Pharmacology · USMLE Step 1

USMLE Pharmacology: Antimicrobial Drugs

Antibacterial, antifungal, antiviral, and antiparasitic drug classes with mechanism and one signature toxicity per card.

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What is the mechanism of action of penicillins and other beta-lactams?
They bind penicillin-binding proteins and inhibit transpeptidase cross-linking of peptidoglycan in the bacterial cell wall.
Penicillin's classic hypersensitivity reaction is ____.
IgE-mediated anaphylaxis
Why do some penicillin-allergic patients also react to cephalosporins?
Cephalosporins share the same beta-lactam ring structure, causing partial cross-reactivity.
What is the mechanism of action of vancomycin?
It binds the D-ala-D-ala terminus of cell wall precursors, blocking transglycosylation and peptidoglycan elongation.
Rapid IV infusion of vancomycin can cause ____, a non-allergic histamine-release reaction.
red man syndrome
What is the mechanism of action of aminoglycosides (e.g., gentamicin)?
They bind the 30S ribosomal subunit and cause misreading of mRNA, blocking initiation.
What is the signature toxicity of aminoglycosides?
Nephrotoxicity and ototoxicity
What is the mechanism of action of tetracyclines?
They bind the 30S ribosomal subunit and block aminoacyl-tRNA attachment.
Tetracyclines are avoided in children and pregnancy because they cause ____.
tooth discoloration and bone growth inhibition
What is the mechanism of action of macrolides (e.g., azithromycin)?
They bind the 50S ribosomal subunit and block translocation.
What is the signature toxicity of macrolides?
QT interval prolongation
What is the mechanism of action of fluoroquinolones?
They inhibit bacterial DNA gyrase (topoisomerase II) and topoisomerase IV.
Fluoroquinolones carry a warning for ____.
tendinitis and tendon rupture
What is the mechanism of action of sulfonamides?
They inhibit dihydropteroate synthase, blocking bacterial folate synthesis.
What is the signature toxicity of sulfonamides?
Stevens-Johnson syndrome

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