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Antimicrobials Flashcards

1
Q
  1. Which condition do you use Amphotericin B? Amphotericin B MOA?
  2. When would you add an antifungal adjuvant? The antifungal adjuvant MOA?
A
  1. Severe systemic mycotic infection. (binds ergosterol to allow leakage)
  2. Cryptococcal meningitis add flucytosine (blocks conversion of 5-FU by cytosine deaminase)
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2
Q

Adverse effects of using Amphotericin B

A

AAmPHotericiN

Anemia, **Arrhythmia, Makes u feverish, **Phlebitis, Hypotension, -oterici Nephrotoxicity B

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3
Q

Which condition do you use nystatin? MOA?

A

Oral candidiasis, vaginal/pelvic candidiasis. (binds ergosterol to allow leakage)

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4
Q

Which condition do you use Azoles? MOA? Key adverse effects?

A

Most local, less serious systemic infection. (inhibit 14-a-demethylase that forms ergosterol from lanosterol)
MOA: gynecomastia (esp ketoconazole)

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5
Q

Which condition do you use terbinafine? MOA?

A

Dermatophytoses (inhibits Squalene epoxide to form lanosterol from squalene) (strong TERBIN good against SQUAL)

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6
Q

Which condition do you use Griseofluvin? MOA? Key complications?

A

oral treatment for severe superficial infections, dermatophytes. (MOA: interferes with microtubule a/b-tubulin dimer)
A/E: teratogenic,carcinogenic, CNS symptoms, **disulfiram-like rxn

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7
Q

What do you use to treat influenza? Which mechanisms does it prevent? What is the point of consideration while prescribing this drug?

A

Zanamivir, oseltamivir
MOA: inhibit influenza neuraminidase to prevent release of progeny virus.
Use the drug within 48 hr of sx

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8
Q

When do we decide to use acyclovir, famciclovir, ganciclovir?

A

Acyclovir: VZV, HSV

famciclovir: VZV
ganciclovir: CMV

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9
Q

A/E of acyclovir and famciclovir. Difference between the MOA of both

A

crystal uropathy.
Both inhibits viral DNA polymerase.
Acyclovir via chain termination, famciclovir via act as competitive inhibitor for viral dGTP

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10
Q

A/E of ganciclovir

A

bone marrow suppression, nephrotoxicity

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11
Q

Mechanisms of viral drug resistance towards acyclovir, famciclovir, ganciclovir? Any drug good against drug resistance virus?

A

Mutated viral thymidine kinase
Foscarnet, Cidofovir
Viral DNA polymerase inhibitor

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12
Q

Penicillin which is good against pseudomonas

A

piperacillin, ticarcillin

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13
Q

Adverse effects of cephalosporins (5)

A

Hypersensitivity, AIHA, disulfiram-like rxn, Vit K deficiency. Aminoglycosides nephrotoxicity

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14
Q

Which cephalosporins can cross BBB?

A

3rd gen

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15
Q

B-lactamase inhibitors (4)

A

clavulanic acid, avibactam, sulbactam , tazobactam

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16
Q

Drug to reduce inactivation of carbapenem. MOA?

A

cilastatin, blocks renal dehydropeptidase 1

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17
Q

Adverse effects of carbapenem (2)

A

Rash, CNS toxicity (seizure) at high plasma lvl

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18
Q

Adverse effects of vancomycins (5)

A

vancomycin is great but NOT trouble Free
NOT F
Nephrotoxicity, Ototoxicity, Thrombophlebitis, Flushing (red man syndrome), DRESS syndrome

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19
Q

vancomycin:
1. MOA
2. Mechanism of resistance

A
  1. Bind to D-Ala-D-Ala to prevent cell wall peptidoglycan formation
  2. D-Ala-D-ala amino acid modification of bacteria
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20
Q

aminoglycoside: (name few)
1. MOA
2. Mechanism of resistance

A

amikacin, gentamycin, tobramcin, neomycin, streptomycin (b-ANGS-a-T) (Amin is a Bangsat who caNNOT kill anaerobes)

  1. inhibit initiation complex by bind to 30S ribosome (buy AT 30, CCEL at 50)
  2. deactivated by bacterial transferase enzymes
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21
Q

Aminoglycoside (name few): adverse effects

A

amikacin, gentamycin, tobramcin, neomycin, streptomycin (b-ANGS-a-T) (Amin is a Bangsat who caNNOT kill anaerobes)
NNOT
Nephrotoxicity, Neuromuscular blockade, Ototoxicity, Teratogenicity

22
Q

Tetracyclines:

  1. MOA
  2. Mechanism of resistance
A
  1. prevent attachment of aminoacyl-tRNA by bind to 30S ribosome (buy AT 30, CCEL at 50)
  2. plasmid-encoded transport pump
23
Q

Tetracyclines: adverse effects (4)

A

teeth yellowing, inhibit bone growth in children, teratogenic, photosensitivity

24
Q

Chloramphenicol:

  1. MOA
  2. Mechanism of resistance
  3. Common areas of usage
A
  1. blocks peptidytransferase by bind to 50S ribosome (buy AT 30, CCEL at 50)
  2. deactivated by plasmid-encoded acetyltransferase
  3. Common meningitis, rickettsia disease
25
Q

Chloramphenicol: adverse effects (3)

A

anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (baby lack UDP-glucuronosyltransferase)

26
Q

Clindamycin: MOA

A
  1. Blocks peptide translocation at 50S ribosome
27
Q

Clindamycin: adverse effect

A

Pseudomembranous colliitis

28
Q

Macrolides (name few):

  1. MOA
  2. Mechanism of resistance
A

MACE (azithromycin, clarithromycin, erythromycin)

  1. Blocks peptide translocation at 23S rRNA of 50S ribosome
  2. Prevents drug binding by methylation of 23S rRNA binding site
29
Q

Macrolides: adverse effect

A

MACROlides

gi Motility issue, Arrthymia by prolonged QT, Cholestatic hepatitis, Rash, eOsinophilia

30
Q

Linezolid

  1. MOA
  2. Mechanism of resistance
  3. Common areas of usage
A
  1. Prevent formation of initiation complex by binding to 50S ribosome
  2. Point mutation of ribosome RNA
  3. VRE, MRSA
31
Q

Linezolid: adverse effect （3）

A

Bone marrow suppression, peripheral neuropathy, serotonin syndrome

32
Q

Sulfonamides

  1. MOA
  2. Mechanism of resistance
A
  1. inhibits dihydropteroate synthase (folate synthesis)

2. altered bacterial dihydropteroate synthase enzyme, bacterial decrease uptake or increase PABA synthesis

33
Q

Sulfonamides: adverse effect （6）

A

hypersensitivity, hemolysis (G6PD Def), nephrotoxicity (tubulointerstitial nephritis), photosensitivity, SJS, Kernicterus (infants), displace other drugs from albumin (warfarin)

34
Q

Trimethoprim: MOA

A
  1. inhibits dihydrofolate reductase (DHFR)
35
Q

Trimethoprim: adverse effect (4)

A

hyperkalemia, megaloblastic anemia, leukopenia, granulocytopenia (avoided with leucovorin/folinic acid)

36
Q

Dapsone:

  1. MOA
  2. adverse effect (3)
  3. Common areas of usage
A
  1. same with sulfonamides = inhibits dihydropteroate synthase (folate synthesis)
  2. hemolysis (G6PD Def), methemoglobulinemia, agranulocytosis
  3. Leprosy (lepromatous, tuberculoid)
37
Q

Fluoroquinolones: (name few)

  1. MOA
  2. Adverse effects (3)
A

Ciprofloxacin

  1. inhibits topoisomerase 2 (DNA gyrase), topoisomerase 4
  2. chromosome-encoded mutation in DNA gyrase, efflux pump, plasmid-mediated resistance
38
Q 
Fluoroquinolones: (name few)
adverse effect(5)
A

GI disturbance, skin rash, tendonitis/tendon rupture, myalgia, cartilage damage

39
Q

Metronidazole: MOA

A

Form toxic free radical

40
Q

Metronidazole: adverse effect (2)

A

Disulfiram-like rxn, metallic taste

41
Q

Echinocandins:

  1. Name few
  2. Common areas of usage
  3. MOA
  4. Adverse effects (1)
A

Echinocandins:

  1. Caspofungin, -fungins
  2. To treat candida and aspergillus infection ONLY
  3. inhibits beta-1,3-D glycan component of cell wall
  4. Flushing
42
Q

Rifamycin

  1. MOA
  2. Mechanisms of resistance
  3. Adverse effects
A
  1. Inhibits DNA dependent RNA polymerase
  2. reduce binding of drug to RNA polymerase
  3. orange body fluids
    * P450 inducer, high risk of resistance if used alone
43
Q

Isoniazid

  1. MOA and key requirement for activation
  2. Mechanisms of resistance
  3. Adverse effects (2)
A
  1. reduce synthesis of mycolic acid. depedent on bacterial catalase peroxidase (encoded by KatG)
  2. underexpression of KatG
  3. drug induced SLE, Vit B6 deficiency (peripheral neruopathy, sideroblastic anemia)
    * the ONLY ONE can be used as monotherapy
44
Q

Pyrazinamide

  1. MOA
  2. Adverse effects
A
  1. dont know

2. Hyperuricemia, hepatotoxicity

45
Q

Ethambutol

  1. MOA
  2. Adverse effects
A
  1. block arabinosyltransferase to reduce carbohydrate polymerization of cell wall
  2. optic neuropathy
46
Q

List down medications to treat Hep C.

  1. their MOA
  2. important side effects
A

Rainbow 5
Ribavirin, NS5A inhib., NS5B inhib., NS3/4A inhib.
NS5A = -asvir
NS5B = -buvir
NS3/4A come before that = -previr
Simeprevir = photosensitivity, rash
Ribavirin (adjunct) = hemolytic anemia, teratogen

47
Q

List down some NRTI

  1. MOA
  2. Adverse effects (4)
A

Emtricitabine, Lamivudine, Tenofovir, Zidovudine

  1. Inhibits nucleotide binding to reverse transcriptase
  2. Bone marrow suppression, peripheral neuropathy, lactic acidosis, anemia (ZDV)
48
Q

List down some NNRTI

  1. MOA
  2. Adverse effects (4)
A

Efavirenz, Nevirapine, Delavirdine

  1. Inhibits reverse transcriptase via other pathway than NRTIs
  2. Rash, hepatotoxic, vivid dream, CNS symptoms
49
Q

List down some integrase inhibitors

  1. MOA
  2. Adverse effects (1)
A
  • tegravir
    1. Prevents integration of HIV into host cell
    2. raised CK
50
Q

List down some Protease inhibitors

  1. MOA
  2. Adverse effects (3)
A
  • navir
    1. Prevents maturation of HIV by blocking HIV-1 protease
    2. Hyperglycemia, lipodytrophy, GI disturbance

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