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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
resistance of chloramphenicol?
plasmid-encoded acetyltransferase that inactivates drug.
26
MOA Clindamycin?
blocks peptide bond formation at 50S ribosomal subunit | bacteriostatic
27
clinical use of clindamycin?
anaerobic infxns (ABOVE Diaphragm) (Bacteriodes fragilis, Clostridium perfringens) especially aspiration pneumo & lung abscesses
28
toxicity of clindamycin?
pseudomembranous colitis (C.diff overgrowth) fever diarrhea
29
Empiric tx for community-acquired penumonia in outpatient setting?
Macrolides
30
What is penicillin bactericidal for?
Gram + cocci, rods. Gram - cocci Spirochetes
31
Clinical use of Pencillin
Gram + orgs and syphilis. Prototype beta-lactam ABX
32
types of Penicillin
Pen G = IV form | Pen V = oral form
33
MOA of Penicillin
1) binds penicillin-binding proteins 2) blocks transpeptidase cross-linking of peptidoglycan 3) activate autolytic enzymes
34
Drugs that block cell wall synthesis by inhibition of peptidoglycan cross-linking
``` Penicillin Methicillin Ampicillin Piperacillin Cephalosporins Aztreonam Imipenem ```
35
MOA ticarcillin, carbenicillin, piperacillin?
Same as penicillin Extended spectrum Penicillinase sensitive Use w/ clavulinic acid
36
Resistance of ampicillin and amoxicillin?
Beta-lactamase cleaves beta-lactam ring
37
Amoxicillin vs ampicillin bioavailability?
AmOxicillin has greater Oral bioavailability.
38
Toxicity of ampicillin and amoxicillin?
Hypersensitivity rxns Pseudo membranous colitis Ampicillin- rash
39
MOA of ampicillin and amoxicillin?
Same as penicillin Wider spectrum Penicillinase sensitive Combo w/ clavulinic acid to protect against beta lactamase *AMP up with Penicillin
40
What are ampicillin and amoxicillin used to treat?
``` Haemophilus influenza E. coli Listeria monocytogenes Proteus mirabilis Salmonella Shigella enterococci ``` *HELPSS kill enterococci
41
Toxicity of methicillin, naficillin, dicloxacillin?
Hypersensitivity rxns | Methicillin- interstitial nephritis
42
MOA of methicillin, naficillin, dicloxacillin?
Penicillinase-resistant penicillins (Bc bulkier R group) Same MOA as penicillin Narrow spectrum
43
What are methicillin, naficillin, and dicloxacillin used for?
Staph. aureus (except MRSA bc altered PBP target site) *use naf for staph
44
Penicillin toxicity?
Hypersensitivity Rxn | Hemolytic anemia
45
Penicillin resistance?
Beta- lactamase (Cleaved beta-lactam ring) Not penicillinase resistant
46
Toxicity of Aztreonam?
nontoxic GI upset no cross-sensitivity with Pen or Ceph
47
Clinical use of Aztreonam?
Gram - rods only no activity against Gram + orgs or anaerobes use if pen allergy or renal insufficiency and cannot tolerate aminoglycosides
48
MOA of Aztreonam?
Monobactam resistant to beta-lactamase. Inhibits cell wall synthesis (binds PBP) Synergistic with aminoglycosides No cross-allergenicity with penicillin
49
Cephalosporin toxicity?
Hypersensitivity rxns Vit K deficiency Nephroxicity inc w/ aminoglycoside Disulfiram-like Rxn with ETOH Cross-hypersensitivity with penicillins
50
Organisms NOT covered by cephalosporins?
Listeria Atypicals (chlamydia, mycoplasma) MRSA Enterococci *LAME
51
Clinical use of 4th gen cephalosporins?
Cefepime | Inc activity against pseudomonas and gram + orgs
52
Clinical use of 3rd gen cephalosporins?
Ceftriaxone, cefotaxime, ceftazidime Serious gram - infxn a resistant to other beta lactams ``` Ceftriaxone = meningitis & gonorrhea Ceftazidime = pseudomonas ```
53
Clinical use of 2nd generation cephalosporins?
``` Cefoxitin, Cefaclor, cefuroxime Gram + cocci H. flu Enterobacter Neisseria Proteus E. coli Klebsiella Serratia ``` *2nd gen: HEN PEcKS
54
Clinical use of 1st generation cephalosporins?
``` Cefazolin & Cephalexin Gram + cocci Proteus mirabilis E. coli Klebsiella pneumo ``` *1st gen PEcKS
55
MOA of cephalosporins?
Inhibit cell wall synthesis (beta-lactams) but less susceptible to penicillinases. Bacteriocidal Beta-lactams
56
Use of beta-lactamase inhibitors?
Added to penicillin abx to protect abx from destruction by beta-lactamase (aka: penicillinase)
57
Beta-lactamase inhibitors?
Clavulinic Acid Sulbactam Tazobactam *CAST off beta-lactamase
58
Toxicity of Ticarcillin, carbenicillin, piperacillin?
Hypersensitivity Rxn
59
Clinical use of Ticarcillin, carbenicillin, piperacillin?
Pseudomonas Gram - rods *TCP = Takes Care of Pseudomonas
60
Drugs that generally block peptidoglycan synthesis?
Bacitracin | Vancomycin
61
Resistance of Vancomycin?
amino acid change (D-ala D-ala to D-ala D-lac) | *Pay back 2 Dalas (dollars) for VANdalizing"
62
Toxicity of Vancomycin?
``` Nephrotoxicity Ototoxicity Thrombophlebitis Diffuse flushing-- 'Red Man Syndrome' (prevent RMS w/ antihistamines & slow infusion) ``` *NOT many problems
63
Clinical use of Vancomycin?
Gram + only | serious, multidrug reistant orgs (S. aureus, enterococci and c. diff)
64
MOA Vancomycin?
inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal
65
Toxicity of Impipenem?
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
Clinical Use of Imipenem?
Gram + cocci Gram - rods anaerbobes wide-spectrum
67
Why is imipenem always administered with cilastatin?
cilastatin inhibits renal dehydropeptidase I decreases inactivation of drug in renal tubules *the kill is LASTIN' with CiLASTATIN
68
MOA of Imipenem?
broad-spectrum beta-lactamase resistant carbapenem.
69
Resistance of sulfonamides?
``` Altered enzyme (dihydropteroate synthetase) dec uptake or inc PABA synthesis ```
70
Toxicity of sulfonamides?
Hypersensitivity rxns hemolysis if G6PD deficiency Nephrotoxicity (tubulointerstitial nephritis) Photosensitivity Kernicterus in infants displaces other drugs from albumin (warfarin)
71
clinical use of sulfonamides?
``` Gram + Gram - Nocardia Chlamydia simple UTI ```
72
MOA Of Sulfonamides?
PABA antimetabolites inhibit dihydropteroate synthetase | Bacteriostatic
73
Toxicity of trimethoprim?
megaloblastic anemia leukopenia granulocytopenia (may alleviate with supplement of folinic acid) *TMP = Treats Marrow Poorly
74
Clinical use of trimethoprim?
``` combo with SMX to treat: UTI's shigella salmonella pneumocystis jiroveci pneumo. ```
75
Combo with trimethoprim?
in combo with sulfonamides (TMP-SMX) | causes sequential block of folate synthesis
76
MOA Of trimethoprim?
inhibits bacterial dihydrofolate reductase (DHFR) | bacteriostatic
77
Which drugs block nucelotide synthesis?
Trimethoprim | Sulfonamides
78
Toxicity of Metronidazole?
disulfiram-like rxn with EtOH Headache metallic taste
79
Clinical Use of Metronidazole?
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
MOA of Metronidazole?
Forms free radical toxic metabolites in bacterial cell that damages DNA. bactericidal & anti-protozoal
81
Which drug damages DNA?
Metronidazole
82
4 R's of Rifampin?
RNA polymerase inhibition Revs up microsomal P450 Red/Orange body fluids Rapid resistance if used alone
83
Toxicity of Rifampin?
Minor hepatotoxicity and drug interactions Inc p450 orange body fluids
84
Clinical use of Rifampin?
Mycobacterium Tuberculosis delays resistance to dapsone when used for leprosy. Meningococcal prophylaxid and chemoprophylaxis with H. flu contact (kids)
85
MOA of Rifampin?
Inhibits DNA-dependent RNA polymerase
86
Which drug class blocks mRNA synthesis?
Rifampin
87
Fluoroquinolones resistance?
chromosome- encoded mutation in DNA gyrase
88
Fluoroquinolones contraindication?
pregnancy & children | due to cartilage damage
89
Toxicity of Fluoroquninolones?
``` GI upset superinfections skin rashes headache dizziness tendonitis & tendon rupture (adults) leg cramps & myalgias (kids) ``` *FluoroquinoLONES hurt attachments to your BONES
90
Clinical use of fluoroquinolones?
Gram - rods of UT and GI tracts | Neisseria, Pseudomonas, some Gram +
91
MOA Of Fluoroquinolones?
Inhibits DNA gyrase (Topoisomerase II) | Bacteriocidal
92
Which drugs are included as Fluoroquinolones?
Ciprofloxacin Norfloxacin Levofloxacin Nalidixic Acid
93
Which drug blocks DNA topoisomerase?
Fluoroquinolones
94
DOC meningococcal infxn?
Ciprofloxacin Rifampin and minocycline are secondary drugs
95
DOC gonorrhea?
Ceftriazone
96
DOC syphilis?
Pen G (benzathine)
97
DOC hx recurrent UTI?
TMP-SMX
98
DOC endocarditis w/ surgical or dental procedures?
Penicillins
99
HIV prophylaxis against PCP pneumo (CD4<200)?
TMP-SMX
100
HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?
TMP-SMX Aerosolized pentamide if intolerant to TMP-SMX, but won't prevent toxoplasmosis
101
HIV prophylaxis against MAI (CD4<50)?
Azithromycin
102
DOC tx MRSA?
Vancomycin
103
DOC tx Vanc-resistant?
Linezolid | Streptogramins (quinupristin or dalfopristin)
104
Outpatient community-acquired pneumo?
Macrolides
105
Tx inpatient community-acquired pneumo?
Fluoroquinolones
106
Tx ICU community-acquired pneumo?
Beta-lactam PLUS Fluoroquinolone or azithromycin
107
DOC meningococcal infxn?
Ciprofloxacin Rifampin and minocycline are secondary drugs
108
DOC gonorrhea?
Ceftriazone
109
DOC syphilis?
Pen G (benzathine)
110
DOC hx recurrent UTI?
TMP-SMX
111
DOC endocarditis w/ surgical or dental procedures?
Penicillins
112
HIV prophylaxis against PCP pneumo (CD4<200)?
TMP-SMX
113
HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?
TMP-SMX Aerosolized pentamide if intolerant to TMP-SMX, but won't prevent toxoplasmosis
114
HIV prophylaxis against MAI (CD4<50)?
Azithromycin
115
DOC tx MRSA?
Vancomycin
116
DOC tx Vanc-resistant?
Linezolid | Streptogramins (quinupristin or dalfopristin)
117
Outpatient community-acquired pneumo?
Macrolides
118
Tx inpatient community-acquired pneumo?
Fluoroquinolones
119
Tx ICU community-acquired pneumo?
Beta-lactam PLUS Fluoroquinolone or azithromycin
120
DOC meningococcal infxn?
Ciprofloxacin Rifampin and minocycline are secondary drugs
121
DOC gonorrhea?
Ceftriazone
122
DOC syphilis?
Pen G (benzathine)
123
DOC hx recurrent UTI?
TMP-SMX
124
DOC endocarditis w/ surgical or dental procedures?
Penicillins
125
HIV prophylaxis against PCP pneumo (CD4<200)?
TMP-SMX
126
HIV prophylaxis against PCP pneumo & toxoplasmosis (CD4<100)?
TMP-SMX Aerosolized pentamide if intolerant to TMP-SMX, but won't prevent toxoplasmosis
127
HIV prophylaxis against MAI (CD4<50)?
Azithromycin
128
DOC tx MRSA?
Vancomycin
129
DOC tx Vanc-resistant?
Linezolid | Streptogramins (quinupristin or dalfopristin)
130
Outpatient community-acquired pneumo?
Macrolides
131
Tx inpatient community-acquired pneumo?
Fluoroquinolones
132
Tx ICU community-acquired pneumo?
Beta-lactam PLUS Fluoroquinolone or azithromycin

Antimicrobials (6 decks)

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