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PHRM 865 > E2 Erdman MSC antibiotics > Flashcards

E2 Erdman MSC antibiotics Flashcards

1
Q

tetracyclines in lecture (3)

A

tetracycline
doxycycline
minocycline

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2
Q

Tetracycline analogs in lecture (3)

A

Tigecycline
eravacycline
Omadacyline

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3
Q

Sulfonamide in lecture (1)

A

TMP-SMX

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4
Q

2 polymyxins in lecture

A

Colistin
Polymyxin b

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5
Q

Lincosamide in lecture (1)

A

clindamycin

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6
Q

Nitroimidazole in lecture (1)

A

metronidazole

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7
Q

tetra MOA

A

reversibly bind 30S

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8
Q

Tetra static or cidal

A

static, but cidal when at high conc against very susceptible organisms

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9
Q

3 mechs of resistance tetras

A
  • efflux pumps
  • dec access to ribosom from ribosomal protection proteins
  • enzymatic inactivation of tetras
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10
Q

Cross-resistance is NOT observed
tetracycline
doxycycline
minocycline

A

mino

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11
Q

T or F:
tetracycline analogs are affected by the major tetra resistance mechs

A

false actually

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12
Q

which 2 are most active against GP aerobes
tetracycline
doxycycline
minocycline

A

Mino and doxy

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13
Q

highlighted GP bacteria tetras are active against

A

MSSA

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14
Q

tetra SoA
GN aerobes

A

Haemophilus influ
Haemophilus duc
Camplyobacter
Helocobacter
Acinetobacter
(NO ENTEROBACTERALES)

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15
Q

2 anaerobic bacteria for tetras

A

Actinomyces
Propionibacterium

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16
Q

Tetra SoA:
MSC bacteria

A

atypical bacteria such as
LEGIONELLA*
Chlamydophila pneumoniae
Mycoplasma
Ureaplasma

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17
Q

tetra analogs SoA:
GP aerobes (highlighted)

A

MSSA
MRSA
entero faecalis (VSE and some VRE)

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18
Q

acronym for tetra analog GN aerobes

A

EEACKSS

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19
Q

T or F:
tetra analogs are active against proteus mirabilis and pseudomonas aeruginosa

A

FALSE*

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20
Q

has higher MIC for GN aerobe Stenotrophomonas maltophilia
A. Tigecycline
B. Eravacycline
C. Omadacycline

A

C

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21
Q

1 highlighted anaerobe for tetra analogs

A

Bacteroides spp

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22
Q

have coverage against atypical bacteria
A. Tigecycline
B. Eravacycline
C. Omadacycline

A

B and C

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23
Q

which 3 tetras + analogs are available PO and IV

A

doxy
mino
omada

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24
Q

which 2 tetras + analogs are only IV

A

Tige
erava

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25
Q

which tetras + analogs have impaired absorption from dairy, zinc, mag, etc?

A

all orals (doxy, mino, omada)

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26
Q

absorption of tetras + analogs is impaired by what

A

di and trivalent cations

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27
Q

1 highlighted location for where tetras + analogs are distributed

A

prostate

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28
Q

T or F:
tetras + analogs penetrate CSF well

A

false, very little amounts

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29
Q

T or F:
tetras + analogs are removed during hemo

A

true BUT minimally

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30
Q

which two tetras do not require dose adjustment in RI

A

doxy
mino

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31
Q

which tetra analogs require dose adjustment in RI

A

none

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32
Q

which is used in outpatient use for CAP
tetracycline
doxycycline
minocycline

A

doxy

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33
Q

used for acinetobacter infections
tetracycline
doxycycline
minocycline

A

Mino

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34
Q

Used for chlamydial infections, including nongonococcal urethritis
tetracycline
doxycycline
minocycline

A

doxy

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35
Q

T or F:
tetra analogs cover proteus and psedomonas

A

false

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36
Q

Tetra + analogs AEs:
GI, which one most likely

A

N/V
Tigecycline*

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37
Q

Tetra + analogs AEs:
dermatologic

A

photosensitivity

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38
Q

T or F:
all tetras + analogs are safe in pregnancy

A

false, all category D

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39
Q

why cant the tetras + analogs be used in pregnancy?

A

discoloration of permanent teet and dec bone growth in children

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40
Q

Which antibiotic will interact with divalent/trivalent cations so that oral absorption is impaired potentially leading to clinical failure?
A. Oral levofloxacin
B. Oral doxycycline
C. Oral ciprofloxacin
D. Oral minocycline
E. All of the above

A

E

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41
Q

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

A

C

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42
Q

TMP-SMX MOA

A

produce sequential blockade of microbial folic acid synthesis, which is necessary for production of DNA

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43
Q

Inhibits dihydropteroate synthesis:
A. TMP
B. SMX

A

B

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44
Q

Inhibits dihydrofolate reductase:
A. TMP
B. SMX

A

A

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45
Q

TMX and SMX are ______ alone but ______ in combination

A

static
cidal

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46
Q

mechs of resistance for TMP-SMX

A
  • point mutations in dihydropteroate synthase and/or altered production or sensitivity of bacterial dihydrofolate reductase (wtf)
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47
Q

TMP-SMX SoA:
GP aerobes

A

S aureus (including some MRSA, especially CA-MRSA)

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48
Q

TMP-SMX SoA:
GN aerobes (1)

A

Stenotrophomonas maltophilia**

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49
Q

what notable GN aerobe does TMP-SMX NOT cover

A

pseudomonas*

50
Q

“other” bacteria that makes TMP-SMX the DRUG OF CHOICE for

A

Pneumocystis carinii***

51
Q

TMP-SMX dosage form(s)

52
Q

how do you achieve steady-state serum conc of TMP-SMX

A

fixed oral or IV combo of 1:5

53
Q

T or F:
TMP-SMX penetrates CSF w/ inflamed meninges

54
Q

2 highlighted locations TMP-SMX distributes to

A

urine
prostatee

55
Q

SMX is ___% protein bound

56
Q

TMP-SMX elimination

A

both are eliminated by liver and kidney

57
Q

When should you consider dose adjustment for TMP-SMX?

58
Q

3 highlighted clinical uses for TMP-SMX

A
  • acute, chronic, or recurrent UTIs
  • acute or chronic bacterial prostatitis
  • skin infxns due to CA-MRSA
59
Q

TMP-SMX AEs:
hematologic

A

leukopenia, thrombocytopenia

60
Q

TMP-SMX AEs:
hypersensitivity

61
Q

TMP-SMX AEs:
CNS

A

headache, aseptic meningitis, seizures

62
Q

TMP-SMX AEs:
other

A

crystalluria, hyperkalemia, inc creatinine

63
Q

T or F:
TMP-SMX is safe in pregnancy and breastfeeding

A

false, can cause kernicterus in newborn

64
Q

TMP-SMX drug interactions

A

warfarin
inc anticoagulation effect

65
Q

TMP-SMX dosage forms and dosing, oral tabs:
Single strength: __mg TMP and ___mg SMX
double strength: ___mg TMP and ___mg SMX

A
  • 80, 400
  • 160, 800
66
Q

_____ are cationic cyclic decapeptides linked to a fatty acid chain by an a-amide linkagee

A

Polymyxins

67
Q

is a prodrug:
A. colistin
B. polymyxin B

68
Q

Polymyxin MOA

A

cationic detergents that binds to anionic lipopolysaccharide molecules in the outer cell membrane of Gram-negative bacteria causing displacement of Ca and Mg  induces changes in permeability and leakage of cellular contents, leading to cell death

69
Q

Polymyxins display (time/conc) dependent and (static/cidal) activity

A

conc
cidal

70
Q

1 resistance mech for polymyxins

A

alteration of outer cell membrane

71
Q

Polymyxins SoA:
GP aerobes

72
Q

Polymyxins SoA:
GN aerobic bacilli
(2 highlighted options)

A

Acinetobacter spp
Pseudomonas aeruginosa

73
Q

Polymyxins SoA:
anaerobes

74
Q

Polymyxins Absorption

A

only IV not absorbed like that ig

75
Q

Polymyxin elimination

A

Colistin and polyB are eliminated by nonrenal routes
HOWEVER
50% of CMS is eliminated unchanged by the kidney

76
Q

requires dose adjustment in RI when CrCl <80
A. colistin
B. polyB

77
Q

Polymyxins clinical uses

A

infections caused by GN bacteria that are resistant to other antibiotics

78
Q

Pref for systemic infections
A. colistin
B. polyB

79
Q

pref for UTI
A. colistin
B. polyB

80
Q

polymyxins AEs:
(2)

A

nephrotox - reversible
neurotox - reversible

81
Q

use what BW for colistin IV

82
Q

use what BW for polyB

83
Q

can both polymyxins be used for inhalation

84
Q

True/False:Colistin is often used for the treatment of infections due to Gram-negative aerobes because it is not associated with serious adverse effects

A

false, only for tx of infections due to MDR GN aerobes bc it is nephro and neurotoxic

85
Q

best for ADA; except for treatment in brain abscesses:
A. Clindamycin
B. Metronidazole

86
Q

best for BDA; useful for brain abscesses due to CNS/CSF pen:
A. Clindamycin
B. Metronidazole

87
Q

clindamycin MOA

88
Q

clinda is (time/conc) dependent and (cidal/static)

A

time
static

89
Q

mechs of resistance for clinda

A
  • altered target sites
90
Q

is active efflux effective against clindamycin

91
Q

Clinda SoA:
GP aerobes
(highlighted)

A

PSSP
CA-MRSA
MSSA

92
Q

clinda is active against many GP and GN anaerobes, but is most useful for anaerobes ________ ____ _______

A

above the diaphragm

93
Q

clinda SoA:
anaerobes (highlighted)

A

some bacteroides spp

94
Q

T or F:
clinda has activity against C diff

95
Q

clinda absorption

A

rapidly and completely absorbed, food has minimal effect

96
Q

Clinda distribution

A

good tissue penetration including bone, minimal CSF pen

97
Q

clinda elimination

A

primarily metabolized by liver

98
Q

T or F:
clinda is removed during hemo

A

FALSE IT IS NOT

99
Q

clindamycin clinical uses

A
  • infections due to anaerobes OUTSIDE THE CNS
  • pulmonary
  • diabetic foot infections
  • penicillin-allergic pts
  • infections due to CA-MRSA*(
100
Q

clinda AEs:
worst inducer of?

101
Q

clindamycin AEs:
highlighted and not Gi

A

hepatotoxicity - rare

102
Q

metronidazole MOA

A

ultimately, inhibits DNA synthesis

103
Q

T or F:
both colistin and metronidazole are prodrugs

104
Q

Metronidazole displays (time/conc) dependent and (cidal/static) activity

105
Q

2 mechs of resistance for metro

A

altered growth requirements
and
altered ferredoxin levels

106
Q

metronidazole SoA:
anaerobes *

A

ADA: peptococcus
BDA: bacteroides
C diff

107
Q

metro is the antianaerobic agent most reliably active against what bacteria

A

bacteroides fragilis

108
Q

metronidazole SoA:
GP anaerobes

A

Clostridium spp including C diff

109
Q

T or F:
metro is inactive against all common aerobic bacteria

110
Q

T or F:
metro penetrates CSF well

111
Q

metronidazole elimination

A

primarily metabolized by liver

112
Q

T or F:
metro is removed during hemo

113
Q

metro clinical uses

A
  • anaerobic infections*
  • pseudomembranous colitis due to C diff
  • trichomonas
  • giardia
114
Q

metro AEs:
GI

A

stomatitis
metallic taste

115
Q

metro AEs:
CNS- most serious btw

A

peripheral neuropathy**

116
Q

Metro AEs:
other significant highlighted one

A

mutagenicity, carcinogenicity (avoid during pregnancy and breastfeeding)

117
Q

2 notable drug interactions with metro

A

warfarin
alcohol

118
Q

Which of the following antibiotics will NOT interact with warfarin?
A. TMP-SMX
B. Metronidazole
C. Ciprofloxacin
D. Clindamycin
E. Clarithromycin

119
Q

Which of the following antibiotics can be safely used during pregnancy?
A. Ampicillin
B. Levofloxacin
C. Doxycyclline
D. Metronidazole
E. Telavancin

120
Q

Which of the following antibiotics does NOT require dosage adjustment in renal insufficiency?
A. Trimethoprim-sulfamethoxazole
B. Vancomycin
C. Gentamicin
D. Cefazolin
E. Nafcillin

A

E, even tho it can cause nephrotox?

121
Q

Which of the following antibiotics is NOT associated with the development of nephrotoxicity?

A. Metronidazole
B. Vancomycin
C. Tobramycin
D. Colistin
E. Nafcillin

PHRM 865 (16 decks)

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