ID I: TIGECYLCINE, POLYMYXINS, CHLORAMPHENICOL

Question 1

Tigecycline is a glycycline. It binds to 30S ribosomal subunit inhibiting protein synthesis; structurally it is related to:

Answer 1

tetracyclines

Question 2

Tigecycline coverage

Answer 2

BROAD SPECTRUM:

gram positive - MRSA, VRE

gram negative - not the 3 Ps

anaerobes

atypicals

Question 3

Among the gram negative, tigecycline is not active against

Answer 3

Pseudomonas, Proteus, Providencia

Question 4

Tigecycline is approved for treating:

Answer 4

complicated SSTI

intra-abdominal infections

CAP - limited though

Question 5

Brand: Tygacil

Answer 5

Generic: tigecycline

Question 6

Tigecycline is a derivative of

Answer 6

minocycline

Question 7

Tigecycline has a boxed warning for

Answer 7

DEATH!!!

Question 8

What infections should you not use tigecycline in?

Answer 8

bloodstream infections

due to lipophillicity - it will go into the tissues

Question 9

Tigecycline reconstituted solution must be what color

Answer 9

yellow-orange, throw out if not

“tigger” = yellow & orange

Question 10

What drugs are in the polymyxin class?

Answer 10

colistemethate sodium (Coly-Mycin M)– “colistin”

Polymyxin B Sulfate

Question 11

polymyxin coverage

Answer 11

gram negative - enterobacter spp, e coli, klebsiella pneumoniae, pseudomonas (NO PROTEUS)

Question 12

due to toxicity, polymyxin coverage is limited to primarily used for

Answer 12

MDR gram negative pathogens in combo with other drugs

Question 13

for colistin, solutions for inhalation must be:

Answer 13

mixed immediately prior to administration

Question 14

What are the warnings for colistin?

Answer 14

dose-dependent nephrotoxicity & neurotoxicity

Question 15

Colistmethate sodium is a prodrug that is converted to

Answer 15

colistin

Question 16

What are the BOXED warnings for polymyxin B?

Answer 16

nephrotoxicity

neurotoxicity == respiratory paralysis from neuromuscular blockade

Question 17

Chloraphenicol REVERSIBLY binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis. It covers:

Answer 17

gram positives

gram negatives

anaerobes

atypical

Question 18

Which drug has a gray syndrome warning?

Answer 18

chloramphenicol – with high serum levels, circulatory collapse, cyanosis, acidosis, abdominal distention, coma, death

Question 19

This abx has a boxed warning for serious and Fata blood dycrasias (aplastic anemia)

Answer 19

chloramphenicol

could be irreversible