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Pharm Exam 2 Overview Flashcards

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1
Q

What are the four factors that are unique to chemotherapy

A
  1. Selective toxicity
  2. Selects for resistant strains
  3. Hypersensitivity and toxicity are potential problems
  4. Lowers the microorganism load so that the hosts defense mechanism can rid the body of foreign organisms
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2
Q

What type of resistance transmission uses a bacteriophage?

A

Transduction

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3
Q

What type of resistance transmission uses genetic information from the environment?

A

Transformation

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4
Q

What type of resistance transmission uses direct contact through a sex pilus?

A

Conjugation

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5
Q

What is the mechanism of action of all bactericidal agents?

A

Inhibit cell wall/DNA synthesis

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6
Q

What is the mechanism of action of most bacteriostatic agents?

A

Inhibit protein synthesis

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7
Q

What is the clinical importance of post antibiotic effect?

A

Less frequent doses and therefore less potential for side effects

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8
Q

What are the 2 most used natural penicillins?

A 
Penicillin G (IV)
Penicillin V (oral)
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9
Q

Natural Penicillins
What is the spectrum of coverage?
What are they DOC for?

A

G+++
G+ infections
Strep pneumonia
Meningitis

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10
Q

What are the penicillin resistant penicillins?

A

Nafcillin (IV)
Dicloxacin (oral)
Oxacillin (oral)

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11
Q

Penicillin Resistant Penicillins
What is the spectrum of coverage?
What are they DOC for?

A

G++/G- (resistant to penicillinase)

MSSA

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12
Q

What are the extended spectrum penicillins?

A

Ampicillin (oral)

Amoxicillin (oral)

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13
Q

Extended Spectrum Penicillins
What is the spectrum of coverage?
What are they DOC for?

A

G+/G—
Listeria
H. pylori (or Metronidazole)
Amoxocillin: EARLY stage Borrelia burgdorferi (or doxycycline)

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14
Q

What is a possible side effect of the Extended Spectrum Penicillins? Does it preclude future use?

A

Ampicillin rash, NOT a hypersensitivity rash and does not preclude future use

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15
Q

What are the antipseudomonal penicillins?

A

Pipercillin (IV)

Ticarcillin (IV)

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16
Q

Antipseudomonal Penicillins
What is the spectrum of coverage?
What are they DOC for?

A

G+/G—

P. aeruginosa (in combo with an aminoglycoside), Acinetobacter

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17
Q

Which agents can be combined with b-lactamase inhibitors to extend their spectrum?

A

Ampicillin, Amoxicillin, Pipercillin, and Ticarcillin

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18
Q

What are the b-lactamase inhibitors that Ampicillin, Amoxicillin, Pipercillin, and Ticarcillin can be combined with to extend their spectrum?

A

Clavulanic acid, Sulbactam, and Tazobactam

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19
Q

What is the main adverse reaction for all penicillins?

A

Hypersensitivity

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20
Q

Are penicillins bactericidal or bacteriostatic? What is their MOA?

A

Bactericidal
B-lactam ring binds to the active site of penicillin binding proteins (PBPs) preventing transpeptidation reaction. Bacteria produces remodeling enzymes called autolysins, which allows their synthesis to proceed without cell-wall repair; eventually leading to lysis
MUST HAVE ACTIVELY GROWING CELLS

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21
Q

Are cephalosporins bactericidal or bacteriostatic? What is their MOA?

A

Bactericidal

B-Lactam (same as penicillin)

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22
Q

What is an advantage that cephalosporins have over penicillins?

A

Increased resistance to b-lactamase

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23
Q

What are the 1st generation cephalosporins?

A

Cafazolin (IV)

Cephalexin (oral)

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24
Q

1st Generation Cephalosporins
What is the spectrum of coverage?
What are they DOC for?

A

G++/G- (narrow spectrum)
Cafazolin- surgical prophylaxis
Proteus, E. coli, Klebsiella
*PEK

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25
What is the most common 2nd generation cephalosporin?
Cefaclor (oral)
26
2nd Generation Cephalosporins What is the spectrum of coverage? What are they DOC for?
G+/G-- (intermediate spectrum) Proteus, E. coli, Klebsiella (PEK) Moraxella
27
What are the 3rd generation cephalosporins?
Ceftriaxone (IV, IM) Ceftotaximine sodium (IV, IM) Cefazidime (IV, IM) Cefixime (oral)
28
3nd Generation Cephalosporins What is the spectrum of coverage? What are they DOC for?
G+/G--- (broad spectrum) Ceftriaxione- CNS penetration, N. gonorrhoeae, LATE stage Borrelia burgdorferi, Salmonella Ceftotaxime- CNS penetration Cefazidime- Antipseudomonal with aminoglycosides (IF penicillin allergy) Moraxella
29
What are the contraindications of 3rd generation cephalosporins?
Neonates, bilirubin displacement, pseudolithiasis
30
What is the 4th generation cephalosporin?
Cefepime (IV)
31
4th Generation Cephalosporin What is the spectrum of coverage? What are the DOC for?
G+/G--- (Broad spectrum- MOST normal flora changes) Antipseudomonal Only used for serious infections Empirical therapy when B-lactamases are anticipated
32
What is the 5th generation cephalosporin?
Ceftaroline fosamil (IV)
33
5th Generation Cephalosporin What is the spectrum of coverage? What are the DOC for?
Binds to mutated PBP that other b-lactams cannot bind to; MRSA and VRSA
34
What are the main adverse reactions for all cephhalosporins (3)?
1. Dilsulfiram-like reaction with alcohol consumption (Metronidazole) 2. Allergy: 10% cross sensitivity with penicillins 3. Does-dependent renal tubular necrosis; do not give to patients with decreased kidney function
35
What are the four groups of B-lactam agents?
1. Penicillins 2. Cefalosporins 3. Monobactams 4. Carbapenems
36
What class is aztreonam in?
Monobactam
37
What is the coverage of aztreonam?
ONLY Aerobic G-, including pseudomonas
38
What is important about the cross sensitivity of aztreonam?
No cross sensitivity with other b-lactam agents (good option for pts with penicillin allergy)
39
What type of agents are Imipenem + Cilastin and Meropenem?
Carbapenems
40
What is the coverage of Imipenem + Cilastin and Meropenem?
Anaerobes, G+, G- (broad spectrum)
41
What are carbapenems DOC for?
Enterobacter
42
What are contraindications/ possible adverse reactions of carbapenems?
Seizures: do not give to pts with head trauma (meropenem less likely) Do not give Imipenem to pts with decreased kidney function
43
Why is imipenem always given with cilastin?
Imipenem is inactivated by renal dihydropepdidases and must be given with cilastatin, a dihydropeptidase inhibitor.
44
How are monobactams and carbapenems given?
IV
45
What is MOA of vancomycin?
Binds to D-ala-D-ala (NOT PBPs); cell wall inhibitor= CIDAL
46
What is the coverage of vancomycin?
ONLY G+
47
What is IV vancomycin DOC for? | What is oral vancomycin DOC for?
IV: MRSA Oral: C. diff Drug of last resort for everything else because of vancomycin resistant enterocooi
48
What are the main adverse reactions of vancomycin?
Ototoxicity Nephrotoxicity Redman syndrome
49
What is the MOA for Fosfomycin? What is the coverage?
Prevents NAG to NAM reduction; cell wall inhibitor=CIDAL | G+, G-
50
What is the MOA for Bacitracin?
Interferes with dephosphorylation; prevents NAG-NAM transport; cell wall inhibitor=CIDAL
51
What is the coverage of Bactracin?
G+
52
What is Bactracin DOC for?
Combined with polymyxin and neomycin to treat superficial skin infections
53
What classes of protein synthesis inhibitors bind to the 50S subunit?
``` Macrolides Ketolides Clindamycin Streptogramins Oxazolidinones Chloramphenicol "50 Men Kiss Cute Strippers On Couches" ```
54
How do protein synthesis inhibitor resistant microbes form?
Efflux pumps | Methylation of ribosome binding site
55
What abx are in the macrolide class?
Erythromycin Clarithromycin Azithromycin
56
What are the macrolides DOC for?
Mycoplasma pneumoniae, Chlamydia
57
What are the most common adverse reactions of macrolides?
Diarrhea QT prolongation Drug interactions
58
Which macrolide does not inhibit CYP3A4? What advantage does this provide?
Azithromycin | Least drug interactions
59
Which macrolide has the most GI effects? | Which macrolide has the least GI effects?
``` Most = Erythromycin Least = Clarithromycin ```
60
What abx is in the ketolide class?
Telithromycin (oral)
61
How do ketolides differ from macrolides?
Ketolides bind to two sites on ribosomal RNA | macrolides are used before ketolides because ketolides can cause hepatoxicity
62
What is clindamycin the DOC for?
Clostridia, streptococcus, staphylococcus, toxic shock syndrome, and osteomyelitis "Catherine clearly should stop taking opiods"
63
What is the main adverse reactions of clindamycin?
Pseudomembranous colitis
64
What should you do if a patient on clindamycin begins to have C. diff symptoms?
Immediately stop clindamycin and initiate oral vancomycin
65
Which 50S protein synthesis class is synergistically CIDAL?
Streptogramins (Dalfopristin and Quinupristin)
66
If Dalfopristin and Quinupristin both target the 50S ribosome, why can be administered together?
They work at different times; Dalfopristin binds first and increases the affinity for Quinupristin
67
What infections are Streptogramins (Dalfopristin and Quinupristin) approved for?
VRE MSSA MRSA
68
What is the most common adverse reaction to Streptogramins (Dalfopristin and Quinupristin)?
Inhibit P450s metabolizing system (CYP3A4) = metabolic interactions (warfarin, diazapam)
69
What are contraindications to Streptogramins (Dalfopristin and Quinupristin)?
Breast feeding Children Hepatic disease Pregnancy
70
What abx is in the Oxazolidinones class?
Linezolid
71
What infections are Oxazolidinones (Linezolid) approved for?
VRE | MRSA
72
What class of protein synthesis inhibitor works as a reversible, nonselective MAO inhibitor?
Oxazolidinones (Linezolid)
73
What drug/food interactions should you consider with oxazolidinones (Linezolid)?
MAO inhibitors Tricyclic antidepressants SSRIs Tyramine rich foods (cheese, pork, smoked/picked foods)
74
What classes of protein synthesis inhibitors bind to the 30S subunit?
Aminoglycosides Tetracyclines Glycylcyclines
75
Which 50S protein synthesis inhibitor class is CIDAL?
Aminoglycosides
76
What is the MOA for the Aminoglycosides?
Irreversible | Require O2 for active transport into the cell
77
What abx are in the Aminoglycoside class?
``` Streptomycin (IV) Gentamicin (IV) Tobramycin (IV) Amikacin (IV) Neomycin (oral) ```
78
What is the spectrum of coverage for the Aminoglycosides?
Aerobic G-
79
What is streptomycin DOC for?
Tularemia Bubonic Plague Tuberculosis Endocarditis
80
What are Gentamicin, Tobramycin, and Amikacin DOC for?
P. aeruginosa (in combo with Antipseudomonal Pen)
81
What is neomycin DOC for?
Entercoccus (in combo with pen)
82
Which Aminoglycosides are DOC for topical wounds and burns?
Neomycin and Gentamicin
83
How does Aminoglycoside resistance occur?
1. Deficiency of ribosomal receptors 2. Lack of permeability 3. Enzymatic modification
84
What are possible adverse effects of Aminoglycosides?
Ototoxicity Nephrotoxicity (Time and concentration dependent)
85
How should Aminoglycosides be prescribed and why?
Single large dose! Aminoglycosides have a post abx effect so they work better with a megadose and it reduces toxic side effects
86
What are the broad spectrum antibiotics?
Chloramphenicol Tetracyclines Glycylcyclines
87
Which abx has the best CNS penetration?
Chloramphenicol
88
What is Chloramphenicol approved for treatment of?
``` Typhoid fever Meningitis Rickettsia Brucellosis Bacterial conjunctivitis ```
89
What are possible adverse effects of Chloramphenicol?
Fetal aplastic anemia Gray baby syndrome Bone marrow supression
90
How does Chloramphenicol resistance occur?
Microbe produces acetyl transferase
91
What abx are in the Tetracycline class?
Tetracycline (oral) Doxycycline (oral) Minocycline (oral)
92
What are the Tetracyclines DOC for?
``` Cholera Mycoplasma pneumonia (or erythro) Chlamydia (or azithro) Rickettsia EARLY stage Borrelia burgdorferi (or amoxicillin) Vibrio species ```
93
What are possible adverse effects of Tetracyclines?
Chelation with Ca, Fe, Al (no milk or multivitamin) Deposit in bone and teeth Normal flora changes Photosensitivity
94
What are contraindications of Tetracyclines?
Pregnancy | < 8 years old
95
What abx is in the Glycylcycline class?
Tigecycline (IV)
96
What is an advantage of the Glycylcyclines over the Tetracyclines?
Glycylcyclines have activity against Tetracycline resistant organisms
97
What is Tigecycline approved for treatment of?
MRSA MRSE PRSP VRE
98
How does resistance to Tetracycline occur? How does this effect Doxycycline and Minocycline?
Efflux pumps | No cross resistance with doxycycline or minocycline
99
What abx are in the Fluoroquinolone class?
``` Ciprofloxacin (oral) Ofloxacin (oral) Levofloxacin (oral) Moxifloxacin (oral) Gemifloxacin (oral) Gatifloxacin (solution) ```
100
What is the coverage of the Fluoroquinolone class?
Aerobic G-, Good G+
101
What Fluoroquinolone abx also has coverage against pseudomonas?
Ciprofloxacin (oral)
102
What Fluoroquinolone abx also have coverage against anaerobes?
Moxifloxacin (oral) | Gemifloxacin (oral)
103
What is the MOA for the Fluoroquinolone class?
Inhibit DNA synthesis via inhibition of DNA gyrase
104
How does resistance to the Fluoroquinolone class occur?
DNA gyrase mutation | Reduced membrane permeability
105
Is the Fluoroquinolone class CIDAL or STATIC?
CIDAL
106
What is Ciprofloxacin (oral) DOC for?
Anthrax | 2nd DOC for UTI
107
What is Ofloxacin (oral) DOC for?
Prostatis
108
What is Levofloxacin (oral) DOC for?
Community acquired pneumonia
109
What are possible adverse effects of the Fluoroquinolone class?
QT prolongation Tendon rupture Photosensitivity
110
What are contraindications of the Fluoroquinolone class?
Pregnancy Breast feeding Children <18
111
What is the MOA for Metronidazole?
Inhibit DNA synthesis
112
What is the coverage of the Metronidazole class?
Anaerobe G+, G-
113
What is Metronidazole DOC for?
H. pylori (extended spec pen) | 2nd DOC for C. diff (oral vancomycin)
114
What are possible adverse reactions to Metronidazole?
Disulfiram-like reaction (cephalosporins) | Disgeusia
115
What are the UTI specific drugs?
Nitrofurantoin (oral) | Methenamine (oral)
116
What is the MOA of Nitrofurantoin (oral)?
Damages bacteria DNA
117
What is the MOA of Methenamine (oral)?
Decomposes formaldehyde and ammonia
118
What is unique about resistance to Methenamine (oral)??
Bacterial resistance to formaldehyde does not develop
119
What is the coverage of the UTI specific drugs, Nitrofurantoin and Methenamine?
G+, G-
120
The UTI specific drugs, Nitrofurantoin and Methenamine, are ___ dependent and are only therapeutic in the ____.
Concentration | Urine
121
What are possible adverse reactions to Nitrofurantoin?
Colors urine brown Hemolytic anemia (G6PD deficiency) Pulmonary fibrosis
122
What are contraindications to Nitrofurantoin?
Decreased kidney function Pregnancy Neonates
123
What are contraindication to Methenamine?
Decreased kidney function | Decreased liver function
124
What is the coverage of Streptogramins?
ONLY G+ aerobic
125
What is the coverage of Oxazolidinones?
ONLY G+ aerobic
126
What classes work on anaerobes?
``` Without: Anaerobes a CAR: Carbapenems (c)LINDA: Clindamycin PENS: Penicillin her GEMini: Gemifloxacin sign on the MOving: Moxifloxacin METRO: Metronidazole Door: Daptomycin ```
127
What is the MOA of the Sulfonamide class?
Compete with PABA to inhibit Folic Acid Synthesis
128
Are Sulfonamides STATIC or CIDAL?
STATIC | ***Except Sulfamethoxazole + Trimethoprim (Bactrim) are CIDAL in the urine
129
How does resistance to the Sulfonamide class occur?
1. Increased PABA production 2. Efflux pumps 3. Alternative pathway for synthesis of folic acid
130
What is the coverage of the Sulfonamide class?
G+, G-
131
What is Sulfamethoxazole + Trimethoprim (Bactrim) DOC for?
First attack UTI
132
What are secondary options for UTI treatment?
Ciprofloxacin Nitrofurantoin Methenamine Fosfomycin
133
What are the Sulfonamides in gereneral DOC for?
``` Moraxella PEK Samonella Vibro species Burkholderia Nocardia ```
134
What are possible treatment options of CAP
``` Penicillin Levofloxacin Macrolides Tetracyclines Ketolides ```
135
What are possible adverse effects of the Sulfonamide class?
``` Aplastic anemia (G6PD deficiency) Photosensitivity Hypersensitivity Drug sensitivity SJS Kernicterus ```
136
What are contraindication to the Sulfonamide class?
Pregnancy Breast feeding Jaundiced infants <2 months
137
Which classes cause anemias (3)?
Sulfonamide and Chloramphenicol= Aplastic anemia | Nitrofurantoin= Hemolytic anemia
138
Which classes cause ototoxicity and nephrotoxicity (2)?
Aminoglycosides and Vancomycin
139
Which classes cause hypersensitivty (2)?
Penicillins and Sulfonamides
140
Which classes are contraindicated in decreased kidney function (5)?
``` Imipenem Vancomycin Aminoglycosides Nitrofurantoin Methenamine Cephalosporins ```
141
Which classes cause photosensitivity (3)?
Tetracyclines Fluoroquinolones Sulfonamides
142
Which classes are contraindicated in pregnancy (5)?
``` Tetracyclines Nitrofurantoin Fluoroquinolones Streptogramins Sulfonamides ```
143
Which classes are contraindicated in children (3)?
Streptogramins (children) Tetracyclines (<8 yrs) Fluoroquinolones (<18 yrs)
144
Which classes cause QT prolongation (2)?
Macrolides and Fluoroquinolones
145
What is the MAO for Daptomycin (IV)?
Bind to membrane causing rapid depolarization; CIDAL
146
What is the coverage of Daptomycin (IV)?
G+ aerobic and anaerobic
147
What is Daptomycin (IV) used for?
Empiric therapy for serious G+ infections (alternative to vancomycin)
148
What is the MAO for Mupirocin (topical)?
Binds to Isoleucyl-tRNA synthetase to inhibit protein and RNA synthesis
149
What is the coverage of Mupirocin (topical)?
G+, G-
150
What is Mupirocin (topical) used for?
Impetigo | Intranasal for MRSA
151
What is the MOA for Polymyxin B/E?
Bind to cell membrane phospholipid (lipid A endotoxin)
152
What is the coverage of Polymyxin B/E (topical)?
G-
153
What can be used to treat VRE?
Streptogramins (Dalfopristin + Quinupristin) Oxazolidinones (Linezolid) Glycylcylines (Tigecycline)
154
Which classes are contraindicated in infants (4)?
3rd Gen Cefalosporins (neonates- bilirubin displacement) Nitrofurantoin (<1 month) Sulfonamides (<2 months) Chloramphenicol (grey baby syndrome)
155
If a patient doesn't want a ceftriaxone injection for N. gonorrhoeae, what can you give them?
Cefixime (oral)
156
What classes absorption can be effected by Ca, Fe, Al, or Mg?
Tetracyclines and Fluoroquinolones

Pharmacology (25 decks)

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