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171 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Genital Herpes Simplex
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Acyclovir
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Group B Strep
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Ampicillin or penicillin G
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H. Influenzae type B
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Rifampin
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Malaria
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Chloroquine
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Meningococcal Infection
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Rifampin
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Pertussis
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Erythromycin
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Pneumococcemia
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Penicillin G
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Pneumocystis Carinii
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TMP-SMX
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TB
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Isoniazid
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UTI
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TMP-SMX
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Macrolides
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50S Inhibit translocation
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plasmid-methyltransferases alter binding site
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Chloramphenicol
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50s inhibit transpeptidation
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plasmid- inactivating acetyltransferases
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Aminoglycosides
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30s, blocks initiation elicits premature termination incorp. incorrect AA
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plamsid- acetyl, phosphoryl, adenyly conjugation
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Tetracyclines
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30s prevent binding the incoming charged tRNA
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plasmid- "pump out"
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Fluoroquinolones
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inhibit topoisomerase
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DNA mutation- change in TE sensitivity, or pump out
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Rifampin
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inhibit DNA dependent RNA polymerase
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change in enzyme
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Sulfonamides
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inhibit folic acid synthesis
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decreased sensitivity of target enzyme, increased formation of PABA, use of exogenous folate
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Beta Lactams
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inhibition of bacterial cell wall synthesis
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#1 plasmid acquired-penicillinase; mutation- modification of PBP-s, change of porins
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Vancomycin
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inhibition of peptidoglycan chain elongation
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mutation- change in pentapeptide, D-ala, D-lactate
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transduction
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bacteriophage
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transformation
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incorporation of free DNA
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conjugation
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direct contact-sex pilus or bridge
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benzyl penicillin (pfizerpen)
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natural penicillin
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Procain Penicillin
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natural penicillin, short term, acute bacterial
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Penicillin V (Pen Vee-K)
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natural penicillin, acid resistant,orally useful
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Benzathine Penicillin (Bicillin)
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Natural penicillin, long term (1month, Rheumatic Fever)
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Nafcillin(Nafcil)
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Penicillinase Resistant, anti-staph
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Oxacillin(Prostaphlin)
Cloxacillin(Cloxapen) |
Penicillinase Resistant, anti-staph
ORAL |
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Methicillin
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TESTING ONLY, Penicillinase Resistant, anti-staph, causes interstitial nephritis in pts
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What is the mechanism of MRSA?
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Mutation- in PBP that inibits and binding of Beta lactams
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What is DOC for MRSA?
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Vancomycin
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Ampicillin
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Extended Spectrum penicillin
DOC for Listeria |
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Amoxicillin
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Extended Spectrum penicillin
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Carbenicillin(Geocillin)
Tixarcillin(Ticar) Mezlocillin(Mezlin) Piperacillin(Pipracil) |
Antipseudomonal penicillins
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What drug class is always given with Antipseudomonal penicillins?
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Aminoglycosides
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Aztreonam(Azactam)
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Monobactams- limited use, No Gram +, no hypersensitivity w/ other Beta Lactams ie used in penicillin allergy
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Imipenem,Cilastatin(Primaxin)
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Carbapenem- IV Broad spectrum, metabolite is nephrotoxic, causes SEIZURES
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Meropenem(Merrem)
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Carbapenem- like Imipenem but less likely to cause seizures
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Ertapenem(Invanz)
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Carbapenem- IV Wide Spectrum (Gram neg, gram pos, anaerobes)
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what are four mechanisms of penicillin resistance?
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inactivaton- Beta lactams- plasmid
dec. outer membrane perm-plasmid PBP alteration- DNA MUTATION lack of cell wall |
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In what ways are penicillins never given?
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intrathecal- cause seizures
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Major side effect of penicillins
bonus- what drug would you use in case of penicillin allergy? |
allergy- all4 types of hypersensitivites
Aztreonam(Azactam) |
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Dose dependent penicillin toxicities
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tissue irritation, excess Na/K, frothy stool/diarrhea, superinfections, enteritis, Jarisch-Herxheimer Rx(severe febrile rxn)
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What are uses of first gen cephalosporins?
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Gram +(minus enterococci, MRSA, S Epidermidis) Gram Neg PEcK
Proteus Mirabilis, E. Coli, Klebsiella Pneumoniae |
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Cefazolin(Ancef, Kefzol, Zolicef)
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1st gen. cephalosporin, DOC for surgical prophylaxis, IM, IV
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Cephalexin Monohydrate(Keflex, Cefanex)
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1st Gen Cep, oral, older drug
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Cephradine(Anspor, Velosef)
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1st Gen Cep, oral, IM, IV
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DOC for enterococci
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Penicillin and Aminoglycosides
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DOC for Treponema
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Penicillin
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DOC for Leptospia
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Penicillin
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DOC for Listeria
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Ampicillin
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DOC for N Gonorrhea
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Ceftriaxone
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DOC for N Meningitis
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Penicillin G
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Cefoxitin(mefoxin)
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2nd gen cephalosporin
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cefamandole(mandol)
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2nd gen cephalosporin, disulfirimide effect- inhibits acetaldehyde dehydrogenation
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Cefaclor(ceclor)
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2nd gen cephalosporin- serum sickness, special adverse effect- oral
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Cefuroxime(Zinacef,Kefurox,Ceftin)
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2nd gen cephalosporin- widely used today
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Cefprozil(cefzil)
Loracarbef(lorabis, cefzil) |
2nd gen cephalosporin- oral
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What are uses of 2nd gen cephalosporins?
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Gram Neg- HEN PECKS
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H flu, Enterobacter, Neisseria, Proteus Mirablis, E Cole, Klebsiella, Serrata Marcescens
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What are uses of 3rd gen cephalosporins?
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less gram +, more enterobactericeae, some against Pseudomonas Aeruginosa, DOC for Salmonella
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Cefotaxime Sodium(Claforan)
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3rd gen cephalosporin- enters cns
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cefoperazone(cefobid)
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3rd gen cephalosporin- NO CNS, met by liver, disulfiram like
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ceftazidime(fortaz)
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3rd gen cephalosporin
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ceftriaxone(rocephin)
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3rd gen cephalosporin- cns penetration, DOC for Gonorrhea, Penicillinres strep pneumonae
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cefixime(suprax)
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3rd gen cephalosporin- doc for gonorrhea?
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what is the only 4gen cehalosporin?
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cefepime(maxipime)
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Cefepime(maxipime)
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4th gen cephalosporin
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what makes cefepime(maxipime) special?
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increased cns penetration, decreased rate of hydrolysis bybeta lactams
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what are toxicities of cephalosporins?
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renal necrosis, dose dependent,synergystic w/ aminoglycosides pseudomembranous colitis, super infections, disulfiram like, penicillin cross-allergy
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vancomycin(vancocin)
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only gram+, especially MRSA, oral for pseudomembranous colitis, OTOTOXIC/NEPHROTOXIC/ red man syndrome
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what is mechanism of vancomycin?
how is resistance achieved? |
d-ala d-ala binding, blocks elongation and transpeptidation
mutation to d-ala d-lactate |
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fosfomycin(monurol)
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2nd gen UTI,inhibits CWS at first stepin peptidoglycan synthesis
for uti in uncomplicated women |
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bacitracin
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whenorganism is resistant to everything else, only given topically, with polymyxin and neomycin
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Cycloserin(seromycin)
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Other CWI- Competes w. D-ala in L-alanine racemase and D-alanine synthetase
CNS toxicity-h/a trmors, psychosis, convulsions 2nd line Tb/UTI NOT IN MARKET |
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Sulfisoxazole(Gantrisin)
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Short acting sulfonamide
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Sulfamethoxazole(Gantanol)
Sulfadoxine |
Intermediate acting sulfonamide
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Sulfasalazine(Azulfidine; SAS500)
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poorly absorbed sulfa, cleaved by bacteria, used locally, used for UC
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Silver Sulfadiazine(Silvadene)
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Topical- cream over burned surface
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Sulfamethozaole-Trimethoprim-TMP-SMX(Bactrim, Septra)
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Combined; DOC for uncomplicated UTI, M. Cat
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What are uses of Bactrim?
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UTI-first attack
Nocardiosis, Moraxella, Toxoplamsosis/Trachoma, Pneumocystis Carinii, 2nd line Listeria |
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Sulfadoxine +Pyrimethamine(Fansidar)
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Combination- toxoplasmosis, not as weel tolerated, causes crystalluria
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What is MOA of Sulfas?
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Compete w/ PABA in folic acid synthesis; bind to Dihydropteroate Synthase, only in bacteria
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What is MOA of Trimethoprim?
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blocks dihydrofolate reduction via dihydrofolate reductase, 60,000 times more effective in lower ogranisms
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What are mechanisms of resistance of tmp-smx?
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1 dec sensitivity of targets
2 inc PABA formation 3 use of exogenous folate |
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What are toxicities of sulfas?
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insoluble in acid urine, cause crystalluria/hematuria,Kernicterus in infants, Kidney/liver, SJS,
Drug sensitivities, Blood Dyscrasias(BM problems) Perripheral nerve damage in slow acetylators in G6PD def. (counter w/ B6) |
crystals
SJS/allergic rx BM/blood dyscrasias peripheral nerve damage-slow acetylators |
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What is MOA of macrolides?
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block 50S- bacteriostatic
What are resistance mechanims? |
1- methylase enzymes modify robosom targets
2 active pump 3esterase hydrolysis 4altered 50S-chromosomal mutation |
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Erythromycin
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Macrolide- similar to Pen G, tx of GAS, syphillis(penicillin alternate) 3 Pneumona- Myco/Chlam/Legion CYP inhibitor, Gi disturbance, Ototoxic, QT prolongation(direct and indirect), DOC for chlamydia in preg
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Clarithromycin
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like erytho, but lung/macrophage penetration, effective against MAC, CAP, M Cat, 3 pneumona, less diarrhea, CYP inhibitor
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Azithromycin
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Macrolide- no p450, excreted into bile, DOC chlamyda trachomatis, wide spectrum, see notes
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Telithromycin(Ketek)
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ketolide- bind 50s, pathogens res. to erytho/azithro, and penicillin pneumococci, intracellular/atypical bacteria, hepatotoxic
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Clindamycin(Cleocin)
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blocks 50s, Anaerobe, Gram+/-, excellent S. Aureus/strep, anaerobes above diaphraghm, causes Pseudomembranous Colitis,
accumulates in BONE good for OSTEOMYELITIS |
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Dalfopristin;Quinupristin(Synercid)
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Streptogramins
50S binding, vanco resis enterococcus/S. Aureus only IV |
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When would you use Dalfopristin;Quinupristin?
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MRSA, resistant to Vanco
Chart says TMP-SMX 2nd choice for MRSA |
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Linezolid(Zyvox)
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Oxazolidinone- only Gram +, MAO inhibitor-many drug interactions, high tissue CNS penetration
no hepato/cyp, BM depression, thrombocytopenia |
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Gentamicin
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Aminoglycoside, tx tullaremia
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Tobramycin
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Aminoglycoside- combine w/ antipseudomonal penicillin
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Amikacin
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aminoglycoside
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Streptomycin
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Aminglycoside- Tx Tullaremia, Bubonic Plague/Yersinia Pestis, Tb, Endocarditis
use in combo w/ tetracyclines except for Tullaremia |
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Neomycin
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Amingolycoside- pre-op normal flora suppresion, hepatic encephalopathy
topical application w/? |
neomycin, polymixin B, bacitracin= Neosporin
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Spectinomycin(Trobicin)
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Aminoglycoside-off market, tx of gonorrhea in people allergic to ceftriazone/ other b-lactams
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What is mechanism of action of aminoglycosides?
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block 30S- require 02
1. block protein synthesis initiaiton 2. block translocation 3. incorporation of incorrect AA What is mode of resistance? |
Plasmid- adenylates, phosphorylates, acetylates
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General features of Aminoglycosides
Toxicities? |
No oral, No CNS penetration,
Nephro, Oto, NMJ |
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Chloramphenicol
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binds 50S, close to erythromycin, broad coverage, wide distribution- 100%CNS, rarely used, CYP inhibitor-hypoglycemis w/tolbutamide and warfarin intx
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What are toxicities of Chloramphenicol
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Reversible BM/hematopoietic depression
Irreversible Fatal aplastiv anemia-genetic Gray Baby syndrom Hemolytic anemia |
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Tetracycline(Sumycin)
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Short acting tetra
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Demeclocycline(Declomycin)
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Intermediate acting tetra- outstanding photosensitivity, ADH antagonist (SIADH)
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Doxycycline(Vibramycin)
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Long acting tetra- DOC for Lyme/ Cholera, good prostate penetration
secreted mostly into bile |
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Minocycline(Minocin)
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Long acting tetra- used in meningococcal carrrier state
secreted mostly into bile |
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Bismuth Subsalicylate, Metronidazole, Tetracycline
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H. Pylori tx
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Tigecycline(Tygacil)
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glycycline-bacteria resistant to tetracyclines; MRSA, MRSEpi, Penicillin resis, S. Pneumona, Vanco resis Enterococci
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What are characteristics of tetracyclines?
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Broad gram+/- NO anaerobic/pseudomonas, chelator absorption interaction-Mg Fe, Ca, liver metab, BONE/TOOTH discoloration- c/c <8yo, prego, liver/renal damage- falconi syndrome, GI overgrowth
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Nitrofurantoin(Furandantin)
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[high urinary] gram+/-, needs ACIDIC envir. typical nursimg home agent, brown urine, pulmonary fibrosis, c/a renal impairment
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Methenamine Mandelate(Mandelamine)
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[high urinary], -> formaldehyde, binds protein amino group, NO RESISTANCE, limited use, C/C renal/hepatic insufficiency
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Nalidixic Acid(Neggram)
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[high urinary] off market,UTI Hen PEcK(no pseudomo) S/E convulsion, hemolytic anemia, cartilage loss, antagonizes nitrofurantoin
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What is MOA of fluoroquinolones?
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inhibits DNA gyrase- topoisomerase II
What is resistance mechanism? |
DNA mutation of TI II
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What are 3 weaknesses of Cipro?
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no CNS, no anaerobes, no S. Pneumonae
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What are general features of fluoroquinolones?
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Good gram+/- see notes for specific, antacids interfere w/ absorption, Gi effects, inc. QT interval, Tendon rupture, inc serum transaminase, LDH, alkaline phosphatase
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Ciprofloxacin(Cipro)
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prototype-fluoroquinolone
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Levofloxacin(Levaquin)
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fluoroquinolone- no theophyliine interaction, for use in complicated UTI/pyelonephritis, CAP, sinusitis, chronic bronchitis
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Norfloxacin(Noroxin)
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fluoroquinolone- not active against C. Dificile
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Ofloxacin(Floxin)
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fluoroquinolone
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Trovafloxacin,Alatrofloxacin(Trovan)
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fluoroquinolone- BLACK BOX WARNING- hepatotoxic; only used in life/limb threatening infections, nosig, pharmacokinetic interaction
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Moxifloxacin(Avelox)
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new-fluoroquinolone-Good CNS, good anaerobe, good S. Pneumoniae, liver(glucoronide/sulfate) metab (not for use in moderate/severe hepatic insuff)
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Gatifloxacin(Zymar)
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new-fluoroquinolone TOPICAL ONLY
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Gemifloxacin(Factive)
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New-fluoroquinolone
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Daptomycin(Cubicin)
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Lipopeptide- what is MOA?
cidal, gram+, IV admin, no resistance, excreted unchanged by kidneys |
binds to membranes--> rapid depolarization
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Mupirocin(Bactroban)
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Topical- reversible binds isoleucyl -tRNA synthetase
Tx impetigo- S. Areus/GBS, intranasal MRSA carrier, little cross res |
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Polymyxin B
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cidal, binds gram neg CM phospholipid--> permeability, topical, nephrotoxic
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What three drugs make up neosporin?
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Polymyxin B, Bacitracin, Neomycin
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Colistimethate Sodium(Coly-Mycin M)
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hydrolized in vitro to colisitn/polymyxin E
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Colistin Sulfate(Coly-Mycin S)
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tx of superficial bacterial infections of Ext. Aud. Canal
combined w. hydrocortison acetate, neomycin sulfate, thonzonium bromide |
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Isonicotinic Acid Hydrazide(Isoniazid, INH)
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inhibits biosynthesis of mycolic acid, Tx of Tb-prophylactic, latent and active intracellular, acetylated metab, genetic rx
What are S/E? |
liver damage, CNS stimulant, peripheral neuritis, lupus like, HA in 6-GPD
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What is the gene of Isonicotinic Acid Hydrazide(Isoniazid, INH) resistance?
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katG, inhA, ndh
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Rifampin(Rimactane)
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inhibits DNA dependent RNA polymerase, Tb tx latent and activewide distribution, bile elimination
What are S/E? |
orange sweat/tears, p450 inducer
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What is Rifampin(Rimactane) gene resistance?
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rpoB
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Ethambutol(Myambutol)
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blocks arabinosyl transferase, 1st line Tb-enters CNS, decrease dose in renal failure
What are s/e |
dec. visual acuity, loss of green-red vision, retrobulbar neuritis
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What is gene of resistance in Ethambutol(Myambutol)?
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embCAB
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Pyrazinamide
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1st line Tb-inhibits translation, wide distribution
HIGH LIVER TOXICITY |
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What is gene of resistance in Pyrazinamide?
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pncA
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Ethionamide(Tecator)
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2nd line Tb- oral, neurologic complications, rapid resistance
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Cycloserine
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2nd line Tb- off market, blocks CWS, oral, peripheral neuropathy, CNS dysfunction, psychotic rxns(controled via phenytoin)
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Rifabutin(Mycobutin)
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2nd line Tb- oral, s/e rash, GI upset, neutropenia, urine discoloration, thrombocytopenia
Rifampin alternative(HIV w/ HARRT) and alternative to clarithro/azithro for 1o M. Avium porphylaxis in HIV |
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Capreomycin(Capstat)
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2nd line Tb, 1st choice- IM kidney damage, Cn VIII damage--> deafness/vesibular, can be alternate for steptomycin
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Clofazimine(Lamprene)
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M. Leprosy- off market binds to mycobacterial DNA (due to high GC content) oral, prevents Erythema Nodosum, Leprosum Rxn s/e hepatitis, CRYSTALLINE deposits in tissues
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Thalidomide(Thalomid)
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M. Leprosy- have to specially trained to dose, human teratogen, heavily regulated, for severe Erythema Nodosum Leprosum
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Dapsone(Avlosulfone)
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M. Leprosy- MOA similar to sulfa- PABA antagonist, oral for 2 weeks, then slowly inc. dose
s/e- liver damage/methemoglobinemia hemolysis/peripheral neuritis, nasal obstruction 2-3 months post |
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DOC M. Cat
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1-TMP-SMZ, Cephalosporin
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DOC N. Gonorrhoea
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1. Ceftriaxone, add azithro if co-infected w/ Chlamydia
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DOC PEcK-Proteus, E. Coli, Klebs
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Cephalosporin 1st/2nd or TMP-SMZ
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DOC Salmonella
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TMP-SMZ, 3rd gen ceph, quinolone
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DOC Shigella
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Quinolone
2nd TMP-SMZ, ampicillin, azithro, ceftria |
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DOC Campylobacter
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Erytho or Azithro
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DOC Vibrio Species
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Tetracycline
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DOC Pseudomonas Aeruginosa
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Antipseudomonal Penicillin + aminoglycoside
2nd APP + quinolone |
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DOC S. Pneumonae
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Penicillin
2 doxy, ceftriazone, quinolone, erythrom, linezolid |
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DOC GAS
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Penicllin, clindamycin
2nd erythro |
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DOC GBS
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penicillin
2nd vanco |
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DOC S. Aureus
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penicillin/penicillinase resist
1st cephalosporin, vancomycin |
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DOC MRSA
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Vanco
2nd TMP-SMZ |
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DOC Enterococci
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Penicillin + aminoglycoside
2nd vanco + aminogly |
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DOC Listeris
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Ampicillin
2nd TMP-SMZ |
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DOC Nocarida
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Sulfa/TMP-SMZ
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DOC C. Dificle
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Metronidazole
2nd vanco, bacitracin |
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DOC M Tb
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Isoniazid + Rifampin + Ehtambutol + Pyrazinamide
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DOC M. Lep
Mb P |
Dapsone
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DOC M. Pneumonae
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Tetra/ erythro
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DOC Chlamydia Trachomatis
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tetra/ azithro
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DOC Chlamydia Pneumonia
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tet/ erythro
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DOC Borrelia
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Doxy
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DOC Treponema
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Penicllin
2nd tetra/azithro/erythro, ceftriaxone |
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Anaerobes below diaphragm
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Metronidazole- DOC for C. Dificile
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