Ch 33 Pharm

Front 1

Macrolides are widely distributed into body tissues and fluids and may be ______________ bactericidal depending on drug concentration in infected tissues.

Back 1

Bacteriostatic

Front 2

Mycobacterium avium complex (MAC) disease is an opportunistic infection that occurs mainly in people with advanced ____________ infection.

Back 2

HIV

Front 3

Helicobacter pylori a pathogen implicated in peptic ulcer disease is treated by _____________ clarithromycin as part of a combination regimen.

Back 3

Azithromycin

Front 4

Telithromycin is excreted by the ___________ and kidneys.

Back 4

Liver

Front 5

The macrolides and ketolides enter microbial cells and reversibly bind to the 50S subunits of __________ thereby inhibiting microbial protein synthesis.

Back 5

Ribosoms

Front 6

Broad spectrum bacteriostatic antibiotic active against most gram positive and gram negative bacteria rickettsiae chlamydiae and treponemes

Back 6

Chloramphenicol (Chloromycetin)

Front 7

A lincosamide similar to the macrolides in its mechanism of action and antimicrobial spectrum.

Back 7

Clindamycin (Cleocin)

Front 8

The first member of the ketolide class

Back 8

Telithromycin (Ketek)

Front 9

A member of the glycylcline class currently the only member in its class.

Back 9

Tigecycline (Tygacil)

Front 10

Belongs to the lipopeptide class a new class of antibiotics

Back 10

Daptomycin (cubicin)

Front 11

Vancomycin is effective against MRSA. What is the mechanism of action of the drug?

Back 11

Vancomycin (Vancocin) is active only against gram positive microorganisms. It acts by inhibiting cell wall synthesis.

Front 12

Mr. Gresham develops antibiotic induced diarrhea (C. difficile) secondary to the use of antibiotics prior to his diagnosis of MRSA pneumonia. He states that the vancomycin he is receiving should also treat the C. difficile. What information can you give Mr. Gresham? What medication wouldyou expect the physician to order for the initial treatment of Mr. Gresham's C. difficile?

Back 12

Oral vancomycin is used only to treat staphyloccal enterocolitis and pseudomembranous colitis caused by C. difficile. Ininitial treatment for c. difficile colitis metronidazole is preferred.

Front 13

Discuss the limitation to the use of vancomycin.

Back 13

Partly because of the widespread use of vancomycin, vancomycin resistant enterocococcci (VRE) are being encountered more often especially in critical care units and treatment options for infections caused by these organisms are limited. To decrease the spread of VRE the CDC recommended limiting the use of vancomyocin.

Front 14

During the second dose of parental vancomycin, Mr. Gresham develops "red man syndrome" What is the syndrome attributed to?

Back 14

Red man syndrome is an adverse reaction characterized by hypotension, flushing, and skin rash. It is cause d by giving an IV infusion too quickly and is attributed to histamine release. It is very important to give IV infusions slowly over 1 to 2hrs to avoid this reaction.

Front 15

If Mr. Gresham were to develop kidney impairment during his hospitalization, what do you expect would happen to his vancomycin dose?

Back 15

Vancomycin is excreted through the kidneys. Dosage should be reduced in the presence of renal impairment.

Front 16

Discuss how erythromycin is metabolized and excreted in the body. Does food have an effect on the absorption of erythromycin?

Back 16

Erythromycin is metabolized in the liver and excreted mainly in bile; approximately 20% is excreted in urine. Depending on the specific salt formation used food can have a variable effect on the absorption of oral erythromycin.

Front 17

What is the mechanism of action of macrolides and ketolides?

Back 17

The macrolides and ketolides enter microbial cells and reversibly bind to the 50S subunits of ribosomes thereby inhibiting microbial protein synthesis. Ketolides have a greater affinity for ribosomal RNA expanding there antimicrobial spectrum compared to macrolides.

Front 18

Identify two contraindications related to the administration of macrolides in ketolides.

Back 18

Marcrolides and ketolides are contraindicated in people who have had hypersensitivity reactions. Telithromycin is contraindicated in people who have had hypersensitivity reactions to macrolides. All macrolides and telithromycin must be used with caution in patients with preexisting liver disease. A black box warning for erythromycin estolate and an FDA alert for telithromycin emphasize the liver toxicity associated with these drugs. Use of erythromycin and etlithromycin concurrently with drugs highly dependent on CYP3Aliver enzymes for metablism (ex. pimozide) is contraindicated. The FDA has issued a black box warning alerting health care professionals that telithromycin is contraindicated in patients with myasthenia gravis due to the potential for life threatening or fatal respiratory failure.

Front 19

Name two categories of drugs that should not be administered with quinupristin dalfopristin. Explain how quinupristin dalfopristin interferes with the identified medications absorption.

Back 19

Quinupristin dalfopristin is a strong inhibitor of cytochrome P450 3A4 enzymes and therefore interferes with the metabloism of drugs such as cyclosporine, antiretrovirals, carbamazepine, and may others. Toxicity may occur with the inhibited drugs.

Front 20

Mr. costello presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the physician removed his wound staples 5 days ago. Mr. Costello states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red and there is evidence of foul smelling drainage. The wound is cultured and an anaerobic bacterium is identified. The Physician orders metronidazole because of it is effective against which of the following organisms?

a. All gram positive bacteria

b. All gram negative bacteria

c. Staphylococcus

d. Anaerobic bacteria

Back 20

d.

Rationale: Metronidazole is effective against infections with anaerobic bacteria and some protozoa.

Front 21

Ms. Robinson is non-compliant with the medication treatment plan for her gonococcal infection. She failed to complete the second course of antibiotics because she felt better after 5 days and states that she experienced unpleasant side effects. You would expect the physician to order medication education and which of the following drugs?

a. Spectinomycin

b. Streptomycin

c. Erythromycin

d. Zithromax

Back 21

a.

Rationale: Spectinomycin is an alternative treatemtn for gonococcal infection when patients are unable to comply with the preferred regimen.

Front 22

Mr. and Mrs. Williams return from a vacation with travelers diarrhea. What is the treatment of choice?

a. Robaxin

b. Rifaximin

c. Rifampin

d. Relafen

Back 22

b.

Rationale: Rifaximin is prescribed for travelers diarrhea caused by escherichia coli infection.

Front 23

Vancomycin is effective against gram __________ organisms only including MRSA and SSNA.

Back 23

Positive

Front 24

Mr. Gustafson, who underwent abdominal surgery 6wks ago is diagonosed with VREF. the physician orders which of the following medications?

a. Vancomycin

b. Rifampin

c. Quinupristin dalfopristin

d. Rifaximin

Back 24

c.

Rationale: Quinupristin dalfopristin belongs to the streptogramin class of antibiotics. It is indicated for VREF and MSSA.

Front 25

Ms. Seinfeld presents to the physicians office with a skin infection on her forearm. The infection is resistant to over the counter antibiotics. After receiving the culture and sensitivity results the physician orders tigecycline. What is the patients diagnosis?

a. C difficile

b. VRE

c. MRSA

d. VREF

Back 25

c.

Rationale: Tigecycline belongs to the glycylcline class of antibiotics. It is similar to tetracycline in structure and properties and can be used to treat skin infections caused by MRSA.

Front 26

Daptomycin belongs to the lipopeptide class of antibiotics that kills gram positive bacteria. What is the mechanism of action for this antibiotic?

a. Inhibition of synthesis of bacterial proteins

b. Inhibition of synthesis of DNA only

c. Inhibition of mitochondrial reproduction

d. Inhibition of cell wall osmosis.

Back 26

a.

Rationale: Daptomycin belongs to the lipopeptide class of antibiotics that kills gram positive bacteria by inhibiting synthesis of bacterial proteins DNA and RNA.

Front 27

Mrs. Benz is taking clindamycin for an infectious process. She presents to the physicians office with symptoms of dehydration. What adverse reaction is she experiencing form the administration of clindamycin.

a. Diuresis

b. Diaphoresis

c. Dysphasia

d. Diarrhea

Back 27

d.

Rationale:Clindamycin belongs to the lincosamide class of antimicrobials similar to macrolides in its mechanism of action and antimicrobial spectrum. A Life threatening adverse effect of clindamycin is the development of pseudomembranous colitis.

Front 28

Ms. Gains is diagnosed with VRE. The physician orders chloramphenicol. Ms. Gains should be monitored for the developement of which of the following side effects?

a. Dizziness

b. Blood Dyscrasias

c. Nausea

d. Vomiting

Back 28

b.

Rationale: Chloramphenicol (chlormycetin) is rarely used due to the possible development of a serious and fatal blood dyscrasias with its use. It is effective against some strains of VRE.

Front 29

Mr. Bethel is diagnosed with myasthenia gravis. He develops an infectious process that is sensitive to telithromycin. Telithromycin is contradicted for Mr. Bethel because of the risk of which of the following conditions?

a. Respiratory failure

b. Congestive heart failure

c. Myocardial infarct

d. Renal Failure

Back 29

a.

Rationale: Telithromycin is contraindicated in patients with myasthenia gravis because of the potential for life threatening or fatal respiratory failure.

Front 30

The ketolide telithromycin and a macrolide erythromycin estolate can cause severe _______________ injury.

Back 30

Liver

Front 31

Mrs. Gonzalez is diagnosed with community acquired pneumonia. The physician orders telithromycin. What is the mechanism of action for this antibiotic?

a. Inhibition of microbial cell wall synthesis

b. Destruction of the microbial cell wall

c. Prevention of osmosis within the microbial cell.

d. Inhibition of microbial protein synthsis.

Back 31

d.

Rationale: The ketolide telithromycin is approved only for community acquired pneumonia. Its mechanism of action is inhibition of microbial protein synthesis.

Front 32

Mr. Amie is diagnosed with an infectious process that is sensitive to penicillin. He is allergic to penicillin, so the physician orders a drug with a similar antibacterial spectrum. Which of the following medications will the physician order?

a. Streptomycin

b. Erythromycin

c. Vancomycin

d. Dicloxacillin

Back 32

b.

Rationale: Erythromycin shares a similar antibacterial spectrum with penicillin, making it a good choice for patients with a penicillin allergy.

Front 33

Ms. Cushings is diagnosed with acute bacterial sinusitis. The physician orders azithromycin. How long a course of this drug do you expect the physician to order?

a. 5 days

b. 10 days

c. 7 days

d. 3 days

Back 33

d.

Rationale: For acute bacterial sinusitis, azithromycin is approved for an abbreviated 3 day treatment duration.

Front 34

Mr. Quinn is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which of the following laboratory tests would you expect the physician to order on a regular basis because of the length of administration of the drug?

a. Electrolytes

b. Complete blood count

c. Potassium

d. Serum albumin

Back 34

d.

Rationale: With the drug linezolid, myelosuppression (anemia, leukopenia, pancytopenia, and thrombocytopenia) is a serious adverse effect that may occure with prolonged therapy lasting longer than 2 weeks. The patient complete blood count should be monitored if myelosuppression occurs linezolid should be discontinued. Myelosuppression usually improves with drug discontinuation.

Front 35

Mr. Quinn is taking digoxin, SSRI's and aspirin as part of his daily drug regimen. A patient with Mr. Quinn's drug history who is also receiving linezolid would be at risk for which of the following?

a. Serotonin syndrome

b. Diabetes type 2

c. Congestive heart failure

d. Renal failure

Back 35

a.

Rationale: Patients receiving linezoid and selective serotonin re-uptake inhibitors (SSRI's) may be at risk for serotonin syndrome which is characterized by fever and cognitive dysfunction.

Front 36

Because linezolid is a weak monoamin oxidase (MAO) inhibitor patients whould avoid foods high in tyramine content, such as which of the following (Select all that apply)

a. Aged cheese

b. Milk

c. Red wine

d. Tap beers

Back 36

a, c, d

Rationale: Because linezolid is a weak monoamine oxidase (MAO) inhibitor patients should avoid foods high in tyramin content (aged cheese, fermented or air dried meats, sauerkraut, soy sauce, tap beers, red wine) while taking the drug.

Front 37

Mrs. Goldmans medical history includes diabetes type 2, CVA, dysphasia and chronic renal failure. She develops an infectious process. The physician orders erythromycin. Based on the clients medical history why is erythromycin the drug of choice?

a. It is metabolized in the liver.

b. It is metabolized in the kidneys.

c. It is excreted into the blood stream

d. It is excreted into the GI tract.

Back 37

a.

Rationale: Erythromycin is generally considered safe. Because it is metabolized in the liver and excreted in the bile, it may be an alternative in patients with impaired renal function.

Front 38

Chloramphenicol concentrations may _____________ in patients with impaired renal function.

Back 38

Increase

Front 39

Erythromycin inhibits liver metabolism and may ___________ elimination of several other drugs.

Back 39

Slow

Front 40

The __________, which include erythromycin, azithromycin
(Zithromax), and clarithromycin
(Biaxin), have similar antibacterial spectra and mechanisms of action.

Back 40

macrolides

Front 41

___________ are effective against gram-positive cocci, including group A streptococci, pneumococci, and most staphylococci.

Back 41

macrolides

Front 42

Name the Macrolides

Back 42

Erythromycin, Azithromycin (Zithromax), Clarithromycin (Biaxin)

Front 43

What other species are macrolides effective against?

Back 43

Corynebacterium, Treponema, Legionella, Chlamydia, Neisseria, and Mycoplasma

Front 44

What 2 Macrolides are effective against the atypical mycobacteria that cause Mycobacterium avium complex (MAC) disease.

Back 44

Azithromycin and clarithromycin

Front 45

______________ the prototype, is now used less often because of microbial resistance, numerous drug interactions,and the development of newer macrolides. This macrolides is metabolized in the liver and excreted mainly in bile; approximately 20% is excreted in urine.

Back 45

Erthromycin

Front 46

True or false

Depending on the specific salt formation used, food can have a variable effect on the absorption of oral erthromycin.

Back 46

true

Front 47

____________ is excreted mainly in bile.

Back 47

Azithromycin

Front 48

___________ is metabolized to an active metabolite in the liver,which is then excreted in urine.

Back 48

clarithromycin

Front 49

A relative of the macrolides,
____________ is the first member of the ketolide class.

Back 49

telithromycin (Ketek)

Front 50

This drug offers better activity against macrolide-resistant strains of Streptococcus pneumoniae, an increasingly common cause of infections in children and adults. Telithromycin is excreted bythe liver and kidneys. Food does not affect the absorption oftelithromycin.

Back 50

telithromycin (Ketek)

Front 51

true or false

The macrolides are widely used for treatment of respiratory tract and skin/soft tissue infections caused by streptococci and staphylococci.

Back 51

true

Front 52

__________ is used as a penicillin substitute in patients who are allergic to penicillin; for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in newborns (ophthalmic ointment); and to treat Legionnaire’s disease, genito urinary infections caused by Chlamydia trachomatis,
intestinal amebiasis caused by
Entamoeba histolytica

Back 52

Erythromycin

Front 53

______________ is approved for treatment of urethritis and cervicitis caused by
C. trachomatis
organisms and is being used for the prevention and treatment of MAC disease.For acute bacterial sinusitis, ______________ is approved for an abbreviated 3-day treatment duration.

Back 53

azithromycin

Front 54

___________ is contraindicated in people who have had hypersensitivity reactions to macrolides.

Back 54

Telithromycin

Front 55

All _________ and ________ must be used with caution in patients with preexisting liver disease.

Back 55

macrolides and telithromycin

Front 56

The FDA has issued a
BLACK BOX WARNING
alerting health care professionals that ____________ is contraindicated in patients with myasthenia gravis due to the potential for fatal and life-threatening respiratory failure.

Back 56

telithromycin

Front 57

______________ is a broad-spectrum,bacteriostatic antibiotic that is active against most gram-positive and gram-negative bacteria, rickettsiae, chlamydiae,and treponemes.

Back 57

Chloramphenicol
(Chloromycetin)

Front 58

This drug is used to treat specific infections such as meningococcal, pneumococcal, Haemophilus meningitis, in penicillin-allergic patients; anaerobic brain abscess;
Bacteroidesfragilis
infections; and rickettsial infections and brucellosis when tetracyclines are contraindicated. In infections due to vancomycin-resistant enterococci VRE

Back 58

Chloramphenicol
(Chloromycetin)

Front 59

________________, a
lincosamide is similar to the macrolides in its mechanism of action and antimicrobial spectrum. Bacteriostatic in usual doses, it is effective against gram-positive cocci, including group A streptococci, pneumo-cocci, most staphylococci, and some anaerobes such as
Bacteroides
and
Clostridia. __________enters microbial cells and attaches to 50S subunits of ribosomes, thereby inhibiting microbial protein synthesis.

Back 59

Clindamycin
(Cleocin)

Front 60

____________ does not reach therapeutic concentrations in the central nervous system (CNS) and cannot be used for treating meningitis.

Back 60

Clindamycin

Front 61

_____________is often used to treat infections caused by
B.fragilis. Because these bacteria are usually mixed with gram-negative organisms from the gynecologic or gastrointestinal(GI) tracts, clindamycin is usually given with another drug,such as an aminoglycoside or a fluoroquinolone, to treat mixed infections.

Back 61

Clindamycin

Front 62

A topical solution is used in the treatment of acne, and a vaginal cream is available. what drug is this?

Back 62

Clindamycin

Front 63

__________is well absorbed with oral administration and reaches peak plasma levels within 1 hour after a dose. It is widely distributed in body tissues and fluids, except CSF, and crosses the placenta. It is highly bound (90%) to plasma proteins. It is metabolized in the liver, and the metabolites are excreted in bile and urine. Dosage may need to be reduced inpatients with severe hepatic failure to prevent accumulation and toxic effects.

Back 63

Clindamycin

Front 64

_____________belongs to the
lipopeptide class, a new class of antibiotics. It is a bactericidal agent effective only for gram-positive infections due to
Staphylococcus aureus
(including oxacillin-resistant strains), Streptococcus pyogenes,
group B streptococci, and
Enterococcus faecalis
(vancomycin-susceptible strains only).

Back 64

Daptomycin
(Cubicin)

Front 65

______________ is a member of the glycylcycline class and is currently the only member in its class. Glycylcyclines binds to the 30S ribosomal subunit of susceptible bacteria, thus inhibiting protein synthesis. The drug is used for the treatment of complicated skin and skin structure infections caused by methicillin-resistant
Staphylococ-cus aureus
(MRSA) and vancomycin-sensitive.

Back 65

Tigecycline
(Tygacil)

Front 66

___________may be associated with antianabolic effects,pancreatitis, photosensitivity, pseudotumor cerebri, or super-infection.

Back 66

Tigecycline

Front 67

__________ is a member of the
oxazolidinone class, a newer class of antibiotics. It is active against aerobic gram-positive bacteria, in which it acts by inhibiting protein synthesis by a unique mechanism.

Back 67

Linezolid
(Zyvox)

Front 68

__________ is indicated for pneumonia (both community acquired and nosocomial), complicated and uncomplicated skin and skin structure infections, and vancomycin-resistant. Enterococcus faecium
(VREF) infections. The drug is bacteriostatic against enterococci (including E. faecalis and E. faecium)and staphylococci (including methicillin-resistant strains) and bactericidal for most streptococci.

Back 68

Linezolid

Front 69

__________is effective against anaerobic bacteria, including gram-negative bacilli such as
Bacteroides, gram-positive bacilli such as Clostridia, and some grampositive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis. Metronidazole achieves therapeutic concentrations in body fluids and tissues and can be used to treat anaerobic brain abscesses. It is eliminated by the liver and kidneys.

Back 69

Metronidazole
(Flagyl)

Front 70

Clinical indications for use include prevention or treatment of anaerobic bacterial infections (e.g., in colorectal surgery, intra-abdominal infections) and treatment of C. difficile infections associated with pseudo membranous colitis. As part of a combination regimen, it is also useful in treatment of infections due to
H. pylori. It is contraindicated during the first trimester of pregnancy and must be used with caution inpatients with CNS or blood disorders.

Back 70

Metronidazole
(Flagyl)

Front 71

____________is indicated for skin and skin structure infections caused by S. aureus or group A streptococcus. It is also used for treatment of patients with serious or life-threatening infections associated with VREF bacteremia;however, a BLACK BOX WARNING
reports that FDA approval for this use is based on the ability of the drug to clear bacteria from the bloodstream rather than its ability to cure the underlying infection. Further clinical studies are underway to verify the clinical benefits of quinupristin-dalfopristin for curing VREF infections.

Back 71

Quinupristin-dalfopristin

Front 72

___________is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral _________ has been used extensively to treat infections caused by methicillin-resistant S. aureus (MRSA)and methicillin-resistant staphylococcal species non-aureus (SSNA
, including Staphylococcus epidermidis) and endocarditis caused by Streptococcus viridans
(in patients allergic to orwith infections resistant to penicillins and cephalosporins) or
E. faecalis(with an aminoglycoside).

Back 72

Vancomycin
(Vancocin)

Front 73

True or false

With azithromycin,give the tablets or oral suspensionwithout regard to meals.Give Azithromycin ER on an empty stomach.Do not give oral azithromycin with aluminum- or magnesium-containing antacids.

Back 73

true

Front 74

WHat is a normal Aspartate aminotransferase (AST)

Back 74

Males:
14–20 units per liter (U/L) or 0.23–0.33 microkats per liter (mckat/L)

Females:
10–36 U/L or 0.17–0.60 mckat/L

Front 75

What would high levels of AST may be indicative of?

Back 75

Recent or severe liver damage, such as hepatitis caused by a viral infection or drug reaction.

Decay of a large tumor (necrosis).

Shock

Front 76

What is the ALT levels for males and females?

Back 76

Average levels of ALT in males: 10-40 units / liter

Average levels of ALT in females: 7-35 units / liter