ch 73

Question 1

Bacteriostatic inhibitors of protein synthesis

key note

Answer 1

Tetracyclines
Macrolides
Clindamycin
Linezolid (Zyvox)
Tedizolid (sivextro)

cannot give to immune compromised pts. Wont work

Question 2

Tetracyclines are a ______-spectrum antibiotics

Answer 2

Broad

Question 3

-cline

Answer 3

Tetracyclines

Tetracycline
doxycycline
minocycline

demeclocycline
eravacycline
omadacycline
sarecycline

Question 4

Tetracyclines are active against a wide variety of _______ and ______

Answer 4

gram positive and gram negative

Question 5

Organism sensitive to tetracyclines are

Answer 5

Rickettsia
spirochetes
Brucella
chlamydia
mycoplasma
H.Pylori
Borrelia burgdorferi
Bacillus anthracis
Vibrio cholerae

Question 6

Tetracyclines are 1st line for

Answer 6

rickettsial disease (Rocky mountain spotted fever)
Typhus fever
Q fever
infections caused by chlamydia trachomatis (trachoma, lymphogranuloma venereum, cervicitis
Brucellosis
cholera
Mycoplasma pneumoniae
lyme disease
anthrax
gastric infections with H. Pylori

Question 7

what 2 tetracyclines are used for Periodontal disease

Answer 7

doxycycline - orally and topically

minocycline - topical

Question 8

oral doxycycline benefit in periodontal disease

Answer 8

inhibits collagenase (destroys connective tissue in gums)

Question 9

topical therapy for periodonal disease does what

Answer 9

adjuncts to scaling and root planing to reduce pocket depth and bleeding

Question 10

drug interactions with tetracyclines

Answer 10

Calcium supplements
milk products (due to calcium)
iron supplements
magnesium containing laxatives
most antacids due to containing mag, aluminum or both

take 1 hour prior or 2 hours after

can increase digoxin or warfarin levels through increasing absorption in GI tract and increased INR by altering vit K producing flora in gut

Question 11

does tetracyclines penetrate to CSF

Answer 11

no

Question 12

adverse effects of tetracyclines

Answer 12

GI - epigastric burning, cramps, n/v/d - giving with food helps but can decrease absorption

esophageal ulceration - avoid dosing at bedtime

diarrhea - risk of c.diff - concern after 1 week

yellow or brown discoloration in teeth when taken by pregnant woman after 4th month gestation - stains deciduous teeth of infant - not perm teeth
if take 4months to 8 years - discolors perm teeth

in pregnancy - suppress growth of long bones in premature infants - reversible with d/c treatment

superinfection - c-diff or candida albicans in mouth pharynx vagina and bowel - symptoms vaginal, anal itching, inflammatory lesions, black furry tongue -> d/c tetracycline if possible or antifungal if not possible

can cause fatty infiltration of the liver - manifests as lethargy and jaundice

pregnant and postpartum or history of kidney disease are higher risk of hepatotoxicity

renal tox

increased sensitivity to sun - sunburn

Question 13

which tetracyclines will food not decrease absorption

Answer 13

minocycline - no change

Doxycycline - some change

Question 14

if a pt has renal impairment, which tetracyclines would be used

Answer 14

doxycycline
minocycline
eliminated primarily by liver

Question 15

what 2 tetracyclines are the most dangerous in renal disease

Answer 15

tetracycline
demeclocycline

accumulate to toxic levels

Question 16

can you give tetracyclines to pregnant woman

Answer 16

no

Question 17

can you give tetracyclines to breastfeeding woman

Answer 17

no - teeth of infant

Question 18

tetracyclines and older adults

Answer 18

can interact with drugs including digoxin

Question 19

Macrolides are ____ spectrum

Answer 19

broad

Question 20

-mycin except clindamycin

Answer 20

Macrolides

Azithromycin
Clarithromycin
Erythromycin

Question 21

Salmonella drug of choice

Answer 21

Ceftriaxone

Question 22

Drug of choice for whooping cough

Answer 22

macrolides

Question 23

drug of choice for Corynebacterium Diphtheriae / acute diphtheria

Answer 23

Erythromycin

Question 24

shared drug of choice for chlamydial infections such as urethritis , cervicitis with tetracyclines

Answer 24

Macrolides (Erythromycin)

Question 25

shared first line with tetracyclines for Mycobacterium pneumoniae

Answer 25

Macrolides (-mycin)

Question 26

what erythromycin base does food not decrease absorption and which 2 is affected

Answer 26

Erythromycin ethylsuccinate - not effected Erythromycin base - is affected Erythromycin stearate - affected

Question 27

which erythromycin is approved for IV use

Answer 27

erythromycin lactobionate

Question 28

can erythromycin cross placenta

Answer 28

yes but BBB is poor

Question 29

metabolism of erythromycin/ drug interactions

Answer 29

CYP3A4 - increases chance of cardiac death CCB - verapamil, diltiazem Azole antifungal drugs - ketoconazole, itraconazole HIV protease inhibitors - ritonavir, saquinavir nefazodone - antidepressant don't combine with - monitor for tox theophylline carbamazepine warfarin clindamycin and chloramphenicol -antagonizing antibacterial effects

Question 30

Adverse effects erythromycin

Answer 30

QT prolongation GI - epigastric pain, n/v/d

Question 31

what bacteria that is sensitive to Clindamycin

Answer 31

Bacteroides fragilis - resistance can be a problem with this one Fusobacterium species clostridium perfringes anaerobic streptococci

Question 32

what drug is good at targeting necrotic tissue

Answer 32

clindamycin

Question 33

Drug of choice for group a strep and gas gangrene (caused by c.perfringens)

Answer 33

Clindamycin

Question 34

adverse effects clindamycin

Answer 34

Clostridium difficile associated diarrhea (CDAD)

Question 35

antibiotics for oxazolidinone class

Answer 35

Linezolid (Zyvox) | Tedizolid (Sivextro)

Question 36

what abx is activity against multi drug resistant gram positive pathogens including Vancomycin resistant Enterococci (VRE) and HC-MRSA, Hospital acquired pneumonia both methicillin susceptible and resistant strains or S.pneumoniae (pennicillin-sucsceptible strains only) complicated skin infetions by S aureaus or S pyogenes saved for VRE or MRSA

Answer 36

Linezolid (zyvox)

Question 37

adverse effects of Linezolid (zyvox)

Answer 37

diarrhea nausea headache reversible myelosuppression - manifests as anemia, leukopenia, thrombocytopenia, pancytopenia CBC counts weekly special caution needed with preexisting myelosuppression if it worsens or new develops then d/c neuropathy - reverses with d/c

Question 38

only give tetracyclines if there is ____with the abscess

Answer 38

cellulitis

Question 39

drug interactions Linezolid (zyvox) and Tedizolid

Answer 39

is a MAO - hypertensive crisis if combined with sympathomimetics (ephedrine, pseudoephedrine, methylphenidate, cocaine) or foods with tyramine (wine and cheese) Combining with SSRI can increase risk for serotonin syndrome because of MAO increases serotonin syndrome. Pt using SSRI cannot take this med (examples - Proxetine - paxil, duloxetine -cymbalta)

Question 40

effective in treatment of MRSA, and bacterial skin and soft tissue infections caused by Staph and Strep (new drug class)

Answer 40

Tedizolid

Question 41

adverse effects of Tedizolid

Answer 41

``` n/v/d dizziness headache neuropathy myelosuppression ```

Question 42

How do you avoid esophageal ulceration in tetracyclines

Answer 42

do not take at night

Question 43

what class is used topically and orally for severe acne

Answer 43

topically and orally for severe acne vulgaris

Question 44

Doxycycline is _____ for staph __for strep

Answer 44

good for staph | bad for strep

Question 45

first choice Chlmydia

Answer 45

Azithromycin 1 gram by mouth 1 time to cure

Question 46

H pylori treated with

Answer 46

macrolides

Question 47

mycobacterium pneumonia treated with

Answer 47

macrolides

Question 48

what drug will you use for anaerobic infections outside of the CNS

Answer 48

Clindamycin

Question 49

CDAD can happen ________ after clindamycin withdrawal

Answer 49

4-6 weeks