Antibiotics I Flashcards

1
Q

recombination

A

incorporate DNA into genome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

transformation

A

uptake of naked DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

transduction

A

bacteriophage transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Penicillins

A
Penicillin G/VK
Nafcillin/Dicolxacillin
Amoxicillin/Ampicillin
Amox/clav + Amp/sulbactam
Piperacillin
Pip/Tazobactam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cephalosporins

A

Cefazolin/Cephalexin
Ceftriaxone
Ceftazdime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Carbapenems

A

Imipenem/Cilastin

Meropenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Monobactams

A

Aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glycopeptide

A

Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oxazolidinone

A

Linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cyclic Lipopeptide

A

Daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Macrolide

A

Erythromycin
Clarithromycin
Azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nitroimidazole

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bacteriostatic target

A

protein synth/DNA synth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bacteriostatic Rxs

A
ECSTaTiC
Erythromycin (macrolides) Clindamycin 
Sulfamethoxazole 
Trimethoprim 
Tetracyclines 
Chloramphenicol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bacteriocidal rxs

A
Really Very Fine At Bug Murder
Rifampin 
Vancomycin 
Fluoroquinolones Aminoglycosides
B-lactams 
Metronidazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cell wall synthesis inhibitor advantages

A

*selectivity - only bacteria have cell wall
peptidogycan
*only active during synthesis (growing bacteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does vancomycin block?

A

cell wall - external phase - strand synthesis

Gucosyltransferase (peptidoglycan synthase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does penicillin (B lactam) block?

A
  • cell wall - strand cross-linking
  • Peptidoglycan transpeptidase PBP
  • covalent enzyme binding - defective cell wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

B lactams select

A

Gram +s, looks like D-ala D-ala to bind peptidoglycan transpeptidase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

B lactam resistance

Gram -

A
  • physical barrier
  • mutant porin in outer cell membrane
  • efflux pump over all 3 layers
  • enzyme inactivation (Gram + AND Gram -) B lactamase
  • mutate transpeptidase (PBP-2a not binding B-lact) (Gram + ONLY) (MRSA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Penicillinase resistant bacteria Penicillins

A

Nafcillin (IV) + Dicloxacillin (PO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Extended spectrum (Gram +/-) Penicillins

A

Amoxi (PO), Ampicillin (IV,PO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Extended spectrum anti-pseudomonal Penicillins

A

piperacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Compounded w/ B-lactamase inhibitor penicillins

A

Amox/clav (PO)
Amp/Sulbactam (IV)
Pip/Tazobactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Penicillin G (IV) + VK (PO)

A
  • susceptible Gram +ves
  • Inactivated by gastric acid
  • Poor CNS penetration (meningitis)
  • Renal secretion - PCT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Penicillin G

A

*bacteria selective - low direct toxicity

27
Q

Penicillin G S.E.

A
  • Superinfection - colitis (acidophilus pills)
  • CNS tremors
  • Hypersensitivity (rash, anaphylactic, skin TEN)
28
Q

Nafcillin (IV) excretion

A

biliary (unusual, most pen are kidney)

29
Q

Which acid-stable Pen-resistant pens are orally active?

A

DICLOXACILLIN
oxacillin
cloxacillin

30
Q

Amoxicillin (extended-spectrum)

A

acid stable - well absorbed

Better GI absorb

31
Q

Ampicillin (extended-spectrum)

A
  • delayed hypersensitivity rxn + non - immune skin rxn

* only use amoxi, this one is IV in hospital

32
Q

Piperacillin (IV/IM)

extended-spectrum

A
  • Inactivated by gastric acid
  • only IV/IM
  • PSEUDOMONAS (“P”)
33
Q

Amoxi/clavulanic acid

+B lac inhbitor

A

*clav = suicide inhibitor of B-lactamase (no intrinsic antibacterial activity)

34
Q

Cephalosporins - 1st gen

GRAM +
some gram -

A
  • Cefalozin (IV) - surgery prophylaxis (skin gram +)
  • Cephalexin (PO)

INACTIVATED BY:

  • broad spectrum B-lacmase
  • Ext. spectr. B-Lacmase
  • don’t bind PBP2a
35
Q

Cephalosporins - 2nd gen
LESS IMPORTANT

More gram - than +

A

Cefoxitin - resistant to b-lactmase
Cefuroxime

INACTIVATED BY:

  • broad spectrum B-lacmase
  • Ext. spectr. B-Lacmase
  • don’t bind PBP2a
36
Q

Cephalosporins - 4th gen + 5
LESS IMPORTANT

More gram - than +

A

4th - Cefepime
5th - MRSA

INACTIVATED BY:
*don’t bind PBP2a

37
Q

Cephalosporins 3rd gen

More gram (-) than (+)

A
  • Ceftriaxone - meningitis, lyme gonorrhea
  • Ceftazidime - Pseudomonas (turn on dime)

INACTIVATED BY:

  • Ext. spectr. B-Lacmase
  • don’t bind PBP2a
38
Q

which Cephalosporin generation penetrates CNS (meningitis)?

A

Ceph gen 3

1 + 2 don’t penetrate

39
Q

How are cephalosporins excreted?

A

kidney

40
Q

Cephalosporins

S.E.

A
  • cross-allergenicity w/ penicillin

* NEPHROTOXIC (adds to aminoglycosides too)

41
Q

Carbapenem characteristics

A

Imipenem/cilastin
Meropenem

  • Gram +/- rods, pseudomonas
  • last resort Rx
  • kill ESB-lactamases
42
Q

Carbapenem Rx characteristics

A

*Imipenem/cilastine - cilastin blocks dehydropeptidase I (imipenim renal hydrolysis)
(lasts longer!!) (watch for renal problems!)

*Meropenem - no cilastin needed

43
Q

Monobactams

A

*Aztreonam = Gram -
Enterobacteriaceae , Pseudomonas
*S.E. - no cross-allergenicity w/ penicillins/ceph

44
Q

All “mycins” come from what bacteria?

A

Streptomyces

45
Q

Mycins

A

Streptomycin (aminoglycoside)
Vancomycin (glycopeptide)
Clarithromycin (macrolide)
Clindamycin (lincosamide)

46
Q

Vancomycin
(glycopeptide)

Characteristics

A
  • IV, kidney excrete
  • Gram +, pseudo, C. difficile
  • block glucotrasferase (peptidoglycan synth)
  • can’t add dissacharide to polymer
  • bind terminal D-ala-D-ala
47
Q

Vancomycine
(glycopeptide)

S.E. + resistance

A

S.E. - “N.O.T. that toxic!”
*Red man (flushing)

Resistance- D-lactate

  • VRE to MRSA
  • Use - Linezolid, Daptomycin
48
Q

Linezolid

Oxazolidinone

A
  • Gram +
  • when pen, ceph, vanc don’t work (last resort)
  • MRSA/VRE + can’t use Vanc
  • liver metabolism
49
Q

Linezolid
(Oxazolidinone)

Resistance + S.E.

A
  • No cross resistance- bind 23S RNA (50S subunit), blocks 70S initiation complex formation
  • Resistance - 23S RNA mutation
  • S.E. - neuropathy (periph/optic)
    • myelosuppression
    • HTN w/ tyramine (MAO inhibitor)
50
Q

Daptomycin

Cyclic Lipopeptide

A
  • after pen, ceph, vanc, linezolid (vanc resistance)
  • Gram + (ALL)
  • forms K efflux pore (little resistance)
  • urine excretion
51
Q

Daptomycin
(Cyclic Lipopeptide)

S.E.

A
  • muscle weakness/discomfort

* not w/ statins (rhabdomyolysis)

52
Q

Which wall agent alternative inhibits protein synthesis?

A

macrolides:

  • Clarythromycin (PO,IV)
  • Azithromycin (PO,IV)
  • Erythromycin (IV, PO)

bind to 50S, stop translocation

53
Q

Which wall agent alternatives are indicated for anaerobes?

A

*Clindamycin (PO,IV) (lincosamide)
(oral>bowel) Gram +/-

*Metronidazole (PO,IV) (nitromidazole)
(bowel sterilizer)

54
Q

Which wall agent alternative is a DNA breaker?

A

Metronidazole (PO,IV)

nitroimidazole

55
Q

Macrolides

Use

A

Gram + more
for allergy to pen/ceph
for Gram + B-lactam resistant

56
Q

MLS cross drug resistance?

A

Macrolides, lincosamides, streptogamins

57
Q

Why is erythromycin bad?

macrolide

A
  • food interferes with absorption
  • biliary excretion
  • drug interactions due to inhibition of P450
  • GI intolerance (motilin receptors)
  • Hepatotoxic - acute cholestatic hepatitis
  • reversible hearing loss
  • QT prolongation (Vtac)
58
Q

What is effect of inhibiting P-gp/CYP 3A4 ?

A

higher bioavailability

59
Q

Clarythromycin
(macrolide)

S.E.

A
  • reversible hearing loss
  • teratogenic
  • drug drug interaction
  • CYP3A4 inhibition
60
Q

Azythromycin

macrolide

A
  • penetrates tissues well
  • keeps working after you stop (t 1/2 = 3days)
  • NO P-450 inhibition
61
Q

Clindamycin

Use

A
  • Gram + aerobe
  • Gram +/- anaerobe
  • MRSA
62
Q

Clindamycin

resistance + S.E.

A

*if resistant, then macrolide resistant (not vice versa)
*liver metab, out in urine + bile
(Hepatic disease?)
*causes Pseudomembranous colitis (c.difficile)

63
Q

Metronidazole (PO,IV)

nitroimidazole

A
  • anaerobic infxn, C.difficile (colitis)
  • bowel surgery
  • Disrupt DNA (covalent bonds)
64
Q

Metronidazole (PO,IV)
(nitroimidazole)

resistance + S.E.

A

Resistance- less nitroreductase

  • S.E. - w/alcohol = disulfiram-like rxn (N/V)
  • P-450 inhibition
  • metallic taste
  • dark red brown urine