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Abx- Part II Flashcards

1
Q

______ helps to connect the peptigoglycan in the bacteria cell wall

A

D-Ala

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2
Q

_____ is an amino-acid that combine with other amino acids to create a polypeptide

A

D-alanine

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3
Q

What are the two glycopeptides?

A

vancomycin and televancin (very expensive)

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4
Q

______ binds to D-ala D-ala, a side chain in peptidoglycan, preventing the formation of peptidoglycan and phospholipids. This results in a weakens the cell wall and inhibition of bacterial replication

A

Glycopeptides (vancomycin and telavancin)

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5
Q

What is the MOA for bacteria that has developed resistance to Vancomycin?

A

Alteration of the binding site to D-ala-D-Lac

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6
Q

Vancomycin has no ____ coverage and only kills _____

A

no gram - coverage

kills gram +

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7
Q

_____ is a gram + cocci that vancomycin targets

A

Stap aureus (MRSA)

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8
Q

_____ is a gram + bacilli that vancomycin targets

A

Clostridium

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9
Q

______ is the MRSA drug of choice for inpatient therapy

A

Vancomycin

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10
Q

What is used to treat severe C. difficile colitis?

A

vancomycin

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11
Q

Vancomycin you must adust for ____ impairment

A

renal

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12
Q

What is the preg category for oral vancomycin? IV?

A

oral: category B

IV: category C

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13
Q

How do you dose Vancomycin?

A

Based upon CrCl and total body weight

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14
Q

When treat patients with vancomycin and they are impaired renal function require ?????

A

less frequent dosing intervals

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15
Q

When monitoring severe MRSA infections, how are dose adjustments made? How are other infection dosing adjustment made?

A

Area Under the Curve (AUC) calculations

based on trough levels

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16
Q

Describe a medication peak

A

greatest level in the blood

measured 30 minutes after the infusion is given

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17
Q

describe a medication trough

A

greatest level in the tissue

measured 30 minutes before the next infusion after steady state is reached

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18
Q

When are you looking at the trough level on a pt on vanc with normal renal function?

A

after the 4th dose

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19
Q

When are you looking at the trough level on a pt on vanc with impaired renal function?

A

assess “spot” serum concentrations until renal function stabilizes and a dosing interval can be determined

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20
Q

What are adverse effects associated with vanc?

A

hyperemia (red man syndrome)

Nephrotoxicity

Ototoxicity

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21
Q

Nephrotoxicity/Ototoxicity is commonly found when vanc and ____ are used together

A

aminoglycosides

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22
Q

Name some abx alternatives to treat MRSA that are NOT vanc

A

Telavancin (Vibativ)
Dalbavancin (Dalvance)
Oritavancin (Orbactiv)
Daptomycin¹ (Cubicin)
Linezolid² (Zyvox)

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23
Q

_____ is a good choice for VRE infections

A

Daptomycin¹ (Cubicin)

but NOT for pneumonia treatment

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24
Q

____ and _____ work on the 30S subunit

A

tetracyclines and aminoglycosides

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25
What are the Aminoglycosides (Gentamicin) modes of resistance?
1. Chromosomal mutation 2. Enzymatic destruction of drug 3. Lack of permeability through cell wall 4. Efflux pumps
26
_____ are indicated for gram - and Mycobacterium tuberculosis
aminoglycosides
27
What preg category are aminoglycosides?
preg category D, DO NOT GIVE TO PREG PTS
27
What are the black box warnings for aminoglycosides?
1. Ototoxicity 2. Nephrotoxicity 3. Neuromuscular paralysis
28
_____ are most frequently used in combo with PCN
gentamicin
29
What abx is associated with hearing loss when given for an extended amount of time? What else do you need to monitor?
aminoglycosides BUN/Cr
30
How are tetracyclines increasing abx resistance?
Active efflux of drug: shoots abx right back out Enzymatic deactivation: degrades abx
31
____ include gram +, gram - and MRSA for pts who are NOT sick enough to be hospitalized
tetracyclines
32
**What types of bacteria are included in the atypicals.
Mycoplasma, Rickettsiae, Chlamydiae, Spirochetes
33
Tetracyclines are first line treatment for what 4 diseases
Lyme Disease (Borrelia burgdorferi) Rocky Mountain Spotted Fever (Rickettsia rickettsii) Cholera (Vibrio) Acne (Propionibacterium Acnes)
34
What are the contraindications for tetracyclines
Pregnancy or nursing mothers Absolute CI - Children < 8-9 y/o
35
Do not take tetracyclines with _____, due to poor absorption
antacids
36
What are some adverse effects of tetracyclines?
GI Distress Hepatotoxicity Photosensitivity Vestibular problems (Vertigo) - specifically Minocycline Candida infections; C. diff
37
azithromycin, erythromycin and clarithromycin are all ______
macrolides
38
What is the MOA?
50S subunit
39
_____ inhibits protein synthesis and translocation needed to replicate- 50S
macrolide MOA
40
What are the macrolide's method of resistance
50S subunit target modification Efflux pumps Degradation enzymes
41
Do macrolides cross the BBB?
No, they are NOT effective on CNS infections
42
What is the first line treatment for community acquired pneumonia?
macrolides
43
macrolides are the first line treatment for ????
Community acquired pneumonia "Atypicals" - Mycoplasma, Chlamydia Increasing resistance with Streptococcus Chlamydia Legionella Diphtheria COPD - acute exacerbations
44
macrolides are the second line treatment for ___ and ____
OM and pharyngitis
45
macrolides: _____ has a broader spectrum of coverage than _____
azithromycin erythromycin
46
What are the adverse effects of macrolides?
GI - N/D (MC), c. diff Hepatotoxicity¹ Prolonged QT interval Ototoxicity (transient)
47
macrolides are preg category ____
category B
48
What is the MOA for clindamycin
50S subunit
49
What abx spectrum of activity includes gram +, MRSA and anaerobes?
Clindamycin
50
What abx is indicated for oral abcesses and bacterial vaginosis?
Clindamycin
51
**What is the black box warning of clindamycin? What preg category?
C diff Preg category B
52
Inhibit Bacterial DNA synthesis / DNA Inhibitors is the MOA for ______
quinolones
53
What are the three ways quinolones have developed resistance.
mutation in chromosomal genes for DNA gyrase and Topoisomerase IV prevents abx from binding Efflux pumps Decreased cell wall permeability
54
Of the -floxacins, which ones have better gram + coverage
Levofloxacin and Moxifloxacin: better Gram + than Ciprofloxacin
55
quinolones are the first line treatment for what 6 diseases?
Otitis externa, ophthalmic infections (topical cipro/levo only) Pyelonephritis (Cipro) Prostatitis (Cipro) Traveller's Diarrhea/Infectious Diarrhea (Cipro) Anthrax (Cipro) URI’s/ Pneumonia with Comorbidities "Respiratory Fluoroquinolone" - Levaquin or Avelox
56
community acquired pneumonia with no comorbiities, what abx?
macrolides
57
_____ are a strong inhibitor of CYP450 enzymes. What pregnancy category?
quinolones Preg category C
58
**What is the black box warning associated with quinolones?
Tendiitis/tendon rupture
59
What is the MOA for sulfonamides and trimethoprim?
folate synthesis
60
_____ spectrum of activity includes Good G -, some G + coverage, MRSA
bactrim
61
_____ is the first line outpatient treatment for MRSA, UTI/cystitis.
Bactrim
62
If you pt is allergic to bactrim, what should you use?
clindamycin
63
____ adverse reactions include Megaloblastic Anemia (Folic Acid Def.), GI distress: N/V/D, Photosensitivity, Hepatotoxicity. Avoid giving to pts with chronically low folate (aka alchoholics)
bactrim
64
______ only function is in the bladder.
Nitrofurantoin (Macrobid/Macrodantin)
65
Would you give Nitrofurantoin (Macrobid/Macrodantin) to a preg pt?
NO, avoid in pregnancy
66
What would you give to a preg pt who has cystitis?
Keflex
67
_____ is used in antiprotozoal / Anaerobic Antimicrobial infection
Metronidazole (Flagyl)
68
_____ MOA works by disrupting microbial DNA
Metronidazole (Flagyl)
69
____ is the first line treatment for Trichomonas, Bacterial Vaginosis (BV), C. difficile colitis, Amebiasis, Giardiasis
Metronidazole (Flagyl)
70
______ you should NOT take with alcohol and has a black box warning carcinogenic in mice and rats
Metronidazole (Flagyl)
71
_____ is given as a topical cream for burns
Silver sulfadiazine (Silvadene)
72
_____ is a solution or ointment for ophthalmic infections Q2-3H during waking hours
Sulfacetamide
73
____ used as adjunct to treat Toxoplasmosis and for malarial prevention
Pyrimethamine (Daraprim)
74
____ Active against Gram +, limited to topical application only due to nephrotoxicity
Bacitracin
75
____ : gram - coverage, IM / IV / Intrathecal / Ophthalmologic uses, rarely used in any form other than ophthalmic drops due to toxicity
Polymyxin B
76
_____ is used mainly for pseudomonas in the eye (contact wearers)
Polymyxin B
77
______: MC indication is Impetigo, Used in combination with chlorhexidine to decolonize MRSA carriers ¹
Mupirocin (Bactroban)

Infectious Disease (16 decks)

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