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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
What are the three general categories of bacteria that carbapenems are used against?
Gram positive cocci Gram negative rods Anaerobes
26
What are the side effects of carbapenems? (2)
Seizures at high plasma levels | Skin rash
27
What is the MOA of vancomycin?
Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors
28
What are the bacteria that vanco are used to treat?
Gram positive only
29
What are the side effects of vanco? ("NOT trouble free")
Nephrotoxic Ototoxic Thrombophlebitis Red man syndrome
30
How can you prevent red man syndrome with Vanco?
Slow administration + antihistamines
31
What is the Mechanism of resistance against Vanco?
Amino-acid modification of D-ala D-ala "Pay back 2 D-alas (dollars) for Vandalizing (Vanco)"
32
What are the two major 30s ribosome inhibitors? Which is bactericidal/bacteriostatic?
Aminoglycosides (bactericidal) | Tetracyclines (bacteriostatic)
33
What are the three 50s ribosome inhibitors? Which is bactericidal/bacteriostatic?
- Chloramphenicol and clindamycin (bacteriostatic) - Erythromycin (macrolides) (bacteriostatic) - Linezolid [variable]
34
What is the mnemonic for recalling the30s and 50s ribosome inhibitors?
"Buy AT 30, CCEL at 50"
35
MOA of aminoglycosides?
30s inhibitors--inhibit formation of initiation complex
36
MOA of macrolides?
50s inhibitor--inhibits the macro"slide"--blocks translocation
37
MOA of tetracyclines?
30s inhibitor--prevents attachment of tRNAs
38
MOA of linezolid?
50s inhibitor
39
MOA of chloramphenicol? Toxicity?
50s inhibitor-- blocks peptidyl transferase Causes anemia and gray baby syndrome
40
MOA of clindamycin? What infections is this used to treat?
50s inhibitor--Blocks peptide transfer Treats infections above the waist
41
What is the 30s subunit responsible for? 50s?
30s is small guy on the bottom that binds mRNA, 50s is the big guy on top that gets all the tRNAs
42
What is the suffix of aminoglycosides?
-micin or -mycin
43
What are the major toxicities of aminoglycosides? (NNOT)
Nephrotoxic Neuromuscular blockade Ototoxic Teratogenic
44
What is the MOA of resistance against aminoglycosides?
Bacterial transferase enzymes inactivate the drug by acetylation
45
What is the suffix for tetracyclines?
-cycline
46
What is the MOA of resistance for tetracyclines?
Decreased uptake/increase efflux
47
What are the major toxicities of tetracyclines?
Discoloration of teeth and inhibition of bone growth in children
48
What is the MOA of resistance to macrolides?
Methylation of the 23s rRAN binding protein
49
What antibiotic causes gray baby syndrome, and why?
Chloramphenicol since infants lack UDP-glucuronyl transferase needed to breakdown it
50
What abx treats infections above the waist? Below?
Above - clindamycin | Below - metronidazole
51
What is the drug that is highly associated with causing C.diff?
Clindamycin
52
What is the MOA of sulfonamides? Use? Toxicity? MOA of resistance?
Inhibits folate synthesis Gram positives and negatives Hemolysis in G6PD, nephrotoxic Altered bacterial DHP synthase)
53
What are the three macrolides?
Erythromycin Clarithromycin Azithromycin "-thromycin" suffix
54
What is the MOA of trimethoprim? Toxicity?
Blocks bacterial dihydrofolate reductase | Megaloblastic anemia and leukopenia
55
What is the MOA of fluoroquinolones? Suffix? Clinical use? Toxicities (2)? MOA of resistance?
Inhibits DNA gyrase (topoisomerase II) - floxacin - Gram negative rods - Tendonitis + prolonged QT - Mutation in DNA gyrase
56
What is the MOA of metronidazole? Toxicity?
Free radical damage to DNA | Disulfiram-like effects
57
What are the infections (parasites and bacteria) that metronidazole is used to treat? (GET GAP on the metro)
``` Giardia Entamoeba Trich Gardnerella Anaerobes Pylori ```
58
What are the four components of TB treatment (RIPE)?
Rifampin Isoniazid Pyrazinamide Ethambutol
59
What is the drug of choice for prophylaxis against TB? MAC?
``` TB = isoniazid MAC = Azithromycin + rifabutin ```
60
What is the MOA of isoniazid? Toxicities?
Decreases synthesis of mycolic acid Neurotoxic and hepatotoxic ("INH Injures neurons and hepatocytes")
61
What is the MOA of rifamycins? What are the two drugs in this class?
Rifampin and rifabutin | Inhibits DNA dependent RNA pol
62
What are the major side effects of Rifampin?
Red/orange body fluids | "RifAMPin RAMPS up p450"
63
What are the "3 R's" of rifampin?
- RNA pol inhibitor - Ramps up p450s - Red/orange fluids
64
What major side effect can be avoided by switching from rifampin to rifabutin?
Avoid p450 induction--useful for AIDS pts
65
What is the MOA of pyrazinamide? Toxicities?
Unknown MOA | Hyperuricemia, hepatotoxic
66
What is the MOA of ethambutol? Toxicities?
``` -Decrease carb polymerization of mycobacterium walls Optic neuropathy (red-green color blindness) ```
67
What is the TB drug that causes color blindness? Orange/red secretions?
Color blindness = ethambutol | Orange/red secretions = Rifampin
68
What is the antibiotic of choice for prophylaxis against: endocarditis?
PCNs
69
What is the antibiotic of choice for prophylaxis against: Gonorrhea?
Ceftriaxone
70
What is the antibiotic of choice for prophylaxis against: UTIs?
TMP-SMX
71
What is the antibiotic of choice for prophylaxis against: Meningococcal infx?
Cipro
72
What is the antibiotic of choice for prophylaxis against: GBS for pregnant women?
Ampicillin
73
What is the antibiotic of choice for prophylaxis against: Gonococcal/chlamydial infx in children?
Erythromycin
74
What is the antibiotic of choice for prophylaxis against: Post surgical S. Aureus infx?
Cefazolin
75
What is the antibiotic of choice for prophylaxis against: strep pharyngitis?
PCN
76
What is the antibiotic of choice for prophylaxis against: Syphilis
PCN
77
What is the antibiotic of choice for prophylaxis against: pneumocystis in AIDS pts? What is the CD4 count for this?
TMP-SMX | Less than 200
78
What is the antibiotic of choice for prophylaxis against: MAC in AIDS pts? What is the CD4 count for this?
Azithromycin | Less than 50
79
What is the antibiotic of choice for: VRE?
Linezolid
80
What is the antibiotic of choice for MRSA?
Vanco or daptomycin
81
What is the MOA of amp B?
Binds to ergosterol to make membrane leaky "amphoTERicin TEArs holes"
82
What is the MOA of nystatin? Clinical use?
Binds to ergosterol to make membrane leaky Oral candidiasis
83
What is the MOA of azoles? Toxicities?
Inhibits ergosterol synthesis | Testosterone synthesis inhibition
84
What is the MOA of flucytosine? Toxicities?
- Inhibits DNA and RNA biosynthesis by conversion of to 5-FU by cytosine deaminase - Myelosuppression
85
What is the suffix of echinocandins? MOA? Toxicities?
- fungin - Inhibits cell wall synthesis of beta-glucan - Hepatotoxic
86
What is MOA of terbinafine? Use? Toxicity?
Inhibits squalene epoxidase Dermatophytoses Hepatotoxic
87
What is MOA of Griseofulvin? Use? Toxicity?
Inhibits microtubule assembly Oral treatment of superficial fungal, infx Increases Warfarin metabolism
88
What is the treatment for toxoplasmosis?
Pyrimethamine
89
What is the treatment for Trypanosoma brucei?
Suramin and melarsoprol
90
What is the MOA of Chloroquine? Use? Toxicity?
Blocks detoxification of heme into hemozoin Plasmodial species BESIDES falciparum Retinopathy
91
What are the two neuraminidase inhibitors against the flu?
Zanamivir | Osletamivir
92
What is the MOA of ribavirin? Use?
Inhibits synthesis of guanine by inhibits inosine monophosphate dehydrogenase RSV
93
What is the MOA of acyclovir, famciclovir, and valacyclovir? Use?
Phosphorylated by thymidine kinase HSV/VZV infx
94
What is the MOA of resistance against acyclovir, famciclovir, and valacyclovir?
Mutated thymidine kinase
95
What is the MOA of ganciclovir? Use
Guanosine analogue that inhibits DNA pol CMV infections
96
What is the MOA of foscarnet? Use?
Viral DNA pol inhibitor that does NOT require activation by a kinase Severe CMV infection--given IV
97
What is the MOA of resistance against Foscarnet?
Mutated DNA polymerase
98
What is the MOA of cidofovir? Use? Toxicity?
Inhibits DNA pol CMV retinitis Nephrotoxic
99
What is the common suffix for HIV protease inhibitors? Toxicities?
- "navir" | - Nephropathy
100
What is the MOA of zidovudine?
NRTI
101
What is the MOA of abacavir?
NRTI
102
What is the general MOA of NRTIs?
Competitively inhibit nucleotide binding to reserve transcriptase
103
What is the only NRTI that does not need to be phosphorylated prior to action?
Tenofovir is a nucleoTide
104
What are the three NNRTIs? MOAs?
- Efavirenz - Nevirapine - Delavirdine Binds to reverse transcriptase at a non-active site
105
What is the MOA of raltegravir?
Inhibits HIV genome integration into host cell chromosome by inhibiting HIV integrase
106
What is the MOA of enfuvirtide?
BInds gp41, inhibiting viral entry
107
What is the MOA of Maraviroc?
binds CCR5 on T cell surface, inhibiting gp120
108
What is the use of interferon-alpha? (4)
Hep B and C Kaposi sarcoma hair cell leukemia Condyloma acuminatum
109
What is the use of IFN-beta?
MS
110
What is the use of IFN-gamma?
Chronic granulomatous disease
111
What are the abx to avoid in pregnancy? (8, SAFe Children Take Really Good Care)
``` Sulfonamides Aminoglycosides Fluoroquinolones Clarithromycin Tetracyclines Ribavirin Griseofulvin Chloramphenicol ```

FA Review (22 decks)

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