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95 Cards in this Set
- Front
- Back
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What is a fungus?
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single-celled or multicellular organism without chlorophyll that reproduces by spores and lives by absorbing nutients from organic matter
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2 types of antifungals and what they target?
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Polyene and azole both target the fungal cell membrain
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Most common mucocutaneous fungal infection?
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Candida albicans
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4 most opportunistic mycoses?
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Aspergillus, Candida, Cryptococcus, and phycomycetes
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4 most common endemic fungal infections?
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Blastomycosis, Histoplasmosis, Coccidiomycosis, and sporotrichosis
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2 common Polyene antifungals?
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Nystatin, Amphotericin B
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Common characteristics of Polyenes?
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lipophilic agents
have a affinity for fungal ergosterol They act like a detergent that causes loss of membrain integrity, cells leak and they die. Toxic |
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Nystatin?
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Used exclusivly for Candida albicans topically.
Never givin IV Resistance not a problem. |
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Amphotericin B?
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Givin IV for systemic life threatening infections
Very Toxic especially nephrotoxic. concidered the most toxic anti-microbial on the market |
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General characteristics of Azole antifungals?
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inhibit biosynthesis of ergosterol by binding to 14-alpha-demethylase
mostly for topical applications can cause serious liver problems becuase it inhibits the fungal form of p450 |
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Name 6 Azoles?
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Fluconazole, Itraconzaole, Voriconazole, Ketoconazole, Clorimazole, and Posaconazole
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fluconazole?
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an Azole
Lowest inccidence of adver affects Used for Crytococcal meningitis in AIDs pats. Oropharyngeal and esophageal candidiases Prophylaxis in HIV pts for candidiasis |
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Itraconazole?
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Breader spectrum of activity than fluconazole
Serious hepatotoxicity 60hr half life inhibits CYP3A4 Contraindicated for pts. taking cisapride, dofetilide, ergot alkyloids, lovaststin, simvaststin |
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Voriconazole?
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similar spectrum to intraconzole
pts. experince some visual disturbances. Cannot be givin to pregnant women |
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Ketoconazole?
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Very toxic, gynecomastia, mensrtual irregularities.
Does not cross blood-brain barrier inhibits testosterone |
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Clotrimazole?
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similar spectrum to ketoconazole but is only used topically.
good drug for oral candidiasis in AIDs pts. |
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Psaconazole?
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Used for prophylaxis of invasive aspergillius and disseminated candidiasis in severly immunocompromised hosts.
active agaist candida species that are resistant to azoles active against zygomycetes |
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Terbinafine?
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used for onychomycosis of toenail or fingernails.
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Griseofulvin?
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nail and scalp infections that do not respond to other therupies.
taken with fatty meals |
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Flucytosine?
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Very toxic to bone marrow and kidneys
used in combo with amphotericin B so treat sever candida or crypococcal infs. |
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Echinocandins?
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class that inhibits fungal enzyme 1,3-beta-D0glucan synthesis.
safe for renaly impaired pts. |
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Caspofungin?
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a Echinocandin
excelent for life-threatening systemic infections for pts. that cannot tolerate ampho B. |
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Micafungin?
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a echinocandin
Does not have major effects on CYP450 system |
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Micafungin
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an echinocandin
doesn nto have major effects on CYP450 system |
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Anidulafungin?
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used for esophagea candidiasis and prophylaxis of candidiasis
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3 common superficial fungal infections?
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athlete's foot, "jock itch" and ringworm
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How is Oral candidiasis treated?
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1. clotrimazole troche
2. Orally with ketocanazole, fluconazole or itraconazole 3. IV ampho B +/- flucytosine |
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How are fungal infections treated in pregnant women?
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Ampho B for life treatening cases
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how to treat fungal infections in prophylaxis?
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Fluconazole
Itraconazole Micafungin |
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Name 3 echinocandins?
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Caspfungin, micafungin, and anidulafungin
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Function of a Nucleotide analog?
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does not have a hydroxyl group at the 3 position and can not be built upon. terminates nucleic acid replication
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Acyclovir?
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A guanosine anolog with a acyclic gourp replacing the ribose sugar.
Risistance is immerging For resistant strains treat with Foscarnet ot cidofovir Not approved for pregnant women. however no effects shown yet |
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What is a alternative treatment for Acyclovir in resopne to resistance?
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Foscarnet or cidofovir
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Ganciclovir?
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drug of choice fo cytomegalovirus infections.
givin IV for life or sight threatening CMV infections Used for prevention of CMV infection in transplant pts. Associated with persistant viremia or progressive disease Resistant strains may be suseptable to foscarnet or codofovir |
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Valganciclovir?
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has largly replaced IV and oral ganciclovir for pts. with CMV retinitis whose lessions are peripheral and not immediatly sight threatening
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Cidofovir?
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cytosine nucleotide analog
IV for CMV retinitis in AIDS pts. who are failing ganciclovir ot foscarnet therapy. For Acyclovir-resistant HSV or VZV |
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NRTIs?
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Nucleotide reverse transcriptase inhibitors
can cause potentially fatal syndrome of lactic acidosis, peripheral lipoatrophy, central fat accumulation and hyperlipidemia |
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Zidovudine? (AZT)
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NRTI
thymidine analog effective at reducing neonatal transmission if mothers take drug from 14 weeks after conception. |
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Stavudine?
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NRTI
most likly to cause fatal lactic acidosis. especially when administered with didanosione |
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HIV protease inhibitors?
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varal protiens tend to transcribe 1 long protein product that is cleaved by a protease inhibitor. These drugs bind to it.
drugs that end in avir Pts. tend to get redistribution of fat, "the hump" |
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Indinavir?
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protease inhibitor.
works well for pediatric pts. |
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Lopinavir?
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protease inhibitor
regiment of choice for both treatment-naive pts. and in those with previous HIV treatment and moderate or no PI resistance |
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Tipranavir?
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protease inhibitor
works well for pts. that have experienced extensive treatment and drug resistance. |
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NNRTIs?
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non-nucleotide transcriptase inhibitors.
metabolized by P-450 |
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HARRT?
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Highly Active Anti-Retroviral Therapy.
Standard of care for HIV+ pts. usually 2+NRTIs and 1+ PIs or NNRTIs |
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How is perinatal transmission avoided?
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Zidovudine. reccomended for newborns for 6 weeks and women need to wait 10-12 weeks after gestation
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Drugs that inhibit the influenza virus neuraminidase enzyme?
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Oseltamivir and Zanamivir. and provide sympomatic relief for both A and B viruses
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Type 1 vaccine?
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Inactivated vaccine
for children 6-59 months Pregnant women Persons older than 50 |
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Type 2 vaccine?
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Live-attenuated
not for pregnant ot immunocompromised pts. people should avoid immunocompromised people |
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How is avian flu treated?
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Oseltamivir and Zanamivir
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Foscarnet?
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inhibits viral NDA polymerase
Renal toxicity Used for Acyclovir-resistant HSV infections in AIDs pts. Acyclovir-resistant VZV infections CMV retinitis in immunocompromised pts. |
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Most effective meathod for preventing HBV infections?
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Vaccine
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Human inferferons?
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switch the cell to a more viral protetive state
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Ribavarin?
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synthetuc triazole nucleoside analogue of guanosine
used in combo with pegylated interferon alpha as a regimen of choice for chronic Hepatitus C can prosist in RBCs Contraindicated in pregnant women People on the drug should not conceive and for 6 months after the drug |
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Gardasil (merck)?
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HPV-like particle vaccine
contraindicated in pregnant women |
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Rotavirus treatment?
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Rota-Teq (merck)
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VZV vaccine?
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Varivax (merck) to prevent chickenpox
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How to prevent shingles?
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Zostavax (merck) prevention of herpes zoster in persons over 60
contraindicated in persons who are immunocompromised |
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Cholinomimetric Drugs?
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agents that directly enhance cholinergic function.
Choline esters and Naturaly occuring cholinergic stimulants |
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4 Choline esters?
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Acetylcholine
Methacholine Carbachol Bethanechol |
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3 Naturally occuring cholinergic stimulants?
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Nicotine
Muscarine Pilocarpine (Isopto Carpine) |
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Anticholinesterase agents?
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agents that indirectly increase cholinergic function
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6 Anticholinesterase reversible agents?
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Physostigmine
Neostigmine Edophonium Ambenonium Pyridostigmine Donepezil |
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3 Anticholinesterase irreversible agents?
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Echothiophate
Parathion and malathion Sarin and Soman |
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Cholinesterase reactivator?
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Pralidoxime (2-PAM)
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6 Muscarinic blockage drugs?
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Atropine
scopolamine Tropicamide Ipratropium Benztropine Oxybutynin |
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Ganglionic stimulant?
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Nicotine
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Ganglionic blockade?
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Hexamethonium
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Cholinergic?
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All neurons in the PNS or CNS that secrete ACh.
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Why do muscarinic stimulants cause vasodiolation?
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non-innervated ACh receptors
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2 ways drugs increase cholinergic function?
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Stimulating the receptor or increasing the effectivness of endogenous ACh
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How does muscarinic receptors slow the heat rate?
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opens K+ channels that cause prolonged depolarization.
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Nicotine will activate Ach receptors in 4 specific areas?
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NMJ
Autonomic ganglia Adrenal medulla CNS |
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Achetycholine?
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must be injected
low doses activate muscarinit receptors high doses stimulate Nicotinic receptors |
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Methacholine?
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Same as ACh with a methyl group
longer duration poten muscarinic stimulator but no nicotinic function no clinicly effective, experimental tool at best |
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Carbachol?
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ACh with a NH2 group
potent nicotinic stimulator little muscarinic function releases ACh used topically for eye to produce miosis |
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Bethanechol?
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ACh with both a methyl and NH2 group
has mostly muscarinic function used for post opt. urinary retention and atony of the GI Clinicly to treat esophageal reflux due to it's stimulatory action on the lower esophageal sphincter |
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Nicotine?
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from tobacco
odorless and colorless stimulates ALL nicotinic receptors activation of all autonomic ganglia when given repeatedly or in large doses, causes bloackade of nicotinic receptors |
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Muscarine?
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derived from mushrooms
mushrom poisoning Atropine is a good antidote will stimulate all muscarinic receptors. |
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Pilocaarpine?
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from a South american shrub
slectivly activates msucarinic receptors used to trear glaucoma |
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Physostigmine?
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isolated from calabar bean
enters the CNS used for glaucoma and the most rational choice for stropine poisoning |
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Neostigmin?
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synthetic
does not enter CNS directly stimulates muscle and s good for myasthenia gravis |
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Ambenoium and Pyridostigmine?
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available to treat myasthenia gravis
some pts. develop tolerance or allergies |
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Danepezil and Tacrine?
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CNS acting anticholionesterase
used for cognitive syfunction in pts. with alzheimer's disease |
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Echothiophate?
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someitmes used to treat glaucoma in pts. refractory to other potent miotics
restricted to aphakic eyes high inccodence of cateract formation |
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Parathion and Malathion
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common insecticides
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Sarin and Soman?
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anti-cholinesterase used in war gases
not reversed by the enyme reactivators |
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Pralidoxime (2-PAM)?
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Cholinesterase reactivator, used to treat against muscaringetic effects
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Atropine?
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readily absorbed orally
produces CNS excitation effects vary with dossage. antagonism of muscarinic receptors seen at higher doses can be toxic to children atropine poisoning can be treated with a anticholinesterase |
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Scopolamine?
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effects similar to atropine except it causes CNS depression
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Ipratropium and Tiotropium?
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synthetic
fewer systemic side effectsoften applied to airways used for pts. with chronic obstructive pulmonary disease |
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Tropicamide?
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less potent and shorter acting muscarinic antagoinsit,
usefull for opthamological exams |
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Benatropine?
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CNS acting antimuscarinogenic drug ised to relieve symptoms of Parkinsons disease
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Oxybutynin?
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atropine-like agent
often used to treat spasms of the bladder seen after urilogical surgury and in some neurological disorders |
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Hexamethonium (C6)
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ganglionic blocking agent. does not compete with ACh
Also accomplished with high doses of nicotine |
