EXAM #4: REVIEW Flashcards
What is Peptidoglycan?
A macromolecule of peptides and sugars
What is Lipopolysaccharide?
A macromolecule of phospholipids and polysaccharides
Outline the ESKAPE mnemonic of nosocomial superbugs.
Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter bumanni Pseudomonas aeruginosa Enterobacter species
What is the function of Penicillin-Binding Proteins (PBPs) or Transpeptidases?
Cross-linking peptidoglycan in the formation of the bacteria cell wall
How can you group the PCN-type drugs?
- Penicillinase-sensitive PCNs
- Penicillinase-resistant PCNs
- Antipseudomonals
*****Penicillinase= Beta-Lactamase
List the Beta-Lactamase sensitive PCNs.
PCN G and V
Ampicillin
Amoxicillin
List the Beta-Lactamase resistant PCNs.
Oxacillin
Nafcillin
Methicillin
Which of the PCNs are “antipseudomonal?”
Ticracillin
Piperacillin
What are the narrow spectrum PCNs?
PCN G and V
Methicillin
Nafcillin
Oxacillin
What are the broad spectrum PCNs?
Ampicillin Amoxacillin Azlocillin Piperacillin Ticracillin
Remember aminopenecillins are amped up PCNs i.e. ampicillin and broader spectrum
What is the hallmark 1st generation Cephalosporin?
Cephazolin
What is the hallmark 2nd generation Cephalosporin? List the other 2nd generation Cephalosporins.
Cefoxitin
- Cefotetan
- Cefaclor
- Cefuroxime
List the 3rd generation Cephalosporins.
Ceftriaxone
- Cefotaxime
- Cefdnir
- Cefixime
What is the only drug in the Monobactam family?
Aztreonam
What type of bacteria can be treated with Aztreonam?
Gram negative (rods) only
What are the two important clinical considerations regarding Aztreonam?
1) Penetrates the BBB
2) Beta-Lactamase resistant
Are the Carbapenams resistant to Beta-Lactamase?
Yes
What enzyme are the Carbapenams susceptible to?
Carbapenemase
What adverse effects are associated with the Carbapenems?
1) GI disturbances (Dr. Henry)
2) CNS toxicity
Note that it is toxicity that limits their use to life-threatening infections and/or after other drugs have failed
What is the MOA of Vancomycin?
Inhibits peptidyglycan formation by binding D-ala portion of cell wall precursors
What is Vancomycin generally used to treat?
Serious, multi-drug resistant organisms including:
- MRSA
- C. diff
What is the MOA of Bacitracin?
Blocks incorporation of amino acids and nucleic acids into the cell wall of bacteria
Remember that Bacitracin is Broad spectrum
What type of antibiotic is Fosfomycin? What is the MOA?
Cell wall synthesis inhibitor that prevents the synthesis of UDP-NAM (component of peptidoglycan)
What is Fosfomycin commonly used to treat?
UTIs
What antibiotic class are the Aminoglycosides? What is the MOA?
30S Protein Synthesis Inhibitors
- Prevent charged tRNA from entering the A site
Remember, “Buy AT 30, CELL at 50” (Aminoglycosides and Tetracyclines= 30S inhibitors)
How are the Aminoglycosides commonly administered in the clinical setting?
With Beta-Lactam antibiotics
When are Aminoglycosides commonly used clinically?
Serious gram negative infections
What is the mnemonic to remember many important features of the Aminoglycosides?
“Mean” (i.e. A-mean-oglycodies) GNATS caNNOT kill anaerobes
G= Gentamicin N= Neomycin A= Amikacin T= Tobramycin S= Streptomycin
N= NEPHROTOXICITY N= neuromuscular blockade O= OTOTOXICITY T= teratogen
(CAPITLAL= Dr. Henry)
What is the MOA of the Macrolides?
Blocks translocation of the growing amino acid chain from the A-site to the P-site
(50S inhibitors)
What side effect is associated with Macrolides? Use a mnemonic to remember.
Macrolides cause Motility issue i.e. GI disturbances
What is the specific MOA of the Tetracyclines?
Blocks charged tRNAs from entering the A-site
30S inhibitors
What should not be taken with a Tetracycline?
1) Milk
2) Antacids
3) Iron supplements
Bind divalent cations, which will inhibit absorption from the gut
In what patient populations are Tetracyclines contraindicated?
1) Kids
2) Pregnant women
Will prevent/induce bone growth–check ppt
What type of antibiotic in Clindamycin?
50S Protein Inhibitor
Clinically, what is Clindamycin commonly prescribed for?
Streptococcus and Staphylococcus soft tissue infections
Thus, it is a NARROW SPECTRUM antibiotic
What is the MOA of Clindamycin?
Blocks growing amino acid chain transfer from A-site to P-site
(50S)
What key adverse effect is Clindamycin associated with?
Pseudomembraous colitis i.e. C.diff
What is the MOA of Chloramphenicol?
Blocks peptidyltransferase at 50S subunit i.e. prevents peptide bond formation
What are the adverse effects seen with Chloramphenicol?
1) Anemia
2) Aplastic anemia
3) Gray Baby Syndrome
What is Chloramphenicol commonly prescribed for?
Rocky Mountain Spotted Fever
Typhus
What type of bacteria is Linezolid effective against?
Gram positive
What is the MOA of Linezolid?
50S inhibitor that blocks the A-site
What adverse effect is associated with Linezolid?
Myelosuppression
What is the general pattern of bacterial specificity of the protein synthesis inhibitors? Which antibiotic does NOT follow the pattern?
Generally broad spectrum, except for Clindamycin, which is used to treat Streoptoccus and Staphylococcus soft tissue infections
List the Sulfonamides.
Sulfamethoxazole (SMX)
Sulfamethizole
Sulfadiazine
What are the key adverse reactions associated with the Sulfonamides? Use a mnemonic to recall these reactions
Sulfonamides= Skin
1) Hypersensitivity
2) Photosensitivity
3) Steven-Johnson Syndrome
What is the bacterial specificity of the Sulfonamides?
Broad-spectrum
What are the two Trimethoprims?
Trimethoprim
Pyrimethamine
What is the bacterial specificity of the Trimethoprims?
Gram negative bacteria
What is the mnemonic to remember the adverse effects associated with the Trimethoprims?
Trimethoprim= TMP
Treats Marrow Poorly i.e. megaloblastic anemia
List the adverse effects associated with the Fluoroquinolones.
1) GI disturbances
2) Bind divalent cations
3) QT prolongation
4) FluoroquinoLONES hurt attachment to your BONES
- Tendonitis
- Tendon rupture
What is the Group 1 Fluoroquinolone?
Norfloaxacin
What are the Group 2 Fluoroquinolones? What type of bacteria are these drugs most specific for?
Ciprfloaxcin
Levofloaxcin
Ofloaxcin
Gram negatives
What are the Group 3 Fluoroquinolones? What type of bacteria are these drugs most specific for?
Gatifloxcin
Gemifloxcin
Moxifloaxacin
Gram positives
What types of microorgansism can be treated with Metronidazole?
Bacteria AND protozoa
What type of bacteria can be treated with Metronidazole?
Anaerobics ONLY (below the diaphragm)
What is the bacterial specificity of Daptomycin?
Gram positives
What is the bacterial specificity of Polymyxin B?
Gram negatives/LPS i.e. it specifically is a detergent that punches in LPS
How is Polymxyin B administered?
Topically
What is a good first choice drug for an uncomplicated skin infection?
1st generation Cephalosporin i.e. Cefazolin
Treats S. aureus and S. pyogenes that cause uncomplicated skin infections
What is a good alternative for an uncomplicated skin infection with hypersensitivity to a 1st generation cephalosporin?
Clindamycin
or Vancomycin
What is a good first choice drug for a complicated skin infection?
Ticracillin and clavulanate
Has anti-pseudomonal activity
What are good drugs to treat MRSA skin infection?
Vancomycin
Daptomycin
Linezolid
What two bacteria cause complicated skin infections?
1) P. aeruginosa (Ticracillin has anti-pseudomonal activity)
2) E. coli
What are good first line agents for bone and joint infections?
Vancomycin or Ceftriaxone (3rd/4th generation cephalosporin)
What is the antibiotic of choice for post-op bone/joint infections?
Ticracillin and clavulanate
What is a good antibiotic choice for septic arthritis?
Ceftriaxone
What is the first line antibiotic for acute sinusitis and chronic bronchitis?
Augmentin i.e. Amoxacillin and clavulanate
What is the first line antibiotic for pharyngitis? What organism commonly causes pharyngitis?
PCN
S. pneumoniae
What bacteria cause URIs (3)?
1) H. influenza
2) S. pneumonia
3) Moraxella catarrhalis
What is the first line antibiotic for ambulatory pneumonia?
Macrolides
How are patients with pneumonia that have to be hospitalized treated?
Add Beta-Lactam to the Macrolide
How is nosocomial pneumonia treated?
Ceftriaxone
How is pyelonephritis treated vs. a simple UTI?
UTI= TMP-SMX Pyelo= add Fluoroquinolone
What is the first line antibiotic for intra-abdominal infections? What bacteria cause intra-abdominal infections?
Ticracillin and clavulanate
Gram negative
What is community acquired meningitis treated (older than 2 y/o)?
Ceftriaxone and Vancomycin
How is neonatal meningitis treated?
1) Ampicillin
2) Cephalosporin
3) +/- Gentamicin (L. monocytogenes)
What are the first line antibiotics for Endocarditis?
1) Ceftriaxone
2) Vancomycin
What are the first line antibiotics for neutropenic fever?
Ciprofloxacin and Augmentin
How are enterococci infections treated?
Deptomycin + Tigacycline
How are gram negative ANTIBIOTIC RESISTANT infections treated?
Carbapenam + Carbapenemase
What toxicities are associated with INH?
1) Hepatitis
2) Peripheral neuropathy
What factors increase the risk of peripheral neuropathy with INH therapy?
1) Malnutrition
2) Alcoholism
3) DM
4) AIDS
What is the MOA of Rifampin?
Inhibition of RNA synthesis
Inhibits bacterial DNA dependent RNA polymerase
What is the mechanism of Pyrazinamide resistance?
- Pyrazinamide requires Pyrazinamidase to be active (prodrug)
- Mutation in Pyrazinamidase
What adverse effect is associated with Pyrazinamide?
Gout/ Hyperuricemia
What is the MOA of Ethambutol?
Inhibits arabinosyl transferase needed for mycolic acid synthesis
What adverse effects are seen with Ethambutol?
1) Retrobulbar neuritis
2) Hyperuricemia
What is a good first line drug to treat disseminated MAC infections in the immunocompromised?
Rifabutin
What four drugs are used for MAC combination therapy?
1) Macrolide
2) Rifabutin
3) Ethambutol
4) Streptamycin
What is the standard drug regimine for Leprosy?
1) Dapsone
2) Clofazamine
3) Rifampin
Note that these drugs are taken for YEARS**
What is the MOA of Dapsone?
PABA analog that inhibits folate synthesis
What adverse effect is associated with Dapsone?
Non-hemotylic anemia
What is Clofazamine?
Bactericidal dye
*Associated with skin pigmentation changes