ANTIMICROBIALS Flashcards
What kind of drugs are nevirapine, delavirdine, and efavirenz?
NNRTI’s
What are the 2 neuraminidase inhibitors?
Zanamavir and Oseltamivir
What drug can be used to treat HBV, HCV, and Kaposi’s?
IFN alpha
What CMV drug must be coadministered with probenecid?
Cidofovir due to nephrotoxicity
What is the AE of zidovudine?
anemia (NRTI)
This drug inhibits renal dehydropeptidase I to prevent breakdown of imipenem
cilastatin
How do you prophylax against endocarditis from surgery and dental procedures?
Penicillins
Which antibiotic inhibits dihydrofolate reductase? Which drug also does this as an antineoplastic?
Trimethoprim; Methotrexate
What is the major AE of chloroquine?
Retinopathy
Which generation of cephalosporins covers gram positive bacteria and Proteus, E. coli, and Klebsiella?
First Generation (PEcK)
Which enzyme activates isoniazid to the active form?
Mycobacterial Catalase Peroxidase (KatG)
How do you prophylax against strep pharyngitis in a kid with Hx of rheumatic fever?
oral penicillin
What is the MOA of griseofulvin?
Interferes with fungal microtubules and disrupts mitosis
Which drugs block the conversion of lanosterol to ergosterol?
azoles
What are the 3 anti-staphylococcal penicillins?
Nafcillin, Oxacillin, and Dicloxacillin
MOA of oseltamivir
neuraminidase inhibitor that decreases release of influenza A and B viral progeny
What bugs are covered by second generation cephalosporins?
Gram positives, Haemophilus, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella (HEN PEcK)
What drug inhibits HIV integrase
Raltegravir
What is the advantage of a cephalosporin over a penicillin regarding beta-lactamase?
Cephalosporins are overall less sensitive to beta lactamase
Which 2 antifungals affect membrane function?
Amphotericin B, Nystatin
Which type of anemia is formed by trimethoprim? What could you give to rescue?
Megaloblastic anemia (lack of folate); rescue with folinic acid (leucovorin) same as for methotrexate
Why are tetracyclines so effective against Chlamydia and Rickettsia?
They can accumulate intracellularly
Describe the full MOA of acyclovir
Gets into cells and is monophosporylated by viral thymidine kinase to the active form. This then functions as a guanosine analog and causes CHAIN TERMINATION (no 3’ OH)
In which setting would you choose aztreonam over aminoglycosides? Can you give both?
In renal failure because aminoglycosides are nephrotoxic. However, the two are synergistic so can be given together under other circumstances.
What is famciclovir used for?
VZV; this drug is related to acylclovir
How do you treat tuberculous leprosy?
Dapsone and Rifampin
MOA of ergosterol
Binds ergosterol to form membrane pores in fungi
What other disorders can hydroxychloroquine be used for aside from malaria?
Rheumatologic disorders
What highly virulent bug is covered by ceftaroline?
MRSA
Which beta-lactams may cause vitamin K deficiency? How would this manifest?
Cephalosporins, bleeding (loss of II, VII, IX, X, and proteins C and S)
2 antibiotic classes inhibiting 30 S
Aminoglycosides and tetracyclines
This antibiotic blocks peptidyltransferase at the 50S subunit
Chloramphenicol
What are the 4 AE of vancomycin?
Nephrotoxicity, Ototoxicity, and Thrombophlebitis as well as Red Man Syndrome
What is the mechanism of resistance to tetracyclines?
Decreased uptake by cells or increased efflux by PLASMID ENCODED GENES
Which antibiotics function by blocking DNA topoisomerase II and IV?
Fluoroquinolones
Which TB drug may cause optic neuropathy?
Ethambutol
AE of macrolides (5)
Motility issues, Arrhythmia (QT prolonged), Cholestatic hepatitis, Rash, eOsinophilia (MACRO)
What are the 2 most serious side effects of amphotericin
Nephrotoxicity and Arryhthmias (and the arrhythmias are ultimately due to the nephrotoxicity)
What is the MOA of aminoglycosides
Bind 30 S ribosome to inhibit formation of initiation complex
How do you prophylax against gonococcal and chlamydial conjunctivitis in a newborn?
Erythromycin ointment
How can you reverse the bone marrow suppression caused by NRTI’s?
G-CSF and EPO
What do you use to treat onychomycosis?
Terbinafine
What determines the half life of isoniazid?
whether the person is a fast or slow acetylator
What is the DOC for Leishmaniasis?
Sodium Stibogluconate
How do you prophylax against meningitis?
Ciprofloxacin = adults; Rifampin = kids
Why do you avoid chloramphenicol in pregnancy?
Gray Baby syndrome, baby has low levels of UDP glucuronyl transferase
What must you co-administer with cidofovir?
It is nephrotoxic so it should be given probenicid and IV saline to decrease toxicity
Which antibiotic is best for anaerobes below the diaphragm?
Metronidazole
Which antiviral inhibits IMP dehydrogenase?
Ribavirin
What is used to Tx flukes such as Schistosomes?
Praziquantel
What kind of bugs are covered by 3rd generation cephalosporins?
Serious gram negative infections
Why do you avoid aminoglycosides in pregnancy?
They are ototoxic
Which ribosomal inhibitors can cause QT prolongation?
macrolides
What is IFN B used to TX?
Multiple Sclerosis
What are the AE of ribavirin (2)?
Hemolytic anemia and SEVERE TERATOGEN
Which drugs inhibit squalene epoxidase and therefore prevent formation of lanosterol?
Terbinafine and Naftifine
How do you prevent red man syndrome?
Antihistamines and a slow infusion rate of vancomycin
Which azole is best for candidal infections of all kinds?
Fluconazole
Which tetracycline is best for a renally impaired patient?
Doxycycline because it is fecally excreted
What is the mechanism of resistance to penicillins?
Beta Lactamase
This tetracycline is excreted fecally rather than renally
Doxycycline
What autoantibodies may be found in the serum of a person on isoniazid?
Antihistone; it causes a lupus like syndrome
What is the mechanism of resistance to macrolides
methylation of the 23S rRNA binding site
What is the MOA of flucytosine? Used for?
blocks DNA and RNA synthesis by using cytosine deaminase to convert to 5 FU
What is the MOA of chloroquine?
Blocks detoxification of heme to HEMOZOIN so heme accumulates and is toxic to plasmodia
Which antifungal drug interferes with microtubule function and may be carcinogenic?
Griseofulvin
What is the MOA of macrolides?
Bind to 23S rRNA at the 50S ribosome and prevent translocation
Which cephalosporin covers MRSA?
Ceftaroline
Why do infants on chloramphenicol get “Gray baby syndrome”
They lack liver UDP-glucuronyl transferase to glucuronidate it
What are the main 3 AE of protease inhibitors?
Hyperglycemia, GI intolerance, and Lipodystrophy
This TB drug blocks arabinosyltransferase and decreases carbohydrate polymerization of the cell wall
Ethambutol
Which 2 antifungals inhibit lanosterol synthesis?
Naftifine and Terbinafine
Ototoxicity with aminoglycosides is potentiated with __________ while nephrotoxicity is potentiated with ______________
Loop diuretics; Cephalosporins
Which drugs are given as prophylaxis for A) Mycobacterium tuberculosis B) MAC and C) M. leprae?
A) Isoniazid B) Azithromycin (when CD4
What is the antiviral that inhibits IMP dehydrogenase indicated for (2)?
This is ribavirin (Chronic Hepatitis C and RSV)
Why is cefazolin used prior to surgery?
To prevent staphylococcal wound infections
How do you prophylax against recurrent UTI’s?
TMP-SMX
What do you use to treat NADPH oxidase deficiency?
IFN gamma
Major AE of rifampin
orange body fluids and hepatoxicity (induce CYP450)
Which protease inhibitor is used to “boost” others by inhibiting cytochrome P450?
Ritonavir
Which antiviral should you use against HSV? VZV?
HSV = Acyclovir; VZV = Famciclovir
What is the AE of raltegravir?
hypercholesterolemia
What are suramin and melarsoprol used to treat?
Trypanosoma brucei
Which tetracycline is rarely used as an antibiotic but instead to act as a diuretic in SIADH?
Demeclocycline
Why do you avoid clarithromycin in pregnancy?
Embryotoxic
What is the utility of ritonavir vs. other protease inhibitors?
Ritonavir is used to boost the concentrations of others by inhibiting cytochrome P450
Which medication would increase the likelihood of tendon rupture in a patient taking fluoroquinolones?
Corticosteroids (prednisone)
What are the AE of cephalosporins?
Hypersensitivity, Vitamin K deficiency (bleeding), and increased nephrotoxicity of aminoglycosides
Aminoglycosides and tetracyclines both act on _____ S
30 S
What is the mechanism of resistance to aminoglycosides?
transferase enzymes that inactivate the drug via acetylation, adenylation, or phosphorylation
What is valganciclovir?
Prodrug of ganciclovir with better oral bioavailability
What are the 4 AE of aminoglycosides?
Nephrotoxicity, Neuromuscular blockade, Ototoxicity, and Teratogenic