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antibiotic inhibiting protein synthesis Flashcards

1
Q

Is linezolid “-static” or “-cidial” for enterococci?

A

“-static”

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2
Q

Is linezolid “-static” or “-cidial” for strept?

A

“-cidal”

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3
Q

What is the basic structure that makes aminoglycosides part of one class?

A

Aminocyclitol ring

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4
Q

What inhibits aminoglycosides?

A

Acidic pH and anaerobic conditions

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5
Q

Besides protein synthesis inhibition, what other effects do aminoglycosides have?

A

Inhibit cell wall membrane

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6
Q

What other classes do aminoglycosides work well with?

A

Penicillin and cephalosporins

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7
Q

What are the 3 known mechanisms of resistance for aminoglycosides?

A

Modification of aminoglycoside molecule
binding of aminoglycosides on rRNA altered
reduced uptake of aminoglycosides

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8
Q

What is a way to combat resistance with aminoglycosides?

A

use with agents that target cell wall in conjunction

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9
Q

What is aminoglycoside active against?

A

Aerobic gam-negative bacilli

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10
Q

When you add cell wall inhibitors what will aminoglycosides start to work better against?

A

gram positive bacteria

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11
Q

What are aminoglycosides used for?

A

UTIs, respiratory tract, skin and soft-tissue infections

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12
Q

When do you use aminoglycosides in combination with other agents?

A

To broaden coverage in serious illness
bacteremia or sepsis
pseudomonal infections
synergism w/ vancomycin or penicillins in the treatment of endocarditis

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13
Q

When do you get more killing of bacteria for aminoglycosides?

A

Post-antibiotic effect (after high level is reached)

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14
Q

When do you use streptomycin?

A

Enterococcal infections

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15
Q

What are 3 common aminoglycosides?

A

gentamicin
tobramycin
amikacin

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16
Q

What are neomycin and kanamycin limited to?

A

Oral or topical use due to toxicity

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17
Q

What is spectiomycin used for?

A

Tx for gonorrhea in PCN allergic patients

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18
Q

What are the two toxicities to be concerned about with aminoglycosides?

A

Otoxicity

Nephrotoxicity

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19
Q

of the aminoglycoside class, what is the most ototoxic drug?

A

Streptomycin

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20
Q

In a patient with Parkinson’s or myasthenia gravis, what can happen when they are put on aminoglycosides?

A

Aggravate muscle weakness; respiratory paralysis

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21
Q

Are hypersensitivity rxns common with aminoglycosides?

A

No (not used frequently, usually used in hospital)

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22
Q

If a patient has allergies to sulfite, what aminoglycoside should they not be given?

A

Streptomycin

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23
Q

What aminoglycoside is given to decontaminate bowel (given PO)?

A

Neomycin

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24
Q

How are aminoglycosides administered?

A

IV

widely distribute in extracellular fluid

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25
Q

Clearance of aminoglycosides is proportional to what?

A

creatinine clearance

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26
Q

With vancomycin what levels do you check?

A

Trough levels

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27
Q

What levels do you check with aminoglycosides?

A 
Peak levels (30 minutes after infusion- allow you to see highest level) 
trough levels
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28
Q

what type dosing is mostly mentioned for aminoglycosides?

A

“once daily” dosing

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29
Q

Who should not be given once daily dosing with amionglycosides?

A

renal insufficiency
Cystic fibrosis
spinal cord infections
burn patients

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30
Q

What weight is used for aminoglycosides?

A

Actual body weight, adjusted for obese

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31
Q

What drugs can aminoglycosides interact with?

A

Loop diuretics - nephrotoxicity

Non-depoloarizing muscle relaxant- resp depression

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32
Q

What levels can neomycin (IV) affect?

A

Digoxin levels (alter GI flora responsible for mechanism)

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33
Q

Most aminoglycosides have what category for pregnancy?

A

Category D- 8th CN toxicity

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34
Q

What aminoglycosides have a Category C for pregnancy?

A

Gentamicin

Neomycin

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35
Q

Are aminoglycosides compatible for breastfeeding moms?

A

Yes

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36
Q

what are the 3 primary tetracyclines?

A

tetracycline
doxycycline
minocycline

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37
Q

what bacteria do tetracyclines cover?

A

gram positive
gram negative
aerobic
anaerobes

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38
Q

What is a difficult condition that tetracyclines can kill?

A

Mycoplasma pneumonia

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39
Q

What drug is used for inhalation anthrax?

A

Doxycycline

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40
Q

What is a concern with the tetracyline class?

A

WIll kill off normal flora easily and concern of overgrowth of opportunistic infections.

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41
Q

WHat other conditions do tetracyclines treat?

A 
Chlamydia
rickettsia (RMSF)
lyme's disease (borrelia burgdorferi) 
inflammatory acne
sinusitis
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42
Q

Is tetracycline long or short acting?

A

Short acting

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43
Q

Are minocycline and doxycycline long or short acting?

A

long acting (better option)

44
Q

What do tetracyclines bind?

A

Reversibly bind RNA

45
Q

Are tetracyclines “-static” or “-cidal”

A

bacteriostatic

46
Q

what is the most important mechanism of resistance to tetracycline?

A

Bacterial efflux pump

47
Q

what are the ROA for tetracycline?

A

Oral
parenteral
ophthalmic

48
Q

What is the most common side effect with tetracyclines?

A 
GI effects (N/V/D) with oral and parenteral routes 
potential for C. diff/ candidiasis
49
Q

Who should tetracyclines not be administered to?

A

Young children and pregnant moms
tetracyclines binds to bony structures and teeth
will get grey discoloration on teeth

50
Q

what pregnancy category are tetracyclines?

A

Category D

51
Q

what is usually the initial therapy for lyme disease?

A

doxycycline

52
Q

What are some other ADRs of tetracyclines?

A

photosensitization

pseudotumor cerebri

53
Q

What are some ADRs with minocycline?

A

Dizziness, vertigo

lupus-like rxn (reversible)

54
Q

Combination of tetracycline and what can inhibit absorption?

A

Dairy
Antacids
Mg, Iron, zinc, aluminum hydroxide

55
Q

Where do tetracyclines distribute?

A

Body, including meninges

56
Q

How are tetracyclines eliminated?

A 
mostly kidneys (except doxy- hepatic)
dosage adjustments may be necessary
57
Q

What is a third generation TCN what has broad spectrum antimicrobial activity, including MRSA?

A

Tigecycline (Tyacil)

58
Q

Why was tigecycline developed?

A

Overcome bacterial resistance mechanisms to TCNs (efflux and ribosomal mutations)

59
Q

What is chloramphenicol reserved for?

A

Life threatening infections: typhoid fever, RMSF, and meningitis in patients allergic to PCN.

60
Q

What is the bad side effect of chloramphenicol?

A

blood dyscrasias

61
Q

Is chloramphenicol bascteriostatic or bactericidial?

A

Both; depending on bacteria speciesis

62
Q

Who can’t chloramphenicol be used in?

A

Pregnant women

Neonates

63
Q

What types of resistance are there with chloramphenicol?

A

plasmid born
decreased cellular permeability
modification of enzymes- acetyltransferases

64
Q

What is an example of a macrolide?

A

Erythromycin

65
Q

What are some semisynthetic derviates of erythromycin? (also macrolide class)

A

Clarithromycin
Azithromycin
(both are more acid stable)

66
Q

Are macrolides bacteriostatic or bacteriocidial?

A

bacteriostatic;

at high concentrations or with rapid bacterial groups become bactericidal

67
Q

What macrolide has more anaerobic coverage?

A

Azithromycin

68
Q

What macrolide has the most reistatnce?

A

erythromycin

69
Q

What does erythromycin work against?

A

Gram (+) bacteria and spirochetes. Specific bacteria include: legionella pneumophila, N gonorrhoeae, N. menigitidis, Poor anaerobic coverage.

70
Q

What does clarithromycin act against?

A

against gram (+) and anaerobic bacteria, H. influenzae, H. pylori, mycobacterium avium

71
Q

Does erythromycin work against h. influenze?

A

No, but the semisynthetic deviates do?

72
Q

Resistance to macrolides is usualuly waht?

A

Plasmid mediated

73
Q

What is erythromycin base destroyed by?

A

Stomach acid, must be administered with enteric coated tablet

74
Q

Where are macrolides widely distributed?

A

Prostate (but not to CNS)

75
Q

how can macrolides be administered?

A

PO, IV, ophthalmic

76
Q

How are erythro and azithro excreted?

A

Unchanged in bile

77
Q

How is clarithromycin excreted?

A

Unchanged in bile and urine (May have to make renal adjustments)

78
Q

What side effects are most common with macrlides?

A

Gastrointestinal

79
Q

When can you see sholestatic jaundice?

A

Estolate salt form of erythromycin

80
Q

when do you see CV issues with macrolids?

A 
IV administration 
(QT prolongations)
81
Q

What does clarithromycin have enhanced coverage of?

A

Atypical mycobacteria

82
Q

compared to erythromycin, clarithyromycin has less what?

A

GI upset and BID dosing

83
Q

What do you get greater of what azithromycin?

A

Greater tissue penetration

prolonged intracellular half-life

84
Q

Erythro and clarithromycin inhibit what?

A

CYP3A4

85
Q

Ketolides have a greater potency against what? (then macrolides)

A

greater potency against gram positive organisms

86
Q

What does telithromycin have a black box warning for?

A

Liver failure and deaths

increased risk of ventricular arrhythmias

87
Q

Patients with what should not take telithromycin?

A

myasthenia gravis

88
Q

How is telithromycin eliminated?

A

hepatic metabolism with eliminiation in bile and urine

89
Q

Talithromycin inhibits what?

A

P450 class

90
Q

What is the main antibiotic associated with lincosamides?

A

Clindamycin

91
Q

What does clindamycin work well for?

A

Strep, staph, pneumococci

anaerobes*** (except C diff)

92
Q

How is clindamycin available?

A

oral, IV, topical

93
Q

What is the most important indication for clindamycin?

A

Anaerobic or mixed infections

Aspiration pneumonia

94
Q

What can clindamycin be topically used for?

A

inflammatory acne

95
Q

what is the most common antibiotic to cause C. diff?

A

clindamycin (IV)

96
Q

What is a bacteriostatic drug that is used to treat VRE (vanco-resistant E. faceium), complicated skin/ sturue infection by methicillin-susceptible S. aureus or S. pygoenes?

A

Quinupristin- Dalfopristin (synecrid)

97
Q

Quinupristin- Dalfopristin (synecrid) has what main AE?

A

Muscle and joint pain

98
Q

What does Quinupristin- Dalfopristin (synecrid) inhibit?

A

P450 3A4 inhibitor

99
Q

What is a better choice for vanco-resistant E. faecium?

A

Linezolid

100
Q

What else is Linezolid used for?

A

no socomial pneumonia due to S. aureus
MRSA or S. pneumoniae
skin/ sturue infection
Gram + CAP

101
Q

What is linezolid bacteriostatic against?

A

enetrococci and staph

102
Q

What is linezolid bactericidal against?

A

strept

103
Q

how is linezolid excreted?

A

Urine

104
Q

What are concerning side effects of linezolid?

A

thrombocytopenia

HTN crisis if combined w/ MAOI, adrenegic and serotonergic drugs

105
Q

What is mupirocin affective against?

A

gram positive cocci

106
Q

what can you use mupriocin for?

A

topical treatment of skin

ex- impetigo

Pharm (29 decks)

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