Pharm Test 2 Antimicrobials: Nucleic Acid Synthesis Inhibitors

Front 1

Fluoroquinolones

1)1st gen =
2)2nd gen =
3)3rd gen =
4)4th gen =

Back 1

1)Nalidixic Acid (QUINOLONE) (Narrow Spectrum)
2)Ciprofloxacin
3)Levofloxacin
4)Moxifloxacin

Front 2

Fluoroquinolones

5)Static or Cidal?
6)MOA
7)CU

Back 2

5)Cidal

6)enter bacteria via porins and inhibit DNA replication by interfering with Topoisomerase 2 (DNA Gyrase) and 4

7)inhibit topo2 -> Gram neg
inhibit top4 -> Gram pos

Front 3

Fluoroquinolones

8)Levofloxacin + Moxifloxacin used for

9)3rd and 4th Gen better at killing

9b) Which gen best at killing Pseudomonas aeruginosa (as in Cystic Fibrosis)?

Back 3

8)Strep Pneumonia (thus known as resp fluoroquinolones)

9)Anaerobic bacteria(C.diff and Bacteroides fragilis)

9b) 2nd Gen

Front 4

Fluoroquinolones

10)1st Gen used for:
11)2nd Gen used for:
12)3rd Gen used for:
13)4th Gen used for:

Back 4

10) Gram neg; Uncomplicated UTIs

11)Gram neg and some Gram pos; E.coli (travellers diarrhea)

12)Gram neg and more Gram pos; Resp infections (S.pneumonia)

13)Gram Neg and Gram Pos; Anaerobic Bacteria

Front 5

Fluoroquinolones

14)Resistance
15)How are gonococci resistant?

16)How are TB, S.aureus, and S. pneumoniae resistant?

Back 5

14)is HUGE in 2nd Gen

15)they mutate DNA gyrase

16)they have efflux mechanisms

Front 6

Fluoroquinolones

17)How are they given?

18)What do divalent cations do (calcium, zinc, iron)?

19)If patient is taking probenecid, why do you have to be careful?

20)AE
21)Contra

Back 6

17) Orally, but 2nd and 3rd gen can be given IV

18)Interfere with absorption

19)because fluorquinelones are excreted in kidney, and probenecid blocked tubular secretion (but thus can give both, because then will excrete less)

2)GI, CNS. Photosensitivity
CONNECTIVE TISSUE PROBLEMS (BLACK BOX WARNING, MUST TELL PATIENT)

21)Pregnancy, Nursing Mom, UNDER 18

Front 7

Fluoroquinolones

22)Contra of 3rd and 4th Gen

23)Contra of 2nd Gen

Back 7

22) Prolong QT
Inc Blood level of Warfarin, Caffeine, and Cyclosporine

23) Inhibits theophylline metabolism

Front 8

Sulfonamides

1)are structural analogs of:
2)Static or Cidal
3)MOA

Back 8

1)p-aminobenzoic acid (PABA)
2)Static

3)analog of PABA -> competitively inhibits dihydropteroate synthase ->inhibit folate production (bacteria need to produce there own folate to survive, thus cant grow) (get Inc PABA, dec dihydrofolic acid)

Front 9

Sulfonamides

4)Resistance

5)Effect on Kidney

6)AE

Back 9

4)d/t althered dihydropteroate synthase, dec permeability, inc PABA (because sulfonamides are competing with this compound)

5) are acetylated in liver and thus can precipitate at neutral or acidic pH, causing kidney damage (thus not used much anymore) (can be reduced by giving in alkaline solution or with lots of fluids)

6)Crystalluria
Are sulfur drugs, so can be allergic
If G6PD defic, can have blood problems
Inc blood levels of Warfarin, Methotrexate, Phenytoin

Front 10

Sulfonamides

7)Contra

8)Given topically for:
9)Given Orally for:

Back 10

7)Kid Less than 2 months (get Kernicterus, because drug competes with bilirubin for binding sites on ALBUMIN -> inc free bilirubin; and infants dont have a functioning Blood Brain Barrier)

8)Burns, Ocular Infections
9)Ulcerative colitis, RA, Toxoplasmosis (alternative)

Front 11

Trimethoprim

1)MOA
2)Why is giving sulfonamides and trimethroprim as combo best idea?

3)Which more potent, sulfonamides, or trimethroprim?

Back 11

1)structurally similar to folic acid, inhibits dihydrofolate reductase ->inhibiting purine, pyrimidine synthesis (get inc dihydrofolic acid, dec tetrahydrofolic acid)

3)Trimethroprim

2)Because inhibiting synthesis of folate at 2 different steps

Front 12

Trimethoprim

4)CU
5)Resistance?
6)high conc of drug where?
7)

Back 12

4)UTI, Bacterial Prostatits, Vaginitis

5)mutation in dihydrofolate reductase
6)in prostatic and vaginal fluids
7)Effects if folic acid defic (megaloblastic anemia, leukopenia)

Front 13

Cotrimoxazole

1)What is it?
2)Cidal or Static
3)CU
4)What opportunistic infection is it used for?

5)AE

Back 13

1)Combo of Sulfamethoxazole and Trimethroprim

2)Bacteriocidal

3)Simple UTI (DOC), RT Infections, Ear and Sinus Infections
4)Pneumocystitis Jiroveci (PCP) = DOC
5)Dermatologic, AIDS patients have higher incidence of side effects

Front 14

DOC

1)Simple UTIs
2)Pneumocystitis Jiroveci (PCP
3)Toxoplasmosis, Nocardiosis

Back 14

1-3 = Cotrimoxazole

Front 15

Metronidazole

1)Static or Cidal

2)DOC for...

3)AE

4)Contra

Back 15

1)Bacteriocidal

2)requires anaerobic enviornments for activity, because needs to be reduced (thus activated) by Ferredoxin, forming toxic products that interfere with nucleic acid synthesis

2)Anaerobic (Bacteroides, C.diff) and Vaginitis

3)GI, Leukopenia, Dark colored urine, Opportunistic Fungal

4)Alcohol (will get very very sick)

Front 16

Bactericidal or Static?

1)Aminoglycosides
2)B lactam
3)Fluoroquinones
4)Metronidazole
5)Vancomycin
6)Streptogramin

Back 16

All Bacteriocidal

Front 17

Bactericidal or Static

1)Clindamycin
2)Macrolides
3)Sulfonamides
4)Tetracyclines

Back 17

All Bacteriostatic

Front 18

Sulfisoxazole

Back 18

Sulfonamide

Short Acting, Oral, Simple UTIs

Front 19

Sulfamethoxazole

Back 19

Sulfonamide

Intermediate Acting

Front 20

Sulfadoxine

Back 20

Sulfonamide

Long Acting

Front 21

Sulfasalazine

Back 21

Sulfonamide

Oral, UC, RA

Front 22

Sulfadiazine

Back 22

Sulfonamide

Topical

Burn, infections

Front 23

Sulfacetamide

Back 23

Sulfonamide

Topical, eye infection

Front 24

Eliminated how:

Aminoglycosides
Cephalosporins
Fluoroquinones
Penicillins
Sulfonamides
Tetracyclines
Vancomycin

Back 24

Through Kidney (thus if kidney prob, conc of drug inc, or longer acting)

Front 25

Eliminated how:

Chloramphenicol
Clindamycin
Erythromycin
Clarithromycin
Nafcillin

Back 25

Through Liver (thus if liver prob, conc of drug inc, or longer acting)

Front 26

Effect on Neonate:

1)Aminoglycosides:
2)tetracyclines
3)sulfonamides
4)Chloramphenicol
5)Fluoroquinolones

Back 26

1)can damage 8th cranial nerve of fetus (FDA Cat D)

2)can cause tooth enamel dysplasia, inhibit bown growth (Dont give under age of 8 years)

3)kernicterus (dont give to infants under 2 months)

4)grey baby syndrome

5)effects growing cartilage (dont give under 18)

Front 27

1)When do you give antimicrobials as surgical prophylaxis?

2)When else would you give it?

Back 27

1)give for procedures that are associated with infection in greater than 50 percent (if immunosuppressed might give it also)

2)Prevention of CMV,HIV,TB,influenza, Meningitis
Animal Bite
Chronic Bronchitis*

Front 28

1)DOC Anaerobe (Aspirated)
2)DOC Bacteroides
3)Alternative for Bacteroides
4)DOC Bordetella Pertussis

Back 28

1)Beta Lactam and Beta Lactamase Inhibitor, or Clindamycin

2)Metronidazole
3)Carbapenems or
Penicillins and Beta Lactamase Inhibitor or
Chloramphenicol

4)Macrolide

Front 29

5)DOC Campylobacter jejuni
6)Alternative for Campylobacter jejuni
7)DOC C. trachomatis
8)Alternative for C. trachomatis

Back 29

5)Erythromycin
6)Fluoroquinolone or Tetracycline
7)Azithromycin
8)Doxycycline

Front 30

9)DOC C. Diff
10)Alternative C. Diff
11)DOC Chancroid

Back 30

9)Metronidazole
10)Vancomycin
11)Azithromycin, or Erythromycin, or Ceftriaxone, or Ciprofloxacin

Front 31

12)DOC E.Coli
13)Alternative E.coli
14)DOC Enterobacter
15)Alternative Enterobacter

Back 31

12)3rd Gen Cephalosporin
13)Penicillins, Fluoroquinolones, Aminoglycosides

14)Carbapenem, or 4th gen Cephalosporin
15)Aminoglycoside, Fluoroquinolone

Front 32

1)DOC Enterococcus
2)Alternative Entercoccus

3)DOC G. vaginalis
4)Alternative G. vaginalis

Back 32

1)Ampicillin
2)Vancomycin and Gentamycin or Linezolid or Daptomycin or
Streptogramins

3)Metronidazole
4)Clindamycin

Front 33

1) DOC H. Influenzae
2)Alternative H. Influenzae

Back 33

1)Amoxicillin
2)2nd or 3rd gen Cephalosporin, Amoxicillin-Cluvanic Acid

Front 34

1)DOC Legionella

2)DOC M. Catarrhalis
3)Alternative M.Catarrhalis

Back 34

1)Fluoroquinolone, Macrolide

2)Amoxicillin-Clavulanic Acid,
2nd/3rd gen cephalosporin
3)Azithromycin, Clarithromycin

Front 35

1)DOC mycoplasma pneumoniae
2)Alternative M.pneumoniae

3)DOC N.gonorrhoae
4)Alternative N. gonorrhoae

Back 35

1)Macrolide or Tetracycline
2)Resp Fluoroquinolone

3)Ceftriaxone
4)Cefixime, Cefotaxime

Front 36

1)DOC N.meningitidis
2)Alternative N. mening

3)DOC P.mirabilis
4)Alternative P. miribalis

Back 36

1)Penicillin G
2)3rd Gen Cephalosporin, Chloramphenicol, Fluoroquinolone

3)Ampicillin
4)Cephalosporins

Front 37

1)DOC P. aeruginosa
2)Alternative P. aeruginosa

3)DOC S. typhi
4)Alternative S. typhia

Back 37

1)Antipseudomonal B-lactam and Ciprofloxacin
2)Levofloxacin, Aminoglycoside

3)Ceftriaxone or Fluroquinolone
4)Chloramphenicol

Front 38

1)DOC Serratia
2)Alternative Serratia

3)DOC Shigella
4)Alternative Shigella

Back 38

1)Aminoglycoside and Anti Pseudomonal B-Lactam
2)Fluoroquinolone

3)Ampilicillin
4)Fluoroquinolone

Front 39

1)DOC S. aureus Methicillin Susceptible
2)Alternative S. aureus Methicillin Susceptible

3)DOC S. aureus Methicillin Resistant
4)Alternative S. Aureus Methicillin Resistant

Back 39

1)Antistaphlococcal Penicillin (Nafcillin, Oxacillin, Dicloxacillin)
2)Cephalosporin, Clindamycin, Fluoroquinolone, Imipenem

3)Vancomycin, Linezolid
4)Daptomycin, Doxycycline, Fluoroquinolone, Streptogramins

Front 40

1)DOC S. pneumoniae Penicillin Susceptible
2)Alternative S. pneumoniae Penicillin Susceptible

3)DOC S. pneumoniae Penicillin Resistant
4)Alternative S. pneumoniae Penicillin Resistant

Back 40

1)Penicillin G, Amoxicillin
2)Cephalosporin, Clindamycin, Fluoroquinolone, Macrolide

3)Fluoroquinolone, 3rd Gen Cephalosporin
4)Vancomycin, Linezolid, Streptogramins

Front 41

1)DOC Trichomoniasis

Back 41

1)Metronidazole

Front 42

1)DOC Legionella

2)DOC M. Catarrhalis
3)Alternative M.Catarrhalis

Back 42

1)Fluoroquinolone, Macrolide

2)Amoxicillin-Clavulanic Acid,
2nd/3rd gen cephalosporin
3)Azithromycin, Clarithromycin

Front 43

1)DOC mycoplasma pneumoniae
2)Alternative M.pneumoniae

3)DOC N.gonorrhoae
4)Alternative N. gonorrhoae

Back 43

1)Macrolide or Tetracycline
2)Resp Fluoroquinolone

3)Ceftriaxone
4)Cefixime, Cefotaxime

Front 44

1)DOC N.meningitidis
2)Alternative N. mening

3)DOC P.mirabilis
4)Alternative P. miribalis

Back 44

1)Penicillin G
2)3rd Gen Cephalosporin, Chloramphenicol, Fluoroquinolone

3)Ampicillin
4)Cephalosporins

Front 45

1)DOC P. aeruginosa
2)Alternative P. aeruginosa

3)DOC S. typhi
4)Alternative S. typhia

Back 45

1)Antipseudomonal B-lactam and Ciprofloxacin
2)Levofloxacin, Aminoglycoside

3)Ceftriaxone or Fluroquinolone
4)Chloramphenicol

Front 46

1)DOC Serratia
2)Alternative Serratia

3)DOC Shigella
4)Alternative Shigella

Back 46

1)Aminoglycoside and Anti Pseudomonal B-Lactam
2)Fluoroquinolone

3)Ampilicillin
4)Fluoroquinolone

Front 47

1)DOC S. aureus Methicillin Susceptible
2)Alternative S. aureus Methicillin Susceptible

3)DOC S. aureus Methicillin Resistant
4)Alternative S. Aureus Methicillin Resistant

Back 47

1)Antistaphlococcal Penicillin (Nafcillin, Oxacillin, Dicloxacillin)
2)Cephalosporin, Clindamycin, Fluoroquinolone, Imipenem

3)Vancomycin, Linezolid
4)Daptomycin, Doxycycline, Fluoroquinolone, Streptogramins

Front 48

1)DOC S. pneumoniae Penicillin Susceptible
2)Alternative S. pneumoniae Penicillin Susceptible

3)DOC S. pneumoniae Penicillin Resistant
4)Alternative S. pneumoniae Penicillin Resistant

Back 48

1)Penicillin G, Amoxicillin
2)Cephalosporin, Clindamycin, Fluoroquinolone, Macrolide

3)Fluoroquinolone, 3rd Gen Cephalosporin
4)Vancomycin, Linezolid, Streptogramins

Front 49

1)DOC Trichomoniasis

Back 49

1)Metronidazole

Front 50

Urinary Antiseptic (Nitrofurantoin)

1)What is it used for?

2)Whats special about it?

3)MOA

4)can you use in pregnancy?

5)Contra

Back 50

1)oral agen with antibacterial activity in urine, but NO systemic effects -> used for prophylaxis and treatment of Lower UTIs (both Gram Pos and Gram Neg) if resistance is a problem

2)Very little resistance to it

3)Inhibits lots of enzymes
4)Yes, until 38 weeks (d/t risk of hemolytic anemia in fetus)

5)Renal insufic, Preganancy at 38 weeks, Infants less then 1 month