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FA Review > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

What is the MOA of PCNs?

A

binds PBPs and block the transpeptidase cross-linking of peptidoglycan

Activate autolytic enzymes

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2
Q

What, generally, are the bacteria that PCNs are used to treat?

A

Gram positives:

  • Strep
  • Staph
  • N Meningitidis
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3
Q

What is the major adverse reaction to PCNs?

A

Hypersensitivity rxns

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4
Q

How is resistance to PCNs conferred to bacteria?

A

Penicillinase in bacteria to cleave the beta-lactam ring

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5
Q

What are the three major beta lactamase inhibitors? (CAST)

A
  • Clavulanic acid
  • Sulbactam
  • Tazobactam
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6
Q

What are the two major anti-pseudomonal PCNs?

A

Ticarcillin and piperacillin

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7
Q

What are the three major penicillinase resistant PCNs? What bacteria do these typically treat?

A

Oxacillin
Nafcillin
Dicloxacillin

“Naf for staph”

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8
Q

What are the two major penicillinase-sensitive abx?

A

Ampicillin

Amox

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9
Q

Which has more oral availability: amoxicillin or ampicillin?

A

AmOxicillin has more O-ral availability

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10
Q

What are the bacteria that ampicillin/amoxicillin are used to treat? (HELPSS)

A 
Haemophilus
E.coli
Listeria
Proteus
Salmonella
Shigella
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11
Q

What is the general MOA of cephalosporins? Are these bactericidal or bacteriostatic?

A

Beta-lactam drugs that inhibit the cell wall synthesis, but are less susceptible to Penicillinases

bactericidal

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12
Q

What are the two first gen cephalosporins, and what are the three bacteria that they usually treat? (PEcK)

A

Cefazolin
Cephalexin

Proteus
Ecoli
Klebsiella

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13
Q

What are the three major third generation cephalosporins, and what are the 7 bacteria that they are used to treat? (HEN PEcKS)

A

Cefoxitin
Cefaclor
Cefuroxime

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14
Q

What is the general side effect of most cephalosporins?

A

Hypersensitivity rxn and it K deficiency

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15
Q

What other abx should never be combined with cephalosporins? Why?

A

aminoglycosides

Nephrotoxic

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16
Q

What is the only monobactam abx? MOA? Is this beta-lactam resistant?

A

Aztreonam
Resistant to beta lactamases
Prevents peptidoglycan cross-linking by binding to PCN-bind proteins

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17
Q

What is the abx that prevents peptidoglycan cross-linking by binding to PCN-bind proteins?

A

Aztreonam

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18
Q

What is the major side effect of aztreonam?

A

Occasional GI upset

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19
Q

What is the major bacterial type that aztreonam usually works against?

A

Gram negative rods ONLY

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20
Q

What two conditions are ceftriaxone used to treat?

A

Meningitis

Gonorrhea

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21
Q

What condition is ceftazidime used to treat?

A

Pseudomonas infx

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22
Q

What, generally, happens to the spectrum of activity as you progress in the generations of cephalosporins?

A

Increased

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23
Q

What is the MOA of carbapenems?

A

PCN-like–binds to PBPs and disrupts cell wall synthesis

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24
Q

Imipenem is always administered with what drug? Why?

A

Cilastatin to inhibit renal dehydropeptidase I

“The kill is lastin’ with cilastatin”

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25
Q

What are the three general categories of bacteria that carbapenems are used against?

A

Gram positive cocci
Gram negative rods
Anaerobes

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26
Q

What are the side effects of carbapenems? (2)

A

Seizures at high plasma levels

Skin rash

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27
Q

What is the MOA of vancomycin?

A

Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors

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28
Q

What are the bacteria that vanco are used to treat?

A

Gram positive only

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29
Q

What are the side effects of vanco? (“NOT trouble free”)

A

Nephrotoxic
Ototoxic
Thrombophlebitis
Red man syndrome

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30
Q

How can you prevent red man syndrome with Vanco?

A

Slow administration + antihistamines

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31
Q

What is the Mechanism of resistance against Vanco?

A

Amino-acid modification of D-ala D-ala

“Pay back 2 D-alas (dollars) for Vandalizing (Vanco)”

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32
Q

What are the two major 30s ribosome inhibitors? Which is bactericidal/bacteriostatic?

A

Aminoglycosides (bactericidal)

Tetracyclines (bacteriostatic)

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33
Q

What are the three 50s ribosome inhibitors? Which is bactericidal/bacteriostatic?

A
  • Chloramphenicol and clindamycin (bacteriostatic)
  • Erythromycin (macrolides) (bacteriostatic)
  • Linezolid [variable]
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34
Q

What is the mnemonic for recalling the30s and 50s ribosome inhibitors?

A

“Buy AT 30, CCEL at 50”

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35
Q

MOA of aminoglycosides?

A

30s inhibitors–inhibit formation of initiation complex

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36
Q

MOA of macrolides?

A

50s inhibitor–inhibits the macro”slide”–blocks translocation

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37
Q

MOA of tetracyclines?

A

30s inhibitor–prevents attachment of tRNAs

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38
Q

MOA of linezolid?

A

50s inhibitor

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39
Q

MOA of chloramphenicol? Toxicity?

A

50s inhibitor– blocks peptidyl transferase

Causes anemia and gray baby syndrome

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40
Q

MOA of clindamycin? What infections is this used to treat?

A

50s inhibitor–Blocks peptide transfer

Treats infections above the waist

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41
Q

What is the 30s subunit responsible for? 50s?

A

30s is small guy on the bottom that binds mRNA, 50s is the big guy on top that gets all the tRNAs

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42
Q

What is the suffix of aminoglycosides?

A

-micin or -mycin

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43
Q

What are the major toxicities of aminoglycosides? (NNOT)

A

Nephrotoxic
Neuromuscular blockade
Ototoxic
Teratogenic

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44
Q

What is the MOA of resistance against aminoglycosides?

A

Bacterial transferase enzymes inactivate the drug by acetylation

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45
Q

What is the suffix for tetracyclines?

46
Q

What is the MOA of resistance for tetracyclines?

A

Decreased uptake/increase efflux

47
Q

What are the major toxicities of tetracyclines?

A

Discoloration of teeth and inhibition of bone growth in children

48
Q

What is the MOA of resistance to macrolides?

A

Methylation of the 23s rRAN binding protein

49
Q

What antibiotic causes gray baby syndrome, and why?

A

Chloramphenicol since infants lack UDP-glucuronyl transferase needed to breakdown it

50
Q

What abx treats infections above the waist? Below?

A

Above - clindamycin

Below - metronidazole

51
Q

What is the drug that is highly associated with causing C.diff?

A

Clindamycin

52
Q

What is the MOA of sulfonamides? Use? Toxicity? MOA of resistance?

A

Inhibits folate synthesis
Gram positives and negatives
Hemolysis in G6PD, nephrotoxic
Altered bacterial DHP synthase)

53
Q

What are the three macrolides?

A

Erythromycin
Clarithromycin
Azithromycin

“-thromycin” suffix

54
Q

What is the MOA of trimethoprim? Toxicity?

A

Blocks bacterial dihydrofolate reductase

Megaloblastic anemia and leukopenia

55
Q

What is the MOA of fluoroquinolones? Suffix? Clinical use? Toxicities (2)? MOA of resistance?

A

Inhibits DNA gyrase (topoisomerase II)

  • floxacin
  • Gram negative rods
  • Tendonitis + prolonged QT
  • Mutation in DNA gyrase
56
Q

What is the MOA of metronidazole? Toxicity?

A

Free radical damage to DNA

Disulfiram-like effects

57
Q

What are the infections (parasites and bacteria) that metronidazole is used to treat? (GET GAP on the metro)

A 
Giardia
Entamoeba
Trich
Gardnerella
Anaerobes
Pylori
58
Q

What are the four components of TB treatment (RIPE)?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

59
Q

What is the drug of choice for prophylaxis against TB? MAC?

A 
TB = isoniazid
MAC = Azithromycin + rifabutin
60
Q

What is the MOA of isoniazid? Toxicities?

A

Decreases synthesis of mycolic acid
Neurotoxic and hepatotoxic

(“INH Injures neurons and hepatocytes”)

61
Q

What is the MOA of rifamycins? What are the two drugs in this class?

A

Rifampin and rifabutin

Inhibits DNA dependent RNA pol

62
Q

What are the major side effects of Rifampin?

A

Red/orange body fluids

“RifAMPin RAMPS up p450”

63
Q

What are the “3 R’s” of rifampin?

A
  • RNA pol inhibitor
  • Ramps up p450s
  • Red/orange fluids
64
Q

What major side effect can be avoided by switching from rifampin to rifabutin?

A

Avoid p450 induction–useful for AIDS pts

65
Q

What is the MOA of pyrazinamide? Toxicities?

A

Unknown MOA

Hyperuricemia, hepatotoxic

66
Q

What is the MOA of ethambutol? Toxicities?

A 
-Decrease carb polymerization of mycobacterium walls
Optic neuropathy (red-green color blindness)
67
Q

What is the TB drug that causes color blindness? Orange/red secretions?

A

Color blindness = ethambutol

Orange/red secretions = Rifampin

68
Q

What is the antibiotic of choice for prophylaxis against: endocarditis?

69
Q

What is the antibiotic of choice for prophylaxis against: Gonorrhea?

A

Ceftriaxone

70
Q

What is the antibiotic of choice for prophylaxis against: UTIs?

71
Q

What is the antibiotic of choice for prophylaxis against: Meningococcal infx?

72
Q

What is the antibiotic of choice for prophylaxis against: GBS for pregnant women?

A

Ampicillin

73
Q

What is the antibiotic of choice for prophylaxis against: Gonococcal/chlamydial infx in children?

A

Erythromycin

74
Q

What is the antibiotic of choice for prophylaxis against: Post surgical S. Aureus infx?

75
Q

What is the antibiotic of choice for prophylaxis against: strep pharyngitis?

76
Q

What is the antibiotic of choice for prophylaxis against: Syphilis

77
Q

What is the antibiotic of choice for prophylaxis against: pneumocystis in AIDS pts? What is the CD4 count for this?

A

TMP-SMX

Less than 200

78
Q

What is the antibiotic of choice for prophylaxis against: MAC in AIDS pts? What is the CD4 count for this?

A

Azithromycin

Less than 50

79
Q

What is the antibiotic of choice for: VRE?

80
Q

What is the antibiotic of choice for MRSA?

A

Vanco or daptomycin

81
Q

What is the MOA of amp B?

A

Binds to ergosterol to make membrane leaky

“amphoTERicin TEArs holes”

82
Q

What is the MOA of nystatin? Clinical use?

A

Binds to ergosterol to make membrane leaky

Oral candidiasis

83
Q

What is the MOA of azoles? Toxicities?

A

Inhibits ergosterol synthesis

Testosterone synthesis inhibition

84
Q

What is the MOA of flucytosine? Toxicities?

A
  • Inhibits DNA and RNA biosynthesis by conversion of to 5-FU by cytosine deaminase
  • Myelosuppression
85
Q

What is the suffix of echinocandins? MOA? Toxicities?

A
  • fungin
  • Inhibits cell wall synthesis of beta-glucan
  • Hepatotoxic
86
Q

What is MOA of terbinafine? Use? Toxicity?

A

Inhibits squalene epoxidase
Dermatophytoses
Hepatotoxic

87
Q

What is MOA of Griseofulvin? Use? Toxicity?

A

Inhibits microtubule assembly
Oral treatment of superficial fungal, infx
Increases Warfarin metabolism

88
Q

What is the treatment for toxoplasmosis?

A

Pyrimethamine

89
Q

What is the treatment for Trypanosoma brucei?

A

Suramin and melarsoprol

90
Q

What is the MOA of Chloroquine? Use? Toxicity?

A

Blocks detoxification of heme into hemozoin
Plasmodial species BESIDES falciparum
Retinopathy

91
Q

What are the two neuraminidase inhibitors against the flu?

A

Zanamivir

Osletamivir

92
Q

What is the MOA of ribavirin? Use?

A

Inhibits synthesis of guanine by inhibits inosine monophosphate dehydrogenase

RSV

93
Q

What is the MOA of acyclovir, famciclovir, and valacyclovir? Use?

A

Phosphorylated by thymidine kinase

HSV/VZV infx

94
Q

What is the MOA of resistance against acyclovir, famciclovir, and valacyclovir?

A

Mutated thymidine kinase

95
Q

What is the MOA of ganciclovir? Use

A

Guanosine analogue that inhibits DNA pol

CMV infections

96
Q

What is the MOA of foscarnet? Use?

A

Viral DNA pol inhibitor that does NOT require activation by a kinase

Severe CMV infection–given IV

97
Q

What is the MOA of resistance against Foscarnet?

A

Mutated DNA polymerase

98
Q

What is the MOA of cidofovir? Use? Toxicity?

A

Inhibits DNA pol
CMV retinitis
Nephrotoxic

99
Q

What is the common suffix for HIV protease inhibitors? Toxicities?

A
  • “navir”

- Nephropathy

100
Q

What is the MOA of zidovudine?

101
Q

What is the MOA of abacavir?

102
Q

What is the general MOA of NRTIs?

A

Competitively inhibit nucleotide binding to reserve transcriptase

103
Q

What is the only NRTI that does not need to be phosphorylated prior to action?

A

Tenofovir is a nucleoTide

104
Q

What are the three NNRTIs? MOAs?

A
  • Efavirenz
  • Nevirapine
  • Delavirdine

Binds to reverse transcriptase at a non-active site

105
Q

What is the MOA of raltegravir?

A

Inhibits HIV genome integration into host cell chromosome by inhibiting HIV integrase

106
Q

What is the MOA of enfuvirtide?

A

BInds gp41, inhibiting viral entry

107
Q

What is the MOA of Maraviroc?

A

binds CCR5 on T cell surface, inhibiting gp120

108
Q

What is the use of interferon-alpha? (4)

A

Hep B and C
Kaposi sarcoma
hair cell leukemia
Condyloma acuminatum

109
Q

What is the use of IFN-beta?

110
Q

What is the use of IFN-gamma?

A

Chronic granulomatous disease

111
Q

What are the abx to avoid in pregnancy? (8, SAFe Children Take Really Good Care)

A 
Sulfonamides
Aminoglycosides
Fluoroquinolones
Clarithromycin
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenicol

FA Review (22 decks)

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