E2 Erdman MSC antibiotics Flashcards
(121 cards)
1
Q
tetracyclines in lecture (3)
A
tetracycline
doxycycline
minocycline
2
Q
Tetracycline analogs in lecture (3)
A
Tigecycline
eravacycline
Omadacyline
3
Q
Sulfonamide in lecture (1)
A
TMP-SMX
4
Q
2 polymyxins in lecture
A
Colistin
Polymyxin b
5
Q
Lincosamide in lecture (1)
A
clindamycin
6
Q
Nitroimidazole in lecture (1)
A
metronidazole
7
Q
tetra MOA
A
reversibly bind 30S
8
Q
Tetra static or cidal
A
static, but cidal when at high conc against very susceptible organisms
9
Q
3 mechs of resistance tetras
A
- efflux pumps
- dec access to ribosom from ribosomal protection proteins
- enzymatic inactivation of tetras
10
Q
Cross-resistance is NOT observed
tetracycline
doxycycline
minocycline
A
mino
11
Q
T or F:
tetracycline analogs are affected by the major tetra resistance mechs
A
false actually
12
Q
which 2 are most active against GP aerobes
tetracycline
doxycycline
minocycline
A
Mino and doxy
13
Q
highlighted GP bacteria tetras are active against
A
MSSA
14
Q
tetra SoA
GN aerobes
A
Haemophilus influ
Haemophilus duc
Camplyobacter
Helocobacter
Acinetobacter
(NO ENTEROBACTERALES)
15
Q
2 anaerobic bacteria for tetras
A
Actinomyces
Propionibacterium
16
Q
Tetra SoA:
MSC bacteria
A
atypical bacteria such as
LEGIONELLA*
Chlamydophila pneumoniae
Mycoplasma
Ureaplasma
17
Q
tetra analogs SoA:
GP aerobes (highlighted)
A
MSSA
MRSA
entero faecalis (VSE and some VRE)
18
Q
acronym for tetra analog GN aerobes
A
EEACKSS
19
Q
T or F:
tetra analogs are active against proteus mirabilis and pseudomonas aeruginosa
A
FALSE*
20
Q
has higher MIC for GN aerobe Stenotrophomonas maltophilia
A. Tigecycline
B. Eravacycline
C. Omadacycline
A
C
21
Q
1 highlighted anaerobe for tetra analogs
A
Bacteroides spp
22
Q
have coverage against atypical bacteria
A. Tigecycline
B. Eravacycline
C. Omadacycline
A
B and C
23
Q
which 3 tetras + analogs are available PO and IV
A
doxy
mino
omada
24
Q
which 2 tetras + analogs are only IV
A
Tige
erava
25
which tetras + analogs have impaired absorption from dairy, zinc, mag, etc?
all orals (doxy, mino, omada)
26
absorption of tetras + analogs is impaired by what
di and trivalent cations
27
1 highlighted location for where tetras + analogs are distributed
prostate
28
T or F:
tetras + analogs penetrate CSF well
false, very little amounts
29
T or F:
tetras + analogs are removed during hemo
true BUT minimally
30
which two tetras do not require dose adjustment in RI
doxy
mino
31
which tetra analogs require dose adjustment in RI
none
32
which is used in outpatient use for CAP
tetracycline
doxycycline
minocycline
doxy
33
used for acinetobacter infections
tetracycline
doxycycline
minocycline
Mino
34
Used for chlamydial infections, including nongonococcal urethritis
tetracycline
doxycycline
minocycline
doxy
35
T or F:
tetra analogs cover proteus and psedomonas
false
36
Tetra + analogs AEs:
GI, which one most likely
N/V
Tigecycline*
37
Tetra + analogs AEs:
dermatologic
photosensitivity
38
T or F:
all tetras + analogs are safe in pregnancy
false, all category D
39
why cant the tetras + analogs be used in pregnancy?
discoloration of permanent teet and dec bone growth in children
40
Which antibiotic will interact with divalent/trivalent cations so that oral absorption is impaired potentially leading to clinical failure?
A. Oral levofloxacin
B. Oral doxycycline
C. Oral ciprofloxacin
D. Oral minocycline
E. All of the above
E
41
Which of the following antibiotics does NOT have activity against atypical bacteria (e.g., Legionella pneumophila)?
A. Azithromycin
B. Levofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
E. Moxifloxacin
C
42
TMP-SMX MOA
produce sequential blockade of microbial folic acid synthesis, which is necessary for production of DNA
43
Inhibits dihydropteroate synthesis:
A. TMP
B. SMX
B
44
Inhibits dihydrofolate reductase:
A. TMP
B. SMX
A
45
TMX and SMX are ______ alone but ______ in combination
static
cidal
46
mechs of resistance for TMP-SMX
- point mutations in dihydropteroate synthase and/or altered production or sensitivity of bacterial dihydrofolate reductase (wtf)
47
TMP-SMX SoA:
GP aerobes
S aureus (including some MRSA, especially CA-MRSA)
48
TMP-SMX SoA:
GN aerobes (1)
Stenotrophomonas maltophilia****
49
what notable GN aerobe does TMP-SMX NOT cover
pseudomonas*
50
"other" bacteria that makes TMP-SMX the DRUG OF CHOICE for
Pneumocystis carinii***
51
TMP-SMX dosage form(s)
IV and PO
52
how do you achieve steady-state serum conc of TMP-SMX
fixed oral or IV combo of 1:5
53
T or F:
TMP-SMX penetrates CSF w/ inflamed meninges
true
54
2 highlighted locations TMP-SMX distributes to
urine
prostatee
55
SMX is ___% protein bound
70
56
TMP-SMX elimination
both are eliminated by liver and kidney
57
When should you consider dose adjustment for TMP-SMX?
CrCl <30
58
3 highlighted clinical uses for TMP-SMX
- acute, chronic, or recurrent UTIs
- acute or chronic bacterial prostatitis
- skin infxns due to CA-MRSA
59
TMP-SMX AEs:
hematologic
leukopenia, thrombocytopenia
60
TMP-SMX AEs:
hypersensitivity
rash
61
TMP-SMX AEs:
CNS
headache, aseptic meningitis, seizures
62
TMP-SMX AEs:
other
crystalluria, hyperkalemia, inc creatinine
63
T or F:
TMP-SMX is safe in pregnancy and breastfeeding
false, can cause kernicterus in newborn
64
TMP-SMX drug interactions
warfarin
inc anticoagulation effect
65
TMP-SMX dosage forms and dosing, oral tabs:
Single strength: __mg TMP and ___mg SMX
double strength: ___mg TMP and ___mg SMX
- 80, 400
- 160, 800
66
_____ are cationic cyclic decapeptides linked to a fatty acid chain by an a-amide linkagee
Polymyxins
67
is a prodrug:
A. colistin
B. polymyxin B
A
68
Polymyxin MOA
cationic detergents that binds to anionic lipopolysaccharide molecules in the outer cell membrane of Gram-negative bacteria causing displacement of Ca and Mg induces changes in permeability and leakage of cellular contents, leading to cell death
69
Polymyxins display (time/conc) dependent and (static/cidal) activity
conc
cidal
70
1 resistance mech for polymyxins
alteration of outer cell membrane
71
Polymyxins SoA:
GP aerobes
none
72
Polymyxins SoA:
GN aerobic bacilli
(2 highlighted options)
Acinetobacter spp
Pseudomonas aeruginosa
73
Polymyxins SoA:
anaerobes
none
74
Polymyxins Absorption
only IV not absorbed like that ig
75
Polymyxin elimination
Colistin and polyB are eliminated by nonrenal routes
HOWEVER
50% of CMS is eliminated unchanged by the kidney
76
requires dose adjustment in RI when CrCl <80
A. colistin
B. polyB
A
77
Polymyxins clinical uses
infections caused by GN bacteria that are resistant to other antibiotics
78
Pref for systemic infections
A. colistin
B. polyB
A
79
pref for UTI
A. colistin
B. polyB
B
80
polymyxins AEs:
(2)
nephrotox - reversible
neurotox - reversible
81
use what BW for colistin IV
IBW
82
use what BW for polyB
TBW
83
can both polymyxins be used for inhalation
yes
84
True/False: Colistin is often used for the treatment of infections due to Gram-negative aerobes because it is not associated with serious adverse effects
false, only for tx of infections due to MDR GN aerobes bc it is nephro and neurotoxic
85
best for ADA; except for treatment in brain abscesses:
A. Clindamycin
B. Metronidazole
A
86
best for BDA; useful for brain abscesses due to CNS/CSF pen:
A. Clindamycin
B. Metronidazole
B
87
clindamycin MOA
50s
88
clinda is (time/conc) dependent and (cidal/static)
time
static
89
mechs of resistance for clinda
- altered target sites
90
is active efflux effective against clindamycin
no
91
Clinda SoA:
GP aerobes
(highlighted)
PSSP
CA-MRSA
MSSA
92
clinda is active against many GP and GN anaerobes, but is most useful for anaerobes ________ ____ _______
above the diaphragm
93
clinda SoA:
anaerobes (highlighted)
some bacteroides spp
94
T or F:
clinda has activity against C diff
false
95
clinda absorption
rapidly and completely absorbed, food has minimal effect
96
Clinda distribution
good tissue penetration including bone, minimal CSF pen
97
clinda elimination
primarily metabolized by liver
98
T or F:
clinda is removed during hemo
FALSE IT IS NOT
99
clindamycin clinical uses
- infections due to anaerobes OUTSIDE THE CNS
- pulmonary
- diabetic foot infections
- penicillin-allergic pts
- infections due to CA-MRSA*(
100
clinda AEs:
worst inducer of?
C diff
101
clindamycin AEs:
highlighted and not Gi
hepatotoxicity - rare
102
metronidazole MOA
ultimately, inhibits DNA synthesis
103
T or F:
both colistin and metronidazole are prodrugs
true
104
Metronidazole displays (time/conc) dependent and (cidal/static) activity
conc
cidal
105
2 mechs of resistance for metro
altered growth requirements
and
altered ferredoxin levels
106
metronidazole SoA:
anaerobes *
ADA: peptococcus
BDA: bacteroides
C diff
107
metro is the antianaerobic agent most reliably active against what bacteria
bacteroides fragilis
108
metronidazole SoA:
GP anaerobes
Clostridium spp including C diff
109
T or F:
metro is inactive against all common aerobic bacteria
true
110
T or F:
metro penetrates CSF well
true
111
metronidazole elimination
primarily metabolized by liver
112
T or F:
metro is removed during hemo
true
113
metro clinical uses
- anaerobic infections*
- pseudomembranous colitis due to C diff
- trichomonas
- giardia
114
metro AEs:
GI
stomatitis
metallic taste
115
metro AEs:
CNS- most serious btw
peripheral neuropathy****
116
Metro AEs:
other significant highlighted one
mutagenicity, carcinogenicity (avoid during pregnancy and breastfeeding)
117
2 notable drug interactions with metro
warfarin
alcohol
118
Which of the following antibiotics will NOT interact with warfarin?
A. TMP-SMX
B. Metronidazole
C. Ciprofloxacin
D. Clindamycin
E. Clarithromycin
D
119
Which of the following antibiotics can be safely used during pregnancy?
A. Ampicillin
B. Levofloxacin
C. Doxycyclline
D. Metronidazole
E. Telavancin
A
120
Which of the following antibiotics does NOT require dosage adjustment in renal insufficiency?
A. Trimethoprim-sulfamethoxazole
B. Vancomycin
C. Gentamicin
D. Cefazolin
E. Nafcillin
E, even tho it can cause nephrotox?
121
Which of the following antibiotics is NOT associated with the development of nephrotoxicity?
A. Metronidazole
B. Vancomycin
C. Tobramycin
D. Colistin
E. Nafcillin
A
