ANTIMICROBIAL AGENTS

1
ANTIMICROBIAL AGENTS
NAPLEX
2

• Selecting Appropriate Antimicrobial Agents

• Empiric therapy
• Identify the causative organism
• Test the sensitivity of the organism to
  antimicrobial drugs
• Identify important host factors
• Site of infection-CNS, bone, prostate, UTI
• Susceptibility to toxicity
• Patient allergies

PG 52
3

• Mechanisms of Action of Antimicrobial Agents

• Interference with cell wall synthesis
• penicillins, cephalosporins
• Inhibition of protein synthesis
• macrolides, clindamycin, tetracyclines,
  quinolones
• Interference with enzyme unique to bacterial cell
• sulfonamides
• Interference with the permeability of microbial
  cell membranes
• amphotericin B

PG 52
4

• Sulfonamides

PABA dihydrofolic acid
(DHFA) tetrahydrolfolic acid
(THFA)
Sulfa
PG 53
5

• General considerations - Sulfonamides

Mechanism of action competitive antagonism of
PABA in enzyme system essential for bacteria
growth. For ophthalmic use, sulfa sodium salt
solutions are very alkaline (i.e., pH 10). The
only sodium salt suitable for ophthalmic use is
sulfacetamide sodium (solutions have pH of about
7.4). Sulfas are eliminated renally unchanged.
Makes them good for UTIs. Sulfas are less
soluble in acid urine. This is one cause of
crystalluria. Stevens-Johnson syndrome is
associated with sulfa use.
PG 53
6
General considerations Sulfonamides (contd)

• Combinations of sulfamethoxazole and trimethoprim
  (Bactrim, Septra, etc.) are less likely to result
  in bacterial resistance.
• Sulfasalazine (Azulfidine) is used in treating
  inflammatory bowel disease and RA. Watch for
  sulfa allergy, salicylate allergy, and urine
  discoloration. - GI side effects, dose is
  titrated upward slowly, monitor blood counts
  dyscrasias
• If a patient cannot use sulfasalazine because of
  sulfa sensitivity, use mesalamine products, i.e.,
  Asacol, Pentasa, Rowasa. various dosage forms
• Remember that silver sulfadiazine (Silvadene) and
  mafenide (Sulfamylon) are used topically for
  treatment of serious burns.

PG 53
7
Penicillins

PG 54
8
General Considerations Penicillins
Mechanism of action interfere with bacterial
cell-wall synthesis (bactericidal) Note that all
penicillins have a beta lactam ring and
thiazolidine ring. Possible cross-sensitivity
with other beta lactam antimicrobials (e.g.,
cephalosporins). - percent cross-sensitive
ranges from 5-7
PG 54
9

• Structure Activity Relationships

• AMino penicillins AMpicillin, AMoxicillin,
  bacAMpicillin
• NOX penicillins penicillinase (beta lactamase)
  resistant penicillins Nafcillin, OXacillin,
  clOXacillin (PO), diclOXacillin(PO)----MSSA
  (vanco alternative)
• MEZPCT penicillins antipseudomonal penicillins
  MEZlocillin, Piperacillin, Carbenicillin,
  Ticarcillin (combo with aminoglycosides, not in
  the same IV)
• Therapy problems with penicillins
• Acid Resistance
• Beta-lactamase (penicillinase) resistance (combo
  products Zosyn, Timentin, Augmentin)
• Hypersensitivity

PG 55
10

• Which of the following is an adverse
• effect associated with use of
• aminopenicillins?
• a. polydipsia
• b. hemolytic anemia
• c. cholelithiasis
• d. tardive dyskinesia
• e. angina
  

11

• Which of the following is an adverse
• effect associated with use of
• aminopenicillins?
• a. polydipsia
• b. hemolytic anemia
• c. cholelithiasis
• d. tardive dyskinesia
• e. angina
  

12

• Cephalosporins

PG 56
13

• General considerations

• Contains beta-lactam ring. Therefore, may have
  cross-sensitivity with penicillins.
• As you go from 1st generation to 4th generation,
  you get
• increased gram-negative activity
• decreased gram-positive activity
• increased resistance to beta-lactamase
  destruction
• increased ability to enter cerebrospinal fluid

PG 56
14

• Which of the following antimicrobial
• agents has effective coverage of
  streptococcus pneumoniae?
• I. amoxicillin
• II. doxycycline
• III. gentamicin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III
  

15

• Which of the following antimicrobial
• agents has effective coverage of
  streptococcus pneumoniae?
• I. amoxicillin
• II. doxycycline
• III. gentamicin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III
  

Gram Non-DRSP
16
General considerations (contd)

• First generation (generally start with CEPH)
• Good for surgical prophylaxis
• Second generation (generally start with CEF)
• Good for otitis, sinusitis and respiratory tract
  infections
• Third generation (generally end with IME or ONE)
• Good for meningitis, CAP, gram-negative bacilli,
  gonorrhea, Proteus, Salmonella, Klebsiella
• Cefixime (suprax), cefotaxime (claforan),
  ceftriaxone (rocephin)
• Fourth generation (cefepime) Maxipime
• Good antipseudomonal activity

PG 57
17

• Tetracyclines

PG 58
18

• General Considerations

• Products
• Tetracycline HCI (Achromycin V, Sumycin, Robitet,
  Panmycin)
• Minocycline (Minocin)
• Doxycycline (Vibramycin, Doxy 100, Doxychel,
  Vibra-Tabs)
• These are bacteriostatic antimicrobials. They
  interfere with protein synthesis.
• Broad spectrum antimicrobials. Work against many
  gram-positive and gram-negative organisms.
• - also effective against atypical organisms
  mycoplasma and chlamydia pneumoniae, useful for
  patients allergic to penicillin b/c gram
  coverage

PG 58
19
General Considerations

• Not for use in children under age 8. May cause
  discoloration of developing tooth enamel.
• Not for pregnant women. May adversely affect
  fetal development.
• Most have the potential for causing
  phototoxicity.
• Drug interaction with divalent (Mg, Ca, Fe) or
  trivalent (Al) compounds and tetracyclines may
  result in complexation and impaired absorption.
  Do not use together.
• Broad spectrum activity can lead to thrush or
  vaginal candidias

PG 58
20

• Macrolides
• General Considerations
• Bacteriostatic inhibit protein synthesis
• May be good for patients who are
• hypersensitive to beta-lactam
• antimicrobials.
• Good respiratory coverage.
• CAP caused by S.pneumo, M.cat, H.flu or
  atypicals (mycoplasma, legionella, and chlamydia)
  

PG 59
21
Erythromycin

• Oral Products
• Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)
• Coating used on most products
• Administer on an empty stomach
• Erythromycin stearate (Erythromycin Stearate,
  Wyamycin S)
• Better absorbed than erythromycin base

PG 59
22
Erythromycin (contd)

• Erythromycin esolate (Ilosone)
• Associated with cholestatic hepatitis
• Better absorbed than erythromycin base
• Erythromycin ethylsuccinate (eryPed, E.E.S.)
• Most well absrobed
• Available in liquid form
• 400 mg of EES 250 mg of erythromycin base
• Parenteral Products
• Erythromycin lactobionate
• Erythromycin glucepate
• Drug Interactions Mainly due to enzyme
  inhibition of erythromycin (3A4)

PG 59
23
Clarithromycin (Biaxin) Usually used BID. XL
form used once daily. Prodrug May be given
with or without meals Used in combination with a
proton pump inhibitor for H. pylori treatment.
Metallic taste
PG 60
24
Azithromycin (Zithromax) More gram-negative
activity than erythromycin or clarithromycin Once-
daily dosing, usually for five days after otitis
media (e.g., Z-Pack) Available as suspension,
tablets, IV Suspension should not be taken with
food or antacids. Dirithromycin
(Dynabac) Prodrug Once-daily dosing
PG 60
25

• Lincosamides
• General considerations
• Watch for pseudomembranous enterocolitis
  (Clostridium difficile).
• Treat clostridium with metronidazole (Flagyl) or
  oral vancomycin.
• Good in gram positive (staph) and gram-negative
  infections, particularly anaerobes

Lincomycin (Lincocin, Lincorex) Morbilliform
rash possible DC drug if it happens Clindamycin
(Cleocin) Available in topical form for acne
PG 61
26

• Which of the following antibiotics has
• bacteriostatic activity?
• a. amoxicillin
• b. ciprofloxacin
• c. erythromycin
• d. penicillin
• e. cephalexin

27

• Which of the following antibiotics has
• bacteriostatic activity?
• a. amoxicillin (cell wall)
• b. ciprofloxacin (inhibits DNA gyrase)
• c. erythromycin (protein synthesis)
• d. penicillin (cell wall)
• e. cephalexin (cell wall)
  

28
Aminoglycosides General Considerations Glycosides
poorly absorbed from the GI tract Bactericidal
Good for serious gram-negative pathogens
(pseudomonas, proteus, etc.) Frequently
administered with extended-action penicillin (IV
incompatible) - dosed q8h or q24h (conc.
dependant kill) Eliminated by glomerular
filtration Watch for ototoxicity Monitor peaks
and troughs peaks 30 min after infusion, trough
30 minutes before next dose. peak 4-10ug/ml
trough 0.5-2, adjust dose if CrCl lt 60ml/min.
hearing test if prolonged therapy
PG 61
29

• Which of the following antimicrobial
• agents is available for parenteral use
  only?
• I. cefaclor
• II. tobramycin
• III. ticarcillin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

30

• Which of the following antimicrobial
• agents is available for parenteral use
  only?
• I. cefaclor
• II. tobramycin
• III. ticarcillin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

31
Parenteral use Streptomycin sulfate Kanamycin
sulfate (Kantrex) Gentamicin sulfate
(Garamycin (4mcg-10mcg/ml) Tobramycin sulfate
(Nebcin) (4mcg-10mcg/ml) Amikacin sulfate
(Amikin) (15mcg-25mcg/ml) Netilmicin
sulfate (Netromycin)
Reference Peak Range
PG 61
32

• Which of the following antibiotics
• requires monitoring of serum levels?
• a. penicillin
• b. ceftazidime
• c. azithromycin
• d. gentamicin
• e. cephalexin

33

• Which of the following antibiotics
• requires monitoring of serum levels?
• a. penicillin
• b. ceftazidime
• c. azithromycin
• d. gentamicin
• e. cephalexin

34
Oral use Not for systemic action Neomycin
sulfate (Mycifradin) - Used for bowel prep prior
to surgery , treat diarrhea caused by e.coli,
neomycin also binds ammonia, use in patients
w/hepatic encephalopathy, watch for absorption
interactions Tobramycin (TOBI) inhaled
product for CF patients
PG 62
35
Fluoroquinolones General Considerations -
Inhibits DNA-Gyrase May cause phototoxicity Not
for patients under 18 affects growth Do not
use within 2-4 hours of antacids iron also
inhibits CYP1A2 (increased levels of theophylline
and caffeine) Generally useful for UTI, lower
respiratory infections, gonorrhea, prostatitis
older agents have more gram -, less gram
coverage, newer agents have broader gram
moxifloxacin, gatifloxacin All end in -oxacin
PG 62
36
Names Second generation Norfloxacin (Noroxin)
high urine levels - UTIs Ciprofloxacin (Cipro)-
renal elimination reduce dose Ofloxacin
(Floxin) Third generation Levofloxacin (Levaquin)
renal elimination reduce dose Sparfloxacin
(Zagam) reports of prolongation of QT interval
(D/C) Gemifloxacin (Factive) renal elimination
reduce dose, skin rash Fourth generation Moxiflox
acin (Avelox) Multi-drug resistant
Streptococcus pneumonia (MDRSP)
PG 62
37
MISCELLANEOUS ANTIMICROBIAL AGENTS Antibacterials
Mupirocin (Bactroban) topical use for
impetigo, intranasal for staph Vancomycin
(Vancocin) associated with red man syndrome
(must be infused slowly, over min of 30 minutes)
reserved for serious/resistant gram infections
(MRSA, enterococcus) rapid drop in BP
accompanied by rash in neck or chest area -
Monitoring 1 hour before and 1 hour after -
Peak 25-40mcg/dl Trough
5-12mcg/dl Metronidazole (Flagyl) active
against gram-negative organisms and protozoa,
(anaerobes) Avoid alcohol. May darken urine.
PG 63
38

• MISCELLANEOUS ANTIMICROBIAL AGENTS (contd)
• Carbapenems
• broad spectrum used for resistant gram /
  organisms, pseudomonas, MRSA, enterococcus,
  anaerobes
• similar to penicillins (cross-sensitivity) but
  b-lactamase resistant
• Risk of seizures and renal adjustment
• Imipenem/cilastatin (Primaxin) cilastatin is a
  renal dipeptidase inhibitor
• Meropenem (Merrem)---lacks good pseudomonas
  coverage
• Doripenem (Doribax)
• Ertapenem (Invanz)
• ----Aztreonam (Azactam)---monobactam, ok with PCN
  allergy

PG 63
39

• Which of the following antibiotic is
• classified as a macrolide?
• a. telithromycin
• b. tobramycin
• c. azithromycin
• d. doxycycline
• e. kanamycin

40

• Which of the following antibiotic is
• classified as a macrolide?
• a. telithromycin
• b. tobramycin
• c. azithromycin
• d. doxycycline
• e. kanamycin

41
MISCELLANEOUS ANTIMICROBIAL AGENTS (contd) VRE
and MRSA drugs Quinupristin / dalfopristin
(Synercid) Linezolid (Zyvox) oral dosing
available Tigecycline (Tygacil)
Chloramphenicol (Chloromycetin) for typhoid
fever may cause aplastic anemia and gray baby
syndrome
PG 63-64
42
Pneumonia

• Organisms
• Treatment

--Comorbidities Chronic obstructive pulmonary
disease (COPD), diabetes, chronic renal failure,
chronic liver failure, heart failure (HF),
cancer, asplenia, immunosuppressed
43
Pneumonia

• Treatment

--Risk factors for MDR organisms recent
antibiotic therapy (in last 90 days),
hospitalized 5 days, ? resistance in
environment, nursing home resident, chronic
dialysis, home infusion therapy, immunosuppressed
44
Meningitis

• Organisms
• Treatment

45
Urinary Tract Infection

• Organisms
• Treatment

46
STDs

• Organisms
• Treatment

47
Antitubercular Drugs

• R rifampin
• I isoniazid
• P pyrazinamide
• E ethambutol
• S streptomycin

PG 64
48

• Antitubercular Drugs
• Isoniazid (Nydrazid, Laniazid)
• May cause B6 deficiency supplement
  malnourished, alcoholics, kids
• Used for prophylaxis or in combo with other drugs
  for active disease
• 6 months of prophylaxis if PPD For treatment
  used in combo with
• rifampin for at least 6 months
• Metabolized by acetylation (slow versus rapid
  acetylators)
• monitor for hepatoxicity
• Rifampin (Rifadin, Rimactane)
• Potent enzyme inducer (potential drug
  interactions with many drugs)
• Potentially hepatotoxic
• Use may result in discoloration of virtually all
  body fluids (urine and tears----watch contact
  lenses)

PG 64
49
Antitubercular Drugs (cont.) Ethambutol
(Myambutal) for treatment of MAC and
drug-resistant Tb as part of combination
therapy - optic neuritis is a rare but serious
side effect - monitor with eye exams
Pyrazinamide used in combination therapy
potentially hepatotoxic - may increase uric acid
levels Steptomycin- can be used as fourth drug
in regimen instead of pyrazinamide
PG 65
50

• Antimalarials
• Quinine sulfate (Quinamm) also used for muscle
  cramps no longer used due to hematologic adverse
  effects
• Doxycycline tetracycline possible
  phototoxicity and binding interactions
• Melfoquine HCl (Lariam) may cause
  neuropsychiatric adverse effects once- weekly
  dosing
• Atovaquone/proguanil (Malarone) newer product
  once daily do not use if renally impaired

PG 65
51

• Antimalarials
• Chloroquine (Aralen) may worsen psoriasis
  symptoms
• Hydroxychloroquine sulfate (Plaquenil Sulfate)
  may worsen psoriasis symptoms
• - also used as a DMARD for RA phototoxicity,
• hematological side effects, ocular
  and ototoxicity
• Primaquine phosphate take with food to reduce
  GI upset may be used for PCP

PG 66
52
HIV Antiretroviral Therapy

• Therapy initiated based on CD4 count, viral load
  and presence of symptoms
• Initial regimen in treatment naive patients
• NNRTI 2 NRTIs
• PI 2 NRTIs
• Learn drug class representatives and major
  toxicities

PG 69
53
Which HIV drug is correctly matched with its
mechanism of action?

• a. Lamivudine - nucleoside reverse transcriptase
  inhibitor
• b. Enfuvirtide - protease inhibitor
• c. Stavudine - binds to human CCR5 receptor
• d. Didanosine protease inhibitor
• e. Indinavir blocks virus entry into human
  cells and subsequent viral replication

54
Which HIV drug is correctly matched with its
mechanism of action?

• a. Lamivudine - nucleoside reverse transcriptase
  inhibitor
• b. Enfuvirtide - protease inhibitor
• c. Stavudine - binds to human CCR5 receptor
• d. Didanosine protease inhibitor
• e. Indinavir blocks virus entry into human
  cells and subsequent viral replication

55
NNRTIs non-nucleoside reverse transcriptase
inhibitors (vir in the middle)

• Delavirdine (rescriptor) (rash, LFTs)
• Efavirenz (Sustiva)
• Drug of choice
• Category X, vivid dreams
• Nevirapine (Viramune)
• Rash (Steven Johnson Syndrom)
• Liver metabolism

56
PIs Protease inhibitors (vir at the end)

• Exception darunavir, tenofovir, raltegravir,
  abacavir
• Metabolized through the liver (commonly 3A4)
• potential for significant drug interactions
• Low dose of ritonavir frequently used to enhance
  the concentrations of coadministered PIs
• Adverse effects GI intolerance, hyperglycemia,
  dyslipidemia, lipodystrophy, LFT alterations

PG 72
57
NRTIs nucleoside reverse transcriptase
inhibitors (all the others)
Exception maraviroc All NRTIs (except abacavir)
are excreted renally require dose adjustment but
few drug interactions Most common ADRs GI
intolerance, typically subsides in first couple
of weeks - High risk for perpheral
neuropathy Black Box warning Risk of lactic
acidosis with hepatic steatosis
PG 69
58
AIDS Opportunistic Infections

• PCP / PJP (pneumocystis carninii pneumonia)
• trimethoprim-sulfamethoxazole
• CMV retinitis
• Ganciclovir
• MAC / MAI (mycobacterium avium complex)
• Macrolide ethambutol
• Cryptococcus neuformans meningitis
• Amphotericin B /- flucytosine
• Fluconazole used for maintenance

PG 74
59
Drugs for influenza M2 inhibitors Amantadine,
rimantidine Effective for influenza A virus
only Begin within 48h of symptom onset continue
2-5 days Neuroaminidase inhibitors Oseltamivir
(Tamiflu) Zanamivir (Relenza) Effective for
influenza A and B viruses Begin with 48h of
symptoms onset continue 5 days
PG 74
60
Drugs for herpes simplex and herpes zoster
(shingles) Acyclovir (Zovirax) for herpes
simplex types 1 and 2 - dosed 5x/day for 10 days,
5 days if recurrence Penciclovir (Denavir)
topical treatment for herpes labialis (cold
sores) Valacyclovir HCl (Valtrex) for herpes
simplex and herpes zoster acyclovir
prodrug Famcyclovir (Famvir) for herpes simplex
and herpes zoster (shingles) penciclovir
prodrug - begin therapy as soon as first sign of
lesion Docosanol (OTC-Abreva) topical cream
PG 75
61

• Anthelmintic drugs of choice
• Nematodes (roundworm)
• Mebendazole (Vermox)do not use in pregnancy
  blocks glucose uptake
• Albendazole (Albenza) degeneration of
  cytoplasmic microtubules intestinal cells of
  helminths
• Piperazine citrate Preg B blocks affect of ACH
• Pyrantel pamoate (Antiminth)
• Trichuriasis (whipworm)
• Mebendazole (do not use in pregnancy)
• Hookworm mebendazole (do not use in pregnancy)

PG 75
62

• Which of the following medication(s) can cause
  nephrotoxicity?
• Ganciclovir
• Foscarnet
• Gentamicin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

63

• Which of the following medication(s) can cause
  nephrotoxicity?
• Ganciclovir
• Foscarnet
• Gentamicin
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

64

• Which of the following agents inhibits the
• HIV enzyme reverse transcriptase?
• I. zanamivir
• II. ritonivir
• III. didanosine
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

65

• Which of the following agents inhibits the
• HIV enzyme reverse transcriptase?
• I. zanamivir (Neuroaminidase inhibitors)
• II. ritonivir (protease inhibitor)
• III. didanosine (nucleoside reverse
  transcriptase inhibitors)
• a. I only
• b. III only
• c. I and II only
• d. II and III only
• e. I, II, and III

66

• DERMATOLOGIC STUDY OUTLINE
• Acne
• Pathophysiology abnormal keratinization leads
  to obstruction of the follicle and accumulation
  of sebum to form a closed comedo or white-head
• Goal of therapy is to unblock follicles

PG 146
67
(No Transcript)
68
Normal Pore Inflamed Pore
69
Dermatologic Study Outline
PG 146
70

• Dermatologic Study Outline
• Isotretinoin (Accutane)
• Effective therapy option for the treatment of
  severe, inflammatory acne, or more moderate forms
  that have been refractory to other treatment
  options
• pregnancy category X
• two forms of contrception, iPLEDGE program
• Oral Antimicrobials
• Tetracycline
• Erythromycin
• Clindamycin

PG 146
71

• Psoriasis
• Pathophysiology exact mechanism unknown. May
  be due to defects in epidermal cell cycle, AA
  metabolism, immunologic mechanisms, environmental
  triggers
• Treatment modalities
• Emollients (e.g., petrolatum)
• Ultraviolet light
• Coal tars (typically compounded)
• Topical corticosteroids
• Systemic corticosteroids (pulse dosing)
• Antineoplastic agents (methotrexate,
  hydroxyurea)
• Psoralens (pulse dosing)
• Immunosuppressant agents (Etanercept,
  Efalizumab)
• Retinoids (pulse dosing)

PG 146
72
Which of the following psoriasis medications is
not pregnancy category X?

• I. Dovonex
• II. Methotrexate
• III. Soriatane
• I only
• III only
• I and II only
• II and III only
• I, II and III

73
Which of the following psoriasis medications is
not pregnancy category X?

• I. Dovonex
• II. Methotrexate
• III. Soriatane
• I only
• III only
• I and II only
• II and III only
• I, II and III

74
A patient presents to the pharmacy with obvious
mild acne, which of the following cannot be
recommended without a prescription?

• a. Benzoyl peroxide 2.5 cream
• b. Sulfur soap
• c. Benzamycin gel
• d. Salicylic acid wash
• e. Benzoyl peroxide 10 lotion

75
A patient presents to the pharmacy with obvious
mild acne, which of the following cannot be
recommended without a prescription?

• a. Benzoyl peroxide 2.5 cream
• b. Sulfur soap
• c. Benzamycin gel
• d. Salicylic acid wash
• e. Benzoyl peroxide 10 lotion

76
Fungal Infections

• Tinea corporis body surface
• Tinea capitis scalp
• Tinea cruris groin (jock itch)
• Tinea pedis feet (athletes foot)
• Onychomycosis nails

PG 67-68 and 147
77

• Therapy
• Prophylaxis. Keep skin dry frequent changes and
  thorough cleaning of clothing and avoid likely
  areas of contamination.
• Active
• Dusting powders (medicated versus nonmedicated),
  wet compresses
• Topical drug therapy
• Fatty acids (undecylenic acid) Tolnaftate
  (Tinactin, Aftate)
• Haloprogin (Halotex) Miconazole
  (Micatin,Monistat)
• Clotrimazole (Lotrimin) Oxiconazole
  (Oxistat)
• Sulconazole (Exelderm)
  Butenafine (Mentax)
• Nystatin (Mycostatin, Nilstat) good for
  superficial candida (thrush)
• Systemic drug therapy for topical fungal
  disorders
• Griseofulvin (microsized versus
  ultramicrosized)
• Terbinafine (Lamisil)
• Avoid corticosteroids

PG 147
78

• Antifungal Drugs (contd)
• Miconazole (Monistat, Micatin) broad-spectrum
  antifungal agent available as powder, aerosol,
  cream, and suppository may be used topically or
  vaginally
• Clotrimazole (Lotrimin, Mycelex) broad-spectrum
  antifungal available as cream, lotion,
  suppositories, and troches (OTC use for 2 weeks
  after infection clears)
• Ketoconazole (Nizoral) for superficial and
  systemic fungal infections also available as OTC
  shampoo for dandruff enzyme inhibitor
• Itraconazole (Sporanox) for oral or topical
  treatment of superficial or systemic fungal
  disorders enzyme inhibitor.
• - hepatotoxicity take w/ food and avoid
  antacids

PG 67
79
Antifungal Drugs (contd)

• Terbinafine (Lamisil) used orally for
  onychomycosis of fingernail or toenail. Used
  topically for superficial tinea infections (OTC
  use for 1 week). Monitor for hepatoxicity with
  oral use.
• Ciclopriox (Penlac) applied topically once
  daily for treatment of onychomycosis. requires
  long-term therapy

PG 67
80
Antifungal Drugs (contd)

• Griseofulvin (Grisactin, Grifulvin V, Fulvicin)
• For tinea only
• Duration of therapy
• depends on type corporis 2-4 wks. capitis
  4-6 wks., pedis 4-8 wk
• Regular versus microsized versus ultramicrosized
• ultra is better absorbed take w/ fatty meal
• causes induction interactions

PG 67
81
Antifungal Drugs (contd)

• Other Azoles
• Posaconazole (Noxafil)
• Voriconazole (Vfend)
• Reserved for severe invasive fungal infections
  (asperigillosis)
• Echinocandins (less DI, but monitor LFTs)
• Anidulafungin (Eraxis)
• Caspofungin (Cancidas)
• Micafungin (Mycamine)
• Ampho B and related Lipid products
• nephrotoxicity

PG 68
82
Sample Questions
NAPLEX
83
Which of the following antibiotics does not have
a significant drug interaction with warfarin?

• ciprofloxacin
• azithromycin
• TMP-SMZ
• Metronidazole
• Nafcillin

84
Which of the following antibiotics does not have
a significant drug interaction with warfarin?

• ciprofloxacin
• azithromycin
• TMP-SMZ
• Metronidazole
• Nafcillin

85
Which of the following medications is the best
treatment option for an uncomplicated urinary
tract infection?

• penicillin
• cefuroxime
• levofloxacin
• gentamicin
• clarithromycin

86
Which of the following medications is the best
treatment option for an uncomplicated urinary
tract infection?

• penicillin
• cefuroxime
• levofloxacin
• gentamicin
• clarithromycin

87
Which of the following antimicrobial agents is
available for parenteral use only?

• piperacillin
• aztreonam
• rifampin
• I only
• III only
• I and II only
• II and III only
• I, II and III

88
Which of the following antimicrobial agents is
available for parenteral use only?

• piperacillin
• aztreonam
• rifampin
• I only
• III only
• I and II only
• II and III only
• I, II and III

89
Which of the following agents is a non-nucleoside
reverse transcriptase inhibitor?

1. didanosine
2. delavirdine
3. stavudine
4. zidovudine
5. lamivudine

90
Which of the following agents is a non-nucleoside
reverse transcriptase inhibitor?

1. didanosine
2. delavirdine
3. stavudine
4. zidovudine
5. lamivudine

91
Which of the following agents may be utilized in
combination with other medications for H. pylori
eradication?

• tetracycline
• azithromycin
• penicillin
• fluconazole
• cefuroxime

92
Which of the following agents may be utilized in
combination with other medications for H. pylori
eradication?

• tetracycline
• azithromycin
• penicillin
• fluconazole
• cefuroxime

93
Peripheral neuropathy is associated with which
one of the following agents

• nevirapine
• delavirdine
• Saquinavir
• Stavudine
• tenofovir

94
Peripheral neuropathy is associated with which
one of the following agents

• Nevirapine (NNRTI)
• Delavirdine (NNRTI)
• Saquinavir (PI)
• Stavudine (NRTI) do not use with AZT (zidovudine)
• Tenofovir (NRTI)

95
Administration of calcium or iron must be
separated by at least 2 hours if antibiotics in
this category are prescribed

• Macrolides
• Tetracyclines
• Fluroquinolones
• I only
• III only
• I and II only
• II and III only
• I, II and III

96
Administration of calcium or iron must be
separated by at least 2 hours if antibiotics in
this category are prescribed

• Macrolides
• Tetracyclines
• Fluroquinolones
• I only
• III only
• I and II only
• II and III only
• I, II and III

97
Which of the following antimicrobial agents has
effective coverage for M. pneumoniae?

1. amoxicillin
2. erythromycin
3. metronidazole
4. cefotriaxone
5. clindamycin

98
Which of the following antimicrobial agents has
effective coverage for M. pneumoniae?

1. amoxicillin
2. erythromycin
3. metronidazole
4. cefotriaxone
5. clindamycin

99
Which of the following regimens is most
appropriate for C. difficile eradication?

• Clarithromycin 500 mg PO q 12 hours
• Clindamycin 300 mg IV q 6 hours
• Vancomycin 125 mg PO q 6 hours
• Doxycycline 100 mg PO q 12 hours
• Vancomycin 1000 mg IV q 12 hours

100
Which of the following regimens is most
appropriate for C. difficile eradication?

• Clarithromycin 500 mg PO q 12 hours
• Clindamycin 300 mg IV q 6 hours
• Vancomycin 125 mg PO q 6 hours
• Doxycycline 100 mg PO q 12 hours
• Vancomycin 1000 mg IV q 12 hours

101
Which agent is available in both a topical and an
oral product for the treatment of acne?

• clindamycin
• erythromycin
• doxycycline
• I only
• III only
• I and II only
• II and III only
• I, II and III

102
Which agent is available in both a topical and an
oral product for the treatment of acne?

• clindamycin
• erythromycin
• doxycycline
• I only
• III only
• I and II only
• II and III only
• I, II and III

103
Which of the following drugs represents first
(primary) agents in the treatment of TB?

• Ethambutol PASA
• Ciprofloxacin PASA
• Isoniazid rifampin
• Cycloserine streptomycin
• Penicillin Benemid

104
Which of the following drugs represents first
(primary) agents in the treatment of TB?

• Ethambutol PASA
• Ciprofloxacin PASA
• Isoniazid rifampin
• Cycloserine streptomycin
• Penicillin Benemid

105
Which of the following antibiotics is considered
first line treatment for a gonorrhea infection?

• Ampicillin
• Ciprofloxacin
• Doxycycline
• Penicillin
• Tetracycline

106
Which of the following antibiotics is considered
first line treatment for a gonorrhea infection?

• Ampicillin
• Ciprofloxacin (also..ceftriaxone, cefixime)
• Doxycycline (chlamydia)
• Penicillin
• Tetracycline

107
Which of the following groups of antibiotics may
be prescribed for a gravid patient with
gonorrhea?

• cephalosporins
• fluoroquinolones
• tetracyclines
• I only
• III only
• I and II only
• II and III only
• I, II and III

108
Which of the following groups of antibiotics may
be prescribed for a gravid patient with
gonorrhea?

• cephalosporins
• fluoroquinolones
• tetracyclines
• I only
• III only
• I and II only
• II and III only
• I, II and III

109
A gravid patient with a Chlamydia infection is
likely to be prescribed which of the following
antibiotics?

• Ampicillin
• Levofloxacin
• Doxycycline
• Erythromycin
• Penicillin

110
A gravid patient with a Chlamydia infection is
likely to be prescribed which of the following
antibiotics?

• Ampicillin
• Levofloxacin
• Doxycycline
• Erythromycin
• Penicillin

111
Which of the following is the BEST treatment for
a patient with herpes zoster?

• Cidofovir
• Famciclovir
• Ganciclovir
• Penciclovir
• Tenofovir

112
Which of the following is the BEST treatment for
a patient with herpes zoster?

• Cidofovir
• Famciclovir
• Ganciclovir
• Penciclovir
• Tenofovir

113
Which of the following medications would be
appropriate for the treatment of Pseudomonas
aeruginosa?

• Ampicillin
• Cefepime
• Ceftriaxone
• Erythromycin
• Clindamycin

114
Which of the following medications would be
appropriate for the treatment of Pseudomonas
aeruginosa?

• Ampicillin
• Cefepime
• Ceftriaxone
• Erythromycin
• Clindamycin