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Pharmacology > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Name that drug

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

Pyrazinamide

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2
Q

which 4th gen Cephalosporins are usually active against pneumococci

A

Cefotaxime & ceftriaxone

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3
Q

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
A

VANCOMYCIN

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4
Q

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

A

CHLROEMPHENICOL

*associated with GRAY BABY SYNDROME

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5
Q

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

A

peripheral neuropathy

Administer with pyridoxine (B6) to help

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6
Q

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

A
  • 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
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7
Q

________ are a common substitute for patients with penicillin allergy

A

Macrolides

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8
Q

what is RECOMMENDED ANTIMICROBIAL THERAPY FOR the Legionella sp.

A

Fluoroquinolone (Cipro)

Macrolide (Azithromycin)

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9
Q

• ________ (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

A

• TETRACYCLINES

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10
Q

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

A

Cefotetan & cefoxitin (both parenteral only)

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11
Q

Name the 4 Macrolides

A

Azithromycin

clarithromycin

telithromycin

erythromycin

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12
Q

what are Rifampin’s 4 R’s?

A
  • *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.

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13
Q

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

A

Both 3rd generations: cefoperazone and ceftriaxone

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14
Q
A
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15
Q

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?

A

Ethambutol

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16
Q

kidney function WILL decline when using which class of Drugs?

A

AMINOGLYCOSIDES

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17
Q

DRUG WITH THE HIGHEST RISK TO CAUSE THE FOLLOWING

Potentially fatal pseudomembranous colitis (superinfection of C.difficile)

A

CLINDAMYCIN

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18
Q

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

A

NOOOO!!!!!

  1. daptomycin (a glycopeptdide) only works on gram POSTIVE BACTERIA
  2. daptomycin binds to is inactivated by surfactant so it is NOT able to treat pneumonia
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19
Q

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

A

Fluoroquinolones

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20
Q

Name the 4 drugs that FREQUENTLY cause C. difficile

“F-A-A-C”

A

Fluoroquinolones

Ampicillin

Amoxicillin

Cephalosporins

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21
Q

30S or 50S?

Streptogramins (Dalfopristin/ Quinupristin)

Other (Chloramphenicol Clindamycin Linezolid Mupirocin Fidaxomicin )

Macrolides (Azithromycin Clarithromycin Erythromycin Telithromycin )

A

50S

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22
Q

• 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
A

SULFONAMIDES

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23
Q

are Monobactams Resistant to action of b-lactamases?

A

yes

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24
Q

Cephalosporin that is the DOC for surgical prophylaxis

(Oral or Parenteral?)

A

Cefazolin

(1st generation)

Parenteral Only

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25
Q

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?

A

LINEZOLID

• its a Weak reversible inhibitor of MAO W

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26
Q

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

A

DAPTOMYCIN

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

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27
Q

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.

A

INPATIENTS, ICU TREATMENT

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28
Q

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

A

Cephlosporins

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29
Q

Monobactam

Name it and what is unique about it?

A

Aztreonam

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

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30
Q

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

A

Tetracyclines, Glycylcyclines

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31
Q

which class of drugs are Drugs of choice for:

  • Chlamydia
  • Mycoplasma pneumoniae
  • Lyme disease
  • Cholera
  • Anthrax prophylaxis

• Rickettsia (Rocky Mountain Spotted Fever, typhus)

A

TETRACYCLINES

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32
Q

N.meningitidis infectoin, whats the DOC?

A

3rd generation cephalosporin

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33
Q
  • _________ (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
A

MACROLIDES

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34
Q

3 b-lactamase inhibitors

“C-A-T”

A

Clavulanic acid

sulbactam

tazobactam

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35
Q

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

A

NO. DOES NOT OCCUR

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36
Q

What class of drug is Streptomycin?

A

AMINOGLYCOSIDE

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37
Q

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

A

AMINOGLYCOSIDES

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38
Q

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

A

R-C-C

RIFAMPIN (has actiivty against MRSA and TB+ gives you ORANGE BODY FLUIDS)

CIPROFLOXACIN (2nd gen fluoro)

CEFTRIAXONE (3rd gen Cephalosporin)

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39
Q

4th gen Cephalosporins are similar to which other generation?

A

1st

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40
Q

The following MOA is associated with which class of drugs;

• Blocks transcription by binding to subunit of bacterial DNA-dependent RNA polymerase

leading to inhibition of RNA synthesis

A

Rifamycins

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41
Q

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

A

Aminoglycosides

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42
Q

NAME THAT DRUG

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

A

BACITRACIN

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

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43
Q

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)
A

• Streptomycin

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44
Q

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

A

Ethambutol

Pronounce “eyethambutol.”

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45
Q
  • 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
A

DAPTOMYCIN

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46
Q

Which antimycobacterial Inhibits arabinosyl transferases

A

Ethambutol

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47
Q

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?

A

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!

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48
Q

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

A

daptomycin

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49
Q

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

A

Amoxicillin

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50
Q

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

A

AIDS patients

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51
Q

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
A

Isoniazid

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52
Q

NAME THAT DRUG

  • Uncomplicated UTI’s (drug of choice)
  • PCP (drug of choice)
  • Nocardiosis (drug of choice)
A

COTRIMOXAZOLE

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53
Q

Drugs of choice for
• enterobacter infections

• extended-spectrum -lactamase producing Gram-negatives

which are these Drugs? Class and name.

A

Meropenem & Imipenem (Carbapenems)

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54
Q

Fosfomycin is used to treat…

A

uncomplicated lower UTI’s

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55
Q

Name that drug

the ONLY topical/intranasal agent with activity against MRSA

A

MUPIROCIN

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56
Q

It also DOC for Endocarditis prophylaxis during dental procedures

A

Amoxicillin

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

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57
Q

• Second line drugs for TB

“S-A-L-E”

A
  • Streptomycin-(aminoglycoside)-(for SEVERE infections) also the DOC for Plague/Tularemia
  • Amikacin (aminoglycoside)-used second like aftter strep or MDR strains
  • Levofloxacin
  • Ethionamide

all teratogenic

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58
Q

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

A

FIDAXOMICIN

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59
Q

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

A

Lactulose

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60
Q

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

A

HIV +ve patients

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61
Q

two drugs used against ANAaerobic bugs are:

A

Metro

Clindamycin

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62
Q

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

A

all are teratogenic (contraindicated in pregnancy)

Aminoglycosides

Tetracyclines

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63
Q

The following Fluoroquinolones are considered “Respiratory Fluoroquinolones”

A

Levofloxacin, moxifloxacin & gemifloxacin

(excellent activity against S.pneumoniae, H.influenzae & M.catarrhalis)

64
Q

what is the main mechanism by which Aminoglycoside is acquired?

A

• 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
65
Q

Name the penicillin that most fits the following AEs

  • Pseudomembranous colitis
  • Maculopapular rash
  • Interstitial nephritis
  • Hematologic toxicities
  • Neutropenia
  • Hepatitis
  • Positive Coombs Test
A
  • 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)
66
Q

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

A

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

67
Q

Is Ceftriaxone ok to use in pregnancy?

A

NOOOOOO

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

68
Q

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

A

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

69
Q

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

A

• Metronidazole

• Fidaxomicin

• Vancomycin

Taking the Metro bc i gotta FIdaX my Van

70
Q

DOC for Ricketssia

A

Doxyclycline

alternatives are

Chloremphenicol

Fluoroquinolones

71
Q

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

A

Clofazimine

72
Q

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

A

RIFAMPIN

( strongest cytP40 INDUCER)

73
Q

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

Rifampin or Rifabutin?

A

Rifabutin

74
Q

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

A

warfarin, caffeine & cyclosporine

75
Q

Yersinia Pestis, DOC?

what if the DOC didnt work or cant be used on the pt? Give___________

A

Streptomycin

Alternative: Doxycycline

76
Q

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)
A

CLOFAZIMINE

77
Q

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

A

5th

78
Q
  • Structurally similar to folic acid
  • Bacteriostatic against Gram-positive & Gram-negative organisms
  • Reaches high concentrations in prostatic & vaginal fluids
A

Trimethoprim

79
Q

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?

A

AMPICILIN

treat Pseudomembranous Colitis with ORALLLLLLLLL VANCOMYCIN

80
Q

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

A

Macrolides (50S):

Clarithromycin

Erythromycin

Lincosamides (50S):

Clindamycin

Broad spectrum peptidyl transferase inhibitor (50S)

Chloramphenicol

Anti-staph Penicillin (PBP)

Nafcillin

81
Q

Erythema nodosum leprosum is an AE of what drug which can be treated with corticosteroids or thalidomide

Hint: this drug is a CYP450 inhibitor

A

Dapsone

82
Q

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

A

LINEZOLID

83
Q

II. INPATIENTS, NON-ICU TREATMENT is…

A

A respiratory fluoroquinolone

A β-lactam plus a macrolide

84
Q

What the mechanism of Vanco resistance?

A
  • Plasmid-mediated changes in drug permeability
  • Modification of the D-Ala-D-Ala binding site (D-Ala replaced by D-lactate)
85
Q

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

A
  • hypoprothrombinemia (Vit. K1 admin can prevent)
  • disulfiram-like reactions (avoid alcohol)
86
Q

Whis penicillin is commonly assocate with Hepatitis

A

Oxacillin

87
Q

list all the meds that can be used against pseudomonas

A
88
Q

This drug binds to and inhibits RNA polymerase and is the DOC or RECURRENT C. DIFFICILE INFECTIONS

is this drug broad or narrow spectrum?

A

FIDAXOMOCIN

NARROW!

89
Q

Penicillin of choice for Syphillis (IV or ORAL?)

A

Penicillin G

IV

90
Q

List the 3 antipseudomonal penicillins

A
  1. Ticarcillin (IV)
  2. Piperacillin (IV)
  3. Carbenicillin (only one that is IV AND Oral)-used for FEBRILE NEUTROPENIA

IN COMBO WITH AN AMINOGLYCOSIDE

91
Q

Where does Vanomycin bind?

What is its MOA?

A

binds to D-Ala-D-Ala terminus of nascent peptidoglycan pentapeptide

• MOA: Inhibits bacterial cell wall synthesis & peptidoglycan polymerization

92
Q

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

A

1st gen cephalexin

2nd gen cefaclor

3rd gen cefixime.

93
Q

can tetracyclines be given in pregnancy? How aboud kids?

A

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

94
Q

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

what drug?

A

VANCOMYCIN

95
Q

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

A

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

96
Q

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

A

Levofloxacin

97
Q

30S or 50S?

Tetracyclines

Aminoglycosides

Glycylcylines

Streptogramins (Dalfopristin/ Quinupristin)

Other (Chloramphenicol Clindamycin Linezolid Mupirocin Fidaxomicin )

Macrolides (Azithromycin Clarithromycin Erythromycin Telithromycin )

A

30S

Tetracyclines

Aminoglycosides

Glycylcylines

T-A-G

98
Q

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:

• meningitis
• miliary dissemination
• severe organ tuberculosis

A

Streptomycin

99
Q

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

A

SULFONAMIDES

Sulfamethoxazole, Sulfadiazine, Sulfasalazine

100
Q

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

A

Penicillin V

Oral (more acid stable)

101
Q

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

A

macrolides and tetracyclines

102
Q

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

A

GLYCYLCINES (Tigecycline)

103
Q
A
104
Q

what is the absolutly number one DOC for Uncomplicated UTI’s

“HIGH YIELD”

A

COTRIMOXAZOLE

105
Q

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?

A

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.

106
Q

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

A
  1. their post antibiotic effect
  2. concentration dependent killing
107
Q

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

A

Vancomycin (Glycopeptide-D ala D ala as binding site)-GRAM +VE ONLY

Linezolid (binding site: 23S of 50S-unique binding site)-GRAM +VE ONLY

108
Q

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

A

Category C

109
Q

Tetracyclines are most commonly used for what dermatological pathologies?

A

severe acne & rosacea

110
Q

what is Acedapsone?

A

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

111
Q

which AE is shared by the “Respiratory Fluoroquinolones”

A

QT prolongation

112
Q

Sulfonamide that inhibits

A

bacterial dihydrofolate reductase

113
Q

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

A

Used in treatment of pneumonia when:

  • First-line agents have failed
  • In the presence of comorbidities

• Patient is an inpatient

114
Q

DOC for Surgical Prophylaxis, Specifically during General, Neuro or Orthopaedic surgery

Prevention of postsurgical infection due to

S aureus for example.

A

Cefazolin

1st generation

(cefazolin, cephalexin)—gram ⊕ cocci

115
Q

5th gen Cephalosporins are similar to which other generation?

A

3rd

116
Q

Name that class of drugs!

Connective tissue problems-TENDON RUPTURE (can be irreversible) (avoid in pregnancy, nursing mother, under 18’s) – Black Box Warning!

A

Fluoroquinolones

117
Q

Name that drug with the folling AE effects:

• 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?)
A

Tetracyclins

• Dizziness, vertigo (esp. doxycycline & minocycline)

118
Q

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

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)

119
Q

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?

A

Cefotetan (2nd gen)

cefomandole (2nd gen)

cefoperazone (3rd gen)

120
Q

Which drug is being described below:

Pro-drug (activated by a mycobacterial catalase- peroxidase - KatG)

A

Isoniazid

121
Q

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)

A
122
Q

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

A

Pyrazinamide

123
Q

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

A

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
124
Q

Do the following show concentration OR time dependent killing?

aminoglycosides

penicillins

cephalosporins

A
  • Concentration-dependent (aminoglycosides)
  • Time-dependent (penicillins, cephalosporins)
125
Q

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

A

have to give Macrolide bc TETRACYCLINES ARE TERATOGENIC!

126
Q

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

A

Fosfomycin

127
Q

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

A

Azithromycin

128
Q

Which Carbapenem forms potentially nephrotoxic metabolite?

And which enzyme inhibitor prevents metabolism thus prevents toxicity & increases availability?

Does Meropenem require this enzyme?

A

Imipenem (IV)

Cilastatin is the enzyme inhibitor

Meropenem does NOT require Cilastatin

129
Q

• 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?

A
  • Pyrazinamid
  • Ethambutol
  • Rifampin
  • Rifabutin (1st line in HIV +ve patients)
  • Isoniazid
130
Q

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

A

Erythromycin

131
Q

23 year old preggers woman with Chlamydial Urethritis, what do you give her?

Azithromycin

Doxyclycine

Ciprofloxin

A

Azithromycin bc

Doxyclycine & Ciprofloxin are not safe in pregnancy

132
Q

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

A

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)

133
Q
A
134
Q
A
135
Q

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

A

Amikacin

136
Q

Name the Protein synthesis Inhibitors !

A
  • Tetracyclines
  • Glycylcyclines
  • Aminoglycosides
  • Macrolides
  • Chloramphenicol
  • Clindamycin
  • Streptogramins
  • Linezolid
  • Mupirocin
137
Q

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

A

GI infections!

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

138
Q

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

A

Sulfonamides

139
Q

Hemolytic Anemia is an antimicrobial effect on the neonate or fetus that can be caused by what drug

Chloramphenicol

Fluoroquinolones

Nitrofurantion

Sulfonamides

Aminoglycosides

A

Nitrofurantion

140
Q

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

A

Ethionamide

141
Q

which marcolides inhibit the CYP450 system? which do not?

A

• Erythromycin, clarithromycin & telithromycin = CYP P450 inhibition

(NOT azithromycin)

142
Q

NAME THAT MACROLIDE!

– Exhibits fatal hepatotoxicity, exacerbations of myasthenia gravis, & visual disturbances don’t use for minor illnesses

A

Telithromycin

143
Q

Theophylline, NSAIDs & corticosteroids enhance toxicity of ___________

A

fluoroquinolones

144
Q

dapsone

rifampin

cllofazimine

are 3 drugs currently recommend by the WHO to treat_______

A

Leprosy (aka: Hansen’s Disease)

145
Q

vancomycin + gentamycin = synergism

A
146
Q

Mutations leading to underexpression of KatG.

A
147
Q

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)
A

VANCOMYCIN

binds to D ALA D ALA

*red man red neck syndrome

148
Q

are sulfonamides Bacteriocidal or Bacteriostatic?

A

Bacteriostatic

149
Q

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)
A

ceftriaxone (3rd)

150
Q

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

A

Chloramphenicol

151
Q

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
A

LINEZOLID

152
Q

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

A

• A macrolide

(Erythromycin, Clarithromycin, Azithromycin (not a P450 inhibitor), Telithromycin)

• Doxycyline (a tetracycline)

153
Q

Most commone AE with Penicillin

A

Hypersensitivity

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

154
Q

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

A

Isoniazid: 6-9 months

Rifampin: 4 months

155
Q

what are the contraindications for Fluoroquinolones?

A

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

156
Q

which drug has the followign MOA:

  • 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

A

DAPTOMYCIN

Pharmacology (14 decks)

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