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copied fr dartmouthmed2010 (june 08)

Neutropenia

A common side effects of Interferon (INF) treatment is?

TMP-SMZ

Antimicrobial prophylaxis for a history of recurrent UTIs

Ceftriaxone

Antimicrobial prophylaxis for Gonorrhea

Rifampin (DOC), minocycline

Antimicrobial prophylaxis for Meningococcal infection

TMP-SMZ (DOC), aerosolized pentamidine

Antimicrobial prophylaxis for PCP

Benzathine penicillin G

Antimicrobial prophylaxis for Syphilis

Yes

Are Aminoglycosides Teratogenic?

No

Are Ampicillin and Amoxicillin penicillinase resistant?

No

Are Carbenicillin, Piperacillin, and Ticarcillin penicillinase resistant?

No, but they are less susceptible than the other Beta lactams

Are Cephalosporins resistant to penicillinase?

Yes

Are Methicillin, Nafcillin, and Dicloxacillin penicillinase resistant?

Mycobacterium tuberculosis, the only agent used as solo prophylaxis against TB

Clinical use of Isoniazid (INH)?

Pseudomembranous colitis (C. difficile), fever, diarrhea

Common side effects associated with Clindamycin include?

GI upset, Superinfections, Skin rashes, Headache, Dizziness

Common toxicities associated with Fluoroquinolones?

Teratogenic, Carcinogenic, Confusion, Headaches

Common toxicities associated with Griseofulvin?

Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

Describe the MOA of Interferons (INF)

Only in limited amounts

Do Tetracyclines penetrate the CNS?

AmOxicillin has greater Oral bioavailability

Does Ampicillin or Amoxicillin have a greater oral bioavailability?

No

Does Amprotericin B cross the BBB?

No

Does Foscarnet require activation by a viral kinase?

Nephrotoxicity

Foscarnet toxicity?

Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity

Ganciclovir associated toxicities?

Chronic Hepatitis A and B, Kaposi's Sarcoma

How are Interferons (INF) used clinically?

Gram +, Gram -, Norcardia, Chlamydia

How are Sulfonamides employed clinically?

Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

How are the HIV drugs used clinically?

Primaquine

How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax, P.ovale) treated?

Pyridoxine (B6) administration

How can Isoniazid (INH)-induced neurotoxicity be prevented?

Fast vs. Slow Acetylators

How can the t1/2 of INH be altered?

With supplemental Folic Acid

How can the toxic effects of TMP be ameliorated?

Pretreat with antihistamines and a slow infusion rate

How can Vancomycin-induced 'Red Man Syndrome' be prevented?

As PABA antimetabolites that inhibit Dihydropteroate Synthase, Bacteriostatic

How do Sulfonamides act on bacteria?

Inhibt Assembly of new virus by Blocking Protease Enzyme

How do the Protease Inhibitors work?

Ganciclovir is more toxic to host enzymes

How does Ganciclovir's toxicity relate to that of Acyclovir?

With an amino acid change of D-ala D-ala to D-ala D-lac

How does resistance to Vancomycin occur?

HSV, VZV, EBV, Mucocutaneous and Genital Herpes Lesions, Prophylaxis in Immunocompromised pts

How is Acyclovir used clinically?

Prophylaxis for Influenza A, Rubella; Parkinson's disease

How is Amantadine used clinically?

Intrathecally

How is Amphotericin B administered for fungal meningitis?

Wide spectrum of systemic mycoses: Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor

How is Amphotericin B used clinically?

Meningitis (H. influenza, N. meningitidis, S. pneumoniae), Conserative treatment due to toxicities

How is Chloramphenical used clinically?

CMV Retinitis in IC pts when Ganciclovir fails

How is Foscarnet used clinically?

Phosphorylation by a Viral Kinase

How is Ganciclovir activated?

CMV, esp in Immunocompromised patients

How is Ganciclovir used clinically?

Oral treatment of superficial infections

How is Griseofulvin used clinically?

Pentavalent Antimony

How is Leishmaniasis treated?

for RSV

How is Ribavirin used clinically?

1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone when used of Leprosy 3. Used in combination with other drugs

How is Rifampin used clinically?

Used in combination therapy with SMZ to sequentially block folate synthesis

How is Trimethoprim used clinically?

For serious, Gram + multidrug-resistant organisms

How is Vancomycin used clinically?

Suramin

How would you treat African Trypanosomiasis (sleeping sickness)?

Premature infants, because they lack UDP-glucuronyl transferase

In what population does Gray Baby Syndrome occur? Why?

No

Is Aztreonam cross-allergenic with penicillins?

Yes

Is Aztreonam resistant to penicillinase?

No

Is Aztreonam usually toxic?

Yes

Is Imipenem resistant to penicillinase?

No - duh

Is Penicillin penicillinase resistant?

Penicillin-G

IV Penicillin

Foscarnet = pyroFosphate analog

Mnemonic for Foscarnet?

1)Binds penicillin-binding proteins 2) Blocks transpeptidase cross- linking of cell wall 3) Activates autolytic enzymes

MOA for Penicillin (3 answers)?

Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole

MOA: Bactericidal antibiotics

Penicillin, Ampicillin, Ticarcillin, Pipercillin, Imipenem, Aztreonam, Cephalosporins

MOA: Block cell wall synthesis by inhib. Peptidoglycan cross-linking (7)

Quinolones

MOA: Block DNA topoisomerases

Rifampin

MOA: Block mRNA synthesis

Sulfonamides, Trimethoprim

MOA: Block nucleotide synthesis

Bacitracin, Vancomycin

MOA: Block peptidoglycan synthesis

Aminoglycosides, Tetracyclines

MOA: Block protein synthesis at 30s subunit

Chloramphenicol, Erythromycin/macrolides, Lincomycin, Clindamycin, Streptogramins (quinupristin, dalfopristin)

MOA: Block protein synthesis at 50s subunit

Polymyxins

MOA: Disrupt bacterial/fungal cell membranes

Amphotericin B, Nystatin, Fluconazole/azoles

MOA: Disrupt fungal cell membranes

Polymyxin B, Polymyxin E

Name common Polymyxins

Erythromycin, Azithromycin, Clarithromycin

Name several common Macrolides (3)

Sulfamethoxazole (SMZ), Sulfisoxazole, Triple sulfas, Sulfadiazine

Name some common Sulfonamides (4)

Tetracycline, Doxycycline, Demeclocycline, Minocycline

Name some common Tetracyclines (4)

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

Name the common Aminoglycosides (5)

Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole

Name the common Azoles

Ciprofloxacin, Norfloxacin, Ofloxacin, Grepafloxacin, Enoxacin, Nalidixic acid

Name the common Fluoroquinolones (6)

Nevirapine, Delavirdine

Name the common Non-Nucleoside Reverse Transcriptase Inhibitors

Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC), Stavudine (d4T), Lamivudine (3TC)

Name the common Nucleoside Reverse Transcriptase Inhibitors

Saquinavir, Ritonavir, Indinavir, Nelfinavir

Name the Protease Inhibitors (4)

Protease Inhibitors and Reverse Transcriptase Inhibitors

Name two classes of drugs for HIV therapy

Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

Name two organisms Vancomycin is commonly used for?

Penicillin-V

Oral Penicillin

Modification via Acetylation, Adenylation, or Phosphorylation

Resistance mechanisms for Aminoglycosides

Beta-lactamase cleavage of Beta-lactam ring

Resistance mechanisms for Cephalosporins/Penicillins

Modification via Acetylation

Resistance mechanisms for Chloramphenicol

Methylation of rRNA near Erythromycin's ribosome binding site

Resistance mechanisms for Macrolides

Altered bacterial Dihydropteroate Synthetase, Decreased uptake, or Increased PABA synthesis

Resistance mechanisms for Sulfonamides

Decreased uptake or Increased transport out of cell

Resistance mechanisms for Tetracycline

Terminal D-ala of cell wall replaced with D-lac; Decreased affinity

Resistance mechanisms for Vancomycin

Hemolysis (if G6PD deficient), Neurotoxicity, Hepatotoxicity, SLE-like syndrome

Side effects of Isoniazid (INH)?

Binds to the Pyrophosphate Binding Site of the enzyme

Specifically, how does Foscarnet inhibit viral DNA pol?

Inhibition of 50S peptidyl transferase, Bacteriostatic

The MOA for Chloramphenicol is?

Megaloblastic anemia, Leukopenia, Granulocytopenia

Toxic effects of TMP include?

Hormone synthesis inhibition (Gynecomastia), Liver dysfunction (Inhibits CYP450), Fever, Chills

Toxic side effects of the Azoles?

Delirium, Tremor, Nephrotoxicity

Toxicities associated with Acyclovir?

Rash, Pseudomembranous colitis

What additional side effects exist for Ampicillin?

Aminoglycosides

What antimicrobial class is Aztreonam syngergestic with?

Ataxia, Dizziness, Slurred speech

What are Amantadine-associated side effects?

Beta-lactam antibiotics

What are Aminoglycosides synergistic with?

Severe Gram - rod infections.

What are Aminoglycosides used for clinically?

Nephrotoxicity (esp. with Cephalosporins), Ototoxicity (esp. with Loop Diuretics)

What are common serious side effects of Aminoglycosides and what are these associated with?

Fever/Chills, Hypotension, Nephrotoxicity, Arrhythmias

What are common side effects of Amphotericin B?

GI intolerance (nausea, diarrhea), Hyperglycemia, Lipid abnormalities, Thrombocytopenia (Indinavir)

What are common side effects of Protease Inhibitors?

BM suppression (neutropenia, anemia), Peripheral neuropathy

What are common side effects of RT Inhibitors?

-Hypersensitivity reactions -Hemolysis -Nephrotoxicity (tubulointerstitial nephritis) -Kernicterus in infants Displace other drugs from albumin (e.g., warfarin)

What are common toxic side effects of Sulfonamides? (5)

GI discomfort, Acute cholestatic hepatitis, Eosinophilia, Skin rashes

What are common toxicities associated with Macrolides? (4)

GI distress, Tooth discoloration and Inhibition of bone growth in children, Fanconi's syndrome, Photosensitivity

What are common toxicities associated with Tetracyclines?

Well tolerated in general but occasionally, Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing='Red Man Syndrome'

What are common toxicities related to Vancomycin therapy?

1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

What are Fluoroquinolones indicated for? (3)

Hypersensitivity reactions

What are major side effects of Methicillin, Nafcillin, and Dicloxacillin?

Staphlococcus aureus

What are Methicillin, Nafcillin, and Dicloxacillin used for clinically?

Resistant Gram - infections

What are Polymyxins used for?

Rifampin, Ethambutol, Streptomycin, Pyrazinamide, Isoniazid (INH)

What are the Anti-TB drugs?

Systemic mycoses

What are the clinical indications for Azole therapy?

Gram + cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae (PEcK)

What are the clinical uses for 1st Generation Cephalosporins?

Gram + cocci, Haemophilus influenza, Enterobacter aerogenes, Neisseria species, P. mirabilis, E. coli, K. pneumoniae, Serratia marcescens ( HEN PEcKS )

What are the clinical uses for 2nd Generation Cephalosporins?

1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

What are the clinical uses for 3rd Generation Cephalosporins?

Gram - rods: Klebsiella species, Pseudomonas species, Serratia species

What are the clinical uses for Aztreonam?

Gram + cocci, Gram - rods, and Anerobes

What are the clinical uses for Imipenem/cilastatin?

-Upper respiratory tract infections -pneumonias -STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) -Mycoplasma, Legionella,Chlamydia, Neisseria

What are the Macrolides used for clinically?

Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)

What are the major structural differences between Penicillin and Cephalosporin?

GI distress, Skin rash, and Seizures at high plasma levels

What are the major toxic side effects of Imipenem/cilastatin?

1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram-like reaction with ethanol (those with a methylthiotetrazole group, e.g., cefamandole)

What are the major toxic side effects of the Cephalosporins?

Neurotoxicity, Acute renal tubular necrosis

What are the side effects of Polymyxins?

Minor hepatotoxicity, Drug interactions (activates P450)

What are the side effects of Rifampin?

Disulfiram-like reaction with EtOH, Headache

What are toxic side effects for Metronidazole?

Aplastic anemia (dose independent), Gray Baby Syndrome

What are toxicities associated with Chloramphenicol?

Giardiasis, Amoebic dysentery (E. histolytica), Bacterial vaginitis (Gardnerella vaginalis), Trichomonas

What conditions are treated with Metronidazole?

Oxygen

What do Aminoglycosides require for uptake?

Mebendazole/Thiabendazole, Pyrantel Pamoate

What do you treat Nematode/roundworm (pinworm, whipworm) infections with?

Pentamidine

What drug is given for Pneumocystis carinii prophylaxis?

AZT, to reduce risk of Fetal Transmission

What drug is used during the pregnancy of an HIV+ mother?, Why?

Praziquantel

What drug is used to treat Trematode/fluke (e.g., Schistosomes, Paragonimus, Clonorchis) or Cysticercosis

Increases coumadin metabolism

What is a common drug interaction associated with Griseofulvin?

Blocks Influenza A and RubellA; causes problems with the cerebellA

What is a mnemonic to remember Amantadine's function?

It must be Phosphorylated by Viral Thymidine Kinase

What is a prerequisite for Acyclovir activation?

Hemolytic anemia

What is a Ribavirin toxicity?

RESPIre

What is an acronym to remember Anti-TB drugs?

Interstitial nephritis

What is an additional side effect of Methicillin?

GI upset

What is an occasional side effect of Aztreonam?

Anaerobic infections (e.g., B. fragilis, C. perfringens)

What is Clindamycin used for clinically?

Pseudomonas species and Gram - rods

What is clinical use for Carbenicillin, Piperacillin, and Ticarcillin?

Recurrent UTIs, Shigella, Salmonella, Pneumocystis carinii pneumonia

What is combination TMP-SMZ used to treat?

Clavulanic acid

What is combined with Ampicillin, Amoxicillin, Carbenicillin, Piperacillin, and Ticarcillin to enhance their spectrum?

Cryptococcal meningitis in AIDS patients and Candidal infections of all types

What is Fluconazole specifically used for?

Cilastatin

What is Imipenem always administered with?

Blastomyces, Coccidioides, Histoplasma, C. albicans; Hypercortisolism

What is Ketoconazole specifically used for?

Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

What is Metronidazole combined with for 'triple therapy'? Against what organism?

Antiprotozoal: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis Anaerobes: Bacteroides, Clostridium

What is Metronidazole used for clinically?

Cestode/tapeworm (e.g., D. latum, Taenia species Except Cysticercosis

What is Niclosamide used for?

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