PHARM EXAM 8--STUDY GUIDE Qs Flashcards
1
Q
Humans are exposed to fungi
when they handle
A
contaminated soil
or inhale spores
2
Q
also occur due to
an overgrowth of a fungus that is normally present in the body.
A
fungal infections
3
Q
The human body is quite resistant to
A
fungi
4
Q
Most serious fungal infections occur in
patients with
A
suppressed immune defenses
5
Q
Previously rare fungal infections occur in
patients with
A
AIDS
6
Q
Other people who are more susceptible for fungal infections
A
patients receiving prolonged therapy with corticosteroids,
experiencing extensive burns,
receiving antineoplastic agents,
having indwelling vascular catheters, or
having recently
received organ transplants
7
Q
can affect those with intact
immune systems.
A
community-acquired infections
8
Q
are those nosocomial infections that occur in
the immunosuppressed patient.
A
opportunistic infections
9
Q
where do protozoan thrive
A
in areas of poor sanitation
10
Q
who is more susceptible to protozoan infections?
A
immunosuppressed
11
Q
which drugs are ineffective to protozoans?
A
drugs used to tx bacterial and fungal infections
12
Q
is the most common protozoal disease and the second most fatal infectious
disease in the world.
A
malaria
13
Q
what is malaria caused by?
A
protozoan plasmodium
14
Q
how is malaria transmitted?
A
by the bite of a female anopheles mosquito
15
Q
how is malaria treated
A
multidrug therapy
16
Q
why is multi drug therapy required for tx of malaria?
A
the complicated life cycle of the parasite
17
Q
Drugs may be administered for prophylaxis, as
therapy for acute attacks, and for prevention of relapses
A
…
18
Q
what also thrives in unsanitary conditions
A
non-malarial protozoan infections
19
Q
other
protozoal diseases include
A
amebiasis,
toxoplasmosis,
giardiasis,
cryptosporidiosis,
trichomoniasis,
trypanosomiasis, and
leishmaniasis
20
Q
Treatment of non-Plasmodium protozoan disease
A
requires a different set of medications from those used for malaria.
21
Q
are parasitic worms that cause significant disease in certain regions of the
world.
A
helminths
22
Q
the group of helminths include
A
roundworms
flukes
tapeworms
23
Q
roundworms
A
nematodes
24
Q
flukes
A
trematodes
25
tapeworms
cestodes
26
most helminths enter the body through ?
the skin or GI tract
27
Once inside the human host, Plasmodium multiplies in the liver and transforms into progeny called ____
merozites
28
about 14-25 days after the infection the ___ are released into the blood, infecting and rupturing RBCs and release more ____.
merozites
29
can remain in a latent state in body tissues for extended periods of time, causing relapses months or years after the initial infection.
plasmodium
30
prevention of plasmodium involves administering prophylactic antimalarials when?
prior to, during, and for 1 week after visits to infested areas.
31
Tx of plasmodium involves interrupting ____ and eliminating _____.
interrupting the erythrocytic stage
and
eliminating the merozites from RBCs.
32
what does prevention of relapse of plasmodium mean?
attempting to eliminate the latent forms of plasmodium residing in the liver.
33
causes some degree of kidney damage in 80% of the patients who take it,
amphotericin B (Fungizone)
34
what to closely monitor for if pt is on amphotericin B
F/E status
35
what can Amphotericin B cause?
ototoxicity (assess for hearing loss, vertigo, unsteady gait, or tinnitus)
36
do not give to patients with chronic alcoholism because this drug can be toxic to the liver.
ketoconazole (Nizoral)
37
Assess for what in pts taking ketoconazole (Nizoral) ?
Assess for nausea, vomiting, abdominal pain, or diarrhea.
Also monitor for signs and symptoms of hepatotoxicity, such as pruritus, jaundice, dark urine, and skin rash.
38
may affect glycemic control in diabetic patients, so monitor blood-sugar levels carefully in these patients.
-azoles
39
Monitor for alcohol use because it increases the risk of side effects, such as nausea and vomiting, and increases blood pressure.
ketoconazole
40
Do not use superficial antifungals, such as nystatin (Mycostatin) when?
intravaginally during pregnancy to treat infections caused by gardener vaginalis or trichomonad species
or in pts. who are lactating
41
what should you monitor for if pt is taking high doses of superficial anti fungal therapy
N/V/D
42
use antiprotozoal drugs with caution in patients with?
preexisting cardiovascular dx and those who are lactating
43
test for G6PD deficiency in pts taking which type of drug?
antiprotozoal drugs
44
may precipitate anemia in those with G6PD
| deficiency and may cause bone-marrow depression
Chloroquine (Aralen)
45
obtain a baseline ___ because of the potential cardiac complications associated with some antimalarial drugs
ECG
46
what kind of GI effects do you need to monitor for in pts taking antiprotozoal drugs?
V/D
| abdominal pain
47
oral antimalarials can be given with ___ to reduce GI distress.
food
48
non-malarial antiprotozoal drugs are contraindicated in ?
alcoholics
49
closely monitor __ & ___ ___ during therapy because serum iodine may increase and cause thyroid enlargement with iodoquinol (yodoxin).
vital signs & thyroid function
50
Monitor for signs of CNS toxicity, such as seizures, paresthesia, nausea, and vomiting,
and for allergic responses, such as urticaria and pruritus.
non malarial, antiprotozoal drugs
51
cases of
| leukopenia, thrombocytopenia, and agranulocytosis have been associated with the use of
albendazole (Albenza)
| Antihelminthic drug
52
The mechanism of action is to bind to ergosterol in fungal cell
membranes, causing them to become permeable or leaky.
amphotericin B
| deoxycholate (Fungizone)
53
adverse effects of amphotericin B
| deoxycholate (Fungizone)?
fever and chills, vomiting, and headache at the beginning of therapy,
which subside as
treatment continues
54
what is common during IV therapy of amphotericin B
| deoxycholate (Fungizone)?
phlebitis
55
Some degree of
nephrotoxicity is observed in most patients.
Electrolyte imbalances frequently occur.
Cardiac arrest, hypotension, and dysrhythmias are possible.
amphotericin B
| deoxycholate (Fungizone)
56
The mechanism of action is to interfere with the synthesis of ergosterol
fluconazole
| Diflucan
57
The
primary use is to penetrate most body membranes to reach fungal infections in the CNS,
bone, eyes, urinary tract, and respiratory tract.
fluconazole
| Diflucan
58
whats possible with high doses of fluconazole (diflucan)
N/V/D
59
what has been reported in patients with immunosuppression while taking fluconazole (diflucan)?
stevens-johnson syndrome
60
The mechanism of action is to bind to sterols in the fungal cell
membrane, allowing leakage of intracellular contents.
nystatin (Mycostatin,
| Nysop)
61
adverse effects of nystatin?
minor skin irritation.
if given orally N/V/D
62
The mechanism of action is to concentrate in the food vacuoles of Plasmodium residing
in red blood cells.
chloroquine (Aralen).
63
once in the vacuole, chloroquine is believed to prevent the metabolism of ___, which then builds to toxic levels within the parasite.
heme
64
adverse effects of chloroquine
N/V
| @ higher doses: CNS, cardiovascular, and retinal toxicity may be observed
65
what type of drug is chloroquine?
antiprotozoal--antimalarial
66
antiprotozoal non malarial agents
metronidazole (Fagyl)
67
It is primarily used to treat most forms of amebiasis,
| and to treat a number of respiratory, bone, skin, and CNS infections.
metronidazole
68
Adverse effects
include relatively frequent cases of anorexia, nausea, diarrhea, dizziness, and headache.
Dryness of the mouth and an unpleasant metallic taste may be experienced. Bone-marrow
suppression is possible, although rare.
metronidazole
69
metronidazole can have a ____ effect
"disulfiram"
70
antihelminthic drugs:
mebendazole (Vermox)
71
The mechanism of
action is to act as a broad-spectrum antihelminthic drug.
It retains high concentrations in
the intestine, where it kills both the adult and larval parasites.
mebendazole
72
why is antiviral therapy challenging?
viruses mutate rapidly, and the drug becomes ineffective.
73
it is difficult for the drug to find the virus without injuring ____ ____.
normal cells.
74
HIV targets what?
the CD4 receptor of the T4 helper lymphocyte
75
how does HIV make viral DNA from RNA?
reverse transcripase
76
bud from the host cell
virions
77
which enzyme enables virion to infect other T4 lymphocytes?
protease
78
HIV is called a "retrovirus" because of this reverse synthesis.
retrovirus
79
when does the latent phase of HIV occur?
when the virus lies dormant
80
what is the current protocol for pts with HIV?
to defer tx in asymptomatic adults who have CD4 counts above 350 cells/mcL.
81
when is therapy initiated?
when CD4 is under 200 cells/mcL or when symptoms appear
82
therapeutic goals of HIV
reduce HIV RNA load in the blood to an undetectable level or less than 50
increase the life span
provide a higher quality of life
decrease the risk of transmission from mother to child
83
5 drug classes for HIV
nucleoside/nucleotide reverse transcriptase inhibitor (NRTI, NtRTIs),
nonnucleoside reverse transcriptase inhibitor (NNRTI),
protease inhibitor (PI),
entry inhibitor (fusion inhibitor and CCR5 antagonist), and
integrase inhibitor.
84
tx failure are common with antiretroviral therapy
Patients have nontolerance of adverse effects,
they do not adhere to the complex regimen,
resistant strains can emerge, and
genetic variability is a factor
85
Drug companies are responding to make treatment ______.
simpler
86
inhibits the viral enzyme protease.
lopinavir with ritonavir (Kaletra)
87
The primary use for lopinavir with ritonavir in combination with other antiretrovirals is for
HIV infected patients
88
is the preferred drug for initial therapy of HIV infection
lopinavir with ritonavir (Kaletra)
89
It is well tolerated, but may lead to nausea, headache, vomiting, dyspepsia, and diarrhea.
Hyperglycemia has been reported.
pancreatitis is a rare, but possible, serious adverse effect.
lopinavir with ritonavir (Kaletra)
90
Lipodystrophy syndrome
occurs in many patients
| receiving long-term therapy of lopinavir with ritonavir (Kaletra)
