FA macrolides/monobactam/metronidazole

Question 1

macrolides examples?

Answer 1

azithromycin, clarithromycin, erythromycin

Question 2

administration of macrolides?

Answer 2

p/os or i/v

Question 3

macrolides static or cidic?

Answer 3

static

Question 4

mechanism of macrolides?

Answer 4

bind to 23S ribosomal RNA molecule of the 50S subunit → blockage of translocation → inhibition of bacterial protein synthesis

Question 5

macrolides Route of elimination?

Answer 5

biliary

Question 6

macrolides for what pneumonia?

Answer 6

Atypical pneumonia caused by:
Mycoplasma pneumonia
Legionella pneumophila
Chlamydophila pneumoniae

Question 7

macrolides for what STI?

Answer 7

STIs caused by Chlamydia

Question 8

macrolides are replacement for what?

Answer 8

Gram-positive cocci especially for the treatment of streptococcal infection in patients who are allergic to penicillin)

Question 9

special indication for claritromycin?

Answer 9

H. pylori (clarithromycin is the part of triple therapy?

Question 10

what other m/os treated with macrolides?

Answer 10

Ureaplasma urealyticum;
bordetela pertussis;

Neisseria spp.:
Second-line prophylaxis for N. meningitidis
Dual therapy with ceftriaxone for N. gonorrhoeae (azithromycin)

Mycobacterium avium
Prophylaxis: azithromycin
Treatment: azithromycin, clarithromycin

Question 11

adverse of macrolides?

Answer 11

Adverse effects
Increased intestinal motility → GI upset
QT-interval prolongation --> arrhythmia
Acute cholestatic hepatitis
Eosinophilia
Rash
Increased risk of hypertrophic pyloric stenosis (erythromycin and azithromycin) in infants up to 6 weeks of age.

Question 12

macrolides actions on what enzyme?

Answer 12

INHIBIT P450

Question 13

macrolides increase concentraton of what?

Answer 13

teophyline and oral anticoagulants (warfarin).

Question 14

half life of macrolides?

Answer 14

All macrolides (except azithromycin) have a short half-life.

Question 15

macrolides mechanism of resistance?

Answer 15

Methylation of the binding site of 23S rRNA prevents the macrolide from binding to rRNA.

Question 16

macrolides in pregnant women?

Answer 16

contraindicated

Question 17

Nitroimidazoles agent?

Answer 17

metronidazole

Question 18

metronidazole administration?

Answer 18

p/os or i/v

Question 19

metronidazole static or cidal?

Answer 19

cidal

Question 20

metronidazole route of elimination?

Answer 20

renal

Question 21

metronidazole BBB penetration?

Answer 21

good

Question 22

metronidazole mechanism of action?

Answer 22

Creates free radicals within the bacterial cell → DNA-strand breaks → cell death (bactericidal and antiprotozoal effect)

Question 23

metronidazole covers what protozoa?

Answer 23

Certain protozoa: Entamoeba histolytica, Giardia, Trichomonas

Question 24

metronidazole what facultative anaerobes?

Answer 24

Gardnerella vaginalis

Helicobacter pylori in place of amoxicillin (e.g., in case of penicillin allergy) as part of a triple therapy regimen

Question 25

metronidazole anaerobes?

Answer 25

C. difficile, Bacteroides spp.

Question 26

metronidazole agains aerobes?

Answer 26

NOT EFFECTIVE

Question 27

metronidazole - most prominent adverse?

Answer 27

Disulfiram-like reaction: a systemic reaction occurs when metronidazole is consumed with alcohol Nitroimidazoles inhibit acetaldehyde dehydrogenase → accumulation of acetaldehyde → immediate hangover-like symptoms after ethanol intake Symptoms include flushing, tachycardia, and hypotension.

Question 28

what are adverse of metronidazole?

Answer 28

headache, disulfiram-like reaction, metatic taste, peripheral neuropathy, vestibular dysfunction

Question 29

metronidazoles for infections in relation to ,,diaphragma"?

Answer 29

metronidazole for anaerobic infections BELOW diaphragm (clindamycin - above)

Question 30

monobactams agent?

Answer 30

aztreonam

Question 31

aztreonam administration?

Answer 31

i/v

Question 32

aztreonam mechanism?

Answer 32

Specifically binds to PBP3: inhibits peptidoglycan cross-linkin PBP3 - penicillin binding protein 3

Question 33

clinical use of aztreonam for gram?

Answer 33

gram - only including nosocomial Pseudomonas, H. influenzae, and N. meningitidis not active agains gram + or anaerobes

Question 34

aztreonam in penicillin allergy?

Answer 34

Alternative for penicillin-allergic patients (no cross-sensitivity with penicillins)

Question 35

aztreonam as alternative for what?

Answer 35

Can be used as an alternative to aminoglycosides for patients with renal insufficiency because it is synergistic with aminoglycosides

Question 36

aztreonam broad spectrum in combination with what?

Answer 36

Broad-spectrum coverage in combination with vancomycin or clindamycin

Question 37

aztreonam adverse?

Answer 37

Adverse effects: rare, usually nontoxic GI upset Injection reactions Rash