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Pharm 5 > Antibacterials > Flashcards

Antibacterials Flashcards

1
Q

natural penicillins

A

penicillin G

penicillin V

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2
Q

B lactamase resistant penicillin

A 
cloxacillin
oxacillin
dicloxacillin
methicillin
nefcillin
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3
Q

broad/extended spectrum penicillins

A 
amoxicillin
ampicillin
ticarcillin
carbenicillin
piperacillin
mezlocillin
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4
Q

penicillinase inhibitors

A

sulbactam

clavulanic acid

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5
Q

1st gen cephalosporins

A

cephalexin

cefazolin

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6
Q

what causes pseudomembranous colitis

A

c. difficile

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7
Q

what group of drugs are B-Lactams

A

penicillins
cephalosporins
carbapenins
aztreonam

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8
Q

what do B-Lactams do?

A

they bind to penicillin binding proteins and inhibit transpeptidaztion, the bacteria can’t make cell wall

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9
Q

what have baceteria developed to resist B lactams

A

B-lactamases

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10
Q

natural penicillins are derived from what

A

penicillin notatium

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11
Q

penicillin G given how

A

IV, cuz its hydrolyzed by the stomach acid

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12
Q

penicillin G characteristics

A

narror spectrum, mostly gram +

destroyed by B-Lactamase

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13
Q

penicillin V is given how

A

orally, acid stable. unpredictable absorption

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14
Q

T/F broad or extended spectrum penicillins are resistant to B-lactamases

A

false

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15
Q

how is amoxicillin given?

A

orally

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16
Q

contraindications with ampicillin

A

causes rash in patients with mononucleosis and other viral infections

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17
Q

what do penicillinase inhibitors do?

A

inhibit penicillinase (B-Lactamase) not an antibiotic

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18
Q

T/F you use penicillinase inhibitors in combination

A

true

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19
Q

S.E. of all penicillins

A

B lactam ring may inhibit GABA
high IV dose may induce seizures
allergic responses

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20
Q

structure of cephalosporins

A

have 2 R groups on B-lactam ring that can be used or changed

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21
Q

how many generations of cephalosporins are there

A

5

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22
Q

each generation of cephalosporin is better at what?

A

more gram - activity

more resistance to B lactamase

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23
Q

second generation cephalosporins

A

cefaclor
cefuroxime
cephamycins

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24
Q

third generation cephalosporins

A

ceftazidime
ceftiaxone
cefoperazone

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25
Q

4th generation cephalosporins

A

cefepime

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26
Q

5th generation cephalosporins

A

ceftaroline

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27
Q

S.E. of cephalosporins

A

some allergic cross reactivity with penicillin sensitive patients.
possibility of superinfection

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28
Q

is there a problem for a pt who is sensitive to penicillin to give them cephalosporin?

A

yes, some cross allergic responses.

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29
Q

carbapenems general characteristics

A

smaller penicillinase resistance B lactams
very broad spectrum
can enter CNS more readily- increase seizures

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30
Q

how are carbapenems given?

A

IV

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31
Q

2 carbapenems

A

imipenem

meropenem

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32
Q

imipenem is better for what

A

gram +

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33
Q

meropenem is better against what

A

gram -

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34
Q

S.E. of imipenem

A

metabolized to a nephrotoxic product, given with another drug that stops the toxic product

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35
Q

what is given with imipenem?

A

cilastatin

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36
Q

what does cilastatin do?

A

inhibits the metabolic enzyme in the kidney that produces the toxic product from imipenem

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37
Q

one of the monobactam drugs

A

aztreonam

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38
Q

aztreonam is given how?

A

IV or IM

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39
Q

is aztreonam affected by B lactamases?

A

no

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40
Q

what is aztreonam used for?

A

aerobic gram - bacteria like e coli.

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41
Q

T/F aztrenam is cross reactive with allergic patients?

A

FALSE, it is not.

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42
Q

S.E. of aztreonam

A

seizures

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43
Q

non B lactic cell wall inhibitors

A 
vancomycin
televancin
dalbavancin
bacitracin
fosfomycin
cycloserine
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44
Q

vancomycin MOA

A

binds to dialamine residues on subunits of the cell wall and prevents cross linking

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45
Q

vancomycin used for what

A

most gram + infections. and staphylococcal infections that are resistant to B lactamases

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46
Q

how is vancomycin given? and what is the exception

A

IV, given orally with c. difficile infection

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47
Q

S.E. of vancomycin

A

nephrotoxicity
ototoxicity
rapid IV causes histamine release, leads to flushing, rash, itching (red man syndrome)

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48
Q

what drug causes red man syndrome

A

vancomycin

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49
Q

T/F bacteria treated with vancomycin can become resistant by changing their dialamine residue to lactic acid

A

TRUE

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50
Q

televancin and dalbavancin are both what

A

lipoglycopeptides

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51
Q

MOA of televancin and dalbavancin

A

act both like vancomycin and as a disrupter of bacterial cell membrane

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52
Q

S.E. of dalbavancin

A

fetal damage
renal damage
metalic taste in mouth

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53
Q

dalbavancin is used to treat what

A

complex skin infections with gram + bacteria and hospital acquired infections.

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54
Q

bacitracin MOA

A

inhibits recycling of the bactoprenol carrier vs gram + cells,

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55
Q

bacitracin is given how, why?

A

topically, given orally causes nephrotoxicity

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56
Q

bacitracin especially useful against what

A

staph

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57
Q

fosfomycin MOA

A

blocks synthesis of n acetyl muramic acid

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58
Q

fosfomycin useful against what

A

aerobic gram - bacteria like e coli and for uncomplicated urinary tract infections

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59
Q

S.E. of fosfomycin

A

diarrhea

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60
Q

cycloserine MOA

A

inhibits incorporation of alumni into n acetyl muramic acid

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61
Q

cycloserine used against what

A

mycobaceterium tuberculosum

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62
Q

S.E. for cycloserine

A

CNS sedation, tremor, psychosis

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63
Q

antibiotics that inhibit bacterial protein synthesis

A

macrolides
aminoglycosides
tetracyclines

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64
Q

macrolides

A

erythromycin
clarithromycin
azithromycin
telithromycin

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65
Q

erythromycin (macrolides) MOA

A

reversibly binds to the 50s subunit and inhibits translocation of mRNA. inhibits binding of tRNA to the “p” site

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66
Q

S.E. of erythromycin

A 
Gi upset- nausea, heat burn
increase Gi activity by increasing motion
inhibits P450
liver damage
cardiac arrhythmias
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67
Q

erythromycin works against what

A

gram + like staph and strep

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68
Q

how do you take clarithromycin?

A

orally

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69
Q

what is clarithromycin used against

A

helicobacter pylori, associated with ulcer formation

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70
Q

what drug inhibits P450

A

erythromycin

71
Q

what is special about azithromycin?

A

longer halflife 3 days

72
Q

telithromycin MOA

A

same as other macrocodes but induces less resistance because it is not as readily transported out of bacterial cell

73
Q

S.E. of telithromycin

A

severe liver toxicity
blocks cholinergic receptors in muscle- worsens myasthemia gravis and inhibits cillary ganglion- decrease visual accomidation

74
Q

what drug induces severe liver toxicity?

A

telithromycin

75
Q

what drug has cholinergic effects, including eye affects

A

telithromycin

76
Q

aminoglycosides

A 
streptomycin
gentamycin
amikacin
neomycin
tobramycin
kanamycin
netilmicin
77
Q

do all macrocodes have same MOA

A

YES

78
Q

do all aminoglycosides have same MOA

A

YES

79
Q

streptomycin (aminoglycoside) MOA

A

irreversibly bind to 30s subunit. can inhibit tRNA binding all along mRNA, including the initial site.

80
Q

how do you give streptomycin?

A

IM, generally does not enter CNS

81
Q

does streptomycin enter CNS?

A

no

82
Q

S.E. streptomycin

A

NNOF
ototoxicity- both balance and hearing affected. hearing loss may be permanent
nephrotoxicity- lead to renal failure
high does leads to decrease Ach and receptors on muscle, neuromuscular blocade
fetal damage

83
Q

targets of streptomycin

A

gram - aerobic bacteria

84
Q

what drug has neuromuscular blocking side affects

A

streptomycin

85
Q

gentamicin used for what

A

eye solution

86
Q

neomycin used how?

A

topically or orally

nephrotoxic

87
Q

tetracycline and other cycline MOA

A

reversibly bind to 30s subunit- bacteriostatic

inhibits binding of tRNA to the “a” site

88
Q

how is tetracycline given?

A

orally or parenterally

89
Q

S.E. of tetracycline

A

binds to cations like Ca deposited in storage site (teeth, bone) causes stains in teeth
preg category D
renal and hepatic toxic- degrades over time to toxic elements, why you don’t use pass expiration date

90
Q

what drug do you definitely not want to use after expiration date and why?

A

tetracycline, turns into renal and hepatic toxins

91
Q

targets of tetracycline

A

rickettsia
spirochetes
helicobacteria
legionella

92
Q

advantages of “other” tetracyclines

A

less likely to bind to Calcium

93
Q

tetracycline drugs

A

tetracycline
doxycycline
minocycline
tigecycline

94
Q

chloramphenicol MOA

A

inhibits peptidyltransferase (enzyme inhibitor)

95
Q

S.E. chloramphenicol

A

inhibits P450
can cause aplastic anemia
GREY BABY SYNDROME

96
Q

what drug causes grey baby syndrome

A

chloramphenicol

97
Q

what is grey baby syndrom

A

chloramphenicol is metabolized by phase 2. enzymes needed/used in phase 2 are not present in new borns so they can’t metabolize the drug, causes vasomotor collapse and baby turns blue, dies?

98
Q

lincosamides

A

clindamycin

lincomycin

99
Q

MOA of clindamycin/lincomycin

A

like erythromycin, inhibits translocation

100
Q

S.E. of clindamycin/ lincomycin

A

severe superinfections with c. difficile

101
Q

targets of clindamycin/ lincomycin

A

severe anaerobic infections like penetrating gut wound

used for dental prophylaxis in patients with heart valve problems

102
Q

streptogramins

A

quinupristin + dalfopristin

103
Q

quinupristin + dalfopristin MOA

A

inhibit A and P sites - quinupristin

inhibits P site- dalfopristin

104
Q

S.E. of quinopristin and dalfopristin

A

muscle pains (beware of synergistic effects)

105
Q

targets of quinupristin and dalfopristin

A

gram +

106
Q

oxazolidinones

A

linezolid, tedizolid

107
Q

linezolid MOA

A

inhibits binding of f methionyl tRNA to the P site, prevents initiation of the synthesis process

108
Q

linezolid S.E.

A

anemia, pseudomembranous colitis

109
Q

most powerful antibiotics causes this

A

pseudomembranous colitis

110
Q

daptomycin is a _____

A

lipopeptide

111
Q

daptomycin MOA

A

not cell wall or protein synthesis

acts by disrupting bacterial cell membrane. forms pores in the membrane

112
Q

S.E. of daptomycin

A

muscle pain and weakness
pneumonia
careful with using with statins

113
Q

what two drugs cause muscle pain and weakness

A

statins and daptomycin

114
Q

targets of daptomycin and what is it used for

A

aerobic gram + only- strep, staph

used in skin and soft tissue infection or severe blood infection with staph Aureus.

115
Q

fidaxomycin is given how

A

orally, non systemically absorbed, used against c. difficle

116
Q

fidaxomycin used against what

A

c. difficle infection

117
Q

fidaxomycin MOA

A

c difficle RNA polymerase, (enzyme inhibitor)

118
Q

Fluoroquinolines

A

“floxacin” 10 on the market

119
Q

ciprofloxacin MOA

A

inhibits topoisomerase 2 and 4. (enzyme inhibitor)

120
Q

T/F ciprofloxacin has an affect on mammalian topoisomerase as well as bacterial

A

FALSE, very specific for bacterial

121
Q

S.E. of ciprofloxacin

A

damage developing cartilage- not for children or pregnant women
tendonitis, achilis tendon rupture
phototoxicity- rash in sun
worsens myasthenia graves

122
Q

who is ciprofloxacin contraindicated in

A

children and preg women, affects developing cartilage

123
Q

targets or ciprofloxacin

A

broad

gram -/+, acid fast

124
Q

antimetabolites- sulfonamides

A

sulfisoxazole
sulfacetamide
sulfadiazine
trimethoprim

125
Q

sulfisoxazole MOA

A

reversibly inhibit dihydropterate synthetase (inhibits enzyme)

126
Q

what does dihydrojpterate synthase eventually create?

A

tetrahydrofolic acid, must be made by the bacteria

127
Q

S.E. of sulfisoxazole

A

allergic whole body rash- stevens johnson syndrome
hemolytic anemia in G6PDH deficient pt’s.
megaloblastic anemia

128
Q

what drug causes steven johnson syndrome

A

sulfisoxazole

129
Q

sulfisoxazole is used for what

A

urinary tract infections. any drug with SUL or SULF is probably a sulfur drug.

130
Q

trimethoprim MOA

A

inhibits dihydrofolate reductase (enzyme inhibitor)

131
Q

trimethoprim is used in conjunction with what

A

sulfamethoxizole

132
Q

S.E. of trimethoprim

A

megalobalstic anemia

can be avoided with use of leukovorin

133
Q

magloblastic anemia caused by trimethoprim can be avoided with use of what

A

leukovorin

134
Q

trimethoprim used for what?

A

gram (-) bacteria, urinary tract infections- concentrates in acidic prostate/ vaginal tissue

135
Q

metronidazole is a _____ and converted to ____

A

prodrug, converted to free radical

136
Q

how is metronidazole given

A

IV

137
Q

what is metronidazole used for

A

anaerobic bacteria infection but mainly for

protozoan infections- trichimonas, gardia

138
Q

what drug is used for protozoan infections?

A

metronidazole

139
Q

nitrofurantoin is a _____

A

reduced by bacteria to highly reactive molecule, concentrates in urine

140
Q

nitrofurantoin is used for what

A

UTI

141
Q

S.E. of nitrofurantoin

A

cough, chest pain, brown colored urine

142
Q

agents used only topically

A 
polymixin B 
gramicidin
neomycin
retapamulin
mupirocin
143
Q

Polymixin B MOA

A

binds to negatively charged sites on LPS of gram - bacteria - Increases membrane permeability.

144
Q

S.E. of polymyxin B

A

nephrotoxic
neurotoxic
ataxia
perioral parasthesia

145
Q

mupirocin MOA

A

binds to bacterial isoleucyl tRNA synthesis

146
Q

retapamulin MOA

A

inhibits pepitdyl transferase

147
Q

retapamulin is used for what

A

topical treatment of skin staph or strep infections

148
Q

antimycobacterial agents

A 
isoniazid
rifampin
pyrazinamide
ethambutol
bedaquiline
149
Q

all antimycobacterial agents are what

A

enzyme inhibitors

150
Q

T/F you always use two or more antimycobacterial agents to prevent resistance

A

TRUE

151
Q

antimycobacterial agents are a major problem in what kinds of people

A

immunosuppresive

152
Q

antimycobacterial agents are different how?

A

cell wall different, live inside target cells can lay inside dormant

153
Q

Isoniazid is a ____

A

prodrug

154
Q

metabolism of isoniazid produces what

A

produces an inhibitor of multiple mycobacterial enzymes, inhibits cell wall synthesis

155
Q

isoniazid is a bacterial____

A

static for dormant cells

156
Q

T/F isonizid is used in combination and for prophylaxis

A

true

157
Q

how is isoniazid metabolized

A

acetylation

158
Q

S.E. of isoniazid

A 
increase excretion of Vit B6 causes pyridoxime deficiency
niacin deficiency - pellegra tumor
optic neuritis
hepatotoxicity
peripheral neuropathy
159
Q

rifampin MOA

A

inhibits DNA depend RNA polymerase- cidal

160
Q

what is a big static antibacterial agents

A

isoniazid

161
Q

rifampin S.E.

A

hepatic toxicity
body fluids TURN RED
induces P450 very strong (little surprise)

162
Q

what drug is related to the “little surprise”

A

rifampin

163
Q

pyrazinamide is a _____

A

prodrug

164
Q

where is pyrazinamide converted and what is its MOA

A

converted in macrophages where TB lives. inhibits fatty acid synthesis by TB

165
Q

S.E. of pyrazinamide

A

gout

hepatitis

166
Q

ethambutol MOA

A

inhibits transferase, necessary for cell wall synthesis

167
Q

S.E. ethambutol

A

optic neuritis

impared red/green discrimmination- decreases vision

168
Q

how do you use bedaquiline

A

always used with at least 3 other antiTB drugs

169
Q

bedaquiline MOA

A

inhibits mycobacterial ATP synthetase

170
Q

S.E. bedaquiline

A

arrhythmias

171
Q

dapsone related to what

A

sulfonamides, same MOA

172
Q

dapsone is used for what

A

mycobacterium leprae

173
Q

you can’t use _______ as antimycoplasma agents

A

any cell wall inhibitors

174
Q

what two drugs will work as antimycoplasms

A

erythromycin

tetracycline

Pharm 5 (3 decks)

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