Overview of antimicrobials Part II, J Kinder, DSA

Question 1

MOA Fluoroquinolones

Answer 1

[ ] dependent, targets DNA gyrase and topoisomerase IV

Question 2

how does R form to fluoroquinolones

Answer 2

mutation in bacterial chromosome genes encoding DNA gyrase or topoisomerase IV or by active transport out of cell

Question 3

spectrum of coverage with FQ

Answer 3

E coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas, S aureus
limited Strep

Question 4

Therapeutic use of FQ

Answer 4

UTI, prostatitis, STI, travelers diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections, propylaxis in neutropenic patients

Question 5

Respiratory specific FQ cover what pathogens

Answer 5

S pneumoniae, H influenzae, Morazella, S aureus, M pneumoniase, C pneumoniae, Legionella

Question 6

Cipro covers what additional pathogen

Answer 6

pseudomonas

Question 7

What are the FQs

Answer 7

Cipro, levofloxacin, moxifloxicin

PO, IV, topical

Question 8

Adverse effects FQs

Answer 8

GI 3-17% (nausea, comiting
CNS: HA, dizziness, rare halucinations
rash photosensitivity
Achilles tendon rupture

Question 9

What are the aminoglycosides

Answer 9

gentamycin IV, IM, topical

Question 10

MOA aminoglycosides

Answer 10

[ ] dependent, bind 30S ribosomes and disrupt normal cycle of ribosomal function by interfering with protein synthesis

Question 11

how do aminoglycosides reach the site of action

Answer 11

diffusion through porin proteins in outer cell membrane of gram negative bacteria and electron transport/Oxygen dependent movement across cytoplasmic membrane

Question 12

What is the post antibiotic effect of aminoglycosides

Answer 12

residual bactericidal activity after serum [ ] below MIC

Question 13

how does R form to aminoglycosides

Answer 13

AG metabolizing enzymes, impaired transport of drug into cell, altered ribosomes

Question 14

Spectrum covered by aminoglycosides

Answer 14

aerobic gram - bacteria

if combined with B lactam of vancomycin then kill gram +

Question 15

Gentamycin is really active against what microbe

Answer 15

Serratia

Question 16

Therapeutic use AGs

Answer 16

UTI
if there is R to other agents
pneumonia, HAP, peritoniitis assoc with dialysis

Question 17

adverse effects of AGs

Answer 17

ototoxicity, nephrotoxicity, NMblock and apnea

Question 18

What are the tetracyclines and glycylcyclines

Answer 18

doxycycline PO IV

Question 19

MOA doxy

Answer 19

bacteriostatic, inhibits bacterial protein synthesis by binding 30S ribosomes and preventing access of aminoacyl tRNA to acceptro site on mRNA complex

Question 20

R to doxy occurs how

Answer 20

decreased influx, acquisition of energy dependent efflux, ribosomal protection proteins, enzymatic inactivation

Question 21

spectrum of doxy

Answer 21

wide range aerobic and anaerobic gram + and gram - activity as well as: Rickettsia, Coxeilla, Mycoplasma, Chlamydia spp, Legionella, Pasmodium, Borrelia, Treponema
B anthracic, Listeria, MRSA, H influenza, Helicobacter

Question 22

What is R to doxy

Answer 22

Pseudomonas spp

Question 23

Therapeutic use doxy

Answer 23

CAP, atypical CAP, community acquired SSTIs, community acquired MRSA, acne, Rickettsial infections(Rocky mountain spotted fever), Q fever, anthrax

Question 24

adverse effects doxy

Answer 24

GI (epigastric burining, abdominal discomfort, nausea, vomiting, diarrhea
superinfections of C difficile, photosensitivity, teeth discoloration, thrombophlebitis

Question 25

What are the macrolides/ketolids

Answer 25

Azithromycin PO IV

Question 26

MOA zpak

Answer 26

bacteriostatic, binds reversibly to 50S ribosomal unit | inhibits translocation where newly synthesized peptidyl tRNA molecule moves to donor site

Question 27

R to zpaks occur how

Answer 27

drug efflux, ribosomal protection proteins, hydrolysis, ribosomal mutations

Question 28

spectrum of zpaks

Answer 28

aerobic gram + cocci and bacilli | Clostridium perfringens, Corynebacterium diphteria, Listeria

Question 29

Therapeutic use of zpaks

Answer 29

respiratory tract infections, alternative for otitis media, sinusitis, bronchitis, SSTIs, Pertussis, gastroenteritis, H pylori, mycobacterial infections

Question 30

adverse effects of zpaks

Answer 30

GI: epigastric distress hepatotoxicity arrhythmia QT prolongation

Question 31

Drug interactions with zpaks

Answer 31

CYP3A4 inhibition | prolongs effects of digoxin, valproate, warfarin, others

Question 32

What are the lincosamides

Answer 32

Clindamycin PO, IV, IM topical

Question 33

MOA clinda

Answer 33

binds 50S and suppresses protein synthesis

Question 34

R to clinda

Answer 34

ribosomal methylation

Question 35

Spectrum clinda

Answer 35

penumococci, S pyogens, viridans, streptococci, MSSA, anaerobes like B fragilis

Question 36

What are R to clindamycin

Answer 36

all aerobic gram - bacilli

Question 37

Therapeutic uses of clinda

Answer 37

SSTIs, nectrotizing SSTIs, lung abscesses, anaerobic lung and pleural space infections, topically for acne vulgaris

Question 38

adverse effects of clinda

Answer 38

``` GI diarrhea pseudomembranous colitis skin rashes reversible increase in aminotransferase activity may potentiate neuromuscular blockade ```

Question 39

What are the streptogramins

Answer 39

quinipristin/dalfopristin (IV) | *non respiratory

Question 40

What are the oxazolidinones

Answer 40

Linezolid PO, IV

Question 41

MOA linezolid

Answer 41

inhibits proteins synthesis binding P of 50S subunits, preventing formatino of larger ribosomal fmet-tRNA complex that initiates protein synthesis

Question 42

R to linezolid occurs how

Answer 42

ribosomal mutations

Question 43

Spectrum of linezolid

Answer 43

gram + staphy and strep, enterococci, gram + anaerobic cocci and rods

Question 44

linezolid is bactericidal against what and bacteriostatic against what

Answer 44

bacteriocidal against strep | bacteriostatic against staphy and enterococci

Question 45

Therapeutic use of linezolid

Answer 45

CRE faecium, nosocomial pneumonia caused by MSSA and MRSA, CAP, complicated SSTI infections, uncomplicated SSTIS

Question 46

linezolid is reserved for what

Answer 46

multiple drug resistanc organisms

Question 47

adverse effects linezolid

Answer 47

myelosuppresion, minor GI complaints, HA, rash

Question 48

drug interactions with linezolid

Answer 48

weak nonspecific inhibitor monoamine oxidase, concomitant adrenergic or serotonergic may lead to serotonin syndrome (palpitations, HA, HTN crisis) short term use

Question 49

What are the polymyxins

Answer 49

Colistin and Polymyxin B | ** not respiratory

Question 50

What are the lipopeptides

Answer 50

daptomycin | ** not respiratory