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🄼 💊M2 PHARM EXAM 3 Rx > 9-11 Tetracyclines/Sulfonamides/Chloram/UTI agents > Flashcards

9-11 Tetracyclines/Sulfonamides/Chloram/UTI agents Flashcards

1
Q

TETRACYCLINE FAMILY

A: 1st Generation Tetracyclines

B: 2nd Generation Tetracyclines (2)

C: GLYcylcycline is a derivative of ________.
C2: Tigecycline is a derivative of ________

D: MOA

E: Bacteriostatic vs. BacteriCIDAL?

A

TETRACYCLINE FAMILY

A: 1st Generation Tetracyclines= Tetracycline

B: 2nd Generation Tetracyclines=

1) Doxycycline
2) Minocycline

C: GLYcylcycline is a derivative of [Minocycline 2º TETRA].
C2: Tigecycline is a derivative of GLYcylcycline lol

D: MOA= [REVERSIBLY binds to [30s ribosomal subunit] preventing [aminoacyl tRNA] from binding to acceptor site.

E: Bacteriostatic but BACTERICIDAL IN HIGH CONCENTRATIONS

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2
Q

TETRACYCLINE FAMILY

A: [Mechanisms of Resistance] (3)

B: All Tetracyclines have cross resistances EXCEPT _______

C: Which Tetracycline can OVERCOME all [Mechanisms of Resistance]?

A

TETRACYCLINE FAMILY

A: [Mechanisms of Resistance]
1. Efflux Pumps

  1. [Ribosomal Protection proteins] = protects against [1st/2nd generation Tetracyclines]
  2. Enzymatic inactivation

B: All Tetracyclines have cross resistances EXCEPT MINOCYCLINE

C: Tigecycline can BYPASS ALL THE [Mechanisms of Resistance]

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3
Q

TETRACYCLINE FAMILY

Important [Gram negative aerobes]: (4)

A

TETRACYCLINE FAMILY

Important [Gram POSITIVE Aerobes]:
1) PssP
2) MssA
3) MORE
——————————————————————————–
Important [Gram negative aerobes]:
1) [Burkholderia Pseudomallei]
2) [Haemophilus Influenzae AND Ducreyi]
3) Neisseria SPECIES

4) And MORE

“Before Handing Nancy TETRACYCLINES Provide Many Meds “

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4
Q

TETRACYCLINE FAMILY:

A: Uncategorized Bacteria: (6)

B: AnAerobes

A

TETRACYCLINE FAMILY:

Uncategorized Bacteria:

1) Mycoplasma
2) Chlamydia
3) Chlamydophila
4) Ureaplasma
5) Rickettsia

6) Legionella

“May Carl CURL the Uncategorized Tetras?”

AnAerobes:
Actinomyces

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5
Q

A: Tigecycline, specifically, covers a BROAD spectrum of [Gram negative aerobes] but does NOT COVER what 4 things?

B: AnAerobes: (2)

C: [Gram POSITIVE aerobes]: (2)

D: Route of Administration

A

A: Tigecycline, specifically, covers a BROAD spectrum of [Gram negative aerobes] but does NOT COVER

1) Proteus SPECIES
2) [Pseudomonas Aeruginosa]
3) Bacteremia
4) UTIs

“Tigers CAN’T hang in a PPUB! “

“Tigers Can Be Seriously Viscious! “

B: AnAerobes:

  • Clostridium Perfringens
  • Bacteroides SPECIES

C: [Gram POSITIVE aerobes:
(+) Staph Aureus - ALL OF THEM
(+) VRE

D: ONLY AVAILABLE IV

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6
Q

TETRACYCLINE FAMILY

A: Absorption impaired by ________
A2: Absorption enhanced by ________

Distribution:
B: Prostate?
B2: CSF?

A

TETRACYCLINE FAMILY

A: Absorption impaired by [Divalent and Trivalent Cations]!
A2: Absorption can be enhanced with empty stomach

” 2 - and - 4 can’t sit with 23“

[Tetro and Fluoroquinolones have impaired absoprtion with di/trivalent cations]

B: GOOD DISTRIBUTION TO PROSTATE

B2: poor CSF penetration

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7
Q

ELIMINATIONS:

A: Tetracycline

B: [Doxy/Minocycline/Tigecycline]

C: Which Tetracycline requires dose adjustment in pt with Liver Disease?

D: [TETRACYCLINE FAMILY] are all ______[Greatly/minimally] removed during hemodialysis

A

ELIMINATIONS:

A: Tetracycline = excreted UNCHANGED in urine –> Required Dose adjustment for renal insufficiency

B: [Doxy/Minocycline/Tigecycline]= [Biliary Excretion]

C: Tigecycline has Required Dose adjustment in [Liver Dz]!

D: [TETRACYCLINE FAMILY] are all minimally removed during hemodialysis

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8
Q

A: [Tetracycline Family] are used to prophylactically treat what?

B: Which Tetracycline is used to treat SIADH?

C: Which Tetracycline is used to treat [COMPLICATED Skin and Soft Tissue infection] and Polymicrobial Infections?

A

A: Malaria

B: Demeclocycline

C: Tigecycline [all- mighty and powerful]

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9
Q

[TETRACYCLINE FAMILY]

A: Adverse Effects (3)

B: CONTRAINDICATED IN _______. What are the 2 effects of taking [TETRACYCLINES] during this condition?

A

[TETRACYCLINE FAMILY]

A: Adverse Effects

“Get a PON to protect from Tetra Side Effects”

1) Photosensitivity

2) [Outdated Tetracycline –> (Fanconi-like syndrome)]
3) Nausea and Vomiting

B: CONTRAINDICATED IN Pregnant Women —>

(x) Discoloration of permanent teeth
(x) DEC pediatric bone growth

“NO DOXY FOR POXY”

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10
Q

SULFONAMIDES

A: MOA= Inhibits ______ which prevents ______ from being converted into ________.
A2: There are _______ and _______ acting Sulfonamides

C: How does Trimethoprim work?
——————————————————————————-
D: [Sulfondamides + Trimethoprim] are _______ _______! Together, they prevent _____________

A

SULFONAMIDES

A: MOA= Inhibits [DiHydropTeroate Synthetase] which prevents [Bacterial PABA] from being converted into [Dihyrdrofolic Acid].
A2: There are short/medium and Long acting Sulfonamides

C: Trimethoprim inhibits [dihyrofolate reductase] which prevents [Dihydrofolic Acid] from being converted into Tetrahydrofolic Acid (precursor to purines)]. .
—————————————————————————–
D: [Sulfondamides + Trimethoprim] are synergistically BacteriCIDAL! Together, they prevent PABA from being converted into Purines!

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11
Q

SULFONAMIDES only

A: [Mechanism of Resistance] (3)

A

SULFONAMIDES only

A: [Mechanism of Resistance]

“Colored Black People will RESIST using Sulfonamides”
1. Cell Wall Permeability DECREASES (plasma mediated)

  1. Binding site changes
  2. PABA Overproduction
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12
Q

BACTRIM [Sulfonamide + Trimethoprim]

A: [Gram POSITIVE] (3)

B: [Gram negative] (2)

C: Can Bactrim be used to treat [Pneumocystis carinii]?

D: Can Bactrim be used to treat [AnAerobes] ?

A

BACTRIM [Sulfonamide + Trimethoprim]

A: [Gram POSITIVE]

1) Staph Aureus
2) Listeria
3) AND MORE

B: [Gram negative]

1) [Stenotrophomonas maltophilia]
2) AND MORE

C: YES

D: [Bactrim] has NO ACTIVITY AGAINST AnAerobes

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13
Q

What are all the bacteria that cause Neonatal Meningitis? (5)

A
  1. Elizabethkingia
  2. GBS [Group B Strep]
  3. Listeria
  4. E.Coli
  5. ## Citrobacter“When Queen ELIZABETH was a baby in [GREAT BRITAIN], she made a wish LIST for COLA and CITRUS”
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14
Q

BACTRIM

A: Distribution

  • Prostate?
  • CSF penetration?

B: What Pharmacokinetic property makes this drug sometimes dangerous? (2)

A

BACTRIM

A: Distribution

  • Distributes WELL TO Prostate
  • Positive CSF penetration

B:
1. The Sulfonamide portion is 70% protein bound

  1. DOSE ADJUSTMENT IS REQUIRED IN PT WITH

[CrCl] < 30 mL/min

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15
Q

BACTRIM

A: Clinical Uses (3)

B: Adverse Effects: (7)

A

BACTRIM

A: “Use BACTRIM for PUS”

Clinical Uses

1) Prostatitis [acute / chronic]
2) UTI [acute/ chronic/recurrent]
3) Skin Infections 2º to [CA-MRSA]

B: Adverse Effects: (7)

” TOO MUCH BACTRIMLeads to STATIC”

(x) Leukopenia
(x) Thrombocytopenia
(x) Anemia (Hemolytic/Aplastic /Megoblastic)
(x) [Stevens-Johnson Rash]
(x) Interstitial Nephritis
(x) tubular necrosis —> HYPERkalemia
(x) Crystalluria

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16
Q

BACTRIM

A: Contraindicated Drugs (3)

A

BACTRIM

A: Contraindicated Drugs

“BACTRIM May Warrant Precaution”

  • Methotrexate
  • Warfarin
  • Phenytoin
17
Q

A: Which abx is mostly exclusively used in DEVELOPING worlds?

B: MOA

C: What was responsible for the widespread outbreak of [Typhoid Fever and Shigella] in [Vietnam and South america]?

D:

  • Excretion
  • Elimination
A

A: Chloramphenicol

B: MOA= Binds to 50s and 70s ribosome

C: [Acetyltransferase inactivation] of Chloramphenicol Abx

D: Renal Excretion but HEPATIC METABOLISM 1ST–> Requires Dose Adjustment in Liver Failure pt

18
Q

C: Adverse Effects: (3)

A

A: Chloramphenicol is NOT active against
1. [Pseudomonas Aeruginosa]

  1. Enterococcus
  2. Staph Aureus

B: Chloramphenicol is MOSTLY USED FOR:
*PNA in [3rd world country]
*Bacterial meningitis in [3rd world country]

*[Rocky Mountain Spotted Fever] in [3rd World Country]

*Typhoid Fever in [3rd World country]

C: Adverse Effects:

  • “Chloram* taken a while AGO = No Side Effects”
    (x) Aplastic Anemia

(x) GRAY BABY SYNDROME= [HIGH levels of Chloramphenicol due to inability to [Hepatically metabolized] or [Renally excreted]
(x) [Optic Neuritis]

19
Q

A1: [Nitrofurantoin MOA]

A2: [Nitrofurantoin Mechanisms of Resistance]

B1: [MethenAmine MOA]

C: Route of Administration for each

A

A1: [Nitrofurantoin MOA] = Inhibits bacterial respiration and pyruvate metabolism

A2: [Nitrofurantoin Mechanisms of Resistance] = E.Coli have chromosomal/plasma mediated [nitrofuran reductase] production

B1: [MethenAmine MOA] = Converted into Formaldehyde in an ACIDIC environment. Formaldehyde denatures proteins and nucleic acids.

C: BOTH OF THESE (Macrobid) ARE PO DRUGS ONLY

20
Q

A: What organ is Nitrofurantoin specifically ineffective?

B: Nitrofurantoin Elimination (2)

C: MethenAmine Elimination

A

A: Nitrofurantoin CAN NOT REACH the PROSTATE :-(

B: Nitrofurantoin Elimination = Renal and Biliary

C: MethenAmine Elimination = Renal

21
Q

A: Nitrofurantoin Clinical Uses: (2)

A2: DO NOT USE Nitrofurantoin for: (2)

A3: Adverse rxns (2)

A

A: Nitrofurantoin Clinical Uses:

  1. [Acute UNCOMPLICATED UTI] 2º to E.Coli
  2. UTI Prophylaxis

A2: DO NOT USE Nitrofurantoin for:

  • Pyelonephritis
  • COMPLICATED UTI

A3: Adverse rxns
(x) [Acute REVERSIBLE Hypersensitive Pulmonary sx (ARHPs) weeks after exposure]

(x) [Bronchitis Obliterans with Organizing PNA]

22
Q

B: MethenAmine Clinical Uses:

B2: DO NOT USE MethenAmine for ____ (3)

B3: Adverse Rxns (3)

A

B: MethenAmine Clinical Uses:
1) [Recurrent UTI Prophylaxis]

B2: DO NOT USE MethenAmine for

“MethenAmine CAN’T be used to Prevent Established UTI”

  • Prophylaxis against [Catheter-associated UTI]
  • Established infections
  • [Urease producing organisms]

B2: Adverse Rxns:

(x) [Hemorrhagic Cystitis with higher dose]
(x) Anemia [Megoblastic/Aplastic]
(x) Eosinophilia

🄼 💊M2 PHARM EXAM 3 Rx (8 decks)

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