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PDA Block 3 > PDA Block 3 Week 2 > Flashcards

PDA Block 3 Week 2 Flashcards

1
Q

Penicillin

A 
Penicillin G and V
Oxacillin
Amipicillin, amoxicillin
Ticarcillin
Piperacillin
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2
Q

Penicillin

A
  • Well distributed to most area of the body: low penetration into CSF but increases during Meningitis
  • 30% hepatic metabolism
  • mostly renal: 80% tubular anionic excretion
  • Time dependent killing
  • Adverse effect: Severe allergic reactions→ anaphylaxis (Pre-Pen for testing); Rash, diarrhea, enterocolitis, elevated liver enzymes, hemolytic anemia, seizures
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3
Q

Beta lactamase inhibitors

A

Clavulanic acid, tazobactam (beta-lactam analogs that bind irreversibly to beta-lactamase)

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4
Q

Cephalosporin

A

Cefazolin: 1
Cephalexin: 1

Cefuroxime: 2
Cefoxitin: 2

Ceftriaxone: 3
Ceftazidime: 3

Cefepime: 4

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5
Q

Penicillin G and V

A

Oral: Pen V and IV/IV= Pen G(poor Oral- not stable to Acid)
G+ Anaerobes: Clostridium (Not Bacterioides fragilis)

G+: Streptococcus

Limited G-: Some use in Neisseria meningitides
Spiochetes: Syphillis

Good activity against: anthrax, Listeria

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6
Q

Oxacillin

A

“methicillin like drug” Beta lactamase producing staphylococci

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7
Q

Amipicillin, amoxicillin

A

IV or oral
Amoxicillin: better after oral dose

Ampicillin: IV (for Neisseria, Listeria) and GI infections (keep more drugs in intestinal tract for Shigella infx)

G+ Beta-lactamase negative: listeria, Strep
G-: haemophilus, Neisseria, E. Coli, Salmonella

Amoxicillin: Alternate choice for Lyme disease
High dose amoxicillin is drug of choice for otitis media – Strep. Pneumo strains

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8
Q

Ticarcillin

A

Retain some G+ against Strep
Anaerobes: ticararillin +Clavulanate

G- to cover pseudomonas ( susceptibile to beta lactamase)

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9
Q

Piperacillin

A

G- including pseudomonas and Klebsiella, including those that are ticarcillin resistant)

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10
Q

Cefazolin

A

Longer half life (1-2 hrs)
Best G+ activity.
Surgical prophylaxis for skin flora

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11
Q

Cephalexin

A

Oral
Half life: 50 min
Mostly G+
Skin, bone/joint, UTI, respiratory, otitis media

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12
Q

Cefuroxime

A
  • CSF penetration
    Haemophilus
    Not good against enterics (E. Coli)
  • Good tolerance to many gram negative beta lactamase
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13
Q

Cefoxitin

A
  • Not for CNS

- Good for anaerobes (Bacteroides) Good tolerance to many G- beta lactamases

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14
Q

Ceftriaxone

A
  • CSF, Long half life
  • G-: Klebsiella, Enterobacter, proteus

Meningitis (Neiserria, S. pneumo, H. influenzae)

Only choice for gonorrhea

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15
Q

Ceftazidime

A
  • CSF
  • Good for some strains of Pseudomonas
    Not great for Strep
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16
Q

Cefepime

A
  • CSF
  • Half life 2 hours
  • G- with pseudomonas activity
  • more resistant to type I beta-lactamases
  • Better for G+ (Strep)
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17
Q

Cephalosporin

A
  • Cell- wall agent
  • Bactericidal
  • Inhibit transpeptidases
    (penicillin binding proteins or PBPs) which catalyze cell wall
    crosslinks
  • B- lactam covalently binds to PBPs
  • Time dependent killing
  • Renal clearance
  • Adverse reaction: allergic, N/V/D, enterocolitis, hepatocellular damage
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18
Q

Beta Lactams

A

-Cell wall agent
- Bactericidal
- Inhibit transpeptidases
(penicillin binding proteins or PBPs) which catalyze cell wall
crosslinks

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19
Q

Bacterial resistance to B- lactams

A
  • Beta- lactamase: enzyme that cleaves beta-lactam ring
  • altered PBP
  • Beta-lactam agent cannot reach PBP
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20
Q

Imipenem

A
  • Cell wall agent
  • Broad spectrum: resistant to many beta lactamases including extended spectrum beta-lactamase
  • Not for meningitis
  • Not effective for MRSA, pseudomonads
  • Ill defined infections

Adverse effects: - Hypersensitivity, some cross allergies with penicillins/cephalosporins

  • Seizures, dizziness, confusion
  • Nausea, vomiting, diarrhea, colitis, superinfection
  • Given with cilastatin: renal peptidase inhibitor
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21
Q

Aztreonam

A
  • Used against G- aerobic rods (Haemophilus, Pseudomonas)
  • Adverse: seizures, anaphylaxis, can affect heart= transient EKG changes, cramps, nausea
  • No allergic cross-reactions with beta-lactams. Can be used in those with known hypersensitivities to penicillin
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22
Q

Vancomycin

A 
- Bactericidal
G+ only (serious infxn!)
- Staph including MRSA
- Strep. Pneumonia
- Enterococcus (VRE)
- Clostridium difficile enterocolitis ( don’t want to overuse)

Inhibits cell wall synthesis: binds to D-Ala-D-ala → interfers with crosslinking and elongation of peptidoglycan (transglycosylation)

  • Red man or red neck syndrome: head and neck erythema
  • Nephrotoxicity
  • Phlebitis (infusion site)
  • Ototoxicity
  • Hypersensitivity
  • Not absorbed → IV administration for systemic infections
  • Primarily used in serious infection
  • use oral for clostridium diff. enteroocolitis

-Cephalosporin tolerance strains: use vancomycin + 3rd gen cephalosporin

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23
Q

Fosfomycin

A
  • Use: uncomplicated UTIs caused by E.coli, & Enterococcus.
  • inhibits synthesis of peptidoglycan building blocks by inactivating enolpyruvyl transferase, (early cell wall synthesis enzyme)- new cell wall of dividing bacteria → rupture
  • Adverse: headache, diarrhea, nausea, vaginitis
  • Single dose effective for treating UTIs
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24
Q

Bacitracin

A
  • Gram + Cocci and bacilli
  • Mechanism: interferes with a cell wall synthesis by interfering with lipid carrier that exports early wall components through cell membranes
  • Toxicity: allergic dermatitis
  • Use: topical use only (very nephrotoxic)
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25
Q

Cell- wall agents

A 
Penicillin G and V
Oxacillin
Amipicillin, amoxicillin
Ticarcillin
Piperacillin
Cefazolin
Cephalexin
Cefuroxime
Cefoxitin
Ceftriaxone
Ceftazidime
Cefepime
Imipenem
Aztreonam
Vancomycin
Fosfomycin
Bacitracin
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26
Q

Cell Membrane agents

A

Polymyxin & Daptomycin

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27
Q

Polymyxin B

A

Bind LPS in outer membrane of G-

  • G- spectrum (pseudomonas)
  • Topical use
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28
Q

Daptomycin

A

Binds to bacterial cytoplasmic membrane

  • bactericidal
  • G+ ONLY
  • Staph aureus (MSSA, MRSA)
  • Strep pyogenes
  • Enterococcus
  • Staph bacteremia

Adverse:

  • Nausea, diarrhea, GI flora alteration
  • muscle pain and weakness (monitor CK levels)
  • Used for complicated skin and skin structure infections
  • not for lung infections
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29
Q

Nucleic Acid agents

A 
Norfloxacin
Ciprofloxacin
Moxifloxacin
Nitrofurantoin
Rifampin
Fidaxomicin
Metronidazole
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30
Q

Quinolones

A
  • Bactericidal
  • inhibits alpha subunit of DNA gyrase (interfers with control of DNA unwinding)

Adverse effects

  • N/V/abdominal pain, enterocolitis
  • dizziness, headache, restlessness, depression
  • seizure
  • rash- photosensitivity
  • EKG irregularities, arrhythmia
  • peripheral neuropathy
  • arthorpathy/tendon rupture

Precautioned: seizure disorder, pregnancy, children

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31
Q

Fluorinated Quinolones

A

Norfloxacin
Ciprofloxacin
Moxifloxacin

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32
Q

Non Fluorinated Quinolones

A
  • used for Enterobacteriacea in urinary tract
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33
Q

norfloxacin

A

urinary tract infections: Enterobacteriaceae

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34
Q

Ciprofloxacin

A
  • UTI
  • infectious diarrhea (shigella, campylobacter),
  • bone and joint infection (enterobacter)
  • Skin infections
  • Chlamydia
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35
Q

Moxifloxacin

A

G+ activity

  • respiratory infections (p. pneumonia, mycoplasma, legionella)
  • not for strep throat
  • Community acquired pneumonia
  • bacterial bronchitis
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36
Q

Nitrofurantoin

A
  • Nitroreductase enzyme converts them to reactive compounds→ damage DNA
  • UTI

Adverse effects:

  • nausea, vomiting, diarrhea
  • peripheral neuropathy
  • hypersensitivity, fever, chills
  • acute/ chronic pulmonary reactions,
  • acute and chronic liver damage
  • Granulocytopenia, leukopenia, megaloblastic anemia
  • acute hemolytic anemia
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37
Q

Rifampin

A
  • inhibits bacterial RNA synthesis by binding RNA pol B
  • Bactericidal
  • used for treatment of pulmonary Tuberculosis
  • prophylaxis for meningococcal meningitis
  • prophylaxis of H. influenza type b meningitis

Adverse:

  • serious hepatotoxicity
  • induces hepatic enzymes ( many CYPs),
  • orange color ( urine, saliva)—very lipophilic
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38
Q

Fidaxomicin

A
  • Non-competitive inhibitor of RNA polymerase (inhibits RNA synthesis)
  • Bactericidal
  • oral, poorly absorbed
    Use: C. Diff infection

Adverse: GI upset, GI bleeding

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39
Q

Metronidazole

A

Anaerobes reduce the nitro group of metraonidazole→ disrupts DNA
- bactericidal

Use: Anaerobes, C. Diff, combo therapy for H, pylori, gardenerella vaginalis

Adverse:
- n.v. anorexia, diarrhea, transient leukopenia, neutropenia, thrombophlebitis after IV infusion, bacterial and fungal superinfections (candida)

40
Q

Protein Synthesis inhibitors

A 
Gentamicin
Tobramycin
Amikacin
Doxycycline
Minocycline
Tigecycline
Chloramphenicol
Erythromycin
Clarithromycin
Azithromycin
Clindamycin
Linezolid
41
Q

Aminoglycoside drugs

A

Gentamicin
Tobramycin
Amikacin

42
Q

Aminoglycosides Properties

A
  • Only Bactericidal protein synthesis inhibitor
  • Not absorbed orally, given IV or IM
  • Glomerular filtration
  • concentration dependent killing

Mechanism:

  • Penetrate pores of outer membrane
  • Bind to transport molecule on outer of surface of cytoplasmic membrane
  • Transported into cell
  • Bind to several ribosomal sites→ stops initiation→ causes pre-mature release of ribosome from mRNA and mRNA misreading

-Primary for G- aerobic bacilli (Enterobacteriaceae, Pseudomonas)

Adverse:
- Nephrotoxicity: usually reversible
- Ototoxicity: both auditory and vestibular damage
Related to dose of therapy
- Neuromuscular blockage
43
Q

Gentamicin

A

Pseudomonas, Klebsiella, Enterobacter

44
Q

Tobramycin

A

Pseudomonas, Klebsiella, Enterobacter

45
Q

Amikacin

A

For some gentamicin & tobramycin resistant strains

46
Q

Tetracycline

A
  • transported into the cell by a protein carrier system
  • Bind to 30S ribosomal subunits, prevent attachment of aminoacyl-tRNA to the acceptor site on the MRNA-ribosomal complex→ amino acid cannot be added to the protein being synthesized
  • Bacteriostatic
  • Use: Rickettsia, Chlamydia, mycoplasma, Ureaplasma, Borrelia (Lyme)
  • calcium (bivalent cation) binds to tetracycline→ inhibits absorption
    (do not take with antacids and Ca2+ containing foods)

Adverse:

  • Gastrointestinal disturbance: pseudomembranous enterocolitis
  • Candida superinfection in colon
  • Photosensitization with rash—sunlight makes rash worse
  • Teeth discoloration—avoid use in children (<8)
  • Contraindicated in pregnancy
47
Q

Doxycycline

A
  • Tetracycline
    Use: Patients with impaired renal function

Alternative for

  • PenG sensitive syphilis
  • Uncomplicated N. gonorrhoea

-Least affinity for calcium

48
Q

Minocycline

A

Use: Prophylaxis of Neiss. meningitidis

Alternative for
- PenG-sensitive syphilis; - uncomplicated gonorrhea

  • Calcium binding: moderate
49
Q

Tigecycline

A
  • Bacteriostatic
  • Binds 30S ribosomal subunit and blocks aminoacyl-tRNA entry

Use

  • Skin/Skin structure infections
  • Complicated intraabdominal infections
  • Community acquired pneumonia (CAP)
  1. G- :E. coli, Citrobacter, Klebsiella, Enterobacter NOT pseudomonas
  2. G+: Staphylococcus (MSSA and MRSA)
  3. Anaerobes: Bacteroides & Clostridium perfingens
  4. CAP: S. pneumonia, Haemophilius

Adverse

  • N/V
  • increase risk of death
50
Q

Chloramphenicol

A

Interferes with binding of aminoacyl-tRNA to 50S subunit and inhibits peptide bond formation

  • Broad spectrum of activity
  • Alternate agent for treatment of meningitis in beta lactam allergic patients (cephalosporin)
  • Brain abscesses (anaerobes)

Adverse reactions:

  • Bone marrow depression→ can progress to a fatal aplastic anemia (can be delayed)
  • Grey baby syndrome: vomiting, pallor, cyanosis, circulatory collapse
  • high levels of unmetabolized drug due to lack of phase II enzymes
  • Optic neuritis and blindness hypersensitivity- GI effects (enterocolitis)
51
Q

Macrolides

A
  • Bind to a 50S ribosomal subunit→ block protein synthesis by blocking translocation along ribosome
  • Bacteriostatic
52
Q

Erythromycin

A
  • Macrolid
  • Primarily against G+ (strep in penicillin-allergic pts); Also good for atypical bugs: chlamydia, mycoplasma, Legionella, Bordetella
  • Very fast N/V (due to enhanced motility); inhibits CYP 3A4 metabolism/excretion of many drugs; increase risk of arrhythmia and cardiac arrest (esp with CYP3A4)
53
Q

Clarithromycin

A
  • Macrolid
  • Alternative to erythromycin for treatment of pharyngitis, respiratory infections. Also: like erythromycin: mycoplasma, legionella, Bordetella. Haemophilus, Moraxella, penicillin-resistant Strep pnemo. Helicobacter & atypical mycobacterial infections. 3 drugs combos: 2 ABX +acid blocker
  • Less GI effects than Erythromycin. Some CV risk (Prolonged QT) interval
54
Q

Azithromycin

A
  • Macrolid
  • Respiratory infections (strep pneumo, Haemophilis, mycoplasma, Moraxella & chlamydia, Neisseria gonorrhoae (Ceftriaxone + azithromycin)
  • Less GI effects than Erythromycin. Some CV risk (Prolonged QT) interval
    Fewer GI disturbances than w/ erythromycin, fewer drug interactions, Cardiac (prolonged QT)
55
Q

Clindamycin

A

macrolide-like mechanism: binds to 50S ribosomal subunit

  • Inhibits most G+ cocci (Strep & MSSA) and many anaerobes including Bacteriodes fragilis
  • Not for hospital acquired MRSA, enterococcus, or G- aerobes

Adverse Rxn

  • Antibiotic-associated enterocolitis—Associated with C. diff
  • GI irritation, diarrhea
  • Hepatotoxicity
56
Q

Linezolid

A
  • Macolid
  • interferes with protein synthesis, binds 50S subunit→ interferes with 70s initiation complex
  • Use: G+ spectrum
  • VRE: vancomycin resistant Enterococcus
  • s taphylococcus auerus (MRSA, MSSA- alterative to vancomycin)
  • Streptococcus, group A and B
  • Streptococcus pneumonia (including multi-drug resistant)

Side effects

  • Non-selective inhibitor of MAO (avoid foods with tyramine)-Contraindicated in SSRI, tricyclics
  • Diarrhea, headache, n/v, bone marrow suppression
57
Q

Anti-folates agents

A

Sulfamethoxazole
sulfadiazine
Tripmethoprim

58
Q

Sulfonamide

A
  • Anti-folate
  • inhibit folate synthesis by competitive inhibition of dihydropteroate synthase
  • Sulfamethoxazole + Trimethoprim for UTI,
59
Q

sulfadiazine

A
  • Anti-folate ( dihydropteroate synthase)

- Silver sulfadiazine: topical for burn patients

60
Q

Tripmethoprim

A
  • inhibits folate synthesis by competitively inhibiting dihydrofolate reductase
  • sulfamethoxazole (Bactrim)= synergistic effect is bactericidal– Uncomplicated urinary infections—most common use

Adverse effects of trimethoprim-sulfa combination

  1. Sulfonamide side effects
  2. N/V, diarrhea, rashes
  3. Eosinophilia, neutropenia, bone marrow suppression
  4. Especially pronounced in AIDS patients
61
Q

Hospital acquired MRSA Treatment

A 
IV
Vancomycin
linezolid
daptomycin
tigecycline
62
Q

Community Acquired MRSA

A 
Oral
Linezolid
doxycyclin
minocycline
clindamycin
TMP-SMX
63
Q

Tuberculosis Treatment

A
  • Caused by M. tuberculosis

- Rx: isoniazid, Rifampin, Ethambutol, Pyrazinamide, Streptomycin

64
Q

Isoniazid (INH)

A

Bactericidal for actively growing cells, -static for resting cells.

  • inhibits synthesis of mycolic acids.
  • pro-drug that is activated by catalase-peroxide (KatG protein) of tubercle bacillus. Activated drug targets enoyl-acyl carrier protein reductase InhA protein ( important for FA elongation and interferes with DNA synthesis. Resistance: results from mutations in KatG or InhA - Primary TB drug. Patients with INH-sensitive strain should receive INH if possible.
  • Give in combination with other agent
  • oral
  • antacids interfere with absorption
  • N- acetylation is under genetic control: Slow= half-life: 2-5 hours. Fast half life= 70 min -Neurotoxicity (peripheral neuritis)- impoved with B6

Adverse
- hepatotoxicity: correlated with increased age. Possible caused by metabolite of IHN

65
Q

Rifampin

A
  • Inhibits bacterial DNA-dependent RNA polymerase (suppresses RNA synthesis).
  • Bactericidal for intra and extracellular organisms - Used with INH. Not used alone - limited penetration into CSF
  • metabolized in liver by deacetylation

Adverse:

  • Hepatotoxicity: can be severe in alcoholics
  • inducer of CYPs (increase metabolism of other drugs—oral contraceptives, digoxin, warfarin)
  • orange/red color to urine, feces, saliva, tears, sweat, sputum
66
Q

Ethambutol

A
  • interferes with arabinosyl transferase→ blocks cell wall synthesis
  • Tuberculostatic: spontaneous resistance occurs 1 in 106 -Use in conjunction with other drugs (INH)
  • well absorbed, adequate levels in CNS
  • half life: 3-4 hours -

Adverse:
well-tolerated
-not hepatotoxic
-optic neuritis→ decrease in visual acuity, loss ability to differentiate red from green

67
Q

Pyrazinamide

A
  • Blocks mycolic acid synthesis by inhibiting fatty acid synthase I
  • Bactericidal -combo therapy
  • important part of short term multi-drug therapy -widely distributed including CSF

Adverse:
-Hepatic damage: may be fatal w/rifampin

68
Q

Streptomycin

A

-binds to several ribosomal sites: stops initiation and causes mRNA misreading -reserved for most serious forms of TB (disseminated disease)

  • IM administration
  • No CNS penetration -

Adverse:

  • ototoxicity
  • nephrotoxicity
69
Q

MAC Rx

A

M. avium-intracellulare

Ex: Rifabutin & Clarithromycin

70
Q

Rifabutin

A
  • Rifampin analog for single agent prophylaxis of MAC in AIDs pts. (rec. for low CD4 counts)
  • multi-drug treatment of MAC

Adverse:
- similar to rifampin but less frequent ( Hepatotoxicity, inducer of CYPs, orange/red body fluids)

71
Q

Clarithromycin

A
  • part of multi-drug regimen for MAC
  • MAC prophylaxis
  • Bactericidal
72
Q

Leprosy Rx

A

Dapsone
Clofazimine
Rifampin

73
Q

Dapsone

A
  • structural analog of p-aminobenzoic acid (PABA)→ inhibits synthesis of folic acid
  • bacteriostatic
  • used in combination with other drugs (ie. Rifampin)
  • prophylaxis (&treatment) of Pneumocysitis jiroveci in AIDS pts.
  • oral
  • metabolized by same enzymes that acetylates INH: slow and fast acetylators

Adverse:

  • Hemolytic anemia
  • methemoglobinemia
74
Q

Clofazimine

A
  • binds to mycobacterial DNA interfering with reproduction and growth
  • used in combo chemotherapy (often for sulfone resistant leprosy -oral
  • highly lipophilic (long half life: ~2 mo)

Adverse:

  • generally well tolerated
  • cause red/brown pigmentation of skin, sweat
75
Q

Systemic Fungal Infections Rx

A 
Amphotericin B
Flucytosine
Caspofungin
Fluconazole
Itraconazole
Voriconazole
76
Q

Superficial Fungal Rx

A 
Fluconazole
Miconazole
Clotrimazole
Itraconazole
Nystatin
Amphotericin B
77
Q

Ophthalmic Fungal Rx

A

Natamycin

78
Q

Dermatophytic infections Oral Rx

A

Terbinafine
Griseofulvin
Itraconazole

79
Q

Amphotericin B

A
  • Very lipophilic, binds ergosterol in fungal membranes producing membrane instability/leakage.
  • effective for most serious systemic mycoses
  • effective against candida, Histo, crypto, blasto, sporothrix, Coccidiodes -
  • IV for 6 to 12 weeks
  • NOT absorbed from GI
  • Total cumulative dose is impt for renal toxicity
  • limited CNS penetration -

Adverse:
Fever, nausea, vomiting, headache, chills, hypotension, hypokalemia, tachypnea, 90% will show non-permanent nephrotoxicity→ enhances toxicity of renally excreted drugs. – can cause permanent renal damage (total drug dose)
–reversible hypochromic, normocytic anemia

80
Q

Flucytosine

A

-fungi contain a cytosine deaminase that converts 5FC→ 5FU. Metabolites of 5FU block nuclei acid synthesis

  • use: serious infection due to Candida, Cryptococcus
  • used with amphotericin -oral
  • when given with amphotericin→ allows reduction of amphotericin dose

Adverse:

  • N/V, diarrhea, enterocolitis, leukopenia, thrombocytopenia
  • reversible elevated hepatic enzyme
  • use extreme caution in those with renal insufficiency or bone marrow depression
81
Q

Caspofungin

A
  • inhibits cell wall synthesis by non-comptitively blocking synthesis of Beta (1,3) glucan→ cell lysis
  • uses: Invasive Aspergillus in pt intolerant of other drugs
  • Candida, esophageal and systemic
  • IV
  • does inhibit P450 -

Adverse
generally well tolerated
-fever, n/v, rash
-phlebitis at infection site

82
Q

Imidazole/Triazole Mechanism of action

A

inhibit sterol 14-alpha sterol demthylase (fungal P450)→ blocks conversion of lanosterol to ergosterol (fungistatic)

Fluconazole
Itraconazole
Voriconazole

83
Q

Fluconazole

A
  • Cryptococcus meningitis
  • some Candida
  • oral
  • Excellent CNS penetration
    -excreted unchanged in urine
    Adverse
    -N/V/rash/Diarrhea/headache
    -hepatotoxicity: inhibits metabolism of several drugs
84
Q

Itraconazole

A
  • Blastomyces
  • Histoplasma
  • Candida, esophageal and oropharyngeal
  • No CNS penetration
  • Metabolized in liver

Adverse:

  • N/V/rash/Diarrhea/headache
  • hepatotoxicity: inhibits metabolism of several drugs
  • contraindicated w/drugs that inhibit CYP3A4
85
Q

Voriconazole

A
  • invasive Aspergillus (-cidal), scedosporium
  • extended Candida spectrum
  • possibly some CNS entry
  • metabolized in liver -

Adverse:
N/V/rash/Diarrhea/headache
-hepatotoxicity: inhibits metabolism of several drugs
-visual disturbances, photosensitive rash
-contraindicated with st. johns wort (p450 inducer)

86
Q

Miconazole

A
  • cream/suppository for vaginal candidiasis -topicals—burning, itching, irritation
87
Q

Clotrimazole

A
  • oral or vaginal candidiasis
  • Topical: oral torches, vaginal tablets, topical creams/solutions

-oral form: may cause abnormal liver function test

88
Q

Itraconazole

A

oropharyngeal and esophageal candidiasis

89
Q

Nystatin

A
  • almost exclusively for Candida of skin, mucous membrane, GI, vaginal
  • Mechanism similar to amphotericin B

-oral: GI distress

90
Q

Amphotericin B

A
  • binds ergosterol
  • topical for cutaneous or mucodal candida
  • not effective against dermatophytes
  • topical: hypersensitivity but no systemic toxicity
91
Q

Natamycin

A
  • Use: fungal eye infections eg. Conjunctivitis
  • Fusarium, Cephalosporium, Aspergillus

Mechanism similar to amphotericin B
- Might be used in conjunction with surgical measures

Toxicity: conjunctival chemosis and hyperemia

92
Q

Terbinafine

A
  • use: 12 week therapy for nail infections, shorter for other dermatophyte infection
  • Inhibits fungal squalene eposidase; non-competitively
  • Accumulation of squalene damages fungal cell membrane
  • Fungicidal
  • oral
  • remains in skin 12 weeks after therapy stopped -

Adverse:
diarrhea, dyspepsia, abdominal pain

93
Q

Griseofulvin

A
  • recalcitrant infections of skin, hair, nails, beyond scope of topical therapy
  • therapy for children w/ tinea capitis
  • Mechanism: slowly deposited into skin, hair, nails→ interferes with microtubule fuciton/mitotic spindle/mitosis (arrest cell cycle)
  • oral
  • use with topical

Adverse:

  • contraindicated for pt with porphyria and advanced liver disease
  • increase metabolism of other drugs (oral contraceptives, warfarin)
  • Caution: penicillin allergies
94
Q

Itraconazole

A
  • 3 mo therapy for toenail infections
  • oral - N/V/ rash/diarrhea, headache, edema
  • discontinue if signs of liver infections appear

-inhibits metabolism of many drugs (digoxin, cyclosporine, warfarin)

95
Q

Topical preparations or treatment of common skin, hair, nail infections

A
  • Miconazole
  • Clotrimazole
  • Tolnaftate: (tinactin)- cream/solution or foot spray or powder
  • Terbinafine: topical for dermatophytes
  • Ciclopirox: lacquer is only topical Rx for fungal nail infections
96
Q

Ciclopirox

A

lacquer is only topical Rx for fungal nail infections

PDA Block 3 (4 decks)

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