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Pharm Sci Test 3 > Antibiotics > Flashcards

Antibiotics Flashcards

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1
Q

[SATA] Which of the following agents inhibit synthesis or disrupt the bacterial cell wall?
A. Monobactams
B. Cycloserine
C. Vancomycin

A

A, B, C

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2
Q 
Which of the following are beta lactic antibiotics?
A. penicillins
B. monobactams
C. 
D. cephalosporins
E.
F. carbapenems
A

A, B, D, F

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3
Q

___________ Inhibits bacterial cell wall synthesis by binding to the penicillin binding proteins (PBP), which inhibits transpeptidation of the cell wall and activates autolysins, causing cell lysis.

A

Penicillins

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4
Q

Are penicillins bactericidal or bacteriostatic?

A

bactericidal

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5
Q

Are penicillins time dependent of concentration dependent killing agents?

A

time dependent

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6
Q

What are two ways bacteria can become resistant to penicillins?

A
  • Destruction of beta-lactam ring by bacterial enzymes

* Inability to reach target PBPs

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7
Q

What are the 4 classes of penicillins?

A
  1. Natural
  2. Penicillinase resistant
  3. Amino-penicillins
  4. Extended spectrum
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8
Q

Name the 2 natural penicillins?

A
  1. Penicillin G

2. Penicillin V

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9
Q

Natural Penicillins are primarily Gram + or Gram - spectrum?

A

Gram +

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10
Q

__________ penicillins are degraded by acid and enzymes in stomach and therefore are not given orally

A

Natural

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11
Q 
Which of the following are penicillinase resistant penicillins?
A. Nafcillin
B. Ampicillin
C. Oxacillin
D. Dicloxacillin
E. Amoxicillin
A

A, C, D

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12
Q

What are 3 drugs that treat C diff?

A

Metronidazole
Oral Vancomycin
Fidaxomicin

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13
Q

List some complications of antibiotic therapy.

A 
Mild GI disturbances
Overgrowth of opportunistic infection
Decreased efficacy of oral contraceptives
increased bleeding
antifungal or yeast infection 
C. diff
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14
Q

Which type of allergic reaction is T-cell mediated?

A

Type IV–delayed allergic reaction

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15
Q

Which type of allergic reaction is immune complex-mediated?

A

Type III allergic reaction

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16
Q

Which allergic reaction usually starts 5-21 days after initial drug exposure?

A

Type III allergic reaction

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17
Q

Which allergic reaction usually starts 2-7 days after initial drug exposure?

A

Type IV–delayed allergic reaction

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18
Q

What is the MOA of Bactrim?

A

Sulfonamide is a structural analog and competitive antagonist of PABA for bacterial synthesis of folic acid. Trimethoprim looks like dihydrofolic acid and competitively inhibits microbial dihydrofolate reductase (Bacteriostatic)

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19
Q

an antiprotozoal drug that treats gram negative anaerobic bacteria by entering cells which contain nitroreductase, where its nitro group is reduced into an unstable intermediate that bind to DNA and inhibits its synthesis causing cell death (bactericidal)

A

Metronidazole

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20
Q

What does Cimetidine do to metronidazole?

A

increases metronidazole’s levels

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21
Q

Spectrum of Natural penicillins?

A

Gram positive

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22
Q

Spectrum of penicillinase resistant?

A

Gram positive

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23
Q

Spectrum of Amino-penicillins?

A

GRAM POSITIVE & modest gram negative spectrum

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24
Q

Spectrum of extended-spectrum penicillins?

A

GRAM POSITIVE + Increased activity against GRAM NEGATIVE pseudomonas and proteus

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25
Spectrum of First generation cephalosporins?
GRAM POSITIVE & modest gram negative spectrum (similar to amino-penicillins)
26
Spectrum of Second generation cephalosporins?
GRAM POSITIVE activity & increased activity against GRAM NEGATIVE (similar to amino-penicillins + ß-lactamase inhibitors)
27
Spectrum of Third generation cephalosporins?
GRAM POSITIVE + Increased activity against GRAM NEGATIVE pseudomonas and proteus
28
Spectrum of Fourth generation cephalosporins?
GRAM POSITIVE + Increased activity against GRAM NEGATIVE pseudomonas and proteus (like 3rd gen)
29
Spectrum of Fifth generation cephalosporins?
GRAM POSITIVE + Increased activity against GRAM NEGATIVE pseudomonas and proteus (like 3rd gen)
30
Which antibacterial inhibits bacterial cell wall synthesis by binding to penicillin binding proteins (PBP), which inhibits transpeptidation of the cell wall and activates autolysins causing cell lysis?
Penicillins & cephalosporins:
31
Which antibacterial inhibits the 2nd stage of bacterial cell wall synthesis by binding to the D-alanyl D-alanine portion of the precursor. Also alters membrane permeability & RNA synthesis (bactericidal)?
Vancomycin
32
Which antibacterial inhibits cell wall synthesis like Vancomycin (synthetic derivative of vanc) (bactericidal)?
Lipoglycopeptides
33
Which antibacterial inhibits bacterial cell wall synthesis, leading to cell lysis and death (bactericidal)
Bacitracin
34
Which antibacterial suggested that it inhibits synthesis of mycolic acid, a component of mycobacterial cell wall (bactericidal)?
Isoniazid
35
Which antibacterial inhibits cell wall synthesis by acting like an alanine analog and interferes with 2 steps in peptidoglycan synthesis (causes competitive inhibition but not complete cell wall inhibition) (bacteriostatic)?
Cycloserine
36
binds to bacterial cell membrane which disrupts membrane structure and increases permeability (bactericidal)
Polymixin B & Colistimethate
37
binds to bacterial membranes and causes a rapid depolarization of membrane potential. The loss of membrane potential leads to inhibition of protein, DNA, and RNA synthesis, which results in bacterial cell death (makes cell “leaky”) (bactericidal)
Daptomycin (Cubicin)
38
Bacteria reduces the drug into an intermediate which inhibits bacterial process (bacteriostatic)
Nitrofurantoin
39
Which drugs bind 50S ribosomal subunit and alter protein synthesis?
``` Chloramphenicol Macrolide Antibiotics (Erythromycin, Clarithromycin, Azithromycin, Fidaxomicin) Ketolide (Telithromycin (Ketek)) Lincosamides (Lincomycin, Clindamycin) Oxalodinones (Linezolid, Tedezolid) Streptogramins (Quinupristin/dalfopristin (Synercid)) ```
40
Which drugs bind 30S ribosomal subunit and alter protein synthesis?
Tetracyclines Glycylcyclines Aminoglycosides
41
What are the agents that affect nucleic acid metabolism?
Rifamycins Quinolones Metronidazole
42
Bactericidal or bacteriostatic? | Beta-lactam Abx
Bactericidal
43
Bactericidal or bacteriostatic? | Vancomycin
Bactericidal
44
Bactericidal or bacteriostatic? | Lipoglycopeptides
Bactericidal
45
Bactericidal or bacteriostatic? | Bacitracin
Bactericidal
46
Bactericidal or bacteriostatic? | Isoniazid
Bactericidal
47
Bactericidal or bacteriostatic? | Detergents: polymyxin, colistimethate
Bactericidal
48
Bactericidal or bacteriostatic? | Lipopetides: Daptomycin
Bactericidal
49
Bactericidal or bacteriostatic? | Polyene antifungal agents: nystatin, amphotericin B
Bactericidal
50
Bactericidal or bacteriostatic? | Streptogramins: Quinupristin + dalfopristin (Synercid)
combined are cidal, separate are static
51
Bactericidal or bacteriostatic? Oxalodinones Linezolid
Bactericidal against streptococci & vanc-resistant enterococcus (VRE) Bacteriostatic against enterococci & staphylococci (including MRSA)
52
Bactericidal or bacteriostatic? | Aminoglycosides
Bactericidal
53
Bactericidal or bacteriostatic? | Metronidazole
Bactericidal
54
Bactericidal or bacteriostatic? | Cycloserine
bacteriostatic
55
Bactericidal or bacteriostatic? | Nitrofurantoin
bacteriostatic
56
Bactericidal or bacteriostatic? | Chloramphenicol
bacteriostatic
57
Bactericidal or bacteriostatic? | Macrolides
bacteriostatic
58
Bactericidal or bacteriostatic? | Lincosamides
bacteriostatic
59
Bactericidal or bacteriostatic? | Spectinomycin
bacteriostatic
60
Bactericidal or bacteriostatic? | Glycylcyclines
bacteriostatic
61
Bactericidal or bacteriostatic? | Tetracyclines
bacteriostatic
62
Bactericidal or bacteriostatic? | Streptogramins (Synercid)
bacteriostatic
63
Bactericidal or bacteriostatic? | Oxalidinones
bacteriostatic
64
Bactericidal or bacteriostatic? | Rifamycins
bacteriostatic
65
Bactericidal or bacteriostatic? | Fluoroquinolones
bacteriostatic
66
Bactericidal or bacteriostatic? | Sulfonamide-Trimethoprim (Bactrim, Septra)
bacteriostatic
67
6. Know the basic mechanism of beta-lactam allergy and the classes of antibiotics to which a patient would potentially be cross-allergic.
The ß-lactam "allergy” is IgE mediated or an immediate-type reaction that includes anaphylaxis, angioedema, skin rashes or hives, or bronchospasm. These IgE mediated reactions occur within minutes after drug administration but can also be delayed up to 72 hours.
68
Identify the 3 beta-lactamase inhibitors
1. Clavulanic Acid: 2. Sulbactam 3. Tazobactam
69
MOA of Clavulanic Acid?
MOA: inhibits the ß-lactamase enzyme by irreversibly binding to a serine residue in the active site and allowing the ß-lactam antibiotic to attack the peptidoglycan cell wall in order to destroy the bacterial cell Active against GRAM POSITIVE and GRAM NEGATIVE beta-lactamases
70
MOA of Sulbactam?
MOA: irreversible inhibitor of ß-lactamase, preventing it from degrading the antibiotic
71
MOA of Tazobactam?
MOA: Binds plasmid & chromosomally mediated enzymes and prevent them from degrading the antibiotic Most potent inhibitor of GRAM NEGATIVE beta-lactamases Most broad spectrum ß-lactamase inhibitor (works very well in treating GRAM NEGATIVE bacteria)
72
Identify the beta-lactamase inhibitor currently contained in an oral antibiotic product and the antibiotic it is combined with.
Clavulanic Acid: Amoxicillin + Clav = Augmentin Ticarcillin + Clav = Timentin *Adverse effects: GI upset (take with food)
73
10. Describe the mechanisms of antibiotic resistance for beta-lactam antibiotics.
Resistance can occur due to: 1. Destruction of ß-lactam ring by bacterial enzymes (ß-lactamases) 2. Inability to reach target PBPs
74
Explain why some antibiotics which are bacteriostatic based upon the mechanism of action, are sometimes described as bactericidal.
Aminoglycosides work by binding to the 30S ribosomal subunit and inhibit protein synthesis, causing premature termination of protein synthesis and producing abnormal proteins. They are considered Bactericidal because they are so efficacious even though MOA leans toward being bacteriostatic.
75
If stated on slides or in class, know which antibiotic classes or antibiotics demonstrate time-dependent or concentration dependent killing.
Time-dependent Killing • Penicillins • Cephalosporins Concentration-dependent Killing • Aminoglycosides • Telavancin
76
What antibiotics are basic?
Chloramphenicol, Macrolide Antibiotics
77
Which antibiotic is lipophilic?
Chloramphenicol is lipophilic and crosses BBB, placenta and breast milk.
78
What are 6 classes of drug therapy that inhibit enzymes?
``` Isoniazid Chloramphenicol Macrolides Minocycline Fluoroquinolones Metronidazole ```
79
Is clarithromycin reversible or irreversible enzyme inhibitor?
irreversible, noncompetitive
80
Which macrolide is not an enzyme inhibitor?
Azithromycin
81
Know which antibiotics are enzyme inducers and describe the effect on other drug therapy.
Isoniazid (induces 2E1) | Rifamycins (induces 3A, 2C8, 2C9)
82
Spectrum of activity of Monobactams?
Resistant to ß-lactamases produced by GRAM NEGATIVE bacteria
83
Spectrum of activity of Carbapenems?
Broad spectrum: GRAM POSITIVE & GRAM NEGATIVE
84
Spectrum of activity of Vancomycin?
GRAM POSITIVE (MRSA)
85
Spectrum of activity of Lipoglycopeptides?
GRAM POSITIVE (MSSA, MRSA, VSE)
86
Spectrum of activity of Bacitracin?
GRAM POSITIVE
87
Spectrum of activity of Cycloserine?
GRAM POSITIVE & GRAM NEGATIVE and mycobacterium
88
Spectrum of activity of Isoniazid?
narrow spectrum, mycobacterium tuberculosis
89
Spectrum of activity of polymyxin B?
GRAM NEGATIVE (except proteus)
90
Spectrum of activity of Colistimethate?
GRAM NEGATIVE
91
Spectrum of activity of daptomycin?
treats systemic & life-threatening infections caused by GRAM POSITIVE bacteria
92
Spectrum of activity of Nitrofurantoin?
some GRAM POSITIVE (ex. S. aureus) & GRAM NEGATIVE (ex. E. coli)
93
Spectrum of activity of Chloramphenicol?
Broad spectrum, GRAM POSITIVE and negative anaerobes, rickettsiae, chlamydiae, mycoplasms and treponemes Generally reserved for atypical infections
94
Spectrum of activity of Macrolides?
All: GRAM positive & Negative AEROBES (H. influenza) Erythromycin: Atypical bacteria (legionella pneumophilia) also
95
Spectrum of activity of Ketolides?
Telithromycin: GRAM POSITIVE & Gram Negative & Atypicals
96
Spectrum of activity of Lincosamides?
GRAM POSITIVE aerobes & Most anaerobes → Gram (+) & (-)
97
Spectrum of activity of Oxalodinones?
Linezolid: Primarily GRAM POSITIVE, NO gram negative activity Tedezolid: GRAM POSITIVE spectrum of activity (MRSA & MSSA)
98
Spectrum of activity of Streptogramins?
GRAM POSITIVE spectrum (MRSA, pen-resistant streptococcus pneumonia, some VRE)
99
Spectrum of activity of tetracyclines?
Broad-spectrum (does not cross BBB → treats many atypical infections)
100
Spectrum of activity of glycylcyclines?
broad spectrum of activity against GRAM NEGATIVE and GRAM POSITIVE bacteria, but are more potent against bacteria that is resistance to tetracyclines. Glycylcycline antibiotics are active against resistant organisms such as methicillin resistant staphylcocci (MRSA), penicillin-resistant streptococcus pneumoniae and vancomycin resistant enterococci (VRE). (drugs.com)
101
Spectrum of activity of aminoglycosides?
GRAM NEGATIVE activity
102
Spectrum of activity of rifamycins?
Broad spectrum against GRAM POSITIVE and GRAM NEGATIVE bacteria, but is mainly used against Mycobacterium sp. (especially M. tuberculosis)
103
Spectrum of activity of quinolones?
Treat GRAM NEGATIVE bacteria
104
Spectrum of activity of metronidazole?
Active against gram negative anaerobes and protozoa
105
Spectrum of activity of bactrim?
Spectrum of activity includes many GRAM POSITIVE and GRAM NEGATIVE aerobic bacteria and some protozoa
106
Know the antibiotics effective against MRSA.
MRSA: a problematic Gram Positive bacterium • 5th generation cephalosporins • Vancomycin • Lipoglycopeptides o Telavancin • Oxazolidinones o Linezolid (Zyvox) (only bacteriostatic against MRSA) o Tedezolid • Streptogramins o Quinupristin/dalfopristin (Synercid) • Glycylcycline (Tigecycline (Tygacil))
107
Know the antibiotics effective against MDR or pen-resistant Streptococcus pneumonia.
Ketolide Telithromycin (Ketek) Treats: MDR Streptococcus pneumonia, which produce methylase Streptogramins Quinupristin/dalfopristin (Synercid) Treats pen-resistant streptococcus pneumonia Glycylcycline Tigecycline (Tygacil) Treats penicillin-resistant streptococcus pneumonia
108
22. Know the antibiotics effective against VRE.
Streptogramins Quinupristin/dalfopristin (Synercid) Treats VRE Oxazolidinones Linezolid Bactericidal against streptococci & vanc-resistant enterococcus (VRE) Mainly treats VRE Glycylcycline Tigecycline (Tygacil) Treats VRE
109
24. Know which antibiotic classes or antibiotics are the primary alternatives for patients with penicillin allergies based upon the desired spectrum of activity.
Macrolide Antibiotics Erythromycin, Clarithromycin, Azithromycin, Fidaxomicin •Used in penicillin allergic pts in place of amino-penicillins
110
23. Know the antibiotics used as first-line treatment of TB
Isoniazid: treats mycobacterium TB Rifamycins: rifampin Cycloserine For TB resistant to 1st line drugs
111
What is neurotoxicity?
when a substance alters the normal activity of the nervous system in a way that caused damage to nervous tissue
112
What are the physical symptoms of neurotoxicity?
Physical Symptoms: weakness, incoordination, paralysis, rigidity, tremor/spasm
113
What are the sensory/cognitive symptoms of neurotoxicity?
vertigo/dizziness, decrease in alertness, processing speed concentration, visual perception, and executive functions
114
What are the behavioral symptoms of neurotoxicity?
anxiety, depression, anger, tension, fatigue, irritability
115
What antibiotics are neurotoxic?
``` carbapenems cycloserine detergents: polymyxin B & colistimethate Aminoglycosides Fluoroquinolones ```
116
What antibiotics are nephrotoxic?
Vancomycin Bacitracin detergents: polymyxin B & colistimethate Aminoglycosides
117
What antibiotics are hepatotoxic?
Isoniazid Cycloserine Ketolide: telithromycin (Ketek) Rifamycins
118
What antibiotics are ototoxic?
vancomycin | aminoglycosides
119
27. Describe why certain antibiotics are only used topically.
Toxic when used systemically
120
28. Describe the drug interaction of daptomycin and HMG-CoA Reductase Inhibitors.
Daptomycin causes neuropathy & myopathy. When given with statins it has additive effects and causes a higher risk of myopathy or rhabdomyolysis.
121
29. Describe the metabolic pathway for chloramphenicol that places patients at risk for Gray syndrome and why infants and other patients develop it.
In pt unable to glucuronidate drugs (or in pt with insufficient renal clearance), chloramphenicol can build up to toxic levels in the body and pt can develop a gray looking skin, hypotension, cyanosis, and CV collapse
122
LO 30
. . . .
123
31. Identify the importance of peak and trough concentrations in aminoglycoside therapy.
* aminoglycosides are nephrotoxicity, neurotoxicity, immediate ototoxicity (deafness --- while on therapy), and latent ototoxicity (presents as dizziness) * toxicity in aminoglycoside therapy has been associated with high trough concentrations not just peak concentrations that exceed the minimum toxic concentration (MTC)
124
32. Describe the interaction of aminoglycosides with beta-lactam antibiotics.
* aminoglycoside abx are degraded in the prescence of ß-lactam abx (physical incompatibility) * in the body however ß-lactam and aminoglycosides have a synergistic effect
125
33. Describe the effect of rifampin on body fluids.
rifampin causes discoloration of body fluids (including urine and stool), both turn red/orange/brown color similar to if there was blood in urine or stool
126
34. Identify the drugs that form chelates and the chelating agents.
``` tetracyclines: • di- or trivalent cations • antacids • mineral supplements (Ca2+, Fe, Mg2+) • dairy • sucralfate (Carafate) • may stain teeth in children ``` quinolones (fluroquinolone --- only ones left on market): • di- or trivalent cations
127
35. Describe the impact of chelation on drug therapy.
Usually just decreases the amount of drug absorbed (can have serious resulting complications)
128
36. Identify the drugs, which are photosensitizing and phototoxic.
* Tetracyclines (Doxy-, Mino, Demeclocycline, Tetracycline): photosensitivity * Quinolones: cause phototoxicity (carcinogenic)
129
37. Describe the effect of fluoroquinolones on tendons and the concern with regard to certain patient populations.
fluroquinolones are associated with an increased risk of tendinitis and tendon rupture patients at higher risk: >60yo, kidney/heart/lung transplant pt, concomitant steroid tx
130
38. Identify antibiotics associated with infusion reactions and describe methods to reduce the reaction.
• Vancomycin: histamine release at site causes infusion site rxn (rash, flushing tachycardia, hypotension) Solution: infuse no more than 1g/h • Streptogramins (pain/inflammation/thrombophlebitis) --- injection rxn
131
39. Identity antibiotics requiring long infusion times.
Vancomycin (no more than 1 g in one hour) Glycylcycline (30-60 min infusion time) Fluoroquinolones (60-90 min infusion)
132
40. Describe the mechanism of sulfonamide allergy and the classes of drugs to which a patient would potentially be cross-allergic.
Sulfamethoxazole-Trimethoprim (Bactrim, Septra)
133
41. Describe the interaction of metronidazole and ethanol.
Disulfuram prevents people from drinking alcohol b/c of side effects like a pounding headache, nausea, vomiting and GI upset that makes people feel so bad, they don’t want to drink again. Metronidazole has this same reaction with alcohol so counsel pts not to drink alcohol or use mouthwash or other products with alcohol in it while on metronidazole and 48 hours after the last dose.
134
42. Identify antibiotics that prolong the QT interval and the consequence of that prolongation.
Macrolides (Fidaxomicin, Azithromycin, Clarithromycin, Erythromycin) Ketolide (Telithromycin (Ketek)) Streptogramins
135
LO 43
. . .
136
LO 44
. . .

Pharm Sci Test 3 (4 decks)

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