Micro Flashcards
MOA: Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
Folate synthesis inhibition via inhibition of dihydropteroate synthase.
Bacteriostatic
Use: UTI
Toxicity of Sulfamethoxazole?
Hemolysis in G6PD deficient pt, Nephrotoxicity, Photosensitivity (SAT for a photo), Kernicterus in infants
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
AE of Trimethoprim sulfate?
Megaloblastic anemia, leukopenia, granulocytopenia (all due to low folic acid)
“TMP: Treats Marrow Poorly”
Name 3 Flouroquinolones
Ciprofloxacin, Levofloxacin, Moxifloxacin… “Floxacins”
MOA of Flouroquinolones
Inhibit DNA gyrase (topoisomerase II)
-Bactericidal
What must not be taken when on a flouroquinolone?
Antacids
When do we use flouroquinolones?
G- rods
UTI
GI infxn
Later generations (Levofloxacin, Moxifloxacin) used for G+ infxns (like s. pneumonia)
AE of Flouroquinolones
Damage to cartilage (tendon rupture)
“FlouroquinoLONES hurt attachment to your BONES)
MOA of Metronidazole
Forms free radical toxic metabolites in the bacterial cell that damage DNA
-Bactericidal, antiprotozoal
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)
Why can’t you drink alcohol with metronidazole?
Disulfiram-like reaction (flushing, tachycardia, hypotension, headache)
MCC of UTI?
- E. coli
- Staph saprophyticus
- Klebsiella
- Proteus mirabilis
MC med used for UTI prophylaxis?
TMP-SMX
MC bacteria in a pt with Struvite kidney stone
Proteus mirabilius
Name 3 Spirochetes
Borrelia, Leptospira, Treponema
“BLT”
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
What causes Weil disease?
Leptospira interrogans
- ictohemorrhagic leptospirosis
- severe from with jaundice and azotemia from liver and kidney disfunction; fever; hemorrhage, and anemia
What is vector for Borrelia burgdorferi?
Ixodes tick
What is Borrelia burgdorferi’s natural reservoir?
Mouse
Initial symptoms of Lyme dz?
Erythema chronicum migrans, flu symptoms, +/- bilateral bell’s palsy
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
Tx for Lyme dz
Doxycycline, ceftriaxone
Bacterial overgrowth, fishy smell, Clue cell
Gardnerella vaginalis (bacterial vaginosis)
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)