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348 Cards in this Set
- Front
- Back
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What makes antimicrobial drugs effective in the tx of infections
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Their Selective toxicity
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What tool provides a rapid assessment of the nature of the pathogen
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Gram stain
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What do you need to do to arrive at a conclusive dx and to determine the susceptibility of an organism
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Culture the organism
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Choice of antimicrobial drugs depends on what factors
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-whether the infxn was hospital or community-acquired
-whether pt is immunocompromised -pt's travel record age |
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When the identity of the organism is unknown or the site makes a polymicrobial infx likely, what therapy would you use
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Broad spectrum
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What Gram negative species often show unpredictable susceptibility patterns and require susceptibility testing
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Bacilli, enterococci, and staphylococci
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What drugs arrest the growth and replication of bacteria and limit the spread of infxn while the body's immune system attacks
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Bacteriostatic
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What drugs kill bacteria and are DOC in seriously ill pts
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Bacteriocidal
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To provide effectivce antimicrobial therapy, the antibiotic concentration in body fluids should be greater or lesser than the minimum inhibitory concentration
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Greater
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what is the name of the lowest concentration of antimicrobial agent that results in 99.9% decline in colony count
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Minimum Bactericidal concentration
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Natural barriers to drug delivery are created by the structures of the capillaries of some tissues such as
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-Prostate
-Vitreous body of the eye -CNS |
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T or F: Barrier is formed by the single layer of tile-like endothelial cells fused by tight junctions that impede entry from the blood to the brain of virtually all molecules, except those that are small and hydrophilic
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False: small and lipophilic
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Lipid soluble drugs have significant penetration into what part of the body?
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CNS
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In what disease does the BBB does not function effectively
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Meningitis
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Does high or low molecular weight drug penetrate poorly into the BBB?
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High
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What's more important in CSF penetration, amount of free (unbound) drug in the serum or total amount of drug present
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Amount of free (unbound) drug in the serum
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Higher than usual doses of bacterial agents or longer courses of treatment are required to eliminate infective organisms in the following individuals
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-alcoholics
-diabietes -HIV -malnutrition -advanced age -immunosuppressive drugs |
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T or F: Serious adverse effects can arise if drug accumulation is not controlled by adjusting the dose
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True
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What lab test is used as an index of renal function for adjustment of drug regiments
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Serum Creatinine
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What pts are particularly vulnerable to accumulation of drugs eliminated by the kidneys
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Elderly
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Antibiotics eliminated by the liver are contraindicated in treating patients with what disease
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Liver
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What may reduce the amount of antibiotic that reaches an area (in diabetics)
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Poor perfusion, such as the lower limbs of a diabetic
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Renal and hepatic elimination are poorly developed in whom?
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Newborns
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Young children should not be treated with what drug which effects bone growth
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Tetracyclines
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What drugs should be avoided in pregnancy due to their ototoxic effect on the fetus
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Aminoglycosides
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T or F: drugs administered to a lactating mother may enter the nursing infant via the breast milk
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True
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Name the phenomenon where PCNs and cephalosporins require dosing schedules that require blood levels greater than MIC 60-70% of the time to be effective
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Concentration-independent or time-dependent killing
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What antimicrobial agents show a significant increase in the rate of bacterial killing as the concentration of antibiotic increases
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Aminoglycosides and fluoroquinolones
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What route of administration exhibits concentration dependent killing, achieving high peak levels favoring rapid killing of pathogen
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Once a day bolus infusion
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What drugs do not have the concentration dependent property, where increasing the concentration of of antibiotic does not significantly increase the rate of kill
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-Beta Lactams
-Glycopeptides -Macrolides |
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Define Post-Antibiotic Effect (PAE)
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Length of time it takes after the transfer for the culture to achieve log phase growth
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Antimicrobials exhibiting a long PAE (several hours) require what dosing?
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1 dose/day
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What 2 classes of antimicrobials exhibit a long PAE
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Aminoglycosides and Fluoroquinolones
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Isoniazid has what type of spectrum and what does it work against
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Narrow, mycobacteria
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What 2 classes of drugs are referred to as broad specturm antibiotics
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Tetracycline and Chloramphenicol
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Administration of broad-spectrum antibiotics can have what effect
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Drastically alter the nature of normal bacterial flora and precipitate a superinfection such as Candida albicans
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Why is it advisable to treat pts with a single agent that is most specific for the infecting organism
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-reduces possibility of superinfection
-decreases emergence of resistant organisms -minimizes toxicity |
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Combination of what two antibiotic classes shows synergism
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Beta-lactams and aminoglycosides
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When is multiple drug therapy indicated
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In special situations - when infection is of unkown origin
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When is bacteria said to be antibiotic resistant
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If the growth is not halted by the maximal level of that antibiotic that can be tolerated by the host
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Microbial species that are normally responsive to a particular drug may develop more virulent, resistant strains how?
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Through spontaneous mutation or acquired resistance
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How can spontaneous mutations of pathogen's DNA occur
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By insertion, deletion, or substitution of one or more nucleotides
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How can DNA transfer of drug resistance occur
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due to DNA transfer from one bacterium to another
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What bacteria is resistant to Beta lactam abx by altering antibiotic's target site through mutation
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S. Pneumoniae
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What 2 mechanisms can confer resistance b/c the drug is unable to attain access to the site of its action in sufficient concentrations to kill the organism
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Decreased uptake or increased efflux
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How can decreased uptake or increased efflux be accomplished
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by altering the number and structure of porins (channels) in the outer membrane and the presence of an efflux pump can limit levels of a drug in an organism
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Give an example of antibiotic enactivating enzyme
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Beta-lactamases
("penicillinases") |
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When is prophylactic use of antibiotics indicated
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-prevention of Strep infx in pts w/ h/o rheumatic heart dz
-pretreatment of dental extractions in pts w/ implanted prosthetic devices -prevention of TB or meningitis of people in close contact w/ infected pts -prior to surgical procedures to prevent infection -tx w/ziduvudine of HIV infected pregnant mother |
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What hypersensitivity reactions may PCNs cause, despite their selective microbial toxicity
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Anything from urticaria to anaphylactic shock
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High serum levels of what antibiotic may cause ototoxicity
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Aminoglycosides
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Drug therapy with broad spectrum antibiotics or combo of agents can lead to alterations of normnal flora in what organ systems, permitting overgrowth of opportunistic organisms, especially fungi or resistant bacteria
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-Upper respiratory
-Intestinal -Genitourinary |
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Inhibitors of cell wall synthesis have little or no effect on bacteria that are not doing what
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Growing or dividing
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Most important drugs that are inhibitors of cell wall synthesis are called what
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Beta-lactams
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What has limited the use of PCNs?
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Increased resistance
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In their mechanism of action, PCNs interfere with what step
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Last step of bacterial wall synthesis
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Are penicillins bacteristatic or bactericidal?
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Bactericidal
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Gram positive organisms have cell walls that are easily traversed by what antibiotics?
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Penicillins
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Gram negative organisms have an outer lipopolysaccharide membrane that presents a barrier to what water soluble drugs
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Penicillins
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What proteins do gram negative bacteria have inserted in the lipopolysaccharide layer that act as water-filled channels that permit transmembrane entry
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Porins
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What Gram neg. bacteria lacks porins which makes it intrinsically resistant to many microbial agents
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Pseudomonas Aeruginosa
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natural penicillins are obtained from fermentations of what mold
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Penicillium chrysogenum
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name the natural penicillin that is the cornerstone of therapy caused bygram positive and gram negative cocci
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Penicillin G
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Penicillin G is susceptible by inactivation of what enzyme
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Beta-lactamases (penicillinases)
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What antistaphylococcal penicillins are penicillinases resistant
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-Methicillin
-Oxacillin -Cloxacillin |
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T or F: Methicillin is not used except to identify resistant strains of S. aureus
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True
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MRSA are usually susceptible to what drug
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Vancomycin
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Name extended spectrum Penicillins that are similar in spectrum to PCN G, but are more affective against gram negative bacilli
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-Ampicillin
-Amoxicillin |
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What is the DOC for gram positive bacillus Listeria monocytogenes
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Ampicillin
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What bacteria are often resistant to Ampicillin and amoxicillin
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E. Coli and H. influenzae
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Formulation with which Beta lactamase inhibitor protects amoxicillin from hydrolysis and extends its antimicrobial spectrum
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Clavulanic acid
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Formulation with which beta lactamase inhibitor protects ampicillin from hydrolysis and extends its antimicrobial spectrum
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Sulbactam
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Name most potent antipseudomonas PCN
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Piperacillin
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Name 3 Antipseudomonal PCNs
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-Piperacillin
-Carbenicillin -Ticarcillin |
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what's the mechanism of action of beta lactamases enzymes
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They hydrolize the cyclic amide bond of beta lactam ring which results in loss of bactericidal activity
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What is a major cause of resistance to PCNs
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Beta-lactamase activity
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Which Beta lactams are only administered orally
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-Penicillin V
-amoxicillin -amoxicillin w/clavulanic acid |
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Which Beta lactams are only administered IV or IM
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-Ticarcillin
-Carbenicillin -Piperacillin -Ampicillin w/sulbactam -Ticarcillin w/clavulanic acid -Piperacillin w/tazobactam |
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What beta lactams are administered IM and serve as depot forms
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-Procaine PCN G
-Benzathine PCN G |
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Are most PCNs completely or incompletely absorbed when administered PO
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incompletely
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When administered PO, do PCNs reach the intestine in sufficient amounts to affect the composition of natural flora
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Yes
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Beta lactam penetration into what parts of the body is insufficient for therapy unless they're inflamed
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-Bone
-CSF |
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What antibiotics are among the safest drugs and whose blood levels do not need to be monitored
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Penicillins
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5% of pts who took PCNs have what type of hypersensitivity rxns
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-maculopapular rash
-angioedema -anaphylaxis |
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What GI complication may occur as a result of incomplete absorption of beta lactam antibiotic, having an extended antibacterial spectrum
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Pseudomembranous colitis
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All PCN's and in particular Methicillin has a potential to cause what renal complication
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Interstitial nephritis
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What class of drugs are beta lactam antibiotics that are closely related to PCNs and have the same mode of action as PCNs
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Cephalosporins
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Are cephalosporins or PCNs more resistant to Beta lactamases
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Cephalosporins
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Are Cephalosporins effective or ineffective against
-MRSA -L. monocytogenes -C. diff |
Ineffective
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2nd generation cephalosporins display greater acitivity against which 3 additional gram negative organisms
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-H. influenzae
-Enterobacter aerogens -some Neisseria species |
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Is gram positive activity stronger in 1st or 2nd generation cephalosporins
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1st generation
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3rd generation cephalosporins have enhanced acitivity against gram negative bacilli of 2nd generation plus which other bacteria
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Serratia Marcescens
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What drug is the DOC for meningitis
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Ceftriaxone
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What generation cephalosporin is Ceftriaxone
|
3rd
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Name a 4th generation cephalosporin
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Cefepime
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T or F: Pts who had anaphylactic response as well as allergic rxns to PCNs should not receive cephalosporins
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True
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When is disulfiram-like effect produced
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when cephalosporins are ingested with alchol or alcohol containing meds
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Mechanism of action of cephalosporins in disulfiram-like effect
|
They block 2nd step in alcohol oxidation, which results in accumulation of acetaldehyde
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What two drugs are the broadest spectrum beta lactam antibiotic preparations currently available
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-Imipenem
-Meropenem |
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Name the only commercially available monobactam
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Aztreonam
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Aztreonam, a monobactam, has antimicrobial activity directed primarily against what bacterial species
|
Enterobacteriaceae
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which Beta lactamase inhibitors contain beta lactam ring but do not themselves have antibacterial activity. Instead, they bind to and inactivate beta-lactamase, thereby protecting the antibiotics
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-Clavulanic acid
-Sulbactam -Tazobactam |
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What antibacterial drug is a tricyclic glycopeptide that is affective against multiple drug resistant organisms such as MRSA and enterococci
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Vancomycin
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What bacteria are vancomycin resistant
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-Enterococsus faecium
-Enterococcus faecalis |
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Vancomycin has been life saving in the treatment of what infections
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MRSA (staph aureus)
MRSE (staph epidermidis) |
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Oral vancomycin is limited to treatment of what disease
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antibiotic associated C. diff colitis
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what 2 protein synthesis inhibitors are available for treatment of vancomycin resistant organisms
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-quinopristin/dalfoprostin
-linezolid |
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When do you use vancomycin PO against C. diff colitis?
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When Metronidazole has proven to be ineffective
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Side effect of Vancomycin
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Flushing "red man syndrome"
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T or F: Drugs that target the bacterial ribosome may cause toxic effects to the mammalian mitochondrial ribosome
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True
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Name drugs that can produce toxic effects as a result of interaction with the mitochondrial ribosome
|
-Chloramphenicol
-Tetracyclines |
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Mechanism of action of tetracyclines
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inhibit bacterial protein synthesis
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What is the spectrum of tetracyclines
|
broad spectrum, bacteriostatic against gram positive and gram negative bacteria
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T or F: widespread resistance to tetracyclines limits their clinical use
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True
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T or F: any organism resistant to one tetracycline is NOT resistant to all
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False, it IS resistant to all
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Taking tetracyclines with what food decreases its absorption due to the formation of nonabsorbable chelates
|
Dairy food - calcium ions and magnesium and aluminum antacids
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tetracyclines bind to what kind of tissue
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Undergoing calcifications
-teeth -bones |
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What drug can be used in renally compromised pts due to its excretion via bile
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Doxycycline
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What drugs may cause epigastric discomfort, but relieved when taken w/ non dairy foods
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Tetracyclines
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What drug causes discoloration and hypoplasia of the teeth and temporarily stunts growth
|
Tetracyclines
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What drug can cause phototoxicity such as a severe sunburn
|
Tetracyclines
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What drug can cause vestibular problems such as dizziness
|
Minocycline (tetracycline)
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What drugs are mainstay for treatment due to aerobic gram-negative bacilli
|
Aminoglycosides
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T or F: Aminoglycosides are associated with serious toxicities
|
True
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What safer drugs have aminoglycosides been replaced with
|
3rd generation cephalosporins and flouroquinolones
|
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Mechanism of action of aminoglycosides
|
inhibit bacterial protein synthesis
|
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DOC Chlamydial infections
|
Doxycycline
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DOC mycoplasma pneumoniae
|
Erythromycin
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DOC Rocky mountain spotted fever
|
Tetracyclines
|
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DOC Lyme disease
|
Doxycycline
|
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DOC Cholera
|
Doxycycline
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Aminoglycosides synergise with what other drugs which enhance diffusion of the aminoglycosides into the bacterium
|
Beta lactam antibiotics
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Aminoglycosides are effective in empirical treatment of infections due to what bacteria
|
Gram negative bacilli including Pseudomonas
|
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What drugs are aminoglycosides combined with to achieve a synergistic effect
|
Beta lactams or vancomycin
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Are aminoglycosides bactericidal or bacteriostatic
|
Bactericidal
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Antibiotics that affect protein synthesis are generally bactericidial or bacteriostatic
|
Bacteriostatic
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|
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How are all aminoglycosides administered (except neomycin)
|
Parenterally
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Neomycin is administered through what rout and why
|
Topically, due to its severe nephrotoxicity
|
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Where do high concentrations of aminoglycosides accumulate
|
-Renal cortex
-endolymph -perilymph of inner ear (may account for high nephrotoxic and ototoxic potential) |
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Which drugs are important to monitor plasma levels of, to avoid dose related toxicities
|
Aminoglycosides
|
|
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Who are particularly susceptible to ototoxicity and nephrotoxicity caused by aminoglycosides
|
Elderly
|
|
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What does ototoxicity correlate with
|
Number of destroyed hair cells in the Organ of corti
|
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What drugs may cause irreversible deafness and effect fetus in utero
|
Aminoglycosides
|
|
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Aminoglycosides combined with what other drug may produce irreversible deafness
|
Loop diuretic
-Ethacrynic acid |
|
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What drugs may cause acute tubular necrosis
|
Aminoglycosdes
|
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What drugs may cause neuromuscular paralysis
|
Aminoglycosides
|
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T or F: neuromuscular paralysis often occurs after direct intraperitoneal or intrapleural application of large doses of aminoglycosides
|
True
|
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Decrease in release of what neurotransmitter results in aminoglycoside induced neuromuscular paralysis
|
Acetylcholine
|
|
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Patients with what disease are particularly at risk for neuromuscular paralysis
|
Myasthenia Gravis
|
|
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What medication can reverse neuromuscular paralysis
|
Neostigmine
|
|
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what drug is a macrolide used as 1st choice as well as alternative to PCN in individuals who are allergic to Beta lactams antibiotics
|
Erythromycin
|
|
|
Name newer versions of macrolides
|
-Clarithromycin
-Azithromycin -Telithromycin |
|
|
Mechanism of action of macrolides
|
Inhibit protein synthesis
|
|
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Are macrolides bactericidal or bacteriostatic
|
Bacteriostatic
|
|
|
Erythromycin is effective against many of the same organisms as which other drug
|
PCN G
|
|
|
DOC in urethritis caused by Chlamydia trochomatis
|
Azithromycin
|
|
|
DOC in Mycobacterium avium-intracellulare complex in AIDS pts
|
Azithromycin
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|
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T or F: Most strains of staph in hospital isolates are resistant to Erythromycin
|
True
|
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What 2 drugs show cross-resistance with erythromycin
|
clarithromycin and azithromycin
|
|
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What macrolide drug can be affective against macrolide resistant organisms
|
Telithromycin
|
|
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What drug diffuses into prostatic fluid and has unique characteristic of accumulating in macrophages
|
Erythromycin
|
|
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Which macrolide has the longest half-life
|
Azithromycin
|
|
|
Most common side effect of erythromycin
|
Epigastric distress
|
|
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Cholestatic jaundice may occur as a side effect of what drug
|
Erythromycin
|
|
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Macrolides are contraindicated in pts with what disease?
|
Hepatic Dysfunction
|
|
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T or F: Chloramphenicol is active against wide range of gram positive and negative organisms, but due to its toxicity its use is restricted to life-threatening infections for which no alternatives exist
|
True
|
|
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Mechanism of action of chloramphenicol
|
inhibits protein synthesis
|
|
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What drug may produce bone marrow toxicity as a side effect
|
Chloramphenicol
|
|
|
Chloramphenicol is what spectrum antibiotic
|
Broad spectrum
|
|
|
Chloramphenicol is particularly active against what type of bacteria
|
Anaerobes
|
|
|
What drug may produce overgrowth of Candida on mucous membranes
|
Chloramphenicol
|
|
|
What drug may cause Aplastic anemia
|
Chloramphenicol
|
|
|
What drug may cause gray baby syndrome
|
Chloramphenicol
|
|
|
What is the Gray baby syndrome
|
High levels of chloramphenicol interfere with mitochondrial ribosomes. This leads to depressed breathing and cyanosis
|
|
|
Most serious side effect of Clindamycin
|
Pseudomembranous colitis caused by C. diff
|
|
|
What drug treats Pseudomembranous colitis caused by C diff?
|
Metronidazole or Vancomycin (if metronidazole is ineffective)
|
|
|
What drug is a mixture of two streptogramins
|
Quinupristin/dalfopristin
"Synercid" |
|
|
DOC for Vancomycin resistant Enterococcus faecium
|
Synercid
|
|
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T or F: Synercid does NOT treat Enterococcus faecalis
|
True
|
|
|
What drug penetrates macrophages and PMNs, imprtant property in tx of VRE
|
Synercid
|
|
|
What recent drug combats resistant gram positive organisms such as
-MRSA -vanco resistant S. aureus -venco resistant E. faecium -vanco resistant E. faecalis -PCN resistant streptococci |
Linezolid "Zyvox"
|
|
|
Adverse effect of Linezolid "Zyvox"
|
Thrombocytopenia
|
|
|
Compared to ciprofloxacin, what new cmpds are more highly active against gram-positive organisms, yet retain favorable activity against gram negative microorganisms
|
Fluoroquinolones
|
|
|
T or F: overuse of fluoroquinolones has led to the emergence of resistant strains
|
True
|
|
|
Are fluoroquinolones bactericidal or bacteriostatic
|
Bactericidal
|
|
|
Newer fluoroquinolones for Strep. pneumoniae
|
Levofloxacin and Gatifloxacin
|
|
|
Name 2nd generation Fluoroquinolones
|
-Ciprofloxacin
-Norfloxacin |
|
|
Name two 3rd generation Fluoroquinolones
|
-Sparfloxacin
-Gatifloxacin |
|
|
Name one 4th generation Fluoroquinolone
|
Trovafloxacin
|
|
|
DOC traveler's diarrhea
|
Ciprofloxacin
|
|
|
DOC for Anthrax
|
Ciprofloxacin
|
|
|
Most potent fluoroquinolone for Pseudomonas
|
Ciprofloxacin
|
|
|
T or F: Cipro is useful in treating Enterobacteriaceae
|
True
|
|
|
DOC for prostitis due to E. Coli
|
Levofloxacin
|
|
|
DOC for STDs, except Syphilis
|
Levofloxacin
|
|
|
Fluoroquinolones used to treat respiratory infxns due to S. pneumoniae
|
Levofloxacin
Gatifloxacin |
|
|
Most common adverse effect of fluoroquinolones
|
Nausea, vomiting, and diarrhea
|
|
|
Phototoxicity is a side effect of what drug
|
Fluoroquinolones
|
|
|
What drugs can cause ruptured tendons in adults
|
Fluoroquinolones
|
|
|
What two drugs inhibit the synthesis of folic acid
|
Sulfonamides and trimethoprim
|
|
|
Drugs effectivce in reducing burn-associated sepsis because they prevent colonization of bacteria
|
Silver sulfadiazine
|
|
|
What drugs cause nephrotoxicity as a result of crystalluria
|
Sulfanimides
|
|
|
What drugs may cause hypersensitivity rxns such as angioedema and Stevens-Johnson syndrome
|
Sulfanimides
|
|
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What disorder may occur in newborns b/c sulfa drugs displace bilirubin from binding sites on serum albumin, which then crosses BBB b/c it's not fully developed
|
Kernicterus
|
|
|
Contraindications for sulfanimides
|
In newborns and infants less than two months of age as well as for pregnant women at term
|
|
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What two drugs compose co-trimoxazole
|
Trimethoprim and sulfa-methoxazole
|
|
|
Other than the preferred fluoroquinolones, what other drug can be used alone for tx of acute UTI, bacterial prostitis, and vaginitis
|
Trimethoprim
|
|
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What drug can produce folic acid deficiency such as megaloblastic anemia
|
Trimethoprim
|
|
|
What can reverse the blood disorders caused by trimethoprim
|
folinic acid
|
|
|
T or F: Combination of trimethoprim with sulfamethoxazole - co-trimoxazole - shows greater antimicrobial activity than equivalent quantities of either drug used alone
|
True
|
|
|
Co-trimoxazole is effective in treating what?
|
UTI
|
|
|
What side effect may occur due to Co-trimoxazole
|
Megaloblastic anemia
|
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Most common pathogen that causes UTIs
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E. coli
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2nd most common pathogen that causes UTIs
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Staph. saprophyticus
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Nitrofurontoin, Macrobid, and Macrodantin are used to treat what infection
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UTI caused by E coli or other gram negative organisms
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Mycobacteria is called what?
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Acid-fast
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In addition to TB, mycobacteria can also cause what disease
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Leprosy
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What bacteria is intracellular, resulting in slow-growing, granulomatous lesions
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Mycobacteria
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T or F: Second line medications for TB are either less effective or more toxic
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True
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TB may be treated for how long
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6mos-2yrs
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T or F: multidrug therapy is used in treating TB to delay or prevent the emergence of resistant strains of mycobacteria
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True
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Name 1st line drugs used in treating TB
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-Isoniazid
-Rifampin -Ethambutol -Streptomycin -Pyrazinamide |
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TB treatment always involves a minimum of how many drugs
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two
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T or F: multidrug regimen is continued well beyond the disappearance of clinical disease
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True
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What is short-course therapy for TB may be like
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Isoniazid, rifampin, and pyrazinamide for 2 months and then isonizid and rifampin for next 4 months. Ethambutol or streptomycin may also be added to this regimen
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What assures better treatment completion of TB
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"Directly observed therapy"
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Most potent of the antitubercular drugs
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Isoniazid "INH"
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Most common adverse effect of INH
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Peripheral neuritis (manifest as paresthesia) due to relative pyridoxine (Vit B6) deficiency, which can be corrected by pyridoxine
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DOC for leprosy
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Rifampin
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Most common side effect of Ethambutol
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Optic neuritis (visual acuity should be periodically examined)
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DOC for multidrug resistant TB?
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Fluoroquinolones: Ciprofloxacin and levofloxacin
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Another name for Leprosy
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Hansen disease
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What is recommended 3 drug regimen for tx of Leprosy and how long
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-dapsone
-clofazimine -rifampin 6-24 months |
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Dapsone is used to treat what 2 bacteria
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Mycobacterium leprae and Pneumocystis jiroveci
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Clofazimine used to treat what 2 bacteria
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Mycobacterium leprae
M avium intracellulare |
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Infectious disease caused by fungi are called what ?
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mycosis
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Are mycosis often chronic or acute in nature
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Chronic
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Which mycosis are life-threatening
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Systemic mycosis
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Are fungal infections susceptible to antibiotics used in treatment of bacterial infections
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No
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What fungal infection is the 4th most common cause of septicemia
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Candidemia
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What has caused pts to be on chronic immunosuppression following organ transplant, those who are on chemo for myelogenous and solid tumors, and HIV infectd pts
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Increased incidence of fungal infections
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DOC for systemic mycosis
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Amphotericin B
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Most common side effect of Amphotericin B?
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Nephrotoxicity
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Is Amphotericin B narrow or broad spectrum antifungal
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Broad spectrum
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What route of administration is sometimes chosen to treat meningitis caused by fungi
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Intrathecal
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Does Amphotericin B have a high or low therapeutic index
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Low
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Small test doses of Amphotericin B are administered to assess degree of a patient's negative responses, such as what?
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Anaphylaxis and convulsions
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What has been the first orally active azole for treatment of systemic mycosis
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Ketoconazole
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Azoles inhibit human gonadal and adrenal steroid synthesis, leading to a decrease in what hormones
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Testosterone and cortisol
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What antifungal drug has replaced Ketoconazole due to its broader spectrum, greater potency, and fewer adverse effects
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Itraconazole
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|
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what drugs impair absorption due to their decrease in gastric acid effect
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-Antacids
-H2 histamine receptor blockers -Proton pump inhibitors |
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Which antimycotic drug lacks endocrine side effects
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Fluconazole
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DOC Cryptococcus Neoformans
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Fluconazole
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What antimycotic drug is not dependent on gastric activity
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Fluconazole
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DOC for aspergillosis
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Voriconazole
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What antimycotic drug has a unique problem of transient visual disturbances occuring shortly after a dose of the drug
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Voriconazole
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Caspufungin is a first or second line antifungal
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2nd line
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Antifungal that causes flushing due to its release of histamine and mast cells
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Caspofungen
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what are 1st line antimycotic agents
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Amphotericin B and Itroconazole
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Fungi that cause superficial skin infections are called what
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Dermatophytes
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What are most common dermatomycoses
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Tinea infections
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|
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DOC onychommycoses
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Terbinafine
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Terbinafine is usually prescribed for how long
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3 months
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Griseofulvin requires treatment for how long
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6-12 months
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Griseofulvin is largely replaced by what drug
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Terbinafine
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DOC topical treatment of Candida
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Nystatin
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DOC for oral Candidiasis, used as an oral agent (swish and swallow)
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Nystatin
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Miconazole and clotrimazole are usually administered through what route
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Topically
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There is no significant difference in clinical outcomes associated with any azole or nystatin in the treatment of what infection?
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Vulvar candidiasis
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What type of infections are common among people in underdeveloped tropical and subtropical countries
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Protozoal infections
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Are protozoas eukaryotic or prokaryotic
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Eukaryotic
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Do protozoas resemble human host or bacterial pathogens and what is the significance
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Human hosts, and are less easily treated than bacterial infections
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Amebic dysentery is caused by what organism
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Entamoeba histolytica
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|
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How are amebicidal drugs classified
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-Luminal
-Systemic -Mixed |
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Luminal amebicides act on the parasite in what part of the bowel
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In the lumen of the bowel
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Systemic amebicides are effective against amebas in what part of the body
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In the intestinal wall and liver
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Mixed amebicide DOC for treating emebic infections
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Metronidazole
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DOC for Giardia lamblia
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Metronidazole
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DOC for Trichomonas vaginalis
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Metronidazole
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DOC for pseudomembranous colitis caused by C. diff
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Metronidazole
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if taken with alcohol, metronidazole will produce what effect
|
Disulfiram-like effect
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After treatment of invasive intestinal amebic disease is complete, a luminal agent, such as what should be administered for treatment of asymptomatic colonization state
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Iodoquinol
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What drugs treat liver abscesses or intestinal wall infections caused by amebas
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Systemic amebicides
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Systemic amebicide useful in treatment of malaria
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Chloroquine
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What parasite is the most dangerous species causing persistent high fever, orthostatic hypotension, and massive erythrocytosis, accompanied by swollen, and reddish condition of the limbs
|
Plasmodium falciparum
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What migrate through blood to the liver, where they form cyst-like structures containing merozoites
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Plasmodium sporozites
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How do you diagnose malaria
|
Identification of parasite in RBCs of peripheral blood smears
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Upon release, each merozite invades a RBC, becoming a trophozoite. Trophozites multiply and become ______. Eventually, the infected cell ruptures releasing ______ that can enter other erythrocytes
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Merozoites
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What drug is an 8-aminoquinolone that eradicates primary exoerythrocytic forms of P. falciparum and P. vivax
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Primaquine
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_______ is not effective against ther erythrocytic stage of malaria and is often used in conjunction with a blood schizonticide, such as ________
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Primaquine, Chloroquine
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Mainstay of malaria therapy, as well as treatment of P. falcipareum malaria, except in resistant strains
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Chloroquine
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Resistance of plasmodia to available drugs has become a serious problem throughout Africa, Asia and Cnetral and South Amierica. Chloroquine resistant therapy consists of combo of _____, _____, _____.
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Quinine, pyrimethamine, and a sulfonamide
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|
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Effective single agent against multiple drug resistant forms of P. falciparum
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Mefloquine
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DOC reserved for severe infestations and for malarial strains that are resistant to other agents such as chloroquine
|
Quinine
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|
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Toxoplasma gondi can be transmitted to humans how?
|
By eating raw or undercooked meat and through cats
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|
|
DOC for toxoplasmosis
|
Pyrimethamine (antifolate drug)
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What drug is often given to prevent against folate deficiency
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Leucovorin
|
|
|
Most commonly diagnosed intestinal parasite in the US
|
Giardia Lamblia
|
|
|
How do you acquire Giardia Lamblia
|
Drinking contaminated water
|
|
|
DOC for Giardia Lamblia
|
Metronidazole
|
|
|
What are the 3 major groups of helminths (worms)
|
Nematodes
Trematodes Cestodes |
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|
What group of helminths are elongated roundworms who possess a complete digestive system including a mouth and anus
|
Nematode
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|
|
DOC against whipworm, hookworm, pinworm, and roundworm
|
Mebendazole
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|
|
Little of an oral dose of Mebendazole is absorbed unless it's taken with what?
|
High fat meal
|
|
|
Drugs against Strongyloides stercoralis and cutaneous larva migrans
|
Thiabendazole
|
|
|
1st DOC against cutaneous larva migrans
|
Ivermectin
|
|
|
Trematodes (flukes) are what type of worms
|
Leaf shaped flatworms
|
|
|
Trematodes are characterized based on what tissue they infect and may be categorized as ____, ____, ____, ____.
|
Liver, lung, intestinal, or blood flukes
|
|
|
DOC for Trematode infections
|
Praziquantel
|
|
|
DOC for schistosomiasis
|
Praziquantel
|
|
|
"True tapeworms", flat, segmented body
|
Cestodes
|
|
|
DOC for Cestode infections
|
Niclosamide
|
|
|
What drug is administered prior to oral administration of niclosamide
|
Laxative (to purge the bowel of all dead segments)
|
|
|
DOC for cysticercosis
|
Albendazole
|
|
|
Obligate intracellular parasites, clinical symptoms appear late
|
Viruses
|
|
|
Viral respiratory tract infections for which treatments exist include ___, ___, ___.
|
Influenza type A, type B, and RSV (respiratory syncytial virus)
|
|
|
Preferred approach to influenza A?
|
vaccine
|
|
|
Viral neuraminidase can be selectively inhibited by what two neuraminidase inhibitors
|
Oseltamivir
Zanamivir |
|
|
Mechanism of action of neuraminidase inhibitors
|
They prevent the release of new virions
|
|
|
Neurominidase inhibitors effective against typa A and type B influenza
|
Oseltamivir
Zanamivir |
|
|
Amantidine and rimantidine are limited to what infection proven to be effective in treatment and prevention
|
Influenza A
|
|
|
Name 2 drugs that are inhibitors of viral uncoating
|
Amantadine
Rimantadine |
|
|
What drugs are effective in preventing infectionn if treatment is begun at the time of or prior to exposure. Duration and severity of systemic symptoms are also decreased if started w/in 48 hrs after exposure
|
Amantadine and Rimantadine
|
|
|
DOC in treating severe RSV in infants and young children
|
Ribavirin
|
|
|
Drug used in treating chronic hepatitis C infection when used in combination with Interferon alpha 2beta
|
Ribavirin
|
|
|
Therapy is currently available for which Hepatitis infections
|
Hepattiis B and C
|
|
|
Treatment of choice for chronic hepatitis C
|
Interferon plus Ribavirin
|
|
|
Herpes virus infections are treated during what phase of the infection
|
Acute phase
|
|
|
Mechanism of action against Herpes virus
|
inhibit viral DNA synthesis
|
|
|
DOC HSV encephalitis
|
Acyclovir
|
|
|
Drug used to treat HSV1, HSV2, varicella zoster virus
|
Acyclovir
|
|
|
What is the most common use of acyclovir
|
Genital herpes virus infection
|
|
|
What drug is given prophylactically to seropositive pts before bone marrow and after heart transplants
|
Acyclovir
|
|
|
What drug has greater oral bioavailablility than acyclovir
|
Valacyclovir
|
|
|
What drug rapidly hydrolyzes to acyclovir and achieves levels comparable to those from intravenous acyclovir administration
|
Valacyclovir
|
|
|
Drug approved for treatment of CMV-induced retinitis in pts with AIDS
|
Cidofovir
|
|
|
Drug used to treat acyclovir resistant HSV and herpes zoster infections
|
Foscarnet
|
|
|
what are the 3 classes of retroviral drugs
|
-Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTI)
-non-nucleoside reverse transcriptase inhibitors (NNRTI) -protease inhibitors (PI) |
|
|
Current recommendation for primary therapy of HIV
|
2 NRTIs with either a PI or NNRTI
|
|
|
Which class of anti HIV drugs have a potential fatal liver toxicity
|
NRTIs
|
|
|
When used with HAART, ____ decreases viral load and increase number of CD4 cells
|
AZT (Zidovudine)
|
|
|
2nd drug approved to treat HIV-1
|
Didanosine
|
|
|
This class of anti HIV drugs has a major advantage of lacking effect on the host blood-forming elements and lack of cross-resistance with NRTIs
|
NNRTIs
|
|
|
Anti HIV class of drugs that has a high incidence of hypersensitivity reactions
|
NNRTIs
|
|
|
2 NNRTI drugs used in treatment of HIV-1 in adults and children
|
Nevirapine
Delavirdine |
|
|
what anti HIV drugs have significantly altered the course of the disease
|
HIV Protease Inhibitors
|
|
|
Treatment of antiretroviral naive pts with a _____ and two NRTIs results in decrease in the plasma viral load to undetectable levels
|
Protease inhibitor
|
|
|
Name 2 Protease inhibitors
|
-Saquinavir
-Ritonavir |
|
|
Name the first drug of the new class of antiretroviral drugs known as fusion inhibitors
|
Enfuvirtide
|
