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Antimicrobials Flashcards

1
Q

bactericidal

A

Very Finely Proficient At Murder: Vancomycin, Fluoroquinolones, Penicillines, Aminoglycosides, Metronidazole (+ Nitrofurantoin)

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2
Q

bacteriostatic

A

ECSTTC: Erythromycin, Clindamycin, Sulfamethoxazole, Trimethoprim, Chloramphenicol

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3
Q

renal tubular reabsorption of Penicillin inhibited by

A

Probenecid

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4
Q

narrow-spectrum penicillins (Staph infections), resistant to inactivation by beta-lactamase

A

methicillin, nafcillin, oxacillin, cloxaciliin

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5
Q

extended spectrum penicillins; may cause pseudomembranous colitis

A

ampicillin/amoxicillin

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6
Q

antimicrobial coverage of extended spectrum penicillins

A

amoxicillin HELPS kill Enterococci (H. inf, E. coli, L. monocytogenes, P. mirabilis, Salmonella spp, Enterococci) + Moraxella

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7
Q

anti-pseudomonal penicillines

A

Takes Care of Pseudomonas: Ticarcillin, Carbenicillin, Piperacillin (also takes care of Klebsiella and Enterobacter)

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8
Q

penicillin with antiplatelet activities, hence risk for bleeding

A

Ticarcillin

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9
Q

1st gen cephalosporins microorganisms

A

Gram +, Proteus mirabilis, E. coli, K. pneumoniae (PEK frist)

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10
Q

mnemonic for 1st gen cephalosporins

A

FADer, help me FAZ my PHarma

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11
Q

2nd gen cephalosporins microorganisms

A

HEN PEKS, H. inf, Enterobacter, Neisseria spp., Proteus, E.Coli, Klebsiella, Serratia

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12
Q

mnemonic for 2nd gen cephalosporins

A

FAMily gathering, FOXy cousin wears a FUR coat drinking TEa. FAC! LORA the PROfessional AZhOLE is still on the FON

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13
Q

cephalosporins exhibiting disulfiram

A

cefamandole, cefotetan (2nd gen), cefoperazone (3rd gen)

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14
Q

3rd gen cephalosporins microorganisms

A

Pseudomonas, Bacteroides

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15
Q

mnemonic for 3rd gen cephalosporins

A

Fenge PO ng PERA to FIX my TTTTTv

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16
Q

anti-pseudomonal cephalosporins

A

ceftazidime, cefoperazone (3rd gen), cefepime (4th)

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17
Q

inhibits renal metabolism of imipenenm

A

cilastatin

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18
Q

silver bullet for gram negative (Klebsiella, Pseudomonas, Serratia)

A

Aztreonam

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19
Q

beta-lactamase inhibitors

A

clavulanic acid, tazobactam, sulbactam

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20
Q

inhibits cell wall synthesis by binding d-ala-d-ala terminus of nascent peptidoglycan

A

vancomycin/ teicoplanin

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21
Q

tx for redman syndrome

A

slow down infusion, antihistamine

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22
Q

interferes with late stage in cell wall synthesis of gram + organisms, reserved for topical use due to nephrotoxicity

A

bacitracin

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23
Q

blocks incorporation of d-ala in peptidoglycan, used for drug-resistant TB, SE: neurotoxicity

A

cycloserine

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24
Q

mnemonic for protein synthesis inhibitors

A

buy AT 30, CELLS at 50 (aminoglycosides, tetracycline, chloramphenicol, erythromycin, lincosamides, linezolid, streptogrammins)

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25
Q

idiosyncratic reaction of chloramphenicol

A

aplastic anemia

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26
Q

dec RBCs, cyanosis and CV collapse, ashen gray skin due to deficient glucoronosyltransferase and inability to metabolize chloramphenicol

A

Gray Baby Syndrome

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27
Q

tetracycline used for SIADH

A

demeclocycline

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28
Q

broadest spectrum tetracycline

A

tigecycline

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29
Q

tetracyclines must not be drank with

A

milk (decreased absorption)

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30
Q

blocks attachment of tRNA to acceptor site (A site)

A

tetracycline

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31
Q

macrolide which does not inhibit CYP450, also has highest Vd and slowest elimination

A

azithromycin

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32
Q

ketolide used for macrolide resistance

A

telithromycin

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33
Q

SE of macrolides

A

cholestatic hepatitis, QT prolongation

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34
Q

anaerobic infections above the diaphragm

A

clindamycin

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35
Q

anaerobic infections below the diaphragm

A

metronidazole

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36
Q

endocarditis prophylaxis (penicillin-allergy), PCP pneumonia, toxoplasmosis

A

lincosamide (clindamycin/lincomycin)

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37
Q

binds at 50S subunit, bactericidal, used for drug resistant gram + infections, SE: arthralgia-myalgia syndrome

A

streptogrammin(quinupristin-dalfopristin)

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38
Q

binds at 50S subunit, bacteriostatic, used for drug resistant gram + infections, Listeria and Corynebacteria, SE: serotonin syndrome, neuropathy, optic neuritis

A

linezolid

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39
Q

killing action continues even when plasma levels have declined, seen in aminoglycosides and fluoroquinolones

A

post-antibiotic effect

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40
Q

narrowest therapeutic window among aminoglycosides, resistant to enzymes that inactivate other aminoglycosides, 2nd line drug for MDR-TB

A

amikacin

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41
Q

bactericidal inhibitor of protein synthesis; ineffective against anaerobes

A

aminoglycoside

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42
Q

notable SE of aminoglycosides

A

reversible nephrotoxicity (ATN), irreversible ototoxicity, neuromuscular blockade

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43
Q

most vestibulotoxic and nephrotoxic aminoglycosides

A

gentamicin and tobramycin

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44
Q

Tx for Tularemia, Bubonic plague, Brucellosis; can cause congenital deafness

A

streptomycin

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45
Q

most ototoxic aminoglycoside

A

kanamycin, amikacin

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46
Q

aminoglycoside used for hepatic encephalopathy

A

kanamycin

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47
Q

aminoglycoside used for visceral leishmaniasis, also anti-protozoal (luminal amebicide)

A

paramomycin

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48
Q

aminoglycoside used for drug-resistant gonorrhea

A

spectinomycin

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49
Q

causes curare-like effect (non depolarizing neuromuscular block) reversible with calcium and neostigmine

A

aminoglycosides

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50
Q

mnemonic for aminoglycosides

A

mean GNATS canNOT kill anaerobes (genta, neomycin, amik, tobra, strepto) nephrotoxicity, ototoxicity, teratogen

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51
Q

have a common chemical nucleus resembling p-aminobenzoic acid

A

sulfonamides

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52
Q

solubility may be decreased in acidic urine; solution

A

sulfonamides; triple sulfa combination to reduce likelihood of precipitation

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53
Q

structurally similar to folic acid

A

trimethoprim

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54
Q

components of hepatic enceph tx

A

lactulose, neomycin, aminoleban

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55
Q

enzyme inhibited by sulfonamides

A

dihydropteroate synthase (found only in prokaryotes)

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56
Q

enzyme inhibited by trimethoprim

A

dihydrofolate reductase

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57
Q

TMP-SMX cidal/static?

A

bacteriostatic individually, cidal combined

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58
Q

similar drug to silver sulfadiazine with better eschar penetration

A

mafenide acetate

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59
Q

sulfonamides displace protein binding of_____ leading to _____

A

bilirubin; kernicterus

60
Q

site of bilirubin deposition in kernicterus

A

subcortical nuclei, basal ganglia

61
Q

interfere with topoisomerase II (DNA gyrase) for gram -, and topoisomerase IV for gram +

A

fluoroquinolones

62
Q

2nd generation fluoroquinolones; coverage

A

ciprofloxacin, ofloxacin, norfloxacin; gram negative, gonococci, gram positive and Mycoplasma coverage (atypical pneumonia and 2nd line drug for TB)

63
Q

notable SE of fluoroquinolones

A

tendinitis and tendon rupture (fluoroquinoLONES hurt your BONES), enhance toxicity of methylxanthines (theophyllines), avoid in children and pregnant women

64
Q

macrolides

A

azithromycin, erythromycin, clarithromycin, telithromycin

65
Q

3rd generation fluoroquinolones; coverage

A

levofloxacin, sparfloxacin, grepafloxacin (withdrawn due to cardiotoxicity); less gram -, more gram + (unlike cephalosporins), streptococci and enterococci

66
Q

4th generation fluoroquinolones; coverage

A

moxifloxacin, trovafloxacin, gemifloxacin, gatifloxacin; gram +, gram -, anaerobes

67
Q

fluoroquinolone with SE: DM; hepatotoxicity

A

gatifloxacin; trovafloxacin

68
Q

reactive reduction by ferrodoxin forming free radicals that disrupt ETC; DOC for protozoal infections, vaginitis (Trichomonas, Gardnerella); SE: metallic taste, disulfiram

A

metronidazole/ tinidazole

69
Q

forms multiple reactive intermediate acted upon by bacterial nitrofuran reductase; used for UTI (except Proteus and Pseudomonas); ok for pregnant pts; can also cause hemolysis in G6PD

A

nitrofurantoin/ nitrofuran

70
Q

inhibits mycolic acid synthesis; bactericidal; mnemonic for side effects; coadminister with

A

isoniazid; affects neurons and hepatocytes; pyridoxine (vit B6)

71
Q

inhibits DNA dependent RNA polymerase; bactericidal; also used as prophylaxis for meningococcal and staphylococcal carrier states, delays resistance to dapsone (leprosy); mnemonic

A

rifampicin (rifabutin, rifapentine); R=RNA polymerase inhibitor, red orange body fluids, rapid dev’t of resistance, revs up CYP450

72
Q

inhibits arabinosyl transferases involved in synthesis of mycobacterial cell wall; bacteriostatic; SE

A

ethambutol; red green color blindness, retrobulbar neuritis, retinal damage

73
Q

antimycobacterial with unknown MOA; static but cidal on actively dividing bacteria; SE

A

pyrazinamide; hyperuricemia, sterilizing agent, most hepatotoxic

74
Q

hepatotoxicity of anti-TB drugs

A

PRI the liver! pyrazinamid>rifampicin>isoniazid

75
Q

alternative antimycobacterial drug with no cross-resistance with INH; SE: severe GI irritation and neurotoxicity

A

ethionamide

76
Q

alternative antimycobacterial drug rarely used because primary resistance is common; SE: GI irritation, hypersensitivity, effects on kidney, liver, thyroid

A

p-aminosalicylic acid (PAS)

77
Q

alternative antimycobacterial drug; SE: ototoxicity, renal dysfuntion

A

capreomycin

78
Q

dapsone, static/cidal; notable SE

A

bacteriostatic; methemoglobinemia

79
Q

clofazimine, static/cidal; notable SE

A

bactericidal; GI irritation, skin discoloration

80
Q

binds to ergosterol in fungal cell membranes (fungicidal); notable SE

A

amphotericin B (polyene); infusion reactions (give antihistamines), nephrotoxicity (RTA)

81
Q

accumulates in fungal cells via permease; inhibits fungal thimidylate synthase, fungistatic

A

flucytosine

82
Q

high systemic toxicity so used topically (for dermatophytosis); blocks ergosterol synthesis, fungistatic

A

ketoconazole

83
Q

blocks ergosterol synthesis, fungistatic, can be used systemically for candidiasis, coccidiomycosis, cryptococcal meningitis

A

fluconazole

84
Q

blocks ergosterol synthesis, fungistatic, can be used systemically for blastomycosis, sporotrichosis

A

itraconazole

85
Q

echinocandin which inhibits B-glucan synthase decreasing fungal cell wall synthesis, fungistatic, salvage therapy for invasive aspergillosis

A

cASPofungin

86
Q

interferes with microtubule formation, fungistatic, for dermatophytosis because it accumulates in keratin; CI in ____

A

griseofulvin; porphyria

87
Q

inhibits squalene oxidase, fungicidal, for dermatophytosis because it accumulates in keratin

A

terbinafine

88
Q

binds to ergosterol in fungal cell membranes (fungicidal); notable SE, swish and swallow preparation

89
Q

azole of choice for seborrheic dermatitis, pityriasis versicolor

A

clotrimazole

90
Q

activated by viral thymidine kinase to forms that inhibit viral DNA polymerase, anti-herpes

91
Q

activated by viral thymidine kinase to forms that inhibit viral DNA polymerase, anti-CMV

A

ganciclovir

92
Q

inhibits viral DNA polymerase, active against strains with absent thymidine kinase; used for acyclovir and ganciclovir resistance, molluscum contagiosum

93
Q

inhibits viral DNA polymerase, RNA polymerase and HIV reverse transcriptase, active against strains with absent thymidine kinase

A

foscarnet (pyroFOSphate analogue)

94
Q

protease inhibitors mnemonic

A

NAVIR tease a PROTEASE

95
Q

NRTI, requires phosphorlyation by cellular enzymes, incorporated in DNA chain; used for reversal of maternal-fetal HIV transmission; SE

A

zidovudine; BM suupression

96
Q

inhibits HIV reverse transcriptase, no phosphorylation required; not incorporated in DNA chain; mnemonic

A

NNRTI (delavirdine, efavirenz, etravirine, nevirapine); never ever deliver, e trapik!

97
Q

delavirdine, nevirapine SE

A

rash, increased AST, ALT

98
Q

efavirenz SE

A

teratogenicity

99
Q

etravirine

A

inc choles, TG, inhibitor and inducer of CYP450, cross-resistance with NNRTIs

100
Q

protease inhibitor causing hyperbilirubinemia and nephrolithiasis

101
Q

binds to gp41 subunit preventing fusion of viral and cellular membranes, causes increased incidence of bacterial pneumonia; equivalent in HSV

A

enFUvirtide; doconasol

102
Q

blocks HIV viral attachment via transmembrane chemokine receptor CCR5

103
Q

anti-influenza A (prevents uncoating) and rubella, also used to treat Parkinsonism; can cause cerebellar dysfunction, livedo reticularis; mnemonic

A

Amantadine, Rimantidine; A man to dine takes off his coat; blocks influenza A and rubellA, causes problems with the cerebellA

104
Q

anti-influenza which inhibits neuraminidase; SE

A

Oseltamivir (GI effects), Zanamivir (bronchospasm in asthmatics)

105
Q

general SE for NRTI

A

lactic acidosis with hepatic steatosis

106
Q

NRTI with SE: hypersensitivity

107
Q

NRTI with SE: pancreatitis

A

didanosine

108
Q

NRTI with SE: peripheral neuropathy

A

stavudine, zalcitabine

109
Q

general SE for protease

A

lipodystrophy, hyperglycemia (never tease)

110
Q

degrades viral RNA via inactivation of host cell RNAase; used for HBV, HCV, Kaposi sarcoma, genital warts, also for hairy cell leukemia, CML and T cell lymphomas

A

interferon alpha

111
Q

inhibits HBV DNA polymerase

A

lamivudine, entecavir, adefovir, telbivudine, tenofovir

112
Q

inhibits RNA dependent RNA polymerase, prevents capping of viral mRNA; used for HCV, RSV, viral hemorrhagic fevers (West Nile, Ebola virus)

113
Q

prevents polymerization of heme into hemozoin; blood schizonticide, may precipitate porphyria

A

chloroquine

114
Q

complexes with DNA to prevent strand separation; blood schizonticide; SE- to prevent, it is commonly used with ____ or ____, DOC for malaria in pregnant

A

quinine; QUInchonism (cinchonism-headache, tinnitus, vertigo), blackwater fever; doxycycline/clindamycin

115
Q

anti-malarial with unknown MOA. blood schizonticide used as alternative to quinine, SE: cardiac conduction defects, psychosis

A

mefloquine

116
Q

releases cellular oxidants. tissue schizonticide and gametocide; radical cure of P.vivax and ovale, should be used with blood schizontocide, also used for PCP pneumonia

A

primaquine

117
Q

blood schizontocide-sporonticide combinations

A

atovaquone-proguanil (malarone), sulfadoxine-pyrimethamine

118
Q

impairs progeny of malarial genes, blood schizonticide, used for chemophrophylaxis in multi-drug resistant malaria; SE

A

doxycycline; tooth enamel dysplacia/discoloration

119
Q

DOC for uncomplicated falciparum malaria in the Phils, blood schizonticide

A

artemether-lumefantrine (CoArtem)

120
Q

malaria chemoprophylaxis: choroquine sensitive

A

chloroquine 500mg/tab 1 tab weekly; 2-3 days before going, during stay and 4 weeks after

121
Q

malaria chemoprophylaxis: choroquine resistant

A

mefloquine 250mg/tab 1 tab weekly or malarone 1 tab daily; 2-3 days before going, during stay and 4 weeks after

122
Q

malaria chemoprophylaxis: multi-drug resistant

A

doxycycline 100mg/tab 1 tab daily; 2-3 days before going, during stay and 4 weeks after

123
Q

2 types of amebicides

A

tissue (act on bowel wall and liver), and luminal (act on lumen)

124
Q

DOC for asymptomatic intestinal amebiasis; back-up

A

diluxonide furoate; iodoquinol, paramomycin

125
Q

DOC for mild to moderate intestinal amebiasis

A

metronidazole + luminal amebicide

126
Q

DOC for severe intestinal amebiasis or hepatic abscess/extraintestinal; back-up drug (back-up only due to CV dysfunction)

A

metronidazole or tinidazole + luminal amebicide; emetine

127
Q

luminal amebicide which can cause thyroid enlargement and neurotoxicity

A

iodoquinol

128
Q

DOC for cryptosporidiosis, also anti-protozoal

A

nitazoxanide

129
Q

DOC for pneumocystosis; back-up

A

TMP-SMX; pentamidine

130
Q

DOC for toxoplasmosis

A

pyrimethamine-sulfadiazine (Fanzidar)

131
Q

back-up drug for pneumocystosis, also used for hemolymphatic african sleeping sickness and visceral leishmaniasis (kala-azar), does not cross BBB

A

pentamidine

132
Q

DOC for advanced West African sleeping sickness, inhibits ornithine decarboxylase, crosses BBB, less toxic than melarsoprol

A

eflornitihine

133
Q

DOC for advanced East African sleeping sickness, inhibits enzyme sulfhydryl groups, causes reactive encephalopathy, usually administered with ____

A

melarsoprol; suramin

134
Q

DOC for Chagas disease

A

nifurtimox

135
Q

DOC for Leishmaniasis (except in India where Ampho B is given)

A

sodium stibogluconate

136
Q

DOC for whipworm/ trichuris infections

A

mebendazole

137
Q

inhibits microtubule synthesis, ovicidal; CI in pregnancy

A

mebendazole

138
Q

inhibits microtubule assembly, larvicidal and ovicidal

A

albendazole

139
Q

DOC for hydatid disease (Echinococcus)

A

albendazole

140
Q

DOC for filiariasis

A

diethylcarbamazine

141
Q

DOC for eye worm disease

A

diethylcarbamazine

142
Q

DOC for hookworm and roundworm infections, in Phils, Enterobius vermicularis (pinworm)

A

pyrantel pamoate

143
Q

DOC for trichinosis

A

thiabendazole

144
Q

DOC for trematodes (Schistosoma, Paragonimus, Clonorchis, Opistorchis) and cestodes (Taenia, Diphyllobotrium) but contraindicated in____, used with ____ in neurocysticercosis

A

praziquantel; ocular cysticercosis (causes irreparable eye damage); corticosteroids

145
Q

alternative drug for cestodes (Taenia, Diphyllobotrium), no effects on ova, avoid ethanol consumption

A

niclosamide

Pharmacology (7 decks)

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