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Pharmacology - Final Exam > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What is the process for abx (antibiotic) selection?

A
  1. Establish presence of infection
  2. Identify site of infection
  3. Direct Empiric antibiotic tx towards likely organism
  4. Identify primary pathogen(s) in the specific pt.
  5. Choose the most appropriate antibiotic for the PATHOGEN, SITE OF INFECTION, AND PATIENT
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2
Q

What will a gram stain tell you?

A

Solubility and shape

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3
Q

What will cultures and sensitivities tell you?

A

What abx is the pathogen sensitive to/ what is it resistant to
What the pathogen is
Quantity of the pathogen

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4
Q

What are the three key things that need to be considered when choosing the most appropriate antibiotic for a pt?

A
  1. Pathogen
  2. Site of infection
  3. Patient (age, renal function, allergies etc)
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5
Q

t/f? In order to properly identify the infecting pathogen it is good to obtain a culture shortly after starting the pt on an antibiotic?

A

F. Obtain culture samples prior to abx therapy

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6
Q

t/f? You should always perform blood cultures with any type of infection?

A

F. You should obtain blood cultures on all acutely ill febrile pt’s. Not every infection warrants a blood culture.

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7
Q

How do gram negative cells appear on microscopy?

A

RED: Decolorized by alcohol and take on the red color when counterstained with safranin

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8
Q

How do gram positive cells appear on microscopy?

A

VIOLET: not decolorized by the alcohol so they retain the violet color.

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9
Q

What might be indicated by presence of epithelial cells on a sputum culture?

A

A bad sample, especially when multiple organisms are identified.

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10
Q

What might recovery of Staph. epidermindis or Corynebacterium from a sterile sample such as CSF, blood, or joint fluid indicate?

A

Contamination. These are bacteria usually found on the skin

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11
Q

What does the term infection refer to in a culture report?

A

The isolated organisms are from the specimen and causing the infection.

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12
Q

What does the term colonization refer to in a culture report?

A

Isolated organisms are from the specimen but are NOT causing the symptoms.

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13
Q

What does the term contamination refer to in a culture report?

A

The isolated organisms came from the pt’s skin/environment

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14
Q

How soon can you expect results from a C&S?

A

about 24-48 hours

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15
Q

What does a C&S provide?

A

The final identification of the organism and information on the effectiveness of antimicrobials.

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16
Q

How are results in a C&S reported?

A

S-Sensitive
R-Resistant
I-Intermediate

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17
Q

What must you consider when identifying what medication will work for a specific pathogen?

A

Antimicrobial spectrum of activity, susceptibility testing, and local susceptibility patterns.

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18
Q

Define minimum inhibitory concentration (MIC)

A

The lowest serum antimicrobial concentration that prevents visible growth of an organism

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19
Q

Define Susceptibility relative to MIC

A

You can get enough drug into the patient to t the infection (MIC<attainable serum levels)

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20
Q

Define intermediate susceptibility relative to MIC

A

You may not be able to get enough drug into the pt to tx the infection unless the drug is safe enough to give in high doses or the drug concentrates exceptionally well at the infection site (MIC~/= attainable serum levels)

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21
Q

Define resistance relative to MIC

A

You cannot get enough drug into the pt to tx the infection (MIC>attainable serum levels)

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22
Q

What drug factors should you consider when prescribing an Abx?

A 
Clinical efficacy (does the drug reach the site of infection)
Antimicrobial spectrum
Available routes of admin.
cost
Bactericidal vs. bacterostatic
P'kinetics, and P'dynamics 
Safety (concerns with preg. etc.)
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23
Q

What are “time dependent killers”?

A

killing is dependent upon the amount of time the organism is in contact with the drug. So the duration that drug concentrations are above the MIC is important.

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24
Q

What are “concentration dependent killers”?

A

Killing is dependent upon the concentration of the drug that organism is exposed to. The higher the concentration the greater the killing.

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25
Q

When is synergy, or the use of 2 abx used together, used?

A

enterococcus endocarditis or bacteremia, sepsis, pseudomonal infeections

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26
Q

Define post antibiotic effect (PAE)

A

Organism growth is suppressed for a period of time after the drug concentration falls below the MIC.

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27
Q

What are the two types of antibiotic resistance?

A
  1. Intrinsic resistance

2. Acquired resistance

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28
Q

Define intrinsic resistance

A

Naturally occurring resistance (drug cannot penetrate the organisms cell wall)

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29
Q

Define acquired resistance

A

A normally sensitive organism becomes resistant

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30
Q

What mechanisms cause acquired resistance?

A
  • Detoxifying enzymes - alter antibiotic structure and function (ex. ESBL Beta Lactamase - breaks down the beta-lactam ring of pan antibiotics)
  • Alteration in antibiotic target site- (Ex MRSA)
  • Decreased cellular accumulation of abx. (impaired influx-decreased permeability, and enhanced eflux)
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31
Q

What type of infection is IV admin most often used?

A
  1. Severe infections: endocarditis, meningitis, sepsis, osteomelitis
  2. When pt can’t tolerate oral meds or has non-functioning GI tract
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32
Q

MOA Beta-Lactams

A

Bind to penicillin binding proteins and inhibit cell wall synthesis causing cell death.

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33
Q

What are the 4 subclasses of PCN?

A

Natural PCN
Aminopenicillins
Penicillinase resistant PCN
Extended spectrum PCN

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34
Q

What do Natural PCN cover (Gram +/-, anaerobes?)

A

Gram +, a few Gram -

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35
Q

What do Aminopenicillins cover (Gram +/-, anaerobes?)

A

Gram +, some Gram -

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36
Q

What do Penicillinase resistant penicillins cover (Gram +/-, anaerobes?)

A

Gram + only

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37
Q

What do extended spectrum penicillin /beta-lactamase combo cover (Gram +/-, anaerobes?)

A

Gram +, Gram -, and anaerobes

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38
Q

What medications are Natural PCN?

A

PCN VK

PCN G

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39
Q

What is the spectrum of activity for PCN VK and PCN G? and what is the most common use?

A

GRAM +: Strep Pyogenes

Some Gram -: Pharyngitis, erysipelas, and syphilis (PCN G)

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40
Q

T/F >90% of staph produce penicillinase so PCN is not effective

A

TRUE

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41
Q

What medications are Aminopenicillins?

What are the most common uses?

A

Ampicillin
Amoxicillin (amoxicillin/clavulanate)

URI, Enterococcal infection, amox/clavulunate used for skin infections, UTI, CAP, Lymphadenitis

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42
Q

What meds are penicillinase resistant penicillins?

A

Dicloxacillin
Nafcillin-IV
Oxacillin-IV
Methacillin (pulled from market)

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43
Q

What bacteria does PCNase resistant PCN cover?

What are the most common uses.

A

Gram Positive; Staphylococcus spp, and Streptococcus spp.
Drug of choice for B-lactam producing staph
Used to tx - cellulitis, endocarditis

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44
Q

What are extended-spectrum penicillins?

A

Tirarcillin/clavulanate
Piperacillin/tazobactam
*the “big guns” only available IV

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45
Q

What bacteria do Extended-sepctrum pcns cover?

Common uses?

A

Gram positive: Streptococcus, Staphylococcus (MSSA)
Gram negative: Enterobacteriaceae (E. Coli, proteus)
Anaerobes: Bacteriodes

Nosocomial pneumonia, Intra-abdominal infections, Skin and soft tissue infections

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46
Q

MOA for B-lactamase inhibitors?

A

Enhances the antimicrobial activity against certain beta-lactamase producing organisms, extending the abx antimicrobial spectrum

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47
Q

What bacteria are covered by B-lactamase inhibitors?

A

Gram positive-S. aureus
Anaerobes-bacteriodes sp.
Gram negative- H. flu, E coli

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48
Q

ADE PCN

A

Rash
Anyphylaxis, angioedema
Ampicillin/amoxicillin - GI upset/diarrhea

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49
Q

Options for management of PCN allergy?

A

Option 1 - administer a cephalosporin
Option 2 - Prescribe/recommend a non beta-lactam abx.
Option 3 - Perform pcn desensitization
Option 4 - Perform a PCN skin test 80-95% of

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50
Q

What are the renal adjustments for PCN’s

A

Must adjust for PCN, Amoxicillin/ampicillin

No adjustment for Dicloxacillin, nafcillin, oxacillin

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51
Q

What DI does Probenecid have with PCN?

A

Probenecid decreases the renal tubular secretion of PCN’s co-admin causes increased serum levels of abx.

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52
Q 
Which of the following abx would be the best choice for treatment of cellulitis caused by Staph aureus (MSSA)?
A. Amoxicillin
B. Piperacillin/tazobactam
C. Penicillin
D. Nafcillin
A

D. Nafcilin-Is a PCNase resistant PCN and is drug of choice for B-lac producing staph

Amox-is broken down by B-lac
Piperacillin/tazo is empiric and very broad-an option but not specific enough
PCN-is broken down by B-lac

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53
Q

What are the 5 groups of Cephalosporins?

A 
1st gen
2nd gen
3rd gen
4th gen
Newer gen

(4th and newer gen are IV only)

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54
Q

Which drugs are first generation cephalosporins?

A

Cephalexin-oral

Cefazolin-IV

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55
Q

What drugs are 2nd generation cephalosporins?

A

Cefuroxime-oral

Cefoxitin-IV

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56
Q

What drugs are 3rd gen Cephalosporins?

A

Cefpodoxime-oral

Ceftriaxone-IV

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57
Q

What drugs are 4th gen cephalosporins?

A

Cefepime-IV

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58
Q

Newer gen

A

IV only

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59
Q

What do first gen cephalosporins cover?

A

Gram positive

some Gram negative

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60
Q

What do 2nd gen cephalosporins cover?

A

Gram pos

some increased gram neg

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61
Q

What do 3rd gen cephalosporins cover?

A

Less gram positive

More gram neg

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62
Q

What do 4th gen cephalosporins cover?

A

Gram pos

Gram neg

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63
Q

What is the spectrum of activity for First gen cephalosporins?

A

Gram positive: Staphlococcus, Streptococcus spp.
Gram negative: Proteus, Escherichia coli, Klebsiella pneumoniae
(SPEcK)

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64
Q

What are the common uses for first gen cephalosporins?

A

Mild skin or soft tissue infections

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65
Q

What is the spectrum of activity for 2nd gen cephalosporins?

A

Gram positive: Staphlococcus, Strepococcus spp.
Gram Negative: H. flu, Moraxella catarrhalis, Proteus mirabilis, E. coli, Klebsiella pneumo.
(HMSPEcK)

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66
Q

What is the spectrum of activity for 3rd gen cephalosporins?

A

Gram positive: Strep pneumo

Gram Negative: Enterobacteriaceae, H. flu, Moraxella catarhalis.

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67
Q

Common uses for 3rd gen cephalosporins?

A

CAP
OM
URI

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68
Q

Spectrum of activity for 4th gen cephalosporins?

Common uses?

A

Gram +, Gram -, Anaerobes

Nosocomial infections

69
Q

Which cephalosporins require renal adjustment
1st gen
2nd gen
3rd gen?

A

all of them.

70
Q

What class of medications have similar adverse reactions to cephalosporins?

71
Q

What special considerations need to be made when taking cephalosporin?

A

Take with food

72
Q

What is the cross sensitivity rate for PCN allergic patients with cephalosporins?

73
Q

What effect does probenicid have on concetrations of cephalosporins?

A

Increases concentrations

74
Q

MOA for Monobactams?

A

Bind to pcn binding protein and inhibit cell wall synth which leads to cell death.

75
Q

What is the only monobactam available in the USA?

A

Aztreonam.

76
Q

What are the administration forms of aztreonam?

A

IV or IM admin

77
Q

t/f Doses must be adjusted for renal function with aztreonam?

78
Q

MOA carbapenems?

A

Bind to PCN binding protein and inhibit cell wall synthesis which leads to cell death.

79
Q

What medications are Carbapenems?

A

Imipenem/cilastin
Meropenem
Doripenem
Ertapenem

80
Q

What are carbapenems the drug of choice for?

A

They are resistant to most beta-lactam and are the drugs of choice for infections caused by ESBL’s

81
Q

Are there any dose adjustments for carbapenems?

A

yes-renal function

82
Q

What is MOA for glycopeptide abx?

A

Prevents cross-linking of the cell wall peptidoglycan during cell wall synthesis

83
Q

What medications are glycopeptides?

A

Vancomycin
Telavancin
Dalbavancin
oritavancin

84
Q

What is Vancomycin most commonly used for?

A

MRSA-sepsis, endocarditis etc.

85
Q

What forms of admin exist for vancomycin?

A

PO - only used for C. Diff bc. oral dosage is not absorbed.

IV

86
Q

What is red man syndrome?

A

Vancomycin, Telavancin, infusion related rxn that is caused by the release of histamine. Erythematous urticarial reactions, flushing, tachycardia, hypotension. This is NOT an allergic rxn.

87
Q

What is the management of red man syndrome?

A

Stop infusion and wait for sx to subside. Then restart but slow infusion rate down. May admin Benadryl prior to to help.

88
Q

What is the Black Box warning for Telavancin?

A

May cause abnormal fetal development. Preg test should be performed on women of child bearing age.

89
Q

What is Telavancin used for?

A

Complicated skin and soft tissue infection and nosocomial pneumonia.

90
Q

“other” cell wall/membrane active agents?

A

Daptomycin
fosfomycin
bacitracin
cycloserine

91
Q

What is the spectrum of activity for daptomycin?

A

Vacnomycin resistant enterococci (VRE) and Vanco intermediate and resistant S. aureus (VRSA)

92
Q

What is common use of Daptomycin?

A

skin/soft tissue infection, bacteremia, endocarditis (not pneumonia)

93
Q

What must you monitor when placing a pt on Daptomycin?

A

CPK and d/c drug if muscle pain and elevation of CPK >5x ULN occurs.

94
Q

Fosfomycin: formulation, coverage, usage?

A

Oral form, gram neg and gram pos, UTI’s in women

95
Q

Bactiracin: form, caution, usage?

A

Topical only, highly nephrotoxic if given IV, tx surface lesions on skin or irrigation of wounds

96
Q

Cycloserine: Coverage, Usage, ADE

A

Gram pos, and gram neg, TX of TB, serious ADE-headaches, tremors, acute psychosis.

97
Q

What is the MOA of tetracyclines (TCNs)

A

TCN binds to the 30S ribosomal subunit, which prevents binding of tRNA to the mRNA-ribosome complex, this interfering with protein synthesis

98
Q

What medications are TCN’s

A

Tetracycline (TCN)
Minocycline
Doxycycline

99
Q

What do TCNs cover?

Common uses?

A

Gram +: S. pneumo, S. pyogenes, CA-MRSA
Gram -: Ecoli, Klebsiella etc.
Atypicals-chlamydia etc.

Resp. infection
CA-MRSA

Doxycycline-anthrax, chlamydia, lyme, CA-MRSA

100
Q

What are the possible ADE of TCN’s

A

Tooth discoloration, and abnormal bone growth-Do no use in second 1/2 of pregnancy or in children

101
Q

What are the special considerations when taking TCN

A

Admin must be separated from food containing aluminum, magnesium , calcium, and iron by at least 1-2 hours.

Careful with this because this is tricky!!!

  • Minocycline-take w/wout food
  • TCN-take on an EMPTY STOMACH
  • Doxycycline- take WITH FOOD due to GI intolerance (crackers by not milk)
102
Q

Which of the 3 TCN’s mentioned does not require renal adjustment?

A

Doxycycline

103
Q

Tigecycline: Efficacy, admin form, class?

A

works for MRSA, MRSE, VRE, PCN resistant strep pneumo, IV only (very very broad spectrum), Derivative of minocycline,

104
Q

What is the MOA of macrolides?

A

Bind to the 50S ribosomal subunit, inhibiting bacterial protein synthesis.

105
Q

What medications are macrolides?

A

Erythromycin
Clarithromycin
Azithromycin
Fidaxomicin

106
Q

What is the spectrum of activity for E-mycin, C-mycin, and Az-mycin?
Common use?

A

Gram pos: Streptococcus
Gram Neg: H. flu
Atypicals-mycoplasma etc.

Alternative for PCN allergic pts, CAP

107
Q

What is the only bacteria that Fidaxomicin is approved for?

108
Q

ADE of E-mycin, A-mycin, C-mycin?

A

N/V, Abd pain, Diarrhea, renal failure,

***QT prolongation (if tx for CAP b/c of atypicals Doxycycline is a good alternative)

109
Q

ADE Fidaxomicin?

A

GI-mc

Hematologic (rare)-anemia, neutropenia

110
Q

DI for erythromycin and Clarithromycin?

A

metablized via Cyt-p450 so can cause increase concentrations of theophylline, warfarin, cyclosporine

111
Q

What might Azitromycin cause in regards to digoxin and cyclosporine levels?

112
Q

clindamycin MOA

A

same as macrolides-binds to 50S ribosomal subunits of bacteria, which inhibits protein synthesis

113
Q

What bacteria does Clindamycin cover?

and MC uses?

A

Staph aureus (CA-MRSA and MSSA)
Anaerobes
skin and soft tissue infection (CA-MRSA), Alternative for dental prophylaxis in PCN allergic pt.s

114
Q

ADE Clindamycin?

A

GI upset, skin rash
HIGHER INCIDENCE OF C. DIFF ASSOCIATED DIARRHEA vs. other abx.
Hepatotoxicity

115
Q

What special considerations regarding food are made when taking Clindamycin?

A

Admin w/ food decreases GI upset

Admin w/ full glass of water dec. esophageal ulceration

116
Q

Linezolid: MC use?

A

MRSA or Vanco resistant E. faecium-Very very expensive and second choice to Vanco

117
Q

What meds must you closely monitor levels of when giving a Linezolid with them?

118
Q

Benefits and drawbacks to prescribing Linezolid?

A

It is extremely effective (99.5%) against staph aureus, has great pulm penetration. Oral formulation is 100% bioavailable (Vanco is not available PO).

Drawbacks: Risk of optic neuropathy, Thrombocytopenia, although oral form is available it is very expensive and not always covered by insurance.

119
Q

MOA aminoglycosides?

A

inhibits protein synthesis by binding to the 30S ribosomal subunit.

120
Q

What medications are Aminoglycoside?

A 
Gentamincin-IV
Tobramycin-IV
Amikacin-IV
Streptomycin-IV (rarely used)
Neomycin-topical (PO prep for bowel surgery, and hepatic encephalopathy)
Kanamycin-topical only
121
Q

What bacteria do Gentamicin, Tobramycin, and amikacin cover?

MC uses?

A

Gram pos: staph aureus
Gram neg: bacilli coverage

Rarely uses alone esp. with gram pos
(synergistic with PCN or Vanco for bacterial endocarditis)

122
Q

ADE of aminoglycosides?

A

Ototoxicity, Nephrotoxicity: monitor renal function and serum drug concentrations every few days.

123
Q

What are the benefits of extended interval dosing?

A 
Probable reduced nephrotoxicity
Decreased lab monitoring
No risk of sub-therapeutic peak level
Decreased-pharm and nursing times
Easier for home care doses
124
Q

What is the MOA for sulfonamides?

A

Competitive antagonist of para-aminobenzoic acid (PABA) which prevents formation of folic acid (folic acid is necessary for amino acid production)

125
Q

What medications are Sulfonamides?

A

Sulfisoxazole

Sulfamethoxazole/trimethoprim (Bactrim)

126
Q

What bacteria do sulfonamides cover?

MC use?

A

Gram positive: staph, S. pneumo
Gram neg: E coli
Atypicals: Chlamydia

MC use:
Sulfamethazole-trimethoprim IS FIRST LINE for CA-MRSA, PCP tx and prophylaxis

127
Q

ADE sulfonamides?

A 
Photosensitivity
N/V/D
Derm-rash, SJS, TENS
Hemolytic anemia
"sulfa allergies" are common
128
Q

Special instructions for pt’s taking sulfonamides?

A

Admin-Instruct pt to drink plenty of fluids

129
Q

DI for sulfa meds:

A

numerous, Warfarin can increase INR

Methotrexate, phenytoin, digoxin

130
Q

MOA fluoroquinolones

A

Inhibit bacterial topoisomerase II (DNA gyrase) and IV thereby blicking DNA synthesis

131
Q

What medications are Fluoroquinolones?

A 
Ciprofloxacin
Ofloxacin
Norfloxacin
Levofloxacin
Moxifloxacin
132
Q

What do Cipro, Oflo, and Norfloxacin cover?

MC use?

A

Gram neg: Enterobacteriaceae, H. Flu,
Pseudomonas (CIPRO ONLY)
Complicated and uncomplicated UTI’s

133
Q

What do Levo, Moxifloxacin and ophthalmic Gatifloxacin cover?
MC Use?

A

Gram positive: Strep pneumo (Including PRSP)
Gram negative: Enterbacteriaceae, H. flu, M. catarrhalis, Pseudomonas(levofloxacin)

Similar to second gen plus CAP and UTI

Moxifloxacin is not used to tx UTI

134
Q

ADE Fluoroquinolones

A 
N/V/D/C
Photosensitivity
Hepatotoxicity
Hypoglycemia/hyperglycemia
QT Prolongation
135
Q

Black box warning fluoroquinolones

A

Tendonitis or tendon rupture-higher risk in elderly, renal insuff., and concurrent steroid use.

136
Q

What are the indications for use of fluoroquinolone in pregnant females?

A

C and NOT recommended when breast feeding!!

137
Q

Administration of fluoroquinolones:

A

asorption reduced when administered with magnesium, calcium, aluminum, iron, zinc-separate by at least 2 hours.

138
Q

DI of fluoroquinolones

A

Increases INR when given with Warfarin (monitor closely)

Avoid use with other meds that prolong QT interval-Cipro least likely, Moxi most likely.

139
Q

Metronidazole spectrum of activity

A

Protozoa and anaerobes-Bacteriodes group. C. diff

140
Q

common use for Metronidazole

A

Intrabd infection, gyencologic infectsion, pseudomembranous colitis caused by C. diff

FIRST LINE FOR C. DIFF!!!

141
Q

ADE metronidazole

A

Gi-N/V, xerostomia, anorexia, abd pain

CNS-Peripheral neuropathy, seizures, encephalopathy, - must discontinue

142
Q

Admin of metronidazole

A

Extended release-admin on empty stomach at least 1 hour before or 2 hours after meals

143
Q

DI metronidazole?

A

Ethanol-avoid alcohol during and 3 days after
Increase INR when on Warfarin
May increase concentrations of Phenytoin

144
Q

Nitrofurantoin MC use?

A

UTI-VERY good option for UTI- 96% E.coli susceptible with nitro vs. 87% with bactrim

145
Q

When is it not OK to use Nitrofurantoin?

A

CrCl less than 60mL/min (not good for use in elderly pt’s)

146
Q

Admin of nitrofurantoin?

A

Food or milk may enhance GI tolerance

147
Q

ADE Nitrofurantoin?

A

GI: N/V

Serious AE with long term tx-hepatotoxicity, and pulmonary toxicity-avoid in elderly

148
Q

DI Nitrofurantoin?

A

Probenecid increases serum conc.

149
Q

T/F pt’s who are allergic to PCN are thought to have a 15% chance of also being allergic to cephalosporin?

A

F - only about a 3-7% chance. Cephalosporins should be considered second line unless the pt has anaphylaxis to the PCN.

150
Q 
Which of the following fluoroquinolones does not require dose adjustment for renal insufficency?
A. Moxifloxacin
B. Levofloxacin
C. Ciprofloxacin
D. Norfloxacin
A

A-Moxifloxacin

151
Q

List the commonly used ABX that DO NOT require renal dosage adjustments:

A 
Ceftriaxon
Metronidazole
Clindamycin
Nafcillin/oxacillin/dicloxacillin
Azithromycin
Doxycycline
Moxifloxacin
152
Q

How many drugs are needed to tx. and prevent resistant strains of TB.

A

A minimum of 2 drugs , usually 3/4 must be used simultaneously to prevent resistance in TB

153
Q

How long is the tx duration at minimum for TB tx.?

A

6mos minimun, up t 2-3 years for multi drug resistant TB (MDR TB)

154
Q

What are the two drugs that are the preferred first line agents for TB?

A

Isoniazid

Rifampin

155
Q

What is the typical 4 drug regiment - with time line for TB tx?

A

Isoniazid-6mos
Rifamipin-6mos
Ethambutol-first 2 mos.
Pyrazainamide-first 2 mos.

156
Q

MOA Isoniazid IV and PO?

A

Inhibit biosynthesis of mycolic acid-a necessary component of cell wall

157
Q

Administration and synergistic medication for Isoniazid?

A

Administer with Pyridoxine 10-50mg / day to minimize adverse CNS effects

158
Q

Spectrum of activity for isoniazid?

A

mycobacterium

159
Q

ADE for Isoniazid?

A

CNS-peripheral neuropathy if not given with pyridoxine
Hepatitis
GI distress, xerostomia, hyperglycemia, metabolic acidosis, urine retetnion,

160
Q

DI isoniazid?

A

Separate admin from antacids by 1 hour
INH may increase conc. of benzodiazepines, carbamepazine, and phenytoin
INH inhibits monoamine oxidase so use avoid co-admin wit other MAO inhibitors

161
Q

MOA Rifampin IV and PO?

A

Inhibits RNA synthesis by binding to beta subunit of RNA polymerase

162
Q

Spectrum of activity for Rifampin?

A

Gram neg and gram pos cocci, mycobacteria, chlamydia-resistance develops quickly-not to be used as mono therapy.

163
Q

Uses for rifampin?

A

TB tx and prophylaxis, leprosy, MRSA, MSSA, eliminates meningococcal carriage, prophylaxis of H. flu type B.

164
Q

ADE rifampin?

A

Change body fluid color-tears, sweat, urine
GI: NVD
Flu like symptoms-fever, chills, myalgia
Renal-interstitial nephritis, glomerulonephritis, nephrotic syndrome

165
Q

DI rifampin?

A

Inducer of CYP 450 enzymes-significant DI’s

has been shown to decrease effectiveness of oral contraceptives!!!

166
Q

ADE Ethambutol

A 
Optic neuritis
Pulm infiltrates
Hepatotoxicity
GI: N/V/D
Not many DI's-separate from aluminum by 4 hours
167
Q

spectrum of activity for Pyranzinamide?

A

Active Vs. only mycobacterium tuberculosis

168
Q

ADE for Pyranzinamide?

A

Hepatotoxicity
Arthralgia (gout)
Hypersensitivity

Pharmacology - Final Exam (4 decks)

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