Griffith Flashcards
First gen cephalosporins - chef zorro and chef flexing + club-sealing prometheus while E-coal-eye and Graham angel watch
cefazolin and cephalexin
Klebsiella, E. coli, Proteus mirabilis and GPC
Klebsiella
GN, ox- bacilli
Proteus mirabilis
GNB, - lactose, facultative anaerobe, swarming, urease, struvite stone (alk urine)
2nd gen ceph - chef fox w/ apple core + chef furry ox + GPC, Heme man w/ knife and serrated knife, Club-seal, and enterobacter attacking prometheus
- cefoxitin, cefaclor, cefuroxime
- GPIC, H. flu, Neisseria, Serrratia, Klebsiella, enterobacter, Proteus mirabilis
Which second generation ceph can cross BBB?
Cefuroxime
H. flu
GN C-B “EMOP”
Serratia marcescens
enterobacteriaceae - nosocomial infections, GNB
Neisseria
GN diplococci
General MOA of cephalosporins?
B-lactams - inhibit bacterial cell wall synthesis (not susceptible to penicillanases)
3rd gen ceph = “3 chefs in the 3 tree” - chef spore-head in ‘3 tree’ holding tax form, chef holding 3 axes, chef Taz w/ a dime + fighting evil Graham devil
- cefotaxime, ceftriaxone (gonorrhea), ceftazidime (pseudo)
- serious GN infections resistant to other beta lactams
Which ceph is given at single IM injection to treat gonorrhea?
ceftriaxone (+ doxy or azithro for chlam) = chef with 3 axes on 3 tree
Which 3rd gen ceph is active against pseudomonas?
ceftazidime = chef Taz holding dime on 3 tree
4th gen ceph - chef spore head stuck on pine tree stabbing sumo-monas and Graham angel with ‘4 fork’
- Cefepime
- pseudomonas
- GP
Two infections associated with A. israelii? Tx?
oral (normal flora)/tooth or facial abscess - dental work, oral trauma (sulfur granules), UTI’s w/ IUD’s (Tx with high dose penicillin)
“Acting mice” - Graham angel overlooks Director Pencil-villain film ant-in-robe with rod speaker as other mice store cheese crumbles in blocked uterus under lights held by branches
- GPB, branching, anaerobe
- Tx penicillin
- Sulfur granules
- UTI w/ IUD
Primary MOA of aminoglycosides? Requirement for uptake by bacteria?
irreversibly bind 30S to interfere with mRNA proofreading
oxygen
Two aminoglycoside toxicities that can be exacerbated with other meds?
- nephrotox w/ ceph
- ototox w/ loop diuretics
Which aminoglycoside is used to treat hepatic encephalopathy and in bowel surgery? Why?
neomycine = neon mouse operating on a liver/GIT
not absorbed by GIT so limited systemic AE’s
How do organisms develop resistance to aminoglycosides?
amigo glider battling the Graham devil is tied up by a sea gull transformer with a phosphate head and crosses on his wings = transferase enzymes acetylate, phosphorylate and adenylate
What AB causes a rash in EBV mono patients?
ampicillin
What AB is associated with induction of pseudomembranous colitis?
ampicillin (C. diff)
What is Augmentin?
amoxicillin (oral) + clavulanic acid (aminopenicillins are susceptible to beta lactamases)
Amino-penicillins? Target? Which can be given orally?
amoxicillin and ampicillin (BROAD: GP, some GN) - amOxicillin = Oral
Aminopenicillins - armored ox holding amigo pen uses amp to stun Heme-man who is slapping prometheus strapped to E coal with a salmon and siccing his lizard on him to eat his intestines
- amoxicillin, ampicillin
- H. flu, Proteus mirabilis, E. coli, Salmonella, Listeria, Enterococci (GDS +)
Anti-pseudo penicillins = ant-tie holding sumo-Mona Lisa blocks tiger smoking pipe on carpet while Graham devil watches
- ticarcillin, piperacillin, carbenicillin
- pseudomonas, GN (broad spectrum)
General MOA of penicillins?
- bind PBP and disrupt cell wall synthesis
- block transpeptidase involved in peptidoglycan cross-linking
monomorphic, septate hyphae branching at acute angles?
aspergillus fumigatus
3 presentations of aspergillus?
ABPA (eosinophilia in asthmatics), invasive (IC), and aspergilloma (cavity, hemoptysis)
How does pneumococcus become resistant to penicillin?
alteration of PBP’s (can overcome by giving large dose)
What drug is commonly used to treat syphilis and GAS?
penicillin
Which cillin is good for Listeria?
ampicillin (also covers enterococcus)
Which respiratory infection should not be treated with AB’s?
bronchitis (except in COPD exacerbation)
What is Unasyn? Admin?
Ampicillin + beta lactamase inhibitor, IV (mixed infections, infected diabetic foot ulcer but doesn’t cover MRSA)
Which two drugs are anti-pseudomonas?
ticarcillin (Timentin), piperacillin (Zosyn)
What 3 drugs are used to Tx non-MRSA staph aureus?
nafcillin and oxacillin IV; PO dicloxacillin
What group of microorganisms are NOT covered by cephalosporins?
anaerobes
What are 2nd gen cephalosporins used to treat clinically?
persistent minor infections (like Augmentin = amox)
Which ceph’s are anti-pseudomonal?
ceftazidime (but induces beta lactamase) so cefepime is preferred (chef on pine tree) - also ticarcillin and piperacillin
Which drugs are quick to induce resistance with extended-spectrum beta lactamase producing GN’s? Examples?
- cephalosporins
- Kleb, Actinobacter, enterobacter, Proteus, pseudomonas, Serratia, E. coli
- don’t use in ICU’s!
Primary use of aminoglycosides?
Severe GN infections (neomycin in bowel surgery)
What drugs are synergistic with beta lactams?
aminoglycosides (endocarditis combo)
3 aminoglycosides from weakest to strongest?
gentamicin, tobramycin, amikacin
Which group of antibiotics cover the atypical pneumonias well?
macrolides (block 50S, bacteriostatic) - myco pneumo, chlamydophila, legionella)
DOC for uncomplicated CA pneumonia?
macrolides
Additional function of erythromycin?
motilin agonist = diarrhea
Cardiac AE of macrolides like erythromycin?
prolonged QT interval
Which AB’s work by blocking nucleotide synthesis by inhibiting bacterial folate synthesis?
How does trimethoprim-sulfamethoxazole work?
Use of TMP-SMX?
great all-around drug = GN, GP (similar to amoxicillin)
Which AB is great for uncomplicated UTI/cystitis? Problem?
- TMP-SMX
- resistant E. coli are becoming a problem
Which AB’s are NOT for use in strep throat, pseudomonas, anaerobic infections?
TMP-SMX
What AB causes hemolysis in G6PD deficient patients?
TMP-SMX
Which drug is useful in P. jirovecii infections and non-serious soft tissue MRSA infections?
TMP-SMX
What drug is starting to be used for UTI w/ resistant E. coli? Serious AE?
- nitrofurantoin
- irreversible pulmonary fibrosis
- BUT safe in pregnancy
What is an alternative to azithromycin for uncomplicated CA pneumonia?
- doxycycline
- covers chlamydia pneumophila, mycoplasma, pneumococcus
Use of doxycycline? AE?
- all-around similar to TMP-SMX
- photosensitivity, teeth-staining
What AB is good for rickettsiae disease (spring/summer w/ fever, low WBC, platelets and elev AST/ALT)?
doxycycline
MOA of quinolones?
inhibit DNA gyrase and topoisomerases
Which AB is great for broad spectrum complicated infections but limited in treating pneumococcus?
quinolones
Which newer quinolone has better pneumococcal coverage?
Levofloxacin - CA pneumonia and hospitalized patients with GN infections
Two AE’s associated with quinolones?
- Achilles tendon rupture
- neuromuscular blocking activity
What two AB’s are primarily for anaerobic infections?
clindamycin (lincosamide) and metronidazole (nitroimidazole)
What must patients abstain from when taking metro?
EtOH
What drug is good for trichomonas and giardia in addition to C. diff colitis?
metronizadole
General bi-MOA of vanco?
inhibits cell wall AND peptidoglycan synthesis (not susceptible to PBP or beta lactamase production)
What drug has great Staph coverage (aureus and epi) and is typically reserved for MRSA?
Vancomycin (clinda can also be used for MRSA - bacteriostatic)
Other than metro, what drug is used to treat C. diff colitis?
PO vancomycin
What patients are given aztreonam?
GN-infected pt’s with penicillin allergies or w/ renal insufficiency (no aminoglycosides)
Which drug is used for GN rods only?
aztreonam
What drug should be co-admin with imipenem and why?
Cilastatin - inhibitor of rnal dehydropeptidase I to dec inactivation of drug in renal tubules
Use of carbapenems?
mega all-around IV drug for serious infections (EBSL GN’s)
Which AB is the only group effective against ESBL GN’s?
carbapenems
Which carbapenem combo is more associated with seizures and renal failure?
Primaxin (imipenem + cilastatin)
Why can’t daptomycin be used to Tx MRSA pneumonia? Pulmonary AE association?
- inactivated by surfactant
- assoc w/ eosinophilic pneumonia
Which drug treats GP bacteria such as VRE (enterococci - GDS), MRSA, and PRSP?
linezolid
Two AE’s of linezolid? SSRI c-admin problem?
- peripheral neuropathy and myelosuppression
- MAOI = serotonin syndrome w/ SSRI
Which two drugs are mainly used fro VRE and VRSA?
quinupristin, dalfopristin
Who is susceptible to invasive aspergillosis? - Mono Man courting the Crone Granny-llama with a band-AID
chronic granulomatous disease (lack of NADPH oxidase) and AIDS/IC (monomorphic - mold)
The AZ tree provides shade for the Mono Man to eat his PB&J and use Graham Devil as bait to catch the resistant beta fish, but sometimes it grows too large and disrupts the wall. Amino-amigo hangs out and ant-robe and Graham angel watch at a distance.
- aztreonam - monobactam that binds the PBP3
- works against GN (not anaerobes, GP)
- MOA prevents cell wall synthesis
- synergystic with aminoglycosides
- alt to pencillin in allergic patients
Baby seal sails over a hemolytic anemone through the NE with his fever beaver guide on the ixodes raft powered by a protozoan propeller flying the Maltese cross flag
- Babesia - protozoan parasite in the NE US that causes hemolytic anemia and fever
- carried by Ixodes (same as Borrelia)
- infects RBC’s (like malaria) and appears as maltese cross inclusions in periperal blood smear
Bacteria droid w/ abscess-guy carry fragile cargo, the Viking King, but the ant-robe threatens to foully fart on VK - rescued by Metro Knight with cleaning mice to make everything fit for a king.
- Bacteroides fragilis is GN, anaerobe in gut that causes GI abscess and produces foul odor and gas in tissue
- part of normal flora and important in Vit K syn
- Tx with metro or clindamycin (anaerobic)
Bartender hen assisted by the Graham Devil pours drinks in pleo-morphic cups for fever beaver who got scratched by a cat and the AIDS patient getting whacked by a bat angel.
- Bartonella hensleae is a GN pleomorphic bacteria
- Causes cat scratch fever w/ lymphadenopathy and bacillary angiomatosis in AIDS patients (may resemble Kaposi’s, BUT benign DDx biopsy)
The soldier and Taz play backgammon to determine who will eat the black beta fish who tries to buy his freedom from the lemon with cleavers with an ace card as the Pencil Villain oversees.
- sulfbactam, tazobactam and clavulinic acid are beta lactamase inhibitors
- combined with penicillins to overcome bacterial resistance
Blast-mouse tries to blow up the doubly-refractive wall protecting skeleton, skin-suit man, and nude Mona and granny-llama rides to safety.
- blastomycoses - dimorphic fungus with BBB
- doubly refractive capsule
- causes lytic bone lesions in disseminated disease, skin ulcerations with small pustules, and acute pneumonia
- granulomatous response in competent patients
Border fence with Border Jenga towers isolates sick babies holding the cat sign on a cock-eyed rod and the Graham Devil from coughing babies holding the pear sign across a river of lympocytes as Earths throw mice at the angry Red Bull who ties up Gi Joe causing his gun to fire off cAMP and insulin.
- Bordetella pertussis is GN coccobacilli grown in Bordet Gengou
- catarrhal (infectious) and paroxysmal stages
- causes lymphocytosis
- Tx with erythromycin
- AB toxin blocks Gi resulting in INC cAMP and therefore insulin release
The barrel burgler fairy steals gems and silver from the Lyme Castle assisted by the ear-licking baby seal - the guard has the flu, the hurt heart can’t ring the droopy bell, and the king has arthritis and can’t defend his castle. The cycling doxen drives the chef with 3 axes to the rescue.
- Borrelia burgdorferi: spirochete, dark-field, silver stain, giemsa stain
- Ixodes: Erlichiosis (Rickett) and Babesia
- Initially flu w/ target rash - heart block/Bell’s palsy - arthralgias in late disease
- Tx with doxy, ceftriaxone
Bruce Lee rides the undulating Fever Beaver rollercoaster held up by cock-eyed rods with Graham Devil, cow, goat, and granny-llama and is about to collide with gentleman mouse helping the cycling doxen with his training.
- Brucellosis: undulating fever and lymphadenopathy; GN coccobacilli transmitted by goat cheese and unpasteurized milk
- granulomas in patients who can’t clear it
- Tx with gentamicin, doxycycline
A curved corkscrew flag marks Camp-ylobacter in June. King Arthur writes on his red toilet as poultry is under-cooked on the camp fire by the incompetent Graham Devil. The King’s unsupervised puppy drinks milk straight from the cow who is flirting with nearby ox-daisies
- Campylobacter jejuni: GN curved bacilli with corkscrew flagella motility
- causes inflammatory bloody diarrhea, Reiter’s and Guillian Barre (ascending)
- transmitted by undercooked chicken, unpasteurized milk, and puppies with diarrhea
- oxidase positive and grows well at 42 degrees
The Canadian Owl wearing a diaper grows pseudohyphae, germ tubes, and a fiery pruritic purple flower in cottage cheese soil in the esophagus sarcophagus as a druggie with a bad heart, fat pancreas and antibiotic bot judge his garden.
- Candida albicans
- psuedohyphae at 20 d, germ tubes at 37 d
- cause of pruritic vaginitis (cottage cheese discharge, erythematous mucosa in DM, AB patients), diaper rash, endocarditis in IVDU, and esophageal thrush in IC
Chlamydia clam sends its elephant minions to follow the ink blots left by epithelial man who stole his ATP batteries (but not the gems). Doxen cycling with zipper mice comes to fight off the elephants.
- Chlamydia is obligate intracellular (cannot make ATP)
- infectious elementary bodies target epithelial cells and reticulate bodies replicate inside cells producing inclusion bodies
- no gram stain, but yes Giemsa
- Tx. with Doxy, azithromycin
On chlamydia idol, contestants sing ‘ABC, L 1-3’. The convict-eye with long lashes and his blind African chorus in a Trachoma tacoma go first, then the gentleman ulcer and lymph-granny-llama wearing a blue bow. DK judges the sick nude Mona with her baby convict-eye singing a staccato cough.
- Chlamydia trachomatis
- Serovars ABC in Africa - trachoma causes follicular conjunctivitis that can thicken the eyelid with scarring causing blindness
- L1-3 causes lymphogranuloma venereum (ulcers first then genital buboes)
- D-K serovars cause urethritis/PID and babies with staccato cough, pneumonia, and conjunctivitis
The chlorine float with a fanny pack shocks many bacteria and wrangles men in tights and 50S rapper drinking his Pepsi. A grey baby w/ a glue transformer floats in a UDP box atop anemones in plastic bottles in the poisoned water. Seagull transformer ties up the chlorine float with a plasmid rope.
- Chloramphenicol: broad spectrum bacteriostatic but high resistance via plasmid-encoded acetyltransferase
- Tx meningitis in developing countries by inhibiting 50S peptidyl transferase
- AE: grey baby syndrome (lack of UDP glucuronyltransferase in liver) and aplastic anemia
As mice clean his lung crib, rapper 50S denies entry to Train Loco after a crazy night - ant-robe catches air on a diaphragm trampoline as an ass sprays water on nude-Mona and abscess-guy tries to bail. Sumo-man in a bra wakes up with a colon belt as a clean mouse shoos him out the door.
- Clindamycin: anaerobic infections above diaphragm; bacteriostatic protein synthesis inhibitor that binds 50S and blocks translocation of ribosomal subunit
- aspiration pneumonia, abscess
- can initiate pseudomembranous colitis
In the classtridium differential equation classroom, sumo-man-bra inappropriately exposes his megacolon that is quickly cleaned by mice standing on an amp. Ant-robe directs the class with a rod while Graham angel pays attention and helps out by taking test tube samples of toilet contents. The bad students misbehave - apple breaks the toilet brush and bee breaks down the toilet structure
- C. diff - anaerobic GP rod
- causes pseudomembranous colitis (and toxic megacolon) after clindamycin or ampicillin Tx
- infection detected by toxins in stool (normal flora)
- TcdA is an enterotoxin that damages brush border enzymes
- TcdB is a cytotoxin that disrupts actin cytoskeleton
What genus is GP, anaerobic, spore-forming?
clostridia
In classtridiroom perfumegens, thin Miss Lacey with her alpha afro teaches ant-robe who is eating eating meat on a toilet seat, but a gang of spore heads sprays noxious perfume, wraps her afro in a lipid bilayer, and sprays the musculature chart with icky cologne. Graham angel tries to defeat the spore gang with heat lamps on rods.
- C. perf: GP rod, anaerobic
- Exo Alpha toxin lecithinase destroys bilayer in RBCs, WBCs and muscle = myonecrosis (gas gangrene)
- Also produces heat labile enterotoxin associated with meat that causes diarrhea
GABA goose tries to stop the Clostridium Titanic from hitting the glycine glacier on a Renshaw wrench, but Captain Ant-robe loses control and exotoxin spills out of the ship, giving Jack lock-jaw and Rose a sardine smile as she arches her back on the bow.
- Clostridium tetani: GP rod, obligate anaerobe
- Exotoxin inhibits release of GABA/Glycine on pre-synaptic membrane of Renshaw cells in the SC causing lockjaw, risus sardonicus, and opisthotonus
A massive earthquake in the southwest washes the cock with his pet nodosaur on his bone raft out to sea. Granny-llama uses the skin sail and men in tights to bring them back to cock’s nude-mona for a cheese-plate date that cock has made special spherule jelly for.
- Cocci: dimorphic fungi - mold with arthrospores in desert, spherule with endospores in body
- causes erythema nodosum and gran rxn w/ caseous necrosis – pneumonia, skin infections, meningitis, osteomyelitis
At the fair, sumo-man-bra pharaoh eats corn dip and sips lime-ade while holding an exotoxin balloon which Graham angel pops with a rod. Beta-fish propeller lassoes the jeans off Red Bull to stop him from charging the elongation elves in tutus who are throwing red-blue metal-chrome balls at blue aliens. The aliens try to call for help, but the telephone is busy writing Chinese letters. Poly the parrot with neuron legs scams fairgoers with mayo-cards
- Corynebact diph: GP rod
- causes psuedomembranous pharyngitis and cervical LAD
- exotoxin encoded on beta prophage is incorporated into genome via lysogeny, causing ADP ribosylation of EF2
- grows on tellurite agar in Chinese letter-like colonies
- when stained with aniline blue, metachromatic inclusions appear red and rest of cell is blue
- Can cause polyneuritis and myocarditis
The flower queen and her flock of oxen chase after and throw bacteria-sliders at sumo-mona-lisa and her evil minion Graham devil who sits atop the stolen gyroscope. Sumo-mona wields her knife and Graham devil prods her with a rod despite her nasty UTI!
- Fluoroquinolones (-floxacin): bactericidal against serious GN rods, particularly pseudomonas, Neisseris, UTI
- inhibits topoisomerase II enzymes (including bacterial gyrase)
The flower queen with diarrhea cannot get peace from her dermatologist and ends up whacking her head in the tiny port-a-potty. Tarantula mom is rushing her kid to the bathroom in a shopping cart after he ate a whole jar of mayo-algae and accidentally hits Flower Queen’s body guard Achilles in the heel.
- Fluoroquinolone AE’s
- diarrhea
- skin rash
- headache
- achilles tendon rupture/cartilage damage
- myalgias in kids
- teratogen
Caesar’s life has gone downhill since winning the Emmy Penny because the statue causes trouble by shooting silly string at his kidney friend who hangs out by the hydrant pep-D. Now he just sits on the toilet, fishes for resistant black beta fish and makes his dermatologist do house calls. He reminisces about days of broad rainbows, Graham angel making silly cock-eyes, and Graham devil poking ant-robe with a rod
- Imipenem: broad spectrum, GPC, GNB, anaerobes
- admin w/ cilastatin which inhibits renal dehydropeptidase I (inactivates the drug)
- causes diarrhea, seizures, rash
- beta lactamase resistant
Macaroni-lights brighten the train track for Train-loco conducted by cock-eyed Graham angel, but rapper 50S riding Rabbi-RNA-Rhino branded 23S blocks the way. The earth throws zipper-mice and the clarinet mouse plays a tune to distract 50S’s rhino, but the methylated rhino with a resistance bandana must step in so that the train can deliver its precious cargo - a Mona Lisa holding an atypical CXR and covering her parts with a clam.
- Macrolides: GPC bacteriostatic
- Bind 23S rRNA of 50S subunit, blocking translocation (protein synthesis)
- erythromycin, azithromycrin, clarithromycin
- resistance via methylation of 23S rRNA binding site
- Tx. atypical pneumonia, chlamydia
Macaroni-lights bind the happy-tie-liver and his bestie collie-static to the toilet. The dermatologist is being intrusive yet again and the pea-450 looks pissed about it. Eosinophilic eagle was able to escape and took off with the ‘ur a QT’ heart balloon
- Macrolide AE’s
- diarrhea (motilin)
- cholestatic hepatitis
- P450 inhibition (bad with statins = rhabdo)
- eosinophilic rash
- long QT
Metro
Metronizadole
Penicillin
Penicillin
polymyxins
polymyxins
protein synthesis inhibitors
protein synthesis inhibitors
Sulfa drug tox
tox
Sulfonamide mech
sulf
Sulfonamide tox
tox
Tet uses
uses
Tet MOA
MOA
Tex tox
tox
Trimethoprim
tri
Vanc MOA
MOA
Vanc Tox
Tox
Gardner-ella had to leave Metro Knight at Club Metal Mouth by midnight on the tricycle with antennae-amoeba she stole from jar-head-lamb because she had a nasty case of vaginitis. Knight went after her destroying the DNA metro tracks and pelting her with bacteria-sliders and free radicals. The dyed-shirt-surfer stayed at the club to party and drink
- Metronidazole: bactericidal; forms free radial toxin metabolites that damage enzymes and DNA
- Tx. giardia lamblia, Gardenerella (gray, fishy), Trichomonas (burning, green), Entamoeba, anaerobes
- AE: metallic taste and disulfiram-like reaction with EtOH
