abx: actions against intracellular activity

Question 1

moa

Answer 1

inhibit or alter protein synthesis: transcription and translation

Question 2

aminoglycosides

Answer 2

gentamicin, amikacin, tobramycin
gram -, also gram + but need other abx for synergistic effect (vancomycin, beta lactam - give these first so aminoglycosides can get into cell)
peak/trough levels
transitioned from 3/day to 1/day

Question 3

aminoglycosides SE

Answer 3

nephrotoxicity (reversible, monitor creatinine levels)
ototoxicity (permanent)
peak trough levels

Question 4

aminoglycosides I

Answer 4

complicated infections
UTI/pyelonephritis, gynecoid infections, peritonitis, endocarditis, pna, osteomyelitis (DM related)

Question 5

aminoglycosides moa

Answer 5

inhibit bacterial ribosomes

Question 6

gentamycin

Answer 6

if given with NM blockade (paralytic) -> be careful, can cause profound resp distress (myasthenia gravis)
CNS SE: confusion, depression, disorientation, numbness, tingling
cochlear damage: ototoxicity, high freq hearing loss, high pitched tinnitus

Question 7

lincosamides: clindamycin

Answer 7

bactericidal or bacteriostatic - depending on drug []
same moa
I: chronic bone infections, GU tract infections, intraabd infections, anaerobic pna, septicemia, serious skin infections, prophylaxis for endocarditis
PO and IV
monitor use with NM blockade meds
very toxic - monitor levels (resp distress)
can cause deadly pseudomembranous colitis (disabiling d -> c. Diff -> colitis)
VRE and CRE and other enterobacter bacteria are resistant to this drug

Question 8

macrolides

Answer 8

erythromycin and ezithromycin
bacteriostatic in general, bactericidal in high enough concentrations
YUCK drugs: GI SE profil intense (esp erythromycin)
moa: inhibit protein synthesis by binding to ribosomes
I: various infections of upper and lower respiratory infections, skin infections, soft tissue infections, STI; legionnaires, listeria, mycoplasma pna can all be treated with macrolides

Question 9

erythromycin

Answer 9

hypomotility benefits for diabetic gastroparesis and increase gastric motility and emptying (given to people with DM which sometimes affect gastric mobility)
doesn’t cross BBB
PO (abs not great, dont take on empty stomach) and IV (painful), topical and ophthalmic also available
lots of drug interactions

Question 10

azithromycin

Answer 10

Z pack!
differ structurally from other macrocodes, has some advantage in coverage compared to erythromycin
less GI upset, still some
Longer DOA (2/day -> 1/day)
very good tissue penetration and long durations of action
taking with food decreases absorption, so dont take with food

Question 11

tetracyclines

Answer 11

tetracycline, doxycycline, minocycline
bacteriostatic, inhibit protein synthesis by binding to ribosomes
broad spectrum, major resistance has developed

Question 12

tetracyclines: I

Answer 12

Rickettsia (Rocky Mountain spotted fever), chlamydia and trichomonas, Lyme, cholera, pelvic inflammatory disease, mycoplasma pneumonia, acne

Question 13

tetracyclines: CI

Answer 13

pregnant and nursing, <8yo

Question 14

tetracyclines: SE

Answer 14

discoloration of permanent teeth and tooth enamel hypoplasia in fetuses and children, photosensitivity (sunscreen!), many others - d, yeast infection, thrombocytopenia

Question 15

tetracycline

Answer 15

bacteriostatic
not available parenterally (PO only): fasting = 75-77% absorbed, gibing more decreases % abs
concentrates in bone, liver, tumor, spleen, teeth! (damage <8yr)
SE: nod, HA, photosensitivity, dizzy; rare = anaphylaxis and angioedema

Question 16

doxycycline

Answer 16

chlamydial and mycoplasma infections
prophylactic for STIs
acne and other non dangerous skin infections

Question 17

minocycline

Answer 17

neisseria meningitides
decreases symptoms of rheumatoid arthritis
solodyn is ER formula - acne
rosacia

Question 18

fluoroquinolones

Answer 18

ciprofloxacin and levofloxacin
potent, broad spectrum
very good oral abs (one of only)
1st and 2nd gen not used anymore
moa: alter bacterial DNA, interfere with bacterial enzymes DNA gyrase and topoisomerase
mostly gram - and some gram +

Question 19

ciprofloxacin

Answer 19

used to treat UTIs, some STIs, upper and lower respiratory tract infections, gonorrhea, and other infections
also treat anthrax (Bacillus anthracis)
PO/IV/topical
minimal penetration of BBB
work well on rapid and slow growing
prolonged post abx effects = concentrated in neutrophils (joints)
SE: arthropathy (joint disease, try not to give for long periods), often irreversible
avoid in pt under 18 and over 60

Question 20

levofloxacin

Answer 20

most widely used quinolones
broad spectrum of activity like cipro but advantages is once daily dosing
PO or IV (100% bioavailability orally)
less resistance
more activity against pneumococcal and other atypical (complicated) respiratory infections
SE: CNS disorders that predispose to seizures, kidney failure, can cause prolongation of QT interval, photosensitivity

Question 21

sulfonamides

Answer 21

sulfamethozale and trimethoprim (combined)
moa: dont destroy bacteria but inhibit growth = bacteriostatic by preventing the synthesis of folic acid needed for DNA synthesis
I: uncomplicated UTIs, rest infections, salmonella, shigellosis, HIV (more SE)
sulfa allergies, photosensitivity

Question 22

metronidazole

Answer 22

antiprotozoal and abx
I: chrons disease and abx associated d, c diff
anaerobic only
moa: inhibit DNA synthesis, similar to fluroquinolones
dont take with alcohol (24 hrs before and 36 after)
SE: n/v, xerostomia, vaginal candidiasis