Antimicrobials III

Question 1

Quinolone and fluoroquinolones attack…

Answer 1

Topoisomerase II (DNA gyrate) and Topoisomerase IV (front end and back end of transcription)

Question 2

Rifampin attacks

Answer 2

RNA polymerase

Question 3

What should you warn Nitrofurantoin patients about?

Answer 3

Red orange pee and sweat

Question 4

What is a second generation quinolone?

Answer 4

Ciprofloxin (fluoro) -Broad spectrum of gut and UTIs, as well as anti anthrax

Question 5

What is a third generation quinolone?

Answer 5

Levofloxacin (Even broader spectrum)

Question 6

What is a fourth generation quinolone?

Answer 6

Moxifloxacin (broad broad spectrum, added ANAEROBES to the killed list)

Question 7

Topoisomerase II is also known as

Answer 7

DNA gyrase

Question 8

TOPO II is the primary target on gram ( ) bacteria by quinolone, whereas TOPO IV is the target of gram ( )microbes

Answer 8

negative,

positive

Question 9

Although as you move through the generations of quinolones you gain a broader spectrum, from negative to more positive, you lose …

Answer 9

Anti-Pseudomonas activity (and gram - activity)

Question 10

What is best against anthrax?

Answer 10

Ciprofloxacin

Question 11

What should you worry about with prescribing moxifloxacin?

Answer 11

Longer QT interval, connective tissue problems,

Question 12

What are some things that are contraindications for quinolones

Answer 12

pregnancy/nursing mothers/children under 18
Myasthenia Gravis
Tendonitis

Question 13

What drugs do quinolones interact with?

Answer 13

Antacids–decrease absorption

Warfarin, theophylline, caffeine, cyclosporin–Inhibited drug metabolism

Question 14

Name three non-quinolone drugs that disrupt nucleic acid synthesis

Answer 14

Metronidazole
Rifampin
Nitrofurantoin

Question 15

What is the mechanism of Metronidazole?

Answer 15

Inhibits DNA replication

Question 16

What does metronidazole kill?

Answer 16

anaerobes, Trichomonas vaginalis, entamoeba histolytic, C. difficile

Question 17

What are the adverse effects of metronidazole?

Answer 17

Metallic taste, GI disturbance, CNS issues (depression, vertigo, headache), dark orange urine. CONTRAINDICATED: don’t take with alcohol (instant severe hangover) or during your 1st trimester of pregnancy (FDA category B drug)

Question 18

How does the extreme hangover take place?

Answer 18

Aldehyde dehydrogenase is disrupted by disulframs, so you get a build up of acetaldehyde (most common with metronidazole, but also B lactase, yada yada)

Question 19

Rifampin MOA

Answer 19

Inhibits DNA-dependent bacterial RNA polymerase.

Question 20

Spectrum of Rifampin

Answer 20

G +, G-, and mycobacteria, (TB, leprosy, and legionella) also Type B influenza

Question 21

What is unique about rifampin?

Answer 21

Make you pee orange, cry orange etc
CYP450 INDUCER (anti-anticontraceptive)

Question 22

What is the MOA of Nitrofurantoin?

Answer 22

form highly reactive intermediates

Question 23

What would you use Nitrofurantoin against?

Answer 23

UTIs and prophylaxis of UTIs

Question 24

Reasons to avoid Nitrofurantoin?

Answer 24

Hepatotoxicity, neuropathy, drug-induced lupus
Contraindications: people with decrease renal function,
last 4 weeks of pregnancy or neonates up to a month due to risk of hemolytic anemia

Question 25

Why is nitrofurantoin so great against UTIs?

Answer 25

Highly absorbed in gut, excreted unchanged into kidney and not metabolized. It is not very penetrable into tissues.