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Pharmacology Exam 2 (Lauren) > Inhibitors Of Protein Synthesis > Flashcards

Inhibitors Of Protein Synthesis Flashcards

1
Q

Which macrolide has the MOST adverse GI effects?

A

Erythromycin

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2
Q

If you give your pt clindamycin and they start to develop c diff overgrowth, what should you do?

A

Take them OFF clindamycin and start them ON oral vancomycin

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3
Q

What is the only time you would even consider using chloramphenicol?

A

Life-threatening infections

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4
Q

Are aminoglycosides static or cidal?

A

Cidal

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5
Q

What drug is associated with gray baby syndrome?

A

Chloramphenicol

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6
Q

Are macrolides static or cidal?

A

Static

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7
Q

What are the 2 ways that macrolides develop resistance?

A

Efflux pumps

Methylation of drug binding site (50S subunit)

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8
Q

What enzyme does linezolid inhibit?

A

Monoamine Oxidase (MAO)**

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9
Q

What is the spectrum for clindamycin?

A

G+ cocci

Anaerobic G- and G+

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10
Q

Are aminoglycosides time-dependent or concentration-dependent killing?

A

Concentration

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11
Q

If your patient is on warfarin, (a drug that is metabolized by CYP3A4,) and they need a macrolide, which one is the safest to give them?

A

Azithromycin, since it has the lowest risk of drug interaction

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12
Q

What must your pt stop taking if you give them a tetracycline?

A

Multivitamins

antacids

calcium supplements

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13
Q

What robosomal subunit does linezolid bind to?

A

50S

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14
Q

Are aminoglycosides given for serious infections only?

A

Yes

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15
Q

QT prolongation is a seriously risky adverse side effect of erythromycin in what situation?

A

When erythromycin is coadministered with other drugs that prolong QT and are ALSO metabolized by CYP3A4

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16
Q

What are the DOCs for Mycoplasma pneumoniae?***

A

Erythromycin
Or
Tetracycline

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17
Q

What are the 3 drugs in the Macrolides class

A

Erythromycin

Clarithromycin

Azithromycin

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18
Q

Why do aminoglycosides always need a transporter?

A

Because they are Big and Polar

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19
Q

What drug is associated with fatal aplastic anemia?

A

Chloramphenicol

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20
Q

Is chloramphenicol a good choice for a jaundiced baby?

A

No never

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21
Q

What drug has severe hepatotoxicity?

Pulled off the market for almost all indications

A

Telithromycin

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22
Q

Is clindamycin static or cidal?

A

Static

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23
Q

What is dalfopristin, quinupristin (synercid) reserved for?

A

Multiple drug resistant G+ infections

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24
Q

Is telithromycin static or cidal?

A

Static

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25
Q

What is the spectrum of dalfopristin, quinupristin (synercid)?

A

Aerobic G+

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26
Q

What two inhibitors of protein synthesis are always given together due to their synergistic effect?

A

Dalfopristin and Quinupristin

They are actually combined into a single pill called synercid

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27
Q

What are the 2 major side effects of chloramphenicol? Which one is independent of the dose?

A

Bone marrow suppression

Fatal aplastic anemia- dose independent. A single dose can kill you, even months after drug has been discontinued.

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28
Q

What is the best drug we have for CNS penetration?

A

Chloramphenicol

100% CNS bioavailability

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29
Q

What drug penetrates bones very well, so it is the first choice for osteomyelitis (bone infections)?

A

Clindamycin ***

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30
Q

What do you need to tell your pt if you give them a tetracycline?

A

Stop vitamins and antacids

Wear sunscreen

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31
Q

What is the spectrum of linezolid?

A

Aerobic G+
G+

G+

G+

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32
Q

Where does telithromycin bind to on the ribosome?

A

50S subunit (on two places)

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33
Q

The spectrum of macrolides is very similar to which class of B-lactams?

A

Natural penicillins

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34
Q

What form is telithromycin available in?

A

Oral

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35
Q

What is the best way to administer aminoglycosides?

A

In Megadoses once per day

Their side effects are Time-dependent, and they have a significant post antibiotic effect

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36
Q

What ribosomal subunit do macrolides bind to?

A

50S

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37
Q

What two ribosomal subunits need to come together to make the 70S ribosome?

A

50S and 30S

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38
Q

The side effects of aminoglycosides depend on (length of time/concentration) of drug?

A

Time-dependent

They depend on the duration of time that the concentration of the drug is above threshold

39
Q

What are the DOCs for Lyme disease (borrelia burg)

A

Tetracyclines or ceftriaxone

40
Q

Are aminoglycosides static or cidal?

A

Bactericidal! (2nd exception to inhibitors of protein synthesis, dalfopristin/quinupristin was the other one)

41
Q

What is the only reason dalfopristin and quinupristin are bactericidal?

A

Because they’re together working synergistically

42
Q

What are the 5 aminoglycosides?

A 
Streptomycin
Gentamicin
Tobramycin
Amikacin
Neomycin
43
Q

Which tetracycline is susceptible to efflux pumps, and which ones can be used instead?

A

Tetracycline is susceptible

Doxycycline or minocycline can be used in the case of tetracycline resistance

44
Q

What are the DOCs for chlamydia trachomitis and Chlamydia pneumoniae**

A

Azithromycin,
Erythromycin
or
Tetracycline

45
Q

What drug has serious hepatotoxicity, and remains only on the market for community acquired pneumonia?

A

Telithromycin

46
Q

What are the major side effects of macrolides?

A

Diarrhea

GI adverse affects

QT prolongation

47
Q

If someone needs penicillin G, but they have a PCN allergy, what is a VERY good substitute?

A

Macrolides, as long as they are Immunocompetent**

Macrolides and Penicillin G have very similar spectrums

48
Q

What subunit do tetracyclines bind to?

A

30S

49
Q

Who is dalfopristin and quinupristin contraindicated for?

A

LOTS of people because it is a NEW** drug

Breast feeding
Children
Hepatic disease
Pregnancy
Streptogramin hypersensitivity
50
Q

What is the spectrum of chloramphenicol?

A

Broad spectrum

But super toxic

51
Q

What is one of the adverse effects of dalfopristin, quinupristin (synercid)

A

Inhibits CYP3A4, and so it has many metabolic interactions

52
Q

Are aminoglycosides administered alone?

A

No, usually used in combo

53
Q

Is linezolid static or cidal

A

Static, except for streptococci

54
Q

Will enterococci be killed by an aminoglycoside or penicillin used alone?

A

No, must be used together

55
Q

Who should NOT be given tetracyclines?

A

Children under 8

Pregnant woman

(Due to bone and teeth deposition)

56
Q

What ribosomnal subunit do aminoglycosides bind to?

A

30S

57
Q

What are the major side effects of aminoglycosides?

A

Ototoxicity

Nephrotoxicity
**

58
Q

What contributes to the reasoning for aminoglycosides’ once daily dosing?

A

Concentration dependent killing

PAE

59
Q

Are tetracyclines static or cidal?

A

Static

60
Q

What is the DOC for vibrio?

A

Tetracyclines

61
Q

What drug is a WELL known cause of pseudomembranous colitis (overgrowth of c diff)?

A

Clindamycin

62
Q

Your pt has Toxic shock syndrome, what drugs should you give and in what order?

A

FIRST give clindamycin*** to stop protein synthesis and make them stop producing the toxin.

Then follow it up with vanco, nafcillin, or a first gen cephalosporin (cidal)

63
Q

Which macrolides have the highest potential for drug interaction?

A

Erythromycin

Clarithromycin

64
Q

What is the spectrum of tetracyclines?

A

Very broad spectrum

Excpet for proteus, pseudomonas and B. fragilis

65
Q

What is the DOC for enterococci?

A

Aminoglycoside + Penicillin

(Only time aminoglycoside can be used on G+, since it’s the penicillin that is busting through the wall and letting it in)

66
Q

What are the DOCs for chalmydia?

A

Tetracyclines or Azithro/erythro

67
Q

Is photosensitivity a side effect of tetracyclines?

A

Yes

68
Q

What forms is clindamycin available in?

A

All forms- oral, parenteral, and topical

69
Q

What is the spectrum for aminoglycosides?

A

Gram negative aerobes ONLY

70
Q

Are macrolides (erythro, Azithro, and clarithro) OK to give to pts with a history of QT prolongation?

A

No, risk of Torsades

71
Q

What is the DOC for Legionella species?

A

Azithromycin (+rifampin or quinolone)

72
Q

For G+ infections that are multiple drug resistant, what might be a good alternative to vancomycin?

A

Dalfopristin, quinupristin (Synercid)

73
Q

What is the DOC for pseudomonas

A

Aminoglycoside + antipseudomonal penicillin (piperacillin/ticarcillin)

74
Q

Is telithromycin the DOC for community acquired pneumonia?

A

No.

75
Q

Why does chloramphenicol cause gray baby syndrome?

A

Neonates have naive livers that have inadequate activity of glucuronyl transferase. They can not conjugate and eliminate the drug.

76
Q

What is the main mode of resistance for tetracyclines?

A

Efflux pumps

77
Q

What is the spectrum like for telithromycin?

A

Broad spectrum

78
Q

Which Macrolide has the lowest risk of drug interaction?

A

Azithromycin

79
Q

What condition would be an absolute contraindication for linezolid? Why?

A

Pheochromocytoma (tumor in adrenal cortex)

Linezolid inhibits MAO, so you would have way too much epinephrine

80
Q

What are the 4 drugs that can be used for H. Pylori infection?

A

Tetracycline or Ampicillin with metronidazole and bismuth

81
Q

What is the only Ketolide discussed in class?

A

Telithromycin

82
Q

What drug is deposited in bones and teeth?

A

Tetracyclines

Inhibit bone elongation and discolor teeth

83
Q

What are the three tetracyclines?

A

Tetracycline
Doxycycline
Minocycline

84
Q

Which macrolide has the highest risk for QT prolongation?

A

Azithromycin

85
Q

Why do aminoglycosides only work on aerobes?

A

Because they depend on a transporter to get in, and that transporter uses active transport, which requires oxygen

86
Q

What is the DOC for Rocky Mountain Spotted Fever?

A

Tetracyclines

87
Q

What should you know about tigecycline?

A

It is very similar to other tetracyclines, so it is a good alternative for tetracycline resistant bugs

88
Q

What is a major drug interaction of linezolid?

A

ANTIDEPRESSANTS***

Serotonin toxicity may result!

(Heterocyclic antidepressants, tricyclics antidepressants, SSRIs)

89
Q

What should you give for osteomyelitis?

A

Clindamycin

Penetrates bones well

90
Q

What is required for the elimination of chloramphenicol?

A

It must be conjugated with glucuronic acid

91
Q

Your pt has Toxic Shock Syndrome, should you give them a cidal drug right off the bat?

A

No. They are sick because of the toxin that the bacteria is producing, so if you give them something that lyses the cells and releases all the toxin, your pt will get even sicker.

92
Q

If a pt has meningitis, we’d use PCN, since it can get through the inflamed BBB. But what could we use if they had a PCN allergy?

A

Chloramphenicol

93
Q

What are the only two classes of IPS that target the 30S subunit?

A

Aminoglycosides

Tetracyclines

94
Q

What subunit does chloramnphenicol bind to?

A

50S

Pharmacology Exam 2 (Lauren) (7 decks)

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