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93 Cards in this Set
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what factors to consider when selecting antimicrobial (6)
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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?) |
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WBC ranges:
NORMAL? AFTER infection? |
Normal:
4000-10000 cells/mm3 Infection: 30000-60000 cells/mm3 |
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what will Sulfonamides cause in NEONATES?
what will Chloramphenicol cause in NEONATES? |
NEONATES:
1. Sulfonamides causes KERNICTERUS 2. Chloroamphenicol causes GRAY BABY SYNDROME |
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Cephalosporin vs Penicillin?
when to prescribe in relation to hypersensitivity |
Cephalosporin can be given in delayed reaction
if immediate type reactions with penicillin occur, CEPHALOSPORINS ARE NOT GIVEN |
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ISONIAZID in elderly patients
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elderly patients hepatic toxicity may manifest with administration of ISONAZID
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what condition would elevate the risk of a patient acquiring hemolytic anemia
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if the patient have an inherited metabolic abnormality such as G6PDH deficiency
ISONIAZID can cause PERIPHERAL NEUROPATHY |
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CNS TOXICITY for antimicrobials
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can be a problem when dose is not adjusted for renal dysfunction
1. penicillins 2. cephalosporins 3. quinolones 4. imipenem |
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HEMATOLOGICAL TOXICITY for antimicrobials
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1. Nafcillin (neutropenia)
2. Piperacillin (platelet dysfunction) 3. Cefotetan (hypoprothrombinemia) 4. Chloroamphenicol (bone marrow suppression) 5. Trimethoprim (megaloblastic anemia) |
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what is empirical therapy
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critically ill patients need immediate administration of drugs covering infections of both gram positive and negative organisms
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what are the advantages and disadvantages of combo therapy
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Advantages:
1. synergism 2. broadening 3. emergence of resistance Disadvantages: 1. competing drug interactions 2. additive toxicities |
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what is the mechanism of action for penicillin
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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 |
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what is the difference between gram positive and gram negative
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POSITIVE:
1. thicker cell wall NEGATIVE: 1. thinner cell wall 2. contains outer cell membranes (lipopolysaccharides) |
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penicillin treat...(6)
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1. Syphilis
2. Actinomycosis 3. Diphtheria 4. Clostridium 5. Anthrax 6. Listeria |
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difference between penicillin V and penicillin G
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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 |
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what are the prophylactic uses of penicillins
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1. streptococcal infections
2. rheumatic fever recurrences 3. gonorrheal opthalmia neonatorium 4. Sx procedures in pts. with VALVULAR DISEASES 5. OPERATIONS |
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what is the drug of choice for LISTERIA
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aerobic gram positive bacilli: LISTERIA
AMPICILLIN!!! |
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what is...
Augmentin Unasyn Zosyn |
1. Augmentin:
Amoxicillin/Clavulanic Acid 2. Unasyn: Ampicillin/Sulbactam 3. Zosyn Piperacillin/Tazobactam |
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what is the adverse effect of Piperacillin
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PLATELET DYSFUNCTION
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what drug is the key features of the first generation cephalosporins? which drug?
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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!!! |
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what are HENPEcK Drugs?
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second generation cephalosporins
1. Haemophilus influenzae 2. Enterbacter aerogenes 3. Neisseria 4. Protease 5. E.coli 6. Klebsiella pneu |
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what is the major feature of third generation cephalosporins
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1. expanded gram negative coverage
2. cross BBB 3. Ceftriaxone and Cefixime are first line drugs for N. gonorrhoeae |
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what TWO cephalosporins are excreted through BILIARY TRACT
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1. Ceftriaxone
2. Cefoperazone no dosage adjustment is necessary in renal insufficiency |
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what is significant about 4th gen. cephalosporins
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CEFEPIME
1. more resistance to hydrolysis by chromosomal beta lactamases produced by Enterobacter. |
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what is significant about 5th gen cephalosporins
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CEFTAROLINE:
1. treats MRSA, VRSA, VISA, hVISA |
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what is the main adverse reaction of CEPHALOSPORINS
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1. DISULFIRAM like symptoms due to aldehyde accumulation with methyl thio tetrazole groups containing cephalosporins when ingested with alcohol
2. YOU VOMIT EVERYWHERE |
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what are beta lactamase inhibitors? (3)
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1. Clavulanic acid
2. Sulbactam 3. Tazobactam PROTECT PENCILLINS!!! |
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what is Primaxin?
adverse reactions? |
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 |
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what is Aztreonam?
specifics? |
MONOBACTAMS!!
1. free beta lactam ring 2. specific for gram NEGATIVE rods (enterobacteria) 3. LOW ALLERGIC REACTIONS |
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what is Vancomycin used to treat?
administration route? adverse reactions? |
1. used ORALLY to treat pseudomembranous colitis caused by Clostridium difficile
2. treat MRSA and MRSE 3. Otoxicity and Nephrotoxicity |
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what drug is approved as a SINGLE, ORAL dose for treatment of UNCOMPLICATED UTI in women
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FOSFOMYCIN!!
safe during pregnancy!! |
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administration route for BACITRACIN
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NEVER GIVE SYSTEMICALLY!!
NEPHROTOXIC!!! therefore used only TOPICALLY for gram POSITIVE |
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what cell wall inhibitor is used to treat tuberculosis
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CYCLOSERINE!!
2nd line drug |
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Tetracyclines
1. mechanism 2. resistance mechanism 3. absorption 4. excretion |
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) |
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tetracyclines and kids
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1. bind to calcium deposited in the newly formed teeth and bone of kids
2. malformation of teeth and bones in kids |
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what is Tigecycline?
what is good about it? |
1. newest tetracycline drug
2. used to treat MRSA, MRSE, PRSP, and VRE |
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what is the most widely used class of drugs?
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MACROLIDES
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how are macrolides eliminated?
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1. biliary tract (non renal)
2. good in elderly |
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what is the difference between azithromycin and erythromycin
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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 |
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mechanism for macrolides
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1. binds to 50S ribosomal subunits of sensitive organisms
2. bacteriostatic 3. activity enhanced at BASIC pH 4. effective against gram POSITIVE |
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what are the TWO resistance mechanism against MACROLIDES
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1. production of esterases for hydrolysis (NEG)
2. modification of ribosomal binding site of the drug by methylase enzyme that is macrolide inducible (POS) |
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what is ketolides good for??
what drugs should you know? |
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 |
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what class of protein synthesis inhibitor is known to cause OTOTOXICITY?
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AMINOGLYCOSIDES
1. auditory and vestibular nerve damage 2. toxicity increases with loop diuretics |
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what aminoglycoside is used as an isolation tool in culturing of organisms
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GENTAMICIN
1. used to isolate streptococcus pneumoniae and strep. pyogenes due to high level of resistance |
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route of administration for aminoglycosides
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INJECTION!!
gram NEGATIVE coverage |
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what is Spectinomycin used for
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almost solely as an alternative treatment for gonorrhea in patients who are allergic to penicillin or when gonococci are resistant to other agents
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application for neomycin and kanamycin
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1. bowel sterilization
2. skin infection |
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application for streptomycin
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1. TB
2. Plague 3. Brucellosis 4. Tularemia 5. Infective endocarditis |
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what aminoglycoside is used to clinically treat serious aerobic gram NEGATIVE bacteria
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1. Gentamycin
2. Amikacin 3. Netilmicin 4. Tobramycin |
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protein synthesis inhibitor that is the second or tertiary choice for endocarditis (prophylaxis)
ADVERSE EFFECT?? |
CLINDAMYCIN
may cause SUPER INFECTION |
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what is the mechanism of sulfonamides
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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 |
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what is recommended to be given with sulfonamides
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TRIMETHOPRIM
1. inhibit dihydrofolate reductase 2. thus inhibiting thymidine synthesis sulfonamides/trimethoprim combo causes sequential block of FOLIC ACID SYNTHESIS |
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what DNA synthesis inhibitor COMBO is used to treat pneumocytosis carinii pneumonia
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ORAL TMP-SMZ
1. trimethoprim 2. sulfmethoxazole *IV TMP-SMZ to treat P.carinii pneumonia in AIDS patients. |
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what DNA synthesis inhibitor COMBO is used to treat MALARIA
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1. Proguanil
2. Atovaquone active metabolite cycloguanil, which selectively inhibits the bifunctional dihydrofolate reductase thymidylate synthetase enzyme of plasmodia |
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which Fluoroquinolone is the drug of choice for UTI
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CIPROFLOXACIN
NORFLOXACIN |
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what are the contraindications for Fluoroquinolones
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1. pregnancy
2. children 3. should not exercise during treatment (tendonitis/rupture) |
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adverse reaction of penicillin
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1. Steven Johnsons
2. Larygl Spasms |
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what is Melarsoprol IV used for?
mechanism? |
treatment of Trypanosoma Cruzi
1. trivalent arsenical that binds to inhibits parasitic enzymes especially sulfhydryl groups |
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what is a formulation of Eflorithine that is used for hairy bitches
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VANIQA
1. topical formulation is available for reducing unwanted facial hair in bitches |
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NIFURTIMOX
class? mechanism? benefits? |
1. antiprotozoal agents
2. produces intracellular free radical that kills the organism 3. used in chronic stages of the disease with minimal effects |
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what two notable drugs are used to treat Giardiasis?
Mech? |
1. Metronidazole:
binds to proteins and DNA of the flagellate 2. Tinidazole: disrupts DNA tertiary structure and inhibits nucleic acid synthesis |
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what two notable drugs are used to treat Trichomoniasis?
Mech? |
1. Metronidazole:
binds to proteins and DNA of the flagellate 2. Tinidazole: disrupts DNA tertiary structure and inhibits nucleic acid synthesis |
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at what stage is it best to treat Amebiasis (amebic dysentery)?
what drug do you use to treat this stage? |
LUMINAL
IODOQUINOL: alternative for asymptomatic carriers, can cause MYELO-OPTIC NEUROPATHY |
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what is used to treat systemic amebiasis?
mechanism? contraindications? |
1. Emetine
2. Dehydroemetine mech: block chain elongation of proteins (IM route) contraindication: pregnancy and cardiotoxicity |
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what antiprotozoal drugs are used to treat toxoplasmosis
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1. Pyrimethamine and Sulfonamide (FANSIDER)
2. Atovaquone (also in AIDS pts to treat P.carinii pneumonia) |
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what is used in conjunction with Pyrimethamine and Sulfonamide to protect against folate deficiency
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LEUCOVORIN is administered to protect against folate deficiency
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what anti-malaria drug is used for PREVENTION
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Mefloquine:
used orally in Chloroquine resistant P. falciparum |
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what is QUININE
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1. reserve drug for blood schizonticide for chloroquinine resistant falciparum
2. NOT active against exoerythrocytic forms 3. affect DNA synthesis |
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Mebendazole
1. mech 2. usage |
1. mech: a benzimidazole, inhibits microtubule synthesis of the parasite (expelled in feces)
2. round worms, pinworms, hookworms, whipworms |
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Thiabendazole
1. mech 2. usage |
1. mech: broad spectrum anthelmintic against STRONGYLOIDES
affects parasitic microtubular aggregation |
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what is used against Wucheria bancrofti (elephantiasis)
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Diethylcarbamazine (Hetrazan):
1. effective against microfilariae 2. NOT adult worms in lymph nodes |
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what is used against Trematodes, Cestodes and Blood Flukes
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Praziquantal (treats all species)
1. increases calcium permeability of the membranes and paralyses worm musculature CONTRAINDICATED in cysticercosis of the eye!! |
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what antifungal is a DNA base analog?
mechanism |
FLUCYTOSINE
1. gets deaminated to a potent ANTIMETABOLITE and inhibits thymidylate synthase enzyme 2. FUNGISTATIC 3. oral used for systemic candidiasis and cryptococcal infections |
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what is the difference between amphotericin B and nystatin
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1. Amphotericin B is used SYSTEMICALLY
2. Nystatin is NOT systemic, only ORALLY!! |
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what is the clinical application for Nystatin
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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 |
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what is Griseofulvin used for
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SYSTEMIC DRUG that treat disease of skin, hair and nails
effective against: 1. Microsporum 2. Epidermophyton 3. Trichophyton *NO EFFECT ON ANY OTHERS |
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what is the mechanism for Griseofulvin
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1. inhibits mitosis by disrupting spindle formation
2. fungistatic |
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what two drugs are not purine/pyrimidine analogues
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1. Foscarnet: phosphate analog
2. Fomivirsen: anti-sense drug |
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what antiviral is a fusion inhibitor
what antiviral is an entry inhibitor |
fusion inhibitor:
ENFUVIRTIDE entry inhibitor: MARAVIROC |
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what is an aerosol approved drug that is used in the US for RSV bronchilitis and pneumonia in hospitalized children
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RIBAVIREN
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what primarily treats influenza A? (2)
mechanism? |
1. Amantadine
2. Rimantadine inhibits replication of influenza A (probably at absorption) endocytosis and uncoating that precedes primary transcription |
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what drugs (2) can treat influenza A and B?
mechanism? |
1. Zanamivir (intranasal)
2. Oseltamivir (pro-drug, ORAL) inhibit viral glycoprotein neuraminidase |
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what is PalivizuMAB
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human monoclonal ab against the F glycoprotein on the surface of RSV
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what four drugs are approved for treating HBV
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1. Lamivudine
2. Adefovir 3. Telbivudine 4. Entecavir |
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what drug is approved to treat HPV?
mechanism |
IMIQUIMOD
1. immune response modifier 2. induces mRNA encoding cytokines (interferon alpha) at the treatment site 3. DOES NOT eradicate HPV, just treat symptoms |
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what are the FOUR first line drugs to treat tuberculosis
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Pyrazinamide
Isoniazid Ethambutol Rifampin |
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what is Isoniazid used for?
mech? |
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 |
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what is RIFAMPIN used for?
mech? |
BACTERIOCIDAL treats TB and LEPROSY
1. blocks bacterial RNA synthesis by binding to DNA dependent RNA polymerase |
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contraindication of RIFAMPIN
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CANNOT use with PROTEASE INHIBITORS in HIV patients
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what is the most effective drug against LEPROSY
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DAPSONE!!!
1. folic acid synthesis inhibitor |
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what are the 3 primary mechanism for DNA synthesis inhibitions (basic)
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1. folate synthesis inhibitors
2. folate reductase inhibitors 3. topoisomerase DNA Gyrase Enzyme Inhibitors |
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what FOUR drugs are indicated against staphylococci that are penicillinase producers
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1. Dicloxacillin (very effective orally, thats what she said)
2. Cloxacillin 3. Oxacillin 4. Nafcillin |
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route of administration for AMOXICILLIN
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ORAL
-achieves higher blood levels and lower incidence of diarrhea than penicillin |
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what cell wall inhibitor has the highest incidence of Steven Johnson syndrome
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AMPICILLIN
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