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COMLEX Level 1 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Penicillin

A

Inhibits Pencillin binding protein (transpeptidase) which prevents cell wall cross linking (cell walls have a D-Ala-D-Ala structure), causing unstable cell walls and cell death

Gram +
N meningitidis
T pallidum

Penicillin V: oral, weaker form
Penicillin G: IV, IM

AA:
o IgE hypersensitivity reaction
o Interstitial nephritis
o Cross reactive with cephalosporins

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2
Q

penicillinase-resistant penicillins

A

Naficillin, oxacillin, dicloxacillin, methicillin
pennicillinase resistant due to bulky R group

Staph aureus besides MRSA
o Osteomyelitis, myocarditis, soft tissue infections

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3
Q

Amoxicillin, ampicillin

A 
Penicillins with wider spectrum
pair with beta-lactamase inhibitors
H. influ
H. pylori
E. coli
Listeria
Proteus
Salmonella
Shigella
HHELPSS

AA:
rash in CMV
liver

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4
Q

Pipercillin, ticacillin

A

anti-pseudomonal penicillins

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5
Q

1st gen cephalosporins

A 
cephalexin, cefazolin (flex, fez)
PEcK +
Proteus
E. coli
Klebsiella
gram positives
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6
Q

2nd gen cephalosporins

A 
cefaclor, cefoxitin, cefuroxime, cefotetan (fake fox fur tea parties)
HENS PEcK
	H. influ
	Enterobacter
	Neisseria
	Serratia
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7
Q

3rd gen cephalosporins

A 
ceftriaxone, cefotaxime, ceftazidime
serious gram - infections
meningitis
psuedomonas (taz covers naz)
gonorrhea
late stage Lyme
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8
Q

4th gen cephalosporins

A

cefepime
broad spectrum
meningitis → crosses CSF
pseudomonas

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9
Q

5th gen cephalosporins

A

ceftaroline
broad spectrum
MRSA
does NOT cover pseudomonas

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10
Q

Carbapenems

A

-penem
beta-lactamase resistant
used in serious life-threatening side effects
broad spectrum
imipenem → adminster with cilastin to ↑ half life

AA:
serious side effects
CNS toxic (seizures)
GI distress
rash
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11
Q

Aztreonam

A

monobactam
Beta-lactamase resistant
Aerobic gram negative rods
o Treats serious gram negative infections
 Sepsis, pneumonia, meningitis
o Pseduomonas
o Penetrates CSF

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12
Q

Vancomycin

A

Inhibits cell wall synthesis by binding directly to D-Ala-D-Ala polypeptides
Bacterial resistance by changing their cell wall to D-Ala-D-LAC

IV
Treats MRSA and other multi-drug-resistant bacteria
S. epidermidis
C. diff → oral vancomycin

AA
o	Red man syndrome → flushing during infusion
o	Thrombophlebitis
o	Ototoxicity
o	Nephrotoxicity
	Excreted through kidneys
	Monitor plasma levels
o	DRESS syndrome → eosinophilia and systemic symptoms
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13
Q

Daptomycin

A

Lipopeptide that disrupts cell membranes
MRSA and VRE
endocarditis
bacteremia

not effective vs pneumonia (surfactant inactivates daptomycin)

AA: rhadomyolysis, myopathy

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14
Q

Tetracycline

A 
doxycycline, minocycline
30S ribosomal binding
Tick born pathogens
	Rickettsia
	Ehrlichia
	Francisella
	Borrelia

Zoonotic diseases
 Brucella
 Coxiella
 Yersinia

chlamydia
acne
MRSA

AA:
Contraindicated in pregnancy
teeth discoloration
inhibits bone growth
photosensitivity
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15
Q

macrolides

A

(-thromycin)
50S ribosomal subunit inhibiting translocation
atypical pneumonia (M. pneumoniae, legionella, chlamydia)
Gram + infections in patients allergic to penicillin
B. pertussis

AA: MACRO
Motility (GI)
Arrhythmia
Cholestatic hepatitis
Rash
eOsinophilia

P450 inhibitor

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16
Q

Clindamycin

A 
50S ribosomal subunit inhibiting translocation
Gram + and anerobes
o	MRSA
o	Lung abscesses
o	Aspiration pneumonia
o	Bacteroides (oral infections)
o	Clostridium perfringens
o	Acne
o	Gardnerella vaginosis

Clindamycin above the diaphragm
Metronidazole below the diaphragm

paired with gentamicin for broad coverage

AA:
o Diarrhea
o C. difficile infections

17
Q

Chloramphenicol

A 
Rarely used in the US
50S ribosome, inhibits translation
Bacteriostatic
Used in meningitis and rocky mountain spotted fever
Cheap 3rd world treatment of meningitis

Adverse reaction
o Anemia
o Gray baby syndrome
 Accumulation of drug due to lack of liver UDP-glucuronosyltransferase

18
Q

Linezolid

A 
50S ribosome, bacteriostatic
Gram +
Staph, strep, enterococcus
MRSA and VRE (vancomycin resistant enterococcus)
Nosocomial pneumonia (MRSA)
Adverse reactions
o	Thrombocytenia 
o	Optic neuropathy
o	Peripheral neuropathy (glove and stocking)
o	Serotonin syndrome
19
Q

Aminoglycosides

A

gentamicin, neomycin, streptomycin, tobramycin, amikacin
30S ribosome, misreading mRNA causing cell death → bacteriocidal
Gram – bacilli, aerobes only
Coupled with beta lactams or vancomycins to help them get through cell wall
IV

Neomycin → bowel surgery prep
Streptomycin → tularemia, Y. pestis
Gentamicin and Tobramycin → severe, drug-resistant gram – rods
Amikacin → new, expensive, effective vs drug resistant

Adverse effects
o Nephrotoxicity
o Ototoxicity
o Neuromuscular blockade (myasthenia gravis is contraindication)
o Teratogen (contraindicated in pregnancy)

20
Q

Tuberculosis drugs

A

rifampin, isoniazid, pyrazinamide, ethambutol

4 drugs for 2 months, then 2 drugs for 4 months

21
Q

Isoniazid

A

Only agent that can be used by itself, iso → isolated
Latent TB
↓ mycolic acids in cell wall

Adverse effects
 INH → injures neurons and hepatocytes
 Drug induced SLE
 Vit B6 deficiency → administer with Vit B6
 Siezures
 P450 inhibition → ↑concentration of drugs

22
Q

Rifampin

A

Inhibits RNA synthesis
P450 stimulation → ↓concentration of drugs
Prophylactic monotherapy to close contacts of patients infected with H. influenzae or N. meningitidis

Adverse effects
 Orange body fluids
 Hepatotoxicity

23
Q

Ethambutol

A

↓ carb polymerization of cell walls by blocking arabinosyltransferase

Adverse reactions
 Optic neuropathy → red-green color blindness

24
Q

Pyrazinamide

A

Adverse effects
 Hyperuricemia → gout
 Hepatotoxicity → hepatic necrosis

25
Q

Mycobacterium avium treatment

A
  • Azithromycin or clarithromycin
  • Ethambutol
  • Rifabutin → less potent stimulator of P450
26
Q

Mycobacterium leprae treatment

A

Tuberculoid form
o Dapsone
o Rifampin
•

Lepromatous form
o Dapsone
o Rifampin
o Clofazimine

27
Q

Sulfonamides

A

Inhibits folate synthesis (dihydopteroate synthase)

Adverse reactions
o	Allergic drug reactions (Rash, fever, urticaria)
o	G6PD deficiency patients → hemolysis
o	Stevens-Johnson syndrome
o	Interstitial nephritis
o	Kernicterus in infants
o	Displace drugs from albumin (such as warfarin)
o	P450 inhibition
28
Q

Trimethoprim

A

Inhibits folate synthesis (dihydrofolate reductase)
Trimethoprim + sulfamethoxazole = bactrim
o 1st line treatment for UTI
o Shigella
o Nocardia
o Pneumocystis jirovecii
o Toxoplasma ghandii prophylaxis

29
Q

Fluorquinolones

A

-floxacins
Inhibits DNA gyrase and topoisomerase, bacteriocidal
gram - rods of UTI and GI
o Complicated UTI’s (bactrim is first line)
Some gram +
Bacillus anthracis
Otitis externa
Divalent and trivalent metals decrease absorption

Adverse effects
o GI
o Teratogenic
o Tendonitis or tendon rupture

30
Q

Metronidazole

A 
Forms free radicals that disrupt bacterial DNA
Anaerobes below the diaphragm (clindamycin → above the diphragm)
o	C. diff
o	Clostridium
Giardia
Entamoeba
Trichamonas 
Gardnerella

Adverse reactions
o When taken with alcohol → flushing, tachycardia, hypotenstion
o Metallic taste

31
Q

Amphotericin

A

Antifungal
Binds to ergosterol, forms (TEARS) pores which leak electrolytes
Serious, life threatening fungal infections
o Mycoses
o Mucor
o Fungal meningitis

Adverse reactions
o Nephrotoxicity (almost always occurs)
o Fever, chills, hypotension
o Thrombophlebitis

32
Q

Nystatin

A
  • Same as amphotericin

* Topical use for candidiasis

33
Q

Flucytosine

A
  • Conversion of uracil to 5-fluoruracil inhibiting DNA and RNA synthesis
  • Systemic fungal infections
  • Cryptococcus
34
Q

Azoles

A

Inhibits ergosterol synthesis (lanosterol → ergosterol) by inhibiting P450
Antifungal

Voriconazole
o Aspergillosis
o Candida

Fluconazole
o Candida
o Cryptococcal meningitis

Itraconazole
o Dimorphic mycoses (2 Iterations)

Clotrimazole and miconazole
o Topical fungal infections (tinea)

Adverse effects
o Inhibits testosterone synthesis
 Gynecomastia
o Inhibits P450

35
Q

Terbinafine

A

inhibits squalene epoxidase

used for dermatophytoses

COMLEX Level 1 (13 decks)

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