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71 Cards in this Set

  • Front
  • Back
Characteristics of gram + bacteria
thick peptidoglycan layer
no periplasmic space
no outer membrane
low lipidsaccharide
Characteristics of gram - bacteria
thin peptidoglycan layer
have outer membrane
periplasmic space
Staphylcocci

Staph aureus
Gram +
Streptococci
Stretococcus pneumoniae
enterococci
gram +
clostridium difficile
gram +
anaerobe
Pseudomonad
Psudomonas aeruginosa
gram -
Acinetobacter
acinetobacter boumannii
gram -
Bacteroides fragilis
gram -
anaerobe
Legionella
gram -
aerobic
Enterobacteriaceae
Escherichia Coli
Kiebsiella
gram -
Penicillins
Class? MOA? Bacteriocidal or bacteriostatic?
Beta lactam
Bacteriocidal
Targets PBP like transpeptidase= no x-linking=no cell wall sx= cell lysis
Cephalosporins
Class? MOA? Bacteriocidal or bacteriostatic?
Beta lactam
Bacteriocidal
Targets PBP like transpeptidase= no x-linking=no cell wall sx= cell lysis
Monobactams
Class? MOA? Bacteriocidal or bacteriostatic?
Beta lactam
Bacteriocidal
Targets PBP like transpeptidase= no x-linking=no cell wall sx= cell lysis
Carbapenems
Class? MOA? Bacteriocidal or bacteriostatic?
Beta lactam
Bacteriocidal
Targets PBP like transpeptidase= no x-linking=no cell wall sx= cell lysis
Vancomycin

Class? MOA? Bacteriocidal or bacteriostatic?
Bacteriacidal
Inhibits cell wall sx
Target: binds D-ala-D-ala of glycan chain, blocks transglycosylase rxn, no new glycan chains incorporated= inhibits cell wall sx
Nalidixic acid
ciprofloxacin
levofloxacin
gemifloxacin
Class? MOA? Bacteriocidal or bacteriostatic?
quinolones; Bactericidal
Inhibit type II topoisomerases- DNA gyrase in gram - and topoisomerase IV in gram +
Metronidazole
Class? MOA? Bacteriocidal or bacteriostatic?
bactericidal
prodrug activated to radical which damages DNA and prevents replication.
activated by ferrodoxin
streptomycin
gentamycin
tobramycin
amikacin
Class? MOA? Bacteriocidal or bacteriostatic?
aminoglycosides, bactericidal
Binds to 30S and blocks initiation of protein sx; causes misreading of mRNA and wrong amino acids get put into protein; or misread causes premature termination.
Membrane uses bad proteins and increases permeability= death
Erthromycin
Clarithromycin
Telithromycin
Class? MOA? Bacteriocidal or bacteriostatic?
Macrolides; bacteriostatic
reversibly inhibit protein sx by binding to 50S ribosome subunit
Doxycycline
minocycline
Class? MOA? Bacteriocidal or bacteriostatic?
tetracyclines; bacteriostatic
reversibly inhibit protein sx by binding to 30 S ribosome subunit and blocking entrance of tRNA
Clindamycin
Class? MOA? Bacteriocidal or bacteriostatic?
bacteriostatic
reversibly inhibit protein sx by binding to 50S ribosome subunit
Sulfamethoxazole
Class? MOA? Bacteriocidal or bacteriostatic?
sulfonamide; bacteriostatic
acts as antimetabolite by competing with PABA for dihydropteroate synthase and inhibits folate sx
Cycloserine
Class? MOA? Bacteriocidal or bacteriostatic?
bacteriostatic
inhibits cell wall sx by inhibition of D-ala racemase and ligases
Methods of resistance for
Beta lactams (3)
Reduced affinity of drug for PBP
Decreased uptake or increased efflux
Beta lactamase inactivate beta lactam
Clavulanic acid
MOA
beta lactamase inhibitor used with amoxicillin or ticarcillin
Sulbactam
MOA
beta lactamase inhibitor used with ampicillin (Unasyn)
Tazobactam
beta lactamase inhibitor used with piperacillin (Zosyn)
Augmentin
clavulanic acid + amoxicillin
Timentin
ticarcillin + clavulanic acid
Unasyn
sulbactam + ampicillin
Zosyn
tazobactam + piperacillin
Spectrum of coverage for penicillins
G: gram +
Oxacillin/ naficillin: +, some -
Amox/ampicillin: more -
ticarcillin, piperacillin, mealocillin: most -
Penicillin drug interactions
Birth control- less bacteria= less enterohepatic circulation= less estrogen
methotrexate: both compete for renal tubular secretion
probenecid: inhibits pcn secretion transporter in proximal tubule
cefazolin

Gen? spectrum?
1st gen cephalosporin
excellent +
modest -
cefuroxime

gen? spectrum?
2nd gen cephalosporin
less + than 1st
more - than 1st
some anaerobes
cefoxitin

gen? spectrum?
2nd gen cephalosporin
less + than 1st
more - than 1st
some anaerobes
cefotetan

gen? spectrum?
2nd gen cephalosporin
less + than 1st
more - than 1st
some anaerobes
Cephalosporin
MOA
beta lactam
inhibits cell wall sx by PBP; inhibits transpeptidase and x linking rxn
cefdinir

gen? spectrum?
3rd gen cephalosporin
excellent +
more - than 2nd
ceftriaxone

gen? spectrum?
3rd gen cephalosporin
excellent +
more - than 2nd
ceftazidime

gen? spectrum?
3rd gen cephalosporin
excellent +
more - than 2nd
cefepime

gen? spectrum?
4th gen cephalosporin
excellent +
more - than 3rd
broadest spectrum
least sensitive to beta lactamases
Aztreonam

MOA
Spectrum
Class
Monobactam; beta lactam- inhibits cell sx thru PBP
Narrow gram - only

NO cross hypersensitivity w/ other b-lactams
Imipenem

MOA
Spectrum
Class
Carbapenam; beta lactam

Broad spectrum
Primaxin

What?
Why?
Imipenem + cilastatin

Cilastatin inhibits renal dehydropeptidase which hydrolyzes imipenem
Bacitracin

MOA
Spectrum
Inhibits stage 3 of cell wall sx; inhibits dePO4lation of lipid carrier so precursors can't be transfered to membrane and incorporated into glycan chain. Prevents polymerization of glycan

Narrow gram +
Nephrotoxic; topical only
Cycloserine

MOA
Spectrum
inhibits D-ala racemase and ligase; inhibits cell wall sx

Broad spectrum

CNS toxicity
Fosfomycin

MOA
Spectrum
binds and inhibits enolpyruvate transferase
blocks sx of peptidoglycan precursors (stage 1) and inhibits cell wall sx

Broad spectrum
Vancomycin

MOA
Spectrum
Binds to D-ala terminal of glycan chain and blocks transglycosylase rxn; inhibits polymerization and cell wall sx

Narrow, gram +
ototoxicity
nephrotoxicity
Red man syndrome
Methods of resistance:
Vancomycin
Enzymes switch from D-ala_D-ala to D-ala_D-lactate
reduced binding affinity
Daptomycin

MOA
Spectrum
Binds to membrane phospholipids in a Ca2+ dependent manner and forms a pore in the membrane. Causes an efflux of K+ out of; similar to a detergent.
Spectrum like vanco (gram +)
Myopathy
Colistin
Polymyxin B

MOA
Spectrum
Binds phospholipids, disrupts membrane like cationic detergent

Narrow, gram -
nephrotoxicity
Quinupristin
Dalfopristin
Class
MOA
Resistance
streptogramins; Synercid
Q:Bind to 50S ribosome subunit and block transpeptidation
D: 50S binding site; enhances binding of Q

Bactericidal together b/c of synergistic effect

Resistance:
Q: induces methylase to alter drug target; inactivated by lactonases
D: increased efffluc; inactivated by acetyltransferase
Linezolid

MOA
Resistance
oxazoladinones; bacteriostatic- reversibly inhibits protein sx:
Binds to P site of 50S ribosomal subunit and prevents formation of fmet-tRNA complex, blocking initiation

altered binding site on target (ribosome)- low cross resistance
gram +
Spectinomycin

MOA
Resistance
spectinomycin; reversibly inhibits protein sx
Binds to 30S and prevents initiation

Altered binding site; enzyme inactivation by adenylyltransferase

narrow, gram -
Tetracyclines
Adverse effects
GI, hepatotoxiciy, deposits in calcifying tissues (brown teeth), photosensitive, chelator, preg cat. D
Tetracyclines
Methods of resistance
Induce ribosomal protection protein that displaces drug from binding site
decreased uptake and increased efflux
enzymatic inactivation
Macrolides
Methods of resistance
alter 50S ribosome target by inducing methylase enzymes or xsome mutation
increased efflux
induces esterases hydrolyze macrolide drugs
Macrolides
adverse effects
Gi, cardiac arrhythmias, hepatotoxiciy, azithromycin Al and MG antacids reduce plasma levels
Macrolides
drug interactions
Inhibit CYP3A4- erythromycin, clrithromycin, telithromycin

NOT azithromycin
Clindamycin
Methods of resistance
alter 50S ribosome target by methylase expression. causes cross-resistance to macrolides

NOT a substrate for efflux
Aminoglycosides
Spectrum?
Methods of resistance?
Narrow, aerobic gram -

Mutations alter drug target
decreased uptake
enzymatic inactivation
Aminoglycosides
Adverse effects
ototoxicity
nephrotoxicity
preg cat D

SYNERGISTIC with beta-lactams
Nitrofurantoin
MOA
Spectrum
bacteria flavoproteins reduce it to reactive intermediates that damage DNA

Broad spectrum
Contraindicated at 38 weeks gestation
Quinolones

Methods of Resistance
mutations alter DNA gyrase or topoisomerase IV
mutations reduce membrane permeability and decrease uptake
Quinolones
Spectrum
gram -: DNA gyrase

gram + : topoisomerase IV
Quionolones

Adverse effects
GI, CNS (HA, dizzy), Achilles tendon rupture or tendonitis (BLACK BOX), QT interval prolongation. photosensitivity
Contraindicated in peds (arthropathy)
Metronidazole

Spectrum
Adverse effects
anaerobic protozoa
anaerobic bacteria

disulfram rxn with alcohol
Trimethoprim
MOA
Inhibits Dihydrofolate reductase, acting as antimetabolite so bacteria can't make folate = no DNA sx (sequential inhibition when combined w/ sulfamethoxazole= synergistic)
Bactrim
Resistance?
Sulfamethoxazole and trimethoprim
Reduced binding affinity of dihydropteroate synthase or DHFR
decreased uptake
increased PABA or DHFR
ADEs Linezolid
thrombocytopenia
periph neuropathy
serotonin syndrome
lactic acidosis
optic neuritis