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209 Cards in this Set

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What is the mechanism of action of PCN
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
1.) bind PCN binding proteins
2.)block transpeptidase cross-linking of cell wall
3. Activate autolytic enzymes
What is the mechanism of action of ampicillin
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of ticarcillin
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of piperacillin
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of imipenem
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of aztreonam
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of cephalosporins
cell wall synthesis blocker by inhibition of peptidoglycan cross-linking
What is the mechanism of action of Bacitracin
block peptidoglycan synthesis
What is the mechanism of action of vancomycin
block peptidoglycan synthesis
cycloserine
block peptidoglycan synthesis
What is the mechanism of action of Polymyxins
Disrupt bacterial/fungal cell membranes
What is the mechanism of action of
ampho B
disrupt fungal membranes
What is the mechanism of action of nystatin
disrupt fungal membranes
What is the mechanism of action of fluconazole/azoles
disrupt fungal membranes
What is the mechanism of action of Sulfonamides
Block nucleotide synthesis -- PABA antimetabolites inhibit dihydropterate synthesis
What is the mechanism of action of trimethoprim
Block nucleotide synthesis---inhibits bacterial dihydrofolate reductase
What is the mechanism of action of Quinolones
Block DNA topoisomerases
What is the mechanism of action of Rifampin
block mRNA synthesis
What is the mechanism of action of Chloramphenicol
block protein synthesis at the 50S ribosomal subunit
What is the mechanism of action of erythromycin/macrolides
block protein synthesis--at the 50S ribosomal subunit
What is the mechanism of action of clindamycin
block protein synthesis at 50S ribosomal subunit
What is the mechanism of action of streptogramins (quinupristin, dalfopristin)
block protein synthesis at 50S ribosomal subunit
What is the mechanism of action of linezolid
block protein synthesis at 50S ribosomal subunit
What is the mechanism of action of Aminoglycosides
block protein synthesis at 30S ribosomal subunit
What is the mechanism of action of tetracyclines
block protein synthesis at 30S ribosomal subunit
Which antibiotics block cell wall synthesis by inhibition of peptidoglycan cross linking
PCN, Ampicillin, ticarcillin, piperacillin, imipenems, aztreonam, cephalosporins
Which antibiotics block peptidoglycan synthesis
Bacitracin, Vancomycin, cycloserine
Which antibiotics disrupt bacterial/fungal cell membranes
Polymyxins
Which antibiotics disrupt fungal cell membranes
Ampho B, nystatin, fluconazole/azoles
which antibiotics block nucleotide synthesis
Sulfonamides, trimethroprim
Which antibiotics block DNA topoisomerases
Quinolones
Which antibiotics block mRNA synthesis
Rifampin
Which antibiotics block protein synthesis at 50S ribosomal subunit
Buy AT 30, CELL at 50
Chloramphenicol
Erythromycin/Macrolides
Lincomycin
Clindamycin
Streptogramins (quin/dalfo)
Linezolid
Which antibiotics block protein synthesis at 30S ribosomal subunit
Buy AT 30, CELL at 50

Aminglycosides
Tetracyclines
What are the bactericidal antibiotics
PCN, Cephalosporins, Vanco, Aminglycosides, Fluoroquinolones, Metronidazole
What is the clinical use for PCN
bactericidal for GPC, GPR, GNC and spriochetes but is not PCNase resistant
what is most common toxicity with PCN
hypersensitivity rxns
What is the mechanism of action for methicillin, nafcillin, dicloxacillin

Clinical Use
Block cell wall resistance--PCNase resistant b/c of bulkier R group.
Narrow Spectrum
MSSA, not MRSA
What toxicity is assoc with Methicillin
Interstitial Nephritis
What is the mechanism of Ampicillin and Amoxicillin
Wider spectru B-lactam, PCNase sensitive
can combine with clavulanic acid --> PCNase inhibitor
What is the clinical use of Ampicillin and Amoxicillin
Extended spect PCN --> GPs and GN (H. flu, E.coli, Listeria, Proteus, Salmonella, enterococci)
Amp/Amox HELPS kill enterococci
What is the mech of Tic/Carbenicillin, Pipercillin
extended spectrum PCN
What is the clinical use of Tic/ Carbenicilline, piperacillin
Takes Care of Pseudomonas
Pseudomonas, GNRs;
susceptible to PCNase (use with clavulanic acid)
What is the mech of action of Cephalosporins
B-lactam that are less susceptible to PCNases.
What is the clinical use of 1st gen cephalosporins (Cephalexin, Cefazolin)
GPC + proteus, E.coli, Klebsiella
1st Gen -PEcK
What is the clinical use of 2nd gen cephalosporins (cefoxitin, cefaclor, cefuroxime)?
2nd gen -- HEN PEcKS
H. flu, Enterobacter, Neisseria, Proteus, E.coli, Klebsiella, Serratia
what is the clinical use of 3rd gen cephalosporins (ceftriaxone, cefotaxime, ceftazidime)
serious GN infxns resistant to other B-lactams
meningitis -- penetrate BBB
ceftazidime -- Pseudomonas
Ceftriaxone -- Gonococcus
What is the clinical use of 4th gen cephalosporins (cefpime, ecfpiramide)
increased Pseudomonal and GP activity
What is the most common toxicity with cephalosporins
Hypersensitivity rxns -- 5-10% cross reactivity w/ PCN;
disulfram like rxn with ETOH
What is the mech of Aztreonam
Inhib cell wall synthesis--monobactam resistant to B-lactamases (bind PBP3)
synergistic with Aminoglycosides
What is the clinical use of Aztreonam
GNR -- klebsiella, Pseudomonas, Serratia; no GP or anaerobic coverage
What is the mechanism of action of imipenem/cilastatin, meropenem
Imipenem is broad spectrum- B-lactamase resistsant carbapenem
Alway admin w/ cilastain to decrease inactivation in renal tubules
What is the clincal use of Imi and meropenem
GPC, GNR and anaerobes, enterobacter
What is the toxicity assoc w/ Imi and meropenem
GI, rash, CNS (seizures)
What is the mech of vancomycin
inhib cell wall mucopeptide by binding D-ala -D-ala portion of cell wall. Bactericidal
resistance in AA change to D-ala --D-lac
What is the clinical use of Vancomycin
MRSA and C. Diff.
What toxicities are assoc w/ Vanc
Nephrotoxicity, Ototoxicity, Thrombophlebitis, Red Man Syndrome
What is the mechanism of action of Aminoglycosides (Gent, Neo, Amikacin, Tobra, Strepto)
30S inhibitors -- inhibit formation of initiation complex and cause mRNA misreading
require O2 for uptake--> ineffective vs anaerobes
What is the clinical use of Aminoglycosides
Severe GNR infxn -- synergistic with B-lactams
Increase uptake with cell wall synthesis inhibition
What is the primary toxicity with Aminoglycosides
Nephrotoxicity, Ototoxicity, Teratogen
Which antibiotics are Aminoglycosides
GNATS
Gent, Neo, Amikacin, Tobra, Strepto
What abx are tetracyclines
Tet, doxy, demeclocycline, minocycline
What is the mechanism of action of tetracycline
bind 30S and prevent aminoacyl-tRNA
limited CNS penetration, not to take with milk
What is the clinical use of tetracyclines
VACUUM THe BedRoom
Vibrio, Acne, Chlamydia, Ureaplasam Urealyticum, Mycoplasma,
Tularemia, H.pylori
Borrelia (lyme), rickettsia (RMSF)
what is the toxicity assoc w/ tetra
GI, teeth discoloration, inhibition of bone growth
What are the macrolides
Erythro, Azithro, Clarithro
What is the mech of action of macrolides (erythro, azithro, clarithro)
50S inhibitors-- block translocation by binding 23S rRNA of 50S subunit
What is the clinical use of macrolides
URI, PNA, STD
URI and PNA:GPC (tx strep in pts w/ PCN allergies)Mycoplasma, legionella,
STD: Chlamydia, Neisseria
What is the toxicity assoc c/ macrolides
GI, acute cholestatic hepatitis, eosinophilia,
increases serum concentrations of theophyllines and oral anticoags
What is the mechanism of chloramphenicol
inhib 50S peptidyltransferase
What is clinical use of chloramphenicol
meningitis (H flu, Neisseria, Strep pneumo)
What is the toxicity assoc w/ Chloramphenicol
Anemia, aplastic anemia, gray baby syndrome b/c lack UDP-glucuronyl transferase
What is the mech of clindamycin
block peptide formation at 50S subunit
What is the clinical use of clindamycin
Anaerobic infections above the diaphragm
Bacteroides fragilis, clostridium perfringens
What is the toxicity assoc w/ clindamycin
Pseudomembranous colitis (c.diff), fever, diarrhea
What is the mech of sulfonamides
block nucleotide synthesis -- PABA antimetab inhib DHP synthese --> decrease in THF
what is the clinical use of sulfas
GP, GN, Nocardia, Chlamydia
what is the toxicity with sulfas
hemolysis in G6PD, tubulointerstitial nephritis, kernicterus in infants, displace other albumin bound drubs (warfarin)
What is the mech of TMP
inhib bacterial DHF reductase --> sequential block of folate synthesis in combo with sulfa
what is the clinical usage of SMX/TMP
recurrent UTI -- Shigella, Salmonella,
Pneumocystis carinii PNA
What is the toxicity assoc w/ TMP
megaloblastic anemia, leukopenia, can supp with folinic acid
What are the fluoroquinolones
cipro, norflox, oflox, sparflox, moxi, gati, enoxacin (FQs);
nalidixic acid (Quinolone)
what is the mech of FQs
DNA Gyrase inhibitors (topo II)
what is the clinical use of FQa
GNR of UTI and GI infxns
Pseudomonas, Neisseria and some GPs
What is the toxicity assoc w FQs
GI, superinfxn, rash, HA , dizziness
Contra in prego 2/2 cartilage damage
Tendonitis in adults
What is the mech of metronidazole
forms toxic metabolites in bacterial cells
what is the clinical use of Metro
GET GAP on the Metro
Antiprotozoal
Giardia, Entamoeba, Trichomonas
Garnerella, Anaerobes (Bacteroides, Clostridium), H. Pylori
What is the toxicity assoc w/ Metro
disulfram-like rxn with ETOH, HA and metallic taste
What is the mechanism of polymyxin
bind to cell membranes of bacteria and disrup their osmotic properties (cationic base proteins like detergents)
What is the clinical use of polymyxin
reisistant GN infxns
What is the toxicity assoc with Polymyxins
Neurotoxicity, acute renal tubular necrosis
What are the anti-TB drugs
INH-SPIRE
INH -- Streptomycin, Pyrazinamide, INH, Rifampin, Ethambutol

all hepatotoxic
What is the mech for INH
decrease synth of mycolic acids
what is the clinical use and toxicity
MTB (solo prophylaxis)
Toxicity: slow acetylators --neuro and hepatotoxic; hemolysis in G6PD, SLE-like syndrome, Pyridoxine (vit B6) can prevent neurotoxicity
What is the mechanism of Rifampin
inhib DNA-dep RNA polymerase, increases microsomal p-450 system
red-orange body fluids
rapid resistance if used solo
What is the clinical use of rifampin
MTB,
delays resistance to dapsone when use in leprosy
meningococcus prophylaxis
chemoprophylaxis in HIB in kids
What is the resistance mechanism to PCN/Cephalosporins
B-lactamase cleavage of B-lactam ring
What is the resistance mechanism to Aminoglycosides
Modification via acetylation, adenylation, phosphorylation,
AGs are 50S inhib of initiation complex
What is the resistance mechanism to Vancomycin
Terminal D-ala of cell wall replaced with D-lac --> decrease affinity
What is the resistance mechanism to chloramphenicol
modification via acetylation
chloramphenicol inhibits 50S peptidyltransferase
What is the resistance mechanism to macrolides
methylation of rRNA near erythromycins ribosome binding site
Macrolides block translocation
What is the resistance mechanism to Tetracyclines
decreased uptake or increased transport out of cell
Tetracycline binds the 30S and prevent attachment of aminoacyl-tRNA
What is the resistance mechanism to Sulfonamides
Altered enzyme (bacterial DHP synthetase), decreased uptake, or increase PABA synthesis
What is prophylaxis for meningococcus
Rifampin or minocycline
What is prophylaxis for Gonorrhea
Ceftriaxone
What is prophylaxis for Syphilis
Benzathine PCN G
What is prophylaxis for hx of recurrent UTI
TMP-SMX
What is prophylaxis for Pneumocystis carinii PNA
TMP-SMX
What is prophylaxis for endocarditis with surg or dental procedures
PCNs
What is the mechanism of Ampho B
bind ergosterol, forms membrane pores --> leakage of electrolytes
what is Ampho B used for
Crypto, Blasto, Coccidoides, Aspergillus, Histo, Candida, Mucor

does not cross BBB --> intrathecal
toxicity with Ampho B
fever/chills, phebitis, nephrotoxicity
What is mech of nystatin
binds ergosterol, disrupt fungal membrane
use of nystatin
oral candidiasis, diaper rash
mech of azoles
inhib fungal steroid (ergosterol) sythesis
use of azole
systemic mycosis
fluconazole in crypto meningitis in AIDS; candidal ifxn
Keto--Blasto, coccidioides, histo, candida
toxicity with azoles
hormone synthe inhib (gynecomastia), liver dysfx (inhib cytochrom p450
mech of flucytosine
inhib DNA synthesis by conversion to FU competing with U
use of flucytosine
system fungal infxn--candida, crypto
mech of caspofungin
inhib cell wall synthesis
use of caspofungin
invasive aspergillosis
mech of terbinafine
inhib fungal enzyme sqalene epoxidase
use of terbinafine
tx dermatophytoses (onychomycosis)
mech of Griseofulvin
interferes with microtubule function, disrupts mitosis --. deposits in keratin containing tissues (nails)
use of griseofulvin
oral tx of superficial infxn, inhib growth of dermatophytes (tinea, ringworm)
toxicity of griseofulvin
teratogenic, carcinogenic, HA, increse p450 and warfarin metab
What are basic mechanism of antiviral therapy
inhib viral absorption (nonspec)
block uncoating (influ A)
block early protein synthesis (CMV)
Reverse transcriptase inhib
block packaging and assembly (vaccinia)
block viral release (influenza)
what is the use, mech, and mech of resistance of amantadine
use: Influenza A --tx and prophylaxis
parkinsons
mech:blocks viral penetration (M2 protein)
resistance: M2 protein (90% in FluA)
what is the use, mech, and mech of resistance of zanamavir/oseltamivir
use: influenza A and B
mech: inhib neuraminidase --> decreased viral release
resistance: segments genomic shifts
what is the use, mech, and mech of resistance of ribavirin
use: RSV, hepC
mech: inhib synthesis of guanine
tox: hemolytic anemia, severe teratogen
what is the use, mech, and mech of resistance of acyclovir
Use: HSV, ZVZ, EBV, prophylaxis in IC pts
Mech: inhib viral DNA polymerase when phosphorylated by thymidine kinase
Resist: lack of thymidine kinase
what is the use, mech, and mech of resistance of gancyclovir
USE: CMV, in IC pts
Mech: inhib CMV DNA polymerase after phosphorylation by viral kinase
Resist: mutation in DNA polymerase or absence of thymidine kinase
what is the use, mech, and mech of resistance of Foscarnet
USE: CMV retinitis in IC pts, when gancyclovir fails, also acyclovir resistant HSV
mech: viral DNA poly inhib, not required to be phosphorylated
resist: mutated DNA polymerase
what are some of the protease inhibitors
ritonavir, indinavir, nelfinavir
what is the mech of protease inhibitors
inhib new virus assembly by blocking protease in progeny viruses
what is the toxicity of protease inhibitros
GI, hyperglycemia, lipodystrophy, thrombocytopenia
what are some of the RTIs
Nucl: zidovudine (AZT), diadanosine (DDI), lamivudine (3TC)
NonNucl: nevirapine, efavirenz, delavirdine
What is the mech of NRTI, NNRTIs
inhib RT of HIV, prevent incorporation into host genome
What is the toxicity of NRTIs
BM suppression, lactic acidosis, rash
What is the clinical use of NRTI
HAART --> CD4 < 500 or high viral load
what is the use, mech, and toxicity of Interferons
USE: IFN-a chronic hep B and C, kaposi's; IFN-b --MS, IFN-g -- NADPH oxidase deficiency
Mech: -- glycoproteins from human leukocytes that block viral RNA and DNA synthesis, induce ribonuclease that degrades viral mRNA
Toxicity: neutropenia
What is Ivermectin use in
Onchcerciasis (rIVER blindness tx w/ IVERmectin
What is mebendazole/thiabendazole used in
Nematode/roundworm (pinworm, whipworm)
What is pyrantel pamoate used in
Giant roundworm (ascaris), hookworm(necator/ancylostomia)
pinworm (enterobius)
waht is praziquantel used in
trematod/fluke (schotsome, paragonimum, clonorhci and cysticercosis
what is niclosamide used in
cestode/tapeworm (diphyllobothrium latum, tenia) except cysticercosis
what is pentavalent antimony used in
Leishmaniasis
What is chloroquine, quinine, mefloquine, atovaquone used in
malaria
what is primaquine used in
latent hypnozoite (liver) forms of malaria--vivax and ovale
What is metronidazole used in
Giardia, amedic dysentery (entamoeba histolytica), BV (gardnerella), and trichomonas
what is TMP-SMX use in prophylactically
Pneucystic carinii PNA prophylaxis
What is nifurtimox used in
Chagas dz, american trypanosomiasis (trypanosoma cruzi)
What is Suramin use in
African trypanosomiasis (sleeping sickness)
What antibiotics should be avoided in pregnancy
SAFE Mom Take Really Good Care
Sulfa (kernicterus), AG (ototoxic), FQ (cartilage), Erythro (hepatitis)
Metro (mutagen), Tetracycline (discolored teeth, inhib bone growth), Ribavirin (teratogen), Griseofulvin (teratogen), Chloramphenicol (gray baby)
What is the normal flora of the skin
staph epi
What is the normal flora of the nose
Staph aureus
What is the normal flora of the oropharynx
viridans strep
What is the normal flora of the dental plaque
strep mutans
What is the normal flora of the colon
bacteroides > e.coli
What is the normal flora of the vagina
lactobacillus, e.coli, GBS
What orgs cause PNA in Children (6wk-18yr)
Virus (RSV)
Mycoplasma, Chlam PNA, Strep Pneumo
what orgs cause PNA in Adults (18-40)
Mycoplasma, C pneumo, S pneumo
What orgs cause PNA in Adults (40-65)
S. pneumo
H flu
Anaerobes
Viruses and Mycoplasma
What orgs cause PNA in Elderly
S. Pneumo
Virus
Anaerobes
H flu
GNR
Org responsible in Hosp Acq PNA
Staph, GNR
Orgs responsible in IC PNA
Staph, GNR, fungi, viruses, Pneumocystis in HIV
Orgs in aspiration PNA
anaerobes
Orgs in Postviral PNA
Staph, H flu
Orgs in Neonatal PNA
GBS, E. coli
Orgs in atypical PNA
Mycoplasma, Legionella, Chlamydia
Orgs in Neonatal Meningitis
GBS, Ecoli, Listeria
orgs in meningitis in kids (6mos-6yrs)
S pneumo, N. mening, H flu, Enterovirus
orgs in meningitis b/w 6yr and 60yrs
N. mening
Enterovirus
S. pneumo
HSV
orgs in meningitis in elderly
S. pneumo
GNR
Listeria
orgs in osteo
S. aureus
osteo in sexually active
N. gono
osteo in DM
Pseudomonas
Osteo in Sickle cell
Salmonella
Osteo in Prosthetic replacement
S aureus, S epi
org in Vertebral osteo
potts-- MTB
org in Ambulatory UTI
Ecoli, Klebsiella, Staph sapro (yg women)
orgs in hospital UTI
ecoli, proteus, klebsiella, serratia, pseudomonas
What does positive Leukocyte esterase and positive nitrite test indicate
Leukocyte esterase -- bacterial
nitrite test -- gram negative
What STD would cause a rectal strictures
Lymphogranuloma venereum
What strains of HPV cause condylomata accuminata
HPV 6 and 11
what are the clinical feature fo chancroid and what is the org
painful genital ulcer, haemophilus ducreyi
What risk factor is assoc w/ CMV and RSV infxns
newborn nursery
what org would likely to cause infxn 2/2 urinary catheterization
e coli
proteus
What infxn in use of respiratory equipment assoc w/
Pseudomonas
what infxn in assoc w/ work in a renal dialysis unit
HBV
what infection is assoc w/ hyperalimentation
candida
what infection is assoc with water aerosols
legionella
What are the ToRCHeS in pregos
dangerous infections in pregos
Toxo
Rubella
CMV
HSV/HIV
Syphilis
What org?
pus, empyema, abscess
S. aureus
what bug
Pediatric infxn, epiglottis
H flu
what bug
PNA in CF or burn victim
pseudomonas
what bug
branching rod in oral infxn
Actinomyces
what bug
traumatic open wound
clostridium perfringens
what bug
surgical wound
s. aureus
what bug
dog or cat bite
pasteurella
what bug
currant jelly sputum
klebsiella
what bug
sepsis/meningitis in newborn
GBS
OI in AIDS
Brain
Crypto, toxo, CMV, AIDS dementia, PML (JC virus)
OI in AIDS
Eyes
CMV retinitis
OI in AIDS
Mouth and throat
thrush -- Candida albican, HSV, CMV, oral hairy leukoplakia (EBV)
OI in AIDS
Lungs
PCP, TB, histo
OI in AIDS
GI
Cryptosporidiosis, MAC, CMV colitis, NHL (EBV)
OI in AIDS
Skin
Shingles (VZV), kaposi (hHV-8)
OI in AIDS
Genitals
HSV, warts, cervical Ca (HPV)