Antimicrobial Flashcards

1
Q

Block Peptidoglycan Crosslinking

A
  • Penicilin, cephalosporin, azotreonam, imipenim

- Bind to PBP and prevent crosslinking

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2
Q

Block peptidoglycan Synthesis

A

Vancomycin

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3
Q

Block Nucleotide production

A
  • Trimethoprim blocks DHFR

- Sulfamethoxazole blocks PABA sythase

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4
Q

Block Topoisomerase

A

-Flouroquinolones

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5
Q

Block RNA polymerase

A

-Rifampin

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6
Q

Damage DNA

A

-Metronidazole

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7
Q

Block 50S ribosome

A
  • CELL

- Macrolides, Clindamycin, Chloramphenicol, Lincosamide, linzolid, streptogrammins

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8
Q

Block 30S

A

-Aminoglycosides and tetracyclines

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9
Q

Penicilin

A
  • Binds to PBP and prevents crosslinking
  • Effective against gram positive and some gram negative
  • Treponema, GAS, Strep Pneumo, Actinomyces
  • SE: Hapten mediated hypersensitivity (hemolysis)
  • Susceptible to beta lactamase
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10
Q

Methiciln, oxacilin etc

A
  • Bulky side group means lower risk of peniclinase
  • Used specifically for MSSA
  • Mutation in PBP
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11
Q

Ampicilin

A
  • INcreased effectivness against gram negatives
  • H Flu, Listeria, E Coli, Salmonella, SHhigella, etc
  • Give with clauvulonate to reduce beta lactamases
  • S/E: Pseudomembrane colitis
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12
Q

Piperacilin, ticracilin

A
  • Used for pseudomonas

- GIve with tazobactam a beta lactamase inhibitor

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13
Q

Beta Lactamase inhibitors

A

-Suicide inhibitors

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14
Q

Cephalosporins

A

-Beta lactams that are wider spectrum and less vulnerable to beta lactamases

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15
Q

Cefazolin (1st gen)

A

-Used as prophylaxis against MSSA and for surgical procedures

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16
Q

Cefoxitin

A

-INcreased use for H flu etc, replaced by 3rd gen

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17
Q

Ceftriaxonem ceftazadime

A
  • Used for NIsseria, and serious gram negative infections

- Crosses BBB and is part of meningitis prophylaxis

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18
Q

Cefepime 4th gen

A

-Used against pseudomonas

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19
Q

Ceftaroline

A

-Can be used for MRSA

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20
Q

Azotreonam

A
  • Gram negative rods only
  • Resistant to beta lactams
  • Given to pen allergic patietns who can’t take aminoglycosides because of renal failure
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21
Q

Imipenem/Cilastatin, meropenam

A
  • Wide spectrum and effective
  • Resistant to beta lactamases
  • Always give with cilastatin to prevent destruction in kidney
  • Usually saved for severe life thretening infections
  • Causes siezures and has seen limited use because of this
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22
Q

Vancomycin

A
  • Inhibits peptidoglycan synthesis
  • Gram positive only, MRSA or C Dif not given metronidazole
  • S/E: Oto and nephrotoxicity. Red mann’s syndrome (Avoid with anti-histamines), thrombophlebitis,
  • Resistance due to mutations of Ala-Ala to Ala-Lactate
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23
Q

Protein Synthesis Inhibitors

A
  • 30S are aminoglycosides and tetracyclines
  • 50s are Clindamycin, macrolides, chloramphenicol, linezolid, lincosamide, Streptogrammins (Dalfoprastone, quinipristin)
  • Majority of resistance is by acetylation or methylation of ribosomes
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24
Q

Aminoglycosides

A
  • Inhibit initation and cause misreading of early protein synthesis
  • Cidal and synergistic with beta lactams
  • Ototoxicity (worse with loop diuretics)
  • Nephrotoxicity (worse with cephalosporins)
  • Can also cause neuromuscular blockade and is a teratogen
  • Must be taken up with oxygen and are not effective agatinst anaerobes
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25
Tetracyclines
Bind to 30S and prevent attachment of aminoacyl tRNA - Static activity - Highly effective against bone and intracellular organisms because of tendency to accumulate intracellularl - Zoonotics, ricketsia, chlamydia, Borellia, etc - Cause discoloration and disformation of bones teratogen - Most cannot be given to renally impaired, but doxyxlycine can - Can't be taken with divalent cations or else absorption will be messed up - Photosensitivity is also a S/E - Resistance by efflux pumps
26
Macrolides
- Bind to 50s subunit and prevent translocation - Static - Used against atypical Pneumonias, STD's and gram positives that are allergic to penicilin - Motilin agonist causes GI problems including cholestatic hepatitis - Also inhibits P450s and can cause elevations in warfarin - Prolonged QT - Methylation of Ribosime is resistance
27
Chloramphenicol
- Binds 50s and prevents translocation - Rarely used because of risk of aplastic anemia and gray baby syndrome (decreased UDP gluconyrl transerase) - Used only as last resort against atypical meningitis - Resistance by acetylation
28
Clindaymycin
- Used against anaerobes only not active against aerobes - Used to treat infections above diaphragm, metronidazole below (oral infections and aspiration pneuonias) - Can cause pseudomembranous colitis
29
Sulfonamides
- Block Dihydroberopterin synthesis leading to decreased PABA, competitive inhibitors - Use is mainly for UTI's and PCP - PRevent Thymidine synthesis - Sulfa reactions, - Also displace bilirubin, warfarin etc from albumin and can cause kernicterus - Resistance by increasig PABA production
30
Trimethoprime
- Inhibits DHFR - Used for PCP etc - Can cause megaloblastic anemia and BM supression - Leucovarin can rescue
31
Flouroquinilones
- Inhibit toposimerase II and IV - Bacteriocidal activity - Absorption will be inhibited by divalent cations - Can cause tendonous rupture and impaired collagen synthesis in fetus
32
Metronidazole
- Generates free radicals that damage and destroy DNA - Bacteriocidal - Used for anaerobes and protozoal infections below diaphragm - Disulfaram reaction and metallic taste
33
TB Drugs
- MTB is RIPE - MAI is atypical pneumonia treated with azythromycin, prophylax once CD4 drops low - Leparae is Daptomycin, Rifampin, and clofroinox (guanosine)
34
INH
- Prevents synthesis of mycolic acids - Can be used alone as prophylaxis - Causes depletion of vitamin B6 - Neurotox (supplement B6 to minimize) - Hepatotox
35
Rifampin
- Inhibits RNA polymerase in bacteria - Not used as monotherapy for TB - Can be used to prophylax against H Flu and Meningitids - Causes red orange body fluids and reduces T1/2 of other drugs (increases P450s)
36
Pyrazinamide
- May cause acidity in phagolysosomes | - Minimal S/E with Hypeuricemia and hepatotox
37
Ethambutol
- Impairs arabinotransferase and inhibits sugar incorporation into wall - Caues red Green Color blindness
38
VRE
-Streptogrammins and linezolid
39
MRSA
-Vanco and ceftaroline
40
Amphoteracin B
- Binds ergosterol in membrane and creates pores causing cell death - Strong with severe painful chills and nephrotoxicity, give with Mg, K, and fludis to minimize kidney damage. - Doesn't cross BBB, give intrathecally
41
Azoles
- Prevent ergosterol synthesis P450 enzyme - Gynecomastia and inhibit steroid synthesis - Block P450 and increase drug concentraions of others - Prophylax in HIV
42
Nystatin
-Same as amphoteracin by applied topically
43
Flucytosine
- Converted to 5-FU intracellularly, strong and given for severe infections - Causes BM supression by inhibiting Thymidine synthesis at thymitidylate synthase
44
Caspofungin
- Inhibits D glucan insertion into cell wall | - Weaker and more mild
45
Terbenafine
- Squalene epoxidase inhibits | - Minimal S/E, can be used chronically for dermatophytes
46
Griseofulvin
- Inhibits MT polymerization - Activator of P450s - Teratogen, Carcinogen
47
Chloroquine
- Used for malaria, prevents heme breakdown to hemazolin and thus accumulates to toxic levels inside RBC and kills malaria - Give primaquine for ovale/vivax - Quinidine for serious infections - Resistance because of efflux pump - S/E: Retinopathy
48
Zanamavir, oseltamavir
-Inhibit viral neuraminidase and prevent release of Flu A and B
49
Ribairan
- Inhibits IMP dehydratase leading to decreaed guanine production and dereased synthesis - Paraflu, RSV, Hep C
50
IFN B
-MS
51
INF A
-Hep C, increase MHC, increase DNAase, decrease translation machinery
52
IFN gamma, IL-8
Increase intracellular killing by macrophages in CGD
53
Acyclovir
ACtivated by TK, inhibits viral DNA pol Minimal S/E -HSV and VZV
54
Ganciclovir
Activated by CMV kinase - Inhibits DNA pol - Nephrotoxicity and BM supression
55
Foscarnet
- Non kinase activated inhibitor of DNA pol - Nephrotox - Used in refractory cases
56
Cidofivir
- Non kinase activated inhibitor of DNA pol | - Nephrotoxicity, give with probenacid
57
HARRT
2 NTRIs and then 1 (NNTRI, Prtoease, or integrase inhibitor)
58
NTRI
Need to be phosphprylated to work (Except for tenofivir) -BM supression and nephrotoxicity Zidovudine can be used as prophylaxis to babies
59
NNTRI
Do not need to be phosphorylated and bind at different site than NTRI
60
Protease inhibtiors
- end in Navir | - Metabolic syndrome and lipdystrophy
61
Ralteravir
Integrase inhibitor | -S/E is hypercholesterolemia
62
Marivaroc
CCR5 inhibtitor