Antimicrobials Flashcards
(150 cards)
1
Q
How to administer Penicillin G?
A
IV and IM
2
Q
How to administer Penicillin V?
A
oral
3
Q
MoA of Penicillin G, V
A
Bind penicillin-binding proteins (transpeptidase)
Block transpeptidase cross-linking of peptidoglycan
Activate autolytic enzymes
4
Q
Toxiticty of Penicillin G & V
A
Hypersensitivity rxn, hemolytic anemia
5
Q
Ampicillin and Amoxicillin used to treat:
A
H. influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, entercocci
6
Q
Ampicillin and Amoxicillin Toxicity
A
Hypersensitivity rxn, Rash, Pseudomembranous colitis
7
Q
Penicillinase-resistant penicillins
A
Oxacillin, Nafcillin, Dicloxacillin - because bulky R group blocks access of beta-lactamase to beta-lactam ring
8
Q
How to treat S. aureus but not MRSA
A
Oxacillin, Nafcillin, Dicloxacillin
9
Q
Toxicity of Oxacillin, Nafcillin, Dicloxacillin
A
Hypersensitivity rxn and interstitial nephritis
10
Q
Antipseudomonals
A
Ticarcillin, Piperacillin
11
Q
Beta-lactamase inhibitors
A
Clavulanic Acid, Sulbactam, Tazobactam (CAST)
12
Q
MoA of Cephalosporins
A
Inhibit cell wall synthesis, bactericidal
13
Q
First Generation Cephalosporin
A
Cefazolin and Cephalexin
against gram positive cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae
14
Q
Drug used prior to Sx to prevent S. aureus wound infections.
A
Cefazolin
15
Q
2nd Generation Cephalosporin
A
Cefoxitin, Cefaclor, Cefuroxime
Gram positive cocci, H. infleunza, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumonia, Serratia marcescens
16
Q
3rd Generation Cephalosporin
A
Ceftriaxone, Cefotaxime, Ceftazidine
17
Q
Tx for meningitis and gonorrhea
A
Ceftriaxone
18
Q
Tx for Pseudomonas
A
Ceftazidime
19
Q
4th Generation Cephalosporin
A
Cefepime, increase activity against Pseudomonas and gram positive organism
20
Q
5th Generation Cephalosporin
A
Ceftaroline
21
Q
Toxicities for Cephalosporins
A
Hypersensitivity reactions, Vitamin K deficiency, increased nephrotoxicities of aminoglycosides
22
Q
Clinical Use for Aztreonam
A
Gram negative rods only
for penicillin-Ax pts and those with renal insufficiency
23
Q
MoA of Carbapenems
A
Broad-spectrum, beta-lacatmase resistant
Administer with cilastatin to decreased inactivation of drug in renal tubules
24
Q
Toxicities of Carbapenems
A
GI distress, skin rash, and CNS toxicity (seizures) at hgih plasma levels
25
MoA of vancomycin
inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors
26
Used to Tx MRSA and C. diff
Vancomycin
27
Red Man Syndrome
Caused by Vancomycin, prevent with pretreatment with antihistamines) - nephrotoxicity, ototoxicity, thrombophlebitis and diffuse flushing
28
30S inhibitors
Aminoglycosides (bactericidal)
| Tetracycline (bacteriostatic)
29
50S inhibitors
Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid
30
Aminoglycosides
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
31
Mechanism of Aminoglycosides
bactericidal, inhibit formation of initiation complex and cause misreading of mRNA.
Block translocation
Require O2 for uptake
32
Toxicity of Aminoglycosides
Nephrotoxicity, Neuromuscular blockade, Ototoxicity, Teratogen
33
MoA of Tetracyclines
Binds 30S and prevent attachment of aminoacyl-tRNA, limited CNS penetration
34
How Doxycycline is eliminated
Fecally, thus can be used in patients with renal failure
35
What can't you eat with Tetracyclines
calcium, antacids or iron-containing preparations because of divalent cations
36
This drug is able to accumulate intracellularly therefore kills Chlamydia and Rickettsia
Tetracyclines
37
Toxicity of Tetracyclines
discolors teeth and inhibits bone growth in children, photosensitivity
38
Macrolides
Azithromycin, Clarithromycin, Erythromycin
39
MoA of Macrolides
Iinhibit protein synthesis by blocking translocation
Binds 23S of rRNA of the 50S ribosomal subunit
Bacteriostatic
40
Toxicity of Macrolides
GI motility, Arrhythmia from porlonged QT, acute Cholestatic Hepatitis, Rash, Eosinophilia
41
Blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic
Chloramphenicol
42
Mechanism of resistance is plasmid-encoded acetyltransferase inactivates this drug.
Chloramphenicol
43
Toxicity is Chloramphenicol
Anemia (dose dependent), Aplastic Anemia, Gray Baby Syndrome (in premature infants because they lack liver UDP-glucuronyl transferase)
44
Causes Pseudomembranous colitis
Clindamycin
45
Treats anaerobes above the diaphragm
Clindamycin
46
Treats anaerobes below the diaphragm
Metronidazole
47
If a bacteria methylate 23S rRNA binding site, it prevents this set of drugs from working
Macrolides (end in -mycin)
48
If bacteria have a plasmid-encoded pumps to decrease uptake or increase efflux, it preventsthis set of drugs from working
Tetracyclines (including doxycycline and minocycline)
49
MoA of Sulfonamides
Inhibit folate synthesis. PABA antimetabolites inhibit dihydropteroate synthase.
50
Hemolysis if G6PD deficient from this drug
Sulfonamides
51
This drug could cause nephrotoxicity (tubulointerstitial nephritis)
Sulfonamides
52
MoA of Trimethoprim (TMP)
Inhibits bacterial dihydrofolate reductase
53
TMP-SMX Used for
UTIs, Shigella, Salmonella, Pneumocystis jirovecii, toxoplasmosis prophylaxis
54
Toxicity from Trimethoprim
Megaloblastic Anemia, Leukopenia, Granulocytopenia
55
Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV.
Fluoroquinolones (end in -floxacin)
56
Drug that can cause tendonitis, tendon rupture, leg cramps, and myalgias.
Fluoroquinolones (end in -floxacin)
57
Reason not to use Fluorquinolones in Pregnant, Nursing mothers and children <18years old
Damages cartilage
58
This drug with my resistant if the bacteria gets a chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps.
Fluoroquinolones
59
MoA of Metronidazole
Forms free radical metabolites in bacteria cell that damage DNA
60
Triple Therapy for H. pylori
PPI, Clarithromycin, Metronidazole
61
Patient drinks alcohol with the drug and it causes sveer flushing, tachy cardia, hypotension
Metronidazole causing a Disulfram-like reaction
62
Tx of M. tuberculosis
RIPE
| Rifampin, Isoniazid, Pyrazinamide, Ethambutol
63
Tx for MAC
Azithromycin or Clarithromycin + Ethambutol
| can add rifabutin or ciprofloxacin
64
Prophylaxis for MAC
Azithromycin, Rifabutin
65
Long Term treatment for M. leprae
Dapsone and Rifampin for tuberculoid form
| Add clofazimine for lepromatous form
66
Decrease mycolic acid synthesis
Isoniazid
67
What enzyme is needed for Isoniazid to work?
Bacterial catalase-peroxidase encoded by KatG
68
Toxicity of Isoniazid
Neurotoxicity, Hepatotoxicity
69
What is needed to prevent neurotoxicity, lupus when taking Isoniazid.
Pyridoxine (Vit B6)
70
Inhibits DNA-dependent RNA polymerase
Rifamycins like Rifampin & Rifabutin
71
Which Rifamycin is prefered in HIV patients?
Rifabutin because less effect on P450
72
Side effect of Rifampin
Orange Urine and Sweat
73
Toxicity of Pyrazinamide
Hyperuricemia and Hepatotoxicity
74
MoA of Ethambutol
decrease carbohydrate polymerization by blocking arabinosyltransferase
75
Causes Optic Neuropathy (red-green colorblindness)
Ethambutol
76
Medication you give to prevent endocarditis with surgery of dental procedures
Penicillins
77
Tx for Gonorrhea
Ceftriaxone
78
Hx of recurrent UTIs
TMP-SMX
79
Pregnant Woman Carrying Group Strep B
Ampicillin
80
Prevention of Post-Sx infection due to S. aureus
Cefazolin
81
Prophylaxis of Strep pharyngitis in child with prior rheumatic fever
Oral penicillin
82
Syphilis
Benzathine penicillin G
83
Prevention of gonococcal or Chlamydial conjunctivitis in newborn
erythromycin ointment
84
medicine you give when CD4 <200cells/mm^3
TMP-SMX to prevent pneumocystis pneumonia
85
medicine you give when CD4 <100cells/mm^3
TMP-SMX to prevent pneumocystic pneumonia and toxoplasmosis
86
medicine you give when CD4 <50cells/mm^3
mycobacterium avium complex
87
Tx for MRSA
vancomycin, daptomycin, linezolid (can cause serotonin syndrome), tigecycline, ceftaroline
88
Tx for VRE
linezolid and streptogramins (quinupristin/dalfopristin)
89
MoA of Amphotericin B
Binds ergosterol; forms membrane pores that allow leakage of electrolytes
90
What you need to supplement with Amphotericin B
Potassium and Magnesium
91
Organ primarily affected by Amphotericin B
Kidneys
92
Tx of Oral Thrush
Nystatin
93
Prevents the conversion of lanosterol to ergosterol by inhibiting P450
Azoles
94
Toxicity of Azoles
inhibits testosterone (gynecomastia, esp with ketoconazole), liver dysfunction (inhibits P450)
95
Used with amphotericin B to stop systemic fungal infections
Flucytosine
96
MoA of Flucytosine
inhibits DNA and RNA biosynthesis by conversio to 5-fluorouracil by cytosine deaminase
97
Toxicity of Flucytosine
Bone Marrow Suppression
98
Used for invasive aspergillosis and Candida
Echinocandins (ends in -fungin)
99
Inhibits fungal enzyme squalene epoxidase
Terbinafine
100
Clinical use of terbinafine
Dermatophtoses esp onychomycosis
101
Toxicity of Terbinafine
GI upset, HA, hepatotoxicity, taste disturbance
102
Oral Tx of superficial infections, inhibits growth of dermatophytes (tinea, ringworm)
Griseofulvin
103
MoA of Griseofulvin
interferes with icrotubule fucntino thus disrupting mitosis. Deposits in keratin areas like nails
104
Tx of T. cruzi
Nifurtimox
105
Tx of Leishmaniasis
Sodium Stibogluconate
106
Tx for T. brucei
suramin and melarsorprol
107
MoA or Chloroquine
Blocks detoxification of heme into hemozoin. Heme accumulates and us toxuc to plasmodia
108
Toxicity of Chloroquine
retinopathy, pruritis (esp if dark skinned)
109
Tx of Schistosoma
Praziquantal
110
Inhibits influenza neuramindase to decreased the release of progeny virus
Zanamivir, Oseltamivir
111
Tx of RSV and chronic HepC
Ribivirin
112
MoA of Ribavirin
Inhibits synthesis of guanine nucleotides, competitively inhibits IMP dehydrogenase
113
Toxicity of Ribavirin
Hemolytic Anemia
114
Used for Herpes Zoster
Famciclovir
115
Prodrug for HSV and VZV
Valacyclovir (prodrug of acyclovir)
116
MoA of Acyclovir, Famciclovir, Valacyclovir
monophosphorylated by HSV/VZV thymidine kinase
117
Toxicity of Acyclovir, Famciclovir, Valacyclovir
obstructive crystalline nephrotoxicity and acute renal failure is not hydrated
118
These drugs won't work if there is mutated thymidine kinase
Acyclovir, Famciclovir, Valacyclovir
119
Used for CMV
Ganciclovir
120
MoA of Ganciclovir
5'-monophosphate formed by CMV viral kinase. Guanosine analog.
Triphosphate formed by cellular kinases
121
Toxicity of Ganciclovir
leukopenia, neutropenia, thrombocytopenia, renal toxicity
122
MoA of Foscarnet
Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme.
123
Drug for CMV retinitis in IC pts when gnciclovir fails, acyclovir resistant HSV
Foscarnet and Cidofovir
124
Foscarnet Toxicity
Nephrotoxicity
125
HAART Therapy Drugs
2 NRTIs + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor
126
Ends in -navir
Protease inhibitor
127
Protease inhibitors prevent what part in HIV infection?
prevents the maturation of new viruses
128
Toxicities from Protease Inhibitors
hyperglycemia, GI intolerane, Lipodystrophy
| nephropathy and hematuria for indinavir
129
MoA of NRTIs
competitively inhibit nucleotide binding to RT and terminate DNA chain (lack a 3'OH group)
130
What to give with NRTI to prevent BM suppression
granulocyte colony-stimulating factor (G-CSF) and erythropoietin
131
general prophylaxis and during pregnancy to decrease risk of fetal transmission
Zidovudine (ZDV) an NRTI
132
A nucleotide NRTI
Tenofovir, doesn't need to be phosphorylated
133
3 NNRTIs
Efavirenz, Nevirapine, Delavirdine
134
Common S/E of NNRTIs
Rash and hepatotoxicity
135
S/E associated with Efavirenz
Vivid Dreams and CNS symptoms
136
Efavirenz and Delavirdine are C/I in
Pregnancy
137
Inhibits HIV integration into host cell by eversibly inhibiting HIV integrase
integrase Inhibitor Raltegravir
138
S/E of Raltegravir
Hypercholesterolemia
139
Binds gp41, inhibiting viral entry
Enfuvirtide, a fusion inhibitor
140
Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120
Maravioc, a fusion inhibitor
141
Clinical use of IFN-alpha
chronic hepatitis B and C, Kaposi Sarcoma, Hairy Cell Leukemia, Condyloma acuminatum, renal cell carcinoma, malignant melanoma
142
Clinical use of IFN-beta
Multiple Sclerosis
143
Clinical use of IFN-gamma
Chronic Granulomatous Disease
144
Sulfonamides in Pregnancy causes
Kernicterus
145
Aminoglycosides during Pregnancy causes
Ototoxicity
146
Fluoroquinolones during Pregnancy causes
Cartilage Damage
147
Clarithromycin during Pregnancy causes
Embryotoxic
148
Ribavirin during Pregnancy
Teratogenic
149
Griseofulvin during Pregnancy
Teratogenic
150
Chloramphenicol during Pregnancy
Gray Baby Syndrome
