DNA Synthesis

Question 1

FQ AE

DDI? FDI? Contra-I?

Answer 1

MOST COMMON IS GIT, N&V

CNS - dizziness, light headed
Cation problem - divalent cation, Mg, Al, Zn, Fe; empty stomach
CDAD - Cipro w highest risk
- think Clindamycin w high risk too;
Accumulation - TENDON: hence stop pregnancy, stop 18 yos

Phototoxicity
Peripheral Neuropathy
- avoid in myasthenia gravis
Prolong QTC
- arrhythmia
Tendonitis in <18 yo

FDI for cation
DDI for CYP INHIBITOR!!!

Question 2

Use of FQ

Differentiate USAGE of 2nd and 3rd gen FQs?

NOTE ENTERIC coliforms are GNR
enterococci is GPC

Answer 2

Cipro // Levo + Moxi

Cipro - mostly gram neg, (IMPROVES GRAM + FOR GEN 3 LOL)

• Enteric Coliforms like salmonella
• pseudomona GNR CAN
• UTI
• only Gram + think bacillus anthrax
• strep NO entero NO, MRSA NO

Levo + Moxi - “respi FQ” - NOTE MOXI - hepatic

• atypicals: chlamydia pn, mycoplasma pn, MTB
• Gram + : strep. pneumonia;

Question 3

FQ EXCRETION

Answer 3

Cipro and Levo = RENAL

- MOXI = hepatic

Question 4

Folate what vitamin

- what congenital disease

Answer 4

Folate is B9
- linked to Spina bifida - posterior neural tube defect

hence RBC synthesis needs B9 and B12
folate is b9 omg

Question 5

Folate synthesis biochemistry & drugs

Answer 5

Dihydropteric Acid to Dihydrofolate

• DHP synthase - blocked by Sulfonamides
• —-DHP SYNTHASE!!! before DHF synthase

Dihydrofolate to Tetrahydrofolate
- DHF reductase - blocked by Trimethoprim

Note first step not in mammals cos we have B9 stuff

Question 6

Sulfonamide

• name
• ROA, ROE
• AE [a lot]

Answer 6

Sulfamethoxazole
Oral, Hepatic metab, Renal excrete

sulfa allergy - Hypersensitivity

• metabolite can precipitate - crystalluria
• • kidney damage

G6PD - hemolytic anemia
- increased ROS

Kernicternus in newborns, when bilirubin displaced by sulfonamide goes to BBB;

• Potentiates Warfarin by albumin displacement;

Question 7

Note trimethoprim resistance by

• DHF reductase altered w lower affinity
• efflux pump, decreased permeability

Note both gram + and gram -ve ok for this and sulfamethoxazole

Answer 7

okie

Question 8

Trimethoprim

ROA, ROE

Answer 8

Oral, Renal

- same as sulfamethoxazole

Question 9

Trimethoprim

AE

Answer 9

Folate acid B6 deficiency

• megaloblastic anemia
• leukopenia, granulocytopenia

give Folinic acid, separate pathway, dont enter bacteria

Question 10

Co-trimoxazole

USE

Answer 10

First line UTI
E. Coli
Pneumonia - HiB, moraxella, Klebsiella

TOXOPLAMOSIS? MRSA
Pneumoncytis Pneumonia by Pneumocystis jiroveci

Question 11

Nitrofurantoin
- note nitrofurantoin is for Prophylaxis and treatment of Lower UTI

MOA
ROA, ROE
- property
AE - think intermediates
Contra-I

Answer 11

Bacteria reduce nitrofurantoin to an active intermediate
- inhibit enzymes, synthesis of DNA, RNA, Proteins;

Oral - RENAL
- concentrate so good for UTI
turns urine brown

GI, N&V

• Hypersensitivity
• Hemolytic anemia in G6PD

because of G6PD
- preg and infants not given;

Question 12

Suspect UTI think what

Answer 12

maybe E. Coli

• Aminoglycosides empirical
• First line Co-trimoxazole;
• then Nitrofurantoin
• Co-amoxazole can also for E.Coli

Question 13

Drugs w Warfarin potentiation problem?

Answer 13

Aspirin + Sulfonamide

Question 14

Ratio of co-trimozazole

Answer 14

1 Trimethoprim : 5 Sulfamethoxazole

Question 15

Whats a gen 2 cephalosporin?
Whats a gen 3 for pseudomonas
Whats a gen 4 cephalosporin

Answer 15

Cefuroxime
Ceftazidime
Cefepime

Question 16

What binds to albumin

• name 3 drug classes
• name 1 host protein

Answer 16

Sulfa drugs
Warfarin
Aspirin

• Bilirubin!

Question 17

What is lower UTI

- what is empirical ROA?

Answer 17

Lower - bladder to ureter

• empirical Oral Nitrofurantoin
• first line is Oral Co-trimoxazole

Question 18

DNA synthesis drugs

ROA

Answer 18

All oral

- FQ can oral, iv, eyedrops

Question 19

Name all capsulated bacteria

Answer 19

S. P, HiB, N. Meningitis

• • Protein: Bacillus ANTRAX only
• Klebsiella + Pseudomonas