Pharmacology 5334 Module 2Quiz - See Attached Bundle

Pharmacology 5334 Module 2Quiz - See Attached Bundle Treatment of choice for oral therapy of UTI's - ANSWER- TMP/SMZ for 3 days; Nitrofurantoin for 5 days Second line drugs for UTI - ANSWER- Ciprofloxacin and levofloxacin for 3 days Nitrofurantoin - ANSWER- Urinary tract antiseptic Nitrofurantoin uses - ANSWER- Lower UTI's; prophylaxis; recurrent lower UTI's. (not absorbed systemically: cannot be used for anything in the kidneys) Nitrofurantoin adverse effects - ANSWER- GI effects; pulmonary reactions; hematologic effects; peripheral neuropathy (demyelination and nerve degeneration can occur and may be irreversible); hepatotoxicity; birth defects Methenamine - ANSWER- Decomposes to formaldehyde and ammonia; used for chronic lower UTI's; contraindicated in renal and liver failure; drug interactions - urinary alkalinizers, which reduce effects, sulfonamides pose risk for crystalluria Acute cystitis treatment - ANSWER- Single dose therapy: fosfomycin; short-course therapy: TMP/SMZ for 3 days; conventional therapy: nitrofurantoin for 7 days Acute uncomplicated pyelonephritis treatment - ANSWER- First line: TMP/SMZ, ciprofloxacin, and levofloxacin for 10-14 days; second line: augmentin, cephalexin Complicated UTI treatment - ANSWER- TMP/SMZ for 7-14 days, ciprofloxacin for 7-14 days, levofloxacin for 5-14 days, augmentin for 7-14 days, cephalexin for 7-14 days Recurrent UTI treatment - ANSWER- Prophylaxis with TMP/SMZ 3 times weekly for 6 months; TMP at bedtime for 6 months; OR nitrofurantoin at bedtime for 6 months Acute bacterial prostatitis treatment - ANSWER- -floxacins for 2-4 weeks Evaluation of drug sensitivity - ANSWER- Best done with sputum culture (takes up to 16 weeks for results); drugs are chosen by patterns of drug resistance in the community and immunocompetence of the patient; a new automated TB assay can identify sensitivity to rifampin in 2 hours and confirm the presence of M. tuberculosis Multi-drug resistant TB (MDR-TB) - ANSWER- Resistant to both isoniazid and rifampin Extremely drug-resistant TB (XDR-TB) - ANSWER- Resistant to isoniazid and rifampin, all fluoroquinolones, and at least one of the injectable second-line drugs First line treatment of TB - ANSWER- Isoniazid, rifampin, pyrazinamide, and ethambutol. Rifapentine and rifabutin are also considered to be first line Two phases of TB treatment - ANSWER- Induction phase: lasts about 8 weeks, eliminate actively dividing tubercle bacilli. Continuation phase: lasts from 18 weeks to 24 months, eliminate intracellular persisters Drug sensitive TB treatment - ANSWER- 8 weeks induction of isoniazid, rifampin, pyrazinamide, and ethambutol; continuation 18 weeks with isoniazid and rifampin Isoniazid-resistant TB treatment - ANSWER- Rifampin, ethambutol, and pyrazinamide for 6 months Rifampin-resistant TB treatment - ANSWER- Isoniazid, ethambutol, and pyrazinamide for 18-24 months MDR-TB and XDR-TB treatment - ANSWER- 24 months with 2nd and 3rd line drugs; poor prognosis Patients with TB plus HIV - ANSWER- More aggressive therapy required; minimum 6 months of treatment; rifampin accelerates metabolism of antiretroviral therapy drugs and decreases their effects Promoting drug adherence in TB patients - ANSWER- Directly Observed Therapy (DOT) - also allows for ongoing assessment of clinical signs; intermittent dosing: 2-3 times/week Latent TB tests - ANSWER- TB skin test; interferon Gamma Release Assays Latent TB treatment - ANSWER- Isoniazid alone for 9 months; isoniazid and rifampin weekly for 3 months; active TB must be ruled out TB vaccination - ANSWER- Bacillus Calmette and Guerin (BCG) vaccine Second line treatment of TB - ANSWER- Levofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, stretpomycin, para-aminosalicylic acid, ethonamid cycloserine Isoniazid - ANSWER- Standard treatment for latent TB; must be given for at least 6 months, preferably 9 months; poses a risk for liver damage Isoniazid adverse effects - ANSWER- Peripheral neuropathy (give pyridoxine and vitamin B6); hepatotoxicity; optic neuritis; anemia Rifampin use - ANSWER- TB, leprosy, meningococcus carriers Rifampin adverse effects - ANSWER- Hepatotoxic/hepatitis; discoloration of body fluids (red/orange); GI disturbances Rifampin drug interactions - ANSWER- Induces P450; can hasten drug metabolism - oral contraceptives, warfarin, drugs for HIV infection Ethambutol - ANSWER- Active against mycobacteria, tubercle bacilli that are resistant to isoniazid and rifampin; adverse effect: optic neuritis Ethambutol use - ANSWER- Initial treatment of TB and treatment of patients who have received therapy previously; always part of the multi-drug regimen Mycobacterium avian complex infection - ANSWER- Colonization begins in the lungs or GI tract; may spread to blood, bone marrow, liver, spleen, lymph nodes, brain, kidneys, and skin Mycobacterium avian complex treatment - ANSWER- Prophylaxis: azithromycin, clarithromycin. Acute infection: same as prophylaxis + ethambutol + rifampin or rifabutin (streptomycin, ciprofloxacin, and amikacin may be added) Acyclovir use - ANSWER- Active only against members of the herpes virus family: first choice for HSV or varicella zoster virus (VZV) infection (herpes simplex genitalis, mucocutaneous herpes simplex infections, VZV infections) Acyclovir absorption - ANSWER- May be administered topically, orally, or IV; oral bioavailability is low 15-30%; no significant absorption occurs with topical use Acyclovir distribution - ANSWER- Widely distributed to body fluids and tissues; levels achieved in CSF are 50% of those in plasma Acyclovir elimination - ANSWER- Renal primarily as the unchanged drug; half-life of 2.5 hours in normal renal function; half-life is prolonged up to 20 hours in anuric patients (adjust dose) Acyclovir adverse effects - ANSWER- Phlebitis, reversible nephrotoxicity, neurotoxicity, GI (oral), vertigo (oral) Initial episode of herpes genitalis treatment - ANSWER- Acyclovir 400 mg 3 times daily for 7-10 days; Valacyclovir 1 gram 2 times daily for 10 days Episodic recurrences of herpes genitalis treatment - ANSWER- Acyclovir 400 mg 3 times daily for 5 days; Valacyclovir 500 mg 2 times daily for 3 days Long-term suppressive therapy of recurrent genital infections - ANSWER- Acyclovir 400 mg 2 times daily for up to 12 months; Valacyclovir 500-1000 mg every day for immunocompetent patients, and 500 mg twice daily for patients with HIV Acute therapy of herpes zoster - ANSWER- Acyclovir 800 mg 5 times daily for 7-10 days VZV (chickenpox) treatment - ANSWER- Acyclovir 20 mg/kg (no more than 800 mg) 4 times daily for 6 days; treatment should begin at earliest sign of rash; topical therapy: 5% cream applied 5 times daily; Valacyclovir (ages 2-18) 20 mg/kg (max 1 gram) three times daily Valacyclovir - ANSWER- Prodrug of acyclovir; uses: herpes zoster (shingles), herpes simplex genitalis, herpes labialis (cold sores), varicella (chicken pox) Valacyclovir absorption - ANSWER- Rapid absorption and essentially complete conversion to acyclovir Herpes labialis treatment - ANSWER- Valacyclovir 2 g/dose 12 hours apart for 1 day Famcyclovir - ANSWER- Prodrug used to treat acute herpes zoster or genital herpes Famcyclovir absorption - ANSWER