Pharm Ii

Front 1

What is Selective Toxicity?

Back 1

Kills the invading organism w/o killing the host by taking advantage of differences between the invader and the host

Front 2

What is an antibiotic?

Back 2

A substance produced by microorganisms to kill of supress growth of other microorganisms

Front 3

What is an Antimicrobial?

Back 3

A substance that kills or suppresses the growth of microorganisms. Term includes antibiotics as well as synthetic substances made in the laboratory

Front 4

Is there a difference between Antibiotic and Antimicrobial?

Back 4

NOPE

Front 5

Name the different types of Anti-infectives?

Back 5

Antivirals, Antibioctics, Antimycobacterials, Antifungals, Antiprotozoals, Antihelmintics, and Urinary Anti-infectives

Front 6

Antimicrobial Agents can be either Bactericidal or Bacteriostatic. Describe these two terms?

Back 6

~Bactericidal: the organisms are killed INSTANTLY (like a bomb)
~Bacteriostatic: the organisms are PREVENTED from growing (like starvation)

Front 7

What type of Antimicrobial Agents MUST be used in an Immunocompromised pt? Why?

Back 7

Bactericidal Agenst must be used b/c they lack proper immunity/antibody function

Front 8

Describe the Post-Antibiotic Effect (PAE)?

Back 8

Persistent suppression of organism growth after concentrations fall below the minimum Inhibitory Concentration (MIC)

Front 9

Describe Minimum Inhibitory Concentration (MIC)?

Back 9

Lowest concentration of an antimicrobial agent that prevents visible growth after an 18 – 24 hour incubation

Front 10

Describe Minimal Bacterial Concentration (MBC)?

Back 10

Minimal concentration that kills 99.9% of bacterial cells

Front 11

What are the different methods used for identification of the infecting organism? Which method is the simplest/fastest? Which provides conclusive identification?

Back 11

~Gram Stain (Fastest/Simplest)
~Culture and Sensitivity (most conclusive/Takes time!)
~Gene Amplification (newest)

Front 12

When using Empiric Therapy, what factors should be considered before Tx?

Back 12

~Most LIKELY pathogen
~Host factors
~Drug factors

Front 13

After initiating Tx, you should monitor the pt. If their Sx are not getting better by ____ days, you might need to think about increasing the dose or changing the Drug?

Back 13

By 3 days!

Front 14

How is a pts therapeutic response monitored?

Back 14

~Clinical Assessment
~Lab Test
~Assessment of Therapeutic failure (no improvement or worsening Sx's)

Front 15

What considerations of the host should be taken into account before Antibiotic use?

Back 15

~Type of infection, immune status,
~Community-acquired
~Health care-associated vs nosocomial,
~Underlying co-morbidities

Front 16

Different organsims of Community Acquired vs. Nosocomial?

Back 16

~Community Acquired: Strep Pneum (gram pos diplococci)
~Nosocomial: Gram Neg

Front 17

Some pts (host) may have anaphylactic rxns to Abx you want to give, for this reason you should always have what?

Back 17

An Alternative drug that you can use

Front 18

Anaphylactic Rxns are Ig_ mediated?

Back 18

IgE Mediated

Front 19

For young children, they should not use either Tetracylines or Flouroquinolones for what reasons?

Back 19

~Tetracyclines cause Gray Teeth
~Fluoroquinolones cause Cartilage damage

Front 20

Why does the anitomical site of infection need to be taken into account when Rx'ing an Abx?

Back 20

You need to make sure that the drug will reach the site of infection (i.e. DM Foot Infection- Abx will be appropriate for bacteria present, but the drug cant reach site due to poor perfusion secondary to swelling and co-morbid dz state)

Front 21

Which route of admin is the MOST reliable but LEAST convenient when giving Abx?

Back 21

IV route is the most reliable but least convenient (patient must usually be hospitalized)

Front 22

How can INFLAMMATION facilitate Abx distribution to site?

Back 22

Inflammation can facilitate antibiotic distribution because it increases blood flow to the area (and the inverse is true as healing occurs)

Front 23

What are the possible CNS SE's w/ prolonged use of PCN, Cephalosporins, Quinololones, and Imipenems?

Back 23

Seizures

Front 24

For pts taking Abx that can cause Hemotologic (blood) issues, their Abx use should always be monitored. Name the drug that causes the following issues:
~Neutropenia?
~Platelet Dysfunction?
~Hypoprothrombinemia?
~Bone-marrow suppression?
~Megaloblastic anemia?

Back 24

~Neutropenia – nafcillin
~Platelet Dysfunction – piperacillin
~Hypoprothrombinemia – cefotetan
~Bone-marrow suppression – chloramphenicol
~Megaloblastic anemia – trimethoprim

Front 25

Name some common drugs that cause Nephrotoxicity, Photosensitivity and Diarrhea/Colitis?

Back 25

~Nephrotoxicity: Aminoglycosides and Vancomycin
~Photosensitivity: Quinolones, Tetracyclines and Sulfonamides
~Diarrhea/Colitis (Clostridium Difficile): Clindamycin

Front 26

Will the Nephrotoxicity go away if the Aminoglycoside or Vancomycin is stopped?

Back 26

Yes

Front 27

Describe the effective uses of Abx Drugs that have a Narrow spectrum? (give an example)

Back 27

Effective against a SINGLE or LIMITED group of microorganisms (Metronidozole - Anaerobes)

Front 28

Describe the effective uses of Abx Drugs that have a Extended spectrum? (give an example)

Back 28

Effective against a LARGE number of Gram Pos and some Gram Neg bacteria (Amoxicillin)

Front 29

Describe the effective uses of Abx Drugs that have a Broad spectrum? (give an example)

Back 29

Effective against a WIDE variety of microbial species including Gram Pos, Gram Neg and Anaerobic bacteria (Fluoroquinolones [Moxifloxacin])

Front 30

Why do you want to minamize the use of Combo Abx when Tx'ing Empirically?

Back 30

~Reduces likelihood of development of resistant organisms
~Using multiple agents can disrupt the action of a single agent and increase the toxicity risk to the patient

Front 31

What are some situations in which you would WANT to use Combination Abx therapy?

Back 31

~To provide broad spectrum therapy to Tx life threatening infections in seriously ill/immunocompromised pts
~To Tx Polymicronial Infections
~Empiric therapy when no one agent is active against potential pathogens
~To decrease toxicity (permit lwr dose of other agent)
~Synergism

Front 32

What is Synergism? How is it beneficial in Combination Abx therapy?

Back 32

~The inhibitory or killing ability of two antimicrobials is greater than the expected antimicrobial ability based on their individual effects (1+1 = 2)
[i.e. β-lactams and Aminoglycosides --> 1+1 = 3 (or more!)]

Front 33

What are the two types of Bacterial Resistance to Abx?

Back 33

~Innate Resistance
~Acquired Resistance

Front 34

Describe Innate Resistance?

Back 34

Essentially you gave the wrong Drug for the wrong Bug!!!

Front 35

Describe Acquired Resistance?

Back 35

Adapted through spontaneous mutation or DNA transfer of drug use (Bug resistance to drug!)

Front 36

The use of Abx to PREVENT specific bacterial infections
should be used when efficacy has been proven and the benefits of prophylaxis therapy outweigh the risk of resistance. What are the two types of Abx prophylaxis?

Back 36

~Surgical Prophylaxis: i.e. upper GI, colon, prosthetics, C-section, dirty surgery, GSW
~Non-surgical Prophylaxis: i.e. prevention of urinary tract infections, bacterial endocarditis, ACNE

Front 37

How long do Abx last for until resistance occurs?

Back 37

Antibiotics last for about 20 years until resistance

Front 38

Abx are classified based on effect of agent during cellular biochemistry. What are the Abx Classifications?

Back 38

1. Cell wall synthesis inhibitors (β- lactams)
2. Inhibition of synthesis or damage to cytoplasmic membrane (Polymyxins)
3. Inhibition or modification of protein synthesis - usually ribosomal (Tetracyclines, Macrolides, etc.)
4. Modification in energy metabolism - Folate Antagonists (Sulfonamides)
5. Modification in synthesis or metabolism of nucleic acids- DNA Gyrase Inhibitors (Fluoroquinolones)

Front 39

****Name the SPACE bugs? What is their MAIN Tx option?
GRAM NEG BUGS

Back 39

~Must be Tx w/ 2 Abx: β-Lactams + Aminoglycoside
-Serratia (can be MDR)
-Pseudomonas
-Acinetobacter
-Citrobacter
-Enterobacter
~Cause of NOSOCOMIAL Infections

Front 40

Name some main bacteria found in the NOSE?

Back 40

~Staphylococcus Aureus
~Staphylococcus Epidermidis

Front 41

Name some main bacteria found in the THROAT?

Back 41

~Staphylococcus
~Haemophilus

Front 42

Name some main bacteria found in the LARGE INTESTINE?

Back 42

~Bacteroides Fragilis
~E.Coli

Front 43

Name some main bacteria found in the MOUTH?

Back 43

~Streptococcus

Front 44

Name some main bacteria found on the SKIN?

Back 44

~Staphylococcus Epidermidis

Front 45

Name some main bacteria found in the VAGINA?

Back 45

~Streptococcus
~Candida Albicans

Front 46

Name some main bacteria found in the URETHRA?

Back 46

~E.Coli

Front 47

Name the Different Types Cell Wall Synthesis Inhibitors?

Back 47

~PCNs
~Cephalosporins
~Carbapenems
~Monobactams
~β-Lactamse Inhibitors
~Vancomycin
~Bacitracin

Front 48

β-lactam drugs are named for their 4-membered ring and require actively proliferating bacteria to work effectively, this makes its MOA beneficial for SELECTIVITY why?

Back 48

This allows their MOA to be beneficial for SELECTIVITY because human cells do not have cell walls. This allows the drug to attack the organism, not the host!!!

Front 49

Bacteria often develop resistance to β-lactam Abx by synthesizing β-lactamase, an enzyme that attacks the β-lactam ring. To overcome this resistance, what is the course of action?

Back 49

β-lactam antibiotics are often given with β-lactamase inhibitors such as Clavulanic Acid

Front 50

Of the drug types that are Cell Wall Synthesis Inhibitors, which ones are β-lactam Agents?

Back 50

~Representative Agents
-Penicillins
-Cephalosporins
-Carbapenems
-Monobactams
-β-Lactamase Inhibitors

Front 51

What are the diff types of Penicillins?

Back 51

~Penicillins (can be either drug or drug class…)
~Anti-Staphylococcal PCNs (Penicillinase or β-lactamase Resistant)
~Extended Spectrum PCNs
-Aminopenicillins
-Anti-pseudomonal PCNs (<-- used to tx pseudomonas)

Front 52

What are the drugs of the PCNs drug class?

Back 52

~Penicillin G (inj)
~Pencillin VK (oral) <-- more acid stable

Front 53

What are the drugs of the Anti-Staphylococcal PCNs (Penicillinase or β-lactamase Resistant)?

Back 53

~Dicloxacillin (Dynapen)
~Nafcillin (Unipen)
~Oxacillin (Prostaphlin)

Front 54

Of the Extended-Spectrum PCNs drug class, what are the Aminopenicillins?

Back 54

~Amoxicillin (Amoxil)
~Amoxicillin / Clavulanic Acid (Augmentin)
~Ampicillin (Omnipen)
~Ampicillin / Sulbactam (Unasyn)

Front 55

Amoxicillin is converted into what in the liver?

Back 55

Ampicillin

Front 56

Of the Extended-Spectrum PCNs drug class, what are the Anti-Pseudomonal PCNs?

Back 56

~Piperacillin (Pipracil)
~Piperacillin / Tazobactam (Zosyn)
~Ticarcillin (Ticar)
~Ticarcillin / Clavulanic Acid (Timentin)

Front 57

What is the MOA of PCNs?

Back 57

Inhibit bacterial cell wall synthesis exposing the osmotically less stable membrane which can lead to cell lysis

Front 58

The Antibacteral Spectrum of PCNs depends on the ability to cross bacterial cell walls, explain?

Back 58

~Gram positive bacteria have cell wall that PCN can cross
~Gram negative bacteria have a lipopolysaccharide membrane that acts as a barrier to water soluble PCNs so entry must be gained by water filled channel

Front 59

What are the Natural PCNs?

Back 59

~Penicillin G (inj)
~Pencillin VK (oral) <-- more acid stable

Front 60

Why is Pen G only used as an injection?

Back 60

B/C it is unstable in stomach acid when it is given orally
-Use Pencillin VK (<-- more acid stable)

Front 61

What is the Spectrum of use for the Natural PCNs?

Back 61

~Gram positive bacteria:
-Streptococci causes pharyngitis --> Tx with Pen VK
-Viridans strep causes IE --> Tx'ed w/ Pen G
~Gram negative bacteria:
-N. Meningitidis causes meningitis --> Tx'ed w/ Pen G
~Treponema Pallidum (spirochete) causes syphilis --> Tx'ed w/ Pen G

Front 62

****What bacteria is resistant to Methicillin, a drug that used to be used as a Antistaphylococcal PCN, and is now Tx'ed w/ Vancomycin?

Back 62

~MRSA (Methicillin Resistant Staph Aureus)
~MRSE (Methicillin Resistant Staph Epidermidis)

Front 63

What is the MOA of the Antistaphylococcal PCNs?

Back 63

Inhibits bacterial cell wall synthesis by binding to one or more of the PCNs Binding Proteins (PBPs)

Front 64

What are the uses for Antistaphylococcal PCNs?

Back 64

~Severe Infections: Osteomyelitis (Bone infections), Joint, Cellulitis and other tissue infections caused by Staph. aureus or group A strep
--> Tx w/ IV Nafcillin or Oxacillin
~Minor infections: Skin infections (Impetigo, Cellulitis) caused by Staphylococcal Aureus and Strep Group A
--> Tx w/ Oral Dicloxacillin

Front 65

What is the pregnancy catergory of Antistaphylococcal PCNs?

Back 65

Cat B

Front 66

What drug has a major interaction w/ Antistaphylococal PCNs?

Back 66

Warfarin

Front 67

What is the Spectrum of use for Extended Spectrum PCNs?

Back 67

Similar to Pen G, but has better activity against Gram Neg organisms due to ability to penetrate the outer membrane

Front 68

Extended Spectrum PCNs are inactivated by β-lactamases unless combined with what?

Back 68

β-Lactamase inhibitor such as **Clavulanic Acid, Tazobactam, or Sulbactam

Front 69

Describe the uses of β-Lactamase inhibitors again?

Back 69

~These substances look like a beta-lactam molecule but they have very little antibiotic activity
~Combined with other PCNs in order to extend their spectrum to include β-lactamase producing bacteria
-Clavulanic acid (clavulanate)
-Sulbactam
-Tazobactam

Front 70

What is the place in therapy of Amoxicillin (Amoxil)?

Back 70

~Otitis Media (caused by Strep Pneum or H. Influenzae)
~Endocarditis Prophylaxis

Front 71

What is the place in therapy of Ampicillin (Omnipen)?

Back 71

~Meningitis (in conjunction w/ a gram neg agent --> Cefotaxime or Gentamicin)
~Neonatal Pneumonia (in conjunction w/ gram neg agent)

Front 72

Are Ampicillin and Gentamicin used together on a routine basis?

Back 72

YES

Front 73

Why is this a good Synergistic relationship?

Back 73

PCN has the ability to destroy the cell wall and allows entry of the Aminoglycoside into the cell

Front 74

What is the place in therapy of the IV Combination agent Ampicillin / Sulbactam (Unasyn)?

Back 74

~Infected wounds w/ sepsis
~Peritoneum / Peritonitis 2nd to bowel perforation

Front 75

What is the place in therapy of the Oral Tabs/Susp Combination agent Amoxicillin / Clavulanic Acid (Augmentin)?

Back 75

~TID dosing and BID dosing
~Otitis media resistant to amoxicillin
~Sinusitis
~Animal and Human bites
~Infected wounds

Front 76

What is the Spectrum of Anti-Pseudomonal PCNs?

Back 76

Spectrum extends Ampicillin to include Pseudomonas Aeruginosa and several other gram neg bacteria (SPACE Bug Coverage)

Front 77

Why are two of the Anti-Pseudomonal PCNs (Piperacillin and Ticaracillin) not used alone?

Back 77

~B/C they are suseptable to β-Lactamase
~This is why they are combined w/ β-Lactamase Inhibitors such as:
-Piperacillin / Tazobactam (Zosyn)
-Ticarcillin / Clavulanic Acid (Timentin)

Front 78

Regarding hypersensitivity, what percent of pts have PCN allergies?

Back 78

1-5% of pts (rash or anaphylaxis)

Front 79

PCNs can cause Diarrhea, is this an allergic rxn?

Back 79

No, it’s a SE

Front 80

****KNOW HOW TO CALCULATE CrCl...
What is the Crockroft-Gault Formula for CrCl?

Back 80

(140-age) x Body Weight (kg) [ X 0.85 for female ]
72 x SCr

Front 81

What is the structure of The Cephalosporins?

Back 81

β-lactam ring attached to six sided ring

Front 82

What is the MOA of Cephalosporins?

Back 82

Same as the PCNs

Front 83

What are the different generations of Cephalosporins and what is the spectrum of each generation?

Back 83

~1st Gen: similar spectrum to Pen G; they are resistant to Penicillinases and β-lactamases (Gram Pos)
~2nd Gen: weaker Gram Pos, but some Gram Neg and Anaerobic activity (bacteroides)
~3rd Gen: enhanced Gram Neg activity but inferior to 1st Gen agents against Gram Pos
~4th Gen: Wide Spectrum (Gram Pos and Gram Neg)

Front 84

What are some of the adverse rxns associated w/ Cephalosporins?

Back 84

~5-15% penicillin cross sensitivity (same rxn as they would w/ PCN)
~Superinfections are possible
~Cephalosporins are generally well tolerated and have few major side effects

Front 85

What are the Cephalosporin 1st Gen Oral Agents?
[G+ AGENTS]

Back 85

~Cephalexin (Keflex)
~Cephradine (Velosef)
~Cefadroxil (Duricef)

Front 86

What are the Cephalosporin 1st Gen Injectable Agents?
[G+ AGENTS]

Back 86

~Cefazolin (Ancef and Kefzol)

Front 87

What is the place in therapy for the 1st Gen Cephalosporin agents (oral, injectable)?

Back 87

~Oral: skin infections (Staph Aureus, Grp A Strep, UTIs
~Injection: pre/post surgery not involving the abdomin
-Cefazolin is DOC for most surgical prophylaxis

Front 88

What are the Cephalosporin 2nd Gen Oral Agents?
[G+, LITTLE G-, ADD ANAEROBIC AGENTS]

Back 88

~Cefuroxime (Ceftin)
~Cefaclor (Ceclor)
~Cefprozil (Cefzil)

Front 89

What are the Cephalosporin 2nd Gen Injectable Agents?
[G+, LITTLE G-, ADD ANAEROBIC AGENTS]

Back 89

~Cefuroxime (Zinacef)
~Cefoxitin (Mefoxin)

Front 90

What is the place in therapy for the 2nd Gen Cephalosporin agents (oral, injectable)?

Back 90

~Oral: option for resistant otitis media, alternate for community acquired pneumonia, pharyngitis and cat bites
~Injection: [Cefoxitin] used in pre/post surgery involving the abdomen

Front 91

What are the Cephalosporin 3rd Gen Oral Agents?
[ENHANCED G-, lower G+ than 1st]

Back 91

~Cefpodoxime (Vantin)
~Ceftibutin (Cedax)
~Cefixime (Suprax)

Front 92

What are the Cephalosporin 3rd Gen Injectable Agents?
[ENHANCED G-, lower G+ than 1st]

Back 92

Ceftriaxone (Rocephin) --> N. gonorrhea urethritis

Front 93

What are the Cephalosporin 3rd Gen IV Agents?
[ENHANCED G-, lower G+ than 1st]

Back 93

Cefotaxime (Claforan)
Cefatazidime (Fortaz)

Front 94

What is the place in therapy for the 3rd Gen Cephalosporin agents (oral, injectable, IV)?

Back 94

~Oral: very similar to the 2nd gen orals, alternative in OM and resistant sinusitis
~Injection: Used to treat N. gonorrhea urethritis (Mix w/ Lidocaine- to be nice), Resistant OM, Tx of MENINGITIS, pharyngitis (gonococcus)
~IV: Used for severe gram negative infections including: MENINGITIS, endocarditis, joint infections and multiple other severe infections (good CNS penetration)

Front 95

For Tx w/ Ceftriaxone (Rocephin) injection for Meningitis, what is the difference in dosing?

Back 95

Dosing will be twice daily, instead of the once daily dose for Gonorrhea

Front 96

What is the Cephalosporin 4th Gen Agent?
[GRAM + and GRAM - = WIDE SPECTRUM]

Back 96

Cefepime (Maxipime)

Front 97

What is the place in therapy for the 4th Gen Cephalosporin agent?

Back 97

Useful in Empiric therapy in Febrile Neutropenia (in Cancer pts)

Front 98

What is the Structure of Monobactam?

Back 98

B-Lactam ring is NOT fused to any other ring

Front 99

What is the Spectrum of Monobactams?

Back 99

~Pure Gram Neg agent (ALL Gram Neg)
-NO Gram Pos or Anaerobic activity
~Resistant to B-Lactamases

Front 100

What is the ONLY Monobactam Agent?

Back 100

Aztreonam (Azactam)

Front 101

What is the place in therapy for Monobactam?

Back 101

Viewed as an alternative to Aminoglycosides in pts w/ diminshed renal function

Front 102

What are the available routes of admin for Monobactam?

Back 102

IV and IM routes -- NOT available orally!!

Front 103

What drug class has synthetic B-Lactams w/ MOA similar to the others?

Back 103

Carbapenems

Front 104

What is the Spectrum of the Carbapenems?

Back 104

Broadest Available Agents
-Gram Pos, Gram Neg and Anaerobic (similar to 4th
Gen Cephalosporin)
-Resistant to B-Lactamase
-LAST LINE AGENT!!!!!!!!!

Front 105

What are the Carbapenem Agents?
[Gram Pos, Gram Neg and Anaerobic agents]

Back 105

~Imipenem / Cilastatin (Primaxin)
~Meropenem
~Ertapenem

Front 106

What are the Clinical Uses for Carbapenems?

Back 106

~Febrile Neutropenia
~Severe Resistance Infections

Front 107

What are the adverse rxns associated w/ Carbapenems?

Back 107

~N/V, Rashes, and seziures
~Approx 50% cross reactivity w/ PCNs

Front 108

What is the available route of admin for Carbapenems?

Back 108

ONLY available IV

Front 109

What is the MOA of Vancomycin?

Back 109

Inhibits bacterial cell wall synthesis at a site EARLIER than the B-lactams (PCNs, Cephalosporins, Carbapenems, Monobactams, β-Lactamase Inhibitors)

Front 110

What is the Spectrum of Vancomycin?

Back 110

~Effective against Gram Pos (narrow spectrum)
~Restrict use as directed:
-B-Lactam resistant G+ bacteria (MRSA)
-Pts who have allergies to B-Lactams
-2nd line Tx for Life threatening Clostridium Difficile Colitis
(prefer Metronidazole)

Front 111

What are the routes of Admin for Vancomycin?

Back 111

~Oral dosages are not absorbed and only used for Clostridium difficile
~All other infections require slow IV infusion
-Good penetration of infected CNS!!!

Front 112

Vancomycin is Synergistic w/ ______ against Enterococcus Faecium and Faecalis?

Back 112

Aminoglycosides

Front 113

Vancomycin is not effectively removed by dialysis and renal adjustment required. Due to this possibility of Nephrotoxicity, what needs to be monitored?

Back 113

Creatinine Clearance (CrCl)

Front 114

What are the Adverse Rxns associated w/ Vancomycin?

Back 114

~Phlebitis, fever, chills, shock, flushing (red man syndrome), hearing loss (rare)
~Renal and ototoxicity risk is increased by concomitant aminoglycides

Front 115

Describe Red Man (Red Neck) Syndrome?

Back 115

~Red man (Red Neck) Syndrome is a histamine rxn caused by infusing too fast!!!
~Avoid by infusing the dose over 1-2 hours
~THIS IS NOT AN ALLERGY

Front 116

What is the MOA of Cyclic Lipopeptides?

Back 116

~Alternative to Vancomycin
~Binds to bacterial membranes and causes rapid depolarization leading to inhibition of protein, DNA and RNA synthesis (cell death)

Front 117

What is the Cyclic Lipopeptide Agent?

Back 117

Daptomycin (Cubicin)

Front 118

What are the Clinical Uses for Cyclic Lipopeptides?

Back 118

~For complicated Skin structure infections caused by Gram Pos bacteria
~Staph, Strep and Vanomycin susceptible E. Faecalis

Front 119

What needs to be monitored weekly while on Cyclic Lipopetides?

Back 119

Creatine Phosphokinase (CPK)

Front 120

What is the MOA, Spectrum and Uses of Bacitracin?

Back 120

~MOA: Inhibits Cell Wall Synthesis
~Spectrum: Gram Pos Organisms
~Uses: Topical or Surgical irrigation soln only

Front 121

Name the Drug that Inhibits the synthesis or damages the cytoplasmic membrane?

Back 121

Polymixin B

Front 122

What is the MOA of Polymixin B? Spectrum?

Back 122

High molecular weight peptide that injures Gram Neg Bacteria plasma membranes

Front 123

What infection is Polymixin B used for?

Back 123

Acenitobacter Infections

Front 124

What is the route of admin for polymixin B?

Back 124

Topical

Front 125

Many Topical Abx are in a combination w/ Polymixin B, Name two and the combinations?

Back 125

~Neosporin
-Polymyxin B, Neomycin and Bacitracin
~Polysporin
-Polymyxin B and Bacitracin

Front 126

What topical agent is effective against S. aureus, Group A strep infections (Impetigo), MSSA, and MRSA? This drug is more expensive than Bacitracin?

Back 126

Mupirocin (Bactroban)

Front 127

What is the MOA of Mupirocin (Bactroban)?

Back 127

Inhibits bacterial protein synthesis (Note – It is NOT a Cell Wall Inhibitor)

Front 128

What are the drugs that Inhibit or Modify Bacterial Protein Synthesis?

Back 128

~Chloramphenicol
~Tetracyclines
~Macrolides
~Clindamycin (its own drug class)
~Aminoglycosides & Spectinomycin
~Oxazolidinones
~Streptogramins
~Ketolides

Front 129

This group of Abx will target what?

Back 129

The Bacterial Ribosome which are smaller than Human Ribosomes

Front 130

What is the MOA of Chloramphenicol?
(DONT WORRY ABOUT!!!)

Back 130

Inhibits bacterial protein synthesis
-RARELY used due to toxicity!!!
-Gray Baby Syndrome
-Don’t worry about this drug!!!

Front 131

What is the MOA of Tetracyclines?

Back 131

Inhibits bacterial protein synthesis

Front 132

What is the Spectrum of Tetracyclines?

Back 132

Broad spectrum Abx that is bacteriostatic (prevents organism from growing)

Front 133

What are Clinical uses of Tetracylines?

Back 133

Widespread use for mild illnesses; including acne

Front 134

What are the three Tetracycline Drugs?

Back 134

~Tetracycline (Sumycin)
~Doxycycline (Vibramycin)
~Minocycline (Minocin)

Front 135

How are Tetracycline drugs eliminated from the body? Why can Doxy be used in pts w/ renal failure, but not the others?

Back 135

~Tetracycline and Minocycline are eliminated renally
~Doxycycline is eliminated in feces and can therefore be used in renal failure

Front 136

What are some Adverse rxns associated w/ Tetracyclines?

Back 136

~GI (N/V/D)
-Reduced by taking med w/ food but absorption reduces.
Tell patients to avoid dairy products / divalent cations /
antacids 1 hr before and 2 hrs after dosing
~Deposition in calcified tissues (gray teeth)
~Phototoxicity
~Fatal hepatotoxicity

Front 137

What pts are Tetracyclines Contraindicated in?

Back 137

~Renal impairment (except Doxycycline)
~Pregnant or breast feeding women
~Children under 8

Front 138

What is the route of Admin and the Uses of Tetracycline (Sumycin)?

Back 138

~Oral route
~Used in Helicobacter pylori protocols and for the Tx of Acne vulgaris

Front 139

What is the route of Admin and the Uses of Doxycycline (Vibramycin)?

Back 139

~Oral and Injectable
~Uses:
-Community Acquired Pneumonia
-Chlamydia
-Rickettsiae species: Rocky Mtn spotted fever
-Bacillus anthracis, Y.pestis, & F. tularemia
-Borrelia burgdorferi: Spirochete that causes Lyme Dz

Front 140

What are the Uses of Minocycline (Minocin)?

Back 140

~All the Tetracyclines are alternative products for inflammatory
~This is the ONLY Tetracycline w/ possible MRSA coverage!!!!!

Front 141

What are some SE's of Minocycline?

Back 141

~Dizziness, N/V (due to concentration in the ear)

Front 142

What is the MOA of Macrolides?

Back 142

Inhibits bacterial protein synthesis

Front 143

What is the Spectrum of Macrolides?

Back 143

~Bacteriostatic or Bacteriocidal
-Helicobacter Pylori (PUD/DU)
-Atypicals (mycoplasma, mycobacterium, legionella)

Front 144

What is the general rule about Macrolides in regards to PCN as a DOC?

Back 144

As a general rule-- Macrolides are used in pts allergic to Penicillins in indications where penicillins are the first line agent

Front 145

What are the Macrolide Drugs?

Back 145

~Erythromycin
~Clarithromycin (Biaxin)
~Azithromycin (Zithromax) <--MC Macrolide!!!!

Front 146

Macrolides-- Take w/ or w/o food?

Back 146

~Erythromycin: Take w/ food!!! (GI issues)
~Azithromycin: Take w/o regard to meals; avoid Antacids
~Clarithromycin: Take w/o regard to meals

Front 147

What are the Clinical Uses of Erythromycin?

Back 147

~Used in Respiratory tract infections, Legionnaire’s disease, Alternate drug in Chlamydia
~Eye ointment is prophylaxis for Ophthalmia Neonatorum

Front 148

What are the Clinical Uses of Azithromycin? What is the Preg Cat?

Back 148

~Urethritis (Chlamydia); respiratory & skin infection; community acquired pneumonia; Otitis media (5 day regimens)
~Pregnancy Cat B

Front 149

What are the Clinical Uses of Clarithromycin? What is the Preg Cat?

Back 149

~Respiratory tract infections, Gastric H. pylori regimens and has some H. Influenza coverage
~Pregnancy Cat C

Front 150

What is the MOA of Clindamycin (Cleocin)?
(Its its own Class!!!!)

Back 150

Inhibits bacterial protein synthesis

Front 151

What is the Spectrum of Clindamycin?

Back 151

Infections caused by anaerobic bacteria possibly due to trauma and non-enterococcal gram positive cocci

Front 152

What are some Adverve Rxns associated w/ Clindamycin?

Back 152

~Diarrhea, nausea and skin rashes
~Overgrowth of Clostridium Difficile leading to potentially fatal Pseudomembranous Colitis

Front 153

What is the Tx for Pseudomembranous Colitis (overgrowth of Clostridium difficile)?

Back 153

Metronidazole OR Vancomycin

Front 154

What is Clindamycins Place in Therapy?

Back 154

~Penetrating Wounds of the Abd
~Acne
~Bacterial Vaginosis
~Endocarditis Prophylaxis
~Sinus Surgery
~Mixed Polymicrobial Infections
~Alternative agent for Dog Bites

Front 155

What is the MOA of Aminoglycosides?

Back 155

Inhibits bacterial protein synthesis

Front 156

What other drug class is Aminoglycosides synergistic w/?

Back 156

Synergistic effect w/ B-lactams; the B-lactams act on the cell wall which increases diffusion of Aminoglycosides into the bacterium (SPACE Bug Coverage)

Front 157

What is the Spectrum of Aminoglycosides?

Back 157

Aerobic Gram Neg Agent (SPACE Bug Coverage!!!)

Front 158

Aminoglycosides are not generally Orally available due to highly polar structure, except in what drug?

Back 158

Neomycin

Front 159

How are Aminoglycosides distributed and what is the possible adverse rxns?

Back 159

~High concentrations accumulate in the renal cortex and inner ear
-Tinnitis can occur leading to deafness or vertigo
-Nephrotoxicity

Front 160

What are the Aminoglycoside Drugs?

Back 160

~Gentamicin (Garamycin) <-- Most popular Inj
~Neomycin (Mycifradin)
~Tobramycin (Nebcin)
~Amikacin (Amikin)
~Streptomycin

Front 161

What is the Place in Therapy for Gentamicin?

Back 161

~Tx of serious infections caused by susceptible organisms
~Complicated UTI DOC
(Space Bugs)

Front 162

What other drug class is Gentamicin synergistic w/ in the Tx of Endocarditis or SPACE BUG Coverage?

Back 162

B-Lactams or Vancomycin

Front 163

Gentamicin Once A Day Dosing works b/c "Concentration Dependent Killing" is an important factor in its ability to destroy bacteria, what does this mean?

Back 163

If you increased the dose (not frequency), you increase the rate of Killing bacteria

Front 164

So how does this affect adverse rxns to Gentamicin in pts w/ burns, pregnancy, endocarditis, dialysis, etc?

Back 164

Evidence now suggests that high-peak levels are not necessarily toxic, but rather it is the total dose that is important

Front 165

****So how is Gentamicin dosed?

Back 165

7mg/kg/day for 3 doses (days)

Front 166

Example for Gentamicin dosage:
Calculate the dose: 200 lb pt w/ Gram Neg Sepsis

Back 166

91kg(7mg/kg) = 630 mg/day for 3 days!!!!

Front 167

What are the uses for Tobramycin (Nebcin), Amikacin (Amikin), and Streptomycin?

Back 167

~Tobramycin (Nebcin): Similar to Gentamicin
~Amikacin (Amikin): Effective against some bacteria that are resistant to Gentamicin
~Streptomycin: Currently used for the treatment of TB

Front 168

What is really the only use of Neomycin (Mycifradin), since the Topical ointment is largely ineffective?

Back 168

Suppression of bowel intestinal bacteria (aerobic)-- used in conjunction w/ enteric coated E-mycin as a pre-op bowel preparation for decontamination

Front 169

What is the MOA of Oxalodinones? What is the drug name? What is it used for?

Back 169

~MOA: Inhibits Cell Wall Synthesis
~Drug: Linezolid (Zyvox)
~Use: for Vancomycin Resistant Enterococcus Faecalis (VREF)

Front 170

What is the MOA of Streptogramins? What is the drug name? What is it used for?

Back 170

~MOA: Inhibits Cell Wall Synthesis in 2 phases
~Drug: Quinupristin / Dalfopristin (Synercid)
~Use: for Vancomycin Resistant Enterococcus Faecium (VREF)

Front 171

Why MUST Quinupristin / Dalfopristin (Synercid) be administered via central line?

Back 171

Due to venous irritation

Front 172

What are the different types of Antifolate (Folate Antagonist) Drugs?

Back 172

~Sulfonamides
~Trimethoprim

Front 173

Describe the process of Antifolate Drugs?

Back 173

~Folic acid is needed by all cells for growth and division
~Human cells absorb Folic Acid whereas bacteria cell walls are impermeable to folic acid and must synthesize folate
~Bacteria make folic acid from p-aminobenzoic acid (PABA)
~Sulfonamides are structural analogs of (PABA) and compete for the enzyme Dihydropteroate Synthetase

Front 174

What is the MOA of Sulfonamides?

Back 174

Compete w/ PABA for the enzyme Dihydropteroate Synthetase

Front 175

What is the Role of Sulfonamides?

Back 175

~Bacteriostatic b/c they INHIBIT production of bacteria, not kill
~Selective b/c human cells and bacterial cells obtain folate in different ways

Front 176

What is the Spectrum of Sulfonamides?

Back 176

Very Broad Spectrum:
-Some gram+ and gram- bacteria, enteric bacteria (E
coli), Pneumocystis, Nocardia, Stenotrophomonas, S.
hemolyticus

Front 177

What are the Clinical uses if Sulfonamides?

Back 177

UTIs, Topical use for Burns, Prophylaxis for Otitis Media, Ulcerative Colitis and PCP

Front 178

What are the three routes of admin, based of pharmacokinetics?

Back 178

~Oral absorbable
~Oral nonabsorbable
~Topical

Front 179

What are some adverse rxns associated w/ Sulfonamides?

Back 179

~Crystalluria (stone formation)-- DRINK WATER
~Hypersensitivity- rash, angioedema
~Stevens-Johnson Syndrome
~Sulfa Allergy
~Hemolytic Anemia (G6PD deficient pts)
~Photosensitivity

Front 180

What are the Contraindications of Sulfonamides?

Back 180

Avoid use is children less than two months and pregnant women near end of term due to Kernicterus (bilrubin displacement)

Front 181

Name the Sulfonamide Drug?

Back 181

Sulfamethoxazole (Gantanol)

Front 182

What is the MOA of Trimethoprim?

Back 182

~Not a sulfonamide but it is an antifolate drug and it has a similar spectrum to the sulfa drugs
~Inhibits bacterial Dihydrofolate Reductase

Front 183

What the the Place in therapy for Trimethorpim?

Back 183

Its biggest place in therapy is using it in conjunction with Sulfamethoxazole due to a synergistic effect

Front 184

What are some adverse effects of Trimethorpim?

Back 184

Folate deficiency causing --> megaloblastic anemia, leukopenia and granulocytopenia

Front 185

What is the combination product between the Sulfonamide and the Trimethoprim?

Back 185

Sulfamethoxazole and Trimethoprim (Septra or Bactrim)

Front 186

What are the main uses for Sulfamethoxazole and Trimethoprim (Septra or Bactrim)?

Back 186

~Prostatitis – DOC to fight Enterobacteriaceae
~Severe diarrhea from Shigella
~Uncomplicated urinary tract infections (DOC)
-Alternative for adults and primary for children
~Respiratory tract infections
-Pneumocystis Jiroveci pneumonia – DOC may require IV
dosing - Most common opportunistic infection in AIDS

Front 187

What other Specific Folate Antagonists is the DOC for Otitis Media prophylaxis, but not effective for active Tx?

Back 187

Sulfisoxazole (Gantrisin) Oral liquid

Front 188

What Specific Folate Antagonists are used for Topical adjunctive Tx for 2nd and 3rd degree burns?

Back 188

~Silver Sulfadiazine (Silvadene)
~Mafenide (Sulfamylon)

Front 189

Which one is the DOC for Non-Infected burns?

Back 189

Silver Sulfadiazine (Silvadene)

Front 190

What are the Specific Folate Antagonist agents used for the Tx of Inflammatory bowel Dz (Ulcerative Colitis and Crohns Dz), both being DOC for this indication?

Back 190

~Sulfasalazine (Azufidine)
~Mesalamine (Asacol and Pentasa)

Front 191

Which Specific Folate Antagonist is used for conjunctivitis or other superficial ocular infections?

Back 191

Sulfacetamide solution

Front 192

Which Specific Folate Antagonist is used as the DOC in suppurative conjunctivitis in adults?

Back 192

Polymixin B and Trimethoprim (Polytrim)

Front 193

What are the Specific Folate Antagonist agents used for the Tx of Gardnerella Vaginalis?

Back 193

~Sulfathiazole
~Sulfacetamide
~Sulfabenzamide (Sultrin Vaginal Cream)

Front 194

What drugs Modify Synthesis or Metabolism of Nucleic Acids- aka. DNA Gyrase Inhibitors?

Back 194

Fluoroquinolones

Front 195

How many Generations of Fluoroquinolones are there?

Back 195

4 generations

Front 196

Of the 4 generations, which drugs dow you need to know for the test???

Back 196

~2nd Gen:
-Ciprofloxacin (Cipro)
~3rd Gen:
-Levofloxacin (Levaquin)
~4th Gen:
-Moxifloxacin (Avelox)
-Trovafloxacin (Trovan)

Front 197

What is the MOA of Fluoroquinolones?

Back 197

Inhibit the replication of bacterial DNA by interfering w/ DNA Gyrase (bacterial topoisomerase II) which is needed for bacteria to replicate, transcribe and repair DNA

Front 198

What is the Spectrum of Fluoroquinolones?

Back 198

Wide variety of Gram Neg organisms and some Gram Pos organisms (Pseudomonas species and Atypicals also)

Front 199

What spectrum are the Fluoroquinolones most active?

Back 199

Gram Neg, Pseudomonas species and Atypicals

Front 200

Although they are overall well tolerated, what are the MC adverse rxns of Fluoroquinolones?

Back 200

~GI SE's- N/V/D
~CNS- h/a, dizziness, agitation and sleep disturbances

Front 201

What are the Clinical uses of Fluoroquinolones?

Back 201

~UTIs, Prostatitis, Gonorrhea, Infectious diarrhea, Community Acquired Pneumonia (CAP)
~Alternates for:
-Bronchitis
-Sinusitis
-Skin

Front 202

Which Fluoroquinolone is used for MENINGITIS Prophylaxis?

Back 202

Ciprofloxacin (Cipro)

Front 203

What are some MAJOR Adverse Rxns associated w/ Fluoroquinolones?

Back 203

~Exploding jt Syndrome (tendonitis and achilles rupture)
~Increased QT interval (Moxifloxacin)
~Nephrotoxicity (Ciprofloxacin)
~Phototoxicity
~Acute Hepatitis and Hepatic Failure (Trovafloxacin)

Front 204

What are the Contraindications of Fluoroquinolones?

Back 204

Avoid in pregnancy and children under 18 due to articular cartilage erosion in animal studies

Front 205

What is the #1 cause of UTIs at >90%?

Back 205

Escherichia Coli

Front 206

What is the #1 Tx of Uncomplicated UTIs?

Back 206

Sulfamethoxazole and Trimethoprim (Septra or Bactrim)

Front 207

What type of drugs do not cause systemic antibacterial effects b/c they concentrate in the urine?

Back 207

Urinary Tract Antiseptics

Front 208

What is the Urinary Tract Antiseptic drug?

Back 208

Nitrofurantoin

Front 209

What is the MOA of Nitrofurantoin?

Back 209

Inhibits bacterial enzymes and damages bacterial DNA

Front 210

What is the Spectrum of Nitrofurantoin?

Back 210

~Includes both Gram +/- bacteria including E coli
~Resistance can be problematic (why this is the #2 drug for UTIs)

Front 211

Due to the Concentration of Nirtofurantoin in the urine, what might you want to tell your pt about the color of their urine?

Back 211

It will discolor their urine BROWN

Front 212

What are the adverse effects associated w/ Nitrourantoin?

Back 212

~GI- N/V/D - symptoms reduced when taken with food
~Acute pneumonitis- RARE
~Hemolytic anemia- caution use in pts w/ G6PD

Front 213

For Tx'ing UTIs in pregnant women, what drug is considered by some to be the DOC, but is still not totally safe (possible mutagenic effect)? How long is the Tx?

Back 213

~Nitrofurantoin (nothing else…gotta use it!!)
~Tx for 7 days

Front 214

What are the two forms of Nitrofurantoin? Whats the difference?

Back 214

~Nitrofurantoin (Macrodantin)
-Active infections require QID dosing
-Long term suppressive therapy is qd dosing
~Nitrofurantoin (Macrobid)
-BID dosing for active infections

Front 215

What Miscellaneous UTI agent exerts local anesthetic/analgesic action of the urinary tract mucosa, which relieves pruritus and pain?

Back 215

Phenazopyridine (Pyridium)

Front 216

Can Phenazopyridine be used by itself? What color does it turn the urine?

Back 216

~Must be used in conjunction w/ Abx
~Colors the urine orange-red

Front 217

What Miscellaneous Agent has ONLY Anaerobic bacteria and Protozoa spectrum and causes cell death by forming reduced cytotoxic compounds that bind to proteins and DNA?

Back 217

Metronidazole (Flagyl)

Front 218

What are the indicated uses of Metronidazole (Flagyl)?

Back 218

~Anaerobic intra-abdominal infections including Abx associated enterocolitis including Clostridium Difficile
~Bacterial vaginosis- covers Trichomoniasis in F and M
~Helicobacter pylori
~Amebiasis – covers protozoal infections (E. histolytica; Giardia, Trichomonas)

Front 219

What are some possible adverse rxns of Flagyl?

Back 219

~GI- N/V and cramps
~Might complain of metallic taste in their mouth

Front 220

What should be avoided by all pts taking Flagyl?

Back 220

Avoid alcohol- Possible disulfiram reaction (N/V/D effects)

Front 221

What are the two possible Tx's for Clostridium difficile?

Back 221

Metronidazole OR Vancomycin

Front 222

Why are fungal infections on the rise?

Back 222

~Increased Broad-spectrum antibiotic usage
~Increasing number of immunodeficient patients

Front 223

What fungal infection is the MC? Where can it be cultured from?

Back 223

~Candida Albicans is the MC
~Can be cultured from the mouth, vagina and feces

Front 224

What are some risk factors for invasive Candida?

Back 224

~Prolonged Neutropenia (HIV)
~Recent Abd surgery
~Broad Spec Abx therapy
~Renal Failure
~Presence of IV catheters
~IV Drug users

Front 225

Antifungal Agents are divided into what 3 categories based on how and what the Tx?

Back 225

1. Systemic Drugs (oral or IV)
2. Oral drugs for mucocutaneous infections
3. Topical drugs for mucocutaneous infections

Front 226

What are the different types of Antifungal drugs?

Back 226

~Amphotericin B (Fungizone)
~Azoles
~Allylamines
~Griseofulvin (Gris-Peg)
~Anidulafungin (Eraxis)
~Nystatin
~Caspofungin (Cancidas)

Front 227

What is the MOA for Amphotericin B?

Back 227

~Fungicidal that binds to Ergosterol more selectively than Cholesterol
~Disrupts fungal membrane function and allows lytes and macromolecules to leak from the cell

Front 228

When would resistance to Amphotericin B occur?

Back 228

~Binding to ergosterol is impaired OR
~Ergosterol membrane concentration is decreased

Front 229

What is the Place in therapy for Amphotericin B?

Back 229

Used in pts w/ Systemic Mycoses, meaning, pts who have a systemic fungal infection due to immune deficiencies who would otherwise not be infected (HIV)

Front 230

What is Amphotericin B the DOC for?

Back 230

The DOC for nearly all life threatening mycotic (fungal) infections

Front 231

When is Amphotericin B used for Empiric Therapy?

Back 231

For high risk untreated systemic infection patients
[e.g. neutropenic (HIV) pt on broad-spectrum antibiotic]

Front 232

Amphotericin B has a narrow therapeutic index, what are some adverse rxns to watch out for?

Back 232

~Infusion Related Toxicity: Fever, chills, muscle spasm, vomiting, h/a, and HoTN
-reduced by slowing infusion rate and reducing dose
-premedicate w/ antipyretics, antihistamines, meperadine
and corticosteroid may be helpful

Front 233

What are some MAJOR Adverse Rxns associated w/ Amphotericin B?

Back 233

~Renal Damage is the MOST significant toxic rxn (occurs in almost all pts)
~K+ and Mg++ wasting (K+ = arrhythmia, Mg++ = seizure)
~Anemia
~Intrathecal dosine (into spinal canal) can cause seizures

Front 234

How much total dose of Amphotericin B has a very HIGH incidence of Toxicity?

Back 234

2g total dose of Amphotericin B

Front 235

What needs to be monitored on this pt?

Back 235

CrCl and Lytes (K and Mg)

Front 236

What are the two alternative formulations of Amphotericin B that have fewer and less severe SE's?

Back 236

~Amphotericin B (Lipid Complex) [ABLC] (Abelcet)
~Amphotericin B (Liposomal) [L-AmB] (AmBisome)
-Better for long term therapy

Front 237

What are the subtypes of the Azole Antifungal drugs?

Back 237

~Imidazoles (less specificity for erosterol, more drug-drug interactions)
-Ketoconazole (Nizoral)
~Triazoles (more specificity for ergosterol)
-Fluconazole (Diflucan)
-Itraconazole (Sporanox)
-Voriconazole (Vfend)

Front 238

What is the MOA of Ketoconazole?

Back 238

Inhibits fungal membrane function and increases permeability (by reducing fungal ergosterol synthesisby inhibiting fungal CYP 450 enzymes)

Front 239

When taking Ketoconazole orally, the acidic environment helps w/ absorption. What can the pt drink to help w/ this?

Back 239

Cola helps

Front 240

What is Ketoconazole used to Tx?

Back 240

~Tinea Versicolor
~Cushings Syndrome

Front 241

What are the Adverse effects of Ketoconazole?

Back 241

~GI upset
~Endocrine effects- blocks androgen/steroid synthesis resulting in gynecomastia, decreased libido, impotence and menstrual irregularities (used in Cushing’s syndrome because of this)
~Monitor level in patients w/ hepatic dysfunction
~Drug interactions
-Inhibits CYP450 system
-Drugs that reduce stomach acid will reduce absorption of
Ketoconazole

Front 242

Fluconazole (Diflucan) is essentially the same drug as Ketoconazole, what advantages does it have over Ketoconazole?

Back 242

~Does not cause endocrine side effects
~Crosses BBB
~Fewer drug-drug interactions
~Avail in Oral and IV forms
~Acidic environment not required for absorption

Front 243

What are the Clinical uses for Fluconazole?

Back 243

~Vaginal Candidiasis <--DOC!!!
~Oropharyngeal and Esophageal Candidiasis

Front 244

What is the MOA of Itraconazole (Sporanox)?

Back 244

Same as other Azoles (inhibits CYP 450)

Front 245

What helps absorption of Itraconazole?

Back 245

Food and Low pH

Front 246

What are the clinical uses of Itraconazole?

Back 246

~Tinea
~Candidiasis
~Onychomycosis
~Poor CNS penetration

Front 247

What is the black box warning associated w/ Itraconazole?

Back 247

Avoid use in congestive heart failure

Front 248

What is the MOA of Voriconazole (Vfend)?

Back 248

Works by inhibiting the fungal CYP450 enzyme system resulting in cell wall integrity problems

Front 249

What are the clincal uses of Voriconazole?

Back 249

Used for Aspergillus (mold) infections

Front 250

Voriconazole is the alternate DOC for life threatening fungal infections behind what other drug?

Back 250

Amphotericin B
(Voriconazole is as effective as Amphotericin B and it has LESS kidney problems)

Front 251

What should be monitored while the pt is on Voriconazole?

Back 251

~Visual disturbances
~Liver and Renal Function

Front 252

Name the Allylamine antifungal drug?

Back 252

Terbinafine (Lamisil)

Front 253

What is the MOA of Terbinafine (Lamisil)?

Back 253

Inhibiting squalene epoxidase resulting ina deficiency of egosterol and an accumulation of squalene within the fungal cell --> causing DEATH!!!!!

Front 254

****What is the MAJOR advantage of Terbinafine over the Azoles?

Back 254

It does NOT inhibit the fungal or human CYP450 system, so has very few drug interaction

Front 255

Should Terbinafine be taken w/ or w/o food?

Back 255

Should be taken w/ food --> Oral availablility is increased if taken w/ food

Front 256

What are the Clinical uses of Terbinafine (Lamisil)? What is it the DOC in?

Back 256

~Onychomycosis (<--DOC)
~Tinea

Front 257

What are the ADRs of Terbinafine? What needs to be monitored while on this drug?

Back 257

~Liver Enzyme abnormalities (3.3%)
~Taste Disturbances (2.8%)
~Monitor AST/ALT for 3 months!!!!

Front 258

What is the MOA of Griseofulvin (Gris-Peg)?

Back 258

~Fungistatic!!!
~Disrupts the mitotic spindle and inhibits mitosis

Front 259

Griseofulvin therapy will need to be continued until NEW tissue replaces the infected tissue, which is how long?

Back 259

Weeks to months

Front 260

What is the Place in Therapy for Griseofulvin?

Back 260

Tinea Capitus (largely been replaced by newer antifungals)

Front 261

What allows for better absorption of Griseofulvin?

Back 261

Increased absorption w/ HIGH fat diet

Front 262

What are the ADRs of Griseofulvin?

Back 262

Induces CYP450 activity

Front 263

What is the MOA of Anidulafungin (Eraxis)?

Back 263

Inhibits glucan synthase blocking fungal production of D-glucan, an essential component of fungal cell walls

Front 264

What are the clinical uses of Anidulafungin?

Back 264

~Invasive Aspergillus in refractory cases
~Candidemia, Candida abscesses/peritonitis, esophagitis
~Empiric Tx of presumed fungal infections in Febrile neutropenia (HIV)

Front 265

ADRs of Anidulafungin?

Back 265

Diarrhea and Hypokalemia (monitor K+ levels)

Front 266

What is the Drug that has exactly the same MOA and Usage as Anidulafungin, but has different ADRs?

Back 266

Caspofungin (Cancidas)

Front 267

What are the ADRs of Caspofungin?

Back 267

Heahache, fever, chills, phlebitis (monitor LFTs)

Front 268

What is the MOA of Nystatin?

Back 268

~Similar to Amphotericin B (Disrupts fungal membrane function and allows lytes and macromolecules to leak from the cell)

Front 269

What is the Clinic Use of Nystatin?

Back 269

Used for topical tx (swish and spit) of Oral Candida (Thrush)

Front 270

According to the Sanford recommendation, what are the Primary and Secondary Tx's for Vaginal Candidiasis?

Back 270

~Primary (DOC): Fluconazole OR Itraconazole
~Secondary: Intravaginal Imidazoles
-Clotrimazole (Gyne-Lotrimin or Mycelex)
-Miconazole (Monistat)
-Terconazole (Terazol)
-Butoconazole (Femstat, Gynazole 1, and Mycelex-3)
-Tioconazole (Vagistat 1 and Monistat 1)

Front 271

What is the biggest reason for Fluconazole being the DOC over the Imidazoles?

Back 271

Fluconazole requires a 1 day Tx, as opposed to the 3-7 day schedule for the Imidazoles

Front 272

The medications for Malaria can be divided into what two major categories?

Back 272

~Chemoprophylaxis- Medications used to prevent malaria
~Treatment- Medications used to treat active infections

Front 273

What are the Vectors and what actually causes Malaria?

Back 273

~Vector: Anopheles Mosquito
~Cause: Plasmodium Protozoa

Front 274

What are the four species of Plasmodium Protozoa?

Back 274

~P. Falciparum (MOST DANGEROUS)
~P. Vivax (most common)
~P. Malariae
~P. Ovale

Front 275

What are some of the S/Sx's of Malaria?

Back 275

HIGH fever, HoTN, and swollen red limbs

Front 276

What is the DOC used after the infected mosquito injects sporozoites into human hosts and sporozoites move to liver and develop into merozoites?

Back 276

Primaquine

Front 277

What are the Drugs used after merozoites leave liver, infect and destroy RBCs (where they use Hgb as a nutrient), and move to other RBCs?

Back 277

Drugs that work here Chloroquine, Quinine, Mefloquine, and Pyrimethamine

Front 278

When Rx'ing Malaria Chemoprophylaxis, what factors need to be considered before Rx?

Back 278

~Location of Travel
~Time before travel
~Traveler specific factors (occupation, pregnancy status, underlying medical conditions)

Front 279

What are the different drugs used for Malaria Chemoprophylaxis?

Back 279

~Atovaquone & Proquanil (Malarone) (<-- DOC)
~Doxycycline (Vibramycin) (<-- Military DOC)
~Mefloquine (Lariam) (<-- Alt #2)
~Chloroquine (Aralen) (<-- not used much/resistant)

Front 280

What is the Dosing Schedule for Chloroquine?

Back 280

1-2 wks before travel, during, and 4 wks after travel

Front 281

For areas of Chloroquine resistant P. Falciparum, what is the 1st line DOC, Alt #1 (Military DOC), and Alt #2?

Back 281

~1st line (DOC): Atovaquone & Proquanil (Malarone)
~Alt #1 (Military DOC): Doxycycline (Vibramycin)
~Alt #2: Mefloquine (Lariam)

Front 282

Which Malaria Prophylactic drug is the BEST option in Kids and Pregnancy?

Back 282

Mefloquine (Lariam)

Front 283

What are some of the ADRs of Mefloquine?

Back 283

~May produce some CNS SE's:
-Dizziness, not recommended for persons w/ epilepsy or
seizure DOs, Severe psychiatric DOs, Cardiac
conduction abnormalities.
~Vomiting – 3%

Front 284

What is the dosing Schedule for Mefloquine? Advantage?

Back 284

~1 wk before travel, during, and 4 wks after travel
~Requires ONCE A WEEK DOSING

Front 285

What is the dosing Schedule for Doxy? Advantage?

Back 285

~1-2 days before travel and 4 wks after
~Requires daily dosing

Front 286

Who is Doxy contraindicated in?

Back 286

~Children <8 yrs
~Pregnant Women

Front 287

What is the dosing Schedule for Atovaquone & Proquanil (Malarone)? Advantage?

Back 287

~1-2 days before travel and 7 days after
~Requires daily dosing

Front 288

What are the ADRs of Malarone?

Back 288

Abdominal pain, N/V, and headache can occur

Front 289

What Folate inhibitor is an alternate in the use of Malarial Prophylaxis?

Back 289

~Pyrimethamine (Daraprim)
-Similar to trimethoprim

Front 290

What Antimalarial Agent is used as the DOC for eradication of DORMANT P. Vivax and P. Ovale?

Back 290

Primaquine

Front 291

When is Primaquine dosed?

Back 291

14 days post travel

Front 292

What travelers should NOT receive Primaquine? Why?

Back 292

Can cause Hemolytic anemia in G6PD pts

Front 293

What are the aspects of the DoD Insect Repellant System?

Back 293

~Permethrin Impregnation Kit (IDA)
~Skin repellent (DEET 33% controlled-release lotion)
~Wear uniform properly
~DoD policy – required use

Front 294

Describe the use of Permethrin Impregnation Kit (IDA)?

Back 294

Used to treat the uniform; lasts approximately 50 washes
(make sure to wash 3-4 time before use)

Front 295

How long does DEET last on the skin?

Back 295

12 hrs

Front 296

What is the general characteristic of Helminthic Nematodes?

Back 296

Elongated Roundworms

Front 297

What is the MC Helminthic infection in the US?

Back 297

Enterobiasis (pinworms)

Front 298

What are the S/Sx's of Pinworm infections?

Back 298

Perianal Pruritus, restlessness, and insomnia

Front 299

What are the TWO main Antihelminthic Drugs?

Back 299

~Mebendazole (Vermox)
~Pyrantel Pamoate (Antiminth)

Front 300

What is the MOA of Mebendazole (Vermox)?

Back 300

Irreversibly blocks uptake of glucose, thus depleting energy level

Front 301

What is the spectrum of use for Mebendazole?

Back 301

Covers Pinworm (Enterobius vermicularis) and Round/Hook worm (Necator americanus)

Front 302

What is the dosing of Mebendazole?

Back 302

~Single dose; repeat in 2 weeks if needed
~Take with high fat meal

Front 303

What are the SE's and CI's of Mebendazole?

Back 303

~SE's: abdominal pain and Diarrhea
~CI: Children <2 yrs and Pregnancy

Front 304

What is the name of the OTC Drug used for the Tx of PINWORM?

Back 304

Pyrantel Pamoate (Antiminth)

Front 305

What is the MOA of Antiminth?

Back 305

Depolarizing neuromuscular blocker works to cause paralysis in worm

Front 306

What are the SE's and CI's of Antiminth?

Back 306

~SE's: N/V/D
~CI: Children <2 yrs and Pregnancy

Front 307

What are some other possible parasitic infections and the associated Tx's?

Back 307

~Entamoeba Histolytica (amebiasis)
-Luminal agent (iodoquinol or paromomycin) +
metronidazole (or tinidazole)
~Giardia Lamblia
-Metronidazole or Tinidazole
~Pneumocystis Jiroveci Pneumonia (PCP)
-Sulfamethoxazole-Trimethoprim (Septra)
~Toxoplasmosis Gondii (catbox)
-Tx: Pyrimethamine + Sulfadiazine
-Proph: Sulfamethoxazole-Trimethoprim (Septra)
~Trichomonas Vaginalis
-Metronidazole

Front 308

Why are Mycobacteria Infections so difficult to Tx w/ Abx?

Back 308

~Slow growing bacteria (many Abx need fast growing cells to be effective)
~Cells have ability to go dormant
~Cells have lipid rich cell wall impermeable to many Abx
~Mycobacteria can live in human cells (macrophages) which protect them
~Mycobacterial infections have ability to develop resistance to single agents quickly

Front 309

What is the causitive organism of Tuberculosis (TB)?

Back 309

Mycobacterium Tuberculosis

Front 310

What Dz is the leading cause of infectious death in the world?

Back 310

TB

Front 311

What pts in the US are more lilely to develop TB?

Back 311

AIDS and Homeless pts

Front 312

Multi-Drug therapy for TB is standard, why?

Back 312

Due to resistance!!!

Front 313

What are considered to be the 1st Line Antitubercular Agents?

Back 313

~Isoniazid
~Rifampin
~Pyrazinamide
~Ethambutol
~Streptomycin

Front 314

Tx of ACTIVE TB infection almost always requires how many of the 1st Line Anti-TB Agents?

Back 314

4 of the 5 above drugs!!!!
-The choice is between Ethambutol OR Streptomycin

Front 315

When is TB contageous?

Back 315

When the pt has Active TB (coughing- spreads by inhaled airborne viable organism)

Front 316

Name and describe the different phases of TB infection?

Back 316

~Primary TB: usually clinically and radiographically silent because T cells and macrophages contain organisms
~Latent TB: individual does not have active disease and can’t transmit the organism but 10% will develop TB in their life time if not treated with medication
~Progressive Primary TB (Active TB): presents with the classic symptoms of TB (usually has immunity compromise)

Front 317

What are the general S/Sx's of Active TB?

Back 317

Malaise, anorexia, weight loss, fever, night sweats, chronic cough, blood streaked sputum

Front 318

What are some additional complications of TB?

Back 318

Lungs collapse, pus in lungs, emphysema, pulmonary fibrosis

Front 319

PPD identifies infected individuals, but does not distinguish between what?

Back 319

Active and Latent infections

Front 320

PPD-- 0.1ml placed intradermally (ID) on forearm and is interpreted in 48-72hrs. What indicates a positive rxn? What does a pos rxn indicate?

Back 320

~Positive Rxn = Raised area >5-15mm in diameter
~A Pos skin test only indicates EXPOSURE

Front 321

What TB vaccine will cause a pt to have a Pos PPD?

Back 321

Bacillus Calmette-Guerin (BCG) vaccine

Front 322

What are the GOALS of TB Therapy?

Back 322

Eliminate all bacilli from infected individual without incurring drug-resistance

Front 323

For Tx of TB, administer multiple drugs for which the organism is susceptible! If Tx fails, ADD at least how many new anti-tubercular agents?

Back 323

Add at least TWO new Anti-Tubercular agents if Tx fails

Front 324

What is the major cause of Tx failure fo TB and developing drug resistance?

Back 324

Non-Compliance!!!!

Front 325

What is the Tx Regimen for the Latent Infection?

Back 325

~Isoniazid (INH) (susceptible) --> 300mg dose
~Continue therapy for 9 months
~Pyridoxine (B6)- possibly
~Routine LFTs (AST/ALT) q month

Front 326

For pts who you foresee Noncompliance, what can be done?

Back 326

Direct Observed Therapy (DOT)

Front 327

How does the Tx for TB change in pts WITH HIV?

Back 327

~Basic approach is similar to Tx for Non-HIV Pts
~General Considerations:
-Longer Duration of Therapy
-More drug-drug interactions (esp between anti-retroviral
drugs and rifamycin derivatives (Rifampin & Rifabutin)
-Pyridoxine (B6): should be added to INH regimen
to reduce central & peripheral nervous system effects

Front 328

What is the MOA of Isoniazid (INH)?

Back 328

~Synthetic Analog of Pyridoxine (B6)
~Interferes w/ enzymes responsible for assembly of mycotic acids into the outer layer of the bacteria

Front 329

What are the Uses of INH?

Back 329

~Active TB (but not as a single agent)
~Use as a single agent for latent infections and exposure

Front 330

Should you take INH w/ or w/o food?

Back 330

Absorption is IMPAIRED w/ food

Front 331

What are the ADRs of INH?

Back 331

~Peripheral neuritis- due to pyridoxine deficiency
-Give Pyridoxine (B6) daily with INH
~Hepatitis and idiosyncratic hepatotoxicity- Higher incidence with age, Rifampin use and alcohol use. Monitor liver transaminases

Front 332

What pts are most at risk for developing Peripheral Neuritis?

Back 332

Diabetic, uremic, malnourished, alcoholics, HIV, pregnancy and seizure disorder

Front 333

What is the MOA of Rifampin (Rifadin or Rimactane)?

Back 333

Inhibts RNA synthesis by supressing the initiating step

Front 334

What are the Uses of Rifampin?

Back 334

TB, Leprosy, Meningitis, amd other bacterial infections

Front 335

What are some important facts that your pt might want to know while on Rifampin?

Back 335

~Crosses BBB
~Stains urine, feces and other secretions red/orange

Front 336

What are some ADRs associated w/ Rifampin?

Back 336

~Nausea, vomiting, rash and fever
~Caution - hepatic failure because of jaundice, watch the elderly and alcoholics

Front 337

Where else in therapy does Rifampin get used?

Back 337

MRSA

Front 338

Why does Rifampin cause so many drug interactions?

Back 338

~Potent CYP450 Inducer w/ multi-drug rxns, including:
-HIV, OCPs, and Azole Antifungals

Front 339

What drug is very similar to Rifampin w/ the same activity and cross-resistance, but its advantage is less induction of the cytochrome P450 enzyme system?

Back 339

Rifabutin

Front 340

Why is Rifabutin of significant value to HIV infected patients who are receiving antiretroviral therapy?

Back 340

LESS multi-drug rxns!!!!

Front 341

What is the MOA of Pyrazinamide (PZA)?

Back 341

UNK

Front 342

What are the Uses of Pyrazinamide?

Back 342

~Use w/ INH and Rifampin in Active TB
~Use w/ Rifampin in pts w/ Latent TB who can’t tolerate INH/resistance to INH

Front 343

What are the ADRs of Pyrazinamide?

Back 343

~Hepatotoxicity (1 to 5%)
~May precipitate gouty attack due to hyperuricemia

Front 344

When is the ONLY time you would use Pyrazinamide in a pregnant pt?

Back 344

Should not be used unless documented resistance to other drugs and susceptibility to drug is shown

Front 345

What are the Uses of Ethambutol (Myambutol)?

Back 345

~Use in combination w/ other agents for Active TB
(either this agent or Streptomycin is used as the 4th agent in Active TB infections when indicated)

Front 346

What are the ADRs of Ethambutol?

Back 346

~Optic Neuritis- diminished VA and color discrimination (red-green color blindness)

Front 347

Will the pts Optic probs ever reverse?

Back 347

YES-- Stop the Med

Front 348

What is the MOA of Streptomycin?

Back 348

It is an aminoglycoside so it inhibits bacterial protein synthesis
(Not used much for the Tx of TB)

Front 349

What are the Uses of Streptomycin?

Back 349

May be alternative first line agent (vs. Ethambutol) added to a regimen for Tx of Active TB when INH resistance rate is >4% or patient is non-compliant

Front 350

What is the Standard route of Admin for Streptomycin?

Back 350

Not orally available - IM is standard route

Front 351

What are the ADRs of Streptomycin?

Back 351

~Ototoxic and nephrotoxic
~Neonatal deafness (Do not use in pregnancy)

Front 352

Give a brief characteristic description of a Virus?

Back 352

~Obligate Intracellular Parasite
~No Cell wall or cell membrane
~Uses host cells for metabolic processes for reproduction

Front 353

So, why is it hard to selectively target drugs against viral processes?

Back 353

B/C the host wll be affected!!

Front 354

For the prevention and Tx of Influenza Type A and B, the vaccine is the best approach. What are the two vaccine types that contain both Type A and B Influenza?

Back 354

~Live, Attenuated Influenza Vaccine (FluMist)
~Inactivated Influenza Vaccine (Flu Shot)

Front 355

Does the Respiratory Syncytial Virus (RSV) have a vaccine?

Back 355

NO

Front 356

Describe the two types of Influenza and the associated Sx's?

Back 356

~Type A: Subject to mutation due to antigen drift
~Type B: Less likely to mutate
~Sx's: abrupt onset of fever, myalgia, HA, severe malaise, cough, sore throat and rhinitis

Front 357

Who is the Inactivated Influenza Vaccine (Flu Shot) recommended for (priority pts)?

Back 357

~Children aged 6–23 MONTHS
~Adults aged >65 yrs
~Pregnant women in their second or third trimester (during influenza season)
~Persons aged >2 yrs w/ chronic conditions (cardiovascular, pulmonary, renal dysfunction, diabetes, immunosuppressed, etc)

Front 358

What pts are the next priority for the Inactivated Influenza Vaccine (Flu Shot)?

Back 358

Those persons at greatest risk for transmission of disease to persons at high risk, including:
-Household Contacts and Health-Care workers

Front 359

What pts are approved for the use of the Live, Attenuated Influenza Vaccine (FluMist)?

Back 359

~Healthy children and adolescents ages 5-17 yrs
~Adults age 18-49 yrs

Front 360

The FluMist must be stored frozen, once thawed how long do you have to use it?

Back 360

Within 60 hrs

Front 361

Which is more expensive, the Flu Shot or FluMist?

Back 361

~FluMist $35.00/dose
~Flu Shot $3.00/dose

Front 362

When should Chemoprophylaxis be used instead of the vaccine for Influenza?

Back 362

~High risk persons who have not been vaccinated
~2 weeks for vaccine to produce antibodies
~Allergies (eggs)
~Immunocompromised persons
~Control outbreaks in institution housing

Front 363

What are the Two drugs used for Influenza Chemoprophylaxis that cover Type A ONLY?

Back 363

~Amantadine (BCF)
~Rimantadine

Front 364

What is the MOA of Amantadine and Rimantadine?

Back 364

Blockade of the viral membrane matrix protein (M2) which acts as an ion channel required for viral/cell membrane fusion

Front 365

Can Amantadine and Rimantadine be used in conjunction w/ the vaccine?

Back 365

YES

Front 366

What are some of the differences between Amantadine and Rimantadine?

Back 366

~Amantadine crosses BBB; Rimantadine does NOT
~Amantadine is NOT metabolized by liver; Rimantadine is metabolized in the liver

Front 367

Between Amantadine and Rimantadine, which one could be used in a pt w/ Renal failure?

Back 367

Rimantadine

Front 368

Since Amantadine crosses the BBB, what other uses does it have?

Back 368

Amantadine is used to Tx Parkinson’s Dz because it will cross the CNS and increase dopamine levels in neurons

Front 369

What are the adverse SE's Associated w/ Amantadine and Rimantadine?

Back 369

~Amantadine- CNS --> insomnia, dizziness and ataxia
~Rimantadine- Fewer CNS problems --> does not readily cross BBB

Front 370

What are the Two drugs used for Influenza Chemoprophylaxis/Tx that cover Type A and B?

Back 370

~Oseltamivir (Tamiflu)
~Zanamivir (Relenza)

Front 371

What is the MOA of Oseltamivir (Tamiflu) and Zanamivir (Relenza)?

Back 371

Inhibition of viral neuraminidase and virus replication

Front 372

What are the Positive effects that Tamiflu and Relenza have on the duration of the Influenza illness?

Back 372

Reduces duration by 1-3 days if started within 12hrs to 2 days of onset

Front 373

What is recommended dosing duration for prevention vs. treatment for Tamiflu and Relenza?

Back 373

~QD for 7 days for prevention (Tamiflu ONLY!!!!!, Relenza is NOT approved for prevention)
~BID for 5 days for treatment (both)

Front 374

What is needed to have before either of these Meds is Rx'ed?

Back 374

Documented labs stating the pts has Type A and B Flu

Front 375

What are the routes of admin for both Tamiflu and Relenza?

Back 375

~Tamiflu
-Oral Capsule --> Take w/ food to prevent nausea
-Suspension for kids
~Relenza
-Dry powder inhaler (Not recommended for asthma/COPD)

Front 376

****How is RSV spread? Who is it most fatal in?
(Just know this about RSV!!!)

Back 376

~Spread person to person
~Can be fatal in premature babies <6 mo old, immune deficient babies and infants with chronic lung disease

Front 377

Describe the different types of Herpes Virus?

Back 377

~HSV-1- gingivostomatitis in infants and children, irritability, anorexia, fever, gingival inflammation w/ painful ulcers in mouth
~HSV-2- transmitted primarily by direct contact
~Herpes Zoster- caused by varicella-zoster virus(chcknpox)

Front 378

Of these different types of Herpes, which has a vaccine? Name the vaccines?

Back 378

~Vaccine for Herpes Zoster
~Varicella (Varivax) --> recommended after first birthday
~Zostavax patients 60 years and older

Front 379

What sre the Drugs used for the Tx of the Herpes Virus?

Back 379

~Acyclovir (Zovirax) (<-- DOC)
~Valacyclovir (Valtrex) (<-- DOC)

Front 380

What is the MOA of Acyclovir (Zovirax)?

Back 380

~Causes viral DNA chain termination by competing w/ Deoxyguanosine Triphosphate (dGTP) as a substrate for viral DNA polymerase
~Requires conversion by thymidine kinase first
(inhibits viral DNA synthesis & viral replication)

Front 381

What are the Indicated uses of Acyclovir?

Back 381

Genital herpes, cold sores (herpes labialis), herpes zoster (shingles, chickenpox)

Front 382

What is the Organism Spectrum of Acyclovir?

Back 382

Organisms include HSV-1 and 2, varicella-zoster and Epstein-Barr

Front 383

What are some of the ADRs associated w/ Acyclovir?

Back 383

~Not significant --> h/a, N/V/D have been reported
~IV --> renal/neuro toxicity (crosses BBB)

Front 384

What is the MOA of Valacyclovir (Valtrex)?

Back 384

Prodrug of Acyclovir therefore same MOA but better bioavailability and LONGER DURATION

Front 385

What are the Indicated uses of Valacyclovir (Valtrex)?

Back 385

Genital herpes, Herpes zoster (shingles)

Front 386

What Dz is responsible for a variety of infections ranging in severity (retinitis, esophagitis, hepatitis and GI) and is a major cause of morbidity and mortality in immunosuppressed pts?

Back 386

Cytomegalovirus (CMV)

Front 387

How is CMV transmitted and what is acquired?

Back 387

CMV is transmitted through blood or bodily fluid and results in an acquired Acute Febrile illness

Front 388

What can occur as a result of contracting CMV during pregnancy?

Back 388

May result in abortion, stillbirth, post natal death due to hemorrhage, anemia, hepatic or CNS damage

Front 389

What are the drugs used for the Tx of CMV?

Back 389

~Ganciclovir (Cytovene and Vitrasert optic insert) (DOC)
~Foscarnet (Foscavir) (ALTERNATE)

Front 390

What is the MOA of Ganciclovir? (<-- DOC)

Back 390

Guanine analog that competes for deoxyguanosine as a substrate for DNA (virostatic)

Front 391

What are the indicated uses for Ganciclovir? (IV vs. Oral)

Back 391

~IV product: only for CMV retinitis in immunocompromised pts and transplants
~Oral product: only for preventing CMV in HIV pts and maintenance for IV indications

Front 392

What are the Black Box Warnings of Ganciclovir?

Back 392

Granulocytopenia, anemia, and thrombocytopenia

Front 393

What is the MOA of Foscarnet?

Back 393

Reversibly ihibits DNA and RNA polymerase thereby terminating chain elongation (virostatic)

Front 394

What are the indicated uses of Foscarnet?

Back 394

CMV retinitis and Acyclovir resistant HSV

Front 395

Foscarnet can be used by itself or in conjunction w/ what other CMV Drug?

Back 395

Ganciclovir

Front 396

What are the ADRs/BBW of Foscarnet?

Back 396

Nephrotoxicity, anemia, nausea and fever (Black Box warning)