Anti-infective drugs 1

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Neda317
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236489
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Anti-infective drugs 1
Updated:
2013-09-23 13:33:53
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Pharm
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antifungal
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  1. name Antifungal
    • A. Polyene Antifungal
    • B. Azole Antifungals
  2. types of Polyene Antifungal
    • 1. Amphotericin B
    • 2. Nystatin
  3. Amphotericin B
    indication
    • IV for serious and life threatening infections
    • Aspergillus, Candida, Cryptococcus, Histoplasma
  4. Amphotericin B
    MOA
    Bindsto ergosterol
  5. Amphotericin B
    Side effects:
    Dose dependant and Infusion dependant
    • Dose dependant
    • Nephrotoxic
    • Hypokalemia
    • Normochromic normocytic anemia
    • Infusion dependant
    • Flu-like symptoms
    • Premedicate patients with antipyretic, antihistaminic and antiemetic agents
  6. Amphotericin B
    Distribution:
    • Low penetration into CSF
    • No BBB crossing  (Given intrathecally)
  7. Amphotericin B
    Drug Interactions:
    • synergistic with fluocytosine
    • Rx of resistant Cryptococcus and candidiasis
    • Resistance: Decreased ergosterol levels
  8. Nystatin
    indication
    • Used topically for Rx of candidiasis
    • too toxic for systemic use
  9. B. Azole Antifungals
    RX?
    • Ketoconazole - Fluconazole - Itraconazole
    • Clotrimazole - Miconazole
  10. B. Azole Antifungals
    MOA
    • Block synthesis of ergosterol by inhibiting
    • 14 alpha demethylase in the fungal P450 complex
  11. B. Azole Antifungals
    resistance
    Decrease intracellular levels of drugs
  12. B. Azole Antifungals
    indications
    • Given PO
    • Candidiasis and coccidiomycosis
    • Paracoccidiomycosis
    • Blastomycosis and Histoplasmosis
  13. Clotrimazole and Miconazole how it's given and what for?
    • topically
    • Rx of candida and dermatophytic infections
  14. B. Azole Antifungals
    side effects
    • Ketoconazole: Gynecomastia and decrease libido
    • Menstrual irregularities
  15. B. Azole Antifungals
    kinetics
    • Fluconazole penetrates CSF
    • Itraconazole: No CSF
    • Absorption increased by food
    • Fluconazole & Itraconazole are available IV
  16. Antifungal with limited indications
    • 1. Griseofulvin
    • 2. Terbinafine
    • 3. Flucytosine
  17. Griseofulvin
    Rx of?
    tinea cruris (Jock itch)
  18. Griseofulvin
    MOA
    Disruption of mitotic spindle by interfering with microtubules
  19. Griseofulvin
    side effect
    and contraindication
    • Increase effects of alcohol
    • Contraindicated in intermittent porphyria
  20. Terbinafine
    MOA
    inhibits squalene epoxidase
  21. Terbinafine
    Rx of?
    Rx of onychomycosis (nail fungal infection)
  22. Terbinafine
    side effect
    Elevated liver function tests
  23. Flucytosine
    MOA
    5 FC -fungal cytosine deaminase-> 5 FU --> 5-Fluorodeoxyuridine MP --> inhibits thymidylate synthetase --> dec, thymine
  24. Flucytosine
    in severe cases used with?
    amphotericin B
  25. Flucytosine
    side effect
    • Decrease bone marrow
    • Leukopenia, thrombocytopenia
    • GI: severe enterocolitis, hepatitis
  26. SideEffects of Amphotericin B
    Nephrotoxicity
  27. Antiviral Drugs
    MOA
    • 1. Inhibition of viral penetration and uncoating
    • 2. Inhibition of Viral DNA Polymerase
    • 3. Inhibition of Viral DNA & RNA Polymerase
    • 4. Inhibition of viral RNA polymerase
    • 5. Inhibition of Viral Reverse Transcriptase
    • 6. Inhibition of Viral Aspartate Protease
    • 7. Inhibition of viral neuraminidase
  28. Rx for Inhibition of viral penetration and uncoating
    Amantadine, Rimantadine
  29. Rx for Inhibition of Viral DNA Polymerase
    Acyclovir, Gancyclovir, Famcyclovir, Valacyclovir
  30. Rx for Inhibition of Viral DNA & RNA Polymerase
    Foscarnet
  31. Rx for Inhibition of viral RNA polymerase
    Ribavirin
  32. Rx for Inhibition of Viral Reverse Transcriptase
    • Zidovudine, didanosine, zalcitabine
    • stavudine, lamivudine, nevirapine
  33. Rx for Inhibition of Viral Aspartate Protease
    • indinavir, ritonavir, saquinavir
    • nelfinavir
  34. Rx for Inhibition of viral neuraminidase
    Zanamivir, oseltamivir
  35. Clinical Antiviral Drugs
    • 1. Amantadine
    • 2. Ribavirin
    • 3. Acyclovir
    • 4. Famciclovir & Valacyclovir
    • 5. Ganciclovir
    • 6. Foscarnet
    • 7. Zanamivir and Oseltamivir
  36. Amantadine
    MOA
    MOA: Interfere with the attachement, penetration and uncoating of the viral particle
  37. Amantadine
    indications
    • Influenza A
    • Parkinson's disease
  38. Amantadine
    side effect
    • Livedo reticularis
    • Anticholinergic effects
  39. Ribavirin
    MOA
    • MOA: inhibits viral RNA polymerase
    • inhibits end capping of viral mRNA
  40. Ribavirin
    indication
    Indication: RSV
  41. Ribavirin
    side effect
    Teratogenic
  42. Acyclovir
    MOA
    MOA: inhibits viral DNA polymerase
  43. Acyclovir
    Resistance
    Resistance: Decrease activity to viral thymidilate kinase
  44. Acyclovir
    indications
    • Herpes simplex
    • Varicella zoster (Shingles)
    • Not effective in CMV infections
  45. Acyclovir
    side effect
    • Nephropathy (IV only)
    • Neurotoxicity and Crystalluria
  46. Famciclovir & Valacyclovir
    • Newly FDA approved for Herpes simplex
    • Similar to Acyclovir
  47. Ganciclovir
    Rx of
    CMV
  48. Ganciclovir
    MOA
    • MOA: similar to Acyclovir
    • Viral thymidylate kinase in Herpes
    • Phosphotransferase in CMV
  49. Ganciclovir
    side effect
    • Side effects: Leukopenia, thrombocytopenia
    • Seizure in overdose
    • Crystalluria
  50. Foscarnet
    MOA
    Inhibits DNA polymerase
  51. Foscarnet
    indications
    • As Ganciclovir
    • Rx of CMV retinitis in AIDS patients
    • Not retinal detachment
  52. Foscarnet
    side effect
    Nephrotoxicity
  53. Foscarnet
    Drug interactions
    IV pentamidine + Foscarnet --> severe hypocalcemia
  54. Zanamivir and Oseltamivir
    MOA
    Inhibits neuraminidases of influenza A & B
  55. Zanamivir and Oseltamivir
    indication
    Prophylaxis to Reduce flu symptoms
  56. Zanamivir and Oseltamivir
    side effect
    • InhaledZanamivir cause throat irritation
    • Nausea & Vomiting
  57. Drugs used for Rx of AIDS
    4 Classes of drugs
    • 1. Nucleosides Reverse Transcriptase Inhibitors
    • 2. NonNucleoside Reverse Transcriptase Inhibitors
    • 3. Protease Inhibitors
    • 4. Fusion Inhibitors
  58. Acquired Immune Deficiency Syndrome (AIDS)
    what cells?
    CD4 cells
  59. AIDS
    When you start therapy?
    • 1. CD4 < 500 normal 600-1200
    • 2. Viral load (PCR) > 10,000-20,000 normal <400
  60. AIDS
    What's recommended?
    • 2+1
    • Any 2 Nucleosides inhibitors (AZT, DDI, 3TC,D4T) + 1 Protease inhibitor (indinavir, Ritonavir)
  61. aids
    When you start prophylaxis?
    • CD4 > 500 --> No prophylaxis
    • Except PPD +ve with any CD4
    • 1. if CD4 < 200
    • 2. If CD4 < 100
    • 3. If CD4 < 75
    • 4. If CD4 < 50
  62. 1. if CD4 < 200
    • a. Pneumocystis carinii pneumonia (PCP) propylaxis
    • b. Pneumococcal vaccine
  63. 2. If CD4 < 100
    • Toxoplasmosis Prophylaxis
    • Trimethoprim/Sulpha
  64. 3. If CD4 < 75
    • Mycobacterium Avium Complex (MAC) prophylaxis
    • Azithromycin
    • Clarithromycin
  65. 4. If CD4 < 50
    • Cytomegalovirus Prophylaxis
    • Ganciclovir
  66. HIV Transmission
    • Needle stick: 1:300
    • Anal receptive: 1:50-100
    • Vaginal: M to F: 1:1000, F to M: 1:2000-3000
    • Pregnant mom to baby: 25%
    • Pregnant taking AZT: 8%
  67. Clinical Cases of HIV
    • 1. Stuck with a needle of HIV+ve patient?
    • 2. Patient had sex one time with an HIV+ve?
    • 3. 27y/old female  CD4 >500 and PCR <400
    • 4. 27 y/old female pregnant CD4 >500 and PCR <200
    • 5. 27 y/old female pregnant CD4 1 and PCR 700,000
  68. 1. Stuck with a needle of HIV+ve patient?
    best recommended
    2 + 1 for 4 weeks
  69. 2. Patient had sex one time with an HIV+ve?
    best recommended
    2 + 1 for 4 weeks
  70. best recommended
    3. 27y/old female  CD4 >500 and PCR <400
    Nothing
  71. best recommended
    4. 27 y/old female pregnant CD4 >500 and PCR <200
    • AZT to prevent transmission
    • reduce risk from mom to baby:  25% to 8%
  72. best recommended
    5. 27 y/old female pregnant CD4 1 and PCR 700,000
    • 2+1
    • PCP - MAC - CMV prophylaxis

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