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Foundations of Medicine Mike Rose > Antibiotics for Final > Flashcards

Antibiotics for Final Flashcards

1
Q

Penicillin

A

MOA = Bind to penicillin binding proteins which are transpeptidases that make the cell wall.

Spectrum = Gram +

Bactericidal

Benzathine = subcutaneous injection for longer half life.

*Anaphalaxis is a concern

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2
Q

Penicillinase

A

Enzymes that break down penicillin. Mechanism of resistnace

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3
Q

Nafcillin & Dicloxacillin

A

Same as penicillin but has larger R group which blocks penicillinase activity

MSSA usage

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4
Q

Beta-lactamase inhibitors

A

Clavulanate
Sulbactam
Tazobactam

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5
Q

Ampicillin and Amoxicillin

A

B-lactam with more gram negative coverage.

Amp + Sulbactam & Amo + Clavulanate

Associated with C diff.

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6
Q

Ticarcillin and Pipercillin

A

B- lactam that can be used against pseudomonas.

Broader action against gram -

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7
Q

Penicillin Allergy

A

3-10% of US

Only 5-10% react the second time

0.05% anaphylactic shock –> Epi

via hapten-protein comples –> IgE

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8
Q

Aztreonam

A

Beta-lactam with no cross allergic responses

Gram negative rods? / Inactivated by beta-lactamases

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9
Q

Cephalosporins

A

B- Lactam Less Susceptible to penicillinases

Dosage adjustment in renal insufficiency

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10
Q

Cefazolin

A

1st generation cephalosporin.
Gram +
Surgical prophylaxis
Doesn’t cross B-B barrier

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11
Q

Cefoxitin and cefuroxime

A

2nd generation cephalosporin
Use right before surgery
Doesn’t cross B-B barrier
Disulfiram-like reaction with EtOH = Hangover!!!

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12
Q

Ceftriaxone and cefotaxime

A 
3rd Gen Ceph
Use for serious gram - 
Can cross blood brain barrier
***Brain infections/Meningitis***
Strong association with C. diff
Kelates calcium
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13
Q

Cefepime

A 
4th generation (1st + 3rd) 
Broadest spectrum ceph = Gram +/- and pseudomonas
Good for empiric therapy
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14
Q

Ceftraroline

A

5th generation

Kills MRSA

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15
Q

Carbapenems - imipenim/cilastatin and meropenem

A

B-lactam
Broad spectrum but no MRSA
**cilastatin used to decrease nephrotoxicity
Now have Klebsiella pneumonia carbapenemase (KPC) superbugs

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16
Q

Genral Notes for Beta - Lactam

A

Seizures
Assume cross alleginicity
Monitor renal clearance

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17
Q

Vancomycin

A

MOA = Binds D-Alanyl-D-alanine terminus of cell wall precursor. Inhibits transglycolase.
Spectrum = gram + and MRSA
Oral vanco is poorly absorbed
Good for empiric
“Say no to Vanco :)”
Side effects = red man syndrome (hypersensitivity), nephrotoxicity (adjust dosage in renal insufficiency)
Now have VRE!!!

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18
Q

VRE resistance mechanism to Vanco

A

replac D-alanyl-D-alanine w/ D-alanyl-D-lactate or D-Alanyl-D-Serine

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19
Q

Bacitracin

A

MOA= inhibits elongation of cell wall (Not B-lactam) –> prevents dephosphorylation of Bactroprenol
Usage= poor bio availability –> topical, ophthalmic, and dermatologic
SA= Neprotoxic when given IM
low resistance

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20
Q

Polymyxin B

A

MOA= Binds to LPS making holes
Spectrum = Multidrug resistant gram negative bacilli
Used in combination iwth other ABs for entry
SA = Nephrotoxicity
Low resistance

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21
Q

Daptomycin

A

MOA = Depolarization of cell membrane
Spectrum = Gram + (Saved for VRE and Vanco resistant MRSA)
Side effects = pulmonary accumulation
Resistance = addition of positively charged lysine to cell surface repels the positively charged drug.

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22
Q

30s inhibitors

A

Aminoglycosides and tetracycline

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23
Q

50s inhibitors

A

linezolid, macrolides, chloramphenicol, clindamycin, quinupristin/dalfopristin

24
Q

Initiation blockers

A

linezolid and aminoglycosides

25
Q

Elongation blockers

A

aminoglycosides, tetracycline, macrolide, chloramphenicol, clindamycin, q/d

26
Q

Protein synthesis inhibitors = static or cidal

A

static except aminoglycosides or certain combinations

27
Q

Which inhibit mitochondrial ribosomes and cause bone marrow suppression

A

TLC Tetracycline, Linezolid, and chloramphenicol

*genetic variation here

28
Q

Linezolid

A

MOA =Binds 50s and prevents formation of initiation complex
Spectrum = Gram + including MRSA and VRE
Resistance = altered 23s binding site –> no cross resistance :)
SA = Bone marrow suppression (tLc), inhibits MAO –> seratonin syndrom with SSRIs (hallucinations, increase heart rate, agitation, and nausea)

29
Q

Aminoglycosides - gentamycin, neomycin, amikacin, tobramycin, and streptomycin (GNATS)

A

MOA - Bacteriocidal -prevents initiation, causes mRNA misreading, and early termination.
Spectrum = gram negative aerobes (Usually used in combo)
Resistance = failure to enter cell wall –> cotreat with cell wall inhibitor (genrally ampiciliin/amoxicillin), enzymes that inactivate the drug

Amikacin –> pseudomonas

Concentration dependent killing!

Adverse side effects = tubular necrosis, ototoxicity, hearing loss in pregnancy (class D)

Notes = IV administration and excluded from CSF

30
Q

Concentration dependent killers

A

aminoglycosides and fluoroquinolones

31
Q

time dependent killers

A

beta lactams and vanco

32
Q

Tetracylcines - tetracycline, doxycycline, democlocycline and minocycline

A 
MOA = binds 30s preventing attachment of aminoacyl tRNA
Spectrum = B. burgdorferi, H. pylori, and Mycoplasm pneumoniae due to resistnance
Resistnace = decreased uptake (intinsic), increased efflux*, altered ribosomal target
Adverse effects: Kelates cations, photosensitivity, discoloration of teeth, pregnancy class D
33
Q

Chloramphenicol

A

MOA = binds 50s preventing peptidyltransferase
Spectrum = extened, but little use due to side effects
Resistance = acetyltransferase alters drug = no binding
Adverse effects = TOXIC, Bone marrow suppression (tlC), Aplastic anemia, Gray baby syndrome (Class D)

34
Q

Grey baby syndrome

A

Caused by chloramphenicol = premature infants lack UDP-glucuronyl transferase and decreased renal function leads to high drug levels –> cardio/pulmonary collapse

35
Q

Macrolides - Erythromycin, azithromycin, clarithromycin

A 
MOA = inhibits tranlsocation of 50s
Spectrum = broad coverage or respiratory pathogens, Chlymidia (single dose) Upper respiratory infections
Resistance = methylation of 23s (shared with clindamycin and q/d)
Adverse effects = hepatic failure, prolonged QT, inhibits cyp450, 
Clarithromycin = pregnancy class D
36
Q

Clindamycin

A

MOA = Blocks translocation of 50s
Spectrum = gram + including anaerobes –> acne
Resistance = mutation of ribosome / methylation of 23s (cross resistance with macrolides and q/d)
Adverse effects = Hypersensitivity, C. Diff!

37
Q

Streptogramins - Quinupristin/ Dalforpristin

A

MOA = Binds 50s to inhibit tranlocation, cobined action is bactericidal
Spectrum = reserved for MRSA and VRE
Resistance = Enzymes that incactivate, Efflux pumps, and methylation of 23s (cross resistance with macrolides and clindamycin)
Adverse effects = arthralgias and myalgias, inhibits cyp450

38
Q

Mech of resistance = decreased uptake

A

Tetracyclines, Sulfonamides, Aminoglycosides, and Chlormaphenicol (The Stupid Ass Coach)

39
Q

Mech of resistance = Increased efflux

A

FAT SCAMS (written as cross) Fluoroquinolones, Aztreonam, Tetracylines (most important), Sulfonamides, cephalosporins, macrolides, streptogramins

40
Q

Mech of resistance = altered target

A

Like everything (need acronym or exclusion list)

41
Q

Mech of reistance = Upregulation of substrate

A

Sulfonamides (increased PABA synthesis)

42
Q

Mech of resistance = enzymatic inactivation

A

MC STAB MC (MCs are incactivating each other to win the rap battle duh! ) = Macrolides Clindamycin - Streptogrammins Tetracylines Aminoglycocidess B-lactamases - Metronidazole Chloramphenicol

43
Q

Rare resistance

A

Bacitracin, polymyxins, nitrofurantoin, metronidazole

44
Q

Rifampin

A

MOA = bactricidal, binds RNA pol and blocks elongation
Spectrum = TB, extended (RIPES due to high resistance)
Resistance = intrinsic due to binding, and aquired due to rpoB mutations preventing binding (Inhibited Binding)
Adverse effects = orange red fluids, Induction of CYP3A4 (faster warfarin metabolism)

45
Q

Fidaxomicin

A

MOA = bacteriocidal Inhibits RNA pol
Spectrum = Narrow Gram + anaerobes - C. diff!
Side effects = Few due to low absorbtion
Resistance = point mutation in RNA pol in vitro (no en vivo yet!)

46
Q

Fluoroquinolones - Ciprofloxacin, levofloxacin, and moxifloxacin

A 
MOA - Inhibit topoisomerase (topo II in gram - and topo IV in gram +)
Spectrum = broad, mycoplasm, hospital aquired pneumonia, UTIs (overperscribed)
Resistance = Active efflux, mutations in topo
Adverse effects = Chelates cations!, confusion and photosensitivity, C diff and candida vaginitis, Pregnancy class D (arthropathy)
47
Q

Sulfonamides - Sulfamethoxazole

A

MOA = PABA analog
Resistance = change in dihydropterate synthetase, efflux, increased PABA production
Adverse effects = hypersensitivity –> Stevens-Johnson, crystalluria –> acute renal failure, Hemolysis in G-6=P DH deficiency, kernicterus (neurologic condition in severly jaundiced newborns
*Can compete for albumin –> adverse effects with warfarin and other drugs

48
Q

Trimethoprim

A

MOA = Inhibits DHFR
Resistance = altered or increased DHFR, alternative metabolic pathways,
Adverse effects
GI upset

49
Q

Bactrim = TMP and SMX

A 
MOA = Sequential folate synthesis blockage
Spectrum = broad treatment of UTIs, pneumocystis
50
Q

Metronidzaole (Flagil)

A 
MOA = electron sink --> free radicals --> DNA breaks
Spectrum = anaerobes --> C diff, Protozoa
Resistance = rare
Adverse effects = pregnancy class D, Disulfiram like reaction with EtOH
51
Q

Nitrofurantoin

A

MOA = inhibits synthesis of DNA, RNA, cell wall, and protein via ribosome destruction
Spectrum = Broad spectrum and rapidly excreted **UTIs
Resistance = Lack of resistance due to variety of processes
Adverse effects = vomiting and rash

52
Q

Don’t use with Newborns

A

Chloramphenicol and Sulfonamides

53
Q

Don’t Use in children

A

Techincal Foul if you use Tetracyclines or Fluoroquinolones

54
Q

Don’t Use During Preganancy

A

Fuck Cunt Shit it’s the MCAT (Because the three worst swear words should be associated with that God-forsaken exam and its likely what you say if you accidently get pregnant) Fluoroquinolones, Chloramphenicol, Sulfonamides, Metronidazol Clarithromycin Aminoglycosides, Tetracyclines

55
Q

Don’t use in elderly / adjust for renal function

A

FAB because old people say fab = fluoroquinolones, aminoglycosides and B lactams

56
Q

Cause Hemolysis

A

Sulfonamides = aplastic anemia in g-6-p dh defeciency

Chloramphenicol too but not g6p related

57
Q

What is coadministered with Penicillin

A

Probenicid (due to low half life of the drug)

Foundations of Medicine Mike Rose (3 decks)

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