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antibiotic inhibiting protein synthesis Flashcards

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1
Q

Is linezolid “-static” or “-cidial” for enterococci?

A

“-static”

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2
Q

Is linezolid “-static” or “-cidial” for strept?

A

“-cidal”

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3
Q

What is the basic structure that makes aminoglycosides part of one class?

A

Aminocyclitol ring

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4
Q

What inhibits aminoglycosides?

A

Acidic pH and anaerobic conditions

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5
Q

Besides protein synthesis inhibition, what other effects do aminoglycosides have?

A

Inhibit cell wall membrane

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6
Q

What other classes do aminoglycosides work well with?

A

Penicillin and cephalosporins

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7
Q

What are the 3 known mechanisms of resistance for aminoglycosides?

A

Modification of aminoglycoside molecule
binding of aminoglycosides on rRNA altered
reduced uptake of aminoglycosides

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8
Q

What is a way to combat resistance with aminoglycosides?

A

use with agents that target cell wall in conjunction

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9
Q

What is aminoglycoside active against?

A

Aerobic gam-negative bacilli

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10
Q

When you add cell wall inhibitors what will aminoglycosides start to work better against?

A

gram positive bacteria

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11
Q

What are aminoglycosides used for?

A

UTIs, respiratory tract, skin and soft-tissue infections

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12
Q

When do you use aminoglycosides in combination with other agents?

A

To broaden coverage in serious illness
bacteremia or sepsis
pseudomonal infections
synergism w/ vancomycin or penicillins in the treatment of endocarditis

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13
Q

When do you get more killing of bacteria for aminoglycosides?

A

Post-antibiotic effect (after high level is reached)

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14
Q

When do you use streptomycin?

A

Enterococcal infections

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15
Q

What are 3 common aminoglycosides?

A

gentamicin
tobramycin
amikacin

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16
Q

What are neomycin and kanamycin limited to?

A

Oral or topical use due to toxicity

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17
Q

What is spectiomycin used for?

A

Tx for gonorrhea in PCN allergic patients

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18
Q

What are the two toxicities to be concerned about with aminoglycosides?

A

Otoxicity

Nephrotoxicity

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19
Q

of the aminoglycoside class, what is the most ototoxic drug?

A

Streptomycin

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20
Q

In a patient with Parkinson’s or myasthenia gravis, what can happen when they are put on aminoglycosides?

A

Aggravate muscle weakness; respiratory paralysis

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21
Q

Are hypersensitivity rxns common with aminoglycosides?

A

No (not used frequently, usually used in hospital)

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22
Q

If a patient has allergies to sulfite, what aminoglycoside should they not be given?

A

Streptomycin

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23
Q

What aminoglycoside is given to decontaminate bowel (given PO)?

A

Neomycin

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24
Q

How are aminoglycosides administered?

A

IV

widely distribute in extracellular fluid

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25
Clearance of aminoglycosides is proportional to what?
creatinine clearance
26
With vancomycin what levels do you check?
Trough levels
27
What levels do you check with aminoglycosides?
``` Peak levels (30 minutes after infusion- allow you to see highest level) trough levels ```
28
what type dosing is mostly mentioned for aminoglycosides?
"once daily" dosing
29
Who should not be given once daily dosing with amionglycosides?
renal insufficiency Cystic fibrosis spinal cord infections burn patients
30
What weight is used for aminoglycosides?
Actual body weight, adjusted for obese
31
What drugs can aminoglycosides interact with?
Loop diuretics - nephrotoxicity | Non-depoloarizing muscle relaxant- resp depression
32
What levels can neomycin (IV) affect?
Digoxin levels (alter GI flora responsible for mechanism)
33
Most aminoglycosides have what category for pregnancy?
Category D- 8th CN toxicity
34
What aminoglycosides have a Category C for pregnancy?
Gentamicin | Neomycin
35
Are aminoglycosides compatible for breastfeeding moms?
Yes
36
what are the 3 primary tetracyclines?
tetracycline doxycycline minocycline
37
what bacteria do tetracyclines cover?
gram positive gram negative aerobic anaerobes
38
What is a difficult condition that tetracyclines can kill?
Mycoplasma pneumonia
39
What drug is used for inhalation anthrax?
Doxycycline
40
What is a concern with the tetracyline class?
WIll kill off normal flora easily and concern of overgrowth of opportunistic infections.
41
WHat other conditions do tetracyclines treat?
``` Chlamydia rickettsia (RMSF) lyme's disease (borrelia burgdorferi) inflammatory acne sinusitis ```
42
Is tetracycline long or short acting?
Short acting
43
Are minocycline and doxycycline long or short acting?
long acting (better option)
44
What do tetracyclines bind?
Reversibly bind RNA
45
Are tetracyclines "-static" or "-cidal"
bacteriostatic
46
what is the most important mechanism of resistance to tetracycline?
Bacterial efflux pump
47
what are the ROA for tetracycline?
Oral parenteral ophthalmic
48
What is the most common side effect with tetracyclines?
``` GI effects (N/V/D) with oral and parenteral routes potential for C. diff/ candidiasis ```
49
Who should tetracyclines not be administered to?
Young children and pregnant moms tetracyclines binds to bony structures and teeth will get grey discoloration on teeth
50
what pregnancy category are tetracyclines?
Category D
51
what is usually the initial therapy for lyme disease?
doxycycline
52
What are some other ADRs of tetracyclines?
photosensitization | pseudotumor cerebri
53
What are some ADRs with minocycline?
Dizziness, vertigo lupus-like rxn (reversible)
54
Combination of tetracycline and what can inhibit absorption?
Dairy Antacids Mg, Iron, zinc, aluminum hydroxide
55
Where do tetracyclines distribute?
Body, including meninges
56
How are tetracyclines eliminated?
``` mostly kidneys (except doxy- hepatic) dosage adjustments may be necessary ```
57
What is a third generation TCN what has broad spectrum antimicrobial activity, including MRSA?
Tigecycline (Tyacil)
58
Why was tigecycline developed?
Overcome bacterial resistance mechanisms to TCNs (efflux and ribosomal mutations)
59
What is chloramphenicol reserved for?
Life threatening infections: typhoid fever, RMSF, and meningitis in patients allergic to PCN.
60
What is the bad side effect of chloramphenicol?
blood dyscrasias
61
Is chloramphenicol bascteriostatic or bactericidial?
Both; depending on bacteria speciesis
62
Who can't chloramphenicol be used in?
Pregnant women | Neonates
63
What types of resistance are there with chloramphenicol?
plasmid born decreased cellular permeability modification of enzymes- acetyltransferases
64
What is an example of a macrolide?
Erythromycin
65
What are some semisynthetic derviates of erythromycin? (also macrolide class)
Clarithromycin Azithromycin (both are more acid stable)
66
Are macrolides bacteriostatic or bacteriocidial?
bacteriostatic; | at high concentrations or with rapid bacterial groups become bactericidal
67
What macrolide has more anaerobic coverage?
Azithromycin
68
What macrolide has the most reistatnce?
erythromycin
69
What does erythromycin work against?
Gram (+) bacteria and spirochetes. Specific bacteria include: legionella pneumophila, N gonorrhoeae, N. menigitidis, Poor anaerobic coverage.
70
What does clarithromycin act against?
against gram (+) and anaerobic bacteria, H. influenzae, H. pylori, mycobacterium avium
71
Does erythromycin work against h. influenze?
No, but the semisynthetic deviates do?
72
Resistance to macrolides is usualuly waht?
Plasmid mediated
73
What is erythromycin base destroyed by?
Stomach acid, must be administered with enteric coated tablet
74
Where are macrolides widely distributed?
Prostate (but not to CNS)
75
how can macrolides be administered?
PO, IV, ophthalmic
76
How are erythro and azithro excreted?
Unchanged in bile
77
How is clarithromycin excreted?
Unchanged in bile and urine (May have to make renal adjustments)
78
What side effects are most common with macrlides?
Gastrointestinal
79
When can you see sholestatic jaundice?
Estolate salt form of erythromycin
80
when do you see CV issues with macrolids?
``` IV administration (QT prolongations) ```
81
What does clarithromycin have enhanced coverage of?
Atypical mycobacteria
82
compared to erythromycin, clarithyromycin has less what?
GI upset and BID dosing
83
What do you get greater of what azithromycin?
Greater tissue penetration | prolonged intracellular half-life
84
Erythro and clarithromycin inhibit what?
CYP3A4
85
Ketolides have a greater potency against what? (then macrolides)
greater potency against gram positive organisms
86
What does telithromycin have a black box warning for?
Liver failure and deaths | increased risk of ventricular arrhythmias
87
Patients with what should not take telithromycin?
myasthenia gravis
88
How is telithromycin eliminated?
hepatic metabolism with eliminiation in bile and urine
89
Talithromycin inhibits what?
P450 class
90
What is the main antibiotic associated with lincosamides?
Clindamycin
91
What does clindamycin work well for?
Strep, staph, pneumococci | anaerobes*** (except C diff)
92
How is clindamycin available?
oral, IV, topical
93
What is the most important indication for clindamycin?
Anaerobic or mixed infections | Aspiration pneumonia
94
What can clindamycin be topically used for?
inflammatory acne
95
what is the most common antibiotic to cause C. diff?
clindamycin (IV)
96
What is a bacteriostatic drug that is used to treat VRE (vanco-resistant E. faceium), complicated skin/ sturue infection by methicillin-susceptible S. aureus or S. pygoenes?
Quinupristin- Dalfopristin (synecrid)
97
Quinupristin- Dalfopristin (synecrid) has what main AE?
Muscle and joint pain
98
What does Quinupristin- Dalfopristin (synecrid) inhibit?
P450 3A4 inhibitor
99
What is a better choice for vanco-resistant E. faecium?
Linezolid
100
What else is Linezolid used for?
no socomial pneumonia due to S. aureus MRSA or S. pneumoniae skin/ sturue infection Gram + CAP
101
What is linezolid bacteriostatic against?
enetrococci and staph
102
What is linezolid bactericidal against?
strept
103
how is linezolid excreted?
Urine
104
What are concerning side effects of linezolid?
thrombocytopenia | HTN crisis if combined w/ MAOI, adrenegic and serotonergic drugs
105
What is mupirocin affective against?
gram positive cocci
106
what can you use mupriocin for?
topical treatment of skin | ex- impetigo

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