Antibiotics Wcc Pharm Exam 2

Front 1

Name the beta-lactam ring ABs

Back 1

Penicillins, Cephalosporins, Carbapenems
Aztreonam is half-ring

Front 2

Penicillin MOA?

Back 2

Interferes w/cell wall synthesis
Bacteriocidal

Front 3

Mech of resistance against penicillins?

Back 3

beta-lactamase or penicillinase

Front 4

Name the AB families that are excreted hepatically

Back 4

Macrolides, some tetracyclines (Doxy), Rifampin, Clindamycin

Hint 4

DREC

Front 5

Special issues re: Cephalosporins

Back 5

Generations 1-4 increasing ability to cross BBB, increasing effectiveness against G-
10-30 % cross-allergy w/Penicillins

Front 6

Mech of resistance against Cephalosporins

Back 6

Beta-lactamases, cephalosporinases, Penicillin-binding proteins (PBPs) that have low affinity for cephalosporins (eg: MRSA)

Front 7

Carbapenem with a beta-lactam half-ring. Why?

Back 7

Azteonam
Safe for beta-lactam allergy

Front 8

Examples of Macrolides

Back 8

Erythromycin, clarithromycin, azithromycin

Front 9

Macrolide MOA?

Back 9

Inhibits protein synthesis at 50S ribosome.
Bacteriostatic (can be -cidal at high concentrations)

Front 10

Mech of resistance to Macrolides

Back 10

Active efflux, altered binding sites.

Front 11

Side effects / special issues w/Macrolides?

Back 11

GI upset
drug interactions (exc. azithromycin)
QT elongation
Inhibits CYP450 (may incr. conc. of some drugs)

Front 12

Tetracycline MOA?

Back 12

Inhibits protein at 30S ribosome subunit.
Bacteriostatic

Front 13

Mech of resistance against Tetracyclines

Back 13

Ribosome protective proteins
Decreased access of drug to ribosomes due to: 1. decreased uptake; 2. increased ability to actively extrude drug

Front 14

Elimination of Tetracyclines

Back 14

Tetracycline - renal
Doxycycline - hepatic

Front 15

Side effects / special issues w/Tetracyclines?

Back 15

Stains teeth
Photosensitivity
Forms chelates w/Ca, Fe, Mg, Al, Zn
- Do not administer with antacids, milk products, or Ca and Fe supplements

Front 16

Name the bacteriostatic inhibitors of bacterial protein synthesis

Back 16

Tetracyclines
Macrolides
Clindamycin
Oxazolidinones (Linezolid)
Chloramphenicol

Front 17

Name the drugs that weaken the bacterial cell wall resulting in cell death

Back 17

Penicillins
Cephalosporins
Carbapenems
Vancomycin

Front 18

Name the bacteriocidal inhibitors of bacterial protein synthesis

Back 18

Aminoglycosides

Front 19

Fluoroquinolone MOA?

Back 19

Inhibits bacterial DNA gyrase

Front 20

Mech of resistance against Fluoroquinolones

Back 20

Altered bacterial DNA gyrase
Reduced ability of Cipro to cross bacterial membranes

Front 21

Elimination of Fluoroquinolones?

Back 21

Renal and hepatic

Front 22

Side effects / special issues w/Fluoroquinolones

Back 22

Altered bone growth in peds
Elongates QT
Achilles tendon rupture
Use against anthrax (Cipro)

Front 23

Sulfanomide MOA?

Back 23

Inhibits synthesis of folic acid.
Bacteriostatic

Front 24

Mech of resistance to Sulfa

Back 24

Synthesis of PABA to overcome sulfanomide-mediated inhibition of digydropteroate synthetase.
Alteration of digy-synthetase.
Reduced drug uptake.

Front 25

Side effects / special issues w/Sulfa drugs?

Back 25

ALLERGIES
Stevens-Johnson Syndrome
hemolytic anemia

Front 26

Examples of Aminoglycosides

Back 26

Streptomycin, gentamycin, tobramycin, amikacin
(generally -mycins except Vancomycin)

Front 27

Aminoglycoside MOA?

Back 27

Inhibits protein synthesis - binds irreversibly to 30S ribosome
Bacteriocidal

Front 28

Mech of resistance to Aminoglycosides

Back 28

Aminoglycoside-inactivating enzymes (more than 20 have been found)

Front 29

Side effects / special issues w/ Aminoglycosides

Back 29

IV only
Nephro- and Oto-toxic
Neuromuscular blockade (paralysis)
Do not mix in solution w/other drugs
Monitor serum drug levels

Front 30

Aminoglycosides spectrum

Back 30

Primarily Gram neg. aerobes

Front 31

Vancomycin MOA?

Back 31

Inhibits cell wall synthesis (no beta-lactam ring)
Stops cell wall synthesis by binding to precursor.
Bacteriocidal

Front 32

Mech of resistance to Vancomycin

Back 32

Modification of binding site of peptidoglycan

Front 33

Side effects / special issues w/Vancomycin

Back 33

Red-man Syndrome (fast infusion)
Rash, neutropenia, thrombophlebitis (IV)
Oto- and Nephro-toxic (when administered with others)
Monitor BUN/Creatinine & CBC

Front 34

Can cause Red-man Syndrome

Back 34

Vancomycin

Front 35

Can cause Stevens-Johnson Syndrome

Back 35

Sulfanomides

Front 36

Used against TB, leprosy and MRSA

Back 36

Rifampin

Front 37

Rifampin MOA?

Back 37

Inhibits bacterial RNA synthesis
Bacteriocidal

Front 38

Mech of resistance to Rifampin

Back 38

Altered RNA polymerase

Front 39

Elimination of Rifampin

Back 39

Hepatic

Front 40

Side effects / special issues w/Rifampin

Back 40

Discoloration of urine, tears, saliva
CYP450 inducer (must increase dose over time)
Used for TB, leprosy and MRSA

Front 41

Linezolid (Oxazolidinone) MOA?

Back 41

Inhibits protein synthesis.
Bacteriostatic

Front 42

Use for Linezolid

Back 42

MRSA and VRE only (per FDA)
Gram + only

Front 43

Side effects / special issues for Linezolid

Back 43

Contains phenylalanin - contraindicated for PKU clients
Drug-drug interaction w/MAOIs and SSRIs

Front 44

FDA recommends use against MRSA and VRE only

Back 44

Linezolid

Front 45

Side effects / special issues for Clindamycin

Back 45

Pseudomembanous Colitis! - monitor for diarrhea
Monitor liver function
Rapid IV can cause cardiac arrest

Front 46

Clindamycin MOA

Back 46

Inhibits protein synthesis at 50S ribosome
Bacteriostatic (can be bacteriocidal at high concentrations)

Front 47

Mech of resistance for Clindamycin

Back 47

Sim to Macrolides and Tetracyclines -
Active efflux
Altered binding sites

Front 48

Forms chelates with calcium, iron (and others)

Back 48

Tetracyclines (exc. Doxy)

Front 49

Name 3 antifungals/antifungal families

Back 49

Azoles, Amphotericin B, Griseofulvin

Front 50

Amphotericin B MOA?

Back 50

Binds to sterols in membrane causing leakage of cations.

Front 51

Side effects / special issues w/Amphotericin B

Back 51

VERY TOXIC
Bone marrow suppression - can completely wipe out WBCs
Mech of elimination unknown - found in tissues after 1 yr

Front 52

Azoles MOA?

Back 52

Inhibits synthesis of ergoesterol in cell membrane

Front 53

Side effects / special issues w/Azoles

Back 53

Inhibits CYP450
GI reactions
Rash
Contraindicated w/Erythromycin and cardiac meds

Front 54

Used for superficial mycosis (ringworm)

Back 54

Griseofulvin

Front 55

Special issues w/Griseofulvin

Back 55

CYP450 inducer
Makes new keratin cells resistant to fungal infection (infected cells are shed)

Front 56

Must increase dose over time

Back 56

Rifampin (CYP450 inducer / hepatically eliminated)

Front 57

IRREVERSIBLY binds to 30S ribosome subunit

Back 57

Aminoglycosides

Front 58

MOA works by inhibiting bacterial DNA gyrase

Back 58

Fluoroquinolones (bacteriocidal)

Front 59

MOA works by inhibiting bacterial synthesis of folic acid

Back 59

Sulfanomides (bacteriostatic)

Front 60

MOA works by inhibiting bacterial RNA synthesis

Back 60

Rifampin (bacteriocidal)

Front 61

Name 2 antimicrobials that induce CYP450

Back 61

Rifampin (bacteriocidal)
Griseofulvin (antifungal)

Front 62

Side effects include discoloration of urine, tears, saliva, etc

Back 62

Rifampin