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Pharm Cram Flashcards

1
Q

Cell Wall synthesis inhibitors

A

B-Lactams: CPCM
Cephalosporin, PCN, Carbapenems, Monobactam

Lipo/Glycopeptide: VDOT
Vancomycin, Dalbacvancin, Oritavancin, Telavancin

Bacitracin

Fosfomycin

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2
Q

Cell Membrane Inhibitors

A

Cyclic Lipopeptide: Daptomycin

Polymyxins: Colistimethate, Polymyxin B

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3
Q

B-Lactam-
Type of killing
MOR
Excretion/Pregnancy safe

A

-cidal, time dependent
MOR: B-lactamase production
Renal/Safe

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4
Q

What are the 4 drugs within the B-lactams that are not renally excreted?

B-Lactam MOA

A

Nafcilin, Oxacillin, Dicloxicillin, Ceftriaxone

Interferes w/ cell wall synthesis of transpeptidase and cross-linkage

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5
Q

Anti-staph PCNs are used against what three microbes?

How are Nafcillin, Oxacillin and Dicloxacillin excreted?

A

Strep
MSSA
Penicillinase producing Staph

Nafcillin- biliary
Oxa/Diclox- biliary, kidney

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6
Q

What are potential s/e of Nafcillin and Oxacillin?

What are the Amino-PCNs?

A

Naf: neutropenia
Oxac: hepatotoxicity

Amoxicillin
Ampicillin

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7
Q

What are Amino-PCNs used for?

A 
BOULDERS
Bite wound
Otitis media
UTI
Listeria
Diabetic foot wound
Endocarditis
Respiratory infxn
Soft tissue infxn
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8
Q

What is Amoxicillin used for?

A

Otitis media
Endocarditis prophylaxis
UTI- only if susceptible/pregnant
H Pylori duodenal ulcer

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9
Q

What is Ampicillin used for?

A

Same as Amox but IV form/more severe infxn:
Meningitis
CAP
Endocarditis

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10
Q

What is Amoxicillin/Clavulanate used for?

A 
Amox resistant Ot. Media
Sinusitis/Tonsilitis
CAP w/ macrolide/doxy
SSTI
Uncomp endocarditis prophylaxis
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11
Q

What is Ampicillin/Sulbactam used for?

A 
HAPneumonia w/ macrolide/resp quinolone
Intra-abdominal infxn
SSTI
Sepsis
Gynecological infection
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12
Q

What is the only anti-pseudomonal PCN?

What other drug class is it combined with frequently?

A

Piper/Tazo

Aminoglycoside

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13
Q

Cephalosporin killing type, clearance

What is the name of the dermatological adverse effect?

A

-cidal, time
Renal, except Ceftriaxone

Steven Johnson Syndrome

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14
Q

What is the drug can/can’t be used if PT has reactions to PCN?

What is the DOC for pre/post-op ABX coverage not involving the abdomen?

A

Rash- use caution
Anaphylaxis- avoid B-Lactams

Cefazolin

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15
Q

First Generation Cephalosporins

What are the primarily used for?

A

Gram Pos coverage
Anti-Staph alternate
No BBB/CNS crossing
No anaerobic coverage

Skin infections

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16
Q

What are the First Generation Cephalosporins?

What is the ABX used if PT has allergy to PCN and Cephalosporin?

A

PO: Cephradine, Cefadroxil, Cephalexin
IV: Cefazolin

Clyndamycin

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17
Q

2nd Generation Cephalosporin

A

Worse Gram Pos, better Gram neg coverage

No BBB/CNS crossing

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18
Q

What are the only two Cephalosporins that have anaerobic coverage?

Which one is used as an alternate for cat bites?

A

Cephamycins- Cefoxitin, Cefotetan

Cefuroxime

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19
Q

What are the 2nd Generation Cephalosporins?

A 
Ceflacor
Cefprozil
Cefuroxime
Cefoxitin
Cefotetan

Pro Flac Fox Fur Fo

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20
Q

3rd Generation Cephalosporins

A

Broad spectrum ABX- Gram Pos and Neg

No anaerobic coverage

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21
Q

What is the only Cephalosporin that covers Pseudomonas?

What three cross the BBB?

A

Ceftazidime

Ceftriaxone, Cefotaxime, Ceftazidime

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22
Q

What is the DOC for treating gonorrhea of the cervix, urethra, or rectum?

What is a unique ability of this drug?

A

Ceftriaxone (possibly in combo w/ Azithromycin)

Excellent CNS penetration

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23
Q

When is Cefepime clinically useful?

Which Cephalosporin is used as an alternative for Vancomycin?

A

Empiric therapy for febrile neutropenia
Nosocomial pneumonia
Post-neuro surgical meningitis

Ceftaroline

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24
Q

What does she want us to know about Cephalosporin combination use?

A

Ceftolaozane/Tazobactam
Cetazidime/Avibactam

Last for severe infections
Approval from infectious Dz
Very complicated infectious Dz

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25
Carbapenems What are the 4 Carbapenems?
Very broad spectrum for: + anaerobic coverage Doripenem Imipenem/Cilastatin Meropenem Ertapenem
26
Carbapenems are used for ? issues?
Febrile neutropenia Nosocomial infection Pseudomonas coverage ESBL producing organism infections
27
What are the exceptions of Ertapenem? Why is Imipenem/Cilastatin only available as a combo?
Pseudomonas Enterococci Kidney protection: imipenem metabolized to toxic substance, Cilistatin inhibits this catalyzation
28
What are the s/e of using Carbapenems?
Seizure risk w/ Imipenem highest risk | Anaphylaxis- cross reactivity w/ PCNs
29
What is the Monobactam ABX under the B-Lactams?
Aztreonam Coverage similar to Ceftiazidime, Aminoglycosides + coverage for Pseudomonas and Enterobacterase - Gram Neg or Anaerobic coverage
30
Aztreonam has no documented cross reactivity except with ? What unique PT population can this drug be used in ?
Ceftazidime PCN/Cephalosporin allergic PTs as long as the reaction wasn't to Ceftazidime
31
What only has Gram Neg What only has Gram Pos
``` Ciprofloxacin Aztreonam Colistin/Polymyxin B Metronidazole Tobra/Amikacin/Gent ``` Vancomycin, Linezolid, Daptomycin
32
What covers Pseudomonas What covers anaerobes
``` Cefepime Aztreonam Meropenem Piper/Taz Ciprofloxacin Tobra/Anika/Gent Colistin ``` ``` Meropenem Piper/Tazo Clindamycin Moxifloxacin Metronidazole Amp/Sulbactam Cefotetan Ertapenem Doxycycline ```
33
Lipo/Glycopeptides
-cidal, time dependent Inhibits cell wall synthesis Most renal clearance
34
What are the 3 s/e of the Lipo/Glycopeptides class and how can they be avoided? What is the DOC for C Diff Tx?
Red Man syndrome- front load w/ Vancomycin, ASA or antihistamine Ototo/Nephrotoxicity Risk inc w/ high dose or combo use PO Vancomycin
35
What is a unique s/e from Telavancin use? Lipo/glycopeptides are Preg Cat ?
Taste disturbance Foamy urine PO Vanc: Cat B IV Vacnc: Cat B, crosses but no harm Telavancin- adverse, no use
36
Lipo/glycopeptides only effective against ? organisms such as ? What type of monitoring is used/preferred with IV Vancomycin use?
Gram Pos MRSA Strep C Diff Trough monitoring
37
What is the different/unique fact about Cyclic Lipopeptides? What is this class' MOA?
-cida, Concentration dependent Bind to membrane causing rapid depolarization and death
38
What re the adverse effects of using Cyclic Lipopeptides? This class is only effective against ? organisms
Rhabdo- monitor CK weekly Nephrotoxicity Gram Pos MSSA MRSA VRE
39
Cyclic Lipopeptides CANT be used for what use? What is the MOA of Polymyxins?
Pulmonary infections- degraded by surfactant Detergent like action on cytoplasmic membrane
40
What are the adverse reactions of using Polymyxins? They are only effective against ? organisms?
Nephrotoxicity due to Acute Tubular Necrosis Neurotoxicity- AMS, weakness Gram neg
41
What is a unique use of Polymyxins? What would Topical forms of this class be used for?
Inhalation administratoin for pulmonary infections (CF w/ Pneumonia) Gram Neg infections of Ear canal, Bladder irrigation, Occular infection
42
What is the MOA and use of Bacitracin?
Cell wall synthesis inhibition | Gram + organisms
43
RNA Polymerase inhibitors Folate synthesis inhibitors DNA gyrase inhibitors
Rifampin Suflonamides Trimethoprim Fluoroquinolones
44
What is the difference in the MOA between Aminoglycoside and Tetracycline?
Tetra- only incorporate incorrect amino acids into DNA Amino- blocks initiation, blocks translation/premature termination, incorporates incorrect amino acids into strand
45
What is a PT education fact that needs to be given when prescribing Tetra/Clycyclines? What is the difference between Tetra, Doxy, Mino and Tigecycline use?
Take on empty stomach Tetra- renal excretion Doxy/Mino- renal and hepatic elimination Tige- hepatic elimination, only adjust for liver impaired
46
Adverse reactions of using Tetra/Glycylcyclines? What PTs is it c/i in?
GI- N/V so severe pretreated prior to dose Hyperpigmentation Photosensitivity Pregnancy Kids under 8
47
What is the MOR of aminoglycosides As a class they cover ? organisms?
Depend on oxygen channels to access bacteria meaning anaerobes are resistant Gram neg Synergistically used for Gram neg if combined (PCN)
48
As a class Aminoglycosides are poorly absorbed by ? and are all Preg Cat ? How are they cleared?
PO D Renal, doses based on CrCl
49
What is the only time Aminoglycosides may be used as monotherapy? They are usually used in combo with ? but still offer no ? coverage
Complicated UTIs susceptible to Gram Negs Cell wall inhibitors Anaerobic
50
Aminoglycoside combos are used for ?
``` Febrile neutropenia CF exacerbation Osteomyelitis Ventilator associated pneumonia Endocarditis Sepsis ```
51
What are the adverse effects of Aminoglycoside use? What is the only thing she wants us to know about Chloramphenicol?
Ototoxicity- irreversible Nephrotoxicity Neuromuscular blockage No use in G6PD Causes Gray Baby Syndrome- lack of ability to glucuronidate medication for degradation/detoxification
52
G6PD deficient PTs can't take what oxidative medications?
``` Dapsone ASA Netrofurantoin Primaquine Quinidein Sulfonamides ```
53
What type of effect do Macrolides/Ketolides exert on microbes? What are the pregnancy categories of Macrolides/Ketolides?
-static Eryth/Azithromycin*- Cat B Clarithro/Telithromycin- Cat C
54
What is a potential adverse reaction to Macrolide/Ketolide usage? Azithroycin can be used for what two things?
Acute cholestasis Hepatic failure- Telithromycin Prolonged QTc- Erythromycin Chlamydia H Pylori ulcers
55
Macrolides/Ketolides are not a good choice for fighting infections that require ? What is the ideal choice for Tx of mild-mod CAP infections?
Bactericidal activity Azithromycin due to long t1/2
56
What class is used for PTs that are allergic to B-Lactams When would the lab do a D-Test and what finding is concerning?
Macrolides Inducible resistance- resistance to Eryth, susceptibility to Clyndamycin Microbe has inducible resistance to Clindamycin
57
What are the adverse effects of Clindamycin use? What Pregnancy Cat is this med?
GI/C Diff Rash- common in HIV Pts Steven Johnson Syndrome Cat B
58
What ABX can we use for necrotizing fasciatis? What does she want us to know about Quinupristin/Dafopristin?
Clyndamycin Little resistance associated w/ it, reserved for bad infections w/ MDROs
59
What is the adverse effect of using Oxazolidinones? What pregnancy category are these?
Hematological S/e Weak MAOI= Serotonin Syndrome Line/Ted- Cat C
60
Oxazolidinones shouldn't be used for ? infection? What is Line/Tedizolid used for?
Bacteremia Line- Nosocomial Pneumonia CAP SSTI Ted- SSTI
61
What is the MOA of Fluoroquinolones? What meds are in each of the Generations that she wants us to know?
DNA gyrase inhibitor -cidal, concentration dependent 2: Cipro 3: Levofloxacin 4: Moxifloxacin
62
What Fluroquinolones are used for respiratory infections? Which one has anaerobic coverage?
Levo Moxi Moxifloxacin
63
What is the difference in coverage between Moxi, Levo and Ciprofloxacin
Moxi- anaerobes, Strep pneumo, no Pseudomonas Levo: Strep Pneumo, Pseudomonas, no anaerobe Cipro: Gram Neg/Pseudomonas All cover atypical
64
What are the s/e of using Fluoroquinolones? What PT population can't take this med?
CNS- hallucinations Achilles Tendon rupture risk, up to 6mon after d/c use 18y/o and younger
65
What PT education has to be done for those taking Fluoroquinolones? What is the agent of choice for Anthrax?
Take on empty stomach Ciprofloxacin
66
What is the primary use of Sulfadiazine What is the primary use of Sulfadoxine
Toxoplasma gondii Malaria Tx
67
What is the primary use of Sulfasalzine? What is the primary use of Sulfacetamide
UC Skin conditions
68
What is the primary use of Pyrimethamine? What is the MOA of Folate Antagonists?
Anti-malarial -static, time dependent Pregnancy Cat D
69
What are the S/e of using Folate Antagonists Sulfonamides?
Hypesensitivity- especially HIV Crystalurea Cross reactivity w/ Sulfa containing meds Hematoogic G6PD
70
Nitroimidazoles are primarily used against ? microbes? What are the adverse effects of using these drugs?
Anaerobes Metallic taste Interact w/ Warfarin, reduce Warfarin Disulfiram reaction- projectile vomiting
71
What is the alternate drug treatment of C Diff if Vancomyin isn't available? This drugs is also the DOC of ?
Nitroimidazoles- Metron DOC for Trichomonas vaginalis
72
What does she want us to know about Fidaxomicin? What is Mupirocin used for?
Protein synthesis inhibition Tx for C Diff Adverse reaction w/ macrolides Protein synthesis inhibitor DOC for impetigo and eradicating nasal MRSA and Group A Strep groups
73
What are the 3 drugs only used for UTIs? What reaction will be seen across all PTs taking this?
Nitrofurantoin Fosfomycin Methenamine- hydrolyzed to formaldehyde and ammonia Brown urine
74
Methenamine can only be used for ? What is the only use of Phenazopyridine and what is the adverse reaction seen w/ use?
UTI prophylaxis, not Tx UTI analgesis, no anti-infective properties Turns urine orange
75
DOC for Peds w/ Otitis Media? What is used if the strain is resistant or the area has high levels of resistant microbes?
Amoxicillin Amoxicillin/Clavulante
76
What ABX is used for Peds PT w/ Otitis Media who has PCN allergy? When is "Watchful Waiting" utilized?
2nd Gen Cephalosporin Ceftriaxone 6-24mon w/ unitlateral, non-severe AOM >24mon w/ non-severe AOM
77
For PT to receive Dx of CAP, they must not have what 4 criteria?
Hospitalization +2days in past 90days Long term care resident IV ABX/chemo past 30days Hostpital/hemodialysis PT
78
Tx for CAP w/ no comorobidities Tx of CAP w/ comorbidities
Macrolide: Clarith/Azithro Doxy/Amoxicillin Moxi or Levofloxacin Macrolide/Doxy Amox, Amox/Clavu, Ceftriaxone, Cefpodoxime, Cefuroxime
79
Tx for CAP PT on an inpatient status?
Anti-pneumo B-lactam w/ Azithromycin Anti-pneumo B-lactam w/ Moxi/Levofloxacin PCN Allergy: Aztreonam + Moxi/Levofloxacin
80
What drugs are antipneumococcal B-Lactams? What drugs can be used for pneumonia and also cover Pseudomonas?
Ceoftaxime, Ceftriaxone, Amp/Sulbactam PCN Fluoroquinolones Cephalosporin Carbapenems Aminoglycosides Monbactam Polymyxins
81
What drugs are used for mild SSTIs w/ low or high MRSA risk?
``` Low: Penicillinase resistant PCN (Anti-staph PCN) 1st Gen Cephalosporin Fluoroquinolone Clindamycin ``` High: Doxy Sulfameth/Trimeth
82
What drugs are used for Mod/Severe SSTIs at risk of MRSA? What drugs are used for mod/severe SSTIs w/ a high MRSA risk?
``` Amp/Sulbactam Carbapenems Cefoxitine/3rd Gen Moxiflox alone Cipro/Levo w/ clindamycin ``` Vancomyin Linezolid Daptomycin Added to any of the Mod/Severe drugs
83
List of 7 meds what work for MRSA? What 3 drugs are used for uncomplicated Cystitis?
``` Trimeth/Sulfameth Clindamycin Doxycycline VDOT Ceftaroline Line/Tedizolid Daptomycin IV ``` TMP/SMX x 3days Nitrofurantoin x 5days Fosfomycin x 1dose
84
What drugs are used for uncomplicated pyelonephritis? What are used in complicated UTIs?
TMP/SMX x 14 days Fluoroquinolone x 7 days Fluoroquinolones Aminoglycoside mono therapy (only time) Extended spectrum BLactam
85
What drugs are used for UTIs in pregnant PTs? What 4 are C/i in these PTs?
Amoxicillin x 7 days Nitrofurantoin x 7 days until wk 37 Cephalexin x 7 days Fluoroquinolones TMP/SMX Aminoglycosides Tetracyclines
86
What meds can be used for Tx of clamydia? What is the next step for these PTs?
Azithromycin x 1 day Doxycycline x 7 days Abstain x 1wk Tx Partner
87
What medication is used for Plaque, Tularemia, Brucellosis, Q-Fever? What two microbes carry TB?
Doxycycline Mycobacterium Tuberclosis/Bovis
88
When will a PTs TB skin test be positive? What is the next phase?
Primary infection, 6-8wks after being infected Clinical/Radiograph silent Spontaneous healing in 6-8mon, Latent Phase
89
What TST size is positive? How is TB transmitted and how does it infect PTs?
5mm or more: HIV, Contact, X-ray, Transplant, ImmComp 10 ore more: LICED Communicable Dz Airborne droplet inhalation
90
# Define Progressive Primary TB When would a PT w/ Latent TB not be treated?
PT presents w/ TB Sxs without converting to latent phase Pregnant, high risk for activating
91
What drugs are First Line agents and used for TB and what are their MOAs?
Rifampin- inhibits RNA synthesis Isoniazid- inhibits cell wall synthesis Pyrazinamide- disrupts plasma membrane and energy metabolism Ethamubutol- inhibits cell wall synthesis
92
What are the Second Line agents for TB? Why would First Line drugs Pyrazinamide or Ethambutol be added to Tx?
Rifabutin Rifapentine Added to INH/Rifampin combo for first 2mon reduces therapy to 6mon w/ decreased efficacy Ethambutol only added if isolates are resistant/ susceptibility is unknown
93
What med for TB can't be used in pregnancy? This means these PTs Tx period will last ?
Pyrozitamide 9mon Tx INH/Rifampin/Ethambutol- first 2mon INH/Rifampin- for remaining 7mon
94
What medication alteration is done for active TB in PTs w/ HIV? How are pregnant PTs w/ ACTIVE TB treated?
Substitute Rifabutin for Rifampin INH, Rifampin, Ethambutol x 9mon Add Pyridoxine for INH s/e
95
How is Active TB Managed? How is Active TB in pregnancy Tx?
RIPE x 2mon Once isolate is known to be sensitive to R/I, d/c E After 2mon, d/c Pyrazinide Continue R/I x 6mon RIE until sensitivity is known Continue x 9mon due to lack of Pyrizinamide
96
What are the 2 ways to Tx LTB?
Isoniazid x 9mon w/ daily meds Preferred in HIV, kids 2 or younger or pregnant (s/ B6 supplement) Isoniazid/Rifampentine x 3mon w/ weekly meds for kids over 2y/o
97
What PT education piece needs to be stressed to TB Tx? Why if B6 given w/ INH therapy?
No alcohol, empty stomach Prevents drug induced neuropathy
98
What is the antibacterial spectrum of INH? When can it not be used as monotherapy?
Only against M TB and M Kansasii - static in Latent - cidal in Active NOT in active Do use in latent, can be combined w/ Rifapentin
99
INH inhibits what CYP pathway? This inhibition can increase concentrations of what meds?
3A4 Phenytoin Carbamenzapine
100
What adverse effects can occur while taking INH? What needs to be monitored in these PTs?
Peripheral neuropathy Hepatitis/Hepatotoxicity- inc risk w/ age, Rifampin and ETOH Systemic lupus/seizure Liver transaminase D/c if hepatitis develops
101
What is the DOC for the Tx of LTB? What are the 3 Rifamycins used and their MOA
INH +/- Rifapentine x 3mon Rifampin Rifabutin Rifapentine Protein inhibitor that inhibits RNA synthesis by clocking production of mRNA
102
What is the DOC of TB? What is the DOC for MAC? Rifamycins are added on for Tx of what other issues?
Rifampin Rifabutin Staph infections of prosthetic heart valves
103
What is the adverse effects of Rifamycins? What is the DOC for Tx of non-TB mycobacteria?
One of the BIGGEST CYP450 inducer (Rifampin) Secretions orange/red Rifampin
104
Rifampin can be used to Tx what issues? When is Rifabutin used in TB Tx?
Non-TB mycobacteria Meningitis Staph A/MRSA infections HIV Pos w/ TB Least potent of class
105
What are the unique s/e that comes with Rifabutin us? When is the analog of Rifampin used?
Uveitis Skin hyperpigmentation Lowest CYP inducer Rifapentine LTB w/ INH
106
What part of the TB treatment is a prodrug? What is the only time were going to see this drug?
Pyrazinamide Non-pregnant PT First 2mon of active TB
107
When is Ethambutol used? What are the adverse effects?
When PT can't tolerate Rifampin Optic neuritis- red/green color blindness
108
What are the c/i of using Ethambutol There is a lack of what big s/e?
Color blind <5y/o Unconscious Dec uric acid excretion No hepatotoxicity
109
What are the fungal cell wall inhibitors? What are the fungal membrane inhibitors?
Enchinocandins Alamines Terbinafine Amphotericin B Nystatin Azoles
110
Azoles and Polyenes MOA Allylamine and Echinocandins MOA
Cell membrane Cell wall
111
Which anti-fungal agent class has less/more effect on CYP450?
Imidazole- less, more drug interactions (KBCMT) Usually topical Triazole- more selective, less interactions (FIVEP)
112
MOA of Systeic Azoles Ketoconazoles are used for ? infections?
Inhibit fungal membranes and increase permeability Tinea cutaneous infections
113
What is Clotrimazole used for? What is Fluconazole uesd for?
Cutaneous/Vaginal/Oral candidiasis infection (Monitor liver) DOC for non/invasive Candidiasis/Cryptococci infection Prophylaxis for invasive fungi in immcompromised PTs
114
What is a beneficial effects of Fluconazole? What is Voriconazole the DOC for?
Lease effect on CYP450 of all -azoles Invasive pulmonary/extra pulmonary infections from Candida DOC Aspergillus infections
115
What are the adverse effects of Voriconazole? What is Posaconazole the prophylaxis for?
Take w/out food High trough levels cause visual disturbances Auditory hallucinations CrCl <50 must use PO form Invasive Aspergillus/Candida in ImmComp PTs Take w/ food
116
What meds need to be avoided when taking Posaconazole? What are the MOA of Allylamines?
HMG-CoA inhibitors, rhabdo QTc prolongation drugs Cell wall damage and destruction
117
Allylamines include what 3? Terbinafine is the DOC for ?
Terbinafine Natifidine Butenafine Anychomycosis
118
What are the adverse effects of using Terbinafine? Who can not take this med?
Liver toxicity- monitor LFTs Taste disturbance Pregnant
119
What is Naftifine used for? What is the MOA of Polyenes?
Tinea corpis, cruris, pedis Disturbs cell membrane function, -cidal
120
What are the 2 Polyenes? What is Amphotericin used for?
Amphoterecin Nystatin IV only DOC serious/invasive infxn Empirically- febrile neutropenia Prophylaxis- bone marrow transplant
121
If infection is resistant to Gluconisol, what would be the next drug? What are the adverse reactions of this drug?
Amphoterecin B Seizure Nephrotoxic F/C/Rigor
122
What is Nystatin used for? What is the MOA of Echinocandins?
Oral fungal infection Topical/axilla/groin infection Inhibits cell wall production of D-glucan leading to lysis
123
What is Echinocandin used for? What are the 3 drugs in this class?
Aspergillus/Candida resistant to Azoles Anidalafungin Micafungin Caspofungin
124
What are the adverse effects of Echinocandin use? What is Anidalafungin used for?
Liver toxicity- monitor LFTs Infusion related Azole resistant Candidemia intrabominal infections
125
What is the DOC for Candida prophylaxis in hematopoietic cell transplant recipients? What is Caspofungin the DOC for?
Micafungin First choice for invasive candidiasis/candidemia
126
What is the MOA of Tolnaftate What is it used for?
Distort hyphae and stunts growth Tenia Pedis, Corpis, Cruris Not for Candida
127
What is the MOA of Ciclopirox What is it used for?
Disrupts synthesis of DNA, RNA, proteins Tinea pedia, corpis, cruris Nail Lacque- mild/mod onychomycosis
128
What are the two DOC in order for fungal infections in immuno compromised/organ transplant PTs? What is the DOC for fungal infection prophylaxis in immunocompromised PTs?
Fluconazole Posaconazole Voriconazole
129
What is the DOC for Pneumocystits jiroveci pneumonia Tx and prophylaxis? What is the DOC for uncomplicated VVC?
Sulfamethoxazole/Trimethoprin PO Azoles
130
What is the DOC for pregnant PT w/ VVC
``` Intravaginal Azole: Clotrim Micon Tercon Buton Tiocon ```
131
What drugs are used for immunocompromised/DM PTs w/ VVC?
Pregnant- Imidazolex7 days | Any of the others used for uncomplicated
132
What drugs are used for uncomplicated VVC?
``` Intravaginal imidazole Clotrimazole- 3-7 days Miconazole- 3-7 days Terconazole- 3-7 days Butoconazole- 1-3 days Tioconazole- 1 day ```
133
What two drugs can be used for mild, uncomplicated oral thrush infections? What 3 drugs can be used for Tinea Pedis/Corpis?
Nystatin troche Clotrimazole Fluconazole Butenafine Terbinafine PO Fluconazole
134
What is the first line drug for Onychomycosis? What is the first line drug used for Pityriasis Versicolor/Tinea Versicolor
Terbinafine Ketoconazole
135
What form of malaria is the most dangerous? What two are more likely to relapse?
P Faciparum Vivax Malariae Ovale
136
What anti-malarial drugs are effective against gametocytic, exorythrocytic, and erythrocytic forms?
Gamet: Primaquine Exo: Primauqine Eryth: Chloroquine, Quinine, Mefloquine, Pyrimethamine
137
Group 1 anti-malarial meds are only effective during the ? stage What drugs does this stage include
Blood Chloroquine Quinine ``` Sulfadoxine Tetracycline Artemisinins Mefloquine Pyrimethamine Sulfadoxine ```
138
Group 2 and 3 anti-malarials are effective where? What drug are included in each category?
Liver and Blood 2: Atovquone/Proguanil 3: Primaquine
139
If ? anti-malaria med is on the test for prophylaxis it's wrong What 3 are used for prophylaxis?
Chloroquine Mefloquine Atovaquone/Proquanil Doxycylcine
140
What areas would require use of Atovaquone/Proguanil, Mefloquine, Doxycycline, Primaquine
A/P: chloroquin resistant P Falciparum M: chloroquin resistant P Falciparum D: multi drug resistant P Falciparum P: terminal prophylaxis for P Vivas/Ovale
141
How far in advance of travel do PTs start the use of Atovaquone/Proguanil, Mefloquine, Doxycycline, Primaquine
A/P: 1-2 days before, 1wk after M: 2wks before, 4wks after D: 1-2 days before, 4wks after P: 14 days after
142
Which Quinolines are used for Tx only and which ones are used for Tx/Prophylaxis
Tx only: Quinidine/Quinine P/Tx: Prima, Chloro, Mefloxoquine
143
What are the adverse reactions of Quinolines use?
CV- quinidine Hematologic- c/i in G6PD Psychiatric- mefloquine Systemic- Quinine induced Cinchonism tinnitus
144
What anti-malarial drug is best for pregnancy? What is the benefit of this med and age allowed?
Mefloquine- Cat B Long t1/2= weekly dosing >6mon
145
What is the only anti-malarial that prevents relapse of the Vivax and Ovale form of malaria? What is the only quinoline available in the US as an IV?
Primaquine Exo-Erythrocytic (Liver) Quinidine
146
If a PT is Dx w/ P Vivax/Ovale, what terminal porphylaxis is added and for how long? What is the MOA of Pyrimethamine and Proguanil?
Primaquine x 2wks Folate synthesis inhibitor
147
What is Pyrimethamine/Sulfadoxine combo used for? What is Pyrimethamine/Sulfadiazine combo used for? What is Atovaquone/Proguanil combo used for?
Chloroqine resistant P Falciparum Tx Toxoplasma Gondi Tx Prophylaxis and Tx
148
What are the adverse effects of taking folate inhibitors for malaria? What is the MOA of Atovaquone/Proguanil?
Mouth ulcers Alopecia w/ proguanil Interferes w/ E+ transport in parasite mitochondria
149
When is Atovaquone/Proguanil used? When is this combo c/i? What is the relation to taking this med w/ food?
Prophylaxis and Tx against chloroquine resistant P Falciparum CrCl <30 Pregnant Take w/ food/milk
150
What is the MOA od Doxy? What is it the DOC for?
-static, protein synthesis inhibitor Prophylaxis in Falciparum areas 1-2 days prior 4wks after
151
Doxy can't be used in what PTs? How Trichomonas Tx?
<8y/o Pregnant Metronidazole Tinidazole (Protein synthesis inhibitors)
152
Why should pregnant PTs avoid litter boxes? What meds can be used to Tx and prophylax against this microbe?
Toxoplasmosis Gondi Tx: Pyrimethamin + Clindamycin/Sufadiazine Proph: Sulfameth/trimethoprim
153
What meds can be used to Tx giardiasis? What is the MOA of Benzimidazoles?
Metronidazole Tinidazole Inhibit elongation of microtubules to disrupt growth/division
154
What are the two Benzimidazoles used for pinworm Tx? What are the adverse effects of these meds?
Albendazole Pyrantel pamoate Albendazole- monitor LFTs, avoid pregnancy x 1mon Kids >2/yo No breast feeding
155
What is the MOA of Pyrantel-Pamoate Who shouldn't take this?
OTC version Depolarizing blocker causing paralysis from Ach release and inhibition of cholinesterase Kids <2y/o 1st trimester of pregnancy
156
What meds are used for the Tx of lice? What is the MOA?
Permethrin- 2mon and up Pyrethrins- 2yrs and up But neither are ovicidal Disrupt Na channel that regulates polarization
157
What is Malathion lotion used for? What is the MOA?
Alternative/Tx failure for Permethrin/Pyrethrin Ovicidal organophosphate cholinesterase inhibitor exerting neurotoxic effect
158
What is a precaution to using Malathion lotion? What is the MOA of Benzyl Alochol
78% alcohol, flammable Occlusive Non-neurotoxin, non-ovicidal capitis Tx in kids +6mon
159
What is the MOA and use of Ivermectin?
Cl channel blocker leading to paralysis Lice Acne rosacea
160
Spinosad highlights
Capitis Tx +4y/o Neurotoxin
161
What med is last in line for Pediculosis Capitis Tx? What is the Black box warning on this drug?
Lindane Organochloride insecticide inhibiting neurotransmission Neurotoxicity Seizure potential Residual for 5 days
162
What PTs need to exercise caution when taking Lindane? What type of parasite are viruses
<110lbs HIV Taking meds that lower seizure threshold Obligate intracellular
163
What strains of influenza are concerning for humans? What are the MOAs of the 3 anti-influenza drugs?
A and B Zana/Oseltamivir- budding/release inhibition Peramivir-
164
What are Neuraminidase inhibitors used for? What is their MOA?
Influenza A and B Inhibits viral neuraminidase preventing virus release/budding
165
What drugs are includes under Neuraminidase? How long are each ones used for during Tx?
Oseltamivir- PO Zanamivir- inhaled Peramivir- IV only O/Z- 5 days P- 1 day
166
What form of influenza Tx if preferred for pregnancy? Which form is not recommended for prophylaxis?
PO Oseltamivir Peramivir
167
Concentration dependent groups
Cyclic lipopeptide Aminoglycosides Fluoroquinolones
168
What Macrolide can be used for H Pylori induced ulcers? What ABX can be static or cidal depending on the concentration of the drug
Clarithromycin Clindamycin
169
What is topical forms of Clindamycin used for? Sulfonamides can cross react with what other meds?
Acne Bacterial vaginitis Sulfonamide moiety
170
WHen do infants get RSV prophylaxis?
``` <12mon: Born <29wks Chronic lung Dz CHDz Neuromuscular ``` <24mon: Transplant Immunocompromised Severe chronic lung Dz
171
What drug is used for RSV prophylaxis? What is the MOA
Palivizumab monthly injection Nov-Apr Binds to protein on virus to prevent it from entering cell
172
What drug is given for the Tx of RSV? What is the MOA?
Ribavarin Ihibits RSV replication and inproves blood oxygenation
173
What is done for RSV Tx? What are two classes we don't use?
``` B2 agonist (albuterol) Racemic epi ``` CCS ABX
174
What are the herpes and varicella vaccines? What age are they recommended
Zostavax- herpes vaccine Varivax- varicella vaccine 60+ 12-18mon, 2nd dose between 4-6yrs
175
Antiviral shingle/herpes zoster therapy needs to start how soon after Sxs? What meds are used for this?
<72hrs Famciclovir 3ID x 7 Acyclovir 5ID x 7 Valacyclovir 2ID x 7
176
What meds are used for genital herpes? What meds are used for oral herpes?
FAV-clovir Penciclovir Docosanol
177
What is the DOC for herpes encephalitis? What is the MOA of Nucleoside analogs?
IV Acyclovir P FAV -clovir Incorporated into the DNA strand to halt replication due to lack of nucleotide needed for elongation
178
All nucleosides are effective for treating ? What is the s/e of IV Acyclovir?
VZV Crystalization in urine
179
What is the MOA of Duconasol What is it used for?
Block virus from entering cell Topical HSV-1 ointment used at first sign of outbreak
180
What is used for Post exposure HIV prophylaxis
Post: Emtricitabine/Tenofovir + Dolutegravir If Preg, subsitute Raltegravir in for Dolutegravir ON EMPTY STOMACH
181
What is used for Pre-Exposure HIV prophylaxis Stopped 57:10
Emtricitabine + Tenofovir disoproxil fumarate Lect 5

IPAP (212 decks)

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