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Pharmacology > Antibacterials > Flashcards

Antibacterials Flashcards

1
Q

3 classes of cell wall inhibitors + 5 subcategories

A

b-lactams
- Penicillins
- Aminopenicillins
- Cephalosporins
- Monobactams
- Carbapenems
Glycopeptides (Vancomycin)
Daptomycin

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2
Q

Cell wall inhibitor MOA

A

Bind to PBP —> no D-Alanine removal
= inhibit synthesis peptidoglycan wall

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3
Q

Mechanism of resistance to b-lactams

A

B-lactamases

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4
Q

Difference between benzathine, procaine, and sodium G penicillin

A

Benzathine: IM, more effect duration 1/mo.
Procaine: less pain, more effect duration 1/day
Sodium: fast and short

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5
Q

Probenecid function

A

Increase duration of penicillin by decreasing excretion

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6
Q

3 penicillinase-resistant drugs

A

Naficillin
Oxacillin
Dicloxacillin***

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7
Q

Dicloxacillin main indication

A

Staphylococcus skin and soft tissue infection

Rare (IV): endocarditis, osteomyelitis

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8
Q

Main side effect of penicillins

A

HYPERSENSITIVITY

Others: AI hemolytic anemia, interstitial nephritis

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9
Q

Indications for penicillin

A

Strep or staph
- Strep throat
- Rheumatic fever
- Viridans endocarditis
- B strep neonatal prophylaxis
- Actinomyces
- C.perfringens
- Pasteurella
- T.pallidum syphillis

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10
Q

Which penicillin is IV, which is oral?

A

Oral: V
IV: G

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11
Q

ONLY gram negative covered by penicillin

A

Neisseria meningitiditis —> meningitis

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12
Q

Cell wall inhibitors are bactericidial or bacteriostatic?

A

Bactericidial

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13
Q

Which MOOS are already mostly resistant against penicillins?

A

S.aureus
S.epidermiditis

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14
Q

4 aminopenicillin drugs

A

Ampicillin
Amoxicillin
Piperacillin
Ticarcillin

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15
Q

Main drugs for MRSA (3)

A

Vancomycin
Daptomycin
Linezolid

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16
Q

B-lactamase for each aminopenicillin

A

Amoxi + clav
Ampi + sulbac
Piper + tazobac
Ticar + clav

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17
Q

Which has broader spectrum: penicillins or aminopenicillins?

A

Aminopenicillins, they include some more gram -

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18
Q

Amoxicillin administration and indications (4)

A

ORAL

Strep throat
RTI: s.p, h.i, m.c
H.pylori
Borrelia lyme’s

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19
Q

Ampicillin administration and indications (3)

A

IV

Anaerobic: enterococcus**can be resistant
Listeria meningitis
E.coli GI and UTI

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20
Q

______ should be used as prophylaxis for s.p and h.i in a patient with asplenia. Also before dental procedures if endocarditis risk.

A

Amoxicillin

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21
Q

In what case to give piper-tazo or ticar-clav instead of other aminopenicillins?

A

PSEUDOMONAS
Hospital-acquired pneumonia or sepsis - serious

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22
Q

Aminopenicillin side effects aside from hypersensitivity

A

Liver injury amoxi
Steven-Johnson’s sx
Rash if EBV infection

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23
Q

B-lactam with broadest spectrum

A

Carbapenems

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24
Q

Carbapenem medications (hint: iMED)

A

Imipenem
Meropenem
Etrapenem
Doripenem

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25
Q

Which carbapenem is given with CILASTATIN to inhibit its degradation in renal tubules?

A

Imipenem

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26
Q

When others fail, we get the job done!

Talks about…

A

Carbapenems

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27
Q

Carbapenem administration and indications

A

IV

Anaerobic intra-abdominal
Pseudomonas
Meningitis

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28
Q

Which resists broad-spectrum b-lactamases: monobactams or carbapenems?

A

Carbapenems

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29
Q

Dangerous carbapenem side effect

A

Lowers seizure threshold

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30
Q

Monobactam medication name

A

Aztreonam

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31
Q

Aztreonam administration and indications

A

IV or IM

Gram - aerobic rods
IF ALLERGIC TO PENICILLIN
Pseudomonas
Meningitis, pneumonia or sepsis
UTIs

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32
Q

What type of drug is vancomycin?

A

Glucopeptide

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33
Q

Vancomycin MOA

A

Binds to D-alanine and transpeptidase can’t cut it

B-lactamases are inefficient

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34
Q

Vancomycin administration and indications

A

IV

Empiric for endocarditis1st
MRSA*1st
Meningitis with ceftriaxone
S.epidermiditis

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35
Q

Which bacteria is resistant to vancomycin?

A

Enterococcus

Turns D-ALA to D-LAC

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36
Q

ONLY oral administration of vancomycin is for:

A

C.difficile

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37
Q

4 vancomycin side effects

A

Red man sx: histamine
Thrombophlebitis
Oto/nephrotoxic
DRESS sx: eosinophilia

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38
Q

It’s important to monitor plasma levels of:

A

Vancomycin

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39
Q

Daptomycin MOA

A

Insert lipid tail to depolarize cell wall

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40
Q

Daptomycin is used for (2):

A

Vancomycin-resistant enterococcus
MRSA*****1st

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41
Q

Which antibiotic can’t be given in pneumonia because its inactivated by surfactant?

A

Daptomycin

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42
Q

Daptomycin main side effect

A

Myopathy
Monitor creatinine phosphokinase (CPK)

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43
Q

1st gen cephalosporins

A

Cephalexin
Cefazolin
Cephalothine

(Tip: all “ph” instead of “f”)

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44
Q

1st gen cephalosporin indications (4)

A

Gram + (strep or staph)
- strep throat
- cellulitis and abscess
- PEK UTIs: proteus, e.coli, klebsiella
- surgical prophylaxis

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45
Q

Which generation of cephalosporin is used for surgical preparation?

A

1st gen

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46
Q

Which cephalosporin is used for MRSA

A

5th gen - ceftaroline

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47
Q

Which cephalosporin is used for pseudomonas?

A

3rd: ceftazidime
4th: cefepime

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48
Q

2nd gen cephalosporins

A

Cefuroxime
Cefoxitin
Cefotetan

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49
Q

2nd gen cephalosporin uses

A

RARE
HENS gram - : H.i, Neisseria, Serratia

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50
Q

3rd gen cephalosporins

A

Ceftriaxone
Cefotaxime
Ceftazidime

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51
Q

3rd gen cephalosporin uses

A

Meningitis H.i - triax, taxi
Pseudomonas - tazi
Viridans
GI gram -
Sepsis empiric
Gonorrhea IM
Lyme’s

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52
Q

What is ceftriaxone given in combination with to treat Listeria?

A

Ampicillin

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53
Q

Cephalosporins don’t work versus:

A

Enterococcus

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54
Q

4th gen cephalosporin and uses

A

Cefepime

Pseudomonas
Meningitis

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55
Q

5th gen cephalosporin and uses

A

Ceftaroline

MRSA

56
Q

Which drug does teicoplanin share mechanism with?

A

Vancomycin

57
Q

Polymyxin B, what is it and uses

A

Concentration-dependent bactericidial
Cation polypeptides bind gram -

Pseudomonas, E.coli, Klebsiella, Acinetobacter, Enterobacter

58
Q

Other name for polymyxin E

A

Colistin

59
Q

Polymyxin B vs E

A

B: parenteral, ophthalmic, otic, topical
E: prodrug, IV or nebulizer

60
Q

2 classes of protein synthesis inhibitors + 6 subclasses

A

30S:
- Tetracyclines
- Aminoglycosides

50S:
- Macrolides
- Lincosamides (Clindamycin)
- Cloramphenicol
- Oxazolidone (Linezolid)

61
Q

30S inhibitors and their mechanism

A

Tetracycline: no tRNA access to A site
Aminoglycosides: irreversible binding —> misread

62
Q

50S inhibitors and mechanism

A

Macrolides: inhibit A —> P translocation
Lincosamides (clindamycin): inhibit A —> P translocation
Chloramphenicol: bind to P site
Oxazolidone (linezolid): inhibit 70S formation

63
Q

Which antibiotic causes RNA misread and what is the result?

A

Aminoglycosides

Bactericidial

64
Q

Tetracyclin MOA and therefore resistance

A

Passive diffusion —> bacteria —> bind 30S
—> prevent aminoacyl tRNA binding to A site

Efflux pumps, mutations in ribosome

65
Q

Antibiotic used mostly for infections acquired in the OUTDOORS

A

Tetracyclines

66
Q

Tetracycline administration and indications

A

Oral or IV

Broad, even MRSA
Rickettsia*****1st line and other tick diseases
Endocarditis sheep —> doxicycline
Chlamydia pelvic and CAP
Atypical pneumonia
Brucellosis, Coxiella, Yersinia

67
Q

Tetracycline main side effect

A

Tooth discoloration (deposits there)

Therefore, avoid in <8y/o and pregnant women

Also: photosensitivity

68
Q

Antibiotic class that has notable fecal excretion

A

Tetracyclines

69
Q

Which antibiotic classes have decreased absorption by cations and milk? (2)

A

Tetracyclines
Fluoroquinolones

70
Q

Macrolide MOA and medication names

A

50S inhibit translocation from A site to P site

Azithromycin
Ezithromycin
Clarythromycin

71
Q

Macrolide administration and indications

A

Oral or IV

H.pylori*****1st line clarythromycin
Chlamydia - azithro, erythro for neonates
LRI: pneumonia, MAC prophylaxis, atypical
Diphtheriae - e
Bordetella + family prophylaxis
Others: babeosis, bartonella

72
Q

Macrolide main side effects (4)

A

GI
Jaundice - HEPATOTOXIC!!
Prolonged QT
Inhibit P450

73
Q

Macrolides (inhibit/activate) P450.

A

Inhibit

74
Q

Tigecyclin

A

Glycylcycline, binds to 30S like tetracycline but 3rd gen
Skin, soft tissue, intra-abdominal
Active even vs MRSA

75
Q

Chloramphenicol indications

A

Meningitis in developing countries (cheapest)
Rocky mountain spotted fever —> rickettsia
—> In pregnancy, when doxicycline is not an option

76
Q

Chloramphenicol side effects

A

Anemia - reversible or aplastic
Gray baby sx (flacid, hypothermia, shock)

77
Q

Clindamycin indications

A

G(+) Anaerobic lung abscesses ***aspiration pneumonia
Bacterioides
MRSA cellulitis
C.perfringens
Acne
Endometriris - chlam or gono if doxi/cephalo don’t work
Gardenella vaginosis

78
Q

Characteristic side effect of clindamycin

A

Diarrhea

C.difficile pseudomembranous colitis

79
Q

Linezolid indications

A

Gram +
MRSA** 1st line
(Complicated skin/soft tissue)
Serious HAP
Vancomycin-resistant enterococcus

80
Q

Linezolid main side effects (4)

A

Cytopenia
Optic neuropathy
Peripheral neuropathy
Serotonin sx

81
Q

ONLY protein synthesis inhibitor that is bactericidial

A

Aminoglycosides

82
Q

Aminoglycosides MOA

A

30S irreversible binding —> misread —> death

Can need cell wall inhibitor at the same time

83
Q

Which cell wall inhibitors are given with aminoglycosides?

A

B-lactams
Or vancomycin

84
Q

Aminoglycosides indications

A

Gram - aerobic bacilli

85
Q

Which medication is given before colorrectal surgery?

A

Neomycin (Aminoglycosides)

86
Q

Which antibiotic can be given vs intraluminal parasites?

A

Paromomycin (Aminoglycosides)

87
Q

Which aminoglycoside is given for tick Franciscella and Yersinia?

A

Streptomycin

88
Q

Which a minoglycoside is given for enterobacter, Serratia, or Klebsiella?

A

Gentamicin

89
Q

Gentamicin uses

A
  • UTIs
  • Septicemia
  • Nosocomial RTI
  • Intra-abdominal
  • Osteomyelitis
90
Q

Which aminoglycosides can be used versus pseudomonas? (3)

A

Genta
Tobra
Amikacin

91
Q

Why is amikacin more expensive than other aminoglycosides?

A

Broad spectrum
Resistant versus enzymes that break others down

92
Q

Aminoglycosides main side effects (2)

A

OTOTOXICITY
- Vestibular and cochlear
- Teratogenic deafness
- Irreversible

NEPHROTOXICITY
- Acute tubular necrosis
- Increase creatinine (monitor)

Other: neuromuscular block

93
Q

Linezolid MOA

A

Binds to 23S of 50S —> inhibit 70S formation

94
Q

SMX and TMP MOAs

A

SMX: PABA analogue that inhibits dihydropteroate synthase
TMP: inhibits DHF reductase

95
Q

TMP-SMX indications

A

UTI1st line
Acute prostatitis
Nocardia1st line
P.jirovecci pneumonia + prophylaxis in AIDS

Note: PYR-SFD for toxoplasmosis prophylaxis in AIDS

96
Q

TMP-SMX has many side effects, the most significant being (3):

A

Hypersensitivity
Teratogenic
Pancytopenia
Displace drugs from albumin
Inhibit P450
Hemolytic anemia

97
Q

TMP-SMX (inhibits/activates) P450.

A

Inhibits

98
Q

What antibiotic is most commonly given for burns?

A

Silver sulfadiazine

Other: mafenide

99
Q

Fluoroquinolones MOA

A

Inhibit topoisomerase
II: cipro
IV: moxi

Levo both

100
Q

Which fluoroquinolone is used for gram + and what is its MOA?

A

Moxifloxacin

Inhibits topoisomerase IV

101
Q

Which fluoroquinolone is used for gram - and what is its MOA?

A

Ciprofloxacine

Inhibit topoisomerase II

102
Q

Fluoroquinolones are empiric treatment for _____

A

Pyelonephritis

103
Q

Ciprofloxacine/levo indications

A

UTI: E.coli, proteus
GI: Shigella, salmonella, campylobacter
Complicated UTI: pseudomonas
Acute prostatitis
Osteomyelitis if px has sickle cell

104
Q

Moxifloxacin/levo indications

A

Bacillus anthracis pneumonia
CAP
Atypical pneumonia

105
Q

Fluoroquinolone main side effect + 2 extras

A

Tendon and cartilage damage
- don’t give to <10y/o or pregnant

Prolonged QT —> torsades
GI

106
Q

Antimycobacterial dosing

A

4 for 2 mo. - RIPE
Followed by
2 for 4 mo. - RI

107
Q

Which antimycobacterial can be used on its own for latent TB?

A

Isoniazid

108
Q

Isoniazid MOA

A

Activated by KatG (mutations decrease KatG)

Inhibit mycolic acid synthesis

109
Q

Why do 4 antimycobacterials have to be given together?

A

To avoid resistance

110
Q

Isoniazid main side effects INH

A

Injury Nerves and Hepatocytes
- CNS: seizures
- PNS: neuropathy, paresthesias due to B6 defficiency
- Metabolic acidosis
- Inhibit P450
- Lupus

111
Q

All antimycobacterials have this side effect

A

HEPATOTOXIC

112
Q

Which vitamin should be given with isoniazid?

A

B6 / pyroxidine to avoid peripheral neuropathy

113
Q

Which is the most potent antimycobacterial?

A

Rifampin

114
Q

Rifampin MOA

A

Inhibit RNA polymerase (rpoB)

if it mutates = resistance

115
Q

Which of these induces and which inhibits P450? Isoniacid/rifampin

A

Induce: rifampin
Inhibit: isoniacid

116
Q

Rifampin can ONLY be given on its own in this disease

A

Meningitis PROPHYLAXIS

117
Q

Characteristic rifampin side effect

A

Orange coloration of fluids - not damaging

118
Q

Rifabutin is an alternative to ______ in the case of _____

A

Rifampin ; HIV

119
Q

Ethambutol MOA

A

Inhibits arabinosyl transferase in WALL
—> inhibit carbohydrate formation

120
Q

Ethambutol side effect

A

Optic neuritis
- Less visual acuity
- Red-green color blindness

121
Q

Pyrazinamide side effect

A

Hyperuricemia, needle shaped uric acid crystals
Gout exacerbations

122
Q

MAC treatment

A

Macrolide + ethambutol +- rifabutin

Also for prophylaxis when CD4<50

123
Q

M.leprae treatment

A

DAPSONE + rifampin
Clofazime if lepromatous (lion-face)

124
Q

Dapsone side effects

A

Agranulocytosis
Hemolytic anemia

125
Q

Rifamycins are excreted via:

A

Feces

126
Q

First line treatment for N.meningiditis

A

Ceftriaxone

127
Q

First line treatment for Bartonella “whooping cough”

A

Macrolides

128
Q

First line treatment for P.jirovecci

A

Sulfonamides

129
Q

Safe with renal impairment DANCER

A

Doxycycline
Ampicillin
Naficillin
Ceftriaxone
Erythromycin
Rifampin

130
Q

Nephrotoxic
tu SUgar TE VA A BEsar (gracias lu)

A

SUlfonamides
TEtracyclines
VAncomycin
Aminoglycosides
BEta-lactams

131
Q

Contraindicated in pregnancy MCAT

A

Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline

132
Q

Macrolides :)

A

ERika, CLAra, AZucena

133
Q

Ototoxic

A

Aminoglycosides

134
Q

Cardiotoxic

A

Macrolides

135
Q

Drug-induced hemolytic anemia

A

3-5 cephalosporins
Sulfonamides

136
Q

NOT IN CHILDREN

A

Tetracyclines
Fluoroquinolones

137
Q

2nd line TB treatment (2 main)

A

Amikacin
Streptomycin

Pharmacology (13 decks)

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