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Pharmacology I Exam #2 > IPS > Flashcards

IPS Flashcards

1
Q

Name the 3 macrolides

A

Erythromycin ORAL/IV
Clarithromycin ORAL
Azithromycin (Z pack) ORAL/IV

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2
Q

Are macrolides bacteriostatic or bacteriocidal?

A

Bacteriostatic (conc. and organism dependent)

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3
Q

Which subunit do macrolides bind to?

A

50s

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4
Q

What is the MOA of the macrolides?

A

Inhibition of protein synthesis

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5
Q

Which of the macrolides is an alternative to penicillin if pt has penicillin allergy?

A

Erythromycin

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6
Q

What is the spectrum coverage of the macrolides?

A

G+

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7
Q

Erythromycin is the DOC for:

A

Legionella species
Mycoplasma pneumoniae
Chlamydia pneumoniae and C. pneumoniae

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8
Q

What is the MOR of the macrolides

A
  • Efflux pumps

- Methylation of drug binding site

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9
Q

Macrolide toxicity

A

-Diarrhea
-GI effects (Clarithro least, Erythro most)
-QT prolongation
-Drug interacts (CYP3A4) (Azithro most favorable)
***Toxicity is synergistic
SEE CHART SLIDE 14

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10
Q

Which abx belongs to the Ketolide family?

A

Telithromycin ORAL

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11
Q

Are Ketolides bacteriostatic or bacteriocidal?

A

Bacteriostatic

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12
Q

MOA for Ketolides

A

Binds to 50s subunit

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13
Q

What is the spectrum of activity of Telithromycin (ketolides)

A
  • Broad spectrum

- Good against respiratory pathogens including erythromycin and penicillin-resistant pneumococci

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14
Q

What is telithromycin used for?

A

Community acquired pneumoniae (2nd choice after macrolides)

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15
Q

Telithromycin (Ketolide) toxicity

A
  • Very hepatotoxic- should NOT be used in children

- Diarrhea

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16
Q

Which enzyme is Telithryomycin an inhibitor of? Is this reversible or irreversible?

A

REVERSIBLE inhibitor of CYP3A4 enzymes

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17
Q

Is Clindamycin bacteriostatic or bacteriocidal?

A
  • Bacteriostatic
  • Can be bacteriocidal depending on concentration at the site of action and on the specific susceptibility of the organism
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18
Q

What is the MOA of Clindamycin?

A

Reversibly binds to 50s subunit - protein synthesis inhibition

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19
Q

What is the spectrum of Clindamycin?

A

Aerobic G+

Some anaerobic G- and G+

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20
Q

What is Clindamycin useful in treating?

A
  • Concentrates highly in bones; useful for osteomyelitis
  • Acne (topical)
  • Toxoplasma enchephalitis (despite poor CNS conc.)
  • Toxic Shock Syndrome (use with vanco, nafcillin, or first gen cephalorsporin
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21
Q

What are the adverse side effects of Clindamycin

A

Well known cause of pseudomonas colitis (C. diff infection)

-Take them off Clinda and put them on Vanco

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22
Q

Clindamycin is the DOC for

A
  • Strep pyogenes

- Clostridia

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23
Q

What drug is in the Oxazolidinones family?

A

Linezolid IV/ORAL

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24
Q

What is the MOA for Linezolid?

A

Reversibly inhibits protein synthesis by binding to 50s subunit

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25
Q

What is Linezolid an inhibitor of?

A

Reversible, non-selective inhiibtor of monamine oxidase (MAO)

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26
Q

What is the spectrum coverage of Linezolid?

A

Aerobic G+ organisms

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27
Q

Is Linezolid bacteriostatic or bacteriocidal?

A

Bacteriostatic EXCEPT it is cidal for streptococci

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28
Q

What are the uses of Linezolid?

A
  • Bacterial pneumoniae
  • Skin infections
  • VRE infections
  • MRSA infections
29
Q

Toxicity of Linezolid

A
  • Usual side effects and interactions as the MAO inhibitors
  • Hypersensitivty
  • Pheochromocytomia (kidney tumor)
30
Q

What are the drug interactions of Linezolid?

A

Heterocyclic antidepressants, tricyclic antidepressantsm SSRIs

31
Q

Name the streptogrammins

A

Dalfopristin

Quinupristin

32
Q

Streptogrammin MOA

A

Inhibit protein synthesis, binds to 50s subunit

33
Q

What is an important pharmacokinetic factor for the streptogrammins

A

When administered together via IV, they have a synergistic

34
Q

Are streptogrammins bacteriostatic or bacteriocidal?

A

When used TOGETHER, they are bacterocidal

35
Q

Streptogrammin spectrum

A

G+

36
Q

Adverse reactions of streptogrammins

A
  • Hepatotoxicity, N/V, pain, pruritus, rash

- INHIBIT THE P450 drug metabolizing system (think warfarin)

37
Q

What are the 5 Aminoglycosides

A 
Streptomycin IV/IM
Gentamycin IV/IM/TOPICAL
Tobramycin IV/IM/TOPICAL
Amikacin IV/IM
Neomycin ORAL/TOPICAL
38
Q

Are the Aminoglycosides static or cidal?

A

CIDAL under AEROBIC conditions only

39
Q

Aminoglycoside MOA

A

Irreversibly inhibit protein synthesis; 30s subunit

40
Q

What should Aminoglycosides always be combined with?

A

B-Lactam abx

  • B-lactams break down the cell wall
  • Aminoglycosides do the killing from the inside
41
Q

What is unique about the Aminoglycoside structure? What do Aminoglycosides require to work?

A

Large and polar, therefore must be actively transported in. This is an oxygen requiring process!

42
Q

We give a pt an aminoglycoside when there is a suspicion of (2 things):

A

Sepsis or endocarditis

43
Q

Aminoglycosides are the DOC for:

A

P. aeruginosa

44
Q

Why do we use a megadose of aminoglycosides once a day?

A

Concentration dependent killing

Have significant PAE

45
Q

Aminoglycoside toxicity

A

Ototoxicity
Nephrotoxicity
***Dependent on duration of TIME the CONCENTRATION of drug is used above threshold

46
Q

MOR against Aminoglycosides

A

-Deficiency of ribosomal receptors
-Lack of permeability into bacteria
-Enzymatic modification by bacteria
(cross-resistance: bacteria resistant to one aminoglycoside is likely resistant to another aminoglycoside)

47
Q

What are the 3 abx that bind to the 30s subunit?

A

-Aminoglycosides
-Tetracyclines (broad spectrum abx)
-Glycylcyclines (broad spectrum abx)
All other IPS bind to 50s

48
Q

What are the Gram + IPS?

A
  • Macrolides
  • Streptogrammins
  • Oxazolidinones

POSITIVE Memories Start in October

49
Q

What are the broad spectrum IPS?

A
  • Broad spectrum abx
  • Ketolides
  • Clindamycin

3 broads Kissed Cliff

50
Q

What abx is associated w/ fatal aplastic anemia, gray baby syndrome, and bone marrow suppression?

A

Chloramphenicol

51
Q

Name the 3 classes of broad spectrum abx

A

Chloramphenicol
Tetracyclines
Glycylcyclines

52
Q

Are the broad spectrum abx static or cidal?

A

Static

53
Q

What subunits do each broad spectrum abx bind to?

A

Chloramphenical 50s

Tetracyclines and Glycylcyclines 30s

54
Q

MOA for broad spectrum abx

A

Inhibit protein synthesis (w/ respective subunits)

55
Q

What can chloramphenicol inhibit in mammalian cells that makes it so toxic?

A

Inhibit mitochondrial protein synthesis in mammalian cells; results in many adverse affects

56
Q

What are some therapeutic uses of chloramphenicol

A

DUE TO TOXIC EFFECTS, ONLY USE THIS DRUG AS A LAST RESORT!

  • Typhoid fever
  • Meningitis
  • Eye infections
  • G- infections
  • Lyme/tick related illnesses
57
Q

Toxicities of Chloramphenicol

A
  • Fatal aplastic anemia
  • Bone marrow suppression
  • Gray baby syndrome
58
Q

Which chloramphenicol toxicities are dose-dependent and dose-independent

A
  • Bone marrow suppression: Dose DEPENDENT

- Fatal aplastic anemia: Dose INDEPENDENT

59
Q

Which drug as the best CNS penetration?

A

Chloramphenicol (but incredibly toxic)

60
Q

Chloramphenicol MOR

A
  • Efflux pumps

- Acetyl transferase produced my resistant organisms inactivates chloramphenicol

61
Q

Name the 3 Tetracyclines

A
  • Tetracycline ORAL/TOPICAL
  • Doxycycline ORAL
  • Minocycline ORAL
62
Q

Tetracyclines are the DOC for:

A
  • H. pylori
  • Mycoplasma pneumoniae
  • Chlamydia infections
  • Virbrio cholera
  • Early lyme disease
63
Q

Tetracycline MOR

A

Efflux pumps

64
Q

What are 2 important pharmacokinetic factors regarding tetracycline

A
  • Avoid taking vitamins (Tetracycline chelates with Ca, Fe, and Al)
  • Deposits in bone and teeth
65
Q

Adverse affects of tetracyclines? Who should NOT be prescribed tetracyclines?

A
  • Normal flor changes
  • Bone growth inhibition
  • Teeth discolorationg
  • Photosensitivity

*Do not prescribe to pregnant women or childreen 8 years old or younger

66
Q

What drug belongs in the Glycylcycline family

A

Tigecycline

67
Q

Tigecycline has a similar spectrum to tetra, doxy, and minocycline, PLUS

A

Activity against tetra-cycline resistant organisms

68
Q

Adverse affects of tigecycline

A

Similar to Tetracyclines + nausea and vomiting

69
Q

What can tigacycline be used to treat

A

MRSA
MRSE
PRSP
VRE

Pharmacology I Exam #2 (3 decks)

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