Lange Pharmacology Flashcards Preview

USMLE High Yield Flashcards > Lange Pharmacology Flashcards > Flashcards

Flashcards in Lange Pharmacology Flashcards Deck (295)
Loading flashcards...
1

Penicillin

*Structural analogs of D-Ala-D-Ala* Cocci (both gram + and -) and spirochetes (like syphilis) Binds PBP-->inhibits peptidoglycan synthesis-->decreased peptidoglycan cross-linking in cell wall *SE = hemolytic anemia, allergy* Resistance = beta-lactamases

2

Ampicillin/Amoxicillin

Penicillinase sensitive: Often add Clavulanic acid or sulbactam "AMinoPenicillins are AMPed up penicillins:" wider spectrum So all cocci, plus gram negative rods and gram positive rods (Listeria) AmOxicillin has > Oral bioavailability than ampicillin Ampicillin/Amoxicillin "HELPSS kill enterococci": H flu, E coli, *Listeria*, Proteus, Salmonella, Shigella, enterococci

3

Piperacillin/Ticarcillin

Tx for pseudomonas Given with Tazobactam (beta lactamase inhibitor)

4

Methicillin/Nafcillin

Penicillinase resistant So MRSA is something that has alterations in the PBPs (doesn't break methicillin down, just doesn't let it bind) "Use naf for staph:" Staph aureus that is But can't use it for MRSA SE = interstitial nephritis

5

Aztreonam

To treat severe gram negative infections in pts with penicillin allergy Everything else on the card really stems off of that

6

Imipenem

Broad-spectrum. The usuals + PEAR (Pseudomonas, enterobacter, anaerobes, gram negative rods) SE= seizures Give Cilistatin too! With imipenem, "the kill is lastin' with cilistatin:" Inhibits renal dihydropeptidase 1-->prevents imipenem breakdown in renal tubules-->longer imipenem duration of action

7

Cephalosporins

Generation 1--gram + and also PEcK Generation 2--gram + and also HEN PEcKS Generation 3--serious gram negative infections Ceftriaxone--gonorrhea and meningitis Ceftazidime--Pseudomonas Generation 4--Cefepime, both gram + and serious gram negative infections SE = disulfiram-like reaction with EtOH; hypersensitivity rxn (10% of those allergic to penicillin will get this)

8

Aminoglycosides (-mycins and Amikacin): Gentamicin, Streptomycin, Neomicin, Tobramycin

Binds 30s-->inhibits initiation complex formation-->mRNA misreading-->nonfunctional proteins Use for severe infections with aerobic gram negative rods (like Pseudomonas) (They require O2 uptake to get into cell so don't work against anaerobes) SE = ATN (esp with cephalosporins); ototoxic (esp with loop diuretics) (Aerobic, ATN")

9

Clindamycin

Binds 50s-->inhibits initiation complex formation "Severe anaerobic infections above the diaphragam." Like infections d/t nl mouth flora Endocarditis prophylaxis before dental procedures as well SE = pseudomembranous colitis

10

Linezolid

Also inhibits 50s, but txs MRSA and VRE (gram positive infections)

11

Chloramphenicol

Binds 50s-->*inhibits peptidyl transferase*-->amino acids can't get added to chain Broad spectrum, but severe SE. Use = alternative tx for bacterial meningitis in pts with penicillin allergy SE = myelosuppression (*aplastic anemia* (dose independent), dose-dependent anemia) Also gray baby syndrome (with vomiting, shock...)

12

Macrolides (-thromycins)

"MAC Daddy": MAC tx and other atypical pneumonias, STDs (what MAC Daddy's get), Diphtheriae Bind 50s-->inhibit translocation For atypical pneumonias (Mycoplasma, Chlamydia, Legionella, MAC) and some STDs (Chlamydia) And for diphtheria Also for Campylobacter when it is fluoroquinolone-resistant SE = GI upset

13

Tetracycline (-cyclines)

"Lime in a four wheeler" Binds 30s-->blocks aa-tRNA from binding ribosome-->inhibits protein synthesis For Lyme disease, Rickettsia, atypical pneumonias SE = teeth discoloration and bone deformity in children; Fanconi syndrome; Photosensitivity rash Divalent cations (milk, antacids...) prevent its absorption, so don't take it with those Fecally eliminated (so can use in renally deficient pts)

14

TMP-SMX

SMX = PABA analog, competitively inhibits dihydropterate synthetase-->decreased THF TMP--inhibits dihydrofolate reductase-->decreased DNA synthesis For Pneumocystis carinii pneumonia, E coli infections mostly "TMP = PCP" SE = Stevens-Johnson syndrome, hemolytic anemia Or in babies--kernicterus (SE = SJ, HaK)

15

Fluoroquinolones (-floxacins):

Inhibit bacterial DNA topoisomerase 2-->DNA strand breaks-->cell death For gram negative infections and some gram positive infections Mostly for pneumonias, UTIS, gonococcal infections (PUG) SE = tendonitis and tendon rupture in adults And damage growing cartilage (so pregnant women and children should not take them)

16

Nitrofurantoin

Used for recurrent UTIs Similar to fluoroquinolones

17

*Vancomycin

*Binds D-ala-D-ala in cell wall-->inhibits transglycosylase-->weakened peptidoglycans in cell wall Uses--serious gram positive multidrug resistant infections (MRSA) SE = (RON) red man syndrome, ototoxicity, nephrotoxicity Remember how to prevent red man syndrome? Skipped Polymyxins and Daptomycin on this card

18

Metronidazole

Metabolized by bacterial proteins-->reduced reactive compounds-->damage-->cell death Uses = anaerobic infections below the diaphragm Also giardia, trichomoniasis, and E histolytica infections *SE = metallic taste; disulfiram-like effect with alcohol (like cephalosporins)*

19

Rifampin

Inhibits bacterial DNA-dependent RNA-polymerase-->decreased RNA synthesis Uses = mycobacteria (combotherapy) Monotherapy for--prophylaxis for contacts of pts with meningococcal meningitis and H flu type B infection SE = harmless orange color to urine; hepatitis

20

Isoniazid

Processed by mycobacterial catalase-peroxidase-->metabolite-->inhibits synth of mycolic acids for mycobacterial cell wall Uses = mycobacteria (combotherapy) Monotherapy = prophylaxis against active TB in pts with a positive PPD SE = peripheral neuropathy (prevent with Vitamin B6); drug-induced lupus; hepatitis (HeNS) The SLE occurs when someone is a slow acetylator in liver (decreased N-acetyltransferase activity)-->Isoniazid metabolization population distribution is bimodal (Having lupus is SHIPP-E)

21

Dapsone

*PABA antagonist* (like sulfonamides) Uses = combotherapy for Mycobacterium leprae *Also prophylaxis against PCP (in HIV pts)* SE = G6PD deficient hemolytic anemia (Hemolysis IS D PAIN)

22

Ethambutol

Inhibits MB arabinosyl transferase-->decreased synth of MB cell wall Uses = combotherapy for MB tuberculosis SE = retrobulbar neuritis (*red-green color blindness, decreased visual acuity*)

23

Pyrazinamide

"Pyraz-inside" Lowers environmental pH (active against IC TB) Uses = combotherapy for MB tuberculosis (like ethambutol) SE = hepatotoxicity

24

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)---"vudines" mostly

Activated by IC phosphorylation-->inhibit HIV reverse transcriptase-->messed up DNA synthesis-->defective viral particle Use = HIV tx Lamivudine--also used for Hepatitis B SE: neutropenia AZT-->megaloblastic anemia/BM suppression (Think of AZT as the biggest name) Didanosine-->pancreatitis

25

Nucleotide Reverse Transcriptase Inhibitors (-fovirs):

Don't need phosphorylated Also inhibit reverse transcriptase Uses = HIV and Hepatitis B infections

26

Non-Nucleoside Reverse Transcriptase Inhibitors (-vir-):

Bind specifically to reverse transcriptase-->decreased DNA synthesis Use = HIV tx SE: *Nevirapine-->Stevens-Johnson syndrome; fulminant hepatitis* *Efavirenz-->delusion and nightmares (CNS disturbances)*

27

Protease inhibitors (-navirs):

Inhibit HIV protease-->virus is unable to replicate d/t no mature proteins for core particle made Uses = HIV SE = altered body fat distribution ("Fat PiG")/hyperlipidemia

28

*Acyclovir

Viral thymidine kinase-->phosphorylates (activates) acyclovir-->dGTP analogue-->incorporates-->inhibits viral DNA synthesis Uses = HSV1, HSV2, VZV, EBV (oral hairy leukoplakia)--Herpes mostly! *SE = nephrotoxicity (via crystallization); neurotoxicity (delirium, tremor)*

29

Ganciclovir

Viral kinase-->phosphorylates (activates) ganciclovir-->guanosine analogue-->inhibits CMV DNA polymerase-->decreased CMV DNA synthesis Uses = CMV infections, especially CMV retinitis SE = pancytopenia

30

Foscarnet

Pyrophosphate analogue-->inhibits viral DNA polymerase But does not require kinase activation! Use = 2DOC for CMV infections and acyclovir-resistant HSV/VZV infections SE = nephrotoxicity (-->hypoCa and hypoMg-->szs)