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USMLE Step 1 > Antimicrobials - First Aid > Flashcards

Antimicrobials - First Aid Flashcards

1
Q

Antimicrobial Therapy

A
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2
Q

Antimicrobials:

IV Penicillin

A

Penicillin G

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3
Q

Antimicrobials:

IM Penicillin

A

Penicillin G

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4
Q

Antimicrobials:

Oral Penicillin

A

Penicillin V

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5
Q

Antimicrobials:

prototype β-lactam antibiotics

A
  • Penicillin G (IV and IM form)
  • Penicillin V (oral form)
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6
Q

Antimicrobials:

Mechanism of Action

  • D-Ala-D-Ala structural analog
  • bind _____-binding proteins (transpeptidases)
  • block transpeptidase cross-linking of peptidoglycan in cell wall
  • activate autolytic enzymes
A
  • Penicillin G
  • Penicillin V
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7
Q

Antimicrobials:

Clinical Use

  • mostly used for gram ⊕ organisms (S. pneumoniae, S. pyogenes, Actinomyces)
  • also used for gram ⊝ cocci (N. meningitidis) and spirochetes (T. pallidum)
  • bactericidal for gram ⊕ cocci, gram ⊕ rods, gram ⊝ cocci, and spirochetes
  • β-lactamase sensitive
A
  • Penicillin G
  • Penicillin V
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8
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
  • direct Coombs ⊕ hemolytic anemia
  • drug-induced interstitial nephritis
A
  • Penicillin G
  • Penicillin V
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9
Q

Antimicrobials:

Resistance

  • β-lactamase cleaves the β-lactam ring
  • mutations in _____-binding proteins
A
  • Penicillin G
  • Penicillin V
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10
Q

Penicillinase-Sensitive Penicillins

A
  • Amoxicillin
  • Ampicillin
  • Aminopenicillins
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11
Q

Antimicrobials:

Mechanism of Action

  • same as penicillin
  • wider spectrum
  • combine with clavulanic acid to protect against destruction by β-lactamas
A

Penicillinase-Sensitive Penicillins

  • Amoxicillin
  • Ampicillin
  • Aminopenicillins

AMinoPenicillins are AMPed-up penicillin.
AmOxicillin has greater Oral bioavailability than ampicillin.

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12
Q

Antimicrobials:

Clinical Use

  • extended-spectrum penicillin
    • H. influenzae
    • H. pylori
    • E. coli
    • Listeria monocytogenes
    • Proteus mirabilis
    • Salmonella
    • Shigella
    • Enterococci
A

Penicillinase-Sensitive Penicillins

  • Amoxicillin
  • Ampicillin
  • Aminopenicillins

Ampicillin/Amoxicillin HHELPSS kill Enterococci.

  • H. influenzae
  • H. pylori
  • E. coli
  • Listeria monocytogenes
  • Proteus mirabilis
  • Salmonella
  • Shigella
  • Enterococci
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13
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
  • rash
  • pseudomembranous colitis
A

Penicillinase-Sensitive Penicillins

  • Amoxicillin
  • Ampicillin
  • Aminopenicillins
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14
Q

Antimicrobials:

Resistance

  • Penicillinase (a type of β-lactamase) cleaves β-lactam ring
A

Penicillinase-Sensitive Penicillins

  • Amoxicillin
  • Ampicillin
  • Aminopenicillins
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15
Q

Penicillinase-Resistant Penicillins

A
  • Dicloxacillin
  • Nafcillin
  • Oxacillin
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16
Q

Antimicrobials:

Mechanism of Action

  • same as penicillin
  • narrow spectrum
  • bulky R group blocks access of β-lactamase to β-lactam ring
A

Penicillinase-Resistant Penicillins

  • Dicloxacillin
  • Nafcillin
  • Oxacillin
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17
Q

Antimicrobials:

Clinical Use

  • S. aureus (except MRSA)
A

Penicillinase-Resistant Penicillins

  • Dicloxacillin
  • Nafcillin
  • Oxacillin

“Use naf (Nafcillin) for staph.”

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18
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
  • interstitial nephritis
A

Penicillinase-Resistant Penicillins

  • Dicloxacillin
  • Nafcillin
  • Oxacillin
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19
Q

Antimicrobials:

Resistance

  • MRSA has altered penicillin-binding protein target site
A

Penicillinase-Resistant Penicillins

  • Dicloxacillin
  • Nafcillin
  • Oxacillin
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20
Q

Antipseudomonal Penicillins

A
  • Piperacillin
  • Ticarcillin
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21
Q

Antimicrobials:

Mechanism of Action

  • same as penicillin
  • extended spectrum
  • penicillinase sensitive
  • use with β-lactamase inhibitors
A

Antipseudomonal Penicillins

  • Piperacillin
  • Ticarcillin
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22
Q

Antimicrobials:

Clinical Use

  • Pseudomonas spp.
  • Gram ⊝ Rods
A

Antipseudomonal Penicillins

  • Piperacillin
  • Ticarcillin
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23
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
A

Antipseudomonal Penicillins

  • Piperacillin
  • Ticarcillin
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24
Q

_____ are often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase (penicillinase).

A

β-Lactamase Inhibitors

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25
Q

β-Lactamase Inhibitors

A

CAST

  • Clavulanic Acid
  • Avibactam
  • Sulbactam
  • Tazobactam
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26
Q

Antimicrobials:

Mechanism of Action

  • β-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases
  • bactericidal
A

Cephalosporins

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27
Q

Organisms typically not covered by 1st–4th generation cephalosporins are _____.

A

LAME:

  • Listeria
  • Atypicals (Chlamydia, Mycoplasma)
  • MRSA
  • Enterococci
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28
Q

1st Generation Cephalosporins

A
  • Cefazolin
  • Cephalexin
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29
Q

2nd Generation Cephalosporins

A
  • Cefaclor
  • Cefoxitin
  • Cefuroxime
  • Cefotetan

2nd graders wear fake fox fur to tea parties.

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30
Q

3rd Generation Cephalosporins

A
  • Ceftazidime
  • Cefpodoxime
  • Cefotaxime
  • Ceftriaxone

Taz’s tornado blows taxis and trees (3) away.

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31
Q

4th Generation Cephalosporins

A

Cefepime

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32
Q

5th Generation Cephalosporins

A

Ceftaroline

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33
Q

Antimicrobials:

Clinical Use

  • Gram ⊕ Cocci
  • Proteus mirabilis
  • E. coli
  • Klebsiella pneumoniae
  • used prior to surgery to prevent S. aureus wound infections
A

1st Generation Cephalosporins

  • Cefazolin—prior to surgery, S. aureus
  • Cephalexin

PEcK:

  • Proteus mirabilis
  • E. coli
  • Klebsiella pneumoniae
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34
Q

Antimicrobials:

Clinical Use

  • Gram ⊕ Cocci
  • H. influenzae
  • Enterobacter aerogenes
  • Neisseria spp.
  • Serratia marcescens
  • Proteus mirabilis
  • E. coli
  • Klebsiella pneumoniae
A

2nd Generation Cephalosporins

  • Cefaclor
  • Cefoxitin
  • Cefuroxime
  • Cefotetan

HENS PEcK:

  • H. influenzae
  • Enterobacter aerogenes
  • Neisseria spp.
  • Serratia marcescens
  • Proteus mirabilis
  • E. coli
  • Klebsiella pneumoniae
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35
Q

Antimicrobials:

Clinical Use

  • serious gram ⊝ infections resistant to other β-lactams
  • can cross blood-brain barrier
A

3rd Generation Cephalosporins

  • Ceftazidime—Pseudomonas
  • Cefpodoxime
  • Cefotaxime
  • Ceftriaxone—meningitis, gonorrhea, disseminated Lyme disease
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36
Q

Antimicrobials:

Clinical Use

  • Gram ⊝
  • ↑ activity against Pseudomonas and gram ⊕ organisms
A

4th Generation Cephalosporins

  • Cefepime
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37
Q

Antimicrobials:

Clinical Use

  • broad gram ⊕ and gram ⊝ organism coverage
  • Listeria
  • MRSA
  • Enterococcus faecalis
  • does not cover Pseudomonas
A

5th Generation Cephalosporins

  • Ceftaroline
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38
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
  • autoimmune hemolytic anemia
  • disulfiram-like reaction
  • vitamin K deficiency
  • low rate of cross-reactivity even in penicillin-allergic patients
  • ↑ nephrotoxicity of aminoglycosides
A

Cephalosporins

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39
Q

Antimicrobials:

Resistance

  • inactivated by _____ases (a type of β-lactamase)
  • structural change in penicillin-binding proteins (transpeptidases)
A

Cephalosporins

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40
Q

Carbapenems

A

DIME:

  • Doripenem
  • Imipenem
  • Meropenem
  • Ertapenem

DIME antibiotics are given when there is a 10/10 (life-threatening) infection.

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41
Q

Antimicrobials:

Mechanism of Action

  • broad-spectrum
  • β-lactamase–resistant
  • always administered with Cilastatin (inhibitor of renal dehydropeptidase I) to ↓ inactivation of drug in renal tubules
A

Carbapenems

  • Imipenem

With imipenem, “the kill is lastin’ with Cilastatin.”

Newer Carbapenems

  • Ertapenem (limited Pseudomonas coverage)
  • Doripenem
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42
Q

Antimicrobials:

Clinical Use

  • Gram ⊕ Cocci
  • Gram ⊝ Rods
  • Anaerobes
  • wide spectrum and significant side effects limit use to life-threatening infections or after other drugs have failed
A

Carbapenems

  • Doripenem
  • Imipenem
  • Meropenem—↓ risk of seizures, stable to dehydropeptidase I
  • Ertapenem
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43
Q

Antimicrobials:

Adverse Effects

  • GI distress
  • rash
  • CNS toxicity (seizures) at high plasma levels
A

Carbapenems

  • Doripenem
  • Imipenem
  • Meropenem
  • Ertapenem
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44
Q

Monobactams

A

Aztreonam

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45
Q

Antimicrobials:

Mechanism of Action

  • less susceptible to β-lactamases
  • prevents peptidoglycan cross-linking by binding to penicillin-binding protein 3
  • synergistic with aminoglycosides
  • no cross-allergenicity with penicillins
A

Monobactams

  • Aztreonam
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46
Q

Antimicrobials:

Clinical Use

  • Gram ⊝ Rods
  • no activity against gram ⊕ rods or anaerobes
  • for penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
A

Monobactams

  • Aztreonam
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47
Q

Antimicrobials:

Adverse Effects

  • usually nontoxic
  • occasional GI upset
A

Monobactams

  • Aztreonam
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48
Q

Antimicrobials:

Mechanism of Action

  • inhibits cell wall peptidoglycan formation by binding D-Ala-D-Ala portion of cell wall precursors
  • bactericidal against most bacteria (bacteriostatic against C. difficile)
  • not susceptible to β-lactamases
A

Vancomycin

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49
Q

Antimicrobials:

Clinical Use

  • Gram ⊕
  • serious, multidrug-resistant organisms, including MRSA, S. epidermidis, sensitive Enterococcus species, and Clostridium difficile (oral dose for pseudomembranous colitis)
A

Vancomycin

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50
Q

Antimicrobials:

Adverse Effects

  • well tolerated in general
  • nephrotoxicity
  • ototoxicity
  • thrombophlebitis
  • Red Man Syndrome
    • diffuse flushing
    • largely preventable by pretreatment with antihistamines and slow infusion rate
  • DRESS Syndrome
    • drug reaction with eosinophilia and systemic symptoms
A

Vancomycin

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51
Q

Antimicrobials:

Resistance

  • occurs in bacteria (eg, Enterococcus) via amino acid modification of D-Ala-D-Ala to D-Ala-D-Lac
A

Vancomycin

If you Lack a D-Ala (dollar), you can’t ride the van.

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52
Q

Protein Synthesis Inhibitors

A
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53
Q

_____ specifically target smaller bacterial ribosome (70S, made of 30S and 50S subunits), leaving human ribosome (80S) unaffected.

A

Protein Synthesis Inhibitors

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54
Q

Protein synthesis inhibitors are all bacteriostatic, except _____.

A
  • Aminoglycosides (bactericidal)
  • Linezolid (variable)
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55
Q

Protein Synthesis Inhibitors

A

30S inhibitors

  • Aminoglycosides
  • Tetracyclines

50S inhibitors

  • Chloramphenicol
  • Clindamycin
  • Erythromycin (Macrolides)
  • Linezolid

“Buy AT 30, CCEL (sell) at 50.”

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56
Q

Aminoglycosides

A

GNATS:

  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin
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57
Q

Antimicrobials:

Mechanism of Action

  • bactericidal
  • irreversible inhibition of initiation complex through binding of the 30S subunit
  • can cause misreading of mRNA
  • also block translocation
  • require O2 for uptake
  • ineffective against anaerobes
A

Aminoglycosides

  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin
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58
Q

Antimicrobials:

Clinical Use

  • severe gram ⊝ rod infections
  • synergistic with β-lactam antibiotics
  • bowel surgery
A

Aminoglycosides

  • Gentamicin
  • Neomycin—bowel surgery
  • Amikacin
  • Tobramycin
  • Streptomycin
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59
Q

Antimicrobials:

Adverse Effects

  • nephrotoxicity
  • neuromuscular blockade
  • ototoxicity (especially when used with loop diuretics)
  • teratogen
A

Aminoglycosides

  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin

“Mean” (aminoglycoside) GNATS caNNOT kill anaerobes.

  • Nephrotoxicity
  • Neuromuscular blockade
  • Ototoxicity
  • Teratogen
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60
Q

Antimicrobials:

Resistance

  • bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation
A

Aminoglycosides

  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin
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61
Q

Tetracyclines

A
  • Tetracycline
  • Doxycycline
  • Minocycline
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62
Q

Antimicrobials:

Mechanism of Action

  • bacteriostatic
  • bind to 30S and prevent attachment of aminoacyl-tRNA
  • limited CNS penetration
  • not taken with milk (Ca2+), antacids (Ca2+ or Mg2+), or iron-containing preparations because divalent cations inhibit drugs’ absorption in the gut
A

Tetracyclines

  • Tetracycline
  • Doxycycline—fecally eliminated, can be used in patients with renal failure
  • Minocycline
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63
Q

Antimicrobials:

Clinical Use

  • Borrelia burgdorferi
  • M. pneumoniae
  • drugs’ ability to accumulate intracellularly makes them very effective against Rickettsia and Chlamydia
  • also used to treat acne
A

Tetracyclines

  • Tetracycline
  • Doxycycline—MRSA
  • Minocycline
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64
Q

Antimicrobials:

Adverse Effects

  • GI distress
  • discoloration of teeth and inhibition of bone growth in children
  • photosensitivity
  • contraindicated in pregnancy
A

Tetracyclines

  • Tetracycline
  • Doxycycline
  • Minocycline
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65
Q

Antimicrobials:

Resistance

  • ↓ uptake or ↑ efflux out of bacterial cells by plasmid-encoded transport pumps
A

Tetracyclines

  • Tetracycline
  • Doxycycline
  • Minocycline
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66
Q

Glycylcyclines

A

Tigecycline

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67
Q

Antimicrobials:

Mechanism of Action

  • tetracycline derivative
  • binds to 30S, inhibiting protein synthesis
  • generally bacteriostatic
A

Glycylcyclines

  • Tigecycline
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68
Q

Antimicrobials:

Clinical Use

  • broad-spectrum anaerobic, gram ⊝, and gram ⊕ coverage
  • multidrug-resistant organisms (MRSA, VRE) or infections requiring deep tissue penetration
A

Glycylcyclines

  • Tigecycline
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69
Q

Antimicrobials:

Adverse Effects

  • GI symptoms: nausea, vomiting
A

Glycylcyclines

  • Tigecycline
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70
Q

Antimicrobials:

Mechanism of Action

  • blocks peptidyltransferase at 50S ribosomal subunit
  • bacteriostatic
A

Chloramphenicol

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71
Q

Antimicrobials:

Clinical Use

  • meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae) and rickettsial diseases (eg. Rocky Mountain Spotted Fever [Rickettsia rickettsii]).
  • limited use due to toxicity but often still used in developing countries because of low cost
A

Chloramphenicol

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72
Q

Antimicrobials:

Adverse Effects

  • anemia (dose dependent)
  • aplastic anemia (dose independent)
  • gray baby syndrome (in premature infants because they lack liver UDP-glucuronosyltransferase)
A

Chloramphenicol

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73
Q

Antimicrobials:

Resistance

  • plasmid-encoded acetyltransferase inactivates the drug
A

Chloramphenicol

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74
Q

Antimicrobials:

Mechanism of Action

  • blocks peptide transfer (translocation) at 50S ribosomal subunit
  • bacteriostatic
A

Clindamycin

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75
Q

Antimicrobials:

Clinical Use

  • anaerobic infections (eg. Bacteroides spp.,Clostridium perfringens) in aspiration pneumonia, lung abscesses, and oral
  • infections
  • also effective against invasive group A streptococcal infection
  • treats anaerobic infections above the diaphragm vs. metronidazole
A

Clindamycin

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76
Q

Antimicrobials:

Adverse Effects

  • pseudomembranous colitis (C. difficile overgrowth)
  • fever
  • diarrhea
A

Clindamycin

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77
Q

Oxazolidinones

A

Linezolid

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78
Q

Antimicrobials:

Mechanism of Action

  • inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex
A

Oxazolidinones

  • Linezolid
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79
Q

Antimicrobials:

Clinical Use

  • Gram ⊕
  • MRSA
  • VRE
A

Oxazolidinones

  • Linezolid
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80
Q

Antimicrobials:

Adverse Effects

  • bone marrow suppression (especially thrombocytopenia)
  • peripheral neuropathy
  • serotonin syndrome
A

Oxazolidinones

  • Linezolid
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81
Q

Antimicrobials:

Resistance

  • point mutation of ribosomal RNA
A

Oxazolidinones

  • Linezolid
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82
Q

Macrolides

A
  • Azithromycin
  • Clarithromycin
  • Erythromycin
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83
Q

Antimicrobials:

Mechanism of Action

  • inhibit protein synthesis by blocking translocation (“macroslides”)
  • bind to the 23S rRNA of the 50S ribosomal subunit
  • bacteriostatic
A

Macrolides

  • Azithromycin
  • Clarithromycin
  • Erythromycin
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84
Q

Antimicrobials:

Clinical Use

  • atypical pneumonias (Mycoplasma, Chlamydia, Legionella)
  • STIs (Chlamydia)
  • Gram ⊕ Cocci (streptococcal infections in patients allergic to penicillin)
  • B. pertussis
A

Macrolides

  • Azithromycin
  • Clarithromycin
  • Erythromycin
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85
Q

Antimicrobials:

Adverse Effects

  • gastrointestinal motility issues
  • arrhythmia caused by prolonged QT interval
  • acute cholestatic hepatitis
  • rash
  • eosinophilia
  • increases serum concentration of theophylline and oral anticoagulants
A

Macrolides

  • Azithromycin
  • Clarithromycin—inhibit cytochrome P-450
  • Erythromycin—inhibit cytochrome P-450

MACRO:

  • gastrointestinal Motility
  • Arrhythmia
  • acute Cholestatic hepatitis
  • Rash
  • eOsinophilia
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86
Q

Antimicrobials:

Resistance

  • methylation of 23S rRNA-binding site prevents binding of drug
A

Macrolides

  • Azithromycin
  • Clarithromycin
  • Erythromycin
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87
Q

Polymyxins

A
  • Colistin (Polymyxin E)
  • Polymyxin B
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88
Q

Antimicrobials:

Mechanism of Action

  • cation polypeptides that bind to phospholipids on cell membrane of gram ⊝ bacteria
  • disrupt cell membrane integrity → leakage of cellular components → cell death
A

Polymyxins

  • Colistin (Polymyxin E)
  • Polymyxin B
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89
Q

Antimicrobials:

Clinical Use

  • salvage therapy for multidrug-resistant gram ⊝ bacteria (eg. P. aeruginosa, E. coli, K. pneumoniae)
A

Polymyxins

  • Colistin (Polymyxin E)
  • Polymyxin B—component of a triple antibiotic ointment used for superficial skin infections
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90
Q

Antimicrobials:

Adverse Effects

  • nephrotoxicity
  • neurotoxicity (eg. slurred speech, weakness, paresthesias)
  • respiratory failure
A

Polymyxins

  • Colistin (Polymyxin E)
  • Polymyxin B
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91
Q

Sulfonamides

A
  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine
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92
Q

Antimicrobials:

Mechanism of Action

  • inhibit dihydropteroate synthase, thus inhibiting folate synthesis
  • bacteriostatic (bactericidal when combined with trimethoprim)
A

Sulfonamides

  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine
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93
Q

Antimicrobials:

Clinical Use

  • Gram ⊕
  • Gram ⊝
  • Nocardia
A

Sulfonamides

  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine

*TMP-SMX for simple UTI

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94
Q

Antimicrobials:

Adverse Effects

  • hypersensitivity reactions
  • hemolysis if G6PD deficient
  • nephrotoxicity (tubulointerstitial nephritis)
  • photosensitivity
  • Stevens-Johnson Syndrome
  • kernicterus in infants
  • displace other drugs from albumin (eg. warfarin)
A

Sulfonamides

  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine
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95
Q

Antimicrobials:

Resistance

  • altered enzyme (bacterial dihydropteroate synthase), ↓ uptake, or ↑ PABA synthesis
A

Sulfonamides

  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine
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96
Q

Antimicrobials:

Mechanism of Action

  • similar to sulfonamides
  • structurally distinct agent
A

Dapsone

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97
Q

Antimicrobials:

Clinical Use

  • Leprosy (lepromatous and tuberculoid)
  • Pneumocystis jirovecii prophylaxis
A

Dapsone

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98
Q

Antimicrobials:

Adverse Effects

  • hemolysis if G6PD deficient
  • methemoglobinemia
A

Dapsone

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99
Q

Antimicrobials:

Mechanism of Action

  • inhibits bacterial dihydrofolate reductase
  • bacteriostatic
A

Trimethoprim

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100
Q

Antimicrobials:

Clinical Use

  • used in combination with sulfonamides
  • causing sequential block of folate synthesis
  • combination used for UTIs
  • Shigella
  • Salmonella
  • Pneumocystis jirovecii pneumonia treatment and prophylaxis
  • Toxoplasmosis prophylaxis
A

Trimethoprim

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101
Q

Antimicrobials:

Adverse Effects

  • megaloblastic anemia
  • leukopenia
  • granulocytopenia
  • may be avoided with coadministration of folinic acid
A

Trimethoprim

TMP Treats Marrow Poorly.

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102
Q

Fluoroquinolones

A
  • Ciprofloxacin
  • Enoxacin
  • Norfloxacin
  • Ofloxacin
  • Gemifloxacin
  • Levofloxacin
  • Moxifloxacin
103
Q

Respiratory Fluoroquinolones

A
  • Gemifloxacin
  • Levofloxacin
  • Moxifloxacin
104
Q

Antimicrobials:

Mechanism of Action

  • inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV
  • bactericidal
  • must not be taken with antacids
A

Fluoroquinolones

105
Q

Antimicrobials:

Clinical Use

  • Gram ⊝ Rods of urinary and GI tracts (including Pseudomonas)
  • some gram ⊕ organisms
  • otitis externa
A

Fluoroquinolones

106
Q

Antimicrobials:

Adverse Effects

  • GI upset
  • superinfections
  • skin rashes
  • headache
  • dizziness
  • less commonly, can cause leg cramps and myalgias
  • contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage
  • some may prolong QT interval
  • tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone
A

Fluoroquinolones

  • Ciprofloxacin —inhibits cytochrome P-450

Fluoroquinolones hurt attachments to your bones.

107
Q

Antimicrobials:

Resistance

  • chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps
A

Fluoroquinolones

108
Q

Antimicrobials:

Mechanism of Action

  • lipopeptide that disrupts cell membranes of gram ⊕ cocci by creating transmembrane channels
A

Daptomycin

109
Q

Antimicrobials:

Clinical Use

  • S. aureus skin infections (especially MRSA)
  • bacteremia
  • endocarditis
  • VRE
  • not used for pneumonia (avidly binds to and is inactivated by surfactant)
A

Daptomycin

110
Q

Antimicrobials:

Adverse Effects

  • myopathy
  • rhabdomyolysis
A

Daptomycin

111
Q

Antimicrobials:

Mechanism of Action

  • forms toxic free radical metabolites in the bacterial cell that damage DNA
  • bactericidal
  • antiprotozoal
A

Metronidazole

112
Q

Antimicrobials:

Clinical Use

  • treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. difficile)
  • can be used in place of amoxicillin in H. pylori “triple therapy” in case of penicillin allergy
  • treats anaerobic infection below the diaphragm vs. clindamycin (anaerobic infections above diaphragm)
A

Metronidazole

GET GAP on the Metro with metronidazole!

  • Giardia
  • Entamoeba
  • Trichomonas
  • Gardnerella vaginalis
  • Anaerobes (Bacteroides, C. difficile)
  • H. Pylori
113
Q

Antimicrobials:

Adverse Effects

  • Disulfiram-like reaction (severe flushing, tachycardia, hypotension) with alcohol
  • headache,
  • metallic taste
A

Metronidazole

114
Q

Antimycobacterial Drugs:

M. tuberculosis Prophylaxis

115
Q

Antimycobacterial Drugs:

M. tuberculosis Treatment

A

RIPE for Treatment:

  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
116
Q

Antimycobacterial Drugs:

M. avium–intracellulare Prophylaxis

A
  • Azithromycin
  • Rifabutin
117
Q

Antimycobacterial Drugs:

M. avium–intracellulare Treatment

A
  • Azithromycin or Clarithromycin + Ethambutol
  • can add Rifabutin or Ciprofloxacin

*More drug resistant than M. tuberculosis

118
Q

Antimycobacterial Drugs:

M. leprae Prophylaxis

119
Q

Antimycobacterial Drugs:

M. leprae Treatment

A
  • Tuberculoid
    • long-term treatment
    • Dapsone
    • Rifampin
  • Lepromatous
    • add Clofazimine
120
Q

Mycobacterial Cell

121
Q

Rifamycins

A
  • Rifampin
  • Rifabutin
122
Q

Antimicrobials:

Adverse Effects

inhibit DNA-dependent RNA polymerase

A

Rifamycins

  • Rifampin
  • Rifabutin

Rifampin’s 4 R’s:

  • RNA polymerase inhibitor
  • Ramps up microsomal cytochrome P-450
  • Red/orange body fluids
  • Rapid resistance if used alone
123
Q

Antimicrobials:

Clinical Use

  • Mycobacterium tuberculosis
  • delay resistance to Dapsone when used for leprosy
  • used for meningococcal prophylaxis and chemoprophylaxis in contacts of children with H. influenzae type b
A

Rifamycins

  • Rifampin
  • Rifabutin
124
Q

Antimicrobials:

Adverse Effects

  • minor hepatotoxicity and drug interactions (↑ cytochrome P-450)
  • orange body fluids (nonhazardous side effect)
A

Rifamycins

  • Rifampin
  • Rifabutin—favored in patients with HIV infection due to less cytochrome P-450 stimulation

Rifampin’s 4 R’s:

  • RNA polymerase inhibitor
  • Ramps up microsomal cytochrome P-450
  • Red/orange body fluids
  • Rapid resistance if used alone

Rifampin ramps up cytochrome P-450, but rifabutin does not.

125
Q

Antimicrobials:

Resistance

  • mutations reduce drug binding to RNA polymerase
  • monotherapy rapidly leads to resistance
A

Rifamycins

  • Rifampin
  • Rifabutin

Rifampin’s 4 R’s:

  • RNA polymerase inhibitor
  • Ramps up microsomal cytochrome P-450
  • Red/orange body fluids
  • Rapid resistance if used alone
126
Q

Antimicrobials:

Mechanism of Action

  • ↓ synthesis of mycolic acids
  • bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite
127
Q

Antimicrobials:

Clinical Use

  • Mycobacterium tuberculosis
  • the only agent used as solo prophylaxis against TB
  • also used as monotherapy for latent TB
  • different half-lives in fast vs. slow acetylators
128
Q

Antimicrobials:

Adverse Effects

  • hepatotoxicity
  • P-450 inhibition
  • drug-induced SLE
  • anion gap metabolic acidosis
  • vitamin B6 deficiency (peripheral neuropathy, sideroblastic anemia)
  • administer with Pyridoxine (B6)
A

Isoniazid

INH Injures Neurons and Hepatocytes.

129
Q

Antimicrobials:

Resistance

  • mutations leading to underexpression of KatG
130
Q

Antimicrobials:

Mechanism of Action

  • uncertain
  • a prodrug that is converted to the active compound Pyrazinoic acid
  • works best at acidic pH (eg. in host phagolysosomes)
A

Pyrazinamide

131
Q

Antimicrobials:

Adverse Effects

  • hyperuricemia
  • hepatotoxicity
A

Pyrazinamide

132
Q

Antimicrobials:

Mechanism of Action

  • ↓ carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase
A

Ethambutol

133
Q

Antimicrobials:

Adverse Effects

  • optic neuropathy (red-green color blindness)
A

Ethambutol

Eyethambutol

134
Q

Antimicrobials:

Mechanism of Action

  • interferes with 30S component of ribosome
A

Streptomycin

135
Q

Antimicrobials:

Adverse Effects

  • tinnitus
  • vertigo
  • ataxia
  • nephrotoxicity
A

Streptomycin

136
Q

Antimicrobials:

Clinical Use

  • Mycobacterium tuberculosis
A
  • Pyrazinamide
  • Ethambutol
  • Streptomycin (2nd line)
137
Q

Antimicrobial Prophylaxis:

high risk for endocarditis and undergoing surgical or dental procedures

A

Amoxicillin

138
Q

Antimicrobial Prophylaxis:

exposure to gonorrhea

A

Ceftriaxone

139
Q

Antimicrobial Prophylaxis:

history of recurrent UTIs

140
Q

Antimicrobial Prophylaxis:

exposure to meningococcal infection

A
  • Ceftriaxone
  • Ciprofloxacin
  • Rifampin
141
Q

Antimicrobial Prophylaxis:

pregnant woman carrying group B strep

A
  • Penicillin G
  • Ampicillin
142
Q

Antimicrobial Prophylaxis:

prevention of gonococcal conjunctivitis in newborn

A

Erythromycin eye ointment

143
Q

Antimicrobial Prophylaxis:

prevention of postsurgical infection due to S. aureus

144
Q

Antimicrobial Prophylaxis:

prophylaxis of strep pharyngitis in child with prior rheumatic fever

A
  • Benzathine Penicillin G
  • Oral Penicillin V
145
Q

Antimicrobial Prophylaxis:

exposure to syphilis

A

Benzathine Penicillin G

146
Q

Prophylaxis in HIV patients:

  • CD4 < 200 cells/mm3
  • Pneumocystis pneumonia
147
Q

Prophylaxis in HIV patients:

  • CD4 < 100 cells/mm3
  • Pneumocystis pneumonia
  • Toxoplasmosis
148
Q

Prophylaxis in HIV patients:

  • CD4 < 50 cells/mm3
  • Mycobacterium avium Complex
A
  • Azithromycin
  • Clarithromycin
149
Q

Treatment of Highly Resistant Bacteria:

MRSA

A
  • Vancomycin
  • Daptomycin
  • Linezolid
  • Tigecycline
  • Ceftaroline
  • Doxycycline
150
Q

Treatment of Highly Resistant Bacteria:

VRE

A
  • Linezolid
  • Streptogramins (Quinupristin, Dalfopristin)
151
Q

Treatment of Highly Resistant Bacteria:

Multidrug-Resistant P. aeruginosa

A
  • Polymyxin B
  • Polymyxin E (Colistin)
152
Q

Treatment of Highly Resistant Bacteria:

Multidrug-Resistant Acinetobacter baumannii

A
  • Polymyxin B
  • Polymyxin E (Colistin)
153
Q

Antifungal Therapy

154
Q

Antimicrobials:

Mechanism of Action

  • binds ergosterol (unique to fungi)
  • forms membrane pores that allow leakage of electrolytes
A

Amphotericin B

Amphotericin “tears” holes in the fungal membrane by forming pores.

155
Q

Antimicrobials:

Clinical Use

  • serious, systemic mycoses
  • Cryptococcus (amphotericin B with/without flucytosine for cryptococcal meningitis)
  • Blastomyces
  • Coccidioides
  • Histoplasma
  • Candida
  • Mucor
  • intrathecally for fungal meningitis
  • supplement K+ and Mg2+ because of altered renal tubule permeability
A

Amphotericin B

156
Q

Antimicrobials:

Adverse Effects

  • fever/chills (“shake and bake”)
  • hypotension
  • nephrotoxicity
  • arrhythmias
  • anemia
  • IV phlebitis
  • hydration ↓ nephrotoxicity
  • liposomal form ↓ toxicity
A

Amphotericin B

157
Q

Antimicrobials:

Mechanism of Action

  • same as Amphotericin B
  • topical use only as too toxic for systemic use
158
Q

Antimicrobials:

Clinical Use

  • “swish and swallow” for oral candidiasis (thrush)
  • topical for diaper rash or vaginal candidiasis
159
Q

Antimicrobials:

Mechanism of Action

  • inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase
A

Flucytosine

160
Q

Antimicrobials:

Clinical Use

  • systemic fungal infections (especially meningitis caused by Cryptococcus) in combination with amphotericin B
A

Flucytosine

161
Q

Antimicrobials:

Adverse Effects

  • bone marrow suppression
A

Flucytosine

162
Q

Azoles

A
  • Clotrimazole
  • Fluconazole
  • Isavuconazole
  • Itraconazole
  • Ketoconazole
  • Miconazole
  • Voriconazole
163
Q

Antimicrobials:

Mechanism of Action

  • inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P-450 enzyme that converts lanosterol to ergosterol
164
Q

Antimicrobials:

Clinical Use

  • local and less serious systemic mycoses
165
Q

Antimicrobials:

Clinical Use

  • for chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types
A

Fluconazole

166
Q

Antimicrobials:

Clinical Use

  • Blastomyces
  • Coccidioides
  • Histoplasma
A

Itraconazole

167
Q

Antimicrobials:

Clinical Use

  • topical fungal infections
A
  • Clotrimazole
  • Miconazole
168
Q

Antimicrobials:

Clinical Use

  • Aspergillus
  • Candida
A

Voriconazole

169
Q

Antimicrobials:

Clinical Use

  • Aspergillus
  • Mucor
A

Isavuconazole

170
Q

Antimicrobials:

Adverse Effects

  • testosterone synthesis inhibition (gynecomastia)
  • liver dysfunction (inhibits cytochrome P-450)
A

Azoles

Ketoconazole—gynecomastia

171
Q

Antimicrobials:

Mechanism of Action

  • inhibits the fungal enzyme squalene epoxidase
A

Terbinafine

172
Q

Antimicrobials:

Clinical Use

  • dermatophytoses (especially onychomycosis—fungal infection of finger or toe nails)
A

Terbinafine

173
Q

Antimicrobials:

Adverse Effects

  • GI upset
  • headaches
  • hepatotoxicity
  • taste disturbance
A

Terbinafine

174
Q

Echinocandins

A
  • Anidulafungin
  • Caspofungin
  • Micafungin
175
Q

Antimicrobials:

Mechanism of Action

  • inhibit cell wall synthesis by inhibiting synthesis of β-glucan
A

Echinocandins

  • Anidulafungin
  • Caspofungin
  • Micafungin
176
Q

Antimicrobials:

Clinical Use

  • invasive aspergillosis
  • Candida
A

Echinocandins

  • Anidulafungin
  • Caspofungin
  • Micafungin
177
Q

Antimicrobials:

Adverse Effects

  • GI upset
  • flushing (by histamine release)
A

Echinocandins

  • Anidulafungin
  • Caspofungin
  • Micafungin
178
Q

Antimicrobials:

Mechanism of Action

  • interferes with microtubule function
  • disrupts mitosis
  • deposits in keratin-containing tissues (eg. nails)
A

Griseofulvin

179
Q

Antimicrobials:

Clinical Use

  • oral treatment of superficial infections
  • inhibits growth of dermatophytes (tinea, ringworm)
A

Griseofulvin

180
Q

Antimicrobials:

Adverse Effects

  • teratogenic
  • carcinogenic
  • confusion
  • headaches
  • disulfiram-like reaction
  • ↑ cytochrome P-450 and warfarin metabolism
A

Griseofulvin

181
Q

Antiprotozoal Therapy:

Toxoplasmosis

A

Pyrimethamine

182
Q

Antiprotozoal Therapy:

Trypanosoma brucei

A
  • Suramin
  • Melarsoprol
183
Q

Antiprotozoal Therapy:

Trypanosoma cruzi

A

Nifurtimox

184
Q

Antiprotozoal Therapy:

Leishmaniasis

A

Sodium Stibogluconate

185
Q

Anti-Mite/Louse Therapy

A
  • Permethrin
    • ​inhibits Na+ channel deactivation → neuronal membrane depolarization)
  • Malathion
    • acetylcholinesterase inhibitor
  • Lindane
    • blocks GABA channels → neurotoxicity

*used to treat scabies (Sarcoptes scabiei) and lice (Pediculus and Pthirus)

Treat PML (Pesty Mites and Lice) with PML (Permethrin, Malathion, Lindane), because they NAG you (Na, AChE, GABA blockade).

186
Q

Antimicrobials:

Mechanism of Action

  • blocks detoxification of heme into hemozoin
  • heme accumulates and is toxic to plasmodia
A

Chloroquine

187
Q

Antimicrobials:

Clinical Use

  • treatment of plasmodial species other than P. falciparum (frequency of resistance is too high)
  • resistance due to membrane pump that ↓ intracellular concentration of drug
A

Chloroquine

188
Q

Antimicrobials:

Adverse Effects

  • retinopathy
  • pruritus (especially in dark-skinned individuals)
A

Chloroquine

189
Q

Antimicrobials:

Clinical Use

  • P. falciparum
A
  • Artemether/Lumefantrine
  • Atovaquone/Proguanil
190
Q

Antimicrobials:

Clinical Use

  • life-threatening malaria
A
  • Quinidine—US
  • Quinine
  • Artesunate
191
Q

Antihelminthic Therapy

A

Helminths get PIMP’D.

  • Pyrantel pamoate
  • Ivermectin
  • Mebendazole (microtubule inhibitor)
  • Praziquantel
  • Diethylcarbamazine.
192
Q

Antiviral Therapy

193
Q

Antimicrobials:

Mechanism of Action

  • inhibit influenza neuraminidase → ↓ release of progeny virus
A
  • Oseltamivir
  • Zanamivir
194
Q

Antimicrobials:

Clinical Use

  • treatment and prevention of both influenza A and B
  • beginning therapy within 48 hours of symptom onset may shorten duration of illness
A
  • Oseltamivir
  • Zanamivir
195
Q

Antimicrobials:

Mechanism of Action

  • guanosine analogs
  • monophosphorylated by HSV/VZV thymidine kinase and not phosphorylated in uninfected cells → few adverse effects
  • triphosphate formed by cellular enzymes
  • preferentially inhibit viral DNA polymerase by chain termination
A
  • Acyclovir
  • Famciclovir
  • Valacyclovir
196
Q

Antimicrobials:

Clinical Use

  • HSV and VZV
  • weak activity against EBV
  • no activity against CMV
  • used for HSV-induced mucocutaneous and genital lesions as well as for encephalitis
  • prophylaxis in immunocompromised patients
  • no effect on latent forms of HSV and VZV
A
  • Acyclovir
  • Famciclovir—herpes zoster
  • Valacyclovir—prodrug of acyclovir, better oral bioavailability
197
Q

Antimicrobials:

Adverse Effects

  • obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
A
  • Acyclovir
  • Famciclovir
  • Valacyclovir
198
Q

Antimicrobials:

Resistance

  • mutated viral thymidine kinase
A
  • Acyclovir
  • Famciclovir
  • Valacyclovir
199
Q

Antimicrobials:

Mechanism of Action

  • 5′-monophosphate formed by a CMV viral kinase
  • Guanosine analog
  • triphosphate formed by cellular kinases
  • preferentially inhibits viral DNA polymerase
A

Ganciclovir

200
Q

Antimicrobials:

Clinical Use

  • CMV
  • immunocompromised patients
A

Ganciclovir

*Valganciclovir—prodrug of ganciclovir, better oral bioavailability

201
Q

Antimicrobials:

Adverse Effects

  • bone marrow suppression (leukopenia, neutropenia, thrombocytopenia)
  • renal toxicity
  • more toxic to host enzymes than acyclovir
A

Ganciclovir

202
Q

Antimicrobials:

Resistance

  • mutated viral kinase
A

Ganciclovir

203
Q

Antimicrobials:

Mechanism of Action

  • Pyrofosphate analog
  • viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor
  • binds to pyrophosphate-binding site of enzyme
  • does not require any kinase activation
A

Foscarnet

Foscarnet = pyrofosphate analog

204
Q

Antimicrobials:

Clinical Use

  • CMV retinitis in immunocompromised patients when Ganciclovir fails
  • Acyclovir-resistant HSV
205
Q

Antimicrobials:

Adverse Effects

  • nephrotoxicity
  • electrolyte abnormalities (hypo- or hypercalcemia, hypo- or hyperphosphatemia, hypokalemia, hypomagnesemia) can lead to seizures
206
Q

Antimicrobials:

Resistance

  • mutated DNA polymerase
207
Q

Antimicrobials:

Mechanism of Action

  • preferentially inhibits viral DNA polymerase
  • does not require phosphorylation by viral kinase
208
Q

Antimicrobials:

Clinical Use

  • CMV retinitis in immunocompromised patients
  • Acyclovir-resistant HSV
  • long half-life
209
Q

Antimicrobials:

Adverse Effects

  • nephrotoxicity (coadminister with probenecid and IV saline to ↓ toxicity)
210
Q

HIV Therapy

A

Highly Active Antiretroviral Therapy (HAART)

*often initiated at the time of HIV diagnosis

211
Q

Strongest Indication for HAART

A
  • low CD4+ cell counts (< 500 cells/mm3)
  • high viral load
212
Q

Highly Active Antiretroviral Therapy (HAART) regimen consists of _____.

A

3 drugs to prevent resistance

  • 2 NRTIs
  • an integrase inhibitor
213
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

A
  • Abacavir (ABC)
  • Didanosine (ddI)
  • Emtricitabine (FTC)
  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Tenofovir (TDF)
  • Zidovudine (ZDV, formerly AZT)
214
Q

HIV Therapy:

  • competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (lack a 3′ OH group)
  • need to be phosphorylated to be active
A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Tenofovir is a nucleoTide; the others are nucleosides.

215
Q

HIV Therapy:

can be used for general prophylaxis and during pregnancy to ↓ risk of fetal transmission

A

Zidovudine (ZDV, formerly AZT)

216
Q

HIV Therapy:

  • bone marrow suppression (can be reversed with granulocyte colony-stimulating factor [G-CSF] and erythropoietin)
  • peripheral neuropathy
  • lactic acidosis (nucleosides)
  • anemia (ZDV)
  • pancreatitis (Didanosine)
A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

217
Q

HIV Therapy:

contraindicated if patient has HLA-B*5701 mutation due to ↑ risk of hypersensitivit

218
Q

Non-Nucleoside Reverse-Transcriptase Inhibitors (NNRTIs)

A
  • Delavirdine
  • Efavirenz
  • Nevirapine
219
Q

HIV Therapy:

  • bind to reverse transcriptase at site different from NRTIs
  • do not require phosphorylation to be active or compete with nucleotides
  • rash and hepatotoxicity are common
A

Non-Nucleoside Reverse-Transcriptase Inhibitors (NNRTIs)

220
Q

HIV Therapy:

vivid dreams and CNS symptoms are commo

221
Q

HIV Therapy:

NNRTIs contraindicated in pregnancy

A
  • Delavirdine
  • Efavirenz
222
Q

Protease Inhibitors

A
  • Atazanavir
  • Darunavir
  • Fosamprenavir
  • Indinavir
  • Lopinavir
  • Ritonavir
  • Saquinavir

Navir (never) tease a protease.

223
Q

HIV Therapy:

  • assembly of virions depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV mRNA into their functional parts
  • prevent maturation of new viruses
  • hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy (Cushing-like syndrome)
A

Protease Inhibitors

224
Q

HIV Therapy:

can “boost” other drug concentrations by inhibiting cytochrome P-450

225
Q

HIV Therapy:

  • nephropathy
  • hematuria
  • thrombocytopenia
226
Q

HIV Therapy:

  • potent CYP/UGT inducer
  • reduces protease inhibitor concentrations
A

Rifampin

*use rifabutin instead

227
Q

Integrase Inhibitors

A
  • Dolutegravir
  • Elvitegravir
  • Raltegravir
228
Q

HIV Therapy:

  • inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase
  • ↑ creatine kinase
A

Integrase Inhibitors

229
Q

Fusion Inhibitors

A
  • Enfuvirtide
  • Maraviroc
230
Q

HIV Therapy:

  • binds gp41, inhibiting viral entry
  • skin reaction at injection sites
A

Enfuvirtide

Enfuvirtide inhibits fusion.

231
Q

HIV Therapy:

  • binds CCR-5 on surface of T cells/monocytes
  • inhibits interaction with gp120
A

Maraviroc

Maraviroc inhibits docking.

232
Q

Antimicrobials:

Mechanism of Action

  • glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of antiviral and antitumoral properties
A

Interferons

233
Q

Antimicrobials:

Clinical Use

  • chronic HBV and HVC
  • Kaposi sarcoma
  • hairy cell leukemia
  • condyloma acuminatum
  • renal cell carcinoma
  • malignant melanoma
  • multiple sclerosis
  • chronic granulomatous disease
A

Interferons

234
Q

Antimicrobials:

Adverse Effects

  • flu-like symptoms
  • depression
  • neutropenia
  • myopathy
A

Interferons

235
Q

Antimicrobials:

  • Hepatitis C
  • viral phosphoprotein (NS5A) inhibitor
  • NS5A plays important role in replication
A

Ledipasvir

236
Q

Antimicrobials:

  • Hepatitis C
  • inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
  • hemolytic anemia
  • severe teratogen
237
Q

Antimicrobials:

  • Hepatitis C
  • HCV protease (NS3/4A)
  • prevents viral replication
  • photosensitivity reactions
  • rash
A

Simeprevir

238
Q

Antimicrobials:

  • Hepatitis C
  • inhibits HCV RNA-dependent RNA polymerase (NS5B) acting as a chain terminator
  • fatigue
  • headache
  • nausea
A

Sofosbuvir

239
Q

_____ is the reduction of pathogenic organism counts to safe levels.

A

Disinfection

240
Q

_____ the inactivation of all microbes including spores.

A

Sterilization

241
Q

Disinfection and Sterilization:

  • pressurized steam at > 120°C
  • sporicidal
  • may not reliably inactivate prions
242
Q

Disinfection and Sterilization:

  • denature proteins and disrupt cell membranes
  • not sporicidal
A
  • Alcohols
  • Chlorhexidine
243
Q

Disinfection and Sterilization:

  • oxidizes and denatures proteins
  • sporicidal
244
Q

Disinfection and Sterilization:

  • free radical oxidation
  • sporicidal
A

Hydrogen Peroxide

245
Q

Disinfection and Sterilization:

  • halogenation of DNA, RNA, and proteins
  • may be sporicidal
A
  • Iodine
  • Iodophors
246
Q

Disinfection and Sterilization:

  • impair permeability of cell membranes
  • not sporicidal
A

Quaternary Amines

247
Q

Antimicrobials to Avoid in Pregnancy

A

Take Really Good Care to keep Children SAFe.

  • Tetracyclines
  • Ribavirin
  • Griseofulvin
  • Chloramphenicol
  • Clarithromycin
  • Sulfonamides
  • Aminoglycosides
  • Fluoroquinolones
248
Q

Antimicrobials to Avoid in Pregnancy:

  • discolored teeth
  • inhibition of bone growth
A

Tetracyclines

249
Q

Antimicrobials to Avoid in Pregnancy:

teratogenic

A
  • Ribavirin
  • Griseofulvin
250
Q

Antimicrobials to Avoid in Pregnancy:

Gray Baby Syndrome

A

Chloramphenicol

251
Q

Antimicrobials to Avoid in Pregnancy:

embryotoxic

A

Clarithromycin

252
Q

Antimicrobials to Avoid in Pregnancy:

kernicterus

A

Sulfonamides

253
Q

Antimicrobials to Avoid in Pregnancy:

ototoxicity

A

Aminoglycosides

254
Q

Antimicrobials to Avoid in Pregnancy:

cartilage damage

A

Fluoroquinolones

USMLE Step 1 (18 decks)

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