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First Aid Drugs > Micro > Flashcards

Micro Flashcards

1
Q

Pn: G vs. V?

- mech, clin use, tox, resistance

A

G is IV/IM, V is PO

  • binds PBPs (transpeptidases) -> can’t X-link PG, act autolytic NZs
  • Gm+, N.meningitidis, Syph
  • hypersensitivity rxns, hemolytic anemia
  • b-lactamases cleave b-lactam ring
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2
Q

Oxacillin, nafcillin, dicloxacillin =

- mech, clin use, tox

A

= Pn-ase resistant Pns

  • same as Pn, bulky R gp blocks b-lactamase from cleaving b-lactam ring
  • S.aureus (except MRSA)
  • hypersensitivity rxns, interstitial nephritis
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3
Q

Amp/amox =

- mech, clin use, tox, resistance

A

= AminoPns

  • same as Pn but wider spectrum; amOx has greater PO bioav than amp
  • HELPSSS kill enterococci: H.flue, E.coli, Listeria, Proteus, Salmonella, Shigella, enterococci
  • hypersensitivity rxns, amp rash, pseudomem colitis
  • b-lactamase sensitive
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4
Q

Ticarcillin, piperacillin =

- mech, clin use, tox

A

= antipseudomonals

  • like Pn, extended spectrum
  • Pseudomonas, GNR, use w/ calvulanic acid
  • hypersensitivity rxns
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5
Q

b-lactamase inhib’s =

A

Clavulanic acid
Sulbactam
Tazobactam

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6
Q

Cephalosporins

  • mech
  • tox
  • org’s not usu covered inc
A
  • b-lactams; inhib cell wall syn, less susceptible to Pn-ases
  • hypersensitivity rxns, VitK defic, low X-rctivity w/ Pns, incr nephrotox of aminoglycosides
  • LAME: Listeria, Atyps (Chlamydia, Mycopl), MRSA (except w/ Ceftaroline), Enterococci
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7
Q

1st gen. Cephalosporins =
- use for?
2nd gen. =
- use for?

A
  • Cefazolin, Cephalexin
  • Gm+ cocci + PEcK: Proteus, E.coli, Klebsiella
  • Cefoxitin, Cefaclor, Cefuroxime
  • Gm+ cocci + HEN PEcKS: H.flue, Enterobacter, Neisseria, PEcK, Serratia
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8
Q

3rd gen. Cephalosporins =

- use for?

A

Ceftriaxone, cefotaxime, ceftazidime

- Serous Gm- infec’s resistant to other b-lactams; ceftriaxone for N.meningitis and NG, ceftazidime for pseudomonas

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9
Q

4th gen Cephalosporin =

- use for?

A

Cefepime

- Pseudomonas and Gm+

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10
Q

Aztreonam

- mech, clin use, tox

A
  • monobactam resistant to b-lactamases, binds PBP3 so no PG X-links, synergistic w/ aminoglycosides, no X-allergenicity w/ Pns
  • GNRs only (NOT for Gm+ or anaerobes), for Pn-allergic pt’s or bad kidneys (no aminoglycosides)
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11
Q

Imipenem/cilastatin, meropenem

- mech, clin use, tox, resistance

A
  • broad-spectrum b-lactamase resistant; give w/ cilastatin to inhib renal dihydropeptidase I to decr it’s inact’n in tubules
  • Gm+ cocci, GNRs, anaerobes; only use when life-threatening and/or all other drugs failed; meropenem has less risk of seizures and is stable to dihydrop. I
  • GI distress, skin rash, CNS tox (seizures) at high pl levels
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12
Q

Vancomycin

- mech, clin use, tox, resistance

A
  • binds D-ala D-ala of cell wall precursors -> no PG forms
  • Gm+ only (MRSA, enterococci, C.dif), give PO for pseudomembranous colitis (or give metronidazole)
  • Well tolerated in gen…NOT: Nephrotox, Ototox, Thrombophlebitis (red man synd)
  • Resistance: change D-alaD-ala to D-alaD-lac
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13
Q

Pr syn inhib’s (at 30 + 50S)

A

buy AT 30, CCEL at 50:

  • 30S: aminoglycosides (bactericidal), tetracyclines (bacteriostatic)
  • 50S: Chloramphenical, Clindamycin, Erythromycin (macrolides) [all are bacteriostatic], Linezolid (variable)
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14
Q

Aminoglycosides =

- mech, clin use, tox, resistance

A

= TANGS: Tobramycin, Amikacin, Neomycin, Gentamicin, Streptomycin

  • bac-cidal; disrupt initiation complex -> misread mRNA (give parentally)
  • AEROBES only (need O2 for uptake); GNR infec’s, synergistic w/ b-lactams (make hole in cell mem); neomycin for bowel surgery (kills urease+, so also for high NH3), pyelo (gentamycin+amp)
  • NNOT good: Nephrotox aka ATN (esp w/ cephalosporins), NM block, Ototox (ALOe, w/ loop diuretics), Teratogen (deaf, hurts CN8)
  • Resistance: acetylation, phos’n, adenylation of drug
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15
Q

Tetracyclines =

  • mech, clin use, tox, resistance
  • which can you use w/ renal failure?
  • don’t take w/?
A

= Tetracycline, doxycycline, demeclocycline, minocycline

  • bac-static; bind 30S, prevent attachment of aminoacyl-tRNA to A site; limited CNS entry
  • VACUUM THe BedRoom: Vibrio, Acne, CT, Ureapl Urely, Mycobl, Tularemia, Hp, Borrelia (Lyme dz), R.richettsii (RMSF)
  • teeth discolor in kids, photosensitivity in adults
  • decr’d uptake/incr’d efflux (plasmid gene)
  • doxycycline bc fecally elim’d
  • milk, antacids, Fe-preps bc divalent cations inhib its ab’n in gut
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16
Q

Macrolides =

- mech, clin use, tox, resistance

A

= MACE: Macrolides, Azithromycin, Clarithromycin, Erythromycin

  • bac-static, bind 23S of 50S, block translocation step
  • atyp pneumos (mycopl, Ct, legionella), STDs (Ct), Gm+ cocci (strep infec w/ Pn allergy)
  • MACRO: Motil issues (help w/ postop ileus), Arrhythmia (long QT), acute Cholestatic hepatitis (erythro bc out in bile), Rash, eO’s; incr’d serum conc of theophyllines and PO anticoag’s
  • methylation of 23S rRNA binding site
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17
Q

Chloramphenicol

- mech, clin use, tox, resistance

A
  • bac-static; blocks peptidyltransferase at 50s (no peptide bond formed)
  • meningitis (H.flue, N.meningitidis, S.pneumo), cheap so used in 3rd world [lipophilic so enters CNS]
  • anemia (dose-dep), aplastic anemia (dose-indepen), gray baby synd (in premature infants bc no liver UDP-glucuronyl transferase)
  • plasmid-encoded acetyltransferase inact’s drug
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18
Q

Clindamycin

- mech, clin use, tox

A
  • bac-static; blocks peptide transfer (transpeptidation) at 50S
  • Anaerobe infec’s in asp. pneumo or lung abscesses; oral infec’s w/ mouth anaerobes (ABOVE diaphragm, metronidazole does below)
  • Pseudomem colitis!!! (C.dif overgrowth), F, D
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19
Q

Sulfonamides =

- mech, clin use, tox, resistance

A

SMX, sulfisoxazole, silfadiazine

  • bac-static, PABA antimetabolites inhib dihydropteroate synthase
  • Gm+/-, Nocardia (SNAP), Ct; 3x sulfas or SMX for UTI
  • HSRs, hemolysis in G6PD, nephrotox (TIN), photosensitivity, kernicterus in infants (bc displace drugs (warfarin/bili) from alb)
  • altered NZ, decr’d uptake, incr’d PABA syn
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20
Q

Trimethoprim

  • mech, clin use, tox, resistance
  • rescue trtmt w/?
A
  • bac-static; inhib’s dihydrofolate reductase
  • use w/ SMX for 2x block of folate syn (-cidal together); UTIs, Shigella, Salmonella, PCP
  • Megaloblastic anemia, -penia’s
  • Leucovorin (folinic acid)
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21
Q

FQ’s =

  • mech, clin use, tox, resistance
  • don’t take w/
  • C/I’d in?
A

= “-oxacin” + nalidixic acid (a quinolone)

  • inhib DNA gyrase (topoII) and topoIV so no DNA “nicking”; bac-cidal
  • GNRs of GI/UT (inc Pseudom.), UTI if sulfa allergy, D (Shigella, ETEC), H.flue
  • GI, superinfec’s, rash, HA, dizziness (less common: tendonitis, tendon rupture, leg cramps, myalgias), long QT, tendon rupture in >60yo and in pt’s on prednisone
  • CHR-encoded mutation in DNA gyrase
  • antacids
  • preg bc damages cart
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22
Q

Metronidazole

- mech, clin use, tox

A
  • forms FRs in bac cell that damage DNA; bac-cidal, antiprotozoal
  • GET GAP on the metro: Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes (Bacteroides, C.dif), h.Pylori (w/ PPI + clarithromycin for 3x tx), + cream for acne rosacea
  • disulfiram-like rxn w/ EtOH, HA, metallic taste
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23
Q

MTb trtmt

- prophylaxis w/?

A

RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol

- INH

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24
Q

MAC trtmt

- prophylaxis w/? when?

A

Azithromycin, rifampin, ethambutol, streptomycin

- azithromycin, HIV and CD4 <50

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25
Q

M. leprae trtmt

A

Tuberculoid: LT dapsone + rifampin
Lepromatous: LT dapsone + rifampin + clofazimine

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26
Q

Isoniazid (INH)

  • mech, clin use, tox
  • to prevent SEs?
  • phenotypic var in metab is due to?
A
  • decr’d syn of mycolic acids, needs bac cat-peroxidase (KatG) to activate (keto-acyl/acyl-carrier pr syn)
  • MTb, used alone for prophylaxis
  • INH Injures Neurons and Hepatocytes: neuroto, hepatotox
  • Give B6 to prevent neurotox (bc inhib’s pyridoxal kinase that act’d B6) [sx: paresthesias, seizures from no GABA], SLE
  • Fast vs. slow acetylators (act’n step)
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27
Q

Rifampin

  • mech, clin use, tox
  • 4 Rs of Rifampin?
A
  • inhib’s DNA-dep RNAP (binds b-subunit)
  • MTb, delays resistance to dapsone when used for leprosy; contacts of kids w/ HiB or N. meningitis get it for prophylaxis
  • minor hepatotox and drug interactions (incr P450 -> HIV pt’s on PIs get Rifabutin), orange body fluids
  • RNAP inhib, Revs up P450, Red/orange body fluids, Rapid resistance if used alone
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28
Q

Pyrazinamide

- mech, clin use, tox

A
  • KO’s FAS I, effective in acidic envt of phagolysosome in Mphage
  • MTb (needs act’n by Mtb like INH)
  • hyperuricemia (GOUT), heptotox
29
Q

Ethambutol

- mech, clin use, tox

A
  • blocks arabinosyltransferase -> decr’d carb polymerization of mycobac cell wall
  • MTb
  • optic neuropathy (red-green color blindness)
30
Q

Give which drug:

  • hx of UTIs
  • preg w/ GBS
  • prevent post-op S.aureus
  • prevent GC or Ct conjunctivitis in newborn
  • MRSA
  • VRE
A
  • TMP-SMX
  • Amp
  • Cefazolin
  • Erythromycin ointment
  • Vanc
  • Linezolid or streptogramins (quinupristin/dalfopristin)
31
Q

AmphoB

  • mech, clin use, tox
  • supplement?
A
  • binds ergosterol (in fungi) -> mem pore -> electrolytes leak out
  • serious systemic mycoses (Crypto, Blasto, Cocci, Histo, Candida, Mucor); IT for fungal meningitis
  • F/chills (shake and bake), hypotension, nephrotox, arrhythmias, anemia, IV phlebitis,
  • K and Mg bc of altered renal tub permeability; hydrate to reduce nephrotox!
32
Q

Nystatin

- mech, clin use

A
  • same as amphoB, binds ergosterol to make mem pore and electrolytes leak; topical only bc too toxic for sys use
  • “swish and swallow” for oral thrush; topical for diaper rash or vaginal candidiasis
33
Q

Azoles =

- mech, clin use, tox

A

“-azole”

  • inhib ergosterol syn in fungi by inhib P450 NZ that converts lanosterol to ergosterol
  • local/less serious sys mycoses; fluconazole for chronic supp’n of Crypto mening. in AIDS, and for candida; itraconazole for Blasto, Cocci, Histo; for tropical fungi use clotrimazole and miconazole
  • inhib’s testos syn (gynecomastia, esp w/ ketaconazole), liver dysfunc (inhib’s P450)
34
Q

Flucytosine

- mech, clin use, tox

A
  • inhib’s DNA/RNA biosyn bc active is 5-FU (via cytosine deaminase)
  • systemic fungal infec’s (Crypto mening) in combo w/ AmphoB
  • BM supp’n
35
Q

Caspofungin, micafungin

- mech, clin use, tox

A
  • inhib b-glucan syn -> inhib fungi cell wall syn
  • invasive aspergillosis, Candida
  • GI upset, flushing (Hist release)
36
Q

Terbinafine

- mech, clin use, tox

A
  • inhib’s fungal NZ squalene epoxidase
  • dermatophytes (esp onychomycosis on nails)
  • abnl LFTs, visual disturbances
37
Q

Griseofulvin

- mech, clin use, tox

A
  • interferes w/ microtubule func; disrupts mitosis; deposits in keratin-containing tissues (nails)
  • PO for superficial infec’s, inhib’s dermatophyte growth
  • teratogenic, carcinogenic, confusion, HAs, incr P450 and warfarin metab
38
Q

Antiprotozoan tx:

  • Toxoplasma (and malaria)
  • Trypanosoma brucei
  • T. cruzi
  • Leishmaniasis
A
  • Pyrimethamine
  • Suramin + melarsoprol
  • Nifurtimox
  • Sodium stibogluconate
39
Q

Chloroquine

- mech, clin use, tox

A
  • blocks detox of heme into hemozoin, heme accum’s and is toxic to plasmodia
  • plasmodial sp other than P. falciparum (resistance bc mem effluc pump)
  • retinopathy
40
Q

P. falciparum trtmt

For life threatening malaria, use?

A

Artemether/lumifantrine or atovaquone/proguanil

- quinidine (quinine) or artisunate

41
Q

Antihelminthic tx =

- for flukes like Schistosoma?

A

Mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziquantel -> immobilize helminths
- Praziquantel

42
Q

Zanamivir, oseltamivir

- mech, clin use

A
  • inhib influenza NA so no viral release (stuck in cells); is a sialic acid analogue
  • trtmt and prevention of influenza A and B
43
Q

Ribavirin

- mech, clin use, tox

A
  • inhib syn of G nt’s by competitively inhib’ing IMP DH
  • RSV, chronic HepC (RibHavirin)
  • Hemolytic anemia, teratogen
44
Q

Acyclovir

  • mech, clin use, tox
  • method of resistance
A
  • G analog; monophos’d by vTK -> tri-P by cell NZs, inhib’s DNAP by chain termination
  • 1-4: HSV and VZV, wk vs. EBV, NOT for CMV (HSV mucocut/genital lesions and encephalitis; prophylaxis in immcomp’d); don’t take PO, decr’d length of viral outbreak
  • few
  • mutated viral TK
45
Q

Valacyclovir =

- why take?

A

prodrug of acyclovir (G analog, needs viral TK and cell NZs to phos it) -> chain termination in HSV/VZV
- better bioavailability, take PO qD to decr recurrence of outbreaks

46
Q

Famciclovir =

A

like acyclovir, but for herpes zoster (shingles)

FAMily, old guy, shingles

47
Q

Ganciclovir

  • mech, clin use, tox
  • method of resistance
A
  • G analog, 5’P’d by CMV kinase -> tri-P’d by cell kinases; inhib’s viral DNAP
  • CMV (diff DNAP than HHV1-4), esp in immcomp’d
  • leukopenia, neutropenia, thrombocytopenia, renal tox; more toxic than acyclovir!
  • mutated CMV DNAP or lack of v. kinase
48
Q

Valganciclovir =

A

prodrug of ganciclovir (G analog for CMV, needs viral and IC kinase activity to be active)
- better bioavailability

49
Q

Foscarnet

  • mech, clin use, tox
  • method of resistance
A
  • inhib’s vDNAP bc binds to pyroPHOSphate-binding site of NZ; doesn’t need viral TK to be active (is pyroPHOSphate analog)
  • CMV retinitis in immcomp’d when gancyclovir fails; acyclovir-resistant HSV
  • nephrotox, hypoCa/K/Mg
  • mutated DNAP
    [Fast Car! Everything moves so fast get kidney problems and can’t reab things!)
50
Q

Cidofovir

- mech, clin use, tox

A
  • inhib’s vDNAP, doesn’t need IC act’n
  • CMV retinitis in immcomp’d; acyclovir-resistant HSV; long t 1/2
  • nephrotox (coad w/ probenecid and IV saline to reduce tox)
51
Q

HIV PI’s =

  • MoA
  • which drug can incr their metab’n?
  • SEs
A

“-navir” = Lopinavir, Atazanavir, Darunavir, Fosamprenavir, Saquinavir, Ritonavir, Indinavir

  • prevent pol gene (protease) from cleaving trsn’d pr into func’l parts
  • Ritonavir (rev’s up P450)
  • hyperGlc, GI intol, lipodystrophy; indinavir has nephropathy and hematuria
52
Q

HIV NRTIs

  • MoA
  • act’n?
  • tox
A
  • inhib nt binding to RT and term DNA chain bc don’t have 3’OH
  • All but Tenofovir (nt analog) are nucleoside analog’s and need to be phos’d to be active
  • BM supp’n (reverse w/ G-CSF and EPO), periph neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), anemia (ZDV)
53
Q

Tenofovir (TDF) =

A

NRTI, nt analog so doesn’t need act’n

54
Q

Emtricitabine (FTC) =

A

NRTI, nucleoside analog so needs phos’n to be active

55
Q

Abacavir (ABC) =

A

NRTI, nucleoside analog so needs phos’n to be active

56
Q

Lamivudine (3TC) =

A

NRTI, nucleoside analog so needs phos’n to be active

57
Q

Zidovudine (ZDV, formerly AZT) =

- SE

A

NRTI, nucleoside analog so needs phos’n to be active

- anemia

58
Q

Didanosine (ddI) =

A

NRTI, nucleoside analog so needs phos’n to be active

59
Q

Stavudine (d4T) =

A

NRTI, nucleoside analog so needs phos’n to be active

60
Q

NNRTIs = (3)

- MoA, tox

A

NED = Nevirapine, Efavirenz, Delavirdine

  • bind RT at site diff than NRTIs, don’t need phos’n to be active
  • same as NRTIs: BM supp’n, periph neuropathy, rash
61
Q

Integrase inhib =

- MoA, tox

A

Raltegravir

  • reversibly inhib’s HIV integrase so no HIV genome insertion into host chr
  • hypercholesterolemia
62
Q

Raltegravir =

A

integrase inhib

63
Q

Nevirapine =

A

NNRTI

64
Q

Efavirenz =

A

NNRTI

65
Q

Delavirdine =

A

NNRTI

66
Q

IFNs

- mech, clin use (IFNa/b/g), tox

A
  • block rep’n of RNA and DNA viruses bc are gp’s made by virus-infected cells
  • IFNa for chronic HepB/C and Kaposi’s, IFNb for MS, IFNg for CGD
  • neutropenia, myopathy
67
Q

Which Abx to not use during preg?

What are their SEs?

A 
"SAFe Children Take Really Good Care"
Sulfonamides (kernicterus)
Aminoglycosides (ototox, deafness, CNVIII)
FQs (cart damage)
Clarithromycin (embryotoxic)
Tetracyclines (discolored teeth, inhib of bone growth)
Ribavirin (antiviral, teratogenic)
Griseofulvin (antifunal, teratogenic)
Chloramphenicol (gray baby)
68
Q

Polymyxins

- MoA, tox, use in?

A

Detergents on cell mem (long hydrophobic tail that’s cationic and basic) -> disrupt osmotic prop’s

  • BIG neuro/nephrotox, only use when all other Rx failed
  • VPN media for NG
69
Q

Daptomycin

- MoA, use for, tox

A

creates mem ch’s -> depol and disrupt mem potention

  • Gm+ ONLY (can’t work w/ Gm- wall), not pneumo bc surfactant inact’s it
  • myopathy w/ incr’d CPK (don’t use w/ statins/fibrates)

First Aid Drugs (13 decks)

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