1A: Dt 3-3

Front 1

PCN G vs PCN V

Back 1

PCN V = oral
PCN G = IV

Front 2

PCN:
MOA
Uses
AE

Back 2

Binds pcn-binding protein
blocks cross-linking of cell wall (via blocking transpeptidases)
Activates autolytic enzymes

Use:
-Gram poz organisms
(S. pneumo, S. pyogenes, actinomyces, GBS; clostridium, listeria, bacillus)
-Syphilis
-Neisseria

AE: Hypersens rxn

Front 3

Penicillinase:
AKA
Activity
Where is it produced?

Back 3

AKA beta-lactamase

PCNase breaks beta-lactam ring of PCNs

Produced in periplasm of bacteria

Front 4

Which beta-lactam drugs are penicillinase resistant?
AE?

Back 4

Methicillin
Nafcillin
Dicloxacillin

AE: Hypersens rxns

Front 5

Staph aureus:
Treatment

Back 5

Nafcillin (naf for staph!)

Front 6

What about MRSA makes it resistant to methicillin?

Back 6

Altered PCN-binding protein target site

Front 7

Clavulanic acid:
Drug Class
Use

Back 7

beta-lactamase inhibitor

Combine with aminopenicillin (AMoxicillin; AMpicillin)

Front 8

Aminopenicillin vs PCN:
General

Back 8

Aminopenicillin is sensitive to PCNase (just like PCN), but has wider spectrum

Also can be combined with PCNase inhibitors

Front 9

Sulbactam:
Drug Class
Use

Back 9

beta-lactamase inhibitor
Combine with aminoPCN

Front 10

Tazobactam:
Drug class
Use

Back 10

beta-lactamase inhibitor
Combine with aminoPCN

Front 11

HELPS mnemonic

Back 11

Ampicillin/amoxicillin HELPS kill enterococci.

H. flu
E. coli
Listeria
Protes mirabilis
Salmonella
and Enterococci

Front 12

Most common cause of mononucleosis.

Back 12

EBV

Front 13

Most common cause of pseudomembranous colitis.

Back 13

C. diff

Front 14

What pencillins are antipseudomonals?

Back 14

TCP: Tace Care of Pseudomonas

Ticarcillin
Carbenicillin
Pipieracillin

Susceptible to PCNase!

Front 15

Cephalosporins:
MOA
Examples by generation
Uses

Back 15

MOA: Beta-lactm drugs that inhibit cell wall synthesis; less susceptible to PCNase

1st gen:
Cephalexin
Cefazolin

2nd Gen:
Cefprozil
Cefuroxime

3rd Gen:
Cefdinir
Ceftriaxone

4th Gen:
Cefipime

Uses:
1st gen: PEcK--Proteus mirabilis, E coli, Klebsiella

2nd gen: HEN PEcKS: H flu, Enterobacter aeorgenes, Neisseria, Proteus mirabilis, E Coli, Klebsiella, Serratia

3rd Gen***:
Ceftriaxone: meningitis, gonorrhea

Front 16

What cephalosporin has the longest half-life?

Back 16

Ceftriaxone--gonorrhea, meningitis

Front 17

What is a disulfiram-like reaction?
What drugs cause this?

Back 17

Disulifram-like reaction:
Accumuln of aldehyde

Results in flushing, sweating, nausea, HA, hypotn

Drugs:
Certain cephalosporins
Metro
1st generation sulfonylureas
Procarbazine

Front 18

Aztreonam:
Drug class
Use

Back 18

Monobactam resistant to beta-lactamases
Inhibits cell wall synthesis

Use on gram neg rods ONLY (E coli, Klebsiella, Pseudomonas, Serratia)

Front 19

Imipenem:
MOA
Use

Back 19

Broad-spectrum, beta-lactamase resistant carbapenem.

ALWAYS administered w/cilastatin (inhibitor of renal dihydropeptidase I) to dec ianctivtn of drug in renal tubulrs

Use: life-threatening infections (not sure of what cause is), or after failure of other drugs.

Front 20

Meropenem:
MOA
Use

Back 20

Broad-spectrum, beta-lactamase resistant carbapenem.

Use: life-threatening infections (not sure of what cause is), or after failure of other drugs.

Less seizure risk than imipenem

Front 21

ID the drug:
Causes red man syndrome

Back 21

Vanco

Front 22

ID the drug:
Next step in tx of otitis media if resistant to amoxicillin

Back 22

Augmentin (amocillin and clavulanic acid) or
Cefdinir

Front 23

ID the drug:
Prophylaxis against bacterial endocarditis

Back 23

Aminopcns
First gen cephalosporinss

Front 24

ID the drug:
Increases nephrotoxicity of aminoglycosides

Back 24

Cephalosporins

Front 25

ID the drug:
Aminoglycoside pretender

Back 25

Aztreonam

Front 26

ID the drug:
Inpatient treatment for MRSA

Back 26

Vanco

Front 27

ID the drug:
Sufficient for treatment of syphilis

Back 27

PCN G (IV)

Front 28

ID the drug:
Single doe treatment for gonorrhea

Back 28

Ceftriaxone

Front 29

ID the drug:
Hospitalized patient with new gram poz cocci in clusters in blood

Back 29

Staph aureus!

Vanco

Front 30

ID the drug:
Treatment for C diff colitis

Back 30

Oral vanco
Metro

Front 31

ID the drug:
Broad spectrum coverage for appendicitis

Back 31

Meropenem
Impienem/cilastatin

Front 32

ID the drug:
Cell wall inhibitors effective against pseudomonas

Back 32

Cefepine (4th generation cephalosporin)
Ticarcillin
Cerbenicillin
Piperacillin

Front 33

Cilastatin:
MOA
Use

Back 33

Inhibitor of renal dihydropeptidase I to dec inactivation of imipenem

Front 34

Vancomycin:
MOA
Use
AEs

Back 34

Inhibits cell wall formation by binding D-ala D-ala of cell wall precursors.

Gram poz--serious multi-drug resistant organisms, including MRSA

AEs: does N.O.T. have many problems:
nephrotoxicity
ototoxicity
thrombophlebitis
Diffuse flushing (red man syndrome)--can avoid by pretreat with histamine

Front 35

Draw gram negative algorithm.

Back 35

Front 36

This agar tests for lactose fermentation.

Which bacteria are lactose fermenters?

Back 36

Lactose is KEE, test with MacConKEE's (maconKey's)

KEE'S:
Klebsiella
E coli
Enterobacter
Serratia

Front 37

Gram neg diplococci

Back 37

Neisseria

Front 38

Gram poz diplococci

Back 38

Strep pneumo

Front 39

Gram poz clusters

Back 39

Staph aureus

Front 40

Sexually active individual
Urethritis
Arthritis

Back 40

Neisseria

Front 41

Urethritis
Epididymitis or Cervicitis

Back 41

Neisseria gonorrhea or Chlamydia trachomatis

Front 42

Identify bug.

Back 42

Gram poz cluster;
Staph aureus

Front 43

Identify bug.

Back 43

Gram poz chain,
Strep pneumo

Front 44

Identify bug.

Back 44

Gram negative, diplococci;
Neisseria gonorrhoeae

Front 45

Gonococci vs Meningococci:
Capsule
Maltose fermentation
Vaccine (yes/no)
Transmission
Effects

Back 45

Gonocci = gonorrhea
No polysaccharide capsule
No maltose fermentation
No vaccine (rapid Agenis variation of pilus prots)
Sexually transmitted
Causes gonorrhea, septic arthritis, neonatal conjunctivitis (all neonates must receive erythromycin eye drops)

Meningococci:
Polysacch capsule
Maltose fermentation
Vaccine present
Resp and oral spread
Causes meningococcemia, meningitis, Waterhouse-Fredrichsen syndrome
Rifampin prophylaxis

Front 46

Pediatric epiglottitis:
Cause
Management

Back 46

Cause: likely Haemophilus influenzae (which is NOT the flu!)

Don't do anything! Make child comfortable, because if child becomes upset, can lose airway.
Have ability to rapidly intubate.

Front 47

H. influenza:
Growth requirements (agar)

Back 47

Chocolate agar
Factors V, X (when child has flu, mom goes to five and dime--V and X--to buy chocolate)

Front 48

Silver stain

Back 48

Legionella

Front 49

Infected water supply

Back 49

Legionella

Front 50

Legionella:
Growth requirements (agar)

Back 50

Think of a French legionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal) with his iron dagger--he is no sissy (cysteine).

Grow on charcoal yeast extract with iron and cysteine.

Front 51

Cystic fibrosis
Pneumonia

Back 51

Pseudomonas

Front 52

Pseudomonas:
Effects
Aerobic/Anaerobic

Back 52

PSEUDO

Pneumonia (esp in cystic fibrosis)
Sepsis (black lzns on skin)
External otitis (swimmer's ear)
UTI
Drug Use and Diabetic Osteomyelitis

AERuginosa: AERobic--water! Burn victims!

Front 53

Hot tub folliculitis

Back 53

Pseudomonas

Front 54

List the 4 types of E. coli, their toxins, mechanism, and presentation.

Back 54

EIEC (invasive; dysentery--bloody diarrhea): shiga-like toxin invades intestinal mucosa-->necrosis and inflammn

ETEC: Traveler's diarrhea (watery): labile toxin/stable toxin; no inflammn/invasion

EPEC: Pediatric diarrhea; no toxin, adheres to apical surface, flattens villi, prevents absorption

EHEC: Dysentery, does not ferment sorbitol; Shiga-like toxin (necrosis/inflammn), hemolytic-uremic syndrome

Front 55

E. coli:
Treatment

Back 55

TMP-SMX
Fluoquinolones (-floxacin)

Front 56

What is the most common cause of gram negative sepsis?

Back 56

E. coli

Front 57

Protease spp.:
Effects

Back 57

UTI
Urease causes ammonium-magnesium-phosphate stones-->staghorn calculi

Front 58

Staghorn calculi

Back 58

Protease spp. (maribilis, vulgarus)

Front 59

Lobar pneumonia in alcoholics

Back 59

Klebsiella (aspirated)

Front 60

Klebsiella:
Effects

Back 60

4A's
Aspiration pneumonia
Abscess in lungs
Alcoholics
di-A-betics

Front 61

4A's mnemonic

Back 61

Effects of Klebsiella:
Aspiration pneumonia
Alcoholics
Abscesses in lungs
di-A-betics

Front 62

Red currant jelly sputum

Back 62

Klebsiella

Front 63

Salmonella vs Shigella:
General
Effects
Transmission

Back 63

Both are non-lactose fermenters; both invade intestinal mucosa and cause bloody diarrhea

Salmonella:
Salmon swim! Motile, flagellated
Can cause typhoid fever (salmonella typhi)

Transmitted via Food, Fingers, Feces, Flies

Shigella:
More virulent
Causes dysentery--watery diarrhea followed by bloody diarrhea w/mucus

Front 64

Grows at 42°C

Back 64

Campylobacter jejuni

Bloody diarrhea in children

Front 65

Rice water diarrhea

Back 65

Vibrio cholerae

Front 66

Bacteria that increases likelhood of cancer.

Back 66

H pylori (lymphoma, adenocarcinoma)

Front 67

ID the bug:
Cat scratch

Back 67

Bartonella

Front 68

ID the bug:
Cat feces

Back 68

Toxoplasmosis

Front 69

ID the bug:
Puppy feces

Back 69

Yersinia enterocolitica

Front 70

Borrelia burgdorferi

Back 70

Lyme dz from ticks that live on deer and mice

Front 71

22-year old presents with burning feeling in gut after meals
Biopsy of gastric mucosa shows gram (-) rods

What's the organism?

Back 71

H pylori

Front 72

50-year old male smoker presents with new cough, flu-like symptoms
Gram stain of sputum shows no organism

What's the organism?

Back 72

Legionella pneumophila

Front 73

ID the bug:
Osteomyelitis in a patient with DM

Back 73

Pseudomonas

Front 74

ID the bug:
Sepsis
DIC
Adrenal hemorrhage

Back 74

WF Syndrome; N. meningitidis sepsis

Front 75

ID the bug:
5 year old with pharyngitis
Drooling
X-ray revelas thumb sign

Back 75

H. flu type B (epiglottitis; not really seen anymore due to immunization)

Front 76

ID the bug:
Osteomyelitis in patient with Sickle Cell

Back 76

Salmonella

Front 77

ID the bug:
Aspiration pneumonia in alcoholic

Back 77

Klebsiella

Front 78

ID the bug:
Child with new puppy develops severe abdominal pain

Back 78

Yersinia enterocolitica

Front 79

What enzymes do obligate anaerobes lack?

Back 79

Lack catalase and superoxide dismutase

Front 80

ID the bug:
Burn wound infeciton

Back 80

Pseudomonas

Front 81

ID the bug:
Motile, causes UTI

Back 81

Proteus mirabilis

Front 82

ID the bug:
Traveler's diarrhea

Back 82

ETEC

Front 83

ID the bug:
Life-threatening meningitis
Purpura

Back 83

N. meningitidis

Front 84

ID the bug:
Common cause of UTI and pneumonia

Back 84

Klebsiells pneumoniae

Front 85

ID the bug:
Corneal infections in contact lens wearers

Back 85

Pseudomonas

Front 86

ID the bug:
Septic arthritis in young, sexually active patients

Back 86

N. gonorrhoeae

Front 87

40 year-old female
Acute unilateral knee pain
Bilateral Bell's palsy

Back 87

Lyme Dz via Ixodes Tick caused by Borrelia

Front 88

Treatment of N. gonorrhoeae.

Back 88

Single dose ceftriaxone

Front 89

Post-amoxicillin
Toxic megacolon
Diarrhea

Back 89

C. diff overgrowth

Front 90

Protein synthesis inhibitors:
MOA

Back 90

Target smaller bacterial ribosome (70S made of 30S and 50S subunits)--leaves human 80S ribosome unaffected

Front 91

30S vs 50S inhibitors:
List
Bacteriostatic/Bacteriocidal?

Back 91

Buy AT 30, CCELL (sell) at 50
30S inhibitors:
Aminoglycosides (cidal)
Tetracyclines (static)

50S:
C: chloramphenicol, clindamycin (static)

E: Erythromycin (static)
L: Lincomycin (static)
L: Linezolid (variable)

Front 92

Aminoglycosides:
MOA
List
Use

Back 92

MOA: cidal; inhibit formation of initiation complex and cause misreading of mRNA; require O2 for uptake so can't kill anaerobes

Aminoglycosides-->AMINO-->Mean GNATS canNOT kill anaerobes

Gentamicin
Neomycin
Amikain
Tobramycin
Streptomycin

Use: severe gram negative rods, and work synergistically w/beta-lactams

Front 93

These drugs are both ototoxic and nephrotoxic.

Back 93

Aminoglycosides (-mycins)
Vancomycin
Loop diuretics
Cisplatin

Front 94

Tetracyclines:
MOA
List
Use

Back 94

Static--bind 30S, prevents attachment of aminoacyl-tRNA

DOn't take with milk, antacids, or iron-containing preparations (will block absorption in gut)

Cyclines: tetracycline, doxycycline, demelocycline, minocycline

Use:
Borrelia burgdorferi, H pylori, M pneumoniae
Rickettsia, Chlamydia

Front 95

This tetracycline is safe in those with renal failure. Why?

Back 95

Doxycyline--because it's fecally eliminated

Front 96

This drug causes a blue pigmentation of the skin.

Back 96

Minocycline

Front 97

What drugs are associated with photosensitivity reactions?

Back 97

SAT for a photo
Sulfonamides
Amiodarone
Tetracyclines

Front 98

Macrolides:
MOA
List
Use

Back 98

Static; Inhibit protein synthesis by binding rRNA of 50S subunit

Erythromycin, azithromycin, clarithromycin

Use: Atypical pneumonias (mycoplasma, chlamydia, legionella), URIs, STDs (PUS)

Front 99

This drug prolongs QT interval.

Back 99

Macrolides, esp erythromycin

Front 100

Gray baby syndrome

Back 100

Chloramphenicol

Front 101

Chloramphenicol:
Uses
AEs

Back 101

Meningitis: H flu, Neisseria, Strep pneumo

AEs:
Dose-dependent anemia
Dose-dependent aplastic anemia
Gray baby syndrome (bc lack liver UDP-gluornyl transferase)

Front 102

Gray man syndrome

Back 102

Amiodarone

Front 103

Clindamycin:
Uses
AEs

Back 103

Anaerobic infections--bacteroides, c. perfringens in aspiration pneumonia

AE: pseudomembranous colitis (C. diff overgrowth)

Front 104

Nitrofurantoin:
MOA
Uses

Back 104

Bacteriocidal--inactivates bacterial ribosomes

Uses: UTI cystitis (not pyelonephritis) by E coli or Staph saprophyticus (not proteus)

Front 105

What organisms most commonly cause UTIs?

Back 105

E coli***
Proteus miarbilis (staghorn calculi)
Klebsiella pneumonia
Staph saprophyticus

Front 106

Sulfonamides:
MOA
List
Uses

Back 106

Bacterial folic acid inhibitors (inhibit folic acid synthesis)

SMX, sulfasoxazole, sulfadiazine

Uses: UTIs

Front 107

What drugs can cause Stevens-Johnson Syndrome?

Back 107

Seizure drugs (ethosuximide, carbamazepine, phneobarbital, phenytoin)
Sulfa drugs
PCN drugs
Allopurinol

Front 108

TMP-SMX:
AEs

Back 108

These drugs both work by inhibiting bacterial folic acid synthesis, however, there is also some inhibition of host folic acid synthesis-->megaloblastic anemia (tx: folic acid supplementation)

Oh, and don't forget SULFA allergies.

Front 109

Patients with sulfa allergies should not take _________.

Back 109

Thiazide diuretics
Acetazolamide
Furosemide
Celecoxib
Probenecid

Front 110

Fluroquinolones:
MOA
List
AEs

Back 110

MOA: inhibits DNA gyrase; CIDAL. don't take antacids

-floxacins

AE: Tendonitis and tendon rupture "fluoroquinoLONES hurt attachments to your BONES"

Front 111

Metronidazole:
MOA
Uses
AE

Back 111

MOA: forms free radical toxic metabs in bact cells that damage DNA. CIDAL

Get gap on the METRO
Giardia
Entamoeba
Trichomonas
Gardenella
Anaerobes (bacteroides, clostridium)
H. pylori

Disulifram-like reaciton!

Front 112

What drugs treat anaerobic infections?

Back 112

Metro
Clindamycin
Imipenem/cilastatin
Meropenem

Front 113

This drug acts like a detergent and disrupts bacterial cell membranes.

Back 113

Detergents get MIXed

Polymyxin

Front 114

What drugs are effective against pseudomonas?

Back 114

Polymyxins
Fluorquinolones
Cefepime
Aztreonam
Aminoglycosides
Extended-spectrum PCNs (Pipercillins)