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Step 1 Pharm > Antimicrobial Tx > Flashcards

Antimicrobial Tx Flashcards

1
Q

Bacterial meningitis empiric tx (unknown organism/pre-culture results)

A

Vancomycin + ceftriaxone/cefotaxime (IV)

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2
Q

Vancomycin adverse rxns

A

“The “red man” life is NOT trouble free”
Nephrotoxicity
Ototoxicity
Thrombophlebitis
“red man syndrome” - hypotension, diffuse flushing, erythematous rash on head and neck -

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3
Q

Tx for “red man syndrome” assoc. with Vanc

A

slow infusion rate + antihistamines

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4
Q

Vanc MOA

A

Inhibits cell wall peptidoglycan formation by binding D-ala D-ala precursors (G+ organisms only)

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5
Q

Vanc MOR

A

VanA gene - encodes for amino acid modification of D-ala D-ala to D-ala D-lac

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6
Q

S. pneumoniae tx (pneumonia/systemic infection)

A

Penicillin/cephalosporin

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7
Q

S. pneumoniae meningitis tx - organism susceptible to PCN

A

Ampicilin or ceftriaxone/cefotaxime

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8
Q

S. pnumoniae meningitis tx - organism resistant to PCN, susceptible to cephalosporins

A

ceftriaxone/cefotaxime

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9
Q

S. pneumoniae meningitis tx - organism resistant to PCN AND cephalosporins

A

IV vancomycin x 10-14 days

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10
Q

M. leprae - lepromatous leprae

A
  1. Dapsone
  2. Rifampin
  3. Clofazimine
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11
Q

M. leprae - tuberculoid type

A
  1. Dapsone

2. Rifampin

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12
Q

Proteus mirabilis

A

Fluoroquinolones - e.g. Ciprofloxacin

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13
Q

Fluoroquinolone MOA

A

Inhibit DNA topoisomerase II (DNA gyrase) and IV

Do NOT take with antacids!

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14
Q

Fluoroquinolones (floxacins/enoxacins) - clinical use

A

G- rods of GI/Urinary Tract:
Psuedomonas
Neisseria
Proteus mirabilis

Some G+ organisms

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15
Q

Fluoroquinolone CI’s

A
  • pregnancy
  • nursing mothers
  • children
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16
Q

Fluoroquinolone adverse rxns

A

“FluoroquinolONES hurt attachments to your bONES”

(e. g. levaquin)
- Cartilage damage in children 60 years or pts taking prednisone.

  • leg cramps
  • myalgias
  • SUPERINFECTIONS (C.diff)
  • skin rash
  • HA/dizziness
  • GI upset
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17
Q

Fluoroquinolones

A

floxacins: e.g. ciproflocacin, levofloxacin

+ enoxacin

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18
Q

Cryptococcal meningitis (AIDS pts - serious infection)

A

Amphotericin B w/ or w/o flucytosine

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19
Q

Amphotericin B MOA

A

“TEaRs” holes in fungal membrane by forming pores = leakage of electrolytes.

  • binds ergosterol (unique to fungi)
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20
Q

Sporothrix shenkii (Sporotrichosis) Tx

A

Itraconazole

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21
Q 
Sporothrix shenkii (Sporotrichosis) 
"rose garden disease"
A

Dimorphic cigar-shaped budding yeast
Grows in branching hyphae with rosettes of conidia
Lives on vegetation
Introduced traumatically e.g. by a thorn

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22
Q

Drugs associated with disulfiram reaction

A 
Metronidazole
(some) cephalosporins
griseofulvin
procarbazine
1st gen sulfonylureas
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23
Q

Giardia tx

A

Metro

Quinacrine (if can’t tolerate metro) - but not available in US?

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24
Q

Chlamydia histo findings

A

**non-staining (intracellular) - Gram - bacteria, elementary and reticulate bodies

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25
Q

Chlamydia (no co-infection) tx

A

Doxycycline (unless pregnant = azithromycin)

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26
Q

Schistosomiasis (e.g. S.hematobium) tx

A

Praziquantel

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27
Q

E.Coli UTI tx

A

Amoxicillin

28
Q

Isoniazid AE’s

A

“INH “I”njures “N”eurons and “H”epatocytes”

  • Hepatotoxicity = spotty necrosis (“balooning degeneration with numerous eosinophils”) or fulminant liver failure. (d/t covalent boding to hepatocytes=actin/mitochondrial disruption)
  • P-450 inhibition
  • Drug-induced SLE
  • Vitamin B6 deficiency(**peripheral neuropathy, sideroblastic anemia)

**Administer with pyridoxine (B6)

29
Q

Isoniazid MOA

A

Decreased synthesis of mycolic acids

Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.

30
Q

TB prophylaxis

A

Isoniazid (supplement B6)

31
Q

Latent TB tx

A

Isoniazid (supplement B6)

32
Q

Active TB tx

A

RIPE = Rifampin + Isoniazid + Pyrazinamide + Ethambutol x 2 weeks, then:

RI x 4 weeks

33
Q

M.avium - intracellulare prophylaxis

A

Azithromycin + rifabutin

34
Q

M.avium tx

A

More drug resistant than M tuberculosis.

Azithromycin or clarithromycin + ethambutol.

Can add rifabutin or ciprofloxacin.

35
Q

M.leprae prophylaxis

A

NONE!

36
Q

M.leprae tx

A

Tuberculoid form: Long-term with Dapsone + Rifampin

Lepromatous form: Dapsone + Rifampin + Clofazimine

37
Q

Rifampin MOA

A

Inhibits DNA-dependent RNA polymerase

= stops mRNA synthesis

38
Q

H. influenzae type B meningitis prophylaxis (contacts of infected children)

A

Rifampin

39
Q

Rifamycin AE’s

A

“Rifampin “ramps up” CP450, “but” Rifabutin does not”

Rifampin’s 4 R’s:

  1. RNA polymerase inhibitor
  2. Ramps up microsomal cytochrome P-450 (minor hepatotoxicity and drug interactions)
  3. Red/orange body fluids (non-hazardous)
  4. Rapid resistance if used alone (d/t mutations that reduced drug binding to RNA polymerase)

**monitor liver fn for hepatotoxicity

Rifabutin favored over rifampin in patients with HIV infection due to less cytochrome P-450 stimulation.

40
Q

Rifampin purpose in M.leprae tx

A

Delays resistance to Dapsone

41
Q

Isoniazid MOR

A

Mutations leading to underexpression of KatG

42
Q

Pyrazinamide AE’s

A
  • **Hyperuricemia

- Hepatotoxicity

43
Q

Ethambutol AE’s

A 
""EYE"thambutol"
Optic neuropathy (red-green color blindness)
44
Q

Ethambutol MOA

A

Decreases carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase

45
Q

Streptomycin Clinical Use

A

M.tuberculosis (2nd line)

46
Q

Streptomycin (aminoglycoside) AE’s

A

Ototoxicity (Tinnitus,Vertigo,Ataxia)

Nephrotoxicity

47
Q

Pyrazinamide MOA

A

Prodrug that is converted to the active compound **pyrazinoic acid.

Works best at acidic pH (eg, in host phagolysosomes)

48
Q

Streptomycin MOA

A

Interferes with 30S component of ribosome (aminoglycoside)

49
Q

-azole

A

Ergosterol synthesis inhibitor

50
Q

-bendazole

A

Antiparasitic/antihelmithic

51
Q

-cillin

A

Peptidoglycan cross-linking inhibitor

52
Q

Chlamydia/Gonorrhea Co-Infection tx

A

Doxy + Ceftriaxone

53
Q

C. diff tx

A

Oral metronidazole

54
Q

C.diff (refractory) tx

A

ORAL vancomycin

55
Q

C.botulinum, C.tetani tx

A

Antitoxin

56
Q

CMV tx

A

Ganciclovir, foscarnet, cidofovir

57
Q

Initial empiric tx for Sickle Cell + osteomyelitis

A

Need to cover G+ and G- organisms (S.aureus and Salmonella)

= Ciprofloxacin (fluoroquinolone for Salmonella) + Vancomycin (S.aureus and MRSA)

58
Q

MCC osteomyelitis (overall)

A

S.aureus

59
Q

MCC osteomyelitis IVDU

A

Pseudomonas, candida, S. aureus

60
Q

C.tetani exotoxin

A

Tetanospasmin - protease

61
Q

C.tetani toxin MOA

A

Cleaves SNARE proteins = decreased release of GABA and glycine (inhibitory NT’s)

62
Q

S. pyogenes exotoxin MOA

A

Binds IgM and C3b = blocks phagocytosis

63
Q

S. aureus TSST-1 MOA

A

Binds MHC-II and T-cell receptor outside of peptide groove, leads to NONSPECIFIC, LARGE number of activated T-cells releasing cytokines

64
Q

C.botulinum exotoxin MOA

A

Cleaves SNARE proteins = decreased release of ACh (excitatory NT’s)

65
Q

C. botulinum paralysis

A

Descending paralysis

66
Q

Bendazole MOA

A

inhibits microtubule formation

67
Q

Hookworm (N. americanus, A.duodenale) tx

A

Bendazoles or Pyrantel Pamoate

Step 1 Pharm (3 decks)

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