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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
Which carbapenem is given with CILASTATIN to inhibit its degradation in renal tubules?
Imipenem
26
When others fail, we get the job done! Talks about…
Carbapenems
27
Carbapenem administration and indications
IV Anaerobic intra-abdominal Pseudomonas Meningitis
28
Which resists broad-spectrum b-lactamases: monobactams or carbapenems?
Carbapenems
29
Dangerous carbapenem side effect
Lowers seizure threshold
30
Monobactam medication name
Aztreonam
31
Aztreonam administration and indications
IV or IM Gram - aerobic rods IF ALLERGIC TO PENICILLIN Pseudomonas Meningitis, pneumonia or sepsis UTIs
32
What type of drug is vancomycin?
Glucopeptide
33
Vancomycin MOA
Binds to D-alanine and transpeptidase can’t cut it B-lactamases are inefficient
34
Vancomycin administration and indications
IV Empiric for endocarditis****1st MRSA*****1st Meningitis with ceftriaxone S.epidermiditis
35
Which bacteria is resistant to vancomycin?
Enterococcus Turns D-ALA to D-LAC
36
ONLY oral administration of vancomycin is for:
C.difficile
37
4 vancomycin side effects
Red man sx: histamine Thrombophlebitis Oto/nephrotoxic DRESS sx: eosinophilia
38
It’s important to monitor plasma levels of:
Vancomycin
39
Daptomycin MOA
Insert lipid tail to depolarize cell wall
40
Daptomycin is used for (2):
Vancomycin-resistant enterococcus MRSA*****1st
41
Which antibiotic can’t be given in pneumonia because its inactivated by surfactant?
Daptomycin
42
Daptomycin main side effect
Myopathy Monitor creatinine phosphokinase (CPK)
43
1st gen cephalosporins
Cephalexin Cefazolin Cephalothine (Tip: all “ph” instead of “f”)
44
1st gen cephalosporin indications (4)
Gram + (strep or staph) - strep throat - cellulitis and abscess - PEK UTIs: proteus, e.coli, klebsiella - surgical prophylaxis
45
Which generation of cephalosporin is used for surgical preparation?
1st gen
46
Which cephalosporin is used for MRSA
5th gen - ceftaroline
47
Which cephalosporin is used for pseudomonas?
3rd: ceftazidime 4th: cefepime
48
2nd gen cephalosporins
Cefuroxime Cefoxitin Cefotetan
49
2nd gen cephalosporin uses
RARE HENS gram - : H.i, Neisseria, Serratia
50
3rd gen cephalosporins
Ceftriaxone Cefotaxime Ceftazidime
51
3rd gen cephalosporin uses
Meningitis H.i - triax, taxi Pseudomonas - tazi Viridans GI gram - Sepsis empiric Gonorrhea IM Lyme’s
52
What is ceftriaxone given in combination with to treat Listeria?
Ampicillin
53
Cephalosporins don’t work versus:
Enterococcus
54
4th gen cephalosporin and uses
Cefepime Pseudomonas Meningitis
55
5th gen cephalosporin and uses
Ceftaroline MRSA
56
Which drug does teicoplanin share mechanism with?
Vancomycin
57
Polymyxin B, what is it and uses
Concentration-dependent bactericidial Cation polypeptides bind gram - Pseudomonas, E.coli, Klebsiella, Acinetobacter, Enterobacter
58
Other name for polymyxin E
Colistin
59
Polymyxin B vs E
B: parenteral, ophthalmic, otic, topical E: prodrug, IV or nebulizer
60
2 classes of protein synthesis inhibitors + 6 subclasses
30S: - Tetracyclines - Aminoglycosides 50S: - Macrolides - Lincosamides (Clindamycin) - Cloramphenicol - Oxazolidone (Linezolid)
61
30S inhibitors and their mechanism
Tetracycline: no tRNA access to A site Aminoglycosides: irreversible binding —> misread
62
50S inhibitors and mechanism
Macrolides: inhibit A —> P translocation Lincosamides (clindamycin): inhibit A —> P translocation Chloramphenicol: bind to P site Oxazolidone (linezolid): inhibit 70S formation
63
Which antibiotic causes RNA misread and what is the result?
Aminoglycosides Bactericidial
64
Tetracyclin MOA and therefore resistance
Passive diffusion —> bacteria —> bind 30S —> prevent aminoacyl tRNA binding to A site Efflux pumps, mutations in ribosome
65
Antibiotic used mostly for infections acquired in the OUTDOORS
Tetracyclines
66
Tetracycline administration and indications
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
Tetracycline main side effect
Tooth discoloration (deposits there) Therefore, avoid in <8y/o and pregnant women Also: photosensitivity
68
Antibiotic class that has notable fecal excretion
Tetracyclines
69
Which antibiotic classes have decreased absorption by cations and milk? (2)
Tetracyclines Fluoroquinolones
70
Macrolide MOA and medication names
50S inhibit translocation from A site to P site Azithromycin Ezithromycin Clarythromycin
71
Macrolide administration and indications
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
Macrolide main side effects (4)
GI Jaundice - HEPATOTOXIC!! Prolonged QT Inhibit P450
73
Macrolides (inhibit/activate) P450.
Inhibit
74
Tigecyclin
Glycylcycline, binds to 30S like tetracycline but 3rd gen Skin, soft tissue, intra-abdominal Active even vs MRSA
75
Chloramphenicol indications
Meningitis in developing countries (cheapest) Rocky mountain spotted fever —> rickettsia —> In pregnancy, when doxicycline is not an option
76
Chloramphenicol side effects
Anemia - reversible or aplastic Gray baby sx (flacid, hypothermia, shock)
77
Clindamycin indications
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
Characteristic side effect of clindamycin
Diarrhea C.difficile pseudomembranous colitis
79
Linezolid indications
Gram + MRSA**** 1st line (Complicated skin/soft tissue) Serious HAP Vancomycin-resistant enterococcus
80
Linezolid main side effects (4)
Cytopenia Optic neuropathy Peripheral neuropathy Serotonin sx
81
ONLY protein synthesis inhibitor that is bactericidial
Aminoglycosides
82
Aminoglycosides MOA
30S irreversible binding —> misread —> death Can need cell wall inhibitor at the same time
83
Which cell wall inhibitors are given with aminoglycosides?
B-lactams Or vancomycin
84
Aminoglycosides indications
Gram - aerobic bacilli
85
Which medication is given before colorrectal surgery?
Neomycin (Aminoglycosides)
86
Which antibiotic can be given vs intraluminal parasites?
Paromomycin (Aminoglycosides)
87
Which aminoglycoside is given for tick Franciscella and Yersinia?
Streptomycin
88
Which a minoglycoside is given for enterobacter, Serratia, or Klebsiella?
Gentamicin
89
Gentamicin uses
- UTIs - Septicemia - Nosocomial RTI - Intra-abdominal - Osteomyelitis
90
Which aminoglycosides can be used versus pseudomonas? (3)
Genta Tobra Amikacin
91
Why is amikacin more expensive than other aminoglycosides?
Broad spectrum Resistant versus enzymes that break others down
92
Aminoglycosides main side effects (2)
OTOTOXICITY - Vestibular and cochlear - Teratogenic deafness - Irreversible NEPHROTOXICITY - Acute tubular necrosis - Increase creatinine (monitor) Other: neuromuscular block
93
Linezolid MOA
Binds to 23S of 50S —> inhibit 70S formation
94
SMX and TMP MOAs
SMX: PABA analogue that inhibits dihydropteroate synthase TMP: inhibits DHF reductase
95
TMP-SMX indications
***UTI***1st line Acute prostatitis ***Nocardia***1st line P.jirovecci pneumonia + prophylaxis in AIDS Note: PYR-SFD for toxoplasmosis prophylaxis in AIDS
96
TMP-SMX has many side effects, the most significant being (3):
Hypersensitivity Teratogenic Pancytopenia Displace drugs from albumin Inhibit P450 Hemolytic anemia
97
TMP-SMX (inhibits/activates) P450.
Inhibits
98
What antibiotic is most commonly given for burns?
Silver sulfadiazine Other: mafenide
99
Fluoroquinolones MOA
Inhibit topoisomerase II: cipro IV: moxi Levo both
100
Which fluoroquinolone is used for gram + and what is its MOA?
Moxifloxacin Inhibits topoisomerase IV
101
Which fluoroquinolone is used for gram - and what is its MOA?
Ciprofloxacine Inhibit topoisomerase II
102
Fluoroquinolones are empiric treatment for _____
Pyelonephritis
103
Ciprofloxacine/levo indications
UTI: E.coli, proteus GI: Shigella, salmonella, campylobacter Complicated UTI: pseudomonas Acute prostatitis Osteomyelitis if px has sickle cell
104
Moxifloxacin/levo indications
Bacillus anthracis pneumonia CAP Atypical pneumonia
105
Fluoroquinolone main side effect + 2 extras
Tendon and cartilage damage - don’t give to <10y/o or pregnant Prolonged QT —> torsades GI
106
Antimycobacterial dosing
4 for 2 mo. - RIPE Followed by 2 for 4 mo. - RI
107
Which antimycobacterial can be used on its own for latent TB?
Isoniazid
108
Isoniazid MOA
Activated by KatG (mutations decrease KatG) Inhibit mycolic acid synthesis
109
Why do 4 antimycobacterials have to be given together?
To avoid resistance
110
Isoniazid main side effects INH
Injury Nerves and Hepatocytes - CNS: seizures - PNS: neuropathy, paresthesias due to B6 defficiency - Metabolic acidosis - Inhibit P450 - Lupus
111
All antimycobacterials have this side effect
HEPATOTOXIC
112
Which vitamin should be given with isoniazid?
B6 / pyroxidine to avoid peripheral neuropathy
113
Which is the most potent antimycobacterial?
Rifampin
114
Rifampin MOA
Inhibit RNA polymerase (rpoB) if it mutates = resistance
115
Which of these induces and which inhibits P450? Isoniacid/rifampin
Induce: rifampin Inhibit: isoniacid
116
Rifampin can ONLY be given on its own in this disease
Meningitis PROPHYLAXIS
117
Characteristic rifampin side effect
Orange coloration of fluids - not damaging
118
Rifabutin is an alternative to ______ in the case of _____
Rifampin ; HIV
119
Ethambutol MOA
Inhibits arabinosyl transferase in WALL —> inhibit carbohydrate formation
120
Ethambutol side effect
Optic neuritis - Less visual acuity - Red-green color blindness
121
Pyrazinamide side effect
Hyperuricemia, needle shaped uric acid crystals Gout exacerbations
122
MAC treatment
Macrolide + ethambutol +- rifabutin Also for prophylaxis when CD4<50
123
M.leprae treatment
DAPSONE + rifampin Clofazime if lepromatous (lion-face)
124
Dapsone side effects
Agranulocytosis Hemolytic anemia
125
Rifamycins are excreted via:
Feces
126
First line treatment for N.meningiditis
Ceftriaxone
127
First line treatment for Bartonella “whooping cough”
Macrolides
128
First line treatment for P.jirovecci
Sulfonamides
129
Safe with renal impairment DANCER
Doxycycline Ampicillin Naficillin Ceftriaxone Erythromycin Rifampin
130
Nephrotoxic tu SUgar TE VA A BEsar (gracias lu)
SUlfonamides TEtracyclines VAncomycin Aminoglycosides BEta-lactams
131
Contraindicated in pregnancy MCAT
Metronidazole Chloramphenicol Aminoglycoside Tetracycline
132
Macrolides :)
ERika, CLAra, AZucena
133
Ototoxic
Aminoglycosides
134
Cardiotoxic
Macrolides
135
Drug-induced hemolytic anemia
3-5 cephalosporins Sulfonamides
136
NOT IN CHILDREN
Tetracyclines Fluoroquinolones
137
2nd line TB treatment (2 main)
Amikacin Streptomycin

Pharmacology (13 decks)

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