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CLIN PHARM > III - Antibacterial Agents > Flashcards

III - Antibacterial Agents Flashcards

1
Q

What are the four classes of antibacterial agents based on mechanism of action?

A
  1. Cell wall synthesis inhibitors
  2. Protein synthesis inhibitors
  3. Antimetabolites
  4. Nucleic acid synthesis inhibitors
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2
Q

List the cell wall synthesis inhibitors (4 broad categories)

A

Penicillins
Cephalosporins
Other beta lactams
Glycopeptides

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3
Q

What are the five families of penicillins?

A
  1. Natural penicillins
  2. Aminopenicillins
  3. Anti-staph penicillins
  4. Anti-pseudomonal penicillins
  5. Beta lactamase inhibitor combinations
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4
Q

2 natural penicillins

A

Penicillin V
Penicillin G

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5
Q

2 aminopenicillins

A

Amoxicillin
Ampicillin

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6
Q

4 anti-staph penicillins

A

Methicillin
Cloxacillin
Dicloxacillin
Oxacillin

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7
Q

3 anti-pseudomonal penicillins

A

Ticarcillin
Piperacillin
Carbenicillin

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8
Q

1 beta lactamase inhibitor combination

A

Amoxicillin clavulanate

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9
Q

How are cephalosporins categorized?

A

1st, 2nd, 3rd generation

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10
Q

List 4 1st generation cephalosporin drugs

A

Cefadroxil
Cephalothin
Cephalexin
Cefazolin

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11
Q

List two second generation cephalosporin drugs

A

Cefaclor
Cefoxitin

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12
Q

List four 3rd generation cephalosporins

A

Ceftiofur
Cefpodoxime
Cefovecin
Ceftriaxone

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13
Q

Name one beta lactam

A

Imipenem-cilastatin

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14
Q

One example of a glycopeptide

A

vancomycin

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15
Q

Five categories of protein synthesis inhibitors

A
  1. Tetracyclines
  2. Aminoglycosides
  3. Amphenicols
  4. Macrolides
  5. Lincosamides
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16
Q

Name three tetracyclines

A

Tetracycline
Oxytetracycline
Doxycycline

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17
Q

Name four aminoglycosides

A

Gentamicin
Amikacin
Tobramycin (ophthalmic)
Neomycin (topical)

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18
Q

Name three amphenicols

A

Chloramphenicol
Florfenicol
Thiamphenicol

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19
Q

Name five macrolides

A

Erythromycin
Tilmicosin
Azithromycin
Tylosin
Tulathromycin

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20
Q

Name two Lincosamides

A

Lincomycin
Clindamycin

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21
Q

Three categories of Antimetabolites (inhibitors of intermediate metabolism)

A
  1. Sulfonamides
  2. Folate reduction inhibitors
  3. Potentiates sulfonamides
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22
Q

Name two sulfonamides

A

Sulfadiazine
Sulfasalazine

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23
Q

Name three folate reduction inhibitors

A

Trimethoprim
Ormetoprim
Pyrimethamine

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24
Q

Name two Potentiates sulfonamides

A

Trimethoprim-sulfa
Ormetoprim-sulfadimethoxine

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25
Q

List the Nucleic Acid Synthesis Inhibitors

A
  1. Fluoroquinolones
  2. Rifampin
  3. Metronidazole
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26
Q

Name seven Fluoroquinolones

A

Enroflaxin
Orbifloxacin
Difloxacin
Barbofloxacin
Danofloxacin
Ciprofloxacin
Pradofloxacin

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27
Q

All beta lactams are considered _____.

A

Bactericidal

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28
Q

Beta lactams bind the ________ enzymes.

A

Bacterial transpeptidase
Aka penicillin binding proteins

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29
Q

This drug binds precursors of peptidoglycans interfering with bacterial cell wall synthesis.

A

Vancomycin

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30
Q

Beta lactams - what are the two most important mechanisms of resistance to penicillins?

A
  1. Enzymatic destruction by beta-lactamases produced by bacteria (cephalosporin lactam ring is more resistant)
  2. Altered target (altered penicillin binding protein)
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31
Q

________ and _________ are NOT effective against Pseudomonas and Styaphylococcus.

A

Natural penicillins - penicillin V and G
Amino penicillins - amoxicillin, ampicillin

(Susceptible to beta lactamase)

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32
Q

Spectrum of Activity: Penicillins
Gram + aerobic

A

Natural P
Aminopenicillins
Antipseudomonal

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33
Q

Spectrum of Activity: Penicillins
Gram - aerobic

A

Natural P (limited)
Aminopenicillins (better than NP)
Antipseudomonal

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34
Q

Spectrum of Activity: Penicillins
Gram + anaerobic

A

Natural P
Aminopenicillins (slightly less than NP)
Antipseudomonal

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35
Q

Spectrum of Activity: Penicillins
Gram - anaerobic

A

Natural P (limited effect)
Aminopenicillins (slightly less than NP)
Antipseudomonal

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36
Q

Spectrum of activity: cephalosporins
Gram + aerobic

A

1G - cefadroxil, cephalothin, cephalexin, cefazolin
2G (weak) - cefactor, cefotoxin, cefotetan
3G - ceftiofur, cefpodoxime, cefovecin, ceftazidime, cefotaxime extended gram negative (Antipseudomonal)

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37
Q

Spectrum of Activity: Cephalosporins
Gram -

A

1G - (fair)
2G - greater than 1G
3G - slightly increased resistance to beta lactamases
3G - Antipseudomonal

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38
Q

Spectrum of activity: cephalosporins
Gram + and - anaerobes

A

2nd generation - just these two
Cefoxitin
Cefotetan

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39
Q

Spectrum of activity: other beta lactams
Aerobic, gram +/-

A

Imipenem
Vancomycin

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40
Q

Spectrum of activity: other beta lactams
Anaerobic gram +/-

A

Imipenem

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41
Q

These two drugs are often reserved for very resistant organisms in human patients, so veterinary use should be limited.

A

Vancomycin
Imipenem

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42
Q

Imipenem-cilastatin-bactericidal
?????
Slide 15/77

A
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43
Q

Beta lactams, in general, are very safe, but the most common adverse reaction is ____________.

A

Hypersensitivity - which can be life threatening

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44
Q

Some of the cephalosporins have been associated with _________ (very rare).

A

Renal failure

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45
Q

Any antibiotic can potentially alter ________, resulting in ____.

A

Normal flora of the GI tract
Resulting in diarrhea

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46
Q

Any drug can potentially irritate the ___, causing ___.

A

Stomach and small intestine
Vomiting / inappetence

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47
Q

Procaine penicillin G can cause a _______ reaction for up to _____ after injection.

A

Positive procaine test
Two weeks

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48
Q

The glycopeptide vancomycin is only available in ____ form.

A

Injectable / IV

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49
Q

Rapid IV administration of Vancomycin causes ______.

A

A hypersensitivity type reaction (histamine release)

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50
Q

Vancomycin has occasionally been associated with what four types of toxicity?

A

Renal toxicity
Ototoxicity
Reversible thrombocytopenia and neutropenia

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51
Q

Is vancomycin approved for use in food animals?

A

NO - it is prohibited.

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52
Q

Sodium and potassium salts of penicillin are commonly used in ____ but have to be administered ___ /day.

A

Foals
4x/day

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53
Q

Procaine penicillin G is commonly used in:

A

Horses and cattle

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54
Q

Indications for benzathine penicillin G

A

Shipping fever complex:
Strep, Staph aureus, Arcanobacterium pyogenes

Blackleg:
Clostridium chauvoei

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55
Q

Anti Staph penicillins are commonly used to treat:

A

Mastitis in dairy cattle

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56
Q

How are antipseudomonal penicillins used?

A

Ticarcillin IV to treat serious gram - infections in dogs

Intrauterine in mares

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57
Q

Amino-penicillins are used to treat:

A

Horses (IV ONLY)
Cattle (intramammary amoxicillin)
Dogs
Cats

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58
Q

The most commonly used first generation cephalosporins (2)

A

Cefadroxil
Cephalexin

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59
Q

Oral bioavailability in horses for these two cephalosporin drugs is very low.

A

Cefadroxil and cephalexin - first generation

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60
Q

This first generation cephalosporin is formulated for dairy cattle.

A

Cephapirin

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61
Q

This first generation cephalosporin is used in dogs, cats, and horses, especially with orthopedic surgeries.

A

Cefazolin - penetrates bone; used prophylactically

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62
Q

These two second generation cephalosporins are used for abdominal surgical prophylaxis in dogs and cats.

A

Cefoxitin
Cefotetan

Because of their activity against gram- and some anaerobic organisms.

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63
Q

Ceftiofur, a third generation cephalosporin is labeled for treating:

A

UTI in cats and dogs (SQ)

Respiratory infections in horses, cattle, and pigs

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64
Q

Cefovecin (Convenia) is a ___ generation cephalosporin used to treat:

A

3rd

Skin infections in dogs and cats
One-time injectable

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65
Q

This 3rd generation cephalosporin is administered daily to treat skin infections in dogs.

A

Cefpodoxime

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66
Q

These 3rd generation cephalosporins are not labeled for use in veterinary medicine but are occasionally used in dogs, cats, and foals for severe, resistant infections.

A

Carbapenems

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67
Q

Vancomycin is not labeled for use in veterinary medicine, and is illegal to use in food animals, but is occasionally used for:

A

Resistant Staphylococcal (MRSA) and/or Enterococcus infections in dogs, cats, and horses.

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68
Q

What are the five categories of protein synthesis inhibitors?

A

Tetracyclines
Aminoglycosides
Amphenicols
Macrolides
Lincosamides

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69
Q

Which protein synthesis inhibitors are bacteriostatic?

A

Tetracyclines
Amphenicols
Macrolides
Lincosamides

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70
Q

Which protein synthesis inhibitors are bacteriocidal?

A

Aminoglycosides

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71
Q

Name three tetracyclines

A

Tetracycline
Oxytetracycline
Doxycycline

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72
Q

Name four aminoglycosides.

A

Gentamicin
Amikacin
Tobramycin (ophthalmic)
Neomycin (topical)

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73
Q

Name three amphenicols

A

chloramphenicol
Florfenicol
Thiamphenicol

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74
Q

Name five macrolides

A

Erythromycin
Tilmicosin
Azithromycin
Tylosin
Tulathromycin

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75
Q

Name two Lincosamides

A

Lincomycin
Clindamycin

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76
Q

Resistance to Lincosamides, macrolides, and amphenicols

A

Inactivation/degradation by bacterial enzymes

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77
Q

Resistance to tetracyclines

A

EFFLEX PUMP that transports the drug out of the bacterial cell; drug fails to reach its target; plasma encoded

Resistance to one tetracycline produces cross resistance to others.

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78
Q

Resistance to aminoglycosides

A

Inactivation/degradation by bacterial enzymes
Failure to reach target because of decreased porin size occurs in some gram - organisms.

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79
Q

These protein synthesis inhibitors are active against rickettsiaceae, mycoplasma anaplasmataceae, and chlamydia

A

Tetracyclines and amphenicols

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80
Q

Staph, Pseudomonas and E. Coli should be considered resistant to which protein synthesis inhibitors until proven otherwise?

A

Tetracyclines

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81
Q

GI side effects of protein synthesis inhibitor tetracycline

A

Anorexia
Vomiting
Diarrhea

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82
Q

In horses, IV administration of this tetracycline can be fatal.

A

Doxycycline

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83
Q

Permanent brown discoloration of teeth can occur if this protein synthesis inhibitor is administered during tooth development.

A

Tetracyclines

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84
Q

Rapid IV administration of _____ in many species has resulted in collapse possibly due to calcium chelation.

A

Tetracyclines

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85
Q

In addition to GI side effects, tetracycline can cause these four issues.

A

Drug-induced fever
Renal toxicity
Hepatotoxicity
Allergic reactions

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86
Q

Cats are particularly prone to _______ caused by tetracyclines. Any dose should be followed by water.

A

Esophageal lesions (fibrosis and stricture)

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87
Q

Aminoglycosides have three main adverse effects:

A

Nephrotoxicity
Ototoxicity
Neuromuscular blockade

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88
Q

_____ concentrations are 50X greater in renal tissue than in plasma.

A

Aminoglycoside

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89
Q

Three ways to decrease nephrotoxicity with aminoglycosides.

A
  1. Use least toxic - Amikacin
  2. Do not use in hypovolemic patients
  3. Avoid concurrent use of other nephrotoxic drugs (furosemide, NSAIDs)
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90
Q

Aminoglycoside Ototoxicity is ____.

A

irreversible

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91
Q

Aminoglycoside Ototoxicity can occur with ____ administration.

A

Topical or systemic

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92
Q

Optic administration of aminoglycosides should be avoided in patients with __.

A

A ruptured tympanic membrane

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93
Q

Auditory toxicity with aminoglycosides is more common in ___ and vestibular toxicity is more common in ___.

A

Auditory - dogs
Vestibular - cats

94
Q

Aminoglycoside toxicity induced neuromuscular blockade is __.

A

Reversible

95
Q

Aminoglycosides can cause ___ in humans.

A

Irreversible aplastic anemia

96
Q

Aminoglycosides can cause reversible ___ in dogs and cats.

A

Bone marrow suppression

97
Q

Chloramphenicol inhibits ____ so can be involved in drug interactions.

A

CYP450 enzymes

98
Q

____ was developed for use in food animals and has advantages over chloramphenicol.

A

Florfenicol

99
Q

Name two advantages of florfenicol over chloramphenicol.

A

Florfenicol is not associated with aplastic anemia in people, so is not prohibited in food animals.

Florfenicol does not inhibit CYP450 enzymes

100
Q

Which aminoglycoside can cause severe diarrhea in horses?

A

Florfenicol

101
Q

This macrolide frequently causes GI upset and vomiting thought to result from its interaction with the motilin receptor which stimulates GI motility.

A

Erythromycin

Newer macrolides do not have this effect

102
Q

Macrolides can cause __ in adult horses and __ in foals.

A

Severe colitis in adult horses
Hyperthermia in foals

103
Q

This macrolide can cause severe cardiovascular toxicity at high doses in cattle, and even at low doses can be fatal in swine, horses, goats, and people.

A

Tilmicosin

Other macrolides do not share this adverse effect

104
Q

Does Micotil 300, an injectable Tilmicosin drug, have an antidote?

A

No

105
Q

In horses, ___ are generally not used because they can cause an overgrowth of Clostridium difficile resulting in severe pseudomembranous colitis.

A

Lincosamides

106
Q

The most commonly used tetracycline in large animal veterinary medicine is ___.

A

Oxytetracycline

107
Q

Oxytetracycline has been used for treating bovine ____, ___, and ____.

A

Bovine respiratory diseases
Mastitis
Anaplasmosis

108
Q

Intrauterine infusion of ____ is used for cows with retained fetal membranes (off label).

A

Oxytetracycline

109
Q

In horses, oxytetracycline has been used to treat ____.

A

Neorickettsia risticii (Potomac Horse Fever)

110
Q

What is the most commonly used tetracycline in small animal veterinary medicine?

A

Doxycycline

111
Q

Is doxycycline a good choice for UTIs?

A

No - unlike other tetracyclines, doxycycline does not achieve high concentrations in urine

112
Q

Doxycycline is ____ and penetrates tissues well.

A

Lipophilic

113
Q

This protein synthesis inhibitor is considered the drug of choice for treating intracellular pathogens such as Ehrlichiosis, Rickettsia, and Mycoplasma.

A

Doxycycline

114
Q

Doxycycline is considered the drug of choice for treating intracellular pathogens such as ___, ___, and ____.

A

Ehrlichiosis
Rickettsia
Mycoplasma

115
Q

What are the three most commonly used aminoglycosides in veterinary medicine?

A

Gentamicin
Amikacin
Neomycin

116
Q

Three differences between the aminoglycosides gentamicin and Amikacin.

A
  1. Amikacin is less susceptible to bacterial inactivation than gentamicin.
  2. Amikacin is potentially less likely to produce nephrotoxicity.
  3. Amikacin is more expensive than gentamicin.
117
Q

Which aminoglycoside (protein synthesis inhibitor) is frequently used systemically in horses?

A

Gentamicin

118
Q

Which aminoglycoside (protein synthesis inhibitor) is used in foals, dogs, and cats.

A

Amikacin

119
Q

Which aminoglycoside (protein synthesis inhibitor) is used as an intrauterine infusion for horses?

A

Amikacin

120
Q

Which aminoglycoside (protein synthesis inhibitor) is used for regional limb perfusion to treat lower limb bone and joint infections?

A

Gentamicin

121
Q

Which protein synthesis inhibitors are lipid soluble?

A

Amphenicols

122
Q

The amphenicols (protein synthesis inhibitors) are lipid soluble and therefore achieve high concentrations within ___ and can gain access to tissues such as ___.

A

Cells
CNS, prostate

123
Q

Chloramphenicol is used in small animals primarily for ___, some ___, and ___.

A

CNS infections
Some rickettsiae
Mycoplasma

124
Q

This protein synthesis inhibitor is sometimes used in horses (has reasonable oral bioavailability and does not cause serious adverse effects on the GI flora) but is ILLEGAL for use in food animals.

A

Chloramphenicol

125
Q

____ is approved for use as an injectable (IM or SQ) for treating bovine respiratory disease and bovine interdigital phlegmon (foot rot).

A

Florfenicol

126
Q

Florfenicol (protein synthesis inhibitor) is approved for use as an injectable (IM, SQ) for treating bovine ___ and bovine ___.

A

Bovine respiratory disease
Bovine interdigital phlegmon (foot rot)

127
Q

These macrolides (protein synthesis inhibitors) are the three most commonly used in small animals and horses.

A

Erythromycin
Azithromycin
Clarithromycin

128
Q

Because of its long tissue half-life in the respiratory tract, this protein synthesis inhibitor has an unusual dosing recommendation - once every three days or once a day for three days then stop.

A

Azithromycin (a macrolide)

129
Q

Macrolides (protein synthesis inhibitors), particularly ____, are lipid soluble, and are therefore useful against susceptible ___.

A

Azithromycin
Intracellular bacteria

130
Q

In horses, both ___ and ____ are effective for treating Rhodococcus equi infections.

A

Clarithromycin
Azithromycin

131
Q

Which two macrolides are used in dogs and cats to treat a variety of respiratory infections?

A

Clarithromycin
Azithromycin

Also effective for treating Rhodococcus equi infections in horses

132
Q

Macrolides are ____ inhibitors.

A

Protein synthesis

133
Q

____ are approved for use as an injectable (IM/SQ) for treating bovine respiratory disease and bovine interdigital phlegmon (foot rot).

A

Macrolides (protein synthesis inhibitors)
- Gamithromycin
- Tulathromycin
- Tilmicosin

134
Q

This macrolide may have direct or indirect immunologic properties and may reduce antigenic stimulation in treating dogs with IBD.

A

Tylosin
(Macrolide / Protein Synthesis Inhibitor)

135
Q

T/F

Considering the role of altered antigens in chronic IBD, favorable experiences, minimal adverse effects, and low cost of the drug, Tylosin remains an option for treatment of canine IBD.

A

True

136
Q

This drug is by far the most commonly used lincosamide (protein synthesis inhibitor).

A

Clindamycin

137
Q

In small animals clindamycin is used to treat these four conditions.

A

Wounds
Abscesses
Periodontal disease
Osteomyelitis

138
Q

Lincosamides are ___ inhibitors.

A

Protein synthesis

139
Q

What are the two categories of Antimetabolites (inhibitors of intermediate metabolism)?

A

PABA analogs
Folate reduction inhibitors

140
Q

Name three PABA analogs (Antimetabolites)

A

Sulfadimetoxine
Sulfadiazine
Sulfametoxazole

141
Q

Name two folate reduction inhibitors (Antimetabolites).

A

Ormetoprim
Trimethoprim

142
Q

The combination of a sulfonamide with a folate reduction inhibitor is ___.

A

Synergistic and bacteriocidal

143
Q

There are numerous mechanisms of resistance to the Antimetabolites; the most important plasmid-mediated form of resistance is ___, which has limited the clinical utility of these drugs in many clinical situations.

A

Impaired penetration

144
Q

Are Antimetabolites useful in treating anaerobes?

A

NO

145
Q

Potentiated _____ are NOT good choices for Staph, Enterococcus, E. Coli, Proteus, Klebsiella, Psuedomonas, and many anaerobes.

A

Sulfonamides

146
Q

Sulfonamides are inhibitors of ____.

A

Intermediate metabolism

147
Q

The most important adverse effect of sulfonamides is a ___ which occurs in people too.

A

Hypersensitivity reaction

148
Q

If a decrease in tear production is noted, these drugs should be discontinued, with normal tear production expected to resume.

A

Sulfonamides (Antimetabolites)

149
Q

_____ can cause immune-mediated diseases ranging from mild to severe and affect skin, liver, kidney, hematopoietic system, and eyes.

A

Sulfonamides (Antimetabolites)

150
Q

Sulfonamides can cause ____ - decreased tear production by the lacrimal glands - and it is recommended that the patient be monitored during treatment with ___.

A

Keratoconjunctivitis sicca (KCS)
Schirmer tear tests

151
Q

Rarely, ____ associated with sulfonamide crystalluria has been reported.

A

Nephrotoxicity

152
Q

Sulfonamides are metabolized by ___. Because dogs lack this metabolic pathway, they are less likely to develop nephrotoxicity associated with ____ than other species.

A

Acetylation
Sulfonamide crystalluria

153
Q

Sulfonamides and potentiated sulfonamides are available in a variety of formulations (oral, injectable, feed additives) with indications including the treatment of which of the below?

  • intestinal infections
  • infections in CNS, joints
  • bacterial enteritis
  • bacterial pneumonia
  • skin and soft tissue infections in dogs and cats
  • cystitis and prostate in dogs
A

All of the above

154
Q

Name the four most common sulfonamides used in veterinary medicine.

A

Sulfadimethoxine
Sulfadimethoxine + Ormetoprim
Sulfadiazine + trimethoprim
Sulfamethoxazole + trimethoprim

155
Q

_______ have caused the most tissue residue violations in the U.S. with the greatest problems coming from pork, veal, and poultry.

A

Sulfonamides

156
Q

This sulfonamide (antimetabolite) is labeled for use in many species.

A

Sulfadimethoxine

157
Q

This sulfonamide (antimetabolite) is labeled for use in dogs.

A

Sulfadimethoxine + Ormetoprim

158
Q

This sulfonamide (antimetabolite) is labeled for use in horses - availability for dogs and cats has declined.

A

Sulfadiazine + trimethoprim

159
Q

This sulfonamide (antimetabolite) is most commonly a human formulation but is used off-label in dogs, cats, and horses.

A

Sulfamethoxazole + trimethoprim

160
Q

Nucleic acid synthesis inhibitors include __, ___, and ___.

A

Fluoroquinolones
Rifampin
Metronidazole

161
Q

Name seven Fluoroquinolones

A

Enrofloxacin
Orbifloxacin
Difloxacin
Marbofloxacin
Danofloxacin
Ciprofloxacin
Pradofloxacin

Enro-Orbi-Di-Margo-Dano-Cipro-Prado

162
Q

What is the MOA of Fluoroquinolones (Nucleic acid inhibitors)?

A

Inhibit bacterial DNA gyrase (topoisomerase II) and topoisomerase IV enzyme which are necessary for transcription, translation, and bacterial replication.

163
Q

Are Fluoroquinolones bacteriostatic or bacteriocidal?

A

Bacteriocidal

164
Q

Fluoroquinolones inhibit ____.

A

Nucleic acid synthesis

165
Q

What is the MOA of rifampin?

A

Inhibits DNA-dependent RNA polymerase interfering with RNA synthesis

Bacteriocidal

166
Q

Is rifampin bacteriostatic or bacteriocidal?

A

Bacteriocidal at high concentrations

167
Q

What is the MOA of metronidazole?

A

Impairs microbial RNA and DNA synthesis by an undefined mechanism.

168
Q

Is metronidazole bacteriostatic or bacteriocidal?

A

Bacteriocidal

169
Q

Fluoroquinolone (Nucleic acid inhibitor) mechanism of resistance

A

Alteration of target - decreased porin size by gram negative bacteria results in failure of drug to reach its target

170
Q

Rifampin (Nucleic acid synthesis inhibitor) mechanism of resistance

A

Alteration of drug target; if used as a sole agent, resistance often develops rapidly, limiting the usefulness of this drug

171
Q

Metronidazole (Nucleic acid synthesis inhibitor) mechanism of resistance

A

Unknown

172
Q

Fluoroquinolones (Nucleic acid inhibitors) are ineffective against ____.

A

Anaerobes

173
Q

___ is a “next generation” fluoroquinolone FDA approved for cats only and has greater gram positive anaerobe activity while maintaining gram negative activity.

A

Pradofloxacin

174
Q

Metronidazole is effective against gram positive and gram negative ___.

A

Anaerobes

175
Q

Metronidazole is a __ inhibitor.

A

Nucleic acid synthesis

176
Q

___ are effective in treating gram positive and gram negative aerobes.

A

Fluoroquinolones

177
Q

Rifampin is effective against gram ____ _____.

A

Gram positive aerobes

178
Q

Fluoroquinolones (Nucleic acid synthesis inhibitors) can cause irreversible _____.

A

Cartilage damage in growing animals

179
Q

____ should not be used in growing animals.

A

Fluoroquinolones

180
Q

This Nucleic acid synthesis inhibitor can cause retinopathy in cats resulting in irreversible blindness.

A

Fluoroquinolones

Tends to be related to higher doses, or use in cats with compromised renal function

181
Q

At high plasma concentrations such as those achieved after IV injection or extremely high oral doses, ___ can be induced by Fluoroquinolones.

A

Seizures

182
Q

Rifampin can cause ____ toxicity and a _____.

A

Liver toxicity
Red-orange discoloration of urine

183
Q

Rifampin ___ drug metabolizing enzymes.

A

Induces
*drug interactions are a concern

184
Q

Are drug interactions a concern with rifampin?

A

Yes - it induces drug metabolizing enzymes

185
Q

Metronidazole can cause dose-dependent ___.

A

Vestibular toxicity
Generally slowly reversible

186
Q

Metronidazole caused ___ in two cats.

A

Neurotoxicosis

187
Q

Three Fluoroquinolones (Nucleic acid synthesis inhibitors) are FDA approved for use in dogs and cats:

A

Enrofloxacin
Marbofloxacin
Orbifloxacin

188
Q

One fluoroquinolone (Nucleic acid synthesis inhibitor) is labeled only for use in dogs:

A

Difloxacin

189
Q

One fluoroquinolone (Nucleic acid synthesis inhibitor) is labeled only for use in cats:

A

Pradofloxacin

190
Q

_____ have a lower incidence of side effects than aminoglycosides.

A

Fluoroquinolones

191
Q

Fluoroquinolones are ___ and achieve high intracellular concentrations and penetrate tissues including prostate, respiratory tract and CNS.

A

Lipid soluble

192
Q

All veterinary labeled Fluoroquinolones achieve high concentrations in urine (and are therefore good choices in treating resistant UTIs) except:

A

Difloxacin

193
Q

Which Fluoroquinolones (Nucleic acid synthesis inhibitors) are approved for use in horses?

A

None, but Enrofloxacin, Orbifloxacin, and Marbofloxacin have been used orally and by injection.

194
Q

In cattle, which two Fluoroquinolones are approved for treating respiratory disease?

A

Enrofloxacin
Danofloxacin

195
Q

Is ELDU of Fluoroquinolones in food animals legal?

A

NO

196
Q

Why are Fluoroquinolones that were once approved for use in poultry pulled from the market in the US?

A

Because of the potential for causing spread of resistant Campylobacter

197
Q

Fluoroquinolones are ____ after oral administration, although __ do occur.

A

Well absorbed
Drug interactions

198
Q

Fluoroquinolones ______ CYP450 drug metabolizing enzymes.

A

Inhibit
Can cause an increase in plasma concentrations of some drugs if administered concurrently

199
Q

Divalent (magnesium and calcium) and trivalent (aluminum) cations significantly ___________ and can lead to therapeutic failure of Fluoroquinolones.

A

Decrease oral bioavailability

200
Q

Pradofloxacin has been shown to cause ____ in dogs, potentially resulting in severe thrombocytopenia and neutropenia.

A

Bone marrow suppression

201
Q

Which fluoroquinolone has been shown to cause bone marrow suppression in dogs?

A

Pradofloxacin

202
Q

In veterinary medicine, rifampin is used mainly in combination with ___ for treating ____.

A

Macrolides
Rhodococcus equi pneumonia in foals

203
Q

Are there FDA approved veterinary formulations for metronidazole?

A

NO

204
Q

This Nucleic acid synthesis inhibitor is used primarily to treat anaerobic infections in dogs and horses.

A

Metronidazole

205
Q

Is it legal to use metronidazole (a Nucleic acid synthesis inhibitor) in food animals?

A

NO

206
Q

Is metronidazole (a Nucleic acid synthesis inhibitor) convenient for dosing cats?

A

NO

207
Q

Metronidazole is highly _____ therefore distributes well to the CNS and into abscesses.

A

Lipid soluble

208
Q

MOA of polymixin B

A

Decomposes in acidic environments to release formaldehyde; Formaldehyde acts as a urinary antiseptic

209
Q

This drug has been used for long-term maintenance of refractive UTIs in dogs.

A

Polymyxin B/Methenamine

210
Q

_________ is well absorbed after oral administration and is excreted unchanged in the urine. Acidic urine results in the release of formaldehyde.

A

Methenamine/Polymyxin B

211
Q

The Polymyxins are water soluble products of ___. They are basic, cyclic decapeptides.

A

Bacillus Polymyxa

212
Q

T/F:

Polymyxin B also comes in many topical preparations - otic, ocular, ophthalmic.

A

True

213
Q

Polymyxin B is used at low, carefully controlled doses to bind ____.

A

Endotoxin

214
Q

_____ may develop resistance to polymyxin B through altered permeability.

A

Pseudomonas

215
Q

MOA Polymyxin B (endotoxins)

A

Detergent-like action disrupts gram negative cell membranes

Cationic polymyxins interact with an ionic phospholipids (endotoxin) in the gram negative cell wall, disrupting cell wall integrity

216
Q

________ is an indication for using low, carefully controlled doses of polymyxin b to bind endotoxins.

A

Equine colic

217
Q

Oral bioavailability of polymyxins is ___.

A

Very poor

218
Q

The polymyxins display ___ in the body, where binding to mammalian cell membranes contributes to significant accumulation during lung therapeutic regiments.

A

Poor distribution

219
Q

Elimination of polymyxin B is via:

A

Glomerular filtration of the parent compound

220
Q

Parenteral administration of polymyxin may lead to:

A

Nephrotoxicity
Neuromuscular blockade
CNS toxicity

221
Q

Polymyxin toxicities appear to be ____.

A

Dose dependent
Treatment with a polymyxin requires strict adherence to dose guidelines

222
Q

Drugs to consider with MRSA infection if a susceptibility test can confirm activity.

A

Chloramphenicol
Tetracycline (doxycycline, minocycline)
Aminoglycosides (gentamicin, Amikacin)
Rifampin

223
Q

Treatment of Pseudomonas

A

Amikacin and gentamycin
2nd/3rd generation cephalosporins (ceftazidime, cefotaxime)
Anti-pseudomonas penicillins (Ticarcillin, piperacillin, carbenicillin, piperacillin-tazobactam)
Imipenem (IV)
Fluoroquinolone + a beta-lactam

224
Q

Tx Nocardia

A

Potentiated sulfonamides

225
Q

Tx mycoplasma

A

Tetracyclines
Macrolides
Amphenicols

226
Q

Tx rickettsiaceae and anaplasmataceae

A

Tetracyclines
Amphenicols

227
Q

Tx Gram positive anaerobes

A

Pradofloxacin (cat)
Metronidazole (no cat)
Aminopenicillins
Newer macrolides

Clindamycin
Natural penicillins
Tetracyclines

228
Q

Tx gram negative anaerobes

A

Pradofloxacin (cat)
Metronidazole (no cat)
Aminopenicillins
Newer macrolides

Amphenicols

229
Q

Tx gram positive and negative anaerobes

A

Pradofloxacin (cat)
Metronidazole (no cat)
Aminopenicillins
Newer macrolides

230
Q

Treatment only gram positive anaerobes

A

Clindamycin
Natural penicillins
Tetracyclines

231
Q

Treatment only gram negative anaerobes

A

Amphenicols

CLIN PHARM (13 decks)

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