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Pharmacology - Exam 3 > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

1
Q

What are superficial infections also known as?

A

Dermatophytic infections

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2
Q

What are superficial fungal infections usually treated with?

A

Topical antifungals

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3
Q

What are five superificial sites often treated with topical antifungals?

A
  • Hair
  • Scalp
  • Skin
  • Nails
  • Mucosa (oral, vaginal)
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4
Q

Antifungal therapy is used to treat what two types of infections?

A
  • Superficial infections
  • Systemic infections
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5
Q

Systemic antifungals are mostly used for patients with what disease?

A

AIDs

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6
Q

Other than patient AIDs paitents, what other high risk patients are treated with systemic antifungals?

A
  • Chemotherapy
  • Burn patients
  • Organ transplants
  • Systemic steroid therapy (long-term)
  • Some cancers (bone marrow suppression)
  • Diabetics (sometimes)
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7
Q

A wide, diverse group of dermatophytes are collectively called what?

A

Tinea

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8
Q

What would you treat this condition with?

A

Nizoral Shampoo bid

(Tinea Versicolor)

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9
Q

Candida albicans is secondary to what three things?

A
  • Antibiotic therapy
  • Antineoplastics
  • Immunosuppressants
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10
Q

Candida albicans may result in what?

A

Overgrowth and systemic infections

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11
Q

Who can get oral thrush?

A
  • Healthy neonates
  • Immunocompromised patients
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12
Q

What are three kinds of candidal infections?

A
  • Oral thrush
  • Cutaneous
  • Vaginal (“yeast infection”)
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13
Q

What are two types of cutaneous candidal infections?

A
  • Diaper dermatitis in healthy babies
  • Intertriginous rashes - (especially immune compromised)
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14
Q

Who can get yeast infection?

A
  • Pregnancy
  • Diabetes mellitus
  • Oral contraceptives
  • Antibiotic therapy
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15
Q

True or False:

A person with a healthy immune system wouldn’t normally get a systemic fungal infection.

A

True

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16
Q

How are systemic fungal infections most often acquired?

A

Inhalation

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17
Q

True or false:

Systemic fungal infections are potentially fatal to immunocompromised.

A

True

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18
Q

Systemic fungal infections are treated with drugs that administered by what two routes?

A

Oral / parenteral drugs

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19
Q

What are six common systemic fungal infections?

A
  1. Histoplasmosis
  2. Coccidiodomycosis
  3. Blastomycosis
  4. Aspergillosis
  5. Cryptococcosis
  6. Systemic Candidiasis
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20
Q

What are the risk factors for developing histomplasmosis?

A

Exposure to bird or bat droppings

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21
Q

What can occur as an infection with pneumonia that spreads to heart, lungs, brain, and kidneys via the bloodstream?

A

Invasive aspergillosis

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22
Q

What is a fungus ball that colonizes in a healed lung scar or abscess from a previous disease?

A

Aspergilloma

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23
Q

What are two antifungal polyenes?

A
  • Amphotericin B - S
  • Nyastatin (Mycostatin) - S / T
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24
Q

What are seven topical imidazoles?

A
  1. Butoconazole (Gynazole-1)
  2. Econazole (Spectazole)
  3. Clotrimazole (Gyne-Lotrimin, Lotrizone)
  4. Oxiconazole (Oxistat)
  5. Sertraconazole (Ertaczo)
  6. Terconazole (Terazol)
  7. Tioconazole (Monistat-1 Day)
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25
Q

What are three systemic imidazoles?

A
  1. Voriconazole (Vfend)
  2. Posaconazole (Noxafil)
  3. Itraconazole (Sporanox)
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26
Q

What are two imidazoles that are both systemic and topical?

A
  1. Ketoconazole (Nizoral)
  2. Fluconazole (Diflucan)
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27
Q

What are four topical misc. antifungal agents?

A
  • Ciclopirox (Loprox)
  • Butenafine (Mentax)
  • Tolnaftate (Tinactin)
  • Naftifine (Naftin)
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28
Q

What are two systemic misc. antifungal agents?

A
  1. Flucytosine (Ancobon)
  2. Griseofulvin
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29
Q

What is a misc. antifungal agent that is both systemic and topical?

A

Terbinafine (Lamisil)

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30
Q

What are seven topical antifungal agents that treat tinea?

A
  1. Ciclopirox (Loprox)
  2. Ketoconazole (Nizoral)
  3. Oxiconazole (Oxistat)
  4. Sertraconazole (Ertaczo)
  5. Terbinafine (Lamisil)
  6. Butrenafine (Mentax)
  7. Tolnaftate (Tinactin)
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31
Q

What are eight topical antifungal agents that treat candida?

A
  1. Nystatin (Mycostatin)
  2. Butoconazole (Gynazole-1)
  3. Clotrimazole (Gyne-Lortimin, Lotrizone)
  4. Terconzaole (Terazol)
  5. Tioconazole (Monistat-1 Day)
  6. Fluconazole (Diflucan)
  7. Econazole (Spectazole) - Both
  8. Naftifine (Naftin) - Both
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32
Q

What is the MOA for polyenes?

A

Drugs bind irreversibly to sterols in fungus cell membrane lining

↓ ↓

Allow K+ and Mg++ to leak out

↓ ↓

Alters fungal cell metabolism

↓ ↓

Fungal cell death (fungicidal)

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33
Q

What is the MOA for imidazoles?

A

Inhibit sterol synthesis in cell membrane

↓ ↓

Damage cell membrane

↓ ↓

Fungal cell death (fungicidal)

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34
Q

What is the polyene prototype?

A

Amphotericin B

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35
Q

What is the route for Amphotericin B?

A

IV Infusion

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36
Q

What is the usual dose for Amphotericin B?

A

0.25 - 1 mg/kg/d

OR

1 mg/kg q.o.d.

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37
Q

What is the max dose for Amphotericin B?

A

1.5 mg/kg/d

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38
Q

What are the indications for Amphotericin B?

A

Progressive, potentially life threatning systemic fungal infections.

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39
Q

How is Amphotericin B metabolized?

A

Unknown

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40
Q

How is Amphotericin B excreted?

A

Renal

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41
Q

What is the half-life for Amphotericin B?

A

15 days

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42
Q

What is the precaution for Amphotericin B?

A

Under no circumstances should a total daily dose of 1.5 mg/kg be exceeded

↓ ↓

Risk of cardiorespiratory arrest

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43
Q

What is the absolute contraindication of Amphotericin B?

A
  • Streptozocin
  • Cidofovir
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44
Q

What tests must you use to monitor a patient on Amphotericin B?

A
  • BUN, Cr at baseline / then frequently
  • CBC
  • Lytes
  • LFTs
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45
Q

What are the side / adverse effects of Amphotericin B?

A

“Shake and Bake”

  • Renal toxicity
  • Nurotoxicity (seizures / paresthesias)

(These are two out of 14 but Shake and Bake describes most of them.)

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46
Q

What is the imidazole prototype?

A

Fluconazole (Diflucan)

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47
Q

What is the route for Fluconazole (Diflucan)?

A

PO and IV

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48
Q

What are the indications for Fluconazole (Diflucan)?

A

Systemic infections (especially candidiasis)

  • Oropharyngeal candidiases
  • Esophageal candidiases
  • Vaginal candidiases
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49
Q

What is the usual dose of Fluconazole (Diflucan) for oropharyngeal / esophageal candidiases?

A

100 mg PO/IV q.d

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50
Q

What is the usual dose of Fluconazole (Diflucan) for vaginal candidiases?

A

150 mg PO x 1

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51
Q

What is the usual dose of Fluconazole (Diflucan) for systemic infections?

A

Varies

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52
Q

How is Fluconazole (Diflucan) metabolized?

A

Liver

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53
Q

How is Fluconazole (Diflucan) excreted?

A

Renal

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54
Q

What are the select side / adverse effects of Fluconazole (Diflucan)?

A
  • Nausea and vomiting
  • Increase LFTs
  • Diarrhea
  • Abdominal pain

(more long term…)

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55
Q

What are the drug interactions for Fluconazole (Diflucan)?

A

Multiple… LOOK it up

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56
Q

What tests do you use to monitor a patient who is taking Fluconazole (Diflucan)?

A

Create a baseline → LFTs

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57
Q

What are six non-malarial protozoal infections?

A
  • Amebiasis
  • Giardiasis
  • Pneumocystosis
  • Toxoplasmosis
  • Trichnomoniases
  • Leishmaniasis
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58
Q

What are four ways that protozoal infections are transmitted?

A
  • Person-to-person
  • Ingestion of contaminated water or food
  • Direct contact with parasite
  • Insect bite (mosquito or tick)
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59
Q

What are three things amebiases causes?

A
  • Dysentery
  • Hepatitis
  • Liver abscess
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60
Q

What does giardiases cause?

A

Diarrhea

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61
Q

What does trichomoniases cause?

A

STD

(cervicitis in woman)

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62
Q

What are two illnesses caused by toxoplasmosis?

A
  • Encephalitis in immune suppressed patients
  • **Brain / retina birth defects in pregnancy **
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63
Q

True or false:

Toxo is not routinely screened in neonates.

A

True

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64
Q

How can women prevent getting toxoplasmosis?

A

They should not touch cat litter box.

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65
Q

Leischmaniases can be what kinds of disease?

A

Cutaneous and visceral

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66
Q

What happens to a person with visceral form of Leishmaniasis?

A
  • Fever
  • Weight loss
  • Hepatosplenomegaly
  • Anemia
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67
Q

True or False:

Leishmaniasis is commonly seen in the U.S.

A

False

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68
Q

What is a special case of protozoal illnesses?

A

Pneumocystosis

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69
Q

Pnuemocystosis was formerly believed to have what kind of etiology? What kind of etiology do we know it to have now?

A

Protozoal

Fungal

70
Q

The causative agent of Pneumocystosis was formerly known as Pneumocystis carinii (PCP). What is it called now?

A

Pneumocystis jiroveci

71
Q

What did we think that Pneumocystosis was fungal?

A

It responds to antiprotozoal drugs

72
Q

A patient presents with intestinal amebiasis. What should you give them?

A

Iodoquinol (Yodoxin)

73
Q

A patient presents with PCP (Pneumocystosis jiroveci). What is the primary drug you treat them with?

A

Pentamidine (Pentam)

74
Q

A patient presentes with an intestinal protozoal infection. What two drugs can you treat them with?

A
  • Paromomycin
  • Metronidazole (Flagyl)
75
Q

What drug has an orphan status for leishmaniasis?

A

Paromomycin

76
Q

What drug is used as adjunct therapy in hepatic coma?

A

Paromomycin

77
Q

A patient presents with extraintestinal amebiases. What do you treat them with?

A

Chloroquine (Aralen)

78
Q

A patient presents with toxoplasmosis. What do you treat them with?

A

Daraprim

79
Q

Which antiprotozoal drug could also be used to treat malaria?

A

Chloroquine (Aralen)

80
Q

Which protozoal drug could be used as a malaria prophylaxis?

A

Pyrimethamine (Daraprim)

81
Q

A patient presents with amebiases, giardiases, or trichomoniasis. What could you treat them with?

A

Tinidazole (Tindamax)

82
Q

A patient presents with bacterial vaginosis. She is not pregnant. What do you treat her with?

A

Tinidazole (Tindamax)

83
Q

Atovaquone (Mepron) can be used to treat what three things?

A
  • Mild to moderate PCP
  • PCP prophylaxis
  • Toxoplasmosis prophylaxis
84
Q

What is the protozoal prototype?

A

Metronidazole (Flagyl)

85
Q

What are nine indications for Metronidazole (Flagyl)?

A
  1. Trichomoniasis (STD)
  2. Intestinal amebiasis
  3. Amebic liver abscess
  4. Giardiasis
  5. PID (pelvic abscess)
  6. Anaerobic bacterial infections
  7. Peri-op prophylaxis
  8. Bacterial vaginosis (BV)
  9. Pseudomembranous colitis (C. diff)
86
Q

What are the routes for Metronidazole (Flagyl)?

A

PO and IV

87
Q

What is the usual dose for Metronidazole (Flagyl)?

A

1.5 - 2.5 gram/d in divided doses

88
Q

How is Metronidazole (Flagyl) excreted?

A

Renal

89
Q

Metronidazole (Flagyl) is contraindicated during what trimester of pregnancy? What category is this?

A

1st trimester

Category B

90
Q

What is the MOA of Metronidazole (Flagyl)?

A

Disrupts nucleic acid synthesis in protozoa

↓ ↓

Bactericidial / Amebicidial / Trichomonacidal

91
Q

What are the side / adverse effects of Metronidazole (Flagyl)?

A
  • Metallic taste
  • Nausea and vomiting
  • Diarrhea
  • Abdominal cramps
  • Potential for serious neurological adverse effects
92
Q

What would happen if a patient drank alcohol within 48 hours of completing the course of Flagyl?

A

They would get really sick.

  • Nausea and vomiting
  • Skin flushing
  • Tachycardia
  • SOB
93
Q

What is an older medication used in alcoholism treatment?

A

Disulfiram (Antabuse)

94
Q

What are the drug interactions of Metronidazole (Flagyl)?

A
  • ETOH
  • Any drug that contains ETOH
  • Busulfan (acute toxicity) - CML drug
95
Q

True or false:

Trichomoniasis has symptoms more prominent in males.

A

False

96
Q

A patient presents with greenish to gray, frothy, malodorous vaginal discharge. Her cervix looks like a strawberry. What does she have? What do you treat her with?

A

Trichomoniasis

Metronidazole (Flagyl)

97
Q

A patient presents with trichomoniasis. What must you advise her to do about her partner?

A

Have him get treated as well.

98
Q

What are characteristics of helminths?

A

Large with complex cellular structures

99
Q

True or False:

Drug treatment for helminths is very specific.

A

True

100
Q

What is very important before prescribing an antihelminthic?

A

Identify the causative worm

101
Q

What are three pathogenic helmninths?

A
  • Cestodes (tapeworms)
  • Nematodes (roundworms)
  • Trematodes (flukes)
102
Q

When diagnosis a helminthic infection, where must you search for ova or larvae?

A
  • Feces
  • Urine
  • Blood
  • Sputum
  • Tissue
103
Q

What are four antiheminthics?

What route are they all administered by?

A
  • Mebendazole (Vermox)
  • Praziquantel (Biltricide)
  • Pyrantel (Pin-X)
  • Albendazole (Albenza)

PO

104
Q

A patient presents with nematode infestation (pinworm). What do you treat them with?

A

Pyrantel (Pin-X)

105
Q

A patient presents with trematode infestation. What do you treat them with?

A

Praziquantel (Biltricide)

106
Q

A patient presents with cestode infestation. What do you treat them with?

A

Praziquantel (Biltricide)

107
Q

A patient presents with headaches, seizures, ataxia, dementia, and hydrocephalus.

What is this?

What is it caused by?

What do you treat them with?

A

CNS disease

Larva of Taenia solium

Albendazole (Albenza)

108
Q

A mother comes into your office with a piece of scotch tape full of worms. What kind of worms are these and what do you treat the son with?

A

Mebendazole (Vermox)

109
Q

What is the antihelminthic prototype?

A

Mebendazole (Vermox)

110
Q

What are the indications for Mebendazole (Vermox)?

A
  • Cestode infestation
  • Nematode infestation
111
Q

Mebendazole (Vermox) is the drug of choice for what kind of helminth?

A

Pinworm

112
Q

What is the MOA for Mebendazole (Vermox)?

A

Inhibits uptake of glucose and other nutrients

↓ ↓

Autolysis and death of the parasitic worm

113
Q

How is Mebendazole (Vermox) administered?

A

PO

114
Q

How is Mebendazole (Vermox) metabolized?

A

Liver

115
Q

How is Mebendazole (Vermox) excreted?

A

Feces

116
Q

What is the usual dose of Mebendazole (Vermox) for pinworms?

A

100 mg PO one time

(tablet / chewable)

117
Q

What is the usual dose of Mebendazole (Vermox) for helminthic infections other than pinworms?

A

100 mg bid x 3 days

118
Q

What are the three adverse / side effects of Mebendazole (Vermox)?

A
  • Diarrhea
  • Abdominal pain
  • TISSUE NECROSIS
119
Q

What is an acid fast aerobic bacillus conveyed by respiratory secretions?

A

Tuberculosis

120
Q

What are tubercles?

A

Calcified fibrous tissue

121
Q

True or False:

Tuberculosis is highly contagious.

A

True

122
Q

What are common infection sites for tuberculosis?

Which one is the primary site?

A
  • Lung (primary site)
  • Brain
  • Bone
  • Liver
  • Kidney
123
Q

What percentage of tuberculosis is extrapulmonary?

A

15%

124
Q

How does tuberculosis gain entry into the body?

A

Inhalation

125
Q

How does tubercle bacilli spread to body organs?

A

Via blood and lymphatic systems

126
Q

How does disseminated TB begin?

A

With 1o lung lesion

Then it spreads basically everywhere…

127
Q

Effectiveness of antitubercular therapy depends on what?

A
  • Site of infection
  • Adequate dosing
  • Sufficient duration of treatment
  • Drug compliance
  • Selection of an effective drug combination
128
Q

How long is TB therapy?

Why does it take this long?

A

6-12 months

Cell wall is resistant to drug penetration

129
Q

If patients develop multidrug-resistant infections with TB, how long must their therapy be?

A

24 months

130
Q

True or False:

TB therapy can be stopped if the patient is asymptomatic.

A

False

(Therapy must continue even if asymptomatic the entire time)

131
Q

What is the drug minimum for treating TB?

A

Up to 2 - 4 drugs

132
Q

When are second-choice drugs used for treatment of TB?

A

When resistance develops

  • They are more toxic
  • Less effective than first-choice
133
Q

When does therapy begin for family members of TB patients?

A

Immediately after positive TB skin test (PPD)

134
Q

What are the first line drugs for TB?

A
  • Isoniazid (INH)
  • Ethambutol (EMB)
  • Pyrazinamide (PZA)
  • Rifampin (RIF)
  • Rifapentine (RPT)
135
Q

What are the second line drugs for TB?

A
  • Streptomycin (SM)
  • Cycloserine
  • P-aminosalicylic acid
  • Ethiomonide
  • Amikacin or Kaanamycin
  • Capreomycin
136
Q

What is the prototype for TB?

A

Isoniazid (INH)

137
Q

How is Isoniazid (INH) administered?

A

PO and IM

138
Q

What is the MOA for Isoniazid (INH)?

A

Inhibits lipid and nucleic acid synthesis

139
Q

What are the indications for Isoniazid (INH)?

A
  • Active disease
  • Prophylactic
140
Q

What is the adult dosage for Isoniazid (INH)?

A

5 mg / kg q.d.

141
Q

What is the max adult dosage for Isoniazid (INH)?

A

300 mg/d

142
Q

Where is Isoniazid (INH) metabolized?

A

Liver

143
Q

How is Isoniazid (INH) excreted?

A

Renal

144
Q

What are drug interactions for Isoniazid (INH)?

A
  • Mefloquine (Lariam)
  • Multiple (LOOK UP!)
145
Q

What tests should you use to monitor a patient on Isoniazid (INH)?

A

Creat and LFTs

146
Q

When administering Isoniazid (INH), what vitamin must be given as well? Why must you give it?

A

B6

To combat peripheral neuritis associated with INH therapy

147
Q

What could happen to diabetic patients taking Isoniazid (INH)?

A

Rise in glucose

148
Q

What is the Black Box Warning for Isoniazid (INH)?

A

Potentially fatal hepatotoxicity

149
Q

What are eight adverse / side effects for Isoniazid (INH)?

A
  1. HEPATOTXICITY
  2. Nausea and vomiting
  3. Fatigue
  4. Paresthesias
  5. Fever
  6. Anorexia
  7. Depression
  8. Jaundice
150
Q

What studies must you do before starting TB therapy?

A

Baseline liver function (LFTs)

(Especially for INF and Rifampin)

151
Q

True or False:

It is OK for TB patients to drink ETHOH during therapy.

A

False

(Patients should NOT consume ETOH)

152
Q

What does INH and Rifampin do to oral contraceptives?

A

Causes them to become ineffective

153
Q

What could ethambutol cause?

A

Retrobulbar neuritis and blindness

154
Q

What causes reddish-orange staining in urine, stool, saliva, sputum, sweat, tears, and contact lenses?

A

Rifampin

155
Q

What do IGRAs measure?

A

How strongly the immune system reacts to the mycobacterium

156
Q

What are the two IGRAs approved by FDA and which available in the US?

A
  1. QuantiFERON
  2. T-SPOT
157
Q

What does a positive IGRA mean?

A
  • Infected with TB bacteria
  • Additional tests needed to determine if latent infection or active disease
158
Q

What does a negative IGRA mean?

A
  • Blood did not react to the test
  • Latent TB infection or TB disease not likely
159
Q

When are IGRAs the preferred testing method for TB?

A
  • Persons who have the BCG vaccine
  • Persons who are not compliant with returning for the F/U reading of TB skin test
160
Q

What are two diseases caused by non-tuberculosis mycobacterium?

A
  • Mycobacterium leprae
  • Mycobacterium avium
161
Q

Mycobacterium leprae is also known as what disease?

A

Leprosy

162
Q

Mycobacterium Avium Complex (MAC) is most often the cause of what type of infection?

A

Lung infections

163
Q

What kind of drugs treat all forms of TB?

A

Antitubercular

164
Q

Non-tuberculous mycobacterium have been isolated from what seven places?

A
  1. Animals
  2. Plants
  3. Soil
  4. Ice
  5. HOT TUBS
  6. Industrial waters (rare)
  7. Pet fish tanks
165
Q

What bacteria does this sound like?

  • Rapidple growing mycobacterium
  • Common water contaminant
  • Found in water, soil, and dust
  • Can contaminate medications and medical devices
A

Mycobacterium Abscessus

166
Q

What are the causes of Mycobacterium Abscessus?

A
  • Chronic lung disease
  • Post-traumatic wound infection
  • Disseminated cutaneous disease
167
Q

What do you treat this with?

What dose would you give them?

A

Fluconazole (Diflucan)

150 mg PO x 1

168
Q

What do you treat this with?

A

Amphotericin B

169
Q

What do you treat this with?

A

Metronidazole (Flagyl)

170
Q

What do you treat this with?

A

Mebendazole (Vermox)

171
Q

What do you treat this with?

A

Isoniazid (INH)

Pharmacology - Exam 3 (4 decks)

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