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Pharmacology > Multi-Systems: ABX > Flashcards

Multi-Systems: ABX Flashcards

1
Q

(3) Mechanisms of ABX that inhibit Cell Wall Biosynthesis?

A
  • Inhibit Peptidoglycan Cross-linking
  • Inhibit Peptidoglycan Polymerization
  • Inhibit Cell wall Synthesis by Binding PBP3
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2
Q

ABX that inhibit Membrane Potential?

A
  • Lipopeptides
    • ​Daptomycin
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3
Q

(1) ABX that cause Cell Membrane Disruption?

A
  • Polymyxins
    • ​Polymyxin A
    • Polymyxin B
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4
Q

(10) ABX that inhibit Protein Synthesis?

A
  • Oxazoladinones
  • Tetracyclines
  • Aminoglycosides
  • Glycylcycline
  • Chloramphenicol
  • Clindamycin
  • Lincosamines
  • Macrolides
  • Streptogramins
  • Trimethoprim
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5
Q

(2) ABX that inhibit Folic Acid Synthesis?

(DNA Methylation)

A
  • Sulfonamides
  • Trimethoprim
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6
Q

(3) ABX that inhibit DNA Replication or Transplatation?

A
  • Fluoroquinolones (DNA Topoisomerase)
    • ​Ciprofloxacin
    • Levofloxacin
  • Nitroimidazole
  • Rifamycin (mRNA synthesis - RNA Polymerization)
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7
Q

(2) ABX that acts on the Transglycosylase enzyme
of the Cell Wall Biosynthesis?

A
  • Vancomycin
    • ​D-ala D-ala portion of cell wall precursor
  • Teicoplanin
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8
Q

(5) Sub-types of ABX that acts on the Transpeptidase
of the Cell Wall Biosynthesis?

(Inhibiting Peptidoglycan Cross-linking)

A
  • Beta-Lactams
    • Penicillins (Sensitive, Resistant)
    • Cephalosporins (I, II, III, IV)
    • Carbecephams
    • Carbepenems
    • Monobactams
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9
Q

(5) Penicillinase-Resistant Penicillins?

“MEt NAsty OX -OX -OX”

A
  • Methicillin
  • Nafcillin
  • Oxacillin
  • Cloxacillin
  • Dicloxacillin
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10
Q

(2) Extended Range Penicillins?

“AM extended”

A
  • Ampicillin
  • Amoxicillin
  • Penicillinase Sensitive
  • Combine w/ Clavulanic Acid
  • -> protect against β-lactamase
  • “AMinoPenicillins are AMPed-up Penicillin”
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11
Q

Anti-Pseudomonal Penicillins?

“Pseudo-cars (2x), Never are more popular”

A
  • Carboxylated derivatives extend range of Ampicillin to
  • P. aeruginosa*; Indole-positive Proteus and Enterobacter
    • Carbenicillin
    • Ticarcillin
  • N-acyl derivatives
    • Azlocillin
    • Mezlocillin
    • Piperacillin
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12
Q

(3) Prophylaxis during intra-abdominal surgery?

A
  • Cefotetan (2nd)
  • Cefoxitin (2nd)
  • Neomycin (Bowel surgery) (Aminoglycoside)
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13
Q

(4) Surgery prophylaxis?

A
  • First Generation
    • Cephalexin
    • Cephadrine
    • Cefadroxil
    • Cefazolin
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14
Q

(1) Used to treat Community-acquired Pneumonia?

(H. influenzae and K. pneumoniae)

A
  • Cefuroxime
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15
Q

(1) Used to treat Diabetic Foot Infections?

A
  • Cephalexin
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16
Q

Drugs of choice for treating?

(1) N. gonorrhea
(2) Meningitis (Adult, Children)
(1) B. burgdorferi

A
  • N. gonorrhea
    • ​Ceftriaxone
  • Meningitis
    • ​Ciprofloxacin (1st)
    • Rifampin (children)
  • B. burgdorferi
    • ​Tetracyclines
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17
Q

(2) ABX for Multidrug-resistant Gram-negative Infections, especially those caused by P. aeruginosa?

A
  • Ceftazidime
  • Cefoperazone
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18
Q

First β-lactam approved for MRSA?

Better drug Rx for MRSA?

A
  • Ceftaroline fosamil (IV) (1st)
  • Vancomycin (Better)
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19
Q

(3) Glycopeptide ABX?

(Inhibits Peptidoglycan Syn. –> Cell Wall Synthesis)

A
  • Vancomycin
  • Bacitracin
  • Teicoplanin
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20
Q

Pathogenic spectrum of Vancomycin?

A
  • G+ only
  • Bacteriostatic against Gram-positive Cocci
  • Bactericidal for Gram-positive Rods
    • Serious Penicillinase producers
    • MRSA
    • Enterococci
  • NOT Effective against Gram negatives
  • Last Resort for Pseudomembranous colitis cause by
  • C. difficile* (Oral Vancomycin)
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21
Q

Where does Vancomycin work?

A
  • Binds to D-Ala-D-Ala terminus of Murein Monomer
  • -> D-Ala-D-Lactate. Same mode of VRE
  • Inhibits Murein Polymer synthesis
  • -> Inhibits Peptidoglycan formation
  • Blocks attachment of Disaccharide subunits to pre-existing Cell Wall
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22
Q

SE of Vancomycin?

“NOT”

A
  • Hypersensitivity Rxn - Skin flushing or Rash
    • “Red man syndrome” - rapid infusion due to Histamine release (slow infusion and pretreatment w/ antihistamines)
  • Nephrotoxicity
  • Ototoxicity
  • Thrombophlebitis
  • Neutropenia
  • Tissue necrosis if given IM
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23
Q

Pathogen spectrum of Lipopeptide ABX?

A
  • Gram positive Aerobic organisms
    • Complicated skin infections
    • Endocarditis
  • Bactericidal against VRE?
  • Bacteriostatic against
    • S. pneumoniae
    • S. aureus
  • Retains activity against Gram-positive bacteria
  • Synergizes w/ Oxacillin against MRSA
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24
Q

Where does Lipopeptide ABX work?

A
  • Binds to Bacterial Membranes
  • Forms membrane channels in a Calcium-dependent manner leading to a rapid membrane depolarization thus inhibiting protein
  • DNA and RNA synthesis
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25
Q

SE of Lipopeptide ABX?

A
  • Irritation at site of Injection
  • Skeletal muscle Pain and Weakness (Myopathy)
  • Increase in CPK (creatine phosphokinase)
  • Renal Failure
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26
Q

Where does Polymyxins ABX work?

A
  • Cationic detergents (positive potential) disrupt the membranes of Gram-negative Bacteria
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27
Q

Pathogen spectrum of Polymyxins?

A
  • Topical: OTC ointments
  • IV: Last resort for Gram-negative infections
  • Ophthalmic drops
  • Otic drops
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28
Q

SE of Polymyxins?

A
  • (IV) EXTREME Nephrotoxicity and Neurotoxic
  • Sometimes used Internally for Multidrug resistant Strains
    • Acinetobactor from the Middle East
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29
Q

(2) ABX that Inhibit Peptidoglycan Polymerization Synthesis?

(Glycopeptides)

A
  • Bactericidal
    • Vancomycin
    • Bacitracin
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30
Q

(1) ABX that Inhibits Cell Wall Synthesis by Binding PBP-3?

(Monbactam - monocyclic β-lactam)

A
  • Bactericidal
    • ​Aztreonam
  • Penicillin-binding-protein 3 (PBP-3)
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31
Q

(1) ABX that Disrupt Outer Membrane in
* *Gram-negative Bacteria**?

A
  • Bactericidal
    • ​Polymyxins
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32
Q

ABX that inhibits Synthesis,
Para-aminobenzoic acid (PABA)
inhibit Dihydropteroate Synthetase
in Nucleotide Synthesis?

1x - Bacteriostatic

A
  • Bacteriostatic
    • ​Sulfonamides
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33
Q

ABX that Inhibit Dihydrofolate Reductase
for Nucleotide Synthesis?

2x - Bactericidal

2x - Bacteriostatic

A
  • Bactericidal
    • ​Trimethoprim (Dihydrofolate reductase)
    • Sulfamethoxazole (inhibit Folate synthesis)
  • Bacteriostatic
    • ​Trimethoprim (Dihydrofolate reductase)
    • Pyrimethamine
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34
Q

ABX that Inhibit DNA gyrase - Type II and TYpe IV Topoisomerase?

1x - Bactericidal

A
  • Bactericidal
    • Fluoroquinolones (must be taken w/ antacids)
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35
Q

ABX that Inhibit mRNA Synthesis?

1x - Bactericidal

A
  • Bactericidal
    • ​Rifampin (DNA-dependent RNA polymerase)
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36
Q

ABX that Binds 23S, Blocks initiation of
Complex formation of 50S Ribosomal subunit?

1x - Bacteriostatic

A
  • Bacteriostatic
    • Linezolid (Binds to 23S RNA)
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37
Q

ABX that Blocks release of Nascent Peptides from the Ribosome at 50S Ribosomal subunit?

1x - Bactericidal

1x - Bacteriostatic

A
  • Bactericidal
    • ​Quinupristin/Dalfopristin​
  • Bacteriostatic
    • ​Macrolides (Erythromycin) (Methylation 23S rRNA)
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38
Q

ABX that Block peptide transfer (translocation) at 50S Ribosomal subunit?

1x - Bacteriostatic

A
  • Bacteriostatic
    • Clindamycin
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39
Q

ABX that inhibits Peptidyltransferase
at 50S Ribosomal subunit?

1x - Bacteriostatic

A
  • Bacteriostatic
    • Chloramphenicol
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40
Q

ABX that Inhibit formation of Initiation complesx cause miscoding (misreading) of mRNA and incorrect Amino acid linking for Peptide formation?
Blocking normal Protein Synthesis at 30S Ribosomal subunit?

1x - Bactericidal

A
  • Bactericidal
    • ​Aminoglycosides (Gentamicin)
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41
Q

ABX that Block binding of aminoacyl-tRNA and Addition of Amino Acids to the Peptide chain of 30S Ribosomal subunit?

1x - Bacteriostatic

A
  • Bacteriostatic
    • Tetracyclines
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42
Q

(1) ABX that works on Dihydropteroate Synthetase
Enzyme that converts PABA –> Dihydrofolate?

(Inhibits Folate Synthesis)

A
  • Sulfonamides
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43
Q

2x ABX that works on Dihydrofolate reductase
enzyme for Dihydrofolate –> THF?

A
  • Trimethoprim
  • Pyrimethamine
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44
Q

(1) ABX that inhibits DNA gyrase Topoisomerase II and Topoisomerase IV activity?

A
  • Fluoroquinolones
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45
Q

(1) ABX that inhibits the formation of mRNA from Nucleotides through blocking DNA-dependent RNA Polymerase?

A
  • Rifampin
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46
Q

(2) ABX that works on Translocase enzyme for
* *Peptide bond formation –> Translocation**?

A
  • Macrolides (23S subunit of 50S)
  • Clindamycin (50S)
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47
Q

(1) ABX that works on Peptidyltransferase at 50S Ribosomal subunit enzyme for Attach of AA-tRNA to Ribosome –> Peptide bond formation?

A
  • Chloramphenicol (50S)
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48
Q

(1) ABX that binds to 30S, blocks Initiation Complex Formation –> Attachment of aminoacyl-tRNA to Ribosome?

A
  • Tetracyclines (30S)
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49
Q

(2) ABXs that inhibit Protein synthesis
- -> Initiation of Complex formation?

A
  • Aminoglycosides (30S)
  • Linezolid (23S subunit of 50S)
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50
Q

(3) Different ways Bacteria protect themselves from
β-lactam drugs?

A
  1. Inactivation via β-lactamase
    • Cleaving C-N ring
  2. Changes in Drug target through mutation of Binding site
    • Transpeptidase changes
  3. Decreased permeability, and Efflux pumps (G- only)
    • Restricting drug entry
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51
Q

SEs of Penicillin?

A
  • Hypersensitivity
    • Urticaria, Pruritus, Fever, Anaphylaxis, Joint swelling
  • Rash
  • Hemolytic anemia
    • Coombs-positive
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52
Q

Clinical use of Penicillin?

A
  • Gram-positive Bacteria
    • S. pneumoniae
    • S. pyogenes
    • Actinomyces
  • Fastidious Gram-negative Bacteria
    • Neisseria meningitidis
    • T. pallidum
  • Gram-positive (Bactericidal)
    • ​Clostridia, Listeria, Bacillus
  • Most anaerobes EXCEPT B fragilis group
  • Spirochetes: Drug of choice for Syphilis (Penicillin G)
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53
Q

Clinical uses of
Ampicillin and Amoxicillin (Aminopenicillins)?

“HELPS Slaughter Enterococcus”

AmOxicillin is an Oral form of Ampicillin

A
  • Gram-positive (moderate)
  • Gram-negative (moderate)
  • UTIs
  • Neonatal infections (+ Gentamicin)
  • HELPS Slaughter Enterococcus
    • Haemophilus influenza, E coli, Listeria,
      Proteus mirabilis, Salmonella, Shigella, Enterococcus
  • Used w/ Clavulanic acid –> Extends coverage by protecting against β-lactamase
    • Gram-negative rods
    • H influenzae, E coli, P mirabilis, Salmonella, Shigella
  • 2nd Line Tx for Lyme Disease
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54
Q

SE of Ampicillin and Amoxicillin?

A
  • Hypersensitivity
  • Rash
    • If they have mononucleolus and you give Ampicillin
  • -> Full body Rash, Head to Toe (non-allergic rxn)
  • Pseudomembranous colitis (Colon colitis, C. dificille)
55
Q

Clinical use of Ticarcillin, Carbenicillin, Piperacillin?

A
  • Extended spectrum for Gram-negative rods including Pseudomonas
  • Synergistic w/ Aminoglycosides against Pseudomonas (both are Bactericidal)
56
Q

SEs of Ticarcillin, Carbenillin, Piperacillin?

A
  • Hypersensitivity; interference w/ Platelet function –> Bleeding
  • Used w/ β-lactamase inhibitors
    • ​Ticarcillin + Clavulanic acid
    • Piperacillin + Tazobactam
57
Q

What does Clavulanic Acid, Sulbactam, and Tazobactam
do for β-lactam ABX?

“CaST”

A
  • Binds to β-lactamase and Prevents its Binding and Destruction of the β-lactam ring on suceptible Penicillins
  • Expands the spectrum of activity of β-lactam ABX
  • Used in combination w/
    • Penicillin, Ampicillin, Piperacillin, Ticarcillin
  • Expands activity against:
    • Gram-positive Cocci –> S aureus
    • Gram-negative Rods –> H influenza, Klebsiella
    • Anaerobes –> B fragilis
58
Q

(2) First-generation Cephalosporins (β-lactam)?

A
  • Cefazolin –> surgical prophylaxis for S. aureus
  • Cephalexin
59
Q

(5) Second-generation Cephalosporins (β-lactam)?

A
  • Cefotetan
  • Cefuroxime
  • Cefaclor
  • Cefprozil
  • Cefoxitin
60
Q

(4) Third-generation Cephalosporins (β-lactam)?

A
  • Cefoperazone
  • Ceftriaxone –> excreted in Bile, Renal Failure pts.
  • Ceftazidime –> Pseudomonas
  • Ceftriaxone –> Meningitis and gonorrhea
61
Q

Clinical use of First-generation Cephalosporins (β-lactam)?

“PEcK”

A
  • Gram-positive cocci
    • URIs
  • Gram-negative
    • P mirabilis
    • E coli (G-neg)
    • K pneumoniae
  • β-lactamase sensitive
62
Q

Clinical use of Second-generation Cephalosporins (β-lactam)?

”+ and - HEN PEcKS

A
  • Gram-positive Cocci
  • Extended Gram-negative coverage
  • H influenzae (G-neg)
  • Enterobacter
  • Neiseria (G-neg)
  • P mirabilis
  • E coli (G-neg)
  • Klebsiella (G-neg)
  • S marcescens
  • Mosderate (β-lactamase resistance
63
Q

Clinical use of Third-generation Cephalosporins (β-lactam)?

A
  • Broad spectrum Gram-negative coverage
  • Most cross BBB and are commonly used for Meningitis and Sepsis​
    • ​E. coli
    • Proteu morabilis
    • Klebsiella
    • Enterobacter
    • Serratia
    • Citrobacter
    • Neisseria
    • H. Influenza
    • Strep. pneuonaie
64
Q

Cephalosporin Rx for Pseudomonas?

A

Ceftazidime

(3rd generation)

65
Q

Cephalosporin Rx for Gonorrheal infections?

A

Ceftriaxone

(3rd generation)

66
Q

(1) Fourth-generation Cephalosporins (β-lactam)?

A
  • Cefepime
  • Increased activity against Pseudomonas and
    Gram-positive Cocci due to increased resistance
    to β-lactamase
67
Q

SEs of Cephalosporins?

A
  • Hypersensitivity
  • Increased Aminoglycoside nephrotoxicity
  • Methylthiotetrazole group (Cefotetan, Cefoperazone)
    • can cause Disulfiram-like Rxn w/ Ethanol and increased risk of Bleeding
  • Cefaclor (2nd) and Cephalexin (1st) can cause
  • *Serum sickness-like** reaction
  • Vit. K deficiency
68
Q

Clinical use of Monobactams (Aztreonam) (β-lactam)?

A
  • Gram-negative rods ONLY
  • Pseudomonas
  • NO activity against Gram-positive organsism or anaerobes
  • NO Renal Involvement
  • β-lactamase-resistant
  • Pts. who cannot tolerate Penicillins or Aminoglycosides
  • SAFE IN PREGNANCY
    • No penicillin cross-reactivity
69
Q

SEs of Aztreonam (Monobactam)?

A
  • Nontoxic
  • No cross-sensitivity w/ Penicillins
  • Occasional rash
  • GI distress
  • Fever
  • Phlebitis
70
Q

Clinical use of Carbapenems?

A
  • Impenem / Cilastatin
  • Meropenem decreased risk of seizures and is stable to dehydropeptidase I
  • Broad spectrum against - Broadest β-lactam available
    • Gram-positive cocci
    • Gram-negative rods
    • Anaerobes
    • Pseudomonas
  • DOES NOT cover MRSA, VRE, Rickettsia, Chlamydia
  • Impenem + Cilastatin –> a Renal dehydropeptidase inhibitor prevents metabolism of Impenem by Kidneys
71
Q

SEs of Imipenem / Cilastatin, Meropenem (Carbapenem)?

A
  • Hypersensitivity
  • Rash
  • GI distress
  • Drug Fever
  • Seizures at High Plasma lvls (CNS toxicity w/ Imipenem)
  • Cross-reactivity w/ Penicillin
  • Meropenem is not degraded by Renal Dehydropeptidase and presents a Reduced risk of Seizures
72
Q

How does Bacitracin work?

A
  • Inhibits Peptidoglycan precursors from being transported across the Bacterial Cell Membrane
73
Q

Clinical use of Bacitracin?

A
  • Topical ABX for wound irrigation
  • Covers Gram-positive bacteria
74
Q

SEs of Bacitracin?

A
  • Nephrotoxicity prevents systemic use
75
Q

How do Polymyxin work?

A
  • Basic proteins that act like Detergents
  • They bind to and disrupt the Cell membrane of
  • *Gram-negative Bacteria**
  • “MYXins MIX up Cell Membranes”
76
Q

Clinical use of Polymyxin?

A
  • Resistant Gram-negative infections
  • Resistant Pseudomonas in Cystic Fibrosis
77
Q

SEs of Polymyxins?

A
  • When given systemically; Nephrotoxicity (Acute tubular necrosis) and Neurotoxicity
78
Q

How do Sulfonamides work?

A
  • Bacteriostatic - Inhibits Folate Synthesis
  • Inhibits Dihydropteroate synthetase
  • Enzyme essential for conversion of
  • *PABA + Pteridine** –> Dihydrofolic acid
  • Synthesis of Purines, Thymidine and AAs is impaired
  • Synergistic w/ Trimethoprim and Pyrimethamine
79
Q

Clinical use of Sulfonamides?

A
  • Gram-positive
  • Gram-negative
  • Nocardia (Tx in combination)
  • Chlamydia
  • Toxoplasma
  • Used w/ Trimethoprim (TMP-SMX) for UTIs
    • TMP - treats marrow poorly
  • Salmonella
  • Shigella
  • Serratia
  • P jiroveci (PCP)
  • Sulfadiazine - silver ointment for Burn infection
80
Q

SEs of Sulfonamides?

A
  • Hemolytic anemia in G6PD deficiency
  • Kernicterus in Neonates (hyperbilirubinemia brain dys.)
  • Hypersensitivity (including Stevens-Johnson syndrome)
  • Photosensitivity
  • Interstitial Nephritis
    • Nephrotoxicity (tubulointerstitial nephritis)
  • Displace other Drugs from Albumin
    • Warfarin
81
Q

How does Trimethoprim and Pyrimethamine work?

A
  • Bacteriostatic
  • Synergistic w/ Sulfonamides
  • Folic acid analog that inhibits
    Dihydrofolate reductase (DHFR)
    Dihydrofolic acid -|-> Tetrahydrofolic acid (THF)
  • Decreases Sythesis of Purines, Thymine, and AAs Methionine and Glycine
82
Q

Clinical use of Trimethoprim and Pyrimethamine?

A
  • Trimethoprim used w/ Sulfonamides
    • UTIs
    • Shigella, Salmonella, Pneumcystitis jirovecii
  • Pyrimethamine + Sulfadiazine –> Toxoplasmosis
83
Q

SEs of Trimethoprim and Pyrimethamine?

A
  • Bone Marrow Suppression
    • Megaloblastic anemia
    • Leukopenia
    • Granulocytopenia
  • GI Distress
  • Pruritus
  • Rash
  • Aleviated w/ supplemental Folinic acid
84
Q

What are the Fluoroquinolones?

”–Floxacin”

A
  • Cipro-Floxacin
  • Nor-Floxacin
  • Levo-Floxacin
  • O-Floxacin
  • Gati-Floxacin
  • Moxi-Floxacin
85
Q

How do Fluoroquinolones work?

A
  • Bactericidal
  • Inhibit DNA gyrase (Topoisomerase II)
    and Topoisomerase IV
  • Bacterial enzymes that unwind, sever, and reanneal DNA during replication and transcription
  • MUST NOT be taken w/ antacids –> Inhibit absorption
86
Q

Clinical use of Fluoroquinolones?

A
  • Gram-negative Rods that cause UTIs and Gastroenteritis
  • Pseudomonas
  • Neisseria gonorrhoeae
  • Mycobacteria
  • Atypicals such as Mycoplasma and Legionella
  • Drug of choice for Anthrax
  • Some Gram-positive
87
Q

SEs of Fluoroquinolones?

A
  • GI distress
  • Rash
  • Superinfections
  • CNS effects
  • Photosensitivity
  • Prolonged QT interval
  • Contraindicated in Pregnant and Kids –> Cartilage Dmg
    • Leg cramps and Myalgias
    • Tendinitis and Tendon rupture (adults)
88
Q

How does Chloramphenicol work?

A
  • Bacteriostatic
  • Binds to Peptidyltransferase at 50S Ribosomal subunit and blocks the Proper positioning of tRNA and the addition of New AA to the Polypeptide chain
89
Q

Clinical use of Chloramphenicol?

A
  • Meningitis
    • Neisseria Meningitidis
    • Streptococcus pneumoniae
    • H influenzae (penicillin allergy)
  • Rocky Mountain Spotted Fever (Rickettsia rickettsii)
  • Used topically for Eye Infections
90
Q

SEs of Chloramphenicol?

A
  • Anemia
    • Dose dependent
  • Idiosyncratic Aplastic Anemia (1/30,000 doses)
    • Dose independent
  • Reversible Bone marrow suppression
  • Gray Baby Syndrome
    • ​Lack of Hepatic UDP-glucuronyl transferase
  • Crosses the BBB and Placenta
    • Severe toxicities for multiple uses
91
Q

What are the (3) Macrolides?

A
  • Erythromycin
  • Azithromycin (Safe to use in Pregnancy)
  • Clarithromycin
92
Q

How do Macrolides work?

A
  • Bacteriostatic
  • Binds reversibly to the 23S rRNA of the 50S Ribosomal subunit and Blocks the Translocation step
93
Q

Clinical Use of Macrolides?

A
  • Broad spectrum of Action
  • STIs
    • Chlamydia
    • N gonorrhea)
  • Pneumonia
    • Mycoplasma
    • Chlamydia
    • Legionella
  • Streptococcal infection in Pts. allergic to Penicillin
  • C diphtheriae
  • Nontuberculous Mycobacteria
94
Q

SEs of Macrolides?

“MACRO”

A
  • Prolonged QT Interval
    • Esp. Erythromycin
  • Gastrointestinal Motility issues
  • Arrhythmia by prolonged QT
  • Acute Cholestatic Hepatitis
  • Rashes
  • eOsinophilia (increases serum Theophyllines)
  • Allergy –> Fever
  • P450 inhibition (Increases lvls of Warfarin)
95
Q

How does Clindamycin and Lincomycin work?

A
  • Bacteriostatic
  • Binds to 50S Ribosomal subunit and Inhibits the Aminoacl translocation step by Blocking the Growth and Release of the Growing Peptide chain
96
Q

Clincial use of Clindamycin and Lincomycin?

A
  • Narrow spectrum, Anaerobes in mixed infections
    • ​Bacteroides spp
    • Chlostridium perfringens
  • Aspiration pneumonia
  • Causative agent in Pseudomembranous colitis
    due to C difficile infection
  • Lung abscesses
  • Oral infections
  • Safe in Pregnancy
97
Q

SEs of Clindamycin and Lincomycin?

A
  • Pseudomembranous colitis (C difficile Superinfection)
  • GI distress (diarrhea)
  • Fever
98
Q

What does “buy AT 30, CELL at 50”?

A
  • Protein Synthesis Inhibitors - specifically target smaller bacterial ribosome (30S + 50S = 70S)
  • Aminoglycosides and Tetracyclines
    inhibit the 30S Ribosomal subunit
  • Chloramphenicol, Erythromycin, Linezolid, and cLindamycin inhibit the 50S Ribosomal subunit
99
Q

How does Linezolid work?

A
  • Bacteriostatic
  • Binds to the 23S of the 50S Ribosomal subunit and inhibits Initiation Complex formation
100
Q

Clinical use of Linezolid?

A
  • MRSA
  • VRE
  • Oral medication for outpatient basis for these two bacteria
101
Q

SEs of Linezolid?

A
  • Pseudomembranous colitis (C difficile Superinfection)
  • GI distress
  • Bone marrow suppression may be treatment-limiting
  • Ocular and Peripheral neuritis
102
Q

How does Quinupristin / Dalforpristin work?

A
  • Bactericidal
  • Combination of Streptogramin ABX binds to the 50S Ribosomal subunit and inhibits Protein synthesis at (2) successive steps
103
Q

Clinical use of Quinupristin / Dalfopristin?

104
Q

SEs of Quinupristin / Dalfopristin?

A
  • Phlebitis
  • Hyperbilirubinemia
105
Q

What are the Aminoglycoside drugs?

“GNATS”

A
  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin
106
Q

How do Aminoglycosides work?

A
  • Enter the Bacteria via an O2-dependent transporter
    • Ineffective against Anaerobes, since O2 is needed for drug uptake
  • Inhibits formation of the 30S Initiaion complex
  • Misreading of mRNA –> Aberrant proteins
  • Prevents all Protein syn. at High concentrations
  • Breakup of Polysomes
107
Q

Clinical use of Aminoglycosides?

A
  • Serious Gram-negative Rod
    • used in combination w/ β-lactam for serious
      Gram-positive infections
  • Neomycin - given in the setting of Bowel surgery and Hepatic encephalopathy
  • Streptomycin - Mycobacteria
  • Spectinomycin - 2nd line Rx for Gonorrhea
108
Q

SEs of Aminoglycosides?

A
  • “mean GNATS caNNOT kill anaerobes”
  • Contraindicated in Renal Insufficiency due to Reversible Nephrotoxicity (esp. w/ Cephaosporins)
  • Neuromuscular blockade
  • Hearing loss - Irreversible Ototoxicity
    • Esp. w/ Loop diuretics
    • “A Mean guy punched a baby in the ear”
  • NOT USED in Pregnancy –> Teratogenicity
  • Fanconi Syndrome (Dys. of Renal electrolyte reabsorp.)
  • Neomycin - GI malabsorption and Superinfection
109
Q

What are the (4) Tetracycline Drugs?

A
  1. Tetracyline
  2. Doxycycline
  3. Minocycline
  4. Demeclocycline
110
Q

What is the (1x) Glycylcycline drug?

A
  • Tigecycline
111
Q

How do Tetracyclines and Glycylcycline drugs work?

A
  • Bacteriostatic
  • Inhibit the 30S Ribosomal subunit by preventing the attachment of the Aminoacyl-tRNA to the Ribosome
  • Must be imported through the Inner cytoplasmic membrane via an energy-dependent Active Transport system only in Bacteria
  • MUST NOT be taken w/ MILK, ANTACIDS,
    IRON-containing agents
    • ​Divalent cations inhibits proper absorption in the Gut
  • Limited CNS penetration
112
Q

Clinical use of Tetracyclines and Glycylcycline?

A
  • Broad-spectrum
    • “VACUUM your BedRooM Tonight”
  • Tigecycline is a new drug used to treag Gram-negative infections resistant to other agents
  • 2nd Line after Penicilin for Syphilis
113
Q

Organisms covered by Tetracyclines?

“VACUUM your BedRooMM Tonight”

A
  • Vibrio cholerae
  • Acne
  • Chlamydia
  • Ureaplasma Urealyticum
  • Mycoplasma pneumoniae
  • Borrelia burgdorferi
  • Rickettsia
  • Multidrig-resistant Malaria (Plasmodium falciparum)
  • Tularemia
114
Q

SEs of Tetracyclines and Glycylcyclines?

A
  • GI distress
  • Tooth discoloration
  • Bone growth abnormalities in Young children
  • Photosensitivity
  • Fatty Liver disease in Women
  • Drugs past expiration date can cause Fanconi Syndrome
  • Minocycline - reversible vestibular toxicity
  • Demeclocycline - used to treat syndrome of Inappropriate antidiuretic hormone (SIADH) because it causes nephrogenic Diabetes Insipidus as an ADH antagonist
115
Q

How does Metronidazole work?

A
  • Bactericidal
  • Anti-Protozoal
  • Bioactivation of the Drug in Anaerobic environments produces toxic metaboites that react w/ Bacterial DNA, Protein, and Bacterial and Protozoal cell membrane
116
Q

Clinical use of Metronidazole?

“GET GAP w/ Metronidazole”

A
  • Drug of choice for Pseudomembranous colitis
    (due to C difficle) - “GET GAP”
  • Anaerobic infections below the Diaphragm
  • Antiprotozoal:
    • Giardia
    • Entamoeba
    • Trichomonas
  • Gardnerella vaginalis
  • Anaerobes (Bacteroides, C. difficile)
  • H. Pylori
  • Used w/ Bismuth and Amoxicillin (or Tetracycline) for
    H pylori “Triple therapy”
117
Q

Use these (3) drugs go get rid of H pylori?

BAM!

A
  1. Bismuth
  2. Amoxicillin
  3. Metronidazole
118
Q

Antiproozoal Coverage w/ Metronidazole?

“GET GAP on the metro(nidazole)”

A
  • Giardia
  • Entamoeba
  • Trichomonas
  • Gardnerella vaginalis
  • Anaerobes
    • Bacteroides
    • Clostridium
  • H Pylori (used w/ Bismuth and Amoxicillin or Tetracycline for Triple Therapy)
119
Q

SEs of Metronidazole?

A
  • Hypotension
  • Tachycardia
  • Flushing
    • Headache
    • Nausea
  • Dysguesia - Metallic taste in Mouth
  • Disulfiram-like Rxns w/ Ethanol
  • Teratogen
  • DO NOT drink Alcohol w/ Metronidazole
120
Q

ABX Contraindicated in Pregnancy?

“SAFe Moms Take Really Good Care”

A
  • Sulfonamides –> Kernicterus
  • Aminoglycosides –> Ototoxicity
  • Fluoroquinolones –> Cartilage damage
  • Metronidazole –> Teratogenic
  • Tetracyclines –> Fatty Liver in Mother, Impaired bone growth and Tooth discoloration in Baby
  • Ribavirin (antiviral) –> Teratogenic
  • Griseofulvin (antifungal) –> Teratogenic
  • Chloramphenicol –> Gray Baby Syndrome
    • UDP-glucuronyl transferase
121
Q

Rx used for Endocarditis w/ Surgical or Dental Procedures?

A

Penicillins

122
Q

Rx used for Gonorrhea?

A

Ceftriaxone

123
Q

Rx for History of Recurrent UTIs?

124
Q

Rx for Meningococcal infection?

A

Ciprofloxacin (drug of choice for Adults)

Rifampin (Children)

125
Q

Rx for Pregnant woman carrying Group B Strep?

A

Ampicillin (During Labor)

126
Q

Rx for Prevention of Gonococcal or
Chlamydial Conjunctivitis in Newborn?

A

Erythromycin Ointmen in the eyes of all newborns

127
Q

Rx used for Prevention of Postsurgcal infection
due to S. aureus?

128
Q

Rx for Prophylaxis of Strep pharyngitis in Child w/
prior Rheumatic Fevor?

A

Oral Penicillin

129
Q

Rx for Syphilis?

A

Benzathine Penicillin G

130
Q

Rx for Pneumocystitis jirovecii?

131
Q

Rx for Exposure to H. Influenza Type B meningitis?

132
Q

Rx for exposure to Anthrax?

A

Ciprofloxacin

133
Q

(7) Rx for Pseudomonas?

A
  • Fluoroquinolones
  • Extended spectrum Penicillins
  • Polymixin
  • 3rd gen. Cephalosporins
  • Cefepime
  • Aztreonam
  • Aminoglycosides

Pharmacology (29 decks)

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