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114 Cards in this Set

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PCN G vs PCN V
PCN V = oral
PCN G = IV
PCN:
MOA
Uses
AE
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
Penicillinase:
AKA
Activity
Where is it produced?
AKA beta-lactamase

PCNase breaks beta-lactam ring of PCNs

Produced in periplasm of bacteria
Which beta-lactam drugs are penicillinase resistant?
AE?
Methicillin
Nafcillin
Dicloxacillin

AE: Hypersens rxns
Staph aureus:
Treatment
Nafcillin (naf for staph!)
What about MRSA makes it resistant to methicillin?
Altered PCN-binding protein target site
Clavulanic acid:
Drug Class
Use
beta-lactamase inhibitor

Combine with aminopenicillin (AMoxicillin; AMpicillin)
Aminopenicillin vs PCN:
General
Aminopenicillin is sensitive to PCNase (just like PCN), but has wider spectrum

Also can be combined with PCNase inhibitors
Sulbactam:
Drug Class
Use
beta-lactamase inhibitor
Combine with aminoPCN
Tazobactam:
Drug class
Use
beta-lactamase inhibitor
Combine with aminoPCN
HELPS mnemonic
Ampicillin/amoxicillin HELPS kill enterococci.

H. flu
E. coli
Listeria
Protes mirabilis
Salmonella
and Enterococci
Most common cause of mononucleosis.
EBV
Most common cause of pseudomembranous colitis.
C. diff
What pencillins are antipseudomonals?
TCP: Tace Care of Pseudomonas

Ticarcillin
Carbenicillin
Pipieracillin

Susceptible to PCNase!
Cephalosporins:
MOA
Examples by generation
Uses
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
What cephalosporin has the longest half-life?
Ceftriaxone--gonorrhea, meningitis
What is a disulfiram-like reaction?
What drugs cause this?
Disulifram-like reaction:
Accumuln of aldehyde

Results in flushing, sweating, nausea, HA, hypotn

Drugs:
Certain cephalosporins
Metro
1st generation sulfonylureas
Procarbazine
Aztreonam:
Drug class
Use
Monobactam resistant to beta-lactamases
Inhibits cell wall synthesis

Use on gram neg rods ONLY (E coli, Klebsiella, Pseudomonas, Serratia)
Imipenem:
MOA
Use
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.
Meropenem:
MOA
Use
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
ID the drug:
Causes red man syndrome
Vanco
ID the drug:
Next step in tx of otitis media if resistant to amoxicillin
Augmentin (amocillin and clavulanic acid) or
Cefdinir
ID the drug:
Prophylaxis against bacterial endocarditis
Aminopcns
First gen cephalosporinss
ID the drug:
Increases nephrotoxicity of aminoglycosides
Cephalosporins
ID the drug:
Aminoglycoside pretender
Aztreonam
ID the drug:
Inpatient treatment for MRSA
Vanco
ID the drug:
Sufficient for treatment of syphilis
PCN G (IV)
ID the drug:
Single doe treatment for gonorrhea
Ceftriaxone
ID the drug:
Hospitalized patient with new gram poz cocci in clusters in blood
Staph aureus!

Vanco
ID the drug:
Treatment for C diff colitis
Oral vanco
Metro
ID the drug:
Broad spectrum coverage for appendicitis
Meropenem
Impienem/cilastatin
ID the drug:
Cell wall inhibitors effective against pseudomonas
Cefepine (4th generation cephalosporin)
Ticarcillin
Cerbenicillin
Piperacillin
Cilastatin:
MOA
Use
Inhibitor of renal dihydropeptidase I to dec inactivation of imipenem
Vancomycin:
MOA
Use
AEs
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
Draw gram negative algorithm.
This agar tests for lactose fermentation.

Which bacteria are lactose fermenters?
Lactose is KEE, test with MacConKEE's (maconKey's)

KEE'S:
Klebsiella
E coli
Enterobacter
Serratia
Gram neg diplococci
Neisseria
Gram poz diplococci
Strep pneumo
Gram poz clusters
Staph aureus
Sexually active individual
Urethritis
Arthritis
Neisseria
Urethritis
Epididymitis or Cervicitis
Neisseria gonorrhea or Chlamydia trachomatis
Identify bug.
Gram poz cluster;
Staph aureus
Identify bug.
Gram poz chain,
Strep pneumo
Identify bug.
Gram negative, diplococci;
Neisseria gonorrhoeae
Gonococci vs Meningococci:
Capsule
Maltose fermentation
Vaccine (yes/no)
Transmission
Effects
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
Pediatric epiglottitis:
Cause
Management
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.
H. influenza:
Growth requirements (agar)
Chocolate agar
Factors V, X (when child has flu, mom goes to five and dime--V and X--to buy chocolate)
Silver stain
Legionella
Infected water supply
Legionella
Legionella:
Growth requirements (agar)
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.
Cystic fibrosis
Pneumonia
Pseudomonas
Pseudomonas:
Effects
Aerobic/Anaerobic
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!
Hot tub folliculitis
Pseudomonas
List the 4 types of E. coli, their toxins, mechanism, and presentation.
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
E. coli:
Treatment
TMP-SMX
Fluoquinolones (-floxacin)
What is the most common cause of gram negative sepsis?
E. coli
Protease spp.:
Effects
UTI
Urease causes ammonium-magnesium-phosphate stones-->staghorn calculi
Staghorn calculi
Protease spp. (maribilis, vulgarus)
Lobar pneumonia in alcoholics
Klebsiella (aspirated)
Klebsiella:
Effects
4A's
Aspiration pneumonia
Abscess in lungs
Alcoholics
di-A-betics
4A's mnemonic
Effects of Klebsiella:
Aspiration pneumonia
Alcoholics
Abscesses in lungs
di-A-betics
Red currant jelly sputum
Klebsiella
Salmonella vs Shigella:
General
Effects
Transmission
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
Grows at 42°C
Campylobacter jejuni

Bloody diarrhea in children
Rice water diarrhea
Vibrio cholerae
Bacteria that increases likelhood of cancer.
H pylori (lymphoma, adenocarcinoma)
ID the bug:
Cat scratch
Bartonella
ID the bug:
Cat feces
Toxoplasmosis
ID the bug:
Puppy feces
Yersinia enterocolitica
Borrelia burgdorferi
Lyme dz from ticks that live on deer and mice
22-year old presents with burning feeling in gut after meals
Biopsy of gastric mucosa shows gram (-) rods

What's the organism?
H pylori
50-year old male smoker presents with new cough, flu-like symptoms
Gram stain of sputum shows no organism

What's the organism?
Legionella pneumophila
ID the bug:
Osteomyelitis in a patient with DM
Pseudomonas
ID the bug:
Sepsis
DIC
Adrenal hemorrhage
WF Syndrome; N. meningitidis sepsis
ID the bug:
5 year old with pharyngitis
Drooling
X-ray revelas thumb sign
H. flu type B (epiglottitis; not really seen anymore due to immunization)
ID the bug:
Osteomyelitis in patient with Sickle Cell
Salmonella
ID the bug:
Aspiration pneumonia in alcoholic
Klebsiella
ID the bug:
Child with new puppy develops severe abdominal pain
Yersinia enterocolitica
What enzymes do obligate anaerobes lack?
Lack catalase and superoxide dismutase
ID the bug:
Burn wound infeciton
Pseudomonas
ID the bug:
Motile, causes UTI
Proteus mirabilis
ID the bug:
Traveler's diarrhea
ETEC
ID the bug:
Life-threatening meningitis
Purpura
N. meningitidis
ID the bug:
Common cause of UTI and pneumonia
Klebsiells pneumoniae
ID the bug:
Corneal infections in contact lens wearers
Pseudomonas
ID the bug:
Septic arthritis in young, sexually active patients
N. gonorrhoeae
40 year-old female
Acute unilateral knee pain
Bilateral Bell's palsy
Lyme Dz via Ixodes Tick caused by Borrelia
Treatment of N. gonorrhoeae.
Single dose ceftriaxone
Post-amoxicillin
Toxic megacolon
Diarrhea
C. diff overgrowth
Protein synthesis inhibitors:
MOA
Target smaller bacterial ribosome (70S made of 30S and 50S subunits)--leaves human 80S ribosome unaffected
30S vs 50S inhibitors:
List
Bacteriostatic/Bacteriocidal?
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)
Aminoglycosides:
MOA
List
Use
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
These drugs are both ototoxic and nephrotoxic.
Aminoglycosides (-mycins)
Vancomycin
Loop diuretics
Cisplatin
Tetracyclines:
MOA
List
Use
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
This tetracycline is safe in those with renal failure. Why?
Doxycyline--because it's fecally eliminated
This drug causes a blue pigmentation of the skin.
Minocycline
What drugs are associated with photosensitivity reactions?
SAT for a photo
Sulfonamides
Amiodarone
Tetracyclines
Macrolides:
MOA
List
Use
Static; Inhibit protein synthesis by binding rRNA of 50S subunit

Erythromycin, azithromycin, clarithromycin

Use: Atypical pneumonias (mycoplasma, chlamydia, legionella), URIs, STDs (PUS)
This drug prolongs QT interval.
Macrolides, esp erythromycin
Gray baby syndrome
Chloramphenicol
Chloramphenicol:
Uses
AEs
Meningitis: H flu, Neisseria, Strep pneumo

AEs:
Dose-dependent anemia
Dose-dependent aplastic anemia
Gray baby syndrome (bc lack liver UDP-gluornyl transferase)
Gray man syndrome
Amiodarone
Clindamycin:
Uses
AEs
Anaerobic infections--bacteroides, c. perfringens in aspiration pneumonia

AE: pseudomembranous colitis (C. diff overgrowth)
Nitrofurantoin:
MOA
Uses
Bacteriocidal--inactivates bacterial ribosomes

Uses: UTI cystitis (not pyelonephritis) by E coli or Staph saprophyticus (not proteus)
What organisms most commonly cause UTIs?
E coli***
Proteus miarbilis (staghorn calculi)
Klebsiella pneumonia
Staph saprophyticus
Sulfonamides:
MOA
List
Uses
Bacterial folic acid inhibitors (inhibit folic acid synthesis)

SMX, sulfasoxazole, sulfadiazine

Uses: UTIs
What drugs can cause Stevens-Johnson Syndrome?
Seizure drugs (ethosuximide, carbamazepine, phneobarbital, phenytoin)
Sulfa drugs
PCN drugs
Allopurinol
TMP-SMX:
AEs
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.
Patients with sulfa allergies should not take _________.
Thiazide diuretics
Acetazolamide
Furosemide
Celecoxib
Probenecid
Fluroquinolones:
MOA
List
AEs
MOA: inhibits DNA gyrase; CIDAL. don't take antacids

-floxacins

AE: Tendonitis and tendon rupture "fluoroquinoLONES hurt attachments to your BONES"
Metronidazole:
MOA
Uses
AE
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!
What drugs treat anaerobic infections?
Metro
Clindamycin
Imipenem/cilastatin
Meropenem
This drug acts like a detergent and disrupts bacterial cell membranes.
Detergents get MIXed

Polymyxin
What drugs are effective against pseudomonas?
Polymyxins
Fluorquinolones
Cefepime
Aztreonam
Aminoglycosides
Extended-spectrum PCNs (Pipercillins)