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80 Cards in this Set
- Front
- Back
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a) Explain stage 1 in baterial cell wall synthesis and which Rx work at this point
b) what is the final product of stage 1 |
-Synthesize NAM pentapeptide @ cytoplasm
Rx: D-cycloserine, analog of D-alanine, reversibly inhibits D-ala-D-ala synthetase, irreversbly inh D-ala racemase Fosfomycin: inh enzyme that adds the lactoyl grp to NAG 3 grams for uncomplicated lower UTI in Wo, safe in pregn. b) UDP-NAM Pentapeptide (T shape molecule) |
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Explain stage 2 in baterial cell wall synthesis and which Rx work at this point
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transport of Nam Peptide (brick) from cytoplasm to exterior leaf by a lipid tansporter
Rx: Vancomycin, Teichoplanin Bacitracin |
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Explain stage 3 in baterial cell wall synthesis and which Rx work at this point
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attach to 1rst D-Ala and Knoct out terminal D-Ala to crosslink in the cell wall
Rx: B-lactam |
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How does Bacitracin work?
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it blocks the phospholipid carrier from being recycled
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Which Rx am I?
a)D-Ala- D-Ala must be present b) I work @ stage 3 c) D-Ala-D-lactic acid is the resistance seen against me d) Do not use Vanco for... e)VRE utilizes this mechanism against me f) Vanco is given ... only |
a) Vanco
b) B-lactam antibiotics c) Vanco d) C. difficile or pseudomembranous colitis e) Vanco f) IV only |
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use ... first, then Vanco to prevent resistance against C.difficile
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metronidazole
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Used for enterococcal infections
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1) Ampicillin (DOC)
2) Vanco |
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Used me for serious Gram + aerobes/anaerobes only except...
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Vanco
except: C diff |
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T or F
Vanco can be used for Gram - bacilli |
F: Gram + cocci
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DOC for MRSA/MRSE
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Vanco +/- Gentamicin +/- rifampin
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DOC for Ampicillin resistant enterococcus + gentamicin
b) wht r SE? |
Vanco
B) RON ON more commom when comnined w Aminoglyc |
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a) Gram +
Topically bcoz of nephro b) Gram - Topically bcoz of nephro |
a)Bacitracin
b)Polymyxins |
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Gram -
Topically bcoz of nephro, neuro |
Polymyxins
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I am a cationic detergents safe @ low dose for Gram - only (No effect wall synthesis)
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Polymyxins
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Good for
Pseudomonas aeroginosa Acinetobacter Klebsiella |
Polymyxins
for multi drug resistance and ESBL producing bugs |
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4 Classes of B-lactam antabiotics
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1) penicillins
2) Condom 3) Aminopenicillins 4) Anti-pseudomonal penicillins (MPCAT) |
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DOC for Gram + cocci/bacilli & anaerobic (specially Neisseria) except B frag
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Penicillin
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T or F
a) Penicillin is for UTI b) Penicillin is for Pseudomembranous colititis c) Penicillin is for B. fragilis d) Penicillin is for Staph e) Penicillin is for MCAT |
a) F, no Gram - rods
b) No C diff (become resistant quickly) c) No Gram - rods d) produce penicillinases which can clease Pen G/V e) Not at all |
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Worst to cause seizures
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Imipenem
Penicillin |
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T or F
All penicillin have long half life b) Doesn't need to be adjusted for renal failure |
F, short half life, administer with probenicid to increase T1/2
b) need to be adjusted for it |
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Depot Form.
a) Release Pen G more slowly than Na & K b) used in Soldiers before going in overseas, up to 30 days with ammonium base |
a) Procaine Penicillin
b) Benzathine Penicillin |
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single shot prophylaxis of syphillis, rheumatic fever (Step pyogenes)
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Bicillin LA (Benzathine pen)
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a) what is Pen V?
b) IV or Oral? |
a) added methoxy grp to Pen G,
b) oral |
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Name for 2nd category of pen
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Penicillinase-resistant pen or B-lactamase-resistant pen or Anti-Staphylococcal or CONDOM
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T or F for 2nd category of pen
1) Penicillinase is 1 type of clinically significant B-lactamase 2) used to treat Mcat 3) 18% of Staph aur exhibit pellicilinase 4) created by add a bulky grp to 6-APA nucleus 5) one of pen class that are B-lactamase resistant 6) Cover Gram - |
1) T
2)F, Staph 3) F, 98% Staph and they will hydrolyse all pen except CONDOM & B-lactamase inh 4)T, can't fit into penicillinase but will in others 5) only pen class that are B-lactamase resistant 6) only Gram + (Staph) |
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CONDOM
SE: interstitial nephritis |
Methicillin
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CONDOM
SE: Neutopenia |
Nafcillin
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CONDOM
A) Prototype B) Not orally C) used in renal Failure D) Parenteral DOC E) Strenght orally |
a) methicillin
b) methicillin c) Nafcillin bcoz 70% elim by biliary d) Oxacillin (also p.o.) e) Dicloxacillin> cloxacillin> oxacillin |
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CONDOM
bone marrow suppression @ high IV dose |
Nafcillin
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DOC for enterococcus, Listeria, Proteus mirabilis
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Ampicillin
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contains ionizable gp to be more hydrophilic
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Pen (COOH) and Aminopenicillin (NH2)
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Greater antibacterial spectrum than Pen, who am I and why?
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Aminopenicillin
enhance ability to penetrate thru porins in gram - |
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Coverage of Aminopenicillins
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Gram- : SS HEMP + B and Gram +
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B fragilis needs to be treated w Aminopenicillin + ...
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B-lactamase inh
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Major SE of Ampicillin and it will most likely cause...
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Diarrhea and it will cause C diff.and other superinfections (fungal, C diff.)
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Ampicillin
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- Diarrhea may lead to Superinfections
- empty stomach/poor oral - better to use ampicillin for Salmonella & Shigella (but DOC: Ceftriaxone/Fluoroquinolones) |
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Amoxicillin
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Oral choice
lower [] in gut, better to use ampicillin for Salmonella & Shigella |
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for serious Gram - bacilli, I also require...
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MPCAT, require dose adjusment in renal failure
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Which of the MPCAT contain a urea grp, why?
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MAP, hydrophilic = thru porins
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Good against
Pseudomonas aer. , Indole + Proteus, B frag. not very effective for Klebsiella |
MPCAT + B-lactamase inh
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for Pseudomonas aer. use
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MPCAT + B-l...ase inh + aminoglycoside
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a) Uredopenicillins are ...
b) which s DOC for non meningital pseudomonas aerug? |
a) MAP from MPCAT
two of which is no longer in Us b) Piperacillin (zosyn)+aminoglyc or Timentin + aminoglyc |
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Anaerobes
a) Gram + rods b) Gram + Cocci |
a) C diff/ tetan/ pyogenes
b) Peptococcus/ Petostreptococcus |
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Anaerobes
a) Gram - rods b) Gram - Cocci |
a) B frag/ mening
b) Neisseria gonorrhea/ mening. M cat |
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Aerobes
a) Gram + rods b) Gram - rods |
a) BLoC
b) SSSH KeeP the PEACE |
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a) Most likely to cause Pseudomonas colitis in all Pen
b) It is DOC for what (specific) |
a) Ampicillin
b) Enterococcus, Listeria, Proteus mirabilis |
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a) DOC for Meningitis
b) DOC for Enterobacteriocae (gram-) c) DOC for SPACE M, 2nd position d) DOC for Neisseiria gonorr e) DOC for surgical prophylaxis, abdominal... f) DOC for pseudomonal meningitis |
a) DOC for Meningitis is 3rd gen cef
b) 3rd gen. Cef except SPACE M c) Carbapenem, 2nd pos. = antipseudomonals d) Ceftriaxone e) Cefoxitin / Cefuroxime ( for gram -/+ ) +metronidazole (for anaerobes) f) Cefepime |
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a) SPACE M are not covered by...
b) No cephalosporins covers... lace |
a) 1rst, 2nd & 3nd cef gen.
b) Enterococcus, Listeria, C diff., Acinetobacter |
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Metronidazole is good for
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C. diff./tetanus
B. frag |
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Best for MRSA & MRSE
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Vanco+ rifampin + gentamicin
Ceftaroline |
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Broadly,
a) Penicillin covers... b) Ampicillin covers |
a) Gram +, aero/anaerobes with except (No Staph or gram- with except
b) Gram +, gram - aero/anaerobes with except |
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Pen is the DOC for what (specific)
Sis Sonia-PC |
a) all Strep (pneumo, pyogenes, viridans low/intermediate)
b) Syphilis c) C. teta/ perfing d) Peptococcus/ Petostreptococcus |
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Cephalosporins
a) DOC for M cat b) only one for B frag c) DOC for Pseudomonal meningitits w AmpC d) easiest to be cleaved by ESBLs e) only one for SPACEM w AmpC f) DOC for pen resis. strep pneumonae g) DOC for N gonorrhea |
a) Cefuroxime
b) Cefotetan c) Cefepime d) Ceftazidine e) Cefepime f) Ceftriaxone g) Ceftriaxone |
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MTT side chain
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I MET a Tan Man at the endZone
Cefmetazole, cefotetan, cefmandole, cefoperazone |
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AmpC, ESBL, B-lactamase are chaarcteriscs of ...
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Cefepime
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PE NIMH is for ...
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2 generation cef
Cefaclor Cefuroxime 1/2 Cefpodoxime |
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The Metal Tan Fox is for...
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Cephamycins= 2 gen special
Cefotetan cefoxitin |
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5 Gener of cef
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Ceftaroline
Not ESBL/AmpC Good for MRSA, CAp, Skin/ soft tissue, cef - & pen resis. Strep pneumonae |
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"Naficillin" of the Cef
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Cefoperazone
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Protonsil
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prodrud, sulfaniamide (SA), dec precipit, bacteriostatic
Enterococcus has intrinsic resistance |
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Protonsil won't work on
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Enterococcus has intrinsic resistance, able to uptake folic acid
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Sulfone ABX is for what? give name
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Dapsone, Leprosy
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Para-aminosalicylic acid
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TB, inh enzyme by incorporating into pteridine precursor (dihydropteroate synthase)
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T or F
a) few / 5% of E coli are resistance to sulfonamide alone b) penetrates to tissue only c) for UTI, use methenamine w sulfonamide d) Sulfonamide should not be used in pregnancy e) @ high dose trimetoprim affect dihydropteroate synthase f) Trimethoprim most likely to cause Stevens-Johnson Syndrome g) Crystalurea is more seen w sulfonamides h) G6PDH deficiency is seen w... |
a) F, 40%, don't give it alone
b) F, all body fluids, tissue & BBB c) F, never both get deactivated d) T, kernicterus (bilirubin displacement) e) F, @ high dose affect bone marrow & megaloblastic anemia (give folinic acid) f) F, Sulfadiazine g) T, elimination is renal h) trimethoprim in hemolitic anemia by free radical |
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MAO & resistance of...
a) Sulfonamides b) Trimethoprim What reduce resistance? |
a) compet inh of dihydropteroate synthase, resistance: mutation of DHS by outcompete the antibiotic
b) compet inh of DHFR, resiatnce: bacteria mutate DHFR or reduce permeability of Rx Bactrim: SMZ/TMP |
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What is HARK
b) What is less common with new sulfonamides? |
Hemolytic anemia by trim., G6PDH deficiency, megaloblastic anemia, thrombo/granulocytopenia
Allergy: hypersensitivity, sulfa mostly causes Stevens Jhonson Syndrome, long act rx Rash: dermatitis, uticartia, photosensitivity Kernicterus: not in preg by displ of bilirubin b) Crystaluria: fluids, Na bicarb, triposulfur, Niacin |
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A) DOC for uncomplicated/complicated UTI
B) DOC for Burn C) Colitis |
A) Bactrim
B) Silver sulfadiazine topically C)SulfaSalazine (prodrug of 5-ASA) |
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A) Ocular Chlamydia trachomatis
B) DOC for Ocular Chlamydia trachomatis C) DOC for Nocardia |
A) Sulfacetamide eyedrops
B) oral Azithromycin #1 form of preventable blindness C) Bactrim |
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A) DOC for Shigella/ Salmonella
B) DOC for H flu related,/ upper respiratory tract C) DOC for Toxoplasma gondii (protozoa) prophylasis & treatment |
A) Ceftriaxone/ Quinolones, bactrim alternative
B) bactrim C) Sulfadiazine (proto) + Pyrimethamine (Bact) |
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a) DOC for stenotrophomonas maltophilia, colonizes breathing tubes
b) DOC for Pneumocystis jerovecii (Aids pts) prophylasis & treatment c) Community acquired MRSA |
a) & b) Bactrim
c) Bactrim or doxycycline |
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A) Na overload and Hypokalemia (CHF)
b) prolonged bleeding time |
Ticarcillin & Carbenicillin
- careful w renal anf CHF pts - interefere w platelets fnx |
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Characteristics of carbepenems
It doesn't cover... |
-All are IV
- cover anaerobes - stable vs ESBL/ AmpC /penicilllinase / cephalosporinases b) MRSA, enterococcus faecium, stenotrophonomas maltophilia, metallo-B-lactamases, KPC B-lactamase |
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Imipenem T or F
a) cover all b) DOC for... c) cleaved by ... d) are expensive e) cross reactivity with penicillin-allergic pts |
a) F, gorilla cillin except atypical
b) SPACEM and ESBL klebsiella c) metallo-b-lactamases / KPC b-lactamase d) T, use last resort for MDR e) T, 50% |
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T or F
a) Cilastin is mixed w ... to ... b) metabolized to a nephrotoxic metabolite c) use imipenem in children d) use meropenem in children e) only one with cilastatin f) more potent carbapemens for pseudomonas aeruginosa |
a) imipenem to form Primaxin
b) imipenem by dehydropeptidases, use cilastatin c) F, never bcoz of seizures d) T, reduce seizure e) imipenem f) Doripenem |
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Ertapenem
a) has no activity b) most common use Doripenem covers... |
a) monkey-cillin bcoz No activity APE
b) for abdominal infections covers APE, more ptent for Pseudomonas..., similar antibacterial spectrum |
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inhibit least hypersensityvity/allergic in all B-lcatam, so use in penicillin allergic pts
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Aztreonam/ Monobactam
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reserved for serious Gram- infectious in the lung/bone/blood/UTI
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Aztreonam/ Monobactam
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Monobactam T or F
a) reversibly inh PBP-4 for septum in bacteria b) active vs Gram + anaerobe c) adjustment in renal is needed d) Not stable for B-lactamase, AmpC, metallo-B-lactamase |
a) F, irreversibly inh PBP-3
b) F, gram - aerobes only (never +/anaerobes) c) F, no need but eliminated by renal d) F, very stable to them except ESBL bcoz of oximino moeity grp |
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B lactamase inh
a) Augmentin b) Timentin c) Unasyn d) Zosyn |
a) the only PO, clavula/amoxi
b) clavula/ticarcillin not for Klesiella c) Sulba + ampicillin d) Piperacillin + Tazobactam (DOC for non-mengit.pseudom) |
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B lactamases
a) No activity on their own b) reversible inh of B lactamase |
a) T
b) irreversible suicide inh of B-lactamase |
