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Flashcards in Micro Drugs Deck (126):
1

Indications for penicillins (1st generation)

Gram(+) organisms + N. meningitidis and T. pallidum

2

Side effects of penicillins

Hypersensitivity; hemolytic anemia

3

2nd generation penicillins (2)

Ampicillin, amoxicillin

4

Indications for 2nd generation penicillins

Same as penicillin + H. flu, E.coli, Listeria, Proteus, Salmonella, shigella, and enterococci (HELPSS)

5

3rd generation penicillins (3)

oxacillin, nafcillin, dicloxacillin

6

Indications for 3rd generation penicillins

"Naf for Staph" - MRSA

7

4th generation penicillins (2)

Ticarcillin, piperacillin

8

Beta-lactamase inhibitors (3)

Clavulanic acid, sulbactam, tazobactam

9

Organisms not covered by cephalosporins (4)

LAME - Listeria, atypicals, MRSA, enterococci

10

1st generation cephalosporins (2)

Cefazolin, cephalexin

11

Indications for 1st generation cephalosporins

PEcK - gram + cocci, Proteus, E. coli, and KLebsiella

12

2nd generation cephalosporins (3)

cefoxitin, cefaclor, cefuroxime

13

Indications for 2nd generation cephalosporins

HEN PEcKs - gram + cocci, H. flu, Enterobacter, Neisseria, PEcK

14

3rd generation cephalosporins (3)

Ceftriaxone, cefotaxime, ceftazidime

15

4th generation cephalosporin (1)

cefepime (for pseudomonas)

16

5th generation cephalosporin (1)

ceftaroline (broad including MRSA, does not cover pseudomonas)

17

Aztreonam is synergistic with ____

Aminoglycosides

18

Indications for aztreonam

Gram - rods only (no gram pos, anaerobes)

19

Carbapenems must always be administered with ____

Cilastatin (inhibitor of renal dehydropeptidase I)

20

Indications for carbapenems

Gram + cocci, gram - rods, anaerobes

21

Side effects of vancomycin

nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome

22

Mechanism of linezolid

Inhibits 23s rRNA of 50S subunit

23

Side effects of linezolid

Optic neuritis, thrombocytopenia, serotonin syndrome

24

Aminoglycosides (5)

GNATS - gentamicin, neomycin, amikacin, tobramycin, streptomycin

25

Mechanism of aminoglycosides

Inhibit formation of initiation complex on 30S and cause misreading of mRNA; require O2 for uptake

26

Indications for aminoglycosides

Severe gram - rods; synergistic with beta-lactams

27

Toxicity of aminoglycosides

Nephrotoxicity (esp. with cephalosporins), NMJ blockade, ototoxicity, teratogen

28

Resistance to aminoglycosides

Bacterial transferase enzymes (esp. acetylation)

29

Tetracyclines (3)

Tetracycline, doxycycline, minocycline

30

Mechanism of tetracyclines

Block attachment of aminoacyl-tRNA on 30S subunit

31

What can't you take with doxycycline?

Divalent cations (Mg, Ca)

32

Indications for tetracyclines

Borrelia, mycoplasma, rickettsia, chlamydia, acne

33

Toxicity of tetracyclines

GI distress, discolored teeth, inhibition of bone growth, photosensitivity

34

Resistance to tetracyclines

Decreased uptake or increased efflux

35

Macrolides (3)

Azithromycin, clarithomycin, erythromycin

36

Mechanism of macrolides

Block translocation by binding 23 rRNa on 50S subunit

37

Indications for macrolides

Atypical pneumonia, STDs (chlamydia), gram+ cocci

38

Toxicity of macrolides

MACRO - motility problems, arrhythmia (prolonged QT), cholestatic hepatis, rash, eosinophiilia

39

Resistance to macrolides

Methylation of 23S rRNA binding site

40

Mechanism of chloramphenicol

Blocks peptidyltransferase at 50S subunit

41

Indications for chloramphenicol

Meningitis, RMSF

42

Toxicities of chloramphenicol

Aplastic anemia, gray baby syndrome, anemia

43

Resistance to chloramphenicol

Plasmid-encoded acetyltransferase inactivation

44

MEchanism of clindamycin

Blocks peptide transfer at 50S subunit

45

Indications for clindamycin

Anaerobes above the diaphragm (Bacteroides, C. perf in aspiration pneumo, lung abscesses, GAS)

46

Drugs causing pseudomembranous colitis

Clindamycin, 2nd generation penicillins

47

Sulfonamides (3)

SUlfamethoxazole (SMX), sulfisoxazole, sulfadizine

48

Indications for sulfonamides

Gram +, gram -, Nocardia, Chlamydia, simple UTI

49

Toxicity of sulfonamides

SJS, TEN, hemolysis in G6PD, nephrotox, photosensitivity, kernicterus (infants), displace other drugs from warfarin

50

Indications for trimethoprim

Combined with SMX for UTI, shigella, salmonella, PCP, toxo

51

Toxicities of TMP

Granulocytopenia, leukopenia, megaloblastic anemia

52

Fluroquinolones

Ciprofloxacin, norfloxacin, levofloxacin, nalidixic acid (and more. . . )

53

Mechanism of fluroquinolones

Inhibit DNA gyrase (topoisomerase II) and topo-IV

54

Do not take fluroquinolones with ____

Antacids

55

Indications for fluroquinolones

Gram - rods of urinary/GI (inc. pseudomonas), Neisseria; no MRSA

56

Toxicities of fluroquinolones

GI upset, superinfection, skin rash, tendonitis, myalgias

57

Mechanism of metronidazole

Free radical toxic metabolites

58

Indications for metronidazole

Giardia, entamoeba, trichomonas, gardnerella, anaerobes, H. pylori

59

Toxicities of metronidazole

Metallic taste, disulfiram-like rxn

60

Drugs for TB

RIPE - rifampin, isoniazid, pyrazinamide, ethambutol

61

Drugs for MAI

Azithromycin, rifabutin

62

Drugs for M. leprae

Dapsone and rifampin (+ clofazimine for lepromatous form)

63

Mechanism of INH

Reduced synthesis of mycolic acids, activated by bacterial catalase peroxidase (encoded by KatG)

64

Toxicity of INH

B6 deficiency, neurotoxicity, hepatotoxicity

65

4 Rs of Rifampin

RNA poly inhibitor, ramps up p450, red/orange body fluids, rapid resistance

66

Mechanism of pyrazinamide

Unknown; accumulates in acidic pH of phagolysosomes

67

Toxicities of pyrazinamide

Hyperuricemia, hepatotoxicity

68

Mechanism of ethambutol

Reduced carbohydrate polymerization (blocks arabinosyltransferase)

69

Toxicity of ethambutol

Optic neuritis (red-green color blindness)

70

Choice prophylaxis for meningococcal infection

Ciprofloxacin (rifampin for peds)

71

MRSA treatments (5)

Linezolid, daptomycin, vancomycin, tigecycline, ceftaroline

72

VRE treatments (2)

Linezolid, steptogamins (quinupristin/dalfopristin)

73

Mechanism of amphotericin B

Binds ergosterol and punches holes in cell membrane

74

Indications for amphoterrible

Cryptococcus, blastomyces, coccidioides, histoplasma, candida, mucor; supplement K+/Mg+

75

Toxicities for amphoterrible

Fever/chills, hypotension, nephrotox, arrhythmias, anemia, IV phlebitis

76

Nystatin

Same as amphiterrible; used for oral candida (swish and spit) and diaper rash/vaginal candidiasis

77

Mechanism of azoles

Block conversion of lamosterol to ergosterol

78

Use of azoles

Local and less serious systemic mycoses; fluconazole for suppression of crypto meningitis in compromised patients

79

Toxicities of azoles

Testosterone synthesis inhibitors, inhibition of p450

80

Mechanism of flucytosine

Inhibits DNA/RNA biosynthesis (conversion to 5-FU by cytosine deaminase)

81

Indication for flucytosine

Systemic fungal infxns in combo with amphoterrible

82

Mechanism of echinocandins (-fungins)

Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan

83

Indication for echinocandins

Invasive aspergillosis, Candida

84

Toxicities of echinocandins

Flushing (histamine release), GI upset

85

Mechanism of terbafine

Inhibition of squalene epoxidase

86

Indication of terbafine

Dermatophytoses

87

Toxicities of terbafine

Gi upset, headaches, hepatotox, taste problems

88

Mechanism of griseofulvin

Accumulates in keratin; interferes with microtubule function

89

Toxicities of griseofulvin

Teratogenic, carinogenic, confusion, headaches, induces p450

90

Therapy for toxoplasmosis

Pyrimethamine

91

Therapy for t. brucei

suramin and melarsoprol

92

Therapy for T. cruzi

Nifurtimox

93

Therapy for leishmaniasis

Sodium stibogluconate

94

Mechanism of chloroquine

Blocks detoxification of heme into hemozoin

95

Toxicities of chloroquine

Retinopathy, pruritus

96

Therapy for flukes

Praziquantel

97

Mechanism of zanamivir/oseltamivir

Inhibit influenza NA

98

Mechanism of ribavarin

Inhibit synthesis of guanine nucleotides by inhibiting inosine monophosphate dehydrogenase

99

Indications for ribavarin

RSV, chronic Hep C

100

Toxicities of ribavarin

Teratogenic, hemolytic anemia

101

Mechanism of acyclovir/famciclovir/valacyclovir

Monophosphorylated by HSV/VSV thymidine kinase; guanosine analog; preferentially inhibits viral DNA poly by chain termination

102

Toxicity of acyclovir/famciclovir/valacyclovir

Crystalline nephrotoxicity, acute renal failure

103

Indication for acyclovir/famciclovir/valacyclovir

HSV/VSV, some EBV (not CMV)

104

Mechanism of gancyclovir

5' monophosphate formed by CMV viral kinase

105

Toxicity of gancyclovir

Leukopenia, neutropenia, thrombocytopenia, renal tox

106

Mechanism of foscarnet, cidofovir

Viral DNA poly inhibitor that binds to pyrophosphate-binding site (no activation required)

107

Indication for foscarent, cidofovir

CMV retinitis; acyclovir-resistant HSV

108

Toxicity of foscarnet, cidofovir

Renal tox

109

HAART initiated with CD4 counts below ___

500

110

HAART consists of _____

2 NRTIs and [ 1 NNRTI oooor 1 protease inhibitor ooor 1 integrase inhibitor ]

111

HIV protease inhibitors all end in ____

-navir

112

Special property of ritonavir issss ___

Inhibition of p450, raises amts of other drugs

113

Toxicity of protease inhibitors

Hyperglycemia, GI intolerance, lipdystrophy, hematuria, renal tox

114

NRTIs (7)

Zidovudine (ZDV/AZT), tenofovir (TDF), stavudine (d4T), lamivudine (3TC), emtricitabine (FTC), didanosine (ddI), abacavir (ABC)

115

Mechanism of NRTIs

Competitive inhibition of nucleotide binding to RT, terminate DNA chain (lack 3' OH group); must be phosphorylated to be active (ex. tenofovir, nucleotide already!)

116

Toxicity of NRTIs

BM suppression (give GM-CSF, epo), peripheral neuropathy, lactic acidosis, rash, anemia, pancreatitis

117

NNRTIs (3)

Efavirenz, nevirapine, delavirdine

118

Mechanism of NNRTIs

Bind to RT on different site than NRTIs; do not require phosphorylation for activity

119

Toxicity of NNRTIs

Rash, hepatotox, vivid dreams, SJS/TEN

120

Raltegravir

Inhibits integrase in HIV

121

Tox of raltegravir

Hypercholesterolemia

122

Fusion inhibitors (2)

Enfuvirtide (gp41), maraviroc (CCR5, blocks gp120)

123

IFNa used in ____

chronic hep B/C, kaposi's sarcoma, hairy cell leukemia, condyloma acuiminatum, RCC, malignant melanoma

124

IFNb used in ___

MS

125

IFN-gamma used in ___

CGD

126

Anti-pseudomonals (6)

4th gen penicillins, 3rd/4th generation cephalosporins, aminoglycosides, ciproflox/levoflox, aztreonam, imipenem + cilastatin