Micro drugs Flashcards
1
Q
MOA: Inhibition of peptidoglycan cross-linking and therefore cell wall synthesis (7)
A
PCN Methicillin Ampicillin Piperacillin Cephalosporins aztreonam imipenem
2
Q
Inhibits peptidoglycan synthesis
A
Bacitracin
Vancomycin
3
Q
Blocks DNA topoisomerase
A
Flouroquinolones
4
Q
Inhibits folic acid synthesis and therefore bacteria nucleotide synthesis
A
Sulfonamides
trimethoprim
5
Q
Damages bacteria DNA
A
Metronidazole
6
Q
Blocks bacteria mRNA synthesis
A
Rifampin
7
Q
Blocks protein synthesis at the 30S ribosomal subunit
A
Tetracyclines
Aminoglycosides
8
Q
Blocks protein synthesis at the 50S ribosomal subunit(5)
A
chloramphenicoa\l macrolides Clindamycin Linezolid Streptogramins
9
Q
List the 3 drugs that inhibit beta lactamase activity?
What is so special about them?
A
Clavulanic acid
Sulbactam
Tazobactam
They should be added to PCNs that are not resistant to beta lactamases
10
Q
PCN (G) and V are used the following organisms
A
Gram positives
Strep pneumo
Strep pyogenes
Actinomyces
N. Meningititis
Syphillis--Troponema pallidum
11
Q
List PCNs that are penicillinase resistant (Hint NOD)
What is one unique toxicity associated wit NOD?
What other drugs(non PCN) are penicillinase resistant?
A
Nafcillin
Oxacillin
Dicloxacillin
Interstitial nephritis
Aztreonam
12
Q
Which particular organism is the penicillinase resistant PCNs used for
A
Staph aureus except for MRSA
13
Q
What is one the particular side effect of Ampicillin—think in relation to another type of bacteria problem
what is the other toxicity
A
Pseudomenbranous colitis
aka c-Diff
Ampicillin Rash
14
Q
Ampicillin and Amoxicillin are used for these organisms (7)
A
H.Influenza E.coli Listeria monocytogenes Proteus mirabilis salmonella shigella enterococci
HELPSS Enterococci
15
Q
What common toxicity is common to the PCNs
A
Hypersensitivity reactions
16
Q
Ticarcillin and Piperacillin are known to work well for this bacteria
What other group can they cover
A
Pseudomonas
Gram negative rods
17
Q
Name the organisms that are not covered by cephalosporins
A
LAME Listeria Atypicals---Chlamydia and mycoplasma MRSA Enterococci
18
Q
What is the one cephalosporin that can cover MRSA
A
Ceftaroline
19
Q
1st generation cephalosporins
A
Cefazolin Az and alexin are 1st
Cephalexin
20
Q
2nd generation cephalosporins
A
Cefoxitin
Cefaclor
cefuoxime
21
Q
3rd generation cephalosporins
A
Ceftriaxone
Cefotaxime
ceftazidime
22
Q
4th generation cephalosporins
A
cefepime
23
Q
What three organisms are the 1st generation cephalosporins used for?
A
PEK
Proteus mirabilis
E.Coli
Klebsiella
24
Q
What is used prior to surg to prevent S.aureus wound infections
A
Cefazolin
25
2nd generation cephalosporins are good for? (6)
```
HENS PEK
H.Influenza
Enterobacter aerogenes
Neisseria
Serratia marcescens
```
Proteus mirabilis
E.Coli
Klebsiella
26
What are the 3rd generation generally used for?
Serious Gram negs
27
Ceftriazone is especially for these two
Meningitis
| gonorrhea
28
Ceftazidime is especially for
Pseudomonas
29
Hypersensitivity
Nephrotoxicity with aminoglycosides
Vit K deficiency
cephalosporin toxicities
30
Under what conditions would you use aztreonam
Only for Gram negative rods in pts with
PCN allergy
Renal insufficiency
31
What drug is always given with imipenem
cilastatin
32
Why cilastatin given with imipenem (MOA)
Imipenem will otherwise be inactivated in the renal tubules--inhibits renal dehydropeptidase
33
GI distress
sezuires
skin rash
Carbapenem
34
Vancomycin inhibits peptidoglycan synthesis by binding to what portion
D-ala D-ala portion of cell wall precursors
35
How do bugs gain resistance to vancomycin
amino acid change from D-ala D-ala to D-ala D-lac
36
Gram positives
MRSA
C.diff
enterococci
Vancomycin
37
```
Nephrotoxicity
ototoxicity
thrombophlebitis
Flushing
(Flushing is NOT cute)
```
Toxicities for vancomycin
38
What two drugs especially cause pseudomembraneous colitis?
Ampicillin
| clindamycin
39
Treatment for c-diff
vancomycin
| metronidazole
40
Prophylactic drug to avoid M.avium-intracellulare disease in AIDs pts
Azithromycin
41
Treatment for Lapramatous Leprosy
Dapsone, Rifampin, and clofazimine
42
Treatment for Tuberculoid Laprosy
Dapsone and Rifampin
43
Treatment for N.meningitis
PCN G and Ceftriaxone
44
Prophylaxis for N.meningitis
Rifampin
ciprofloxacin
or ceftriaxone
also for meningitis from H.flu
45
N.gonorrhea treatment
ceftriaxone
plus
Azithromycin and doxycycline(chlamydia)
46
Treatment for psuedomonas
Aminoglycosides
| plus extended course Pipercillin/ticarcillin
47
treatment for lyme disease (Borrelia Burgdoferi)
Ceftriaxone
| Doxycycline
48
Treatment for Rickettsial and vector-borne diseases
Doxycyline
49
Treatment for Chlamydiae
Azithromycin or doxycycline
50
Prophylactic treatment to prevent pneumonia caused by RSV virus in premature children
Palivizumab
51
List five aminoglycosides
```
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
(GNATS)
```
52
Specific mechanism of aminoglycosides
Inhibits the formation of the initiation complex which= misreading of the mrna
53
Why are amynoglycosides ineffective against anerobes?
Because they require O2 for uptake
54
Neomycin is used for?
Bowel surgery
55
Aminoglycosides are typically used for?
Serious Gran neg rods
56
Aminoglycosides toxicities
Nephrotoxicity (esp with cephalosporin)
Neuromuscular block
ototoxicity
teratogen
57
Name the tetracyclines
tetracycline
doxycycline
minocycline
Demeclocycline
58
Which tetracycline is used as an ADH antagonist for use in SIADH
Demeclocyline
59
What is the specific MOA of tetracycline?
Prevents the attachment of amino-acyl-tRNA after binding to 30S ribosome
60
Tetracyclines are used for
Borrelia Burgdoferi
Mycoplasma pneumoniae
Rickettsia
chlamydia
61
Why are tetracylines especially effective against chlamydia and rickettsia?
They have the ability to accumulate intracellularly
62
side effects of tetracyclines
Photosensitivity
Discoloration of teeth in kids
inhibition of bone growth in kids
teratogen
63
List macrolides
erythromycine
azithromycin
clarithromycine
64
Macrolides specific MOA
Blocks translocation (23) of 50S subunit
65
Macrolides are used for
Pneumonia from atypicals( Mycoplasm/legionella/chlamydia)
Chlamydia STD
gram+ cocci inPCN allergy
66
Macrolides toxicities
```
Motility issues
Arrythmia--QT
Cholestatic hepatitis--acute
rash
eOsinophils
```
67
Macrolides increase serum concentration of
theophyllines
| oral anticoagulants
68
Treatment for Toxoplasmosis
Sulfadiazine + pyrimethamine
69
Psuedomonas drugs
```
Ticercillin/pipercillin
ceftazidime and cefepime
ciprofloaxacin and levofloxacin
imipenem and meropenem
Amikacin/gentamycin/tobramycin
```
70
Specific MOA of chloramphenicol
blocks peptidytransferase at the 50S subunit
71
Chloramphenicol toxicities
Anemia
Aplastic anemia
grey baby syndrome
72
Blocks peptide transfer at the 50S subunit
clindamycin
73
What is used to treat anaerobes above the diaphragm
What is used to treat anaerobes below the diaphragm
clindamycin
metronidazole
74
Clindamycin is used for?
Anaerobes above the diaphragm
Anaerobe infections in aspiration pneumonia or lung abscess
oral infections with Anaerobe
75
Clindamycin toxities
c. Diff
Fever
diarrhea
76
Side effect of omeprazole
v. cholera infection
77
List the sulfonamides
Sulfamethoxazole
sulfisoxazole
sulfadiazine
78
Inhibited by sulfonamides
dihydropteroate synthase
79
Sulfonamides toxicities (6)
```
G6PD deficiency hemolysis
nephrotoxicity
photosensitivity
kernicterus in infants
Warfarin displacement from albumin
hypersensitivity rxn
```
80
Trimethoprim inhibits
dihydrofolate reductase
81
Trimethoprim toxicities
Megaloblastic anemia
leukopenia
granulocytopenia
TMP treats marrow poorly
82
TMP-SMx are combined to treat the following
UTIs
Shigella
Salmonella
Pneumocystis jiroveci
83
How would you recognize that a drug is a fluoroquinolone
Floxacin
84
Fluroquinolones are contraindicated in?
Why?
Preg
children
Damage to cartilage
85
Less common toxicities associated with fluroquinolones
Tendonitis
Tendon rupture
leg cramps
myalgia
86
Superinfections, rash, headache, and dizziness
common toxicities of fluroquinolones
87
How does metronidazole damage DNA
By forming free radicals
88
Metronidazole are used for
```
Anerobes below the diaphragm
c-diff and bacteroides
Giardia
Entamoeba
Trichomonas
Gardenerella vaginalis
```
89
Metronidazole toxicities
Metallic taste
HA
Disulfiram-like reaction with etoh
90
M.tuberculosis treatment
Rifampin
isoniazid
pyrazinamide
ethambutol
91
TB prophylaxis
isoniazid
92
M.avium-intercellulare treatment
Rifampin
azithromycin
ethambutol
streptomycin
93
Isoniazid MOA
Decreased the synthesis of mycolic acid
94
What does isoniazid need in order to be active
conversion into its active form by bacterial catalase peroxidase
95
Isoniazid toxicities
Neurotoxicity
| Hepatotoxicity
96
Give this to prevent Isoniazid neurotoxicity and lupus
pyridoxine
97
Rifampin specific MOA
Inhibits DNA-dependent RNA polymerase
98
Rifampin toxicities
P-450
orange body fluids
Minor hepatotoxicity
99
Should Rifampin be used alone?
if not why?
No
| Rapid resistance
100
Pyrazinamide's acidic product is good for
Acidic pH of phagolysosomes where TB engulfed macrophages are found
101
Pyrazinamide Toxicities
hepatotoxicity
| hyperurecemia
102
Ethambutol MOA
Decreases carbohydrate polymerization of mycobacterium cell wall
103
Ethambutol toxicity
Red-green color blindness
104
Prophylaxis against gonococcal or chlamydial conjuctivitis in newborn
Erythromycin ointment
105
Prohylaxis for a child with prior rheumatic fever
oral PCN
106
GBS prophylaxis in preg
Ampicillin
107
Prophylaxis against endocarditis with surgical/dental stuff
PCNs
108
Prophylaxis in a pt with h/o recurrent UTIs
TMP-SMX
109
Prophylaxis for syphillis
BENZATHINE PCN G
110
HIV prophylaxis to prevent Toxoplasmosis ann Pneumocystis pneumonia (CD4<100)
TMP-SMX
111
Treatment for vancomycin resistant enterococci
Linezolid and streptogramins
112
What two groups of antifungals inhibit membrane function
Amphotericin B
| Nystatin
113
What antifungal messes with nucleic acid synthesis
5-Flucytosine
114
What antifungals mess with Lanosterol synthesis?
Naftifine
| Terbinafine
115
What antifungals mess with ergosterol synthesis
Azoles
116
What antifungals mess with cell wall synthesis
the Fungins--
117
Amphotericin B MOA
Binds ergosterol and forms pores in the membrane for electrolytes
118
Amphotericin B is used
Serious systemic mycosis
119
Amphotericin B toxicities
```
Shake and bake
hypoTN
nephrotoxicity
arrythmias
anemia
IV phlebitis
```
120
How is Nystatin used and why?
Give an Ex
Topically because it is too toxic to be be used systemically
Swish ans swallow for thrush treament
121
Specific MOA for the azoles
Inhibits the P-450 enzymes that converts Ianosterol to ergosterol
122
Fluconazole is used for
chronic suppression of cryptococcal meningitis in AIDS pts and candida in all pts
123
itraconizole is used for
Blastomyces, coccidoiides, histoplasmosis
124
Azoles toxicities
Testosterone syn inhibition--->gynecomastia
| p450 inhibition---->liver dysfunction
125
How exactly does 5-Flucytosine mess with nucleic acid synthesis
Conversion to 5-fluorouracil by cytosine deaminase
126
Flucytosine toxicity
Bone marrow suppression
127
The fungins--capofungin and micafungin MOA
inhibits synthesis of Beta-glucan
128
Capofungin and Micafungin toxicities
Flushing (histamine)
| GI upset
129
The Fungins are used for
Invasive aspergillosis and candida
130
Terbinafine/naftifine MOA
Used to treat
Inhibit fungal enzyme squalene epoxidase
fungal infections of the fingers and toe nails
131
Griseofulvin used for
treatment of superficial fungal infections like tinea.
| Disrupts mitosis
132
Antiprotozoan theraoy for trypanosoma brucei
Suramin and melarsorprol
133
Antiprotozoan therapy for t.cruzi
Nifurtinox
134
Antitprotozoan therapy for leishmaniasis
Sodium stibogluconate
135
Methronidazole has both
bacteria and antiprotozoal ability
136
Chloroquine MOA
inhibits the detoxification of heme into hemozoin---heme is toxic to plasmodia
137
Chloroquine used not be used for
P.falciparum because of resistance
138
How does P.falciparum gain resistance
membrane pump that decreases the intracellular conc of the drug
139
P.falcipurum should be treated instead with
Atovaquone/proguanil
140
Use this for life threatening malaria
Quinidine
141
Chloroquine toxicity
retinopathy
142
Praziquantal is used against
Flukes like schistosoma
143
Test for this before giving quinidine
G6PD deficiency
144
For vivax/ovale malaria,add this
primaquine
| to prevent relapse
145
Neuroaminidase inhibitor
Effect=
Zanamivir and oseltamivir
decrease the the release of progeny virus
146
Ribavirin is used for
RSV, Chronic HCV
147
Ribavirin MOA
Guanosine analog that competitively inhibits IMP dehydrogenase and Decreases guanine nucleotides syn
148
Ribavirin toxicities
Teratogen
| hemolytic anemia
149
Acyclovir used for
HSV--lesions and encephalitis
| VSV--primary
150
VSV zoster
Famciclovir
151
Acyclovir MOA
Guanosin analog that preferentially inhibits viral DNA polymerase by chain termination
152
Acyclovir need to be monphosphorylated by
HSV/VSV thymidine kinase
153
Ganciclovir is used for
CMV
154
Ganciclover MOA
Guanosine anolog that preferentially inhibits viral DNA polymerase
155
Ganciclover is monophosporylated by
CMV viral kinase
156
Ganciclover toxicities
Leukopenia
Neutropenia
Thrombocytopenia
renal toxicity
157
Compare Ganciclover and acyclover in terms of toxicity
Ganciclover is much more toxic to us than acyclovir
158
Foscarnet and cidofovir are used when
CMV retinitis in immunocom when ganciclover fails
| acyclovir resistant HSV
159
Foscarnet MOA
A pyrofosphate analog that binds to the pyrophosphate-binding site of viral DNA polymerase
160
How is Forcarnet and cidofovir 's MOA different from that of ganciclover and acyclovir
It does not have to be activate by viral kinase
161
This combination is used for HAAAT in HIV pts to prevent resistance
2 NRTIs
+
1NNRTI or 1 protease inhibitor or 1 integrase inhibitor
162
MOA of protease inhibitors
They prevent cleavage of the big polypeptide into their functioning parts and thus prevent maturation of new virions
163
How to recognize protease inhibitors
Navir
164
Protease inhibitor toxicities
Hyperglycemia
lipodystrophy
Nepropathy/hematuria
165
MOA of NRTIs
competively inhibits nucleotide binding to reverse transcriptase and terminate the DNA chain
166
List NRTIs(7)
```
Tenofovir
Abacavir
Stavudine
zidovudine
Lamivudine
Emtricitabine
Didanosine
```
167
Which NRTIs does not have to be activated
Tenofovir
168
Zidovudine is used for
which is used in preg to reduce fetal transmission and as general prophylaxis
169
NRTIs and NNRTIs toxicity
```
Bone marrow suppression
Peripheral neuropathy
Lactic acidosis
rash
anemia
```
170
List NNRTIs
Nevirapine
Efavirenz
Delavirdine
171
MOA of NNRTIs
Bind at a different site to reverse transcriptase
172
Raltegravir is a
Intergrase inhibitor that inhibits HIV genome integration into host cell chromosome
173
Raltegravir toxicity
Hypercholesterolemia
174
Interferon therapy blocks
replication of RNA and DNA
175
IFN-alpha use
Chronic Hep B and C
| Kaposi's sarcoma
176
IFN-beta use
MS
177
IFN-gamma use
NADPH oxidase deficiency
178
Interferon toxicity
Neutropenia and myopathy
179
Take Really Good Care= Children SAF stands for
```
Drugs not to use during preg
Tetracycline--teeth and bone
Ribavirin--teratogen
Griseofulvin---teratogen
Chloramphenicol---grey babe
Clarithromycin---embryotoxic
Sulfonamides--Kernicterus
Aminoglycosides--ototoxicity
fluroquinolones--cartilage damage
```
