Pharmacotherapeutics Exam 2 Flashcards
Carbapenem MOA
Ertapenem, imipenem, meropenem, doripenem
Inhibits bacterial trans-peptidases
B-lactamase resistant
Botulism Antitoxins
Equine serum heptavalent botulism antitoxin
Over 1 year old
Human derived botulism immune globulin
under 1 year old
Inhibitors of viral penetration:
Amantadine
Rimantadine.
Mechanism of action Antibiotics
Nucleic acid synthesis (DNA Gyrase)
Quinolones
Mechanism of action Antibiotics
Cell Wall
Other (2)
Vancomycin
Bacitracin
General Info about Streptococcus pyrogenes
Spherical
Gram Positive
Chlamydia trachomatis
highly susceptible to tetracyclines and macrolides.
Within these two classes, first-line agents includedoxycyclineandazithromycin, respectively.
CDC recommend either as first line.
Azithromycin 1 gram single dose
Doxy 100mg twice daily for 7 days
Disease For Enterococcus faecium
bacteremia, endocarditis, peritonitis
Gram positive bacteria types to know
Rods
Bacillus
Clostridium
Listeria
What happens when gram negative bateria repilate or are killed off
They release Lipid A of the LPS which is an endotoxin
Antiretroviral drugs
Used to treat infections caused by HIV, the virus that causes AIDS
The four major goals of treatment of Rheumatic fever are:
Symptomatic relief of acute disease manifestations (eg, arthritis)
Eradication of group A beta-hemolyticStreptococcus(GAS)
Prophylaxis against future GAS infection to prevent progression of cardiac disease.
Provision of education for the patient and patient’s caregivers
Disease For Moraxella catarrhalis
respiratory infection
Botulism
A rare but potentially life-threatening neuroparalytic syndrome caused by a neurotoxin produced byClostridium botulinum,
a heterogeneous group of gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria.
Disease For Pseudomonas aeruginosa
nosocomial pneumonia, burn infection, bacteremia
Campylobacter jejuni drug of choice
Macrolides
Azithromycin
Erythromycin
Tetanus Treatment
Wound management & Airway Mgmt is key
Metronidazole(500 mg [IV] Q6-8 hours)
is the preferred treatment for tetanus,
butpenicillin G(2 to 4 million units IV Q4-6 hours) is a safe and effective alternative.
We suggest a treatment duration of 7 to 10 days.
Bacterialcidal Classes
B-Lactams Aminoglycosides Glycopeptides Quinolones Ansamycins Stretptogramins Lipopeptides
(Causes bacterial cell death)
Botulism causes
Infants - most common (honey) (floppy baby)
Food borne
Wound
Most potent biologic toxin in the world
Botulism inhibits ACH release at presynaptic receptors
Which of the following is not considered a beta-lactam antibiotic?
Marcolides
Monobactams
Penicillins
Carbapenems
Marcolides
CCR5 receptor inhibitor
Selzentry – maraviroc
Which of the following antibiotics treats Group-A streptococcal pharyngitis?
Amoxicillin
Metronidazole
Doxycycline
Ciprofloxacin
Amoxicillin
Influenza treatment
neuraminidase inhibitors = oseltamivir
The adamantanes,amantadineandrimantadine, which are only active against influenza A.
Due to a marked increase in resistant isolates, the United States Centers for Disease Control and Prevention (CDC) recommends that adamantanesnotbe used in the United States for the treatment of influenza, except in selected circumstances
Pseudomembranous colitis
Swelling or inflammation of the large intestine (colon) due to an overgrowth of (C difficile) bacteria.
Most common antibiotics that cause this are: Clindamycin, fluoroquinolones, and CMCs (cephalosporins, monobactams, and carbapenems)
DNA polymerase inhibitors
Purine Nucleoside Analogues:
Acyclovir, Ganciclovir, Famiciclovir, Valacyclovir
General Info about Pseudomonas Aeruginosa
Gram Negative
Aerobic
rod shaped
Disease For Escherichia coli
bacteremia, urinary-tract and gastrointestinal infection
Gram Positive Bacteria
Has thick cell wall
Has glycans in cell wall. the lysosymes we produce help break apart glycans (natrual defense for Gram (+))
has one phospholipid bilayer
Much easier to penetrate that gram negative due to only one phospholipid bilayer
Viral
Chronic infections
Hepatitis B
Bacteriostatic Classes
Chloramphenicol Oxazolidinones Sulfonamides Tetracyclines Macrolides
(Restricts growth and reproduction)
General Info about Enterococcus
Gram positive
Cocci
The treatment of respiratory diphtheria consists of what antibiotic therapy
(Erythromycin 500 mg four times a day)
anddiphtheria antitoxinfor severe cases
Duration of prophylactic therapy for rheumatic fever
RF with Carditis and heart disease
10 years or until 40 (whichever is longer)
RF with carditis no heart disease
10 years or until 21 (whichever is longer)
RF no carditis
5 years or until 21 (whichever is longer)
General Info about Clostridium Difficile
Anaerobic
spore forming rod (bacilus)
Tdap (Adults)
Years
Every 10 years
Disease For Mycobacterium tuberculosis
Tuberculosis
Mechanism of action Antibiotics
Cell Wall
Beta Lactam
Penicillins
Cephalosporins
Carbapenems
Monobactams
Which of the following antibiotics has a mechanism of action of folate synthesis?
Penicillins
Sulfonamides
Macrolides
Tetracyclines
Sulfonamides
Varicella-zoster virus infections
Primary infection with VZV results in varicella, also known as chickenpox, characterized by vesicular lesions in different stages of development on the face, trunk, and extremities.
Herpes zoster, also known as shingles, results from reactivation of endogenous latent VZV infection within the sensory ganglia.
When carbapenems are used as a single agent against initially susceptible isolates ofPseudomonas aeruginosa, what may occur?
Resistance may emerge during therapy.
Anti-retrovirals
Nucleoside reverse transcriptase inhibitors
Zidovudine (Retrovir)
Protease inhibitors:
Lopinavir/Ritonavir (Kaletra)
CCR5 receptor inhibitor:
Maraviroc (Selzentry)
Integrase inhibitor:
Raltegravir (Isentress)
Disease For Enterococcus faecalis
bacteremia, endocarditis, urinary-tract infection, peritonitis
Disease For Acinetobacter spp.
pneumonia in immuno-compromised patients
Gonococcal infections
treatment
Ceftriaxoneis treatment for gonorrhea
Single IM dose
For most patients, 500 mg
individuals who weigh ≥150 kg we give a 1 g dose
The mainstay of treatment for individuals with infectious mononucleosis (IM) and other manifestations of primary EBV disease is
Supportive care
Acetaminophenor nonsteroidal antiinflammatory drugs are recommended for the treatment of fever, throat discomfort, and malaise.
Provision of adequate fluids and nutrition is also appropriate.
Although getting adequate rest is prudent, bed rest is unnecessary.
However, strenuous activity should be avoided for at least three weeks after onset of IM.
Viruses are classified on the basis of
morphology,
chemical composition,
and mode of replication.
General Info about Salmonella
Gram negative
rod shaped
Gram Negative bacteria types to know
Rods (non-enteric)
Bordella Hemophilus Legionella Pasteurella Pseudomonas (both)
3rd Generation Cephalosporin
Ceftriaxone,
Gonorrhea
Ceftazidime
Pseudomonas,
Bacteriostatic
Restricts growth and reproduction
MRSA Meds
Bactrim Clindamycin doxycycline Vancomycin Linezolid
Monobactam MOA
Aztreonam
Bind to PBP - Inhibit cell wall synthesis
Influenza Treatments
Neuraminidase inhibitors
oseltamivir, zanamivir, peramivir
M2 channel Blockers (only flu A)
amantadine, rimantadine
HIV drugs
Maraviroc
Zidovudine (AZT)
Raltegravir
Lopeinavir
Which of the following antibiotic is considered a third-generation cephalosporin?
Cefazolin
Ceftazidime
Ceftriaxone
cefepime
Ceftriaxone
Rubella (German Measles)
Treatment consists of supportive care. No specific therapy for rubella infection is available.
Neuraminidase Inhibitors:
Zanamivir,
Oseltamivir.
1st Generation Cephalosporin
Cefazolin
most gram posititve cocci
E.coli, Proteus, Klebsiella
Bacteriocidal
Causes bacterial cell death
Which of the following types of HPV does not cause the most cases of genital warts including cancer?
5
11
16
18
5
Tdap (preteens)
Years
11 through 12 years
Shapes
Bacilli
Rod
Which of the following antibiotics does not treat cholera?
Doxycycline
Azithromycin
Ciprofloxacin
Amoxicillin
Amoxicillin
Gram Negative bacteria types to know
Cocci
Acinetobacter
Moraxella
Neisseria
Jones Criteria For Strep
Joints (polyarthritis) Carditis Nodules Erythema marginatum Syndenhams chorea
Disease For Proteus spp.
urinary-tract infection
Acyclovir MOA
Guanosine analogs requiring phosphorylation
by infected cells thymidine kinase
(Translation) = inhibits viral DNA polymerase
HSV, VZV and EBV (high dose)
Renal damage (IV dose) (hydration can minimize)
Carbapenems have a broad spectrum of activity against
gram-negative organisms (including those that produce extended spectrum beta-lactamases),
anaerobes (includingBacteroides fragilis),
gram-positive organisms (includingEnterococcus faecalisandListeria).
4 classes of meds that fight Group-A Strep
Penicillins
Cephalosporins
Macrolides
Lincosamides
Rheumatic fever
Mitral valve stenosis, regurge, heart damage
Fever, Joint pain, red hot swollen joints,
Chest pain, murmur, fatigue,
unusual outbursts
painless bumps beneath skin
Risk factors= Family history, strains of strep, Envirnomental factors
Gram positive bacteria types to know
Cocci
Enterococcus
Staphylococcus
Streptococcus
Peptostreptococcus
Mechanism of action Antibiotics
Protein synthesis 30 s
Tetracyclines
Aminoglycosides
Nucleoside reverse transcriptase inhibitors (NRTI)
thymidine analogue (azidothymidine, AZT)
MOA: inhibits viral reverse transcriptase in preference to cellular DNA polymerase
Anemia and neutropenia are the most important and dose-related adverse effects.
Protease Inhibitors (PI)
atazanavir(Reyataz)
Mechanism: Protease inhibitors (PIs) block protease (an HIV enzyme).
By blocking protease, PIs prevent new (immature) HIV from becoming a mature virus that can infect other CD4 cells
Mechanism of action Antibiotics
Nucleic acid synthesis (RNA Polymerase)
Rifampin
4 groups of Beta Lactams
Penicillins
Cephalosporins
Monobactams
Carbapenems
Advanced Generation Cephalosporin
Ceftaroline
MRSA
Cytomegalovirus infections (CMV) treatments
ganciclovir
valganciclovir
foscarnet
Inhibitors of viral penetration
amantadine (Symmetrel)
Narrow antiviral spectrum active only against influenza A
Varicella-zoster Treatment
The goals of antiviral therapy are to promote more rapid healing of skin lesions, lessen the severity and duration of pain associated with acute neuritis, and potentially reduce the incidence or severity of chronic pain, referred to as postherpetic neuralgia.
We recommend antiviral therapy for patients with uncomplicated herpes zoster who present within 72 hours of clinical symptoms.
The nucleoside analoguesacyclovir,valacyclovir, orfamciclovircan be used for treatment of acute herpes zoster infection.
We prefer valacyclovir (1000 mg three times daily) or famciclovir (500 mg three times daily) because of their lower dosing frequency compared with acyclovir (800 mg five times daily).
All regimens should be given for seven days. Analgesic drugs (acetaminophen vs. gabapentin)
Mechanism of action Antibiotics
Protein synthesis 50 s
Macrolides Clindamycin Linezoid Chloramphenicol Streptogramins
Viral
Latent infections
Herpes simplex
Varicella simplex
Why Fluoroquinolones for salmonella treatment
Antibiotics are not always needed
When antibiotics are needed
Fluoroquinolones (eg,ciprofloxacin500 mg orally twice daily orlevofloxacin500 mg orally once daily)
are generally the most appropriate agents for adults because of their activity against most common gram-negative enteric pathogens, their high tissue and intracellular concentrations, and their favorable side effect profile.
Roseola
In most cases, roseola is a benign and self-limited disease. Treatment is supportive.
Mechanism of action Antibiotics
Folate synthesis
Sulfonamides
Trimethoprim
Which of the following antibiotics has a mechanism of action of protein synthesis via 50s subunit?
Penicillins
Sulfonamides
Macrolides
Tetracyclines
Macrolides
Disease For Staphylococcus Aureus
skin and wound infection, abscess, bacteremia, nosocomial pneumonia, endocarditis, toxic shock syndrome
Shapes
cocci
Round
Ways to treat HPV
Don’t treat / observation, meds, surgical removal
Aldara - cream (stimulates immune system)
Podofilux - gel (destroys skin of wart)
Veregen - ointment (immunocompromised patients
Tricholoroacetic acid - destorys virus proteins (
(applied by Dr)
2nd Generation Cephalosporin
Haemophilus influenza
Moraxella catarrhalis
Gram Negative bacteria types to know
Rods (enteric)
Bacterioides Campylobacter Enterobacter Escherichia Klebsiella Proteus Pseudomonas (both) Salmonella Shigella Vibrio
Antibiotics Can Protect The Queens Men Servants Guards
Aminoglycosides Cephalosporins Penicillins Tetracyclines Quinolones (flouroquinolones) Macrolides Sulfonamides Glycopeptides
Campylobacter
Campylobacterenteritis cause of acute diarrhea worldwide.
It is typically caused byCampylobacter jejuniorCampylobacter coli,
and is largely a foodborne disease.
Poultry, Waterborne outbreaks
Can lead to Guillen-barre
Disease For Streptococcus pneumoniae
upper respiratory infection, pneumonia, otitis, sinusitis, meningitis
Which of the following antivirals treat cytomegalovirus (CMV)?
Acyclovir
Ganciclovir
Raltegravir
Atazanavir
Ganciclovir
Rabies
There is no known effective treatment for rabies,
although the disease can be very effectively prevented after recognized exposures using post-exposure rabies prophylaxis
The most critical therapy in diarrheal illness is
hydration,
preferably by the oral route with solutions that contain water, salt, and sugar
Salmonella antibiotic
We generally do not recommend antibiotic treatment for immunocompetent individuals between 12 months and 50 years of age who have documentedSalmonellagastroenteritis with mild to moderate symptoms, as the illness is typically self-limited
Viral
Acute infections
Influenza
Hepatitis A
Disease For Haemophilus influenzae
respiratory infection, otitis, sinusitis, meningitis
HPV Vaccine
Gardasil (merck)
Types 6, 11, 16, 18
Anal, cervical, vaginal and vulvar precancer, cancer. Genital warts
Contra: Hypersensitivity to yeast
3 dose series: 0, 2, 6 Months
General Info about Escheria Coli
Gram negative
rod shaped
Dtap (children)
years
2,4, and 6 months
15 through 18 months
4 through 6 years
Antibiotic regimens for prevention of endocarditis prior to dental and respiratory procedures
Amoxicillin 2 grams
If allergic to penicllins
Clindamycin 600mg
Both single dose, both oral
Integrase Inhibitor
Isentress (raltegravir)
HSV-1 Oral Disease treatment
Herpes Simplex 1
Acyclovir: 200 mg five times daily
Famciclovir: 250 mg three times daily or 500 mg twice daily
Valacyclovir: 1 g twice daily
PrEP - Pre Exposure Prophylaxis
Descovy 1 tablet by mouth every day
Truvada 1 tablet by mouth every day
Only two medications FDA Approved for PrEP
Cholera antibiotics
Tetracyclines
Macrolides
Fluoroquinolones
Rocky mountatin spotted fever
Doxy 100mg BID 5-7 days
Rickettsia rickettsii
Gram negative
obligate intracellular coccobacillus
We prefer doxycycline even for pregnant women, since there is increasing evidence of the relative safety of doxycycline in pregnancy compared with older tetracyclines.
Tetanus Vaccines
Dtap (children)
Tdap (preteen)
Tdap (Adults)
Measles
MMR vaccine is a MUST!!
Mechanism of action Antibiotics
Cell Wall
Cell Membrane
Polymixins
MMR Dose schedule
1st dose 12-18 months
2nd dose 4-6 years
4th Generation Cephalosporin
Cefepime
Pseudomonas
General Info about Staphylococcus Aureus
Facultative anaerobe
Gram Posisitve
Cocci
Which of the following antibiotics is considered the standard therapy to treat Campylobacter jejuni?
Doxycycline
Azithromycin
Amoxicillin
Ciprofloxacin
Azithromycin
Erythema infectiosum (5th disease)
No treatment as far as antiviral
Parvovirus
Slapped cheek
Disease For Klebsiella pneumoniae
hospital-acquired pneumonia, bacteremia
Shigellosis
Bloody diarrhea
fever
stomach cramps
5-7 days
Fluoroquinolones are often used first for Shigella
Levo, Cipro
What is the standard dosage of oseltamivir (Tamiflu)?
25 mg twice a day by mouth
50 mg twice a day by mouth
75 mg twice a day by mouth
100 mg twice a day by mouth
75 mg twice a day by mouth
Disease For Streptococcus pyrogenes
pharyngitis, tonsillitis, skin and soft-tissue infection, scarlet fever
Gram Negative Bacteria
Has thin cell wall
has two phospholipid bilayers
Has a lipoprotein layer between the cell wall and the inner phospholipid bilayer
Outer phospholipid bilayer has lipopolysaccharides (LPS) inbedded in it
Much harder to penetrate that gram positive due to 2 phospholipid bilayers
Has pores that allow small things in.
