USMLE Pharmacology .txt

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USMLE Pharmacology .txt
2013-11-29 15:11:33
Anti bacterial microbial microbe usmle step high yield

USMLE Step 1 Pharmacology flash cards Antibacterials - in progress Antivirals - no started Antifungals - not started Antiprotozals - not started Major drug reactions - DONE CYP450 inducers - DONE CYP450 inhibitors - DONE
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  1. What is the MOA of Penicillins and how does resistance occur?
    • MOA:
    • 1.Bind PBP (Penicillin Binding Protein)
    • 2. Block transpeptidase cross-linking of cell wall
    • 3. Activate autolytic enzymes

    • Resistance:
    • 1. Alteration of PBP protein.
    • 2. Beta lactamases 3.
    • 3.Porin structure change

    • Penicillin (V) - Oral
    • Penicillin (G) - IV
  2. Drugs of choice for Penicillin resistant S. Aureus
    • Methicillin
    • Naficillin
    • Dicloxacillin
  3. Drug of choice for MRSA
  4. Clavulinic acid, sulbactam and tazobactum are what kind of drugs?
    Beta lactamase inhibitors

  5. What are the aminopenicillins and what is their coverage?
    Amoxicillin and Ampicillin

    Influenzae, E. Coli, Listeria, Proteus, Salmonella and enterococci.

    • HELPS with enterococci.
    • amOxicillin -- Oral
  6. Ticarcillin, carbenicillin, pipercillin treat which infection?

    TCP - Take Care of Pseudomonas
  7. What are the 1st generation cephalosporins and what are they indicated for?
    Cefazolin and Cephalexin

    • Proteus, E. coli, Klebsiella
    • Gram (+) cocci

  8. What are the 2nd generation cephalosporins are indicated for which infections?
    • H. influenzae, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
    • Gram(+) cocci

  9. What is Ceftriaxone (3rd gen) used for?
    • Meningitis
    • Gonorrhea
  10. What is Ceftazidime (3rd gen) used for?
  11. What are the side effects of vancomycin?
    • Thrombophlebitis
    • Redman Syndrome (diffuse flushing)
    • Ototoxcicity
    • Nephrotoxcicity

    TRON was filmed in VANCouver
  12. What are the side effects of aminoglycosides?
    • Nephrotoxcicity
    • Ototoxcicity
    • Teratogen

  13. Which drugs should be avoided with aminoglycosides for fear of side effect exacerbation and what side effects are exacerbated respectively?
    Aminoglycosides + cephalosporins = Nephrotoxcicity

    Aminoglycosides + loop diuretics = Ototoxcicity
  14. What are the aminoclycosides and what are they indicated for?
    Gentamycin, Neomycin, Amikacin, Tobramycin

    • MOA: Enter cell through oxygen transporter and inhibit initiation complex and cause misreading of mRNA. 30s subunit inhibitor
    • Indications: Severe gram(-) rod infections

    • aminO2glygosides
    • Suffix: -mycin
  15. What is a drug with penicillin-like activity that is safe for Penicillin allergic patients and renal compromised patients who cannot tolerate aminoglycosides? What's the drug's spectrum?
    • Aztreonam (binds to PBP3)
    • Only works for gram (-) infections
  16. Drugs used for severe life threatening bacterial infections or as a last resort when all has failed
    • Impipenem + Cilastatin
    • Meropenem
  17. What is the MOA of vancomycin and how does resistance to it occur?
    • MOA: Inhibits cell wall transglycosylation by binding to D-ala D-ala of cell wall
    • Resistance: Change of D-ala D-ala to D-ala D-lac
  18. 1st line treatment for syphilis
    Penicillin (G)
  19. What is Linezolid indicated for and what is its MOA and side effects?
    Indications: VRSE and VRE

    MOA: Inhibit formation of initiation complex by binding to 50s subunit.

    Side Effects: has weak MAOI activity which can lead to serotonin syndrome as a drug reaction.
  20. Which drugs bind to the ribosomal 30s subunit and which bind to the 50s subunit?
    30s : Aminoglycosides, Tetracyclines

    50s : Chloramphenicol, Clindamycin, Erythromycin(macrolides), Lincomycin, Linezolid.

    Buy AT 30, CCELL at 50
  21. What are the side effects of Chloremphenicol?
    • Anemia (dose dependent)
    • Aplastic anemia (dose dependent)
    • Gray baby syndrome (premature infants lack UDP-glucoronyl transferase)
  22. Drugs causing interstitial nephritis?
    • Methicillin
    • NSAIDs
    • Furosemide
  23. Which drugs predispose the patient to pseudomembranous colitis (C. Diff)?
    • Clindamycin
    • Ampicillin
  24. What is the most worrying side effect of the Imipenem + Cilastatin combo?
    CNS toxicity (seizures)
  25. How can vancomycin "red man syndrome" be prevented?
    Pretreatment of with antihistamines or slow infusion rate
  26. When is the only time that vancomycin is indicated for oral use?
    Psuedomembranous colitis (C. diff)
  27. What are the sulfonamide drugs and what is their MOA?
    • Sulfamethaxazole (SMX), Sulfisoxazole, Sulfadiazine
    • MOA: Act as PABA antimetabolites causing inhibition of dihydropteroate synthetase
  28. What are the side effects of sulfonamides?
    • Hypersensitivity
    • G6PD hemolysis
    • Nephrotoxicity (tubulointerstitial nephritis)
    • Photosensitivity (SAT for a photo)
    • Kernicterus (infants)
  29. What is drug A and what it drug B?
  30. What is the MOA of Trimethoprim and what is it used for?
    • MOA: Inhibits bacterial Dihydrofolate Reductase (DHFR)
    • Uses: Recurrent UTIs, Shigella, Salmonella, Pneumocystis jirovecci pneumonia
  31. What are the side effects of Trimethoprim?
    • Megaloblastic Anemia
    • Leukopenia
    • Granulocytopenia

    Rx: Leucovorin rescue (folinic acid supplementation)
  32. What are the tetracyclines and what are their MOA and indications?
    Tetracyline, Doxycycline, Demeclocycline, Minocycline

    Bind 30s subunit and prevent attachment of aminoacyl-tRNA

    Indications: V
    .cholera, Acne, Chlamydia, Ureaplasma urealyticum, Mycoplasma, Tularemia, H.pylori, Borrelia burgdoferi, Rickettsia

    VACUuM THe Bed Room

    Suffix: -cycline
  33. What are the main side effects of tetracyclines?
    • Discoloration of teeth
    • Inhibition of bone growth
    • Photosensitivity
    • Fanconi's syndrome (expired tetracyclines)

    • Contraindicated in pregnancy and children
    • Fanconi's syndrome - renal proximal tubule damage leading to decreased reabsorption of solutes.
  34. Which drug class(es) should not be taken with milk or antacids?
  35. What are the macrolides and what is their MOA and indications?
    Erythromycin, Azithromycin, Clarithromycin

    MOA:Inhibit protein synthesis by blocking  translocation, bind to 23s tRNA of 50s subunit.

    Indications: Pneumonias (atypical- Mycoplasma, Chlamydia, Legionella), URTIs, STDs

    • PUS
    • Suffix: -thromycin
  36. What is the MOA of Cholramphenicol and what is it indicated for?
    MOA: Inhibits 50s peptidyltransferase activity

    Indications: Meningitis (H.influenzae, N.meningiditis, S.pneumoniae)
  37. What are the main side effects of Chloramphenicol?
    • Gray baby syndrome (premature infants lack UDP-glucuronyl transferase)
    • Anemia (dose dependent)
    • Aplastic anemia (dose dependent)
  38. What is the MOA of clindamycin and what is it indicated for?
    MOA: Blocks peptide bond formation at 50s subunit

    Indications: Anaerobic infections in the lungs
  39. What are the Flouroquinolones and what is their MOA?
    Ciprofloxacin, Norfloxacin, Ofloxacin, Moxifloxacin, Gatifloxacin, Enoxacin

    MOA: Inhibit DNA Gyrase (bacterial topoisomerase II).

    Suffix: -oxacin
  40. What are the side effects of Flouroquinolones?
    • Tendonitis and tendon rupture (adults)
    • Cartilage damage (children)
    • Leg cramps and myalgias (children)

    Contraindicated in pregnancy and children
  41. Which organisms can Metronidazole be used for? And what's it's MOA?
    MOA: Creates free radicals that cause bacterial DNA damage

    Indications: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (below the lungs), H.Pylori

    GET GAP on the Metro!
  42. What are the side effects of Metronidazole?
    • Disulfram reaction
    • Metallic taste
  43. What are the polymyxins and what are their MOA and side effects?
    Polymyxin B, Colistimethate (Polymyxin E)

    MOA: Bind bacterial cell membrane and disrupt osmotic properties

    Side effects: Neurotoxicity, Acute renal tubular necrosis
  44. What is the Tuberculosis drug regiment?
    • Rifampin
    • Isoniazid
    • Pyrazinamide
    • Ethambutol


    Streptomycin can be added too.
  45. What is the MOA of Rifampin and what are the side effects?
    MOA: Inhibits DNA-dependent RNA polymerase

    • Side effects:
    • Induces CYP450
    • Causes secretions to turn red/orange
    • Mild hepatoxicity

    • R's of Rifampin:
    • Revs up CYP450
    • RNA polymerase
    • Red/orange secretions
  46. What are the MOA and side effects of Isoniazid(INH)?
    MOA: Decreases mycolic acid synthesis

    Side Effects: Neurotoxicity, Hepatoxicity, Lupus

    • INH causes NHL
    • or
    • INH causes lNH (lower case L)
  47. Which drugs are known to cause drug induced lupus?
    Sulfa drugs, Hydralazine, Isonizid, Phenytoin, Procainamide

  48. Solo drug used for prophylaxis of TB?
  49. What are the Isoniazid drug toxicities?
    Lupus, Neurotoxicity, Hepatotoxicity

    • INH can cause lNH (lower case L)
    • or just remember NHL
  50. Drug(s) causing gingival hyperplasia
  51. Drug's that can cause gout?
    • Furosemide
    • Thiazides
  52. Drugs that can cause photosensitivity?
    • Sulfonamides
    • Amiodarone
    • Tetracyclines

    SAT for a photo
  53. Drugs that can cause Steven-Johnson syndrome?
    • Ethoxsumide
    • Lamotrigine
    • Carbamezapine
    • Phenobarbital
    • Phenytoin
    • Sulfa drugs
    • Penicillin
    • Allopurinol

    Seizure Sulfa-cillin
  54. Drugs causing cinchonism?
    • Quinidine
    • Quinine

    • All quinine drugs (derived from cinchona tree)
    • Cinchonism - rash, blurred vision, tinnitus, headache, nausea, vomiting, confusion
  55. Drug's causing drug induced nephrogenic diabetes insipidus?
    • Lithium
    • Demeclocycline
  56. Drugs potentiating seizures?
    • Buproprion
    • Imipenem/Cilastatin
    • Isoniazid
  57. Drugs causing Parkinsonian symptoms?
    • Haloperidol
    • Chlorpromazine
    • Reserpine
    • Metoclopramide

    They all decrease dopamine levels.
  58. Drugs causing Nephrotoxicity AND Neurotoxicity?
    • Aminoglycosides
    • Vancomycin
    • Loop diuretics
    • Cisplatin
  59. Drugs causing thyroid dysfunction?
    • Amiodarone - contains high levels of iodine
    • Lithium
  60. Drugs causing hot flashes?
    • Tamoxifen
    • Clomiphene
  61. Drugs causing gynecomastia?
    • Spironolactone
    • Digitalis
    • Cimetidine
    • Alcohol
    • Ketoconazole
    • Estrogen

    Some Drugs Create Awesome Knockers!
  62. Drugs causing focal and massive hepatic necrosis?
    • Acetaminophen
    • Halothane
    • Valproate
    • Deathcap Mushroom (Amanita phalloides)
  63. Drugs causing pulmonary fibrosis?
    • Bleomycin
    • Amiodarone
    • Busulfan
  64. Drugs causing agranulocytosis?
    • Clozapine
    • Carbamezapine
    • Colchicine
    • Propylthiouracil
    • Methimazole
    • Dapsone
  65. Drugs causing aplastic anemia?
    • Chloromphenicol
    • Benzene
    • NSAIDs
    • Propylthiouracil
    • Methimazole
  66. Drugs causing hemolytic anemia in G6PDH deficient patients?
    • Isoniazid
    • Sulfonamides
    • Primaquine
    • Aspirin
    • Ibuprofen
    • Nitrofurantoin

    Hemolytic anemis IS PAIN
  67. Drugs causing megaloblastic anemia?
    • Phenytoin
    • Methotrexate
    • Sulfadrugs

  68. Drugs causing Torsades de Pointes?
    • Potassium channel blockers (class III)
    • Quinidine (class IA)
  69. Drugs causing cutaneous flushing?
    • Vancomycin
    • Adenosine
    • Niacin
    • Ca2+ channel blockers
  70. Cytochrome P-450 Inducers
    • Barbituates
    • Carbamezapine
    • Griseofulvin
    • Phenytoin
    • Quinidine
    • Rifampin
    • St. John's wort

  71. Cytochrome P-450 Inhibitors
    • Protease Inhibitors (HIV)
    • Isoniazid
    • Cimetidine
    • Ketokonazole
    • Erythromycin
    • Grapefruit
    • Sulfonamides