Antimicrobials Flashcards by roxannadelatorre roxannadelatorre

Name that drug

First-line agent
Used in combination with isoniazid, rifampin & ethambutol
Must be enzymatically hydrolysed to active pyrazinoic acid

Pyrazinamide

How well did you know this?

Not at all

Perfectly

which 4th gen Cephalosporins are usually active against pneumococci

Cefotaxime & ceftriaxone

How well did you know this?

Not at all

Perfectly

Which drug meets the following characteristics?

Used In combination with an aminoglycoside for empirical treatment of infective endocarditis
Used In combination with an aminoglycoside for treatment of enterococcal endocarditis or PRSP

VANCOMYCIN

How well did you know this?

Not at all

Perfectly

which drug, which is NEVER given systemically for a simple minor infection, can inhibit protein synthesis in mitochondrial ribosomes–> bone marrow toxicity –> main AE of APLASTIC ANEMIA

CHLROEMPHENICOL

*associated with GRAY BABY SYNDROME

How well did you know this?

Not at all

Perfectly

whats the number one side effect of ISONIAZID? and what can you give to help it?

peripheral neuropathy

Administer with pyridoxine (B6) to help

How well did you know this?

Not at all

Perfectly

• Penicillins are mostly excreted via kidney (beware in kidney failure)…what is one notable exception?

Nafcillin (Antistaphylococcal Penicilin) = exception as primarily excreted in BILE! it also has erractic activity in the GI tract is given via IV not orally
Oxacillin & dicloxacillin = renal & biliary excretion

How well did you know this?

Not at all

Perfectly

________ are a common substitute for patients with penicillin allergy

Macrolides

How well did you know this?

Not at all

Perfectly

what is RECOMMENDED ANTIMICROBIAL THERAPY FOR the Legionella sp.

Fluoroquinolone (Cipro)

Macrolide (Azithromycin)

How well did you know this?

Not at all

Perfectly

• ________ (class of drug) Bind reversibly to 30S subunit prior to ribosome formation, preventing attachment of aminoacyl tRNA leading to

• misreading of mRNA, &
• inhibition of translocation

• TETRACYCLINES

How well did you know this?

Not at all

Perfectly

which two snd generation Cephalosporins are DOC for prophylaxis & therapy of abdominal and pelvic cavity infections

Cefotetan & cefoxitin (both parenteral only)

How well did you know this?

Not at all

Perfectly

Name the 4 Macrolides

Azithromycin

clarithromycin

telithromycin

erythromycin

How well did you know this?

Not at all

Perfectly

what are Rifampin’s 4 R’s?

*R**NA polymerase inhibitor
*R**amps up microsomal cytochrome P-450
*R**ed/orange body fluids
*R**apid resistance if used alone

*NOTE: Rifampin ramps up cytochrome P-450, but rifabutin does not.

How well did you know this?

Not at all

Perfectly

The major route of elimination for Cephalosporins is renal excretion. However, _____ and _________ are excreted mainly in the bile.

Both 3rd generations: cefoperazone and ceftriaxone

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

Dose-dependent visual disturbances (eg, red/green color blindness) – which cannot be used in children too young to receive sight tests is associated with which Antimycobacterial drug?

Ethambutol

How well did you know this?

Not at all

Perfectly

kidney function WILL decline when using which class of Drugs?

AMINOGLYCOSIDES

How well did you know this?

Not at all

Perfectly

DRUG WITH THE HIGHEST RISK TO CAUSE THE FOLLOWING

Potentially fatal pseudomembranous colitis (superinfection of C.difficile)

CLINDAMYCIN

How well did you know this?

Not at all

Perfectly

can daptomycin be used to treat pneumonia caused by, for example, H. Influenzae? why or why not?

NOOOO!!!!!

daptomycin (a glycopeptdide) only works on gram POSTIVE BACTERIA
daptomycin binds to is inactivated by surfactant so it is NOT able to treat pneumonia

How well did you know this?

Not at all

Perfectly

Tendon rupture/damage is an antimicrobial effect on the neonate or fetus that can be caused by what drug

Chloramphenicol

Fluoroquinolones

Nitrofurantion

Sulfonamides

Tetracyclines, Glycylcyclines

Aminoglycosides

Fluoroquinolones

How well did you know this?

Not at all

Perfectly

Name the 4 drugs that FREQUENTLY cause C. difficile

“F-A-A-C”

Fluoroquinolones

Ampicillin

Amoxicillin

Cephalosporins

How well did you know this?

Not at all

Perfectly

30S or 50S?

Streptogramins (Dalfopristin/ Quinupristin)

Other (Chloramphenicol Clindamycin Linezolid Mupirocin Fidaxomicin )

Macrolides (Azithromycin Clarithromycin Erythromycin Telithromycin )

50S

How well did you know this?

Not at all

Perfectly

• Oral or topical admin

• AE: Kernicterus (in newborns and infants <2 months):

CONTRAINDICATED IN newborns & infants < 2 months (kernicterus) – drugs compete with bilirubin for binding sites on albumin
Oral or topical Warfarin, phenytoin and methotrexate can lead to increased plasma levels
Acetylated in liver. Can precipitate at neutral or acidic pH kidney damage

SULFONAMIDES

How well did you know this?

Not at all

Perfectly

are Monobactams Resistant to action of b-lactamases?

yes

How well did you know this?

Not at all

Perfectly

Cephalosporin that is the DOC for surgical prophylaxis

(Oral or Parenteral?)

Cefazolin

(1st generation)

Parenteral Only

How well did you know this?

Not at all

Perfectly

Pt is being treated for an infection with a multi drug resistant gram +ve infection with this antibiotic and TCAls, SNRI's, SSRI's and Antidepressants are Contraindicated. which drug is this pt being treated with and why are these drugs CI?

**LINEZOLID** • its a **Weak reversible inhibitor of MAO** W

Which antibiotic whose MOA involves binding to cell membrane via calcium-dependent insertion of **lipid tai**l has a AE **shared by Statins** and what is this AE?

**DAPTOMYCIN** **Elevated** **creatine phosphokinases** (leading to Myopathy & Rhabdomyolysis) JUST LIKE STATINS so take them off statins while you take them

the following regimens are recommendations for pts in what healthcare setting? A **β-lactam** (cefotaxime, ceftriaxone, or ampicillin-sulbactam) **plus** either **azithromycin** or a **respiratory fluoroquinolone.** For **penicillin-allergic patients**, a **respiratory fluoroquinolone** and **aztreonam** are recommended.

**INPATIENTS**, **ICU** TREATMENT

which class of Antibiotics (ibhibitors of cell wall synthesis) are considered inactive against **enterococci, Listeria, Legionella, Chlamydia, mycoplasma, and acinetobacter species.**

Cephlosporins

Monobactam Name it and what is unique about it?

**Aztreonam** Works against **Aerobic Gram-negative rods ONLY (including pseudomonas)**

**Tooth enamel dysplasia, inhibition of bone growth** is an antimicrobial effect on the neonate or fetus that can be caused by what drug Chloramphenicol Fluoroquinolones Nitrofurantion Sulfonamides Tetracyclines, Glycylcyclines Aminoglycosides

**Tetracyclines, Glycylcyclines**

which class of drugs are Drugs of choice for: * Chlamydia * Mycoplasma pneumoniae * Lyme disease * Cholera * Anthrax prophylaxis • Rickettsia (Rocky Mountain Spotted Fever, typhus)

TETRACYCLINES

N.meningitidis infectoin, whats the DOC?

3rd generation cephalosporin

* _________ (class of drug) Reversibly bind to the 23S rRNA of the 50S subunit inhibiting translocation * Binding site is identical or close to that for clindamycin & chloramphenicol

**MACROLIDES**

3 b-lactamase inhibitors "C-A-T"

Clavulanic acid sulbactam tazobactam

Does cross-resistance between other anti-tuberculosis drugs and Isoniazid occur?

NO. DOES **NOT** OCCUR

What class of drug is Streptomycin?

**AMINOGLYCOSIDE**

Pt taking this class of drug experiences SEVERE OTOTOXICITY, which drug did they take?

AMINOGLYCOSIDES

List the 3 meds that can be given for **BACTERIAL MENINGITIS PROPHYLAXIS**

R-C-C **RIFAMPIN** (has actiivty against MRSA and TB+ gives you *_ORANGE BODY FLUIDS)_* **CIPROFLOXACIN** (*2nd* gen fluoro) **CEFTRIAXONE** (*3rd* gen Cephalosporin)

4th gen Cephalosporins are similar to which other generation?

1st

The following MOA is associated with which class of drugs; ## Footnote • Blocks transcription by binding to subunit of bacterial DNA-dependent **RNA polymerase** leading to **inhibition of RNA synthesis**

Rifamycins

**Possible damage to the eighth cranial nerve of the fetus** is an antimicrobial effect on the neonate or fetus that can be caused by what drug Chloramphenicol Fluoroquinolones Nitrofurantion Sulfonamides Tetracyclines, Glycylcyclines Aminoglycosides

**Aminoglycosides**

NAME THAT DRUG ## Footnote inhibits cell wall formation by interfering with dephosphorylation in cycling of the lipid carrier that transfers peptidoglycan subunits to the growing cell wall.

BACITRACIN Due to this unique mechanism, there is **no cross-resistance between bacitracin and other antimicrobial drugs.**

Name that class of drugs! * Empiric therapy of **infective endocarditis** in combination with either a penicillin or (more commonly) vancomycin * is the drug of choice for **Plague** (Y.Pestis)

• Streptomycin

Optic neuropathy (red-green color blindness) is an AE of what drug?

**Ethambutol** **Pronounce “eyethambutol.”**

* Novel mechanism of action useful against multi-drug resistant bacteria * Binds to cell membrane via calcium-dependent insertion of lipid tail * Results in depolarization of cell membrane with K+ efflux--\>cell death

DAPTOMYCIN

Which antimycobacterial **Inhibits arabinosyl transferases**

Ethambutol

pt takes this med for acne and he reports back with a blistering sunburt skin What did he take and what patient population is this med Contraindicated in?

DOC for acne is **DOXYCYCLINE (tetracycline family)** AE: **PHOTOSENSITIVITY** additional AE: inhibition of bone growth in kids and teeth discoloration **CI in PREGGERS AND KIDS \< 8 years old!**

Which drug is **antagonized by Pulmonary surfactant** so it **should not be used to treat PNEUMONIA (OF ANY ORIGIN)**

daptomycin

Which extended spectrum Ab has greater oral bioavailability and is indicated for use in children and pregnant women.

Amoxicillin

what demographic of pts have a higher incidence of AE associated with COTRIMOXAZOLE (especially the dermatological AE's)

**AIDS patients**

Name that drug * Synthetic analog of pyridoxine * First-line agent * Most potent antitubercular drug * PART OF COMBINATION THERAPY * Sole drug in treatment of latent infection

Isoniazid

NAME THAT DRUG * Uncomplicated UTI’s (drug of choice) * PCP (drug of choice) * Nocardiosis (drug of choice)

**COTRIMOXAZOLE**

Drugs of choice for • enterobacter infections • extended-spectrum -lactamase producing Gram-negatives which are these Drugs? Class and name.

Meropenem & Imipenem (Carbapenems)

Fosfomycin is used to treat...

uncomplicated lower UTI’s

Name that drug the **ONLY** **topical**/**intranasal** agent with activity against MRSA

**MUPIROCIN**

It also DOC for Endocarditis prophylaxis during dental procedures

Amoxicillin (DOC for **otitis media and sinusitis**), Mild **S. M. H** infections).

• Second line drugs for TB **"S-A-L-E"**

* **S**treptomycin-(aminoglycoside)-(for SEVERE infections) also the DOC for Plague/Tularemia * **A**mikacin (aminoglycoside)-used second like aftter strep or MDR strains * **L**evofloxacin * **E**thionamide all teratogenic

the following drug does a better job at **preventing recurrence** of **C. Difficile** but is **so much more expensive** than vancomycin or metronidazole?

**FIDAXOMICIN**

what drug, which is a Nonabsorbable disaccharide is taken in order to reduce plasma ammonia concentrations?

Lactulose

• Rifabutin is 1st line in tx of TB in what patient population?

HIV +ve patients

two drugs used against ANAaerobic bugs are:

Metro Clindamycin

what is one feature that all protein synthesis inhibitors whose binding site is the **30S ribosomal subunit** share?

all are **teratogenic** (contraindicated in pregnancy) **Aminoglycosides** **Tetracyclines**

The following Fluoroquinolones are considered "Respiratory Fluoroquinolones"

**Levofloxacin, moxifloxacin & gemifloxacin** (excellent activity against S.pneumoniae, H.influenzae & M.catarrhalis)

what is the main mechanism by which Aminoglycoside is acquired?

• Plasmid-associated synthesis of enzymes that modify and inactivate drug the 3 mechanisma are 1. **Plasmid-associated synthesis of enzymes that modify and inactivate drug** 2. Decreased accumulation of drug 3. Receptor protein on 30S ribosomal subunit may be deleted or altered due to mutation

Name the penicillin that most fits the following AEs * Pseudomembranous colitis * Maculopapular rash * Interstitial nephritis * Hematologic toxicities * Neutropenia * Hepatitis * Positive Coombs Test

* Pseudomembranous colitis (ampicillin) * Maculopapular rash (ampicillin, amoxicillin) • Interstitial nephritis (particularly methicillin) * Neurotoxicity (epileptic patients at risk) * Hematologic toxicities (ticarcillin) * Neutropenia (nafcillin) * Hepatitis (oxacillin) * Positive Coombs Test (penicillin G, V)

why does Trimethoprim reach high concentrations in prostatic & vaginal fluids?

bc its a weak base and gets trapped in acidic environments--\> high concentrations

Is Ceftriaxone ok to use in pregnancy?

NOOOOOO Ceftriaxone should **NOT** be used in pregnancy as it can cross the BBB and displace bilirubin from binding sites leading to **kernicterus.**

METRONIDAZOLE not only treats anaroebic baterial infections but it is the DOC for what type of PARASITIC disease?

DOC for **INVASIVE AMEBIASIS** (in combo with a luminal agent)-Entamoeba histolytica cyts and trophozoites an alternative to this woule be Tetracycline Metro woudl also treat Giardia

What 3 treatments in addition to Fecal Microbiota Transplant can be used in the treatment of C. difficile?

**• Metronidazole** **• Fidaxomicin** **• Vancomycin** **Taking the Metro bc i gotta FIdaX my Van**

DOC for Ricketssia

Doxyclycline alternatives are Chloremphenicol Fluoroquinolones

RED BROWN dicoloration of skin is assocaited with what drug used to treat Leprosy?

**Clofazimine**

patient comes to you coming to you bc they are crying **ORANGE tears,** what drug are they on?

**RIFAMPIN** **( strongest cytP40 INDUCER)**

• Preferred drug for use in HIV patients (due to lesser effects on CYP enzymes) Rifampin or Rifabutin?

**Rifabutin**

3rd & 4th generation Fluoroquinolones raise serum levels of \_\_\_\_\_, _______ & \_\_\_\_\_\_\_

**warfarin, caffeine & cyclosporine**

Yersinia Pestis, DOC? what if the DOC didnt work or cant be used on the pt? Give\_\_\_\_\_\_\_\_\_\_\_

**Streptomycin** Alternative: **Doxycycline**

NAME THAT DRUG! * Phenazine dye * Redox properties may generate cytotoxic oxygen radicals * Bactericidal to M.leprae (**some activity against M. avium- intracellulare complex)** * Eosinophillic enteritis * Erythema nodosum **DOES NOT** develop (drug has anti- inflammatory action)

**CLOFAZIMINE**

which generation of cephalosporins are unique in that they have activity against MRSA.

5th

* Structurally similar to folic acid * Bacteriostatic against Gram-positive & Gram-negative organisms * **Reaches high concentrations in prostatic & vaginal fluids**

Trimethoprim

Which penicillin is commonly assocate with Pseudomembranous Colitis as an AE? what class and name of drug could you give a patient with Pseudomembranous Colitis?

**AMPICILIN** **treat** Pseudomembranous Colitis with **ORALLLLLLLLL VANCOMYCIN**

ANTIMICROBIALS THAT UNDERGO **HEPATIC** (VS RENAL) ELIMINATION hint: 4 of them are 50S subunit Protein synthesis inhibitors the last one is an Antistaph penicillin which onlly works against gram +ve bacteria

**Macrolides (50S):** Clarithromycin Erythromycin **Lincosamides (50S):** Clindamycin **Broad spectrum peptidyl transferase inhibitor (50S)** Chloramphenicol **Anti-staph Penicillin (PBP)** Nafcillin

**Erythema nodosum leprosum** is an AE of what drug which can be treated with **corticosteroids** or **thalidomide** **Hint: this drug is a CYP450 inhibitor**

Dapsone

• _________ (drug) inhibits formation of 70S initiation complex; Binds to unique site on 23S ribosomal RNA of 50S subunit

**LINEZOLID**

II. **INPATIENTS**, **NON-ICU** TREATMENT is...

A **respiratory fluoroquinolone** A **β-lactam** plus a **macrolide**

What the mechanism of Vanco resistance?

* **Plasmid-mediated** changes in drug permeability * Modification of the **D-Ala-D-Ala binding site (D-Ala replaced by D-lactate)**

• **Cefamandole, cefoperazone & cefotetan** contain **methyl-thiotetrazole group**, what AE does this cause?

* hypoprothrombinemia (Vit. K1 admin can prevent) * disulfiram-like reactions (avoid alcohol)

Whis penicillin is commonly assocate with Hepatitis

Oxacillin

list all the meds that can be used against pseudomonas

This drug **binds to and inhibits RNA polymerase** and is the DOC or RECURRENT C. DIFFICILE INFECTIONS is this drug broad or narrow spectrum?

**FIDAXOMOCIN** **NARROW!**

Penicillin of choice for Syphillis (IV or ORAL?)

Penicillin G IV

List the 3 antipseudomonal penicillins

1. **Ticarcillin** (IV) 2. **Piperacillin** (IV) 3. **Carbenicillin** (only one that is IV AND Oral)-used for FEBRILE NEUTROPENIA IN COMBO WITH AN AMINOGLYCOSIDE

Where does Vanomycin bind? What is its MOA?

binds to **D-Ala-D-Ala terminus** of nascent peptidoglycan pentapeptide • MOA: I**nhibits bacterial cell wall synthesis & peptidoglycan polymerizatio**n

Most **cephalosporins** are administered **parenterally** due to **poor oral absorption**. Drugs available for **oral use**?

1st gen cephalexin 2nd gen cefaclor 3rd gen cefixime.

can tetracyclines be given in pregnancy? How aboud kids?

NO! No if the kids are under 8 years old?

**Red man’ or ‘red neck’ syndrome** (infusion-related flushing over face and upper torso). what drug?

**VANCOMYCIN**

what aspect of the pharmokinetics of **Fidaxomicin** makes it the Treatment of choice for reccurent **C.difficile colitis** (in adults)?

• bc When administered orally, systemic absorption is negligible **but fecal concentrations are high**

which second like antimycobacterial is being described? Ethionamide, Levofloxacin, Amikacin or Strptomycin Recommended for use against first-line drug-resistant strains. Should always be used in combination. **Teratogenic**

**Levofloxacin**

30S or 50S? ## Footnote **Tetracyclines** **Aminoglycosides** **Glycylcylines** Streptogramins (**Dalfopristin/ Quinupristin**) Other (**Chloramphenicol Clindamycin Linezolid Mupirocin Fidaxomicin** ) Macrolides (**Azithromycin Clarithromycin Erythromycin Telithromycin** )

30S **Tetracyclines** **Aminoglycosides** **Glycylcylines** T-A-G

**Increasing frequency of resistance** to **which drug** limits use of it. This drug is used in drug combinations for treatment of **life-threatening tuberculous disease** such as: ## Footnote **• meningitis • miliary dissemination • severe organ tuberculosis**

**Streptomycin**

Structural analogs of p-aminobenzoic acid (PABA) describes which class of drugs?

**SULFONAMIDES** Sulfamethoxazole, Sulfadiazine, Sulfasalazine

Penicillin of choice for Strep throat (IV or ORAL?)

Penicillin V Oral (more acid stable)

which two classes of drugs are used bc they both target intracellular bacteria (atypical) pnemonias (community acquired)?

macrolides and tetracyclines

which class of drugs that is used to treat complicated skin, soft tissue and intra- abdominal infections is also associated with a **BLACK BOX WARNING**

GLYCYLCINES (Tigecycline)

what is the absolutly **number one DOC** for **Uncomplicated UTI’s** **"HIGH YIELD"**

**COTRIMOXAZOLE**

if a pt is given **moxifloxacin to treat Community acquired pmn.** Improvement is evident after 3 days' treatment. However, after receiving moxifloxacin for 5 days, he experiences **diarrhea with cramping and abdominal pain. What do these signs and symptoms suggest? What is the recommended medication?**

They suggest Clostridium difficile-associated diarrhea (CDAD, pseudomembranous colitis). **4Oral metronidazole** and **oral vancomycin** have similar efficacy in the treatment of CDAD. However, ***_metronidazole is the treatment of choice_*** because of cost and the risk of selection for vancomycin-resistant enterococci in the stool with oral vancomycin.

which 2 factors contribute to the fact that Aminoglycosides are only given ONCE DAILY?

1. their post antibiotic effect 2. concentration dependent killing

what is the ANTIMICROBIAL THERAPY RECOMMENDED FOR **Methicillin resistant Staphylococcus aureus?** **A. Fluoroquinolone, azithromycin** **B. Amoxicillin** **C. Vancomycin or linezolid** **D. 2nd or 3rd generation cephalosporin, amoxicillin-clavulanate**

**Vancomycin** (Glycopeptide-**D ala D ala** as binding site)-**GRAM +VE ONLY** **Linezolid** (binding site: **23S of 50S**-unique binding site)-**GRAM +VE ONLY**

Pyrazinamide is Category ___ and is only recommended in preganancy when benefits outweight the risks

**Category C**

Tetracyclines are most commonly used for what dermatological pathologies?

severe acne & rosacea

what is Acedapsone?

**Acedapsone** = repository form of dapsone that provides inhibitory plasma concentrations for several months

which AE is shared by the "Respiratory Fluoroquinolones"

**QT prolongation**

Sulfonamide that inhibits

bacterial **dihydrofolate reductase**

What three criteria need to be met in order for the "Respiratory Fluoroquinolones" to be appropriately used in the treatment of Pneumonia?

**Used in treatment of pneumonia when:** * First-line agents have failed * In the presence of comorbidities • Patient is an inpatient

DOC for Surgical Prophylaxis, Specifically during General, Neuro or Orthopaedic surgery Prevention of postsurgical infection due to S aureus for example.

**Cefazolin** **1st generation** **(cefazolin,** cephalexin**)—gram ⊕ cocci**

5th gen Cephalosporins are similar to which other generation?

3rd

Name that class of drugs! ## Footnote Connective tissue problems-TENDON RUPTURE (can be irreversible) (avoid in pregnancy, nursing mother, under 18’s) – Black Box Warning!

**Fluoroquinolones**

Name that drug with the folling AE effects: ## Footnote **• Discoloration & hypoplasia of teeth, stunting of growth (generally avoided in pregnancy & not given in children under 8y)** * **Fatal hepatotoxicity** (in pregnancy, with high doses, patients with hepatic insufficiency) * **Photosensitization** * Dizziness, vertigo (especially in? which 2 drugs?)

Tetracyclins • Dizziness, vertigo (esp. **doxycycline & minocycline**)

what is a patient has **presence of comorbidities** such as **chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions** or **use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months: what do you give the patient?**

A **_respiratory fluoroquinolone_** such as: **moxifloxacin, gemifloxacin, levofloxacin OR** _A **β-lactam:**_ **• penicillins** **• cephalosporins** **• carbapenems • monobactams** **PLUS** a **_macrolid:_** **(Erythromycin, Clarithromycin, Azithromycin (not a P450 inhibitor), Telithromycin)**

Which **Cephalosporins** contain an N- methylthiotetrazole **(NMTT) side chain** which **competitively inhibit vitamin K action**, leading to prolongation of the prothrombin time and bleeding as an AE?

Cefotetan (2nd gen) cefomandole (2nd gen) cefoperazone (3rd gen)

Which drug is being described below: **Pro-drug (activated by a mycobacterial catalase- peroxidase - KatG)**

Isoniazid

3 main mechanisms (usually plasmid encoded): • Reduced membrane permeability or active efflux **• *_Production of esterase_* that hydrolyze drugs (by enterobacteriaceae)** • Modification of ribosomal binding site (by chromosomal mutation or by methylation)

• **Nongouty polyarthralgia** is an Adverse effect associated with intake of what drug in ~ 40% of pts

**Pyrazinamide**

•Penicillin is characteristically Synergistic with what other drug what do they treat?

**PENICILLIN + AMINOGLYCOSIDES (eg: most commonly Gentimicin)** * Penicillins facilitate movement of aminoglycosides throughcell wall * Should never be placed in same infusion fluid (form inactive complex) * Effective empiric treatment for **infective endocarditis**

Do the following show concentration OR time dependent killing? aminoglycosides penicillins cephalosporins

* Concentration-dependent (**aminoglycosides**) * Time-dependent (**penicillins, cephalosporins**)

Pregnant woman with Community acq pmn from **Mycoplasma pmn,** which drug do you give out of the two DOC drugs for Mycoplasma pmn?

have to give Macrolide bc TETRACYCLINES ARE TERATOGENIC!

which drug inhibits **cytoplasmic enzyme enolpyruvate transferase** in early stage of cell wall synthesis

Fosfomycin

If a pt has a **Campylobacter jejuni** infection, what is the DOC to use?

**Azithromycin**

Which Carbapenem forms potentially nephrotoxic metabolite? And which enzyme inhibitor prevents metabolism thus prevents toxicity & increases availability? Does Meropenem require this enzyme?

Imipenem (IV) **Cilastatin** is the enzyme inhibitor Meropenem does NOT require **Cilastatin**

**• First line drugs** for TB treatment: list them. **"P-E-R-R-I"** **Aww, Christina Perri has TB and now we have to treat her with these..:(** **-CRAP. She has HIV. Which drug in this list would be the DOC?**

* **P**yrazinamid * **E**thambutol * **R**ifampin * **R**ifabutin (1st line in HIV +ve patients) * **I**soniazid

which Macrolide is the DOC for whooping cough by (B.pertussis)?

**Erythromycin**

23 year old preggers woman with **Chlamydial Urethritis**, what do you give her? Azithromycin Doxyclycine Ciprofloxin

**Azithromycin** bc Doxyclycine & Ciprofloxin are not safe in pregnancy

List all the drugs that have activity against anaroebes as well as the two Classic ones used for treatment of anaroebes

**Metronidazole** (broad spectrum) **& Clindamycin** (only gram +ve) **Carbapenems (Imipenem** (needs cilastatin to help with Nephrotoxicity) **& meropenem)** broad spectrum-include activity against p. aer **Fidaxomicin** (Gram +ves only)-excellent actiivy against C. Diff **4th gen Fluoros (Gemifloxacin & Moxifloxacin**)-they are broad spectrium resp fluros but includes Anaroebes (most active against S.M.H-S. pneumo, M. Cararrhalis & H. influenzae)

which second like antimycobacterial is being described? Ethionamide, Levofloxacin, Amikacin or Strptomycin Used for streptomycin- or multi-drug-resistant strains. **Similar adverse effects to streptomycin. Teratogenic**

**Amikacin**

Name the Protein synthesis Inhibitors !

* Tetracyclines * Glycylcyclines * Aminoglycosides * Macrolides * Chloramphenicol * Clindamycin * Streptogramins * Linezolid * Mupirocin

What infection would require Vanco to be given ORALLY and not IV how it is usully administered?

GI infections! Given **orally** for the treatment of staphylococcal **enterocolitis** or antibiotic-associated **pseudomembranous colitis** (C.difficile)

**Kernicterus (displacement of bilirubin from serum albumin)** is an antimicrobial effect on the neonate or fetus that can be caused by what drug Chloramphenicol Fluoroquinolones Nitrofurantion Sulfonamides Tetracyclines, Glycylcyclines Aminoglycosides

**Sulfonamides**

Hemolytic Anemia is an antimicrobial effect on the neonate or fetus that can be caused by what drug Chloramphenicol Fluoroquinolones Nitrofurantion Sulfonamides Aminoglycosides

Nitrofurantion

which second like antimycobacterial is being described? Ethionamide, Levofloxacin, Amikacin or Strptomycin Congener of INH (**no cross-resistance**). **Major Disadvantage:** Severe GI irritation & adverse neurologic effects. Also hepatotoxicity & endocrine effects. **Teratogenic**

Ethionamide

which marcolides inhibit the CYP450 system? which do not?

• Erythromycin, clarithromycin & telithromycin = CYP P450 inhibition (NOT azithromycin)

**NAME THAT MACROLIDE**! ## Footnote – Exhibits fatal hepatotoxicity, exacerbations of myasthenia gravis, & visual disturbances don’t use for minor illnesses

Telithromycin

Theophylline, NSAIDs & corticosteroids enhance toxicity of \_\_\_\_\_\_\_\_\_\_\_

**fluoroquinolones**

**dapsone** **rifampin** **cllofazimine** are 3 drugs currently recommend by the WHO to treat\_\_\_\_\_\_\_

**Leprosy (aka: Hansen's Disease)**

vancomycin + gentamycin = synergism

Mutations leading to underexpression of **KatG.**

Name that Antibiotic: * Bacterial **glycoprotein** * **Bactericidal** * Active against **Gram-positive bacteria only** * Virtually all **Gram-negative organisms are intrinsically resistant** * Effective against multi-drug resistant organisms (**eg, MRSA, enterococci, PRSP)**

VANCOMYCIN binds to D ALA D ALA \*red man red neck syndrome

are sulfonamides Bacteriocidal or Bacteriostatic?

**Bacteriostatic**

Name that Cephalosporin, what generation? * DOC for **gonorrhea** * DOC for **meningitis due to ampicillin-resistant H.influenzae in children** * Prophylaxis of **meningitis in exposed individuals** * Treatment of **Lyme disease** (CNS or joint infection)

ceftriaxone (3rd)

**Gray baby syndrome** is an antimicrobial effect on the neonate or fetus that can be caused by what drug Chloramphenicol Fluoroquinolones Nitrofurantion Sulfonamides Tetracyclines, Glycylcyclines Aminoglycosides

**Chloramphenicol**

Name the drug has the following Mechanism of Action and is a **weak inhibitor of MAO** so it can lead to **Serotonin Syndrome** Mechanism of action * Inhibits formation of 70S initiation complex * Binds to **unique site** on 23S ribosomal RNA of 50S subunit

**LINEZOLID**

RECOMMENDED EMPIRICAL ANTIBIOTICS FOR **COMMUNITY-ACQUIRED** **PNEUMONIA** in a previously **healthy** and **no use of antimicrobials** within the previous 3 months

**• A macrolide** **(Erythromycin, Clarithromycin, Azithromycin (not a P450 inhibitor), Telithromycin)** **• Doxycyline (a tetracycline)**

Most commone AE with Penicillin

**Hypersensitivity** • **Penicilloic acid (breakdown product of Penicillin)**= major antigenic determinant

Does Rifampin or Isoniazid have a longer duration of treatment for Latent TB?

**Isoniazid**: 6-9 months Rifampin: 4 months

what are the contraindications for Fluoroquinolones?

**• Pregnancy & nursing mothers • Children \< 18y (unless benefits outweigh risks)**

which drug has the followign MOA: ## Footnote * Binds to cell membrane via calcium-dependent insertion of lipid tail * Results in depolarization of cell membrane with **K+ efflux cell death** USEFUL AGAINST multi-drug resistant bacteria

DAPTOMYCIN