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Flashcards in Antibiotic drugs Deck (154):
1

drugs that block peptidoglycan synthesis

bacitracin, vancomycin

2

drugs that work by damaging DNA

metronidazole

3

Drugs that block 50S

Chloramphenicol, clindamycin, Linezolid
Erythromycin

Also streptogramins (-pristin)

4

cephalosporin, aztreonam, imipenem mechanism

block cell wall synthesis by inhibiting peptidoglycan cross linking

5

penicillin toxicity

allergy
hemolytic anemia

6

clinical use of penicillin

S pneumo
S pyogenes
actinomyces
(STREP is susceptible!)
Also neisseria meningitidis and syphilis

7

toxicity of oxacillin

hypersensitivity
interstitial nephritis

8

Ampicillin vs amoxicillin

amoxicillin has greater oral availability

9

amp/amoxicillin coverage

Hemophilus
E Coli
Listeria
Proteus
Salmonella
Shigella

HELPSS

10

Toxicity of ampicillin/amoxicillin

pseudomembranous colitis

11

Which bugs not covered by cephalosporins?

Listeria
Atypicals
MRSA
Enterococci

12

Ceftazidime

pseudomonas (3rd generation)

13

Cefazolin coverage

PEcK
Proteus
E coli
Klebsiella
Cefazolin

14

Ceftriaxone use

meningitis and gonorrhea

15

Additional coverage of 2nd generation cephalosporin (Cefoxitin)

H flu
Enterobacter
neisseria
Serratia

16

Toxicity of cephalosporins

Vitamin K deficiency
Increases toxicity of aminoglycosides on kidneys

17

aztreonam coverage

gram negatives

18

when do you use aztreonam?

For pts allergic to penicillin
For pts with renal insufficiency and can't take aminoglycosides

19

Mechanism aztreonam

Prevents peptidoglycan cross linking by binding to PBP3.

Resistant to beta lactamases

20

Imipenem mechanism

beta-lactamase resistant carbapenem

21

what do you administer with imipenem/meropenem?

ciastatin, an inhibitor of renal dehydropeptidase I which extends activation

22

coverage of imipenem/meropenem?

gram positive cocci
gram negative rods

23

Side effects of imipenem/meropenem

Seizure (but meropenem does NOT cause seizure)
GI, skin rash, CNS toxicity

24

Mechanism vanco

Inhibits peptidoglycan formation by binding D-Ala D Ala

25

resistance to vanco arises from

Changing Dala D ala to D Ala D lac

26

Toxicity of vanco

nephrotoxicity
ototoxicity
thrombophlebitis
RED MAN syndrome

27

How do you prevent red man syndrome

slow infusion rate
--Can also pre-treat with antihistamines

28

Indications for VANCO

enterococci
C Difficile

29

mech: AGs

inhibit formation of initiation complex and cause misreading of mRNA at 30S. Requires O2 for uptake

30

Tox of Ags

nephrotox
ototox
teratogen
neuromuscular blockade

31

AG resistance

transferase enzymes inactivate the drug by acetylation, phosphorylation, adenylation

32

Demeclocycline use

ADH antagonist. Used in SIADH

33

Doxy is okay to use in patients with

Renal failure

34

don't take tetracyclines with

milkd, antacids, iron preparation. Any divalent ions inhibit absorption

35

Tx for mycoplasma pneumoniae

azithromycin/levofloxacin

36

Tetracycline uses

lyme
rickettsia
chlamydia
mycoplasma pneumoniae
---DRUG ACCUMULATES INTRACELLULARLY

37

Tox: tetra

grey teeth
inhibition of bone growth
photosensitivity
DON"T use in pregnant women

38

Mech: erythromycin, azithromycin, clarithromycin

Bind to 23S rRNA of 50S subunit

39

Use: macrolides

Atypical pneumonias: mycoplasma, chlamydia, legionella
STDS (chlamydia)
gram positive cocci

40

side effect of macrolides

motility
Prolonged QT
acute cholestatic hepatitis
Rash
Eosinophilia

41

Resistance to macrolides

methylation of 23S rRNA binding site

42

Most protein synthesis inhibitor drugs are bacteriostatic EXCEPT for

aminoglycosides

43

Mechanism of chloramphenicol

Block of 50S ribosomal subunit peptidyltransferase

44

Tox of chloramphenicol

anemia
aplastic anemia
gray baby syndrome

45

Chloramphenicol use

meningitis from encapsulated organism (Strep, HiB, N men)

46

clinamycin mechanism

Blocks PEPTIDE TRANSFER

47

use: clinamycin

anaerobic infections and aspiration pneumonia. treats anerobes ABOVE the diaphragm

48

Sulfonamide mechanism

PABA antimetabolites inhibit dihydropteroate synthase in bacteria. Bacteriostatic

49

Clinical use of sulfonamides

Gram positive, gram negative, nocardia, chlamydia Good for UTI

50

Tox of sulfonamides

Hypersensitivity rxn, Hemolysis in G6PD individuals
nephrotoxicity
photosensitivity
kernicterus
displaces warfarin from albumin

51

Sulfonamide resistance comes from

altered enzyme decreased uptake or increased PABA synthesis

52

Bactrim is good for

UTIs, shigella, salmonella, PCP

53

Side effects of trimethoprim

megaloblastic anemia
leukopenia
granulocytopenia
May be helped by leucovorin rescue

54

Fluoroquinolones cannot be taken with

antacids

55

Toxicity of fluoroquinolones

GI upset
prolong QT interval
tendon rupture, myalgias especially in peeps takin prednisone

56

fluoroquinolones are contraindicated in

pregnant women and children. may damage cartilage

57

resistance to fluoroquinolones

efflux pumps
or mutation in DNA gyrase

58

Side effect of metro

disulfiram reaction with alcohol

59

Metro treats

giardia
entamoeba
trichomonas
gardnerella
anaerobes
H pylori

60

Tx; MAC

azithromycin
rifampin
ethambutol
streptomycin

Treat for 12 months with 2-3 of these

61

isoniazid mechanism

decreased synthesis of mycolic acids. Needs bacterial catalase peroxidase to convert INH to an active metabolite

62

why might you need to adjust the INH dosing?

Different INH half lives in fast vs slow acetylators

63

Tox of isoniazid

neurotoxicity
hepatotoxicity

64

how do you prevent isoniazid toxicity?

vitamin B6 (pyridoxine)

65

Rifampin mechanism

inhibits DNA-dependent RNA polymerase

66

The 4 R's of rifampin

RNA polymerase inhibitor
Revs up microsomal P450
Red body fluids
Rapid resistance if used alone

67

USe of rifampin prophylactically

Meningitis in kids
HiB

68

Tox of pyrazinamide

Unknown mechanism
--hyperuricemia
--hepatotoxicity

69

Etham butol mechanism

decreased carbohydrate polymerization of mycobacterium cell wall. Blocks arabinosyltransferase.

70

Ethambutol toxicity

optic neuropathy

71

prophylaxis of meningitis

ceftriaxone

72

prevention of gonococcal or chlamydial conjunctivits in a newborn

erythromycin

73

Prevention of postsurgical infection from S aureus

Cefazolin

74

Pregnant woman with GBS

ampicillin

75

Prevention of rheumatic fever

oral penicillin

76

Prevention of PCP and toxoplasma

Sulfa-TMP

77

Prevention of MAC

azithromycin

78

Treatment of VRE

Linezolid and streptogramins

79

streptogramins

quinupristin/dalfopristin

80

amphotericin binds

ergosterol

81

what do you need to supplement ampho B with?

K and Mg

82

Side effect of ampho

fever
hypotension
nephrotox
arrhythmias
anemia
IV phlebitis

83

Nystatin for

oral candidiasis or diaperrash/vaginal candida

84

Mech: azoles

inhibit ergosterol synthesis
--inhibits P-450 enzyme that converts lanosterol to ergosterol

85

Toxicity of zoles

gynecomastia
Inhibits P450

86

Itraconazole for

blastomyces, coccidioides, histoplasma

87

fluconazole for

chronic suppression of cryptococcal meningitis

88

clotrimazole and miconazole for

topical fungal infections

89

flucytosine mechanism

Inhibits DNA/RNA biosynthesis by conversion to 5 FU by cytosine deaminase

90

toxicity of flucytosine

bone marrow suppression

91

use: flucytosine

combo with ampho B for systemic fungal infections like cryptococcus

92

Caspofungin mechanism

inhibits cell wall synthesis of B glucan

93

Indications of caspofungin

invasive aspergillosis
candida

94

Side effect of caspofungin

GI upset and flushing

95

terbinafine used for

dermatophytoses like onychomycosis

96

Terbinafine tox

Abnormal LFTs and visual disturbances

97

Griseofulvin mechanism

Interferes with microtubule function, mitosis

98

Where does griseofulvin deposit

In nails and kertin tissues. used for dermatophytes like ring worm or tinea

99

Tox griseofulvin

Increase P450 and warfarin metabolism
Teratogen, carcinogen
headaches

100

Tx: leishmaniasis

sodium gluconate

101

Chloroquine mechanism

Blocks detoxification of heme into hemozoin. Then, the hem accumulates and becomes toxic to plasmodia

102

toxicity of chloroquine

retinopathy

103

use: chloroquine

Treatment of plasmodial species OTHER than P falciprum. Because resistance is really high in falciprum

104

In general, use praziquantel against

flukes

105

zanamivir, oseltamivir mechanism

inhibits influenza neuraminidase, decreasing release of progeny virus

106

Ribavirin mechanism

Inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase

107

Toxicity of ribavirin

Hemolytic anemia TERATOGEN

108

Acyclovir mechanism

activated by the HSV thymidine kinase. Works as guanosine analog=CHAIN TERMINATION

109

Rivavirin use:

RSV, chronic Hep C

110

Resistance to acyclovir

mutated viral thymidine kinase

111

Use: acyclovir

HSV and VZV

112

Tx of herpes zoster

famciclovir (shingles) Because acyclovir has NO effect on latent forms

113

Valacyclovir

like acyclovir but better oral availability

114

Ganciclovir used to treat

CMV

115

Mechanism ganciclovir

CMV viral kinase forms guanosine triphosphate from monophosphate.

Inhibits DNA polymerase

116

Valganciclovir

ganciclovir with better oral bioavailability

117

Tox: gangiclovir

leukopenia, neutropenia, thrombocytopenia, renal toxicity

118

Resistance of ganciclovir

Mutated CMV DNA polymerase or NO viral kinase

119

Foscarnet mechanism

Inhibits DNA polymerase
--binds pyrophosphate site of enzyme
--no activation by viral kinase NEEDED!!

120

Use: foscarnet

CMV retinitis in immunocompromised pts when ganciclovir fails
OR acyclovir resistant HSV

121

Tox of foscarnet

Nephrotoxicity

122

resistance foscarnet

mutated DNA poly

123

Cidofovir mechanism

like foscarnet. Inhibits DNA polymerase. No phosphorylation needed by viral kinase

124

Cidofovir indications

CMV retinitis in immunocompromised pts or acyclovir HSV

125

Cidofovir toxicity

Nephrotoxicity

126

how to reduce toxicity of cidofovir

give with probenecid and IV saline

127

Toxicity of protease inhibitors

hyperglycemia GI intolerance lipodystrophy

128

-inavir

protease inhibitor

129

Ritonavir uses

protease booster; inhibits P45-

130

tox of indinavir

nephropathy and hematuria

131

Mechanism NRTIs

lack a 3' OH group, inhibiting nucleotide binding to RT and terminates DNA

132

Name the NRTIs

-tenofovir
emtricitabine
-abacavir
-lamivudine
-zidovudine (AZT)
didanosine
stavudine

133

benefit of tenofovir

No need to be activated. a nucleotide, not a nucleoside

134

Zidovudine use

prophylaxis during pregnancy

135

toxicity of NRTIs

bone marrow suppression
peripheral neuropathy
lactic acidosis
anemia

136

Name the NNRTIs

nevirapine
efavirenz
delavirdine

137

what's different about NNRTIs

Do NOT require phosphorylation to be active or compete with nucleotides. They bind to the reverse transcriptase itself

138

Raltegravir

integrase inhibitor

139

Mechanism of raltegravir

blocks integrase

140

toxicity of raltegravir

hypercholesterolemia

141

Interferon drugs: mechanism?

Blocks replication of both RNA and DNA viruses

142

IFN a

chronic Hep B and C

143

IFN b

MS

144

IFN y

NADPH oxidase deficiency

145

toxicity of interferons

neutorpenia and myopathy

146

Drugs to avoid in pregnancy

SAFe Children Take Really Good Care
-sulfonamide
aminoglycoside
fluoroquinolone
clarithromycin
tetracycline
ribavirin
griseofulvin
chloramphenicol

147

sulfonamide in pregnancy

kernicterus

148

aminoglycoside in pregnancy

ototoxicity

149

fluoroquinolone in pregnancy

cartilage damage

150

clarithromycin in pregnancy

embryotoxin

151

tetracycline in pregnancy

discolored teeth, bone growth problem

152

griseofulvin in pregnancy

teratogen

153

ribavirin in pregnancy

teratogen

154

chloramphenicol in pregnancy

gray baby syndrome