Block RESPI Flashcards
The most common means of HCV transmission
IV drug use
Antiretroviral drugs that inhibit the insertion of proviral DNA into the host cell genome
Integrase inhibitors
The dose-limiting toxicity of didanosine
Peripheral neuropathy
An HIV patient was referred to an ophthalmologist for complains of decreasing visual acuity and whitish
particles floating in his vision. CD4+ cell count: 40/uL. On indirect ophthalmoscopy, areas of hemorrhage,
exudate and necrosis are seen in the retina. Starting retinal detachment is also seen in the temporal side of
the left eye. The patient was diagnosed with CMV retinitis. Which of the following can be started on the patient?
- Ganciclovir
- Famciclovir
- Trifluridine
- Acyclovir
Ganciclovir
The preferred NNRTI. It is well distributed, including to the CNS. Most adverse effects are associated with the CNS including dizziness, headaches, vivid dreams, and loss of concentration. Nearly half of patients experience these complaints.
Efavirenz
The drug of choice for urogenital infections due to Chlamydia during pregnancy.
Erythromycin
A protein synthesis inhibitor primarily employed in the treatment of infections caused by anaerobic bacteria. Its most serious side effect is potentially fatal pseudomembranous colitis caused by overgrowth of C. difficile.
Clindamycin
The most potent of the antitubercular drugs. Its most common adverse effect is peripheral neuritis which is corrected by giving pyridoxine/vitamin B6.
Isoniazid
Selection of the appropriate antimicrobial agent does not require knowledge of:
The organism’s susceptibility
• Liver and renal function
• The organism’s identity
• Cost of production
Cost of production
. A 75-year-old man was admitted to the hospital for hip replacement. Which of the following antibiotics would be an appropriate prophylactic agent to be given prior to surgery?
- Aztreonam
- Tetracycline
- Cefazolin
- Metronidazole
Cefazolin
The broadest spectrum beta-lactam antibiotic currently available:
Imipenem and Meropenem
Match each item to a choice: Cefuroxime - Ceftriaxone - Dapsone - Amikacin - Azithromycin -
Choices: • Antimycobacterial • Aminoglycoside • Second-generation cephalosporin • Macrolide • Third-generation cephalosporin
Cefuroxime - Second-generation cephalosporin
Ceftriaxone - Third-generation cephalosporin
Dapsone - Antimycobacterial
Amikacin - Aminoglycoside
Azithromycin - Macrolide
T/F
Lipid-soluble drugs, such as chloramphenicol and metronidazole, have significant penetration into the CNS,
whereas beta-lactam antibiotics, such as penicillin, are ionized at physiologic pH and have low lipid solubility.
True
Pregnancy Category of Medications. Match each item to a choice:
Amoxicillin -
Doxycycline -
Clarithromycin -
Choices:
• C
• B
• D
Amoxicillin - B
Doxycycline - D
Clarithromycin - C
Drug of choice for syphilis
Penicillin G
. Drug of choice for Listeria monocytogenes (gram-positive bacillus):
Ampicillin
Among penicillins, which drug has the most potential to cause acute interstitial nephritis?
Methicillin
Which of the following is true of cephalosporins?
- 2nd generation cephalosporins have greater activity against gram (+) organisms than 1st generation drugs
- Major elimination is through the bile
- Most first- and second-generation cephalosporins can enter the CSF
- Binds to PBPs on bacterial cell membranes and is bactericidal
Binds to PBPs on bacterial cell membranes and is bactericidal
Which cephalosporin is active against MRSA?
- Cefepime
- Ceftaroline
- Cefuroxime
- Cefazolin
Ceftaroline
Gray baby syndrome is associated with which antibiotic?
Chloramphenicol
Which of the following is true regarding macrolides?
- Generally bactericidal bacteriostatic
- Bind irreversibly to a site on the 30S subunit of the bacterial ribosome aminoglycoside
- Side effects include epigastric distress, jaundice, and ototoxicity
- Consist of four fused rings with a system of conjugated double bonds tetracycline
Side effects include epigastric distress, jaundice, and ototoxicity
T/,F
Aminoglycosides synergize with beta-lactams because of the latter’s action on cell wall synthesis. This enhances diffusion of the aminoglycosides into the bacterium.
True
Adverse Effects of Anti-TB drugs. Match each item to a choice: Isoniazid - Ethambutol Pyrazinamide Rifampin
Choices: • Optic neuritis • Hepatitis • Flu-like syndrome • Peripheral neuropathy
Isoniazid - Hepatitis
Ethambutol - Optic neuritis
Pyrazinamide - Peripheral neuropathy
Rifampin - Flu-like syndrome
Which statement is incorrect?
• Clofazimine is bacteriostatic to M. leprae and has some anti-inflammatory activity
• 70% of all leprosy cases in the world are located in India
• Dapsone is associated with the development of erythema nodosum leprosum
• Treatment of leprosy consists of a triple-drug regimen for 6 to 24 months
Dapsone is associated with the development of erythema nodosum leprosum
The drug of choice in the treatment of most infections caused by rickettsiae, including Rocky Mountain spotted
fever.
Tetracycline
Which one of the following patients is least likely to require antimicrobial treatment tailored to the individual’s condition?
- Patient with liver disease
- Patient undergoing chemotherapy for breast cancer
- Patient with kidney disease
- Elderly patient
- Patient with hypertension
Patient with hypertension
Which of the following organisms show predictable susceptibility patterns to antibiotics?
- Enterococci
- Staphylococcus
- Streptococcus pyogenes
- Gram-negative bacilli
Streptococcus pyogenes
Which of the following drugs should be avoided during pregnancy?
- Penicillin
- Aminoglycoside
- Cefuroxime
- Paracetamol
Aminoglycoside
A 65-year old diabetic was admitted to the hospital for productive cough, fever, and dyspnea. Chest x-ray suggested pneumonia, while sputum specimen contained the gram-negative coccobacilli, Haemophilus influenzae. Patient was started on ampicillin-sulbactam plus azithromycin. Which of the following is inaccurate of sulbactam?
- It protects hydrolyzable penicillins
- It contains a beta-lactam ring
- It has significant antibacterial activity
- It inactivates beta-lactamases produced by H. influenzae
It has significant antibacterial activity
A patient on the 5th day of ampicillin therapy, started to experience abdominal cramping and had loose, watery stools. Endoscopic evaluation showed pseudomembranes consisting of raised yellow plaques over the colorectal mucosa. Overgrowth of which bacteria is responsible for this condition?
Clostridium difficile
A 30-year old farmer develops furuncles or boils in his armpit area. This is due to infection with S. aureus. Which is the appropriate treatment for his infection?
Oxacillin
An antipseudomonal penicillin
Piperacillin
A 22-year-old woman complains of a 2-week history of vaginal discharge. When questioned about her sexual activity, she reports having vaginal intercourse, at times unprotected, with two men in the last 6 months. Pelvic examination revealed mucopurulent discharge from the endocervical canal. A urine specimen was obtained to test for chlamydia and gonorrhea, as well as a prenancy test as she reported missing her last period. What is the a treatment option for her possible chlamydial infection given the possibility of pregnancy?
- Telithromycin
- Erythromycin
- Doxycycline
- Azithromycin
Erythromycin
Which of the following protein synthesis inhibitors act by binding to the 30s ribosomal subunit?
- Tetracycline
- Lincosamide
- Macrolides
- Chloramphenicol
Tetracycline
Which of the following aminoglycosides is the most nephrotoxic?
- Neomycin
- Amikacin
- Streptomycin
- Gentamicin
Gentamicin
The most serious toxic effect of streptomycin
Vestibular dysfunction
A 45 years old male was brought to SWU-MC ER dept due to dyspnea. Physical examination findings noted dullness to percussion and decreased breath sounds in right middle to basal lung fields. You decide to do a thoracentesis to evacuate the pleural effusion. Where will you insert the needle?
T7-T8 interspace
You are making rounds on a stroke patient assigned to your care. The nurse referred to you that the patient has been having a fever and cough. You are thinking that the patient might have aspiration pneumonia. Which part of the lung fields will you most likely hear crackles?
Right mid to basal area
This refers to a painless but uncomfortable awareness of breathing that isinappropriate to the level of exertion.
Dyspnea
A 50 year old male consulted in the OPD because he “coughed out” blood. He took a picture of it and you noted the color to be a dirty yellow with bright red blood streaks. How will you label this in the patient’s chart?
Hemoptysis
A 54 year old male was referred to you because of dyspnea. He is a 40 pack year smoker and was admitted last year due to an exacerbation of COPD. He was advised smoking cessation but refused. On inspection of the chest, what ratio would you expect his anteroposterior (AP) diameter to the lateral chest diameter to be?
> 0.9
The selection of the most appropriate antimicrobial agen requires knowledge of
- the organism’s identity
- the organism’s susceptibility to a particular agent
- site of infection
- pt factors
- safety of the agent
- cost of therapy
- All
- None
• All
Immediate administration of drug/s prior to bacterial indetification and susceptibility testing
Empiric therapy
Central to selection of the proper drug
Characterization/Identification of the organism
Basis for a rapid assessment of the nature of the pathogen can sometimes be made on
Gram stain
What should necessarily done to arrice at a conclusive diagnosis and to determine the susceptibility of the bacteria to antimicrobial agents.
Culture
When is essential to obtain a sample culture?
Prior to initiating treatment
Needed initially for serious infectoons when the identity of the organism is unknown or the site makes a polymicrobial infection likely
Broad-spectrum therapy
Natural barriers to drug delivery are created by the structures od the capillaries such as
- liver
- prostate
- vitreous body of the eye
- CNS
Liver
Drugs that have significant penetration in the CNS.
- penicillin
- quinolones
- ampicillin
- metronidazole
quinolones
metronidazole
Drug/s that has limited penetration though the blood-brain barrier under normal conditions
Penicillin
A compound with a _______ has an ____ ability to cross the blood-brain barrier, whereas compounds with _____ are ____ even in the presence of meningeal inflammation.
Low mol weight, enhanced
High mol. Weight, penentrate poorly
Causes accumulation in the body of antibiotics that ordinarily are eliminated by this route.
Poor kidney function
Infants and neonates are vulnerable to the toxic effectd of these drugs.
Chloramphenicol
Sulfonamides
Drug/s that affect the bone grown in young children
Tetracyclines
T/F
All antibiotics cross the placenta.
True
Drugs that have ototoxic effects on the fetus that should he avoided in pregnancy
Aminoglycosides
Pregnancy Category of Drugs
- No human of fetal risk
- Human fetal risk present but benefits outweigh risks
- Animal fetal toxicity demonstrated; human risk undentified
- Human fetal risk present but doesn’t outweigh benefits; contraindicated in pregnancy
- No controlled studies show humn risk
1- A 2- D 3- C 4- X 5- B
Drugs that are less microorganism specific and are reserved for life-threatening infections because of the drug’s potential for serious toxicity to the Pt.
E.g. Chloramphenicol
Major antibiotics that inhibit bacterial cell wall synthesis
Penicillins and cephalosporin
Drugs that inhibit cell wall synthesis but are not nearly as important as the beta-lactam drugs.
Vancomycin
Fosfomycin
Bacitracin
Drugs that are polar compound and not metabolozed extensively and usually they’re excreted unchanged in the urine
Penicillin
Forms of penicillin G that are administered intramuscularly and have long plasma half-lives
Procaine and benzathine
Beta lactam antiobiotics are _____ drugs
Bacterial drugs
Use for narrow-spectrum penicillinase-susceptible agents
Penicillin
Used for the therapy of infection caused by common streptococci, meningococci, gram-positive bacilli and spirochetes
Penicillin
Resistant via production of beta-lactamases.
Most strains of Staphylococcus aureus
Neisseria gonorrhoea
Oral druv used mainly in oropharyngeal infections and more acid-srable than penicillin G.
Penocillin V
Prototype of penicillins but rarely used owing to its nephrotic potential
Methicillin
Drug of choice for gram-positive bacillus Listeria monocytogenes.
Ampicillin
Employed prophylactically by dentists for patients with abnormal heart valnce who are to undergo entensive oral surgery.
Amoxicillin
Why some are resistantce to antibiotics that become a major clinical problem is because of inactivation by plasmid-mediated…?
Penicillinase
Formulation of these substances protects amoxicillin or ampicillin from enxymatic hydrolysis and extends their antimicrobial spectrum.
Beta-lactamase inhibitor (clavulanic acid or sulbactam)
Called antipsuedomonal penicillins becausw of their activity against P. aeruginosa
Piperacillin and ticarcillin
Formulation of these substances extends the antimicrobial spectrum of these antibiotics to include penicclinase-producing organisms
Ticarcillin/piperacillin with clavulanic acid or tazobactam
Most important adverse effect of the penicillins
Allergy
Causes interstitial nephritis
Methicillin
Causes interstitial nephritis
Methicillin
Frquently causes maculopapular skin rash that doesn’t appear to be an allergic reaction
Ampicillin
Occurs when taking oral penicillin especially with ampicillin
Nausea and diarrhea
Has bren implicated in psudomembranoud colitis
Ampicillin
Derivatives of 7-aminocephalosporanic acid and contain the beta-lactam ring structure
Cephalosporins
They are available for oral use but are administered parenterally
Cephalosporins
The major elimination mechanism for cephalosporins is ____ via active tubular secretion
Renal excretion
Class of cephalosporins that are secreted mainly in the bile
Cefoperazone and ceftriaxone
Cephalosporins that do not enter the cerebrospinal fluid even when the meninges are inflamed.
Most 1dt and 2nd generation
Drugs that have adequate therapeutic levels in the CSF, regardless of inflammation, are acheived only with
3rd gen. Cephalosporims
Effective in treatmemt of neonatal and childhood meningitis caused by H influenza
Ceftriaxone or cefotaxime
Find application as a single prophylaxis dose prior to surgery because its 1.8hr half-life and its activity against penicillinase-producing S aureus
Cefazolin
T/F. All cephalosporins cross the placenta
True
Cephalosporin binds to ____ to inhibit bacterial cell wall synthesis by mechanisms similar to penicillins
PBP on bacterial cell membranes
First generation drug of cephalosporins that are use parentally and orally.
Cefazolin-parental
Cephalexin- oral
The 1st generation cephalosporin also have activity other than stap prnicillinase against what bacteria?
PEcK
Proteus mirabilis
E. coli
Klebsiella pneimoniae
The 2nd generation of cephalospotins display greater activity against additional gram (-) organisms
HENPEck
H influinzae
Enterobacter aerogenes
Neisseria sp
Have enhanced activity against gram (-) bacilli, as well as most other enteric organisms plus Serratia marcescens
HENPEcK + enteric + marcescens
Agents of choice in the Tx of meningitis
Ceftriaxone and cefotaxime
Drugs of choice in gonorrhea
Ceftriaxone and cefixime
Drugs in the 4th gen of cephalosporin combines the gram (+) activity of 1st gen agents w/ wider gram (-) spectrum of 3rd gen cephalosporins.
Cefepime
T/F
Patients who have had an anaphylactic response to penicillins should receive cephalosporins.
False. Should not receive
Drugs that may cause pain at the intramuscular injection site and phlebitis after intravenous administration. They also increase the nephrotoxicity of aminoglycosides when the 2 are admin together
Cephalosporin
Drugs thay disrupt bacterial cell wall synthesis and are unique because the beta-lactam ring is not fused to another ring.
Monobactams
Only commercially availablr monobactams and has abtimicrobial activity directed primarily against enterobacteriaceae but it also acts against aerobic gram (-) rods including P aeroginosa
Aztreonam
Lacks activity against gram (+) organisms and anaerobes
Monobactam
Resistant to the action of beta-lactamases
Aztreonam
Drug that is relatively non toxic but may caise phlebitis, skin rash, and occasionally abnormal liver function tests
Aztreonam
Are synthetic beta-lactam antibiotics that differ in structure from the penicillins in that sulfur atom of the thiazolidine ring has been externalized and replaced by a carbon atom.
Carbapenems
Compounded with cilastatin to protect it from metabolism by renal dehydropeptidase.
Imipenem
The broadest-spectrum beta-lactam antibiotic preparations currently available.
Imipenem/cilastatin and meropenem
Resists hydrolysis by most beta-lactamases but not the metallo-beta-lactamases
Imipenem
This drug plays a role in empiric therapy because it’s active against penicillinase-producing gram (+) and gram (-) organisms and anaerobes and P aeruginosa
Carbapenems
Is jot an alternative for P aeroginosa coverage because most strains exhibit resistance
Ertapenem
Are administered IV and penetrate well into body tissues and fluids, including CSF when the meninges are inflamed
Imipenem and meropenem
Excreted by glomerular filtrations
Carbapenems
Undergoes cleavage by dehydropeptides found in the brush border of the proximal renal tubules. Thid enzyme forms an inactive metabolite that is potentially nephrotoxic.
Impenem
Compounding the imipenem with this drug protects the parent drug and prevents the formation of the toxic metabolite
Cilastatin
Class of carbapenems that does not undergo metabolism
Meropenem
Adverse effects of Imipenem/cilastatin
Nausea, vomiting, diarrhea
High level of imipenem manly provoke
Seizures
Drugs used in fixef combinations with certain hydrolyze penicillins
Clavulanic acid, sulbactam, tazobactam
A tricyclic glycopeptide that has become increasingly important because of its effectiveness against multiple drug-resistant organism, such as MRSA and enterococci
Vancomycin
Inhibits synthesis of bacterial cell wall phospholipids as well as peptifoglycan polymerazation by binding to the D-Ala-D-ala side chain of the precursor pentapeptide
Vancomycin
Drugs thay is lifesaving in the Tx of MRSA and methicillin-resistant Stap epidermis (MRSE) infections as well as enterococcal infections
Vancomycin
Organisms that limit oral vancomycin Tx foe potentially life-threatening, antibiotic-associated colitis.
C. Difficile or staph
Vancomycin is used in individials with ____ and in pt undergoing ___€
Prothetic heart valves
Implantation with prothetic devices
Employed for Tx of systemic infections or for prophylaxis
Slow IV infusion (60-90mins)
Normal half-life of vancomycin
6-10 hrs
Adverse effects of vancomycin
Fever
Chills
And/or phlebitis at the infusion site
Results from histamine release ass w/ a rapid infusion
Flushing (red man syndrome)
Is a peptide antibiotic that interfers with a late stage in cell wall synthesis in gram (+) organisms
Bacitracin
Limited to topical use because of its marked nephrotoxicity
Bacitracin
An antimemtabolite that blocks the incorporation of D-ala inyo the pentapeptide side chain of peptidoglycan
Cycloserine
Side effects of cycloserine
Tremors
Seizures
Psychosis
Cycloserine is used only to treat caused bu organism resistant to 1st line antituberculous drugs
Tuberculosis
This drug is eleminated via kidney
Daptomycin
Should be monitored because it may cause myophaty
Creatine phospokinase
A novel cyclic lipopeptide with spectrum similar to vancomycon but active against vancomycin-resistant strains of enterococci and staph
Daptomycin
The primary mechanism of antibacterial action of the penicillin involves inhibition of
- beta lactamases
- N-acetylmuramic acid synthesis
- Peptidoglycan cross-linking
- Synthesis of cell membranes
- Transglycosylation
Peptidoglycan cross linking
The most appropriate Tx of gonorrhea in
Procaine penicillin G Im as a single does plus oral provenecid
