Inhibitors Of Protein Synthesis Flashcards
1
Q
Which macrolide has the MOST adverse GI effects?
A
Erythromycin
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
3
Q
What is the only time you would even consider using chloramphenicol?
A
Life-threatening infections
4
Q
Are aminoglycosides static or cidal?
A
Cidal
5
Q
What drug is associated with gray baby syndrome?
A
Chloramphenicol
6
Q
Are macrolides static or cidal?
A
Static
7
Q
What are the 2 ways that macrolides develop resistance?
A
Efflux pumps
Methylation of drug binding site (50S subunit)
8
Q
What enzyme does linezolid inhibit?
A
Monoamine Oxidase (MAO)**
9
Q
What is the spectrum for clindamycin?
A
G+ cocci
Anaerobic G- and G+
10
Q
Are aminoglycosides time-dependent or concentration-dependent killing?
A
Concentration
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
12
Q
What must your pt stop taking if you give them a tetracycline?
A
Multivitamins
antacids
calcium supplements
13
Q
What robosomal subunit does linezolid bind to?
A
50S
14
Q
Are aminoglycosides given for serious infections only?
A
Yes
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
16
Q
What are the DOCs for Mycoplasma pneumoniae?***
A
Erythromycin
Or
Tetracycline
17
Q
What are the 3 drugs in the Macrolides class
A
Erythromycin
Clarithromycin
Azithromycin
18
Q
Why do aminoglycosides always need a transporter?
A
Because they are Big and Polar
19
Q
What drug is associated with fatal aplastic anemia?
A
Chloramphenicol
20
Q
Is chloramphenicol a good choice for a jaundiced baby?
A
No never
21
Q
What drug has severe hepatotoxicity?
Pulled off the market for almost all indications
A
Telithromycin
22
Q
Is clindamycin static or cidal?
A
Static
23
Q
What is dalfopristin, quinupristin (synercid) reserved for?
A
Multiple drug resistant G+ infections
24
Q
Is telithromycin static or cidal?
A
Static
25
What is the spectrum of dalfopristin, quinupristin (synercid)?
Aerobic G+
26
What two inhibitors of protein synthesis are always given together due to their synergistic effect?
Dalfopristin and Quinupristin
| They are actually combined into a single pill called synercid
27
What are the 2 major side effects of chloramphenicol? Which one is independent of the dose?
Bone marrow suppression
Fatal aplastic anemia- dose independent. A single dose can kill you, even months after drug has been discontinued.
28
What is the best drug we have for CNS penetration?
Chloramphenicol
| 100% CNS bioavailability
29
What drug penetrates bones very well, so it is the first choice for osteomyelitis (bone infections)?
Clindamycin ***
30
What do you need to tell your pt if you give them a tetracycline?
Stop vitamins and antacids
Wear sunscreen
31
What is the spectrum of linezolid?
Aerobic G+
G+
G+
G+
32
Where does telithromycin bind to on the ribosome?
50S subunit (on two places)
33
The spectrum of macrolides is very similar to which class of B-lactams?
Natural penicillins
34
What form is telithromycin available in?
Oral
35
What is the best way to administer aminoglycosides?
In Megadoses once per day
Their side effects are Time-dependent, and they have a significant post antibiotic effect
36
What ribosomal subunit do macrolides bind to?
50S
37
What two ribosomal subunits need to come together to make the 70S ribosome?
50S and 30S
38
The side effects of aminoglycosides depend on (length of time/concentration) of drug?
Time-dependent
They depend on the duration of time that the concentration of the drug is above threshold
39
What are the DOCs for Lyme disease (borrelia burg)
Tetracyclines or ceftriaxone
40
Are aminoglycosides static or cidal?
Bactericidal! (2nd exception to inhibitors of protein synthesis, dalfopristin/quinupristin was the other one)
41
What is the only reason dalfopristin and quinupristin are bactericidal?
Because they’re together working synergistically
42
What are the 5 aminoglycosides?
```
Streptomycin
Gentamicin
Tobramycin
Amikacin
Neomycin
```
43
Which tetracycline is susceptible to efflux pumps, and which ones can be used instead?
Tetracycline is susceptible
Doxycycline or minocycline can be used in the case of tetracycline resistance
44
What are the DOCs for chlamydia trachomitis and Chlamydia pneumoniae****
Azithromycin,
Erythromycin
or
Tetracycline
45
What drug has serious hepatotoxicity, and remains only on the market for community acquired pneumonia?
Telithromycin
46
What are the major side effects of macrolides?
Diarrhea
GI adverse affects
QT prolongation
47
If someone needs penicillin G, but they have a PCN allergy, what is a VERY good substitute?
Macrolides, as long as they are Immunocompetent**
| Macrolides and Penicillin G have very similar spectrums
48
What subunit do tetracyclines bind to?
30S
***
49
Who is dalfopristin and quinupristin contraindicated for?
LOTS of people because it is a NEW**** drug
```
Breast feeding
Children
Hepatic disease
Pregnancy
Streptogramin hypersensitivity
```
50
What is the spectrum of chloramphenicol?
Broad spectrum
| But super toxic
51
What is one of the adverse effects of dalfopristin, quinupristin (synercid)
Inhibits CYP3A4, and so it has many metabolic interactions
52
Are aminoglycosides administered alone?
No, usually used in combo
53
Is linezolid static or cidal
Static, except for streptococci
54
Will enterococci be killed by an aminoglycoside or penicillin used alone?
No, must be used together
55
Who should NOT be given tetracyclines?
Children under 8
Pregnant woman
(Due to bone and teeth deposition)
56
What ribosomnal subunit do aminoglycosides bind to?
30S
57
What are the major side effects of aminoglycosides?
Ototoxicity
Nephrotoxicity
**
58
What contributes to the reasoning for aminoglycosides’ once daily dosing?
Concentration dependent killing
PAE
59
Are tetracyclines static or cidal?
Static
60
What is the DOC for vibrio?
Tetracyclines
61
What drug is a WELL known cause of pseudomembranous colitis (overgrowth of c diff)?
Clindamycin
62
Your pt has Toxic shock syndrome, what drugs should you give and in what order?
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
Which macrolides have the highest potential for drug interaction?
Erythromycin
Clarithromycin
64
What is the spectrum of tetracyclines?
Very broad spectrum
Excpet for proteus, pseudomonas and B. fragilis
65
What is the DOC for enterococci?
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
What are the DOCs for chalmydia?
Tetracyclines or Azithro/erythro
67
Is photosensitivity a side effect of tetracyclines?
Yes
68
What forms is clindamycin available in?
All forms- oral, parenteral, and topical
69
What is the spectrum for aminoglycosides?
Gram negative aerobes ONLY
70
Are macrolides (erythro, Azithro, and clarithro) OK to give to pts with a history of QT prolongation?
No, risk of Torsades
71
What is the DOC for Legionella species?
Azithromycin (+rifampin or quinolone)
72
For G+ infections that are multiple drug resistant, what might be a good alternative to vancomycin?
Dalfopristin, quinupristin (Synercid)
73
What is the DOC for pseudomonas
Aminoglycoside + antipseudomonal penicillin (piperacillin/ticarcillin)
74
Is telithromycin the DOC for community acquired pneumonia?
No.
75
Why does chloramphenicol cause gray baby syndrome?
Neonates have naive livers that have inadequate activity of glucuronyl transferase. They can not conjugate and eliminate the drug.
76
What is the main mode of resistance for tetracyclines?
Efflux pumps
77
What is the spectrum like for telithromycin?
Broad spectrum
78
Which Macrolide has the lowest risk of drug interaction?
Azithromycin
79
What condition would be an absolute contraindication for linezolid? Why?
Pheochromocytoma (tumor in adrenal cortex)
Linezolid inhibits MAO, so you would have way too much epinephrine
80
What are the 4 drugs that can be used for H. Pylori infection?
Tetracycline or Ampicillin with metronidazole and bismuth
81
What is the only Ketolide discussed in class?
Telithromycin
82
What drug is deposited in bones and teeth?
Tetracyclines
| Inhibit bone elongation and discolor teeth
83
What are the three tetracyclines?
Tetracycline
Doxycycline
Minocycline
84
Which macrolide has the highest risk for QT prolongation?
Azithromycin
85
Why do aminoglycosides only work on aerobes?
Because they depend on a transporter to get in, and that transporter uses active transport, which requires oxygen
86
What is the DOC for Rocky Mountain Spotted Fever?
Tetracyclines
87
What should you know about tigecycline?
It is very similar to other tetracyclines, so it is a good alternative for tetracycline resistant bugs
88
What is a major drug interaction of linezolid?
ANTIDEPRESSANTS***
Serotonin toxicity may result!
(Heterocyclic antidepressants, tricyclics antidepressants, SSRIs)
89
What should you give for osteomyelitis?
Clindamycin
| Penetrates bones well
90
What is required for the elimination of chloramphenicol?
It must be conjugated with glucuronic acid
91
Your pt has Toxic Shock Syndrome, should you give them a cidal drug right off the bat?
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
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?
Chloramphenicol
93
What are the only two classes of IPS that target the 30S subunit?
Aminoglycosides
Tetracyclines
94
What subunit does chloramnphenicol bind to?
50S
