Microbiology Drugs Flashcards
1
Q
Antimicrobials drugs that inhibits the folic acid synthesis and reduction ( DNA methylation) ;
A
- Sulfonamides.
- Trimethoprim
2
Q
Which type of penicillin use as IV and IM ?
A
Penicillin G
3
Q
Which type of penicillin used as oral ?
A
Penicillin V
4
Q
Which Antimicrobials drugs contains Beta lactam ring ?
A
- Penicillin.
- Cephalosporins.
- Carba-penems
- Monobactam (Aztreo-nam).
5
Q
Mechanism of penicillin:
A
Penicillin break down of the bacterial cell wall by inhibition of the cross-linking of transpeptidase, therfore, it’s prevent the cell wall formation— lead to increasing the osmotic pressure in the cell —- lyisis of the cell .
6
Q
Penicillin doesn’t affects the human cell wall due to :
A
Because the human cell wall consist of L-Ala (not D-Ala like the bacteria )
7
Q
Cross linking of the bacterial cell wall occurs by :
A
Transpeptidase( penicillin binding protein )
8
Q
Clinical use of penicillin :
A
- Gram + (s.pneumonea, s. Pyogenes {specially for sore throat}, Actinomyces )
- Gram (-) cocci : mainly(N.meningitis)
- Spirochets :( T.pallidum)
- Penicillinase sensitive.
9
Q
What is penicillinase ?
A
B-lactamase enzyme present in the periplasm of the gram (-) bacteria .
10
Q
Mechanism of penicillinase “B-lactamase” ?:
A
Destruction of beta lactam ring.
11
Q
Adverse effect of penicillin:
A
- Hypersinsivity (type1,2,3,4)
- Jaresch-herxeimer reaction
12
Q
What’s the hypersinsivity reaction of penicillin ?
A
- Type 1 hypersinsivity
- Type 2 hypersinsivity ( Hemolytic anemia ).
- Type 3 hypersinsivity (Serum sickness).
- Type 4 hypersinsivity (Maculopapular rash).
13
Q
Hemolytic anemia that cause by penicillin, which typer of hypersinsivity reaction is considered?
A
Typer 2 hypersensitivity
14
Q
Maculopapular rash that cause by penicillin, which type of hypersinsivity reaction considered ?
A
Type 4 hypersinsivity reaction
15
Q
Resistance of penicillin by :
A
- Penicillinase(B-lactamase)
- Modification of PBP( changing of penicillin-binding protein )
- Reduced bacterial cell pentration by:
*Gram (-) bacteria “that have outer membrane “.
*decrease number of porins channel ( that responsible for transporting chemical element to outside and inside the bacterial call ).
16
Q
Which drug increase the duration of penicillin in the blood by decrease the penicillins renal secrtion?
A
Probencid
17
Q
B-lactamase inhibitors :
A
- Clavulanic acid
- Sul-bactam
- Tazo-bactam
- Avi-bactam
18
Q
Penicillinase-sensitive penicillin (anino-penicillins): oral, IV ..?
A
- Amoxicillin (oral)
- Ampicillin (IV)
19
Q
Mechanism of Penicillinase-sensitive penicillin :
A
The same with penicillin but have more Penetration of porin channels of gram (-) bacteria .
20
Q
Augmentin it’s :
A
Amoxicillin + clavulenic acid
21
Q
Augmentin (Amoxicillin +clavulanic acid) uesed for :
A
Resistance cases of otitis media
22
Q
Unasyn (Ampiccillin +sulbactum) uesed for :
A
Surgical infection
23
Q
Clinical use of penicillinase-sensitive penicillin :
A
- HHELPSS :
- H-influenza,
- H-pylori,
- E.coli,
- Listeria
- Proteus
- Salmonella,
- Shigella, ++++ enterococci
24
Q
Penicillinase- resistance penicillins (antistaphylococcal penicillins ):
A
- Dicl-oxa-cillin.
- Naf-cillin.
- Oxa-cillin.
- Methi-cillin.
25
Mechanism of Penicillinase- resistance penicillins (antistaphylococcal penicillins ):
Same with penicillin.
26
Why Penicillinase- resistance penicillins are resistance to penicillinase ?
Because “bulky side chain R group “ block access of B-lactamase to B-lactamase ring.
27
Clinical use of Penicillinase- resistance penicillins (antistaphylococcal penicillins ):
S.aureus skin infection{cellulitis and impetigo, folliculitis } (except MRSA resistance)
28
Adverse effect of Penicillinase- resistance penicillins (antistaphylococcal penicillins ):
1. Hypersinsivity
2. Acute Interstitial nephritis.
29
Antipseudomonal penicillins :
1. Pi-pera-cillin,
2. Ticar-cillin .
30
Piperacillin, ticarcillin used for :
1.Pseudomonas
2. Most gram (+) bacteria
31
Ticarcillin + clavulonate =
Time-nitin
32
Piperacillin+ tazobactam =
Zosyn
33
Penicillin is bactericidal or bacteriostatic
Bacteriocidal
34
Cephalosporins is bactericidal or bacteriostatic
Bactericidal
35
Mechanism of cephalosporins ?
B-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinase .
36
Which organism not covered (not effected ) by 1st-4th generation of cephalosporins ?
LAME
1. Listeria
2. Atypical {mycobacterium, chlamydia}
3. MRSA
4. Enterococci
37
1st generation of cephalosporin:
1. Cefa-zolin,
2. Ceph-alexin.
38
2nd generation of cephalosporin:”
1. Cefa-clor,
2. Cefo-xitin,
3. Cefu-roxime.
39
3rd generation of cephalosporin :
1. Cef-triaxone,
2. Cef-tazidime
3. Cef-podoxime,
4. Cefo-taxime
40
4th generation of cephalosporin:
Cefepime
41
5th generation of cephalosporin:
Cefta-roline
42
Clinical use of 1st generation of cephalosporin:
** KEP:-
1. Proteus
2. E.coli
3. Klebsiella pneumonia
43
Which drug used prior to surgery to prevent s.aureus wound infection ?
Cefazolin
44
Clinical use of 2nd generation of cephalosporin
KEP +SHEN
1. H-influnza
2. Enterobacter
3. Niesseria
4. Serratia
45
Which drug from 3rd generation of cephalosporin used for meningitis and gonorrhoea and disseminated Lyme disease ?
Ceftriaxone
46
Which drug from 3rd generation of cephalosporin used for pseudomonas?
Ceftazidime
47
Which generation of cephalosporins covered the listeria and MRSA and enterococcus but not covered the pseudomonas ?
5th genereation(ceftraoline)
48
Which drugs have this adverse effects: hypersinsivity reaction, autoimmune hemolytic anemia, disulfiram-like reaction, vit K deficiency , hypoprothombinemia, increasing of neurotoxicity of aminoglycosides ?
Cephalosporins
49
Carba-penems drugs :
1. Imi-penem.
2. Mero-penem.
3. Erta-penem.
4. Dori-penem.
50
Which drugs that inhibitor of renal dehydropeptidase 1?
Cilastatin
51
Why the 5th generation of cephalosporins covers the listeria and enterococcus and MRSA ?
Because it’s bind on another site that the fist 4 generation bind to it, it bind to PBP2a
52
Which drug of carbapenems inhibit by renal dehydropeptidase ?
Imipenem
53
Which drug of carbapenems have CNS toxicity side effect (seizures)?
Imipneme
54
Why the meropneme bitter than imipneme ?
1. Because the imipneme break down by renal dehydropeptidase-1
2. Because the imipneme have CNS toxicity side effect (siezures)
55
Monobactams (aztreonam) mechanism of action:
1. Prevent the peptidoglycan cross-linking by binding to PBP-3 (only in G-negative).
2. Synergistic with aminoglycosides .1+1=3
56
Clinical use of monobactams :
1. For penicillin allergic.
2. Patient those with renal insufficiency who can’t tolerate aminoglycosides
3. Gram (-) rod only
57
Which drug that have the highly resistance to B-lactamase ?
Carbapenems
58
Which drug that have highly sensitive to B-lactamase ?
Penicillins
59
Penicillin binding protein :
1. PBP-3 :?
2. PBP-2a ?
1. PBP-3: aztreonam
2. PBP-2a: ceftaroline.
60
اقوى سلاح لل: gram - bacteria
B-lactamase
61
Mechanism of vancomycin :
Inhibit cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursor .
62
Why Vancomycin can’t affects the gram (-) bacteria ?
Because it has too large molecule that can’t pentrate the outer membrane of the gram (-) bacteria
63
Which drugs cause red man syndrome as adverse effects?
Vancomycin
64
Which drug can cause nephrotoxicity , ototoxicity, thrombophlebitis?
Vancomycin
65
Which syndrome characterised by diffuse flushing of the whole body, and non specific mast cell degranulation “histamin release” ?
Red man syndrome
66
Treatment of red man syndrome. :
1. Stop the drug
2. Give Anti-Histamines
3. Restart the medication
67
Mechanism of resistance of vancomycin ?
Via amino acid modification of D-Ala D-Ala to D-Ala D-Lac
68
Treatment of MRSA by:
.6 ادويه
69
Treatment of VRSA by :
1. Quinu-pristin
2. Dalfo-pristin
70
All protein synthesis inhibitor are bacteriostatic except :
Aminoglycosides
71
Amino glycoside is bactericidal due to
Miss reading of mRNA
72
Which of protein synthesis inhibitor are variable( bacteriostatic + bacteriocaidal) ?
1. Dlafo- pristin.
2. Quinu-pristin.
73
Protein synthesis inhibitor divided into : 30s inhibitor and 50s inhibitor, which drug are the 30s inhibitors ?
1. Aminoglycosides
2. Tetracycline
74
Protein synthesis inhibitor divided into : 30s inhibitor and 50s inhibitor, which drug are the 50s inhibitors ?
1. Chloramphenicol
2. Clindamycin
3. Marcrolides
4. Linezolides
5. Strepto-gramins
75
Aminoglycosides drugs:
* “GNATS “
1. Genta-mycin
2. neo-mycin
3. Amikacin
4. Tobra-mycin
5. Strepto-mycin
76
Mechanism of aminoglycosides :
1. Irreversible inhibtion of initiation complex though binding to 30s subunit causing missreading of mRNA
2. Block translocation
77
Why aminoglycosides ineffective aginst anaerobes ?
Because it require O2 for uptake
78
Which drugs use for severe gram (-) rod infection , and also can be synergistic with B-lactam antibiotics ؟
aminoglycosides
79
Which aminoglycosides used for bowel surgery and hepatic encephalopathy ?
Neomycin
80
Aminoglycoside it synergistic with B-lactam antibiotics , it’s rare to used alone. Which aminoglycoside drug that use with vancomycin to treatment the endocarditis ?
Vancomycin + gentamycin
81
Aminoglycoside it synergistic with B-lactam antibiotics , it’s rare to used alone. Which aminoglycoside drug that use with ampicillin to treatment the neonatal meningitis ?
Ampicillin +gentamycin
82
Advers effects of aminoglycosides :
NNOT
1. Nephrotoxicity,
2. Neuromuscular blockage (⬇️ Ach) ,
3. Ototoxicity (specially when used with loop diuretics,
4. Teratogen
83
Which drug have this adverse effects: Nephrotoxicity, neuromascular blockage (⬇️ Ach) , ototoxicity (specially when used with loop diuretics, teratogen
Aminoglycoside
84
Mechanism of resistance of aminoglycosides :
* Bacterial transferase enzyme inactivate the drug by :
* 1. Acetylation
* 2. Phosphorylation
* 3. Adenylation
85
Bacterial transferase enzyme inactivate the aminoglycoside by :
1.acetylation
2. Phosphorylation
3. Adenylation
86
Tetracycline drugs :
1. Tetra-cycline
2. Doxy-cycline
3. Mino-cycline
87
Mechanism of tetracycline :
Bind to 30s and prevent attachment of aminoacyl-tRNA
88
Don’t take tetracycline with milk (calcium) antacid or iron due to :
The milk , antacids and irons decrease the absorption of the tetracycline in the gut.
89
Which drug have ability to accumulate intracellularly and make them very effective aginst rickettsia and chlamydia ?
Tetracycline
90
Which drug can use for borrelia burgdorferi and. M.pneumoniae, rickettsia and chlamydia and also used for treat acne ?
Tetracycline
91
Which drug can used in patient with renal faliure and have effect aginst MRSA?
Doxycycline
92
Which type of tetracycline not used as antibiotics, used as ADH antagonist, so it’s given for SIADH?
Demeclocycline
93
Which drugs have this adverse effects :
GI distress, discoloration of teeth, inhibition of bone growth in children , photosensivity, contraindicated in pregnance ?
Tetracycline
94
Which drug have this mechanism of resistance : ⬇️ Uptake or ⬆️ efflux out of bacterial cell by plasmid -encode transport pumps ?
Tetracycline
95
Clinical uses for tetracycline :
1. Zoonosis : borrelia, M.pneumonea.
2. Intracellular orgasnism : chlamydia, rickettsia
3. Acne: prpprionecacterium
4. Doxycycline : 1. Can use in case-of bacterial infection in patient with renal failure because it does not effect on kidney 2. MRSA
96
Drugs with photo-sensivity :
1. Aminoglycosides
2. Tetracycline
3. Sulfonamides
97
Gly-cyl-cycline: drug
Tige-cycline.
98
What is tigecycline ?
tetracycline derivative bind to 30s and inhibit protein synthesis
99
Clinical use of tigecycline :
For multidrug-resistance (MRSA,VRE)
100
Mechanism of action of chloramphenicol :
Bind to 50s and inhibit peptidyltransferase
101
Clinical use for chloramphenicol:
1. Meningitis,
2. Rocky moutain spotted fever (in case of pregnancy for the 1st and 2nd trimester only )
102
Which drug if used it the pregnant women in the first and seconde trimester does not have side effect, but if she used it in the 3d trimester can lead to gray baby syndrome ?
Chloramphenicol
103
Gray baby syndrome cause by which enzyme lack in liver ?
Liver UDP-glucu-rony-ltransferase.
104
Which drug have this mechanism of resistance: plasmid-encoded acetyltransferase inactivates the drug
Chloramphenicol
105
Which syndrome characterised by : vomiting, ashen grey color of the skin, poor muscle tone, cyanosis, CV collapse ?
Gray baby syndrome
106
1. Gray baby syndrome cause by :
2. Gray man syndrome cause by :
3. Red man syndrome cause by:
1. Gray baby syndrome cause by :chloramphenicol
2. Gray man syndrome cause by :amidarone
3. Red man syndrome cause by: vancomycin
107
Macrolides:
1. Az-thromycin
2. Clari-thromycin
3. Erthromycin
108
Mechanism of macrolides:
Inhibition of protein synrthesis by blocking translocation , bind to the 23S rRNA of the 50s subunit
109
Mechanism of clindamycin :
Block peptide transfer (translocation) at 50s ribosoma subunit “ same as macrolides
110
Which drug Block peptide transfer (translocation) at 50s ribosoma subunit “ same as macrolides
Clindamycin
111
Clinical uses of clindamycin :
1. Anaerobic infection
2. Group A strep infection
3. MRSA
112
Which drugs cause pseudomembranous colitis as side effects ?
1. Clindamycin
2. Streptogramin
113
Mechanism of resistance of clindamycin :
As macrolides “methylation”
114
Oxazolidinones drug:
Linezolid
115
Mechanism of linezolid:
Inhibit protein synthesis by binding to 50s subunit- prevent formation of initial complex
116
Clinical uses of linezolid:
Last line for bacterial resistance (MRSA,VRE)
117
Which drug have thius adverse effects: bone marrow supression especially thrombocytpnea), peripheral neuropathy, serotonin syndrome when given with SSRIs (selictive serotonin reuptake inhibitors)
Linezolid
118
How linezolid lead to serotonin syndrome ?
When giver the linezolid with SSRIs , the linezolid is weak MAOIs (increase serotonin)+ SSRIs also increase the sertonin, taking the twice togther lead to serotonin syndrome
119
Which drug have point mutation of ribosomal RNA as mechanism of resistance ?
Linezolid
120
Which drugs can cause prephral neuropathy ?
1. Linezolid
2. isoniazid
121
Azithromycin, larithromycin, erthromycin, for which group of drug belongs?
Microlides
122
Which drug have this mechanism of action: ihibit protein synthesis by blocking translocation, bind to the 23s rRNA of the 50s ribosomal subuint?
Macrolides
123
How the macrolides effect aginst intracellular organisms?
By concentration inside the macrophage and other cells
124
Clinical use of macrolides :
1. Atypical pneumonias ( Mycoplasma,chlamydia , legionella)
2. Upper respiratory infection :( str. Pneumonia, str. Pyogenes, proteussis ).
3. Streptococcal infection in patient allergic to penicillin.
125
Which drug of microlides can used in motility disoreder of GIT ( eg, gastroparesis) ?
Erthromycin
126
Erthromycin bind to which receptor in GIT, that leade to smooth muscle contraction ?
Motilin receptor
127
adverse effects of macrolide
GAARE
1. Gastrointistinal motility issues,
2. Arrhythmia
3. Acute cholestatic hepatitis
4. Rash
5. Esinophilia
128
Which macrolides inhibit cytochrome p-450 that lead to increase serum concentration of theophyline, oral anticoagulants ?
Erthromycin and clarithromycin
129
Mechanism of resistance of macrolides:
Methylation of 23s rRNA-binding site ,prevent binding of drugs.
130
Sulfonamides drugs :
1. Sulfa-methoxazole (SMX)
2. Sulfa-soxazole
3. Sulfa-diazine
131
Which drug have this mechanism : inhibit dihydropteroate synthesis ?
1.Sulfonamide
2. Dapsone
132
Which bacteriostatic drug converts to bacteriocidal when combined with trimethoprim ?
Sulfonamides
133
Which drug have the following adverse effects : hypersensivity reaction, hemolysis if G6PD deficient, bind to albumin ?
Sulfonamides
134
Which drug have the following mechanism of resistance :
1. Altered enzyme ( bacterial dihydropteroate synthase)
2. ⬇️ uptake
3. ⬆️PABA synthesis
Sulfonamides
135
Which drug have similar mechanism to sulfonamides but structurally distinct agent, and use for leprosy and pneumocystis jivovecii prophylaxis ?
Dapsone
136
Which drug inhibit bacterial dihydrofolate reductase, and may cause megaloblastic anemia leukopenia, granulocytopenia?
Trimethoprim
137
Trimethoprim side effects :
Bone marrow supression:
1. Megaoblastic anemia
2. Leukopnia
3. Granulocytopenia
138
Which drug causing sequential block of folate synthesis in case of used in combination with sulfonamides ?
Trimethoprim
139
How the trimethoprim lead to megaloblastic anemia ?
By effect on human dihydrofolate reductase
140
Which drugs are vairable (static\sidal) and synthesized by the streptomycess virginia ?
Strepto-gramins:- quinupristin, dalfopristin
141
Strepto gramins used for:
1. MRSA
2. VRE
3. Staph
4. Strept skin infection
142
Fluroquinolones drugs :
1. Cipro-floxacin
2. Nor-floxacin
3. Levo-floxacin
4. Oflo-floxacin
5. Moxi-floxacin
6. Gemi-floxacin
7. Eno-xacin
143
Which drugs inhibit prokaryotic enzymes topoisomerase 2 gyrse and topoisomerase 4 ?
Floroquinolones
144
Which drugs use for gram (-) rods of urinary and GI tract and some gram(+) organsims and otitis externa “ ?
Fluroquinolones
145
“Cipro drops “ ( fluroquinolones derivatives) used for :
Otitis externa
146
Which drugs have this adverse effects:, tendonitis or tendon rapture in people > 60 or patient taking prednisalon, cartilage damage in children, leg cramps and myalgias ,and may cause prolong QT interval ?
Fluroquinolones
147
Fluroquinolones contraindicated in :
1. Old age -tendonitis
2. Children <18 - cause cartilage damage
3 . Pregnant women
4. Nursing mother
148
Which fluroquinolon derivatives inhibit cytochrome p-450 ?
Ciprofloxacin
149
Which drugs have this mechanism of resistance: chromosome-encoded mutation in DNA gyrase, plasmid- mediated resistance efflux pumps ?
Fluroquinolones
150
Lipopeptide drug that disrupts cell membrane of gram (-) cocci by creating transmembrane channels ?
Depatomycin
151
Which drug have the following adverse effects :myopathy, rhabdo-myolysis ?
Depato-mycin
152
Which drug form toxic free radical metabolites in the bacterial cell that damage DNA that lead to cell death .
Metronidazole
153
What’s meaning of metronidazole prodrug ?
It’s inactive form of metronidazole
154
Activation of metronidazole (from prodrug to active drug) occurs by reduction, which organisms cand reducing it ?
Anaerobic bacteria
155
Why metronidazole work as antiprotozoa ?
Because it effects on the anaerobes, protozoa doesn’t have mitochondria so it’s anaerobes
156
Clinical uses of metronidazole :
1.Antiprotozoa “GGET” : giardia, entamobea, trichomonas, gradnerella vaginalis,
2. Anaerobic bacteria( bacteroides, c.difficile).
3. Can use in place of amoxicillin in triple therapy of H.pylori
4. Anaerobic infection below the diaphragm
157
Which drug has the following adverse effects: disulfram-like reaction( severe flushing, tachycardia, hypotension), metallic state .
Metronidazole
158
Prophylaxis of tuberculosis :
Isoniazid
159
Prophylaxis of M.avium-intracellulare :
Azithromycin, rifabutin
160
Treatment of tuberculosis:
1. Rifampin
2. Isoniazide
3. Pyrazimaide
4. Ethambutol
161
Treatment of M.avium-intracellulare :
1. Azithromycin + ethambtul ( can also add rifabultin or ciprofluxacin )
2. Clarithromycin + ethambtul ( can also add rifabultin or ciprofluxacin )
162
Treatment of M.leprae:
1. For tuberculoid form :
2. For lepromatous form :
1. For tuberculoid form :dapsone and rifampin.
2. For lepromatous form :dapsone + rifampin + clofazimine
163
Which drug used for treatment of tuberculosis by this mechanism :inhibit of bacterial DNA-dependent RNA polymerase .
Rifampin
164
Which drug used for treatment of tuberculosis by this mechanism : inhibit mycolic acid synthesis
Isoniazid
165
Which drug used for treatment of tuberculosis by this mechanism : inhibition of arabinosyl transferase ?
Ethambutol
166
Which drug used for treatment of tuberculosis and have this side effects : hepatotoxicity ,optic neuropathy?
Ethambutol
167
Which drug used for treatment of tuberculosis and have this side effects : hepatotoxicity red-orange body fluids, cytopnia , increase cyt p-450 :
Rifampin
168
Which drug used for treatment of tuberculosis and have this side effects : neurotoxicity, hepatoxicity, vit B6 deficiency , decrease cyt p-450
Isoniazid
169
Which drug used for treatment of tuberculosis and have this side effects : hepatotoxicity and hyperuricemia?
Pyrazinamide
170
Rifamycins drugs:
1. Rifa-mpin.
2. Rifa-butin
171
Which tuberculosis drug inhibit cytochrome P-450
, isoniazid
172
Isoniazid (inactive) converts to isoniazid( active) by:
Catalase peroxidase( that release from bacteria )
173
Which gene encoded the catalase peroxidase enzyme ?
KatG
174
Reisistance of isoniazide by mutation of which gene ?
KatG
175
Which tuberculosis drug increase cytochrome P-450
Rifampin
176
Which drugs block translocation?
1. Macrolides
2. Clindamycin
3. Aminoglycosides
177
Dehydrofolate reductase :
1. In human inhibit by :
2. In baceria inhibit by :
1. In human inhibit by : methotrexate
2. In baceria inhibit by : trimethoprim, pyrimehamine
178
Mechanism of rifampin ?
Inhibition of DNA dependent RNA polymerase
179
Which drug used for tuberculosis as 2nd line and cause tinnitus, vertigo, ataxia, nephrotoxicity ?
Streptomycin
180
Which antimicrobial prophylaxis used in case of high risk for endocarditis and undergoing surgical or dental procedures ?
Amoxicillin
181
Which antimicrobial prophylaxis used in case of exposure to gonorrhea ?
Ceftriaxone + azithromycin
182
Which antimicrobial prophylaxis used in case of history of recurrent UTI
TMP-SMX
183
Which antimicrobial prophylaxis used in case of exposure to meningiococcal infection :
Ceftriaxone , ciproflocxacin, rifampin.
184
Which antimicrobial prophylaxis used in case of pregnant women carrying group B strep?
Intrapartum penicillin G or ampicillin
185
Which antimicrobial prophylaxis used in order to prevention of gonococcal conjunctivitis in newborn ?
Erthromycin ointment on eyes
186
Which antimicrobial prophylaxis used to prevention postsurgical infectioon due to s.aureus ?
Cefazolin
187
Which antimicrobial prophylaxis used to strep pharyngitis in child with prior rheymatic fever?
Benzathine penicillin G or oral penicillin V
188
Which antimicrobial prophylaxis used in case off exposure to syphilis
Benzathine penicillin G
189
Prophylaxis of HIV patients in case of CD4<200, with pneumocystis pneumonea ,
TMP-SMX
190
Prophylaxis of HIV patients in case of CD4< 100, with pneumocystis pneumonea ,toxoplasmosis :
TMP-SMX
191
Prophylaxis of HIV patients in case of CD4<50, with mycobacterium avium complex infection :
Azithromycin or clarithromycin
192
Treatment of MRSA:
1. Vanco-mycin
2. Dapto-mycin
3. Linezolid
4. Tige-cycline
5. Cefta-roline
6. Doxy-cycline
193
Treatment of VRE :
1. Linezolid,
2. Streptogramins (quinupristin, dalfopristin)
194
Different between amphotericin B and nyastatin in the clinical used:
Amphotericin uesd in systemic mycosis, but nyastatin used only in topical mycosis
195
Why Amphotericin B used only in case of severe fungal infection ?
Because it “amphoterrible” (have severe side effects )
196
Antifungal therapy that work on cell membrane integrity “ form membrane pores “
Polyenes :
1. Amphotericin B
2. Nyastatin
197
Antifungal therapy that inhibit nucleic acid synthesis :
Flu-cyto-sine
198
Antifungal therapy that inhibit cell wall synthesis :
Echino-candins:
1. Anidul-fungin
2. Caspo-fungin
3. Muca-fungin
199
Antifungal therapy that inhibit lanosterol synthesis :
Ter-bina-fine
200
Antifungal therapy that inhibit ergosterol synthesis :
Azoles :
1.clotrim-azole.
2. Flu-con-azole
3. Itra-con-azole
4. Keto-con-azole
5. Mi-con-azole
6. Vori-con-azole
201
Which drugs bind to ergosterol and forms membrane pores that allow leakage of elctrolytes?
Polyenes: amphotricin, nyastatin
202
Which antifungal drugs have the following side effects :fever, chills (shake and bake), hypotension, nephrotoxicity, arrhythmias, anemia , IV phelebitis (amphoterrible)?
Amphotericin B
203
The nephrotoxicity that cause by amphotricin can decrease it by :
Hydration
204
Which antifungal drugs inhibit DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase ?
Flucytosine
205
Which antifungal drug used with combination with amphotricin to treat the systemic mycosis ?
Flucytosine
206
Side effect of flucytosine:
Bone marrow supression
207
Which antifungal drugs inhibit fungal stgerol(ergosterol) synthesis, by inhibition of the cytochrome P-450 enzyme that converet lanosterol to ergosterol
Azoles
208
Azoles inhibit fungal ergosterol synthesis by :
Inhibition of cytochrome P-450 that converts lanosterol to ergosterol
209
Which enzyme convert lanosterol to ergosterol in fungi?
14-alpha-demethylase (Cytochrome P-450)
210
Which azoles drug used for : chronic suppression of cryptococcal meningitis in AIDS patients?
Fluco-nazole
211
Which azoles drug used for : blastomyces, coccidioides, histoplasma?
Itra-con-azoles
212
Which azoles drug used for : atypical fungal infection?
1. Clotrim-azoles,
2. Mi-con-azoles
213
Which azoles drug used for : aspergillus and candida?
Voriconazole
214
Which azoles drug used for :aspergillus and mucorales infections?
Isavu-con-azole
215
Which antifungal dugs that can cause testesterone synthesis inhibition , gynecomastia
Azoles: specially”ketoconazoles”.
216
Azoles side effects:
1. Testosterone synthesis inhibition ,
2. Gynecomastia,
3. Liver dysfunction (by inhibition of cytochrome P-450
217
Azoles can cause liver dysfunction by :
by inhibition of cytochrome P-450
218
Which antifungal drug inhibit the fungal enzyme squalene epoxide ?
Ter-bina-fine
219
Clinical uses of terbinafne :
Dermato-phytoses (especially onychomycosis -fungal infection of finger or toe nails)
220
What’s onychomycosis -
Type of dermatophytoses that characterized by fungal infection of finger or toe nails
221
Which antifungal drugs inhibit cell wall synthesis by inhibition synthesis of B-glucan ?
Echinocandins
222
Clinical uses of echinocandins :
Invasive aspergillus and candida
223
Which anti-fungal drug can cause GI upset and flushing ( by histamine release )?
Echinocandines
224
Which antifungal therapy interferes with microtubule function, disrupts mitosis. Deposites in keratin containing tissue ?
Griseo-fulvin
225
anti-malaria therapy
Chloro-quine
226
What happen when chloroquine block detoxification of heme into hemozin ?
Heme accumulates and it is toxic to plasmodia
227
Clinical uses of chloroqine :
Treatment of plasmodial species (except P.falciparum)
228
Artemether\lumefantrine or atovaquone\ proguani used for :
P.falciparum
229
For long treatment of malaria use :
1. Quinidine
2. Arte-sunate.
230
Side effects of chlorquine :
Retinopathy
231
Antihelminthic theapy that act as microtubule inhibitor :
Mebendazole
232
Infection by HIV occurs by fusion, fusion of HIV consist of two mechanisms :
1. Attachment.
2. Penetration
Which drgus inhibit this mechanism?>
1. Attachment : mara-viroc
2. Penetration: Enfu-virtide
233
HIV converts from RNA to DNA by reverse transcriptase to pentrate the nuceleus of the cell, we can prevent this pentration by :
reverse transcriptase inhibitors
234
reverse transcriptase inhibitors: two types
1. NRTI “nucleotide reverse transcriptase inhibitors”
2. NNRTI “ Non nucleotide reverse transcriptase inhibitors”
235
Integrase enzyme responsible for intigration of the HIV DNA with the Cell DNA , (After converting the HIV RNA to DNA ),whcih drug can prevent this process .
Integrase inhibitors :3 drugs the ends by “ gravir”
1. Dolute-gravir.
2. Elvite- gravir.
3. Ralte- gravir.
236
HIV utilize the proteolytic enzyme “protease” to lytic the protein that form after translation, we can prevent this process by :
Inhibition of protease enzyme
237
Protease inhibitor :(for HIV therapy)
Drugs that end by “navir”
1. Ataza-navir,
2. Lopi-navir,
3. Indi-navir etc…
238
General HIV therapy :
1. Fusion inhibitors
2. Reverse transcriptase inhibitors
3. Intigrase inhibitors.
4. Protease inhibitors
239
Viral protein synthesis inhibitors :
Interferon-alpha
240
Viral uncoting inhibitors :
1. Aman-tadine,
2. Riman-tadine .
241
Viral nucleci acid synthesis inhibitor :
1. Guanosine analogs (acyclovir, ganciclovir).
2. Viral DNA polymerase inhibitors ( cidofovir, foscarnet )
3. Guanine nucleutide synthesis ( ribavirin )
242
Viral Guanosine analogs :
1.Acy-clovir.
2.ganci-clovir.
3. Famci-clovir
4. Valacy-clovir
243
Direct viral DNA polymerase inhibitors:
1. Cidofovir.
2.foscarnet.
244
Guanine nucleutide synthesis :
ribavirin
245
Neuroaminidase it’s enzyme that utilised it the virus to release from the cell, we can inhibit this enzyme by neuroaminidase inhibitors :
1. Oselta-mivir.
2. Zana-mivir
246
Drug of Choice to CMV :
Ganciclovir
247
Acy-clovir, famci-clovir, valacy-clovir this drugs use for
Viral dependent nucleosides :
1. HSV,
2. VZV,
3. Herpes zoster.
248
Why acyclovir have few adverse effects ?
Because it work only on infected cells
249
Drug of choice for HZV:
Famciclovir
250
Which drug have bitter oral bioavailability:
1. Acyclovir
2. Valacyclovir
Valacyclovir
251
Which antiviral therapy can cause obstructive crystalline nephropathy that may lead to acute renal failure ?
Acyclovir, famiclovir.valacyclovir
252
How to prevent the side effect that can develped after adminstration of acyclovir and other derivatives (obstructive crystalline nephropathy that may lead to acute renal faliure) ?
By good hydration
253
Amphotricin B can cause nephropathy, how we can treat this side effect ?
By good Hidration
254
Mutated of viral thymidine kinase lead to resistance of which drugs ?
Acyclovir and dervitaives
255
What’s the different between ganciclovir and val-ganciclovir ?
Valganciclovir have better bioavailability
256
Side effects of ganciclovir:
1. Bone marrow supression
2. Renal toxicity
257
Foscarnet mechanism of action
Direct inhibition of DNA\RNA polymerase , and HIV reverse transcriptase inhibitor.
258
CMV form resistance aginst ganciclovir by:
Mutated viral kinase
259
If CMV form resistance aginst ganciclovir, which drug we can use in the case ?
Foscarnet
260
Foscarnet clinical uses :
1. CMV retinitis.
2. Resistance of ganciclovir aginst CMV.
3. Resistance of acyclovir aginst HSV.
261
Side effects of foscarnet :
1. Nephrotoxicity
2. Electrolytes abnormalitis “ hypokalemia, hypomagnesemia” that can lead to seizures
3. Seizures ( by decrease Mg\ Na )
262
Mechanism of resistrance of foscarnet :
Mutated DNA polymerase
263
Cidofovir similar in mechanism and clinical uses with which antiviral drug ?
Foscarnet
264
Cidofovir better than foscarnet by :
1. Long half life
2. Does not cause electrolites abnormalitis like the foscarnet
265
Clinical uses of interferon beta :
Multiple sclerosis
266
Clinical uses of interferon gamma:
chronic granulomatus disease.
267
Which antiviral drug used in case of: chronic hepatits B,and C, kapsi sarcoma, hairy cell leukaemia, condylomata acuminata, renal cell carcinoma, malignant melanoma?
Interferon alpha
268
Hepatitis C therapy :
1. Ledipasvir
2. Ribavirin
3. Sofos-bu-vir
4. Sime-pre-vir
269
HCV protease inhibitor :
Sime-pre-vir
270
Viral phosphoprotein (NS5A) inhibitor. That used for HCV:
Ledi-pas-vir
271
Which anti-HCV inhibit synthesis of guanine nucleotides ?
Ribavirin
272
Which drug inhibit HCV RNA-dependent RNA polymerase ?
Sofos-bu-vir
273
MecA gene encoded of :
PBP-2a
274
Cell wall synthesis occur by two mechanisms :
1. Peotidoglycan synthesis
2. Peptidoglycan cross-linking
275
Peptidoglycan synthesis inhibitors :
Glycopeptides :
1. Vancomycin
2. Biucatricin
276
Peptidoglycan cross-linking inhibitors ( transpeptidase inhibitors )
1. Penecillinase sensitive penicillin
2. Penicillinase resistance penicillin
3. Anti-pseudomonal
4. Caphalosporins
5. Carbapenems
6. Monobactam
277
Ribosomes consist of :
1. 50 s subunit (large subunit)
2. 30 s subunit (small subunit)
278
Unasyn it’s combination between :
1. Ampicillin
2. Sulbactam
279
Augmintin it’s combination between:
1. Amoxicillin
2. Clavulenic acid
280
Otitis media cause by
H-influnza
281
Neonatal meningitis cause by :
Listeria
282
Tratment of neonatal meningitis :
Ampicillin
283
Patient in ventilation, infected by pneumonia, which bacteria cause this pneumonia and which drugs most used to treated it?
* Cause: pseudomonas,
* treatment 4’th generation of cephalosporins :”cefepime”.
284
Disulfiram- like reaction cause by inhibition of which enzyme ?
Acetyl dehyd dehydrogenase
285
Which drug from B- lactams antibiotics work as disulfiram ?
Caphaosporins
286
How cephalosporins cause Vit k deficiency ?
1. By killing the bacteria flora that found in the intestine and responsible for production of vitamin K .
2. By decrease the activation of vitamin K in liver by inhibition of Epoxide reductase enzyme .
287
Why to avoid to uses of warfarin with cephalosporins?
To prevent the severe deficiency of vitamin k, because the two drugs decrease the activity of vitamin k in the liver by inhibition of epoxide peroxidase.
288
The reason of contraindication of cephalosporins with aminoglycosides ?
Because the cephalosporine increase the risk of nephrotoxicity of amninoglucosides
289
What’s ESBL “extended spectrum B-lactamase:
It’s type of B-lactamase that resistance to most B-lactam antibiotics : penicillin cephalosporins, monobactam.
290
Which bacteria contains ESBL “extended spectrum B-lactamase:
Only gram (-) bacteria : KEEP-3S
1. Klibsella
2. E.coli
3. Enterobacter
4. Pseudomonas
5. Salmonella
6. Serratia
7. Shigella
291
Drug of choice for ESBL :
Carbapnems
292
Which drug used with imipneme to increase the half-life of the drug ?
Cilastatin
293
How the imipenem cause seizures ?
By inhibition of GABA receptors
294
Why. The monobactams effects only on gram negative bacteria ?
Because it bind to PBP-3 that found only in gram (-) bacgteria
295
What’s meaning of synergetic effect of the drugs ?
1+1=3
296
Which drug synergetic with monobactam ?
Aminoglycosides
297
Vancomycin it’s bacteriosidal aginst all of the bacteria except one bacteria work as bacteristatic :
C.diffice
298
Vancomycin used as IV except on case that used as oral, which case ?.
In case of pseudomembranous colitis that cause by c.difficile
299
How the red man syndrome occurs ?
When the doctor administrate the vancomycin to the patient rapidly
300
administration of amoxicillin to patient with EBV pharyngitis lead to :
Maculopapular rash
301
Why the aminogycosides are bactericidal ?
Due to miss-reading of mRNA
302
Neomycin clinical use:
1. Bowel surgery .
2. Hepatic encephalopathy
303
How the neomycin can treat the hepatic encephalopathy ?
Neomycin kill the gram (-) bacteria that located as normal flora in GIT-this bacteria produce amonia ,when neomycin kill this bacteria it lead to decrease production of amonia that cause hepatic encephalopathy
304
Plasmed encoded of transport pump, it’s cause resistance for tetracycline, by which mechanism ?
By decrease uptake of the drug and increase efflux out of the drug
305
Which drug inhibit peptidyltransferase ?
Chloramphenicol
306
Drug of choice of rocky-mountain spotted fever :
Doxycycline
307
Drug of choice of rocky-mountain spotted fever in case of pregnancy : (for 1’st and 2nd trimester only)
Chloramphenicol
308
Using of chloramphenicol after the 2nd trimester of pregnancy lead to
Gray- babe syndrome
309
Side effects of chloramphenicol
1. Anemia
2. Aplastic anemia
3. Gray baby syndrome
310
Liver responsible for detoxification of chloramphenicol by which enzyme?
UDP-Glucoronyltransferase
311
Treatment of gray baby syndrome
1. Stop the drug
2. Exchange transfusion phenobarbital (enzyme inducer- increase UDP-Glucoronyltransferase)
312
Which drug inactivate by acyl-transferase enzyme than encoded by plasmid ?
Chloramphenicol
313
Treatment of anaerobic bacteria above the diaphragm :
Clindamycin
314
Treatment of anaerobic bacteria below the diaphragm :
Metronidazole
315
Initial complex inhibitors :
1. Aminoglycoside :by bind to 30s
2. Linezolid : by bind to 50s
316
Which syndrome characterised by : fever, confusion, agitation, hyperrflexia?
Serotonin syndrome
317
Antimicrobial drugs that inhibit translocation
1. Macrolide
2. Clindamycin
318
Which antimicrobial drug use for gastropariesis “GI motility disorders “
Erythromycin
319
Combination between Quinupristin and Dalfopristin =
Syner-cid
320
For simple UTI we use :
Sulfamethoxazole
321
Using of sulfonamide for new-born lead to
Kernicterus
322
To long duration of penicillin, we administration it in combination with :
Probenecid
323
Mechanism of Antifungal therapy: “
1. Protein synthesis inhibitor
2. Nucleic acid synthesis inhibitor
3. Lanosterol synthesis inhibitor
4. Ergosterol synthesis inhibitor ( inhibit the enzyme, or formation of membrane pores )
324
Which enzyme inhibit by azoles ?
14-alpha-demethylase (cytochrome p-450)
325
Candida infection therapy : (1st, 2nd, 3rd lines )
1. 1st line : fluconazoles
2. 2nd line : echinocandins
3. 3rd line amphotrisin B
326
Which two drug that use for dermatophysis ?
1. Teribuinafine
2. Griseofulvin
327
Which anti fungal drug deposit in keratin-containing tissue. ?
Grieseofulvin
328
Microtubule inhibitors : in fungal , in human, in protozoa ?
1. In fungal : griseofulvin
2. In protozoa : mebendazole
3. In human : anti-cancer therapy : paclitaxil, vincristine
329
Mechanism of anti-malarial therapy :
block detoxification of heme into hemozin
330
Which anti-fungal therapy characterised by the following side effects: teratogenic, carcinogenic, disulfram like reaction, decrease cytochrome p-450
Griseofulvin
331
The main mechanisms of HIV therapy
1. Fusion inhibitors
2. Reverse transcriptase inhibitor
3. Integrase inhibitor
4. Protease inhibitor
332
Side effect of integrase inhibitor of HIV :
Myopathy
333
Side effect of protease inhibitors of HIV
Metabolic complications :
1. Lipodystrophy
2. Dyslipidemia
3. Insulin resistance
334
Monophosphorylation of acyclovir by :
Thymidine kinase (viral kinase )
335
Monophosphorylation of ganciclovir by
CMV viral kinase
336
Which virus conatins thymidine kinase ?
HSV, VZV
337
Side effects of acyclovir
1. Obstruction crystalline nephropathy
2. Acute renal failure
338
Side effects of ganciclovir
1. Bone marrow suppression
2. Renal toxicity
339
Mechanism of ribavirin
Inhibit inosine monophosphate dehydrogenase, that convert IMP to GMP
340
Initial complex consist of
1. 50s
2. 30s
3. mRNA
4. Initiator tRNA
341
Peptide bond that connects the two tRNA formed by
Peptidyltransferase
342
TMP-SMX mechanism :
Sequentially block of folic acid synthesis
343
What’s kernicterus
Newborn have physiological jaundice that characterised by high level of bilirubin, bilirubin bind to albumin to prevent the penetration the BBB, using of sulfonamide lead to bind of the drug to albumin, therefore the bilibrubin will be free in the blood and it will pass BBB and deposit in basal ganglia and cause kernicterus
344
Which drug may cause hemolysis in case of G6PD deficiency
1. Dapsone
2. Sulfonamide
345
Triple therapy of H.pylori
1. Clarithromycin
2. PPI
3. Amoxicillin or metronidazole
346
Treatment of megaloblastic anemia that cause by trimephorime ?
Folonic acid ( that convert to tetrahydrofloic acid with out dihydrofloate reductase
347
Drug of choice to atypical (chlamydia, mycoplasma) :
Macrolide
348
Drug of choice to listeria (neonatal meningitis ):
Ampicillin + gentamycin
349
Drug of choice to meningitis
Ceftriaxon
350
Drug of choice to pseudomonas
1. Cefepime
2. Ceftazidim,
351
Drug of choice to ESBL
Carbapenems
352
Which antimicrobial drugs may cause disulfram like reaction
1. Metronidazole
2. Cephalosporins
3. Griseofulvin
353
Which antimicrobial drug may cause metallic test
1. Metronidazole
2. Terbinafine
354
Prophylaxis of meningitis
Rifampin
355
Drug of choice for atypical pneumonia
Azithromycin
356
Treatment of gonorrhea infection
Azithromycin + ceftriaxone
357
Daptomycin inactivate by
Pulmonary surfactant
