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Infectious Disease and Medical Microbiology > Antibiotic Therapy > Flashcards

Antibiotic Therapy Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
0
Q

Mechanism of action of glycopeptides

A

Inhibition of bacterial cell wall synthesis. Work at an earlier stage than do beta-lactams.

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1
Q

Vancomycin is a “BLANK”

A

Glycopeptide

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2
Q

Daptomycin is a “BLANK”

A

Lipopeptide

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3
Q

Mechanism of action of Lipopeptides

A

Disruption of cell wall.

  • Calcium dependent
  • Depolarizes cell membrane
  • Disrupts RNA, DNA, protein synthesis –> cell death
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4
Q

In general, Glycopeptides/Lipopeptides are active against:

A

Gram +ve organisms, including beta-lactam resistant organisms (i.e. MRSA)

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5
Q

Are Glycopeptides/Lipopeptides bacteriostatic or bactericidal?

A

Bactericidal

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6
Q

This Glycopeptide is slowly cidal, and when given PO is not systemically absorbed

A

Vancomycin

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7
Q

Lung surfactant inactivates “BLANK”; therefore, this agent should not be used to treat pneumonia!

A

Daptomycin

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8
Q

Spectrum and indications for Vancomycin IV

A

Spectrum: Gram +ve (Enterococci, penicillin resistant Streptococci, MRSA, CNS

Indications: Bacteremia, pneumonia, endocarditis, bone/joint, SSTI, surgical prophylaxis

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9
Q

Spectrum and indications for Vancomycin PO

A

Spectrum: C. difficile

Indications: C. difficile infection

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10
Q

Spectrum and indications for Daptomycin IV

A

Spectrum: Gram +ve (Enterococci, penicillin-resistant Streptococci, MRSA, CNS, and VRE)

Indications: Bacteremia, endocarditis, bone/joint, SSTI

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11
Q

Gentamycin and Tobramycin are both “BLANKS”

A

Aminoglycosides

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12
Q

Mechanism of action for Aminoglycosides

A

Inhibit protein synthesis by binding the 30S ribosomal subunit

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13
Q

Are Aminoglycosides bacteriostatic or bactericidal?

A

Bactericidal

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14
Q

Aminoglycosides are renally excretable and may cause the following toxicities (2)

A
  1. Nephrotoxicity

2. Ototoxicity

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15
Q

Gentamicin and beta-lactams act synergistically against what?

A

Enterococci

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16
Q

Spectrum and indications for Gentamicin IV

A

Spectrum: Gram -ve, Pseudomonas, synergy vs Streptococci and Enterococci with beta-lactam or vancomycin

Indications: Drug resistant UTI, combination therapy for Gram -ve sepsis, synergy for Gram +ve bacteremia and endocarditis

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17
Q

Spectrum and indications for Tobramycin IV

A

Spectrum: Gram -ve, Pseudomonas (better than gentamicin)

Indications: Drug resistant UTI, combo therapy for serious Pseudomonas infections

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18
Q

Azithromycin is a “BLANK”

A

Macrolide

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19
Q

Mechanism of action for Macrolides

A

Inhibit protein synthesis by binding the 23S rRNA in the 50S ribosomal subunit

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20
Q

Macrolides are active against intracellular organisms, true or false?

A

TRUE

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21
Q

Are Macrolides bacteriostatic or bactericidal?

A

Bacteriostatic

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22
Q

Does Azithromycin have a long or short half life?

A

LONG

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23
Q

Spectrum and indications for Azithromycin IV/PO

A

Spectrum: Mycoplasma, Chlamydophila, Legionella, M. catarrhalis, Chlamydia trachomatis, N. gonorrheae, MAC

Indications: Combo therapy for MAC Tx, MAC prophylaxis in HIV pt’s, 2nd line for STI’s, combo with beta-lactam for CAP

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24
Q

Why is Azithromycin the preferred macrolide over erythromycin and clarithromycin? (5)

A
  1. Broader spectrum
  2. Fewer drug interactions
  3. Once daily dosing
  4. Tolerability
  5. IV option
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25
Q

Clindamycin is a “BLANK”

A

Lincosamide

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26
Q

What is the mechanism of action of Clindamycin?

A

Inhibits proteins synthesis by binding to the 50S ribosomal subunit

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27
Q

What is the bioavailability of Clindamycin?

A

Excellent

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28
Q

Is Clindamycin bacteriostatic or bactericidal?

A

Bacteriostatic

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29
Q

Clindamycin inhibits toxin production from what?

A

Group A Streptococcus

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30
Q

Clindamycin is used in combination with what other antibiotic to treat necrotizing faciitis?

A

Penicillin

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31
Q

Clindamycin is high risk for what?

A

C. difficile

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32
Q

Spectrum and indications for Clindamycin PO/IV

A

Spectrum: Streptococci, S. aureus, MRSA (if susceptible), anaerobes

Indications: SSTI, bone/joint, abscesses, alternative for dental infections, polymicrobial infections in combo with Gram -ve agent, combo vs necrotizing faciitis

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33
Q

Doxycycline and Tigecycline fall under what family of antibiotics?

A

Tetracyclines/Glycylcyclines

34
Q

What is the mechanism of action of Tetracyclines/Glycylcyclines?

A

Inhibits protein synthesis by binding the 30S and 50S ribosomal subunits

35
Q

Tetracyclines/Glycylcyclines are bacteriostatic, true or false?

A

TRUE

36
Q

Tetracyclines and Glycylcyclines are active against intracellular pathogens, true or false?

A

TRUE

37
Q

Spectrum and indications for Doxycycline PO

A

Spectrum: Mycoplasma, Chlamydophila, Legionella, Chlamydia trachomatis, S. pneumoniae, Haemophilus, Moraxella, S. aureus (including MRSA)

Indications: COPD, CAP, Chlamydial STIs, purulent cellulitis (suspected MRSA)

38
Q

Spectrum and indications for Tigecycline IV

A

Spectrum: Broad spectrum, Gram +ve (E. faecalis, MRSA), Gram -ve, anaerobes

Indications: Last line option of polymicrobial, multidrug resistant organisms if susceptibility confirmed

39
Q

3 problems with Tetracycline PO

A
  1. Requires QID dosing on an empty stomach
  2. Poorly tolerated
  3. Narrower spectrum than Doxycycline
40
Q

Ciprofloxacin and Levofloxacin are both “BLANKS”

A

Fluoroquinolones

41
Q

What is the mechanism of action of Fluoroquinolones?

A

Inhibition of DNA gyrase and topoisomerase

42
Q

Bioavailability of Fluoroquinolones

A

EXCELLENT

43
Q

Are Fluoroquinolones bacteriostatic or bactericidal?

A

Bactericidal

44
Q

What 2 Fluoroquinolones are active against intracellular pathogens?

A
  1. Levofloxacin

2. Moxifloxacin

45
Q

Fluoroquinolones are high risk for C. difficile, true or false?

A

TRUE

46
Q

Widespread use of Fluoroquinolones is leading to the development of resistance by which type of bacteria?

A

Gram -ve

47
Q

Spectrum and indications for Ciprofloxacin IV/PO

A

Spectrum: Gram -ve, Pseudomonas

Indications: Not usually 1st line due to increasing Gram -ve resistance, UTI, in combo with metronidazole or clindamycin for polymicrobial infections

48
Q

Spectrum and indications for Levofloxacin IV/PO

A

Spectrum: Streptococci, Mycoplasma, Chlamydophila, Legionella, Gram -ve

Indications: Not 1st line, reserve for suspected drug-resistant respiratory infections or allergy to 1st line agents.

49
Q

Moxifloxacin is a respiratory fluoroquinolone, what is the risk of C. difficile with this drug?

A

High

50
Q

Which Fluoroquinolone is active against multidrug resistant TB?

A

Moxifloxacin

51
Q

Which Fluoroquinolone has no Pseudomonas activity and does not get to therapeutic concentration in the urinary tract?

A

Moxifloxacin

52
Q

TMP-SMX and Nitrofurantoin are considered to be part of what family of antibiotics?

A

Anti-folates

53
Q

Mechanism of action of Trimethoprim-sulfamethoxazole

A

Together they inhibit purine synthesis, preventing DNA synthesis

54
Q

What is the mechanism of action of nitrofurantoin?

A

It is reduced inside the cell to produce reactive intermediates that cause cellular damage. There is minimal resistance due to complex mechanism.

55
Q

TMP/SMX acts as a “BLANK” agent

A

Bacteriostatic

56
Q

The bioavailability of TMP/SMX is…

A

EXCELLENT (PO)

57
Q

Nitrofurantoin is (bacteriostatic/bactericidal), and only achieves therapeutic concentrations in (urine/blood)

A

Bactericidal, Urine

58
Q

Nitrofurantoin is effective for cystitis, but not “BLANK”

A

Pyelonephritis

59
Q

Spectrum and indications for Trimethoprim/Sulfamethoxazole IV/PO

A

Spectrum: Gram -ve, S. aureus (MRSA), S. pneumoniae, Nocardia, Pneumocystis jiroveci

Indications: UTI (not first line), purulent cellulitis (MRSA), Nocardia infections, PCP Tx and prophylaxis

60
Q

Spectrum and indications for Nitrofurantoin PO

A

Spectrum: E. coli, Klebsiella, E. faecalis

Indications: 1st line for cystitis

61
Q

Metronidazole is in which family of antibiotics?

A

Nitroimidazoles

62
Q

What is the mechanism of action for Metronidazole?

A

It inhibits DNA synthesis

63
Q

What is the bioavailability of Metronidazole?

A

EXCELLENT - also has excellent penetration of the CNS

64
Q

What should you avoid when taking Metronidazole?

A

Alcohol (disulfiram reaction)

65
Q

Spectrum and indications for Metronidazole PO/IV

A

Spectrum: Anaerobes (including C. difficile), Protozoa (i.e. Giardia)

Indications: C. difficile, used in combo for polymicrobial infections/abscesses, trichomoniasis

66
Q

Linezolid belong to this class of antibiotics…

A

Oxazolidinones

67
Q

Mechanism of action for Linezolid

A

Inhibits protein synthesis by binding to 23S rRNA in 50S ribosomal subunit - prevents the formation of 70S ribosome.

68
Q

Bioavailability of Linezolid…

A

EXCELLENT

69
Q

Linezolid is bacteriostatic/bactericidal…

A

Bacteriostatic

70
Q

What is there a risk of with prolonged use (> 2 weeks) of Linezolid?

A

Cytopenias

71
Q

Linezolid has activity against beta-lactam and vancomycin resistant organisms, true or false?

A

TRUE

72
Q

Spectrum and indications for Linezolid PO/IV

A

Spectrum: Streptococci, Enterococci, Staphylococci, anaerobes

Indications: Resistance, allergy or failure with vancomycin therapy

73
Q

Which 4 drugs were presented as anti-tuberculosis drugs?

A
  1. Rifampin
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
74
Q

The 4 drug combo used for TB is bacteriostatic/bactericidal?

A

Bactericidal

75
Q

Anti-tuberculosis drugs are poorly absorbed, true or false?

A

FALSE

76
Q

Rifampin is a potent inhibitor/inducer of CYP 3A4?

A

Inducer

77
Q

What type of toxicity should you monitor for when giving someone the empirical 4 drug combo for TB?

A

Hepatotoxicity

78
Q

Indications for Rifampin

A

Penetrates Staph biofilms, TB, MAC, latent TB Tx

79
Q

Indications for Isoniazid

A

TB and latent TB Tx

80
Q

Indications for Pyrazinamide

A

TB

81
Q

Indications for Ethambutol

A

TB, MAC

82
Q

How much can you save by switching to Geico?

A

15% or more

83
Q

Which antibiotics are effective against MRSA?

A
  1. Vancomycin IV (PO is not systemically absorbed)
  2. Daptomycin IV
  3. Clindamycin PO/IV (if susceptible..) - High risk of C. difficile!
  4. Doxycycline PO
  5. Tigecycline IV (last line option)
  6. TMP/SMX IV/PO
  7. Linezolid PO/IV (expensive, cytopenias with prolonged Tx)

Infectious Disease and Medical Microbiology (23 decks)

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