Antibiotic drugs Flashcards
1
Q
drugs that block peptidoglycan synthesis
A
bacitracin, vancomycin
2
Q
drugs that work by damaging DNA
A
metronidazole
3
Q
Drugs that block 50S
A
Chloramphenicol, clindamycin, Linezolid
Erythromycin
Also streptogramins (-pristin)
4
Q
cephalosporin, aztreonam, imipenem mechanism
A
block cell wall synthesis by inhibiting peptidoglycan cross linking
5
Q
penicillin toxicity
A
allergy
hemolytic anemia
6
Q
clinical use of penicillin
A
S pneumo S pyogenes actinomyces (STREP is susceptible!) Also neisseria meningitidis and syphilis
7
Q
toxicity of oxacillin
A
hypersensitivity
interstitial nephritis
8
Q
Ampicillin vs amoxicillin
A
amoxicillin has greater oral availability
9
Q
amp/amoxicillin coverage
A
Hemophilus E Coli Listeria Proteus Salmonella Shigella
HELPSS
10
Q
Toxicity of ampicillin/amoxicillin
A
pseudomembranous colitis
11
Q
Which bugs not covered by cephalosporins?
A
Listeria
Atypicals
MRSA
Enterococci
12
Q
Ceftazidime
A
pseudomonas (3rd generation)
13
Q
Cefazolin coverage
A
PEcK Proteus E coli Klebsiella Cefazolin
14
Q
Ceftriaxone use
A
meningitis and gonorrhea
15
Q
Additional coverage of 2nd generation cephalosporin (Cefoxitin)
A
H flu
Enterobacter
neisseria
Serratia
16
Q
Toxicity of cephalosporins
A
Vitamin K deficiency
Increases toxicity of aminoglycosides on kidneys
17
Q
aztreonam coverage
A
gram negatives
18
Q
when do you use aztreonam?
A
For pts allergic to penicillin
For pts with renal insufficiency and can’t take aminoglycosides
19
Q
Mechanism aztreonam
A
Prevents peptidoglycan cross linking by binding to PBP3.
Resistant to beta lactamases
20
Q
Imipenem mechanism
A
beta-lactamase resistant carbapenem
21
Q
what do you administer with imipenem/meropenem?
A
ciastatin, an inhibitor of renal dehydropeptidase I which extends activation
22
Q
coverage of imipenem/meropenem?
A
gram positive cocci
gram negative rods
23
Q
Side effects of imipenem/meropenem
A
Seizure (but meropenem does NOT cause seizure)
GI, skin rash, CNS toxicity
24
Q
Mechanism vanco
A
Inhibits peptidoglycan formation by binding D-Ala D Ala
25
resistance to vanco arises from
Changing Dala D ala to D Ala D lac
26
Toxicity of vanco
nephrotoxicity
ototoxicity
thrombophlebitis
RED MAN syndrome
27
How do you prevent red man syndrome
slow infusion rate
| --Can also pre-treat with antihistamines
28
Indications for VANCO
enterococci
| C Difficile
29
mech: AGs
inhibit formation of initiation complex and cause misreading of mRNA at 30S. Requires O2 for uptake
30
Tox of Ags
nephrotox
ototox
teratogen
neuromuscular blockade
31
AG resistance
transferase enzymes inactivate the drug by acetylation, phosphorylation, adenylation
32
Demeclocycline use
ADH antagonist. Used in SIADH
33
Doxy is okay to use in patients with
Renal failure
34
don't take tetracyclines with
milkd, antacids, iron preparation. Any divalent ions inhibit absorption
35
Tx for mycoplasma pneumoniae
azithromycin/levofloxacin
36
Tetracycline uses
```
lyme
rickettsia
chlamydia
mycoplasma pneumoniae
---DRUG ACCUMULATES INTRACELLULARLY
```
37
Tox: tetra
grey teeth
inhibition of bone growth
photosensitivity
DON"T use in pregnant women
38
Mech: erythromycin, azithromycin, clarithromycin
Bind to 23S rRNA of 50S subunit
39
Use: macrolides
Atypical pneumonias: mycoplasma, chlamydia, legionella
STDS (chlamydia)
gram positive cocci
40
side effect of macrolides
```
motility
Prolonged QT
acute cholestatic hepatitis
Rash
Eosinophilia
```
41
Resistance to macrolides
methylation of 23S rRNA binding site
42
Most protein synthesis inhibitor drugs are bacteriostatic EXCEPT for
aminoglycosides
43
Mechanism of chloramphenicol
Block of 50S ribosomal subunit peptidyltransferase
44
Tox of chloramphenicol
anemia
aplastic anemia
gray baby syndrome
45
Chloramphenicol use
meningitis from encapsulated organism (Strep, HiB, N men)
46
clinamycin mechanism
Blocks PEPTIDE TRANSFER
47
use: clinamycin
anaerobic infections and aspiration pneumonia. treats anerobes ABOVE the diaphragm
48
Sulfonamide mechanism
PABA antimetabolites inhibit dihydropteroate synthase in bacteria. Bacteriostatic
49
Clinical use of sulfonamides
Gram positive, gram negative, nocardia, chlamydia Good for UTI
50
Tox of sulfonamides
```
Hypersensitivity rxn, Hemolysis in G6PD individuals
nephrotoxicity
photosensitivity
kernicterus
displaces warfarin from albumin
```
51
Sulfonamide resistance comes from
altered enzyme decreased uptake or increased PABA synthesis
52
Bactrim is good for
UTIs, shigella, salmonella, PCP
53
Side effects of trimethoprim
megaloblastic anemia
leukopenia
granulocytopenia
May be helped by leucovorin rescue
54
Fluoroquinolones cannot be taken with
antacids
55
Toxicity of fluoroquinolones
GI upset
prolong QT interval
tendon rupture, myalgias especially in peeps takin prednisone
56
fluoroquinolones are contraindicated in
pregnant women and children. may damage cartilage
57
resistance to fluoroquinolones
efflux pumps
| or mutation in DNA gyrase
58
Side effect of metro
disulfiram reaction with alcohol
59
Metro treats
```
giardia
entamoeba
trichomonas
gardnerella
anaerobes
H pylori
```
60
Tx; MAC
azithromycin
rifampin
ethambutol
streptomycin
Treat for 12 months with 2-3 of these
61
isoniazid mechanism
decreased synthesis of mycolic acids. Needs bacterial catalase peroxidase to convert INH to an active metabolite
62
why might you need to adjust the INH dosing?
Different INH half lives in fast vs slow acetylators
63
Tox of isoniazid
neurotoxicity
| hepatotoxicity
64
how do you prevent isoniazid toxicity?
vitamin B6 (pyridoxine)
65
Rifampin mechanism
inhibits DNA-dependent RNA polymerase
66
The 4 R's of rifampin
RNA polymerase inhibitor
Revs up microsomal P450
Red body fluids
Rapid resistance if used alone
67
USe of rifampin prophylactically
Meningitis in kids
| HiB
68
Tox of pyrazinamide
Unknown mechanism
- -hyperuricemia
- -hepatotoxicity
69
Etham butol mechanism
decreased carbohydrate polymerization of mycobacterium cell wall. Blocks arabinosyltransferase.
70
Ethambutol toxicity
optic neuropathy
71
prophylaxis of meningitis
ceftriaxone
72
prevention of gonococcal or chlamydial conjunctivits in a newborn
erythromycin
73
Prevention of postsurgical infection from S aureus
Cefazolin
74
Pregnant woman with GBS
ampicillin
75
Prevention of rheumatic fever
oral penicillin
76
Prevention of PCP and toxoplasma
Sulfa-TMP
77
Prevention of MAC
azithromycin
78
Treatment of VRE
Linezolid and streptogramins
79
streptogramins
quinupristin/dalfopristin
80
amphotericin binds
ergosterol
81
what do you need to supplement ampho B with?
K and Mg
82
Side effect of ampho
```
fever
hypotension
nephrotox
arrhythmias
anemia
IV phlebitis
```
83
Nystatin for
oral candidiasis or diaperrash/vaginal candida
84
Mech: azoles
inhibit ergosterol synthesis
| --inhibits P-450 enzyme that converts lanosterol to ergosterol
85
Toxicity of zoles
gynecomastia
| Inhibits P450
86
Itraconazole for
blastomyces, coccidioides, histoplasma
87
fluconazole for
chronic suppression of cryptococcal meningitis
88
clotrimazole and miconazole for
topical fungal infections
89
flucytosine mechanism
Inhibits DNA/RNA biosynthesis by conversion to 5 FU by cytosine deaminase
90
toxicity of flucytosine
bone marrow suppression
91
use: flucytosine
combo with ampho B for systemic fungal infections like cryptococcus
92
Caspofungin mechanism
inhibits cell wall synthesis of B glucan
93
Indications of caspofungin
invasive aspergillosis
| candida
94
Side effect of caspofungin
GI upset and flushing
95
terbinafine used for
dermatophytoses like onychomycosis
96
Terbinafine tox
Abnormal LFTs and visual disturbances
97
Griseofulvin mechanism
Interferes with microtubule function, mitosis
98
Where does griseofulvin deposit
In nails and kertin tissues. used for dermatophytes like ring worm or tinea
99
Tox griseofulvin
Increase P450 and warfarin metabolism
Teratogen, carcinogen
headaches
100
Tx: leishmaniasis
sodium gluconate
101
Chloroquine mechanism
Blocks detoxification of heme into hemozoin. Then, the hem accumulates and becomes toxic to plasmodia
102
toxicity of chloroquine
retinopathy
103
use: chloroquine
Treatment of plasmodial species OTHER than P falciprum. Because resistance is really high in falciprum
104
In general, use praziquantel against
flukes
105
zanamivir, oseltamivir mechanism
inhibits influenza neuraminidase, decreasing release of progeny virus
106
Ribavirin mechanism
Inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase
107
Toxicity of ribavirin
Hemolytic anemia TERATOGEN
108
Acyclovir mechanism
activated by the HSV thymidine kinase. Works as guanosine analog=CHAIN TERMINATION
109
Rivavirin use:
RSV, chronic Hep C
110
Resistance to acyclovir
mutated viral thymidine kinase
111
Use: acyclovir
HSV and VZV
112
Tx of herpes zoster
famciclovir (shingles) Because acyclovir has NO effect on latent forms
113
Valacyclovir
like acyclovir but better oral availability
114
Ganciclovir used to treat
CMV
115
Mechanism ganciclovir
CMV viral kinase forms guanosine triphosphate from monophosphate.
Inhibits DNA polymerase
116
Valganciclovir
ganciclovir with better oral bioavailability
117
Tox: gangiclovir
leukopenia, neutropenia, thrombocytopenia, renal toxicity
118
Resistance of ganciclovir
Mutated CMV DNA polymerase or NO viral kinase
119
Foscarnet mechanism
Inhibits DNA polymerase
- -binds pyrophosphate site of enzyme
- -no activation by viral kinase NEEDED!!
120
Use: foscarnet
CMV retinitis in immunocompromised pts when ganciclovir fails
OR acyclovir resistant HSV
121
Tox of foscarnet
Nephrotoxicity
122
resistance foscarnet
mutated DNA poly
123
Cidofovir mechanism
like foscarnet. Inhibits DNA polymerase. No phosphorylation needed by viral kinase
124
Cidofovir indications
CMV retinitis in immunocompromised pts or acyclovir HSV
125
Cidofovir toxicity
Nephrotoxicity
126
how to reduce toxicity of cidofovir
give with probenecid and IV saline
127
Toxicity of protease inhibitors
hyperglycemia GI intolerance lipodystrophy
128
-inavir
protease inhibitor
129
Ritonavir uses
protease booster; inhibits P45-
130
tox of indinavir
nephropathy and hematuria
131
Mechanism NRTIs
lack a 3' OH group, inhibiting nucleotide binding to RT and terminates DNA
132
Name the NRTIs
```
-tenofovir
emtricitabine
-abacavir
-lamivudine
-zidovudine (AZT)
didanosine
stavudine
```
133
benefit of tenofovir
No need to be activated. a nucleotide, not a nucleoside
134
Zidovudine use
prophylaxis during pregnancy
135
toxicity of NRTIs
bone marrow suppression
peripheral neuropathy
lactic acidosis
anemia
136
Name the NNRTIs
nevirapine
efavirenz
delavirdine
137
what's different about NNRTIs
Do NOT require phosphorylation to be active or compete with nucleotides. They bind to the reverse transcriptase itself
138
Raltegravir
integrase inhibitor
139
Mechanism of raltegravir
blocks integrase
140
toxicity of raltegravir
hypercholesterolemia
141
Interferon drugs: mechanism?
Blocks replication of both RNA and DNA viruses
142
IFN a
chronic Hep B and C
143
IFN b
MS
144
IFN y
NADPH oxidase deficiency
145
toxicity of interferons
neutorpenia and myopathy
146
Drugs to avoid in pregnancy
```
SAFe Children Take Really Good Care
-sulfonamide
aminoglycoside
fluoroquinolone
clarithromycin
tetracycline
ribavirin
griseofulvin
chloramphenicol
```
147
sulfonamide in pregnancy
kernicterus
148
aminoglycoside in pregnancy
ototoxicity
149
fluoroquinolone in pregnancy
cartilage damage
150
clarithromycin in pregnancy
embryotoxin
151
tetracycline in pregnancy
discolored teeth, bone growth problem
152
griseofulvin in pregnancy
teratogen
153
ribavirin in pregnancy
teratogen
154
chloramphenicol in pregnancy
gray baby syndrome
