Transcript Kaplan Medical Template Design

NAPLEX
ANTIMICROBIAL
AGENTS
Selecting Appropriate Antimicrobial Agents




PG 52
Empiric therapy
Identify the causative organism
Test the sensitivity of the organism to
antimicrobial drugs
Identify important host factors:
 Site of infection-CNS, bone, prostate, UTI
 Susceptibility to toxicity
 Patient allergies
Mechanisms of Action of Antimicrobial Agents

Interference with cell wall synthesis


penicillins, cephalosporins
Inhibition of protein synthesis

macrolides, clindamycin, tetracyclines, quinolones
Interference

with enzyme unique to bacterial cell
sulfonamides
Interference
with the permeability of microbial cell
membranes

PG 52
amphotericin B
Sulfonamides
PABA
dihydrofolic acid (DHFA)
Sulfa
PG 53
tetrahydrolfolic acid (THFA)
General considerations - Sulfonamides
Mechanism of action : competitive antagonism of PABA in enzyme
system essential for bacteria growth.
For ophthalmic use, sulfa sodium salt solutions are very alkaline (i.e.,
pH 10+). The only sodium salt suitable for ophthalmic use is
sulfacetamide sodium (solutions have pH of about 7.4).
Sulfas are eliminated renally unchanged. Makes them good for UTIs.
Sulfas are less soluble in acid urine. This is one cause of crystalluria.
Stevens-Johnson syndrome is associated with sulfa use.
PG 53
General considerations – Sulfonamides (cont’d)
Combinations of sulfamethoxazole and trimethoprim (Bactrim, Septra, etc.)
are less likely to result in bacterial resistance.
Sulfasalazine (Azulfidine) is used in treating inflammatory bowel disease
and RA. Watch for sulfa allergy, salicylate allergy, and urine discoloration.
- GI side effects, dose is titrated upward slowly, monitor blood counts – dyscrasias
If a patient cannot use sulfasalazine because of sulfa sensitivity, use
mesalamine products, i.e., Asacol, Pentasa, Rowasa. – various dosage
forms
Remember that silver sulfadiazine (Silvadene) and mafenide (Sulfamylon)
are used topically for treatment of serious burns.
PG 53
Penicillins
PG 54
General Considerations – Penicillins
Mechanism of action: interfere with bacterial cell-wall
synthesis (bactericidal)
Note that all penicillins have a beta lactam ring and
thiazolidine ring.
Possible cross-sensitivity with other beta lactam
antimicrobials (e.g., cephalosporins).
- percent cross-sensitive ranges from 5-7%
PG 54
Structure Activity Relationships:



AMino penicillins – AMpicillin, AMoxicillin, bacAMpicillin
NOX penicillins – penicillinase (beta lactamase) resistant
penicillins: Nafcillin, OXacillin, clOXacillin (PO),
diclOXacillin(PO)----MSSA (vanco alternative)
MEZPCT penicillins – antipseudomonal penicillins: MEZlocillin,
Piperacillin, Carbenicillin, Ticarcillin (combo with
aminoglycosides, not in the same IV)
Therapy problems with penicillins:
PG 55

Acid Resistance

Beta-lactamase (penicillinase) resistance (combo products;
Zosyn, Timentin, Augmentin)

Hypersensitivity
Which of the following is an adverse
effect associated with use of
aminopenicillins?
a. polydipsia
b. hemolytic anemia
c. cholelithiasis
d. tardive dyskinesia
e. angina
Which of the following is an adverse
effect associated with use of
aminopenicillins?
a. polydipsia
b. hemolytic anemia
c. cholelithiasis
d. tardive dyskinesia
e. angina
Cephalosporins
PG 56
General considerations
Contains beta-lactam ring. Therefore, may have cross-sensitivity with
penicillins.
As you go from 1st generation to 4th generation, you get:
PG 56

increased gram-negative activity

decreased gram-positive activity

increased resistance to beta-lactamase destruction

increased ability to enter cerebrospinal fluid
Which of the following antimicrobial
agents has effective coverage of streptococcus
pneumoniae?
I. amoxicillin
II. doxycycline
III. gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Which of the following antimicrobial
agents has effective coverage of streptococcus
pneumoniae?
I. amoxicillin
II. doxycycline
III. gentamicin
Gram +
Non-DRSP
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
General considerations (cont’d)
First generation (generally start with CEPH):

Good for surgical prophylaxis
Second generation (generally start with CEF):

Good for otitis, sinusitis and respiratory tract infections
Third generation (generally end with IME or ONE):
●
Good for meningitis, CAP, gram-negative bacilli, gonorrhea,
Proteus, Salmonella, Klebsiella
●
Cefixime (suprax), cefotaxime (claforan), ceftriaxone (rocephin)
Fourth generation (cefepime) Maxipime:
●
PG 57
Good antipseudomonal activity
Tetracyclines
PG 58
General Considerations
Products:

Tetracycline HCI (Achromycin V, Sumycin, Robitet, Panmycin)

Minocycline (Minocin)

Doxycycline (Vibramycin, Doxy 100, Doxychel, Vibra-Tabs)
These are bacteriostatic antimicrobials. They interfere with protein
synthesis.
Broad spectrum antimicrobials. Work against many gram-positive
and gram-negative organisms.
- also effective against atypical organisms mycoplasma and
chlamydia pneumoniae, useful for patients allergic to penicillin b/c gram +
coverage
PG 58
General Considerations
Not for use in children under age 8. May cause discoloration of
developing tooth enamel.
Not for pregnant women. May adversely affect fetal
development.
Most have the potential for causing phototoxicity.
Drug interaction with divalent (Mg, Ca, Fe) or trivalent (Al)
compounds and tetracyclines may result in complexation and
impaired absorption. Do not use together.
Broad spectrum activity can lead to thrush or vaginal candidias
PG 58
Macrolides
General Considerations:
Bacteriostatic – inhibit protein synthesis
May be good for patients who are
hypersensitive to beta-lactam
antimicrobials.
Good respiratory coverage.
 CAP caused by S.pneumo, M.cat, H.flu or atypicals
(mycoplasma, legionella, and chlamydia)
PG 59
Erythromycin
Oral Products
Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)
Coating used on most products
Administer on an empty stomach
Erythromycin stearate (Erythromycin Stearate,
Wyamycin S)
Better absorbed than erythromycin base
PG 59
Erythromycin (cont’d)
Erythromycin esolate (Ilosone)
Associated with cholestatic hepatitis
 Better absorbed than erythromycin base
Erythromycin ethylsuccinate (eryPed, E.E.S.)
Most well absrobed
Available in liquid form
400 mg of EES = 250 mg of erythromycin base
Parenteral Products
Erythromycin lactobionate
Erythromycin glucepate
Drug Interactions: Mainly due to enzyme inhibition of erythromycin – (3A4)
PG 59
Clarithromycin (Biaxin)
Usually used BID. XL form used once daily.
Prodrug: May be given with or without meals
Used in combination with a proton pump inhibitor for H.
pylori treatment.
Metallic taste
PG 60
Azithromycin (Zithromax)
More gram-negative activity than erythromycin or
clarithromycin
Once-daily dosing, usually for five days after otitis media
(e.g., Z-Pack)
Available as suspension, tablets, IV
Suspension should not be taken with food or antacids.
Dirithromycin (Dynabac)
Prodrug
Once-daily dosing
PG 60
Lincosamides
General considerations
Watch for pseudomembranous enterocolitis (Clostridium
difficile).
•Treat clostridium with metronidazole (Flagyl) or oral
vancomycin.
Good in gram positive (staph) and gram-negative infections,
particularly anaerobes
Lincomycin (Lincocin, Lincorex)
Morbilliform rash possible; DC drug if it happens
Clindamycin (Cleocin)
Available in topical form for acne
PG 61
Which of the following antibiotics has
bacteriostatic activity?
a. amoxicillin
b. ciprofloxacin
c. erythromycin
d. penicillin
e. cephalexin
Which of the following antibiotics has
bacteriostatic activity?
a. amoxicillin (cell wall)
b. ciprofloxacin (inhibits DNA gyrase)
c. erythromycin (protein synthesis)
d. penicillin (cell wall)
e. cephalexin (cell wall)
Aminoglycosides
General Considerations
Glycosides – poorly absorbed from the GI tract
Bactericidal
Good for serious gram-negative pathogens (pseudomonas,
proteus, etc.)
Frequently administered with extended-action penicillin (IV
incompatible) - dosed q8h or q24h (conc. dependant kill)
Eliminated by glomerular filtration; Watch for ototoxicity
Monitor peaks and troughs – peaks 30 min after infusion, trough 30
minutes before next dose. peak = 4-10ug/ml trough = 0.5-2, adjust
dose if CrCl < 60ml/min. hearing test if prolonged therapy
PG 61
Which of the following antimicrobial
agents is available for parenteral use only?
I. cefaclor
II. tobramycin
III. ticarcillin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Which of the following antimicrobial
agents is available for parenteral use only?
I. cefaclor
II. tobramycin
III. ticarcillin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Parenteral use
Reference Peak Range
Streptomycin sulfate
Kanamycin sulfate (Kantrex)
Gentamicin sulfate (Garamycin
(4mcg-10mcg/ml)
Tobramycin sulfate (Nebcin)
(4mcg-10mcg/ml)
Amikacin sulfate (Amikin)
(15mcg-25mcg/ml)
Netilmicin sulfate (Netromycin)
PG 61
Which of the following antibiotics
requires monitoring of serum levels?
a. penicillin
b. ceftazidime
c. azithromycin
d. gentamicin
e. cephalexin
Which of the following antibiotics
requires monitoring of serum levels?
a. penicillin
b. ceftazidime
c. azithromycin
d. gentamicin
e. cephalexin
Oral use
Not for systemic action
Neomycin sulfate (Mycifradin) - Used for bowel prep prior to
surgery , treat diarrhea caused by e.coli, neomycin also binds
ammonia, use in patients w/hepatic encephalopathy, watch for
absorption interactions
Tobramycin (TOBI) – inhaled product for CF patients
PG 62
Fluoroquinolones
General Considerations - Inhibits DNA-Gyrase
May cause phototoxicity
Not for patients under 18 – affects growth
Do not use within 2-4 hours of antacids; iron – also inhibits
CYP1A2 (increased levels of theophylline and caffeine)
Generally useful for UTI, lower respiratory infections,
gonorrhea, prostatitis – older agents have more gram -,
less gram + coverage, newer agents have broader gram +
[moxifloxacin, gatifloxacin]
All end in -oxacin
PG 62
Names
Second generation
Norfloxacin (Noroxin) – high urine levels - UTIs
Ciprofloxacin (Cipro)- renal elimination: reduce dose
Ofloxacin (Floxin)
Third generation
Levofloxacin (Levaquin) – renal elimination: reduce dose
Sparfloxacin (Zagam) – reports of prolongation of QT interval (D/C)
Gemifloxacin (Factive) – renal elimination: reduce dose, skin rash
Fourth generation
Moxifloxacin (Avelox) – Multi-drug resistant Streptococcus pneumonia
(MDRSP)
PG 62
MISCELLANEOUS ANTIMICROBIAL AGENTS
Antibacterials
Mupirocin (Bactroban) – topical use for impetigo, intranasal for staph
Vancomycin (Vancocin) – associated with red man syndrome (must be
infused slowly, over min of 30 minutes); reserved for serious/resistant
gram + infections (MRSA, enterococcus)
– rapid drop in BP accompanied by rash in neck or chest area
- Monitoring – 1 hour before and 1 hour after
- Peak – 25-40mcg/dl & Trough 5-12mcg/dl
Metronidazole (Flagyl) – active against gram-negative organisms and
protozoa, (anaerobes) Avoid alcohol. May darken urine.
PG 63
MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)
Carbapenems
•broad spectrum; used for resistant gram +/– organisms, pseudomonas,
MRSA, enterococcus, anaerobes
•similar to penicillins (cross-sensitivity) but b-lactamase resistant
•Risk of seizures and renal adjustment
Imipenem/cilastatin (Primaxin) – cilastatin is a renal dipeptidase
inhibitor
Meropenem (Merrem)---lacks good pseudomonas coverage
Doripenem (Doribax)
Ertapenem (Invanz)
----Aztreonam (Azactam)---monobactam, ok with PCN allergy
PG 63
Which of the following antibiotic is
classified as a macrolide?
a. telithromycin
b. tobramycin
c. azithromycin
d. doxycycline
e. kanamycin
Which of the following antibiotic is
classified as a macrolide?
a. telithromycin
b. tobramycin
c. azithromycin
d. doxycycline
e. kanamycin
MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)
VRE and MRSA drugs
Quinupristin / dalfopristin (Synercid) –
Linezolid (Zyvox) –……oral dosing available
Tigecycline (Tygacil) –
Chloramphenicol (Chloromycetin) – for typhoid fever; may cause
aplastic anemia and gray baby syndrome
PG 63-64
Pneumonia

Organisms:

Treatment:
--Comorbidities:
Chronic obstructive
pulmonary disease
(COPD), diabetes,
chronic renal failure,
chronic liver failure,
heart failure (HF),
cancer, asplenia,
immunosuppressed
Pneumonia

Treatment:
--Risk factors for
MDR organisms:
recent antibiotic
therapy (in last 90
days), hospitalized ≥
5 days,  resistance
in environment,
nursing home
resident, chronic
dialysis, home
infusion therapy,
immunosuppressed
Meningitis

Organisms:

Treatment:
Urinary Tract Infection

Organisms:

Treatment:
STDs

Organisms:

Treatment:
Antitubercular Drugs
R
I
P
E
S
PG 64
rifampin
isoniazid
pyrazinamide
ethambutol
streptomycin
Antitubercular Drugs
Isoniazid (Nydrazid, Laniazid)
May cause B6 deficiency – supplement malnourished, alcoholics, kids
Used for prophylaxis or in combo with other drugs for active disease
 6 months of prophylaxis if +PPD; For treatment used in combo with
rifampin for at least 6 months
Metabolized by acetylation (slow versus rapid acetylators)
 monitor for hepatoxicity
Rifampin (Rifadin, Rimactane)
Potent enzyme inducer (potential drug interactions with many drugs)
Potentially hepatotoxic;
Use may result in discoloration of virtually all body fluids (urine and
tears----watch contact lenses)
PG 64
Antitubercular Drugs (cont.)
Ethambutol (Myambutal) – for treatment of MAC and drug-resistant Tb
as part of combination therapy
- optic neuritis is a rare but serious side effect
- monitor with eye exams
Pyrazinamide – used in combination therapy; potentially hepatotoxic
- may increase uric acid levels
Steptomycin- can be used as fourth drug in regimen instead of
pyrazinamide
PG 65
Antimalarials
Quinine sulfate (Quinamm) – also used for muscle cramps;
no longer used due to hematologic adverse effects
Doxycycline – tetracycline; possible phototoxicity and
binding interactions
Melfoquine HCl (Lariam) – may cause neuropsychiatric
adverse effects; once- weekly dosing
Atovaquone/proguanil (Malarone) – newer product; once
daily; do not use if renally impaired
PG 65
Antimalarials
Chloroquine (Aralen) – may worsen psoriasis symptoms
Hydroxychloroquine sulfate (Plaquenil Sulfate) – may
worsen psoriasis symptoms
- also used as a DMARD for RA; phototoxicity,
hematological side effects, ocular and ototoxicity
Primaquine phosphate – take with food to reduce GI upset;
may be used for PCP
PG 66
HIV Antiretroviral Therapy

Therapy initiated based on CD4 count,
viral load and presence of symptoms
 Initial regimen in treatment naive patients:
• NNRTI + 2 NRTIs
• PI + 2 NRTIs

PG 69
Learn drug class representatives and
major toxicities
Which HIV drug is correctly matched
with its mechanism of action?
a. Lamivudine - nucleoside reverse
transcriptase inhibitor
b. Enfuvirtide - protease inhibitor
c. Stavudine - binds to human CCR5
receptor
d. Didanosine – protease inhibitor
e. Indinavir – blocks virus entry into human
cells and subsequent viral replication
Which HIV drug is correctly matched
with its mechanism of action?
a. Lamivudine - nucleoside reverse
transcriptase inhibitor
b. Enfuvirtide - protease inhibitor
c. Stavudine - binds to human CCR5
receptor
d. Didanosine – protease inhibitor
e. Indinavir – blocks virus entry into human
cells and subsequent viral replication
NNRTIs
non-nucleoside reverse transcriptase
inhibitors (vir in the middle)



Delavirdine (rescriptor) (rash, LFTs)
Efavirenz (Sustiva)
 Drug of choice
 Category X, vivid dreams
Nevirapine (Viramune)
 Rash (Steven Johnson Syndrom)
 Liver metabolism
PIs
Protease inhibitors (vir at the end)
Exception – darunavir, tenofovir, raltegravir, abacavir
Metabolized through the liver (commonly 3A4)
• potential for significant drug interactions
Low dose of ritonavir frequently used to enhance
the concentrations of coadministered PIs
Adverse effects: GI intolerance, hyperglycemia,
dyslipidemia, lipodystrophy, LFT alterations
PG 72
NRTIs
nucleoside reverse transcriptase
inhibitors (all the others)
Exception – maraviroc
All NRTIs (except abacavir) are excreted renally; require
dose adjustment but few drug interactions
Most common ADRs – GI intolerance, typically subsides in
first couple of weeks
- High risk for perpheral neuropathy
Black Box warning: Risk of lactic acidosis with hepatic
steatosis
PG 69
AIDS – Opportunistic Infections

PCP / PJP (pneumocystis carninii pneumonia)


CMV retinitis


Macrolide + ethambutol
Cryptococcus neuformans meningitis


PG 74
Ganciclovir
MAC / MAI (mycobacterium avium complex)


trimethoprim-sulfamethoxazole
Amphotericin B +/- flucytosine
Fluconazole used for maintenance
Drugs for influenza
M2 inhibitors
Amantadine, rimantidine
Effective for influenza A virus only
Begin within 48h of symptom onset; continue 2-5 days
Neuroaminidase inhibitors
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Effective for influenza A and B viruses
Begin with 48h of symptoms onset; continue 5 days
PG 74
Drugs for herpes simplex and herpes zoster (shingles)
Acyclovir (Zovirax) – for herpes simplex types 1 and 2
- dosed 5x/day for 10 days, 5 days if recurrence
Penciclovir (Denavir) – topical treatment for herpes labialis
(cold sores)
Valacyclovir HCl (Valtrex) – for herpes simplex and herpes
zoster; acyclovir prodrug
Famcyclovir (Famvir) for herpes simplex and herpes zoster
(shingles); penciclovir prodrug
- begin therapy as soon as first sign of lesion
Docosanol (OTC-Abreva) topical cream
PG 75
Anthelmintic drugs of choice
Nematodes (roundworm)
Mebendazole (Vermox)—do not use in pregnancy – blocks glucose uptake
Albendazole (Albenza) – degeneration of cytoplasmic microtubules intestinal cells
of helminths
Piperazine citrate Preg B – blocks affect of ACH
Pyrantel pamoate (Antiminth)
Trichuriasis (whipworm)
Mebendazole (do not use in pregnancy)
Hookworm – mebendazole (do not use in pregnancy)
PG 75
Which of the following medication(s) can cause
nephrotoxicity?
I.
II.
III.
Ganciclovir
Foscarnet
Gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Which of the following medication(s) can cause
nephrotoxicity?
I.
II.
III.
Ganciclovir
Foscarnet
Gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Which of the following agents inhibits the
HIV enzyme reverse transcriptase?
I. zanamivir
II. ritonivir
III. didanosine
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Which of the following agents inhibits the
HIV enzyme reverse transcriptase?
I. zanamivir (Neuroaminidase inhibitors)
II. ritonivir (protease inhibitor)
III. didanosine (nucleoside reverse transcriptase inhibitors)
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
DERMATOLOGIC STUDY OUTLINE
Acne
Pathophysiology— abnormal keratinization
leads to obstruction of the follicle and
accumulation of sebum to form a closed
comedo or “white-head”
Goal of therapy is to unblock follicles
PG 146
Normal Pore
Inflamed Pore
Dermatologic Study Outline
PG 146
Dermatologic Study Outline
Isotretinoin (Accutane)
 Effective therapy option for the treatment of severe,
inflammatory acne, or more moderate forms that have been
refractory to other treatment options
 pregnancy category X
 two forms of contrception, iPLEDGE program
Oral Antimicrobials
• Tetracycline
• Erythromycin
• Clindamycin
PG 146
Psoriasis
Pathophysiology — exact mechanism unknown. May be due to
defects in epidermal cell cycle, AA metabolism, immunologic
mechanisms, environmental triggers
Treatment modalities
• Emollients (e.g., petrolatum)
• Ultraviolet light
• Coal tars (typically compounded)
• Topical corticosteroids
• Systemic corticosteroids (pulse dosing)
• Antineoplastic agents (methotrexate, hydroxyurea)
• Psoralens (pulse dosing)
• Immunosuppressant agents (Etanercept, Efalizumab)
• Retinoids (pulse dosing)
PG 146
Which of the following psoriasis
medications is not pregnancy category
X?
I. Dovonex
II. Methotrexate
III. Soriatane
A.
B.
C.
D.
E.
I only
III only
I and II only
II and III only
I, II and III
Which of the following psoriasis
medications is not pregnancy category
X?
I. Dovonex
II. Methotrexate
III. Soriatane
A.
B.
C.
D.
E.
I only
III only
I and II only
II and III only
I, II and III
A patient presents to the pharmacy
with obvious mild acne, which of the
following cannot be recommended
without a prescription?
a. Benzoyl peroxide 2.5% cream
b. Sulfur soap
c. Benzamycin gel
d. Salicylic acid wash
e. Benzoyl peroxide 10% lotion
A patient presents to the pharmacy
with obvious mild acne, which of the
following cannot be recommended
without a prescription?
a. Benzoyl peroxide 2.5% cream
b. Sulfur soap
c. Benzamycin gel
d. Salicylic acid wash
e. Benzoyl peroxide 10% lotion
Fungal Infections





Tinea corporis – body surface
Tinea capitis – scalp
Tinea cruris – groin (“jock itch”)
Tinea pedis – feet (“athlete’s foot”)
Onychomycosis – nails
PG 67-68 and 147
Therapy
Prophylaxis. Keep skin dry; frequent changes and thorough cleaning of
clothing; and avoid likely areas of contamination.
Active:
Dusting powders (medicated versus nonmedicated), wet compresses
Topical drug therapy
• Fatty acids (undecylenic acid)
• Tolnaftate (Tinactin, Aftate)
• Haloprogin (Halotex)
• Miconazole (Micatin,Monistat)
• Clotrimazole (Lotrimin)
• Oxiconazole (Oxistat)
• Sulconazole (Exelderm)
• Butenafine (Mentax)
Nystatin (Mycostatin, Nilstat) – good for superficial candida (thrush)
Systemic drug therapy for topical fungal disorders
• Griseofulvin (microsized versus ultramicrosized)
• Terbinafine (Lamisil)
• Avoid corticosteroids
PG 147
Antifungal Drugs (cont’d)
Miconazole (Monistat, Micatin) – broad-spectrum antifungal
agent available as powder, aerosol, cream, and
suppository; may be used topically or vaginally
Clotrimazole (Lotrimin, Mycelex) – broad-spectrum
antifungal available as cream, lotion, suppositories, and
troches (OTC use for 2 weeks after infection clears)
Ketoconazole (Nizoral) – for superficial and systemic fungal
infections; also available as OTC shampoo for dandruff;
enzyme inhibitor
Itraconazole (Sporanox) – for oral or topical treatment of
superficial or systemic fungal disorders; enzyme inhibitor.
- hepatotoxicity; take w/ food and avoid antacids
PG 67
Antifungal Drugs (cont’d)

Terbinafine (Lamisil) – used orally for
onychomycosis of fingernail or toenail. Used
topically for superficial tinea infections (OTC
use for 1 week). Monitor for hepatoxicity with
oral use.

Ciclopriox (Penlac) – applied topically once
daily for treatment of onychomycosis. –
requires long-term therapy
PG 67
Antifungal Drugs (cont’d)

Griseofulvin (Grisactin, Grifulvin V, Fulvicin)
 For tinea only
 Duration of therapy
• depends on type: corporis: 2-4 wks.; capitis: 4-6 wks.,
pedis: 4-8 wk

Regular versus microsized versus
ultramicrosized
• ultra is better absorbed; take w/ fatty meal
• causes induction interactions
PG 67
Antifungal Drugs (cont’d)

Other Azoles
 Posaconazole (Noxafil)
 Voriconazole (Vfend)
• Reserved for severe invasive fungal infections (asperigillosis)


PG 68
Echinocandins (less DI, but monitor LFTs)
 Anidulafungin (Eraxis)
 Caspofungin (Cancidas)
 Micafungin (Mycamine)
Ampho B and related Lipid products
 nephrotoxicity
NAPLEX
Sample Questions
Which of the following antibiotics does
not have a significant drug interaction
with warfarin?
A.
B.
C.
D.
E.
ciprofloxacin
azithromycin
TMP-SMZ
Metronidazole
Nafcillin
Which of the following antibiotics does
not have a significant drug interaction
with warfarin?
A.
B.
C.
D.
E.
ciprofloxacin
azithromycin
TMP-SMZ
Metronidazole
Nafcillin
Which of the following medications is
the best treatment option for an
uncomplicated urinary tract infection?
A.
B.
C.
D.
E.
penicillin
cefuroxime
levofloxacin
gentamicin
clarithromycin
Which of the following medications is
the best treatment option for an
uncomplicated urinary tract infection?
A.
B.
C.
D.
E.
penicillin
cefuroxime
levofloxacin
gentamicin
clarithromycin
Which of the following antimicrobial
agents is available for parenteral use
only?
I.
II.
III.
piperacillin
aztreonam
rifampin
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which of the following antimicrobial
agents is available for parenteral use
only?
I.
II.
III.
piperacillin
aztreonam
rifampin
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which of the following agents is a
non-nucleoside reverse
transcriptase inhibitor?
A.
B.
C.
D.
E.
didanosine
delavirdine
stavudine
zidovudine
lamivudine
Which of the following agents is a
non-nucleoside reverse
transcriptase inhibitor?
A.
B.
C.
D.
E.
didanosine
delavirdine
stavudine
zidovudine
lamivudine
Which of the following agents may be
utilized in combination with other
medications for H. pylori eradication?
A.
B.
C.
D.
E.
tetracycline
azithromycin
penicillin
fluconazole
cefuroxime
Which of the following agents may be
utilized in combination with other
medications for H. pylori eradication?
A.
B.
C.
D.
E.
tetracycline
azithromycin
penicillin
fluconazole
cefuroxime
Peripheral neuropathy is associated
with which one of the following agents:
A.
B.
C.
D.
E.
nevirapine
delavirdine
Saquinavir
Stavudine
tenofovir
Peripheral neuropathy is associated
with which one of the following agents:
A.
B.
C.
D.
E.
Nevirapine (NNRTI)
Delavirdine (NNRTI)
Saquinavir (PI)
Stavudine (NRTI) do not use with AZT (zidovudine)
Tenofovir (NRTI)
Administration of calcium or iron must
be separated by at least 2 hours if
antibiotics in this category are
prescribed:
I.
II.
III.
Macrolides
Tetracyclines
Fluroquinolones
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Administration of calcium or iron must
be separated by at least 2 hours if
antibiotics in this category are
prescribed:
I.
II.
III.
Macrolides
Tetracyclines
Fluroquinolones
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which of the following antimicrobial
agents has effective coverage for
M. pneumoniae?
A.
B.
C.
D.
E.
amoxicillin
erythromycin
metronidazole
cefotriaxone
clindamycin
Which of the following antimicrobial
agents has effective coverage for
M. pneumoniae?
A.
B.
C.
D.
E.
amoxicillin
erythromycin
metronidazole
cefotriaxone
clindamycin
Which of the following regimens is
most appropriate for C. difficile
eradication?
A.
B.
C.
D.
E.
Clarithromycin 500 mg PO q 12 hours
Clindamycin 300 mg IV q 6 hours
Vancomycin 125 mg PO q 6 hours
Doxycycline 100 mg PO q 12 hours
Vancomycin 1000 mg IV q 12 hours
Which of the following regimens is
most appropriate for C. difficile
eradication?
A.
B.
C.
D.
E.
Clarithromycin 500 mg PO q 12 hours
Clindamycin 300 mg IV q 6 hours
Vancomycin 125 mg PO q 6 hours
Doxycycline 100 mg PO q 12 hours
Vancomycin 1000 mg IV q 12 hours
Which agent is available in both a
topical and an oral product for the
treatment of acne?
I.
II.
III.
clindamycin
erythromycin
doxycycline
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which agent is available in both a
topical and an oral product for the
treatment of acne?
I.
II.
III.
clindamycin
erythromycin
doxycycline
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which of the following drugs
represents first (primary) agents in the
treatment of TB?
A.
B.
C.
D.
E.
Ethambutol + PASA
Ciprofloxacin + PASA
Isoniazid + rifampin
Cycloserine + streptomycin
Penicillin + Benemid
Which of the following drugs
represents first (primary) agents in the
treatment of TB?
A.
B.
C.
D.
E.
Ethambutol + PASA
Ciprofloxacin + PASA
Isoniazid + rifampin
Cycloserine + streptomycin
Penicillin + Benemid
Which of the following antibiotics is
considered first line treatment for a
gonorrhea infection?
A.
B.
C.
D.
E.
Ampicillin
Ciprofloxacin
Doxycycline
Penicillin
Tetracycline
Which of the following antibiotics is
considered first line treatment for a
gonorrhea infection?
A.
B.
C.
D.
E.
Ampicillin
Ciprofloxacin (also..ceftriaxone, cefixime)
Doxycycline (chlamydia)
Penicillin
Tetracycline
Which of the following groups of
antibiotics may be prescribed for a
gravid patient with gonorrhea?
I.
II.
III.
cephalosporins
fluoroquinolones
tetracyclines
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
Which of the following groups of
antibiotics may be prescribed for a
gravid patient with gonorrhea?
I.
II.
III.
cephalosporins
fluoroquinolones
tetracyclines
A.
I only
B.
III only
C.
I and II only
D.
II and III only
E.
I, II and III
A gravid patient with a Chlamydia
infection is likely to be prescribed
which of the following antibiotics?
A.
B.
C.
D.
E.
Ampicillin
Levofloxacin
Doxycycline
Erythromycin
Penicillin
A gravid patient with a Chlamydia
infection is likely to be prescribed
which of the following antibiotics?
A.
B.
C.
D.
E.
Ampicillin
Levofloxacin
Doxycycline
Erythromycin
Penicillin
Which of the following is the BEST
treatment for a patient with herpes
zoster?
A.
B.
C.
D.
E.
Cidofovir
Famciclovir
Ganciclovir
Penciclovir
Tenofovir
Which of the following is the BEST
treatment for a patient with herpes
zoster?
A.
B.
C.
D.
E.
Cidofovir
Famciclovir
Ganciclovir
Penciclovir
Tenofovir
Which of the following medications
would be appropriate for the treatment
of Pseudomonas aeruginosa?
a.
b.
c.
d.
e.
Ampicillin
Cefepime
Ceftriaxone
Erythromycin
Clindamycin
Which of the following medications
would be appropriate for the treatment
of Pseudomonas aeruginosa?
a.
b.
c.
d.
e.
Ampicillin
Cefepime
Ceftriaxone
Erythromycin
Clindamycin