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1

Name 2 key targets of antimicrobials that work by inhibiting bacterial protein synthesis?

50S, 30S bacteria ribosomal subunits

2

Name at least 2 classes of antibiotics which are 30S protein synthesis inhibitors

tetracyclines, glycylcycline, aminoglycosides

3

Name 3 examples of tetracyclines

tetracycline, doxycycline, minocycline

4

Tetracycline prevents binding of ___________ to the A site of mRNA-ribosome complex

tRNA

5

Tetracyclines should not be administered with dairy products or substances that contain divalent and trivalent cations as this would lead to the formation of ___________, which would ___________ the absorption of the drugs.

non-absorbable chelates,

reduce

6

Comment on tetracycline’s antimicrobial coverage

It has broad spectrum activity against many Gram-negative and Gram-positive bacteria. It also has coverage against atypical bacteria. It does not have adequate coverage against Pseudomonas aeruginosa and Proteus

7

How is tigecycine administered?

Intravenously (It has poor oral bioavailability unlike the tetracyclines.)

8

Glycylcyclines (tigecycline) were designed to overcome which two mechanisms of tetracycline resistance?

Expression of efflux pumps, and ribosomal protection

9

Tigecycline is useful in targeting some of the resistant microbes including

1. Methicillin resistant staphylococci (MRSA),
2. Multidrug-resistant streptococci,
3. Vancomycin-resistant enterococci (VRE),
4. useful against carbapenem resistant strains of Extended-spectrum β-lactamase–producing gram-negative bacteria

10

Name at least 4 adverse effects associated with the use of tetracyclines

1. Gastrointestinal distress (To reduce ulceration, drink plenty of fluids and do not take it before sleep)
2. Phototoxicity (Like fluoroquinolones)
3. Superinfection like thrush
4. Deposition in bone/primary dentition and may cause discoloration of teeth

11

The use of tetracyline and tigecycline is contraindicated in which populations of patients?

1. Pregnant women,
2. Breastfeeding women
3. Children less than 8 years of age

12

Aminoglycosides are transported across the inner membrane of Gram-negative bacteria by ___________ , which is an energy dependent process.

active transport

13

Aminoglycosides are particularly effective against _______ Gram-negative bacteria

aerobic

14

Name 5 examples aminoglycosides

gentamicin, streptomycin, tobramycin, amikacin, neomycin

15

Aminoglycosides demonstrate synergism when combined with which class of antibiotics? Name one class.

Beta lactams (e.g. gentamicin and ceftriaxone for the management of staphylococcus endocarditis)

16

How are aminoglycosides commonly administered?

Parenterally (They have poor oral bioavailability)

17

Name an aminoglycoside that is used in the management of tuberculosis

Streptomycin (administered IM)

18

How are aminoglycosides cleared?

Renally

19

Name at least 2 adverse effects associated with aminoglycosides

1. Ototoxicity
2. Nephrotoxicity (Do not combine with other nephrotoxicity)
3. Neuromuscular paralysis (Especially when used with neuromuscular blockers)

20

Name an aminoglycoside that is administered orally

Neomycin (bowel prep)

21

Name 2 groups of patients in whom aminoglycosides would be contraindicated

1. Pregnant women,
2. Patients suffering from myasthenia gravis because of the risk of prolonged neuromuscular blockade
3. Patients with severe renal Impairment

22

What are the 6 “NOs” in relation to aminoglycosides?

1. No to protein synthesis
2. Particularly active against aerobic Gram-Negative Organisms
3. No to use during pregnancy
4. No to oral administration
5. No to CSF penetration
6. Nephro- and Oto- toxicities

23

Name 3 types of 50S protein synthesis inhibitors

Macrolides, clindamycin, linezolid

24

Name 3 macrolides

Erythromycin, clarithromycin, azithromycin

25

25 Are macrolides bacteriostatic or bactericidal antibiotics?

Bacteriostatic

26

How can macrolides be administered?

Oral and IV

27

Name some of the microbial infections that the macrolides are useful against

Respiratory infections caused by S.pneumoniae, H. influenzae and Moraxella catarrhalis and those caused by atypical bacteria such as Legionella pneumophilia, Mycoplasma and Chlamydia
STDs caused by Chlamydia trachomatis and Neisseria gonorrhoea
H.pylori infections

28

Name 2 adverse effects associated with macrolides

1. Gastric Distress
2. Hepatotoxicity
3. Ototoxicity
4. May prolong QT interval

29

How are macrolides cleared?

Erythromycin and clarithromycin undergoes hepatic clearance
Azithromycin – is mainly eliminated unchanged in faeces

30

Which of the macrolides cause the most GI distress?

Erythromycin