Pharm Quiz 3 Flashcards
1
Q
How are drugs most selectively toxic?
A
Disrupting cell wall synthesis.
Disrupting bacterial protein synthesis.
Disrupting bacterial enzymes.
2
Q
Narrow-Spectrum ATBs
A
Penicillins
Aminoglycosides
TB drugs
1+2 Cephalosporins
3
Q
Broad-Spectrum ATBs
A
Fluoroquinolones
Amoxicillin
Sulfonamides
Tetracyclines
3 Cephalosporin
4
Q
What do HIV meds end in?
A
AVIR
5
Q
What do Flu meds end in?
A
IVIR
6
Q
What drugs are anti-fungal?
A
Amphotericin, “FUNGOLE”, “AZOLE”
7
Q
Antimetabolites
A
Disrupt specific biochemical reactions
8
Q
Microbial MOA of Resistance
A
Decrease drug concentration
Alter receptors
Produce drug-metabolizing enzymes
Antagonize production
9
Q
NDMI-1
A
Inactivates all ATBs with a B-lactam ring. Easily transferred on a plasmid.
10
Q
Spontaneous Mutations
A
Only transmits resistance to one organism
11
Q
Conjugation
A
R-Factor (includes resistance and sexual code) goes to a different organism (can even occur between normal flora and bad)
12
Q
How do ATBs affect normal flora?
A
They promote resistant normal flora that can conjugate to bad bacteria.
13
Q
Superinfection
A
A 2nd infection develops from ATBs d/t suppression of normal flora.
14
Q
ATB for Bronchitis
A
Trimethoprim
15
Q
ATB for Lyme Disease
A
Doxycycline and Amoxicillin
16
Q
What is a necessary drug level for ATBs?
A
4-8x the MIC
17
Q
When is mixed-therapy appropriate?
A
Severe infections when broad, broad therapy is effective.
18
Q
Where are mixed infections normal?
A
Brain abscesses, pelvic infections, abdominal perforations
19
Q
When is ATB prophylaxis indicated?
A
UTI, STI, Flu, Rheumatic Fever
20
Q
What type of ATBs are Penicillins
A
Beta-Lactam which cause cell walls to breakdown, which means they are bactericidal.
21
Q
Why are Penicillins useful?
A
They are effective against many bacteria and their direct drug toxicity is low.
22
Q
Transpeptidases
A
Enzymes that give cell walls strength
23
Q
Autolysins
A
Promote cell wall growth
24
Q
How do Penicillins breakdown cell walls?
A
They target transpeptidases and autolysins, so they only effect cells that are reproducing.
25
What is challenging about gram-negative bacteria?
They have a third outer membrane that only some ATBs can breakthough.
26
B-Lactamases (Penicillinases)
Breakdown ATBs (Penicillins)
27
What bacteria has a lot of penicillinases?
80% of S. Aureus is resistant to Penicillins.
28
What ATBs is MRSA resistant to?
All penicillins and cephalosporins
29
What is the common drug of choice for MRSA?
Vancomycin
30
Where does CA-MRSA usually cause problems?
Skin
31
Ampicillin
Broad spectrum used against E. Coli, E. faecium, and listeria. Nonallergic rash is common.
32
Is Amoxicillin or Ampicillin better PO?
Amoxicillin
33
ATBs with B-lactamase Inhibitors
Augmentin, Unasyn, Zosyn
34
Piperacillin
Extended-Spectrum for P. aeruginosa
35
What is Penicillin G effective against?
Gram-positive, some Gram-negative, anaerobic, spirochetes
36
ADME of Penicillin
A: Na and K are absorbed rapidly.
Procaine and Benzathine are slowly absorbed.
D: Especially good when inflammation in eyes, joints, and CSF.
M&E: Low metabolism and largely excreted by kidneys
37
Allergy to Penicillins
Most common drug allergy and should not be give Cephalosporins if anaphylactic.
38
Hapten
Broken down Penicillins bound to a larger protein that antibodies usually target.
39
Desensitization Schedule
Small but increasing doses of Penicillin are administered every 60 minutes if there there is no other tx option for endocarditis.
40
Ceftaroline
The one B-Lactam ATB that MRSA responds to d/t to a high affinity to PBP
41
AD Cephalosporins
A: Mostly IV
D: Good except for eyes
42
What happens if you take Cefazoline or Cefotetan with ETOH?
Severe disulfiram reaction
43
What side effect does Cefazoline, Cefotetan, and Ceftriaxone cause?
Severe bleeding d/t interference with Vit K
44
What generation Cephalosporins are preferred for many infections?
3
45
What are 4+5 Cephalosporins effective against?
Resistant organisms
46
What are 6 Cephalosporins effective against?
MRSA and HA-PNA
47
What ATBs are good for patients with renal impairment?
Ceftriaxone (Cephalosporin)
48
Carbapenems
Very broad-spectrum and IV only
49
Imipenem
Used for multi-organism infections
50
Why is Imipenem quite effective?
It is resistant to many B-lactamases and works against gram-negative and anaerobic bacteria.
51
What drug does Imipenem interfere with?
Valproate
52
How is CDI acquired?
Preceded by ATB use and spores are extremely hard to kill.
53
S&S of CDI
2-3 unformed stools and a positive CDI test
54
How is CDI treated?
Discontinuing original ATBs (which may alone cure it) and implementing Vancomycin
55
Alternatives to Vanc for CDI:
Rifaximin (reduces recurrence), antibodies, inoculating the bowel with a benign strain of CDI
56
Single use drug for UTIs?
3g Fosfomycin
57
For what infections are Tetracyclines first line?
Rocky-Mountain, Lymes,
Cholera,
Acne Vulgaris
Typhus
58
How is H pylori treated?
Tetracyclines, Metronidazole, PPIs
59
What should be avoided when taking Tetracyclines?
Metal ions
60
Tetracycline side effects:
GI irritation, hepatic sensitivity, CDI, hypersensitivity reaction, yellowing teeth, skin sensitivity
61
What is an alternative to Penicillin G?
Erythromycin and Clindamycin
62
Erythromycin Base
Inactivated by stomach acid but only active form of Erythromycin
63
How is Erythromycin eliminated?
Liver
64
What is Clindamycin indicated for?
Infections outside the CSF
65
What side effect does Clindamycin cause?
CDAD
66
What is Linezolid used for?
VRE, MRSA, P. aeruginosa, S. pneumoniae
67
Tedizolid Indications:
MRSA and Staphylococcus and Streptococcus skin infections
68
Aminoglycoside Chemistry:
They are positively charged, so they do not readily cross membranes and can only be given IV.
69
What infections do Aminoglycosides target?
P. aeruginosa and E. Coli
70
Distribution Aminoglycosides
Easily bind to kidneys and easily penetrate ears, so cause toxicity.
71
Concentration Dependent
The higher the dose, the quicker the cell kill
72
Postantibiotic Effect
Cell kill continues after ATB below MIC
73
What should practitioners be aware of when prescribing aminoglycosides?
There is a larger personal variability, so doses must be prescribed for the patient.
74
Amikacin
Aminoglycoside most resistant to microbe enzymes.
75
Sulfa Microbial Spectrum
Broad against gram-positive bacteria
76
Sulfa Distribution
Other fluids better than blood
77
Sulfa AE:
Photosensitivity, Kernicterus, Steven-Johnson, Red cell lysis
78
What is Sulfamethoxazole and Trimethoprim (sulfa) used for?
UTI, Malaria, Toxoplasmosis
79
Drug interactions with sulfas:
Diuretics, hypoglycemic agents, Warfarin
80
How many UT pathogens are subject to Bactrim (sulfamethoxazole + Trimethroprim?
80%
81
TMP/SMZ dose:
80mg/140mg
82
Causes of complicated UTIs:
Strictures, Calculi, Tumors
83
Reinfection UTI:
Colonization from a new bacteria
84
How to treat reinfections >3x/year:
Prophylactic ATB at low doses
85
How to treat relapse?
Correct structural issue or continue long-term ATBs (6 months)
86
Treatment for bacterial prostatitis:
Fluoroquinolones IV and then oral
87
Urinary Tract Antiseptics:
Nitrofurantion and Methanamine
88
Acute Cystitis Tx:
Bactrim, Nitro, Cipro (allergy to B-Lactam ring), Levo
89
Complicated UTI and acute pyelonephritis:
Bactrim, Cipro, Levo, Augmentin
90
Prophylaxis UTI:
Bactrim, Nitrofurantoin
91
Tx of choice for infants with UTI:
Gentamycin and Ampicillin
92
What are fluoroquinolones used for?
Broad spectrum ATBs that can be taken orally rather than parenterally.
93
What is a side effect of fluoroquinolones?
Tendinitis and photo sensitivity
94
What type of drug is Ciprofloxacin?
Fluoroquinolones
95
What is Ciprofloxacin used for?
Respiratory, GI, Skin, Joints, and soft tissues
96
What should Ciprofloxacin used for in children?
Complicated UTI infections or Anthrax
97
Black Box Warnings Ciprofloxacin:
Myasthenia Gravis
98
What food decreases Cipro absorption?
Calcium
99
What drugs can Cipro elevate?
Warfarin, Theophylline, Tinidazole
100
What is Flagyl (Metronidazole) used for?
Abdominal surgeries, C. diff, H pylori
101
What is Daptomycin used for?
Endocarditis and skin infections caused by S. aureus
102
How is Daptomycin administered?
IV
103
What is a side effect of Daptomycin?
Muscle damage
104
Why are we affected by Amphotericin B?
While it binds stronger to Ergosterol, it also binds to Cholesterol.
105
Amphotericin B Metabolism and Excretion
Unknown. Levels have been detected a year after administration.
106
AZOLE ADME
A: Cola increases absorption
M: Can be given orally, but it decreases P450 --> increases in other meds.
E: 40% is excreted by the liver (should not be given to liver patients).
107
AZOLE Black Box Warning
Should not be given to liver patients.
108
What does Caspofungin target?
Aspergillus and Candidiasis
109
What does Flucytosine target?
Candidiasis and Cryptococcosis
110
What should Flucytosine be given with?
Amphotericin B to increases effectiveness and decrease resistance
111
Where is Flucytosine well absorbed?
Better to CSF than blood
112
Black Box Warning Flucytosine:
Renal Impairment
113
How should tinea corporis be treated?
Topical AZOLE or Allylamine
114
Tinea Cruris
Infection of the groin
115
How is tinea capitis treated?
Oral Griseofulvin or Terbafinine
116
What are some common drugs for vulvovaginal, oral, and skin candidiasis?
Mycostatin (Nystatin),Clotrimazole, Miconazole, Butoconazole, and Econazole
117
Oral therapy for onychomycosis?
Terbinafine and Griseofulvin that absorb in to Keratin. Only 50% effective.
118
Ciclopirox:
Nail polish for onychomycosis that is only moderately effective.
119
Topical application for onychomycosis caused by dermatophytes:
Efinaconazole, Tavaborole, Tolnaftate, Undecylenic Acid
120
What is Nystatin only effective against?
Candidiasis
121
What medication is used for the Tineases?
Butefanine
122
What is the first choice drug for HSV and VZV?
Acyclovir
123
Resistant HSV and VZV:
Occurs in immunocompromised patients causing severe lesions. Responds to Foscarnet or Cidofovir.
124
When should Acyclovir be started for Chicken Pox?
Within 24 hours
125
Valacyclovir
Prodrug of Acyclovir that is more bioavailable.
Genital Herpes
126
Famicyclovir
Reduces the length of Herpes zoster
127
Penciclovir and Docosanol cream
Apply every 2 hours to slightly decrease the duration of HSV-2
128
Trifluridine and Ganciclovir Topical
Ocular infections caused by HSV
129
Ganciclovir Systemic
CMV
130
Black Box Warning Ganciclovir and Valganciclovir:
Thrombocytopenia and Granulcytopenia
131
Cidofovir
CMV for patients with AIDS
132
Foscarnet Systemic
CMV for patients with AIDS and Acyclovir resistant HSV
133
Foscarnet and Cidofovir Black Box Warning
Renal Impairment
134
Most common types of Hepatitis:
B and C
135
Drugs for Hepatitis C
Daclatasvir, Sofosbusvir, Simeprevir
136
6 Drugs for Hepatitis B
Interferon Alfa 2-B
Peginterferon
Lamivudine
Adefovir
Entecavir
Tenofivir
137
Considerations for Hepatitis B Drugs:
Relapse is likely so long-term use is necessary. This can cause toxicity, so only for patients with highest risk.
138
What is the ending of Sulfonamides?
Most are a combination of sulfamethoxazole and trimethoprim.
139
What is the ending of Tetracyclines?
Cycline
140
What type of drug is Ceftaroline
Cephalosporin
141
What type of ATB is Bactrim?
Sulfa
142
What is the ending of Aminoglycosides?
Mycin
143
What is the more common Influenza strain?
A
144
Who needs repeat of an Influenza strain?
Children 2-8 who have not been vaccinated before.
145
What are the three types of Influenza vaccines?
Inactivated Influenza Vaccine, Recombinant Hemagglutinin Vaccine, and Live, Attenuated Vaccine.
146
Who cannot receive the Flu vaccine?
Febrile persons
147
Who can receive the Flu vaccine?
Pts with a cold without a fever, people with an egg allergy, and pts 6 months or older.
148
When should pts receive Oseltamivir and Zanamivir?
Preferably before 12 hours and ideally before 48 hours
149
Who can receive Oseltamivir?
Patients older than 1 year and pregnant patients
150
Who can receive Zanamivir?
Patients older than 7
151
Who should not receive Zanamivir?
Patients with an underlying airway disease
152
What is Baloxivir Marboxil active against?
Influenza A and B
153
Who can have Baloxivir Marbixil?
Patients 12 and older
154
Palivizumab
Monoclonal antibody for preventing RSV in infants and at-risk patients.
155
What is the definition of AIDS?
A T-cell count less than 200 or and AIDS defining illness.
156
What are AIDS viruses?
Pneumocystis pneumonia, CMV retinitis, disseminated histoplasmosis, TB, and Kaposi sarcoma
157
Retrovirus
Viruses must transcribe from RNA to DNA
158
What do CD4 lymphocytes do?
They help create B lymphocytes antibodies and cytolytic T lymphocytes.
159
Where is the HIV virus stored during a chronic infection?
Macrophages and Microglial cells in the CNS because they are resistant to destruction but still can be attacked.
160
How long do HIV patients remain asymptomatic?
10 years
161
What is the steady state rate of HIV?
1,000-100,000 but their half-life is only 6 hours, so billions are created every day.
162
How do patients become resistant to HIV meds?
The transcription process is prone to errors, so the more virions a person has the more chance for resistance.
163
What is a common complication of HIV?
Peripheral neuropathies early
CNS complications late
Due to actual HIV or opportunistic infections
164
What is the first line antiretroviral treatment for AIDS?
2 NRTIS and another drug
165
NRTI (Nucleotide Reverse Transcriptase Inhibitors)
Abacavir
Emtricitabine
Didanosine
Lamivudine
Stavudine
Tenofovir
Zidovudine
166
What NRTI should be administered without food?
Didanosine bc food decreases serum levels
167
Adverse Effects of ART
Lactic Acidosis
Steatosis
Redistribution of adipose tissue
Peripheral neuropathy
CNS
Hepatomegaly with Steatosis
Teratogenicity
Diabetes
Cardiac Conduction Changes
168
Immune Reconstitution Syndrome
A paradoxical inflammation from existing infections after ART
169
What is the preferred combination therapy for ART?
Abacavir
Lamivudine
Efavirenz
170
HLA-B*5107
Hypersensitivity gene ppl need to be tested for before taking Abacavir
171
What NTRI cannot be taken with food?
Food taken with Didanosine decreases serum levels
172
NNRTI (Nonucleoside Reverse Transcriptase Inhibitors)
Efavirenz
173
What are NNRTIs effective against?
Only HIV-1
174
What food increases serum levels of NNRTIs
Fats
175
What body system does Efavirenz attack HIV in?
CNS because it cross the BBB also causes more adverse effects there.
176
How do ART medications change other meds?
P450 substrates, inhibitors, and inducers
CYP2C9 that metabolizes meds
177
What should patients do toinimize CNS effects of ART therapy?
Take at night.
Symptoms usually reside after 2-4 weeks.
178
PI (Protease Inhibitors that inhibit HIV maturation)
Atazanavir
Darunavir
Foasamprenivir
Indinavir
Lopinavir
Nelfinavir
Ritonavir
Saquinavir
Tipranavir
179
What are the most effective antiretrovirals?
Protease inhibitors but must be taken with something else.
180
INSTIs (Integrase Strand Transferse Inhibitors). Stop integration of HIV DNA.
GAVIR
181
Enfuvirtide T-20
Inhibits the fusion of HIV.
Very effective.
Treatment requires SQ injections.
Expensive.
182
Why is Enfuvirtide effective?
It does not share cross resistance with NRTIs, NNRTIs, INSTIs, or PIs. Therefore, it is reserved for patients who are resistant to those medications.
183
Maraviroc
CCR5 Inhibitors blocks the entry of HIV into cells.
Reserved for resistant HIV.
184
What should patients do if they miss a dose of ART?
Take the missed dose immediately unless the next dose is less than 6 hours away.
185
What lab testing do HIV patients need?
HIV
CD4
AST/ALT
Kidney
Resistance
Hepatitis B and C
Liver
CBC
BMP
Lipid Profile
Glucose
Urinalysis
186
What patients need PrEP?
Do not use condoms.
Have other STIs.
Engage in sex for things.
Use recreational drugs.
Are imprisoned.
187
What are the FDA approved drugs for PrEP and PEP?
Tenofovir 300mg
Emtricitabine 200mg
188
How many days should a prescription for PrEP be?
90 days
189
When should Postexposure Prophylaxis be initiated?
Preferably within 2 hours and no later than 72 hours.
It should last for 28 days.
190
When should patients possibly exposed to HIV be tested?
At the time of exposure
6 weeks
12 weeks
6 months
191
What is the goal of HIV therapy?
HIV viral load to 10% of baseline in 8-10 weeks.
16-20 weeks should be undetectable.
192
What is the treatment for Chlamydia in healthy adolescents and adults?
Azithromycin 1g once
Or
Doxycycline 100mg 7 days
193
What is the treatment for Chlamydia in at-risk patients?
Erythromycin 12.5mg/kg 4x/day for 14 days
194
What is the treatment for Gonorrhea for healthy people >45kg?
Ceftriaxone 250 mg once
And (due to resistance)
Azithromycin 1g once
195
What is the treatment for Gonorrhea for patients <45kg?
Ceftriaxone 25-50mg/kg 1x/day for 7 days
196
What is the treatment for Syphillis in adults and children?
Benzathine Penicillin 2.4 million units once
Benzathine Penicillin 50,000 units/kg once
197
What is the treatment for neurosyphillis or congenital syphillis?
Aqueous crystalline Penicillin G 50,000 units/kg continuous infusion 7-14 days
198
What is the treatment for bacterial vaginosis?
Metronidazole 500 mg PO x 7 days
Metronidazole gel x 5 days
Clindamycin cream x 7 days
199
What is the treatment for Trichomoniasis?
Metronidazole or Tinidazole 1g PO x 7 days
200
What is the treatment for Chancroid?
Azithromycin 1g PO
201
What is the treatment for Genital Herpes?
Acyclovir 200-800mg 2-5x/day for 3-10 days.
202
What is the treatment for a severe infection of Genital Herpes?
Acyclovir 5-10mg/kg IV until clinical improvement and then oral
203
What is the dose for Acyclovir treating Genital Herpes in infants?
20mg/kg for 7-14 days
204
What is the treatment for Nongonococcal Urethritis?
Azithromycin 1g
Doxycycline
Maxifloxacin
Gentamycin
205
What is the treatment for Pelvic Inflammatory Disease?
Doxycycline 100mg plus Cefoxitin or Gentamycin or Clindamycin
206
What is the most common STD?
Chlamydia Trachomatis
207
What can Chlamydia Trachomatis cause?
Sterility, Ectopic Pregnancy, and PID
208
Lymphogranuloma Venerum
Infection from Trichomatis that results in enlarged genitals. Typically found in the tropics.
209
What is the treatment for lymphogranuloma venerum?
Doxycycline
210
Disseminated Gonococcal Infection
Usually skin and muscle problems. Occasionally causes endocarditis or meningitis. Treated with Ceftriaxone IV plus Azithromycin.
211
Why do infants need Erythromycin immediately post-partum?
Gonococcal neonatal opthalmia
212
What is nongonococcal urethritis?
Any infection not caused by N. gonorrhea
213
What is PID?
A syndrome that involves Endometritis, pelvic peritonitis, and tuboovarian abscess.
214
Stages of Syphillis
1. lesion
2. flu
3. 5-40 years when it gets serious
215
Treatment for Syphillis with patients allergic to Penicillins?
Doxycycline unless child or pregnant then do a desensitization schedule.
216
What is Chanchroid?
A painful ulcer on outside genitalia
217
Proctitis
Inflammation of the rectum
218
What is the treatment for Proctitis?
Ceftriaxone plus Doxycycline
219
What are genital warts caused by?
Human papillomaviruses (HPV)
220
What ATB is used for Enterobacter species?
Ceftriaxone and Carbapenems
221
What ATB is used for Pseudomonas aeruginosa?
Carbapenems
222
What are penicillinase resistant ATBs?
Carbapenems, Fluoroquinolones, Linezolid, Vancomycin
223
What is a treatment for Streptococcus infections?
Penicillin G
224
What ATB is used for clostridium tetani?
Metronidazole
225
What is the treatment for Diphtheria?
Erythromycin
226
What is the ATB for Klebsiella pneumoniae?
Cefotaxime
227
What is the treatment for Salmonella?
Cefotaxime
228
What is the treatment for Bordstella pertussis?
Azithromycin
229
What is the treatment for meningitis and epiglottis?
Cefotaxime
230
What can Gentamycin cause if used during pregnancy?
Hearing loss
231
What ATBs are safe for infant?
Penicillins, 3 Cephalosporins
232
What is a preferred ATB for pregnant woman?
Evidence suggests no damage is done in the 2nd and 3rd trimesters from Penicillins, Macrolides, and Cephalosporins.
233
What ATB is safe for use while breastfeeding?
Amoxicillin, Cephalosporins
234
Penicillin Doses
2-12 grams
235
Cephalosporin Doses
30-200 mg/kg
236
Carbapenem Doses
30-120 mg/kg
237
Doxycycline Dose
2.2-4.4 mg/kg q24 hours
238
Mycin Doses
5-50 mg/kg
239
What ATBs inhibit bacterial protein synthesis?
Macrolides
Aminoglycoside
Linezolid
Tetracyclines
240
What medications cause harm to fetuses?
Fluoroquinolones
Aminoglycosides
Ganciclovir
Sulfonamides
241
Aminoglycoside Black Box Warning
Nephrotoxicity
Neuromuscular Blockade —> respiratory depression
242
Aminoglycoside Dose
1-1.7 mg/kg
243
Ciprofloxacin Dose
250mg BID x3 days
244
Nitrofurantoin Dose
50-100 mg QID
245
Metronidazole Black Box Risk
Carcinogenic Risk
246
Antifungal safety
Generally considered safe in low doses for all age groups except for Amphotericin B
247
Caspofungin Dose
50 mg/day
248
What populations is Acyclovir safe for?
Pregnant woman, infants, and the elderly.
249
What can Ganciclovir cause?
Sterility and bone marrow suppression
250
Ganciclovir Dose
5mg/kg IV q12 hours for 14-21 days.
251
Ritonavir (HCV) Black Box Warning
Life-threatening adverse effects when administered with hypnotics
252
Ribaviren (HCV and RSV) Blck Box Warning
Hemolytic Anemia and Cardiac Decompensation
253
What is the approved treatment for children and pregnant women for HBV?
Lamivudine
Entecavir
254
Oseltamivir Dose
75mg BID
255
NRTI Dose
300 mg BID
256
Meds with Dose <100
Mycins
Erythromycin
Nitrofuratoin
Caspofungin
Oseltamivir
Ganciclovir
257
Meds w Dose >100
Metronidazole
Doxycycline
NRI
Ceftriaxone
258
Meds w Dose >1g
Azithromycin
Penicillin
259
Meds w Significant Dose Range
Cephalosporin
Carbapenems
260
What is the treatment for Pneumonia?
Clindycin
Vancomycin
Linezolid
