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Step 1 11.1.12

Microbiology XI

QuestionAnswer
What is the mech of penicillin, methicillin, ampicillin, pipericillin, cephalospirins, azetreonam, impipenem? block cell wall synthesis by inhbiting peptidoglycan cross linking
What is the mech of bacitracin, vancomycin? block peptidoglycan synthesis
What is the mech of sulfonamides, trimethoprim? block nucleotide synthesis
What is the mech of fluoroquinolones? block DNA topoisomerases
What is the mech of rifampin? blocks mRNa synth
What is the mech of penicillin, methicillin, ampicillin, pipericillin, cephalospirins, azetreonam, impipenem? block cell wall synthesis by inhbiting peptidoglycan cross linking
What is the mech of bacitracin, vancomycin? block peptidoglycan synthesis
What is the mech of sulfonamides, trimethoprim? block nucleotide synthesis
What are the 3 mechs of penicilin G and penicilin V? 1. bind penicilin binding proteins 2. block transpeptidase crosslinking of peptidoglycan 3. activate autolytic enzymes
What is the clinical use of penicillin? G+ (strep pneumoniae, S. pyogenes, actinomyces), syphilis
What is the mech of fluoroquinolones? block DNA topoisomerases
What are the major SE of penicillin? hypersensitivity reactions, hemolytic anemia
What is the mech of rifampin? blocks mRNa synth
What is the mech of metronidazole? damage DNA
What is the mech of chloramphenocol, macrolides, clindamycin, streptogrammins (quinupristin, dalfopristin), linezolid? block protein synth at 50 S subunit
What is the mech of aminoglycosides, tetracyclines? blcok protein synth at 30 S ribosomal subunit
What is the clinical use of methicillin, naficillin, dicloxicillin? S. aureus, except MRSA which resists due to altered penicillin binding protein
What are the 3 mechs of penicilin G and penicilin V? 1. bind penicilin binding proteins 2. block transpeptidase crosslinking of peptidoglycan 3. activate autolytic enzymes
What are the major SE or methicillin, naficillin, dicloxicillin? hypersensitivity reactions, methicillin-interstitial nephritis
What is the clinical use of penicillin? G+ (strep pneumoniae, S. pyogenes, actinomyces), syphilis
What are the non species clinical use of penicillin? G+ cocci, G+ rods, G- cocci, spirochetes. not penicillinase resistant
What are the major SE of penicillin? hypersensitivity reactions, hemolytic anemia
What allows for resistance to penicillin? beta lactamases cleave the Beta lactam ring
What is the clinical coverage of ampicillin, amoxicillin? HELPSS kill enterococci.: Haemophilus influnezae, E. coli, Listeria monocytogenes, Proteus mirabilis, salmonella, shigella
What is the class of methicillin, naficillin, dicloxicillin? penicillinase resistant penicillins
What are the SE ampicillin, amoxicillin? hypersensitivity, ampicillin rash, pseudomembranous colitis
What is the mech and resistance development to penicillinase for the methicillin, naficillin, dicloxicillin? mech is same as penicilling: beta lactams. resist penicillinase because of bulkier R group
What is the clinical use of methicillin, naficillin, dicloxicillin? S. aureus, except MRSA which resists due to altered penicillin binding protein
What are the major SE or methicillin, naficillin, dicloxicillin? hypersensitivity reactions, methicillin-interstitial nephritis
What is the mech of ampicillin, amoxicillin? beta lactam, but wider spectrum but penicillinase sensitive. amoxicillin has better oral availability than ampicillin
What should ticarcillin, carbenicillin, piperacillin be administered with to resist penicillimase? clavulanic acid
What do you give with ampicillin, amoxicillin to make them resist penicillinase? clavulanic acid
What is the major SE of ticarcillin, carbenicillin, piperacillin? hypersensitivity rxn
What is the clinical coverage of ampicillin, amoxicillin? HELPSS kill enterococci.: Haemophilus influnezae, E. coli, Listeria monocytogenes, Proteus mirabilis, salmonella, shigella
What are the Beta lactamase inhibitors? CAST: clavulanic acid, Sulbactam, tazobactam
What are the SE ampicillin, amoxicillin? hypersensitivity, ampicillin rash, pseudomembranous colitis
What is the mech of the cephalosporins? beta lactam drugs which inhibit cell wall synth but less susceptible to penicillinase
What is the mech of ticarcillin, carbenicillin, piperacillin? same as penicillin, anti pseudomonals
What organisms are not covered by cephalosporins? LAME: listeria, Atypicals ( Chlamydia, Mycoplasma), MRSA, Enterococci
What is the clinical use of ticarcillin, carbenicillin, piperacillin? Pseudomonas spp, G- rods.
What are the 1st gen cephalosporins and what are they effective against? cefazolin, cephalexin. Proteus miribilis, E. coli, Klebsiella PEcK
What should ticarcillin, carbenicillin, piperacillin be administered with to resist penicillimase? clavulanic acid
What are the 2nd gen cephalosporins and what are they effectivde against? cefoxitin, cefaclor, cefuroxime. HEN PEcKS: Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp, Proetus mirabilis, E. coli, Klebsiella, Serratia marcese
What is the major SE of ticarcillin, carbenicillin, piperacillin? hypersensitivity rxn
What are the Beta lactamase inhibitors? CAST: clavulanic acid, Sulbactam, tazobactam
What is the mech of the cephalosporins? beta lactam drugs which inhibit cell wall synth but less susceptible to penicillinase
What organisms are not covered by cephalosporins? LAME: listeria, Atypicals ( Chlamydia, Mycoplasma), MRSA, Enterococci
What are the 1st gen cephalosporins and what are they effective against? cefazolin, cephalexin. Proteus miribilis, E. coli, Klebsiella PEcK
What are the 2nd gen cephalosporins and what are they effectivde against? cefoxitin, cefaclor, cefuroxime. HEN PEcKS: Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp, Proetus mirabilis, E. coli, Klebsiella, Serratia marcese
What are the 3rd generation cephalospirins and what are they effective against? ceftriaxone, cefotaxime, ceftazidime. good against serious G- infections resistant to other lactams. Ceftriaxone: meningitis, gonorrhea. Ceftazidime: pseudomonas
What is the 4th generation cepholosporin and what is it effective agaisnt? incr activity against pseudomonas ans G+ organisms
What are the major SE of cephalosporins? hypersensitivity, vit K deficiency, incr nephrotoxicity of aminoglycosylides, disulfram rxn with ethanol
What is the mech of aztreonam? monobactam resistant to Beta lactamases. inihibts cell wall synth (binds PBP3). syngistic with aminoglycosylides. no cross allergenicity
What is the clinical use of aztreonam? G- rods only. not for G+ or anaerobes.for penicillin allergic pt and those with renal insufficiency who cant tolerate aminoglycosylides
What are the major SE for aztreonam? usually non toxic. occasional GI upset. no cross sensity w penicillin or cephalosporins
What is the mech of imipenem/cilastatin, meropenem? broad spectrum Beta lactamase resistant carbapenem. always given with cilastatin (inhibits renal dehydropeptidase I)
What is the use of imipenem/cilastatin, meropenem? G+ cocci, G- rods, anaerobes. wide spectrum but SE limit its use to life threatening infections. meropenem is a little better
What are the major SE of imipenem/cilastatin? GI distress, skin rash, CNS toxicity, seizures at high plasma levels
What is the mech of vancomycin? inhibits cell wall mucopeptide formation by binding D-ala D-ala protion of cell wall precursors. bacterocicdal.
What is the clinical use of vancomycin? G+ only. serious, multidrug resistant orgamisms. like S. aureus, enterococci, Clostridium difficle.
What are the major SE of vancomycin? nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing "red man" syndrome (prevent with antihistamine or slow infusion). does NOT have mant problems
How does resistance to vancomycin develop? AA change from Dala Dala to Dala Dlac
Which abtx attack the 30 S subunit? AT. aminoglycosides {bactericidal}
Which abtax attack the 50 S subunit? Chloramphenicol, clindamycin (bacterostatic) Erythromycin (macrolides) (bacterostatic Linezolid (vaires) CEL
What are the aminoglycosylides? Gentamycin, neomycin, amikacin, tobramycin, strpetomycin Mean GNATS can NOT kill anaearobes
What is the mech of Gentamycin, neomycin, amikacin, tobramycin, strpetomycin? bactericidal. inhibits formation of initiation complex and cause misreading of mRNA. Require O2 for uptake. thus ineffective against anaerobes
What is the clinical use of Gentamycin, neomycin, amikacin, tobramycin, strpetomycin? aminoglycosalides. for severe G- rods. syndergistic with beta lactams. neomycin used for bowel surgery
What are the major SE of Gentamycin, neomycin, amikacin, tobramycin, strpetomycin? When might they be increased? aminoglycosylides. nephrotoxicity(esp w cephalosporins), ototoxicity (esp w loop diruretics), teratogen
How does resistance to Gentamycin, neomycin, amikacin, tobramycin, strpetomycin develop? transferase enzymes inactivate drug by acetylation, phosphrylation or adenylation
What is demeclocycline? ADH antagonist, acts as diuretic in SIADH
What is the mech of tetracycline, doxycycline, demeocycline, minocycline? bacteriostatic. bind to 30S and prevent attatchment of aminoacyl t-RNA. limited CNS penetration.
How is doxycline eliminated and who should not get it? fecally eliminated, dont use in renal failure
What should tetracycline, doxycycline, demeocycline, minocycline not be taken with? milk, antacids, iron containing preps because they will inhbits its abdorbtion
What is the clinical use of tetracycline, doxycycline, demeocycline, minocycline? Borellia burgdoferi, M. pneumoniae. drugs ability to accumlulate in the cell makes it effective against Rickettsia, Chlamydia
What is the SE of tetracycline, doxycycline, demeocycline, minocycline? GI distress, discoloration of teeth, inhbition of bone growth in kids, photosenstitivty. CONTRA in pregnency
How does resistance to tetracycline, doxycycline, demeocycline, minocycline develop? decr uptake into cells or incr efflux by plasmid qtransport pumps
What is the class of erytromycin, azithromycin, clarithromycin? macrolides
What is the mech of erytromycin, azithromycin, clarithromycin? bacteriostatic. bind 23S rRNA of 50S subunit to block translocation
What is the clinical use of erytromycin, azithromycin, clarithromycin? atypical pneumonias (mycoplasma, chlamydia, legionella), URI, STDs, G+ cocci (streptococcus if pt allergic to penicillin), Neisseria
What are the SE of erytromycin, azithromycin, clarithromycin? prolonged QT interval (esp erythromycin), GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rashes.
What are some important drug interactions of erytromycin, azithromycin, clarithromycin? incr serum theophyllines, oral anticoagulants
How does resistance to erytromycin, azithromycin, clarithromycin develop? methylation of 23 S rRNA binding site
What is the mech of chloramphenicol? blocks peptide bond formation at 50 S rbiosomal unit. bacterostatic.
What is the clinical use of chloramphenicol? meningitis (H. influnza, Nesseria meningitidis, Step. pneumoniae). conservative use owing to toxicity but still used in developing countries due to low cost
What is the toxicity of chloramphenicl? anemia, aplastic anemia, gray baby syndrome (b/c infants lack UDP glucuronyl transferase)
How does resistance to chloramphenicol develop? plasmid encoded acetyltransferase that inactivates drug
What is the mech of clindamycin? blocks peptide bond formation at 50S ribosomal subunit,. bacteriostatic
What is the clinical use of clindamycin? anaerobic infections (Bacteroides fragilis, Clostridium perfingens) in aspiration pneumonia and lung absesses
How do you treat anaerobic bacteria above the diaphragm as opposed to below? clindamycin above, metranidazole below
What are the major SE of clindamycin? pseudomembranous colitis (C. difficle overgrowth), fever, diarrhea
What is the mech of sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine? PABA antimetabolites inhibit dihydropteroate synthetase. bacteriostatic
What is the clinical use of sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine? G+, G-, Norcardia, Chlamydia. Triple sulfas or SMX for simple UTI
What are the major SE of sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine?? hypersensitivity reactions, hemolyisis if G6PD deficient, nephrotixicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displace warfarin from albumin
How does resistance to sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine develop? altered enzme (bacterial dihydropteroate sythetase), decr uptake, or incr PABa synth
What is the mech of trimethoprim? inhibits bacteria DHF reductase. bacteriostatic
WHat is the clinical use of trimethoprim? used in combo tieh sulfonimdes, causing sequential block of folate synthesis. combo used for UTI, Shigella, Salmonella, Pneumocystis jiroveci pneumonia
What are the major SE of trimethoprim? megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with folinic acid supplement)
What do all flouroquinolones end with? floxacin except enoxacin, and nalidixic acid which is just a quinolone
What is the mech of the fluoroquinolones? inhibit DNA gyrase (topoisomeraseII), bacterocidal. not taken with antacids
What is the clinical use of fluoroquinolones? G- rods of urinary and GI tract (including pseudomonas), Neisseria, some G+ organisms
What are the major SE of fluoroquinolones? GI upset, superinfections, skin rash, HA, dizziness. Contraindicated in children and pregnant women b/c of cartilage damage.
What might fluoroquinolones cause in adults vs kids? tendonitis and tendon rupture in adults, leg cramps and myalgias in kids
How does resistance to fluoroquinolones happen? chromosome encoded mutation in DNa gyrase
What is the mech of metronidazole? forms free radical toxic metabolites in bacterial cell that damage DNA. bacteriocidal and antiprotozoal
What is the clinical use of metronidazole? GET GAP on the Metro: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (bacteroides, C. difficle)
How is metronidazole used in peptic ulcer disease? used with bismuth and amoxicillin or tetracyclin for triple therapy against H. pylori
What is the major SE of metronidazole? disulfram reaction with alcohol, HA, metallic taste
What is the prophylactic Tx for M. tuberculosis? isoniazid
What is the tx for M. tb? Rifampin, isoniazide, Pyrazinamide, ethambutol
What is the prophylactic Tx for Mycobacterium avium-intracellulare? azithromycin
What is the tx for mycobacterium avium-intracellulare? azithromycin, rifampin, ethambutol, streptomycin
What is the tx for mycobacteriu leprae? dapsone, rifampin, clofazimine
What is the mechanism of isonizide? What is required for its activation decr synth of mycolic acids. bacteria catalase peroxidase needed to convert INH to active metabolite
What is the clinical use of isoniazide? M. tb. only solo prophylaxis for tb
What is the major SE of isoniazide? How can some of them be avoided? neurotoxicity, heptotoxicity, lupus. pyridoxone (B6) can prevent neurotoxicity, lupus
What is the mech of rifampin? inhibits DNA dependent RNA pol
What is the clinical use of rifampin? M. tb. delays resistance to dapsone if used with leprosy. used for meningococal prophylaxis and chemoprophylaxis in contancts of children w H influenza type B
What are the major SE of rifampin? minor hepatoxicity and drug interactions (incr P-450), orange body fluids (nonhazrdous side effects)
What are the 4 R's of rifampin? RNA polymerase inhibitor, Revs up microsomal P-450, Red/organge body fluids, Rapid resistance if used alone
What is the mech of pyrazinamide? inhibits mycolic acid production by blocking FA synthase I. effective in acid pH of phagolysosomes where TB engulfed by macrophages is found
What is the clinical use of pyrazinamide? M. tb
What are the SE of pyrazinimide? hyperuricemia, hepatotoxicty
What is the mech of ethambutol? decr carbohydrate polymerization of mycobacterial cell wall by blocking arabinosyltranferase
What is the clinical use of ethambutol? mycobacterium tuberculosis
What are the major SE of ethambutol? optic neuropathy (RG color blindness)
Created by: tjs2123