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Antibiotic drugs Flashcards

1
Q

drugs that block peptidoglycan synthesis

A

bacitracin, vancomycin

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2
Q

drugs that work by damaging DNA

A

metronidazole

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3
Q

Drugs that block 50S

A

Chloramphenicol, clindamycin, Linezolid
Erythromycin

Also streptogramins (-pristin)

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4
Q

cephalosporin, aztreonam, imipenem mechanism

A

block cell wall synthesis by inhibiting peptidoglycan cross linking

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5
Q

penicillin toxicity

A

allergy

hemolytic anemia

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6
Q

clinical use of penicillin

A 
S pneumo
S pyogenes
actinomyces 
(STREP is susceptible!)
Also neisseria meningitidis and syphilis
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7
Q

toxicity of oxacillin

A

hypersensitivity

interstitial nephritis

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8
Q

Ampicillin vs amoxicillin

A

amoxicillin has greater oral availability

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9
Q

amp/amoxicillin coverage

A 
Hemophilus
E Coli
Listeria
Proteus
Salmonella
Shigella

HELPSS

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10
Q

Toxicity of ampicillin/amoxicillin

A

pseudomembranous colitis

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11
Q

Which bugs not covered by cephalosporins?

A

Listeria
Atypicals
MRSA
Enterococci

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12
Q

Ceftazidime

A

pseudomonas (3rd generation)

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13
Q

Cefazolin coverage

A 
PEcK
Proteus
E coli
Klebsiella
Cefazolin
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14
Q

Ceftriaxone use

A

meningitis and gonorrhea

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15
Q

Additional coverage of 2nd generation cephalosporin (Cefoxitin)

A

H flu
Enterobacter
neisseria
Serratia

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16
Q

Toxicity of cephalosporins

A

Vitamin K deficiency

Increases toxicity of aminoglycosides on kidneys

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17
Q

aztreonam coverage

A

gram negatives

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18
Q

when do you use aztreonam?

A

For pts allergic to penicillin

For pts with renal insufficiency and can’t take aminoglycosides

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19
Q

Mechanism aztreonam

A

Prevents peptidoglycan cross linking by binding to PBP3.

Resistant to beta lactamases

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20
Q

Imipenem mechanism

A

beta-lactamase resistant carbapenem

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21
Q

what do you administer with imipenem/meropenem?

A

ciastatin, an inhibitor of renal dehydropeptidase I which extends activation

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22
Q

coverage of imipenem/meropenem?

A

gram positive cocci

gram negative rods

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23
Q

Side effects of imipenem/meropenem

A

Seizure (but meropenem does NOT cause seizure)

GI, skin rash, CNS toxicity

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24
Q

Mechanism vanco

A

Inhibits peptidoglycan formation by binding D-Ala D Ala

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25
Q

resistance to vanco arises from

A

Changing Dala D ala to D Ala D lac

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26
Q

Toxicity of vanco

A

nephrotoxicity
ototoxicity
thrombophlebitis
RED MAN syndrome

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27
Q

How do you prevent red man syndrome

A

slow infusion rate

–Can also pre-treat with antihistamines

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28
Q

Indications for VANCO

A

enterococci

C Difficile

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29
Q

mech: AGs

A

inhibit formation of initiation complex and cause misreading of mRNA at 30S. Requires O2 for uptake

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30
Q

Tox of Ags

A

nephrotox
ototox
teratogen
neuromuscular blockade

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31
Q

AG resistance

A

transferase enzymes inactivate the drug by acetylation, phosphorylation, adenylation

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32
Q

Demeclocycline use

A

ADH antagonist. Used in SIADH

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33
Q

Doxy is okay to use in patients with

A

Renal failure

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34
Q

don’t take tetracyclines with

A

milkd, antacids, iron preparation. Any divalent ions inhibit absorption

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35
Q

Tx for mycoplasma pneumoniae

A

azithromycin/levofloxacin

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36
Q

Tetracycline uses

A 
lyme
rickettsia
chlamydia
mycoplasma pneumoniae
---DRUG ACCUMULATES INTRACELLULARLY
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37
Q

Tox: tetra

A

grey teeth
inhibition of bone growth
photosensitivity
DON”T use in pregnant women

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38
Q

Mech: erythromycin, azithromycin, clarithromycin

A

Bind to 23S rRNA of 50S subunit

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39
Q

Use: macrolides

A

Atypical pneumonias: mycoplasma, chlamydia, legionella
STDS (chlamydia)
gram positive cocci

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40
Q

side effect of macrolides

A 
motility
Prolonged QT
acute cholestatic hepatitis
Rash
Eosinophilia
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41
Q

Resistance to macrolides

A

methylation of 23S rRNA binding site

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42
Q

Most protein synthesis inhibitor drugs are bacteriostatic EXCEPT for

A

aminoglycosides

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43
Q

Mechanism of chloramphenicol

A

Block of 50S ribosomal subunit peptidyltransferase

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44
Q

Tox of chloramphenicol

A

anemia
aplastic anemia
gray baby syndrome

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45
Q

Chloramphenicol use

A

meningitis from encapsulated organism (Strep, HiB, N men)

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46
Q

clinamycin mechanism

A

Blocks PEPTIDE TRANSFER

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47
Q

use: clinamycin

A

anaerobic infections and aspiration pneumonia. treats anerobes ABOVE the diaphragm

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48
Q

Sulfonamide mechanism

A

PABA antimetabolites inhibit dihydropteroate synthase in bacteria. Bacteriostatic

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49
Q

Clinical use of sulfonamides

A

Gram positive, gram negative, nocardia, chlamydia Good for UTI

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50
Q

Tox of sulfonamides

A 
Hypersensitivity rxn, Hemolysis in G6PD individuals
nephrotoxicity
photosensitivity
kernicterus
displaces warfarin from albumin
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51
Q

Sulfonamide resistance comes from

A

altered enzyme decreased uptake or increased PABA synthesis

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52
Q

Bactrim is good for

A

UTIs, shigella, salmonella, PCP

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53
Q

Side effects of trimethoprim

A

megaloblastic anemia
leukopenia
granulocytopenia
May be helped by leucovorin rescue

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54
Q

Fluoroquinolones cannot be taken with

A

antacids

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55
Q

Toxicity of fluoroquinolones

A

GI upset
prolong QT interval
tendon rupture, myalgias especially in peeps takin prednisone

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56
Q

fluoroquinolones are contraindicated in

A

pregnant women and children. may damage cartilage

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57
Q

resistance to fluoroquinolones

A

efflux pumps

or mutation in DNA gyrase

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58
Q

Side effect of metro

A

disulfiram reaction with alcohol

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59
Q

Metro treats

A 
giardia
entamoeba
trichomonas
gardnerella
anaerobes
H pylori
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60
Q

Tx; MAC

A

azithromycin
rifampin
ethambutol
streptomycin

Treat for 12 months with 2-3 of these

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61
Q

isoniazid mechanism

A

decreased synthesis of mycolic acids. Needs bacterial catalase peroxidase to convert INH to an active metabolite

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62
Q

why might you need to adjust the INH dosing?

A

Different INH half lives in fast vs slow acetylators

63
Q

Tox of isoniazid

A

neurotoxicity

hepatotoxicity

64
Q

how do you prevent isoniazid toxicity?

A

vitamin B6 (pyridoxine)

65
Q

Rifampin mechanism

A

inhibits DNA-dependent RNA polymerase

66
Q

The 4 R’s of rifampin

A

RNA polymerase inhibitor
Revs up microsomal P450
Red body fluids
Rapid resistance if used alone

67
Q

USe of rifampin prophylactically

A

Meningitis in kids

HiB

68
Q

Tox of pyrazinamide

A

Unknown mechanism

  • -hyperuricemia
  • -hepatotoxicity
69
Q

Etham butol mechanism

A

decreased carbohydrate polymerization of mycobacterium cell wall. Blocks arabinosyltransferase.

70
Q

Ethambutol toxicity

A

optic neuropathy

71
Q

prophylaxis of meningitis

A

ceftriaxone

72
Q

prevention of gonococcal or chlamydial conjunctivits in a newborn

A

erythromycin

73
Q

Prevention of postsurgical infection from S aureus

A

Cefazolin

74
Q

Pregnant woman with GBS

A

ampicillin

75
Q

Prevention of rheumatic fever

A

oral penicillin

76
Q

Prevention of PCP and toxoplasma

A

Sulfa-TMP

77
Q

Prevention of MAC

A

azithromycin

78
Q

Treatment of VRE

A

Linezolid and streptogramins

79
Q

streptogramins

A

quinupristin/dalfopristin

80
Q

amphotericin binds

A

ergosterol

81
Q

what do you need to supplement ampho B with?

A

K and Mg

82
Q

Side effect of ampho

A 
fever
hypotension
nephrotox
arrhythmias
anemia
IV phlebitis
83
Q

Nystatin for

A

oral candidiasis or diaperrash/vaginal candida

84
Q

Mech: azoles

A

inhibit ergosterol synthesis

–inhibits P-450 enzyme that converts lanosterol to ergosterol

85
Q

Toxicity of zoles

A

gynecomastia

Inhibits P450

86
Q

Itraconazole for

A

blastomyces, coccidioides, histoplasma

87
Q

fluconazole for

A

chronic suppression of cryptococcal meningitis

88
Q

clotrimazole and miconazole for

A

topical fungal infections

89
Q

flucytosine mechanism

A

Inhibits DNA/RNA biosynthesis by conversion to 5 FU by cytosine deaminase

90
Q

toxicity of flucytosine

A

bone marrow suppression

91
Q

use: flucytosine

A

combo with ampho B for systemic fungal infections like cryptococcus

92
Q

Caspofungin mechanism

A

inhibits cell wall synthesis of B glucan

93
Q

Indications of caspofungin

A

invasive aspergillosis

candida

94
Q

Side effect of caspofungin

A

GI upset and flushing

95
Q

terbinafine used for

A

dermatophytoses like onychomycosis

96
Q

Terbinafine tox

A

Abnormal LFTs and visual disturbances

97
Q

Griseofulvin mechanism

A

Interferes with microtubule function, mitosis

98
Q

Where does griseofulvin deposit

A

In nails and kertin tissues. used for dermatophytes like ring worm or tinea

99
Q

Tox griseofulvin

A

Increase P450 and warfarin metabolism
Teratogen, carcinogen
headaches

100
Q

Tx: leishmaniasis

A

sodium gluconate

101
Q

Chloroquine mechanism

A

Blocks detoxification of heme into hemozoin. Then, the hem accumulates and becomes toxic to plasmodia

102
Q

toxicity of chloroquine

A

retinopathy

103
Q

use: chloroquine

A

Treatment of plasmodial species OTHER than P falciprum. Because resistance is really high in falciprum

104
Q

In general, use praziquantel against

A

flukes

105
Q

zanamivir, oseltamivir mechanism

A

inhibits influenza neuraminidase, decreasing release of progeny virus

106
Q

Ribavirin mechanism

A

Inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase

107
Q

Toxicity of ribavirin

A

Hemolytic anemia TERATOGEN

108
Q

Acyclovir mechanism

A

activated by the HSV thymidine kinase. Works as guanosine analog=CHAIN TERMINATION

109
Q

Rivavirin use:

A

RSV, chronic Hep C

110
Q

Resistance to acyclovir

A

mutated viral thymidine kinase

111
Q

Use: acyclovir

A

HSV and VZV

112
Q

Tx of herpes zoster

A

famciclovir (shingles) Because acyclovir has NO effect on latent forms

113
Q

Valacyclovir

A

like acyclovir but better oral availability

114
Q

Ganciclovir used to treat

A

CMV

115
Q

Mechanism ganciclovir

A

CMV viral kinase forms guanosine triphosphate from monophosphate.

Inhibits DNA polymerase

116
Q

Valganciclovir

A

ganciclovir with better oral bioavailability

117
Q

Tox: gangiclovir

A

leukopenia, neutropenia, thrombocytopenia, renal toxicity

118
Q

Resistance of ganciclovir

A

Mutated CMV DNA polymerase or NO viral kinase

119
Q

Foscarnet mechanism

A

Inhibits DNA polymerase

  • -binds pyrophosphate site of enzyme
  • -no activation by viral kinase NEEDED!!
120
Q

Use: foscarnet

A

CMV retinitis in immunocompromised pts when ganciclovir fails
OR acyclovir resistant HSV

121
Q

Tox of foscarnet

A

Nephrotoxicity

122
Q

resistance foscarnet

A

mutated DNA poly

123
Q

Cidofovir mechanism

A

like foscarnet. Inhibits DNA polymerase. No phosphorylation needed by viral kinase

124
Q

Cidofovir indications

A

CMV retinitis in immunocompromised pts or acyclovir HSV

125
Q

Cidofovir toxicity

A

Nephrotoxicity

126
Q

how to reduce toxicity of cidofovir

A

give with probenecid and IV saline

127
Q

Toxicity of protease inhibitors

A

hyperglycemia GI intolerance lipodystrophy

128
Q

-inavir

A

protease inhibitor

129
Q

Ritonavir uses

A

protease booster; inhibits P45-

130
Q

tox of indinavir

A

nephropathy and hematuria

131
Q

Mechanism NRTIs

A

lack a 3’ OH group, inhibiting nucleotide binding to RT and terminates DNA

132
Q

Name the NRTIs

A 
-tenofovir
emtricitabine
-abacavir
-lamivudine
-zidovudine (AZT)
didanosine
stavudine
133
Q

benefit of tenofovir

A

No need to be activated. a nucleotide, not a nucleoside

134
Q

Zidovudine use

A

prophylaxis during pregnancy

135
Q

toxicity of NRTIs

A

bone marrow suppression
peripheral neuropathy
lactic acidosis
anemia

136
Q

Name the NNRTIs

A

nevirapine
efavirenz
delavirdine

137
Q

what’s different about NNRTIs

A

Do NOT require phosphorylation to be active or compete with nucleotides. They bind to the reverse transcriptase itself

138
Q

Raltegravir

A

integrase inhibitor

139
Q

Mechanism of raltegravir

A

blocks integrase

140
Q

toxicity of raltegravir

A

hypercholesterolemia

141
Q

Interferon drugs: mechanism?

A

Blocks replication of both RNA and DNA viruses

142
Q

IFN a

A

chronic Hep B and C

143
Q

IFN b

A

MS

144
Q

IFN y

A

NADPH oxidase deficiency

145
Q

toxicity of interferons

A

neutorpenia and myopathy

146
Q

Drugs to avoid in pregnancy

A 
SAFe Children Take Really Good Care
-sulfonamide
aminoglycoside
fluoroquinolone
clarithromycin
tetracycline
ribavirin
griseofulvin
chloramphenicol
147
Q

sulfonamide in pregnancy

A

kernicterus

148
Q

aminoglycoside in pregnancy

A

ototoxicity

149
Q

fluoroquinolone in pregnancy

A

cartilage damage

150
Q

clarithromycin in pregnancy

A

embryotoxin

151
Q

tetracycline in pregnancy

A

discolored teeth, bone growth problem

152
Q

griseofulvin in pregnancy

A

teratogen

153
Q

ribavirin in pregnancy

A

teratogen

154
Q

chloramphenicol in pregnancy

A

gray baby syndrome

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