02 Protein Synthesis

• Bicycle: tetracycline
• Typewriter: acts on bacterial ribosome, inhibiting translation
• Paper jam: bacteriostatic
• 30 sec timer: binds reversibly to 30S ribosomal subunit
• prism: broad spectrum
• Bicyclist coughing: taken orally
• sewage pipe: eliminated fecally, safe in renal failure patients and no dose adjustments

• No mercy pharaoh: activity against methicillin resistant Staph aureus (MRSA)
• Ticks: activity against tick borne bacteria (e.g. Rickettsia, Ehrlichia, Franisella, Borrelia)
• Bruce the cow: activity against Brucella
• Sheep with heart bell: treats culture negative endocarditis caused by Coxiella
• fleas: activity against Yersinia
• clam seat: treats chlamydial cervicitis and urethritis
• uterus shape: treats chlamydial pelvic inflammatory disease
• clam bra: treats chlamydial bronchitis and atypical pneumonia
• cross country skier: treats atypical “walking” pneumonia caused by Mycoplasma
• white capped mountains: treats acne

• medals: multivalent cations (e.g. calcium, iron, magnesium) decrease absorption
• bike pump: resistance via efflux pumps

Tetracycline resistance can occur through a decrease in intracellular concentrations of the drug (by increased efflux or decreased influx) and via synthesis of a protein that allows ribosomes to perform translation even in the presence of the antibiotic.

• Causes tooth discoloration in young children (Ca deposits in newborn teeth)
• Tarantula: deposits in fetal teeth and bone - teratogenic
• mud puddle: GI side effects (e.g. nausea, vomiting, diarrhea)
• sensitive photos: photosensitivity
• Fan cone: Fanconi syndrome (type 2 RTA) associated with use of expired tetracyclines

MRSA empirical treatment

pto, vanco, linelolid..

Macrolide

• Crow: macrolide
• Typewriter: acts on bacterial 50S ribosomal subunit, inhibiting translocation
• Paper jam: bacteriostatic

• Red crow: erythromycin
• A-Z: azithromycin
• Keep clear: clarithromycin

• Boarded soldier: treats Bordetella pertussis
• Family photo: prophylaxis for Bordetella pertussis in close contacts
• Rusty chest plate: azithromycin and clarithromycin treat community acquired pneumonia caused by Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
• Pencil wound: macrolides can be used in patients with a h/o penicillin allergy
• Cold walking snowshoer: azithromycin treats atypical “walking” pneumonia caused by Mycoplasma pneumoniae
• Legion of ships: azithromycin treats atypical “walking" pneumonia caused by Legionella
• Clam lady: azithromycin treats atypical “walking” pneumonia caused by Chlamydia pneumoniae
• Clam lady: azithromycin treats urethritis and cervicitis caused by Chlamydia trachomatis
• Bart the leopard: azithromycin treats infections with Bartonella henselae (e.g. cat scratch fever
• Caged mockingbird: azithromycin and clarithromycin have activity against mycobacterium avium
• Azithromycin prophylaxis with patients with CD4 < 50

• Oral erythromycin treats neonatal conjunctivitis and pneumonia caused by Chlamydia trachomatis
• Dripping wax: erythromycin drops treat neonatal conjunctivitis caused by Neisseria gonorrhoeae
• Bull neck: erythromycin treats diphtheria

• Vampire babe: clarithromycin plus atovaquone treats babesiosis
• Helicopter: clarithromycin, amoxicillin, and a PPI as triple therapy for Helicobacter pylon infection

• Brown puddle: increased GI motility
• yellow face: Acute cholestatic hepatitis causing jaundice
• Torsades strip: prolonged Q-T
• Broken chrome bumper: cytochrome P-450 inhibition.

Clindamycin

• Keep clean: clindamycin
• Typewriter: acts on the bacterial 50S ribosomal subunit, inhibiting translocation
• Paper jam: bacteriostatic

• Purple coccoid dumbbells: activity against Staph and Strep

• Gasmask: anaerobic coverage

• pie and red puffy glove: treats Strep pyogenes (group A strep) soft tissue infections (e.g. cellulitis)

• Lung stains with holes: excellent penetration into abscesses (e.g. lung)

• Choking on Bacteraid: treats oral infections and aspiration pneumonia caused by Bacteroides fragilis

• Perforated pants: activity against Clostridium perfringens

• Snow-capped mountains: topical clindamycin treats moderate to severe inflammatory acne

• Uterus machine: clindamycin plus gentamicin treat polymicrobial female genital tract infections (e.g. endometritis)

• Judo practitioner with sai: gentamicin paired with clindamycin for broad coverage

• Venus fly trap garden: treats bacterial vaginosis caused by Garderella vaginalis

• Brown puddle: diarrhea
• Brown geyser: pseudomembranous colitis caused by Clostridium difficile

• aspiration pneumonia: important cause of lung abscess
• reduced consciousness: alcoholics, anesthetized, upper GI disorders (dysphagia), upper GI
• seizures (intubation, NG tube)

• Clinda for anaerobes above diagphragm
• Metronidazole for anaerobes below

Chloramphenicol

• Typewriter: acts on bacterial ribosome (binds 50s), inhibiting peptide bond formation and halting translation
• Paper jam: bacteriostatic

• Meningitis space helmet: empiric treatment for meningitis in developing countries (e.g. Strep pneumoniae, Haemophilus influenzae, Neisseria meningitidis)
• Earth ball: used in developing countries
• Spotted hand and foot rock climber: alternative agent in serious rickettsial infections (e.g. Rocky Mountain spotted fever - tick borne disease caused by Rickettsia rickettsiae) (doxy CI in pregnancy)

• Deflated inner tubes: anemia due to dose related reversible suppression of RBC production
• Plastic bone: aplastic anemia
• Grey baby syndrome - accumulation of the drug in newborns (due to ineffective glucuronic acid conjugation system) causes flaccidity, hypothermia, shock.

Linezolid

• Police line: linezolid
• Typewriter: binds to bacterial 50S ribosomal subunit, preventing formation of initiation complex
• Paper jam: bacteriostatic

• Purple jewels in clusters and chains: activity against gram positive bacteria (Staph, Strep, Enterococcus)
• No mercy pharaoh: activity against MRSA
• Coughing nurse: treats nosocomial MRSA infections (e.g. hospital acquired pneumonia)
• Resisting van: activity against vancomycin resistant bacterial strains
• Diplococcus rock drums: activity against vancomycin resistant enterococcus (VRE)

• Broken plates: thrombocytopenia
• Cut security camera wire: optic neuropathy
• Gloves and shoe-covers: stocking-glove peripheral neuropathy
• Happy face: serotonin syndrome.

Aminoglycosides

• Sai: aminoglycoside
• Kanji translators, tRNA hat: acts on the bacterial ribosome, halting translation
• 30 min: binds irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex
• Smeared kanji: misreading of mRNA
• Dead translator: bactericidal

• Ninjutsu master: neomycin
• Sai master: streptomycin
• Cobra ninja: tobramycin (similar spectrum of activity as gentamicin)
• Katana master: amikacin
• Judo master: gentamicin.

• Ivy: IV administration
• Neomycin: oral
• Beta-lactam bomb: coupled with cell wall active drugs (e.g. beta- lactams, vancomycin)

• Red bacilli bricks: activity against aerobic gram negative bacilli
• Bellows: transported into bacteria via an oxygen dependent process (aerobic bacteria)
• Secret colon tunnel: neomycin remains active in GI tract, given prophylatically before surgery

• Double purple taiko drums: activity against enterococcus when coupled with a cell wall active agent (e.g. penicillin, vancomycin)

• Rabbit ears: streptomycin treats tularemia caused by Francisella tularensis
• Squirrels with fleas: streptomycin treats the plague caused by Yersinia pestis

• Judo master: gentamicin treats resistant gram negative infections (e.g. Enterobacter, Serratia, Klebsiella)
• Red Shogun: systemic gram negative infections (e.g septicemia, nosocomial RTI, complicated UTI, intra-abdominal infection)
• Mona Lisa: activity against Pseudomonas (gentamicin, tobramycin, amikacin)

• Inactivating ninja stars: inactivated by an acetylation enzyme (e.g. E. faecium againsttobramycin)

Aminoglycoside (eg, gentamicin) resistance develops through bacterial production of aminoglycoside-modifying enzymes that transfer different chemical groups (eg, acetyl groups, adenyl groups, phosphate groups) to the aminoglycoside antibiotic molecule outside of the bacterium, thereby decreasing the ability of the antibiotic to bind to ribosomes and exert its antimicrobial effects. This resistance is not chromosomally mediated; it is an acquired resistance mediated by plasmids or transposons.

• Cracked gong: ototoxicity (vestibular or cochlear damage)
  • vertigo, lightheadnness, NV, ataxia, hearing loss
• Sai in flank armor: nephrotoxicity
• Rusty downspout draining muddy water: acute tubular necrosis (ATN)
  • muddy cast on urinalysis.

• Grave with postsynaptic outlet: myasthenia gravis is an absolute contraindication
• Tarantula on gong: teratogenic - deafness in newborn.