Final FA review > 4/3 micro > Flashcards

4/3 micro Flashcards

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1
Q

Which cardiac abnormality causes wide & fixed splitting?

A

ASD

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2
Q

In cardiac splitting of S2: which sound comes last?

A

pulm. valve closing.

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3
Q

systolic ejection murmur that inc. in intensity w/standing.

A

hypertrophic cardiomyopathy

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4
Q

abrupt standing: how does this affect cardiac parameters?

A
  • dec. preload.

- dec. afterload.

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5
Q

What gets converted to propionyl coa?

-mnemonic?

A

VOMIT pathway:

  • valine
  • odd chain FA
  • methionine
  • isoleucine
  • threonine
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6
Q

glucocorticoids effect on glycogen in liver:

A

glycogenesis!

-you would think glycogenolysis, but nope!

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7
Q

fenoldopam

  • mech?
  • ues?
A
  • dopamine D-1 receptor agonist. Dec. BP & inc. natriuesis.

- hypetensive emergencies.

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8
Q

Cephalosporins

  • What do they not cover?
  • Whats the one exception?
A

LAME

  • listeria
  • atypicals
  • MRSA (except ceftaroline)
  • enterococci
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9
Q

Only cephalosporin to kill MRSA:

A

ceftaroline.

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10
Q

1st generation cephalos:

  • name them?
  • coverage?
  • mnemonic:
A
  • cefazolin, cephalexin.
  • PEcK
  • Proteus
  • E.coli
  • Klebsiella
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11
Q

2nd gen cephalos

  • coverage?
  • mnemonic?
A

HEN PEcKS

  • H. influenzae
  • enterobacter
  • neisseria
  • proteus
  • E.coli
  • klebsiella
  • serratia
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12
Q

Ceftriaxone

  • which gen. cephalo?
  • uses?
A
  • 3rd gen.

- meningitis and gonorrhea.

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13
Q

Ceftazidime

  • which gen. cephalo?
  • uses?
A
  • 3rd gen.

- Pseudomonas.

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14
Q

Cefepime

  • which gen. cephalo?
  • uses?
A
  • 4th gen.

- Pseudomonas.

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15
Q

ceftaroline

  • which gen. cephalo?
  • uses?
A
  • 5th gen.

- MRSA.

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16
Q

Which cephalos target pseudomonas?

-mnemonic?

A

CeftazaDIME & cefe”PRIME” = the girl in the tub in the pseudomonas vid was a DIME piece, super PRIME.

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17
Q

Cephalos

-tox:

A
  • vitamin K deficiency.

- nephrotoxicity of aminoglycosides.

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18
Q

Which antibiotic can cause vitamin K deficiency?

A

Cephalos

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19
Q

Which 2 antibiotic classes together are very nephrotoxic?

A

Cephalos & aminoglycosides.

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20
Q

tryptase

-marker for what?

A
  • released by mast cells.

- marker for mast cell activation.

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21
Q

Aztreonam

  • is it a lactam?
  • sensitive to beta-lactamases?
  • can you use it if you’re allergic to PCN?
A
  • yes.
  • no, not sensitive.
  • yes, no cross-reactivity w/PCN.
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22
Q

Aztreonam

-mech:

A

-Prevents peptidoglycan cross-linking by binding to

penicillin-binding protein 3.

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23
Q

Aztreonam:

-Synergistic with:

A

Synergistic with aminoglycosides.

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24
Q

Aztreonam:

  • target:
  • can it target anaerobes?
A
  • gram (-) rods.
  • the specific type of PBP it binds to are only found on gram (-) rods.
  • can NOT target anaerobes!
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25
Carbapenems - lactam? - sensitive to beta-lactamases? - can you use it if you're allergic to PCN?
- yes. - no, not sensitive. - no, you cant.
26
Imipenem - must administer w/what drug? - why?
- Cilastatin = inhibitor of renal dehydropeptidase I | - To dec. inactivation of drug in renal tubules.
27
Carbapenems | -suffix?
-"penem"
28
Carbapenems - tox? - which is safest carbapenem?
- CNS toxicity (seizures). | - meropenem.
29
Vancomycin - tox: - mnemonic:
NOT trouble free - Nephrotoxicity, Ototoxicity, Thrombophlebitis. - red man syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate).
30
Linezolid | -mech:
prevent formation of 70S ribosome.
31
Aminoglycosides | -why cant they be used against anaerobes?
bc they req. O2 for uptake.
32
Aminoglycosides | -mnemonic for names & tox:
mean GNATS caNNOT kill anaerobes! - gentamicin - neomycin - amikacin - tobramycin - streptomycin - nephrotoxic (esp. w/cephalos) - NMJ blockade - ototoxicity - teratogen *cant kill anaerobes.
33
Aminoglycosides | -mech:
-Inhibit formation of initiation complex and cause misreading of mRNA. Also blocks translocation.
34
Aminoglycosides - ototoxicity is worse when used w/what? - nephrotoxicity is worse when used w/what?
- oto = loop diuretics. | - neph = cephalosporins.
35
Aminoglycosides | -mech of resistance?
Bugs conjugate the drug so its eliminated faster than it can work. -using transferase enzymes.
36
Tetracyclines - coverage? - mnemonic:
May Cause Rough Bite - mycoplasma - chlamydia - ricketsia - borrelia burgdorferi
37
Tetracyclines - mech: - what inhibits its absorption?
- prevents binding of tRNA to A site. | - divalent cations inhibit its absorption in the gut. Its a chelator.
38
Tetracyclines | -tox:
- Discoloration of teeth and inhibition of bone growth in children, photosensitivity. - teratogen.
39
Tetracyclines | -mech of resistance:
Plasmid-encoded transport pumps.
40
Macrolides | -how to recognize?
-"thro mycin".
41
Which macrolide is NOT a P450 inhibitor?
azithromycin.
42
Macrolides - mech: - which part of ribo does it bind?
-Blocking translocation (“macroslides”); bind to the 23S rRNA of the 50S ribosomal subunit.
43
Macrolides - coverage: - mnemonic?
``` "blew out MCL during "slide". Soccer ball represents gram (+) cocci. M=mycoplasma C=chlamydia L=legionella *Its also atypical to blow your MCL out in soccer - atypical pneumonias ```
44
Macrolides - tox: - mnemonic:
MACRO - motility (binds to motilin receptors). - arrythmia (QT prolongation). - cholestatic hepatitis - rash - eOsinophilia
45
Macrolides | -mech of resistance:
Methylation of 23S rRNA-binding site prevents binding of drug.
46
linezolid | -tox:
bone marrow suppression (esp. platelets).
47
Chloramphenicol - coverage? - tox? - mnemonic?
GRAM - grey baby syndrome - ricketsia - aplastic anemia - meningitis
48
Chloramphenicol - mech: - mech of resistance?
- Blocks peptidyltransferase at 50S ribosomal subunit. | - Plasmid-encoded acetyltransferase inactivates the drug.
49
Clindamycin - mech: (same as which other drug)? - mech of resistance?
-Blocks peptide transfer (translocation) at 50S ribosomal subunit. -same as macrolide. -Methylation of 23S rRNA-binding site prevents binding of drug.
50
Clindamycin - coverage? - mnemonic?
- linDAA has GAS. AAD = anaerobes above diaphragm. | - GAS = group A strep, also reminds you about psuedomembranous colitis.
51
Sulfonamides - mech? - bacteriocidal or static?
- PABA antimetabolites inhibit dihydropteroate synthase. | - bacteriostatic! (stops it from growing, doesn't kill it).
52
Sulfonamides - coverage? - tox? - mnemonic?
CUNG HANK - chalmydia - UTI - nocardia - gram +/- - hemolysis in G6PD def. - albumin displaced - nephrotoxic - kernicterus
53
Babies w/E.coli or GBS meningitis (or any E.coli infection) should NOT be treated _____. -why?
sulfondamides | -can cause kernicterus in kids by displacing unconjugated bili from albumin.
54
which bilirubin is complexed w/albumin?
indirect bili.
55
TMP-SMX | -bacteriostatic or cidal?
static
56
TMP - tox: - mnemonic:
Treats Marrow Poorly. | -Megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folinic acid).
57
Fluoroquinolones | -suffix?
-oxacin.
58
Fluoroquinolones - mech? - cidal or static? - dont take it with what drug?
- Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV. - Bactericidal. - Must not be taken with antacids.
59
If you're on antacids, which ABx should you NOT take?
Fluoroquinolones
60
nalidixic acid | -what is it?
a quinolone
61
Fluoroquinolones - C/I in which pts? - tox: - mnemonic:
- children not done w/growth spurt, nursing mothers, pregnant women. - Fluoroquinolones hurt attachments to your bones. - tendonitis, tendon rupture, leg cramps, and myalgias. - some prolong QT interval & can cause torsades bc they interefere w/ions like Calcium.
62
Which two ABxs can cause QT prolongation and possible torsades? -which one more associated with this?
Macrolides & fluoroquinolones. | -macrolides.
63
Fluoroquinolones | -tendon rupture risk inc. w/concurrent use of what drug?
prednisone.
64
Metronidazole | -mech:
-Forms free radical toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.
65
Metronidazole - targets? - mnemonic?
GET GAP on the Metro - giardiasis - entamoeba histolytica - trichomonas vaginalis - gardnerella vaginalis - anaerobes below diaphragm (C. dif, bacteroides). - h. Pylori
66
Metronidazole - tox: - mnemonic:
- you're on a metal (metallic taset) metro-train and you get car sick (disulfiram). - metallic taste, disulfiram like reaction.
67
M. avium–intracellulare | -Tx:
Azithromycin or clarithromycin + ethambutol. | *Can add rifabutin or ciprofloxacin.
68
M. leprae | -Tx:
Long-term treatment with dapsone and rifampin for tuberculoid form. -Add clofazimine for lepromatous form.
69
M. tuberculosis | -prophylaxis?
isoniazid + B6
70
Isoniazid (INH) - mech: - what does it need to be activated?
- Inhibit synthesis of mycolic acids. | - Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite.
71
Which TB med is a prodrug? | -what does it need to be activated?
- Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH to active metabolite. * pyrazinamide is also a prodrug.
72
Isoniazid (INH) - how is it metabolized? - whats special about this? - what other drugs are metabolized this way?
- isoniazid, dapsone, hydralazine, procainamide = all metabolizes thru acetylation. - slow/fast acetylators: can get bimodal distribution graph.
73
Isoniazid (INH) | -effect on P450 system:
Inhibitors P450 system.
74
Isoniazid (INH) - tox: - mnemonic:
INH Injures Neurons and Hepatocytes. - Neurotoxicity, hepatotoxicity, drug-induced lupus. - B6 def => peripheral neuropathy.
75
What type of anemia can isoniazid lead to? | -why?
- B6 deficiency. - Can't build heme w/o B6. You'll get sideoblastic anemia. The RBCs will be made w/o Iron. So you will get inc. serum iron.
76
Rifamycins | -mech:
-Inhibits DNA-dependent RNA polymerase.
77
Rifamycins | -prophylaxis for which bugs?
H. influenza, N. meningitidis.
78
Rifamycins - which two drugs? - which one inc. P450? - which one favored in HIV pts?
rifampni, rifabutin. - rifampin ramps up P450, rifabutin does not. - Rifabutin favored over rifampin in patients with HIV infection due to less cytochrome P-450 stimulation.
79
Pyrazinamide | -mech:
- acidify intracellular environment. | - Effective in acidic pH of phagolysosomes, where TB engulfed by macrophages is found.
80
Pyrazinamide | -tox:
Hyperuricemia, hepatotoxicity.
81
which TB drug can cause gout?
Pyrazinamide can cause hyperuricemia.
82
Ethambutol | -mech:
Inhibit carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase. *like a beta-lactam but for TB cell wall.
83
Ethambutol - tox: - mnemonic:
Ethambutol sounds like ethanol. Arabs drink lots of ethanol. When you're hammered you cant see straight. * Arabs dont celebrate christmas (no red/green). - Optic neuropathy (red-green color blindness).
84
Endocarditis with surgical or dental procedures | -pophylaxis:
PCN
85
Meningococcal infection | -pophylaxis:
Ciprofloxacin (drug of choice), rifampin for children.
86
Pregnant woman carrying group B strep | -prophylaxis:
ampicillin.
87
Prevention of postsurgical infection due to S. aureus:
Cefazolin
88
Prophylaxis of strep pharyngitis in child with | prior rheumatic fever:
PCN
89
Syphilis | -prophylaxis
Benzathine penicillin G
90
pentamidine | -can treat what?
pneumocystis jirovecci
91
Which ABxs can treat MRSA?
- vancomycin - daptomycin - linezolid (can cause serotonin syndrome) - tigecycline - ceftaroline
92
Which ABxs can treat VRE?
- linezolid | - streptogramins (quinupristin/dalfopristin).
93
Daptomycin - mech? - targets? - what inactivates it?
- Bacteriocidal against almost all gram (+) bacteria. - creates transmembrane channels which disrupts the membrane. Fucks up the membrane potential. Leaking ions. - inactivated by pulmonary surfactant, so cant treat pneumonias - cant penetrate outer membrane, so cant treat gram negatives.
94
Daptomycin | -tox:
-Associated w/myopathy. CK levels checked periodically.
95
surfactant inactivates which ABx?
Daptomycin
96
linezolid - mech: - targets:
- bacteriostatic. | - inhibits protein synth by binding to 50S subunit.
97
linezolid | -tox:
- Occasionally linked to bone marrow suppression. - neuritis. - Can have MAO inhibitory actions as well, so watch out if you take it w/SSRI = could get serotonin syndrome.
98
wolff parkinsons white -PR interval: -QRS complex: are they inc or dec?
- PR interval dec. | - QRS complex widened.
99
Brocas | -which lobe?
frontal lobe
100
beta-blocker OD | -tx?
glucagon | -by increasing cAMP.
101
isoproterenol | -whats it do?
nonspecific beta agonist.
102
How is digoxin cleared?
Renally.
103
sickle cell | -whats the substitution?
valine put in for glutamic acid at residue 6.
104
Hartnup disease | -whats the problem?
Deficiency in neutral AA absorption in kidney & gut. - ie. tryptophan (which is used to make serotonin, niacin, & melatonin). - results in B3 (niacin) deficiency => photosensitivity & pellagra like skin rashes.
105
tocopherol | -what is it?
vitamin E
106
tocotrienol | -what is it?
vitamin E
107
GLUT-2 - high or low Km? - high or low capacity? - which tissues?
- high Km - high capacity - liver, pancreatic B-cells, renal tubular cells, small intestine.
108
In which situation will you see acyclovir nephrotoxicity?
Young HSV-1 encephalitis pt hospitalized receiving IV acyclovir.
109
Which sexual development disorder can present w/virilization of the mother in utero?
aromatase deficiency. *placenta has aromatase. Thats why a 21-hydroxylase def. or anything like that would not lead to maternal virizilation. The placental aromatase would handle those excess androgens.
110
Amphotericin B | -what do you have to supplement this drug with?
-Supplement K+ and Mg2+ because of altered renal tubule permeability.
111
Amphotericin B | -commonly used w/which other drug?
flucytosine
112
Amphotericin B - tox? - how to dull some of the toxic effects?
- Fever/chills, hypotension, nephrotoxicity, arrhythmias, IV phlebitis. - suppression of EPO synth => anemia. - Hydration dec.  nephrotoxicity. - Liposomal amphotericin dec. toxicity.
113
Azoles | -mech:
- Inhibit 14–α–demethylase which converts lanosterol to ergosterol. - its a P450 enzyme!
114
Azoles | -which is only azole that crosses BBB?
fluconazole
115
topical fungal infections | -which anti-fungals?
Clotrimazole and miconazole. | -aka clotrimin-ultra.
116
Azoles | -tox:
- Testosterone synthesis inhibition = a P450 enzyme makes testosterone. - gynecomastia (esp. with ketoconazole) - liver dysfunction = inhibits cytochrome P-450.
117
What other random drug had anti-androgen effects like the azoles?
spironolactone
118
How does ketoconazole produce anti-androgen effects?
Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis. -will reduce androgens as well as cortisol.
119
How does spironolactone produce anti-androgen effects?
1) Inhibits desmolase which converts cholesterol to pregnenolone - one of first steps of steroid synthesis. - will reduce androgens as well as cortisol. 2) inhibits steroid binding. 3) inhibits 17alpha-hydroxlase.
120
How do spironolactone and ketoconazole lead to amenorrhea?
No androgens means no estrogens. | -no estrogen = no menses.
121
Flucytosine - what is it? - mech?
- Inhibits DNA and RNA biosynthesis => anti-fungal. - converted to 5-FU by cytosine deaminase. * 5-FU inhibits thymidilate synthase.
122
Flucytosine | -use?
Systemic fungal infections (esp. meningitis caused by Cryptococcus) in combination with amphotericin B.
123
Echinocandins | -suffix?
-fungin.
124
Echinocandins - mech? - mnemonic:
Inhibits cell wall synthesis by inhibiting synthesis of β-glucan. -echinocanDIN(ner) - ends w/GIN: Glucan INhibitor.
125
Echinocandins - target? - mnemonic:
- Invasive aspergillosis, Candida. | - C-AS-pofungin: C=candida, AS=aspergillosis.
126
Echinocandins | -tox:
GI upset, flushing (by histamine release).
127
Terbinafine - mech: - mnemonic:
-Inhibits the fungal enzyme squalene epoxidase. Part of ergosterol synth pathway. "Use epoxy glue to fix the turbine. They were squeeking."
128
Terbinafine | -use:
Dermatophytoses (especially onychomycosis—fungal infection of finger or toe nails).
129
Terbinafine - tox: - mnemonic:
- hepatotoxicity, taste disturbance. | - think of turbines in nose and associate w/taste impairment
130
Griseofulvin - mech: - mnemonic:
Interferes with microtubule function. Deposits in keratin-containing tissues. -Grease up the MTs.
131
Griseofulvin | -use:
Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm).
132
Griseofulvin | -tox:
Teratogenic, carcinogenic, confusion, headaches, inc. P-450 and warfarin metabolism.
133
Besides the azoles, which other antifungal inc. P450 system?
griseofulvin. | "greasy"
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