Exam 2 Flashcards
1
Q
toxicities of sulfa drugs
A
aplastic anemia hypersensitivity Stevens Johnson Syndrome photosensitivity kernicterus
2
Q
contraindications for sulfa drugs
A
near term pregnant women
nursing, premature, or jaundice infants
< 2 months old
3
Q
sulfasalazine MOA and use
A
prodrug, metabolite mesalamine is anti-inflammatory
used for Crohn’s, ulcerative colitis, RA
4
Q
1st DOC for UTI
A
Bactrim
5
Q
MOA for Bactrim
A
sulfamethoxazole: compete with PABA in bacterial cell folic acid synthesis
trimethoprim: prevents conversion of DHF to THF for purine synthesis
6
Q
spectrum for Bactrim
A
G+ and G-
7
Q
relationship of trimethoprim and sulfamethoxazole
A
synergistic
8
Q
use of silver sulfaziadine
A
topical for burns
9
Q
Bactrim: cidal or static?
A
bacteriostatic, except it is bactericidal in the urinary tract
10
Q
MOA of daptomycin
A
rapidly depolarizes membrane which eventually leads to cell death
11
Q
spectrum of daptomycin
A
cidal, G+ (MRSA, MSSA)
12
Q
route of administration for daptomycin
A
IV
13
Q
MOA of mupirocin
A
inhibit tRNA synthetase of isoleucine, inhibits protein and RNA synthesis
14
Q
route of administration for mupirocin
A
topical
skin: impetigo
nares: MRSA
15
Q
spectrum of mupirocin
A
G+ and G-, bacteriostatic at low concentrations and bactericidal at high concentrations
16
Q
MOA for polymixin B and E
A
binds to lipid A, increases permeability which results in loss of metabolites
17
Q
spectrum of polymixin B and E
A
G-
18
Q
route of administration for polymixin B and E
A
topical (nephrotoxic), used in combination with neomycin and bacitracin
19
Q
1st gen cephalosporins
A
Cephalexin (oral), Cefazolin (IV/IM)
20
Q
2nd gen cephalosporins
A
Cefuroxime (IV/IM), Cefprozil (oral), Cefaclor (oral)
21
Q
3rd gen cephalosporins
A
Ceftriaxone, Cefixime (oral), Ceftazidime, Cefotaxime
-all others are IV/IM
22
Q
4th gen cephalosporins
A
Cefepime (IV)
23
Q
“5th” gen cephalosporins
A
Ceftaroline (IV)
24
Q
DOC for surgery prophylaxis
A
Cefazolin (IV/IM)
25
DOC for N. Gonnorhea
Ceftriaxone (IV/IM)
26
What advantage does cephalosporins have over penicillins?
They have a 7 methyl group that makes them more resistant to penicillinase
27
MOA of cephalosporins
ICWS, b-lactam
28
spectrum for 1st gen cephalosporins
good G+, relatively moderate G-, MSSA
29
spectrum for 2nd gen cephalosporins
lower G+, more G- (E.coli, Klebsiella, Proteus)
30
3rd gen cephalosporin for Pseudomoas
ceftazidime + aminnoglycoside
31
spectrum for 3rd gen cephalosporins
less G+, pseduomonas, enterobacteriaceae
32
contraindications for 3rd gen cephalosporins
neonates due to bilirubin displacement
33
spectrum for 4th gen cephalosporins
comparable to 3rd gen with more G+ coverage + MSSA
34
spectrum for 5th gen cephalosporins
G+ and G-, MRSA, VRSA, CABP
| NO PSEUDOMONAS ACTIVITY
35
DOC for E. Coli, Proteus, Klebsiella
1st or 2nd gen cephalosporins
36
DOC for late stage Borrelia Burgdorferi
Ceftriaxone
37
Toxicity of cephalosporins
```
superinfection
diarrhea
disulfram like reaction
allergy (10% cross reaction with pen allergy)
dose dependent renal tubular necrosis
```
38
MOA for Aztreonam
a b-lactam, ICWS, PBP, cidal
39
spectrum for aztreonam
G- only
40
route of administration for azetronam
parenteral
41
list carbapenems
imipenem (+ cilastatin), meropenem, ertapenem
42
route for imipenem and meropenem
IV
43
spectrum for impienem and meropenem
G+, G-, Anaerobes
| BROAD SPECTRUM
44
toxicity of imipenem
can cause seizures, so patients with past history, impaired kidney function, CNS deficits should avoid
45
DOC for B-lactam producing enterobacter infection
imipenem or meropenem
46
spectrum for ertapenem
G+, G-, anaerobic, particular enterobacteriaceae
| do not use for pseudomonas
47
route for ertapenem
IV or IM
48
MOA for vancomycin
cidal, ICWS, prevents transpeptidation of chain by binding to the D-alanine site
49
Resistance MOA for vancomycin
bacteria mutates d-ala to d-lactate so drug cannot bind
50
Adverse affects of vancomycin
ototoxicity
nephrotoxicity
red man syndrome (not a hypersensitivity)
51
route for vancomycin
ORAL
52
spectrum for vancomycin
G+, MRSA, G+ infections not responding to penicillin
53
DOC for C. Diff
Vancomycin
54
MOA of fosfomycin
inhibits cell wall synthesis at one of the first steps in the peptidoglycan pathway
55
spectrum of fosfomycin
G+ and G-
56
MOA of bacitracin
interferes with the final dephosphorylation step, NAG-NAM cannot get transported across the membrane
57
route for bacitracin
parenteral (rarely nephrotoxic) and topical
58
spectrum for bacitracin
mostly G+
59
MOA for fluoroquinolones
bactericidal
| Inhibits DNA gyrase and Topo IV
60
Spectrum for fluoroquinolones
Mostly Gram - aerobes, some G+
| Moxi and Gemi also cover anaerobes
61
Ciprofloxacin
UTIs, systemic tx, anthrax prophylaxis, Pseudomonas
62
Ofloxacin
Prostatitis, some systemic, some STDs (no syphilis), TB
63
Levofloxacin
CAP
64
Moxifloxacin
Anaerobes, Pen. resistant Strep pneumoniae
65
Gatifloxacin
ocular application only
66
Gemifloxacin
Anaerobes, Pen. resistant Strep pneumoniae, CAP
67
route of administration for fluoroquinolones
ORAL
68
patient education on fluoroquinolones
must stop taking supplements during course of treatment
69
adverse effects of fluoroquinolones
```
GI disturbances
long QT interval
photosensitivity
cartilage erosion
tendon rupture
```
70
FQ contraindications
children under 18 and pregnant women
71
MOA for metronidazole
prodrug, interacts with ferredoxin, metabolite up taken by bacterial cell, bactericidal
72
spectrum of metronidazole
Anaerobes: G+ and G-
73
indication for metronidazole use
bacterial vaginosis, endocarditis, C.diff, RTI, abdominal infections, h. pylori therapy
74
route of administration for metronidazole
oral, IV, topical
75
adverse reactions of metronidazole
disulfram like reaction, disgeusia (metallic taste)
76
most common UTI pathogen
E. coli
77
second most common UTI pathogen
staph. saprophyticus
78
most important property of UTI drugs
they are renally excreted
79
MOA for Nitrofurantoin
bactericidal, damages bacterial DNA, a prodrug
80
Resistance to Nitrofurantoin
Proteus and Pseudomonas organisms
81
route of administration for nitrofurantoin
oral
82
Nitrofurantoin should not be used if creatinine clearance is less than what?
50 mL/min
83
toxicity of nitrofurantoin
pulmonary fibrosis in elderly, hepatocellular damage, hemolytic anemia
84
contraindications for nitrofurantoin
pregnancy, < 1 month old, reduced renal function
85
MOA for methenamine
prodrug, metabolizes into ammonia and formaldehyde, formaldehyde is what kills the bacteria
86
spectrum for methenamine
nearly all bacteria are sensitive, but those that increase the pH of the urine inhibit the release of formaldehyde (Proteus species)
87
contraindications for methenamine
hepatic insufficiency, too much ammonia build up
| renal insufficiency, low urinary output
88
30 s subunit
tetracyclines and aminoglycosides
89
aminoglycosides: cidal or static?
cidal
90
Name the 3 macrolides
Azithromycin, oral/IV
Clarithromycin, oral
Erythromycin, oral/IV
91
MOA of macrolides
binds to the 50s subunit on the ribosome, bacteriostatic
92
DOC for chlamydia
Azithromycin
| **if pregnant must use erythromycin
93
DOC for legionella species
Azithromycin
94
DOC for mycoplasma pneumoniae
Erythromycin, also tetracycline would work
95
Spectrum for macrolides
similar to PEN G, G+
| most species resistant to erythromycin
96
Forms of resistance against macrolides
METHYLATION, efflux pumps
97
Toxicity of macrolides
```
diarrhea and adverse GI effects: clarithro least, erythro most
long QT: azithro most, than erythro
drug interactions (CYP3A4): clarithro and erythro most
```
98
Name the only ketolide drug
Telithromycin
99
MOA of telithromycin
binds to two places on the 50s subunit, bacteriostatic
100
spectrum of telithromycin
respiratory pathogens, resistant strains of pneumonia, intracellular and atypical bacteria
101
route of administration for telithromycin
oral
102
most common side effects of telithromycin
diarrhea, n/v, dizziness
103
MOA of clindamycin
binds to the 50s subunit, bacteriostatic or cidal depending on concentration and organism susceptibility
104
spectrum of clindamycin
broad
G+ aerobes
G+ and G- anaerobes
105
toxicity of clindamycin
CDAD: c.diff associated diarrhea
| crosses placenta readily and gets into breast milk, avoid while nursing
106
use for clindamycin
osteomyelitis (good bone concentration)
TSS: use with vancomycin
streptococci and staphylococci extremely susceptible
toxoplasma encephalitis
107
Name the streptogramins
Dalfopristin and quinupristin
108
MOA of streptogramins
each static but together cidal
act on 50s subunit
dalfopristin acts in early phase while quinuprisitn acts in late phase
109
route of administration of synercid
IV
110
spectrum of synercid
Gram + aerobes including:
| penicillin resistant pneumonia, MDR strep, complicated skin infections due to staph, vanco resistant enterococcus
111
major adverse reactions of synercid
inhibits p450 system, CYP3A4
112
contraindications of synercid
breast feeding, children, hepatic disease, pregnancy
113
MOA of linezolid
binds to 50s subunit, bacteriostatic (except strep)
| reversible, non-selective inhibitor of MAO
114
spectrum of linezolid
G+, reserve for MRD bacteria if possible
115
route of administration of linezolid
IV or oral, oral is 100% bioavailable
116
Adverse reactions of linezolid
diarrhea, headache, n/v
MAO side effects
insomnia, constipation, rash, dizziness, fever
superinfection can occur
117
contraindications of linezolid
hypersensitivity, pheochromcytoma
118
drug interactions of linezolid
b-blockers, general anesthetics, epi, SSRI, TCA, other antidepressants
119
MOA of aminoglycocides
30s subunit, irreversible
| Block initiation, translation, and incorporate the wrong amino acid
120
spectrum of aminoglycosides
aerobic G- enteric bacteria
| when sepsis or endocarditis is suspected
121
use for streptomycin
tularemia, bubonic plague, TB, endocarditis
122
DOC for tularemia
gentamycin
123
DOC for pseudomonas aeruginosa
piperacillin or ticaracillin +
| gentamycin/tobramycin/amikacin
124
DOC for enterococcus and strep. agalactiae
PEN G + gentamycin
125
toxicity of aminoglycosides
ototoxicity and nephrotoxicity
| dependent on time and concentration
126
route of administration for aminoglycosides
IV, oral, topical
127
resistance of aminoglycosides
cross resistance: resistant to one, resistant to all
| deficiency of ribosomal receptors, lack of permeability, enzyme modification
128
MOA for chloramphenicol
bacteriostatic (mostly)
binds to 50s subunit
can also inhibit mito protein synthesis in mammalian cells
129
spectrum for chloramphenicol
G+, G-, aerobes and anaerobes, atypicas
| **for life threatening situations**
130
route of administration for chloramphenicol
parental, 100% CNS penetration
131
toxicity of chloramphenicol
reversible dose dependent bone marrow suppression
irreversible dose independent fatal aplastic anemia
gray baby syndrome, immature liver enzymes
132
chloramphenicol resistance
acetyl transferase inactivates chloramphenicol
efflux pumps
binding site modification
133
MOA for tetracycline
binds to 30s ribosome, bacteriostatic
134
spectrum for tetracycline
broad spectrum
| G+, G-, aerobes, anaerobes, atypicals
135
organisms resistant to tetracyclines
b. fragilis, proteus, pseudomonas
136
Name cases were tetracycline is DOC
Cholera, Mycoplasma Pneumonia, Chlamydia, Ricketssial, Lyme disease (early disease), vibrio species
137
tetracycline resistance
efflux pumps
| if tetracycline resistant, may still use doxy or minocycline
138
route of administration for tetracycline
oral
139
adverse reactions of tetracyclines
normal flora changes, bone and teeth (chelators), photosensitivity
140
contraindications for tetracyclines
pregnant women or children under 8 years old
141
route of administration tigecycline
IV
| **life threatening situations**
142
spectrum of tigecycline
same as tetracyclines, but also on tetracycline resistant bacteria, MRSA, MRSE, PRSP, VRE
143
MOA of penicillins
inhibitor of cell wall synthesis, PBP, bactericidal
144
method of resistance for penicillins
b-lactamases
