Board Micro Pharm

Front 1

Questions: What statement about sulfonamides is accurate?

Back 1

Sulfonamides inhibit dihydropteroate synthase. Example of applying this concept: Dysfunction of the basal ganglia may occur in the newborn if sulfonamides are administered late in pregnancy.

It is a bacteriostatic drug.

Front 2

Which ones are bactericidal and bacteriostatic out of the 30S and 50S inhibitors?

Back 2

30S inhibitors:

Aminoglycosides (streptomycin, gentamicin, tobramycin, amikacin): bactericidal

Tetracyclines: bacteriostatic

50S inhibitors:

Chloramphenicol, clindamycin, erythromycin, lincomycin: bacteriostatic

Linezolid: variable

Front 3

Questions: A 24 year old woman has returned from a vacation abroad suffering from traveler's diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this PT?

Back 3

Levofloxacin (fluoroquinolones are very effective in diarrhea caused by bacterial pathogens).

Front 4

What is acyclovir used for? What are other drugs in this class? What do you use for herpes zoster?

Back 4

HSV, VZV, and EBV.

HSV induced mucocutaneous and genital lesions as well for encephalitis. Prophylaxis immunocompromised PTs.

For herpes zoster, use famciclovir.

Note: no effect on latent forms of HSV and VZV.

Front 5

Questions: What statement about the clinical use of sulfonamides is true?

Back 5

Resistant bacterial strains may have decreased intracellular accumulation of sulfonamides; sulfonamides have activity against C. trachomatis and can be used topically for the treatment of chlamydia infections of the eye; sulfonamide resistance can occur in some strains of bacteria because of increased production of PABA.

Front 6

Block cell wall syntehsis by inhibition of peptidoglycan cross-linking?

Block peptidoglycan synthesis?

Disrupt bacterial cell mm?

Block nucleotide synthesis?

Block DNA topoisomerase?

Block mRNA synthesis?

Block protein synthesis at 50S?

Block protein synthesis at 30s?

Back 6

Beta-lactams, imipenem, aztreonam, cephalosporins

Bacitracin, vancomycin

Polymyxins

Sulfonamides, trimethoprim

Fluroquinolones

Rifampin

Chloramphenicol, macrolides, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid

Aminoglycosides, tetracyclines.

Front 7

Questions: A 31 year old man has gonorrhea. He has no drug allergies, but a few years ago acute hemolysis followed use of an antimalarial drug. The physician is concerned that the PT has an accompnaying urethritis caused by C trachomatis, although no cultures or enzyme tests have been performed. Which of the following drugs is most likely to be effective against both gonococci and C. trachomatis in this PT?

Back 7

Ofloxacin and other fluoroquinolones (however, norfloxacin is the least active fluoroquinolone) are effective against both. Cefixime is effective only against gonorrhea.

Front 8

Question: Consumption of ethanol together with this drug causes nausea, vomiting, abdominal cramps, flushing, and headache in some PTs.

Back 8

Metronidazole.

Inhibits aldehyde dehydrogenase and may cause disulfiram-like reaction with alcohol.

Front 9

Questions: What statement about the fluoroquinolones is accuate?

Back 9

Antacids decrease oral bioavailability of fluoroquinolones. Neither hepatic nor renal dysfunction is contraindicated with the use of fluoroquinolones (most undergo renal elimination and dosage should be modified with creatinine clearance <50 mL/min). Fluoroquinolones should not be used first with children due to effects on cartilage. Gonococcal resistance to fluorquinolones may involve changes in DNA gyrase.

Front 10

What is chloramphenical MOA, and due to its toxicity, it is seldom use; however, it is useful for?

Back 10

Inhibits 50S peptidyltransferase.

Back up for meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae); and those sensitive to beta-lactams; Rocky Mountain spotted fever when tetracycline side effects are not worth it (young children and pregnant women).

OTHERWISE, it is a broad-spectrum bacteriostatic against many gram-positive and gram-negative.

Front 11

Questions: A 55 year old man complains of periodic bouts of diarrhea with lower abdominal cramping and intermittent rectal bleeding. Seen in the clinic, he appears well nourished, with blood pressure in the normal range. Examination reveals moderate abdominal pain and tenderness. His current medications are limited to loperamide for his diarrhea. Signmoidoscopy reveals mucosal edema, friability, and some pus. Laboratory findings include mild anemia and decreased serum albumin. Microbiologic examination via stool cultures and mucosal biopsies do not reveal any evidence for bacterial, amebic, or cytomegalovirus involvement. A preliminary diagnosis is made of mild to moderate ulcerative colitis. The most appropriate drug to use in this PT is?

Back 11

Sulfasalazine. Without evidence to microbial cause of colitis, a drug that reduces inflammation is indicated. Sulfasalazine is also used for its anti-inflammatory effects in rheumatoid arthritis.

Front 12

What is the MOA of acyclovir? What is the mode of resistance?

Back 12

Acyclovir is phosphorylated by viral thymidine kinase to dGTP that inhibits viral DNA polymerase and leads to chain termination by incorporating into the viral DNA strand.

Resistance from lack of thymidine kinase.

Front 13

Questions: What statement about the combination of trimethoprim plus sulfamethoxazole (TMP-SMX) is true?

Back 13

It is an alternative to ampicillin in the treatment of listeriosis; effective for treatment of pneumonia caused by Pneumocystis jiroveci (not community-acquired pneumonia); fever and pancytopenia occur frequently when these drugs are given to AIDS PTs; produces sequential blockade of folic acid synthesis.

Front 14

What are the side effects of chloramphenicol?

Back 14

Myelosuppresion and, gray baby syndrome due to deficiency of UDP-glucuronyl transferase in the newborn liver.

Gray baby syndrome: vomiting, flaccidity, decrease RBCs, gray skin hue, and shock in newborns

Front 15

Questions: What drug is effective in the treatment of nocardiosis and, in combination with pyrimethamine, is prophylactic against Pneumoncystis jiroveci infections in AIDS PTs?

Back 15

Sulfadiazine and TMP-SMX are the DOC for nocardiosis.

Front 16

DOC chlamydophyla (C. pneumoniae)

Back 16

Macrolide or tetracycline

Front 17

Trimethoprim is a selective inhibitor of?

Sulfonamides are a structural analog of what, and what is the significance of this?

Back 17

Bacterial dihydrofolate reductase, thereby, inhibiting folic acid synthesis.

PABA antimetabolite, therefore sulfonamides inhibit dihydropteroate synthetase.

Front 18

What are the tetracycline and their MOA? Which tetracycline is fecally eliminated and can be used with PTs with renal failure? What can you NOT take with tetracyclines?

Back 18

Tetracycline, doxycycline, demeclocycline, minocycline.

Broad-spectrum bacteriostatic. It binds to the 30S and prevent attachment of aminoacyl tRNA from binding to the ribosome.

Doxycycline.

Do NOT take with milk, antacids, or iron-containing preparations because divalent cations inhibit its absorption in the gut.

Front 19

Trimethoprim-sulfamethoxazole (TMP-SMX) is effective against?

Back 19

Gram negative and Gram positive, Chlamydia trachomatis, Nocardia

TMP-SMX
T: respiratory Tree (Streptococcus pneumoniae and Haemophilus influenzae); otitis media, sinusitis, bronchitis, and pneumonia

M: Mouth (GI tract) for gram-negative for diarrhea (Shigella, Salmonella, Enterobacter, Kelbsiella, E. coli)

P: Pee (genitourinary tract) for UTI, prostatitis, urethritis caused by Enterics (E. coli)

SMX (Syndrome): AIDS, for prophylactic intervention of Pneumonocystis carinii pneumonia.

protozoans (Toxoplasma gondii and Isospora belli)

Front 20

Treatment of CMV infections in immunosuppression and organ transplant. Are they used with other drugs?

Back 20

Ganciclovir, valganciclovir (primary drugs). Because of their toxicity (pancytopenia), they are used only with CMV. But they can treat HSV, HZV, and EBV.

Also: cidofovir, foscarnet, fomiversin

Front 21

TMP-SMX is the DOC for?

Back 21

Nocardia and Pneumocystis jiroveci pneumonia.

Shigella, Salmonella, UTIs

Front 22

What is the primary use of tetracycline useful for?

Back 22

Rickettsia and Borrelia burgdorferi, Chlamydia, Mycoplasma pneumoniae.

Or what a young soldier may get when crawling around in the jungle and mingling with prostitutes on leaves: Chlamydai trachomatis, walking pneumonia via Mycoplasma pneumoniae, animal and tick-borne diseases by Borrelia and Rickettsia, plus it works well with acne.

Also for H. pylori infections, Vibrio, Ureaplasma Urealyticum, Tularemia. Otherwise, a board spectrum against gram-positive and gram-negative

Front 23

What are the side effects of TMP-SMX?

Back 23

Steven-johnson syndrome, hemolytic anemia, kernicterus in newborns, bone marrow suppression.

Note: administer folic acid to compensate for megaloblastic anemia, leukopenia, and granulocytopenia.

Allergic reactions

Front 24

What is the MOA of polymyxins?

Back 24

These drugs act like cationic detergents, disrupting bacterial cell mm and increasing osmotic permeability of cell mm to polar molecules.

Front 25

What are the fluoroquinolones and what is the single quinolone? MOA?

Back 25

-floxacin (e.g., ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin; nalidixic acid is the quinolone (is rapidly excreted and hardly used.

Inhibits bacterial DNA topoisomerase II (DNA gyrase), inducing DNA strand breakage and cell death in gram negative organisms.

Front 26

What are the side effects of tetracycline?

Back 26

Teeth discoloration and bone deformity in children due to chelation, photosensitivty, a teratogenic, and superinfection (S. aureus or C. difficile).

Front 27

DNA gyrase (topoisomerase II) performs?

Back 27

Induces negative supercoiling of dsDNA that balances the positive supercoiling of DNA replication, acting as a "swivel" to prevent damage to DNA strand.

Front 28

What is the MOA of Ganciclovir? Mode of resistance?

Back 28

An analogue of guanosine, it is phosphorylated by CMV viral kinase or HSV/VZV thymidine kinase into 5'monophosphate that inhibits DNA polymerase

Resistance by mutated CMV DNA polymerase or lack of viral kinase.

Front 29

Fluoroquinolones are effective against?

Back 29

Gram negatives very well!! UTIs, and respiratory tract infections. Can treat pseudomonas, Neisseria, and some gram-positives.

Front 30

What are the three macrolides and their MOA?

Back 30

Erythromycin, clarithromycin, and azithromycin

Inhibit protein synthesis by blocking translocation; it binds to the 23S rRNA of the 50S ribosomal subunit.

Front 31

Fluoroquinolones are contraindicated in? What should they not be taken with.

What are the SE of fluoroquinolones?

Back 31

Pregnant woman and children due to damage to growing cartilage.

Antacids.

Tendonitis and tendon rupture. Superinfection.

Front 32

What does trypanothione do? And what drug acts on trypanothione reductase?

Back 32

A form of glutathione in protozoans known as kinetoplastidans. It helps maintain a reduced state of intracellular thiols, and is essential for survival.

Nifurtimox is used in Chagas' disease (T. cruzi)

Front 33

Fluoroquinolone achieves high levels in the?

Back 33

Stool, kidneys, penetrate well into bone and prostate. AND, achieve high intracellular levels.

Excreted in the bile and reabsorbed in the intestine and then excreted via the kidney.

Front 34

Macrolides are used to treat?

Back 34

URIs, pneumoniaes, STDs, Streptococcal infections in PTs allergic to penicillin, Mycoplasma, Legionella, Chlamydia, Neisseria.

Otherwise, a wide-spectrum with gram positive cocci, and some gram negative.

Front 35

What is trimethoprim MOA? SE?

Back 35

Inhibits dihydrofolate reductase.

Note: once TH4 gives up a carbon, it becomes TH2 (dihydrofolate) and must be reduced back to TH4 by dihydrofolate reductase.

SE: Megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid.

Front 36

What are the SE of Ganciclovir?

Back 36

Pancytopenia, renal toxicity.

More toxic to host enzymes than acyclovir.

Front 37

Combination of trimethoprim plus sulfamethoxazole, is bactericidal or bacteriostatic?

Back 37

Bactericidal.

Front 38

Side effects of macrolides?

Back 38

GI upset (common cause of noncompliance), prolonged QT (especially erythromycin, acute cholestatic hepatitis, skin rash, eosinophilia.

Increases serum concentrations of theophyllines, oral anticoagulants.

Front 39

What is triple sulfa used for?

Back 39

Due to solubility limitation, a combination of 3 separate sulfonamides are used to reduce the likelihood that any one drug will precipitate.

Front 40

What is polymyxins used for and their SE?

Back 40

Because of their toxicity (acute renal tubular necrosis and neurotoxicity), they are used only topically to treat infected skin lesions of resistant gram-negative rods.

Front 41

What are three some sulfonamides? SE?

Back 41

Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine.

Hypersensitivity reactions, hemolysis in G6PD deficienct, nephrotoxicity, photosensitivity, kernicterus in infants, dispalce other drugs from albumin (warfarin), Steven-Johnson syndrome.

Front 42

What is clindamycin MOA and what is it useful for?

Back 42

Blocks peptide bond formation at 50S ribosomal subunit.

Severe infections caused by anaerobes (Bacteroides fragilis, Clostridium perfringens). Treats anaerobes above the diaphragm.

Due to its gram-positive cocci coverage, its a back up for those who are allergic to penicillin and cephalosporin and MRSA. Also recommended for prophylaxis of endocarditis for those who are allergic to penicillin.

Front 43

Sulfonamides are active against?

Back 43

Chlamydia and Nocardia.

UTI: triple sulfa, sulfisoxazole

Ocular infections: topical sulfacetamide

Burn: topical mafenide, silver sulfadiazine

Ulcerative colitis, rheumatoid arthrits: oral sulfasalazine

Toxoplasmosis: oral sulfadizine plus pyrimethamine plus folinic acid.

Front 44

What is the second line drug (in acyclovir resistant strains) for CMV, its MOA and what is special about their MOA and its SE? Mode of resistance.

Back 44

Foscarnet. It inhibits DNA polymerase that binds to the pyrophosphate-binding site and does not need thymidine kinase-deficient or viral kinase to become activated.

Foscarnet is also a backup for ganciclovir for CMV retinitis; acyclovir-resistant HSV.

Nephrotoxicity.

Resistance: mutated DNA polymerase.

Front 45

Specific examples of fluoroquinolone usage: norfloxacin and ofloxacin; levoflxacin, gatifloxacin, and moxifloxacin

Back 45

Norfloxacin and ofloxacin: mainly for UTIs

Levofloxacin and moxifloxacin: are "respiratory" fluoroquinolones with enhanced activity against gram-positive cocci and atypicals (chlamydia, legionella, mycoplasma).

Front 46

What is a side effect if clindamycin?

Back 46

Pseudomembranous colitis (penicillin family can do so as well), which is treated with metronidazole or vancomycin

Fever, diarrhea.

Front 47

Gemifloxacin and moxifloxcin usage?

Back 47

Have the widest spectrum: includes both gam-positive and gram negative, and some anaerobic bacteria and atypical pneumonia agents.

Front 48

DOC M. pneumoniae

Back 48

Macrolide or tetracycline

Front 49

Sulfa drug allergies?

Back 49

Sulfasalazine, sulfonylureas, thiazide diuretics, acetazolamide, or furosemide.

Front 50

What is linezolid (class oxazolidinones) useful for?

Back 50

The main indication of linezolid is the treatment of severe infections caused by Gram-positive bacteria that are resistant to other antibiotics: MRSA, PRSP, and VRE.

Also against L. monocytogenes and corynebacteria.

Front 51

Trimethoprim is used with what?

Back 51

Sulfonamides, causing sequential block of folate synthesis

Recurrent UTIs, Shigella, Salmonella, Pneumocystis jiroveci pneumonia.

Front 52

How do you treat HIV?

Back 52

Current approach is to use 3 or more antiretroviral drugs, such as nucleoside reverse transcriptase with inhibitors of HIV protease.

Front 53

A 2 year old child is brought to the hospital after ingesting pills that a parent had used for bacterial dysentery when traveling outside the US. The child has been vomiting for more than 24 h and has had diarrhea with green stools. He is now lethargic with an ashen color. He has hypothermia, hypotension, and abdominal distention. What drug most likely caused this problem?

Back 53

Chloramphenicol, which causes dose dependent suppression of erythropoiesis.

Front 54

What is nitrofurantonin used for and its SE.

Back 54

UTIs (but not for Proteus or Pseudomonas).

Hemolysis in PTs with glucose-6-phosphate dehydrogenase (G6PD) deficiency, pulmonary infiltrates, phototoxicity, neuropathies.

Front 55

A 24 year old woman has primary syphilis. She has a history of penicillin hypersensitivity, so tetracycline will be used to treat the infection. Which statement about the proposed drug treatment of this PT is correct?

Back 55

For full effectiveness, tetracycline must be taken for 15 days. Azithromycin is a backup drug for penicillin G for treatment of syphilis, as is tetracycline. Ingestion of antacids and foods containing multivalent cations can interfere with absorption of tetracyclines.

Front 56

What is the MOA of nucleoside reverse transcriptase inhibitors (NRTIs)?

Back 56

They are converted into triphosphates by the host cell kinases, which then inhibits HIV reverse transcriptase and act as chain terminators via their insertion into the growing DNA chain.

Cross-resistance is common, but incomplete.

Front 57

Clarithromycin and erythromycin have very similar spectra of antimicrobial activity. The major advantage of clarithromycin is that it?

Back 57

Is more active against M avium complex, T gondii, and H pylori.

It can be administered less frequently.

Front 58

What are the antimalarial drugs?

How should you start treatment?

Back 58

Chloroquine, mefloquine, primaquine, quinine, antifolates

Start with chloroquine; if resistant, use mefloquine.

Front 59

A primary mechanism underlying the resistance of gram-positive organisms to macrolide antibiotics is?

Back 59

Methylation of binding sites on the 50S ribosomal subunit.

Front 60

What are some NRTIs?

Back 60

Zidovudine (prototype), lamivudine, didanosine, zalcitabine, stavudine, and abacavir

Lamivudine is felt to be the backbone of most combination therapy regimens and is also used in treatment of chronic HBV.

Front 61

A 26 year old woman was treated for gonorrhea at a neighborhood clinic. Since she was allergic to beta-lactams, a single intramuscular injection of spectinomycin was administered, and she was given a prescription for oral doxycycline to be take for 7 days. Two weeks later she returns to the clinic with mucopurulent cervicitis. On questioning, she admits that she did not have the prescription filled because she has no money. The best course of action at this point would be to?

Back 61

Treat her with a single dose of azithromycin. Oral doxycycline would have eradicated C trachomatis that can cause Cervicitis or urethritis 2 - 3 weeks after treatment of gonorrhea.

Front 62

DOC T. pallidum

Back 62

Penicillin G

Front 63

A 55 year old PT with a prosthetic heart valve is to undergo a periodontal procedure involving scaling and root planing. Several years ago, the PT had a severe allergic reaction to procaine penicillin G. Regarding prophylaxis against bacterial endocarditis, what is appropriate?

Back 63

Administer clindamycin orally 1 h before the procedure.

Front 64

What are the SE of NRTIs?

Zidovudine, abacavir, didanosine, stavudine and zalcitabine.

Back 64

Lactic acidemia with severe hepatomegaly, fat redistribution (lipodystrophy), steatosis, hypersensitivity reaction (rash), peripheral neuropathy.

Zidovudine: megaloblastic anemia

Didanosine: pancreatitis

Note: to treat bone marrow suppression, use GM-CSF and erythropoietin.

Front 65

A 24 year old woman comes to the clinic with complains of dry cough, headache, fever, and malaise, which have lasted 3 or 4 days. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The PT informs the attending physician that her husband is not sick but that a colleague at work has symptoms similar to those she is experiencing. The PT has no history of serious medical problems. The PT is taking loratadine for allergies, multivitamins, and supplementary iron tablets. She is an avid consumer of coffee and caffeinated beverages. The physician makes an initial diagnosis of community acquired pneumonia.

What drug is most suitable?

If this PT were to be treated with erythromycin, what should she avoid?

The PT should not be given telithromycin because of what?

A 5-d course of treatment for community-acquired pneumonia would be effective in this PT with little risk of drug interactions if the drug prescribed were?

Back 65

Doxycycline (Is it caused by TYPICAL pathogen, S. pneumoniae, H influenzae, or M catarrhalis, OR by an ATYPICAL pathogen Legionella, Mycoplasma, or C pneumoniae?; therefore, treat with a drug that covers both spectrums instead of using a double-drug therapy)

Decrease her intake of caffeinated beverages (Erythromycin inhibits CYP1A2, which metabolizes methylxanthines.

Hepatotoxicity

Azithromycin has a half-life more than 70 h, allowing for once-daily dosing and does not inhibit CYP450, unlike other macrolides involved in drug metabolism.

Front 66

Since protozoan parasites require purine salvage because they are unable to synthesize them, what gout agent can you use to treat Lesihmania, Schistomoma, and Trpanosoma species?

Back 66

Allopurinol (although, only mini pharm indicates this), which degrades purines.

Front 67

In a PT with culture-positive enterococcal bacteremia who has failed to respond to vancomycin because of resistance, the treatment most likely to be effective is?

Back 67

Linezolid

Front 68

What is the MOA of nonnucleoside reverse transcriptase inhibitors (NNRTIs)?

Back 68

They inhibitor HIV reverse transcriptase with no phosphorylation required.

There are no cross-resistance with NRTIs but there are with NNRTIs (resistance to one drug confers resistance with other drugs in NNRTI category).

Front 69

What drug inhibits bacterial protein synthesis, has a narrow spectrum of activity, has been used in the management of abdominal abscess caused by Bacteroides fragilis, and may cause antibiotic associated colitis?

Back 69

Clindamycin. DOC for B fragilis is metronidazole. Carbapenems, chloramphenicol, clindamycin, and ticarcillin (with clavulanic acid) are alternative drugs.

Front 70

DOC Bacteroides

Back 70

Metronidazole

Front 71

Why would a surgeon use clindamycin with an aminoglycoside?

Back 71

When the GI is perforated, gram-negative and anaerobic bugs are released. Aminoglycosides cover the aerobic gram-negative bugs and clindamycin covers the anaerobes.

Front 72

What are some drugs that belong to NNRTIs and their SE?

Back 72

Delavirdine (prototype) and nevirapine: elevated liver function enzymes.

Nevirapine: Steven-Johnson syndrome; induction of CYP

Efavirenz (DOC in this class): teratogenicity, CNS disturbances (delusions, nightmares, insomnia).

They are all inducers of CYP450.

Front 73

How do you treat pseudomembrane colitis?

Back 73

Vancomycin or metronidazole (preferred: cheaper and vancomycin may contribute to vancomycin resistant enterococcus).

Front 74

Question: The primary reason for the use of drug combinations in the treatment of tuberculosis is to?

Back 74

Delay or prevent the emergence of resistance.

Front 75

What happens with tetracycline during digestion and what benefit does doxycycline have?

Back 75

Tetracycline chelates cations in milk (milk products), yogurt, aluminum hydroxide, Ca++ and Mg++. When chelated, it will pass through the intestine without being absorbed.

Doxycycline chelates cations poorly, therefore, is better absorbed with food.

Front 76

What is the MOA of protease inhibitors?

Back 76

Protease inhibitors inhibit protease enzyme; therefore, the virus cannot replicate.

HIV virions are dependent on an aspartate protease encoded by the pol gene to cleave the precursor polyproteins to form the final structural proteins of the mature virion core.

Front 77

What are broad spectrum bacterial protein synthesis inhibitors?

Back 77

Chloramphenicol and tetracyclines

Front 78

DOC Campylobacter jejuni

Back 78

Macrolide

Front 79

What are moderate spectrum bacterial protein synthesis inhibitors?

Back 79

Macrolides and Ketolide

Front 80

What are some drugs that belong to protease inhibitors and their SE?

Back 80

They all end in -navir (saquinavir, ritonavir, indinavir, nelfinnavir, amprenavir)

Inhibition of lipid-regulating proteins: hyperglycemia, insulin resistance or hyperlipidemia with altered body fat distribution. Buffalo hump, gynecomastia, and truncal obesity. They can all inhibit CYP450, but ritonavir is the most severe.

Indinavir (prototype): thrombocytopenia, hyperbilirubinemia and nephrolithiasis--drink lots of water!!

Ritonavir: SE is turn positive is inhibition of CYP; therefore, this drug is used to "boost other PIs.

Front 81

What are narrow spectrum bacterial protein synthesis inhibitors?

Back 81

Lincosamides, streptogramins, and linezolid

Front 82

What is the MOA of suramin?

Back 82

Binds to glycolytic enzymes and may prevent the incorporation of the enzymes into the glycosome.

Front 83

Demeclocycline, similar to tetracycline, is used for?

Back 83

To treat SIADH since it acts as a competitive antagonists at the V2 receptors. Demeclocycline inhibits renal actions of ADH.

Front 84

What are two entry inhibitors and their MOA?

Back 84

Maraviroc: blocks the receptor CCR5 to prevent viral attachment.

Enfuvirtide: binds to gp41 of the viral envelop to prevent conformational changes required for fusion with CD4; therefore, block entry and subsequent replication.

Front 85

Streptogramins are? SE?

Back 85

A nasty medication that should only be use as a lost option (e.g., life threatening VRE, vancomycin resistant Enterococcus, and VRSA, vancomycin resistant Staph aureus).

They cause pain upon IV, with arthralgia-myalgia syndrome.

Streptogramins = (quinupristin/dalfopristin)

Front 86

DOC Enterobacter spp

Back 86

Carbapenem, cefepime

Front 87

What are the clinical usage and SE of enfuvirtide and maraviroc?

Back 87

Used in PTs with persistent viral replication in spite of antiretroviral therapy and used in combination with other drugs.

Enfuvirtide: hypersensitivity reactions at injection site, increase risk of bacterial pneumonia.

Marviroc: muscle/joint pain, liver enzymes are increased

Front 88

What is the MOA of chloroquine? SE

Back 88

Concentrates in parasite food vacuoles and prevents hemoglobin breakdown product heme to hemozoin. Heme is toxic to the parasite.

Retinal damage, color vision changes, pruritus,hemolytic anemia in G6PD deficiency, auditory impairment, and toxic psychosis.

Front 89

What can be used for prophylactic against influenza A (but not B) and to reduce the duration of symptoms?

Back 89

Amantadine and Rimantadine.

Front 90

DOC E. coli

Back 90

Cephalosporin (3rd generation)

Front 91

What is the MOA of amantadine and rimantadine? Their SE? Mode of resistance.

Back 91

They prevent viral penetration/uncoating of influenza A (NOT B) by binding to M2 protein; may buffer pH of endosome.

SE: CNS symptoms (ataxia, slurred speech, confusion), livdeo reticularis, and teratogenic; rimantadine has less CNS SE (does not cross the BBB)

Resistance is by mutation of mutated M2 protein.

Note: also causes release of dopamine from intact nerves; therefore, can also treat Parkinson's disease.

Front 92

How does atovaquone work?

Back 92

It is a quinone, an antimalarial drug (also Pneumocystis carinii infections) that works on the cytochrome complex and inhibits MT electron transport.

Front 93

What can be used for influenza A and B, and active against both H3N2 and H1N1? Their MOA?

Back 93

Oseltamivir and Zanamivir

They inhibit neuraminidases produced by both influenza A and B. These viral enzymes cleave sialic acid residues from viral proteins and surface proteins of infected cells.

Front 94

DOC G. vaginalis

Back 94

Metronidazole

Front 95

What are some drugs used to treat hepatitis?

Back 95

Interferon-alpha, adefovir-dipivoxil, entecavir, lamivudine, ribavirin

Front 96

What is the MOA of amphotericin B? What is it used for?

Back 96

Binds to ergosterol and causes formation of artificial pores.

Widest antifungal spectrum of any agent, and DOC, or codrug of choice for: Aspergillus, Blastomyces, Candida albicans, Crptococcus, histoplasma, and Mucor. Intrathecally for fungal meningitis; does NOT cross the BBB>

Front 97

What is the MOA of interferon-alpha?

Back 97

To increase the formation of antiviral proteins. They do so by activation of host cell ribonuclease that degrades viral mRNA. IFN-alpha also promotes formation of NK cells to destroy infected liver cells.

Front 98

DOC K. pneumoniae

Back 98

Cephalosporin (3rd generation)

Front 99

What is MOA of interferon, what is INF-alpha, beta, and gamma used for and their SE?

Back 99

Glycoproteins from human leukocytes that block various stages of viral RNA and DNA synthesis. Induce ribonuclease that degrades viral mRNA.

IFN-alpha: chronic HBV and HCV, Kaposi sarcoma.

IFN-beta: MS

IFN-gamma: NADPH oxidase deficiency.

Neutropenia

Front 100

What drug inhibits microtubule synthesis and function and affects what parasite?

Back 100

Mebendazole (and albenazole), and acts on helminths.

Front 101

SE of interferon alpha?

Back 101

Bone marrow suppression, alopecia

Front 102

DOC P. mirabilis

Back 102

Ampicillin

Front 103

What drug can be used for both HIV and HBV?

SE of of this drug?

Back 103

Adefovir Dipivoxil.

It is a nucleotide analog revers transcriptase inhibitor, thereby inhibiting DNA synthesis. Tenofovir has the same MOA and is used for chronic HBV infection.

Adefovir: Lactic acidosis and severe hepatomegaly with steatosis. Nephrotoxicity is dose-limiting.

Front 104

MOA of quinine and its use?

SE?

Back 104

Complexes with dsDNA to prevent strand separation, resulting in block of DNA replication and transcription to RNA.

**Cinchonism, **hemolysis in G6PD deficiency, and Blackwater fever and positive Coomb's test

Front 105

MOA of ribavirin and its use? Its SE?

Back 105

Guanosine analog that inhibits guanine nucleotide synthesis by competitively inhibiting IMP dehydrogenase.

HCV and RSV bronchiolitis

SE: hemolytic anemia, and severe teratogenic compound.

Note: ribavirin is used with IFN-alpha for chronic HCV.

Front 106

DOC Enterococcus spp

Back 106

Ampicillin +/- gentamicin

Front 107

Question: What drug is most likely to cause additive anemia and neutropenia if administered to an AIDS PT taking zidovudine?

Back 107

Ganciclovir is a myelosuppressant that can result in ganulocytopenia or thrombocytopenia.

Zidovudine also can cause the same problem alone; therefore, when these two drugs are taken together, colony-stimulating factors may be needed.

Front 108

What drug activates parasitic nicotinic receptors, and what parasite does this work on?

Back 108

Pyrantel pamoate, and works on hookworms, roundworms, and pinworms.

Front 109

Question: Oral formulation of this drug should not be used in pregnant AIDS PT because they contain propylene glycol. One of the adverse effects of the drug is hyperpigmentation on the hands and soles of the feet, especially in African-American PTs.

Back 109

Emtricitabine and fosamprenavir both contain propylene glycol--however, the answer is emtricitabine since it can cause hyperpigmentation.

Also, efavirenz can cause abnormalities in pregnant monkeys. Delavirdine is also teratogenic.

Front 110

DOC S. aureus or epidermidis methicillin-susceptible

Back 110

Nafcillin

Front 111

Question: What drug binds to a CCR5 receptor of CD4 cells blocking the entry of HIV?

Back 111

Maraviroc

Note: Enfuvirtide binds to gp41 to prevent conformational changes for penetration of the virus.

Front 112

Why are PTs from Southeast Asia and native Americans commonly INH resistant?

Back 112

They are fast acetylators, and therefore, the half life of INH is decreased.

Front 113

Question: More than 90% of this drug is excreted in the urine in intact form. Because its urinary solubility is low, PTs should be well hydrated to prevent nephrotoxicity. What drug is being described?

Back 113

Acyclovir.

Nephrotoxic effects: hematuria, crystalluria are enhanced when PTs are dehydrated or with preexisting renal dysfunction. It can cause nephrolithiasis.

Front 114

DOC S. aureus or epidermidis methicillin-resistant

Back 114

Vancomycin +/- gentamicin +/- rifampin

Front 115

Used in the prophylaxis and treatment of infection caused by influenza viruses including H1N1 strains, this drug facilitates clumping of mature virions and their adhesion to infected cells.

Back 115

Oseltamivir and zanamivir--they inhibit neuraminidase produced by influenza A and B. They prevent trimming of sialic acid residues from viral protein, which interferes with their clumping and adhesion to host that are already infected.

Front 116

What drug increases Ca++ uptake, causing parasite contraction and paralysis? And works on?

Back 116

Praziquantel. The drug is antischistosomal and antitapeworm agent.

Front 117

Question: What antiretroviral drugs are safe to use in pregnancy?

Back 117

Lamivudine, lopinavir/ritonavir, nevirapine, and zidovudine.

Front 118

DOC S. pneumoniae penicillin-susceptible

Back 118

Penicillin G, amoxcillin

Front 119

Drug used for HSV, VZV?

Back 119

Acyclovir (primary drug).

Front 120

SE of mefloquine?

Back 120

**Mental status change and psychiatric disorders with vivid dreams, dizziness. Also, cardiac conduction defects, neurologic symptoms.

Front 121

Drug used for HBV?

Back 121

IFN-alpha, lamivudine (primary drug).

Front 122

DOC S. pneumoniae penicillin-resistant

Back 122

Vancomycin + ceftriazone or cefotaxime +/- rifampin

Front 123

Drug for HCV?

Back 123

IFN-alpha (primary)

Also: ribavirin.

Front 124

Certain anaerobic protozoan parasites lack MT and generate energy-rich compounds such as acetyl-CoA by means of enzymes present in organelles called hydrogenosomes. A key enzyme involved is?

Back 124

Pyruvate-ferredoxin oxidoreductase. Metronidazole inhibits this enzyme.

Front 125

Drug for influenza A?

Drug for influenza B?

Back 125

A: oseltamivir (primary). Also: amantadine, rimantadine, zanamivir.

B: Oseltamivir (primary). Also: zanamivir.

Front 126

DOC N gonorrhoeae

Back 126

Ceftriazone

Front 127

What is the key difference between acyclovir and ganciclovir?

Back 127

To become active, acyclovir must first be phosphorylated by virus specific thymidine kinase, while ganciclovir does not.

CMV of the herpesviridae, lacks thymidine kinase, so acyclovir is less active for CMV.

Ganciclovir kills all herpesviridae, including CMV>

Front 128

What are the aminoglycosides?

Back 128

Gentamicin, neomycin, amikacin, tobramycin, streptomycin.

Front 129

HAART treatment?

Back 129

Three drugs: two nucleoside reverse transcriptase inhibitors combined with either a protease inhibitor or a non-nucleoside analog.

Regime is tailored to avoid SE.

Front 130

DOC M meningitidis

Back 130

Penicillin G

Front 131

What protease inhibitor has the less impact on lipids compared to others? And what is its SE.

Back 131

Atazanavir. It also causes a rise in indirect bilirubin but rarely clinical jaundice; therefore, this can be used to monitor PTs adherence.

Front 132

What drug enhances GABA actions on the neuromuscular junctions of nematodes and arthropods)?

Back 132

Ivermectin and is the DOC for Onchocerca volvulus.

Front 133

Which HAART drug can be used during pregnancy to reduce risk of fetal transmission?

Back 133

Zidovudine

Front 134

DOC M catarrhalis

Back 134

Cefuroxime, fluoroquinolone

Front 135

What drug is a tissue schizonticide (kills schizonts in the liver) and limits malaria transmission by acting as a gametocide? What its MOA? Which malaria are involved? What is its SE?

Back 135

Primaquine, which acts as an oxidant.

Hepatic forms of P. vivax and P. ovale.

SE is acute hemolytic anemia in G6PD-deficient PTs. Also, methemoglobinemia.

Front 136

DOC C difficile

Back 136

Metronidazole

Front 137

Mebendazole binds to?

Back 137

Tubulins to alter the transport functions of microtubules

Front 138

DOC C trachomatis

Back 138

Azithromycin or other macrolide

Front 139

What TB drug is a CYP450 inducer?

Back 139

Rifampin

Front 140

DOC proteus-indole positive

Back 140

Cephalosporin (3rd generation)

Front 141

Suramin binds to?

Back 141

Glycolytic enzymes and prevents their incorporation into glycosomes.

Front 142

DOC S. typhi

Back 142

Ceftriazone or fluoroquinolone

Front 143

Metronidazole is effective against? SE?

Back 143

Anaerobic bacteria (Clostridium and Bacteroides species) and protozoans (Giardia, Entamoeba, Trichomonas, and Gardnerella vaginalis), and pseudomembranous colitis

Also, H. pylori

Metallic taste, disulfiram-like effect with alcohol. Ppotentiates actions of anticoagulant drugs.

Note: used for anaerobic infection below the diaphragm.

Front 144

DOC Serratia spp

Back 144

Carbapenem

Front 145

Which drug increases membrane permeability to calcium in trematode and cestode muscles?

Back 145

Pyrantel pamoate and praziquantel, which are antihelmintics.

Front 146

DOC Shigella spp

Back 146

Fluoroquinolone

Front 147

What are the SE of amphotericin B?

Back 147

Dose-limiting nephrotoxicity; infusion reactions (chills, fever, muscle spasms, hypotension), IV phlebitis ("amphoterrible").

Hydration reduces nephrotoxicity. Liposomal amphotericin reduces toxicity.

Note: in the hospital, BUN and creatinine levels are drawn every day to assess kidney function.

Front 148

-bendazoles or pyrantel pamoate is the DOC for?

Back 148

Enterobius wermicularis (pinworm), Ascaris lumbricoides), Ancylostoma duodenale, Necator americanus

Trichinella spiralis and Echinococcus granulosus: -bendazoles

Strongyloides Stercoralis: -bendazole or ivermectin

Front 149

MOA of metronidazole?

Back 149

Pyruvate-ferredoxin oxidoreductase transfers electorns form pyruvate to a nitro group to nitroimidazoles (e.g., metronidazole) forming cytotoxic products that inhibit growth by binding to the parasite's proteins and DNA.

Note: Certain anaerobic protozoans that lack mitochondria, posses this enzyme to generate acetyl-CoA via an electron transport.

Front 150

Ivermectin is the DOC for?

Back 150

Onchocerca volvulus

Note: transmitted by a blackfly that causes hyperpigmentation of the skin, river blindness.

Front 151

Question: The mechanism of high-level INH resistance of M tuberculosis is?

Back 151

Reduced expression of the katG gene, resulting in underproduction of mycobacterial catalase-peroxidase, an enzyme that bioactivates INH.

Front 152

DOC for dracunulus medinensis

Note: in drinking water, skin inflammation and ulceration.

Back 152

Niridazole

Front 153

TMP-SMX is the DOC for? SE?

Back 153

P. carinii/ jiroveci pneumonia, Isospora belli, and against toxoplasmosis.

Prophylaxis in AIDS PTs (started when CD4 < 200).

Also used for UTI (e.g., E. coli)

Steven-Johnson syndrome, hemolytic anemia (in G6PD), granulocytopenia, kernicterus, nephrotoxicity.

Note: Coadminister folinic acid to prevent anemia without effecting its antibacteiral effect.

Front 154

Diethylcarbamazine is the DOC for?

Back 154

Loa loa, Wunchereria bancrofti, Toxocara canis,

Front 155

Question: What is the MOA of gentamicin, and other aminoglycosides?

Back 155

Bactericidal inhibitors

Binding to 30S and inhibit the formation of the initiation complex while also causing mRNA misreading, and inhibit translocation.

Front 156

Praziquantel is the DOC for?

Back 156

Diphyllobothrium latum, Schistosoma, Clonorchis sinesis, Paragonimus westermani

Front 157

Nifurtimox is the DOC for? MOA?

Back 157

American trypanosomiasis (T. cruzi) (Chagas' disease).

Inhibits trypanothione reductase in parasites.

Note: Is the alternative agent in African form of the disease.

Front 158

Question: A PT with AIDS and a CD4 has M. avium complex. Optimal management of this PT is to?

What is the prophylaxis?

Back 158

Treat with azithromycin, rifampin, ethambutol, streptomycin.

Azithromycin.

Front 159

What is the DOC for early hemolymphatic stages of African trypanosomiasis (trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense) (before CNS involvement) and is also an alternative treatment to Ivermectin in the treatment of Onchocerca volvulus

DOC for CNS invovlement?

Back 159

Suramin

Melarsoprol

Front 160

What is the MOA of flucyosine?

Back 160

Inhibits DNA synthesis by conversion to 5-fluorouracil.

Within fungal cell, it is converted into nucleotide analogues (5-FdUMP and 5-UTP), which acts to inhibit thymidylate synthetase that inhibits fungal DNA and RNA synthesis.

Front 161

DOC for leishmaniasis.

Back 161

Stibogluconate. Kills the parasite by inhibition of glycolysis or effects on nucleic acid metabolism.

It is potentially cardiotoxic (QT prolongation)

Front 162

What drug is used as a prophylaxis for meningococcal, Haemophilus influenzae type B, and staph carriers.

Back 162

Rifampin

Front 163

Question: This drug can clear trypanosomes from the blood and lymph nodes and is active in the late CNS stages of African sleeping sickness.

Back 163

Melarsoprol, since it enters the CNS unlike pentamidine or suramin.

Front 164

Aminoglycosides are dependent on what and therefore, are ineffective against what?

Back 164

They are dependent on oxygen for uptake into bacterial cell; therefore, they are ineffective against anaerobes.

Front 165

What are bacteriostatic drugs?

Back 165

Macrolides (clindamycin, azithromycin, clarithromycin), sulfonamides, trimethoprim, chloramphenicol, tetracyclines

Front 166

Question: Plasmodial resistance to chloroquine is due to?

Back 166

Decreased accumulation of the drug in the food vacuole.

Front 167

What are bactericidal drugs?

Back 167

Aminoglycosides, beta-lactams, fluoroquinolones, metronidazole, and most antimycobacterial agents, cephalosporin, streptogramins, and vancomycin.

Front 168

Question: Risk factors for multi-drug-resistant tuberculosis include?

Back 168

History of treatment without rifampin; recent immigration from Asia and living in an area over 4% isoniazid resistance; recent immigration form Latin America; residence in regions where isoniazid resistance is known to exceed 4%.

Front 169

Some bactericidal agents (aminoglycosides and fluoroquinolones) cause?

Back 169

Concentration-dependent killing. Maximizing peak blood levels increases the rate and extent of their bactericidal effects. High dose, once a daily administration.

Front 170

Which antimalarial drug causes a dose-dependent toxic state that includes flushed and sweaty skin, dizziness, nausea, diarrhea, tinnitus, blurred vision, and impaired hearing?

Back 170

Quinidine

Note: these are dose dependent symptoms of alkaloids (quinine, quinidine)

Front 171

Some bactericidal agents (beta-lactams, vancomycin) cause?

Back 171

Time-dependent killing. Their killing action is independent of drug concentration and continues while blood levels are maintained above the minimal bactericidal concentration.

Front 172

What is flucytosine used for? How is it used?

Back 172

Used for Cryptococcus neoformans and candidal infections. Very narrow scope.

Rarely used alone. It is used with amphotericin B--amphotericin B punches holes into the fungus while flucytosine inhibits DNA/RNA synthesis.

Front 173

The following drugs should be avoided if possible in pregnancy and/or neonates, why: SAFE Moms Take Really Good Care


aminoglycosides, tetracyclines, sulfonamides, chloramphenicol, and fluoroquinolones

Back 173

Sulfonamides: by displacing bilirubin from serum albumin, may cause kernicterus in the neonate.

Aminoglycosides: ototoxicity

Fluoroquinolones: effects on growing cartilage.

Erythromycin: acute cholestatic hepatitis in mom (and clarithromycin--embryotoxic)

Metronidazole: mutagenesis

Tetracyclines: tooth enamel dysplasia and inhibition of bone growth.

Ribavarin (antiviral): teratogenic

Griseofluvin (antifungal): teratogenic

Chloramphenicol: may cause gray baby syndrome.

Front 174

What is cinchonism and blackwater fever associated with quinine?

Back 174

Cinchonism:
Ears: tinnitus, vertigo
Eyes: visual disturbances
GI: nausea, vomiting, etc.
CNS: headache and fever

Blackwater fever: massive lysis of RBCs, causing dark urine with hemoglobinuria, renal failure, intravascular coagulation, and possibly death.

Front 175

What are the major drugs used in tubercuolsis?

What is a second line drug for TB?

Back 175

RIPES: Rifampin, Isoniazid (INH), pyrazinamide, ethambutol, and streptomycin.

2nd line drug: cycloserine.

Note: streptomycin is usually reserved for use in severe forms of TB or for infections known to be resistant to first line drugs.

Front 176

What is the synergistic effect of clavulanic acid, sulbactam, and tazobactam with penicillinase-sensitive beta-lactam drugs?

Back 176

Clavulanic acid, sulbactam, and tazobactam inhibits penicillinase to all the beta-lactam to work more efficient.

Front 177

When considering risk/benefit analysis, what is the DOC for malaria during pregnancy?

Back 177

Quinine and clindamycin

Front 178

Gentamicin, tobramycin, and amikacin are important drugs against?

Back 178

Aerobic gram-negative bacteria (E. coli, Enterobacter, Kelbsiella, Proteus, Providencia, Pseudomonas, and Serratia.

Front 179

Metronidazole and iodoquinol are both used to treat?

Back 179

Entamoeba histolytica

Front 180

What is the MOA of isoniazid?

Back 180

Inhibition mycolic acid, a characteristic component of mycobacterial cell wall. Resistance emerges if used alone.

Front 181

What is the treatment for Babesia?

Back 181

Quinine, clindamycin.

Babesiosis: fever, hemolytic anemia; Ixodes tick transmission, the same as Borrellia burgdorferi.

Front 182

What are the SE of flucytosine?

Back 182

Bone marrow suppression (leukopenia, thrombocytopenia).

Note: Antimetabolite drugs cause bone marrow suppression (leukopenia and thrombocytopenia), such as methotrexate, sulfa drugs, 5-fluorouracil. They can cause cause nausea, vomiting, and diarrhea.

Front 183

Although INH is one of the more important drugs for TB, what else is it good for in regards to TB?

Back 183

During latent infection including skin test converters, and for close contacts of PTs with active disease, INH is used as a sole drug.

Front 184

Streptomycin is used to treat?

Back 184

With combination of penicillin, os more effective in enterococcal carditis than other aminoglycosides. Tuberculosis, plaque, and tularemia.

Front 185

What is the side effects of INH? What should you give with INH?

Back 185

Hepatotoxicity, peripheral neuropathy; drug induced lupus; G6PD-deficient hemolytic anemia.

Note: pyridoxine or vitamin B6 is given to prevent peripheral neuropathy; INH increases excretion of B6

Front 186

What are some azoles? MOA?

Back 186

Ketoconazole, fluconazole, itraconazole, clotrimazole, miconazole, and voriconazole.

Inhibit fungal P450 enzyme that blocks ergosterol synthesis; therefore, inhibiting formation of fungal cell mm.

Front 187

What is the MOA of rifampin? Its SE?

Back 187

Its a bactericidal agent that inhibits DNA-dependent RNA polymerase.

harmless orange color to urine, sweat and tears; minor hepatitis; induces liver CYP450.

Front 188

Due to neomycin toxicity, it is restricted to?

Back 188

Bowel surgery (kills bowel flora; therefore, reducing chance of infection) and topical use.

Front 189

What are the uses of rifampin?

Back 189

Active against mycobacteria, as well as certain gram-negative bacteria (prophylaxis for PTs with meningococcal meningitis and H. influenzae type B).

It is also used with other drugs to fight TB and leprosy.

Front 190

What is ketoconazole used for and its SE?

Back 190

Rarely used due to its toxic effects. But used for chronic muocutaneous candidiasis. Also, Blastomyces, Coccidioides, Histoplasma.

Since it inhibits CYP450: inhibition of adrenal and gonadal steroid synthesis (decreased libido, gynecomastia, menstrual irregularities, infertility)

Front 191

Rifampin does what to CYP-450?

Back 191

Induces, increasing metabolism of warfarin, oral contraceptives, prednisone, ketoconazole, digoxin, glyburide.

Front 192

What are the toxicity associated with aminoglycosides.

Back 192

NEPHROTOXICITY (especially with amphotericin BH, vancomycin, or cephalosporin) and OTOTOXICITY (esp. with loop diuretic); and teratogen.

Rare curare-like effect (neuromusclar blockade--muscle paralysis and apnea)

Always follow PT's BUN and creatinine levels.

Front 193

What is the MOA of ethambutol? What is it used for and its SE

Back 193

Inhibits arabinosyl transferases, a component of mycobacterial cell walls.

Used to treat M. tuberculosis infections.

Does dependent retrobulbar neuritis, resulting in decreased visual acuity, red-green color blindness, and retinal damage.

Front 194

What is fluconazole used for? What is special about it?

Back 194

This drug is used often. It is the DOC for Candida albicans and Cryptococcus neoformans (because fluconazole can cross the blood-brain barrier).

Front 195

What is pyrazinamide used for, and what is its side effects?

Back 195

Used with other drugs against M. tuberculosis.

FA: didn't have any SE. . . Polyarthralgia, photosensitivity, hepatotoxicity; GI intolerance, fever, hyperuricemia (gout), maculopapular rash, porphyria. Avoid in pregnancy!

Front 196

Aminoglycosides are often used synergistically with what?

Back 196

With beta-lactams

Front 197

What is the DOC for leprosy and its MOA?

Back 197

Dapsone. It inhibits folic acid synthesis. Rifampin and clofazimine are also used.

Front 198

Question: What is a correct statement about bacterial resistance to aminoglycosides?

Back 198

Modificaiton via acetylation, adenylation, or phosphorylation.

Clinical resistance mainly occurs through plasmid mediated formation of group transferase enzymes.

Front 199

SE of dapsone?

Back 199

G6PD-deficient hemolytic anemia, methemoglobinemia

Front 200

What is voriconazole used for? SE?

Back 200

Wide spectrum, but mainly against Aspergillosis.

Can cause transient visual disturbances and is class D drug for pregnancy risk.

Front 201

Dapsone can be used as a prophylaxis against?

Back 201

P. jiroveci infection in HIV PTs

Note: TMP-SMX (DOC???) and pentamidine can also be used for P. jiroveci

Front 202

Question: Which antibiotic is the most effective agent in the treatment of an infection due to enterococci if used in combination with penicillin G?

Out of: amikacin, gentamicin, neomycin, neomycin, spectinomycin, streptomycin

Back 202

Streptomycin.

Note: about 15% of enterococcal isolates that are resistant to gentamicin and other systemic aminoglycosides remain susceptible to streptomycin.

Front 203

M. avium complex (MAC) is a disseminated infection of what, and what are the drugs used to fight it and prophylaxis?

Back 203

AIDS

Azithromycin (or clarithromycin) with or without rifabutin is recommneded for prophylaxis in PTs with less 50/uL CD4 count.

Treatment: rifabutin, ethambutol, azithromycin streptomycin.

Note: rifabutin is less likely to cause CYP450 induction than rifampin; therefore, rifabutin is used instead for MAC.

Front 204

What drug belongs to echinocandins? Its MOA?

Back 204

Caspofungin and micofungin.

It inhibits synthesis of beta(1,2)glycan, a component of fungal cell wall.

Front 205

How do you treat active TB?

Back 205

6 month regimen with rifampin. 2 months with isoniazid, rifampin, ethambutol, and pyrazinamide. Followed by 4 months of isoniazid and rifampin.

PT still has cavitary pulmonary TB and sputum cultures after 2 months of treatment, than second phase of isonizid and rifampin for 4 - 7 months.

Front 206

Question: Regarding the antibacterial action of gentamicin, what is a correct statement?

Back 206

Antibacterial action of aminoglycosides is concentration-dependent rather than time-dependent.

When the plasma level of gentamicin falls below the minimal inhibitory concentration, the drug continues to exert antibacterial effects for several hours--a postantibiotic effect.

Note: this explains the administration of a single large does instead of multiple smaller doses.

Front 207

What is the main complication of TB treatment with INH and what must be monitor?

Back 207

Hepatoxicity and ALT and ASt

Front 208

What is caspofungin used for? SE?

Back 208

For Candida infections who fail to respond to amphotericin B, and "salvage" therapy in apergillosis.

SE: flushing from histamine release.

Front 209

Isoniazid, rifampin, and pyrazinamide all cause what?

Back 209

Hepatotoxicity! Monitor liver enzymes.

Front 210

Question: An adult PT weights 70 kg, has bacteremia, suspected from a gram-negative rod. Tobramycin is administered once a day, and the loading dose must be calculated to achieve a peak plasma level of 20 mg/L. Assume normal renal function. Vd = 20 L; T 1/2 = 3 h; CL = 80 mL/min. What loading dose should be given?

Back 210

400 mg. LD = plasma concentration x volume distribution.

Front 211

Side effects of Rifampin?

Back 211

Think Red for Rifampin: Body fluids (urine, feces, saliva, sweat, tears, all are bright red-orange color.

Also, RNA, for DNA-dependent RNA polyermase inhibition of M. TB

Hepatitis (less than INH)

Front 212

What drugs are used for treatment of dermatophytoses?

Back 212

Griseofulvin, terbinafine, and several azole.

Front 213

What is rifabutin used for, and what is it similar to?

Back 213

It is similar to rifampin; therefore, similar side effects but less likely to induce CYP-450. It is used to treat Mycobacterium avium-intracellulare.

Front 214

Question: What drug is most likely to be effective against multi-drug-resistant strains of M. tuberculosis, including those resistant to streptomycin.

Back 214

Amikacin. Treatment of TB, amikacin or streptomycin are always used in combination with other antitubercular agents.

Front 215

What is clofazimine used for, and its side effects?

Back 215

Binds to DNA as an anti-inflammatory drug used to treat leprosy reactions.

Since it is a red-colored compound, where it deposits on the skin conjunctiva, it colors these tissues red. Where there is leprosy lesions, it colors these tan or black.

Front 216

What is the MOA of Griseofulvin? SE?

Back 216

Interferes with microtubule function in dermatophytes, in keratin-rich tissues (eg, skin, nails, hair) to inhibit mitosis and replication. This is a slow acting, static drug. Largely replaced by terbinafine.

Mental confusion, carcinogenic, confusion, headaches, increase CYP450 and warfarin metabolism.

Front 217

What is one of the uses of thalidomide?

Back 217

To treat anti-inflammatory erythema nodosum leprosum.

Front 218

Question: A 67 yo man is seen complaining of pain in and behind the right hear. There is edema of external otic canal with purulent exudate and weakness of the muscles on the right side of face. Pt is diabetic. Gram stain of exudate shows polymorphonucleocytes and gram-negative rods. Diagnosis is external otitis. What is the appropriate plan?

Back 218

The PT should be hospitalized and treatment started with gentamicin plus ticarcillin.

Likely pathogens include E. coli and Pseudomonas aeruginosa, and coverage must include other gram-negative rods. Combination of aminoglycoside plus a wider spectrum penicillin is must suitable for pseudomonas strains.

Front 219

What is the MOA of terbinafine?

Back 219

Inhibits a fungal enzyme, squalene epoxidase.

This causes accumulation of toxic levels of squalene, which interferes with ergosterol synthesis. This is fungicidal.

Front 220

Question: What is true about neomycin?

Back 220

Used in hepatic coma, to decrease protein intake and suppress coliform bacteria; therefore, reducing ammonia intoxication.

Also, used for sterilization prior to bowel surgery.

Front 221

What is Terbinafine used for?

Back 221

Dermatophytoses (sepcially onychomycosis).

Front 222

Streptomycin is the DOC for?

Back 222

Plaque, tularemia, adjunctive value in TB.

Front 223

What is nystatin used for and its MOA?

Back 223

It disrupts fungal membranes by binding to ergosterol. It is used topically to suppress oral and cutaneous (diaper rash or vaginal) Candida infections.

Note: too toxic for systemic use.

Front 224

Question: This drug has pharmacodynamic and pharmacokinetic properties almost identical to those of gentamicin, but has poor activity in combination with penicillin against enterococci.

Back 224

Tobramycin, and must less effective than either gentamicin or streptomycin when used in combination with penicillin or vancomycin for enterococcal endocarditis.

Front 225

Questions: Interactions between this drug and cell membane components can result in the formation of pores lined by hydrophilic groups present in the drug molecule.

Back 225

Nystatin and amphotericin.

Front 226

Question: Your 23 year old female PT is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. Worried about compliance, you would like to treat this PT with a single dose, so you choose?

Back 226

Spectinomycin.

Avoid cephalosporins in PTs with history of hypersensitivity to penicillins; avoid fluoroquinolones in pregnancy.

Front 227

Questions: What is true about fluconazole?

Back 227

It has the least effect of all azoles on hepatic drug metabolism.

Voriconazole and itraconazole has activity against Aspergillus.

Fluconazole is the best absorbed orally and readily penetrates into CSF. It also has the least effect of all azoles on hepatic microsomal drug-metabolizing enzymes.

Front 228

In the empiric treatment of severe bacterial infections of unidentified etiology, this drug, often used in combination with an aminoglycoside, provides coverage against many staphylococci.

Back 228

Nafcillin or cephalosporin.

Front 229

Clotrimazole and miconazole are used for what?

Back 229

Topical fungal infections.

Front 230

Question: Which statement about "once-daily" dosing with aminoglycosides is accurate?

Back 230

Convenient for outpatient therapy; often less toxic; less nursing time; under dosing is less of a problem. AND, is important for appropriate dose in PTs with renal insufficiency.

Aminoglycosides are eliminated by the kidneys.

Front 231

A woman with leukemia undergoes chemotherapy with IV of antineoplastic drug. She developes a systemic infection from an opporutnistic pathogen. There was a white vaginal discharge. Empiric antibiotic therapy was started with gentamicin, nafcillin, and ticarcillin TV. THe PTs condition did not improve. Her throat was sore, and white plaques had appeared in her pharynx. Cultures did not have bacterial growth, but her blood and urine grew Candida albicans.

Back 231

*****

Front 232

Aminoglycosides must diffuse across the cell wall; therefore, they are often used with what that helps breaks down the wall to facilitate diffusion?

Back 232

Penicillin.

Front 233

***Question: At this point, the best course of action is to?

Back 233

Stop current antibiotics and start griseofulvin.

This PT did not have bacterial infection, instead had a fungal infection.

Front 234

Owing to their polar nature, aminoglycosides are not?

Back 234

Absorbed after oral administration.

Front 235

****Questions: If amphotericin B is administered, the PT should be premedicated with?

Back 235

Diphenhydramine, ibuprofen, prednisone: any or all that is mentioned.

Infusion of amphotericin B include chills and fevers, muscle spasms, nausea, headache, and hypotension. Antipyretics, antihistamines, and glucocorticoids all can help.

Front 236

Because of what risk, streptomycin should not be used when other drugs will serve?

Back 236

Ototoxicity.

Front 237

***Questions: The does-limiting toxicity of amphotericin B is?

Back 237

Renal tubular acidosis.

Note: Azotemia can be severe enough to warrant dialysis. Decrease in GFR is reversible, but irreversible damage can occur with acidosis with hypokalemia and hypomagnesemia.

Front 238

Spectinomycin is used for?

Back 238

Its sole purpose is to be used as a backup drug, most commonly in those who are allergic to beta-lactams.

Front 239

***Questions: Candida is a major cause of nosocmial bloodstream infection. The opportunistic fungal infection in this PT could have been prevented by administration of?
The PT should be treated with?

What is the DOC if the PT is suffering from persistent lung lesion or disseminated disease caused by Coccidioides immitis?

What drug is least likely to be effective in the treatment of esophageal candidiasis if it is used by the oral route?

Back 239

He should not be treated with any medications. Pulmonary symptoms of coccidioidomycosis are self-limiting.

Itraconazole or fluconazole.

Griseofulvin has no activity against C. albicans. "Swish and swallow" formulations of clotrimazole and nystatin are commonly used though. Most of the azoles are effective in esophageal candidiasis.

Front 240

Question: A PT living on the East Coast was transferred to California for 6 months for work. On his return, he had influenza-like symptoms with fever and cough. He has red, tender nodules on his shins. The physician suspects the symptoms are due to coccidioidomycosis.

The PT should be treated with?

What is the DOC if the PT is suffering from persistent lung lesion or disseminated disease caused by Coccidioides immitis?

What drug is least likely to be effective in the treatment of esophageal candidiasis if it is used by the oral route?

Back 240

He should not be treated with any medications. Pulmonary symptoms of coccidioidomycosis are self-limiting.

Itraconazole or fluconazole.

Griseofulvin has no activity against C. albicans. "Swish and swallow" formulations of clotrimazole and nystatin are commonly used though. Most of the azoles are effective in esophageal candidiasis.

Front 241

Question: What is true about flucytosine?

Back 241

It is bioactivated by fungal cytosine deaminase to the antimetabolite fluorouracil, which causes inhibition of thymidylate synthase. It can enter the CSF and can be used with amphotericin B in cryptococcal meningitis.

Front 242

Question: Serious cardiac effects have occurred when this drug was taken by PTs using the antihistamines astemizole or terfenadine

Back 242

Ketoconazole due to inhibit metaoblism of hepatic CYP450.

Front 243

Which drug is most appropriate for oral use in the treatment of vaginal candidiasis?

Back 243

Fluconazole and itraconazole.

Clotrimazole and nystatin is used topically for vaginal candidiasis.

Front 244

Regarding the clinal use of liposomal formulation of amphotericin B, which statement is accurate?

Back 244

They decrease nephrotoxicity of amphotericin B.

Front 245

Which drug used IV for disseminated and mucocutaneous candida infection is an inhibitor of the synthesis of fungal cell wall components?

Back 245

Caspofungin, and echinocandins.

Front 246

What is the triple therapy for H. pylori?

Back 246

Bismuth and amoxicillin (or tetracycline) with metronidazole.

Front 247

What are the major antibiotics that inhibit bacterial cell wall synthesis?

Back 247

Penicillins and Cephalosporins, which are beta-lactams

Front 248

What type of drug is beta-lactams?

Back 248

Bactericidal drugs

Front 249

What are the steps of beta-lactam?

Back 249

1) binding to penicillin-binding proteins in the bacterial cytoplasmic mm; 2) inhibition of transpeptidation reaction (cross-links the peptidoglycan chain of the cell wall); 3) activation of autolytic enzyme that cause lesions in the bacterial cell wall.

Front 250

What is a major form of resistance to beta-lactams?

Back 250

Beta-lactamses (penicillinases) by most staphylococci and many gram-negative organisms.

Front 251

Penicillin G (Narrow-spectrum penicillinase-susceptible) is useful for and is the DOC for?

What can enhance its activity, and against what microbe?

Back 251

Gram-positive cocci (streptococci, enterococci), and the DOC for spirochetes (Treponema pallidum), Neisseria meningococcal (but not N. gonorrhoeae)

Activity against enterococci is enhanced with aminoglycoside.

Front 252

Penicillin G is not useful for?

Back 252

Staphylococcus aureus, Neisseria gonorrhoeae and many strains of pneumonococci.

Front 253

What drugs are used to treat known or suspected staphylococcal infections?

Back 253

I MET a NAsty OX (beta-lactamase resistant penicillins: METHicillin, NAfcillin, and OXacillin)

Front 254

Ampicillin and amoxicillin (wide spectrum penicillinase-susceptible drugs) are useful for?

Back 254

Similar to penicillin G, but also:

HELPS:
(Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella)

(Enterococci, and these drugs are amongst the few effective against this bug!).

Gram-negative cocci, Gram-negative rods, and gram-positive cocci

Front 255

TCP: Ticarcillin, Carbenicillin, Piperacillin (wide spectrum penicillinase-susceptible drugs) are useful for?

Back 255

TCP: Takes Care of Pseudomonas

Pseudomonas, Enterobacter, and Klebsiella.

Front 256

What drug can be used with penicillin/ampicillin to have a synergistic effect against enterococcal and listerial infections (and broader gram negative coverage)?

Back 256

Aminoglycosides.

Front 257

What are some allergic reactions with penicillin?

Back 257

Drug-induced Coombs' positive hemolytic anemia; urticaria, severe prutirtius, fever, joint swelling, nephritis, and anaphylaxis.

Front 258

What drug can result in pseudomembranous colitis?

Back 258

Clindamycin, cephalosporins, or any penicillin (amoxicillin)

Front 259

Oral penicillins can cause what GI upsets?

Back 259

Nausea and diarrhea, which may be caused by overgrowth of gram-positive organisms or yeasts.

Front 260

Cephalosporins bind with what?

Back 260

Penicillin-binding proteins.

Front 261

What type of drug is cephalosporins?

Back 261

Bactericidal against those who are susceptible.

Front 262

What is the first generation of cephalosporins and what are the effective against?

PEcK

Back 262

Cefazolin and cephalexin:

Proteus mirabilis, E. coli, Klebsiella pneumoniae.

Effective against gram-positive cocci

Front 263

What is the second generation of cephalosporins and what are the effective against?

HEN PEcKS

Back 263

Cefoxitin, cefaclor, cefuroxime.

Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens.

Less effective against Gram-positive cocci compared to first generation, but more effective against gram-negative such as anaerobe (e.g., bacteroides fragilis) and sinus, ear, and respiratory infections caused by H. influenzae or M catarrhalis.

Front 264

What is the third generation of cephalosporins and what are they effective against?

Back 264

Ceftazidime, ceftriaxone, cefotaxime:

Most penetrate the blood-brain barrier: meningitis.

Gram-negative bacteria and against pneumonia, meningitis, and gonorrhea.

Front 265

What is the fourth generation of cephalosporins and what are the effective against?

Back 265

Cefepime:Broad activity, beta-lactamase-stable. Combines gram-positive activity of first-generation with wider gram-negative spectrum of third-generation.

Against beta-lactamaes (Enterobacter, Haemophilus, Neisseria, and some penicillin-resistant pneumonococci).

Front 266

What is the allergic reaction against cephalosporins?

Back 266

From skin rashes to anaphylactic shock. Disulfiram-like reaction with ethanol (cefamandole, cefotetan, and cefoperazone), and nephrotoxicity.

Front 267

Although, there is a cross reactivity between penicillins and cephalosporins, and those who are allergic to penicillin can sometimes be treated with cephalosporin; however, if the PT has had a history of anaphylaxis to penicillin, can they be treated with cephalosporin?

Back 267

No

Front 268

What drug is resistant to beta-lactamases produced by gram-negative rods (Klebsiella, Pseudomonas, and Serratia); and therefore can be used to treat against those infections?

Back 268

Aztreonam. It is only effective against Gram-negative bacteria (including Pseudomonas aeruginosa), and NOT Gram-positive.

Front 269

How does aztreonam work?

Back 269

Binds to PBP (pinicillin-binding protein) and blocks peptidoglycan cross-linking .

Front 270

What drug does not have a cross-allergen of penicillin?

Back 270

Aztreonam.

Note: for penicillin-allergic PTs and those with renal insufficiency who cannot tolerate aminoglycosides.

Front 271

What drug belongs to the class of monobactam?

Back 271

Aztreonam

Front 272

Carbapenems are effective against?

Back 272

Broad spectrum includes PRSP strains (not MRSA), gram-negative rods, gram-positive cocci, and anaerobes.

Front 273

What are the side effects of carbapenems?

Back 273

CNS toxicity (confusion, encephalopathy, seizures). Seizures can be reduced by reducing dosage in PTs with renal impairment. Partial cross-reactivity with penicillins.

Note: the significant side effects limits its use to being the DOC for Enterobacter

Front 274

What inactivates bacterial beta-lactamases, and added to amoxicillin or ampicillin to broaden the spectrum of coverage against against gonococci, streptococci, E. coli, and H. influenzae.

Back 274

Clavulanic acid, sulbactam, tazobactam.

NOT against Enterobacter, Pseudomonas, and Serratia.

Front 275

What inactivates bacterial beta-lactamases and added to piperacillin to broaden the spectrum against gram-negative organisms and S. aureus infections?

Back 275

Tazobactam.

Front 276

What drug inhibits transglycosylase (by binding to D-Ala-D-Ala termina) an enzyme involved in peptidoglycan elongation and cross-linking?

Back 276

Vancomycin.

Front 277

What is vancomycin used for?

Back 277

It covers all Gram-positive bacteria (staphylococci, enterococci, streptococci) and against multi-drug resistant infections (sepsis, endocarditis), including MRSA and is a back up for C. difficile pseudomembranous colitis (metronidazole is the DOC). It also covers enterococcus, and multi-resistant Staph. epidermidis. It can treat Strept and Staph in penicillin-allergic PTs.

Front 278

Side effects of vancomycin?

Back 278

Red man syndrome (due to release of histamine) nephrotoxicity, otoxicity

Front 279

The primary mechanism of antibacterial action of cephalosporins involves inhibition of?

Back 279

Reactions involving transpeptidation; therefore, inhibiting peptidoglycan cross-linking.

Front 280

Vancomycin inhibits?

Back 280

Transglycoslase, preventing elongation of peptidoglycan (it complexes with D-alanine D-alanine to inhibit transpeptidation).

Front 281

What is the most appropriate treatment of gonorrhea?

Back 281

Ceftriaxone.

Front 282

What drug works best against Treponema pallidum?

Back 282

Penicillin G. If allergic, than doxycycline or tetracycline.

Front 283

An elderly debilitated PT has a fever believed to be due to an infection. He has extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-positive cocci. The DOC is?

Back 283

Nafcillin, which is resistanct to penicillinases and against many S. aureus (but not MRSA) and common streptococci. Bacterial lesions of the skin are most likely caused by staphylococci or streptococci.

Front 284

A 36 year old woman recently treated for leukemia is admitted to the hospital with malaise, chills, and high fever. Gram stain of blood reveals the presence of gram-negative bacilli. The initial diagnosis is bacteremia, and parenteral antibiotics are indicated. The records of the PT reveal that she had a severe uricarial rash, hypotension, and respiratory difficulty after oral penicillin V. What is the drug regimen?

Back 284

Aztreonam, which has no cross-reactivity between penicillins.

Front 285

PT presents with S. pneumoniae, but is penicillin G resistant. What treatment should be given?

Back 285

Cefotaxime or ceftriaxone are the most active cephalosporins against penicilling-resistant pneumococci, and the addition of vancomycin or rifampin is recommended.

Front 286

The molecular basis for the resistance of certain strains of S. pneumoniae to penicillin G is?

Back 286

Changes in penicillin binding protein.

Front 287

Diptheroid-like gram-positive rods in the CSF of a elderly PT are indicative of what? And what drug should be given?

Back 287

Listeria monocyogenes, and ampicillin.

Listeria are common in neonates, the elderly PTs, and those who are immunocompromised.

Front 288

A PT had a severe anaphylactic reaction to penicillin G. What would be the best treatment against enterococcal endocarditis?

Back 288

Vancomycin. Aminoglycoside may be added for synergistic effect against the enterococci.

Front 289

This drug has activity against many strains of Pseudomonas aeruginosa. However, when it is used alone, resistance has emerged during the course of treatment. The drug should not be used in penicillin-allergic PTs. Its activity against gram-negative rods is enhanced if used in combination with tazobactam. It is also effective against anaerobes (Bacteroides fragilis)

Back 289

Piperacillin.

Front 290

Vancomycin is not susceptible to?

Back 290

Penicillinase.

Front 291

Transpeptidase AKA?

Back 291

Penicillin-binding protein

Front 292

What can be given with imipenem to increase its duration of action. It is the DOC for?

Back 292

Cilastatin, which inhibits renal dihydropeptidase I (inactivates imipenem in the renal tubules).

DOC for Enterobacter.

Note: cilastatin is ALWAYS given with imipenem.

Front 293

What is similar to methicillin, in the sense that it is resistant to beta-lactamases?

Back 293

Aztreonam

Front 294

What is peptidoglycan and transpeptidases?

Back 294

Peptidoglycan are chains of polysaccharides and polypeptides that are cross-linked to form the bacterial cell wall. Transpeptidases are bacterial enzymes involved in the cross-linking of linear peptidoglycan chains, the final step in cell wall synthesis.

Front 295

What can of spectrum do methicillin, nafcillin, and oxacillin fall under, and what is their main use? Which one is hardly used due to its nephrotoxic potential.

Back 295

They are very-narrow-spectrum penicillinase-resistant drugs. Their primary use is in the treatment of known or suspected staphylococcal infections.

Methicillin is hardly used due to its nephrotoxic potential.

Front 296

What drugs belong to the class carbapenems, that have a low susceptibility to beta-lactamases, and structurally different than penicilling but retains the beta-lactam ring structure?

Back 296

Imipenem, meropenem, and ertapenem.

Front 297

What drug is less likely to cause seizures in the carbapenems class?

Back 297

Meropenem. It is not metabolized by renal dehydropeptidases.

Front 298

What drug has a spectrum similar to vancomycin and active against vancomycin-resistant strains of enterococci and staphylococci?

What should be monitor with this drug and why?

Back 298

Daptomycin

Creatine phosphokinase, since daptomycin may cause myopathy.

Front 299

What are the major antibiotics that inhibit bacterial cell wall synthesis?

Back 299

Penicillins and Cephalosporins, which are beta-lactams

Front 300

What are the steps of beta-lactams and cephalosporins?

Back 300

1) binding to penicillin-binding proteins in the bacterial cytoplasmic mm; 2) inhibition of transpeptidation reaction (cross-links the peptidoglycan chain of the cell wall); 3) activation of autolytic enzyme that cause lesions in the bacterial cell wall.

Front 301

Pencillin G is useful for what and is the DOC for?

Back 301

Gram-positive cocci and rods and DOC for spirochetes (Treponema pallidum), Neisseria meningococcal (but NOT N. gonorrhoeae).

Activity against enterococci is enhanced with aminoglycoside.

Front 302

Penicillin G is not useful for?

Back 302

Staphyloccous aureus, Neisseria gonorrhoeae and many strains of pneumonococci.

Front 303

What drugs are used to treat known or suspected staph infections?

Back 303

I MET a NAsty OX (beta-lactamase resistant penicillins: METHicillin, NAFcillin, and OXacillin)

Also: dicloxacillin.

Front 304

Ampicillin and amoxicillin (wide spectrum but penicillinase-susceptible) are used for?

Back 304

Similar to penicillin G but also gram-positive bacteria and gram-negative rods:

HELPS: (Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella)

And Enterococci, and these drugs are amongst the few effective against this bug!)

Front 305

TCP: Ticarcillin, Carbenicillin, Piperacillin (wide spectrum penicillinase-susceptible drugs) are useful for?

Back 305

TCP: Takes Care of Pseudomonas

Pseudomonas

Note: use with clavulanic acid (beta-lactamase inhibitors)

Front 306

What drug can be used with penicillin/ampicillin to have a synergistic effect against enterococcal and listerial infections (and broader gram negative coverage)?

Back 306

Aminoglycosides

Front 307

What are some allergic reactions with penicillin? Methicillin?

Back 307

Drug-induced Coombs' positive hemolytic anemia; urticaria, severe prutirtius, fever, joint swelling, nephritis, and anaphylaxis

Methicillin? interstitial nephritis

Front 308

What drug can result in pseudomembranous colitis?

Back 308

Clindamycin, cephalosporins, or any penicillin (amoxicillin)

Front 309

Oral penicillins can cause what GI upset?

Back 309

Nausea and diarrhea, which may be caused by overgrowth of gram-positive organisms or yeast.

Front 310

What is the first generation of cephalosporins and what are they effective against?

PEcK

Back 310

Cefazolin and cephalexin:

Proteus mirabilis, E. coli, Klebsiella pneumoniae.

Note: Effective against gram-positive cocci

Front 311

What is the second generation of cephalosporins and what are they effective against?

HEN PEcKS

Back 311

Cefoxitin, cefaclor, cefuroxime

H. influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens.

Less effective against Gram-positive cocci compared to the first generation, but more effective against gram-negative such as anaerobe (e.g., bacteroides fragilis) and sinus, ear, and respiratory infections caused by H. influenzae or M. catarrhalis.

Front 312

What is the third generation of cephalosporins and what are they effective against?

Back 312

Ceftazidime, ceftriaxone, cefotaxime:

Most penetrate the BBB: meningitis; serious gram-negative infections resistant to other beta-lactams.

Ex. Ceftazidime for Pseudomonas; ceftriaxone for gonorrhea

Front 313

What is the fourth generation of cephalosporins and what are they effective against?

Back 313

Cefepime

Broad activity, beta-lactamase-stable.

Combines gram-positive activity of first-generation with wider gram-negative spectrum of 3rd generation; increase activity against Pseudomonas.

Against beta-lactamases (Enterobacter, Haemophilus, Neisseria, and some penicillin-resistant pneumococci)

Front 314

What is the allergic reaction against cephalosporins?

Back 314

From skin rash to anaphylactic shock. Disulfiram-like reaction with ethanol (with a methylthiotetrazole gorup, e.g., cefamandole), and nephrotoxicity; cross-hypersensitivity with penicillins.

Front 315

Although, there is a cross reactivity between penicillins and cephalosporins, and those who are allergic to penicillin can sometimes be treated with cephalosporin; however, if the PT has had a history of anaphylaxis to penicillin, can they be treated with cephalosporin?

Back 315

NO

Front 316

What drug is a monobactam that is resistant to beta-lactamases produced by gram-negative rods (Klebsiella, Pseudomonas, and Serratia); and therefore can be used to treat against those infections?

Back 316

Aztreonam. It is only effective against Gram-negative rods (including Pseudomonas, Klebsiella, Serratia) and NOT gram-positive or anaerobes

Front 317

How does aztreonam work?

Back 317

Binds to PBP and blocks peptidoglycan cross-linking.

Front 318

What drug does not have a cross-allergenicity with penicillin or cephalosporins?

Back 318

Aztreonam.

Note: for penicillin-allergic PTs and those with renal insufficiency who cannot tolerate aminoglycosides.

Front 319

The drugs that belong to carbapenems, imipenem/cilastatin and meropenem, are effective against? DOC for?

Note: carbapenems are structurally different than penicillin but retains the beta-lactam ring structure.

Back 319

Broad spectrum and are beta-lactamase-resistant. Includes PRSP strains (not MRSA), gram-negative rods, gram-positive cocci, and anaerobes.

DOC: Enterobacter

Note: aztreonam is also resistant to beta-lactamases.

Front 320

What are the SE of imipenem/cilastatin, meropenem? WHich drug is less likely to cause a seizure in this class?

Back 320

CNS toxicity (confusion, encephalopathy, seizures). Seizures can be reduced by reducing dosage in PTs with renal impairment.

Meropenem. It is not metabolized by renal dehydropeptidases.

Note: the significant SE limits its use to being the DOC for Enterobacter and in life-threatening infections when other drugs have failed.

Front 321

What inactivates bacterial beta-lactamases, and added to amoxicillin or ampicillin to broaden the spectrum of coverage against gonococci, streptococci, E. coli, and H. influenzae?

Back 321

Clavulanic acid, sulbactam, tazobactam.

NOT against Enterobacter, Pseudomonas, and Serratia.

Front 322

What inactivates bacterial beta-lactamases and added to piperacillin to broaden the spectrum against gram-negative and S. aureus infections?

Back 322

Tazobactam

Front 323

What drug inhibits transglycosylase (by binding to D-Ala-D-Ala terminal) an enzyme involved in peptidoglycan elongation and cross-linking?

Back 323

Vancomycin

Front 324

What is vancomycin used for?

Back 324

Serious gram-positive resistant organisms, including S. aureus and Clostridium difficile (pseudomembranous colitis, but metronidazole is the DOC)

Front 325

SE of vancomycin?

Back 325

Nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing--"red main syndrome"(due to histamine release) (can largely be prevented by pretreatment with antihistamines and slow infusion rate).

Front 326

MOA of cephalosporins involves inhibition of?

Back 326

Reactions involving transpeptidation; therefore, inhibiting peptidoglycan cross-linking.

Front 327

What is the DOC for gonorrhea?

Back 327

Ceftriaxone

Front 328

What is the DOC for Treponema pallidum?

Back 328

Penicilling G.

If allergic, than doxycycline or tetracycline.

Front 329

A debilitated PT has a fever from a skin infection, which yields gram-positive cocci. DOC is?

Back 329

Nafcillin, which is resistant to penicillinases and S. aureus (but not MRSA) and common strep. Bacterial lesions are most likely staph or strep

Front 330

A women is treated for bacteremia with gram-negative bacilli. Records show that she has had severe rash, hypotension, and respiratory distress after penicillin V. What is the drug regimen?

Back 330

Aztreonam, which has no cross-reactivity between penicillins.

Front 331

PT presents with S. pneumoniae, but is penicillin G resistant. What is the treatment?

Back 331

Cefotaxime or ceftriaxone, which are the most active cephalosporins against penicillin-resistant pneumococci, and the addition of vancomycin or rifampin is recommended.

Front 332

Diptheroid-like gram-positive rods in the CSF in an elderly PT are indicative of what? What is the DOC?

Back 332

Listeria monocytogenes. Ampicillin.

Listeria are common in neonates, the elderly PTs, and those who are immunocompromised.

Front 333

PT with severe anaphylactic reaction to penicillin G, has enterococcal endocarditis. What is the DOC?

Back 333

Vancomyin. Aminoglycoside may be added for synergistic effect.

Front 334

This drug has activity against Pseudomonas; however, when used alone, resistance emerges. The drug should not be used in penicillin-allergic PTs. Its activity against gram-negative rods is enhanced if used in combination with tazobactam. It is also effective against anaerobes (Bacteroides fragilis)

Back 334

Piperacillin

Front 335

Vancomycin is not susceptible to?

Back 335

Penicillinase

Front 336

Transpeptidase AKA?

Back 336

penicillin-binding protein

Front 337

What can be given with imipenem to increase its duration of action. It is the DOC for?

Back 337

Cilastain, which inhibits renal dihydropeptidase I (inactivates imipenem in the renal tubules)

DOC for Enterobacter.

Note: cilastatin is ALWAYS given with imipenem.

Front 338

What is similar to methicillin, in the sense that it is resistant to beta-lactamases?

Back 338

Aztreonam

Front 339

What are peptidoglycan and transpeptidases?

Back 339

Peptidoglycan are chains of polysaccharides and polypeptides that are cross-linked to form the bacterial cell wall.

Transpeptidases are bacterial enzymes involved in the cross-linking of linear peptidoglycan chains, the final step in cell wall synthesis.

Front 340

What spectrum do methicillin, nafcillin, and oxacillin fall under, and what is their main use? Which one is hardly used due to its nephrotoxic potential?

Back 340

Very narrow spectrum penicillinase-resistant drugs. Treatment of staph infections.

Methicillin is hardly used due to nephrotoxic potential

Front 341

What drug has a spectrum similar to vancomycin and active against vancomycin-resistant strains of enterococci and staph?

What should be monitor with this drug and why?

Back 341

Daptomycin

Creatinine phosphokinase, since daptomycin may cause myopathy.

Front 342

Prophylaxis:

Meningococcal

Gonorrhea

Sphilis

Recurrent UTIs

Pneumocystis jiroveci pneumonia

Endocarditis with surgical or dental procedures

Back 342

Rifampin (DOC), minocycline

Ceftriaxone

Benzathine penicillin G

TMP-SMX

TMP-SMX (DOC, aerosolized pentamidine

Penicillin

Front 343

MRSA

VRE

Back 343

Vancomycin

Linezolid and streptogramins (quinupristin/dalfopristin)