- pregnancy - nursing mothers - children

"TEaRs" holes in fungal membrane by forming pores = leakage of electrolytes. - binds ergosterol (unique to fungi)

Antimicrobial Tx Flashcards by Erica Strandberg

Bacterial meningitis empiric tx (unknown organism/pre-culture results)

Vancomycin + ceftriaxone/cefotaxime (IV)

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Vancomycin adverse rxns

“The “red man” life is NOT trouble free”
Nephrotoxicity
Ototoxicity
Thrombophlebitis
“red man syndrome” - hypotension, diffuse flushing, erythematous rash on head and neck -

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Tx for “red man syndrome” assoc. with Vanc

slow infusion rate + antihistamines

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Vanc MOA

Inhibits cell wall peptidoglycan formation by binding D-ala D-ala precursors (G+ organisms only)

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Vanc MOR

VanA gene - encodes for amino acid modification of D-ala D-ala to D-ala D-lac

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S. pneumoniae tx (pneumonia/systemic infection)

Penicillin/cephalosporin

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S. pneumoniae meningitis tx - organism susceptible to PCN

Ampicilin or ceftriaxone/cefotaxime

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S. pnumoniae meningitis tx - organism resistant to PCN, susceptible to cephalosporins

ceftriaxone/cefotaxime

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S. pneumoniae meningitis tx - organism resistant to PCN AND cephalosporins

IV vancomycin x 10-14 days

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M. leprae - lepromatous leprae

Dapsone
Rifampin
Clofazimine

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M. leprae - tuberculoid type

Dapsone

2. Rifampin

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Proteus mirabilis

Fluoroquinolones - e.g. Ciprofloxacin

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Fluoroquinolone MOA

Inhibit DNA topoisomerase II (DNA gyrase) and IV

Do NOT take with antacids!

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Fluoroquinolones (floxacins/enoxacins) - clinical use

G- rods of GI/Urinary Tract:
Psuedomonas
Neisseria
Proteus mirabilis

Some G+ organisms

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Fluoroquinolone CI’s

pregnancy
nursing mothers
children

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Fluoroquinolone adverse rxns

“FluoroquinolONES hurt attachments to your bONES”

(e. g. levaquin)
- Cartilage damage in children 60 years or pts taking prednisone.

leg cramps
myalgias
SUPERINFECTIONS (C.diff)
skin rash
HA/dizziness
GI upset

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Fluoroquinolones

floxacins: e.g. ciproflocacin, levofloxacin

+ enoxacin

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Cryptococcal meningitis (AIDS pts - serious infection)

Amphotericin B w/ or w/o flucytosine

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Amphotericin B MOA

“TEaRs” holes in fungal membrane by forming pores = leakage of electrolytes.

binds ergosterol (unique to fungi)

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Sporothrix shenkii (Sporotrichosis) Tx

Itraconazole

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Sporothrix shenkii (Sporotrichosis) 
"rose garden disease"

Dimorphic cigar-shaped budding yeast
Grows in branching hyphae with rosettes of conidia
Lives on vegetation
Introduced traumatically e.g. by a thorn

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Drugs associated with disulfiram reaction

Metronidazole
(some) cephalosporins
griseofulvin
procarbazine
1st gen sulfonylureas

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Giardia tx

Metro

Quinacrine (if can’t tolerate metro) - but not available in US?

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Chlamydia histo findings

**non-staining (intracellular) - Gram - bacteria, elementary and reticulate bodies

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Chlamydia (no co-infection) tx

Doxycycline (unless pregnant = azithromycin)

Schistosomiasis (e.g. S.hematobium) tx

Praziquantel

E.Coli UTI tx

Amoxicillin

Isoniazid AE's

"INH "I"njures "N"eurons and "H"epatocytes" - Hepatotoxicity = spotty necrosis ("balooning degeneration with numerous eosinophils") or fulminant liver failure. (d/t covalent boding to hepatocytes=actin/mitochondrial disruption) - P-450 inhibition - Drug-induced SLE - Vitamin B6 deficiency(**peripheral neuropathy, sideroblastic anemia) **Administer with pyridoxine (B6)

Isoniazid MOA

Decreased synthesis of mycolic acids Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.

TB prophylaxis

Isoniazid (supplement B6)

Latent TB tx

Isoniazid (supplement B6)

Active TB tx

RIPE = Rifampin + Isoniazid + Pyrazinamide + Ethambutol x 2 weeks, then: RI x 4 weeks

M.avium - intracellulare prophylaxis

Azithromycin + rifabutin

M.avium tx

More drug resistant than M tuberculosis. Azithromycin or clarithromycin + ethambutol. Can add rifabutin or ciprofloxacin.

M.leprae prophylaxis

NONE!

M.leprae tx

Tuberculoid form: Long-term with Dapsone + Rifampin Lepromatous form: Dapsone + Rifampin + Clofazimine

Rifampin MOA

Inhibits DNA-dependent RNA polymerase | = stops mRNA synthesis

H. influenzae type B meningitis prophylaxis (contacts of infected children)

Rifampin

Rifamycin AE's

"Rifampin "ramps up" CP450, "but" Rifabutin does not" Rifampin’s 4 R’s: 1. RNA polymerase inhibitor 2. Ramps up microsomal cytochrome P-450 (minor hepatotoxicity and drug interactions) 3. Red/orange body fluids (non-hazardous) 4. Rapid resistance if used alone (d/t mutations that reduced drug binding to RNA polymerase) **monitor liver fn for hepatotoxicity Rifabutin favored over rifampin in patients with HIV infection due to less cytochrome P-450 stimulation.

Rifampin purpose in M.leprae tx

Delays resistance to Dapsone

Isoniazid MOR

Mutations leading to underexpression of KatG

Pyrazinamide AE's

- **Hyperuricemia | - Hepatotoxicity

Ethambutol AE's

``` ""EYE"thambutol" Optic neuropathy (red-green color blindness) ```

Ethambutol MOA

Decreases carbohydrate polymerization of mycobacterium cell wall by blocking *arabinosyltransferase*

Streptomycin Clinical Use

M.tuberculosis (2nd line)

Streptomycin (aminoglycoside) AE's

Ototoxicity (Tinnitus,Vertigo,Ataxia) | Nephrotoxicity

Pyrazinamide MOA

Prodrug that is converted to the active compound **pyrazinoic acid. Works best at acidic pH (eg, in host phagolysosomes)

Streptomycin MOA

Interferes with 30S component of ribosome (aminoglycoside)

-azole

Ergosterol synthesis inhibitor

-bendazole

Antiparasitic/antihelmithic

-cillin

Peptidoglycan cross-linking inhibitor

Chlamydia/Gonorrhea Co-Infection tx

Doxy + Ceftriaxone

C. diff tx

Oral metronidazole

C.diff (refractory) tx

ORAL vancomycin

C.botulinum, C.tetani tx

Antitoxin

CMV tx

Ganciclovir, foscarnet, cidofovir

Initial empiric tx for Sickle Cell + osteomyelitis

Need to cover G+ and G- organisms (S.aureus and Salmonella) | = Ciprofloxacin (fluoroquinolone for Salmonella) + Vancomycin (S.aureus and MRSA)

MCC osteomyelitis (overall)

S.aureus

MCC osteomyelitis IVDU

Pseudomonas, candida, S. aureus

C.tetani exotoxin

Tetanospasmin - protease

C.tetani toxin MOA

Cleaves SNARE proteins = decreased release of GABA and glycine (inhibitory NT's)

S. pyogenes exotoxin MOA

Binds IgM and C3b = blocks phagocytosis

S. aureus TSST-1 MOA

Binds MHC-II and T-cell receptor outside of peptide groove, leads to NONSPECIFIC, LARGE number of activated T-cells releasing cytokines

C.botulinum exotoxin MOA

Cleaves SNARE proteins = decreased release of ACh (excitatory NT's)

C. botulinum paralysis

Descending paralysis

Bendazole MOA

inhibits microtubule formation

Hookworm (N. americanus, A.duodenale) tx

Bendazoles or Pyrantel Pamoate

Antimicrobial Tx Flashcards

(67 cards)