Term
| generation of penicillins that are lactamase-resistant |
|
Definition
| 2nd gen (methicillin, nafcillin, oxacillin) |
|
|
Term
| use penicillinase inhibitors with this generation of penicillins |
|
Definition
3rd gen (ampicillin, amoxicillin)
Ex: clavulanic acid, sulbactam, tazobactam |
|
|
Term
| Penicillins that are "antipseudomonal" |
|
Definition
|
|
Term
| major SE of 3rd gen penicillins |
|
Definition
| C.diff colitis (ampicillin, amoxicillin) |
|
|
Term
|
Definition
|
|
Term
| name the beta lactamase inhibitors (3) |
|
Definition
| clavulanic acid, sulbactam, tazobactam |
|
|
Term
| exception to the "ph" rule for cephalosporins |
|
Definition
| cefazolin (only 1st gen to not have a "ph" in it) |
|
|
Term
| 3rd gen cephalosporin that is too lipid soluble (and thus too protein bound) to cross BBB |
|
Definition
|
|
Term
| prophylaxis for gonorrhea |
|
Definition
|
|
Term
| always safe in meningitis treatment |
|
Definition
| 3rd gen cephalosporin (esp ceftriaxone); exception is cefoperazone |
|
|
Term
| cephalosporin used for pseudomonas |
|
Definition
|
|
Term
| cephalosporins with disulfiram-like effect |
|
Definition
| those w/ methylthiotetrazole group (e.g. cefamandole, cefoperazone) |
|
|
Term
| what type of penicillin allergy contraindicates the use of cephalosporins? |
|
Definition
| anaphylaxis (but not rash) |
|
|
Term
|
Definition
|
|
Term
|
Definition
- imipenem (remember, always with cilastatin)
- meropenem |
|
|
Term
|
Definition
| renal dihydropeptidase 1 inhibitor: prevents imipenem (a carbapenem) from too quick of a degradation & renal excretion |
|
|
Term
| Which is used in pts w/ G(-) infection, with a penicillin allergy, and a decreased GFR? |
|
Definition
Aztreonam (monobactam): used when there is a penicillin allergy, and aminoglycosides can't be used because of decreased renal function
Is a possible Tx for pseudomonas |
|
|
Term
| MOA of aztreonam (a monobactam) |
|
Definition
| similar to penicillins: binds to PBP3 & is resistant to beta lactams |
|
|
Term
| a penicillin-like drug that is synergistic with aminoglycosides |
|
Definition
|
|
Term
|
Definition
| vancomycin (administered too fast) |
|
|
Term
| red man syndrome prevention |
|
Definition
| slow infusion & antihistamines |
|
|
Term
T/F for side effects of Vanco:
Ototoxicity
Hepatotoxicity
Nephrotoxicity
Thrombophlebitis
Myalgias
Tendonitis
Osteomalacia
Chills/fever |
|
Definition
T- Ototoxicity
F- Hepatotoxicity
T- Nephrotoxicity
T- Thrombophlebitis
F- Myalgias
F- Tendonitis
F- Osteomalacia
T- Chills/fever |
|
|
Term
| mechanism of resistance to vanco |
|
Definition
| change D-ala D-ala to D-ala D-lac |
|
|
Term
| protein synthesis inhibitor that is bacteriocidal |
|
Definition
|
|
Term
| Use these protein synthesis inhibitor in combination w/ beta lactams & aztreonam |
|
Definition
|
|
Term
| aminoglycoside used in bowel surgery |
|
Definition
| neomycin (b.c. it's poorly absorbed) |
|
|
Term
protein synthesis inhibitors that are chelators of divalent cations?
What is the implication of this? |
|
Definition
Tetracyclines (can't give with meals)
(as a side-note, fluoroquinolones are also mild chelators, and cannot be coadministered w/ antacids) |
|
|
Term
| PSI that shouldn't be used when expired? |
|
Definition
| Tetracyclines, they cause Fanconi's syndrome (proximal tubule dysfunction, mechanism unknown) |
|
|
Term
|
Definition
|
|
Term
| Tetracycline used in renal failure? why? |
|
Definition
| doxycycline; because it is completely fecally eliminated |
|
|
Term
|
Definition
| methylation of binding site on 30S (23S rRNA) |
|
|
Term
Tx for atypical pneumonias
list the atypical pneumonias (3) |
|
Definition
Macrolides
chlamydia pneumoniae, mycoplasma pneumoniae, legionella pneumoniae |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| cholestasis (cholestatic hepatitis) |
|
Definition
|
|
Term
| PSI with Eosinophilia & skin rash |
|
Definition
|
|
Term
|
Definition
| Chloramphenicol (from insufficient glucuronyl transferase in neonates) |
|
|
Term
| PSI causing anemia & aplastic anemia from bone marrow supression? |
|
Definition
|
|
Term
| reserved for severe salmonella & bacterial meningitis in beta-lactam sensitive patients |
|
Definition
|
|
Term
| what is the spectrum of chloramphenicol? |
|
Definition
| very wide (but limited b.c. of side effects) |
|
|
Term
what is the resistance for chloramphenicol?
What is it carried on? |
|
Definition
acetyl transferase that inactivates the drug
plasmid |
|
|
Term
| mechanism of resistance for tetracycline |
|
Definition
|
|
Term
| contraindicated in pregnancy because it decreases bone growth |
|
Definition
| tetracyclines (remember, they are chelators) |
|
|
Term
|
Definition
| tetracyclines (chelators) |
|
|
Term
| Fanconi's syndrome when expired |
|
Definition
|
|
Term
| Hepato & vestibular toxicities; mechanism of resistance is increased transport pumps. PSI |
|
Definition
|
|
Term
| #1 reason for noncompliance noncompliance with macrolides |
|
Definition
| GI distress (remember it is pro-kinetic) |
|
|
Term
| PSI that will increase coumadin concentrations |
|
Definition
| macrolides (p450 inhibitor) |
|
|
Term
|
Definition
| narrow: anaerobic infections (ABC) such as those caused by aspirational pneumonia |
|
|
Term
| most important side effect of clindamycin |
|
Definition
|
|
Term
| mechanism of resistance of clindamycin |
|
Definition
| methylation of 30S (same as macrolides) |
|
|
Term
| How is aminoglycoside resistance carried? |
|
Definition
| Plasmid-mediated (group transferases) |
|
|
Term
| ethacrynic acid and aminoglycosides share this side effect |
|
Definition
| ototoxicity (all loop diuretics) |
|
|
Term
| This side effect is a major problem when aminoglycosides are combined with cephalosporins |
|
Definition
|
|
Term
| PSI that causes MAO inhibition & thrombocytopenia |
|
Definition
| Oxazolidinones (e.g. linezolid) |
|
|
Term
|
Definition
| VRSA (e.g. Linezolid, a PSI) |
|
|
Term
| MOA of sulfonamides (what else shares this?) |
|
Definition
inhibits dihydropteroate synthase
p-aminosalicylic acid (PAS) and pyramethamine (an antiprotozoal for P.falciparum & toxo) |
|
|
Term
| 3 mechanisms of resistance to sulfonamides |
|
Definition
1) altered dihydropteroate synthase
2) decreased uptake
3) increased PABA synthesis |
|
|
Term
| hemolytic anemia in G6PD def. Kernicterus in newborns b.c. it displaces unconjugated bilirubin from albumin. |
|
Definition
|
|
Term
| Tubulointerstitial nephritis from this folate inhibiting drug |
|
Definition
|
|
Term
|
Definition
| inhibits dihydrofolate reductase |
|
|
Term
| why is TMP good for UTIs? |
|
Definition
| b.c. it is excreted unchanged into the urine |
|
|
Term
Drug causing: megaloblastic anemia, leukopenia, granulocytopenia.
Hint: it is an antibacterial, it isn't a penicillin or PSI |
|
Definition
|
|
Term
what is the common denominator for these drugs:
Furosemide, clelcoxib, probenecid, acetazolamide |
|
Definition
| they are all sulfa drugs (that don't have "thio" or "sulf" in the name |
|
|
Term
| are fluoroquinolones bacteriocidal or bacteriostatic? |
|
Definition
|
|
Term
| don't take this antibiotic with antacids (not tetracycline) |
|
Definition
| fluoroquinolones (weak divalent cation chelator) |
|
|
Term
Drug that causes tendonitis & tendon rupture in adults?
(what do you get in kids?) |
|
Definition
Fluoroquinolones
Myalgias & leg cramps
These drugs are contraindicated in preganancy because of the connective tissue issues |
|
|
Term
| 2 mechanism of resistance for fluoroquinolones |
|
Definition
1) chromosomal mutation in DNA gyrase
2) efflux pumps |
|
|
Term
| T/F: metronidazole is bacteriostatic? |
|
Definition
|
|
Term
| Protozoal infections that you use metronidazole for? |
|
Definition
Trichomonas vaginalis
Giardia lamblia
Entameoba histolitica |
|
|
Term
| what anaerobe can't you use metronidazole on? |
|
Definition
| actinomyces (good for the others, though) |
|
|
Term
|
Definition
Bismuth, metronidazole, tetracycline (or amoxicillin)
used for elimination of H.pylori (the cheaper drug regimin). The other regimin is Omeprazole, amoxicillin, and clarithromycin. |
|
|
Term
| H pylori eradication protocols? |
|
Definition
BMT
Amoxicillin, Clarithromycin, Omeprazole
usually no longer than 14 days |
|
|
Term
|
Definition
| pokes holes in bacteria (cationic detergent; used in thayer martin media to eliminate G(-) rods) |
|
|
Term
|
Definition
| very resistant pseudomonas |
|
|
Term
|
Definition
| neurotoxicity & acute tubular necrosis |
|
|
Term
| Possible drugs used for Tx of TB (5) |
|
Definition
RIPE & streptomycin
rifampin, INH, ethambutol, pyrazinamide |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| drugs used for Tx of M.leprae (3) |
|
Definition
| Dapsone, rifampin, clofazimine |
|
|
Term
|
Definition
1) binds guanines --> inhibits prolif
2) increase PLA2 in bacteria --> toxic damage |
|
|
Term
| mycobacteria drug w/ SE of: skin problems & discolorations & eosinophilic enteritis |
|
Definition
| clofazimine (leprae drug) |
|
|
Term
| drug w/ SE of red-green color blindness |
|
Definition
|
|
Term
| which drugs in RIPE treatment have hepatotoxicity? |
|
Definition
| "IPE" (INH, pyrazinamide, ethambutol) |
|
|
Term
|
Definition
| blocks arabinosyl transferase --> decreased carbohydrate polymerization in mycobacterium cell wall |
|
|
Term
| where is pyrazinamide active? |
|
Definition
| in the phagosomes (it is stable at low pH); this is why it's a good TB drug, because it is active where the TB are held |
|
|
Term
|
Definition
| decreased synthesis of mycolic acid |
|
|
Term
|
Definition
| yes, it needs activation by bacterial catalase-peroxidase |
|
|
Term
|
Definition
|
|
Term
|
Definition
RNA polymerase inhibitor (DNA-dep RNA polymerase)
Revs up the microsomal P450 (inducer)
Red-orange body fluids
Rapid resistance if used alone |
|
|
Term
| What drug does rifampin delay resistance to in Tx of leprosy? |
|
Definition
|
|
Term
| prophylaxis of meningococcal |
|
Definition
|
|
Term
| prophylaxis of H.influenza group B |
|
Definition
|
|
Term
|
Definition
minor hepatotoxicity (not as much as the "IPE" part)
orange body fluids
P450 inducer |
|
|
Term
| does amphotericin B cross BBB? |
|
Definition
| no, must give intrathecally for meningitis |
|
|
Term
| Mechanism of resistance to amphotericin B |
|
Definition
resistance is uncommon:
- altered or decreased amount of ergosterol |
|
|
Term
| What is special about amphotericin B nephrotoxicity? |
|
Definition
| cumulative over lifetime (give fluids during administration to minimize damage) |
|
|
Term
| Drug with "Shake and bake" symptoms from cytokine storm |
|
Definition
| Amphotericin B (fever & chills) |
|
|
Term
| antifungal that can decrease EPO |
|
Definition
amphotericin B
(this causes anemia) |
|
|
Term
| name SE of amphotericin B (5) |
|
Definition
-"Shake & bake" (fever & chills)
- Nephrotoxicity (cumulative)
- reduced EPO --> anemia
- Arrythmias
- IV phlebitis (amphoterrible) |
|
|
Term
|
Definition
| 5FU-like: inhibits S-phase by preventing thiamine synthesis |
|
|
Term
|
Definition
- N/V & diarrhea
- Bone marrow suppression
- Alopecia |
|
|
Term
| flucytosine is usually used in combination with what drug? |
|
Definition
|
|
Term
|
Definition
| prevents P450 conversion of lanosterol --> ergosterol |
|
|
Term
| which azole can cross BBB and be used for crytococcus meningitis (AIDS) |
|
Definition
|
|
Term
| mechanism of resistance of -azoles and flucytosine |
|
Definition
| decreased sensitivity of target enzymes to drug |
|
|
Term
| -azole used for hypercortisolism |
|
Definition
| ketoconazole (gynecomastia is a SE) |
|
|
Term
SE of -azoles (5)
(one is rare) |
|
Definition
- gynecomastia
- Fever, chills
- GI upset: vomiting, diarrhea
- skin rash
-rare liver toxicity |
|
|
Term
| inhibits synthesis of B-1,2 glycan |
|
Definition
| echinocandin/caspofugin (antifungal) |
|
|
Term
| used for invasive aspergillus |
|
Definition
|
|
Term
| Systemic antifungals used for systemic fungal diseases |
|
Definition
-Ampho B (no CNS penetration)
- Flucytosine (narrow spectrum: candida & crypto; used in combination of Ampho B)
- Azoles
- Echinocandin/caspofugin (invasive aspergillosis) |
|
|
Term
| disrupts microtubules in fungi |
|
Definition
|
|
Term
| accumulates in keratin (esp nails) |
|
Definition
|
|
Term
|
Definition
- Disulfiram like
- Confusion & vertigo
- induces P450
(also Carcinogenic & teratogenic) |
|
|
Term
| is griseofulvin teratogenic? |
|
Definition
|
|
Term
| Inhibits squalene epoxidase |
|
Definition
| Terbinafine (used for onchomycosis) |
|
|
Term
| Drugs used for superficial infections (3 systemic; 1 topical) |
|
Definition
Systemic:
- griseofulvin
- terbinafin
- -azoles
Topical:
- Nystatin |
|
|
Term
|
Definition
- contact dermatitis
- steven johnson syndrome |
|
|
Term
|
Definition
| same as ampho B (resistance is same, too) |
|
|
Term
|
Definition
inhibits protozoal DHF reductase (same as TMP)
(best for P.falciparum &
DOC when used in combo w/ sulfadiazine for Toxo) |
|
|
Term
|
Definition
unknown (?messes up protozoal energy metabolism)
(DOC for T.brucei rhodensiense when there is no CNS involvement) |
|
|
Term
|
Definition
inhibits sulfhydryl groups in parasite enzymes
(DOC for T.brucei if there is CNS involvement) |
|
|
Term
|
Definition
ROS production
(Tx for T.cruzei) |
|
|
Term
| MOA of Sodium stibogluconate |
|
Definition
inhibits protozoal PFK --> inhibits glycolysis
(Tx for leishmaniasis) |
|
|
Term
|
Definition
Blocks heme-polymerase --> toxic hemoglobin breakdown products damage/kill plasmodium
(DOC for falciparum & malaria; add primaquin for ovale & vivax b.c. primaquin needed to eliminate exoerythrocytic infection) |
|
|
Term
|
Definition
unknown
used as prophylaxis for chloroquine resistant malarias |
|
|
Term
|
Definition
unknown
Used as TREATMENT for chloroquine resistant malarias |
|
|
Term
antimalarial with SE of:
Gi distress, pruritis, headache, dizziness, hemlysis, ocular dysfunction |
|
Definition
| Chloroquine, hydroxychloroquine |
|
|
Term
anitmalarial w/ SE of:
NVD, dizziness, syncope, extrasystoles, CNS effects (rare) |
|
Definition
|
|
Term
antimalarial with these SE:
GI distress, headache, dizziness, neutropenia, hemolysis |
|
Definition
|
|
Term
antimalarial w/ these SE:
GI distress, cinchonism, CNS effects, hemolysis, hepatotoxicity |
|
Definition
|
|
Term
|
Definition
- flushed, sweaty
- tinnitis
- lichenoid reaction
- vertigo
- NVD |
|
|
Term
| avoid this antimalarial in psoriasis |
|
Definition
|
|
Term
| avoid this antimalarial in seizures, psyche disorders, & CV conduction defects |
|
Definition
| mefloquine (can cause syncope/extrasystoles) |
|
|
Term
| avoid this antimalarial in pregnancy, G6PD def, and autoimmune disorders |
|
Definition
|
|
Term
| avoid this antimalarial in pregnancy |
|
Definition
|
|
Term
|
Definition
| viral penetration/uncoating (M2 protein on influenza A) |
|
|
Term
| which antiviral can be used as a Tx for parkinsons? |
|
Definition
| Amantidine (because it induces release of dopamine from nerve terminals) |
|
|
Term
| antiviral that causes ataxia, dizziness, & slurred speach? |
|
Definition
|
|
Term
| Mechanism of resistance to amantadine |
|
Definition
| mutated M2 protein on influenza A (~90% are resistant, so it is only used for prophylaxis) |
|
|
Term
| Amantidine without the CNS effects |
|
Definition
|
|
Term
| Two antivirals that inhibit viral neuraminidase |
|
Definition
Oseltamivir, Zanamivir
(Tx for influenza A & B) |
|
|
Term
| antiviral that is a competetive inhibitor for IMP dehydrogenase |
|
Definition
ribavirin
(used in chronic HepC & RSV) |
|
|
Term
|
Definition
- Hemolytic anemia
- Severe teratogen (makes since since it's a purine analog)
(used in chronic HepC & RSV) |
|
|
Term
| non-HIV tx, antiviral Guanosine analogs |
|
Definition
|
|
Term
|
Definition
phosphorylated by HSV/VZV thymidine kinase
(guanosine analog goes on to inhibit viral DNA polymerase by chain termination) |
|
|
Term
|
Definition
| phosphorylated (activated) by CMV viral kinase or HSV/VZV thymidine kinase --> guanosine analog inhibits viral DNA pol |
|
|
Term
|
Definition
|
|
Term
|
Definition
- leukopenia, neutropenia, thrombocytopenia
- renal toxicity |
|
|
Term
| mechanism of resistance to acyclovir & gancyclovir |
|
Definition
- Acyclovir: lack of viral thymidine kinase (never gets activated)
- Gancyclovir: mutated CMV DNA pol or lack of viral thymidine kinase |
|
|
Term
|
Definition
|
|
Term
|
Definition
viral DNA pol inhibitor: binds to pyrophosphate-binding site
this drug, unlike acyclovir/gancyclovir does not require activation |
|
|
Term
| mechanism of resistance of foscarnet |
|
Definition
|
|
Term
|
Definition
- metallic taste
- disulfiram like |
|
|
Term
| MOA of Artemether & Artesunate |
|
Definition
| blocks P.falciparum ER ATPase |
|
|
Term
| 2 drugs that block P.falciparum ER ATPase |
|
Definition
|
|
Term
| drugs that can cause G6PD def pts to hemolyze? (3) |
|
Definition
Sulfonamides
INH
quinine derivatives (esp primaquin) |
|
|
