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Pharmacology 2 > Antibiotics II & III > Flashcards

Antibiotics II & III Flashcards

1
Q

what is topoisomerase II also called and what is it primarily for?

A

DNA gyrase
gram -

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2
Q

what is topoisomerase IV primarily for?

A

gram +

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3
Q

which fluoroquinolone has intrinsic affinity for topoisomerase II?

A

2G ciprofloxacin

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4
Q

which fluoroquinolone has intrinsic affinity for topoisomerase IV?

A

4G moxifloxacin

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5
Q

what is the spectrum of activity of fluoroquinolones?

A

gram +
gram -
atypical (intracellular organisms)

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6
Q

what is the MOA of fluoroquinolones?

A

inhibit DNA synthesis (topo II and topo IV) = bactericidal

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7
Q

1st gen fluoroquinolone

A

nalidixic acid

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8
Q

name the 2nd gen fluoroquinolones (4) and what they cover?

A

Ciprofloxacin
Ofloxacin
Norfloxacin
Enoxacin

gram -
atypical

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9
Q

name the 3rd gen fluoroquinolone and what it covers?

A

levofloxacin

gram -
gram +
atypical

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10
Q

name the 4th gen fluoroquinolones (3) and what they cover?

A

moxifloxacin
delafloxacin
gemifloxacin

gram -
gram +
atypical
anaerobes

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11
Q

what decreases the absorption of fluoroquinolones and should be avoided?

A

calcium

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12
Q

how is most levofloxacin excreted?

A

kidney

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13
Q

how is most ciprofloxacin excreted?

A

kidney

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14
Q

how is most moxifloxacin excreted?

A

liver

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15
Q

how should FQ’s be dosed and why?

A

QID/BID

long T 1/2

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16
Q

what medications have an increased DDI with ciprofloxacin due to its inhibition of CYP1A2? (2)

A

theophylline
caffeine

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17
Q

what is the only FQ used for enterococcus and MRSA?

A

delafloxacin

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18
Q

what are the names of the possible 5th generation FQs?

A

nemonoxacin
zabofloxacin

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19
Q

what are 4 ADR of FQs?

A

Skin rash/Sun sensitivity
Prolonged QT/Peripheral Neuropathy
Ruptured tendon
Increased risk of C. difficile
Neuro
GI disturbances

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20
Q

what patients are FQ contraindicated/not recommended in? why?

A

pregnancy
children

weakens cartilage

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21
Q

what is an ADR specific to ciprofloxacin?

A

photosensitivity

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22
Q

what 2 FQs + their generation cause tendonitis/tendon rupture, leading to a BBW?

A

ofloxacin (2G)
levofloxacin (3G)

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23
Q

if a patient has a history of cardiac complications, what ADR should we consider with the use of FQs? (2)

A

aortic dissection
aneurysm

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24
Q

which 2 FQs can be used for UTI?

A

ciprofloxacin (2G)
levofloxacin (3G)

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25
Q

which 2 FQs can be used for respiratory tract infections?

A

levofloxacin (3G)
moxifloxacin (4G)

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26
Q

since FQs are good for mycobacteria, they can help treat _______

A

multi-drug resistant tuberculosis

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27
Q

which FQ is considered a treatment for MRSA?

A

delafloxacin

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28
Q

what are the uses for ciprofloxacin? (4)

A

UTI
anthrax
traveler’s diarrhea
typhoid fever

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29
Q

what is the spectrum of activity of metronidazole?

A

gram -
some gram +
anaerobes

intra-abdominal infections
brain abscess
2nd line for pseudomembranous colitis
H. pylori for PCN allergy

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30
Q

what are 2 ADR of metronidazole?

A

metallic taste
disulfiram reaction with alcohol

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31
Q

sulfa-
and MOA

A

sulfonamides
folate antagonists

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32
Q

what drugs do sulfonamides have a DDI with? (3) why?

A

warfarin
phenytoin
methotrexate

all bind to albumin

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33
Q

sulfonamides have a cross-sensitivity to which 4 medications/classes?

A

thiazides
loop diuretics
acetazolamide
sulfonylureas

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34
Q

what are the ADR of sulfonamides? (4)

A

Steven-Johnsons Syndrome
Skin rashes
S - low solubility = crystalluria
Serum albumin displacement = kernicterus

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35
Q

in which patients do sulfonamides cause hemolytic anemia?

A

G6PD deficient patients

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36
Q

what are 2 main ADRs of trimethoprim?

A

hyperkalemia
megaloblastic anemia

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37
Q

to avoid megaloblastic anemia in a patient by giving them trimethoprim, what can we add to their treatment?

A

folinic acid

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38
Q

what are 7 uses for trime-sulfa?

A

UTI
pneumonia in AIDS
toxoplasmosis
outpatient MRSA (SSTI)
prostatitis
norcardia infection
sepsis/meningitis

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39
Q

a urinary tract anti-infective agent that goes through excretion where 25% of the dose is unchanged in the kidney

A

nitrofurantion

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40
Q

what is nitrofurantoin used for?

A

uncomplicated UTI

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41
Q

in which patients is nitrofurantoin CI in? (2)

A

CrCl < 40
elderly

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42
Q

what is a special ADR of nitrofurantoin?

A

brown urine

N/V/D
headache
abdominal pain

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43
Q

what is the spectrum of activity for polymyxin B and E (colistin)?

A

gram - bacteria

44
Q

what is polymyxin B used for?

A

bacteremia

45
Q

what is polymyxin E used for?

A

UTI

46
Q

what kind of antibiotics are aminoglycosides synergistic with?

A

cell wall inhibitors

47
Q

why do aminoglycosides have little activity against anaerobes?

A

they transport into cells that are partially dependent on oxygen

48
Q

what is the most toxic aminoglycoside?

A

neomycin

49
Q

what is the spectrum of activity of aminoglycosides?

A

Gram - bacteria

50
Q

what is the main organism that aminoglycosides treat?

A

severe pseudomonal infections

51
Q

aminoglycosides are combined with beta-lactam antibiotics to treat what?

A

severe enterococcal infections

52
Q

what is the elimination of aminoglycosides?

A

renal

53
Q

what is topical neomycin used for?

A

eye, ear, skin infections

54
Q

what is oral neomycin used for?

A

bowl sterilization prior to bowel sx

55
Q

what is streptomycin used for? (2)

A

TB
enterococcal endocarditis

56
Q

what is plazomicin used for?

A

complicated, unresponsive UTI

57
Q

what is paromomycin used for? (2)

A

tape worms
intestinal amebiasis

58
Q

which ribosomal subunit do aminoglycosides bind to?

A

30S

59
Q

what are the 4 major ADR of aminoglycosides?

A

cross placenta
nephrotoxicity
ototoxicity
neuromuscular blockade

60
Q

in regards to ototoxicity, which aminoglycoside causes auditory problems?

A

amikacin

61
Q

in regards to ototoxicity, which aminoglycosides cause vestibular impairment? (3)

A

gentamicin
tobramycin
streptomycin

62
Q

what is inhaled tobramycin used for?

A

cystic fibrosis

63
Q

what is the administration rout of aminoglycosides?

A

IV only

64
Q

which 2 meds cannot be used with aminoglycosides?

A

ethacrynic acid
cisplatin

65
Q

a patient who is taking an aminoglycoside presents with muscle paralysis. how can this be reversed? (2)

A

neostigmine
Ca gluconate

66
Q

-cycline

A

tetracyclines

67
Q

what is the spectrum of activity of tetracyclines?

A

gram + and gram -

68
Q

what products cause a decreased absorption of tetracyclines? (4)

A

Ca, Mg, Fe, and Al

69
Q

how are tetracyclines eliminated?

A

renal

70
Q

how do tetracyclines become resistant?

A

over-expression of efflux pump

71
Q

what does doxycycline specifically treat? (2)

A

CAP
Malaria

72
Q

what does minocycline specifically treat?

A

acne (oral or topical)

73
Q

what does tetracycline specifically treat?

A

H. pylori

74
Q

what are 2 general uses for tetracyclines?

A

infections by atypical (intracellular) organisms

SSTI by MRSA, MSSA in patients with PCN allergy

75
Q

what are the ADRs of tetracyclines? (5)

A

Bone defects
Liver damage
Abdominal pain
Skin rash/Sun sensitivity
Teeth discoloration

76
Q

which patients should not use a tetracycline?

A

pregnancy
lactation
children less than 8 yo

77
Q

-thromycin

A

macrolides

78
Q

what is the spectrum of activity of macrolides?

A

gram +, some gram -

intracellular (atypical) organisms

79
Q

what ribosome subunit do macrolides bind to?

A

50S

80
Q

how are macrolides eliminated?

A

liver

81
Q

what are 3 therapeutic uses for macrolides?

A

strep pneum if PCN allergy
atypical CAP

82
Q

what is a specific use for azithromycin? how is it used?

A

H. flu
once daily dosing

83
Q

how is clarithromycin used?

A

BID

84
Q

which macrolide does not have good oral absorption since it is acid labile?

A

erythromycin

85
Q

what are some ADR of macrolides?

A

GI
metallic taste
QT prolongation

86
Q

to avoid inhibiting P450 enzyme, which macrolide should we use since it interferes the least with P450?

A

azithromycin

87
Q

what is the DOC for atypical pathogens in CAP?

A

erythromycin

88
Q

what is the spectrum of activity of lincosamides (clindamycin)?

A

gram +

89
Q

what ribosome subunit do lincosamides bind to?

A

50S

90
Q

how are lincosamides eliminated?

A

liver

91
Q

what is the distribution for lincosamides? where is it not distributed?

A

tissue
bone

NOT in CNS

92
Q

what are 3 ADR of lincosamides (clindamycin)?

A

diarrhea
BAD super-infection
pseudomembranous collitis

93
Q

in which patients should we avoid lincosamides?

A

patients with history of collitis

94
Q

what are 5 therapeutic uses for lincosamides (clindamycin)?

A

aspiration pneumonia
SSTI
MRSA
osteomyelitis
topical for acne

95
Q

-zolid

A

oxazolidinones

96
Q

what ribosome subunit do oxazolidinones bind to?

A

50S

97
Q

what is the spectrum of activity for oxazeolidinones?

A

gram +

98
Q

what are 2 uses specific for tedizolid?

A

MRSA
Linezolid-resistant MRSA

99
Q

what are 5 uses for oxazolidinones?

A

MRSA
VRE
SSTI
CAP
nosocomial pneumonia

100
Q

what are 2 ADR of oxazolidinones?

A

cheese reaction
hypertensive crisis

101
Q

a patient presents with serotonin syndrome. what drug class is the SSRI/SNRI interacting with? (2)

A

Oxazolidinone

102
Q

name the streptogramin and it’s spectrum of activity

A

quinupristin-dalfopristin

Gram +

103
Q

MOA of streptogramins?

A

protein synthesis inhibitor

104
Q

what enzyme does streptogramin inhibit?

A

CYP3A4

105
Q

what are ADR of streptogramins?

A

C. difficile
angioedema

Pharmacology 2 (22 decks)

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