Inhibits dihydrofolate reductase - Used in combo with Sulfonamethoxazole (TMP-SMX) to treat UTI inxn, - Shigella, Salmonella infxn - Pneumocystis jirovecci pneumonia prophylaxis (AIDS pts, when CD4 count is <200) - Toxoplasmosis prophylaxis

1. E. coli 2. Staph saprophyticus 3. Klebsiella 4. Proteus mirabilis

Micro Flashcards by Jeff Atherton

MOA: Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine

Folate synthesis inhibition via inhibition of dihydropteroate synthase.
Bacteriostatic
Use: UTI

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Toxicity of Sulfamethoxazole?

Hemolysis in G6PD deficient pt, Nephrotoxicity, Photosensitivity (SAT for a photo), Kernicterus in infants

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MOA of Trimethoprim?

Inhibits dihydrofolate reductase

Used in combo with Sulfonamethoxazole (TMP-SMX) to treat UTI inxn,
Shigella, Salmonella infxn
Pneumocystis jirovecci pneumonia prophylaxis (AIDS pts, when CD4 count is <200)
Toxoplasmosis prophylaxis

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AE of Trimethoprim sulfate?

Megaloblastic anemia, leukopenia, granulocytopenia (all due to low folic acid)
“TMP: Treats Marrow Poorly”

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Name 3 Flouroquinolones

Ciprofloxacin, Levofloxacin, Moxifloxacin… “Floxacins”

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MOA of Flouroquinolones

Inhibit DNA gyrase (topoisomerase II)

-Bactericidal

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What must not be taken when on a flouroquinolone?

Antacids

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When do we use flouroquinolones?

G- rods
UTI
GI infxn
Later generations (Levofloxacin, Moxifloxacin) used for G+ infxns (like s. pneumonia)

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AE of Flouroquinolones

Damage to cartilage (tendon rupture)

“FlouroquinoLONES hurt attachment to your BONES)

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MOA of Metronidazole

Forms free radical toxic metabolites in the bacterial cell that damage DNA
-Bactericidal, antiprotozoal

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What bugs do you treat with metronidazole?

Giardia, Entamoeba, Trichomonas, Garnerella vaginalis, Anaerobes (Bacteroides, C. dificile), H. Pylori
“GET GAP on the metro with Metronidazole”
-Part of triple therapy for H. pylori (PPI, Clarithromycin, Metronidazole or Amoxicillin)

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Why can’t you drink alcohol with metronidazole?

Disulfiram-like reaction (flushing, tachycardia, hypotension, headache)

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MCC of UTI?

E. coli
Staph saprophyticus
Klebsiella
Proteus mirabilis

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MC med used for UTI prophylaxis?

TMP-SMX

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MC bacteria in a pt with Struvite kidney stone

Proteus mirabilius

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Name 3 Spirochetes

Borrelia, Leptospira, Treponema

“BLT”

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What do surfers get when they swim in dolphin pee?

Leptospira interrogans

water contaminated with animal urine
Leptospirosis: flu symptoms, jaundice, photophobia, conjunctival suffusion
Prevalent among surfers and tropics

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What causes Weil disease?

Leptospira interrogans

ictohemorrhagic leptospirosis
severe from with jaundice and azotemia from liver and kidney disfunction; fever; hemorrhage, and anemia

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What is vector for Borrelia burgdorferi?

Ixodes tick

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What is Borrelia burgdorferi’s natural reservoir?

Mouse

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Initial symptoms of Lyme dz?

Erythema chronicum migrans, flu symptoms, +/- bilateral bell’s palsy

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Later symptoms of Lyme dz?

Monoarthritis (painful knee), Migratory polyarthritis, AV nodal block, Bilateral bell’s palsy
“FAKE a key Lyme pie”
Facial nerve palsy, Arthritis, Kardiac block, Erythema migrans

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Tx for Lyme dz

Doxycycline, ceftriaxone

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Bacterial overgrowth, fishy smell, Clue cell

Gardnerella vaginalis (bacterial vaginosis)

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Fever, Rash on palms and soles, Tick

RMSF

Fever, Tick, Central rash that spreads outwards

Rickettsiae prowazekii and typhi

Ectopic pregnancy, urethritis, infertility

Chlamydia trachomatis

Transmitted via aerosol, treated with doxycycline or azithromycin, interstitial pneumonia

M. pneumonia, Chlamydia pneumonia

Q fever, spore former, negative Weil Helix

Coxiella burnetti

Man w/ pneumonia has sputum that doesn't gram stain. Silver stain identifies a G- rod. Causative organism?

Legionella pneumophila

Common cause of pneumonia in immunocompromised pts

Pneumocystis jeroveci

MCC of atypical (walking) pneumonia

Mycoplasma pneumoniae

Common cause of pneumonia in alcoholics

Klebsiella pneumoniae

Bird handler with interstitial pneumonia

Chlamydia psittaci

Bat droppings in caves

Histoplasma

Cause of pneumonia in pt who has visited Southern California, New Mexico or West TX

Coccidioides

Pneumonia with "currant jelly" sputum

Klebsiella

Q fever

Coxiella burnetii

Pneumonia from an AC unit

Legionella pneumophila

MCC of pneumonia in child <1 y/o

RSV

MCC of pneumonia in the neonate (birth-28 days)

GBS, E. coli

MCC of pneumonia in children and young adults

Mycoplasma pneumonia

MCC of viral pneumonia

RSV

Causes Wool-sorter's dz

Bacillus anthracis

Common pneumonia in ventilator pts and those with cystic fibrosis

Pseudomonas auruginosis

Pontiac fever

Legionella

How do Cephalosporins work?

Beta-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases than the penicillins

Which has greater effect on G+ organisms, 1st gen cephalosporins or 4th gen cephalosporins?

1st gen have more G+ effect, 4th gen has more G- effect

What are the 1st generation cephalosporins?

Cefazolin, Cephalexin

What bugs are the 1st gen cephalosporins used to treat?

"PEcK" Proteus mirabilis E. coli Klebsiella

What are the 2nd generation cephalosporins?

Cefoxitin, Cefaclor, Cefuroxime

What bugs do the 2nd gen cephalosporins treat?

``` "HENS PEcK" Haemophilus influenzae Enterobacter aerogenes Neisseria spp Serratia marcescens Proteus mirabilis E. coli Klebsiella ```

What are the 3rd generation cephalosporins?

Ceftriaxone, Cefotaxime, Ceftazidime

What are 3rd gen cephalosporins used for?

Serious G- infections resistant to other beta-lactams

What illnesses are Ceftriaxone used for?

Meningitis, Gonorrhea infxn

What bug is Ceftazidime used to treat?

Pseudomonas

What is the 4th generation cephalosporin?

Cefepime

WHat is the 5th gen cephalosporin?

Ceftaroline

What organisms are typically not covered by cephalosporins?

``` "LAME" Listeria Atypical bacteria (Chlamydia, Mycoplasma) MRSA (except Ceftaroline) Enterococci ```

What are the bacterial protein synthesis inhibitors that target the 30S ribosomal subunit?

"Buy AT 30, CCEL (sell) at 50" 30S inhibitors: Aminoglycosides Tetracyclines

what are the 50S bacterial protein synthesis inhibitors?

``` "Buy AT 30, CCEL at 50" Chloramphenicol Clindamycin Erythromycin Linezolid ```

What drugs comprise the Aminoglycosides?

``` "Mean GNATS caNNOT kill anaerobes" Gentamicin Neomycin Amikacin Tobramycin Streptomycin ``` Nephrotoxicity NM toxicity Ototoxicity Teratogen

What drug causes Gray baby syndrome?

Chloramphenicol

What drug causes Gray man syndrome?

Amiodarone

What drug causes Red man syndrome?

Vancomycin

What are the clinical uses of the macrolides?

"PUS" Pneumonia URI STDs

Prophylaxis for meningococcal meningitis

Ciprofloxacin (flouroquinolone) | Rifampin for kids (cipro damages cartilage in kids)

Prophylaxis for gonorrhea

Ceftriaxone (3rd gen cephalosporin)

History of recurrent UTI

TMP-SMX

Prophylaxis for endocarditis following dental procedure

Penicillin (think strep veridans with dental procedures)

What do we give a pregnant woman with GBS infxn?

Ampicillin during labor to prevent transmission to the baby

Gonoccal or chlamydial conjunctivitis in newborn

Erythromycin ointment (Macrolide)

What's the DOC for anthrax infxn?

Ciprofloxacin

What drug types are useful against Pseudomonas?

Flouroquinolones, Extended spectrum penicillins, 3rd generation cephalosporins, Cefepime, Aztreonam, aminoglycosides, polymixin

Pneumonia in neonate

E. coli, GBS

What are the associated symptoms with Toxoplasma infection of a newborn?

(ToRCHeS infxn) | Triad: Chorioretinitis, hydrocephalus, intracranial calcifications

What is the classic triad of symptoms for rubella infection?

(ToRCHeS) | Triad: PDA, cataracts, deafness

What is the MC ToRCHeS infxn?

CMV

CMV neonatal infxn

**Unilateral hearing loss | Seizures, chorioretinitis, hydrocephalus, intracranial calcifications

What complication can Parvovirus B19 cause in a fetus?

Hydrops fetalis

What are the ToRCHeS infections?

``` Toxoplasma Other-ParvoB19 Rubella CMV Herpes/HIV Syphilis ```

MCC of UTI in hospitalized pt

E. coli

Clue cells

Bacterial vaginosis (Gardnerella)

Painless genital ulcer

Syphilis chancre

Strawberry cervix caused by flagellated cells

Trichomonas

Inhibits 50S peptidyltransferase

Chloramphenicol

Binds 50S, blocking translocation

Macrolides, Lincomycin, Clindamycin, Streptogramins

Binds 30S, prevents attachment of tRNA

Tetracyclines

Inhibits prokaryotic RNA polymerase

Rifampin

Inhibits Prokaryotic topoisomerase

Fluoroquinolones

inhibits prokaryotic DHFR

Trimethoprim

Where are mRNA and tRNA synthesized

Nucleoplasm (liquid portion of the nucleus)

where is rRNA synthesized?

Nucleolus

Dark purple nodules on the skin of an HIV patient

Kaposi Sarcoma (HHV-8)

Temporal lobe encephalitis

HSV-1

Owl's eye inclusions in organ tissue

CMV infxn (don't get these confused with Reed Sternberg cells seen w/ Hodgkins lymphoma)

Intranuclear eosinophilic droplets

Cowdry bodies (HSV, CMV)

What test is used to diagnose HSV-1, HSV-2 and VZV

Tzanck test (Tzanck heavens I don't have herpes!)

Aplastic anemia in a sickle cell patient

ParvoB19

Child with fever and "slapped cheek" rash on the face that spreads to his body

Fifth dz (ParvoB19)

Fever, runny nose, cough, conjunctivitis, and diffuse rash

Measles (Rubeola>Cough, Conjunctivitis, Coryza)

Small, irregular blue-gray spots on the buccal mucosa, surrounded by a base of red

Koplick's spots (measles)