Infectious Drugs/Derm Drugs
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Questions and Answers

Why is lindane contraindicated for premature infants?

  • Premature infants are more susceptible to the anti-inflammatory effects of lindane, leading to complications.
  • It can cause abnormal follicular keratinization.
  • It primarily targets RARs affecting cellular differentiation and proliferation, which is dangerous for infants.
  • It may lead to hemolytic anemia, especially in infants with G6PD deficiency. (correct)

A patient with a known seizure disorder is prescribed a topical medication for head lice. Which medication requires special counseling due to a boxed warning?

  • A medication that reduces counts of propionibacterium acnes
  • A retinoid targeting RARs
  • Lindane (correct)
  • Malathion

What is the primary mechanism of action of retinoids mentioned in the text?

  • Targeting RARs to affect cellular differentiation and proliferation (correct)
  • Reducing counts of _propionibacterium acnes_
  • Reducing inflammation associated with dermatitis
  • Correcting abnormal follicular keratinization disorders

Which of the following is a targeted therapeutic action of certain medications used to treat dermatological conditions?

<p>Correcting abnormal follicular keratinization (B)</p> Signup and view all the answers

A 7-year-old child is diagnosed with head lice. Considering the information provided, which treatment option is most suitable?

<p>Malathion, as it is indicated for head lice in children older than 6 years (A)</p> Signup and view all the answers

Which of the following mechanisms of action correctly describes how tetracyclines combat bacterial infections?

<p>Inhibiting bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing aminoacyl tRNA from binding. (D)</p> Signup and view all the answers

A patient is prescribed a medication known to inhibit folic acid synthesis in bacteria. Which class of antibiotics does this medication most likely belong to?

<p>Sulfonamides (A)</p> Signup and view all the answers

How do beta-lactam antibiotics, such as penicillins and cephalosporins, inhibit bacterial growth?

<p>By inhibiting the last step in peptidoglycan synthesis, weakening the bacterial cell wall. (C)</p> Signup and view all the answers

Which characteristic is crucial for nucleoside analogues, like acyclovir, to effectively combat viral infections?

<p>Ability to either block entry into cells or be active inside host cells to disrupt viral DNA synthesis and replication. (A)</p> Signup and view all the answers

Why are sulfonamides considered bacteriostatic rather than bactericidal?

<p>Because they inhibit bacterial growth by interfering with metabolic pathways, rather than directly killing the bacteria. (C)</p> Signup and view all the answers

A patient with a penicillin allergy needs treatment for a bacterial infection. Considering the mechanism of action of beta-lactam antibiotics, which alternative class of antibiotics should be approached with caution due to potential cross-reactivity?

<p>Cephalosporins (A)</p> Signup and view all the answers

Which of the following factors is a key determinant in the effectiveness of tetracycline antibiotics?

<p>Its specific binding affinity to the 30S ribosomal subunit in bacteria. (C)</p> Signup and view all the answers

How do nucleoside analogues interfere with viral replication?

<p>By inhibiting viral DNA synthesis and replication. (D)</p> Signup and view all the answers

Which of the following characteristics is most indicative of antimicrobials effective against anaerobes?

<p>Concentration-dependent killing with a significant postantibiotic effect. (C)</p> Signup and view all the answers

A patient has an infection involving both Bacteroides fragilis and Staphylococcus aureus. Which antimicrobial would be least appropriate due to its spectrum of activity?

<p>Vancomycin (D)</p> Signup and view all the answers

A patient develops antimicrobial resistance to macrolides. What implication does this have for the use of Lincosamides?

<p>Resistance to macrolides may lead to resistance to Lincosamides. (D)</p> Signup and view all the answers

A patient taking a certain medication is advised to maintain a high daily urine output to prevent crystalluria. Which adverse effect is the medication likely associated with?

<p>Crystalluria (D)</p> Signup and view all the answers

Which of the following describes the mechanism of action of polyene macrolides like amphotericin B?

<p>Disruption of fungal membrane integrity by binding to ergosterol. (D)</p> Signup and view all the answers

Why are tetracyclines such as doxycycline and minocycline typically avoided in pregnant women and children under 8 years old?

<p>They can lead to retardation of bone growth and tooth discoloration. (A)</p> Signup and view all the answers

Which of the following is a common application of Interferon alpha?

<p>Treatment of viral hepatitis and certain cancers (D)</p> Signup and view all the answers

What is a significant consideration when using aminoglycosides like tobramycin or amikacin?

<p>They require monitoring due to potential toxicities and have concentration-dependent killing. (B)</p> Signup and view all the answers

A patient is prescribed a medication known to cause photosensitivity. What specific advice should the healthcare provider give to this patient?

<p>Use sunscreen and protective clothing when exposed to sunlight. (D)</p> Signup and view all the answers

A patient undergoing treatment with amphotericin B begins to show signs of bone marrow suppression. What is the most appropriate course of action?

<p>Reduce the dosage of amphotericin B and monitor the patient closely. (D)</p> Signup and view all the answers

A patient is taking a medication that is found to have chelate formation with calcium, antacids, and minerals. What is the primary concern related to this interaction?

<p>Reduced absorption of the medication. (D)</p> Signup and view all the answers

Trimethoprim-Sulfamethoxazole (Bactrim) inhibits tetrahydrofolic acid synthesis by targeting which enzyme?

<p>Bacterial dihydrofolate reductase (DHFR) (C)</p> Signup and view all the answers

Which of the following best describes a key pharmacokinetic aspect of amphotericin B administration?

<p>It has a long tissue half-life, allowing for accumulation in certain organs. (C)</p> Signup and view all the answers

A patient with a known Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency should be closely monitored while taking a certain medication due to an increased risk of:

<p>Increased risk of developing hemolytic anemia (C)</p> Signup and view all the answers

What is the mechanism of action of a medication that acts as a nucleotide analog by inhibiting RNA-dependent RNA polymerase (RdRp)?

<p>Interfering with viral replication (C)</p> Signup and view all the answers

A patient is prescribed Trimethoprim-Sulfamethoxazole (Bactrim) for a bacterial infection. Which of the following statements is most important to consider regarding its mechanism of action?

<p>It blocks sequential steps in tetrahydrofolic acid synthesis. (D)</p> Signup and view all the answers

Nystatin is primarily effective against which type of infection?

<p>Fungal infections (A)</p> Signup and view all the answers

Why is nystatin powder preferred over creams or ointments for moist candidal lesions like diaper rash?

<p>Powders help to keep the area dry, inhibiting fungal growth. (D)</p> Signup and view all the answers

A patient is prescribed nystatin oral suspension for oral candidiasis. What is a potential challenge with this route of administration?

<p>The suspension is poorly absorbed in the gastrointestinal tract. (B)</p> Signup and view all the answers

What is the mechanism of action (MOA) of Apretude in preventing HIV transmission?

<p>Integrase strand transfer inhibition (B)</p> Signup and view all the answers

A person is using PrEP to prevent HIV transmission through receptive anal sex. Approximately how long does it take to reach maximum protection with daily oral PrEP?

<p>7 days (B)</p> Signup and view all the answers

A patient is starting Apretude (cabotegravir extended-release) for PrEP. What is the recommended initial dosing schedule?

<p>Two 600 mg IM injections, one month apart (C)</p> Signup and view all the answers

Which of the following is a key difference between PrEP and PEP in the context of HIV prevention?

<p>PrEP is used <em>before</em> a potential HIV exposure, while PEP is used <em>after</em>. (C)</p> Signup and view all the answers

A patient using PrEP tests positive for HIV. What is the MOST appropriate course of action?

<p>Discontinue PrEP immediately and initiate a standard HIV treatment regimen. (D)</p> Signup and view all the answers

Which of the following best describes the mechanism of action (MOA) of topical selenium sulfide, pyrithione zinc, and sodium sulfacetamide?

<p>Involves variable absorption among different body sites, affecting drug concentration and efficacy. (D)</p> Signup and view all the answers

Why is it crucial to avoid pregnancy for 3 years after acitretin treatment?

<p>To avoid the risk of retinoid-induced embryopathy. (C)</p> Signup and view all the answers

A patient with extensive cutaneous fungal infection has shown poor response to topical treatments. Which systemic treatment is most appropriate?

<p>Oral fluconazole (A)</p> Signup and view all the answers

A patient is prescribed calcipotriene for psoriasis. What is its primary mechanism of action?

<p>Modulating cell differentiation and proliferation through the vitamin D receptor. (C)</p> Signup and view all the answers

Why is ketoconazole not typically preferred for superficial fungal infections?

<p>It carries a risk of severe hepatotoxicity and prolonged QT interval. (B)</p> Signup and view all the answers

How long does it typically take for acitretin to provide full clinical benefit for cutaneous manifestations of psoriasis?

<p>Within 3-6 months of starting treatment. (D)</p> Signup and view all the answers

When are systemic antifungal treatments like terbinafine or fluconazole typically considered for fungal infections?

<p>Only when topical therapies have proven ineffective or for extensive cutaneous involvement. (C)</p> Signup and view all the answers

Which class of topical medications can be used for bacterial coverage, in addition to their primary antifungal properties?

<p>Antifungal agents (B)</p> Signup and view all the answers

Flashcards

Favipiravir MOA

A nucleotide analog that inhibits RNA-dependent RNA polymerase (RdRp).

Favipiravir Adverse Effects

Rash, fever, GI symptoms, decreased GFR, hemoglobin, and lymphocyte count.

Favipiravir Black Box Warning

Severe: SJS, Vasculitis, Hemolytic anemia (G6PD deficiency).

Favipiravir - Monitoring

Encourage water intake and monitor renal & hepatic function.

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Trimethoprim (TMP) MOA

Inhibits bacterial dihydrofolate reductase (DHFR), blocking tetrahydrofolic acid synthesis.

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Tetracyclines - Drug Interactions

Chelate formation leading to decreased absorption.

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Tetracyclines

Bacteriostatic protein synthesis inhibitors targeting ribosomes.

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Tetracycline MOA

Inhibits bacterial protein synthesis by binding to the 30S bacterial ribosome subunit, preventing aminoacyl tRNA binding.

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Doxycycline/Minocycline - Important point

Photosensitivity - use sunscreen

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Tetracyclines - Contraindications

Pregnancy (Category D) – Can bind to fetal bone and teeth, leading to retardation of bone growth and tooth discoloration. Do NOT use in children < 8YO.

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Sulfonamides

DNA disruptors that inhibit folic acid synthesis.

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Sulfonamide MOA

Inhibits folic acid synthesis in susceptible bacteria.

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Beta-Lactam Antibiotics

Cell membrane/wall inhibitors, including penicillins and cephalosporins.

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Beta-Lactam MOA

Inhibit the last step in peptidoglycan synthesis by acylating transpeptidase via cleavage of the β-lactam ring.

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Nucleoside Analogues

Anti-herpes/antiviral agents.

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Nucleoside Analogues MOA

Inhibit viral DNA synthesis and replication; must block entry into cells or be active inside host cells to be effective.

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Nystatin's Action

Inhibits fungal growth (fungistatic) or kills fungi (fungicidal).

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Nystatin Uses

Oral suspension treats candidiasis in the oral cavity. Also used for vaginal candidiasis and intertriginous candidal infections.

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Nystatin Absorption

Nystatin isn't well-absorbed via the GI tract, skin, or vagina. Therefore given topically.

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Nystatin Application

For moist lesions (like diaper rash), powder is preferred, applied 2-3 times daily. Creams/ointments are applied twice daily.

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PrEP Definition

Medication taken to prevent HIV transmission through sex or injection drug use.

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PEP

Stands for Post-Exposure Prophylaxis

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PrEP Details

Prevents HIV, reaches max protection for receptive anal sex in 7 days

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Apretude

Extended-release cabotegravir, given as an intramuscular injection.

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Concentration-dependent killing

Kill bacteria in a manner dependent on concentration, where higher concentrations lead to greater killing rates.

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Postantibiotic effect (PAE)

The continued suppression of bacterial growth even after the antibiotic concentration falls below the MIC.

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Anaerobes Sensitive to Lincosamides

Gram-positive anaerobes including peptostreptococci and Clostridium perfringens.

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Lincosamides: Toxin Inhibition

Inhibit toxin production in Group A Streptococcus and MRSA.

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Cross-Resistance: Macrolides & Clindamycin

Resistance to macrolides might cause resistance to clindamycin.

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MOA of Interferon Alpha

Causes antiproliferative effects against tumor cells, inhibits viral replication, and modulates the host immune response.

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Amphotericin B Characteristics

It is an amphipathic or amphoteric polyene macrolide molecule with broad spectrum of activity.

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Gold Standard Treatment

It is the gold standard treatment for cryptococcal meningitis in combination with 5-flucytosine.

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Lindane contraindications

Not for use in premature infants; risk of seizures.

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Retinoid action

Abnormal follicle issues corrected by Vitamin A analogs.

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Retinoids MOA

Targets RARs altering cell differentiation and growth.

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Lindane boxed warning

Mandatory patient education with each prescription.

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Malathion use

Treats head lice in kids over 6 years old.

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Topical Treatment Absorption

Absorption varies depending on the application site.

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Topical Treatment Efficacy

Starts strong, then weakens; effectiveness decreases over time.

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Acitretin Use

Used for skin problems from psoriasis. Treatment benefit seen after multiple weeks.

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Acitretin Pregnancy Warning

Avoid pregnancy for 3 years after treatment to prevent fetal harm.

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Calcipotriene Use

A topical vitamin D analogue to treat psoriasis.

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Calcipotriene MOA

Works through vitamin D receptors in the skin.

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Systemic Treatment Use

Use if topical treatments don't work or extensive cutaneous involvement

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Antifungal Agents Use

Can be used for bacterial coverage.

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Study Notes

  • Study notes generated from the provided text:

Infectious Drugs

Tetracyclines (Bacteriostatic Protein Synthesis Inhibitors)

  • Derivatives of a basic 4-ring structure.
  • Common medications end with "-cycline".
  • Effective against Demeclocycline, tetracycline, minocycline, and doxycycline.
  • Inhibits bacterial protein synthesis by binding to the 30S bacterial ribosome subunit.
  • Prevents aminoacyl tRNA from binding to the mRNA-ribosome complex.
  • Broad spectrum bacteriostatic and generally 2nd line drugs of choice.
  • More active against gram (+) than (-) bacteria.
  • Useful against MSSA and MRSA.
  • Useful for treating atypical community-acquired pneumonia.
  • Useful for malaria prophylaxis.
  • Useful against Bacillus anthracis.
  • An alternative for syphilis (Treponema pallidum).
  • Minocycline is effective against acne and has fewer GI side effects.
  • Tigecycline is effective against Enterobacteriaceae, Acinetobacter, and B. fragilis, even some tetracycline-resistant bacteria.
  • Respiratory infections cause from pneumoniae, H. influenzae, mycoplasma, and chlamydophila pneumoniae.
  • Doxycycline can treat chlamydia and epididymitis.
  • Limited penetration into CSF, enhanced in inflammation.
  • Resistance mechanisms affect pharmacokinetics.
  • Doxycycline and minocycline have longer half-lives (~16-18 hours).
  • Contraindicated in pregnancy (Category D) because it can bind to fetal bone and teeth, leading to retardation of bone growth and tooth discoloration.
  • Avoided in children < 8 years old.
  • Causes Photosensitivity and use sunscreen.
  • Monitor renal & hepatic function.
  • Chelate formation with calcium, antacids, and minerals will decrease in absorption.
  • Bacteriostatic effects may reduce the activity of PCNs.
  • Decreases effectiveness in COCs.
  • Potentiates warfarin (impairs Vit K-producing gut flora).

Sulfonamides (DNA Disruptors)

  • Derivatives of para-minobenzenesulfonamide and derivatives of para-aminobenzoic acid (PABA).
  • Sulfur must attach directly to the benzene ring.
  • Inhibits folic acid synthesis in susceptible bacteria and is bacteriostatic.
  • Highly protein-bound (albumin).
  • Common medications include "sulfas" or Trimethoprim-Sulfamethoxazole (Bactrim).
  • Competitively inhibits dihydropteroate synthase, blocking folic acid synthesis.
  • Active against some gram +/- bacteria and parasites.
  • Effective against Haemophilus ducreyi, Nocardia, Klebsiella.
  • Many strains of E.coli are resistant.
  • Metabolized in the liver and absorbed in small intestine.
  • Used for UTI, Nocardiosis, and Toxoplasmosis.
  • Rapid GI absorption (70%-100% of PO dose).
  • Found in urine within 30 mins.
  • Peak levels in 2-6 hours.
  • Avoided in pregnancy because of disruption in folic acid synthesis (neural tube defects).
  • Interacts with anticoagulants, sulfonylurea hypoglycemic agents, and hydantoin anticonvulsants.
  • Primarily causes derm hypersensitivity reactions.
  • Common side effects include; rash, fever, GI symptoms.
  • Uncommon side effects include crystalluria - encourage 1200ml urine output daily to prevent, drink lots of water.
  • Black Box warning for Severe side effects; Stevens Johnson syndrome, Vasculitis, and Hemolytic anemia (G6PD deficiency)
  • The patient should encourage water intake.
  • Bactrim, Trimethoprim (TMP) synergizes with sulfonamides by inhibiting bacterial dihydrofolate reductase (DHFR), blocking sequential steps in tetrahydrofolic acid synthesis.
  • Can be both Bacteriostatic and/or bactericidal

Beta-Lactam Antibiotics (Cell Membrane Inhibitors)

  • Common medications include PCN, cephalosporins, carbapenems, and monobactams which share a common structure (ß-lactam ring).
  • Broad spectrum (gram +/-), potent antibacterial killing.
  • Natural PCNs are active against aerobic, gram (+) organisms.
  • Considerations for PCNs: allergy testing
  • Wide distribution in the body, high concentrations in tissues and fluids.
  • Rapid renal elimination, short half-lives.
  • Resistance mechanisms affect pharmacokinetics.
  • Uses: Prophylaxis, Spleen patients and rheumatic fever
  • Adverse effects; Post treatment completion symptoms can persist 1-2 weeks.
  • Cross-hypersensitivity with cephalosporins observed.
  • PCN G injection, monitor for 15 minutes for reaction.
  • Toxic effects include bone marrow depression, granulocytopenia, and hepatitis.

Fluoroquinolones

  • Common medications end with "-floxacin".
  • Active against Pseudomonas.
  • Atypicals, Beta lactamase, DRSP, MRSA, +/- Pseudomonas, and +/- Anaerobes.
  • Target bacterial DNA gyrase and topoisomerase IV, inhibits bacterial growth.

Nucleoside Analogues (Anti Herpes/Antiviral Agents)

  • Common meds: acyclovir (zovirax), valacyclovir (valtrex), famciclovir (famvir), penciclovir, ganciclovir & valganciclovir
  • MOA: inhibit viral DNA synthesis & replication; must block entry into cells or be active inside hot cells to be effective
  • Used/Duration: Lifetime - prophylactic use -may be considered
  • HSV (initial outbreak & suppression therapy)
  • Herpes zoster (shingles),Varicella (chickenpox),Bell's palsy, Active against CMV & all herpes virus (used for CMV retinitis)
  • Safe during pregnancy (acyclovir, valacyclovir, & famciclovir)
  • Acyclovir - excreted in breastmilk; safest choice for children
  • Acyclovir/Valacyclovir: N/V/D, HA, neurotoxicity & nephrotoxicity (rare)
  • Valacyclovir: risk of thrombocytopenic purpura & hemolytic uremic syndrome in immunocompromised patients
  • Chronic acyclovir suppression has been safely used for up to 10 years.
  • A nucleotide analog, acts by inhibiting RNA-dependent RNA polymerase (RdRp)
  • Decreased glomerular filtration rate, hemoglobin and lymphocyte count, respiratory failure, pyrexia, hyperglycemia, and increased glucose is seen
  • Used for global pandemics: EBOLA, MERS, SARS, & COVID

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