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M2 - Pharm > Review - Antibiotics > Flashcards

Review - Antibiotics Flashcards

1
Q

Tetracyclines

A
  • Rx: GramPos
  • MOA: Bacteriostatic
    • Binds to 30S (Thirty S) subunit
    • Prevents Aminoacyl-tRNA attachment
  • Limited CNS penetration
  • Avoid milk, antacids, iron
  • Resistance: Transport pumps (plasmid encoded) decrease uptake into cells or increase efflux out of cells
  • Side Effects:
    • Tummy problems
    • Can’t get Taller
    • Terrible Vision (photosensitivity)
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2
Q

Tetracyclines Clinical Use

A
  • Borrelia Burgdorferi
  • Mycoplasma Pneumoniae
  • Rickettsia (intracell accum)
  • Chlamydia (intracell accum)
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3
Q

Doxycycline

A

Hepatic excretion

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4
Q

Demeclocycline

A
  • ADH antagonist
  • Can be used as diuretic in SIADH
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5
Q

Minocycline

A

Effective for acne (Mi-NO like acne!)

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6
Q

Aminoglycosides

A
  • Rx: GramNeg
  • MOA: Bacteriocidal
    • Block Initiation Factor II @ 30S (A = 1st letter → initiation)
    • Cause mRNA misreading
    • Require O2
  • Low CNS penetration
  • Resistance: Transferases inactivate via APA
    • Acetylation
    • Phosphorylation
    • Adenylation
  • Side Effects: (ami-NOT-glycosides)
    • Nephrotoxicity, esp w/Cephalosporins
    • Ototoxicity, esp w/Loop Diuretics
    • Teratogen
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7
Q

Aminoglycosides Clinical Use

A
  • Severe GramNeg Rod infections (ami-NOT)
  • Synergistic w/ß-lactams
  • Monitor peak & trough
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8
Q

Examples of Aminoglycosides

A
  • Gentamycin
  • Streptomycin
  • Neomycin
  • Amikacin
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9
Q

Examples of Tetracyclines

A
  • Doxycyline
  • Demeclocycline
  • Minocycline
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10
Q

Gentamycin

A
  • Aminoglycoside
  • Marketed longest
  • Most Side Effects
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11
Q

Streptomycin

A
  • Aminoglycoside
  • Rx:
    • TB
    • Tularemia
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12
Q

Neomycin

A
  • Aminoglycoside
  • Bowel Sx
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13
Q

Amikacin

A

Only hepatically-excreted aminoglycoside

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14
Q

Penicillins

A
  • Rx: GramPos Cocci & Rods, GramNeg Cocci, Spirochetes
  • MOA: Bacteriocidal – Interfere w/Cell Walls
    • Bind PBPs
    • Block Transpeptidase cross-linking of peptidoglycan
    • Activate Autolytic Enzymes
  • Resistance: ß-lactamases cleave ring
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15
Q

Penicillins Clinical Use

A
  • Bacteriocidal for:
    • GramPos cocci & rods
    • GramNeg cocci
    • Spirochetes
  • Clincal:
    • Strep Pneumo
    • Strep Pyogenes
    • Actinomyces
    • Syphilis
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16
Q

Penicillins Side Effects

A
  • Hemolytic Anemia
  • Hypersensitivity
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17
Q

Oral Penicillin

A

Penicillin V

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18
Q

IV Penicillin

A

Penicillin G

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19
Q

Penicillinase-Resistant Penicillins

A
  • Rx: Staph Aureus (not MRSA)
  • MOA: Same as penicillins
    • Bind PBPs
    • Inihibt Transpeptidase cross-linking of peptidoglycans
    • Activate autolytic enxymes
  • Narrow Spectrum
  • Penicillinase Resistant → bulkier R group
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20
Q

Penicillinase-Resistant Penicillins Clinical Use

A

Staph Aureus (but not MRSA)

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21
Q

Penicillinase-Resistant Penicillins Side Effects

A
  • Interstitial Nephritis – Methicillin
  • Hypersensitivity
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22
Q

This penicillin can cause interstitial nephritis

A

Methicillin (Penicillinase-Resistant)

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23
Q

Examples of Penicillinase-Resistant Penicillins

A
  • Methicillin
  • Nafcillin
  • Dicloxacillin
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24
Q

Aminopenicillins

A
  • MOA: same as penicillins
    • bind PBPs
    • block Transpeptidase cross-linking of peptidoglycans
    • activate autolytic enzymes
  • Wider spectrum
  • Usually combined w/Clavulanic Acid (ß-lactamase inhibitor)
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25
Q

Aminopenicillins Clinical Use

A

Extended Spectrum good for:

  • H. Influenzae
  • E. Coli
  • Listeria Monocytogenes
  • Proteus Mirabilis
  • Salmonella
  • Shigella
  • Enterococci
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26
Q

Aminopenicillins Side Effects

A
  • Pseudomembranous Colitis
  • Rash - Ampicillin
  • Hypersensitivity
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27
Q

This tetracycline is hepatically excreted

A

Doxycycline

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28
Q

This tetracycline can be used as a diuretic in SIADH

A

Demeclocycline

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29
Q

This tetracycline is used for acne

A

Minocycline

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30
Q

This aminoglycoside is hepatically excreted

A

Amikacin

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31
Q

This penicillin can cause a rash

A

Ampicillin (Aminopenicillin)

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32
Q

This type of penicillin can cause pseudomembranous colitis

A

Aminopenicillins

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33
Q

Examples of Aminopenicillins

A
  • Ampicillin
  • Amoxicillin
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34
Q

Ampicillin

A
  • Aminopenicillin
  • Can cause rash
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35
Q

Amoxicillin

A
  • Aminopenicillin
  • Greater Oral bioavailability (amOxicillin → Oral)
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36
Q

This aminopenicillin has greater oral bioavailability

A

Amoxicillin

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37
Q

Anti-Pseudomonals

A
  • Rx: GramNeg rods, Pseudomonas
  • MOA: same as penicillins
    • bind PBPs
    • block Transpeptidase cross-linking of peptidoglycans
    • activate autolytic enzyme
  • Extended Spectrum
  • Susceptible to Penicillinase
    • Usually combined w/Clavulanic Acid (ß-lactamase inhibitor)
38
Q

Anti-Pseudomonals Clinical Use

A
  • Pseudomonas
  • GramNeg Rods
39
Q

Anti-Pseudomonals Side Effects

A

Hypersensitivity

40
Q

Examples of Anti-Pseudomonals

A
  • Ticarcillin
  • Carbenicillin
  • Piperacillin

Take Care of Pseudomonas!

41
Q

ß-lactamase inhibitors

A
  • Added to penicillins to prevent destruction by penicillinase / ß-lactamase
  • Include:
    • Clavulanic Acid
    • Sulbactam
    • Tazobactam
42
Q

ß-lactamase

A
  • aka penicillinase
  • breaks down ß-lactam ring → penicillin resistance
43
Q

Cephalosporins

A
  • MOA: ß-lactams that inhibit Cell Wall Synthesis
  • Less susceptible to penicillinase
44
Q

Cephalosporins Side Effects

A
  • VItamin K Deficiency
    • Clotting Factors 10, 9, 7, 2 + Proteins C & S
    • bleed into cavities
  • Cross-Hypersensitivity w/Penicillins in 5-10% of pts
  • Increase Nephrotoxicity of Aminoglycosides
  • Disulfiram-like rxns w/EtOH
45
Q

1st Gen Cephalosporins

A
  • Drugs: “Jeremy Lin is #1 and Drives a Lexus”
    • Cefazolin
    • Cephalexin
  • Rx: “ 1 PEcK”
    • Proteus Mirabilis
    • E. Coli
    • Klebsiella Pneumoniae
46
Q

2nd Gen Cephalosporins

A
  • Drugs: “2 Fake Fox Furs”
    • Cefaclor
    • Cefoxitin
    • Cefuroxime
  • Rx: “2 HEN PEcKS”
    • H. Influenzae
    • Enterobacter Aerogenes
    • Niesseria Spp
    • Proteus Mirabilis
    • E. Coli
    • Klebsiella Pneumoniae
    • Serratia Marcescens
47
Q

3rd Gen Cephalosporins

A
  • Drugs: “T for Three”
    • Ceftriaxone
    • Cefotaxime
    • Ceftazidime
  • Rx: Serious GramNeg
48
Q

this cephalosporin is good for Rx meningitis and gonorrhea

A

Ceftriaxone (3rd gen)

“TRI meningitis and gonorrhea”

49
Q

this 3rd gen cephalosporin is good for Rx pseudomonas

A

Ceftazidime

“TAZe that pseudomonas!”

50
Q

4th Gen Cephalosporins

A
  • Drug: “Fe for Four”
    • Cefepime
  • Rx:
    • Pseudomonas
    • GramPos
51
Q

5th Gen Cephalosporins

A
  • Drug:
    • Ceftaroline
  • Rx:
    • MRSA
52
Q

First beta-lactam approved for Rx MRSA

A

Ceftaroline (5th gen cephalosporin)

53
Q

Chloramphenicol

A
  • MOA: blocks peptide bond formation at 50S subunit (chloramFENicol at FIFTY)
  • Resistance: Acetyltransferase (plasmid-encoded) inactivates drug
  • Rx: Meningitis
54
Q

Chloramphenicol Clinical Use

A

MENingitis

(→ ChloraMphENicol)

55
Q

Chloramphenicol Side Effects

A
  • Dose-DEpendent Anemia
  • Dose-INdependent Aplastic Anemia
  • Gray Baby Syndrome
56
Q

Clindamycin

A
  • MOA: blocks peptide bond formation at 50S subunit (like chloramFENicol at FIFTY)
57
Q

Clindamycin Clinical Use

A
  • Anaerobic Infections above diaphragm
  • Aspiration Pneumonia
  • Lung Abscess
58
Q

Clindamycin Side Effects

A
  • Pseudomembranous colitis
  • Fever
  • Diarrhea
59
Q

These two drugs can cause pseudomembranous colitis

A
  • Aminopenicillins
  • Clindamycin
60
Q

Macrolides

A
  • MOA: bacteriostatic protein synthesis inhibitors
    • block translocation at 50S subunit
    • MacroSLIDE → translocation
  • ​Resistance: Methylation of rRNA binding site at 23S of 50S subunit
    • Methylation → Macrolide resistance
61
Q

Macrolides Clinical Use

A
  • Atypical Pneumonias
    • Mycoplasma (walking pneumonia – Xray looks way worse than symptoms)
    • Chlamydia
    • Legionella (silver stain, standing water)
  • URI
  • STDs
  • GramPos Cocci
  • Strep when pt allergic to penicillin
  • Neisseria
62
Q

Examples of Macrolides

A
  • ErythROmycin
  • AzithROmycin
  • ClarithROmycin

(macROlides)

63
Q

Macrolides Side Effects

A
  • Prolonged QT interval (Erythro) → arrhythmia
  • Acute Cholestatic Hepatitis
  • Dysgeusia (Clarithro)
  • Increased serum conc of:
    • Theophyllines
    • ​Oral anticoagulants
  • GI discomfort
  • Eosinophilia
  • Skin Rashes
64
Q

this macrolide can prolong QT interval

A

Erythromycin

(erythro sounds like arrhythmia)

65
Q

This macrolide can cause dysgeusia

A

Clarithromycin

66
Q

This macrolide is safe to use in pregnancy

A

Azithromycin

67
Q

Fluoroquinolones

A
  • MOA: Bacteriocidal DNA Gyrase inhibitors
    • aka Topoisomerase II
    • DNA can’t separate → no replication
  • Resistance: DNA gyrase mutation (chromosome-encoded)
  • Renal excretion
68
Q

Fluoroquinolones Clinical Use

A
  • GramNeg rods in Urinary & GI tracts
    • Pseudomonas
    • Neisseria
  • Some GramPos organisms
69
Q

Fluoroquinolones Side Effects

A
  • Superinfections
  • Tendonitis / Tendon Rupture
  • Leg Cramps, Myalgias in kids
  • C/I kids, pregnancy → cartilage/bone damage
    • likes to steal calcium
  • GI Upset
  • Skin rash
  • Headache
  • Dizziness
70
Q

Examples of Fluoroquinolones

A
  • Ciprofloxacin
    • Any-floxacin!
  • Enoxacin
  • Nalidixic Acid
71
Q

Fluoroquinolones for Gonorrhea

A
  • Ofloxacin
  • Moxifloxacin
  • Gatifloxacin

“Oh My God - I have gonorrhea!”

72
Q

Metronidazole

A
  • MOA: Bacteriocidal and Antiprotozoal
    • form free radicals
    • pyruvate oxidoreductase → ferredoxin → reacts w/free radicals → anaerobe death
73
Q

Metronidazole Clinical Use

A
  • Infections below diaphragm:
    • Giardia
    • Entamoeba
    • Trichomonas
    • Gardenerella
    • Anaerobes
    • H. Pylori

GET GAP on the Underground Metro!

74
Q

Metronidazole Side Effects

A
  • Disulfiram-like rxn w/EtOH
    • Inhibits aldehyde dehydrogenase → EtOH not metabolized → aldehyde buildup
  • Metallic Taste / Dysgeusia
  • Flushing
  • Sweating
  • Nausea
  • Headache
  • Hypotension
75
Q

Aztreonam

A
  • Monobactam
  • MOA: Binds to PBP3 → prevents peptidoglycan cross-linking
76
Q

Aztreonam Clinical Use

A
  • GramNeg Rods
  • Pts w/Penicillin Allergy
  • Pts w/Renal Insufficiency who can’t take Aminoglycosides
77
Q

Carbapenems

A
  • Beta-lactamase resistant
  • Imipenem + Ciliastatin to help drug stay in body longer (decrease inactivation in renal tubules)
  • Gram + cocci
  • Gram – rods
  • Anaerobes
  • CNS toxicity (seizures)
  • GI distress
78
Q

Examples of Carbapenems

A
  • Imipenem (+cilistatin)
  • Meropenem
79
Q

Vancomycin

A
  • binds D-ala-D-ala to inhibit cell wall peptidogycan formation
  • Gram +
  • Resistant organisms
    • C. diff
    • MRSA
    • Enterococci
  • Nephrotoxicity
  • Ototoxicity
  • Thrombophlebitis
  • Red Man Syndrome
80
Q

Sulfonamides

A
  • bacteriostatic
  • inhibit Dihydropteroate Synthase via PABA antimetabolites
  • Use for:
    • Gram +
    • Gram –
    • Nocardia
    • Chlamydia
    • Simple UTI
  • Resistance:
    • altered enzyme
    • decreased uptake
    • increased PABA synthesis
81
Q

Examples of Sulfonamides

A
  • Sulfamethoxazole (SMX)
  • Sulfisoxazole
  • Sulfadiazine
82
Q

Sulfonamide Side Effects

A
  • Hypersensitivity
  • Nephrotoxicity
  • Photosensitivity
  • Kernicterus (high bilirubin) (infants)
  • Hemolysis (if G6PDH deficient)
83
Q

TMP-SMX

A
  • Bactrim
    • Trimethoprim-Sulfamethoxazole
  • UTI
  • Shigella
  • Salmonella
  • Pneumocystis jirovecii
84
Q

Trimethoprim

A
  • inhibits dihydrofolate reductase
  • usually combined w/SMX
    • Megaloblastic anemia
    • Leukopenia
    • Granuloycytopenia
  • Leucovorin can alleviate S/E by replenishing folate
85
Q

Rifampin

A
  • inhibits DNA-dependent RNA polymerase
  • Rapid resistance if used by itself
  • Rx:
    • TB
    • Leprosy
    • Meningococcal prophylaxis
  • Red-orange secretions
  • Hepatotoxicity

(Rifampin for RNA and Red-orange)

86
Q

Isoniazid

A
  • Activated by KATG bacterial catalase-peroxidase (INH-KATG)
  • Inhibits Mycolic Acid synthesis
  • Can cause B6 deficiency (heme, GABA)
    • anemia
    • seizures
  • Hepatotoxicity
87
Q

Pyrazinamide

A
  • Unknown MOA
  • Rx: TB
  • Hyperuricemia
  • Hepatotoxicity
88
Q

Ethambutol

A
  • Blocks arabinosyltransferase
    • decreases carb polymerization of cell wall
  • Rx: TB
  • Red-green colorblindness
  • Optic neuropathy
89
Q

Rx for TB?

A

RIPES

  • Rifampin
  • INH
  • Pyrazinamide
  • Ethambutol
  • Streptomycin
90
Q

Rx Regimen for TB

A
  • First 2-9mos: INH + Rifampin + Pyrazinamide + Ethambutol
  • Continuation: INH + Rifampin
  • Completion determined by total # doses (not total therapy time)
91
Q

Resistant TB

A
  • MDR TB: resistant to at least INH and Rifampin
    • Rx: at least 5-7 drugs
  • XMDR TB: resistant to isoniazid, rifampin, any fluoroquinolone, and either capreomycin, kanamycin, or amikacin
  • Treatment continued for 18-24 months, or 12-18 months after culture becomes negative

M2 - Pharm (10 decks)

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