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Infectious Disease > Abx- Part II > Flashcards

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
Q

What are the Aminoglycosides (Gentamicin) modes of resistance?

A
  1. Chromosomal mutation
  2. Enzymatic destruction of drug
  3. Lack of permeability through cell wall
  4. Efflux pumps
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26
Q

_____ are indicated for gram - and Mycobacterium tuberculosis

A

aminoglycosides

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27
Q

What preg category are aminoglycosides?

A

preg category D, DO NOT GIVE TO PREG PTS

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27
Q

What are the black box warnings for aminoglycosides?

A
  1. Ototoxicity
  2. Nephrotoxicity
  3. Neuromuscular paralysis
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28
Q

_____ are most frequently used in combo with PCN

A

gentamicin

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29
Q

What abx is associated with hearing loss when given for an extended amount of time? What else do you need to monitor?

A

aminoglycosides

BUN/Cr

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30
Q

How are tetracyclines increasing abx resistance?

A

Active efflux of drug: shoots abx right back out

Enzymatic deactivation: degrades abx

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31
Q

____ include gram +, gram - and MRSA for pts who are NOT sick enough to be hospitalized

A

tetracyclines

32
Q

**What types of bacteria are included in the atypicals.

A

Mycoplasma, Rickettsiae, Chlamydiae, Spirochetes

33
Q

Tetracyclines are first line treatment for what 4 diseases

A

Lyme Disease (Borrelia burgdorferi)

Rocky Mountain Spotted Fever (Rickettsia rickettsii)

Cholera (Vibrio)

Acne (Propionibacterium Acnes)

34
Q

What are the contraindications for tetracyclines

A

Pregnancy or nursing mothers
Absolute CI - Children < 8-9 y/o

35
Q

Do not take tetracyclines with _____, due to poor absorption

A

antacids

36
Q

What are some adverse effects of tetracyclines?

A

GI Distress
Hepatotoxicity
Photosensitivity
Vestibular problems (Vertigo) - specifically Minocycline
Candida infections; C. diff

37
Q

azithromycin, erythromycin and clarithromycin are all ______

A

macrolides

38
Q

What is the MOA?

A

50S subunit

39
Q

_____ inhibits protein synthesis and translocation needed to replicate- 50S

A

macrolide MOA

40
Q

What are the macrolide’s method of resistance

A

50S subunit target modification
Efflux pumps
Degradation enzymes

41
Q

Do macrolides cross the BBB?

A

No, they are NOT effective on CNS infections

42
Q

What is the first line treatment for community acquired pneumonia?

A

macrolides

43
Q

macrolides are the first line treatment for ????

A

Community acquired pneumonia
“Atypicals” - Mycoplasma, Chlamydia
Increasing resistance with Streptococcus
Chlamydia
Legionella
Diphtheria
COPD - acute exacerbations

44
Q

macrolides are the second line treatment for ___ and ____

A

OM and pharyngitis

45
Q

macrolides: _____ has a broader spectrum of coverage than _____

A

azithromycin

erythromycin

46
Q

What are the adverse effects of macrolides?

A

GI - N/D (MC), c. diff
Hepatotoxicity¹
Prolonged QT interval
Ototoxicity (transient)

47
Q

macrolides are preg category ____

A

category B

48
Q

What is the MOA for clindamycin

A

50S subunit

49
Q

What abx spectrum of activity includes gram +, MRSA and anaerobes?

A

Clindamycin

50
Q

What abx is indicated for oral abcesses and bacterial vaginosis?

A

Clindamycin

51
Q

**What is the black box warning of clindamycin? What preg category?

A

C diff

Preg category B

52
Q

Inhibit Bacterial DNA synthesis / DNA Inhibitors is the MOA for ______

A

quinolones

53
Q

What are the three ways quinolones have developed resistance.

A

mutation in chromosomal genes for DNA gyrase and Topoisomerase IV
prevents abx from binding

Efflux pumps

Decreased cell wall permeability

54
Q

Of the -floxacins, which ones have better gram + coverage

A

Levofloxacin and Moxifloxacin: better Gram + than Ciprofloxacin

55
Q

quinolones are the first line treatment for what 6 diseases?

A

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
Q

community acquired pneumonia with no comorbiities, what abx?

A

macrolides

57
Q

_____ are a strong inhibitor of CYP450 enzymes. What pregnancy category?

A

quinolones

Preg category C

58
Q

**What is the black box warning associated with quinolones?

A

Tendiitis/tendon rupture

59
Q

What is the MOA for sulfonamides and trimethoprim?

A

folate synthesis

60
Q

_____ spectrum of activity includes Good G -, some G + coverage, MRSA

A

bactrim

61
Q

_____ is the first line outpatient treatment for MRSA, UTI/cystitis.

A

Bactrim

62
Q

If you pt is allergic to bactrim, what should you use?

A

clindamycin

63
Q

____ 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)

A

bactrim

64
Q

______ only function is in the bladder.

A

Nitrofurantoin (Macrobid/Macrodantin)

65
Q

Would you give Nitrofurantoin (Macrobid/Macrodantin) to a preg pt?

A

NO, avoid in pregnancy

66
Q

What would you give to a preg pt who has cystitis?

A

Keflex

67
Q

_____ is used in antiprotozoal / Anaerobic Antimicrobial infection

A

Metronidazole (Flagyl)

68
Q

_____ MOA works by disrupting microbial DNA

A

Metronidazole (Flagyl)

69
Q

____ is the first line treatment for Trichomonas, Bacterial Vaginosis (BV), C. difficile colitis, Amebiasis, Giardiasis

A

Metronidazole (Flagyl)

70
Q

______ you should NOT take with alcohol and has a black box warning carcinogenic in mice and rats

A

Metronidazole (Flagyl)

71
Q

_____ is given as a topical cream for burns

A

Silver sulfadiazine (Silvadene)

72
Q

_____ is a solution or ointment for ophthalmic infections Q2-3H during waking hours

A

Sulfacetamide

73
Q

____ used as adjunct to treat Toxoplasmosis and for malarial prevention

A

Pyrimethamine (Daraprim)

74
Q

____ Active against Gram +, limited to topical application only due to nephrotoxicity

A

Bacitracin

75
Q

____ : gram - coverage, IM / IV / Intrathecal / Ophthalmologic uses, rarely used in any form other than ophthalmic drops due to toxicity

A

Polymyxin B

76
Q

_____ is used mainly for pseudomonas in the eye (contact wearers)

A

Polymyxin B

77
Q

______: MC indication is Impetigo, Used in combination with chlorhexidine to decolonize MRSA carriers ¹

A

Mupirocin (Bactroban)

Infectious Disease (16 decks)

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