Protein Synthesis inhibitors- Macrolides, tetracyclines

Question 1

List the Macrolides

Answer 1

Azithromycin
Clarithromycin
Erythromycin

Question 2

Are macrolides bacteriostatic or Bacteriocidal?

Answer 2

Bacteriostatic, may be cidal in very high doses

Question 3

Covers which gram pos cocci (this is an alternative for pen-allergic pt)

Answer 3

Strep pneumo, strep pyo (pneumonia, pharyngitis)

Question 4

Covers which gram neg cocci

Answer 4

M. Catt (otitis media, community aquired pnuemonia)

Question 5

Covers which gram neg bacilli

Answer 5

bordatella pertussis (ALL), H. Flu (Az and Cl), H. Pylori (Cl) Leigionella (Az)

Question 6

Covers which gram pos bacilli

Answer 6

diptheria (e-mycin)

Question 7

Macrolides are distributed into the brain and CSF (true or False)

Answer 7

False, widely distributed everywhere else. It even penetrates the placenta and enters the fetus

Question 8

Erythromycin is metabolized via the _____

a. Kidneys
b. Liver

Answer 8

b. it is metabolized by the liver and excreted by bile. Would probably need to be dosed differently for those with liver disease

Question 9

Clarithromycin is metabolized by_______

Answer 9

Kidneys

Question 10

_______ is not metabolized at all. it has high tissue penetration.

Answer 10

Azithromycin

Question 11

A serious side effect of macrolides is that they can

a. cause QT prolongation
b. can abort a fetus
c. cause poisoning

Answer 11

a. QT prolongation: DO NOT give with other meds that have this side effect as well.

Question 12

A few medication known to have drug -drug intactions with macrolides (except azitrhomycin)

Answer 12

theophylline, warfarin, methylprednisolone, cyclosporine, SSRIs, benzodiazepines.

Question 13

List the tetracyclines

Answer 13

Doxycycline, Minocylcine, Tetracycline

DMT

Question 14

Are tetracyclines bacteriostatic or bacteriocidal?

Answer 14

Bacteriostatic

Question 15

When resistance to tetracyclines occur what is an option?

Answer 15

Tigacycline, it is not affected by the same mechanisms of resistance as the others are.

Question 16

What is the spectrum of tetracyclines

a. gram neg
b. gram pos
c. broad spectrum

Answer 16

These are broad spectrum but this has led to wide spread resistance due to over use

Question 17

The gram pos cocci that are not resistant to tetracyclines

Answer 17

Staphylococcus aureus (MRSA): localized cutaneous infection, pneumonia, food poisoning (doxy, mino, tige)

Question 18

The gram neg cocci that are not resistant to tetracyclines

Answer 18

Moraxella catarrhalis –> otitis media, community-acquired pneumonia [Doxycycline]

Question 19

The gram pos bacillus that is not resistant to tetracyclines

Answer 19

Bacillus anthracis – anthrax [Doxycycline]

Question 20

The gram neg bacilli that is effective against tetracyclines

Answer 20

H. influenzae – otitis media, community-acquired pneumonia [Doxycycline]
H. pylori – peptic ulcers [Tetracycline]
Vibrio cholerae – cholera [Doxycycline]

Question 21

Anaerobes treated with tetracyclines

Answer 21

Propionobacterium acnes (gram + rod) – acne [Minocycline, Doxycycline]

Question 22

Atypical organisms treated by tetra cyclines

Answer 22

Chlamydia -trachoma, community-acquired pneumonia, urethitis [Doxycycline]
Mycoplasma pneumoniae – community-acquired pneumonia [Doxycycline]
Richettsia – Rocky Mountain spotted fever, Q fever [Doxycycline]

Question 23

Spirocetes treated with tetracyclines

Answer 23

Borrelia burgdorferi – Lyme disease (early) [Doxycycline]

Question 24

Most of the tetracyclines are best absorbed on an______ stomach

Answer 24

empty

Question 25

what dietary choice hinders the absorption of tetracyclines?

Answer 25

dairy products

Question 26

Which tetracycline is the choice for patients with renal disease or are breast feeding?

Answer 26

Doxy

Question 27

Most of them are excreted into the urine except for which two?

Answer 27

Doxy and mino

Question 28

Tetracyclines are concentrated in the ________. For this reason you need to try to avoid for those with hepatic impairment

Answer 28

Liver

Question 29

You have an 8 year old pateint you notice that his teeth are a gray color. You suspect that he was given a course of ________ when he was younger

Answer 29

Tetracyclines. for this reason they should not be given to children under 8 or to women in the second half of pregnancy.. They cause a temporary depression of bone growth

Question 30

Some drug - drug interactions to consider with tetracyclines

Answer 30

 Antacids / Iron Supplements  Phenytoin / Barbiturates / Carbamazepine  Oral Anticoagulants