22 Midterm 2 Review Questions Flashcards by Chris Clark

Which antibiotics are Pregnancy Category B?

All Beta-Lactams, Synercid, Daptomycin, Clarithromycin, Azithromycin, Clindamycin, Flagyl (avoid 1st trimester), Nitrofurantoin (avoid at time of gestation), TMP/SMX (avoid in 1st and 3rd trimester)

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Which antibiotics are Oral only?

Amoxicillin, Augmentin, Clarithromycin, Nitrofurantoin

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Which antibiotics are IV only?

Unasyn (A/S), Oxacillin, Pip-Tazo, all CEPHs (except cefuroxime), all carbapenems, Synercid, Daptomycin, Telavancin, Aminoglycosides (Gent/Tobra), Tigecycline, Clindamycin

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Which antibiotics have a Type I PD?

Aminoglycosides, FQs

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Which antibiotics have a Type II PD?

All Beta-Lactams, Linezolid, Clarithromycin

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Which antibiotics have a Type III PD?

Vancomycin, Synercid, Azithromycin, Doxycycline, Clindamycin

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Which Beta-Lactams require no renal adjustment?

Oxacillin, Nafcillin, Ceftriaxone

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What prophylaxis are Natural PCNs used for?

Rheumatic fever

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What is the DOC for Treponema (syphilis)?

Benzathine Pen G

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What is the DOC for Clostridia (Gas Gangrene)?

Natural PCNs

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What is Oxacillin often used for?

Staphylococci

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What is Amoxicillin often used for?

Endocarditis, prophylaxis for patient undergoing dental procedures

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What is the only PCN derivative to cover Pseudomonas?

Pip/Tazo

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Which CEPH covers B. fragilis, and therefore is good for surgical prophylaxis (colorectal)/intraabdominal?

Cefoxitin

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Which Carbapenems have adequate CSF penetration with inflamed meninges?

Imipenem and Meropenem only

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At what point do Carbapenems need renal adjustment?

All: CrCl < 10-20. Doripenem: CrCl < 50

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What is the MOA of FQs?

Exerts antibiotic effect through inhibiting DNA synthesis –> inhibits bacterial topoisomerase II (DNA Gyrase) and topoisomerase IV

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What is the MOR for FQs?

1) Target site mutation (gram (+); topo IV (parC, parE)). 2) Increased drug efflux (gram (-); OprM, MexA, MexB)

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What is the PD of FQs?

Concentration dependent. Bactericidal

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Which FQ doesn’t require renal adjustment?

Moxifloxacin

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Most FQs are QD dosing, which one required BID?

Ciprofloxacin

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What are some notable ADRs associated with FQs?

Cartilage toxicity. Photosensitivity

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What are some notable DDIs associated wtih FQs?

ALL FQ agents interact with multivalent cations (chelation reactions can result in forming insoluble, inactive complex). Levo, Gati, Moxi - avoid QT prolongation drugs (erythro, antipsychotics, TCA)

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What is some patient counseling for FQs?

May get drowsy, dizzy. Avoid/minimal caffeine. Separate antacids by 4 hours. Keep out of sun

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What is the MOA of Bactrim?

Sulfonamide inhibits dihydropteroate synthetase. Trimethoprim inhibits dihydrofolate reductase

How does E. coli develop resistance to Bactrim?

Alteration to dihydropteroate synthetase --> lower affinity for sulfonamide

How does N. gonorrhoeae, S. aureus develop resistance to Bactrim?

Increase production of essential metabolite or drug (i.e. Increase PABA)

What is renal adjustment like for Bactrim?

Adjust when < 30 by increasing interval

What is Bactrim the DOC for?

Pneumocystis carinii

What are some serious ADRs associated with Bactrim?

Erythema multiforme, SJS, TEN

What needs to be monitored while on Bactrim?

Fluid status, CBC to f/u blood dyscrasias

What are some notable ADRs associated with Nitrofurantoin?

Peripheral neuropathy (w/ long term use). Respiratory

What are some precautions before Nitrofurantoin use?

Lung disease. Peripheral neuropathy. G6PD

What are contraindications to Nitrofurantoin use?

CrCl < 40. Pregnancy at term. Infants < 1 month

What is some patient counseling for Nitrofurantoin?

May cause GI upset, take with food or milk. May cause brown urine

What is the MOA of Metronidazole?

Enter cell, reductive activation

What are some notable ADRs with Metronidazole?

Nausea, abdominal pain. Metallic taste. CNS

What is some patient counseling for Metronidazole?

Can take w/ food to decrease stomach upset. Do not drink alcohol (including cough/cold) d/t disulfuram-like reaction. Metallic taste perverse

What is the MOA of Macrolides?

Reversibly bind to 23S ribosomal RNA in the 50S subunit of the bacterial ribosome. Interferes w/ peptide bond formation of growing peptide chain --> suppress RNA dependent protein synthesis

What is the MOR against Macrolides?

Target site alteration (ermA, B, C). Alteration in transport (efflux): mrsA, mefA, mefE

What are the class effects for PK of Macrolides?

Lipophilic, extensive tissue/fluid penetration. Respiratory concentration > serum

What is the PD of Macrolides like?

Bacteriostatic. Time dependent

Which Macrolide requires renal adjustment?

Clarithromycin

What are the clinical applications of Erythromycin?

Motilin effect. Diabetic gastroparesis. Post op ileus

What is a notable ADR associated with Clarithromycin?

Taste perversion (metallic)

What is a rare effect that Macrolides have?

Immunomodulatory effects

What class of antibiotic is Telithromycin?

Ketolide

What is Telithromycin designed to do?

Treat macrolide-resistant respiratory tract infection

What are some notable ADRs of Telithromycin?

Hepatotoxicity, QT prolongation, NV

Which antibiotics are strong inhibitors of CYP3A4?

Macrolides (not azithro). Telithromycin, Synercid, Metronidazole

What does Clindamycin not get to?

CSF

What is a notable ADR with Clindamycin?

Increased LFTs

Which Tetracyclines require renal adjustment?

Tetracycline. Minocycline

What is the MOA of Tetracyclines?

Reversible bind to 30S ribosome, inhibits binding of aminoacyl-tRNA to acceptor site on 70S ribosome

What is the PD of Tetracyclines?

Bacteriostatic. Time dependent

Which Tetracycline doesn't require renal adjustment?

Doxycycline

Which Tetracycline is PO only?

Tetracycline

What are some notable ADRs associated with Tetracyclines?

Photosensitivity. Tooth discoloration. Inhibition of growth and bone deformities

What are some additional ADRs only seen in Minocycline?

Vertigo. Drug induced lupus

What are some counseling points for Tetracyclines?

Separate dose from milk, antacids, iron supplements by > 2 hours

Does does Tigecyline not cover?

No coverage of the Big 3P: Pseudomonas, Proteus, Providencia

What are the clinical applications of Tigecycline?

Complicated skin and skin structure (cSSSi). Complicated intraabdominal infections (cIAi)

What are the common ADRs of Tigecycline?

N/V/D

Why is Tigecycline not used anymore?

Increased risk of mortality from post market data

What is the MOA of Quinupristin/Dalfopristin?

Inhibits protein synthesis. Dalfo alters ribosomal conformation, increasing affinity for quinu

What is the PD of Synercid?

Bactericidal except E. faecium (static)

What is a notable ADR associated with Synercid?

Arthraigia, myalgia: may require analgesics for pain control, and extend dose to Q8 - Q12

What is the MOA of Linezolid?

Attacks at pre-initiation (unique)

What is the PD of Linezolid?

Bacteriastatic against most, cidal against some pneumococcis. Concentration independent

What are the clinical applications of Linezolid?

Vanco-R Enterococci infection. MRSA infection (d/t intolerance to vanco or vanco failure)

What are the big ADRs associated with Linezolid?

Thrombocytopenia, Anemia, Leucopenia. Increased risk with duration > 2 weeks. Monitor CBC weekly

What is a notable DDI with Linezolid?

Serotonin syndrome when used with SSRIs

What is the MOA of Daptomycin?

Binds to bacterial cell membrane, calcium dependent, insertion of lipid tail. Rapidly depolarizes cell --> cell death

What is the PD of Daptomycin?

Concentration dependent killing. Bactericidal

What are some notable ADRs with Daptomycin?

CPK elevations (monitor weekly), look out for muscle pain, weakness, distal extremities

What is Daptomycins place in therapy?

Only for treatment of cSSSi caused by susceptible organisms and bloodstream infection cause by S. aureus