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Step 1 > microbio antimicrobials > Flashcards

microbio antimicrobials Flashcards

1
Q

penicllin G (IV and IM) and penicillin V (oral)

A

bind penicillin binding proteins (transpeptidases) and block transpeptidase crosslinking of proteoglycans in the cell wall; used for gram pos (strep, actinomyces); also used for gram neg cocci (mainly meningococcus) and spirochetes (t. pallidum); bactericidal; can see hypersens reactions and hemolytic anemia

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2
Q

amoxicillin, ampicillin

A

same mechanism as penicillins but wider spectrum, but still penicillinase sens; can be used for H. influenzae, H. pylori, E coli, Liseria, proteus, salmonella, shigella, enterococci

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3
Q

dicloxacillin, nafcillin, oxacillin

A

these are the penicillinase-reistant penicillins; used for staph aureus (but not MRSA); can cause hypersens reactions or interstitial nephritis

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4
Q

piperacillin, ticarcillin

A

antipseudomonal penicilllins; used for pseudomonas and gram neg rods; susceptible to penicillinase; use with beta-lactamase inhib

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5
Q

beta-lactamase inhibitors

A

clavulanic acid, sulbactam, tazobactam; often added to the penicillin antibiotics

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6
Q

first generation cephalosporins

A

cephalexin, cefazolin; gram pos cocci, proteus, e coli, klebsiella; cefazolin is often used prior to surgery to prevent staph aureus wound infections

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7
Q

second generation cephalasporins

A

cefoxitin, cefaclor, cefuroxime; gram pos cocci, h flu, enterobacter, neisseria, proteus, e. coli, klebsiella, serratia

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8
Q

third gen cephalasporins

A

ceftriaxone, cefotaxime, ceftazidime; serious gram neg infections

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9
Q

fourth gen cephalasporins

A

cefepime; gram neg organisms, with increaed activity against pseudomonas and gram pos organisms

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10
Q

fifith gen cephalasporins

A

ceftaroline; broad gram pos and gram neg organism coverage, incl MRSA; does not cover pseudomonas

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11
Q

ceftazidime

A

good pseudomonas coverage

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12
Q

toxicity of the cephalasporins

A

hypersens reactions, autoimmune hemolytic anemia, disulfuram-like reaction, vit K def, exhibit cross-reactivity with penicillins; they increase the nephrotoxicity of aminoglycosides

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13
Q

carbapenems

A

imipenem, meropenem, ertapenem, doripenem; these inhibit cell wall synthese and are resistant to beta lactamase; used for gram pos cocci, GNR, and anaerobes; wide spectrum but signif side effects; toxicity includes GI distress, skin rash, and CNS toxicity (seizures) at high levels

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14
Q

imipenem

A

always administered with cilastatin to decreae inactivation of the drug in renal tubules

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15
Q

monobactams

A

aztreonam; inhibits cell wall synthesis; no cross-allergenicity with penicillins; used for gram neg rods only (no activity against gram pos or anaerobes); used in penicillin-allergic patients and those with renal insuff who cannot tolerate aminoglycosides; usually nontoxic, occasional GI upset

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16
Q

vancomycin

A

inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors; not sucesceptible to beta lactamases; used for gram pos only (MRSA< staph epi, enterococcus, c. diff); nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome (diffuse flushing, but can be prevented with antihistamines and slow infusion rate); resistance develops when bacteria change D-ala D-ala to D-ala D-lac

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17
Q

aminoglycosides

A

gentamycin, neomycin, amikacin, tobramycin, and streptomycin; inhibit 30S subunit; use for severe gram neg rod infections; synergystic with beta lactams; toxicity is nephrotoxicity, neuromuscular blockade, ototoxicity (esp when used with loop diuretics), teratogen;

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18
Q

tetracylcines

A

tetracycline, doxy, minocycline; 30S inhibitor; limited CNS penetration; doxy is fecally eliminated and can be used in patients with renal failure; do not take teracyclines with milk, antacids, or iron-containing preparations bc divalent cations inhibit drug’s absorption in the gut; great intracellular accumulation, so good against rickettsia and chlamydia; also used to tx acne

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19
Q

toxicity of tetracyclines

A

GI distress, discoloration of teeth and inhib of bone growth in kids, photosens; contraindic in pregnancy

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20
Q

chloramphenicol

A

blocks peptidyltransferase at 50S ribisomal subunit; toxicity is anemia (dose-dep), apalstic anemia (dose-indep), gray baby syndrome (in premature infants)

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21
Q

clindamycin

A

block peptide transfer at 50S; used for anerobes in aspiration pneumonia, lung abscesses, and oral infections; also effective against invasive group A strep; “treats anaerobes above the diaphragm vs. metronidazole, which treats them below the diaphragm”; assoc with pseudomembranous collitis, fever, diarrhea

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22
Q

linezolid

A

inhibits protein synthesis at the 50S subunit; good for gram pos species, incl MRSA and VRE; can cause bone marrow suppression (esp thrombocytopenia), peripheral neuropathy, serotonin syndrome

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23
Q

macrolides

A

azithromycin, clarithromycin, erythromycin; inhibit 50S; use for atypical pneumonias (legionell, mycoplasma, chalamydia), STIs (chlamydia), gram pos cocci (strep), and b. pertussis; toxicity includes GI, arrythmia caused by prolong QT, acute cholestatic hepatitis, rash, eosinophilia; increases serum concentrations of theophyllines and oral anticoagulants; Clarithromycin adn erythromycin inhib P450

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24
Q

trimethoprim

A

inhibits bacterial dihydrofolate reductase; used in combo with sulfonamides, causing sequential block of folate synthesis; toxicity is megaloblastic anemia, leukopenia, granulocytopenia (may allev with suplemental folinic acid)

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25
Q

sulfonamides

A

inhibit folate synthesis; PABA antimetabolites inhibit dihydropteroate synthase (Dapson, used to treat lepromatous leprosy, is a closely related drug that also inhibits folate synthesis); treats GP, GN, nocardia, chlamydia; toxicity is hypersens reactions, hemolysis if G6PD def, nephrotoxicity (TIN), photosensitivity, kernicterus in infants, displace other drugs from albumin;

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26
Q

prophylaxis for TB

A

isoniazid

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27
Q

treatment for TB

A

rifampin, isoniazid, pyrazinamide, ethambutol (RIPE); isoniazid and ethambutol act on the cell wall, while rifampin inhibits mRNA synthesis, and pyrazinimide has unknown mechanism

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28
Q

rifamycins

A

rifampin, rifabutin; inhibit DNA-dep RNA polymerase; used for TB, also to delay resistance to dapsone when used for leprosy, used for meningococcal proph and chemoproph in contacts of kids with HIB; toxicity is minor hepatotoxicity and drug interactions (increases cyp450), organge body fluids; monotherapy rapidly leads to resistance

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29
Q

isoniazid

A

decreases synthesis of mycolic acids; treats TB; this is the only agent used as solo prophylaxis against TB; toxicity includes neurotoxicity, hepatotoxicity, pyridoxine (Vit B6) can prevent neurotoxicity; INH Injures Neurons and Hepatocytes

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30
Q

Pyrazinamide

A

mech unknown; used to treat TB; toxicity is hyperuricemia and hepatotoxicity

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31
Q

Ethambutol

A

decreases carbohydrate polymerization of mycobacterium cell wall; toxicity is optic neuropathy

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32
Q

fluoroquinolones

A

inhibit prokaryotic enzymes topoisomerase II and topoisomerase IV; must not be taken with antacids; used for GNR of urinary and GI tracts (incl pseudomonas), neisseria, some GP organisms; toxicity is GI upset, skin rashes, HA, dizziness; less commonly cau cause leg cramps and myalgias; contraindicated in pregnant women and nursing women; may prolong QT; may cause tendonitis or tendon rupture

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33
Q

daptomycin

A

disrupts cell membrane of GPC; great for staph aureus skin infections (esp MRSA), bacteremia,, endocarditis, VRE; NOT used for PNA (inactivated by surfactant); toxicity is myopathy and rhabdo

34
Q

metronidazole

A

forms toxic free radical metabolites in the bacterial cell that damage DNA; treats giardia, entamoeba, trichomonas, gardnerella vaginalis, anaerobes (incl b. frag and c. diff); used with PPI and clarithromycin in triple therapy against H pylori; toxicity is disulfuram-like reaction (severe flushing, tachycardia, hypotension) with alcohol; headache, metallic taste

35
Q

Prophylaxis for patients at high risk for endocarditis and undergoing surgical or dental procedure

A

amoxicillin

36
Q

prophylaxis for exposure to gonorrhea

A

ceftriaxone

37
Q

prophylaxis for history of recurrent UTIs

A

bactrim

38
Q

proph for exposure to meningococcal infection

A

ceftriaxone, cipro, or rifampin

39
Q

proph for pregnant women carrying GBS

A

penicillin G

40
Q

proph for prevention of gonococcal conjunctivitis in the newborn

A

erythromycin ointment

41
Q

proph for prevention of post surgical infection due to staph aureus

A

cefazolin

42
Q

proph for strep pharyngitis in child with prior rheumatic fever

A

benzathine penicillin G or oral penicillin V

43
Q

proph for exposure to syphillis

A

penicillin G

44
Q

proph for CD4 less than 200

A

bactrim for PCP proph

45
Q

proph for CD4 less than 100

A

bactrium for PCP and toxo

46
Q

proph for CD4 less than 50

A

azithro or clarithro for MAC

47
Q

What drugs cover MRSA?

A

Vanc, dapto, doxy, bactrim, linezolid, tigecycline, ceftaroline

48
Q

What drugs cover VRE?

A

linezolid and strepogramins

49
Q

amphotericin B

A

antifungal that binds ergosterol and forms pores that allow leakage of electrolytes out of the fungal membrane; ; toxicity includes fevers, chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis

50
Q

nystatin

A

same mech as amphotericin B; topical use only as too toxic for systemic use; swish and swallow for oral candidiasis; topical for diaper rash or vaginal candidiasis

51
Q

flucytosine

A

inhibits DNA and RNA biosynthesis; toxicity is bone marrow suppression

52
Q

azoles

A

inhibit fungal sterol (ergosterol) synthesis by inhibiting the cyp450 enzyme that converts lanosterol to ergosterol; used for local and less serious systemic mycoses; toxicity is that it has testosterone synthesis inhib, esp with ketoconazole, liver dysfunction

53
Q

terbinafine

A

inhibits the fungal enzyme squalene epixidae; used to treat dermaophytes (esp toenail infxn); can cause GI upset, HA, hepatotoxicity, taste disturbance

54
Q

echinocandins

A

examples are caspofungin, micafungin, and anidulafungin; inhibit cell wall synthesis; causes GI upset and flushing due to histamine release

55
Q

griseofulvin

A

interferes with microtubule function and disrupts mitosis; deposits in keratin containing tissues, like nails; oral tx of superficial infections; caution because it is a teratogen, carcinogenic, can cause confusion, HA, increase cyp450 and warfarin metabolism

56
Q

antiprotozoan therapy

A

pyrimethamine (toxo);suramin and melarsprol (trypansoma brucei), nifurtimox (t. cruzi), sodium stibogluconate (leishmaniasis)

57
Q

anti-mite/louse therapy

A

permethrin (neurotoxicity); malathion (achesterase inhib); lindane (neurotox); used to treat scabies and lice

58
Q

chloroquine

A

blocks detoxification of heme into hemozoin; heme accumulates and is toxic to plasmodia; used for treatment of plasmodial species other than p. falciparum (high resistance in p. falciparum); toxicity is retinopathy, pruritis

59
Q

antihelminthic therapy

A

mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziquantel

60
Q

oseltamavir, zanamivir

A

inhibits influenza neuraminidase (decreased release of progeny of virus); treatment and prevention of both flu A and B

61
Q

acyclovir, famcyclovir, valacyclovir

A

guanosine analogue; preferentially inhibits viral DNA polymerase by chain termination; used for HSV and VZV, weak activity against EBV, no activity against CMV; toxicity includes obstructive crystalline nephropathy and acute renal failure if not adequately hydrated

62
Q

ganciclovir

A

preferentially inhibits viral DNA polymerase; used for CMV; toxicity include leukopenia, neutropenia, thrombocytopenia, and renal toxicity

63
Q

foscarnet

A

viral DNA/RNA polymerase inhib and HIV reverse transcriptase inhib; used for CMV retinitis in immunocompromised patients when gancyclovir fails and used for acyclovir resistant HSV; nephrotoxic, electrolyte abnormalities can lead to seizures;

64
Q

cidofovir

A

inhibits viral DNA polymerase; used for CMV retinitis in immunocompromised patients and in those with acyclovir resistant HSV; has long half life; toxicity is nephrotoxicity (coadminister with probenecid and IV saline to decrease toxicity)

65
Q

HIV therapy

A

2 NRTIs and 1 of the following: NNRTI or protease inhib or integrase inhib

66
Q

protease inhib

A

“-navir”; “navir tease a protease”; can cause hyperglycemia, GI intolerance, lipodystrophy, nephropathy, hematuria (indinavir); rifampin is contraindicated with protease inhib because it can decreaed protease inhib concentration

67
Q

ritonavir

A

can boost other drugs by inhibiting cytochrome p-450

68
Q

NRTIs

A

abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir, zidovudine (formerly AZT); toxicities are bone marrow suppression which can be reversed with G-CSF and EPO, peripheral neuropathy, lactic acidosis (nucleosides), anemia (ZDV), and pancreatitis (didanosine)

69
Q

NNRTIs

A

delavirdine, efavirenz, nevirapine; toxicities include rash and hepatotoxicity are common to all, vivid dreams and CNS sx are common with efavirenz. Delavirdine and efavirenz are contraindic in pregnancy

70
Q

integrase inhib

A

raltegravir; increases CK

71
Q

fusion inhib

A

enfuvirtide, maraviroc; these can cause skin reaction at injection site

72
Q

interferon alpha

A

treats chronic hep b and c, kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, RCC and melanoma

73
Q

interferon beta

A

treats multiple sclerosis

74
Q

inteferon gamma

A

treats chronic granulomatous disease

75
Q

toxicity of interferons

A

neutropenia and myopathy

76
Q

Hep C therapy

A

ribavirin, simeprevir, and sofosbuvir

77
Q

ribavirin

A

used for chronic hep c, also used in RSV; toxicity is hemolytic anemia and severe teratogen

78
Q

simeprevir

A

hep C protease inhib; prevents viral replication; used for chronic hep c in combo with ribavirin and pedinterferon alfa; do not use as monotherapy; can cause photosensitivity reactions, rash

79
Q

sofosbuvir

A

inhibits hep C RNA polymerase acting as chain terminator; used for chronic hep C in combo with ribavirin with or without peginterferon alfa; do not use as monotherapy; toxicity is headache, fatigue, nausea

80
Q

hydrogen peroxide

A

free radical oxidation. Sporocidal

81
Q

iodine and iodophors

A

halogenation of DNA, RNA, and proteins. May be sporocidal

82
Q

antibiotics to avoid in pregnancy

A

sulfonamides (kernicterus), aminoglycosides (ototoxicity), fluoroquinolones (cartilage damage), clarithromycin (embryotoxic), tetracyclines (discolored teeth, inhib of bone growth), ribavirin (teratogenic), griseofulvin (teratogenic), chloramphenicol (gray baby syndrome)

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