Pharmacology Antibiotics And Principles

Front 1

What are the three Beta-lactamase resistant penicillins?

Back 1

Methicillin (no longer used), Nafcillin (use Naf for Staph), and Oxacillin (oral); (MNO)

Front 2

Name the penicillins that targets Pseudomona aeruginosa and other gram-negative aerobes.

Back 2

Ticarcillin, Carbenicillin, and Piperacillin (Takes Care of Pseudomonas)

Front 3

Amoxicillin (oral) and Ampicillin HELPS

Back 3

Haemophilus, E. coli, Listeria, Proteus, Salmonella

Front 4

What is the molecule found in the cell wall of bacteria that is triggered by penicillins that aid in the destruction of the bacterium through the formation of a spheroplast?

Back 4

peptidoglycan hydrolase

Front 5

What medication (used as a uricosouric) is used to increase the half life of penicillin by blocking the excretion of penicillin in the PCT of the kidney?

Back 5

Probenecid

Front 6

What multiple of the MIC of penicillin is used for a systemic infection? How about a CNS infection?

Back 6

4, 10

Front 7

What is the indications for Penicillin G?

Back 7

Streptococcus infections, Syphilis (Benzathine Penicillin G), Neisseria meningitidis, anaerobes (e.g. Clostridium perfringens)

Front 8

How does a penicillin become resistant to a penicillinase?

Back 8

Either through addition of clavulinic acid or through increasing the -R group of the penicillin molecule

Front 9

What happens when you increase the size of the -R group, when you are trying to make a penicillinase-resistant penicillin?

Back 9

The penicillin becomes less potent, so you must increase the dose.

Front 10

What are the penicillinase-resistant penicillins generally good for?

Back 10

Skin infections (Methicillin/Nafcillin IV; Oxacillin oral)

Front 11

Name five general penicillins that are targeted to Gram negatives.

Back 11

Ampicillin, Amoxacillin, Ticarcillin, Carbenicillin, and Pipercillin

Front 12

What is special about the amino groups on the R-groups of the aminopenicillins (e.g. ampicillin and amoxacillin)

Back 12

They increase the penetration of the Gram negative's outer membrane

Front 13

Which two antibiotics do you often see a skin rash with?

Back 13

Aminopenicillins (amoxicillin and ampicillin) and sulfamethoxazole

Front 14

Which form of antibiotics are more likely to cause diarrhea: oral or IV/IM?

Back 14

Oral (amoxicillin vs. ampicillin)

Front 15

Name two antibiotics that are most associated with pseudomembraneous colitis.

Back 15

Amoxicillin and clindamycin

Front 16

Is ticarcillin and pipercillin effective against Pseudomonas? Bacteroides fragilis (Gram negative anaerobe)?

Back 16

Yes, yes

Front 17

Name three bacteria that pipercillin is more affective against versus ticarcillin.

Back 17

Pseudomonas, Proteus, Klebsiella (PiPerKillin)

Front 18

What is the Gold Standard for treating Gram negative aerobes?

Back 18

Aminoglycosides (GNATS: Gentamycin, Neomycin, Amakacin, Tobramycin, Streptomycin)

Front 19

What is an excellent synergistic combination of antibiotics against Pseudomonas?

Back 19

Aminoglycosides and Ticarcillin/Carbenicillin/Pipercillin

Front 20

What is a potential side effect of having to use such a high dose of anti-pseudomonas penicillinases (low potency due to large R-group)?

Back 20

Sodium salt overload; bad for hypertension

Front 21

What is the main structural difference between penicillins and cephalosporins?

Back 21

Cephalosporins have two R-groups, whereas penicillins have one R-group

Front 22

Will the cephalosporins resist the Staph penicillinase?

Back 22

The first (Cephalexin and Cefazolin) and fourth (cepepime) generations will, but not the second (cefotetan, cefoxitin, and cefuroxime) and third (ceftriaxone, cefotaxime, and ceftazadime) generations.

Front 23

Which cephalosporin is highly effective against anaerobes (especially Bacteroides fragilis)?

Back 23

Cefoxitin (Second generation; send the fox down the pipe to get the B. fragilis).

Front 24

Which generation(s) of cephalosporin is effective against Pseudomonas?

Back 24

Third and fourth

Front 25

What percent of patients having an allergic reaction to penicillins will have an allergic reaction to cephalosporins? Is it worth risking?

Back 25

10%; probably not

Front 26

What is the broadest spectrum Beta-lactam? What does it cover?

Back 26

imipenem. Aerobe/anaerobe Gram positive/negative

Front 27

What must you watch about using imipenem?

Back 27

Imipenem should not be used first because the bacteria will secrete massive amounts of lactamase because imipenem won't even bind the lactamase.

Front 28

What compound must you take with imipenem in order to prevent the kidney's breakdown of imipenem by a dipeptidase?

Back 28

Cilastatin; the kill is LASTIN with CiLASTATIN.

Front 29

Aztreonam (aka Monobactam): spectrum and MOA

Back 29

Gram negative aerobes; MOA similar to Pen G

Front 30

Mupirocin: use? MOA?

Back 30

Impetigo cause by Staph and Strep (even lactamase-secreting Staph); Bacterial protein and RNA synthesis are inhibited

Front 31

Vancomycin: MOA; Use; toxicities

Back 31

inhibits bacterial cell wall synthesis; MRSA, Enterococcus faecalis/faecium, C. difficile (should use metronidazole though); NOT (nephrotoxicity, ototoxicity, thrombophlebitis (Red Man Syndrome (histamine release; take with aspirin and give slower))

Front 32

Explain the Davis model as to why aminoglycosides are bacteriocidal.

Back 32

When a [small] of aminoglycosides gets inside the bacterial cell, it causes an altered protein product, which implants within the bacterial membrane and serves as a pore. Through this pore flows additional aminoglycosides that serve to finish off the bacterial cell.

Front 33

Name the members of the aminoglycoside family.

Back 33

GNATS: Gentamycin, Neomycin, Amikacin, Tobramycin, and Streptomycin

Front 34

What feature of aminoglycosides make them similar to vancomycin, as far as oral dosing remaining within the GI tract?

Back 34

All the amino groups pick up positive charges, and cannot cross membranes very well (vancomycin is just so damn big)

Front 35

What is a downstream consequence of the amino groups on the aminoglycosides (think kidney)?

Back 35

These molecules are mistaken as amino acids in the PCT of the kidney, where 35% of the dose is accumulated, leading to inhibition of lysosomal enzymes, leading to lysosomal burst and renal toxicity

Front 36

What are the three main toxicities of aminoglycosides?

Back 36

NON or amiNOglycosides: Nephrotoxicity, Ototoxicity, and neuromuscular block (treat with neostigmine; usually follows bowel rupture)

Front 37

Name three mechanisms for resistance to aminoglycosides.

Back 37

1) ribosomal resistance, 2) decreased drug uptake, and 3) aminoglycoside modifying enzymes

Front 38

What distinguishes the newer Amikacin from the older kanamycin aminoglycosides?

Back 38

Amikacin has a larger R-group that inhibits many modifying enzymes

Front 39

What is the main use for aminoglycosides?

Back 39

Combo therapy with a beta-lactam to treat Gram negative infections or sometimes Staph/Strep infections (aminoglycosides are exclusively targeted against aerobes)

Front 40

How well do aminoglycosides enter the CNS?

Back 40

None, due to amino groups

Front 41

Must you monitor serum drug concentrations and kidney functions when administering aminoglycosides?

Back 41

YES

Front 42

What are the indications for aminoglycoside use?

Back 42

Serious aerobic gram-negative infections, including Pseudomonas aeruginosa

Front 43

What is unique about the newer tetracyclines doxycycline and minocycline?

Back 43

They are more lipophilic, have higher protein binding, lower renal excretion, higher half life, and very little renal excretion (doxycycline can be used in renal failure patients).

Front 44

Which tetracycline can be used in renal failure patients?

Back 44

Doxycycline (higher lipophilicity with excretion in fecal matter and bile)

Front 45

Which two antibiotics must you not take with food, milk, other dairy products, and antacids?

Back 45

Tetracyclines and Floroquinolones (both like bone/cartilage)

Front 46

What is a negative side effect of tetracycline dosing in children younger than 12?

Back 46

Gray/brown stained teeth.

Front 47

How does tetracycline gain access to the bacterial cell?

Back 47

It is actively pumped in (it is confused with a natural nutrient).

Front 48

Which antibiotic is known for producing a blistering rash?

Back 48

Tetracyclines

Front 49

What are the indications for tetracyclines?

Back 49

Pulmonary infections (Mycobacterium pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae), Chlamydia (DOC), Rickettsia (DOC), and Lyme disease (DOC)

Front 50

What antibiotic spectrum does Chloramphenicol have in common?

Back 50

Tetracyclines

Front 51

Which side effect of Chloramphenicol put this antibiotic off the market, and how common is it?

Back 51

Aplastic anemia, which is idiosyncratic, occurs in 1/30000 patients

Front 52

Name the Macrolides

Back 52

ACE: Azithromycin, Clarithromycin, and Erythromycin.

Front 53

What is the DOC for Legionella?

Back 53

Erythromycin

Front 54

What are the indications for Marcrolides (ACE)?

Back 54

UPS: URI:Gram positive (Staph and Strep), Staph aureus (resistant to penicillinases); Pneumonia: Mycoplasma pneumoniae, Haemophilus influenzae; STD: Chlamydia

Front 55

What are macrolides known for?

Back 55

Their ability to penetrate tissues well (ears, lungs).

Front 56

What is the most common side effect associated with Macrolides (ACE)?

Back 56

GI disturbances (erythromycin causes a motilin-like activity).

Front 57

Linezolid: uses, price, interaction, and SEs

Back 57

VRE, MRSA; $45/pill; inhibits MAO; causes BM suppression

Front 58

Name the antibiotic with an activity similar to vancomycin, without resistance, used to treat nasty Gram positive organisms like VRE and MRSA.

Back 58

Daptomycin

Front 59

Clindamycin has activity similar to which antibiotic? If you have resistance to clindamycin, which other antibiotic will you most likely also have resistance to?

Back 59

Erythromycin, erythromycin

Front 60

What is the indications for Clindamycin?

Back 60

Anaerobic infections (e.g. Bacteroides fragilis); but also covers Staph aureus, Strep pyogenes and Strep pneumoniae

Front 61

What is the most common side effect of Clindamycin?

Back 61

SPECTACULAR DIARRHEA often (20% of time) leading to pseudomembranous colitis (do NOT treat diarrhea with kaopectate or loperamide)

Front 62

What is the treatment of choice for Clostridium difficile

Back 62

Vancomycin, or metronidazole

Front 63

Metronidazole: things to know

Back 63

GET GAP (Giardia, Entameba, Trichomonas, Gardnerella, Anaerobes, H. pylori); don't drink (disulfiram like reaction); alters DNA helical coiling

Front 64

Sulfamethoxazole: MOA; main SOA; Resistance; Toxicity

Back 64

Inhibits DHF synthetase; UTI; increase PABA or salvage of aas/purines/pyrimidines from environment (this is why you can't use sulfamethoxazole on an abscess); skin rashes and displaces bilirubin from albumin

Front 65

Trimethoprim: MOA

Back 65

DHF reductase

Front 66

TMP-SMX indications

Back 66

the Super Sport for UTIs and URIs:

Salmonella, Shigella
UTI: E. coli
URI: Strep pneumo, H. influenzae, S. aureus, PCP!

Front 67

Quinolones: MOA; specialty; indications

Back 67

Inhibits DNA gyrase (topoisomerase II); oral antibiotics for gram negative infections (including P. aeruginosa)

Indications: Ciprofloxacin (not for respiratory bugs, just gram -s)
Levofloxacin (gram negative bugs plus Staph/Strept)
Moxifloxacin (gram negative bugs, Staph/Strep, anaerobes)

Front 68

What is the main toxicity associated with quinolones?

Back 68

Cartilage and tendon damage

Front 69

Best antibiotic for the following combo of bugs: Neisseria, Bacteroides fragilis, and E. coli

Back 69

Cefoxitin

Front 70

Name two polyenes, and their MOA (antifungals)

Back 70

Nystatin and Amphotericin B; irreversibly binds ergosterol

Front 71

What is the MOA of the azoles (antifungals)?

Back 71

Interfere with the biosynthesis of ergosterol by inhibiting 14 alpha-sterol demethylase

Front 72

Name an azole that is used as a losenge for the treatment of oral candidiasis.

Back 72

Clotrimazole

Front 73

What is so special about Griseofulvin? MOA? Indications?

Back 73

Oral pill for topical infections; Inhibits microtubule formation; surface fungal infections

Front 74

Terbinafine: MOA? Indications?

Back 74

Inhibits ergosterol formation by inhibiting squalene monooxygenase; Indicated for onychomycosis (3 month treatment)

Front 75

Caspofungin: MOA? Indications?

Back 75

Inhibits formation of Beta-Glucan in cell wall; Used for systemic candida infections ("Ca"spofungin for "Ca"ndida)

Front 76

Which antifungal is most commonly used to treat Cryptococcus?

Back 76

Fluconazole

Front 77

Acyclovir and Gancyclovir: MOA? Indications?

Back 77

Phosphorylated by viral Tyrosine Kinase and cellular kinases, where they inhibit DNA polymerase; Herpes, and CMV

Front 78

How do you deal with the short half life of acyclovir?

Back 78

Add a valine to it, producing valacyclovir!

Front 79

Amantadine and Rimatadine: MOA? Indications?

Back 79

Inhibit M2 protein, inhibiting viral uncoating; use as prophylaxis for Influenza A (90% are resistant now)

Front 80

Zanamivir and Oseltamivir: MOA? Indications?

Back 80

Inhibits neuraminidase; prophylaxis of Influenza (Oseltamivir decreases mortality associated with H5N1 bird flu and H1N1 swine flu)

Front 81

Name four Nucleoside Reverse Transcriptase Inhibitors (NRTI) for HIV treatment.

Back 81

LADZ: Lamivudine (pancreatitis), Abacavir (newer, less SEs), Didanosine (peripheral neuropathy and pancreatitis), and Zidovudine (anemia and granulocytopenia)

Front 82

What is the MOA of HIV NRTI?

Back 82

Inhibits the RNA-dependent DNA polymerase (reverse transcriptase). The NRTIs are lacking the 3'OH.

Front 83

Name the suffix for protease inhibitors. MOA?

Back 83

(Navir TEASE a proTEASE) -navir (e.g. saquinavir); inhibit maturation of HIV viral proteins.

Front 84

Name three NNRTI for HIV treatment. MOA?

Back 84

NED: Neviripine, Efavirenz, Delavirdine; inhibits Reverse Transcriptase.

Front 85

What is the MOA for Enfuvirtide? What is the drug?

Back 85

HIV drug; inhibits viral attachment and entry of the HIV virus, through blocking CD41 molecule folding.

Front 86

Name four drugs used for tuberculosis treatment, along with their toxicities.

Back 86

RIPE for treatment;
Rifampin (turns excretions red/orange, Red Lobster Man),
Isoniazide (DOC; hepatitis and peripheral neuropathy, supplement with vitamin B6)
Pyrazinamide (hepatitis)
Ethambutol (retrobulbar neuritis, leading to blurry vision and red/green color blindness)

Need 6 months of treatment