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105 terms

Micro Antibiotics

STUDY
PLAY
Name the primary uses of penicillin
gram+
syphillis
Name the primary uses of nafcillin
naf for staph
Name the primary uses of ampicillin + amoxicillin
gram+
gram- rods = HELPS (H flu, E coli, Listeria, Proteus, Salmonella)
Name the primary uses of piperacillin
Pseudomonas
Name the primary uses of 1st generation cephalosporins
gram+
PEcK = Proteus, E coli, Klebsiella
Name the primary uses of 2nd generation cephalosporins
gram+
HEN PEcKS = H flu, Enterobacter, Neisseria, Proteus, E coli, Klebsiella, Serratia
Name the primary uses of 3rd generation cephalosporins
gram-
meningitis, gonorrhea, Pseudomonas
Name the primary uses of aztreonam
gram- rods
Name the primary uses of imipenem
gram+ cocci
gram- rods
anaerobes
Pseudomonas
Name the primary uses of vancomycin
gram+ esp. resistant bugs
MRSA
C. difficile
Name the primary uses of aminoglycosides
gram- rods (no anaerobes b/c they require O2 for uptake)
Name the primary uses of tetracyclines
MR CHuB = M. pneumo, Rickettsia, Chlamydia, H. pylori, Borrelia; also atypical pneumo
Name the primary uses of macrolides
Atypical pnemo (mycoplasm, chlamydia, legionella)
gram+ cocci (Strep, Neisseria)
Name the primary uses of clindamycin
anaerobes (Bacteroides, Clostridium)
Name the primary uses of SMX/TMP
Gram+
Gram-
Nocardia
Chlamydia
UTI
Shigella
Salmonella
PCP
Name the primary uses of fluoroquinolones
gram- rods (esp. urinary/GI)
Pseudomonas
Neisseria
Name the primary uses of metronidazole
GET GAP = Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, h. Pylori; also C. difficile
What drugs are used to treat Pseudomonas?
Pipercillin, 3rd-4th generation cephalosporin, imipenem, fluoroquinolones, aminoglycosides
What drugs are used to treat syphilis?
penicillin
What drugs are used to treat gram- rods?
Amp/Amoxicillin, 3rd generation cephalosporin, aztreonam, imipenem,
Name the primary uses of amphotericin B
serious mycoses
Name the primary uses of azoles
serious mycoses, incl. cryptococcus in AIDS patients
Name the primary uses of echinocandin
Candida, Aspergillis
Name the primary uses of amantadine
Flu A, Parkinson's
Name the primary uses of oseltamivir
Flu A + B
Name the primary uses of ribavirin
RSV, chronic HCV
Name the primary uses of acyclovir
HSV, VZV, EBV
Name the primary uses of ganciclovir
CMV
What drugs are used to treat CMV?
ganciclovir
What drugs are used to treat RSV?
ribavirin
What drugs are used to treat chronic HCV?
ribavirin
What drugs are used to treat HSV?
acyclovir
What drugs are used to treat EBV?
acyclovir
What drugs are used to treat VZV?
acyclovir
What drugs are used to treat flu A?
amantadine, oseltamivir
What drugs are used to treat Flu B?
oseltamivir
What drugs are used to treat cryptococcus in AIDS patients?
azoles
Name the important anti-fungals
Amphotericin B
Azoles
Echinocandin
Fluorocytosine
What drug is used to treat VRE?
linezolid
Name the anti-TB drugs
INH-SPiRE (inspire)
Isoniazid (INH), Streptomycin, Pyrazinamide, Rifampin, Ethambutol
What drug has CNS adverse effects based on B6 deficiency?
isoniazid (anti-TB)
What drugs are used for atypical pneumonias?
Macrolides (azithromycin)
Tetracyclines (doxycycline)
What drug chelates with Calcium so cannot be taken with milk?
tetracyclines
What drug gives kids gray teeth and depresses bone growth?
tetracyclines
What drug is particularly rash-o-genic?
clindamycin (also penicillins and cephalosporins)
What drug can produce a rash 7-10 days after administration?
TMP/SMX
What drug has particularly bad side effects in AIDS patients?
TMP/SMX
What drug displaces serum albumen and can cause kernicturis?
TMP/SMX
What drugs are used for anaerobes (e.g. Bacteroides)?
metronidazole, 2nd gen cephalosporin, pipercillin, imipenem, tetracycline, linezolid
What drugs is used for pediatric meningitis?
ceftriaxone (3rd gen cephalosporin)
What drug is used for expanded activity against a community acquired pneumonia with an unknown agent?
cefuroxime (2nd gen cephalosporin)
What drugs are used to treat C. difficile?
vancomycin, metronidazole
What drug has the adverse side effect of redman syndrome and how can this be avoided?
vancomycin, avoided by slowing infusion rate
What drug is described as being "slowly cidal"?
vancomycin
What drugs are used for legionella?
fluoroquinolone (ciprofloxacin)
macrolides
What drug can cause tendonitis and cartilage damage?
fluoroquinolones (ciprofloxacin)
What drug causes red-green color blindness?
ethambutol
What drug causes ocular toxicity and optic neuritis?
ethambutol
What drug cannot be used during pregnancy because of the endocrine side effects?
azoles (ketoconazole, fluconazole)
What antifungal has the fewest side effects?
echinocandins (just drug-drug interactions)
What drug inhibits viral DNA polymerase but must be activated by thymidine kinase for activity?
acyclovir
What drug inhibits viral DNA polymerase but does not need thymidine kinase for activity?
ganciclovir
What antiviral causes bone marrow toxicity?
ganciclovir, ribavirin
What antiviral is teratogenic?
ribavirin
How is Pasteurella treated?
augmentin (amoxicillin + clavulanate)
What drug is resistant to Listeria?
cephalosporins
What are the principle resistance mechanisms to penicillin?
B-lactamase hydrolysis of ring
Alteration of PBP site
Alteration of permeability
What is the principle resistance mechanism to vancomycin?
changes D-Ala D-Ala to D-Ala D-Lac
What is the principle resistance mechanism to macrolides?
23S ribosomal RNA binding site mutations
Plasma-mediated inactivating enzymes
Efflux
What is the principle resistance mechanism to tetracyclines?
Efflux
What are the principle resistance mechanisms to aminoglycosides?
transferase enzymes inactivate drug
What is the principle resistance mechanism to sulfonamides and trimethoprim?
Altered dihyropteroate synthetase, decreased uptake, increased PABA
TMP impermeability
What is the principle resistance mechanism to fluoroquinolones?
chromosome encoded DNA gyrase mutation
Which antibiotics have a disulfiram-like reaction with ethanol?
cephalosporin, metronidazole
What side effects are common with imipenem?
GI distress, skin rash, CNS toxicity (seizures)
What side effects are common with cephalosporins?
hypersensitivity
disulfiram-like reaction with ethanol
What side effects are common with aztreonam?
mild, occasional GI
What side effects are common with vancomycin?
generally well-tolerated, does NOT have many problems:
NOT = nephrotoxicity, ototoxicity, thrombophlebitis
also redman syndrome
What side effects are common with aminoglycosides?
Nephrotoxicity (esp with concurrent cephalosporin)
Ototoxicity
Teratogenic
What side effects are common with tetracyclines?
GI distress
Tooth discoloration and bone growth inhibition
Photosensitivity
What side effects are common with macrolides?
Prolonged QT
GI discomfort
Hepatitis
Eosinophilia
Skin rashes
What side effects are common with clindamycin?
C. diff overgrowth
Fever
Diarrhea
What side effects are common with SMX?
Hypersensitivity
Nephrotoxicity
Photosensitivity
Kernicterus in infants
Displaces albumin
What side effects are common with TMP?
Megaloblastic anemia
Leukopenia
Granulocytopenia
What side effects are common with fluoroquinolones?
GI upset
Superinfection
Skin rashes
HA
Dizziness
Tendonitis and tendon rupture
What side effects are common with metronidazole?
disulfiram-like reaction with alcohol
HA
What side effects are common with isoniazid?
Neurotoxicity
Hepatotoxicity
Lupus
Vitamin B6 deficiency
What side effects are common with rifampin?
hepatotoxicity
induces CYPs
orange body fluids
What side effects are common with amphotericin B?
Fevers/chills
Hypotension
Nephrotoxicity
Arrhythmias
Anemia
IV phlebitis
What side effects are common with azoles?
hormone synthesis inhibition
CYP inhibits
fever/chills
Name the primary antibiotic that does not have an effect on Streptococci.
aminoglycosides
Name the cell wall inhibitors
Penicillin
Cephalosporin
Name the antimetabolites
SMX
TMP
Name the DNA inhibitors
Quinolones
Name the protein synthesis inhibitors
Aminoglycosides
Tetracyclines
Chloramphenicol
Erythromycin
MOA SMX?
inhibits folate synth via dihydropteroate synthase
MOA TMP?
inhibits folate synth via dihydrofolate reductase (like methotrexate!)
MOA quinolones?
inhibit topoisomerase (like etoposide!)
MOA aminoglycosides?
binds 30S ribosomal subunit (CLEAN TAG)
MOA tetracyclines?
binds 30S ribosomal subunit (CLEAN TAG)
MOA chloramphenicol?
binds 50S ribosomal subunit (CLEAN TAG)
MOA erythromycin?
binds 50S ribosomal subunit (CLEAN TAG)
antibiotics to avoid in pregnancy?
SAFE Moms Take Really Good Care
Sulfa
Aminoglycosides
Fluoroquinolones
Erythromycin
Metronidazole
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenocol
Antibiotic that causes seizures?
imipenem
Antibiotic that causes long QT?
macrolides (esp erythromycin)