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105 Cards in this Set
- Front
- Back
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Inhibition of cell wall synthesis?
Which step? |
1. Penicillin, cephalosporins, imepenem, meropenem, aztreonam. Vancomycin.
2. Transpeptidation |
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Inhibition of formation of initiation complex?
Bacteriostatic? Bacterocidial? |
Aminoglycosides--30S (Streptomycin, Gentamycin)
Linezolid---50S tx for Staph. A (Bacterocidial |
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Interfere with incorporation of next amino acid?
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Tetracyclin 30S
Dalfopristin,Quinupristin--50S Prevent tRNA from entering into site A. Bacteriostatic. |
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Inhibition of formation of peptide bond?
Interfere with translocation? |
chloramphenicol/
Macrolides Clindamycin. |
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Inhibition of Folic Acid synthesis?
which enzyme is inhibited? |
Sulfonamide
-Dihydropteroate synthetase Trimethoprim and pyrimethamine -Dihydrofolate reductase. |
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Inhibition of cell wall synthesis?
Which step? |
1. Penicillin, cephalosporins, imepenem, meropenem, aztreonam. Vancomycin.
2. Transpeptidation |
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Inhibition of formation of initiation complex?
Bacteriostatic? Bacterocidial? |
Aminoglycosides--30S (Streptomycin, Gentamycin)
Linezolid---50S tx for Staph. A (Bacterocidial |
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Interfere with incorporation of next amino acid?
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Tetracyclin 30S
Dalfopristin,Quinupristin--50S Prevent tRNA from entering into site A. Bacteriostatic. |
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Inhibition of formation of peptide bond?
Interfere with translocation? |
chloramphenicol/
Macrolides Clindamycin. |
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Inhibition of Folic Acid synthesis?
which enzyme is inhibited? |
Sulfonamide
-Dihydropteroate synthetase Trimethoprim and pyrimethamine -Dihydrofolate reductase. |
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Inhibition of nucleic acid synthesis?
which enzyme is inhibited? |
Fluroquinolones
-DNA gyrase Topoisomerase II Rifampin. -DNA dependent RNA polymerase. |
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Mechanism of Resistance
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Things bacteria has for resistance
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1. B-lactamase
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Penicillin
Cephalosporin They also prevent cell wall synthesis. |
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2. Conjugating enzymes to increase drug clearance
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Aminoglycosides
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3. acetylating enzymes
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chloramphenicol
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4. Methylation
5. Active transport system |
Macrolides (M&M)
Tetracylins |
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6. formation of PABA
7. increase inhibition to resistance of topoisomerase II |
Sulfonamides
Fluoroquinolones. |
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Synergetic Effect
Antagonist Effect |
Penicililn + Aminoglycosides
Penicillin + Tetracyclins |
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1. Amoxillin+ Clavulunate
2. Ampicllin + Sulbactam 3. Piperacillin + Tazobactam 4. Titeracillin + Clavulunate |
Strep. G-ve. Staph. A
Strep. G-ve, Staph. A Strep. G-ve(pseudomonas), StaphA Gram -ve, gram +ve, Staph.A |
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Broad Spectrum
Extended Spectrum |
Amoxicillin, Ampicillin.
Piperacillin, Titracillin, Carbncillin |
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If allergic to penicillin what do u give?
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Cephalosporins.
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Superinfection?
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disturbance of normal flora of the body.
Foul smelling stool. Black furry overgrowth of the tongue. vaginal itching or discharge. |
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1st generation Cephalosporins
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against G+ve
-Cefazolin--Surgical prophylaxis -Cephalothin--Renal tubular necrosis No CNS entry. |
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2nd Generation Cephalosporin
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Gram +ve&gram -ve
Ceftetan--bacteroid fragillis(disulfram like action) Cefaclor--serum sickness NO CNS entry except Cefuroxime |
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Third generation Cephalosporin
side effect of cefoprenazone |
Gram -ve and pesudomonas
-Ceftriaxone--IV single shot for gonnorhea -cefixime Ceftriaxone+cefoprenazone-->biliary sludge ----also metabolized in liver Pseduomonas colitis. |
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Fourth generation Cephalospoirn
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just as good as 3rd generation
cefepime IV also good against gram +ve. |
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Cephalosporins are not effective against?
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chlamydia, listeria, mycoplasma, MRSA, Enterococci.
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New Beta lactams
1.Monobactam MOA Resistant to beta lactamase? |
Aztreonam--IV against Gram -ve
***most effective to Pseudomonas Transpeptidation not allergic if allergic to penicillin. synergetic with aminoglycosides. -YES |
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2. Carbapenem
Resistant to beta lactamase? Effective against? Side effects? |
Imipenem & Cilastatin
Imipenem--rapidly metabolized by renal dipeptidase. Cilastatin--inhibits renal dipeptidase Meropenem--tx of seroius infection -YES -IV against gram-ve, +ve anaerobes -Renal dysfunction with siezures(imipenem) |
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Vancomycin
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Only effective against Gram +ve
IV against MRSA Oral against Clositridium Difficle(PC) blocks elongation of Peptidoglycan |
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Adverse effects of vancomycin
HORN |
Hypersensitivity
Ototoxicity Red Man Syndrome - rash, fever, chills, red face and neck. Nephrotoxicity |
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Macrolides
ACE |
Azithromycin, Clarithromycin, Erythromycin.
Not effective against MRSA Effective against--Community acquired pneumonia, mycoplasma pneumonia. Erythromycin estolate causes cholestatic jaundice. Binds to motilin receptor-->Diarrhea reversible ototoxicity. |
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Erythromycin
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Against staph, strep, mycoplasma
Side effects--> GI , long QT intervals) |
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Azithromycin
Clarithromycin |
same as erythromycin + chlamydial urethritis. less side effects than erythromycin.
Same as erythromycin + H.pylori. H. Influenza. also good against mycobacterium avium complex in HIV. - inhibits cytochrome p450. |
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New Macrolides
Ketolides |
Telithromycin
-similar to Azythromycin. -inhibits cytochrome p450. -prolonged QT interval. |
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Anaerobic Infections
Bacteroids AAPMC--> |
Clindamycin
- oral infections -Risk for AAPMC Metronidazole -intra-abdominal infections Rx for AAPMC |
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Metronidazole
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Bactericidal.
Drug of Choice for Protozoa--Giardia Lambia --Entamoeba Histolytica --Trichomonas Vaginalis Bacterial --Bacteroids Fragillis --G. Vaginallis |
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Adverse effects of Mitronidazole
Disulfram drug action drugs |
Peripheral neuropathy
Disulfram like action Furry tongue, Glossitis Disulfram drug action drugs -Metronidazole -Cefopremazone -Cefotetan -Cefamandole -Griseofulvin |
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Tetracyclins
Rx of? Cant take them with? |
"Dem DoMino"
Demeclocycline,Doxycycline, Minocycline. tetracycline *good for Yersinia, Mycoplasma, Chlamydia, Brucella, Vibrio Cholera Demeclocycline-->inhibits ADH for Rx of SiADH. Doxycycline-->Rx of prostatitis. Dairy Products--reduce absorption (except Do Mino) Also LYME disease |
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Adverse reactions of Tetracycline?
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-permanent discoloration of teeth under 8 y/o.
-Phototoxicity -Nephrogenic Diabetes Insipidus.(deme) -Hepatotoxicity---pregnant women. -Fanconi like syndrome--outdated -Vestibular Ototoxicity-->Minocycline |
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Fluroquinolones
Analogue of what? RX? |
C STONE
Ciprofloxacin, Sparfloxacin, Trovafloxacin, Ofloxacin, Norfloxacin, Enoxacin. -Analogue of Nalidixic acid --Anthrax DOC ---Penicllin and tetracycline second --Gram -ve sepsis. Cipro&Oflo-->single shot for gonorrhea. Spar--resistant pneumococcus Oflo--Chlamydia |
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Aminoglycosides
Rx? |
Gentamycin,Tobramycin, Paromomycin
Streptomycin, Kanamycin, Amikacin, Neomycin. -Gram -ve infections -Endometritis--Gentamycin, Ampicillin, Metronidazole. -Enterococcus Synergetic with Ampicillin. -Psudomonas infections synergetic with extended spectrum penicillin. |
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Adverse reactions of Aminoglycosides?
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1.Ototoxicity
-Auditory--Irreversible Cochlear--high pitch first -Vesitublar--Reversible 2. Nephrotoxicity - Proteinuria, Hypokalemia, Acute tubular Necrosis 3. Neuromuscular - Decrease prejunctional release of Acetylcholine |
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Enhanced Ototoxicity
Enhanced Nephrotoxicity |
Furosemide, Ethacrynic acid
Ciplastin, Vancomycin, Amphotericin B, Cyclosporin. Spectinomycin--not an aminoglycoside..rx of gonorrhea. |
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Sulfonamides
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Sulfisoxazole--UTI & norcardial inf.
Sulfasalazine--UC Sulfacetamide--Trochoma(causes blindness) Silver Sulfadiazine--Burns Sulfadiazine&pyrimethamine-- Toxoplasmosis Sulfamethaxazole&Trimethoprim--PCP--Pneumo Carnii Pneumonia |
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Side Effects of Sulfonamides
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Hypersensitivity--Rash to SJS
Hemolysis in G6PD Photosensitivity Crystalluria Kernicterus--3rd trimester Increase with warfarin Increase with phenytoin |
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Trimethoprin/Sulfomethaxazole
Co-trimoxazole Adverse effects |
DOC for prophylaxis
2nd choice for MRSA, Salmonella, Chanchroid. Adverse effects Thrombocytopenia, Leukopenia, GI distress in AIDS, Hemolysis |
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Urinary Tract Antiseptics
Urinary Tract Anelgesics |
Nitrofurantoin, Methenamine, Mandelate
Phenazopyridine Orange red urine that stains clothing. |
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Broad spectrum antibacterial
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Chloramphenicol
Aplastic anemia Gray baby syndrome. |
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MRSA
VRSA VRE |
Vacomycin
Linezolid Quinopristin/Dalfopristin |
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Antifungals
Polyene Antifungals MOA Side effects |
Amphotericin B
Lifethreatening infectinos: Aspergillosis, Candidias, Histoplasmosis, Cryptococcus -Binds to Ergosterol -Nephrotoxic, Hypokalemia, Normochromic normocytic Anemia |
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Side effects of Antifungals
Synergetic with? . |
Infusion dependent Flu like symptoms.
-so give antipyretic, antihistaminic, antiemetic agents -given intrathecally -with Fluocytosine -Resistance by decreasing ergosterol. Rx of Cryptococcus, candidiasis. |
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Nystatin
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Used topically for Candidiasis..too toxic if used systemically.
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Azole Antifungals
MOA Resistance Administered and RX of? |
Fluconazole,Ketoconazole, Miconazole, Clotimazole, Itraconazole
Block synthesis of Ergosterol Reduce intracellular drug. Given PO Coccidiomycosis, HIstoplasmosis, Blastomycosis, Paracoccidiomycosis, candidiasis. |
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Rx of Candida and Dermophytic Infections?
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Clotrimazole, Miconazole
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Side effects of Kitoconazole?
Kinetics? Which penetrates CSF? which one does not? Which one is give IV |
Gynacomastia, dec libido, menstural problems.
-Fluconazole -Itraconazole -Both |
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Antifungals with limited indications
1. Griseofulvin MOA -Rx. -Contraindication |
Binds to mitotic spindle
-Rx of jock itch -Contraindicated in intermittent porphyria -increased effects with alcohol |
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2.Terbinafine (lamisil)
Rx- MOA |
Onychomosis
Increased liver enzyme test. Squalene Epoxidase |
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3. Flucytosine
MOA Side effects |
Used with Amphotericin B to treat severe Candidiasis.
-Inhibits thymidilate synthetase -Decrease Bone marrow -leukopenia -thrombocytopenia |
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THE END OF?
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ANTIFUNGALS
GOOD JOB!! |
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AntiViral Drugs MOA
1. inhibition of penetration and uncoating |
Amantidine
Rimantidine |
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2. Inhibition of Viral DNA polymerase
3.Inhibiton of viral RNA polymerase 4. Inhibition of viral DNA polymerase |
Famcyclovir
Acyclovir Gancyclovir Valacyclovir(valtrex) -Ribavirin -Foscarnet |
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5. Inhibition of viral Reverse transcriptase
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Zidovidine, Stavudine, Lamvinodine, Didinosine, Nevirapine, Zalcitabine
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6. Inhibition of viral aspartate protease
7. Inhibition of Viral Neuroaminidase |
Indinavir, Ritonavir, saquinavir, nelfinavir
Oseltamavir, Zanamivir |
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Clinical antiviral drugs
1. Amantadine MOA Indication Side effects |
prevents attachment, penetration and uncoating
-Parkinsons -Influenza A Livedo reticularis Anticholinergic effects |
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2. Ribavirin.
MOA Indications side effects |
Inhibit rna polymerase. binds end capping.
Rx of RSV Side effects--teratogenic |
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3. Acyclovir
MOA Resistane Indications Side effects |
inhibits DNA polymerase
-Decrease activity of thymidine kinase -Herpes Simplex -Shingles -Nephropathy--IV -Neurotoxicity and crystalluria |
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4. Famcyclovir, Valacyclovir
5. Gancyclovir |
New drug for Herpes simplex
Rx for CMV Viral thymidine kinase in herpes simplez Phosphotransferase in CMV Side effects-->Leukopenia, thrombocytopenia, seizures in OD, crystalluria |
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6. Foscarnet
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Just like Gancyclovir
-inhibits DNA polymerase -RX of CMV retinitis in AIDS pts. Side effect--nephrotoxicity Drug interaction-->IV pentamidine + foscarnet--Severe hypocalcemia |
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7. Zanamir and Oseltamivir
MOA |
Inhibits viral neuroaminidase in influenza A and B.
Prophylaxis to reduce symptoms -side effects of inhaled zanamivir causes throat irritation, vommiting, nausea |
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Drugs used for Rx of Aids
Adverse effects A. Zidovidine (AZT) |
Bone Marrow suppression, neutopenia, peripheral neuropathy.
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B. Stavudine
C. Zalcitabine D. Didanosine E. Lamivudine(hepB correlation) |
Peripheral Neuropathy
Peripheral Neuropathy Peripheral neuropathy, Hyperuricemia, Pancreatitis GI distress First oral drug to remove sAg from blood in hepatitis B |
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Adeofovir
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latest approved for HBV
not for HIV due to renal toxicity |
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2. Nonnucleoside RT Inhibitors(vir)
DEN Side effects |
Delvirdine
Efavirenz Nevirapine Rash . no bone marrow suppression |
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3. Protease Inhibitors
MOA which gene is involved? |
Indinavir,Ritonavir, Saualinavir, Nel
Inhibits Aspartate protease point mutation in POL gene |
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Adverse reactions of following drugs?
Indinavir |
Nephrolithiasis
Hyperbilirubinemia inhibition of p450 |
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Drugs used for Rx of Aids
Adverse effects A. Zidovidine (AZT) |
Bone Marrow suppression, neutopenia, peripheral neuropathy.
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B. Stavudine
C. Zalcitabine D. Didanosine E. Lamivudine(hepB correlation) |
Peripheral Neuropathy
Peripheral Neuropathy Peripheral neuropathy, Hyperuricemia, Pancreatitis GI distress First oral drug to remove sAg from blood in hepatitis B |
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Adeofovir
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latest approved for HBV
not for HIV due to renal toxicity |
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2. Nonnucleoside RT Inhibitors(vir)
DEN Side effects |
Delvirdine
Efavirenz Nevirapine Rash . no bone marrow suppression |
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3. Protease Inhibitors
MOA which gene is involved? |
Indinavir,Ritonavir, Saualinavir, Nel
Inhibits Aspartate protease point mutation in POL gene |
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Adverse reactions of following drugs?
Indinavir |
Nephrolithiasis
Hyperbilirubinemia inhibition of p450 |
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AIDS
When do u start therapy? Whats recommended? |
CD4 cells
CD4<500 VIral load (PCR) >10,000 Any 2 nucleosides inhibitors + 1 Protease inhibitor |
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When do u start prophylaxis?
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If CD<200
-PCP prophylaxis -TMP/SMX -Dapsone -Pentamidine b.Pneumococcal vaccine |
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2. If CD<100
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Toxoplasmosis prophylaxis
-TMP/SMX |
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3.If CD<75
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MAC prophylaxis
-Azithromycin -Clathromycin |
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4. If CD<50
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CMV prophylaxis
Ganciclovir |
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HIV transmission
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Needle Stick 1:300
M-F 1:1000 F-M 1:2000 Anal receptive 1: 50 |
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Clinical Cases of HIV
1. Stuck with needle of HIV+ve pt? 2. Pt had sex one time with HIV +ve? |
2+1 for 4 weeks
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3. 27y/o female CD4>500 and PCR<400
4. 27 y/o female pregnant CD4>500 PCR<200? |
3. Nothing
4. AZT to reduce transmission of infection from 25% to 8%. |
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5. 27 y/o female pregnant CD4 1 and PCR 700,00
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2+1 PCP- MAC- CMV prophylaxis.
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Anti tuberculosis Drugs
MOA Resistance |
1. Isoniazid (INH)
MOA-Prevents mycolic acid synthesis Resistance-Deletion of INHA gene-->acyl carries gene for isoniazid High resistance-->deletion of katG-encodes for catalase required for isoniazid activation. |
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Adverse effects of Isoniazid?
What do u give to prevent Neuritis? |
Hepatitis
Neuritis Hemolysis in G6PD SLE in slow acetylators Pyridoxine (B6) to prevent tingling due to neuritis. |
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2. Rifampin
MOA Resistance Adverse effects |
Inhibition of DNA dependent RNA polymerase.
-Change in polymerase gene -Red orange discoloration of urine. -flu like symptoms -proteinuria. -thrombocytopenia -induces p450 |
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3.Ethambutol
MOA Adverse Effects |
Inhibits synethesis of arabinogalactan
-cell wall component Retinobulbar Neuritis. Loss of green red acuity. |
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4.Pyrazinamide
MOA Adverse effects |
Unknown
-Hepatotoxicity -Athralgia due to hyperuricemia -Increase porphyrin synthesis. |
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5. Aminoglycosides
MOA Adverse effects |
Inhibits protein synthesis
-Stretomycin-->Hearing loss,ataxia, nephrotoxicity -Amikacin-->Nystagmus -Kanamycin-->Electrolyte imbalance. |
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6. Capreomycin
MOA Adverse effects |
2nd choice used for resistant TB with Aminosalicylic acid and cycloserine
-Hearing loss, ataxia "It is not an aminoglycoside" |
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Disseminated Mycobacterium Avium Complex (DMAC)
Adverse effects |
Azithromycin, Rifabutin, Ethambutol
Rifampin. -GI effects -Neutropenia -Rashes -No hepatotoxicity -Induces p450 (also by rifampin) |
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How long do you treat TB?
IF HIV +ve |
4 drugs for 2 months
-INH, Rif, Pza, Ethambutol 2 drugs for 4 months -INH-Rif -initial therapy is the same then increase duration. |
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Antiprotozoal
1.Giardiasis 2. Amebiasis asymptomatic non invasive intestinal amebiases 3. Trichomonas Vaginalis |
Metronidazole for all three.
-Diloxanide |
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4. Leishmaniases
5. Trypanosomiasis (Chagas disease) African sleeping sickness |
-Stibogluconate
-Nifurtimox -Suramin, Melarsoprol |
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PCPhttp://www.flashcardexchange.com/mycards/add/1001154
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TMP SMX
-Pentamidine Atovaquone |
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Malaria
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Chloroquine + Primaquine
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Prophylaxis for Chloroquine Sensitive malaria
Prophylaxis for Chloroquine Resistant malaria |
Chloroquine+- Primaquine
2nd line -->Pyrimethamine+sulfadiazine Mefloquine 2nd line--> Atovaquone-proquanil Doxycycline |
