Exam 2 Pharm

Question 1

Tx for fungal infections

Answer 1

ketoconazole or fluconazole

amphotericin B for pregnancy

Question 2

Tx for allergic pulmonary aspergillosis

Answer 2

corticosteroids

Question 3

Tx for Pneumocystis jirvocei

Answer 3

TMP-SMX aka bactrim

Question 4

Tx for Paragonimus westermani

Answer 4

praziquantal

Question 5

Tx for strep pneumo

Answer 5

ampicillin

erythromycin/azithromycin

Question 6

Tx for klebsiella

Answer 6

gentamicin

ciprofloxacin

Question 7

Tx for chlamydophila pneumonia

Answer 7

erythromycin/azithromycin

Question 8

Tx for bacillus anthracis

Answer 8

pencillin/doxycycline

Question 9

Tx for yersinia pestis

Answer 9

streptomycin/gentamicin
tetracycline/doxycycline
chloramphenicol

Question 10

Tx for TB

Answer 10

RIfampin
Isoniazid
Pyrazinamide
Ethambutol

Question 11

Tx for nocardia

Answer 11

IV TMP-SMX

linezolid

Question 12

Tx for diphtheria

Answer 12

penicillin

erythromycin

Question 13

Tx for pertussis

Answer 13

erythromycin

Question 14

Diphtheria prevention

Answer 14

DTaP-5 doses for children
Tdap-adults single dose
Td-10 yr booster
DT-no pertussis vaccine

Question 15

MOA of fluoroquinolones

Answer 15

prevents topoisomerase II in gram (-) (gyrase)
prevents topoisomerase IV in gram (+) (separates)
bactericidal, blocks DNA synthesis

Question 16

Types of resistance to fluoroquinolones

Answer 16

GyrA/GyrB pt mutation- decrease binding to DNA gyrase
ParC/ParE pt mutation-decrease topoisomerase IV binding
increased efflux/decreased influx
plasmid resistance (inhibits fluoroquinolones)

Question 17

Fluoroquinolones for gram (-)

Answer 17

ciprofloxacin

levofloxacin

Question 18

Fluoroquinolones for gram (+)

Answer 18

moxifloxacin

gemifloxacin

Question 19

Fluoroquinolones for respiratory infections

Answer 19

levo/moxi/gemifloxacin

not ciprofloxacin

Question 20

Fluroquinolones for anaerobic infection

Answer 20

moxifloxacin

Question 21

Metabolism of fluoroquinolones

Answer 21

cipro/levo/gemifloxacin by kidneys

moxifloxacin by liver

Question 22

Absorption of fluoroquinolones

Answer 22

inhibited by cations

forms complexes

Question 23

Fluoroquinolones for nosocomial pneumonia

Answer 23

ciprofloxacin

levofloxacin

Question 24

Fluoroquinolone for UTI

Answer 24

not moxifloxacin (liver metabolism)
cipro/levofloxacin

Question 25

Fluoroquinolones for skin infection

Answer 25

levo and moxifloxacin

Question 26

Adverse effects of fluroquinolones

Answer 26

``` QT prolongation tendonitis/ruptured tendons (cartilage deg) peripheral neuropathy (inhibits GABA in CNS) photosensitivity ```

Question 27

MOA of macrolides

Answer 27

attaches to 50s subunit of ribosome no protein synthesis bacteriostatic affinity for domain V of 23s RNA

Question 28

MOA of ketolides

Answer 28

binds 50s rRNA | binds domain V and domain II of 23s RNA

Question 29

Resistance to macrolides

Answer 29

decreased permeability/increased efflux (gram +) methylation of binding site (erm gene, gram +) hydrolyzation by esterases at lactone ring (ere gene)

Question 30

Absorption of macrolides

Answer 30

erythromycin is acid labile | others are acid stable

Question 31

Metabolism of macrolides

Answer 31

all by CYP3A4 except azithromycin clarithromycin has some renal excretion azithromycin has long t1/2

Question 32

Best macrolides for gram (+)

Answer 32

telithromycin/clarithromycin/erythromycin/azithromycin | in descending order of effectiveness

Question 33

Best macrolides for gram (-)

Answer 33

telithromycin/azithromycin/clarithromycin/erythromycin | in descending order of effectiveness

Question 34

Adverse effects of macrolides

Answer 34

QT prolongation myasthenia gravis liver failure (especially telithromycin) ototoxicity (erythromycin)

Question 35

Drugs contraindicated with macrolides

Answer 35

``` theophylline warfarin CCB's cyclosporine digoxin ```

Question 36

MOA of linezolid

Answer 36

binds 50s rRNA inhibits complex formation with fmet-tRNA/mRNA bacteriostatic no cross resistance

Question 37

Resistance to linezolid

Answer 37

mutation at binding site on 23s RNA

Question 38

Adverse effects of linezolid

Answer 38

thrombocytopenia | lactic acidosis

Question 39

Level I tx for strep pneumo

Answer 39

erythro/azithro/clarithromycin

Question 40

Level I tx for strep pneumo with comorbidities

Answer 40

respiratory fluoroquinolones OR | beta lactams + macrolides

Question 41

Level I tx for inpatient ICU-CAP

Answer 41

respiratory fluoroquinolones

Question 42

Tx for acute sinusitis

Answer 42

amoxicillin | TMP-SMX

Question 43

Tx for chronic sinusitis

Answer 43

clindamycin cefazolin or cefuroxime + metronidazole clarithromycin fluoroquinolones

Question 44

Tx for pharyngitis

Answer 44

penicillin G Benzathine (intramuscular) | penicillin V

Question 45

Antibiotics for COPD

Answer 45

TMP-SMX doxycycline azithro/clarithromycin

Question 46

Tx for penicillin resistant strep pneumo

Answer 46

doxycycline clindamycin levofloxacin

Question 47

Tx for legionnaires disease

Answer 47

tigecycline fluoroquinolones azithromycin

Question 48

Tx for MRSA caused pneumonia

Answer 48

linezolid vancomycin tigecycline