Exam 4 Flashcards
Is peptidolgycan in gram-negative gram-positive or both?
both
What are the four β-lactam drugs? Cidal or static?
penicillin/cephalosporin/monobactams/carbapenems
-cidal
What is the main adverse effect of the penicillins?
hypersensitivity
What is the main β-lactamase inhibitor?
Clavulanic acid
What two drugs are contained in augmentin?
amoxicillin and clavulonic acid
What is the main adverse effect of cephalosporins?
hypersensitivity
Which two antibiotics can have disulfarim effects?
metronidazole and cephalosporins
Is Aztreonam effective against gram positives or gram negatives?
Negative
What is the only monobactam? What is notable about this drug? Susceptible to β-lactamase?
Aztreonam
enters CSF
no
What is the main adverse effect of Aztreonam?
hypersensitivity
Can Carbapenems penetrate the CNS?
yes
Which β-lactam is resistant to β-lactamase?
Carbapenems
What other drug is imipenem administered with? Why?
cilastatin
to prevent renal clearance
Can carbapenems penetrate the CSF?
yes
What is the main adverse effect of carbapenems?
GI issues
What amino acid sequence is vancomycin specific for?
D-ala-D-ala
What are the three toxicities of vancomycin?
oto
nephro
redman
What is the MOA of bacitracin? What two types of applications is bacitracin found? Gram negative, positives of both?
prevent incorporation of amino acids into cell wall
topical and ophthalmic
both
What is the MOA of fosfomycin?
prevent synthesis of UDP-N-acetylmuramic acid
What condition is fosfomycin commonly used to treat?
UTIs
What step of protein synthesis do aminoglycosides inhibit?
initiation complex
What drug class are aminoglycosides often used in combination with? To treat what?
β-lactam
gram-negative infections
What ribosomal subunit to aminoglycosides bind?
30S
What are the two most common toxicities of aminoglycosides?
nephrotoxic
ototoxic
What ribosomal subunit do macrolides bind? What step do they block?
50s
translocation to P-site
What are the three macrolides we have to know for this test?
Erythromycin
Clarithromycin
Azithromycin
What is the main adverse effect of macrolides?
GI issues
What ribosomal subunit do tetracyclines bind? What step do they block?
30S
binding of tRNA to A-site
What are the two main adverse effects of tetracyclines?
sequester calcium
photosensitivity
What is the main use of clindamycin?
soft tissue infections causes by staph or strep
What ribosomal subunit does clindamycin bind?
50S
inhibit translocation to P-site
What are the two MOAs of clindamycin?
prevent binding to A site
prevent peptide elongation
According to Henry, what two serious infections is chloramphenical reserved for?
RMSF and Typhus
Which ribosomal subunit does chloramphenicol bind? Which step of protein synthesis is blocked?
50S
blocks peptidyl elogation
What are the two toxicities of chloramphenicol? Why?
myelosuppression
Gray Baby Syndrome –> lack of glucoronidation
Which ribosomal subunit does Linezolid bind? What is the MOA of linezolid?
50S
prevent formation of bond between ribosome and fMet-tRNA
What antibiotic that interferes with protein synthesis is reserved for severe infections?
Linezolid
What is the toxicity of Linezolid?
myelosuppression
What enzyme do sulfonamides inhibit? What intermediate do they compete with?
Dihydropterate Synthase
PABA
What product do sulfonamides interfere with the synthesis of?
Dihydrofolate
What is the main adverse effect of sulfonamides? What are the three sulfonamide antibiotics?
photosensitivity
Sulfadiazine/sulfamethoxazole/sulfamethizole
What drug functions like trimethoprim? What is the MOA of these drugs?
Pyrimethamine
interfere with bacterial DHFR
What are the two main uses for TMP/SMX?
UTI
prostatitis
Are fluoroquinolones successful against gram negatives, positives or both?
both
What is the MOA of fluoroquinolones?
inhibit topo. II
What are the three main side effects of fluoroquinolones?
GI disturbances
QT prolongation
bind divalent cations
What is the MOA of daptomycin?
depolarizes bacterial cell membrane
Is daptomycin effectvie against gram-positives or gram-negatives?
gram-positives
What organ is effected by Daptomycin?
skeletal muscles
What is the MOA of polymyxin B?
detergent
Is polymyxin B effective against gram positives or gram negatives?
gram negatives
What component of the cell membrane does Polymyxin B bind to particularly well?
LPS
What two drugs are sued to treat an uncomplicated skin infection? What if there is an allergy?
Penicillin or 1st gen. cephalosporin
vanc. or clindamycin
What two drugs are used to treat a skin infection if it is complicated?
penicillin + lactamse inhibitor
What three drugs are used to treat MRSA?
Vancomycin
Linezolid
Daptomycin
What three drugs are used to treat osteomyelitis empirically?
vancomycin
ceftriaxone
cefepime
What is used to treat osteomyelitis in surgeries?
penicillin + lactamse inhibitors
What drug is used to treat septic arthritis empirically?
ceftriaxone
Which antibiotic works well on adherent bacteria especially in a joint?
Rifampin
What drug is used to treat acute sinusitis?
augmentin
What two drugs are used to treat pharyngitis?
penicillin or amoxicillin
What drug is used to treat community acquired pneumonia?
macrolide
What two drugs are used to treat hospital acquired pneumonia?
β-lactam (+) macroldie
What two drugs are used to treat MRSA pneumonia?
vancomycin and linezolid
What drug is used to treat ventilator associated pneumonia?
ceftriaxone
What drug combination is used to treat cystitis?
TMP/SMX
What drug combination is used to treat pyelonephritis? In the kidney?
TMP/SMX
Fluroquinolone
What drug is used to treat complicated UTI and prostatitis?
Fluroquinolone
What two drugs are used to treat intra-abdominal infections?
Ticeracillin and clavulunate
What drug combination is used to treat bacterial meningitis?
ceftriaxone/cefotaxime + vanc.
What drug combination is used to treat neonatal meningitis?
ampicillin + cephalosporin + gentamicin
What drug combination is used to treat sepsis?
cefepime + vancomycin
What drug combination is used to treat endocarditis?
ceftriaxone + vancomycin
What drug combination is used to treat fever and neutropenia?
ciprofloxacin + augmentin
What three drugs are used to treat enterococci?
linezolid
daptomycin
tigecycline
What cells does TB reproduce in? Is TB dormant or active inside a granuloma?
macrophages
dormant
Is INH cidal or static? What enzyme activates INH?
-cidal
Kat G
What cells can INH penetrate?
macrophages
Is INH more effective in MTB or MAC?
MTB
What is the MOA of INH?
inhibits synthesis of mycolic acid
What enzyme activates INH?
KatG
What type of people can develop peripheral neuropathy to INH?
slow acetylators
Other than peripheral neuropathy, atients taking INH can develop what other side effect? What exacerbates this side effect?
hepatitis
alcohol
What is the MOA of rifampin? Via what protein?
inhibits bacterial RNA synthesis
DNA dependent RNA polymerase
Is rifampin cidal or static?
-cidal
Which anti-TB drug is a potent p450 enzyme inducer?
Rifampin
Which anti-TB drug is specifically used in HIV(+) individuals?
Rifabutin
Which anti-TB drug is used almost exclusively in combination with other drugs?
Pyrazinamide
Which drug is particularly effective in the acidic environment of macrophages?
Pyrazinamide
What is the main side effect of Pyrazinamide?
hyperuricemia
What is the MOA of ethambutol?
inhibits arabinosyl transferases
Which anti-TB drug is used to treat MAC?
Ethambutol
Which anti-TB drug can produce red/green color blindness?
Ethambutol
Which aminoglycoside can be used against TB?
Streptomycin
Which has greater activity against MAC, rifampin or rifabutin?
rifabutin
What is the special enzyme possessed by bacteria and protozoa that render them susceptible to metronidazole?
pyruvate:ferredoxin oxireductase
What four drugs are known for their disulfarim like activities?
metronidazole
cephalosporins
griseofulvin
procarbazine
Which three specific bugs are primarily treated by metronidazole?
trich and giardia
trophozytes entamoeba histolytica
Which two drugs are used to treat the cysts of Entamoeba?
iodoquinol or Paromomycin
What type of drug is iodoquinol? Effective against?
halogenated hydroxyquinolone
cysts and trophozites
What is the only location where iodoquinol is effective?
lumen
What is the toxicity of iodomycin? What population?
optic atrophy
kids
What type of drug is paromomycin? Effective against?
aminoglycoside
trophozite and cyst
What bug is responsible for diarrhea or HIV?
cryptosporidium parvum
What drug is used to treat C. parvum?
Nitazoxanide
What is the supposed MOA of Nitazoxanide?
interferes with PFOR
What is the Tx for P. jirovecci?
TMP/SMX
What drug combination is used for T. gondii?
Pyrimethamine/Sulfadiazine
What enzyme do Sulfonamides inhibit? This leads to a decreased production of what compound?
Dihydropterate Synthase
Folate
What two drugs belong to the class of Diaminopyrimidines?
trimethoprim and pyrimethamine
What is the MOA of pyrimethamine and trimethoprim?
inhibit DHFR
What are the two drugs used to treat toxoplasmosis?
Pyrimethamine and Sulfadiazine
What drug combination is used to treat P. jirovecii?
TMP/SMX
What are the two most common side effects of quinine? What stage?
Cinchonism and hypoglycemia
erythrocytic
Which anti-malarial is effective against all species?
Mefloquine
What is primaquine effective against?
liver stages of ovale and vivax
Patients being treated with what anti-malarial have to be first screened for G6PDase status?
Primaquine
What is the only drug effective against falciparum?
Malarone
What is artemisinin used for?
resistant species of falciparum
What are the two side effects of Benzimidazoles?
GI and CNS
When are benzimidazoles contraindicated?
pregnancy
What drug is used to treat Strongyloidiases? What is the MOA of this drug?
Ivermectin
muscle paralysis
What three organisms is praziquantel used to treat? MOA of this drug?
cestodes and flukes and cysticercosis
increase Ca2+ permeability
Does amphotericin B have good or poor CNS penetration? What is amphotericin B complexed to?
poor
deoxycholic acid
What is the main toxicity of amphotericin B?
nephrotoxic
Does amphotericin B produce vasodilation or vasoconstriction? Afferent or efferent?
vasoconstriction, afferent
What is the MOA of all azoles?
inhibit the enzyme that converts lanosterol to ergosterol
Which azole inhibits p450?
Ketoconazole
Which azole has the widest therapeutic index? What bug is fluconazole particularly good at eliminating?
Fluconazole
Candidiasis
Which drug has replaced amphotericin B as the drug of choice for disseminated aspergillosis?
Voriconazole
Which organism is almost the sole exclusive use for flucytosine?
Cryptococcus
What is the main side effect of flucytosine?
bone marrow suppression
What is the MOA of echinocandins? Which two fungi are echinocandins used to treat?
inhibit synthesis of β-glucans
Candidia and Aspergillus
What is the common suffix for all echinocandins?
-fungin
Which two anti-fungals get concentrated in the keratin? What does this mean?
Griseofulvin and terbinafine
prolonged function
What is the MOA of all Allyamines?
inhibit activity of squalene epoxidase
What class of drug is nystatin?
polyene
What enzyme activates acyclovir?
viral thymidine kinase
What is the MOA of acyclovir?
inhibits viral DNA synthase
What is the MOA of foscarnet? Requires phosphorylation?
occupies pyrophosphate site on HSV DNA polymerase
no
When is Foscarnet used?
when resistance to acyclovir is developed in HSV/CMV
What ezyme activates gangciclovir?
CMV UL97
What is the MOA of Oseltamivir?
inhibits neuroaminidase
How old do kids have to be to be given Oseltamivir?
older than 1 yr
How old does one have to be to use zanamivir?
7 years
How is zanamivir administered?
inhalation
How is Peramivir administered? MOA?
IV
Neuroaminidase inhbitor
What protein is inhibited by Amantidine and Rinantadine?
Influenza A M2
What is the function of Influenza A M2?
nucleocapsid release
What drug is used to treat RSV and HCV?
Ribavirin
What is ribavirin an analogue of?
Guanosine
What is the MOA of paritaprevir? What is the name of this protein?
inhibits HCV protease
NS3/4A
What is the MOA of Ledipasvir? What drug is Ledispavir coadministered with?
inhibits NS5A protein of HCV
Sofosbuvir
What is the MOA of ombitasvir? What two drugs is Ombitasvir combined with to treat HCV?
inhibits NS5A protein of HCV
Paritaprevir and Ritonavir
What is the MAO of sofosbuvir?
HCV RNA polymerase inhibitor
What is the MOA of dasabuvir?
non-nucleoside inhibitor of RNA polymerase
Which NRTI is associated with a life-threating allergic rxn and must be screened? What is the haplotype being screened?
Abacavir
HLA-B5707
What is Lamivudine an analogue of? How is lamivudine administered?
Cytosine
orally
What is Emtricitabine? How is emtricitabine administered?
fluorinated analogue of lamivudine
orally
What are the two advantages of Emtricitabine over Lamivudine?
increase half-life
increase bioavailability
In which four conditions is Emtricitabine contraindicated?
preg/kids/liver/renal
What is Tenofovir an analogue of? Administered?
adenosine
orally
What is Zimovudine an analogue of?
deoxythymidine
What are the two NNRTIs?
Nevirapine and Efavirenz
What is the most severe rxn of NNRTIs?
Steven Johnson Syndrome
How is Efavirenz administered?
orally
Which NNRTI induces p450?
Efavirenz
Which protease inhibitors p450?
Atazanavir and Rotinavir
Which protease inhibitor is used as a booster? Which requires acid for absorption?
ritonavir
Atazanavir
When is Darunavir used? Route of administration?
protease resistant viruses
oral
What is the MOA of maraviroc? Route of administration? Screening required?
CCR5 antagonist
oral
CCR5 tropism
What is the MOA of Enfuvirtide?
fusion inhibitor
What is the only anti-retro viral administered parenterally?
Enfuvirtide
When are the two indications for the use of Enfurvitide?
experienced patients
patients with HIV replication in the presence of ART
What is the MOA of Raltegravir?
integrase inhibitor
What is the MOA of Elvitegravir? What drug does this need to be coadministered with?
integrase inhibitor
cobicistat
What is the MOA of Dolutegravir?
integrase inhibitor
What are the two combinations of ARV therapies?
one integrase inhibitor + two NRTIs
one protease inhibitor + two NRTIs
How is resistance to daptomycin generated? Which amino acid?
addition of positive charge to membrane
Lysine
How is resistance to tetracyclines generated?
efflux pump
How is resistance against metronidazole generated?
mutations in activating enzyme
How is resistance generated against aminoglycosides?
chemical modification of the antibiotic
Which two classes of drugs are susceptible to β-lactamases?
penicillins and cephalosporins
What enzyme is inhibited by TMP?
DHFR
What enzyme is inhibited by Sulfonamides?
Dihydropterate Synthase
What is high dose aspirin used for?
anti-inflammatory
What is low dose aspirin used for?
anti-pyretic
analgesic
What property does acetominophen not possess?
anti-inflammatory
What two properties does acetominophen possess?
anti-pyretic and analgesic
What receptor does Capsaicin activate?
Vanilloid
What does prolonged activation of the vanilloid receptor cause?
decrease release of substance P
What drug do NSAIDs inhibit the activity of?
diuretics
Which NSAID is used to treat gout?
indomethacin
How does colchicine aid in the treatment of gout?
inhibits Neutrophil migration
What is the most severe side-effect of colchicine?
diarrhea
What are the two Xanthine Oxidase Inhibitors?
Allopurinol
Febuxostat
What drug acts like probenecid?
Sulfipyrazone
What generations of cephalosporin enters the CNS?
3rd and 4th
What antibiotic does not penetrate the CNS?
vancomycin
Are aminoglycosides cidal at low or high concentrations?
high
What drug class does Amikacin belong to?
Aminoglycoside
What two species are found in MAC?
avium and intracellularle
How is MAC transmitted?
ingestion of contaminated food or water
Which form of TB is Isoniazid not particularly useful for?
MAC
What other bug is Rifampin useful for?
Chlamydia
What is pyrayinamide an analogue of?
nicotinamide
What does Brittingham say the toxicity of Ethambutol is?
hyperuricemia
What three drugs are used to treat MAC?
Macrolide
Rifampin
Ethambutol
What two drugs are used for MAC prophylaxis in HIV patients?
clathiromycin or azithromycin
What three drugs are used to treat Leprosy?
dapsone
rifampin
clofazime
What is dapsone an analogue of? What does dapsone inhibit the synthesis of?
PABA
folate
Which anti-TB drug can exacerbate the hemolytic anemia of G6PDase deficiency?
Dapsone
Which antibiotic is effective against malaria? What is the side effect of the drug?
Doxycycline
photosensitivity
What is the drug of choice for pinworm? MOA of this drug?
Pyrantel Pamoate
nAchR depolarizing agent
Where does Sporotrix schenkii come from?
rose bushes
According to Brittingham, what are the four dimorphic fungi?
Histoplasma
Blastomycoses
Coccidiodes
Sporotrix
What are the two polyenes?
Amphotericin B
Nystatin
What is the common suffix for all azoles?
-conazole
What is the common suffix for all echinocandins?
-fungin
What does Amphotericin B bind?
ergosterol
Which fungi is posaconazole particularly effective at treating?
Aspergillus
What are the two allyamines?
Terbiniafine
naftifine
Which yeast branches at 45 degrees?
Aspergillus
How is acyclovir administered? Used for?
oral or IV
herpes or VZV
What is the organ toxicity of acyclovir?
nephrotoxic
What is valcyclovir a prodrug of? What is the benefit?
acyclovir
more bioavailable
What is the route of administration of foscarnet?
IV only
What is the toxicity of foscarnet?
nephrotoxic
Which virus is gangcyclovir particularly useful for?
CMV
How is gangcyclovir administered?
IV and then orally
What is the prodrug of gangciclovir? What is its advantage?
Valgangciclovir
more bioavailable
Is influenza RNA or DNA?
RNA
Which influenza isotypes is oseltamivir effective against?
A and B
When is Zanamivir contraindicated?
respiratory issues
What enzyme activates Ribavirin?
Adenosine Kinase
How is Ribavirin administered for RSV?
aerosolized
What is the MOA of Simeprevir?
inhibits HCV NS3/4A of HCV
What is the function of NS5A of HCV?
required for viral RNA replication
Which is the common suffix for all Protease Inhibitors?
-Navir
What is the common suffix for all Integrase Inhibitors?
-Gravir
What other virus may NRTIs be useful in treating?
HBV
What is the administration route of Abacavir?
oral
What is Zidovudine an analogue of? Administered?
Deoxythymidine
orally
What are the two uses for indomethacin?
Gout and ankylosing spondylitis
What does SPOK stand for?
Sulindac
Piroxicam
Oxaprozin
Ketorolac
How does methotrexate improve the symptoms of RA?
inhibits Tcell activation
Why is cyclosporine used to treat RA?
inhibits production of IL1 and IL2
Why is leflunomide used to treat RA? Which enzyme?
inhibits ribonucleotide production
Dihydroorotate Dehydrogenase
Which two antimalarials are used to treat RA?
chloroquine and hydroxychloroquine
What are the two anti-TNF drugs used for RA?
Etanercept and infliximab
What is the MOA of anakinra?
IL1 inhibitor
Which two β-blockers are used to treat migraines?
Propranalol and metoprolol
Which TCA is used to treat a migraine?
Amitriptyline
Which two anti-epileptics are used to treat migraines?
valproate and topiramate
Which three anti-emetics are used to treat migraines?
Metochlopromide
Chlorpromazine
Prochlorperazine
Which two ergot derivatives are used for migraines?
Ergotamine
Dihydroergotamine
What is the MOA that ergotamine and dihydroergotamine can improve the symptoms of a migraine? Via what receptor? What nerve afferents?
vasoconstriction
5HT1D
Trigeminal
Which class of drugs with a common suffix is used to treat migraines? Via which receptors?
-Triptans
5HT1B and 5HT1D
Which two viruses can Ribivarin treat?
HCV and RSV
Which azole requires acid for absorption?
Itraconazole
What specific interleukin molecule is downregulated by steroids?
IL2
Do glucocorticoids downregulate Bcells or Tcells more?
Bcells
What is considered low dose glucocorticoid therapy?
What is considered medium dose glucocorticoid therapy?
7.5 - 30 mg
What is considered high dose glucocorticoid therapy?
30-100
What is considered very high dose glucocorticoid therapy?
> 100
What is considered a glucocorticoid pulse?
> 250
What does cyclosporin bind? What does this form a complex with?
cyclophilin
calcineurin
Which interleukin is not produced because of cyclosporines actions?
IL2
What is the MOA of tacrolimus?
same as cyclosporine
What drug is easier to moniter the blood levels of, tacrolimus or cyclosporine?
tacrolimus
What does azathioprine get converted into?
6MP
What are the two MOAs of azathioprine as an immunosuppressant?
inhibit lymphocyte DNA
inhibit de novo purine synthesis
What two viruses pop up during azathioprine use?
HSV and VZV
Mycophenolate inhibits the activity of what enzyme?
IMP dehydrogenase
Mycophenolate inhibits the production of what nucleoside?
guanine
What virus pops up during the use of mycophenolate?
CMV
When is mycophenolate contraindicated?
pregnancy
Which immunosuppressant binds mTOR? Which cell cycle progression checkpoint is blocked?
Sirolimus
G1/S
What are the two mechanisms by which Antithymocyte Globulin suppresses the immune system?
complement mediated
sequestering thymocyte surface receptors
What is the main side-effect of thymocyte globulin? How is this suppressed?
cytokine storm
glucocorticoids
Which cells express CD3?
Bcells
Tcells
What drug is a CD3 antibody?
Muromonab
What is the function of Muromonab?
to treat glucocorticoid resistant rejection
What are the three anti-TNF agents?
Inflixamab
Etanercept
Adalimumab
Which anti-TNF agent is a human and mouse chimera?
infliximab
Which anti-TNF agent is a recombinant human IgG?
Adalimumab
Which anti-TNF agent contains the human anti-TNF and Fc IgG?
Etanercept
What are albendazole and mebendazole effective against?
all worms
Can Oseltamivir be used for H1N1?
yes
What are oseltamivir and zanamivir analogues of?
sialic acid
What is the function of NS3/4A?
cleavage of polypeptides required for viral infection
What is the function of IL2?
Tcell growth factor
Which Immunosuppressant can produce hirsutism?
cyclosporine
What is the function of echinacea? Whe should echinacea not be used?
improve immune function
not used = immune dysfunction
What is the function of gingko biloba? Via what receptor?
improve memory function
5HT1A
What are the two main side effects of ginko biloba?
anti-platelet
seizures
What are the three main uses of garlic?
HTN
cholesterol
athesclerosis
What is the main side effect of garlic?
increased bleeding risk
What are the two uses of ginseng?
boost stamina and boost immune system
What is the use of milk thistle?
liver cirrhosis
What is the use of St. Johns WOrt?
anti-depressant
What is the use of saw palmetto?
benign prostatic hyperplasia
When should melatonin not be used?
those trying to conceive
What is the use of butterbur and feverfew?
migraines
What is the use of CoQ10?
statin induced myopathy
What vitamin does CoQ10 resemble?
Vitamin K
