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101 Cards in this Set

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Mechanism of Action of:

Penicillin, Ampicillin, ticarcillin, piperacillin
Imipenam
Aztreonam
Cephalosporins
Block cell wall synthesis
Inhibit peptidoglycan cross-link
Drugs that:

Block cell wall synthesis
Inhibit peptidoglycan cross-link
Penicillin, Ampicillin, ticarcillin, piperacillin
Imipenam
Aztreonam
Cephalosporins
Mechanism of Action of:

Bacitracin
Vancomycin
Block peptidoglycan synthesis
Drugs that:

Block peptidoglycan synthesis
Bacitracin
Vancomycin
Mechanism of Action of:

Polymyxins
Disrupt bacterial cell membrane
Drugs that:

Disrupt bacterial cell membrane
Polymyxins
Mechanism of Action of:

Sulfonamides
Trimethoprim
Block nucleotide synthesis
Drugs that:

Block nucleotide synthesis
Sulfonamides
Trimethoprim
Mechanism of Action of:

Quinolones
Block DNA topoisomerase and gyrase
Drugs that:

Block DNA topoisomerase and gyrase
Quinolones
Drugs that:

Block mRNA synthesis
Rifampin
Mechanism of:

Rifampin
Block mRNA synthesis
Drugs that:

Block 50S subunit
Chloramphenicol
Macrolides
Clindamycin
Streptogramins (quinupristin, daflopristin)
Linezolid
Mechanism of:

Chloramphenicol
Macrolides
Clindamycin
Streptogramins (quinupristin, daflopristin)
Linezolid
Block 50S subunit
Drugs that:

Block 30S subunit
Aminoglycosides
Tetracyclines
Mechanism of:

Aminoglycosides
Tetracyclines
Block 30S subunit
Bacteriostatic Abx's (6)
"ECSTaTiC"

Erythromycin
Clindamycin
Sulfamethoxazole
Trimethoprim
Tetracyclines
Chloramphenicol
Bactericidal Abx's (6)
"Very Finely Proficient At Cell Murder"

Vancomycin
Fluoroquinolones
Penicillin
Aminoglycosides
Cephalosporins
Metronidazole
Penicillin Mechanism
prototype B-lactam Abx
G: IV, V: oral
bacteriocidal

1. Binds Penicillin Binding Proteins (PBP)

2. Block transpeptidase cross-link

3. Activate autolytic enzymes
Penicillin Clinical Use
Bacteriocidal

Gram + cocci, rods
Gram - cocci
Spirochetes
Penicillin resistance mediated by
B-lactamase
Penicillin toxicity
Hypersensitivity rxns
Hemolytic anemia
Methicillin, nafcillin, dicloxacillin
(penicllinase-resistant penicillins)

Mechanism?
Same as penicillin
Narrow spectrum
Penicillin resistant b/c of bulky R group

"Use naf for staph"
Methicillin, nafcillin, dicloxacillin
(penicllinase-resitant penicillins)

Clinical use?
S. aureus
(except MRSA)
How is MRSA resistant?
Altered PBP (penicillin binding protein)
Methicillin, nafcillin, dicloxacillin
(penicllinase-resitant penicillins)

Toxicity?
Hypersensitivity rxn
Methicillin: interstitial nephritis
Ampicillin, amoxicillin (aminopenicillins)

Mechanism?
Same as penicillin
Wider spectrum
Combine with clavulanic acid to enhance spectrum
Which has greater oral availability, amoxicillin or ampicillin?
"amOxicillin has greater Oral availability"
What do you combine aminopenicllins and antipseudomonals with to enhance spectrum?
Clavulanic acid
Ampicillin, amoxicillin (aminopenicillins)

Clinical use?
Extended spectrum penicillin

certain gram + rods

gram - rods
"HELPS"
H. influenzae
E.coli
Listeria monocytogenes
Proteus
Salmonella
enterococci
Ampicillin, amoxicillin (aminopenicillins)

Toxicity?
Hypersensitivity rxn
Ampicillin rash
Pseudomembranous colitis
Ticarcillin, carbenicillin, piperacillin
(Anti-pseudomonals)

Mechanism?
Same as penicillin.
Extended spectrum.
Ticarcillin, carbenicillin, piperacillin
(Anti-pseudomonals)

Clinical use?
Pseudomonas
Gram - rods

Susceptible to penicillinase
Use with clavulanic acid

"TCP": Takes Care of Pseudomonas
Ticarcillin, carbenicillin, piperacillin
(Anti-pseudomonals)

Toxicity?
Hypersensitivity rxn
Mechanisms of Cephalosporins
B-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases.

Bactericidal.
Cephalosporins--1st generation uses
Cefazolin, cephalexin

Gram + cocci

PEcK
Proteus
E.coli
Klebsiella
Cephalosporins--2nd generation uses
cefoxitin, cefaclor, cefuroxime

gram + cocci

HEN PEcKS
H. influenzae
Enterobacter
Neisseria
Proteus
E.coli
Klebsiella
Serratia
Cephalosporins--3rd generation uses
ceftriaxone, cefotaxime, ceftazidime

serious gram-negative infxns resistant to other B-lactams
meningitis (penetrate BBB)

ex:
ceftazidime for Pseudomonas
ceftriaxone for Gonorrhea
Cephalosporin Toxicities
Hypersensitivity rxns
Some cross-reactivity with penicillins
Increases nephrotoxicity of aminoglycosides
Disulfram-like rxn with ethanol
Aztreonam Mechanism
Monobactam resistant to B-lactamases
Inhibits cell wall synthesis by binding to PBP3

Synergistic with aminoglycosides
No cross rxn with penicillins
Aztreonam Clinical Use
Gram - rods
Klebsiella
Pseudomonas
Serratia

No activity with gram + or anaerobes
In what circumstance would you use Aztreonam?
Penicillin allergic Pts
Pts with renal insufficiency who can't tolerate aminoglycosides
4th generation Cephalosporins
Increased activity against Pseudomonas

Gram +
Aztreonam Toxicity
Usually non-toxic
Occasional GI upset
No cross reactivity with penicillins or cephalosporins
Impenem/cilastatin, meropenem

Mechanism?
Broad-spectrum carbapenem
B-lactamase resistant
Always administered with cilastatin to decrease inactivation in renal tubules

"The kill is LASTIN' with CILASTATIN"
Aztreonam Clinical Use
Gram + cocci
Gram - rods
Anaerobes
ENTEROBACTER

Significant side effects limit use to life threatening infxns or after failed drugs
Aztreonam toxicity
GI distress
CNS toxicity (seizures), at high levels
Skin rash
Vancomycin Mechanism?
Inhibits cell wall formation by binding D-ala D-ala

Bactericidal
Mechanism of Vancomycin resistance?
Amino acid change of D-ala D-ala to D-ala D-lac
Vancomycin clinical use?
Serious gram + multidrug resistant organisms
S.aureus (MRSA)
C. difficile
Vancomycin toxicity
"does NOT have many problems"

Nephrotoxicity
Ototoxicity
Thrombophlebitis

"red man syndrome" (diffuse flushing)
What is "red man syndrome" and how can you prevent it?
Diffuse flushing as a side effect of vancomycin use

Prevention:
Pre-treatment with anti-histamines
Slow infusion rate
Protein synthesis inhibitors (7)
"buy AT 30, CCELL (sell) at 50"

30S:
Aminoglycosides
Tetracyclines

50S:
Chloramphenicol, Clindamycin
Erythromycin
Lincomycin
Linezolid
30 S inhibitors (2)
Aminoglycosides
Tetracyclines

"AT"
50 S inhibitors (5)
Chloramphenicol
Clindamycin
Erythromycin
Lincomycin
Linezolid

"CCELL"
Aminoglycoside Drugs (5)
Gentamicin
Neomycin
Tobramycin
Streptomycin

"Mean" (amine) GNATS canNOT kill anaerobes"
Aminoglycoside Mechanism
Bactericidal
Inhibition of initiation complex formation
Requires O2 for uptake

Ineffective for anaerobes
Which does Aminoglycoside require for uptake and what are the implications of this?
Requires O2.
Makes it ineffective for anaerobes
Aminoglycosides

Clinical Use?
Severe gram - rod infxns
Synergistic with B-lactams.
Aminogycoside toxicity?
Nephrotoxicity
Ototoxicity
Teratogen
Tetracycline Drugs (4)
Tetracycline
Doxycycline
Demeclocycline
Minocycline
Tetracycline Mechanism?
Bacteriostatic
Binds 30S

Limited CNS penetration
How is Doxycycline eliminated and what are the implications of this?
Fecally eliminated, so can be used in Pts with renal failure.

CANNOT take with milk, antacids or Fe containing compounds--inhibits absorption
Tetracycline Clinical Use?
"VACUUM THe Bed Room"

V. cholerae
Acne
Chlamdyia
Ureaplasma
Urealyticum
Mycoplasma pneumonia
Tularemia
H. pylori
Borrelia burdorferi
Rickettsia
Tetracycline Toxicity?
GI Distress
Discoloration of teeth
Inhibition of bone growth in kids
Photosensitivity
Contraindicated in pregnancy
Macrolide Drugs (3)
Erythromycin
Azithromycin
Clarithromycin
Macrolide mechanism
Bacteriostatic
Binds 50S subunit
Macrolide clinical use
Gram + cocci (strep Pts allergic to Penicillin
URI
Pneumonia
STDs

Mycoplasma
Legionella
Chlamdyia
Neisseria
Macrolide toxicity
GI discomfort
Cholestatic hepatitis
Eosinophilia
Skin rashes
Chloramphenicol Mechanism
Bacteriostatic
Inhibit 50 S subunit
Chloramphenicol Clinical Use
Meningitis (H. influenzae, N. meningitidis, S. pneumoniae)

Conservative use b/c of toxicity
Chloramphenicol Toxicity
Aplastic anemia
gray baby syndrome
Cause of gray baby syndrome?
Chloramphenicol
Clindamycin Mechanism?
Bacteriostatic.
Binds 50S subunit
Clindamycin use?
Anaerobic infxns.
(Bacteroides, C. perfringens, etc.)
Clindamycin toxicity
Pseudomembranous colitis (C. diff overgrowth)
Fever
Diarrhea
Sulfonamide Drugs (4)
Sulfamethaxole (SMX)
Sulfisoxazole
Triple sulfas
Sulfadiazine
Sulfonamide Mechanism?
Bacteriostatic
PABA antimetabolites inhibit dihydropteroate synthase
Sulfonamides clinical use?
Gram +
Gram -
Nocardia
Chlamydia
Simple UTI
Sulfonamide toxicity?
Hypersensitivity rxn
Hemolysis (GP6D deficient)
Nephrotoxicity
Photosensitivity
Kernicterus in infants
Displace other drugs from albumin (warfarin)
Trimethoprim Mechanism?
Bacteriostatic
Inhibits folate synthesis
Trimethoprim Clinical Use
Used with sulfonamides

Combination use for:
recurrent UTI
Shigella
Salmonella
PCP pneumonia
Trimethoprim toxicity
Megaloblastic anemia
Leukopnia
Granulocytopenia
Fluoroquinolone Drugs
"Flox" drugs
Enoxacin
Nadilixic acid (quinolones)
Fluoroquinolone Mechanism?
Bactericidal
Inhibit DNA gyrase (topoisomerase)

Must not be taken with antacids
Fluoroquinolone Clinical Use?
Gram (-) rods of urinary and GI tract
Pseudomonas
Neisseria

Some gram + organisms
Fluoroquinolone Toxicity
GI upset
Tendonits/tendon rupture
Cramps/myalgia in kids
Contraindicated in pregnant women

"fluoroquinoLONES hurt attachments to your BONES"
Metronidazole Mechanism
Bactericidal
Forms toxic metabolites that damage DNA
Metronidazole Clinical Use
Antiprotozoal, anaerobes

"GET GAP on the Metro"
Giardia
Entamoeba
Trichomonas
Gardnerella
Anaeroebes (Bacteroides, Clostridium)
(h.)Pylori (triple therapy)
Metronidazole Toxicity
Disulfiram-like toxicity with alcohol
HA
Metallic taste
Polymyxins Mechanism
" 'MYXins MIX up membranes"

Disrupt cell membranes.
Polymyxins Clinical Use
Resistant to gram (-) infections
Polymyxins toxicity
Neurotoxicity
ATN (acute tubular necrosis)
M. tuberculosis prophylaxis
Isoniazid
M. tuberculosis treatment
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
Isoniazid Mechanism
Decreases mycolic acid synthesis
Isoniazid clinical use
Solo prophylaxis for TB
Isoniazid toxicity
"INH"

Injures Neurons and Hepatocytes"
Rifampin Mechanism
Inhibit RNA polymerase
Rifampin Clinical Use
M. tuberculosis

Delays dapsone resistance in leprosy
Prophylaxis for contacts of Pts with H.influenzae
Treatemnt of VRE (Vancomycin Resistant Enterococcus)
Linezolid and streptogramins
(quinupristin/daflopristin)