Inhibitors of DNA Synthesis

Question 1

What are the Fluoroquinolones

Answer 1

Nalidixic acid (1st)
Ciprofloxacin (2nd)
Levofloxacin (3rd)
Moxifloxacin (4th)
Gemifloxacin (4th)

Question 2

What are the Sulfonamides

Answer 2

Sulfacetamide
Sulfadiazine
Sulfamethoxazole
Sulfasalazine
Sulfisoxazole

Question 3

What are the Misc inhibitors of DNA synth

Answer 3

Trimethoprim
Co-trimoxazole
Metronidazole

Question 4

What is the Urinary Antiseptic

Answer 4

Nitrofurantoin

Question 5

Relationship between Fluoroquinolone generation and gram

Answer 5

Low gen = More G-

High gen = More G+

Question 6

Which Fluoroquinolone is good against S. pneumoniae

Answer 6

Levofloxacin

Question 7

Which Fluoroquinolone is synergistic with beta-lactams

Answer 7

Ciprofloxacin

Question 8

What are 1st gen Fluoroquinolones for

Answer 8

Uncomplicated UTIs

Question 9

What are 2nd gen Fluoroquinolones for

Answer 9

Traveler’s Diarrhea (ETEC)
P. aeruginosa in CF
Meningitis prophylaxis

Question 10

What are 3rd gen Fluoroquinolones for

Answer 10

Prostatitis (E. coli)
STIs (not syphillis)
Acute sinusitis, bronchitis, TB

Question 11

What are 4th gen Fluoroquinolones for

Answer 11

Monotherapy Community acquired PNA

Question 12

S. pneumoniae 2nd line outpt, 1rd line inpt

Answer 12

Respiratory quinolones (3rd, 4th)

Question 13

How do Fluoroquinolones act

Answer 13

Enter bacteria via porins

Inhibit Topo II, IV

Question 14

What inpt infections can Fluoroquinolones be used for

Answer 14

S. pneumoniae
H. influenza
M. catarrhalis
Atypical pathogens

Question 15

Don’t give with milk or acid

Answer 15

Fluoroquinolones

Question 16

What messes with Fluoroquinolone absorption

Answer 16

Divalent cations (Fe, Zn, Ca)

Question 17

For which Fluoroquinolone do you not have to adjust the dose for in renal dysfunction

Answer 17

Moxifloxacin

Question 18

Which Fluoroquinolones can cause QT prolongation

Answer 18

3rd, 4th

Question 19

What can enhance toxicity of Fluoroquinolones

Answer 19

Theophylline
NSAIDS
Corticosteroids

Question 20

3rd and 4th Fluoroquinolone AE

Answer 20

Increase warfarin, caffeine and cyclosporine levels

Question 21

Main Fluoroquinolone AE

Answer 21

Tendon rupture

Question 22

When are Fluoroquinolones contraindicated

Answer 22

Pregnant
Nursing mothers
Everyone <18

Question 23

General Fluoroquinolone AE

Answer 23

Photosensitivity
GI distress
CNS
Rash

Question 24

Fluoroquinolone Resistance

Answer 24

Chromosomal mutation in gyrase and topo IV

Expression of efflux pumps

Question 25

Why are Sulfonamides given in triple therapy

Answer 25

Resistance with alone

Question 26

How do Sulfonamides work

Answer 26

Inhibit Dihydropteroate Synthase | Decreases folate

Question 27

Which Sulfonamide can you give for IBD

Answer 27

Sulfasalazine

Question 28

When can you give Sulfonamides topically

Answer 28

Eyes | Burns

Question 29

When can you give Sulfonamides orally

Answer 29

Simple UTI

Question 30

What is the structure of Sulfonamides

Answer 30

PABA analog

Question 31

When can Sulfonamides accumulate

Answer 31

Renal failure

Question 32

What can increase Sulfonamide plasma levels

Answer 32

Warfarin Phenytoin MTX

Question 33

Main Sulfonamide AE

Answer 33

Hypersensitivity | Crystalluria

Question 34

Sulfonamide Contraindications

Answer 34

Infants, newborns (Kernicterus)

Question 35

Who gets hemolytic anemia with Sulfonamides

Answer 35

G6PD deficiency

Question 36

General Sulfonamide AE

Answer 36

Photosensitivity GI distress Fever, Rash

Question 37

Sulfonamides Resistance

Answer 37

Altered enzyme Decreased permeability Enhanced PABA production Decreased accumulation

Question 38

How do Sulfonamides cause kidney damage

Answer 38

Acetylation in liver causes metabolite precipitation at neutral/acid pH

Question 39

What is TMP used for clinically

Answer 39

UTIs Bacterial prostatitis (after cipro) BV

Question 40

What does TMP do

Answer 40

Inhibit DHF reductase

Question 41

What goes well with TMP

Answer 41

SMX

Question 42

Where does TMP hit high conc

Answer 42

Prostate | Vagina

Question 43

When is TMP contraindicated

Answer 43

Pregnancy

Question 44

TMP AE

Answer 44

Megaloblastic anemia Leukopenia Rash, pruritis

Question 45

What do you give for TMP leukopenia

Answer 45

Leucovorin

Question 46

DOC PCP, Uncomplicated UTIs, Nocardiosis, Toxoplasmosis

Answer 46

Co-trimoxazole

Question 47

What is Co-trimoxazole

Answer 47

TMP + SMX

Question 48

When is Co-trimoxazole contraindicated

Answer 48

Pregnancy

Question 49

Co-trimoxazole AE

Answer 49

Stevens-Johnson GI Hemolytic anemia More AE in AIDS

Question 50

DOC C. Diff

Answer 50

Metronidazole

Question 51

Aside from C. diff, what's Metro good for

Answer 51

Anaerobic/mixed intra-abdominal infections T. vaginalis, BV, Gardnerella vaginalis Brain abscess Triple therapy for H. pylori

Question 52

How does Metro work

Answer 52

Reductive bioactivation of nitro group by ferredoxin Cytotoxic product Interfere with nucleic acid synth

Question 53

How is Metro eliminated

Answer 53

Liver

Question 54

What are the general Metro AE

Answer 54

``` GI stomatitis Peripheral neuropathy, HA Dark urine Leukopenia, dizziness, ataxia Opportunistic fungal infections ```

Question 55

What is the most notable Metro AE

Answer 55

Disulfiram-like reaction

Question 56

Can you give Metro in pregnancy

Answer 56

Avoid in 1st trim

Question 57

Prophylaxis and Tx of lower UTI

Answer 57

Nitrofurantoin

Question 58

When is Nitrofurantoin contraindicated

Answer 58

Renal failure Pregnancy at term Infants

Question 59

What should you give to at-term pregnancy instead of Nitrofurantoin

Answer 59

Amoxicillin

Question 60

Where is the only place therapeutic levels of Nitrofurantoin are found

Answer 60

Urine

Question 61

Nitrofurantoin AE

Answer 61

Anorexia N/V Neuropathy

Question 62

Does Nitrofurantoin have cross reactivity

Answer 62

No

Question 63

How does Nitrofurantoin act

Answer 63

Reduced by bacteria | Damage DNA