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M2 - Pharm > FA Antibiotics > Flashcards

FA Antibiotics Flashcards

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1
Q

Penicillin G

A

IV

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2
Q

Penicillin V

A

Oral

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3
Q

Penicillin MOA

A

Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes

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4
Q

Penicillin Clinical Use

A

SASS: S. pneumo, Actinomyces, S. pyogenes, Syphilis
Generally: Bactericidal for GramPos/Neg cocci, GramPos rods, spirochetes

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5
Q

Penicillin Toxicity

A

HS, hemolytic anemia

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6
Q

Penicillin Resistance

A

Beta-lactamase cleavage of beta-lactam ring

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7
Q

Aminopenicillin Drugs

A

Amoxicillin, Ampicillin

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8
Q

Aminopenicillin MOA

A 
Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes
Wider spectrum (AMPed up penicillins)
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9
Q

Aminopenicillin Clinical Use

A

Wider spectrum –> HHELLPS kill enterococi: H. flu, H. pylori, E. coli, Listeria, Proteus, Shigella, Salmonella, enterococci

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10
Q

Aminopenicillin with better oral bioavailability

A

AmOxicillin

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11
Q

Aminopenicillin Toxicity

A

HS, Amp Rash, Pseudomembranous Colitis

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12
Q

Aminopenicillin Resistance

A

Beta-lactamase cleavage of beta-lactam ring

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13
Q

Penicillinase-Resistant Penicillin Drugs

A

Dicloxacillin, Nafcillin, Oxacillin, Methicillin

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14
Q

Penicillinase-Resistant Penicillin MOA

A

Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes
Narrower-spectrum
Bulky R-group prevents beta-lactamase access to ring

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15
Q

Penicillinase-Resistant Penicillin Clinical Use

A

S. aureus (not MRSA)

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16
Q

Antipseudomonal Penicillin Drugs

A

Ticarcillin, Piperacillin (+ beta-lactamase inhibitor)

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17
Q

Antipseudomonal Penicillin MOA

A

Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes
Extended spectrum
Susceptible to beta-lactamases

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18
Q

Antipseudomonal Penicillin Clinical Use

A

Pseudomonas, GramNeg Rods

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19
Q

Antipseudomonal Penicillin Toxicity

A

HS

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20
Q

Beta-lactamase inhibitors

A

Clavulanic Acid, Sulbactam, Tazobactam

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21
Q

Cephalosporin MOA

A

Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes
Less susceptible to beta-lactamases
Bactericidal

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22
Q

Cephalosporin Toxicity

A

HS, autoimmune hemolytic anemia, disulfiram-like rxn w/EtOH, Vit K deficiency
Cross-reactive w/penicillins
Increase nephrotoxicity of Aminoglycosides

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23
Q

Cephalosporin Resistance

A

structural change in PBPs (transpeptidases)

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24
Q

These drugs can cause a disulfiram-like reaction with alcohol

A

Metronidazole, Cephalosporins

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25
1st Gen Cephalosporin Drugs
Lin, Lex: Cefazolin, Cefalexin
26
1st Gen Cephalosporin Clinical Use
PEcK: Proteus, E. coli, Klebsiella
27
2nd Gen Cephalosporin Drugs
Fake Fox Fur: Cefaclor, Cefoxitin, Cefuroxime
28
2nd Gen Cephalosporin Clinical Use
HEN PEcKS: H. flu, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
29
3rd Gen Cephalosporin Drugs
Tri, Tax, Taz: Ceftriaxone, Cefotaxime, Ceftazidime
30
3rd Gen Cephalosporin Clinical Use
Triax: Meningitis, Gonorrhea, disseminated Lyme Taz: Pseudomonas
31
4th Gen Cephalosporin Drugs
Cefepime
32
4th Gen Cephalosporin Clinical Use
Pseudomonas, GramNeg, additional GramPos activity
33
5th Gen Cephalosporin Drugs
Ceftaroline
34
5th Gen Cephalosporin Clinical Use
MRSA, broad GramPos and GramNeg coverage (not Pseudomonas)
35
These antibiotics are relatively safe in pregnancy
Beta-lactams, Azithromycin, Clindamycin, Metronidazole
36
These antibiotics can be used against Pseudomonas
Aminoglycosides (GNATS), Aztreonam, Carbapenems, Cefepime, Ceftazidime, Fluoroquinolones, Ticarcillin/Piperacillin, Colistin and Ploymixin B (MDR Strains)
37
Carbapenem Drugs
Imipenem, Meropenem, Ertapenem, Doripenem
38
Carbapenem MOA
Bind PBPs, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes Broad spectrum Beta-lactamase resistant Imipenem always + cilistatin to reduce inactivation by dihydropeptidase I in renal tubules
39
Carbapenem Clinical Use
GramPos Cocci, GramNeg Rods, Anaerobes
40
Imipenem always adminstered with what, and why?
Cilastatin to reduce inactivation by dihydropeptidase I in renal tubules
41
These drugs can be given to a pt w/penicillin allergy
Monobactams, Macrolides, Clindamycin
42
Carbapenem Toxicity
CNS toxicity (seizures), GI distress, skin rash
43
Monobactam drugs
Aztreonam
44
Monobactam MOA
Bind PBP3, inhibit transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes Less susceptible to beta-lactamases Synergistic w/aminoglycosides No cross-allergicity w/penicillins
45
Monobactam Clinical Use
GramNeg rods ONLY
46
These drugs can be used in pts w/renal insufficiency instead of aminoglycosides
Monobactams (Aztreonam)
47
These drugs are less susceptible to beta-lactamases
Monobactams,
48
These drugs are beta-lactamase resistant
Carbapenems, Vancomycin, Cephalosporins, Penicillinase-Resistant Penicillins
49
These drugs should be administered with beta-lactamase inhibitors
Penicillin, Aminopenicillins, Antipseudomonal Penicillins
50
Monobactam Toxicity
usually nontoxic; occasional GI upset
51
Vancomycin MOA
binds D-ala-D-ala to inhibit cell wall elongation Bactericidal Beta-lactamase resistant
52
Vancomycin Clinical Use
MRSA, Staph epi, Enterococcus, C. diff
53
Vancomycin Toxicity
"Red Man's NOT in the Van": Red Man Syndrome (antihistamines), Nephrotoxicity, Ototoxicity, Thrombophlebitis
54
Vancomycin Resistance
amino acid modification of D-ala-D-ala to D-ala-D-lac
55
This carbapenem has decreased risk of seizures and is stable to dihydropeptidase I in renal tubules
Merepenem
56
These bugs are NOT covered by Cephalosporins
LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA (except 5th gen), Enterococci
57
These drugs bind to 30S subunit to inhibit protein synthesis
"Ami has 30 Tetras": Aminoglycosides, Tetracyclines
58
These drugs bind to 50S subunit to inhibit protein synthesis
"CCEL at 50": Chloramphenicol, Clindamycin, Erythromycin (Macrolides), Linezolid
59
Aminoglycoside Drugs
GNATS: Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
60
Aminoglycoside MOA
Bind 30S subunit --> misreading of mRNA, blockage of translocation Bacteriocidal Require O2 for uptake (Amin"O2"glycosides)
61
Aminoglycoside Clinical Use
Severe GramNeg Rod infxns (Ami"NOT"glycoside) Synergistic w/Beta-lactams Bowel sterilization for Sx (neomycin)
62
These drugs are synergistic w/Beta-lactams
Aminoglycosides
63
This drug is used for bowel sterilization pre-Sx
Neomycin
64
This aminoglycoside is hepatically excreted
Amikacin
65
Aminoglycoside Toxicity
"caNNOT kill anaerobes:" Nephrotoxicity, NMJ blockade, Ototoxicity (esp. w/loop diuretics), Teratogen
66
Aminoglycoside mnemonic
Mean GNATS caNNOT kill anaerobes
67
Aminoglycoside Resistance
Bacterial tranferase enzymes inactivate via APA: Adenylation, Phosphorylation, Adenylation
68
Tetracycline Drugs
Tetracycline, Doxycycline, Minocycline, Demeclocycline, Tygecycline
69
Tetracycline MOA
T's: Bind to 30S (Thirty) subunit --> prevent tRNA attachment Accumulate intracellularly Limited CNS penetration Ca2+, Mg2+, Fe2+ decrease absorption in gut
70
This tetracycline is hepatically eliminated
Doxycycline
71
This tetracycline is commonly used for acne
Minocycline
72
This tetracycline can be used as a diuretic in SIADH
Demeclocycline
73
These products inhibit tetracycline absorption
Ca2+, Mg2+, Fe2+
74
Tetracycline Clinical Use
Borrelia burgdorferi, M. pneumoniae, Rickettsia, Chlamydia, acne
75
Tetracycline Toxicity
Tummy (GI distress), can't get Taller (inhibition of bone growth in kids), Tooth discoloration, Teratogenic
76
Tetracycline Resistance
decreased uptake or increased efflux via plasmid-encoded transport pumps
77
Chloramphenicol MOA
Blocks peptidyltransferase at 50S subunit | Bacteriostatic
78
Chloramphenicol Clinical Use
Meningitis (H. flu, N. meningitidis, S, pneumo), Rocky Mtn Spotted Fever (Rickettsia)
79
Chloramphenicol Toxicity
Dose-dependent anemia, dose-independent aplastic anemia, gray baby syndrome
80
What is gray baby syndrome and what causes it?
Chloramphenicol --> Vomiting, Ashen gray skin color, Limp body tone, HypOtension, Cyanosis, Hypothermia, Cardiovascular collapse
81
Chloramphenicol Resistance
Plasmid-encoded acetyltransferase inactivates drug
82
Clindamycin mnemonic
Clindamycin Cleans Up Anaerobes (anaerobic infxns above diaphragm)
83
Clindamycin MOA
``` Blocks translocation (peptide transfer) at 50S subunit Bacteriostatic ```
84
Clindamycin Clinical Use
Anaerobic infxns (Bacteroides, C. perfringens) in aspiration pneumonia, lung abscesses, oral infxns; invasive Strep pyogenes infxn
85
Clindamycin Toxicity
Pseudomembranous colitis from superinfxn (C. diff overgrowth) (primary cause), fever, diarrhea
86
Oxazolidinone Drugs
Linezolid
87
Linezolid MOA
Binds 50S subunit and blocks Initiation Complex formation
88
Linezolid Clinical Use
GramPos, incl. MRSA and VRE
89
Linezolid Toxicity
Bone marrow suppression (esp thrombocytopenia), peripheral neuropathy, serotonin syndrome
90
What is serotonin syndrome and what antibiotic causes it?
Linezolid --> excessive accumulation of serotonin --> symptoms can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures)
91
These drugs can suppress bone marrow
Linezolid, TMP
92
Linezolid Resistance
rRNA point mutation
93
Macrolide Drugs
ACE: Azithromycin, Clarithromycin, Erythromycin
94
Macrolide MOA
Binds to 23S rRNA of 50S subunit --> blocks translocation (macro"slide") Bacteriostatic
95
Macrolide Clinical Use
Atypical pneumonia (Mycoplasma, Chlamydia, Legionella), STIs (Chlamydia), GramPos Cocci (Strep in pts w/penicillin allergy), B. pertussis
96
Macrolide Toxicity
MACRO: Increased GI Motility, Arrhythmia from prolonged QT interval, acute Cholestatic hepatitis, Rash, eOsiniphilia Increases serum conc of theophyllines and oral anticoagulants Erythro and Clarithro inhibit P450
97
Macrolide Resistance
Methylation of 23S rRNA-binding site
98
Trimethoprim MOA
Inhibits bacterial Dihydrofolate Reductase (folate synthesis) Bacteriostatic
99
Trimethoprim Clinical Use
Used w/SMX to cause sequential block of folate synthesis (bactericidal) -- UTIs, Shigella, Salmonella, Pneumo jirovecii, Pneumonia Rx and prophylaxis, toxoplasmosis prophylaxis
100
Trimethoprim Toxicity
Treats Marrow Poorly: Megaloblastic anemia, leukopenia, granulocytopenia (alleviate w/folinic acid)
101
Sulfonamide MOA
PABA metabolites inhibit dihydropterate synthase (folate synthesis) Bacteriostatic
102
Sulfonamide Clinical Use
GramPos, GramNeg, Nocardia, Chlamydia, simple UTI (triple sulfas or SMX)
103
Sulfonamide Toxicity
HS, Hemolysis in G6PDH Def, Nephrotoxicity (tubulointerstitial nephritis), Photosensitivity, Kernicterus in infants, displaces other drugs from albumin (warfarin), Stevens-Johnson Syndrome
104
Sulfonamide Resistance
Altered enzyme, decreased uptake, or increased PABA synthesis
105
TMP-SMX Toxicity
Stevens-Johnson Syndrome (mostly SMX)
106
TMP-SMX MOA
Sequential inhibition of folate synthesis
107
TMP-SMX Clinical Use
PUSS: Pneumo jirovecii, UTIs, Shigella, Salmonella
108
Fluoroquinolone Drugs
Ciprofloxacin, Levofloxacin, Moxifloxacin
109
Fluoroquinolone MOA
inhibit DNA Topoisomerase I (DNA Gyrase) and DNA Topoisomerase IV Bactericidal Cannot be taken w/antacids
110
These antibiotics cannot be taken with antacids
Fluoroquinolones, Tetracyclines
111
Fluoroquinolone Clinical Use
GramNeg Rods in urinary and GI tracts; Pseudomonas, Atypical pneumonia (Levo, Moxi), Neisseria, some GramPos organisms
112
Fluoroquinolone Toxicity
Superinfection, Tendon Rupture, GI upset, may prolong QT interval, skin rash, headache, dizziness C/I in pregnancy, nursing, kids under 18 (cartilage damage) "Quinolones hurt attachments to Bones"
113
Fluoroquinolone Resistance
Chromosome-encoded mutation in DNA gyrase; plasmid-mediated resistance; efflux pumps
114
Daptomycin MOA
Lipopeptide that disrupts cell membrane of GramPos cocci
115
Daptomycin Clinical Use
S. aureus skin infxns (esp. MRSA), bacteremia, endocarditis, VRE -- NOT used for pneumonia (inactivated by surfactant)
116
Daptomycin toxicity
Myopathy, rhabdomyolysis
117
Metronidazole MOA
Forms toxic free radical metabolites that damage bacterial DNA Bactericidal, antiprotozoal
118
Metronidazole Clinical Use
GET GAP on the Underground Metro: anaerobes below diaphragm: Giardia, Entamoeba, Trichomonas, Gardenerella, Anaerobes (Bacteroides, C. diff), H. Pylori (w/PPI and Clarithromycin)
119
These 2 antibiotics are used in "triple therapy" w/PPI to treat H. pylori
Clarithromycin, Metronidazole
120
Metronidazole Toxicity
Disulfiram-like rxn w/EtOH, headache, dysgeusia
121
Disulfiram-like reaction
severe flushing, tachycardia, hypotension
122
These antibiotics should be avoided in pregnancy
SAFe Children Take Really Good Care: Sulfonamides, Aminoglycosides, Fluoroquinolones, Clarithromycin, Tetracyclines, Ribavirin (antiviral), Griseofulvin (antifungal), Chloramphenicol
123
post-antibiotic effect
persistent suppression of bacterial growth after a brief exposure (1 or 2 hours) of bacteria to an antibiotic even in the absence of host defense mechanisms
124
this antibiotic exhibits post-antibiotic effect
Azithromycin
125
These drugs can be used against MRSA
Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline
126
These drugs can be used against VRE
Linezolid, Tigecycline, Daptomycin
127
These drugs can be used against anaerobes
Clindamycin (above diaphragm), Metronidazole (below diaphragm), Tigecycline, Cefoxitine, Zosyn (Piperacillin + Tazobactam), Respiratory Fluoroquinolones (Moxi > Levo), Carbapenems
128
These drugs can be used against Atypical Pneumonia (Legionella, Mycoplasma, Chlamydia)
Macrolides, Tetracyclines, Moxifloxacin, Levofloxacin
129
These drugs can be used for UTIs
TMP-SMX, Fluoroquinolones, Fosfomycin (if the others don't work)
130
These drugs can be used for outdoor diseases (Borrelia Lyme Disease/Ricksietta Rocky Mtn/Y. pestis Plague)
Tetracyclines, Ceftriaxone (Lyme)
131
These drugs can be used for Chlamydia
Macrolides
132
These drugs can be used for Syphilis
Penicillin G
133
These drugs can be used for Gonorrhea
Ceftriaxone
134
These drugs can be used for MDR Pseudomonas
Polymixins B/E (Colistin)
135
These drugs can be used for Hepatic encephalopathy
Neomycin
136
These drugs can be used for Anthrax
Doxycycline, Fluoroquinolones
137
These drugs can cause pseudomembranous colitis (superinfxn)
Clindamycin, Tetracyclines, Aminopenicillins (Treat w/Vanco, Metronidazole)
138
These drugs can cause ototoxicity
Aminoglycosides (esp w/loop diuretics), Vancomycin
139
These drugs can cause myopathy
Daptomycin
140
These drugs can cause tendon rupture and cartilage damage
Fluoroquinolones
141
These drugs are motilin agonists that can cause severe diarrhea
Macrolides (ACE)
142
These drugs can cause NMJ blockade
Aminoglycosides (GNATS)
143
These drugs can cause seizures
Carbapenems, Isoniazid
144
This drug can cause Red Man Syndrome
Vancomycin
145
These drugs can cause bone marrow suppression
TMP, Linezolid
146
These drugs can cause kernicterus
Sulfonamides
147
These drugs can cause hemolysis in G6PDH deficiency
Sulfonamides
148
These drugs can cause Vit B6 deficiency / peripheral neuropathy
Isoniazid
149
These drugs can cause Vit K deficiency
Cephalosporins
150
These drugs can cause nephrotoxicity
Aminoglycosides, Vancomycin, Sulfonamides
151
These drugs can cause optic neuropathy / red-green colorblindness
Ethambutol ("Eye"-thambutol)
152
These drugs can cause megaloblastic anemia
Trimethoprim
153
These drugs can cause red-orange body fluids
Rifampin
154
These drugs can cause hyperuricemia
Pyrazinamide
155
These drugs can cause aplastic anemia
Chloramphenicol
156
These drugs can cause hepatotoxicity
Isoniazid, Pyrazinamide
157
These drugs can cause acute cholestatic hepatitis
Erythromycin
158
These drugs are P450 2C9 inhibitors
Sulfonamides, Metronidazole
159
These drugs are P450 2C9 inducers
Rifampin
160
These drugs are P450 inhibitors
Isoniazid, Clarithromycin and Erythromycin (NOT Azithromycin), Ciprofloxacin
161
Rifampin MOA
Inhibits DNA-dependent RNA Polymerase
162
Rifampin Clinical Use
Mycobacterium tuberculosis; delay resistance to Dapsone in leprosy; prophylaxis for close contacts of kids with HiB meningitis
163
Rifampin Toxicity
Minor hepatotoxicity, P450 inducer (drug interaxns), Red-Orange body fluids
164
Rifamycin Drugs
Rifampin, Rifabutin
165
Which rifamycin is preferred in HIV and why?
Rifabutin b/c less P450 stimulation
166
Rifampin Resistance
Mutations reduce drug binding to RNA Pol | Monotherapy rapidly leads to resistance
167
4 R's of Rifampin
DNA-dependent RNA Polymerase Ramps up P450 Red-orange body fluids Rapid Resistance when used alone
168
These drugs are used for active TB
RIPE for treatment: Rifampin, INH, Pyrazinamide, Ethambutol
169
These drugs are used for latent TB
Rifampin, INH
170
Isoniazid MOA
decrease Mycolic Acid synthesis | requires bacterial KatG (catalase-peroxidase) for activation
171
Isoniazid Clinical Use
Mycobacterium tuberculosis -- only agent used as solo prophylaxis
172
This drug is the only agent used as solo prophylaxis against TB
Isoniazid
173
Isoniazid Toxicity
Neurotoxicity (B6 deficiency -- peripheral neuropathy -- treat w/pyridoxine), hepatotoxicity
174
Isoniazid Resistance
Mutations causing underexpression of KatG
175
Pyrazinamide MOA
Uncertain -- somehow converted to active cpd pyrazinoic acid
176
Pyrazinamide Clinical Use
Mycobacterium tuberculosis
177
Pyrazinamide Toxicity
Hyperuricemia, hepatotoxicity
178
Ethambutol MOA
inhibits arabinosyltransferase --> decreases carbohydrate polymerization of cell wall
179
Ethambutol Clinical Use
Mycobacterium tuberculosis
180
Ethambutol Toxicity
Optic neuropathy, Red-Green colorblindness ("Eye"-thambutol)
181
This drug is used as prophylaxis for endocarditis, Sx/dental procedures
Amoxicillin
182
This drug is used as prophylaxis for gonorrhea
Ceftriaxone
183
This drug is used as prophylaxis for recurrent UTIs
TMP-SMX
184
This drug is used as prophylaxis for meningococcal exposure
Ceftriaxone, Ciprofloxacin, or Rifampin
185
This drug is used as prophylaxis for pregant women w/Group B Strep
Penicillin G
186
This drug is used as prophylaxis for gonorrheal conjunctivitis in newborn
Erythromycin ointment
187
This drug is used as prophylaxis for post-Sx Staph aureus infxn
Cefazolin
188
This drug is used as prophylaxis for Strep pharyngitis in kids w/Hx Rheumatic Fever
Benzathine Penicillin G or Oral Penicillin V
189
This drug is used as prophylaxis for syphilis
Benzathine Penicillin G
190
What gene is implicated in MRSA strains?
MecA codes for new PBP2a
191
Which carbapenem has best activity against Pseudomonas?
Doripenem
192
What drug can be used to treat C. diff?
ORAL Vancomycin, Metronidazole
193
Which tetracycline is used for antibiotic-resistant infections?
Tygecycline (broad spectrum)
194
Antibiotic for Staph skin infxn?
Mupirocin (can also eliminate nasal carriage)
195
These drugs These agents may compete with penicillin for renal tubular secretion, prolonging the half-life of penicillin
Aspirin, furosemide, indomethacin, sulfonamides, thiazide diuretics

M2 - Pharm (10 decks)

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