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69 Cards in this Set
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- Back
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MOA of aminoglycosides… use of neomycin…
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Inhibit formation of initiation complex after binding to 30s. require O2 for uptake. Neomycin used for bowel surgery
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Toxicity of aminoglycosides…
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NOT: nephro (esp when combined w/ cephalos), ototoxicity (esp + loop diuretics), Teratogen
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Drugs to avoid adding w/ cephalosporins…
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Penicillin, aminoglycosides (nephrotox), ethanol (disulfram rxn)
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Drug that is synergistic w/ aminoglycosides and is beta lactamase resistant… use…
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Aztreonam. Used to tx gram negative rods (no gram + activity). Also used in patients who have renal dx and cannot take aminoglycosides
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Drug of choice for enterobacter…
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Enterobacter is gram – rod in mechanical ventilation. Drugs is imipenem + cilistatin (inhibits degredation by dihydropeptidaseI)
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Toxicity of vancomycin…
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Similar to aminoglycosides: NOT- Nephro, Ototoxicity, but THROMBOPHLEBITIS- red man syndrome (tx w/ diphenhydramine)
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Bacteriocidal drugs…
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Vanco, Fluoroquinolones, Penicillin, Aminoglycosides, Cephalosporins, Metronidazole
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Tetracycline used in renal failure…
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Doxycycline
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Toxicity of tetracyclines…
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Teeth (discoloration, poor bone growth), Eyes (photosensitivity-burns), and GIs
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Azithromycin drug of choice for…
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Chlymadia and also used as prophylaxis for M. Avium
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Toxicities of chloramphenicol… how does gray baby syndrome work…
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Anemia and dose independent aplastic anemia. Gray baby happens because chloramphenicol must be glucuronated by UDP-gluronyltransferase and babies lack it
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Anaerobic bugs and drug of choice to tx them…
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Actinomyctes (penicillin), Bacteroides, Costridium (both use Clindamycin)
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Dihydropteroate synthase… drug that blocks it…
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Takes PABA to dihyropteroic acid THF. Sulfa drugs are PABA metabolites and they block it.
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Side effects of sulfa drugs…
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Hypersensitivity, nephrotoxicty (TIN), photosensitive, kernicterus, displaces warfarin from albumin, hemolysis in G6PD
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TMP used for…
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UTIs, Shigella and Salmonella, Pneum Pneumo
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Fluoroquinolones (floxacins) used to tx… avoid using w/ what drugs…
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Gram – rods in urinary/GI tracts, Neisseria. Avoid taking w/ antacids (divalent cations), prophlaxis for Traveler’s diarrhea
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Toxicity of fluoroquinolones…
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GI upset, superinfxns, skin rashes, HA, dizziness. Contraindicated in pregos and children cause tendon rupture, leg cramps
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MOA of metronidazole…
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Forms toxic metabolites that damage bacterial DNA, thru free radicals.
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Clinical use of metronidazole…
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GET GAP: Giardia, Entamoeba, Trichomonas Gardnerella, Anaerobes h. Pylori
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Polymyxin MOA… use…
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Bind cel membranes and disrupt osmotic properties. Basic, cationic proteins (detergents). Tx resistant gram – infxns. SEs: neurotoxic and ATN (like
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Drugs used to tx M. leprae…
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Dapsone, Rifampin, clofazimine
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TB drug effective against intracellular bacteria… other interstig facts about it…
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Pyrazinamide. Needs acidic environment to work
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How is INH activated… MOA…
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Activated intracellularly by mycobacteria catalase-peroxidase. Decr synthesis of mycolic acids
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Toxicity of INH…
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Injures Neurons (B6 def) and Hepatocytes
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Use of rifampin…
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1. TB 2. delays resistance to dapsone 3. Meningococcal prophylaxis and prophylaxis for H flu type B
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Cyclosporine MOA… toxicity…
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Cyclophilin-cyclosporine complex blocks calcineurin which usually induces prodxn of IL-2. can predispose to viral infxns and lymphoma, nephrotoxic (reversible w/ mannitol diuresis)
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Tacrolimus MOA… toxicity…
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Binds FK-binding protein thus inhibiting IL-2. Can cause nephrotoxicity, periph neuro, HTN, hyperglycemia, pleural effusion
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Azathioprine MOA… use… toxicity…
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Activated by HGPRT and blocks nucleic acid syn. Used in kidney transplant, autoimmunes: hemolytic anemia, UC, glomerulonephritis. Can cause bone suppression. Metabolized by XA or allopurinal makes worse (possibly mego anemia)
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MOA of the drug most likely to cause cytokine storm…
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OKT3 blocks CD3 thus inhibiting T-cell signal transduction
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Dapsone use… toxicity…
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M leprae. SE: hemoylsis and methemoglobinemia
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Portion of gram – bacteria that makes them resistant to penicillins and vancomycin…
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Outer-membrane
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Tx for Trypanosoma gamb/rhod…
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Suramin (blood) or melarsoprol (CNS)
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Tx of trypanosome cruzi…
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Nifurtimox (Tom Cruz in Nice Fur coat)
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Added to tx vivax/ovale infxns to cover for dormant liver forms…
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Primaquine
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Infxns treated w/ bendazoles…
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Enterobius vermicularis, ascaris, trichinella, strongyloides, ancylostoma, necator, echinococcus
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Infxns treated w/ diethylcarbamazine…
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Loa loa, wuchereria bancrofti, Toxocara canis
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Most common mechanism of resistance for penicillins or cephalosporins…
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Beta-lactamase cleavage of b-lactam ring; altered PBP in case of MRSA or penicillin resistant S pneumonia
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How does S pneumo cause resistance to penicillins…
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Altered PBP, is the same MOA for MRSA
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Mechanism of resistance to aminoglycosides…
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Acetylation, adenylation, phosphorylation
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Mechanism of resistance to chloramphenicol…
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Modification via acetylation
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Mechanism of resistance to macrolides…
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Methylation of rRNA near erythromycins ribosome-binding site
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Mechanism of resistance to tetracyclines…
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Decr uptake or incr transport out of cell
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Mechanism of resistance to sulfonamides…
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Altered enzyme (dihydropteroate synthetase), decr uptake or incr PABA synthesis
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If patient is allergic to rifampin and needs meningococcal prophylaxis, what is the drug of choice…
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Minocycline
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Prophylaxis for gonorrhea…
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Ceftriaxone
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Prophylaxis for syphilis…
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Benz penicillin G
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Prophylaxis for endocarditis w/ surgical or dental procedures…
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Penicillins
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Tx for Vanco Resistant Strains of bacteria…
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Linezolid and streptogramins
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Drug used for fungal meningitis and how administered…
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Ampho B administered intrathecally
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SEs of ampho B…
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Fever/chills, hypotension, nephrotoxic (reduced w/ hydration), arrhythmias, anemia, IV phlebitis.
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MOA of azoles and uses of each…
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Inhibit synthesis of ergosterol from lanosterol. Fluconazole used for cryptococcal meningitis in AIDS (crosses BBB) and candida infxns of all types. Ketoconazole used for blasto, coccido, histo, candida, hypercortisolism. Clotrimazole and miconazole for topical fungal infxns.
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SEs of azoles…
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Hormone synthesis inhibition (gynecomastia), liver dysfunxn (inhibits p450), fever, chills
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MOA of flucytosine and uses… SEs…
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Inhibits DNA synthesis by conversion to 5FU. Used for systemic infxns (Candida, Cryptococcus) in combo w/ ampho B. SEs: bone marrow suppression, N/V?D
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MOA of caspofungin and uses… SEs…
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Inhibits cell wall synthesis by inhibiting beta-glucan. Used to tx invasive aspergillosis. GI upset, flushing
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MOA of terbinafine…
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Inhibits squalene epoxidase thus stopping conversion of squalene to lanosterol
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MOA of griseofulvin… SEs…
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Interferes w/ microtubule runxn and disrupts mitosis. Deposits in keratin containing tissues. SEs: teratogen, carcinogen, confusion, HA, incr p450
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MOA of how rifampin treats vaccinia…
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Blocks viral packaging and assembly
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Toxicity and mechanism of resistance for amantadine…
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SEs: ataxia, dizziness, slurred speech. Mutated M2 protein causes resistance
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MOA of ribavirin… uses and SEs…
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Inhibits IMP dehydrogenase, thus stopping synthesis of guanine nucleotides. Use: RSV, hep C. SEs: hemolytic anemia and teratogen
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MOA and uses of acyclovir… when is it not useful in these infxns…
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Guanosine analog that is monophosphorylated by HSV/VZV TK and then triphosphate formed by cellular enzymes. Chain terminator. Used in tx of HSV, VZV, EBV and for prophylaxis. Has no effect on latent forms so must use famciclovir
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MOA of gangcyclovir and uses… SEs…
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Guanosine analog formed by monophosphorylation by viral kinases and cellular kinases. Used in CMV in immunoccompromised. SEs: leucopenia, neutropenia, thrombocytopenia, renal toxicity.
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MOA, use and SEs of foscarnet…
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DNA poly inhibitor by binding to pyrophosphate site of enzyme. Does NOT need viral kinase activation. Used for CMV retinitis or acyclovir resistant HSV. SEs: nephrotoxic, hypoMg, hypoCa. Resistance is due to mutated DNA poly
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SEs of protease inhibitors…
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GI intolerance, hyperglycemia, lipodystrophy, thrombocytopenia (indinavir). Never tease a protease even though he’s fat (lipodystrophy) diabetic kid (hyperglycemia) or he will punch you in the gut (GI disturbance)
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Nucleoside RT inhibitors…
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Zidovudine (AZT), didanosine, zalcitabine, stavudine, lamivudine, abacavir
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Non-nucleoside RT inhibitors…
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Nevirapine, Efavirenz, Delavirdine (Never Efin’ Deliver nucleosides)
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MOA of RT inhibs (both types)…
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Inhibit RT and prevent incorporation of viral DNA into host DNA
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SEs of RT inhibitors (both types)…
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Bone marrow suppression (neurtopenia, anemia), periph neuropathy, lactic acidosis (nucleosides, if don’t dine you will get lactic acidosis), rash (non-nucleosides), megaloblastic anemia (ZDV)
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MOA, uses, and SEs of enfuvirtide…
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Binds viral gp41, inhibits conformational change required for fusion w/ CD4 cells and block entry and replication. Used when other drugs fail. SEs: hypersensitivity rxns, rxns at subcutaneous site, incr risk of bacterial pneumonia
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Antibiotics to avoid in pregos and why for each one…
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Sulfonamides (kernicterus), Aminoglycosides (ototox), Fluoroquinolones (cartilage dmge), Erythromycin (cholestatic hep in mom, clarithro is embryo toxic), Metronidazole (mutagenesis), Tetracyclines (teeth and bones), Ribavirin (teratogen), Griseofulvin (teratogen), Chloramphenicol (gray baby).
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