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USMLE

New FA Micro 3

QuestionAnswer
block nucleotide synthesis sulfonamides, trimethoprim
block DNA topoisomerases quinolones
block mRNA synthesis rifampin
block protein synthesis at 50S ribosomal subunit chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid
block protein synthesis at 30S ribosomal subunit aminoglycosides, tetracyclines
bacteriacidal antibiotics (6) penicilin, cephalosporins, vancomycin, aminoglycosides, fluoroquinolones, metronidazole
penicillin mechanism bind PBPs, block transpeptidase cross-linking of cell wall; activate autolytic enzymes
penicillin toxicity hypersensitivity reactions, hemolytic anemia
mechanism of methicillin, nafcillin, dicloxacillin bind PBPs, block transpeptidase cross-linking of cell wall - penicillinase resistant because of bulkier R group
methicillin toxicity interstitial nephritis
ampicillin, amoxicillin toxicity hypersensitvity, ampicillin rash (esp. in pts. w/ mono), pseudomembranous colitis
ticarcillin, carbenicillin, piperacillin usage pseudomonas (Takes Care of Pseudomonas)
mechanism of cephalosporins beta-lactam drugs that inhibit cell wall synthesis - less susceptible to penicillinases
antibiotic for penicillin-allergic patients and patients w/ renal toxicity who can't tolerate aminoglycosides aztreonam (synergistic w/ aminoglycosides)
drug of choice for enterobacter imipenem/cilastin
antibiotic that can cause seizures at high plasma levels imipenem/cilastin
mechanism of vancomycin inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors
mechanism of resistance to vancomycin amino acid change of D-ala D-ala to D-ala D-lac
vancomycin toxicity well tolerated in general - does NOT have many problems: nephrotoxicity, ototoxicity, thrombophlebitis
aminoglycosides streptomycin, gentamicin, tobramycin, amikacin - bacteriacidal
mechanism of action of aminoglycosides inhibit 30S subunit - inhibit formation of initiation complex and cause misreading of mRNA
are aminoglycosides effective agains anaerobes? no! require O2 or uptake
aminoglycosides cause nephrotoxicity especially when used in combination with _________ cephalosporins
aminoglycosides cause ototoxicity especially when used with_________ loop diuretics
are aminoglycosides safe to use in pregnancy? no! teratogenic
which tetracycline can be used in patients with renal failure? doxycycline because it is fecally eliminated
can you take tetracyclines with milk? no! nor atacids or iron-containing preparations because divalent cations inhibit its absorption in the gut
tetracycline toxicity discoloration of teeth and inhibition of bone growth in children, photosensitivity
mechanism of action of macrolides inhibit protein synthesis by blocking translocation - bind to 23S rRNA of the 50S subunit
name 3 macrolides erythromycin, azithromycin, clarithromycin
when can sulfonamides cause hemolysis? G6PD deficiency
most common cause of noncompliance with macrolides GI discomfort
macrolides increase the serum concentration of what drugs? theophyllines, oral anticoagulants
acute cholestatic hepatitis & eosinophilia are toxicities of which class of antibiotics? macrolides
clinical use of chloramphenicol meningitis - H. flu, neisseria, strep pneumo
why does chloramphenicol cause gray baby syndrome? because infants lack liver UDP-glucoronyl transferase
is the aplastic anemia seen with chloramphenicol dose dependent? no! the anemia is, however
mechanism of action of chloramphenicol inhibits 50S peptidyltransferase
what is the clinical use of clindamycin? treatment of anaerobic infections - B. frag, C. perfringfens
clindamycin toxicity pseudomembranous colitis - destroys normal GI flora
mechanism of action of sulfonamides (sulfamethoxazole, sulfisoxazole, triple sulfas, etc.) PABA antimetabolites inhibit dihydropteroate synthase
what side effect can sulfonamides cause in infants? kernicterus
mechanism of action of trimethoprim inhibits bacterial dihydrofolate reductase
trimethoprim toxicity megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid)
mechanism of action of fluoroquinolones inhibit DNA gyrase (topoisomerase II)
what class of antibiotics can cause cartilage damage in kids? fluoroquinolones
what drug is associated with a disulfiram-like reaction with alcohol and a metallic taste metronidazole
what can prevent the neurotoxicity associated with INH? pyridoxine (vitamin B6)
INH toxicity hemolysis if G6PD deficient, neurotoxicity, hepatotoxicity, SLE-like syndrome
mechanism of action of rifampin inhibits DNA-dependent RNA polymerase
what drug delays resistance to dapsone when used for leprosy? rifampin
resistance mechanism for penicillins/cephalosporins beta-lactamase cleavage of beta lactam ring
resistance mechanism for aminoglycosides modification via acetylation, adenylation, or phosphorylation
resistance mechanism for chloramphenicol modification via acetylation
resistance mechanism for macrolides methylation of rRNA near erythromycin's ribosome binding site
resistance mechanism for tetracycline decreased uptake or increased transport out of cell
resistance mechanism for sulfonamides altered enzyme (bacterial dihydropteroate synthetase), decreased uptake, or increased PABA synthesis
mechanism of action of amphotericin B binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes and disrupt homeostasis
drug of choice for systemic mycoses amphotericin B
amphotericin B toxicity fever/chills, hypotension, nephrotoxicity, arrhythmias, hypochromic normocytic anemia
do ketoconazole and ampho B act synergistically? no - they antagonize each other's actions, so should never be used together
Created by: Asclepius