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Step 1 11.13.12
Microbiology XII
| Question | Answer |
|---|---|
| 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
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