Session 3 Pharm -9- Protein Syntheis Inhibitors 1

Front 1

What type of drug is erythromycin (E-mycin)

Back 1

Macrolide (50s)

Front 2

What type of drug is azithromycin (Zithromax)

Back 2

Macrolide (50S)

Front 3

What type of drug is Clarithromycin (Biaxin)

Back 3

Macrolide (50s)

Front 4

What type of drug is Dirithromycin (Dynabac)

Back 4

Macrolide (50s)

Front 5

Why would you probably avoid prescribing erythromycin

Back 5

Many drug interactions (CYP450-3A4), Poor Half life, GI effects, No H. Flu coverage and poor S. Pneumoniae

Front 6

What would you prescribe Azithromycin and Clarithromycin for

Back 6

good for Gram + (not MRSA), some gram neg, good for atypicals like Legionella sp., mycoplasma pneumoniae, and chlamydia pneumonia

Front 7

Which of the macrolides requires adjustment in renal impairment

Back 7

Clarithromycin

Front 8

How do the macrolides work

Back 8

inhibit translocation steps by binding 50s subunit

Front 9

What are the major s/e of using macrolides

Back 9

GI s/e, Hepatitis (mostly with erythromycin) cholestatic hepatitis, QTc prolongation, allergic reactions

Front 10

What resistance mechanisms have bacteria developed to macrolides

Back 10

altered target site, antibiotic efflux pump,

Front 11

What type of drug is Telithromycin (Ketek)

Back 11

Ketolide

Front 12

What is the advantage of the ketolide telithromycin

Back 12

less resistance than macrolides but still has drug interactions (3A4)

Front 13

What are the major s/e of using telithromycin the ketolide

Back 13

diarrhea, visual changes (blurry, difficulty focusing), QTc Prolongation, Hepatotoxicity,

Front 14

Is a ketolide a first-line therapy

Back 14

no only approved for CAP not used first line

Front 15

What place in therapy does clindamycin have

Back 15

covers CA-MRSA but not HA-MRSA, covers anaerobes. Mostly used for its coverage of anaerobes. Commonly used in pts with PCN allergy

Front 16

What are the s/e of clindamycin

Back 16

diarrhea, (C. Difficile), hepatotoxicity, Rash

Front 17

What type of drug is linezolid (Zyvox)

Back 17

Oxazolidinones

Front 18

What is the clinical use for linezolid (Zyvox)

Back 18

used against gram + bacteria and HA- MRSA, Enterococcus faecalis and Faecium including VRE. Becoming first line DOC for MRSA

Front 19

Why is Linezolid (Zyvox) becoming the drug of choice for MRSA

Back 19

PO formulation with 100% bioavailability doesn't need adjustment in renal or hepatic failure

Front 20

What are the s/e of Linezolid (Zyvox)

Back 20

Myelosuppression (thrombocytopenia), Peripheral/optic neuropathy, lactic acidosis, serotonin syndrome (inhibits MAOI)

Front 21

Pt is taking an MAOI for depression and has come down with a MRSA infection would you prescribe them Linezolid (Zyvox) if so why if not why

Back 21

Though it is considered first line therapy for MRSA you would avoid using it in this case because Zyvox inhibits MAOI as well and can cause serotonin syndrome if combined with MAOI drugs

Front 22

What is the DOC when switching from IV vancomycin

Back 22

Linezolid (Zyvox)

Front 23

What type of drug is Quinupristin-dalfopristin (Synercid)

Back 23

Streptogramin

Front 24

What is the place in therapy for Quinupristin-dalfopristin (Synercid)

Back 24

Good against Gram +, enterococcus faecium (VRE)a and MRSA (not approved though). ITS MAIN ROLE IT TO TX VRE

Front 25

What are the major s/e of Quinupristin-dalfopristin (Synercid)

Back 25

Infusion related reactions, elevation of conjugated bilirubin, arthralgias/myalgias

Front 26

What type of drug is doxycycline

Back 26

tetracycline

Front 27

What type of drug is minocycline

Back 27

tetracycline

Front 28

What type of drug is demecyclocycline

Back 28

tetracycline

Front 29

What type of drug is Oxytetracycline

Back 29

tetracycline

Front 30

What is the DOC for rickettsial infections (Lyme disease, Q fever, Rocky Mt spotted fever, Ehrlichiosis)

Back 30

Doxycycline

Front 31

What is the 2nd line agent for CAP, COPD exacerbation and can be used to tx Acne and Chlamydia

Back 31

Doxycycline

Front 32

What is the primary use of Demeclocycline

Back 32

used in SIADH, blocks ADH induced water resorption

Front 33

What drug of the tetracycline family is prescribed for Rheumatoid arthritis and can be used for Staph infections including CA-MRSA but is limited due to is s/e profile

Back 33

Minocycline

Front 34

What are the major s/e of using minocycline

Back 34

deposition in calcified tissue= tooth discoloration, deformation of bone/growth inhibition. Avoid giving with calcium, causes photosensitivity, GI upset, Vestibular rxn, hepatotoxicity

Front 35

Why should you counsel pt to throw away old tetracycline meds

Back 35

they decompose into toxic compounds

Front 36

What type of med is Tigecycline (Tygacil)

Back 36

Glycylcyclines

Front 37

What is the probably future use for Tigecycline (Tygacil)

Back 37

broad spectrum of activity covers MRSA, enterococcus faecalis, gram negatives except Pseudomonas and some of the anaerobes. Currently approved for cSSSI, intra-abdominal infections and Acinetobacter

Front 38

Tigecycline works at the exact same site as the tetracycline why is it more effective

Back 38

it overcomes all the resistance mechanisms bacteria have to tetracycline like the efflux pumps and ribosomal modifications

Front 39

What are the major s/e of Tigecycline

Back 39

GI disturbances, photosensitivity, Pseudotumor cerebri

Front 40

What is the use for chloramphenicol

Back 40

Last resort for tx of rickettsial infections in children

Front 41

What drug can cause gray baby syndrome

Back 41

Chloramphenicol

Front 42

What drug can cause aplastic anemia

Back 42

chloramphenicol

Front 43

What type of drug is Gentamicin

Back 43

Aminoglycoside

Front 44

What type of drug is Tobramycin

Back 44

Aminoglycoside

Front 45

What type of drug is Amikacin

Back 45

Aminoglycoside

Front 46

What type of drug is streptomycin

Back 46

Aminoglycoside

Front 47

What type of drug is Netilmicin

Back 47

Aminoglycoside

Front 48

What type of drug is Kanamycin

Back 48

Aminoglycoside

Front 49

What type of drug is Neomycin

Back 49

Aminoglycoside

Front 50

What is the primary use for the aminoglycosides

Back 50

lesser and greater gram neg coverage IE Pseudomonas A., Serratia Marcescens, Acinetobacter

Front 51

What do you usually prescribe with an aminoglycoside and why

Back 51

a beta lactam because they have synergy working together

Front 52

What types of resistance are there to aminoglycosides

Back 52

altered ribosomes, altered uptake

Front 53

Why don't aminoglycosides cover the anaerobes

Back 53

require oxygen to get across the cell membrane to exert their action

Front 54

What concerns do you need to be aware of when prescribing an aminoglycoside

Back 54

it is cleared renally and has a narrow therapeutic index monitor peaks and troughs and caution in renally impaired pt

Front 55

What are the major s/e of the aminoglycosides

Back 55

Nephrotoxicity (tubular necrosis), Ototoxicity/vestibulotoxicity (often permanent careful with high doses)