Pharm Exam II
Terms
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- Anti TB first line agents
-
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
Streptomycin - Second line TB drugs
-
Para- aminosalicylic acid
Ethionamide
Cycloserine - Why are second line TB drugs not a drug of choice but back up drug
- TOXICITY
- Anti Leprosy agents
-
Dapsone
Rifampin - Isoniazid MOA
- Inhibits MYCOLIC ACID synthesis
- Drug of choice for Mycobacterium Avium intracellulare (AIDS patients)
- Ethambutol
- MOA Rifampin
- Inhibits RNA synthesis by binding to DNA dependent RNA polymerase
- Pyrazinamide MOA
- It is a prodrug that must be converted by pyrazinamidase present in M. tuberculosis to pyrazinoic acid which acts against intracellular organisms - NOT EFFECTIVE AGAINST OTHER MYCOBACTERIA- TB ONLY
- Para aminosalicylic acid MOA
- Inhibits dihydropteorate synthesis of tubercle bacilli - WIDELY DISTRIBUTED (except to the brain)
- Ethionamide MOA
- Blocks mycolic acid synthesis
- Cycloserine MOA
- Inhibits ALANINE RACEMASE and is an effective anti tumor agent
- Dapsone MOA
- - Inhibits folic acid production much like sulfonamides - resistance could develop
- Most effective bactericidal drug against M.leprae (leprosy)
- Rifampin
- Which TB drug is best for disease that spread to the brain
- Rifampin - great distribution to the tissues
- Which drug in combination with trimethoprim used for prophylaxis of Pneumocystis carinii pneumonia in AIDS patients
- Dapsone
- Which TB drug concentrates in erythrocytes (serve as depot)
- Ethambutol
- Isoniazid adverse reactions
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-HEPATOTOXIC especially in elderly and FAST acetylators
- Peripheral and central neuropathy - to fix this supplement with B6 - Ethambutol adverse reactions
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- Optic neuritis
- Joint pain - Rifampin adverse effects
-
- AT toxic levels drug present in tears, sweat, urine, saliva (turn red)
- Acetylates in liver
- Stomach cramps, drowsiness, fatigue, headache, renal failure could occur - Pyrazinamide adverse effects
- - Hyperuricemia can occur - "pseudogout" - PATIENT SHOULD AVOID EATING MEAT
- Para aminosalicylic acid adverse effects
- Sever GI problems + HYPERSENSITIVITY
- Ethionamide adverse effects
-
- SEVERE gastric pain
- Neurotoxic potential
- Resistance develops rapidly - Cycloserine adverse effect
- Drug induced psychosis
- Dapsone adverse effects
-
-Rashes
- Hemolytic anemia - check CBC - Isoniazid is contraindicated in _
-
- ALCOHOLIC - because of hepatotoxicity
- SEIZURE PATIENTS - Dapsone is contraindicated in patients with _
- G6PD- increases risk of hemolytic anemia
- Which drugs should not be used together with isoniazid
-
- Alfentanil- strong analgesic
- Carbamazepine and phenytoin
- Alcohol - Whic drug should not be used together with dapsone
- Didanosine (HIV medication) - because DAPSONE requires acidic environment to be absorbed
- How do you diagnose acute otitis media
-
Earache is the only symptom with sufficient positive predictive value
- Cloudiness and bulging of tympanic membrane can help in diagnosis - Most common pathogen causing otitis media
- Strep. pneumoniae
- What antibiotic is initial treatment of choice in otitis media
- Amoxicillin, if that doesnt work give amoxicillin/clavulanate - AUGMENTIN - but may cause diarrhea
- WHat is initial drug of choice for otitis media if the child is allergic to penicillins
- Sulfonamides (bactrim) could be used as long as there is no hemolytic problems
- For children allergic to sulfa drugs what would you give for otitis media
- Erythromycin
- Name few intracellular pathogens
-
Chlamydia
Rickettsia
Legionella
E coli
Shigella
Salmonella - Antibiotic of choice for Rocky Mountain Spotted fever
- Doxycycline
- MOA for tetracyclines
- Tetracyclines inhibit 30S ribosome or more specifically anticodon reading portion of protein synthesis
- Adverse effects for doxycycline
-
GI cramping or pain
CNS issues
allergy
phototoxicity - can lead to Stevenson-Johnson syndrome - If the patient with Rocky Mountain spotted fever intolerable to doxycycline, what is the next best drug
- Chloramphenicol
- Antibiotic with superior CSF penentration
- Chloramphenicol
- If patient with brain abscess is intolerant to chloramphenicol, what is the other drug
-
Ceftriaxone or ceftazidime
Imipenem+ cilastin is another option