Lecture 3

Question 1

What causes vancomycin resistant?

Answer 1

Alteration of binding site to D-ala-D-lac

Question 2

What does vancomycin cover?

Answer 2

MRSA and Clostridium

Question 3

What medications are used for C Dif?

Answer 3

Orał vanycomycin

Question 4

What do we need to do when we start giving Vancomycin?

Answer 4

Give a loading dose (for severe infections)
25-30mg/kg, to nearest 250mg increment
Monitor to adjust dose based on AUC
If not severe monitor adjust based on through levels

Question 5

When do we monitor when giving vancomycin?

Answer 5

When it is a severe MRSA infection such as…
Bacteremia
Infective endocarditis
Meningitis
Osteomyelitis
Pneumonia
Sepsis

Question 6

What are some adverse effects of vancomycin?

Answer 6

Hyperemia(red man syndrome)
Nephrotoxicity/ototoxicity

Question 7

How does one get red man syndrome from vancomycin?

Answer 7

Rapid infusion or high doses

Question 8

How do you avoid or treat red man syndrome?

Answer 8

Take slow infusions (1-2hours)
Pretreat with antihistamines

Question 9

What causes nephrotoxicity/ototoxicity in taking vancomycin?

Answer 9

Increasing daily dose >4g
Renal impairment
Elderly
Use in combination with aminoglycosides

Question 10

What do you need to monitor for nephrotoxicity/otoxicity?

Answer 10

BUN/Creatinine

Question 11

What are some alternative medications for MRSA infections other than vancomycin?

Answer 11

Televancin, Dalbavancin, Oritavancin (same class as vancomycin)
Daptomycin (good for VRE)
Lizolid

Question 12

Which alternatives to vancomycin are not effective against VRE?

Answer 12

Talavancin
Dalbavancin

Question 13

What is daptomycin?

Answer 13

DNA/RNA inhibitor
Not for pneumonia treatment

Question 14

How does linezolid work?

Answer 14

Inhibit bacterial protein synthesis

Question 15

What are the aminoglycosides?

Answer 15

Gentamicin
Tobramycin
Amikacin
Streptomycin

Question 16

What is the MOA for aminoglycosides?

Answer 16

Binds to 30S subunit inhibiting bacterial protein synthesis (bacteriostatic, bactericidal at high concentrations)
Post antibiotic suppression of bacterial growth

Question 17

What subunits are responsible for mRNA translation for protein synthesis within a cell?

Answer 17

30S and 50S

Question 18

What are ways bacteria can get resistance from aminoglycosides?

Answer 18

Chromosomal mutations
Enzymatic destruction of drug
Lack of permeability through cell wall
Efflux pumps(pumps out abx if entered in cell)

Question 19

What are aminoglycosides indicated for?

Answer 19

Gram -
Mycobacterium tuberculosis

Question 20

What are the BBW warning for aminoglcyosides?

Answer 20

Ototoxicity
Nephrotoxicity
Neuromuscular paralysis

Question 21

What pregnancy category is aminoglycosides?

Answer 21

D

Question 22

What are ways bacteria get resistance to Tetracyclines?

Answer 22

Active efflux of drug
Enzymatic deactivation

Question 23

What first line treatments are for tetracyclines?

Answer 23

Lyme disease
Rocky Mountain spotted fever
Cholera
Acne

Question 24

What other diseases are treated by tetracyclines?

Answer 24

Chlamydia infections
Empiric therapy for CAP

Question 25

What are the contraindications for tetracyclines?

Answer 25

Children <8-9 (teeth discoloration) Children <13 Pregnancy (hepatotoxicity, fetal affect)

Question 26

What do you NOT take with tetracyclines?

Answer 26

Antacids Dairy products

Question 27

What are SE of tetracyclines?

Answer 27

GI distress Hepatotoxicity Photosensitivity Vestibular problems(vertigo) especially with minocycline Candida infections, C Dif

Question 28

What are the macrocodes?

Answer 28

Erythromycin Azithromycin Clarithromycin

Question 29

What is the MOA?

Answer 29

Inhibits protein synthesis and translation needed to replication 50S subunit (bacteriostatic)

Question 30

What are ways bacteria can build resistance against macrocodes?

Answer 30

50S subunit target modifcation Efflux pumps Degradation enzymes

Question 31

What are the first line treatments for macrolides?

Answer 31

Community acquired pneumonia Increasing resistance with strep Atypicals: mycoplasma, chlamydia legionella Diphtheria COPD

Question 32

What are the 2nd line treatments for macrolides?

Answer 32

OM Pharyngitis

Question 33

What is the PK of macrolides?

Answer 33

Metabolized by liver: CYP450 inhibitor (not azithromycin) Eliminated in bile Use with caution in liver impairment

Question 34

What are the adverse effects of macrolides?

Answer 34

GI: N/D, C dif Hepatotoxicity Prolonged QT interval Ototoxicity(transient) Pregnancy Category B

Question 35

What are possible routes for clindamycin?

Answer 35

Capsulse IV/IM Vaginal cream/supp

Question 36

What is the BBW for clindamycin?

Answer 36

C dif

Question 37

What are the SE of clindamycin?

Answer 37

Diarrhea Nausea Skin rashes Pregnancy category B

Question 38

What are types of quinolones?

Answer 38

Ciprofloxacin Levofloxacin Moxifloxacin

Question 39

What is the MOA of quinolones?

Answer 39

Inhibits DNA gyrase and topoisomerase IV(bactericidal)

Question 40

Clinically, what significant use are the quinolones for?

Answer 40

Cipro is good for the belly button down Levo and moxi are good for belly button up

Question 41

What are the first line treatments for quinolones?

Answer 41

Otitis externa, ophthalmic infections Pheylonephritis Prostatitis Traveler's diarrhea/infectious diarrhea Anthrax URI's/Pneumonia with commorbitidies

Question 42

What is the BBW for quinolones?

Answer 42

Tendinitis/Tendon rupture?

Question 43

What are the SE of quinolones?

Answer 43

GI distress Nephrotoxicity Lowers seizure threshold C dif HA/dizziness Hepatotoxicity Alterations in glucose level Photosensitivity

Question 44

What is the MOA for Trimethoprim/Sulfamethoxazole (Bactrim)?

Answer 44

Trimethoprim: folate reeducates inhibitor, inhibits bacteria AA synthesis Sulfamethoxazole: folate synthesis inhibitor (bacteriostatic)

Question 45

What is the MOA for Trimethoprim/Sulfamethoxazole (Bactrim)?

Answer 45

Trimethoprim: folate reeducates inhibitor, inhibits bacteria AA synthesis Sulfamethoxazole: folate synthesis inhibitor (bacteriostatic)

Question 46

When do we use Bactrim or vancomycin for MRSA?

Answer 46

Bactrim for mild cases Vancomycin for serious cases

Question 47

What is CI for Trimethoprim/Sulfamethoxazole (Bactrim)?

Answer 47

Sulfa allergy

Question 48

What are the SE of Trimethoprim/Sulfamethoxazole (Bactrim)?

Answer 48

Megaloblastic anemia (folic acid def.) GI distress: N/V/D Photosensitivity Hepatotoxicity Pregnancy category C

Question 49

What are the types of nitrofurantoin?

Answer 49

Macrobid/Macrodantin

Question 50

What drug treats simple cystitis and is safe for pregnancy?

Answer 50

Cephalexin (Keflex), 1st gen

Question 51

What do you not take with Metronidazole (flagyl)?

Answer 51

Alcohol Causes disulfiram-like reaction

Question 52

What do you not take with Metronidazole (flagyl)?

Answer 52

Alcohol Causes disulfiram-like reaction

Question 53

What is silver sulfadiazine (silvadene)

Answer 53

Folate synthesis inhibitor Topical cream for burns

Question 54

What is Bacitracin?

Answer 54

Polypeptide Use for Gram + Topical application only due to nephrotoxicty

Question 55

What is chloramphenicol?

Answer 55

Misc Synthetic abx Broad spectrum (G-,G+, anaerobes) Rarely used too dangerous (hematologic toxicity)

Question 56

What do you do to choose the abx for treatment?

Answer 56

Empiric treatment and get narrowest spectrum of activity Consider... Resistance, cost, dosage, I/CI Pt compliance and education