Mecn Pharmacology Antimicrobials_03_Study Guide Qs

Front 1

Name 2 agents used to treat c. difficile superainfections.

Back 1

Metronidazole (Flagyl) and Vancomycin (po).

Front 2

Compared to other penicillin groups, aminopenicillins are effective against the following gram-negatives:

Back 2

H. influenzae, E Coli, Salmonella, Shigella.

Front 3

Extended spectrum penicillins extend ampicillin spectrum to these organisms:

Back 3

Klebsiella and enterobacteria (gram negative) and pseudomonas

Front 4

What type of drug is vancomycin?

Back 4

Glycopeptides.

Front 5

What is the mechanism of action of glycopeptides?

Back 5

Vancomycin inhibits synthesis of bacterial cell wall phospholipids as well as peptidoglycan polymerization. This prevents the transglycosylation of strep in peptidoglycan polymerization, weakening the cell wall and damaging the underlying membrane.

Front 6

What class of drugs is an inhibitor of CYP3A4 enzymes?

Back 6

Macrolides

Front 7

Name 3 advantages of using azithromycin.

Back 7

1) penetrates tissues 2) long half-life (3 days) 3) permits daily dosing

Front 8

List 3 newer protein synthesis inhibitors that are bacteriostatic.

Back 8

Clindamycin (Cleocin), Streptogamins, Linezolid.

Front 9

This new protein synthesis drug is used as a penicillin alternative.

Back 9

Clindamycin (Cleocin)

Front 10

This new protein synthesis drug is useful against anaerobes (severe Group A strep, abdominal and pelvic infections with B. fragillis).

Back 10

Clindamycin (Cleocin)

Front 11

This new protein synthesis drug is useful against gram-positive cocci (multiple drug resistant strains of strep and staph, and vancomycin resistant enterobacteria)

Back 11

Streptogramins

Front 12

This new protein synthesis drug is reserved for vancomycin resistant E faecium, MRSA, MRSE, and drug resistant strep pneumoniae.

Back 12

Streptogramins

Front 13

This new protein synthesis drug is bacteriostatic against gram positive bacteria, and used for vancomycin resistant enterobacteria and multiple drug-resistant organisms.

Back 13

Linezolid (Zyvox)

Front 14

This drug is reserved for VRSE and MRSA.

Back 14

Linezolid (Zyvox)

Front 15

Which class of drugs inhibits protein synthesis in 3 ways and is bacteriocidal?

Back 15

Aminoglycosides

Front 16

Describe the protein synthesis inhibiting mechanism of aminoglycosides.

Back 16

Aminoglycosides bind to the 30s ribosomal subunit, (1) block initiation, (2) terminate synthesis before the new protein is complete, and (3) cause misreading of the genetic code, which results in synthesis of faulty proteins.

Front 17

Name 2 toxicities associated with aminoglycosides.

Back 17

1) ototoxicity (cellular injury in the ear) and 2) nephrotoxicity (cellular injury in the proximal renal tubules)

Front 18

How are aminoglycosides administered?

Back 18

Parenterally. Aminoglycosides carry multiple positive charges.
Oral therapy is only used for local effects within the intestine.

Front 19

What is aminoglycosides mainly used for?

Back 19

Serious infections due to aerobic gram-negative bacilli. P. aeruginosa and enterobacteriacease.

Front 20

Name one aminoglycoside drug that is use in combination with either vancomycin or B-lactam antibiotic to treat serious gram positive cocci.

Back 20

Gentamicin. Used in combination to treat serious gram positive cocci such as Enterococcs species and some strep.

Front 21

Name 3 aminoglycosides used commonly for parenteral therapy.

Back 21

Gentamicin, trobramycin, amikacin.

Front 22

List 5 common floroquinolones.

Back 22

Ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin

Front 23

Describe the mechanism of action of Floroquinolones.

Back 23

They block bacterial DNA synthesis by inhibiting bacterial DNA gyrase. Inhibition of DNA gyrase prevents the relaxation of supercoiled DNA that is required for transcription on replication.

Front 24

Floroquinolones are
a) bacteriostatic
b) bacteriocidal

Back 24

B. Floroquinolones are bacteriocidal

Front 25

Name a floroquinolone drug that is most effective against gram negatives

Back 25

Ciprofloxacin

Front 26

Name a floroquinolone drug that is most effective against gram positives

Back 26

Levofloxacin

Front 27

Describe the spectrum of activity of newer floroquinolones compared to older floroquinolones.

Back 27

Original drugs are excellent against gram negatives, with moderate gram positive activity.
Newer drugs have improved activity against gram positives.

Front 28

Newer floroquinolones are active against atypical organisms such as:

Back 28

Mycoplasma pneumoniae, Chlamydia pneumoniae

Front 29

This class of drugs is used in wide variety: resp infections, UTI's, soft tissue/bone/joint infections, gonococcal infections

Back 29

Floroquinolones

Front 30

Name 2 key pharmacokinetics of floroquinolones.

Back 30

1) well absorbed orally with bioavailability of 70-95%, distributed widely in body tissues.
2) Serum half-lives range from 3 to 10 hrs.

Front 31

List two sites of infection where floroquinolones are particularly useful.

Back 31

(More than 2 listed)
Respiratory infection, UTIs, soft tissue/bone/joint infections, gnococcal infections

Front 32

What 2 antimicrobial agents do Bactrim and Septra contain?

Back 32

Bactrim and Septra contain trimethoprim and sulfamethaxazole.

Front 33

What is the mechanism of action for sulfonamides and trimethoprim?

Back 33

They are analogs of PABA that competes for a synthetic enzyme and block folic acid synthesis needed for DNA.

Front 34

What classes of drugs are antimetabolites?

Back 34

Sulfonamides and trimethoprim.

Front 35

What class of drug could lead to Stevens-Johnson syndrome?

Back 35

Sulfonamides.

Front 36

Name 2 photosensitive classes of drugs.

Back 36

Tetracylcine and sulfonamides

Front 37

List some adverse effects of Bactrim and Septra (sulfonamides and trimethoprim).

Back 37

Hyper sensitivity reactions and rashes,
Photo sensitivity,
Nausea and vomiting,
Hemolitic anemia and bone marrow depression
Stevens Johnson Syndrome

Front 38

Name 3 major tetracyclines.

Back 38

Tetracycline,
Demeclocycline (Declomycin),
Doxcycline (Vibramycin),
Minocycline (Minocin)

Front 39

3 resistant mechanisms in tetracyclines:

Back 39

1) Efflux by active transport protein pump, 2) Ribosome protection by proteins that interfere with tetracycline binding, 3) Enzymatic inactivation

Front 40

Tetracyclines are ____ spectrum drugs.

Back 40

Broad.
Bacteriostatic for gram positive and gram negative, including anerobes, chlamydiae, mycoplasmas, and ameobas.

Front 41

This class of drugs is the DOC for Mycoplasma pnemoniae, chlamydiae, and rickettsiae.

Back 41

Tetracyclines

Front 42

This class of drugs is used in combinations to combat h pylori ulcer disease

Back 42

Tetracyclines

Front 43

List 3 major adverse reactions in tetracyclines.

Back 43

1) Photosensitivity
2) Binds to Calcium (cause teeth discoloration, bone deformation/growth inhibition
3) N/V that causes D/C in pts

Front 44

Why are newer formulation of Amphotericin B less toxic?

Back 44

The newer formulations reduce nonspecific binding of the drug to human cell membranes. This reduces toxicity.

Front 45

List the commonly used triazole antifungal that is absorbed orally.

Back 45

Fluconazole (difulcan) can be given via IV and po; has excellent oral bioavailability.

Front 46

Name the triazole that is found in Monistat and Lotrimin.

Back 46

Miconazole (Monistat)
Clotrimazole (Lotrimin)

Front 47

Name two classes of drugs that should not be given during pregnancy.

Back 47

Floroquinolones and Tetracyclines.

Front 48

Name for classes of drugs that are considered safe.

Back 48

Penicillins, Cephalosporins, Clarithromycin, Erythromycin, Azithromycin.
(Clarithromycin, Erythromycin, and Azithromycin are all Macrolides)

Front 49

Is Terbinafine, an antifungal, an triazole?

Back 49

No. Terbinafine (Lamisil) is not an azole but it also prevents ergosterol synthesis, much like triazoles.

Front 50

Induction phase treatment for TB involves the following drugs:

Back 50

Izoniazid, rifampim, pyrazinaminde, ethambutol

Front 51

Continuation phase of TB treatment involves the following drugs:

Back 51

Isoniazid, rifampin

Front 52

Toxicity for Isoniazid

Back 52

Peripheral neuropathy, hepatotoxicity

Front 53

Toxicity for Rifampin

Back 53

Hepatoxicity, red-orange body fluids

Front 54

Toxicity for Pyrazinamine

Back 54

Hepatoxicity

Front 55

Toxicity for Ethambutol

Back 55

Well tolerated but may cause optic neuritis

Front 56

What is the first choice therapy for an acute uncomplicated UTI? Duration?

Back 56

Aminopenicilins (ambicillin, amoxicillin)

Front 57

Name 3 drugs that provide particularly good coverage for anaerobes.

Back 57

Metronidazole (Flagyl)
Clindamycin
Imipenem (Primaxin)