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General Principles > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

penicillin mechanism

A

1) bind PBP (transpeptidase)
2) block transpeptidase cross-linking peptidoglycan
3) active autolytic enzymes

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2
Q

penicllin spectrum

A

gram positive (s. pneumo. s. pyogenes, actinoymyces), n. meningitidis, T. pallidum.

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3
Q

penicillin toxicity:

A

hypersensitivity + hemolytic anemia

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4
Q

ampicillin / amoxicillin spectrum of use

A

extended-spectrum penicillin: H. influenzae, E. coli, Listeria mono, Proteus mirabilis, Salmonella, Shigella (HELPSS)

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5
Q

ampi/amoxicillin toxicity

A

hypersensitivity, rash, pseudomembranous colitis

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6
Q

penicillinase-resistant penicillins = oxacillin, nafcillin

A

bulky R group blocks access of beta-lactamase to b-lactam ring.

used for s. aureus

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7
Q

nafcillin toxicity

A

interstitial nephritis

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8
Q

ticarcillin / piperacillin = antipseudomonals

A

use WITH b-lactamase inhibitors.

be careful of hypersensitivity

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9
Q

cephalosporins general mechanism

A

inhibit cell wall synthesis –> bactericidal

less susceptible to penicillinase.

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10
Q

cephalo organisms by generation

A

1) PEK = proteus, Ecoli, Klebsiella
2) HEN PEKS = H. influ, Enterobacter, Neisseria, Protus, Ecoli, Klebsiella, Serratia
3) serious gram-negative infections (resistant to b-lactams):

Ceftriaxone = meningitis / gonorrhea
Ceftazidime = pseudomonas

4) Cefepime = incr. activity against pseudomonas + gram-positive
5) ceftaroline = broad spectrum gram-pos & gram-neg –> MRSA! (no pseudomonas)

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11
Q

cephalo sfx

A

1) vit. K deficiency.

2) INCREASED nephrotoxicity of aminoglycosides

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12
Q

aztreonam mechanism

A

prevents peptidoglycan cross-linking by binding to PBP 3. synergistic w/ aminoglycosides

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13
Q

aztreonam spectrum

A

gram-neg rods: NOT useful for gram+ or anaerobes. useful for those who have penicillin allergies / renal insufficiency w/o aminoglycoside tolerance

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14
Q

carbapenems mechanism

A

broad-spectrum. administer w/ cilastin (inhibi renal dehydropeptidase I) to dec. drug inactivation in renal tubules

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15
Q

carbapenem spectrum

A

gram-+ cocci, gram- rods, anaerbos. wide spectrum. reserved for life-threatening infections / last resort.

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16
Q

special carbapenems

A

meropnem has dec. risk of seizures –> stable against dehydropeptiase I

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17
Q

carbapenem toxicity

A

seizures / rash

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18
Q

vancomycin mechanism

A

binds D-ala-D-ala part of cell wall precursor. bactericidal that inhibits cell wall peptidoglycan

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19
Q

vanco clinical use

A

gram+ (MRSA, c. difficile)

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20
Q

vanco toxicity

A

NOT: nephrotoxicity, Ototoxicity, Thrombophelbitis.

diffuse flushing = red man syndrome (infuse slowly & w/ antihistamines)

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21
Q

aminoglycosides mechanism

A

inhibition formation of initiation complex –> misreading of mRNA. block translocation.

requires O2 for UPTAKE –> ineffective against ANAEROBES

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22
Q

clinical use of aminoglycosides

A

gram-negative rod infections. synergistic w/ b-lactam. neomycin for bowel surgery

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23
Q

aminoglycosides toxicity

A

1) nephrotoxicity (when combined w/ cephalosporin)
2) neuromuscular blockade
3) ototoxicity
4) teratogen

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24
Q

tetracycline mechanism

A

bacteriostatic: bind to 30S –> prevent aminoacyl-tRNA attachment.

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25
Q

tetracycline contraindications

A

avoid milk, antacids, iron –> divalent cations –> inhibit gut absorption

26
Q

tetracycline spectrum

A

intracellular –> effective against rickettsia / chlamydia. borrelia burgdorferi, m. pneumo

27
Q

macrolides (azithromycin, clarithromycin, erythromycin) mechanism

A

inhibit protein synthesis by blocking translocation –> bacteriostatic

28
Q

macrolide clinical use

A

atypical pneumos (mycoplasma, chlamydia, legionella), STDs (chlamydia), gram-pos cocci

29
Q

macrolides toxicity

A

MACRO: Gi MOtility, Arrythmia due to prolonged QT, Cholestatic hepatitis, Rash, eOsinophilia

INCREASES [theophylline, anticoagulants]

30
Q

chloramphenicol mechanism of action

A

bacteriostatic –> blocks peptidyltransferase at 50S

31
Q

chloramphenicol spectrum

A

meningitis (h. influ, N. menigiti, Strep pneumo)

Rocky Mountain spotted fever (rickettsia rickettsii)

32
Q

chloramphenicol toxicity

A

1) aplastic anemia

2) gray baby syndrome –> lack of UDP-glucuronyl transferase

33
Q

clindamycin mechanism

A

blocks peptide translocation –> baceriostatic

34
Q

clinamycin spectrum

A

anerobes ABOVE the diaphragm

1) anaerobes of aspiration pneumo: bacteriodes, c. perfringens
2) invasive group A strep

35
Q

clindamycin toxicity

A

pseudomembranous colitis, fever, diarrhea

36
Q

sulfonamide mechanism

A

inhibit folate synthesis –> bacteriostatic

37
Q

sulfonamide spectrum of action

A

gram +, gram -, nocardia, chlamydia,

38
Q

sulfonamide toxicity

A

1) nephrotoxicity –> tubuloninterstitial nephritis
2) kernicterus in infants
3) displace drugs from albumin –> warfarin
4) hemolysis if G6PD
5) photosensitivity

39
Q

trimethoprim mechanism

A

bacteriostatic –> inhibit dihydrofolate reductase

40
Q

trimethoprim spectrum

A

1) sulfonamides –> block folate synthesis

2) combo for UTIs, shigella, salmonella, P. jirovecii. toxoplasmosis prophylaxis

41
Q

trimethoprim sfx

A

pancytopenia; TMP: Treats Marrow Poorly.

supplement w/ folinic acid

42
Q

fluoroquinolones mechanism

A

bactericidal: inhibit DNA gyrase (topoisomerase II) / topoisomerase IV. avoid in antacids

43
Q

fluoroquinolone spectrum

A

gram-neg rods of urinary / GI tracts (pseudomonas), neisseria, gram + organisms

44
Q

fluoroquinolones toxicity

A

1) tendonitis / rupture
2) superinfections
3) contraindicated in pregnancy / children –> cartilage damage
4) prolonged QT interval

45
Q

metronidazole mechanism

A

free radical toxic metabolites in cell –> damage DNA (bactericidal / antiprotozoal)

46
Q

metronidazole spectrum

A

GET GAP (infxn below diaphragm)

1) Giardia
2) Entamoeba
3) Trcichomonas
4) Gardnerella vaginalis
5) Anaerobes (Bacteroides / c. diff)

47
Q

metronidazole sfx

A

disulfiram rxn: flushing, tachycardia, hypotension w/ EtoH

48
Q

m tb treatment

A

RIPE (rifamin, isoniazid, pyrazinamide, ethambutol)

49
Q

m tb prophylaxis

A

isoniazid

50
Q

m. avium-intracellular prophylaxis

A

azithromycin, rifabutin

51
Q

m. avium-intracellular treatment

A

more drug resistant than tb –>

1) azithromycin / clarithromycin
2) ethambutol
3) rifabutin / cipro

52
Q

m. leprae

A

dapsone / rifampin –> tb.

clofazimine for lepromatous form

53
Q

isoniazid (INH)

A

dec. synthesis of mycolic acids –> need bacterial catalase-peroxidase to convert INH to active.

54
Q

isoniazid toxicity

A

INH = Injures Neurons Hepatocytes

supplement pyridoxine. may induce lupus

55
Q

rifamycin

A

1) RNA polymerase inhibitor
2) ramps up cytochrome P450
3) Red body fluids
4) rapid resistance when used alone
5) Rifampin ramps up cytochrome P560 but rifaBUTin does not

56
Q

pyrazinamie

A

1) m. tb
2) sfx = hyperuricemia, hepatotoxicity
3) acidify inracellular environment –> active onl in acidic pH of phagolysosomes, where macrophage engulfed TB exists

57
Q

ethambutol

A

dec. carbo polymerization of mycobacterium cell wall –> blockage of arabinosyltransferase

58
Q

ethambutol sfx

A

optic neuropathy (red-green color blindness)

59
Q

highly resistant bacteria treatment: MRSA

A

vanco, dapto, linezolid (caution: serotonin syndrome), tigecycline, ceftraroline

60
Q

treatment of VRE

A

1) linezolid / streptogramins (quinupristin/dalfopristin)

General Principles (16 decks)

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