Pharm-Final Final

Front 1

Cephalexin (Keflex)

Back 1

Indications: alt to PCN; Gram + cocci; resistant to staph penicillinase
MOA: inhibits cross-linkage of cell wall peptidoglycans
Adverse effects: Cross-sensitivity; hypersensitivity; broader spectrum can lead to opportunistic infections (candidiasis)
Class: 1st gen cephalosporin

Front 2

Antibiotics

Back 2

Substances produced by the natural metabolic processes of some bugs that can inhibit or destroy other bugs.

Front 3

Semisynthetic

Back 3

Drugs which are chemically modified in the lab after being isolated from natural sources.

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Synthetic

Back 4

The use of chemical rxns to synthesize antimicrobial compounds in the laboratory

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Narrow spectrum

Back 5

Effective against a limited number of bugs

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Broad spectrum

Back 6

Effective against a wide variety of bugs

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What are the steps involved in choosing the right drug?

Back 7

1. ID bug/its sensitivity
2. Be aware of drug interactions/combinations
3. ID site of infection
4. Know the toxicity of the drug
5. Know pt factors
6. Cost

Front 8

What is imipenem/cilastatin?

Back 8

A broad spectrum abx

Front 9

What is MIC?

Back 9

Minimum inhibitory concentration. This is the lowest concentration that inhibits growth in broth.

Front 10

What are the pharmacokinetics of the BBB?

Back 10

Tight junctions prevent passage so drugs often must be administered intrathecally.

Front 11

What are the pharmacokinetics of the prostate?

Back 11

It has an acidic environment that favors bases

Front 12

What do abx do to kidney fxn?

Back 12

Most abx are excreted by the kidneys; this may allow amino glycosides to reach toxic levels

Front 13

When is chloramphenicol used?

Back 13

For life threatening illness because it is very toxic

Front 14

What are the mechanisms of resistance?

Back 14

1. DNA mutations or DNA transfer
2. Modification of target
3. Decreased permeability/increased efflux
4. Inactivation of the drug

Front 15

What are the ways bugs can transfer DNA to one another?

Back 15

1. Conjugation
2. Transformation
3. Transduction

Front 16

What are the sites of action of abxs?

Back 16

1. Cell wall synthesis
2. Metabolism
3. Protein synthesis
4. Nucleic acid synthesis and fxn

Front 17

Which abxs are inhibitors of cell wall synthesis?

Back 17

1. B-lactams
2. Vancomycin

Front 18

Which abxs are inhibitors of protein synthesis?

Back 18

1. Tetracyclines
2. Aminoglycosides
3. Macrolides
4. Clindamycin
5. Chloramphenicol

Front 19

Which abxs are inhibitors of metabolism?

Back 19

1. Sulfas
2. Trimethoprim

Front 20

Which abxs are inhibitors of nucleic acid synthesis and fxn?

Back 20

1. Fluoroquinolones
2. Rifampin

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PCN

Back 21

Indications: inf due to: Gram + cocci, Gram + bacilli, Gram - cocci, anaerobes which are B-lactamase negative, spirochetes
MOA: inhibits cross-linkage of cell wall peptidoglycans
Adverse effects: occasional hypersensitivity
Resistance: B-lactamase

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Amoxicillin

Back 22

Indications: sim to PCN but more Gram - organisms; w/clavulanante, extends spectrum to S. aureus; UTI, sinusitis, otitis, lower resp tract infections
MOA: same as PCN
Adverse effects: same as PCN
Resistance: sim to PCN; reduced uptake, altered PBP

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Cephalexin (Keflex)

Back 23

Indications: Alt to PCN; resists staph penicillinase
MOA: same as PCN
Adverse effects: cross-sensitivity w/ PCN, hypersensitivity; opportunistic infections
Class: 1st gen cephalosporin

Front 24

Cefaclor (Ceclor)

Back 24

Indications: More Gram -, less Gram +; H. flu
MOA: PCN
Adverse effects: hypersensetivity rxns, renal tox
Info: po, excreted by kidney, inhib aldehyde dehydrogenase
Class: 2nd gen cephalosporin

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Cefotaxime (Claforan)

Back 25

Indications: More Gram +, less Gram -; specific for meningitis
MOA: PCN
SE: hypersensetivity rxns, renal tox
Info: IM, IV, penetrates CNS, inhib aldehyde hydrogenase
Class: 3rd gen cephalosporin

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Cefepime (Maxipime)

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Indications: meningitis, P. aeruginosa
MOA: PCN; very broad
Adverse effects: inc risk of superinfection; renal toxicity; inhibition of aldehyde dehydrogenase
Class: 4th gen cephalosporin

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Carbapenems

Back 27

Indications: broadest B-lactam; staph (not MRSA), strep, neisseria, klebsiella, haemophilius, proteus, pseudomonas, bacteroides, anaerobes (except c diff)
MOA: imipenem inhibits cell wall synthesis; cilastatin inhibits renal dihydropeptidase I, which prevents imipenem metabolism
Adverse effects: PCN allergy cross reactivity; sz noted w/imipenem

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Aztreonam

Back 28

Indications: aerobic Gram - rods (H. flu, N. gonorrhea, E. coli, Klebseilla, Proteus, Pseudomonas)
MOA: inhibits cell wall synthesis
Adverse effects: low cross allergenicity; Gram + superinfections

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Vancomycin

Back 29

Indications: MRSA
MOA: inhibition of peptidoglycan synthesis
Adverse effects: fever, chills, redman, shock
Resistance: reduced targets

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What type of inhibition is bacteriostatic?

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Reversible

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What type of inhibition is bacteriocidal?

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Irreversible

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Tetracycline

Back 32

Indications: broad; effective against intracellular organisms; Mycoplasma pneumonae, Chlamidae, Rickettsiae
MOA: binds to 30s ribosomal subunit, blocking tRNA access, therefore protein synthesis
Adverse Effects: GI, bones, teeth, kidney, liver, photosensitivity
Resistance: Decreased influx, increased efflux, decreased binding to 30s subunit, enzymatic inactivation of drug
Class: tetracycline

Front 33

Erythromycin

Back 33

Indications: diptheria, chlamydial inf, CAP
MOA: binds 50s subunit
Adverse Effects: GI, liver
Resistance: reduce uptake, increased efflux, enzymatic hydrolysis of drug, altered 50s subunit
Class: macrolide

Front 34

Streptomycin

Back 34

Indications: Gram - enteric bacteria; used w/B-lactams; plague, tularemia; 2nd line for TB
MOA: inhibits protein synthesis
CI: pregnancy
SE: oto & nephrotox, vertigo
Info: IV, IM, doesn't enter CNS, eye or cells, cleared by kidney, used in combo w/β-lactam ab
Resistance: dec influx, inactivation, altered target
Class: aminoglycoside

Front 35

Ciproflaxcin (Cipro)

Back 35

Indications: Prostatitis, MRSA, P. aeruginosa, UTI, bacterial diarrhea; Gram - aerobic bacteria, Gram +
MOA: inhibitions of DNA gyrase (inhibits nucleic acid synthesis/fxn)
Adverse Effects: GI, dizziness, HA, insomnia, hepatitis
Resistance: point mutations in DNA gyrase
Class: fluoroquinolone

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Rifampin

Back 36

Indications: TB, meningitis, h. flu; Mycobacteria, Gram+/Gram-
MOA: inhibits DNA dependent RNA polymerase of some Gram +/- TB and N. meningitidis
Adverse Effects: free of toxicity; orange poop; stigmata
Resistance: dec affinity of the polymerase; develops rapidly-use in combination w/ other drugs
Class: semisynthetic macrocyclic

Front 37

Sulfisoxazole

Back 37

Indications: UTIs, pneumocystis carinii
MOA: inhibits folate metabolism; PO
Adverse Effects: hypersensitivity, SJS, precipitates in pee
Resistance: utilization of exogenous folate, overproduction of PABA, loss of target affinity
Class: sulfas

Front 38

How is TB spread?

Back 38

By airborne droplets from 1-5 microns in size

Front 39

Why is TB hard to kill w/abx?

Back 39

-Slow growing
-Possess a fortified cell wall
-Grows within cell
-Very good at developing resistance to single agents

Front 40

What is the standard combination therapy for TB?

Back 40

RIPE
1. Rifampin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol

Front 41

Isoniazid

Back 41

Indications: TB
MOA: prevents synthesis of mycolic acids; bactericidal for growing cells and bacteriostatic for resting cells
Adverse Effects: allergic rxns, hepatitis, peripheral neruopathy, jaundice, peripheral neuritis
Resistance: aletred mycolic acid synthesis proteins
Class: antimycobacterial

Front 42

Rifampicin

Back 42

Indications: TB; prophylaxis against meningcoccus, staph inf
MOA: inhibits DNA dependent RNA polymerase
Adverse Effects:
Resistance: target alteration
Class: rifamycins

Front 43

Ethambutol

Back 43

Indications: TB
MOA: inhibits arabinosyl transferases-cell wall synthesis
Adverse Effects: dose dependent diminished visual acuity

Front 44

Pyrazinamide

Back 44

Indications: TB
MOA: inhibits FA synthase I gene
Adverse effects: hepatotoxicity, hyperuricemia, gout
-Bactericidal at weak pH, where TB is found in macrophages

Front 45

What are the considerations for treating fungal diseases?

Back 45

1. Fungi/human cells have the same size large ribosomal subunit while bacteria have a smaller one
2. Fungi are slower growing and larger than bacteria
3. Locations of infection
4. Toxicity associated w/long term therapy
5. Fungi have a chitinous cell wall w/B-glucans
6. Fungi use ergosterol instead of cholesterol
7. Antimetabolites

Front 46

What are the types of fungal infections?

Back 46

Superficial/Subcutaneous
Systemic

Front 47

What subtypes are associated with systemic infections?

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-Exogenous
-Opportunistic

Front 48

Caspofungin

Back 48

Indications: oropharyngeal/esophageal candidiasis; invasive aspergillosis
MOA: inhibits B-(1,3)-glucan synthase-inhibits cell wall synthesis
Adverse Effects: HA, fever, phebitis at site; IV only

Front 49

Amphotericin B

Back 49

Indications: systemic fungal infections
MOA: binds to ergosterol; increases permeability of cell membrane
Adverse Effects: hypokalemia, acidosis, glomerular damage, renal tubule degeneration, fevers, HA, NVD, anemia, thrombophlebitis
Resistance: occurs w/altered sterols

Front 50

Nystatin

Back 50

Indications: tx of candida
MOA: binds to cell membrane sterols
Info: cream, ointment & powder → mucocutaneous, lozenges → oral candidiasis, PO tabs & suspensions → intestinal candidiasis

Front 51

Clotrimazole (Lotrimin)

Back 51

Indications: oral, skin, vaginal infxns; topical: dermatophytes, candidiasis, cryptococcus, tinea (not scalp or nails)
MOA: alters cell membrane permeability
Adverse Effects: induction of liver enzymes

Front 52

Miconazole (Monistat)

Back 52

Indications: vulvovaginitis
MOA: disrupts cell membrane
Adverse Effects: itching, burning, cramps, HA

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Ketoconazole

Back 53

Indications: dermatophytes, mucosal infections, seborrbeic dermatitis; systemic infections
MOA: disrupts cell membranes
Adverse Effects: N/V
Resistance:
Class:

Front 54

Fluconazole

Back 54

Indications: thrush, esophageal/systemic candidiasis, cryptococcal meningitis
MOA: disrupts cell membrane
Adverse Effects: elevated liver enzymes
Resistance: increased efflux through altered demethylase
Class:

Front 55

Itraconazole

Back 55

Indications: blastomycosis, histoplasmosis, onychomycosis
MOA: disrupts cell membrane

Front 56

Voriconazole

Back 56

Indications: invasive aspergillosis, invasive nonalbicans candidiasis
MOA: disrupts cell membrane
SE: visual disturbances, altered perception of light, chromatopsia, phytophobia, may ↑ hepatic enzymes (transitory but death possible)
Info: po availability 96% vs IV

Front 57

5-Fluorocytosine

Back 57

Indications: Candida, Aspergillus, Cryptococcus; prophylaxis w/ AIDS (w/amphotecerine B)
MOA: inhibits DNA/RNA synthesis
Adverse Effects: neutropenia, BMD
Resistance: transport, cytosine deaminase, anabolism
Info: PO, CSF, low protein binding, no metabolism, renal filtration, neutropenia, BMD, combo w/AZT

Front 58

Griseofulvin

Back 58

Indications: dermatophytes
MOA: inhibits microtubules; fungicidal/fungistatic
Adverse effects: CYT3A4 induction-reduces wafarin, BCPs

Front 59

Amantadine

Back 59

Indications: tx/prevent flu A; parkinson's
MOA: inhibits viral uncoating

Front 60

Oseltamivir

Back 60

Indications: flu A/B
MOA: neurominidase
SE:

Front 61

Acyclovir

Back 61

Indications: HSV 1/2; chickenpox
MOA: inhibits DNA synthesis
SE: GI and HA, rare nephrotox w/IV; alteration of VTK causes resistance

Front 62

Ganciclovir

Back 62

Indications: CMV
MOA: inhibts DNA synthesis
SE: myelosuppresion; MOA same as acyclovir

Front 63

Zidovudine

Back 63

Indications: HAART
MOA: NRTI
SE: myelosuppresion

Front 64

Nevirapine

Back 64

Indications: HAART; can be prophylactic for delivery
MOA: NNRTI, binds and inhibits HIV-1rtase
SE: SJS (7%)

Front 65

Ritonavir

Back 65

Indications: HAART
MOA: protease-inhibitors; inhibits proteolytic cleavage of GAG-POL polyprotein
SE: induces lipodystrophy

Front 66

Protease Inhibitors

Back 66

Indications:
MOA: HAART
SE: induces lipodystrophy

Front 67

Interferons

Back 67

Indications: HepB, HepC
MOA: suppresses cell proliferation & inhibits viral replication
SE: severe depression, SI/SA, flu-like s/sx

Front 68

Ribavirin

Back 68

Indications: RSV, flu, HepC
MOA: selective viral RNA & DNA synthesis

Front 69

PIs

Back 69

Indications: HIV
MOA: protease inhibitor; inhibits proteolytic cleavage of gag-pol polyprotein
SE: Induces lipodystrophy; resistance to monotherapy

Front 70

Choloroquine

Back 70

Indications: clinical cure (all forms), prophylaxis for sensitive organisms, radical cure (P. falciparum & P. malariae)
SE: rash, puritis, lupus-like syndromes, retinal/corneal toxicity, ototoxicity w/high doses
CI: porphyria, poriasis

Front 71

Quinine/Quinidine

Back 71

Indications: malaria-RBC forms; DOC for chloroquine-resistant plasmodia
SE: may increase uterine contractions, hemolysis/hemoglobinuria, skeletal muscle relaxation from mild NM blockade; PO/IV

Front 72

Mefloquine

Back 72

Indications: prophylaxis against all chloroquine-resistant P. vivax (RBC forms)
SE: GI upset, myocardium depression, sz, possible teratogen; PO; sleep/behavior disturbances, elicit latent psych issues

Front 73

Pyrimethamine/Sulfadoxine

Back 73

Indications: malaria; presumptive tx; mainly RBC form, some effect on sporozites/pre-RBCs, some effect on 2nd tissue forms
SE: sulfa drug

Front 74

Primiquine

Back 74

Indications: malaria; exoerythrocyte and gametocytes; radical cure of p.vivax and p. ovale; won't suppress dz once developed; only drug available for tissue/late stage tx
SE: GI upset, HA, dizziness,

Front 75

Metronidazole

Back 75

Indications: E. histolytica, G. lamblia, T. vaginalis; anaerobic bacteria: Bacteroides fragilis & Clostridum difficile
SE: GI irritation, metallic taste, reddish urine, disulfiram-like effect (avoid -OH), carcinogenic in animals, rarely: HA, ataxia, seizures, neuropathies, neutropenia, pregnancy- avoid 1st trimester Info:distributes widely (inc CSF), kills amoeba in GI lumen (mixed amebicide), po & parenteral

Front 76

Paromomycin

Back 76

Indications: luminal trophozoites & cysts of E. histolytica, T. vaginalis, tapeworm; combo w/metronidazole for ambebiasis or w/o for asymptomatic amebiasis
SE: SE: GI upset- potential for oto and nephrotox w/paren (aminoglycoside AB) Info: poorly abs from GI tract

Front 77

Sulfatrim

Back 77

Indications: pneumocytosis, useful for toxicoplasmosis, porphylaxis
SE: rash, pruritis, cytopenias & transaminase elevation

Front 78

Mebendazole

Back 78

Indications: roundworm, whipworm, hookworm, pinworm, trichinosis (w/corticosteriod), may work for some tapeworms
MOA: binds to tubulin, interferes w/protein fxn
SE: GI discomfort & diarrhea Info: 10% abs from GI (↓ system tox), caution in preg- may be teratogenic

Front 79

Pyrantel pamoate

Back 79

Indications: roundworm, pinworm, hookworm; 2nd DOC for mebendazole
MOA: cholinesterase inhibitor; depolarizing NM blockage in worm
SE: dizziness, HA, drowsiness

Front 80

Ivermectin

Back 80

Indications: DoC for filaria infestation & onchocerciasis (O. volvulus -> river blindness), also for threadworm, roundworm & cutaneous larva migrans
MOA: alters Cl- permeability/paralyzes parasite
SE: puritis, tender lymph nodes, fever; CI w/BBB compromise, don't use w/ drugs that act on the GABA receptor

Front 81

Thiabendazole

Back 81

Indications: strongyloidiasis (threadworm), useful for larva migrans and effective in trichinosis and visceral larva migrans
MOA: interferes w/microtubule aggregation
SE: anorexia, N/V, diarrhea, pruritus, HA, dizz, visual & neuropsychiatric disturbances, potential for allergic rxns Info: has anti-inflamm properties

Front 82

Niclosamide

Back 82

Indications: most tapeworms
MOA: inhbibits anaerobic oxidative phosphorylation
SE: HA, skin rashes, pruritis (antigenic material from worms), loose stools abdominal discomfort Info: single dose = cure, not abs not effective against cysticercosis (use laxatives for T. solium)

Front 83

Praziquantel

Back 83

Indications: shistosomes, many cestodes, trematodes, cysticercosis
MOA: increases Ca2+ permeability, causes contractions then paralysis
SE: low tox, N/V, abdominal discomfort from release of dead worm protein Info: well absorbed, good for systemic infections, little effect on human muscle

Front 84

What causes Pneumocystosis

Back 84

Pneumocystis carinii (Pneumocystis jiroveci)

Front 85

What causes Toxoplasmosis

Back 85

Toxoplasma gondii

Front 86

What causes Trichomoniasis

Back 86

Trichomonas vaginalis

Front 87

What treats E. histolytica?

Back 87

Flagyl, paromomycin (cysts)

Front 88

What causes amebiasis?

Back 88

E. histolytica

Front 89

What treats toxicoplasmosis?

Back 89

Sulfatrim, pryimethamine+sulfadiazine (DOC)

Front 90

What treats giardiasis?

Back 90

Flagyl

Front 91

What treats triachomonoasis?

Back 91

Flagyl

Front 92

What treats pneumocystosis?

Back 92

Sulfa-trim (DOC)