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Pharmacology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

toxicities of sulfa drugs

A 
aplastic anemia
hypersensitivity
Stevens Johnson Syndrome
photosensitivity 
kernicterus
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2
Q

contraindications for sulfa drugs

A

near term pregnant women
nursing, premature, or jaundice infants
< 2 months old

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3
Q

sulfasalazine MOA and use

A

prodrug, metabolite mesalamine is anti-inflammatory

used for Crohn’s, ulcerative colitis, RA

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4
Q

1st DOC for UTI

A

Bactrim

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5
Q

MOA for Bactrim

A

sulfamethoxazole: compete with PABA in bacterial cell folic acid synthesis
trimethoprim: prevents conversion of DHF to THF for purine synthesis

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6
Q

spectrum for Bactrim

A

G+ and G-

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7
Q

relationship of trimethoprim and sulfamethoxazole

A

synergistic

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8
Q

use of silver sulfaziadine

A

topical for burns

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9
Q

Bactrim: cidal or static?

A

bacteriostatic, except it is bactericidal in the urinary tract

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10
Q

MOA of daptomycin

A

rapidly depolarizes membrane which eventually leads to cell death

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11
Q

spectrum of daptomycin

A

cidal, G+ (MRSA, MSSA)

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12
Q

route of administration for daptomycin

A

IV

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13
Q

MOA of mupirocin

A

inhibit tRNA synthetase of isoleucine, inhibits protein and RNA synthesis

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14
Q

route of administration for mupirocin

A

topical

skin: impetigo
nares: MRSA

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15
Q

spectrum of mupirocin

A

G+ and G-, bacteriostatic at low concentrations and bactericidal at high concentrations

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16
Q

MOA for polymixin B and E

A

binds to lipid A, increases permeability which results in loss of metabolites

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17
Q

spectrum of polymixin B and E

A

G-

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18
Q

route of administration for polymixin B and E

A

topical (nephrotoxic), used in combination with neomycin and bacitracin

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19
Q

1st gen cephalosporins

A

Cephalexin (oral), Cefazolin (IV/IM)

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20
Q

2nd gen cephalosporins

A

Cefuroxime (IV/IM), Cefprozil (oral), Cefaclor (oral)

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21
Q

3rd gen cephalosporins

A

Ceftriaxone, Cefixime (oral), Ceftazidime, Cefotaxime

-all others are IV/IM

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22
Q

4th gen cephalosporins

A

Cefepime (IV)

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23
Q

“5th” gen cephalosporins

A

Ceftaroline (IV)

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24
Q

DOC for surgery prophylaxis

A

Cefazolin (IV/IM)

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25
Q

DOC for N. Gonnorhea

A

Ceftriaxone (IV/IM)

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26
Q

What advantage does cephalosporins have over penicillins?

A

They have a 7 methyl group that makes them more resistant to penicillinase

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27
Q

MOA of cephalosporins

A

ICWS, b-lactam

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28
Q

spectrum for 1st gen cephalosporins

A

good G+, relatively moderate G-, MSSA

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29
Q

spectrum for 2nd gen cephalosporins

A

lower G+, more G- (E.coli, Klebsiella, Proteus)

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30
Q

3rd gen cephalosporin for Pseudomoas

A

ceftazidime + aminnoglycoside

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31
Q

spectrum for 3rd gen cephalosporins

A

less G+, pseduomonas, enterobacteriaceae

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32
Q

contraindications for 3rd gen cephalosporins

A

neonates due to bilirubin displacement

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33
Q

spectrum for 4th gen cephalosporins

A

comparable to 3rd gen with more G+ coverage + MSSA

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34
Q

spectrum for 5th gen cephalosporins

A

G+ and G-, MRSA, VRSA, CABP

NO PSEUDOMONAS ACTIVITY

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35
Q

DOC for E. Coli, Proteus, Klebsiella

A

1st or 2nd gen cephalosporins

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36
Q

DOC for late stage Borrelia Burgdorferi

A

Ceftriaxone

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37
Q

Toxicity of cephalosporins

A 
superinfection
diarrhea
disulfram like reaction
allergy (10% cross reaction with pen allergy)
dose dependent renal tubular necrosis
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38
Q

MOA for Aztreonam

A

a b-lactam, ICWS, PBP, cidal

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39
Q

spectrum for aztreonam

A

G- only

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40
Q

route of administration for azetronam

A

parenteral

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41
Q

list carbapenems

A

imipenem (+ cilastatin), meropenem, ertapenem

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42
Q

route for imipenem and meropenem

A

IV

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43
Q

spectrum for impienem and meropenem

A

G+, G-, Anaerobes

BROAD SPECTRUM

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44
Q

toxicity of imipenem

A

can cause seizures, so patients with past history, impaired kidney function, CNS deficits should avoid

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45
Q

DOC for B-lactam producing enterobacter infection

A

imipenem or meropenem

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46
Q

spectrum for ertapenem

A

G+, G-, anaerobic, particular enterobacteriaceae

do not use for pseudomonas

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47
Q

route for ertapenem

A

IV or IM

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48
Q

MOA for vancomycin

A

cidal, ICWS, prevents transpeptidation of chain by binding to the D-alanine site

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49
Q

Resistance MOA for vancomycin

A

bacteria mutates d-ala to d-lactate so drug cannot bind

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50
Q

Adverse affects of vancomycin

A

ototoxicity
nephrotoxicity
red man syndrome (not a hypersensitivity)

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51
Q

route for vancomycin

A

ORAL

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52
Q

spectrum for vancomycin

A

G+, MRSA, G+ infections not responding to penicillin

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53
Q

DOC for C. Diff

A

Vancomycin

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54
Q

MOA of fosfomycin

A

inhibits cell wall synthesis at one of the first steps in the peptidoglycan pathway

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55
Q

spectrum of fosfomycin

A

G+ and G-

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56
Q

MOA of bacitracin

A

interferes with the final dephosphorylation step, NAG-NAM cannot get transported across the membrane

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57
Q

route for bacitracin

A

parenteral (rarely nephrotoxic) and topical

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58
Q

spectrum for bacitracin

59
Q

MOA for fluoroquinolones

A

bactericidal

Inhibits DNA gyrase and Topo IV

60
Q

Spectrum for fluoroquinolones

A

Mostly Gram - aerobes, some G+

Moxi and Gemi also cover anaerobes

61
Q

Ciprofloxacin

A

UTIs, systemic tx, anthrax prophylaxis, Pseudomonas

62
Q

Ofloxacin

A

Prostatitis, some systemic, some STDs (no syphilis), TB

63
Q

Levofloxacin

64
Q

Moxifloxacin

A

Anaerobes, Pen. resistant Strep pneumoniae

65
Q

Gatifloxacin

A

ocular application only

66
Q

Gemifloxacin

A

Anaerobes, Pen. resistant Strep pneumoniae, CAP

67
Q

route of administration for fluoroquinolones

68
Q

patient education on fluoroquinolones

A

must stop taking supplements during course of treatment

69
Q

adverse effects of fluoroquinolones

A 
GI disturbances
long QT interval
photosensitivity 
cartilage erosion
tendon rupture
70
Q

FQ contraindications

A

children under 18 and pregnant women

71
Q

MOA for metronidazole

A

prodrug, interacts with ferredoxin, metabolite up taken by bacterial cell, bactericidal

72
Q

spectrum of metronidazole

A

Anaerobes: G+ and G-

73
Q

indication for metronidazole use

A

bacterial vaginosis, endocarditis, C.diff, RTI, abdominal infections, h. pylori therapy

74
Q

route of administration for metronidazole

A

oral, IV, topical

75
Q

adverse reactions of metronidazole

A

disulfram like reaction, disgeusia (metallic taste)

76
Q

most common UTI pathogen

77
Q

second most common UTI pathogen

A

staph. saprophyticus

78
Q

most important property of UTI drugs

A

they are renally excreted

79
Q

MOA for Nitrofurantoin

A

bactericidal, damages bacterial DNA, a prodrug

80
Q

Resistance to Nitrofurantoin

A

Proteus and Pseudomonas organisms

81
Q

route of administration for nitrofurantoin

82
Q

Nitrofurantoin should not be used if creatinine clearance is less than what?

83
Q

toxicity of nitrofurantoin

A

pulmonary fibrosis in elderly, hepatocellular damage, hemolytic anemia

84
Q

contraindications for nitrofurantoin

A

pregnancy, < 1 month old, reduced renal function

85
Q

MOA for methenamine

A

prodrug, metabolizes into ammonia and formaldehyde, formaldehyde is what kills the bacteria

86
Q

spectrum for methenamine

A

nearly all bacteria are sensitive, but those that increase the pH of the urine inhibit the release of formaldehyde (Proteus species)

87
Q

contraindications for methenamine

A

hepatic insufficiency, too much ammonia build up

renal insufficiency, low urinary output

88
Q

30 s subunit

A

tetracyclines and aminoglycosides

89
Q

aminoglycosides: cidal or static?

90
Q

Name the 3 macrolides

A

Azithromycin, oral/IV
Clarithromycin, oral
Erythromycin, oral/IV

91
Q

MOA of macrolides

A

binds to the 50s subunit on the ribosome, bacteriostatic

92
Q

DOC for chlamydia

A

Azithromycin

**if pregnant must use erythromycin

93
Q

DOC for legionella species

A

Azithromycin

94
Q

DOC for mycoplasma pneumoniae

A

Erythromycin, also tetracycline would work

95
Q

Spectrum for macrolides

A

similar to PEN G, G+

most species resistant to erythromycin

96
Q

Forms of resistance against macrolides

A

METHYLATION, efflux pumps

97
Q

Toxicity of macrolides

A 
diarrhea and adverse GI effects: clarithro least, erythro most
long QT: azithro most, than erythro 
drug interactions (CYP3A4): clarithro and erythro most
98
Q

Name the only ketolide drug

A

Telithromycin

99
Q

MOA of telithromycin

A

binds to two places on the 50s subunit, bacteriostatic

100
Q

spectrum of telithromycin

A

respiratory pathogens, resistant strains of pneumonia, intracellular and atypical bacteria

101
Q

route of administration for telithromycin

102
Q

most common side effects of telithromycin

A

diarrhea, n/v, dizziness

103
Q

MOA of clindamycin

A

binds to the 50s subunit, bacteriostatic or cidal depending on concentration and organism susceptibility

104
Q

spectrum of clindamycin

A

broad
G+ aerobes
G+ and G- anaerobes

105
Q

toxicity of clindamycin

A

CDAD: c.diff associated diarrhea

crosses placenta readily and gets into breast milk, avoid while nursing

106
Q

use for clindamycin

A

osteomyelitis (good bone concentration)
TSS: use with vancomycin
streptococci and staphylococci extremely susceptible
toxoplasma encephalitis

107
Q

Name the streptogramins

A

Dalfopristin and quinupristin

108
Q

MOA of streptogramins

A

each static but together cidal
act on 50s subunit
dalfopristin acts in early phase while quinuprisitn acts in late phase

109
Q

route of administration of synercid

110
Q

spectrum of synercid

A

Gram + aerobes including:

penicillin resistant pneumonia, MDR strep, complicated skin infections due to staph, vanco resistant enterococcus

111
Q

major adverse reactions of synercid

A

inhibits p450 system, CYP3A4

112
Q

contraindications of synercid

A

breast feeding, children, hepatic disease, pregnancy

113
Q

MOA of linezolid

A

binds to 50s subunit, bacteriostatic (except strep)

reversible, non-selective inhibitor of MAO

114
Q

spectrum of linezolid

A

G+, reserve for MRD bacteria if possible

115
Q

route of administration of linezolid

A

IV or oral, oral is 100% bioavailable

116
Q

Adverse reactions of linezolid

A

diarrhea, headache, n/v
MAO side effects
insomnia, constipation, rash, dizziness, fever
superinfection can occur

117
Q

contraindications of linezolid

A

hypersensitivity, pheochromcytoma

118
Q

drug interactions of linezolid

A

b-blockers, general anesthetics, epi, SSRI, TCA, other antidepressants

119
Q

MOA of aminoglycocides

A

30s subunit, irreversible

Block initiation, translation, and incorporate the wrong amino acid

120
Q

spectrum of aminoglycosides

A

aerobic G- enteric bacteria

when sepsis or endocarditis is suspected

121
Q

use for streptomycin

A

tularemia, bubonic plague, TB, endocarditis

122
Q

DOC for tularemia

A

gentamycin

123
Q

DOC for pseudomonas aeruginosa

A

piperacillin or ticaracillin +

gentamycin/tobramycin/amikacin

124
Q

DOC for enterococcus and strep. agalactiae

A

PEN G + gentamycin

125
Q

toxicity of aminoglycosides

A

ototoxicity and nephrotoxicity

dependent on time and concentration

126
Q

route of administration for aminoglycosides

A

IV, oral, topical

127
Q

resistance of aminoglycosides

A

cross resistance: resistant to one, resistant to all

deficiency of ribosomal receptors, lack of permeability, enzyme modification

128
Q

MOA for chloramphenicol

A

bacteriostatic (mostly)
binds to 50s subunit
can also inhibit mito protein synthesis in mammalian cells

129
Q

spectrum for chloramphenicol

A

G+, G-, aerobes and anaerobes, atypicas

for life threatening situations

130
Q

route of administration for chloramphenicol

A

parental, 100% CNS penetration

131
Q

toxicity of chloramphenicol

A

reversible dose dependent bone marrow suppression
irreversible dose independent fatal aplastic anemia
gray baby syndrome, immature liver enzymes

132
Q

chloramphenicol resistance

A

acetyl transferase inactivates chloramphenicol
efflux pumps
binding site modification

133
Q

MOA for tetracycline

A

binds to 30s ribosome, bacteriostatic

134
Q

spectrum for tetracycline

A

broad spectrum

G+, G-, aerobes, anaerobes, atypicals

135
Q

organisms resistant to tetracyclines

A

b. fragilis, proteus, pseudomonas

136
Q

Name cases were tetracycline is DOC

A

Cholera, Mycoplasma Pneumonia, Chlamydia, Ricketssial, Lyme disease (early disease), vibrio species

137
Q

tetracycline resistance

A

efflux pumps

if tetracycline resistant, may still use doxy or minocycline

138
Q

route of administration for tetracycline

139
Q

adverse reactions of tetracyclines

A

normal flora changes, bone and teeth (chelators), photosensitivity

140
Q

contraindications for tetracyclines

A

pregnant women or children under 8 years old

141
Q

route of administration tigecycline

A

IV

life threatening situations

142
Q

spectrum of tigecycline

A

same as tetracyclines, but also on tetracycline resistant bacteria, MRSA, MRSE, PRSP, VRE

143
Q

MOA of penicillins

A

inhibitor of cell wall synthesis, PBP, bactericidal

144
Q

method of resistance for penicillins

A

b-lactamases

Pharmacology (7 decks)

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