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Final FA review > 4/3 micro > Flashcards

4/3 micro Flashcards

1
Q

Which cardiac abnormality causes wide & fixed splitting?

A

ASD

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2
Q

In cardiac splitting of S2: which sound comes last?

A

pulm. valve closing.

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3
Q

systolic ejection murmur that inc. in intensity w/standing.

A

hypertrophic cardiomyopathy

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4
Q

abrupt standing: how does this affect cardiac parameters?

A
  • dec. preload.

- dec. afterload.

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5
Q

What gets converted to propionyl coa?

-mnemonic?

A

VOMIT pathway:

  • valine
  • odd chain FA
  • methionine
  • isoleucine
  • threonine
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6
Q

glucocorticoids effect on glycogen in liver:

A

glycogenesis!

-you would think glycogenolysis, but nope!

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7
Q

fenoldopam

  • mech?
  • ues?
A
  • dopamine D-1 receptor agonist. Dec. BP & inc. natriuesis.

- hypetensive emergencies.

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8
Q

Cephalosporins

  • What do they not cover?
  • Whats the one exception?
A

LAME

  • listeria
  • atypicals
  • MRSA (except ceftaroline)
  • enterococci
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9
Q

Only cephalosporin to kill MRSA:

A

ceftaroline.

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10
Q

1st generation cephalos:

  • name them?
  • coverage?
  • mnemonic:
A
  • cefazolin, cephalexin.
  • PEcK
  • Proteus
  • E.coli
  • Klebsiella
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11
Q

2nd gen cephalos

  • coverage?
  • mnemonic?
A

HEN PEcKS

  • H. influenzae
  • enterobacter
  • neisseria
  • proteus
  • E.coli
  • klebsiella
  • serratia
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12
Q

Ceftriaxone

  • which gen. cephalo?
  • uses?
A
  • 3rd gen.

- meningitis and gonorrhea.

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13
Q

Ceftazidime

  • which gen. cephalo?
  • uses?
A
  • 3rd gen.

- Pseudomonas.

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14
Q

Cefepime

  • which gen. cephalo?
  • uses?
A
  • 4th gen.

- Pseudomonas.

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15
Q

ceftaroline

  • which gen. cephalo?
  • uses?
A
  • 5th gen.

- MRSA.

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16
Q

Which cephalos target pseudomonas?

-mnemonic?

A

CeftazaDIME & cefe”PRIME” = the girl in the tub in the pseudomonas vid was a DIME piece, super PRIME.

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17
Q

Cephalos

-tox:

A
  • vitamin K deficiency.

- nephrotoxicity of aminoglycosides.

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18
Q

Which antibiotic can cause vitamin K deficiency?

A

Cephalos

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19
Q

Which 2 antibiotic classes together are very nephrotoxic?

A

Cephalos & aminoglycosides.

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20
Q

tryptase

-marker for what?

A
  • released by mast cells.

- marker for mast cell activation.

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21
Q

Aztreonam

  • is it a lactam?
  • sensitive to beta-lactamases?
  • can you use it if you’re allergic to PCN?
A
  • yes.
  • no, not sensitive.
  • yes, no cross-reactivity w/PCN.
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22
Q

Aztreonam

-mech:

A

-Prevents peptidoglycan cross-linking by binding to

penicillin-binding protein 3.

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23
Q

Aztreonam:

-Synergistic with:

A

Synergistic with aminoglycosides.

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24
Q

Aztreonam:

  • target:
  • can it target anaerobes?
A
  • gram (-) rods.
  • the specific type of PBP it binds to are only found on gram (-) rods.
  • can NOT target anaerobes!
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25
Q

Carbapenems

  • lactam?
  • sensitive to beta-lactamases?
  • can you use it if you’re allergic to PCN?
A
  • yes.
  • no, not sensitive.
  • no, you cant.
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26
Q

Imipenem

  • must administer w/what drug?
  • why?
A
  • Cilastatin = inhibitor of renal dehydropeptidase I

- To dec. inactivation of drug in renal tubules.

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27
Q

Carbapenems

-suffix?

A

-“penem”

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28
Q

Carbapenems

  • tox?
  • which is safest carbapenem?
A
  • CNS toxicity (seizures).

- meropenem.

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29
Q

Vancomycin

  • tox:
  • mnemonic:
A

NOT trouble free

  • Nephrotoxicity, Ototoxicity, Thrombophlebitis.
  • red man syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate).
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30
Q

Linezolid

-mech:

A

prevent formation of 70S ribosome.

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31
Q

Aminoglycosides

-why cant they be used against anaerobes?

A

bc they req. O2 for uptake.

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32
Q

Aminoglycosides

-mnemonic for names & tox:

A

mean GNATS caNNOT kill anaerobes!

  • gentamicin
  • neomycin
  • amikacin
  • tobramycin
  • streptomycin
  • nephrotoxic (esp. w/cephalos)
  • NMJ blockade
  • ototoxicity
  • teratogen

*cant kill anaerobes.

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33
Q

Aminoglycosides

-mech:

A

-Inhibit formation of initiation complex and cause misreading of mRNA. Also blocks translocation.

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34
Q

Aminoglycosides

  • ototoxicity is worse when used w/what?
  • nephrotoxicity is worse when used w/what?
A
  • oto = loop diuretics.

- neph = cephalosporins.

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35
Q

Aminoglycosides

-mech of resistance?

A

Bugs conjugate the drug so its eliminated faster than it can work.
-using transferase enzymes.

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36
Q

Tetracyclines

  • coverage?
  • mnemonic:
A

May Cause Rough Bite

  • mycoplasma
  • chlamydia
  • ricketsia
  • borrelia burgdorferi
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37
Q

Tetracyclines

  • mech:
  • what inhibits its absorption?
A
  • prevents binding of tRNA to A site.

- divalent cations inhibit its absorption in the gut. Its a chelator.

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38
Q

Tetracyclines

-tox:

A
  • Discoloration of teeth and inhibition of bone growth in children, photosensitivity.
  • teratogen.
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39
Q

Tetracyclines

-mech of resistance:

A

Plasmid-encoded transport pumps.

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40
Q

Macrolides

-how to recognize?

A

-“thro mycin”.

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41
Q

Which macrolide is NOT a P450 inhibitor?

A

azithromycin.

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42
Q

Macrolides

  • mech:
  • which part of ribo does it bind?
A

-Blocking translocation (“macroslides”); bind to the 23S rRNA of the 50S ribosomal subunit.

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43
Q

Macrolides

  • coverage:
  • mnemonic?
A 
"blew out MCL during "slide". 
Soccer ball represents gram (+) cocci. 
M=mycoplasma
C=chlamydia
L=legionella
*Its also atypical to blow your MCL out in soccer - atypical pneumonias
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44
Q

Macrolides

  • tox:
  • mnemonic:
A

MACRO

  • motility (binds to motilin receptors).
  • arrythmia (QT prolongation).
  • cholestatic hepatitis
  • rash
  • eOsinophilia
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45
Q

Macrolides

-mech of resistance:

A

Methylation of 23S rRNA-binding site prevents binding of drug.

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46
Q

linezolid

-tox:

A

bone marrow suppression (esp. platelets).

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47
Q

Chloramphenicol

  • coverage?
  • tox?
  • mnemonic?
A

GRAM

  • grey baby syndrome
  • ricketsia
  • aplastic anemia
  • meningitis
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48
Q

Chloramphenicol

  • mech:
  • mech of resistance?
A
  • Blocks peptidyltransferase at 50S ribosomal subunit.

- Plasmid-encoded acetyltransferase inactivates the drug.

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49
Q

Clindamycin

  • mech: (same as which other drug)?
  • mech of resistance?
A

-Blocks peptide transfer (translocation) at 50S
ribosomal subunit.
-same as macrolide.
-Methylation of 23S rRNA-binding site prevents binding of drug.

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50
Q

Clindamycin

  • coverage?
  • mnemonic?
A
  • linDAA has GAS. AAD = anaerobes above diaphragm.

- GAS = group A strep, also reminds you about psuedomembranous colitis.

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51
Q

Sulfonamides

  • mech?
  • bacteriocidal or static?
A
  • PABA antimetabolites inhibit dihydropteroate synthase.

- bacteriostatic! (stops it from growing, doesn’t kill it).

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52
Q

Sulfonamides

  • coverage?
  • tox?
  • mnemonic?
A

CUNG HANK

  • chalmydia
  • UTI
  • nocardia
  • gram +/-
  • hemolysis in G6PD def.
  • albumin displaced
  • nephrotoxic
  • kernicterus
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53
Q

Babies w/E.coli or GBS meningitis (or any E.coli infection) should NOT be treated _____.
-why?

A

sulfondamides

-can cause kernicterus in kids by displacing unconjugated bili from albumin.

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54
Q

which bilirubin is complexed w/albumin?

A

indirect bili.

55
Q

TMP-SMX

-bacteriostatic or cidal?

A

static

56
Q

TMP

  • tox:
  • mnemonic:
A

Treats Marrow Poorly.

-Megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folinic acid).

57
Q

Fluoroquinolones

-suffix?

A

-oxacin.

58
Q

Fluoroquinolones

  • mech?
  • cidal or static?
  • dont take it with what drug?
A
  • Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV.
  • Bactericidal.
  • Must not be taken with antacids.
59
Q

If you’re on antacids, which ABx should you NOT take?

A

Fluoroquinolones

60
Q

nalidixic acid

-what is it?

A

a quinolone

61
Q

Fluoroquinolones

  • C/I in which pts?
  • tox:
  • mnemonic:
A
  • children not done w/growth spurt, nursing mothers, pregnant women.
  • Fluoroquinolones hurt attachments to your bones.
  • tendonitis, tendon rupture, leg cramps, and myalgias.
  • some prolong QT interval & can cause torsades bc they interefere w/ions like Calcium.
62
Q

Which two ABxs can cause QT prolongation and possible torsades?
-which one more associated with this?

A

Macrolides & fluoroquinolones.

-macrolides.

63
Q

Fluoroquinolones

-tendon rupture risk inc. w/concurrent use of what drug?

A

prednisone.

64
Q

Metronidazole

-mech:

A

-Forms free radical toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.

65
Q

Metronidazole

  • targets?
  • mnemonic?
A

GET GAP on the Metro

  • giardiasis
  • entamoeba histolytica
  • trichomonas vaginalis
  • gardnerella vaginalis
  • anaerobes below diaphragm (C. dif, bacteroides).
  • h. Pylori
66
Q

Metronidazole

  • tox:
  • mnemonic:
A
  • you’re on a metal (metallic taset) metro-train and you get car sick (disulfiram).
  • metallic taste, disulfiram like reaction.
67
Q

M. avium–intracellulare

-Tx:

A

Azithromycin or clarithromycin + ethambutol.

*Can add rifabutin or ciprofloxacin.

68
Q

M. leprae

-Tx:

A

Long-term treatment with dapsone and rifampin for tuberculoid form.
-Add clofazimine for lepromatous form.

69
Q

M. tuberculosis

-prophylaxis?

A

isoniazid + B6

70
Q

Isoniazid (INH)

  • mech:
  • what does it need to be activated?
A
  • Inhibit synthesis of mycolic acids.

- Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.

71
Q

Which TB med is a prodrug?

-what does it need to be activated?

A
  • Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.
  • pyrazinamide is also a prodrug.
72
Q

Isoniazid (INH)

  • how is it metabolized?
  • whats special about this?
  • what other drugs are metabolized this way?
A
  • isoniazid, dapsone, hydralazine, procainamide = all metabolizes thru acetylation.
  • slow/fast acetylators: can get bimodal distribution graph.
73
Q

Isoniazid (INH)

-effect on P450 system:

A

Inhibitors P450 system.

74
Q

Isoniazid (INH)

  • tox:
  • mnemonic:
A

INH Injures Neurons and Hepatocytes.

  • Neurotoxicity, hepatotoxicity, drug-induced lupus.
  • B6 def => peripheral neuropathy.
75
Q

What type of anemia can isoniazid lead to?

-why?

A
  • B6 deficiency.
  • Can’t build heme w/o B6. You’ll get sideoblastic anemia. The RBCs will be made w/o Iron. So you will get inc. serum iron.
76
Q

Rifamycins

-mech:

A

-Inhibits DNA-dependent RNA polymerase.

77
Q

Rifamycins

-prophylaxis for which bugs?

A

H. influenza, N. meningitidis.

78
Q

Rifamycins

  • which two drugs?
  • which one inc. P450?
  • which one favored in HIV pts?
A

rifampni, rifabutin.

  • rifampin ramps up P450, rifabutin does not.
  • Rifabutin favored over rifampin in patients with HIV infection due to less cytochrome P-450 stimulation.
79
Q

Pyrazinamide

-mech:

A
  • acidify intracellular environment.

- Effective in acidic pH of phagolysosomes, where TB engulfed by macrophages is found.

80
Q

Pyrazinamide

-tox:

A

Hyperuricemia, hepatotoxicity.

81
Q

which TB drug can cause gout?

A

Pyrazinamide can cause hyperuricemia.

82
Q

Ethambutol

-mech:

A

Inhibit carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase.
*like a beta-lactam but for TB cell wall.

83
Q

Ethambutol

  • tox:
  • mnemonic:
A

Ethambutol sounds like ethanol. Arabs drink lots of ethanol. When you’re hammered you cant see straight.

  • Arabs dont celebrate christmas (no red/green).
  • Optic neuropathy (red-green color blindness).
84
Q

Endocarditis with surgical or dental procedures

-pophylaxis:

A

PCN

85
Q

Meningococcal infection

-pophylaxis:

A

Ciprofloxacin (drug of choice), rifampin for children.

86
Q

Pregnant woman carrying group B strep

-prophylaxis:

A

ampicillin.

87
Q

Prevention of postsurgical infection due to S. aureus:

A

Cefazolin

88
Q

Prophylaxis of strep pharyngitis in child with

prior rheumatic fever:

A

PCN

89
Q

Syphilis

-prophylaxis

A

Benzathine penicillin G

90
Q

pentamidine

-can treat what?

A

pneumocystis jirovecci

91
Q

Which ABxs can treat MRSA?

A
  • vancomycin
  • daptomycin
  • linezolid (can cause serotonin syndrome)
  • tigecycline
  • ceftaroline
92
Q

Which ABxs can treat VRE?

A
  • linezolid

- streptogramins (quinupristin/dalfopristin).

93
Q

Daptomycin

  • mech?
  • targets?
  • what inactivates it?
A
  • Bacteriocidal against almost all gram (+) bacteria.
  • creates transmembrane channels which disrupts the membrane. Fucks up the membrane potential. Leaking ions.
  • inactivated by pulmonary surfactant, so cant treat pneumonias
  • cant penetrate outer membrane, so cant treat gram negatives.
94
Q

Daptomycin

-tox:

A

-Associated w/myopathy. CK levels checked periodically.

95
Q

surfactant inactivates which ABx?

A

Daptomycin

96
Q

linezolid

  • mech:
  • targets:
A
  • bacteriostatic.

- inhibits protein synth by binding to 50S subunit.

97
Q

linezolid

-tox:

A
  • Occasionally linked to bone marrow suppression.
  • neuritis.
  • Can have MAO inhibitory actions as well, so watch out if you take it w/SSRI = could get serotonin syndrome.
98
Q

wolff parkinsons white
-PR interval:
-QRS complex:
are they inc or dec?

A
  • PR interval dec.

- QRS complex widened.

99
Q

Brocas

-which lobe?

A

frontal lobe

100
Q

beta-blocker OD

-tx?

A

glucagon

-by increasing cAMP.

101
Q

isoproterenol

-whats it do?

A

nonspecific beta agonist.

102
Q

How is digoxin cleared?

A

Renally.

103
Q

sickle cell

-whats the substitution?

A

valine put in for glutamic acid at residue 6.

104
Q

Hartnup disease

-whats the problem?

A

Deficiency in neutral AA absorption in kidney & gut.

  • ie. tryptophan (which is used to make serotonin, niacin, & melatonin).
  • results in B3 (niacin) deficiency => photosensitivity & pellagra like skin rashes.
105
Q

tocopherol

-what is it?

A

vitamin E

106
Q

tocotrienol

-what is it?

A

vitamin E

107
Q

GLUT-2

  • high or low Km?
  • high or low capacity?
  • which tissues?
A
  • high Km
  • high capacity
  • liver, pancreatic B-cells, renal tubular cells, small intestine.
108
Q

In which situation will you see acyclovir nephrotoxicity?

A

Young HSV-1 encephalitis pt hospitalized receiving IV acyclovir.

109
Q

Which sexual development disorder can present w/virilization of the mother in utero?

A

aromatase deficiency.
*placenta has aromatase. Thats why a 21-hydroxylase def. or anything like that would not lead to maternal virizilation. The placental aromatase would handle those excess androgens.

110
Q

Amphotericin B

-what do you have to supplement this drug with?

A

-Supplement K+ and Mg2+ because of altered renal tubule permeability.

111
Q

Amphotericin B

-commonly used w/which other drug?

A

flucytosine

112
Q

Amphotericin B

  • tox?
  • how to dull some of the toxic effects?
A
  • Fever/chills, hypotension, nephrotoxicity, arrhythmias, IV phlebitis.
  • suppression of EPO synth => anemia.
  • Hydration dec.  nephrotoxicity.
  • Liposomal amphotericin dec. toxicity.
113
Q

Azoles

-mech:

A
  • Inhibit 14–α–demethylase which converts lanosterol to ergosterol.
  • its a P450 enzyme!
114
Q

Azoles

-which is only azole that crosses BBB?

A

fluconazole

115
Q

topical fungal infections

-which anti-fungals?

A

Clotrimazole and miconazole.

-aka clotrimin-ultra.

116
Q

Azoles

-tox:

A
  • Testosterone synthesis inhibition = a P450 enzyme makes testosterone.
  • gynecomastia (esp. with ketoconazole)
  • liver dysfunction = inhibits cytochrome P-450.
117
Q

What other random drug had anti-androgen effects like the azoles?

A

spironolactone

118
Q

How does ketoconazole produce anti-androgen effects?

A

Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis.
-will reduce androgens as well as cortisol.

119
Q

How does spironolactone produce anti-androgen effects?

A

1) Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis.
- will reduce androgens as well as cortisol.
2) inhibits steroid binding.
3) inhibits 17alpha-hydroxlase.

120
Q

How do spironolactone and ketoconazole lead to amenorrhea?

A

No androgens means no estrogens.

-no estrogen = no menses.

121
Q

Flucytosine

  • what is it?
  • mech?
A
  • Inhibits DNA and RNA biosynthesis => anti-fungal.
  • converted to 5-FU by cytosine deaminase.
  • 5-FU inhibits thymidilate synthase.
122
Q

Flucytosine

-use?

A

Systemic fungal infections (esp. meningitis caused by Cryptococcus) in combination with amphotericin B.

123
Q

Echinocandins

-suffix?

A

-fungin.

124
Q

Echinocandins

  • mech?
  • mnemonic:
A

Inhibits cell wall synthesis by inhibiting synthesis of β-glucan.
-echinocanDIN(ner) - ends w/GIN: Glucan INhibitor.

125
Q

Echinocandins

  • target?
  • mnemonic:
A
  • Invasive aspergillosis, Candida.

- C-AS-pofungin: C=candida, AS=aspergillosis.

126
Q

Echinocandins

-tox:

A

GI upset, flushing (by histamine release).

127
Q

Terbinafine

  • mech:
  • mnemonic:
A

-Inhibits the fungal enzyme squalene epoxidase. Part of ergosterol synth pathway.
“Use epoxy glue to fix the turbine. They were squeeking.”

128
Q

Terbinafine

-use:

A

Dermatophytoses (especially onychomycosis—fungal infection of finger or toe nails).

129
Q

Terbinafine

  • tox:
  • mnemonic:
A
  • hepatotoxicity, taste disturbance.

- think of turbines in nose and associate w/taste impairment

130
Q

Griseofulvin

  • mech:
  • mnemonic:
A

Interferes with microtubule function. Deposits in keratin-containing tissues.
-Grease up the MTs.

131
Q

Griseofulvin

-use:

A

Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm).

132
Q

Griseofulvin

-tox:

A

Teratogenic, carcinogenic, confusion, headaches, inc. P-450 and warfarin metabolism.

133
Q

Besides the azoles, which other antifungal inc. P450 system?

A

griseofulvin.

“greasy”

Final FA review (52 decks)

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