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Thera VII > 22 Midterm 2 Review Questions > Flashcards

22 Midterm 2 Review Questions Flashcards

1
Q

Which antibiotics are Pregnancy Category B?

A

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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2
Q

Which antibiotics are Oral only?

A

Amoxicillin, Augmentin, Clarithromycin, Nitrofurantoin

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3
Q

Which antibiotics are IV only?

A

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

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4
Q

Which antibiotics have a Type I PD?

A

Aminoglycosides, FQs

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5
Q

Which antibiotics have a Type II PD?

A

All Beta-Lactams, Linezolid, Clarithromycin

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6
Q

Which antibiotics have a Type III PD?

A

Vancomycin, Synercid, Azithromycin, Doxycycline, Clindamycin

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7
Q

Which Beta-Lactams require no renal adjustment?

A

Oxacillin, Nafcillin, Ceftriaxone

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8
Q

What prophylaxis are Natural PCNs used for?

A

Rheumatic fever

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9
Q

What is the DOC for Treponema (syphilis)?

A

Benzathine Pen G

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10
Q

What is the DOC for Clostridia (Gas Gangrene)?

A

Natural PCNs

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11
Q

What is Oxacillin often used for?

A

Staphylococci

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12
Q

What is Amoxicillin often used for?

A

Endocarditis, prophylaxis for patient undergoing dental procedures

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13
Q

What is the only PCN derivative to cover Pseudomonas?

A

Pip/Tazo

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14
Q

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

A

Cefoxitin

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15
Q

Which Carbapenems have adequate CSF penetration with inflamed meninges?

A

Imipenem and Meropenem only

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16
Q

At what point do Carbapenems need renal adjustment?

A

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

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17
Q

What is the MOA of FQs?

A

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

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18
Q

What is the MOR for FQs?

A

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

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19
Q

What is the PD of FQs?

A

Concentration dependent. Bactericidal

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20
Q

Which FQ doesn’t require renal adjustment?

A

Moxifloxacin

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21
Q

Most FQs are QD dosing, which one required BID?

A

Ciprofloxacin

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22
Q

What are some notable ADRs associated with FQs?

A

Cartilage toxicity. Photosensitivity

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23
Q

What are some notable DDIs associated wtih FQs?

A

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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24
Q

What is some patient counseling for FQs?

A

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

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25
Q

What is the MOA of Bactrim?

A

Sulfonamide inhibits dihydropteroate synthetase. Trimethoprim inhibits dihydrofolate reductase

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26
Q

How does E. coli develop resistance to Bactrim?

A

Alteration to dihydropteroate synthetase –> lower affinity for sulfonamide

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27
Q

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

A

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

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28
Q

What is renal adjustment like for Bactrim?

A

Adjust when < 30 by increasing interval

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29
Q

What is Bactrim the DOC for?

A

Pneumocystis carinii

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30
Q

What are some serious ADRs associated with Bactrim?

A

Erythema multiforme, SJS, TEN

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31
Q

What needs to be monitored while on Bactrim?

A

Fluid status, CBC to f/u blood dyscrasias

32
Q

What are some notable ADRs associated with Nitrofurantoin?

A

Peripheral neuropathy (w/ long term use). Respiratory

33
Q

What are some precautions before Nitrofurantoin use?

A

Lung disease. Peripheral neuropathy. G6PD

34
Q

What are contraindications to Nitrofurantoin use?

A

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

35
Q

What is some patient counseling for Nitrofurantoin?

A

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

36
Q

What is the MOA of Metronidazole?

A

Enter cell, reductive activation

37
Q

What are some notable ADRs with Metronidazole?

A

Nausea, abdominal pain. Metallic taste. CNS

38
Q

What is some patient counseling for Metronidazole?

A

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

39
Q

What is the MOA of Macrolides?

A

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

40
Q

What is the MOR against Macrolides?

A

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

41
Q

What are the class effects for PK of Macrolides?

A

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

42
Q

What is the PD of Macrolides like?

A

Bacteriostatic. Time dependent

43
Q

Which Macrolide requires renal adjustment?

A

Clarithromycin

44
Q

What are the clinical applications of Erythromycin?

A

Motilin effect. Diabetic gastroparesis. Post op ileus

45
Q

What is a notable ADR associated with Clarithromycin?

A

Taste perversion (metallic)

46
Q

What is a rare effect that Macrolides have?

A

Immunomodulatory effects

47
Q

What class of antibiotic is Telithromycin?

A

Ketolide

48
Q

What is Telithromycin designed to do?

A

Treat macrolide-resistant respiratory tract infection

49
Q

What are some notable ADRs of Telithromycin?

A

Hepatotoxicity, QT prolongation, NV

50
Q

Which antibiotics are strong inhibitors of CYP3A4?

A

Macrolides (not azithro). Telithromycin, Synercid, Metronidazole

51
Q

What does Clindamycin not get to?

A

CSF

52
Q

What is a notable ADR with Clindamycin?

A

Increased LFTs

53
Q

Which Tetracyclines require renal adjustment?

A

Tetracycline. Minocycline

54
Q

What is the MOA of Tetracyclines?

A

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

55
Q

What is the PD of Tetracyclines?

A

Bacteriostatic. Time dependent

56
Q

Which Tetracycline doesn’t require renal adjustment?

A

Doxycycline

57
Q

Which Tetracycline is PO only?

A

Tetracycline

58
Q

What are some notable ADRs associated with Tetracyclines?

A

Photosensitivity. Tooth discoloration. Inhibition of growth and bone deformities

59
Q

What are some additional ADRs only seen in Minocycline?

A

Vertigo. Drug induced lupus

60
Q

What are some counseling points for Tetracyclines?

A

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

61
Q

Does does Tigecyline not cover?

A

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

62
Q

What are the clinical applications of Tigecycline?

A

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

63
Q

What are the common ADRs of Tigecycline?

A

N/V/D

64
Q

Why is Tigecycline not used anymore?

A

Increased risk of mortality from post market data

65
Q

What is the MOA of Quinupristin/Dalfopristin?

A

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

66
Q

What is the PD of Synercid?

A

Bactericidal except E. faecium (static)

67
Q

What is a notable ADR associated with Synercid?

A

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

68
Q

What is the MOA of Linezolid?

A

Attacks at pre-initiation (unique)

69
Q

What is the PD of Linezolid?

A

Bacteriastatic against most, cidal against some pneumococcis. Concentration independent

70
Q

What are the clinical applications of Linezolid?

A

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

71
Q

What are the big ADRs associated with Linezolid?

A

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

72
Q

What is a notable DDI with Linezolid?

A

Serotonin syndrome when used with SSRIs

73
Q

What is the MOA of Daptomycin?

A

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

74
Q

What is the PD of Daptomycin?

A

Concentration dependent killing. Bactericidal

75
Q

What are some notable ADRs with Daptomycin?

A

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

76
Q

What is Daptomycins place in therapy?

A

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

Thera VII (37 decks)

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