Drugs for GI infections II

Question 1

MOA bismuth subsalicaylate

Answer 1

bismuth coats ulcers and erosions forming protective barrier
atimulates PG, mucus, and HCO3
salicylate inhibites intestinal PG and Cl secretion (reduce stool frequency and liquidity in infecitous diarrhea)

Question 2

therapeutic use bismuth subsalicylate

Answer 2

dyspepsia and acute diarrhea
travelers diarrhea
H pylor infection

Question 3

adverse reactions from bismuth subsalicylate

Answer 3

harmless blackening of stool, liwuid could cause blackening of tongue
high doses: slaicylate toxicity, Reyes syndrome in kids
avoid in renal impairment

Question 4

MOA fluoroquinolones

Answer 4

[ ] dep killing

targets bacterial DNA gyrase and topoisomerase IV

Question 5

bacterial R to fluoroquinolones

Answer 5

mutation in bacterial chromosome genes encoding DNA gyrase or topoisomerase IV or by active trasnport out of the cell

Question 6

fluoroquinolones work on what bacteria

Answer 6

E coli, salmonella, shigella, enterobacter, campylobacter, neisseria, pseudomonas, aeruginosa, S aureus

Question 7

which fluoroquinolones work on strep spp

Answer 7

levofloxacin, gatifloxacin and moxifloxacin

Question 8

therapeutic uses of fluoroquinolones

Answer 8

UTI, prostatisi, STI, travelers diarrhea, shigellosis, joint STTI infeciotns, DM foot infections

Question 9

adverse effects fluoroquinolones

Answer 9

GI (nausea, vomiting, abdominal discomfort)
CNS(mild HA, dizziness, delirium, rare hallucinations)
rash, photosensitivity, Achilles tendon rupture

Question 10

contraindications to fluoroquinolones

Answer 10

children because of achilles tendon rupture

Question 11

MOA aminoglycosides

Answer 11

[ ] dependent, binds 30s ribosomeal subunit and disrupts normal cycle ribosomal funciton by interfering with initiation protein synthesis

Question 12

bacterial R to aminoglycosides

Answer 12

AG metabolizing enzymes, impaired transport of drug into cell, altered ribosom

Question 13

what microbesn are aminoglycosdes used against

Answer 13

aerobic gram - bacteria, limited action against gram +, produces synergistic bactericidal effects in gram + when combine with a cell wall active agent

Question 14

GI uses aminoglycosides

Answer 14

UTI, peritonitis with peritoneal dialysis

Question 15

adverse effects aminoglycosdes

Answer 15

ototoxicity, nephrotoxicity, neuromuscular block and apnea

Question 16

what are the aminoglycosides

Answer 16

amikacin
tobramycin
gentamicin

Question 17

MOA tetracycline

Answer 17

bacteriostatic, inhibits bacterial protein synthesis by binding 30s bacterial ribosome and preventing access of aminoacyl tRNA to acceptro A site on mRNA ribosome complex

Question 18

bacterial R to tetracyline

Answer 18

decreased influx acquisition of energy dependent efflux, ribosomal protection proteins, enzymatic inactivation

Question 19

spectrum tetracycline covers

Answer 19

aerobic and anaerobic gram + and gram -
also rickettsie, coxiella, mycoplasma, borrelia, treponema
Pseudomonas resistant

Question 20

therapeutic use tetracyline

Answer 20

MRSA, rickettsial, CAP, Q fever, anthrax

Question 21

adverse effects tetracycline

Answer 21

GI (epigastric burining, abdominal discomfort, nausea, vomiting, diarrhea, superinfecitons like C diff, photosensiticity, teeth discoloration

Question 22

what are macrolides

Answer 22

azithromycin erythromycin

Question 23

MOA macrolides

Answer 23

bacteriostatic, binds reversibly to 50s ribosomal subunit, inhibits translocation where a newly synthesized peptidyl tRNA molecule moves from acceptor site on ribosome to peptidyl donor site

Question 24

bacterial R with macrolids

Answer 24

drug efflux, ribosomal protection proteins, hydrolysis, ribosomal mutaitons

Question 25

spectrum covered by macrolides

Answer 25

aerobic gram + cocci, bacilli | clostridium , listeria monocytogenes

Question 26

therapeutic use of macrolides

Answer 26

``` respiratory tract infections alternative otitis media,s inusitis, bronchitis and SSTIs pertussis, gastroenteritis H pylori mycobacterial infecitons ```

Question 27

MOa metronidazole

Answer 27

prodrug that requires reductive activation by susceptible organisms

Question 28

bacterial resistance to metronidazole

Answer 28

decreased formation of nitro radicals

Question 29

spectrum metronidazole

Answer 29

anaerobic coccie and both anaerobic gram - bacilli and anaerobic spore forming gram + bacilli, trichomoniasis, amebiasis, giardiasis, Helicobacter and Campylobacter

Question 30

Therapeutic use of metronidazole

Answer 30

bacterial vaginosis, amebic liver abscess, Tx anaerobic bacterial infections part of regimen prophylazis coloretal surgery, C difficile, Crohns

Question 31

adverse effects metronidazole

Answer 31

HA, nausea, dry mouth, metallic taste, vomiting, diarrhea, abdominal distress!! esp with alcohol!!! dizziness, vertigo, encephalopathy

Question 32

drug interactions metronisazole

Answer 32

induced metabolism of phenobarbital, prednisone, rifampin, prolongs prothrombin time with those on warfarin metabolism is inhibited by cimetidine

Question 33

MOA TMP-SMX (bactrim)

Answer 33

sulfonamide: bacteristatic and competetive inhibitors dihyropteroate synthase (needed for precursot to folic acid) trimethoprim: inhibits microbial dihydrofolate reductase

Question 34

bacterial R to TMP-SMX

Answer 34

lower affinity of enzymes to drug binding, decreased bacterial permeability or active efflux, alternative pathway for essential metabolites synthesis, increased production of essential metabolie

Question 35

spectrum of TMP-SMX

Answer 35

``` chlamydia, N meningitis S aureus S epidermidis and pygoesns viridans E coli Proteus Enterobacter Salmonella Shigella Serratia Klebsiella Brucella Pasteurella Yersinia ```

Question 36

therapeutic use of TMP-SMX

Answer 36

UTI, bacterial prostatitis, bronchitis, shigellosis, travelers diarrhea, salmonella, pneumocysitis jiroveci prophylaxis in neutropenia,

Question 37

adverse effects tMP-SMX

Answer 37

allergic skin rashes, nausea, comtiing, CNS, photosensitivity, renal dysfunction, Stevens-Johnson syndrome

Question 38

drug interactions of TMP-SMX

Answer 38

potentiate effects of warfarin

Question 39

what is the glycopeptide antibiotic

Answer 39

vancomycin

Question 40

MOA vancmoycin

Answer 40

inhibits cell wasll synthesis binding with high affinity to D alanyl D alanine terminal cell wall unites

Question 41

bacterial R to vancomycin

Answer 41

alteration to D alanyl D to D alanyl D lactate or serine

Question 42

spectrum covered by vancomycin

Answer 42

gram + S aureus, S epidermidis, Strep, Bacillus, Corynebacterium, actinomyces, clostriudum, all gram - and mycobacterium

Question 43

therapeutic uses vancomycin

Answer 43

osteomyelitis, endocarditis, MRSA< strep, enterococci, CNS infections, bacteremia, orally for C difficle

Question 44

adverse effects vancomycin

Answer 44

macular skin rash, chills, fever, red man syndrome from rapid infusion direct toxicity from vanco on mast cells causing release histamine ototoxicity, nephrotoxicity

Question 45

MOA loperamide

Answer 45

inhibit presynaptic cholinergic nerves in submucals and myenteric plexuses, increase transit time, increase fecal water absorption, decrease mass colonic movements

Question 46

therapeutic use loperamide

Answer 46

nonspecific Tx diarrhea moderate- severe diarrhea loperamide useful in travelers diarrhea

Question 47

side effects loperamide

Answer 47

may cause toxic megacolon in patients with active IBD should not be used in those with UC or acute bacillary or amoebic dysentery dixcontinued if clinical improvement does not occur within 48 hours