Antibiotics

Question 1

Sub-classes of Beta lactams

Answer 1

1. Penicillins,
2. Cephalosporins,
   3.Carbapenems,
3. Monobactams

Question 2

Penicillins: Sub-classes & Coverage

Answer 2

1.NATURAL PENICILLINS: PENICILLIN G,(Benzylpenicillin)
PENICILLIN V (Phenoxymethylpenicillin)

(NARROW-SPECTRUM, GRAM-POSITIVE)

Question 3

PENICILLIN G administration

Answer 3

Penicillin G - administered intravenously or intramuscularly due to its instability in the stomach

Question 4

Penicillin V - administration

Answer 4

Penicillin V - orally as it is more stable in acidic environments.

Question 5

Beta-lactams- aminopenicillins

Answer 5

AMOXICILLIN, AMPICILLIN (EXTENDED-SPECTRUM, SOME GRAM-
NEGATIVE)

Question 6

Beta-lactams- Penicillinase resistant

Answer 6

OXACILLIN, NAFCILLIN (RESISTANT TO BETA-LACTAMASE ENZYMES

Question 7

Beta-lactams- EXTENDED-SPECTRUM PENICILLINS

Answer 7

EXTENDED-SPECTRUM PENICILLINS: PIPERACILLIN
(ENHANCED GRAM-NEGATIVE, PSEUDOMONAS)

Question 8

The main subgroups of Beta-lactams are

Answer 8

4

Question 9

Cephalosporins generations

Answer 9

1st Gen: Cephalexin (Gram-positive, some Gram-negative)
2nd Gen: Cefuroxime (expanded Gram-negative)
3rd Gen: Ceftriaxone (broad Gram-negative, better CNS penetration)
4th Gen: Cefepime (Pseudomonas)
5th Gen: Ceftaroline (MRSA coverage)

Question 10

5th Gen cephalosporins coverage

Answer 10

Ceftaroline (MRSA coverage)

Question 11

3rd gen coverage

Answer 11

3rd Gen: Ceftriaxone (broad Gram-negative, better CNS penetration)

Question 12

Glycopeptide coverage

Answer 12

Spectrum: Gram-positive, including MRSA and C. difficile

Question 13

Aminoglycosides moa

Answer 13

INHIBIT PROTEIN SYNTHESIS BY BINDING TO THE 30S RIBOSOMAL SUBUNIT

Question 14

Egs of Aminoglycosides

Answer 14

GENTAMICIN,
AMIKACIN,
TOBRAMYCIN

Question 15

SPECTRUM of Aminoglycosides

Answer 15

GRAM-NEGATIVE,
ESPECIALLY PSEUDOMONAS

Question 16

Aminoglycosides pharmacology

Answer 16

CONCENTRATION-DEPENDENT KILLING, SYNERGISTIC WITH BETA-
LACTAMS

Question 17

Macrolides MOA

Answer 17

INHIBIT PROTEIN SYNTHESIS BY BINDING TO THE 50S RIBOSOMAL SUBUNIT

Question 18

Coverage of Macrolides

Answer 18

GRAM-POSITIVE,
ATYPICAL BACTERIA (E.G.,
MYCOPLASMA, CHLAMYDIA)

Question 19

Macrolides egs

Answer 19

ERYTHROMYCIN,
AZITHROMYCIN,
CLARITHROMYCIN

Question 20

Tetracycline moa

Answer 20

Inhibit protein synthesis (bind to the 30S ribosomal subunit)

Question 21

Egs of Tetracyclines

Answer 21

Doxycycline, Tetracycline, Minocycline

Question 22

Fluroquinolones moa

Answer 22

Inhibit DNA gyrase and topoisomerase IV

Question 23

First generation Fluroquinolones, example and coverage

Answer 23

Nalidixic Acid : • Limited to Gram-negative bacteria

uncomplicated urinary tract infections (UTIs)

Question 24

2nd generation Fluroquinolones, example and coverage

Answer 24

Ciprofloxacin,
Ofloxacin

Coverage •Broad Gram-negative, including Pseudomonas; limited Gram-positive and atypical coverage

Question 25

3rd generation Fluroquinolones, example and coverage

Answer 25

Example: Levofloxacin Enhanced Gram-positive (including Streptococcus pneumoniae), moderate Gram-negative, atypicals

Question 26

4th generation Fluroquinolones

Answer 26

Example: Moxifloxacin Gram-positive (including Streptococcus pneumoniae), anaerobes, atypicals; weaker Gram-negative bacterial conjunctivitis

Question 27

Best uses of Ciprofloxacin

Answer 27

UTIs, GI infections, anthrax, bone/joint infections

Question 28

Best use of Levofloxacin

Answer 28

Community-acquired pneumonia, skin infections, UTIs

Question 29

Side effects of Fluroquinolones

Answer 29

Tendonitis and tendon rupture (Black Box Warning) mostly in children • QT prolongation (risk of arrhythmias, especially with Moxifloxacin) • CNS effects: Confusion, hallucinations (more common in elderly) • Phototoxicity

Question 30

Aminoglycosides SE

Answer 30

1. Nephrotoxicity (dose-dependent), ototoxicity (hearing loss, tinnitus, vertigo) Neuromuscular blockade (in patients with pre-existing muscle conditions or when combined with certain anesthetics) serious

Question 31

Common SE of vancomycin

Answer 31

Red man syndrome (flushing due to rapid infusion), nephrotoxicity

Question 32

Metronidazole SE

Answer 32

Peripheral neuropathy (with prolonged use), seizures Disulfiram-like reaction when taken with alcohol (flushing, vomiting, headache)

Question 33

Sodium Nitroprusside moa

Answer 33

Dilates bot venous and arterial vessels

Question 34

Hydralazine moa

Answer 34

Direct vasodilator at the arterial smoth muscles reducing total peripheral resistance

Question 35

Hydralazine is CI in ? Why?

Answer 35

CAD, because the reflexes tachycardia causes an increase in myocardial oxygen demand worsening ischemia