Pharm Final

Front 1

mechanism of amphotericin B

Back 1

-binds to the ergosterol component of fungal cell membranes and alters permeability to allow leakage of ions and other intracellular components
-greater selectivity for fungal membranes which contain ergosterol instead of cholesterol as in mammalian cells

Front 2

broadest-spectrum antifungal and is the drug of choice for major systemic fungal infections, especially in immunocompromised patients

Back 2

amphotericin B

Front 3

ADRs of amphotericin B

Back 3

-infusion reactions: fever, chills, headache, nausea; usually occur 1-3 hr after starting infusion and severity lessens with subsequent dosing; may be managed by pretreatment with NSAIDs, antihistamines and steroids
-nephrotoxicity (80%)
((use lipid formulations to prevent nephrotoxicity))

Front 4

__ is a synthetic pyrimidine antimetabolite used adjunctively in combination with amphotericin B for treatment of systemic mycoses and meningitis

Back 4

Flucytosine (5FC)

Front 5

Flucytosine (5FC) is a synthetic pyrimidine antimetabolite used adjunctively in combination with __ for treatment of __ and __

Back 5

amphotericin B

systemic mycoses and meningitis

Front 6

how do you take Flucytosine (5FC)?

Back 6

it is a well absorbed PO..penetrates CNS

Front 7

5FC is transported into fungal cells by a __(not found in mammalian cells) and is then converted to fluorouracil; after several steps the metabolite 5-FdUMP is formed which inhibits thymidylate synthetase, stopping DNA synthesis

Back 7

permease

Front 8

mechanism of action of azoles

Back 8

inhibition of the P450 isoenzyme that converts lanosterol to ergosterol; inhibition of ergosterol production results in deficient fungal membranes with increased permeability, leakage of cellular contents, and inhibition of fungal growth

Front 9

what impairs absorption of ketoconazole? what enhances it?

Back 9

food, antacids, H2 antagonists, PPIs

acidic cola drinks

Front 10

what are the ADRs of ketoconazole?

Back 10

-endocrine: gynecomastia, impotence
-black box warning for hepatotoxicity: rare, serious hepatic dysfunction

Front 11

DIs of ketoconazole

Back 11

-Do not take with antacids since gastric acidity is required for dissolution and absorption. If antacids, anticholinergics, H2 blockers, or PPIs are needed, give at least 2 hr after ketoconazole.
-inhibits P450 system

Front 12

antagonizes action of amphotericin B, concurrent use is contraindicated; considered a class effect of azoles

Back 12

azoles

Front 13

fluconazole: po absorption __ on gastric acidity

Back 13

not dependent (like it is in ketoconazole)

Front 14

what is fluconazole (diflucan) the DOC for?

Back 14

- cryptococcal meningitis (excellent penetration into CSF)
- coccidioidomycosis

Front 15

Itraconazole..is this used orally or topically? does it penetrate the CSF?

Back 15

orally

no

Front 16

indication for itraconazole

Back 16

Pulse dosing for onychomycosis (fungal nail infections)

Front 17

Pulse dosing for onychomycosis (fungal nail infections)

Back 17

itraconazole

Front 18

1st-line agent for treatment of acute, invasive aspergillosis

Back 18

voriconazole

Front 19

indications for voriconazole

Back 19

-1st-line agent for treatment of acute, invasive aspergillosis
-treatment of nonneutropenic patients with candidemia or deep tissue candidal infection

Front 20

treatment of nonneutropenic patients with candidemia or deep tissue candidal infection

Back 20

voriconazole

Front 21

prophylaxis of invasive aspergillosis and candidiasis in patients who are severely immunocompromised

Back 21

Posaconazole

Front 22

indication for Posaconazole

Back 22

prophylaxis of invasive aspergillosis and candidiasis in patients who are severely immunocompromised

Front 23

ADRs of posaconazole

Back 23

- hepatic failure, sometimes severe
- QT prolongation

Front 24

empirical treatment of presumed fungal infections in febrile, neutropenic patients

Back 24

Caspofungin

Front 25

indication for Caspofungin

Back 25

empirical treatment of presumed fungal infections in febrile, neutropenic patients

Front 26

OTC 1% cream or solution; treatment of tinea pedis, tinea cruris, and tinea corporis

Back 26

clotrimazole

Front 27

-interacts with the fungal cell microtubules to disrupt the mitotic spindle and inhibit mitosis
-therapy must be continued until normal tissue replaces infected tissue (weeks to months)

Back 27

griseofulvin

Front 28

is Griseofulvin fungicidal or fungistatic?

Back 28

fungistatic..only active against dermatophytes

Front 29

-synthetic fungicidal agent which inhibits squalene epoxidase, an essential enzyme in fungal sterol synthesis; produces a deficiency of ergosterol and an accumulation of squalene inside the fungal cell resulting in cell death
-indicated for treatment of onychomycosis of the toenail or fingernail due to dermatophytes

Back 29

terbinafine

Front 30

indication for terbinafine

Back 30

treatment of onychomycosis of the toenail or fingernail due to dermatophytes

Front 31

Agents for Topical/Vaginal Candidiasis

Back 31

-Nystatin
-Clotrimazole
-Miconazole

Front 32

vaginal formulations for local treatment of VVC

Back 32

-terconazole
-butoconazole

Front 33

how is Nystatin dosed?

Back 33

oral suspension: 5 mL qid (one-half of dose in each side of mouth, “swish and swallow”, retaining the drug as long as possible before swallowing)

-topical for superficial Candida fungal infections of the skin, mucous membranes, and intestinal tract
-oral suspension for “swish and swallow” treatment of oral candidiasis
(too toxic for systemic administration; not absorbed po)

Front 34

polyene antibiotic similar in structure and mechanism of action to amphotericin B (alters cell membrane permeability); broad-spectrum, may be either fungicidal or fungistatic

Back 34

nystatin

Front 35

is clotrimazole fungicidal or static?

Back 35

cidal

Front 36

how is clotrimazole given?

Back 36

buccal tablet: indicated for local treatment of oropharyngeal candidiasis (1 troche 5 times qd for 14 days), and for prophylaxis of oropharyngeal candidiasis in immunocompromised patients

Front 37

DOC for trichomoniasis

Back 37

metronidazole

Front 38

metronidazole tx for trichomoniasis guidelines

Back 38

- clinical syndromes of vaginitis, nongonococcal urethritis (5% of cases in males), prostatitis
- must also treat sexual partner and practice abstinence until cure is effected (therapy completed and both partners asymptomatic)
- preferred regimen is 2 g po single dose

Front 39

DOC for helminthic infections (pinworm, whipworm, roundworm, hookworm)

Back 39

Mebendazole: 100 mg chewable tablet

Front 40

what is mebendazole the DOC for?

Back 40

helminthic infections (pinworm, whipworm, roundworm, and hookworm)

Front 41

CDC recommended that neither __ or __ be used for treatment or prophylaxis of influenza in the US until susceptibility is re-established among circulating influenza A viruses

Back 41

amantadine nor rimantadine

Front 42

ADR of zanamivir

Back 42

not recommended for treatment or prophylaxis in patients with underlying airways disease (asthma or COPD) due to risk of serious bronchospasm

Front 43

- treatment of uncomplicated acute illness due to influenza virus (Types A and B) in adults and adolescents >= 7 years old who have been symptomatic for <= 2 days

Back 43

zanamivir

Front 44

treatment of uncomplicated acute illness due to influenza virus in patients > 1 year of age who have been symptomatic for <= 2 days

Back 44

oseltamivir

Front 45

neuraminidase inhibitors

Back 45

zanamivir and oseltamivir

Front 46

__is a synthetic guanosine nuceloside analog; in host cells, ribavirin is phosphorylated by cellular kinases to the monophosphate, diphosphate, and triphosphate forms; these forms subsequently interfere with critical reactions needed for viral replication, blocking the synthesis and replication of viral RNA

Back 46

ribavirin

Front 47

TREATMENT of severe lower respiratory tract infections due to RSV in hospitalized infants and young children

Back 47

ribavirin

Front 48

indicated for prevention of serious lower respiratory tract disease caused by RSV in high-risk pediatric patients

Back 48

palivizumab

Front 49

TX of RSV is __
PREVENTION of RSV is __

Back 49

ribavirin
palivizumab

Front 50

acyclovir is phosphorylated in the viral-infected cell by the viral enzyme __; basis for selective toxicity is that this reaction occurs 100 times more rapidly inside the virus-infected cell than in noninfected host cells

Back 50

thymidine kinase

Front 51

what disease is resistant to acyclovir? why? what diseases are sensitive to it?

Back 51

cytomegalovirus (CMV) is resistant since it lacks a specific viral thymidine kinase

herpes simplex virus-1 (HSV1), HSV2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV)

Front 52

ADR of acyclovir

Back 52

nephrotoxicity if given as IV bolus or if solubility is exceeded due to tubular precipitation of ACY crystals (give only by slow infusion over at least 1 hr with adequate hydration)

Front 53

synthetic analog of ACY; prodrug which is converted intracellularly to an active triphosphate form

Back 53

ganciclovir

Front 54

spectrum of antiviral activity is similar to ACY with the exception that ganciclovir is __

Back 54

active vs. CMV

Front 55

antiviral that is active against CMV

Back 55

ganciclovir

Front 56

ADR of ganciclovir

Back 56

myelosuppression
- neutropenia
- anemia
- thrombocytopenia

Front 57

DIs with ganciclovir

Back 57

-nephrotoxic drugs: increased SCr, additive nephrotoxicity
-probenecid: decreased renal clearance of ganciclovir
-zidovudine: additive neutropenia and anemia

Front 58

prodrug of the antiviral agent penciclovir

Back 58

famciclovir

Front 59

indication for famciclovir

Back 59

treatment of acute herpes zoster

Front 60

treatment of acute herpes zoster

Back 60

famciclovir

Front 61

prodrug of acyclovir to counter the problems with absorption of ACY

Back 61

valacyclovir (also acyclovir)

Front 62

2nd-line agent to ganciclovir for CMV

Back 62

foscarnet sodium

Front 63

indications for foscarnet sodium

Back 63

-2nd-line agent to ganciclovir for CMV
-active vs. ganciclovir-resistant CMV and ACY-resistant HSV and VZV

Front 64

ADRs of foscarnet sodium

Back 64

-renal dysfunction
-seizures- increased risk with low serum calcium
-chelation of divalent cations may cause hypocalcemia; decreased serum calcium may cause seizures;
-anemia

Front 65

3rd-line agent for CMV

Back 65

cidofovir

Front 66

how must cidofovir be given?

Back 66

must be administered by slow IV infusion with probenecid and IV saline prehydration

Front 67

ADRs of cidofovir

Back 67

-nephrotoxicity
-neutropenia

Front 68

ester prodrug of ganciclovir

Back 68

valganciclovir

Front 69

primary keratoconjunctivitis and recurrent epithelial keratitis due to HSV-1 and HSV-2

Back 69

trifluridine

Front 70

indicated for treatment of recurrent herpes labialis (cold sores) in adults

Back 70

penciclovir

Front 71

antiretroviral therapy (ART) should be initiated in all patients with __ or __

Back 71

a history of an AIDS-defining illness or with a CD4 count < 350 cells/cmm

Front 72

ART should also be initiated, regardless of CD4 count, in patients with the following conditions: (3)

Back 72

-pregnancy
-HIV-associated nephropathy
-HBV coinfection when treatment of HBV is indicated

Front 73

antiretroviral therapy is recommended for patients with CD4 counts between __cells/cmm

Back 73

350-500

Front 74

HHART-all of the currently preferred regimens have the following characteristics:(3)

Back 74

-at least three antiretroviral drugs are used
-the regimens have combinations of drugs that have different mechanisms of action
-class-sparing

Front 75

recommended preferred antiretroviral regimens for initiating treatment in naïve patients

Back 75

regimen #1: one NNRTI plus two NRTIs

(efavirenz plus tenofovir/emtricitabine)

Front 76

HAART: regimen #2

Back 76

ritonavir boosted PI plus two NRTIs

(atazanavir plus ritonavir tenofovir/emtricitabine or darunavir plus ritonavir tenofovir/emtricitabine)

Front 77

HAART: regimen #3

Back 77

INSTI plus two NRTIs

(raltegravir plus tenofovir/emtricitabine)

Front 78

preferred antiretroviral regimen for pregnant women

Back 78

lopinavir/ritonavir plus zidovudine/lamivudine

Front 79

HAART: __is the essential parameter in decisions to start or modify the drug regimen

Back 79

HIV RNA viral load testing

Front 80

key factor for deciding whether to initiate antiretroviral therapy and chemoprophylaxis for OIs

Back 80

CD4+ cell count

Front 81

HIV: strongest predictor of subsequent disease progression and survival

Back 81

CD4+ cell count

Front 82

treatment of acute HIV infection is considered __at this time

Back 82

optional

Front 83

resistance testing is of greatest value when performed before or within __

Back 83

4 weeks after drugs are discontinued

Front 84

NRTI stands for?

Back 84

NucleoSide Inhibitors of Viral Reverse Transcriptase

Front 85

clas effect ADR of NRTI

Back 85

rare cases of lactic acidosis with hepatic steatosis

Front 86

ADRs of zidovudine

Back 86

myelosuppression, neutropenia, severe anemia

Front 87

ADRs of didanosine

Back 87

-pancreatitis
-class effect: lactic acidosis and severe hepatomegaly with steatosis
-peripheral neuropathy

Front 88

ADR of lamivudine

Back 88

peripheral neuropathy

Front 89

combivir is a combination of what two drugs?

Back 89

lamivudine plus zidovudine

Front 90

ADR of abacavir

Back 90

hypersensitivity reactions

***screen them for HLA-B*5701 before starting this drug