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395 Cards in this Set
- Front
- Back
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what contributes to 80% of failure of chemotherapy
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chemo resistance
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what contributes to 80% of failure of chemotherapy
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chemo resistance
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what type of resistance builds to one agent only
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single resistance
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what type of resistance builds to many chemotherapeutic agents after tx with only a single drug
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multidrug resistance
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what are 3 common mech or resistance
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drug can't get in cell, drug pumped out of cell, cell inactivate drug
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what chemo is adding multiple agents together in a specific sequence
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combination
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what is combo chemo designed based on
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based on side effects
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Most chemo drugs cause myelosuppression out to around __ days, so combo chemo is typically cycled every _____
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28, month
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what is the rationale for combo chemo
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1. overcome resistance, 2. enhance anti0tumor effect, 3. rescue normal cells from cell death
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what is added to methotrexate tx
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leucovorin
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what is a complete respone to chemotherapy
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disappearance of all dx
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what is partial response to chemotherapy
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greater 50% red
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what MUST be considered when thing of chemo
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quality of live
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what are the 3 major classes of chemo
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1. alkylating agents, 2. antimetabolites, 3.plant alkaloids
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how and to what do alkylating agents bind
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how: covalently, to DNA
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What do alkylating agents do to DNA
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inhibits DNA synthesis and stops cell growth
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what cells do alkylating agents attack
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ANY
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From what was alkylating agents derived from, and when were they first used to tx cancer
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derived from chem warfare agents (mustard gas), 1st used WWII
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what are 2 common alkylating agents [cc]
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cyclophosphamide, carmustine
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what chemo agent block the biosynthesis or use of normal cellular metabolites
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antimetabolites
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the classes of antimetabolites we study in class inhibit what
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DNA synthesis
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what is the difference between antimetabolites and alkylating agent is what
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antimetabolites attach slower growing tumors better than alkylators
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what are 2 antimetabolite drugs
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methotrexate, 5-fluorouracil
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what are the vincas [4] of plant alkaloids
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vincristine, vinblastine, vinorelbine, vindesine
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where do vincas come rom
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periwinkle bush
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how do the vincas [plant alkoids] arrest cell division
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prevent formation of mitotic spindle thrugh disaggregation of microtubules
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what are the [2] taxenes of plant alkaloids
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paclitaxel, docetaxel
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where are taxenes [plant alkaloids] isolated from
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yew bush
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how do the taxenes prevent cell division
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stabalize microtubules to inhibit mitotic spindle assembly
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what are the 3 major toxicities of chemo agents
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1. myelosuppression, 2. dermatologic tox, 3. GI tox
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what is myelosuppression
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bone marrow suppression
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what is the most common dose limiting tox of chemo agenst and is both DOSE AND AGENT related
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myelosuppression
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why is myelosuppression a problem
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pt susceptible to infections
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what are the 3 derm tox
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1. alopecia (hair loss), 2. extravasation necrosis 3. oral mucositis
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how does alopecia affect pt
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quality
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what is localized issue damage if drug is adminstered outside a vein
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extravastion necrosis
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what are 2 things seen with oral mucositis
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1. erythema, 2. inc infections
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how tx oral mucositis
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1. saline or bicarbonate rinse, 2. mucosal coating agents, 3. lubricating agents, 4. topical anesthetics, 5. film-forming agents
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what is the most upsetting adverse effect to pt
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gi tox- nausa and vomiting
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what causes GI tox
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direct irritation GI membrane, CTZ zone, death GI mucosal cells
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3 classes of adrenal cortical steroids
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1. corticosteroids, mineralcorticocoids, 3. adrogens
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what is the main cortiosteroid
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cortisol- prod resp ACTH
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what is the main mineralcorticocoids
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aldosterone-
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what are the normal levels of adrenal steroids
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low
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what are the level of adrenal steroids during stress
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high
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what are the 4 effects of clucorticoids
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1. anti inflammatory, 2. lipid metabolism, 3. CNS, 4. blood defects
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what is caused by hypersecretion of cortisol
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cushings syndrom- gain fat neck
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where is glucocorticoid steroid met
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liver- taken PO, IV, skin, nose, inhale
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what effect glucorticoid have on blood effect
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dec amt, dec T cells
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what are the SE of glucocorticoids
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1. adrenal suppression, 2. inc inf susceptibility, 3. myopathy, 4. CNS effects, 5. cararacts, 6. osteoporosis, 7. growth inhibition, 8. cushings
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what bone related cells are suppressed and stimulated by glucocortroids
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sup- osteoblasts, stim- osteoclasts
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with glucocorticoids toxicity is proportion to what
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done to number of doses
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what are the 9 uses of steroids
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1. replacement therapy, 2. allergies, 3. arthritis, 4. cerebral edema, 5. ocular disease, 6. GI, 7. general immunosuppression, 8. cancer, 9. skin dx
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replacement therapy is used for what 2 dx
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1. acute adrenal insufficiency, 2. addisons dx
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steroid inc risk cancer b/c
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kill t cell
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what is the endogenous steroid
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cortisol
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what are the 3 synthetic steroids
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1. prednisone, 2. dexamethasone, 3. triamcinolone
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what is major estogen in body
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estradiol- sys in ovary follicle by FSH
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estrogen act similar to what
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thyroid hormone and adrenal steroids- all act same- gonadal MOA
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what plays a role in endometrial lining
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estrogen
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if estrogen is given continuously can get what of endometrium
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hyperplasia
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what are 3 metabolic effects of estrogens
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1. inc bone mass, dec LDL, inc HDL, 3.inc prod clotting prot
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what are positive things of HRT
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inc bone mass, menopause symptoms reduced
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what are neg things asso with HRT
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CV problems, no help iwth memory, inc risk cancers
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progestins is an endogenous what
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progesterone- syn over resp to LH
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what are the actions or progestins
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1. reproductive effects, 2. menstrual cycle, 3. maintenance of preg
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what do oral contraceptives inhibit
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FSH and LH
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what are oral contraceptive with progestin only called
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minipills- not consistenly inhibit ovulation
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what are post-coital contraceptives
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high dose estrogen, estrogen-progestin combo
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how are oral contraceptives metabolized
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P450 enzymes
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when taking OC what kill the normal gut flora resp or abs of OC
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antibiotics
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what are the 4 major complicaiton of OC
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1. thromboembolic comp, 2. cancer, 3. inc gallstones, 4. inc migraine headaches
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what caused vaginal tumors in female offstring of women too OC
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diethylstilbestrol
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what are the health benefits of OC
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1. dec anemia, 2. dec ovarian cancer, 3. dec inf pelvic dx, 4. inc BD, 5. dec acne
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what are the 3 androgens
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testosterone, dihydrotestosterone, estradiol
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what is major androgen, synthesized leydig cells of testes
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testosterone
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which androgen is an active metabolite of testosterone, formed by actions of enzyme 5 reductase
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dihydrotestosterone (DHT)
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what androgen is made by cyclization of testosterone
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estridiol
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what is the anabolic effect of androgens
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promote body growth in both sexes
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what are the 5 SE of adrogens
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1. masculinization, 2. feminization, 3. edema, 4. hepatoxicity, 5. CNS
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how is edema (SE) related to androgens
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mineralocorticoid effects
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what is the MOA of bisphosphonates
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analogs of pyrophosphate that inhibit osteoclast formation --> bone resp
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what are bixphosphonates used for
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osteoporosis
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what are the bisphosphonates
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1. alendronate, 2. risedronate, 3. etidronate, 4. zolendronate
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what are the ADR to bisphosphonates
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GI, given am after fast,
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what is concerned with the deleterious effects of these chemical agents on all living systems
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toxicology
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what type of tox delas with chem found in workplace
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occupational tox
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what tox deals with impact of chemicals present as polutaints of enviro
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enviro tox
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what is major route exp with endustrial tox
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inhalation
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how atmospheric pollutans gain entry
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inhlation
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how pollutants of water and soil gain entry
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oral ingestion
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what is principle route of exp for humans
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oral ingestion
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what is the major air pollutants
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CO
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what does CO+Hb=
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carboxy Hb
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does carboxy Hb transport O2
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NO
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what organs most affect by CO
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brain and heart
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how tx CO tox
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1. remove exp source, 2. maintenance of resp, 3. admin O2.
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what is the specific antagonist of CO
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O2
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what are 2 solvents
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1. halogenated aliphatic hydrocarbins, 2. aromatic hydrocarons
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what are examples of halogenated aliphatic hydrocarbons
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industrial solvents, degressing agenst, cleaning agents
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what are signs and symptoms of halogenated aliphatic hydrocarbon tox
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CNS dep, liver injury kidney injury, CV tox
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what is the 2 aromatic hydrocarbons
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benzene, toluene
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what aromatic hydrocarbon is used for solvent prop and systhesis of other chem
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benzene
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what occurs with acute tox of benzene
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CNS dep
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what is the most sig effect of chronic exp benzene
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bone marrow suppression
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what are the effects of tulene
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CNS dep, no myelosuppression
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what are the 2 types of insecticides
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chlorinated hydrocarbon and oragnophosphorus and cabamate
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what are signs and sym of chlorinated hydrocarbon tox
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CNS stim, convulsion, tremor, tumorigenicity
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what are most symptoms of tox of organophosphorus and carbamate due to
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effect on inhibition of acetylcholinesterase (Ach-ase)
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what is an example of and enviro pollutant
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polychlorinated biphenyls (PCB)
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T/F PCB are presistent in the enviroment
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T- stable, highly lipophilic, poor metabolized, ver resistant degrade, bioaccumulate food chain
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what is the major souce of PCB exposure
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food
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what are the main sign and symptoms of PCB tox
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dermatologic prob
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what is the olest occupational and enviro dx in the world- a tox of heavy metal
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lead
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where do you see sign and symptoms
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CNS
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how tx lead tox
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remove exp, supportive care, CHELATION therapy
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what does lead replace
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calcium
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what is found in water supply and is a problem in OK
|
arsenic
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Why is mercury a problem in certain fish
|
bioaccumulate
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Where are sign and symptom of acute
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GI, and hypotension
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Where is mercury poorly abs and volatile and abs readily
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poor- GI, readily- lungs
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the chelating agents for heavy metals is usually flexible with 2 or more electroneg groups to stable with cationic metal atom
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how many cases of acute poisoning a year
|
million cases- small % fatal
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what are most deaths due to poisoning
|
intentional suicide
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what causes the poisoned pt to die
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depress CNS, CV tox, hypoxia, seizures, hyperthermia
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how initial mgt of the poisoned pt ABCD
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Airway, breathing, circulation, challenge with concentration dextrose- test diabetes
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how decontaminate skin
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removing clothing, and wash with soap and water
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how decontaminat GI
|
adm activated charcoal-bind ing poisons if ingested w/in 1hr emesis or lavage
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what is formed from histidine and occurs primarily bound to heparin in mast
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histamine
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what are initiators of allergic rxn
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mast cells
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what do mast cells do to blood flow
|
inc
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which receptor for histamine causes vasodiolation, NN stimulation, and bronchiolar and intestinal constriction
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H1
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what receptor for histamine are impt for gastric secretion
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H2
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what is the triple response of histamine
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1. red spot (vasodiol), 2. wheal (edema), 3. flare (NN stimulaiton)
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what are constricted by histamine
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bronchioles, gut, and urinary bladder
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leukotrienes are the most impt mediator of what
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anaphylaxis tx is epi
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what are the 6 H1 antihistamines
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1. diphenhydramine, 2. promethazine, 3. chlorpheniramine, 4. loratadine, 5. fexofenadine, 6. meclizine
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what is the main OCT block vaxcular, brain--> drowsy, sleep aid
|
diphenhydramine
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what is a broad spectrum, CNS action, used ER prevent crisis, also effects of diphenhydramine
|
promethazine
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what are the 2 Rx antihistamine- no BBB
|
loratadine, fexofenadine
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what is the antihistamine H1 for motion sickness, Rx cental hist block
|
mexlizine
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what are the 4 H2 used for gastic acid secretion
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1. cimetidine, 2. ranidine, 3. ramotidine, nizatidine
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leading cause of death 4. lower resp dx, 7. pneumonia and influenza
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what is an inflammatory dx asso bronchospasm
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asthma
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what are 4 symptoms of asthma
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shortness of breath, cough, wheezing, chest tightness
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what are the 2 drugs for asthma
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1. quick relief med (dec attack), 2. long-term controllers (dec inflammatory dx)
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what are the 3 quick relief medication
|
1. inhaled beta 2 adrenoceptors agonist, 2. anticholinergic, 3. systemic corticosteroids
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what is used for the relief of acute symptoms/bronchospasms, prevent asthma b4 exercise
|
albuterol
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what is the acute SE that has not been seperated brom bronch spasm
|
tremor
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what is the inhaled beta 2 adrenoceptor agonist
|
albuterol
|
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what is the anticholinergic quick relief
|
ipratropium
|
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what quick relief med relief acute bronchospasm, addictive beta 2 agonist,
|
ipratropium- anticholinergic
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what has mech of bronchiodiolation by competive inhibiton of muscarinic cholinergic rec
|
anticholinergic- ipratropium
|
|
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what is the systemic steroid for quick relief
|
prenisone
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what quick relief med is for short term burst to gain control, speed recovery, and prevent recurrence of asthma
|
prednisone
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what antiinflammatory reduce airway hyperresponsive, block late rxn to allergens
|
prednisone
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what are the 6 long term asthma controllers
|
1. inhaled corticosteroid, 2.histamine release inhibitors 3. leukotriene modifiers oral 4. long act inhaled beta 2 adrenoceptor agonist, 5. systeimic steroids, 6. methylxanthine
|
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what are the 2 inhaled steroids for long relief
|
beclomethasone, fluticasone
|
|
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what long term is used to prevent symptoms, suppression, controla dn reverse inflammaiton,
|
inhaled steroids
|
|
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what is the histamine release inhibitor
|
cromolyn
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what long term med prevent symptoms, modify inflammation, preventive tx prior exp to ex or allergen
|
hist release inhib-cromolyn
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what long relief stabilize mast cell membranes
|
hist release inhib-cromolyn
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what are the 3 leukotriene modifiers
|
zafirlukast, montelukoast, zileuton
|
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what long releif is prevent mild presistent asthma, is a leukotriene inhibitor
|
zafirlukast, montelukast
|
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what leukotriene modifier prevent mild persisten asthma, inibit 5-lipoxygenase
|
zileuton
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|
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what is the long acting inhaled beta 2 adrenoceptor agonist
|
salmeterol
|
|
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what drug is a long prevention of symptoms, noctural symptoms, prev of exercise induced bronchospasm
|
salmeterol beta 2 agonist
|
|
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what long act mech to broncho diolate by adenylate cyclase activation, inc cyclic AMP, long dur due to exosite binding
|
salmeterol beta 2 agonist
|
|
|
how long does it take for salmeterol to work
|
1 hr
|
|
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what is the systemic steroid
|
prednisone
|
|
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when use prednisone for long term use
|
severe presistent asthma
|
|
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what long relief reduce airway hyper responsiveness, block late rxn antigens, inhibits sytokine prod, adhesion protein activion and inflammatory cell migration and activation
|
prednisone
|
|
|
what is amethylxanthine
|
theophyline sustained release
|
|
|
what is used to prevent symptoms nocturnal, broncho diol from phosphodiesterase inhibition and adenosine antagonism
|
theophyline sustained release
|
|
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what are used to remove microbes from objects
|
disinfectants
|
|
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what ware used on skin to remove microbes
|
antiseptics
|
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what is and essential feature of any valuable chemotherapeutic agent
|
selective toxicity
|
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the selective toxicity of chemo drugs is closely related to their what
|
mech of action
|
|
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what are the 5 ways most chemo drugs act
|
1. inhibit cell walls synthesis, 2. inhibit protein synthesis, 3. destructio cell membrane fun, 4. altered nucleic acid synthesis, 5. misc action
|
|
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what is the most common side effect of chemo
|
GI
|
|
|
what antibacterial spectrum are primary G+ OR G-
|
narrow
|
|
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what antibacterial spectrum are effect against G+ AND G-
|
broad
|
|
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what spectrum designation is intermediate bt narrow spectrum and broad spectrum
|
extended
|
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|
faculative bacteria grow in what enviroment
|
anaerobic or aerobic
|
|
|
what antibiotic is indicated for anaerobic inf
|
clindamycin of metronidazole
|
|
|
how do bactericidal drugs affect bacteria
|
directly kill
|
|
|
what do bacteriostatic drugs do to bacteria
|
stop from growing
|
|
|
what is the concentration that must be achieved to inhibit bact growth
|
MIC minimum inhibitory [ ]
|
|
|
what antibiotics include penicilllins and cephalosporins are the most inpt group of cell wall synthesis inhibitors
|
B lactam antibiotics
|
|
|
what are bacteria prod enzymes referred to as
|
B lactamases
|
|
|
what is the adv of amoxicillin over other B lactam antibiotics
|
ext abs GI tract, extended antibacterial spectrum, low SE
|
|
|
what is the B lactamase inhibitor combined with amoxicillin to increase its effectiveness
|
clavulanic acid
|
|
|
what antibiotics inhibits bacterial protein synthesis (50 S ribosome)
|
macrolide antibiotics
|
|
|
what was the first macrolide antibiotic deveolped
|
erythomycin
|
|
|
what are the alternative to penicillins
|
azithromycin, clarithromycin
|
|
|
what penicillin alt has long half life and is most widely used macrolide
|
azithromycin
|
|
|
what macrolide is stable in acid and is well abs from GI tract and is alt to erythomycin
|
clarithromycin
|
|
|
what antibiotic inhibits bacterial prot synthesis 30S ribosome
|
tetracyclines
|
|
|
what has become the tetracycline of choic bc of its excellent abs from GI, long half life, low SE
|
doxycycline
|
|
|
what antibiotic alters nucleic acid met
|
fluoroquinolones
|
|
|
what are the the 2 MS fluoroquinolones
|
1 ciprofloxacin and levofloxacin
|
|
|
what is the most widely used fluoroquinolones
|
ciprofloxacin
|
|
|
what is the newer, improved activity against G+
|
levofloxacin
|
|
|
what antibiotics inhibit bacterial folic acid biosynthesis and recycling
|
sulfonamides and trimethoprim
|
|
|
what antibiotic inhibits folate reductase
|
trimethoprim
|
|
|
what is trimethoprim usually adminstered w
|
sulfamethoxazole
|
|
|
fungal membranes contain a sterol what
|
ergosterol
|
|
|
what antibiotic directly bind w ergosterol and has SE in kidney
|
amphotericin B
|
|
|
what antibiotics inhibit erogosterol biosynthesis
|
the azoles
|
|
|
what is an orally effective azole drug given by injection
|
fluconazole
|
|
|
what antiviral inhibits viral nuclei acid synthesis
|
antiviral nucleoside analogs
|
|
|
what is one of the most successful nucleoside analogs- used 1* Herpes simplex
|
acyclovir
|
|
|
what nucleoside analogs used for HIV tx, and has reverse transcriptase inhibitors
|
zidovudine
|
|
|
what are the 2 antiviral nucleoside analogs
|
acyclovir and zidvudine
|
|
|
what is an antiparasitic drug
|
metronidazole
|
|
|
what is imperative for orofacial infections
|
incision and drainage
|
|
|
what antibiotic inhibit bac cell wall
|
B lactam
|
|
|
what are 5 impt features of B lactam antibiotics
|
1. B lactam ring, 2. covalent binding to pen bind protein, 3. safe and effective, 4. tox is allergic rxn, 5. B lactamase prod=resistance
|
|
|
what is the most common reason for bac resistance to B lactam anti
|
b lactamase prod
|
|
|
what are penicillins good at treating
|
gram + bac
|
|
|
what % of bac in mouth is sensitive to prenicillins
|
90%
|
|
|
how do penicillins bind covalently to proteins in cell membrane
|
PBP Penicillin binding proteins
|
|
|
what or when are penicillins effective
|
dividing bacteria
|
|
|
what are 2 common features among penicillins
|
1. high allergic rxn, 2. short duration exc urine
|
|
|
what pt must concern with when rx penicillin
|
kidney failure
|
|
|
in pt with kidney failure penicillin can lead to what (2)
|
1. seizures, 2. platelet aggregation prob
|
|
|
what penicillin is not stable in acid, erratic results take orally, injection preferred method
|
Penicillin G
|
|
|
what are 2 sodium penicillin G
|
procaine and benzathine
|
|
|
how give sodium penicillin G
|
IV or IM
|
|
|
what penicillin is used PO
|
penicillin V
|
|
|
what are 2 penicillinase resistant penicillins
|
cloxacillin, dicloxacillin
|
|
|
why did bacteria begin to develop resistance to penicillins after intro to penicillin G
|
penicillinase
|
|
|
what is the best abs penicillin after PO
|
dicloxacillin
|
|
|
what 2 bac are resistant to B lactam antibiotics
|
staph aureus (penicillinase), methicillin-resistant Staph aureus (modified PBP)
|
|
|
what are 2 extended spec penicillins
|
ampicillin, amoxicillin
|
|
|
what are extended spectrum pen effective against
|
G bac
|
|
|
what extended spec pen is better abs from PO
|
amoxicillin
|
|
|
what is a B lactamase inhibitor
|
clavulanic acid
|
|
|
what are B lactamases given with
|
penicillins to dec bac resistance
|
|
|
how id clavulanci adic abailable
|
oral
|
|
|
what is the trade name of clavulanic acid
|
augmentin
|
|
|
what is the most common response to penicillin allergies
|
anaphylactic shock very common
|
|
|
what is the msot common cuase of antibiotic induced diarrhea/colitis
|
amoxicillin
|
|
|
oral penicillins can be antagonized by other what
|
bacteriostatic antibiotics
|
|
|
what do NSAIDS do to half life of penicillins
|
inc half life, dec their renal excretion
|
|
|
who should not be give penicillins
|
ppl with allergies and pt taking coumarin anticoagulants
|
|
|
what is an PO cephalosporin
|
cephalexin
|
|
|
what in a perenteral cepthalosporin
|
cefazolin
|
|
|
what are useful for surgical and endocarditis prophy
|
cephalosporin first generation
|
|
|
what generation of cephalosporin isused to tx resp inf
|
2nd generation
|
|
|
what are the 3rd generation cephalosporins reistant to
|
B lactamases
|
|
|
what generation of cephalosporins most resistant to B lactamases
|
4th
|
|
|
who should not take cephalosporins
|
ppl with severe penicillin rxn
|
|
|
what are 2 carbapenems
|
imipenem and cilastatin
|
|
|
most denal infection respond to what
|
penicillin V
|
|
|
if a pt has received extensive pen therapy or suspect staph what should be used to tx
|
dicloxacillin- penicillinase restistant penicillin
|
|
|
oral inf that are mix gram +/- what drugs should be used
|
amoxicillin, ampicillin
|
|
|
if organisims prod B lactamase what should be used to tx
|
amoxicillin + clavulanic acid
|
|
|
what most impt indication is for tx of methicillin resistant inf
|
vancomycin
|
|
|
does vancomycin have dental indications
|
NO
|
|
|
inhibitors of bacterial protein synthesis bind to bacterial ribosomes because ribosomes are what
|
protein synthesis machinery
|
|
|
what are 2 macrolide antibiotics
|
erythromycin and clarithromycin
|
|
|
the current macrolide antibiotics are usually what
|
bacteriostatic
|
|
|
what inhibitor of bacterial protein synthesis is not acid stable
|
erythromycin
|
|
|
what re the 3 SE of erythromycin
|
GI symptoms, cholestatic jaundice, torsades de pointes
|
|
|
what inhibitor of bacterial protein synthesis has alonger half life, acid stability, better abs from GI
|
clarithromycin
|
|
|
what macrolide is rapidly distributed into tissues and within cells, plasma ratio greater than 100 for the lung and tonsil, about 70 cervix, 35 for skin
|
azithomycin
|
|
|
what is the half life of azithomycin
|
68 HR
|
|
|
what macrolide is not metabolied in the live, drug indication b.c of alterd metabolism are uncommon
|
azithromycin
|
|
|
what is the main denal indication of macrolides
|
B lactam allergic pt
|
|
|
what is the max daily does of macolide for adult and renal impaired
|
adult 4g, renal 1.5g
|
|
|
macrolide interfere with what kind of drugs
|
those met in liver
|
|
|
Pt with what shouldn't take macrolide
|
cholestatic hepatitis
|
|
|
what are the 2 lincosamides
|
lincomycin, clindamycin
|
|
|
what is a chlorinated derived lincomycin, increased antimicrobial potency, better abs GI
|
clindamycin
|
|
|
are lincosamides more efficitive against aerobes or anarobes
|
anarobes
|
|
|
what is the most often asso SE of clindamycin
|
antibiotic asso colitis
|
|
|
Lincosamides should not be co administered with what
|
neuromuscular blocking drugs
|
|
|
what antibiotic bind to sites on the bacterial 30S ribosomal subunit
|
tetracycline
|
|
|
is tetracycline short or long acting
|
short
|
|
|
is doxycycline short or long acting
|
long
|
|
|
where are the highest concentration of tetracycline found
|
skin and saliva
|
|
|
what is the best absorbed tetracycline, and safe in renal pt
|
doxycycline
|
|
|
when are tetracyclines tox to kidneys
|
when beyond exp date
|
|
|
who is tertracyclines contraindicated in
|
young kids, preg women, ppl with sulfite allergy
|
|
|
aminoglycosides are what kind of drug
|
bactericidal
|
|
|
what is a aminoglycoside bactericidal
|
gentamicin
|
|
|
a combo of aminoglycosides and B lactam antibiotics prod what effect
|
synergistic antibacterial effects
|
|
|
what are the inhibitors of bact nucleic acid synthesis
|
quinolones, sulfonamides,
|
|
|
fluoroquinolones are inhibitor of bac nucleic acid synthesis inhibits bac enzyme called what
|
DNA gyrase
|
|
|
what is one of the original fluoroquinolones, most widley used
|
ciprofloxacin 2nd gen
|
|
|
what quinolone has improved G+ activity
|
levofloxacin 3rd gen
|
|
|
what drug causes permanent damage to cartilage has been observed in growing animals, not recommended kids
|
quinolones- inhibitor of bac nucleic acid synthesis
|
|
|
are there any denal indication for quinolones
|
none
|
|
|
what agent acts synergistically with sulfonamides, is an inhibitor of bac nucleic acid
|
trimethoprim
|
|
|
how do sulfonamides work
|
inhibit enzyme dihydropteroate synthesis
|
|
|
what enzyme is essential to prod folic acid
|
dihydropteroate synthesis
|
|
|
what inf are tx with sulfonamides
|
resp, urinary, GI
|
|
|
do sulfonamides have an indication for dental
|
NO
|
|
|
what antibacterial is highly effective anaerobic bac, including bacteroides species
|
metronidazole
|
|
|
metronidazole has no specific indication for dental but could be used for what
|
NUG
|
|
|
what durg used to tx mycobacterial inf
|
isoniazid
|
|
|
what is the drug of choice to tx TB
|
isoniazid
|
|
|
what does isoniazid inhibit
|
synthesis of mycolic acid
|
|
|
isoniazid interferes with what
|
pyridoxine (vit B6)
|
|
|
what should isoniazid be co adminstered with
|
vitamins
|
|
|
who should prophylaxis antibiotics be used for
|
cardiac cond- proc involve manipulation of gingiva, PA region
|
|
|
what is the most dangerous form of malaria species
|
P falciparum
|
|
|
what are injected into bloodstream when bit by infected mosquito
|
sporozoites
|
|
|
sporozoites are met to what in liver
|
schizonts
|
|
|
when hepatic schizonts rubpute what enter the circulation
|
merozoites
|
|
|
merozoites enter what
|
RBC
|
|
|
most antimalarial drugs available are active against the erythocytic forms of dx, are classified as blood what
|
schizontocides
|
|
|
what antimalarial is drug of choice for prph and tx of an acute attack of malaria
|
chloroquine
|
|
|
what chem related to quinine, effective for P falciparum resistant drugs
|
mefloquine
|
|
|
mefloquine should not be given concurrently with what
|
antiarrhythmic drugs
|
|
|
mefloquine is contraindicated in pt w hx of what
|
depression, psycosis, anxiety, schizo
|
|
|
what is a classical antimalarial drug
|
quinine
|
|
|
what acts by inhibiting plasmodial electron transport in mito
|
atovaquone
|
|
|
what is an active metabolite inhibit plasmodial dihydrofolate reductase activity (folic acid synthesis
|
proguanil
|
|
|
what is the prototype antimalarial effetive against exoerythocytic forms
|
primaquine
|
|
|
primaquine destroys the what
|
exoerythromcytic liver lurking forms
|
|
|
what drugs mech is thought to interfere with ubiquinone in the mito electron transport chain
|
primaquine
|
|
|
pt taking what can cause glucose 6 phosphate dehydrogenase def causeing hemolytic anemia and methemoglobinemia
|
primaquine
|
|
|
what are contracted by ingestion of fecally contaminated food or water
|
amebiasis or amebic inf
|
|
|
what can be used if asymptomatic cyst passer or infection is confined to the intestinal tranct
|
non abs luminal amebicides
|
|
|
what is the drug of choice for systemic inf
|
metronidazole
|
|
|
what type of inf is metronidazole used for
|
anaerobic org
|
|
|
metronidazole has disulfiram like effect there for alcohol should be avoided to prevent what
|
flushng and other adverse effects of acetaldehyde accumulations
|
|
|
what are the 3 luminal amebicides
|
diloxanide furoate, lodoquinel, paromomycin
|
|
|
what is the MC reported protozoan dx in US
|
giardiasis
|
|
|
what is the drug of choice to tx giardiasis
|
metronidazole
|
|
|
what is was recently approved agent for diarrhea asso giardiasis
|
nitazoxamide
|
|
|
what is an early antimalarial and antihelminic drug
|
quinacrine
|
|
|
what is the drug of choice for trichomoniasis
|
metronidazole
|
|
|
what is the drug of choice to tx pneumocystosis
|
sulfamethoxazole + trimethoprim
|
|
|
what is the drug of choice to tx toxoplasmosis
|
pyrimethamine + sulfamiazine
|
|
|
what are the 2 most impt classes of antifungals
|
polyene and azole
|
|
|
what is MC mucocutaneous fungal inf in oral lesions caused by bungus
|
candida albicans
|
|
|
what are the 2 main groups of fungal inf
|
1. opportunistic mycoses, 2. endemic mycoses
|
|
|
what are the 2 polyene membrane active antimycotics
|
nystatin and amphotericin B
|
|
|
Nystatin and amphorericin B have a particular affinity for fungal membranes, which are rich in a serol called what
|
ergosterol
|
|
|
what drug is to tox to be given IV
|
nystatin
|
|
|
what polyene is given by IV, some exp renal damage
|
amphotericin B
|
|
|
what is the most toxic antibiotic in use
|
ampho B- nephrotoxic
|
|
|
what is an inhibiyot of ergosterol biosynthesis
|
azole antifungals
|
|
|
where do effective levels of azole drugs reached
|
saliva
|
|
|
what si the perferred drug for candidiasis
|
fluconazole
|
|
|
what is seldomly used now due to adverse effects
|
ketoconazole
|
|
|
what is drug of choice for oral candidiasis in AIDS pt
|
clotrimazole
|
|
|
what may dec contraceptive effect of oral contraceptives
|
itraxonazole
|
|
|
what enzmes are effected by voriconazole
|
liver
|
|
|
what drug appears to be effective in treating oropharyngeal and esophageal candidiasis refractory to tx with fluconazole or itraconazole
|
posaconazole
|
|
|
what is most commonly combined with ampho B for tx of candidal or cryptococcal inf
|
flucytosine
|
|
|
what is a new class of antifungal drugs that target a fungal enzyme, which is essential polysaccharide of fungal cell wall
|
echinocandins
|
|
|
is echinocandins orally effective
|
NO
|
|
|
what is the first representative of echinocandins
|
caspofungins
|
|
|
what is an example of DNA viruses
|
herpesviruses
|
|
|
what is an example of RNA viruses
|
measles
|
|
|
what is the most common mech of action of the antiviral drugs involves inhibition of what
|
viral nucleic acid synthesis
|
|
|
for nucleic acid synthesis , nucleosides must be phosphorylated on the 5 position of the ribose by cellular what
|
kinases
|
|
|
what is an example of nucleoside analogs with anti herpes activity
|
acyclovir
|
|
|
what is a guanosine analog w an acyclic group replacing the ribose sugar
|
acyclovir
|
|
|
what is drug of choice for cytomegalovirus inf
|
ganciclovir
|
|
|
how is ganciclovir usually givin
|
IV
|
|
|
where is ganciclovir excreted
|
kidney
|
|
|
what are sever SE of ganciclovir
|
aspermatogenesis, granulocytopenia and thrombocytopenia, and carcinogenic and teratogenic
|
|
|
that is a nucleoside analog with anti HIV activity
|
zidovudine, stavudine
|
|
|
what nucleoside analogs with anti HIV acityity is most highly asso with lactic acidosis
|
stavudine
|
|
|
what are sued i HIV therapy are all missing the 2, 3 hydroxyl groups on the ribose part of the molecule
|
nucleoside reverse transcriptase inhibitors
|
|
|
what are the 2 nucleoside analogswith anti HIV activity
|
zidovudine, didanosine
|
|
|
what is other antiviral drugs used for HIV ing
|
HIV protease Inhibitors
|
|
|
what is a protease inhibitor
|
helfinavir
|
|
|
what is the MC used protease inhibitor and had mildest tox
|
helfinavir
|
|
|
what are 3 other antiviral catagories of drugs used for HIV inf
|
1. HIV protease inhibitor, 2. HIV non nucleoside reverse transcriptase inhibitor, 3. highly active anti retroviral therapy
|
|
|
what are 2 types of anti influenza drugs
|
live attenuated or inactivated
|
|
|
how are inactivated vaccine adminstered
|
IM
|
|
|
what should not be given to preg, immunosuppresed, pt chronic CV, pulmonary, renal, metabolic dx
|
intranasal
|
|
|
what is given by inhalation, and is an neuraminidase
|
zanamiriv
|
|
|
what is a prodrug that is given orally, neuraminidase inhibitor
|
oseltamivir
|
|
|
qht drug is polymerase inhibitor
|
foscarnet
|
|
|
what tox is pt taking foscarnet at risk for
|
renal
|
|
|
ribavarin is contraindicated in who
|
preg
|
|
|
human inferons promoste what state in uninfected cells
|
antiviral state
|
|
|
what are 3 main antacids
|
1. sodium bicarbonate, 2. calcium carbonate, 3. Mg hydroxide plus Al hydorxide
|
|
|
what does Mg do to GI
|
diarrhea
|
|
|
what does Al do to GI
|
constipate
|
|
|
what are the 4 H2 receptor antagonist
|
cimetidine, ranitidine, famotidine, nizatidine
|
|
|
what are 3 proton pump inhibitors
|
esomeprazole, omeprazole, lanoprazole
|
|
|
what do prokinetic drugs stimulate
|
GI motility
|
|
|
what is a prokinetic drug
|
metoclopramide
|
|
|
what are 3 antiemetic drugs
|
ondansetron, prochlorperazine, dronabinol
|
|
|
what are 2 antidiarrheal agents
|
loperamide, diphenoxylate
|
|
|
are antidiarrheal agents effective in pt with irritable or inflammatory bowl dx
|
YeS
|
|
|
what drugs may cause parkinsons
|
antiemetic
|
