Multisystems Midterm Flashcards
(185 cards)
1
Q
Staphylococcus aureus
A
Gram + cocci in clusters Catalase + Coagulase + a/w acute endocarditis in IV drug abusers Large vegetations that destroy the valve, commonly tricuspid Secondary bronchopneumonia, blepharitis, conjuctivitis, endophthalmitis (post-surgical, post-trauma, hematogenous), otitis externa, sinusitis
2
Q
Streptococcus pneumoniae
A
Gram + diplococci Catalase - Alpha hemolytic Optochin sensitive Bile soluble Most common cause of community-acquired pneumonia Most common cause of bacterial meningitis in infants, children, adults a/w endocarditis in alcoholics, otitis media, conjuctivitis, sinusitis
3
Q
Haemophilus influenzae
A
Gram - coccobacilli Catalase + Oxidase + Culture on blood agar Requires factors X (hemin) and V (NAD) to grow Type b (Hib) is capsulated and causes meningitis in infants, epiglottitis, cellulitis, pneumonia (secondary, COPD), conjuctivitis, otitis media, sinusitis
4
Q
Respiratory Syncytial Virus (RSV)
A
Paramyxovirus Enveloped -ssRNA –> must bring RNA-dependent RNA polymerase Helical Replicates in cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse Replicates in the cytoplasm (syncitia) Pink cytoplasmic inclusions Causes URT, croup, bronchiolitis, pneumonia in infants Winter epidemic
5
Q
Klebsiella pneumoniae
A
Gram - rod Lactose fermenter Thick mucoid capsule –> current jelly suputum Pneumonia in malnourished, alcoholics, diabetics
6
Q
Pseudomonas aeruginosa
A
Gram - rod Lactose non-fermenter Oxidase + Smells like artificial grape Produces green pigment (pyocyanin) Causes pneumonia in CF patients, hot tub folliculitis, otitis externa, otitis media, UTIs, infectious keratitis, endophthalmitis (post-traumatic) Treat with aminoglycoside plus extended-spectrum penicillin (e.g. piperacilin)
7
Q
Legionella pneumophila
A
Gram - rod (gram stains poorly but can use silver stain) LPS can be detected in a urine sample Culture on charcoal yeast with iron and cysteine Causes GI symptoms + pneumonia (typical and atypical) Treat with macrolide or quinolone
8
Q
Mycoplasma pneumonia
A
Atypical pneumonia in young adults in close quarters
9
Q
Chlamydia pneumonia
A
Atypical pneumonia in young adults
10
Q
Cytomegalovirus
A
Enveloped, dsDNA virus May cause TORCH congenital infection: periventricular calcifications, sensorineural hearing loss Diagnose with nasal culture Atypical pneumonia in the immunosuppressed (e.g. HIV) Nuclear and cytoplasmic inclusions Treat with ganciclovir
11
Q
Mycobacterium tuberculosis
A
Gram + like (but won’t gram stain) Mycolic acid in cell envelope –> acid fast stain Aerobic Causes TB (can be latent, reactivated, miliary, disseminated) Characterized by Ghon complex in mid zone of lung (primary infection), caseating granuloma, or secondary infection (cavitary lesion in upper lobes) Can spread hematogenously and effect vertebrae and cranial nerves Treat with RIPE
12
Q
What kind of infections are associated with Candida?
A
Oral candidiasis, endophthalmitis, chorioretinitis, otitis externa
13
Q
What kind of infections are associated with aspergillus?
A
Endophthalmitis, chorioretinitis, otitis externa, chronic sinusitis
14
Q
Candida (C. albicans)
A
Yeast Pseudohyphae, true hyphae, germ tubes, and budding yeasts Can cause candidiasis (oral, esophageal) in immunocompromised patients Can cause yeast infections in women –> thick white discharge; treat with OTC azole-based ointments or oral fluconazole Treat disseminated candida with fluconazole, amphotericin B, or caspofungin
15
Q
What can cause a positive PPD test?
A
Current TB infection Past TB exposure BCG vaccination
16
Q
What can cause a false negative PPD test?
A
Steroid use Malnutrition Immunocompromised Sarcoidosis
17
Q
What can cause a positive PPD test?
A
Current TB infection Past TB exposure BCG vaccination
18
Q
What can cause a false negative PPD test?
A
Steroid use Malnutrition Immunocompromised Sarcoidosis
19
Q
Mycobacterium leprae
A
Acid-fast bacillus Likes cool temperatures so affects skin and nerve of the hands and feet Armadillos serve as reservoir Lepromatous form –> Th2 response; treat with dapsone, rifampin, clofazimine for 2-5 years Tuberculoid form –> Th1 response; treat with dapsone and rifampin for 6 months
20
Q
Aspergillus fumigatus
A
Mold fungus (not dimorphic) Hyphae branch at acute angles Causes invasive aspergillus, allergic bronchopulmonary aspergillosis (Type 1 hypersensitivity a/w asthma, CF), aspergillomas (esp. after TB), hepatocellular carcinoma (via aflatoxins)
21
Q
Pneumocystis jirovecii
A
Yeast that can’t be cultured Can cause pneumocystic pnemonia (PCP) in immunosuppressed patients Ground-glass appearance on CXR Treatment and prophylaxis with TMP-SMX Prophylaxis when CD4 counts
22
Q
Mucor
A
Mold Large hyphae branch at obtuse angles Causes mucormycosis, facial ischemia in diabetics and leukemic patients –> fungi proliferate in blood vessels when glucose and ketones are high Can penetrate brain Treat with amphotericin B, poscanazole
23
Q
Rubella virus
A
Togavirus Enveloped +ssRNA Icosahedral pH-dependent endocytosis Causes fever, lymphadenopathy, arthralgias, and fine rash that starts on the face and spreads to the rest of the body (first manifestation) Can cause TORCH infection in newborns (transplancental, esp. 1st trimester) –> petechial rash, deafness, blindness/cataracts, heart and brain defects
24
Q
Polio virus
A
Pircornavirus Non-enveloped +ssRNA Icosahedral
25
Parainfluenza
Paramyxovirus Enveloped -ssRNA --\> must bring RNA-dependent RNA polymerase Helical Replicates in the cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse (syncitia) Causes croup Autumn epidemic
26
Measles
Paramyxovirus Enveloped -ssRNA --\> must bring RNA-dependent RNA polymerase Helical Replicates in the cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse (syncitia) Koplik spots (red spots with blue-white center on buccal mucosa) precede descending maculopapular rash (CTL response) Sequelae include: post-infectious encephalitis, acute disseminated encephalomyelitis (ADEM), measles inclusion body encephalitis (MIBE), subacute sclerosing panencephalitis (SSPE), giant cell pneumonia (in immunosuppressed)
27
Mumps
Paramyxovirus Enveloped -ssRNA --\> must bring RNA-dependent RNA polymerase Helical Replicates in the cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse (syncitia) Causes parotitis, orchitis (usually unilateral, can cause infertility in teenagers), meningitis
28
What respiratory infections are associated with AIDS?
CMV pneumonia Aspergilllosis Pneumocystis peumonia --\> Pneumocystis jirovecii Pneumonia --\> S. pneumoniae TB-like disease --\> Mycobacterium avium-intracellulare (Mycobacterium avium complex [MAC])
29
Mycobacterium avium-intracellulare
Causes TB-like disease --\> Mycobacterium avium complex (MAC) When CD4 count
30
What are dermatologic infections associated with AIDS?
Candidiasis of mouth, esophagus Hairy leukoplakia on lateral tongue --\> EBV Bacillary angiomatosis --\> Bartonella henselae
31
What are neurologic infections associated with AIDS?
Ring-enhancing lesions --\> Toxoplasma gondii Dementia Encephalopathy --\> JC virus reactivation Meningitis --\> cryptococcus neoformans Retinitis --\> CMV (cotton-wool spots)
32
What are oncologic disease associated with AIDS?
Non-Hodgkin lymphoma --\> EBV Primary CNS lymphoma --\> EBV Squamous cell carcinoma of rectum or cervix --\> HPV Kaposi sarcoma --\> HHV-8
33
What respiratory infections are associated with AIDS?
CMV pneumonia Aspergilllosis Pneumocystis peumonia --\> Pneumocystis jirovecii Pneumonia --\> S. pneumoniae TB-like disease --\> Mycobacterium avium-intracellulare (Mycobacterium avium complex [MAC])
34
Mycobacterium avium-intracellulare
Causes TB-like disease --\> Mycobacterium avium complex (MAC) When CD4 count
35
What are dermatologic infections associated with AIDS?
Candidiasis of mouth, esophagus Hairy leukoplakia on lateral tongue --\> EBV Bacillary angiomatosis --\> Bartonella henselae
36
What are neurologic infections associated with AIDS?
Ring-enhancing lesions --\> Toxoplasma gondii Dementia Encephalopathy --\> JC virus reactivation Meningitis --\> cryptococcus neoformans Retinitis --\> CMV (cotton-wool spots)
37
What are oncologic disease associated with AIDS?
Non-Hodgkin lymphoma --\> EBV Primary CNS lymphoma --\> EBV Squamous cell carcinoma of rectum or cervix --\> HPV Kaposi sarcoma --\> HHV-8
38
Human Immunodeficiency Virus (HIV)
Retrovirus 2 copies +ssRNA Enveloped Reverse transcriptase
39
Herpes Simplex Virus (HSV)
Enveloped, dsDNA virus Infects mucosa epithelial cells Causes vesicles or ulcers on mouth, genitals Can cause congenital herpes, keratitis Treat with acyclovir, valacyclovir, ganciclovir
40
Acyclovir
Treats herpes infections (HSV-1, HSV-2, VZV) Guanosine analog --\> primary phosphorylation by viral thymidine kinase --\> inhibits viral DNA polymerase by chain termination
41
Valacyclovir
Treats herpes infections (HSV-1, HSV-2, VZV) Guanosine analog --\> primary phosphorylation by viral thymidine kinase --\> inhibits viral DNA polymerase by chain termination Prodrug of acyclovir, activated in the liver, higher bioavailability
42
Which anti-retrovirals have activity against HBV?
Lamivudine (NRTI) Tenofovir (Nucleotide RTI) Emtricitabine (NRTI)
43
Hepatitis B virus
Enveloped, circular DNA virus Parenteral, sexual, maternal-fetal transmission HBV DNA polymerase has DNA and RNA-dependent functions HBV DNA polymerase completes partial dsDNA --\> incorporated into host genome --\> host RNA polymerase makes mRNA --\> HBV DNA polymerase reverse transcribes mRNA into DNA to form new viral particle
44
Hepatitis C virus
RNA flavivirus Transmitted via blood (IVDU, post-transfusion), sex Causes cirrhosis, hepatocellular carcinoma Treat with INFα, ribavirin, sofosbuvir
45
Zidovudine (AZT)
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Used as prophylaxis or treatment of HIV; safe in pregnancy to reduce transmission Side effects include lactic acidosis, macrocytic anemia, neutropenia
46
Emtricitabine
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Treats HIV and HBV Side effects include lactic acidosis
47
Abacavir
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Treats HIV Need to genotype patient to prevent hypersensitivity reaction Side effects include lactic acidosis
48
Lamivudine
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Treats HIV and HBV Safe during pregnancy Side effects include lactic acidosis
49
Didanosine
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Treats HIV Side effects include lactic acidosis, pancreatitis, peripheral neuropathy
50
Stavudine
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Side effects include lactic acidosis, pancreatitis, peripheral neuropathy
51
Tenofovir
Nucleotide Reverse Transcriptase Inhibitor (NRTI) Doesn't require primary phosphorylation so effective in resting cells Nephrotoxic (Fanconi's syndrome --\> phosphaturia, glucosuria)
52
Nevirapine
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Prophylaxis in pregnancy Side effects include rash, hepatotoxicity, drug-drug interactions (CYP3A4), Stevens Johnson Syndrome
53
Rilpivirine
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Side effects include rash, hepatotoxicity, drug-drug interactions (CYP3A4) Contraindicated with other NNRTIs due to cross resistance
54
Etravirine
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Recommended for patients with resistance to other NNRTIs Side effects include rash, hepatotoxicity, unpredictable drug-drug interactions (CYP3A4)
55
Efavirenz
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Side effects include rash, hepatotoxicity, drug-drug interactions (CYP3A4), vivid dreams, CNS symptoms Contraindicated in pregnancy
56
Delavirine
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Side effects include rash, hepatotoxicity, drug-drug interactions (CYP3A4) Contraindicated in pregnancy
57
Maraviroc
Inhibits binding of gp120 to CCR5 Not effective if CXCR4 tropism
58
Enfuviritide
Locks gp41 in extended conformation Injected subcutaneously
59
Raltegravir
Integrase inhibitor Side effects include hypercholesterolemia
60
Atazanavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities Lower incidence of lipodystrophy
61
Darunavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities Given with rotinavir
62
Fosamprenavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities
63
Indinavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities, nephropathy (nephrolithiasis)
64
Lopinavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities Given with rotinavir Recommended during pregnancy
65
Ritonavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities Recommended during prenancy Strongly inhibits CYP3A4
66
Saquinavir
HIV Protease inhibitor Side effects include lipodystrophy, dyslipidemia, hyperglycemia, insulin resistance, cardiac conduction abnormalities
67
Ribavirin
Inhibits HCV, RSV purine biosynthesis and interferes with RNA metabolism Use with IFNα Side effect include hemolytic anemia Contraindicated in pregnancy
68
Sofosbuvir
Inhibits HCV RNA synthesis by inhibiting polymerase Genotyping to determine if combination therapy needed (IFNα and ribavirin)
69
Boceprevir
HCV protease inhibitor Use with IFNα and ribavarin
70
Telaprevir
HCV protease inhibitor Use with IFNα and ribavarin
71
Simeprevir
HCV protease inhibitor Use with IFNα and ribavarin
72
Trimethoprim/Sulfamethoxazole (TMP-SMX)
Antibiotic Treatment and prevention of PCP in HIV+ patients Side effects include N/V, fever, rash, neutropenia, thrombocytopenia
73
Pentamidine
IV form treats PCP Aerosolized form is PCP prophylaxis (but not protection against disseminated PCP or toxo) Side effects include nephrotoxicity, hypoglycemia, hepatotoxicity, hypotension, pancreatitis, prolong QT (torsades), low magnesium
74
Dapsone
Inhibits synthesis of dihydrofolic acid Treatment or prophylaxis for PCP (also protects against toxo) Treatment for Hansen's disease Comes in liquid form Check for G6PD deficiency --\> hemolytic anemia Side effect include rash, fever, bone marrow suppression Contraindicated in patients with a sulfa allergy
75
Cryptococcus neoformans
Yeast Large capsule Found in soil, pigeon droppings Can cause meningitis, pneumonia
76
MMR Vaccine
Live-attenuated vaccine against measles, mumps, and rubella Rubella component may induce arthralgias
77
Parvovirus B19
Icosahedral, nonenveloped, ssDNA Virus is transmitted through respiratory droplets and infects RBC precursors Causes erythema infectiosum (slapped cheek rash), aplastic crisis in people with chronic hemolytic anemia, hydrops fetalis, polyarthritis (esp. in adult women) Can cross placenta
78
Roseola
Caused by HHV-6 and HHV-7 Causes infectious mononucleosis, febrile seizures Causes fever, encephalitis, pneumonitis in immunocompromised
79
Varicella
Caused by varicella zoster virus Primary infection = chickenpox; vesicular lesions of different ages Recurrent infection = shingles; vesicular lesions in dermatomal distribution
80
For which viruses are there live attenuated vaccines?
Vaccinia Polio Yellow fever Measles Mumps Rubella Rotavirus Adenovirus Varicella
81
From which viruses are there killed vaccines?
Rabies Polio Influenza Hepatitis B Hepatitis A Japanese encephalitis Papilloma
82
What viruses are associated with a maculopapular rash?
Measles Rubella Scarlet fever Roseola Parvovirus B19 Rash-associated enteroviruses
83
Bordetella pertussis
Gram - coccobacilli Encapsulated Requires fatty acid for culture (Bordet-Gengou agar or Regan Lowe charcoal with horse blood) Colonizes ciliated bronchial epithelia --\> tracheal cytotoxin damages epithelium --\> activation of adeylyl cyclase increases cAMP thus increasing fluid secretion (pertussis toxin) --\> pertussis toxin causes systemic problems without bacteremia Causes pertussis (whooping cough) DTaP vaccine for children
84
Corynebacterium diphtheriae
Gram + rod Catalase + "Chinese letters" Causative agent of diphtheria Pseudomembrane may occlude airways The toxin can be cleaved into a fragment that catalyzes the NAD+ -dependent ADP-ribosylation of elongation factor 2, thereby inhibiting protein synthesis Treat with horse antitoxin Prevent with DTaP vaccine
85
Escherichia coli
Gram - rod Lactose-fermenting Pink on MacConkey agar
86
Klebsiella pneumoniae
Gram - rod Lactose-fermenting Pink on MacConkey agar Mucoid colonies
87
Clostridium difficile
Gram + Spore-forming (resistant to alcohol-based antiseptics) Toxin mediates watery diarrhea, leukocytosis, and psueomembranous colitis
88
Acinetobacter baumannii
Gram - rod Non-lactose fermenting (non-pink colonies on MacConkey agar) Can cause nosocomial pneumonia, bacteremia, wound infections, UTIs
89
Isoniazid
Inhibits synthesis of mycolic acids in the cell wall of mycobacterium TB treatment and prophylaxis Side effects include neuropathy --\> take concurrently with pyridoxine (vitamin B6), interactions with phenytoin
90
Rifampin
Inhibits bacterial DNA-dependent RNA-polymerase Treats TB Prophylaxis against H. influenza meningitis and staph Lots of drug interactions Side effects include orange-red discoloration of urine, feces, saliva
91
Ethambutol
Inhibits arabinogalactan synthesis Treats TB Avoid in children May cause optic neuritis (decreased visual acuity and red-green colorblindness)
92
Pyrazinamide
Inhibits fatty acid synthetase 1 Treats TB Side effects include hepatotoxicity, gouty and non-gouty arthralgia
93
Clofazimine
May inhibit template function of DNA Treats lepromatous Hansen's disease Side effects include red discoloration of the skin
94
Cyclosporine A
Calcineurin inhibitor prevents NFAT-mediated transcription of IL-2 Prevents acute rejection of solid organs and GVHD, RA, chronic dry eye Side effects include nephrotoxicity, drug interactions
95
Tacrolimus
Binds FKBP-12 that inhibits calcineurin Prevents acute rejection of solid organs, atopic dermatitis Less nephrotoxic than CsA
96
Sirolimus (rapamycin)
Binds FKBP-12 that inhibits mTOR and blocks transcription and translation of IL-2 Prevents renal allograft rejection (no nephrotoxicity) Contraindicated in liver/lung transplants
97
Mycophenolate mofetil (MMF)
Prodrug hydrolyzed by liver to MPA which inhibits de novo purine biosynthesis Used for kidney, heart, liver transplants, esp. with calcineurin inhibitor toxicity
98
Azathioprine
Metabolized to 6-mercaptopurine and disrupts de novo purine synthesis Prevents organ rejection, treats severe RA
99
Methotrexate
Folic acid analogue inhibits dihydrofolate reductase to reduce nucleoside biosynthesis First line RA treatment (DMARD) Contraindicated in pregnancy
100
Sulfasalazine
Scavenger of ROS produced by neutrophils Treats RA, Chron's
101
Penicillamine
Prevents IL-1 generation and collagen maturation Metal chelator Treats RA, Wilson's disease, heavy metal poisoning Contraindicated in pregnancy and renal disease
102
Chloroquine
Anti-malarial drug perturbs lysosomal processing and antigen presentation Treats RA Side effects include ocular toxicity
103
Leflunomide
Prodrug whose active metabolite inhibits dihydroorotate dehydrogenase essential in pyrimidine biosynthesis Treats RA
104
Tofacitinib
JAK inhibitor inhibits cytokine signaling (common gamma chain) Treats RA that fails MTX
105
Daclizumab
Anti-CD25 of IL-2 receptor Reduces risk of acute rejection in kidney and cardiac transplantation
106
Basiliximab
Anti-CD25 of IL-2 receptor Reduces risk of acute rejection in kidney and cardiac transplantation May have acute hypersensitivity
107
Infliximab
Anti-TNF Treats Chron's, ulcerative colitis, RA, psoriasis
108
Etanercept
Anti-TNF Treats Chron's, ulcerative colitis, RA, psoriasis
109
Adalimumab
Anti-TNF Treats Chron's, ulcerative colitis, RA, psoriasis
110
Abatacept
CTLA4 and IgG1 Fc chimera binds CD80/86 (B7) on APCs to prevent T cell costimulation through CD28 engagement Treats RA
111
Muromonab
Anti-CD3 on TCR Reverses rejection of heart, liver, kidney transplants Side effects include hypersensitivity and activation of T cells
112
Anakinra
IL-1 receptor antagonist Treats RA Increased risk of serious bacterial infections
113
Tocilizumab
Anti-IL-6 receptor Treats RA
114
Rituximab
Anti-CD20 Treats RA, non-Hodgkin's lymphoma, CLL
115
Natalizumab
Anti-VLA4 inhibits lymphocyte migration to sites of inflammation Treats Chron's disease and MS a/w JC virus-induced PML
116
Omalizumab
Anti-IgE Fc (won't cross-link IgE already bound) --\> Type I HS Treats allergic asthma unresponsive to corticosteroids
117
Fingolimod
Binds sphingosine-1 phosphate receptors to prevent lymphocytes from migrating out of lymph nodes Treats MS Increased risk of fatal infections
118
IFN-β
Decreases T cell proliferation and activation and inhibits leukocyte migration across BBB Treats MS
119
Epoetin alpha
EPO analogue stimulated formation of RBCs
120
Darbepoetin alpha
EPO analogue stimulated formation of RBCs Longer half-life than epoetin alpha
121
Filgastrim
G-CSF stimulated neutrophil proliferation and maturation
122
Penicillin G
Penicillinase-sensitive penicillin (β-lactam) IV or IM Bactericidal for G (+/-) Cocci / G (+) Rods / Spirochetes Hypersensitivity, hemolytic anemia
123
Penicillin V
Penicillinase-sensitive penicillin (β-lactam) Oral Bactericidal for G (+/-) Cocci / G (+) Rods / Spirochetes Hypersensitivity, hemolytic anemia
124
How do β-lactam antibiotics work?
Antibiotic binds penicillin-binding proteins (transpeptidases) that blocks cross-linking of peptidoglycans --\> inhibits cell wall synthesis
125
Ampicillin
Extended spectrum penicillinase-sensitive penicillin (β-lactam) Same as Penicillin / Haemophilus / E. Coli / Listeria / Salmonella / Shigella Hypersensitivity reactions, rash, pseudomembranous colitis
126
Amoxicillin
Extended spectrum penicillinase-sensitive penicillin (β-lactam) Same as Penicillin / Haemophilus / E. Coli / Listeria / Salmonella / Shigella Hypersensitivity reactions, rash, pseudomembranous colitis
127
Oxacillin
Penicillinase-resistant penicillin (β-lactam) G (+) Cocci: S. aureus Hypersensitivity, interstitial nephritis
128
Nafcillin
Penicillinase-resistant penicillin (β-lactam) G (+) Cocci: S. aureus Hypersensitivity, interstitial nephritis
129
Dicloxacillin
Penicillinase-resistant penicillin (β-lactam) G (+) Cocci: S. aureus Hypersensitivity, interstitial nephritis
130
Ticarcillin
Penicillinase-sensitive antipseudomonal penicillin (β-lactam) Pseudomonas spp. / Gram (-) Rods Hypersensitivity
131
Piperacillin
Penicillinase-sensitive antipseudomonal penicillin (β-lactam) Pseudomonas spp. / Gram (-) Rods Hypersensitivity
132
Clavulanic acid
β-lactamase inhibitor
133
Sulbactam
β-lactamase inhibitor
134
Tazobactam
β-lactamase inhibitor
135
Cephazolin
1st generation cephalosporin IV or IM G (+) Cocci / Proteus Mirabilis / E. Coli / Klebsiella pneumoniae / Used prior to surgery to prevent S. aureus
136
Cephalexin
1st generation cephalosporin G (+) Cocci / Proteus Mirabilis / E. Coli / Klebsiella pneumoniae
137
Cefoxitin
2nd generation cephalosporin G (+) Cocci / H. Flu, Enterobacter, Neisseria, Proteus, E. Coli, Klebsiella, Serratia
138
Cefaclor
2nd generation cephalosporin G (+) Cocci / H. Flu, Enterobacter, Neisseria, Proteus, E. Coli, Klebsiella, Serratia
139
Cefuoxime
2nd generation cephalosporin G (+) Cocci / H. Flu, Enterobacter, Neisseria, Proteus, E. Coli, Klebsiella, Serratia
140
Ceftriaxone
3rd generation cephalosporin Serious G (-) / meningitis / gonorrhea
141
Cefotaxime
3rd generation cephalosporin Serious G (-)
142
Ceftazidime
3rd generation cephalosporin Serious G (-) / Pseudmonas
143
Cefipime
4th generation cephalosporin G (+) / Pseudomonas
144
Ceftaroline
5th generation cephalosporin Gram (+/-) / MRSA
145
Azotreonam
Monobactam Resistant to β-lactamase Gram (-) rods only Synergistic with aminoglycosides
146
Imipenem
Carbapenem Resistant to β-lactamase G (+) Cocci / G (-) Rods / Anaerobes Always give with cilastatin which slows inactivation of drug in kidney
147
Meropenem
Carbapenem Resistant to β-lactamase G (+) Cocci / G (-) Rods / Anaerobes
148
Ertapenem
Carbapenem Resistant to β-lactamase G (+) Cocci / G (-) Rods / Anaerobes
149
Doripenem
Carbapenem Resistant to β-lactamase G (+) Cocci / G (-) Rods / Anaerobes
150
Vancomycin
Glycopeptide G (+) / C.diff / MRSA / enterococci Gram + because too big to fit into porin channels Nephrotoxicity, ototoxicity, thrombophlebitis Red man syndrome if infusion rate too fast
151
Bacitracin
Glycopeptide G (+/-)
152
How do glycopeptides work?
Binds to D-ala-D-ala portion of cell wall precursors which inhibits cell wall synthesis
153
Gentamicin
Aminoglycoside G (-) Rods (severe) Synergistic with β-lactams Nephrotoxic, ototoxic, neuromuscular blockage, teratogenic
154
Neomycin
Aminoglycoside G (-) Rods (severe) / bowel surgery Synergistic with β-lactams Nephrotoxic, ototoxic, neuromuscular blockage, teratogenic
155
Amikacin
Aminoglycoside G (-) Rods (severe) Synergistic with β-lactams Nephrotoxic, ototoxic, neuromuscular blockage, teratogenic
156
Tobramycin
Aminoglycoside G (-) Rods (severe) Synergistic with β-lactams Nephrotoxic, ototoxic, neuromuscular blockage, teratogenic
157
Streptomycin
Aminoglycoside G (-) Rods (severe) Synergistic with β-lactams Nephrotoxic, ototoxic, neuromuscular blockage, teratogenic
158
How do aminoglycosides work?
Inhibits formation of the initiation complex (30S) and causes misreading of mRNA
159
Tetracycline
Tetracycline M. pneumoniae / Rickettsia / Chlamydia Discoloration of teeth, inhibition of bone growth in children, photosensitivity Contraindicated in pregnancy Avoid milk, antacids (divalent cations inhibit absorption)
160
Doxycycline
Tetracycline M. pneumoniae / Rickettsia / Chlamydia Discoloration of teeth, inhibition of bone growth in children, photosensitivity Contraindicated in pregnancy Avoid milk, antacids (divalent cations inhibit absorption)
161
Minocycline
Tetracycline M. pneumoniae / Rickettsia / Chlamydia Discoloration of teeth, inhibition of bone growth in children, photosensitivity Contraindicated in pregnancy Avoid milk, antacids (divalent cations inhibit absorption)
162
How do tetracyclines work?
Binds to 30S and prevents attachment of aminoacyl-tRNA
163
Azithromycin
Macrolide Atypical Pneumonias (mycoplasma, chlamydia, legionella) / Chlamydia / G (+) cocci / Strep infections in pts allergic to penicillin May cause GI motility issues, arrhythmia (prolonged QT), cholestatic hepatitis, rash, eosinophilia
164
Clarithromycin
Macrolide Atypical Pneumonias (mycoplasma, chlamydia, legionella) / Chlamydia / G (+) cocci / Strep infections in pts allergic to penicilin May cause GI motility issues, arrhythmia (prolonged QT), cholestatic hepatitis, rash, eosinophilia
165
Erythromycin
Macrolide Atypical Pneumonias (mycoplasma, chlamydia, legionella) / Chlamydia / G (+) cocci / Strep infections in pts allergic to penicilin May cause GI motility issues, arrhythmia (prolonged QT), cholestatic hepatitis, rash, eosinophilia
166
How to macrolides work?
Binds to 50S and blocks translocation to prevent protein synthesis
167
Chloramphenicol
Blocks peptidyltransferase at 50S subunit Meningitis (H. flu, N. meningitides, S. pneumo), Rickettsia (Rocky Mtn Spotted Fever) Anemia, gray baby syndrome in premature infants
168
Clindamycin
Prevents translocation at 50S Anaerobic infections: Bacteroides spp., Clostridium perfringens / GAS May cause psudomembranous colitis (C. diff), fever, diarrhea
169
Sulfamethozaxole (SMX)
Sulfonamide Inhibits folate synthesis G (+/-), Nocardia, Chlamydia, UTIs Hypersensitivity, hemolysis if G6PD deficient, nephrotoxicity, kernicterus in infants, Stevens-Johnson Syndrome
170
Trimethoprim (TMP)
Inhibits dihydrofolate reductase Use with SMX G (+/-), UTIs, Shigella, Salmonella, Pneumonocystis jirovecii pneumonia (tx/prophylactic), toxoplasmosis (prophylactic) Megaloblastic leukemia, leukopenia, granulocytopenia --\> can supplement with folic acid
171
Ciprofloxacin
Fluoroquinolone G (-) Rods / UTI / Pseudomonas / Neisseria / Some G (+) May cause tedonitis, myalgias Contraindicated in pregnancy, nursing mothers, children
172
Levofloxacin
Fluoroquinolone G (-) Rods / UTI / Pseudomonas / Neisseria / Some G (+) May cause tedonitis, myalgias Contraindicated in pregnancy, nursing mothers, children
173
How do fluoroquinolones work?
Inhibits DNA gyrase (topoisomerase II) and topoisomerase IV
174
Nalidixic acid
Quinolone G (-) Rods / UTI / Pseudomonas / Neisseria / Some G (+) May cause tedonitis, myalgias Contraindicated in pregnancy, nursing mothers, children
175
Metronidazole
Forms free radical toxic metabolites that damage bacterial and protozoal DNA Giardia, Entamoeba, Trichomonas / Gardnerella vaginalis, Anaerobes, H. Pylori
176
Which antibiotics are concentration-dependent?
Aminoglycosides Daptomycin Quinolones
177
Which antibiotics are time-dependent?
β-lactams Vancomycin
178
Which antibiotics are AUC?
Chloramphenicol Clindamycin Tetracycline Glycopeptides Macrolides Sulfonamides
179
Linezolid
Oxazolidinone Binds 50S preventing formation of initiation complex Gram (+) / MRSA
180
Which antibiotics are bactericidal?
β-lactams Aminoglycosides Vancomycin (variable) Daptomycin (variable) Fluoroquinolones Metronidazole Type B streptogramins Nitrofurantoin Rifamycins
181
Which antibiotics are bacteriostatic?
Macrolides Tetracylines Sulfonamides Chloramphenicol (variable) Clindamycin Trimethoprim Linezolid
182
Belatacept
CTLA4 and IgG1 Fc chimera binds CD80/86 (B7) on APCs to prevent T cell costimulation through CD28 engagement Cobo therapy for transplants
183
Belimumab
Anti-BAFF (anti-B cell) Treats SLE
184
Golimumab
Anti-TNF Treats Chron's, ulcerative colitis, RA, psoriasis
185
How do you treat anaphylaxis?
Avoid the trigger OR IM epinephrine to reverse bronchoconstriction and vasodilation Remove antigen Anti-histamines Corticosteroids IV fluids to counteract hypotension
