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Block 1: Pharmacology > Exam 1 (Part 2) > Flashcards

Exam 1 (Part 2) Flashcards

1
Q

(Antibiotic)
Bacteriostatic?

A

(Inhibit bacterial cell replication)
(STATEC)
-Tetracyclines
-Erythromycin
-Chloramphenicol

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2
Q

(Antibiotic)
Bactericidal?

A

(Causes microbial cell death and lysis at clinically achieved concentrations)
(PACS A PUNCH)
-Penicillins
-Aminoglycosides (Gentamycin, Tobramycin)
-Cephalosporins

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3
Q

(Antibiotic)
Sulfonamides?

A

Either -cidal or -static

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4
Q

Cell Wall Synthesis?

A

(“I hit a wall, Please Come C My Vehicle”)
-Penicillin (G, Ampicillin)
-Cephalosporin
-Monobactams
-Carbapenems
-Vancomycin

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5
Q

DNA –> RNA?

A

(MR. Q)
-Metronidazole-DNA
-Rifampin-RNA Polymerase
-Quinolones-DNA Gyrase

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6
Q

Protein Synthesis?

A

(MAT C)
-Macrolides
-Aminoglycosides
-Tetracyclines
-Chloraphenicol

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7
Q

Cell Membrane?

A

-Polymyxins
-Daptomycin

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8
Q

Folic Acid?

A

-Trimethoprim
-Sulfonamides

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9
Q

Skin and Subcutaneous Tissues?

A

-Burns (SSP)
-Skin Infections (SSH)
-Decubitus Wound Infections (SEB)
-Traumatic and Surgical Wounds (SSP)

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10
Q

(Skin and Subcutaneous Tissues)
Burns/Traumatic and Surgical Wounds?

A

(SSP)
-Staph aureus
-Strep
-Pseudo aeru

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11
Q

(Skin and Subcutaneous Tissues)
Skin Infections?

A

(SSH)
-Staph aureus
-Strep
-Herpes

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12
Q

(Skin and Subcutaneous Tissues)
Decubitus Wound Infections?

A

(SEB)
-Staph
-E. coli
-Bact fragilis

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13
Q

(“First Choice”)
Treponema pallidum, Syphilis?

A

Benzathine (salt) + Penicillin G

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14
Q

(“First Choice”)
Mycobacterium tuberculosis?

A

(RIPE)
Rifampin + Isoniazid + Pyrazinamide + Ethambutol

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15
Q

(“First Choice”)
Pseudomonas aeru, Pneumonia?

A

(PTT)
Piperacillin/Tazobactam + Tobramycin)
(B Lactam/ B Lactam Inhibitor)

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16
Q

(Hepatic Function)
Chloramphenicol, IV?

A

-Hepatic function impairment (use with caution)
-Reduced dosage

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17
Q

(Hepatic Function)
Clindamycin, IV?

A

-Hepatic function impairment, No dosage adjustment
-Use with caution with severe liver disease

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18
Q

(AGE)
(Neonates)
Chloramphenicol?

A

-Low concentrations of UGT, cleared by kidneys
-Gray Baby Syndrome
-Give low dose

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19
Q

(AGE)
(Neonates)
Sulfonamides?

A

-Displace bilirubin from albumin in blood which can deposit in brain, Kernicterus or toxic encephalopathy
-Contraindicated in neonates

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20
Q

Increase Gentamicin dose for?

A

Infants/Young Children

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21
Q

(AGE)
(Children)
Tetracycline?

A

-Teeth Discoloration
-Intracranial Hypertension

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22
Q

(AGE)
Isoniazid?

A

-Increased hepatitis risk with increased age

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23
Q

(AGE)
CHF Patients?

A

Ticarcillin disodium/ Clavulanate potassium –> Na+ and K (can cause edema and arrhythmia)

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24
Q

(Pregnancy and Nursing Contradictions)
Metronidazole?

A

Mutagenic

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25
Q

(Pregnancy and Nursing Contradictions)
Sulfonamides?

A

-Breast milk
-Kernicterus: increased bilirubin, displaced from albumin

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26
Q

(Pregnancy and Nursing Contradictions)
Antifolate drugs?

A

-Decreased concentrations of folic acid in pregnant women
-Can lead to spina bifida

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27
Q

(Pregnancy and Nursing Contradictions)
Fluoroquinolones?

A

Affect cartilage growth

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28
Q

(Pregnancy and Nursing Contradictions)
Tetracyclines?

A

-Inhibit bone growth
-Tooth enamel dysplasia

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29
Q

Do NOT use 2 drugs of?

A

Same class or same mechanism of action

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30
Q

(Bacteria)
Gram +?

A

(Lactamase outside, thicker peptidoglycan wall)
(Vancomycin)
-Staph
-Strep
-E. Faccalis
-Mono

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31
Q

(Bacteria)
Gram -?

A

(Outer membrane with porin channel, thin peptido., lactamase inside)
(Aminoglycosides)
-E. Coli
-Kleb
-Pseudo
-H. Influenzae

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32
Q

(Bacteria)
Anaerobes?

A

-C. Diff
-Bacterio Fragile

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33
Q

(Bacteria)
Miscellaneous?

A

-Trep
-Myco
-Rickett

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34
Q

Penicillin targets?

A

Transpeptidase (Penicillin Binding Protein)

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35
Q

Penicillins?

A

-Pencillin G (Natural)
-Amoxicillin, Ampicillin (Amino group added)
-Dicloxacilin (Narrow, staph)
-Ticarcillin + Piperacillin (Pseudo)

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36
Q

(Penicillins)
Penicillin G?

A

-Narrow
-Penicillinase-sensitive
(Strep, Pepto, Trep, Necrotize)

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37
Q

(Penicillins)
Dicloxacilin?

A

-Narrow
-Penicillinase-resistant
-MSSA
-MSSE
(Staph + Run of the mill)

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38
Q

(Penicillins)
Amoxicillin?

A

-Broad Spectrum
-Penicillinase-sensitive
-Ear/URTI

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39
Q

(Penicillins)
Ticarcillin?

A

-Broad
-Penicillinase-sensitive
(Pseudo Aeru + G- Nocosomial (hospital acquired))

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40
Q

(Penicillins)
Piperacillin?

A

-Extended
-Penicillinase-senstive
(Klebsiella pneumoniae)

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41
Q

(Penicillins)
Mechanisms of Action?

A

-Inhibit peptidoglycan transpeptidase
-Prevents cross-linking of glycopeptide polymers
-PBP
-Trigger autolysis

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42
Q

(Penicillins)
Pharmacokinetics?

A

-Renal clearance
-Distributed widely
-Poor in absence of inflammation
-Conc. of drug achieved to treat meningitis, arthritis, endophthalmitis

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43
Q

(Penicillins)
Side Effects?

A

-NVD
-Superinfection of GI Tract: C. Diff
-IV/IM: phlebitis, pain
-Neurotoxicity
-Penicillin allergy

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44
Q

(Pencillins)
Mechanisms of Resistance?

A

-Changes in PBP
-Tolerance
-Changes in porins (Gram -)
-B-lactamase

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45
Q

Cephalosporins?

A

-Cefazolin (1st)
-Cefoxitin (2nd)
-Ceftriaxone (3rd)
-Cefepime (4th)
-Ceftaroline (5th)

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46
Q

(Cephalosporins)
Mechanisms of Action?

A

(Same as Penicillin)
-Inhibit peptidoglycan transpeptidase
-Prevents cross-linking of glycopeptide polymers
-PBP
-Trigger autolysins

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47
Q

(Cephalosporins)
Cefazolin?

A

(1st)
(PEKS)
-Proteus, E. coli, Kleb, Staph/Strep
-Prevention of surgical prophylaxis

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48
Q

(Cephalosporins)
Cefoxitin?

A

(2nd)
(HEN PEK)
-Haemo, E. aero, Neiss (PEK)

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49
Q

(Cephalosporins)
Ceftriaxone?

A

(3rd)
(ACES)
-2nd + Acine, Citro, Entero, Serr
-Gram -
-Meningitis

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50
Q

(Cephalosporins)
Cefepime?

A

(4th)
(Gram +)
-3rd + MSSA, Strep, Pseudo, Citro
-B-lactmase resistance
-Serious G- nosocomial infections

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51
Q

(Cephalosporins)
Ceftaroline?

A

(5th)
-4th + MRSA
-Acute bacterial skin and skin structure infections
-Community acquired pneumonia

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51
Q

(Cephalosporins)
Pharmacokinetics?

A

-Renal elimination
(COME BACK TO SLIDE 42)

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52
Q

(Cephalosporins)
Side Effects?

A

-Local reactions
-Hypersensitivity reactions
-Usually less immunogenic than penicillins
(do NOT give to patients with Penicillin allergies)

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53
Q

(Cephalosporins)
Mechanisms of Resistance?

A

(Similar to Cillins)
-Changes in PBP
-Tolerance
-Changes in porins
-B-lactamase

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54
Q

Carbapenems?

A

Imipenem

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55
Q

(Carbapenems)
Mechanisms of Action?

A

(Same as Penicillin)
-Inhibit peptidoglycan transpeptidase
-Prevents cross-linking of glycopeptide polymers
-PBP
-Trigger autolysis

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56
Q

(Carbapenems)
Therapeutic Uses?

A

-Mostly G-rods (pseudo, mono)
-Empiric treatment of serious nosocomial infections

57
Q

(Carbapenems)
Pharmacokinetics?

A

-Renally cleared
-Imipenem hydrolyzed in kidney

58
Q

(Carbapenems)
Side Effects?

A

-Seizures
-Hypersensitivity reactions

59
Q

(Carbapenems)
Mechanisms of Resistance?

A

(Similar to Penicillins)
-B-lactamase
-PBP
-Porins
-Autolysis

60
Q

Monobactam?

A

Aztreonam (give if allergic to Penicillin)

61
Q

(Monobactam)
Mechanisms of Action?

A

(Same as Penicillin)
-Inhibit peptidoglycan transpeptidase
-Prevents cross-linking of glycopeptide polymers
-PBP
-Trigger autolysins

62
Q

(Monobactam)
Therapeutic Uses?

A

Mostly G-rods (Pseudomonas aeruginosa)

63
Q

(Monobactam)
Pharmacokinetics?

A

Renally cleared

64
Q

(Monobactam)
Side Effects?

A

-GI upset
-Phlebitis (IV), pain at injection (IM)
-Hypersensitivity reaction (1% B-lactam allergic patients)

65
Q

(Monobactam)
Mechanisms of Resistance?

A

(Similar to cillins)
-B-lactamase
-PBP
-Porins
-Autolysins

66
Q

Tricyclic Glycopeptide?

A

Vancomycin

67
Q

(Tricyclic Glycopeptide)
Mechanisms of Action?

A

-Inhibitor of peptidoglycan synthase (attaches to NAG and NAM)
-Binds to D-Ala-D-Ala
-Inhibitor of pentapeptide precursor and membrane carrier

68
Q

(Tricyclic Glycopeptide)
Therapeutic Uses?

A

-Primarily G+:MRSA, MRSE
-Serious multi-drug resistant infections
-Clostridioides difficile (PO)

69
Q

(Tricyclic Glycopeptide)
Pharmacokinetics?

A

-Renally cleared
-Penetrates into pleural, pericardial, synovial and ascetic fluids
-Can enter CSF with inflamed meninges

70
Q

(Tricyclic Glycopeptide)
Side Effects?

A

-Ototoxicity: rare
-Nephrotoxicity: uncommon
-Red man syndrome

71
Q

(Tricyclic Glycopeptide)
Mechanisms of Resistance?

A

-D-Ala-D-Lactase
-VRE
-VISA

72
Q

Cyclic Lipopeptide?

A

Daptomycin

73
Q

(Cyclic Lipopeptide)
Mechanisms of Action?

A

-Binds to cell membrane, forms pores
-Depolarization
-Rapid Cell Death

74
Q

(Cyclic Lipopeptide)
Therapeutic Use?

A

-Primarily G+: MRSA, VRE
-Treatment of skin/soft tissue infections
-Endocarditis

75
Q

(Cyclic Lipopeptide)
Pharmacokinetics?

A

-Renally cleared
-Pulmonary surfactant inactivates it
(CANNOT use for lung infections like Pneumonia)

76
Q

(Cyclic Lipopeptide)
Side Effects?

A

-Myopathy, Rhabdomyolysis
-Allergic pneumonitis, if used >2 weeks

77
Q

(Cyclic Lipopeptide)
Mechanisms of Resistance?

A

Treatment failure (increase MIC)

78
Q

70s?

A

Bacterial Ribosomes

79
Q

80s?

A

Eukaryotic

80
Q

Tetracyclines?

A

-Minocycline
-Tetracycline
-Doxycycline

81
Q

(Tetracyclines)
Mechanisms of Action?

A

-Inhibit protein synthesis
-Bind to bacterial 30s ribosomal subunit
-Prevent attachment of aminoacyl-tRNA
-Bacteriostatic (TEC)

82
Q

(Tetracyclines)
Therapeutic Uses?

A

-Mycoplasma pneumoniae
-Cutibacterium acnes

83
Q

(Tetracyclines)
Pharmacokinetics?

A

-Limited CNS penetration
-PO
-Doxycyline primarily fecally eliminated –> OK with renal failure

84
Q

(Tetracyclines)
Side Effects?

A

-Contraindicated during pregnancy
-N/V
-Discoloration of teeth and inhibit bone growth
-Photosensitivity
-Superinfection (C. diff, C. albicans)

85
Q

(Tetracyclines)
Mechanisms of Resistance?

A

-Plasmid-determined resistance: decreased influx and increased efflux
-Ribosomal change

85
Q

Glycylcyclines?

A

Tigecycline
(reserved for: difficult to treat infections)

86
Q

(Glycylcyclines)
Mechanisms of Action?

A

-Bind to bacterial 30s ribosomal subunit
-Bacteriostatic

87
Q

(Glycylcyclines)
Therapeutic Use?

A

-Broad spectrum, many G+, G-, Anaerobes, MRSA, VRE, PRSP
-Complicated skin and skin structure infections
-Complicated intra-abdominal infections

88
Q

(Glycylcyclines)
Side Effects?

A

-Mortality risk (limit use for multi-resistance)
-Contraindicated in pregnancy, superinfection

89
Q

Macrolides?

A

-Erythromycin
-Azithromycin
-Clarithromycin

90
Q

(Macrolides)
Mechanisms of Action?

A

-Inhibit protein synthesis
-Binds to peptidyl-tRNA binding region (P site) on 50s ribosome subunit
-Bacteriostatic

91
Q

(Macrolides)
Therapeutic Use?

A

-Broad Spectrum (Chlamydia pneumoniae, H. influenzae, M. catarrhalis
-Communit acquired: URTI, Pneumonia, Otitis media

92
Q

(Macrolides)
Side Effects?

A

-Prolong QTc interval
-NVD Rash
-Chloestatic hepatitis
-Embryotoxic (C, animals)

93
Q

(Macrolides)
Mechanisms of Resistance?

A

-Methylation of 23 rRNA-binding site
-Prevents binding

94
Q

(Macrolides)
Drug Interactions?

A

-Erythromycin&raquo_space; clarithromycin
-Inhibit CYP3A4

95
Q

Chloramphenicol?

A

Chloramphenicol

96
Q

(Chloramphenicol)
Mechanisms of Action?

A

-Binds to 50s subunit
-Inhibits peptide bond formation
-Bacteriostatic
-Bactericidal for meningitis treatment

97
Q

(Chloramphenicol)
Therapeutic Uses?

A

-Haemophilius influenzae
-Neisseria
-Strep
-Rickett

98
Q

(Chloramphenicol)
Side Effects?

A

-Anemia (dose-related)
-Aplastic anemia (dose-independent)
-GRAY BABY SYNDROME (decreased UGT)

99
Q

Lincosamides?

A

(“CCC”)
-Clinamycin
-Ca-mrsa
-CDAD

100
Q

(Lincosamides)
Mechanisms of Action?

A

-Binds to 50s ribosome subunit
-Bacteriostatic

101
Q

(Lincosamides)
Therapeutic Uses?

A

-CA-MRSA
-BLA (B-lactam allergy)

102
Q

(Lincosamides)
Side Effects?

A

-CDAD
-Diarrhea
-Rash
-Fever
-Neutropenia (rare)

103
Q

(Lincosamides)
Mechanisms of Resistance?

A

-Methylation of 23 rRNA-binding site
-Prevents binding

104
Q

Streptogramins?

A

-Quinopristin/ Dalfopristin (in same dose) (synergistically)

105
Q

(Streptogramins)
Mechanisms of Action?

A

-Binds to 50s ribosome subunit
-Bactericidal

106
Q

(Streptogramins)
Therapeutic Uses?

A

Primary G+
-Enterococcus faecium (VRE)
-MRSA
-PRSP
-Osteomyelitis
-Endocarditis

107
Q

(Streptogramins)
Side Effects?

A

-Pain
-Phlebitis at infusion site
-Arthralgia
-Myalgias

108
Q

(Streptogramins)
Mechanisms of Resistance?

A

-Ribosomal methylate (Q)
-Acetyltransferase (D)

109
Q

Oxazolidinones?

A

-Linezolid
-Tedizolid

110
Q

(Oxazolidinones)
Mechanisms of Action?

A

-Binds to 50s ribosome subunit
-Bacteriostatic

111
Q

(Oxazolidinones)
Therapeutic Uses?

A

-Primary G+
-L
-VRE
-MRSA
-MRSE
-PRSP
-Skin infections
-Pneumonia
-Bacteremia

112
Q

(Oxazolidinones)
Side Effects?

A

-Myelosuppression
-MAOI
-Rash
-Peripheral neuropathy

113
Q

(Oxazolidinones)
Mechanisms of Resistance?

A

Ribosomal binding site mutation

114
Q

Aminoglycosides?

A

-Gentamicin
-Amikacin
-Tobramycin

115
Q

(Aminoglycosides)
Mechanisms of Action?

A

-Inhibit protein synthesis
-Binds to 30s ribosomal subunit
-Bactericidal
-Concentration-dependent killing
-Synergistic with B-lactams (PCCVM)

116
Q

(Aminoglycosides)
Therapeutic Uses?

A

-Often combined with B-lactam
-Bowel surgery (N)

117
Q

(Aminoglycosides)
Pharmacokinetics?

A

-Primary renally cleared
-Polar –> decreases distribution (CNS, lungs)

118
Q

(Aminoglycosides)
Side Effects?

A

-Nephrotoxicity
-Ototoxicity
-Neuromuscular blockade
-Teratogen (8th CN)
-Myelosuppression (rare)

119
Q

(Aminoglycosides)
Mechanism of Resistance?

A

-Decreased porin permeation
-Decreased ribosomal binding
-Enzymatic inactivation: acetyltransferase
-Phosphotransferase

120
Q

Macrocyclic Antibiotic?

A

Fidaxomicin

121
Q

(Macrocyclic Antibiotic)
Mechanisms of Action?

A

-Binds to sigma unit of RNA polymerase
-Inhibits protein synthesis

122
Q

(Macrocyclic Antibiotic)
Therapeutic Use?

A

-Clostridioides diffcile
-CDAD (Vancomycin, Fidaxomicin)

123
Q

(Macrocyclic Antibiotic)
Side Effects?

A

-N/V
-Abdominal pain
-GI Hemorrhage
-BMS (2%)

124
Q

(Macrocyclic Antibiotic)
Pharmacokinetics?

A

-PO: very little systemic absorption
-High fecal concentration

125
Q

Sulfonamides?

A

Sulfamethoxazole

126
Q

(Sulfonamides)
Mechanisms of Action?

A

-Inhibition of dihydropteroate synthase which inhibits synthesis of folic acid
-Decreased biosynthesis of DNA, RNA, AA, Bacteriostatic

127
Q

(Sulfonamides)
Therapeutic Use?

A

-Broad Spectrum
-UTI
-Treatment of conjunctivitis
-Burns, Ag Sulfadiazine

128
Q

(Sulfonamides)
Side Effects?

A

-Rash
-Sulfa allergy
-SJS
-TEN
-Kernicterus: Newborn Encephalopathy, Bilirubin deposits in brain, Sulfa displacement on albumin

129
Q

(Sulfonamides)
Pharmacokinetics?

A

-Renally cleared
-NAT (primary) and UGT substrate
-Inhibit CYP2C9 –> increased Warfarin AUC

130
Q

(Sulfonamides)
Mechanisms of Resistance?

A

-Do not biosynthesize folic acid
-Increase PABA production
-Dihydropteroate synthase
-Decreased sulfa permeability

130
Q

Trimethoprim/ Sulfamethoxazole?

A

-DFHR
-DFHS

131
Q

(Trimethoprim/ Sulfamethoxazole)
Mechanisms of Action?

A

-DHFRI, DHPSI, Synergism
-Bacteriostatic

132
Q

(Trimethoprim/ Sulfamethoxazole)
Therapeutic Uses?

A

-MRSA
-E. coli
-UTI
-Prostatitis

133
Q

(Trimethoprim/ Sulfamethoxazole)
Side Effects?

A

-Hemolytic anemia

134
Q

(Trimethoprim/ Sulfamethoxazole)
Mechanisms of Resistance?

A

Trimethoprim

135
Q

Quinolones (Floxacin)?

A

-Ciprofloxacin
-Levofloxacin
-Moxifloxacin

136
Q

(Quinolones (Floxacin))
Mechanisms of Action?

A

-Inhibit Topoisomerase II (bacterial DNA gyrase)
-Inhibit DNA replication

137
Q

(Quinolones (Floxacin))
Side Effects?

A

-Tendonitis
-Maysthenia graves

138
Q

(Quinolones (Floxacin))
Drug Interactions?

A

-Chelation, Al, Mg, Fe, Ca
-Inhibit CYP1A2, increased caffeine

139
Q

(Quinolones (Floxacin))
Mechanisms of Resistance?

A

-Mutations in Topoisomerase II or IV, decreased binding
-Increased efflux
-Decreased influx

Block 1: Pharmacology (9 decks)

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