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0
Q

What is MOA of bacitracin and vancomycin

A

Block peptidoglycan synthesis

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1
Q

What is MOA of penicillins, cephalosporins, aztreonam and imipenem?

A

Block cell wall synthesis by inhibiting crossing linking of peptidoglycan (binding transpeptidases)

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2
Q

What is MOA of sulfonamides/trimethoprim?

A

Block nucleotide synthesis by inhibiting folic acid synthesis

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3
Q

What is th MOA of fluoroquinolnes?

A

Block DNA topoisomerases

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4
Q

What is the MOA of rifampin?

A

Blocks mRNA synthesis

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5
Q

What is th MOA of metronidazole?

A

Damages DNA

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6
Q

What is the MOA of chloramphenicol , macrolides, clindamycin, streptogramins, linezolid?

A

Inhibits protein synthesis at 50S subunit

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7
Q

What is the MOA of amino glycosides and tetracyclines?

A

Block protein synthesis at 30S ribosomal unit

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8
Q

What is the MOA of penicillin?

A

Bind penicillin binding proteins, transpeptidases, and inhibits cross-linking of the peptidoglycan wall
Activates autolytic enzymes

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9
Q

What is the penicillin used for?

A

Gram positive orgs: s. pneumo, s.pyogenes, actinomyces

Neisseria meningitidis, syphilis

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10
Q

Is penicillin bacteriacidal or bacteriostatic?

A

Cidal

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11
Q

What are the side effects of penicillin?

A

Hypersensitivity reactions

Hemolytic anemia

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12
Q

What is the mechanism of resistance to penicillin?

A

Production of B-lactamases

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13
Q

What are the penicillinase-resistant penicillins?

A

Oxacillin, nafcillin, dicloxacillin

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14
Q

What organism are the penicillinase-resistant penicillins used for?

A

S. aureus

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15
Q

What are the side effects of oxacillin, dicloxacillin, nafcillin?

A

Hypersensitivity

Interstitial nephritis

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16
Q

What are the amino penicillins?

A

Ampicillin

Amoxicillin

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17
Q

What are the uses for amino penicillins?

A

Broader spectrum: H. Flu, Listeria, Proteus, E. coli, Salmonella, Shigella, enterococcus

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18
Q

What is the mneumonic for the amino penicillins?

A 
HELPSS:
H.flu
E.coli
Listeria
Proteus
Salmonella
Shigella
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19
Q

What are the side effects of amino penicillins?

A

Hypersensitivity
Rash
Pseudo membranous colitis

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20
Q

What is the mech of resistance to amino penicillins?

A

Production of beta lactamases

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21
Q

What is in amoxicillin?

A

Clavulanic acid - prevents from beta-lactamases

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22
Q

What are the anti pseudomonal penicillins?

A

Ticarcillim, piperacillin

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23
Q

What are the anti pseudomonals used for?

A

Pseudomonas

Gram negative rods

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24
What is the side effect of anti-pseudomonals?
Hypersensitivity
25
What are the B-lactamase inhibitors?
CAST: Clavulanic Acid Sulfabtam Tazobactam
26
Why can't you use penicillinase-resistant penicillins against MRSA?
MRSA is resistant because it has an altered penicillin-binding site
27
What are the organisms that are not covered by cephalosporins?
``` LAME: Listeria Atypicals: chlamydia, mycoplasma MRSA Enterococci ```
28
Which cephalosporin can be used for MRSA ?
Ceftaroline
29
What is the advantage of cephalosporin over penicillin?
Less susceptible to b-lactamase
30
Are cephalosporins bacteriostatic or cidal?
Cidal
31
What are the first generation cephalosporins?
Cefazolin | Cephalexin
32
What are the first generation cephalosporins used for?
Gram positives Proteus E. coli Klebsiella
33
What is cefazolin used for?
Used prior to surgery to prevent staph wound infections
34
What are the second generation cephs?
Cefoxitin Cefaclor Cefuroxime
35
What are the second generation cephs used for?
``` Gram positive cocci HEN PEKS: H. Flu Enterobacter Neisseria Proteus E.coli Klebsiella Serratia ```
36
What are the third generation cephalosporins?
Ceftriaxone Cefoxatime Ceftazidime
37
What are the third gen cephs used for?
Serious gram negatives that are resistant to other beta-lactams Neisseria Pseudomonas
38
What is the 4th gen ceph?
Cefepime
39
What is the 4th gene ceph used for?
Pseudomonas and gram positives.
40
What is the mech of resistance of cephalosporins?
Change in protein structure of the penicillin binding sites
41
What are the side effects of cephalosporins?
Hypersensitivity | Vit K def
42
What is the MOA for aztreonam?
Prevents peptidoglycan cross-linking by binding to PBP3
43
What is aztreonam used for?
Only gram negative rods
44
When is aztreonam used?
When a patient is allergic to penicillin | When a patient has renal insufficiency and can't tolerate amino glycosides
45
What are the side effects of aztreonam?
Well tolerated - occasional GI upset
46
What is imipenem?
Broad spectrum, b-lactamase resistant carbapenem - inhibits cell wall synthesis
47
What is imipenem inactivated by?
Dihydropeptidases in the renal tubules
48
What is cilastatin?
Inhibits dihydropeptidases in renal tubules
49
What is imipenem the DOC for?
Enterobacter
50
What are the other clinical uses of imipenem?
Gram positive cocci Gram negative rods Anaerobes
51
What is the advantage or meropenem?
Reduced risk of seizures | Stables in dihydropeptidases
52
What are the side effects of imipenem?
GI Skin rash CNS tox - seizures
53
When is imipenem used and why?
In life threatening situations when nothing else has worked because of its side effects
54
What is the MOA of vancomycin?
Inhibits bac wall synthesis by binding to the d-ALA, d-ALA portion of the cell wall precursors
55
Is vancomycin bacteriocidal or bacteriostatic?
Cidal
56
What is vancomycin used for?
Gram positive only: serious multi-drug resistant orgs: MRSA enterococcus C. Difficile
57
What are the side effects of vanc?
Nephrotoxicity Ototoxicity Thrombophlebitis Red man syndrome - prevented with antihistamines and slow infusion rate
58
What is the mech of resistance to vanc?
Change of D-ALA D-ALA to D-ALA D-LAC
59
What are the amino glycosides?
``` Gentamicin Neomycin Amikacin Tobramycin Streptomycin ```
60
Are aminoglycosides bacteriocidal or bacteriostatic?
Cidal
61
What's the MOA of aminoglycosides?
Inhibit formation of the initiation complex causing misreading of mRNA Block translocation
62
What is required for aminoglycoside uptake?
O2 | So not effective against anaerobes
63
What are aminoglycosides used for?
Severe gram negative rod infections: Chronic UTI P. aeroginosa Enterococcus endocarditis
64
What aminoglycoside is used for bowel surgery?
Neomycin
65
What drugs are aminoglycosides synergistic with
B-lactams
66
What is the toxicity of aminoglycosides?
Nephrotoxicity Ototoxicity Teratogenicity Neuromuscular blockade
67
What is the mech of resistance?
Plasmid dependent - carries enzymes that inactivate the aminoglycosides by acetylation, phosphorylation, adenylation
68
Are tetracyclines bacteriocidal or static?
Static
69
What is the MOA of tetracyclines?
Bind to 30s and prevent attachment of aminoacyl-tRNA - inhibits addition of amino acids to growing chains
70
What are tetracyclines used for?
Borrelia Mycobacterium Rickettsia Chlamydia
71
What are the side effects of TC?
``` GI Discoloration of teeth Inhibition of bone growth Photosensitivity Teratogenicity ```
72
What is the mech of resistance against a TC?
Decreased uptake | Or increased efflux by plasmid-encoded transport pumps
73
What is the MOA of macrolides?
Inhibits protein synthesis by blocking translocations | Bind to 23S rRNA and 50S ribsosomal subunit
74
What are the macrolides?
Azithromycin Clarithromycin Erythromycin
75
Are macrolides cidal or static?
Static
76
What are the uses of macrolides?
Atypical pneumonia Chlamydia Gram positive cocci
77
What are the side effects of macrolides?
``` Motility issues Arrhythmia - prolonged QT Acute cholestatic hepatitis Rash Eosinophilia Increased conc. of theophylline, anticoagulants ```
78
What is the mech of resistance to a macrolides?
Methylation of 23S rRNA binding site | Transmembranous efflux pumps
79
What is the MOA of chloramphenicol?
Blocks peptidyltransferase at 50S ribosomal subunit
80
Is chloramphenicol bacteriocidal or static?
Static
81
What is chloramphenicol used for?
Meningitis
82
What are the side effects of chloramphenicol?
Anemia Aplastic anemia Gray baby syndrome
83
Why do babies get gray baby syndrome?
Because they lack UDP-glucuronyl transferase
84
What is the mech of resistance of chloramphenicol?
Plasmid-encoded acetyl transferase that inactivates it
85
What is the MOA of clindamycin?
Blocks peptide transfer at 50S subunit
86
Is clindamycin bacteriocidal or static?
Static
87
What is clindamycin used for?
Anaerobic infections: B. gracilis in abscesses C. Perfringens Treats anaerobics ABOVE the diaphragm
88
What is the toxicity of clindamycin?
Fever, diarrhea, pseudo membranous colitis
89
What is the MOA of sulfonamides?
Inhibit dihydroteroate reductase
90
Are sulfonamides cidal or static?
Static
91
What are sulfonamides used for?
Gram pos Gram neg Chlamydia Nocardia
92
What are the side effects of sulfonamides?
``` Hypersensitivity Hemolysis in g6PD def Nephrotoxicity Photosensitivity Kernicterus Displaces drugs from albumin - warfarin ```
93
What is the mech of resistance of sulfonamides?
Altered dihydropteroate synthase Decreased uptake Increased PABA
94
What is the MOA of trimethoprim?
Inhibits dihydrofolate reductase
95
What is the MOA of TMP-SMX?
Blockade of folic acid synthesis
96
What is TMP-SMX used for?
UTIs | Pneumocystis
97
What are the side effects of TMP?
Megaloblastic anemia Leukopenia Granulocytopenia
98
What is the MOA of fluoroquinolones?
Blocks DNA gyrase (topo II) and topo IV
99
Are quinolones cidal or static?
Cidal
100
What are quinolones used for?
Gram neg rods of GU and GI tract | Some gram positives
101
What are the toxicities of fluoroquinolones?
``` GI Dizziness Super infections (c. Difficile) Headache Skin rash Tendinitis Tendon rupture Cartilage damage (teratogen) Prolonged QT ```
102
What is the mech of resistance to fluoroquinolones?
Mutation in DNA gyrase Plasmid resistance Efflux pumps
103
What decreases the absorption of fluoroquinolones
Antacids
104
What decreases the absorption of TCs?
Milk, antacids, iron containing preps | Divalent cations
105
What is the MOA of metronidazole?
Forms free radical toxic metabolites that damage the bac cell DNA
106
Is metro cidal or static?
Cidal and antiprotozoal
107
What is metro used for?
``` GET GAP Giardia Entamoeba Trichomonas Gardnerella Anaerobes (below diaphragm) H. Pylori ```
108
What is the tox?
Disulfiram like reaction with alcohol Headache Metallic taste
109
What is the tx for mycobacterium TB?
``` RIPE Rifampin Isoniazid Pyrazinamide Ethambutol ```
110
What is the prophylaxis for mycobacterium TB?
Isoniazid
111
What is the prophylaxis for M. Avium-intracellulare?
Azithromycin
112
What is the tx for m.avium TB?
``` EARS: Ethambutol Azithromycin Rifampin Streptomycin ```
113
What is the tx for M. Leprae?
Long- term tx with dapsone and rifampin for tuberculoid form | Dapsone+rifampin+clofazimine for lepromatous form
114
What is the MOA of isoniazid?
Decreases synthesis of mycolic acid
115
What is needed for isoniazid to be converted to active metabolite?
Bacterial catalase peroxidase
116
What is the toxicity of isoniazid?
Neurotoxicity | Hepatotoxicity
117
What can be used for prevent neurotoxicity caused by isoniazid?
Vit b6
118
What is the MOA of rifampin?
Inhibits DNA-dependent RNA pol
119
What is rifampin used for?
Prophylaxis for meningococcal meningitis Chemoprophylaxis in children exposed to H. Flu type B Delays resistance to dapsone M. TB
120
What are the side effects?
Red/orange body fluids Minor hepatotoxicity Induces P450 Rapid resistance if used alone
121
What is the MOA of pyrazinamide?
Acidify intracellular environment via conversion to pyrazinoic acid,
122
What are the side effects of pyrazinamide?
Hyperuricemia | Hepatotoxicity
123
What is the MOA of ethambutol?
Decreased carb polymerization of mycobacterium cell wall by blocking arabinosyltransferase
124
What is the side effect of ethambutol?
Optic neuropathy - red/green color blindness
125
What do you use to treat VRE?
Linezolid and streptogramins
126
What is the MOA of amphotericin B and nystatin?
Binds ergosterol and forms pores in the membrane
127
What are the side effects of amphotericin B?
``` Fever Chills Hypotension Nephrotoxicity Arrythmia anemia IV phlebitis ```
128
What are the uses of amphotericin B?
Cryptococcal meningitis | Systemic fungal infections: histo, blasts, coccidiosis. Candida
129
What needs to be supplemented when giving amphotericin B?
K and Mg because of altered renal tubule permeability
130
What are the uses of nystatin?
Only topical Swish and swallow for oral thrush Topical for diaper rash, vaginal candidiasis
131
What is MOA of Azoles?
Inhibit P450 enzymes - no ergosterol synthesis
132
What are Azoles used for?
Local less serious systemic mycoses
133
What is fluconazole used for?
Chronic suppression of cryptococcal meningitis in AIDS | Candidiasis infection
134
What is intraconazole used for?
Blasto Histo Coccidiosis
135
What is clotrimazole and miconazole used for?
Topical fungal infections
136
What are the side effects of Azoles?
Testosterone synthesis inhibition - gynecomastia | Liver dysfunction
137
What is the MOA of flucytosine?
Inhibits DNA and RNA synthesis by converting to 5-fluorouracil by cytosine deaminase
138
What is the clinical use of of flucytosine?
Systemic fungal infections - meningitis by cryptococcal in combo with amphotericin B
139
What is the toxicity of flucytosine?
Bone marrow suppression
140
What is the MOA of caspofungin, mica fungin?
Inhibiting cell wall synthesis by inhibiting synthesis of beta-glucan
141
What are the fungins used for?
Invasive aspergillosis and candida
142
What is the toxicity of the fungins?
GI upset | Flushing
143
What is the MOA of terbinafine?
Inhibits fungal enzyme squalene epoxidase
144
What is terbinafine used for?
Dermatophytoses - onycho
145
What are the side effects of terbinafine?
Abnormals LFTs | Visual disturbances
146
What is the MOA of griseofulvin?
Interferes with MT function - disrupts mitosis
147
What is griseofulvin used for?
Oral tx of superficial infections | Inhibits growth of dermatophytes
148
What is the tox of griseofulvin?
``` Teratogenic Carcinogenic Confusion Headaches Induces P450 and warfarin metabolism ```
149
What is the MOA for chloroquine?
Blocks detox of heme into hemozoin --> heme builds up and is toxic to plasmodia
150
What is chloroquine uses for?
Plasmodia except falciparum
151
What is the toxicity of chloroquine?
Retinopathy
152
What is the mech of resistance employed by falciparum?
Efflux pump
153
What do you tx falciparum with?
Artemether/lumifantrine | Atorvaquone/proguanil
154
What do you use for life threatening malaria?
Quinidine or artisunate
155
What are the antiprotozoal therapies?
Pyrimethamine - toxoplasmosis Suramin and melarsopol - T. Brucei Nifurtimox - T. Cruzi Sodium stibogluconate- leishmaniasis
156
What are the antihelminthic therapies?
``` Mebendazole Pyrantel pamoate Ivermectin Diethylcarbamazine Praziquantel - flukes ```
157
What is the MOA of zanamivir, oseltamivir?
Inhibit neuroaminidase - decrease release of progeny
158
What is zanamivir used for?
Tx and prevention of flu A and B
159
What is the MOA of ribavirin?
Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase
160
What is ribavirin used for?
RSV | HEP C
161
What is the toxicity of ribavirin?
Hemolytic anemia | Severe teratogen
162
What is the MOA of acyclovir and ganciclovir?
Guanosine analog - inhibits viral DNA pol by chain termination
163
What is acyclovir used for?
HSV VZV Genital and mucho cutaneous lesions and encephalitis
164
What is acyclovir ineffective against?
Weak for EBV | No effect on CMV or latent infection of HSV/VZV
165
Which cyclovir has better bioavailability?
Valacyclovir and valganciclovir
166
What do you use for VZV?
Famiciclovir
167
What is the mech of resistance to cyclovir?
Mutated viral thymidine kinase | Normal thymidine kinase monophosphorylates the acyclovir for incorporation into DNA
168
What is ganciclovir used for?
CMV
169
What is the toxicity of ganciclovir?
Pancytopenia | Renal toxicity
170
What is the mech of resistance to ganciclovir?
Mutated CMV DNA pol | Lack of viral kinase
171
What is the MOA of foscarnet and cidofovir?
Bind to pyro phosphate binding site of viral DNA pol | Inhibits viral DNA pol
172
What Are foscarnet and cidofovir used for?
CMV retinitis | Acyclovir resistant HSV
173
What is the toxicity of foscarnet and cidofovir?
Nephrotoxicity
174
What is the mech of resistance to foscarnet?
Mutated DNA pol
175
What does HAART include?
2 nucleoside reverse transcriptase inhibitors 1 non-nucleoside reverse transcriptase inhibitors OR 1 protease inhibitors OR 1 integrate inhibitor
176
What is the MOA of protease inhibitors?
Prevent maturation of new viruses by preventing HIV protease from cleaving HIV mRNA into new products.
177
What are the protease inhibitors?
The -inavirs
178
What is the toxicity of protease inhibitors?
``` Hyperglycemia GI Lipodystrophy Nephropathy Hematuria (indinavir) ```
179
Which protease Inhibitor inhibits P450?
Ritonavir
180
What is the MOA of NRTIs?
Nucleoside analogs that competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain because they lack the 3' OH group All must be activated by phosphorylation except tenofovir
181
What are the NRTIs?
``` -vudine Tenofovir Emtricitabine Abacivir Didanosine ```
182
Which NRTIs are used for prophylaxis and to reduce transmission during pregnancy?
Zidovudine
183
What are the toxicities of NRTIs?
``` Bone marrow suppression (reverse with G-CSF and EPO) Peripheral neuropathy Lactic acidosis Rash Anemia (ZDZ) ```
184
What are the NNRTIs?
Nevirapine Efavirenz Delaverdine
185
What is the MOA of NNRTIs?
Bind the reverse transcriptase at a different site than NRTI | Don't require phosphorylation
186
What are the side effects of NNRTIs?
``` Bone marrow suppression (reverse with G-CSF and EPO) Peripheral neuropathy Lactic acidosis Rash Anemia ```
187
What is the integrate inhibitor?
Raltegravir
188
What is the MOA of raltegravir?
Inhibits HIV genome integration into host cell
189
What is the toxicity of raltegravir?
Hypercholesterolemia
190
What is the MOA of INFs?
Block replication of RNA and DNA viruses
191
What are INFs used for?
Alpha - chronic hep B and C, Kaposi's Beta- multiple sclerosis Gamma - chronic granulomatous disease
192
What is the toxicity of IFN?
Neutropenia | Myopathy
193
What are the antibiotics to avoid in pregnancy?
``` SAFe Children Take Really Good Care Sulfonamides Aminoglycosides Fluoroquinolones Clarithromycin Tetracyclines Ribavirin Griseofulvin Chloramphenicol ```
194
What is the mech of resistance to isoniazid?
Decreased levels of catalase peroxidase
195
What is needed for isoniazid to become active?
Catalase peroxidase in the mycobacterium
196
What is the mech of resistance to streptomycin?
Altered 30S ribosomal protein structure so antibiotic cant bind
197
What is needed for pyrazinamide to work?
Bacterial pyrazinamidase
198
What is the tx of choice for malaria?
Chloroquine
199
What is the tx for life threatening malaria?
IV quinidine
200
What is added for tx of plasmodium vivax and ovale?
Primaquine to kill the hypnozoite in the liver
201
What is used to treat African sleeping sickness?
Pentamidine
202
What is the tx for leishmaniasis?
Pentamidine
203
What is the tx for p. jirovecii?
Pentamidine | TMP
204
What is used to tx Chaga's?
Nifurtimox
205
What is the MOA of isopropanol as a disinfectant?
Disruption of cell membranes | Degradation of proteins
206
What is the MOA of chlorhexidine as an disinfectant?
Disruption of cell membranes | Coagulation of cytoplasm
207
What is the MOA of hydrogen peroxide as a disinfectant?
Produces destructive free radicals that oxidize cellular components Also sporicidal
208
What is MOA of iodine as an disnfectant?
Halogenation of proteins and nucleic acids | Sporicidal
209
When is chlorhexidine used?
Surgeries and percutaneous procedures
210
What surgeries is chlorhexidine contraindicated in?
Neurologic, otologic, and ophthalmic procedures
211
What is the MOA of formaldehyde as a disinfectant?
Alkylation and cross-linking of DNA and proteins
212
What is formaldehyde used for?
Cleaning hospital instruments that cannot withstand autoclaving
213
What is the MOA of daptomycin?
Depol of cell membrane used in MRSA
214
What are the side effects of daptomycin?
Myopathy and CPK elevation
215
What is daptomycin inhibited by?
Pulmonary surfactant
216
What is the MOA of linezolid?
Inhibits bac synthesis by binding to 50S subunit
217
What are the side effects of linezolid?
TCP Optic neuritis Serotonin syndrome
218
What is daptomycin used for?
Treating skin infections | Bacteremia due to S. aureus
219
What is daptomycin ineffective against?
Gram negatives
220
Which drugs are well known for inhibiting warfarin metabolism?
TMP Metronidazole Macrolides Azoles
221
What is ricin?
A potent toxin for the castor oil plant that inhibits protein synthesis by cleaving the rRNA component of the eukaryotic 60S subunit

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