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
tetracycline contraindications
avoid milk, antacids, iron --> divalent cations --> inhibit gut absorption
26
tetracycline spectrum
intracellular --> effective against rickettsia / chlamydia. borrelia burgdorferi, m. pneumo
27
macrolides (azithromycin, clarithromycin, erythromycin) mechanism
inhibit protein synthesis by blocking translocation --> bacteriostatic
28
macrolide clinical use
atypical pneumos (mycoplasma, chlamydia, legionella), STDs (chlamydia), gram-pos cocci
29
macrolides toxicity
MACRO: Gi MOtility, Arrythmia due to prolonged QT, Cholestatic hepatitis, Rash, eOsinophilia INCREASES [theophylline, anticoagulants]
30
chloramphenicol mechanism of action
bacteriostatic --> blocks peptidyltransferase at 50S
31
chloramphenicol spectrum
meningitis (h. influ, N. menigiti, Strep pneumo) Rocky Mountain spotted fever (rickettsia rickettsii)
32
chloramphenicol toxicity
1) aplastic anemia | 2) gray baby syndrome --> lack of UDP-glucuronyl transferase
33
clindamycin mechanism
blocks peptide translocation --> baceriostatic
34
clinamycin spectrum
anerobes ABOVE the diaphragm 1) anaerobes of aspiration pneumo: bacteriodes, c. perfringens 2) invasive group A strep
35
clindamycin toxicity
pseudomembranous colitis, fever, diarrhea
36
sulfonamide mechanism
inhibit folate synthesis --> bacteriostatic
37
sulfonamide spectrum of action
gram +, gram -, nocardia, chlamydia,
38
sulfonamide toxicity
1) nephrotoxicity --> tubuloninterstitial nephritis 2) kernicterus in infants 3) displace drugs from albumin --> warfarin 4) hemolysis if G6PD 5) photosensitivity
39
trimethoprim mechanism
bacteriostatic --> inhibit dihydrofolate reductase
40
trimethoprim spectrum
1) sulfonamides --> block folate synthesis | 2) combo for UTIs, shigella, salmonella, P. jirovecii. toxoplasmosis prophylaxis
41
trimethoprim sfx
pancytopenia; TMP: Treats Marrow Poorly. supplement w/ folinic acid
42
fluoroquinolones mechanism
bactericidal: inhibit DNA gyrase (topoisomerase II) / topoisomerase IV. avoid in antacids
43
fluoroquinolone spectrum
gram-neg rods of urinary / GI tracts (pseudomonas), neisseria, gram + organisms
44
fluoroquinolones toxicity
1) tendonitis / rupture 2) superinfections 3) contraindicated in pregnancy / children --> cartilage damage 4) prolonged QT interval
45
metronidazole mechanism
free radical toxic metabolites in cell --> damage DNA (bactericidal / antiprotozoal)
46
metronidazole spectrum
GET GAP (infxn below diaphragm) 1) Giardia 2) Entamoeba 3) Trcichomonas 4) Gardnerella vaginalis 5) Anaerobes (Bacteroides / c. diff)
47
metronidazole sfx
disulfiram rxn: flushing, tachycardia, hypotension w/ EtoH
48
m tb treatment
RIPE (rifamin, isoniazid, pyrazinamide, ethambutol)
49
m tb prophylaxis
isoniazid
50
m. avium-intracellular prophylaxis
azithromycin, rifabutin
51
m. avium-intracellular treatment
more drug resistant than tb --> 1) azithromycin / clarithromycin 2) ethambutol 3) rifabutin / cipro
52
m. leprae
dapsone / rifampin --> tb. clofazimine for lepromatous form
53
isoniazid (INH)
dec. synthesis of mycolic acids --> need bacterial catalase-peroxidase to convert INH to active.
54
isoniazid toxicity
INH = Injures Neurons Hepatocytes supplement pyridoxine. may induce lupus
55
rifamycin
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
pyrazinamie
1) m. tb 2) sfx = hyperuricemia, hepatotoxicity 3) acidify inracellular environment --> active onl in acidic pH of phagolysosomes, where macrophage engulfed TB exists
57
ethambutol
dec. carbo polymerization of mycobacterium cell wall --> blockage of arabinosyltransferase
58
ethambutol sfx
optic neuropathy (red-green color blindness)
59
highly resistant bacteria treatment: MRSA
vanco, dapto, linezolid (caution: serotonin syndrome), tigecycline, ceftraroline
60
treatment of VRE
1) linezolid / streptogramins (quinupristin/dalfopristin)