Step 1: Antibx I

Front 1

How to remember the Bacteriocidal antibx?
- all the others are what?

Back 1

Very Finely Proficient At Cell Murder

Vancomycin, Fluoroquinolones, Penicillins, Amingoglycosides, Cephalosporins, Metronidazole

Bacteriocidal.

Front 2

What are the four toxicities of penicillin G?

Back 2

hypersensitivity (IgE), hemolytic anemia (type II), serum sickness (type III), maculopapular xanthems (Type IV)

Front 3

What are the penicillinase resistant penicllins?
- what is the mechanism of admin?
- do they work against gram -'s?

Back 3

"IVe Met a Nasty Ox"

IV; Methacillin, nafcillin, oxacillin/dicloxacillin

not really.

Front 4

What antibx should be used for serious staph aureus infections, like endocarditis, etc?

Back 4

nafcillin.

Front 5

What has a greater oral bioavailability, Ampicilin or Amoxicillin?
- what do these drugs often get paired up with and why?

Back 5

AmOxacillin
- these both tx (-)'s better than normal Penicillin G... but they're still sensitive to penicillinase/B-lactamase. Thus, they're administered with clavulonic avid, tazobactam, or sulbactam (B-lactamase inhib) to let them work in staph.

Front 6

What are some clinical uses of the amino penicillins?
- toxicities?

Back 6

"aminopenicillin HELPS kill Enterococci"

H. influ, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterocci

hyperS; possible cause of pseudomembranous colitis.

Front 7

How do penicillins work?

Back 7

They b/transpeptidase (PBP)

Front 8

How does MRSA become resistant to penicillins?

Back 8

alters PBP (transpeptidase) structure.

Front 9

What are the antipseudomonal peniclilins?
- are the susceptible to penicillinase?

Back 9

Ticarcillin, Carbenicillin, Piperacillin, Mezlocillin
- yes, so if you're gonna use 'em against a staph better use clavulonic acid, etc. w/ 'em.

Front 10

Let's walk through the nomenclature of cephalosporins.
- 1st generation?
- 2nd?
- 3rd?
- 4th?

Also give me their activities.

Back 10

- have a "-ph", except for cefazolin ("but don't let that FAZe you")
- -fam, -fa, -fur, -fox, -te; MetNiProLor!
"after I got a PHd, had FAntastic FAMily TEa while wearing FOX FUR"
- most have a t, or tri in their names. (ceftriaxone, cefotaxime, ceftaxidime)
Exceptions: "Po' people Fix Feta at the opera"
cefpodoxin, cefixime, cefetamet, cefoperazone
- cifepime (-fep)

- 1st gets gram (+) cocci and PEcK (Proteus, E. coli, Klebsiella)
- 2nd gets gram (+) cocci and HEN PEcKS (h.influ, enterobacter, neisseria, "..." Serratia Marcescens"
- 3rd is for SERIOUS gram - infections... like meningitis b/c they penetrate BBB well.
- 4th is for pseudomonas, and other gram (+)s.

Front 11

What has the broadest antibacterial coverage known?

What is cilastatin?

SE of Imipenem?

What is Imipenem the drug of choice for?

Advantages of Meropenem?

Back 11

Imipenem / Meropenem.

inhibitor of the dihydropeptidase in kidney that breaks imipenem down.

All that of penicillin, and also lowers seizure threshold.

Enterobacter.

Reduced seizure risk and is stable to dipeptidase I.

Front 12

What is our B-lactam that has a "magic bullet" for gram (-) aerobics?
- activity against gram +'s? Why?

Back 12

aztreonam.
- none, doesn't b/their PBP.

Front 13

What % of pts with ceph allergy will have cross penicillin allergy?

Back 13

~10%

Front 14

What B-lactam can a pt allergic to both ceph and penicillin still be given?

Back 14

aztreonam.

Front 15

Tox of cephalosporins:
- what do they do re: aminoglycosides?
- some have what type of rxn w/ alcohol?

Back 15

- potentiate renal tox
- those with methylthiotetrazole group (cefamandole) can have a disulfram-like rxn.

Front 16

Klebsiella spp, Pseudomonas spp., and Serratia spp. are all BOOM'ed by what B-lactam?

Back 16

Aztreonam: only works against gram -'s that like oxygen (klebsiella is a facultative anaerobe,

Front 17

How does vancomycin work?
- how does shit get resistant to it?
- tox? (mnemonic?)
+ good thing to prevent some of this?

Back 17

Inhibits cell wall synth by b/D-Ala-D-Ala portion of cell wall precursors.
- starts using D-ala-D-lac
- well tolerated, does "NOT" have many problems: Nephrotox, ototox, thrombophlebitis, dissues flushing "RED MAN syndrome"
+ pre tx w/ antihistamines and use a slow infusion rate of vanc when it's started.

Front 18

What are the classes of protein synth inhibitors, and what do they inhibit?

Back 18

CCLLEan = 50s
TAg = 30s

Chloramphenicol, Clindamycin, Erythromycin, Linezolid, Lincomycin

Tetracycline, Aminoglycoside

Front 19

Way to remember the Aminoglycosides, AND what they do?

Why are they limited to this action?

Used primarily for?

As a class, syngergistic with what?

Back 19

"Mean" GNATS canNOT kill anaerobes.

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

NOT = tox = nephro, ototo, teratogen

Require O2 for uptake, thus don't work against anaerobes.

Severe gram - rod infections.

Penicillins, which break down the wall, then they don't need O2 to get in.

Front 20

What antibx is used especially after bowel surgx? class?

Back 20

Neomycin, aminoglycoside.

Front 21

What bumps the renal tox of aminoglycosides waaAAAay up?

Back 21

concurrent cephalosporin use.

Front 22

Mechanism of aminoglycosides?

Back 22

b/50s subunit and prevent formation of iniation complex --> mRNA misreading.

Bacteriocidal.

Front 23

What antibiotics must NOT be taken with miklk, antacids, or iron-containing preparations? why?

Back 23

Tetracyclines; divalent cations inhibit it's absorption in the gut.

Front 24

Can Doxycycline be used in pt's with renal failure? why?

Back 24

yes, it is elimated in the bowel, not urine.

Front 25

clinical uses of tetracyclines? (mnemonic)
- toxicities?
- can they be used in pregnancy? why/why not?

Back 25

VACUUM THe BedRoom

vibrio cholera, acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rickettsia.
- Discoloration of teeth and inhibition of bone growth in children, photosensitivity, Gi distress.
- no; discolored teeth, inhibition of bone growth in child.

Front 26

What are the macrolides?
- mechanism?
- toxicities (long list)?
- clinical uses?

Back 26

Erythromycin, azithromycin, clarithromycin
- inhibit protein synth by blocking translocation @50s (23S rRNA component of the 50S, to be specific)
- prolonged QT interval (esp. erythromycin), GI discomfort, actue cholestatic hepatitis, eosinopihla, skin rashes.
- URI, pneumonias, STD (gram + cocci), streptococcal infection in pt's allergic to penicillin, Mycoplasma, Legionella, Chlamydia, Neisseria

Front 27

What antibiotic increases serum concentrations of theophyllines and oral anticoagulants?

Back 27

Erythromycin (macrolides, in general)

Front 28

What can be used to tx streptococcus infections in pt's allergic to penicillins and ceph's?

Back 28

Macrolide (Erythromycin).

Front 29

What drug is primarily used to tx meningitis caused by H. influ, N. meningitidis, and Strep. pneumo?
Why?
- issues with pregnancy?

Back 29

Chloramphenicol (50S inhibitor)
- serious toxicities: dose dependent anemia, aplastic anemia (dose independent).

contraindicated in pregnancy b/c of grey baby syndrome.

Front 30

What drug primarily treats anaerobes ABOVE the diaphragm? Name two it can tx.
- tox?

Back 30

Clindamycin; bacteriodes fragillis, Clostridium perfringens

big cause of pseudomembranous colitis, fever, diarrhea.