w/in 48hrs of sx
n/v + abdominal pain
Inhaler formulation for influenza
Zanamivir
Same as tamaflu
Infection
isolated organisms CAUSE infection
Colonization
isolated organism NOT causing sx
Contamination
Isolated organism from PTS SKIN/ENVIRONMENT
Susceptible
get enough drug into pts system to tx infection
MIC
Intermediate
MAY NOT be able to get enough drug into pt to tx infection unless safe enough to give high doses/drug concentrations exceptionally well @ infection site
MIC = attainable serum levels
Resistant
CAN’T get enough drug into pt to tx infection
MIC> attainable serum levels
MIC
lowest abx concentration to prevent visible growth of an organism
What are the drug factors for abx
Clinical efficiency Pharmacokinetic + dynamics Time dependent killers Synergy Post abx effect ABX spectrum Route of admin bactericidal vs. bacteriostatic
Time dependent killers
Killing is dependent on the time an organism is in contact w/drug
Duration that drug concentrations are above the MIC (Time>MIC)
Beta lactams, vancomycin
Concentration dependent killers
Killing dependent on concentration of drug
Higher conc. the greater the killing
MIC=peak serum drug concentration
Fluoroquinolones, aminoglycosides
Post abx effect
Organism growth is suppressed for a period of time after the drug concentration falls below MIC
Two types of abx resistance
intrinsic + acquired
Intrinsic resistance
naturally occurring
Drug cant penetrate organisms cell wall/no receptor site available
Acquired resistance
Normally sensitive organism becomes resistant
Mechanisms of acquired resistance
Detoxifying enzymes alter structure + fxn
Beta lactamase breaks down ring of PCN
Alteration of target site like pcn binding protein
Dec. cellular accumulation impaired/enhanced influx/efflux
Advantages/disadvantages of PO/IV
IV severe infection
ALL else PO b/c excellent bioavailability
Oral decc. cost, less resources, pts prefer, reduce exposure nosocomial pathogens, reduce risk phlebitis, earlier discharge, inc. mobility, + dec. personnel time
What are the penicillins? (beta lactams)
Natural (G/VK)
Aminopenicillins (ampacillin/amoxacillin)
penicillinase resistant (nafcillin, oxacillin, dicloxacillin)
extended spectrum (ticarcillin/clavulanate, piperacillin/tazobactam)
Natural PCNs (beta lactams) VK/G spectrum
POSITIVE + NEGATIVE
Strep/treponema
Aminopenicillins (beta lactams) Ampacillin/amoxacillin spectrum
POSITIVE + NEGATIVE + ANAEROBES (A for all!)
Spectrum for penicillinase resistant penicillin (beta lactams) nafcillin, oxacillin, + dicloxacillin
ONLY GRAM + (resistant in the name so only covers 1)
Staph/strep
Spectrum of extended spectrum penicillin (beta lactams) ticarcillin/clavulante, piperacillin/tazobactam
POSITIVE NEGATIVE + ANAEROBES
ALL b/c extended spectrum
Staph/strep, enterobacteriaceae, bacteriodes
Two pcns that cover all organisms
extended spectrum
aminopenicillins
What are natural pcns used for?
pharyngitis, erysipelas, + syphilis
What are aminopenicillins used for?
URIs, susceptible enterococcal infections, UTI, CAP, lymphadenitis, Amoxacillin clavulante used for skin
What are penicillinase resistant penicillins used for
B-lactamase producing staph, cellulitis, + endocarditis
What are extended spectrum penicillins used for
Nosocomial pneumonia
Intrabdominal infections
Skin + soft tissue infections
Beta lactamase inhibitors
Enhance abx activity against certain beta lactamase producing organism extending the abx spectrum
Clavulanate, tazobactam, + sulbactam
What are the s/e of PCNS?
Leukocytopenia/thrombocytopenia
Jarisch-herxheimer rxn: w/spirochetes like treponema pallidum/lime release toxins after killing bacteria causing chills, myalgia, + fever
GI upset/diarrhea clavulanate
hepatitis for nafcillin/oxacillin
Desensitization for PCN allergy
Administer cephalosporin if non-life threatening
Non beta lactam abx like macrolides, quinolones, sulfonamides, vancomycin
PCN desensitization in. every 15-30m in ICU
PN skin test
Drug interactions of PCNs
Propenicid- decreases renal tubular secretions of PCns so co-administration causes inc. serum levels of abx
Methotrexate- PCN inhibits renal tubular secretion of it + may result in high levels of methotrexate
OCPs-rifampin dec. levels of hormones b inc. metabolism through liver enzymes
MOA for beta lactams
Bind to pcn binding proteins + inhibit cell wall synthesis causing death
What is the drug of choice for infections caused by ESBLs?
Carbapenems
Clinical uses of carbapenems
UTI, LRI, intraabdominal + gynecological infections, skin, soft tissue, bone + jt. infections (like extended spectrum pcns)
Special consideration of carbapenems
CROSS REACTIVITY W/PCN
Names of carbapenems
Impenem/cilastin, meropenem, doripenem, ertpenem
ALL HAVE PENEM
Imipenem a carbapenem is combined w/ cilastatin to
prevent breakdown y renal dihydropeptdase
c is used w/ impenem for the d
Spectrum of carbapenems
POSITIVE NEGATIVE + ANAEROBES
staph/strep, listeria, + pseudomonase EXCEPT ERTAPENEM
Monobactams spectrum (Aztreonam)
ONLY GRAM - including pseudomonas (penicillinase resistant pcn only gram +)
Glycopeptides drugs
vancomycin
telavancin
dalbavancin
oritavancin
MOA of glycopeptides
Prevent cross linking of the cell wall peptidoglycan during cell wall syntheisis
Spectrum of vancomycin
GRAM + ONLY
MRSA (oral form not absorbed-only for c-diff)
S/E of vancomycin
RED MAN’S syndrome!
Infusion related rxn by histamines so looks like allergic rxn
Erythmatous urtiarial flushing, tachycardia, + hypo tension
STOP INFUSION! wait till subside then slow infusion rate no more than 1gm/hr + can give benadryl
double infusion time
Telavancin indications
soft tissue, skin + nosocomial infections (similar to extended spectrum penicillin, + carbamapens)
S/E of televancin (glycopeptide)
Red mans syndrome, nephrotoxicity, gi upset, metalllic taste (more s/e than vancomycin)
BB warning in pregnancy!
What are the four generations of cephalosporins?
Cephalexin PO, cefazolin IV Cefuroxime PO, cefoxitin IV Cefdoxime PO, ceftriaxone IV Cefeptime IV NEWER: cetazimide/avibactam + ceftolozane/tazobactam, ceftaroline IV against MRSA/VRSA/VISA SO RESERVED
First generation cephalexin PO + cefazolin IV cephalosporin uses
+/-
SPecK (staph/strep, proteus, ecoli, klebsiella
Mild skin/soft tissue infections
2nd generation cefuroxime PO, cefoxitin IV cephalosporin uses
+/-
HMSpecK: H. flu, moraxella catarrhalis, staph/strep, proteus, e.coli, + klebsiella
Replaced by third generation
3rd generation Cefpoxime PO, ceftriaxone IV cephalosporin uses
+/-
HEMS: h.flu, enterobacteriaceae, moraxella catarrhalis, strep
CAP, otitis media, URI
4th generation Cefeptime IV cephalosporin uses
+/-/anaerobes
Nosocomial infections
Cephalosporins are ______ susceptible to B-lactamases giving them a ____ spectrum of action compared to pcns includin staphylococcus
less, broader
Earlier generations of cephalosporins have better gram ____ coverage than later generations
positive
Later generations of cephalosporins have better gram ____ coverage than earlier generations
NEGATIVE
S/E of cephalosporins
Caution in pts w/pcn allergy CROSS SENSITIVITY (higher for 1st gen) Cefotetan has mtt side chain that can cause hypoprothrombinemia + bleeding MONITOR RENAL FXNN PROBENICID also inc. Drug interaction
Which drugs are cell all inhibitors?
monobactams
carbapenems
glycopeptides
Other cell wall/membrane active agents
daptomycin
fosfomycin
bacitracin cycloserine
daptomycin
VRE + VISA/VRSA
Skin + soft tissue infections, bacteremia, NOOOOOTTT PNEUMONIA
if muscle aches monitor CPK + if elevated dixc. drug
Fosfomycin
Gram + and -
UTIs
Bacitracin
HIGHLY nephrotoxic so only used topically
Surface lesions on skin/irrigation wounds/jts.
Cycloserine
Gram + and -
used for RESISTANT TB
SERIOUS h/a, tremors, acute psychosis
