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102 Cards in this Set
- Front
- Back
Penicillin mechanism of action
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inhibits cell wall synthesis by binding to PBPs on cell surface
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3 antibiotics to consider first
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Penicillin G, V and Amoxicillin
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Advantages of Pen G, V, Amoxicillin
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selective toxicity, bactericidal, potent, wide toxic-theraputic ratio, active over broad pH, not inactivated by pus, can be "forced" into inaccessible areas, many routes, inexpensive
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T or F Penicillin is inactivated by pus and a low pH
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FALSE
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T or F Penicillin is bacteristatic
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FALSE bacteriocidal
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T or F Pen G and ampicillin are absorbed well from the GI
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FALSE
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T or F Pen V and amoxicillin are the of choice PO
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TRUE
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Where are penicillins not easily distributed systemically
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CNS, and humors of the eye
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____ to ____ % protein binding occurs with Pen
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25-45 % = good, greater affinity would inhibit distribution
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Pen is excreted by the _______
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kidneys
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Why do Procain Pen G and Benzathine Pen G maintain high concentrations
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crystaline formation = extended release others use Na+/K+ salts
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List in arder from highest to lowest transient concentration after administration - Pen G (PO) - Pen G (IM) - Pen V (PO)
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Pen G (IM), Pen V (PO), Pen G (PO)
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Pen V (PO) and Pen G (PO) are in for about 4 days T or F
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TRUE
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Pen G (IM) is excreted fastest T or F
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TRUE
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Pen G and V aerobic spectrum
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G+, beta-lactamase negative
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Pen G, V anaerobic spectrum
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G+ and G -, b-lac neg (cocci, spirochetes, Clostridium) *B fragilis is resistant
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Pen __ is used for mild infections while Pen __ is used for severe infections
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Pen V = mild, Pen G = serious
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How do beta-lactamase resistant Pen.'s work
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bulky side chains hinder beta-lac
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Methicilin, nafcilin, oxacilin, cloxacilin, dicloxacilin are all __________ Pen.s
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beta-lactamase-resistant
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Beta-lactamase-resistant spectrum
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G+ cocci and bacilli
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Aminopenicillins have better penetration of the _______ _______ which enhances _______ activity
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outer membrane, G -
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List two common aminopenicillins
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ampicillin (PO/IV), amoxicillin (PO)
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Amoxicillin (PO) is better absorbed in the GI than Ampicillin T or F
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True (only 40% of ampicilin is absorbed --> resistance of intestinal flora)
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Aminopen spectrum
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G+, G-, beta-lac negetive anaerobes
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Amoxicillin is commonly used for prophylaxis T or F
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True kills both G+,-, in 1 office dose
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Carboxypen.s have greater G- spectrum including pseudomonas, are parenteral and used in hospital name two
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Carbenicillin and Ticarcillin both IM/IV
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Augmentin is a common Pen+beta-lac combination of which two
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Amoxicillin + claulanate (kills B fragilis)
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Pen adverse effects
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Allergy (IgE 1% pop), superinfections, Rare - seizures (don't inject on nerve), hepatic and hematologic (bleeding/neutropenia) probs
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Cephalosporins are bactericidal T or F
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TRUE
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Cef.s spectrum (1st gen. Cefazolin, Cefadroxil, Cephalexin)
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aerobic G +
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Which 1st generation Cef is used for surgical prophy
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Cefazolin
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Which 1st generation Cef is commonly used PO
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Cephalexin
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Most Cef's are semi-synthetic, not easily hydrolyzed by staph penicillinase and very expensive T or F
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TRUE
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Older Pen.s are less potent than Cef.s to bacteria which are susceptible to both T/F
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False Pen.s are more potent
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Most studies show __ to __ % of Cef.s cross-allergy w/ Pen
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5-15%
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Bleeding may be a side effect of Cef.s due to interference with _________ or prevention of _______ __________
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prothrombin (due to NMTT side chain, tx = VitK) or platelet aggregation
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Pen is the most over-used Rx T or F
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FALSE Cephalosporins are most used and abused
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Side effects of Cef.s
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Allergy, bleeeding, disulfiram rxn (antabuse-like), rash
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List 3 indications for systemic antibiotics
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cure established inf., localize (prevent spread) of inf., prophy
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List settings for prophy (4)
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major oral surgery, trauma, minor surgery on immunocomp, risk of SBE
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Which macroglides are indicated for SBE prophy if allergic to Pen
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Azithromycin or Clarythromycin
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Which Cef.s indicated for SBE prophy if allergic to Pen
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Cephalexin or Cephadroxil
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Clindamycin, cephalexin, cefadroxil, azithromycin and clarithromycin are all alternitives to Pen used for SBE prophy T or F
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TRUE
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Settings for parenteral SBE prophy (4)
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patient unable to take oral, past SBE, artificial valves, previous RF (latter 3 = high risk)
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Drugs for parenteral prophy include _________(IM/IV) or for Pen allergies _____ (IV) or _________(IM/IV)
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ampicillin, clindamycin, cefazolin
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Timing of prophy oral ______ before, IV ______ before, IM ______ before procedure
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oral = 1 hr, IV = just before, IM = 30 min
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T or F macroglides can be administered parenterally
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FALSE
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A combination bactericidal and bacteristatic antibiotics will cause a positive synergistic effect T or F
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FASLE they will hinder each other
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Vitamins containing PABA will ________ the effect of sulfonamides
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decrease
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Topical neomycin supplemented with gentimycin will cause aminoglycoside ________.
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toxicity
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Taking Fe supplements will _________ the effect of tetracylclines
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decrease
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Kidney problems facilitate the removal of from the T or F
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Fasle concentrations will
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Checklist: What (3)
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what organism (G+,- aerobe ect), penetration/distribution, patient modifiers
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If does not work one should recheck patients HX, and look for ______, _______ _____and ______ __ _____
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abscess, foreign bodies, obstruction to drainage
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Clindamycin must be used to treat chronic osteomyelitis because it is bectericidal. T or F 2 statements
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1st true, 2nd false Clindamycin is bacteristatic (it is used for its penetrating properties)
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Chronic osteomyleitis is caused by
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Staph
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Imipenem, Meropenem and Ertapenem are part of which family
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beta-lactam (carbopenems)
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Vancomycin and Gentimicin are toxic to what (2)
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nephrotoxic and ototoxic
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Vancomycin is bactericidal and is used for treating highly resistant G+ including MRSA T or F
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TRUE
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Other than Vanc what other are used to treat MRSA
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Clindamycin, Tigecycline
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Vancomycin routes of administration
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PO, IV
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Pen.s, Cef.s, beta lactams and Vancomycin are bactericidal how?
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inhibit cell wall biosynthesis
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Aminoglycosides are bacteristatic T or F
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False Aminoglycosides are bactericidal
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Aminoglycosides are bactericidal, how?
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Inhibit protein synthesis by atttaching to ribosomes
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Chloramphenicol is bacteriostatic against G+ and G- but may cause serious side effects which include ___ and ____
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bone marrow supression and 1:40K
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Gentimicin and Neomycin are both classified as
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Aminoglycosides
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Aminoglycoside spectrum
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G - bacilli, primary choice for nosocomial G- inf
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What is wrong with prescribing gentimycin if a patient is using neomycin (topical)
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Aminoglycoside toxicity (neomycin is extremely potent and diffuses into system)
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Tetracyclines are bactericidal and inhibit protein synthesis T/F 2 statements
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F (tetracyclines are bacteristatic is correct), True
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Tetracycline spectrum
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G+,-, effective against bacteria w/o cell wall
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Tetracylcine side effects
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dysgenesis (skeletal dev.), tooth staining, photosensitivity, nausea, expired Rx = nephrotoxic
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Tige-, Mino-, Doxy-, and Tetracylcine are all ______
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bacteriostatic
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Macroglides are bacteriostatic T or F
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TRUE
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List 3 Macroglides
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Erythromycin, Clarithromycin, Azithromycin
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Erythromycin, Clarithromycin and Azithromycin can all be taken orally T/F
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TRUE
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Macroglide spectrum
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G+ staph and resp inf
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Macroglides often cause liver damage and/or gastric disturbances T/F
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FALSE
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Clindamycin is bacteriostatic and inhibits cell wall synthesis T/F 2 statements
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T, F (Clindamycin = inhibits protein synth)
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Clindamycin spectrum
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G+, anaerobes
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Clidamycin is effective against B fragilis, MRSA and staph induced chronic osteomyelitis T/F
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TRUE (3 reasons to use clidamycin vs macroglides)
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Clindamycin may cause __________ ______ due to the proliferation of C difficile
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pseudomembranous colitis
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________ are bactericidal inhibitors or membrane function (neurotoxic).
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Polymixins
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Polymixins are used _____ in combination with neomycin.
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topically
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Polymixin spectrum
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G-
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CHX used for perio is a ________
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Polymixin
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Fluoroquinolones suffix _______
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floxacin
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How are fluoroquinolones bactericidal
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intefere with DNA gyrase/topoisomerase
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Why are fluoroquinolones not indicated for children
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may interfere with collagen formation in joints
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fluoroquinolone spectrum
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G+,-
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_____ is bactericidal and used to treat aggressive (juvenile) perio = anaerobic bacteria
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Metronidazole
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List used to treat TB (4)
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Rifampin, Isoniazid, Ethambutol, Paraaminosalicylic acid
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Rifampin is bacteriostatic by inhibiting ________
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DNA dependant RNA polymerase
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Aminoglycosides and Polymixin are effect against G__ inf
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G-
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Pen.s, Cef.s, Vancomycin, Macroglides, Clindamycin and Rifampin are effective against G__
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G+
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Drugs effective against both G+ and - include Carbopenems, fluoroquinolones, beta-lactams, ________ and _______
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Amoxicillin , Tetracyclines
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Pen.s, Cef.s, beta-lactlms, Vancomycin, Aminoglycosides, Polymyxixns, Fluoroquilinones and Metronidazole are all _______
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bactericidal
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Tetracylcines, Chloramphenicol, Macroglides, Clindamycin and Rifampin are all _________
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bacteriostatic
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List inhibitors or cell wall synthesis
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Pen.s, Cef.s, beta-lactams and Vancomycin
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Aminoglycosides, Tetracycline, Chloramphenicol, Macroglides and Clindamycin all inhibit ______ ________
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protein synthesis
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Polymixins inhibit _______ ________
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membrane synthesis
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________ interfere with w/ DNA
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fluoroquinolones
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Rifampin inhibits ________
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RNA polymerase
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