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74 Cards in this Set
- Front
- Back
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Fungal infections are most common in what type of patients
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Immunocompromised patients
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Two common groups of fungi are ________ & ___________
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Candida-like and tinea
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Mucocutaneous candidal infections (usually due to C. albicans) are treated with what 4 medications
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Nystatin, clotimazole, ketoconazole, or fluconazole
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Tinea infections affect the _________.
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Skin
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Nystatin is a prescription antifungal agent that is produced by the bacteria ______ _______
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Streptomyces noursei
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Nystatins mechanism of action involves:
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Binding to sterols in the fungal membrane allowing leakage of cell constituents
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How does one treat oral candidiasis with Nystatin?
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Nystatin aqueous suspension. Swish and spit or swallow. Best to leave in mouth 2 minutes. Do this qid
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Besides a liquid, what are other forms of Nystatin?
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Vaginal tablets, cream, ointment and pastilles
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How long does one typically treat candidiasis with nystatin
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10-14 days or two days after last symptoms
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What are the three imidazole antifungal agents
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Clotrimazole, miconazole, and ketoconazole
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Clotrimazole acts by binding with the _______ in the cell membrane of the fungus altering permeability
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Phospholipids
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Clotrimazole primarily works against this fungal species
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Candida
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Besides abdominal pain, diarrhea, and nausea, Clotrimazole has been reported to produce elevations in __________ enzymes in 15% of patients
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Liver
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Can vaginal clotrimazole tablets be used to treat oral candidiasis and if so, what would be the advantages or disadvantages of doing so?
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Yes. Advantage is no sugar (diabetics) and last longer in mouth than a suspension. Disadvantage is they are not flavored.
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How does ketoconazole work?
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Alters cellular membranes and interferes with intracellular enzymes
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In addition to inhibiting funal cell membrane synthesis, ketoconazole has what affect on human hormones
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Inhibits sex steroid biosynthesis (testosterone), and corticosteroid secretion
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Ketoconazol absorption depends on it being in a/an _________ environment
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Acidic
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What other medicines should not be taken with ketoconazole
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Antacids or H2 blockers or proton pump inhibitors
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All imidazole antifungal agents require a/an ________environment for best absorption
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Acidic
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Ketoconazoles primary route of excretion is the __________
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Liver
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What fungal infections are treated with ketoconazole?
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Blastomycosis, candidiasis, coccidiodomycosins, and histoplasmosis
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Most frequent adverse reaction to ketoconazole (3-10%)
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Nausea and vomiting so take with food
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Most serious adverse reaction to ketoconazole with incidence of 1:10,000
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Hepatotoxicity
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Is ketoconazole teratogenic?
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Yes, FDA pregnancy category C. Also present in breast milk
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What kind of drug interactions occur with ketoconazole?
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Acid reducing medicines reduce absorption, Inhibits cytochrome P-450 enzyme in liver, levels of ketoconazole decreased by isoniazid, phenytoin, theophylline and rifampin. Oral contraceptives less effective
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Uses of ketoconazole
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mucocutaneous and oropharyngeal candidiasis after topical antifungals have failer
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Dose of ketoconazole for candidiasis
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200-400mg po qday for at least two weeks
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fluconazole is indicated for treatment of ____________
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oropharyngeal/esophageal candidiasis and serious systemic candidal infection. One tablet for vaginal candidiasis
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Itraconazole is used for __________ and is the first antifungal agent effective for fungal infections of the _____ or ___________
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Blastomycosis, histoplasmosis, aspergillosis. First to be used for toenail and fingernail fungus
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This antifungal is used for systemic fungal infections, goes by the nickname "amphoterrible" and is only given parenterally
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Amphotericin
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Spectrum of amphotericin
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Many fungi like Paracoccidioides, aspergillus, coccidioides, cryptococcus, histoplasma, mucor, and candida as well as protozoan Leishmania
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Amphotericin adverse reactions are many but include:
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hypokalemia, HA, chills, fever, malaise, muscle and joint pain, GI complaints and 80% have nephrotoxicity
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Griseofulvin is an ___________ produced by _________ ___________
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Antibiotic, Penicillium griseofunvum
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Griseofulvin works by:
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Arresting cell division in metaphase
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Griseofulvin is preferentially deposited in these structures
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Hair, nails, and skin
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Griseofulvin spectrum includes:
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Tinea (ringworm), Trichophyon, microsporum and epidermophyton species by NOT CANDIDA
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One adverse effect of griseofulvin is the overgrowth of what organisms in the oral cavity
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Candida organisms causing thrush
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A cross-sensitivity with ____________ may occur with griseofulvin
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Penicillins
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Griseofulvin is used to treat fungal infections of these structures
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Hair, skin, and nails
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How long is griseofulvin used for to treat fungal infection
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Deposited in growing tissue so treat until affected area completely grown out (2 weeks to 8 months)
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Why has it been difficult to develop antiviral drugs?
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Because viruses are intracellular parasites and to kill them the host cell is often damaged or killed
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Herpes virus infection of the finger is called this:
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Herpetic whitlow
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Most antiviral agents are either _____ or _____ analogs that inhibit DNA synthesis
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Purine, pyrimidine
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Acyclovir is a _________ _______ nucleoside that works by inhibiting DNA replication
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Purine
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What cells are most likely to take up acyclovir
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Infected host cells
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What viruses may be treated with acyclovir?
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HSV-1 and HSV-2, varicella-zoster, Epstein-Barr, Herpesvirus simiae, and CMV virus
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Can viruses be resistant to acyclovir
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Yes
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What are two common adverse effects associated with oral acyclovir?
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Headache (13%) and GI reactions
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Parenteral use of acyclovir may cause these adverse effects
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pain at injection site, elevated BUN or Creatinine levels, encephalopathy
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Indications for topical acyclovir
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Herpes genitalis, HSV-1 and HSV-2. Not good for recurrent herpes genitalis
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Oral form of acyclovir used for _____________
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Initial herpes genitalis, recurrent herpes in immunocompromised and nonimmunocompromised patients. Also used for prophylaxis of recurrent herpes infections
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Severe herpes genital infections in nonimmunocompromised and intitial/recurrent HSV infections in immunocompromised patients may be treated by parenteral __________
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Acyclovir
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This nonprescription drug is used topically and decreases healing time for recurrent orolabial herpes by a half day when started within 12 hours of prodromal symptoms
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10% Docosanol
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This topical drug is used for primary and recurrent herpes simplex and achieves higher concentrations in the cells
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Penciclovir
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These two drugs are prodrugs converted to penciclovir and acyclovir
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Famciclovir and valacyclovir
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Famciclovir and valacyclovir is used to treat:
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Recurrent genital herpes, varicella-zoster infections
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AIDS is produced by what virus
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Retrovirus humann immunodeficiency virus (HIV)
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What types of drugs are used to treat AIDS
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nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors
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Names of nucleoside analogs used for HIV
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Didanosine, lamivudine, stavudine, zalcitabine, zidovudine
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Names of nonnucleoside analogs
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Delavirdine and nevirapine
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Names of protease inhibitors
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Indinavir, nelfinavir, ritonavir, saquinavir
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What are some common opportunistic infections that occur in AIDS patients
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Cryptococcus neoformans, Candida, Pneumocystis carinii, CMV, Mycobacterium tuberculosis, and Toxoplasma gondii
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Zidovudine integrates into DNA polymerase (reverse transcriptase) preventing viral DNA synthesis. The reverse transcriptase of HIV is ______ times more susceptible to inhibition than are normal human cells
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100
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Do zidovudine and other nucleoside antiretroviral agents have any effect on HIV containing host cells
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No, they only prevent viral replication and conversion into a form that can get into an uninfected host cell
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Zidovudine toxicity causes:
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Bone marrow depression, HA, nausea (50%), altered sense of taste, edema of tongue, bleeding gums, and mouth ulcers
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Zidovudine (AZT) metabolism is inhibited by also taking these common medications
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Acetaminophen, indomethacin, and aspirin
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The nonnucleoside reverse transcriptase inhibitor Nevirapine is specific for _________
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HSV-1 and resistance develops quickly when used alone
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Saquinaqvir, a protease inhibitor prevents the generation of viral protein precursors. One main difference between this and the other two groups is _____________
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It also can interfere with the action of HIV-infected cells
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Oral adverse reactions to protease inhibitors include ______________
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Buccal mucosal ulceration
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The combination of antiviral drugs used to treat AIDS is called a ____________
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Cocktail
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Normally HIV patients will be taking a drug from each of these three classes
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A nucleoside, a nonnucleoside reverse transcriptase inhibitor, and a protease inhibitor like lamidudine, nevirapine and saquinavir
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Amantadine is used to shorten the symptoms of this virus and also is used to prevent infection with this virus
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Influenza A virus
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The most common use of interferons is in the treatment of these two diseases
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Hepatitis C and multiple sclerosis
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This syndrome may occur when taking interferons
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A flulike syndrome
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