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95 Cards in this Set
- Front
- Back
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What is a ghon complex?
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TB granuloma with lobar and perihilar lymph node involvemnt- 1ry infection or exposure
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What happens in 1ry TB?
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Heals by fibrosis->Immunity and Hypersensitivity->+TST
Progressive lung disease (HIV, malnutrition)-> death Severe bacteremia-> Miliary TB-> Death Preallergic lymphatic or hematogenous dissemination->dormant tubercle bacilli-> reactivation |
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What are some sites of extra-pulmonary TB?
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CNS- granulomas at base of brain, meningitis
Vertebral body- potts Lymphadenitis- scrofula Renal- sterile pyuria GI Miliary- little granulomas all over the place |
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what are the various derivatives of mycosides in TB?
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Mycolic Acid- large fatty
Mycoside- mycolic acid bound to a carb Cord factor- 2 mycolic acids bound with a dissacharide- can cause inhibition of neutrophil migration. cachexia Sulfatides- mycosides like the cor, but with sulfur- helps with facultative intracellularness Wax D- adjuvant- protects the cellular immune system |
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What is leprosy?
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M. Leprae- likes cool temp- skin and superficial nerves.
rmadillos Rx- dapsone- toxicity is hemolysis and methemoglobinemia Alt Rx- rifampin and clofazimine and adpsome |
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Which drugs are useless against mycoplasma?
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Penicillin
cephalos they have a sterol cell wall |
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What is the difference between tuberculoid and lepramatous leprosy?
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tuberculoid- has an immune response, has decreased sensation, one lesion.
lepromatous- worse, no immune, no loss of sensation, crazy acid-fast bacilli. |
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Describe the leonine facies of leprosy.
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loss of eybrows
nasal collapse lumpy earlobe |
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What drugs block cell wall synthesis by inhibition of peptidoglycan cross-linking?
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Penicillin, Ampicillin, Ticarcillin, Piperacillin, Imipenem, Aztreonam, cephalosporins
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What drugs blcok peptidoglycan synthesis?
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Bacitracin, vancomycin, cycloserine
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What drugs disrupt bacterial/fungal cell membranes?
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polymyxins
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What drugs disrupt fungal cell membranes?
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Amphotericin B, Nystatin, Fluconazole
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What drugs block nucleotide synthesis?
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sulfonamides, Trimethomprim
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What drugs block DNA topoisomerases?
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Quinolones
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What drugs block mRNA synthesis?
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Rifampin
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What drugs blcok the 50S?
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Chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins, linezolid
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What drugs blcok protein synthesis at the 30S?
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Aminoglycosides, tetracyclines
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What is the evolution of Penicillin?
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Penicillin G
Aminopenicillins- more G-s penicillinase resistant penicillins- useful against b-lactamase anti-pseudomonal- wider coverage of G-s cephalosporins- resistant to b-lactamase, broad spectrum |
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What major adverse effect can all penicillins cause?
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anaphylaxis
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When is penicillin still used?
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Pneumonia by S. pneumoniae
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What bugs are susceptible to Aminopenicillins?
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E. coli and the other enterics
HELPS H. Influenza E. Coli Listeria Proteus Salmonella |
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What are the aminopenicillins?
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Amoxicillin, ampicillin
fit in the ol porin channels of the G-s |
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Why are methicillin, nafcillin, and oxacillin awesome?
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they are penicillinase resistant
but are given IV |
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What makes dicloxacillin and cloxacillin so frickin' sweet?
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they are oral and penicillinase resistant
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What are the pseudomonas penicillins?
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Carboxypenicillins- Ticarcillin and Carbenicillin
Ureidopenicillins Piperacillin and Mezlocillin still sensitive to penicillinases |
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What are teh disadvantages of Carbenicillin?
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lower activity, higher doses, high Na load, platelet dysfunction, and hypokalemia
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What are the SEs of Methicillin?
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interstitial nephritis
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What are the side effects of ampicillin?
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ampicillin rash, pseudomembranous colitis
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What is the difference between 1st, 2nd, and 3rd generation cephalosporins?
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1st- good on strep and G+s, used pre-surgery(ph- except cefazolin, cfadroxil)
2nd- okay on G-s, G+s, and strep (fam, fa, fur, fox) 3rd- good on G-s, Strep; multi-drug resistance, nosocomial pneumonia, meningitis, sepsis, and UTI(tri, taz, tax, ti) 4th- cefepime, like 3rd generation, but with more against G+s adn Pseudomonas |
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What is good about cefotetan, cefoxitin, and cefmetazole?
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good against anaerobes, like bacteroides fragilis.
intra-ab infections, aspiration pneumonia, colorectal surgery prophylaxis |
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What cephalos are good against Pseudomonas?
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ceftazidime, cefoperazone, and cefepime
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What are some good things about Ceftriaxone?
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CSF penetrator, meningitis
Gonorrhea |
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What drugs don't follow the PH rule of 1st generation cephalos?
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Cefazolin, cefdroxil
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What drugs don't follow the F rule in 2nd generation cephalos?
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loracarbef
Cefixime (3rd) Cefoperazone (3rd) cefpodoxin (3rd) cefetamet (3rd) cefepime (4th) |
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What drugs don't follow the T rule for 3rd generation?
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cefotetan(2nd generation)
cefixime cefoperazone cefpodoxin cefetamet |
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What are 1st generatioin cephalos used for?
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PEcK
proteus mirabilis, E. colie, Klebsiella |
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What are 2nd generation cephalos used for?
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HEN PEcKS
H. influenzae, Enterobacter aerogenes Neisseria Proteus mirabilis E. Coli Klebsiella Serratia marcescens |
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What are the SEs of cephalos?
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Increased nephroxicity of aminoglycosides
Cefamandole- blocks acetyladehyde breakdown with alcohol |
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What is the role of Imipenem?
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cabapenem with broadest spectrum
MRSA, some pseudomonas and mycoplasma are resistant Given with cilastin |
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What is the role of cilastin?
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prevents breakdown of imipenem by renal dihydropeptidase I
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What are the SEs of imipenem
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Seizure, GI distress, rash, allergic
Meropenem is newer- less seizure |
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What is the role of aztreonam?
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magic bullet for G- aerobes
monobactam. Only G- usually used with vancomycin or clindamycin no cross allergenicity to penicillin |
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Vancomycin
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Good for all G+ bugs
SEs- Nephrotox, Ototox, Thrombophlebitis, red man syndrome- histamine release |
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What drugs are 30S and 50S inhibitors?
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Buy AT 30, CELL at 50
30 Aminogclycocides (IV only) Tetracylcines 50 Chloramphenicol Erythromycin Lincomycin cLindamycin |
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What are the SEs of Chloramphenicol?
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Anemia, aplastic anemia, gray baby syndrome (no UDP-glucouronyldase)
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Despite it's side effects, why is chloramphenicol used?
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BBB crossing ability, wide spectrum.
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What is clindamycin good for?
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Anaerobes. Not G-s.
used for perforated abdomen, septic abortions, acne |
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What are the SEs of clindamycin?
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GI overgrowth (pseudomembranous colitis)
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What is Linezolid?
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will be used as a last resort drug. has activity against resistant bugs. does cause headache and GI upset.
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What is the role of Erythromycin?
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binds to the 23S rRNA of the 50S.
100x more potent in G+ htan G- good against mycoplasma, legionella and chlamydia GOOD for Community Aquired Pneumonia azithromycin, clarithromycin also exist. |
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What are the SEs of Erythromycin?
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dose-dependant GI effects
rare cholestatic hepatitis |
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Why don't you give tetracycline with milk?
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it chelates with the Ca, so it just passes through and isn't absorbed.
Doxycycline does not. |
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What do you use Doxycycline for?
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VACUUM THe BedRoom
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Tularemia H. pylori Borrelia Rickettsia |
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What are the SEs of doxycycline?
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GI irritation
phototoxic dermatitis renal and hepatic toxicity discolored teeth depressed bone growth (don't give to preggers) |
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What drugs are Aminoglycocides?
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GNATS
gentamycin neomycin amikacin tobramycin |
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What is Streptomycin?
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Aminoglycoside
many are resistant good for enterics |
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Gentamicin
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Aminoglycoside
used comonly in hospitals. combine with penicillin |
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Tobramycin
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aminoglycoside
good against pseudomonas |
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amikacin
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aminoglycoside
broad spectrum- good for hospital aquired infection that are resistant to other drugs. |
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neomycin
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aminoglycoside
broad coverage, but toxic used for skin infections |
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Netilmicin
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aminoglycoside
preoperative coverage for GI (not absorbed) |
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what is the mechanism of Aminoglycosides?
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Inhibid initiation complex formation- misread mRNA
need O2 to work. |
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What are the SEs of aminoglycosides
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Nephrotoxicity, ototoxicity (with loop diuretics), teratogens
neuromuscular blockade |
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What is spectinomycin?
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acts on the 30S ribosome
IM injection treats gonorrhea |
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What is the risk of isoniazid hepatitis?
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Increases with age.
rare <20 2.3% at 50 W/ alcohol, increased metabb, increased incidence of hepatitis |
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Who do you treat with TB with <5mm PPD? (Great Risk)
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HIV
Fibrotic change on X-ray Close contacts with newly active TB |
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Who do you treat w/ >10mm?
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Lower immune system- DM, steroid or immunosuppressed, renal failure, and others
Injection drug users Recent PPD coversion If less than 35 Homeless, prisons, nursing homes, foreign born |
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What is the mechanism of Isoniazid?
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interferes with the biosynthesis of mycolic acid of mycobacteria
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What are the SEs of Isoniazid?
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Hemolysis if G6PD deficient
neurotoxicity SLE-like syndrome Pyridoxine - B6 |
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What are teh 4 Rs of Rifampin?
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RNA polymerase Inhibition
Revs up microsomal P450 Red/orange body fluids Rapid resistance if used alone |
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What are some of the clinical uses of Rifampin?
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TB
delay dapsone resistance in leprosy meningococcal prophylaxis chemoprophylaxis in kids iwwth H. influenzae type B |
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What are the SEs of Rifampin?
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Hepatitis- less than INH
Drug x-reactions- Coumadin decreases, OC less efffective (breakthrough bleed), oral hypoglycemics adn corticosteroids Anticonvulsants |
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What's the deal with Rifabutin?
When is it used? what is it's role? |
Used for M. avium-intracellulare. Otherwise it is very similar to Rifampin, but less effect on the cP450 so good for HIV
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What is pyrazinamide?
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TB drug, mechanism unknown.
cannot give for >2months don't give to preggers |
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What are the SEs of Ethambutol?
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Ethane-butane torch
torch an eye decreased visual acuity with loss of central vision (central scotomata) (Loss of color vision) |
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What are some 2nd line TB drugs?
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Cycloserine
ethionamide |
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What is the Rx for leprosy?
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Severe- rifampin, dapsone, clofazimine for 2 yrs
less severe- rifampin, dapsone for 6 months |
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What is the mechanism of clofazimine?
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binds to DNA of M. leprae.
colors skin and conjunctiva red(turns leprosy patch tan/black) |
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What are type 1 and type 2 reactions in leprosy treatment?
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Inflam of nerves, testes, eyes, joints, and skin
1- borderline, in 1st year. swelling of lesions, can ulcerate, prednisone and clofazimine Rx for this time. Delayed-type hypersensitivity Reaction 2- Erythema Nodosum Leprosum, in more severe forms, painful nodular rash erupts in previously normal-appearing skin with high fever. Neuritis, orchitis, arthritis, iritis. Immune complex mediated. Thalidomide is the Rx. |
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Why are the flouroquinolones becoming so popular so fast?
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They have good oral absorption, safe, and penetrate into tissues well.
end in floxacin |
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What is the mechanism of action of the fluoroquinolones?
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inhibit the DNA gyrase (topo II)
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what are flouroquinolones NOT good for?
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Cipro- poor G+, bad for strep, but can be used for staph and anthrax.
anaerobes are generally not covered |
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How does resistance to flouroquinolones develop?
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point mutation in the DNA gyrase
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What are the SEs of fluoroquinolones?
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GI irritabillity (nausea, vomiting, belly pain, diarrhea)
Damage cartilage (avoid in kids) Rare achilles rupture or tendonitis CNS- headache, restlessness and insomnia |
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Why is Cipro dangerous in a renal patient?
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excreted renally and high levels block GABA and can cause seizure
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What are flouroquinolones good for?
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G-s
Pseudomonas (CF) Enterobacteriaceae (not anaerobes) E. Coli, Salmonella, Shigella, Campylobacter Resistant UTIs G- intracellulars |
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What four flouroquinolones are good for G+s and community aquired pneumonia?
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Levofloxacin
Ofloxacin Sparfloxacin Grepafloxacin |
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What is the good and the bad of trovafloxacin?
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good- covers everything
bad- liver toxicity ONLY IN PATIENS WITH THE FIVE CONDITIONS: Nosocomial pneumonia Community aquired pneumonia intra-ab infections gyne and pelvic infections complicated skin and skin structure infections, diabetic foot infection |
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What are the special SEs of Sparfloxacin?
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8% of pts develop mild to severe photosensitivity
Prolongs QT on EKG- Torsades!!! |
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What is the mechanism of the sulfa drugs?
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they competatively inhibit the creation of TH4
They look like PABA, so the bacteria grab it. |
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What is the mechanism of trimethoprim?
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blocks dihydrofolate reductase preventing dihydrofolate formation.
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What are the adverse effects of TMP/SMX?
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nausea, vomiting, diarrhea, and skin rash.
W/ AIDS- 1/2 get complications. skin rash and bm suppression W/ Warfarin- increased action, more bleeding as it is displaced from warfarin hemolysis if G6PD deficient Nephrotoxic kernicterus |
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What are the clinical roles of SMX/TMP?
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TMP-SMX
Tree- respiratory- Strep and Haemophilus Mouth- GI tract, shigella, salmonella, e. coli Pee- GU- UTIs, Prostatitis, urethritis SMX Syndrome- prevents pneumocystis carinii, toxoplasma and Isospora |
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What can cause liver abscesses and bloody diarrhea?
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entamoeba
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What are some bacterial causes of liver abscesses?
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E. coli
Klebsiella strep staph bacteroides pseudomonas |
