Week 3- Other antimicrobials/ TB Treatment Goals Flashcards
what drug class is acyclovir, famciclovir and valacyclovir
Nucleoside Analogue
How does acyclovir, famciclovir and valacyclovir work?
interferes with DNA synthesis and inhibiting viral replication
what are acyclovir, famciclovir and valacyclovir commonly used for
HSV 1 & 2, Varicella- Zoster, EBV
what does acyclovir, famciclovir and valacyclovir target to do
Increases rate of healing, not prevent recurrences
common side effects of acyclovir and valacyclovir
Headache, skin rash, nausea, vomiting, diarrhea
common side effects of famiciclovir?
Headache, dizziness, somnolence, paresthesias
adverse reaction of acyclovir
Renal failure, acute tubular necrosis, neurologic effects
adverse effects of all herpes meds
renal failure
adverse effects of valacyclovir
Renal failure, TTP/HUS in immunocompromised patients
what drug class is Nirmatrelvir / Ritonavir (Paxlovid)
Antiviral- for mild/mod COVID
how does Nirmatrelvir / Ritonavir (Paxlovid) work
Nirm: viral protease inhibitor that halts viral replication
Riton: hibits CYP3A-mediated metabolism to increase Nirm
is Paxlovid or Remdesivir 1st line
Paxlovid- PO, easier for outpatient use
common side effects of Paxlovid
Decrease sense of taste/smell, diarrhea, myalgia
adverse reactions of Paxlovid
Strong CYP3A inhibitor- many drug inx, ^ effect of opioid, v effect of oral BC, hold statins
adverse reaction of remdesivir
Interacts w/ chloroquine, warfarin, watch for kidney/liver injury
what drug class is oseltamivir and zanamivir
antiviral- prophylaxis and treatment of flu a and b
how do oseltamivir and zanamivir work?
Neuraminidase inhibitor- prevents release of virus
what is zanamivir’s route?
inhaled treatment
side effects of oseltamivir
nausea/vomitting
side effects of zanamivir
bronchitis, cough, shortness of breath
adverse reaction of zanamivir
r/o severe bronchospasm for asthmatics
what drug class is itraconazole, fluconazole, ketaconazole and voriconazole
Antifungal- triazole
are itraconazole, fluconazole, ketaconazole and voriconazole fungistatic or cidal?
static at low concentrations, cidal at high concentrations
how do itraconazole, fluconazole, ketaconazole and voriconazole work?
Reduce ergosterol production by enzyme inhibition (CYP 450)
what is fluconazole used for?
Vaginal candidiasis oral candidiasis
what are side effects of fluconazole?
GI s/s, exfoliative skin disorder, QT prolongation
adverse effects of fluconazole
Hepatotoxicity, interactions w/ warfarin & rifampin
what is itraconazole used for?
Onychomycosis, histoplasmosis, blasto
side effects of itraconazole
HEART FAILURE, GI s/s, exfoliative skin disorder, QT prolongation
adverse effects of itraconazole
Hepatotoxicity, teratogenic, many drug interactions
what is ketoconazole used for
also topical agent, but used for Vulvovag candidiasis, fungal PNA,
side effects of ketoconazole
GI s/s, exfoliative skin disorder, QT prolongation
adverse effect of ketoconazole
hepatoxicity
what is voriconazole used for?
Invasive aspergillosis, deep candida infection
side effects of voriconazole
Visual disturbance, GI s/s, exfoliative skin disorder, QT prolongation
adverse effects of voriconizole
Hepatotoxicity, teratogenic
what class is terbinafine
Antifungal- Allylamines
how does terbinafine work?
Reduces ergosterol production by inhibition of squalene epoxide
what is terbinafine used for
Onychomycosis, fungal infection of scalp, body, feet, groin
side effects of terbinafine
GI, loss/change of taste
adverse effects of terbinafine
Hepatotoxicity, no drinking alc, caffeine
what drug class is albendazole and mebendazole
Anthelmintic- benzimidazole
how do mebendazole and albendazole work?
Bind to beta tubulin causing inhibition of polymerization
what does albendazole clinically treat
Whipworm, roundworm, hookworm, giardiasis,
what are some side effects and considerations with albendazole?
negative pregnancy test, W/ high fat meal, neutropenia,
adverse effects of albendazole
Teratogenic, bone marrow suppression, hepatitis
what does mebendazole treat
Whipworm, roundworm, hookworm
what are side effects/adverse effects of mebendazole
Bone marrow suppression, hepatitis, teratogenic, take with high fat meals
what class is ivermectin
Anthelmintic, semisynthetic
how does ivermectin work?
Binds selectively to glutamate-gated chloride ions, paralysis & death
what does ivermectin treat?
Roundworm,scabies, threadworm
side effects of ivermectin
Lightheaded, skin rash
adverse reaction to ivermectin
Teratogenic, Mazzotti reaction
what is pyrantel pamoate
Anthelmintic- Depolarizing NM blocking agent
how does pyrantel work?
Spastic paralysis of worm, inhibits cholinesterase
what does pyrantel treat?
OTC, Pinworm, whipworm, hookworm
What drug class is metronidazole?
Nitroimidazole
how does metronidazole work?
Disrupts DNA and protein synthesis
what does metronidazole treat?
BV, C. Diff, Giardia, Trichomoniasis (bacterial and parasitic ifxns)
side effects of metronidazole
Seizures, r/o hepatic dysfunction, anorexia, nausea, abd pain, dry mouth, metallic taste
adverse reactions of metronidazole
Severe N/V if alcohol consumed while on medication , blood dyscrasias, dont take with disulfiram or you’ll go insane
Class of tindazole
antiprotozoal (also antibacterial properties
how does tinidazole work?
Disrupts DNA and protein synthesis
what does tinidazole treat?
Intestinal amebiasis, giardia, trichomoniasis
side effects of tinidazole
anorexia, nausea, abd pain, dry mouth, metallic taste
considerations with tinidazole
Monitor INR, no drinking
goals of TB treatment
- To reduce the bacillary population rapidly, decrease severity of the disease, prevent death, and halting transmission of M. tuberculosis
- Prevent relapse after therapy
- Prevent drug resistance
INH:
isoniazid
RIF:
rifampin
PZA:
pyrazinamide (vitamin B6)
EMB
ethambutol
preferred drug combination for treatment of TB
INH, RIF, PZA, EMB for 2 months
INH & RIF for 4 months (7 d/wk doses)
alternate drug combo for TB
INH, RIF, PZA, EMB for two months (5 d/wk) for 8 weeks
INH & RIF 5 d/wk for 18 weeks
