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USMLE
Antimicrobials
68
Health Care
Graduate
05/19/2011

Additional Health Care Flashcards

 


 

Cards

Term
Block cell wall synthesis by inhibiting peptidoglycan cross linking
Definition
B-lactams = -"cillin", imipenem, aztreonam, cephalosporins
Term
block peptidoglycan synthesis
Definition
bacitracin, vancomycin
Term
Disrupt bacterial cell wall membranes
Definition
Polymyxin
Term
Block nucleotide synthesis
Definition
Sulfonamides, trimethoprim (SMX, TMP)
Term
Block DNA topoisomerases
Definition
Fluoroquinolones
Term
Block mRNA synthesis
Definition
Rifampin
Term
block protein synthesis at the 50s ribosomal subunit
Definition
macrolides, streptogramins (dalfopristin, quinupristin), clindamycin,linezolid, chloramphenicol
Term
block protein synthesis at the 30s ribosomal subunit
Definition
aminoglycosides, tetracyclines
Term
bacteriostatic antimicrobials
Definition
ECSTaTiC = erythromycin, clindamycin, sulfamethoxazole, trimethoprim, tetracylcine, chloramphenicol
Term
Bactericidal antimicrobials
Definition
Very Finely Proficient At Cell Murder =
Vancomycin, Fluoroquinolones, Penicillin, Aminoglycosides, cephalosporin, metronidazole
Term
Penicillin (G and V)
Definition
Mechanism: 1. block penicillin binding proteins 2. block transpeptidase cross linking 3. activate autolytic enzymes

USE: Gram + AND syphilis
BacteriCIDAL for gram +, gram - cocci and spirochetes

Tox: hypersensitivity and hemolytic anemia
Term
Aminopenicillin = Amoxicillin and Ampicillin
Definition
Mechanism: Same as Penicillin but Broader Spectrum - penicillinase sensitive
- AmOxicillin has better Oral F

USE: Broader spectrum for gram + and some gram - rods
HELPS kill enterococci = H. inf, E. Coli, listeria, proteus, salmonella

Tox: hypersensitive, ampicillin rash, psuedomembranous colitis
Term
Clavulanic Acid
Definition
B-lactamase inhibitor
Use with ampicillin, amoxicillin and anti-pseudomonals to prevent destruction by B-lactamase
Term
Antipseudomonals - ticarcillin, carbenicillin, piperacillin
Definition
Mechanism: penicilin + extended spectrum

Use: Pseudomonas and gram - rods
penicillinase sensitive, use with clavulanic acid

Tox: hypersensitvity
Term
B-lactamase (penicillinase) resistant = methicillin, dicloxacllin, nafcillin
Definition
Mechanism: Penicillin but resistant to B-lactamases; narrow spectrum
'
Use: Staph Aureus EXCEPT MRSA

Tox: hypersensitivity
methicillin - interstitial nephritis
Term
AMinopenicillins for gram + and enteric gram - rods
Definition
ampicillin, amoxicillin
Term
anti-pseudomonals
Definition
ticarcillin, piperacillin, carbenacillin
Term
B-lactamase resistant penicillins
Definition
dicloxacillin, methicillin, nafcillin
Term
B-lactamase inhibitors - added to penicillins to protect from B lactamases
Definition
CAST = clavulanic acid, sulbactam, tazobactam
Term
Cephalosporins
Definition
B lactam that inhibits cell wall synthesis by inhibiting cross linking of peptidoglycan and not as suseptible to B-lactamases
BACTERICIDAL
Term
4th generation cephalosporin
Definition
cefepime
Term
cefepime
Definition
4th generation cephalosporin
Psuedomonas and gram +
Term
3rd generation cephalosporins
Definition
ceftriaxone, ceftazidime, cefotaxime
Term
ceftriaxone, ceftazidine, cefotaxime`
Definition
3rd generation cephalosporins - serious gram negative infections resistant to other B lactams
Term
ceftriaxone
Definition
gonorrhea and meningitis
Term
ceftazidime
Definition
pseudomonas
Term
2nd generation cephalosporin
Definition
cefoxitin, cefaclor, cefuroxime
Term
cefoxitin, cefaclor, cefuroxime
Definition
2nd generation cephalosporins
gram positive cocci and HEN PEcKS = H. infl, enterobactor, neisseria, proteus, e. coli, Klebsiella, serratia
Term
1st generation cephalosporin
Definition
cefazolin, cephalexin
Term
cefazolin, cephalexin
Definition
1st generation cephalosporins -
gram + cocci and PEcK = proteus, e. coli, klebsiella
Term
Toxicity with cephalosporins
Definition
hypersensitivity
cross reactivity with peniciilins (10%)
increased nephrotoxicity with aminoglycosides
disulfuram rxn with ethanol
Term
Toxicity with cephalosporins
Definition
hypersensitivity
cross reactivity with peniciilins (10%)
increased nephrotoxicity with aminoglycosides
disulfuram rxn with ethanol
Term
Aztreonam
Definition
B lactamase resistant monobactam
inihibts cell wall synthesis and crosslinking of peptidoglycan by binding PBP3
Synergy with AMINOGLYCOSIDES and NO crossreactivity with penicillin or cephalosporin

USE: Gram - Rods ONLY
given to penicillin allergic pts and pts with renal insufficiency who cannot use aminoglycosides

Tox: little/gi
Term
Imipenem/cilastatin, meropenem
Definition
B lactamase resistant carbanepem that block peptidoglycan cross links

USE: Broad spectrum, gram + cocci, gram - rods, anaerobes
LIFE THREATENING INFECTIONS OR REFRACTORY TO TX

Toxicity: GI, skin rash, SEIZURE
no seizure with meorpenem
Term
cilastatin
Definition
prevents breakdown of imipinem in the kidney as a renal dihydropeptidase I inhibitor
Term
Vancomycin
Definition
Mechanism:
BacteriCIDAL and inhibits cell wall synthesis of peptidoglycan by binding D-ala D-ala cell wall precursor

USE: GRAM POSITIVE ONLY - serious and multidrug resistant - S. aureus, enterococi, C. Dificile

Tox: Oto, Nephro, thrombophlebitis, flusihing (red man syndrome) can reduce with pre-antihistamines and slow transfusion

Resistance - D ala D ala becomes D ala D lac
Term
Protein synthesis inhibitors - 30s
Definition
Aminoglycosides
Tetraclycine
Term
Protein synthesis inibitors - 50 s
Definition
CCELL
Clindamycin
chloramphenicol
erythromycin
lincomycin
linezolid
Term
Aminoglycoside
Definition
30 s inhibitor, Bactericidal
Mechanism: inhibits formation of initiation complex and causes mRNA misreading
- requires O2

USE: severe gram - rods
Neomycin in bowel surgery
Synergy with aztreonam

Tox: nephro (esp with cephalosporin), oto with loop diuretics
TERATOGEN

Resistance - transferase enzymes inactivate the drug by acetylation, phosphorylation, adenylation
Term
Aminoglycosides (5)
Definition
GNATS
Gentamicin, neomycin, amikacin, tobramycin, streptomycin
Term
tetracyclines (4)
Definition
tetracyline, doxycycline, demeclocycline, minocycline
Term
Tetracyclines
Definition
Bacteriostatic, bind 30s and prevent attachement of aminoacyl t-RNA
- limited in CNS

USE: borellia, mycoplasma pneumo, h. pylori, CHLAMYDIA, RICKETTSIA

- doxycylcine with renal failure - excreted fecally
- do NOT take with milk, antacids, Fe - divalent cations prevent absorption

Tox: GI, discolored teeth, decreased bone growth in kids, photosensitive
C/I in pregnacy

Resistance - decreased uptake or increased efflux
Term
demeocycline
Definition
ADH antagonist - SIADH as a diuretic
Term
Macrolides (3)
Definition
erythromycin, azithromycin, clarithromycin
Term
Macrolides
Definition
Mechanism" binds the 23sRRNA of 50 s ribosome to inhibit protein synthesis by blocking translocation
Bacteriostatic

USE: Atypical penumo (myco, chlamydia, legionella), URI, STDS, neisseria, gram + cocci if penicillin allergic

Tox: prolonged QT (erythro), Gi (bad compliance), acute cholestatic hep, eosinophilia, skin rash, and increased concentrations oftheophylline and oral antiocoagulants

Resistance - methylation of the 23s rRNA
Term
chloramphenicol
Definition
inhibis 50s peptidyltransferase, bacteriostatic
Use; meninigitis - h. inf, neisseria, s. penumo but conservative

tox: anemia, aplastic anemia, gray baby syndrome

Resistance - acteyl transferace inactivation of drug
Term
Clindamycin
Definition
blocks peptide bond at 50s ribosome, blocks translocation, bacteriostatic

Use: Anaerobics Above the diaphragm (metronidazole is below), bacteroides, c. perfringens in aspiration pneumo/lung abscess

Tox: pseudomembrane colitis, fever, diarrhea
Term
Sulfonamids
Definition
(SMX, sulfisoxazole, sulfadiazine)
M: increased PABA antimetabolites, inhibits dihydrpteroate synthetase and blocks nucleotide synthesis, bacteriostatic

Use; gram +, gram -, nocardia, chlamydia, UTI

Tox: hypersensitive, hemolysis if G6PD def, kernicterus, nephro, photosensitive, displace other drugs from albumin

R: altered bacterial dihydropteroate synthetase, decreased uptake, increased PABA
Term
Trimethoprim (TMP)
Definition
M: inhibts DHF reductace and blocks nucleotide syntheis - bacteriostatic

U: combo with SMX = TMP-SMX to block folate, recurrent UTI, shigella, salmonella, P. jirovecii

T - megaloblastic anemia, leukopenia, granulocytopenia - treat with leucovorin
Term
Drugs with sulfer - sulfa allergies
Definition
SMX, sulfonamides, probenicid, celecoxib, furosamide, acetazolamide, thiazide diruteics,
Term
Metronidazole
Definition
M: free radical metabolites in bacterial cell damaging DNA - cidal and anti-protozoal

U: GET GAP = giardia, entameoba, trichamonas, gardnerella, aneraobes (below diaprham), H. Pylori (triple therapy includes Bismuth, amoxicillin, metronidazole)

T - disufulfuram rxn with alcohol, headache, metallic taste
Term
Flouroquinolones (floxacin)
Definition
inhibit DNA gyrase (topo II), cidal
do not take with antacids

USe: gram - rods in urinary and Gi infections, pseudomonas, neisseria and some gram +

T = Gi, superindection, rash, headache, C/I in pregnancy - affects cartilage
adults - tendon rupture or tendonitis
kids - myalgia, leg cramps

resistance = mutated gyrase
Term
polymyxin
Definition
binds bacterial membrane and disrupts osmotic properties like a detergent

U: gram - resistant strands

T - neurotox, acute renal tubular necrosis
Term
M. Tb
Definition
prophylaxis - isoniazid
tx - RIPE - rifampin, isoniazid, pyrazinamide, ethambutol, strptomycin
Term
M. AI
Definition
prophylaxis - azithromycin
tx = azithroymycin, rifampin, ethambutol, streptomycin
Term
M. leprae
Definition
Dapsone, rifampin, clofazimine
Term
INH
Definition
Isoniazid
M: decreased synthesis of mycolic acid

U: M. TB and prophylaxis
T = neuro and hepatotox, lupus
give pyridoxine (B6) to stop neurotox and lupus
Term
Rifampin
Definition
M: inhibits DNA dpdt RNA pol
U: TB, decrease need for dapson in leprosy, meningocoocal prophylaxis and contacts of kids with H inf B

T - minor hepato, drug interactions, orange body fluid, rapid resistance if alone
Term
amphotericin B
Definition
forms pores and binds ergosterol
U: serious SYSTEMIC mycoses - cryto, coccidio, histo, blasto, aspergillus, candida, mucor
give intrathecal for meningitis

T: shake and bake, nephrotox, arrythmia, anemia, IV phlebitis, decreased BP
Term
Nystatin
Definition
Forms pores and binds ergosterol
U: Topical fungal infections, swish and swallow in oral thrush and topical if diaper or vaginal
Term
Azoles
Definition
M: inhibit ergosterol syntheis - block lonsterol to ergosterol

U: systemic mycoses

Tox: horomone syntheis inhibition (gynecomastia), liver dysfunction, fever, chills
Term
fluconazole
Definition
for cryptococcal meninigits of AIDS pts - crosses BBB and also for all candida infections
Term
ketoconazole
Definition
blasto, coccidio, hiso, and candida infections, hypercortisolism
Term
clotrimazole and miconazole
Definition
topical fungal infections
Term
terbinafine
Definition
M: inhibits ergosterol synthesis by blocking squalene epoxidase (squalene to lanosterol)
U: dermatophytoses (toes and fingernails)
Term
Flucytosine
Definition
M: Blocks DNA synthesis by converting to 5-FU
U: systemic fungal infecitons WITH amphotericin B

T: nausea, vomit, diarrhea, bone marrow suppression
Term
caspofungin
Definition
inhibits B glucan synthesis which inhibits cell wall synthesis
U: invasive aspergillosis
T: Gi and flushing
Term
Griseofulvin
Definition
M: inhibit microtubules and mitosis and deposits in keratin tissues like hair and nails
U: oral tx of superficial infections like dermatophytes (ringworm, tinea)

Tox: CARCINOGEN, TERATOGEN, confusion, headache, increases P450 and warfarin metabolism
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