Pharmacology Ii Exam 1

Front 1

what factors to consider when selecting antimicrobial (6)

Back 1

1. sensitivity to agent
2. severity and site of infection
3. safety of agent: renal and hepatic function
4. age, pregnancy, etc of patient
5. cost of therapy
6. antibiogram of the institution and specifically unit specific antibiogram (MRSA?)

Front 2

WBC ranges:
NORMAL?
AFTER infection?

Back 2

Normal:
4000-10000 cells/mm3

Infection:
30000-60000 cells/mm3

Front 3

what will Sulfonamides cause in NEONATES?

what will Chloramphenicol cause in NEONATES?

Back 3

NEONATES:

1. Sulfonamides causes KERNICTERUS

2. Chloroamphenicol causes GRAY BABY SYNDROME

Front 4

Cephalosporin vs Penicillin?

when to prescribe in relation to hypersensitivity

Back 4

Cephalosporin can be given in delayed reaction

if immediate type reactions with penicillin occur, CEPHALOSPORINS ARE NOT GIVEN

Front 5

ISONIAZID in elderly patients

Back 5

elderly patients hepatic toxicity may manifest with administration of ISONAZID

Front 6

what condition would elevate the risk of a patient acquiring hemolytic anemia

Back 6

if the patient have an inherited metabolic abnormality such as G6PDH deficiency

ISONIAZID can cause PERIPHERAL NEUROPATHY

Front 7

CNS TOXICITY for antimicrobials

Back 7

can be a problem when dose is not adjusted for renal dysfunction

1. penicillins
2. cephalosporins
3. quinolones
4. imipenem

Front 8

HEMATOLOGICAL TOXICITY for antimicrobials

Back 8

1. Nafcillin (neutropenia)
2. Piperacillin (platelet dysfunction)
3. Cefotetan (hypoprothrombinemia)
4. Chloroamphenicol (bone marrow suppression)
5. Trimethoprim (megaloblastic anemia)

Front 9

what is empirical therapy

Back 9

critically ill patients need immediate administration of drugs covering infections of both gram positive and negative organisms

Front 10

what are the advantages and disadvantages of combo therapy

Back 10

Advantages:
1. synergism
2. broadening
3. emergence of resistance

Disadvantages:
1. competing drug interactions
2. additive toxicities

Front 11

what is the mechanism of action for penicillin

Back 11

1. inhibit cross linking step in the synthesis of bacterial cell wall
2. combine with and inactivate TRANSPEPTIDASE
3. BACTERICIDAL
4. penicillin more effective against GRAM POSITIVE

Front 12

what is the difference between gram positive and gram negative

Back 12

POSITIVE:
1. thicker cell wall

NEGATIVE:
1. thinner cell wall
2. contains outer cell membranes (lipopolysaccharides)

Front 13

penicillin treat...(6)

Back 13

1. Syphilis
2. Actinomycosis
3. Diphtheria
4. Clostridium
5. Anthrax
6. Listeria

Front 14

difference between penicillin V and penicillin G

Back 14

1. Penicillin V is more stable in acidic environments and is the oral form of penicillin (against anaerobes)
2. Penicillin V has POOR bioavailibility

BOTH:
1. food interferes with absorption, take ~1hr BEFORE meals and 2-3 hrs AFTER meals
2. PROBENECID prolongs the duration due to proximal renal tubule mech.
3. ~99% of PG and PV are eliminated via kidneys

Front 15

what are the prophylactic uses of penicillins

Back 15

1. streptococcal infections
2. rheumatic fever recurrences
3. gonorrheal opthalmia neonatorium
4. Sx procedures in pts. with VALVULAR DISEASES
5. OPERATIONS

Front 16

what is the drug of choice for LISTERIA

Back 16

aerobic gram positive bacilli: LISTERIA

AMPICILLIN!!!

Front 17

what is...
Augmentin
Unasyn
Zosyn

Back 17

1. Augmentin:
Amoxicillin/Clavulanic Acid

2. Unasyn:
Ampicillin/Sulbactam

3. Zosyn
Piperacillin/Tazobactam

Front 18

what is the adverse effect of Piperacillin

Back 18

PLATELET DYSFUNCTION

Front 19

what drug is the key features of the first generation cephalosporins? which drug?

Back 19

1. can be penicillin G substitutes that is resistant to staphyococcal penicillinase
2. Protease, E.coli and Klebsiella pneu...(PEcK drugs)

3. CEFAZOLIN is the drug of choice in SURGICAL PROPHYLAXIS!!!

Front 20

what are HENPEcK Drugs?

Back 20

second generation cephalosporins
1. Haemophilus influenzae
2. Enterbacter aerogenes
3. Neisseria
4. Protease
5. E.coli
6. Klebsiella pneu

Front 21

what is the major feature of third generation cephalosporins

Back 21

1. expanded gram negative coverage
2. cross BBB
3. Ceftriaxone and Cefixime are first line drugs for N. gonorrhoeae

Front 22

what TWO cephalosporins are excreted through BILIARY TRACT

Back 22

1. Ceftriaxone
2. Cefoperazone

no dosage adjustment is necessary in renal insufficiency

Front 23

what is significant about 4th gen. cephalosporins

Back 23

CEFEPIME
1. more resistance to hydrolysis by chromosomal beta lactamases produced by Enterobacter.

Front 24

what is significant about 5th gen cephalosporins

Back 24

CEFTAROLINE:
1. treats MRSA, VRSA, VISA, hVISA

Front 25

what is the main adverse reaction of CEPHALOSPORINS

Back 25

1. DISULFIRAM like symptoms due to aldehyde accumulation with methyl thio tetrazole groups containing cephalosporins when ingested with alcohol
2. YOU VOMIT EVERYWHERE

Front 26

what are beta lactamase inhibitors? (3)

Back 26

1. Clavulanic acid
2. Sulbactam
3. Tazobactam

PROTECT PENCILLINS!!!

Front 27

what is Primaxin?
adverse reactions?

Back 27

CARBAPENEMS!!

1. Imipenem and Cilastatin
2. broadest spectrum of all the beta lactam antibiotics
3. excessive levels in patients with renal impairment can lead to SEIZURES

Front 28

what is Aztreonam?
specifics?

Back 28

MONOBACTAMS!!

1. free beta lactam ring
2. specific for gram NEGATIVE rods (enterobacteria)
3. LOW ALLERGIC REACTIONS

Front 29

what is Vancomycin used to treat?
administration route?
adverse reactions?

Back 29

1. used ORALLY to treat pseudomembranous colitis caused by Clostridium difficile
2. treat MRSA and MRSE
3. Otoxicity and Nephrotoxicity

Front 30

what drug is approved as a SINGLE, ORAL dose for treatment of UNCOMPLICATED UTI in women

Back 30

FOSFOMYCIN!!

safe during pregnancy!!

Front 31

administration route for BACITRACIN

Back 31

NEVER GIVE SYSTEMICALLY!!
NEPHROTOXIC!!!

therefore used only TOPICALLY for gram POSITIVE

Front 32

what cell wall inhibitor is used to treat tuberculosis

Back 32

CYCLOSERINE!!
2nd line drug

Front 33

Tetracyclines
1. mechanism
2. resistance mechanism
3. absorption
4. excretion

Back 33

1. binds to 30S ribosomal RNA
2. reduced permeability or INCREASE EFFLUX by an active transport protein pump
3. most absorption takes place from the stomach and the upper small intestine (MINOCYCLINE cross BBB in the absence of inflammation)
4. excreted through KIDNEYS (except doxycycline)

Front 34

tetracyclines and kids

Back 34

1. bind to calcium deposited in the newly formed teeth and bone of kids
2. malformation of teeth and bones in kids

Front 35

what is Tigecycline?
what is good about it?

Back 35

1. newest tetracycline drug
2. used to treat MRSA, MRSE, PRSP, and VRE

Front 36

what is the most widely used class of drugs?

Back 36

MACROLIDES

Front 37

how are macrolides eliminated?

Back 37

1. biliary tract (non renal)
2. good in elderly

Front 38

what is the difference between azithromycin and erythromycin

Back 38

azithromycin has a methyl sub nitrogen atom in the lactone ring of erythromycin.

1. improved acid stability
2. increased tissue penetration
3. broadened antimicrobial spectrum

Front 39

mechanism for macrolides

Back 39

1. binds to 50S ribosomal subunits of sensitive organisms
2. bacteriostatic
3. activity enhanced at BASIC pH
4. effective against gram POSITIVE

Front 40

what are the TWO resistance mechanism against MACROLIDES

Back 40

1. production of esterases for hydrolysis (NEG)
2. modification of ribosomal binding site of the drug by methylase enzyme that is macrolide inducible (POS)

Front 41

what is ketolides good for??
what drugs should you know?

Back 41

1. effective against some macrolide resistant bacteria, due to ability to bind on two ribosomal sites

2. TELITHROMYCIN used in URTI that is resistant to penicillin and erythromycin

Front 42

what class of protein synthesis inhibitor is known to cause OTOTOXICITY?

Back 42

AMINOGLYCOSIDES
1. auditory and vestibular nerve damage
2. toxicity increases with loop diuretics

Front 43

what aminoglycoside is used as an isolation tool in culturing of organisms

Back 43

GENTAMICIN
1. used to isolate streptococcus pneumoniae and strep. pyogenes due to high level of resistance

Front 44

route of administration for aminoglycosides

Back 44

INJECTION!!
gram NEGATIVE coverage

Front 45

what is Spectinomycin used for

Back 45

almost solely as an alternative treatment for gonorrhea in patients who are allergic to penicillin or when gonococci are resistant to other agents

Front 46

application for neomycin and kanamycin

Back 46

1. bowel sterilization
2. skin infection

Front 47

application for streptomycin

Back 47

1. TB
2. Plague
3. Brucellosis
4. Tularemia
5. Infective endocarditis

Front 48

what aminoglycoside is used to clinically treat serious aerobic gram NEGATIVE bacteria

Back 48

1. Gentamycin
2. Amikacin
3. Netilmicin
4. Tobramycin

Front 49

protein synthesis inhibitor that is the second or tertiary choice for endocarditis (prophylaxis)

ADVERSE EFFECT??

Back 49

CLINDAMYCIN

may cause SUPER INFECTION

Front 50

what is the mechanism of sulfonamides

Back 50

1. antimetabolites
2. inhibit DPS, responsibile for incorporating PABA into the immediate precursor of FOLIC ACID
3. bacteria that can synthesize their own folic acid is affected
4. bacteria that can utilize pre-formed folate are not affected

Front 51

what is recommended to be given with sulfonamides

Back 51

TRIMETHOPRIM
1. inhibit dihydrofolate reductase
2. thus inhibiting thymidine synthesis

sulfonamides/trimethoprim combo causes sequential block of FOLIC ACID SYNTHESIS

Front 52

what DNA synthesis inhibitor COMBO is used to treat pneumocytosis carinii pneumonia

Back 52

ORAL TMP-SMZ
1. trimethoprim
2. sulfmethoxazole

*IV TMP-SMZ to treat P.carinii pneumonia in AIDS patients.

Front 53

what DNA synthesis inhibitor COMBO is used to treat MALARIA

Back 53

1. Proguanil
2. Atovaquone

active metabolite cycloguanil, which selectively inhibits the bifunctional dihydrofolate reductase thymidylate synthetase enzyme of plasmodia

Front 54

which Fluoroquinolone is the drug of choice for UTI

Back 54

CIPROFLOXACIN
NORFLOXACIN

Front 55

what are the contraindications for Fluoroquinolones

Back 55

1. pregnancy
2. children
3. should not exercise during treatment (tendonitis/rupture)

Front 56

adverse reaction of penicillin

Back 56

1. Steven Johnsons
2. Larygl Spasms

Front 57

what is Melarsoprol IV used for?
mechanism?

Back 57

treatment of Trypanosoma Cruzi
1. trivalent arsenical that binds to inhibits parasitic enzymes especially sulfhydryl groups

Front 58

what is a formulation of Eflorithine that is used for hairy bitches

Back 58

VANIQA
1. topical formulation is available for reducing unwanted facial hair in bitches

Front 59

NIFURTIMOX
class?
mechanism?
benefits?

Back 59

1. antiprotozoal agents
2. produces intracellular free radical that kills the organism
3. used in chronic stages of the disease with minimal effects

Front 60

what two notable drugs are used to treat Giardiasis?

Mech?

Back 60

1. Metronidazole:
binds to proteins and DNA of the flagellate

2. Tinidazole:
disrupts DNA tertiary structure and inhibits nucleic acid synthesis

Front 61

what two notable drugs are used to treat Trichomoniasis?

Mech?

Back 61

1. Metronidazole:
binds to proteins and DNA of the flagellate

2. Tinidazole:
disrupts DNA tertiary structure and inhibits nucleic acid synthesis

Front 62

at what stage is it best to treat Amebiasis (amebic dysentery)?

what drug do you use to treat this stage?

Back 62

LUMINAL

IODOQUINOL:
alternative for asymptomatic carriers, can cause MYELO-OPTIC NEUROPATHY

Front 63

what is used to treat systemic amebiasis?

mechanism?
contraindications?

Back 63

1. Emetine
2. Dehydroemetine

mech: block chain elongation of proteins (IM route)

contraindication: pregnancy and cardiotoxicity

Front 64

what antiprotozoal drugs are used to treat toxoplasmosis

Back 64

1. Pyrimethamine and Sulfonamide (FANSIDER)
2. Atovaquone (also in AIDS pts to treat P.carinii pneumonia)

Front 65

what is used in conjunction with Pyrimethamine and Sulfonamide to protect against folate deficiency

Back 65

LEUCOVORIN is administered to protect against folate deficiency

Front 66

what anti-malaria drug is used for PREVENTION

Back 66

Mefloquine:
used orally in Chloroquine resistant P. falciparum

Front 67

what is QUININE

Back 67

1. reserve drug for blood schizonticide for chloroquinine resistant falciparum
2. NOT active against exoerythrocytic forms
3. affect DNA synthesis

Front 68

Mebendazole
1. mech
2. usage

Back 68

1. mech: a benzimidazole, inhibits microtubule synthesis of the parasite (expelled in feces)
2. round worms, pinworms, hookworms, whipworms

Front 69

Thiabendazole
1. mech
2. usage

Back 69

1. mech: broad spectrum anthelmintic against STRONGYLOIDES

affects parasitic microtubular aggregation

Front 70

what is used against Wucheria bancrofti (elephantiasis)

Back 70

Diethylcarbamazine (Hetrazan):
1. effective against microfilariae
2. NOT adult worms in lymph nodes

Front 71

what is used against Trematodes, Cestodes and Blood Flukes

Back 71

Praziquantal (treats all species)
1. increases calcium permeability of the membranes and paralyses worm musculature

CONTRAINDICATED in cysticercosis of the eye!!

Front 72

what antifungal is a DNA base analog?

mechanism

Back 72

FLUCYTOSINE
1. gets deaminated to a potent ANTIMETABOLITE and inhibits thymidylate synthase enzyme
2. FUNGISTATIC
3. oral used for systemic candidiasis and cryptococcal infections

Front 73

what is the difference between amphotericin B and nystatin

Back 73

1. Amphotericin B is used SYSTEMICALLY
2. Nystatin is NOT systemic, only ORALLY!!

Front 74

what is the clinical application for Nystatin

Back 74

1. Candida infection of the mucosa, skin, intestinal tract and vagina
2. Topical Nystatin is the drug of choice for oral moniliasis, thrush, denture stomatits

Front 75

what is Griseofulvin used for

Back 75

SYSTEMIC DRUG that treat disease of skin, hair and nails

effective against:
1. Microsporum
2. Epidermophyton
3. Trichophyton

*NO EFFECT ON ANY OTHERS

Front 76

what is the mechanism for Griseofulvin

Back 76

1. inhibits mitosis by disrupting spindle formation
2. fungistatic

Front 77

what two drugs are not purine/pyrimidine analogues

Back 77

1. Foscarnet: phosphate analog
2. Fomivirsen: anti-sense drug

Front 78

what antiviral is a fusion inhibitor
what antiviral is an entry inhibitor

Back 78

fusion inhibitor:
ENFUVIRTIDE

entry inhibitor:
MARAVIROC

Front 79

what is an aerosol approved drug that is used in the US for RSV bronchilitis and pneumonia in hospitalized children

Back 79

RIBAVIREN

Front 80

what primarily treats influenza A? (2)
mechanism?

Back 80

1. Amantadine
2. Rimantadine

inhibits replication of influenza A (probably at absorption) endocytosis and uncoating that precedes primary transcription

Front 81

what drugs (2) can treat influenza A and B?
mechanism?

Back 81

1. Zanamivir (intranasal)
2. Oseltamivir (pro-drug, ORAL)

inhibit viral glycoprotein neuraminidase

Front 82

what is PalivizuMAB

Back 82

human monoclonal ab against the F glycoprotein on the surface of RSV

Front 83

what four drugs are approved for treating HBV

Back 83

1. Lamivudine
2. Adefovir
3. Telbivudine
4. Entecavir

Front 84

what drug is approved to treat HPV?

mechanism

Back 84

IMIQUIMOD
1. immune response modifier
2. induces mRNA encoding cytokines (interferon alpha) at the treatment site
3. DOES NOT eradicate HPV, just treat symptoms

Front 85

what are the FOUR first line drugs to treat tuberculosis

Back 85

Pyrazinamide
Isoniazid
Ethambutol
Rifampin

Front 86

what is Isoniazid used for?
mech?

Back 86

BEST treatment of tuberculosis
1. inhibition of synthesis of enzymes needed for mycolic acid synthesis
2. mediated via oxygen dependent pathways (catalase peroxidase reaction)
3. BACTERIOSTATIC

Front 87

what is RIFAMPIN used for?
mech?

Back 87

BACTERIOCIDAL treats TB and LEPROSY
1. blocks bacterial RNA synthesis by binding to DNA dependent RNA polymerase

Front 88

contraindication of RIFAMPIN

Back 88

CANNOT use with PROTEASE INHIBITORS in HIV patients

Front 89

what is the most effective drug against LEPROSY

Back 89

DAPSONE!!!
1. folic acid synthesis inhibitor

Front 90

what are the 3 primary mechanism for DNA synthesis inhibitions (basic)

Back 90

1. folate synthesis inhibitors
2. folate reductase inhibitors
3. topoisomerase DNA Gyrase Enzyme Inhibitors

Front 91

what FOUR drugs are indicated against staphylococci that are penicillinase producers

Back 91

1. Dicloxacillin (very effective orally, thats what she said)
2. Cloxacillin
3. Oxacillin
4. Nafcillin

Front 92

route of administration for AMOXICILLIN

Back 92

ORAL
-achieves higher blood levels and lower incidence of diarrhea than penicillin

Front 93

what cell wall inhibitor has the highest incidence of Steven Johnson syndrome

Back 93

AMPICILLIN