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50 Cards in this Set

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Fluoroquinolones

1)1st gen =
2)2nd gen =
3)3rd gen =
4)4th gen =
1)Nalidixic Acid (QUINOLONE) (Narrow Spectrum)
2)Ciprofloxacin
3)Levofloxacin
4)Moxifloxacin
Fluoroquinolones

5)Static or Cidal?
6)MOA
7)CU
5)Cidal

6)enter bacteria via porins and inhibit DNA replication by interfering with Topoisomerase 2 (DNA Gyrase) and 4

7)inhibit topo2 -> Gram neg
inhibit top4 -> Gram pos
Fluoroquinolones

8)Levofloxacin + Moxifloxacin used for

9)3rd and 4th Gen better at killing

9b) Which gen best at killing Pseudomonas aeruginosa (as in Cystic Fibrosis)?
8)Strep Pneumonia (thus known as resp fluoroquinolones)

9)Anaerobic bacteria(C.diff and Bacteroides fragilis)

9b) 2nd Gen
Fluoroquinolones

10)1st Gen used for:
11)2nd Gen used for:
12)3rd Gen used for:
13)4th Gen used for:
10) Gram neg; Uncomplicated UTIs

11)Gram neg and some Gram pos; E.coli (travellers diarrhea)

12)Gram neg and more Gram pos; Resp infections (S.pneumonia)

13)Gram Neg and Gram Pos; Anaerobic Bacteria
Fluoroquinolones

14)Resistance
15)How are gonococci resistant?

16)How are TB, S.aureus, and S. pneumoniae resistant?
14)is HUGE in 2nd Gen

15)they mutate DNA gyrase

16)they have efflux mechanisms
Fluoroquinolones

17)How are they given?

18)What do divalent cations do (calcium, zinc, iron)?

19)If patient is taking probenecid, why do you have to be careful?

20)AE
21)Contra
17) Orally, but 2nd and 3rd gen can be given IV

18)Interfere with absorption

19)because fluorquinelones are excreted in kidney, and probenecid blocked tubular secretion (but thus can give both, because then will excrete less)

2)GI, CNS. Photosensitivity
CONNECTIVE TISSUE PROBLEMS (BLACK BOX WARNING, MUST TELL PATIENT)

21)Pregnancy, Nursing Mom, UNDER 18
Fluoroquinolones

22)Contra of 3rd and 4th Gen

23)Contra of 2nd Gen
22) Prolong QT
Inc Blood level of Warfarin, Caffeine, and Cyclosporine

23) Inhibits theophylline metabolism
Sulfonamides

1)are structural analogs of:
2)Static or Cidal
3)MOA
1)p-aminobenzoic acid (PABA)
2)Static

3)analog of PABA -> competitively inhibits dihydropteroate synthase ->inhibit folate production (bacteria need to produce there own folate to survive, thus cant grow) (get Inc PABA, dec dihydrofolic acid)
Sulfonamides

4)Resistance

5)Effect on Kidney

6)AE
4)d/t althered dihydropteroate synthase, dec permeability, inc PABA (because sulfonamides are competing with this compound)

5) are acetylated in liver and thus can precipitate at neutral or acidic pH, causing kidney damage (thus not used much anymore) (can be reduced by giving in alkaline solution or with lots of fluids)

6)Crystalluria
Are sulfur drugs, so can be allergic
If G6PD defic, can have blood problems
Inc blood levels of Warfarin, Methotrexate, Phenytoin
Sulfonamides

7)Contra

8)Given topically for:
9)Given Orally for:
7)Kid Less than 2 months (get Kernicterus, because drug competes with bilirubin for binding sites on ALBUMIN -> inc free bilirubin; and infants dont have a functioning Blood Brain Barrier)

8)Burns, Ocular Infections
9)Ulcerative colitis, RA, Toxoplasmosis (alternative)
Trimethoprim

1)MOA
2)Why is giving sulfonamides and trimethroprim as combo best idea?

3)Which more potent, sulfonamides, or trimethroprim?
1)structurally similar to folic acid, inhibits dihydrofolate reductase ->inhibiting purine, pyrimidine synthesis (get inc dihydrofolic acid, dec tetrahydrofolic acid)

3)Trimethroprim

2)Because inhibiting synthesis of folate at 2 different steps
Trimethoprim

4)CU
5)Resistance?
6)high conc of drug where?
7)
4)UTI, Bacterial Prostatits, Vaginitis

5)mutation in dihydrofolate reductase
6)in prostatic and vaginal fluids
7)Effects if folic acid defic (megaloblastic anemia, leukopenia)
Cotrimoxazole

1)What is it?
2)Cidal or Static
3)CU
4)What opportunistic infection is it used for?

5)AE
1)Combo of Sulfamethoxazole and Trimethroprim

2)Bacteriocidal

3)Simple UTI (DOC), RT Infections, Ear and Sinus Infections
4)Pneumocystitis Jiroveci (PCP) = DOC
5)Dermatologic, AIDS patients have higher incidence of side effects
DOC

1)Simple UTIs
2)Pneumocystitis Jiroveci (PCP
3)Toxoplasmosis, Nocardiosis
1-3 = Cotrimoxazole
Metronidazole

1)Static or Cidal

2)DOC for...

3)AE

4)Contra
1)Bacteriocidal

2)requires anaerobic enviornments for activity, because needs to be reduced (thus activated) by Ferredoxin, forming toxic products that interfere with nucleic acid synthesis

2)Anaerobic (Bacteroides, C.diff) and Vaginitis

3)GI, Leukopenia, Dark colored urine, Opportunistic Fungal

4)Alcohol (will get very very sick)
Bactericidal or Static?

1)Aminoglycosides
2)B lactam
3)Fluoroquinones
4)Metronidazole
5)Vancomycin
6)Streptogramin
All Bacteriocidal
Bactericidal or Static

1)Clindamycin
2)Macrolides
3)Sulfonamides
4)Tetracyclines
All Bacteriostatic
Sulfisoxazole
Sulfonamide

Short Acting, Oral, Simple UTIs
Sulfamethoxazole
Sulfonamide

Intermediate Acting
Sulfadoxine
Sulfonamide

Long Acting
Sulfasalazine
Sulfonamide

Oral, UC, RA
Sulfadiazine
Sulfonamide

Topical

Burn, infections
Sulfacetamide
Sulfonamide

Topical, eye infection
Eliminated how:

Aminoglycosides
Cephalosporins
Fluoroquinones
Penicillins
Sulfonamides
Tetracyclines
Vancomycin
Through Kidney (thus if kidney prob, conc of drug inc, or longer acting)
Eliminated how:

Chloramphenicol
Clindamycin
Erythromycin
Clarithromycin
Nafcillin
Through Liver (thus if liver prob, conc of drug inc, or longer acting)
Effect on Neonate:

1)Aminoglycosides:
2)tetracyclines
3)sulfonamides
4)Chloramphenicol
5)Fluoroquinolones
1)can damage 8th cranial nerve of fetus (FDA Cat D)

2)can cause tooth enamel dysplasia, inhibit bown growth (Dont give under age of 8 years)

3)kernicterus (dont give to infants under 2 months)

4)grey baby syndrome

5)effects growing cartilage (dont give under 18)
1)When do you give antimicrobials as surgical prophylaxis?

2)When else would you give it?
1)give for procedures that are associated with infection in greater than 50 percent (if immunosuppressed might give it also)

2)Prevention of CMV,HIV,TB,influenza, Meningitis
Animal Bite
Chronic Bronchitis*
1)DOC Anaerobe (Aspirated)
2)DOC Bacteroides
3)Alternative for Bacteroides
4)DOC Bordetella Pertussis
1)Beta Lactam and Beta Lactamase Inhibitor, or Clindamycin

2)Metronidazole
3)Carbapenems or
Penicillins and Beta Lactamase Inhibitor or
Chloramphenicol

4)Macrolide
5)DOC Campylobacter jejuni
6)Alternative for Campylobacter jejuni
7)DOC C. trachomatis
8)Alternative for C. trachomatis
5)Erythromycin
6)Fluoroquinolone or Tetracycline
7)Azithromycin
8)Doxycycline
9)DOC C. Diff
10)Alternative C. Diff
11)DOC Chancroid
9)Metronidazole
10)Vancomycin
11)Azithromycin, or Erythromycin, or Ceftriaxone, or Ciprofloxacin
12)DOC E.Coli
13)Alternative E.coli
14)DOC Enterobacter
15)Alternative Enterobacter
12)3rd Gen Cephalosporin
13)Penicillins, Fluoroquinolones, Aminoglycosides

14)Carbapenem, or 4th gen Cephalosporin
15)Aminoglycoside, Fluoroquinolone
1)DOC Enterococcus
2)Alternative Entercoccus

3)DOC G. vaginalis
4)Alternative G. vaginalis
1)Ampicillin
2)Vancomycin and Gentamycin or Linezolid or Daptomycin or
Streptogramins

3)Metronidazole
4)Clindamycin
1) DOC H. Influenzae
2)Alternative H. Influenzae
1)Amoxicillin
2)2nd or 3rd gen Cephalosporin, Amoxicillin-Cluvanic Acid
1)DOC Legionella

2)DOC M. Catarrhalis
3)Alternative M.Catarrhalis
1)Fluoroquinolone, Macrolide

2)Amoxicillin-Clavulanic Acid,
2nd/3rd gen cephalosporin
3)Azithromycin, Clarithromycin
1)DOC mycoplasma pneumoniae
2)Alternative M.pneumoniae

3)DOC N.gonorrhoae
4)Alternative N. gonorrhoae
1)Macrolide or Tetracycline
2)Resp Fluoroquinolone

3)Ceftriaxone
4)Cefixime, Cefotaxime
1)DOC N.meningitidis
2)Alternative N. mening

3)DOC P.mirabilis
4)Alternative P. miribalis
1)Penicillin G
2)3rd Gen Cephalosporin, Chloramphenicol, Fluoroquinolone

3)Ampicillin
4)Cephalosporins
1)DOC P. aeruginosa
2)Alternative P. aeruginosa

3)DOC S. typhi
4)Alternative S. typhia
1)Antipseudomonal B-lactam and Ciprofloxacin
2)Levofloxacin, Aminoglycoside

3)Ceftriaxone or Fluroquinolone
4)Chloramphenicol
1)DOC Serratia
2)Alternative Serratia

3)DOC Shigella
4)Alternative Shigella
1)Aminoglycoside and Anti Pseudomonal B-Lactam
2)Fluoroquinolone

3)Ampilicillin
4)Fluoroquinolone
1)DOC S. aureus Methicillin Susceptible
2)Alternative S. aureus Methicillin Susceptible

3)DOC S. aureus Methicillin Resistant
4)Alternative S. Aureus Methicillin Resistant
1)Antistaphlococcal Penicillin (Nafcillin, Oxacillin, Dicloxacillin)
2)Cephalosporin, Clindamycin, Fluoroquinolone, Imipenem

3)Vancomycin, Linezolid
4)Daptomycin, Doxycycline, Fluoroquinolone, Streptogramins
1)DOC S. pneumoniae Penicillin Susceptible
2)Alternative S. pneumoniae Penicillin Susceptible

3)DOC S. pneumoniae Penicillin Resistant
4)Alternative S. pneumoniae Penicillin Resistant
1)Penicillin G, Amoxicillin
2)Cephalosporin, Clindamycin, Fluoroquinolone, Macrolide

3)Fluoroquinolone, 3rd Gen Cephalosporin
4)Vancomycin, Linezolid, Streptogramins
1)DOC Trichomoniasis
1)Metronidazole
1)DOC Legionella

2)DOC M. Catarrhalis
3)Alternative M.Catarrhalis
1)Fluoroquinolone, Macrolide

2)Amoxicillin-Clavulanic Acid,
2nd/3rd gen cephalosporin
3)Azithromycin, Clarithromycin
1)DOC mycoplasma pneumoniae
2)Alternative M.pneumoniae

3)DOC N.gonorrhoae
4)Alternative N. gonorrhoae
1)Macrolide or Tetracycline
2)Resp Fluoroquinolone

3)Ceftriaxone
4)Cefixime, Cefotaxime
1)DOC N.meningitidis
2)Alternative N. mening

3)DOC P.mirabilis
4)Alternative P. miribalis
1)Penicillin G
2)3rd Gen Cephalosporin, Chloramphenicol, Fluoroquinolone

3)Ampicillin
4)Cephalosporins
1)DOC P. aeruginosa
2)Alternative P. aeruginosa

3)DOC S. typhi
4)Alternative S. typhia
1)Antipseudomonal B-lactam and Ciprofloxacin
2)Levofloxacin, Aminoglycoside

3)Ceftriaxone or Fluroquinolone
4)Chloramphenicol
1)DOC Serratia
2)Alternative Serratia

3)DOC Shigella
4)Alternative Shigella
1)Aminoglycoside and Anti Pseudomonal B-Lactam
2)Fluoroquinolone

3)Ampilicillin
4)Fluoroquinolone
1)DOC S. aureus Methicillin Susceptible
2)Alternative S. aureus Methicillin Susceptible

3)DOC S. aureus Methicillin Resistant
4)Alternative S. Aureus Methicillin Resistant
1)Antistaphlococcal Penicillin (Nafcillin, Oxacillin, Dicloxacillin)
2)Cephalosporin, Clindamycin, Fluoroquinolone, Imipenem

3)Vancomycin, Linezolid
4)Daptomycin, Doxycycline, Fluoroquinolone, Streptogramins
1)DOC S. pneumoniae Penicillin Susceptible
2)Alternative S. pneumoniae Penicillin Susceptible

3)DOC S. pneumoniae Penicillin Resistant
4)Alternative S. pneumoniae Penicillin Resistant
1)Penicillin G, Amoxicillin
2)Cephalosporin, Clindamycin, Fluoroquinolone, Macrolide

3)Fluoroquinolone, 3rd Gen Cephalosporin
4)Vancomycin, Linezolid, Streptogramins
1)DOC Trichomoniasis
1)Metronidazole
Urinary Antiseptic (Nitrofurantoin)

1)What is it used for?

2)Whats special about it?

3)MOA

4)can you use in pregnancy?

5)Contra
1)oral agen with antibacterial activity in urine, but NO systemic effects -> used for prophylaxis and treatment of Lower UTIs (both Gram Pos and Gram Neg) if resistance is a problem

2)Very little resistance to it

3)Inhibits lots of enzymes
4)Yes, until 38 weeks (d/t risk of hemolytic anemia in fetus)

5)Renal insufic, Preganancy at 38 weeks, Infants less then 1 month