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Flashcards in 4/3 micro Deck (133):
1

Which cardiac abnormality causes wide & fixed splitting?

ASD

2

In cardiac splitting of S2: which sound comes last?

pulm. valve closing.

3

systolic ejection murmur that inc. in intensity w/standing.

hypertrophic cardiomyopathy

4

abrupt standing: how does this affect cardiac parameters?

-dec. preload.
-dec. afterload.

5

What gets converted to propionyl coa?
-mnemonic?

VOMIT pathway:
-valine
-odd chain FA
-methionine
-isoleucine
-threonine

6

glucocorticoids effect on glycogen in liver:

glycogenesis!
-you would think glycogenolysis, but nope!

7

fenoldopam
-mech?
-ues?

-dopamine D-1 receptor agonist. Dec. BP & inc. natriuesis.
-hypetensive emergencies.

8

Cephalosporins
-What do they not cover?
-Whats the one exception?

LAME
-listeria
-atypicals
-MRSA (except ceftaroline)
-enterococci

9

Only cephalosporin to kill MRSA:

ceftaroline.

10

1st generation cephalos:
-name them?
-coverage?
-mnemonic:

-cefazolin, cephalexin.
-PEcK
-Proteus
-E.coli
-Klebsiella

11

2nd gen cephalos
-coverage?
-mnemonic?

HEN PEcKS
-H. influenzae
-enterobacter
-neisseria
-proteus
-E.coli
-klebsiella
-serratia

12

Ceftriaxone
-which gen. cephalo?
-uses?

-3rd gen.
-meningitis and gonorrhea.

13

Ceftazidime
-which gen. cephalo?
-uses?

-3rd gen.
-Pseudomonas.

14

Cefepime
-which gen. cephalo?
-uses?

-4th gen.
-Pseudomonas.

15

ceftaroline
-which gen. cephalo?
-uses?

-5th gen.
-MRSA.

16

Which cephalos target pseudomonas?
-mnemonic?

CeftazaDIME & cefe"PRIME" = the girl in the tub in the pseudomonas vid was a DIME piece, super PRIME.

17

Cephalos
-tox:

-vitamin K deficiency.
-nephrotoxicity of aminoglycosides.

18

Which antibiotic can cause vitamin K deficiency?

Cephalos

19

Which 2 antibiotic classes together are very nephrotoxic?

Cephalos & aminoglycosides.

20

tryptase
-marker for what?

-released by mast cells.
-marker for mast cell activation.

21

Aztreonam
-is it a lactam?
-sensitive to beta-lactamases?
-can you use it if you're allergic to PCN?

-yes.
-no, not sensitive.
-yes, no cross-reactivity w/PCN.

22

Aztreonam
-mech:

-Prevents peptidoglycan cross-linking by binding to
penicillin-binding protein 3.

23

Aztreonam:
-Synergistic with:

Synergistic with aminoglycosides.

24

Aztreonam:
-target:
-can it target anaerobes?

-gram (-) rods.
-the specific type of PBP it binds to are only found on gram (-) rods.
*can NOT target anaerobes!

25

Carbapenems
-lactam?
-sensitive to beta-lactamases?
-can you use it if you're allergic to PCN?

-yes.
-no, not sensitive.
-no, you cant.

26

Imipenem
-must administer w/what drug?
-why?

-Cilastatin = inhibitor of renal dehydropeptidase I
-To dec. inactivation of drug in renal tubules.

27

Carbapenems
-suffix?

-"penem"

28

Carbapenems
-tox?
-which is safest carbapenem?

-CNS toxicity (seizures).
-meropenem.

29

Vancomycin
-tox:
-mnemonic:

NOT trouble free
-Nephrotoxicity, Ototoxicity, Thrombophlebitis.
-red man syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate).

30

Linezolid
-mech:

prevent formation of 70S ribosome.

31

Aminoglycosides
-why cant they be used against anaerobes?

bc they req. O2 for uptake.

32

Aminoglycosides
-mnemonic for names & tox:

mean GNATS caNNOT kill anaerobes!
-gentamicin
-neomycin
-amikacin
-tobramycin
-streptomycin

-nephrotoxic (esp. w/cephalos)
-NMJ blockade
-ototoxicity
-teratogen

*cant kill anaerobes.

33

Aminoglycosides
-mech:

-Inhibit formation of initiation complex and cause misreading of mRNA. Also blocks translocation.

34

Aminoglycosides
-ototoxicity is worse when used w/what?
-nephrotoxicity is worse when used w/what?

-oto = loop diuretics.
-neph = cephalosporins.

35

Aminoglycosides
-mech of resistance?

Bugs conjugate the drug so its eliminated faster than it can work.
-using transferase enzymes.

36

Tetracyclines
-coverage?
-mnemonic:

May Cause Rough Bite
-mycoplasma
-chlamydia
-ricketsia
-borrelia burgdorferi

37

Tetracyclines
-mech:
-what inhibits its absorption?

-prevents binding of tRNA to A site.
-divalent cations inhibit its absorption in the gut. Its a chelator.

38

Tetracyclines
-tox:

-Discoloration of teeth and inhibition of bone growth in children, photosensitivity.
-teratogen.

39

Tetracyclines
-mech of resistance:

Plasmid-encoded transport pumps.

40

Macrolides
-how to recognize?

-"thro mycin".

41

Which macrolide is NOT a P450 inhibitor?

azithromycin.

42

Macrolides
-mech:
-which part of ribo does it bind?

-Blocking translocation (“macroslides”); bind to the 23S rRNA of the 50S ribosomal subunit.

43

Macrolides
-coverage:
-mnemonic?

"blew out MCL during "slide".
Soccer ball represents gram (+) cocci.
M=mycoplasma
C=chlamydia
L=legionella
*Its also atypical to blow your MCL out in soccer - atypical pneumonias

44

Macrolides
-tox:
-mnemonic:

MACRO
-motility (binds to motilin receptors).
-arrythmia (QT prolongation).
-cholestatic hepatitis
-rash
-eOsinophilia

45

Macrolides
-mech of resistance:

Methylation of 23S rRNA-binding site prevents binding of drug.

46

linezolid
-tox:

bone marrow suppression (esp. platelets).

47

Chloramphenicol
-coverage?
-tox?
-mnemonic?

GRAM
-grey baby syndrome
-ricketsia
-aplastic anemia
-meningitis

48

Chloramphenicol
-mech:
-mech of resistance?

-Blocks peptidyltransferase at 50S ribosomal subunit.
-Plasmid-encoded acetyltransferase inactivates the drug.

49

Clindamycin
-mech: (same as which other drug)?
-mech of resistance?

-Blocks peptide transfer (translocation) at 50S
ribosomal subunit.
-same as macrolide.
-Methylation of 23S rRNA-binding site prevents binding of drug.

50

Clindamycin
-coverage?
-mnemonic?

-linDAA has GAS. AAD = anaerobes above diaphragm.
-GAS = group A strep, also reminds you about psuedomembranous colitis.

51

Sulfonamides
-mech?
-bacteriocidal or static?

-PABA antimetabolites inhibit dihydropteroate synthase.
-bacteriostatic! (stops it from growing, doesn't kill it).

52

Sulfonamides
-coverage?
-tox?
-mnemonic?

CUNG HANK
-chalmydia
-UTI
-nocardia
-gram +/-

-hemolysis in G6PD def.
-albumin displaced
-nephrotoxic
-kernicterus

53

Babies w/E.coli or GBS meningitis (or any E.coli infection) should NOT be treated _____.
-why?

sulfondamides
-can cause kernicterus in kids by displacing unconjugated bili from albumin.

54

which bilirubin is complexed w/albumin?

indirect bili.

55

TMP-SMX
-bacteriostatic or cidal?

static

56

TMP
-tox:
-mnemonic:

Treats Marrow Poorly.
-Megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folinic acid).

57

Fluoroquinolones
-suffix?

-oxacin.

58

Fluoroquinolones
-mech?
-cidal or static?
-dont take it with what drug?

-Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV.
-Bactericidal.
-Must not be taken with antacids.

59

If you're on antacids, which ABx should you NOT take?

Fluoroquinolones

60

nalidixic acid
-what is it?

a quinolone

61

Fluoroquinolones
-C/I in which pts?
-tox:
-mnemonic:

-children not done w/growth spurt, nursing mothers, pregnant women.
-Fluoroquinolones hurt attachments to your bones.
-tendonitis, tendon rupture, leg cramps, and myalgias.
-some prolong QT interval & can cause torsades bc they interefere w/ions like Calcium.

62

Which two ABxs can cause QT prolongation and possible torsades?
-which one more associated with this?

Macrolides & fluoroquinolones.
-macrolides.

63

Fluoroquinolones
-tendon rupture risk inc. w/concurrent use of what drug?

prednisone.

64

Metronidazole
-mech:

-Forms free radical toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.

65

Metronidazole
-targets?
-mnemonic?

GET GAP on the Metro
-giardiasis
-entamoeba histolytica
-trichomonas vaginalis
-gardnerella vaginalis
-anaerobes below diaphragm (C. dif, bacteroides).
-h. Pylori

66

Metronidazole
-tox:
-mnemonic:

-you're on a metal (metallic taset) metro-train and you get car sick (disulfiram).
-metallic taste, disulfiram like reaction.

67

M. avium–intracellulare
-Tx:

Azithromycin or clarithromycin + ethambutol.
*Can add rifabutin or ciprofloxacin.

68

M. leprae
-Tx:

Long-term treatment with dapsone and rifampin for tuberculoid form.
-Add clofazimine for lepromatous form.

69

M. tuberculosis
-prophylaxis?

isoniazid + B6

70

Isoniazid (INH)
-mech:
-what does it need to be activated?

-Inhibit synthesis of mycolic acids.
-Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.

71

Which TB med is a prodrug?
-what does it need to be activated?

-Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.
*pyrazinamide is also a prodrug.

72

Isoniazid (INH)
-how is it metabolized?
-whats special about this?
-what other drugs are metabolized this way?

-isoniazid, dapsone, hydralazine, procainamide = all metabolizes thru acetylation.
-slow/fast acetylators: can get bimodal distribution graph.

73

Isoniazid (INH)
-effect on P450 system:

Inhibitors P450 system.

74

Isoniazid (INH)
-tox:
-mnemonic:

INH Injures Neurons and Hepatocytes.
-Neurotoxicity, hepatotoxicity, drug-induced lupus.
-B6 def => peripheral neuropathy.

75

What type of anemia can isoniazid lead to?
-why?

-B6 deficiency.
-Can't build heme w/o B6. You'll get sideoblastic anemia. The RBCs will be made w/o Iron. So you will get inc. serum iron.

76

Rifamycins
-mech:

-Inhibits DNA-dependent RNA polymerase.

77

Rifamycins
-prophylaxis for which bugs?

H. influenza, N. meningitidis.

78

Rifamycins
-which two drugs?
-which one inc. P450?
-which one favored in HIV pts?

rifampni, rifabutin.
-rifampin ramps up P450, rifabutin does not.
-Rifabutin favored over rifampin in patients with HIV infection due to less cytochrome P-450 stimulation.

79

Pyrazinamide
-mech:

-acidify intracellular environment.
-Effective in acidic pH of phagolysosomes, where TB engulfed by macrophages is found.

80

Pyrazinamide
-tox:

Hyperuricemia, hepatotoxicity.

81

which TB drug can cause gout?

Pyrazinamide can cause hyperuricemia.

82

Ethambutol
-mech:

Inhibit carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase.
*like a beta-lactam but for TB cell wall.

83

Ethambutol
-tox:
-mnemonic:

Ethambutol sounds like ethanol. Arabs drink lots of ethanol. When you're hammered you cant see straight.
*Arabs dont celebrate christmas (no red/green).
-Optic neuropathy (red-green color blindness).

84

Endocarditis with surgical or dental procedures
-pophylaxis:

PCN

85

Meningococcal infection
-pophylaxis:

Ciprofloxacin (drug of choice), rifampin for children.

86

Pregnant woman carrying group B strep
-prophylaxis:

ampicillin.

87

Prevention of postsurgical infection due to S. aureus:

Cefazolin

88

Prophylaxis of strep pharyngitis in child with
prior rheumatic fever:

PCN

89

Syphilis
-prophylaxis

Benzathine penicillin G

90

pentamidine
-can treat what?

pneumocystis jirovecci

91

Which ABxs can treat MRSA?

-vancomycin
-daptomycin
-linezolid (can cause serotonin syndrome)
-tigecycline
-ceftaroline

92

Which ABxs can treat VRE?

-linezolid
-streptogramins (quinupristin/dalfopristin).

93

Daptomycin
-mech?
-targets?
-what inactivates it?

-Bacteriocidal against almost all gram (+) bacteria.
-creates transmembrane channels which disrupts the membrane. Fucks up the membrane potential. Leaking ions.
-inactivated by pulmonary surfactant, so cant treat pneumonias
-cant penetrate outer membrane, so cant treat gram negatives.

94

Daptomycin
-tox:

-Associated w/myopathy. CK levels checked periodically.

95

surfactant inactivates which ABx?

Daptomycin

96

linezolid
-mech:
-targets:

-bacteriostatic.
-inhibits protein synth by binding to 50S subunit.


97

linezolid
-tox:

-Occasionally linked to bone marrow suppression.
-neuritis.
-Can have MAO inhibitory actions as well, so watch out if you take it w/SSRI = could get serotonin syndrome.

98

wolff parkinsons white
-PR interval:
-QRS complex:
are they inc or dec?

-PR interval dec.
-QRS complex widened.

99

Brocas
-which lobe?

frontal lobe

100

beta-blocker OD
-tx?

glucagon
-by increasing cAMP.

101

isoproterenol
-whats it do?

nonspecific beta agonist.

102

How is digoxin cleared?

Renally.

103

sickle cell
-whats the substitution?

valine put in for glutamic acid at residue 6.

104

Hartnup disease
-whats the problem?

Deficiency in neutral AA absorption in kidney & gut.
-ie. tryptophan (which is used to make serotonin, niacin, & melatonin).
-results in B3 (niacin) deficiency => photosensitivity & pellagra like skin rashes.

105

tocopherol
-what is it?

vitamin E

106

tocotrienol
-what is it?

vitamin E

107

GLUT-2
-high or low Km?
-high or low capacity?
-which tissues?

-high Km
-high capacity
-liver, pancreatic B-cells, renal tubular cells, small intestine.

108

In which situation will you see acyclovir nephrotoxicity?

Young HSV-1 encephalitis pt hospitalized receiving IV acyclovir.

109

Which sexual development disorder can present w/virilization of the mother in utero?

aromatase deficiency.
*placenta has aromatase. Thats why a 21-hydroxylase def. or anything like that would not lead to maternal virizilation. The placental aromatase would handle those excess androgens.

110

Amphotericin B
-what do you have to supplement this drug with?

-Supplement K+ and Mg2+ because of altered renal tubule permeability.

111

Amphotericin B
-commonly used w/which other drug?

flucytosine

112

Amphotericin B
-tox?
-how to dull some of the toxic effects?

-Fever/chills, hypotension, nephrotoxicity, arrhythmias, IV phlebitis.
-suppression of EPO synth => anemia.
-Hydration dec.  nephrotoxicity.
-Liposomal amphotericin dec. toxicity.

113

Azoles
-mech:

-Inhibit 14–α–demethylase which converts lanosterol to ergosterol.
-its a P450 enzyme!

114

Azoles
-which is only azole that crosses BBB?

fluconazole

115

topical fungal infections
-which anti-fungals?

Clotrimazole and miconazole.
-aka clotrimin-ultra.

116

Azoles
-tox:

-Testosterone synthesis inhibition = a P450 enzyme makes testosterone.
-gynecomastia (esp. with ketoconazole)
-liver dysfunction = inhibits cytochrome P-450.

117

What other random drug had anti-androgen effects like the azoles?

spironolactone

118

How does ketoconazole produce anti-androgen effects?

Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis.
-will reduce androgens as well as cortisol.

119

How does spironolactone produce anti-androgen effects?

1)Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis.
-will reduce androgens as well as cortisol.
2)inhibits steroid binding.
3)inhibits 17alpha-hydroxlase.

120

How do spironolactone and ketoconazole lead to amenorrhea?

No androgens means no estrogens.
-no estrogen = no menses.

121

Flucytosine
-what is it?
-mech?

-Inhibits DNA and RNA biosynthesis => anti-fungal.
-converted to 5-FU by cytosine deaminase.
*5-FU inhibits thymidilate synthase.

122

Flucytosine
-use?

Systemic fungal infections (esp. meningitis caused by Cryptococcus) in combination with amphotericin B.

123

Echinocandins
-suffix?

-fungin.

124

Echinocandins
-mech?
-mnemonic:

Inhibits cell wall synthesis by inhibiting synthesis of β-glucan.
-echinocanDIN(ner) - ends w/GIN: Glucan INhibitor.

125

Echinocandins
-target?
-mnemonic:

-Invasive aspergillosis, Candida.
-C-AS-pofungin: C=candida, AS=aspergillosis.

126

Echinocandins
-tox:

GI upset, flushing (by histamine release).

127

Terbinafine
-mech:
-mnemonic:

-Inhibits the fungal enzyme squalene epoxidase. Part of ergosterol synth pathway.
"Use epoxy glue to fix the turbine. They were squeeking."

128

Terbinafine
-use:

Dermatophytoses (especially onychomycosis—fungal infection of finger or toe nails).

129

Terbinafine
-tox:
-mnemonic:

-hepatotoxicity, taste disturbance.
-think of turbines in nose and associate w/taste impairment

130

Griseofulvin
-mech:
-mnemonic:

Interferes with microtubule function. Deposits in keratin-containing tissues.
-Grease up the MTs.

131

Griseofulvin
-use:

Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm).

132

Griseofulvin
-tox:

Teratogenic, carcinogenic, confusion, headaches, inc. P-450 and warfarin metabolism.

133

Besides the azoles, which other antifungal inc. P450 system?

griseofulvin.
"greasy"