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STEP > ID 18 > Flashcards

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

A

FA 179

25
Q

Rifamycins

A

Rifampin

Rifabutin

26
Q

rifampin/rifabutin MOA

A

inhibit DNA-dependent RNA polymerase

27
Q

Why is rifampin used for leprosy?

A

Delays resistance to dapsone

28
Q

Why is rifabutin used in patients with HIV infection rather than rifampin?

A

less CYP-450 stimulation

29
Q

MOA of resistance to rifampin?

A

Mutations reduce drug binding to RNA polymerase.

30
Q

enzyme required to activate isoniazid…

A

catalase peroxidase (encoded by KatG)

31
Q

acetylation point with isoniazid

A

different INH half-lives in fast vs slow acetylators

32
Q

treatment for latent TB?

A

INH can be used as monotherapy

33
Q

isoniazid MOA of resistance

A

mutations leading to under expression of KatG

34
Q

pyrazinamide caveats

A

1) prodrug (active compound = pyrazinoic acid)

2) works best at acidic pH (eg, in host phagolysosomes)

35
Q

2nd line for TB?

A

streptomycin

36
Q

streptomycin AE’s

A

Tinnitus
Vertigo
Ataxia
Nephrotoxicity

37
Q

strep viridan’s prophylaxis

A

amoxicillin

38
Q

Prophylaxis of strep pharyngitis in child with prior rheumatic fever

A

Benzathine penicillin G or oral penicillin V

39
Q

Drugs covering MRSA

A 
Vancomycin
Daptomycin
Linezolid
Tigecycline
Ceftaroline
40
Q

Drugs covering VRE

A

Linezolid

streptogramins (quinupristin, dalfopristin)

41
Q

Drugs for multidrug-resistant P aeruginosa or acinetobacter baumannii?

A

polymyxins B and E (colistin)

42
Q

Squalene epoxidase action

A

squalene –> squalene epoxide

43
Q

14 alpha-demethylase action

A

lanosterol –> ergosterol

44
Q

caveat about administering amphotericin

A

Need to supplement K and Mg because of altered renal tubule permeability.

45
Q

amphotericin AE’s

A

1) fever/chills
2) hypotension
3) nephrotoxicity
4) arrhythmias
5) anemia
6) IV phlebitis

46
Q

How do you decrease toxicity of amphotericin?

A

Hydration

Liposomal amphotericin

47
Q

nystatin caveat

A

can only be used topically since too toxic

48
Q

flucytosine MOA

A

Inhibits DNA and RNA biosynthesis by conversion to 5-FU by cytosine deaminase.

49
Q

azole mechanism

A

Inhibit ergosterol synthesis by inhibiting CYP450 enzyme that converts lanoserol to ergosterol.

50
Q

Fluconazole use..

A

Chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections.

51
Q

Azoles for use in topical fungal infections?

A

Clotrimazole

Miconazole

52
Q

azoles and CYP450?

A

Inhibit

53
Q

terbinafine AE’s

A

GI upset
headaches
hepatotoxic
taste disturbance

54
Q

echinocandins AE’s

A

GI upset + flushing (histamine release)

55
Q

colistin

A

Polymyxin E

56
Q

polymyxins

A

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
Q

pyrimethamine MOA and usage

A

1) t gondii

2) inhibits dihydrofolate reductase

STEP (85 decks)

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