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74 Cards in this Set

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