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PPP I for PT > Immune system Pharmacology > Flashcards

Immune system Pharmacology Flashcards

1
Q

what are the 6 Bacterial Wall inhibitors (antimicrobial)

A
  1. penicillin
    - antistaphylococcal
    - aminopenicillian
    - antipseudomonal
    - B-lactamase inhibitors
  2. cephalosporans
  3. carbapenams &monobactams
  4. glycopeptides
  5. bacitracin
  6. polymyxin B & E
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2
Q

what are the 6 bacterial protein synthesis inhibitors (antimicrobial)

A
  1. aminoglycosides
  2. macrolides
  3. tetracyclines
  4. streptogramins
  5. oxazolidinones
  6. glycilcyclines
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3
Q

what are the 3 inhibitors of bacterial DNA synthesis or breaking DNAs strands

A
  1. fluoroquinolones
  2. nitroimidazoles
  3. antifolates
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4
Q

what are the 4 antimycobacterial agents

A
  1. isoniazid
  2. rifampin
  3. pyrazinamide
  4. ethambutol
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5
Q

what are the 5 antiviral agents

A
  1. inhibition of uncoating
  2. inhibitors of viral transcription
  3. ribavirin
  4. inhibitor of viral RNA or DNA replication
  5. inhibitors of viral release
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6
Q

5 agents for HIV treatment (HAART)

A
  1. nucleotide reverse transcriptase inhibitor
  2. non-nucleotide reverse transcriptase inhibitor
  3. protease inhibitors
  4. fusion inhibitors
  5. integrase inhibitors
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7
Q

3 types of antifungal agents

A
  1. polyene macrolide antibiotics
  2. antifungal azoles
  3. allylamines
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8
Q

2 bacterial classifications and their characteristics

A
  1. Gram-positive: thick cell walls, stain purple or black

2. Gram- negative: thin walls and stain pink

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9
Q

5 methods of classifying antibiotics

A
  1. selective toxicity: targets specific cells
  2. bacteriorstatic: inhibits bacteria growth
  3. bactericidal: high concentration (time and concentration dependent)
  4. broad spectrum agents: works for many types
  5. narrow-spectrum agents: works for few types
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10
Q

2 general concerns pertaining to drug resistance for antimicrobial agents

A
  1. innate: bacteria lack transport mechanism for agent to enter cell
  2. acquired
    - spontaneous mutation: prevent drug from entering cell
    - extra chromosomal genetic material: R plasmids, alter drug binding site
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11
Q

5 factors to consider when choosing an antimicrobial

A
  1. type of bacteria
  2. allergies
  3. presence of liver or kidney dysfunction
  4. age
  5. site of infection
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12
Q

Standard Penicillin

  1. Name the 2 types
  2. how is it administered
  3. Spectrum?
  4. resistance level
A
  1. types: G & V
  2. G parenterally, V orally
  3. narrow spectrum
  4. resistance increasing via bacterial production of B lactamase
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13
Q

Antistaphylococcal

  1. 4 Types (cillin)
  2. function
  3. Allergy?

associated with MRSA (methicillin resistant staphylococcal aureus)

A
  1. methicillin, nafcillin, oxacillin, cloxacillin
  2. not inactivated by lactamase and target cells that contain that enzyme
  3. high incidents of allergic reactions
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14
Q

Aminopenicillin

  1. 2 types
  2. 2 functions
A
  1. ampicillin, amoxicillin
    • addition of amino acid to penicillin side chain
    • enhances activity against gram-negative
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15
Q

Antipseudomonal

  1. 3 types
  2. function
A
  1. carbenicillin. ticarcillin, pipeacillin

2. similar to aminopenicillin with activity against more gram- negative

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16
Q

B-lactamase inhibitors

  1. 3 types
  2. what can it be combined with
A
  1. Clavulanate, sulbactum, tazobactum

2. can be combined with penicillin to prevent resistance (caluvulanate+amoxicillin=augmentin)

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17
Q

6 clinical uses for penicillins

A
  1. Used for many gram positive and negative bacteria
  2. First choice drug if tolerated by patient
  3. Used to treat if tolerated by patient
  4. Used to treat CNS infections
  5. Certain UTIs
  6. Used to treat some STDs
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18
Q

5 ADRs for penicillins

A
  1. GI discomfort
  2. allergies
  3. urticaria (hives)
  4. joint swelling
  5. respiratory problems (could affect exercise tolerance during PT)
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19
Q

mechanism of action for bacteria cell wall inhibitor

A

Bind to penicillin-binding proteins and inhibit linking of peptide chains to bacteria cell wall

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20
Q

cephalosporins (1st generation)

  1. 5 types (or what suffix to look for)
  2. effective for what type of bacilli and cocci
  3. used for?
A
  1. (cef/ceph) cefadroxil, cefazolin, cefmetazole, cephalexin, cephradine
  2. effective for gram positive cocci and gram negative bacilli
  3. used for skin, soft tissue, and post-surgical infections
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21
Q

cephalosporins (2nd generation)

1. effect

A
  1. effective for gram positive cocci

- more effective than 1st generation for gram negative bacilli

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22
Q

cephalosporins ( 3rd generation)

  1. effect
  2. what system can it enter
A
  1. effective against gram-negative bacilli

2. enters the CNS

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23
Q

6 clinical uses for cephalosporins

A
  1. septicemia
  2. pneumonia
  3. meningitis
  4. biliary infections (galbladder infection)
  5. skin infections
  6. sinusitis
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24
Q

2 ADRs for cephalosporins

A
  1. hypersensitivity

2. GI disturbances

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25
MOA for carbapenems and monobactams
Developed to treat specifically B-lactamase-producing gram-negative bacteria
26
monobactams 1. type 2. limited to what type 3. allergy? 4. ADRs
1. type: aztreonam 2. limited to only aerobic gram negative bacilli 3. relatively non-allergenic 4. GI disturbances, utricaria
27
carbapenems 1. 3 types 2. function 3. Allergy? 4. ADRs
1. imipenem, meropenem, ertapenem 2. gram positive and negative, anaerobic bacteria can be treated 3. relatively non-allergenic 4. GI disturbances, utricaria
28
MOA for glycopeptides
Lack B-lactam ring and bind to specific amino acids of the cell wall backbone
29
Glycopeptides 1. 2 types 2. effective against 3. resistance? 4. Works well with what type of patient 5. ADRs
1. Types: Vancomycin, Teicoplanin 2. Effective against resistant gram positive 3. few cases of resistance, serious condition 4. works well with hypersensitive to antimicrobial penicillin patients 5. ADRs: - erythematous rash confined to neck and upper trunk (red man syndrome - this is a result of a histamine reaction if the drug is infused to quick through oral
30
Bacitracin MOA
Blocks recycling of membrane lipid carrier which is needed to add new wall units
31
Bacitracin 1. 2 types 2. how is it used
1. Polymyxin B, Neomycin 2. used as topical for minor skin infections - prescription needed for internal use
32
Polymyxin B & E MOA | 1. used for
Destroy integrity of membrane allow for escape of nutrients 1. treatment of skin infections - systemic exposure can be neurotoxic and nephrotoxic (CNS changes)
33
general MOA for bacterial protein synthesis inhibitors
targets bacterial ribosomes by affecting mRNA and tRNA
34
Aminoglycosides (bacterial protein synthesis inhibitor) 1. 3 types 2. how does it enter cells 3. resistance 4. used for
1. streptomycin, gentamicin, neomycin 2. enters cell on oxygen dependent transport system 3. resistance becoming an issue 4. treats enteric organisms and treatment of sepsis
35
Macrolides (bacterial protein synthesis inhibitor 1. 3 types 2. function 3. used for 4. ADRs
1. erythromycin, clarithromycin, azithromycin 2. inhibits formation of peptide bonds between amino acids and tRNA 3. used to treat respiratory infections 4. erythromycin poorly tolerated-- nausea & vomiting - others produce less severe GI disturbances
36
Tetracyclines (bacterial protein synthesis inhibitor 1. 3 types 2. function 3. used for 4. ADRs
1. tetracycline, doxycycline, minocycline 2. blocks binding of rRNA to mRNA 3. used to treat acne vulgaris 4. bone impairing growth, yellowing of teeth
37
Streptogramins (bacterial protein synthesis inhibitor 1. administration 2. function 3. used with and for 4. ADRs
1. administered as synergistic pair (quinupristin & dalfopristin 2. dalfopristin configurates a binding site on the ribosome for quinupristin 3. used in combination with other antimicrobials to fight resistant bacteria 4. ADRs: inflammation at infusion site, GI effects, myalgias, arthralgias
38
Oxazolidinones (bacterial protein synthesis inhibitor 1. MOA 2. Type 3. resistance
1. interfers of tRNA binding 2. linezolid 3. rare resistance (means not given often and pt has serious condition)
39
Glycilcyclines (bacterial protein synthesis inhibitor 1. MOA 2. Type 3. administered 4. used for 5. ADRs
1. blocks entry of tRNA into ribosome 2. tigecycline 3. administered through IV 4. treats serious infections 5. mild to moderate GI discomfort (can affect exercise during PT
40
General MOA of inhibition of bacterial DNA synthesis or break DNA strands agents
Inhibits topoisomerase 2 (DNA gyrase), which reseals breaks in a DNA strand
41
Fluroquinolones (inhibition of bacterial DNA synthesis or break DNA strands) 1. 4 types 2. used for 3. ADRs
1. ciprofloxacin, levofloxacin, gatifloxcin, moxifloxacin 2. treats UTIs, respiratory tract infections, otitis caused by gonorrhea, bacterial prostatitis, anthrax 3. ADRs: - GI effects - dizziness - headaches - arthralgias - myalias - tendinitis (rotator cuff) - tendon ruptures (most often achilles with patients 60 or older, and have undergone heart, kidney or lung transplant surgery - highest incidences within 30 days of drug withdrawn (end of treatment)
42
Nitroimidazoles (inhibition of bacterial DNA synthesis or break DNA strands) 1. type 2. function 3. used for 4. ADRs
1. metronidazole 2. reduced in mitochondria and resulting intermediates affect DNA 3. used to treat bacterial vagninosis and C. difficile 4. numbness in the hands and vomiting with alcohol intake
43
antifolates (inhibition of bacterial DNA synthesis or break DNA strands) 1. MOA 2. 3 types 3. used for 4. resistance 5. ADRs
1. Interfere with folate production which is needed for purine synthesis (DNA formation) 2. • Silver sulfaziazine •Sulfamethoxazole •Trimethoprim- sulfamethoxazole 3. treats conjunctivitis, UTIs, inflammatory bowel disease, topically for infected burns 4. high bacterial resistance 5. ADRs: allergenic
44
Isoniazid (antimycobacterial) 1. MOA 2. used with 3. ADRs
1. Inhibits synthesis of mycolic acid which helps form the cell wall 2. used in combination with Rifapin to treat TB 3. ADRs •Hepatitis •Peripheral neuropathy – affects balance •Hematological changes – clotting, cell count, anemia •Arthritic symptoms – joint pain •Vasculitis
45
Rifampin (antimycobacterial) 1. MOA 2. treats 3. ADRs
1. inhbits RNA synthesis 2. can treat infections (TB) 3. ADRs - thrombocytopenia (deficiency of platelets) - nephritis - orange discoloration of most secretions - induces hepatic P450 enzymes (increases metabolism, decrease half life, decrease effectiveness of other drugs)
46
Pyrazinamide (antimycobacterial) 1. MOA 2. ADR
1. inhibits enzyme fatty acid synthesis 1 | 2. ADR: heptotoxicity
47
Ethambutol 1. MOA 2. Bizzarre ADRs
1. inhibits RNA production 2. ADR - affects vision: retrobulbar neuritis leading to red-green blindness and loss of visual acuity
48
PT concerns for antimycobacterial agents
1. vision problems 2. GI disfunction 3. CNS 4. peripheral neuropathy 5. muscle/joint pain 6. pain in upper quandrant or liver dysfunction 7. bone growth impairment 8. hypersensitivity 9. skin & respiratory changes 10 pt needs to eat food with meds 11. hygiene is important for patient and PT
49
inhibitors of uncoating (antiviral) 1. MOA 2. 2 types 3. used for 4. when should it be started 5. ADRs
1. blocks hydrogen channels that are needed to acidify the interior of the virus 2. amantatdine, rimantadine 3. treats influenza A 4. start meds within 2 days of illness starting (if accomplished it is only 10-27% effective) 5. ADRs - dizziness - insomnia - orthostatic hypotension - slurred speech - livedo reticular (lace like purplish discoloration of the lower extremities
50
Inhibitors of viral transcription (antiviral) 1. MOA 2. types 3. used for 4. ADRs
1. interferons that bind to cell kinase receptors to enhance cellular resistance to viruses -interferons often used in conjunction with ribavirin, which disrupts viral transcription 2. interferons NOT orally bioavailable and must be injected 3. treats hepatitis B & C, kaposi's sarcoma, herpes, HPV 4. ADRs -Flu-like syndrome •Myelosuppression (neutropenia and thrombocytopenia) •Neurotoxic (head, anxiety, dizziness) •Fatigue (can be severe) •Can develop antibodies against the thyroid leading to thyroid disease •SLE •Depression
51
Ribavirin (antiviral) 1. administered 2. treats 3. used with what 4. ADRs
1. enteral and parenteral 2. treats respiratory syncytial virus in kids, - bronchiolitis, - pneumonia, - west nile virus, - hemorrhagic and lassa fever associated with hanta virus 3. used with interferons for greater effect 4. ADRs: hemolytic anemia - carcinogenic in animals
52
First type Inhibitor of Viral RNA or DNA replication (antiviral) 1. MOA 1st type 2. type 3. treats 4. ADRs
1. Activated intracellularly using a virus-specific thymidine, kinase and host enzymes and then competes for a port in the DNA polymerase creating a chain termination 2. acyclovir 3. treats herpes simples, varicella zoster, cytomegalovirus, epstein-barr 4. ADRs: Generally well tolerated - lethargy - confusion - tremors - seizures
53
2nd type inhibitor of viral RNA or DNA replication (antiviral ) 1. MOA (2nd type) 2. type 3. treats 4. ADRs
1. direct inhibition on viral DNA without activation 2. foscarnet 3. treats viruses associated with AIDs 4. ADRs - organ toxicity ( urinary tract, CNS, Hematologic system)
54
Inhibitors of viral release 1. MOA 2. 2 types 3. ADRs
1. inhibit influenza neuraminidase which is needed for cleaving the budding virion 2. zanamivir, oseltamivir 3. ADRs: - nausea - vomiting - few instances of bronchospasm
55
Nucleotide reverse transcriptase inhibitor (HAART) 1. MOA 2. 6 types 3. ADRs
1. Works as a dideoxynucleoside analog that lacks a hydroxyl needed for adding bases and stops elongation of the DNA chain 2. • Zidovudine aka azidothymidine •Emtricitabine(Emtriva) •Lamivudine(Epivir) •Tenovir(Viread) •Didanosine(Videx) •Stavudine(Zerit) 3. ADRs: •Potential to produce fatal lactic acidosis - low pH = increase HR •Fat redistribution and hyperlipidemia •Anemia •Neutropenia (low white blood cell count) •Myopathy •Headaches •nausea •Vomiting •Myelosuppression •Pancreatitis •Diarrhea •Peripheral neuropathy •AIDS related dementia
56
Non-nucleotide reverse transcriptase inhibitor (HAART) 1. MOA 2. 4 types 3. ADRs
1. binds to a portion of the reverse transcriptase and inactivating it 2. etravirine, nevirapine, efavirens, delavirdine 3. ADRs - maculopapular rashes (must discontinue treatment) - hepatitis - neuropsychiatric symptoms (less sleep=noncompliance with therapy) - CNS effects occur hours after dose - use P450 for metabolism and can affect other drugs
57
Protease inhibitors (HAART) 1. MOA 2. 7 types (or suffix) 3. ADRs
1. bind to protease enzyme of H1V1 and 2, stops viral assembly and budding 2. suffix=vir - saquinavir - tripranavir - ritonavir - darunavir - indinavir - nelfinavir - amprenavir 3. ADRs - GI symptoms - syndrome of lipodystrophy - -increase central obesity and increased serum triglycerides and cholesterol, insulin resistance
58
Fusion inhibitors (HAART) 1. MOA 2. type 3. ADRs
1. bind to viral envelope and prevents fusion with host cell 2. enfuvirtide 3. ADRs: •Injection forms can cause mild/moderate pain, erythema, induration, and cysts at injection site •Increased in bacterial pneumonia
59
integrase inhibitors (HAART) 1. MOA 2. type 3. ADRs
1. Interferes with the integrase enzyme that is needed to integrate vital genetic material to human DNA 2. raltegravir 3. ADRs: Diarrhea, fatigue, headache NOTE: not metabolized by P450
60
PT concerns for HAART
1. CNS effet (dizziness, personality changes) 2. rashes 3. fatigue: affects compliance with exercise and lower immune system 4. cardiovascular 5. prevent blood transmission
61
polyene macrolide antibiotics (antifungal) 1. MOA 2. types 3. ADRs
1. binds to ergosteral and produces an open channel to allow potassium and magnesium to flow out of fungal cell membrane 2. types: amphotericin B and nystatin 3. ADRs for AMPHOTERICIN o Renal toxicity o Impaired hepatic function o Thrombocytopenia o Tachycardia o Chills o Fever o Tinnitus o Headache o Vomiting - Limited to use on the skin ``` ADRs for NYSTATIN o Nausea o Vomiting o Diarrhea o Cramps o Rash o Urticaria ```
62
antifungal azoles 1. MOA 2. suffix for types 3. treats 4. ADRs
1. inhibit ergosterol synthesis and interferes with membrane associated enzymes 2. -azole 3. treats both skin and systemic fungal infections 4. ADRs o Nausea o Vomiting o Photophobia o Cardiac arrhythmias o Rashes o Hepatotoxicity o Gynecomastia o Menstrual irregularities o Inhibits P450 enzyme
63
allylamines (antifungal) 1. MOA 2. Type 3. Treats 4. ADRs
1. inhibit ergosterol synthesis 2. terbinafine 3. treats tinea pedia, tinea cruris, tinea corpus, onychomycosis 4. ADRs - nausea - abdominal pain - elevated liver enzymes
64
PT concerns for antifungal agents
1. elevated serum transaminase - jaundice 2. renal damage - have patients weigh themselves, any rapid increase could mean fluid retention 3. compliance with long dosing regimens of antifungal

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