Pharmacology Quiz on Antibiotics and Antiparasitics
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Questions and Answers

Which drug is primarily used for the treatment of lymphatic filariasis?

  • Ivermectin
  • Pyrimethamine
  • Clindamycin
  • Diethylcarbamazine (DEC) (correct)

    • What is the mechanism by which opiates reduce pain perception?

  • Inhibit adenylyl cyclase leading to increased cAMP
  • Activate torpid receptors to increase neuronal excitability
  • Enhance presynaptic calcium influx
  • Increase potassium efflux and reduce neurotransmitter release (correct)

    • Which drug primarily treats tapeworm infections by damaging the tapeworm's outer membrane?

  • Albendazole
  • Dexamethasone
  • Niclosamide
  • Praziquantel (correct)

    • What is a significant possible side effect of high-dose or prolonged use of gentamicin?

    <p>Nephrotoxicity</p> Signup and view all the answers

    Which pharmacokinetic characteristic is true regarding metronidazole?

    <p>Widely distributed, including the cerebrospinal fluid</p> Signup and view all the answers

    Which combination is recommended for the treatment of gonorrhea?

    <p>Procaine Penicillin G with Probenecid</p> Signup and view all the answers

    Which side effect is particularly associated with high doses of nafcillin therapy?

    <p>Neutropenia</p> Signup and view all the answers

    What is the mechanism of action for cephalosporins?

    <p>Inhibit bacterial cell wall synthesis</p> Signup and view all the answers

    In which case is amoxicillin used prophylactically?

    <p>In patients at high risk for bacterial endocarditis</p> Signup and view all the answers

    Which cephalosporin generation is primarily effective against MRSA?

    <p>None of the above</p> Signup and view all the answers

    What is a serious skin condition associated with penicillin use?

    <p>Steven Johnson syndrome</p> Signup and view all the answers

    Which 1st generation cephalosporin is administered parenterally?

    <p>Cefazolin</p> Signup and view all the answers

    What is the primary indication for the use of doxycycline?

    <p>Management of mycoplasma pneumonia</p> Signup and view all the answers

    Which cephalosporin is specifically recognized as the drug of choice for Neisseria gonorrhoeae?

    <p>Ceftriaxone</p> Signup and view all the answers

    Which generation of fluoroquinolones demonstrates enhanced activity against anaerobes?

    <p>4th generation</p> Signup and view all the answers

    What is a common side effect associated with the use of tetracyclines?

    <p>Teeth discoloration</p> Signup and view all the answers

    Which antibiotic is known to have a significant risk of causing a seizure at high levels?

    <p>Imipenem</p> Signup and view all the answers

    What is the primary mechanism of action of monobactams like aztreonam?

    <p>Disruption of cell wall synthesis</p> Signup and view all the answers

    Which of the following drugs is resistant to beta-lactamases produced by gram-negative rods?

    <p>Aztreonam</p> Signup and view all the answers

    What is a notable feature of cefepime compared to first generation cephalosporins?

    <p>Resistance to beta-lactamases</p> Signup and view all the answers

    Which fluoroquinolone is commonly used to treat urinary tract infections?

    <p>Nalidixic acid</p> Signup and view all the answers

    What is a major side effect of rifampin that requires monitoring during treatment?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which of the following is used as a first-line treatment for drug-resistant Plasmodium falciparum malaria?

    <p>Artemisinin-based combination therapies (ACTs)</p> Signup and view all the answers

    What side effect is most commonly associated with ethambutol?

    <p>Optic neuritis</p> Signup and view all the answers

    Which drug is specifically indicated for multi-drug resistant tuberculosis (MDR-TB)?

    <p>Capreomycin</p> Signup and view all the answers

    Which of the following best describes the use of oseltamivir?

    <p>Neuraminidase inhibitor for influenza treatment</p> Signup and view all the answers

    What is a possible side effect of pyrazinamide that healthcare providers should monitor for?

    <p>Gout attacks</p> Signup and view all the answers

    Which medication is commonly associated with ototoxicity as a side effect?

    <p>Streptomycin</p> Signup and view all the answers

    What kind of drug is tenofovir, and what is its primary use?

    <p>NRTI for Hepatitis B</p> Signup and view all the answers

    What is the mechanism by which maraviroc functions in HIV treatment?

    <p>Entry inhibitor</p> Signup and view all the answers

    Which of these is a common side effect of aminoglycosides?

    <p>Ototoxicity</p> Signup and view all the answers

    Which fluoroquinolone is specifically indicated for the prophylaxis and treatment of anthrax?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What is the main mechanism of action of sulphonamides, such as Trimethoprim-Sulfamethoxazole?

    <p>Competing for the dihydropteroate synthetase</p> Signup and view all the answers

    Which fluoroquinolone is NOT recommended for community-acquired pneumonia due to poor coverage for Pseudomonas aeruginosa?

    <p>Moxifloxacin</p> Signup and view all the answers

    What side effect is most commonly associated with sulphonamides?

    <p>Fever and skin rashes</p> Signup and view all the answers

    In combination therapy for active tuberculosis, which side effect is most directly associated with the use of Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which antifungal agent is primarily used for the treatment of severe systemic fungal infections such as Mucormycosis?

    <p>Amphotericin B</p> Signup and view all the answers

    Which class of antifungal agents works by inhibiting 14α-demethylase?

    <p>Azoles</p> Signup and view all the answers

    What serious condition has been occasionally associated with the use of fluoroquinolones?

    <p>Aortic dissection or rupture</p> Signup and view all the answers

    Which combination of medications is typically used to treat acute toxoplasmosis?

    <p>Sulfadiazine and pyrimethamine</p> Signup and view all the answers

    What is the main use of silver sulfadiazine?

    <p>Burn wound infection prevention</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Penicillins

    • Treatment of Gonorrhea: Previously treated with procaine penicillin G and probenecid, but now primarily uses 3rd-generation cephalosporin ceftriaxone due to resistance.
    • Treatment of Syphilis (Treponema pallidum): Benzathine penicillin G (3-week treatment, single injection).
    • Treatment of Meningitis: Penicillin G (benzylpenicillin).
    • Side Effects:
      • Allergic reactions: Rash, angioedema, anaphylaxis. Severe blistering and peeling skin (Stevens-Johnson syndrome/toxic epidermal necrolysis) is a significant concern.
      • Gastrointestinal: Diarrhea, pseudomembranous colitis (Clostridioides difficile infection) especially with ampicillin use.
      • Renal: Acute interstitial nephritis, particularly with methicillin.
      • Neurological: Seizures (intrathecal injection).
      • Hematologic: Reduced coagulation (high doses of piperacillin, nafcillin, penicillin G); neutropenia (with nafcillin), prolonged use.
    • Prophylaxis for Surgery and Dental Procedures:
      • Dental: Amoxicillin for high-risk bacterial endocarditis cases.
      • Surgical: Ampicillin-sulbactam (Unasyn), cefazolin (a 1st-generation cephalosporin) are used.

    Cephalosporins

    • Mechanism of Action: Binds to penicillin-binding proteins (PBPs), inhibiting bacterial cell wall synthesis. Less susceptible to penicillinases than penicillins.
    • Classes and Uses:
      • 1st generation: Cefazolin (parenteral), cephalexin (oral). Active against gram-positive cocci (staphylococci, streptococci). Limited activity against gram-negative organisms, enterococci, MRSA, and most gram-negative rods. Used for cellulitis and surgical prophylaxis.
      • 2nd generation: Cefaclor, cefuroxime, cefprozil. Less gram-positive activity but more gram-negative coverage, varying activity against different organisms. Used for infections involving anaerobic Bacteroides fragilis (cefotaxime, cefoxitin), and sinus, ear, and respiratory infections with H. influenzae or Moraxella catarrhalis (cefuroxime, cefaclor).
      • 3rd generation: Ceftazidime, cefotaxime; increased gram-negative activity, good blood-brain barrier penetration. Active against many gram-negative organisms including penicillin-resistant pneumococci, Pseudomonas, and other beta-lactamase-producing bacteria. Ceficprone is used for oral treatment of Gonorrhea (alternative to ceftriaxone)
      • 4th generation: Cefepime, ceftaroline. Combines gram-positive activity of 1st-generation cephalosporins with gram-negative activity of 3rd-generation ones. Resistant to beta-lactamases produced by many gram-negatives (including Enterobacter, Klebsiella, Pseudomonas, Serratia). Ceftaroline has notable activity against MRSA.
    • Side Effects:
      • Allergies (skin rashes to anaphylaxis); less frequent than with penicillin. Partial cross-reactivity exists between penicillins and cephalosporins—avoidance of cross-allergenic reaction should be applied.
      • Injections: pain at injection site, phlebitis (IV).
      • Combinations: Increased nephrotoxicity with aminoglycosides. Methylthiotetrazole-containing drugs (some cephalosporins) may cause hypoprothrombinemia and disulfiram-like reaction to ethanol.

    Monobactams and Carbapenems

    • Monobactams (Aztreonam):
      • Mechanism: Inhibits bacterial cell wall synthesis.
      • Uses: Gram-negative infections, synergistic with aminoglycosides.
      • Side Effects: Nausea, vomiting, diarrhea, vertigo, and rarely hepatotoxicity. No cross-reaction with penicillin.
    • Carbapenems:
      • Mechanism: Inhibits cell wall synthesis.
      • Uses: Broad-spectrum activity against gram-positive and gram-negative bacteria, anaerobes, and Pseudomonas aeruginosa. Ertapenem has limited Pseudomonas coverage.
      • Side Effects: Nausea, vomiting, diarrhea, eosinophilia/neutropenia, seizures with high doses of imipenem, rare cross-reactions with penicillin. Combinations with beta-lactamase inhibitors (e.g., imipenem-cilastatin) provide enhanced coverage, and are used in the treatment of complicated Utis, hospital-acquired pneumonia and ventilator-acquired pneumonia.

    Tetracyclines

    • Uses: Mycoplasma pneumonia (adults), chlamydia, rickettsial infections, vibrios, some spirochetes. Alternative in treatment of pneumonia.
    • Doxycycline: Lyme disease (early and disseminated), malaria, amebiasis.
    • Tetracycline: Helicobacter pylori, meningococcal carrier state.
    • Tigecycline: Complicated skin and soft tissue infections, intra-abdominal infections, community-acquired pneumonia.
    • Side Effects:
      • General: Gastric irritation, esophagitis, tooth discoloration and hypoplasia, growth stunting, hepatotoxicity, photosensitivity, benign intracranial hypertension (pseudotumor cerebri). Contraindicated in pregnancy and children < 8 years.
      • Tigecycline specific: Nausea, vomiting, acute pancreatitis, liver/kidney dysfunction, photosensitivity, pseudotumor cerebri, permanent teeth discoloration. Decreases warfarin clearance.

    Fluoroquinolones

    • Mechanism of Action: Inhibits bacterial DNA gyrase and topoisomerase IV, interfering with DNA replication and transcription.
    • Uses:
      • GI and GU: Gram-negative infections (e.g., gonorrhea, E. coli, Klebsiella, Pseudomonas). Traveler's diarrhea, typhoid fever, anthrax, and pseudomonas.
      • Respiratory: Community-acquired pneumonia (CAP), including atypical pathogens (chlamydiae, mycoplasma, legionella).
      • Skin/skin structure: Infections including MRSA and Enterococcus using Delafloxacin.
      • Other: Meningococcal carrier state, TB treatment and neutropenic patients prophylaxis.
    • Side Effects:
      • Common: Nausea, vomiting, diarrhea.
      • Serious: Tendinitis, tendon rupture, cartilage damage and arthropathy in children and young patients. Avoid in pregnancy and those < 18.
      • Other: Skin rashes, headache, dizziness, insomnia, liver problems, photosensitivity, neurotoxicity, opportunistic infections (Candida). QTc prolongation possible.
    • Important Considerations: Often combined with other agents for staphylococcal infections. Avoid in enterococcal infections. Gatifloxacin is available as an ophthalmic solution.

    Sulfonamides

    • Mechanism: Antimetabolites inhibiting folic acid synthesis.
    • Uses:
      • Pneumocystis pneumonia: Trimethoprim-sulfamethoxazole (TMP-SMZ) is the drug of choice.
      • Skin infections: TMP-SMZ, skin and skin structure infections - cellulitis and abscesses.
      • Other infections: Sinusitis, ear and respiratory infections (H. influenzae/M. catarrhalis), nocardiosis, toxoplasmosis, backup for cholera, typhoid, shigellosis, MRSA, Listeria. Sulfasalazine is used for inflammatory bowel disease, Sodium sulfacetamide for bacterial conjunctivitis, silver sulfadiazine for burn wound prophylaxis.
    • Side Effects:
      • Common: Fever, rashes, photosensitivity, nausea, vomiting, diarrhea.
      • Serious: Stevens-Johnson syndrome, crystalluria, hemolytic/aplastic anemia, granulocytopenia, thrombocytopenia, leukemoid reactions. Hemolytic reactions are possible in G6PD deficiencies.

    Antifungals

    • Polyenes (Amphotericin B, Nystatin): Binds to ergosterol, creating pores in fungal membranes.
    • Antimetabolites (Flucytosine): Converted to 5-fluorouracil to inhibit nucleic acid synthesis.
    • Azoles (Fluconazole, Itraconazole, Voriconazole, Posaconazole): Inhibit ergosterol synthesis.
    • Echinocandins: Inhibit β-(1,3)-glucan synthase, impeding cell wall production..
    • Allylamines (Terbinafine): Inhibit squalene epoxidase, blocking ergosterol synthesis.
    • Other: Griseofulvin, Ciclopirox, Tolnaftate – different mechanisms and targets. Specific indications for each.

    Anti-TB Drugs

    • First-line Drugs: Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), and Ethambutol (EMB).
    • Mechanism of action: Varies but generally disrupting TB bacteria growth.
    • Uses and Side Effects:
      • INH: active and latent TB; hepatotoxicity, peripheral neuropathy, CNS effects, lupus syndrome.
      • RIF: active TB, latent TB (INH-resistant cases); hepatotoxicity, orange discoloration, GI upset, flu-like symptoms, drug-interactions.
      • PZA: active TB initial therapy; hepatotoxicity, hyperuricemia, arthralgia, GI upset.
      • EMB: active TB combination therapy; optic neuritis, hyperuricemia, peripheral neuropathy.
    • Second-line Drugs: Streptomycin, Ethionamide, Capreomycin; used when first-line drugs are ineffective or not tolerated due to drug resistance or intolerance.

    Antimalarials

    • Treatment: Chloroquine, artemisinin-based combination therapies (ACTs), quinine, mefloquine. Specific agents are indicated for particular cases and areas (Chloroquine, mefloquine, or Doxycycline are more appropriate for prevention)
    • Prevention: Chloroquine, mefloquine, atovaquone-proguanil, and doxycycline.

    Antivirals

    • Hepatitis B: Nucleoside reverse transcriptase inhibitors (NRTIs) (tenofovir, entecavir, lamivudine).
    • Influenza: Neuraminidase inhibitors (oseltamivir, zanamivir, baloxavir marboxil); and Amantadine and Rimantadine (less-commonly used).
    • HIV: NRTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors, entry inhibitors.

    Aminoglycosides

    • Side effects: Ototoxicity and nephrotoxicity (kidney damage). Gentamicin, tobramycin, and amikacin are most commonly associated with nephrotoxicity.

    Antiprotozoals

    • Metronidazole (pharmacokinetics): Well-absorbed, metabolized in the liver, excreted in urine.
    • Filariasis: Diethylcarbamazine (DEC), ivermectin, and albendazole.
    • Toxoplasmosis: Pyrimethamine (with sulfadiazine), clindamycin, spiramycin, or atovaquone.
    • Tapeworm infections: Praziquantel, niclosamide, and albendazole.

    Opiates

    • Mechanism of Action: Bind opioid receptors in the CNS, mimicking endogenous peptides. Inhibit adenylyl cyclase, increase postsynaptic potassium efflux, and reduce presynaptic calcium influx.
    • Uses: Analgesia, cough suppression, diarrhea treatment, acute pulmonary edema, anesthesia adjuncts
    • Specific Drugs: Morphine, codeine.

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    Test your knowledge on pharmacology with this quiz focused on antibiotics and antiparasitic drugs. Explore drug mechanisms, side effects, and recommended treatments in various infections, including lymphatic filariasis, tapeworms, and gonorrhea. This quiz is perfect for students and professionals in the medical field.

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