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MICROBIOLOGY- Antimicrobials Flashcards

0
Q

This medication acts inhibiting the conversion from PABA to Dihydrofolate in DNA methylation

A

Sulfonamides

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1
Q

Which antimicrobials interfere with folic acid synthesis?

A

Sulfonamide

Trimethoprim

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2
Q

Who are examples of sulfonamides?

A

Sulfamethoxazole
Sulfisoxazole
Sulfadiazine

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3
Q

This antimicrobal inhibits the convertion of DHF to THF

A

Trimethoprim

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4
Q

How are classified the antimicrobials who inhibit cell wall synthesis?

A

Peptydoglycan synthesis

Peptydoglycan cross linking

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5
Q

Who are consider inhibitors of peptydoglycan synthesis?

A

Glycopeptides

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6
Q

Which medicines are glycopeptides?

A

Vancomycin

Bacitracin

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7
Q

Which families are from peptydoglycan cross linking?

A 
Penicillinase sensitive penicillins
Penicillinase resistant penicillins
Antipseudomonals
Cephalosporins
Carbapenems
Monobactams
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8
Q

Which is the mechanism of action for Fluoroquinolones and quinolones?

A

Inhibiting DNA topoisomerase

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9
Q

This antimicrobial damages directly bacterias DNA

A

Metronidazole

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10
Q

Which is the mechanism of action of Rifampin?

A

Inhibits mRNA synthesis by inhibiting RNA Polymerase

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11
Q

How are classified antimicrobials who inhibit proteins?

A

Inhibitors of 50 S subunit

Inhibitors of 30 S subunit

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12
Q

They are classified as Inhibitors of 50 S subunit

A 
Chloramophenicol
Clindamycin
Linezolid
Macrolides
Streptogramins
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13
Q

Which antimicrobials inhibit 30 S subunit?

A

Aminoglycosides

Tetracyclines

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14
Q

Who are consider penicillinase sensitive penicillins?

A

Penicillin G, V
Ampicillin
Amoxicillin

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15
Q

Who are consider prototype beta lactam antibiotics?

A

Penicillin G and V

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16
Q

Which is the way of administration for penicillin G?

A

IV and IM form

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17
Q

How do you administer penicillin V?

A

Oral

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18
Q

Which is the mechanism of action of Penicillin G, V?

A

Blind penicillin-binding proteins (transpeptidase)
Block transpeptidase cross-linking of peptidoglycan
Activate autolytic enzymes

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19
Q

Which is the clinical use for penicillin G and V?

A

Mostly used for gram-positive organisms

Also used for N. Meningitidis and T. Pallidum

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20
Q

Which gram-positive organisms are concealer penicillinase sensitive?

A

S. Pneumoniae
S. Pyogenes
Actinomyces

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21
Q

For which bacterias are penicillin G and V consider bactericidial?

A

Bactericidial for gram-positive cocci, gram-positive rods, gram negative cocci and sphirochetes

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22
Q

These are consider toxicity reactions to penicillin G and V

A

Hypersensitivity reactions

Hemolytic anemia

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23
Q

Who are consider resistant to penicillin V and G?

A

Penicillinase in bacteria (a type of beta lactamase) cleaves beta lactam ring

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24
Who are consider aminopenicillins?
Ampicillin, amoxicillin
25
Which is the mechanism of action of ampicillin and amoxicillin?
Same as penicillin
26
Who has wider spectrum between aminopenicillin and penicillin? Why?
Aminopenicillin | Penicillinase sensitive
27
Which medicine is combined with aminopenicillins to protect against beta lactamase?
Clavulanic acid
28
Who has greater oral bioavailability between ampicillin and amoxicillin?
Amoxicillin
29
Which is the clinical use for Aminopenicillins?
Extended spectrum penicillin
30
Which bacterias are sensitive to aminopenicillins?
``` Haemophilus influenzae E. Coli Listeria monocytogenes Proteus mirabilis Salmonella Shigella Enterococci ```
31
Which are the clinical manifestations of toxicity caused by aminopenicillins?
Hypersensitivity reactions, rash and pseudomembranous colitis
32
Who can present resistance to aminopenicillins?
Penicillinase in bacteria (a type of beta lactamase) cleaves beta lactam ring
33
Which medicines are consider penicillinase resistant penicillins?
Oxacillin Nafcillin Dicloxacillin
34
Which is the mechanism of action of penicillinase resistant penicillins?
Same as penicillin. Narrow spectrum
35
Why do dicloxacillin has narrow spectrum than penicillin?
Because penicillin resistant penicillins only act for penicillinase resistant because bulky R group blocks access of Beta lactamase to beta lactam ring
36
Which is the principal use for Dicloxacillin (penicillinase resistant penicillin)?
S. Aureus
37
Is Every type of S. Aureus sensitive to penicillinase resistant penicillins?
No, MRSA is resistant because of altered penicillin binding protein target site
38
Which are adverse effects of penicillinase resistant penicillins?
Hypersensitivity reactions, interstitial nephritis
39
These medicines are consider antipseudomonals
Ticarcillin, pioeracillin
40
Which is the mechanism of action of antipseudomonals?
Same as penicillin but with extended spectrum
41
Which is the clinical use for ticarcillin?
Antipseudomonal | Pseudomonas spp and gram negative rods, susceptible to penicillinase
42
Which medicines are commonly used with pseudomonals?
Beta lactamase inhibitors
43
Who are considered beta lactamase inhibitors?
Clavulanic acid Sulbactam Tazobactam
44
Why do we add beta lactamase inhibitors to penicillin antibiotics?
To protect antibiotic from destruction by beta lactamase
45
Which is the effect penicillinase?
Destroy penicillin antibiotics by beta lactamase
46
How many generations do cephalosporins have?
5
47
This is how cephalosporin work
Beta lactam drugs that inhibit cell wall synthesis
48
Which is the problem of cephalosporins?
Less susceptible to penicillinases
49
How are cephalosporin consider bactericidal or bacteriostatics?
Bactericidal
50
Which organisms typically are not covered by cephalosporins?
``` Chephalosporins are LAME Listeria Atypicals (chlamydia, mycoplasma) MRSA Entericocci ```
51
Which cephalosporin covers MRSA?
Ceftaroline
52
What do first generation cephalosporins cover?
Gram positive cocci
53
Name some examples of first generation cephalosporins
Cefazolin | Cephalexin
54
Used prior to surgery to prevent S. Aureus wound infection
Cefazolin
55
Which bacteria are cover by second-generation cephalosporins?
Gram-positive cocci
56
Which are considered second-generation cephalosporins?
Cefoxitin Cefaclor Cefuroxime
57
These bacterias are cover by second generation cephalosporins
``` Haemophilus influenzae Enterobacter aerogenes Neisseria spp Proteus mirabilis E. Coli Klebsiella pneumoniae Serratia marcescens ```
58
When is recommended the use of third-generation cephalosporins?
Serious gram-negative infections resistance to other Beta lactams
59
Name some third-generation cephalosporin
Ceftriaxone Cefotaxime Ceftazidine
60
When is recommended ceftriaxone?
Meningitis and gonorrhea
61
This third-generation cephalosporin is useful for pseudomonas
Ceftazidime
62
How is cefepime classified?
4th generation cephalosporin
63
Which is the mechanism of action of cefepime?
Increased activity against pseudomonas and gram-positive organisms
64
Consider the only fifth generation cephalosporin
Ceftaroline
65
What does Ceftaroline covers for?
Broad gram-positive and gram-negative organisms coverage, including MRSA
66
Which bacteria specially ceftaroline does not covers?
Pseudomona
67
When is consider that cephalosporins cause Toxicity?
Hypersensitivity reactions Vitamin K deficiency Low cross reactivity with penicillins Increase nephrotoxicity of aminoglycosides
68
Which medicine is consider monobactam?
Aztreonam
69
How do you classify Aztreonam?
Monibactam resistant to beta lactamase
70
What does aztreonam prevents?
Prevents peptidoglycan cross linking by binding to penicillin binding protein 3
71
With which medication is aztreonam synergic?
Aminoglycosides
72
Do monobactams have cross allergenicity with penicillins?
False
73
Which are the only bacterias sensitive to aztreonam?
Gram negative rods
74
For which bacterias Aztreonam does not has activity
No activity against gram positives or anaerobes
75
When is recommended the clinical use of aztreonam (monobactams)?
For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
76
How toxic is Aztreonam?
Usually nontoxic, occasionally GI upset
77
Who are categorized as carbapenems?
Imipenem Meropenem Ertapenem Dorioenem
78
How is imipenem classified?
Broad spectrum, beta lactamase resistant carbapenem
79
Which medication it's always administer with Imipenem?
Cilastatin
80
Why is cilastatin always administered with Carbapenems?
To decrease inactivation of drug in renal tubes
81
What does cilastatin inhibits?
Renal dehydropeptidase I
82
Ertapenem is limited to treat...
Pseudomona
83
Which is the clinical use for imipenem?
Gram positive cocci, gram negative rods and Anaerobes
84
When is recommended to use imipenem?
Wide spectrum but significant side effects limit use to life threatening infections or after other drugs have fail
85
Which is the advantage of meropenem compare to imipenem?
Meropenem has a decrease risk of seizures and is stable to dehydropetidase I
86
These are the adverse effects of imipenem
GI distress, skin rash, and CNS toxicity (seizures) at high plasma levels
87
Which is the mechanism of action of vancomycin?
Inhibits cell wall peptidoglycan formation by binding D ala D ala portion of cell wall precursors
88
Is vancomycin a bactericidal or bacteriostatic?
Bactericidal
89
Which is a clinical use for vancomycin?
Gram-positive only serious multidrug resistant organisms including MRSA, enterococci and Clostridium difficile
90
When is recommended the use of vancomycin to treat Clostridium difficile?
Oral dose for pseudomembranous colitis
91
Although vancomycin is well tolerated, what are the risks for its use?
Nephrotoxicity, ototoxicity, Thrombophlebitis diffuse flushing
92
This adverse effect with vancomycin consists of diffuse flushing
Red man syndrome
93
How can you prevent red man syndrome caused by Vancomycin?
Pretreatment with antihistamines and slow infusion rate
94
When does resistance to vancomycin happens?
Occurs in bacteria via amino acid modification of D ala D lac
95
Which bacterial structure contains 30 s and 50 s subunits?
Ribosomes
96
Who are primarily target by protein synthesis inhibitors?
Smaller bacterial ribosome (70s made of 30s and 50s subunits)
97
Why is humman ribosome not affected by protein synthesis inhibitors?
They just affect 30s and 50 s subunits and the human ribosome is 80s
98
Consider 30s inhibitor bacteriostatic
Tetracyclines
99
Consider 30s bactericidal
Aminoglycosides
100
Who is considered 50 S inhibitor bacteriostatic?
Chloramphenicol, clindamycin | Macrolides (erythromycin)
101
50 S inhibitor but variable between bacteriostatic and bactericidal
Linezolid
102
These medicines are consider aminoglycosides
Gentamicin, neomycin, amikacin, tobramycin, streptomycin
103
How do aminoglycosides work?
Bactericidial, inhibit formation of initiation complex and cause misreading of mRNA Blook translocation
104
Why aminoglycosides are ineffective against anaerobes?
Because aminoglycosides require O2 for uptake
105
When is recommended the clinical use for aminoglycosides?
Severe gram negative rod infections
106
Which medicines are synergistic with aminoglycosides?
Beta lactam antibiotics
107
What is recommended Neomycin?
For bowel surgery
108
Which are the toxicity risk for using Aminoglycosides?
Nephrotoxicity Neuromuscular blockade Ototoxicity Teratogen
109
The use of aminoglycosides with these antibiotics increase the risk of nephrotoxicity
Cephalosporins
110
Which medicines when used in conjunction with aminoglycosides can increase the risk for ototoxicity?
Loop diuretics
111
Which is the mechanism from which bacterias inactivate aminoglycosides?
Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation
112
Who are considered tetracyclines?
Tetracycline, doxycycline, minocycline
113
This is the mechanism of action of tetracyclines
Bacteriostatic, bind to 30S and prevent attachment of aminoacyl-tRNA
114
How well tetracyclines penetrate to CNS?
Limited CNS penetration
115
How is doxycycline eliminated?
Fecally
116
In which patients can doxycyclin can be safely used?
Renal failure patients
117
In these occasions is not recommended the use of Tetracyclines
Do not take with milk (Ca2+), antacids (Ca2+ or Mg2+) or iron containing preparations
118
Why is not recommended the combination of tetracyclines with milk (Ca2+), antacids (Ca2+ or Mg2+) or iron containing preparations?
Because divalent cations inhibit its absorption in the gut
119
These bacterias are susceptible to tetracyclines
Borrelia burgdorferi | M. Pneumoniae
120
Which is the clinical use for tetracyclines?
Ricketssia and chlamydia
121
Why are tetracyclines effective against Chlamydia and Rickettsia?
Because tetracyclines have the ability to accumulate intracellularly
122
Which dermatologic disease can be treated with tetracyclines?
Acne
123
Name adverse effects of using tetracyclines
GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity
124
When are specially contraindicated tetracyclines?
Pregnancy
125
Which is the mechanism of resistance to tetracyclines?
Decrease uptake or increase efflux out of bacterial cells by plasmid encoded transport pumps
126
Who are classified as macrolides?
Azithromycin, clarithromycin, erythromycin
127
How do macrolides work?
Inhibit protein synthesis by blocking translocation
128
Where do macrolides bind?
To the 23 S RNA of the 50 S ribosomal subunits
129
Are macrolides bacteriostatic or bactericidal?
Bacteriostatic
130
When is clinically recomended the use of macrolides?
Atypical pneumonias Sexually transmited diseases (chlamydia) Gram positive cocci
131
Which bacteria can cause atypical pneumonias?
Mycoplasma Chlamydia Legionella
132
In streptococcal infections in patients allergic to penicillin which is the alternative treatment?
Macrolides
133
Which are adverse effects of macrolides?
Gastrointestinal motility issues, Arrhytmia caused by prologue QT, acute cholestatic hepatitis, rash, eosinophilia
134
Which medicines do macrolides increase serum concentrations?
Theophylines | Oral anticoagulants
135
This is the mechanism of resistance to macrolides
Methylation of 23 rRNA binding site prevents binding of drug
136
How does chloramphenicol works?
Blocks pepetydiltransferase at 50S ribosomal subunit
137
Is chloramphenicol bactericidal or bacteriostatic?
Bacteriostatics
138
Which cases is recommended the use of Chloramphenicol?
Meningitis (H. Influenzae, Neisseria meningitidis, S. Pneumoniae) Rickettsia rickettssi
139
Why is limited the use of chloramphenicol?
Due to toxicities but often used in developing countries because of low cost
140
Which are the toxic effects caused by chloranphenicol?
``` Anemia (dose dependent) Aplastic anemia (dose independent) Gray baby syndrome ```
141
In whom and why chloramohenicol can cause gray baby syndrome?
In premature infants because they lack liver UDP glucuronyl transferase
142
What inactivates chloramphenicol?
Plasmid encoded acetyltransferase inactivates the drug
143
This is the mechanism of action of clindamycin
Blocks peptide transfer (translocation) at 50 S ribosomal subunit
144
Is clindamycin bactericidal or bacteriostatic?
Bacteriostatic
145
Which is the clinical use for clindamycin?
Anaerobic infections in aspiration pneumonia, lung abscesses and oral infections Also effective against invasive group A streptococcal infection
146
Who are consider anaerobic bacterias treated with clindamycin?
Bacteriodes spp | Clostridium perfringens
147
Which is a mnemonic for treating anaerobes?
Clindamycin treats anaerobes above the diaphragm vs metronidazole treats anaerobic infections below diaphragm
148
These are some toxicity manifestations by clindamycin
Pseudomembranous colitis (C difficile overgrowth) fever, diarrhea
149
These three are consider sulfonamides
Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
150
Which is the mechanism of sulfonamides?
Inhibit folate synthesis | Para aminobenzoic acid (PABA) antimetabolites inhibit dihydropteroate synthase
151
Sulfonamides... Bactericidal or bacteriostatic?
Bacteriostatic
152
Which bacterias are susceptible to sulfonamides?
Gram positive Gram negative Nocardia Chlamydia
154
Which clinical use of triple sulfas or SMX?
For simple UTI
155
What happens if G6PD is deficient and you administer Sulfonamides?
Hemolysis
156
Which could be the secondary effects of Sulfonamides?
Hypersensitivity reactions, hemolysis, nephrotoxicity, photosensitivity, kernicterus in infants
157
Which kind of nephrotoxicity can Sulfonamides cause?
Tubulointerstitial nephritis
158
How can sulfonamides affect other drugs?
Displace other drugs form albumin
159
Which is an example of drug that can be displace by sulfonamide?
Warfarin
160
What can produce resistance to sulfonamides?
Altered enzymes (bacterial dihydrofolate synthase), ↓ uptake, or ↑ PABA synthesis
161
Which enzymes do Sulfonamides inhibit?
Dyhydrofolate synthase
162
Which enzyme is inhibited by Trimethoprim and pyrimethamine?
Dihydrofolate reductase
163
Which convertions is catalyzed by dihydrofolate reductase?
Dihydrofolic acid to Tetrahydrofolic acid (THF)
164
Which conversion is catalyzed by Dyhidrofolate synthase?
PABA+ Pteridine to Dihydropteroic acid
165
Is Trimethoprim bactericidal or bacteriostatic?
Bacteriostatic
166
What does the combination of Trimethoprim with Sulfametoxazole (TMP-SMX) allows?
Sequential block of folate
167
What is the clinical use for TMP-SMX?
For UTIs, Shigellan Salmonella, pneumocystisi jirovecii pneumonia treatment and prophylaxis, toxoplasmosis prophylaxis
168
Which are adverse effects of Trimethoprim?
Megaloblastic anemia Leukopenia Granulocytopenia
169
The toxicity caused by Trimethoprim may be alleviate with...
Folinic Acid
170
Who are consider Fluoroquinolones?
Ciprofloxacin, norfloxacin, levofloxacin, ofloxacinm sparfloxacin, moxifloxacin, gemifloxacinm enoxacin
171
This medicine is a quinolone
Nalidixic acid
172
Which is the mechanism of action of Fluoroquinolones?
Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV
173
Which topoisomerase is DNA gyrase?
Topoisomerase II
174
Are fluoroquinolones bactericidal or bacteriostatics?
Bacteriostatics
175
Which medicines must not be taken with fluoroquinolones?
Antacids
176
When is recommended the use of Fluoroquinolones?
Gram negative rods of urinary and GI tracts (including pseudomonas). Neisseria, some gram positive organisms
177
Which could be the most common secondary effects to Fluoroquinolones?
GI upset, superinfections, skin rashes, headache, dizziness
178
Which are less common toxicity effects of fluoroquinoles?
Tendonitis, tendon rupture, leg cramps, and myalgias
179
When are fluoroquinoles contraindicated?
Pregnant women, nursing mothers and children under 18 years old due to possible damage to cartilage
180
Consider a possible cardiac toxicity manifestation by fluoroquinoles
Prolonged QT interval
181
Who are at higher risk of tendon rupture using fluoroquinolones?
People >60 years old and in patients taking prednisone
182
This is the mechanism of resistance to Fluoroquinolones
Chromosome encoded mutation in DNA gyrase, plasmid mediated resistancem efflux pumps
183
How does Metronidazole damages bacterias?
Forms free radical toxic metabolites in tje bacterial cell that damage DNA
184
This antibiotic is also consider a antiprotozoal
Metronidazole
185
Is metronidazole a bacteriostatic or bactericidal?
Bactericidal
186
Which pathogens are suceptible to Metronidazole?
``` Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobes (Bacteroides, C. Difficile) ```
187
In which medications does the triple therapy for H. Pylori consists?
Proton pump inhibitor Clarithromycin Metronidazole
188
Which is the most common side effect of Metronidazole?
Disulfiram like reaction with alcohol
189
What is the disulfiram like reaction?
Severe flushing Tachycardia Hypotension
190
Which are the symptoms of Disulfiram like reaction with alcohol?
Headache | Metallic taste
191
Who are consider mycobacterium?
M. Tuberculosis M. avium- intracellulare M leprae
192
Which is the profilaxis treatment for M. tuberculosis?
Isoniazid
193
Which medicines are included in the treatment for M. Tuberculosis
Rifampin Isoniazid Pyrazinamide Ethambutol
194
For M. avium intracellulare, which is the prophylaxis treatment?
Azithromycin | Rifabutin
195
Who is more resistant to treatment between M. Tuberculosis and M. avium intracellulare?
M. avium intracellulare
196
Which is the recommended treatment for M. avium intracellulare?
Azithromycin or clarithromycin+ ethambutol. | Can add rifabutin or ciprofloxacin
197
Is there any prophylaxis treatment for M. Leprae?
N/A
198
How do you treat infection by M. Leprae, Tuberculoid form?
Long term treatment with dapsone and rifampin for tuberculoid form
199
How is lepromatous form treated?
Long term treatment with dapsone and rifampin Add clofazimine for lepromatous form
200
This is the mechanism of action of Isoniazid?
↓ synthesis of mycolic acids, Bacterial catalase- peroxidase(encoded by KatG) needed to convert Isoniazid to active metabolite
201
Is there a difference of Isoniazid related to half lives?
Different Isoniazid half lives in fast vs low acetylators
202
Which are the probable secondary effects of Isoniazid?
Neurotoxicity, hepatotoxicity
203
This medicine can prevent neurotoxicity, lupus caused by Isoniazid
Pyridoxine (vitamin 6)
204
Who are consider Ryfamycins?
Rifampin, Rifabutin
205
How do Ryfamycins work?
Inhibits DNA dependent RNA polymerase
206
Which is the advantage of combining Rifampin with Dapsone in Leprosy treatment?
Rifampin delays resistance to dapsone when used for leprosy
207
When is Rifampin used as prophylaxis treatment?
Meningococcal prophylaxis and chemoprophylaxis in contacts of children with Haemophilus influenzae type B
208
Which are the possible side effects of Rifampicin?
Minor hepatotoxicity and drug interactions (↑P-450) | Orange body fluids
209
When is preferred the use of Rifabutin more than Rifampicin?
HIV infections due to less cytochrome P-450 stimulation
210
This is the mechanism of action of Pyrazinamide
Mechanism uncertain. Though to acidify intracellular enviroment via conversion to pirazinoic acid.
211
On which enviroment is Pyrazinamide effective?
In acidic pH of phagolysosomes, where TB engulfed by macrophages is found
212
These are consider toxic findings with Pyrazinamide use
Hyperuricemia | Hepatotoxicity
213
Which is the mechanism of action of Ethambutol?
↓ carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase
214
This is the possible secondary effect of Ethambutol toxicity
Optic neuropathy (red green color blindness)
215
This medication is used as prophylaxis for endocatitis with surgical or dental procedures
Penicillins
216
You can use this medicine for Gonorrhea prophylaxis
Ceftriaxone
217
In case of history of recurrent UTIs this is an alternative of treatment
TMP-SMX
218
Drug of choice in meningococcal infection prophylaxis
Ciprofloxacin
219
For Meningococcal infection prophylaxis this is the selected treatment for children
Rifampin
220
Which is the prophylaxis treatmen for pregnant women carrying group B strep?
Ampicillin
221
Prevention of gonococcal or chlamydial conjuntivitis in newborn
Erythromycin ointment
222
Prevention of postsurgical infection due to S. aureus
Cefazolin
223
Phophylaxis of strep pharyngitis in child with prior rheumatic fever
Oral penicillin
224
For syphilis this is the selected treatment
Benzathine penicillin G
225
When CD4 counts are <200 cells/ mm3, which is the recommended prophylaxis?
TMP-SMX
226
Which infection are you trying to prevent with TMP-SMX when CD4 counts are <200 cells/ mm3?
Pneumocystis pneumonia
227
When CD4 counts are <100 cells/ mm3, which is the recommended prophylaxis? and which infections are prevented?
TMP-SMX | Pneumocystis pneumonia and toxoplasmosis
228
When CD4 counts are <50 cells/ mm3, which is the recommended prophylaxis?
Azithromycin
229
Which infection are you trying to prevent with TMP-SMX when CD4 counts are <50 cells/ mm3?
Mycobacterium avium complex
230
In prophylaxis treatment in HIV if TMP-SMX is not tolerated by the patient, which is the alternative?
Aerolized pentamidine
231
Can Aerolized pentamidine prevent Toxoplasmosis?
NO
232
Which bacterias are consider highly resistant bacterias?
MRSA (Methicillin Resistant S. Aureus) | VRE (Vancomycin Resistant Enterococcus)
233
Which medicines work for MRSA?
``` Vancomycin Daptomycin Linezolid Tigecycline Ceftaroline ```
234
Which adverse effect can Linezolid cause?
Serotonin syndrome
235
For VRE which are the alternative treatment?
Linezolid and streptogramins
236
Who are consider Streptogramins?
Quinuspristin/ Dalfopristin
237
In Antifungal therapy these are the possible mechanisms of action inhibited?
``` Lanosterol Synthesis Ergosterol Synthesis Cell wal synthesis Nucleic acid synthesis Forms membrane pores ```
238
Which group of medicines of Antifungal form membrane pores?
Polyenes
239
Who are Polyenes?
Amphotericin B | Nystatin
240
Which is the mechanism of action of Amphothericin B?
Binds ergosterol; forms memebrane pores that allow leakage of electrolytes
241
When is recommended the clinical use of Amphotericin B?
Serious, systemic mycoses
242
Who respond to Amphotericin B treatment?
``` Cryptococcus Blastomyces Coccidiodes Histoplasma Cnadida Mucor ```
243
For cryotococcal meningitis, what is the treatment?
Amphotericine B with/ without Flucytosine
244
What is recommended for Fungal meningitis?
Intrathecally treatment
245
What is recommended to supplement when you prescribe amphotericin B? Why?
Supplement K+ and Mg2+ because of altered renal tubule permeability
246
These are the possible secondary effects of amphotericin
Fever/ chills (shake and bake), hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis
247
What decreases the risk of nephrotoxicity when Amphotericin B is used?
Hydration
248
Which amphotericin has decrease risk of toxicity?
Liposomal amphotericin
249
This is the mechanism of action of Nystatin
Binds ergosterol; forms memebrane pores that allow leakage of electrolytes
250
Which is the administration way for Nystatin?
Topical form because too toxic for systemic use
251
This is the clinical use for Nystatin
Swish and swallow for oral candidiasis (thrush) | Topical for diaper rash or vaginal candidiasis
252
Who inhibit ergosterol synthesis?
Azoles
253
Name some Azoles
Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Miconazole, Voriconazole
254
Which is the mechanism of action of Azoles?
Inhibit Fungal sterol (ergosterol) synthesis, by inhibiting the cytochrome P-450 enzyme that converts lanosterol to ergosterol
255
Which enzyme is inhibited by Azoles?
1,4 α demethylase
256
This is the clinical use for Azoles
Local and less serious systemic mycoses
257
When is recommended Fluconazole?
For chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types
258
Itraconazole is recommended for...
Blastomyces, Coccidioides, Histoplasam
259
Which Azoles are recomended for topical fungeal infections?
Miconazole and Clotrimazole
260
These could be the Toxicity manifestations of Azoles
Testosterone synthesis inhibition, liver dysfunction
261
What can Ketoconazole cause by Testosterone synthesis inhibition?
Gynecomastia
262
Why can Azoles cause Liver dysfunction?
They inhibit cytochrome P 450
263
This medicine inhibits nucleic acid synthesis
5- Flucytosine
264
What mechanism of action does Flucytosine has?
Inhibits DNA and RNA biosynthesis by conversion to 5 fluorouracil by cutosine deaminase
265
Which is the clinical use for Flucytosine?
Systemic Fungal infections (meningitis caused by Cryptococcus) in combination with amphotericin B
266
You need to be careful to prescribe Flucytosine because can cause...
Bone marrow suppression
267
This group of medicines inhibit cell wall synthesis in Fungal organisms
Echinocandins
268
Who are consider Echinocandins?
Caspofungin, Micafunginm anidulafungin
269
Which is the mechanism of action of Caspofungin?
Inhibits cell wall synthesis by inhibiting synthesis of β glucan
270
When are Echinocandins recommended?
Invassive aspergillosis, Candida
271
These are the clinical findings in case of Caspofungin toxicity
GI upset, flushing
272
How do Echinocandins produce flushing?
Histamine release
273
This medicine inhibits Lanosterol synthesis
Terbinafine
274
Which enzyme is inhibited by Terbinafine?
Fungal enzyme squalene epoxidase
275
Which is the clinical use for Terbinafine?
Dermatophytoses (especially onychomycosis- fungal infection of finger or toe nails)
276
These are consider Toxicity manifestations of Terbinafine
GI upset, headaches, hepatotoxicity, taste disturbance
277
This antifungal interferes with microtubule function; disrups mitosis
Griseofulvin
278
Where does Griseofulvin deposits?
In keratin- containing tissues (eg. Nails)
279
Which is the clinical use for Griseofulvin
Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm)
280
Which are the secondary effects of griseofulvin?
``` Teratogenic Carcinogenic Confusion Headaches ↑ P450 and warfarin metabolism ```
281
Name antiprotozoan therapy
Pyrimethamine Suramin and Melarsoprol Nifurtimox Sodium stibogluconate
282
For which microorganism is recomended Pyrimethamine
Toxoplasmosis
283
Suramin and melarsoprol are used for...
Trypanosoma brucei
284
An infection by... is recommended the use of Nifurtimox
T. cruzi
285
In this case we recommend sodium stibogluconate
Leishmaniasis
286
How does Chloroquine works?
Blocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodia
287
For these cases Chloroquine is recommended
Treatment for Plasmodial species other than P. Falciparum
288
Why the treatment with Chloroquine against P falciparum does not work?
Resistance is too high. Resistance due to membrane pump that ↓ intracellular concetration of drug
289
So what is recommended to treat P. Falciparum infection?
Artemether/ lumefantrine or atovaquine/ proguanil
290
What is recommended for life threatening malaria?
Quinidine in US (quinine elsewhere) or artesunate
291
These are possible secondary effects due to Chloroquine use
Retinopathy; pruritus (specially in dark skinned individuals)
292
These medicines are antihelminthic therapy
Mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziquantel
293
Which is the effect of antihelminthic therapy?
Immobilize helminths
294
When is recommended praziquantel?
Against flukes (trematodes) such as Schistosoma
295
Which antiviral therapy inhibit the release of progency virus?
Oseltamivir | Zanamivir
296
Which is the mechanism of action of Oseltamivir and Zanimivir?
Inhibit influenza neuroaminidase → ↓ the release of progency virus
297
These antivirals are used for Treatment and prevention of both influenza A and B
Zanamivir | Oseltamivir
298
How does Ribavirin works?
Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
299
Which antiviral therapy may work for RSV and Hepatitis C?
Ribavirin
300
Which could be the secondary effects of Ribavirin?
Hemolytic anemia | Severe Teratogen
301
These antivirals are Guanosine analogs
Acyclovir, Famcicloclovir, valacyclovir | Ganciclovir
302
Who phosphorilates Acyclovir, Famcicloclovir, valacyclovir?
Monophosphorylated by HSV/ VZV thymidine kinase
303
Which is the reason Acyclovir, Famcicloclovir, valacyclovir cause few adverse effects?
They just Monophosphorylated by HSV/ VZV thymidine kinase and not phosphorylated in uninfected cells
304
Triphosphate formed by cellular enzymes
Acyclovir, Famcicloclovir, valacyclovir
305
This is the mechanism of action of Acyclovir, Famcicloclovir, valacyclovir
Inhibits viral DNA polymerase by chain termination
306
Which is the clinical use for Acyclovir, Famcicloclovir, valacyclovir?
HSV and VZV | Weak activity against EBV
307
How much effectivity can Acyclovir, Famcicloclovir, valacyclovir have for EBV?
No activity against EBV
308
Which case of HSV infection responds to Acyclovir, Famcicloclovir, valacyclovir?
HSV induced mucocutaneous and genital lesions as well as for encephalitis
309
When is recommended the prophylaxis treatment with Acyclovir, Famcicloclovir, valacyclovir?
In immunocompromised patients
310
Which cases of HSV and VZV infection have nos response to Acyclovir, Famcicloclovir, valacyclovir?
Latent forms of HSV and VZV
311
Which is the prodrug of Acyclovir?
Valacyclovir
312
Comparing Valacyclovir to Acyclovir which is the difference?
Valacyclovir has better oral bioavailabity
313
For Herpes Zoster what is recommended?
Use a related agent, Famciclovir
314
Which are the risk for using Acyclovir, Famcicloclovir, valacyclovir? How can we prevent them?
Obstructive crystalline neprhopathy and acute renal failure if not adequately hydrated
315
This the mechanism of resistance to Acyclovir, Famcicloclovir, valacyclovir
Mutated viral thymidine kinase
316
Triphosphate formed by cellular kinase
Ganciclovir
317
How does Ganciclovir works?
Inhibits viral DNA polymerase
318
When is recommended the clinical use for Ganciclovir?
CMV, especially in immunocompromised patients
319
What is the product of CMV after the treatment with Ganciclovir?
5´monophosphate formed by a CMV viral kinase
320
Which is the prodrug of Ganciclovir? and which is the advantage of the prodrug?
Valganciclovir, has better oral bioavailabity
321
Which are the possible after effects of Ganciclovir?
Leukopenia, neutropenia, thrombocytopenia, renal toxicity
322
Which medicine is more toxic to host enzymes between acyclovir and ganciclovir?
Ganciclovir
323
This is the mechanism of resistance to ganciclovir
Mutated CMV DNA polymerase or lack of viral kinase
324
Viral DNA polymerase inhibitor
Foscarnet
325
Where does Foscarnet binds?
Binds to pyrophosphate binding site of the enzyme
326
Does foscarnet requires activation by viral enzymes?
No
327
When ganciclovir fails to treat CMV, which medicine is the alternative?
Foscarnet
328
When is recommended the treatment with Foscarnet?
CMV retitnitis in immunocompromised patients when ganciclovir fails Acyclovir resistant HSV
329
This is the principal risk for using Foscarnet
Nephrotoxicity
330
This is the mechanism of resistance to Foscarnet
Mutated DNA polymerase
331
What does Cidofovir inhibits?
Viral DNA polymerase
332
Does Didofovir requires phosphorylation by viral kinase?
No
333
These are indications for Cidofovir
CMV retinitis in immunocompromised patients; acyclovir resistant HSV
334
How is the half life of Cidofovir?
Long half life
335
Posible toxic effect of Cidofovir
Nephrotoxicity
336
What is recommended to decrease Cidofovir Nephrotoxicity?
Coadminister with probenecid and IV saline to ↓ toxicity
337
Which is the main point in HIV therapy?
Highly active antiretroviral therapy (HAART)
338
When is initiated HIV therapy?
When patients presetn with AIDS defining illness, low CD4 cell counts, or high viral load
339
This CD4 cell count is when we consider starting HIV therapy
< 500 cell/ mm3
340
How many drugs are used in HIV therapy?
3
341
This is the regimen for HIV to prevent resistance
2 nucleotide reverse transcriptase inhibitors (NRTIs) + | 1 non nucleoside reverse transcriptase inhibitor (NNRTI) OR 1 protease inhibitor OR 1 integrase inhibitor
342
Which are consider protease inhibitors?
``` ALL NAVIR Atazanavir Darunavir Fosamprenavir Indinavir Lopinavir Ritonavir Saquinavir ```
343
What is needed for HIV assembly of virions?
Depends on HIV-1 protease
344
Which is an alternative name for HIV-1 protease?
pol gene
345
What is the function of HIV-1 protease?
Cleaves the polypeptide products of HIV mRNA into their functional parts
346
What is inhibited by protease inhibitors?
HIV-1 protease
347
What does protease inhibitors prevent?
MAturation of new viruses
348
Why do we need to have precautions in the use of Ritonavir?
Because can boost other drug concentrations by inhibiting cytochrome P-450
349
These are consider toxicity situations caused by protease inhibitors
Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy
350
Which protease inhibitor can cause nephropathy and hematuria?
Indinavir
351
Who are Nucleoside reverse transcriptase inhibitors?
``` Abacabir (ABC) Didasone (ddl) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4T) Tenofovir (TDF) Zidovudine (ZDV) ```
352
Formerly which names does Zidovudine received?
AZT
353
Which is the mechaism if action of Nucleoside reverse transcriptase inhibitors?
Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain(lack 3´OH group)
354
Which is the only Nucleoside reverse transcriptase inhibitor that is Nucleotide?
Tenofovir
355
What is the requirement to activate Nucleoside reverse transcriptase inhibitors?
They need to be phosphorylated to be activated
356
Which is the Nucleoside reverse transcriptase inhibitor that does not requires phosphorylation to be activated?
Tenofovir
357
Which Nucleoside reverse transcriptase inhibitor is used as general prophylaxis?
Zidovudine
358
This Nucleoside reverse transcriptase inhibitor is used during pregnancy to decrease the risk if fetal transmission
Zidovudine
359
Which toxic effects can Nucleoside reverse transcriptase inhibitors cause?
Bone marrow suppression | Peripheral neuropathy
360
This secondary effects is just for Nucleoside reverse transcriptase inhibitors (nucleosides)
Lactic acidosis
361
Which secondary effects is just for Nucleoside reverse transcriptase inhibitors (non-nucleosides)?
Rash
362
This secondary effect is only for Zidovudine?
Anemia
363
This Nucleoside reverse transcriptase inhibitor can cause pancreatitis
Didanosine
364
These medicines are Non nucleoside reverse transcriptase inhibitor
Efavirenz Nevirapine Delavirdine
365
What is the difference between Non nucleoside reverse transcriptase inhibitor (NNRTIs) and Nucleoside reverse transcriptase inhibitors (NRTIs)?
NNRTIs bind to reverse transcriptase at site different from NRTIs. Do not require phosphorylation to be activate or compete with nucleotides
366
What is the toxic effect common to all Non nucleoside reverse transcriptase inhibitor (NNRTIs)?
Rash and hepatotoxicity
367
What can be expected with the use of Efavirenz?
Vivid dreams and CNS symptoms
368
Which Non nucleoside reverse transcriptase inhibitor (NNRTIs) are contraindicated in pregnancy?
Delaviridine and efavirenz
369
In case of bone marrow suppression caused by nucleoside reverse transcriptase inhibitors (NRTIs), what can reverse it?
Granulocyte colony stimulating factor (G-CSF) and erythropoietin
370
Is an example of integrase inhibitor
Raltegravir
371
This is the mechanism of action of Raltegravir
Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase
372
This is an adverse effect of Raltegravir
Hypercholesterolemia
373
Name Fusion inhibitor medicines related to HIV
Enfuvirtide | Maraviroc
374
This fusion inhibitor inhibits attachment of HIV
Maraviroc
375
This fusion inhibitor inhibits penetration of HIV
Enfuvirtide
376
How does Enfuviride inhibits penetration of HIV?
Binds gp41, inhibiting viral entry
377
This explain how Maraviroc inhibits the attachment
Binds CCR-5 on surface of T cell/ monocytes, inhibiting interaction with gp120
378
For Maraviroc and Enfuvirtide this is the common side effect
Skin reaction at injection sites
379
Which is the mechanism of action of Interferons?
Glycoproteins normally synthesized by virus- infected cells, exhibiting a wide range of antiviral and antitumoral properties
380
Name the interferons
Interferon α Interferon β Interferon γ
381
What is the clinical use for Interferon α?
``` Chronic hepatitis B and C Kaposi Sarcoma Hiry cell leukemia Condyloma acuminatum Renal cell carcinoma Malignant melanoma ```
382
This is the reason to use Interferon β
Multiple scleosis
383
When is recommended the use of Interferon γ?
Chronic granulomatous disease
384
Which are the toxic effects of Interferons?
Neutropenia, myopathy
385
Antibiotics to avoid in pregnancy
``` Sulfonamides Aminoglycosides Fluoroquinolones Clarithromicyn Tetracyclines Chloramphenicol ```
386
Which antiviral is contraindicated in pregnancy?
Ribavirin
387
This antifungal needs to be avoided in pregnancy
Griseofulvin
388
Which antibiotic increase the risk of kernicterus if used in pregnancy?
Sulfonamides
389
What is the risk of using aminoglycosides in pregnancy?
Ototoxicity
390
This is the reason why is not recommended the used of fluoroquinoles in pregnancy
Cartilage damage
391
Why is important to avoid clarithromycin in pregancy?
Embryotoxic
392
You need to be careful not to use tetracyclines in pregnant patients because risk for...
Discolored teeth, inhibition of bone growth
393
You must not use Ribavirin in pregnant women because...
It is teratogenic
394
This is the reason griseofulvin is contraindicated during pregnancy
Teratogenic
395
This is the secondary effect of Chloramphenicol if used in pregant patients
Gray baby

MICROBIOLOGY (8 decks)

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