Ratio 3rd Shifting Even Flashcards
DOC for N. meningitidis meningitis but will not eliminate carrier state
Penicillin
DOC for MRSA,
Vancomycin
A 20 year old student was diagnosed with bacterial meningitis probably due to Streptococcus pneumonia. The most appropriate empiric antibiotic therapy considering its efficacy against this pathogen and good penetration into the BBB achieving therapeutic concentration in the CSF?
Ceftriaxone
Drug that can be used to eliminate the carrier state of N. meningitidis meningitis
Rifampicin, Ciprofloxacin, Ceftriaxone
the DOC for meningitis as a substitute for beta lactams if there is hypersensitivity to beta lactam
chloramphenicol
Concentration dependent antibiotics
these are given as single large daily dose
SAD MFKr - sad muderfuker?
Streptogramins (dalfopristin quinupristin), aminoglycosides, daptomycin, metronidazole, fluoroquinolones, ketolides (telithromycin)
time dependent antibiotics
requires continuous IV infusion
CLAM TV
Clindamycin, linezolid, All beta lactams, macrolides, tetracycline, vancomycin
gene mutation in Rifampicin vs Streptomycin resistance
Rifampicin: rpoB
Streptomycin: rpsL, Rrs
A 30 year old patient with latent TB was started in isoniazid. The antibacterial effect of this drug most likely is mediated by the inhibition of the synthesis of what molecule?
Mycolic acid
Inhibition of DNA dependent RNA polymerase is the MOA of which anti-TB drug?
Rifampicin
similarity of linezolid and ethambutol
both can cause optic neuritis
A 13 y/o taking unrecalled antibiotic presents with respiratory paralysis. This patient may have been given very high doses of:
Gentamicin
A 34 year old female with Rheumatic Heart Disease was admitted for treatment of infective enterococcal endocarditis/ In the past she had severe anaphylactic reaction to Penicillin G. The best drug to give is:
Enterococcal endocarditis: vancomycin plus gentamicin
most associated antibiotic with colitis
Clindamycin
Although PPIs have a very short half life, their acid suppression effect lasts for 24 hours because of this reason:
Inactivation of the HK atpase is irreversible
Anti-emetic with the MOA of:
- Centrally acting D2 antagonist
- 5HT3 receptor antagonist
- Muscarinic receptor antagonist
- Metoclopramide
- Ondansetron
- Scopolammine
only macrolide wherein bioavailability is not affected by food intake
Clarithromycin
What laxatives have the ff side effects:
- Bloating and flatus formation
- Melanosis coli
- Vitamin D and E deficiency
- Lactulose
- Senna
- Mineral oil
DOC for flukes
praziquantel - almost always
drugs that can cause Mazzotti reaction
DEC
Ivermectin
Praziquantel
Treatment in a PREGNANT patient with:
- Uncomplicated chloroquine-sensitive
- Uncomplicated chloroquine-resistant:
- Uncomplicated falciparum (2nd and 3rd trim)
- Uncomplicated P. vivax and ovale:
- Severe malaria (1st trim)
- Severe malaria (2nd & 3rd trim):
- Chloroquine
- Quinine (oral) + Clindamycin
- ACT (Arthemter Based Combination Therapy)
- Weekly Chloroquine prophylaxis until delivery and breastfeeding, then if G6PD levels are normal switch to Primaquine
- IV Quinine + Clinda
- IV/IM Artemether
Prophylaxis in a PREGNANT patient with:
- Chloroquine-sensitive
- Chloroquine-resistant
- Malaria-endemic areas
- Chloroquine
- Mefloquine
- FDC Sulfadoxine-Pyrimethamine
A traveler consulted you for drug prophylaxis prior to going to Thailand, known to be HIGHLY endemic for multi-drug resistant falciparum malaria. The most appropriate drug is:
Doxycycline
acts by inhibiting neuraminidase leading to clumping of newly released influenza virus
Oseltamivir and Zanamivir
drug that selectively inhibits viral DNA synthesis
Acyclovir
Drug that is indicated for acyclovir resistant HSV and VZV in immunocompromised individuals
Foscarnet
Drugs that prevent the vertical transmission of HIV
Zidovudine and Nevirapine
Drug that prevents vertical transmission of HBV when given in that last 4 weeks of gestation
Lamivudine
A 28 y/o HIV (+) patient who is being treated with multiple drugs, develops breast hypertrophy, central adiposity, and insulin resistance. If these changes are related to his drug treatment, this drug belongs to what group of antiretroviral drugs?
NRTIs
anti HBV drug that can cause flu-like syndrome (fever, chills, and muscle aches)
interferon alfa
A patient with Hepatitis B and co-infected with HIV is best treated with:
Lamivudine
antifungal drug that can cause
- menstrual irregularities
- shake and bake syndrome (chills and fever)
- Ketoconazole
2. Amphotericin B
the most common cause of Clostridium difficile toxin-mediated diarrhea (Pseudomembranous colitis or toxic megacolon)
Clindamycin
DOC for:
- atypical pneumonia
- Diphteria
- Pertussis
- Ricketssia infection
- Cholera
- Erythromycin
- Erythromycin
- Erythromycin
- Doxycycline
- Doxycline
T.L., 20 y/o with leukemia and on her 3rd cycle of chemotherapy is suspected of having febrile neutropenia. The most appropriate monotherapy for her is:
Meropenem
anti-MRSA antibiotic that functions by disrupting the cell membrane function by binding to the D-ala-D-ala terminus
Daptomycin
mnemonic for antibiotic that are protein synthesis inhibitors
AT (30s) CELLS (50s) - protein synthesis inhibitors
Aminoglycosides
Tetracyclines
Chloramphenicol Erythromycin (Macrolides) Lincosamides Linezolid Streptogramins
The primary mechanism of resistance of Strep. Pneumoniae to beta lactam antibiotics is:
Beta-lactams act at PBP (penicillin binding protein) to inhibit transpeptidation/cross linking of peptidoglycan units. Resistance occurs when PBP of the bacteria evolve/transform to PBP2a wherein B-lactams can no longer bind
Hypersensitivity, jaundice, GI intolerance and thrombocytopenia are side effects of which first line anti-TB agent?
Rifampicin
A 30 y/o woman of childbearing potential, currently on contraceptive pills was discovered to have sputum (+) PTB. You are about to start anti-TB treatment but wary of possible drug interaction. Which of the anti-TB drugs is most likely to interact with the oral medication and pose a risk of decreased protective efficacy against pregnancy VERSUS drug that will prolong the effect of drug she is currently taking and cause toxicity
Rifampicin is an enzyme inducer hence it catalyzes the metabolism of other drugs which are metabolized by the CYP450 system. Here, contraceptive pills might be metabolized much more rapidly leading to decreased protective efficacy
In contrast, Isoniazid is an enzyme inhibitor, with opposite effects as to Rifampicin which might predispose an individual to prolonged therapeutic effect of drugs or toxicity
standard triple vs quadruple therapy for PPI
Standard “triple therapy” (BID for 14 days):
Proton Pump Inhibitors
Clarithromycin
Amoxicillin or Metronidazole
Quadruple therapy:
Proton Pump Inhibitors
Bismuth subsalicylate
Tetracycline
Metronidazole
Small amounts of atropine is added to one of these antidiarrheal agents to discourage overdosage thus preventing opioid dependence:
Diphenoxylate - crosses the BBB —> CNS effects and opioid dependence
Role of somatostatin vs beta blocker in variceal bleeding
Somatostatin -> ACTIVE BLEEDING
Beta Blocker -> PROPHYLAXIS
The half-life of this anti-malarial drug is longer in patients with severe malaria than in healthy individual:
Plasma level, protein binding, half-life of quinine depend on severity of malaria (severe = higher: due to increased alpha-1-acid glycoprotein)
- Causes paralysis of the parasite by depolarizing neuromuscular synapse causing the release of acetylcholine and inhibiting acetylcholinesterase
- Inhibit microtubule polymerization by binding to the parasite‟s beta-tubulin
- Increase permeability of trematode and cestode cell
membranes to calcium causing spastic paralysis - Paralysis of parasite by intensifying GABA-mediated transmission of signals in the parasite‟s peripheral nerves
- Pyrantel pamoate
- Mebendazole
- Praziquantel
- Ivermectin
Anti TB meds with the ff ADR:
- peripheral neuropathy, hepatitis
- hyperuricemia, hepatitis
- discoloration of body fluids
- retrobulbar neuritis
- Isoniazid
- Pyrazinamide
- Rifampicin
- Ethambutol
laxative that causes direct stimulation of the ENS leading to colonic fluid and electrolyte secretion
VERSUS
Hydrolyzed in the upper small intestine to a colonic irritant that stimulates intestinal motility
- Senna
2. Castor oil
Antibiotics that cause QTc prolongation
Levofloxacin
Erythromycin
3rd gen FQs (Levo, Moxi, Gati, Gemi)
apart from Gray Baby syndrome, what is another ADR of chlorampencol
Aplastic anemia
