Exam 3 - Fluoroquinalones, Antifolates, and Other Antibiotics

Question 0

UTI and prostate infection
Pneumocytis jiroveci
CA-MRSA
Gram -, enterobacteriaceae

Answer 0

Trimethoprim-sulfamethaxazole (TMP-SMX)

Question 1

UTIs in sulfa-allergic patients (prevention and treatment)

Answer 1

Trimethoprim

Question 2

2C9 inhibitor (significant interaction w/ Warfarin)

Answer 2

Trimethoprim-sulfamethoxazole

Question 3

Adverse effects of sulfa drugs

Answer 3

• Megaloblastic anemia
• Photosensitivity
• Hyperkalemia

Question 4

Adverse effects: crystalluria, Steven-Johnson Synrome (life threatening skin condition)

Answer 4

TMP-SMX

Question 5

Drug interaction of sulfonamides w/ phenytoin

Answer 5

increased plasma levels leading to toxicity

Question 6

Inhibits bacterial DNA-type II topoisomerase (DNA gyrase), inhibits resealing of DNA

Answer 6

Fluroquinolones - primary target for gram negative

Question 7

Inhibits DNA-type IV topoisomerase which stops bacterial cell dividion

Answer 7

Fluoroquinolone - primary target for gram positive

Question 8

Fluoroquinolones spectrum

Answer 8

ALL EFFECTIVE AGAINST:
GRAM NEGATIVE - H. influenzae, M. Catarrhalis, Enterobacteriaceae
ATYPICAL

Gram positive - S. pneuomoniae (except Ciprofloxacin)

ACID FAST BACILLI
ANAEROBES (ABDOMINAL INFECTIONS)

Question 9

Fluoroquinolones pharmacokinetics

Answer 9

• concentration dependent killing, postantibiotic effect
• RENALLY ELIMINATED (EXCEPT MOXIFLOXACIN)
• Inhibits CYP 450

Question 10

• Avoid drugs that prolong QT interval

Answer 10

Fluoroquinolones

Question 11

Increase Warfarin levels

Answer 11

Fluoroquionolones adverse effects

Question 12

Potentiates effect of sulfonylureas - blood sugar in diabetics, stimulates pancreas to make insulin

Answer 12

Fluoroquionolones adverse effects

Question 13

Antacids, iron, zinc, sucralfate, calcium inhibit the absorption of ….

Answer 13

Fluoroquionolones adverse effects

Question 14

Ciprofloxacin

Answer 14

EXCEPTION OF FLUROQUINOLONES: NO ACTIVITY AGAINST S. PNEUMONIA

Activity against PSEUDOMONAS

Question 15

Fluroquinolones that have activity against Pseudomonas

Answer 15

Ciprofloxacin

Levofloxacin

Question 16

Moxifloxacin

Answer 16

ANAEROBES

NOT RENALLY ELIMINATED - NOT USED FOR UTI

Question 17

Nitrofurantioin spectrum

Answer 17

Gram positive - Staphylococcus saprophyticus (UTI pathogen)

Gram negative - E. coli, Klebsiella, Citrobacter (UTI pathogens)

Question 18

Agent used only for the treatment and prevention of UTI; may cause pulmonary fibrosis

Answer 18

Nitrofurantoin

Question 19

Do not use w/ CrCl less than 50 ml/min, may build up and cause accumulation
RAPIDLY RENALLY EXCRETED

Answer 19

Nitrofurantoin

Question 20

N&V
Pulmonary fibrosis
Acute pnesumonitis
Neuropathies
HEMOLYTIC ANEMIA (RBCs GET BROKEN DOWN)

Answer 20

Nitrofurantoin

Question 21

Spectrum:
MRSA
Vancomycin-sensitive enterococci

Answer 21

Daptomycin

Question 22

CPK elevations (myopathy, rhabdomyolosis)
*caution w/ statins

Answer 22

Daptomycin

Question 23

Nonabsorbed, oral antibiotic (stays in the gut)

Answer 23

Rifaximin

Question 24

Reduce ammonia-producing enteric bacteria

Answer 24

Rifaximin

Question 25

Indicated for Traveler's diarrhea

Answer 25

Rifaximin

Question 26

Indicated for prevention of hepatic encephalopathy (worsening brain function occurs when liver is no longer able to remove toxic substances in the blood) - recurrence in patients w/ advanced liver disease

Answer 26

Rifaximin