Microbiology Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
| Question | Answer |
| What are the most common Sulfonamides? | Sulfamethoxazole (SMX), Sulfisoxazole, and Sulfadiazine |
| Trimethoprim is: | Folic acid synthesis and reduction (DNA methylation) |
| What two categories of antibiotics disrupt the cell wall? | 1. Peptidoglycan synthesis 2. Peptidoglycan cross-linking |
| What two common Glycopeptides? | Vancomycin and Bacitracin |
| Common Penicillinase-sensitive penicillins: | Penicillin G, V Ampicillin Amoxicillin |
| Which are some Penicillinase-resistant penicillins? | Oxacillin Nafcillin Dicloxacillin |
| Common Antipseudomonas? | Ticarcillin and Piperacillin |
| What is the most common Monobactam? | Aztreonam |
| What are common Carbapenems? | Imipenem, Meropenem, Ertapenem, and Doripenem |
| The 30S subunit ribosomes is attacked by: | Aminoglycosides, Glycylcycline, and Tetracyclines |
| What are the most common aminoglycosides? | Gentamicin Neomycin Amikacin Tobramycin Streptomycin |
| Three tetracyclines | Tetracycline, Minocycline, and Doxycycline |
| Which ribosomal subunit do Tetracyclines attack? | 30S |
| Which antibiotic categories act by inhibiting protein synthesis through inactivation of the 50S ribosomal subunit? | Chloramphenicol, Clindamycin, Linezolid, Macrolides, and Streptogramins |
| What are the MC streptogramins? | Quinupristin and Dalfopristin |
| Common macrolides? | Azithromycin, Clarithromycin, and Erythromycin |
| Common antibiotic that disrupts DNA integrity via free radicals? | Metronidazole |
| Rifampin works by: | Inhibition of mRNA synthesis by the use of an RNA polymerase |
| Which are the two types of Gyrase antibiotic categories? | Fluoroquinolones and Quinolones |
| Common Fluoroquinolones | Ciprofloxacin, Levofloxacin |
| Nalidixic acid is an _________________ | Quinolone |
| Daptomycin works by inhibiting the ______________ _____________. | Membrane integrity |
| The 50S ribosomal subunit is attacked by: | Chloramphenicol, Clindamycin, Linezolid, Macrolides, and Streptogramins |
| What medication prevents the formation of THF? | TMP |
| Which antibiotics are known to inhibit PABA? | Sulfonamides |
| DNA gyrase is inhibited by _____________________. | Fluoroquinolones |
| Which antibiotics work on the Cell Wall? | Penicillins and Glycopeptides (vancomycin andbacitrancin) |
| What forms is Penicillin G found? | IV and IM forms |
| Penicillin V is only found in the ____________ form. | Oral |
| Which penicillin, G or V, is administered orally only? | Penicillin V |
| What are the prototype B-lactam antibiotics? | Penicillin G, V |
| What is the mode of action of Penicillin G and Penicillin V? | Binds penicillin-binding proteins --> blocks transpeptidase cross-linking of peptidoglycan in cell wall. Activate autolytic enzymes |
| What are the clinical uses for Penicillin G, V? | 1. Mostly gram (+) organisms (S. pneumoniae, S. pyogenes, Actinomyces) 2. Gram (-) cocci (mainly N. meningitidis) 3. Spirochetes (T. pallidum) |
| Penicillin G, V, is bactericidal or bacteriostatic? | Bactericidal |
| What are the adverse effects associated with Penicillin G, V? | 1. Hypersensitive reactions 2. Direct Coombs (+) hemolytic anemia 3. Drug-induced interstitial nephritis |
| Mode of resistance of Penicillin G, V? | B-lactamase cleaves the B-lactam ring. ---> MUTATIONS in PBP |
| Another name for Penicillin-binding proteins? | Transpeptidases |
| The MOA is same as Penicillin. Wider spectrum; penicillinase sensitive; combine with clavulanic acid to protect against destruction by B-lactamase. | Penicillinase-sensitive penicillins |
| Which hver wider spectrum of action, Penicillin G, V or Penicillinase-sensitive penicillins? | Penicillinase-sensitive penicillins |
| What are the clinical uses of Penicillinase-sensitive penicillins? | H. influenzae, H. pylori, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, and enterococci. |
| What mnemonic is used to remember the coverage of Penicillinase-sensitive penicillins? | HHELPSS |
| HHELPSS stands for: | H. influenzae H. pylori E. coli Listeria monocytogenes Proteus mirabilis Salmonella Shigella Enterococci |
| What are common adverse effects of Penicillinase - sensitive penicillins? | Hypersensitive reactions, rash, and Pseudomembranous colitis |
| Amoxicillin is an | Penicillinase-sensitive penicillin |
| What is the mode of acquired resistance of Amoxicillin and ampicillin? | Penicillinase (a type of B-lactamase) cleaves B-lactam ring. |
| Which type of penicillins are of narrow spectrum? | Penicillinase-resistant penicillins |
| What makes Penicillinase-resistant penicillins "resistant"? | The bulky R group blocks access of B-lactamase to B-lactam ring. |
| What is the use for Penicillinase-resistant penicillins? | S. aureus only |
| Why is MRSA not treated with Dicloxacillin? | It is resistant to Penicillinase-resistant penicillins due to altered PBP. |
| What are the main adverse effects of Nafcillin, Oxacillin, and Dicloxacillin? | Hypersensitivity reactions and Interstitial nephritis |
| What nephrotic disorder is seen as adverse effect of Penicillinase-resistant penicillins? | Interstitial nephritis |
| Which type of penicillins may have interstitial nephritis as an adverse effect? | Penicillin G, V and Penicillinase-resistant penicillins |
| Spectrum type of each: 1. Penicillinase-sensitive penicillins 2. Penicillinase-resistant penicillins 3. Antipseudomonal penicillins | 1. Broad 2. Narrow 3. Extended |
| Antipseudomonal are penicillinase __________________. | Sensitive |
| What is often added to anti pseudomonal to protect them from B-lactamase destruction? | B-lactamase inhibitors |
| What are the clinical uses (infections) treated with Antipseudomonal penicillins? | Pseudomonas spp. and gram (-) rods |
| What are the most (4) B-lactamase inhibitors? | Clavulanic acid, Avibactam, Sulbactam, and Tazobactam |
| What mnemonic is used to summarize the B-lactamase inhibitors? | CAST Clavulanic acid, Avibactam Sulbactam Tazobactam |
| What is the function of B-lactamase inhibitors? | Added to penicillin antibiotics to protect the antibiotic from destruction by B-lactamase |
| What is another name for B-lactamase? | Penicillinase |
| What is prevented by adding Clavulanic acid to Piperacillin? | Destruction of Piperacillin with B-lactamase |
| Cephalosporins are _________________. | Bactericidal |
| Mechanism of action of Cephalosporins | B-lactam drugs that inhibit cell wall synthesis but ar less susceptible to penicillinases. |
| Which are more susceptible to penicillinases, penicillins or cephalosporins? | Penicillins |
| Which organisms are NOT covered with generations 1st-4th Cephalosporins? | LAME Listeria Atypicals (Chlamydia, Mycoplasma) MRSA Enterococci |
| What mnemonic is used to remember the organisms not covered by generations 1-4 of cephalosporins? | LAME |
| What are the two main 1st generation cephalosporins? | Cefazolin and Cephalexin |
| Cefazolin is a _______ generation cephalosporin. | 1st |
| What cephalosporin is generation is Cephalexin? | 1st |
| Cefazolin and Cephalexin are both _______ generation cephalosporins? | 1st |
| What organisms are covered by 1st generation cephalosporins? | PEcK Proteus mirabilis E. coli Klebsiella pneumoniae |
| What is the common use for Cefazolin? | Used prior to surgery to prevent S. aureus wound infections |
| HENS PEcK | Mnemonic used for organisms covered by 2nd Gen cephalosporins |
| What are the most common 2nd Generation Cephalosporins? | Cefaclor, Cefoxitin, Cefuroxime, and Cefotetan |
| Cefaclor is ______ gen cephalosporin. | 2nd |
| Cefoxitin and Cefuroxime are both _____ generation cephalosporins. | 2nd |
| What generation of cephalosporins are Cefaclor, Cefoxitin, Cefuroxime, and Cefotetan? | 2nd |
| What mnemonic is used to summarize the organisms covered by 2nd generation cephalosporins? | HENS PEcK |
| What organisms are covered by 2nd Generation cephalosporins? | 1. Gram (+) cocci 2. H. influenzae 3. Enterobacter aerogenes 4. Neisseria spp 5. Serratia marcescens 6. Proteus mirabilis 7. E. coli 8 . Klebsiella pneumoniae |
| Which cephalosporins can cross the BBB? | 3rd generation cephalosporins |
| What are the 3rd generation cephalosporins? | Ceftriaxone, Cefotaxime, Cefpodoxime, and Ceftazidime |
| What is the main use for 3rd generation cephalosporins? | Serious gram (-) infections resistant to other B-lactams |
| What re the most common uses for Ceftriaxone? | Meningitis, gonorrhea, disseminated Lyme disease |
| Which cephalosporin is often used to treat disseminated Lyme disease? | Ceftriaxone |
| What generation of cephalosporin is Ceftriaxone? | 3rd generation |
| Which 3rd gen Cephalosporin is used to treat Pseudomonas? | Ceftazidime |
| Ceftazidime is a _____ generation cephalosporin | 3rd |
| What type or generation of cephalosporins are used in seriums gram (-) infections? | 3rd |
| Cefotaxime is a ______ generation cephalosporin | 3rd |
| What is the MC 4th generation cephalosporin? | Cefepime |
| What are the clinical uses of Cefepime? | Gram (-) organisms, with increased activity against Pseudomonas and gram (+) organisms |
| Besides gram negative activity, what other infections can be treated with 4th generation cephalosporins? | Pseudomonas and gram (+) organisms |
| What is the most commonly referred 5th generation Cephalosporin? | Ceftaroline |
| What is the coverage of 5th generation cephalosporins? | Broad gram (+) and gram (-) organism |
| Unlike generations 1st --- 4th, the ______ generation of cephalosporins cover: | 5th; Listeria, Atypicals (Chlamydia and Mycoplasma), MRSA, and Enterococci |
| MRSA is covered by ______ generation cephalosporins | 5th |
| What is covered by the 4th generation cephalosporins, but NOT by the 5th generation? | Pseudomonas |
| List of adverse effects seen with Cephalosporins: | 1. Hypersensitivity reactions 2. Autoimmune hemolytic anemia 3. Disulfiram-like reaction 4. Vitamin K deficiency 5. Low rate of cross-reactivity even in penicillin-allergic patients 6. Increase nephrotoxicity with aminoglycosides |
| What kind of anemia may be seen with Cephalosporin therapy? | Autoimmune hemolytic anemia |
| What common Vitamin deficiency is a possible adverse effect of prolonged use of Cephalosporins? | Vitamin K |
| A disulfiram-like reaction is seen with all generations of __________________. | Cephalosporins |
| What other type of antibiotics increase the risk of nephrotoxicity seen in Cephalosporin therapy? | Aminoglycosides |
| What kind of antibiotics should be avoided in patients on Cephalosporin? | Aminoglycosides |
| What is always coadministered with Imipenem? | Cilastatin |
| What is the MOA of Cilastatin? | Inhibition of renal dehidropeptidasa I |
| Inhibitor of renal dehydropeptidase I | Cilastatin |
| Which are the newer Carbapenems? | Ertapenem and Doripenem |
| What is the purpose of using Cilastatin with Imipenem? | Decrease inactivation of drugs in renal tubules |
| What are the main uses for Carbapenems? | 1. Gram (+) cocci 2. Gram (-) rods 3. Anaerobes |
| What is the safest carbapenem? | Meropenem |
| What enzyme is inactivated in renal tubules by the use of Carbapenems? | Dehydropeptidase I |
| What are the adverse effects of carbapenems? | GI distress, rash, and CNS toxicity (seizures) at high plasma levels |
| What is the most significant side effect seen with Carbapenems? | CNS toxicity ---> seizures |
| Aztreonam is an ________________________. | Monobactam |
| Monobactam are less susceptible to ___________________. | B-lactamases |
| How does Aztreonam prevent peptidoglycan cross-linking? | Binding to Penicillin-Binding protein 3 |
| What kind of antibiotics act by binding to PBP-3? | Monobactam |
| Monobactams are synergistically with ____________________. | Aminoglycosides |
| What is the use of Aztreonam? | Gram (-) rods only |
| Which patients are the ones usually treated with Monobactams? | Penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides |
| Inhibits cell wall peptidoglycan formation by binding D-Ala-D-Ala portion of cell wall precursors. | Vancomycin |
| Vancomycin is not susceptible to ______________________. | B-lactamases |
| What bugs are treated with Vancomycin? | Gram (+) bugs |
| Examples of gram (+) bugs treated with Vancomycin? | Serious, multi resistant organisms, including MRSA, S. epidermidis, sensitive Enterococcus species, and C. difficile |
| Vancomycin is bactericidal except for: | C. difficile |
| What is the main syndrome due adverse reaction to Vancomycin? | Red man syndrome |
| What is the cause of Red man syndrome? | Adverse effect to Vancomycin |
| What is the Red man syndrome? | Diffuse flushing due to vancomycin toxicity |
| What are the most common adverse effects of Vancomycin? | Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing (red man syndrome), drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) |
| DRESS syndrome and Red man syndrome are commonly associated with: | Vancomycin toxicity |
| What is the amino acid modification that causes Vancomycin resistance? | D-Ala-D-Ala ----> D-Ala-D-Lac |
| D-Ala-D-Lac | Amino acid change causing Vancomycin resistance |
| How is Red man syndrome prevented? | 1. Pretreatment with antihistamines 2. Slow rate of infusion of Vancomycin |
| What are the bacterial ribosomes targeted by protein inhibitors? | 30S and 50S |
| 30S +50S = | 70S bacterial ribosome |
| All protein inhibitors are _______________________, except for: | Bacteriostatic; Aminoglycosides (bactericidal) LInezolid (variable) |
| Which kind of protein inhibitors are the only bactericidal? | Aminoglycosides |
| Linezolid is bactericidal or bacteriostatic? | Variable (both) |
| Aminoglycosides and Tetracyclines target the _______ ribosomal subunit. | 30S |
| What are the main protein inhibitors that target bacterial 50S ribosomal subunit? | Chloramphenicol, Clindamycin, Erythromycin (macrolides) Linezolid |
| What protein inhibitors directly affect Translocation? | Macrolides and Clindamycin |
| What is the mechanism of action of Aminoglycosides? | 1. Irreversible inhibition of initiation complex through binding of the 30S subunit 2. Cause misreading of mRNA 3. Block translocation |
| Why are aminoglycosides ineffective against anaerobes? | They require Oxygen to work |
| What is the result of aminoglycosides inhibition of the initiation complex by binding to the 30S subunit? | Misreading of mRNA |
| What is the main use of aminoglycosides? | Severe gram (-) rod infections |
| What aminoglycoside is used for bowel surgery? | Neomycin |
| Aminoglycosides work synergistic with? | B-lactam antibiotics |
| What are the most common adverse effects of aminoglycosides? | Nephrotoxicity Neuromuscular blockade Ototoxicity Teratogen |
| Ototoxicity by Aminoglycosides is increased if used with: | Loop diuretics |
| What kind of antibiotic should be avoided in case a patient is on Furosemide? | Aminoglycosides |
| What is the mechanism of resistance presented by aminoglycosides? | Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation. |
| Which protein inhibitor drug class targets/inhibits the A-site tRNA binding? | Tetracyclines |
| Peptidyl transferase is inhibited by _____________________. | Chloramphenicol |
| Linezolid inhibition of 50S subunit prevents _____________ to integrate. | Initiator tRNA |
| Bind to 30S and prevent attachment of aminoacyl-tRNA. | Tetracyclines |
| Tetracyclines have limited ______ penetration. | CNS |
| How is Doxycycline eliminated from the body? | Fecally |
| Why is doxycycline used in renal failure patients? | It is fecally excreted |
| Which products, meds or preparations must be avoided when taking tetracyclines? | 1. Milk (Ca2+) 2. Antacids (Ca2+ and Mg2+) 3.. Iron-containing preparations |
| What kind of cations can inhibit tetracycline absorption in the gut? | Divalent (2+) |
| A person with severe GERD is taking OTC antacids, which protein inhibitor antibiotic should be avoided? | Tetracyclines |
| What are the clinical uses for Tetracyclines? | 1. Borrelia burgdorferi 2. M. pneumoniae 3. RIckettsia and Chlamydia 4. Acne 5. Doxycycline is effective against MRSA |
| Which tetracycline is used for MRSA infection? | Doxycycline |
| Why are tetracyclines especially against Rickettsia and Chlamydia? | Drug's' ability to accumulate intracellularly |
| What are common adverse effects of Tetracyclines? | 1. GI distress 2. Discoloration of teeth and inhibition of bone growth in children 3. Photosensitivity 4. Contraindicated in pregnancy |
| Discolored teeth due a medication. | Tetracycline toxicity |
| What is the mechanism of resistance? | Decrease uptake or increase effeflux out of bacterial cells by plasmid-encoded transport pumps |
| Tigecycline is a _____________________. | Glycylcyclines |
| What are a type of tetracycline derivatives? | Glycylcycline |
| What are the clinical uses of Glycylcyclines? | 1. Broad-spectrum anaerobic, gram (-), and gram (+) coverage 2. MRSA and VRE 3, Infection requireing deep tissue penetration |
| What is the mechanism of action of Chloramphenicol? | Blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic |
| What are the MC uses of Chloramphenicol? | 1. Meningitis (H. influenzae, N. meningitidis, Strep pneumoniae) 2. Rickettsial diseases (Rocky Mountain spotted fever) |
| What are the adverse effects of Chloramphenicol? | 1. Anemia (dose dependent) 2. Aplastic anemia (dose independent) 3. Gray baby syndrome |
| Why do infants develop gray baby syndrome in Chloramphenicol? | They lack liver UDP-glucuronosyltransferase |
| What is the mode of resistance of Chloramphenicol? | Plasmid-encoded acetyltransferase inactivates the drug |
| MOA of Clindamycin: | Blocks peptide transfer (translocation) at 50S ribosomal subunit. Bacteriostatic |
| What are common uses of Clindamycin? | - Anaerobic infections in aspiration pneumonia, lung abscess, and oral infections. - Also effective against invasive group A streptococcal infetion |
| What are adverse effects associated with Clindamycin? | Pseudomembranous colitis (C. difficile overgrowth), fever and diarrhea. |
| Clindamycin treats infections _________________________ diaphragm. | Above |
| What is the most common Oxazolidinones? | Linezolid |
| What type of antibiotic is Linezolid? | Oxazolidinones |
| What is the mode of action of Linezolid? | Inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex. |
| What organisms are commonly treated with Linezolid? | Gram (+) species including MRSA and VRE |
| What are most important adverse effects of Linezolid? | 1. Bone marrow suppression (especially thrombocytopenia) 2. Peripheral neuropathy 3. Serotonin syndrome |
| What syndrome is adversely seen in the use of Linezolid? | Serotonin syndrome |
| How can Linezolid acquire resistance? | Point mutation of ribosomal RNA |
| What are the MC macrolides? | Azithromycin, clarithromycin, and erythromycin |
| What cell process is inhibited by Macrolides? | Translocation |
| What is the mechanism of action of Macrolides? | Inhibit protein synthesis by blocking translocation; bind to the 23S rRNA of the 50S ribosomal subunit |
| Where do macrolides bind to prevent protein synthesis? | 23S of the 50S ribosomal subunit |
| What are the MC clinical uses of Macrolides? | 1. Atypical pneumonias (Mycoplasma, Chlamydia, Legionella) 2. STIs (Chlamydia) 3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin), 4. B. pertussis |
| What antibiotics can be used to treat atypical pneumonias? | Macrolides |
| Mnemonic of adverse effects seen in macrolides | MACRO |
| What are the most common adverse effects of Macrolides? | 1. Gastrointestinal Motility issues 2. Arrhythmia caused by prolonged QT interval 3. acute Cholestatic hepatitis 4. Rash 5. eOsinophilia |
| What macrolides inhibit cytochrome P-450? | Clarithromycin and Erythromycin |
| Methylation of 23S rRNA-binding site prevents binding of drug. | Mechanism of resistance of macrolides |
| What are the most common Polymyxins? | Colistin (polymyxin E), polymixin B |
| MOA of Polymyxins | Cation polypeptides that bind to phospholipids on cell membrane of gram (-) bacteria. |
| What is the clinical use for Polymyxins? | Salvage therapy for multidrug-resistant gram (-) bacteria (P. aeruginosa, E. coli, Klebsiella pneumoniae). |
| What is a common use for Polymyxin B? | Component of a triple antibiotic ointment used for superficial skin infections |
| What are the most significant adverse effects seen with Polymyxins? | Nephrotoxicity, Neurotoxicity (slurred speech, weakness, paresthesias), and respiratory failure. |
| What enzyme is primarily blocked or inhibited by Sulfonamides? | Dihydropteroate synthase |
| What is the end result of inhibition of dihydropteroate synthase by sulfonamides? | Inhibition of folate synthesis |
| When are sulfonamides bactericidal? | When combined with TMP |
| Sulfonamides are bacteriostatic or bactericidal, when used alone? | Bacteriostatic |
| What are the most significant clinical uses of Sulfonamides? | Gram (+), gram (-), Nocardia |
| TMP-SMX is used in treating? | Simple UTI |
| What is a problems seen in a G6PD deficiency patient on Sulfonamides? | Hemolysis |
| What are some adverse effects seen with Sulfonamides? | - Hypersensitivity reactions - Hemolysis (in G6PD deficiency) - Nephrotoxicity (Tubulointerstitial nephritis) - Photosensitivity -Stevens-Johnson syndrome - Kernicterus in infants - Displacement of other drugs form albumin |
| What is the teratogenic adverse effect of Sulfonamides? | Kernicterus |
| Which patients are at higher risk of hemolysis by using sulfonamides? | G6PD deficient |
| What is the way of resistance of Sulfonamides? | Altered enzyme (bacterial dihydropteroate synthase), decrease uptake, or increase PABA synthesis |
| What acid is prevented from forming by the use of Sulfonamide and/or Dapsone? | Dihydropteroic acid |
| What is the MC use for Dapsone? | 1. Leprosy, 2. Pneumocystis jirovecii prophylaxis |
| Two serious adverse effects of Dapsone therapy? | 1. Hemolysis of G6PD deficient 2. Methemoglobinemia |
| What does TMP stand for? | Trimethoprim |
| What is the mechanism of action of TMP? | Inhibits bacterial dihydrofolate reductase; Bacteriostatic |
| What antibiotic combination cause a sequential block of folate synthesis? | TMP-SMX |
| What infections are treated with TMP in combination with Sulfonamides? | UTIs, Shigella, Salmonella, Pneumocystis jirovecii pneumonia, and toxoplasmosis prophylaxis |
| What is a common treatment for Toxoplasmosis prophylaxis? | TMP-SMX |
| List of TMP adverse effects: | 1. Megaloblastic anemia 2. Leukopenia 3. Granulocytopenia |
| How can granulocytopenia seen with TMP can be avoided? | Coadministration of folinic acid |
| What is the common suffix seen fluoroquinolone nomenclature? | -floxacin |
| Mechanism of action of fluoroquinolones | Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. |
| What should never be taken with fluoroquinolones? | Antacids |
| Antacids should be avoided when also taking: | Fluoroquinolones and Tetracyclines |
| Clinical uses of Fluoroquinolones: | 1. Gram (-) rods of urinary and GI tracts 2. Some gram (+) organisms 3. Otitis externa |
| Why pregnant women cannot take fluoroquinolones? | May cause cartilage damage |
| What populations are at risk of cartilage damage by Fluoroquinolone use? | Pregnant women, nursing mothers, and children < 18 years old. |
| What is a possible ECG adverse effect of fluoroquinolones? | QT prolongation |
| What is a risk of fluoroquinolone therapy in persons over 60 years old or those using prednisone? | May cause Tendonitis or tendon rupture |
| Which two organs or tissues are at risk of damage in Fluoroquinolone therapy? | Cartilage and tendos |
| What effect does ciprofloxacin have on the CYP450 system? | Inhibits |
| How do fluoroquinolones acquired resistance? | Chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps |
| What is the mode of action of Dapsone? | Lipopeptide that disrupts cell membranes of gram (+) cocci by creating transmembrane channels |
| What drug is known to destroy cell membrane by creating transmembrane channels? | Daptomycin |
| What are the most common uses for Daptomycin? | 1. S. aureus skin infections (especially MRSA) 2. Bacteriemia 3. Endocarditis 4. VRE |
| VRE and MRSA can be treated with ________________, by disrupting the cell membrane. | Daptomycin |
| Why is Daptomycin not used in pneumonias? | It tends to avidly bind to and is inactivated by surfactant |
| What medication is known to bind to surfactant and also by inactivated by surfactant as well? | Daptomycin |
| Adverse effects seen in Daptomycin? | Myopathy and rhabdomyolysis |
| What is the mechanism of action of Metronidazole? | Forms toxic free radicals metabolites in the bacterial cell that damage DNA |
| Metronidazole is ______________ and _______________. | Bactericidal and antiprotozoal |
| GET GAP | Mnemonic used to summarize organisms trated with Metronidazole |
| What does GET GAP stand for: | G- Giardia E- Entamoeba T- Trichomonas G- Gardnerella vaginalis A- Anaerobios (Bacteroides, C. diff) P. H. Pylori |
| What medication can substitute Amoxicillin in triple therapy for H. pylori infection? | Metronidazole |
| Metronidazole treat ANAEROBIC infections _________ the diaphragm. | Below |
| Clindamycin treats anaerobic infections ______________ the diaphragm. | Above |
| What adverse effect is seen with Metronidazole + ETOH? | Disulfiram-like reaction |
| What is disulfiram-like reaction presented? | Severe flushing, tachycardia, and hypotension |
| What are the lesser adverse effects of Metronidazole? | Headache and metallic taste |
| What DNA damaging antibiotic may provoke a disulfiram -like reaction if combined with alcohol? | Metronidazole. |
| What is used for prophylaxis is use for M. tuberculosis? | Isoniazid |
| What is the common treatment for M. tuberculosis? | Rifampin, Isoniazid, Pyrazinamide, and Ethambutol |
| RIPE | Mnemonic for M. tuberculosis treatment |
| What drugs are use for prophylaxis for M. avium-intracellulare? | Azithromycin, rifabutin |
| What is the empiric treatment for M. avium-intracellulare? | Azithromycin or clarithromycin + ethambutol. Can add rifabutin or ciprofloxacin |
| What is the long-term treatment of Tuberculoid M. leprae? | Dapsone and rifampin |
| What drug is added to leprae treatment in the Lepromatous form? | Clofazimine |
| What are the two most common Rifamycins? | Rifampin and Rifabutin |
| What is the mechanism of action of Rifamycin? | Inhibit DNA-dependent RNA polymerase |
| What are some clinical uses for Rifamycins? | 1. Mycobacterium tuberculosis 2. Delay resistance to dapsone when used for leprosy 3. Meningococcal meningitidis prophylaxis 4. Chemoprophylaxis in contacts of children with H. influenzae type b. |
| Why is are rifamycins used with Dapsone in treating Leprosy? | It helps delay the resistance to Dapsone |
| What drug causes orange body fluids? | Rifampin |
| Which rifamycin is favored in HIV? | Rifabutin |
| Why is rifabutin used in HIV patients and not Rifampin? | RIfabutin has less cytochrome P-450 stimulation |
| What are the adverse effects seen with Rifamycins? | 1. Minor hepatotoxicity 2. Induction of CYP450 system 3. Orange body fluids |
| What is the mode of resistance of Rifamycins? | Mutations reduce drug binding to RNA polymerase |
| What is a risk of rifampin monotherapy? | Rapid development of resistance to medication |
| What is the mode of action of Isoniazid? | Decreased synthesis of mycolic acids |
| Enzyme required to convert Isoniazid into active metabolite | Bacterial catalase-peroxidase |
| What is encoded by KatG? | Bacterial catalase-peroxidase |
| A deficiency or mutation to KatG gene can result in: | Defective function of INH due to inactivation |
| What is the main infection treated with Isoniazid? | M. tuberculosis |
| Which is the only agent (RIPE), that can be used in monotherapy prophylaxis of TB? | Isoniazid |
| Monotherapy for latent TB? | Isoniazid |
| What defines INH half-lives? | Fast vs Slow acetylators |
| Fast and slow acetylators. Association? | Represent possible Isoniazid half-lives |
| List of Isoniazid adverse effects: | 1. Hepatotoxicity 2. P-450 inhibition 3. Drug-induced SLE 4. Vitamin B6 deficiency --->Neuropathy and Sideroblastic anemia |
| What vitamin may be depleted by use of Isoniazid? | Vitamin B6 |
| What are clinical manifestations of Vitamin B6 deficiency due to INH toxicity? | Peripheral Neuropathy and Sideroblastic anemia |
| What anemia may be seen as side effect of INH toxicity? | Sideroblastic anemia |
| What is co administered with Isoniazid in order to prevent Vitamin B6 deficiency? | Pyridoxine |
| Mutations leading to underexpression of KatG | Mechanism of resistance of Isoniazid |
| What two cell types are most affected by Isoniazid? | Neurons and Hepatocytes |
| What does RIPE stand for? | Rifampin Isoniazid Pyrazinamide Ethambutol |
| What is the clinical use for Pyrazinamide? | M. tuberculosis |
| Which are the two associated adverse effects of Pyrazinamide? | Hyperuricemia and hepatotoxiciy |
| What is the best pH level for Pyrazinamide to function properly? | Acidic |
| What is the mechanism of action of Ethambutol? | Decreased carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase |
| What is the associated adverse effects of Ethambutol? | Optic neuropathy |
| Description of the Optic Neuropathy due to Ethambutol use? | Red-green color blindness |
| Which RIPE drug works by blocking arabinosyltransferase? | Ethambutol |
| Inhibition of mycolic acids in Mycobacterium tuberculosis is done with ___________________. | Isoniazid |
| Decrease the carbohydrate polymerization of mycobacterium cell wall. | Ethambutol |
| What is a second line drug for the treatment of M. tuberculosis? | Streptomycin |
| Which ribosome component is interfered by Streptomycin? | 30S |
| What are associated side effects of Streptomycin? | Tinnitus, vertigo, ataxia, and nephrotoxicity. |
| Agent used as prophylaxis in cases of high risk for endocarditis and undergoing surgical or dental procedures? | Amoxicillin |
| Prophylaxis in cases of exposure to gonorrhea? | Ceftriaxone |
| What agent is used in prophylaxis o recurrent UTIs? | TMP-SMX |
| Ceftriaxone, Ciprofloxacin, or rifampin, are used as prophylaxis in: | Cases of exposure to meningococcal infection |
| What is the prophylaxis for pregnant women (+) group B strep? | Intrapartum penicillin G or ampicillin |
| Erythromycin ointment on eyes. Prophylaxis? | Prevention of gonococcal conjunctivitis in newborn |
| Which cases is Cefazolin used as prophylaxis measure? | Prevention of postsurgical infection due to S. aureus |
| Benzathine penicillin G is used a prophylaxis of: | Syphilis |
| What can be used as prophylaxis measures for strep pharyngitis in child with prior rheumatic fever? | Benzathine penicillin G or oral penicillin V |
| What is the most most common infection in HIV patient with CD4+ count < 50, and what is the prophylaxis drug? | Mycobacterium avium complex (MAC); Azithromycin or clarithromycin |
| TMP-SMX is used as prophylaxis in HIV patients with which possible infections? | Pneumocystis pneumonia and toxoplasmosis |
| Medications for MRSA? | Vancomycin, daptomycin, linezolid, tigecycline, ceftaroline, and doxycycline |
| What medications can be used to treat VRE? | Linezolid and streptogramins |
| What is the most common medication used for Multi-drug resistant P. aeruginosa? | Polymyxins B and E (colistin) |
| What enzyme is inhibited by Terbinafine? | Squalene epoxidase |
| What enzyme is inhibited by Azoles? | 14-a-demethylase |
| Which antifungals interfere in Ergosterol synthesis? | Azoles |
| Antifungals that disrupt cell wall synthesis | Ehinocandins |
| What are some importnat echinocandins? | Anidulafungin, Caspofungin, and Micanfungin |
| What is the common ending in nomenclature azoles? | -azole |
| What antifungal disrupts nucleic acid synthesis? | Flucytosine |
| What are common Polyenes? | Amphotericin B and Nystatin |
| What kind of antifungals inhibited cell membrane integrity? | Polyenes |
| What is the MOA of Amphotericin B? | Binds ergosterol; forms membrane pores that allow leakage of electrolytes |
| What cell structure is unique to fungi? | Ergosterol |
| Forms membrane pores that allow leakage of electrolytes. MOA of? | Amphotericin B |
| What important antifungal is used in serious, systemic mycoses? | Amphotericin B |
| What are some organism treated with Amphotericin B? | Cryptococcus, Blastomyces, Coccidioides, Histoplasma, Candida, Mucor. |
| What electrolytes should be supplemented in a patient on Amphotericin B? | K+ and Mg2+ |
| Why is K+ and Mg2+ supplemented in a patient on Amphotericin B? | Due to altered renal tubule permeability |
| What are adverse effects of Amphotericin B? | Fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis |
| IV phlebitis is associated with: | Amphotericin B |
| What are the most important adverse effects of Amphotericin B? | Nephrotoxicity, arrhythmias, andmia and phleblitis. |
| Which antifungal is used topically and not as toxic as Amphotericin B, and with the same mechanism action of Amphotericin B? | Nystatin |
| What is the clinical use of Nystatin? | "Swish and swallow" for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis. |
| What is a common medication for diaper rash or vaginal candidiasis? | Nystatin |
| What are 3 common Azoles? | Ketoconazole, Itraconazole, fluconazole |
| Inibito fungal sterol (ergosterol) synthesis by inhibiting that CYP450 enzyme that converts lanosterol to ergosterol | Azole mechanism of action |
| Associated adverse effects of Azoles | 1. Testosterone synthesis inhibition 2. Liver dysfunction |
| Which azole is the most likely to cause Gynecomastia? | Ketoconazole |
| Which antifungals are used for local and less serious systemic mycoses? | Azoles |
| What is the MOA of Terbinafine? | Inhibits the fungal enzyme squalene epoxidase |
| What is the most common use for Terbinafine? | Dermatophytosis |
| What is the most common dermatophytose treated with Terbinafine? | Onychomycosis |
| What is Onychomycosis? | Fungal infection of finger or toe nails |
| What are some adverse effects associated with Terbinafine? | GI upset, headaches, hepatotoxicity, and taste disturbance. |
| What is the MOA of Echinocandins? | Inhibit cell wall synthesis by inhibiting synthesis of B-glucan |
| Decrease synthesis is B-glucan is achieved by which kind of antifungals? | Echinocandins |
| What are the most common uses for Echinocandins? | 1. Invasive aspergillosis 2. Candida |
| Why is there flushing in the use of Caspofungin? | Echinocandins release histamine --> flushing |
| What process of the cell cycle is disrupted by Griseofulvin? | Mitosis |
| What is the MOA of Griseofulvin? | Interferes with microtubule function; disrupts mitosis. |
| Where is Griseofulvin commonly deposited? | Keratin-containing tissues (nails) |
| What kind of infection is often treated with Griseofulvin? | Dermatophytes (tinea, ringworm) |
| What is the most significant adverse effect of Griseofulvin therapy? | Disulfiram-like reaction |
| What are the effects on CYP450 and Warfarin, by the use of Griseofulvin? | Increase the metabolism of both |
| Suramin and melarsoprol are used to treat: | Trypanosoma brucei |
| T. cruzi is treated with: | Nifurtimox |
| Nifurtimox is a antiprotozoal agent used to treat _____________. | T. cruzi infection |
| Pyrimethamine is used in treating ___________________. | Toxoplasmosis |
| What is a common treatment option for Leishmaniasis? | Sodium Stibogluconate |
| List of common anti-mite/louse drugs: | 1. Permethrin 2. Malathion 3. Oral Ivermectin |
| What is the use for Permethrin? | Scabies and lice infection |
| Mode of action of Permethrin? | Inhibits Na+ channel deactivation --> neuronal membrane depolarization |
| MOA of Malathion | Acetylcholinesterase inhibitor |
| What is the mode of action of Chloroquine? | Blocks detoxification of heme into hemozoin |
| The accumulation of heme due to Chloroquine, is toxic to which organism spp? | Plasmodia |
| What is a common drug used to treat plasmodial species other than P. falciparum? | Chloroquine |
| Why is Chloroquine not used in treating P. falciparum? | Frequency of resistance is too high |
| What are some common adverse effects seen with Chloroquine? | Retinopathy; pruritus |
| List of anti-helminthic therapy drugs | Pyrantel pamoate Ivermectin Mebendazole Praziquantel Diethylcarbamazine |
| Which is a antihelminthic medication that works as an microtubule inhibitor? | Mebendazole |
| What is the mode of action of Praziquantel? | Increased Ca2+ permeability and increased vacuolization |
| HIV Reverse transcriptase include: | NRTIs and NNRITs |
| Common NRTIs | Abacavir (ABC), Didanosine (ddI), Emtricitabine (FTC), Lamivudine (3TC), Stavudine (d4T), Tenofovir (TDF), Zidovudine (ZDV) |
| Commn NNRTIs include: | Delavirdine, Efavirenz, and Nevirapine |
| ABC | Abacavir |
| ddI | Didanosine |
| Emtricitabine | FTC |
| 3TC | Lamivudine |
| Lamivudine | 3TC |
| d4T | Stavudine |
| Stavudine | d4T |
| TDF | Tenofovir |
| Tenofovir is a common HIV ___________________. | NRTI |
| Tenofovir is abbreviated as _______. | TDF |
| Zidovudine | ZDV |
| Which to HIV antivirals prevent the entry of the virus? | Maraviroc and Enfuvirtide |
| What action does Maraviroc prevent that does not allow for entry of HIV to host cell? | Attachment |
| Maraviroc prevents ______________ of HIV to the cell. | Attachment |
| Penetration of HIV to host cell is prevented with ___________. | Enfuvirtide |
| What HIV antiviral prevents entry of HIV by blocking its penetration? | Enfurvitide |
| List of HIV integrase inhibitors | Dolutegravir Elvitegravir Raltegravir Bictegravir |
| What suffix is shared by all HIV integrase inhibitors? | -- tegravir |
| --tegravir | Integrase inhibitor |
| -tegravir is _______________ inhibitor, and --navir is _____________ inhibitor. | Integrase; Protease |
| Raltegravir is a very common ______________________. | HIV integrase inhibitor |
| What process in HIV replication/infection process is disrupted by Integrase inhibitors? | DNA integration |
| DNA integration occurs right after______________________ and before _____________. | Reverse transcription ; Transcription |
| What are 3 common protease inhibitors used in HIV therapy? | Indinavir, Saquinavir, and Lopinavir |
| -- navir | Protease inhibitor |
| What common suffix identifies all or most of HIV Protease inhibitors? | - navir |
| What process in HIV replication in the CD4+ cell is disrupted by Protease inhibitors? | Proteolytic processing |
| HIV proteolytic processing is inhibited with _____________ inhibitors. | Protease |
| Which are categories of antivirals (non-HIV), that disrupt Nucleic Acid synthesis? | 1. Guanosine analogs 2. Viral DNA polymerase inhibitors 3. Guanine nucleotide synthesis |
| Name two common Guanosine analogs (antivirals): | Acyclovir and Ganciclovir |
| Acyclovir is a _____________________________ | Guanosine analog |
| What action is disrupted by Acyclovir? | Nucleic acid synthesis |
| Cidofovir and Foscarnet both are ________________________. | Viral DNA polymerase inhibitors |
| What are common viral infections treated with Foscarnet and Cidofovir? | HSV and CMV |
| What type of nucleic acid synthesis inhibitor is Ribavirin? | Guanine nucleotide synthesis inhibitor |
| Which are the two most common Neuraminidase inhibitors? | Oseltamivir and Zanamivir |
| What are common antivirals used to treat Influenza A and B? | Oseltamivir and Zanamivir |
| Oseltamivir and Zanamivir are: | Neuraminidase inhibitors |
| What is prevented by the use of Neuraminidase inhibitors? | Release of progeny virus |
| Inhibit influenza neuraminidase | Mechanism of action of Oseltamivir and Zanamivir |
| What are the main uses for Acyclovir and other Guanosine analogs? | HSV and VZV |
| Which Guanosine analog has the best oral bioavailability? | Valacyclovir |
| What are the most significant adverse effects of Acyclovir and other Guanosine analogs? | 1. Obstructive crystalline nephropathy 2. Acute renal failure if not adequately hydrated |
| What is the mechanism of resistance? | Mutated viral thymidine kinase |
| What conditions are most commonly treated with acyclovir? | HSV-induced mucocutaneous and genital lesions as well as for encephalitis. |
| Prodrug of acyclovir? | Valacyclovir |
| Why is there few adverse effects with acyclovir and its derivatives? | It monophosphorylated HSV/VZV infected cells by thymidine kinase |
| What is the mechanism of action of Ganciclovir? | 5'- monophosphate formed by a CMV viral kinase |
| What is the most common use for Ganciclovir? | CMV, especially in immunocompromised patients |
| What is the prodrug of Ganciclovir? | Valganciclovir |
| Adverse effects of Ganciclovir | 1. Bone marrow suppression (leukopenia, neutropenia, thrombocytopenia) 2. Renal toxicity |
| What is the MOA of Foscarnet? | Viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor. |
| Where does the Foscarnet binds? | Pyrophosphate-binding site of enzyme |
| Which antiviral does not require any kinase activation | Foscarnet |
| Pyrophosphate analog | Foscarnet |
| 1. Viral DNA/RNA polymerase inhibitor 2. HIV reverse transcriptase inhibitor | Mechanisms of action of Foscarnet |
| What are the two most common uses for Foscarnet? | 1. CMV retinitis in immunocompromised patients when Ganciclovir fails 2. Acyclovir-resistant HSV |
| List of adverse effects Foscarnet: | 1. Nephrotoxicity 2. Electrolyte abnormalities ----> seizures |
| What are the common electrolyte abnormalities of Foscarnet? | Hypo-or-Hypercalcemia, hypo/hyperphosphatemia, hypokalemia, and hypomagnesemia |
| What is severe consequence seen in Foscarnet-induced electrolyte abnormalities? | Seizures |
| What is the mode of resistance of Foscarnet? | Mutated DNA polymerase |
| Mechanism of action of Cidofovir? | Inhibits viral DNA polymerase |
| What is the main adverse effect seen with Cidofovir? | Nephrotoxicity |
| What does HAART stand for? | Highly active antiretroviral therapy |
| What are the strongest indications for HAART? | 1. AIDS-defining illness 2. Low CD4+ cell counts (<500 cells/mm), 3. High viral load |
| What is the regimen that composes HAART? | A total of 3 drugs; 2 NRTIs + 1 Integrase inhibitor |
| What is the mechanism of action of NRTIs? | Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain |
| All NRTIs are nucleosides, except for ___________________. | Tenofovir (nucleoTide) |
| What are some unique ZDV clinical uses? | 1. General prophylaxis 2. During pregnancy to decrease risk of fetal transmission |
| What are the associated adverse effects of NRTIs? | 1. Bone marrow suppression 2. Peripheral neuropathy 3. Lactic acidosis 4. Anemia 5. Pancreatitis |
| What NRTI is contraindicated in a patient with HLA-B*5701 mutation? | Abacavir |
| How is bone marrow suppression due to NRTI toxicity reversed? | Co-administer granulocyte colony-stimulating factor [G-CSF] and erythropoietin |
| What is an associated adverse effect of ZDV? | Anemia |
| What is the associated adverse effect of Didanosine? | Pancreatitis |
| What adverse effect is seen with all nucleoside NRTIs? | Lactic acidosis |
| Efavirenz is a _____________. | NNRTI |
| Nevirapine and Delavirdine are both, _____________. | NNRTIs |
| What is the mechanism of action of NNRTIs? | Bind to reverse transcriptase at site different from NRTIs. |
| What are some differences of in mechanism of action between NRTIs and NNRTIs? | 1. Bind different site in the reverse transcriptase 2. NNRTIs do NOT require phosphorylation |
| What are all the common to all NNRTIs adverse effects? | Rash and hepatotoxicity |
| What are adverse effects seen with Efavirenz? | Vivid dreams and CNS symptoms |
| Which NNRTIs are contraindicated in pregnancy? | Delavirdine and Efavirenz |
| What is the mechanism of action of Protease inhibitors? | Assembly of virions depends on HIV-1 protease, which cleaves the polypeptide products of HIV mRNA into their functional parts. |
| Which HIV antivirals prevent the maturation of new viruses? | Protease inhibitors |
| Which Protease inhibitor "boost" other drug concentrations by inhibiting CYP450 system? | Ritonavir |
| Which rifamycin is can be use with Protease inhibitors? | Rifabutin |
| What are shared adverse effects of Protease inhibitors? | Hyperglycemia, GI intolerance, lipodystrophy (Cushing-like syndrome) |
| What are associated side effects of Indinavir? | Nephropathy, hematuria, thrombocytopenia |
| What is the result of Protease inhibitors and Rifampin? | Reducts protease inhibitors concentrations, since Rifampin is potent CYP/UGT inducer. |
| Integrase inhibitor mechanism of action | Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase |
| Adverse effect of Integrase inhibitors | Increased creatine kinase |
| What HIV antiviral is associated with increased levels creatine kinase? | Integrase inhibitors |
| What is the mechanism of action Enfuvirtide? | Binds gp41, inhibiting viral entry. |
| Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120. | Mechanism of action Maraviroc |
| What is the associated adverse effect of Enfuvirtide? | Skin reaction at injection sites |
| _____________ inhibits fusion. | Enfuvirtide |
| _____________ inhibits docking. | Maraviroc |
| What is the mechanism of action interferons? | Glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of antiviral and antitumoral properties. |
| Adverse effects associated Interferons? | Flu-like symptoms, depression, neutropenia, and myopathy. |
| List of clinical uses for interferon therapy. | 1. Chronic HBV and HCV 2. Kaposi sarcoma 3. Hairy cell leukemia 4. Condyloma acuminatum 5. RCC 6. Malignant melanoma 7. Multiple sclerosis 8. Chronic granulomatous disease |
| What drug is used with Hepatitis C virus and RSV? | Ribavirin |
| What drugs are commonly used HCV infection? | Ledipasvir, Ribavirin, Simeprevir, and Sofosbuvir. |
| What is MOA of Ledipasvir? | Viral phosphoprotein (NS5A) inhibitor |
| Ribavirin mechanism of action | Inhibitors synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase |
| What are adverse effects of Ribavirin? | Hemolytic anemia and severe teratogen |
| What is the mechanism of action Simeprevir? | HCV protease (NS3/4A); prevents viral replication |
| Adverse effects of Simeprevir? | Photosensitivity reactions |
| Which HCV antiviral works by inhibiting HCV RNA-dependent RNA polymerase (NS5B) acting as a chain terminator? | Sofosbuvir |
| What is the teratogenic effect of Sulfonamides? | Kernicterus |
| Teratogenic effect of Aminoglycosides? | Ototoxicity |
| Cartilage damage is teratogenic effect of: | Fluoroquinolones |
| Associated teratogenic effect of Tetracyclines | Discolored teeth, inhibition of bone growth |
| Gray baby syndrome is the teratogenic result of ______________ in pregnant women. | Chloramphenicol |
Created by:
rakomi
Popular USMLE sets