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Step 1 11.13.12

Microbiology XII

QuestionAnswer
What are 3 options for meningococcal prophylaxis? ciprofloxacin (DOC), rifampin, minocylcine
What is the prophylaxis for gonorrhea? ceftriaxone
What is the prophylaxis for syphilis? benzanthine penicillin G
What is the prophylaxis for a person with a Hx of recurrent UTI? TMP-SMX
What is the prophylaxis against endocarditis in a surgical or dental procedure? penicillins
What is the prophylaxis and against what for HIV CD4<200? TMP-SMX for pneumocysitis jirovecii ( aerosol pentamide if cant tolerate)
What is the prophylaxis and against what for HIV CD4<100? TMP-SMX agsint pneumocystis jirovecii, toxoplasmosis (can use penamide aerosol but wont prevent toxo)
What is the prophylaxis and against what for HIV CD4<50? azithromycin against mycobacterium avium complex
How do you treat MRSA? vancomycin
How do you treat VRE? linezolid and streptogramins(quinupristin/dalfopristin)
What is the empiric therapy for outpatient community acquired pneumonia? macrolides
What is the empiric therapy for inpatient community acquired pneumonia? fluoroquniolones
What is the empiric therapy for ICU community acquired pneumonia? beta lactam + (flouroquinolone or azithro)
What is the target of amphotericin B? fungal membrane function
What is the target of caspofungin? fungal cell wall synth
What is the target of fluconazole, itraconazole, voriconazole? fungal ergosterol synth
What is the target of naftifine, terbinafine? fungal lanosterol synth
What is the target of 5 Flurocytosine? fungal nucelic acid synth
What is the mech of amphotericin B? bingd ergosterol (unique to fungi), formes pores which allow electrolyte leakage
What is the use of amphotericin B? Serous, systemic mycoses. Cryptococcus, blastomyces, coccidioides, aspergillus, histoplasma, candida, Mucor. intrathecal for fungal meningitis
What must be supplemented in a pt on amphotericin B? K and Mg becuase it will alter renal tubule permeability
What are the major SE of amphotericin B? fever/chills (shake and bake), hypoTN, nephrotoxicity, arrythmias, anemia, IV phlebitis
How might you reduce some of amphotericins toxicities? hydration for nephrotoxicity, liposomal amphotericin for general toxicity
What is the mechanism of nyastatin? bind ergosterol. Topical form because too toxic for systemic
What is the clinical use of nyastatin? "swish and swallo" for oral candidiasis (thrush), topical for diaper or vaginal thrush
What is the mech of fluconazole and other azoles? inhibits ergosterol synthesis by inhibiting P-450 which converts lanosterol to ergosterol
What is the clinical use of the azoles? systemic mycoses
What is fluconazole used for? crypto meningitis in AIDS (crosses BBB) and candida infections
What is ketoconazole used for? Blastomyces, coccidioides, histoplasma, Candida albicans; hypercortisolism
What are Clotrimazole and miconazoleused for? topical fungal infections
What are the major SE of the azoles? hormone synth inhibition (gynecomastia), liver dysfunction (cyt P450 inh), fever, chills
What is the mech of flucytosine? inhibits DNA synth by converting to 5-fluorouracil via cytosine deaminase
What is the use of flucytosine? systemic fungal infections (Cryptococcus) with amphotericin B
What are the major SE of flucytosine? n/v, diarrhea, bone marrow surpression
What is the mech of caspofungin? inhibits cell wall synth by inhibiting synth of Beta glucan
What is the clinical use of caspofungin? invasive aspergillosis, candida
What are the major SE of caspofungin? GI upset, flushing
What is the mech of terbinafine? inhibits squalene epoxidase
What is the use of terbinafine? used to treat dermatomycoses ( esp onychomycosis (finger or toe nails))
What are the SE of terbinafine? abnormal LFTs, visual disturbances
What is the mech of griseofulvin? interferes with microtubule function, disrupts mitosis. depositis in keratin containing tissues
What is the clinical use of griseofulvin? oral tx of superficial infvections. also inhibits growth of dermatophytes ( tinea, ringworm)
What are the major SE of griseofulvin?> teratogenic, carcinogenic, confusion, HA, incr P450 and warfarin metabolism
What is used against toxoplasmosis or plasmodium falciparum? pyrimethamine
What is used against trypanosoma brucei? suramin, melarsoprol
What is used against Trypanosoma cruzi? nifurtimox
What is used against leishmaniasis? sodium stibogluconate
What is the mech of chloroquine? blocks plasmodium heme polymerase
What is the use of chloroquine? plasmodium species
What should be used for plasmodium prophylaxis? mefloquine
What should be used for resistant plasmodium? quinine + pyrimethamine/sulfonamide
what are mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziqunatel used for and mech? antihelmitnthics which acts by immobilizing helminths
What is the target of gamma globulins? block viral adsorbtion/penetration
What is the target of amantadine? block influ A uncoating
What is the target of purine and pyramidine analogs, and Reverse transcriptase inhbiitors? block nucleic acid synth
What is the target of protease inhbitors? block late viral protein synth and processing
What is the target of rifampin? blocks viral packaging and assembly
What is the target of neuramidase inhbitors? block viral release of influenza
What is the mech of amantidine?> blocks viral pnentrations and uncoating. also causes DA release from nerve terminals
What brain structure could be affected by amantidine? cerebella
What is the use of amantidine? prophylaxis and Tx of influenza A; Parkinson's dieseas
What are the major SE of amantidine? ataxia, dizziness, slurred speech
What is the mech of amantadine resistance? mutated M2 protein. 90% of all influ A strains are resistant
What is the mech of zanamivir, oseltamivir ? inhibits influenza neuramidase, decreasing release of progeny virus
What is the use of zanamivir, oseltamivir? both influenza A and B
What is the mech of ribavirin? inhibits synth of guanine nucleotides by inhibiting IMP dehydrogenase
What is the use of ribavirin? RSV, chronic Hep C
What are the SE of ribavirin? hemolytic anemia, severe teratogen
What is the mech of acyclovir? monophosphorylated by HSV/VZV thymidine kinase. guanosine analog. triphosphate formed by cell enzymes. preferentially inhibits viral DNA polymerase by chain termination
What is the use of acyclovir? How might it affect a latent virus? HSV, VZV, EBV. HSV lesions and encephalitis. prophylaxis in ICPT. no effect on latent HSV VZV
What is valacylcovir and what is its advantage? prodrug of acyclovir, better oral availability
What is the best drug for herpes zoster? famciclovir
What is the mech of acyclovir resistance? lack of viral thymidine kinase
What is the mech og ganciclovir? 5 monophosphate fromed by CMV viral kinase. Guanosine analog. triphosphate formed by cellular kinase. inhibits viral DNApol
What is the use of ganciclovir? CMV. esp ICPT.
What is valganciclovir and its advantagE? prodrug of ganciclovir. better oral availability
What are the major SE of ganciclovir? leukopenia, neutropenia, thrombocytopenia, renal tox. more toxic to host enzymes than acyclovir
What are the major SE of acylcovir? none
What is the mech of resistance to ganciclovir? mutated CMV DNApol or lack of viral kinase
What is the mech of foscarnet? viral DNA pol inhibitor that binds to phosphate binding site. pyrophosphate nalog. doestnt require viral kinase activation
What is the clinical use of foscarnet? CMV retinitis in ICPT if ganciclovir fails. and for acyclovir resistant HSV
What is the major SE of foscarnet? nephrotoxicity
What is the mech of resistance to foscarnet? mutated DNApol
What is the mech of cidofovir? inhbiits viral DNApol, doesnt require viral kinase phosphorylation
What is the use of cidofovir? CMV retinits in ICPt, acyclovir resistant HSv. long T1/2
What is the major SE of cidofovir? What should be given with it? NEPHROTOXICITY (coadminster with probenecid)
When is HAART initiated? AIDs defining illness, low CD4 (<350) or high viral load
What is HAART? 3 drugs to prevent riesistance. 2 nucleoside rt inhibitors and 1 non nucleoside rt inhbiitor. OR 1 protease inh or 1 integrase inhibitor
What is the mech of all the navirs? protease inhbitors which prevent cleavage of polypeptide products of HIV mRNA. prevent maturation of new viruses
What is the use of ritonavir in HAART? can boost other drug concentrations by inhbiting Cyt P450
What are the SE of the navirs? hyperglycemia, GI intolerance (n, diarrhea), lipodystophy
What is the mech of tenofovir, emtricitabine, abacavir, lamivudine, zidovudine, didanosine, stavudine? competitively inhbiit nucleoside binding to Rt in HIV and terminate DNA chain. must be phosphorylated by thymidine kinase to be active. all are NRTIS (nucleoside rt inh)
What is the additonal use of zidovidine? general prophylaxis in HIV and to reduce pregnancy spread to child
What are the major SE of tenofovir, emtricitabine, abacavir, lamivudine, zidovudine, didanosine, stavudine? bone marrow surpression (can reverse with G-CSF and Epo), peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia (esp zidovudine)
What is the mech of neVIRapine, efaVIRenz, delaVIRdine? bind to RT at site different from NRTI's in HIV. don't require phosphorylation to compete
What are the SE of neVIRapine, efaVIRenz, delaVIRdine? bone marrow surpression (can reverse with G-CSF and Epo), peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia
What is the mech of raltegravir? inhbits HIV genome integration into host genome by inhbiting HIV integrase
What are the major SE of raltegravir? hypercholesterolemia
What is the mech of interferons? glycoproteins made by infected cell block replication of RNA and DNA viruses
What is the clinical use of interferon alpha? chronic Hep B, C Karposi's sarcoma
What is the clinical use of interferon Beta? MS
What is the clinical use of interferone gamma? NADPH oxidase deficinecy
What are the SE of the interferons? neutropenia
What is the mnemonic for abtx NOT used in pregnancy? Countless SAFe Moms Take Really Good Care ( clarithromycin, sulfonamides, aminoglycosylides, fluroquinolones, metronidazole, tetracycline, ribavirn, griseofulvin, chloramphenicol
Why dont you use clarithromycin in pregnancy? embryotoxic
Why don't you use sulfonamides in pregnancy? kernicterus
Why don't you use aminoglycosides in pregnancy? ototoxicity
Why don't you use fluoroquinolones in pregnancy? cartilage damage
Why don't you use metronidazole in pregancy? mutagenesis
Why don't you use tetracyclines in pregnancy? discolored teeth and bone growth inhbition
Why don't you use ribavirin in pregnancy? teratogenic
Why don't you use griseofulvin in pregancy? teratogenic
Why don't you use chloramphenicol in pregnancy? gray baby syndrome
Created by: tjs2123