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ID 18 Flashcards

1
Q

Sulfonamides

A

Sulfamethoxazole
Sulfisoxazole
Sulfadiazine

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2
Q

Dihydropteroate synthase action

A

PABA + Pteridine –> Dihydropteroic acid

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3
Q

dihyrofolate reductase action

A

Dihydrofolic acid –> tetrahydrofolic acid

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4
Q

sulfonamide MOA

A

Inhibit dihyropteroate synthase

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5
Q

sulfonamide uses

A

nocardia

chlmaydia

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6
Q

nephrotoxic mechanism of sulfonamides

A

tubulointerstitial nephritis

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7
Q

sulfonamide MOA of resistance

A

1) Altered enzyme (bacterial dihydropteroate synthase)
2) decrease uptake
3) Increase PABA synthesis

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8
Q

Dapsone mechanism

A

similar to sulfonamides but structurally distinct; inhibits dihydropteroate synthase

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9
Q

trimethoprim MOA

A

Inhibits bacterial dihydrofolate reductase.

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10
Q

trimethoprim uses

A

1) UTIs
2) shigella
3) salmonella
4) pneumocystis jirovecii
5) pneumonia treatment and prophylaxis
6) toxoplasmosis prophylaxis

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11
Q

TMP AE’s

A

1) megaloblastic anemia
2) leukopenia
3) granulocytopenia

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12
Q

fluoroquinolone mechanism

A

inhibit topo II and IV

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13
Q

topo II

A

DNA gyrase

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14
Q

fluoroquinolones AE’s

A

1) GI upset
2) superinfection
3) skin rashes
4) headache
5) dizziness
6) leg cramps and myalgia
7) QT prolongation

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15
Q

fluoroquinolone contraindications

A

pregnant or nursing
kids under 18
patients taking prednisone
tendonitis or tendon rupture in people over 60

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16
Q

fluoroquinolone resistance AE

A

1) *chromosome encoded mutation in DNA gyrate
2) plasmid-mediated resistance
3) efflux pumps

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17
Q

daptomycin mechanism/structure

A

lipopeptide that disrupts cell membrane

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18
Q

daptomycin use

A

S aureus skin infections (especially MRSA)
bacteremia
endocarditis
VRE

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19
Q

caveat about daptomycin

A

can’t use it for pneumonia because it binds to and is inactivated by surfactant.

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20
Q

disulfiram-like reaction presentation

A

severe flushing
tachycardia
hypotension

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21
Q

metronidazole uses

A 
Guardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes (bactericides, C diff)
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22
Q

other drug that can be used as prophylaxis for m avium

A

rifabutin

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23
Q

m avium treatment

A

azithromycin or clarithromycin + ethambutol. Can add rifabutin or ciprofloxacin

24
Q

Structure of mycobacterial cell

25
Rifamycins
Rifampin | Rifabutin
26
rifampin/rifabutin MOA
inhibit DNA-dependent RNA polymerase
27
Why is rifampin used for leprosy?
Delays resistance to dapsone
28
Why is rifabutin used in patients with HIV infection rather than rifampin?
less CYP-450 stimulation
29
MOA of resistance to rifampin?
Mutations reduce drug binding to RNA polymerase.
30
enzyme required to activate isoniazid...
catalase peroxidase (encoded by KatG)
31
acetylation point with isoniazid
different INH half-lives in fast vs slow acetylators
32
treatment for latent TB?
INH can be used as monotherapy
33
isoniazid MOA of resistance
mutations leading to under expression of KatG
34
pyrazinamide caveats
1) prodrug (active compound = pyrazinoic acid) | 2) works best at acidic pH (eg, in host phagolysosomes)
35
2nd line for TB?
streptomycin
36
streptomycin AE's
Tinnitus Vertigo Ataxia Nephrotoxicity
37
strep viridan's prophylaxis
amoxicillin
38
Prophylaxis of strep pharyngitis in child with prior rheumatic fever
Benzathine penicillin G or oral penicillin V
39
Drugs covering MRSA
``` Vancomycin Daptomycin Linezolid Tigecycline Ceftaroline ```
40
Drugs covering VRE
Linezolid | streptogramins (quinupristin, dalfopristin)
41
Drugs for multidrug-resistant P aeruginosa or acinetobacter baumannii?
polymyxins B and E (colistin)
42
Squalene epoxidase action
squalene --> squalene epoxide
43
14 alpha-demethylase action
lanosterol --> ergosterol
44
caveat about administering amphotericin
Need to supplement K and Mg because of altered renal tubule permeability.
45
amphotericin AE's
1) fever/chills 2) hypotension 3) nephrotoxicity 4) arrhythmias 5) anemia 6) IV phlebitis
46
How do you decrease toxicity of amphotericin?
Hydration | Liposomal amphotericin
47
nystatin caveat
can only be used topically since too toxic
48
flucytosine MOA
Inhibits DNA and RNA biosynthesis by conversion to 5-FU by cytosine deaminase.
49
azole mechanism
Inhibit ergosterol synthesis by inhibiting CYP450 enzyme that converts lanoserol to ergosterol.
50
Fluconazole use..
Chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections.
51
Azoles for use in topical fungal infections?
Clotrimazole | Miconazole
52
azoles and CYP450?
Inhibit
53
terbinafine AE's
GI upset headaches hepatotoxic taste disturbance
54
echinocandins AE's
GI upset + flushing (histamine release)
55
colistin
Polymyxin E
56
polymyxins
o Coded character: Polly Nichols, as a DJ having a dance party in her kitchen: she’s pouring laundry detergent over everyone/MOA: bind to gram-negative bacterial cell membrane phospholipids and destroy the membrane by acting like a detergent. Monsterous green Ozed/used to treat severe gram-negative infections that are resistant to less toxic antimicrobials, such as multi-drug resistant pseudomonas meningitis. Her arms and legs are ice cubes + giraffe in the corner + she has stag antlers on her head (nystagmus code) + motorcycle goggles on/toxicity = numbness of the extremities + nephrotoxicity + nystagmus + blurred vision. J. Cole rapping to the left of Polly/colistin is polymixin E. Huge Giorgio armanii in left corner/also use for multidrug-resistant Acinetobacter baumannii. o Location: Nichol’s kitchen
57
pyrimethamine MOA and usage
1) t gondii | 2) inhibits dihydrofolate reductase

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