Cumulative Pharm CIS

Question 1

acute on chronic bronchitis antibiotics use?

Answer 1

Yes; 
signs that suggest that:
- increased sputum
- increased SOB
- purulent sputum

Question 2

most likely adverse drug reaction of levofloxacin?

Answer 2

GI, such as mild nausea

they are renally excreted; with renal dysfunction they can build up in the CNS

Question 3

What drug can cause myelosuppression?

Answer 3

linezolid

Question 4

what drugs inhibit the final transpeptidation step in cell wall synthesis?

Answer 4

beta lactams

Question 5

what drugs prevent initiation of protein synthesis?

Answer 5

aminogllycosides

Question 6

what drugs form pores in the bacterial cell membrane?

Answer 6

polymyxins

Question 7

what prevents access of aminoacyl tRNA to acceptor A site?

Answer 7

doxycycline

Question 8

CAP – Empiric Antimicrobial Guidelines (outpatient)

Answer 8

Previously healthy
Macrolide PO (azithromycin, clarithromycin)
-OR-
Doxycycline PO

DRSP risk (comorbidities, age > 65 years, use of antimicrobials within 3 months)
Respiratory fluoroquinolone PO (levofloxacin, moxifloxacin)
-OR-
B-lactam PO [high dose amoxicillin or amoxicillin-clavulanate preferred (alternates: ceftriaxone, cefuroxime)] PLUS a macrolide PO

Question 9

Protein Synthesis InhibitorsMechanisms of Action

Answer 9

Aminoglycosides (30S)

• Interferes with initiation
• Causes misreading & aberrant proteins

Tetracyclines (30S)
- Blocks aminoacyl tRNA acceptor site

Macrolides (50S)
- Inhibits translocation

Clindamycin (50S)
- Inhibits translocation

Linezolid (50S)
- Blocks formation of initiation complex

Question 10

Inpatient, Non-Intensive Care Unit Recommendations

CAP

Answer 10

Respiratory FQ IV or PO (levofloxacin, moxifloxacin)
-OR-
B-lactam IV (ceftriaxone, cefotaxime, or ampicillin) PLUS macrolide IV (azithromycin)

Question 11

multidrug resistant TB means

Answer 11

resistant to at least rifampin and isoniazid

Question 12

a pt is having hepatotoxicity. Which standard TB drugs to we eliminate, and what do we replace with?

Answer 12

All but ethambutal need to be dropped
(PZA, rifampin, INH)

add a fluoroquinolone and an injectable agent like streptomycin

then we add the other drugs in one at a time every 2 weeks or so, PZA last, and extend drug therapy to 18-24 months

Question 13

This drug class is preferred for HIV-infected treatment-naïve patients in combination with tenofovir/emtricitabine:

Answer 13

Integrase Strand Transfer Inhibitors (INSTIs)

Question 14

P450 Induction by Rifamycins

Answer 14

Rifampin is a strong P450 inducer (1A2, 2C9, 2C19, 2D6, 3A4)

• Use with caution in patients with HIV who are taking protease inhibitors (PIs) and non-nucleoside reverse-transcriptase inhibitors (NNRTIs)
• Half-lives, and thus efficacy, of agents metabolized by CYP450s (e.g., PIs, NNRTIs) are reduced
• Other agents metabolized by P450s: isoniazid, digoxin, propranolol, warfarin, oral contraceptives, etc.

Rifampin is the most potent P450 inducer

Rifabutin is the least potent