GI_Final_Drugs&Bugs_westernu

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gmwestern13
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72475
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GI_Final_Drugs&Bugs_westernu
Updated:
2011-03-13 18:21:55
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westernu GI pharm micro
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westernu GI final for sessions 5-10 of the drugs & bugs
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  1. For: enterobacteriaceae, salmonella, shigella, norovirus, rotavirus & HAV, HBV, entamoeba histolytica, giardia
    see related sessions
  2. For Yersinia enterocolitica describe:
    features
    transmission
    pathogenesis
    associated diseases
    • G-, pleomorphic rods
    • carried by pigs, cattle, rodents, etc
    • can grow at 4C, often contaminates milk (to culture might need "cold enrichment"
    • associated diseases:
    • acute enterocolitis
    • mesetneric lymphadenitis (can mimic appendicitis)
    • mucosal ulcerations
    • septicemia
    • transfusion septicemia
  3. For Campylobacter describe:
    features
    transmission
    pathogenesis
    associated diseases
    • Features:
    • G-, curved rod, motile ("darting"), very small
    • microaerophilic, slow grower (needs selective campy-BAP media)
    • Transmission: fecal-oral contaminant of food (esp poultry) & fluids (milk/water)
    • Pathogenesis:
    • infiltration of PMNs --> diarrhea, fever malaise
    • Dz:
    • C. jejuni = most common cause bacterial gastroenteritis in U.S. (C. coli for developing)
    • associated w/ Guillain-Barre (O:19 serotype of C. jejuni)
    • reactive arthritis
  4. For Clostridium perfringens describe:
    features
    transmission
    pathogenesis
    associated diseases
    • G+ rod, spore former
    • often ingest food containing toxin (type A)
    • enteric infections (and gas gangrene)
    • enteritis necroticans (type C)
  5. what species of Vibrio are known for their association with shellfish (oysters)?
    • V. parahemolytics, & V. vulnificus
    • explosive watery diarrhea
    • is invasive, but not severe illness like V. cholerae
  6. how does food poisoning occur? what's the onset? Name & describe the bacteria associated w/food poisoning.
    • Occurs via ingestion of pre-formed toxins
    • quick onset

    • S. aureus:
    • G+ cocci, cat +, coag+, mannitol fermenter, likes salt
    • contaminate meat/dairy
    • enterotoxins = Superantigens (T cell polyclonal activator based on binding to particular Vbeta families of T cell receptor)
    • heat stabile

    • Bacillus cereus:
    • G+ rod, spore former
    • emetic: heat stabile enterotoxin--fried rice
    • diarrheal: heat labile enterotoxin meat/veggies

    • Clostidium perfringens:
    • meat/poultry; Sxs 8-16hrs post ingest (longer than B cereus or S. aureus)

    • Clostridium botulinum:
    • G+ rod, spore former, anaerobic
    • AB toxin: B-binds motor neurons, A prevents release of aCh = flaccid paralysis
    • droopy eyelids, blurred vision, difficulty swallowing, slurred speech, arm/leg weakness
  7. describe features of Primary Bacterial Peritonitis
    • often due to enteric Gram-bacteria (E. coli in ~50% of the cases and Klebsiella – 10%), Streptococcus pneumonia and Group A streps (~15-20% of cases)., or anaerobic/microaerophilic organisms (5%)
    • ascites
    • often associated with liver disease (due to alcoholism, chronic hepatitis, liver cancer, or lupus).
    • Complement proteins are lower in ascites and the neutrophils do not work well (even though they are present in the ascites)
    • if >250-300 PMNs/ml of ascites = PBP
    • fever almost always present
  8. describe 2ndary peritonitis
    • peritonitis secondary to intra-abdominal disease (trauma, appendicitis, etc)
    • polymicrobic – anaerobes (Bacterioides fragilis) and aerobes (E. coli, Proteus, Klebsiella, various streptococci)
    • -sepsis and endotoxin-mediated pathology
  9. describe tertiary peritonitis
    • pt w/peritoneal dialysis (continuous ambulatory peritoneal dialysis, CAPD)
    • fever, leukocytosis, bacteria or fungi from the effluent fluid monomicrobial, often due to skin microbes (Staphylococcus, Pseudomonas, Candida, etc)
  10. what is most comon cause of intra-abd abscesses? describe the types.
    • mostly due to unTx peritonitis; associated w/ appendicitis & abd surgery
    • intraperitoneal (most common):
    • due to microbe AND host response
    • plymicrobial
    • mostly Bacteroides fragilis (anaerobe) & other enteric flora
    • visceral:
    • poly microbial (often liver)
    • enteric G-, fungi (cancer chemoTx)
    • splee abscesses--often from Streps, then S. aureus after bacterial endocarditis
    • perinephric/renal abscesses: following UTI; Ecoli, Proteus, Klebsiella
  11. describe features of the Enterovirus, Picornaviridae.
    • +ssRNA, naked icosahedral
    • includes:
    • Poliovirus:
    • infect GI, spread to lymph, then blood, then CNS
    • Enterovirus:
    • non-specific febrile illness, assoc w/aseptic meningitis
    • also, pneumonia, hand-food, mouth (CoxsackieA16 & Entero71)
  12. describe features of HCV
    • Hepacivirus (Flaviviridae)
    • enveloped, +ssRNA
    • interrupts apoptotic signals = survival of infected cells -->persistent infection
    • usually becomes chronic --> cirrhosis & primary HCC
    • ELISA for anti-HCV abs; PCR for HCV RNA
  13. describe features of HDV
    • -ssRNA, circular
    • is 'defective' b/c needs co-infection w/HBV to use HBsAg
    • 40% will progress to fulminant hepatitis
  14. describe HEV features
    • Hepeviridae, +ssRNA virus
    • fatality rate is low ecept pregos
    • no vaccine
  15. name and describe the features of the dsDNA enveloped virus of the Herpesviridae family. describe it's pathogenesis.
    • Epstein-Barr Virus (EBV aka HHV-4)
    • linear genome that circulizes in host (replicate via rolling circle)
    • obtains envelope from nucleus (v.s. membrane)
    • latency is important
    • Patho:
    • mostly due to host immune response
    • replicates in Bcells & epithelial cells
    • stim B cell prolif & non-specific ab secretion (= heterophile ab's)
    • ---->IgM isotype may cross-react to sheep/beef RBCs, ampicillin (can cause rash)
    • infected B cells may progress to B cell llympoma (Burkitt's)
    • CD8+ T cells become activated
  16. what member of Herpesviridae causes heterophile (-) mono?
    CMV
  17. what motile protozoa causes dysentery w/o extra-intestinal infection?
    • Balantidium coli
    • relatively large, kidney-bean shaped nucleus
  18. describe features of Crptosporidium infection
    • C. hominis, non motile
    • prob for immunosuppressed
    • watery D
    • acid-fast stain to detect parasite
  19. what is Isospora belli? what does it cause? How is it identified?
    • = non-motile protozoan, opportunistic
    • self-limited D in immunocompetent
    • severe in immune-compromised
    • possible Hemorrhagic colitis in AIDS
    • Dx via oocysts in stool or UV autofluroescence is rapid & sensitive
  20. what is considered the "human" tapeworm?
    • Taenia saginata and T. solium:
    • humans are definitive host
    • cattle & pigs = intermediate
    • cattle & pigs ingest eggs from human stool, larva hatch & move to mm
    • humans eat undercooked meat --> worms mature & release eggs
    • infection often aSxic, but larvae can develop in mm, brain, eye causing life-threatening infections
  21. what is considered "fish tapeworm"?
    • Diphyllobothrium latum:
    • Humans get infected by eating raw/undercooked fish infected by the worm.
    • most aSx, heavyinfections can-->anemia b/c the worm absorbs vitamin B12
    • Fish from the Great Lakes, Pacific coast, and salmon (sashimi) have been linked to infection by this worm
  22. name & describe the "dog" tapeworm.
    • Echinoccoccus granulosus:
    • Humans can be intermediate host, where the larvae can developinto a hydatid cyst in various organs.
    • The normallife cycle is where dogs serve as the definitive host and sheep are theintermediate host.
    • The hydatid cyst can develop in a variety of organs, including the liver, CNS, lungs, etc
  23. what "fluke" is associated with veins near intestines or bladder?
    • Schistosoma:
    • adult female lives w/in groove in male
    • humans are definitive host
    • some eggs can get swept up blood to liver --> granuloma
  24. what adult "fluke" can be found in hepatic bile duct?
    • Fasciola hepatica:
    • eggs released in stool --> water --> snail --> 'water plant'
    • -->human ingests
    • serologic testing or operculated eggs in stool
    • Clonorchis sinensis "chinese liver fluke":
    • from eating undercooked fish
    • inflammatory rxn to eggs can cause granuloma
  25. what types of worms migrate b/w lungs & intestines? describe them.
    • Ascaris lumbricoides:
    • thick shell ingested, larvae burry through intestine
    • -->blood --> lungs -->burrow/cough -->swallowed
    • develop into adults
    • heavy infections can cause:
    • 2ndary bacterial infection in lungs
    • intestinal rupture (adults can be up to 1ft long)
    • Strongyloids stercoralis "threadworm":
    • penetrate skin --> lungs, swallow --> intestines
    • sometimes penetrate intestinal mucosa
    • --> hyperinfection (autoinfection) esp in corticosteroid users
    • -->-->pneumonia &/or diarrhea
    • Dx: ID rhabditiform larvae
    • Hookworms (N. americanus, A. duodenales):
    • like Stronglyloides
    • attach to intestine & take blood
    • A. duodenales more likely cause anemia
    • smooth cell, easy to view larvae
  26. For Ciprofloxacin describe:
    MOA
    Uses
    SE
    • MOA:
    • rapid concentration-dependent killing by inhibiting DNA gyrase of GNRs; potent post-antibiotic effect
    • Uses:
    • Infectious diarrhea (Salmonella, Shigella, Campylobacter, E. coli (NOT shiga-toxin strains), Cholera, Yersiniosis)
    • Intra-abd infections: (SBP prophylax, community-aquired complicated extra-biliary infections w/metronidazole; severe/complicated cholecystiti/cholangitis
    • **don't use Quinolones for E. coli unless hospital survey indicate >90% susceptibilty
    • SE:
    • pseudomemb. colitis
    • hypersensitivity
    • theophylline toxicity
    • HA, dizzy
    • achilles tendon rupture
  27. For Moxifloxacin describe:
    MOA
    Uses
    SE
    • MOA:
    • inhibit DNA gyrase of GNRs
    • uses:
    • mild-mod intra-abd extra-biliary infections
    • SE:
    • rare QT-prolongation
  28. For Ceftriaxone describe:
    MOA
    Uses
    SE
    • MOA:
    • 3rd gen ceph.
    • bind & inhibit penicillin-binding proteins to inhibit cell-wall syntehsis
    • -->bactericidal vs actively growing bacteria
    • Uses:
    • Diarreah: salmonella (typhoid), severe yersiniosis
    • Intra-abd (SBP, mild-mod community cholecystitis, mild-mod complicated intra-abd infection w/metronidazole)
    • SE:
    • Pseudomembranous colitis
    • hypersensitivity
    • biliary stasis (prolonged use)
    • bone marrow suppression (rare)
  29. For Azithromycin describe:
    MOA
    Uses
    SE
    • MOA:
    • bacteriostatic; reversibly bind 50S --> inhibit protein synthesis
    • does NOT get to brain/CSF
    • Uses:
    • Diarrhea (salmonella (typh), campylo, Ecoli (Not STtype), cholera)
    • SE:
    • none listed
  30. For Trimethoprim-sulfamethoxazole describe:
    MOA
    Uses
    SE
    • MOA:
    • Sequential blockage of enzymatic pathway for synthesis of THF
    • Uses:
    • infectious diarrhea (isosporiasis, severe yerinia, NOT for shigella b/c resistance)
    • intra-abd: SBP prophylaxis
    • SE:
    • rash
  31. For doxycycline describe:
    MOA
    Uses
    SE
    • MOA:
    • bind to 30S & prevent access of aminoacyl tRNA to acceptor site on mRNA-ribosome complex; bacteriostatic
    • Uses:
    • diarrhea of cholera
    • or yersinia (w/gentamicin)
    • SE:
    • photosensitivity
  32. For Metronidazole/tinidazole describe:
    MOA
    Uses
    SE
    • MOA:
    • accepts e-s to cause toxic free-radicals that damage anaerobic & microaerophilic DNA & biomolecules
    • [ ]'s well in tissues, esp. pus & liver abscesses
    • Uses:
    • diarrhea: (abx associated C. diff, trohpozoids, giardia)
    • intra-abd: (amebic liver abscess, community acquired complicated extra-biliar infections w/cef, or cipro;)
    • SE:
    • peripheral sensory neuropathy
    • disulfiram-like rxn
    • HA
    • metalic taste or nausea
  33. For Nitazoxanide describe:
    MOA
    Uses
    SE
    • MOA:
    • unk, maybe interfere w/PFOR enzyme-dependent e- transfer rxn
    • Use:
    • diarrhea: crypto, abx C. diff, giardia
    • SE:
    • none listed
  34. For Vancomycin describe:
    MOA
    Uses
    SE
    • MOA:
    • inhibit cell wall synthesis by high affinity binding to D-alanyl-D-alanine terminus of cell wall precursor unites
    • Uses: severe abx-associated C. diff
    • SE: o
  35. For Paromomycin describe:
    MOA
    Uses
    SE
    • MOA:
    • bind 30S robosomal unit
    • Use:
    • acts v.s. amebic cysts
    • giardia
  36. For Piperacillin-tazobactam describe:
    MOA
    Uses
    SE
    • MOA:
    • cidal vs actively growing; bind & inhibit penicillin-bindig proteins to inhibit cell wall synthesis
    • Uses:
    • comm-aquired intra-abd biliary AND extra-biliary infections w/ high risk or severity
    • healthcare-associated biliary infection of any severity
    • SE:
    • volume overload
    • impaired platelet aggrgtn
    • hypersensitivity
    • bone marrow suppression
    • pseudomembranous colitis
    • hepatitis (rare)
  37. For Cefoxitin describe:
    MOA
    Uses
    SE
    • MOA:
    • cidal vs active growing; bind & inhibit penicillin-binding proteins
    • Uses:
    • mild-mod comm-aquired intra-abd extra-biliary infections
    • SE:
    • hypersens
    • bmsuppression
    • pseudomembranous coloitis
  38. For Aztreonam describe:
    MOA
    Uses
    SE
    • MOA:
    • interacts w/pen-binding proteins & induces formation of long filamentous bacterial structures; resistant to many beta-lactamases; ONLY active vs G-'s
    • Uses:
    • 2ndary peritonitis (w/metronidazole & agent for G+cocci)
    • Pyogenic liver abscess ("")
    • Chelecystitis/cholangitis ("")
    • Pancreatic abscess ("")
    • SE:
    • hypersensitivity but little cross-rxn if beta-lactam allergic (except ceftazidime)
  39. For Carbapenems describe:
    MOA
    Uses
    SE
    • MOA:
    • bind pen-binding proteins
    • Uses:
    • mild-mod comm-acquired intra-abd infections (ertapenem)
    • high risk or severe (others)
    • SE:
    • hypersens (esp. crossrxn if beta-lactam allergic)
    • Sz's (imi>mero)
  40. For Lamivudine describe:
    MOA
    Uses
    SE
    • MOA:
    • nucleoside analog that may inhibit HBV dna polymerase
    • absorbed rapidly & highly available
    • Uses:
    • HBV infection
    • SE:
    • neutropenia
    • discontin. can cause reboud replication & exacerbation of hepatitis
    • HA, N
  41. For Tenofir describe:
    MOA
    Uses
    SE
    • MOA:
    • prodrug metabolized several times before active as a competitive inhibitor of viral reverse transcriptase but low affinity for human DNA polymerases
    • high fat meal increases bioavalability (only to 39%)
    • only need 1daily dose
    • Uses:
    • HBV
    • SE:
    • flatulence
    • discont. --> rebound replication & hepatitis exacerbation
  42. For Entecavir describe:
    MOA
    Uses
    SE
    • MOA:
    • guanosine analogue polymerase inhibitor of HBV dna polymerase
    • efficacy decreased by food
    • Uses:
    • HBV
    • SE:
  43. what medications are indicated in only for HBV infection?
  44. For Adefovir describe:
    MOA
    Uses
    SE
    • MOA:
    • metabolized to a competitive inhibitor of viral DNA polymerases & reverse transcriptases w/respect to deoxyadenosine
    • Uses:
    • HBV
  45. For Ribavirin describe:
    MOA
    Uses
    SE
    • MOA:
    • interferes w/synthesis of GTP, thus nucleic acids
    • carried in RBC's
    • Uses: HBV, HCV
    • SE:
    • hemolytic anemia
    • teratogenicity & fetal death
    • rash
    • cough
    • mild lymphopenia
  46. For Interferon alpha describe:
    MOA
    Uses
    SE
    • MOA:
    • activate JAK-STAT signal transductino pathway --> nuclear translocation of cellular protein complex that binds to genes containg IFN-specific element
    • -->inhibition of protein synthesis
    • increase activity of 2-5synthetase (used as marker for activity)
    • Uses: HBV, HCV
    • SE:
    • flu-like sx
    • fatigue, depression or severe mental illness
    • cytopenia
    • rashes
    • autoimmune thyroiditis
    • autoimmune hepatitis
  47. For Abendazole describe:
    MOA
    Uses
    SE
    • MOA:
    • inhibit microtubule polymerization by binding to beta-tubulin
    • variably absorbed; enhanced by fatty meals
    • Uses:
    • Nematodes:
    • ~Helminths
    • --ascariasis
    • --T. canis
    • --Tichuriasis
    • --Hookworms
    • --Enterobiasis
    • ~Trichinosis
    • Cestodes
    • ~echinococcosis
    • ~taenia solium
    • SE: mild GI
  48. For Mebendazole describe:
    MOA
    Uses
    SE
    • MOA:
    • inhibit microtubule polymerization by binding to beta-tubulin
    • bad bioavail & 95% protein bound
    • Uses:
    • Nematodes (ascar, trichur, hooks, enterobiasis, trichinosis)
    • SE: mild GI
  49. For Pyrantel pamoate describe:
    MOA
    Uses
    SE
    • MOA:
    • depolarizing neuromuscular blocking agent; opens nonselevtive cation channels & induces activatio of nivotinic aCh receptors causing spastic paralysis; also inhibits cholinesterases
    • poorly absorbed
    • Uses:
    • ascariasis, hookworms, enterobiasis
    • SE: mild GI
  50. For Ivermectin describe:
    MOA
    Uses
    SE
    • MOA:
    • binds blutamate-activated Cl- channels in nematode nn/mm
    • Uses:
    • strongyloidiasis
    • SE:
    • Mazzotti-like rxns
  51. For Praziquantel describe:
    MOA
    Uses
    SE
    • MOA:
    • lower [ ]'s induce spastic paralysis so orms detach
    • higher [ ]'s induces tegumental damage leading to influx Ca2+ across tegument
    • Uses:
    • Cestodes:
    • Intestinal form of Taenia solium (pork tapeworm)
    • Taenia saginata (beef tapeworm)
    • Diphyllobothrium latum (fish tapeworm)
    • Hymenolepis nana (dwarf tapeworm)
    • Trematodes:
    • Schistosomiasis (blood flukes)
    • Clonorchis sinensis, Opisthorchis viverrini, O. felineus (Chinese liver flukes)
    • Fasciolopsis buski, Heterophyes heterophyes, Metagonimus yokogawai, Nanophyetus salmincola
    • SE:
    • mild abd discomfort
  52. For Triclabendazole describe:
    MOA
    Uses
    SE
    • MOA:
    • active sulfoxide metabolite binds to fluke tubulin & disrupts microtubule-based processes
    • rapidly absorbed, enhanced w/food
    • Uses:Trematodes
    • Fasciola hepatica (liver fluke)
    • Paragonimus westermani (lung fluke)
  53. name drugs that can be indicated in infectious diarrhea. which covers the most organisms? what's its' MOA?
    • ciprofloxacin--inhibits DNA gyrase of GNRs
    • --salmonella, shigella, camp, E. coli (except ST-type), cholera, yersiniosis
    • ceftriaxone
    • azithromycin
    • TMP-SMX
    • Doxycycline
    • Metro/ti-nidazole
    • nitazoxanide
    • vancomycin
    • paromycin
  54. name drugs used for SBP prophylaxis or Tx.
    • prophylaxis:
    • Ciprofloxacin
    • TMP-SMX
    • Tx:
    • ceftriaxone
  55. name drugs that can Tx cholera
    • ciprofloxacin
    • azythromycin
    • doxycycline
  56. what Rx covers cryptosporidiosis? what does it also cover? what's its MOA?
    • Nitazoxanide
    • also abx ass. C. diff & giardia
    • unclear mech, but may interfere w/PFOR e- transfer
  57. what Rx can treat C. diff? specific for severe illness?
    • Metronidazole/tinidazole
    • nitazoxanide
    • Vancomycin for severe C. diff
  58. list drugs used for giardiasis
    • metronidazole/tinidazole
    • nitazoxanide
    • paromycin
  59. name drugs that can be used for BOTH HBV and HCV infections
    • Ribavirin
    • INF-a
  60. what drug(s) cover strongyloidia?
    Ivermectin (Ivan-strong)
  61. what is the drug(s) that cover BOTH nematodes & cestodes?
    Albendazole (I'll bend to tape the todes together)

    covers echinococcosis, cysticercosis
  62. what drug covers tapeworms and flukes?
    Praziquantel ("can't tell" if tape or fluke)
  63. what drug covers lung and liver flukes, but not blood flukes or tape worms?
    Triclabendazole

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