E2 Erdman Macrolides

Question 1

3 macrolides we are talking about

Answer 1

Erythromycin
Azithromycin
Clarithromycin
(ACE)

Question 2

which is a natural macrolide
Erythromycin
Azithromycin
Clarithromycin

Answer 2

Eryth

Question 3

macrolide MOA

Answer 3

bind to 50S subunit

Question 4

Macrolides cidal or static

Answer 4

static, but may be cidal in high concentrations against very susceptible organisms

Question 5

Concentration dependent
A. Erythromycin
B. Azithromycin
C. Clarithromycin

Answer 5

B

Question 6

time-dependent
A. Erythromycin
B. Azithromycin
C. Clarithromycin

Answer 6

A and C

Question 7

3 mechs of resistance for Macrolides

Answer 7

• active efflux
• altered binding sites
• cross resistance between ALL macrolides

Question 8

confers low-level resistance to the macrolides
A. active efflux
B. altered binding sites
C. cross resistance between ALL macrolides

Answer 8

A

Question 9

confers high-level resistance to all macrolides
A. active efflux
B. altered binding sites
C. cross resistance between ALL macrolides

Answer 9

B

Question 10

does NOT have best activity for GP aerobes
A. Azithromycin
B. Clarithromycin
C. Erythromycin

Answer 10

A

Question 11

macrolide SoA:
GP aerobes

Answer 11

• group and viridans streptococci
• Streptococcus pneumoniae (ONLY PSSP)
• MSSA (staph a)
• Bacillus spp, Corynebacterium spp

Question 12

Macrolide SoA:
GN aerobes, order of drugs and enhanced activity

Answer 12

A>C>E (cool spells ace)

Question 13

T or F:
Macrolides have activity against Enterobacteriaceae

Answer 13

false, DO NOT

Question 14

Macrolide SoA:
GN aerobes
actual bacterias

Answer 14

• Haemophilus influenzae (not erythromycin)
• Moraxella catarrhalis
• Neisseria spp

Question 15

does NOT have activity against Haemo Influenzae
A. Azithromycin
B. Clarithromycin
C. Erythromycin

Answer 15

C

Question 16

Macrolide SoA:
anaerobes

Answer 16

activity against upper airway anaerobes

Question 17

Macrolide SoA:
atypical bacteria

Answer 17

ALL macrolides have excellent activity against
- Legionella - a DOC*
- Chlamydia spp
- Mycoplasma pneumoniae
- Ureaplasma urealyticum

Question 18

Macrolide SoA:
“other organisms” highlighted option from slides

Answer 18

Mycobacterium avium complex

Question 19

Absorption:
erytho base ->
erythro esters and ester salts ->

Answer 19

base: destroyed by gastric acid; enteric coated
esters: more acid stable and better absorbed

Question 20

Absorption:
clarithromycin

Answer 20

acid stable and well absorbed from the GI tract (regardless of presence of food)

Question 21

Absorption:
Azithromycin

Answer 21

acid stable, food does not affect absorption of tabs or suspension

Question 22

does not have a very large Vd
A. Azithromycin
B. Clarithromycin
C. Erythromycin

Answer 22

C

Question 23

T or F:
all macrolides penetrate the CSF well

Answer 23

false, minimal CSF pen

Question 24

All 3 macrolides extensively distribute into _____ and _____

Answer 24

tissues and cells (macrophages and neutrophils)

Question 25

erythromycin is excreted in ____ and metabolized by ______

Answer 25

bile CYP450

Question 26

Clarithromycin is metabolized and partially eliminated by the ______

Answer 26

kidney

Question 27

Clarithromycin requires dose adjustment when CrCl < __?

Answer 27

30

Question 28

Azithromycin is eliminated by?

Answer 28

biliary excretion

Question 29

has the longest half life of 68 hours A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 29

A

Question 30

clarithromycin metabolized in liver by ?

Answer 30

CYP450

Question 31

which macrolides are removed during hemodialysis or peritoneal dialysis

Answer 31

none you fool

Question 32

macrolide clinical uses: RTI's - disease state - especially for _____ coverage

Answer 32

comm acqu pneumonia atypical

Question 33

community acquired pneumonia: __________ for outpatients OR combined with _______ for inpatients

Answer 33

monotherapy ceftriaxone

Question 34

which macrolide to treat STDs? what dose?

Answer 34

azithromycin, one gram

Question 35

use of azithro for an STD is treating urethritis or cervicitis from what bacteria

Answer 35

chlamydia trachomatis

Question 36

what is MAC

Answer 36

mycobacterium avium complex infection

Question 37

used alone as prophylaxis for MAC A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 37

A

Question 38

used with ethambutol and/or rifabutin for treatment of MAC A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 38

B

Question 39

T or F: macrolides are frequently used as alternatives for penicillin-allergic pts

Answer 39

true

Question 40

main AE for macrolides and how to mitigate it

Answer 40

GI upset, take with food

Question 41

most commonly causes GI upset A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 41

C

Question 42

which of the following can cause Thrombophlebitis with IV use A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 42

A and C

Question 43

how do you partially avoid thrombophlebitis from IV erythro or azithro (3)

Answer 43

dilution of dose slow admin infuse into large vein

Question 44

"other" highlighted AE of macrolides

Answer 44

QTc **

Question 45

Does NOT inhibit CYP450 A. Azithromycin B. Clarithromycin C. Erythromycin

Answer 45

A

Question 46

macrolide drug interactions, may increase conc of what drugs? (7) (start with important one)

Answer 46

- warfarin - theophylline - carbamazepine - cyclosporine - phenytoin - digoxin - valproic acid (also azithro is not affiliated with these*)

Question 47

Which of the following antibiotics does NOT have activity against atypical bacteria (e.g., Legionella pneumophila)? A. Azithromycin B. Levofloxacin C. Amoxicillin-clavulanate D. Clarithromycin E. Moxifloxacin

Answer 47

C

Question 48

Which of the following antibiotics is least likely to interact with warfarin? A. Azithromycin B. Levofloxacin C. Ciprofloxacin D. Clarithromycin E. Moxifloxacin

Answer 48

A