Antibacterial Flashcards
(176 cards)
1
Q
What is the mechanism of action of beta-lactam antibiotics?
A
Inhibits transpeptidation
2
Q
What is the mechanism of action of action of penicillin resistance in beta-lactams?
A
hydrolyze beta lactam ring by lactamases
3
Q
What is the mechanism of action of penicillin resistance of pseudomonas?
A
change in porin structure in outer cell wall
4
Q
What drug inhibits renal tubular reabsorption of penicillin?
A
probenecid
5
Q
What are examples of long acting intramuscular preparations of penicillin?
A
Benzathine Penicillin and Procained Penicillin
6
Q
What drug is given together with penicillin to exhibit an increased activity agains enterococci?
A
Aminoglycoside
7
Q
Drugs that are anti-staphylococcal?
A
Cloxacillin Oxacillin Nafcillin Dicloxacillin Methicillin
8
Q
Anti-staphylococcal drug that exhibits biliary clearance
A
Methicillin
9
Q
Penicillin that are resistant to beta lactamase inhbitiion
A
Isoxazoyl penicillin
Cloxacillin Oxacillin Nafcillin Dicloxacillin Methicillin
10
Q
An extended penicillin that can cause pseudomembranous colitis and rash
A
Ampicillin
11
Q
Extended penicillins that undergoes enterohepatic recirculation
A
Ampicillin
12
Q
Extended penicillin that is inactivated by beta-lactamase inhibitors
A
Ampicillin, Amoxicillin
13
Q
Drugs that are susceptible to extended spectrum penicillin
A
HELPS
Haemophilus influenzae Escherichia coli Listeria monocytogenes Proteus mirabilis Salmonella sp Enterococci
14
Q
Examples of antipseudomonal penicillins
A
- Carbenicillin
- Piperacillin
- Ticarcillin
15
Q
Penicillins with greater activity agains gram negative infections
A
- Carbenicillin
- Piperacillin
- Ticarcillin
16
Q
Penicillins that has a greater activity to pseudomonas, enterobacter and Klebsiella
A
- Carbenicillin
- Piperacillin
- Ticarcillin
17
Q
Examples of antipseudomonal penicillins that are inactivated by penicillinase
A
- Carbenicillin
- Piperacillin
- Ticarcillin
18
Q
These antipseudomonal penicillins has synergistic effect when combined with?
A
aminoglycosides
19
Q
Different diseases associated with pseudomonas?
A
Pneumonia Sepsis Ecthyma gangrenosus UTI DM Otitis externa Mucopolysaccharidoses - cystic fibrosis Osteomyelitis Nosocomial infections Skin Infection
20
Q
What are your first generation cephalosporins?
A
Cefadroxil Cefazolin Cephalothin Cephapirin Cepharadine Cephalexin
FADer, help me FAZ my PHarmacology boards
21
Q
Indications for 1st generation cephalosporin
A
- Surgical prophylaxis
- Bone infections
- Skin and soft tissue infections
- UTI
22
Q
Combining 1st generation cephalosporin and aminoglycosides can increase?
A
Nephrotoxicity
23
Q
First generation cephalosporins are effective against?
A
PEK
Proteus mirabilis
Escherichia coli
Klebsiella pneumoniae
24
Q
What are your second generation cephalosporins?
A
Cefamandole
Cefoxitin
Cefuroxime
Cefotetan
Foxy cousin wearing a Fur coat and drinking TEA
25
Second generation cephalosporins are effective agains what microorganisms?
Haemophilus
Proteus mirabilis
Escherichia coli
Klebsiella pneumoniae
26
This second generation cephalosporin has an improved action agains pneumococcos and H. influenza
Cefuroxime
27
This second generation cephalosporin has a good activity agains B. fragilis (used for abdominal and pelvic infections
Cefotetan and Cefoxitin
28
[What generation is this]
```
Cefaclor
Loracarbef
Cefprozil
Cefmetazole
Cefonicid
```
2nd generation
FAC LORA the PROfessional AZhOLE is still on the FONe
29
What are your third generation cephalosporins?
CefoTAXime
CefoPERAzone
CeftaziDIME
CefTIZOxime
CeFIXime
CefTRIAxone
```
Cefpodoxime proxetil
Cefnidir
Cefditoren pivoxil
Ceftibuten
Moxalactam
```
30
This generation of cephalosporin has a decreased gram positive coverage, and increased gram negative activity
Third generation
31
What cephalosporins are used for gonorrhea?
Ceftriaxone
| Cefixime
32
What generation of cephalosporins are useful for pseudomonas, bacteroides, providencia, serratia?
third generation
33
Which third generation cephalosporin have renal excretion?
Cefoperazone
| Ceftriaxone
34
Which third generation cephalosporin CANNOT cross the BBB
Cefoperazone
| Cefixime
35
Which third generation cephalosporin are the most active against penicillin-resistant S. pneumoniae
Ceftriaxine
| Cefotaxime
36
Which third generation cephalosporin are commonly used agains bacteroides?
Ceftizoxime
37
Which third generation cephalosporin has a good CNS penetration?
Ceftriaxone
38
What are your fourth generation cephalosporins?
Ceftaroline
Cefpiro
Cefepime
Taro, Piro, Fepi
39
These cephalosporins have a wide coverage against gram positive and gram negative bacteria
Third generation
40
What fourth generation cephalosporin can be used for MRSA
Ceftaroline
41
What are you anti-pseudomonal cephalosporins?
Ceftazidime
Cefepime
Cefoperazone
42
A novel cephalosporin, combined with tazobactam, used for the treatment of complicated urinary tract infections and itraabdominal infections
Ceftolozone
43
a carbapenem inhibits the renal metabolism of imipinem
cislastated
44
Which carbapenem has no activity agains pseudomonas and acinetobacter
Ertapenem
45
What renal enzyme metabolize imipenem?
dihydropeptidase
46
A monobactam used to treat Klebsiella, Pseudomonas, Serratia
Aztreonam
47
Which beta-lactamase inhibitor is not a good inhibitor of inducible chromosomal B lactamase (enterobacter, Pseudomonas, Serratia)
Sulbactam
48
Glycopeptides inhibit cell wall synthesis by binding to___
D-Ala-D-Ala terminus; prevents elongation and cross-linking
49
Which drug class will you use for drug-resistant, gram positive organisms?
Glycopeptide
50
What are your glycopeptide?
Vancomycin
Teicoplanin
Dalbavancin
Telavancin
51
How will you manage red man syndrome?
Slow the rate of infusion
52
Glycopeptides that are used for bacterial enterocolitis
Teicoplanin
Televancin
since they are not absorbed in the GIT
53
Among the glycopeptides, which has the longest half life?
Dalbavancin
54
What drugs are considered to be drugs of last resort?
```
Imipenem
Amikacin
Meropenem
Linezolid
Streptogramins
Vancomycin
```
55
___ is a peptide antibiotic that interferes with a late stage in cell wall synthesis in gram positive organism
bacitracin
56
___ blocks incorporation of D-ala into pentapeptide side chain of the peptidoglycan
cycloserine
57
An agent used as a second-line agent in TB
cycloserine
58
___ binds to the cell membrane causing depolarization and rapid cell death
daptomycin
59
Daptomycin cant be used against pneumonia since it is inactivated by ____
pulmonary surfactants
60
___ acts on the cell wall by inactivating UDP-N-acetyglucosamine-3-enol pyruvyltransferase thereby preventing formation of NAM
fosfomycin
61
A 50s protease inhibitor that is a backup drug for salmonella, Rickettsia and bacteroides
Chloramphenicol
62
a 50s protease inhibitor that can cause idiosyncratic aplastic anemia and gray baby syndrome
Chloramphenicol
63
Chloramphenicol is bactericidal to these microorganisms
1. H. influenza
2. Neisseria
3. Bacteroides
4. S. pneumoniae
64
Gray baby syndrome is due to a decrease in ____
hepatic glucoronyltransferase
65
What are the examaples of protein synthesis inhibitors?
```
Aminoglycoside
Tetracycyclines
Chloramphenicol
Erythromycin
Lincozamide
Linezolid
Streptogramins
```
66
A 50S inhibitor that can cross the placenta and BBB
Chloramphenicol
67
A 30s protease inhibitor that can be used in peptic ulcer disease
tetracycline
68
A 30s protease inhibitor that can be used in SIADH
Demeclocycline
69
A 30s protease inhibitor that can be used in bronchitis, chlamydia, Rickettsia
Doxycycline
70
A 30s protease inhibitor that can cause tooth enamel dysplasia
Tetracycline
71
A 30s protease inhibitor that can cause reversible vestibulotoxicity
minocycline
72
A 30s protease inhibitor that are considered divalent, concommitant milk intake is not advised
Tetracycline
73
A 30s protease inhibitor that is excreted via the bile
Doxycyline
74
What is the resistance mechanism of tetracycline?
1. development of efflux pumps for active extrusion of tetracycline
2. formation of ribosomal protection
75
A 50s protease inhibitor (macrolide) causes what ECG changes
QT prolongation
76
Which macrolide cannot inhibit CYP450
Azithromycin
77
What macrolide is used in rare fulminant hepatic failure?
Telithromycin
78
What macrolide has the highest Vd, slowest elimination
Azithomycin
79
What is the resistance mechanism for macrolides?
1. Efflux pumps
| 2. production of methylase enzyme
80
What are examples of lincosamides?
Clindamycin
81
A 50s binder used for endocarditis prophylaxis
Clindamycin
82
A 50s binder that can lead to pseudomembranous colitis
clindamycin
83
What is the mechanism of clindamycin resistance?
1. Methylation of binding sites
| 2. Enzymatic inactivation
84
Clindamycin is used for anaerobes ___ (above/below) the diaphragm
above
85
Metronidazole is used for anaerobes ___ (above/below) the diaphragm
below
86
What are examples of streptogramin?
Quinupristin-Dalfoprisin
87
A 50s subunit binder used to treat drug-resistant staphylococcus and E. faecium
Quinupristin-Dalfopristin
88
What are examples of your Oxazolidinone
Linezolid
| Tedizolid
89
What is the mechanism of action of you linezolid?
Binds to the 23S rRNA of 50s subunit
90
What will you give to treat drug-resistant Listeria, Corynebacterium?
Linezolid
91
Taking of linezolid and SSRIs can cause what syndrome
Serotonin Syndrome
92
What is the resistance pattern of linezolid?
decreased affinity of drug to binding site
93
Aminoglycosides exhibit these unique killing action
1. Concentration-dependent killing action
2. Time-dependent killing action
3. Post-antibiotic effect
94
What is the major mode of excretion of aminoglycosides?
renal excretion
95
Among the aminoglycosides, this has the narrowest therapeutic window
Amikacin
96
What ribosomal subunit dies aminoglycosides bind to?
30S
97
What is the mechanism of resistance of aminoglycosides
plasmid-mediated
98
Streptomycin resistance is due to?
changes in the ribosomal binding site
99
What are examples of aminoglycosides?
```
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
```
GNATS
100
What are the side effects of your aminoglycosides?
Nephrotoxicity
Ototoxicity
Teratogenicity
101
Aminoglycosides used for ocular infections
1. Tobramycin
| 2. Gentamicin
102
Aminoglycosides can cause irreversible ___
ototoxicity
103
Amikacin can be used for ____
1. Proteus
2. E. coli
3. Klebsiella
PEK
4. Enterics (Providencia, Pseudomonas, Serratia)
104
What aminoglycoside is used as second line drug for MDRTB
Amikacin
105
Aminoglycoside effective for bubonic plague
Streptomycin
106
Aminoglycoside effective for tularemia
Streptomycin
107
What aminoglycoside can cause congenital deafness
Streptomycin
108
Drug of choice used in elective bowel surgery
1. Neomycin
2. Kanamycin
3. Paromomycin
109
What is the drug of choice for Kala-azar?
Kala-azar = Visceral Leishmaniasis
Paromomycin
110
Aminoglycosides that cause neuromuscular blockade
1. Kanamycin
2. Neomycin
3. Paromomycin
111
How will you reverse the neuromuscular blockade caused by kanamycin, neomysin and paromomycin?
1. Calcium gluconate
| 2. Neostigmine
112
What is the drug of choice for drug-resistant gonorrhea?
Spectinomycin
Harvey specter
113
What is the drug of choice for patients with gonorrhea but are allergic to penicillin?
Spectinomycin
Can cause anemia
114
This amonoglycoside has no cross resistance to other anti-gonorrheal drug
Spectinomycin
Can cause anemia
115
This amonoglycoside has no cross resistance to other anti-gonorrheal drug
Spectinomycin
Can cause anemia
116
Among the aminoglycosides, which is the most ototoxic?
1. Kanamycin
| 2. Amikacin
117
Among the aminoglycosides, which is the most vestibulotoxic?
1. Tobramycin
| 2. Gentamicin
118
Among the aminoglycosides, which is the most nephrotoxic?
1. Tobramycin
| 2. Gentamicin
119
Among the aminoglycosides, that can usually cause skin reactions?
1. Neomycin
| 2. Streptomycin
120
A protease inhibitor that inhibits the protein translocation used as topical agent against S. aureus
Fusidic acid
121
____ are weakly acidic compounds that have a common chemical nucleus resembling PABA
sulfonamides
122
What are your short acting sulfonamides
1. Sulfacytine
2. Sulfisoxazole
3. Sulfamethizole
Site, Socks, Methi
123
What are your intermediate acting sulfonamides
1. Sulfadiazine
2. Sulfamethoxazole
3. Sulfapyridine
Azine, metho, fire
124
What are you long acting sulfonamides?
Sulfadoxine
125
Antifolate drug structurally similar to folic acid; weak base that is trapped in acidic environment
Trimethoprim
126
Trimethoprim reaches high concentrations in these bodily fluids
1. Prostatic fluids
| 2. Vaginal fluids
127
Sulfonamides are bacteriostatic inhibitors of folic acid synthesis. It competitively inhibits what enzyme
dihydropteroate synthase
128
___ are selective inhibitor of bacterial dihydrofolate reductase
Trimethoprim
129
Combination of TMP-SMX is ___ bactericidal/bacteriostatic?
bactericidal
130
___drug competes with PABA
sulfonamides
131
Resistance to TMP-SMX is due to?
plasmid-mediated
132
A sulfonamide used in burn infection that can cause metabolic acidosis and can penetrate eschar
Mefenide acetate
133
A sulfonamide used to treat P. jirovecii
Co-trimoxazole
134
What is the ration of TMP-SMX in co-trimoxazole?
1:5
135
Sulfonamide used only for lower UTI
Sulfisoxazole
136
What is the DOC for toxoplasmosis?
Sulfadiazine-Pyrimethamine
137
What sulfonamide is the 2nd line for malaria?
Sulfadoxine-Pyrimethamine
138
Sulfonamide that is co-administered with leucovorin to limit bone marrow toxicity
Pyrimethamine
139
Sulfonamide can displace protein binding affecting levels of these drugs?
1. Warfarin
| 2. Methotrexate
140
DNA gyrase (Topoisomerase II) in gram negative organism prevents what in the DNA
prevents relaxation of supercoiled DNA
141
Topoisomerase IV in gram positive bacteria interferese with
separation of replicated chromosomal DNA during cell division
142
What are the resistance pattern of fluoroquinolones?
1. Efflux pump
2. Porin structure
3. changes the sensitivity of the target enzyme via point mutation
143
What are example of your first generation fluoroquinolones?
1. Nalidixic acid
2. Oxolinic acid
3. Cinoxacin
4. Rosoxacin
144
What are example of your second generation fluoroquinolones?
1. Ciprofloxacin
2. Ofloxacin
3. Norfloxacin
4. Lomefloxacin
5. Enoxacin
145
What are example of your third generation fluoroquinolones?
1. Levofloxacin
2. Gemflixacin
3. Moxifloxacin
4. Sparfloxacon
5. Grepafloxacin
6. Gatifloxacin
7. Pazufloxacin
8. Tosufloxacon
9. Balofloxacin
146
What are example of your fourth generation fluoroquinolones?
1. Trovafloxacin
2. Alatrofloxacin
3. Prulifloxacin
4. Clinafloxacin
147
[What generation of FQ]
Urinary tract infections
1st generation
148
[What generation of FQ]
gram negative, gonococci, mycoplasma
2rd generation
149
[What generation of FQ]
gram positives, stretococci, enterococci
3rd generation
150
[What generation of FQ]
broad specturm, anaerobes
4th generation
151
2nd generation FQ used as 2nd line drug for TB
Ciprofloxacin
152
Intake of this anti-asthmatic drug enhances the toxicity of 2nd generation FQ
methylxanthinse (theophylline)
153
FQ that does not compete with probenecid
Moxifloxacin
154
3rd generation FQ used as 2nd line treatment for TB
Levofloxacin
155
What is the mode of clearance for moxifloxacin>
hepatic
156
3rd generation FQ used to treat C. trachomatis
Ofloxacin
157
What generation of FQ is also called respiratory quinolones
third generation
158
Levofloxacin can be used in CAP that is caused by
1. Chlamydia
2. Mycoplasma
3. Legionella
159
Third generation FQ that can cause QT prolongation
1. Levofloxacin
2. Gemfloxacon
3. Moxifloxacin
160
Third generation FQ that can cause hyperglycemia in DM patients
Gatifloxacon
161
Metronidazole belongs to what class of drugs
1. Nitroimidazole
| 2. Antiprotozoal
162
What is the MOA of metronidazole?
Reactive reduction by ferredoxin forming free radicals that disrupt ETC
163
What is the DOC for amebiasis and giardiasis?
metronidazole
164
Used to treat Trichomonas and Garnerella
metronidazole
165
This forms reactive intermediate when acted upon by bacterial nitrofuran reductase
Nitrofurantoin
166
nitrofurantoin can be used in UTI except if it is caused by what organisms?
1. Proteus
| 2. Pseudomonas
167
___ inhibits staphylococcal isoleucyl tRNA synthetase
mupirocin
168
topical DOC for impetigo
mupirocin
169
__ are cationic detergents that disrupt bacterial cell membrane, bind and inactivate endotoxin
polymixin
170
Polymixin is used are salvage therapy of these organisms
1. Acinetobacter
2. Enterobacteriacease
3. Pseudomonas
171
These organism are resistant to polymixin
1. Proteus
| 2. Neisseria
172
____ binds to the sigma subunit of RNA polymerase
Fidaxomycin
173
DOC for C. difficile colitis in adults
Fidaxomicin
174
What is the outpatient regimen of PID?
1. Ceftriaxine 250mgIM
2. Doxycyclin 100 mg BID PO x14
3. Metronidazole 500mg PO BID for 14 days
175
What is the regimen A for parenteral treatment of PID
1. Cefotetan 2g IV q12h or Cefoxitin 2g IV q6h
PLUS
2. Doxycycline 100mg IV PO q12h
176
What is the regimen B for parenteral treatment of PID
1. Clindamycin 900mg IV q8h
| 2. Gentamicin LD 2mg/kg then maintainance dose 1.5mg/kg q8h
