Ppal99 Dissecting The Usmle 1,2,3 Antibiotics

Front 1

what is pharmacokinetics?
what are 4 steps that the body does to the drug?

Back 1

what the body does to drug:
1) Absorbed
2) Distributed
3) Metabolized
4) Excreted

Front 2

what are the 5 ways to Absorb drugs?

Back 2

"TAP IT"
Topical
Alimentary
Parenteral
Inhalation
Transdermal

Front 3

Inhalation

Back 3

pulmonary drugs

Front 4

Topical

Back 4

localized disease

Front 5

Transdermal

Back 5

sustained release

Front 6

what are the 4 different alimentary ways of absorbing drugs?
which ones bypasses the liver
which one goes straight to the venous circulation?
which one uses the small intestine for absorption?

Back 6

>Oral- uses small intestine (large surface area)
>Buccal- goes into venous circulation
>Sublingual- goes into SVC (bypass liver)
>Rectal - 50% bypass liver

Front 7

what are the 4 different ways parenteral of absorbing drugs?
which one goes 100% to circulation?
which one goes to subarachnoid space?

Back 7

• IV- 100% goes into circulation
• IM
• Subcutaneous
• Intrathecal- into subarachnoid space

Front 8

2 ways to distribute drugs in the body.

Back 8

Diffusion: high ⇨ low conc, may be facilitated
Active transport: against concentration gradient, ATP ⇨ ADP

Front 9

what are the 5 different ways to metabolize drugs?
define Metabolism.
polar/fat soluble is eliminated quicker?

Back 9

Metabolism is when lipids pass through cell membrane
polar eliminates quicker.
>Phase I rxn
>Phase II rxn
>Biotransformation factors
>Zero-order Kinetics
>1st-order Kinetics

Front 10

Phase I rxn: location and MOA

Back 10

Liver ER: redox and hydrolysis =>polar groups

Front 11

Phase II rxn

Back 11

Liver cytosol: conjugation => add glutathione, acetic acid, sulfate

Front 12

Biotransformation factors: give 5 examples

Back 12

Genetics, age, gender, liver disease, P45O

Front 13

Zero-order Kinetics
define
give 3 examples
EtOH (100mg/dL/hr): what is this equivalent to?

Back 13

metabolism independent of concentration
Ex: EtOH, Phenytoin, Chemo drugs
EtOH (100mg/dL/hr): 1 glass wine, 1 shot whiskey, 2 cans of beer

Front 14

define 1st order Kinetics
Ex: 10% of drug (conc=100mg/dL) eliminated every 2 hours:
• T=O hrs: [D]=
• T=2 hrs: [D]=
• T=4 hrs: [D]=

Back 14

constant drug percentage metabolism over time:
Ex: 10% of drug (conc=100mg/dL) eliminated every 2 hours:
• T=O hrs: [D]=100mg/dL
• T=2 hrs: [D]=90 mg/dL
• T=4 hrs: [D]=81 mg/dL

Front 15

2 ways to remove the drug from the body:

Back 15

Excretion
Secretion

Front 16

Excretion

Back 16

removal of drug from body via urine, feces, respiration, skin, breast milk

Front 17

Secretion

Back 17

transport drug to another compartment

Front 18

Pharmacodynamics

Back 18

what drugs do to the body

Front 19

4 types Receptor interactions and examples

Back 19

>Transmembrane (Ex: Insulin)
>Ligand-gated ion channels (Ex: BZ, ACh)
>Transcription factors (Ex: Steroid hormone receptors)
>Second-messengers: (Ex: cAMP, cGMP, IP3)

Front 20

Agonist

Back 20

activates receptors

Front 21

Antagonist

Back 21

inhibits receptors

Front 22

t1/2= formula

Back 22

(.693)(Vd) /clearance

Front 23

Vd
equation
what does a large Vd mean?

Back 23

total drug / plasma conc
(large Vd => most of drug is sequestered)

Front 24

Loading dose:

Back 24

(desired plasma conc)(Vd)

Front 25

Maintenance dose:

Back 25

(desired plasma conc)(clearance)

Front 26

Steady-state plasma conc (Css)
how many half lives does it take?

Back 26

availability rate = elimination rate
takes 4.5 halflives

Front 27

Clearance

Back 27

volume of plasma cleared of drug

Front 28

calculate the Excretion rate:

Back 28

(clearance)(plasma conc) - rate of elimination

Front 29

TI= formula
what does high TI mean?

Back 29

(toxic dose)/(therapeutic dose)
(High TI => safe drug) = LD50, ED50

Front 30

Peak level
what if the peak level is high? management

Back 30

4 hrs after dose
(too high=> decrease dose)

Front 31

Trough level
management if the trough level is high?

Back 31

2 hrs before dose
(too high => give less often)

Front 32

Bacteriostatic:

Back 32

protein synthesis inhibitors
(except aminoglycosides)

Front 33

Bacteriocidal

Back 33

all the rest

Front 34

p450-dependant drugs:

Back 34

levels rise if you inhibit p450
"Women's DEPT"
Warfarin
Digoxin
Estrogen
Phenytoin
Theophylline

Front 35

Hospital Abscesses:
Day 1-3:
Day 4-7:
>7:

Back 35

Hospital Abscesses:
Day 1-3: Staph aureus - lots of 02
Day 4-7: Strep viridans- no enzymes
>7: Anaerobes - PMNs

Front 36

Staph Drugs: (7)

Back 36

(at least one)
• Amoxicillin + Clavulanate
• Ampicillin + Sulbactam
• Methicillin
• Naficillin
• Cephalosporins
• Vancomycin
• Macrolide

Front 37

Inhibit p450:

Back 37

"Frequently I Do SMACK Grapefriut juice"
Fluoroquinolones
INH
Diltiazem
Sulfa drugs
Macrolides
Amiodorone
Cimetidine
Ketoconazole
Grapefruit juice

Front 38

Pseudo Drugs: name all 8

Back 38

(at least two)
• Ticarcillin + Clavulinic
• Piperacillin +Tazobactam
• Carbenacillin
• Ceftazidime or Cefepime
• Vancomycin
• Fluoroquinolones
• Aminoglycosides

Front 39

what should be started with pseudo drug when fever is >48 hrs.

Back 39

Start anti-fungal if fever >48hr

Front 40

p450 Inducers:

Back 40

"Queen Barb StealS Phen-Phen And Then Refuses Greasy Carbs"
Quinidine
Barbiturates
St. John's wort/spirololactone
Phenytoin
Alcohol
Tetracyclines
Rifampin
Griseofulvin
Carbamazepine

Front 41

Cystic Fibrosis acute exacerbation of the lung tx

Back 41

Tx: penicillin/cephalosporin + aminoglycoside
ie. ceftazidime and gentamycin

Front 42

DNA Synthesis Inhibitors:

Back 42

Fluoroquinolones
RNA Polymerase Inhibitors
Sulfa Drugs

Front 43

Fluoroquinolones
MOA
do not mix with what drug?
bug tx
SE
CI

Back 43

MOA: inhibit Topo II (DNA gyrase), decreased w/ antacids
Tx: Gram +/- , Atypicals (not anaerobes)
SE: Inhibit rapidly dividing cells => anemia, UTI, dry skin, fetal growth retardation
CI: Pregnancy, Kids

Front 44

what are the fluoroquinolone drugs?

Back 44

the "ofloxacin" drugs
Levofloxacin
Ciprofloxacin
Norfloxacin
Trovafloxacin
Ofloxacin
Gatifloxacin

Front 45

Ciprofloxacin

Back 45

best Pseudomonas coverage

Front 46

Norfloxacin

Back 46

tx UTI only

Front 47

Trovafloxacin

Back 47

taken off market due to hepatic necrosis

Front 48

Ofloxacin

Back 48

tx Gonorrhea (1-dose), increasing resistance

Front 49

Gatifloxacin

Back 49

tx Gonorrhea (1-dose), increasing resistance

Front 50

drugs that cause Myositis:

Back 50

"RIPS"
• Rifampin
• INH
• Prednisone (any steroid)
• Statins

Front 51

what drugs cause disulfiram Rxns:

Back 51

• Metronidazole
• Cephalosporins
• Procarbazine

Front 52

RNA Polymerase Inhibitors:
SE (2)
Tx
MOA

Back 52

'The 5 R 's of Rifampin"
SE: Revs up P450, Red-orange secretions, Resistance if used alone
SE: Fat soluble=> myositis (rips up muscle), hepatitis
Tx: TB, N. Meningitidis and HI-B prophylaxis (give to close contacts)
• Rifampin (inhibits beta subunit of RNA Pol)

Front 53

Sulfa Drugs:
MOA
bugTx (2)
SE: (3)

Back 53

MOA: inhibit folate synthesis/PABA
bug Tx: Gram+, simple Gram -
SE: G-6PD hemolytic anemia, porphyria, MetHb

Front 54

what are the sulfa drugs

Back 54

Sulfamethoxazole
• Sulfadiazine
• Sulfacetamide
• Sulfasalazine
• Sulfapyrazone

Front 55

Trimethoprim Sulfamethoxazole
what does Sulfamethoxazole inhibit? used for who?
what does Trimethoprim inhibit
SE

Back 55

Sulfamethoxazole - inhibits DHP synthetase, used for kids
Trimethoprim- inhibits DHF reductase
SE: kernicterus, renal failure, no sulfur

Front 56

Sulfadiazine

Back 56

tx burn pts (cream)

Front 57

Sulfasalazine

Back 57

tx UC

Front 58

Sulfapyrazone

Back 58

tx UC

Front 59

Sulfacetamide
tx

Back 59

tx Chlamydia eye infections
prevent neonatal blindness in 3rd world

Front 60

Polymixins class
MOA
bug Tx

Back 60

Cell membrane disrupter
cationic detergents
Tx: Gram ( - )

Front 61

Metronidazole MOA

Back 61

02 free radicals

Front 62

metronidazole tx

Back 62

''GGETon the Metro"=>
Tx: Giardia, Gardnerella, Entamoeba, Trichomonas, all anaerobes

Front 63

why does metronidazole cause disulfiram rxn.

Back 63

>Inhibits acetaldehyde dehydrogenase => hemolytic anemia due to oxidation
>disulfiram rxn (N/V /D w/ EtOH)

Front 64

drugs that cause dysgeusia:

Back 64

Clarithromycin
Li
metronidazole

Front 65

Protein Synthesis Inhibitors:
30S Inhibitors:

Back 65

"buy' AT 30, CEL at 50"
Aminoglycosides
Tetracyclines

Front 66

Aminoglycosides:
MOA
bacteriostatic/bacteriocidal
SE
bug Tx
CI with what disease?

Back 66

MOA: inhibit IF2; bacteriocidal
Tx: All Gram ( - )
SE: ototoxicity, nephrotoxicity, neurotoxicity
(inhibits presynaptic Ca influx) =>can't use w/ NM

Front 67

name the aminoglycosides

Back 67

Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
Spectinomycin

Front 68

Gentamicin
SE

Back 68

neuropathy

Front 69

Neomycin
SE
function

Back 69

topical (including gut surface) => rash
kills NH4-producing bacteria

Front 70

Amikacin
1/2 life
excretion

Back 70

hepatic excretion=> OK for kidneys, long t1/2

Front 71

Tobramycin

Back 71

tx CF pts

Front 72

Spectinomycin

Back 72

former gonorrhea
"now just a spectator"

Front 73

Streptomycin
treatment for what two diseases

Back 73

tx TB pts, tx tularemia

Front 74

Tetracyclines
MOA
bug TX

Back 74

MOA: block tRNA
Tx: all Gram+ , simple Gram-, Atypicals (not Staph aureus), Rickettsia

Front 75

Tetracyclines
SE (6)
should not mix with what drugs?
CI (2)

Back 75

SE: photosensitivity (wear SPF15), errosive esophagitis,
permanent grey teeth, revs up P450, Fanconi's (if old drug), negates Oral contraceptives
binds Ca2+=> don't use w/ Tums or milk
CI: Pregnancy, kids

Front 76

Tetracyclines name all

Back 76

Minocycline
Doxycycline
Demecocycline
Oxytetracycline

Front 77

Minocycline

Back 77

tx acne "mean-o-teenagers have acne"

Front 78

Doxycycline
how is it excreted?

Back 78

hepatic excretion

Front 79

Demecocycline: MOA
SE

Back 79

blocks ADHr =>nephrogenic DI (like Li)

Front 80

Triple Antibiotic:

Back 80

"Brand New Patient"
Bacitracin
Neomycin,
Polymyxin D

Front 81

50S Inhibitors:

Back 81

Lincosamides
Macrolides
Chloramphenicol

Front 82

Chloramphenicol
MOA
Tx bugs: (2)
SE: (3)

Back 82

"CAM" - blocks peptidyl transferase
• Tx: all Gram +, Rickettsia
• SE: aplastic anemia, inhibits ETC complex IV, grey-baby syndrome

Front 83

Macrolides
MOA
Tx: (3)
SE: (2)

Back 83

MOA: block translocation
• Tx: all Gram +, simple Gram (-), Atypicals
• SE: inhibit P450, Torsade w / 3rd generation anti-histamines

Front 84

Macrolides name all

Back 84

Clarithromycin
Erythromycin
Azithromycin

Front 85

Clarithromycin:
class
MOA
SE

Back 85

MacroLide
transLocase on the 50S subunit
dysguisia (metallic taste)

Front 86

Azithromycin:
class and MOA
t1/2
tx for what bug
good for what patients

Back 86

Macrolide: Inhibits transLocase on the 50S subunit
longest t1/2,
tx MAI (AIDS pts)
good for pregnant women

Front 87

Erythromycin:
class and MOA
SE
tx

Back 87

Macrolide: Inhibits transLocase on the 50S subunit
GI upset
tx Legionella pneumonia

Front 88

Lincosamides
MOA
Tx
SE

Back 88

MOA: block translocation (tranlocation on 50S subunit)
• Tx: all Gram +, simple Gram- , all Anaerobes
• SE: pseudomembranous Colitis

Front 89

Lincosamides
which one is not used now?

Back 89

Clindamycin
Lincomycin: not used now

Front 90

Lincomycin

Back 90

Lincosamides that is not used now

Front 91

Chlamydia 1-dose Tx:
dose to treat with GC

Back 91

• Azithromycin (1g)
• Or 2g to tx GC

Front 92

who is at risk of Staph /Pseudo Attack:

Back 92

• DM
• CF
• Burn pts
• Neutropenic pts

Front 93

3 bugs Vancomycin tx:

Back 93

• MRSA
• Staph. epidermidis
• Enterococcus

Front 94

Gonorrhea 1-dose Tx:

Back 94

"TRI to FIX the FOX with 3 FLOX''
• Ceftriaxone
• Cefixeme
• Cefoxitin
• Ciprofloxacin
• Ofloxacin
• Gatifloxacin

Front 95

Cell wall synthesis inhibitors (5)

Back 95

Penicillins
Cephalosporins
Carbapenems
Monobactams
Vancomycin

Front 96

Vancomycin
MOA
Tx:
SE

Back 96

MOA: irreversibly blocks formation of cell wall peptide bridges
Tx: all Gram +
SE: ototoxicity, nephrotoxicity, red man syndrome

Front 97

Aztreonam:
class
tx for what bug
MOA
usage

Back 97

Monobactams:
Gram- rods
good for penicillin allergies

Front 98

Carbapenems:
Tx for what bugs?
and 2 drugs

Back 98

everything (except atypicals)
• Imipenem + Cilastatin
• Meropenem

Front 99

Imipenem + Cilastatin
how does this decrease seizure incidence?

Back 99

(inhibits renal enzymes to decrease seizure incidence)

Front 100

Cephalosporins:
Tx:
SE: same as what drug? crossover
gram - coverage

Back 100

Tx: all Gram+, simple Gram-, simple anaerobes
SE: same as penicillins (15% crossover with penicillins for anaphylaxis)
More Gram - coverage as you progress through generations

Front 101

how many generations of cephalosporins?
name all the first generations?

Back 101

There are 3 generations of cephalosporins:
1stGen:
Cefazolin
Cephalothin
Cephalexin

Front 102

Cefazolin

Back 102

parenteral (IV)

Front 103

Cephalothin
SE
class

Back 103

interstitial nephritis
1st generation cephalosporin

Front 104

2nd gen cephalosporins: name all drugs

Back 104

"FOX FAMily are FACking FOes and wearing FUR "

Cefaclor
Cefotetan
Cefoxitin
Cefamandole
Cefuroxime

Front 105

Cefaclor
class
who uses it
SE (4)

Back 105

2nd gen cephalosporins
use in kids => erythema multiforme, urticaria, bone pain, serum sickness

Front 106

Cefotetan

Back 106

inhibits Vit K =>bleeding

Front 107

Cefoxitin

Back 107

excellent complete anaerobic coverage

Front 108

Cefamandole

Back 108

inhibits Vit K => bleeding

Front 109

Cefuroxime
tx for what diesease
class

Back 109

tx epiglottitis
second generation cephalosporin

Front 110

3rd Generation cephalosporins
which one is take orally?
which one is renally excreted? and treatment for meningitis <2 y/o?

Back 110

Ceftriaxone
Cefixeme - oral
Cefotaxime -renal excretion, tx meningitis <2m/o
Ceftazidime
Cefoperazone
Moxalactam

Front 111

Ceftriaxone
MOA
crosses what barrier
tx:
why cannot be used for <2mo

Back 111

cross BBB
hepatic excretion (not <2m/o),
tx meningitis >2 mo

Front 112

Ceftazidime
class
coverage

Back 112

third generation
best Pseudo coverage ''pseudo tazo tea"

Front 113

Cefoperazone
class
SE

Back 113

third generation cephalosporin
dec. Vit K

Front 114

Moxalactam
class
SE

Back 114

third generation cephalosporin
dec. Vit K

Front 115

4th Generation cephalosporin

Back 115

Cefepime

Front 116

4 types of Penicillins:

Back 116

Simple
Extended Spectrum
Anti-Staphylococcal
Anti-Pseudomonal

Front 117

Penicillins:
Tx for what bugs
SE (6)

Back 117

Tx: Gram + (not Staph), simple anaerobes
SE: anaphylaxis, non-specific rash, drug fever
SE: hemolytic anemia, interstitial nephritis, bone marrow suppression

Front 118

what are the Simple penicillins

Back 118

• Penicillin G
• Penicillin V
• Benzathine
• Procaine

Front 119

Penicillin G

Back 119

shot

Front 120

Penicillin V

Back 120

oral
"remember the terminal Sulcus v line in the back of the tongue?"

Front 121

Benzathine

Back 121

simple penicillin
long-acting

Front 122

Procaine

Back 122

simple penicillin
short -acting

Front 123

Extended Spectrum:
MOA (bug coverage)
name the drugs (2)

Back 123

MOA: also cover E. coli, H. influ + Staph aureus (β -lactamase inhibitors)
• Amoxicillin + Clavulinic acid
• Ampicillin + Sulbactam

Front 124

Ampicillin + Sulbactam
class
SE (2)
what is it used for?

Back 124

Extended Spectrum penicillins
=> J-H rxn (EBV, CMV, Syphilis), #2 interstitial nephritis,
tx pregnant UTIs

Front 125

5 Anti-Staphylococcal penicillins
which one is oral

Back 125

• Methicillin
• Nafcillin
• Oxacillin
• Cloxacillin
• Dicloxacillin: oral

Front 126

Methicillin
type of penicillin
route
SE

Back 126

>>Anti-Staphylococcal penicillins
>>IV=> #1 PCN causing interstitial nephritis

Front 127

Nafcillin
type of antibiotic
route/SE

Back 127

>>Anti-Staphylococcal penicillins
>>IV-high Na load (do not use w/ Conn's, arrhythmias, HTN, seizures)

Front 128

what are the three Anti-Staphylococcal penicillins that can be taken orally?

Back 128

• Oxacillin
• Cloxacillin
• Dicloxacillin

Front 129

4 Anti-Pseudomonal penicillins

Back 129

• Ticarcillin + Clavulinic acid
• Piperacillin + Tazobactam
• Carbenacillin
• Mezlocillin

Front 130

Ticarcillin + Clavulinic acid
coverage

Back 130

anti-pseudomonal penicillins
(also covers S. Aureus)

Front 131

Carbenacillin
class
SE

Back 131

anti pseudomonal penicillins
high Na load