5/21/06
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| Drugs that block cell wall synthesis by inhibiting peptidoglycan x-linking | PCN, Ampicillin, Ticarcillin, Piperacillin, Imipenem, Aztreonam, Cephalosporins
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| Drugs that block peptidoglycan synthesis | Bacitracin, Vancomycin, Cycloserine
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| Drugs that block protein synthesis at 50S ribosomal subunit | Chloramphenicol, Erythromycin/Macrolides, Lincomycin, Clindamycin, Streptogramins (Quinupristin, Dalfopristin), Linezolid
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| Drugs that block protein synthesis at 30S ribosomal subunit | Aminoglycosides, Tetracyclines
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| Drugs that block nucleotide synthesis | Sulfonamides, Trimethoprim (TMP)
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| Drugs that block DNA topoisomerases | Quinolones
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| Drugs that block mRNA synthesis | Rifampin
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| Bactericidal antibiotics | Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole
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| Drugs that disrupt bacterial/fungal cell wall membranes | Polymyxins
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| Drugs that disrupt fungal cell wall membranes | Amphotericin B, Nystatin, Fluconazole/azoles
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| PCN (G = IV, V = oral); hypersensitivity rxn and hemolytic anemia | Bactericidal for G+ cocci (1st line for Pneumococcal Pneumonia); G+ rods, G- cocci, Spirochetes (syphilis, lyme dz)
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| Methicillin, Nafcillin, Dicloxacillin (hypersensitivity rxn; meth = interstitial nephritis) | Narrow spectrum Abx; Penicillinase Resistant d/t bulkier R group; use for Staph aureus
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| Ampicillin, AmOxicillin (better oral availability); (hypersensitivity, amp rash, pseudomembranous colitis) | Wider spectrum HELPS kill enterococci (Haemophilus, E. coli, Listeria, Proteus, Salmonella, enterococcus); sensitive to penicillinase, but can combine with Clavulanic Acid (inhibitor);
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| Carbenicillin, Piperacillin, Ticarcillin (hypersensitivity) | Extented spectrum (Pseudomonas, G- rods); use with Clavulanic acid
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| Cephalosporins | b-lactam drugs inhibit cell wall synthesis but are less susceptible to penicillinases; bactericidal
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| 1st generation cephalosporins (Cephalexin, Cefadroxil, Cefazolin): PEcK | Proteus, E. coli, Klebsiella
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| 2nd generation cephalosporins (Loracarbef, Cefprozil, Cefuroxime, Cefaclor): HEN PEcKS | Haemophilus, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
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| 3rd generation cephalosporins (Ceftazidime, Ceftriaxone) | great G- coverage; Tx meningitis, Pseudomonas, Gonorrhea
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| 4th generation cephalosporins | increased activity against Pseudomonas and G+ bugs
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| Cefoperazone | 2nd generation cephalosporin; use in pts with decreased renal failure; HEN PEcKS
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| Ceftazidime | 3rd generation cephalosporin; use for Pseudomonas (and other G-s)
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| Ceftriaxone | 3rd generation cephalosporin; use for GONORRHEA (and other G-s)
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| Cephalosproin toxicity | Disulfiram-like rxn w/ethanol (ex: Cefamandole d/t methylthiotetrazole grp); hypersensitivity rxns d/t x-reactivity w/PCNs in some pts; They increase nephrotoxicity of aminoglycosides
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| Aztreonam | G- rods ONLY: Klebsiella, Pseudomonas, Serratia; Good for RENAL PTs who can't tolerate aminoglycosides; resistant to b-lactamase; no PCN x-allergenicity
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| Imipenem/Cilastatin (imipenem is renally longer LASTIN' with ciLASTIN) | #1 for ENTEROBACTER; Broad spectrum (G+ cocci, G- rods, Anaerobes); can cause seizures
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| Vancomycin (nephrotoxic, ototoxic, thrombophlebitis, "red man syndrome" from fast infusion) | Save for SERIOUS G+ MULTI-DRUG RESISTANT bugs: S. aureus and Clostridium difficile; changes AAs from D-ala to D-lac;
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| Protein Synthesis Inhibitors: "Buy AT 30, CELL at 50" | 30s (Aminoglycosides - bactericidal, Tetracyclines); 50S (Chloramphenicol, Erythromycin, Lincomycin, cLindamycin); all except aminoglycosides are bacteriostatic
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| Gentamicin, Neomycin, Tobramycin, Streptomycin, Amikacin | Aminoglycosides; Good for SEVERE G- Rod infxns; bactericidal - no initiation complex/misread mRNA; synergistic with b-lactams; requires O2 for uptake (no anaerobic coverage);
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| Neomycin | used for bowel surgery
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| Toxicity of Aminoglycosides + Cephalosporins | Nephrotoxicity
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| Toxicity of Aminoglycosides + Loop diuretics | Ototoxicity
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| Tetracycline, Doxycycline, Demeclocycline (VACUUM your BedRoom Tonight) | Vibrio, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Borrelia, Rickettsia, Tularemia; Bacteriostatic; bind 30S/prevent tRNA attachment; don't take with Ca or Fe b/c divalent cations bind in gut
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| Doxycycline | safe to use in renal patients
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| Toxicity of Tetracycline, doxycycline, demeclocycline | discoloration of teeth and inhibition of bone growth in kids; photosensitivity; GI distress
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| Erythromycin, Azithromycin, Clarithromycin (GI discomfort is bad; acute cholestatic hepatitis, eosinophilia, rash) | URIs, Pneumonias, STDs, Strep infxns in PCN-allergies; Mycoplasma, Legionella, Chlamydia, Neisseria; Macrolides; block protein translocation (23S rRNA of 50S subunit); Bacteriostatic
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| Chloramphenicol (anemia, aplastic anemia, gray baby d/t lack of liver UDP-glucuronyl transferase) | Meningitis (H. influenza, N. menigitidis, S. pneumoniae); Bacteriostatic; inhibits 50S peptidyltransferase; Toxicity = use conservatively
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| Clindamycin (causes C. difficile overgrowth) | blocks 50S peptide bond; bacteriostatic; Tx ANAEROBIC infxns above diaphragm (Bacteriodes fragilis, Clostridium perfringens
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| Sulfamthoxazole (SMX), Sulfisoxazole, Triple Sulfas, Sulfadiazine | G+, G-, Nocardia, Chlamydia coverage; UTI; bacteriostatic; sulfonamides; PABA-antimetabolites inhibit dihydropteroate synth; hemolysis in G6PD deficiency; nephrotoxic, kernicterus infant, diplaces warfarin from albumin
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| Trimethoprim | Treat recurrent UTIs, Shigella, Salmonella, Pneumocystis carinii; bacteriostatic; inhibits bacterial dihydrofolate reductase; use in combo w/SMX to block folate synth; may cause marrow suppression
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| Ciprofloxacin, Norfloxacin, Ofloxacin, Sparfloxacin, Moxifloxacin, Gatifloxacin, Enoxacin, Nalidixic acid | Treat G- rods in UTI, GI infxns; PSEUDOMONAS, Neisseria, some G+s; Bactericidal; inhibit DNA gyrase (topoisomerase II); Fluoroquinolones; contra in pregnancy; may cause Tendonitis/rupture
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| Metronidazole: GETon the metro! | Antiprotozoal: Giardia, Entamoeba, Trichomonas, Gardernela vaginalis, ANAEROBES (Bacterioides, Clostridium); Use as part of triple therapy for H.pylori (w/bismuth, amoxicillin or tetracycline); Disulfiram-like rxn w/alcohol, HA
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| Polymyxin B, Polymyxin E | Use for resistant G- infections; alter osmotic properties in bacterial membrane; cationic basic ptns that act as detergents; can be neurotoxic, nephrotoxic
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| Anti-TB drugs | RESPIre: rifampin, ethambutol, streptomycin, pyrazinamide, isoniazid (INH); all are hepatotoxic; (2nd line = Cycloserine)
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| Isoniazid | Can solely prophylax against TB; decreases mycolic acid synthesis; "INH" = injures neurons and hepatocytes; also causes hemolysis in G6PD deficiency; B6/pyridoxine can prevent neurotoxicity
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| Rifampin | Treats TB; delays dapsone resistance in leprosy; Meningococcal prophylaxis for Hib; "4 Rs" = RNA polymerase inhibitor, revs up P450; Red/orange body fluids, Rapid resistance if used alone
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| Penicillin/cephalosporin resistance mechanism | b-lactamase cleavage of b-lactam ring
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| Aminoglycoside resistance mechanism | modification via acetylation, adenylation, or phosphorylation
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| Vancomycin resistance mechanism | terminal D-ala of cell wall replaced with D-lac; decreases affinity
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| Chloramphenicol resistance mechanism | modification via acetylation
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| Macrolide resistance mechanism | methylation of rRNA near erythromycin's ribosomal binding site
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| Tetracycline resistance mechanism | decreased or increased transport out of cell
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| Sulfonamide resistance mechanism | altered enzyme (bacterial dihydropteroate synthase); dec uptake or inc PABA synthesis
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| Nonsurgical antimicrobial prophylaxis for Meningococcal infection | Rifampin (drug of choice), minocycline
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| Nonsurgical antimicrobial prophylaxis for Gonorrhea | Ceftriaxone
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| Nonsurgical antimicrobial prophylaxis for Syphilis | Benzathine PCN-G (IV)
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| Nonsurgical antimicrobial prophylaxis for h/o recurrent UTIs | TMP-SMX
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| Nonsurgical antimicrobial prophylaxis for Pneumocystic carinii pneumonia | TMP-SMX (drug of choice), aerosolized pentamidine
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| Amphotericin B | Treat systemic mycoses: Cryptococcus, Blastomycoses, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor; binds ergosterol, "tears" pores in membrane; fever/chills, hypotension, nephrotoxic, Arrhythmias
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| Nystatin | "swish and swallow" for oral candidiasis; binds ergosterol disrupting fungal membranes
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| Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole, Voriconazole | Treat Systemic mycoses and hypercortisolism: inhibit ergosterol synthesi
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| Fluconazole | Treat cryptococcal meningitis in AIDS and all candidiasis infxns (except yeast)
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| Ketoconazle | Treat Blastomyces, Coccidioides, Histoplasma, Candida albicans, hy
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