Micro/id Block 2: Antibiotics

Front 1

What class of antibiotics includes penicillins, cephalosporins, monobactams and carbapenems?

Back 1

β-lactams

Front 2

How do β-lactams act against bacteria?

Back 2

Inhibit peptidoglycan cell wall synthesis (competitively inhibit transpeptidase, disrupting NAG-NAM pentaglycine bridge formation). Causes S aureus, normally under 10-20 atm P, to POP.

Front 3

Which class of bacteria has a thicker cell wall: gram + or gram -?

Back 3

Gram +, by 8X.

Front 4

What treats streptococci, enterococci, CNS Lyme, T pallidum, B burgdorferi, N meningitidis, actinomyces, mouth anaerobes, meningococcus, listeria, and can be used for rheumatic fever prophylaxis?

Back 4

Penicillin

Front 5

What penicillin drug is used to test for penicillinase (resistance)? There are 2 names used.

Back 5

oxacillin / methicillin

Front 6

Name one penicillins indicated for resistant (penicillinase producing) S aureus.

Back 6

nafcillin, oxacillin (methicillin), dicloxacillin

Front 7

What adverse events might occur from using methicillin?

Back 7

leukopenia, renal damage

Front 8

What bacterial genus are carbenicillin and piperacillin used against?

Back 8

Pseudomonas

Front 9

What are penicillin AEs?

Back 9

Hypersensitivity, anaphylaxis, granulocytopenia, seizures

Front 10

What can monobactams treat?

Back 10

gram - rods (like P aeruginosa). NOT gram + or anaerobes

Front 11

What is the broadest spectrum β-lactam class?

Back 11

Carbapenems
(e.g., imipenem + cilastatin)

Front 12

What antibiotics are associated with disulfiram (Antabuse)-like reactions?

Back 12

cephalosporins, metronidazole

Front 13

What AE were we told to monitor in using imipenem?

Back 13

Seizures

Front 14

What do you co-administer with a β-lactamase inhibitor to kill bacteria?

Back 14

A β-lactam - β-lactamase inhibitors are not antibacterials on their own.

Front 15

What is clavulanate?

Back 15

A β-lactamase inhibitor

Front 16

What is a prominent side effect of clavulanate?

Back 16

diarrhea. When you increase the β-lactam dose, you do not increase clavulanate to avoid exacerbating diarrhea

Front 17

What type of bacteria (gram status) is vancomycin indicated for?

Back 17

Most gram +s

Front 18

Why is vancomycin called "Jack of all trades, master of none?"

Back 18

It works against most gram +s, but is less efficacious than β-lactams against S aureus. New problem: VRSA

Front 19

What drug causes red-neck rash syndrome (histamine, NOT allergic) and ototoxicity?

Back 19

Vancomycin

Front 20

What type of bacteria (gram status) is polymyxin indicated for?

Back 20

Gram -s

Front 21

What infections are daptomycin indicated for?

Back 21

Staph-, strep-, and enterococci

Front 22

For what infection should you NOT use daptomycin because it does not penetrate the affected organ well?

Back 22

pneumonia

Front 23

What can you combine with penicillin to treat TB synergistically?

Back 23

Streptomycin

Front 24

What class of intracellular-acting antibiotics are water soluble and dependent on aerobic metabolism?

Back 24

Aminoglycosides (e.g., streptomycin)

Front 25

What are the 2 most serious AEs of aminoglycoside (e.g., streptomycin) use?

Back 25

nephrotoxicity and ototoxicity (vertiginousness for life). Monitor because aminoglycosides have a narrow therapeutic window

Front 26

What large carbon ring drug undergoes internal rearrangement in acidic aqueous environments?

Back 26

Erythromycin

Front 27

What class of drugs include erythromycin, clarithromycin, and azithromycin (Z packs)?

Back 27

Macrolides (MLS drugs)

Front 28

How do aminoglycosides, macrolides, lincosamides streptogramins, ketolides (MLS K group) tetracyclines, chloramphenicol and oxazolidinones act against bacteria?

Back 28

Intracellular action, bind to ribosomes and inhibit protein synthesis

Front 29

What bacteria do the MLS K group and ketolides act against?

Back 29

MLS K: Strep, staph
M: C diphtheriae, Moraxella catarrhalis, H flu, H pylori, chlamydia
L: Bacteroides fragilis
S: E faecium, NOT faecalis
K: H flu, macrolide-resistant s pneumoniae

Front 30

What is a major drawback to macrolide use as a monotherapy?

Back 30

resistance may develop

Front 31

On what drug have patients reported a metallic taste?

Back 31

Clarithromycin

Front 32

What AE can lincosamides cause because they affect the normal mucosal flora?

Back 32

diarrhea via C difficile

Front 33

How do streptogramins work individually vs. in combination?

Back 33

individually, bacteriostatic
together, synergistic

Front 34

What drug class's AE makes central line administration preferable to a peripheral venous line?

Back 34

streptogramins - phlebitis

Front 35

What AE has been reported for ketolides?

Back 35

blurry / changes in vision, mostly time limited

Front 36

What bacteria do tetracyclines act against?

Back 36

staph, strep, gram -s, anaerobes
V cholera
plasmodium spp

Front 37

What are AEs of tetracyclines?

Back 37

Antagonizes penicillin when used for pneumococcal meningitis ~ 2X mortality

GI upset, vertigo, photosensitivity
tooth discoloration when used in childhood <7

Front 38

How is Fanconi syndrome, a renal tube dysfunction, acquired?

Back 38

degraded (expired) tetracycline

Front 39

What can a patient take with tetracyclines that lowers bioavailability?

Back 39

Milk
bi- and trivalent cations: Ca, Mg, Fe, Al

Front 40

What are glycylcyclines (e.g., tigecycline)?

Back 40

tetracycline derivatives with the same MOA but broader spectrum, included tetracycline-resistant gram +s, gram -s and anaerobes

Front 41

Chloramphenicol, a cheap to produce and broad spectrum antibiotic, is hardly used in the US because of this nasty AEs.

Back 41

Aplastic anemia in bone marrow

Front 42

What organisms are susceptible to sulfonamides?

Back 42

Those that make their own folate: gram +s and gram -s
Mimics PABA, blocking folate synthesis

Front 43

What are AEs of sulfonamides (sulfa drugs)?

Back 43

GI upset, rash, hypersensitivity, DEATH
WBC abnormalities, thrombocytopenia,
Newborns: kernicterus(extreme jaundice then neurological symptoms)

Front 44

What drug makes sulfonamides 20-100X more potent?

Back 44

Trimethoprim (DHFR inhibitor)

Front 45

What are AEs of trimethoprim?

Back 45

all in bone marrow:
megaloblastic anemia, leukopenia, granulocytopenia

Front 46

What common infection are quinolones (e.g., cipro), among other antibiotics, often prescribed for?

Back 46

UTIs

Front 47

How do quinolones work against bacteria?

Back 47

Inhibit DNA synthesis via topoisomerases
II: gram -
IV: gram +

Front 48

What AEs are associated with quinolones?

Back 48

all rare: seizures, rash, tendon rupture
arthropathy in immature animals (like children)

Front 49

What can decrease the bioavailability of quinolones?

Back 49

Divalent cations:
Ca, Mg, Fe

Front 50

What antibiotic will turn you oompa-loompa orange?

Back 50

Rifamycin

Front 51

How do rifamycins (e.g., rifampin) inhibit bacteria?

Back 51

inhibit RNA polymerase, block protein translation

Front 52

What historically important pathogen are rifamycins active against?

Back 52

Mycobacteria tuberculosis

Front 53

What antibacterial agent for C difficile might you remember from the anti-protozoal greatest hits?

Back 53

Metronidazole - giardia

Front 54

What DNA-damaging antibiotic is active against E coli?

Back 54

nitrofurantoin

Front 55

What is an irreversible AE that you would monitor in a patient taking nitrofurantoin long term for recurrent UTI?

Back 55

interstitial pulmonary fibrosis

Front 56

What oligamer of formaldehyde may be used as a urinary tract antiseptic?

Back 56

Methenamine