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micro - antimicrobials Flashcards

1
Q

inhibiting peptidoglycan cross-linking –> block cell wall synthesis

A

penicillin, methicillin, ampicillin, piperacillin

cephalosporins, zaztreonam, imipenem

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2
Q

block peptidoglycan synthesis

A

bacitran and vancomycin

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3
Q

inhibit folic acid synthesis (methylation) –> block nucleotide synthesis

A

sulfonamides, trimethroprim

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4
Q

block DNA topoisomerase

A

fluoroquinolones

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5
Q

block mRNA synthesis

A

rifampin

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6
Q

damage DNA

A

metronidazole

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7
Q

block protein synth at 50S ribosomal unit

A

chloramphenicol, clindamycin, linezolid, macrolides, streptogramins (-pristin)

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8
Q

block protein synth at 30S ribosomal unit

A

aminoglycosides, tetracycline

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9
Q

macrolides MOA

A

block 50S

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10
Q

penicillin general

A

prototype beta lactam, blocks peptidoglycan cross linking - inhibits cell wall synthesis

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11
Q

penicillin MOA

A

binds penicillin-binding protein (transpeptidases) –> block transpeptidase cross-linking of peptidoglycan
activate autolytic enzymes

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12
Q

penicillin clinical use

A

gram positive organisms - strep pneumo, strep pyogenes, actinomyces
neisseria meningitis, treponema pallidum, syphilis

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13
Q

penicillin toxicity

A

hypersensitivity rxn

hemolytic anemia

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14
Q

penicillin resistance

A

beta-lactamase cleaves beta-lactam ring

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15
Q

penicillin G

A

IV and IM form

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16
Q

penicillin V

A

oral

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17
Q

penicillin bactericidal vs.

A

gram positive cocci and rods, gram negative cocci, and spirochetes

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18
Q

penicillinase-resistant penicillins

A

NOD IF U RESIST

nafcillin, oxacillin, dicloxacillin

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19
Q

PRP MOA

A

same as penicillin - bind PBP (transpeptidase) -> inhibit transpeptidase crosslinking of peptidoglycan –> inhibit cell wall synthesis
narrow spectrum!

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20
Q

PRP MOA of resistance to penicillinase

A

bulky R group blocks access of beta-lactamase to beta-lactam group

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21
Q

which PRP used for staph

A

nafcillin

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22
Q

PRP clinical use

A

staph aureus (except MRSA)

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23
Q

MRSA resistance MOA

A

altered penicillin binding protein target site

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24
Q

PRP toxicity

A

hypersensitivty rxn

interstitial nephritis

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25
Q

aminopenicillins

A

ampicillin and amoxicillin

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26
Q

aminopenicillins MOA

A

same as penicillin *bind penicillin binding protein (transpeptidases) –> inhibit transpeptidase crosslinking of peptidoglyan –> inhibit cell wall synthesis
wider spectrum!

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27
Q

aminopenicillin with greater oral bioavailability

A

amoxicillin

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28
Q

aminopenicillin clinical use

A

extended spectrum penicillin (AMPED UP) - HELPSS kill enterococci
h flu, e coli, listeria monocytogenes, proteus mirabilis, salmonella, shigella, enterococci

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29
Q

aminopenicillin toxicity

A

hypersensitivity rxn, ampicillin rash, pseudomembranous colitis

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30
Q

aminopenicillin resistance

A

beta lactamase cleaves beta lactam ring ***add CLAVULANIC acid to help protect

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31
Q

antipseudomonals

A

ticarcillin, pipercillin

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32
Q

antipseudomonals MOA

A

same as penicillin - extended spectrum

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33
Q

antipseudomonals clinical use

A

pseudomonas and gram negative rods

suscept to beta-lactamase –> use with beta-lactmasease inhibitors

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34
Q

antipseudomonals toxicity

A

hypersensitivity rxn

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35
Q

beta lactamse inhibitors

A

CAST - clavulanic acid, sulbactam, tazobactam

often added to penicillin antibiotics to protect antibiotic from destruction by beta-lactamase

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36
Q

cephalosporins MOA

A

beta lactam - block peptidoglycan cross linking –> inhibit cell wall synthesis **lessss susceptible to beta-lactamase
bactericidal

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37
Q

not covered by cephalosporins

A

LAME = listeria, atypicals (chlamydia/mycoplasma), MRSA and enterococci

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38
Q

which cephalosporin blocks MRSA

A

ceftaroline

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39
Q

cephalosporins 1st generation

A

cefazolin, cephalexin

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40
Q

cephalosporins 1st generation bugs

A

PEcK - gram positive cocci, proteus mirabilis, e coli, klebsiella pneumoniae

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41
Q

what is used prior to surgery to prevent staph aureus wound infections

A

cefazolin

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42
Q

cephalosporins 2nd generation

A

cefoxitin, cefaclor, cefuroxime

43
Q

cephalosporins 2nd generation bugs

A

HEN PEcKS
gram positive occci, h flu, enterobacter aerogenes, neisseria, proteus mirabilis, e coli, klebsiella pneumo, serratia marcescens

44
Q

cephalosporins 3rd generation

A

ceftriaxone, cefotaxime, ceftazidime

45
Q

cephalosporins 3rd generation bugs

A

serious gram negative infections resistant to other beta-lactams

46
Q

cephalosporins 4th generation

47
Q

cephalosporins 4th generation bugs

A

pseudomonas and gram positive

48
Q

ceftriaxone

A

meningitis and gonorrhea

49
Q

ceftazidime

A

pseudomonas

50
Q

cephalosporins toxicity

A

HS rxn, vitamin K deficiency
low cross-reactivity with penicillins
increase nephrotoxicity of amino glycosides

51
Q

aztreonam MOA

A

prevents peptidoglycan cross linking by binding PBP3
synergistic with amino glycosides
no cross-allergenicity with penicillins

52
Q

monobactam resistant to beta-lactamases

53
Q

aztreonam clinical use

A

gram negative rods ONLY

for penicillin allergic patients and those with renal insufficiency who cant tolerate amin glycosides

54
Q

aztreonam toxicity

A

nontoxic - occasional GI upset

55
Q

imipenam

A

broad spectrum beta-lactamase resistant carbapenem

56
Q

imipenam MOA

A

inhibit peptidoglycan cross linking –> inhibit cell wall synth
always administered with cilastatin to decrease inactivation of drug in renal tubules
kill is lastinnn with cilastatin

57
Q

cilastatin MOA

A

inhibits renal dehydropeptidase I

58
Q

imipenam clinical use

A

gram positive cocci, gram neg rods and anaerobes

SE limit use to life-threatening infections or after other drugs failed

59
Q

meropenem

A

reduced risk of seizures and stable to dehydropeptidase I

60
Q

carbapenem toxicity

A

GI distress, skin rash, and CNS toxicity (seizure) and high plasma levels

61
Q

newer carbapenems

A

ertapenem and doripenem

62
Q

vancomycin MOA

A

binds D-ala D-ala portion of cell wall precursors –> inhibits cell wall peptidoglycan formation
*bactericidal

63
Q

vancomycin clinical use

A

gram positive

serious multidrug resistant organisms like MRSA< enterococci and c diff

64
Q

pseudomembranous colitis c diff

A

oral vancomycin

65
Q

MRSA

A

vancomycin

66
Q

vancomycin toxicity

A

NOT - nephrotoxicity, ototoxicity, thrombophlebitis

well tolerated in general

67
Q

red man syndrome

A

diffuse flushing from vancomycin

68
Q

how to prevent red man syndrome

A

pretx w antihistamines and slow infusion rate

69
Q

30S inhibitors

A

aminoglycosides(bacteriCidal) and tetracycline (bacteriosTatic)

70
Q

50s inhibitors

A

chloramphenicol, clindamycin, erythromycin (macrolides), linezolid
mostly bacteriostatic

71
Q

aminoglycosides

A

GNATS - gentamicin, neomycin, amikacin, tobramycin, streptomycin

72
Q

aminoglycosides MOA

A

block protein synth at 30S - bactericidal
inhibit formation of initiation complex (A initates alphabet) –> mRNA misreading
block translocation
require O2 for uptake (aminO2glycosides)

73
Q

aminoglycosides clinical use

A

severe gram negative rod infections

synergistics with beta-lactams

74
Q

aminoglycoside for bowel surgery

75
Q

aminoglycoside toxicity

A

NNOT - nephrotoxicity, neuromusc blockage, ototoxicity, teratogen

76
Q

aminoglycoside plus cephalosporin

A

nephrotoxicity

77
Q

aminoglycoside plus loop diuretics

A

ototoxicity

78
Q

aminoglycoside resistance

A

transferase enzymes inactive drug via acetylation, phosphorylation or adenylation

79
Q

tetracyclines

A

tetracycline, doxycycline, demeclocycline, minocycline

80
Q

demeclocycline

A

ADH antagonist - diuretic in SIADH

81
Q

tetracyclines MOA

A

block protein synth @ 30S; bacteristatic

prevent attachement of aminoacyl-tRNA - limited CNS penetration

82
Q

doxycycline

A

fecally eliminated - used in pts w/ renal failure

83
Q

tetracycline warnings

A

dont take with milk, antacides or iron-containing preps bc divalent cations inhibit absorption in gut

84
Q

tetracycline clinical use

A

borrelia burgdorferi, m. pnuemoniae

acumulate intracellularly = very effectives vs rickettsia and chlamydia

85
Q

tetracycline toxicity

A

GI, discolor teeth + inhibit bone growth in kids, photosensitivity

86
Q

tetracycline CI

87
Q

tetracycline resistance

A

decrease uptake in cells or increase efflux by plasmid-encoded transport pumps

88
Q

macrolides

A

azithryomycin, erthryomycin, clarythromycin

89
Q

macrolides MOA

A 
block protein synth at 50S - bacteriostatic
block translocation (macroSLIDES)
bind 23S rRNA of 50S ribosomal subunit
90
Q

macrolides clinical use

A

atypical penuomnia (mycoplasma, chalmydia, legionella), STD (chlamydia), gram pos cocci (step infections in pts allergic to penicillin)

91
Q

macrolides toxicity

A

MARO - motility issues, arrhythmia due to QT prolongation, acute cholestatic hepatitis, rash, eosinophilia

92
Q

macrolides increases serum concentration of

A

theophyllines, oral anticoagulants

93
Q

macrolides resistance

A

methylation of 23S rRNA binding site

94
Q

chloramphenicol MOA

A

blocks protein synth at 50S - bacteriostatic

blocks peptidyl transferase

95
Q

chloramphenicol clinical use

A

meningitis (h flu, n. men, strep pneumo)

conserv use to to toxicity but cost allows use in developing countries

96
Q

chloramphenicol toxicity

A

anemia (dose), aplastic anemia

97
Q

gray baby syndrome

A

chloramphenicol toxicity

premature infants lack liver UDP-glucoronyl transferase

98
Q

chloramphenicol resistance

A

plasmid-encoded acetyl transferase inactivates drug

99
Q

clindamycin MOA

A

blocks protein synth at 50 S - bacteriostatic

blocks peptide transfer (translocation)

100
Q

chloramphenicol clinical use

A

anaerobic (bact fragilis, c perf) infections in aspiration pneumonia or lung abscesses
oral infections with mouth anaerobes

101
Q

treats anaerobes above the diaphragm

A

chloramphenicol

102
Q

treats anaerobes below the diaphram

A

metronidazole

103
Q

clindamycin toxicity

A

pseudomembranous colitis (c diff growth), fever, diarrhea

FA (13 decks)

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