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Micriobio: Therapy Flashcards

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1
Q

what is penicillin G

A

this is a first generation classic lactam antibiotic. it is beta lactam sensitive

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2
Q

what does penicillin G treat

A

mostly used for gram positive organisms like S pneumonia, s pyogenes. commonly used in T pallidum (syphillis)

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3
Q

toxicity of penicillin G

A

hemolytic anemia and hypersensitivity reaction

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4
Q

how does resistance develop to penicillin G

A

penicillinase (beta lactamase)

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5
Q

what are ampicillin and amoxicillin

A

2nd generation penicillins. still sensative to beta lactamase. greater spectrum of use.

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6
Q

bugs that 2nd generation penicillins can kill

A 
HELPSS kill enterococci
H influenza
E coli
Listeria monocytogenes
Proteus mirabilis
Salmonella
Shigella
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7
Q

toxicity of 2nd generation penicillins

A

HS reaction, rash, and pseudomembranous colitis.

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8
Q

what is the one bug that 3rd generation penicillins treat

A

S aereus (really only nafcillin)

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9
Q

what are examples of 3rd generation penicillins

A

oxacillin, nafcillin, dicloxacillin

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10
Q

what is different about 3rd generation penicillins

A

they have beta lactam resistance by having a very very bulky R group. this limits their action those.

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11
Q

strange side effect from 3rd generation penicillins

A

interstitial nephritis

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12
Q

what is special about 4th generation penicillins

A

they treat psuedomonas (and gram negative rods)

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13
Q

examples of 4th generation penicillins

A

ticarcillin, piperacillin

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14
Q

beta lactamase inhibitors

A

CAST
Clavulonic Acid
Sulbactam
Tazobactam.

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15
Q

how do cephalosporins kill bacteria

A

same way penicillins do! they bind to penicilin binding protein (PBP) and block transpeptidase cross linking of peptidoglycan

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16
Q

what generation cephalosporin are cefazolin and cephalexin?

A

first generation

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17
Q

what are cephalexin and cefazolin used for?

A

gram positive cocci. PEcK:
Proteus miribalis
E Coli
Klebsiella pneumoniae

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18
Q

what is cefazolin specifically used for

A

surgical prophylaxis against S aureus infections

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19
Q

what generation cephalosporin are cefoxitin, cefaclor, cefuroxime?

A

2nd generation

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20
Q

what do second generation cephalosporins treat

A

gram positive cocci infections like H influenza, Enterobacter, Neisseria, Proteus, Ecoli Klebsiella,
Serratia

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21
Q

what generation cephalosporins are ceftriaxone, cefotaxime, ceftazidime

A

3rd generation

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22
Q

what do you use 3rd generation cephalosporins for

A

gram negative infections that are resistant to other beta lactams

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23
Q

what is special about ceftriaxone?

A

often used to treat meningitis

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24
Q

which 3rd generation cephalosporin cannot be used to treat meningitis

A

cefoperazone. does not cross the BBB

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25
Q

which cephalosporin (3rd gen) is good for pseudomonas

A

ceftazidime

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26
Q

what is cefepime?

A

4th generation cephalosporin

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27
Q

what are 4th generation cephalosporins good for?

A

increased activity against pseudomonas and gram positive organisms

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28
Q

what is ceftaroline?

A

5th generation cephalosporin

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29
Q

what are 5th generation cephalosporins good for?

A

very broad coverage. covers gram positive and gram negative organisms including MRSA but NOT pseudomonas.

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30
Q

toxicity from cephalosporins?

A

vitamin K deficiency, low cross reactivity with penicillin, increases nephrotoxicity of aminoglycosides

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31
Q

what is aztreonam used for

A

gram negative rods. usually pseudomonas.

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32
Q

why is aztreonam’s status as a monobactam important

A

no cross reactivity in pen allergic patients.

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33
Q

how does aztreonam work?

A

binds specifically to PBP3.

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34
Q

toxicity of aztreonam

A

basically none. very well tolerated. maybe some GI upset

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35
Q

what kind of drug ends in “penem”

A

any of the carbapenems like imipenem and meropenem

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36
Q

what is important to remember about imipenem

A

it must be given with cilastatin (inhibition of renal dehydropeptidase I) to decrease inactivation of the drug in the renal tubules. “the kill is lastin with cilastin”

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37
Q

are the carbepenems resistant to beta lactamase

A

yes

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38
Q

what do the carbepenems function against?

A

gram positive cocci, gram negative rods and anerobes.

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39
Q

do we use the carbepenem drugs often?

A

no because life threatening side effects. only use in serious infections.

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40
Q

major toxocity associated with imipenem

A

seizures

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41
Q

newer carbepenems

A

ertapenem and doripenem. have increased pseudomonas coverage

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42
Q

vancomycin mechanism

A

inhibits cell wall peptidoglycan formation by binding to d-ala d-ala portion of the cell wall. bacteriocidal.

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43
Q

what do we use vancomycin for?

A

gram positive organisms only- serious multi drug resistant organisms only. includes MRSA, enterococci, and C diff (oral dose)

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44
Q

which drug is red man syndrome associated with?

A

Vancomycin- red man syndrome- can be prevented with anti histamines and slow infusion rate

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45
Q

other toxic effects of vancomycin

A

NOT: nephrotoxicity, ototoxicity, Thrombophlebitis (vein inflammation associated with a clot)

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46
Q

resistance to vanco

A

bacteria modify their amino acid sequence from D ala-D ala to D ala Dlactose.

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47
Q

which two drugs inhibit the 30 S subunit

A

Aminoglycosides and Tetracyclines

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48
Q

which drugs inhibit the 50S subunit

A

chloramphenicol, clindamycin (bacteriostatic)
Macrolides (erythromycin for ex)
Linezolid

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49
Q

which 2 drugs target the initiation complex

A

aminoglycosides and linezolid

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50
Q

which drugs inhibit the elongation (the A site)?

A

tetracyclines and dalfopristin

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51
Q

which drug inhibits the peptidyl transferase enzyme

A

chloramphenicol

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52
Q

which drugs inhibit translocation of the ribosome

A

macrolides and clindamycin

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53
Q

gentamicin, neomycin, amikacin, tobramycin and streptomycin are what kind of drug

A

aminoglycoside

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54
Q

mechanism of aminoglycosides

A

cause misreading of mRNA and block translocation.

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55
Q

what is unique about uptake into the cell of aminoglycosies

A

require oxygen

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56
Q

are aminoglycosides bacteriostatis or cidal?

A

bacteriocidal

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57
Q

clinical use of amionglycosides

A

severe gram negative rod infections. neomycin for bowel surgery. can be used against pseudomonas

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58
Q

toxic side effects of aminoglycosides

A

nephrotoxic (especially when used with a cephalosporin),
neuromuscular blockage- blocks ach release
ototoxicity (especially when used with loop diuretics)
teratogen

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59
Q

resistance to amninoglycosides

A

bacteria produced enzymes that inactivate the drug by acetylation, phosphorylation or adenylation

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60
Q

what class of drugs do: tetracyclin, doxycycline and minocycline belong to?

A

tetracyclines.

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61
Q

cyclin drugs are…

A

tetracycline group. blocks the elongation so it cannot put a tRNA into the A group

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62
Q

why is doxycycline different?

A

eliminated via liver and colon so it can be used in patients with renal disease

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63
Q

what inhibits all tetracycline absorption in the gut?

A

any divalent cations like Ca2+ or Mg2+ or iron containing things. do not take with these.

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64
Q

what are tetracyclines used for?

A

can accumulate in the cell and makes them effective against things like ricketssia, chlamydia etc. also can be used to treat acne

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65
Q

what are side effects of tetracyclines?

A

discoloration of the teeth, inhibition of bone growth in children, photosensitivity

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66
Q

resistance to tetracyclines

A

bacteria has pumps that it uses to pump the drug out. pumps are plasmid encoded.

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67
Q

azithromycin, clarithromycin and erythromycin- what class of drug do these belong to?

A

macrolides. prevent translocation. bind to the 23S rRNA of the 50S ribosomal subunit. bacteriostatic.

68
Q

what do we use macrolides for?

A

atypical pneumonia (mycoplasma, chlamydia, legionella), STDs (chlamydia) and gram positive cocci

69
Q

what is the really important bug that macrolides kill that boards love to ask about?

A

legionella pneumophilia

70
Q

toxicity of macrolides

A

activate motilin receptors increasing GI movement, reversible deafness, rash, arrythmias from prolonged QT intervals, cholestatic hepatitis, eosinphilia.

can increase serum concentration of theophyllines, oral anticoagulants.

71
Q

drug resistance to macrolides

A

methylation of the 23S rRNA binding site so the drug can’t bind

72
Q

chloramphenicol

A

blocks peptidyltransferase function at the 50S ribosome. bacteriostatic

73
Q

chloramphenicol uses

A

meningitis (H influenza, N meningitidis, S pneumonia) and Rocky mountain spotted fever

74
Q

do we use chloramphenical in the US

A

no because of toxicity. very rare.

75
Q

toxicity of chloramphenical

A

anemia, aplastic anemia, gray baby syndrome in premature infants (see blue lips and blue baby because they lack the UDP glucuronyl transferase).

76
Q

resistance to chloramphenical

A

plasmid encoded acetyltransferase inactivates the drug

77
Q

mechanism of clindamycin

A

this is not a macrolide! it is similar though. it blocks translocation at 50s unit. bacteriostatic.

78
Q

function of clindamycin

A

treats anerobes above the diaphragm (metronidazole treats below the diaphragm). things like bacteirodes, C perfringes, aspiration pneumonia, lung abscess, oral infections. also treats Group A strep.

79
Q

toxicity from clindamycin

A

pseudomembranous colitis, fever, diarrhea

80
Q

drugs that end in “Zole” or have sulfa in them are…

A

sulfonamides.

81
Q

what enzyme do the sulfonamides inhibit?

A

dihydropteroate synthase

82
Q

what is the mecanism of sulfonamides

A

inhibit folate production which is necessary for bacteria

83
Q

what disease should you test for before giving sulfonamides?

A

G6PD deficiency

84
Q

toxicity of sulfonamides

A

hemolysis if G6PD, nephrotoxicity, photosensitivity, kernicterus, displace other drugs like warfarin from alubmin. likes to bind proteins!!!

85
Q

how can bacteria build resistance to sulfonamides

A

alter the dihydropteroate synthase enzyme or increase PABA

86
Q

what enzyme does trimethoprim inhibit

A

dihydrofolate reductase.

87
Q

what drug is trimethroprim commonly used with?

A

sulfamethoxazole- making the TMP-SMX combination

88
Q

what do you use TMP-SMX to treat?

A

UTIs, shigella, salmonella, pneumocytis jirovecii pneuumonia and prophalaxis, toxoplasmosis prophylaxis

89
Q

toxicity of trimethroprim

A

megaloblastic anemia, bone marrow supression

90
Q

what drugs end in “floxacin”…

A

floroquinolines.

91
Q

mechanism of floroquinolones

A

inhibit DNA gyrase (DNA topoisomerase II IV).

92
Q

what drug should you not take floroquinolones with?

A

antacids

93
Q

use of floroquinolones?

A

gram negative rods like pseudomonas, neisseria, soma gram positives.

94
Q

what does bacterial topoisomerase II do?

A

prevents supercoiling of bacteria so it can replicate the DNA

95
Q

what does bacterial topoisomerase IV do?

A

prevents sister chromatids from twisting. helps with G2 and mitosis phase.

96
Q

unique toxicity of floroquinolones

A

tendonitis, tendon rupture, increased QT interval, photosensitivity.

97
Q

why should you not use floroquinolones in pregnant women?

A

they have development issues with the cartilage.

98
Q

resistance to floroquinolones

A

chromosome encoded mutation in DNA gyrase, plasmid mediated resistance, efflux pumps.

99
Q

drug that prevents the introduction of negative super coils

A

quinolones!

100
Q

metronidazole mechanism

A

forms free radical toxic metabolites in the bacterial cell that damages DNA

101
Q

what do we use metronidazole to treat?

A

Giardia, Entameoba, Trichomonas, Gardenella vaginalis. can be used with a PPI to treat H pylori (and clarithromycin).

102
Q

what does metronidazole have to do with the diaphragm

A

we usually say it is used to treat infections below the diaphragm. clindamycin is used to treat infections above the diaphragm (anaerbic).

103
Q

unique metronidazole toxicities

A

disulfram like reaction and metallic taste.

104
Q

pneumonic for drugs to treat TB

A

RIPE: rifampin, isoniazid, pyrazinamide, ethambutol.

105
Q

how to prophylaxis against TB

A

isoniazid

106
Q

M avium intracellularae prophylaxis

A

Azithromycin, rifabutin

107
Q

drugs to treat M avium intracellurae

A

actually more resistant than TB itself. use azithromycin, clarithromycin, ethambutol as a minimum

108
Q

how to treat mycobacterium leprae infection

A

dapsone and rifampin for tuberculoid form.

109
Q

what drug do you use to treat lepromatous leprosy form?

A

dapsone, rifampin, clofazimine

110
Q

INH mechanism

A

decrease mycolic acid production.

111
Q

what does INH need to work?

A

bacterial catalase peroxidase (encoded by KatG) needed to convert INH to active drug

112
Q

toxicity from INH

A

neurotoxicity, hepatotoxicity, B6 deficiency, lupus

113
Q

what are both rifampin and rifabutin

A

rifamycins

114
Q

mechanism of rifamycins

A

inhibits DNA dependent RNA polymerase

115
Q

what do you use rifampin for

A

TB, leprosy, meningococcal prophylaxis and in close contacts (kids) with H influenza type B.

116
Q

toxicity of rifampin

A

increases P450, orange body fluids,

117
Q

in HIV patient, do you prefer rifampin or rifabutin?

A

rifabutin bc less increase in P450.

118
Q

pyrazinamide mechanism

A

unknown. thought to acidify intracellular envrionment via conversion to pyrazinoic acid. effective in acidic pH of phagolysosomes, where TB engulfed by macrophages is found.

119
Q

toxicity of pyrazinamide

A

hyperuricemia

120
Q

ethambutol mehcanism

A

blocks arabinosyltransferase which is necessary for carbohydrate polymerization of mycobacterium cell wall.

121
Q

unique toxicity of ethambutol

A

optic neuropathy- red green color blindness

122
Q

what do we give people to prevent endocarditis from surgical or dental procedures

A

penicillins

123
Q

what do we give people to prevent gonorrhea

A

ceftriaxone

124
Q

what do we give those with recurrent UTI infections

A

TMP/SMX

125
Q

what to give to prevent meningococcal infection

A

ciprofloxin for adults, rifampin for children

126
Q

what do we give pregnant women carrying group B strep?

A

ampicillin

127
Q

what do we give to prevent gonoccocal or chlamydia conjunctivitis in a newborn

A

erythromycin ointment.

128
Q

how to prevent post surgical infections with S aureus

A

Cefazolin

129
Q

prophylaxis of strep in a kid with prior rheumatic fever

A

oral penicillin

130
Q

how to prevent syphillis

A

Benzathine penicillin G

131
Q

prophylaxis when CD4<200 in HIV patient

A

TMP-SMX for pneumocystis pneumonia

132
Q

prophylaxis when CD4<100 in HIV patient

A

TMP-SMX for pneumocystic pneumonia and toxoplasmosis

133
Q

prophylaxis when CD4<50 in HIV patient

A

Azithromycin for mycobacterium avium complex

134
Q

how to treat MRSA

A

vanco, daptomycin, linezolid (can cause seratonin syndrome), cetaroline

135
Q

how to treat VRE

A

linezolid and streptogrammins

136
Q

mechanism of Amphotericin B

A

binds to ergosterol forms membrane pores and leaks electrolytes

137
Q

what does amphotericin B treat

A

serious systemic mycoses. can be combined with flucytosine for cryptococcoal meningitis. can be given intrathecally for fungal meningitis.

138
Q

what do you need to supplement with amphotericin B

A

K+ and Mg2+ because of altered renal tubule permeability

139
Q

toxic effects of amphotericin B

A

nephrotoxic, arrythmias, anemia, IV phlebitis, . hydration and liposomal amphotericin decrease toxicity

140
Q

nystatin

A

this is the topical form of amphotericin B. too strong for systemic use

141
Q

classic clinical use for nystatin

A

“swish and swallow”.. for oral candidiasis. topical for diaper rash and vaginal candidiasis

142
Q

azole mechanism

A

inhibit ergosterol synthesis by inhibiting the 14 alpha demethylase enzyme.

143
Q

what are azoles used for?

A

can be used for cryptococcal minigitis in AIDS patients and any other infections.

144
Q

treatment for blastomyces, coccidoides, histoplasma

A

Intraconazole

145
Q

topical fungal infection treatment

A

clotrimazole and miconazole

146
Q

toxicity of azoles

A

testosterone synthesis inhibition- gynecomastia, especially common with ketoconazole. can get liver issues, inhibits P450

147
Q

flucytosine mechanism

A

inhibits DNA and RNA biosynthesis by conversion of 5FU to cytosine deaminase. it is incorporated into the fungal RNA once three phosphates are added. also forms 5Fd-UMP which inhibits thymine production.

therefore blocks gene expression and DNA replication

148
Q

use of flucytosine

A

especially with amphotericin B in cryptococcal meningitis.

149
Q

toxicity of flucytosine

A

bone marrow supression

150
Q

caspofungin, micafungin, etc.

A

are all echinocandins

151
Q

mechanism of echinocandins

A

inhibits cell wall synthesis by inhibiting synthesis of beta glucan.

152
Q

clinical use of echinocandins

A

invasive aspergillosis and candida

153
Q

toxicity of echinocandins

A

flushing -increased histamine

154
Q

Terbinafine

A

inhibits the fungal enzyme squalene expoxidase, which is the first enzyme in ergosterol production.

155
Q

clinical use of terbinafine

A

dermatophytes- especially of the nails

156
Q

griseofulvin mechanism

A

interferes with microtubule formation and disrupts mitosis. deposits in the keratin containing tissues so it stays on the skin and nails.

157
Q

clinical uses of griseofulvin

A

oral treatment of superficial infections. inhibits growth of dermatophytes.

158
Q

toxicity of griseofulvin

A

teratogenic, carcinogenic, condusion, increase P450 and warfarin metabolism

159
Q

what does pyrimethamine treat

A

toxoplasmosis

160
Q

what do suramin and melarsoprol treat

A

Trypanosome brucei

161
Q

what does nifurtimox treat?

A

T. cruzi

162
Q

what does sodium stibogluconate treat?

A

leishmaniasis

163
Q

chloroquine mechanism

A

this blocks detoxification of heme into hemozoin. heme accumualtes and is toxic to plasmodium.

164
Q

chloroquine clinical use

A

plasmodium other than falciporum bc resistance is too high. resistance comes from membrane pumps to decrease intracelular concentration of the drug.

165
Q

how to treat malaria

A

artemether/lumefantrine or atovaquone/proguanil.

166
Q

how to treat life threatening malaria in US

A

quinidine or artesunate

167
Q

praziquantel

A

should be used to treat flukes (trematodes) like shistosoma

FA Microbiology (7 decks)

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