Pharm Spring Exam 1 - Antibiotics

Front 1

isoniazid
MOA
MOR
SE

Back 1

MOA - inhibit mycolic acid synthesis
MOR - chromosomal: katG, inhA, ndh
SE - hepatotoxicity (fast acetylators), peripheral neuritis (slow acetylators), hemolysis (G6PD)

Front 2

rifampin
MOA
MOR
SE

Back 2

MOA - inhibit DNA dep. RNA polymerase
MOR - chromosomal: rpoB
SE - orange metabolites, decrease effectiveness of OCPs

Front 3

ethambutol
MOA
MOR
SE

Back 3

MOA - inhibit synth of arabinogalactan (cell wall)
MOR - chromosomal: embCAB
SE - optic neuritis, ↓ visual acuity

Front 4

pyrazinamide
MOA
MOR
SE

Back 4

MOA - inhibits trans-translation
MOR - chromosomal: pncA
SE - hyperuricemia, hepatic dysfunction, porphyria

Front 5

treatment principles of TB & leprosy

Back 5

TB: for latent, give either INH or rifampin
active, give all 4 (RIPE) to prevent resistance

leprosy: ALWAYS give multiple drugs
multibacillary = dapsone + rifampin + clofazimine
paucibacillary = dapsone + rifampin

Front 6

tx of TB in HIV+

Back 6

need to substitute RIFABUTIN for rifampin

rifampin will induce P450 and interact w/ protease inhibitors

Front 7

macrolides
MOA
MOR

Back 7

50S, inhibit translocation

methyltransferases alter binding site

Front 8

chloramphenicol
MOA
MOR

Back 8

50S, inhibit transpeptidation

inactivating acetyltransferases

Front 9

aminoglycosides
MOA
MOR

Back 9

30S, blocks initiation, elicits premature termination, incorporate incorrect AA

acetyl, phosphoryl, or adenylyl conjugation

Front 10

tetracyclines
MOA
MOR

Back 10

30S, prevent binding the incoming charged tRNA

"pump out"

Front 11

fluroquinolones
MOA
MOR

Back 11

inhibiting topoisomerase

∆ in sensitivity of TE
"pump out"

Front 12

rifampin
MOA
MOR

Back 12

inhibits DNA dependent RNA polymerase

∆ in enzyme

Front 13

sulfas
MOA
MOR

Back 13

inhibition of folic acid synthesis

↓ sensitivity of target enzymes
↑ formation of PABA
use of exogenous folate

Front 14

beta lactams
MOA
MOR

Back 14

inhibition of bacterial cell wall synthesis (inhibit transpeptidation)

penicillinase, modification of PBPs (transpeptidase), ∆ of porins

Front 15

vancomycin
MOA
MOR

Back 15

inhibition of peptidoglycan chain elongation

∆ in pentapeptide, D-ala-D-lactate (DNA mutation)

Front 16

tendon rupture

other SEs of this class?

Back 16

FQs

also prolong QT interval & hepatotoxic

Front 17

3 shortcomings of cipro?

Back 17

• not very effective against anaerobes
• not effective against pneumococci
• not great CNS penetration

***moxi– & gemifloxacin have improved on these 3 weaknesses

Front 18

4 major drug classes for anaerobic infections?

Back 18

• chloramphenicol
• carbapenems
• combo of extended spectrum penicillin w/ penicillinase inhibitor
• metronidazole

Front 19

3 agents that are used only for UTIs? why?

Back 19

nitrofurantoin
methenamine mandelate
nalidixic acid

don't reach high enough [plasma] but they get concentrated in the urine, making them effective for UTIs

Front 20

major route of elimination for cephalosporins? drug interaction?

which 2 cephs are eliminated by a different route?

Back 20

• most by kidney
• acid, so probenecid will compete & ↓ excretion, prolonging t1/2

• cefoperazone = 100% liver
• ceftriaxone = 50% liver
(these are both 3rd gen)

Front 21

3 drugs that are beta-lactamase inhibitors, used in combo w/ penicillins

Back 21

• clavulanic acid
• sulbactam
• tazobactam

Front 22

staph aureus treatment:
beta-lactamase negative
beta-lactamase +
methicillin resistant

Back 22

• if doesn't produce beta-lactamase, penicillin is DOC

• staph can acquire beta-lactamase via PLASMID. in this case, penicillinase resistant pen is DOC

• MRSA is due to modification of PBPs via CHROMOSOMAL mutation. vancomycin is DOC

Front 23

2nd line drugs for treatment of MRSA?

Back 23

TMP-SMX, minocycline, linezolid, daptomycin, tigecycline

Front 24

side effect of imipenem

Back 24

seizures

Front 25

ICWS that is very resistant to penicillinase and is effective against only gram –

Back 25

aztreonam
(class is monobactams)

also important to know that it has NO cross hypersensitivity w/ penicillin or cephalosporins

Front 26

inhibitor of protein synthesis that is bactericidal

Back 26

aminoglycosides

includes gentamicin, tobramycin, amikacin, streptomycin, neomycin

Front 27

triple antibiotic combo for post-op wound healing

Back 27

neomycin + bacitracin + polymixin

Front 28

which macrolide can be used during pregnancy?

Back 28

azithromycin

Front 29

streptogramins
drug name?
MOA?
use?
SE?

Back 29

• dalfopristin, quinupristin
• 50S binding; synergistic action
• developed for VRSA & VRE; only gr+ & only parenteral
• inhibits P450 (watch out for warfarin/phenytoin)

Front 30

oxazolindinones
drug name?
MOA?
use?
SE?

Back 30

• linezolid
• inhibit protein synthesis
• only gr+; very high tissue penetration into CNS
• reversible MAO inhibition, so lots of drug interactions, esp. tyramine containing foods

Front 31

drug most famous for pseudomembranous colitis?

treatment for PMC?

Back 31

• clindamycin (they can all cause PMC, but this is the classic drug)

• tx w/ metronidazole (DOC) or oral vancomycin

Front 32

treatment for osteomyelitis

what makes this drug an effective choice?

Back 32

• clindamycin
• it accumulates in the bones and is excellent for staph aureus (mcc of osteomyelitis)

Front 33

macrolides
diarrhea & P450 spectrum?

Back 33

• erythromycin: worst for diarrhea & inhibits P450

• clarithromycin: causes the least diarrhea, but still inhibits P450

• azithromycin: causes moderate diarrhea level, but does NOT inhibit P450

Front 34

drug to treat ENL (erythemo nodosum leprosum)

Back 34

thalidomide

Front 35

sulfa drug used topically

Back 35

silver sulfadiazine