Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
107 Cards in this Set
- Front
- Back
Which generation of cephalosporins provide gram positive coverage?
|
"1st and 2nd generation cephalosporins, some 4th"
|
|
Which generation of cephalosporins provide gram negative coverage?
|
3rd and 4th generation cephalosporins
|
|
What is the MOA of aminoglycosides?
|
"Acts at the 30S subunit and inhibits formation of initiation complex, causing the misreading of mRNA."
|
|
What is the MOA of tetracyclines?
|
Acts at the 30S subunit and prevents attachmen of aminoacyl-tRNA to acceptor site.
|
|
What is the MOA of chloramphenicol?
|
Acts at the 50S subunit and inhibits peptidyl transferase.
|
|
"What is the MOA of erythromycin, lindomycin, and clindamycin?"
|
Acts at the 50S subunit and blocks the aminoacyl-tRNA complex translocation step. (Clindamycin also blocks initiation complex formation.)
|
|
A bleeding disorder caused by penicillins.
|
Drug-induced Coombs' positive hemolytic anemia.
|
|
How do penicillins work?
|
They bind to PBPs and block peptidoglycan cross-linking.
|
|
What is the spectrum of penicillins?
|
"Cocci. Treat gram positives (streptococci, enterococci), gram negative (Neisseria), and spirochetes (Treponma pallidum |penicillin G)."
|
|
What is the advantage of using ampicillin (or amoxicillin) over penicillin?
|
"Ampicillin has an extended spectrum of coverage. In addition to cocci, it covers gram-negative rods (H. influenza, E. coli, Listeria moncytogenes, Proteus mirabilis, Salmonella)."
|
|
When is amoxicillin preferred to ampicillin?
|
Amoxicillin is good for outpatient treatment because it can be given orally.
|
|
What can be added to amoxicillin or ampicillin to broaden the specturm against gram-negatives through their ability to inactivate bacterial beta-lactamases?
|
Clavulanic acid and sulbactam
|
|
What beta-lactam drug provides coverage for Pseudomonas?
|
Piperacillin
|
|
What drug is added to piperacillin to provide added coverage against gram-negatives and S. aureus and what is its MOA?
|
Tazobactam is a beta-lactamase inactivator (like clavulanic acid and sulbactam).
|
|
"Which beta-lactamase can be used to treat UTIs (Klebsiella, Pseudomonas, Serratia) in penicillin allergic patients or patients who cannot tolerate aminoglycosides (renal insufficiency)?"
|
Aztreonam (relatively resistant to beta-lactamases)
|
|
Which drug is a broad spectrum antibiotic that is given with a second drug that prevents its inactivation in the rena tubules?
|
Imipenem
|
|
Which drug is given with impenem to extend its half-life through the inhibition of renal dihydropeptidase I?
|
Cilastatin
|
|
Which class of antibiotics can cause disulfiram-like reactions when given with alcohol?
|
Cephalosporins
|
|
What makes cephalosporins an attractive alternative to the penicillins?
|
The cephalosporins are relatively resistant to beta-lactamases.
|
|
What is the side effect profile with gentamicin?
|
Nephrotoxic (ATN) with cephalosporins; ototoxic with loop diuretics; teratogen
|
|
What is the MOA of gentamicin?
|
"Like other aminoglycosides, it acts at the 30S subuit to inihibit the formation of an initiation complex leading to mRNA misreading."
|
|
What is the spectrum of gentamicin and other aminoglycosides?
|
"They are used to treat severe infections with gram-negative rods (sepsis, endocarditis/w/vanco, pneumonia, Pseudomonas)."
|
|
What is one prominent side effect of clindamycin?
|
It is a cause of pseudomembranous colitis.
|
|
What is the spectrum of clindamycin?
|
Its effective against some anaerobes and some gram-positive cocci. It can treat anaerobic infections above the diaphragm and as endocarditis prophylaxis before dental procedures.
|
|
What is the MOA of clindamycin?
|
It binds the 50S subunit and inhibits formation of the initiation complex and translocation of the aminoacyl peptide during protein synthesis.
|
|
What is the MOA of linezolid?
|
It is a protein synthesis inhibitor that acts at the 50S subunit to prevent the formation of the ribosomal complex.
|
|
What is the spectrum of linezolid?
|
Pretty narrow. Gram-positives including MRSA and VRE and Listeria (gram positive bacilli).
|
|
What are the side effects of chloramphenicol?
|
dose-dependent anemia and aplastic anemia; gray baby syndrome
|
|
What is the MOA of chloramphenicol?
|
It reversibly binds the 50S subunit inhibiting peptidyl transferase.
|
|
When might chloramphenicol be used?
|
As a last resort in patients with bacterial meningitis that are allergic to penicillins and other antibiotics.
|
|
What is the MOA of erythromycin?
|
"It blocks the 50S ribosomal subunit, inhibiting the formation of the initiation complex as well as the translocation of the aminoacyl peptide during protein synthesis."
|
|
What is the spectrum of erythromycin?
|
"Broad. Gram-postivie cocci, atypical organisms, Corynebacteria, and some gram-negatives. Used primarily to treat upper respiratory infections (but also some STDs, H. pylori, Corynebacteria)."
|
|
What is a prominent side effect of methicillin?
|
Interstitial neprhitis
|
|
Why is methicillin an improvement over penicillin?
|
Methicillin has a bulkier structure that resists beta-lactamase.
|
|
What are some similar antibiotics to methicillin?
|
"Naficillin, oxacillin, dicloxacillin"
|
|
What is the MOA of tetracycline?
|
It binds the 30S subunit and block the aminoacyl-tRNA from binding to the ribosome.
|
|
What is the spectrum of tetracycline?
|
"Broad. Gram positives and Gram negatives. Vibrio, chlamydia, rickettsiae, mycoplasmas, spirochetes, some anaerobes."
|
|
What diseases does tetracycline treat?
|
"Pneumonia (mycoplasma, chlamydia), Rocky mountain spotted fever, Lyme diseases, cholera, sexually transmitted chlamydia infections"
|
|
What are some prominent side effects of tetracycline?
|
"Teeth discoloration and bone deformity in children, Fanconi syndrome, photosensitivity"
|
|
What drug that is similar to tetracycline can be used in renally insufficient patients?
|
Doxycycline because it is eliminated in feces.
|
|
What dietary considerations must be considered with tetracycline?
|
"It cannot be taken with divalent cations due to inhibited absorption (i.e. antacids, milk, iron-containing substances)."
|
|
What tetracycline related drug can be used to treat SIADH?
|
Demeclocycline works as a competitive antagonist at the V2 receptor.
|
|
What is the MOA of Trimethoprim-Sulfamethoxazole (TMP-SMX)?
|
TMP works by inhibiting dihydrofolate reductase. Sulfamethoxazole acts as a structural analog of PABA and competitively inhibits dihydropteroate synthase.
|
|
What is the spectrum for Trimethoprim-Sulfamethoxazole?
|
"Broad. Gram positives and gram-negatives including enterics, Chlamydia, Nocardia, and P. jiroveci."
|
|
What conditions does trimethoprim-sulfamethoxazole treat?
|
Pneumonia and urinary tract infections.
|
|
What are the prominent side effects of trimethoprim-sulfamethoxazole?
|
"Steven-Johnson syndrome, hemolytic anemia, kernicterus in newborns, granulocytopenia that can be alleviated with folinic acid."
|
|
What is the MOA of ciprofloxacin and other fluoroquinolones?
|
"Inhibitors of bacterial DNA topoisomerase II, inducing strand breakage and cell death."
|
|
What is the spectrum for ciprofloxacin?
|
"Gram negatives. Neisseria, Haemophilus, Klebsiella, E. coli, Enterobacter, Mycoplasm, Legionella"
|
|
What is ciprofloxacin used for?
|
"UTIs, pneumonias, gonococcal infections, other respiratory tract infections, GI infections"
|
|
What are the side effects of ciprofloxacin?
|
"Tendonitis and tendon rupture, contraindicated in pregnant women and children"
|
|
"Which antibiotic is preferentially reduced inside bacterial cells, increasing its reactivity and making it a useful treatment against UTIs?"
|
Nitrofurantoin
|
|
What is the MOA of vancomycin?
|
"Binding of the D-ala D-ala terminus of bacterial cell wall precursors, inhibiting transglycosylase, limiting elongation and crosslinking."
|
|
What is the spectrum of vancomycin?
|
"Gram-positive bacteria. Staph, strep, enterococci."
|
|
What are the uses for vancomycin?
|
Gram-positive multi-drug-resistant infections like sepsis and endocarditis. Also used for pseudomembranous colitis.
|
|
What are the side effects of vancomycin?
|
"Red man syndrome, ototoxicity, nephrotoxicity"
|
|
What is the MOA for polymyxins?
|
Bind to bacterial cell membranes and increase the permeabiliyt of the cell membrane to polar molecules.
|
|
Name one antibiotic that is used for anaerobic infections above the diaphragm and one that is used for anaerobic infections below the diaphragm.
|
Clindamycin and metronidazole
|
|
What is the MOA of metronidazole?
|
"It is metabolized by bacterial proteins into reduced reactive compounds that damage bacterial DNA, protein, and membranes."
|
|
What is the spectrum of metronidazole?
|
"Anaerobic bacteria and protozoans. (Clostridium, Bacteriodes, Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis)"
|
|
What precautions must a patient taking metronidazole be aware of?
|
Disulfiram-like effect with alcohol
|
|
What are some important drug interactions to be aware of with metronidazole?
|
"Potentiates warfarin and other anticoagulants, levels decreased by phenytoin and phenobarbital, levels increased by cimetidine"
|
|
What is the MOA of rifampin?
|
Inhibition of bacterial DNA-dependent RNA polymerase.
|
|
Under what circumstances is rifampin used prophylactially?
|
"Contacts of patients with meningococcal meningitis, and H. influenza type B infection."
|
|
What coverage does rifampin provide?
|
"Mycobacteria, Neisseria meningococcus, H. influenza"
|
|
What are a couple of key side effects of rifampin?
|
Orange color in urine and sweat; hepatitis
|
|
What are some of the drug interactions of rifampin?
|
"Induces cytochrome P-450 affecting metabolism of warfarin, oral contraceptives, prednisone, ketoconazole, digoxin, and glyburide."
|
|
What medication is used prophylactically against active tuberculosis?
|
Isoniazid
|
|
What is the MOA of isoniazid?
|
It inhibits the synthesis of mycolic acid.
|
|
What are some side effects of isoniazid?
|
"Peripheral neuropathy (unless given with vitamin B6), drug-oinduced lupus, hepatitis, G6PD-deficient hemolytic anemia"
|
|
What fact of pharmacokinetics is important to remember when administering isioniazid?
|
"Some patients are fast metabolizers due to genetic differences in the liver enzyme N-acetyltransferase, so serum level should be monitored to assure therapeutic levels."
|
|
Which antimycobacterial agents are used in combination with other medications (like rifampin and isoniazid) to treat TB?
|
Ethambutol and pyrazinamide
|
|
Which antimicrobial can be used in combination with rifampin to treat leprosy?
|
Dapsone
|
|
What's the MOA of ethambutol?
|
Inhibits mycobacterial arabinosyl transferase which is important for mycobacterial cell wall synthesis.
|
|
What's the MOA of dapsone?
|
It’s a PABA antagonist that inhibits folic acid synthesis in a manner similar to sulfonamides.
|
|
What is a prominent side effect of dapsone?
|
G6PD-deficient hemolytic anemia
|
|
What is a prominent side effect of ethambutol?
|
Retrobulbar neuritis
|
|
What is a prominent side effect of pyrazinamide?
|
Hepatotoxicity
|
|
What are some prominent side effects of nucleoside reverse transcriptase inhibitors?
|
Megaloblastic anemia (AZT) and pancreatitis (ddI)
|
|
List seven nucleoside revers transciptase inhibitors.
|
"zidovudine (AZT), didanosine (ddI), zalcitabine (ddC), lamivudine (3TC), stavudine (d4T), emtricitabine (FTC), and abacavir"
|
|
What are the names and MOAs of two medications used to treat HIV infection (one of which can also be used for hepatitis B).
|
Tenofovir and adefovir (hep B effective) are nucleotide analog reverse transcriptase inhibitors that also inhibit viral reverse transcriptase.
|
|
Which nucleoside reverse transcriptase inhibitor is used in the treatment of chronic hepatitis B.
|
Lamivudine
|
|
What are the treatments for gonorrhea and Chlamydia?
|
Ceftriaxone and azithromycin or doxycycline (7 days)
|
|
What is the MOA of non-nucleoside reverse transcriptase inhibitors (NNRTIs)?
|
"They bind specifically to HIV reverse transcriptase, blocking DNA synthesis."
|
|
What are the NNRTIs (3)?
|
"Nevirapine, efavirenz, delavirdine"
|
|
What are NNRTIs used for?
|
Treatment of HIV infection.
|
|
What are some of the side effects of nevirapine?
|
"Induction of cytochrome P-450 system (OCPs, warfari, metronidazole, ketoconazole, protease inhibitors affected), Stevens-Johnson, fulminant hepatits"
|
|
What are some of the side effects of efavirenz?
|
CNS disturbances including nightmares and delusions
|
|
What are some of the suffixes of the protease inhibitors?
|
*nivir and *navir
|
|
What is the MOA of protease inhibitors?
|
They prevent replication by interfering with the maturation process (precursor cleavage) of viral core proteins.
|
|
What are protease inhibitors used for?
|
Treatment of HIV infection.
|
|
What are some side effects of protease inhibitors?
|
"Altered distribution of body fat (buffalo hump, truncal obesity), insulin resistance, hyperlipidemia."
|
|
Which protease inihibitor has the side effect profile of inhibiting cytochrome P-450?
|
Ritonavir
|
|
What is the MOA of acyclovir?
|
It is phosphorylated by viral thymidine kiase to an analogue of dGTP that inhibits DNA synthesis by chain termination.
|
|
What is acyclovir used for?
|
"HSV-1 and 2, VZV, and EBV. Genital herpes, herpes encephalitis, acute VZV infection and oral hairy leukoplakia associated with EBV."
|
|
What are some of the side effects of acyclovir?
|
"Neurotoxicity (tremor, delirium)"
|
|
How might a virus become resistant to acyclovir?
|
It may lack thymidine kinase.
|
|
Which drugs are related to acyclovir?
|
"valacyclovir, penciclovir, famciclovir"
|
|
What is the MOA of ganciclovir?
|
It is a guanosine analogue that when phosphorylated by a viral kinase into a nuleotide analogue preferentially inhibits CMV DNA polymerase.
|
|
What is ganciclovir used for?
|
CMV infections; particularly CMV retinitis
|
|
What is a major side effect of ganciclovir?
|
Pancytopenia
|
|
What is foscarnet?
|
A pyrophospate analog that inhibits viral DNA polymerase.
|
|
What is foscarnet used for?
|
It is a second-line treatment of CMV retinitis and other CMV infections. Side effect is nephrotoxicity.
|
|
What is the MOA of amantadine?
|
"Binds to the M2 surface protein proton channel on influenza A, blocking the uncoating of the viral RNA within the host cell."
|
|
What are the clinical uses of amantadine?
|
"Amantadine reduces the duration of the influenza A symptoms and also stimulats the release of dopamine from the nigra striatum, making it a useful treatment for Parkinson disease."
|
|
What are the side effects of amantadine?
|
"CNS symptoms including ataxia, slurred speech, and dizziness."
|
|
What is the MOA of zanamivir?
|
"It inhibits neuraminidase, preventing viral replication and release of viral particles from infected cells."
|
|
What are the clinical uses of zanamivir?
|
It is used in the treatment and prophylaxis of both influenza A and B.
|