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Boards II > Pharm TB, Virus, Fungi, Parasites > Flashcards

Pharm TB, Virus, Fungi, Parasites Flashcards

1
Q

Treatment of active vs latent TB

A

Active: comination (RIPE: rifampin, isoniazid, pyrazinamide, ethambutol)

Latent: isoniazid or rifampin monotherapy

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2
Q

Rifampin

  • brand name & indication
  • MOA
  • adverse effects
A

Rifadin; TB

Prevents mRNA synth (transcription) by binding to beta subunit of DNA-dependent RNA polymerase

Hepatotoxicity = most common, evident as incr AST and ALT
Exudative conjitis (rare)
Orange-pink discoloration of urine and tears
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3
Q

Isoniazid

  • brand name & indication
  • MOA
  • adverse effects
A

Nydrazidl; TB

Prevents cell wall synth by inhibiting mycolic acid synth

Hepatotoxicity
Pyridoxine (vit B6) deficiency that may result in peripheral neuropathy
Rare: optic neuritis & optic atrophy -> loss of vision

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4
Q

Ethambutol

  • brand name & indication
  • MOA
  • adverse effects
A

Myambutol; TB

Inhibits synth of mycobacterial cell wall by inhibiting arabinosyl transferase

Optic neuritis - retrobulbar, bilateral; complaints of reduced VA, possible color blindness; vision loss is usually reversible, but may take months to normalize
Pts should receive baseline and periodic assessments of VA and red-green color discrimination

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5
Q

Oseltamivir

  • brand name & indication
  • MOA
A

Tamiflu; influenza

Inhibits flu A and B viral neuraminidase, prevents spread of virus along mucous lining of respiratory tract
Conjitis due to influenza has been reported in 1% of pts

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6
Q

Zidovudine

  • brand name
  • MOA
  • clinical indication
  • adverse effects
A

Retrovir, AZT

Nucleoside analog of thymidine; acts as potent inhibitor of viral RNA-dependent DNA polymerase (reverse transcriptase)

Component of 3-drug therapy for HIV
AZT is also used during pregnancy to lower risk of transmitting to fetus

Bone marrow suppression (granulocytopenia, anemia, pancytopenia)
Lactic acidosis
Muscle breakdown (myopathy, myositis)
Amblyopia and macular edema have been reported

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7
Q

Ribavirin

  • brand name & indication
  • MOA
  • adverse effects
A

Copegus, Rebetol; Hep C therapy

Inhibits viral RNA polymerase; always used in combo with interferon for tx of hep c

Conjitis = most common ocular SE
Also RIBAViriN: Retinal detachment, Ischemia (cws), retinal Bleeding (hemorrhage), Arterial and Venous occlusion, optic Neuritis
A baseline ocular exam is recommended, as well as periodic dilated exams for pts with dm/htn retinopathy who are also on combo therapy with ribaviron and interferon

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8
Q

Trifluridine

  • brand name
  • MOA
  • clinical indications & dosing
A

Viroptic

Anti-herpetic = inhibition of viral DNA synthesis by selectively inhibiting DNA polymerase

HSV dendritic keratitis: 9 times daily until dendrite heals (5-7 days), then 5 times daily for 5-7 days
-in general, do not use more than 21 days due to potential corneal toxicity

HSV stromal keratitis: rx’d with topical ophthalmic steroids as prophylaxis

  • dosed Q2h with PredForte Q2h until there is no longer improvement in corneal edema; both gtts then slowly tapered with equal frequency over weeks-months
  • Zirgan QID may be used in place of Viroptic
  • some pts may require QD or QOD steroid dosing indefinitely to prevent recurrence
  • HEDS-2 study showed oral acyclovir 400mg BID for 1 year decr risk of recurrence by 12%
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9
Q

Acyclovir, Valacyclovir, Famciclovir

  • brand name
  • MOA
  • clinical indications & dosing
  • adverse effects
A

Acyclovir (Zovirax)
Valacyclovir (Valtrex)
Famciclovir (Famvir)

Anti-herpetic = inhibition of viral DNA synthesis by selectively inhibiting DNA polymerase

Cold sores (HSV1), genital sores (HSV2)
HZO: acyclovir 800mg 5 times day x 7 days; valacyclovir 1000mg TID x 7 days; famciclovir 500mg TID x 7 days
HSV keratitis: acyclovir 400mg 5 times day x 7 days; valacyclovir 500mg TID x 7 days; famciclovir 250mg TID x 7 days
prophylaxis for HSV keratitis: acyclovir 400mg BID; valacyclovir 250mg BID; famciclovir 125mg BID
*orals can be used for HSV epithelial keratitis, but topical ophthalmics are considered standard of care; orals doses should be decr in pts with kidney damage

HA & GI effects are most common, esp in pts with renal dysfunction
Elderly, immunocompromised, and pts with renal/liver dz should be dosed and monitored carefully
High doses of valacyclovir are uncommonly assoc with confusion, hallucinations, and (rarely) severe thrombocytopenia - fam and acyclo are more appropriate in these pts

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10
Q

Ganciclovir

  • brand name
  • MOA
  • clinical indications & dosing
  • adverse effects
A

Zirgan

Anti-herpetic = inhibition of viral DNA synthesis by selectively inhibiting DNA polymerase

Better dosing (5 times daily) and reduced corneal toxicity (BAK vs thimerosal) compared to Viroptic

HSV keratitis: 1 gtt 5 times daily until dendrite heals, then 1gtt TID x 7 days
Also available in intraocular sustained release for CMV retinitis

Blurred vision, ocular irritation
Intravitreal: immediate but temporary decr in VA; RD and vit hemorrhage have been reported

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11
Q

Foscarnet

  • brand name
  • MOA
  • clinical indications & dosing
  • adverse effects
A

Foscavir

Anti-herpetic = inhibition of viral DNA synthesis by selectively inhibiting DNA polymerase

IV solution
CMV retinitis when ganciclovir therapy fails (safety “net”)
Acyclovir-resistant HSV infections in pts with AIDS

Nephrotoxicity, seizures

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12
Q

Natamycin, Amphotericin B, Nystatin

  • brand name
  • MOA
A

Natamycin (Natacyn)
Ampho B (Amphocin)
Nystatin (Mycostatin)

Bind to ergosterol and form pores within fungal cell membrane -> cell death

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13
Q

Antifungals

  • bind to ergosterol and form pores
  • inhibit ergosterol synth
  • inhibits mitosis by interfering with microtubules
A

Natamycin, Ampho B, Nystatin

Ketoconazole, Fluconazole, Miconazole

Griseovulvin

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14
Q

Natamycin, Amphotericin B, Nystatin

-clinical indications & dosing

A

Natamycin: fungal bleph, conjitis, & keratitis from Candida, Aspergillus, and Fusarium

Amphotericin B: broad-spec antifungal; available in topical ophthalmic (ointment or solution) for fungal keratitis; IV form to tx systemic and ocular fungal infections (nephrotoxicity common with intravenous)
-topical ophthalmic not commercially available - can get at compounding pharm

Nystatin: Candida oral (thrush) and vaginal (yeast) infxns; NOT indicated for ophthalmic use

Ophthalmic: natamycin or ampho b every 1-2h while awake
-orals may be added (e.g. ketoconazole) in severe cases or in cases of acanthamoeba

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15
Q

Ketoconazole, Fluconazole, Miconazole

  • brand name
  • MOA
  • clinical indications & dosing
  • adverse effects
A

Ketoconazole (Nizoral)
Fluconazole (Diflucan)
Miconazole (Monostat-Derm)

Inhibit ergosterol synth

Ketoconazole: first oral azole antifungal; indicated for tx of severe fungal corneal ulcers, systemic infxns, and acanthamoeba
-acanthamoeba: ketoconazole 200mg QD x several weeks

Fluconazole: oral, topical, or subconj injection
-increasing resistance and ineffectiveness against agents that cause endophthalmitis are concerning

Hepatotoxicity

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16
Q

Griseofulvin

  • brand name
  • MOA
  • clinical indication
A

Grifulvan

Oral; inhibits fungal mitosis by interfering with microtubule formation during cell wall synth

Scalp and skin infxns, including finger and toenails

17
Q

Chloroquine

  • brand name
  • MOA
  • clinical indications
A

Aralen

1) Build of up heme (breakdown of hemoglobin) within RBCs -> toxic to intra-erythrocytic Plasmodium parasite responsible for malaria
2) Inhibits phospholipase A2 to decr inflammation (though not generally used for this due to SE)

Anti-malarial

18
Q

Chloroquine

-adverse effects, pathophysiology, & risk factors

A

Reversible whorl keratopathy = most common ocular
Bull’s eye maculopathy = greatest threat to vision (“granular hyperpigmentation surrounded by a zone of depigmentation”)
-central and paracentral scotomas are the most common field defects
-color vision is typically normal in early stages

Chloroquine binds to melanin within RPE cells -> localized RPE damage -> migration of RPE cells to the ONL/OPL
Initial sign is RPE mottling

Risk incr with:

  • dosage >3mg/kg of ideal body weight or 2.3mg/kg of real body weight
  • tx duration > 5 years
  • abnormal renal function
  • high body fat percentage
  • Age >60
  • liver dz
  • concomitant renal dz
19
Q

Lindane

  • brand name
  • MOA
  • clinical indications
  • adverse effects
A

Kwell

Lipophilic; absorbed through the exoskeleton of insects -> seizures, death

Lice, scabies

Conjitis when shampoo is applied to eyelashes

Boards II (5 decks)

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