Antimicrobial Review

Question 1

These are broad spectrum not usually used to treat gram (-) UTIs.

Answer 1

Tetracyclines

Question 2

List 3/6 other usefulness for tetracyclines

Answer 2

chlamydia, mycoplasma, rickettsia, cholera, anthrax, acne vulgaris

Question 3

Top 3 tetracycline drugs

Answer 3

TCN, doxycycline, minocycline

Question 4

What are the common doses for doxy- and mono cycyline

Answer 4

100 mg 2x/day for 10 days

Question 5

What reduces the oral absorption of tetracycylines?

Answer 5

dairy products, antacids

Question 6

Does TCN have an anti-inflammatory action?

Answer 6

Yes

Question 7

T/F, doxycycline levels are affected by renal disease

Answer 7

F

Question 8

Who are tetracyclines contraindicated in?

Answer 8

pregnant women, children <8

Question 9

What are the adverse effects of tetracycline?

Answer 9

photo-sensitivity, Gastric/GI upset

Question 10

This is considered a glycylcyclines reserved for resistant staph and strep infections.

Answer 10

Tigecycline

Question 11

What are the adverse effects of tigecycline?

Answer 11

more nausea and vomitting

Question 12

These are used in serious gram negative infections, like septic shock, with a gram positive abx.

Answer 12

aminoglycosides

Question 13

Since aminoglycosides are poorly absorbed in the GI tract, how are they given?

Answer 13

parenteral

Question 14

Top 4 aminoglycosides

Answer 14

amikacin, gentamicin, tobramycin, neomycin

Question 15

What are the toxicities of aminoglycosides?

Answer 15

ototoxic, nephrotoxic, toxicity increased by loop diuretics

Question 16

These abx have good gram (+) coverage and are safe in pregnancies and peds.

Answer 16

Macrolides

Question 17

What abx is similar to tetracyclines?

Answer 17

macrolides

Question 18

What are the other useful tx of macrolides?

Answer 18

chlamydia, legionella, mycoplasma, treponema, helicobacter, diphtheria

Question 19

What is the most commonly used macrolides?

Answer 19

Azithromycin

Question 20

This group of abx has a broader spectrum of action, less bacterial resistance

Answer 20

ketolides

Question 21

This is the current choice of ketolides

Answer 21

telithromycin

Question 22

What are the macrolide toxicities?

Answer 22

GI upset (motilin-lie effects), and drug interactions, liver toxicity, ototoxicity

Question 23

This drug classes main indication is c diff and acts against bacterial transcription

Answer 23

macrolide derivative - Fidaxomicin

Question 24

Since lincomycin is too toxic, this drug is given and is especially good against anaerobes

Answer 24

clindamycin

Question 25

What does clindamycin not work against?

Answer 25

c diff

Question 26

Besides c diff, what are the other risks of clindamycin?

Answer 26

liver fx impairment, neutropenia

Question 27

What are the abx who have the greatest risk for c diff?

Answer 27

clindamycin, amoxicillin, ampicillin, cephalosporin, fluoros

Question 28

Choramphemicol is a broad spectrum abx seldomly used and its greatest risk are?

Answer 28

bone marrow suppression, aplastic anemia, neonatal toxicity, drug interactions

Question 29

This abx is a part of the new class of bacteriostatic againt gram (+) aerobes and anaerobes given oral and IV for vancy resistant organisms.

Answer 29

Linezolid

Question 30

These are bacteriocidal for most organisms IV use only for vancy resistant. Cause arthralgia, myalgia, and hyperbili

Answer 30

quinupristin, dalfopristin

Question 31

These inhibit nucleic acids

Answer 31

fluoros

Question 32

This is a second generation fluoro used alot for gram (-), atypical coverage, and some (+) coverage

Answer 32

cipro

Question 33

This is a commonly used 3rd generation agent; has better gram (+) coverage

Answer 33

levofloxacin

Question 34

This is a 4th generation fluoro with better gram (+) and anaerobic coverage but less useful against atypicals

Answer 34

moxifloxacin

Question 35

Why do we avoid fluoros in <18 and pregnancy?

Answer 35

damage cartilage, preg is tech class C

Question 36

What tendon issue is common in fluoro use? and who does it effect

Answer 36

achilles tendon damage/rupture; >60 y/o and corticosteroid use

Question 37

What is a black box warning regarding CNS adverse effects of fluoros?

Answer 37

increase symptoms of MS; can also cause insomina and lower seizure threshold

Question 38

What is the FDA recommendation for using fluoros?

Answer 38

don't use them to treat minor infections

Question 39

These abx inhibit folate biosynthesis/inhibit metabolism?

Answer 39

sulfonamides, trimethoprim, co-trimoxazole

Question 40

What is the generic term for sulfonamide analogs?

Answer 40

PABA

Question 41

This is the most commonly utilized sulfa drug; used for UTIs, prostatic infections, alt adjunct

Answer 41

cotrimoxazole

Question 42

What percentage of ppl have a sulfa class allergic reaction?

Answer 42

5%

Question 43

When are sulfonamides contraindicated?

Answer 43

< 2 mos old, late pregnancy, concurrent use with methenamide

Question 44

What 3 "other" abx help with UTIs?

Answer 44

methenamine, nitrofurantoin, nitrofurantoin monohydrate

Question 45

What abx is useful in uncomplicated cystitis?

Answer 45

methenamine

Question 46

When do you avoid using methenamine?

Answer 46

liver & kidney probs, with sulfa drugs, upper UTI

Question 47

This "other abx" has a limited spectrum of action, discolors urine (makes it really brown), and cause rare complications.

Answer 47

nitrofuratoin

Question 48

What are the big two mycobacterium that cause TB?

Answer 48

mycobacterium TB, mycobacterium bovis

Question 49

To tx leprosy, what do you use?

Answer 49

dapsone

Question 50

What are the adverse effects of dapsone?

Answer 50

hemolysis, peripheral neuropathy

Question 51

When can TB affect every organ system?

Answer 51

in the late stages

Question 52

Conversion of latent TB becomes active TB happens in these immunosuppressed states?

Answer 52

corticosteroid therapy, chemo, immunosuppression therapy

Question 53

What is the popular TB tx 6 month regimen?

Answer 53

``` intensive phase: 1-2 mos consolidation phase (3-6 mos) ```

Question 54

What are the INH toxicities?

Answer 54

peripheral neuritis, hepatitis/liver tox, drug interactions

Question 55

This TB tx is well tolerated can cause nausea and rash and interactis wit CYP induction drugs ESPECIALLY ORAL CONTRACEPTION

Answer 55

rifampin

Question 56

When this drug is combined with Rifampin, there is a significant risk of liver tox!

Answer 56

pyrazinamide

Question 57

What two fluoros are used to tx TB?

Answer 57

moxifloxacin, gatifloxacin