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Fiser Absite > Fiser Absite. Ch 06-07. Antibiotics. Medicines And Pharmacology > Flashcards

Fiser Absite. Ch 06-07. Antibiotics. Medicines And Pharmacology Flashcards

1
Q

What is the difference between an antiseptic and a disinfectant?

A

antiseptic kills and inhibits organisms on body. disinfectant kills and inhibits organisms on inanimate objects

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2
Q

What is the difference in coverage for iodophors like Betadine and Clorhexidine?

A

Both cover GPCs, GNRs but Chlorhexidine is better for fungi

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3
Q

What is the mechanism of action for penicillins, cephalosporins, carbapenems, monobactams and vancomycin?

A

inhbition of cell wall synthesis

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4
Q

What is the mechanism of action of tetracycline, aminoglycosides and linezolid?

A

inhibitors of the 30s ribosome and protein synthesis

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5
Q

What is the mechanism of action of erythromycin, clindamycin, chloramphenicol, Synercid?

A

inhibitors of the 50s ribosome and protein synthesis

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6
Q

What is the mechanism of quinolones?

A

inhibitor of DNA helicase (DNA gyrase)

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7
Q

What is the mechanism of rifampin?

A

inhibitor of RNA polymerase

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8
Q

What is the mechanism of metronidazole?

A

Produces oxygen radicals that breakup DNA

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9
Q

Whast is the mechanism of sulfonamides?

A

PABA analogue, inhibit purine synthesis

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10
Q

What is the mechanism of trimethoprim?

A

inhibits dihydrofolate reductase, inhibits purine synthesis

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11
Q

____ have irreversible binding to ribosome and are considered bactericidal

A

aminoglycosides

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12
Q

What is the most common method of antibiotic resistance?

A

transfer of plasmids

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13
Q

How is the mechanism of resistance to methiclllin or vancomycin developed?

A

mutation in cell wall binding protein

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14
Q

How is the mechanism of resistance to gentamicin developed?

A

resistance due to modifying enzymes leading to decrease in active transport

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15
Q

What do you do if abx peak is too high?

A

decrease amount of each dose

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16
Q

trough too high?

A

decrease frequency

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17
Q

Which antibiotic’s coverage can be described as: Not effective against Staphylococcus or Enterococcus. But effective against GPCs, streptococci, syphilis, Neisseria meningitides (GPR), Clostridium perfringens (GPR), beta-hemolytic Streptococcus, anthrax

A

Penicillin

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18
Q

Anti-staph penicillins

A

Oxacillin/nafcillin

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19
Q

Same coverage as penicillin but also picks up enterococci

A

Ampicillin/amoxicillin

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20
Q

Name the two abx that are broad-spectrum - pick up GPCs (staph and strep), GNRs, +/- anaerobic coverage. Effective for enterococci but not effective for pseudomonas, acinetobacter or serratia.

A

Unasyn (ampicillin/sulbactam) and Augmentin (amoxicillin/clavulanic acid)

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21
Q

Name the two antipseudomonal abx that are broad spectrum – pick up GPCs (staph and strep), GNRs, anaerobes. Effective for enterococci; effective for Pseudomonas, Acinetobacter, and Serratia.

A

Timentin (ticarcillin/clavulanic acid) and Zosyn (piperacillin/sulbactam)

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22
Q

What are the side effects of ticarcillin/piperacillin?

A

inhibit platelets; high salt load

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23
Q

Name two first generation cephalosporins

A

Ancef (cefazolin), Keflex (cephalexin)

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24
Q

What does the first generation cephalosporins cover?

A

GPCs staph and strep

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25
Q

limitations of ancef / keflex

A

Not effective for enterococcus; does not penetrate CNS

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26
Q

Which first generation cephalosporin is best for phrophylaxis?

A

cefazolin (Ancef) has the longest half-life

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27
Q

What are the side effects of the first generation cephalosporins?

A

can produce positive coombs test

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28
Q

Name three 2nd-generation cephalosporins

A

cefoxitin, cefotetan, cefuroxime

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29
Q

Main side effect of 2nd-generation cephalosporins.

A

Prolonged PT

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30
Q

Third generation cephalosporins cover ___ mostly, +/- anaerobic coverage.

A

GNRs

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31
Q

What major side effect of ceftriaxone?

A

cholestatic jaundice, sludging in the gallbladder

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32
Q

Monobactam (aztreonam) covers GNRs and picks up what 3 others?

A

Pseudomonas, Acinetobacter, Serratia

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33
Q

Carbapenems (meropenem/imipenem) are broad spectrum covering GPCs, GNRs and anaerobes. Not effective for what 3 (with mnemonic)?

A

MEPP: MRSA, Enterococcus, Proteus, Pseudomonas

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34
Q

What can be added to carbapenems to prevent renal hydrolysis of the drug and increase half-life.

A

cilastin

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35
Q

What is the major side effect of carbapenems?

A

can cause seizures

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36
Q

What is the coverage of Bactrim?

A

GNRs, +/- GPCs. Not effective Enteroccoccus, Pseudomonas, Acinetobacter, and Serratia

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37
Q

Bactrim side effects?

A

teratogenic, allergic reactions, renal damage, Steven-Johnson syndrome (erythema multiforme, hemolysis in G6PD-deficient patients

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38
Q

What is the coverage of quinolones?

A

GPCs, mostly GNRs. Not effective for Enterococcus; picks up Pseudomonas, Acinetobacter and Serratia. 40% of MRSA sensitive

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39
Q

What is the coverage of aminoglycosides?

A

GNRs. Good for pseudomonas, Acinetobacter and Serratia. Not effective for anerobes (need O2).

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40
Q

Aminoglycosides are synergistic with ___ for Enterococcus

A

ampicillin

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41
Q

What is the coverage for macrolides?

A

GPCs; best for CAP and atypical pneumonias

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42
Q

The main side effects of macrolides are ___ (PO) and ___ (IV). Also binds ___ receptor.

A

nausea, cholestasis, motilin receptor (prokinetic for bowel)

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43
Q

Name side effects of vancomycin

A

HTN, redman syndrome (histamine release), nephrotoxicity, ototoxicity

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44
Q

Main side effect of tetracycline?

A

tooth discoloration in children

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45
Q

Coverage of clindamycin

A

anaerobes, some GPCs, good for aspiration pneumonia. Can be used to treat C. perfringens

46
Q

Main side effect of clindamycin?

A

pseudomembranous colitis

47
Q

Metronidazole covers ____

A

anaerobes

48
Q

2 main side effects of metronidazole

A

disulfiram-like reaction, peripheral neuropathy

49
Q

Prolonged broad-spectrum antibiotics +/- fever -> add ____

A

fluconazole

50
Q

Possible fungal sepsis -> add ___

A

amphotericin

51
Q

2 side effects of Isoniazid?

A

hepatotoxicity, B6 deficiency

52
Q

2 side effects of Rifampin?

A

hepatotoxicity, GI sx

53
Q

Side effect of Pyrazinamide?

A

hepatotoxicity

54
Q

Side effect of Ethambutol?

A

retrobulbar neuritis

55
Q

Name 4 TB drugs?

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

56
Q

Inhibits DNA polymerase, usually used for HV infections; can be used for EBV.

A

Acyclovir

57
Q

Used for CMV infections. Side effects decreased bone marrow, CNS toxicity.

A

Ganciclovir

58
Q

Name 4 drugs effective for enterococcus.

A

vancomycin, Timentin/Zosyn, ampicillin/amoxicillin, or gentamicin with ampicillin.

59
Q

Name drugs effective for Pseudomonas, Acinetobacter and Serratia

A

ticarcillin/piperacillin, Timentin/Zosyn, third-generation cephalosporins, aminoglycosides, meropenam/imipenam (resistance can develope in Pseudomonas), or fluoroquinolones

60
Q

Significance of sublingual and rectal drugs?

A

do not pass through liver first

61
Q

skin absorption based on ____ through the epidermis

A

lipid-solubility

62
Q

CSF absorption is restricted to ____, ____ drugs

A

nonionized, lipid-soluble

63
Q

Albumin - largely responsible for binding drugs (____ and ____ 90% bound)

A

PCN, warfarin

64
Q

____ will displace unconjugated bilirubin in newborns

A

sulfonamides

65
Q

___ and heavy metals stored in bone

A

tetracycline

66
Q

In what type of kinetics constant amount of drug is eliminated regardless of dose?

A

0 order kinetics

67
Q

In what type of kinetics is drug eliminated proportional to dose?

A

1st order kinetics

68
Q

How many half-lives for a drug to reach steady state?

A

5

69
Q

Amount of drug in the body divided by amount of drug in plasma or blood

A

Volume of distrobution

70
Q

Drugs with a high volume of distrobution have higher concentrations in the ___ compartment compared with the ___ compartment.

A

extravascular (ie fat tissue), intravascular

71
Q

Fraction of unchanged drugs reaching the systemic circulation. Assumed to be 100% for IV drugs, less for other routes.

A

bioavailability

72
Q

Drug level at which desired effect occurs in 50% of pts.

A

ED50

73
Q

Drug level at which death occurs in 50% of pts.

A

LD50

74
Q

Tachyphylaxis

A

tolerance after only a few doses

75
Q

Dose required for effect.

A

Potency

76
Q

Ability to achieve result without untoward effect

A

efficacy

77
Q

Microsomal drug metabolism takes place in ____

A

hepatic cell endoplasmic reticulum, P-450 system

78
Q

Which phase of microsomal drug metabolism has demethylation, oxidation, reduction, hydrolysis reactions (mixed function oxidases, requires NADPH/oxygen)

A

Phase I

79
Q

Which phase of microsomal drug metabolism has glucuronic acid and sulfates attache (forms water-soluble metabolite); often inactive and ready for excretion.

A

Phase II

80
Q

P-450 Inducers with mnemonic

A

Queen Barb Steals Phen-phen and Refuses Greasy Carbs Chronically; Qunidine, Barbituates, St. John’s wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic etoh

81
Q

P-450 inhibitors with mnemonic

A

SIC KEG A Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erthyromycin, Grapefruit juice, Acute etoh

82
Q

P-450 system transforms aromatic hydrocarbons into ___

A

carcinogens

83
Q

What is the most important organ for eliminating most drugs?

A

kidney (glomerular filtration and tubular secretion)

84
Q

What type of druges are more water soluble and more likely to be eliminated in unaltered form.

A

Polar drugs (ionized)

85
Q

What type of drugs are more fat soluble and more likely to metabolized before excretion?

A

Nonpolar drugs (nonionized)

86
Q

Gout is caused by uric acid buildup; end product of ___ metabolism

A

purine

87
Q

Used in the tx of gout, anti-inflammatory; binds tubulin and inhibits migration.

A

Colchicine

88
Q

Used in the tx of gout, anti-inflammatory.

A

Inomethacin

89
Q

Used in the tx of gout, xanthine oxidase inhibitor, blocks uric acid formation from xanthine.

A

Allopruinol

90
Q

Used in the tx of gout, increases renal secretion of uric acid.

A

Probenecid

91
Q

Lipid lowering agent that can bind vitamin K and cause bleeding tendancy.

A

cholestyramine (Questran)

92
Q

What antiemetic causes tardive dyskinesia (inhibits dopamine receptors)? what is the tx?

A

Promethazine (Phenergan), diphenhydramine (Benadryl)

93
Q

Prokinetic drug that is a dopamine receptor blocker that can be used to increase gastric motility and gut motility in general.

A

Metoclopramide (Reglan)

94
Q

Antiemetic; serotonin receptor inhibitor.

A

Ondansetron (Zofran)

95
Q

Somatostatin analog used to treat acromegaly and diarrhea associated with carcinoid syndrome and VIPomas.

A

Octreotide

96
Q

Digoxin MOA?

A

inhibits Na/K ATPas and increases myocardial calcium

97
Q

Digoxin major side effect

A

decreased blood flow to intestine has been implicated in mesenteric ischemia

98
Q

What does hypokalemia do to Digoxin?

A

increased sensitivity of heart, can precipitate arrhythmia or AV block

99
Q

Is digoxin cleared with dialysis?

A

no

100
Q

3 major side effects of Procainamide

A

lupus-like syndrome, pulmonary fibrosis, torsades

101
Q

treatment for Torsades?

A

Magnesium

102
Q

QT interval that is concerning with Procainamide

A

> 400

103
Q

Medication that causes transient interruption of the AV node?

A

adenosine

104
Q

Best single agent shown to reduce mortality in pts with CHF. Can also prevent CHF post-MI.

A

ACEi (captopril)

105
Q

MOA of atropine

A

acetylcholine antagonist

106
Q

Name 2 drugs used to inhibit adrenal steroid synthesis. Used in patients with adrenocortical CA.

A

Metyrapone and aminoglutethimide

107
Q

Analogue of GnRH and LHRH. Inhibits release of LH and FSH from pituitary when given continuously (paradoxic effect)

A

Leuprolide

108
Q

Can be used in pts with GI bleeding by reducing intestinal blood flow.

A

Vasopressin (ADH)

109
Q

Used in gout and to close PDA

A

indomethacin (inhibits prostaglandin production)

110
Q

PGE1 derivative; a protective prostaglandin used to prevent peptic ulcer disease. Consider use in pts on chronic NSAIDs

A

Misoprostol

111
Q

What is the 1st and 2nd acid/base disturbances seen in ASA poisoning.

A

1st respiratory alkalosis; 2nd metabolic acidosis

112
Q

Side effect of Gadolinium?

A

nausea

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