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Antibiotics Flashcards

1
Q

Which drugs block protein synthesis at 50S ribosomal subunit?

A 
Chloramphenicol
Macrolides (Erythromycin)
Clindamycin
Linezolid
Stretogramins (Quinupristin, Dalfopristin)
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2
Q

Which drugs block protein synthesis at 30S ribosomal subunit?

A

Aminoglycosides

Tetracyclines

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3
Q

Mnemonic for subunits?

A

“Buy AT 30, CCEL (sell) at 50”
AT = 30
CCEL = 50

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4
Q

Which drugs are aminoglycosides?

A 
Gentamycin
Neomycin
Amkiacin
Tobramycin
Streptomycin

*Mean GNATS canNOT kill anaerobes

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5
Q

MOA of aminoglycosides?

A

inhibits formation of initiation complex (30S) and cause misreading of mRNA.
require O2 for uptake– ineffective against anaerobes.
batericidal

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6
Q

Clinical use of aminoglycosides?

A

severe Gram - rods
synergistic with Beta-lactams
Neomycin for bowel surgery

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7
Q

Toxicity of Aminoglycosides?

A

Nephrotoxicity (when used with cephs)
Ototoxicity (when used with loop diuretics)
Teratogen

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8
Q

Resistance of aminoglycosides?

A

transferase enzymes that inactivate the drug by acetylation, phosphorylation, adenylation

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9
Q

Types of Tetracyclines?

A

Tetracycline
Doxycycline
Demeclocycline
Minocycline

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10
Q

MOA of tetracyclines?

A

binds 30S and prevents attachment of aminoacyl-tRNA

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11
Q

Contraindications of tetracyclines?

A

Doxy cannot be used in renal failure patients (fecally eliminated)
Cannot take with milk, antacids, iron-containing preps bc divalent cations inhibit gut absorption

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12
Q

clinical use of tetracyclines

A 
Borrelia burgdorferi
Mycoplasma pneumo
Rickettsia
Chlamydia
(accumulates intracellularly)
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13
Q

Toxicity of tetracyclines

A

GI distress
discoloration of teeth
inhibition of bone growth in children
photosensitivity

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14
Q

contraindication of tetracyclines

A

pregnancy

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15
Q

resistance of tetracyclines

A

dec uptake into cells or inc efflux out of cell by plasmid-encoded transport pumps

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16
Q

Demeclocycline additional uses

A

ADH antagonist

Diuretic usage in SIADH

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17
Q

Types of macrolides?

A

Erythromycin
Azithromycin
Clarithromycin

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18
Q

MOA of macrolides?

A

inhibits protein synthesis by blocking translocation (macroSLIDES). binds to the 23S rRNA of the 50S ribosomal subunit
Bacteriostatic

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19
Q

Clinical Use of macrolides?

A

Atypical Pneumonias (Mycoplasma, Chlamydia, Legionella)
URIs, STDs
Gram + cocci (strep infxns in pts allergic to penicillins)
Neisseria

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20
Q

Toxicity of macrolides?

A

Prolonged QT interval (especially erythromycin)
GI discomfort (MCC noncompliance)
acute cholestatic hepatitis
eosinophilia
skin rashes
inc serum conc of theophyllines, oral anticoags

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21
Q

Resistance with macrolides?

A

methylation of 23S rRNA binding site

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22
Q

MOA chloramphenicol?

A

blocks peptide bone formation at 50S ribosome subunit.

bacteriostatic

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23
Q

clinical use of chloramphenicol?

A

Meningitis (H. flu, N. meningitidis, Strep. pneumo)

conservative use d/t toxicities.

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24
Q

toxicity of chloramphenicol?

A 
Anemia (dose-dep)
aplastic anermia (dose-indep)
gray baby syndrome (premies bc lack liver enzyme: UDP-glycuronyl transferase)
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25
Q

resistance of chloramphenicol?

A

plasmid-encoded acetyltransferase that inactivates drug.

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26
Q

MOA Clindamycin?

A

blocks peptide bond formation at 50S ribosomal subunit

bacteriostatic

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27
Q

clinical use of clindamycin?

A

anaerobic infxns (ABOVE Diaphragm)
(Bacteriodes fragilis, Clostridium perfringens)
especially aspiration pneumo & lung abscesses

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28
Q

toxicity of clindamycin?

A

pseudomembranous colitis (C.diff overgrowth)
fever
diarrhea

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29
Q

Empiric tx for community-acquired penumonia in outpatient setting?

A

Macrolides

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30
Q

What is penicillin bactericidal for?

A

Gram + cocci, rods.
Gram - cocci
Spirochetes

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31
Q

Clinical use of Pencillin

A

Gram + orgs and syphilis.

Prototype beta-lactam ABX

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32
Q

types of Penicillin

A

Pen G = IV form

Pen V = oral form

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33
Q

MOA of Penicillin

A

1) binds penicillin-binding proteins
2) blocks transpeptidase cross-linking of peptidoglycan
3) activate autolytic enzymes

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34
Q

Drugs that block cell wall synthesis by inhibition of peptidoglycan cross-linking

A 
Penicillin
Methicillin
Ampicillin
Piperacillin
Cephalosporins
Aztreonam
Imipenem
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35
Q

MOA ticarcillin, carbenicillin, piperacillin?

A

Same as penicillin
Extended spectrum

Penicillinase sensitive
Use w/ clavulinic acid

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36
Q

Resistance of ampicillin and amoxicillin?

A

Beta-lactamase cleaves beta-lactam ring

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37
Q

Amoxicillin vs ampicillin bioavailability?

A

AmOxicillin has greater Oral bioavailability.

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38
Q

Toxicity of ampicillin and amoxicillin?

A

Hypersensitivity rxns
Pseudo membranous colitis
Ampicillin- rash

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39
Q

MOA of ampicillin and amoxicillin?

A

Same as penicillin
Wider spectrum
Penicillinase sensitive

Combo w/ clavulinic acid to protect against beta lactamase

*AMP up with Penicillin

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40
Q

What are ampicillin and amoxicillin used to treat?

A 
Haemophilus influenza
E. coli
Listeria monocytogenes
Proteus mirabilis
Salmonella
Shigella enterococci

*HELPSS kill enterococci

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41
Q

Toxicity of methicillin, naficillin, dicloxacillin?

A

Hypersensitivity rxns

Methicillin- interstitial nephritis

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42
Q

MOA of methicillin, naficillin, dicloxacillin?

A

Penicillinase-resistant penicillins
(Bc bulkier R group)
Same MOA as penicillin
Narrow spectrum

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43
Q

What are methicillin, naficillin, and dicloxacillin used for?

A

Staph. aureus
(except MRSA bc altered PBP target site)

*use naf for staph

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44
Q

Penicillin toxicity?

A

Hypersensitivity Rxn

Hemolytic anemia

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45
Q

Penicillin resistance?

A

Beta- lactamase
(Cleaved beta-lactam ring)

Not penicillinase resistant

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46
Q

Toxicity of Aztreonam?

A

nontoxic
GI upset
no cross-sensitivity with Pen or Ceph

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47
Q

Clinical use of Aztreonam?

A

Gram - rods only
no activity against Gram + orgs or anaerobes
use if pen allergy or renal insufficiency and cannot tolerate aminoglycosides

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48
Q

MOA of Aztreonam?

A

Monobactam resistant to beta-lactamase.
Inhibits cell wall synthesis (binds PBP)
Synergistic with aminoglycosides
No cross-allergenicity with penicillin

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49
Q

Cephalosporin toxicity?

A

Hypersensitivity rxns
Vit K deficiency
Nephroxicity inc w/ aminoglycoside

Disulfiram-like Rxn with ETOH
Cross-hypersensitivity with penicillins

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50
Q

Organisms NOT covered by cephalosporins?

A

Listeria
Atypicals (chlamydia, mycoplasma)
MRSA
Enterococci

*LAME

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51
Q

Clinical use of 4th gen cephalosporins?

A

Cefepime

Inc activity against pseudomonas and gram + orgs

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52
Q

Clinical use of 3rd gen cephalosporins?

A

Ceftriaxone, cefotaxime, ceftazidime
Serious gram - infxn a resistant to other beta lactams

Ceftriaxone = meningitis & gonorrhea
Ceftazidime = pseudomonas
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53
Q

Clinical use of 2nd generation cephalosporins?

A 
Cefoxitin, Cefaclor, cefuroxime
Gram + cocci
H. flu
Enterobacter
Neisseria
Proteus
E. coli
Klebsiella
Serratia

*2nd gen: HEN PEcKS

54
Q

Clinical use of 1st generation cephalosporins?

A 
Cefazolin & Cephalexin
Gram + cocci
Proteus mirabilis
E. coli
Klebsiella pneumo

*1st gen PEcKS

55
Q

MOA of cephalosporins?

A

Inhibit cell wall synthesis (beta-lactams) but less susceptible to penicillinases.
Bacteriocidal
Beta-lactams

56
Q

Use of beta-lactamase inhibitors?

A

Added to penicillin abx to protect abx from destruction by beta-lactamase (aka: penicillinase)

57
Q

Beta-lactamase inhibitors?

A

Clavulinic Acid
Sulbactam
Tazobactam

*CAST off beta-lactamase

58
Q

Toxicity of Ticarcillin, carbenicillin, piperacillin?

A

Hypersensitivity Rxn

59
Q

Clinical use of Ticarcillin, carbenicillin, piperacillin?

A

Pseudomonas
Gram - rods

*TCP = Takes Care of Pseudomonas

60
Q

Drugs that generally block peptidoglycan synthesis?

A

Bacitracin

Vancomycin

61
Q

Resistance of Vancomycin?

A

amino acid change (D-ala D-ala to D-ala D-lac)

*Pay back 2 Dalas (dollars) for VANdalizing”

62
Q

Toxicity of Vancomycin?

A 
Nephrotoxicity
Ototoxicity
Thrombophlebitis
Diffuse flushing-- 'Red Man Syndrome'
(prevent RMS w/ antihistamines & slow infusion)

*NOT many problems

63
Q

Clinical use of Vancomycin?

A

Gram + only

serious, multidrug reistant orgs (S. aureus, enterococci and c. diff)

64
Q

MOA Vancomycin?

A

inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors.
Bactericidal

65
Q

Toxicity of Impipenem?

A

GI distress
skin rash
CNS toxicity (Seizures) at high plasma levels
S/E’s limit use to life-threatening infxns

Meropnenm = reduced risk of seizures bc stable to dihydropeptidase I

66
Q

Clinical Use of Imipenem?

A

Gram + cocci
Gram - rods
anaerbobes
wide-spectrum

67
Q

Why is imipenem always administered with cilastatin?

A

cilastatin inhibits renal dehydropeptidase I
decreases inactivation of drug in renal tubules

*the kill is LASTIN’ with CiLASTATIN

68
Q

MOA of Imipenem?

A

broad-spectrum beta-lactamase resistant carbapenem.

69
Q

Resistance of sulfonamides?

A 
Altered enzyme (dihydropteroate synthetase)
dec uptake or inc PABA synthesis
70
Q

Toxicity of sulfonamides?

A

Hypersensitivity rxns
hemolysis if G6PD deficiency
Nephrotoxicity (tubulointerstitial nephritis)
Photosensitivity
Kernicterus in infants
displaces other drugs from albumin (warfarin)

71
Q

clinical use of sulfonamides?

A 
Gram +
Gram -
Nocardia
Chlamydia
simple UTI
72
Q

MOA Of Sulfonamides?

A

PABA antimetabolites inhibit dihydropteroate synthetase

Bacteriostatic

73
Q

Toxicity of trimethoprim?

A

megaloblastic anemia
leukopenia
granulocytopenia
(may alleviate with supplement of folinic acid)

*TMP = Treats Marrow Poorly

74
Q

Clinical use of trimethoprim?

A 
combo with SMX to treat:
UTI's
shigella
salmonella
pneumocystis jiroveci pneumo.
75
Q

Combo with trimethoprim?

A

in combo with sulfonamides (TMP-SMX)

causes sequential block of folate synthesis

76
Q

MOA Of trimethoprim?

A

inhibits bacterial dihydrofolate reductase (DHFR)

bacteriostatic

77
Q

Which drugs block nucelotide synthesis?

A

Trimethoprim

Sulfonamides

78
Q

Toxicity of Metronidazole?

A

disulfiram-like rxn with EtOH
Headache
metallic taste

79
Q

Clinical Use of Metronidazole?

A

Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes (bacteriodes & C. diff) ABOVE the diaphragm
H. Pylori (with bismuth & amoxicillin or tetracycline for triple therapy)

*GET GAP on the Metro

80
Q

MOA of Metronidazole?

A

Forms free radical toxic metabolites in bacterial cell that damages DNA.
bactericidal & anti-protozoal

81
Q

Which drug damages DNA?

A

Metronidazole

82
Q

4 R’s of Rifampin?

A

RNA polymerase inhibition
Revs up microsomal P450
Red/Orange body fluids
Rapid resistance if used alone

83
Q

Toxicity of Rifampin?

A

Minor hepatotoxicity and drug interactions
Inc p450
orange body fluids

84
Q

Clinical use of Rifampin?

A

Mycobacterium Tuberculosis
delays resistance to dapsone when used for leprosy.
Meningococcal prophylaxid and chemoprophylaxis with H. flu contact (kids)

85
Q

MOA of Rifampin?

A

Inhibits DNA-dependent RNA polymerase

86
Q

Which drug class blocks mRNA synthesis?

87
Q

Fluoroquinolones resistance?

A

chromosome- encoded mutation in DNA gyrase

88
Q

Fluoroquinolones contraindication?

A

pregnancy & children

due to cartilage damage

89
Q

Toxicity of Fluoroquninolones?

A 
GI upset
superinfections
skin rashes
headache
dizziness
tendonitis & tendon rupture  (adults)
leg cramps & myalgias (kids)

*FluoroquinoLONES hurt attachments to your BONES

90
Q

Clinical use of fluoroquinolones?

A

Gram - rods of UT and GI tracts

Neisseria, Pseudomonas, some Gram +

91
Q

MOA Of Fluoroquinolones?

A

Inhibits DNA gyrase (Topoisomerase II)

Bacteriocidal

92
Q

Which drugs are included as Fluoroquinolones?

A

Ciprofloxacin
Norfloxacin
Levofloxacin
Nalidixic Acid

93
Q

Which drug blocks DNA topoisomerase?

A

Fluoroquinolones

94
Q

DOC meningococcal infxn?

A

Ciprofloxacin

Rifampin and minocycline are secondary drugs

95
Q

DOC gonorrhea?

A

Ceftriazone

96
Q

DOC syphilis?

A

Pen G (benzathine)

97
Q

DOC hx recurrent UTI?

98
Q

DOC endocarditis w/ surgical or dental procedures?

A

Penicillins

99
Q

HIV prophylaxis against PCP pneumo (CD4<200)?

100
Q

HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?

A

TMP-SMX

Aerosolized pentamide if intolerant to TMP-SMX, but won’t prevent toxoplasmosis

101
Q

HIV prophylaxis against MAI (CD4<50)?

A

Azithromycin

102
Q

DOC tx MRSA?

A

Vancomycin

103
Q

DOC tx Vanc-resistant?

A

Linezolid

Streptogramins (quinupristin or dalfopristin)

104
Q

Outpatient community-acquired pneumo?

A

Macrolides

105
Q

Tx inpatient community-acquired pneumo?

A

Fluoroquinolones

106
Q

Tx ICU community-acquired pneumo?

A

Beta-lactam
PLUS
Fluoroquinolone or azithromycin

107
Q

DOC meningococcal infxn?

A

Ciprofloxacin

Rifampin and minocycline are secondary drugs

108
Q

DOC gonorrhea?

A

Ceftriazone

109
Q

DOC syphilis?

A

Pen G (benzathine)

110
Q

DOC hx recurrent UTI?

111
Q

DOC endocarditis w/ surgical or dental procedures?

A

Penicillins

112
Q

HIV prophylaxis against PCP pneumo (CD4<200)?

113
Q

HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?

A

TMP-SMX

Aerosolized pentamide if intolerant to TMP-SMX, but won’t prevent toxoplasmosis

114
Q

HIV prophylaxis against MAI (CD4<50)?

A

Azithromycin

115
Q

DOC tx MRSA?

A

Vancomycin

116
Q

DOC tx Vanc-resistant?

A

Linezolid

Streptogramins (quinupristin or dalfopristin)

117
Q

Outpatient community-acquired pneumo?

A

Macrolides

118
Q

Tx inpatient community-acquired pneumo?

A

Fluoroquinolones

119
Q

Tx ICU community-acquired pneumo?

A

Beta-lactam
PLUS
Fluoroquinolone or azithromycin

120
Q

DOC meningococcal infxn?

A

Ciprofloxacin

Rifampin and minocycline are secondary drugs

121
Q

DOC gonorrhea?

A

Ceftriazone

122
Q

DOC syphilis?

A

Pen G (benzathine)

123
Q

DOC hx recurrent UTI?

124
Q

DOC endocarditis w/ surgical or dental procedures?

A

Penicillins

125
Q

HIV prophylaxis against PCP pneumo (CD4<200)?

126
Q

HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?

A

TMP-SMX

Aerosolized pentamide if intolerant to TMP-SMX, but won’t prevent toxoplasmosis

127
Q

HIV prophylaxis against MAI (CD4<50)?

A

Azithromycin

128
Q

DOC tx MRSA?

A

Vancomycin

129
Q

DOC tx Vanc-resistant?

A

Linezolid

Streptogramins (quinupristin or dalfopristin)

130
Q

Outpatient community-acquired pneumo?

A

Macrolides

131
Q

Tx inpatient community-acquired pneumo?

A

Fluoroquinolones

132
Q

Tx ICU community-acquired pneumo?

A

Beta-lactam
PLUS
Fluoroquinolone or azithromycin

Antimicrobials (6 decks)

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