Chapter 73-Bacteriostatic Inhibitors of Protein Synthesis

Question 1

Tetracyclines are considered (bactericidal/bacteriostatic) whereas penicillin is considered (bactericidal/bacteriostatic).

Answer 1

Tetracyclines are considered bacteriostatic whereas penicillin is considered bactericidal.

Question 2

Tetracyclines are considered (broad/narrow) spectrum whereas penicillin is considered (broad/narrow).

Answer 2

Tetracyclines are considered broad spectrum whereas penicillin is considered narrow.

Question 3

Tetracyclines primarily treat:

a) gram negative
b) gram positive
c) both

Answer 3

Answer: c)both

Question 4

Tetracyclines MOA is _____ whereas penicillins MOA is ______.

Answer 4

Tetracyclines MOA is preventing protein synthesis via the 30s ribosomal unit. Penicillin MOA is disrupting the cell wall.

Question 5

How are human cells protected from harm of tetracycline treatment?

a) ribosomes in mammal cell do not bind the drug
b) they lack a cell wall
c) they are not protected, tetracycline can be very damaging to human cells
d) they lack energy-dependent transport systems

Answer 5

Answer: d) they lack energy-dependent transport systems

Tetracyclines enter bacterial cells by an energy-dependent transport. Mammal cells lack this so the drug does not ACTIVELY accumulate in host normal cells.

Question 6

True or false, tetracyclines are the first drug of choice.

Answer 6

False. They rarely are the first drug of choice.

Question 7

True or false, tetracyclines are used as second-line agents when infections are resistant to first-line agents?

Answer 7

True

Question 8

True or false, all tetracyclines are similar in their pharmacokinetics.

Answer 8

False. They vary greatly.

Question 9

What are complications of tetracycline/side effects?

a) GI irritation
b) constipation
c) permanent staining of infants’ teeth if taken during pregnancy
d) liver failure
e) one or more of the above

Answer 9

Answer: a, b, and d

If a pregnant woman takes tetracycline the infants’ deciduous teeth may be stained but the permanent teeth of the infant will not be.

Question 10

Which antibiotic is c.diff commonly associated with?

a) erythromycin
b) penicillin
c) tetracycline
d) clindamycin
e) more than one of the above

Answer 10

Answer: c)tetracyclines and d)clindamycin

Question 11

What patient should the NP avoid the use of tetracyclines in?

a) 4 month old
b) pregnant woman
c) 7 year old
d) One or more of the above

Answer 11

Answer d) one or more of the above

Pregnant women should be educated that the use of tetracycline could stain the deciduous teeth of the infant, but it will not permanently stain the infants’ teeth. Additionally, tetracycline use should be avoided in those aged 4 months-8 years due to risk of permanent discoloration of teeth.

Question 12

Which patient is at most risk for fatty liver, and or liver failure?

a) patient receiving high IV doses
b) patient receiving high oral doses
c) pregnant patient
d) one or more of above

Answer 12

Answer: a & c

Question 13

How is tetracycline eliminated?

Answer 13

Kidneys

Question 14

Tetracycline is primarily eliminated/metabolized by the ____ whereas penicillin is primarily eliminated/metabolized by the ____.

Answer 14

Tetracycline=kidneys

Penicillin=kidneys

Question 15

What antibiotic is associated with forming chelates (calcium, iron, Mg, zinc, etc)?

a) aminoglycosides
b) penicillin
c) macrolides
d) tetracyclines

Answer 15

Answer: d) tetracyclines

Question 16

Tetracyclines should not be given ____2 hours prior to, or ______hours after iron and milk products and antacids.

Answer 16

separated by 2 hours prior or 6 hours after iron and milk products and antacids.

Rationale: it decreases absorption

Question 17

Tetracycline can alter vitamin K production which would lead to an increased risk for:

Answer 17

Bleeding, due to increased INR.

Question 18

Macrolides are considered _____ spectrum.

Answer 18

Broad.

Question 19

Tetracyclines are considered (broad/narrow) spectrum, penicillin is considered (broad/narrow), and macrolides are considered (broad/narrow).

Answer 19

Tetracyclines are considered broad spectrum, penicillin is considered narrow, macrolides are considered broad.

Question 20

Erythromycin is part of what family?

a) tetracyclines
b) macrolides
c) aminoglycosides
d) Fluoroquinolones

Answer 20

Answer: b) macrolides

Question 21

Tetracyclines MOA is preventing protein synthesis via the 30s ribosomal unit. Penicillin MOA is disrupting the cell wall. The MOA for macrolides are _____.

Answer 21

Answer: inhibit protein synthesis via 50s ribosomal subunit

Question 22

Tetracyclines are considered bacteriostatic whereas penicillin is considered bactericidal. What are macrolides considered?

Answer 22

Answer: usually bacteriostatic unless the organism is highly susceptible or dose is HIGH

Question 23

Macrolides are effective against gram ___.

Answer 23

Most gram positive (some gram negative)

Question 24

PCN and macrolides are effective against most gram ____ and some gram ____.

Tetracyclines are effective against gram ______.

Answer 24

PCN and macrolides are effective against most gram + and some gram -.

Tetracyclines are effective against both gram positive and negative.

Question 25

True or false, the only active form of erythromycin (macrolide) is erythromycin base.

Answer 25

True. The other two forms must be converted to work.

Question 26

Tetracycline=kidneys
Penicillin=kidneys
Macrolides=___________

Answer 26

Tetracycline=kidneys
Penicillin=kidneys
Macrolides= hepatic enzymes

Question 27

Macrolides are associated with what dangerous side effect?

a) liver failure
b) QT prolongation
c) vitamin K synthesis inhibition
d) none of the above

Answer 27

Answer: QT prolongation which can lead to fatal dysrhythmias

When taken with CYP3A4=5x risk of cardiac death!!!

Question 28

Clindamycin MOA: __________
Tetracyclines MOA: preventing protein synthesis via the 30s ribosomal unit. Penicillin MOA: disrupting the cell wall. Macrolide MOA: inhibit protein synthesis via 50s ribosomal subunit

Answer 28

Clindamycin MOA: Prevents protein synthesis at 50s subunit

Question 29

Clindamycin is effective against gram ______.

Answer 29

Gram positive and negative

Like tetracycline which is also effective against gram + and -

Question 30

What is the most severe reaction seen with clindamycin?

a) C. diff associated diarrhea
b) peptic ulcers
c) QT prolongation
d) liver failure

Answer 30

Answer: a) C.diff

Can occur in first week of tx and also 4-6 weeks post withdrawal

Question 31

True or false, if a patient has C. diff, we should order drugs that decrease bowel motility.

Answer 31

False. This may actually worsen symptoms.

Question 32

Oxazolidinone antibiotic “linezolid” is used against what types of organisms?

a) gram negative
b) gram positive
c) both
d) multi-drug resistant organisms

Answer 32

Answer d) VRE, MRSA, S. aureus, S. pneumoniae

NOT EFFECTIVE AGAINST GRAM-NEGATIVE

Question 33

Linezolid MOA: ___________

Answer 33

Prevents protein synthesis at 50s subunit like macrolide and clindamycin

Question 34

What patient cannot take linezolid?

a) immunosuppressed
b) kidney failure
c) PKU deficient
d) none of the above

Answer 34

Answer: c)PKU deficient

oral suspension has PKU in it, therefore patients deficient in this cannot take the oral suspension

Question 35

Serious complications associated with linezolid and tedizolid:

a) myelosuppression
b) bleeding
c) hypotension
d) QT prolongation
e) one or more of the above

Answer 35

Answer a)myelosuppression

Myelosuppression is reversible but CBC monitoring should be done weekly.

Other side effects include neuropathy (optic is reversible but peripheral is permanent), hypertensive crisis, and serotonin syndrome.

Question 36

Patients taking linezolid and tedzolid should avoid what:

a) foods rich in thymine
b) blood thinners
c) aspirin products
d) SSRIs
e) one or more of above

Answer 36

Answer d) SSRIs

Patient use of SSRIs with these medications places them at risk for serotonin syndrome. Patient should avoid foods rich in tyramine as they can increase risk for hypertensive crisis (due to inhibition of MAO).