Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
97 Cards in this Set
- Front
- Back
M. tuberculosis prophylaxis?
|
Isoniazid
|
|
M. avium-intracellulare prophylaxis?
|
Azithromycin
|
|
M. leprae prophylaxis?
|
N/A
|
|
M. tuberculosis treatment?
|
"RIPE for treatment"
R - Rifampin I - Isoniazid P - Pyrazinamide E - Ethambutol |
|
M. avium-intracellulare treatment?
|
- rifampin
- ethambutol - azithromycin - streptomycin |
|
M. leprae treatment?
|
- rifampin
- dapsone - clofazimine |
|
Anti-TB drugs?
|
"INH-SPIRE (inspire)"
INH - Isonizid (prophylaxis) S - Streptomycin P - Pyrazinamide I - Isoniazid R - Rifampin E - Ethambutol |
|
Anti-TB drugs 2nd line of therapy?
|
Cycloserine
|
|
Important ethambutol side effect?
|
- optic neuropathy (red-green colorblindness)
|
|
Important side effect of other anti-TB drugs?
|
Hepatotoxicity
|
|
Isoniazid (INH) mechanism?
|
- decreases synthesis of mycolic acids
- different INH half-lives in fast vs. slow acetylators |
|
Clinical uses of isoniazid (INH)?
|
- Mycobacterium tuberculosis
- the only agent used as solo prophylaxis against TB |
|
Isoniazid (INH) toxicity?
|
"INH = Injures Neurons and Hepatocytes"
- neurotoxicity - hepatotoxicity - Pyridoxine (vitamin B6) can prevent neurotoxicity |
|
What can prevent neurotoxicity in Isoniazid (INH)?
|
- pyridoxine (vitamin B6)
|
|
Rifampin mechanism?
|
- inhibits DNA-dependent RNA polymerase
|
|
Clinical uses of rifampin?
|
- Mycobacterium tuverculosis
- delays resistance to dapsone when usedused for leprosy - meningococcal prophylaxis - chemoprophylaxis in contacs of kids with Haemophilus influenzae type B |
|
Rifampin toxicity?
|
- minor hepatotoxicity
- minor drug interactions (increase P-450) - orange body fluids (non-hazardous side effect) |
|
Which drug causes orange body fluids as a side effect?
|
- Rifampin
- nonhazardous side effect |
|
Rifampin's 4 R's?
|
- RNA pol inhibitos
- Revs up microsomal P-450 - Red/orange body fluids - Rapid resistance if used alone |
|
Resistance mechanism for penicillins/cephalosporins?
|
- beta-lactamase cleavage of beta-lactam ring
or - altered PBP in cases or MRSA penicillin-resistant S pneumoniae |
|
Resistance mechanism for aminoglycosides?
|
- modification of drug via acetylation, adenylation, or phosphorylation
|
|
Resistance mechanism for vancomycin?
|
- terminal D-ala of cell wall component is replaced with D-lac causing decreased affinity
|
|
Resistance mechanism for chloramphenicol?
|
- modification of drug via acetylation
|
|
Resistance mechanism for macrolides?
|
- methylation of rRNA near erythromycin's ribosome-binding site
|
|
Resistance mechanism for tetracycline?
|
- decreased uptake
or - increased transport out of cell |
|
Resistance mechanism for sulfonamides?
|
- altered enzyme (bacterial dihydropteroate synthetase)
- decreased uptake - increased PABA synthesis |
|
Resistance mechanism for quinolones?
|
- altered gyrase
or - reduced uptake |
|
Nonsurgical antimicrobial prophylaxis:
Meningococcal infection |
- rifampin (DOC)
- minocycline |
|
Nonsurgical antimicrobial prophylaxis:
Gonorrhea |
Ceftriaxone
|
|
Nonsurgical antimicrobial prophylaxis:
Syphilis |
Benzathine penicillin G
|
|
Nonsurgical antimicrobial prophylaxis:
history of recurrent UTIs |
TMP-SMX
|
|
Nonsurgical antimicrobial prophylaxis:
Pneumocystis jiroveci pneumonia |
- TMP-SMX (DOC)
- aerosolized pentamidine |
|
Nonsurgical antimicrobial prophylaxis:
Endocarditis with surgical or dental procedures |
Penicillins
|
|
Treatment of highly resistant bacteria:
MRSA |
Vancomycin
|
|
Treatment of highly resistant bacteria:
VRE |
Vancomycin-Resistant Enterococci
- linezolid - strptogramins (quinopristin/dalfopristin) |
|
Which anti-fungals form artificial pores, disrupting fungal membranes?
(2) |
- amphotericin
- nystatin |
|
Which anti-fungal disrupts microtubules?
|
Griseofulvin
|
|
Which anti-fungal blocks pyrimidine precursors?
|
Flucytosine
|
|
Which anti-fungal blocks squalene --> lanosterol in ergosterol synthesis?
|
Terbinafine
|
|
Which anti-fungal blocks lanosterol --> ergosterol in ergosterol synthesis?
|
Azoles
|
|
Amphotericin B mechanism?
|
"amphoTERicin TEARS holes in the fungal membrane by forming pores"
- binds ergosterol (unique to fungi) and forms membrane pores that allow leakage of electrolytes |
|
Clinical uses of amphotericin B?
|
- wide spectrum of systemic mycoses
- Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor (systemic mycoses) - intrathecally for fungal meningitis - does not cross BBB |
|
Amphotericin B toxicity?
|
"amphoterrible"
- fever/chills ("shake and bake") - HYPOtension - nephrotoxicity - arrhythmias - anemia - IV phlebitis |
|
What reduces the nephrotoxicity of amphotericin B?
|
Hydration
|
|
Complexing amphotericin B to what reduces its toxicity?
|
Lipids --> liposomal amphotericin
|
|
Nystatin mechanism?
|
- binds to ergosterol, disrupting fungal membranes
- too toxic for systemic use |
|
Clinical uses of nystatin?
|
- "Swish and swallow" for oral candidiasis (thrush)
- topical for diaper rash or vaginal candidiasis |
|
Why isn't nystatin used systemically?
|
- too toxic
|
|
Azoles?
(6) |
- fluconazole
- ketoconazole - clotrimazole - miconazole - itraconazole - voriconazole |
|
Azole mechanism?
|
- inhibit fungal sterol (ergosterol) synthesis
|
|
Clinical uses of azoles?
|
- systemic mycoses
|
|
Clinical uses of fluconazole?
|
- cryptococcal meningitis in AIDS pts (because it can cross BBB)
- candidal infections of all types (ie. yeast infections) |
|
Clinical uses of ketoconazole?
|
- Blastomyces
- Coccidioides - Histoplasma - Candida albicans - hypercortisolism |
|
Clinical uses of clotrimazole and miconazole?
|
- topical fungal infections
|
|
Azole toxicity?
|
- hormone sunthesis inhibition (gynecomastia)
- liver dysfunction (inhibits cytochrome P-450) - fever - chills |
|
Flucytosine mechanism?
|
- inhibits DNA synthesis by conversion to 5-FU
|
|
Clinical uses of flucytosine?
|
- systemic fungal infections (ie. Candida and Cryptococcus) in combo with amphotericin B
|
|
Flucytosine toxicity?
|
- nausea
- vomiting - diarrhea - bone marrow suppression |
|
Caspofungin mechanism?
|
- inhibits cell wall synthesis by inhibiting synthesis of beta-glucan
|
|
Clinical uses of caspofungin?
|
Invasive aspergillosis
|
|
Caspofungin toxicity?
|
- GI upset
- flushing |
|
Terbinafine mechanism?
|
- inhibits the fungal enzyme squalene epoxidase
|
|
Clinical uses of terbinafine?
|
- used to treat dermatophytoses (especially onychomycosis)
|
|
Griseofulvin mechanism?
|
- interferes with microtubule function --> disrupts mitosis
- deposits in keratin-containing tissues (ie. nails) |
|
Clinical uses of griseofulvin?
|
- oral treatment of superficial infections
- inhibits growth of dermatophytes (tinea, ringworm) |
|
Griseofulvin toxicity?
|
- teratogenic
- carcinogenic - confusion - headaches - increased P-450 and warfarin metabolism |
|
Which anti-viral drugs block viral adsorption?
|
- gamma-globulins (non-specific)
|
|
Which anti-viral drugs block viral uncoating?
|
- amantadine (influenza A only)
|
|
Which anti-viral drugs block viral nucleic acid synthesis?
|
- purine and pyrimidine analogs
- reverse transcriptase inhibitors |
|
Which anti-viral drugs block viral packaging and assembly?
|
- Rifampin (vaccinia)
|
|
Which anti-viral drugs block viral release?
|
- neuraminidase inhibitors (influenza)
|
|
Amantadine mechanism?
|
"A man to dine" takes off his COAT
- blocks viral penetration/unCOATING (M2 protein) - may buffer pH of endosome - also causes the release of dopamine from intact nerve terminals |
|
Clinical uses of amantadine?
|
"Amaintadines blocks influenza A and rubellA and causes problems with the cerebellA"
- prophylaxis and treatment for influenza A - Parkinson's disease |
|
Amantadine toxicity?
|
"Amaintadines blocks influenza A and rubellA and causes problems with the cerebellA"
- ataxia - dizziness - slurred speech - Rimantidine is a derivative with fewer CNS side effects --> does not cross the BBB |
|
Amantadine resistance mechanism?
|
- mutated M2 protein
- 90% of all influenza A strains are resistant to amantadine, so not used |
|
Zanamivir and Oseltamivir mechanism?
|
- inhibit influenza neuraminidase --> decreasing the release of progeny virus
|
|
Clinical uses of Zanamivir and Oseltamivir?
|
- both influenza A and B
|
|
Ribavirin mechanism?
|
- inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase
|
|
Clinical uses of ribavirin?
|
- RSV
- chronic hepatits C |
|
Ribavirin toxicity?
|
- hemolytic anemia
- severe teratogen |
|
Acyclovir mechanism?
|
- monophosphorylated by HSV/VZV thymidine kinase
- guanosine analog - triphosphate formed by cellular enzymes - preferentially inhibits viral DNA polymerase by chain termination |
|
Clinical uses of acyclovir?
|
- HSV, VZV, EBV
- used for HSV-induced mucocutaneous and genital lesions as well as for encephalitis - prophylaxis in immunocompromised patients - for herpes, zoster, use a related agent, famciclovir - no effect on latent forms of HSV and VZV |
|
What drug do you use for herpes zoster?
|
- famciclovir --> related to acyclovir
|
|
Acyclovir toxicity?
|
generally well tolerated
|
|
Acyclovir mechanism of resistance?
|
- lack of thymidine kinase
|
|
Ganciclovir mechanism?
|
- 5'-monophosphate formed by a CMV viral kinase or HSV/VZV thymidine kinase
- guanosine analog - triphosphate formed by cellular kinases - preferentially inhibits viral DNA polymerase |
|
Clinical uses of ganciclovir?
|
- CMV --> especially in immunocompromised patients
|
|
Ganciclovir toxicity?
|
- leukopenia
- neutropenia - thrombocytopenia - renal toxicity - more toxic to host enzymes than acyclovir |
|
Ganciclovir mechanism of resistance?
|
- mutated CMV DNA pol
- lack of viral kinase |
|
Foscarnet mechanism?
|
"FOScarnet = pyroFOSphate analog"
- viral DNA pol inhibitor that binds to the pyrophosphate-binding site of the enzyme - does NOT require activation by viral kinase |
|
Does foscarnet require activation by viral kinase?
|
No
|
|
Clinical uses of foscarnet?
|
- CMV retinits in immunocompromised patients when ganciclovir fails
- acyclovir-resistant HSV |
|
Foscarnet toxicity?
|
- nephrotoxicity
|
|
Foscarnet mechanism of resistance?
|
- mutated DNA pol
|
|
HIV Therapy:
Protease Inhibitors (5) |
"NAVIR (never) TEASE a proTEASE"
- all protease inhibitors end in -navir - saquiNAVIR - ritoNAVIR - indiNAVIR - nelfiNAVIR - ampreNAVIR |
|
HIV Therapy:
Protease Inhibitors Mechanism |
- inhibit maturation of new virus by blocking protease in progeny virus
|
|
HIV Therapy:
Protease Inhibitors Toxicity |
- GI intolerance (nausea, diarrhea)
- hyperglycemia - lipodystrophy - thrombocytopenia (indinavir) |