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Micro Flashcards

1
Q

Penicillin G

A

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant2) IV Penicillin (Prototype Beta-lactam abx;Non-penicillinase resistant); Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes3) Hypersensitivity rxns; Hemolytic anemia4) Resistance: Beta-lactamases cleave Beta-lactam ring

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2
Q

Penicillin V

A

1) Gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces) & syphillis; Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, & spirochetes; Not penicillinase resistant2) PO Penicillin (Prototype Beta-lactam abx;Non-penicillinase resistant); Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes3) Hypersensitivity rxns; Hemolytic anemia4) Resistance: Beta-lactamases cleave Beta-lactam ring

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3
Q

Methicillin

A

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site)2) PNC-Resistant PNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group3) Hypersensitivity rxns; Interstitial nephritis (Methicillin specific)

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4
Q

Nafcillin

A

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site)2) PNC-Resistant PNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group3) Hypersensitivity rxns4) Use naf for staph!

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5
Q

Dicloxacillin

A

1) S. aureua (except MRSA; resistant d/t altered PNC-binding protein target site)2) PNC-Resistant; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Narrow spectrum; Penicillinase resistant b/c of bulkier R-group3) Hypersensitivity rxns

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6
Q

Ampicillin

A

1) Extended-spectrum PNC–Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci)2) AminoPNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Wider spectrum; Penicillinase sensitive. Also combine w/ clavulonic acid to protect against Beta-lactamase.3) Hypersensitivity rxs; Ampicillin rash; Pseudomemranous colitis4) Resistance: Beta-lactamases cleave Beta-lactam ring

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7
Q

Amoxicillin

A

1) Extended-spectrum PNC–Haemophilus influenza, E. Coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (HELPSS kill enterococci)2) AminoPNCs; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Wider spectrum; Penicillinase sensitive. Also combine w/ clavulonic acid to protect against Beta-lactamase.3) Hypersensitivity rxs; Ampicillin rash; Pseudomemranous colitis4) Resistance: Beta-lactamases cleave Beta-lactam ring; AmOxicillin has greater Oral bioavailability vs Ampicillin

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8
Q

Ticarcillin

A

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum3) Hypersensitivity rxns4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

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9
Q

Carbenicillin

A

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum3) Hypersensitivity rxns4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

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10
Q

Piperacillin

A

1) Pseudomonas spp. & gram-negative rods; Susceptible to penicillinase; Use w/ Clavulonic acid (to protect against Beta-lactamase) 2) Antipseudomonals; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). Extended spectrum3) Hypersensitivity rxns4) TCP (Ticarcillin, Carbenicillin, & Piperacillin)–Takes Care of Pseudomonas

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11
Q

Clavulonic Acid

A

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase)2) Beta-lactamase inhibitor3) –4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

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12
Q

Sulbactam

A

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase)2) Beta-lactamase inhibitor3) –4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

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13
Q

Tazobactam

A

1) Often added to PNC abxs to protect the abx from destruction by Beta-lactamase (penicillinase)2) Beta-lactamase inhibitor3) –4) CAST (Clavulonic Acid, Sulbactam, & Tazobactam)

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14
Q

Cefazolin

A

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae. **Cefazolin–used prior to surgery to prevent S. aureus wound infections.2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Orgs covered by 1st Generation=PEcK–Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Orgs typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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15
Q

Cephalexin

A

1) Gram-positive cocci, Proteus mirabilis, E. Coli, Klebsiella pneumoniae2) Beta-lactam, 1st Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptible to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Orgs covered by 1st Generation=PEcK–Proteus mirabilis, E. Coli, Klebsiella pneumoniae; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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16
Q

Cefoxitin

A

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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17
Q

Cefaclor

A

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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18
Q

Cefuroxime

A

1) Gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens2) Beta-lactam, 2nd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Orgs covered by 2nd Generation=HEN PEcKS–Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. Coli, Klebsiella pneumoniae, Serratia marcescens; Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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19
Q

Ceftriaxone

A

1) Serious gram-negative infections resistant to other Beta-lactams; **Ceftriaxone–meningitis & gonorrhea2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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20
Q

Cefotaxime

A

1) Serious gram-negative infections resistant to other Beta-lactams2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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21
Q

Ceftazidime

A

1) Serious gram-negative infections resistant to other Beta-lactams; **Ceftazidime–Pseudomonas.2) Beta-lactam, 3rd Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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22
Q

Cefepime

A

1) Increase activity against Pseudomonas & gram-positive orgs2) Beta-lactam, 4th Generation Cephalosporins; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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23
Q

Ceftaroline

A

1) **Only Cephalosporin that covers MRSA2) Beta-lactam, **Newest Generation Cephalosporin; Beta-lactam rx that inhibits cell wall synthesis but are less susceptibl to penicillinases. Bactericidal3) Hypersensitivity rxns, Vit K deficiency. Low cross-reactivity w/ Penicillins. Increased nephrotoxicity of Aminoglycosides.4) Organisms typically not covered by Cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA & Enterococci. (Exception= Ceftaroline-covers MRSA)

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24
Q

Aztreonam

A

1) Gram-negative rods only–No activity against gram-positives or anaerobes. For penicllin-allergic pts & those w/ renal insufficiency who cannot tolerate aminoglycosides
2) Beta-lactam, Monobactam; Resistant to Beta-lactamases. Prevents peptidoglycan cross-linking by binding to PBP3. Synergistic w/ Aminoglycosides. No cross-allergenicity w/ Penicillins.
3) Usually nontoxic; Occasional GI upset

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25
Q

Meropenem

A

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to life-threatening infections, or after other drugs have failed. **Meropenem, however, has a reduced risk of seizures & is stable to dehydropeptidase I.2) Beta-lactam, Carbapenem; Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC)3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma levels

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26
Q

Imipenem (w/ Cilastatin)

A

1) Gram-positive cocci, gram-negative rods, & anaerobes. Wide spectrum, but the significant side effects limit use to life-threatening infections, or after other drugs have failed. *Meropenem, however, has a reduced risk of seizures & is stable to dehydropeptidase I.2) Beta-lactam, Carbapenem; *Imipenem–broad-spectrum, Beta-lactamase-resistant carbapenem. Bind PNC-binding proteins; Block transpeptidase cross-linking of peptidoglycan; Activates autolytic enzymes (=Same MOA as PNC). **Always administered w/ Cilastatin (inhib of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules.3) GI distress, Skin rash, & CNS toxicity (seizures) at high plasma level

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27
Q

Vancomycin

A

1) Gram-positive only–serious, amultidrug-resistant orgs, including MRSA, enterococci, & C. difficile (oral dose for pseudomembranous colitis)
2) Antimicrobial; Inhib cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal.
3) Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing–red man syndrome (can largely prevent by pretreatment w/ antihistamines & slow infusion rate). Well tolerated in general (–does NOT have many problems)
4) Resistance: Occurs w/ amino acid change of D-ala D-ala to D-ala D-lac. [“Pay back 2 D-alas (dollars) for VANdalizing (VANcomycin)]

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28
Q

Streptomycin

A

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.
2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet)
3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.
4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.
4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

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29
Q

Tobramycin

A

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet)3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

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30
Q

Amikacin

A

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet)3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

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31
Q

Neomycin

A

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.; *Neomycin–for bowel surgery2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet)3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

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32
Q

Gentamicin

A

1) Severe gram-negative rod infections. Synergistic w/ Beta-lactam Abs.2) Aminoglycoside; Bactericidal. Inhibits formation of initiation complex & cause misreading of mRNA. Also block translocation. Req O2 for uptake; therefore, ineffective against anaerobes. (A “initiates” the Alphabet)3) Nephrotoxicity (esp when used w/ Cephalosporins), Neuromuscular blockade, Ototoxicity (esp when used w/ Loop diuretics). Teratogen.4) Resistance: Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.4) Aminoglycoside Rxs & ADES: “MEAN”=(aMINoglycosides) GNATS caNNOT kill anaerobes–Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin, Nephrotox, Neuromuscular blockade, Ototoxicity, Teratogen

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33
Q

Minocycline

A

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia.2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

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34
Q

Demeclocycline

A

1) Acts as diuretic in SIADH; (ADH antagonist) *Rarely used as antibiotic (Role of abx= Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia.)
2) Tetracycline; MOA in SIADH tx=ADH antagonist; MOA as abx=Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut
3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.
4) Resistance: Decreased uptake into cells or Increased efflux of cell by plasmid-encoded transport pumps.

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35
Q

Doxycycline

A

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia.2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. *Doxycycline is fecally eliminated & can be used in pts w/ renal failure. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

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36
Q

Tetracycline

A

1) Borrelia burgdorferi, M. pneumoniae. Drug’s ability to accumulate intracellularly makes it very effective against Rickettsia & Chlamydia.
2) Tetracycline; Bacteriostatic. Bind to 30S & present attachment of aminoacyl-tRNA; Limited CNS penetration. Do not take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhib its absorption in the gut
3) GI distress, Discoloration of teeth & inhib of bone growth in children, Photosensitivity. Contraindicated in pregnancy.
4) Resistance: Decreased uptake into cells or Increased efflus of cell by plasmid-encoded transport pumps.

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37
Q

Erythromycin

A

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)
2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic.
3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.
4) Resistance: Methylation of 23S rRNA binding site.

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38
Q

Clarithromycin

A

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)
2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic.
3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.
4) Resistance: Methylation of 23S rRNA binding site.

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39
Q

Azithromycin

A

1) Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (for Chlamydia), & gram-positive cocci (Strep infections in pts allergic to penicillins)
2) Macrolide; Inhib protein synth by blocking translocation; Bind to 23S rRNA of 50S ribosomal subunit. Bacteriostatic.
3) Motility issues, Arrhythmia caused by prolonged QT, acute Cholecstatic hepatitis, Rash, eOsiniphilia (=MACRO). Increases serum concentration of theophyllines, oral anticoagulants.
4) Resistance: Methylation of 23S rRNA binding site.

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40
Q

Chloramphenicol

A

1) Meningitis (Haemophius influenzae, Neisseria meningitidis, Streptococcus pneumoniae). Conservative use d/t toxicities but often still used in developing countries b/c of low cost
2) Protein Synthesis Inhib; Blocks peptidyltransfease at 50s ribosomal subunit. Bacteriostatic
3) Anemia (dose dep), Aplastic aneima (dose dep), Gray baby syndrome (in premature infants b/c lack liver UDP-glucuronyl transferase)
4) Resistance: Plasmid-encoded acetyltransferase that inactivates drug

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41
Q

Clindamycin

A

1) Anaerobic infections (e.g., Bacteroides fragilis, Clostridium perfringens) in aspiration pneumonia or lung abscesses. Also oroal infections w/ mouth anaerobes.
2) Protein Synthesis Inhib; Block peptide transfer (transpeptidation at 50s ribosomal subunit. Bacteriostatic.3) Pseudomembranous colitis (C. dificile overgrowth), fever, diarrhea.4) Clindamycin tx anaerobes ABOVE the diaphragm vs Metronidazole (which tx anaerobes BELOW the diaphragm)

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42
Q

Sulfadiazine

A

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic.3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

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43
Q

Sulfisoxazole

A

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic.3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

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44
Q

Sulfamethoxazole (SMX)

A

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic.3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

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45
Q

Trimethoprim (TMP)

A

1) Used in combo w/ sulfonamides [trimethoprim-sulfamethoxazole (TMP-SMX)], causing sequential block of folate synth. This combination is used to tx: UTIs, Shigella, Salmonella, Pneumocystic jirovecii pneumonia (tx & prophylaxis)2) Inhib bacterial dihydrofolate reductase. Bacteriostatic3) Megaloblastic anemia, leukopenia, granulocytopenia. [May alleviate w/ supplemental folinic acid (=Leucovorin rescue)]4) TMP–Treats Marrow Poorly

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46
Q

Ciprofloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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47
Q

Norfloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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48
Q

Levofloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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49
Q

Ofloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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50
Q

Sparfloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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51
Q

Moxifloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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52
Q

Gatifloxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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53
Q

Enoxacin

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Fluoroquinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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54
Q

Nalidixic acid

A

1) Gram-negative rods of urinary & GI tracts (including Pseudomonas), Neisseria, some gram-positive orgs2) Quinolone; Inhib DNA gyrase (topoisomerase II) & topoisomerase IV. Bacterocidal. Must not be taken w/ antacids.3) GI upset, Super infections, Skin rashes, HA, Dizziness. Less comonly–tendonitis, tendon rupture, leg cramps, & myalgias. Contraindicated in–pregnant women & children b/c animal studies show damage to cartilage. Some may cause prolonged QT interal. May cause tendon rupture in ppl >60 yo & in pts taking Prednisone.4) Resistance: Chromosome-encodede mut in DNA gyrase, plasmid-mediated resistance, efflux pumps

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55
Q

Metronidazole

A

1) Txs Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. dificile). Used w/ proton pump inhib & Clarithromycin for “triple therapy” against H. Pylori (GET GAP on the Metro w/ metronidazole!)2) Forms free radical toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal3) Disulfuram-like rxn w/ alcohol; HA, Metallic taste

56
Q

Antimicrobial Drugs: Prophylaxis & Tx-M. tuberculosis-M. avium-intracelluare-M. leprae

A

Antimicrobial Drugs: Prophylaxis & Tx-M. tuberculosis–Prophylaxis=Isoniazid & Tx=Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE for tx)-M. avium-intracelluare–Prophylaxis=Azithromycin & Tx=Azithromycin, Rifampin, Ethanobutol, Streptomycin-M. leprae–Prophylaxis=N/A & Tx=Long-term tx w/ Dapsone & Rifampin for tuberculoid form. Add Clofazimine for lepromatous form.

57
Q

Isoniazid (INH)

A

1) Mycobacterium tuberculosis; Only drug used as solo prophylaxis against TB
2) Antimicrobial; Decreases synth of mycolic acids. Bacterial catalase-peroxidases (KatG) needed to convert INH to active metabolite (resistance: decreased expression of catalase peroxidase)
3) Neurotoxicity, Hepatotoxicity. Pyridoxine (vit B6) can prevent neurotoxicity, lupus (INH–Injures Neurons & Hepatocytes)
4) Different INH half-lives in fast vs slow acetylator

58
Q

Rifampin

A

1) Mycobacterium tuburculosis; Delays resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ Haemophilus influenzae type B
2) Antimicrobial; Inhib DNA-dep RNA polymerase
3) Minor hepatotoxicity & drug rxns (increased P-450); Orange body fluids (nonhazardous side effect)
4) 4 Rs–RNA polymerase inhib, Revs up microsomal P-450, Red/orange body fluids, Rapid resistance if used alone (Rifabutin does NOT ramp up p450–> used in HIV pts more)

59
Q

Pyrazinamide

A

1) Mycobacterium tuberculosis
2) Antimicrobial; Mech unknown–thought to acidify intracellular env via conversion to pyrazinoic acid. Effective in acidid pH of phagolysosomes, where TB engulfed by macs is found
3) Hyperuricemia, Hepatotoxicity

60
Q

Ethambutol

A

1) Mycobacterium tuberculosis
2) Antimicrobial; Decreases carbohydrate polymerization of mycobacterum cell wall by blocking arabinosyltransferase
3) optic neuropathy (red-green color blindness)

61
Q

Antimicrobial Prophylaxis:-Meningococcal infection

A
  • Ciprofloxacin (Rx of choice)

- Rifampin for children

62
Q

Antimicrobial Prophylaxis:-Gonorrhea

A

-Ceftriaxone

63
Q

Antimicrobial Prophylaxis:-Syphilis

A

-Benzathine penicillin G

64
Q

Antimicrobial Prophylaxis:-History of recurrent UTIs

A

-TMP-SMX

65
Q

Antimicrobial Prophylaxis:-Endocarditis w/ surgical or dental procedures

A

-Penicillins

66
Q

Antimicrobial Prophylaxis:-Pregnant woman carrying group B strep

A

-Ampicillin

67
Q

Antimicrobial Prophylaxis:-Strep pharyngitis in child w/ prior rheumatic fever

A

-Oral penicllin

68
Q

Antimicrobial Prophylaxis:-Prevention of postsurgical infection due to S. aureus

A

-Cefazolin

69
Q

Antimicrobial Prophylaxis:-Prevention of gonococcal or chlamydial conjunctivitis in newborn

A

-Erythromycin ointment

70
Q

HIV: Prophylaxis Tx & Infection-CD4 < 200 cells/mm3-CD4 < 100 cells/mm3-CD4 < 50 cells/mm3

A

HIV Prophylaxis Tx & Infection:-CD4 < 200 cells/mm3=TMP-SMX; Pneumocytis pneumonia-CD4 < 100 cells/mm3=TMP-SMX=Pneumocytis pneumona & Toxoplasmosis-CD4 < 50 cells/mm3=Azithromycin; Mycobacterium avium complex*Aerosolized Pentamidine–can be used if pt is unable to tolerate TMP-SMX, butt this may not prevent toxoplasmosis

71
Q

Tx for highly resistant bacteria:-MRSA-VRE

A

-MRSA tx = Vancomycin-VRE tx =Linezolid & Streptogramins (quinupristin/dalfopristin)

72
Q

Amphotericin B

A

1) Serious systemic mycoses, Cryptococcus (w or w/o Flucytosine for cryptococcal meningitis), Blastomyces, Coccidioides, Histoplasma, Candida, Mucor. Intrathecally for fungal meningitis.
2) Antifungal; Alters membrane fnx–Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes (AmphoTERicin “TEARs” holes in fungal membrane)
3) Fever/chills (“shake & bake”), Hypotension, Nephrotoxicity, Arrhythmias, Anemia, IV phlebitis (“AMPHOTERRIble); Hydration reduces nephrotoxicity (see line #
4) ; Liposomal Amphotericin reduced toxicity4) Supplement K & Mg b/c of altered renal tubule permeability

73
Q

Nystatin

A

1) “Swish & swallow” for oral candidiasis (thrush); Topical for diaper rash or vaginal candidiasis2) Antifungal; Same MOA as Amphotericin B [=Alters membrane fnx–Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes (AmphoTERicin “TEARs” holes in fungal membrane)]. Topical form b/c too toxic for systemic use

74
Q

Fluconazole

A

1) Local & Less serious systemic mycoses; Floconazole specific=Chronic suppression of cryptoccal meningitis in AIDs pts & candida infection of all types2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

75
Q

Ketoconazole

A

1) Local & Less serious systemic mycoses2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia, esp Ketoconazole) Liver dysfnx (inhib cytochrome P-450)

76
Q

Clotrimazole

A

1) Local & Less serious systemic mycoses; Clotrimazole (& Miconazole) specific=Topical fungal infections2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

77
Q

Miconazole

A

1) Local & Less serious systemic mycoses; Miconazole (& Clotrimazole) specific=Topical fungal infections2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

78
Q

Itraconazole

A

1) Local & Less serious systemic mycoses; Itraconazole specific=Tx for Bastomyces, Coccidiodes, & Histoplasma2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

79
Q

Voriconazole

A

1) Local & Less serious systemic mycoses2) Antifungal-Azole; Inhib fungal sterol (ergosterol) synth by inhib P-450 enzyme that converts lanostrerol to ergosterol3) Testosterone synth inhib (gynecomastia) Liver dysfnx (inhib cytochrome P-450)

80
Q

Flucytosine

A

1) Tx of systemic fungal infections (esp. meningitis caused by Cryptococcus) in combo w/ Amphotericin B2) Antifungal; Inhib DNA & RNA biosynth by conversion to 5-fluorouracil by cytosine deaminase3) BM suppression

81
Q

Caspofungin

A

1) Invasive aspergilliosis, Candida2) Antifungal; Inhib cell wall synth by inhibiting synth of Beta-glucan3) GI upset, flushing (by histasmine release)

82
Q

Micafungin

A

1) Invasive aspergilliosis, Candida2) Antifungal; Inhib cell wall synth by inhibiting synth of Beta-glucan3) GI upset, flushing (by histasmine release)

83
Q

Terbinafine

A

1) Tx dermatophytoses (esp onchomycosis=fungal infection of finger or toe nails)2) Antifungal; Inhib fungal enzyme squalene epoxidase3) Abn LFTs, Visual disturbances

84
Q

Griseofulvin

A

1) PO tx of superficial infections; Inhib growth of dermatophytes (tinea, ringworm)2) Antifungal; Interferes w/ microtubule fnx; Disrupts mitosis. Deposits in keratin-containing tissues (e.g. nails)3) Teratogenic, Carinogenic, Confusion, HAs, Increase P-450 & warfarin metabolism

85
Q

Pyrimethamine

A

1) Tx Toxoplasmosis2) Antiprotozoan

86
Q

Suramin

A

1) Tx Trypanosoma brucei2) Antiprotozoan

87
Q

Melarsoprol

A

1) Tx Trypanosoma brucei2) Antiprotozoan

88
Q

Nifurtimox

A

1) Tx Trypansoma cruzi 2) Antiprotozoan

89
Q

Sodium stibogluconate

A

1) Tx Leishmaniasis2) Antiprotozoan

90
Q

Chloroquine

A

1) Tx of plasmodial species other than P. falciparium ( d/t high resistance; see line #4)2) Blocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodia3) Retinopathy4) P. falciparum mechanism of resistance: Membrane pump that decreases intracellular concentration of Chloroquine; Tx P. falciparum w/ Artemether/Lumifantrine OR Atovaquone/Proguanil; Tx life-threatening malaria w/ Quinidine in US (quinine elsewere) or Artisunate

91
Q

Txs for P. falciparum

A

-Artemether/Lumifantrine OR Atovaquone/Proguanil-NOT Chloroquine (d/t resistance)

92
Q

Txs for life-threatening malaria

A

-Quinidine in US (quinine elsewere) or Artisunate

93
Q

Mebendazole

A

2) Antihelminthic therapy; Immobilize helminths

94
Q

Pyrantel pamoate

A

2) Antihelminthic therapy; Immobilize helminths

95
Q

Ivermectin

A

2) Antihelminthic therapy; Immobilize helminths

96
Q

Diethylcarbamazine

A

2) Antihelminthic therapy; Immobilize helminths

97
Q

Praziquantel

A

1) Tx for flukes (trematodes, e.g. Schistosoma)2) Antihelminthic therapy; Immobilize helminths

98
Q

Zanamivir

A

1) Tx and prevention of: Influenza A & B2) Antiviral therapy; Inhib influenza neuraminidase, Decreasing the release of pogeny virus

99
Q

Oseltmavir

A

1) Tx and prevention of: Influenza A & B2) Antiviral therapy; Inhib influenza neuraminidase, Decreasing the release of pogeny virus

100
Q

Ribavirin

A

1) RSV, Chronic hepatitis

C2) Antiviral therapy; Inhib synth of guanine nucleotides by competitively inhibiting IMP dehydrogenase (IMP –> GMP)

3) Hemolytic anemia, Severe teratogen

101
Q

Acyclovir

A

1) HSV & ZVZ; Weak activity against EBV. No activity against CMV. Used for HSZ-induced mucocutaneous & genital lesions as well as encephalitis. Prophylaxis in immunocompromised pts. No effect on latent forms of HSZ & ZVZ.
2) Antiviral therapy; Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inihib viral DNA polymerase by chain termination
3) tox: renal tubule crystallization and acute renal failure if not adequately hydrated ***
4) Mechanism of resistance: Mutated viral thymidine kinase

102
Q

Valacyclovir

A

1) HSV & ZVZ; Weak activity against EBV. No activity against CMV. Used for HSZ-induced mucocutaneous & genital lesions as well as encephalitis. Prophylaxis in immunocompromised pts. No effect on latent forms of HSZ & ZVZ. 2) Antiviral therapy; = a prodrug of Acyclovir, so has better oral bioavailability vs Acyclovir Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inihib viral DNA polymerase by chain termination
3) same tox as acyclovir

4) Mechanism of resistance: Mutated viral thymidine kinase

103
Q

Famciclovir

A

1) Herpes Zoster

2) Antiviral therapy; Related to Acyclovir

104
Q

Ganciclovir

A

1) CMV, esp in immunocompromised pts.2) Antiviral therapy; 5’-monophosphate formed CMV viral kinase Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhib viral DNA polymerase3) Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity; More toxic to host enzymes vs Acyclovir4) Mechanism of resistance: Mutated CMV DNA polymerase or lack of viral kinase

105
Q

Valganciclovir

A

1) CMV, esp in immunocompromised pts.2) Antiviral therapy; a prodrug of Ganciclovir, so has better ora bioavailability vs Ganciclovir 5’-monophosphate formed CMV viral kinase Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhib viral DNA polymerase3) Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity; More toxic to host enzymes vs Acyclovir4) Mechanism of resistance: Mutated CMV DNA polymerase or lack of viral kinase

106
Q

Foscarnet

A

1) CMV retinitis in immunocompromised pts when Ganciclovir fails; Acyclovir-resistant HSV2) Antiviral therapy; A pyrophosphate analog (Foscarnet=pyroFOSphate analog). Viral DNA polymerase inhib that binds to pyrophosphate-binding site of the enzyme. Does not req activation by viral kinase3) Nephrotoxicity4) Mechanism of resistance: Mutated DNA polymerase

107
Q

Cidofovir

A

1) CMV retinitis in immunocompromised pts; Acyclovir-resistant HSV2) Antiviral therapy; Preferentially inhib viral DNA polymerase. Does not req phosphorylation by viral kinase. Long t-1/2.3) Nephrotoxicity (co-admin w/ Probenecid & IV saline to reduce toxicity)

108
Q

HIV Therapy:-Name-When to initiate-Drug regimen

A

-Highly active antiretroviral therapy (HAART)-Initiate when pts present w/ AIDS-defining illness, low CD4+ cts (

109
Q

Lopinavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

110
Q

Atazanavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

111
Q

Darunavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

112
Q

Fosaprenavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

113
Q

Saquinavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

114
Q

Ritonavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy4) All protease inhibitors end in -navir [ Navir (never) tease a protease]; Ritonavir specific=CYP450 inhib

115
Q

Indinavir

A

1) HIV therapy2) Protease inhib; Prevents maturation of new viruses by cleaving HIV-1 protease (Assembly of virions depends on HIV-1 protease, which cleaves polypeptide products of HIV mRNA into their functional parts)3) Hyperglycemia, GI intolerance (N/D), Lipodystrophy, Nephropathy; Indinavir specific ADE=Hematuria4) All protease inhibitors end in -navir [ Navir (never) tease a protease]

116
Q

Tenofovir (TDF)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy, Lactic Acidosis4) Is a nucleotide analog, so does not have to be activated (vs other NRTIs, which are nucleoside analogs & therefore, req activation)

117
Q

Emtricitabine (FTC)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

118
Q

Abacavir (ABC)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

119
Q

Lamivudine (3TC)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

120
Q

Zidovudine (ZDV, formerly AZT)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis; ZDZ specific ADE=Anemia4) Used for general prophylaxis & during pregnancy to reduce risk of fetal transmission; Must be phosphorylated to be activated (the second statement is true of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

121
Q

Didanosine (ddl)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

122
Q

Stavudine (d4T)

A

1) HIV therapy2) Nucleoside reverse transcriptase inhib (NRTI); Completely inhib nucleotide binding to reverse transcriptase & terminate te DNA chain (lack a 3’ OH group)3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Lactic acidosis4) Must be phosphorylated to be activated (True of all NRTIs, except Tenofovir b/c it is a nucleotide vs nucleoside analog)

123
Q

Nevirapine

A

1) HIV therapy2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

124
Q

Efazirenz

A

1) HIV therapy2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

125
Q

Delavirdine

A

1) HIV therapy2) Non-nucleoside reverse transcriptase inhib (NNRTI); Bind to reverse transcriptase at site different from NRTIs (Nucleoside RTIs). Do not req phosphorylation to be active or compete w/ nucleotides3) BM suppression (can be reversed w/ G-CSF & EPO), Peripheral neuropathy; Rash

126
Q

Raltegravir

A

1) HIV therapy2) Integrase inhib; Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase3) Hypercholesterolemia

127
Q

IFN-Alpha

A

1) Chronic hepatitis B & C; Kaposi’s sarcoma2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses3) Neutropenia, Myopathy

128
Q

IFN-Beta

A

1) MS2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses3) Neutropenia, Myopathy

129
Q

IFN-Gamma

A

1) NADPH oxidase deficiency2) Interferon; Glycoproteins synth by virus-infected cells; Blocks replication of both RNA & DNA viruses3) Neutropenia, Myopathy

130
Q

Abx to avoid in pregnancy

A

Contraindicated in Pregnancy –> Adverse Effect:-Sulfonamides –> Kernicterus-Aminoglycosides –> Ototoxicity-Fluoroquinolones –> Cartolage damage-Clarithromycin –> Embryotoxic-Tetracyclines –> Discolored teeth, Inhib of bone growth-Ribavirin (antiviral) –> Teratogenic-Griseofulvin (antifungal) –> Teratogenic-Chloramphenicol –> “Gray baby”

(SAFe Children Take Really Good Care)

131
Q

Sulfadiazine

A

1) Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.2) Sulfonamides; PABA antimetabolites inhib dihydropteroate synthase. Bacteriostatic.3) Hypersensitivity rxns, Hemolysis if G6PD deficient, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, Displace other drugs from albumin (e.g. Warfarin)4) Resistance: Altered enzyme (bacterial dihydropteroate synthase), Decreased uptake, or Increased PABA synthesis

132
Q

Organisms not covered by cephalosporins

A

LAME: Listeria, Atypicals (chlamydia, mycoplasma), MRSA, Enterococci. (exception: ceftaroline covers MRSA).

133
Q

Macrolide toxicities

A

MACRO: GI motility issues, Arrhythmia (prolonged QT), acute Cholestatic hepatitis, Rash, eOsinophilia

134
Q

MAC prophylaxis and tx

A

prophylaxis: azithromycin, rifabutin
tx: azithromycin + ethambutol. can add rifabutin or cipro

135
Q

M. leprae tx

A

long term tx with dapsone and rifampin for TB form. add clofazimine for lepromatous form.

Pharm (15 decks)

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