Drugs for PNA

Question 1

The fluoroquinolone, Ciprofloxacin, inhibiys what enzyme?

Answer 1

DNA Gyrase

important in killing Gram - bacteria (pseudomonas)

Question 2

Fluoroquinolones that block Topo IV is important for killing which type of organisms?

Answer 2

Gram +

(streptococcus respt. infections)

Question 3

Are fluoroquinolones a first choice drug or a last resort drug for CAP?

Answer 3

Last resort for CAP

Question 4

Should penicillins and aminoglycosides be combined in the same IV?

Answer 4

NO!

Question 5

What is the MOA of Amoxicilin?

What step of peptidoglycan synthesis is inhibited?

Is it effective against G+ and G-?

Answer 5

inhibits bacterial cell wall synthesis by binding to PBP

the final transpeptidation step is inhibited

Yes

Question 6

Does Amoxicillin +/- Clavulanate kill Pseuodomonas?

What is this combination used for?

Answer 6

No!

CAP

Question 7

what are the main adverse effects of Amoxicillin +/- Clavulanate?

Answer 7

Anaphylactic Rxn

C. Diff

In Mono-rash

Question 8

What is the MOA of Piperacillin?

What is the MOA of Tazobactam?

Is it active against Pseudomonas?

Answer 8

inhibits bacterial cell wall synthesis

Inhibits beta-lactamases

Yes!

Question 9

Piperacillin + Tazobactam kill which types of pathogens?

Answer 9

Gram + and Gram - aerobic and anaerobic, including those who produce beta-lactamases

Question 10

What are the main indications for Piperacillin + Tazobactam?

Answer 10

CAP and HAP/VAP

Question 11

What is the benefit of using Ceftriaxone in patients with kidney diseases?

Answer 11

It is not eliminated by the kidney, so the dose does not need to be adjusted for renal impairment

Question 12

What class of drugs can cause bleeding tendencies?

Answer 12

Cephalosporins

(cefmetazole, cefoperazone, cefotetan, ceftriaxone)

Question 13

What are the third and fourth generation parenteral cephalosporins?

Answer 13

Ceftriaxone (3rd)

Cefepime (4th)

Question 14

What are the third generation oral cephalosporins

Answer 14

Cefditoren

Cefpodoxime-Proxetil

Question 15

What are the clinical applications for Cefpodoxime?

Answer 15

COPD

OM

CAP outpatient tx

Question 16

What are the clinical applications for Cefditoren?

Answer 16

exerbation of chonric bronchitis

CAP

pharyngitis

Question 17

Are Cefpodoxime and Cefditoren orally active?

What is the 1/2 life?

Are there any drug-drug interactions?

Answer 17

Yes

2-3 hours and 1.6hrs, increased with worsening renal function

Yes

Question 18

What are some concerning adverse effects of Cefpodoxime and Cefditoren?

Answer 18

B-lactam allergies

Superinfection (C.diff)

Question 19

Which drug class is bacteriostatic at the 30S subunit ?

Answer 19

Tetracyclines

Kills bacteria that lack cell walls (Mycoplasma pneumonia)

Question 20

Which tetracycline is the drug of choice for CAP?

Answer 20

Doxycycline

Question 21

Who should not receive Tetracyclines and why?

Answer 21

Don’t use in children due to risk of teeth staining

Question 22

What things interfere with tetracycline absorption?

What is recommended to avoid GI upset?

Should it be combined with bactericidal drugs (PNC)?

Answer 22

Antacids (Aluminum, Ca, Mg, Fe) and dairy products

Take with water

No, generally not recommended

Question 23

Which drug class binds to the 50S subunit and blocks elongation and is BacterioStatic ?

Answer 23

Macrolides (Erythromycin)

Question 24

What are the macrolide drug of choice for CAP?

Answer 24

Azithromycin

Clarithromycin

Question 25

Macrolides are effective against which bugs?

Answer 25

**Most Aerobic and anaerobic gram + bugs** Not Gram negatives except: Pasturella, Haemophilus, Neisseria **Legionella, Mycoplasma, mycobacteria, rickettsia, chlamydia** No fungi

Question 26

Which drug is a well knwon inhibitor of cytochrome P450?

Answer 26

Erythromycin increases concentration of other drugs

Question 27

Which drug causes less GI upset, erythromycin or clarithromycin?

Answer 27

Clarithromycin causes LESS GI upset

Question 28

Unlike Erythromycin, which macrolide does NOT disrupt CP450?

Answer 28

Azithromycin concentrates in cells and slowly releases bacteriostatic levels over 2-4 days (1/2 life)

Question 29

Which drug class is broad-spectrum, administered orally, and is more effective than tetracyclines or macrolides for PNA?

Answer 29

Fluoroquinolones (-Oxacins) Use as LAST RESORT to minimize tolerance

Question 30

What is the main adverse effect of Fluoroquinolones?

Answer 30

Tendon rupture, especially Achille's Tendon in elderly, children, and those at risk

Question 31

What are the indications for Vancomycin? What can infusing too fast cause?

Answer 31

MRSA, MRSE, serious allergy to PNC C. diff Red Man Syndrome

Question 32

Which drug binds to ribosomal A to prevent tRNA binding, thus inhibiting the first step of protein synthesis

Answer 32

Linozolid

Question 33

What are the clinical applications of Linezolid?

Answer 33

VRE CAP (methicillin susceptible) and HAP (methicillin-susceptible and resistant)

Question 34

Linezolid can be administered which two ways? It inhibits which important enzyme, leading to which side effects?

Answer 34

Oral and IV MAO--\> neurologic sx, serotonin syndrome

Question 35

What is the MOA of Aztreonam? What is it effective against?

Answer 35

inhibits bacterial cell wall synthesis by binding to PBP Gram -, including Pseudomonas No use against Gram + or anearobes

Question 36

What is the MOA of Imipenem? What is it effective against?

Answer 36

inhibits bacterial cell wall synthesis by binding to PBP Wide spectrum of G+ and G-, aerobes and anaerobes, many MDR strains

Question 37

What is the main clinical application of Imipenem?

Answer 37

lower respiratory tract infections

Question 38

Gentamicin binds to which ribosomal subunit thus inhibiting growth? What is Gentamicin used for?

Answer 38

30S subunit Respiratory tract infections?

Question 39

What are the main toxicities of Gentamicin?

Answer 39

Nephrotoxicity Neurotoxicity Ototoxicity

Question 40

What drug used to be the drug of choice for aspiration PNA but now is associated with C. diff?

Answer 40

Clindamycin

Question 41

What bugs undergo post-translational modifications that give rise to antibiotic resistance? (mnemonic)

Answer 41

ESKAPE E. Coli Staphylococcus Klebsiella Acinetobacter Pseudomonas Enteroccocus