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A - USMLE Step 1 Pharm > Microbiology - Pharmacology > Flashcards

Microbiology - Pharmacology Flashcards

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0
Q

Penicillin G and V - Mechanism + Clinical Use + Toxicity + Resistance

A

G = IV + IM vs. V = Oral
Mechanism - Bind transpeptidases + block the cross-linking of peptidoglycan - B-Lactam Antibiotic
Uses - Gram Positive (S. pneumoniae + actinomyces) + N. menigitidis + T pallidum - Bactericidal
Toxicity - Hypersensitivity Reactions + Hemolytic Anemia
Resistance - B-Lactamase cleaves the B-Lactam Ring (Primarily in Gram (-))

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1
Q

Cell Wall Antibiotics

A

Penicillins + Vancomycin + Bacitracin + Antipseudomonals + Cephalosporins + Carbapenems + Monobactams

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2
Q

Ampicillin + Amoxicillin Mechanism + Clinical Use + Toxicity + Resistance

A

Mechianism - Same inhibitor as penicillin + wider spectrum
Clinical Use - Haemophilus Influenzae + E. Coli + Listeria + Protus mirabilis + Salmonella + Shigella + Enterococci
Toxicity - Hypersensitivity Reaction + Rash + Colitis
Mechanism of Resistance - B-Lactamase (use clavulanic acid to protect the penicillin)

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3
Q

Naficillin - Mechanism + Clinical Use + Toxicity

A

Mechanism - B-Lactam penicillin
Clinical Use - Narrow (Staph except MRSA) –> Use naf for staph
Toxicity - Hypersensitivity + interstitial nephritis

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4
Q

B-Lactamase Inhibitors - Name + Mechanism

A

Inhibit B-Lactam and save penicillins

CAST - Clavulanic Acid + Sulbactam + Tazobactam –> E.g Amoxicillin + Clavulanic Acid = Augmentin

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5
Q

Cephalosporins - Mechanism + Organisms Not Covered + Toxicity

A

Mechanism - B-Lactam drugs that inhibit cell wall synthesis - Bactericidal - Broader specturm
Not Covered - LAME - Listeria + Atypicals (mycoplasma + chlamydia) + MRSA + Enterococci
Toxicity - Hypersensitivity Reactions + Vitamin K Deficiency + Gross reactivity with penicillins + nephrotoxicity + Hemolytic Anemia

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6
Q

1st Generation Cephalosporins - Name and Uses

A

Name - Cefazolin + Cephalexin

Uses - Gram Positive Cocci + Proteus Mirabilis + E Coli + Klebsiella pneumoniae - PEcK

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7
Q

2nd Generation Cephalosporins - Name and Uses

A

Names - Cefoxitin + Cefaclor + Cefuroxime
Uses - Gram Positive, + Haemophilus influenzae + Enterobacter aerogenes + Neisseria + Proteus Mirabilis + E. Coli + Klebsiella Pneumoniae + Serratia marcescens - HEN PEcKS

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8
Q

3rd Generation Cephalosporins - Names and Uses

A

Ceftriaxone - Meningitis + Gonorrhea
Ceftazidime - Pseudomonas
Used for serious resistant gram negative bacteria

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9
Q

4th Generation Cephalosporins - Names and Uses

A

Cefepime - Increased activity against pseudomonas and gram positive organisms - Good CNS Coverage

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10
Q

5th Generation Cephalosporins - Names and Uses

A

Ceftaroline - Broad Spectrum for Gram + and Gram - –> Covers MRSA but not Pseudomonas

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11
Q

Carbapenams - Mechanism + Clinical Use + Toxicity

A

Mechanism - B-Lactamase resistant B-Lactam with CNS Activity + IV Administration
Clinical Uses - Gram (+) Cocci + Gram (-) Rods + Anerobes - Wide spectrum but significant side effects (last resort option)
Toxicity - Gi Distrest + Skin Rash + CNS Toxicity (Seizures) + Renal Insufficiency makes it even worse

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12
Q

Monobacatam - Aztreonam Mechanism + Clinical Use + Toxicity

A

Mechanism - Prevents peptidoglycan cross=linking - Synergist with protein inhibitors + no cross reactivity with penicillin
Uses - Gram (-) Rods only (no Gram (+) impact)
Toxicity - Usually nontoxic - occasional GI symptoms

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13
Q

Vancomycin - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Inhibits cell wall peptidoglcan formation by beinding the D-ala D=ala portion - Bactericidal
Uses - Gram Positive only (to large from Gram (-)) + Serious MDR organisms (e.g. C. diff + MRSA)
Toxicity - Well tolerated but NOT without problems –> Nephrotoxicity + Ototoxicity + Thrombophlebitis - Red Man Syndrome (diffuse flushing)
Resistance - Changes D-Ala + D-Ala to D-Ala + D-Lac - Can’t bind anymore

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14
Q

Protein Synthesis Inhibitors - Classes and Names

A

Buy AT 30 CCEL at 50
30S Inhibitors - Aminoglycosides + Tetracyclines
50S Inhibitors - Chloramphenicol + Clindamycin + Erythromycin + Linezolid
Aminoglycosides are the only bactericidal

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15
Q

Aminoglycosides - Drug Names + Mechanism + Clinical Use + Toxicity + Resistance

A

Mean (Amino) GNATS caNNOT kill anaerobes
Names - GNATS - Gentamicin + Neomycin + Amikacin + Tobramycin + Streptomycin (TB Treatment)
Mechanism - 30S Inhibitor - Bactericidal - Inhibit initiation complex + mRNA misreading + block translocation - Require O2
Use - Severe Gram (-) Rod infection - Synergistic with B-Lactams + Neomycin for bowel surgery
Toxicity - NNOT - Nephrotoxicity + Neuromuscular blockade + Ototoxicity + Teratogen —> Keep treatment to less than 5 days
Resistance - Bacterial enzymes inactive the drug

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16
Q

Tetracyclines - Names + Mechanism + Clinical Use + Toxicity + Resistance

A

Names - Tetracycline + Doxycycline + Minocycline +Tigecycline
Mechanism - 30S Inhibitor - Bacteriostatic - Stops Translation
Uses - Rickettsia (RMSF + Typhus) + Chlamydia + Borrelia bungdorferi + M. pneumonia –> Doxy is a second line drug for anthrax and malaria
Special - Doxy - Fecal elimination (okay in renal failure)
Toxicity - GI Disturbances + Photosensitivity - Also affects Ca deposits in teeth and bone growth (contraindicated in children and pregnancy)
Resistance - Increased efflux + decreased intake via bacterial pumps

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17
Q

Macrolides - Names + Mechanism + Clinical Use + Toxicity + Resistance

A

Names - Azithromycin + Clarithromycin + Erythromycin
Mechanism - 50S Inhibitor - Bacteriostatic - Inhibits translocation - Long Lasting (Days –> Z-Pack)
Uses - Atypical Pneumonia (Mycoplasma + Chlamydia + Legionella) + STDs + Gram (+) Cocci (For Otitis Media + Diphtheria + Pertussis)
Toxicity - MACRO - GI Motility + Arrhythmia (Long QT) + Cholestatic Hepatitis + Rash + eOsinophilia
Resistance - Methylation of the 23S rRNA binding site

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18
Q

Chloramphenicol - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Blocks peptidyltransferased on 50S - Bacteriostatic
Use - Meningitis + RMSF
Toxicity - Anemia + Aplastic Anemia + Gray Baby Syndrome
Resistant - Plasmid enzyme that inactivates the drug

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19
Q

Clindamycin - Mechanism + Clinical Use + Toxicity

A

Mechanism - 50S Translocation Blocker - Bacteriostatic
Use - Anaerobic infections (bacteroides + clostridum perfringens) in lungs and aoral infections + Group A strep - Strong against Gram (+) but worthless against Gram (-) - Treats the anaerobes above the diaphragm vs. Metronidazole treats them below
Toxicity - Highly linked to C. diff and pseudomembranous colitis

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20
Q

Anti-Folate Drugs (2) - Names/Combo + Mechanism + Clinical Use + Toxicity

A

Sulfonamides + Trimethoprim - Almost always used together as TMP-SMX - Bacteriostatic alone but bactericidal together - Used together to avoid resistance
Mechanism - Anti-Folate (Sulfonamides compete with PABA and Trimethoprim inhibits Dihydrofolate reductase) - 2 Steps of same pathway
Use - Uncomplicated UTIs + Shigella + Salmonella + Pneumocystis jirovecii
Toxicity –> TMP –> Treats Marrow Poorly (Megaloblastic anemia + leukopenia)

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21
Q

Fluroquinolones (FQs) - Names + Mechanism + Clinical Use + Toxicity + Resistance

A

Names - Floxacins (E.g. Cirpofloxacin + Levofloaxcin)
Mechanism - Inhibit DNA Gyrase (Topo. II) and Topo IV - Bactericidal - Can’t be taken with antacids - Multiple Generations
Uses - Gram (-) Rods of the Urinary and GI Tracts (E.g. pseudomonas) + Neisseria
Toxicity - LGI Upset + Can damage growing cartilage - Counter indicated in children except those with CF (who get a lot of pseudomonas)
Resistance - Via Chromosome mutations of the DNA gyrase + Plasmid Efflux Pumps

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22
Q

Metronidazole - Mechanism + Clinical Use + Toxicity

A

Mechanism - Anti DNA - Forms free radicals that damage DNA - Bactericidal + Antiprotozoal
Uses –> GET GAP onto the Metro - Giardia + Entamoeba + Trichomonas + Gardnerella vaginalis + Anaerobes (C. Diff) + H. Pylori
Toxicity - Disulfiram reaction (severe flushing + hypotension + tachycardia) + metallic taste (Godzilla eats the metal metro train)

23
Q

Antimycobacterial Drugs - Names

A

RIPE for TB Treatment - Rifampin (RIF) + Isoniazid (INH) + Pyrazinamide (PZA) + Ethanbutol (EMB)

24
Q

Isoniazid (INH) - Mechanism + Clinical Use + Toxicity

A

Mechanism - Pro-drug activated by bacterial KatG to inhibit Mycolic acid synthesis and incorporation into the cell wall (via the FAS II enzyme) –> Leads to lysis
Use - Mycobacterium tuberculosis - Only one used for prophylaxis
Toxicity - INH - Injures Neurons and Hepatocytes - Pyridoxine (B6) helps reduce toxicity

25
Q

Rimfampin (RIF) - Names + Mechanism + Clinical Use + Toxicity

A

Names - Rifampin + Rifabutin (less CYP450 involvement)
4 R’s of RIF - 1) RNA polymerase inhibitor + 2) Ramps up P450 + 3) Red/Orange Body Fluids + 4) Rapid Resistance if used alone
Mechanism - Inhibits RNA synthesis
Use - MTB + Helps with Dapsone for leprosy + meningococcal prophylaxis + H. influenzae type B
Toxicity - Hepatotoxicity + P450 + Orange/Red Body Fluids

26
Q

Pyrazinamide (PZA) - Mechanism + Clinical Use + Toxicity

A

Mechanism - Structurally similar to INH - Pro-drug converted via PcnA enzyme - Inhibits the trans-translation (9saving of the ribosome during the inactive state)
Use - Mtb (with RIF and INH)
Toxicity - Hyperuricemia + Hepatotoxicity

27
Q

Ethambutol (EMB) - Mechanism + Clinical Use + Toxicity

A

Mechanism - Targets arabinosyl transferases and blocks the formation of the arabinogalactan layer of the Mtb cell wall –> Easier for the immune system to attack the Mtb
Use - Mtb
Toxicity - Optic neuropathy (Red/Green Colorblindness) - No Children

28
Q

Anti-Fungals - Classes and Names

A

Cell Membrane Inhibitors (Ergosterol) - Amphotericin B + Azoles + Nystatin
Nucleic Acid/DNA Inhibitors - Flucytosine
Cell Wall Inhibitor - Echinocandins

29
Q

Amphotericin B - Mechanism + Clinical Use + Toxicity

A

Mechanism - Ampipathic ring that binds ergosterol and forms membrane pores allowing electrolyte leakage and fungal cell death
Uses - Broad Spectrum - Drug of choice for serious systemic mycoses (but no CSF access) - Use liposomal preparations to improve packaging + reduce nephrotoxicity
Toxicity - Must avoid chronic use - Fever/chills/vomiting + nephrotoxicity + anemia + liver function impairment + IV phlebitis

30
Q

Nystatin - Mechanism + Clinical Use

A

Mechanism - Same as Amphotericin B - Topical form becasue it is too toxic
Use - Oral thrush + diaper rash + vaginal candidiasis

31
Q

Flucytosine - Mechanism + Clinical Use + Toxicity

A

Mechanism - Converts to 5-FU and inhibits DNA/RNA synthesis
Use - Limited spectrum - Primarily meningitis from Cryptococcus (has CSF access)
Toxicity - Bone marrow suppression

32
Q

Anti-Fungal - Azoles - Classes + Mechanism + Clinical Use + Toxicity

A

1st Generation = Imidazole + 2nd Generation = Triazole
Mechanism - Inhibits ERG1 protein for ergosterol synthesis - no membrane building + toxic intermediate build-up
Use - Miconazole + Clotrimazole are used topically (1st Generation) + Itraconazole (Wide Spectrum but no CSF access) + Fluconazole (chronic suppression of cryptococcus in AIDs patients due to CSF access + long half life) (2nd Generation)
Toxicity - Liver disfunction + teratogenic

33
Q

Echinocandins - Name + Mechanism + Clinical Use + Toxicity

A

Name - All end in Fungin - Caspofungin + Micafungin
Mechanism - Inhibits B-Glucan cell wall synthesis - newest class
Use - Asperilla + candida
Toxicity - GI issues + flushing due to histamine release

34
Q

Terbinafine - Mechanism + Clinical Use + Toxicity

A

Mechanism - Anti-fungal - inhibits ezymes for ergasterol biosynthesis (ERG1) - Toxic intermediate build up + membrane failure
Use - Skin and nail fungal infections
Toxicity - GI + hepatotoxicity + bad tase

35
Q

Enfuviritide - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Anti HIV Fusion Inhibitor - Binds gp41 - Prevents viral entrance into the CD4 Cell
Clinical Use - Anti HIV - 2x Daily Injections
Toxicity - Skin Reactions (At injection site) + $$
Resistance - Mutation in gp41

36
Q

Maraviroc - Mechanism + Clinical Use + Toxicity

A

Mechanism - Anti HIV Fusion inhibitor - Binds human CCR5 preventing co-receptor activation
Clinical Use - Anti HIV - 2x oral dosage - Only effective against CCR5 strands
Toxicity - P450 Drug Interactions

37
Q

NRTIs - Class + Function + Examples + Toxicity

A

Nucleotide Reverse Transcriptase Inhibitors - Nucleosides for chain termination prevention in viral replication
Prodrugs that must be phosphorylated by cytoplasmic enzymes
Examples - Emtricitabine + Tenofovir
Toxicity - Can impact Mito. DNA polymerase - Lactic acidosis + muscle weakness

38
Q

Tenofovir - Mechanism + Clinical Use + Toxicity

A

Mechanism - NRTIs - Tenofovir already has the first phosphate hidden for fast activation
Clinical Use - Anti HIV - Combined with Emtricitabine (NRTI) to form Truvada
Toxicity - Minimal - Some P450 interaction but overall very low

39
Q

NNRTIs - Class + Function + Examples + Toxicity

A

Non-nucleoside reverse transcriptase inhibitors - bind different site of RT then NRTIs - Not pro-drugs (no need to phosphorylate)
Examples - Etravirine
Toxicity - P450 interaction + raised lived enzymes + rash + counter indicated in pregnancy

40
Q

Etravirine - Mechanism + Clinical Use + Toxicity

A

Mechanism - NNRTI - Highly effective + escapes resistance
Clinical Use - Saved for HIV patients who fail the first line therapy
Toxicity - P450 interactions

41
Q

Raltegravir - Class + Mechanism + Clinical Use + Toxicity + Resistance

A

Class - HIV Integrase inhibitor - Prevents integrase from incorpoating the viral DNA into host DNA
Mechanism - Inhibits strand transfer (LTR and U3/U5 addition)
Clinical Use - Anti-HIV (No P450 interaction)
Toxicity - Hypercholesterolemia
Resistance - Integrase Mutations

42
Q

Elvitegravir - NOT BOARDS - Mechanism + Clinical Use

A

Mechanism - Anti-HIV Integrase Inhibitor
Use - Used with Cobicstat which has no intrinsic anti HIV effect but increases the half life of elvitegravir (but Cobicstat has P450)

43
Q

Ritonavir - Class/Others + Mechanism + Clinical Use + Toxicity

A

Protease Inhibitor - all end in navir - Darunaiv + Atazanavir
Mechanism - Inhibit HIV protease from the pol gene so it can’t cleave the products of HIV mRNA
Clinical Use - Combination therapy for HIV
Toxicity - Changes in body fat distribution + hyperlipidemia + GI intolerance + hyperglycemia (diabetic control issues)

44
Q

Tipranavir - Mechanism + Clinical Use + Toxicity

A

Mechanism - HIV Protease Inhibitor
Clinical Use - Last line HIV therapy after resistance to all otehrs
Toxicity - Liver Function

45
Q

Acyclovir - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Chain terminating nucleoside analog for DNA viruses - Pro drug is phosphorylated by viral thymidine kinase
Clinical Use - Oral + Topical for HSV + VZV - Herpes
Toxicity - Small renal issues - generally well tolerated
Resistance - Mutated viral thymidine kinase

46
Q

Cidofovir - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Chain terminating nucleoside analog (with a phosphate)
Clinical Use - CMV + Acyclovir resistant HSV
Toxicity - Nephrotoxicity - Give with Probenecid to reduce the nephrotoxicity
Resistance - mutation in DNA polymerase

47
Q

Granciclovir - Mechanism + Clinical Use + Toxicity

A

Mechanism - Chain terminating nuceloside analog
Clinical Use - Not much - Immunocompermised patients (CMV)
Toxicity - Lots - Mutagenic + Carcinogenic + Teratogenic

48
Q

Foscarnet - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Blocks viral DNA polymerase + RNA polymerase
Clinical Use - CMV when ganciclovir and cidofovir fail + acyclovir resistant HSV
Toxicity - Nephrotoxicity
Resistance - Mutated DNA Polymerase

49
Q

Amantadine + Rimantadine NOT BOARDS - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Block the M2 pump preventing RNA virus (influenza) from leaving the capsid and entering the cytoplasm - Prevent unsheathing
Clinical Use - None - Virus is resistant
Toxicity - None
Resistance- M2 Mutation

50
Q

Zanamivir + Oseltamivir - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Prevent RNA virus (influenza) budding - prevent neuramididase from cleaving the sialic acid residues after the virus infects - upon release the virus rebinds the sialic acids on the original host cell
Oseltamivir = Tamiflu
Clinical Use - Influenza A + B - Zanamivir = Inhaler
Toxicity - Minimal GI complaints

51
Q

Interferons - Mechanism + Clinical Use + Toxicity + Resistance

A

Mechanism - Mimic normally produced human antiviral IFN
Clinical Use - Alpha (HBV + HCV + Kaposi Sarcoma) + Beta (MS) + Gamma (CGD)
Toxicity - Neuropenia + Myopathy
PEG - Added to increase half life

52
Q

Ribavirin (RBV) - Mechanism + Clinical Use + Toxicity

A

Mechanism - Multiple viral targets via reduced guanosine
Clinical Use - Combo therapy with PEG-IFN for HCV
Toxicity - Hemolytic Anemia + Teratogen + Psychiatric Affects

53
Q

Telaprevir + Simeprevir (NOT BOARDS) - Mechanism

A

Mechanism - HCV Protease Inhibitor - significant success rate with PEG-IFN + RBV

54
Q

Sofobuvir - (NOT ON BOARDS) Mechanism + Clinical Use + Toxicity

A

Mechanism - HCV Chain Terminator - Nucleoside pro-drug like tenofovir
Clinical Use - Sometimes with PEG-IFN + RBV …… Sometimes with just RBV (only oral stand alone treatment) - Once daily pill with high impact on SVR
Toxicity - Limited

A - USMLE Step 1 Pharm (11 decks)

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