22 Midterm 2 Review Questions Flashcards Preview

Thera VII > 22 Midterm 2 Review Questions > Flashcards

Flashcards in 22 Midterm 2 Review Questions Deck (76):
1

Which antibiotics are Pregnancy Category B?

All Beta-Lactams, Synercid, Daptomycin, Clarithromycin, Azithromycin, Clindamycin, Flagyl (avoid 1st trimester), Nitrofurantoin (avoid at time of gestation), TMP/SMX (avoid in 1st and 3rd trimester)

2

Which antibiotics are Oral only?

Amoxicillin, Augmentin, Clarithromycin, Nitrofurantoin

3

Which antibiotics are IV only?

Unasyn (A/S), Oxacillin, Pip-Tazo, all CEPHs (except cefuroxime), all carbapenems, Synercid, Daptomycin, Telavancin, Aminoglycosides (Gent/Tobra), Tigecycline, Clindamycin

4

Which antibiotics have a Type I PD?

Aminoglycosides, FQs

5

Which antibiotics have a Type II PD?

All Beta-Lactams, Linezolid, Clarithromycin

6

Which antibiotics have a Type III PD?

Vancomycin, Synercid, Azithromycin, Doxycycline, Clindamycin

7

Which Beta-Lactams require no renal adjustment?

Oxacillin, Nafcillin, Ceftriaxone

8

What prophylaxis are Natural PCNs used for?

Rheumatic fever

9

What is the DOC for Treponema (syphilis)?

Benzathine Pen G

10

What is the DOC for Clostridia (Gas Gangrene)?

Natural PCNs

11

What is Oxacillin often used for?

Staphylococci

12

What is Amoxicillin often used for?

Endocarditis, prophylaxis for patient undergoing dental procedures

13

What is the only PCN derivative to cover Pseudomonas?

Pip/Tazo

14

Which CEPH covers B. fragilis, and therefore is good for surgical prophylaxis (colorectal)/intraabdominal?

Cefoxitin

15

Which Carbapenems have adequate CSF penetration with inflamed meninges?

Imipenem and Meropenem only

16

At what point do Carbapenems need renal adjustment?

All: CrCl < 10-20. Doripenem: CrCl < 50

17

What is the MOA of FQs?

Exerts antibiotic effect through inhibiting DNA synthesis --> inhibits bacterial topoisomerase II (DNA Gyrase) and topoisomerase IV

18

What is the MOR for FQs?

1) Target site mutation (gram (+); topo IV (parC, parE)). 2) Increased drug efflux (gram (-); OprM, MexA, MexB)

19

What is the PD of FQs?

Concentration dependent. Bactericidal

20

Which FQ doesn't require renal adjustment?

Moxifloxacin

21

Most FQs are QD dosing, which one required BID?

Ciprofloxacin

22

What are some notable ADRs associated with FQs?

Cartilage toxicity. Photosensitivity

23

What are some notable DDIs associated wtih FQs?

ALL FQ agents interact with multivalent cations (chelation reactions can result in forming insoluble, inactive complex). Levo, Gati, Moxi - avoid QT prolongation drugs (erythro, antipsychotics, TCA)

24

What is some patient counseling for FQs?

May get drowsy, dizzy. Avoid/minimal caffeine. Separate antacids by 4 hours. Keep out of sun

25

What is the MOA of Bactrim?

Sulfonamide inhibits dihydropteroate synthetase. Trimethoprim inhibits dihydrofolate reductase

26

How does E. coli develop resistance to Bactrim?

Alteration to dihydropteroate synthetase --> lower affinity for sulfonamide

27

How does N. gonorrhoeae, S. aureus develop resistance to Bactrim?

Increase production of essential metabolite or drug (i.e. Increase PABA)

28

What is renal adjustment like for Bactrim?

Adjust when < 30 by increasing interval

29

What is Bactrim the DOC for?

Pneumocystis carinii

30

What are some serious ADRs associated with Bactrim?

Erythema multiforme, SJS, TEN

31

What needs to be monitored while on Bactrim?

Fluid status, CBC to f/u blood dyscrasias

32

What are some notable ADRs associated with Nitrofurantoin?

Peripheral neuropathy (w/ long term use). Respiratory

33

What are some precautions before Nitrofurantoin use?

Lung disease. Peripheral neuropathy. G6PD

34

What are contraindications to Nitrofurantoin use?

CrCl < 40. Pregnancy at term. Infants < 1 month

35

What is some patient counseling for Nitrofurantoin?

May cause GI upset, take with food or milk. May cause brown urine

36

What is the MOA of Metronidazole?

Enter cell, reductive activation

37

What are some notable ADRs with Metronidazole?

Nausea, abdominal pain. Metallic taste. CNS

38

What is some patient counseling for Metronidazole?

Can take w/ food to decrease stomach upset. Do not drink alcohol (including cough/cold) d/t disulfuram-like reaction. Metallic taste perverse

39

What is the MOA of Macrolides?

Reversibly bind to 23S ribosomal RNA in the 50S subunit of the bacterial ribosome. Interferes w/ peptide bond formation of growing peptide chain --> suppress RNA dependent protein synthesis

40

What is the MOR against Macrolides?

Target site alteration (ermA, B, C). Alteration in transport (efflux): mrsA, mefA, mefE

41

What are the class effects for PK of Macrolides?

Lipophilic, extensive tissue/fluid penetration. Respiratory concentration > serum

42

What is the PD of Macrolides like?

Bacteriostatic. Time dependent

43

Which Macrolide requires renal adjustment?

Clarithromycin

44

What are the clinical applications of Erythromycin?

Motilin effect. Diabetic gastroparesis. Post op ileus

45

What is a notable ADR associated with Clarithromycin?

Taste perversion (metallic)

46

What is a rare effect that Macrolides have?

Immunomodulatory effects

47

What class of antibiotic is Telithromycin?

Ketolide

48

What is Telithromycin designed to do?

Treat macrolide-resistant respiratory tract infection

49

What are some notable ADRs of Telithromycin?

Hepatotoxicity, QT prolongation, NV

50

Which antibiotics are strong inhibitors of CYP3A4?

Macrolides (not azithro). Telithromycin, Synercid, Metronidazole

51

What does Clindamycin not get to?

CSF

52

What is a notable ADR with Clindamycin?

Increased LFTs

53

Which Tetracyclines require renal adjustment?

Tetracycline. Minocycline

54

What is the MOA of Tetracyclines?

Reversible bind to 30S ribosome, inhibits binding of aminoacyl-tRNA to acceptor site on 70S ribosome

55

What is the PD of Tetracyclines?

Bacteriostatic. Time dependent

56

Which Tetracycline doesn't require renal adjustment?

Doxycycline

57

Which Tetracycline is PO only?

Tetracycline

58

What are some notable ADRs associated with Tetracyclines?

Photosensitivity. Tooth discoloration. Inhibition of growth and bone deformities

59

What are some additional ADRs only seen in Minocycline?

Vertigo. Drug induced lupus

60

What are some counseling points for Tetracyclines?

Separate dose from milk, antacids, iron supplements by > 2 hours

61

Does does Tigecyline not cover?

No coverage of the Big 3P: Pseudomonas, Proteus, Providencia

62

What are the clinical applications of Tigecycline?

Complicated skin and skin structure (cSSSi). Complicated intraabdominal infections (cIAi)

63

What are the common ADRs of Tigecycline?

N/V/D

64

Why is Tigecycline not used anymore?

Increased risk of mortality from post market data

65

What is the MOA of Quinupristin/Dalfopristin?

Inhibits protein synthesis. Dalfo alters ribosomal conformation, increasing affinity for quinu

66

What is the PD of Synercid?

Bactericidal except E. faecium (static)

67

What is a notable ADR associated with Synercid?

Arthraigia, myalgia: may require analgesics for pain control, and extend dose to Q8 - Q12

68

What is the MOA of Linezolid?

Attacks at pre-initiation (unique)

69

What is the PD of Linezolid?

Bacteriastatic against most, cidal against some pneumococcis. Concentration independent

70

What are the clinical applications of Linezolid?

Vanco-R Enterococci infection. MRSA infection (d/t intolerance to vanco or vanco failure)

71

What are the big ADRs associated with Linezolid?

Thrombocytopenia, Anemia, Leucopenia. Increased risk with duration > 2 weeks. Monitor CBC weekly

72

What is a notable DDI with Linezolid?

Serotonin syndrome when used with SSRIs

73

What is the MOA of Daptomycin?

Binds to bacterial cell membrane, calcium dependent, insertion of lipid tail. Rapidly depolarizes cell --> cell death

74

What is the PD of Daptomycin?

Concentration dependent killing. Bactericidal

75

What are some notable ADRs with Daptomycin?

CPK elevations (monitor weekly), look out for muscle pain, weakness, distal extremities

76

What is Daptomycins place in therapy?

Only for treatment of cSSSi caused by susceptible organisms and bloodstream infection cause by S. aureus