Pharmacology Module 2; Section 5

True statements about Penicillin mechanism of action

PBPs are bacterial enzymes that catalyze cell wall peptidoglycan synthesis. Penicillin mechanism of action is to bind to proteins called PBPs, which inhibit cell wall synthesis causing cell lysis and death. Penicillin (PCN) G was the first commercially produced pencillin; however it is poorly absorbed orally due to stomach acid inactivation. PCN G is well-absorbed intramuscularly and is the preferred route of administration.

Which agent is used for prophylaxis and treatment of systemic cytomegalovirus? gangciclovir, entecavir, acyclovir, amantadine

Ganciclovir is prescribed for both prophylaxis and treatment of systemic cytomegalovirus. It is a synthetic purine nucleoside analogue used in immunocompromised patients as well as those with CMV retinitis.

Which of the following is false regarding highly active antiretroviral therapy (HAART)? It reduces viral load. It increases viral load. It delays the onset of AIDS. It increases CD4 cell counts.

HAART does not increase viral load, but reduces it. This therapy also increases CD4 lymphocyte counts, delays the onset of AIDS, and prolongs survival of patients with AIDS. In HART therapy, 3-4 drugs effective against AIDS are combined.

Which type of viral hepatitis may be prevented by vaccine? hepatitis E, hepatitis C, hepatitis A, hepatitis G

Hepatitis A may be prevented by vaccine, as well as hepatitis B. The other forms of hepatitis currently have no vaccines. Hepatitis A may also be treated with IM immunoglobulin, and hepatitis B may also be treated with NRTIs and antiviral interferons.

cross-resistance

History of antimicrobial use

experienced rash, fever, urticaria, pruritus, erythema, or anaphalaxis with similar medication

History of hypersensitivity

long-term corticosteroid use

Immunocompromised

presence of HIV with treatment

Immunucompromised

block the integrase enzyme to prevent HIV from adding DNA into the CD4 cells

Integrase Strand Transfer Inhibitor

medication can be absorbed through breast milk

Neonate or elderly

cumulation due to changes in organ function

Neonate or eldery

block reverse transcriptase directly by binding to active reverse transcriptase centers to prevent it from working correctly to build new DNA - structurally different from naturally-occurring nucleosides with a different mechanism of action.

Non-nucleoside Reverse Transcriptase Inhibitor (NNRTIs)

block HIV ability to use reverse transcriptase enzyme to build new DNA

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Nucleoside analogs are derived from ___. hydrochloric acid, protease inhibitors, nicotinic acid, or nucleic acid

Nucleoside analogs are derived from nucleic acid. The are combined with protease inhibitors and used in HAART therapy. This type of therapy involves the combination of 3-4 drugs effective against HIV.

Macrolides

Originally obtained from a soil sample, macrolides are products of actinomycetes or semi-synthetic derivatives of them. It has been noted that there is increased antimicrobial activity observed in alkaline pH.Resistance to macrolides develops in 2 ways: MLS phenotype pattern of resistance and efflux pumps which remove the macrolide antibiotics before they have a chance to reach the target organism. Macrolide antibiotics act to inhibit protein synthesis by binding to the 23SrRNA molecule (in the 50 S subunit) of the bacterial ribosome and by blocking exit of the growing polypeptide chain in sensitive microorganisms. The association between erythromycin and the ribosomes is reversible and takes place only when the 50 S subunit is free from tRNA molecules bearing nascent peptide chains.

Certain viruses protect themselves from attack by the human immune system by creating which of the following? a virion, an interferon, an envelope, an antitoxin

Certain viruses protect themselves by creating an envelope. Viruses contain cores of deoxyribonucleic acid or ribonucleic acid surrounded by protein coatings.

block viral entry into cells; considered an entry inhibitor.

Chemokine Receptor 5 Antagonist (CCR5 antagonists)

Which of the following is false regarding the structure of HIV? It is surrounded by a capsid. Its envelope contains glycoproteins. it is made up of DNA. It is surrounded by core proteins.

The HIV virus is not made up of DNA. Its structure is simplistic, being made of RNA, surrounded by core proteins, which are then surrounded a a protein shell known as a capsid.

The most common complication of influenza is _____. bacterial encephalitis, Reye syndrome, bacterial pneumonia, viral meningitis

The most common complication of influenza is bacterial pneumonia. Primary influenza viral pneumonia is rare, yet has a high fatality rate. Risks for complications and hospitalizations are higher in people age 65+, in very young children, or in any age if there are certain underlying medical conditions. Other complications may include Reye syndrome (particularly linked with children on aspirin), myocarditis, and death.

Jane Smith developed community-acquired pneumonia and was treated with amoxicillin (broad-spectrum synthetic penicillin). After 5 days of treatment, she experienced soreness of her mouth and throat with white patches on her tongue and oral mucosa. She likely has Candida albicans. How did this superinfection occur?

The penicillin altered the balance of Jane's normal flora causing an overgrowth of Candida which is normally found on the skin and mucous membranes.

Tiny genetic parasites that require the host cell to replicate and spread are ___. bacteria, parasites, viruses, fungi

These tiny genetic parasites are viruses. The number of drugs available to treat many types of viruses is still quite low.

Micafungin is contraindicated in patients who have which of the following? yeast infections, fever or chills, heart failure, liver or kidney disease

liver or kidney disease

A fungal infection is termed a ____. mucocutaneous infection, dermatophytosis, coccidioidomycosis, mycosis

mycosis

Select all indications for antibiotic prophylaxis.

neutropenia with fever, exposure to anthrax (bioterrorism), exposure to STD prior to sign of infection , history of rheumatic fever prior to surgical or dental procedures, presence of some prostheses or implants prior to surgical or dental procedures

An infection that is present because the immune system cannot fight the normal flora found on the body or in the environment is a/an ________.

opportunistic infection

Ethambutol is an anti-tubercular agent that may cause:

optic neuritis

Fungal superinfections usually occur in the anal, genital, and ____ areas. oral,ear, nail, eye

oral

This type of organism is considered a/an

parasite.

active against Gram-positive staphylococci and streptococci, Gram-negative neisseria and E. coli, spirochetes, and some anaerobic bacteria

penecillins

A precaution to prescribing cephalosporins is a history of allergy to which medication classes?

penicillins

Macrolides are named for the large size of the chemical compounds and are ______.

primarily bacteriostatic and indicated for treatment of Legionnaires' disease, Chlamydia infections, and atypical respiratory tract infections

Onychomycosis is also known as _____. tinea unguium, tinea corporis, tinea barbae, tinea pedis

tinea unguium

Sulfamethoxazole with trimethoprim is first-line treatment for ______. One important point of patient education is to instruct the patient to drink 8-10 glasses of water per day to prevent ____ in the kidneys.

utis; crystallization

In which phase of HIV infection are patients asymptomatic?, final phase, post clinical phase, clinical latency phase, replication phase

Patients with HIV infection are usually asymptomatic in the clinical latency phase. In this phase, HIV levels are lower. Even so, HIV does continue to replicate as CD4 T-lymphocytes progressively decline. This period averages about 10 years.

Immune system attacks healthy cells at site

Presence of prothetic joints, pacemaker, or other implantation

broad-spectrum and active against both Gram-negative and -positive; however more effective against Gram-negative bacteria

cephalosporins

A fungus is a one-celled plant that lacks ____. color and chlorophyll, spores, pathogenicity

color and chlorophyll

All people with weakened immune systems are considered ____. opportunistic, drug-resistant, infectious, immunocompromised

immunocompromised

During all stages of HIV infection, the virus replicates very quickly, particularly during stage: 1, 2, 3, 4

1

Antibiotics are substances produced by microorganisms that can ____

inhibit or kill other microorganisms

After exposure to HIV, prophylactic antiretroviral drugs should be administered within ___. 72-96 hours, 3--4 weeks, 1-2 hours, or 1-2 weeks

After exposure to HIV, prophylactic antiretroviral drugs should be administered within 1-2 hours, and no longer than 72 hours after exposure. These drugs must be continued for 28 days. The patient must be tested for antibodies against HIV at the time of exposure if possible, then again at 6 weeks, 12 weeks, and 6 months after exposure.

The human immunodeficiency virus infects which type of leukocyte? CD4 cells, plasma cells, CD8 cells, B-lymphocytes

CD4 cells

Richard has an infected lesion on his leg. Dr. Merry orders a prescription topical antibiotic to be applied to the lesion tid. Richard has taken multiple antibiotics in the past for a variety of illnesses. Select all true statements about this case.

Dr. Merry did not order an oral antibiotic because there was no indication of a systemic infection. The local antibiotic is less likely to cause cross-resistance given Richard's history of antibiotic use. Dr. Merry would order an oral antibiotic if Richard showed signs and symptoms of a systemic infection.

prevent HIV from entering cell by blocking fusion of the viral membrane with the bilipid layer of plasma membrane.

Entry/ Fusion Inhibitors (FI)

Carbapenems are broad-spectrum bactericidal medications that are frequently prescribed with other antibiotics to treat major infections

False

block protease enzyme to prevent the strands of genetic materials from being formed into functional pieces. Most effective in reducing viral loads to undetectable levels - used with NRTIs.

Protease Inhibitors

Antimicrobial resistance is a growing public health issue. Refer to this FDA-sponsored video in the lecture notes on this issue and select all correct statements about how resistance occurs.

Transduction occurs as bacterial DNA is transferred from one bacterium to another inside a virus that infects bacteria, called a phage, which then takes over the infected bacterium genetic processes to produce more phages that can infect other bacteria with the resistant DNA. Selection pressure is the outcome of natural selection, or the Darwinian principle of the "survival of the fittest", which has resulted in the ability of microorganisms to develop resistance to antimicrobials. Some mechanisms of antimicrobial resistance include mutuation, destruction (or inactivation), and efflux. Antimicrobial resistance can occur as a result of genetic transfer via conjugation, transformation, or transduction.

Sherry has recurrent HSV-1 lesions on her lips that develop when she is stressed or ill. When instructing her on the proper administration of docosanol and care of an outbreak, you include: HSV-1 is not very contagious, Wash and dry hands before and after applying, Clean and dry area/lesions before application of medication, Apply a thin layer of the cream every 3-4 hours 5 times a day during outbreak, She does not need to worry about spreading the during outbreaks, Use at the first sign of tingling, burning, redness, or a bump

Wash and dry hands before and after applying, Clean and dry area/lesions before application of medication, Apply a thin layer of the cream every 3-4 hours 5 times a day during outbreak, Use at the first sign of tingling, burning, redness, or a bump

Sara Jones is a 20-year-old college student. She wakes up with an extremely sore throat. Sara calls the doctor's office stating that she has a cold and a sore throat and requests a prescription for an antibiotic. Select all true statements about this case.

When the culture and sensitivity results are reported, the doctor may change the prescription to a narrow-spectrum antibiotic specific to the identified organism. The doctor will not order an antibiotic, but may schedule an office visit once more information is obtained about her signs and symptoms. Once the doctor sees Sara and determines that her signs/symptoms point to strep pharyngitis, the doctor will order a broad-spectrum antibiotic until the throat culture results are reported.

The ideal antimalarial should eradicate the microzoan from the blood and the tissue to ensure _____. The most common drug used for prophylaxis and treatment of acute malarial attacks is ____. resistance; quinine a treatment cycle; doxycycline prophylaxis; priaqmuine a radical cure;chloroquine

a radical cure; chloroquine

The usual treatment of Hepatitis A is with _____. protease inhibitors, immunoglobulin, no treatment - resolves on its own, NRTIs

immunoglobin

Tetracycline is contraindicated in all of the following except _______. infancy, lactation, pregnancy, adolescence

adolescence

Which drug is used for prophylaxis and treatment of influenza that works to inhibit replication of the influenza A virus by uncoating of the virus so it cannot attach. Select all that apply. ribavirin, amantadine, acylovir, zidovudine

amantadine

The drug with the widest spectrum of antifungal activity is ____. amphotericin B, flucytosine, ketoconazole, griseofulvin

amphotericin B

For the most effective treatment of an infection, the causative microorganism should be identified along with its drug susceptibility (or sensitivity) to the medication. One way of identifying microorganisms is by oxygen requirement. A bacterium that requires an oxygen-free environment is ____.The bacterium that can survive with or without oxygen is termed ________. A bacterium that requires oxygen to live is _____.

anaerobic, facultative, aerobic

An allergic reaction, or type I hypersensitivity reaction, to a medication may be manifested most often in the following ways ___.

anaphylaxis, hives, and rash

Which is not a risk factor for candidal infections? corticosteroid therapy, anemia, diabetes mellitus, pregnancy

anemia

Subtherapeutic doses are those that are

below the level used to treat a disease

Amphotericin B adverse effects include ____.

blood dyscrasias, loss of hearing, renal damage

Drugs with a wide range of effectiveness against both gram-positive and gram-negative bacteria are called ______________. Antibiotics that are effective against a few or specific bacteria are called_______.

broad spectrum antibiotics, narrow spectrum antibiotics

broad-spectrum and bactericidal action (antagonistic with other antibiotics)

carbapenems

As we've learned, the pharmacological action of antibiotics occurs at the cellular level. The effect is either bactericidal or bacteriostatic with each antibiotic group being defined by type or mechanism of action. What are the cellular actions of antibiotics?

destroy cellular wall, block respiratory enzymes, suppress nucleic acid synthesis, derange membrane function to interfere with metabolism and protein synthesis

The tetracyclines act by _____ to treat diseases/conditions like ___.

diffusing through bacterial wall to bind to ribosomes interfering with reproduction; Rocky Mountain spotted fever, Mycoplasma pneumoniae, cholera, chlamydia, Lyme disease, and acne

The term pathogenic means

disease-causing

Which drug is indicated for the treatment of Rocky Mountain spotted fever, typhus fever, and chlamydia and prophylaxis for travelers to regions that are endemic for malaria? tinidazole, metronidazole, pyrimethamine, doxycycline

doxycycline

Entamoeba histolytica and Giardia lablia are two protozoal organisms that frequently cause ____. ____ is the drug that treats both infections caused by these 2 organisms. dysentery; Tinidazole chlamydia; Metronidazole malaria; Pyrimethamine trichomoniasis; Nitazoxanide

dysentery; Tinidazole

Mary Jones is an 18 y/o who presents with complaint of a sore throat with fever, swollen tonsils, and enlarged cervical lymph nodes. The rapid strep test is negative and a swab is sent for culture and sensitivity (C&S) testing. Because of experience and observation, the physician feels that Mary has a bacterial infection, which may or may not turn out to be strep. The physician orders a broad spectrum antibiotic until the C&S results are reported within 48-72 hours. This type of treatment is termed ____. standard practice, anecdotal therapy, evidenced-based practice, empiric therapy

empiric therapy

Most antifungal drugs act by interfering with the synthesis of ___. gossypol, ergosterol, proteins, fluorouracil

ergosterol

Herpes zoster is a very painful rash that develops on one side of the face or body that follows a nerve pathway. It is managed with analgesics and which antiviral medications? There is more than 1 answer. famciclovir, acyclovir, amantadine, entecavir

famciclovir and acyclovir

Cryptococcal meningitis can be treated by IV injection of the antifungal agent _____. voriconazolde, itraconazole, fluconazole, griseofulvin

fluconazole

Which of the antifungal agents may cause angioedema, taste sensation changes, and hepatitis? fluconazole, amphotericin B, caspofungin, flucytosine

fluconazole

A one-celled organism that forms spores and thrives on dead organic matter is a/an

fungus

Fungicidal is defined as ____. increasing fungal growth, slowing fungal growth without destroying it, having a killing action on fungi, having a killing action of protozoans

having a killing action on fungi

Viruses are small amounts of genetic material wrapped in a protein coat. They can only replicate within a living cell relying on the______ to provide nutrition, metabolism, and reproduction.

host

What drug is a folic acid antagonist used to manage both malaria and toxoplasmosis? Patients taking this drug should be monitored for _____ and receive ____ to minimize this adverse effect. nitazoxanide; neutropenia; vitamin E pyrimethamine; bone marrow suppression; folinic acid nifurtimox; leukopenia; vitamin B12 primaquine; megaloblastic anemia; folic acid

pyrimethamine; bone marrow suppression; folinic acid

The treatment of choice for severe P. falciparum infection is ____. It is not used for malaria prophylaxis because of _____. quinidine; resistance quinine; high toxicity primaquine; superinfection development

quinine; high toxicity

You should inform patients that ____ may cause tears and urine to become a red-orange color.

rifampin

LaDonna White was being treated with a 21-day course of Augmentin for chronic sinusitis. After 10 days she developed a sore mouth with white patches on her tongue and oral cavity. This is an example of a/an________ , which is a secondary infection arising from the treatment with Augmentin for her primary infection. This candida albicans fungal yeast infection resulted because the microorganisms normally found in Jane's oral cavity, or _______were no longer inhibited so they created an overgrowth known as candidiaisis, or_______. The doctor treated her with a topical nystatin solution applied 4 times a day. What type of solution would this be?

superinfection, normal flura, thrush, antifungal

A common candidiasis infection of the mouth is called ___. aspergillosis, gossypol, gingivitis, thrush

thrush