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