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;
77 Cards in this Set
- Front
- Back
|
Antagonistic when used in combination with Beta lactam antibiotics
|
Tetracyclines
|
|
|
tetracycline mech of action
|
Bacteriostatic
Binds reversibly to 30 S Inhibits attachment of aminoacyl-tRNA |
|
|
Mechanism of Resistance
against tetracyclines |
*****facilitated efflux of drug****
Decreased entry |
|
|
main usage spectrum of tetracyclines
|
Atypical agents – Mycoplasma, Chlamydia, Chancroid, Rickettsia, Borrelia, Entamoeba
|
|
|
Rickettsia causes
|
rocky mt spotted fever
|
|
|
DOC for rickettsia/rocky mt spotted fever
|
tetracyclines
|
|
|
Lyme Disease doc
|
Lyme Disease (borrelia doc = ceftriaxone)
|
|
|
tetracycline toxicity
|
***Fetal and childhood effects on bones and teeth – Contraindication!
***Pseudotumor cebri ***Jarisch - Herxheimer reaction Hepatic necrosis (especially Doxy) may be fatal Photosensitivity Renal – renal tubular acidosis |
|
|
Tigecycline mech of action
|
Bacteriostatic
binds 30s post antibiotic effect |
|
|
tigecycline metabolism
|
metabolized in liver
excreted in bile/biliary tract |
|
|
pseudotumor cerebri
|
tetracycline and tigecycline
|
|
|
chloramphenicol MOA
|
bacteriostatic
binds 50s Inhibits peptidyl transferase |
|
|
mech of resistance against chloramphenicol
|
inactivating enzymes made by plasmid
reduced permeability |
|
|
chloramphenicol clinical use
|
drug of last choice for
brain abscess rocky mt spotted fever |
|
|
chloramphenicol toxicity
|
Idiosyncratic Aplastic anemia, irreversible
Dose related Aplastic anemia Gray baby syndrome – cant conjugate chloramphenicol because of immaturity/decreased levels of glucuronosyl transferase |
|
|
which drug classes concentrate in respiratory secretions
|
macrolides n ketolides concentrate here
|
|
|
macrolides ex?
|
Erythromycin
Clarithromycin Azithromycin |
|
|
ketolides ex
|
telithromycin
|
|
|
which drug concentrates in phagocytic cells
|
azithromycin concentrates here
|
|
|
macrolides/ketolides MOA
|
bacteriostatic
binds 50s Prevents ribosomal translocation down m-RNA |
|
|
mech of resistance of macrolides/ketolides
|
***Target alteration – receptor on ribosome is altered by a methylase, encoded by erm beta gene on the plasmid***
**Inactivating enzymes** dec permeability inc efflux |
|
|
DOC salmonella (typhoid fever)
|
azythromycin
|
|
|
doc Legionnaire’s disease
|
azythromycin
|
|
|
DOC Mycoplasma
|
azythromycin
|
|
|
Bordetella pertussis
|
azythromycin
|
|
|
doc Atypical Mycobacteria
|
Clarithromycin doc
|
|
|
azythromycin doc for
|
salmonella
legionnella mycoplasma bordetella pertusis |
|
|
macrolide toxicity
|
***pyloric stenosis in infants***
**rarely cardiotoxicity and death** |
|
|
ketolides (telithromycin) toxicity
|
***Blurred Vison
***Prolonged QT Interval ***Exacerbation of Myasthenia gravis*** |
|
|
clindamycin MOA
|
bacteriostatic
binds 50s prevents ribosomal translocation down the mRNA |
|
|
clindamycin spectrum
|
Excellent for g+ (including Staph aureus, severe invasive strep), NOT Enterococci
Excellent activity against anaerobes |
|
|
clindamycin toxicity
|
Pseudomembranous colitis secondary to C. diffocoel overgrowth.
+ the usual |
|
|
synercid moa
|
bacteriocidal
binds 50s prevents ribosomal translocation down mRNA prevents protein synthesis at elongation |
|
|
mech of resistance against synercid
|
efflux
inactivating enzymes target alteration |
|
|
synercid spectrum
|
Spectrum
Staph aureus and epidermidis, Strep pyogenes and aglacia, Some enterococci |
|
|
synercid toxicity
|
Precludes widespread use:
drug interactions, phlebitis 40%, jaundice 30%, arthralgia and myalgia 20% |
|
|
this drug has Better penetration into lung (pneumonia) than Vancomycin
|
linezolid
|
|
|
linezolid mech of action
|
bacteriostatic
binds 50s inhibits initiation complex n translocation of tRNA |
|
|
linezolid resistance
|
target alteration so dec affinity
|
|
|
linezolid spectrum
|
All aerobic gram positive organisms especially resistant staph, strep and enterococci
|
|
|
linezolid toxicity
|
Thrombocytopenia and neutropenia (reversable bone marrow suppression)
Weak MAO inhibitor ***Hyperserotonin effect [rare but severe] in patients on SSRI drugs (headache, syncope, palpitations) ***Rare Lactic acidosis |
|
|
sulfonamides resemble
|
paba
para amino benzoic acid |
|
|
sulfa drugs ex
|
salfisoxazole
sulfamethoxazole sulfadiazine |
|
|
sulfonamides mech of action
|
bacteriostatic
inhibit synthesis of folic acid via action on Dihydropteroate synthetase |
|
|
trimethoprim action
|
inhibit dihydrofolate reductase needed to make folic acid.
|
|
|
**mech of resistance agaisnt sulfonamides
|
**porin mutations - dec intracellular accumulation
**dec sensitivity of dihydropteroate synthetase **inc production of PABA |
|
|
combo of tmp-sulfa called
|
Cotrimoxazole
|
|
|
sulfonamides spectrum
|
Gram negative bacteria: Neisseria meningitidis, E. coli
Gram positive bacteria: Strep pyogenes, Strep pneumoniae, some MSSA and MRSA Chlamydia (but not for neonate) Nocardia ****Toxoplasma ****Pneumocystis |
|
|
sulfonamides clinical uses
|
Uncomplicated urinary tract infections (TMP – Sulfa methoxazole)
Otitis Media (TMP – Sulfamethoxazole) Topical burn prophylaxis (Mafenide acetate – Sulfamylon) (Silver sulfadiazine) Ulcerative colitis (Salicylazosulfapyridine – Azulfidine) Toxoplasmosis (pyrimethamine added as second drug) PCP prophylaxis and treatment (TMP – Sulfa) |
|
|
drug for toxoplasmosis
|
sulfonamides + pyrimethamine****
|
|
|
drug for PCP prophylaxis n tx
|
tmp-sulfa
|
|
|
sulfonamides resemble
|
paba
para amino benzoic acid |
|
|
sulfa drugs ex
|
salfisoxazole
sulfamethoxazole sulfadiazine |
|
|
sulfonamides mech of action
|
bacteriostatic
inhibit synthesis of folic acid via action on Dihydropteroate synthetase |
|
|
trimethoprim action
|
inhibit dihydrofolate reductase needed to make folic acid.
|
|
|
**mech of resistance agaisnt sulfonamides
|
**porin mutations - dec intracellular accumulation
**dec sensitivity of dihydropteroate synthetase **inc production of PABA |
|
|
combo of tmp-sulfa called
|
Cotrimoxazole
|
|
|
sulfonamides spectrum
|
Gram negative bacteria: Neisseria meningitidis, E. coli
Gram positive bacteria: Strep pyogenes, Strep pneumoniae, some MSSA and MRSA Chlamydia (but not for neonate) Nocardia ****Toxoplasma ****Pneumocystis |
|
|
sulfonamides clinical uses
|
Uncomplicated urinary tract infections (TMP – Sulfa methoxazole)
Otitis Media (TMP – Sulfamethoxazole) Topical burn prophylaxis (Mafenide acetate – Sulfamylon) (Silver sulfadiazine) Ulcerative colitis (Salicylazosulfapyridine – Azulfidine) Toxoplasmosis (pyrimethamine added as second drug) PCP prophylaxis and treatment (TMP – Sulfa) Rheumatic Fever Prophylaxis (in PCN allergic) |
|
|
drug for toxoplasmosis
|
sulfonamides + pyrimethamine****
|
|
|
drug for PCP prophylaxis n tx
|
tmp-sulfa
|
|
|
drug for Topical burn prophylaxis
|
Silver sulfadiazine
|
|
|
sulfonamides toxicity
|
Hypersensitivity (Stevens-Johnson Syndrome)
Severe hepato-toxicity in HLA-B 5701 positive recipients, Transaminase elevation Neonatal hyperbilirubinemia with resultant kernicterus [cerebral palsey and deafness] (contraindicated in late pregnancy) Pancytopenia (bone marrow suppression) Acute haemolytic anemia in G6PD deficiency Phototoxicity Nephrotoxicity, Severe dysglycemia in elderly |
|
|
ceftriaxone can displace bilirubin in neonates n give kernictirus. substitute for ceftriaxone?
|
cefotaxime
|
|
|
FLUROQUINOLONES examples
|
Ciprofloxacin Levofloxacin Moxifloxacin
|
|
|
quinolones oral absorption hindered by
|
oral absorption hindered by antacids
|
|
|
quinolones mech of action
|
Bacteriocidal inhibition of DNA Gyrase topoisomerase II and IV
Exhibit post-antibiotic effects |
|
|
mech of resistance against quinolones
|
***Alteration of DNA gyrase (target mutation)
Increased efflux Alteration of bacterial permeability to drug |
|
|
quinolones spectrum
|
Gram negatives, including pseudomonas, H. influenzae, morexella, salmonella, shigella, E.coli, campylobacter,
Gram positive (especially newest fluoroquinolones) including PCN resistant Strep pneumonia Atypicals: Legionella, chlamydia, Mycoplasma |
|
|
fluroquinolones dont work against
|
anaerobes
|
|
|
3 drugs for anaerobes
|
cefoxitin
cefotetan clindamycin |
|
|
quinolones spectrum
|
***Prostate infections
***Respiratory infections; including those caused by atypical agents, sever community (CAP), and ventolator (VAP) acquired pneumonias Urinary tract infections; gonorrhea Enteric infections and Typhoid fever Osteomyelitis Soft tissue infections Pseudomonas infections (resistance may develop rapidly |
|
|
DOC for prostate infections
|
quinolones/fluoroquinolones
|
|
|
DOC for community and ventilator acquired pneumonia
|
quinolones/fluoroquinolones
|
|
|
quinolones toxicity
|
****Achilles tendon rupture in adults
***Articular cartilage injury in under 18yo. So NOT USEED IN UNDER 18 YEARS OF AGE ***CONTRAINDICATED IN PREGNANCY Older quinolones demonstrate serious neurotoxicity (seizures) G.I. upset is common (5%) Increase QT interval Candida overgrowth (superinfection) |
|
|
Imipenem is given with which drug and why
|
cilastatin. it decreases imipenem's renal inactivatin by dehydropeptidase 1
|
|
|
role of cilastatin
|
given with imipenem to decrease its renal inactivation by dehydropeptidase 1.
|
