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USMLE
Pharm 2
| Question | Answer |
|---|---|
| Name antibiotics that block protein synthesis at 50S ribosomal unit | Chloramphenicol, Erythromycin/macrolides, Lincomycin, Clindamycin, Streptogramins (quinupristin, dalfopristin), Linezolid |
| Name antibiotics that block protein synthesis at 30S ribosomal unit | Aminoglycosides, Tetracyclines |
| Name antibiotics that block nucleotide synthesis | Sulfonamides, Trimethoprim |
| Name antibiotics that block DNA topoisomerase | Quinolones |
| Name antibiotic that blocks mRNA synthesis | Rifampin |
| Name bactericidal antibiotics | Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole |
| Name drugs that disrupt bacterial/fungal cell membrane | Polymyxins |
| Name drugs that disrupt fungal cell membranes | Amphotericin B, Nystatin, Flucoconazole/azoles |
| Oral form of penicillin is called _ IV form? | Penicillin V, Penicillin G |
| Mechanism of penicillin | - Binds penicillin binding proteins - Blocks transpeptidase cross linking of cell walls - Activates autolytic enzymes |
| This antibiotic is bactericidal for gram positive cocci, gram positive rods, gram negative cocci and spirochetes. Not penicillinase resistant | PENICILLIN |
| Toxicity of penicillin | Hypersensitivity reactions Hemolytic anemia |
| Methicillin, nafcillin, dicloxacillin - mechanism of action? Narrow or broad action? Penicillinase resistant or not? | Same as penicillin. Narrow action. Penicillinase resistant because of bulkier R groups |
| Methcillin, nafcillin and dicloxacillin are clinically used for treatment of what bug? | S. aureus |
| Methicillin toxicity | Interstitial nephritis |
| Methcillin, nafcillin, dicloxacillin toxicity | Hypersensitivity reactions |
| Ampicillin, Amoxicillin- mechanism of action Penicillinase sensitive or resistant? Spectrum narrow or wide? | SAME AS PENICILLIN Wide spectrum Penicillinase sensitive |
| Ampicillin, amoxicillin can be combined with _ to enhance spectrum | Clavulinic acid |
| Which has greater oral bioavailibility - amoxicillin or ampicillin | AmOxicillin has greater Oral bioavailibility |
| Name antibiotics that are extended-spectrum penicillins - against certain gram positive and gram negative rods Name rods | HELPS kill enterococci - H influenzae, E.coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci Ampicillin, amoxicillin |
| Toxicity for ampicillin and amoxicillin | Hypersensitivity reactions, ampicillin rash, pseudomembranous colitis |
| Mechanism for carbenicillin, pipercillin, ticarcillin Spectrum? | Same as penicillin, extended spectrum |
| Name penicillins used for treatment of Pseudomonas, and gram negative rods Is it penicillinase resistant or sensitive Can it be used with clavulinic acid | Carbencillin, Piperacillin, Ticarcillin. Penicillinase sensitive. Use with clavulinic acid |
| Toxicity for carbencillin, piperacillin, ticarcillin | Hypersensitivity reactions |
| Beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases, bactericidal | CEPHALOSPORINS |
| Which cephalosporins target gram positive cocci + Proteus , E. coli,Klebsiella | 1st generation |
| Which cephalosporins target gram positive cocci + H. flu, Enterobacter, Neisseria, Proteus, E coli Klebsiella, Serratia | 2nd generation |
| Which cephalosporins target serious gram negative infections resitant to other beta lactams, meningitis (most penetrate BBB) - give examples | 3d generation - ceftazidime, ceftriaxone |
| 3d generation cephalosporin used for treatment of Pseudomonas | Ceftazidime |
| 3d generation cephalosporin used for treatment of gonorrhea | Ceftriaxone |
| Which cephalosporins have increased activity agains Psedudomonas and gram positive organisms | 4th generation |
| Is there cross hypersensitivity between cephalosporins and penicillin | Yes, 5-10% |
| Toxicity for cephalosporins | Hypersensitivity reactions Increase nephrotoxicity of aminoglycosides Disulfiram like reaction with ethanol (in cephalosporins with methylthiotetrazole group) - cefamandole |
| A monobactam resistant to beta lactamases. Inhibits cell wall synthesis (binds to PBP3), synergistic with aminoglycosides, no cross allerginicity with penicillins | AZTREONAM |
| This antibiotic is used for Gram negative rods (Klebsiella, Pseudomonas, Serratia), no activity agains gram positives or anaerobes, for penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides | AZTREONAM |
| Is there any toxicity associated with AZTREONAM | Usually nontoxic, occasional GI upset |
| Broad spectrum beta lactamase resistant carbapenem | Imipenem |
| Imipenem is ALWAYS administered with _ WHY? | CILASTATIN Inhibitor of renal dihydropeptidase I - to decrease inactivation of the drug in renal tubules |
| Drug of choice for Enterobacter, also active against gram positive cocci, gram negative rods and anaerobes | Imipenem + cilastatin |
| Toxicity associated with Imipenem/cilastatin | GI distress, skin rash, CNS toxicity (seizures) at high plasma levels |
| Inhibits cell wall mucopeptide formation by binding D ala D ala portion of cell wall precursors. Resistance occurs with amino acid change of D ala D ala to D ala D lac | VANCOMYCIN |
| This antibiotic is used for serious gram positive multi drug resistant organisms, including S aureus, and Clostridium difficile (pseudomembranous colitis) | VANCOMYCIN |
| Diffuse flushing ("red man syndrome") associated with vancomycin can be largely prevented by? | Pretreatment with antihistamines and slow infusion rate |
| Toxicity for Vancomycin | Nephrotoxicity Ototoxicity Thrombophlebitis Well tolerated in general - does NOT have many problems |
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