Dynamics Iv Final

Front 1

Ampho B MOA

Back 1

binds to ergosterol and creates pores

relative selectivity ergosterol> our cholesterol

Front 2

DOC for life-threatening systemic fungal infections

Back 2

Ampho B

Front 3

whats first line for invasive Aspergillis

Back 3

Ampho B

but Voriconazole used more

Front 4

what is Ampho B used for?

Back 4

acute cryptococcus neoformins meningitis

Front 5

Ampho ADRs

Back 5

rev Nephrotoxic
no more than 4g/tx episode

causes hypoK
anemia

Front 6

how to Tx infusion related ADR's of Ampho?
tx thrombophlebitis

Back 6

meperidine, cortisol, Ibuprofen

-inject heparin along with ampho

Front 7

is Ampho cidial or static?

Back 7

cidal in vitro

Front 8

how is Ampho eliminated/metab

Back 8

Unkown
t1/2=15 days

Front 9

Nystatin MOA

Back 9

like Ampho-pokes holes
fungicial

Front 10

uses of nystatin

Back 10

candidiasis(thrush)
fungal diarrhea

Front 11

nystatin toxic when given...?

Back 11

systemically
oral is ok

Front 12

which drugs are polyene antifungals?

Back 12

ampho B
nystatin

Front 13

Anti-metab antifungal drug?

Back 13

flucytosine

Front 14

Flucytosine MOA

static or cidal?

Back 14

converted to 5-FU only in fungal cells-inhibits thymidylate synthetase

static

Front 15

Flucocytosine slectivity, how?

Back 15

only fungal cells have a cytosine permease-brings drug into cell
-cytosine deaminase converts drug to 5-FU(only in fungus)

Front 16

Flucytosine suse?

Back 16

tx's cryptococcal meningitis
used with amphoB

Front 17

flucytosine resistance

Back 17

develops rapidly-never use as the singular agent

Front 18

Flucytosine ADR's

Back 18

bacteria convert it to 5-FU in the intestine-abs in body and inhibits OUR thymidylate synthetase

Front 19

Flucytosine result of ADR's

Back 19

teratogenic
bone marrow depression
hair loss

Front 20

azole has most CYP inhib
least?

Back 20

most-ketoconazole
least-fluconazole

Front 21

azole MOA

Back 21

blocks the synthesis of ergosterol-inhibits enzyme sterol 14-alpha-demethylase

Front 22

what should not be used with azole?

Back 22

ampho B NOT to be used concomitantly

Front 23

azole cidal or static?

Back 23

static, but at hight dosescan be cidal

Front 24

fluconazole DOC for?

Back 24

oropharynheal/systemic candida

Front 25

which azoles have broadest antifungal spectrums

Back 25

voriconazole
posaconazole

Front 26

which drugs is 2nd line for aspergillus

Back 26

itraconazole

Front 27

what is DOC for invasive aspergillus

Back 27

voriconazole

Front 28

posaconazole covers?

Back 28

good-candida + aspergillus

only agent for-zygomycetes

Front 29

DOC for treating cushings disease?

Back 29

ketoconazole

Front 30

posaconazole should be taken how?

Back 30

with fatty meal

Front 31

tx for chronic suppression cryptococcal neoformans meningitis

Back 31

fluconazole

Front 32

which azole is only excreted thry kidney

Back 32

fluconazole

Front 33

what inhibits P-glycoprotein

Back 33

keto and fluconazole

Front 34

ketoconazole
absorption?
CNS penet?

Back 34

ab-requires acidic environment
tk with coke
decrease abs with food
No CNS penetration

Front 35

Fluconzole
abs?
CNS?

Back 35

abs-unaffected by food
CNS-yes

Front 36

Itraconazole
abs
CNS

Back 36

requires acidic environ.
abs incr. with food in caps
abs dec with food in oral soln

Front 37

which 2 antifungals can cross BBB

Back 37

FF
Fluconazole + flucytosine

Front 38

Vori inhibits

Back 38

2C19
2C9
3A4

Front 39

Cyp inhib by potentcy

Back 39

keto>itra=vori>>flu

Front 40

ketoconazole SE

Back 40

inhib formation of testosterone- no hardons, big tities, N/V

Front 41

monitor what in all AZOLES?

Back 41

LFTs-for hepatotoxicity
HTN + fluid retention in all Azoles

Front 42

Fluconazole SE

Back 42

rash in immunosupp. pt's

Front 43

Vori SE

Back 43

visual disturbances

Front 44

itraconazole SE

Back 44

may exacerbate or cause HF

Front 45

which azoles are teratogenic

Back 45

ALL

Front 46

Griseofulvin is an inhib of what?

Back 46

NOTHING
ITS A INDUCER!!!!

Front 47

uses for griseofulvin

Back 47

onychomycosis-tx for 6 months

Front 48

griseofulvin
abs
SE

Back 48

abs-increased with fatty meals + microcrystallne formulation

SE-photosens. HA/insomnia memory impairment

Front 49

terbinafine MOA
cidal or static?

Back 49

inhibits squalene oxidase-results in decreased synthesis of ergosterol

cidal

Front 50

terbinafine uses

Back 50

onychomycosis-3months

Front 51

terbinafine AE

Back 51

taste disturbances
hemotopoetic effects-pancytopenia, neutropenia
changes in ocular lens + retina

Front 52

Bufenatine, Naftifine
MOA?

Back 52

like terbinafine

Front 53

ciclopirox MOA

Back 53

chelates AL + Fe-inhibits metal dep. enzymes necessary for degradtion of toxic peroxides

Front 54

capsofungin
MOA

Back 54

echinocandins
blocks synthesis of B(1.3) cell wall

Front 55

capsofungin biggest use

Back 55

fluconazole resistant candida

Front 56

capsofungin elimination?
absorb?

Back 56

primarily feces

IV no oral

Front 57

capsofungin ADR

Back 57

releases histamine-warmth/vasodil.

Front 58

micafungin and anidulofungin

Back 58

same as capsofungin

use micafungin-candidia prophylaxis in HSCT(stem cell transplant)

Front 59

prevention of viral pen or uncoating

Back 59

amantadine, rimantadine

Front 60

inhib of viral specific enzymes

Back 60

all nucleoside analogs

Front 61

steps of viral infection

Back 61

absorption
penetration
uncoating
translation
replication
release

Front 62

drugs interfering with uncoating

Back 62

amantadine
rimantadine

Front 63

Amantadine/rimantadine
MOA

Back 63

inhibit viral M2 protein->prevents dissociation (uncoating)

Front 64

amanaadines/riman uses

Back 64

prophylaxis and tx of influenza A with 24-48H

Front 65

Amantadine/Rim SE

Back 65

anticholinergic effects(rim has less)
N/V
encephalopathy with amantadine(renal failue)

Front 66

when should we use amantadine?
when not?

Back 66

use in liver failure
not in renal failue

Front 67

when should we use rimantadine
when not?

Back 67

use in kideny failure
not in liver

Front 68

tadines are C/I when?

Back 68

pregnancy

Front 69

Neuraminidase inhib.

Back 69

zanamivir
oseltamivir

Front 70

zanamivir/oseltamivir
MOA

Back 70

dec. release of infected cell particles, increases form of viral aggregates

Front 71

uses of amivir's

Back 71

for influenza A + B

Front 72

amivirs used how?

Back 72

zanamvir is inhaled

oseltamivir is ORAL prodrug

Front 73

what is oseltamivir DOC for

Back 73

avian "bird" flu

Front 74

IFN-alpha MOA

Back 74

induces synthesis of TIPS, slectively inhibits translation of viral mRNA

activates macros and natural killer lymphocytes

Front 75

INF-alpha uses

Back 75

Hep B+HepC, haircell leukemia, Karposi

Front 76

INF-alpha SE

Back 76

flu, fatigue, depression

Front 77

guanosine analogs

Back 77

acyclovir, valacyclovir, ganciclovir, pencyclovir, ribavirin

Front 78

thymidine analogs

Back 78

idoxuridine, trifluridine, cidofovir

Front 79

adenosine analog

Back 79

vidarabine

Front 80

cytosine analogs

Back 80

cytarabine

Front 81

acyclovir uses

Back 81

slective toxicity->only herpes infected cells

IV-DOC for serious infections

Front 82

Acyclovir SE

Back 82

crystalline nephropathy-must hydrate

burning sensation when topical

Front 83

Valacyclovir

Back 83

prodrug of acyclovir(prodrug)

esterified with valine

Front 84

famciclovir
penciclovir

Back 84

fam-prodrug of pen
pen is active form
hydrolysis to active form in liver + small intestine

pen is NOT a side chain terminator-its a DNA poly inhib.

Front 85

fam
pen
uses

Back 85

localized herpes zoster-give within 72H
recurrent genital herpes in immunoCOMPETENT pts

Front 86

Ganciclovir
MOA

Back 86

admined IV
comp inhib of DNA poly. and a chain term.
-undergoes slow catabolism

Front 87

whats prob with ganciclovir

Back 87

incorporated into human DNA also

Front 88

valganciclovir

Back 88

oral prodrug of ganciclovir

Front 89

ganciclovir uses

Back 89

CMV retinitis
DOC for any CMV virus

Front 90

ganciclovir SE

Back 90

myelosuppresion
seizures--gancic is worst
retinal detachment
mutagenic and carcinogenic

Front 91

Foscarnet MOA

Back 91

not a nucleoside analogue
NO activation req. by viral or host kinases

Front 92

foscarnet uses
how is it taken?

Back 92

Epstein-Barr
ganciclovir-resistant CMV

IV-poor oral bioavail.

Front 93

Foscarnet SE

Back 93

electrolyte disturbances
nephrotoxic
N/V(47%)-WORST antiviral

Front 94

cidofovir MOA

Back 94

inhib and substrate for DNA poly.
does not need activation by viral Thymidalye kinase

Front 95

cidofovir admin?
SE

Back 95

IV

nephrotoxic(give with probenacid)
ocular problems

Front 96

idoxuridine MOA

Back 96

NOT a side termin
puts kinks into DNA-susceptible for breaking

Front 97

idoxuridine uses

Back 97

topically only
herpes of eye

Front 98

idoxuridine SE

Back 98

corneal + conjuctival ulceration and change

Front 99

trifluridine MOA

Back 99

mech unkown
rev. inhibits thymidylate synthetase

Front 100

trifluridine use
SE

Back 100

topically only-herpes keratitis
DOC cuz its LEAST toxic

palpebral edema

Front 101

Ribavirin MOA

Back 101

interferes with IMP dehydrogenase-required for synthesis of guanosine

Front 102

ribavirin is DOC for?
how do you give ribavirin

Back 102

respiratory syncytial virus

aerosol-requires special nebulizing dose

also used with INF-Hep C

Front 103

Adefovir MOA

Back 103

nucleoTIDE analog-active form is diphosphate
serves as chain termin.
tri-P like

Front 104

Adefovir uses
SE

Back 104

Chronic active Hep B

severe hepatitis exacerbation when discontinued
Nephrotoxic

Front 105

Nucleoside Reverse Transcriptase Inhib.(NRTIs) gen info

Back 105

all are prodrugs->must be converted to triphosphates
3P's are added by host kinases
-chain terminators

Front 106

NRTI's never give as?

Back 106

monotherapy

Front 107

Zidovudine(AZT)
moa

Back 107

triphos-incorp in to viral DNA

monophos-comp inhib of host TK

Front 108

Zidovudine ADR

Back 108

HEMATOLOGICAL toxicites-myelosuppresion
panctyopenia-after 14 weeks of tx
asethnia-muscle weakness

Front 109

Zidovudine interactions

Back 109

antagonizes actions of stavudine, ribavirin

with ganciclovir-may cause additive myelosupp but NOT a C/I

Front 110

Didanosine(DDI) MOA

Back 110

incorp into DNA-chain terminator
highly selective

Front 111

DDI kinetics

Back 111

degrades in acid
caution with quinolones/tetracyclines
MUST take on EMPTY stomach

Front 112

DDI adr's

Back 112

pancreatitis-WORST among NRTI
peripheral neuropathy-all NRTI with d in it do this
caution if pentamadine also given

Front 113

Zalcitabine(ddC) MOA

Back 113

least potent NRTI
no longer marketed

severe peripheral neuropathy
oral/esophageal ulcers

Front 114

STAVUDINE(D4T) ADR

Back 114

highest incidence of lactic acidosis + hepatic steatosis
highest lipotrophy among NRTI

hyperlipidemia

Front 115

stavudine interctions

Back 115

interacts with zidovudine, zid inhibits hosts TK, which Stav needs to become activated

Front 116

Lamivudine(3TC) adr

Back 116

NO major toxicites-1st breakthru drug

never use alone(only a single point mutation=resistance)

Front 117

Lamivudine interactions

Back 117

synergistic with zidovudine
AZT+Lami=combivir
AZT +Lami+Abacavir=Trizivir
Abacavir+Lami=epzicom

Front 118

Abacavir ADR

Back 118

hypersent. reaction

if hypersent..dont ever go back->hypotension, resp distress

Front 119

Emtricitabine MOA

Back 119

a QD fluorinated lamivudine

emtric + tenofovir=truvada
truvada+efavirenz=atripla

Front 120

NucleoTIDE reverse transcriptase inhib.

Back 120

tenofovir

Front 121

tenofovir MOA

Back 121

doesnt need to add 1st P
chain termin
dosed QD

Front 122

tenofovir ADR

Back 122

well tolerated
renal insuff/fanconi syndrome
decreae in mineral density/osteomalacia

Front 123

Non-nucleoside rev. transc. inhib.(NNRTI's)
MOA

Back 123

inhib thru allosteric inhib following binding to enzyme at regions REMOTE fromactive site

Front 124

NNRTI class toxicites

Back 124

Rash-nevirapine most likely
LFT elevations

Front 125

resistance for NNRTIs

Back 125

a single mutation causes resistance to 3 of the NNRTI's

Front 126

Nevirapine
inhib or induces?
se

Back 126

induces CYP3A4

most likely to cause rash, elevated LFTs
Niviraprine-more severe hepatotoxic
may cause withdrawls if pt on methadone

Front 127

Delaviradine

Back 127

rasies levels of protease inhib
least potent NNRTI
TID dosing

Front 128

Efavirenz

Back 128

MOST potent of NNRTIs
QD dosing
inducer and inhib of CYP450

Front 129

Efavirenz ADR

Back 129

pen CNS-nightmares, vivid dreams, dizziness, conf, hallucinations

do not use in 1st trimester of preg

Front 130

Etravirine abs
inducer or inhib?

Back 130

admin with meal to enhance absorpt. (fasting reduces abs by 50%)

induces 3A4 + INHIB 2C9, 2C19

Front 131

Etravirine uses

Back 131

treatment-resistent patients
BID dosing

Front 132

Protease inhib class MOA

Back 132

protease diffs from human protease-ours has aspartate

bind non-cov-thus are reversible inhib

NEVER mono therapy

Front 133

PI class toxicities

Back 133

dislipemias + changes in fat distrub.->protease paunch
hyperchloesterolemia insulin resist.
GI interolance

Front 134

PIs are inducers or inhib?

Back 134

inhibitors

Front 135

Saquinavir

Back 135

LEAST potent PI
ALWAYS comboed with ritonavir(cuz ritonavir inhib metabolism of saq)

Front 136

ritonavir

Back 136

potent inhibtor of 3A4
caps must be refrigerated

Front 137

ritonavir ADRs

Back 137

circumoral parasthesias
taste perversion with liquid formulation
SEVERE nausea

Front 138

Indinavir
ADR's

Back 138

Q 8 H, NOT TID(???) wtf?
nephrolithiasis-avoid by hydration
hyperbilirubinemia

Front 139

Nelfinavir ADR

Back 139

diarrhea + loose stools-use loperamide
Never finish going to the bathroom

Front 140

fosamprenavir
abs?
allergy?

Back 140

high fat meals decrease abs
watch in sulfa allergy

Front 141

atazanavir

Back 141

is prefereed PI
needs acid for dissolution

Front 142

atazanavir ADR

Back 142

indirect hyperbilrubinemia
prolong PR interval
lowest incidence of hyperlipidemia-advantage

Front 143

lopinavir/ritonavir

Back 143

recc. PI in preg.

Front 144

tipranavir and darunavir

Back 144

newest PI
must be comboed with ritonovir

Front 145

which drugs watch out for if sulfa allergy?

Back 145

fosamprenavir
tipranavir
darunavir

Front 146

tipranavir toxicities

Back 146

severe hepatotoxic including fatalities or cerebreal hemorrhage
NOT preferred agent

Front 147

darunavir

Back 147

better tolerated
new onset of diabetes, hyperglycemia NOT seen with darunavir like most PI's

Front 148

viral infusion inhibitor

Back 148

enfuviritide

Front 149

enfuviritide MOA

Back 149

fusion inhibtor
very expensive(last line)

Front 150

maraviroc

Back 150

CCR5 antagonist
not all HIV strands need ccr5 to bind-so test pt first

Front 151

maraviroc uses
taken how?

Back 151

last line
for tx experienced pts

PO

Front 152

maraviroc interaction with?

Back 152

Saint johns wart
decreases maraviroc serum conc.

Front 153

raltegravir

Back 153

integrase inhib
slows adv of HIV by blocking integrase enzyme

Front 154

raltegravir SE

Back 154

associated with increase in CPK, myopathy

Front 155

hydroxyurea MOA

Back 155

no direct anti-viral activity
inhib cellular ribonucleotide reducatase
-arrests cell in GI prior to DNA synthesis-depletes dNTP pool

Front 156

agents dosed qd

Back 156

LATEE
Lamivudine
Atazanavir
Tenofovir
Emtricitabine
Efavirenz