Week 2 Drug List: Antibiotics

Question 1

What classes of drugs are Beta-Lactams?

Answer 1

Penicillins
Cephalosporins

Question 2

What are 4 drugs in the Penicillin subclass?

Answer 2

Penicillin V (PO)
Penicillin G (IM)
Amoxicillin
Amoxicillin/Clavulanate

Question 3

What 2 drugs are in the 1st-generation Cephalosporin subclass?

Answer 3

Cephalexin
Cefazolin (IM/IV)

Question 4

What drug is in the 2nd-generation Cephalosporin subclass?

Answer 4

Cefuroxime

Question 5

What 3 drugs are in the 3rd-generation Cephalosporin subclass?

Answer 5

Cefdinir
Cefpodoxime
Ceftriaxone (IM/IV)

Question 6

Name 2 Fluoroquinolones

Answer 6

Ciprofloxacin
Levofloxacin

Question 7

What drug has a high potential to cause severe diarrhea and C.diff?

Answer 7

Clindamycin

Question 8

Name 3 Macrolides

Answer 8

Azithromycin
Erythromycin
Clarithromycin

Question 9

Name an Oxazolidanone

Answer 9

Linezolid

Question 10

Sun sensitivity is significant with which drug class?

Answer 10

Tetracyclines (Doxycycline and Tetracycline)

Question 11

Which drugs have a higher number of drug interactions due to being strong inhibitors of the CYP enzymes?

Answer 11

Erythromycin
Clarithromycin
(Both Macrolides)

Question 12

What drugs should be stopped while taking Erythromycin and Clindamycin, and what is the risk if continued?

Answer 12

HMG-CoA Reductase Inhibitors (Statins)

Risk of severe myopathy or rhabdomyolysis

Question 13

In which drug classes do dairy products/antacids interfere with GI absorption?

Answer 13

Fluoroquinolones
Tetracyclines

Question 14

What drug class is Vancomycin Oral in?

Answer 14

Glycopeptides

Question 15

What is the drug treatment of C. diff?

Answer 15

Oral Vancomycin (Poor oral absorption)

Question 16

Name the 4 Antimycobacterials (“RIPE”)

Answer 16

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Question 17

What drug class is mainly used to treat Tuberculosis?

Answer 17

Antimycobacterials

Question 18

What is the main use of Nitrofurantoin?

Answer 18

Lower UTI’s because it rapidly concentrates in the urinary tract

Question 19

What is the MOA of Beta Lactams?

Answer 19

Bactericidal

Bind PBP (tanspeptidase, carboxypeptidase, endopeptidase), which are involved in terminal formation of cell wall.

**PCNs enter CSF poorly

Question 20

Common side effects of Penicillins

Answer 20

N/V/D
Maculopapular rash with amoxicillin

Question 21

Major side effects of PCN

Answer 21

Type 1 hypersensitivity
C. diff
Seizure/neurotoxicity
Hyperkalemia

Question 22

How is PCN excreted?

Answer 22

Renally

Question 23

Indications for PCN

Answer 23

Group A/B strep
Bacterial URI
PNA
STI (Syphillus Pen G)
UTI
Wound Infections
Endocarditis Prophylaxis

Question 24

Which generation of Cephalosporins generally has more Gram negative coverage?

Answer 24

3rd gen Cephalosporins

Question 25

Indications for Cephalosporins

Answer 25

Acute Otitis Media Sinusitis PNA GAS (group A strep) Chronic Bronchitis UTI- Cefixime 1st line for upper UTI Gonorrhea- Ceftriaxone/Azithromycin

Question 26

Cephalosporin side effects

Answer 26

Common: Diarrhea MAJOR: Allergy and seizure sickness Seizure with renal impairment C. diff Hemolytic Anemia (watch for bleeding, bruising, yellowing, lethargy)

Question 27

Clindamycin MOA:

Answer 27

Binds to bacterial ribosome to suppress synthesis Metabolized by the liver

Question 28

MOA of Fluoroquinalones

Answer 28

Bactericidal Interfere with DNA synthesis, preventing replication and transcription Concentration-dependent killing of bacteria.

Question 29

Side effects of Fluoroquinolones

Answer 29

Common: Photosensitivity and Phototoxicity, Dizziness, Crystalluria MAJOR: QTC prolongation, Liver Failure, Avoid in pregnancy, Avoid in <18 year olds, C. diff.

Question 30

Fluoroquinalones: BLACK BOX WARNING

Answer 30

Tendon Rupture/tendinitis Myasthenia Gravis Precipitation

Question 31

Clindamycin side effects

Answer 31

Common: Diarrhea, N/V/ bitter taste, dizziness, vertigo, headache, hypotension MAJOR: C. diff, intensify neuromuscular blockade, cardiac arrhythmia (rare)

Question 32

Macrolide indications

Answer 32

1st line for uncomplicated CAP or mycoplasma PNA in peds. STDs h. pylori Gonorrhea- azith/ceftriaxone Chlamydia/chancroid- azith

Question 33

MOA of macrolides

Answer 33

Bacteriostatic Binds to ribosome and inhibits RNA synthesis Disassociates tRNA from ribosomes Immunomodulating properties

Question 34

Side effects of macrolides

Answer 34

Common: NVD, cramping, eczema MAJOR: QTC prolongation, myasthenia gravis, c. diff, liver problems, Stevens Johnson syndrome.

Question 35

Side effects of Linezolid

Answer 35

Common: N/D, headache, myelosuppression, c. diff MAJOR: Neurotoxicity- NO MAOI use, Serotonin Syndrome

Question 36

MOA of Nitrofurantoin

Answer 36

Alters and inactivates ribosomes--protein synthesis, metabolism, RNA and DNA.

Question 37

Side effects of Nitrofurantoin

Answer 37

MAJOR: Neuropathy, pulmonary toxicity/risk of fibrosis with long term use, blood dyscrasias

Question 38

MOA of Trimethoprim/Sulfamethoxazole

Answer 38

Bacteriostatic Sulfa: inhibit dihydrofolate synthetase, prevents folic acid synthesis Trim: Inhibits bacterial dihydrofolate acid reductase, prevents purine synthesis.

Question 39

Side effects of Trimethoprim/Sulfamethoxazole

Answer 39

Common: Folate deficiency, Anorexia, NVD, C diff, Photosensitivity MAJOR: SJS, hepatotoxicity, QTC prolongation, Blood dyscrasias

Question 40

Indication for Trimethoprim/Sulfamethoxazole

Answer 40

UTIs

Question 41

MOA of Tetracyclines

Answer 41

Inhibit protein synthesis of ribosome/prevent amino acid growth

Question 42

Side effects of Tetracyclines

Answer 42

Common: N/V/D, C diff, photosensitivity, rash MAJOR: Caution with liver problems, caution <8 years old r/t calcium, Intracracial HTN (benign) causing headache, dizziness, vision changes, SJS

Question 43

Vancomycin MOA

Answer 43

Weakens call wall and Lysis Damages cell membraneSE o

Question 44

SE of Vancomycin

Answer 44

Common: Skin rash, ototoxicity MAJOR: Nephrotoxic, Vanco infusion syndrome (low BP, flushing)

Question 45

MOA of Antimycobacterials

Answer 45

Rifampin: Inhibit RNA synthesis Isoniazid: Interferes with lipid and nucleic acid biosynthesis in growing organisms. Pyrazinamide: Exact MOA unknown: good activity with macrophages, kills intracellular organisms Ethambutol: Inhibits synthesis of arabinogalactan, an essential component of mycobateria cell walls

Question 46

SE of Antimycobacterials

Answer 46

Common: GI upset MAJOR: Hypersensitivity reactions, ototoxicity, optic neuritis, peripheral neuritis, hepatotoxicity, elevated uric acid levels, body fluid discoloration, blood dyscrasias

Question 47

Bacteriostatic

Answer 47

Rely on functioning immune system; only suppress cellular activity. Kills bacteria but less than 99% eradication in 24 hours. Do NOT use in neutropenic of immunocompromised patients "We're ECSTaTiC about Antibiotics" Erythromycin Clindamycin Sulfamethoxazole Trimethoprim Tetracyclines Chloramphenicol

Question 48

Bactericidal

Answer 48

Meds that kill bacteria regardless of a working immune system. 99.9% eradication of bacteria in 24 hours. "Very Finely Proficient At Cell Murder" Vancomycin Fluoroquinolones Penicillin Aminoglycosides Cephalosporin Metronidazole

Question 49

Factors contributing to antibiotic resistance

Answer 49

Increases in populations of immunocompromised patients The number and complexity of invasive medical procedures Use (appropriate or inappropriate) of antimicrobials Survival of patients with chronic diseases Spread of resistant bacteria in day cares, overcrowding, travel, and the use of antibiotics in angriculture.

Question 50

What are the leading risks of having a drug-resistant pathogen?

Answer 50

Recent use of antimicrobials Multiple medical comorbidities Recent hospitalization or other skilled health-care contact Immunosuppression