Chapter 73-Bacteriostatic Inhibitors of Protein Synthesis Flashcards
Tetracyclines are considered (bactericidal/bacteriostatic) whereas penicillin is considered (bactericidal/bacteriostatic).
Tetracyclines are considered bacteriostatic whereas penicillin is considered bactericidal.
Tetracyclines are considered (broad/narrow) spectrum whereas penicillin is considered (broad/narrow).
Tetracyclines are considered broad spectrum whereas penicillin is considered narrow.
Tetracyclines primarily treat:
a) gram negative
b) gram positive
c) both
Answer: c)both
Tetracyclines MOA is _____ whereas penicillins MOA is ______.
Tetracyclines MOA is preventing protein synthesis via the 30s ribosomal unit. Penicillin MOA is disrupting the cell wall.
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: 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.
True or false, tetracyclines are the first drug of choice.
False. They rarely are the first drug of choice.
True or false, tetracyclines are used as second-line agents when infections are resistant to first-line agents?
True
True or false, all tetracyclines are similar in their pharmacokinetics.
False. They vary greatly.
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: 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.
Which antibiotic is c.diff commonly associated with?
a) erythromycin
b) penicillin
c) tetracycline
d) clindamycin
e) more than one of the above
Answer: c)tetracyclines and d)clindamycin
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 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.
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: a & c
How is tetracycline eliminated?
Kidneys
Tetracycline is primarily eliminated/metabolized by the ____ whereas penicillin is primarily eliminated/metabolized by the ____.
Tetracycline=kidneys
Penicillin=kidneys
What antibiotic is associated with forming chelates (calcium, iron, Mg, zinc, etc)?
a) aminoglycosides
b) penicillin
c) macrolides
d) tetracyclines
Answer: d) tetracyclines
Tetracyclines should not be given ____2 hours prior to, or ______hours after iron and milk products and antacids.
separated by 2 hours prior or 6 hours after iron and milk products and antacids.
Rationale: it decreases absorption
Tetracycline can alter vitamin K production which would lead to an increased risk for:
Bleeding, due to increased INR.
Macrolides are considered _____ spectrum.
Broad.
Tetracyclines are considered (broad/narrow) spectrum, penicillin is considered (broad/narrow), and macrolides are considered (broad/narrow).
Tetracyclines are considered broad spectrum, penicillin is considered narrow, macrolides are considered broad.
Erythromycin is part of what family?
a) tetracyclines
b) macrolides
c) aminoglycosides
d) Fluoroquinolones
Answer: b) macrolides
Tetracyclines MOA is preventing protein synthesis via the 30s ribosomal unit. Penicillin MOA is disrupting the cell wall. The MOA for macrolides are _____.
Answer: inhibit protein synthesis via 50s ribosomal subunit
Tetracyclines are considered bacteriostatic whereas penicillin is considered bactericidal. What are macrolides considered?
Answer: usually bacteriostatic unless the organism is highly susceptible or dose is HIGH
Macrolides are effective against gram ___.
Most gram positive (some gram negative)
PCN and macrolides are effective against most gram ____ and some gram ____.
Tetracyclines are effective against gram ______.
PCN and macrolides are effective against most gram + and some gram -.
Tetracyclines are effective against both gram positive and negative.
True or false, the only active form of erythromycin (macrolide) is erythromycin base.
True. The other two forms must be converted to work.
Tetracycline=kidneys
Penicillin=kidneys
Macrolides=___________
Tetracycline=kidneys
Penicillin=kidneys
Macrolides= hepatic enzymes
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: QT prolongation which can lead to fatal dysrhythmias
When taken with CYP3A4=5x risk of cardiac death!!!
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
Clindamycin MOA: Prevents protein synthesis at 50s subunit
Clindamycin is effective against gram ______.
Gram positive and negative
Like tetracycline which is also effective against gram + and -
What is the most severe reaction seen with clindamycin?
a) C. diff associated diarrhea
b) peptic ulcers
c) QT prolongation
d) liver failure
Answer: a) C.diff
Can occur in first week of tx and also 4-6 weeks post withdrawal
True or false, if a patient has C. diff, we should order drugs that decrease bowel motility.
False. This may actually worsen symptoms.
Oxazolidinone antibiotic “linezolid” is used against what types of organisms?
a) gram negative
b) gram positive
c) both
d) multi-drug resistant organisms
Answer d) VRE, MRSA, S. aureus, S. pneumoniae
NOT EFFECTIVE AGAINST GRAM-NEGATIVE
Linezolid MOA: ___________
Prevents protein synthesis at 50s subunit like macrolide and clindamycin
What patient cannot take linezolid?
a) immunosuppressed
b) kidney failure
c) PKU deficient
d) none of the above
Answer: c)PKU deficient
oral suspension has PKU in it, therefore patients deficient in this cannot take the oral suspension
Serious complications associated with linezolid and tedizolid:
a) myelosuppression
b) bleeding
c) hypotension
d) QT prolongation
e) one or more of the above
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.
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 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).
