Pharm Exam 2 Questions

Front 1

what are some concentration dependent drugs

Back 1

aminoglycosides, quinolones, daptomycin,

Front 2

what are some time dependent drugs

Back 2

carbapenems, PCN, cephalosporins

Front 3

what are some other factors that influence probability of killing bugs, other than time & conc

Back 3

distribution of organism MICs for the drug, population distribution of pharmacokinetic parameters, drug protein binding

Front 4

what are some ways to titrate abx so that it hits the right MIC and kill the bugs

Back 4

1. give the dose over a couple of hours rather than all at once

2. doubling the dose is not better - give agent over longer period of time instead

3. use a combo of drugs to manipulate half-lives and to be more effective against resistance

Front 5

what are some ways bugs resist drugs

Back 5

they intrinsically or acquire ability to do: efflux, inactivation by microbial enzymes, or reduce uptake/affinity of drug by altering themselves

Front 6

which PK factors affect your selecting the drug

Back 6

consider ADME, oral bioavailability, IV, serum conc, distribution in site of infection, route of elimination, half life, antibiogram, resistance patterns

Front 7

which areas have compromised drug penetration?

Back 7

CSF, bone, prostate, eye, abscesses (meningitis inflammation makes drugs harder to get in. UTIs are actually easy to treat because drug concentrates in urine)

Front 8

oral contraceptives with abx interaction?

Back 8

if you take drugs that disturb hormonal balance, use backup BC method.

Front 9

warfarin and abx interaction?

Back 9

warfarin: disrupts synthesis of K, check INR

Front 10

1st dosing for aminoglycosides in renal patients

Back 10

use a normal first dose

Front 11

general rule with combination abx therapy

Back 11

avoid using 2 agents with same mechanism of action

Front 12

how do you take cultures from people with endocarditis

Back 12

additional blood cultures bc yield is low. do at least 3 blood cultures for native valve endocarditis, 4-5 for prosthetic valve endocarditis

Front 13

blood cultures from suspected bacteremia or candidemia

Back 13

single set not enough. do 3-4 cultures

Front 14

pneumonia cultures: how do you do it

Back 14

sputum if non-intubated, BAL/ET aspirate if intubated

Front 15

how do you send labs for: skin, meningitis, abscesses

Back 15

debrided tissue, CSF, and pus in that order

Front 16

what do you do before giving antibiotics

Back 16

2 blood cultures done at least 10 mins apart, and a culture from infected site. use catheter tip +3 (4) for peripheral cultures. cultures for strict anaerobes should be sent via anaerobic transport media, duh

Front 17

when do you do swab cultures

Back 17

only body fluids, tissue, pus and exudates, nothing else.

Front 18

does time above MIC matter for conc dependent drugs

Back 18

NOOOOO

Front 19

what do you consider when choosing the right drug

Back 19

site of infection, patient, allergies, antibiogram, spectrum of activity

Front 20

which drugs target cell wall synthesis?

Back 20

cephalosporins

d-cycloserine

cephamycins

vancomycin

pcn

bacitracin

beta lactam antibiotics

carbapenems

Front 21

which drugs target DNA synthesis

Back 21

metronidazole

Front 22

which drug targets DHA gyrase (nucleic acid metabolism)

Back 22

quinolone

Front 23

which drug targets RNA polymerase (nucleic acid metabolism)

Back 23

rifamycins

Front 24

which drug targets phospholipid membranes

Back 24

polymyxins

amphotericin

ketoconazole

Front 25

which drug targets protein synthesis

Back 25

chloramphenicol

tetracyclines

glycycline

macrolides

clindamycin

streptogramins

oxazolidinones

aminoglycosides

Front 26

which drug inhibits folate synthesis

Back 26

sulfonamides

trimethoprim

Front 27

what are some beta lactam drugs and what do they do

Back 27

pcn

cephalosporins

monobactam

carbapenems

they work at the cell wall to inhibit it

Front 28

what is a glycopeptide drug and what does it do

Back 28

vancomycin, it does cell wall inhibition

Front 29

what are the three phases of cell wall synthesis

Back 29

monomer synthesis

monomer polymerization

cross linking of polymers

Front 30

describe monomer synthesis

Back 30

1st phase of cell wall synthesis, takes place in cytoplasm where peptidoglycan monomers from amino acids and sugars synthesize. precursor formation.

Front 31

describe monomer polymerization

Back 31

2nd sty of cell wall synth: links to form long polymer, lipid mediated and takes place at cytoplasmic membrane

Front 32

describe cross linking of polymers

Back 32

mediated by transpeptidases.

facts: pcn binding proteins (PBPs), extracellular, takes place in periplasmic space.

Front 33

describe structure of b lactam drugs

Back 33

has thiazolidine ring and b lactam ring attached to side chain.

nucleus is structural requirement for main bio activity

side chain determines characteristics

you get different PCNs by adding side chains

Front 34

how do b lactams work

Back 34

interferes with last step of cell wall synthesis (transpeptidation or cross linkage)

inactivates PBPs by binding to them, leads to autolysis/cell death

time dependent kill

bactericidal against actively dividing bacteria

Front 35

how do bugs resist b lactams?

Back 35

b lactamase enzymes hydrolyzes b lactam rings

decreased permeability thru cell membrane

altered PBPs with lower affinity

efflux (gram -)

Front 36

what are some natural PCNs

Back 36

PCN G (parenteral): potassium or sodium salt, procaine IM (comparable levels to IV for 24 hrs), benzathine IM (maintains low levels for weeks)

PCN VK (oral)

Front 37

spectrum of activity for natural PCNs

Back 37

active against sensitive strains of gram + cocci, anaerobes (clostridium per fringes), and some gram - cocci (neisseria)

spirochetes

hydrolyzed by penicillinase (beta lactamase)

works well for STIs but usually for wimpy bugs

Front 38

penicillinase resistant PCNs?

Back 38

antistaphylococcal penicillins:

methicillin (not available),

nafcillin, oxacillin (both parenteral) and

PO: cloxacillin, dicloxacillin

Front 39

for which bugs do penicillinase resistant PCNs work

Back 39

penicillinase producing staphylococci (methicillin susceptible s. aureus (MSSA))

pcn susceptible streptococcus sp.

PO for skin/soft tissue infections, IV for endocarditis, osteomyelitis, etc.

well tolerated, good oral absorption

NOT FOR MRSA, ENTEROCOCCI, LISTERIA

Front 40

what are some aminopenicillins

Back 40

ampicillin (parenteral, PO)

amoxicillin PO

Front 41

spectrum of aminopenicillins?

Back 41

similar to PCN G, additional activity against enterococci, listeria, select gram - (e coli, proteus mirabilis, haemophilus influenza, salmonella that is not producing beta lactamase

Front 42

does amino penicillin gets hydrolyzed by beta lactamase

Back 42

yes

Front 43

clinical use of aminopenicillins

Back 43

strep infections

enterococcus - endocarditis

listeria - bacteremia, meningitis

prophylaxis of neonatal group b strep disease and rheumatic fever (dental)