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95 Cards in this Set

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What is a ghon complex?
TB granuloma with lobar and perihilar lymph node involvemnt- 1ry infection or exposure
What happens in 1ry TB?
Heals by fibrosis->Immunity and Hypersensitivity->+TST
Progressive lung disease (HIV, malnutrition)-> death
Severe bacteremia-> Miliary TB-> Death
Preallergic lymphatic or hematogenous dissemination->dormant tubercle bacilli-> reactivation
What are some sites of extra-pulmonary TB?
CNS- granulomas at base of brain, meningitis
Vertebral body- potts
Lymphadenitis- scrofula
Renal- sterile pyuria
GI
Miliary- little granulomas all over the place
what are the various derivatives of mycosides in TB?
Mycolic Acid- large fatty
Mycoside- mycolic acid bound to a carb
Cord factor- 2 mycolic acids bound with a dissacharide- can cause inhibition of neutrophil migration. cachexia
Sulfatides- mycosides like the cor, but with sulfur- helps with facultative intracellularness
Wax D- adjuvant- protects the cellular immune system
What is leprosy?
M. Leprae- likes cool temp- skin and superficial nerves.
rmadillos
Rx- dapsone- toxicity is hemolysis and methemoglobinemia
Alt Rx- rifampin and clofazimine and adpsome
Which drugs are useless against mycoplasma?
Penicillin
cephalos
they have a sterol cell wall
What is the difference between tuberculoid and lepramatous leprosy?
tuberculoid- has an immune response, has decreased sensation, one lesion.
lepromatous- worse, no immune, no loss of sensation, crazy acid-fast bacilli.
Describe the leonine facies of leprosy.
loss of eybrows
nasal collapse
lumpy earlobe
What drugs block cell wall synthesis by inhibition of peptidoglycan cross-linking?
Penicillin, Ampicillin, Ticarcillin, Piperacillin, Imipenem, Aztreonam, cephalosporins
What drugs blcok peptidoglycan synthesis?
Bacitracin, vancomycin, cycloserine
What drugs disrupt bacterial/fungal cell membranes?
polymyxins
What drugs disrupt fungal cell membranes?
Amphotericin B, Nystatin, Fluconazole
What drugs block nucleotide synthesis?
sulfonamides, Trimethomprim
What drugs block DNA topoisomerases?
Quinolones
What drugs block mRNA synthesis?
Rifampin
What drugs blcok the 50S?
Chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins, linezolid
What drugs blcok protein synthesis at the 30S?
Aminoglycosides, tetracyclines
What is the evolution of Penicillin?
Penicillin G
Aminopenicillins- more G-s
penicillinase resistant penicillins- useful against b-lactamase
anti-pseudomonal- wider coverage of G-s
cephalosporins- resistant to b-lactamase, broad spectrum
What major adverse effect can all penicillins cause?
anaphylaxis
When is penicillin still used?
Pneumonia by S. pneumoniae
What bugs are susceptible to Aminopenicillins?
E. coli and the other enterics
HELPS
H. Influenza
E. Coli
Listeria
Proteus
Salmonella
What are the aminopenicillins?
Amoxicillin, ampicillin
fit in the ol porin channels of the G-s
Why are methicillin, nafcillin, and oxacillin awesome?
they are penicillinase resistant
but are given IV
What makes dicloxacillin and cloxacillin so frickin' sweet?
they are oral and penicillinase resistant
What are the pseudomonas penicillins?
Carboxypenicillins- Ticarcillin and Carbenicillin
Ureidopenicillins Piperacillin and Mezlocillin
still sensitive to penicillinases
What are teh disadvantages of Carbenicillin?
lower activity, higher doses, high Na load, platelet dysfunction, and hypokalemia
What are the SEs of Methicillin?
interstitial nephritis
What are the side effects of ampicillin?
ampicillin rash, pseudomembranous colitis
What is the difference between 1st, 2nd, and 3rd generation cephalosporins?
1st- good on strep and G+s, used pre-surgery(ph- except cefazolin, cfadroxil)
2nd- okay on G-s, G+s, and strep (fam, fa, fur, fox)
3rd- good on G-s, Strep; multi-drug resistance, nosocomial pneumonia, meningitis, sepsis, and UTI(tri, taz, tax, ti)
4th- cefepime, like 3rd generation, but with more against G+s adn Pseudomonas
What is good about cefotetan, cefoxitin, and cefmetazole?
good against anaerobes, like bacteroides fragilis.
intra-ab infections, aspiration pneumonia, colorectal surgery prophylaxis
What cephalos are good against Pseudomonas?
ceftazidime, cefoperazone, and cefepime
What are some good things about Ceftriaxone?
CSF penetrator, meningitis
Gonorrhea
What drugs don't follow the PH rule of 1st generation cephalos?
Cefazolin, cefdroxil
What drugs don't follow the F rule in 2nd generation cephalos?
loracarbef
Cefixime (3rd)
Cefoperazone (3rd)
cefpodoxin (3rd)
cefetamet (3rd)
cefepime (4th)
What drugs don't follow the T rule for 3rd generation?
cefotetan(2nd generation)
cefixime
cefoperazone
cefpodoxin
cefetamet
What are 1st generatioin cephalos used for?
PEcK
proteus mirabilis, E. colie, Klebsiella
What are 2nd generation cephalos used for?
HEN PEcKS
H. influenzae, Enterobacter aerogenes
Neisseria
Proteus mirabilis
E. Coli
Klebsiella
Serratia marcescens
What are the SEs of cephalos?
Increased nephroxicity of aminoglycosides
Cefamandole- blocks acetyladehyde breakdown with alcohol
What is the role of Imipenem?
cabapenem with broadest spectrum
MRSA, some pseudomonas and mycoplasma are resistant
Given with cilastin
What is the role of cilastin?
prevents breakdown of imipenem by renal dihydropeptidase I
What are the SEs of imipenem
Seizure, GI distress, rash, allergic
Meropenem is newer- less seizure
What is the role of aztreonam?
magic bullet for G- aerobes
monobactam.

Only G-
usually used with vancomycin or clindamycin

no cross allergenicity to penicillin
Vancomycin
Good for all G+ bugs
SEs- Nephrotox, Ototox, Thrombophlebitis, red man syndrome- histamine release
What drugs are 30S and 50S inhibitors?
Buy AT 30, CELL at 50
30
Aminogclycocides (IV only)
Tetracylcines
50
Chloramphenicol
Erythromycin
Lincomycin
cLindamycin
What are the SEs of Chloramphenicol?
Anemia, aplastic anemia, gray baby syndrome (no UDP-glucouronyldase)
Despite it's side effects, why is chloramphenicol used?
BBB crossing ability, wide spectrum.
What is clindamycin good for?
Anaerobes. Not G-s.
used for perforated abdomen, septic abortions, acne
What are the SEs of clindamycin?
GI overgrowth (pseudomembranous colitis)
What is Linezolid?
will be used as a last resort drug. has activity against resistant bugs. does cause headache and GI upset.
What is the role of Erythromycin?
binds to the 23S rRNA of the 50S.
100x more potent in G+ htan G-
good against mycoplasma, legionella and chlamydia
GOOD for Community Aquired Pneumonia

azithromycin, clarithromycin also exist.
What are the SEs of Erythromycin?
dose-dependant GI effects
rare cholestatic hepatitis
Why don't you give tetracycline with milk?
it chelates with the Ca, so it just passes through and isn't absorbed.
Doxycycline does not.
What do you use Doxycycline for?
VACUUM THe BedRoom
Vibrio cholerae
Acne
Chlamydia
Ureaplasma Urealyticum
Mycoplasma pneumoniae
Tularemia
H. pylori
Borrelia
Rickettsia
What are the SEs of doxycycline?
GI irritation
phototoxic dermatitis
renal and hepatic toxicity
discolored teeth
depressed bone growth (don't give to preggers)
What drugs are Aminoglycocides?
GNATS
gentamycin
neomycin
amikacin
tobramycin
What is Streptomycin?
Aminoglycoside
many are resistant
good for enterics
Gentamicin
Aminoglycoside
used comonly in hospitals. combine with penicillin
Tobramycin
aminoglycoside
good against pseudomonas
amikacin
aminoglycoside
broad spectrum- good for hospital aquired infection that are resistant to other drugs.
neomycin
aminoglycoside
broad coverage, but toxic
used for skin infections
Netilmicin
aminoglycoside
preoperative coverage for GI (not absorbed)
what is the mechanism of Aminoglycosides?
Inhibid initiation complex formation- misread mRNA
need O2 to work.
What are the SEs of aminoglycosides
Nephrotoxicity, ototoxicity (with loop diuretics), teratogens
neuromuscular blockade
What is spectinomycin?
acts on the 30S ribosome
IM injection
treats gonorrhea
What is the risk of isoniazid hepatitis?
Increases with age.
rare <20
2.3% at 50

W/ alcohol, increased metabb, increased incidence of hepatitis
Who do you treat with TB with <5mm PPD? (Great Risk)
HIV
Fibrotic change on X-ray
Close contacts with newly active TB
Who do you treat w/ >10mm?
Lower immune system- DM, steroid or immunosuppressed, renal failure, and others
Injection drug users
Recent PPD coversion

If less than 35
Homeless, prisons, nursing homes, foreign born
What is the mechanism of Isoniazid?
interferes with the biosynthesis of mycolic acid of mycobacteria
What are the SEs of Isoniazid?
Hemolysis if G6PD deficient
neurotoxicity
SLE-like syndrome
Pyridoxine - B6
What are teh 4 Rs of Rifampin?
RNA polymerase Inhibition
Revs up microsomal P450
Red/orange body fluids
Rapid resistance if used alone
What are some of the clinical uses of Rifampin?
TB
delay dapsone resistance in leprosy
meningococcal prophylaxis
chemoprophylaxis in kids iwwth H. influenzae type B
What are the SEs of Rifampin?
Hepatitis- less than INH
Drug x-reactions- Coumadin decreases, OC less efffective (breakthrough bleed), oral hypoglycemics adn corticosteroids
Anticonvulsants
What's the deal with Rifabutin?
When is it used?
what is it's role?
Used for M. avium-intracellulare. Otherwise it is very similar to Rifampin, but less effect on the cP450 so good for HIV
What is pyrazinamide?
TB drug, mechanism unknown.
cannot give for >2months
don't give to preggers
What are the SEs of Ethambutol?
Ethane-butane torch
torch an eye
decreased visual acuity with loss of central vision (central scotomata)
(Loss of color vision)
What are some 2nd line TB drugs?
Cycloserine
ethionamide
What is the Rx for leprosy?
Severe- rifampin, dapsone, clofazimine for 2 yrs
less severe- rifampin, dapsone for 6 months
What is the mechanism of clofazimine?
binds to DNA of M. leprae.
colors skin and conjunctiva red(turns leprosy patch tan/black)
What are type 1 and type 2 reactions in leprosy treatment?
Inflam of nerves, testes, eyes, joints, and skin
1- borderline, in 1st year. swelling of lesions, can ulcerate, prednisone and clofazimine Rx for this time. Delayed-type hypersensitivity Reaction

2- Erythema Nodosum Leprosum, in more severe forms, painful nodular rash erupts in previously normal-appearing skin with high fever. Neuritis, orchitis, arthritis, iritis. Immune complex mediated. Thalidomide is the Rx.
Why are the flouroquinolones becoming so popular so fast?
They have good oral absorption, safe, and penetrate into tissues well.

end in floxacin
What is the mechanism of action of the fluoroquinolones?
inhibit the DNA gyrase (topo II)
what are flouroquinolones NOT good for?
Cipro- poor G+, bad for strep, but can be used for staph and anthrax.

anaerobes are generally not covered
How does resistance to flouroquinolones develop?
point mutation in the DNA gyrase
What are the SEs of fluoroquinolones?
GI irritabillity (nausea, vomiting, belly pain, diarrhea)
Damage cartilage (avoid in kids)
Rare achilles rupture or tendonitis
CNS- headache, restlessness and insomnia
Why is Cipro dangerous in a renal patient?
excreted renally and high levels block GABA and can cause seizure
What are flouroquinolones good for?
G-s
Pseudomonas (CF)
Enterobacteriaceae (not anaerobes) E. Coli, Salmonella, Shigella, Campylobacter
Resistant UTIs
G- intracellulars
What four flouroquinolones are good for G+s and community aquired pneumonia?
Levofloxacin
Ofloxacin
Sparfloxacin
Grepafloxacin
What is the good and the bad of trovafloxacin?
good- covers everything
bad- liver toxicity

ONLY IN PATIENS WITH THE FIVE CONDITIONS:
Nosocomial pneumonia
Community aquired pneumonia
intra-ab infections
gyne and pelvic infections
complicated skin and skin structure infections, diabetic foot infection
What are the special SEs of Sparfloxacin?
8% of pts develop mild to severe photosensitivity
Prolongs QT on EKG- Torsades!!!
What is the mechanism of the sulfa drugs?
they competatively inhibit the creation of TH4
They look like PABA, so the bacteria grab it.
What is the mechanism of trimethoprim?
blocks dihydrofolate reductase preventing dihydrofolate formation.
What are the adverse effects of TMP/SMX?
nausea, vomiting, diarrhea, and skin rash.

W/ AIDS- 1/2 get complications. skin rash and bm suppression

W/ Warfarin- increased action, more bleeding as it is displaced from warfarin

hemolysis if G6PD deficient
Nephrotoxic
kernicterus
What are the clinical roles of SMX/TMP?
TMP-SMX
Tree- respiratory- Strep and Haemophilus
Mouth- GI tract, shigella, salmonella, e. coli
Pee- GU- UTIs, Prostatitis, urethritis
SMX Syndrome- prevents pneumocystis carinii, toxoplasma and Isospora
What can cause liver abscesses and bloody diarrhea?
entamoeba
What are some bacterial causes of liver abscesses?
E. coli
Klebsiella
strep
staph
bacteroides
pseudomonas