Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
86 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Gray Baby Syndrome
|
cloramphenicol
|
50s inhibitor that gets into mitochondria ("ram"s into them)
|
|
|
broad spectrum 50s inhibitor that gets into mitochondria (bone marrow suppression)
LOW SAFETY INDEX |
chloramphenicol
|
'ram'
|
|
|
neurological problems - especially in cystic fibrosis
|
chloramphenicol
|
'ram'
|
|
|
-thromycin
|
macrolides
|
|
|
|
Binds to 23s of 50s ribosomal subunit
bacteriostatic, BROAD spectrum |
macrolides
|
-thromycin
|
|
|
Prolongs QT
|
macrolides especially erythromycin
|
|
|
|
long acting macrolides
|
azithromycin
dirithromycin |
|
|
|
sudden cardiac death associated with CYP450 inhibitors - Ca channel blockers, antifungals (azoles), typical antidepressants
|
macrolides
|
-thromycin
|
|
|
True or False: you should use two 50s antibiotics together
|
FALSE - no added benefit
|
|
|
|
can cause pseudomembranous colitis - either from killing natural flora with C. dif overgrowth or purely a drug effect
|
clindamycin
|
'dam'
|
|
|
50s inhibitor with no mitochondrial penetration that is used for strep and staph (most gram + and some anaerobic gram -)
|
clindamycin
|
'dam'
can't 'ram' into mitochondra |
|
|
Black box warning:
Vancomyicin resistant Streptococcus faecium |
Quinupristin-Dalfopristin
|
50s inhibitor - "constipates ribosome"
|
|
|
ribosomal constipation
|
Quinupristin-Dalfopristin
|
50s inhibitor
|
|
|
HEPATOTOXICITY - Hyperbilirubinemia
from 50s drug |
Quinupristin-Dalfopristin
|
|
|
|
Vancomycin resistant enterococcal infections
|
Linezolid
|
50s inhibitor
|
|
|
Low Safety Index Antibiotics
|
aminoglycosides
chloramphenicol |
|
|
|
Protein Synthesis Inhibitors
|
Aminoglycosides - 30s
Tetracylines - 30s Chloramphenicol Erythromycin Linezolid cLindamycin |
buy AT 30 CELL at 50
|
|
|
Black Box:
Hepatotoxicity over 35 pregnancy high acetylators |
Isoniazid
|
TB drug
|
|
|
decreases synthesis of mycolic acid
|
isoniazid
|
TB first line drug
|
|
|
first line TB drugs
|
Isoniazid, Ethambutol, Streptomycin, Rifampin, Pyrazinamide
|
RESPIre
|
|
|
retrobulbar neuritis (loss of central vision, impaired red/green vision)
|
ethambutol
|
uto
|
|
|
Only drug used as solo prophylaxis against TB
|
isoniazid
|
activated by mycobacterial catalase
|
|
|
give for neurotoxicity associated with isoniazid
|
vitamin B6 (pyridoxine)
|
vitamin
|
|
|
red-orange body fluids
|
rifampin, rifabutin
|
a first and second line TB drug
|
|
|
Hepatotoxicity especially in high acetylators and when given with isoniazid
|
rifampin
|
|
|
|
inhibitis synthesis of arabinogalactan disrupting cell wall synthesis
|
ethambutol
|
first line TB drug
|
|
|
RNA polymerase inhibitor
Revs up P450 Red/ orange body fluids Rapid resistance alone |
Rifampin
|
first line TB drug
|
|
|
TB drug activated by deacetylation (this process is induced and half-life falls in early stages of therapy)
|
Rifampin
|
first line TB drug
|
|
|
Lethal to intra and extra cellular forms of pathogen (mycobacterium)
|
Rifampin
|
|
|
|
Immunosuppressive Effect with intermittent therapy
|
Rifampin
|
early flu-like sx
|
|
|
First line TB drug with flexible treatment schedule and Hyperuricemia
|
Pyrazinamide
|
|
|
|
Second Line TB drugs
|
Para-aminosalicyclic acid
Ethionamide Cycloserine Rifabutin Quinolones |
|
|
|
Second line TB drug that inhibits folic acid synthesis by preventing PABA entry into folic acid pathway
|
para-aminosalicyclic acid
|
PAS
|
|
|
Second line TB drugs that should be avoided in patients with psychiatric disorders
|
Ethionamide and Cycloserine
|
ION
|
|
|
second line TB drug (good for renal TB) that is a competitive inhibitor of D-alanine
|
Cycloserine
|
|
|
|
Second line TB drug that inhibits DNA dependant RNA polymerase
|
Rifabutin
|
very similar to Rifabutin
|
|
|
True or False
Use Rifampin and Rifabutin together |
FALSE not different enough
|
both produce red orange body secretions
|
|
|
Second line TB drug where intermittent therapy is as good as chronic therapy
|
Para-aminosalicyclic acid
|
PAS
|
|
|
Second Line TB drug that causes sodium overload
|
Para-aminosalicyclic acid
|
PAS
|
|
|
This drug causes "sulfone" syndrome.
|
Dapsone
|
Used for Leprosy and Tuberculosis
|
|
|
Mechanism of Dapsone
|
inhibits folic acid sythesis (structurally related to sulfonamides)
|
structurally related to sulfonamides
|
|
|
Turns infected tissues reddish-brown.
|
Clofazimine
|
Also has anticholinergic effects, and its anti-inflammatory action may be important.
|
|
|
Spectrum of action for Sulfonamides.
|
Broad
Gram - and Gram + nocardia chlamydia |
|
|
|
Sulfonamide mechanism
|
inhibits folate sythesis (competive inhibitor of dihydopteroate synthetase preventing PABA into folic acid)
|
|
|
|
Two common combinations of folate antagonists that become super additive.
|
trimethoprim - sulfamethoxazole
pyrimethamine - sulfadoxine |
a sulfonamide + ___________
|
|
|
Mechanism of Trimethoprim and Pyrimethamine
|
Folate antagonist
inhibits bacterial dihydrofolate reductase |
similar to sulfonamide but lower in the pathyway
|
|
|
Why is trimethaprim and pyrimethamine used for UTIs?
|
It is elimated renally.
|
|
|
|
The three main side effects of sulfonamides are...
|
Hypersensitivity (Stevens Johnson syndrome)
Kernicterus Acute Hemolytic Anemia (worse in G6PD) |
H.K.A
|
|
|
Mechanism of action for nitrofurantoin (nitrofuran)
|
reactive nitro group that damages nucleic acids --> attacks DNA
|
BROAD SPECTRUM
|
|
|
Main adverse reaction of Nitrofurantoin
|
pulmonary reactions
|
area of high oxygen
|
|
|
Difference between 1st and 2nd generation (and beyond) fluoroquinolones
|
some gram + activity
|
|
|
|
Added benefit of 4th generation fluoroquinolone Trovafloxacin
|
anaerobic activity
|
|
|
|
Main indication for fluoroquinolones
|
gram (-) rods of urinary and GI tract
|
|
|
|
Mechanism of fluoroquinolones
|
inhibits topoisomerase II (and topoisomerase IV)
|
bacteriocidal and very aggressive
|
|
|
Main adverse reactions to fluoroquinolones
|
CNS effects
Cartilage effects Hemolytic Anemia (G6PD) |
lones hurt connections to bones
|
|
|
Vancomycin mechanism
|
inhibits cell wall synthesis by binding D-ala-D-ala terminal preventing polymerization of linear peptidoglycan
|
gorillacillin
|
|
|
Indications for vancomycin
|
MRSA, Gram + multidrug resistant organisms
|
gorillacillin
|
|
|
"red man syndrome"
|
vancomycin (histamine induced rash that includes increased HR, hypotension and broncospasm) worse with anesthetic
|
gorillacillin
|
|
|
Adverse reactions to Vancomycin
|
Nephrotoxicity
Ototoxicity Thrombophlebitis also red man syndrome |
Does NOT have many problems.
|
|
|
Mechanism of methenamine
|
converted to formaldehyde (no known resistance)
|
requires acidic environment
|
|
|
In alkaline urine during a UTI what would need to be done in order to use methenamine?
|
acidify urine to less than pH 5.5 (cranberry juice, vitamin C, mendelic acid)
|
think of its mechanism of action
|
|
|
Anti-staphylococcal penicillins
|
cloxacillin
oxacillin nafcillin dicloxacillin methicillin |
CONDoM
|
|
|
Why wouldn't you add clavulinic acid to the anti-staph penecillins?
|
already penicillinase resistant
|
|
|
|
Hepatic and Renal elimination
|
Oxacillin
Nafcillin Ampicillin Piperacillin |
|
|
|
There is a high cross reaction (when Type I hypersenstivity) between B-lactams which B lactam can you still use?
|
Aztreonam
|
gram (-) that's commonly used in therapy with Vancomycin
|
|
|
penicillin that causes neutropenia
|
nafcillin
|
N
|
|
|
Cephalorsporins that have disulfiram like reaction.
|
Cefotetan
Cefamandole Cefoperazone |
|
|
|
1st generation Cephalosporins
|
Cefazolin
Cephalothin Cephalexin Cefadroxil |
fa, pha except fac
|
|
|
2nd generation cephalosporins
|
cefaclor
cefotetan cefuroxime cefoxitin cefmetazole loracerbef |
all the rest
|
|
|
3rd generation cephalosporins
|
cefoperazone
ceftazidme ceftizoxime ceftriaxone cefixime |
ceft, fix, fop
|
|
|
4th generation cephalosporin
|
cefepime
|
|
|
|
Moving from 1st-4th generation cephalosporins what are the trends?
|
increased activity against gram (-)
decreased activity against gram (+) except from 3rd to 4th where 4th has more action increased resistance to B lactamases increased distribution in body tissues and fluids |
mostly increasing...
|
|
|
Spectrum of Imipenem with Cilastin
|
VERY BROADEST spectrum
|
the kill is lastin with ciLASTIN
|
|
|
Drug of choice for enterobacter
|
imipenem with cilastin
|
|
|
|
Main drawback of aztreonam
|
gram (-) only rods
|
|
|
|
Mechanism of daptomycin
|
lipoprotein that binds membranes of gram (+)
|
no known resistance
|
|
|
Drug interactions of daptomycin
|
Statins!!!
Warfarin Tobramycin |
causes depolarization (myopathy and peripheral neuropathy)
|
|
|
aminoglycoside mechanism
|
binds 30s subunit and induces errors in translation of mRNA
|
|
|
|
Adverse reactions to aminoglycosides
|
nephrotoxicity (NEVER USE WITH ANOTHER nephrotoxic drug)
ototoxicity |
amiNOglycosides
Low safety index |
|
|
Indication for aminoglycosides
|
aerobic gram (-)
|
|
|
|
Long acting tetracyclines
|
doxycycline
minocylcine |
dm
|
|
|
short acting tetracyclines
|
tetracyclcine
oxytetracycline use in hard to manage patients |
TOo short
|
|
|
mechanism of tetracycline
|
binds to 30s subunit
|
|
|
|
difference of doxycycline from rest of class of tetracylcines
|
fecal elimination
|
can use in renal impairment
|
|
|
Drugs used to enhance aminoglycoside activity
|
penicillins
|
can't give in same injection (acid base reaction)
|
|
|
Problems of tetracyclines
|
teeth and bone accumulation
no children or pregancy ototoxicity |
also psuedotumor cerebri
|
