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Drugs- Basic High Yield Stuff for Boards > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Pen G and Pen V:

Route of admin
MOA

A

Pen G- IV and IM
Pen V- oral

D-ala D-ala analog.
Binds PBP to block transpeptidase cross-linking of peptidoglycan in cell wall. Activate autolytic enzymes.

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2
Q

Clinical use for PenG/PenV (5)
Bactericidal or Bacteriostatic?
Penicillinase Sensitivity?

A
  1. S. pneumo
  2. S. pyogenes
  3. Actinomyces
  4. N. meningitidis
  5. T.pallidum

Bactericidal
Penicillinase sensitive

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3
Q

PenG/PenV
Adverse (2)
Mech of Resistance

A
  1. Hypersensitivity (Rash/anaphylaxis)–>Type1 Hypersens
  2. direct Coombs hemolytic anemia (Haptan)–>Type2 Hypersens

Resistance: Penicillinase in bacteria (B-lactamase) cleaves B-lactam ring between N and C=O

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4
Q

Name 2 penicillinase sensitive penicillins

A

Aminopenicillins

  1. Amoxicillin
  2. Ampicillin
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5
Q

Aminopenicillins (Amoxicillin/Ampicillin)
MOA
MOResistance
Penicillinase Sensitivity?

A

MOA:
Same as penicillin w/ wider spectrum

Penicilinas (B-lactamase) cleaves B-lactam ring

Penicillinase sensitive–>combine w/ clavulanic acid to protect against destruction by B-lactamase

Typically: Amox w/ sulbactam, Amp w/ clavulanic acid

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6
Q 
Aminopenicillins:
Clinical Use (8*)
A 
Broad Spectrum
"Ampicillin/Amoxicillin HHELPSS kill Enterococci"
H.flu
H.pylori
E.coli
Listeria
Proteus
Salmonella
Shigella
Enterococci
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7
Q

Aminopenicillins (Amoxicillin/Ampicillin):

Adverse (3)

A
  1. Hypersensitivity
  2. Rash–>not a hypersensitivity (not IgE) but specific for amoxicillin with mononucleosis
  3. pseudomemb colitis
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8
Q

What contributes to Penicillin’s clinical use

A

The R group on penicillins determines

  1. Broad vs. Narrow
  2. ability of drug to cross Bacterial membrane
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9
Q

Name Penicillinase-resistant penicillins (4)

Why “resistant”?

A
  1. Dicloxacillin
  2. Nafcillin
  3. Oxacillin
  4. Methicillin

Bulky -R group blocks B-lactamase’s access to B-lactam ring

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10
Q 
Name Penicillinase-resistant penicillins:
Clinical Use(1*)
A

Narrow spectrum
1. S. aureus (Except MRSA-it mutates transpeptidase enzyme gene so drug can’t bind))

“use Naf for Staph”

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11
Q

Name Penicillinase-resistant penicillins:

Adverse (2)

A
  1. Hypersensitivity (Rash/anaphylaxis)

2. Interstitial Nephritis (remember Methicillin was taken off market for beating up too many kidneys)

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12
Q

Name Antipseudomonal penicillins (2)

Penicillinase Sensitivity?

A
  1. Pipercillin
  2. Ticarcillin

Penicillinase sensitivity–>use B-lactamase inhibitors
*classically Tazobactam w/ Pipercillin/Ticarcillin

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13
Q 
Antipseudomonal penicillins: 
Clinical Use (2)
Adverse (1)
A
  1. Pseudo spp.
  2. Gram (-) rods
    * typically with Tazobactam
  3. Hypersensitivity
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14
Q

Why use B-lactamase inhibs?

Name 3* B-lactamase inhibs

A

Added to penicillin abx to protect abx from penicillinase destruction

“CAST a net to protect Penicillins”

  1. Clavulanic Acid (w/ Amox)
  2. Sulbactam (w/ Amp)
  3. Tazobactam (w/ Pip or Ticar)
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15
Q 
Cephalosporins:
MOA
Bactericidal or Bacteriostatic?
Penicillinase Sensitivity?
MOResistance
A
  • B-lactam drugs inhib cell wall synthesis
  • Bactericidal
  • Less susceptible to penicillinase
  • Structural change in PBP (transpeptidase)
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16
Q

Cephalosporins:

Organisms typically not covered by 1st-4th generation

A

“1st-4th Generation cephalosporins are LAME”

  1. Listeria
  2. Atypicals (chlamydia/mycoplasma)
  3. MRSA (covered by ceftaroline-5th gen)
  4. Enterococci
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17
Q

1st Gen Cephalosporins:
Names (2)
coverage (5)
Any special uses

A
  1. Cefazolin-used pre surgery to prevent S.aureus infection
  2. cephalexin

“PEcK-g”

  1. gram + cocci
  2. Proteus
  3. E.coli
  4. Klebsiella
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18
Q

2nd Gen Cephalosporins:
Names (3)
Coverage (8)

A

“FAke FOX FUR”

  1. CeFOXitin
  2. CeFAclor
  3. CeFURoxime

“PEcK-g HENS”

  1. gram + cocci
  2. Proteus
  3. E.coli
  4. Klebsiella
  5. H. flu
  6. Enterobacter aerogenes
  7. Neisseria
  8. Serratia marcescens
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19
Q

3rd Gen Cephalosporins:
Names (3)
Coverage (3,1)

A

Serious gram (-) infections resistant to other B-lactams

  1. Ceftriaxone- 1. N.meningitids 2. N.gonorrhea 3. Lyme
  2. Cefotaxime
  3. Ceftazidine- 1. Pseudo
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20
Q

4th Gen Cephalosporins:
Names (1)
Coverage (3)

A

Cefepime

  1. Gram (+)
  2. Gram (-)
  3. Pseudo
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21
Q

5th Gen Cephalosporins:
Names (1)
Coverage (3)

A

Ceftaroline

  1. Gram (+)
  2. Gram (-)
  3. MRSA
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22
Q

Name 2 Cephalosporins that cover Psuedomonas

A
  1. Ceftaz (3rd gen)

2. Cefepime (4th gen)

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23
Q

Cephasporins:

Adverse (6)

A
  1. Hypersensitivity
  2. Autoimmune Hemolytic anemia
  3. Disulfuram-like Rxn
  4. Vit K def (from killing off enteric bacteria)
  5. Cross-react w/ penicillins
  6. Nephrotox w/ Aminoglycosides
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24
Q

Name Carbapenems (4)

Special considerations per drug

A
  1. Imipenem
  2. Meropenem- less Seizure Risk, stable to Dehydropeptidase I
  3. Ertapenem-new, limited Pseudomonas coverage
  4. Doripenem-new
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25
Q

Carbapenems:
MOA
Special administration*?
Broad or Narrow

A

MOA: B-lactamase resistant

  • Always admin w/ CILASTATIN (inhib Renal Dehydropeptidase I) to decrease inactivation of drug in Renal tubules
  • Broad spectrum

“With imipenem, the kill is LASTIN’ with CILASTATIN”

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26
Q

Carbapenems:
Coverage(3)

When used?

A
  1. Gram + cocci
  2. Gram - rods
  3. anaerobes
  • Wide spectrum but limited use to life-threatening infections or after other drugs fail b/c of significant Adverse
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27
Q

Carbapenems:

Adverse (3)

A
  1. Seizures/ CNS tox @ high plasma levels
  2. GI distress
  3. Skin rash
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28
Q

Aztreonam (a Monobactam):
MOA
Penicillinase sensitivity
Adverse

A

Prevents Peptidoglycan cross-linking by binding to PBP-3

  • Less susceptible to B-lactamases
  • usually non-toxic, occasional GI upset
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29
Q

Aztreonam:
Coverage (1)
3 special uses

A

Gram - rods

  1. Penicillin-allergic patients safe
  2. well-tolerated in renal insuff pt (who can’t use Aminoglycosides)
  3. Synergistic activity w/ amino glycosides
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30
Q

Vancomycin:
MOA
Penicillinase Sensitivity
Bactericidal or Bacteriostatic

A
  • binds Dala Dala portion of cell wall precursors to prevent peptidoglycan formation
  • Not sensitive to penicillinase
  • Bactericidal against most (Bacteriostatic for C.Diff)
  • bacterial A.A. mutation to Dala Dlac

“Pay back 2Dala’s (dollars) for VANdalizing”

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31
Q

Vancomycin:

Adverse(4)

A

“Vancomycin is generally well tolerated but NOT trouble free”

  1. Nephrotox
  2. Ototox
  3. Thrombophlebitis
  4. Red Man Syndrome- pretreat w/ histamines & slow infusion
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32
Q

Bacterial Ribosome subunits

A

70S (30S, 50S)

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33
Q

Which Abx bind 30S and which bind 50S?

Bactericidal or Bacteriostatic

A

” Buy AT 30, CCEL (sell) at 50”

30S:

  1. Aminoglycosides- bactericidal
  2. Tetracyclines-bacteriostatic

50S:

  1. Chloramphenicol-bacteriostatic
  2. Clindamycin-bacteriostatic
  3. Erythromycin (macrolides)-bacteriostatic
  4. Linezolid-variable
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34
Q

Name Aminoglycosides (5)*

A

“MEAN (a-min-oglycoside) GNATS caNNOT kill ANAEROBES.”

  1. Gentamicin
  2. Neomycin
  3. Amikacin
  4. Tobramycin
  5. Streptomycin
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35
Q

Aminoglycosides:
MOA(2)*
Special consideration about MOA*

A

“‘A’ starts the alphabet, ‘A’minoglycosides inhib INITIATION”

  1. Irreversible inhib initiation–>mRNA misread
  2. inhib translocation

Require O2 for uptake making them ineffective against anaerobes
“‘Mean’ GNATS caNNOT kill ANAEROBES”

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36
Q 
Aminoglycosides:
Clinical use (4)
A

1 . Severe Gram - rod (like Pseudo/E.coli)

  1. Synergistic w/ B-lactams–> increase response
  2. Bowel surgery (Neomycin)
  3. Neonate suspected infections (Gentamycin & Ampicillin)
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37
Q

Aminoglycosides:

Adverse*

A

“‘Mean’ GNATS caNNOT kill ANAEROBES”

  1. Nephrotox (worse w/ cephalosporines)
  2. Neuromuscular blockade
  3. Ototox (worse w/ Loops)
  4. Teratogen
38
Q

Aminoglycosides:

MOResistance

A

Bacterial transferase enzymes inactivate drug by:

  1. acetylation
  2. phosphorylation
  3. adenylation
39
Q

Abx’s ending in -mycin (4 groups)

A
  1. Aminoglycosides (‘GNAT’)
  2. Clindamycin
  3. Macrolides (Azithromycin, Clarithromycin, Erythromycin)
  4. Daptomycin
40
Q

Tetracyclines: Tetracycline, Doxycycline, Minocycline
MOA
Bactericidal or Bacteriostatic
MOResistance

A

Binds 30S –>prevent aminoacyl-tRNA attachment

Bacteriostatic

Plasmid-encoded transport pumps decrease uptake/increase efflux

41
Q

Tetracyclines: Tetracycline, Doxycycline, Minocycline
CNS penetration
D-D(3)

A
  • limited CNS penetration

- Milk(Ca+2), antacids (Ca/Mg), Fe+-containing preparations: Divalent cations inhib gut drug absorption

42
Q

Tetracyclines: Tetracycline, Doxycycline, Minocycline
Coverage (5)
Special population use

A

Atypicals/Intracellular:

  1. Lyme (borrelia burgdorferi)
  2. M. pneumo
  3. RMSF (Rickettsia)
  4. Clamydia
  5. Acne

Fecally excreted–>Good for pt w/ Renal Failure

VACUUM THe BedRoom:
Vibreo, acne, chlamydia, ureaplasma, urealyticum, mycoplasma, Tuleremia, H pylori, Borrelia burgdorferi, rickettsia

43
Q

Tetracyclines: Tetracycline, Doxycycline, Minocycline
Adverse(4)
Contra(2)

A
  1. GI distress (fecally excreted)
  2. Discoloration of Teeth
  3. Inhib bone growth children (not
44
Q

Chloramphenicol:
MOA
Bactericidal or Bacteriostatic
MOResistance

A

Blocks peptidyltransferase of 50S
Bacteriostatic
Plasmid-encoded acetyltransferase inactivates drug

45
Q 
Chloramphenicol:
Clinical use(2)
A
  1. Meningitis (H.flu/Neisseria/S.pneumo)

2. RMSF (Rickettsia)

46
Q

Chloramphenicol:
Adverse (3)
(special note)

A
  1. Microcytic Anemia (dose dependent)–>*know picture
  2. Aplastic Anemia (dose independent)
  3. Gray-Baby syndrome (premature babies lack UDP-glucuronyl transferase–>decrease renal excretion)

*Limited use in USA b/c adverse but still used in developing countries($cheap)

47
Q

Clindamycin:
MOA
Bactericidal or Bacteriostatic

A

Block peptide transfer at 50S

Bacteriostatic

48
Q 
Clindamycin:
Clinical Use (4)
A

Treats anaerobic infections above diaphragm

  1. aspiration pneumo
  2. lung abscesses
  3. oral infections
  4. invasive GAStrep
49
Q

Aspiration pneumo patients (3)

A
  1. alcoholics
  2. seizures
  3. Altered mental status
50
Q

Gray Baby symptoms(4)

Which drug causes this?

A
  1. Gray ash-colored skin
  2. V
  3. Limp Muscles
  4. CV collapse

Cloramphenicol- premies lack UDP glucuronyl transferase

51
Q

Clindamycin:

Adverse (2)

A
  1. C.diff-pseudomembranous colitis

2. F/D

52
Q

Abx to treat Lyme disease (2)

Vector

A
  1. Doxycycline
  2. Ceftriaxone

Ixodes tick

53
Q

Use of Demeclocycline

MOA

A

treat SIADH

block V2-R in collecting duct (and bind 30s to prevent attachment of aminoacyl-tRNA)

54
Q

C.diff causing Abx: (2)

A

potentially all Abx but the 2 big ones are:

  1. Clindamycin
  2. Ampicillin (aminopenicillin)
55
Q

Linezolid (a Oxazolidinone):
MOA
Bactericidal or Bacteriostatic
MOResistance

A

Bind 50S and prevent initiation complex formation
Bacteriostatic
rRNA point mutations

56
Q

Linezolid (a Oxazolidinone):

Clinical Use

A

Gram + esp. MRSA & VRE

57
Q

Linezolid (a Oxazolidinone):

Adverse (3)

A
  1. BM suppression (esp. thrombocytopenia)
  2. peripheral neuropathy
  3. serotonin syndrome
58
Q

treatment of pt w/ MRSA and kidney disease?

A

Linezolid (not Vancomycin- Nephrotox)

59
Q

Macrolides:

Names (3)

A
  1. Azithromycin
  2. Clarithromycin
  3. Erythromycin
60
Q

Macrolides:
MOA*
Bactericidal or Bacteriostatic
MOResistance

A 
Bind 23S (of 50S) to block translocation ("macroSLIDES")
Bacteriostatic
Methylation of 23S
61
Q 
Macrolides:
Clinical Use (4)
A
  1. Atypical pneumonia (Mycoplasma/Chlamydia/Legionella)
  2. STI (Chlamydia)
  3. Gram + Cocci (Strep in penicillin-allergic)
  4. B. pertussis
62
Q

Macrolides:
Adverse (5)*
D-D(2)

A

“MACRO”

  1. Motility issues (GI)
  2. Arrhythmia (prolonged QT–>torsades de pointe)
  3. Cholestatic hepatitis (bile produced in liver/stored in gallbladder)
  4. Rash
  5. eOsinophilia

Clarithromycin & Erythromycin INHIB P450–>^serum concentration

  1. Theophylline
  2. oral anticoag
63
Q 
Serotonin Syndrome
Symp (6)
Causative ABx
Treatment
serotonin precursor molecule
A

Life threatening!!

  1. HA
  2. Aggitation
  3. Sweating
  4. muscle twitch
  5. clonus
  6. Hallucinations

Abx cause: Linezolid
Tx: stop med

Tryptophan–>serotonin

64
Q

Sulfonamides:

Name (3)

A
  1. Sulfamethoxazole (SMX)
  2. Sulfisoxazole
  3. sulfadiazine
65
Q

Sulfonamides:
MOA
Bactericidal or Bacteriostatic
MOResistance(3)

A

Competitive Inhib DihyDROPteroate synthase–>inhib folate synthesis
“Don’t DROP the ‘S’oap”

Bacteriostatic (bactericidal w/ Trimethoprim)

  1. alter dihyDROPteroate synthase
  2. decrease uptake
  3. increase PABA (substrate for RXN)
66
Q 
Sulfonamides:
Clinical Use(5)
A
  1. Gram +
  2. Gram -
  3. Nocardia
  4. Clamydia
  5. Simple UTI

“SNAP”
Sulphonamides=Nocardia
Actinomyces = Penicillin

67
Q

Sulfonamides:

Adverse(6)

A
  1. Hypersensitivity
  2. Hemolysis of G6PD def
  3. Nephrotox (Tubulointerstitial Nephritis)
  4. Photosensitivity
  5. Kernicterus (infants)
  6. Displace drugs from Albumin (esp. warfarin–>must decrease dose)
68
Q

Drugs causing Photosensitivity(4)

A

“SAT For PHOTO”

  1. Sulfonamides
  2. Amidarone
  3. Tetracyclines
  4. 5-FU
69
Q

Drugs causing Hemolysis in G6PD def (7)

Characteristic cells found on G6PD blood smear?

A

“Hemolysis IS D PAIN”

  1. isoniazid
  2. sulfonamides
  3. dapsone
  4. primaquine
  5. aspirin
  6. ibuprofen
  7. nitrofurantoin

Bite cells & Heinz bodies(Hb precipitation)

70
Q

What is Kernicterus?
Cause in infants?
Why do sulfonamides cause kernicterus?

A
  • Kernicterus is buildup of bilirubin in CNS
  • Babies have immature BBB

-Sulfonamides outcompete bilirubin for binding albumin–>increase free bilirubin crosses the immature BBB

71
Q

Dapsone:
MOA
Clinical Use(2)
Adverse

A

-inhib DihyDROPteroate synthase(like sulfonamides, differ structure)

  1. Leprosy(lepromatous/tuberculoid)
  2. px Pneumocystis jirovecii (PCP)

Hemolysis in G6PD def

72
Q

Trimethoprim (TMP):
MOA
Bactericidal or Bacteriostatic

A

Inhib bacterial Dihydrofolate reductase

Bacteriostatic (bactericidal w/ Sulfamethoxazole)

73
Q 
Trimethoprim (TMP):
Clinical Use(4 tx, 2 px in immunocompromised)
A

Combo with Sulfamethoxazole

  1. UTIs
  2. Shigella
  3. Salmonella
  4. PCP
  5. PCP
  6. Toxo
74
Q

Fluroquinolones:

Names(7)

A

” -oxacin”

  1. Ciprofloxacin
  2. Norfloxacin
  3. Levofloxacin
  4. Ofloxacin
  5. Moxifloxacin
  6. Gemifloxacin
  7. Enoxacin
75
Q

Fluroquinolones:
MOA
Bactericidal or Bacteriostatic
MOResistance(3)

A

Inhib prokaryotic topoisomerase-II(DNA gyrase) & topo-IV
(topoisomerases break DNA to undo supercoils)

Bactericidal

  1. Chromosome-encoded mutation in DNA gyrase
  2. plasmid-mediated resistance
  3. Efflux pumps
76
Q

Fluroquinolones:
Clinical Use(3)
Which fluroquinolone loves the Lung?

A
  1. Gram - rods UTI & GI (including pseudomonas)
  2. Neisseria
  3. some gram +

Levofloxacin “Levo loves the lungs”
-S.pneumo/ H.flu/ Leigenella/ Mycoplasma/ Chlamydia Pneumonia

77
Q

Fluroquinolones:
Adverse(6)
Contra (2, why)

A
  1. GI upset
  2. Superinfections
  3. Skin rashes
  4. HA/dizzy
  5. leg cramps/myalgias (less common)
  6. prolong QT interval (some)

Contra:
1. Pregnant/Nursing Moms/ Cartilage Damage
2. >60yo/ pt on prednisone–>Tendonitis or Tendon Rupture
“FluroquinoLONES hurt attachments to your BONES”

78
Q

Daptomycin:
MOA
Clinical Use (4)

A

Lipopeptide disrupts cell membrane of Gram + cocci

Severe infections

  1. S.aureus skin infections (esp MRSA)
  2. Bacteremia
  3. Endocarditis
  4. VRE
79
Q

Mnemonic for Endocarditis

A 
"FROM JANE"
Fever
Roth spots
Osler nodules
Murmur
Janeway lesions
Anemia
Nailbed hemorrhages
Emboli
80
Q

Daptomycin:
Adverse(2)
What can daptomycin not be used for?

A
  1. Myopathy
  2. Rhabdomyolysis (“Dapto causes Rhabdo”)

“Dapto = SurfactNO”
can’t be used for pneumonia b/c avidly binds to and is inactivated by surfactant

81
Q

Metronidazole:
MOA
Bactericidal or Bacteriostatic
Other organisms Metronidazole can treat?

A

Forms Toxic Free Radical metabolites in the bacterial cell that damages DNA

Bactericidal
anti-protazoal

82
Q 
Metronidazole:
Clinical Use (6- targeting 3 systems)
A

“GET GAP on the METRO with METRONIDAZOLE”

  1. GI (Giardia/Enteromoeba)
  2. Vaginitis (Trichomonas/ Gardnerella vaginalis)
  3. Entero (Anaerobes (Bacteroides, C. Diff)/h. Pylori (part of triple therapy)
83
Q

What drug treats anaerobes above the diaphragm?

Below the diaphragm?

A 
Above= Clindamycin
Below= Metronidazole
84
Q

What is the triple therapy for H.pylori?

A
  1. PPi
  2. Metronidazole / amoxicillin
  3. Clarithromycin
85
Q

Metronidazole:

Adverse (3)

A
  1. Disulfiram-like Rxn
  2. HA
  3. Metallic taste (‘METro causes METallic taste”)
86
Q

Drugs causing Disulfiram-like Rxn (5)

Symptoms

A
  1. Metronidazole
  2. Certain cephalosporins
  3. Griseofulvin
  4. Procarbazine
  5. 1st gen sulfonylureas

Symps: Flushing, Tachycardia, Hypotension

87
Q

Compare Trichomonas vs. Gardnerella:

  • smell
  • discharge
  • Micro view
  • cervix appearance
  • Does the partner need treated too?
A

Trich: Foul smell, green discharge, trich species/WBC, strawberry cervix, YES YOU TREAT PARTNER

Gardnerella:Fish smell, white discharge, Clue cells, NO NEED TO TREAT PARTNER

88
Q

Compare Giardia vs. Entamoeba:

A

Giardia: bloating/Gas, Foul smelling fatty diarrhea, typically in campers/hikers (be able to identify species with face)

Entamoeba: BLOODY diarrhea, liver abscess, “anchovy paste exudate”, RUQ pain, flask shaped ulcer

89
Q

How to treat MRSA?

A

“Very Dangerous Cocci Loathe Treatment”

  1. vancomycin (not for renal failure)
  2. daptomycin
  3. Ceftaroline
  4. Linezolid
  5. Tigecycline
90
Q

How to treat VRE?

How does resistance develop?

A

“VRE Doesn’t Quite Like Vancomycin”

  1. Dalfopristin
  2. Quinupristin
  3. Linezolid

Vancomycin resistance: Dala Dala–>Dala Dlac

Drugs- Basic High Yield Stuff for Boards (20 decks)

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