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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
Q

Carbapenems

What are the 4 Carbapenems?

A

Very broad spectrum for:
+ anaerobic coverage

Doripenem
Imipenem/Cilastatin
Meropenem
Ertapenem

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26
Q

Carbapenems are used for ? issues?

A

Febrile neutropenia
Nosocomial infection
Pseudomonas coverage
ESBL producing organism infections

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27
Q

What are the exceptions of Ertapenem?

Why is Imipenem/Cilastatin only available as a combo?

A

Pseudomonas
Enterococci

Kidney protection: imipenem metabolized to toxic substance, Cilistatin inhibits this catalyzation

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28
Q

What are the s/e of using Carbapenems?

A

Seizure risk w/ Imipenem highest risk

Anaphylaxis- cross reactivity w/ PCNs

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29
Q

What is the Monobactam ABX under the B-Lactams?

A

Aztreonam
Coverage similar to Ceftiazidime, Aminoglycosides
+ coverage for Pseudomonas and Enterobacterase
- Gram Neg or Anaerobic coverage

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30
Q

Aztreonam has no documented cross reactivity except with ?

What unique PT population can this drug be used in ?

A

Ceftazidime

PCN/Cephalosporin allergic PTs as long as the reaction wasn’t to Ceftazidime

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31
Q

What only has Gram Neg

What only has Gram Pos

A 
Ciprofloxacin
Aztreonam
Colistin/Polymyxin B
Metronidazole
Tobra/Amikacin/Gent

Vancomycin, Linezolid, Daptomycin

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32
Q

What covers Pseudomonas

What covers anaerobes

A 
Cefepime
Aztreonam
Meropenem
Piper/Taz
Ciprofloxacin
Tobra/Anika/Gent
Colistin
Meropenem
Piper/Tazo
Clindamycin
Moxifloxacin
Metronidazole
Amp/Sulbactam
Cefotetan
Ertapenem
Doxycycline
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33
Q

Lipo/Glycopeptides

A

-cidal, time dependent
Inhibits cell wall synthesis
Most renal clearance

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34
Q

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?

A

Red Man syndrome- front load w/ Vancomycin, ASA or antihistamine
Ototo/Nephrotoxicity
Risk inc w/ high dose or combo use

PO Vancomycin

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35
Q

What is a unique s/e from Telavancin use?

Lipo/glycopeptides are Preg Cat ?

A

Taste disturbance
Foamy urine

PO Vanc: Cat B
IV Vacnc: Cat B, crosses but no harm
Telavancin- adverse, no use

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36
Q

Lipo/glycopeptides only effective against ? organisms such as ?

What type of monitoring is used/preferred with IV Vancomycin use?

A

Gram Pos
MRSA
Strep
C Diff

Trough monitoring

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37
Q

What is the different/unique fact about Cyclic Lipopeptides?

What is this class’ MOA?

A

-cida, Concentration dependent

Bind to membrane causing rapid depolarization and death

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38
Q

What re the adverse effects of using Cyclic Lipopeptides?

This class is only effective against ? organisms

A

Rhabdo- monitor CK weekly
Nephrotoxicity

Gram Pos
MSSA
MRSA
VRE

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39
Q

Cyclic Lipopeptides CANT be used for what use?

What is the MOA of Polymyxins?

A

Pulmonary infections- degraded by surfactant

Detergent like action on cytoplasmic membrane

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40
Q

What are the adverse reactions of using Polymyxins?

They are only effective against ? organisms?

A

Nephrotoxicity due to Acute Tubular Necrosis
Neurotoxicity- AMS, weakness

Gram neg

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41
Q

What is a unique use of Polymyxins?

What would Topical forms of this class be used for?

A

Inhalation administratoin for pulmonary infections (CF w/ Pneumonia)

Gram Neg infections of Ear canal, Bladder irrigation, Occular infection

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42
Q

What is the MOA and use of Bacitracin?

A

Cell wall synthesis inhibition

Gram + organisms

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43
Q

RNA Polymerase inhibitors

Folate synthesis inhibitors

DNA gyrase inhibitors

A

Rifampin

Suflonamides
Trimethoprim

Fluoroquinolones

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44
Q

What is the difference in the MOA between Aminoglycoside and Tetracycline?

A

Tetra- only incorporate incorrect amino acids into DNA

Amino- blocks initiation, blocks translation/premature termination, incorporates incorrect amino acids into strand

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45
Q

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?

A

Take on empty stomach

Tetra- renal excretion
Doxy/Mino- renal and hepatic elimination

Tige- hepatic elimination, only adjust for liver impaired

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46
Q

Adverse reactions of using Tetra/Glycylcyclines?

What PTs is it c/i in?

A

GI- N/V so severe pretreated prior to dose
Hyperpigmentation
Photosensitivity

Pregnancy
Kids under 8

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47
Q

What is the MOR of aminoglycosides

As a class they cover ? organisms?

A

Depend on oxygen channels to access bacteria meaning anaerobes are resistant

Gram neg
Synergistically used for Gram neg if combined (PCN)

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48
Q

As a class Aminoglycosides are poorly absorbed by ? and are all Preg Cat ?

How are they cleared?

A

PO
D

Renal, doses based on CrCl

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49
Q

What is the only time Aminoglycosides may be used as monotherapy?

They are usually used in combo with ? but still offer no ? coverage

A

Complicated UTIs susceptible to Gram Negs

Cell wall inhibitors
Anaerobic

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50
Q

Aminoglycoside combos are used for ?

A 
Febrile neutropenia
CF exacerbation
Osteomyelitis
Ventilator associated pneumonia
Endocarditis
Sepsis
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51
Q

What are the adverse effects of Aminoglycoside use?

What is the only thing she wants us to know about Chloramphenicol?

A

Ototoxicity- irreversible
Nephrotoxicity
Neuromuscular blockage

No use in G6PD
Causes Gray Baby Syndrome- lack of ability to glucuronidate medication for degradation/detoxification

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52
Q

G6PD deficient PTs can’t take what oxidative medications?

A 
Dapsone
ASA
Netrofurantoin
Primaquine
Quinidein
Sulfonamides
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53
Q

What type of effect do Macrolides/Ketolides exert on microbes?

What are the pregnancy categories of Macrolides/Ketolides?

A

-static

Eryth/Azithromycin*- Cat B
Clarithro/Telithromycin- Cat C

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54
Q

What is a potential adverse reaction to Macrolide/Ketolide usage?

Azithroycin can be used for what two things?

A

Acute cholestasis
Hepatic failure- Telithromycin
Prolonged QTc- Erythromycin

Chlamydia
H Pylori ulcers

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55
Q

Macrolides/Ketolides are not a good choice for fighting infections that require ?

What is the ideal choice for Tx of mild-mod CAP infections?

A

Bactericidal activity

Azithromycin due to long t1/2

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56
Q

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?

A

Macrolides

Inducible resistance- resistance to Eryth, susceptibility to Clyndamycin

Microbe has inducible resistance to Clindamycin

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57
Q

What are the adverse effects of Clindamycin use?

What Pregnancy Cat is this med?

A

GI/C Diff
Rash- common in HIV Pts
Steven Johnson Syndrome

Cat B

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58
Q

What ABX can we use for necrotizing fasciatis?

What does she want us to know about Quinupristin/Dafopristin?

A

Clyndamycin

Little resistance associated w/ it, reserved for bad infections w/ MDROs

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59
Q

What is the adverse effect of using Oxazolidinones?

What pregnancy category are these?

A

Hematological S/e
Weak MAOI= Serotonin Syndrome

Line/Ted- Cat C

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60
Q

Oxazolidinones shouldn’t be used for ? infection?

What is Line/Tedizolid used for?

A

Bacteremia

Line-
Nosocomial Pneumonia
CAP
SSTI

Ted- SSTI

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61
Q

What is the MOA of Fluoroquinolones?

What meds are in each of the Generations that she wants us to know?

A

DNA gyrase inhibitor
-cidal, concentration dependent

2: Cipro
3: Levofloxacin
4: Moxifloxacin

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62
Q

What Fluroquinolones are used for respiratory infections?

Which one has anaerobic coverage?

A

Levo
Moxi

Moxifloxacin

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63
Q

What is the difference in coverage between Moxi, Levo and Ciprofloxacin

A

Moxi- anaerobes, Strep pneumo, no Pseudomonas
Levo: Strep Pneumo, Pseudomonas, no anaerobe
Cipro: Gram Neg/Pseudomonas
All cover atypical

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64
Q

What are the s/e of using Fluoroquinolones?

What PT population can’t take this med?

A

CNS- hallucinations
Achilles Tendon rupture risk, up to 6mon after d/c use

18y/o and younger

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65
Q

What PT education has to be done for those taking Fluoroquinolones?

What is the agent of choice for Anthrax?

A

Take on empty stomach

Ciprofloxacin

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66
Q

What is the primary use of Sulfadiazine

What is the primary use of Sulfadoxine

A

Toxoplasma gondii

Malaria Tx

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67
Q

What is the primary use of Sulfasalzine?

What is the primary use of Sulfacetamide

A

UC

Skin conditions

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68
Q

What is the primary use of Pyrimethamine?

What is the MOA of Folate Antagonists?

A

Anti-malarial

-static, time dependent
Pregnancy Cat D

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69
Q

What are the S/e of using Folate Antagonists Sulfonamides?

A

Hypesensitivity- especially HIV
Crystalurea
Cross reactivity w/ Sulfa containing meds
Hematoogic

G6PD

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70
Q

Nitroimidazoles are primarily used against ? microbes?

What are the adverse effects of using these drugs?

A

Anaerobes

Metallic taste
Interact w/ Warfarin, reduce Warfarin
Disulfiram reaction- projectile vomiting

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71
Q

What is the alternate drug treatment of C Diff if Vancomyin isn’t available?

This drugs is also the DOC of ?

A

Nitroimidazoles- Metron

DOC for Trichomonas vaginalis

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72
Q

What does she want us to know about Fidaxomicin?

What is Mupirocin used for?

A

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

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73
Q

What are the 3 drugs only used for UTIs?

What reaction will be seen across all PTs taking this?

A

Nitrofurantoin
Fosfomycin
Methenamine- hydrolyzed to formaldehyde and ammonia

Brown urine

74
Q

Methenamine can only be used for ?

What is the only use of Phenazopyridine and what is the adverse reaction seen w/ use?

A

UTI prophylaxis, not Tx

UTI analgesis, no anti-infective properties
Turns urine orange

75
Q

DOC for Peds w/ Otitis Media?

What is used if the strain is resistant or the area has high levels of resistant microbes?

A

Amoxicillin

Amoxicillin/Clavulante

76
Q

What ABX is used for Peds PT w/ Otitis Media who has PCN allergy?

When is “Watchful Waiting” utilized?

A

2nd Gen Cephalosporin
Ceftriaxone

6-24mon w/ unitlateral, non-severe AOM
>24mon w/ non-severe AOM

77
Q

For PT to receive Dx of CAP, they must not have what 4 criteria?

A

Hospitalization +2days in past 90days
Long term care resident
IV ABX/chemo past 30days
Hostpital/hemodialysis PT

78
Q

Tx for CAP w/ no comorobidities

Tx of CAP w/ comorbidities

A

Macrolide: Clarith/Azithro
Doxy/Amoxicillin

Moxi or Levofloxacin
Macrolide/Doxy
Amox, Amox/Clavu, Ceftriaxone, Cefpodoxime, Cefuroxime

79
Q

Tx for CAP PT on an inpatient status?

A

Anti-pneumo B-lactam w/ Azithromycin
Anti-pneumo B-lactam w/ Moxi/Levofloxacin

PCN Allergy:
Aztreonam + Moxi/Levofloxacin

80
Q

What drugs are antipneumococcal B-Lactams?

What drugs can be used for pneumonia and also cover Pseudomonas?

A

Ceoftaxime, Ceftriaxone, Amp/Sulbactam

PCN
Fluoroquinolones
Cephalosporin

Carbapenems
Aminoglycosides
Monbactam
Polymyxins

81
Q

What drugs are used for mild SSTIs w/ low or high MRSA risk?

A 
Low:
Penicillinase resistant PCN (Anti-staph PCN)
1st Gen Cephalosporin
Fluoroquinolone
Clindamycin

High:
Doxy
Sulfameth/Trimeth

82
Q

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?

A 
Amp/Sulbactam
Carbapenems
Cefoxitine/3rd Gen
Moxiflox alone
Cipro/Levo w/ clindamycin

Vancomyin
Linezolid
Daptomycin
Added to any of the Mod/Severe drugs

83
Q

List of 7 meds what work for MRSA?

What 3 drugs are used for uncomplicated Cystitis?

A 
Trimeth/Sulfameth
Clindamycin
Doxycycline
VDOT
Ceftaroline
Line/Tedizolid
Daptomycin IV

TMP/SMX x 3days
Nitrofurantoin x 5days
Fosfomycin x 1dose

84
Q

What drugs are used for uncomplicated pyelonephritis?

What are used in complicated UTIs?

A

TMP/SMX x 14 days
Fluoroquinolone x 7 days

Fluoroquinolones
Aminoglycoside mono therapy (only time)
Extended spectrum BLactam

85
Q

What drugs are used for UTIs in pregnant PTs?

What 4 are C/i in these PTs?

A

Amoxicillin x 7 days
Nitrofurantoin x 7 days until wk 37
Cephalexin x 7 days

Fluoroquinolones
TMP/SMX
Aminoglycosides
Tetracyclines

86
Q

What meds can be used for Tx of clamydia?

What is the next step for these PTs?

A

Azithromycin x 1 day
Doxycycline x 7 days

Abstain x 1wk
Tx Partner

87
Q

What medication is used for Plaque, Tularemia, Brucellosis, Q-Fever?

What two microbes carry TB?

A

Doxycycline

Mycobacterium Tuberclosis/Bovis

88
Q

When will a PTs TB skin test be positive?

What is the next phase?

A

Primary infection, 6-8wks after being infected
Clinical/Radiograph silent

Spontaneous healing in 6-8mon, Latent Phase

89
Q

What TST size is positive?

How is TB transmitted and how does it infect PTs?

A

5mm or more: HIV, Contact, X-ray, Transplant, ImmComp
10 ore more: LICED

Communicable Dz
Airborne droplet inhalation

90
Q

Define Progressive Primary TB

When would a PT w/ Latent TB not be treated?

A

PT presents w/ TB Sxs without converting to latent phase

Pregnant, high risk for activating

91
Q

What drugs are First Line agents and used for TB and what are their MOAs?

A

Rifampin- inhibits RNA synthesis

Isoniazid- inhibits cell wall synthesis

Pyrazinamide- disrupts plasma membrane and energy metabolism

Ethamubutol- inhibits cell wall synthesis

92
Q

What are the Second Line agents for TB?

Why would First Line drugs Pyrazinamide or Ethambutol be added to Tx?

A

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
Q

What med for TB can’t be used in pregnancy?

This means these PTs Tx period will last ?

A

Pyrozitamide

9mon Tx
INH/Rifampin/Ethambutol- first 2mon
INH/Rifampin- for remaining 7mon

94
Q

What medication alteration is done for active TB in PTs w/ HIV?

How are pregnant PTs w/ ACTIVE TB treated?

A

Substitute Rifabutin for Rifampin

INH, Rifampin, Ethambutol x 9mon
Add Pyridoxine for INH s/e

95
Q

How is Active TB Managed?

How is Active TB in pregnancy Tx?

A

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
Q

What are the 2 ways to Tx LTB?

A

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
Q

What PT education piece needs to be stressed to TB Tx?

Why if B6 given w/ INH therapy?

A

No alcohol, empty stomach

Prevents drug induced neuropathy

98
Q

What is the antibacterial spectrum of INH?

When can it not be used as monotherapy?

A

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
Q

INH inhibits what CYP pathway?

This inhibition can increase concentrations of what meds?

A

3A4

Phenytoin
Carbamenzapine

100
Q

What adverse effects can occur while taking INH?

What needs to be monitored in these PTs?

A

Peripheral neuropathy
Hepatitis/Hepatotoxicity- inc risk w/ age, Rifampin and ETOH
Systemic lupus/seizure

Liver transaminase
D/c if hepatitis develops

101
Q

What is the DOC for the Tx of LTB?

What are the 3 Rifamycins used and their MOA

A

INH +/- Rifapentine x 3mon

Rifampin
Rifabutin
Rifapentine
Protein inhibitor that inhibits RNA synthesis by clocking production of mRNA

102
Q

What is the DOC of TB?

What is the DOC for MAC?

Rifamycins are added on for Tx of what other issues?

A

Rifampin

Rifabutin

Staph infections of prosthetic heart valves

103
Q

What is the adverse effects of Rifamycins?

What is the DOC for Tx of non-TB mycobacteria?

A

One of the BIGGEST CYP450 inducer (Rifampin)
Secretions orange/red

Rifampin

104
Q

Rifampin can be used to Tx what issues?

When is Rifabutin used in TB Tx?

A

Non-TB mycobacteria
Meningitis
Staph A/MRSA infections

HIV Pos w/ TB
Least potent of class

105
Q

What are the unique s/e that comes with Rifabutin us?

When is the analog of Rifampin used?

A

Uveitis
Skin hyperpigmentation
Lowest CYP inducer

Rifapentine
LTB w/ INH

106
Q

What part of the TB treatment is a prodrug?

What is the only time were going to see this drug?

A

Pyrazinamide

Non-pregnant PT
First 2mon of active TB

107
Q

When is Ethambutol used?

What are the adverse effects?

A

When PT can’t tolerate Rifampin

Optic neuritis- red/green color blindness

108
Q

What are the c/i of using Ethambutol

There is a lack of what big s/e?

A

Color blind
<5y/o
Unconscious
Dec uric acid excretion

No hepatotoxicity

109
Q

What are the fungal cell wall inhibitors?

What are the fungal membrane inhibitors?

A

Enchinocandins
Alamines

Terbinafine
Amphotericin B
Nystatin
Azoles

110
Q

Azoles and Polyenes MOA

Allylamine and Echinocandins MOA

A

Cell membrane

Cell wall

111
Q

Which anti-fungal agent class has less/more effect on CYP450?

A

Imidazole- less, more drug interactions (KBCMT)
Usually topical

Triazole- more selective, less interactions (FIVEP)

112
Q

MOA of Systeic Azoles

Ketoconazoles are used for ? infections?

A

Inhibit fungal membranes and increase permeability

Tinea cutaneous infections

113
Q

What is Clotrimazole used for?

What is Fluconazole uesd for?

A

Cutaneous/Vaginal/Oral candidiasis infection
(Monitor liver)

DOC for non/invasive Candidiasis/Cryptococci infection
Prophylaxis for invasive fungi in immcompromised PTs

114
Q

What is a beneficial effects of Fluconazole?

What is Voriconazole the DOC for?

A

Lease effect on CYP450 of all -azoles

Invasive pulmonary/extra pulmonary infections from Candida
DOC Aspergillus infections

115
Q

What are the adverse effects of Voriconazole?

What is Posaconazole the prophylaxis for?

A

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
Q

What meds need to be avoided when taking Posaconazole?

What are the MOA of Allylamines?

A

HMG-CoA inhibitors, rhabdo
QTc prolongation drugs

Cell wall damage and destruction

117
Q

Allylamines include what 3?

Terbinafine is the DOC for ?

A

Terbinafine
Natifidine
Butenafine

Anychomycosis

118
Q

What are the adverse effects of using Terbinafine?

Who can not take this med?

A

Liver toxicity- monitor LFTs
Taste disturbance

Pregnant

119
Q

What is Naftifine used for?

What is the MOA of Polyenes?

A

Tinea corpis, cruris, pedis

Disturbs cell membrane function, -cidal

120
Q

What are the 2 Polyenes?

What is Amphotericin used for?

A

Amphoterecin
Nystatin

IV only
DOC serious/invasive infxn
Empirically- febrile neutropenia
Prophylaxis- bone marrow transplant

121
Q

If infection is resistant to Gluconisol, what would be the next drug?

What are the adverse reactions of this drug?

A

Amphoterecin B

Seizure
Nephrotoxic
F/C/Rigor

122
Q

What is Nystatin used for?

What is the MOA of Echinocandins?

A

Oral fungal infection
Topical/axilla/groin infection

Inhibits cell wall production of D-glucan leading to lysis

123
Q

What is Echinocandin used for?

What are the 3 drugs in this class?

A

Aspergillus/Candida resistant to Azoles

Anidalafungin
Micafungin
Caspofungin

124
Q

What are the adverse effects of Echinocandin use?

What is Anidalafungin used for?

A

Liver toxicity- monitor LFTs
Infusion related

Azole resistant Candidemia intrabominal infections

125
Q

What is the DOC for Candida prophylaxis in hematopoietic cell transplant recipients?

What is Caspofungin the DOC for?

A

Micafungin

First choice for invasive candidiasis/candidemia

126
Q

What is the MOA of Tolnaftate

What is it used for?

A

Distort hyphae and stunts growth

Tenia Pedis, Corpis, Cruris
Not for Candida

127
Q

What is the MOA of Ciclopirox

What is it used for?

A

Disrupts synthesis of DNA, RNA, proteins

Tinea pedia, corpis, cruris
Nail Lacque- mild/mod onychomycosis

128
Q

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?

A

Fluconazole
Posaconazole

Voriconazole

129
Q

What is the DOC for Pneumocystits jiroveci pneumonia Tx and prophylaxis?

What is the DOC for uncomplicated VVC?

A

Sulfamethoxazole/Trimethoprin

PO Azoles

130
Q

What is the DOC for pregnant PT w/ VVC

A 
Intravaginal Azole:
Clotrim
Micon
Tercon
Buton
Tiocon
131
Q

What drugs are used for immunocompromised/DM PTs w/ VVC?

A

Pregnant- Imidazolex7 days

Any of the others used for uncomplicated

132
Q

What drugs are used for uncomplicated VVC?

A 
Intravaginal imidazole
Clotrimazole- 3-7 days
Miconazole- 3-7 days
Terconazole- 3-7 days
Butoconazole- 1-3 days
Tioconazole- 1 day
133
Q

What two drugs can be used for mild, uncomplicated oral thrush infections?

What 3 drugs can be used for Tinea Pedis/Corpis?

A

Nystatin troche
Clotrimazole
Fluconazole

Butenafine
Terbinafine
PO Fluconazole

134
Q

What is the first line drug for Onychomycosis?

What is the first line drug used for Pityriasis Versicolor/Tinea Versicolor

A

Terbinafine

Ketoconazole

135
Q

What form of malaria is the most dangerous?

What two are more likely to relapse?

A

P Faciparum

Vivax
Malariae
Ovale

136
Q

What anti-malarial drugs are effective against gametocytic, exorythrocytic, and erythrocytic forms?

A

Gamet: Primaquine

Exo: Primauqine

Eryth: Chloroquine, Quinine, Mefloquine, Pyrimethamine

137
Q

Group 1 anti-malarial meds are only effective during the ? stage

What drugs does this stage include

A

Blood

Chloroquine
Quinine

Sulfadoxine
Tetracycline
Artemisinins
Mefloquine
Pyrimethamine
Sulfadoxine
138
Q

Group 2 and 3 anti-malarials are effective where?

What drug are included in each category?

A

Liver and Blood

2: Atovquone/Proguanil
3: Primaquine

139
Q

If ? anti-malaria med is on the test for prophylaxis it’s wrong

What 3 are used for prophylaxis?

A

Chloroquine

Mefloquine
Atovaquone/Proquanil
Doxycylcine

140
Q

What areas would require use of Atovaquone/Proguanil, Mefloquine, Doxycycline, Primaquine

A

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
Q

How far in advance of travel do PTs start the use of Atovaquone/Proguanil, Mefloquine, Doxycycline, Primaquine

A

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
Q

Which Quinolines are used for Tx only and which ones are used for Tx/Prophylaxis

A

Tx only: Quinidine/Quinine

P/Tx: Prima, Chloro, Mefloxoquine

143
Q

What are the adverse reactions of Quinolines use?

A

CV- quinidine
Hematologic- c/i in G6PD
Psychiatric- mefloquine
Systemic- Quinine induced Cinchonism tinnitus

144
Q

What anti-malarial drug is best for pregnancy?

What is the benefit of this med and age allowed?

A

Mefloquine- Cat B

Long t1/2= weekly dosing
>6mon

145
Q

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?

A

Primaquine
Exo-Erythrocytic (Liver)

Quinidine

146
Q

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?

A

Primaquine x 2wks

Folate synthesis inhibitor

147
Q

What is Pyrimethamine/Sulfadoxine combo used for?

What is Pyrimethamine/Sulfadiazine combo used for?

What is Atovaquone/Proguanil combo used for?

A

Chloroqine resistant P Falciparum Tx

Toxoplasma Gondi Tx

Prophylaxis and Tx

148
Q

What are the adverse effects of taking folate inhibitors for malaria?

What is the MOA of Atovaquone/Proguanil?

A

Mouth ulcers
Alopecia w/ proguanil

Interferes w/ E+ transport in parasite mitochondria

149
Q

When is Atovaquone/Proguanil used?

When is this combo c/i?

What is the relation to taking this med w/ food?

A

Prophylaxis and Tx against chloroquine resistant P Falciparum

CrCl <30
Pregnant

Take w/ food/milk

150
Q

What is the MOA od Doxy?

What is it the DOC for?

A

-static, protein synthesis inhibitor

Prophylaxis in Falciparum areas
1-2 days prior
4wks after

151
Q

Doxy can’t be used in what PTs?

How Trichomonas Tx?

A

<8y/o
Pregnant

Metronidazole
Tinidazole
(Protein synthesis inhibitors)

152
Q

Why should pregnant PTs avoid litter boxes?

What meds can be used to Tx and prophylax against this microbe?

A

Toxoplasmosis Gondi

Tx: Pyrimethamin + Clindamycin/Sufadiazine

Proph: Sulfameth/trimethoprim

153
Q

What meds can be used to Tx giardiasis?

What is the MOA of Benzimidazoles?

A

Metronidazole
Tinidazole

Inhibit elongation of microtubules to disrupt growth/division

154
Q

What are the two Benzimidazoles used for pinworm Tx?

What are the adverse effects of these meds?

A

Albendazole
Pyrantel pamoate

Albendazole- monitor LFTs, avoid pregnancy x 1mon
Kids >2/yo
No breast feeding

155
Q

What is the MOA of Pyrantel-Pamoate

Who shouldn’t take this?

A

OTC version
Depolarizing blocker causing paralysis from Ach release and inhibition of cholinesterase

Kids <2y/o
1st trimester of pregnancy

156
Q

What meds are used for the Tx of lice?

What is the MOA?

A

Permethrin- 2mon and up
Pyrethrins- 2yrs and up
But neither are ovicidal

Disrupt Na channel that regulates polarization

157
Q

What is Malathion lotion used for?

What is the MOA?

A

Alternative/Tx failure for Permethrin/Pyrethrin

Ovicidal organophosphate cholinesterase inhibitor exerting neurotoxic effect

158
Q

What is a precaution to using Malathion lotion?

What is the MOA of Benzyl Alochol

A

78% alcohol, flammable

Occlusive
Non-neurotoxin,
non-ovicidal capitis Tx in kids +6mon

159
Q

What is the MOA and use of Ivermectin?

A

Cl channel blocker leading to paralysis

Lice
Acne rosacea

160
Q

Spinosad highlights

A

Capitis Tx
+4y/o
Neurotoxin

161
Q

What med is last in line for Pediculosis Capitis Tx?

What is the Black box warning on this drug?

A

Lindane
Organochloride insecticide inhibiting neurotransmission

Neurotoxicity
Seizure potential
Residual for 5 days

162
Q

What PTs need to exercise caution when taking Lindane?

What type of parasite are viruses

A

<110lbs
HIV
Taking meds that lower seizure threshold

Obligate intracellular

163
Q

What strains of influenza are concerning for humans?

What are the MOAs of the 3 anti-influenza drugs?

A

A and B

Zana/Oseltamivir- budding/release inhibition
Peramivir-

164
Q

What are Neuraminidase inhibitors used for?

What is their MOA?

A

Influenza A and B

Inhibits viral neuraminidase preventing virus release/budding

165
Q

What drugs are includes under Neuraminidase?

How long are each ones used for during Tx?

A

Oseltamivir- PO
Zanamivir- inhaled
Peramivir- IV only

O/Z- 5 days
P- 1 day

166
Q

What form of influenza Tx if preferred for pregnancy?

Which form is not recommended for prophylaxis?

A

PO Oseltamivir

Peramivir

167
Q

Concentration dependent groups

A

Cyclic lipopeptide
Aminoglycosides
Fluoroquinolones

168
Q

What Macrolide can be used for H Pylori induced ulcers?

What ABX can be static or cidal depending on the concentration of the drug

A

Clarithromycin

Clindamycin

169
Q

What is topical forms of Clindamycin used for?

Sulfonamides can cross react with what other meds?

A

Acne
Bacterial vaginitis

Sulfonamide moiety

170
Q

WHen do infants get RSV prophylaxis?

A 
<12mon:
Born <29wks
Chronic lung Dz
CHDz
Neuromuscular

<24mon:
Transplant
Immunocompromised
Severe chronic lung Dz

171
Q

What drug is used for RSV prophylaxis?

What is the MOA

A

Palivizumab monthly injection Nov-Apr

Binds to protein on virus to prevent it from entering cell

172
Q

What drug is given for the Tx of RSV?

What is the MOA?

A

Ribavarin

Ihibits RSV replication and inproves blood oxygenation

173
Q

What is done for RSV Tx?

What are two classes we don’t use?

A 
B2 agonist (albuterol)
Racemic epi

CCS
ABX

174
Q

What are the herpes and varicella vaccines?

What age are they recommended

A

Zostavax- herpes vaccine
Varivax- varicella vaccine

60+
12-18mon, 2nd dose between 4-6yrs

175
Q

Antiviral shingle/herpes zoster therapy needs to start how soon after Sxs?

What meds are used for this?

A

<72hrs

Famciclovir 3ID x 7
Acyclovir 5ID x 7
Valacyclovir 2ID x 7

176
Q

What meds are used for genital herpes?

What meds are used for oral herpes?

A

FAV-clovir

Penciclovir
Docosanol

177
Q

What is the DOC for herpes encephalitis?

What is the MOA of Nucleoside analogs?

A

IV Acyclovir

P FAV -clovir
Incorporated into the DNA strand to halt replication due to lack of nucleotide needed for elongation

178
Q

All nucleosides are effective for treating ?

What is the s/e of IV Acyclovir?

A

VZV

Crystalization in urine

179
Q

What is the MOA of Duconasol

What is it used for?

A

Block virus from entering cell

Topical HSV-1 ointment used at first sign of outbreak

180
Q

What is used for Post exposure HIV prophylaxis

A

Post: Emtricitabine/Tenofovir + Dolutegravir

If Preg, subsitute Raltegravir in for Dolutegravir

ON EMPTY STOMACH

181
Q

What is used for Pre-Exposure HIV prophylaxis

Stopped 57:10

A

Emtricitabine + Tenofovir disoproxil fumarate

Lect 5

IPAP (212 decks)

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