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Unit 1 ID+LC > Antimicrobials II > Flashcards

Antimicrobials II Flashcards

1
Q

Which drugs are eliminated Hepatically?

A

CCRIMES

Clindamycin
Chloramphenicol

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2
Q

Which drugs inhibit folic acid metabolism? List exact enzymes that they target.

A
  1. Trimethoprim
    - Inhibits bacterial dihydrofolate reductase
  2. Sulfonamides
    - PABA antimetabolites inhibit dihydropteroate synthase

*Useful bc humans dont have DHPS or synthesize folic acid so these drugs have selective toxicity

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3
Q

PABA

  • what is it
  • steps used to make folic acid out of it
A

Para-aminobenzoic acid (PABA) is critical in folic acid metabolism (paired with Pteridine)

PABA + Pteridine --> 
(Dihydropteroate synthase) --> Dihydropteroic acid --> 
Dihydrofolic acid -->
(Dihydrofolate reductase) -->
THF --> DNA, RNA, Proteins
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4
Q

Which intermediate acting sulfonamide is used in conjunction with trimethoprim?
When is this combo used?

A

Sulfamethoxazole

used in combo in UTIs, Shigella, Salmonella, Pneumocystis jirovecii, toxoplasmosis prophylaxis

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5
Q

Toxicity of Trimethoprim (TMP)

A
  1. Megaloblastic anemia
  2. Leukopenia
  3. Granulocytopenia

(TMP Treats Marrow Poorly)
- can give supp folinic acid

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6
Q

Toxicity of sulfonamides

A
  1. Hypersensitivity rxns
    - photosensitivity
    - exfoliative dermatitis
    - serum sickness
  2. Hemolysis if G6PD deficient
    - hemolytic anemia
    - agranulocytosis,
    - aplastic anemia
  3. Nephrotoxicity
    - AIDS
  4. Kernicterus in infants (bilirubin induced brain dmg)
  5. DDI with oral anticoags (warfarin)
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7
Q

CLinical uses of sulfonamides

A

Not used alone very much anymore

Broad spectrum

  1. Nocardia (in combo with macrolides or streptomycin(AG))
  2. Chlamydia
  3. SImple UTI
  4. MRSA
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8
Q

DNA metabolism inhibitors.

List their targets

A
  1. Flouroquinolones (-floxacins)
    - Inhibit topoisomerase (DNA gyrase)
  2. Metronidazole
    - damages DNA
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9
Q

How are FQ selectively toxic?

A

Humans dont have gyrase (topoiso II)

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10
Q

What drug should you avoid if you take antacids? This drug will also increase CNS stimulation (seizure risk) if taken with NSAIDS.

A

FQs since antacids reduce oral absorption

Oflox-Levo (95%) > Cipro > Nor (50%)

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11
Q

Clinical use of FQ (187)

A

GNR of urinary and GI tracts (including pseudomonas),
Neisseria,
some GP organisms

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12
Q

Toxicity of FQ (187)

A 
GI upset
CNS dist (HA, Dizzi)
Superinfxns
Skin rash
\_\_\_\_\_\_\_\_\_
Leg cramp/ myalgias (uncommon)
Tendonitis, tendon rupture
*FQuinoLONES hurt attachments to your BONES*

Do not give to preg women or children

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13
Q

Metronidazole MOA

A

Degrades DNA
- forms toxic free radical metabolites in bacterial cell and damages DNA

  • M in criMes
  • renally excreted
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14
Q

toxicity of Metronidazole

A

Disulfiram-like rxn with alcohol

  • severe flushing
  • tachycardia
  • hypotension

HA
Metallic taste
Superinfection

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15
Q

How to treat pseudomembranous colitis if vancomycin doesnt work?

A

Metronidazole

C. diff overgrowth due to clindamycin

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16
Q

Clinical use for Metronidazole (187)

A

GET GAP on the Metro!

Giardia
Entamoeba
Trichomonas
Garderella vaginalis
Anaerobes (Bacteroides, C. diff)
h. Pylori
17
Q

Tx for H. pylori

A

triple therapy

  1. Metronidazole
  2. PPI
  3. Clarithromycin
18
Q

Nitrofurantoin
MOA
Clinical use

A

Urinary antiseptic that targets bacterial DNA

Use:

  1. UTIs (E.coli, enterococci)
  2. Usage increasing due to resistance to TMP/SMX
  3. UTIs in pts allergic to sulfa drugs
19
Q

Cell membrane disrupter

  • MOA
  • Toxicity
A

Polymyxin B,

  • lyse GRAM (-) phospholipids (like detergent)
  • highly nephrotoxic
  • Used for pseudomonas meningitis after other Abs have failed

Daptomycin

  • inhibit cell wall peptidoglycan form. by binding D-ala D-ala (like vanc) and kills GRAM (+)
  • rare eosinophilic pneumonia
  • used for gram + that are resistent to methicilin, vanco, linezolid
20
Q

What drug is used for pseudomonas meningitis after other Abs have failed?

A

Polymyxins

21
Q

Bactericidal agents (7)

A
  1. PCN
  2. Cephalosporins
  3. Vancomycin
  4. AG
  5. GQ
  6. Rifampin
  7. Polymyxins, daptomycin

*cidal agents are best for severe infxns

22
Q

Bacteriostatic agents (6)

A
  1. Sulfonamides
  2. Trimethoprim
  3. TCN
  4. Macrolides
  5. Clindamycin
  6. Chloramphenicol

*cidal agents are best for severe infxns

Unit 1 ID+LC (32 decks)

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