Picmonic Flashcards
1st generation Celphalosporins
- Cefazolin 2.Cephalexin 3. Proteus Mirabilis 4. Klebsiella 5. E. coli 6. Gram +
2nd Generation Cephalosporins
- Cefoxitin
- Cefaclor
- Cefuroxime
- Proteus mirabilis, Ecoli, kebsiella, Gram + cocci, Haemophilus influenzae, Neisseria, Serratia, Enterbacter
3rd Generation Cephalosporin
- Cefotaxime
- Ceftriaxone
- Cetazidime
- Serious gram negative bacteria to other beta lactams
4th Generation Cephalosporin
- Increased activity against pseudomonas and gram positives
- Cefepime
Aminoglycosides
- Bactericidal
- Inhibit formation of initiation complex
- Cause misreading of mRNA
- Require O2 for uptake
- Use for gram negative rod infections
- Synergistic with B lactam antibiotics
- Nephrotoxicity especially when used with cephalosporins
- Ototoxicity when used with loop diuretics
- Teratogen
- Gentamicin, Amikacin, Tobramycin, Streptomycin
- Use neomycin for bowl surgery
- Resistance by transferase enzymes bye acetylation, phosphorylation and adenylation
Aminopenicillin Mechanism
- Broader spectrum
- Ampicillin and Amoxicillin
- Beta lactamase sensitive
- Combine with clavulanic acid
- Hypersensitivity reactions
- Ampicillin rash
- Pseudomembranous colitis
Aminopenicillin Uses
- Ampicillin, amoxicillin
- Enterococci
- Listeria
- Haemophilus influenzae
- E coli
- Salmonella
- Proteus mirabilis
Anemia Lab value for Iron Deficiency Anemia
Serum iron decreased
Transferrin increased
Ferritin decreased
% transferrin saturation decreased
Anemia lab values for Pregnancy and OCP use
serum iron normal
transferrin increased
ferritin normal
% transferrin saturation decreased
Anemia lab values for chronic disease anemia
serum iron decreased
transferrin decreased
Ferritin increased
%transferrin saturation normal
Anemia lab values for Hemochromatosis
serum iron increased
transferrin decreased
ferritin increased
% tranferrin saturation increased
Anion Gap metabolic acidosis
* MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Isoniazid
Iron
Lactic Acid
Ethylene glycol
Salicylate
Antipseudomonal Penicillins
- Mechanism same as penicillin
- Ticarcillin, Carbenicillin, Piperacillin
- Extended spectrum
- Clinical use on antipseudomonas and gram negative rods
- Beta lactamase sensitive
- Use with clavulanic acid
7 Hypersensitivity reactions
Aztreonam
- Monobactam
- Resistant to beta lactamases
- Binds to penicilin binding protein
- Inhibit cell wall synthesis
- No activity on gram positives or anaerobes
- Use on gram negative rods
- Non allergenic to penicillin
- Synergistic with aminoglycodsidases
Beta Lactamase Inhibitors
- Often added to penicillin antiobiotics
- Clavulanic acid
- Sulbactam
- Tazobactam
Cephaloporin MOA and AE
- Beta lactam drug
- Inhibits cell wall synthesis
- Bactercidal
- Hypersensitivity reactions
- Vitamin K deficiency
- Increased nephrotoxicity of aminoglycosides
Chloramphenicol
- Bateriostatic
- Inhibits 50S peptidyltransferase activity
- Menigitis
- Anemia
- Aplastic Anemia
- Gray baby syndrome due to lack of UDP- glucuronyl transferase
- Resistance caused by plasmid encoded acetyltransferase
Clindamycin
- Bacteriostatic
- Binds 50S ribosomal subunit
- Blacks translocation
- Anaerobic infections above teh diaphragm
- Aspiration pneumonia
- Lung abscesses
- Can cause pseudomembranous colitis
Clostridium Difficile
- Gram positive
- Bacilli
- Anaerobe
- Diarrhea
- Clindamycin and ampicillin
- Toxin A enterotoxin
7 Damages brush border of gut
- Toxin B cytotoxin
- Damages cytoskeletal structure
- Pseudomembranous colitis
- Toxic megacolon
- Detect toxins in stool
- Detect toxins in stool
- Vancomycin
Digoxin Mechanism and indication
- Direct inhibition of NA K ATPase
- Indirect inhibition of Na Ca exchanger
- Increase Ca in cell
- Positive inotropy
- CHF
- Stimulate vagus nerve
- Decreased conduction at AV node
- Atrial fibrillation
Digoxin Toxicity
- Cholinergic (nausea, vomiting, diarrhea)
- Blurry yellow green vision
- Bradycardia
- Decreased QT
- Scooping on EKG
- T wave inversion
- Prolonged PR interval
- Arrhythmia
- Hyperkalemia
Ethambutol
- Blocks arabinoysl transferase
- Arabinosyl transferase polymerizes carbohydrates
- Carb polymers make mycobacterium TB cell wall
- Red/ green color blindness
Fluoroquinolones
- Floxacins, ciprofloxacin, moxifloxacin
- Inhibit topoisomerase II enzymes including DNA gyrase
- Bactercidal
- Gram negative rods
- Urinary tract infections
- Pseudomonas
- Neisseria
Foluroguinolones Toxcities
- Diarrhea
- Skin Rash
- Headache
- Damage to cartilage
- Tendon rupture in adults
- Myalgias in kid
- Teratogen
Imipenem
- Resistant to beta lactamases
- Broad spectrum anaerobe
- Gram - rods, gram + cocci
- Must administer with cilastatin
- Cilastatin is inhibitor of renal Dehydropeptidase I
- Diarrhea, skin rash, seizures
- Meropenem
- Stable to dehydropeptidase I
- Reduced risk of seizures (non seizure causing)
Isoniazid
- Used to treat TB
- Requires catalase peroxidase
- Decreases mycolic acid synthesis
- Fast vs slow acetylators
- B6 deficiency
- Neurotoxicity
- Hepatotoxicity
- Drug induced lupus
Macrolides
- Bacteriostatic
- Erythromycin, azithromycin, clarithromycin
- Bind to 23 S rRNA of 50S subunit
- Inhibit protein synthesis by blocking translocation
- Gram positive cocci
- Atypical pneumonia
- Chlamydia
- Resistance by methylation of 23 S rRNA binding
Macrolide Toxicity
- P450 inhibitor
- Prolonged QT
- Diarrhea
- Cholestatic hepatitis
- Eosinophilia
- Skin Rash
Metabolic Alkalosis
- Diuretic use
- Vomiting
- Antacid
- Hyperaldosteronism
Metronidazole
- Bactericidal
- Forms free radical toxic metabolites
- Damages DNA
- Giardia lamblia
- Entaemoeba
- Trichomonas
- Anaerobe
- Gardnerella
- Metallic taste
- Disulfiram like reaction with alcohol
Normal gap metabolic acidosis
- Diarrhea
- Hyperchloremia
- Renal tubular acidosis
- Glue sniffing
Penicillin
- Gram Positives
- Spirochetes
- Bind PBPs
- Block transpeptidase cross linking of cell wall
- Activate autolytic enzymes
- Bactericidal
- Hypersensitivity reactions
- Hemolytic anemia
- Beta lactamase sensitive
Polymyxins
- Cationic
- Act like detergents
- Bind to cell membranes of bacteria
- Disrupt their osmotic properties
- Use for resistant gram negative infections
- Neurotoxicity
- Renal tubular necrosis
Protein Synethesis Inhibitors
- 30S inhibitors
- Aminoglycosides
- Tetracyclines
- 50S inhibitors
- Chloramphenicol
- Clindamycin
- Erythromycin
- Lincomycin
- Linezolid
Respiratory Acidosis
- Hypoventilation
- Increased PCO2 > 40
- Babiturates depress central respiratory center of brain
- Opioids depress central respiratory center of the brain
- Airway obstruction
- Respiratory muscle weakness/ paralysis
Respirary Alkalosis
- Hyperventilation
- High altitude
- Aspirin
- Restrictive lung disease
- Pulmonary embolism
- Progesterone
- Progesterone
- Rib fracture
- Anxiety
Rifampin
- Mycobacterium TB
- Blocks RNA polymerization
- Haemophilus influenzae B
- Leprosy
- Meningitis
- P450 inducer
- Red-orange urin
Sulfa Drug Allergies
- Sulfasalazine
- Sulfonylureas
- Thiazide diuretics
- Acetazolamide
- Furosemid diuretic
- Celeboxib
- Probenecid
Sulfonamides Mechanisms
- Bacteriostatic
- Gram + and -
- Nocardia
- Chlamydia
- PABA antimetabolites
- Inhibit dihydropteroate synthetase
- Sulfamethoxazole
- Sulfisoxazole
- Sulfadiazine
Sulfonamides Toxicities
- Hypersensitivity
- Hemolysis of G6PD deficient people
- Nephrotoxicity
- Photosensitivity
- Displace warfarin from albumin
- Kernicterus in infants
Tetracycline drugs and uses
1 Doxycycline, Demeclocyline, Minocycline
- Fecally eliminated (doxycycline)
- Use in renal failure
- Antidiuretic hormone antagonist
- Chlamydia
- Rickettsia
- Borrelia Burgdoferi
- Helicobacter pylori
- Mycoplasma pneurmonia
Tetracycline Mechanism
- Binds to 30 S to prevent attachment of aminoacyl tRNA
- Limited CNS penetration
- Divalent cations inhibit absorption
- Must not take with milk, antacids, iron
Tetracycline Toxicities
- Photosensitivity
- GI distress
- Teratogen
- Discoloration of teeth
- Inhibition of bone growth in children
Trimethoprim
- Bacteriostatic
- Inhibits bacterial dihyrdofolate reductase
- Used in comboination with sulfamethoxazole
- Causes sequential block of folate synthesis
- Combination used for recurrent UTIs
- Shigella
- Salmonella
- Pneumocystis jiroveci pneumonia
- Decrease in red and white blood cells
- Can be alleviated with leucovorin rescue
Vancomycin Mechanism
- Bactericidal
- Gram positive
- Inhibits cell wall mucopeptide
- Binds to D-ala D ala
- Resistance with change to D-ala D-lac
- Staph aureus
- Clostridum difficile
- Enterococci
Vancomycin Toxicity
- Thrombophlebitis
- Nephrotoxicity
- Ototoxicity
- Diffuse flushing called red man syndrom
- Red man syndrome can be prevented with antihistamine
- Red man syndrom can be prevented with slow infusion
11 Beta hydroxylase deficiency
- Decreased cortisol
- Decreased aldosterone
- Increased sex hormones
- Masculinization
- Increased 11 deoxycoticosterone
- Hypertension
17 Alpha hydroxylase
- Decreased cortisol
- Decreased sex hormones
- Increased mineralocoticoids
- Hypertension
- Hypokalemia
- XY externally phenotypic female
- No internal reproductive structures due to Mullerian inhibitory factor
- XX externally phenotypic femal
- Sexual infantilism
21 hydroxylase Deficiency
- Decreased cortisol
- Increased 17 hydroxyprogesterone
- Decreased aldosterone
- Hypotension
- Increased renin
- Hyperkalemia
- Femal pseudohermaphroditism
Adenovirus
- Non enveloped
- linear
- double stranded
- Pharyngitis
- Conjunctivitis
- fever
7 summer swimming
- daycare centers
- acute hemorrhagic cystitis
- pneumonia
Ataxia Telangiectasia
- Defect in DNA repair
- Cerebellar defects
- Spider angiomas
- senstivite to radiation
- defective tumor suppressor gene
- Increased risk of cancer, leukemias, and lymphomas
- IgA deficiency
- repeated sino pulmonary infections
Bruton’s Agammaglobulinemia
- X linked recessive
- Defective tyrosine kinase
- Blocks B cell maturation
- Decreased immunoglobulins of all classes
- Bacterial infections after 6 months
- Maternal IgG protects before 6 months
Chondrosarcoma
- Cartilaginous tumor
- Malignant
- Men 30-60 years old
- Pelvic and femur bones
- Glistening mass in medullary cavity
- Can be primary in origin origin or from osteochondroma
- Metastasize to lungs
Circle of Willis
- Anterior cerebral arteries ACA supply motor/ sensory parts of cortex for lower extremities
- Anterior Communicating artery Acomm connects ACA to ACA
- Internal carotid arteries ICA
- Middle cerebral arteries MCA supplies cortex for upper limbs and face
- Posterior communicating artery Pcomm connects ICA to PCA
- Posterior cerebral arteries PCA supplies occipital
- Basilar Artery supplies Medulla, Pons and PCA
Common variable immunodeficiency
- Defect in B cell maturation
- Decreased Plasma cells
- Decreased immunoglobulins
- SInopulmonary infections
- increased risk of autoimmune disease
- Lymphoma
Craniopharyngioma
- Hypopituitary
- Remnants of rathkes pouch
- Tooth enamel like calcification
- Cholesterol crystals
- Yellow viscous fluid
- Headache
- Bitemporal hemianopsia
Cytomegalovirus
- Enveloped
- double stranded DNA
- Herpesvirus 5
- Congenital TORCH infection
- Mononucleosis
- Non heterphile antibodies
- AIDS retinitis and esophagitis
- infection in transplant recipients
- Owl’s eye inclusions
Ependymoma
- Occur in children
- Fourth ventricle
- Hydrocephalus
- Perivascular pseudorosettes
- Rod shaped blepharoplasts
- Cauda equina in adults
- poor prognosis
Epstein Barr Virus
- Herpesvirus 4
- Enveloped
- Double stranded DNA
- Linear
- Virus attaches to CD21 in B cells
- Infectious mononucleosis
- Nasopharyngeal carcinoma
- Burkitt’s Lymphoma
Epstein Barr Virus Mononucleosis
- Mononucleosis
- Fever
- Hepatosplenomegaly
- Pharyngitis
- Posterior cervical lymphadenopathy
- Atypical lymphocytes
- Heterophile antibodies
- Rash develops if treated with ampicillin
Ewings Sarcoma
- Most common in boys <15 years old
- 11;22 translocation
- Long bones, pelvis, ribs
- Diaphysis
- Small Blue cells
- Malignant
- Aggressive
- Onion skin appearance
- Responsive to chemotherapy
Giant Cell Tumor
- Osteoclastoma
- Epiphyseal end of long bones
- Peak incidence 20-40 years
- Benign
- Knee region
- Soap bubble appearance on x ray
- Spindle shaped cells
- Multinucleated giant cells
Glioblastoma Multiforme
- Most common primary brain tumor
- Grade 4 astrocytoma
- Can cross corpus callosum
- Butterfly glioma
- Pseudo-palisading tumor cells
- Areas of necrosis and hemorrhage
- Stain astrocytes for glial fibrillary acidic protein (GFAP)
- Grave prognosis
HBV Characteristics
- Hepadnavirus
- Enveloped
- Double stranded DNA
- Partial circular
- Has reverse transcriptase
- IV drug use
- Sex
- Maternal fetal routes
- 3 month incubation period
HBV Disease
- Can turn chronic
- Less than 10% of adults become chronic carriers
- 90% of newborns become chronic carriers
- Cirrhosis
- Hepatocellular carcinoma
- Membranous glomerulonephritis
- Polyarteritis nodosa
- Serum sickness like syndrome
Hemangioblastoma
- Most often cerebellar
- Associated with Von Hippel Lindau
- Retinal Angiomas
- Can produce EPO
- Secondary polycythemia
- Foamy cells
- High vascularity
Herpes Simplex Virus
- Enveloped
- Double stranded DNA
- Linear
- Type 1 HSV
- Gingivostomatitis
- Keratoconjunctivitis
- Encephalitis of temporal lobes
- Latent in trigeminal ganglia
- Type 2 HSV
- Genital vesicles
- Neonatal herpes
- TORCHES
- Latent in sacral ganglia
- Tzank test
- Multinucleated giant cells
- Cowdry A inclusions
- Acyclovir
Human Papillomavirus
- Non enveloped
- Circular
- Double stranded DNA
- Warts 1,2,6,11
- Condyloma acuminata
- Type 16, 18
- Cervical carcinoma
- Penile carcinoma
- Immunosuppression/ AIDS
- Worsened by smoking
- Koilocytic change in squamous epithelium
- Pyknotic nuclei surrounded by clear halo
- Vaccine available
Hyper IgM Syndrome
- Defective CD 40 Ligand on helper T cells
- CD 40 ligand receptor on B cell
- INability to class switch
- Pyogenic abscess
- Decreased IgG, IgA and IgE
Medulloblastoma
- Occur in children
- Cerebellum
- Primitive neuroectodermal tumor PNET
- Small blue cells
- Lots of mitotic figures
- Homer wright rosettes
- Perivascular pseudorosettes
- 4th Ventricle
- Hydrocephalus
- Ataxia
- Wide based gait
- Radiosensitive