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139 Cards in this Set
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block cell wall synth via peptidoglycan cross-linking
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penicillin
cephalosporins aztreonams imipenem |
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block peptidoglycan synthesis
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bacitracin
vanco |
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block nucleotide synth
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sulfonamides
trimethoprim |
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block DNA topoisomerases
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fluoroquinolones
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block dna mRNA synthesis
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rifampin
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damage dna
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metronidazole
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block protein synth at 50S
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chloramphenicol
macrolides clindamycin streptogramins |
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block protein synth at 30S
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aminoglycosides
tetracyclines |
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what does penecillin do?
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bind PBP (penecillin binding proteins)
which does what? |
block peptidoglycan cross-linking
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which bugs do you use for GMP and syphilis?
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penecillin
ADE? |
hypersens
hemolytic anemia |
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what causes penecillin resistant?
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beta-lactamases which cleave b-lactam ring
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which penicllins are beta-lactamase resistant?
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methicillin
nafcillin oxacillin dicloxacillin what are these best for? |
s. aureus but not MRSA
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ADE of methcillin?
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interstitial neph
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which penicillin do you add clavulanic acid to?
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ampicillin
amoxicillin used for? |
h. influ
e.coli listeria proteus salmonella shigella entero moraxella s.pneumo |
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what is better about amox than ampicillin?
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it has greater oral bioavalability, good for out-patient
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what are ade for ampicillin and amox?
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rash
pseduomem colitis +diarrhea |
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what are two other drugs like clavulonic acid
and what do they do? |
tazobactam + sulbactam
added to penecillin to protect from b-lactamase/penicillinase |
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piperacillin/ticarcillin used for?
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pseuod and GMN (klebsiella)
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3 drugs most affected beta-lactamase..
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penecillin
ampicillin piperacillin |
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how do cephalosporins differ from penecillin?
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inhibit cell wall synth but are less suscept to peniciliinase...bactericidal
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what are ADE of cephalosporin>
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HS
vit. k defic increase nephrotox of aminoglycosides disulfarm rxn with ethanol |
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1st gen cephalosporin cover?
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PEcK
proteus ecoli klebsiella ex. |
cefazolin and cephalexin
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2nd gen cephalosporin cover?
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HEN PEcKS
H. Influ Entero Neisseri + Proteus, Ecoli, Kleb, Serratia ex. |
cefamandole
cefoxitin cefaclor cefuroxime |
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3rd gen cephalosporin cover?
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meningitis and gon (ceftriaxone)
psuedo (ceftazidime) |
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4th gen cephalo
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cefepime good for
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psudo and GMP
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which 4 organisms are not covered by cephalosporins?
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LAME
Listeria Atypicals (chlam and mycoplasma) MRSA Enterococci |
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a abx used only for GMN rods..
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aztreonam
how does it work? |
binds to PBP3 and inhibits cell wall synthesis
synergy with amioglycosides |
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for whom is aztreonam good for?
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patients with penecillin allergy
poor renal function who cant do amioglycosides |
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what would happen to imipenem if it wasnt given with cilastin?
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it would be inactivated in renal tubules by dehydropeptidase 1
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what are ADE of imipenem
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GI distress
skin rash seizures so u usually use? |
meropenem
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what can you use vanco for?
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GMP
ex |
MRSA
Enterococci C. Diff |
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where does vanco bind?
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D-ala D-ala
ADE |
nephro
oto thrombophlebitis flushing (red man) |
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how do you prevent vanco effects?
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anti-histamines and slow infusion
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vanco resistance?
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D-ala D-ala to
D-Ala D-lac |
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30S abx, which cidal/static
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aminoglycosides [bacteriocidal]
tetracyclines [bacteriostatic] |
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50S abx, which cidal/static
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chloramphenicol [static]
clinda [static] erythromycin [static] linezolid [variable] |
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ex of aminoglycosides:
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gentamicin
neomycin amikacin tobramycin streptomycin |
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who do aminoglycoside work
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inhibit formation of initiation complex and misreading of mRNA
which types of bacteria (ex) are they ineffective for? |
anaerobic, since they require 02 for uptake
clostridium, bacteroides, actinomyces |
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what are aminoglycoside work for?
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GMN rods
synergy with? |
b-lactam abx
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which abx used for bowel surgery?
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neomycin
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what ade do aminoglycosides have?
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nephrotox
ototox teratogen |
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which abx can u use as an ADH antag/diuretic for SIADH?
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demeclocycline
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who do tetracycline do?
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bind 30S and prevent attachment of aminoacyl-tRNA but cant get into CNS
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which tetracylcine is good for renal failure?
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doxycycline
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which abx cant you take with milk?
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tetracycline
what other things cant you take with tetracycline? |
antacids
iron-containing preps |
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which tricky bacteria is tetracylcine good for?
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chlam
rickettsia |
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examples of macrolides:
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erythromycin
azithromycin clarithromycin how do they work? |
inhibit protein synthesis by blocking translocation, binds to the 23S rRNA of the 50S ribosomal subunit
bacteriostatic |
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atypical pneumonias:
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mycoplasma
chlamydia legionella what is a good tx? |
macrolides
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if you are allergic to penecillin and you have a strep infection, what can you use?
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macrolides
ADE? |
prolonged QT {erythro}
GI issues P450 Inhibitor |
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blocks peptide from of 50S subunit and is static?
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chloramphenicol
used for? |
encap meningitis [h. influ, n. men, s. pneumo]
used abroad |
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ADE of chloramphenicol?
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anemia (dose dep)
aplastic anemia (does indep) gray baby |
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what does clindamycin work on?
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anaerobic infections, aspiration pneumonia/lung abscess
ie |
bacteroides
c. perfringens |
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which abx does anaerobes above the diaphragm and which below?
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clinda above
metro below |
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ade clindamycin?
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pseudomemb colitis like which other drug?
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ampicillin/amox
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inhibits dihydropteroate synthetase?
cidal/static |
sulfonamides (static)
meand bacteria cant? |
make nucleosid (messed with THF)
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which drug is good for nocardia/chlamydia?
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SMX [sulfamethoxazole]
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ade of SMX?
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hypersens
hemolysis if G6PD def nephrotox kernicterus in infants p450 inhib |
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inhibits dihydrofolate reducatase?
static/cidal |
trimethoprim [static]
ade? |
megaloblastic anemia
leukopenia granulocytopenia |
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TMP-SMX used for?
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uti
shig salmonella PCP |
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floroquinilones end in?
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floxacin
except? |
nalidixic acid
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inhibit DNA gyrase/topoisomerase 2?
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floroquinolones
what cant you take with them? |
antacids
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floroquinolones are good for?
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GMN of urinary and GI tracts (pseudo, neisseria)
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who cant get fluoroquinolones and why?
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preg women (damage cartilage)
kids (tendonitis, tendon rupture, cramps, myalgias) |
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what bugs is metronidazole good for?
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GET GAP off METRO
giardia, entamoeba, trichomonas, gardnerella vag, anaerobes [clostridium, bacteroides, actinomyces] |
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tripe drug for h.pylori?
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metro
bismuth amox/tetra |
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ade of metronidazole?
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metallic taste
disulfruam like rxn ha |
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tx for chlamydia urethritis?
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doxy/azithromycin
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tx for candida vaginitis?
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fluconazole
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prophylaxis for:
m. tb m. avium m. leprae |
isoniazid
azithromycin N/A |
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tx for
m. tb m. avium m. leprae |
Rifampin, isoniazid, pyrazinamide, ethambutol
azithro, rifampin, ethambutol, strepto dapson, rifampin, clofazimine |
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decreases synthesis of mycolic acids in the mycobacterial wall
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isoniazid
what is unique? |
only solo prophylaxis against TB
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isoniazid ADE
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neurotox
hepatotox lupus how to prevent ADE? |
vit B6
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inhibits DNA-dep RNA polymerase
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rifampin
ADE? |
hepatotox
p450 inducer red/orange body fluids rapid resistance if used alone |
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rifampin has several uses:
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1. delays resistance to dapson in leprosy
2. meningococcal prophylaxis and chemoprophylaxis in contacts of kids with H. influ (stops carrier state) use for TB? |
never used alone
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inhibits mycolic acid production blocking mycobact FA synthase
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pyrazinamide
works best for? |
intracell TB but not for necrotic foci/cavities
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ADE pyrazinamide:
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hyperuricemia
hepatox |
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decreases carb polymeraziation of mycobacterium cell wall by blocking arabinosyltransferase..
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ethambutol
ade |
optic neuropathy (red-green colorblind)
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prophylaxis for meningococcal infection?
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ciprofloxacin
rifampin |
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prophylaxis for gonorrhea?
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ceftriaxone
prophylaxis for syphilis? |
peneciliin G
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prophylaxis for recurrent UTI?
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TMP-SMX
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CD4<200 worried about
<100 <50 |
PCP
PCP or toxo Mycobact avium prevention for each? |
TMP-SMX
TMP-SMX Azithromycin |
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tx for:
MRSA VRE |
vanco
linezolid/streptogramins [quinupristin/dalfopristin] |
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patients walks in with pneumonia, tx is?
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macrolide:
erithromycin azithromycin clarithromycin |
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patient in the hospital develops pneumonia tx is?
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floroquinolone
ciprofoxacin levofloxacin moxifoloxacin |
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this drugs affects fungal membrane function:
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ampho b
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this drug affects fungal cell wall synthesis:
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caspofungin
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this drug inhibits fungal nucleic acid synthesis?
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5-fluorocystosine
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this drug inhibits fungal lanosterol synthesis
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terbinafine/naftifine
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this drug inhibits ergosterol synthesis:
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fluconazole
itraconazole voriconazole |
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binds to ergosterol to form pores that allow leakage of electrolytes
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ampho b
used for: |
systemic and serious mycoses, intrathecally if fungal meningitis
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which crosses the BBB ampho b or fluconazole?
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fluconozole
what do you need to supplement when using ampho b? |
k and mg
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ade of ampho b?
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fevers/chills
hypotension arrhthmias IV phlebitis anemia how to reduce toxicity? |
hydration or use of liposomal ampho b
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what do you use during "swish and swalow"
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nystatin, topical form of ampho b
good for? |
oral candida, or in cream for for diaper rash/vaginal candida
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inhibit fungal ergosterol synth by inhibiting the P450 enzyme (demethylase ) that converts lanosterol to ergosterol
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fluconozole
used for? |
crypto meningitis in AIDS
candida infections |
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what is ketoconazole best for?
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blasto, cocci, histo, candida
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what is miconazole/clotrimazole for?
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topical fungal infections
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what ADE do conazoles have?
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-hormone synthesis inhibition (gynecomastia)
-liver dysfunction |
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inhibits DNA synthesis by conversion to 5-FLU
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flucytosine
used for? |
cryptococcus in combo with ampho B
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ADE of 5-FLU?
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NV
Diarrhea BM suppression |
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inhibits cell wall synthesis by inhibiting synthesis of b-glucan?
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caspofungin
used for: |
invasive aspergillossis
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ade of caspofungin:
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GI upset
flushing |
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inhibits the fungal enzyme squalene epoxidase?
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terbinafine
used to treat: |
onychomycosis, fungal infection of finger or toe nail
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ade of terbinafine?
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abnl LFT
visual distrubances |
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interferes with MT function ie it does what?
what drug |
disrupts mitosis, griseofulvin
where does it deposit? |
in keratin-containing tissue
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what is greosulvin used for?
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tinea, oral tx of superficial infections, inhibits growth of dermatophytes
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tx for leishmaniasis?
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sodium stibogluconate
tx for t.cruzi |
nifurtimox
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tx for plasmodium falciparum?
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pyrimethamine
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blocks plasmodium heme polymerase?
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chloroquine
used for? |
malaria
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prophylaxis for malaria?
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mefloquine
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drugs for anti-helmiths:
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mebendazole
ivermectin praziquantel |
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prevents viral penetration/uncoating?
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amantadine
another thing it does: |
release of dopamine from intact nerve terminals
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prophylaxis for influenza A?
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amantadine [but most resistant so not used]
what are the ADE? |
ataxia
dizziness slurred speech |
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why is rimantidine better?
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fewer CNS side effects
does it cross BBB? |
no
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what is a better drug for influenza A & B?
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zanamivir or oseltamavir
what does it do? |
influenza neuraminidase, so that there are less progeny virus
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what is a drug used for HCV and RSV?
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ribavirin
what does it do? |
inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase
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teratogenic abx:
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aminoglycosides
tetracycline fluoroquinolones griseofulvin |
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needs to be monophosphorylated by HSV/VZV/EBV thymidine kinase before it can inhibit viral DNA polymerase
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acyclovir
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does acyclovir work for latent HSV or VZV?
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no
which variant of acyclovir has better oral availability? |
valacyclovir
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best for herpes zoster?
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famciclovir
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needs to be 5-monophosphate from CMV viral kinase preferentially inhibits viral DNA polymerase
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ganciclovir
used for? |
CMV in immunocomp
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which drug has better oral bioavailabilty than ganciclovir?
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valganciclovir
ADE? |
leukopenia
neutropenia thrombocytopenia renal tox |
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ganciclovir vs. acyclovir?
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gangciclovir is more toxic
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inhibits viral dna polymerase inhibitor, binds to pyrophosphate-binding site
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foscarnet
used for? |
CMV retinitis
or when ganciclovir fails acyclovir-resistant HSV |
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what is foscarnet analog?
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pyrofosphate
ade: |
nephrotoxicity
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two guanosine analogs:
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acyclovir
ganciclovir |
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inhibits viral DNA polymerase?
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cidofovir
does it require phosphorylation? |
no
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which has a longer half-life cidofovir or foscarnet?
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cidofovir
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when do you start HAART?
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aids-defining illness
low CD4 <350 high viral load what type of drugs used: |
3
2 nucleoside reverse transcrip 1 non-nuc reverse transcrip or 1 protease inhib or 1 integrase inhib |
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nucloesoide reverse trancriptase inhibitors...
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tenofovir
emtricitabine abacavir lamivudine zidovudine (AZT) |
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what do NRTIs do?
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inhibit nucleotide binding (compete with nucleotides) to reverse transcriptase and terminate DNA chain
do they have to be phosphorylated? |
yes! by thymidine kinase
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what do you give for HIV prophylaxis during pregnancy?
|
ZDV/AZT
ADE of NRTI? |
BM suppression
megaloblastic anemia rash periph neuropathy lactic acidosis |
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how do you reverse BM suppression from NRTI?
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G-CSF and EPO
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protease inhibitors...
|
Navirs...
lopinavir atazanavir ritonavir what do they do? |
prevent maturation of new viruses
|
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ADE of protease inhibitors:
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hyperglycemia
GI intol (N/Diarrhea) lipodystrophy |
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non-nucleoside reverse transcriptase inhibitors..
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nevirapine
efavirenz delavirdine how do they work? |
bind to reverse transcriptase at a diff site than NRTI
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what is a big diff between NNRTI and NRTIs?
|
NNRTIs dont need to be phosphorylated to be active and dont compete with nucleotides
ADE of NNRTI? |
same as NRTI
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inhibits HIV genome integration into host cell chromo by reversibly inhibiting HIV integrase?
|
raltegravir (integrase inhibitor)
ADE? |
hypercholesterolemia
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what do interferons do?
|
block replication of RNA and DNA viruses
made by? |
virus-infected cells
|
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interferons used for?
|
alpha: HBV, HCV, Karposi
beta: MS gamma: NADPH oxidase def ADE of interferon? |
neutropenia
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