Anti-Microbial Drugs I Flashcards
(95 cards)
1
Q
All aminoglycosides concentrate in:
A
Renal cortex
2
Q
Spectrum of the aminoglycosides:
A
More Gram (-) rods Some Gram (+) cocci
3
Q
Aminoglycosides are DOC for:
A
Enterobacter E. coli K. pneumonia Proteus Serratia P. aeruginosa
4
Q
“mycin” drugs are derived from:
A
Streptomyces
5
Q
“micin” drugs are derived from:
A
Micromonospora
6
Q
Once a day dosing is effective if the drug has:
A
Significant post-antibiotic effect
Concentration dependent killing
7
Q
Most stable aminoglycoside against R-plasmid enzymes?
A
Amikacin
8
Q
Most vesitbulotoxic aminoglycosides:
A
Streptomycin
Gentamycin
9
Q
Most hearing toxic aminoglycosides:
A
Neomycin
Kanamycin
Amikacin
10
Q
Most nephrotoxic aminoglycosides:
A
Neomycin
Tobramycin
Gentamycin
11
Q
Aminoglycosides must not be used with __ due to its __ effects
A
Neuromuscular blockers; neurotoxic
12
Q
Penicillins bind to PBPs at the ___ terminal and inhibit the ___ enzyme.
A
d-ala-d-ala; transpeptidase
13
Q
Exceptions to renal clearance of PCNs:
A
Naficillin (biliary)
Oxacillin, Cloxacillin, Dicloxacillin (biliary and renal)
14
Q
This drug inhibits secretion of PCN:
A
Probenecid
15
Q
Nafcillin is not as nephrotoxic as other PCN but may cause:
A
neutropenia
16
Q
Most active PCN against pneumococci:
A
Aminopenicillins
17
Q
Extended spectrum penicillins are combined with ___ to achieve synergistic effect:
A
aminoglycoside
18
Q
Cephalosporins are NOT active against:
A
L-monocytogenes
Atypicals
MRSA
Enterococci
19
Q
Cephalosporins excreted through bile:
A
Cefamandole
Cefoperazone
Ceftriaxone
20
Q
Cephalosporins with disulfiram-like effectsL
A
Cefamandole
Cefoperazone
Moxalactam
21
Q
Only first generation Cephalosporin still in use:
A
Cefazolin
22
Q
2nd Gen Ceph used against community acquired pneumonia:
A
Cefuroxime
23
Q
More effective than Cefuroxime in crossing the BBB:
A
3rd Gen:
Ceftriaxone
Ceftaxime
24
Q
2nd Gen Ceph active against Bacteriodes:
A
Cefoxitin
25
2nd Gen Ceph more susceptible to beta-lactamase:
Cefaclor
26
2nd Gen Ceph active against H. influenzae:
Cefmandole
Cefuroxime
Cefaclor
27
Only 3rd Gen Ceph that cannot cross the BBB:
Cefoperazone
28
Only 3rd Gen Ceph with activity against Gram (+):
Cefotaxime
29
Ceftriaxone is effective against:
Resistant salmonella typhi
| Gonorrhea
30
3rd Gen Ceph more active against pseudomonas:
Ceftazidime (+ cefoperazone)
31
3rd Gen Ceph with more activity against anaerobes:
Ceftizoxime (+ moxolactam)
32
Ceftriaxone and Cefotaxime are effective against:
Meningitis due to pneumococci, meningococci, h. influenza
33
For neutropenic, febrile, immunocompromised patient:
Ceftazidime+ antibiotic
34
4th Gen Cephalosporin:
Cefepime
35
Aztreonam is only active against:
Gram (-) rods (including pseudomonas)
36
Absorption of aztreonam:
IV only, not absorbed orally
37
Advantages of Aztreonam:
Not nephrotoxic
"cidal" under anaerobic conditions
No PCN cross allergenicity
38
Carbapenem only active against intracellular bacteria:
Imipenem
39
This carbapenem is more often used and is more active against:
Meropenem; Enterobacteria and p. aeruginosa
40
Carbapenems bind to these PBPs preferentially, leading to rapid lysis:
PBP-1 "steady"
| PBP-2 "moving"
41
Imipenem is combined with this drug to increase it's half-life:
Cilastatin (inhibitor of renal dihydropeptidase)
42
Beta-lactamase inhibitors:
Clavulanic Acid
Sulbactam
Tazobactam
43
Lack of ____ in neonates leads to this adverse reaction:
hepatic glucoronosyltransferase (glucoronic acid); Gray baby syndrome
44
Dose dependent adverse reaction to chloramphenicol:
Aplastic anemia
45
Chloramphenicols are an alternate drug for ____ and ineffective against ____.
Pneumonia; chlamydia
46
Chloramphenicols have an antagonistic effect with:
Aminoglycosides and Penicillins (-cidal drugs)
47
Lincosamides inhibit protein synthesis by binding to:
23s portion of 50s subunit
48
Lincosamides are active against ___, except for:
Gram (+) cocci, anaerobes;
| Not active against: Staph, strep, enterococcus
49
Drug associated with pseudomembranous colitis:
Clindamycin
50
Excretion of lincosamides:
Biliary and renal
51
Lincosamides have good penetration in ___, but not in:
Bone, fibrous CT, alveolar macrophages;
| no penetration in CNS
52
Clinical uses for Lincosamides:
```
Acne
Osteomylitis
Pneumocystis carinii
Toxoplasmosis gondii
Prophylaxis for valvular diseases
```
53
DOC against clostridium dificile:
Metronidazole (also amoeba organisms)
54
Spectrum of Macrolides:
Gram (+) aerobes
Some gram (-) aerobes (DOC for legionella)
Atypicals
55
Macrolide excreted in bile and feces:
Erythromycin (renal failure no problem)
56
Macrolide excreted in liver and kidneys:
Clarithromycin
57
Macrolide excreted slowly in urine, unchanged:
Azithromycin
58
Macrolide with high distribution in tissues and phagocytes vs. plasma:
Azithromycin
59
This drug is used in treatment of gastroparesis by binding to:
Erythromycin; motilin receptors
60
This macrolide is CI in pregnant women due to risk of ___.
Erythromycin estolate; acute cholestatic hepatitis
61
Absorption of erythromycin is mainly in the:
Duodenum (impeded by food)
62
Best absorbed erythromycin:
estolate salt
63
Erythromycin and CYP3A inhibitors increase the risk of:
Cardiac arrhythmia
64
Co-administration of these drugs with erythromycin should be avoided by those with heart abnormalities:
Diltiazem or verapamil
65
Reasons for telithromycin (ketolide) effectiveness against resistant strains:
Poor substrate for efflux pump
| Higher affinity for ribosomes
66
MOA of polymixin:
Disrupt bacterial cell membranes
| Bind and activate endotoxin
67
Adverse effects of polymixin:
Substantial nephrotoxicity
Substantial neurotoxicity
(no longer used systematically)
68
First oral anti-pseudomonal drug:
Quinolones
69
MOA of Quinolones?
Inhibit DNA gyrase (topo II and topo IV)
70
Quinolones more active against p.aeruginosa:
Ciproflaxin
71
Quinolones active against staphylococci:
Fluoroquinolones
72
Quinolones active against streptococci:
Levofloxacin and Moxifloxacin
73
Inhibitors of folic acid synthesis:
Sulfonamides (dihydropteroate synthetase)
| Diaminopyrimidines (dihydrofolate reductase)
74
Tetracyclines have excellent activity against:
Mycoplasma pneumonia
| Chlamydia trachomatis
75
Tetracyclines have good activity against:
Gram (+), e. coli, klebsiella
76
Tetracyclines have minimal activity against:
anaerobes
77
Primary indications of tetracycline:
```
Mycoplasma
Chlamydia
Rickettsia
Vibrios
Borrelia
```
78
Secondary indications of tetracyclines:
Syphilis
Respiratory infection
Leptospirosis
acne
79
Most tetracyclines are excreted ___, except for:
Renally; Doxycycline (liver)
80
Tetracylcine affinity for ____ is responsible for it's effect of:
Chelators (calcium, iron, aluminum); enamel dysplasia (mottling of teeth)
81
Adverse reactions of tetracycline:
Hepatotoxicity
Nephrotoxicity (Fanconi like syndrome)
Photosensitivity
Vestibular toxicity
82
Vancomycin is a ___ and so does not cross the BBB:
Glycopeptide
83
Red man syndrome is associated with:
Type I hypersensitivity caused by Vancomycin
84
2 streptogamins in a ____ ratio that interact ___:
Dalfopristin (Streptogamin A) and Quinipristin (Streptogamin B); 70:30 ratio; synergystically
85
Excretion of vancomycin is completely:
Renal (problem in renal patients)
86
Resistance to streptogamins is due to modification of the ___ site:
quinipristin
87
Spectrum of streptogamins:
Gram (+) cocci (including drug resistant)
88
Oxazolidinones have a unique __ binding site:
23s
89
Oxazolidinones are primarily static, but bactericidal for:
Streptococci
90
Most common adverse reaction to oxazolidinones:
Thrombocytopenia
91
Inhibits very early stage of bacterial wall synthesis:
Fosfomycin
92
These drugs act only in the urinary bladder, not systemically:
```
Nitrofurantoin (except p. aeruginosa & proteus)
Methenamine hippurate (except proteus)
Phenazopyridine (analgesic only)
```
93
MOA of daptomycin:
Disruption of cytoplasmic membrane
94
Daptomycin is effective against ___ but not against ___.
Staphylococcus; respiratory infections
95
Bacteriostatic activity against MRSA:
Tigecycline
