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Antimicrobials
First Aid: Antimicrobials
| Question | Answer |
|---|---|
| Block cell wall synthesis by inhibition of peptidoglycan cross-linking | Penicillin and it's derivatives (anything ending in cillin), cephalosporins, aztreonam, and imipenem |
| These are the penicillin derivatives are resistant to penicillinase and used to treat S. aureus. | Methicillin, nafcillin, dicloxacillin; not used to treat MRSA (methicillin resistant s. aureus) |
| These drugs can cause pseudomembranous colitis. | Clindamycin, ampicillin |
| Ampicillin is effective against these organisms. | "HELPS!"; H. influenzae, E. coli, Listeria, Proteus, Salmonella |
| Extended spectrum penicillins, used to treat pseudomonas infection. | Ticarcillin, carbenicillin, piperacillin; use with clavulinic acid |
| This drug, often used in conjunction with penicillin, inhibits Beta lactamase | Clavulinic acid (also sulbactam and tazobactam) |
| The second generation of this drug was expanded to include H. influenzae, Enterobacter, and Serratia. What did the first generation already treat? | Cephalosporins; Proteus, E. coli, Kliebsella |
| This is the drug of choice for enterobacter, and is administered with cilastatin. | Imipenem; cilastatin inhibts renal dihydropeptidase I which inactivats imipenem in the renal tubules |
| This drug is first choice for enterbacter, but can causes seizures (CNS toxic). | Imipenem |
| This drug inhibits mucopeptide formation by binding D-ala D-ala portion of cell wall precursors preventing crosslinking. | Vancomycin |
| What is vancomycin used against and what are it's side effects? | Multidrug-resistant organisms such as S. aureus and Clostridium difficile; nephrotoxic, ototoxic, thrombophlebitis, diffuse flushing "red man syndrome" |
| What are the protein synthesis inhibitors and what ribosomal subunit do they act on? | "Buy AT 30, CELL at 50!"; aminoglycosides (gentamicin, streptomycin) work on 30s; Chloramphenicol, Erythromycin (a macrolide), Lincomycin, and cLindamycin work on 50s |
| What are the major side effects of aminoglycosides? | Nephrotoxic, ototoxic, teratogenic |
| This aminoglycoside is given orally as prophylaxis for bowel surgery. | Neomycin |
| This drug can cause discoloration of the teeth and inhibition of bone growth in children. | Tetracycline |
| This drug is used to treat meningitis (H. influenzae, N. meningitidis, and s. pneumoniae) | Chloramphenicol |
| What are the major toxicities of chloramphenicol? | myelosuppression and occasionally an irreversible aplastic anemia; also causes "gray baby syndrome" (cyanosis and cardiovascular collapse) |
| This drug is used to treat anaerobic infections (e.g. Bacteroides fragilis, C. perfringens) | Clindamycin |
| These two drugs used in combination cause sequential block of folate synthesis. | Sulfonamides (inhibit dihydropterate synthase); Trimethroprim (inhibits dihydrofolate reductase) |
| What two antimicrobials are triggers for G6PD hemolysis? | Sulfonamides and isoniazid (INH) |
| This drug inhibits DNA gyrase (topoisomerase II). | Fluoroquinolones (-floxacin) |
| What are the major side effects of fluoroquinolones? | Tendonitis and tendon rupture in adults; myalgias and leg cramps in kids |
| This antiprotozoal is also used in combination therapy for H. pylori. | Metronidazole; Bismuth and amoxicillin (or tetracycline) are the other two in H. pylori treatment |
| What drug has a disulfiram like reaction with alcohol. Interestingly disulfiram may be effective in treating organisms resistant to this drug. | Metronidazole (Cephalosporins also have a disulfiram like reaction) |
| This topical agent disrupts bacterial cell membranes. | Polymyxins |
| What are the 5 major anti-TB drugs, and what is their common toxicity? | "SPIRE" Streptomycin, Pyrazinamide, Isoniazide, Rifampin, Ethambutol; all are hepatotoxic |
| This drug is the only solo prophylactic TB agent. | Isoniazid |
| What are the major toxicities of isoniazid? | neurotoxic (preventable w/ B6), hepatotoxic (like all anti-TB's), SLE-like syndrome, G6PD hemolysis |
| This drug inhibits DNA-dependent RNA polymerase, and may be used as prophylactic agent for HIB contacts. | Rifampin (treats tuberculosis) |
| This drug can cause Red/orange body fluids. | Rifampin |
| This antifungal, too toxic for systemic use, is used for "swish and swallow" treatment of oral candidiasis or topically for diaper rash. | Nystatin; binds ergosterol disrupting fungal membranes |
| This drug is used to treat cryptococcal meningitis in AIDS patients. | Fluconazole |
| What is the treatment for systemic mycoses? | Locally, treat with ketaconazole and fluconazole; systemically treat with amphotericin B |
| These drugs cause gynecomastia by inhibiting hormone synthesis. | Azoles |
| This drug, which works in a similar fashion to the azoles, is used to treat dermatophytoses. | Terbinafine |
| This drug interferes with microtubule function disrupting mitosis. Used to treat tinea (ringworm). | Griseofulvin |
| This drug which blocks viral penetration/uncoating is used as prophylaxis for influenza A and has use in parkinson's treatment. | Amantadine |
| What are the side effects of amantadine? | ataxia, slurred speech, dizziness; rimantidine is a derivative with fewer CNS effects |
| These drugs inhibit influenza neuraminidase and are effective against both A and B. | Zanamivir, oseltamivir |
| This drug inhibits guanine synthesis and is used to treat RSV and chronic hepatitis C | Ribavirin |
| This drug preferentially inhibits CMV DNA polymerase. | Ganciclovir |
| This drug is used to treat HSV, VZV, EBV. | Acyclovir |
| This is the drug used for CMV retinitis or acyclovir resistant HSV. | Foscarnet |
| What are the HIV protease inhibitors? | saquinavir, ritonavir, indinavir |
| Nucleoside reverse transcriptase inhibitors. | Zidovudine (AZT), lamivudine, didanosine (ddI), stavudine, abacavir |
| Non-Nucleoside reverse transcriptase inhibitors. | Nevirapine, efavirenz, delavirdine |
| Are antimicrobials fun to learn? | Yes!!! |
| Treatment for gaint roundworm (Ascaris), hookworm(Ancylostoma), pinworm (Enterobius). | Mebendazole and pyrantel pamoate |
| Treatment for schistosomes. | Praziquantel |
| Treatment for clonorchis sinensis | praziquantel |
| Treatment for pneumocystis carinii. | TMP-SMX |
| Treatment for Chaga's disease? | Nifurtimox |
| Treatment for trypanosomiasis? | Suramin (except chaga's, use nifurtimox) |
| Firstline treatment for malaria? | Chloroquine |