Id Test #2

Front 1

Aminoglycoside are bacterio___

Back 1

cidal

Front 2

Think Gram ___ for aminoglycosides

Back 2

negative

Front 3

What's the most toxic aminoglycoside of all?

Back 3

neomycin B

Front 4

This aminoglycoside is isolated from Micromonospora sp?

Back 4

Gentamicin

Front 5

Why are Aminoglycosides limited to aerobic bacteria?

Back 5

Bc rely on transporter to get into the bac cell (this transporter is dependent upon O2, electrons, and ATP)

the pump normally brings in sugar (energy) but gets confused and brings in AG's as well bc also very sugary

Front 6

What two things can inhibit the O2/e- pump for the Aminoglycosides?

Back 6

divalent cations
acidic environment (spetemia, ketoacidosis, inflammed sites)

Front 7

What are the 3 reasons why aminoglycosides are cidal drugs and not static?

Back 7

(1) binding to ribosomal subunits is in an irreverisble manner
(2) the effects of increased permeability of the membrane  leakage and eventually lyses
(3) the ability of the pump has been taken away

Front 8

Prokaryotes ribosomes have the ___ and ___ units.

Back 8

23S (50S)

16S (30S)

Front 9

Eukaryotes ribosomal units are ___ and ___.

Back 9

28S (60S)

18S (40S)

Front 10

Which PSI has bad SE's due to it's likely ability to bind with 28S/18S?

Back 10

chloramphenicol

Front 11

AUG codon is for ____.

Back 11

methimine

Front 12

At what site do aminoglycosides bind on the ribosome?

Back 12

A site - specifically 16/30S

this is an irreversible bond --> reason why cidal

Front 13

What 3 ways do aminoglycosides stop/inhibit protein synthesis?

Back 13

block initiation

block further translation - get premature termination

incorp incorrect AA's --> can't fxn appropriately

Front 14

Which AA is the difference between the aminoglycoside binding site to prok vs eukaryotes?

Back 14

Adenine

(humans have guanine at the binding site - thus are not sensitive to AG's)

Front 15

Which 3 ways do bac become resistant to aminogylcosides?

Back 15

mutation
loss of permeability
enzymatic alteration (MOST IMPT!!)

Front 16

Which bug has higher resistance to aminoglycosides due to it's narrower binding area?

Back 16

Streptomycin

Front 17

what are the 3 types of aminoglycoside modifying enzymes?

Back 17

AAC (N-acetyltransfreases)
ANT (O-adneyltransferases)
APH (O-phosphtransferse)

RM these enzymes are made from same soil that AG's were found

Front 18

____ bulkiness decreases the ability for AG enzymes to modify it and thus create resistance.

Back 18

Amikacin’s

Front 19

Which bug species is the most concerned about aminoglycoside inactivating enzymes?

Back 19

Enterococci sp.

Enterococcus faecalis
Enterococcus faecium

Front 20

Can you treat an enterococci infection with Vancomycin/Penicillin/AG? Why or why not?

Back 20

no

synergisim is lost bc of the AG inactivating enzymes the bug possess

Front 21

What Gram + bug are aminoglycosides good for?

Back 21

Streptococcus sp.

Front 22

This class is used for serious sepsis, bone, endocarditis, RTI, and skin/burn infections.

Back 22

aminoglycosides

Front 23

T/F

Aminoglycosides treat P. aeruginosa

Back 23

True

(even tho bug does not have porin channels - but have gated channels)

Front 24

This aminoglycoside is distinugished by treatment of TB and for binding to a single domain of the 30S A-site.

Back 24

Streptomycin

(always used in combo of at least 1 other agent when treating TB)

Front 25

Can treat bacterial endocariditis by Enterococci and Y. pestis.

Back 25

streptomycin

(RM Enterococci sp must NOT produce inactivating enzymes)

Endocarditis usually treated with PCN for 4-6 wks (w/o AG if in an uncomplicated elder)

Front 26

Which two bugs especially does Garamycin have excellent activity against?

Back 26

P. aeruginosa
L. monocytogenes (Gram +)

Front 27

Gentamicin has a ____ group that will attack the amide on the ____ ring.

Back 27

amine

B-lactam

(seperate when given to same person - Gent has the greatest potency for this to happen)

Front 28

Is Nebcin effective as Garamycin in treating Gram + (enterococci) with Pen?

Back 28

no

Front 29

This agent is the perferred agent in the initial treatment of nosocomial Gram - bacillary infections
(including DOC for M. avium).

Back 29

Amikacin (Amikin)

Front 30

When see oral neomycin think what?

Back 30

preparation for surgery (kills off bugs in GI lumen)

Front 31

Vestibular effects is highest with what two AG's?

Back 31

Streptomycin
Gentamicin

Front 32

Which 2 AG's have the highest choclear effects?

Back 32

Amikacin
neomycin

Front 33

Which AG has equal vestibular and choclear effects?

Back 33

tobramycin

Front 34

Which part of the ear is more irreversibly affected with AG's?

Back 34

CN 8 - vestibular nerve

Front 35

AG's penetrate the hair cell membranes causes leakage which causes a loss of ____, especially ___.

Back 35

ions

Mg2+

Front 36

N-acetyl-L-cysteine has been investigated as a possible prophylactic option for _____.

Back 36

AG otoxicity

Front 37

Which AG is the least nephrotoxic and why?

Back 37

streptomycin

bc it's less concentrating; neomycin concentrates the greatest

Front 38

How do AG's worsen Myasthenia Gravis (2)? What is a way to fix it.

Back 38

(1) dec synaptic release of ACh
(2) dec sensitivity of any nicotinic receptor

Give Ca2+ helps by releasing ACh from vesicles to be released

Front 39

Which agent is rapidly inactivated by metal cations?

Back 39

TETs

(in food, vitamins, supplements)

Front 40

What form are TETs water soluble?

Back 40

as salts - primarily in HCL

Front 41

At what position is the NH2 in when the TET is active? Inactive?

Back 41

active = NH2 is going back
inactive = NH2 will go forwards (towards me)

Front 42

TETs bind to what subunit? and Blocks what site?

Back 42

16S (30S)

A-site reversible bind - why more STATIC than cidal

Front 43

Which two TETs are so lipophilic that it is more cidal?

Back 43

aminocycline
doxycycline

(lipo allows them to stay around longer and penetrate bugs better --> maybe even prokary's)

Front 44

How do TETs get into the bac cell?

Back 44

diffuse thru outer membrane (bc lipophilic) - unlike AG's

and thru O2, ATP, electron pump (like AG's)

Front 45

At high doses what do TETs bind to?

Back 45

inhibits mammalian 40S subunit

Front 46

Which class has an antianabolic effect and thus should not be used in prego's.

Back 46

TETs

(this inc BUN --> renal and hepatic effects)

Front 47

What 3 ways can TETs create resistance?

Back 47

(1) dec influx or inc efflux
(2) riobososmal protection proteins
(3) enzymatic inactivation

(why only used for less serious infections like acne and not typical DOC)

Front 48

TETs indications? (P,L,R,C,C,C)
Add on indications? (2)

Back 48

Propionibacteria (acne vulgaris)
Lyme Disease (B. burgdorferi)
Ricketts
Chlamydia
Cholera
Clostridium sp

Add on: Y. pestis and B. anthracis

Front 49

Can TETs treat CA-MSSA, CA-MRSA? Can it treat UTIs?

Back 49

CA-MSSA/MRSA if there's been a susceptibilty test (some S. aureus are sensitive to TETs)

No - not UTIs
(E. coli, Shigella, Salmonella or other Enterobacteriaceae)

Front 50

Can TETs treat Shingella or Salmonella?

Back 50

No, neither

Front 51

Which class can cause free radical formation from absorption of UV light?

Back 51

TETs
(the darker the better, but still no way to predict)

Front 52

This agent is the DOC for N. gonorrhoeae when the pt has a PCN allergy.

Back 52

Tetracycline (Sumycin)

Front 53

This agent can be used in combination Bismuth, flagyl and a PPI to treat H. pylori.

Back 53

Tetracycline (Sumacyin)

Front 54

Loss of the C ring -OH and -CH3 does what for Minocycline (Minocin)?

Back 54

increases lipophilicity

(100% oral absorb, stable in acid, and inc in blood levels)

Front 55

This agent causes membrane leakage AND inhibits the 30S subunit.

Back 55

Minocycline (Minocin)

also don't take with food or on full stomach
(1 hour before, 2 hours after)

Front 56

This TET is the most stable, has the longest t1/2 (qd dosing) and is 100% absorbed.

Back 56

Doxycycline (Vibramycin)

Front 57

What two bugs does Vibramycin have excellent activity against?

Back 57

T. pallidum
N. gonorrhoeae

Front 58

When see Tigecycline what should you think? What are some bugs it covers? (E,K, B, S/S, E, E/R)

Back 58

think = extended spectrum TET (even tho really new class: glycylcyline)

E. coli
K. pneuomoniae
Bacteroides fragilis
Streptococci/ Staphylococci (MSSA)
Enterococcus sp.
Ehrlichiosis/Rickettsia

Front 59

DOC for Rocky mountain fever / Ehrlichiosis? Alternate drug?

Back 59

doxycycline --> trt immediately

chloramphenicol

Front 60

Where in the body does V. cholerae infect? What's the most common methods of contraction in the US?

Back 60

small intestines

shellfish and travel

Front 61

The cholera A toxin binds to what in the cell? What does this cause?

Back 61

binds to Gs(alpha) when active --> locks it in an active position

AC is continually stimualte so cCAMP is continually activated and now all electrolytes and water are steadily effluxed out --> diarrhea

Front 62

This class is made of sugars, but lipophilic, has a pKa of ~8, and is bacteriostatic.

Back 62

macrolides

Front 63

What subunit and site do macrolides bind?

Back 63

23S (50S) at the P-site

RM: TETs and AG's bind to 16S/30S

Front 64

What 3 ways do bugs become resistant to mac's?

Back 64

Efflux of drug by active pump mech (MAIN ONE IN US --> low level resistance)
Ribosomal protection via methylation
Mutation at teh 23S subunit

Front 65

When see macrolides think Gram ____?

Back 65

positive

(Gram - bugs intrinsic resistant due to a lack of penetration of drug)

Front 66

European bugs more resistant to which class?

Back 66

Macrolides

(they req much more drug to kill)

Front 67

Which 2 drug especially inc the half-life of macrolides and may cause toxicity?

Back 67

astemizole
terfenidine

(3A4 inhibitors)

Front 68

Name 4 drugs that should not be given with macrolides?

(E, T, Br, M)

Back 68

ergotamine
theophylline
bromocryptine
methylprednisolone

Front 69

Which mac causes pro-propulsition thru gastrin stimulation?

Back 69

erthromycin

Front 70

Name 5 drugs that should not be coadmin with macrolides?

(Cy, Be, O, S, C)

Back 70

cyclosporin
benzo's
OC's
statins
CCBs

Front 71

Usually go to drug for PCN allergies

Back 71

macrolides

Front 72

DOC for H. pylori?

Back 72

macorlides
Clarithromycin is best!!!

Front 73

This agent is deactivated in acid (ketals), is dec to nothing when given with food, rarely DOC except maybe L. pneumonphila, and requires heavy, spordic dosing.

Back 73

Erythromycin (E-Mycin)

Front 74

Purpose of ethylsuccinate?

Back 74

mask bitter taste of drug

(RM - prodrug bc has ester --> dosed less often)

Front 75

What does Biaxin's change to -OCH3 do for the drug?

Back 75

increases lipophilicity
dec ketal formation --> less cramps

Adds extraordinary potency against H. influenza

Front 76

This bug releases VacA (vacuolating cytotoxin) which causes vacuolation of lumincal cells.

Back 76

H. pylori

(RM: dec somatostatin and inc gastrin release at the gene level)

Front 77

This agent is a loading agent, syngergisitic with Cephs to treat gonorrhea, and has dec 3A4 inhibition.

Back 77

Azithromycin

Front 78

This agent has a mac backbone but replaced sugar with ketone, is only indicated for MDRI S. penumoniae, and has a black box warning bc bad SE's.

Back 78

Telithromycin (Ketek)

SE's: severe liver damage (esp when given with 3A4 drugs [statins]), spontaneous fainting, visual disturbance including visual loss

Front 79

This agent is not really a MAC, inhibits mRNA, good for C. diff (>18 yo), and is poorly absorbed so min systemic SE's.

Back 79

Fidaxomicin (Dificid)

(oral = effective as oral vanc with 1 less risk of occurrence)

Front 80

This agent is quite lipophilic, binds to the 50S subunit, broad spectrum, and treats P. acnes.

Back 80

Cleocin

Front 81

Which MISC protein synthesis inhib has similar resistance to macrolides?

Back 81

Cleocin

Front 82

This agent inhibits the binding of tRNA to the 70S ribosome, thus preventing the formation of the ternary complex.

Back 82

Linezolid (Zyvox)

Front 83

When see Linezolid which 4 bugs should you think of? When should use?

Back 83

MRSA
VRSA
VISA
VRE

when nothing else has worked on them

Front 84

At which site specifically does Zyvox bind?

Back 84

the P-site

(70S - combined structure)

Front 85

Which agent causes serotonin syndrome?

Back 85

LineZOlid (Zyvox)

Front 86

This agent binds to the 23S RNA of the 50S subunit, prevents tRNA binding to the A-site, and is highly toxic due to mammalian cell death (protein syn stops)

Back 86

Chloramphenicol (Chlomycetin)

Front 87

Which agent should not be given in anemic patients? Why?

Back 87

Chloramphenicol (Chlomycetin)

it causes aplastic anemia --> leads to hemorrhaging, bruising, and leukopenia

Front 88

Which agent is a last resort for bacterial menigitis? Is does it have a broad or small spectrum?

Back 88

Chloramphenicaol (Chlomycetin)

think BROAD

Front 89

This agent is resevered for treatment of serious infections caused by multiple drug resistant E. faecium.

Back 89

Synercid
(Q&D pritsin)

Front 90

T/F

Synercid can be used for E. faecalis.

Back 90

False

for E. faecium!!!

Front 91

This agent is approved for MDR or Vanco resistant E. faecium and skin/skin structure infections from MSSA or S. pyogenes.

Back 91

Synercid

(Q&D pristin) --> RM only by IV

Front 92

Quin binds to ____ while Dalf binds to ____.

Back 92

Q = P-site

D = A-site

(enzymatic inactivation - only way for resistance)

Front 93

This agent has SE's that are infused, is a potent inhibitor of 3A4s, and can cause toxicity and HTN when given with other 3A4 substrates.

Back 93

Synercid

(Q & D prisitin)

Front 94

Amoebiasis are diseases of the ___ intestines caused by _____ ____.

Back 94

LARGE

Entamoeba histolyctica

Front 95

This parasite has 2 forms: motile trophozoite (formed in the SI) and a dormant cyst.

Back 95

Amoebiasis

(RM: chlorinated water does not kill)

Front 96

What's the main cause of traveler's diarrhea? Where is the infection in the body?

Back 96

Giardiasis (water-borne --> US)

Small intestines

Front 97

Which parasite has a infectious cyst: Amoebiasis or Giardiasis?

Back 97

Giardiasis

Front 98

This parasite causes ocular disease to unborn babies 15-20 years later.

Back 98

Toxoplasmosis

Front 99

How is Toxoplasmosis linked to Schizophrena/paranoia?

Back 99

(1) Acute Toxo infections can cause psychosis (2) some antiphy drugs actually inhibit toxo growth – like haloperidol (3) higher AB’s against this organism in schizo pts vs. not schizo patients (4) organism can damage astrocytes in brain similarily to those we see in schizo pt

Front 100

AIDS plus toxoplasmosis = ??

Back 100

Toxoplasmic-encephalitis (major cause of death)

Front 101

What's also good for Toxoplasma gondii, besides Flagyl?

Back 101

sulfa/trimeth (Bactrim)

Front 102

This agent can treat ALL anaerobic cocci and bacilli (Bacteroides sp.)

Back 102

Flagyl

(distinguishing feature)

Front 103

How is Flagyl similar to Nitrofurantoin?

Back 103

metabolized by sensitive species

Front 104

This agent offers protection from Parkinson, creates N or O reactive species, and is CI during 1st trimester of prego.

Back 104

Flagyl

Front 105

This agent is used for resistant species of ameobiasis and is only available thru the CDC.

Back 105

Diloxanide FURoate (FURomide)

Front 106

This drug is limited to Giardiasis only - so reserved for special use only.

Back 106

Nitazoxanide (Alinia)

Front 107

Tindamax is similar to ____. What 3 parasites is it approved for?

Back 107

Flagyl

Trich (and bac) vaginalis
Giardiasis (> 3)
Ameobiasis (> 3)

Front 108

This parasite primiarily occurs in AIDs patients (w/ 50% occurance), immunosuppressed pts post transplant, and premature/malnourished infants.

Back 108

Pneumocystis

P. jirovecii (formally P. carinii)

Front 109

This parasite is an opportunistic microbe and infects lung lining & alveolae.

Back 109

pneumocystis

Front 110

What 4 agents can be used for Pneumocystis Pneumonia?
(S, C, TF, A)

Back 110

Sulf/Trim (trt and pvt)
Clindamycin
Trimetrexate + Folinic acid
Atovaguone

Front 111

MOA of Trimetrexate + Folinic acid?

Back 111

Neutrexin inhibits DHRF

Leucovorin replenishes mammaliam folate

Front 112

Malaria is caused by the genus ___ and in humans mostly by the ____ species.

Back 112

Plasmodium

falciparum

Front 113

This has a classical feature of cyclical fevers, 2 stages (liver and RBC), and feeds more on prego's.

Back 113

Malaria in humans

Front 114

This has merozoires involved in it's growth process? What is one prevention of getting?

Back 114

P. falciparum

Sickle cell hetero's of A and S

Front 115

When are Quinine (8S, 9R) and Quinidine (8R, 9S) used?

Back 115

when other anti-malarials have not worked

this is bc they are quite toxic

Front 116

DOC's for malaria? MOA?

Back 116

Chloroquine (Aralen)
Hydroxychoroquine (Plaquenil)

basic drugs --> get into lysosome bac --> now malaria can't use it to breakdown the hemoglobin they usu do

Front 117

Aralen and Plaquenil are excellent against what species? Does it work against E. histolytica?

Back 117

Plasmodium

suppress P. vivax and P. ovale
prevents P. falciparum

Yes, also E. hist

Front 118

If a pt has a chloroquine-resistant Plasmodium sp. what should be used?

Back 118

Mefloquine (Lariam)

good for suppression and prevention

(higher SE's!)

Front 119

Pyrimethamine (Daraprim) reduces THF synthesis is Plasmodium - thus get a def in what 3 things?

Back 119

thymidine
purines
methimine

good for trt and prevention of chloroquine-resistant malaria

Front 120

This agent is given to prevent P. falciparium and to treat acute, uncomplicated P. falciparum.

Back 120

Malarone (Atovaquone and Proquanil)

Front 121

What is the make up of Malarone? (specifics)

Back 121

Atovaquone - selective inhib of parastic mitochondrial e- transport

Proquanil (bc's cycloquaril) - selective DHFR inhib in parasites

Front 122

What 3 drugs dec plasma concentrations of malarone?

Back 122

TETs
Metoclopramide
Rifamfin/Rifabutin

Front 123

This agent is good to treat acute attacks due to chloroquine-resistant P. falciparum.

Back 123

TETs

(RM - sulfonamides are also active against)

Front 124

What are the 2 causes of Tapeworms?

Back 124

Taenia saginate (Beef)
Taenia solium (pork --> BAD)

Front 125

Which worm is capable of penetrating the foot?

Back 125

Larvae of the hookworm

Front 126

This worm is most widely spread, lives in GI lumen, causes itching around anus/vagina.

Back 126

Pinworms

Front 127

This worm can cause blindness, heart attacks, convulsions and psychotic disorders.

Back 127

Tapeworm

Front 128

Mebendazole (Vermox) and Albendazole (Zental) can treat which 2 helminths?

Back 128

Nematodes (Hook, pin, & round)
Cestodes (Tapeworms)

Front 129

What 3 functions do microtubules do? Which drugs affect them?

Back 129

1. forming the worm's cytoskeleton
2. spindle formation
3. vesicular trafficking

Meb and Albend

Front 130

What is the secondary mechanism of Meb and Albend?

Back 130

blocking ATP (essentially)

Front 131

How is resistance conferred in Benzimidazoles (Alben and Meb)?

Back 131

1. switching the B-tubulin for 1 to 2
2. mutations in B-tululine genes (simple hydroxy change)

Front 132

Mectizan and Stromectol is excellent against which worm types?

Back 132

Pinworm
Roundworm

Front 133

What is the DOC for onchocerciasis (river blindness)?

Back 133

Mectizan, Stromectol

Front 134

Ivermectin MOA?

Back 134

causes paralysis of organism
binds to glutamate gated Cl- channels

(dec feeding behavior in nematodes)

Front 135

This agent has a MOA of Ca2+ influx (paralysis), inhibits phosphoinositide (contractions), and drug induced damage to tegument (AB attack on worm's antigen).

Back 135

Praziquantel (Biltricide)

Front 136

Does Praziquantel (Biltricide) treat Nematodes?

Back 136

No

(just cestode and trematodes)

Front 137

Pin-X is used for what worms only? Why is it safe to be OTC?

Back 137

pinworms, roundworms, hookworms

bc confined to GI tract and not systemically absorbed

Front 138

Pin-X moa?

Back 138

NMBA (paralysis)
Activates nicotinic receptors

Front 139

1% g-benzene hexachloride is ____?

Back 139

Lindane (Kwell)

Front 140

Why does Lindane cause dizziness, clumsiness and confusion? What weight does it bc 2nd line for scabies and lice?

Back 140

bc it binds to GABA-R --> allows constant stimulation

<110 lbs

Front 141

Pyrethryins are contracted from ____ and are less toxic so kids can use. What some examples? (2)

Back 141

mums

A-200 and RID

Front 142

Permithrin is synthetic derivative from Py's...what are some examples? (3)

Back 142

Nix-1
Elimite
Acticin

(RM they have increased stability so do not need a synergist like Py's)

Front 143

MOA of Pyrethryins and Permithrin?

Back 143

blocks the arm of the Na+ channel --> so leaves it open

works very quickly

Front 144

Why are Pyrethryins and Permithrins not toxic to humans?

Back 144

bc humans very quickly metabolize them to various harmless products in the body

bugs take much longer to do so

Front 145

What is added to Pyrethryins in a 10:1 ratio? What do they do?

Back 145

Piperonyl butoxide (PBX)

inhibit the CYP450 enzyme that breaks down the pyrethryin

Front 146

This agent is approved for head lice ( > 4 yo), contains benzyl alcohol, and causes 100% paralysis in insects.

Back 146

Spinosad (Natroba)

Front 147

What is the 3 step process of tetrahydrofolic acid synthesis?

Back 147

Dihydropteroate Synthase (Dihy + PABA)
Conjugation (Dihy acid + glutatmate)
Dihydrofolate Reductase (DHFR) --> tetrafol

Front 148

What enzyme in the tetrafolate synthesis do we not have compared to bugs? What type of inhibition is it with sulfonamides?

Back 148

we dont have dihydro synthase (1st step)

Sulfa mimicing PABA --> competitive

Front 149

How can bugs bc intrinsically resistant to sulfonamides?

Back 149

by getting their folate (dihydrofolate acid) from the environment (like we do) and making tetrafol from that

ie: not making folate acid de novo

Front 150

What are 2 ways of sulfonamide resistance?

Back 150

1. low affinity of the sulfo for the dihydro synthase
(happens thru mutations, plasmids)

2. increased PABA synthesis

Front 151

Which sulfanilamide form is active? Which form can penetrate into the bug?

Back 151

ionized form is active

but unionized form is only way to get into bug (bc is lipid soluble)

Front 152

Sulfanilamide is a(n) _____ drug despite its ___ pKa.

Back 152

acidic drugs (suflone is what's e- withdrawing)

high pKa (~10.5)

so they need a more basic environment to bc active (ionized)

Front 153

In the urine sulfanilamide is more ionized or unionized? what' the result?

Back 153

unionized (bc it's a like-like situation)

this causes concentration --> crystals

Front 154

What does the phenyl ring do for sulfadiazine?

Back 154

dec it's pKa --> less acidic --> more ionizable form in body --> more water soluble in urine

Front 155

What are 2 reasons why Sulfadiazine is 142X better than Sulfanilamide?

Back 155

greater lipophilicity (inc t1/2)

AND

low pKa

(RM lipo is not only reason bc the -amide can get in bug too, just can't get activated once inside)

Front 156

When see sulfonamides think ____ spectrum.

Back 156

BROAD

(cover everything)

Front 157

Triple Sulfa is used for ____ and is often dosed with ______ to increase clearance.

Back 157

UTI
(from anything)

Na-Bicarbonate

Front 158

What is Silvadene is used for? What action does it provide?

Back 158

for: non-life threatening burns

provides synergism with sulfadiazine and Ag+

Front 159

This sulfo covers Gram + and Gram - organisms very well. And inhibits growth of nearly all bac and fungi in vitro.

Back 159

Silvadene

Front 160

This sufla has good activity for UTIs and otitis media. Is rapidly absorbed and eliminated.

Back 160

Sulfisoxazole (Gastrisin)

Front 161

What make Phenazopyridine good with sulfisoxazole?

Back 161

adds local analgesic properties to urinary tract

RM Azo-Gantrisin is good for UTIs but will stain clothes, urine, contact lenses, etc

Front 162

The nitro proton with the acetyl group in Sulfisoxazole Acetyl does what? What does it have good activity against?

Back 162

grants tastelessness

good for otitis media

Front 163

This sulfa is slower absorbed and eliminated, has a pKa of 6 and has a very WIDE spectrum.

Back 163

Sulfamethoxazole (Gantanol)

GRAND-DADDY of the Sulfa's

Front 164

Does Gantanol cover MRSA?

Back 164

not on it's on

(does cover T. gondii tho)

Front 165

This sufla is distinguishably by the fact it is excellently water soluble - thus used extensively in ophthalmic infections.

Back 165

Sulfacetamide (Isoptocetamisde, Na-sulamyd)

Front 166

What is connected to the sulfonamide that cause allergic rxns?

Back 166

arylamine

(RM not enough Glutathione is the problem)

Front 167

Why doesn't trimethoprim recognize mammalian DHFR?

Back 167

bc of a single difference in the enzyme

(RM trimethroprim works at the end of tetrafolate formation - works very well with sulfon's)

Front 168

Can Bactrim treat MRSA?

Back 168

yes, some (??)

very wide spectrum

Front 169

What happens if a pt is on Trimethoprim + an ACE, ARB or sprionolactone?

Back 169

hyperkalemia

(RM this is bc Trimethoprin dec K+ excretion)

Front 170

Which sulfonamide has the lowest (best) MIC? Highest?

Back 170

lowest = sulfamethoxazole

highest = sulfanilamide

Front 171

____ is the most potent antibacterial thus far. Why?

Back 171

Quinolones

bc not real resistance as of yet

(RM florou group is added at the 6th position)

Front 172

DNA gyrase cutting and gluing back together is called:

Back 172

decatenation (cutting)

catenation

Front 173

For humans what enzyme is similar to DNA gyrase?

Back 173

Topoisomerase II

Front 174

This enzyme is absolutely required for decatanation ahead of the replication fork of DNA.

Back 174

Topoisomerase IV

(works with DNA-gyarse; it didnt have Top IV rep would NOT occur; didn't have DNA-gyrase --> slows rep down to the point cell cannot live long)

Front 175

MOA for Quinolones?

Back 175

inhibit DNA synthesis by binding and inhibting DNA gyrase (stops supercoiling & tension relxation) and TOPO IV (stops decetanation & causes SCISSION)

Front 176

In Gram + bugs quinolone's primary target is...?

Back 176

TOPO IV

Front 177

In Gram - bugs quinolone's primary target is...?

Back 177

DNA Gyrase

Front 178

High doses of quinolones can cause what?

Back 178

dec in selectivity of the TOPO's --> so TOPO II maybe inhibited rather than IV

Front 179

Where do quinolones bind on the DNA gyrase? On the TOPO IV?

Back 179

DNA gyrase --> gyrA or gyrB

TOPo IV --> parC

(if mutate these areas = resistance; 1 = low level resistance, both = high)

Front 180

What bug is unsual in that it has higher resistant rates with Quinolones?

Back 180

N. gonerrhea

Front 181

Levaquin 500 vs Levaquin 750?

Back 181

500 led to low level resistance
750 now used bc kills all bugs by binding to both gyrA and parC

Front 182

This QL is extensively used in Gram - UTI and is P. aeurginosa resistant.

Back 182

Nalidixic Acid (Negram)

Front 183

This gen FQ has poor serum/tissue conc, not available for systemic infcections, and limited to UT disinfectants?

Back 183

1st gen FQ

Front 184

Which FQ gen lacks P. aeruginosa, Gram + organisms, and intracellular organisms?

Back 184

1st gen FQ's

Front 185

What does the floro group add to quinolones?

Back 185

lipophilicity

now can penetrate bac membranes better (and some human cell membranes too!)

Front 186

This FQ is more Gram - than Gram +, is very potent with low MIC, covers P. aeruginosa, and antagonizes the GABA-A receptor.

Back 186

Norfloxacin (Noroxin)
2nd gen

RM: convulsions can occur bc of the GABA-A binding

Front 187

This FQ gen is excellent for systemic infections, has no activity for anaerobes, good Gram - and weak Gram +, and covers P. aeruginosa?

Back 187

2nd gen

Front 188

Cipro is what FQ gen? Does it cross CSF?

Back 188

2nd gen

yes - some family members will be treated prohlayaxis with this drug

Front 189

DOC for anthrax?

Back 189

Cipro

(2nd gen)

Front 190

Is Levofloxin better at Gram + bugs than cipro? What isomer is more potent?

Back 190

yes better at Gram +

S- is more potent
(Ofloxacin rarely used anymore - mixture)

Front 191

URI are more Gram ____ so see which FQ used more?

Back 191

positive

levofloxacin

Front 192

LRI and UTIs are more Gram ___, so see which FQ used more?

Back 192

negative

cipro

Front 193

Which FQ can target MSR pneumoniae?

Back 193

Levofloxacin

Front 194

This FQ class has once daily dosing, active against S. pneuomoniae, and is better penetrating.

Back 194

3rd gen

Front 195

Are 3rd gen FQ's good given systemically?

Back 195

No (cause QT prolongation and liver tox)

Zagam (sparfloxacin) and Tequin (gatifloxacin) BOTH removed from the market

Front 196

This FQ is less active against UTI (due to elimination), better at intracellular bac, and is excellent against S. pneumonia.

Back 196

Moxifloxacin

Front 197

Is Avelox used for anaerobes like Bacteroides fragilis?

Back 197

yes

(RM better tho at Gram + than Gram - since a 4th gen)

Front 198

What gen is Factive? What should you think of when see this gen (2)?

Back 198

4th gen

Gram + and QT prolongation

Front 199

What does the urine have to be for FQ's to cause crystalurina?

Back 199

basic

(rare tho)

Front 200

What chem structure causes convulsions in FQ's? Which drug class enhance convulsions with the FQ's?

Back 200

the piperazine ring (less in newer agents)

NSAIDs

Front 201

What is the age restriction on FQ's? Why?

Back 201

18 years or older

causes arhtropathy

Front 202

Do FQ's cause chelation? Photosenstivity?

Back 202

yes and yes!

Front 203

Quinolone drug interactions is with CYP____. Which 4 drugs should be avoided when given together?

Back 203

1A2

Warfarin, Theophylline (esp w/ Cipro), Caffeine, Antacids

Front 204

Hiprex generates ____ and ____. Why are Proteus sp resistant to it while almost all other bac are sensitive to it?

Back 204

ammonia and formaldehyde (why an antispetic)

bc they make urine more basic (need acid to get A and F) --> never used alone to treat UTI

Front 205

This agent inhibits DNA and RNA functions, is used for E. coli and Enterococci sp. only, and comes in 3 forms?

Back 205

Nitrofurantoin

Front 206

This Nitrofurantoin is a powder is most associated with creating N/V. It changes urine color to brown.

Back 206

Furadantin

Front 207

This Nitrofurantoin is in a crystal form, it decreases the initial absorption of drug so less n/v.

Back 207

Macrodantin

Front 208

This Nitrofurantoin has crystals and a gelatenous polymer mixture. It slows absorb very much and last longer so only need BID.

Back 208

Macrobid