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57 Cards in this Set

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Name 2 agents used to treat c. difficile superainfections.
Metronidazole (Flagyl) and Vancomycin (po).
Compared to other penicillin groups, aminopenicillins are effective against the following gram-negatives:
H. influenzae, E Coli, Salmonella, Shigella.
Extended spectrum penicillins extend ampicillin spectrum to these organisms:
Klebsiella and enterobacteria (gram negative) and pseudomonas
What type of drug is vancomycin?
Glycopeptides.
What is the mechanism of action of glycopeptides?
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.
What class of drugs is an inhibitor of CYP3A4 enzymes?
Macrolides
Name 3 advantages of using azithromycin.
1) penetrates tissues 2) long half-life (3 days) 3) permits daily dosing
List 3 newer protein synthesis inhibitors that are bacteriostatic.
Clindamycin (Cleocin), Streptogamins, Linezolid.
This new protein synthesis drug is used as a penicillin alternative.
Clindamycin (Cleocin)
This new protein synthesis drug is useful against anaerobes (severe Group A strep, abdominal and pelvic infections with B. fragillis).
Clindamycin (Cleocin)
This new protein synthesis drug is useful against gram-positive cocci (multiple drug resistant strains of strep and staph, and vancomycin resistant enterobacteria)
Streptogramins
This new protein synthesis drug is reserved for vancomycin resistant E faecium, MRSA, MRSE, and drug resistant strep pneumoniae.
Streptogramins
This new protein synthesis drug is bacteriostatic against gram positive bacteria, and used for vancomycin resistant enterobacteria and multiple drug-resistant organisms.
Linezolid (Zyvox)
This drug is reserved for VRSE and MRSA.
Linezolid (Zyvox)
Which class of drugs inhibits protein synthesis in 3 ways and is bacteriocidal?
Aminoglycosides
Describe the protein synthesis inhibiting mechanism of aminoglycosides.
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.
Name 2 toxicities associated with aminoglycosides.
1) ototoxicity (cellular injury in the ear) and 2) nephrotoxicity (cellular injury in the proximal renal tubules)
How are aminoglycosides administered?
Parenterally. Aminoglycosides carry multiple positive charges.
Oral therapy is only used for local effects within the intestine.
What is aminoglycosides mainly used for?
Serious infections due to aerobic gram-negative bacilli. P. aeruginosa and enterobacteriacease.
Name one aminoglycoside drug that is use in combination with either vancomycin or B-lactam antibiotic to treat serious gram positive cocci.
Gentamicin. Used in combination to treat serious gram positive cocci such as Enterococcs species and some strep.
Name 3 aminoglycosides used commonly for parenteral therapy.
Gentamicin, trobramycin, amikacin.
List 5 common floroquinolones.
Ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin
Describe the mechanism of action of Floroquinolones.
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.
Floroquinolones are
a) bacteriostatic
b) bacteriocidal
B. Floroquinolones are bacteriocidal
Name a floroquinolone drug that is most effective against gram negatives
Ciprofloxacin
Name a floroquinolone drug that is most effective against gram positives
Levofloxacin
Describe the spectrum of activity of newer floroquinolones compared to older floroquinolones.
Original drugs are excellent against gram negatives, with moderate gram positive activity.
Newer drugs have improved activity against gram positives.
Newer floroquinolones are active against atypical organisms such as:
Mycoplasma pneumoniae, Chlamydia pneumoniae
This class of drugs is used in wide variety: resp infections, UTI's, soft tissue/bone/joint infections, gonococcal infections
Floroquinolones
Name 2 key pharmacokinetics of floroquinolones.
1) well absorbed orally with bioavailability of 70-95%, distributed widely in body tissues.
2) Serum half-lives range from 3 to 10 hrs.
List two sites of infection where floroquinolones are particularly useful.
(More than 2 listed)
Respiratory infection, UTIs, soft tissue/bone/joint infections, gnococcal infections
What 2 antimicrobial agents do Bactrim and Septra contain?
Bactrim and Septra contain trimethoprim and sulfamethaxazole.
What is the mechanism of action for sulfonamides and trimethoprim?
They are analogs of PABA that competes for a synthetic enzyme and block folic acid synthesis needed for DNA.
What classes of drugs are antimetabolites?
Sulfonamides and trimethoprim.
What class of drug could lead to Stevens-Johnson syndrome?
Sulfonamides.
Name 2 photosensitive classes of drugs.
Tetracylcine and sulfonamides
List some adverse effects of Bactrim and Septra (sulfonamides and trimethoprim).
Hyper sensitivity reactions and rashes,
Photo sensitivity,
Nausea and vomiting,
Hemolitic anemia and bone marrow depression
Stevens Johnson Syndrome
Name 3 major tetracyclines.
Tetracycline,
Demeclocycline (Declomycin),
Doxcycline (Vibramycin),
Minocycline (Minocin)
3 resistant mechanisms in tetracyclines:
1) Efflux by active transport protein pump, 2) Ribosome protection by proteins that interfere with tetracycline binding, 3) Enzymatic inactivation
Tetracyclines are ____ spectrum drugs.
Broad.
Bacteriostatic for gram positive and gram negative, including anerobes, chlamydiae, mycoplasmas, and ameobas.
This class of drugs is the DOC for Mycoplasma pnemoniae, chlamydiae, and rickettsiae.
Tetracyclines
This class of drugs is used in combinations to combat h pylori ulcer disease
Tetracyclines
List 3 major adverse reactions in tetracyclines.
1) Photosensitivity
2) Binds to Calcium (cause teeth discoloration, bone deformation/growth inhibition
3) N/V that causes D/C in pts
Why are newer formulation of Amphotericin B less toxic?
The newer formulations reduce nonspecific binding of the drug to human cell membranes. This reduces toxicity.
List the commonly used triazole antifungal that is absorbed orally.
Fluconazole (difulcan) can be given via IV and po; has excellent oral bioavailability.
Name the triazole that is found in Monistat and Lotrimin.
Miconazole (Monistat)
Clotrimazole (Lotrimin)
Name two classes of drugs that should not be given during pregnancy.
Floroquinolones and Tetracyclines.
Name for classes of drugs that are considered safe.
Penicillins, Cephalosporins, Clarithromycin, Erythromycin, Azithromycin.
(Clarithromycin, Erythromycin, and Azithromycin are all Macrolides)
Is Terbinafine, an antifungal, an triazole?
No. Terbinafine (Lamisil) is not an azole but it also prevents ergosterol synthesis, much like triazoles.
Induction phase treatment for TB involves the following drugs:
Izoniazid, rifampim, pyrazinaminde, ethambutol
Continuation phase of TB treatment involves the following drugs:
Isoniazid, rifampin
Toxicity for Isoniazid
Peripheral neuropathy, hepatotoxicity
Toxicity for Rifampin
Hepatoxicity, red-orange body fluids
Toxicity for Pyrazinamine
Hepatoxicity
Toxicity for Ethambutol
Well tolerated but may cause optic neuritis
What is the first choice therapy for an acute uncomplicated UTI? Duration?
Aminopenicilins (ambicillin, amoxicillin)
Name 3 drugs that provide particularly good coverage for anaerobes.
Metronidazole (Flagyl)
Clindamycin
Imipenem (Primaxin)