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C. Year 3: Core Drugs > Antibiotics - Tetracyclines > Flashcards

Antibiotics - Tetracyclines Flashcards

1
Q

What is transcription?

1 - copying of specific part of DNA to create mRNA
2 - converting mRNA into proteins using the ribosome
3 - adding molecules to proteins
4 - packaging proteins into vesicles

A

1 - copying of specific part of DNA to create mRNA

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2
Q

What is translation (also called protein synthesis)?

1 - copying of specific part of DNA to create mRNA
2 - converting mRNA into proteins using the ribosome
3 - adding molecules to proteins
4 - packaging proteins into vesicles

A

2 - converting mRNA into proteins using the ribosome

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3
Q

Ribosomes in prokaryotes (bacteria) is smaller in eukaryotes (human cells). Why is this important for drug development?

1 - means bacteria are limited to how they replicate
2 - drugs can inhibit mRNA
3 - drugs can be targeted against prokaryotes ribosome specifically
4 - bacterial wall production can be inhibited

A

3 - drugs can be targeted against prokaryotes ribosome specifically

  • prokaryotes - 50 and 30S = 70S
  • eukaryotes - 60 and 40S = 80S
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4
Q

Which of the following is NOT a step in translation (protein synthesis)?

1 - elongation
2 - transcription
3 - initiation
4 - termination

A

2 - transcription

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5
Q

Which of the following described initiation?

1 - codon signalling termination is recognised by P site
2 - 1st tRNA binds to P site and begins adding further tRNA
3 - 50S and 30S subunits bind to mRNA forming ribosome-mRNA complex
4 - tRNA bind to the A, P and E binding sites of ribosome

A

3 - 50S and 30S subunits bind to mRNA forming ribosome-mRNA complex

  • mRNA is the blueprint for protein synthesis
  • composed of 3 nucleotide sequences called codons
  • tRNA binds to codons with matching anti-codon sequence
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6
Q

Which of the following described elongation?

1 - codon signalling termination is recognised by P site
2 - 1st tRNA binds to P site and begins adding further tRNA at site A
3 - 50S and 30S subunits bind to mRNA forming ribosome-mRNA complex
4 - tRNA bind to the A, P and E binding sites of ribosome

A

2 - 1st tRNA binds to P site and begins adding further tRNA at site A

  • this repeats until protein is finished
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7
Q

Which of the following described termination?

1 - codon signalling termination is recognised by P site
2 - 1st tRNA binds to P site and begins adding further tRNA at site A
3 - 50S and 30S subunits bind to mRNA forming ribosome-mRNA complex
4 - tRNA bind to the A, P and E binding sites of ribosome

A

1 - codon signalling termination is recognised by P site

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8
Q

The ribosome complex has 3 specific sites where the mRNA can bind. Which of the following is NOT one of these sites?

1 - A site (aminoacyl site)
2 - B site (binding site)
3 - P site (peptidyl site)
4 - E site (exit site)

A

2 - B site (binding site)

  • correct codons are added at sites A and P, building a protein, once finished a stop codon is recognised and the mRNA is then detached and a protein is formed.
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9
Q

The ribosome complex has 3 specific sites where the mRNA can bind, A site (aminoacyl site), P site (peptidyl site) and E site (exit site). Once the correct codons have been added at site A and P, the mRNA is then detached and a protein is formed.

A
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10
Q

Which of the following described elongation?

1 - codon signalling termination is recognised by P site
2 - 1st tRNA binds to P site and begins adding further tRNA at site A
3 - 50S and 30S subunits bind to mRNA forming ribosome-mRNA complex
4 - tRNA bind to the A, P and E binding sites of ribosome

A

2 - 1st tRNA binds to P site and begins adding further tRNA at site A

  • this repeats until protein is finished
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11
Q

Which of the following is the core Tetracycline that we need to be aware of?

1 - Doxycycline
2 - Clarithromycin
3 - Erythromycin
4 - Gentamicin

A

1 - Doxycycline

  • formed of 4 (tetra) rings (cyclines) bound together
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12
Q

Doxycycline is the core Tetracycline that we need to be aware of. What is the mechanism of action of this class of antibiotics?

1 - binds to penicillin binding protein
2 - interfere with NAG and NAMs
3 - bind to 50S ribosome
4 - binds to A site on the 30S ribosome

A

4 - binds to A site on the 30S ribosome

  • essentially inhibits protein synthesis before it even starts
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13
Q

Doxycycline is the core Tetracycline that we need to be aware of. Is this a bactericidal or bacteriostatic?

A
  • bacteriostatic
  • suppress growth of bacteria, keeping them in the stationary phase of growth
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14
Q

Doxycycline is the core Tetracycline that we need to be aware of. Is this a broad or narrow spectrum antibiotic?

A
  • broad spectrum
  • effective against Gram + and Gram - bacteria and protozoa and mycobacteria
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15
Q

Doxycycline is the core Tetracycline that we need to be aware of. Doxycycline is indicated in all of the following EXCEPT which one?

1 - acne vulgaris (especially when inflamed papules/pustules are present_
2 - lower RTI including COPD (Haemophilus influenza - Gram -) and pneumonia
3 - Chlamydial infection (pelvic inflammatory disease)
4 - tpypoid, malaria, and lyme disease
5 - clostridium difficile colitis

A

5 - clostridium difficile colitis

  • vancomycin is 1st line for this
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16
Q

Doxycycline is the core Tetracycline that we need to be aware of. In addition to a myriad of uses it is used in severe skin, soft tissue and abdominal infections in what scenario?

1 - allergies
2 - age of patient
3 - renal impairment
4 - other medications have failed or are contraindicated

A

4 - other medications have failed or are contraindicated

17
Q

All of the following are adverse events of Doxycycline, the core Tetracycline that we need to be aware of. But which is the most common?

1 - hypersensitivity reactions
2 - GI upset
3 - oesophageal ulcerations/dysphagia
4 - photosensitivity
5 - discolouration and hypoplasia of tooth enamel
6 - hepatotoxicity
7 - intracranial hypertension

A

2 - GI upset

  • photosensitivity = exacerbated reaction to sun exposure
  • accumulate in teeth, affecting colour and bone growth
  • hepatotoxicity is generally if used beyond expiry date
18
Q

GI upset is the most common adverse event of Doxycycline. Why does this occur?

1 - irritates mucosal membrane
2 - has osmotic effect inducing diarrhoea
3 - healthy flora are killed causing C. difficile and colitis
4 - stimulates serotonin receptors and induces nausea and vomiting

A

3 - healthy flora are killed causing C. difficile and colitis

  • not as much risk as in penicillins though
19
Q

GI upset is the most common adverse event of Doxycycline as healthy flora are killed causing C. difficile and colitis. This can increase the anticoagulant effect and bleeding risk of which drug?

1 - heparin
2 - enoxaparin
3 - edoxaban
4 - warfarin

A

4 - warfarin

  • healthy gut flora are important for vitamin K absorption
20
Q

Doxycycline should not be used in all of the following, EXCEPT which one?

1 - children <12 y/o
2 - pregnancy
3 - renal impairment
4 - women breast feeding

A

3 - renal impairment
- can be used but with caution as they can increase urea and reduce drug excretion

21
Q

When taking Doxycycline, why should they NOT be taken with food?

1 - bind divalent cations
2- bind with bile and be passed through faeces
3 - may be digested accidentally
4 - bind fat soluble vitamins (ADEK)

A

1 - bind divalent cations
- Ca2+, Mg+, antacids and iron

  • stops the molecule being absorbed
  • minimum 2 hours before or after food
22
Q

In severe infections how is Doxycycline typically administered?

1 - oral
2 - IV
3 - IM
4 - suppository

A

2 - IV
- only when other treatment options have failed or are not available

23
Q

Typically how is Doxycycline administered?

1 - oral
2 - IV
3 - IM
4 - suppository

A

1 - oral
- should be taking standing with lots of water to reduce risk of oesophageal ulceration

  • loading dose = 200mg on day 1
  • 100-200mg orally after day 1
24
Q

When prescribing any antibiotics, in accordance with antibiotic stewardship, which of the following must be document on the prescription and in the patients notes?

1 - indication
2 - review date
3 - treatment duration
4 - all of the above

A

4 - all of the above

25
Q

If prescribed as IV, how long should it be before the antibiotics are switched to oral where appropriate?

1 - 12h
2 - 24h
3 - 48h
4 - 72h

A

3 - 48h

26
Q

Broad spectrum antibiotics are prescribed empirically, when we do not know the specific cause of the infection. However, what is the main driver to switch antibiotics to a narrow spectrum antibiotic?

1 - cost
2 - patients request
3 - microbiology results
4 - allergies

A

3 - microbiology results

C. Year 3: Core Drugs (125 decks)

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