Antibiotics

Question 1

Cell Wall Antibiotics

Answer 1

Beta Lactams

Glycopeptics

Question 2

Protein Synthesis Inhibitors

Answer 2

30S
Tetracycline, Doxocyclin
Aminoglycosides (Tobramycin, Amikacin, Gentamycin)
50S
Clindamycin
Macrolides (Azithromycin, Clarithromycin, Erythromycin)
Linezolid

Question 3

Nucleic Acid Inhibitors

Answer 3

Flouroquinolones

Metronidazole (DNA Damage)

Question 4

Anti-Metabolites

Answer 4

Sulfonamides

Question 5

Anti Tuberculosis

Answer 5

Isoniazid
Rifampin
Pyrazinamide

Question 6

Beta Lactam Category

Answer 6

penicillins
cephalosporins
carbapenems
monobactams

Question 7

Beta Lactam Mechanism

Answer 7

Inhibition of bacterial cell wall synthesis by acylating transpeptidases

Mechanism of Resistance: B-lactamase inhibitors

Question 8

Side Effects of Beta Lactams

Answer 8

Generally well tolerated unless patient is hypersensitive/allergic and then can lead to rashes, fever and other bad things

Question 9

Glycopeptics

Answer 9

VANCOMYCIN
MOA:
- Only effects gram + bacteria
- Inhibits cell wall synthesis (binds D-Ala-D-Ala terminus of pentapeptide

Question 10

Resistance to Glycopeptics

Answer 10

Substrate modification (D-ala-D-ala to D-ala-D-lactate) through VanA transposon

Question 11

Side Effects of Glycopeptics

Answer 11

10% of all cases
MINOR:
-  Tissue irritation, chills, fever
MAJOR:
-  Ototoxicity and Nephrotoxicity

Question 12

Tetracyclines include …

Answer 12

Includes:

• Tetracycline
• Doxocyclin
• Tigecycline

Question 13

Tetracyclines work by …

Answer 13

inhibiting protein synthesis. Bind irreversibly to the 30S subunit of the bacterial ribosome. Blocks the aminoacyl-tRNA to acceptor site on mRNA-ribosome complex

Question 14

Tetracyclines resistance

Answer 14

Impaired influx or increased efflux by active transport protein
Ribosome protection via interfering proteins

Question 15

Tetracyclines side effects

Answer 15

GI - nausea, vomiting, diarrhea
Bony structures - can be deposited in bones of growing fetus
Renal Tubular Acidosis
Hepatic function impairment in patients with hepatic issues

Question 16

Aminoglycosides include …

Answer 16

Tobramycin
Amikacin
Gentamycin

Question 17

Aminoglycosides work by …

Answer 17

Irreversibly inhibiting protein synthesis by binding the 30S. Interfers with the initiation complex, misreading of mRNA, breaks up polysome into nonfunctional monosomes

Question 18

Aminoglycosides resistance

Answer 18

• production of transferase enzyme (inactivates Aminoglycosides)
• Impaired entry (porin protein mutation)
• Receptor protein on 30S is deleted or altered

Question 19

Aminoglycosides side effects

Answer 19

Increase when drug is taken for more than 5 days!
OTOTOXICITY
NEPHROTOXICITY
RESPIRATORY PARALYSIS

Question 20

Macrolides include …

Answer 20

Erthromycin
Clarithromycin
Azithromycin

Question 21

Macrolides works by …

Answer 21

Inihibtion of protein synthesis by binding the 50S subunit (blocks exit channel)

Most effective against gram positive bacteria

Question 22

Macrolides resistance

Answer 22

• Reduced permeability
• Production of Esterases that hydrolyze macrolides
• Ribosomal protection via inhibitory proteins

Question 23

Macrolides Side Effects

Answer 23

Anorexia, nausea, vomiting, diarrhea

Erythromycin –> Acute cholestatic hepatitis and inhibits cytochrome p450

Question 24

Linezolid works by …

Answer 24

preventing bacterial protein synthesis by binding to 23S ribosomal RNA of the 50S subunit. Bacteriostatic

Question 25

Linezolid resistance

Answer 25

primarily due to efflux pumps

Question 26

Linezolid side effects

Answer 26

Hematogenic - duration-dependent bone marrow suppression, neuropathy, and optic neuritis Serotonin Syndrome

Question 27

Flouroquinolones include ...

Answer 27

Ciprofaxin, levofloaxin, moxifloaxin

Question 28

Flouroquinolones works on ..

Answer 28

both gram positive and negative

Question 29

Flouroquinolones works by ...

Answer 29

Inhibiting topoisomerase II (DNA gyrase) and topoisomerase IV Interferes with transcription (II), translation (II), and chromosome segregation during mitosis (IV)

Question 30

Flouroquinolone resistance

Answer 30

Target Modification Target production Drug Modification

Question 31

Flouroquinolone side effects

Answer 31

Generally well tolerated Contraindicated for patients with QTc interval prolongation May damage cartilage (not usually recommended <18) Tendonitis

Question 32

Metronidazole used for ...

Answer 32

ANAEROBIC bacteria!!! C. Diff colitis

Question 33

Metronidazole works by ...

Answer 33

Disturbing ETC, reduced by ferredoxin, results in products that are toxic to anaerobic cells

Question 34

Sulfonamides

Answer 34

usually combined with inhibitor of dihydrofolate reductase (trimethoprim) for UTI

Question 35

Metronidazole side effects

Answer 35

Nausea, diarrhea, stomatitis, peripheral neuropathy AVOID ALCOHOL ... ADH inhibitor

Question 36

Sulfonamides work on ..

Answer 36

Gram positive and negative

Question 37

Sulfonamides work by ..

Answer 37

antifolate, many bacteria cannot use exogenous folate, must synthesize it from PABA and Sulfonamidesare PABA analogs

Question 38

Sulfonamide Resistance

Answer 38

- Overproduction of PABA - Production of different enzymes w/ low Sulfonamide affinity - Impair permeability

Question 39

Sulfonamide Side Effects

Answer 39

Megablastic Anemia, Leukopenia, Granulocytopenia Nausea, Vomiting , Fever Vasculitis, renal damage, CNS disturbance

Question 40

Isoniazid

Answer 40

Most active drug for TB treatment

Question 41

Isoniazid works by ...

Answer 41

- Inhibits my colic acid synthesis, an essential component of the cell wall - Forms covalent bond with acyl carrier protein

Question 42

Isoniazid resistance

Answer 42

Caused by over expression of inna gene, which encodes an NADH-dependent acyl carrier protein reductase *Occurs often so a combination therapy is required

Question 43

Isoniazid side effects

Answer 43

``` Hepatotoxic - may cause hepatitis. Peripheral Neuropathy (give pyridoxine to prevent) ```

Question 44

Rifampin

Answer 44

Used in conjunction with isoniazid

Question 45

Rifampin works on ....

Answer 45

Both gram + and -

Question 46

Rifampin works by ...

Answer 46

Binding beta subunit of bacterial RNA polymerase. Bactericidal for mycobacteria

Question 47

Rifampin resistance

Answer 47

Point mutations in rpoB, the gene for B subunit of the RNA polymerase

Question 48

Rifampin side effects

Answer 48

- Rashes, thrombocytopenia, nephritis | Strong induction of cyto p450 and thus increases rate of elimination of drugs

Question 49

Pyrazinamide

Answer 49

Used in conjunction to isoniazid and rifampin

Question 50

Aztreonam

Answer 50

Monobactam | Gram negative rod aerobes only