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Pharm Decisions > Antimicrobial Review > Flashcards

Antimicrobial Review Flashcards

1
Q

What are the two main subdivisions of beta-lactam antibiotics?

A

(Penicillins and cephalosporins)

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2
Q

What major subdivisions of penicillin are more commonly used in vet med?

A

(Benzylpenicillins and aminopenicillins)

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3
Q

Because penicillins are highly susceptible to destruction by beta-lactamases, that makes them bad for treating which types of bacteria?

A

(Staphylococci and Bacteroides fragilis)

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4
Q

Are the following bacteria treatable with benzylpenicillins?

  • Streptococci
  • Staphylococci
  • Gram positive anaerobes
  • Gram negative anaerobes
  • Gram negative aerobes
A
  • Streptococci (Yes)
  • Staphylococci (No)
  • Gram positive anaerobes (Yes)
  • Gram negative anaerobes (Yes, with the exception of - Bacteroides fragilis)
  • Gram negative aerobes (No)
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5
Q

Are the following bacterial classes treatable with aminopenicillins?

  • Streptococci
  • Staphylococci
  • Gram positive anaerobes
  • Gram negative anaerobes
  • Gram negative aerobes
A
  • Streptococci (Yes)
  • Staphylococci (No)
  • Gram positive anaerobes (Yes, higher doses may be needed)
  • Gram negative anaerobes (Yes, higher doses may be needed, with the exception of Bacteroides fragilis)
  • Gram negative aerobes (Some, if urinary in origin since these drugs concentrate in the urine)
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6
Q

What is the purpose of clavulanic acid and sulbactam?

A

(They are beta-lactamase inhibitors added to amoxicillin and ampicillin respectively to extend their spectrum to cover some staphylococci bacteria (no MRSA) and Bacteroides)

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7
Q

Which of the following are true?

  • As you increase the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram positives.
  • As you increase the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram negatives.
  • As you decrease the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram negatives.
  • As you decrease the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram positives.
A
  • As you increase the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram positives. (False)
  • As you increase the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram negatives. (True)
  • As you decrease the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram negatives. (False)
  • As you decrease the generation number of the cephalosporin you choose to use, you are increasing the spectrum against gram positives. (True)
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8
Q

Are the following bacterial classes treatable with 1st generation cephalosporins? Be specific.

  • Streptococci
  • Staphylococci
  • Anaerobes
  • Gram negatives in general
A
  • Streptococci (Yes)
  • Staphylococci (Maybe, definitely not MRSA)
  • Anaerobes (Not great, cefazolin is okay against gram-positives, neither cefazolin or cephalexin good for - Clostridium (gram positive anaerobe))
  • Gram negatives in general (Cefazolin +/-, cephalexin no)
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9
Q

What generation of cephalosporin does cefoxitin belong in and what is it primarily used for?

A

(2nd generation, used for surgical prophylaxis in areas with high likelihood of anaerobes being present such as dental/gingival dz, also gets staphs (no MRSA) and streps)

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10
Q

Which of the third generation cephalosporins does not have any coverage of staphylococci bacteria?

A

(Ceftiofur)

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11
Q

Cefpodoxime and cefovecin can be used against gram negative/positive (choose) anaerobes.

A

(Negative)

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12
Q

Which of the 3rd generation cephalosporins has the most activity against gram negative aerobes?

A

(Cefpodoxime)

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13
Q

If you had to choose between a penicillin or a cephalosporin to treat a Clostridial infection, which would you choose?

A

(Penicillin, Clostridium is a gram positive anaerobe, penicillins have the best anaerobic spectrum of the two choices)

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14
Q

What is the mechanism of action of aminoglycoside antimicrobials?

A

(Inhibition of protein synthesis at the 30s ribosomal subunit, amikacin also works at the 50s)

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15
Q

Of the following bacteria, which can be treated using aminoglycosides?

  • E. coli
  • Fusobacterium
  • MRSs
  • C. diff
  • S. pyogenes
  • S. aureus
A
  • E. coli (Yes, this is a gram negative aerobe against which aminoglycosides have activity)
  • Fusobacterium (No, this is a gram negative anaerobe against which aminoglycosides have no activity, they need o2 for uptake)
  • MRSs (Some yes, this is staphylococci against which aminoglycosides have activity)
  • C. diff (No, this is a gram positive anaerobe against which aminoglycosides have no activity, they need o2 for uptake)
  • S. pyogenes (No, this is a streptococci against which aminoglycosides have no activity)
  • S. aureus (Yes, this is a staphylococci against which aminoglycosides have activity)
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16
Q

Which class of antimicrobial drug works by inhibiting DNA gyrase?

A

(Fluoroquinolones)

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17
Q

(T/F) Any use of a fluoroquinolone in horses is off-label.

A

(T)

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18
Q

What is the main difference in the spectrum of activity of fluoroquinolones and aminoglycosides?

A

(Fluoroquinolones get rickettsia and mycoplasma whereas aminoglycosides do not and fluoroquinolones rarely get streps otherwise the same (get gram negative aerobes, staphylococci, and definitely no anaerobes)

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19
Q

If you had to choose between a penicillin, a cephalosporin, or an aminoglycoside to treat a Clostridial infection, which would you choose?

A

(Still penicillin, Clostridium is a gram positive anaerobe, penicillins have the best anaerobic spectrum between the two beta lactam options and aminoglycosides absolutely do not get anaerobes)

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20
Q

What is the spectrum of activity of tetracyclines?

A

(Gram positives, gram negatives, anaerobes, and rickettsia)

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21
Q

What is the mechanism of action of potentiated sulfonamides?

A

(Folic acid pathway inhibition)

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22
Q

What is the spectrum of activity of potentiated sulfonamides?

A

(Gram positive aerobes, gram negative aerobes, and protozoa)

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23
Q

Which of the following drugs inhibit protein synthesis at the 30s ribosomal subunit?

  • Amikacin
  • Doxycycline
  • Erythromycin
  • Chloramphenicol
  • Gentamicin
  • Azithromycin
  • Oxytetracycline
  • Clindamycin
A
  • Amikacin (Yes)
  • Doxycycline (Yes)
  • Erythromycin (No)
  • Chloramphenicol (No)
  • Gentamicin (Yes)
  • Azithromycin (No)
  • Oxytetracycline (Yes)
  • Clindamycin (No)
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24
Q

Which of the following drugs inhibit protein synthesis at the 50s ribosomal subunit?

  • Amikacin
  • Doxycycline
  • Erythromycin
  • Chloramphenicol
  • Gentamicin
  • Azithromycin
  • Oxytetracycline
  • Clindamycin
A
  • Amikacin (Yes)
  • Doxycycline (No)
  • Erythromycin (Yes)
  • Chloramphenicol (Yes)
  • Gentamicin (No)
  • Azithromycin (Yes)
  • Oxytetracycline (No)
  • Clindamycin (Yes)
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25
Q

What is the spectrum of activity for macrolides and lincosamides?

A

(Gram positive aerobes and clindamycin/maybe azithromycin cover anaerobes)

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26
Q

Nitroimidazoles are useful against anaerobes/aerobes (choose) and protozoa.

A

(Anaerobes, do not work in oxygenated environment)

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27
Q

Give the route(s) of administration available for the following drugs:

  • Potassium penicillin
  • Procaine penicillin
  • Benzathine/procaine penicillin
  • Clavamox
  • Unasyn
A
  • Potassium penicillin (IV)
  • Procaine penicillin (IM)
  • Benzathine/procaine penicillin (IM)
  • Clavamox (Oral)
  • Unasyn (IV, ampicillin alone also has oral)
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28
Q

Penicillins are… (choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Hydrophilic)
  • Low/moderate/high protein binding (Low)
  • Renal or hepatic elimination (Renal)
  • Minimally/highly metabolized (Minimally)
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29
Q

Give the route(s) of administration available for the following drugs:

  • Cefazolin
  • Cephalexin
A
  • Cefazolin (IV)
  • Cephalexin (Oral)
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30
Q

1st generation cephalosporins are…(choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Hydrophilic)
  • Low/moderate/high protein binding (Low to moderate)
  • Renal or hepatic elimination (Renal)
  • Minimally/highly metabolized (Minimally)
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31
Q

Give the route(s) of administration available for the following drugs:

  • Ceftiofur sodium
  • Ceftiofur crystalline free acid
  • Cefovecin
  • Cefpodoxime proxetil
A
  • Ceftiofur sodium (IM and IV)
  • Ceftiofur crystalline free acid (IM)
  • Cefovecin (SC)
  • Cefpodoxime proxetil (Oral)
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32
Q

3rd generation cephalosporins are…(choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Hydrophilic)
  • Low/moderate/high protein binding (Low (cefpodoxime) to moderate (ceftiofur) to high (cefovecin/ceftiofur’s metabolite))
  • Renal or hepatic elimination (Renal)
  • Minimally/highly metabolized (Minimally besides ceftiofur)
33
Q

What is the best way to get more efficacy out of your time dependent antibiotics?

A

(Adjusting the time between doses)

34
Q

Aminoglycosides are…(choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Hydrophilic)
  • Low/moderate/high protein binding (Low)
  • Renal or hepatic elimination (Renal)
  • Minimally/highly metabolized (Minimally)
35
Q

Fluoroquinolones are…(choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Lipophilic with enro being the most)
  • Low/moderate/high protein binding (Moderate)
  • Renal or hepatic elimination (Mostly renal with exceptions → enro partially biliary, and prado mostly hepatic)
  • Minimally/highly metabolized (Minimally except enro which is metabolized into cipro)
36
Q

Give the route(s) of administration for the following drugs:

  • Doxycycline
  • Minocycline
  • Oxytetracycline
A
  • Doxycycline (PO for D/C, absolutely no IV for H)
  • Minocycline (PO good for D/C)
  • Oxytetracycline (IV or IM)
37
Q

Of the tetracyclines available for us, which is the most lipophilic?

A

(Doxy, but also has the highest protein binding so doesn’t get into CNS, prostate, etc. as well as minocycline)

38
Q

What is the route of administration for potentiated sulfonamides?

A

(PO)

39
Q

Give the site of elimination for the following drugs:

  • Minocycline
  • Doxycycline
  • Oxytetracycline
A
  • Minocycline (Mostly hepatic)
  • Doxycycline (Renal and hepatic)
  • Oxytetracycline (Mostly renal)
40
Q

Potentiated sulfonamides are…(choose)

  • Hydrophilic/lipophilic
  • Low/moderate/high protein binding
  • Renal or hepatic elimination
  • Minimally/highly metabolized
A
  • Hydrophilic/lipophilic (Moderately lipophilic)
  • Low/moderate/high protein binding (Moderate)
  • Renal or hepatic elimination (Mainly renal, some hepatic)
  • Minimally/highly metabolized (Highly metabolized in the liver into inactive metabolites)
41
Q

How are macrolides eliminated?

A

(By the liver)

42
Q

How are lincosamides eliminated?

A

(By the liver)

43
Q

What is the route of administration for lincosamides?

A

(PO)

44
Q

What is the route of administration of choice for macrolides?

A

(PO, rarely given IV in animals but an option)

45
Q

Macrolides, lincosamides, and chloramphenicol all are widely distributed throughout the body and reach intracellular spaces, but only one of them can be used for CSF infections, which one?

A

(Chloramphenicol)

46
Q

Chloramphenicol is extensively metabolized in the liver and inhibits what key enzyme there as well?

A

(CYP450)

47
Q

What are your route of administration options for nitroimidazoles?

A

(PO and IV but needs to be given slowly)

48
Q

How are nitroimidazoles eliminated?

A

(By the liver)

49
Q

What is the only protein synthesis inhibitor that is bactericidal?

A

(Aminoglycosides)

50
Q

Give whether the following drugs are time or concentration dependent:

  • Beta-lactams
  • Aminoglycosides
  • Fluoroquinolones
A
  • Beta-lactams (Time)
  • Aminoglycosides (Concentration)
  • Fluoroquinolones (Concentration)
51
Q

How do high concentrations of penicillins/beta-lactams in general cause CNS excitement and seizures?

A

(By inhibiting GABA)

52
Q

What are the rare ADEs associated with use of cephalosporins?

A

(Types I, II, and III hypersensitivity reactions and GI signs (v/d))

53
Q

With which cephalosporin will adverse drug effects be prolonged d/t the drug being long acting?

A

(Cefovecin)

54
Q

In what types of patients are the risks for nephrotoxicity increased when using an aminoglycoside?

A

(Dehydrated patients, febrile patients, patients with pre-existing renal dz, neonates, and patients you plan to give other nephrotoxic drugs to such as NSAIDs)

55
Q

Why is administration of calcium along with aminoglycosides protective against nephrotoxicity?

A

(Calcium targets the same transporters that aminoglycosides do on renal tubular cells, can prevent accumulation in those cells of aminoglycosides)

56
Q

Which species is at an increased risk of secondary ototoxicity d/t aminoglycoside administration?

A

(Cats)

57
Q

How do aminoglycosides induce a neuromuscular blockade?

A

(By competitively interfering with calcium transport at motor endplates, should not be adm with certain anesthetic, skeletal muscle relaxants, paralytic agents, or when there is dz of the NMJ such as botulism)

58
Q

What do fluoroquinolones chelate in cartilage that leads to a decreased cell-matrix interaction in chondrocytes and the signs associated with cartilage toxicity?

A

(Magnesium)

59
Q

What characteristics of the animal/drug protocol increase the risk for cartilage toxicity when using fluoroquinolones?

A

(Young age, heavier weight, higher activity level, and more doses given)

60
Q

Cats are less likely to have cartilage toxicity when compared to dogs and horses, what other issue can they develop when given fluoroquinolones?

A

(Ocular toxicity → retinal degeneration and blindness)

61
Q

Enrofloxacin dosed at what mg/kg or higher will result in ocular toxicity in cats?

A

(5 mg/kg)

62
Q

What are the two components necessary for ocular toxicity in cats associated with fluoroquinolones?

A

(Giving fluoroquinolones at a dose of 5 mg/kg or higher and exposure to light)

63
Q

Why is pradofloxacin not FDA approved in the US?

A

(Caused bone marrow suppression in some dogs and is potentially arrhythmogenic)

64
Q

Which of the tetracyclines is associated with nephrotoxicity?

A

(Oxytet, higher doses or prolonged use, formulations that use propylene glycol, and older formulations specifically, causes renal tubular necrosis specifically)

65
Q

Which of the tetracyclines is associated with hepatotoxicity?

A

(Doxycycline, typically idiosyncratic in dogs, and when combined with rifampin in foals)

66
Q

What is the primary reason why dogs have the potential to develop numerous adverse effects when given potentiated sulfonamides?

A

(Bc dogs have a decreased ability to acetylate drugs in their liver (this is how horses and cats metabolizes sulfas into nontoxic metabolites), dogs instead turn them into toxic metabolites in their liver)

67
Q

What breed of dog is predisposed to hypersensitivity reactions to potentiated sulfonamides?

A

(Dobermans, rottweilers too)

68
Q

Potentiated sulfonamides can cause cutaneous eruptions, polyarthropathy, lymphadenopathy, fever, polymyositis, glomerulonephropathy, and focal retinitis idiosyncratically in dogs when it is used for at least how many days?

A

(5, if it occurs in a doberman it is not considered idiosyncratic)

69
Q

What ocular issue can be caused typically by prolonged administration of potentiated sulfonamides?

A

(KCS, may not be reversible unless you discontinue early)

70
Q

Why is it important to know that potentiated sulfonamides can induce hypothyroidism by blocking the formation of thyroxine and thyronine?

A

(Bc it can affect thyroid hormone testing and should be avoided in already hypothyroid animals bc it could make them worse)

71
Q

What occurs due to the folate antagonism that is a side effect of potentiated sulfonamides?

A

(Bone marrow suppression)

72
Q

Why are horses less likely to have urinary crystal formation associated with use of potentiated sulfonamides when compared to dogs and cats?

A

(Bc their urine is basic and the crystal formation occurs in acidic urine, which dogs and cats have)

73
Q

Diarrhea in horses induced by macrolides is age dependent, so older/younger (choose) horses tend to get diarrhea when using macrolides.

A

(Older which is fine because it is mostly used for R. equi which is a baby horse dz)

74
Q

Which of the macrolides inhibits hepatic microsomal enzymes which can decrease metabolism of other drugs and is more likely to cause anhidrosis in foals?

A

(Erythromycin)

75
Q

The use of lincosamides causes fatal antibiotic-induced diarrhea in what two species?

A

(Horses and rabbits)

76
Q

Why are cats more susceptible to developing hematologic toxicity (anemia, neutropenia, etc.) associated with chloramphenicol?

A

(Bc they lack glucuronyl transferase which is the enzyme that metabolized chloramphenicol, can still use but not at a dose of 60 mg/kg/day or higher)

77
Q

Long acting florfenicol otic preparations can cause dry eye, how should this be avoided?

A

(STT prior to use, if they have an bad STT don’t give the florfenicol)

78
Q

What type of toxicity does a metronidazole overdose cause?

A

(Neurotoxicity → severe ataxia, vertical or rotary nystagmus, and seizures, these signs are often preceded by anorexia and vomiting, toxic dose is 66 mg/kg/day)

79
Q

What do you need to pay attention to if you are going to compound metronidazole because it tastes disgusting?

A

(Some compound pharmacies will report the dose as the metronidazole benzoate dose (which will lead you to underdosing metro) or they will list it as metronidazole base (which is the accurate metro dose))

Pharm Decisions (13 decks)

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